Medications Flashcards
Glyceryl Trinitrate Indications
- Chest pain/discomfort of presumed cardiac origin not relieved by rest and reassurance with systolic BP > 90mmHg
- Acute Cardiac Pulmonary Oedema with systolic BP > 90mmHg
Ondansetron Contrainidications
- IM - Paediatrics less than 2 years old.
- Hypersensitivity.
Amiodarone Precautions / Complications
- Heart failure;
- Thyroid dysfunction;
- Amiodarone is only indicated for shock resistant VF/VT, and should be administered post 3 consecutive shocks;
- In the hypothermic patient, withhold until body temperature is above 30C.
- Between 30-35C double the interval between doses.
Methoxyflurane Contraindications
- Patients who are unable to understand or co-operate.
- Patients with severe renal impairment. Patients with head injury and altered consciousness that prevents co-operation with its use.
- Hypersensitivity e.g. malignant hyperthermia
Cophenylcaine Description
Topical pump spray containing :
- Lignocaine hydrochloride 50mg/ml
- Phenylephrine 5mg/ml
A topical local anaesthetic and haemorrhage control agent for the relief of surface pain, nasal and oral bleeding
Aspirin Description
Aspirin has the following pharmacological actions:
- Analgesic
- Antipyretic
- Anti-inflammatory
- Anti-platelet aggregation agent
Reduces mortality significantly in Acute Myocardial Infarction by minimising platelet aggregation and thrombus formation in order to
retard the progression of coronary artery thrombosis.
Midazolam Indications
- Seizures (CPG 2.3).
- Disturbed/ abnormal behaviour (CPG 2.5).
- Back pain due to muscular spasm in adults.
Naloxone Indications
- Reverse of respiratory depression in a suspected narcotic overdose.
Paracetamol Precautions / Complications
- Advise not to take more Paracetamol during the next 4 hours.
- Overdose may cause serious, potentially fatal liver damage.
Lignocaine Indications
Local anaesthesia for:
- IV cannulation
- IO infusion
- Suturing
Glyceryl Trinitrate Description
Glyceryl Trinitrate (GTN): Spray bottle containing 200 x 0.4mg atomised sprays. Nitrates cause the relaxation of vascular smooth muscle resulting in:
- Vasodilation.
- Peripheral pooling and reduced venous return.
- Reduced left ventricular and diastolic pressure (preload).
- Reduced systemic vascular resistance (afterload).
- Reduced myocardial energy and oxygen requirements.
- Relaxes spasm of coronary arteries
Methoxyflurane Description
3ml Ampoule.
- A halogenated ether that produces powerful modification of the awareness of pain with an associated light headed sensation.
- 6-8 breaths/ 1-2 min onset with maximum level after 2-4 minutes.
Methoxyflurane Indications
- Pain
IV Crystalloid Solutions Contraindications
- Circulatory overload
Glucose Oral Gel Description
15g glucose gel in tube.
- Rapidly absorbed from oral/buccal mucosa to increase blood glucose concentration.
- Onset 2-5 minutes, duration 12-25 minutes
Copheylcaine Indications
- Local pain: abrasions, small cuts and wounds
- Relief of mild and moderate epistaxis
- Post tonsillectomy haemorrhage
- Intra-oral haemorrhage
Midazolam Precautions / Complications
- If small, frail or over 65 years old, try half adult dose first.
- Myasthenia gravis.
- Further doses above maximum require authorisation by phone consult to Ambulance Medical Advisor.
- Respiratory depression.
- Hypotension.
- Anterograde and retrograde amnesia.
Intravenous Glucose Contraindications
- Diabetic coma where blood glucose levels are excessively high.
- Glucose / galactose malabsorption syndrome.
- Anuria.
- Intraspinal or intracranial haemorrhage.
- Corn (maize) allergy.
- Patients at risk of ischaemic stroke.
- Use after an ischaemic stroke.
Ondansetron Precautions / Complications
- Administer IV Ondansetron slowly over 2 minutes (neat or diluted) to prevent blurred vision and dizziness.
- Preferred method for paediatric patients is oral wafer.
- Headache. Malaise / fatigue. Drowsiness. Dizziness. Rash/ allergic reaction.
Fentanyl Indications
- Moderate to severe pain.
- Acute Coronary Syndromes with a pain/discomfort score > 3/10 post 1 spray of GTN.
Heparin Sodium Indications
Patients with STEMI going directly to Cardiac Catheterisation Laboratory as per receiving hospital 12-lead ECG interpretation.
