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WFA CPGs > EMT DRUGS REVISED > Flashcards

EMT DRUGS REVISED Flashcards

1
Q

adrenaline mechanism

A
  • Adrenaline stimulates alpha and beta receptors, with the predominant effects occurring at alpha 1, beta 1 and beta 2 receptors.
  • Alpha 1 stimulation causes smooth muscle contraction, vasoconstriction of blood vessels and stimulation of glycogenolysis and gluconeogenesis.
  • Beta 1 stimulation causes an increase in inotropy (cardiac contractility), an increase in chronotropy (heart rate) and an increase in dromotropy (speed of electrical conduction within the heart).
  • Beta 2 stimulation causes smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation, and stabilisation of mast cell membranes, reducing histamine release.
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2
Q

adrenaline indication

A

EMT
Clinically significant epistaxis
Stridor causing moderate to severe respiratory distress
Anaphylaxis
Severe asthma
Clinically significant bleeding from a wound

Other indications
Cardiac arrest
Imminent respiratory arrest from COPD
Severe bradycardia
BP support if unresponsive to metaraminol
Septic shock, cardiogenic shock, and neurogenic shock, unresponsive to 0.9% sodium chloride IV and metaraminol IV

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3
Q

adrenaline contraindications

A

nil

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4
Q

adrenaline cautions

A

Myocardial ischaemia. Adrenaline will increase myocardial oxygen consumption.
Tachydysrhythmias. Adrenaline will usually make tachydysrhythmias wors

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5
Q

topical use of adrenaline

A

Topical: dilute each mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Apply topically in addition to direct pressure.

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6
Q

IN admin of adrenaline

A

IN for epistaxis
drawup with 8mls sodium chloride
0.2 mg (2 mls) aged 12 and over
0.1 mg (1 mls) 5-11 years.

Repeat dose after 20 mins

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7
Q

IM adrenaline admin

A

IM for asthma/anaphylaxis
Undiluted
0.5 mg
repeat every 5 to 10 mins

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8
Q

Arrest adrenaline admin

A

Cardiac arrest: 1mg every 4 mins
a) Adults and children whose weight has been rounded to 50 kg or more: administer undiluted as an IV bolus.
b) Children whose weight has been rounded to 40 kg or less: dilute 1 mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Draw up the dose from this solution and administer as an IV bolus.

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9
Q

common adverse affects of adrenaline

A
  • Tachycardia.
  • Tachydysrhythmia.
  • Myocardial ischaemia.
  • Ventricular ectopy.
  • Hypertension.
  • Nausea and vomiting.
  • Tremor, anxiety and sweating.
  • Hyperglycaemia.
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10
Q

usual onset of adrenaline

A
  • IV: 5-10 seconds.
  • IM: 2-5 minutes.
  • Nebulised, IN and topical: on contact with the target site.
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11
Q

duration of adrenaline

A
  • The cardiovascular effects last 5-15 minutes.
  • The mast cell membrane effects may last for several hours.
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12
Q

pharmokinetics of adrenaline

A
  • Adrenaline is metabolised by the liver and taken up by sympathetic nerve endings.
  • There are no significant effects from liver impairment on acute administration.
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13
Q

common interactions with adrenaline

A

Increased doses may be required if the patient is taking a beta-blocker or a calcium channel blocker. This effect is particularly prominent in the setting of poisoning if a large dose of a beta-blocker and/or calcium channel blocker has been taken.

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14
Q

aspirin mechnism

A

Aspirin (acetylsalicylic acid) has antiplatelet, antipyretic, anti-inflammatory and analgesic effects. In the out-of-hospital setting aspirin is only administered for its antiplatelet activity.
* Aspirin inhibits the enzyme cyclooxygenase which results in a reduction in the formation of prostaglandins and thromboxane.

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15
Q

indication of aspirin

A

myocardial ischemia

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16
Q

contraindications of aspirin

A

Known severe allergy.
pregnancy

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17
Q

cautions of aspirin

A

^ Known bleeding disorder. Aspirin will increase the risk of bleeding, however the balance of risk is usually in favour of administering aspirin.
^ Clinically significant bleeding. Aspirin will increase the risk of bleeding and the nature and risk of the bleeding must be taken into account.
^ Known worsening of bronchospasm with NSAIDs. Some patients with asthma or COPD have known worsening of bronchospasm with NSAIDs (including aspirin) and a decision must be made based on the balance of risk. If there
is a clear history of significant bronchospasm with NSAIDs, aspirin should be withheld.

