Medicines Flashcards
12.1
1
Q
A
2
Q
A
3
Q
Adenosine MOA SOP Condras
A
MOA: is an antidysrhythmic used for tx of SVT SOP: ICP’s Condraindications: known severe allergy Sick Sinus Syndrome without internal pacemaker. Previous 2/3rd degree Heart Block without internal pacemaker. Previous Heart transplant without internal pacemaker. Cautions: Asthma - bronchospasm CORD - bronchospasm Wolff-Parkinson -White (WPW) pregnancy/breasfeeding - seek guidance Dose: 6mg - adult Adminstration: Administer undiluted as a rapid IV Bolus followed by a rapid 20ml flush.
4
Q
Adenosine :
Effects
Onset
Duration
Pharmacokinetics
A
Common Effects: bradycardia/sinus pause up to 30 secs Ventricular ectopy SOB or urge to breathe deeply Light-headedness Nausea and flushing chest pressure Usual onset: 5-10 secs Usual Duration: 10-20 secs Pharmacokinetics: rapidly taken up and metabolised within seconds by ref blood cells and vascular endothelial cells.
5
Q
Adrenaline: 1 MOA
A
MOA: stimulates alpha & Beta Receptors- Alpha 1: smooth muscle contractions; vasoconstriction of blood vessels;stimulates glycogenolysis. Beta 1: Stimulates increase cardiac contractility, increase heart rate & speed of conduction of the heart. Beta 2: stimulates smooth muscle relaxation, skeletal muscle vasodilation, mast cell reduction of histamine release.
6
Q
Adrenaline: 2 Indications ( CASSIMITS) Cautions Dose
Given for nebulised, intranasal, topical, IV for Cardiac Arrest
A
Cardiac Arrest,
Anaphylaxis,
Severe Asthma,
Intranasal - significant epistaxis blood loss
Topical - significant wound bleeding
, Cautions: Myocardial ischaemia - adrenaline with increase myocardial oxygen consumption. Tachydysrhythmias. Dose: dependent on use.
7
Q
Adrenaline: 3 Common Effects
A
Common Effects Tachycardia, Tachydysrhythmia, Myocardial Ischaemia, Ventricular Ectopy, Hypertension, Nausea & Vomiting, tremor, anxiety, sweating, Hyperglycaemia
8
Q
Adrenaline: 4 Doses
A
Topical: 1mg + 9ml NACL = 0.1mg per ml - apply direct Intranasal: 1mg + 9ml NACL = 0.1 ml - give 2ml into each bleeding nostril. Neb: undiluted IM: undiluted Cardiac Arrest: > 50kg+ undiluted + every 4 mins < 50kg: 0.1mg/ml as per weights IV Infusions: 1mg into 1 Litre = 0.001mg (ICP) shake & Label
9
Q
Amiodarone : 5 Cautions (CLASHPPP)
A
Cautions Cardiac arrest - non if in this Low cardiac output AF assoc with severe sepsis Sick sinus syndrome Hypotension Poor perfusion Pregnancy Previous 2nd & 3rd degree HB
10
Q
Amiodarone: 2 Scope
A
Paramedics - cardiac arrest ICP - all indication
11
Q
Amiodarone: 6 Dose
A
Cardiac Arrest: Adult 300mg IV If VT or VF persists - 2nd dose @ 150mg IV If Tachdysrhymia in a adult: 300mg IV over 30mins if persists a further 150mg IV over 30mins may be given
12
Q
Amiodarone: 8 Onset Dose
A
onset = 5-10mins duration = 1-4 hours after single dose Dose - 150mg in 3ml
13
Q
Amiodarone: 9 Other
A
Metabolised in the liver may potentiate the action of cyclic antidepressants in cyclic poisoning May cause bradycardia if on beta-blocker or centrally acting calcium channel blocker ( eg: metoprolol, propranolol, diltiazem) When diluting with NACL - may go cloudy
14
Q
Amiodarone: 1 MOA
A
Antidysrhythmic Class # activity Prolongs action potential duration Reduces automaticity prolongs action potential at atrial, nodal & ventricular tissue reduces abnormal electrical activity, electrical conduction, heart rate and stabilization of SA & AV nodes. increase in coronary blood flow and reduction in myocardial oxygen needs
15
Q
Amiodarone: 3 Indications
A
Indications: Cardiac Arrest - VF or VT post first adrenaline dose Sustained VT in absence of Cardiac Arrest Moderate Cardiovascular compromise from AF or fast atrial flutter
16
Q
Amiodarone: 4 Condras
A
Known Severe Allergy Known severe allergy to Iodine VT 2nd to cyclic anti-depressant poisoning.
