Para Meds Flashcards
Learning Meds
How does Salbutamol work
Salbutamol is a Bronchodilator that stimulates the Beta receptors.
It is absorbed through the liver and passed through the urine.
What is the Contras and Indications of Salbutamol
Contras: Known severe allergy
Cautions: None
Indications:
Bronchospasm secondary to Asthma or COPD
Bronchospasm secondary to airway burns, smoke inhalation or chest infection
Release syndrome
Hyperkalaemia
Adverse effects:
Tremor
Tachycardia
Usual onset:
2-5 mins
Usual duration:
1-2 hrs
How does Adrenaline work
Adrenaline works in 3 different ways
Alpha 1: stimulation causes smooth muscle contraction, vasoconstriction, glycogenolysis and gluconeogensis
Beta 1: stimulation causes cardiac contractility and causes a increase in heart rate
Beta 2: stimulation causes vasodilation, bronchodilation and stabilization of mast cell membranes, reducing histamine release
What are the Contras and Indications of Adrenaline
Contraindications: None
Cautions: MI (will increase o2 consumption)
Tachydysthrmias (adrenaline will usually make it worse)
Indications
Cardiac arrest
Anaphylaxsis
Resp arrest from COPD
Severe bradycardia
Stridor
Usual onset:
IM - 2-5mins
Usual duration:
Cardiovascular effects last 5-10mins
Mast cell membrane effects may last several hours
How does Panadol work?
Panadol Inhibits the production of prostaglandins resulting in a reduction of pain and fever
What are the Contras and Indications for Panadol
Contra: Known severe allergy
Cautions: Pt has taken in the last 4 hours
Known severe liver impairment
Indications: Mild - moderate pain
Common effects:
None
Usual onset:
30-60 mins
Usual duration:
4-6hrs
How does Ibuprofen work
Ibuprofen is a NSAID (non-steroidal anti-inflammatory drug
It inhibits the activity prostaglandin synthetease therefore reducing the production of prostaglandin
What are the contras and indications of Ibuprofen
Contra: Known severe allergy
Pregnancy
Presence of sepesis, dehydration, shock or significant bleeding. can cause increase risk of bleeding or renal impairment.
Known worsening of bronchospasm with NSAIDS
Cautions:
Pt has taken in the last 4 hours
Abdo pain
Age greater or equal to 75
Adverse effects:
Renal impairment
Increased bleeding
GI bleeding and ulceration (chronic use)
Usual duration:
4-6 hrs
Usual onset
30-60 mins
How does Ipratropium work?
Ipratropium is a bronchodilator, It is a anticholingeric agent which primeritaly blocks ACH receptors causing vagal inhibition resulting in bronchodilation
What are the Contras and indications for Ipratropium
Contra: Known severe allgergy
Cautions: none
Indications: Bronchospasm secondary to asthma or COPD Prominent bronchospasm secondary to airway burn, smoke inhalation or chest infection.
Usually used with Salbutomal
Adverse effects:
Tachycardia
Dry Mouth
Blurred vision (repeated doses)
Usual onset
2-5 mins
Usual duration
6hrs
How does GTN work
GTN is a vasodilator. It works on the smooth muscle causing aterial vasodilation with the predominent effact being on viens.
MOA - this is not clear but GTN results in the formation of nitric oxide (vasodilator)
What are the Contras and Indications for GTN
Contras:
Known severe allergy
Systolic BP less than 100 mmHg
HR less than 40/min
HR greater than 150/min
VT
Cautions:
STEMI Involving the right ventricle
Frail patient
Signs of shock
Dysryhthmia
Known aortic or mitral stenosis
Indications:
MI
CPO
Control of hypertension
STEMI
Adverse effects:
Hypotention
Flushing
Headace
Tachycardia
Light headed
Usual onset: 1-2 mins
Usual duration 15-30 mins
Methoxyflurane
Methoxyflurane is a inhaled analgesic
What are the Contras and Indications for Methoxy
Contras:
Known severe allergy
History of malignant
Known renal impairment
Methoxy administered with in a week
Cautions:
Age greater or equal to 75
Pre-eclampsia (for renal impairment)
Acute exacerbation of chronic pain
Administered in a confined space
Indications:
Moderate to severe pain
Adverse effects:
Sedation
Light headedness
Usual onset:
1-2 mins
Usual duration
2-5 mins
How does Asprin work
Asprin is a antiplatelet, anti-inflammatory and analgesic effects. It inhibits the enzyme cyclooxygenase which results in the reduction in prostaglandins and thromboxane
What are the Contras and Indications for Asprin
Contras:
Known severe allergy
Third trimester pregnancy
Cautions:
Known bleeding disorder
Clinically significant bleeding
Known worsening of bronchospasm with NSAID’s
Indications:
MI
STEMI
Adverse effects:
