Paramedic Authority Medicines Flashcards
Learn contraindications, indications, dosages and the mechanism of action of Paramedic specific Medications. This will be updated as the CPG's update - 14/09/2023.
What are the 6 paramedic indications for Adrenaline.
Cardiac arrest IV. Anaphylaxis IM. Severe asthma IM. Epistaxis IN. Stridor IM. Topical for bleeding.
What are the 2 cautions for Adrenaline?
Cautions are myocardial ischemia and tachydysrhythmias.
Dosages for Adrenaline.
IV cardiac arrest 1mg bolus 1 - 1000.
IM is 0.5mg undiluted. 1 - 1000.
IN is 1mg diluted with 9ml Saline. 1 - 10,000. Then 2ml into nostril via MAD.
Topical is 1mg diluted with 9ml Saline. 1 - 10,000 Then adequate dose appropriate for wound.
Nebulised is 5mg with 8L/m. 5x 1 - 1000.
Adrenaline action, metabolism and adverse effects.
Adrenaline is a non-specific alpha and beta receptor agonist.
Alpha 1 causes smooth muscle contraction, vasoconstriction, glycogenolysis and gluconeogenesis.
Beta 1 causes an increase in cardiac contractility (inotropy), HR (chronotropy) and speed of electrical conduction in the heart (dromotropy).
Beta 2 causes smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation, and stabilisation of mast cell membranes reducing histamine release.
Metabolised in the liver, diffused into sympathetic nerve endings.
Adverse effects include tachycardia, tachydysrhythmias, myocardial ischemia, ventricular ectopy, hypertension, nausea, vomiting, tremors, anxiety, perspiration and hyperglycemia.
What is Aspirin’s indication.
Myocardial ischemia and infarction.
What are Aspirin’s 2 contraindications and 3 cautions.
Known severe allergy.
Third trimester of pregnancy.
Cautions.
Known bleeding disorder.
Significant bleeding.
Known worsening bronchospasm with NSAIDs in COPD/ asthmatic patients.
What is the Aspirin dosage.
300mg PO chewed under the tounge or dissolved.
What is Aspirin’s action, metabolism, and adverse effect.
Aspirin has antiplatelet, antipyretic, anti-inflammatory and analgesic effects. It prohibits the enzyme cyclooxygenase resulting in a reduction in the formation of prostaglandins and thromboxane.
Metabolism - liver.
Adverse - Can displace warfarin from binding to sites but is not clinically significant in our setting.
What are the 2 indications for Ceftriaxone?
Suspected meningococcal septicaemia and sepsis where cefazolin is not indicated.
What is the contraindication for Ceftriaxone?
Anaphylaxis to cephalosporins.
No cautions.
What is Ceftriaxone’s mechanism of action and where is it excreted?
Ceftriaxone is a cephalosporin antibiotic with broad spectrum activity against gram negative and gram positive bacteria. It inhibits production of the bacteria cell wall causing bacterial death.
Excreted half in urine and half in bile. Painful injection.
What is Ceftriaxone’s dosage?
IM 2g, half in each lateral thigh due to pain.
IV 2g, IV over 1-2min via running line. (add 4ml NaCl into the 2g, dissolve, dilute to 10ml, give IV over 1-2min via running line).
What is the Glucagon indication?
Glucagon is indicated in hypoglycemia, where the patient cannot swallow and IV access can’t be obtained.
What is the contraindication for Glucagon?
Contraindications.
Known severe allergy.
No cautions.
What is Glucagon’s mechanism of action and where is it metabolised and excreted?
Glucagon increases BGL by stimulating glycogenolysis (break down of glucagon into glucose).
Excreted in bile and urine. Relies on stored glycagon being available so will not work if BGL is too low.
What is Glucagon’s dosage?
1mg IM for adult
What is Glucose gel’s mechanism of action and where is it metabolised?
Provides a rapid source of glucose absorbed by the stomach and small intestine.
Metabolised by cells.
What is the indication for Glucose gel?
Conscious hypoglycemia.
Glucose gel dosage.
10 to 20g for all ages.
GTN sublingual mechanism of action.
GTN is a vasodilator acting on smooth muscle to cause both venous and arterial dilation. It reduces preload, reduces myocardial oxygen demand, reduces afterload and dilates coronary arteries.
GTN spray 5 indications.
Myocardial ischemia.
Cardinogenic pulmonary oedema.
Control of autonomic dysreflexia hypertension.
Control of hypertension prior to STEMI treatment for fibrinolytic treatment.
STEMI (Not R) sided)
GTN spray 5 contraindications and 6 cautions.
Known severe allergy. Systolic BP <110. Bradycardic <40. Tachycardic >150. VT rhythm.