17
Q
Amiodarone: 7 Common Adverse Effects
A
lightheadedness Hypotension Bradyarrhythmia Sweating/Flushing Decreased HR Nausea/Vomiting
18
Q
Amoxicillin/Clavulanic Acid: 1 MOA
A
Inhibits production of Bacterial cell wall - dies Beta-Lactam antibiotic with Broad spec activity.
19
Q
Amoxicillin/Clavulanic Acid: 2 Indications
A
Clinical diagnosis - meningococcal septicaemia regardless of the distance from ED Septic shock if > 30mins from ED Cellulitis - single IV dose if referred to primary care and delay in seeing GP
20
Q
Amoxicillin/Clavulanic Acid: 3 Condras
A
Known Severe allergy Known severe allergy to penicillins anaphylaxis to any beta-lactam AB’s eg pencillins/cephalosporins Cautions - nil
21
Q
Amoxicillin/Clavulanic Acid: 4 Dose Adminstration
A
1.2g adult IV: Dissolve 1.2g in 5ml NACL and dilute to 10mls Administer into a running line over 1-2 mins IM: Dissolve 1.2g using 2ml NACL - good shake - final volume = 2.4ml
22
Q
Aspirin: 1 MOA
A
Has antiplatelet, antypyretic, anti-inflammatory and analgesic effects - we give for the antiplatelet effects
23
Q
Aspirin: 2 Indications
A
for Myocardial ischaemia
24
Q
Aspirin; 4 Cautions
A
Known Bleeding disorder Clinically significant bleeding Known worsening of bronchospasm 3rd trimester of pregnancy - premature delivery and closing of ductus arteriosus
25
Aspirin; 3 Contraindications
Known severe Allergy 3rd Trimester pregnancy
26
Aspirin; 5 Dose
300mg chewed or dissolved in water
27
Fentanyl : 1: MOA
MOA
Is an Opiate analgesia.
Opiate agonist - stimulates that binds to the opiate receptors
in the brain. Kappa, Mu, Delta
28
Fentanyl: Contras
Known severe allergy
unable to obey commands
Current respiratory depression
29
Fentanyl: Doses
ampule = 100mcg in 2 ml
dilute 100mcg to a total of 10ml + NACL
Adult IV: 10-50mcg every 3-5 minutes -Adult IV
Adult IN:
Draw up undilutes into 1ml syringe - x1 ml per nostral
Adult IN: 80kg or less =100mcg
further dose = 50mcg after 10mins
ADult IN 80kg + = 200mcg
further dose = 100mcg after 10mins
30
Fentanyl: Adverse Effects
Sedation
Europhoria
Respiratory Depression
Bradycardia
Hypotension
Nausea & Vomiting
Itch
31
Fentanyl: Onset effect
Fentanyl:
IV; 2-5mins (depressants not for 10-15mins)
IN; 5-10mins
32
Fentanyl Indications
Moderate to severe pain
Intense short term pain relief for joint relocation
clinically significant shock
does not have IV Access
33
Fentanyl: Cautions
Ages less than 1 year
High risk of Respiratory depression
Labour
34
Five Rights include:
1. the right medicine to be given 2. the right dose to be be given 3. the right patient to receive the medicine 4. the right route 5. given at the right time 6. contraindicaitons and cautions have be considered
35
Ketamine 8 Administration
should be given as well as other opiate; either morphine 10mg or fentanyl 100mg IV should receive sufficient opiate until further doses are not providing additional analgesia. IM route is preferred route over PO due to IM absorption more reliable. IM site = lateral thigh or lateral upper arm PO - give undiluted in a liquid.
