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full drug log Flashcards

1
Q

what is adrenaline

A

Adrenaline is a hormone and neurotransmitter, that is released in your bloodstream from the adrenal glands during sympathetic nervous system stimulation (fight or flight)

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2
Q

adrenaline presentation

A

Comes in an ampoule containing 1mg/1ml

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3
Q

adrenaline mechanism of action

A

Adrenaline stimulates alpha and beta receptors, primarily alpha 1, beta 1 and beta 2.

Alpha 1:
Smooth muscle contraction
Vasoconstriction of blood vessels
Stimulation of glycogenolysis (Glycogen → glucose) and gluconeogenesis (Glucose formation from carbs/sources)

Beta 1 causes an increase in:
Inotropy = cardiac contractility
Chronotropy = heart rate
Dromotropy = speed of electrical conduction of heart

Beta 2:
Smooth muscle relaxation
Skeletal muscle vasodilation
Bronchodilation
Stabilisation of mast cell membranes which reduces histamine release

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4
Q

adrenaline indications

A

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

ILS INDICATIONS
all of the above and adrenaline IV for cardiac arrest

OTHER IND
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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5
Q

adrenaline contraindications

A

nil

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6
Q

adrenaline cautions

A

Myocardial ischaemia - increases myocardial oxygen demand
Tachydysrhythmias - worsens this

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7
Q

adrenaline for epistaxis dosage

A

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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8
Q

adrenaline for stridor dosage

A

5mg undiluted

repeat after 10 minutes

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9
Q

adrenaline for asthma/anaphlaxsis

A

0.5 mg every 5-10 minutes as required

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10
Q

adrenaline from cardiac arrest

A

1mg undiluted every 4 minutes

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11
Q

adrenaline adverse effects

A

Hypertension, hyperglycaemia
Ectopy
Sweating
Ischaemia
Tachycardia / tachydysrhythmia
Anxiety
Nausea / vomiting
Tremor

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12
Q

IM onset of adrenaline

A

2-5 minutes

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13
Q

Iv onset of adrenaline

A

5-10 seconds

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14
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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15
Q

amiodarone preparation

A

150mg in 3ml

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16
Q

what is amiodarone

A

class III anti-dysthymic with broad spectrum activity

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17
Q

mechanism of amiodoarone

A

blocks channels in ( predominately potassium) and beta adrenergic receptors;

  • prolonging action potential and refractory period
  • reduction in automatic
  • stabilisation of the nodes
    -and decrease in HR
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18
Q

indications of amiodarone

A

Cardiac arrest with VF or VT at any time after the first dose of adrenaline

ICP
Adults with sustained VT in the absence of cardiac arrest.
Adults with moderate cardiovascular compromise as a result of fast atrial fibrillation or fast atrial flutter.

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19
Q

contraindications of amiodarone

A

Known severe allergy

Known severe allergy to iodine.

VT secondary to cyclic antidepressant poisoning. In this setting amiodarone administration can be associated with severe worsening of shock, without resolution of the rhythm.

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20
Q

cautions of amiodarone

A

NIL IN CARDIAC ARREST

  1. poor perfusion or signs of low cardiac output
  2. hypotension
  3. AF with sepsis
  4. sick sinus syndrome without pacemaker
  5. pervious SSS without internal pacemaker
  6. pregnancy
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21
Q

amiodarone in pregnancy?

A

not unless strong clinical indication

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22
Q

dosage of amiodarone in cardiac arrest

A

300 mg if in VT or VF

150mg if VT or VF persists

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23
Q

adverse effects of amiodarone

A

Hypotension.
Lightheadedness.
Bradydysrhythmia.

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24
Q

onset of amiodarone

A

5-10 minutes

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25
Q

duration of amiodarone

A

1-4 hours after a single dose

slowly realised into tissue, thus more given, longer half life

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26
Q

goal of treatment for amiodarone in AF

A

If the indication is atrial fibrillation causing moderate cardiovascular compromise, the goal of treatment is to control the ventricular rate and not to revert the rhythm to sinus rhythm, although treatment with amiodarone may result in reversion of the rhythm to sinus rhythm. If a patient has been in atrial fibrillation for longer than a few days, there is a small risk that this may be associated with emboli leaving the left atrium. This is why amiodarone is reserved for patients with cardiovascular compromise that is clinically significant.

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27
Q

what to do if patient reverts while amiodarone is being administered

A

If amiodarone is commenced, the full dose should be administered even if the rhythm reverts to sinus rhythm, unless severe hypotension or bradycardia occurs.

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28
Q

ECG changes with amiodarone

A

Amiodarone is often described as relatively contraindicated in the presence of a prolonged QT interval, but this only applies to long-term administration.

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29
Q

aspirin dosage

A

300mg tablets

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30
Q

what is aspirin

A

Also acetylsalicylic acid
→ An antiplatelet medicine which reduces the chance of forming blood clots

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31
Q

aspirin mechanism

A

It has antiplatelet (clot preventing), antipyretic (reduce fever), anti-inflammatory, and analgesic effects, and we use it for its antiplatelet effects
→It inhibits the enzyme cyclooxygenase which reduces the formation of prostaglandins and thromboxane

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32
Q

aspirin indications

A

myocardial ischemia

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33
Q

aspirin contraindications

A

allergy
third trimester of pregnancy

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34
Q

aspirin cautions

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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35
Q

aspirin and pregnancy?

A

no

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36
Q

adverse effects of aspirin

A

increased bleeding

long term indigestion and GI ulceration

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37
Q

onset of aspirin

A

30-60 minutes

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38
Q

duration of aspirin

A

3-5 days

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39
Q

cefazolin preparation

A

1g powder

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40
Q

what is cefazolin

A

first generation cephalosporins

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41
Q

cefazolin mechanism

A

the AB’s binds to the penicillin binding protein
PBP function inhibited, thus cell walls of bacteria not built effectively
due to ineffective cell wall, the cell cannot withstand the osmotic pressure, thus ruptures, killing the bacterias cell

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42
Q

indication of cefazolin

A

Sepsis, where the source of infection appears to be the soft tissues or joint, and:
1.The patient is aged greater than or equal to 12 years, and
2. Has one or more clinical features indicating antibiotics, and
3. Time to hospital is greater than 30 minutes.

Cellulitis. In this setting a single dose may be administered if the patient is not being directly referred (or transported) to a medical facility.

compound fracture including skull fracture
large contaminated wounds
following chest decompression

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43
Q

contraindications of cefazolin

A

allergy to cephalosporins

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44
Q

cautions of cephalosporins

A

nil

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45
Q

pregnancy and ABs?

A

safe and administer if indicated

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46
Q

admin of cefazolin

A

Add approximately 4 ml of 0.9% sodium chloride to a 1 g ampoule and shake until dissolved.
Draw up the ampoule contents and dilute to a total of 10 ml.
Administer IV over 1-2 minutes preferably into a running line.

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47
Q

adverse effects of cefaolin

A

nil

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48
Q

onset of cefazolin

A

30-60

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49
Q

duration of cefazolin

A

6-8 hours

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50
Q

rapid admin of cefazolin can cause

A

pain and phlebitis, which is why it should be preferably administered into a running line.

