Medicines Flashcards
Adenosine dose
6mg IV followed by second dose 12mg IV if SVT does not revert
Adenosine indication
Patients older than 12 with SVT and ventricular rate greater than 150,
and known responsiveness to adenosine
and causing moderate cardiovascular compromise
Adenosine contraindications
Known severe allergy
Known sick sinus syndrome
History of second or third degree heart block without pacemaker
Heart transplant without pacemaker
Adenosine caution
Asthma or COPD acute exacerbation and/or history of life threatening bronchospasm
Wolf Parkinson White if any chance of rapid atrial fibrillation
Adenosine administration
6mg in 2ml, given neat into ACF followed by rapid flush.
Adenosine adverse effects
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
Adenosine pharmokinetics
Rapidly taken up and metabolised within seconds by red blood cells and vascular endothelial cells
Adenosine onset of effect
5 to 10 seconds
Adenosine duration of effect
10-20 seconds.
Adrenaline mechanism of action
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
Adrenaline indication
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
Adrenaline contraindications
None
Adrenaline cautions
Myocardial ischaemia
Tachydysrhythmia
Adrenaline dose
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
Adrenaline adverse effects
Tachycardia Tachydysrhythmia Myocardial Ischaemia Ventricular ectopy Hypertension Nausea and vomiting Tremor, anxiety, sweating Hyperglycaemia
Adrenaline onset IV
5-10 seconds
Adrenaline onset IM
2-5 minutes
Adrenaline onset topical and intranasal
on contact
Adrenaline pharmacokinetics
Adrenaline is metabolised by the liver and taken up by sympathetic nerve endings. There are no significant effects from liver impairment on acute administration.
Amiodarone mechanism
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.
Amiodarone indications
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
Amiodarone contraindications
Known severe allergy
Known severe allergy to iodine
VT secondary to TCA poisoning (can cause worsening shock).
Amiodarone cautions
None in cardiac arrest
Amiodarone dosage
300mg for adult… (2x 150mg in 2ml vial)
If VT or VF persists, a second dose of 150mg May be administered.
Amiodarone administration
Neat IV bolus of 300mg in 4ml, two vials
Amiodarone adverse effects
Hypotension
Lightheadedness
Bradydysrhysmia
Amiodarone onset
5-10 minutes
Amiodarone duration
1-4 hours after single dose.
Amiodarone pharmacokinetics
Metabolised by liver.
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.
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.
Amoxiclav contradindications
Known severe allergy
Known severe allergy penicillins or cephalosporins
Amoxiclav cautions
None! Free square.
Amoxiclav dose
1.2g
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.
Amoxiclav onset
30-60 minutes
Amoxiclav duration
6-8 hours
Amoxiclav Pharmacokinetics
Excreted in urine - clearance prolonged in renal impairment, does not alter dose.
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
Aspirin indications
Myocardial ischaemia
Aspirin contraindications
Known severe allergy
Third trimester of pregnancy
Aspirin caution
Known bleeding disorder (usually in favour of administration)
Clinically significant bleeding
Known worsening bronchospasm with NSAIDs
Aspirin dose
300mg in 1 tablet
Aspirin admin
One 300mg tablet sublingual or dispersed in water.
Aspirin common adverse effects
Increased bleeding
Indigestion and gastric bleeding only risk with prolonged use
Aspirin onset
30-60 minutes
Aspirin duration
3-5 days for antiplatelet activity
Aspirin pharmacokinetics
Absorbed in stomach, metabolised in liver
Aspirin interactions
Warfarin
Ceftriaxone mechanism
Cephalosporin antibiotic with broad activity against gram negative and positive bacteria. inhibits production of the bacterial cell wall.
Ceftriaxone indications
Suspected meningococcal septicaemia
Ceftriaxone contraindications
Anaphylaxis to cephalosporins
Ceftriaxone cautions
None. Free square.
Ceftriaxone dose
2g IV
2g IM if IV access cannot be obtained
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
Ceftriaxone adverse effects
None
Ceftriaxone onset
30-60 minutes
Ceftriaxone duration
24 hours
Ceftriaxone pharmacokinetics
Excreted in urine and bile
Clopidogrel mechanism
Powerful antiplatelet agent, blocks ADP.
Clopidogrel indications
STEMI thrombolysis.
Clopidogrel contraindications
Known severe allergy
Clopidogrel cautions
Clinically significant bleeding
At risk of bleeding
Pregnancy
Clopidogrel dose
300mg if less than 75 years
75mg if greater than 75 years
Tablet
Clopidogrel adverse effects
Increased bleeding
Clopidogrel onset
30-60 minutes
Clopidogrel pharmacokinetics
prodrug, must be metabolised in the liver into active form.
