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ILS Precepting > Medicines > Flashcards

Medicines Flashcards

12.1

1
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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.

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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.

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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.

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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.

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7
Q

Adrenaline: 3 Common Effects

A

Common Effects Tachycardia, Tachydysrhythmia, Myocardial Ischaemia, Ventricular Ectopy, Hypertension, Nausea & Vomiting, tremor, anxiety, sweating, Hyperglycaemia

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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 &amp; Label

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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 &amp; 3rd degree HB

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10
Q

Amiodarone: 2 Scope

A

Paramedics - cardiac arrest ICP - all indication

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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

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12
Q

Amiodarone: 8 Onset Dose

A

onset = 5-10mins duration = 1-4 hours after single dose Dose - 150mg in 3ml

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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

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14
Q

Amiodarone: 1 MOA

A

Antidysrhythmic Class # activity Prolongs action potential duration Reduces automaticity prolongs action potential at atrial, nodal &amp; ventricular tissue reduces abnormal electrical activity, electrical conduction, heart rate and stabilization of SA &amp; AV nodes. increase in coronary blood flow and reduction in myocardial oxygen needs

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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

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16
Q

Amiodarone: 4 Condras

A

Known Severe Allergy Known severe allergy to Iodine VT 2nd to cyclic anti-depressant poisoning.

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17
Q

Amiodarone: 7 Common Adverse Effects

A

lightheadedness Hypotension Bradyarrhythmia Sweating/Flushing Decreased HR Nausea/Vomiting

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18
Q

Amoxicillin/Clavulanic Acid: 1 MOA

A

Inhibits production of Bacterial cell wall - dies Beta-Lactam antibiotic with Broad spec activity.

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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

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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

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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

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22
Q

Aspirin: 1 MOA

A

Has antiplatelet, antypyretic, anti-inflammatory and analgesic effects - we give for the antiplatelet effects

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23
Q

Aspirin: 2 Indications

A

for Myocardial ischaemia

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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

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25
Q

Aspirin; 3 Contraindications

A

Known severe Allergy 3rd Trimester pregnancy

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26
Q

Aspirin; 5 Dose

A

300mg chewed or dissolved in water

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27
Q

Fentanyl : 1: MOA

MOA

A

Is an Opiate analgesia.

Opiate agonist - stimulates that binds to the opiate receptors

in the brain. Kappa, Mu, Delta

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28
Q

Fentanyl: Contras

A

Known severe allergy

unable to obey commands

Current respiratory depression

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29
Q

Fentanyl: Doses

A

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

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30
Q

Fentanyl: Adverse Effects

A

Sedation

Europhoria

Respiratory Depression

Bradycardia

Hypotension

Nausea & Vomiting

Itch

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31
Q

Fentanyl: Onset effect

A

Fentanyl:

IV; 2-5mins (depressants not for 10-15mins)

IN; 5-10mins

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32
Q

Fentanyl Indications

A

Moderate to severe pain

Intense short term pain relief for joint relocation

clinically significant shock

does not have IV Access

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33
Q

Fentanyl: Cautions

A

Ages less than 1 year

High risk of Respiratory depression

Labour

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34
Q

Five Rights include:

A
  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
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35
Q

Ketamine 8 Administration

A

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.

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36
Q

Ketamine 11 Pharmacokinetics

A

Ketamine is metabolised in the liver Warn patient it is possible to feel strange following administration.

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37
Q

Ketamine 10 Onset of Effect

A

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

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38
Q

Ketamine 9 (SHANTT) Common adverse effects

A

Sedation Hallucinations Apnoea Nausea &amp; Vomiting Tachycardia Transient Hypertension

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39
Q

Ketamine: 1 MOA

A

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

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40
Q

Ketamine: 4 Contras

A

Known severe Allergy

Age less than 1 year

Current myocardial ischaemia

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41
Q

Ketamine: 3 Indications

A

Severe pain in addition to other medications esp MS or burns pain inducing dissociation eg: cardioversion joint relocation /limb alignment

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42
Q

Ketamine: 2 Scope

A

ICP and clinical desk

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43
Q

Ketamine: 5 Cautions (CHUA)

A

Clinical conditions that may be made worse by hypertension - hemorrhagic stroke

Hypertension

Unable to obey commands

Active psychosis

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44
Q

Ketamine: 6 Administration

A

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.