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51
Q

presentation of ceftriaxone

A

2g powder

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52
Q

what is Ceftriaxone

A

Ceftriaxone is a cephalosporin antibiotic with broad activity against gram-negative and gram-positive bacteria

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53
Q

ceftriaxone mechanism

A

the AB’s binds to the penicillin binding protein
PBP function inhibited, thus cell walls of bacteria not built effectively
due to ineffective cell wall, the cell cannot withstand the osmotic pressure, thus ruptures, killing the bacterial cell

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54
Q

ceftriaxone indications

A

Suspected meningococcal septicaemia.

Sepsis, where cefazolin is not indicated, and:
The patient is aged greater than or equal to 12 years,
One or more clinical features indicating antibiotics are present,
Time to hospital is greater than 30 minutes.

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55
Q

contraindications fo ceftriaxone

A

Anaphylaxis to cephalosporins.

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56
Q

cautions of ceftriaxone

A

nil

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57
Q

adverse effects of ceftriaxone

A

nil

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58
Q

onset of ceftrixone

A

30-60

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59
Q

duration of ceftriaxone

A

24 hours

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60
Q

preparation needed for ceftriaxone in context of meningococcal

A

As meningococcal bacteria die they release endotoxins. The body’s immune response to endotoxins can cause profound worsening of shock following antibiotic administration. Be prepared to treat this with 0.9% sodium chloride IV, and metaraminol or adrenaline IV. It is rare for significant amounts of endotoxins to be released from other bacteria.

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61
Q

droperidol preparation

A

2.5mg/1ml

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62
Q

what is droperidol

A

antipsychotic/ butyrophenone (D2 blocker)

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63
Q

mechanism of droperidol

A

The main actions seem to stem from its potent Dopamine(2) receptor blocker with minor antagonistic effects on alpha-1 adrenergic receptors as well, resulting inresulting in sedation, reduced agitation and a state of mental detachment, and antiemetic action.

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64
Q

indications of droperidol

A

Patients aged greater than or equal to 12 years with acute behavioural disturbance causing a mild to moderate risk to safety, when olanzapine has not been administered or is ineffective.

Moderate to severe pain associated with one of the following, despite opiate analgesia, and ketamine is not appropriate:
Chronic or complex pain.
Chronic use of opiates.
Severe headache.
Severe pain associated with agitation.
Pain associated with severe nausea and/or vomiting.

Management of agitation or pain that does not respond to an opiate during end of life care.
Nausea and/or vomiting that persists despite ondansetron, or where motion sickness is a component of the patient’s nausea and/or vomiting.

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65
Q

droperidol contraindications

A

Known severe allergy.
Aged less than 12 years.
Pregnancy (analgesia and nausea and/or vomiting only).

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66
Q

droperidol cautions

A

Altered level of consciousness. This will increase and prolong the effects.
🔶Parkinson’s disease. There is a risk of worsening the movement disorder associated with Parkinson’s disease.
🔶Concurrent administration of ketamine or midazolam. This will increase and prolong the effects.
🔶Aged greater than or equal to 75 years, particularly if frail. The effects of droperidol will be increased and prolonged in this cohort.
🔶Signs of shock. Droperidol may make shock worse due to its alpha receptor blocking properties

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67
Q

droperidol dose for analgesia

A

1.25 mg IV for an adult, once only. Consider reducing the dose to 0.625 mg IV if a caution is present.

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68
Q

droperidol doseage for ABD

A

10 mg IV or IM.
Consider reducing the dose to 5 mg if a caution is present.
The dose may be repeated once after 20 minutes.
IV: Draw up the required dose into a 10 ml syringe and dilute to a total of 10 ml using 0.9% sodium chloride

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69
Q

droperidol for end of life care dosege

A

2.5 mg IV/IM/SC.
The dose may be repeated as required.

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70
Q

dorperidol dosage and draw up for nausea and vomiting

A

0.625 mg IV/IM for an adult, once only.
Draw up 2.5 mg into a 5 ml syringe and dilute to a total of 4 ml using 0.9% sodium chloride. This gives a 0.625 mg/ml solution.

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71
Q

adverse effects droperidol

A

hypotension (due to Alpha 1 antagonist)

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72
Q

onset of droperidol

A

IV/IM: 5-10 minutes.

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73
Q

duration of droperidol

A

4-6 hours

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74
Q

drug interactions of droperidol

A

Intoxication. Droperidol will have increased sedative effects if the patient is intoxicated with alcohol or has taken recreational drugs.

Sedative drugs. Concurrent administration with other sedative drugs (such as olanzapine or midazolam) will result in an increased sedative effect.

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75
Q

droperidol and QT interval

A

Droperidol has been reported to prolong the QT interval. This generally involved repeated and/or high doses and one or two doses are safe, even if the patient is known to have a prolonged QT interval.

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76
Q

What kind of pain is droperidol used for?

A

Droperidol has a role in reducing pain associated with chronic or complex pain, headache, and pain associated with clinically significant distress, nausea and/or vomiting.

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77
Q

What kind of movements can droperidol cause

A

Droperidol may cause dyskinesia (abnormal, uncoordinated and involuntary movements) but this is unusual following one or two doses.

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78
Q

preparation of fentanyl

A

100mcg/2mls

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79
Q

what is fentanyl

A

opioid receptor stimulation (mu receptors)

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80
Q

fentanyl mechanism

A

binds to opiate receptors (stimulates them) causing analgesia
( fent/morph binds to opioid receptor stimulating G protein, G protein flicks a switch, to stop calcium going into the neuron stopping it from becoming positive, thus inhibiting from sending signals, G protein opens potassium channels, letting positive change out of the cell, further inhibiting signal)

Opioid analgesics are believed to bind to mu receptors, one of three different types of opioid receptors.

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81
Q

fentanyl indications

A

Moderate to severe pain.
Cardiogenic pulmonary oedema with severe anxiety.
Rapid sequence intubation.
Sedation post intubation.
Control of pain, agitation, or shortness of breath during end of life car

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82
Q

fentanyl contrindications

A

known allergy

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83
Q

fentanyl cautions

A
  1. altrerd LOC
  2. Respiratory depression or at high risk of respiratory depression.
  3. signs of shock
  4. Concurrent administration of other opiates, ketamine or midazolam.
  5. labour
  6. Aged greater than or equal to 75 years, particularly if frail.
  7. Aged less than one year.
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84
Q

why is being less than one a caution for opioids

A

(Children under the age of one year are at increased risk of respiratory depression following opiate administration)

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85
Q

why is resp depression a caution for opioids

A

(Such patients may develop respiratory depression following opiate administration because it inhibits the neutrons from firing up the spinal cord into the medulla)

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86
Q

why is labour a caution for opioids

A

(Opiates cross the placenta and may cause drowsiness and/or respiratory depression in the baby, particularly when administered within an hour or two of birth. Discuss administration with the lead maternity carer if possible. Following birth, close observation of the baby is required and personnel must be prepared to treat respiratory depression)

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87
Q

IV dosage for fentanyl

A

IV for analgesia:
10-50 mcg every five minutes for an adult, as required. Use a dose at the lower end of the range if the patient is frail or has signs of shock.