36
Ketamine 11 Pharmacokinetics
Ketamine is metabolised in the liver Warn patient it is possible to feel strange following administration.
37
Ketamine 10 Onset of Effect
IV: 1-2 mins IM: 5-10 mins PO: 10-20 mins duration of effect - 10-60mins interactions: will be increased with othr analgesic medication or sedatives
38
Ketamine 9 (SHANTT) Common adverse effects
Sedation Hallucinations Apnoea Nausea & Vomiting Tachycardia Transient Hypertension
39
Ketamine: 1 MOA
Is an analgesic NMDA receptor antagonist -blocker which inhibits excitatory neurotransmitters in the brain low doses cause analgesia larger doses cause amnesia and dissociation high doses causes anaesthesia
40
Ketamine: 4 Contras
Known severe Allergy
Age less than 1 year
Current myocardial ischaemia
41
Ketamine: 3 Indications
Severe pain in addition to other medications esp MS or burns pain inducing dissociation eg: cardioversion joint relocation /limb alignment
42
Ketamine: 2 Scope
ICP and clinical desk
43
Ketamine: 5 Cautions (CHUA)
Clinical conditions that may be made worse by hypertension - hemorrhagic stroke
Hypertension
Unable to obey commands
Active psychosis
44
Ketamine: 6 Administration
Analgesia: ICP DRUG - CALL CLINICAL DESK make up: Adult: dilute 200mg to a total of 20ml or 100mg in 10mls = 10mg/ml. Child: dilute 100mg to a total 10ml = 10mg/ml.
45
Ketamine: 7 Dose
Analgesia: 10-50mg - most adults will need 20-30mg dose at lower end of range if patient is small or frail. repeat 3-5mins. 1mg/kg- round off to nearest 10kg IM or PO up to a maximum of 100mg if IV can not be accessed. repeat after 10mins. Dissociation: titrate to effect, need approx 0.5mg/kg Severe Agitated Delirium: 50-100mg ketamine IV every 3-5mins 200-400mg ketamine IM = repeated after 10mins RSI: Significant movement during CPR that is interfering with resus= adult: 50mg IV ONCE child: 0.5mg/kg IV ONCE
46
Lignocaine 1 % 9 Other info
dont apply to eyes warming Lignocaine in pocket or hands may reduce the stinging Overdose when giving is rare but can occure if doses exceed 3mg/kg or \> 1mg/kg is give IV this may signs of: tingling, seizure, Dysrhythmias, bradys. hypotension, Cardiac Arrest.
47
Lignocaine 1 % 8 Preparation
ampoule containing 50mg in 5 ml
48
Lignocaine 1% 1 MOA
local anaesthetic blocks the initiation & transmission of nerve impulses by blocking the movement of sodium ions across the nerve cell membrane.
49
Lignocaine 1% 3 Contras: Cautions:
Known Severe Allergy Local infection at site of injection
50
Lignocaine 1% 2 Indications
1. Subcut injection for prophylaxis of pain assoc with IV cannulation 2. Subcut Injection for digital ring blocks for pain relief 3. Intraosseous injection for bone pain assoc with fluid infusion via ISO.
51
Lignocaine 1% 4 Doseage
Subcut: (SC) Adult: max dose 20ml repeat after one hour Intraosseous: Adult: 5ml Repeat after 15mins
52
Lignocaine 1% 5 Adminsitration
SC for IV insertion: administer into the subcutaneous tissue at site of cannulation, raise a bleb & wait approx 1 min before insertion. Ring Blocks: admin 1-2ml into tissue either side of the web space of the digit. Intraosseous: admin slowly over 1-2 mins & wait 1 min before infusing fluid.