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45
Q

Ketamine: 7 Dose

A

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

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46
Q

Lignocaine 1 % 9 Other info

A

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.

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47
Q

Lignocaine 1 % 8 Preparation

A

ampoule containing 50mg in 5 ml

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48
Q

Lignocaine 1% 1 MOA

A

local anaesthetic blocks the initiation &amp; transmission of nerve impulses by blocking the movement of sodium ions across the nerve cell membrane.

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49
Q

Lignocaine 1% 3 Contras: Cautions:

A

Known Severe Allergy Local infection at site of injection

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50
Q

Lignocaine 1% 2 Indications

A
  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.
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51
Q

Lignocaine 1% 4 Doseage

A

Subcut: (SC) Adult: max dose 20ml repeat after one hour Intraosseous: Adult: 5ml Repeat after 15mins

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52
Q

Lignocaine 1% 5 Adminsitration

A

SC for IV insertion: administer into the subcutaneous tissue at site of cannulation, raise a bleb &amp; 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 &amp; wait 1 min before infusing fluid.

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53
Q

Lignocaine 1% 7 Onset of effect

A

IV cannulation = 1-2 mins Ring Blocks= 5-10 mins Duration = 30-60mins

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54
Q

Lignocaine 1% 6 Adverse Effects

A

Stinging at time of injection

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55
Q

Methoxyflurane 3 Condras

A

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

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56
Q

Methoxyflurane 4 cautions

A

age greater than > to 75yrs (illness, infection or dehydration = ? renal impairement =? increases Pre-eclampsia Adminstration within a confined space

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57
Q

Methoxyflurane 6 Common adverse effects

A

Sedation Light headness Nausea Dislike of taste/smell

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58
Q

Methoxyflurane 7 Onset Duration

A

1-2 mins 2-5mins after stopping giving

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59
Q

Methoxyflurane 8 Prep

A

3ml bottle with plastic bag Approx 20% is exhaled - remainder is metablished in the liver

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60
Q

Methoxyflurane 1 MOA

A

Inhaled analgesic

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61
Q

Methoxyflurane 5 Dose

A

Max 6mls >12yrs and older Max 3mls ,12 yrs

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62
Q

Methoxyflurane 2 Indications

A

Moderate to Severe Pain

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63
Q

Methoxyflurane 9 Malignant Hypethermia (MH)

A

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

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64
Q

Methoxyflurane: 1.

MOA

A

Inhaled analgesic

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65
Q

Metoprolol 6 Dose

A

1-2mg every 5-10 mins Must be discussed with STEMI coordinator/Clinical Desk/Dr Administer IV undiluted as a bolus

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66
Q

Metoprolol 8 Effect

A

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.

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67
Q

Metoprolol 3 Indications

A

Control of hypertension prior to fibrinolytic therapy for STEMI

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68
Q

Metoprolol 5 Cautions

A

Previous 2nd/3rd degree HB Asthma or CORD Known sick sinus syndrome 1st Degree HB

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69
Q

Metoprolol 1 MOA

A

Is a Beta-blocker It antagonises (blocks) beta-1 receptors in the heart - decrease heart rate, cardiac output and blood pressure.

70
Q

Metoprolol 2 Scope

A

ICP’s Paramedic with clinical desk only

71
Q

Metoprolol 7 Common Adverse Effects (ABC)

A

Bronchospasm Bradycardia Hypotension

72
Q

Metoprolol 4 Contrads:

A

Known Severe Allergy Bradycardia Hypotentsion

73
Q

Midazolam: 1 MOA

A

Is a benzodiazepine enhances the activity of GABA receptors within the CNS, provides anticonvulsant activity, sedation, amnesia, anxiolysys and muscle relaxation

74
Q

Midazolam: 4 Contrads: Cautions:

A

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
Q

Midazolam: 2 Scope

A

Paramedics- IM &amp; IV for seizures Paramedics - IM for agitated delirium ICP - all routes and indications

