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HFB2117 - Clinical Practice 3 > HFB2117 Pharmacology - All drug sheets > Flashcards

HFB2117 Pharmacology - All drug sheets Flashcards

1
Q

Adrenaline - Presentation

A

1 mg in 1 mL glass ampoule (1:1000)

1 mg in 10 mL glass ampoule (1:10,000)

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2
Q

Adrenaline - Pharmacology

A

A naturally occurring alpha and beta-adrenergic stimulant

Actions:

  • Increases HR by increasing SA node firing rate (Beta1)
  • Increases conduction velocity through AV node (Beta1)
  • Increases myocardial contractility (Beta 1)
  • Increases the irritability of the ventricles (Beta 1)
  • Causes bronchodilatation (Beta 2)
  • Causes Peripheral vasoconstriction (Alpha)
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3
Q

Adrenaline - Metabolism

A

By monoamine oxidase and other enzymes in the blood, liver and around nerve endings; excreted by kidneys

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4
Q

Adrenaline - Primary emergency indications

A
  1. Cardiac arrest - VF/VT, Asystole or PEA
  2. Inadequate perfusion (cardiogenic or non-cariogenic/non-hypovolaemic)
  3. Bradycardia with poor perfusion
  4. Anaphylaxis
  5. Severe asthma - imminent life threat not responding to nebuliser therapy, or unconscious with no BP
  6. Croup
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5
Q

Adrenaline - Contraindications

A
  1. Hypovolaemic shock without adequate fluid replacement
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6
Q

Adrenaline - Precautions

A

Consider reduced dose for:

  1. Elderly/frail Pt
  2. Pt with cardiovascular disease
  3. Pt on monoamine oxidase inhibitors
  4. Higher doses may be considered for Pts on beta blockers
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7
Q

Adrenaline - Route of administration

A

IV

IM

Nebulised

IV infusion

IO

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8
Q

Adrenaline - Side effects

A

Sinus tachycardia

Supraventricular arrhythmias

Ventricular arrhythmias

Hypertension

Pupillary dilatation

May increase size of MI

Feeling of anxiety/palpatations in the conscious Pt

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9
Q

Adrenaline - Special Notes

A

IV Adrenaline should be reserved for life threatening situations.

IV effects:

Onset: 30sec

Peak: 3-5min

Duration: 5-10min

IM effects:

Onset: 30-90sec

Peak: 4-10min

Duration: 5-10min

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10
Q

Aspirin- Presentation

A

300mg chewable tablet

300mg soluble/water dispensable tablet

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11
Q

Aspirin - Pharmacology

A

An analgesic, antipyretic, anti-inflammatory and antiplatelet aggregation agent

Actions:

  • To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS
  • Inhibits synthesis of prostaglandins
  • anti-inflammatory actions
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12
Q

Aspirin - Metabolism

A

Converted to salicylate in the gut mucosa and liver; excreted mainly by the kidneys

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13
Q

Aspirin - Primary emergency indications

A
  1. ACS
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14
Q

Aspirin - Contraindications

A
  1. Hypersensitivity to aspirin/salicylates
  2. Actively bleeding peptic ulcers
  3. Bleeding disorders
  4. Suspected dissecting aortic aneurysm
  5. Chest pain associated with psychostimulant OD if systolic BP >160mmHg
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15
Q

Aspirin - Precautions

A
  1. Peptic ulcers
  2. Asthma
  3. Pt on anticoagulants
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16
Q

Aspirin - Route of administration

A

Oral

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17
Q

Aspirin - Side effects

A

Heartburn, nausea, gastrointestinal bleeding Increased bleeding time Hypersensitivity reactions

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18
Q

Aspirin - Special notes

A

Aspirin is C/I for use in acute febrile illness in children and adolescents

The anti-platelet effects of Aspirin persist for the natural life of platelets

Onset: n/a

Peak: n/a

Duration: 8-10days

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19
Q

Dexamethasone - Presentation

A

8mg in 2mL glass vial

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20
Q

Dexamethasone - Pharmacology

A

A corticosteroid secreted by the adrenal cortex

Actions:

  • Relieves inflammatory reactions
  • Provides immunosuppression
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21
Q