53
Lignocaine 1% 7 Onset of effect
IV cannulation = 1-2 mins Ring Blocks= 5-10 mins Duration = 30-60mins
54
Lignocaine 1% 6 Adverse Effects
Stinging at time of injection
55
Methoxyflurane 3 Condras
Known severe allergy Personal or family hx of malignant hyperthermia unable to obey commands Known Renal impairment Has already had it in the last week (lots can increase risk of renal impairement
56
Methoxyflurane 4 cautions
age greater than \> to 75yrs (illness, infection or dehydration = ? renal impairement =? increases Pre-eclampsia Adminstration within a confined space
57
Methoxyflurane 6 Common adverse effects
Sedation Light headness Nausea Dislike of taste/smell
58
Methoxyflurane 7 Onset Duration
1-2 mins 2-5mins after stopping giving
59
Methoxyflurane 8 Prep
3ml bottle with plastic bag Approx 20% is exhaled - remainder is metablished in the liver
60
Methoxyflurane 1 MOA
Inhaled analgesic
61
Methoxyflurane 5 Dose
Max 6mls \>12yrs and older Max 3mls ,12 yrs
62
Methoxyflurane 2 Indications
Moderate to Severe Pain
63
Methoxyflurane 9 Malignant Hypethermia (MH)
MH is a rare, inherited disorder of the muscle metabolism 20 families in NZ Ususally well known to those who have it Renal failure with dialysis - can have it Kidney stones or renal colic -can have it
64
**Methoxyflurane: 1.**
**MOA**
Inhaled analgesic
65
Metoprolol 6 Dose
1-2mg every 5-10 mins Must be discussed with STEMI coordinator/Clinical Desk/Dr Administer IV undiluted as a bolus
66
Metoprolol 8 Effect
onset - 2-3 mins duration - 1-2 hrs comes in ampule 5mg in 5ml blood pressure and heart rate will be potentiated by other lowering medications - antihpertensives, and centrally acting calcium channel blockers.
67
Metoprolol 3 Indications
Control of hypertension prior to fibrinolytic therapy for STEMI
68
Metoprolol 5 Cautions
Previous 2nd/3rd degree HB Asthma or CORD Known sick sinus syndrome 1st Degree HB
69
Metoprolol 1 MOA
Is a Beta-blocker It antagonises (blocks) beta-1 receptors in the heart - decrease heart rate, cardiac output and blood pressure.
70
Metoprolol 2 Scope
ICP's Paramedic with clinical desk only
71
Metoprolol 7 Common Adverse Effects (ABC)
Bronchospasm Bradycardia Hypotension
72
Metoprolol 4 Contrads:
Known Severe Allergy Bradycardia Hypotentsion
73
Midazolam: 1 MOA
Is a benzodiazepine enhances the activity of GABA receptors within the CNS, provides anticonvulsant activity, sedation, amnesia, anxiolysys and muscle relaxation
74
Midazolam: 4 Contrads: Cautions:
Known Severe allergy Cautions include concurrent adminsitration of opiates or ketamine - will increase the effect. Intoxication - will increase the effect. Elderly - older age will increase and prolong the effect
75
Midazolam: 2 Scope
Paramedics- IM & IV for seizures Paramedics - IM for agitated delirium ICP - all routes and indications
76
Midazolam: 3 Indications: (AMPSJP)
use - prolonged seizures IM/IV
moderate agitated delirium - IM
77
Midazolam: 5 Administration
IV Admin: dilute 2ml from 15mg/3ml ampule with NACL - 1mg/ml give IV IM Admin: Draw up approx dose from 15mg/3ml =dont dilute prefferred site = lat thigh, lat upper arm Sedation: combine 10mg midazolam + 10mg Morphne & dilute to a total of 10ml + NACL Must be able to obey commands at all times