76
Q

Midazolam: 3 Indications: (AMPSJP)

A

use - prolonged seizures IM/IV

moderate agitated delirium - IM

77
Q

Midazolam: 5 Administration

A

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 &amp; dilute to a total of 10ml + NACL Must be able to obey commands at all times

78
Q

Midazolam: 6 Effect

A

IV: 2-3 mins IM: 3-5 mins Duration - 30-60mins

79
Q

Midazolam: 5 Common Adverse Effects (RASH)

A

Respiratory Depression Amnesia Sedation Hypotension

80
Q

Morphine: 1 MOA

A

Opiate analgesic binds the opiate receptors in the brain +spinal cord

81
Q

Morphine: 7 Onset of effect

A

IV: 2-5mins ( 10-15mins) IM: 5-10mins duration: 30-60mins

82
Q

Morphine: 6 Common Adverse Effects

A

Respiratory depression

Hypotension

Nasuea and Vomiting Sedation

Histamine release & Itch

83
Q

Morphine: 4 Cautions

A

age <1 yr - increased risk of respiratory depression high risk of respiratory depression (severe CORD, morbid obesity or home BiPAP Labour

84
Q

Morphine: 3 Contras:

A

known severe allergy unable to obey commands (except agitated delirium & Post intubation) Current respiratory depression

85
Q

Morphine: 5 Doseage

A

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
Q

Morphine: 8 Pharmacokinetics

A

morphine is less lipophilicity than fentanyl morphine causes more histamine release than fentanyl is metabolised in the liver

87
Q

Morphine: 2 Indications

A

moderate to severe pain

cardiogenic pulmonary oedema with severe anxiety

respiratory distress sedation post intubation

88
Q

Naloxone: 1 MOA

A

Opiate receptor antagonist (Blocker) reverse effects of opiates - respiratory depression ; sedation.

89
Q

Naloxone: 3 Contras:

A

known severe allergy

90
Q

Naloxone: 4 Doseage

A

Adult: 0.1-0.4mg IV every 3-5mins Adult: 0.8mg IM= repeated every 10misn

91
Q

Naloxone: 5 Adminstration

A

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
Q

Naloxone: 2 Indications

A

Opiate poisoning is suspected significant impairement LOC impaired Breathing excess adverse effects from adminstration of opiates

93
Q

Naloxone: 6 Common adverse effects

A

Tachcardia Hypertension Sweating

94
Q

Naloxone: 7 Effects

A

IV: 1-2 mins IM: 5-10mins

95
Q

Olanzapine: 4 Dose:

A

comes in 5mg tablets (wafers) 80kg + 10mg 80kg < 5mg repeat after 20mins orally dispersible and dissolve in mouth.

96
Q

Olanzapine: 2 Indication

A

MILD agitation

97
Q

Olanzapine: 3 Contras:

A

Known Severe allergy age less than 12yrs

98
Q

Olanzapine: 1 MOA

A

atypical anti-psychotic reacts at multiple receptor sites within the brain to reduce agitation, sedation, anxiolysis and mood stabilsation

99
Q

Ondansteron: 1 MOA

A

Antimetic antagonises (blocks) serotonin receptors in the CNS and peripherally in the GI tract = decreased nausea nd vomiting

100
Q

Ondansteron: 2 Indications

A

clinically significant nasuea/or vomiting

101
Q

Ondansteron: 3 Contras:

A

Known severe allergy age < 1yrs

102
Q

Ondansteron: 4 Dose

A

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
Q

Ondansteron: 5 Common Adverse Effects

A

Headache, Flushing Metallic Taste

104
Q

Ondansteron: 6 Onset

A

PO: 10-20mins IV: 2-5 mins IM: 5-10mins

105
Q

Oxytocin: 1 MOA

A

synthetic version of oxytocin hormone normally released from the pituitary gland stimulates the oxytocin receptors on the uterus causes uterine contraction &amp; reduces blood loss from uterus.