Dexamethasone - Metabolism

A

By the liver and other tissues; excreted predominantly by the kidneys

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22
Q

Dexamethasone - Primary emergency indications

A
  1. Bronchospasm associated with acute respiratory distress not responsive to nebulised Salbutamol
  2. Moderate - severe croup
  3. Acute exacerbation of COPD
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23
Q

Dexamethasone - Contraindications

A
  1. Known hypersensitivity
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24
Q

Dexamethasone - Precautions

A
  1. Solutions which are not clear or are contaminated should be discarded
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25
Q

Dexamethasone - Route of administration

A

IV (administered over 1-3min)

Oral

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26
Q

Dexamethasone - Side effects

A

Nil of significance in above indication

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27
Q

Dexamethasone - Special notes

A

Does not contain an antimicrobial agent, therefore use solution immediately and discard any residue

IV effects:

Onset: 30-60min

Peak: 2hours

Duration: 36-72hours

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28
Q

Dextrose 10 - Presentation

A

25g in 250mL infusion soft pack

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29
Q

Dextrose 10 - Pharmacology

A

A slightly hypertonic crystalloid solution

Composition:

  • Sugar - 10% dextrose
  • Water

Actions:

  • Provides a source of energy
  • Supplies body water
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30
Q

Dextrose 10 - Metabolism

A

Dextrose:

  • Broken down in most tissues
  • Stored in liver and muscle as glycogen

Water:

  • Excreted by the kidneys
  • Distributed throughout total body water, mainly in the extracellular fluid compartment
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31
Q

Dextrose 10 - Primary emergency indications

A
  1. Diabetic hypoglycaemia (BGL analysis < 4 mol/L) in Pt with altered conscious state who is unable to self-administer oral glucose
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32
Q

Dextrose 10 - Contraindications

A
  1. Nil of significance in the above indication
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33
Q

Dextrose 10 - Precautions

A
  1. Nil of significance in the above indication
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34
Q

Dextrose 10 - Route of administration

A

IV infusion

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35
Q

Dextrose 10 - Side effects

A

Nil of significance in the above indication

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36
Q

Dextrose 10 - Special notes

A

IV effects:

Onset: 3min

Peak: n/a

Duration: Depends on severity of hypoglycaemic episode

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37
Q

Fentanyl - Presentation

A

100mcg in 2mL glass ampoule

250mcg in 1 Ml glass ampoule or cartridge (IN use only)

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38
Q

Fentanyl - Pharmacology

A

A synthetic opioid analgesic

Actions:

CNS effects:

  • Depression - leading to analgesia
  • Respiratory depression - leading to apnoea
  • Dependence (addiction)

Cardiovascular effects:

  • Decreases conduction velocity through the AV node
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39
Q

Fentanyl - Metabolism

A

By the liver; excreted by the kidneys

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40
Q

Fentanyl - Primary emergency indications

A
  1. Sedation to facilitate intubation
  2. Sedation to maintain intubation
  3. Sedation to facilitate transthoracic pacing
  4. Sedation to facilitate synchronised cardioversion
  5. CPR interfering Pt - ALS
  6. Analgesia - IV/IN
    - Hx of hypersensitivity or allergy to morphine
    - Known renal impairment/failure
    - Short duration of action desirable
    - Hypotension
    - Nausea and/or vomiting
    - Severe headache
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41
Q

Fentanyl - Contraindications

A
  1. Hx of hypersensitivity
  2. Late second stage of labour
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42
Q

Fentanyl - Precautions

A
  1. Elderly/frail Pt
  2. Impaired hepatic function
  3. Respiratory depression e.g. COPD
  4. Current asthma
  5. Pt on monoamine oxidase inhibitors
  6. Known addiction to opioids
  7. Rhinitis, rhinorrhea or facial trauma (IN route)
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43
Q

Fentanyl - Route of administration

A

IV

IN

IV infusion

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44
Q

Fentanyl - Side effects

A

Respiratory depression

Apnoea

Rigidity of the diaphragm and intercostal muscles

Bradycardia

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45
Q

Fentanyl - Special notes

A

Fentanyl is a schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility

Respiratory depression can be reversed with Naloxone

100mcg Fentanyl is equivalent in analgesic activity to 10mg Morphine

IV effects:

Onset: Immediate

Peak: < 5min Duration: 30-60min

IN effects:

Peak: 2min

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46
Q

Glucagon - Presentation

A

1mg (IU) in 1mL hypo kit

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47
Q

Glucagon - Pharmacology

A

A hormone normally secreted by the pancreas

Actions:

