Medications Flashcards
Adrenaline
Introduction:
- Presentation:
1 mg/1 mL (1:1000) ampoule - A naturally occurring sympathomimetic agent
- Causes peripheral vasoconstriction
- Stimulation of cardiac conduction system causes increased contractions
- Causes bronchodilation and dilation of blood vessels in muscles
- IV/IO: Onset 30 seconds, half-life 5 minutes, duration 5-10 minutes
- IM: Onset 60 seconds, half-life 5 minutes, duration 5-10 minutes
Indications:
- Anaphylaxis
- Life-threatening asthma
- Cardiac Arrest
- Post-ROSC
- Severe croup
- Haemorrhage control post cricothyroidotomy
Contraindications
- There are no absolute contraindications to adrenaline
Special Considerations:
- Tachyarrhythmias, palpitations
- Hypertension
- Pupil dilation
- Tremor
- Anxiety
Aspirin
Introduction:
Aspirin has the following pharmacological actions:
- Analgesic
- Antipyretic
- Anti-inflammatory
- Anti-platelet aggregation
Reduces mortality significantly in Acute Myocardial Infarction by minimising platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis.
Indications:
- Patients with suspected Acute Coronary Syndromes
Contraindications:
- Known hypersensitivity to aspirin / salicylates / NSAIDs.
- Children < 16 years of age.
Special Condiserations:
- Heart burn, nausea, GI bleeding.
- Increased bleeding time.
- Anaphylactic reaction (some patients, especially asthmatics) exhibit notable sensitivity to aspirin, which may provoke various hypersensitivity / allergic reactions.
Cophenylcaine
Introduction:
Pump spray containing:
- Lidocaine (lignocaine) hydrochloride monohydrate 5%, 5 mg/spray
- Phenylephrine hydrochloride 0.5%, 500 microg/spray
A topical local anaesthetic and haemorrhage control agent for the relief of surface pain, nasal and oral bleeding.
Indications:
- Local pain: abrasions, small cuts and wounds
- Relief of mild and moderate epistaxis
- Post tonsillectomy haemorrhage
- Intra-oral haemorrhage
Contraindications:
- Pregnancy
- Children < 2
- Hypersensitivity to phenylephrine, lidocaine or other anaesthetics
Special Considerations:
Oral administration may cause a transient bitter taste.
Fentanyl
Introduction:
A short acting synthetic narcotic analgesic
- Fentanyl: 450 microg/1.5 mL (300 microg/mL); intra-nasal administration only
- Fentanyl Citrate: 100 microg/2 mL ampoule (50 microg/mL); IV/IO only
- Fentanyl Citrate: 500 microg/10 mL ampoule (50 microg/mL); IV/IO only
Indications:
- Moderate to severe pain.
- Acute Coronary Syndromes where GTN has been ineffective
Contraindications:
- Hypersensitivity to fentanyl
- Child <1 year of age (for IV / IO only)
- Occluded nasal passages or epistaxis (for IN only)
Special Considerations:
- Adopt a low threshold to engage with the ED team if pain remains difficult to control
- Drowsiness
- Nausea/vomiting
- Respiratory depression; monitor pulse oximetry for all patients having IV / IN Fentanyl
- Cardiovascular effects:
Bradycardia
Hypotension (rare)
Glucagon
Intoduction:
- A hyperglycaemic agent that increases blood glucose concentration by activating hepatic glucose production and decreasing GI motility
- Onset: 4-7 minutes; duration 10-40 minutes
Indications:
- For demonstrated hypoglycaemia where oral glucose cannot be administered and IV access cannot be obtained in a safe and timely manner.
- Altered conscious state in a known diabetic or of otherwise unknown cause where blood glucose level is below 4mmol/L.
Contraindications:
- Hypersensitivity
- Known pheochromocytoma, insulinoma, glucagonoma
Special Considerations:
- Nausea/vomiting
- Gastric pain
- Transient rise of blood pressure for patients taking beta blockers.
