Medication in acute care

Question 1

Main drugs used in resus

Answer 1

Oxygen and adrenaline

Question 2

Four main treatments in emergency care

Answer 2

Oxygen, analgesia, antibiotics and fluids

Question 3

What happens when a medium dose of adrenaline is given

Answer 3

Acts on beta 1 receptors which cause the heart to drive SAN and myocardial contractility receptors

Question 4

What happens when a high dose of adrenaline is given

Answer 4

Acts on alpha 1 receptors (after B1 are full) which cause constriction of peripheral blood vessels

Question 5

How often is IV adrenaline used

Answer 5

Every 3-5 minutes

Question 6

How much of adrenaline is used

Answer 6

10mls of 1/1000 solution

Question 7

What is the overall aim of administering adrenaline

Answer 7

Increase BP and increase coronary artery perfusion - increase diastolic BP

Question 8

When is amiodarone used

Answer 8

Shockable cardiac arrest rhythms, quickly in cardiac arrest, slowly in arrhythmias when patients are awake

Question 9

How much amiodarone is used

Answer 9

30mg/ml injection

Question 10

What is the action of amiodarone

Answer 10

Reduces myocardial excitability by increasing action potential duration and prolonging refractory period - reducing SA and AV node activity

Question 11

What shockable rhythm is amiodarone used in

Answer 11

VF / pulseless VT defibrilator resistant to 3 shocks

Question 12

What type of drug is amiodarone

Answer 12

Anti-arrhythmic. Class III (K blocker) but with other class effects such as beta blocker, Ca/Na blocker

Question 13

What type of drug is adenosine

Answer 13

Naturally found nucleoside

Question 14

What is the diagnostic action of adenosine used for

Answer 14

Used to block AV node to see the underlying pathology of what the atria are doing, to unmask the atrial activity. Diagnoses AF

Question 15

What is the action of adenosine

Answer 15

Hyperpolarises cells to increase K+ influx and decrease Ca influx - slows SA node and blocks AV node conduction

Question 16

What is the therapeutic action of adenosine

Answer 16

Used in narrow complex regular tachycardias

Question 17

What is the role of atropine

Answer 17

Used in bradycardia with adverse features of MI, HF, shock or syncope

Question 18

How much atropine is given

Answer 18

500 mcg IV

Question 19

How much adenosine is given

Answer 19

6 mg rapid IV bolus then can increase if not effect

Question 20

Action of atropine (3)

Answer 20

Anticholinergic, blocking vagal nerve activity and increasing HR

Question 21

Triad of anaesthesia and drugs to achieve this

Answer 21

unconsciousness, hypnosis and amnesia - analgesia and muscle relaxation used

Question 22

Which drugs give analgesic effects

Answer 22

Propofol, ketamine, fentanyl and morphine

Question 23

Which drugs are given for muscle relaxant effect

Answer 23

Vecuronium and rocuronium

Question 24

What is the action of beta 2 agonists

Answer 24

Smooth muscle relaxation

Question 25

What is the action of muscarinic antagonists

Answer 25

Blocks ACh receptors

Question 26

What is the action of methylxanthines

Answer 26

Inhibit phosphodiesterase enzyme

Question 27

Side effects of aminophylline

Answer 27

Toxicity and narrow therapeutic windoe

Question 28

Action of steroids in respiratory ED

Answer 28

Anti-inflammatories but all act by intracellular pathways so have slow action

Question 29

Side effects of beta 2 agonists (3)

Answer 29

Low K+, tremor, arrhythmia

Question 30

What do cardiac vasoactive drugs need to be able to do (3 main things)

Answer 30

Act on preload, contractility and afterload

Question 31

What do inotropes act on

Answer 31

Increase cardiac output by increasing velocity and force of myocardic connection

Question 32

What do inodilators do

Answer 32

Increase cardic output by combination of inotropic and vasodilation to reduce SVR

Question 33

What do vasopressors do

Answer 33

Increase SVR by increasing arteriolar smooth muscle

Question 34

6 types of renal drugs

Answer 34

Carbonic anhydrase inhibitors, osmotic diuretics, loop diuretics, thiazides, K+ sparing, aldosterone antagonists

Question 35

Types of haematological drugs

Answer 35

RBCs, fresh frozen plasma, platelets, tranexamic acid, anticoagulants

Question 36

Treatment of generic sepsis

Answer 36

Co-amoxiclav + Gentamicin

Question 37

Treatment of UTI/pyelonephritis with systemic features

Answer 37

Ciprofloxacin +/- Gentamicin

Question 38

Treatment of moderate community acquired pneumonia

Answer 38

Amoxicillin + Doxycycline

Question 39

Treatment of severe community acquired pneumonia

Answer 39

Cefuroxime + Azithromycin

Question 40

Treatment of early onset severe hospital acquired pneumonia

Answer 40

Ceftriaxone + Gentamicin

Question 41

Treatment of late onset severe hospital acquired pneumonia

Answer 41

Piperacillin- Tazobactam

Question 42

Treatment of peripheral line sepsis

Answer 42

Flucloxacillin

Question 43

Treatment of central line sepsis

Answer 43

Vancomycin

Question 44

Treatment of paediatric sepsus

Answer 44

Ceftriaxone

Question 45

Treatment of neonatal sepsis

Answer 45

Cefotaxime (+/- amoxicillin +/- aciclovir)

Question 46

Treatment of cellulitis

Answer 46

Flucloxacillin

Question 47

Treatment of neutropenic sepsis

Answer 47

Piperacillin - Tazobactam + Gentamicin

Question 48

Main antiviral treatment in acute care

Answer 48

Aciclovir

Question 49

Common legal drugs to overdose on

Answer 49

Paracetemol, aspirin, NSAIDs, antidepressants, antipsychotics, morphine

Question 50

Common illicit drugs to overdose on

Answer 50

Opioids, amphetamines