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Paramedic Drugs (South Africa) > Paediatric dosages > Flashcards

Paediatric dosages Flashcards

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1
Q

NALOXONE HYDROCHLORIDE

respiratory depression due to acute opiate usage

Adult Dosage

A
  • 0.4mg slowly IVI/IMI (0,1mg/kg)
  • Repeat every 5 minutes, up to 2mg
  • Should 2mg fail to elicit the desired response, then overdose with agents other than opioids should be considered
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2
Q

MORPHINE SULPHATE

Acute severe pain

Adult Dosage

A
  • Dilute to concentration of 1mg/ml and titrate to effect at 1mg/30 seconds slowly IVI (This approach reduces incidence of nausea, vomiting and other complications)
  • Titrate to effect (use minimum effective dosage)
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3
Q

MORPHINE SULPHATE

Continuing ischaemic chest pain (Acute Coronary Syndromes (ACS) that is NOT RELIEVED by Glyceryl Trinitrate

Adult Dosage

A

• Dilute to concentration of 1mg/ml and titrate to effect at 1mg/30 seconds slowly IVI

(This approach reduces incidence of nausea, vomiting and other complications)

• Titrate to effect (use minimum effective dosage)

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4
Q

MORPHINE SULPHATE

Cardiogenic pulmonary oedema

Adult Dosage

A

• Dilute to concentration of 1mg/ml and titrate to effect at 1mg/30 seconds slowly IVI

(This approach reduces incidence of nausea, vomiting and other complications)

• Titrate to effect (use minimum effective dosage)

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5
Q

MORPHINE SULPHATE

Concomitant use with benzodiazepines for synergism in induction Adult Dosage

A

• Dilute to concentration of 1mg/ml and titrate to effect at 1mg/30 seconds slowly IVI

(This approach reduces incidence of nausea, vomiting and other complications)

• Titrate to effect (use minimum effective dosage)

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6
Q

MIDAZOLAM

Sedation

Adult Dosage

A

1mg/min slowly IVI Titrate to effect : use the minimum effective dosage

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7
Q

MIDAZOLAM

Maintenance infusion

Adult Dosage

A

0.03mg/kg/hr - 0.1mg/kg/hr when used in combination with narcotic analgesics

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8
Q

MIDAZOLAM

Convulsions

Adult Dosage

A

0.15mg/kg slowly IVI (maximum 0.3mg/kg) IMI not recommended as first line route – absorption too slow.

ONLY give IMI if no IV access available 0.15mg/kg IMI (maximum 0.3mg/kg)

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9
Q

MIDAZOLAM

Induction

Adult Dosage

A

1mg / 15 to 30 seconds IVI Titrate to effect : use the minimum effective dosage

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10
Q

METOCLOPRAMIDE MONOHYDROCHLORIDE

Nausea and vomiting due to: - Stimulation of CETZ by medication (e.g. morphine) - Motility disorders of the GIT (e.g. gastro-enteritis)

Adult Dosage

A

• Adults > 60 kg: 10 mg slowly IVI/ IMI • Adults < 60 kg: 5 mg slowly IVI/ IMI

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11
Q

MAGNESIUM SULPHATE

Cardiac arrest and acute severe asthma unresponsive to conventional therapy

Adult Dosage

A

• 1 – 2g (2 to 4 ml of a 50% solution) • Dilute 1g/2ml vial to 10ml with sterile water = 10% solution. • Give slowly, not exceeding 1.5ml/min, with continuous careful monitoring.

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12
Q

MAGNESIUM SULPHATE

Convulsion in toxaemia of pregnancy

Adult Bolus Dosage

A

• 2 – 4g of a 10% solution given very slowly, with careful monitoring not exceeding 1.5ml/min (10% solution is obtained by diluting the 1g/2ml vial to 10 ml with sterile water)

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13
Q

MAGNESIUM SULPHATE

Convulsion in toxaemia of pregnancy

Adult Infusion

A

• 3g in 200 ml 0.9% sodium chloride solution at a rate not exceeding 3ml/min.

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14
Q

LORAZEPAM

Status epilepticus

Adult Dosage

A
  • 2 – 4 mg slowly IVI (< 2 mg/min)
  • If required an additional 4mg IVI may be administered after 10 minutes
  • Titrate to effect (use the lowest effective dosage)
  • Maximum 8mg / 12 hours
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15
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Stable VT or complex ventricular ectopy with myocardial ischemia or causing haemodynamic compromise

Adult Dosage (loading, repeat and maximum)

A

• Loading dose : 1mg/kg slowly IVI • Repeat loading dose : 0.5mg/kg every 5 minutes • Maximum dose : 3mg/kg

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16
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Stable VT which was successfully restored into a stable rhythm

Adult Dosage (Maintenance infusion)

A

1-4mg/min (20 – 50 μg / kg / min)

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17
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Restoration of a stable rhythm with reappearance of arrhythmia during constant infusion

Adult Dosage

A

0.5mg/kg slow IVI bolus dose, and an increase in the infusion rate in incremental doses (maximal rate = 4mg/min)

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18
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Stable VT or complex ventricular ectopy with myocardial ischemia or causing haemodynamic compromise which was successfully restored into a stable rhythm

When must the administration of boluses be terminated?