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88
Q

IM fent doseage

A

IM and SC for analgesia if IV access cannot be obtained:
50-100 mcg IM/SC.
Subsequent doses may be administered every 20 minutes up to a total of three doses.
Halve all doses if the patient is frail or has signs of shock.

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89
Q

IV fent for 10kg 1 year old dose

A

2-10 mcg

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90
Q

fent adverse effects

A

Respiratory depression.
Bradycardia.
Hypotension.
Sedation.
Nausea and vomiting.
Itch.
Euphoria.

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91
Q

IV onset of fent

A

IV: 2-5 minutes. The maximal analgesic and respiratory depressant effects may not occur until 10-15 minutes and this may be longer in the elderly.

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92
Q

IM onset of fent

A

IM/SC: 5-10 minutes.

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93
Q

duration of fent

A

30-60 minutes.The effect on respiration may last for several hours.

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94
Q

common interactions of fent

A

The effects will be increased in the presence of other opiates and sedatives, for example, benzodiazepines or alcohol.

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95
Q

GTN presentation

A

0.4 mg sublingual spray

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96
Q

what is GTN

A

a vasodilator

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97
Q

mechanism of GTN

A

→ Acts on vascular smooth muscle, causing venous and arterial vasodilation, predominant effect on veins
→ MOA is not clear but appears that it forms nitric oxide which is a vasodilator

GTN causes:
Reduction in venous return (preload) and peripheral resistance (afterload) which reduces myocardial oxygen demand and blood pressure
Dilation of coronary arteries with increases coronary blood supply

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98
Q

GTN indications

A

Myocardial ischaemia
ACPO
Control of HTN for autonomic dysreflexia
Control of HTN prior to fibrinolysis for STEMI
Control of HTN during inter-hospital transfer for STEMI

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99
Q

GTN contradictions

A

Known severe allergy
SBP less than 100 mmHg
HR less than 40
HR above 150
VT

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100
Q

GTN cautions

A

STEMI, especially RV (
Frail patient
Signs of shock (CO may fall further with GTN)
Dysrhythmia (CO may fall further with GTN)
Phosphodiesterase in the last 24 hours
Known aortic or mitral stenosis (Narrowing of aortic or mitral valves)

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101
Q

GTN admin for myocardial ishcemia

A

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

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102
Q

GTN admin for ACPO

A

ACPO 0.8 mg every 3-5 mins

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103
Q

if GTN is admisntered when a caution is present, Pt should be…..

A

Patient should be lying flat, IV access should be obtained, interval should be 10 mins and be ready to administer fluids if needed

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104
Q

GTN adverse effects

A

Hypotension
Flushing
Headache
Tachycardia
Light-headed

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105
Q

GTN onset

A

1-2 minutes

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106
Q

GTN duration

A

15-30 minutes

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107
Q

glucose sachet indications

A

Hypoglycaemia ( less than 3.5) provided the patient is conscious to be able to swallow safely

Hypoglycaemia in neonates

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108
Q

glucagon indications

A

Hypoglycaemia (<3.5mmol/L) when the patient cannot swallow and IV cannot be obtained

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109
Q

when should IV glucose be admisntered

A

Administer glucose IV if the patient has a significantly altered level of consciousness or cannot swallow safely:

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110
Q

dosage of IV glucose

A

100 ml of 10% glucose IV for an adult.
2 ml/kg of 10% glucose IV for a child.

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111
Q

presentation of ibuprofen

A

200mg tablet

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112
Q

what is ibuprofen

A

NSIAD

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113
Q

ibuprofen mechanism

A

Inhibits activity of prostaglandin synthetase, reducing prostaglandin production which reduces inflammation, pain and fever

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114
Q

ibuprofen indications

A

Mild to moderate pain, usually in combo with paracetamol
Moderate to severe pain, usually in combo with other meds
(Particularly useful for soft tissue pain musculoskeletal pain, and renal colic)

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115
Q

ibuprofen contraindications

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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116
Q

ibuprofen cautions

A

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)

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)

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117
Q

ibuprofen dosage

A

600 mg over 80 kgs
→ 400 mgs over 80 kgs

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118
Q

presentation of paediatric ibuprofen

A

100mg/5 mls

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119
Q

adverse effects of ibuprofen

A

Renal impairment
Increased bleeding
Long term indigestion, GI ulceration and bleeding

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120
Q

onset of ibuprofen

A

30-60

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121
Q

duration of ibuprofen

A

4-6 Horus

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122
Q

presentation of ipatropium bromide

A

0.5 mg in 2mls

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123
Q

what is ipartopium

A

long acting bronchodilator

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124
Q

mechanism of ipatropium

A

→ Anticholinergic agent with antimuscarinic activity (As it acts on muscarinic receptors)
→ It antagonises acetylcholine receptors causing vagal inhibition resulting in bronchodilation
(Bronchoconstriction is driven by parasympathetic stimulation of the vagus nerve, so inhibiting the effects of the vagus nerve reduces this)

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125
Q

indications of ipatropium

A

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

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126
Q

contraindications of ipatropium

A

allergy

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127
Q

cautions of ipatropium

A

nil

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128
Q

adminstration of ipatropium

A

→0.5 mg undiluted nebulised adult and children
→ using oxygen as driving gas for asthma or medical air for COPD
No repeats

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129
Q

adverse effects of ipatropium

A

Tachycardia
Dry mouth
Blurred vision → repeated doses

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130
Q

onset of ipatropium

A

2-5 minutes

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131
Q

duration of ipatropium

A

4-6 hours

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132
Q

ketamine

A
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133
Q

ceftriaxone presentation

A

2g powder for reconstitution

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134
Q

what is ceftriaxone

A

Ceftriaxone is a cephalosporin antibiotic with broad activity against gram-negative and gram-positive bacteria

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135
Q

ceftriaxone mechanism

A

the AB’s binds to the penicillin binding protein
PBP function inhibited, thus cell walls of bacteria not built effectively
due to ineffective cell wall, the cell cannot withstand the osmotic pressure, thus ruptures, killing the bacterial cell

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136
Q

ceftriaxone indication

A

Suspected meningococcal septicaemia.

Sepsis, where cefazolin is not indicated, and:
The patient is aged greater than or equal to 12 years,
One or more clinical features indicating antibiotics are present,
Time to hospital is greater than 30 minutes.

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137
Q

admin of ceftriaxone

A

2 g IV for an adult.

2 g IM for an adult if IV access cannot be immediately obtained (meningoccocal septicaemia only).

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138
Q

adverse effects of ceftriaxone

A

nil

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139
Q

onset of ceftriaxone

A

30-60 minutes

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140
Q

duration of ceftriaxone

A

24 hours

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141
Q

preparation of admisnreting ceftriaxone with maningacoccal

A

As meningococcal bacteria die they release endotoxins. The body’s immune response to endotoxins can cause profound worsening of shock following antibiotic administration. Be prepared to treat this with 0.9% sodium chloride IV, and metaraminol or adrenaline IV. It is rare for significant amounts of endotoxins to be released from other bacteria.

