Gastrointestinal

Question 1

Indications of Activated Charcoal? What is paracetamol overdose?

Answer 1

Acute oral poisoning/drug overdose.
Acute overdose defined as >4 g, or >75 mg/kg, in <1 hour.

Question 1

Contra-indications of Activated Charcoal?

Answer 1

<1 year.
>1 hour since ingestion.
Vomiting.
Reduced GI motility, with risk of obstruction.
Poisoning from cyanide, petroleum distillates, metal salts, ethanol, methanol, ethylene glycol, other mineral acid, or corrosive substances.

Question 2

Cautions for Activated Charcoal?

Answer 2

Risks of aspiration, ensure patient can swallow (decreased alertness).
Shake bottle before administration.

Question 3

Side effects of Activated Charcoal?

Answer 3

Black stools, intestinal obstruction, bezoar (ball of material) formation.

Question 4

Dose of Activated Charcoal?

Answer 4

Adults, 12+ = 50 g, 250 ml.
Children 1-11 = 25 g, 125 ml.

Question 5

Indications of Glucagon?

Answer 5

Hypoglycaemia.
Unconsciousness where hypoglycaemia is likely (BM <4.0)
Oral glucose not possible, and IV access not possible.

Question 6

Actions of Glucagon and Cautions for it?

Answer 6

Glucagon is a hormone converts glycocen to glucose in the liver.
Therefore low glycogen stores (recent glucagon use or starvation) mean glucagon may be ineffective.

Question 7

Side effects of Glucagon?

Answer 7

Nausea vomiting.
Abdominal pain in adults.
Diarrhoea in children.
Hypokalaemia.
Hypotension in adults.

Question 8

Dose of Glucagon?

Answer 8

1 mg in 1 vial.
If no response within 10 minutes, administer IV glucose.

Question 9

Indications for Glucose 10%?

Answer 9

Hypoglycaemia where oral administration is not possible.
Unconsciousness, where hypoglycaemia is likely cause.
No response to Glucagon after 10 minutes.

Question 10

Cautions for Glucose 10%?

Answer 10

Flush IV thoroughly to reduce vein irritation from residual glucose.

Question 11

Dose of Glucose 10%?

Answer 11

10 g in 100 ml, repeated after 5 minutes, to a max of 30 g or 300 ml.

Question 12

Indications for Glucose 40%?

Answer 12

Known/suspected hypoglycaemia in a conscious patient, with no risk of choking/aspiration.

Question 13

Cautions for Glucose 40%?

Answer 13

Risk of choking or aspiration. Can soak a swab and place between patients lip and gum.

Question 14

Indications for Metoclopramide?

Answer 14

Treatment of nausea/vomiting in adults 18+.
Prevention/treatment of nausea/vomiting after Morphine.

Question 15

Actions of Metoclopramide?

Answer 15

Anti-emetic, acts centrally as well as on GI tract.

Question 16

Contra-indications for Metoclopramide?

Answer 16

<18 years.
Renal failure.
Phaeochromocytoma (vascular tumor of adrenal medulla).
GI obstruction.
Perforation/haemorrhage/3-4 days after GI surgery.
Drug overdose.

Question 17

Side effects of Metoclopramide?

Answer 17

Drowsiness, restlessness.
Cardiac conduction abnormalities after IV.
Diarrhoea.
Rash.

Question 18

Dose of Metoclopramide? Route?

Answer 18

10 mg in 2ml. Only one dose.
IM or slow IV injection.

Question 19

Indications for Ondansetron?

Answer 19

Prevention/treatment of opiate-induced nausea/vomiting.
Treatment of nausea/vomiting.
Travel-associated nausea/vomiting in children.

Question 20

Actions of Ondansetron?

Answer 20

Anti-emetic. Blocks 5HT receptors centrally and in the GI tract.

Question 21

Contra-indications of Ondansetron?

Answer 21

Known sensitivity.
Infants <1 month.
Congenital long QT syndrome.

Question 22

Cautions of Ondansetron?

Answer 22

QT interval prolongation (avoid administration of drugs that prolong QT).
Hepatic impairment.
Pregnancy.
Breastfeeding.

Question 23

Side effects of Ondansetron?

Answer 23

Hiccups.
Constipation.
Flushing.
Hypotension.
Chest pain.
Arrhythmias.
Bradycardia.
Headache.
Seizures.
Movement disorders.
Injection site reactions.

Question 24

Dose of Ondansetron?

Answer 24

4 mg in 2 ml, repeated after 30 minutes. Max dose 8 mg.