Glucagon Contraindications
- Hypersensitivity.
- Known pheochromocytoma
Ketamine Indications
- A second line agent for severe pain of traumatic origin.
- Actively disturbed patients requiring sedation where midazolam has already been utilised.
- Combative Traumatic Brain Injury.
Amiodarone Description
- 150mg in a 3ml ampoule;
- Class III antidysrhythmic agent that prolongs the action potential duration and hence the refractory period of atrial, nodal and ventricular tissue.
- It has characteristics of all Vaughan-Williams classes of antidysrhythmics;
- Immediate onset, peak
Naloxone Precautions / Complications
- Polypharmacy overdose.
- Naloxone half life may be less than that of the Narcotic
- Withdrawal symptoms eg: aggression, agitation, nausea, vomiting, dilated pupils, lacrimation
Glucagon Precautions / Complications
- Glucagon is effective in treating hypoglycaemia only if sufficient liver glycogen is present (eg: it does not work on alcohol or anorexia induced hypoglycaemia).
- Even if fully recovered patients should be encouraged to be transported to a medical facility to ensure effective follow up and review.
- Nausea/vomiting, Gastric pain
- Transient rise of blood pressure for patients taking beta blockers
Adrenaline Precautions / Complications
- Ischaemic Heart Disease;
- In the hypothermic patient, withhold until body temperature is above 30C.
- Between 30-35C double the interval between doses
- Dysrhythmias;
- Hypertension;
- Pupil dilation;
- Tremor;
- Anxiety;
- Palpitations
Heparin Sodium Contraindications
- Hypersensitivity to Heparin
- Presence of known haemorrhagic states
Glyceryl Trinitrate Precautions / Complications
- Nitrates are an early intervention and should not be delayed until on the stretcher or inside the ambulance.
- Administer to the patient in a seated or semi-recumbent position.
- Do not shake GTN bottle prior to administration.
- Assess BP before every dose.
- Severe hypotension is an uncommon side effect.
- Tachycardia, Flushing, Headache
Ketamine Precautions / Complications
- Used with caution in patients with stable psychiatric disorders such as Schizophrenia (unless pre-treatment with midazolam).
- Use with caution in patients with hyperthyroidism or receiving thyroid replacement due to increased risk of hypertension and tachycardia.
- Use cautiously with IV Fentanyl due to potentiation of anaesthesia effects, waiting 5 minutes between doses.
- Blood pressure and pulse frequently elevated.
- Random purposeless movements, muscle twitching and rash are common.
- Hypersalivation.
- Emergence reactions (10%).
- Transient laryngospasm.
- Transient apnoea or respiratory depression
Lignocaine Description
20mg/2ml - (1%) in a plastic ampoule
- Sodium Channel blocker
- Onset 1-2 minutes
Lignocaine Contraindications
- Hypersensitivity
Atrovent Description
- Presents as 250mcg in 1ml nebule.
- An anticholinergic bronchodilator. It inhibits the vagal reflexes that mediate bronchospasm.
- Combined with a nebulised beta-2 agonist (Salbutamol), Ipratropium bromide produces significantly greater bronchodilation than a beta-2 agonist alone.
Glucose Oral Gel indications
Demonstrated hypoglycaemia in:
- Altered conscious state in a known Diabetic.
- Altered conscious state of unknown medical cause, where blood glucose Level is below 4mmol/L.
Aspirin Precautions / Complications
- Actively bleeding peptic ulcers.
- Suspected AAA.
- Heart burn, nausea, GI bleeding.
- Increased bleeding time.
Adrenaline Indications
- Cardiac arrest;
- Anaphylaxis;
- Severe asthma;
- Severe croup with retractive breathing.
Fentanyl Description
short acting synthetic narcotic analgesic:
- Fentanyl: 600mcg in 2ml (300mcg/ml) - Intranasal only.
- Fentanyl Citrate (Sublimaze): 100mcg in 2ml ampoule (50mcg/ml) - IV/IO.
Salbutamol Sulphate Contraindications
- Hypersensitivity
- Cardiogenic Pulmonary Oedema
Heparin Sodium Description
A naturally occurring anticoagulant which inhibits the clotting of blood by enhancing the rate at which antithrombin III neutralises thrombin and activated factor X (Xa).
- Ampoules 5,000 IU/5ml.
- Onset of action is immediate following IV administration.