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18
Q

aspirin and pregnancy interactions

A
  • May cause harm during pregnancy. Aspirin has been associated with premature delivery and premature closure of the ductus arteriosus, when administered in the third trimester of pregnancy.
  • The likelihood of clinically important myocardial ischaemia occurring in a woman who is pregnant is so low that the balance of risk is usually in favour of aspirin being withheld.
  • May be administered if the patient is breastfeeding. Advise the patient to stop breastfeeding and seek further advice from their lead maternity carer or GP
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19
Q

aspirin dosage

A

300mg

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20
Q

common adverse affects of aspirin

A
  • Increased bleeding.
  • Although indigestion, gastrointestinal ulceration and gastrointestinal bleeding are commonly listed as adverse effects, these are only associated with long- term administration.
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21
Q

usual onset of aspirin

A
  • 30-60 minutes.
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22
Q

usual duration of aspirin

A
  • 3-5 days for the antiplatelet activity. This is because platelets exposed to aspirin are impaired for the life of the platelet which is 7-10 days. Approximately 10% of platelets are replaced each day.
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23
Q

pharmokinetics of aspirin

A
  • Absorption occurs in the stomach and small intestine. The presence of food in the stomach will delay absorption, but this is not usually clinically significant.
  • Aspirin is predominantly metabolised in the liver.
  • There are no significant effects from liver impairment on acute administration.
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24
Q

common interactions of aspirin

A
  • Aspirin displaces warfarin from binding sites and increases the activity of warfarin. However, this effect is most prominent with chronic administration and aspirin is indicated if a patient taking warfarin has clinically significant myocardial ischaemia.
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25
Q

glucagon mechnism

A
  • Glucagon increases the blood glucose level by stimulating glycogenolysis (the breakdown of glycogen into glucose), predominantly within the liver.
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26
Q

glucagon indication

A

Hypoglycaemia when the patient cannot safely swallow glucose/food and IV access cannot be obtained.

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27
Q

glucagon contraindications

A

Known severe allergy.

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28
Q

glucagon cautions

A

nil

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29
Q

glucagon dosage

A
  • 1 mg IM once for an adult or child aged greater than or equal to five years.
  • 0.5 mg IM once for a child aged less than five years.
    NO REPEATS
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30
Q

admin of glucagon

A
  • Dissolve the powder using the syringe within the kit and administer IM.
  • The preferred site is the lateral thigh as this has the best absorption. If this site is not suitable use the lateral upper arm.
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31
Q

adverse affects of glucagon

A

nil

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32
Q

usual onset of glucagon

A

5-10 mins

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33
Q

usual duration of glucagon

A

15-60 mins

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34
Q

pharmokinetics of glucagon

A
  • Glucagon is predominantly excreted unchanged into bile and urine.
  • There are no significant effects from liver or kidney impairment on acute administration.
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35
Q

Glucagon relies on stored glycogen being available to exert its effect and if glycogen stores are not available, glucagon may be ineffective. Examples include if the patient:

A

ū Does not have diabetes.
ū Has sepsis.
ū Is a young child.
ū Has undergone strenuous exercise.
ū Has not eaten food for more than 12 hours.
ū Is suffering from adrenal insufficiency.
ū Is suffering from chronic hypoglycaemia.
ū Is suffering from alcohol-induced hypoglycaemia.

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36
Q

indication of glucose gel

A

 Hypoglycaemia in adults and children provided the patient is conscious enough to be able to swallow safely.
 Hypoglycaemia in neonates.

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37
Q

cautions and contraindications of glucose gel

A

nil

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38
Q

dosage of glucose gel

A
  • 10-20 g for all ages.
  • Administer one sachet and repeat every ten minutes if hypoglycaemia persists or recurs.
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39
Q

onset and duration of glucose gel

A

Usual onset of effect
* 5-10 minutes.
Usual duration of effect
* 30-60 minutes.

