medicines Flashcards
All medicines administered must be documented, including:
a) The time, dose and route of administration.
b) The infusion rate, infusion concentration and total dose/volume
administered, if an infusion is used.
indications of adenosine
Patients aged greater than or equal to 12 years with SVT and a ventricular rate greater than or equal to 150/minute, and
ū Causing moderate cardiovascular compromise, or
ū Known to be responsive to adenosine.
adrenaline mechanism of action
- Adrenaline stimulates alpha and beta receptors, with the predominant effects occurring at alpha 1, beta 1 and beta 2 receptors.
- Alpha 1 stimulation causes smooth muscle contraction, vasoconstriction of blood vessels and stimulation of glycogenolysis and gluconeogenesis.
- Beta 1 stimulation causes an increase in inotropy (cardiac contractility), an increase in chronotropy (heart rate) and an increase in dromotropy (speed of electrical conduction within the heart).
- Beta 2 stimulation causes smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation, and stabilisation of mast cell membranes, reducing histamine release.
indications of adrenaline
Cardiac arrest.
Anaphylaxis.
Severe asthma.
Imminent respiratory arrest from COPD.
Severe bradycardia.
Blood pressure support if unresponsive to metaraminol.
Septic shock, cardiogenic shock and neurogenic shock unresponsive to
0.9% sodium chloride IV and metaraminol IV.
Moderate to severe stridor.
IN for clinically significant epistaxis.
Topical for clinically significant bleeding from a wound.
cautions for adrenaline
^ ^
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Myocardial ischaemia. Adrenaline will increase myocardial oxygen consumption.
Tachydysrhythmias. Adrenaline will usually make tachydysrhythmias wors
topical use of adrenaline
Topical: dilute each mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Apply topically in addition to direct pressure.
IN administered of adrenaline dose
dilute each mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Administer the appropriate dose into each bleeding nostril using a mucosal atomising device, in addition to direct pressure.
Neb adrenaline administration
administer undiluted.
IM admisnteration of adrenaline
undiluted. The preferred IM site is the lateral thigh. If this site is not suitable use the lateral upper arm.
dosage of adrenaline in cardiac arrest
a) 1mg IVAdults and children whose weight has been rounded to 50 kg or more: administer undiluted as an IV bolus.
b) Children whose weight has been rounded to 40 kg or less: dilute 1 mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Draw up the dose from this solution and administer as an IV bolus.
IV infusion of adrenaline
place 1 mg of adrenaline into a 1 litre bag of 0.9% sodium chloride. Shake well and label. This solution is 1:1,000,000 and contains 0.001 mg/ml.
a) For an adult: administer as an IV infusion starting at 2 drops/second. Adjust the rate to the patient’s condition.
b) For a child aged 5-14 years: administer as an IV infusion starting at 1 drop/ second. Adjust the rate to the patient’s condition.
adverse affects of adrenaline
- Tachycardia.
- Tachydysrhythmia.
- Myocardial ischaemia.
- Ventricular ectopy.
- Hypertension.
- Nausea and vomiting.
- Tremor, anxiety and sweating.
- Hyperglycaemia.
onset of adrenaline
- IV: 5-10 seconds.
- IM: 2-5 minutes.
usual duration of adrenaline
The cardiovascular effects last 5-15 minutes.
* The mast cell membrane effects may last for several hours.
amieodarone mechanism of action
- Amiodarone is an antidysrhythmic with a broad spectrum of activity.
- Amiodarone has predominantly class III activity. It prolongs the action potential duration, reduces automaticity and prolongs the refractory period of atrial, nodal and ventricular tissues.
- The electrophysiological effects result in a reduction in abnormal electrical activity (for example ectopy), a reduction in electrical conduction, a reduction in heart rate and a stabilisation of the SA and AV nodes.
- Amiodarone also causes a small increase in coronary blood flow (although this is not usually clinically significant) and a reduction in myocardial oxygen consumption by reducing inotropy (the force of cardiac contraction).
indications of amiodarone
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 fast atrial flutter.
contraindicatons to amiodarone
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.
cautions with amiodarone
^ None if the patient is in cardiac arrest.
