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PARA Drugs 2024 NZCPG St John > Paramedic Authority Medicines > Flashcards

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.

1
Q

What are the 6 paramedic indications for Adrenaline.

A 
Cardiac arrest IV.
Anaphylaxis IM. 
Severe asthma IM. 
Epistaxis IN.
Stridor IM.
Topical for bleeding.
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2
Q

What are the 2 cautions for Adrenaline?

A

Cautions are myocardial ischemia and tachydysrhythmias.

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3
Q

Dosages for Adrenaline.

A

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.

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4
Q

Adrenaline action, metabolism and adverse effects.

A

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.

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5
Q

What is Aspirin’s indication.

A

Myocardial ischemia and infarction.

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6
Q

What are Aspirin’s 2 contraindications and 3 cautions.

A

Known severe allergy.
Third trimester of pregnancy.

Cautions.
Known bleeding disorder.
Significant bleeding.
Known worsening bronchospasm with NSAIDs in COPD/ asthmatic patients.

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7
Q

What is the Aspirin dosage.

A

300mg PO chewed under the tounge or dissolved.

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8
Q

What is Aspirin’s action, metabolism, and adverse effect.

A

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.

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9
Q

What are the 2 indications for Ceftriaxone?

A

Suspected meningococcal septicaemia and sepsis where cefazolin is not indicated.

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10
Q

What is the contraindication for Ceftriaxone?

A

Anaphylaxis to cephalosporins.

No cautions.

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11
Q

What is Ceftriaxone’s mechanism of action and where is it excreted?

A

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.

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12
Q

What is Ceftriaxone’s dosage?

A

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).

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13
Q

What is the Glucagon indication?

A

Glucagon is indicated in hypoglycemia, where the patient cannot swallow and IV access can’t be obtained.

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14
Q

What is the contraindication for Glucagon?

A

Contraindications.
Known severe allergy.
No cautions.

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15
Q

What is Glucagon’s mechanism of action and where is it metabolised and excreted?

A

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.

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16
Q

What is Glucagon’s dosage?

A

1mg IM for adult

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17
Q

What is Glucose gel’s mechanism of action and where is it metabolised?

A

Provides a rapid source of glucose absorbed by the stomach and small intestine.
Metabolised by cells.

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18
Q

What is the indication for Glucose gel?

A

Conscious hypoglycemia.

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19
Q

Glucose gel dosage.

A

10 to 20g for all ages.

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20
Q

GTN sublingual mechanism of action.

A

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.

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21
Q

GTN spray 5 indications.

A

Myocardial ischemia.
Cardinogenic pulmonary oedema.
Control of autonomic dysreflexia hypertension.
Control of hypertension prior to STEMI treatment for fibrinolytic treatment.
STEMI (Not R) sided)

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22
Q

GTN spray 5 contraindications and 6 cautions.

A 
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.
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23
Q

GTN spray dosage.

A
  1. 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.

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24
Q

GTN adverse reactions and it’s metabolism and absorption.

A

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.