Adult Dosage

A

administration of bolus doses must be terminated when either: - A maximum of 3mg/kg has been administered, or - The blood pressure drops by >10%, or - Ventricular arrhythmias cease, or - Signs of toxicity develop • In the presence of decreased cardiac output, in patients older than 70 years, and in those with hepatic dysfunction, the dose should be reduced: usual bolus followed by half the normal maintenance infusion.

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19
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Restoration of a stable rhythm with reappearance of arrhythmia during constant infusion

When should the usual bolus be followed by half the normal maintenance infusion?

A

• In the presence of decreased cardiac output, in patients older than 70 years, and in those with hepatic dysfunction, the dose should be reduced: usual bolus followed by half the normal maintenance infusion.

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20
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Patient with decreased level of consciousness due to ventricular tachycardia with hypotension,pulmonary oedema, congestive cardiac failure or AMI, After first successful cardioversion

Adult dosage (Loading dose, maintenance infusion)

A

• Loading dose : 1mg/kg slowly IVI followed by Maintenance infusion of 1-4mg/min (20 – 50 μg / kg / min)

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21
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Patient with decreased level of consciousness due to ventricular tachycardia with hypotension,pulmonary oedema, congestive cardiac failure or AMI.

Arrhythmia has reappeared after first successful cardioversion and second immediate cardioversion

Adult Dosage

A

0.5mg/kg IVI Continue infusion 1-4mg/min (20 – 50 μg / kg / min)

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22
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Ventricular fibrillation (Amiodarone is not available)

Adult Dosage (Initial bolus, repeated dose and maximum total bolus dose)

A

Bolus dose of 1mg/kg IVI/IO push (or 2mg/kg ET as last resort)

followed by 0.5mg/kg IVI/IO (or 1mg/kg ET) every 5 minutes

Maximum total bolus dose = 3mg/kg IVI

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23
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Ventricular fibrillation (Amiodarone is not available)

After Successful defibrillation

Adult Dosage (Infusion)

A

Maintenance infusion of 1-4mg/min (20 – 50 μg / kg / min)

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24
Q

IPRATROPIUM BROMIDE

Acute bronchospasm

Adult Dosage UDV

A

UDV: • Ipratropium bromide 0.5mg + appropriate 2 stimulant + balance of N/S to a total of 5ml solution

• Nebulised over 10 minutes

25
Q

GLYCERYL TRINITRATE

Acute Coronary Syndrome

Adult Dosage

A
  • One tablet sublingual OR one spray (without inhaling) onto oral mucosa (preferably sublingual)
  • Repeat every 5 minutes until pain is relieved, or max dose taken
  • Maximum of 3 sprays/ tablets
26
Q

GLYCERYL TRINITRATE

Acute Pulmonary Oedema

Adult Dosage

A
  • One tablet sublingual OR one spray (without inhaling) onto oral mucosa (preferably sublingual)
  • Repeat every 5 minutes until pain is relieved, or max dose taken
  • Maximum of 3 sprays/ tablets
27
Q

GLYCERYL TRINITRATE

  • Angina pectoris
  • Acute myocardial infarction
  • Acute pulmonary oedema

When should administration be terminated?

A

• Terminate administration if systolic blood pressure (SBP) :

  • Decreases by more than 10% in a normotensive patient
  • Decreases by more than 30% in a hypertensive patient
  • Measures lower than 90 mmHg
28
Q

GLUCAGON

Symptomatic hypoglycaemia (blood glucose < 3.5mmol/L)

Adequate IV access or IV dextrose is not available or effective.

Adult Dosage

A
  • 1mg IMI / IVI / SC
  • IMI is preferred route
29
Q

GLUCAGON

Severe symptomatic bradycardia from beta blockade overdose not responding to other medications e.g. adrenaline

Adult Dosage

A

• 3mg IV initially as adjuvant treatment of beta blocker OD,

followed by 3mg/hour infusion

30
Q

GLUCAGON

Calcium channel blocker OD

Adult Dosage

A

• 3mg IV initially as adjuvant treatment of calcium channel blocker OD,

followed by 3mg/hour infusion

31
Q

GLUCAGON

Severe anaphylactic reactions.