^ Poor perfusion or signs of low cardiac output. Amiodarone reduces inotropy and may cause a significant 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. Amiodarone may cause a significant fall in cardiac output.^ Known sick sinus syndrome without an internal pacemaker in place. Amiodarone slows the heart rate and severe bradycardia may occur following reversion of a 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.
dosage of ameodarone
a) 300 mg for an adult.
b) If VF or VT persists, a second dose of 150 mg may be administered.
c) See the paediatric drug dose tables for a child.
common adverse affect of amiodarone
- Hypotension.
- Feeling light-headed.
- Bradydysrhythmia.
usual onset of ameodarone
5-10 mins
Amoxicillin/clavulanic acid mechanism of action
Amoxicillin/clavulanic acid is a beta-lactam antibiotic with broad activity against gram-negative and gram-positive bacteria. It also has some activity against anaerobic bacteria, particularly those from the mouth.
* Amoxicillin is the active ingredient and is part of the penicillin class of antibiotics. Amoxicillin inhibits production of the bacterial cell wall, causing bacteria to die.
* Many bacteria are resistant to amoxicillin due to their ability to produce beta-lactamase (an enzyme) which destroys the active part of beta-lactam antibiotics. Clavulanic acid inhibits the beta-lactamase enzyme and has no direct antibacterial action.
indications for Amoxicillin/clavulanic acid
Sepsis and:
ū The patient is aged greater than or equal to 12 years, and
ū One or more high risk factors are present, and
ū Time to hospital is greater than 30 minutes.
Cellulitis. In this setting a single IV dose may be administered if the patient is being referred to primary care and there may be a delay in the patient seeing a doctor.
dose of Amoxicillin/clavulanic acid
1.2g, Dissolve 1.2 g using approximately 4 ml of 0.9% sodium chloride and dilute to a total of 10 ml.
* Administer IV over 1-2 minutes, preferably into a running IV line.
* Do not administer IM if IV access cannot be obtained.
aspirin mechanism of action
- Aspirin (acetylsalicylic acid) has antiplatelet, antipyretic, anti-inflammatory and analgesic effects. In the out-of-hospital setting aspirin is only administered for its antiplatelet activity.
- Aspirin inhibits the enzyme cyclooxygenase which results in a reduction in the formation of prostaglandins and thromboxane.
contraindications of aspirin
Known severe allergy.
Third trimester of pregnancy.
cautions for aspirin
^ 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. Aspirin will increase the risk of bleeding and the nature and risk of the bleeding must be taken into account.
^ Known worsening of bronchospasm with NSAIDs. Some patients with asthma or COPD have known worsening of bronchospasm with NSAIDs (including aspirin) and a decision must be made based on the balance of risk. If there
is a clear history of significant bronchospasm with NSAIDs, aspirin should be withheld.
dose of aspirin
300 mg
Ceftriaxone indication
Suspected meningococcal septicaemia
Ceftriaxone dosage
- 2 g IV for an adult.
- 2 g IM for an adult if IV access cannot be immediately obtained.
- See the paediatric drug dose tables for a child.
admin of ceftriaxone
a) Add 4 ml of 0.9% sodium chloride to a 2 g ampoule and shake until dissolved.
b) Draw up the ampoule using two syringes with approximately half in each. The total volume will be 5 ml.
c) Discard unrequired volume before administration for a child.
d) Administer one syringe into each lateral thigh. If this site is not suitable, use
each lateral upper arm.
Clopidogrel mechanism of action
- 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.
indications of clopidogrel
STEMI in conjunction with fibrinolytic therapy.
dose of clopidogrel
300 mg if the patient is aged less than 75 years.
* 75 mg if the patient is aged greater than or equal to 75 years.
droperidol mechanism
- Droperidol blocks dopamine and alpha receptors centrally, resulting in sedation, reduced agitation and a state of mental detachment.
droperidol indications
Patients aged greater than or equal to 12 years with agitated delirium causing a mild to moderate risk to safety, when olanzapine has not been administered or is ineffective.
cautions for droperidol
^ Parkinson’s disease. There is a risk of worsening the movement disorder associated with Parkinson’s disease.
^ Concurrent administration of other sedatives. This will increase and prolong the effects.
^ Intoxication. This will increase and prolong the effects.
^ Elderly and/or frail. These will increase and prolong the effects
dosage of droperidol
- 10 mg IM or IV.
- Reduce the dose to 5 mg if the patient is frail.
- The dose may be repeated once after 20 minutes.