106
Q

Oxytocin: 4 Dose

A

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
Q

Oxytocin: 5 Common adverse effects

A

Tachycardia Flushing Abdominal cramping

108
Q

Oxytocin: 6 Onset effect

A

5-10mins 30-60mins effecct

109
Q

Oxytocin: 2 Indications

A

Following a normal birth Post partum haemorrhage

110
Q

Oxytocin: 3 Contras: Cautions:

A

Known severe allergy no cautions

111
Q

Paracetamol: 3 Contras:

A

known severe allergy current paracetamol poisoning

112
Q

Paracetamol: 2 Indications

A

mild to moderate pain and combined with other medications

113
Q

Paracetamol: 4 Cautions

A

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
Q

Paracetamol: 5 Doseage

A

Adults <80kg - 1g > 80kg 1.5g can be given for fever above 39Degrees and causing discomfort

115
Q

Paracetamol: 1 MOA

A

Inhibits the production of prostaglandins = reduces pain and fever

116
Q

Prednisone: 2 Indications

A

Bronchospasm assoc with CORD/Asthma Prominent rash assoc with anaphylasis provided all systemic signs of anaphylaxis have ressolved Minor allergy associated with rash

117
Q

Prednisone: 1 MOA

A

Is a cortisosteroid with anti-infma and immunosuppressants actions causes a reducion in inflammatory &amp; Immune responses

118
Q

Prednisone: 3 Contrads:

A

Known Severe Allergy age <1 yr old

119
Q

Prednisone: 5 Dose onset effect

A

40mg for adult 30-60mins 24hrs

120
Q

Prednisone: 4 Common Adverse Effects

A

Bitter taste fatigue Sodium and warer retension GI reflux

121
Q

Salbutamol: 1 MOA`

A

Bronchodilator agonist (stimualtor) of Beta2 receptors

122
Q

Salbutamol: 2 Indications

A

Bronchospasm 2nd to asthma or CORD Prominetn bronchospasm 2nd to airway burns or smoke inhalation.

123
Q

Salbutamol: 3 Contrads: Cautions:

A

known severe allergy None

124
Q

Salbutamol: 4 Dose

A

5mg initial dose is combined with 0.5mg of ipratropium undiluted nebulised

125
Q

Salbutamol: 5 Common adverse effects

A

Tremor Tachycardia

126
Q

Salbutamol: 6 onset

A

2-5 mins duration 1-2 hours

127
Q

Sodium Valproate: 5 Effect

A

IV: 10-20mins duration: 6-12hrs BACK UP/CLinical desk to be called first

128
Q

Sodium Valproate: 1 MOA

A

Anticonvulsant = blocks the sodium channels enhances the GABA activity and receptors of the CNS

129
Q

Sodium Valproate: 2 Indicators

A

status epilepticus that have not responded to 2 doses of midazolam

130
Q

Sodium Valproate: 3 Contras:

A

Known severe allergy Cautions NONE

131
Q

Sodium Valproate: 4 Dose

A

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
Q

Tenecteplase:

A

STEMI PATHWAY DRUG

133
Q

Tramadol: 1 MOA`

A

Is an analgesic Multiple actions within the CNS = opiate receptor stimulation + inhibition of the re-uptake of noradrenaline; serotonin.

134
Q

Tramadol: 4 Cautions

A

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
Q

Tramadol: 5 other

A

dose = 50mg duration = 30-60mins effect = 4-8hrs can cause serotonin syndrome with .50mg and SSRI’s and tricyclics, and recreational drugs

136
Q

Tramadol: 2 Indications

A

Moderate pain + paracetamol &amp; Ibuprofen can be given for severe pain if not ILS available

137
Q

Tramadol: 3 Contras:

A

Known severe allergy age less than 12 yrs

138
Q

0.9% Normal Saline: 1

MOA

A

= Hypovolaemia

=Blunt trauma

= Peripheralblood loss

=GI bleed

= Antepartum Haemorrage

= Hyperthermia

=Fluid Loss

=hypovolaemia other causes

139
Q

Enoxaparin: low moleculare weight Heparin -Anticoagulant Actions:

Indications:

Contras

A

Potentiates the activity of anti-thrombin III - naturally occuring anticoagulant.