Increased bleeding
Indigestion and gastrointestinal ulceration (long term use)
Usual duration:
3-5 days antiplatlet activity
How does Ceftriaxone work
Cerftriaxone is a broad spectrum antibiotic inhibiting the production of the bacterial cell wall causing the bacteria to die
What are the contras and indications for Ceftriaxone
Contras:
Anaphylaxis to cephalosporins
Cautions:
None
Indications:
Suspected meningococcal septicemia
Sepsis where cefazolin is not indicated
What are the contras and indication for Glucose gel
Contras: None
Cautions: None
Indications:
Hypoglycemia in adults and children providing they can swallow
Hypoglycemia in neonates
Adverse effects: None
Usual onset: 5-10 mins
Usual duration: 30-60 mins
How does Glucagon work
Glucagon increases the blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose)
What are the contras and indications for Glucagon
Contras: known severe allergy
Cautions: None
Indications:
Hypoglycemia when the patient can not safely swallow food and IV can not be obtained
Adverse effects: None
Usual onset: 5-10 mins
Usual duration: 15-60 mins
How does Loratadine work
Loratadine is a non-sedating antihistamine which blocks the peripheral histamine receptors, therefore blocking the action of histamine
What are the contras and indications for Loratadine
Contras:
Known severe allergy
Age less than 1
Cautions:
Pregnancy
Indications:
Minor allergic reaction confined to skin involvement
Prominent itch associated with anaphylaxis provided all systemic signs of anaphylaxis are resolved
Adverse effects: None
Usual onset: 30-60 mins
Usual duration: 12-24 hrs
What is Midazolam used for
Midazloam is a benzodiazepine, it enhances the activity of gamma-aminobutyric acid (GABA). At these receptors in the nervous system it results in anticonvulsant activity, sedation, amnesia, anxiolysys and muscle relaxation
What are the contras and indication for Midazolam
Contras:
Known severe allergy
Ages less than 12 (analgesia only)
Cautions:
Altered level of consciousness
Respiratory depression
May worsen signs of shock
Concurrent administration of opiates or ketamine
Aged greater or equal to 75
Indications:
Generalised seizures that continue for more than 5 mins, or seizures that are recurrent
Acute behavioural disturbance (Where droperidol is ineffectvie or unavaliable)
Pain associated with severe muscle spasm
Sedation
Severe anxiety accociated with COPD
Control of anxiety or shorthness of breath that does not respond to opiate during end of life care
Adverse effects:
Sedation
Respiatory depression
Hypotention
Amnesia
Usual onset:
30-60 mins
Usual duraiton:
30-60 mins
How does Ondansetron work
This is an antiemetic. It antagonizes (blocks) serotonin receptors centrally in the brain and peripherally in the gastrointestinal tract resulting in reduction in nausea and vomiting
What are the Contras of Ondansetron
Contras: Known severe allergy, Age less than one, Suspected serotonin syndrome
Cautions: None
Adverse effects:
Headache
Flushing
Usual onset:
IV 2-5 mins
IM 5-10 mins
Usual duration:
4-8 hrs
How does Prednisone work
This is a prodrug that is metabolized to prednisolone in the liver.
Prednisolone is a corticosteroid with ani-inflammatory and immunosuppressant actions. It inhibits the production of inflammatory mediators, including prostaglandins and leukotrienes, resulting in reduction in inflammatory and immune response
What are the contras/ cautions for Prednisone
Contras:
Known severe allergy
Cautions:
Age less than 5 with asthma
Indications:
Bronchospasm associated with asthma or COPD
Croup
Prominent rash associated with anaphylaxis provided all systemic signs of anaphylaxis are resolved
Minor allergy associated with rash
Adverse effects:
Fatigue
Sodium and water retention
Gastro reflux
Usual onset:
30-60 mins
Usual duration
24 hrs
How does Tramadol work
This is an analgesic. It has multiple actions within the central nervous system, including opiate receptor stimulation and inhibition of the re-uptake of noradrenaline and serotonin.
What are the contras/cautions for Tramadol
Contras:
Known severe allergy
Age less than 12
Cautions:
Taken in the last 4 hours
Abdo pain, particularly if vomiting or nauseated
Age greater or equal to 75, particularly is there is a previous history of dementia or confusion
Confusion
Pregnancy
Indications:
Moderate to severe pain, particularlylarly if an opiate or ketamine is not going to be administered
How does Amiodarone work
Amiodarone is an antidysrhythmic.