78
Midazolam: 6 Effect
IV: 2-3 mins IM: 3-5 mins Duration - 30-60mins
79
Midazolam: 5 Common Adverse Effects (RASH)
Respiratory Depression Amnesia Sedation Hypotension
80
Morphine: 1 MOA
Opiate analgesic binds the opiate receptors in the brain +spinal cord
81
Morphine: 7 Onset of effect
IV: 2-5mins ( 10-15mins) IM: 5-10mins duration: 30-60mins
82
Morphine: 6 Common Adverse Effects
Respiratory depression
Hypotension
Nasuea and Vomiting Sedation
Histamine release & Itch
83
Morphine: 4 Cautions
age \<1 yr - increased risk of respiratory depression high risk of respiratory depression (severe CORD, morbid obesity or home BiPAP Labour
84
Morphine: 3 Contras:
known severe allergy unable to obey commands (except agitated delirium & Post intubation) Current respiratory depression
85
Morphine: 5 Doseage
IV for analgesia Adult: 1-5mg every 3-5mins IM for analgesia Adult: 5-10mg repeated once after 10mins Cardiogenic Pulmonary Oedema 1-2mg IV sparingly Sedation post intubation Adult: 1-2mg IV in combinaiton with 1-2mg midazolam IV, every 10-15mins
86
Morphine: 8 Pharmacokinetics
morphine is less lipophilicity than fentanyl morphine causes more histamine release than fentanyl is metabolised in the liver
87
Morphine: 2 Indications
moderate to severe pain
cardiogenic pulmonary oedema with severe anxiety
respiratory distress sedation post intubation
88
Naloxone: 1 MOA
Opiate receptor antagonist (Blocker) reverse effects of opiates - respiratory depression ; sedation.
89
Naloxone: 3 Contras:
known severe allergy
90
Naloxone: 4 Doseage
Adult: 0.1-0.4mg IV every 3-5mins Adult: 0.8mg IM= repeated every 10misn
91
Naloxone: 5 Adminstration
Preferred route is IV comes in 0.4mg in 1 ml IV: dilute 0.4mg to a total of 4ml = 0.1mg/ml IM: give undilated
92
Naloxone: 2 Indications
Opiate poisoning is suspected significant impairement LOC impaired Breathing excess adverse effects from adminstration of opiates
93
Naloxone: 6 Common adverse effects
Tachcardia Hypertension Sweating
94
Naloxone: 7 Effects
IV: 1-2 mins IM: 5-10mins
95
Olanzapine: 4 Dose:
comes in 5mg tablets (wafers) 80kg + 10mg 80kg \< 5mg repeat after 20mins orally dispersible and dissolve in mouth.
96
Olanzapine: 2 Indication
MILD agitation
97
Olanzapine: 3 Contras:
Known Severe allergy age less than 12yrs
98
Olanzapine: 1 MOA
atypical anti-psychotic reacts at multiple receptor sites within the brain to reduce agitation, sedation, anxiolysis and mood stabilsation
99
Ondansteron: 1 MOA
Antimetic antagonises (blocks) serotonin receptors in the CNS and peripherally in the GI tract = decreased nausea nd vomiting
100
Ondansteron: 2 Indications
clinically significant nasuea/or vomiting
101
Ondansteron: 3 Contras:
Known severe allergy age \< 1yrs
102
Ondansteron: 4 Dose
12yrs + PO: 8mg 12yrs + IV/IM: 4mg + repeat after 10mins a max of two IV/IM doses may be given in addition to 1 PO dose
103
Ondansteron: 5 Common Adverse Effects
Headache, Flushing Metallic Taste
104
Ondansteron: 6 Onset
PO: 10-20mins IV: 2-5 mins IM: 5-10mins
105
Oxytocin: 1 MOA
synthetic version of oxytocin hormone normally released from the pituitary gland stimulates the oxytocin receptors on the uterus causes uterine contraction & reduces blood loss from uterus.
