Emergency Drugs

Question 1

When can you give adrenaline in a cardiac arrest?

Answer 1

During the 3rd round of chest compressions if VF / pVT is persisting
Can also be given during compressions of non-shockable rhythms (PEA and asystole)

Question 2

What does of adrenaline should be given during CPR and how often?

Answer 2

Give 1mg IV every 3-5 minutes

Question 3

When can amiodarone be given to treat cardiac arrest?

Answer 3

Given to treat SHOCKABLE RHYTHMS

Given after trial of adrenaline

Question 4

What dose is amiodarone given in?

Answer 4

300mg IV

Question 5

What 4 drugs should you consider giving for acute pulmonary oedema?

Answer 5

Opiates (morphine and diamorphine)
Nitrates
Furosemide
Oxygen

Question 6

Why is morphine/diamorphine given in acute pulmonary oedema and in what dose?

Answer 6

By taking the edge off pain patients are more likely to successfully breathe for themselves
Also means patients tolerate NIV better
Reduces sympathetic nervous activity meaning symptoms of anxiety and stress are eased
DOSE: 1-3mg

Question 7

Why is furosemide given in acute pulmonary oedema and in what dose?

Answer 7

Loop diuretic given to start drawing fluid out of lungs and removing it in urine
Inhibit Cl-, K+ and Na+ reabsorption in loop of Henle
DOSE: 40-80mg (consider the higher doses for patients in CKS or who are already taking a diuretic)

Question 8

Why are nitrates given in acute pulmonary oedema and in what dose?

Answer 8

In small doses they cause venodilation leading to decreased preload and in high doses cause arteridilation leading to decreased after load. Both decrease work of the heart and decrease pulmonary vascular resistance

DOSE: 5-10mcg per minute double dose by 5mcg every 5 minutes until max dose 200mcg per minute

Question 9

What dose is nebuliser salbutamol given in and how often can they be given?

Answer 9

2.5-5mg (usually 5mg in acute asthma cases)

Can be run back to back or spaced hourly, 2 hourly, 4 hourly if necessary

Question 10

What dose is IV salbutamol given in?

Answer 10

5mcg a minute or 250mcg slow injection

Only given in very serious cases - senior decision

Question 11

How should hydrocortisone be given in an acute asthma attack?

Answer 11

IV
Children 4mg/kg every 6 hours up to max 100mg
Adults max 100mg
Reduces inflammation, reduces secretions

Question 12

How does ipratropium bromide work and how is it given?

Answer 12

Is a MUSCARINIC ANTAGONIST and so causes smooth muscle relaxation –> bronchodilator
Given inhaled or nebulised

Question 13

How long does ipratropium bromide take to work and in what dose should it be given?

Answer 13

Onset of action is 10-15mins
Given as 20-40mcg doses 3-4 times a day - aerosol
Or 200-500mcg doses 3-4 times a day

Question 14

What dose is magnesium sulphate given in and how does it work?

Answer 14

IV bronchodilator
1.2-2g IV over a period of 20 mins
40mg/kg max for children

Question 15

What should your non-pharmaceutical initial management for anaphylactic shock be?

Answer 15

Work through A-E and respond
Lie patient flat and lift their legs
Remove allergen

Question 16

What should your immediate pharmaceutical management for anaphylaxis be? And in what dose is it given?

Answer 16

ADRENALINE
1 in 1000 preparation
DOSE for ADULTS: 5mL IM (500mcg)

Question 17

What other pharmaceutical treatment options are there in anaphylaxis?

Answer 17

Consider steroids
HYDROCORTISONE sodium succinate (eases bronchospasm)
CHLORPHENAMINE
IV FLUIDS

Question 18

How does chlorphenamine work and what dose should it be given in?

Answer 18

It is an anti-histamine agent and is particularly effective against H1 receptors meaning it works well to ease swelling
Should be given as 10mg slow IV or IM

Question 19

What sort of fluid therapy should you consider in anaphylaxis?

Answer 19

BOLUS of CRYSTALLOID

500ml NaCl 0.9% - repeat if not responding

Question 20

What drug can be given to reverse benzodiazepine overuse? In what dose?

Answer 20

FLUMAZENIL 200mcg given over 15s then an extra 100mcg every 1 min if necessary
Competitive inhibitor of BZD receptors

Question 21

How can IV glucose be given as part of treatment for hypoglycaemia?

Answer 21

500mg/kg IV infusion of 10% glucose solution -must give through wide bore cannula as glucose can be very irritant

Question 22

Other than IV glucose what other pharmaceutical agents should be considered for hypoglycaemia? How should it be given?

Answer 22

GLUCAGON - frees up the glucose stored in the liver quickly
Can be given IM or IV
1mg - if there is no response after 1 min give IV glucose

Question 23

What drug can be given in opioid intoxication or overdose?

Answer 23

NALOXONE

Question 24

What sorts of symptoms does naloxone cause?

Answer 24

Symptoms of opioid withdrawal:

• Restlessness
• Agitation
• N&V
• Sweating
• Tachycardia

Question 25

What dose is naloxone given in and what do you have to remember about its action?

Answer 25

400mcg IV
Then up to 2 additional 800mcg doses every minute if not responding. Then one 2mg dose

***naloxone is broken down much faster than the opioid so its effects will wear off and the person can once again be under the effects of the opioid - need repeat doses

Question 26

What is the first pharma step of emergency seizure treatment?

Answer 26

Carbamazepine, lamotrigine or phenytoin 600mg (in patient with TONIC-CLONIC seizures)
Always consider phenytoin 20mg/kg loading dose (max 2g) then slow IV infusion

Question 27

What anti-convulsant should be considered if seizures are just partial or atonic?

Answer 27

Consider sodium valproate

Question 28

What anti-convulsants should be considered in absence seizures?

Answer 28

lamotrigine, sodium valproate or ethosuximide

Question 29

What anti-convulsant should be given in myoclonic seizures?

Answer 29

Sodium valproate or levitaracetam