Medicines Flashcards
(258 cards)
1
Q
Adenosine dose
A
6mg IV followed by second dose 12mg IV if SVT does not revert
2
Q
Adenosine indication
A
Patients older than 12 with SVT and ventricular rate greater than 150,
and known responsiveness to adenosine
and causing moderate cardiovascular compromise
3
Q
Adenosine contraindications
A
Known severe allergy
Known sick sinus syndrome
History of second or third degree heart block without pacemaker
Heart transplant without pacemaker
4
Q
Adenosine caution
A
Asthma or COPD acute exacerbation and/or history of life threatening bronchospasm
Wolf Parkinson White if any chance of rapid atrial fibrillation
5
Q
Adenosine administration
A
6mg in 2ml, given neat into ACF followed by rapid flush.
6
Q
Adenosine adverse effects
A
Bradycardia and/or sinus pause up to 30 seconds
Shortness of breath or urge to breathe deeply
Lightheadedness
Nausea, flushing
Chest pressure or severe apprehension
7
Q
Adenosine pharmokinetics
A
Rapidly taken up and metabolised within seconds by red blood cells and vascular endothelial cells
8
Q
Adenosine onset of effect
A
5 to 10 seconds
9
Q
Adenosine duration of effect
A
10-20 seconds.
10
Q
Adrenaline mechanism of action
A
Stimulates alpha and beta receptors, primarily alpha 1, beta 1, and beta 2 receptors.
alpha 1 stimulation causes smooth muscle contraction, vasoconstriction, stimulation of glycogenolysis and gluconeogenesis
beta 1 causes increase in inotropy, chronotropy, and dromotropy
beta 2 causes smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation, and stabilisation of mast cell membranes to reduce histamine release
11
Q
Adrenaline indication
A
Cardiac arrest Anaphylaxis Severe asthma Imminent respiratory arrest in COPD Severe bradycardia Moderate to severe stridor IN for epistaxis topical for wounds shock where unresponsive to metaraminol
12
Q
Adrenaline contraindications
A
None
13
Q
Adrenaline cautions
A
Myocardial ischaemia
Tachydysrhythmia
14
Q
Adrenaline dose
A
Topical 1:10000 diluted to total of 10ml.
Intranasal 1:10000 diluted to a total of 10ml, with 0.2mg or 2ml through a MAD
Nebuliser, 5mg undiluted
IM neat (0.5mg for asthma repeated q10 minutes, q10 for not improving anaphylaxis, q5 minutes for deteriorating anaphylaxis)
IV undiluted for cardiac arrest
15
Q
Adrenaline adverse effects
A
Tachycardia Tachydysrhythmia Myocardial Ischaemia Ventricular ectopy Hypertension Nausea and vomiting Tremor, anxiety, sweating Hyperglycaemia
16
Q
Adrenaline onset IV
A
5-10 seconds
17
Q
Adrenaline onset IM
A
2-5 minutes
18
Q
Adrenaline onset topical and intranasal
A
on contact
19
Q
Adrenaline pharmacokinetics
A
Adrenaline is metabolised by the liver and taken up by sympathetic nerve endings. There are no significant effects from liver impairment on acute administration.
20
Q
Amiodarone mechanism
A
An antidysrthymic with broad spectrum of activity.
Predominately class three activity (it prolongs the action potential duration, reduces automaticity and prolongs refractory period of atrial, nodal and ventricular tissues)
… resulting in reduction of abnormal electrical activity, a reduction in electrical conduction, reduction in heart rate, and stabilisation of SA and AV nodes.
Small increase in coronary blood flow & reduction in myocardial oxygen consumption by reducing inotropy.
21
Q
Amiodarone indications
A
Cardiac arrest in VT or VF after first dose of adrenaline
adults in sustained VT
Adults with moderate cardiovascular compromise as result of fast AFib or fast AFlutter
22
Q
Amiodarone contraindications
A
Known severe allergy
Known severe allergy to iodine
VT secondary to TCA poisoning (can cause worsening shock).