106
Oxytocin: 4 Dose
10IU given as an IM undiluted in lat thogh multiple births = give after last one born post partum haem= requires a 2nd dose - met another truck
107
Oxytocin: 5 Common adverse effects
Tachycardia Flushing Abdominal cramping
108
Oxytocin: 6 Onset effect
5-10mins 30-60mins effecct
109
Oxytocin: 2 Indications
Following a normal birth Post partum haemorrhage
110
Oxytocin: 3 Contras: Cautions:
Known severe allergy no cautions
111
Paracetamol: 3 Contras:
known severe allergy current paracetamol poisoning
112
Paracetamol: 2 Indications
mild to moderate pain and combined with other medications
113
Paracetamol: 4 Cautions
taken within last 4 hours can be contained within other medications - ie flu remedies etc abdo pain if unwell and vomiting known severe liver disease
114
Paracetamol: 5 Doseage
Adults \<80kg - 1g \> 80kg 1.5g can be given for fever above 39Degrees and causing discomfort
115
Paracetamol: 1 MOA
Inhibits the production of prostaglandins = reduces pain and fever
116
Prednisone: 2 Indications
Bronchospasm assoc with CORD/Asthma Prominent rash assoc with anaphylasis provided all systemic signs of anaphylaxis have ressolved Minor allergy associated with rash
117
Prednisone: 1 MOA
Is a cortisosteroid with anti-infma and immunosuppressants actions causes a reducion in inflammatory & Immune responses
118
Prednisone: 3 Contrads:
Known Severe Allergy age \<1 yr old
119
Prednisone: 5 Dose onset effect
40mg for adult 30-60mins 24hrs
120
Prednisone: 4 Common Adverse Effects
Bitter taste fatigue Sodium and warer retension GI reflux
121
Salbutamol: 1 MOA`
Bronchodilator agonist (stimualtor) of Beta2 receptors
122
Salbutamol: 2 Indications
Bronchospasm 2nd to asthma or CORD Prominetn bronchospasm 2nd to airway burns or smoke inhalation.
123
Salbutamol: 3 Contrads: Cautions:
known severe allergy None
124
Salbutamol: 4 Dose
5mg initial dose is combined with 0.5mg of ipratropium undiluted nebulised
125
Salbutamol: 5 Common adverse effects
Tremor Tachycardia
126
Salbutamol: 6 onset
2-5 mins duration 1-2 hours
127
Sodium Valproate: 5 Effect
IV: 10-20mins duration: 6-12hrs BACK UP/CLinical desk to be called first
128
Sodium Valproate: 1 MOA
Anticonvulsant = blocks the sodium channels enhances the GABA activity and receptors of the CNS
129
Sodium Valproate: 2 Indicators
status epilepticus that have not responded to 2 doses of midazolam
130
Sodium Valproate: 3 Contras:
Known severe allergy Cautions NONE
131
Sodium Valproate: 4 Dose
1 ampule = 400mg 1200mg = adult administer IV for over 10-15mins into a running line Use NACL not water Dissolve each ampule using 4mls NACL = draw up amps into 1 syringe and dilute further to a total of 10mls if vol is less - administer 1ml IV every 1-2 mins Val may be added to 100ml bag 5% glucose and shake well. 2-3DPS via standard IV set will deliver 100mls of 10-15mins. Adminstration set to be flushed with NACL post completion to ensure all sod. val is given
132
**Tenecteplase:**
STEMI PATHWAY DRUG
133
Tramadol: 1 MOA`
Is an analgesic Multiple actions within the CNS = opiate receptor stimulation + inhibition of the re-uptake of noradrenaline; serotonin.