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40
Q

GTN mechanism

A
  • GTN is a vasodilator. It acts on vascular smooth muscle to cause venous and arterial vasodilation, with the predominant effect being on veins.
  • The mechanism of action is not clear, but it appears that GTN results in the formation of nitric oxide which is a vasodilator. GTN causes:
    ū A reduction in venous return (preload) to the heart. This reduces ventricular filling and cardiac output which reduces myocardial oxygen demand.
    ū Arterial dilation which reduces peripheral resistance (afterload). This reduces the force the left ventricle must overcome to eject blood into the arteries which reduces myocardial oxygen demand.
    ū Dilation of the coronary arteries which may increase coronary blood supply, though this is not usually clinically significant.
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41
Q

indications of GTN

A

 Myocardial ischaemia.
 Cardiogenic pulmonary oedema.
 Control of hypertension associated with autonomic dysreflexia.
 Control of hypertension (usually in conjunction with labetalol or metoprolol) prior to fibrinolytic treatment for STEMI.
 Control of hypertension (usually in conjunction with labetalol or metoprolol) during inter-hospital transfer for STEMI.

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42
Q

contraindications of GTN

A

Known severe allergy.
Systolic BP less than 100 mmHg.
Heart rate less than 40/minute.
Heart rate greater than 150/minute.
Ventricular tachycardia.

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43
Q

cautions of GTN

A

STEMI, especially RV (If there is low CO then GTN decreases this)
STEMI involving RV can cause significant reduction in RV contractility, this decreases CO
GTN can cause a significant fall in venous pressure which decreases CO
Frail patient
Signs of shock (CO may fall further with GTN)
Dysrhythmia (CO may fall further with GTN)
Phosphodiesterase in the last 24 hours (Severe/prolonged hypotension may occur) (EG phosphodiesterase inhibitors used to treat erectile dysfuntion and pulmonary hypertension)
Known aortic or mitral stenosis (Narrowing of aortic or mitral valves) - (CO may fall further with GTN) (Rheumatic fever can lead to this)

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44
Q

dosage of GTN

A

Myocardial ischaemia: 0.4 mg every 3-5 mins.
Increase dosing to 10 mins if any cautions
ACPO 0.8 mg every 3-5 mins
HTN 0.4-0.8 mg every 3-5 mins

IF ADMINED IN CAUTION: lie flat, IV acsess, interval 10 mins, fluids ready if needed

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45
Q

common adverse affects of GTN

A
  • Hypotension.
  • Flushing.
  • Headache.
  • Tachycardia.
  • Feeling light-headed.
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46
Q

onset of GTN

A

1-2 mins

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47
Q

duration of GTN

A

15-30 mins

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48
Q

pharamacokineics of GTN

A
  • GTN is rapidly absorbed from the oral mucosa and reaches the vascular system without passing through the liver.
  • GTN is predominantly metabolised in the liver.
  • There are no significant effects from liver impairment on acute administration.
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49
Q

common interactions of GTN

A

The effects may be increased if the patient is taking an antihypertensive medicine.
* Severe and/or prolonged hypotension may occur if a medicine for erectile dysfunction has been taken within the last 24 hours:
ū There is a range of medicines with different names used for erectile dysfunction and some of them (particularly sildenafil) are also used in the treatment of pulmonary hypertension.
ū All of these medicines are long-acting vasodilators and the administration of GTN may cause further vasodilation.

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50
Q

GTN and STEMI cautions

A

GTN must be used with caution in the presence of STEMI because the risks may outweigh the benefits:
ū GTN may cause a significant fall in cardiac output.
ū GTN has a role in treating symptomatic myocardial ischaemia, but does not
usually have a significant role in treating STEMI.
* Particular caution must be used in the presence of STEMI involving the right ventricle and personnel must have a low threshold for withholding GTN:
ū STEMI involving the right ventricle can result in a significant reduction in right ventricular contractility.
ū When the right ventricle is significantly impaired, it may provide little in the way of contribution to cardiac output and blood may be passively flowing down a pressure gradient between the inferior vena cava (IVC), the superior vena cava (SVC) and the left atrium.
ū This may result in the preload (filling) of the left side of the heart being dependent on the venous pressures within the IVC and SVC.
ū GTN can result in a significant fall in venous pressure (and thus a fall in preload) which may cause a significant fall in cardiac output.

