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SD3 > Medications > Flashcards

Medications Flashcards

1
Q

Dexamethasone Pharmacology

A

A corticosteroid secreted by the adrenal cortex
Actions:
Relieves inflammatory reactions
Provides immunosuppression

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2
Q

Dex Indications

A
  1. Bronchospasm associated with acute respiratory distress not responsive to nebulised Salbutamol
  2. Moderate - severe croup
  3. Acute exacerbation of COPD
  4. Adult stridor (non-foreign body obstruction)
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3
Q

Dex Contras

A
  1. Known hypersensitivity
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4
Q

Dex Precautions

A
  1. Solutions which are not clear or are contaminated should be discarded
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5
Q

Dex Side Effects

A

Nil

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6
Q

Dex Onset/Peak/Duration Times

A

IV effects:
Onset: 30 - 60 minutes
Peak: 2 hours
Duration: 36 - 72 hours

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7
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 A-V node

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8
Q

Fentanyl Indications

A
  1. Sedation to facilitate intubation (RSI - modified or Paediatric IFS)
  2. Sedation to maintain intubation
  3. Sedation to facilitate transthoracic pacing
  4. Sedation to facilitate synchronised cardioversion
  5. CPR interfering patient - ALS
  6. Analgesia – IV/IN
    History of hypersensitivity or allergy to morphine
    Known renal impairment / failure
    Short duration of action desirable
    Hypotension
    Nausea and/or vomiting
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9
Q

Fentanyl Contraindications

A
  1. History of hypersensitivity
  2. Late second stage of labour
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10
Q

Fentanyl Precautions

A
  1. Elderly/frail patients
  2. Impaired hepatic function
  3. Respiratory depression, e.g. COPD
  4. Current asthma
  5. Patients on monoamine oxidase inhibitors
  6. Known addiction to opioids
  7. Rhinitis, rhinorrhea or facial trauma (IN route)
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11
Q

Fentanyl Side Effects

A

Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles
Bradycardia

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12
Q

Fentanyl Onset/Peak/Duration Times

A

IV effects:
Onset: Immediate
Peak: < 5 minutes
Duration: 30 - 60 minutes
IN effects:
Peak: 2 minutes

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13
Q

Ipratropium Bromide Indications

A
  1. Severe respiratory distress associated with bronchospasm
  2. Exacerbation of COPD irrespective of severity
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14
Q

Ipratropium Bromide Contras

A
  1. Known hypersensitivity to Atropine or its derivatives
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15
Q

Ipratropium Bromide Precautions

A
  1. Glaucoma
  2. Avoid contact with eyes
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16
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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17
Q

Ipratropium Bromide Pharmacology

A

Anticholinergic bronchodilator
Actions:
Allows bronchodilatation by inhibiting cholinergic bronchomotor tone (i.e. blocks vagal reflexes which mediate bronchoconstriction)

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18
Q

Ipratropium Bromide Onset/Peak/Duration Times

A

Onset: 3 - 5 minutes
Peak: 1.5 - 2 hours
Duration: 6 hours

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19
Q

Ketamine Mode of Action

A

Anaesthetic agent with analgesic properties at lower doses.
Exact mechanism of action is unclear, but primarily works as an antagonist at N-methyl-D-aspartate
(NMDA) receptors. Ketamine may also interact with opioid, muscarinic and other receptors. Produces
a trance-like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes.

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20
Q

Ketamine Indications

A

Intubation
Analgesia
Sedation:
- Agitation
- Patient movement during CPR

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21
Q

Ketamine Contras

A

Suspected non-traumatic brain injury with severe hypertension (SBP > 180)

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22
Q

Ketamine Precautions

A

May exacerbate cardiovascular conditions (e.g. uncontrolled hypertension, stroke, recent MI,
cardiac failure) due to effects on HR and BP.

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23
Q

Ketamine Adverse Effects

A

CV: hypertension, tachycardia
CNS: emergence reactions (e.g. vivid dreams, restlessness, confusion, hallucinations, irrational
behavior); increased skeletal muscle tone (may resemble seizures)
Respiratory: transient respiratory depression and apnoea (rare)
GI: nausea and vomiting
Other: injection site pain, lacrimation, hypersalivation, diplopia, nystagmus

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24
Q

Ketamine Onset/Peak/Duration times

A

Onset of action:
IV
Onset 30 seconds (anaesthesia)
Duration 5-10 minutes (anaesthesia)

IN
Onset 5 minutes
Peak 20 mins
Duration 45 mins

IM
Onset 3-4 mins
Duration 12-25 mins

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25
Q

Methoxyflurane Mode of Action

A

Inhaled anaesthetic – produces analgesia at low concentrations, however the exact mode of
action is unknown