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142
Q
A
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143
Q

droperidol presentation

A

2.5 mg/1ml ampule

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144
Q

what is droperidol

A

antipsychotic/ butyrophenone (D2 blocker)

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145
Q

droperidol mechanism

A

droperidol causes a CNS depression centrally via D2 receptor blocking as well as minor antagonistic effects on alpha-1 adrenergic receptors resulting in a sedative, anti-agitation, antiemetic and mental detachment

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146
Q

droperidol inactions

A

atients aged greater than or equal to 12 years with acute behavioural disturbance causing a mild to moderate risk to safety, when olanzapine has not been administered or is ineffective.

Moderate to severe pain associated with one of the following, despite opiate analgesia, and ketamine is not appropriate:
Chronic or complex pain.
Chronic use of opiates.
Severe headache.
Severe pain associated with agitation.
Pain associated with severe nausea and/or vomiting.

Management of agitation or pain that does not respond to an opiate during end of life care.

Nausea and/or vomiting that persists despite ondansetron, or where motion sickness is a component of the patient’s nausea and/or vomiting.

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147
Q

droperidol contraindications

A

Known severe allergy.
Aged less than 12 years.
Pregnancy (analgesia and nausea and/or vomiting only).

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148
Q

droperdiol cautions

A

🔶 Altered level of consciousness. This will increase and prolong the effects.
🔶Parkinson’s disease. There is a risk of worsening the movement disorder associated with Parkinson’s disease.
🔶Concurrent administration of ketamine or midazolam. This will increase and prolong the effects.
🔶Aged greater than or equal to 75 years, particularly if frail. The effects of droperidol will be increased and prolonged in this cohort.
🔶Signs of shock. Droperidol may make shock worse due to its alpha receptor blocking properties

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149
Q

droperdiol in pregnancy?

A

balance risk v benefit for ABD, do not give for nausea or vomiting

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150
Q

droperidol for analgesia

A

1.25 mg IV for an adult, once only. Consider reducing the dose to 0.625 mg IV if a caution is present.

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151
Q

droperdiol dose for ABD

A

10 mg IV or IM.
Consider reducing the dose to 5 mg if a caution is present.
The dose may be repeated once after 20 minutes.
IV: Draw up the required dose into a 10 ml syringe and dilute to a total of 10 ml using 0.9% sodium chloride

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152
Q

droperidol dose for end of life care

A

2.5 mg IV/IM/SC.
The dose may be repeated as required.

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153
Q

droperidol dose for nausea/vomiting

A

0.625 mg IV/IM for an adult, once only.
Draw up 2.5 mg into a 5 ml syringe and dilute to a total of 4 ml using 0.9% sodium chloride. This gives a 0.625 mg/ml solution.

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154
Q

adverse effects droperidol

A

hypotension (due to Alpha 1 antagonist)

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155
Q

onset of droperidol

A

IV/IM: 5-10 minutes.

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156
Q

duration of droperidol

A

4-6 hours

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157
Q

common interaction of droperidol

A

Intoxication. Droperidol will have increased sedative effects if the patient is intoxicated with alcohol or has taken recreational drugs.

Sedative drugs. Concurrent administration with other sedative drugs (such as olanzapine or midazolam) will result in an increased sedative effect.

158
Q

Droperidol and QT Interval?

A

Droperidol has been reported to prolong the QT interval. This generally involved repeated and/or high doses and one or two doses are safe, even if the patient is known to have a prolonged QT interval.

159
Q

what type of pain is droperidol good for

A

Droperidol has a role in reducing pain associated with chronic or complex pain, headache, and pain associated with clinically significant distress, nausea and/or vomiting.

160
Q

what kind of movements dose droperidol cause

A

Droperidol may cause dyskinesia (abnormal, uncoordinated and involuntary movements) but this is unusual following one or two doses.

161
Q

fentanyl presentation

A

100mcg in 2ml

162
Q

what is fent

A

opioid analgesia

163
Q

mechanism of fentanyl

A

binds to opiate receptors (mu) (stimulates them) causing analgesia
( fent/morph binds to opioid receptor stimulating G protein, G protein flicks a switch, to stop calcium going into the neuron stopping it from becoming positive, thus inhibiting from sending signals, G protein opens potassium channels, letting positive change out of the cell, further inhibiting signal)

164
Q

fentanyl indications

A

Moderate to severe pain.
Cardiogenic pulmonary oedema with severe anxiety.
Rapid sequence intubation.
Sedation post intubation.
Control of pain, agitation, or shortness of breath during end of life car

165
Q

fentanyl contrindications

A

allergy

166
Q

fentanyl cautions

A

Aged less than one year. (Children under the age of one year are at increased risk of respiratory depression following opiate administration)

Respiratory depression or at high risk of respiratory depression. For example, severe COPD, morbid obesity or on home BiPAP. (Such patients may develop respiratory depression following opiate administration because it inhibits the neutrons from firing up the spinal cord into the medulla)

Labour. (Opiates cross the placenta and may cause drowsiness and/or respiratory depression in the baby, particularly when administered within an hour or two of birth. Discuss administration with the lead maternity carer if possible. Following birth, close observation of the baby is required and personnel must be prepared to treat respiratory depression)

Concurrent administration of other opiates, ketamine or midazolam. (This will increase and prolong the effects)

Aged greater than or equal to 75 years, particularly if frail.( The effects of fentanyl will be increased and prolonged in this cohort)

Signs of shock. Fentanyl may make shock worse

167
Q

fent and pregnancy

A

if required give it

168
Q

analgesia IV dose for fent

A

→IV for analgesia:
10-50 mcg every five minutes for an adult, as required. Use a dose at the lower end of the range if the patient is frail or has signs of shock.

169
Q

IM dose for fent

A

50-100 mcg IM/SC.
Subsequent doses may be administered every 20 minutes up to a total of three doses.
Halve all doses if the patient is frail or has signs of shock.

170
Q

fent and morphine doses for severe anxiety in acute cariogenic pulmonary oedema

A

Fentanyl in 10-20 mcg doses IV or morphine in 1-2 mg doses IV may be administered every five minutes as required for severe anxiety.

171
Q

adverse effects of fentanyl

A

Respiratory depression.
Bradycardia.
Hypotension.
Sedation.
Nausea and vomiting.
Itch.
Euphoria.

172
Q

IV fent onset

A

IV: 2-5 minutes. The maximal analgesic and respiratory depressant effects may not occur until 10-15 minutes and this may be longer in the elderly.

173
Q

IM fent onset

A

IM/SC: 5-10 minutes.

174
Q

common interactions of fent

A

The effects will be increased in the presence of other opiates and sedatives, for example, benzodiazepines or alcohol.

175
Q

duration of fentanyl

A

30-60 minutes.The effect on respiration may last for several hours.

176
Q

GTN presentation

A

Bottle each spray is 0.4mg

177
Q

GTN mechanism

A

→ Acts on vascular smooth muscle, causing venous and arterial vasodilation, predominant effect on veins GTN causes:
Reduction in venous return (preload) and peripheral resistance (afterload) which reduces myocardial oxygen demand and blood pressure
Dilation of coronary arteries with increases coronary blood supply

178
Q

GTN indications

A

Myocardial ischaemia
ACPO
Control of HTN for autonomic dysreflexia
Control of HTN prior to fibrinolysis for STEMI
Control of HTN during inter-hospital transfer for STEMI

179
Q

GTN contraindications

A

Known severe allergy
SBP less than 100 mmHg
HR less than 40
HR above 150
VT

180
Q

GTN cautions

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)

181
Q

GTN for MI dosage

A

0.4 mg every 3-5 mins.