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25
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.
26
Ibuprofen Indications.
Mild to severe pain. Can be used in conjunction with other medications.
27
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. ```
28
Ibuprofen Dosage.
400mg PO under 80kg or syrup containing 20mg/ml to equivalent 400mg dosage.
29
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.
30
Ipratropium Indications.
Bronchospasm secondary to COPD, Asthma, Airway burns, chest infection or smoke inhalation.
31
Ipratropium Contraindications.
Known severe allergy.
32
Ipratropium dosage.
1 ampule containing 0.5mg in 2ml, at 8L/m.
33
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.
34
Loratadine 2 indications.
Skin confined allergic reaction. Itch post anaphylaxis. | Itch associated with anaphylaxis post systemic effects of the anaphylaxis have cleared.
35
Loratadine 2 Contraindications and 1 caution.
Known severe allergy. Aged under 1 year. Cautions. Pregnancy.
36
Loratadine Dosage.
10mg PO for over 12 year old patients.
37
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.
38
Methoxyflurane indications.
Moderate to severe pain when IV relief is not available quickly or if IV relief is inappropriate.
39
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. ```
40
Methoxyflurane Dosage.
2 doses max of 3ml via inhalation device in adults greater than 12 years old, or one dose in children.
41
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.
42
Midazolam Paramedic Indications.
Prolonged seizure activity IM/ IV, and Acute Behavioural Disturbance IM.
43
Midazolam 1 contraindication and 3 cautions.
``` Known severe allergy. Cautions. Concurrent opiate administration as it will prolong effects. Intoxication. Elderly or frail. ```
44
Midazolam dosage.
Seizures 5mg IV (dilute 10mg from ampoule to total of 10mg/10ml which makes 1mg/ml), 10mg IM. ABD - 10mg IM.
45
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.
46
Ondansetron Indications.
Significant nausea or vomiting.
47
Ondansetron 3 contraindications.
Known severe allergy. Age under 1. Suspected serotonin syndrome. | Aged under 1 year.
48
Ondansetron Dosage
4mg IM Undiluted repeated in 20 minutes. 8mg IV max.
49
What are the 5 'R's of checking medications prior to medication?
``` Right dose Right patient Right time Right route Right medication ```
50
What are the 4 'C's of checking a medication prior to administration?
Clarity Concentration Colour Container
51
What is the 'E' acronym for checking a medication prior to administration?
Expiration date.
52
Paracetamol Mechanism of action.
Paracetamol inhibits the production of prostaglandins resulting in a reduction in pain and fever. It is metabolised in the liver.
53
Paracetamol indications.
Mild to moderate pain. | In addition to other medications for severe pain especially if transport is extended.
54
Paracetamol 1 contraindication and 3 cautions.
``` Known severe allergy. Cautions. Paracetamol in the last 4 hours. Abdominal pain. Known severe liver disease. ```
55
Paracetamol dosage.
1000mg PO <80kg or 1500mg PO >80kg
56
Oxygen flow rates for the 5 routes.
``` Nasal Prongs - 1-4L/m Simple Mask - 6-8L/m Reservoir Mask - 10-15L/m Manual Ventilation Bag - 10-15L/m Nebulizer Mask - 8L/m ```
57
Oxygen use in COPD retainers. What is the Sp02 range to titrate between? And when do we administer oxygen in non COPD patients?
COPD range is 88% to 92% if unknown. | normal is <94%
58
What are oxygen's 9 indications?
``` Severe TBI Airway obstruction. 02 <92% Respiratory distress Shock Smoke inhalation Carbon Monoxide Poisoning Prior to sedation treatment Decompression illness. ```
59
Prednisone and Prednisolone Mechanism of action and metabolism. Adverse effects.
Prednisone is metabolised into Prednisolone in the liver. Prednisolone is a corticosteroid with anti-inflammatory and immunosuppressant actions. It inhibits prostaglandins and leukotrienes resulting in the reduction in the immune and inflammatory response. Adverse effects are fatigue, sodium and water retention, and Gastrointestinal reflux.
