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ILS Study > Medications > Flashcards

Medications Flashcards

1
Q

Adrenaline MOA

A
  1. Adrenaline stimulates the alpha and beta receptors with predominant effects occurring at alpha 1, beta 1 and beta 2 receptors
  2. Alpha 1 stimulation causes smooth muscle contraction, vasoconstriction of blood vessels and stimulation of glycogenolysis and gluconeogenesis
  3. Beta 1 stimulation causes an increase in inotropy (cardiac contractility), chronotropy (HR) and dromotopy (speed of electrical conduction within the heart).
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2
Q

Scopes of practice adrenaline

A

EMTS: Nebulised, IM, IN and tropical adrenaline
Paramedics: All of the above and adrenaline IV for cardiac arrests

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3
Q

Indications for adrenaline

A

Cardiac arrest
Anaphylaxis
Severe asthma
Imminent respiratory arrest from COPD
Severe bradycardia
BP support if unresponsive to to metaraminol
Septic shock, cardiogenic shock, and neurogenic shock unresponsive to 0.9% sodium chloride IV and metaraminol IV
Stridor causing moderate to severe respiratory distress
IN for clinically significant epistaxis
Topical for clinically significant bleeding from a wound

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4
Q

Contraindications for adrenaline

A

Nil

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5
Q

Cautions for adrenaline

A

Myocardial ischaemia. Adrenaline will increase myocardial oxygen consumption
Tachydysrhythmias. Adrenaline will usually make it worse

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6
Q

Use in pregnancy adrenaline

A

Safe and should be administered when indicated

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7
Q

Administration for adrenaline TOPICAL

A

Dilute each mg of adrenaline to a total of 10ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1mg/ml.

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8
Q

Administration for adrenaline IN

A

Dilute each mg of adrenaline to a total of 10ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1mg/ml. Administer the appropriate dose into each bleeding nostril using a MAD

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9
Q

Administration for adrenaline NEBULISED

A

5mg undiluted

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10
Q

Administration for adrenaline IM

A

Undiluted. Preferred site is lateral thigh but if not suitable use upper arm

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11
Q

Administration for adrenaline in cardiac arrest

A

Adults and children whose weight is >50kg, administer undiluted as a bolus
Children weighing <40kg, dilute 1mg to a total of 10ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1mg/ml. Draw up the dose from this solution and administer as an IV bolus.

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12
Q

Usual onset of effect adrenaline

A

IV: 5-10 seconds
IM: 2-5 minutes
Nebulised, IN and topical: On contact with the target site

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13
Q

Usual duration of effect adrenaline

A

The cardiovascular effects last 5-15 minutes
The mast cell membrane effects may last for several hours

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14
Q

Usual preparation of adrenaline

A

Ampoule 1mg in 1ml

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15
Q

Pharmacokinetics adrenaline

A

Adrenaline is metabolised by the liver and taken up by sympathetic nerve endings.
There are no significant effects from liver impairment on acute administration.

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16
Q

Common interactions adrenaline

A

Increased doses may be required if the patient is taking a beta-blocker or a calcium channel blocker. This effect is particularly prominent in the setting of poisoning if a large dose of a beta-blocker and/or calcium channel blocker has been taken.

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17
Q

Amiodarone MOA

A

Amiodarone is an antidysrhythmic with a broad spectrum of activity.
Amiodarone has class III activity. it prolongs the action potential duration, reduces the automaticity and prolongs the refractory period of atrial, nodal and ventricular tissues.
The electrophysiological effects result in a reduction in abnormal electrical activity (e.g ectopy), a reduction in electrical conduction, a reduction in HR and a stabilisation of the SA and AV nodes.
Amiodarone also causes a small increase in coronary blood flow (not usually clinically significant) and a reduction in myocardial oxygen consumption by reducing inotropy (force of cardiac contraction)

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18
Q

Scopes of practice Amiodarone

A

Paramedics: Cardiac arrest

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19
Q

Indications for amiodarone

A

Cardiac arrest with VF or VT at any time after the first dose of adrenaline
Adults with sustained VT in the absence of cardiac arrest
Adults with moderate cardiovascular compromise as a result of fast atrial fibrillation or atrial flutter

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20
Q

Contraindications for amiodarone

A

Known severe allergy.
Known severe allergy to iodine.
VT secondary to cyclic antidepressant poisoning. In this setting amiodarone administration can be associated with severe worsening of shock without resolution of the rhythm