Droperidol mechanism of action
Blocks dopamine and alpha receptors centrally, resulting in sedation, reduced agitation, and 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 olanzapone has not been administered or is ineffective.
Droperidol contraindications
Known severe allergy
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
Droperidol dosage
10mg IM or IV, reduce to 5 if patient is frail, repeat once after 20 minutes.
Droperidol administration
IM neat, lateral thigh
Dilute 10mg to 10ml and administer IV over 1-2 minutes.
Enoxaparin mechanism
Low molecular weight heparin anticoagulant, potentiating activity of antithrombin III causing inhibition of multiple coagulation factors
Enoxaparin indication
STEMI thrombolysis
Enoxaparin contraindications
Known severe allergy
Enoxaparin cautions
Clinically significant bleeding
Risk of bleeding
Pregnancy
Enoxaparin dose
Weight and age based. 60-100mg for those under 75 and 44-75 for those over 75.
Enoxaparin administration
subcut into abdominal wall
Enoxaparin onset
10-30 minutes
Enoxaparin duration
12-24 hours
Enoxaparin pharmacokinetics
Excreted in urine.
Fentanyl mechanism of action
Opiate analgesic.
Fentanyl indications
Moderate to severe pain Cardiogenic pulmonary oedema with severe anxiety RSI Sedation post intubation Symptom control at end of life care
Fentanyl contraindications
Known severe allergy
Unable to obey commands (other than rsi, end of life care, post intubation)
Respiratory depression
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.
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.
Fentanyl adverse effects
Respiratory depression Bradycardia Hypotension Sedation Nausea and vomiting Itch Euphoria
Fentanyl onset
IV 2-5 minutes, maximum in 10-15.
IN 5-10 minutes.
IM 5-10 minutes
Fentanyl duration
30-60 minutes although respiratory depression may last hours.
Fentanyl pharmacokinetics
Fat soluble, well absorbed through nasal mucosa.
Causes histamine release. Small fall in blood pressure.
Metabolised in liver.
Gentamicin mechanism of action
Aminoglycoside antibiotic with broad activity against gram-negative bacteria. inhibits cell protein synthesis.
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
Gentamicin contraindications
Known severe allergy
Pregnancy
Gentamicin cautions
Empty square player choice
Gentamicin dosage
400mg if greater than 80kg
320 if 60-80kg
240 if less than 60kg
Gentamicin administration
Dilute dose up to 10-20ml of saline and give IV over 1-2 minutes preferably into a running IV line
Gentamicin adverse effects
Damage to inner ear with prolonged use
Rental impairment with prolonged use
Gentamicin onset of effect
30-60 minutes
Gentamicin duration
24 hours
Gentamicin pharmacokinetics
Excreted in urine.
Gentamicin interactions
May potentiate effects of neuromuscular blockers, resulting in longer duration of action for these drugs
Glucagon mechanism
Increases blood glucose level by stimulating glucogenolysis, predominately within the liver.
Glucagon indication
Hypoglycaemia when patient cannot safely swallow and IV access cannot be obtained
Glucagon contraindications
Known severe allergy
Glucagon cautions
Blank square player choice.
Glucagon dosage
1mg IM for adult or child 5+
0.5mg IM for child <5
Glucagon onset
5-10 minutes
Glucagon duration
15-60 minutes
Glucagon pharmacokinetics
Excreted unchanged into bile and urine.
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.
GTN indications
Myocardial ischaemia
Cardiogenic pulmonary oedema
Control of hypertension associated with autonomic dysreflexia
Control of hypertension prior to fibrinolytic treatment for STEMI.
GTN contraindications
Known severe allergy Systolic BP less than 100mmHg Heart rate less than 40/min Heart rate greater than 150/minute VT
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
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.
GTN adverse effects
Hypotension Flushing Headache Tachycardia Feeling light-headed
GTN onset
1-2 minutes
GTN duration
15-30 minutes
GTN pharmacokinetics
Absorbed through oral mucosa, reaches vascular system without passing through liver.
Metabolised in liver.
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.
Heparin mechanism
Anticoagulant, potentiates activity of antithrombin III causing inhibition of multiple coagulation factors.
Heparin indication
STEMI fibrinolytic pathway
Heparin contraindications
Known severe allergy
Age 75 or older.
Heparin cautions
Clinically significant bleeding
At risk of bleeding.