60
Prednisone and Prednisolone indications.
Bronchospasm associated with COPD or Asthma Croup Prominent rash associated with anaphylaxis provided systemic signs of anaphylaxis have resolved. Minor allergy associated with rash.
61
Prednisone and Prednisolone 1 contraindication and 1 caution.
Known severe allergy. Cautions. Age under 5 with asthma.
62
Prednisone and Prednisolone dosage.
40mg for adult.
63
Salbutamol Mechanism of action, adverse effects and Metabolism.
Salbutamol is a bronchodilator, and antagonises Beta 2 receptors. Most is absorbed into the atmosphere and is metabolised in the liver and excreted in urine.
64
Salbutamol 7 indications.
``` Asthma COPD Smoke inhalation Hyperkalaemia Airway burns Chest infection Crush syndrome ```
65
Salbutamol contraindication.
Known severe allergy
66
Salbutamol dosage
5mg continuous at 8L/m
67
Amiodarone indication
Cardiac arrest VT/ VF.
68
Amiodarone 3 Contraindications. No cautions for Para.
Allergy, allergy to Iodine, VT secondary to cyclic antidepressant poisoning.
69
Amiodarone Mechanism of action, adverse effects, and metabolism.
Broad spectrum antidysrhythmic, prolonging action potential and causing negative chronotropic (HR), dromotropic (speed of conduction), inotropic (contractility) effects. Also stabilises the SA and AV nodes. Adverse effects are hypotension and bradydysrhythmia. Metabolised in the liver.
70
Amiodarone dosage
300mg IV bolus in VT/ VF.
71
Droperidol Indications
Bevavioural disturbance (Mild to moderate safety risk), end of life care after opiates, chronic or complex pain or nausea.
72
Droperidol Dosage.
Nausea - 0.675mg IV ABD - 10mg IV/IM Pain - 1.25mg End of life - 2.5mg IM/IV
73
Droperidol MOI / Adverse effects / Metabolism.
Central dopamine and alpha inhibitor, causes mental detachment and sedation. Hypotension if rapidly pushed. Metabolised in the liver.
74
Droperidol 3 Contras / 5 Cautions
Contras - allergy, under 12yrs, pregnancy. Cautions - ALOC, Parkinsons, Concurrent Ketamine / Midazolam, aged over 75yrs, shock.
75
Fentanyl Indications
Moderate + pain CPO with anxiety RSI Sedation after intubation End of life care
76
Fentanyl Contraindication and 7 cautions.
Allergy. Cautions - ALOC, Under 1yr, Resp depression, Labour, Concurrent ketamine, opiates, midazolam administration. Aged 75yrs. Shock.
77
Fentanyl Mechanism, adverse effects, metabolism.
Fentanyl is an opiate analgesic, agonises CNS opiate receptors. Adverse - resp depression, bradycardia, hypotension, sedation, nausea, itch, euphoria. Metabolised in the liver.
78
Fentanyl dosage.
IV - 10-50mcg / 5mins prn. (draw up 100mcg, dilute to 100mcg/10ml, this is now 10mcg/ml). IM - 50-100mcg / 20mins.
79
Ketamine indication (para)
Analgesia only.
80
Ketamine 2 Contras and 5 cautions
Allergy, age under 1. Cautions ALOC, Shock, Myocardial ischaemia, concurrent opiate or midazolam use, age over 75.
81
Ketamine action, adverse effects, and metabolism.
NMDA receptor blocker, inhibiting excitatory neurotransmitters. Adverse - hypertension, tachycardia, apnoea, nausea, sedation, hallucinations. Metabolised in the liver.
82
Ketamine dose
IV 0.25mg/kg - draw up 100mg/1ml and put it into a 100ml bag of glucose. This is now 1mg/1ml. Now administer the dose as a bolus. (Do not infuse).
83
Lignocaine Indications
Ring blocks, IO access (conscious), IV access pain.
84
Lignocaine 2 Contraindications, 1 caution.
Allergy, local infection at the site. Caution - anticoagulation (ring blocks).
85
Lignocaine action, adverse effect, and metabolism.
Local anaesthetic, ion traps as the molecules move to a different pH gradient, ionizing. Is now not lipophilic and is trapped, stopping sodium channels and nerve impulses. Adverse effects - stinging due to acidity. Metabolised in the liver.
86
Naloxone indications
Opiate poisoning or excessive adverse effects from opiates.
87
Naloxone contraindication and caution.
Allergy. Chronic opiate use.
88
Naloxone action, adverse effects, and metabolism.