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21
Q

Cautions for amiodarone

A

None if the patient is in cardiac arrest.
Poor perfusion or signs of low cardiac output. Amiodarone reduces inotropy and may cause a fall in cardiac output, particularly when administered rapidly.
Hypotension. Amiodarone causes vasodilation and may worsen hypotension, particularly when administered rapidly.
Atrial fibrillation associated with sepsis. May cause a significant fall in cardiac output.
Known sick sinus syndrome without an internal pacemaker in place. Amiodarone slows the HR and severe bradycardia may occur following reversion of the tachydysrhythmia.
Previous 2nd or 3rd degree heart block without an internal pacemaker in place. Amiodarone slows the heart rate and severe bradycardia may occur following reversion of a tachydysrhythmia.
Pregnancy

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22
Q

Use in pregnancy amiodarone

A

May cause harm during pregnancy. Do not administer unless there is a strong clinical indication to.
May be administered if patient is breastfeeding. Advise pt stop breastfeeding and seek further advice from their lead maternity carer or GP.

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23
Q

Dosage amiodarone

A

Cardiac arrest:
300mg for an adult, if VF/VT persists a second dose of 150mg may be administered.
Seek paed dose table for paed dosages

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24
Q

Administration amiodarone

A

Cardiac arrest: administer IV undiluted as a bolus

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25
Q

Common adverse effects amiodarone

A

Hypotension
Lightheadedness
Bradydysrhythmia

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26
Q

Usual onset of effect amiodarone

A

5-10 minutes

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27
Q

Usual duration of effect amiodarone

A

1-4 hours after a single dose
Amiodarone is taken up into tissues and slowly released. This may result in a prolonged half-life, particularly when one or more doses have been administered.

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28
Q

Usual preparation amiodarone

A

Ampoule containing 150mg in 3ml.

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29
Q

Pharmacokinetics amiodarone

A

Metabolised in the liver.
No significant effects from liver impairment on acute administration.

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30
Q

Common interactions amiodarone

A

May potentiate the action of cyclic antidepressants in cyclic poisoning.
May cause bradydysrhythmia following reversion of dysrhythmia if the pt is taking a betablocker and/or centrally acting calcium channel blocker.

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31
Q

Aspirin MOA

A

Aspirin has antiplatelet, antipyretic, anti-inflammatory and analgesic effects. In the prehospital setting only administered for antiplatelet activity
Aspirin inhibits the enzyme cyclooxygenase which results in a reduction in the formation of prostaglandins and thromboxane.

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32
Q

Aspirin scopes

A

EMTS, paramedics, icps

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33
Q

Indications for Aspirin

A

Myocardial ischemia
STEMI

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34
Q

Contraindications for Aspirin

A

Known severe allergy.
Third trimester pregnancy.

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35
Q

Cautions for Aspirin

A

Known bleeding disorder. Aspirin will increase the risk of bleeding, however the balance of risk is usually in favour of administering aspirin.
Clinically significant bleeding.
Known worsening bronchospasm with NSAIDS.

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36
Q

Use in pregnancy Aspirin

A

May cause harm during pregnancy. Aspirin has been associated with premature delivery and premature closure of the ductus arteriosus when administered in the third trimester of pregnancy.
Likelihood of clinically important myocardial ischemia occurring in a woman who is pregnant is so low that the balance of risk is in favour of aspirin being withheld.
May be administered if breastfeeding.

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37
Q

Dosage for Aspirin

A

300mg tablet

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38
Q

Administration for Aspirin

A

Administer PO. Chew tablet or dissolved in water.

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39
Q

Usual onset of effect Aspirin

A

30-60 minutes

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40
Q

Usual duration of effect Aspirin

A

3-5 days for the antiplatelet activity. Platelets exposed to aspirin are impaired for the life of the platelet which is 7-10days.

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41
Q

Usual preparation Aspirin

A

300mg tablet

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42
Q

Pharmacokinetics Aspirin

A

Absorption occurs in the stomach and small intestine.
Aspirin is predominantly metabolised in the liver.
No significant effects from liver impairment on acute administration

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43
Q

Cefazolin MOA

A

Cefazolin is a first-generation cephalosporin antibiotic with activity against gram negative and gram-positive bacteria. It inhibits production of the bacterial cell wall causing bacteria to die.

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44
Q

Scopes of practice Cefazolin

A

Paramedics, ICPs and CCPs

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45
Q

Indications Cefazolin

A

Sepsis, where the source of the infection appears to be the soft tissues or joint and:
The patient is aged >12yrs
Has one or more clinical features indicating taking antibiotics and
Time to hospital is >30 minutes.
Cellulitis. In this setting a single dose may be administered if the patient is not being directly referred or transported to a medical facility.

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46
Q

Contraindications Cefazolin

A

Known severe allergy to cephalosporins.

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47
Q

Cautions Cefazolin

A

None

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48
Q

Use in pregnancy Cefazolin

A

Safe and should be administered if indicated.