182
Q

GTN for ACPO dosage

A

ACPO 0.8 mg every 3-5 mins

183
Q

if administering GTN in the preenceses of a caution…

A

Patient should be lying flat, IV access should be obtained, interval should be 10 mins and be ready to administer fluids if needed

184
Q

GTN adverse effects

A

Hypotension
Flushing
Headache
Tachycardia
Light-headed

185
Q

GTN onset

A

1-2 mins

186
Q

GTN duration

A

15-30 mins

187
Q

glucose gel indications

A

Hypoglycaemia provided the patient is conscious to be able to swallow safely

Hypoglycaemia in neonates

188
Q

adult dose of IV glucose

A

100 ml of 10% glucose IV for an adult.

189
Q

paediatric dose of IV glucose

A

20ml/kg

190
Q

when should glucose be administered IV:

A

Administer glucose IV if the patient has a significantly altered level of consciousness or cannot swallow safely:

191
Q

indication of glucagon

A

Hypoglycaemia (<3.5mmol/L) when the patient cannot swallow and IV cannot be obtained

192
Q

mechanism of glucagon

A

Increases the blood glucose level by stimulating glycogenolysis (breakdown of glycogen in the liver to glucose) predominantly in the liver

193
Q

Conditions where stored glycogen may be depleted, making glucagon ineffective

A

Does not have diabetes
Sepsis
Young child
Strenuous exercise
Not eaten for more than 12 hours
Adrenal insufficiency
Chronic hypoglycemia
Alcohol-induced hypoglycaemia

194
Q

following glucagon administration what needs to be done

A

Following glucagon administration the patient’s glycogen stores will be depleted. For this reason it is important the patient eats food such as complex carbs

195
Q

ibuprofen presentation

A

200mg tablets

196
Q

what is ibuprofen

A

NSAID

197
Q

ibuprofen indications

A

Mild to moderate pain, usually in combo with paracetamol
Moderate to severe pain, usually in combo with other meds
(Particularly useful for soft tissue pain musculoskeletal pain, and renal colic)

198
Q

ibuprofen contraindications

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

199
Q

ibuprofen cautions

A

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)

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)

200
Q

ibuprofen dosage

A

→ 600 mg over 80 kgs
→ 400 mgs over 80 kg

201
Q

paediatric ibuprofen presentation

A

100mg/5 mls

202
Q

ibuprofen onset

A

30-60 mins

203
Q

ibuprofen duration

A

4-6 hours

204
Q

ipatropium presentation

A

→ 500mcg (0.5mg) in 2 mls

205
Q

what is ipatropium

A

→ Bronchodilator
→ Stops the air passages from closing

206
Q

ipatropium mechanism

A

→ Anticholinergic agent with antimuscarinic activity (As it acts on muscarinic receptors)

→ It antagonises acetylcholine receptors causing vagal inhibition resulting in bronchodilation
(Bronchoconstriction is driven by parasympathetic stimulation of the vagus nerve, so inhibiting the effects of the vagus nerve reduces this)

207
Q

ipatropium indications

A

Bronchospasm secondary to asthma or COPD

Prominent bronchospasm to airway burns, smoke inhalation or chest infection

208
Q

ipatropium contridicaitons

A

allergy

209
Q

iptropium cautions

A

nil

210
Q

dosage of ipatropium

A

→0.5 mg undiluted nebulised adult and children
→ using oxygen as driving gas for asthma or medical air for COPD
No repeats

211
Q

ipatropium and pregnancy?

A

give if needed

212
Q

adverse effects of ipatropium

A

Tachycardia
Dry mouth
Blurred vision → repeated doses

213
Q

onset and duration of ipatropium

A

Onset
2-5 mins

Duration
6 hours

214
Q

ketamine présentation

A

Ampoule containing 200 mg in 2 ml.

215
Q

what is ketamine

A

Dissociative anaesthetic

216
Q

ketamine mechanism

A

Ketamine has complex actions but is predominantly an N-methyl-d-aspartate (NMDA a receptor on glutamate ) receptor antagonist (blocker), resulting in inhibition of excitatory neurotransmitters in the brain.
Low doses cause analgesia, larger doses cause amnesia and dissociation, and high doses cause anaesthesia.

glutamate is an excitetory neurotransmitter NMDA sits on

217
Q

ILS ketamine indication

A

Severe pain that has not been adequately controlled with an opiate.

218
Q

ICP ketamine inductions

A

inducing dissociation.

Acute behavioural disturbance causing a severe to immediately life-threatening risk to safety.

Rapid sequence intubation (RSI).

Significant movement during CPR that is interfering with resuscitation.

Asthma with severe agitation that is impairing the ability to safely provide treatment or transport.

219
Q

ketamine contraindications

A

Allergy
Less than one

220
Q

ketamine cautions

A

Altered level of consciousness. Ketamine may reduce the level of consciousness.

Signs of shock. Ketamine may make shock worse.

Current myocardial ischaemia. Ketamine may increase myocardial oxygen demand.

Concurrent administration of opiates or midazolam. This will increase and prolong the effects.

Aged greater than or equal to 75 years, particularly if frail. The effects of ketamine will be increased and prolonged in this cohort

221
Q

ketamine IV dosage for analgesia

A

IV:0.25 mg/kg IV up to a maximum of 25 mg for an adult, administered over approximately 15 minutes. Repeat as required.

222
Q

steps to draw up ketamine

A

Draw up 100mg/1lm ketamine into 1 mL syringe
Decant dose into 100ml glucose bag,so 100mg/100mls
Draw out dose
Give slowly over 15 mins

223
Q

ketamine adverse effects

A

Transient hypertension.
Tachycardia.
Apnoea.
Nausea and vomiting.
Sedation.
Hallucinations.

224
Q

IV ketamine dosage

A

IV: 1-2 minutes

225
Q

duration of ketamine

A

10-60 minutes.

226
Q

what should be done prior to ketamine admin

A

Prior to administering ketamine for pain, sufficient opiates should be administered so that further doses are not providing additional analgesia. This will usually require 150-200 mcg of fentanyl or 15-20 mg of morphine for an adult.

227
Q

management of hallucinations post ketamine admistertion

A

Do not treat hallucinations routinely with midazolam because the combination of midazolam and ketamine is commonly associated with a reduced level of consciousness, particularly if an opiate has also been administered. Most hallucinations will settle with a combination of explanation and time. However, midazolam in low doses may be administered IV if the hallucinations are severe provided the patient is obeying commands and physiologically stable.

228
Q

how to calculate dosage of ketamine

A

Round the patient’s weight up to the nearest 10 kg when calculating doses.

229
Q

lignocaine presentation

A

Ampoule containing 50 mg in 5 ml.

230
Q

what is lignocaine

A

local anaesthetic

231
Q

lignocaine mechanism

A

Lignocaine blocks the initiation and transmission of nerve impulses by blocking the movement of sodium ions across the nerve cell membrane.

232
Q

lignocaine inductions

A

Subcutaneous injection for prophylaxis of pain associated with IV cannulation.