23
Q
Amiodarone cautions
A
None in cardiac arrest
24
Q
Amiodarone dosage
A
300mg for adult… (2x 150mg in 2ml vial)
If VT or VF persists, a second dose of 150mg May be administered.
25
Amiodarone administration
Neat IV bolus of 300mg in 4ml, two vials
26
Amiodarone adverse effects
Hypotension
Lightheadedness
Bradydysrhysmia
27
Amiodarone onset
5-10 minutes
28
Amiodarone duration
1-4 hours after single dose.
29
Amiodarone pharmacokinetics
Metabolised by liver.
30
Amoxiclav mechanism
Is a beta-lactate antibiotic with broad activity against gram negative and gram positive bacteria. Also has some activity against anaerobic bacteria, particularly those from the mouth.
Inhibits production of the bacterial cell wall causing bacteria to die.
31
Amoxiclav indications
Sepsis and:
Patient is aged greater than 12
One or more High Risk factors are present
Time to hospital greater than 30 minutes
Cellulitis where single IV dose may be given if referred to primary care but delay may be present.
32
Amoxiclav contradindications
Known severe allergy
| Known severe allergy penicillins or cephalosporins
33
Amoxiclav cautions
None! Free square.
34
Amoxiclav dose
1.2g
35
Amoxiclav administration
Dissolve 1.2g in nacl and dilute to 10ml. administer IV over 1-2 minutes preferably into running IV line
Do not administer IM if IV access cannot be obtained.
36
Amoxiclav onset
30-60 minutes
37
Amoxiclav duration
6-8 hours
38
Amoxiclav Pharmacokinetics
Excreted in urine - clearance prolonged in renal impairment, does not alter dose.
39
Aspirin mechanism
Has antiplatelet, antipyretic, anti-inflammatory and analgesic effects but only given for antiplatelet effect
Inhibits cyclooxygenase which results in reduction of formation of thromboxane and prostaglandins
40
Aspirin indications
Myocardial ischaemia
41
Aspirin contraindications
Known severe allergy
| Third trimester of pregnancy
42
Aspirin caution
Known bleeding disorder (usually in favour of administration)
Clinically significant bleeding
Known worsening bronchospasm with NSAIDs
43
Aspirin dose
300mg in 1 tablet
44
Aspirin admin
One 300mg tablet sublingual or dispersed in water.
45
Aspirin common adverse effects
Increased bleeding
| Indigestion and gastric bleeding only risk with prolonged use
46
Aspirin onset
30-60 minutes
47
Aspirin duration
3-5 days for antiplatelet activity
48
Aspirin pharmacokinetics
Absorbed in stomach, metabolised in liver
49
Aspirin interactions
Warfarin
50
Ceftriaxone mechanism
Cephalosporin antibiotic with broad activity against gram negative and positive bacteria. inhibits production of the bacterial cell wall.
51
Ceftriaxone indications
Suspected meningococcal septicaemia
52
Ceftriaxone contraindications
Anaphylaxis to cephalosporins
53
Ceftriaxone cautions
None. Free square.
54
Ceftriaxone dose
2g IV
| 2g IM if IV access cannot be obtained
55
Ceftriaxone administration
Reconstitute 2g and dilute to 10ml, administer IV over 1-2 minutes preferably into a running line.
Reconstitute 2g with 4ml nacl and split into roughly equal doses for IM administration
56
Ceftriaxone adverse effects
None
57
Ceftriaxone onset
30-60 minutes
58
Ceftriaxone duration
24 hours
59
Ceftriaxone pharmacokinetics
Excreted in urine and bile
60
Clopidogrel mechanism
Powerful antiplatelet agent, blocks ADP.
61
Clopidogrel indications
STEMI thrombolysis.
62
Clopidogrel contraindications
Known severe allergy
63
Clopidogrel cautions
Clinically significant bleeding
At risk of bleeding
Pregnancy
64
Clopidogrel dose
300mg if less than 75 years
75mg if greater than 75 years
Tablet
65
Clopidogrel adverse effects
Increased bleeding
66
Clopidogrel onset
30-60 minutes
67
Clopidogrel pharmacokinetics
prodrug, must be metabolised in the liver into active form.