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49
Q

Dosage Cefazolin

A

1G IV

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50
Q

Administration Cefazolin

A

Add 4ml of 0.9% Sodium Chloride to a 1G ampoule and shake until dissolved.
Draw up the ampoule contents and dilute to a total of 10ml.
Administer IV over 1-2 minutes preferably into a running line.

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51
Q

Common adverse effects Cefazolin

A

None

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52
Q

Usual onset of effect Cefazolin

A

30-60 minutes

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53
Q

Usual duration of effect Cefazolin

A

6-8 hours

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54
Q

Usual presentation Cefazolin

A

Ampoule containing 1g of Cefazolin as a powder for reconstitution

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55
Q

Pharmacokinetics Cefazolin

A

Cefazolin is predominantly excreted in the urine.
Clearance is prolonged if the patient has significant kidney impairment but does not alter the initial dose.

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56
Q

Common interactions Cefazolin

A

N/A

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57
Q

Ceftriaxone MOA

A

Ceftriaxone is a cephalosporin antibiotic with broad activity against gram-negative and gram-positive bacteria. It inhibits production of the bacterial cell wall, causing bacteria to die.

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58
Q

Delegated scopes Ceftriaxone

A

Paramedics, ICPs, CCPs

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59
Q

Indications Ceftriaxone

A

Suspected meningococcal septicaemia.
Sepsis, where Cefazolin is not indicated and:
Pt is aged >12 years.
One or more clinical features indicating antibiotics are present and
Time to hospital >30 mins.

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60
Q

Contraindications Ceftriaxone

A

Anaphylaxis to Cephalosporins

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61
Q

Cautions Ceftriaxone

A

None

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62
Q

Use in pregnancy Ceftriaxone

A

Safe and should be administered if indicated.

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63
Q

Dosage Ceftriaxone

A

2g IV for an adult
2 g IM for an adult if IV access cannot be immediately obtained (Meningococcal septicaemia only).
See paeds dose table for a child.

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64
Q

Administration Ceftriaxone

A

IV:
Add 4ml of 0.9% sodium chloride to a 2g ampoule, shake until dissolved.
Draw up the ampoule and dilute to a total of 10ml.
Discard unrequired volume before administration for a child.
Administer IV over 1-2 min preferably in a running line.

IM:
Add 4ml of 0.9% sodium chloride to a 2g ampoule, shake until dissolved.
Draw up the ampoule using 2 syringes with approximately half in each. Total volume will be 5ml.
Discard unrequired volume before administration for a child.
Administer one syringe into each lateral thigh.

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65
Q

Common adverse effects Ceftriaxone

A

None

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66
Q

Usual onset of effect Ceftriaxone

A

30-60 minutes

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67
Q

Usual duration of effect Ceftriaxone

A

24 hours

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68
Q

Usual preparation Ceftriaxone

A

Ampoule containing 2 g of ceftriaxone as a powder for reconstitution.

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69
Q

Pharmacokinetics Ceftriaxone

A

50% is excreted in urine and 50% in bile.
Neither renal impairment nor hepatic impairment after initial dose.

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70
Q

Clopidogrel MOA

A

Clopidogrel has antiplatelet activity.
Clopidogrel antagonises (blocks) the binding of adenosine diphosphate (ADP) to platelets and impairs platelet function. Clopidogrel provides significantly more antiplatelet activity than aspirin.

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71
Q

Delegated scopes Clopidogrel

A

Paramedics, ICPs, CCPs

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72
Q

Indications Clopidogrel

A

STEMI, in conjunction with fibrinolytic therapy

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73
Q

Contraindications Clopidogrel

A

Known severe allergy.

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74
Q

Cautions Clopidogrel

A

Clinically significant bleeding. Clopidogrel will increase bleeding.
At risk of bleeding, any cautions present within the fibrinolytic therapy checklist, personnel must seek advice.
Pregnancy.

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75
Q

Use in pregnancy Clopidogrel

A

Safety has not been demonstrated during pregnancy. Likelihood of STEMI in pregnancy is so low that personnel must seek clinical advice.
May be administered if pt is breastfeeding.

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76
Q

Dosage Clopidogrel

A

300mg if patient is aged <75.
75mg if the patient is aged >75.

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77
Q

Administration Clopidogrel

A

PO

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78
Q

Common adverse effects Clopidogrel

A

Increased bleeding

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79
Q

Usual onset of effect Clopidogrel

A

30-60 minutes

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80
Q

Usual duration of effect Clopidogrel

A

3-5 days. Refer to aspirin duration

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81
Q

Usual preparation Clopidogrel

A

75mg tablets

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82
Q

Pharmacokinetics Clopidogrel

A

A prodrug and must be metabolised to the active form of the liver.
No significant effects from liver impairment on acute administration.