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26
Q

Methoxyflurane Indications

A

Analgesia

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27
Q

Methoxyflurane Contraindications

A

Pre-existing renal disease (see Notes below)
Known (or genetic susceptibility) to malignant hyperthermia

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28
Q

Methoxyflurane Precautions

A

Patients should not be administered > 6 mL of methoxyflurane in a 24 hour period, due to
increased risk of nephrotoxicity
To limit occupational exposure, methoxyflurane should not be administered in a confined space. Ensure adequate ventilation in ambulance. Place used Penthrox inhalers in a closed plastic bag when not in use.

29
Q

Methoxyflurane Adverse Effects

A

CNS: Dizziness, drowsiness
CV: Hypotension
GIT: Nausea and vomiting

30
Q

Methoxyflurane Onset/Peak/Duration Times

A

Onset of action: Within 6 to 10 breaths
Duration of action: Effects last 3-5 minutes after stopping the inhalation. One vial provides up
to 25 minutes of analgesia with continuous use

31
Q

Midazolam Pharmacology

A

Short acting CNS depressant
Actions:
Anxiolytic
Sedative
Anti-convulsant

32
Q

Midazolam Indications

A
  1. Status epilepticus
  2. Sedation to maintain intubation
  3. Sedation to facilitate intubation (RSI - modified or Paediatric IFS)
  4. Sedation to facilitate synchronised cardioversion
  5. Sedation to facilitate transthoracic pacing
  6. Sedation in the agitated patient (including patients under the Mental
    Health Act 2014)
  7. Sedation in psychostimulant OD
33
Q

Midazolam Contras

A
  1. Known hypersensitivity to benzodiazepines
34
Q

Midazolam Precautions

A
  1. Reduced doses may be required for the elderly/frail, patients with
    chronic renal failure, CCF or shock
  2. The CNS depressant effects of benzodiazepines are enhanced in the presence of narcotics and other tranquillisers including alcohol
  3. Can cause severe respiratory depression in patients with COPD
  4. Patients with myasthenia gravis
35
Q

Midazolam Side Effects

A

Depressed level of consciousness
Respiratory depression
Loss of airway control
Hypotension

36
Q

Midazolam Onset/Peak/Duration Times

A

IM effects:
Onset: 3 – 5 minutes
Peak: 15 minutes
Duration: 30 minutes
IV effects:
Onset: 1 – 3 minutes
Peak: 10 minutes
Duration: 20 minutes

37
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, pinpoint pupils)
Dependence (addiction)
Cardiovascular effects:
Vasodilatation
Decreases conduction velocity through the A-V Node

38
Q

Morphine Indications

A
  1. Pain relief
  2. Sedation to maintain intubation
  3. Sedation facilitate intubation (where fentanyl not appropriate for RSI -
    modified or Paediatric IFS)
39
Q

Morphine Contras

A
  1. History of hypersensitivity
  2. Renal impairment / failure
  3. Late second stage of labour
40
Q

Morphine Precautions

A
  1. Elderly/frail patients
  2. Hypotension
  3. Respiratory depression
  4. Current asthma
  5. Respiratory tract burns
  6. Known addiction to opioids
  7. Acute alcoholism
  8. Patients on monoamine oxidase inhibitors
41
Q

Morphine Side Effects

A

CNS effects:
Drowsiness
Respiratory depression
Euphoria
Nausea, vomiting
Addiction
Pin-point pupils

Cardiovascular effects:
Hypotension
Bradycardia

42
Q

Morphine Onset/Peak/Duration times

A

IV effects:
Onset: 2 – 5 minutes
Peak: 10 minutes
Duration: 1 – 2 hours
IM effects:
Onset: 10 – 30 minutes
Peak: 30 – 60 minutes
Duration: 1 – 2 hours

43
Q

Naloxone Pharmacology

A

An opioid antagonist
Actions:
Prevents or reverses the effects of opioids

44
Q

Naloxone Indications

A
  1. Altered conscious state and respiratory depression secondary to administration of opioids or related drugs
45
Q

Naloxone Contras

A

Nil

46
Q

Naloxone Precautions

A
  1. If patient is known to be physically dependent on opioids, be prepared for a combative patient after administration
  2. Neonates
47
Q

Naloxone Side Effects

A

Symptoms of opioid withdrawal:
Sweating, goose flesh, tremor
Nausea and vomiting
Agitation
Dilatation of pupils, excessive lacrimation
Convulsions

48
Q

Naloxone Onset/Peak/Duration Times

A

IV effects:
Onset: 1 – 3 minutes
Peak: n/a
Duration: 30 – 45 minutes
IM effects:
Onset: 1 – 3 minutes
Peak: n/a
Duration: 30 – 45 minutes

49
Q

Naloxone Presentation

A

0.4 mg in 1 mL glass ampoule

50
Q

Ondansetron Mode of Action

A

5-HT3 antagonist – exact mode of action is not fully understood. Release of serotonin (5-HT) is
thought to trigger a vomiting reflex in both the peripheral (GIT) and central nervous system.