68
Droperidol mechanism of action
Blocks dopamine and alpha receptors centrally, resulting in sedation, reduced agitation, and mental detachment.
69
Droperidol indications
Patients aged greater than or equal to 12 years with agitated delirium causing a mild to moderate risk to safety when olanzapone has not been administered or is ineffective.
70
Droperidol contraindications
Known severe allergy
71
Droperidol cautions
Parkinson’s disease - risk of worsening movement disorder.
Concurrent administration of other sedatives - this will increase and prolong effects.
Intoxication - potentiates
Elderly or frail - increase/prolong effects
72
Droperidol dosage
10mg IM or IV, reduce to 5 if patient is frail, repeat once after 20 minutes.
73
Droperidol administration
IM neat, lateral thigh
| Dilute 10mg to 10ml and administer IV over 1-2 minutes.
74
Enoxaparin mechanism
Low molecular weight heparin anticoagulant, potentiating activity of antithrombin III causing inhibition of multiple coagulation factors
75
Enoxaparin indication
STEMI thrombolysis
76
Enoxaparin contraindications
Known severe allergy
77
Enoxaparin cautions
Clinically significant bleeding
Risk of bleeding
Pregnancy
78
Enoxaparin dose
Weight and age based. 60-100mg for those under 75 and 44-75 for those over 75.
79
Enoxaparin administration
subcut into abdominal wall
80
Enoxaparin onset
10-30 minutes
81
Enoxaparin duration
12-24 hours
82
Enoxaparin pharmacokinetics
Excreted in urine.
83
Fentanyl mechanism of action
Opiate analgesic.
84
Fentanyl indications
```
Moderate to severe pain
Cardiogenic pulmonary oedema with severe anxiety
RSI
Sedation post intubation
Symptom control at end of life care
```
85
Fentanyl contraindications
Known severe allergy
Unable to obey commands (other than rsi, end of life care, post intubation)
Respiratory depression
86
Fentanyl cautions
Aged less than one year
High risk of respiratory depression (severe copd, home bipap)
Labour
Concurrent administration of other opiates or cns depressants
Elderly or frail
Signs of shock.
87
Fentanyl dose
IV analgesia - 10-50mcg every five minutes for an adult.
IN analgesia 100mcg for adult, further doses 50mcg every ten minutes without maximum dose. 200 + 100 adult over 80kg.
IM 50-100mcg for an adult.
88
Fentanyl adverse effects
```
Respiratory depression
Bradycardia
Hypotension
Sedation
Nausea and vomiting
Itch
Euphoria
```
89
Fentanyl onset
IV 2-5 minutes, maximum in 10-15.
IN 5-10 minutes.
IM 5-10 minutes
90
Fentanyl duration
30-60 minutes although respiratory depression may last hours.
91
Fentanyl pharmacokinetics
Fat soluble, well absorbed through nasal mucosa.
Causes histamine release. Small fall in blood pressure.
Metabolised in liver.
92
Gentamicin mechanism of action
Aminoglycoside antibiotic with broad activity against gram-negative bacteria. inhibits cell protein synthesis.
93
Gentamicin indications
Sepsis, in addition to amoxicillin/clavulanic acid) where site of infection is urinary tract, abdomen, or unknown and:
Patient aged 12+
One or more high risk factors
Time to hospital is greater than 30 minutes
94
Gentamicin contraindications
Known severe allergy
| Pregnancy
95
Gentamicin cautions
Empty square player choice
96
Gentamicin dosage
400mg if greater than 80kg
320 if 60-80kg
240 if less than 60kg
97
Gentamicin administration
Dilute dose up to 10-20ml of saline and give IV over 1-2 minutes preferably into a running IV line
98
Gentamicin adverse effects
Damage to inner ear with prolonged use
| Rental impairment with prolonged use
99
Gentamicin onset of effect
30-60 minutes
100
Gentamicin duration
24 hours
101
Gentamicin pharmacokinetics
Excreted in urine.