It predominately has a class 3 activity and prolongs the action potential. This reduces the automaticity and prolongs the refractory period of atrial nodal and ventricular tissues
What are the contras for Amiodarone
Indications (Para): Cardiac arrest with VT/VF after first dose of adrenaline
Adults with sust ain VT in the absence of cardiac arrest
Adults with moderate cardiovascular compromise as a results of fast AF or atrial fluttter
Contras: Known severe allergy
Known severe allergy to iodine
VT secondary to cyclic antidepressant poising
Cautions: None if in cardiac arrest
Poor perfusion or lowered CO
Hypotension
AF
Known sick sinus rythum without internal pacemaker
Previous 2nd or 3rd degree heart block
Pregnancy
How does Cefazolin work
Cefazolin is a first-generation cephalosporin antibiotic with activity against gram Negative and gran Positive bacteria. It inhibits the production of the cell wall causing the bacteria to die
What are the indications and contras for Cefazolin
Indications:
Sepsis where source of infection appears to be soft tissue or joint and (greater than 12 years old, has 1 or more clinical features indication antibiotics, time to hospital or more than 30 mins)
Compound fracture
Large contaminated wound
Following chest decrompression
Following amputation
Cellulitis
Contras:
Known severe allergy to cephalosporins
Cautions: None
How does Ceftriaxone work
Ceftriaxone is a cephalosporin antibiotic with broad activity against gram neg and gram pos bacteria. It inhibits the production of the cell wall causing the bacteria to die.
What are the indications and Contras for Ceftriaxone
Indications:
Suspected meningococcal septicaemia
Sepsis where Cefazolin is not indicated
Contras:
Anaphylaxsis to cephalosporins
Cautions:
None
How does Clopidogrel work
Clopidogrel has antiplatlet activity. It blocks the binding of adenosine diphosphate to platelets and impairs platelet funtion
What are the contras and indications of clopidogrel
Indications:
STEMI in conjunction with fibrinolytic therapy
Contras:
Known severe allergy
Cautions:
Clinically significant bleeding
At risk of bleeding
Pregnancy
How does Droperidol work
Droperidol blocks dopamine and alpha receptors centrally, resulting in sedation, reduced agitation and a state of mental detachment and antiemetic action
What are the Contras for Droperidol
Indications:
Pt’s 12 years or older with a true behavioural disturbance causing mild to moderate risk to safety when olanzapine has not been administered or ineffective
Moderate to severe pain despite opiate analgesia and ketamine is not indicated associated with (chronic or complex pain, chronic use of opiates, severe headache, severe pain accounted with agitation, pain associated with severe nausea or vomiting)
Management of agitation or pain that does not respond to opiate during end of life care
Nausea/vomiting that persists despite Ondansatron
Contras:
Known severe allergy
Age less than 12
Pregnancy (analgesia. And nausea/vomiting only)
Cautions:
Alerted LOC
Parkinson’s
Concurrent administration of Ketamine or midazolam
Age greater or = to 75
Signs of shock
How does Enoxaprin work
Enoxaprin is a low molecular weight heparin anticoagulant. It potentiates the activity of anti thrombin 3 causin inhibition of multiple coagulation factors
What are the contras for Enoxaprin
Indications:
STEMI in conjunction with fibrinolytic therapy
Contras:
Known severe allergy
Cautions:
Clinically significant bleeding
At risk of bleeding
Pregnancy
How does Fentanyl work
Fentanyl is an opiate analgesic. It is a opiate stimulator that binds to opitate receptors in the brain and spinal cord
What are the contras of fentanyl
Indications:
Moderate to severe pain
CPO with severe anxiety
RSI
Sedation post intubation
Control of pain, agitation, or SOB during end of life care
Contras:
Known severe allergy
Cautions:
Altered LOC
Age less than 1
Respiratory depression or at high risk of respiratory depression
Labour
Concurrent administration of opiates, ketamine or midazolam
Age greater or = to 75
Signs of shock
How does Heparin work
Heparin is a anticoagulant, It potentiates the activity of antithrombin 3 causing inhibition of multiple coagulation factors
What are the contras for Heparin
Indications:
STEMI in conjunction with fibrinolytic therapy
Contras:
Known severe allergy
Age greater or = to 75 (higher risk for intra cerebral heamorage
Cautions
Clinically significant bleeding
At risk of bleeding
Pregnancy
How does Ketamine work
Ketamine has many actions but it predominately an N-methyl-d-aspartate (NMDA) receptor blocker resulting in inhibition of excitatory neurotransmitters in the brain
What are the contras for Ketamine
Indications(PARA only analgesia)
Severe pain that has not been adequately controlled with an opiate
