Neurological

Question 1

Indications for Benzylpenicillin?

Answer 1

Suspected meningococcal disease in the presence of:
A non-blanching rash (may be petechial = pin-point, or purpuric = purple spots)
AND/OR
Symptoms suggestive of meningococcal septicaemia

Question 2

Contra-indications for Benzylpenicillin?

Answer 2

Known severe penicillin allergy.

Question 3

Dose of Benzylpenicillin?

Answer 3

1.2 g in 19 ml water for injection, 20 ml total.
One dose only.

Question 4

Indications for Midazolam?

Answer 4

Convulsions lasting 5 minutes or longer, and still convulsing.
3 or more convulsions in an hour and still convulsing.
Eclamptic convulsions, lasting over 2-3 minutes.
Convulsion continuing 10 minutes after 1st dose of anticonvulsant.

Question 5

Dose of Midazolam? And route?

Answer 5

10 mg in 2 ml, repeated after 10 minutes if necessary.
Buccal or IV if possible.

Question 6

Indications for Diazepam?

Answer 6

Convulsions lasting 5 minutes or longer, and still convulsing.
3 or more convulsions in an hour and still convulsing.
Eclamptic convulsions, lasting over 2-3 minutes.

Question 7

Actions of Benzodiazepines?

Answer 7

CNS depressant, act as anticonvulsants and sedatives.

Question 8

Cautions and Side Effects of Benzodiazepines?

Answer 8

Side effect: Respiratory depression and hypotension may occur. Caution: Use of alcohol, antidepressants or other CNS depressants may increase likelihood of side effects.

Question 9

Dose of Diazepam?

Answer 9

Rectal.
Adult <70 years, 20 mg repeated after 10 minutes with 10 mg. Max dose 30 mg.
Adult >70 years, 10 mg repeated after 10 minutes. Max dose 20 mg.

Question 10

Indications of Naloxone?

Answer 10

Reversal of acute opioid/opiate toxicity for respiratory arrest/depression.
Unconsciousness associated with respiratory depression, where opioid overdose is a possibility.
Cardiac arrest, where opioid toxicity is a likely cause.

Question 11

Actions of Naloxone?

Answer 11

Complete/partial reversal of the respiratory depressive effects of opioid drugs.
Restores adequate respirations, not necessarily full consciousness.

Question 12

Side Effects and Cautions of Naloxone?

Answer 12

In dependency on opioids, naloxone may cause violent withdrawal symptoms. Titrate dose to reverse cardiac and respiratory depression.
Similarly neonates born to opioid-addicted mothers can suffer serious withdrawal effects. Emphasise BVM and oxygen.
Vomiting is common following naloxone, ensure suctioning.

Question 13

Dose of Naloxone?

Answer 13

400 mcg in 1 ml every 3 minutes, max dose 4000 mcg.
Can dilute up to 800 mcg (2 ml) with 8 ml of water, and give 1 ml at a time.