  • Causes in blood glucose concentration by converting stored liver glycogen to glucose
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48
Q

Glucagon - Metabolism

A

Mainly by the liver, also by the kidneys and in the plasma

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49
Q

Glucagon - Primary emergency indications

A
  1. Diabetic hypoglycaemia (BGL <4mmol/L) in Pt with an altered conscious state who are unable to self-administer oral glucose
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50
Q

Glucagon - Contraindications

A
  1. Nil of significance in the above indication
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51
Q

Glucagon - Precautions

A
  1. Nil of significance in the above indication
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52
Q

Glucagon - Route of administration

A

IM

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53
Q

Glucagon - Side effects

A

Nausea and vomiting (rare)

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54
Q

Glucagon - Special notes

A

Not all patients will respond to glucagon, e.g. those with inadequate glycogen stores in the liver (alcoholics, malnourished).

IM effects:

Onset: 5min

Peak: n/a

Duration: 25min

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55
Q

GTN - Presentation

A
  1. 3mg tablet
  2. 6mg tablets

Transdermal GTN Patch (50mg 0.4mg/hr release)

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56
Q

GTN - Pharmacology

A

Principally a vascular smooth muscle relaxant

Actions:

  • Venous dilatation promotes venous pooling and reduces venous return to the heart (reduces preload)
  • Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces preload)

The effects of the above are:

  • Reduced myocardial O2 demand
  • Reduced systolic, diastolic and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure
  • Mild collateral coronial artery dilatation may improve blood supply to ischaemic areas of myocardium
  • Mild tachycardia secondary to slight fall in blood pressure
  • Preterm labour: Uterine quiescence in pregnancy
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57
Q

GTN - Metabolism

A

By the liver

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58
Q

GTN - Primary emergency indications

A
  1. Chest pain with ACS
  2. Acute LVF
  3. Hypertension associated with ACS
  4. Autonomic dysreflexia
  5. Preterm labour (consult)
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59
Q

GTN - Contraindications

A
  1. Known hypersensitivity
  2. Systolic blood pressure <110 mmHg tablet
  3. Systolic blood pressure <90 mmHg patch
  4. Sildenafil Citrate (Viagra) or Vardenafil (Levitra) administration in the last 24hr or Tadalafil (Cialis) administration in the previous 4 days (PDE5 inhibitors)
  5. Heart rate > 150bpm
  6. Bradycardia HR <50bpm (excluding autonomic dysreflexia)
  7. VT
  8. Inferior STEMI with systolic BP <160 mmHg
  9. Right ventricular MI
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60
Q

GTN - Precautions

A
  1. No previous administration
  2. Elderly Pt
  3. Recent MI
  4. Concurrent use with other tocolytics
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61
Q

GTN - Route of administration

A

SL

Buccal

Transdermal

Infusion (interhospital transfer only)

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62
Q

GTN - Side effects

A

Tachycardia

Hypotension

Headache

Skin flushing (uncommon)

Bradycardia (occasionally)

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63
Q

GTN - Special notes (there are a shitload)

A

Storage:

  • GTN is susceptible to heat and moisture. Make sure that tablets are stored in their original light resistant, tightly sealed bottles. The foil pack of the patches should be intact.
  • Do not administer patient’s own tablets, as its storage may not have been in optimum condidtions or it may have expired.
  • Patches should be discarded prior to use-by date.
  • Since both men and women can be prescribed PDE5 inhibitors all patients should be asked if and when they last had the medication to determine if GTN is C/I.
  • Tadalafil (Cialis) may also be prescribed to men for treatment of benign prostatic hypertrophy. This is a new indication for this medication and may lead to an increased number of patients under this treatment regimen.
  • GTN by IV infusion may be required for an inter hospital transfer as per the treating doctor’s orders

Interhospital transfer:

The IV dose is to be prescribed and signed by the referring hospital medical officer. Infusions usually run in the range of 5 mcg/minute to 200 mcg/minute and increased 3-5 mcg/minute.