Inducing dissociation
Acute behavioural disturbance causing threat to safety
RSI
Significant movement in CPR interfering with resus
Asthma with severe agitation
Contras:
Known severe allergy
Age less than 1
Cautions
Altered LOC
Signs of shock
Current MI
Concurrent Administration of opiates or midazolam
Age greater or = to 75
How does levetiracetam work
Levetiracetam is an anticonvulsant. It is thought to inhibit siezure activity by blocking some calcium channels and also binding synaptic proteins to modulate neurotransmitter release
What are the contras for levetiracetam
Indications: Siezure that continues or recurs after 2 douses of midazolam
Siezure activity associated with severe TBI even if seizure activity has ceased following midazolam
Contras: Known severe allergy
Cautions: None
How does Lignocaine 1% work
Lignocaine is a local anaesthetic. It blocks the initiation and transmission of nerve impulses by blocking the movement of sodium ions across the nerve cell membrane
What are the contras for Lignocaine
PARA’s need to seek clinical advice before administration
Indications:
Subcutaneous injection for prophylaxis’s of pain associated with IV
Subcutaneous injection for digital rings blocks for analgesia when transport time is less than 60 mins or Ropivacaine is not available
IO injection for significant bone pain with IO administration
Contras:
Known severe allergy
Local infection in the area of injection
Cautions:
Taking an anticoagulant (ring block)
How does Metoprolol Tartate work
Metoprolol is an immediate release beta blocker. It blocks beta receptors in the heart causing a decrease in heart rate and CO
What are the contras for Metoprolol
Indications:
Adults with mild or no cardiovascular compromise as a result of fast AF or atrial flutter
Adults with moderate cardiovascular compromise as a result of fast AF or atrial flutter if amiodrone is not available or is contraindicated
Contras:
Known severe allergy
Hypotension
Cautions:
1st degree heart block
Known sick sinus syndrome
Previous 2nd or 3rd degree heart block
Asthma or COPD
Hear failure
Pregnancy
How does Midazolam work
Midazolam is a benzodiazepine. It enhances the activity of gamma-aminobutyruc acid GABA. At GABA receptors with in the CNS resulting in anticonvulsant activity, sedation, amnesia, anxiolysis and muscle relaxation
What are the contras for Midazolam
Para (IM & IV for seizures and IM for Acute behavioural distrubance)
Indications:
Generalised seizures that continue for more than 5 mins or are recurrent
Acute behavioural disturbance causing mild to moderate risk to safety
Pain accociated with severe muscle spasm or severe anxiety
Sedation
Sedation post intubation
Severe anxiety associated with COPD
Control of anxiety or SOB that does not respond to opiate during end of life care
Contras:
Known severe allergy
Age less than 12 (analgesia only)
Cautions:
Altered LOC
Resp depression or at high risk of resp depression
Signs of shock
Concurrent administration of opiates or ketamine
Age greater or = to 75
How does Naloxone work
Naloxone is an opiate receptor blocker. By blocking opiate receptors it reversers the effects of opiates
What are the contras of Naloxone
Indications: Opiate poisoning is suspected and the pt has a significantly impaired LOC or significantly impaired breathing
Excess adverse effects from administrations of opiates
Contras: Known severe allergy
Cautions:
Chronic opiate use
How does Olanzapine work
Olanzapine is an atypical antipsychotic. It has actions at multiple receptors with in the brain causing a reduction in agitation, sedation, anxiolysis and stabilisation of mood
What are the contras for Olanzapine
Indications: Pt’s aged more or = to 12 with acute behavioural disturbance causing a mild to modaerate risk to safety with the pt will take oral medicine.
Contras:
Known severe allergy
Poisoning with antipsychotic
Cautions:
Pregnancy
Intoxication
Age greater or = to 75
How does oxytocin work
Oxytocin is a synthetic version of the hormone made in the pituitary gland. It stimulates oxytocin receptors on the uterus, causing increased uterine contraction and deducting blood loss from uterus
What are the contras for Oxytocin
Indications:
Following normal birth
PPH
Contra:
Known severe allergy
Cautions:
None
How does TXA work
Tranexamic acid is an anti fibrinolytic. It blocks the conversion of plasminogen to plasmin, reducing fibrinolysis and bleeding
What are the contras for TXA
Indications:
PPH
Clinically significant bleeding or signs of hypovolemia following trauma
Non-traumatic bleeding and shock is severe
Cardiac arrest secondary to trauma
Bleeding following tonsillectomy
Crush injury
Contras:
Known severe allergy
Trauma when TXA will be administered more than 3 hours after time of injury
Cautions:
Non