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51
Q

ibuprofen mechnism

A
  • Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that is predominantly used for treating pain.
  • Ibuprofen inhibits the activity of the enzyme prostaglandin synthetase, reducing prostaglandin production and causing a reduction in inflammation, pain and fever.
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52
Q

ibuprofen indications

A

 Mild pain (usually in combination with paracetamol), particularly soft tissue pain, musculoskeletal pain or headache.
 May be administered in addition to other medicines for moderate to severe pain, particularly when the transport time is long. This is not a priority but will reduce the need for subsequent analgesia and improve the quality of pain relief.

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53
Q

ibuprofen contrindications

A

Known severe allergy
Pregnancy
Presence of sepsis, dehydration, shock or clinically significant bleeding (Ibuprofen can worsen renal impairment and increase bleeding risk)
Known worsening of bronchospasm with NSAIDS

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54
Q

ibuprofen cautions

A

Abdo pain, particularly if unwell or vomiting (The possibility of significant intra-abdominal pathology exists and oral meds should usually be withheld)
Age greater than 75 years particularly if frail (Renal impairment is likely and ibuprofen worsens this
Taken within last four hours (Additional ibuprofen may be administered if the total dose in the last 4 hours does not exceed the CPG dose)

55
Q

dosage of ibuprofen

A
  • 600 mg for an adult weighing greater than 80 kg.
  • 400 mg for an adult weighing 80 kg or less.
  • See the paediatric drug dose tables for a child.
56
Q

common adviser affects of ibuprofen

A
  • Renal impairment.
  • Increased bleeding.
  • Although indigestion, gastrointestinal ulceration and gastrointestinal bleeding are commonly listed as adverse effects, these are only associated with chronic administration.
57
Q

onset and duration of ibuprofen

A

Usual onset of effect
* 30-60 minutes.
Usual duration of effect
* 4-6 hours.

58
Q

pharmacokinetics of ibuprofen

A

Ibuprofen is absorbed in the stomach and small intestine. The presence of food in the stomach will delay absorption, but this is not usually clinically significant.
* Ibuprofen is metabolised by the liver.
* There are no significant effects from liver impairment on acute administration.

59
Q

common interactions of ibuprofen

A
  • Warfarin. Ibuprofen displaces warfarin from binding sites and increases the activity of warfarin.
60
Q

Ipatropium mechnism

A
  • Ipratropium is a bronchodilator.
  • Ipratropium is an anticholinergic agent with predominantly antimuscarinic activity. It antagonises (blocks) acetylcholine receptors, causing vagal inhibition resulting in bronchodilation.
61
Q

indication of ipatropium

A

 Bronchospasm secondary to asthma or COPD.
 Prominent bronchospasm secondary to airway burns, smoke inhalation or
chest infection.

62
Q

contrindications of ipatropium

A

Known severe allergy

63
Q

dosage of ipatropium

A

Dosage
* 0.5 mg for adults and children once only.

64
Q

common adverse affects of ipatropium

A

Common adverse effects
* Tachycardia.
* Dry mouth.
* Blurred vision. This usually only occurs with repeated doses.

65
Q

onset and duration of ipatropium

A

Usual onset of effect
* 2-5 minutes.
duration 6 hours

66
Q

pharmokinetics of ipatropium

A
  • Only a small amount of the nebulised dose is absorbed, with most of the dose being nebulised to the atmosphere. The inhaled ipratropium is absorbed through the lungs and some is swallowed.
  • Excretion is predominantly via the urine.
  • Clearance is prolonged if the patient has significant kidney impairment, but this does not alter the initial (loading) dose.
67
Q

loradatine mechnism

A
  • Loratadine is a non-sedating antihistamine.
  • Loratadine antagonises (blocks) peripheral histamine receptors, blocking the action of histamine and reducing itching and redness.
68
Q

loraditine indications

A

 Minor allergic reactions confined to skin involvement.
 Prominent itch associated with anaphylaxis, provided all systemic signs of
anaphylaxis have resolved.