S/L effects:

Onset: 30sec - 2min

Peak: 5 - 10min

Duration: 15 - 30min

IV effects:

Onset: 30sec - 1min

Peak: 3 - 5min

Duration: 15 - 30min

Transdermal effect:

Onset: Up to 30mi

Peak: 2hrs

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64
Q

Ipratropium Bromide - Presentation

A

250 mcg in 1 mL nebule or polyamp

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65
Q

Ipratropium Bromide - Pharmacology

A

Anticholinergic bronchodilator

Actions:

  • Allows bronco dilatation by inhibiting cholinergic bronchomotor tone (i.e. blocks vagal reflexes which mediate bronchoconstriction)
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66
Q

Ipratropium Bromide - Metabolism

A

Excreted by the kidneys

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67
Q

Ipratropium Bromide - Primary emergency indications

A
  1. Severe respiratory distress associated with bronchospasm
  2. Exacerbation of COPD irrespective of severity
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68
Q

Ipratropium Bromide - Contraindications

A
  1. Known hypersensitivity to Atropine or its derivatives
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69
Q

Ipratropium Bromide - Precautions

A
  1. Glaucoma
  2. Avoid contact with eyes
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70
Q

Ipratropium Bromide - Route of administration

A

Nebulised (in combination with salbutamol)

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71
Q

Ipratropium Bromide - Side effects

A

Headache

Nausea

Dry mouth

Skin rash

Tachycardia (rare)

Palpitations (rare)

Acute angle closure glaucoma secondary to direct eye contact (rare)

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72
Q

Ipratropium Bromide - Special notes

A

There have been isolated reports of ocular complications (dilated pupils, increased intraocular pressure, acute angle glaucoma, eye pain) as a result of direct eye contact with Ipratropium Bromide formulations.

The nebuliser mask must therefore be fitted properly during inhalation and care taken to avoid Ipratropium Bromide solution entering the eyes.

Ipratropium Bromide must be nebuliser in conjunction with Salbutamol and is to be administered as a single dose only.

Onset: 3 - 5min

Peak: 1.5 - 2hrs

Duration: 6hrs

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73
Q

Methoxyflurane - Presentation

A

3 mL glass bottle

74
Q

Methoxyflurane - Pharmacology

A

Inhalation analgesic agent at low concentrations

75
Q

Methoxyflurane - Metabolism

A

Excreted mainly by the lungs

By the liver

76
Q

Methoxyflurane - Primary emergency indications

A
  1. Pain relief
77
Q

Methoxyflurane - Contraindications

A
  1. Pre-existing renal disease / renal impairment
  2. Concurrent use of tetracycline antibiotics
  3. Exceeding total dose of 6 mL in 24hr period
  4. Personal or family history of malignant hypothermia
  5. Muscular dystrophy
78
Q

Methoxyflurane - Precautions

A
  1. The Penthrox inhaler must be hand-held by the Pt so that if unconsciousness occurs it will fall from the patient’s face. Occasionally the operator may need to assist but must continuously assess the level of consciousness
  2. Pre-eclampsia
  3. Concurrent use with oxytocin may cause hypotension
79
Q

Methoxyflurane - Route of administration

A

Self-administered under supervision using the hand held Penthrox inhaler

80
Q

Methoxyflurane - Side effects

A

Drowsiness

Decrease in blood pressure and bradycardia (rare)

Exceeding the maximum total dose of 6 mL in a 24hr period may lead to renal toxicity

81
Q

Methoxyflurane - Special notes

A

The maximum initial priming dose for Methoxyflurane is 3 mL. This will provide approximately 25 minutes of analgesia and may be followed by one further 3 mL dose once the initial dose is exhausted if required. Analgesia commences after 8 - 10 breaths and lasts approximately 3 - 5 minutes once discontinued.

Do not administer in a confined space. Ensure adequate ventilation in ambulance.

Malignant hyperthermia is a very rare condition that can be induced by volatile anaesthetics such as methoxyflurane. Ask Pt about any past history or family history of adverse reactions to inhaled anaesthetics.

In patients with muscular dystrophy, volatile agents may precipitate life-threatening rhabdomyolysis.