102
Gentamicin interactions
May potentiate effects of neuromuscular blockers, resulting in longer duration of action for these drugs
103
Glucagon mechanism
Increases blood glucose level by stimulating glucogenolysis, predominately within the liver.
104
Glucagon indication
Hypoglycaemia when patient cannot safely swallow and IV access cannot be obtained
105
Glucagon contraindications
Known severe allergy
106
Glucagon cautions
Blank square player choice.
107
Glucagon dosage
1mg IM for adult or child 5+
| 0.5mg IM for child <5
108
Glucagon onset
5-10 minutes
109
Glucagon duration
15-60 minutes
110
Glucagon pharmacokinetics
Excreted unchanged into bile and urine.
111
GTN mechanism
Vasodilator. causes venous and arterial dilation.
Reduction in venous return (preload). reduces myocardial oxygen demand.
Arterial dilation reduces afterload by dilating arteries, reduces work of left ventricle and drops oxygen demand.
May dilute coronary arteries and improve blood supply.
112
GTN indications
Myocardial ischaemia
Cardiogenic pulmonary oedema
Control of hypertension associated with autonomic dysreflexia
Control of hypertension prior to fibrinolytic treatment for STEMI.
113
GTN contraindications
```
Known severe allergy
Systolic BP less than 100mmHg
Heart rate less than 40/min
Heart rate greater than 150/minute
VT
```
114
GTN cautions
```
STEMI especially right sided.
Small, frail or unstable patient
Poor perfusion
Dysthymia
Medicine for erectile dysfunction in last 24
Known aortic or mitral stenosis
```
115
GTN dosage
Myocardial ischaemia: 0.4mg every 3-5 minutes, increase dosing interval to every ten if required.
CPO 0.8mg every 3-5 minutes. increase dose and frequency if patient not improving, provided systolic BP stable over 100mmHg.
116
GTN adverse effects
```
Hypotension
Flushing
Headache
Tachycardia
Feeling light-headed
```
117
GTN onset
1-2 minutes
118
GTN duration
15-30 minutes
119
GTN pharmacokinetics
Absorbed through oral mucosa, reaches vascular system without passing through liver.
Metabolised in liver.
120
GTN interactions
Increased effect if patient taking antihypotensive medication
Severe and prolonged hypotension may occur if medicine for ED has been taken in last 24.
121
Heparin mechanism
Anticoagulant, potentiates activity of antithrombin III causing inhibition of multiple coagulation factors.
122
Heparin indication
STEMI fibrinolytic pathway
123
Heparin contraindications
Known severe allergy
| Age 75 or older.
124
Heparin cautions
Clinically significant bleeding
At risk of bleeding.
Pregnancy
125
Heparin dosage
5000 units.
126
Heparin administration
Dilute to total volume of 10ml using saline, administer over 1-2 minutes.
127
Heparin adverse effects
Increased bleeding.
128
Heparin onset
5-15 minutes
129
Heparin duration
24 hours
130
Heparin pharmacokinetics
Unclear.
131
Ibuprofen mechanism
NSAID
| inhibits activity of prostaglandins, reducing pain inflammation and fever.
132
Ibuprofen indications
Mild pain, particularly soft tissue and musculoskeletal pain.
133
Ibuprofen contraindications
Known severe allergy
| Third trimester pregnancy
134
Ibuprofen cautions
```
Taken ibuprofen within last 4 hours.
Abdominal pain with vomiting
Age greater than or equal to 75 years
Dehydration or shock
Known renal impairment
Known bleeding disorder
Clinically significant bleeding
Known worsening bronchospasm with NSAIDs
Warfarin
Pregnancy
```
135
Ibuprofen dose
600mg for adult 80kg+
400 for patient under 80kg
Paediatric doses
136
Ibuprofen adverse effect
Rental impairment
| Increased bleeding
137
Ibuprofen onset
30-60 minutes
138
Ibuprofen duration
4-6 hours
139
Ibuprofen pharmacokinetics
Absorbed in stomach and small intestine
| Metabolised by liver
140
Ibuprofen interactions
Warfarin
141
Ipratropium mechanism
Bronchodilator
Anticholinergic agent with predominantly antimuscarinic activity. blocks acetylcholine receptors to cause vagal inhibition resulting in bronchodilation
142
Ipratropium indication
Bronchospasm secondary to asthma or COPD
| Prominent bronchospasm secondary to airway burns, smoke inhalation or chest infection
143
Ipratropium contraindications
Known severe drug allergy
144
Ipratropium cautions
None, free square, player choice.