69
Q

contraindications of loradtine and cautions

A

Known severe allergy.
Age less than one year.
Cautions
^ Pregnancy.

70
Q

dosage of loradtine

A

10 mg for an adult or child aged greater than or equal to 12 years.
* 5 mg for a child aged 1-11 years.

71
Q

common adverse affects of loradtine

A

nil

72
Q

onset and duration of loradtine

A

Usual onset of effect
* 30-60 minutes.
Usual duration of effect
* 12-24 hours.

73
Q

pharmacokinetics of loradtine

A

Pharmacokinetics
* Loratadine is predominantly metabolised by the liver.
* There are no significant effects from liver impairment on acute administration.

74
Q

methoxy mechnism

A

Mechanism of action
* Methoxyflurane is an inhalational analgesic.
* The mechanism of action is not clear.

75
Q

methoxy indications

A

ndications
 Moderate to severe pain when:
ū Personnel able to administer fentanyl and/or ketamine are not available within an appropriate time, or
ū Fentanyl and/or ketamine administration is inappropriate.

76
Q

methoxy contraindications

A

Known severe allergy
Hx malignant hyperthermia (Inherited disorder of muscle metabolism, when exposed to anaesthetic agents the patient may develop a life-threatening hypermetabolic state with severe hyperthermia)
Renal impairment (Kidneys/ureter/urethra) (Dialysis pts, kidney stones and renal colic pts can have methoxy)
Administered in last week (Increase risk of renal impairment with frequent admin)

77
Q

cautions of methoxy

A

Age greater than 75, particularly if frail
Pre-eclampsia (Renal impairment is likely and methoxy will worsen this)
Confined space

78
Q

methoxy and pregnancy

A

Safety has not been formally demonstrated in pregnancy, but methoxyflurane may be administered. Methoxyflurane has been extensively used during labour in Australia and New Zealand for many years without adverse effects.
* Methoxyflurane may cause temporary drowsiness in the baby and administration should be discussed with the lead maternity carer if there are known signs of foetal distress.
* May be administered if the patient is breastfeeding. Advise the patient to stop breastfeeding and seek further advice from their lead maternity carer or GP.

79
Q

dosage of methoxy

A

Dosage
* Maximum of 6 ml (two doses) for a patient aged greater than or equal to 12 years.
* Maximum of 3 ml (one dose) for a child aged less than 12 years.

80
Q

common adverse affects of methoxy

A

Common adverse effects
* Sedation.
* Feeling light-headed.

81
Q

onset and duration of methoxy

A

Usual onset of effect
* 1-2 minutes.
Usual duration of effect
* 2-5 minutes after stopping administration.

82
Q

pharomocokinetics of methoxy

A
  • Approximately 20% is exhaled. The remainder is metabolised in the liver.
  • One of the metabolites is fluoride ions. High concentrations of fluoride ions have been associated with renal impairment and this is the reason for known renal impairment being a contraindication and for having a maximum dose.
83
Q

common interactions of methoxy

A
  • The effects will be increased in the presence of other pain relieving medicines or sedatives, for example opiates, benzodiazepines or alcohol.
84
Q

ondansatron mechnism

A

Ondansetron is an antiemetic.
* Ondansetron antagonises (blocks) serotonin receptors centrally in the brain and peripherally in the gastrointestinal tract, resulting in a reduction in nausea and vomiting.

85
Q

ondasatron indication

A

 Clinically significant nausea and/or vomiting.

86
Q

ondans contras and cautions

A

Known severe allergy.
Age less than one year.
nil cautions

87
Q

ondansatron and pregnancy

A
  • Safety has not been demonstrated during pregnancy, but ondansetron may be administered if nausea and/or vomiting is severe.
  • May be administered if the patient is breastfeeding. Advise the patient to stop breastfeeding and seek further advice from their lead maternity carer or GP.
88
Q

ondansatron dose

A

4mg IM if IV cannot be obtained.
Repeat once after 20 mins prn
Undiluted

89
Q

common adverse affects of ondansatron

A
  • Headache.
  • Flushing.
90
Q

onset and duration on ondansatron

A

Usual onset of effect
* IV: 2-5 minutes.
* IM: 5-10 minutes.
Usual duration of effect
* 4-8 hours.