82
Q

Morphine - Presentation

A

10 mg in 1 mL glass ampoule

83
Q

Morphine - Pharmacology

A

An opioid analgesic

Actions:

CNS effects

  • Depression (leading to analgesia)
  • Respiratory depression
  • Depression of cough reflex
  • Stimulation (changes of mood, euphoria or dysphoria, vomiting, pin-point pupils
  • Dependence (addiction)

Cardiovascular effects:

  • Vasodilatation
  • Decreases conduction through the AV node
84
Q

Morphine - Metabolism

A

By the liver; excreted by the kidneys

85
Q

Morphine - Primary emergency indications

A
  1. Pain relief
  2. Sedation to maintain intubation
  3. Sedation to enable intubation
  4. RSI
86
Q

Morphine - Contraindications

A
  1. History of hypersensitivity
  2. Renal impairment / failure
  3. Late second stage of labour
87
Q

Morphine - Precautions

A
  1. Elderly / frail Pt
  2. Hypotension
  3. Respiratory depression
  4. Current asthma
  5. Respiratory tract burns
  6. Known addiction to opioids
  7. Acute alcoholism
  8. Pt on monoamine oxidase inhibitors
88
Q

Morphine - Route of administration

A

IV

IM

Subcutaneous

89
Q

Morphine - Side effects

A

CNS effects:

  • Drowsiness
  • Respiratory depression
  • Euphoria
  • Nausea, vomiting
  • Addiction
  • Pin-point pupils

Cardiovascular effects:

  • Hypotension
  • Bradycardia
90
Q

Morphine - Special notes

A

Morphine is a Schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility.

Side effects of Morphine can be reversed with Naloxone

Occasional wheals are seen in the line of the vein being used for IV injection. This is not an allergy, only a histamine release.

IV effects:

Onset: 2 - 5min

Peak: 10min

Duration: 1 - 2hrs

IM effects:

Onset: 10 - 30min

Peak: 30 - 60min

Duration: 1 - 2hrs

91
Q

Naloxone - Presentation

A

0.4 mg in 1 mL glass ampoule

92
Q

Naloxone - Pharmacology

A

An opioid antagonist

Action:

  • Prevents or reverses the effects of opioids
93
Q

Naloxone - Metabolism

A

By the liver

94
Q

Naloxone - Primary emergency indications

A
  1. Altered conscious state and respiratory depression secondary to administration of opioids or related drugs
95
Q

Naloxone - Contraindications

A
  1. Nil of significance in the above indication
96
Q

Naloxone - Precautions

A
  1. If Pt is known to be physically dependent on opioids, be prepared for a combative Pt after administration
  2. Neonates
97
Q

Naloxone - Route of administration

A

IM

IV

98
Q

Naloxone - Side effects

A

Symptoms of opioid withdrawal:

  • Sweating, goose flesh, tremor
  • Nausea and vomiting
  • Agitation
  • Dilatation of pupils, excessive lacrimation
  • Convulsions
99
Q

Naloxone - Special notes

A

The duration of action of naloxone is often less than that of the opioid used, therefore repeated doses may be required.

Naloxone reverses the effects of opioids with none of the actions produced by other opioid antagonists when no opioid is present in the body. (For example, it does not depress respiration or or cause pupillary constriction). In the absence of opioids, Naloxone has no perceivable effects.

Following an opioid associated cardiac arrest Naloxone should not be administered. maintain assisted ventilation.

Following head injury Naloxone should not be administered. Maintain assisted ventilation if required.

IV effects:

Onset: 1 - 3min

Peak: n/a

Duration: 30 - 45min

IM effects:

Onset: 1 - 3min

Peak: n/a

Duration: 30 - 45min

100
Q

Normal Saline - Presentation

A

10 mL polyamp

500 mL and 1000 mL infusion soft pack

101
Q

Normal Saline - Pharmacology

A

An isotonic crystalloid solution

Composition:

Electrolytes (sodium and chloride in a similar concentration to that of extracellular fluid)

Action:

  • Increases the volume of the intravascular compartment
102
Q

Normal Sline - Metabolism

A

Electrolytes:

  • Excreted by the kidneys

Water:

  • Excreted by the kidneys
  • Distributed throughout total body water, mainly in the extracellular fluid compartment
103
Q

Normal Saline - Primary emergency indication

A
  1. As a fluid replacement in volume depleted patients
  2. Cardiac arrest secondary to hypovolaemia or where the Pt might be fluid responsive
  3. To expand intravascular volume in the non-cardiac, non-hypovolaemic hypotensive Pt e.g. anaphylaxis, burns. sepsis
  4. As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive patients (other than LVF). e.g. asthma
  5. Fluid for diluting and administering IV drugs
  6. Fluid TKVO for IV administration of emergency drugs
104
Q