51
Q

Ondansetron Indications

A

Undifferentiated nausea and vomiting
Prophylaxis where vomiting could be clinically detrimental (e.g. spinally immobilised, penetrating eye trauma)

52
Q

Ondansetron Contras

A

Apomorphine

53
Q

Ondansetron Precautions

A

Pregnancy 1st trimester – consult with receiving hospital

Congenital Long QT syndrome – ondansetron causes QT prolongation (dose-dependent effect) and increases the risk of Torsades de pointes in patients with a prolonged QT interval (QTC > 500 ms). Unlikely when administered at approved doses but avoid if patient has a history of
congenital Long QT syndrome.

Severe hepatic disease (e.g. cirrhosis) – limit total daily dose to a maximum of 8 mg (all routes of administration)

Ondansetron ODT may contain aspartame which should be avoided in patients with phenylketonuria. Ondansetron injection can be administered if appropriate

54
Q

Ondansetron Adverse Effects

A

CNS: Headache, dizziness
CV: QT prolongation (rare)
GI: Constipation
Other: Visual disturbance, including transient loss of vision (rare, associated with rapid IV administration)

55
Q

Ondansetron Significant Interactions

A

Apomorphine (injection used in the treatment of severe Parkinson’s disease) – reports of profound hypotension and loss of consciousness. Do not administer ondansetron to patients currently receiving apomorphine

56
Q

Ondansetron Onset/Peak/Duration Times

A

Peak: 10 minutes (IV, IM); 30 minutes (oral)
Duration of action: Several hours

57
Q

Prochlorperazine Mode of Action

A

Dopamine antagonist – antiemetic effects are primarily due to D2 receptor blockade. Also acts on
other neurotransmitter systems including histaminic, cholinergic and α-adrenergic receptors

58
Q

Prochlorperazine Indications

A

Nausea and vomiting in patient ≥ 21 years of age; specifically for
Known allergy or C/I to ondansetron
Vestibular nausea
Headache (irrespective of nausea / vomiting)

59
Q

Prochlorperazine Contras

A

CNS depression (i.e. unconscious or severely intoxicated)
Patients < 21 years of age.
Children and young adults are more susceptible to extrapyramidal reactions with
prochlorperazine.

60
Q

Prochlorperazine Precautions

A

Elderly patients - More susceptible to adverse effects

Parkinson’s disease - Can worsen symptoms of Parkinson’s disease, avoid if possible

61
Q

Prochlorperazine Adverse Effects

A

CNS: Sedation, blurred vision
CV: Postural hypotension, QT prolongation (rare)
Other: Extrapyramidal reactions

62
Q

Prochlorperazine Onset/Peak/Duration Times

A

Onset of action: 10-20 minutes
Duration of action: 3-4 hours

63
Q

Paracetamol Mode of Action

A

Analgesic and antipyretic – exact mechanism of action is unclear; thought to inhibit prostaglandin synthesis in the CNS

64
Q

Paracetamol Indications

A

Mild pain, or pain relief in combination with other analgesics
Headache

65
Q

Paracetamol Contras

A

Children < 1 month of age

66
Q

Paracetamol Precautions

A

Hepatotoxicity can occur with overdose. - Do not administer if paracetamol has already been given within past 4 hours, or if total paracetamol intake within past 24 hours exceeds 4g (adults) or 60 mg/kg (children)

Risk of hepatotoxicity is increased in the following circumstances:
Impaired hepatic function or liver disease
Elderly / frail patients
Malnourishment

67
Q

Paracetamol Adverse Effects

A

Hypersensitivity reactions including severe skin rashes (rare)
Haematological reactions (rare)
Hypotension has been reported with IV infusion, particularly in critically ill patients

68
Q

Paracetamol Onset/Peak/Duration Times

A

Onset of action: 30 minutes (oral), 5-10 minutes (IV)
Duration of action: 4 hours

69
Q

Paracetamol Presentation

A

500 mg tablets, 120mg in 5 mL oral liquid (24 mg/mL)

15mL/kg

SD3 (13 decks)

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