Medication Indications and Contraindication

Question 1

ICP - Adenosine - Indication Only

Answer 1

I:
1 Regular Supra-ventricular Tachycardia (SVT) (narrow complex)
2 Regular supra-ventricular Tachycardia with ventricular aberrancy of conduction (SVT-A)

Question 2

Adrenaline - I & C/I

Answer 2

I:
1-3 Cardiac Arrest rhythms (Persistent VF or unconscious pulseless VT, Asystole, PEA)
4-5 Inadequate Perfusion (cardiogenic, non-cardiogenic)
6 Anaphylaxis reactions
7 Severe Asthma
8 Unconscious asthma with no blood pressure
9 Croup or suspected croup/epiglottitis
10 Bradycardia with poor perfusion

C/I:
Hypovolaemic shock without adequate fluid replacement

Question 3

ICP - Amiodarone - Indications Only

Answer 3

I:
1 VF or pulseless VT refractory to cardioversion
2 Sustained or recurrent VT

Question 4

Aspirin - I & C/I

Answer 4

I:
To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS.

C/I:
1 Hypersensitivity
2 Active bleeding peptic ulcers
3 Bleeding disorders
4 Suspected dissecting aortic aneurysm
5 Chest pain with psychostimulant overdose with BP >160

Question 5

ICP - Atropine - Indications Only

Answer 5

I:
1 Bradycardia with less than adequate perfusion
2 Organophosphate poisoning with excessive cholinergic effects
3 Nerve agent poisoning

C/I:
Nil in the above indication

Question 6

Ceftriaxone - I & C/I

Answer 6

I:
1 Suspected Meningococcal Septicaemia
2 Severe Sepsis (with medical consult)

C/I:
1 Hypersensitivity to cephalosporin antibiotics

Question 7

ICP - Clopidogrel - I & C/I

Answer 7

I:
1 Pts with STEMI who have been approved for thrombolysis

C/I:
1 Allergy to clopidogrel
2 Pts who are contraindicated as per the AT Reprofusion Checklist

Question 8

Dexamethasone - I & C/I

Answer 8

I:
Severe COVID19

ICP
1 Bronchospasm associated with acute respiratory distress not responsive to nebulised Salbutamol
2 Acute exacerbation of COPD
3 Suspected Croup

C/I:
Known hypersensitivity to dexamethasone or other corticosteroids

Question 9

Diazepam - I & C/I

Answer 9

I:
1 Pts with a SAT score >= +1

C/I:
1 Hypersensitivity to diazepam or other benzodiazepines
2 Myasthenia Gravis

Question 10

Droperidol - I & C/I

Answer 10

I:
1 Pts with a SAT score >= +2

C/I:
1 Known allergy or adverse reaction
2 Parkinson's Disease
3 Previous Hx dystonic reactions
4 Paeds <8

Question 11

ICP - Enoxaparin - I & C/I

Answer 11

I:
1 Pts with STEMI who have been approved for thrombolysis by AT Retrieval Consultant

C/I:
1 Allergy to Enoxaparin
2 Pts who are contraindicated as per the AT Reprofusion Checklist

Question 12

ICP - Ergometrine - Indications Only

Answer 12

I:
PPH or post-abortal haemorrhage greater than 600ml, and certain all foetuses have been delivered

C/I:
1 Known allergy
2 Past Hx of pre-eclampsia
3 Hypertension (BP >160)

Question 13

Fentanyl - I & C/I

Answer 13

I:
1 Pain Relief
2 Sedation to maintain intubation

C/I:
1 Hypersensitivity
2 Active Labour
3 Paeds <1 years
4 For IN use - Epistaxis or occluded nasal passages

Question 14

ICP - Frusemide - Indications Only

Answer 14

I:
Acute Left ventricular failure with evidence of fluid overload

C/I:
Nil in the above setting

Question 15

Glucagon - I & C/I

Answer 15

I:
Diabetic Hypoglycaemia (BGL <4mmol/L) in Pts unable to self administer oral glucose paste

C/I:
Nil in the above indication

Question 16

GTN - I & C/I

Answer 16

I:
1 Chest pain associated with ACS
2 Hypertension associated with ACS (SBP >160, DBP >100)
3 Left Ventricular Failure (pulmonary oedema)
4 Autonomic Dysreflexia

C/I:
1 Ventricular Tachycardia
2 Right Ventricular Infarct
3 HR >150 or <50 (excluding for Autonomic Dysreflexia)
4 BP less than 100mmHg
5 Use of Viagra in past 24hrs, or Cialis in the past 4/7
6 Hypersensitivity

Question 17

ICP - Heparin - I & C/I

Answer 17

I:
1 Pts with STEMI who have been approved for thrombolysis by AT Retrieval Consultant

C/I:
1 Allergy to Heparin
2 Pts who are contraindicated as per the AT Reprofusion Checklist