91
Q

ondasatron intercations

A

Ondansetron has been reported to prolong the QT interval, particularly if high doses are administered in conjunction with other medicines that also prolong the QT interval, for example erythromycin. However, one or two doses in this setting is safe.

92
Q

paracetamol mechnism

A
  • Paracetamol inhibits the production of prostaglandins resulting in a reduction in pain and fever.
93
Q

paracetamol indications

A

 Mild or moderate pain, usually in combination with other medicines.
 Paracetamol may be administered in addition to other medicines for severe pain, particularly if the transport time is long. This is not a priority but will reduce the need for subsequent analgesia and improve the quality of pain relief.

94
Q

paracetamol contraindication

A

known severe allergy

95
Q

paracetamol cautions

A

Patient taken paracetamol within last 4 hours
Abdo pain, particularly if pt is unwell or vomiting. (The possibility of significant intra-abdominal pathology exists and oral medicines should usually be withheld)
Known severe liver disease (Liver disease must be severely impaired before paracetamol clearance is altered, but usually withhold)

96
Q

paracetamol dosage

A
  • 1.5 g PO for an adult weighing greater than 80 kg.
  • 1 g PO for an adult weighing 80 kg or less.
  • See the paediatric drug dose tables for a child.
97
Q

onset and duration of paracetamol

A

Usual onset of effect
* 30-60 minutes.
Usual duration of effect
* 4-6 hours.

98
Q

pharmockinetics of paracetamol

A
  • Paracetamol is metabolised in the liver.
  • If liver impairment is severe, paracetamol clearance will be significantly delayed, but this does not affect the initial (loading) dose.
99
Q

prednisone mechnism

A
  • Prednisone is a prodrug that is metabolised to prednisolone in the liver.
  • Prednisolone is a corticosteroid with anti-inflammatory and immunosuppressant actions. It inhibits the production of inflammatory mediators, including prostaglandins and leukotrienes, resulting in a reduction in the inflammatory and immune response.
100
Q

prednisone indications

A

 Bronchospasm associated with asthma or COPD.
 Croup.
 Prominent rash associated with anaphylaxis, provided all systemic signs of anaphylaxis have resolved.
 Minor allergy associated with rash.

101
Q

contraindications and cautions of prednisone

A

Contraindications
Known severe allergy. Cautions
^ Age less than five years with asthma. Steroids do not usually have a role in children aged less than five years because they do not generally alter the course of their asthma exacerbation. However, a steroid is indicated if the child has a clear history of asthma and has previously received oral steroids.

102
Q

dosage of prednisone

A

Dosage
* 40 mg for an adult.
* See the paediatric drug dose tables for a child.

103
Q

if the patient has already taken prednisone:

A

a) Administer an additional full dose if the patient is taking a dose that is lower than that described in these CPGs. If the patient is not transported by ambulance to a medical facility, advise the patient to discontinue their usual prednisone, take the prednisone supplied by ambulance personnel and have their treatment reviewed in primary care (preferably by their own GP) within two days.
b) Do not administer an additional dose if the patient is taking a dose
equal to or higher than that described in these CPGs. If the patient is
not transported by ambulance to a medical facility, advise the patient to continue taking their usual prednisone and have their treatment reviewed by a doctor (preferably their own GP) within two days.

104
Q

common adverse affects of prednisone

A

Fatigue (As it affects hormones such as cortisol (energy) and melatonin (sleepy))
Sodium and water retention (As it alters sodium balance maintained by kidneys, this causes retention)
GI reflux

105
Q

onset and duration of prednisone

A

Usual onset of effect
* 30-60 minutes.
Usual duration of effect
* 24 hours.

106
Q

salbutamol mechnism

A
  • Salbutamol is a bronchodilator. It is an agonist (stimulator) of beta-2 receptors.
107
Q

salbutamol indications

A

 Bronchospasm secondary to asthma or COPD.
 Prominent bronchospasm secondary to airway burns, smoke inhalation or
chest infection.
 Release syndrome following crush injury.

108
Q

contraindications and cautions of salbutamol

A

Contraindications
Known severe allergy. Cautions
^ None.