134
Tramadol: 4 Cautions
Taken within the last 4 hours Abdo pain + unwell and vomiting \>75yrs old + hx of confusion or dementia Pregnancy metabolised in the liver and excreted by the kidneys
135
Tramadol: 5 other
dose = 50mg duration = 30-60mins effect = 4-8hrs can cause serotonin syndrome with .50mg and SSRI's and tricyclics, and recreational drugs
136
Tramadol: 2 Indications
Moderate pain + paracetamol & Ibuprofen can be given for severe pain if not ILS available
137
Tramadol: 3 Contras:
Known severe allergy age less than 12 yrs
138
**0.9% Normal Saline: 1**
**MOA**
= Hypovolaemia
=Blunt trauma
= Peripheralblood loss
=GI bleed
= Antepartum Haemorrage
= Hyperthermia
=Fluid Loss
=hypovolaemia other causes
139
Enoxaparin: low moleculare weight Heparin -Anticoagulant Actions:
Indications:
Contras
Potentiates the activity of anti-thrombin III - naturally occuring anticoagulant.
Used in conjunction with fibrinolytic theapy
Risk of bleeding & Pregnancy
140
## Footnote
**Gentamicin: 1.**
**MOA**
Is an Aminoglycoside antibiotic
broad spectrum
works agains gram negative and some gram postitive bacteria
inhibits the baterical cell protein synthesis = bacteria die
141
**Gentamicin: Doses**
**Administration:**
**Ampoule:** 80mg in 2ml
**Adults:**
- 240mg if ,60kg
- 320mg if 60-80kg
- 400mg if \> 80kg
A: Give the Amoxicillin first
A: Gent to be given in 1 litre bag NACL, labelled and shake well.
142
**Gentamicin: 2.**
**Indications:**
**Contrads:**
Septic Shock combined with Amoxicillin/clavulanic acid
if more that 30 mins from hospital
if infection site = urinary tract, abdoen or unknown
Known severe allergy
pregnancy
143
**Glucagon: 1**
**MOA:**
**Indications:**
**Doseage**
Glucagon increases blood glucose level by stimulating the breakdown of glycogen into glucose (glycogenolysis)
in the liver
Ampule contains 1mg of powder
Hypoclycaemia when a patient can not swallow glucose/food and IV access can not be obtained.
Adult: 1mg IM
Child: \<5yrs - 0.5mg
DONT Repeat dose
144
## Footnote
**Glucose Gel:**
**MOA:**
**Indications:**
**Contras:**
**Cautions:**
**Dose**
Easily swallowed and rapidly absorbed glucose gel
Hypoglycaemia (3.5mmols) and can swallow
None
Nil
10-20 for all ages and repeat sachet every 10mins
145
## Footnote
**Glyceryl Trinitrate (GTN)**
**MOA**
GTN is a vasodilator
\*Acts on the vascular smooth muscles to cause venous & arterial vasodilation with predominant effect on the veins.
\*Forms nitric oxide as a vasodilator
\*reduction in venous return - preload to the heart
\*reduces ventricular filling & cardiac output -decreases the myocardial oxygen demand
\*Arterial Dilation reduces peripheral resistance (afterload)
\*Reduces left ventricular forces - reduces mucardial oxygen demand
\*Dilation of the coronary arteries, increases the coronary blood supply
146
GTN \: Right Ventrical NO GTN
ST elevation - V1, looks at the right ventricle
ST Elevation - III - II
ST Elevation - V1 - V2
ST Elevation - V1 and depression V2
Isoelectric ST segment V1 with marked ST Depression V2
147
## Footnote
**GTN: 5**
**Doseage**
MI: 0.4mg every 3-5 mins
CPO: 0.8mg every 3-5mins
AD: 0.4-0.8 every 3-5mins
148
**GTN:**
**Cautions:**
STEMI involving Right ventricle - may cause a fall in cardiac output
Small, frail or physiologically unstable
poor perfusion
dysrhythmia
erectile drugs
aortic or mitral stenosis
149
## Footnote
**GTN: 3**
**Contras:**
\* Systolic BP less than 100mmHg
\* Heart Rate less than 40BPM
\* Heart rate greater thatn 130BPM if primary is MI, STEMI, OR CPO
\* Heart rate greater than 150BPM if primary is Autonomic dysreflexia
\* Ventricular Tachycardia
150
**GTN:**
**Indications:**
Myocardial Ischaemia
Cardiogenic pulmonary oedema
Hypertension assoc with autonomic dysreflexia
151
**Heparin: 3**
**Contras:**
**Cautions:**
**Dose:**
= known severe allergy
= aged 75yrs +
Clinically significant bleeding
risk of bleeding
pregnancy
= 5000 units - dilute to 5-10mls NACL give post fibrinolytic therapy over 15mins
152
**Ibuprofen: 5**
**Doses**
= adults: 600mg \> 80kg,
= adults: 400mg \< 80kg
153
**Ibuprofen: 1.**
**MOA**
non-steroidal anti-inflammatory NSAID
treating pain
inhibits the activity of prostaglandin synthetase
reduction of prostaglandin production
reduction of inflammation, pain and fever
154
**Ibuprofen: 2.**
**Indications**
- mild to moderate pain
- combination with paracetamol
- can be given with other measures for severe pain, on long hauls.
