Emergency Drugs

Question 1

Cardiac Arrest Adrenaline Dose and Route.

Answer 1

Adrenaline (Epinephrine)

1mg of 1:10,000 (100mcg/ml) every 3-5 minutes

IV

Question 2

Anaphylaxis Adrenaline Dose and Route

Answer 2

Adrenaline (Epinephrine)

500 micrograms of 1:1000 every 5 minutes according to BP, pulse and resps.

IM

Question 3

Hydrocortisone - Emergency use, dose, and route

Answer 3

Severe or Life-threatening Asthma

100mg every 6 hours until conversion to oral prednisolone is possible. Preferrably given as sodium succinate.

IV

Question 4

Chlorphenamine Maleate use, dose, route

Answer 4

Anaphylaxis

10mg repeated if necessary (max 4 doses daily)

IM or IV

Question 5

Atropine use, dose, route

Answer 5

Post-MI Bradycardia

500 micrograms every 3-5 minutes (max 3mg per course)

IV

Question 6

Aspirin use, dose, route

Answer 6

Unstable angina, NSTEMI or STEMI

300mg chewed or dispersed in water

PO

Question 7

Clopidogrel use, dose, route

Answer 7

Acute coronary syndrome (STEMI or NSTEMI)

NSTEMI = 300mg initially then 75mg daily for 12 months. STEMI = If <76 300mg then 75mg for at least 4 weeks. If 76 or older 75mg daily for at least 4 weeks.

PO

Question 8

Calcium gluconate use, dose, route

Answer 8

Acute severe hyperkalaemia (>6.5mmol/L or ECG changes)

10-20ml of 10% calcium gluconate (dose titrated and adjusted to ECG improvement)

Slow IV

Question 9

Insulin/Dextrose infusion use, dose, route

Answer 9

Acute severe hyperkalaemia (>6.5mmol/L or ECG changes)

5-10 units of insulin with 50ml glucose 50% over 5-15 minutes. Repeated if necessary or a continuous infusion.

Slow IV

Question 10

Oral glucose gel use, dose, route

Answer 10

Emergency Hypoglycaemia Treatments

75g tube of 40% glucose gel. Take 2 tubes and repeat after 10-15 minutes if needed (max of 3 treatments). Convert to carbs once over 4mmol/L.

PO

Question 11

Glucose use, dose, route

Answer 11

Emergency Hypoglycaemia Treatments

15-20g over 15 minutes as Glucose 10% or 20%

IV infusion via large vein (care as these concentrations are irritant)

Question 12

Glucagon use, dose, route

Answer 12

Emergency Hypoglycaemia Treatments

1mg. If no response within 10 minutes give IV glucose.

S/C or IM

Question 13

Diazepam use, dose, route

Answer 13

Status epilepticus, Convulsions due to poisoning

10mg (then 10mg after 10 minutes if needed). Give at 1ml (5mg) per minute. IV

OR

10-20mg (then 10-20mg after 10-15 mins if needed) PR

Question 14

Lorazepam use, dose, route

Answer 14

Status epilepticus, Convulsions due to poisoning

4mg for 1 dose (then 4mg after 10 mins if required for 1 dose) - must be a large vein.

IV

Question 15

Salbutamol Nebuliser use, dose, route

Answer 15

Moderate, Severe, or Life-threatening asthma

5mg (repeat every 20-30 mins or when required. Give via oxygen-driven nebuliser).

Nebulised

Question 16

Morphine use, dose ,route

Answer 16

Acute pain

10mg every 4 hours initially (adjusted according to response). Avoid S/C in oedematous patient. Half dose in elderly. PO. S/C. or IM

5mg every 4 hours, adjusted according to response (can be adjusted more frequently in titration. Reduced dose in frail and elderly. IV

Question 17

Naloxone hydrochloride use, dose, route

Answer 17

Opioid overdose

400micrograms initially, then 800 micrograms for up to 2 doses at 1 minute intervals (if no response to preceeding dose). Then up to 2mg for 1 dose if still no response. 4mg may be needed in seriously poisoned patients. Further doses if respiratory function deteriorates. IV

Question 18

IV Fluids stat

Answer 18

Depends on the situation. If shocked, 500ml 0.9% NaCl STAT over 15 minutes can be given for resuscitation.

Question 19

Anticipatory meds

Answer 19

Morphine 2.5-5mg 1 hourly PRN S/C

Midazolam 2.5-5mg 1 hourly PRN S/C

Levomepromazine 2.5-5mg 4 hourly PRN S/C

Glycopyrronium 200-400 micrograms 4 hourly (max 1.2mg/24 hours) S/C

Question 20

Adrenaline MOA?

Answer 20

Acts on alpha and beta receptors to increase HR and contractility. Also causes peripheral vasodilation (beta 2) and vasoconstriction (alpha)

Question 21

Hydrocortisone MOA?

Answer 21

Glucocorticoid and mineralcorticoid activity.

Question 22

Chlorphenamine maleate class

Answer 22

Antihistamine

Question 23

Atropine class

Answer 23

Antimuscarinic agent

Question 24

Aspirin MOA?

Answer 24

Anti-platelet (COX1 inhibitor which reduces prostaglandin production).

Question 25

Clopidogrel MOA?

Answer 25

Blocks ADP binding to platelet receptor, stopping cascade for platelet aggregation.

Question 26

Calcium gluconate moa?

Answer 26

Protects cardiac membranes from deleterious effects of hyperkalaemia.

Question 27

Insulin/dextrose infusion moa?

Answer 27

Insulin causes potassium to be moved intracellularly via Na-K-ATPase. Dextrose is to prevent hypoglycaemia.

Question 28

Glucose/Glucogel moa?

Answer 28

Raised blood glucose level.

Question 29

Glucagon moa?

Answer 29

Polypeptide hormone normally made by alpha cells of islets of Langerhans. Increase blood glucose concentration by mobilising glycogen stored in liver. Therefore won’t work in those with liver glycogen depletion (e.g. those after long periods of fasting, chronic hypoglycaemia, adrenal insufficiency, or alcohol induced hypoglycaemia. May be less effective in those taking sulphonylurea.

Question 30

Diazepam and Lorazepam MOA?

Answer 30

Benzodiazepines enhance the effect of GABA at the GABA-A receptors, resulting in sedation, hypnotic, anxiolytic, anti-convulsant, and muscle relaxant properties.

Question 31

Salbutamol MOA?

Answer 31

Beta-2 agonist which causes bronchodilation (due to relaxing bronchiole small muscle).

Question 32

Morphine MOA?

Answer 32

Opioid medication which acts an opioid receptors.

Question 33

Naloxone moa?

Answer 33

Competitive antagonist at opioid receptors.