145
Ipratropium dosage
0.5mg for adults and children once only
146
Ipratropium common adverse effects
Tachycardia
Dry mouth
Blurred vision (repeat doses)
147
Ipratropium onset
2-5 minutes
148
Ipratropium duration
6 hours.
149
Ipratropium pharmacokinetics
Small amount of nebulised dose absorbed, mostly in lungs or swallowed.
Excreted through urine
150
Ketamine mechanism
Ketamine is an analgesic, complex actions but primarily an NMDA receptor antagonists - inhibits excitatory neurotransmitters in the brain.
Low doses for analgesia, large doses for amnesia and dissociation, larger for anaesthesia
151
Ketamine indications
Severe pain
Dissociation for cardioversion, joint relocation, limb alignment.
Agitated delirium causing severe or life threatening risk to safety
RSI
Movement during CPR interfering with resuscitation
Asthma with severe agitation that is impairing ability to provide safe treatment/transport
152
Ketamine contraindications
Known severe allergy
| Aged less than 1 year
153
Ketamine cautions
Unable to obey commands
Active psychosis
Hypertension
Clinical conditions that may be worsened by hypertension such as stroke
Current myocardial ischaemia
Concurrent administration of sedatives or midazolam
Elderly and/or frail
154
Ketamine dosage
Analgesia:
30mg IV over 15 minutes for patient over 80kg repeated as required.
20mg IV over approximately 15 minutes if patient weighs 50-80kg repeated as required
See paediatric drug dose table, give over 15 minutes.
0.5mg/kg IM or PO up to maximum of 50mg if IV access cannot be obtained. this may be repeated once after 20 minutes.
155
Ketamine administration
IV if possible
Over fifteen minutes if possible
Dilute 100mg (1ml) into. 100ml bag of 5% glucose. shake well and label.
draw up dose and admitted 2mg/2ml every 1-2 minutes
Or run at 2-3 drops a second.
156
Ketamine common adverse effects
```
Transient hypertension
Tachycardia
Apnoea
Nausea and vomiting
Sedation
Hallucinations
```
157
Ketamine onset
IV 1-2 minutes
IM 5-10 minutes
PO 10-20 minutes
158
Ketamine duration
10-60 minutes
159
Ketamine pharmacokinetics
Metabolised in liver.
160
1% lignocaine mechanism
Local anaesthetic, blocks the initiation and transmission of nerve impulses by blocking the moment of sodium ions across the nerve cell membrane.
161
Lignocaine indications
Subcut for IV cannulation pain
Subcut for digital ring blocks
Intraosseous for bone pain associated with fluid infusion via IO needle
162
1% lignocaine contraindications
Known severe allergy
| Local infection in area of injection
163
1% lignocaine cautions
Anticoagulant when using for ring block
164
1% lignocaine dose
```
Subcut max dose for adult 200mg (20ml of 1%) - may be repeated once after thirty minutes.
Intraosseous 50mg (5ml) for an adult. May be repeated once after fifteen minutes
```
165
1% lignocaine adverse effects
Sting at site of injection
166
1% lignocaine onset
1-2 minutes for IV cannulation
| 5-10 for digital ring block
167
1% lignocaine duration
30-60 minutes
168
1% lignocaine pharmacokinetics
Liver
169
Loratadine mechanism
non-sedating antihistamine; blocks peripheral histamine receptors.
170
Loratadine indications
Minor allergic reactions confined to skin involvement.
| Prominent itch associated with anaphylaxis, if all systemic signs have resolved
171
Loratadine contraindications
Known severe allergy
| Age under 1 year
172
Loratadine cautions
Pregnancy
173
Loratadine dose
10mg oral for adult or 5mg for child 1-11.