Patient is unresponsive to adrenaline, and is taking beta blockers Adult Dosage

A

1 - 2 mg every 5 min IM or slow IV if unresponsive to adrenaline, & especially if on beta blockers

32
Q

FUROSEMIDE

Acute pulmonary oedema of cardiac, hepatic or renal origin

Adult Dosage

A

0.5mg - 1mg/kg IVI slowly over 1-2 minutes

33
Q

FLUMAZENIL

Central nervous system sedative effects and respiratory depression due to benzodiazepines alone

Adult Dosage (Initial, Repeat and maximum)

A
  • Initial bolus : 0.2mg slowly IVI over 15 seconds
  • Repeat : 0.1mg at 1 minute intervals
  • Max dose : 1mg
34
Q

DIAZEPAM

Convulsions

Adult dosage (Initial, repeat, maximum)

A
  • Convulsions: 5 mg/min slowly IVI (0.15mg/kg)
  • Repeat every 2 - 5 minutes
  • Titrate to effect (use the lowest effective dosage)
  • Maximum 20mg
  • Rectally 10mg (maximum 20mg)
35
Q

DIAZEPAM

Sedation

Adult dosage

A

Sedation: 1mg every 30 seconds IV titrated to effect when necessary

36
Q

DEXTROSE 50%

Symptomatic hypoglycaemia Blood glucose

Adult dosage

A

• 10g (20ml of a 50% solution) slowly IVI • Repeat every 5 minutes should blood glucose remain

37
Q

CORTICOSTEROIDS

Severe allergy / anaphylaxis

Adult dosage

A

Hydrocortisone: 200mg – 500mg IVI slowly 5 mg/kg IVI slowly

38
Q

CORTICOSTEROIDS

Acute asthma attack

Adult dosage

A

Hydrocortisone: 200mg – 500mg IVI slowly 5 mg/kg IVI slowly

39
Q

CLOPIDOGREL

Patient who has true aspirin allergy (who cannot tolerate aspirin) with suspected acute myocardial infarction (acute coronary syndromes)

Adult dosage

A

Administer 300mg orally, i.e. four of the 75mg tablets stat

40
Q

CALCIUM CHLORIDE 10%

Hyperkalaemia (indicated by tall peaked t-waves, flattened p-waves, broadened QRS complexes, e.g. renal failure, severe tissue damage – crush syndrome)

Adult dosage

A
  • 10ml of calcium chloride 10% solution, slowly IVI
  • If being administered pre-arrest, administer at 1ml/min
41
Q

CALCIUM CHLORIDE 10%

Calcium channel blocker toxicity (e.g. verapamil)

Adult dosage

A
  • 10ml of calcium chloride 10% solution, slowly IVI
  • If being administered pre-arrest, administer at 1ml/min
42
Q

CALCIUM CHLORIDE 10%

Beta blocker toxicity (e.g. propanolol)

Adult dosage

A
  • 10ml of calcium chloride 10% solution, slowly IVI
  • If being administered pre-arrest, administer at 1ml/min
43
Q

LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)

Complex ventricular ectopy with myocardial ischemia or causing haemodynamic compromise which was successfully restored into a stable rhythm

Adult Dosage (Maintenance infusion)

A

1-4mg/min (20 – 50 μg / kg / min)

44
Q

SALBUTAMOL

Acute bronchospasm

Adult dosage (Inhalant solution)

A

1ml Salbutamol (5mg/ml) + 4ml N/S

• Repeat continuously if necessary

45
Q

SALBUTAMOL

Acute bronchospasm

Adult dosage (UDV)

A

• 2.5mg/2.5ml or 5mg/2.5ml UDV + N/S diluted up to 5 ml

46
Q

SALBUTAMOL

Acute bronchospasm

Adult dosage (IV-ampoule)

A
  • 250 μg/10min Dilute 500μg/1ml ampoule Salbutamol with 19ml N/S = 500μg / 20ml = 25 μg / ml
  • Administer 1ml/min over 10min (total of 250μg / 10 min)
47
Q

SALBUTAMOL

PREMATURE / OBSTRUCTED LABOUR / PROLAPSED CORD

Adult dosage (maintenance infusion)

A
  • Dilute 2mg [4 x 500mcg/ml] into 200ml N/S (10 μg/ml solution)
  • Start with 10μg/min. May increase by 10μg/min every 10 min to a max of 45 μg/min

Note: Maternal & foetal heart rates & Inhibition of uterine contractions must be continually monitored during infusions.