Normal Saline - Contraindications

A
  1. Nil of Significance in the above indication
105
Q

Normal Saline - Precautions

A
  1. Consider modifying factors when administering for hypovolaemia
106
Q

Normal Saline - Route of administration

A

IV

IO

107
Q

Normal Saline - Side effects

A

Nil of significance in the above indication

108
Q

Normal Saline - Special notes

A

IV half life:

Approximately 30 - 60min

109
Q

Ondansetron - Presentation

A

4 mg orally disolved tablet

8 mg in 4 mL glass bottle

110
Q

Ondansetron - Pharmacology

A

Anti-emetic

Action:

5HT3 antagonist which blocks receptors both centrally and peripherally

111
Q

Ondansetron - Metabolism

A

By the liver

112
Q

Ondansetron - Primary emergency indications

A
  1. Undifferentiated nausea and vomiting
  2. Prophylaxis for spinally immobilised or eye injured Pt
  3. Vestibular nausea in Pt <21 years of age
113
Q

Ondansetron - Contraindications

A
  1. Known hypersensitivity
  2. Concurrent Anpomorphine use
  3. Known long Q-T syndrome
  4. Hypokalaemia or hypomagnesaemia
114
Q

Ondansetron - Precautions

A
  1. Pt with liver disease should not receive more than 8 mg of Ondansetron per day
  2. Care should be taken with patients on diuretics who may have an underlying electrolyte imbalance
  3. Ondansetron contains aspartame and should not be given to patients with phenylketonuria
  4. Concurrent use of Tramadol
  5. Pregnancy
115
Q

Ondansetron - Route of administration

A

Oral (ODT)

IV

IM

116
Q

Ondansetron - Side effects

A

Rare (<0.1%)

Hypersensitivity reactions (including anaphylaxis)

Q-T prolongation

Widened QRS complex

Tachyarrythmias (including AF and SVT)

Seizures

Extrapyramidal reaction

Visual disturbances (including transient loss of vision)

Common (>1%)

Constipation

Headache

Fever

Dizziness

Rise in liver enzymes

117
Q

Ondansetron - Special notes

A

ODT

Onset: 2min

Peak: 20min

Duration: 120min

IV

Onset: 5min

Peak: 10min

Duration: between 2.5 and 6.1hrs

IV doses should be delivered as a slow push push (minimum 30sec)

118
Q

Paracetamol - Presentation

A

500 mg tablets

120 mg in 5 mL oral liquid (24 mg/mL)

119
Q

Paracetamol - Pharmacology

A

An analgesic and antipyretic agent

Actions:

  • Exact mechanism of action unclear; thought to inhibit prostaglandin synthesis in the CNS
120
Q

Paracetamol - Metabolism

A

By the liver; excreted by the kidneys

121
Q

Paracetamol - Primary emergency indications

A
  1. Mild pain
  2. Headache
122
Q

Paracetamol - Contraindications

A
  1. Hypersensitivity to paracetamol
  2. Children < 1 month of age
  3. Paracetamol already administered within past 4hrs
  4. Total paracetamol intake within past 24hrs exceeding 4 g (adults) or 60 mg/kg (children)
  5. Chest pain in suspected acute coronary syndrome
123
Q

Paracetamol - Precautions

A
  1. Impaired hepatic function or liver disease
  2. Elderly/frail
  3. Malnourished
124
Q

Paracetamol - Route of administration

A

Oral

125
Q

Paracetamol - Side effects

A
  1. Hypersensitivity reactions including severe skin rashes (rare)
  2. Haematological reactions (rare)
126
Q

Paracetamol - Side notes

A

There are several brands of paracetamol available in Australia. Paracetamol is also found in many combination medicines, both prescription and over the counter. Carefully determine previous Paracetamol intake before dose administration.

The usual dose of Paracetamolfor children is 15 mg/kg per dose. the maximum total dose of 60 mg/kg therefore equates to 4 doses within a 24hr period.

Hepatic damage is very rare when Paracetamol is taken at recommended dosages.

Paracetamol is not indicated for the treatment of fever in the emergency setting.