Glucose oral gel
Introduction:
Oral glucose (dextrose) for rapid response to mild hypoglycaemia
Indications:
- Hypoglycaemia, altered conscious state in known person with diabetes or of unknown medical cause, where blood glucose level is below 4 mmol/L
- Patient must be able to safely take gel orally/buccally
Contraindications:
Nil
Special Considerations:
Monitoring required post administration: Even if fully recovered, encourage patient to consume a long-acting complex carbohydrate (biscuit, bread) following oral glucose administration to prevent delayed hypoglycaemia.2,
GTN
Introduction:
Nitrates cause the relaxation of vascular smooth muscle resulting in:
- Vasodilation
- Peripheral pooling and reduced venous return
- Reduced left ventricular end diastolic pressure (preload)
- Reduced systemic vascular resistance (afterload)
- Reduced myocardial energy and oxygen requirements
- Relaxes spasm of coronary arteries
Also known as nitroglycerin
Indication:
- Chest pain/discomfort of presumed cardiac origin not relieved by rest and reassurance with:
Systolic BP > 90 mmHg; AND
Heart rate is between 50-150 beats per minute. - Acute Cardiac Pulmonary Oedema with systolic BP >90 mmHg.
- Autonomic Dysreflexia with systolic BP > 160 mmHg.
Contraindications:
- Hypersensitivity
- Hypotension < 90 mmHg
- Ventricular Tachycardia (VT)
- Recent use of medications used for sexual dysfunction or specific regular medication used in the treatment of pulmonary arterial hypertension (brand names below are not exhaustive):
Sildenafil (Viagra® / Revatio®), Vardenafil (Levitra®) or Avanafil (Spedra®) use in the previous 24 hours
Tadalafil (Cialis®) use in the previous 3 days
Riociguat (Adempas®)
Special Considerations:
Side effects:
- Hypotension (rare)
- Tachycardia
- Flushing
- Headache
- Dizziness
Normal Saline
Introduction:
A sterile isotonic crystalloid solution
Indication:
Fluid replacement (volume expansion) for the treatment of shock, fluid loss, and cardiac arrest.
Contraindication:
Severe pulmonary oedema
Special Considerations:
Hypervolemia
Ipratropium Bromide
Introduction:
- An anticholinergic bronchodilator. It inhibits the vagal reflexes that mediate bronchospasm
- Combined with a nebulised short-acting beta-2 agonist (e.g. salbutamol), ipratropium bromide produces significantly greater bronchodilation than a short-acting beta-2 agonist alone
Indication:
Severe bronchospasm:
- Adult:
Severe to life-threatening asthma or COPD - Paediatric:
Severe to life-threatening asthma
Contraindications:
Hypersensitivity
Special Considerations:
- Headache
- Nausea, dizziness
- Dry mouth, throat irritation
- Taste disturbance
- Skin rash
Loratadine
Introduction:
Second generation (less-sedating) long acting antihistamine
Indication:
Symptomatic urticaria (without evidence of anaphylaxis)
Contraindication:
- Children < 30 kg
- Hypersensitivity to loratadine
Special Consideration:
Common Adverse Effects: drowsiness, fatigue, headache, nausea, dry mouth
Methoxyflurane
Introduction:
- Inhaled anaesthetic
- Onset of pain relief after 6-10 inhalations
- Pain relief lasts 20-30 mins with continuous use, up to 60 mins with intermittent use
Indication:
Analgesia
Contraindication:
- Hypersensitivity to fluorinated anaesthetics
- Children under 1 year of age
- Patients who are unable to understand or co-operate including those affected by alcohol or illicit drugs
- Patients with a severe head injury and altered state of consciousness
- Patients susceptible to malignant hyperthermia
Special Considerations:
- Common Adverse Effects: cough (initial dose, advise to inhale gently), dizziness, drowsiness, headache, dry mouth, disinhibition
- Monitoring required post administration: Pain score
Naloxone
Introduction:
Naloxone is a pure opioid antagonist that exerts its effect by competitive inhibition at the opioid receptor sites. It prevents or reverses the effects of opioids, including respiratory depression, sedation and hypotension. In the absence of opioids, it exhibits essentially no pharmacological activity.
Indication:
Reversal of respiratory depression in a suspected narcotic overdose.
