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YEAR 4 ACC ME > Emergency Drugs > Flashcards

Emergency Drugs Flashcards

1
Q

When can you give adrenaline in a cardiac arrest?

A

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)

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2
Q

What does of adrenaline should be given during CPR and how often?
Mechanism of action? (5)

A

Give 1mg IV every 3-5 minutes

Agonist of a1, a2, b1, b2 = vasoconstriction to skin, vasodilation to heart, increase HR + contraction, bronchodilation

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3
Q

When can amiodarone be given to treat cardiac arrest?

A

Given to treat SHOCKABLE RHYTHMS

Given after trial of adrenaline

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4
Q

What dose is amiodarone given in?

Mechanism of action

Contraindications (3)

Interactions (3)

A

300mg IV

Blocks Na, Ca, K channels = reduces spontaneous depolarisation

1) Severe hypotension
2) Heart block
3) Thyroid disease

1) Digoxin
2) Verapamil
3) Diltiazem
Increase risk bradycardia, AV block + heart failure

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5
Q

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

A

Opiates (morphine and diamorphine)
Nitrates
Furosemide
Oxygen

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6
Q

Why is morphine/diamorphine given in acute pulmonary oedema? (2)

Dose?

Contraindications? (2)

SE (acronym)

Interactions (1)

A

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

DOSE: 5-10mg

1) Resp depression
2) Acute abdo

MORPHINE 
Myosis 
Out of it (sedation)
Resp depression
Pneumonia 
Hypotension 
Infrequency (constipation, urinary retention)
Nausea 
Emesis

Sedating drugs

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7
Q

Why is furosemide given in acute pulmonary oedema?

Dose?

2 other indications

3 SEs

Interactions

A

Loop diuretic given to start drawing fluid out of lungs and removing it in urine
Inhibits water reabsorption by blocking Cl-, K+ and Na+ cotransporter in loop of Henle

DOSE: 40-80mg

1) HTN
2) HF

1) Dehydration
2) Hypokalaemia, Hyponatraemia
3) Hypotension

1) Drugs that are excreted by kidneys (increased levels due to reduced excretion)
- Lithium
2) Increase toxicity due to hypokalaemia
- Digoxin
2) Ototoxicity & nephrotoxicity
- Aminoglycosides

NB. take in morning - need to pass water soon after taking

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8
Q

Why are nitrates given in acute pulmonary oedema?

Dose?

3 Contraindications

4 SEs

3 Interactions

A

Vasodilation = decreased preload + after load = decrease cardiac work & oxygen demand & decrease pulmonary vascular resistance

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

1) Aortic stenosis
2) Haemodynamic instability
3) Hypotension

1) Drowsy
2) Flushing
3) Hypotension

1) Noradrenaline
2) AntiHTNs - increase hypotension
3) Sildenfail (erection) - hypotension & collapse

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9
Q

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

Mechanism of action

5 SEs

5 Interactions - increase risk of hypokalaemia

A

2.5-5mg (usually 5mg in acute asthma cases)
Can be run back to back or spaced hourly, 2 hourly, 4 hourly if necessary

Beta 2 agonist - binds to epinephrine’s active site in receptor = decreased intracellular Ca = smooth muscle relaxation

1) Hypokalaemia
2) Palpitations
3) Tremor
4) Tachycardia
5) Increase glucose

1) Furosemide
2) B blockers
3) Theophylline
4) Steroids
5) Tricyclics

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10
Q

What dose is IV salbutamol given in?

A

5mcg a minute or 250mcg slow injection

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11
Q

How should hydrocortisone be given in an acute asthma attack?

Mechanism of action

6 SEs

Interactions

  • Increase hypokalaemia (3)
  • Increase peptic ulcer (1)
  • Efficacy reduced by (1)
A

IV
Children 4mg/kg every 6 hours up to max 100mg
Adults max 100mg

Reduces inflammation + secretions

1) Immunosuppression
2) DM
3) Osteoporosis, muscle/skin weakness
4) Hypokalaemia
5) Cushing’s
6) Adrenal suppression

1) Diuretics, beta agonists, theophylline
2) NSAIDs
3) CP450 inducers

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12
Q

How does ipratropium bromide work and how is it given?

5 SEs

A

Antimuscarinic = smooth muscle relaxation + reduces secretions
Given inhaled or nebulised

1) Dry mouth
2) Constipation
3) Cough
4) Oropharyngeal candidiasis
5) Headache

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13
Q

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

A

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

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14
Q

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

Interactions (1)

2 SEs

A

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

AntiHTNs - risk of hypotension

1) Hypotension
2) Flushing

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15
Q

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

Side effects (3)

A

ADRENALINE
1 in 1000 IM (500mcg)

1) HTN
2) Tremor
3) Palpitations

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16
Q

What other pharmaceutical treatment options are there in anaphylaxis?

A

HYDROCORTISONE
CHLORPHENAMINE
IV FLUIDS

17
Q

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

1 SE

A

Anti-histamine (H1 receptors antagonist)

Should be given as 10mg slow IV or IM

1) Sedation

18
Q

What sort of fluid therapy should you consider in anaphylaxis?