Naloxone is an opiate receptor antagonist which reverses their effects. Adverse effects can be sweating, tachycardia, hypertension. Metabolised in the liver.
89
Olanzapine Indication
Adult acute behavoural disturbance with mild to moderate risk to safety.
90
Olanzapine 2 contras and 3 cautions.
Allergy, antipsychotic poisoning. Cautions. Pregnancy, intoxications, frailty.
91
Olanzapine Action, adverse effects, and metabolism.
Oral, atypical antipsychotic with many actions, leading to sedation, mood stability, and anxiolysis. Adverse - sedation. Metabolism - Liver
92
Olanzapine dose
PO 10mg, repeated once at 20mins if required. Half if frail.
93
Oxytocin 2 Indications
Normal birth, or PPH.
94
Oxytocin action, adverse, and metabolism.
Oxytocin is a synthetic hormone, usually released from the pituitary gland, and stimulates oxytocin receptors causing uterine contraction. Adverse - cramping, tachycardia, flushing. Metabolism - Liver and kidneys.
95
Oxytocin dose
IM 10u, repeated if PPH presents.
96
Tranaxemic Acid indications
PPH. Hypovolaemia from uncontrolled bleeding. Any bleeding with hypovolaemia requiring fluids. Traumatic arrest. Crush injury.
97
TXA contraindications
Allergy, 3 hours since onset of the trauma.
98
TXA action, adverse effects, and metabolism.
TXA is an antifibrinolytic that blocks the conversion of plasminogen to plasmin, reducing fibrinolysis. Adverse - None Metabolism - excreted in urine.
99
TXA dose
2g IV over 1-2mins with fluids.
100
Naloxone dose
IM - 0.8mg IV - 0.4mg max every 5mins. (Dilute 0.4mg to total of 4ml, this is now 0.1mg/ml).
101
Lignocaine dose
IO - 50mg over 1-2min. SC - Max 200mg. Usually only use <2ml into each side of digit.
102
Cefazolin indications
Sepsis - joint/ soft tissue/ cellulitis. (>30min to ED time).
103
Cefazolin Contraindication
Allergy to cephalosporins.
104
Cefazolin action, adverse effects, and metabolism.
First gen cephalosporin AB with activity against gram negative and positive bacteria. It inhibits the cell wall. No adverse effects. Excreted in urine.
105
Cefazolin dosage.
1g IV via 1-2min running line. (add 4ml into 1g, dissolve, dilute to 10ml, administer over 1-2mins via line).
106
Levetiracetam indication
Seizure continuing / reoccurring after 2x parenteral Midazolam. Must call for CCP if administered.
107
Levetiracetam Contraindication
Allergy.
108
Levetiracetam action, adverse effects, and metabolism.
Anticonvulsant that inhibits calcium channels and binds synaptic proteins to modulate glutamate release. Adverse - none Excreted by the kidneys.
109
Levetiracetam dosage
2g IV 1-2min running line. (Draw up the dose and dilute to 40ml NaCl+, administer over 1-2mins into running line). Has 10min onset time.
110
Metoprolol indications
No to Mild compromise due to rapid AF/Flutter. Moderate compromise due to AF/Flutter and Amiodarone is contraindicated.
111
Metoprolol 2 contraindications and 6 cautions.
Allergy, Hypotension. Cautions - 1st degree AVHB, No pacemaker and has hx of 2nd/3rd degree AVHB or sick sinus syndrome. Asthma / COPD. Heart Failure. Pregnancy.
112
Metoprolol action, adverse effects, and metabolism.
Beta 1 adrenergic receptor antagonist, decreasing SA and AV node responsiveness. it has negative inotropic (contractility force), chronotropic (HR), and dromotropic (speed of electrical conduction) effects. Adverse - none. Metabolised - liver.
113
Metoprolol dosage.
50mg PO.
114
Intraosseous access site locations - Humeral, Femur, proximal and distal Tibia.
Humeral IO - Place their hand across the abdo. Seat my two hands at the surgical head of the humeral neck. Place thumbs into the centre of the neck, feeling for the most prominent portion. Femoral - Locate superior aspect of the patella. Go up 1cm. Go slightly medially (inwards) to avoid the quadriceps tendon. Proximal Tibia - Locate the inferior aspect of the patella. Go down 3cm. Move medially (inwards) 1cm to find the flat part. Distal Tibia - Find the medial malleolus. Move up 3cm.
115

PARA Drugs 2024 NZCPG St John (1 decks)

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