Paramedic Drugs Flashcards by Alice Roberts

What drugs might be given to a patient with anaphylactic shock?

Adrenaline (IM)
Hydrocortisone (IV)
Chlorphenamine (O/IV/IO)

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Name 3 indications for prescribing adrenaline

Anaphylaxis, Cardiac Arrest, Life-threatening asthma

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How does adrenaline work in:

a) cardiac arrest
b) anaphylaxis

a) ACTS on alpha and beta adrenergic receptors. CAUSES vasoconstriction INCREASING peripheral resistance and perfusion pressures ENHANCING myocardial and cerebral perfusion.
b) Stabilises mast cell membranes therefore reducing their degradation and the release of histamine which leads to inflam response

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What dose of adrenaline should be given in a cardiac arrest ? When should this dose be given?

IV/IO 1mg in 10ml. (1 in 10,000)
Given after 3rd shock (then 5th/7th etc.)
Give IV immediately if in a non-shockable rhythm

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What dose of adrenaline should be given in anaphylaxis?

IM (or SC) 500 mcg.
1 in 1000
If severe can give it slow IV with same dose

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Three indications for Hydrocortisone ?

Acute severe asthma
Acute adrenal failure
Anaphylaxis and Allergic reaction

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What are the respective doses of hydrocortisone given in asthma, adrenal crisis and anaphylaxis ?

Asthma- IV 100mg
Adrenal crisis - IV 100mg
Anaphylaxis - IV- 200mg

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What type of drug is Chlorphenamine ? How does it work?

Sedating antihistamine

Binds to H1 receptors which reduces histamine-induced vasodilation, oedema and secretion

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What dose of chlorphenamine is given in anaphylaxis ?

Slow IV/IO- 10mg in 1ml

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When would you administer Amiodarone ?

Shockable cardiac arrest after 3rd shock. I.e. VF or pulseless VT

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How does amiodarone work? How does this improvement manifest on an ECG?

1) Blocks Na and K ion channels in myocardium
2) lengthens action potential and INCREASES refractory period

On an ECG this increase the QT interval

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What dose of amiodarone should be given in shockable rhythms?

300mg slow IV with 10ml of NaCl

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What class of drug is Atropine ?

Anticholinergic

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4 indications for Atropine

1) Bradycardia with hypotension
2) Vagal stimulation
3) organophosphate positioning
4) non VF Cardiac arrest

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What are the effects of Atropine ? What are some of the side effects of the drug ?

Tachycardia, cardiac output and systemic hypertension

Can also cause other sympathetic side effects e.g. Pupillary dilation and drying of secretions

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Name a CI to prescribing adrenaline

Hypothermic patients

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Name a side effect of Amiodarone

Bradycardia, vasodilation (hypotension, flushing), bronchospasm

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Name a CI for Atropine

Do not give to treat bradycardia in hypothermia

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Name a side effect of atropine

Dry mouth, visual blurring, pupil dilation

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Indication for Benzylpenicillin

Suspected meningococcal disease i.e. non blanching rash AND signs and symptoms of meningococcal septicaemia

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CI for Benzylpenicillin

Known severe allergy (not just sensitivity)

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Dose and administration of Benzylpenicillin

Can be given IV/IO (preferred) or IM.
For IV/IO- 1.2 grams of drug dissolved in 19.2ml of water.
For IM- 1.2 grams dissolved in 3.2 ml of water

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Name 2 indications for Cholrphenamine

Severe anaphylactic reaction

Severe allergic reaction which causes the patient distress e.g. severe itching

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How does Chlorphenamine work?

Antihistamine which blocks the histamine receptors reducing hypersensitivity reaction. Also has anticholinergic properties (hence side effects)

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When is chlorphenamine contraindicated?

If hypersensitive to the drug (lol)

Name a side effect to Chlorphenamine

Sedation, dry mouth (anticholinergic), headache, blurred vision Similar side effect to atropine which is also an anticholinergic drug

How is chlorphenamine administered?

IV/IO/PO

State the dose of chlorphenamine if given orally and IV/IO

Oral - 4mg | IV/IO- 10 mg in 1ml

When is it indicated to administer clopidogrel?

STEMI For patients NOT already taking it, who are receiving (or anticipate receiving) thrombotic therapy or for patients who are expected to have a PCI

What class of drug is Clopidogrel?

Antiplatelet

How does Clopidogrel work?

Inhibits platelet aggregation

Name a CI to Clopidogrel

Liver impairment, active pathological bleeding e.g. peptic ulcer, ICH

Name a side effect of clopidogrel

Bleeding

What is the route for administering clopidogrel?

Oral

What initial dose of clopidogrel is given to adults aged 18-75 with a suspected STEMI? What dose should be given for the following 4 weeks?

300mg for thrombolysis and 600 mg for anticipated PCI | 75 mg daily

What initial dose of clopidogrel should be given to patients over the age of 75 with a suspected STEMI?

75mg

What initial dose of clopidogrel should be given to patients for thrombolysis and PCI respectively?

Thrombolysis- 300mg | PCI- 600mg

What is an indication for dexamethasone?

Moderate-severe croup

How does dexamethasone work?

It's a corticosteroid and reduces subglottic inflammation

Contraindication for dexamethasone?

