Emergency Drugs Flashcards
When can you give adrenaline in a cardiac arrest?
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)
What does of adrenaline should be given during CPR and how often?
Mechanism of action? (5)
Give 1mg IV every 3-5 minutes
Agonist of a1, a2, b1, b2 = vasoconstriction to skin, vasodilation to heart, increase HR + contraction, bronchodilation
When can amiodarone be given to treat cardiac arrest?
Given to treat SHOCKABLE RHYTHMS
Given after trial of adrenaline
What dose is amiodarone given in?
Mechanism of action
Contraindications (3)
Interactions (3)
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
What 4 drugs should you consider giving for acute pulmonary oedema?
Opiates (morphine and diamorphine)
Nitrates
Furosemide
Oxygen
Why is morphine/diamorphine given in acute pulmonary oedema? (2)
Dose?
Contraindications? (2)
SE (acronym)
Interactions (1)
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
Why is furosemide given in acute pulmonary oedema?
Dose?
2 other indications
3 SEs
Interactions
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
Why are nitrates given in acute pulmonary oedema?
Dose?
3 Contraindications
4 SEs
3 Interactions
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
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
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
What dose is IV salbutamol given in?
5mcg a minute or 250mcg slow injection
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)
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
How does ipratropium bromide work and how is it given?
5 SEs
Antimuscarinic = smooth muscle relaxation + reduces secretions
Given inhaled or nebulised
1) Dry mouth
2) Constipation
3) Cough
4) Oropharyngeal candidiasis
5) Headache
How long does ipratropium bromide take to work and in what dose should it be given?
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
What dose is magnesium sulphate given in and how does it work?
Interactions (1)
2 SEs
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
What should your immediate pharmaceutical management for anaphylaxis be? And in what dose is it given?
Side effects (3)
ADRENALINE
1 in 1000 IM (500mcg)
1) HTN
2) Tremor
3) Palpitations
What other pharmaceutical treatment options are there in anaphylaxis?
HYDROCORTISONE
CHLORPHENAMINE
IV FLUIDS
How does chlorphenamine work and what dose should it be given in?
1 SE
Anti-histamine (H1 receptors antagonist)
Should be given as 10mg slow IV or IM
1) Sedation
What sort of fluid therapy should you consider in anaphylaxis?
BOLUS of CRYSTALLOID
500ml NaCl 0.9% - repeat if not responding
What drug can be given to reverse benzodiazepine overdose?
In what dose?
Mechanism of action
6 SEs
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
How can IV glucose (dextrose) be given as part of treatment for hypoglycaemia?
100ml 10% -must give through wide bore cannula as glucose can be very irritant
Other than IV glucose what other pharmaceutical agents should be considered for hypoglycaemia? How should it be given?
1 SE
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
What drug can be given in opioid intoxication or overdose?
Mechanism of action
NALOXONE
- Competitive antagonist to opioid receptors
What sorts of symptoms does naloxone cause?
Symptoms of opioid withdrawal:
- Restlessness
- Agitation
- N&V
- Sweating
- Tachycardia
- Dilated pupils
What dose is naloxone given in and what do you have to remember about its action?
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
First line FOCAL anti-convulstants
1) Carbamazepine
2) Lamotrigine
First line GENERALISED anti-convulsants
1) Sodium valproate
2) Lamotrigine
4 Indications of diazepam/lorazepam (benzos)
Mechanism of action
3 Contraindications
5 SEs
1 Interaction - increase effect of benzo
Dose of:
diazepam
lorazepam
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
Anti-convulsants:
mechanism of action
- of all
- sodium valproate
- lamotrigine
- levetiracetam
Binds to Na+ channels = reduces neuronal excitability
- Sodium valproate - increases GAMA
- Lamotrigine - supresses glutamate & aspartate (excitatory neurotransmitters)
- Levetiracetam - inhibits presynaptic calcium channels
Anticonvulsants
2 Contraindications
1) Heart block
2) Acute porphyrias
Phenytoin SE (acronym)
P450 inducer Hirsutism Enlarged gums NYstagmus & other cerebellar sings (ataxia, diplopia, dysarthria, vertigo) Teratogenicity Osteopenia Interference with folic acid (megaloblastic anaemia) Neuropathy
Valproate SE (acronym)
Appetite increase, weight gain Liver failure Pancreatitis, P450 inhibitor Reversible hair loss Oedema Ataxia Teratogenicity, tremor, thrombocytopenia Encephalopathy
CARBAMazepiNe SE (acronym) + 1 extra
induCer CP450 Ataxia Retards Bone Marrow (thrombocytopenia, neutropenia) Bad for baby hypoNatremia (nausea, drowsy, headache) \+ SJS
5 Lamotrigine & Levetiracetam SEs
1) Agitation/tremor
2) Diplopia
3) Photosensitivity
4) Arthralgia
5) SJS
CP450 Inhibitors
SICKFACES.COMG
Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol Chloramphenicol Erythromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole Grapefruit juice
CP450 inducers
CRAP GPS/S
Carbemazepines Rifampicin Alcohol (chronic) Phenytoin Griseofluvin Phenobarbitone Sulphonylureas /St John
Hyperkalaemia management - what is the role of insulin-glucose solution?
Insulin shifts K into cells
Glucose prevents hypoglycaemia
Paracetamol overdose
How much activated charcoal to give
How much acetylcysteine to give (3 steps)
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.
Ethosuximide - SEs (2)
1) night terrors
2) rashes
