Medical Toxicology Drugs Flashcards
What are the indication for adrenaline?
Cardiac arrest
Anaphylaxis OR severe allergic reaction
Severe life-threatening bronchospasm OR silent chest
Shock unresponsive to adequate fluid resuscitation
Bradycardia with poor perfusion
Croup (moderate to severe)
What are the contraindications for adrenaline?
Nil
What are the precautions for adrenaline?
Hypertension
Hypovolaemic shock
Concurrent MAOI therapy
Quetiapine toxicity
What are the side effects of adrenaline?
Anxiety
Hypertension
Palpations/tachyarrhythmias
Pupil dilation
Termor
What is the onset, duration, and half-life for adrenaline?
30 sec (IV) OR 60 sec (IM)
5-10 mins
2 mins
What is the adult dose of adrenaline in a cardiac arrest?
IV: 1mg - repeated at 3-5 min intervals (no max dose)
What is the adult dose of adrenaline for anaphylaxis OR severe allergic reaction?
IM: 500 mcg - repeated at 5 min intervals
NEB: 5mg - single dose
What is the paediatric dose of adrenaline for anaphylaxis OR severe allergic reaction?
IM: 6yrs or older - 300mcg
1 yr to <6 yrs - 150mcg
6 mths to <1 yr - 100mcg
<6 mths - 50mcg
NEB: 5mg single dose
What is the indication(s) for loratadine?
Symptomatic urticaria (without evidence of anaphylaxis)
What are the contraindications for loratadine?
Allergy AND/OR ADR
Anaphylaxis
Patients <8 years
What are the precautions for loratadine?
Severe hepatic impairment
Increased risk of sedation and anticholinergic effects in older people
What are the side effects of loratadine?
Drowsiness
Fatigue
Headache
Nausea
Dry mouth
What are the adult and paediatric doses for loratadine?
Adult: PO 10mg single dose
Paed >8yrs: PO 10mg single dose
What are the indications for ceftriaxone?
Suspected meningococcal septicaemia (with a non-blanching petechial AND/OR purpuric rash)
What are the contraindications for ceftriaxone?
Absolute:
Allergy AND/OR ADR
Known immediate OR severe hypersensitivity to penicillin OR carbapenem based drugs
Relative:
Patients <1 month
What are the precautions for ceftriaxone?
Any allergy of hypersensitivity to penicillin or carbapenem
What are the side effects of ceftriaxone?
Pain and/or inflammation at the injection site
What is the adult dose for ceftriaxone?
IM: 2g (2x 1g IM injections) single dose only - reconstitute with 2.4mL of water for injection in a 3mL syringe (1g/3mL)
IV: 2g slow push over 5 minutes
Reconstitute 2g with 18.8mL of water for injection (2g/20mL)
What is the paediatric dose for ceftriaxone?
IM: 50mg/kg (rounded to the nearest 5kg) - reconstitute 1g with 2.4mL water for injection.
<5kg = 250mg or 0.75mL
>5-10kg = 500mg or 1.5mL
>10-15kg = 750mg or 2.25mL
>15kg = 1g or 3mL
What is the indication for glucose gel?
Symptomatic hypoglycaemia (with the ability to self-administer oral glucose)
What are the contraindications for glucose gel?
Unconsciousness
Patients with difficulty swallowing
Patients less than 2 years of age
What are the precautions of glucose gel?
Nil
What are the side effects of glucose gel?
Nausea and/or vomiting
Diarrhoea
What are the adult and paediatric doses for glucose gel?
15g
Repeated once at 15 minutes if BGL is < 4.0mmol/L
Total max dose 30g
What are the indications for glucagon?
Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3xIM adrenaline injections and adequate fluid challenges)
What are the contraindications for glucagon?
Allergy AND/OR ADR
What are the precautions for glucagon?
Nil
What are the side effects of glucagon?
Nil
What are the adult doses of glucagon for both indications?
IM: 1mg - reconstitute with 1mL of water for injection in a 3mL syringe
IV: 1mg - same as above
What are the paediatric doses of glucagon for both indications?
IM: > 25kg - 1mg
< 25kg - 0.5mg - decant 0.5mL of prepared solution before injecting
IV: > 25kg - 1mg
< 25kg - 0.5mg
What are the indications for glucose 10%?
Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Unconscious hypoglycaemia
What are the contraindications for glucose 10%?
Nil
What are the precautions for glucose 10%?
Hyperglycaemia
What are the side effects of glucose 10%?
Nil
What is the adult dose for glucose 10%?
IV INF: 15g (150mL)
Repeated at 10g (100mL) boluses every 5 minutes until BGL >4.0 mmol/L
What is the paediatric dose for glucose 10%?