Subcutaneous injection for digital ring blocks for analgesia when transport time is less than 60 minutes or ropivacaine is not available.

Intraosseous injection for significant bone pain associated with intraosseous administration.

233
Q

contraindications of lignocaine

A

Known severe allergy
Local infection in the area of injection.

234
Q

cautions of lignocaine

A

Taking an anticoagulant (ring block)

235
Q

lignocaine and pregnancy?

A

safe, administer if indicated

236
Q

lignocaine dose for ring block

A

administer approximately 1-2 ml of 1% lignocaine into the tissue on either side of the web space of the digit.

237
Q

lignocaine max dose

A

The maximum subcutaneous dose for an adult is 200 mg (20 ml of 1% lignocaine). The subcutaneous dose may be repeated once after 30 minutes

238
Q

IO lignocaine admin and dose

A

50 mg (5 ml of 1% lignocaine) for an adult.
The intraosseous dose may be repeated once after 15 minutes
administer slowly over 1-2 minutes and wait one further minute before infusing fluid. This is intended to limit the amount of lignocaine flushed into the circulation.

239
Q

lignocaine adverse effects

A

stinging at site

240
Q

onset of lignocaine

A

1-2 minutes for IV cannulation.
5-10 minutes for digital ring blocks.

241
Q

duration of lignocaine

A

30-60 mins

242
Q

lignocaine overdose presentation

A

Tingling around the mouth.
Seizures.
Dysrhythmias, particularly bradydysrhythmias.
Hypotension.
Cardiac arrest.

243
Q

doses causing ligncoine overdose

A

Overdose of lignocaine when administered subcutaneously is very rare, but can occur if doses exceed 3 mg/kg or more than 1 mg/kg is inadvertently administered IV. If this occurs the following may develop:

244
Q

levetiracetam presentation

A

500mg in 5 mls

245
Q

levetiracetam mechanism

A

Levetiracetam is an anticonvulsant. It is thought to inhibit seizure activity by blocking some calcium channels and also binding synaptic proteins to modulate neurotransmitter release.

246
Q

what is levetiracetam

A

anticonvulsant

247
Q

indication of levetiracetam

A

Seizure that continues or recurs after two doses of parenteral midazolam.

Seizure activity associated with TBI even if seizure activity has ceased post midazolam

248
Q

levetiracetam contradictions

A

KDA

249
Q

levetiracetam cautions

A

nil

250
Q

levetiracetam and pregnancy?

A

safe and should be administered if indicated

251
Q

levetiracetam dosage and admin

A

2g IV (20mls) diluted with 20-40 mls of saline, given over running line

252
Q

adverse effects of levetiracetam

A

nil

253
Q

onset of levetiracetam

A

10 minutes

254
Q

duration of levetracitam

A

6-8 hours

255
Q

loratadine presentation

A

10mg tablets

256
Q

what is loratadine

A

non-sedative antihistamine

257
Q

loratadine mechanism

A

Antagonises peripheral histamine receptors, blocking histamine and reducing itchiness/redness

258
Q

loratadine indications

A

Minor allergic reaction confined to skin involvement

Prominent itch associated with anaphylaxis, provided all systemic signs have resolved

259
Q

loratadine contraindications

A

Known severe allergy

Age less than 1 year

260
Q

loratadine cautions

A

pregnancy

261
Q

dosage of loratadine

A

→20 mg aged greater than 12
→ 10 mg aged 1-11

262
Q

adverse effects of loratadine

A

nil

263
Q

onset of loratadine

A

30-60 mins

264
Q

duration of loratadine

A

12-24 hours

265
Q

methoxy presentation

A

3mls

266
Q

methoxy indication

A

Moderate to severe pain, especially when there is a delay in opiate admin

267
Q

methoxy contradictions

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)

268
Q

methoxy cautions

A

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

269
Q

dose of methoxy

A

→6 mls for patients aged above 12
→ 3 mls child aged less than 12

270
Q

side effects of methoxy

A

Sedation
Light headed

271
Q

metoprolol presentation

A

50mg tablets

272
Q

what is metoprolol

A

beta blocker

273
Q

metoprolol mechanism

A

Metoprolol is an immediate release beta blocker. It antagonises (blocks) beta-1 receptors in the heart, causing a decrease in heart rate, cardiac output and blood pressure.

274
Q

metoprolol indications

A

Adults with mild or no cardiovascular compromise as a result of fast atrial fibrillation or atrial flutter.

Adults with moderate cardiovascular compromise as a result of fast atrial fibrillation or atrial flutter, if amiodarone is not available or is contraindicated

275
Q

metoprolol contraindications

A

Known severe allergy.

Hypotension. Metoprolol will further reduce the blood pressure

276
Q

metoprolol cautions

A

First degree heart block. Metoprolol may cause bradycardia.

Known sick sinus syndrome without an internal pacemaker in place. Metoprolol may cause bradycardia.

Previous second or third degree heart block without an internal pacemaker in place. Metoprolol may cause worsening of heart block and bradycardia.

Asthma or COPD. Metoprolol may cause bronchospasm and should usually be withheld if the patient regularly takes bronchodilators.

Heart failure. Metoprolol will reduce cardiac output and may make heart failure worse.

Pregnancy.

277
Q

metoprolol and pregnancy

A

seek clinical advise

278
Q

onset of metoprolol

A

10-20 mins

279
Q

duration of metoprolol

A

4-6 hours

280
Q

common interactions of metoprolol

A

The blood pressure effect will be potentiated by other medicines that lower blood pressure. For example, GTN, antihypertensive medicines and amiodarone.
The heart rate effects will be potentiated by other medicines that lower the heart rate. For example, amiodarone and centrally acting calcium channel blockers such as diltiazem.

281
Q

should metoprolol be used if pt already beta blocked

A

Patients with chronic or paroxysmal atrial fibrillation/atrial flutter may be prescribed a beta blocker. Personnel should still administer metoprolol as indicated, even if the patient has taken their own beta blocker

282
Q

midazolam preperation

A

→ 15mg/3mls

283
Q

what is midazolam

A

benzodiazepine

284
Q

mechanism of midazolam

A

GABA( an inhibitory neuron) binds to a receptor under the influence by midaz
receptors response more prominent, thus more chloride flows into the cell
cells much less likely to fire, thus reduces dysregulated firing

285
Q

indications of Midazolam

A

ILS
Generalised seizures that continue for more than five minutes, or seizures are recurrent.

Acute behavioural disturbance causing a mild to moderate risk to safety and droperidol is unavailable or ineffective.

ICP
Pain associated with severe muscle spasm or severe anxiety if adequate analgesia is not being achieved with an opiate and ketamine is not appropriate.

Sedation, for example, for joint relocation.

Sedation post intubation.

Severe anxiety associated with COPD.

Control of anxiety or shortness of breath that does not respond to an opiate during end of life care.

286
Q

midazolam contridication

A

Known severe allergy
Aged less than 12 years (analgesia only).

287
Q

midaz cautions

A

Altered level of consciousness. Midazolam will further reduce the level of consciousness.

Respiratory depression or at high risk of respiratory depression. For example, severe COPD, morbid obesity or on home BiPAP. Such patients may develop respiratory depression following midazolam administration.