Onset: 30min

Peak:

Duration: 4hrs

127
Q

Prochlorperazine (Stemetil) - Presentation

A

12.5 mg in 1 mL glass ampoule

128
Q

Prochlorperazine (Stemetil) - Pharmacology

A

An anti-emetic

Action:

  • Acts on several central euro-transmitter systems
129
Q

Prochlorperazine (Stemetil) - Metabolism

A

Metabolised by the liver; excreted by the kidneys

130
Q

Prochlorperazine (Stemetil) - Primary emergency indications

A
  1. Treatment or prophylaxis of nausea / vomiting for
    - Motion sickness
    - Planned aeromedical evacuation
    - Known allergy or C/I to Ondansetron administration
    - Headache irrespective of nausea / vomiting
    - Vertigo
131
Q

Prochlorperazine (Stemetil) - Contraindications

A
  1. Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension)
  2. CNS depression
  3. Previous hypersensitivity
  4. Pt < 21 years of age
  5. Pregnancy
132
Q

Prochlorperazine (Stemetil) - Precautions

A
  1. Hypotension
  2. Epilepsy
  3. Pt affected by alcohol or on anti-depressants
133
Q

Prochlorperazine (Stemetil) - Route of administration

A

IM

134
Q

Prochlorperazine (Stemetil) - Side effects

A

Drowsiness

Blurred vision

Hypotension

Sinus tachycardia

Skin rash

Extrapyramidal reactions (usually the dystonic type)

135
Q

Prochlorperazine (Stemetil) - Special notes

A

IM effects:

Onset: 20min

Peak: 40min

Duration: 6hrs

136
Q

Salbutamol - Presentation

A

5 mg in 2.5 mL polyp

pMDI (100 mcg per actuation)

137
Q

Salbutamol - Pharmacology

A

A synthetic beta adrenergic stimulant with primary beta 2 effects

Action:

  • Causes bronchodilatation
138
Q

Salbutamol - Metabolism

A

By the liver; excreted by the kidneys

139
Q

Salbutamol - Primary emergency indications

A
  1. Respiratory distress with suspected bronchospasm:
    - asthma
    - severe allergic reactions
    - COPD
    - smoke inhalation
    - oleoresin capsicum spray exposure
140
Q

Salbutamol - Contraindications

A
  1. None of significance in the above indications
141
Q

Salbutamol - Precautions

A
  1. Large doses of Salbutamol have been reported to intracellular metabolic acidosis
142
Q

Salbutamol - Route of administration

A

Nebulised

pMDI

143
Q

Salbutamol - Side effects

A

Sinus tachycardia

Muscle tremor (common)

144
Q

Salbutamol - Special notes

A

Salbutamol nebulas / polyps have a shelf life of one month after the wrapping is opened. The date of the opening of the packaging should be recorded and the drug and the drug should be stored in an environment of < 30°C

Although infrequently used, Salbutamol by IV infusion may be required during inter hospital transfers of some women in premature labour

The dose is to be prescribed and signed by the referring hospital medical officer

Nebulised effects:

Onset: 5 - 15min

Peak: n/a

Duration: 15 - 50min

145
Q

Who’s a good boy?

A
146
Q

Ceftriaxone - Presentation

A

1 g sterile powder in a glass vile

147
Q

Ceftriaxone - Pharmacology

A

Cephalosporin antibiotic

148
Q

Ceftriaxone - Metabolism

A

Excreted unchanged in urine (33% - 67%) and in bile

149
Q

Ceftriaxone - Primary Emergency Indications

A
  1. Suspected meningococcal septicaemia
  2. Severe sepsis (consult only)
150
Q

Ceftriaxone - Contraindications

A
  1. Allergy to Cephalosporin antibiotics
151
Q

Ceftriaxone - Precautions

A
  1. Allergy to Penicillin antibiotics
152
Q

Ceftriaxone - Route of Administration

A

IV (preferred)

IM (if IV access unavailable)

153
Q

Ceftriaxone - Side effects

A

Nausea

Vomiting

Skin rash

154
Q

Ceftriaxone - Special notes

A

Usual dose: adult 1 g, child 50 mg/kg (max. 1 g)

Ceftriaxone IV must be made up to 10 mL using sterile water and dose administered over 2 minutes

Ceftriaxone IM must be made up to 4 mL using 1% Lignocaine and dose administered in lateral upper thigh

IM/IV effects:

Onset: n/a

Peak: n/a

Duration: n/a

155
Q

Heparin - Presentation

A

5000 units in 5 mL plastic ampoule

156
Q

Heparin - Pharmacology

A

Anticoagulant

Inactivates clotting factors IIa (thrombin) and Xa by binding to antithrombin III