Question 18

Ipratropium Bromide - I & C/I

Atrovent

Answer 18

I:
Severe respiratory distress with associated bronchospasm

C/I:
Known hypersensitivity to Atropine or its derivatives

Question 19

ICP - Ketamine - Indications Only

Answer 19

I:
Enhanced pain relief in patients with borderline or inadequate perfusion associated with uncontrolled MSK pain or severe burns

C/I:
1 Known hypersensitivity
2 Paeds <1yr
3 Traumatic Head Injury
4 Hypertension (BP >180mmHg SYS, >100mmHg DIA)
5 Suspected ACS
6 Suspected heart failure
7 Known hydrocephalus or raised intraoccular pressure

Question 20

Lignocaine Hydrochloride - I & C/I

Answer 20

I:
Diluent for Ceftriaxone for IM administration for suspected meningococcal disease

C/I:
1 Known hypersensitivity
2 Bradycardia with inadequate perfusion
3 Evidence of 2nd or 3rd degree heart block

Question 21

ICP - Magnesium Sulphate - Indications Only

Answer 21

I:
1 Pts with severe asthma not responding to nebulised salbutamol
2 Torsardes de Pointes
3 Eclampsia
4 Pre-eclampsia (with medical consult)

C/I:
1 Known hypersensitivity
2 Heart Blocks
3 Impaired renal or hepatic function
4 Addison's Disease

Question 22

Methoxyflurane - I & C/I

Answer 22

I:
Pain relief where narcotics are contraindicated or not appropriate

C/I:
1 Pre-existing renal disease or impairment
2 Family Hx of anaesthetic induced malignant hyperthermia
3 Concurrent Tetracycline antibiotics use
4 Exceeding dose more than 6mls in 24 hours OR 15mls in any 7 day period

Question 23

Metoclopramide - I & C/I

Maxolon

Answer 23

I:
Nausea and vomiting associated with
1 Narcotics pain relief
2 Past Hx of migraines

C/I:
1 Known hypersensitivity
2 GIT haemorrhage, perforation or obstruction
3 Paeds <16yrs

Question 24

Midazolam - I & C/I

Answer 24

I:
1 Continuous or recurrent Seizures

ICP
2 Severe Trauma or Severe Burns
3 Sedation to maintain intubation
4 Sedation to enable synchronized cardiversion
5 Sedation for agitated patients
6 Sedation for psychostimulant overdose

C/I:
1 Known hypersensitivity to benzodiazapines

Question 25

Morphine - I & C/I

Answer 25

I:
Pain relief
Sedation to maintain intubation

C/I:
1 Known hypersensitivity
2 Active Labour

Question 26

Naloxone - I & C/I

Answer 26

I:
Severe respiratory depression and altered conscious state secondary to narcotics or related drug use

C/I:
Nil in the in the above setting

Question 27

Ondansatron - I & C/I

Answer 27

I:
Nausea and vomiting associated with
1 Cardiac Chest Pain
2 Secondary to cytotoxic drugs or radiotherapy
3 Severe gastroenteritis
4 Previous Dx migraine
Prophylaxis use in
1 Eye injuries
2 Suspected Spinal Injuries
3 Planned AMR transport
4 Motion sickness

C/I:
1 Known hypersensitivity
2 Paeds <2yrs

Question 28

Paracetamol - I & C/I

Answer 28

I:
Mild Pain

C/I:
1 Known hypersensitivity
2 Suspected cardiac chest pain (ACS)
3 Paeds <1 months age
4 Any previous dose in the past 4 hours OR more than 4g (60mg/kg paeds) in the past 24hrs

Question 29

Prochlorperazine - I & C/I

Stemetil

Answer 29

I:
Treatment or prophylaxis of N&V for
1 Motion sickness
2 Eye injuries
3 Planned AMR transport
4 Vertigo or N&V associated with migraine, labyrinthitis or Meniere’s Synrome
5 Known allergy or contraindiction to Metoclopramide

C/I:
1 Circulatory collapse
2 CNS Depression
3 Previous hypersensitivity
4 Paeds <2years

Question 30

Salbutamol - I & C/I

Answer 30

I:
Respiratory distress with suspected brochospasm
1 Asthma
2 Allergic Reaction
3 COPD
4 smoke inhalation

C/I:
Ni in the above indication

Question 31

ICP - Sodium Bicarbonate - Indications Only

Answer 31

I:
1 Sympomatic TCA overdose or hyperkalaemia (peaked T waves)
2 Crush syndrome with evidence of hyperkalaemia
3 Cardiac arrest with suspected hyperkalaemia or TCA overdose

C/I:
Nil in the above indications

Question 32

ICP - Tenecteplase - I & C/I

Answer 32

I:
1 Pts with STEMI who have been approved for thrombolysis by AT Retrieval Consultant

C/I:
1 Allergy to Tenectaplase
2 Pts who are contraindicated as per the AT Reprofusion Checklist