Para drugs Flashcards
Adrenaline 1 in 1000
Route - IM, antero-lateral aspects of thigh
Indications:
Anaphylaxis
Life threatening asthma with failing ventilation and continued deterioration despite nebuliser
Actions:
Sympathomimetric that stimulates alpha and beta andrenergic receptors. Myocardial and cerebral blood flow enhanced during CPR and CPR becomes more effective due to increased peripheral resistance which improves perfusion pressures.
Reverses allergic manifestations of acute anaphylaxis.
Relieves bronchospasm in acute severe asthma.
Cautions:
Severe hypertension may occur in patients on non-cardioselective beta-blockers.
Do NOT administer IV adrenaline in cases of anaphylaxis
Aspirin
300milligram tablet
Indications:
Adults with clinical or ECG evidence suggestive of MI or ischaemia
Actions:
Antiplatelet, so reduces clot formation
Contra-indications:
Aspirin allergy
<16 years old
Active gastrointestinal bleeding
Haemophilia or other clotting disorders
Severe hepatic failure with jaundice
Cautions:
can be given to patients with
Asthma
Pregnancy
Renal failure
Moderate hepatic disease without jaundice
Gastric or duodenal ulcer
Current treatment with anticoagulants
Side effects:
Increased risk of gastric bleeding
Wheezing in some asthmatics
Entonox (nitrous oxide)
entonox 1ml per 1ml medical gas; nitrous oxide 50%, oxygen 50%
Indications:
Moderate to severe pain
Labour pains
Actions:
Analgesia
Contra-indications:
don’t give to patients with
Severe head injuries with impaired consciousness
Decompression sickness where entonox can cause nitrogen bubbles in the blood stream to expand
Violently disturbed psychiatric patients
An intraocular injection of gas within the last 8 weeks
Abdominal pain where intestinal obstruction is suspected
Cautions
Any patient at risk of having a pneumothorax, pneumomemediastinum and/or a pneumoperitoneum
Glucagon
1 milligram powder in vial for reconstitution with water for injections
Indications:
Hypoglycaemia or unconscious patients where hypoglycaemia is considered likely cause
Only administered where 10% glucose is not possible
Actions:
Hormone that induces the conversion of glycogen to glucose in the liver
Contra-indications:
Pheochromocytoma
NOT as IV
Cautions
Low glycogen stores
Side effects:
Nausea
Vomiting
Abdo pain adults
Diarrhoea in children
Hypokalaemia
Hypotension in adults
Acute hypersensitivity in adults
40% Glucose gel
Plastic tube with 25g glucose
Indications:
known or suspected hypoglycaemia in conscious patient
Actions:
rapid increase in blood glucose levels via buccal absorption
Cautions:
altered consciousness - risk of choking or aspiration
Contra-indications:
none
GTN
Sublingual spray containing 400micrograms GTN per metered dose
Sublingual tablets containing GTN 300, 500 or 600 per tablet
Indications:
cardiac chest pain due to angina or myocardial infarction, when systolic blood pressure greater than 90mmHg
breathlessness due pulmonary oedema in acute heart failure when systolic blood pressure is greater than 110mmHg
patients with suspected cocaine toxicity presenting with chest pain
Actions:
vasodilator resulting in:
dilation of coronary arteries
dilation of systemic veins resulting in lower pre-load
reduced blood pressure
Cautions:
pts with suspected posterior myocardial infarction or right-ventricular infarction
Contra-indications:
hypotension
hypovolaemia
head trauma
cerebral haemmorhage
slidenfal (viagra) and other related drugs
unconscious patients
known severe aortic or mitral stenosis
Side effects:
headache
dizziness
hypotension
Hydrocortisone
Presentation:
Solution for injection - Hydrocortisone sodium phosphate 100mg/1ml solution for injection ampoules
Powder for injection - hydrocortisone 100mg powder for reconstitution with up to 2ml water
An ampoule containing 100milligrams hydrocortisone sodium succinate for reconstitution with up to 2ml water
Indications:
severe or life-threatening asthma
anaphylaxis
adrenal crisis - time critical medical emergency with an associated mortality