IV INF: 0.25g/kg (2.5mL/kg)
Repeated at 0.1g/kg (1mL/kg) boluses every 5 minutes until BGL > 4.0 mmol/L
What are the indications for hydrocortisone?
Asthma (excluding mild)
Acute exacerbation of COPD (with evidence of respiratory distress)
Refractory anaphylaxis with persistent wheeze (and unresponsive to 3xIM adrenaline)
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
What are the contraindications for hydrocortisone?
Allergy AND/OR ADR
What are the precautions of hydrocortisone?
Hypertension
What are the side effects of hydrocortisone?
Nil
What are the adult doses for hydrocortisone?
IM: 100mg single dose only
IV: 100mg slow push over 1 minute
Refractory anaphylaxis with persistent wheeze:
IM: 200mg single dose only
IV: 200mg slow push over 1 minute
Each 100mg vial is to be reconstituted with 2mL sodium chloride 0.9% or water for injection
What are the paediatric doses for hydrocortisone?
Asthma & refractory anaphylaxis:
IM: 4mg/kg, single dose only not exceeding 100mg
IV: 4mg/kg slow push over 1 minute
Adrenal insufficiency
IM: 0-4 yrs - 25mg
5-10 yrs - 50mg
>10 years -100mg
single dose only
IV: same as above but slow push
What are the indications for midazolam (relevant to 2nd year)?
Generalised seizures/focal seizure (GCS < 12)
What are the contraindications for midazolam?
Allergy AND/OR ADR
What are the precautions for midazolam?
Reduced dosages must be considered in:
- low body weight, older cachectic or frail pt
- patients with chronic renal failure, congestive cardiac failure or shock
Can cause severe respiratory depression in pts with COPD
Myasthenia gravis
Multiple sclerosis
What are the side effects of midazolam?
Hypotension
Respiratory depression particularly when associated with other CNS depressants including alcohol and narcotics
What is the adult dose for midazolam (2nd year relevance)?
NAS/IM: 5mg repeated every 10mins (max dose 20mg)
IV: 5mg - same as above
What is the paediatric dose for midazolam (2nd year relevance)?
NAS/IM: 200mcg/kg - single dose not to exceed 5 mg, repeated at half the initial dose (max 2.5mg) at 10-minute intervals - max dose 10mg
IV: 100mcg/kg
single dose not to exceed 2.5mg, repeated at 5 min intervals - max dose 10mg
What are the indications for GTN? (in relevance to med tox)
Autonomic dysreflexia (with a systolic BP >160 mmHg)
What are the contraindications for GTN?
Allergy AND/OR ADR
HR < 50 OR > 150 bpm
Systolic BP < 100 mmHg
Acute CVA
Head trauma
Phosphodiesterase 5 inhibitor medication administration:
- Sildenafil OR vardenafil in the previous 24 hrs
- Tadalafil in the previous 48 hrs
What are the precautions for GTN?
Inferior AMI
Cerebra vascular disease
Risk of hypotensions and/or syncope
Intoxication
Phosphodiesterase 5 inhibitor medication administration in the previous 4 days
What are the side effects of GTN?
Dizziness
Hypotension
Syncope
Reflex tachycardia
Vascular headaches
What is the adult dose for GTN (med tox relevance)?
SUBLING: 400mcg repeated at 5 min intervals, no max dose
What are the indications for naloxone?
Respiratory depression (secondary to the administration of narcotic drugs)
What are the contraindications for naloxone?
Allergy AND/OR ADR
The newly born patient
What are the precautions for naloxone?
Patients with pre-existing cardiac disease
What are the side effects of naloxone?
Combativeness, sweating, tachycardia and hypertension
Acute withdrawal convulsions in the chronic narcotic user
Pulmonary oedema
What is the adult dose for naloxone?
IM: 1.6mg single dose only
What is the paediatric dose for naloxone?
IM: 20mcg/kg
single dose only, do not exceed 800mcg
What are the indications for hydroxocobalamin?
Life-threatening cyanide toxicity (e.r. shock, respiratory failure, seizure, ALOC or myocardial ischaemia)
What are the contraindications for hydroxocobalamin?
Allergy AND/OR ADR
What are the precautions for hydroxocobalamin?
Hypertension
Pregnancy
What are the side effects of hydroxocobalamin?
Anaphylaxis
Chromaturia
Erythema
Rash
Hypertension
Renal failure
Headache
N and/or V
Pain at infusion site
What is the adult dose for hydroxocobalamin?
IV INF: 5g over 15 minutes
