Meds Flashcards
What is the presentation of Dexamethasone?
8mg/2ml
What is dexamethasone?
It’s a corticosteroid secreted by the adrenal cortex.
What is the action of dexamethasone?
1) relieves inflammatory reactions
2) provides immunosepression
What are the contraindications of dexamethasone?
Known hypersensitivity
What are the precautions of dexamethasone?
Solutions which are not clear or contaminated should be discarded
What are the side effect of dexamethasone?
None
What is the peak time of IV dexamethasone?
2 hours
What is the onset time of IV dexamethasone?
30-60mins
What is the duration of dexamethasone?
36-72 hours
What is the presentation for fentanyl?
100mcg/2ml or 250mcg cartridge
What is fentanyl?
A synthetic opioid analgesic
What is the action of fentanyl?
1) CNS depression leading to analgesia
2) Respiratory depression leading to apnoea
3) Dependance (addiction)
4) Decreased conduction velocity through AV node
What is the metabolism of fentanyl?
Secreted by liver, excreted by kidneys
What are the contraindications of fentanyl?
Hypersensitivity
Late 2nd stage labour
What are the precautions of fentanyl?
-Elderly/frail
-Impaired hepatic function
-Respiratory depression eg COPD
-Current asthma
-Patients on monoamine oxidase inhibitors
-Known addiction to opioids
-Rhinitis, Rhinorrea or facial trauma (IN route)
What are the side effects of fentanyl
Respiratory depression
Apnoea
Rigidity of diaphragm & intercostal muscles
Bradycardia
What is the onset of IV Fentanyl?
Immediate
What is the peak of IV Fentanyl?
<5mins
What is the duration of IV fentanyl?
30-60mins
What is the peak time for IN fentanyl?
2mins
What is Glyceryl Trinitrate?
An organic nitrate that relaxes vascular smooth muscle
What is Glyceryl Trinitrate’s action?
Relaxes vascular smooth muscle
1) Venodilation promotes venous pooling & reduces venous return to the heart (decreased preload)
2) Arteriodilation reduces SVRI and arterial pressure (reduced afterload
What are the expected effects of GTN?
1) Reduced myocardial 02 demand
2) Reduces systolic, diastolic and MAP whilst maintaining coronary perfusion pressure
3) Mild collateral coronary artery dilation may improve blood supply to ischaemic areas of heart
4) Mild tachycardia secondary to fall in BP
5) Preterm labour: uterine quiescence (contractility) in pregnancy
What are the indications of GTN?
Chest pain in ACS
Acute cardiogenic pulmonary oedema (full field or mid zone fine crackles & hx CCF/HF)
HTN in ACS
Autonomic dysreflexia
Preterm labour (consult for patch)
What are the contraindications of GTN?
HR< <50bpm (except in AD) or >150bpm
VT
SBP <100mmHg
Riociguat
PDE5 inhibitors (Levitra, cialis & viagra)
What are the precautions of GTN?
1) Use lower doses (300mcg) in pts who are elderly, have no previous exposure to GTN or with recent MI as they may be more susceptible to adverse effects
2) Right ventricular MI or inferior STEMI with SBP<160, use cautiously due to risk of severe hypotension from preload reduction
3) Preterm labour - concurrent use with other tocolytics
What are the adverse effects of GTN?
CVS: Hypotension, tachycardia, bradycardia (occasionally)
CNS: HA, dizzy, syncope
Other: Skin flushing
What routes is GTN available for administration?
Sublingal & transdermal
What are the presentations for GTN?
SL: 300mcg tablets
Transdermal: 50mg patch- 400mcg/hr
What are the onset times for GTN SL & transdermal?
SL: 1-3mins
TD: Up to 30mins
What are the peak times for GTN?
SL: 5mins
TD: 2hrs
What is the duration of action for GTN?
SL: At least 25mins
TD: continues for 5 days until patch removed.
What is Ipratropium Bromide?
An anticholinergic bronchodilator
What is Ipratropium Bromide’s action?
Allows bronchodilation by inhibiting cholinergic bronchomotor tone (blocks vagal reflexes which mediate bronchoconstriction)
What are the indications of Ipratropium Bromide?
Severe respiratory distress associated with bronchospasm
Exacerbation of COPD irrespective of severity
What are the contraindications of Ipratropium Bromide?
Known hypersensitivity to Atropine or its derivatives
What are the precautions of Ipratropium Bromide
1) Glaucoma (vision loss due to damaged optic nerve)
2) Avoid contact with eyes
What are the side effects of Ipratropium Bromide?
1) Headache
2) Nausea
3) Dry mouth
4) Skin rash
5) Tachycardia (rare)
6) Palpitations (rare)
7) Acute angle closure glaucoma secondary to direct eye contact (rare)
What is the onset of Ipratropium Bromide?
3-5mins
What is the peak of Ipratropium Bromide?
1.5-2 hours
What is the duration of Ipratropium Bromide?