Cautions. STEMI in R ventricle. Shock. Frail. Dysrhythmia. Taken erectile dysfunction medication (SIldenafil). Known aortic or mitral stenosis.
GTN spray dosage.
- 4mg 1 spray under tongue every 5 minutes for MI and HTN, double the dose for CPO.
0. 8mg 2 sprays under tongue every 3-5 minutes for CPO.
GTN adverse reactions and it’s metabolism and absorption.
GTN adverse effects can be a headache, flushed expression, Hypotension, Tachycardia and feeling lightheaded.
GTN is absorbed sublingually very rapidly, reaching the vascular system without going through the liver. It is eventually metabolised through the liver.
Ibuprofen Mechanism of Action, adverse effects and metabolisation.
Ibuprofen is a NSAID used for pain relief. It inhibits the enzyme Prostaglandin synthetase, thus reducing inflammation, pain and fever.
Adverse effects are renal impairment and increased bleeding in chronic use. It is metabolised in the stomach and small intestine then liver. Ibuprofen can displace Warfarin and make Warfarin activity increase.
Ibuprofen Indications.
Mild to severe pain. Can be used in conjunction with other medications.
Ibuprofen 2 Contraindications and 8 Cautions.
Known severe allergy. Pregnancy. Sepsis, dehydration, shock, bleeding. Worsening bronchospasm with NSAIDs. Cautions. Taken within the last 4 hours. Abdominal pain or vomiting. Age in excess of 75 years old.
Ibuprofen Dosage.
400mg PO under 80kg or syrup containing 20mg/ml to equivalent 400mg dosage.
Ipratropium Mechanism of Action, adverse effects and metabolisation.
Ipratropium is a Bronchodilator and antagonises acetylcholine receptors causing vagal inhibition which cause the Bronchodilation. Basically, it mimics the parasympathetic nervous system, and stops it from working, so the “rest and digest” phase is unable to occur, so the airways cannot constrict. Most of the dose is nebulised to the atmosphere, but those that are not are absorbed into the lungs or swallowed. Excretion is via urine. Adverse effects may be Tachycardia, Dry mouth or blurred vision.
Ipratropium Indications.
Bronchospasm secondary to COPD, Asthma, Airway burns, chest infection or smoke inhalation.
Ipratropium Contraindications.
Known severe allergy.
Ipratropium dosage.
1 ampule containing 0.5mg in 2ml, at 8L/m.
Loratadine Mechanism of Action, adverse effects and metabolisation.
Loratadine is a non sedating anti histamine, antagonising peripheral histamine receptors reducing itchiness and redness. Loratadine is metabolised via the liver.
Loratadine 2 indications.
Skin confined allergic reaction.
Itch post anaphylaxis.
Itch associated with anaphylaxis post systemic effects of the anaphylaxis have cleared.
Loratadine 2 Contraindications and 1 caution.
Known severe allergy.
Aged under 1 year.
Cautions.
Pregnancy.
Loratadine Dosage.
10mg PO for over 12 year old patients.
Methoxyflurane Mechanism of Action, adverse effects and metabolisation.
MoA is not clear, however results in the metabolisation of fluoride ions. Side effects include sedation, bad taste, and feeling light headed. It is metabolised in the liver.
Methoxyflurane indications.
Moderate to severe pain when IV relief is not available quickly or if IV relief is inappropriate.
Methoxyflurane 4 contraindications and 3 cautions.
Known severe allergy. Malignant hyperthermia. Known renal impairment. Has received Methoxyflurane in the past week. Cautions. Age greater than 75. Pre-eclampsia Confined space Chronic pain.
Methoxyflurane Dosage.
2 doses max of 3ml via inhalation device in adults greater than 12 years old, or one dose in children.
Midazolam Mechanism of Action and 4 adverse effects.
Midazolam is a benzodiazepine and enhances the GABA activity within the nervous system resulting in anticonvulsant activity, sedation, amnesia, anxiolysis (minor sedatant during minor procedures, anti-anxiety) and muscle relaxation.
Adverse - sedation, respiratory depression, hypotension, amnesia.
Midazolam Paramedic Indications.
Prolonged seizure activity IM/ IV, and Acute Behavioural Disturbance IM.
Midazolam 1 contraindication and 3 cautions.
Known severe allergy. Cautions. Concurrent opiate administration as it will prolong effects. Intoxication. Elderly or frail.
Midazolam dosage.
Seizures 5mg IV (dilute 10mg from ampoule to total of 10mg/10ml which makes 1mg/ml),
10mg IM.
ABD - 10mg IM.
Ondansetron Mechanism of Action, adverse effects and metabolisation.
Ondansetron is an antiemetic, and antagonises serotonin receptors reducing vomiting and nausea. may cause headaches and flushed expression. May prolong the QT interval.
Ondansetron Indications.
Significant nausea or vomiting.