Systemic infection/sepsis

What is the route for dexamethasone?

ORAL- but prepared IV

What is the dose for dexamethasone?

Maximum dose varies from 2-4mg depending on age

Name 3 indications for administering Diazepam

1) Fits lasting longer than 5 minutes and STILL fitting 2) Repeated fits without time for recovery in between 3) Status Epilepticus 4) Eclamptic fits 5) Symptomatic cocaine toxicity (severe HTN/chest pain/fitting)

How does diazepam work?

Enhances binding of GABA to GABA A receptor Anticonvulsant Sedative CNS depressant

Name a side effect of diazepam

Can cause respiratory depression when given to a patient who has consumed alcohol (both CNS depressants)

What route would you choose when administering diazepam to a child?

Although IV is preferred, the quicker the drug is given the more likely it is to be effective. Therefore administer rectally whilst IV access is sought

What dose of diazepam is given IV/IO

10 mg in 2 ml. Can repeat dose every 5 minutes. Maximum dose 20 mg therefore can repeat twice (maths)

What dose of diazepam is given rectally?

1 , 10 mg tube

If a single dose of rectal diazepam has been administered, can a single dose of IV diazepam be administered once access is sought?

YES

What is Entonox?

50% nitrous oxide and 50% oxygen

Name two indications for entonox

Moderate-severe pain | Labour pains

How is entonox delivered?

Inhaled using a facemask or mouthpiece.

Name a contraindication for entonox

Severe head injury with impaired consciousness

Why would Dr Nabeel administer furosemide ?

For pulmonary oedema secondary to Left Ventricular Failure. However nitrates are preferred to diuretics for the treatment

State a CI to furosemide ?

Severe renal failure with anuria

Side effect of furosemide?

Hypotension, GI

What is the route of administering furosemide?

What is the dose of furosemide?

40mg IV

How does glucagon improve hypoglycaemia?

Hormone that converts glycogen to glucose in the liver

What agent would be chosen to treat hypoglycaemia in a hypoglycaemic seizure?

Glucose 10% IV

What are the indications to administer glucagon or glucose 10%

1) Hypoglycaemia (blood glucose <4.0 millimoles/litre) 2) clinically suspected hypoG where oral admin not possible 3) unconscious patient where hypoG is a likely cause

What are the advantages of IV glucose 10% vs. glucagon?

Glucose 10% has no side effects whereas glucagon can cause N&V and diarrhoea

How is Glucagon administered?

What is the dose of glucagon?

1 vial therefore 1mg

If patient doesn't respond to glucagon within 10 minutes, what should be done?

IV Glucose 10% should be administered

What is the dose of Glucose 10%?

10 grams in 100ml. | Can be repeated if no response after 5 minutes

When would Glucose 40% Oral Gel be administered?

Known/Suspected hypoglycaemia in a conscious patient where there is no risk of choking or aspiration

What is the dose of Glucose 40% Oral gel?

10 grams in 25 grams of gel.

What is the maximum dose of Glucose 40% Oral Gel?

THE LIMIT DOES NOT EXISIT

How is the administration of Glucose 40% Oral Gel monitored?

Measure blood glucose level after each dose

Name two indications for GTN spray?

1) Cardiac chest pain because of angina or MI | 2) Acute cardiogenic pulmonary oedema (superior to furosemide)

How does GTN work?

VASODILATION therefore - dilation of coronary arteries and relief of coronary spasm - dilation of systemic veins therefore lower pre-load - reduced blood pressure

Name a CI for GTN

Hypotension or hypotension

How is GTN administered (specific please)?

Buccal- oral mucosa must be moist for absorption so moisten if necessary ;) Spray under patients tongue and close mouth

What type of drug is heparin?

Anticoagulant

What are the indications for heparin?

STEMI to prevent re-infarction (with reteplase/telecteplase)

Side effect of heparin?

Haemorrhage

CI of heparin?

Haemophilia and other haemorrhagic disorders

What is the route and dose of heparin ?

IV | 5,000 units with 1ml.

State three indications for hydrocortisone

1) Anaphylaxis 2) Adrenal crisis 3) Life-threatening asthma

How is hydrocortisone administered?

IV or ... | IO/IM

What dose of hydorcortisone is given to treat asthma and adrenal crisis?

100mg in 1ml

What dose of hydrocortisone is given to treat anaphylaxis?

200mg in 2ml

Indication of ibuprofen?

Mild to moderate pain and/or high temperature

What are the actions of Ibuprofen? (3 A's)

Analgesic, Antipyretic, Anti-inflammatory

CI or Ibuprofen?

Pregnant, hypovolaemic

Side effect of Ibuprofen?

N&V

Dose of Ibuprofen?

400mg orally every 8 hours

What drug is often tried before ipratropium bromide is administered?

Salbutamol- beta agonists generally work faster

Name 2 indications of ipratropium bromide ?

Acute severe asthma | Exacerbation of COPD

What type of drug is Ipratropium Bromide?

Antimuscarinic bronchodilator

Side effects of Ipratropium Bromide?

Headache, N&V, Dry mouth

How is Ipratropium Bromide administered?

Nebuliser with 6-8 litres of oxygen

What is the dose of nebulised ipratropium bromide?

500 ug in 2 ml