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83
Q

Common interactions Clopidogrel

A

The risk of bleeding will be increased if the patient is taking an anticoagulant.

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84
Q

Droperidol MOA

A

Droperidol blocks dopamine and alpha receptors centrally, resulting in sedation, reduced agitation and a state of mental detachment, and antiemetic action.

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85
Q

Delegated scopes Droperidol

A

Paramedics, ICPs, CCPs

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86
Q

Indications Droperidol

A

Patients aged >12 years with acute behavioural disturbance causing a mild to moderate risk to safety, when olanzapine has been administered or is ineffective.
Moderate to severe pain associated with one of the following despite opiate analgesia and ketamine not appropriate:
Chronic or complex pain
Chronic use of opiates
Severe headache
Severe pain associated with agitation
Pain associated with severe nausea and/or vomiting.
Management of agitation or pain that does not respond to an opiate during end of life care.
Nausea and/or vomiting that persists despite ondansetron or where motion sickness is a component of the patients nausea/vomiting.

87
Q

Contraindications Droperidol

A

Known severe allergy.
Aged <12 years.
Pregnancy (analgesia and nausea/vomiting only).

88
Q

Cautions Droperidol

A

ALOC. Increases and prolongs effects.
Parkinsons disease. Risk of worsening the movement disorder associated with parkinsons disease.
Concurrent administration of ketamine or midazolam. Increases and prolongs effects.
Aged >75 years, particularly if frail. Effects will be increased and prolonged.
Signs of shock. Droperidol will make shock worse.

89
Q

Use in pregnancy

A

Likelihood of requiring droperidol for breastfeeding or pregnant patient with acute behavioural disturbance is very low, however, the balance of risk is such that it should be administered if indicated in this context.
In the context of analgesia and nausea and/or vomiting, the balance of risk is not in favour of administration of droperidol and therefore is contraindicated.

90
Q

Dosage Droperidol

A

Analgesia: 1.25mg IV for an adult, once only. Consider reducing the dose to 0.625mg if a caution is present.
For ABD: 10 mg IV or IM, consider reducing to 5mg if a caution is present, can be repeated after 20 minutes.
End of life care: 2.5mg IV/IM/SC, dose may be repeated as required
Nausea and/or vomiting: 0.625mg IV/IM for an adult, once only.

91
Q

Administration Droperidol

A

IV in ABD:
Draw up required dosage into 10ml syringe, dilute to total of 10ml using 0.9% sodium chloride. Administer over 1-2 minutes.
IV for nausea/vomiting:
Draw up 2.5mg into 5ml syringe and dilute to 4ml using 0.9% sodium chloride. This gives a 0.625mg/ml solution. Administer the required dose as an IV bolus.
IM:
Administer undiluted.
SC:
Administer undiluted subcutaneously into abdominal wall.

92
Q

Common adverse effects Droperidol

A

Hypotension. May occur if a large IV dose is administered rapidly.

93
Q

Usual onset of effect Droperidol

A

IV/IM: 5-10 minutes

94
Q

Usual duration effect Droperidol

A

4-6 hours

95
Q

Usual preparation Droperidol

A

Ampoule containing 2.5mg in 1ml

96
Q

Pharmacokinetics Droperidol

A

Predominantly metabolised in the liver with metabolites being excreted in the urine.
There are no significant effects from liver impairment on acute administration.

97
Q

Common interactions Droperidol

A

Intoxication: Increased sedative effects with alcohol or recreational drugs.
Sedative drugs: Concurrent administration with other sedative drugs (i.e Olanzapine or Midazolam) will result in increased sedative effect.

98
Q

Enoxaparin MOA

A

A low molecular weight heparin anticoagulant.
Enoxaparin potentiates the activity of antithrombin III (naturally occuring anticoagulant) causing inhibition of multiple coagulation factors, particularly factor Xa.

99
Q

Delegated scopes Enoxaparin

A

Paramedics, ICPs, CCPs

100
Q

Indications Enoxaparin

A

STEMI in conjunction with fibrinolytic therapy.

101
Q

Contraindications Enoxaparin

A

Known severe allergy.

102
Q

Cautions Enoxaparin

A

Clinically significant bleeding. Clopidogrel will increase bleeding.
At risk of bleeding, any cautions present within the fibrinolytic therapy checklist, personnel must seek advice.
Pregnancy.

103
Q

Use in pregnancy Enoxaparin

A

Safety has not been demonstrated during pregnancy. Likelihood of STEMI in pregnancy is so low that personnel must seek clinical advice.
May be administered if pt is breastfeeding.