48
Q

SALBUTAMOL

PREMATURE/ OBSTRUCTED LABOUR / PROLAPSED CORD

Adult dosage (bolus)

A

Slow IV 100 – 250 μg IV

Dilute 500μg/1ml ampoule Salbutamol with 19ml N/S = 500μg /20ml = 25 μg / ml

• Administer 1ml/min until: - Total of 250μg/10 min has been given,

i. e. 10ml.
- Mother’s heart rate > 120bpm
- Contractions cease

49
Q

ATROPINE SULPHATE

REFRACTORY SYMPTOMATIC BRADYCARDIA

Adult dosage (initial bolus, repeat, maximum)

A

0.5mg IVI push

Repeat : 0.5 – 1mg every 3 to 5 minutes

Maximum : 3mg (0.04mg/kg) = total vagolytic dose

50
Q

ATROPINE SULPHATE ORGANOPHOSPHATE POISONING

Adult dosage (initial bolus, repeat, maximum)

A
  • Intravenous : 0.5 – 2.5 mg IVI
  • Repeat : every 4 minutes until atropinisation occurs(decreasing bronchial secretions is single most reliable factor)
  • Titrate to effect
  • No absolute maximum dosage
51
Q

AMIODARONE HYDROCHLORIDE

DEFIBRILLATION REFRACTORY VENTRICULAR FIBRILLATION OR PULSELESS VENTRICULAR TACHYCARDIA

Adult dosage

A
  • Administer 300mg IVI as a rapid bolus
  • Perform 2 minutes of CPR and reassess rhythm — deliver shock for VF / Pulseless VT
  • If ventricular fibrillation or pulseless ventricular tachycardia does not respond to defibrillation, administration of initial 300mg IVI bolus, and further defibrillation,

then consider the administration of an additional dose of 150 mg in 3 to 5 minutes

52
Q

AMIODARONE HYDROCHLORIDE

Successful defibrillation with Amiodarone

Adult dosage (infusion)

A

Slow intravenous infusion of 1mg/minute (360mg IV over 6 hours) may be administered

• Maximum cumulative dose of 2.2g IV/24 hours

53
Q

AMIODARONE HYDROCHLORIDE

STABLE VENTRICULAR TACHYCARDIA or SUPRAVENTRICULAR TACHYCARDIA

Adult dosage (bolus, follow up infusion)

A
  • 150mg IVI over 10 minutes (15mg/min), followed by:
  • Infusion: slow IVI of 1mg/minute (360mg over 6 hours)
  • Maximum cumulative dose of 2.2g IV/24 hours
54
Q

ADRENALINE

Cardiac arrest

Adult dosage

A
  • Intravenous / Intraosseous : 1mg IVI push
  • Tracheal : 2mg, diluted to 10ml with water for injection preferred.

NOTE: Tracheal option is the last resort route of administration - IV/IO definitely preferred.

• Repeat : every 3 to 5 minutes

55
Q

ADRENALINE

Post-cardiac arrest hypotension (BP< 70mmHg)

Adult dosage

A

2-10μg/min –titrating to effect [add 1ml of 1:1000 to 200mls normal saline = 5μg/ml]

56
Q

ADRENALINE

Resistant symptomatic bradycardia (SBP<85mmHg)

Adult dosage (infusion)

A
  • 2-10μg/min
  • Titrate to effect
57
Q

ADRENALINE

Anaphylaxis

Adult dosage

A

Intramuscular:

  • Initial : 0.3mg of 1:1000 undiluted (ideally anterolateral thigh)
  • Repeat : every 15 - 20 minutes if no clinical improvement
  • Titrate to effect

Intravenous (only if life-threatening / unresponsive to IMI):

  • Caution – extremely dangerous and must be diluted
  • Continuous patient and ECG monitoring is required
  • Initial : 0.1mg IVI diluted slowly over 5 minutes (see below)
  • Repeat : every 5 minutes if no clinical improvement
  • Carefully titrate to effect
58
Q

ADRENALINE

Life threatening asthma (near fatal asthma)

Adult dosage

A

Subcutaneously/intramuscularly

• 0.01 mg/kg divided into three doses of 0.3 mg given very 20 minutes,

i.e: • Initial : 0.3 mg or 1:1000 undiluted

  • Repeat : after 20 minutes if no clinical improvement, and then again at 40 minutes
  • Titrate to effect
59
Q

ADENOSINE

Stable patients with narrow-complex Paroxysmal Supra-Ventricular Tachycardia, to terminate the reentry SVT.

Adult dosage

A
  • 6 mg rapid IV push (followed immediately by 20 ml N/S IVI push) (Draw up adenosine dose and flush in two separate syringes)
  • 12 mg rapid IV push if no response after 2 minutes.
  • 12 mg rapid IV push may be considered if no response after 2 minutes

Paramedic Drugs (South Africa) (7 decks)

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