109
Q

dosage of salbutamol

A
  • 5 mg for adults and children. The initial dose is combined with 0.5 mg ipratropium, but subsequent doses are not.
110
Q

common adverse affects of salbutamol

A
  • Tremor.
  • Tachycardia.
111
Q

onset and duration of salbutamol

A

Usual onset of effect
* 2-5 minutes.
Usual duration of effect
* 1-2 hours.

112
Q

tramadol mechnism

A
  • Tramadol is an analgesic. It has multiple actions within the central nervous system, including opiate receptor stimulation and inhibition of the re-uptake of noradrenaline and serotonin.
113
Q

tramadol indications

A

 Aged greater than or equal to 12 years with moderate to severe pain (usually in combination with paracetamol and/or ibuprofen), particularly if personnel are not available to administer fentanyl and/or ketamine.

114
Q

tramadol contraindications and cautions

A

Contraindications
Known severe allergy
Age less than 12

CAUTIONS
Taken within last 4 hours (Additional can be given if it is clear the total dose within the last 4 hours does not exceed the dose in CPGs)
Abdo pain, particularly if unwell or vomiting (Possibility of significant intra-abdominal pathology exists and oral meds should usually be withheld)
Age greater than 75, particularly if previous history of dementia or confusion (Tramadol has anticholinergic activity and may worsen confusion)
Confusion (Tramadol has anticholinergic activity and may worsen confusion)
Pregnancy

115
Q

tramadol and pregnancy

A
  • Safety has not been demonstrated in pregnancy and tramadol should usually be withheld.
  • May be administered if the patient is breastfeeding. Advise the patient to stop breastfeeding and seek further advice from their lead maternity carer or GP.
116
Q

tramadol dosage

A

50 mg PO.

117
Q

common adverse affects of tramadol

A

Common adverse effects
* Nausea and/or vomiting.
* Feeling light-headed or unusual.
* Sedation.
* Dry mouth.

118
Q

onset and dutration of tramadol

A

Usual onset of effect
* 30-60 minutes.
Usual duration of effect
* 4-8 hours.

119
Q

tramadol common interactions

A

Tramadol has been reported to cause serotonin syndrome in patients taking other medicines or recreational drugs that also raise serotonin levels within the brain. Examples include selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants and Ecstasy. However, this usually only occurs when doses of tramadol higher than 50 mg are taken regularly.

120
Q

under 1 estimate weight

A

5kg

121
Q

age 1-10 weight formula

A

(Age in years + 4) x 2

122
Q

11-14 estimate weight calculation

A

age x 3

123
Q

defib kids calculation

A

4j/kg

124
Q

how to estimate child wight class

A

They are based on rounding the child’s weight up to 5, 10, 20, 30 or 40 kg. For example, a child known or estimated to weigh between 11 and 20 kg receives a dose based on 20 kg, and a child known or estimated to weigh between 31 and 40 kg receives a dose based on 40 kg.

125
Q

Children weighing greater than 40 kg can usually be administered

A

adult doses, but clinical judgement must be used if the dose may be potentially harmful, for example when administering paracetamol. If there is any doubt, a paediatric dose should be administered.

126
Q

10% glucose IV dosage per kg for kids

A

2 ml/kg

127
Q

PEAD IM adrenaline dosage

A

less than 1= 0.05mg
1y/o= 0.1mg
2-5y/0= 0.2mg

128
Q

PEAD ibuprofen dosage

A

less than 1 = 50mg/2.5ml
1y/o= 50mg/2.5ml
2-5y/o= 150mg/7.5ml
6-10y/o= 200mg/ 10ml

129
Q

PEAD ondans dosage

A

1y/o= 1mg/0.5ml
2-5y/o= 2mg
6-10y/o=3mg

130
Q

PEAD paracetamol dosage

A

1y/o= 150mg
2-5y/o=250mg
6-10y/o=375mg

131
Q

REDIPRED DOSAGE

A

1y/o= 5mg
2-5y/o= 10mg/2ml
6-10y/o=20mg/4ml

132
Q

readipred presentation

A

25mg/5ml

133
Q

peads brofen presentation

A

100mg/5ml

134
Q

peads paracetamol presentation

A

250mg/5ml

WFA CPGs (64 decks)

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