104
Q

Dosages Enoxaparin

A

Refer to guideline, varies from age and weight.

105
Q

Administration Enoxaparin

A

Administer SC into abdominal wall.
Discard unwanted drug from the syringe before administration.
If an error is made in discarding the unwanted drug volume and the dose remaining in the syringe is less than planned, administer remaining dose.

106
Q

Common adverse effects Enoxaparin

A

Increased bleeding.

107
Q

Usual onset of effect Enoxaparin

A

10-30 minutes.

108
Q

Usual duration of effect Enoxaparin

A

12-24 hours.

109
Q

Usual preparation Enoxaparin

A

Pre-filled syringe containing 100mg in 1ml

110
Q

Pharmacokinetics Enoxaparin

A

Predominately excreted in the urine.
Clearance is prolonged if the patient has significant renal impairment, but this does not alter the initial dose.

111
Q

Common interactions Enoxaparin

A

Risk of bleeding will be increased if the patient is taking an anticoagulant.

112
Q

Fentanyl MOA

A

Fentanyl is an opiate analgesic. It is an opiate agonist (or stimulator) that binds to opiate receptors of the brain and spinal cord causing analgesia.

113
Q

Delegated scopes of practice Fentanyl

A

Paramedics, ICPs, CCPs

114
Q

Indications Fentanyl

A

Moderate to severe pain
Cardiogenic pulmonary odema with severe anxiety
RSI
Sedation post intubation
Control of pain, agitation, or SOB during end of life care

115
Q

Contraindications Fentanyl

A

Known severe allergy

116
Q

Cautions Fentanyl

A

ALOC - Fentanyl may reduce LOC
Aged <1 year. Increased risk of respiratory depression following opiate administration
Respiratory depression or high risk of respiratory depression - E.g Severe COPD, morbid obesity, at home BiPAP.
Labour - Opiates cross the placenta and may cause drowsiness and/or respiratory depression in the baby
Concurrent administration of other opiates, ketamine or midazolam. May increase and prolong the effects.
Aged >75 years, particularly if frail - effects of fentanyl will be increased and prolonged in this cohort.
Signs of shock - fentanyl may make shock worse.

117
Q

Use in pregnancy Fentanyl

A

Safety has not been demonstrated, should be administered if indicated.
May be administered if the pt is breastfeeding.

118
Q

Dosage Fentanyl

A

IV for analgesia:
10-50mcg every 5 minutes for an adult.
Consider commencing an infusion using service guidelines.
Seek paed dosage table for a child.

IN for analgesia:
Children: Seek paed dosage table for children
Subsequent doses may be administered every 20 minutes up to a total of 3 doses.
Halve all doses if the patient has signs of shock.

IM and SC for analgesia:
Adult: 50-100mcg IM/SC
Same as IN
Children: Refer to paed drug dose tables

119
Q

Administration Fentanyl

A

Preferred route of administration is IV
IV for analgesia: Dilute 100mcg to a total of 10ml using 0.9% sodium chloride for an adult or a child whose weight has been rounded up to 30kg or >. Final solution contains 10mcg/ml.
Dilute 100mcg to a total of 100ml for a child whose weight has been rounded to 20kg or <. This final solution contains 1mcg/ml.

IN for children:
Draw up undiluted, place half the total dose into two seperate 1ml syringes, additional 0.1ml and expel through the MAD to fill dead space.
Administer IN rapidly into each nostril, rapid injection required to achieve a fine mist, maximizing absorption.

IM administration: Administer undiluted.

SC administration:
Administer undiluted SC into the abdominal wall.
Pinch a fold of skin over the anterior abdominal wall between the thumb and forefinger. Introduce the entire length of the needle using the dart technique and inject.

120
Q

Common adverse effects Fentanyl

A

Respiratory depression
Bradycardia
Hypotension
Sedation
Nausea and vomiting
Itch
Euphoria

121
Q

Usual onset of effect Fentanyl

A

IV: 2-5 minutes.
IN: 5-10 minutes.
IM/SC: 5-10 minutes.

122
Q

Usual duration of effect Fentanyl

A

30-60 minutes.

123
Q

Usual preparation Fentanyl

A

Ampoule containing 100mcg in 2ml

124
Q

Pharmacokinetics Fentanyl

A

Fentanyl is more lipophilic (fat soluble) than morphine, which is why fentanyl is well absorbed through the nasal mucosa.
Fentanyl may cause a small amount of histamine release. In combination with relief of pain this results in a small fall in BP.
Fentanyl is metabolised in the liver
No significant effects from liver impairment on acute administration

125
Q

Common interactions Fentanyl

A

Effects will be increased in the presents of other opiates and sedatives.