Used in conjunction with fibrinolytic theapy

Risk of bleeding & Pregnancy

140
Q

Gentamicin: 1.

MOA

A

Is an Aminoglycoside antibiotic

broad spectrum

works agains gram negative and some gram postitive bacteria

inhibits the baterical cell protein synthesis = bacteria die

141
Q

Gentamicin: Doses

Administration:

A

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
Q

Gentamicin: 2.

Indications:

Contrads:

A

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
Q

Glucagon: 1

MOA:

Indications:

Doseage

A

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
Q

Glucose Gel:

MOA:

Indications:

Contras:

Cautions:

Dose

A

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
Q

Glyceryl Trinitrate (GTN)

MOA

A

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
Q

GTN : Right Ventrical NO GTN

A

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
Q

GTN: 5

Doseage

A

MI: 0.4mg every 3-5 mins

CPO: 0.8mg every 3-5mins

AD: 0.4-0.8 every 3-5mins

148
Q

GTN:

Cautions:

A

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
Q

GTN: 3

Contras:

A

* 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
Q

GTN:

Indications:

A

Myocardial Ischaemia

Cardiogenic pulmonary oedema

Hypertension assoc with autonomic dysreflexia

151
Q

Heparin: 3

Contras:

Cautions:

Dose:

A

= 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
Q

Ibuprofen: 5

Doses

A

= adults: 600mg > 80kg,

= adults: 400mg < 80kg

153
Q

Ibuprofen: 1.

MOA

A

non-steroidal anti-inflammatory NSAID

treating pain

inhibits the activity of prostaglandin synthetase

reduction of prostaglandin production

reduction of inflammation, pain and fever

154
Q

Ibuprofen: 2.

Indications

A
  • mild to moderate pain
  • combination with paracetamol
  • can be given with other measures for severe pain, on long hauls.
155
Q

Ibuprofen: 4:

Cautions:

A

= 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
Q

Ipratropium: 4

Dose

A

= 0.5mg x1 dose

in combination with salbutamol

157
Q

Ipratropium: 1.

MOA

A
  • Bronchodilator
  • anticholinergic agent with predominantly antimuscarinic activty
  • antagonises - blocks- acetylcholine receptors = vagal inhibition = brondilation.
158
Q

Loratadine: 3

Contras:

Cautions:

A
  • known severe allergy
  • age >1 yr

pregnancy

159
Q

Methoxyflurane: 4

Cautions: 3 cautions =

A
  • Age greater than 75yrs with illness
  • Pre-eclampsia
  • Confined spaces
160
Q

Methoxyflurane: 5

Doses

A

Adult: max 2 doses = 6ml >12yrs old

161
Q

Methoxyflurane; 2

Indications

A

moderate to severe pain

not to be used as a Paramedic

162
Q

0.9% Normal Saline: 2

Doses

A

=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
Q

Heparin: 1.

MOA

A

= anticoagulant

=potentiates the anti-thrombin 111

=naturally occuring anticoagulant

inhibits multiple coagulation factors

164
Q

Heparin: 2

Indication

A

=STEMI pathway

165
Q

Ibuprofen: 3

COntras:

A

= known severe allergy

= 3rd trimester pregnancy

166
Q

Ipratropium: 2

Indications

A

= bronchospasm 2nd to asthma or CORD

= prominent bronchospasm 2nd to airway burns or smoke inhalation

167
Q

Ipratropium: 3

COntras:

Cautions

A

= known severe allergy

= none

168
Q

Loratadine: 2

Indications =2

A
  • Minor allergic reactions confined to skin involvement
  • priminent itch assoc with anaphylaxis, provided all systemic signs of anaphylaxis have been ressolved.
169
Q

Loratadine: 1. MOA

A
  • non-sedating antihistamine

antagonises (blocks) peripherial histamine receptors, which blocks the histamine and decreases itching and redness

170
Q

Methoxyflurane: 3

Contras: PHURS

A
  • personal or family hx of malignant hyperthermia
  • has received methoxyflurane in the last week
  • unable to obey commands
  • renal impairement

–severe allergy

ILS Precepting (65 decks)

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