Emergency Drugs (doses)

Question 1

Adrenaline
Indication: Anaphylaxis

Answer 1

500 micrograms (0.5mg) using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes.

Anterolateral aspect of the middle third of the thigh

MOI: Acts on both alpha and beta receptors and increases both heart rate and contractility (beta1 effects); it can cause peripheral vasodilation (a beta2 effect) or vasoconstriction (an alpha effect).

Question 2

Chlorphenamine
Indication: Anaphylaxis

Answer 2

10 mg, repeated if necessary; maximum 4 doses per day. IM or IV

MOI: Antihistamine H1 receptor antagonist

Question 3

Hydrocortisone
Indication: Adrenal Crisis/ Addisonian Crisis (low Na, high K) Hydrocortisone

Answer 3

Initially 100 mg IM or IV, then (by continuous intravenous infusion) 200 mg every 24 hours, diluted in Glucose 5%- assuming hypoglycaemia

Alternatively (by intramuscular injection or by intravenous injection) 50 mg every 6 hours, dose increased to 100 mg every 6 hours in patients who are severely obese. No fludrocortisone is required because high cortisol exerts weak mineralocorticoid action (until hydrocortisone below 50mg).

Oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days (Maintenance: hydrocortisone ~20mg, fludrocortisone ~50mg daily. DHEA not routinely given)

MOI: Corticosteroid with both mineralcorticoid (aldosterone) and glucocorticoid (cortisol) receptor agonist actions.

Question 4

Hydrocortisone
Indication: Angioedema or Anaphylactic shock: Adjunct to Adrenaline

Answer 4

100–300 mg, to be administered as sodium succinate

MOI: Corticosteroid with both mineralcorticoid (aldosterone) and glucocorticoid (cortisol) receptor agonist actions.

Question 5

Hydrocortisone
Indication: Acute Asthma

Answer 5

IV 100 mg every 6 hours until conversion to oral prednisolone is possible, dose given, preferably, as sodium succinate.

MOI: Corticosteroid with both mineralcorticoid (aldosterone) and glucocorticoid (cortisol) receptor agonist actions.

Question 6

Atropine
Indication: Bradycardia following myocardial infarction (particularly if complicated by hypotension)

Answer 6

500 micrograms every 3–5 minutes; maximum 3 mg per course.

MOI: Antimuscarinic

Question 7

Aspirin
Indication: Management of unstable angina, NSTEMI and STEMI

Answer 7

300 mg, chewed or dispersed in water.

MOI: Prevents platelet aggregation
Cyclooxygenase inhibitor
Inhibits COX-1 therefore no production of platelet aggregating agent thromboxane A2

Question 8

Aspirin
Indication: Acute ischaemic stroke

Answer 8

300 mg once daily for 14 days started 24 hours after thrombolysis or ASAP within 48 hours of symptom onset in patients not receiving thrombolysis.

MOI: Prevents platelet aggregation
Cyclooxygenase inhibitor
Inhibits COX-1 therefore no production of platelet aggregating agent thromboxane A2

Question 9

Aspirin
Indication: Suspected transient ischaemic attack

Answer 9

300 mg once daily until diagnosis established.

MOI: Prevents platelet aggregation
Cyclooxygenase inhibitor
Inhibits COX-1 therefore no production of platelet aggregating agent thromboxane A2

Question 10

Clopidogrel
Indication: Prevention of atherothrombotic events in NSTEMI (given with aspirin)

Answer 10

Initially 300 mg, then 75 mg daily for up to 12 months

MOI: Prevents platelet aggregation
ADP R antagonist
Irreversible inhibition of P2Y12, preventing ADP binding and activation of GPIIb/IIIa R (indep of COX)

Question 11

Clopidogrel
Indication: STEMI (18-75 year olds)

Answer 11

Initially 300 mg, then 75 mg for at least 4 weeks.

MOI: Prevents platelet aggregation
ADP R antagonist
Irreversible inhibition of P2Y12, preventing ADP binding and activation of GPIIb/IIIa R (indep of COX)

Question 12

Clopidogrel
Indication: STEMI (76+ year olds)

Answer 12

75 mg daily for at least 4 weeks.

MOI: Prevents platelet aggregation
ADP R antagonist
Irreversible inhibition of P2Y12, preventing ADP binding and activation of GPIIb/IIIa R (indep of COX)

Question 13

Calcium Gluconate
Indication: Severe acute hypocalcaemia or hypocalcemic tetany

Answer 13

Start 10–20 mL injection 10% (~2.25–4.5 mmol calcium), administered with plasma-calcium and ECG monitoring. Repeat if required. if only temporary improvement, continuous intravenous infusion to prevent recurrence, initially 50 mL/hour, adjusted according to response, administered using 100 mL of calcium gluconate 10% diluted in 1 litre of glucose 5% or sodium chloride 0.9%.

Question 14

Calcium Gluconate
Indication: Acute severe hyperkalaemia (plasma-potassium concentration 6.5 mmol/litre or greater, or in the presence of ECG changes)

Answer 14

30 mL, calcium gluconate 10% (providing approximately 6.8 mmol of calcium) should be administered as a single dose, repeat dose if no improvement in ECG within 5 to 10 minutes.

Question 15

Diazepam
Indication: Status epilepticus, Febrile convulsions, Convulsions due to poisoning

Answer 15

IV - 10 mg, repeated after 10 minutes if required, administered at a rate of 1 mL (5 mg) per minute.

PR - 10–20 mg, then 10–20 mg after 5–10 minutes if required. Only 10mg in elderly/frail.

MOI: Benzodiazepine
Increase GABA activity at GABA A R- positive allosteric modulator. Causes hyperpolarisation due to increased Cl- efflux

Question 16

Diazepam
Indication: Acute alcohol withdrawal, severe acute panic attack

Answer 16

10 mg, then 10 mg after at least 4 hours if required, intravenous injection to be administered into a large vein, at a rate of not more than 5 mg/minute.

MOI: Benzodiazepine
Increase GABA activity at GABA A R- positive allosteric modulator. Causes hyperpolarisation due to increased Cl- efflux

Question 17

Diazepam
Indication:

Answer 17

MOI: Benzodiazepine
Increase GABA activity at GABA A R- positive allosteric modulator. Causes hyperpolarisation due to increased Cl- efflux