Adrenal crisis may occur in patients on long-term steroid therapy, either:
as replacement therapy for adrenal insufficiency from any cause
in long-term therapy at doses of 5+mg prednisolone
Administer hydrocortisone to:
1) Pts in established adrenal crisis
Ensure parenteral hydrocortisone is given prior to transportation
2) Pts with suspected adrenal insufficiency or on long-term steroid therapy who have become unwell, to prevent adrenal crisis
3) If in doubt about adrenal insufficiency, it is better to administer hydrocortisone
Actions:
Glucocorticoid drug that restores blood pressure, blood sugar, cardiac synchronicity and volume. High levels are important to survive shock. Therapeutic actions include suppression of inflammation and immune response
Contra-indications:
known allergy to the product/excipients
where patient has adrenal crisis it is preferable to give whatever preparation is available
Cautions:
none relevant to single dose
avoid IM administration if pt likely to require thrombolysis
Side effects:
may cause stinging or burning sensations due to phosphate preservatives
Ibuprofen
Solution or suspension containing ibuprofen and 100milligrams in 5ml
Tablet containing 200milligrams or 400milligrams ibuprofen
Indications:
relief of mild to moderate pain
pyrexia with discomfort
soft tissue injuries
best when used as part of a balanced analgesic regimen
Actions:
analgesia
antipyretic
anti-inflammatory
Contra-indications:
dehydration
hypovolaemic
known renal insufficiency
pts with active upper gastrointestinal disturbances (oesophagitis, peptic ulcer, dyspepsia)
women in last trimester of pregnancy
child with chickenpox
pt who has previously shown hypersensitivity reactions in response to non-steroidal anti-inflammatory drugs
pt with active peptic ulcer/haemorrhage
pt with severe heart failure, renal failure or hepatic failure
Avoid giving further non-steroidal anti-inflammatory drugs (NSAIDs) if an NSAID containing product has been used within the previous 4 hours or if the maximum cumulative daily dose has been given
Do NOT offer NSAIDs to frail or older adults with fractures
Cautions:
asthmatic pts due to risk of hypersensitivity and bronchoconstriction - if asthmatic has not used NSAIDs previously, do not use prehospitally
older people (>65) that have not recently used and tolerated NSAIDs
pts with coagulation defects
Crohn’s disease and ulcerative colitis as condition may be exacerbated
avoid in pts with established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, congestive heart failure
hypertension
Side effects:
nausea
vomiting
tinnitus
Ipratropium Bromide
Nebuliser liquid Ipratopium bromide 250 microgram per 1ml liquid unit dose vial
Nebuliser liquid Ipratropium bromide 500 microgram per 2ml liquid unit dose vial
Indications:
acute severe or life-threatening asthma
acute asthma unresponsive to salbutamol
exacerbation of COPD, unresponsive to salbutamol
Actions:
antimuscarinic bronchodilator drug, may provide short-term relief in acute asthma, but beta2 agonists (ie salbutamol) usually work more quickly
considered of greater benefit in:
children suffering acute asthma
adults suffering COPD
Contra-indications:
none in emergency situation
Cautions:
used with care in pts with
glaucoma (protect eyes from mist)
pregnancy and breastfeeding
prostatic hyperplasia
If COPD is a possibility limit nebulisation with oxygen to 6 minutes
Side effects:
nausea
dry mouth
tachycardia/arrhythmia
paroxysmal tightness of the chest
allergic reaction
Midazolam
Midazolam oromucosal solution, 5mg/ml, 2.5mg, 5mg, 7.5mg or 10mg)
Indications:
pts who have prolonged convulsions (5mins+) OR repeated convulsions (3 or more in an hour) and are currently convulsing
convulsion continuing 10 mins after first dose of medication 
PGD required to administer midazolam unless pt has own prescribed supply.
Actions:
short-acting benzodiazepine with anxiolytic, sedative and anticonvulsant properties.