Signs of shock. Midazolam may worsen shock.

Concurrent administration of opiates or ketamine.
This will increase and prolong the effects.

Aged greater than or equal to 75 years, particularly if frail. The effects of midazolam will be increased and prolonged in this cohort

288
Q

pregnancy and Midazolam

A

Yes, if indicated (safety not proven)

289
Q

IV midaz for seizure dosage

A

→Administer midazolam IV:
a) 5 mg of midazolam IV for an adult. Reduce the dose to 3 mg if the patient is frail.
c) This may be repeated once after five minutes.

290
Q

IM midaz for seizure dosage

A

) 10 mg of midazolam IM for an adult. Reduce the dose to 5 mg if the patient is frail.
c) This may be repeated once after ten minutes

291
Q

paediatric dose of midaz

A

10 kg / 1 year old

Midazolam IM (seizures)
2 mg
0.4 ml (undiluted)

292
Q

IV midaz for ABD dose

A

IV 2-3mg in 5 minute intervals

293
Q

IM midazolam of ABD dose

A

10mg IM, 20 minutes intervals

294
Q

adverse effects of midazolam

A

Sedation.
Respiratory depression.
Hypotension.
Amnesia.

295
Q

onset of midazolam

A

IV: 2-3 minutes.
IM: 3-5 minutes

296
Q

duration of midaz

A

30-60 minutes. The sedative effect may be longer, particularly in the elderly.

297
Q

morphine presentation

A

Ampoule containing 10 mg in 1 ml.

298
Q

what is morphine

A

opioid analgesic

299
Q

morphine MOA

A

binds to opiate receptors (stimulates them) causing analgesia
( fent/morph binds to opioid receptor stimulating G protein, G protein flicks a switch, to stop calcium going into the cell stopping it from becoming positive, thus inhibiting from sending signals, G protein opens potassium channels, letting positive change out of the cell, further inhibiting signal)

300
Q

morphine indications

A

Moderate to severe pain.

Cardiogenic pulmonary oedema with severe anxiety.

Control of pain, agitation, or shortness of breath during end of life care.

301
Q

morphine contriadicaitons

A

Known severe allergy
Renal failure on ant dialysis

302
Q

morphine cautions

A

Altered level of consciousness. Morphine may further reduce the level of consciousness.

Aged less than one year. Children under the age of one year are at increased risk of respiratory depression following opiate administration.

Respiratory depression or at high risk of respiratory depression.

Labour. Opiates cross the placenta and may cause drowsiness and/or respiratory depression in the baby, particularly when administered within an hour or two of birth. \

Concurrent administration of other opiates, ketamine or midazolam. This will increase and prolong the effects.\

Aged greater than or equal to 75 years, particularly if frail. The effects of morphine will be increased and prolonged in this cohort.

Signs of shock. Morphine may worsen shock.

303
Q

morphine and pregnancy

A

give if needed

304
Q

IV morphine dosage analgesia

A

IV for analgesia:
1-5 mg every five minutes for an adult as required. Use a dose at the lower end of the range if the patient is frail or has signs of shock.

305
Q

IV morphine for ACPO dosage

A

IV or morphine in 1-2 mg doses IV may be administered every five minutes as required for severe anxiety.

306
Q

IM morphine dosage

A

5-10 mg IM/SC.
Subsequent doses may be administered every 20 minutes up to a total of three doses.
Halve all doses if the patient is frail or has signs of shock.

307
Q

morphine side effects

A

Respiratory depression.
Hypotension.
Sedation.
Nausea and vomiting.
Histamine release and itch.

308
Q

IV onset morphine

A

IV: 2-5 minutes. The maximal analgesic and respiratory depressant effects may not occur until 10-15 minutes and this may be longer in the elderly.

309
Q

IM onset of morphine

A

IM/SC: 5-10 minutes.

310
Q

duration of morphine

A

30-60 minutes.The effect on respiration may last for several hours, particularly in the elderly.

311
Q

Morphine is usually the preferred opiate if

A

the patient requires analgesia for a longer period of time, or the patient is receiving end of life care.

312
Q

naloxone presentation

A

Ampoule containing 0.4 mg in 1 ml.

313
Q

what is naloxone

A

opiate receptor antagonist (blocker)

314
Q

naloxone mechanism

A

Naloxone is an opiate receptor antagonist (blocker). By blocking opiate receptors, naloxone reverses the effects of opiates, particularly respiratory depression and sedation.

315
Q

naloxone indications

A

Opiate poisoning is suspected and the patient has a significantly impaired level of consciousness or significantly impaired breathing.

Excess adverse effects from administration of opiates.

316
Q

naloxone contradictions

A

KSA

317
Q

naloxone cautions

A

Chronic opiate use. If the patient is taking an opiate chronically, there is a risk of adverse physiological effects associated with rapid opiate withdrawal.

318
Q

naloxone and pregnancy

A

safety not proven but give if indicated

319
Q

dosage of naloxone

A

→0.1-0.4 mg IV every five minutes as required for an adult.
0.8 mg IM as required for an adult. This may be repeated every 10 minutes.

320
Q

how to draw up naloxone

A

IV: dilute 0.4 mg to a total of 4 ml. This final solution contains 0.1 mg/ml.
Administer the minimum dose required to produce improvement. Rapid reversal of opiates may be associated with seizures, hypertension, pulmonary oedema or severe agitation, particularly if the patient takes opiates regularly.

321
Q

naloxone adverse effects

A

Sweating.
Tachycardia.
Hypertension.

322
Q

IM AND IV onset of naloxone

A

IV: 1-2 minutes.
IM: 5-10 minutes.

323
Q

duration of nalaxone

A

30-60 minutes.
The duration of action of naloxone may be shorter than the duration of action of the opiate that has been administered/taken and naloxone may need to be repeated.

324
Q

role of nolaxone in cardiac arrest

A

There is no role for naloxone in the treatment of cardiac arrest associated with opiate poisoning. In this setting cardiac arrest is secondary to respiratory arrest and once cardiac arrest has occurred naloxone has no useful effect. The best treatment is CPR that includes a focus on ventilation. If ROSC occurs, naloxone should still not be administered because it may be associated with seizures, hypertension, pulmonary oedema or severe agitation.

325
Q

oxygen admin in nalaxone

A

There is no evidence to support the commonly held view that adequate oxygenation prior to naloxone administration reduces the severity of agitation following naloxone administration. However, treatment of severe hypoxia takes precedence over the administration of naloxone.

326
Q

withdrawals and agitation in naloxone

A

Acute opiate withdrawal following naloxone administration can lead to patient agitation and/or aggression, particularly when there has also been a period of hypoxia. Ensure a planned team approach to maintain safety of both the patient and personnel.

327
Q

olanzapine presentation

A

5mg PO

328
Q

what is olanzapine

A

atypical antipsychotic (2nd generation)

329
Q

olanzapine mechanism

A

Olanzapine has actions at multiple receptors within the brain, such as inhibiting dopamine and serotonin receptors, causing a reduction in agitation, sedation, anti-anxiety and stabilisation of mood

330
Q

olanzapine indications

A

Patients aged greater than or equal to 12 years with acute behavioural disturbance causing a mild to moderate risk to safety, when the patient will take an oral medicine

331
Q

olanzapine contradictions

A

Known severe allergy.
Poisoning with an antipsychotic, for example quetiapine, risperidone or olanzapine.