174
Loratadine onset
30-60 minutes
175
Loratadine duration
12-24 hours
176
Midazolam mechanism
Benzodiazepine, enhances activity of GABA to cause anticonvulsant, sedative, amnesiac, and anxiolytics function.
177
Midazolam indications
Prolonged seizures
| Agitated delirium causing a mild to moderate safety risk and droperidol is unavailable or ineffective
178
Midazolam contraindications
Free square player choice.
179
Midazolam cautions
Concurrent administration with other sedatives
Intoxication
Elderly or frail
180
Midazolam dose
IV - dilute 2 ml from a 15mg/3nl ampule to a total of 10ml and administer as IV bolus. 5mg, repeated once after five minutes.
IM - draw up a dose from 3ml ampule, neat. 10mg, repeat once after ten minutes.
181
Midazolam adverse effects
sedation
Respiratory depression
Hypotension
Amnesia
182
Midazolam onset
IV 2-3minutes
| IM 3-5 minutes
183
Midazolam duration
30-60 minutes; sedative effect may last longer.
184
Midazolam pharmacokinetics
Liver
185
Naloxone mechanism
Opiate receptor antagonist, competes with opiates and reverses their effects.
186
Naloxone indication
Opiate poisoning suspected, significantly impaired level of consciousness or impaired breathing
Excess adverse effects from administration of opiates
187
Naloxone contraindications
Known severe allergy
188
Naloxone cautions
Chronic opiate use - risk of adverse physiological effect with rapid opiate withdrawal.
189
Naloxone dose
0. 1 - 0.4 IV every five minutes as required for an adult
| 0. 8 IM as required, repeated every 20 minutes.
190
Naloxone common adverse effects
Sweating
Tachycardia
Hypertension
191
Naloxone onset
IV 1-2 minutes
| IM 5-10 minutes
192
Naloxone duration
30-60 minutes
193
Olanzapine mechanism
Atypical antipsychotic; reduces agitation, causes sedation and anxiolytics and stabilisation of mood.
194
Olanzapine indications
Patients aged 12 or greater with agitated delirium causing mild to moderate risk to safety, when the patient will take an oral medication.
195
Olanzapine contraindications
Known severe allergy
| Poisoning with an antipsychotic such as quetiapine or risperidone.
196
Olanzapine cautions
Pregnancy
Intoxication
Elderly or frail
197
Olanzapine dose
10mg PO repeated once. 5mg PO if patient is frail.
198
Olanzapine adverse effects
Sedation
199
Olanzapine onset
10-20 minutes
200
Olanzapine duration
12-24 hours
201
Ondansetron mechanism
Antiemetic, blocks serotonin receptors in brain and GI tract, reducing nausea and vomiting
202
Ondansetron indication
Clinically significant nausea and/or vomiting
203
Ondansetron contraindications
Known severe allergy
| Aged less than one year
204
Ondansetron cautions
Player choice.
205
Ondansetron dose
4mg IM repeated once after 20 minutes
IV 8mg.
Total of 12mg may be given if IV access gained after an IM dose.
206
Ondansetron adverse effects
Headache
| Flushing
207
Ondansetron effects
IV 2-5 minutes
| IM 5-10 minutes
208
Ondansetron duration
4-8 hours
209
Oxytocin mechanism
Synthetic version of naturally occurring hormone normally released from pituitary gland.
Stimulates receptors in the uterus causing increased contraction and reduced blood loss.
210
Oxytocin indication
Following normal birth
| Postpartum haemorrhage
211
Oxytocin contraindications
Known severe allergy
212
Oxytocin cautions
Free square player choice
213
Oxytocin dose
10 units IM, neat. May need repeat dose if PPH occurs following administration for normal birth.
214
Oxytocin adverse effects
Tachycardia
Flushing
Abdominal cramps
215
Prednisone & prednisolone mechanism
Corticosteroid with anti-inflammatory and immunosuppressant actions. Inhibits production of inflammatory mediators including prostaglandins and leukotrienes, resulting in a reduction in inflammatory and immune responses.