Pregnancy
Heparin dosage
5000 units.
Heparin administration
Dilute to total volume of 10ml using saline, administer over 1-2 minutes.
Heparin adverse effects
Increased bleeding.
Heparin onset
5-15 minutes
Heparin duration
24 hours
Heparin pharmacokinetics
Unclear.
Ibuprofen mechanism
NSAID
inhibits activity of prostaglandins, reducing pain inflammation and fever.
Ibuprofen indications
Mild pain, particularly soft tissue and musculoskeletal pain.
Ibuprofen contraindications
Known severe allergy
Third trimester pregnancy
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
Ibuprofen dose
600mg for adult 80kg+
400 for patient under 80kg
Paediatric doses
Ibuprofen adverse effect
Rental impairment
Increased bleeding
Ibuprofen onset
30-60 minutes
Ibuprofen duration
4-6 hours
Ibuprofen pharmacokinetics
Absorbed in stomach and small intestine
Metabolised by liver
Ibuprofen interactions
Warfarin
Ipratropium mechanism
Bronchodilator
Anticholinergic agent with predominantly antimuscarinic activity. blocks acetylcholine receptors to cause vagal inhibition resulting in bronchodilation
Ipratropium indication
Bronchospasm secondary to asthma or COPD
Prominent bronchospasm secondary to airway burns, smoke inhalation or chest infection
Ipratropium contraindications
Known severe drug allergy
Ipratropium cautions
None, free square, player choice.
Ipratropium dosage
0.5mg for adults and children once only
Ipratropium common adverse effects
Tachycardia
Dry mouth
Blurred vision (repeat doses)
Ipratropium onset
2-5 minutes
Ipratropium duration
6 hours.
Ipratropium pharmacokinetics
Small amount of nebulised dose absorbed, mostly in lungs or swallowed.
Excreted through urine
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
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
Ketamine contraindications
Known severe allergy
Aged less than 1 year
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
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.
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.
Ketamine common adverse effects
Transient hypertension Tachycardia Apnoea Nausea and vomiting Sedation Hallucinations
Ketamine onset
IV 1-2 minutes
IM 5-10 minutes
PO 10-20 minutes
Ketamine duration
10-60 minutes
Ketamine pharmacokinetics
Metabolised in liver.
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.
Lignocaine indications
Subcut for IV cannulation pain
Subcut for digital ring blocks
Intraosseous for bone pain associated with fluid infusion via IO needle
1% lignocaine contraindications
Known severe allergy
Local infection in area of injection
1% lignocaine cautions
Anticoagulant when using for ring block
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
1% lignocaine adverse effects
Sting at site of injection
1% lignocaine onset
1-2 minutes for IV cannulation
5-10 for digital ring block
1% lignocaine duration
30-60 minutes
1% lignocaine pharmacokinetics
Liver
Loratadine mechanism
non-sedating antihistamine; blocks peripheral histamine receptors.
Loratadine indications
Minor allergic reactions confined to skin involvement.
Prominent itch associated with anaphylaxis, if all systemic signs have resolved
Loratadine contraindications
Known severe allergy
Age under 1 year
Loratadine cautions
Pregnancy
Loratadine dose
10mg oral for adult or 5mg for child 1-11.
Loratadine onset
30-60 minutes
Loratadine duration
12-24 hours
Midazolam mechanism
Benzodiazepine, enhances activity of GABA to cause anticonvulsant, sedative, amnesiac, and anxiolytics function.
Midazolam indications
Prolonged seizures
Agitated delirium causing a mild to moderate safety risk and droperidol is unavailable or ineffective
Midazolam contraindications
Free square player choice.
Midazolam cautions
Concurrent administration with other sedatives
Intoxication
Elderly or frail
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.
Midazolam adverse effects
sedation
Respiratory depression
Hypotension
Amnesia
Midazolam onset
IV 2-3minutes
IM 3-5 minutes
Midazolam duration
30-60 minutes; sedative effect may last longer.
Midazolam pharmacokinetics
Liver
Naloxone mechanism
Opiate receptor antagonist, competes with opiates and reverses their effects.
Naloxone indication
Opiate poisoning suspected, significantly impaired level of consciousness or impaired breathing
Excess adverse effects from administration of opiates
Naloxone contraindications
Known severe allergy
Naloxone cautions
Chronic opiate use - risk of adverse physiological effect with rapid opiate withdrawal.
Naloxone dose
- 1 - 0.4 IV every five minutes as required for an adult
0. 8 IM as required, repeated every 20 minutes.