126
Q

Glucagon MOA

A

Glucagon increases the blood glucose level by stimulating glycogenolysis (the breakdown of glycogen into glucose), predominantly within the liver.

127
Q

Glucagon Scopes

A

EMTs, Paramedics, ICPs, and CCPs

128
Q

Indications Glucagon

A

Hypoglycaemia when the patient cannot safely swallow glucose/food and IV access cannot be obtained.

129
Q

Contraindications Glucagon

A

Known severe allergy.

130
Q

Cautions Glucagon

A

None

131
Q

Use in pregnancy Glucagon

A

Safe and should be administered if indicated

132
Q

Dosage glucagon

A

1mg IM once for an adult or child aged greater than or equal to 5 years old
0.5mg IM once for a child aged <5 years

133
Q

Administration Glucagon

A

Dissolve the powder using the syringe within the kit and administer IM.
Preferred site lateral thigh as it has the best absorption

134
Q

Common adverse effects Glucagon

A

None

135
Q

Usual onset of effects Glucagon

A

5-10 minutes

136
Q

Usual duration of effect Glucagon

A

15-60 minutes

137
Q

Usual preparation Glucagon

A

Ampoule containing 1mg as a powder

138
Q

Pharmacokinetics Glucagon

A

Predominantly excreted unchanged into bile and urine
No significant effects from liver or kidney impairment on acute administration

139
Q

Glucose Gel MOA

A

Provides a source of glucose that can be easily swallowed and rapidly absorbed.

140
Q

Delegated scopes Glucose gel

A

All

141
Q

Indications Glucose gel

A

Hypoglycemia in adults and children provided the patient is conscious enough to be able to swallow safely.
Hypoglycemia in neonates

142
Q

Contraindications Glucose gel

A

None

143
Q

Cautions Glucose gel

A

None

144
Q

Use in pregnancy Glucose gel

A

Safe and should be administered if indicated

145
Q

Dosage Glucose gel

A

10-20g for all ages
Administer one sachet and repeat every 10 minutes if hypoglycemia persists or recurs.

146
Q

Administration Glucose gel

A

Administer PO
May be spread on the gums, tongue or inside the cheeks of a baby or small child.

147
Q

Common adverse effects Glucose gel

A

None

148
Q

Usual onset of effect Glucose gel

A

5-10 minutes

149
Q

Usual duration of effect Glucose gel

A

30-60 minutes

150
Q

Usual preparation Glucose gel

A

Multitude of different brands
Most are a sachet containing 10-20g glucose

151
Q

Pharmacokinetics Glucose gel

A

Absorbed in the stomach and small intestine
Rapidly metabolised by cells

152
Q

Common interactions Glucose gel

A

None

153
Q

GTN (Glyceryl Titrate) Spray MOA

A

GTN is a vasodilator. Acts on vascular smooth muscle to cause venous and arterial vasodilation, with the predominant effect being on the veins.

MOA is unclear. It appears that GTN results in the formation of nitric oxide which is a vasodilator. GTN causes:
A reduction in venous return (preload) to the heart. This reduces ventricular filling and cardiac output which reduces myocardial oxygen demand.
Arterial Dilation which reduces peripheral resistance (afterload). This reduces the force the left ventricle must overcome to eject blood into the arteries which reduces myocardial oxygen demand.
Dilation of the coronary arteries which may increase coronary blood supply, though this is not usually clinically significant

154
Q

Scopes GTN (Glyceryl Titrate) Spray

A

EMTs, Paramedics, ICPs, CCPs

155
Q

Indications GTN (Glyceryl Titrate) Spray

A

Myocardial ischaemia
Cardiogenic pulmonary odema
Control of HTN associated with autonomic dysreflexia
Control of HTN (usually in conjunction with labetalol) prior to fibrinolytic treatment for STEMI
Control of HTN (usually in conjunction with labetalol) during inter-hospital transfer for STEMI.
STEMI

156
Q

Contraindications (usually in conjunction with labetalol) GTN (Glyceryl Titrate) Spray

A

Known severe allergy
Systolic BP <110mmHg
HR <40/min
HR >150/min
VT

157
Q

Cautions GTN (Glyceryl Titrate) Spray

A

STEMI - Involvement of R ventricle. GTN causes a significant fall in CO.
The pt is frail
Signs of shock. Reduced CO may fall further with GTN.
Dysrhythmia. Same as above
Has taken a phosphodiesterase inhibitor in the last 24 hours.
Known aortic or mitral stenosis. With aortic or mitral stenosis CO may be reduced as a result of the narrowed valve and fall in preload may cause further fall in CO.