Contraindication:
Hypersensitivity to Naloxone
Special Considerations:
Withdrawal symptoms such as:
- Aggression
- Agitation
- Nausea/vomiting
- Dilated pupils and lacrimation
Olanzapine
Introduction:
- Olanzapine is a second generation antipsychotic agent that acts on multiple receptors (incl. serotonin and dopamine receptors), resulting in sedation
- Onset of effect usually ~ 10 mins.
- Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer.
Indication:
- Disturbed and Abnormal Behaviour (RASS 1 ~ 3) if considered appropriate where risk to safety is evident and de-escalation has not been effective
- Patient is able to tolerate or self-administer an oral wafer
- Preferred first line sedation agent in frail patients and those with Dementia
Contraindication:
- Known Allergy
- Known Parkinsons Disease
- Age < 6 years old
Special Considerations:
- Extrapyramidal effects / Dyskinesia
- Increased falls risk
- Hypotension – Apply monitoring as soon as practicable
Ondansetron
Introduction:
- Antiemetic. Central and peripheral 5HT3 antagonist.
- Oral:
Onset of Action: 15 - 30 mins; Half-life: 4 - 11 hrs; Duration of Action: 4 - 8 hrs - IM:
Onset of Action: 10 - 15 mins; Half-life: 2.5 - 6 hrs; Duration of Action: 4 - 8 hrs - IV:
Onset of Action: 3 - 5 mins; Half-life: 2.5 - 6 hrs; Duration of Action: 4 - 8 hrs
Indications:
- Moderate to severe nausea
- Active vomiting
- Nausea and vomiting prophylaxis for eye and spinal injuries
Contraindications:
- Hypersensitivity to ondansetron
- Treatment with apomorphine: risk of severe hypotension and LOC
- Paediatrics < 2
Special Considerations:
- Common Adverse Effects: constipation, headache, dizziness
- IV: blurred vision (transient visual disturbance with rapid IV administration4), dizziness, flushing
- Monitoring required post administration: ECG changes following IV administration
- Look alike, sound alike (LASA) medication: Olanzapine orally disintegrating tablet
Oxygen
Introduction:
Oxygen is a treatment for hypoxaemia and has not been shown to have any effect on breathlessness in non-hypoxaemic patients.
Indications:
- Adult:
Oxygen should be titrated to achieve oxygen saturations of between 94 – 98%, (or 88 – 92% for COPD patients). These are achieved through the use of different flow rates and oxygen masks. - Paediatric:
All paediatric patients with significant illness or injury should receive oxygen. Newborn resuscitation should be commenced with room air for the 30 seconds of initial inflation breaths.
Contraindications:
- Explosive or flammable environments
- Normoxia
Paracetamol
Introduction:
- Analgesic and antipyretic
- Oral:
Onset of action: 30-60 minutes; Half-life: 2 hours; Duration of action: 3-4 hours - IV (product information):
Onset of action: 5-10 minutes; Half-life: 1-3 hours; Duration of action: 4-6 hours
Indications:
- Mild to moderate pain
E.g. Headache, sprain, strain - As a component of a multimodal analgesic regime
Contraindications:
- Hypersensitivity to paracetamol
- Patients less than 6 months of age (oral solution)
- Patients less than 3 years of age 120mg (chewable tablets)
- Patients less then 9 years of age (500mg tablets)
- Patients less than 1 month of age (IV)
- Any paracetemol containing product within the last four hours (including prior to SJWA arrival)
Special Considerations:
Common Adverse Effects: Nausea
Salbutamol
Introduction:
- Short acting Beta 2 agonist that causes relaxation of bronchial smooth muscle (bronchodilation).
- Onset: 2-5 minutes, maximum by 10 minutes.
Indications:
Bronchospasm and respiratory distress associated with wheeze:
- Acute Bronchial Asthma
- Bronchitis
- Smoke inhalation
- Severe allergic / anaphylactic reactions
- Acute Pulmonary Oedema of non-cardiac origin
- Salt Water Aspiration Syndrome (SCUBA divers)
- Chronic Obstructive Pulmonary Disease (COPD)
Contraindications:
- Known hypersensitivity to salbutamol
- Cardiogenic pulmonary oedema
- Age less than 12 months
Special Considerations:
- Muscle tremor
- Tachycardia, palpitations
- Headache