Naloxone Contraindications
- Responsive patients with adequate respirations and who are protecting their own airway
IV Crystalloid Solutions Complications / Precautions
- IV access/ fluid administration should be avoided in patients on the side of mastectomy or lymph node removal unless life-saving.
- Circulatory Overload
Intravenous Glucose Indications
Demonstrated hypoglycaemia where oral glucose administration is inappropriate in:
- Altered conscious state in known diabetic.
- Altered conscious state of unknown medical cause with blood glucose Level below 4mmol/L
- Cardiac arrest.
Naloxone Description
- 4mg (400mcg) in 1ml vial
* Naloxone is a pure narcotic 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.
Fentanyl Contraindications
- Hypersensitivity to Fentanyl.
- Less than 1 year of age (IV/IO only).
- Occluded nasal passages or epistaxis (IN only).
Ketamine Contraindications
- Hypersensitivity.
- Age
- Non traumatic pain
- Active cardiovascular disease including cardiac chest pain, heart failure, severe or poorly controlled hypertension.
- Active psychiatric condition (unless pretreatment with midazolam).
Intravenous Glucose Precautions / Complications
- High concentration of IV glucose may aggravate dehydration due to its hypertonicity whereby it draws water from the cells.
- IV glucose is corrosive and IV patency must be ensured before administration.
- Careful titration of glucose in head injured patients is vital as glucose leaking into CNS tissue will aggravate the injury, resulting in cerebral oedema.
- Monitor blood glucose level carefully;
- Beware of drop in level again after the patient has recovered.
- Even if fully recovered, patients should be encouraged to be transported to a medical facility to ensure effective follow up and review.
- IO administration is only as a last resort after all other avenues have been exhausted and the patient needs lifesaving glucose.
- Hyperglycaemia. Diuresis. Tissue necrosis. Thrombophlebitis
Atrovent Indications
Severe bronchospasm:
- Paediatric- severe to life-threatening asthma (CPG 3.2).
- Adult- severe to life-threatening asthma (CPG 3.2) and COPD (CPG 3.3).
Paracetamol Contraindications
- Known allergy to paracetamol.
- Paracetamol during the preceding four hours.
Midazolam Contraindications
- Hypersensitivity
Salbutamol Sulphate Description
5mg in 2.5ml plastic nebule 100mcg dose per puff from MDI.
- Sympathomimetic — a short acting synthetic beta 2 adrenoreceptor stimulant that causes relaxation of bronchial smooth muscle (bronchodilation).
- Initial effect 2-5 minutes maximum by 10 minutes.
Intravenous Glucose Description
500ml bag 10% glucose (10g per 100ml).
- A hypertonic crystalloid solution that provides a readily available source of energy (Glucose).
- Onset within 1 minute.
Aspirin Indications
- Chest pain/discomfort of presumed cardiac origin.
IV crystalloid Solutions Description
- Normal saline (NaCl 0.9%) in 1000ml soft plastic bag.
- 10 ml plastic vial
- A sterile isotonic crystalloid solution
Lignocaine Precautions / Complications
- Adverse drug reactions are rare when lignocaine is used as a local anaesthetic and is administered correctly.
- Tinnitus, dizziness, anxiety, confusion, perioral numbness
- Cardiovascular effects: Bradycardia, hypotension, dysrhythmias
- CNS effects
- Respiratory depression
IV Crystalloid Solutions Indications
- Fluid replacement (volume expansion) for the treatment of shock, fluid loss, and cardiac arrest.
Salbutamol Sulphate Precautions / Complications
- Tachycardia
- A spacer / MDI is the preferred route for Salbutamol administration where the patient presents with influenza like
illness. - Muscle tremor
- Tachycardia
Ondansetron Indications
- Moderate to severe nausea.
- Active vomiting.
- Prophylaxis for eye and spinal injuries
Ketamine Description
200mg in 2ml.
- Rapid acting dissociative anaesthetic.
- IM onset: 5-10 minutes.
- IV onset: 1 minute
Glyceryl Trinitrate Contraindications
- Hypersensitivity.
- Hypotension < 90mmHg.
- Medications used for erectile dysfunction within 24 hours (e.g. Sildenafil®, Vardenafil®).
Salbutamol Sulphate Indications
Bronchospasm and respiratory distress associated with wheeze:
- Acute Bronchial Asthma (CPG 3.2)
- Bronchitis.
- Smoke inhalation.
- Severe allergic / anaphylactic reactions.
- Acute Pulmonary Oedema of non cardiac origin.
