JRCALC Drugs Flashcards
Presentation and Route of Activated Charcoal
50g in 250ml - granules or suspension in water
Oral
Max dose 50g
Indications of Activated Charcoal
- Acute oral poisoning and oral drug overdose
- Ingestion less than an hour before attendance by ambulance
- Toxbase or NPIS have advised use
Contra-indications of Activated Charcoal
- children under 1
- more than an hour since ingestion
- not advised by Toxbase or NPIS
- vomiting
- reduced GI motility e.g. opiod users or recent abdo surgery
- poisoning by: cyanide, petroleum distillates, metal salts, ethanol, methanol, ethylene glycol, iron salts, sodium chloride, lead boric acid, other mineral acid, malathion, corrosive substances
Cautions of Activated Charcoal
- precautions to prevent aspiration
- reduced effectiveness of other antidotes
- alcohol consumption - need to be alert enough to swallow
- shake bottle before administration
Side effects of Activated Charcoal
- Black stools
- intestinal obstruction
- bezoar formation
- intestinal perforation
Presentation, Route and Dosage of Adrenaline (1 in 10000)
Pre-filled syringe (1 in 10000)
IV/IO - rapid bolus
1 milligram (10ml) every 3-5 minutes with no limit
Indications for adrenaline (1 in 10000)
Cardiac arrest
Actions of adrenaline (1 in 10000)
A sympathomimetic that stimulates alpha and beta adrenogenic receptors
Myocardial and cerebral blood flow increases during CPR and CPR is more effective due to increased peripheral resistance which improves perfusion pressures
Cautions of adrenaline (1 in 10000)
Severe hypertension may occurs in patients on non-cardioselective beta-blockers e.g. propranolol
Do NOT give repeated doses of adrenaline in hypothermic patients
Contra-indications of adrenaline (1 in 10000)
None
Presentation, route and dosage of adrenaline (1 in 1000)
Pre-filled syringe 1mg in 1ml
IM - antero-lateral aspect of thigh
500mcg every 5 minutes with no limit
Indications of adrenaline (1 in 1000)
Anaphylaxis
Life threatening asthma with failing ventilation and deterioration despite nebuliser therapy
Actions of adrenaline (1 in 1000)
Reverses allergic manifestations of acute anaphylaxis
Relieves bronchispasm in acute severe asthma
Stimulates alpha and beta receptors
Cautions of adrenaline (1 in 1000)
Severe hypertension may occur in patients on non-cardioselective beta-blockers e.g. propranolol
Presentation, route and dosage of Amiodarone hydrochloride
Pre-filled syringe containing 300mg in 10 ml
IV/IO - rapid bolus
300mg, 150mg after 5th shock, total max dose 450mg
Indications for amiodarone hydrochloride
Shockable rhythm cardiac arrest
Actions of amiodorone hydochloride
Antiarrhythmic - lengthens cardiac action potential and therefore effective refractory period. Prolongs QT interval on ECG
Blocks sodium and potassium channels in cardiac muscle
Acts to stabilise and reduce electrical irritability of cardiac muscle
Contra-indications of amiodarone hydrochloride
None
Side effects of amiodorone hydrochloride
- Bradycardia
- Vasodilation causing hypotension, flushing
- Bronchospasm
- Arrhythmias - Torsades de pointes
Presentation, route and dosage of aspirin
Chewable tablet, oral, 300mg
Give regardless of previous aspirin taken that day
Indications for aspirin
Clincial or ECG evidence suggestive of MI or ischaemia
Actions of aspirin
Anti platelet which reduces clot formation
Contra-indications of aspirin
- known sensitivity/allergy
- children under 16
- active GI bleeding
- haemophilia
- severe hepatic disease
Cautions for aspirin
- asthma
- pregnancy
- kidney or liver failure
- gastric or duodenal ulcer
- current treatment with anticoagulants
Side effects of aspirin
Increased risk of gastric bleeding
Wheezing in some asthmatics
Presentation, dosage and route of atropine sulphate
Pre-filled syringe, 3mg, IV/IO
Indications for atropine
Symptomatic bradycardiac with any:
- absolute bradycardia
- low systolic BP
- paroxysmal ventricular arrhythmias requiring suppression
- inadequate perfusion causing confusion
- bradycardia following ROSC
Contra-indications for atropine
Bradycardia in suspected hypothermia
Actions of atropine
- Reverses effects of vagal drive
- Increases HR by blocking vagal activity in sinus bradycardia, second or third degree heart block
- Enhances AV conduction
Side effects of atropine
Dry mouth Visual blurring Pupil dilation Confusion Hallucinations Tachycardia Dont use small dose as can cause paradoxical bradycardia
Presentation, route and dosage of Benzylpenicillin sodium
Injection vial of powder for solution, IV/IO or IM, 1.2g
Indications for Benzylpenicillin sodium
Suspected meningitis
Actions of Benzylpenicillin sodium
Narrow spectrum antibiotic
Contra-indications of Benzylpenicillin sodium
Known severe penicillin allergy
Presentation, route and dosage of chlorphenamine
IV/IO/IM 10mg
Oral 4mg tablet
Oral 10ml (4mg) solution
Indications for chlorphenamine
Severe anaphylactic reactions after resus
Symptomatic allergic reactions e.g. severe itching
Action of chlorphenamine
Antihistamine with anticholinergic properties that blocks the effect of histamine during a hypersensivity reaction
Contra-indications of chlorphenamine
Known allergy
MAOIs in last 14 days
Cautions of chlorphenamine
Pregnancy and breastfeeding Hypotension Epilepsy Glaucoma Severe liver disease
Side effects of chlorphenamine
Sedation Dry mouth Headache Blurred vision Urinary retention Psychomotor impairment GI disturbance Convulsions
Presentation, route and dosage of clopidogrel
Oral tablet 300mg
Indications for clopidogrel
STEMI: -In patient not taking clopidogrel In patients receiving thrombolytic treatment Anticipated thrombolytic treatment Anticipated PPCI
Actions of clopidogrel
Inhibits platelet aggregation
Contra-indications of clopidogrel
Allergy
Severe liver impairment
Pathological bleeding - e.g. peptic ulcer or intracranial haemorrhage
Cautions of clopidogrel
Pregnancy
Patients taking NSAIDs
Renal impairment
Side effects of clopidogrel
Dyspepsia
Abdominal pain
Diarrhoea
Bleeding (GI and intracranial)
Presentation, route and dosage of dexamethasone
Soluble tablets or oral solution, dosage depends on age
Indications for dexamethasone
Croup
Action of dexamethasone
Corticosteroid - reduces sobglottic inflammation
Contraindications of dexamethasone
Impending respiratory failure
Cautions of dexamethasone
Distressing the child can increase airway compromise
Side effects of dexamethasone
GI upset
Hypersensivity anaphylactic reaction