216
Prednisone indications
Bronchospasm associated with COPD and Asthma
Croup
Prominent rash associated with anaphylaxis where systemic effects have resolved
Minor allergy associated with rash
217
Prednisone contraindications
Known severe allergy
218
Prednisone
Kids under 5 with asthma, unless previously received them - may not make a difference.
219
Prednisone dose
40mg for an adult PO
220
Prednisone adverse effects
Fatigue
Sodium and water retention in prolonged use
Gastrointestinal reflux
221
Prednisone onset
30-60 minutes
222
Prednisone duration
24 hours
223
Salbutamol mechanism
Bronchodilator, beta-2 stimulation.
224
Salbutamol indications
Bronchospasm secondary to asthma, COPD.
Prominent bronchospasm secondary to airway burns or chest infection
Release syndrome following crush injury
225
Salbutamol contraindications
Known severe allergy
226
Salbutamol cautions
None
227
Salbutamol dose
5mg nebulised (initial dose with ipratropium)
228
Tenecteplase mechanism
Fibrinolytic, accelerates breakdown of blood clots by converting plasma protein plasminogen into the active enzyme plasmin which breaks down fibrin
229
Tenecteplase indication
STEMI when PCI is not chosen reperfusion strategy.
230
Tenecteplase contraindications
Known severe allergy
Suspected aortic dissection
Major surgery, major trauma or severe brain injury within last six weeks.
Intercranial surgery last six months
Ischaemic stroke within last six months
Previous intracerebral haemorrhage
Known cerebral aneurysm, arteriovenous malformation or tumour
231
Tenecteplase cautions
Significant bleeding
Ten minutes or more of CPR
Non-compressible vascular puncture within 24 hours
Internal bleeding in last six weeks
Lumbar puncture or epidural within last six weeks
TIA in last three months
Known bleeding disorder
Taking an anticoagulant
Systolic BP more than 180 or diastolic 110.
Know to be pregnant or less than two weeks postpartum
Time of onset greater than 12 hours ago
Dependant on others for ADLs
Another disease significantly shortening life expectancy
Very frail
232
Tenecteplase dose
By weight and age: 80-90 kilo person under 75 would receive 45mg.
233
Tenecteplase adverse effects
Bleeding
| Dysrhythmia (reperfusion arrhythmia)
234
Tenecteplase onset
5-10 minutes
235
Tenecteplase duration
2-6 hours
236
Tramadol mechanism
Synthetic opioid analgesic, also inhibits noradrenaline and serotonin reuptake
237
Tramadol indication
Aged 12 or greater with moderate to severe pain particularly where IV pain relief is not available
238
Tramadol cautions
Taken within last four hours.
Abdominal pain especially if unwell if vomiting
Aged 75 or over, especially if hx dementia or confusion
Confusion
Pregnancy
239
Tramadol dose
50mg PO
240
Tramadol adverse effects
Nausea and/or vomiting
Feeling light headed or unusual
Sedation
Dry mouth
241
Tramadol onset
30-60 minutes
242
Tramadol duration
4-8 hours
243
Tranexamic acid mechanism
Antifibrinolytic — blocks conversion of plasminogen to plasmin, reducing fibrinolysis.
244
TXA indications
PPH
Hypovolaemia from uncontrolled bleeding
Any other form of bleeding severe enough to cause hypovolaemia requiring fluids
245
TXA contraindications
Known severe allergy
| Trauma when TXA will be given more than three hours after time of injury.
246
TXA cautions
Free square. Player choice.
247
TXA dose
1g IV for an adult
248
TXA administration
Neat, IV, slowly.
249
TXA adverse effects
None??
250
TXA onset
30-60 minutes
251
TXA duration
8 hours
252
Valproate mechanism
Anticonvulsant, blocks sodium channels and enhances GABA activity within central nervous system.
253
Valproate indications
Status epilepticus not responding to two doses of midazolam.
254
Valproate contraindications
Severe allergy
255
Valproate cautions
Free square
256
Valproate dose
1200mg IV preferably into running IV line
257
Valproate onset
10-20 minutes
258
Valproate duration
6-12 hours