buccal route onset of action mins
sedative effect decreases from 15 minutes onwards
Cautions:
can lead to respiratory depression leading to respiratory arrest
susceptible pts are children, adults >60 years and those with chronic illness
enhanced side effects when alcohol or other sedative drugs are present
Contra-indications:
none
Side effects:
respiratory depression
hypotension
reduced level of consciousness leading to impaired airway control
confusion leading to increased agitation
amnesia in some pts
Adrenaline 1 in 10’000
Presentation
Pre-filled syringe containing 1milligram of adrenaline in 10ml ADX
Indications
cardiac arrest
Actions
Sympathomimetic that stimulates alpha and beta-adrenergic receptors, so myocardial and cerebral blood flow is enhanced during CPR and CPR becomes more effective due to increased peripheral resistance, which improves perfusion pressures
Cautions
severe hypertension on non-cardioselective beta-blockers
Don’t administer when pts core temp is below 30°C, when temp is 30-35°C, double time period between doses
Shockable rhythms - administer after 3rd shock and then every alternate shock
Non-shockable rhythms - administer adrenaline immediately IV access achieved then alternate loops
Amiodarone Hydrochloride
Presentation
pre-filled syringe containing 300milligrams amiodarone in 10ml
Indications
Cardiac arrest
only shockable rhythms - if unresponsive to defibrillation administer after 3rd shock and an additional bills depending on age to unresponsive VF or pulseless VT following the 5th shock
Actions
Antiarryhthmic; lengthens cardiac action potential and therefore effective refractory period, prolongs QT interval on ECG
Blocks sodium and potassium channels in cardiac muscle
Acts to stabilise and reduce electrical irritability of cardiac muscle
Slows depolarisation at phase 3,prolongs action potential and refractory period
Contra indications
none
Side effects
Bradycardia
Vasodilation causing hypotension, flushing
Bronchospasm
Arrhythmias - Torsades de pointes
Administration
administer to large veins as extravasating can cause burns
Follow administration with 20ml 0.9% sodium chloride flush
Atropine
Presentation
pre-filled syringe containing 1milligram atropine surface in 10 or 5 ml
pre-filled syringe containing 3milligrams atropine sulfate in 10ml
ampoule containing 600 micrograms in 1 ml
Indications
Symptomatic bradycardia in presence of any of these adverse signs:
absolute bradycardia (<40bpm)
systolic blood pressure below expected for age
paroxysmal ventricular arrhythmia requiring suppression
Inadequate perfusion causing confusion
Bradycardia following ROSC
Contra indications
should not be given to treat bradycardia in suspected hypothermia
Actions
reverse of vagal overdrive
increases HR by blocking vagal activity in the sinus bradycardia, second or third degree heart block
Enhances A-V conduction
Side effects
Dry mouth, visual blurring and pupil dilation
Confusion and occasional hallucinations
Tachycardia
Do not use small doses (<100 micrograms
May induce tachycardia after MI
Sodium chloride 0.9%
Presentation:
100, 250, 500 and 1000ml packs
Iv infusion
Indications:
Adult fluid therapy -
Medical conditions without haemorrhage
Medical conditions with haemorrhage
Trauma related haemorrhage
Burns
Limb crush injury
Child fluid therapy -
Medical conditions
Trauma related haemorrhage
Burns
Flush -
Confirm patency of iv or io cannula
Following drug administration
Actions:
Increases vascular fluid volume which consequently raises cardiac output and improves perfusion
Contra-indications:
Do not administrate solely for purpose of keeping vein open - may lead to inadvertent fluid administration
Side effects:
May precipitate pulmonary oedema and cause breathlessness
Naloxone hydrochloride
Presentation:
400micrograms per 1ml ampule
Indications:
Reversal of acute opioid or opiate toxicity for respiratory arrest or respiratory depression
Unconsciousness associated with respiratory depression of unknown cause, where opioid overdose is a possibility
In cardiac arrest where opioid toxicity is considered to be the likely cause
Pts exposed to high potency veterinary or anaesthetic preparations should be given urgently if consciousness is impaired or exposure occurred in the last 10 minutes
Actions:
Complete or partial reversal of respiratory depression effects of opioid drugs
Aim is to restore respirations but not necessarily restore full consciousness
Contra-indications:
Neonates born to opioid addicted mothers can result in serious withdrawal effects, emphasis on bvm ventilation and oxygenation
Side effects:
In pts physically dependent on opioids, may precipitate violent withdrawal symptoms, including cardiac arrhythmias. In these cases it is better to titrate the dose of naloxone
Vomiting
All cases of opioid overdose should be transported to hospital as duration of naloxone is 30-90 minutes
Chlorphenamine
Presentation:
Ampule 10milligrams in 1ml
Tablet containing 4milligrams
Oral solution containing 2milligrams in 5ml
Indications:
Severe anaphylactic reactions after initial resuscitation
Symptomatic allergic reactions falling short of anaphylaxis but causing pt distress
Actions:
Antihistamine with anticholinergic properties that blocks the effect of histamine released during a reaction
Contra-indications:
Known hypersensitivity
Injections contra-indicated in pts who have been treated with MAOI’s in the last 14 days
Cautions:
Pregnancy and breastfeeding
Hypotension
Epilepsy
Glaucoma
Severe liver disease
Side effects:
Sedation
Dry moth
Headache
Blurred vision
Urinary retention
Psychomotor impairment
Gi disturbance
Convulsions (rare)
Children and older ppl are more likely to suffer side effects
Warn anyone taking this to against driving or any other complex psychomotor task