6 hours
What is adrenaline?
An endogenous catecholamine, an alpha and beta adrenergic stimulant
What is the action of adrenaline?
BETA 1:
-Increases HR why increasing SA node firing rate
-Increases conduction velocity through the AV node
-Increases myocardial contractility
-Increases the irritability of the ventricles
BETA 2:
-Causes bronchodilation
ALPHA:
-Peripheral vasoconstriction
How is Adrenaline metabolised & excreted?
By monoamine oxidase (enzyme removes neurotransmitters from brain) & other enzymes in the blood, liver and around nerve endings.
Excreted by the kidneys
What are the contraindications of Adrenaline?
Hypovolaemic shock without adequate fluid replacement
What are the precautions of Adrenaline?
Elderly/frail, those with cardiovascular disease, those on monoamine oxidase inhibitors (Antidepressant), higher doses may be required for those on beta blockers.
What are the side effects of Adrenaline?
Sinus Tachycardia
Supraventricular arrhythmias
Ventricular arrhythmias
HTN
Pupillary dilation
May increase size of MI
Feeling of anxiety/palpitations in the conscious patient
What is the onset time for IV & IM Adrenaline?
IV: 30 secs
IM: 30-90 secs
What is the peak time for IV/IM Adrenaline?
IV: 3-5 mins
IM: 4-10 mins
What is the duration of IV/IM Adrenaline?
IV: 5-10 mins
IM: 5-10 mins
What is Ketamine?
An anaesthetic agent with analgesic properties at lower doses
What is Ketamine’s action?
Exact action is unknown but primarily works as an antagonist at NMDA receptors. Ketamine may also interact with opioid, muscarinic and other receptors. Produces a trance like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes.
What are the contraindications for Ketamine?
Suspected non-traumatic brain injury with severe hypertension (SBP >180)
What are the precautions of Ketamine?
May exacerbate cardiovascular conditions (uncontrolled HTN, stroke, recent MI, cardiac failure) due to its effects on HR & BP.
What are the adverse effects of Ketamine?
CVS: HTN, Tachycardia
CNS: Emergence reactions (vivid dreams, restlessness, confusion, hallucinations, irrational behaviour), increased skeletal muscle tone (may resemble seizures)
RESP: Transient respiratory depression and apnoea (rare)
GI: Nausea & vomiting
Other: Injection site pain, lacrimation (flow of tears), hypersalivation, diplopia (double vision), nystagmus
What is the presentation of ketamine?
200mg/2ml
What are the routes of Ketamine?
IV, IM, IN
What is the onset of action for Ketamine?
IV: 30 secs
IM: 3-4 mins
IN: 5 mins
What is the peak time for IN Ketamine?
20mins
What is the duration of action of Ketamine?
IV: 5-10 mins
IM: 12-25 mins
IN: 45 mins
What is methoxyflurane?
Inhaled anaesthetic which produces analgesia at low concentrations
What is the action of methoxyflurane?
The exact action is unknown
Contraindications of Methoxyflurane?
1) Pre-existing renal disease
2) Known or genetic susceptibility to malignant hyperthermia
What are the precautions for Methoxyflurane?
Patients shouldn’t be administered >6ml in 24h due to nephrotoxicity
To limit occupational exposure, it shouldn’t be administered in a confined space
What are the adverse effects of Methoxyflurane?
CNS: Dizziness, drowsiness
CVS: Hypotension
GIT: Nausea & vomiting
What is the presentation of Methoxyflurane?
3ml bottle
What is the route of Methoxyflurane?
Inhalation via Penthrox inhaler device
What is the onset of Methoxyflurane?
6-10 breaths
What is the duration of action of Methoxyflurane?
Effects last 3-5 mins after stopping inhalation. One vial can provide up to 25mins analgesia
In the Methoxyflurane medication card, what does pre-existing renal disease include?
Current or past renal impairment or failure. Not including kidney stones or renal colic
What is midazolam?
A benzodiazepine, a short acting CNS depressant
What is the action of Midazolam?
Anxiolytic (reduce anxiety), sedative, anticonvulsant
How is midazolam metabolised & excreted?
Metabolised in the liver, excreted by the kidneys
What are the contraindications of Midazolam?
Known sensitivity to benzodiazepines
What are the precautions of Midazolam?
1) Reduced doses for elderly/frail, chronic renal failure, CCF or shock
2) The CNS depressan effects are enhanced in presence of narcotics/alcohol
3) Can cause severe resp depression in COPD patients
4) Patients with myasthenia gravis (A weakness and rapid fatigue of muscles under voluntary control- resp depression)
What are the side effects of Midazolam?
Depressed level of consciousness
Respiratory depression
Loss of airway control
Hypotension
What is the onset time for Midazolam IV/IM?
IV: 1-3mins
IM: 3-5mins
What is the peak time for Midazolam IV/IM?
