Paramedic Drugs Flashcards
1
Q
Fentanyl - Indications
A
- Moderate to severe pain
- Anxiety with CPO
- Agitation, pain or SOB with end of life care
2
Q
Fentanyl - Contraindications
A
- Known severe allergy
3
Q
Fentanyl - cautions
A
- ALOC
- Age <1
- Respiratory depression
- Labour
- Concurrent administration of other opiates
- Age greater or equal to 75
- Signs of shock
4
Q
Mechanism of action of Fentanyl
A
Fentanyl is an opiate analgesic, it is an opiate agonist (or stimulator) that binds to opiate receptors in the brain and spinal cord causing analgesia
5
Q
Route of fentanyl
A
- IV, IM, IN, SC
6
Q
Doses of fentanyl
A
- IV 10-50mcg every 5 minutes using a lower dose in the range if the pt is frail or signs of shock
- IN as per paediatric drug table every 20 minutes up to 3 doses
- IM / SC 50-100mcg every 20 minutes up to 3 doses halving if pt frail or shocked
7
Q
Side effects of fentanyl
A
- Respiratory depression
- Bradycardia
- Hypotension
- Sedation
- Nausea and vomiting
- Itch
- Euphoria
8
Q
Indications for ketamine
A
- Severe pain that has not been adequately controlled with an opiate
9
Q
Contraindications for ketamine
A
- Known severe allergy
- Aged < 1
10
Q
Cautions of ketamine
A
- ALOC
- Signs of shock
- Current myocardial ischaemia
- Concurrent administration of opiates
- Aged greater or equal to 75
11
Q
Mechanism of action of ketamine
A
- Ketamine has complex actions but is predominantly an N-methyl-d-aspartate (NMDA) receptor antagonist (blocker) resulting in inhibition of excitatory neurotransmitter in the brain.
- Low doses cause analgesia, large doses cause amnesia and dissociation and high doses cause anaesthesia
12
Q
Route of ketamine
A
- IV
- IM
- PO
13
Q
Dose of ketamine
A
- IV 0.25mg/kg max of 25mg over approximately 15 minutes repeat as required
- IM or PO 0.5mg/kg max of 50mg repeated once after 20 minutes
14
Q
Side effects of ketamine
A
- Transient hypertension
- Tachycardia
- Apnoea
- Nausea and vomiting
- Sedation
- Hallucinations
15
Q
Indications of Lignocaine 1%
A
- SC for prophylaxis of pain associated with IV
- SC for digital ring block for analgesia when transport is less than 60 minutes or ropivacaine is not available
- IO for significant bone pain associated with IO administration
16
Q
Contraindications of Lignocaine
A
- Known severe allergy
17
Q
Cautions of Lignocaine
A
- Taking an anticoagulant (Ring Block)
18
Q
Mechanism of action of Lignocaine
A
- Lignocaine is local anaesthetic
- Lignocaine blocks the initiation and transmission of nerve impulses by blocking the movement of sodium ions across the nerve cell membranes
19
Q
Route of lignocaine
A
- SC
- IO
20
Q
Dose of lignocaine
A
- SC Max dose of 200mg may be repeated once after 30 minutes
- IO 50mg for adult repeated once after 15 minutes
21
Q
Side effects of Lignocaine
A
None
22
Q
Indications for Midazolam
A
- Prolonged seizures
23
Q
Contraindications of Midazolam
A
- Known severe allergy
24
Q
Cautions of Midazolam
A
- ALOC
- Respiratory depression
- Concurrent administration of other opiates
- Age greater or equal to 75
- Signs of shock
25
Mechanism of action of Midazolam
- Midazolam is a benzodiazepine
- Midazolam enhances the activity of gamma-aminobutyric acid (GABA) at GABA receptors within the CNS resulting in anticonvulsant activity, sedation, amnesia, anxiolytics and muscle relaxation
26
Route of Midazolam
- IV
- IM
27
Dose of Midazolam
- IV 5mg reduced to 3 if pt is frail repeating once after 5 minutes
- IM 10mg reduced to 5mg if frail repeating once every 10 minutes
28
Side effects of Midazolam
- Sedation
- Respiratory depression
- Hypotension
- Amnesia
29
Indications of Ondansetron
- clinically significant Nausea or Vomiting
30
Contraindications of ondansetron
- Known severe allergy
- Age < 1
31
Cautions of Ondansetron
None
32
Mechanism of action of Ondansetron
- Ondansetron is a antiemetic
- Ondansetron antagonises (blocks) serotonin receptors centrally in the brain and peripherally in the GI tract resulting in reduction of nausea and vomiting
33
Route of Ondansetron
- IV
- IM
34
Dose of Ondansetron
- IV 8mg in addition to 1 IM dose totally 12mg max
- IM 4mg can be repeated after 20 minutes
35
Indications of Tranexamic Acid
- Postpartum haemorrhage
- Hypovolaemia from uncontrolled bleeding
- Any other form of bleeding severe enough to cause hypovolaemia requiring sodium chloride to the administered
36
Contraindications of Tranexamic Acid
- Known severe allergy
- Trauma when TXA will be administered more than three hours after time of injury. this appears to increase mortality rates the cause of which is not clear
37
Cautions of Tranexamic Acid
- None
38
Mechanism of action of Tranexamic Acid
- TXA is a antifibrinolytic medicine. It blocks the conversion of plasminogen to plasma reducing fibrinolysis ( breakdown of blood clots) and bleeding
39
Routes of Tranexamic Acid
- IV
40
Doses of Tranexamic Acid
- 1g
41
Side effects of TXA
- None
42
Indications for sodium valproate
- Status epilepticcus that is not responsive to 2 doses of Midazolam
43
Contraindications for sodium valproate
- known severe allergy
44
Cautions of sodium valproate
None
45
Action of sodium valproate
- Anticonvulsant, predominantly blocks sodium channels but also enhances the activity of GABA receptors in the CNS
46
Route of sodium valproate
IV
IO - make sure the IO is not extraivasating prior to administration and it can cause tissue necrosis
47
Dose of sodium valproate
1200mg for adult
Paediatric drug doses
48
Side effects of sodium valproate
None
49
Side effects of ondansetron
Headache
Flushing
50
Indication of fluids
- Shock
- Hypovolemia
- Crush injury
- To Flush IV drugs
51
Contraindications of fluids
-None
52
Cautions of fluids
- Cardiogenic shock,
- CPO
53
Actions of fluids
- Expands intravascular volume and extracellular fluid volume
54
Route of Fluids
- IV
- IO
55
Dose of fluids
- Uncontrolled bleeding 500ml repeat as needed
- Controlled bleeding 500ml repeat as needed
- Hyperglycaemia 1000ml / 1 hr
- Cardiogenic Shock 250-500ml max 1L
- Neurogenic shock 1000ml max
- crush injury 2-3L Minimum of 2 L
- Other as per CPG
56
Side effects of fluids
-None
57
Glucose Indications
- Hypoglycaemia <3.5 if IV access can be obtained and PO not appropriate
58
Glucose contraindications
-None
59
Glucose Caution
- None
60
Glucose action
- Increases blood glucose level in the blood
61
Glucose route
IV
62
Glucose dose
- IV 100ml adult, 2ml/kg child
63
Side effects of glucose
- none