158
Q

Use in pregnancy GTN (Glyceryl Titrate) Spray

A

Safety has not been demonstrated. The likelihood of a pregnant or breastfeeding patient requiring GTN is very low but should be administered if indicated

159
Q

Dosage GTN (Glyceryl Titrate) Spray

A

Myocardial Ischaemia: 0.4mg every 5 minutes. Consider incr dosing to 10 minute intervals if a caution is present.
STEMI: 0.4mg with caution, withhold if signs of poor perfusion are present.
Cardiogenic pulmonary odema: 0.8mg every 5 minutes. Consider increasing dosing to 10 minute intervals if a caution is present.
Control of HTN: 0.4mg every 5 minutes

160
Q

Administration GTN (Glyceryl Titrate) Spray

A

Spray under the tongue, if unable to be achieved spray in mouth.
If administered with a caution present
The patient should be laying flat
IV access should have been obtained whenever possible
Dosing should be increased to 10 minutes
Be ready to administer 0.9% sodium chloride if there is a significant fall in CO or blood pressure

161
Q

Common adverse effects GTN (Glyceryl Titrate) Spray

A

Hypotension
Flushing
Headache
Tachycardia
Feeling lightheaded

162
Q

Usual onset of effect GTN (Glyceryl Titrate) Spray

A

1-2 minutes

163
Q

Usual duration of effect GTN (Glyceryl Titrate) Spray

A

15-30 minutes

164
Q

Usual preparation GTN (Glyceryl Titrate) Spray

A

Metered dose bottle delivering 0.4mg doses

165
Q

Pharmacokinetics GTN (Glyceryl Titrate) Spray

A

GTN is rapidly absorbed from the oral mucosa and reaches the vascular system without passing through the liver.
GTN is predominantly metabolised in the liver.
There are no significant effects from liver impairment on acute administration.

166
Q

Common interactions GTN (Glyceryl Titrate) Spray

A

The effects may be increased if the patient is taking an antihypertensive medication.
Severe and/or prolonged hypotension may occur if a phosphodiesterase inhibitor has been taken within the last 24 hours

167
Q

Mechanism of action Heparin

A

An anticoagulant. It potentiates the activity of thrombon III (a naturally occuring anticoagulant) causing inhibition of multiple coagulation factors

168
Q

Scopes Heparin

A

Paramedics, ICPs, CCPs

169
Q

Indications Heparin

A

Stemi in conjunction with Fibrinolytic therapy

170
Q

Contraindications Heparin

A

Known severe allergy
Aged >75 years. When heparin is administered in combination with fibrinolytic therapy in patients aged greater than or equal to 75 years, there is an increased risk of intracerebral hemorrhage

171
Q

Cautions Heparin

A

Clinically significant bleeding
At risk of bleeding
Pregnancy

172
Q

Use in pregnancy Heparin

A

Safety has not been demonstrated during pregnancy. Seek clinical advice
May be administered if pt is breastfeeding

173
Q

Dosage Heparin

A

5000 units.

174
Q

Administration Heparin

A

Dilute to a total volume of 10ml using 0.9% sodium chloride
Administer IV over 1-2 minutes

175
Q

Common adverse effects Heparin

A

Increased bleeding

176
Q

Usual onset of effect Heparin

A

5-15 minutes

177
Q

Usual duration of effect Heparin

A

2-4 hours

178
Q

Usual preparation Heparin

A

Ampoule containing 5000 units

179
Q

Pharmacokinetics Heparin

A

It is unclear how heparin is cleared

180
Q

Common interactions Heparin

A

The risk of bleeding will be increased if the patient is taking an anticoagulant

181
Q

Mechanism of action Ibuprofen

A

A non steroidal anti-inflammatory drug that is predominantly used for treating pain.
Inhibits the activity of the enzyme prostaglandin synthetase, reducing prostaglandin production and causing a reduction in inflammation, pain and fever.

182
Q

Delegated scopes of practice Ibuprofen

A

EMTs, Paramedics, ICPs and CCPs

183
Q

Indications Ibuprofen

A

Mild to moderate pain, usually in combination with paracetamol.
Moderate to severe pain, usually in combination with other medications.

184
Q

Contraindications Ibuprofen

A

Known severe allergy.
Pregnancy.
The presence of sepsis, dehydration, shock or clinically significant bleeding. Ibuprofen can worsen renal impairment, and increase the risk of bleeding.
Known worsening bronchospasm with NSAIDs. Some patients with asthma or COPD have known worsening bronchospasm with NSAIDs.

185
Q

Cautions Ibuprofen

A

The patient has taken Ibuprofen within the last 4 hours.
Abdominal pain, particularly if the patient is very unwell or vomiting, the possibility of significant intraabdominal pathology exists and oral medications should be withheld.
Aged > 75 years, particularly if frail. In this setting, renal impairment is likely, and ibuprofen may worsen renal impairment.