332
Q

olanzapine cautions

A

Pregnancy.

Intoxication. This will increase and prolong the effects.

Aged greater than or equal to 75 years, particularly if frail. The effects of olanzapine will be increased and prolonged in this cohort.

333
Q

olanzapine dosage

A

10 mg PO.
Consider reducing the dose to 5 mg PO if a caution is present.
The dose may be repeated once after 20 minutes.

334
Q

olazapine adverse effects

A

sedation

335
Q

olanzpine onset

A

10-20 minutes

336
Q

olanzpaine duration

A

12-24 hours

337
Q

olanzapine common interactions

A

Intoxication. Olanzapine will have increased and prolonged effects if the patient is intoxicated with alcohol or has taken recreational drugs.

Sedative drugs. Concurrent administration with other sedative drugs (such as midazolam or droperidol) will result in an increased and prolonged effect.

338
Q

preparation of ondansetron

A

→ 4 mg in 2 mls

339
Q

what is ondansetron

A

antiemetic

340
Q

ondansetron mechanism

A

Antagonises serotonin receptors centrally in the brain and peripherally in the GI tract, reducing nausea and vomiting
(Serotonin receptors can effect nausea, and when in the GI tract can induce vomiting)

341
Q

contradictions of ondansetron

A

Known severe allergy
Age less than 1 year

342
Q

oxytocin preparation

A

10 units

343
Q

what is oxytocin

A

→ Oxytocin is a synthetic version of the naturally occurring hormone oxytocin which is normally released from the pituitary gland.

344
Q

oxytocin mechanism

A

→ Oxytocin stimulates oxytocin receptors on the uterus, causing an influx of calcium, triggering a positive feedback loop strengthening the contraction of the uterus and stimulating the production of endogenous oxytocin, increasing contraction and reducing the risk of PPH.

345
Q

oxytocin indications

A

Following normal birth
Postpartum haemorrhage

346
Q

oxytocin contraidcations

A

allergy

347
Q

oxytocin cautions

A

nil

348
Q

oxytocin for normal birth

A

Administer IM undiluted. The preferred site is the lateral thigh as this has the best absorption. If this site is not suitable use the lateral upper arm.

349
Q

oxytocin for PPH

A

If oxytocin has already been administered as part of routine treatment following normal birth, an additional 10 units of oxytocin should be administered (in the other thigh) if postpartum haemorrhage develops. This may require meeting another vehicle.

350
Q

adverse effects of oxytocin

A

Abdominal cramping.
Tachycardia.
Flushing.

351
Q

onset of oxytocin

A

5-10 minutes

352
Q

duration of oxytocin

A

30-60 mites

353
Q

oxytocin and QT interval

A

Oxytocin has been reported to cause prolongation of the QT interval if the patient is taking other medicines that also prolong the QT interval. However, this is usually associated with prolonged IV infusions and is not a clinically significant consideration when administering one or two IM doses.

354
Q

when would oxytocin be administered IV

A

Oxytocin must not be administered IV unless instructed to do so by a lead maternity carer or a doctor via the Clinical Desk.

355
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)

356
Q

mechanism of prednisone

A

→ Corticosteroid with anti-inflammatory and immunosuppressive actions.
→ Inhibits production of inflammatory mediators, prostaglandins and leukotrienes, reducing inflammatory and immune response.

357
Q

indication of prednisone

A

Bronchospasm associated with asthma or COPD
Croup
Minor allergy associated with rash

358
Q

prednisone cautions

A

Age less than 5 with asthma (Steroids do not usually have a role as they do not generally alter the course of their asthma exacerbation)

359
Q

Ticagrelor presentation

A

90 mg PO tablet

360
Q

what is ticagrelor

A

antiplatlet

361
Q

ticagrelor mech

A

Ticagrelor has antiplatelet activity. It produces reversible inhibition of the ADP receptor on platelets, decreasing platelet aggregation.

362
Q

ticagrelor indications

A

STEMI, in conjunction with the primary PCI pathway, when requested by the accepting clinician.

363
Q

ticagrelor contraidications

A

Known severe allergy

364
Q

ticegralor cautions

A

Clinically significant bleeding. Ticagrelor will increase bleeding.
At risk of bleeding.
Pregnancy.

365
Q

Ticagrelor and pregnancy?

A

not proven, seek clinical advise

366
Q

ticagrelor doseage

A

180mg PO for an adult

367
Q

Ticagrelor side effects

A

Increased bleeding

368
Q

ticagrelor onset

A

30-60 minutes

369
Q

ticagrelor duration

A

24 hours

370
Q

Why do we want to inhibit ADP in the context of a STEMI?

A

ADP catalyses the aggregation of platelets, thus increasing the size of the thrombus. As platelets accumulate, they release chemicals that in turn attract more platelets in a positive feedback loop. thus, inhibiting ADP, inhibits this feedback loop.

371
Q

tramadol presentation

A

50mg tablets

372
Q

what is tramadol

A

analgesic

373
Q

tramadol mechanism

A

→ Multiple actions in central nervous system, including opiate receptor stimulation and inhibition of the reuptake of noradrenaline and serotonin

374
Q

tramadol indications

A

Moderate to severe pain, particularly if an opiate / ketamine is not going to be administered

375
Q

tramadol contraindications

A

Known severe allergy
Age less than 12

376
Q

tramadol cautions

A

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

377
Q

tramadol side effects

A

Nausea or vomiting
Light headed or unusual
Sedation
Dry mouth

378
Q

TXA presentation

A

10 ml ampoule containing 1 g OR 5 ml ampoule containing 500 mg.

379
Q

what is TXA

A

→Tranexamic acid is an antifibrinolytic medicine

380
Q

TXA mechanism

A

→ It blocks the conversion of plasminogen to plasmin, reducing fibrinolysis (breakdown of blood clots) and bleeding.

381
Q

TXA indications

A

Postpartum haemorrhage.

Clinically significant bleeding or signs of hypovolaemia following trauma. Non-traumatic bleeding and shock is severe.

Cardiac arrest secondary to trauma.

Bleeding following tonsillectomy.

Crush injury.

382
Q

TXA contraindications

A

Known severe allergy
Trauma when tranexamic acid will be administered more than three hours after the time of injury.

383
Q

TXA cautions

A

nil

384
Q

TXA and pregnancy

A

safety not proven, given if needed

385
Q

dose of TXA for adult cardiac arrest secondary to trauma, bleeding from trauma & crush injury

A

2 g IV for an adult cardiac arrest secondary to trauma, bleeding from trauma & crush injury

386
Q

TXA for non traumatic bleeds

A

1g non traumatic bleeding

387
Q

TXA tonsillectomy bleed dosage

A

500mg nebulised and 1g IV for tonsillectomy bleeding

388
Q

TXA adverse effects

A

nil

389
Q

TXA onset

A

30-60 mins

390
Q

TXA duration

A

8 hours

391
Q

THROMBOLYTICCS

A

para drugs (3 decks)

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