A

BOLUS of CRYSTALLOID

500ml NaCl 0.9% - repeat if not responding

19
Q

What drug can be given to reverse benzodiazepine overdose?

In what dose?

Mechanism of action

6 SEs

A

FLUMAZENIL

200mcg given over 15s then an extra 100mcg every 1 min if necessary

Competitive inhibitor of GABA receptors

1) Tremor
2) Palpitations
3) Hypotension
4) Flushing
5) Diplopia
6) Anxiety

20
Q

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

A

100ml 10% -must give through wide bore cannula as glucose can be very irritant

21
Q

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

1 SE

A

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

1) Increases anticoagulant effect of warfarin

22
Q

What drug can be given in opioid intoxication or overdose?

Mechanism of action

A

NALOXONE

- Competitive antagonist to opioid receptors

23
Q

What sorts of symptoms does naloxone cause?

A

Symptoms of opioid withdrawal:

  • Restlessness
  • Agitation
  • N&V
  • Sweating
  • Tachycardia
  • Dilated pupils
24
Q

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

A

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

25
Q

First line FOCAL anti-convulstants

A

1) Carbamazepine

2) Lamotrigine

26
Q

First line GENERALISED anti-convulsants

A

1) Sodium valproate

2) Lamotrigine

27
Q

4 Indications of diazepam/lorazepam (benzos)

Mechanism of action

3 Contraindications

5 SEs

1 Interaction - increase effect of benzo

Dose of:
diazepam
lorazepam

A

1) Seizures
2) Alcohol withdrawal
3) Anxiety
4) Insomnia

Bind GABA to GABA receptor = depressant effect

1) Resp depression
2) Sleep apnoea
3) Myasthenia gravis

1) Sedation
2) Airway obstruction
3) Withdrawal
4) Dependence
5) Movement disorders

1) CP450 inhibitors - amiodarone, macrolides, fluconazole, diltiazem

Dose:
10mg 1ml/min –> repeat after 10 mins

4mg –> repeat after 10 mins

28
Q

Anti-convulsants:

mechanism of action

  • of all
  • sodium valproate
  • lamotrigine
  • levetiracetam
A

Binds to Na+ channels = reduces neuronal excitability

  • Sodium valproate - increases GAMA
  • Lamotrigine - supresses glutamate & aspartate (excitatory neurotransmitters)
  • Levetiracetam - inhibits presynaptic calcium channels
29
Q

Anticonvulsants

2 Contraindications

A

1) Heart block

2) Acute porphyrias

30
Q

Phenytoin SE (acronym)

A 
P450 inducer
Hirsutism 
Enlarged gums 
NYstagmus & other cerebellar sings (ataxia, diplopia, dysarthria, vertigo)
Teratogenicity 
Osteopenia 
Interference with folic acid (megaloblastic anaemia) 
Neuropathy
31
Q

Valproate SE (acronym)

A 
Appetite increase, weight gain 
Liver failure 
Pancreatitis, P450 inhibitor 
Reversible hair loss 
Oedema 
Ataxia
Teratogenicity, tremor, thrombocytopenia 
Encephalopathy
32
Q

CARBAMazepiNe SE (acronym) + 1 extra

A 
induCer CP450
Ataxia
Retards 
Bone 
Marrow (thrombocytopenia, neutropenia)
Bad for baby
hypoNatremia (nausea, drowsy, headache)
\+ SJS
33
Q

5 Lamotrigine & Levetiracetam SEs

A

1) Agitation/tremor
2) Diplopia
3) Photosensitivity
4) Arthralgia
5) SJS

34
Q

CP450 Inhibitors

SICKFACES.COMG

A 
Sodium valproate 
Isoniazid 
Cimetidine 
Ketoconazole 
Fluconazole 
Alcohol 
Chloramphenicol 
Erythromycin 
Sulfonamides
Ciprofloxacin 
Omeprazole 
Metronidazole 
Grapefruit juice
35
Q

CP450 inducers

CRAP GPS/S

A 
Carbemazepines 
Rifampicin 
Alcohol (chronic)
Phenytoin 
Griseofluvin 
Phenobarbitone 
Sulphonylureas /St John
36
Q

Hyperkalaemia management - what is the role of insulin-glucose solution?

A

Insulin shifts K into cells

Glucose prevents hypoglycaemia

37
Q

Paracetamol overdose
How much activated charcoal to give
How much acetylcysteine to give (3 steps)

A

CHARCOAL
50g if <1hr & >150mg/kg ingested

ACETYLCYSTEINE
1) 150mg/kg in 200mls of 5% dextrose over 1 hr
2) 50mg/kg in 500mls of 5% dextrose over 4 hours
3) 100mg/kg in 1000mls of 5% over 16 hours
The aim is to administer 300mg/kg over 21 hours.

38
Q

Ethosuximide - SEs (2)

A

1) night terrors

2) rashes

YEAR 4 ACC ME (6 decks)

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