186
Q

Use in pregnancy Ibuprofen

A

May cause fetal harm during pregnancy. Ibuprofen has been associated with premature delivery and premature closure of the ductus arteriosus when administered during the third trimester of pregnancy.
May be administered if breastfeeding.

187
Q

Dosage Ibuprofen

A

600mg for an adult weighing >80kg.
400mg for an adult weighing <80kg
Seek paed dosages for paediatric

188
Q

Administration Ibuprofen

A

Administer PO.
Children unable to swallow tablets may be administered ibuprofen syrup, or tablets that have been crushed and placed in soft food such as jam or honey.

189
Q

Common adverse effects Ibuprofen

A

Renal impairment.
Increased bleeding.
Although indigestion, GI ulceration, and GI bleeding are listed as commonly listed as adverse effects, this is only associated with chronic administration.

190
Q

Usual onset of effect Ibuprofen

A

30-60 minutes.

191
Q

Usual duration of effect Ibuprofen

A

4-6 hours.

192
Q

Usual preparation Ibuprofen

A

200mg tablets
Syrup containing 20mg/ml.

193
Q

Pharmacokinetics Ibuprofen

A

Ibuprofen is absorbed in the stomach and small intestine. The presence of food in the stomach will delay absorption, but this is not usually clinically significant.
Ibuprofen is metabolised by the liver.
There are no significant effects from liver impairment on acute administration.

194
Q

Common interactions Ibuprofen

A

Warfarin. Ibuprofen displaces warfarin from binding sites and increases the activity of warfarin.

195
Q

Mechanism of action Ipratropium

A

Ipratropium is a bronchodilator.
Ipratropium is an anticholinergic agent with predominantly antimuscarinic activity. It antagonises (blocks) acetylcholine receptors causing vagal inhibition resulting in bronchodilation.

196
Q

Delegated scopes Ipratropium

A

EMTs, Paramedics, ICPs, and CCPs

197
Q

Indications ipratropium

A

Bronchospasm secondary to asthma or COPD
Prominant bronchospasm secondary to airway burns, smoke inhalation, or chest infection.

198
Q

Contraindications Ipratropium

A

Known severe allergy

199
Q

Cautions ipratropium

A

None

200
Q

Use in pregnancy Ipratropium

A

Has not been demonstrated but should be administered if indicated.
May be administered if the patient is breastfeeding.

201
Q

Dosage Ipratropium

A

0.5mg for adults and children once only

202
Q

Administration Ipratropium

A

Administer nebulised undiluted (in combination with salbutamol 5mg) using:
Air as the driving gas for COPD
Oxygen as the driving gas for asthma

203
Q

Common adverse effects Ipratropium

A

Tachycardia
Dry mouth
Blurred vision. Usually only occurs in repeated doses

204
Q

Usual onset of effect Ipratropium

A

2-5 minutes

205
Q

Duration of effect ipratropium

A

6 hours

206
Q

Usual preparation Ipratropium

A

Ampoule containing 0.5mg in 2ml

207
Q

Pharmacokinetics Ipratropium

A

Only a small dose is absorbed, with most of the dose being absorbed into the atmosphere. The inhaled ipratropium is absorbed through the lungs and some is swallowed.
Excretion is predominantly via the urine.
Clearance is prolonged if the pt has significant kidney impairment. This does not alter the initial dose.

208
Q

Mechanism of Action Ketamine

A

Has complex actions but is predominantly an N-methyl-d-aspartate (NMDA) receptor antagonist, resulting in inhibition of excitatory neurotransmitters in the brain.
Low doses cause analgesia, larger doses cause amnesia and dissociation. High doses cause anesthesia.

209
Q

Scopes Ketamine

A

Para: Analgesia

210
Q

Indications Ketamine

A

Severe pain that has not been adequately controlled with an opiate.
Inducing dissociation.
Acute behavioural disturbance causing severe to immediately life-threatening risk to safety.
RSI.
Significant movement during CPR that is interfering with resuscitation.
Asthma with severe agitation that is impairing the ability to safely provide treatment or transport.

211
Q

Contraindications Ketamine

A

Known severe allergy.
Aged <1 year.

212
Q

Cautions Ketamine

A

ALOC. Ketamine may reduce LOC.
Signs of shock, ketamine may make shock worse.
Current myocardial ischaemia, ketamine may increase myocardial oxygen demand.
Concurrent administration of opiates or midazolam will increase or prolong the effects.
Aged > or equal to 75 years, particularly if frail. Effects of ketamine will be increased or prolonged in this cohort.

213
Q
A

ILS Study (3 decks)

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