- Salt Water Aspiration Syndrome (SCUBA divers).
- Chronic Airway Limitation (CAL).
Glucagon Description
- 1mg in 1ml vial, accompanied by diluent for injection.
- A hyperglycaemic agent that converts stored liver glycogen to glucose to increase blood glucose concentration.
- Onset 4–7 minutes, duration 10–30 minutes
Glucagon 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.
- Altered conscious state of unknown medical cause, where blood glucose level is below 4mmol/L.
Methoxyflurane Precautions / Complications
- Use PenthroxTM inhaler only with charcoal filter attached.
- Instruct the patient to breathe in through their mouth and out through their mouth via the inhaler. For maximum effect cover the air dilutor hole.
- Initial breath is strong and may cause the patient to cough, so advise to take gently.
- Watch for drowsiness.
- If oxygen is required deliver separately.
- Place in a sealed plastic bag when not in use.
- Lightheaded. Dizziness. Drowsy. Nausea. Malignant hyperthermia
Cophenylcaine Contraindications
- Hypersensitivity to lignocaine or other anaesthetics
- Hypersensitivity to phenylephrine
- Paediatrics less than 2 years
- Pregnancy
Glucose Oral Gel Precautions / Complications
- Have patients airway patent and in lateral position if unconscious.
- Always consider patient’s airway when administering gel.
- Even if fully recovered, patients should be encouraged to be transported to a medical facility to ensure effective follow up and review.
- Will liquefy over 30C, however it is still useable
Amiodarone Indications
- Cardiac Arrest with persistent/shock resistant Ventricular
Fibrillation/Ventricular Tachycardia (Post 3 consecutive shocks only);
Paracetamol Description
- Simple oral analgesia for mild to moderate pain and fever
Adrenaline Description
- 1mg in 1ml (1:1000);
- A naturally occurring sympathomimetic agent;
- Causes peripheral vasoconstriction;
- Stimulation of cardiac conduction system causes increased contractions;
- Causes bronchodilatation and dilation of blood vessels in muscles;
- IV/IO: Onset 30 seconds, peak 3-5 minutes, duration 5-10 minutes;
- IM: Onset 30-90 seconds, peak 5-10
- minutes, duration 5-10 minutes
Paracetamol Indications
500mg tablets.
- Headache.
- Minor pain / ache.
- Fever.
Aspirin Contraindications
- Known hypersensitivity to aspirin / salicylates.
- In asthmatic patients with known hypersensitivity to salicylates.
- Children < 12 years of age
Fentanyl Precautions / Complications
- Elderly patients.
- Respiratory depression.
- Patients on MAO inhibitors.
- Simultaneous use of IV Fentanyl and Ketamine requires medical advisor authorisation.
- Nausea/vomiting.
- Cardiovascular effects:
- Bradycardia
- Hypotension (rare)
Midazolam Description
- 15mg in 3mls (5mg/ml).
- A water-soluble benzodiazepine that has anxiolytic, sedative and anticonvulsive characteristics. These are based on its
bond with receptors in the central nervous system; its action to increase the inhibitory effect of the g-aminobutyric acid (GABA) neurotransmitter on the GABA receptors and subsequent membrane threshold. - Midazolam is lipid-soluble in physiological pH and it reaches the central nervous system quickly.
Ondansetron Description
4mg in 2mls ampoule.
- 4mg Oral wafers.
- Anti-nauseant and anti-emetic.
- Selective 5-HT3 receptor antagonist blocking serotonin centrally in the chemoreceptor trigger zone and peripherally on Vagus nerve terminals.
- Onset of action up to 30 minutes.
Heparin Sodium Precautions / Complications
- Haemorrhagic risks in case of possible trauma
*
Atrovent Complications / Precautions
- The nebulised form of Ipratropium Bromide is preferred in children due to its unpleasant taste.
- Glaucoma.
- Avoid contact with eyes.
- It may not be beneficial in milder exacerbations or after stabilisation
- Headache. Nausea. Dry Mouth. Skin rash
Atrovent Contraindications
- Hypersensitivity
Cophenylcaine Precautions
- Used with caution in patients with cardiovascular, hepatic and/or renal disease.
- For oral use, nozzle inserted within the anterior 1/3 of mouth to avoid gag stimulation.
- Each spray delivers 100 microlitres of fluid. The dose of lignocaine in each squirt is 5 mg and the dose of phenylephrine in each squirt is 0.5mg