IV: 10mins
IM: 15mins
What is the duration of action of Midazolam IV/IM?
IV: 20mins
IM: 30mins
What is morphine?
An opioid analgesic
What is morphines action?
CNS effects:
-Depression leading to analgesia
-Respiratory depression
-Depression of cough reflex
-Stimulation (changes of mood/euphoria/dysphoria/vomiting/pinpoint
-Dependence (addiction
CVS effects:
-Vasodilation
-Decreases conduction velocity through the AV node (the speed at which action potentials are distributed throughout the tissue
How is Morphine metabolised & excreted?
Metabolised by the liver & excreted by the kidneys
What are the contraindications of Morphine?
Hx of hypersensitivity
Renal impairment/failure
Late 2nd stage labour
What are the precautions of Morphine?
Elderly/frail
Hypotension
Respiratory depression
Current asthma
Respiratory tract burns
Known addiction to opioids
Acute alcoholism
Patients on monoamine oxidase inhibitors (?)
What are the side effects of Morphine?
CNS effects:
Drowsiness
Respiratory depression
Euphoria
Nausea & vomiting
Addiction
Pin point pupils
CVS:
Hypotension
Bradycardia
What is the onset time for Morphine IV/IM?
IV: 2-5mins
IM: 10-30mins
What is the peak time for Morphine IV/IM?
IV: 10mins
IM: 30-60mins
What is the duration of action of Morphine IV/IM?
IV: 1-2hrs
IM: 1-2hrs
What drug might you see wheals (red skin) in the line of the vein being used for IV injection & what is it caused by?
Morphine & it’s ahistamine reaction
What is normal saline?
An isotonic crystalloid solution
What is the composition & action of normal saline?
Composition: Electrolytes (sodium & chloride in similar concentration to extracellular fluid
Action: Increases the volume of the intravascular compartment
What are the contraindications & precautions of Normal saline?
None
What is the IV half life of normal saline?
30-60mins
What is ondansetron?
A 5-HT3 (5-hydroxytryptamine) antagonist (stops creation/release of serotonin which is thought to trigger vomiting reflex)
What is the action of ondansetron?
The actions not fully known. It is thought the release of serotonin (5-HT) is thought to trigger a vomiting reflex in both peripheral (GIT) and central nervous system.
What are the contraindications of Ondansetron?
Apomorphine (used for parkinsons)- causes profound hypotension/decreased consciousness.
What are the precautions of Ondansetron?
Pregnancy 1st trimester (consult with receiving hospital)
Congenital Long QT syndrome (increased risk of torsades in QT>500ms)
Severe hepatic disease (cirrhosis) Limit 8mg/day
Ondansetron ODT may contain aspartame- avoid in pts with phenylketonuria (A birth defect that causes an amino acid called phenylalanine to build up in the body.)
What are the adverse effects of Ondansetron?
CNS: Headache, dizziness
CVS: Prolonged QT (rare)
GIT: Constipation
Other: Visual disturbance including transient loss of vision (rare, fast push)
Presentation of Ondansetron?
ODT 4mg, 8mg/4ml ampoule
How long do you inject Ondansetron over IV?
30secs (preferrably 3-5mins)
What is the peak time for IV/IM & ODT ondansetron?
IV/IM: 10mins
ODT: 30mins
What is the duration of action of Ondansetron?
Several hours
What is paracetamol?
An analgesic and antypyretic (An antipyretic is a substance that reduces fever)
What is the action of Paracetamol?
Exact mechanism is unclear, thought to inhibit prostaglandin synthesis in the CNS
What are the contraindications of Paracetamol?
Children <1month age
What are the precautions of Paracetamol?
Hepatotoxicity can occur with overdose (do not administer if given in past 4/24 or >4g in 24hrs)
Risk of hepatotoxicity is increased in impaired hepatic function or liver disease, elderly/frail patients, malnourishment
What are the adverse effects of paracetamol?
Hypersensitivity reactions including severe skin rashes (rare)
Haematological reactions (rare)
Hypotension has been reported with IV infusion
What are the presentations of paracetamol?
500mg tablets
Oral liquid 24mg/ml
t is the onset of action of paracetamol?
Oral: 30mins
What is the duration of action of paracetamol?
4 hrs
What is the max paediatric dose of paracetamol in 24hrs?
60mg/kg
What is Salbutamol & whats it’s action?
A synthetic beta adrenergic stimulant with primarily beta 2 effects
Action: causes bronchodilation
How is Salbutamol metabolised & excreted?
Metabolised by liver, excreted by kidneys
What are the contraindications of Salbutamol?
Nil
What are the precautions of salbutamol?
Large doses have been reported to cause metabolic acidosis
What are the side effects of Salbutamol?
Sinus tachycardia
Muscle tremor
What are the routes of Salbutamol?
pMDI, nebulised
What is the onset of nebulised Salbutamol?
5-15mins
What is the duration of nebulised salbutamol?
15-50mins