157
Q

Heparin - Metabolism

A

Metabolised by the liver; excreted by the kidneys

158
Q

Heparin - Primary Emergency Indications

A
  1. Acute STEMI
159
Q

Heparin - Contraindications

A
  1. Known allergy or hypersensitivity
  2. Active bleeding (excluding menses)
  3. Oral anticoagulants
  4. Bleeding disorders
  5. History of Heparin-Induced Thrombocytopaenia (HIT)
  6. Severe Hepatic Impairment / disease, including oesophageal varices
  7. Recent trauma or surgery
160
Q

Heparin - Precautions

A

Renal impairment

161
Q

Heparin - Route of Administration

A

IV

162
Q

Heparin - Side Effects

A
  1. Bleeding
  2. Bruising and pain at injection site
  3. Hyperkalaemia
  4. Thromocytopaenia (mild to severe)
163
Q

Heparin - Special Notes

A

Do not inject IM due to risk of causing haematoma; Onset: Imediate; Duration: 3-6 hours. The plasma half-life of heprain is 60 minutes. As such, any patient recieving Heparin as a bolus dose will also require repeat doses if their travel time to PCI is > 1 hour.

164
Q

Midazolam - Presentation

A

5 mg in 1 mL glass ampoule

15 mg in 3 mL glass ampoule

165
Q

Midazolam - Pharmacology

A

Short acting CNS depressant

Actions:

  • Anxiolytic
  • Sedative
  • Anti-convulsant
166
Q

Midazolam - Metabolism

A

In the liver; excreted by the kidneys

167
Q

Midazolam - Primary emergency indications

A

1. Status epilepticus

  1. Sedation to enable intubation (RSI/IFS)
  2. Post Intubation Sedation
  3. Sedation to facilitate synchronised cardioversion
  4. Sedation to facilitate transthoracic pacing

6. Sedation in the agitated patient (including patients under the mental health act 2014)

7. Sedation in psychostimulant OD

168
Q

Midazolam - Contraindications

A
  1. Known sensitivity to benzodiazepines
169
Q

Midazolam - Precautions

A
  1. Reduced doses may be required for the elderly/frail, patients with chrnic renal failure, CCF or shock
  2. The CNS depressant effects of benzodiazepines are enhanced in the presence of narcotics and other tranquilizers including alcohol
  3. Can cause severe respiratory depresion in patients with COPD
  4. Patients with myasthenia gravis
170
Q

Midazolam - Route of administration

A

IM

IV

IV infusion

171
Q

Midazolam - Side effects

A

Depressed level of conciousness

Respiratory depression

Loss of airway control

Hypotension

172
Q

Midazolam - Special notes

A

IM effects:

Onset: 3 - 5 min

Peak: 15 min

Duration: 30 min

IV effects:

Onset: 1 - 3 min

Peak: 10 min

Duration: 20 min

173
Q

Lignocaine 1% - Presentation

A

50 mg in 5 mL amp (1%)

174
Q

Lignocaine 1% - Pharmacology

A

A local anaesthetic agent

Actions:

  • Prevents initiation ad transmission of nerve impulses causing local anaesthesia (1% solution)
175
Q

Lignocaine 1% - Metabolism

A

By the liver (90%)

Excreted unchanged by the kidneys (10%)

176
Q

Lignocaine 1% - Primary emergency indications

A
  1. Diluent for Ceftriaxone for IM administration in suspected meningococcal disease
  2. Chest wall infitration as local anaesthetic to facilitate chest wall infiltration in patients with GCS > 10
177
Q

Lignocaine 1% - Contraindications

A
  1. Known hypersensitivity
178
Q

Lignocaine 1% - Precautions

A
  1. when using Lignocaine 1% under these indications it is importnt to rule out inadvertent IV administration due to potential CNS complications
179
Q

Lignocaine 1% - Route of administration

A

IM (1% solution with Ceftriaxone onlu)

Local tissue infiltration for chest decompression (MICA only)

180
Q

Lignocaine 1% - Side effects

A

Nil - unless inadvertant IV administration

181
Q

Lignocaine 1% - Special notes

A

IM effects:

Onset: Rapid

Peak: n/a

Duration: 1 - 1.5 hours

HFB2117 - Clinical Practice 3 (22 decks)

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