155
**Ibuprofen: 4:**
**Cautions:**
= taken in last 4 hours - cold and flu tablets
= Abdominal pain - unwell or vomiting
=age =\> 75yrs
=Dehydration or shock
=renal impairment
=Bleeding disorder
=worsening bronchospasm with NSAIDS
= warfarin use
= pregnancy
156
## Footnote
**Ipratropium: 4**
**Dose**
= 0.5mg x1 dose
in combination with salbutamol
157
## Footnote
**Ipratropium: 1.**
**MOA**
- Bronchodilator
- anticholinergic agent with predominantly antimuscarinic activty
- antagonises - blocks- acetylcholine receptors = vagal inhibition = brondilation.
158
**Loratadine: 3**
**Contras:**
**Cautions:**
- known severe allergy
- age \>1 yr
pregnancy
159
## Footnote
**Methoxyflurane: 4**
**Cautions: 3 cautions =**
- Age greater than 75yrs with illness
- Pre-eclampsia
- Confined spaces
160
## Footnote
**Methoxyflurane: 5**
**Doses**
Adult: max 2 doses = 6ml \>12yrs old
161
**Methoxyflurane; 2**
**Indications**
moderate to severe pain
not to be used as a Paramedic
162
**0.9% Normal Saline: 2**
**Doses**
=Triate to intravascular volume/perfusion
shock = global reducation on blood flow/perfusion to organs
Adults: 1 litre
Child: 20mls/kg
HR - be aware of beta blockers
Pulse Pressure
CAP
BP
LOC
Warm - remove wet clothes
Ectopic pregnancy/miscarriage
163
**Heparin: 1.**
**MOA**
= anticoagulant
=potentiates the anti-thrombin 111
=naturally occuring anticoagulant
inhibits multiple coagulation factors
164
**Heparin: 2**
Indication
=STEMI pathway
165
**Ibuprofen: 3**
**COntras:**
= known severe allergy
= 3rd trimester pregnancy
166
**Ipratropium: 2**
**Indications**
= bronchospasm 2nd to asthma or CORD
= prominent bronchospasm 2nd to airway burns or smoke inhalation
167
**Ipratropium: 3**
**COntras:**
**Cautions**
= known severe allergy
= none
168
**Loratadine: 2**
**Indications =2**
- Minor allergic reactions confined to skin involvement
- priminent itch assoc with anaphylaxis, provided all systemic signs of anaphylaxis have been ressolved.
169
**Loratadine: 1. MOA**
- non-sedating antihistamine
antagonises (blocks) peripherial histamine receptors, which blocks the histamine and decreases itching and redness
170
**Methoxyflurane: 3**
Contras: PHURS
- personal or family hx of malignant hyperthermia
- has received methoxyflurane in the last week
- unable to obey commands
- renal impairement
--severe allergy