Naloxone common adverse effects
Sweating
Tachycardia
Hypertension
Naloxone onset
IV 1-2 minutes
IM 5-10 minutes
Naloxone duration
30-60 minutes
Olanzapine mechanism
Atypical antipsychotic; reduces agitation, causes sedation and anxiolytics and stabilisation of mood.
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.
Olanzapine contraindications
Known severe allergy
Poisoning with an antipsychotic such as quetiapine or risperidone.
Olanzapine cautions
Pregnancy
Intoxication
Elderly or frail
Olanzapine dose
10mg PO repeated once. 5mg PO if patient is frail.
Olanzapine adverse effects
Sedation
Olanzapine onset
10-20 minutes
Olanzapine duration
12-24 hours
Ondansetron mechanism
Antiemetic, blocks serotonin receptors in brain and GI tract, reducing nausea and vomiting
Ondansetron indication
Clinically significant nausea and/or vomiting
Ondansetron contraindications
Known severe allergy
Aged less than one year
Ondansetron cautions
Player choice.
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.
Ondansetron adverse effects
Headache
Flushing
Ondansetron effects
IV 2-5 minutes
IM 5-10 minutes
Ondansetron duration
4-8 hours
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.
Oxytocin indication
Following normal birth
Postpartum haemorrhage
Oxytocin contraindications
Known severe allergy
Oxytocin cautions
Free square player choice
Oxytocin dose
10 units IM, neat. May need repeat dose if PPH occurs following administration for normal birth.
Oxytocin adverse effects
Tachycardia
Flushing
Abdominal cramps
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.
Prednisone indications
Bronchospasm associated with COPD and Asthma
Croup
Prominent rash associated with anaphylaxis where systemic effects have resolved
Minor allergy associated with rash
Prednisone contraindications
Known severe allergy
Prednisone
Kids under 5 with asthma, unless previously received them - may not make a difference.
Prednisone dose
40mg for an adult PO
Prednisone adverse effects
Fatigue
Sodium and water retention in prolonged use
Gastrointestinal reflux
Prednisone onset
30-60 minutes
Prednisone duration
24 hours
Salbutamol mechanism
Bronchodilator, beta-2 stimulation.
Salbutamol indications
Bronchospasm secondary to asthma, COPD.
Prominent bronchospasm secondary to airway burns or chest infection
Release syndrome following crush injury
Salbutamol contraindications
Known severe allergy
Salbutamol cautions
None
Salbutamol dose
5mg nebulised (initial dose with ipratropium)
Tenecteplase mechanism
Fibrinolytic, accelerates breakdown of blood clots by converting plasma protein plasminogen into the active enzyme plasmin which breaks down fibrin
Tenecteplase indication
STEMI when PCI is not chosen reperfusion strategy.
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
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
Tenecteplase dose
By weight and age: 80-90 kilo person under 75 would receive 45mg.
Tenecteplase adverse effects
Bleeding
Dysrhythmia (reperfusion arrhythmia)
Tenecteplase onset
5-10 minutes
Tenecteplase duration
2-6 hours
Tramadol mechanism
Synthetic opioid analgesic, also inhibits noradrenaline and serotonin reuptake
Tramadol indication
Aged 12 or greater with moderate to severe pain particularly where IV pain relief is not available
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
Tramadol dose
50mg PO
Tramadol adverse effects
Nausea and/or vomiting
Feeling light headed or unusual
Sedation
Dry mouth
Tramadol onset
30-60 minutes
Tramadol duration
4-8 hours
Tranexamic acid mechanism
Antifibrinolytic — blocks conversion of plasminogen to plasmin, reducing fibrinolysis.
TXA indications
PPH
Hypovolaemia from uncontrolled bleeding
Any other form of bleeding severe enough to cause hypovolaemia requiring fluids
TXA contraindications
Known severe allergy
Trauma when TXA will be given more than three hours after time of injury.
TXA cautions
Free square. Player choice.
TXA dose
1g IV for an adult
TXA administration
Neat, IV, slowly.
TXA adverse effects
None??
TXA onset
30-60 minutes
TXA duration
8 hours
Valproate mechanism
Anticonvulsant, blocks sodium channels and enhances GABA activity within central nervous system.
Valproate indications
Status epilepticus not responding to two doses of midazolam.
Valproate contraindications
Severe allergy
Valproate cautions
Free square
Valproate dose
1200mg IV preferably into running IV line
Valproate onset
10-20 minutes
Valproate duration
6-12 hours
