Paramedic Drugs Flashcards
What drugs might be given to a patient with anaphylactic shock?
Adrenaline (IM)
Hydrocortisone (IV)
Chlorphenamine (O/IV/IO)
Name 3 indications for prescribing adrenaline
Anaphylaxis, Cardiac Arrest, Life-threatening asthma
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
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
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
Three indications for Hydrocortisone ?
Acute severe asthma
Acute adrenal failure
Anaphylaxis and Allergic reaction
What are the respective doses of hydrocortisone given in asthma, adrenal crisis and anaphylaxis ?
Asthma- IV 100mg
Adrenal crisis - IV 100mg
Anaphylaxis - IV- 200mg
What type of drug is Chlorphenamine ? How does it work?
Sedating antihistamine
Binds to H1 receptors which reduces histamine-induced vasodilation, oedema and secretion
What dose of chlorphenamine is given in anaphylaxis ?
Slow IV/IO- 10mg in 1ml
When would you administer Amiodarone ?
Shockable cardiac arrest after 3rd shock. I.e. VF or pulseless VT
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
What dose of amiodarone should be given in shockable rhythms?
300mg slow IV with 10ml of NaCl
What class of drug is Atropine ?
Anticholinergic
4 indications for Atropine
1) Bradycardia with hypotension
2) Vagal stimulation
3) organophosphate positioning
4) non VF Cardiac arrest
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
Name a CI to prescribing adrenaline
Hypothermic patients
Name a side effect of Amiodarone
Bradycardia, vasodilation (hypotension, flushing), bronchospasm
Name a CI for Atropine
Do not give to treat bradycardia in hypothermia
Name a side effect of atropine
Dry mouth, visual blurring, pupil dilation
Indication for Benzylpenicillin
Suspected meningococcal disease i.e. non blanching rash AND signs and symptoms of meningococcal septicaemia
CI for Benzylpenicillin
Known severe allergy (not just sensitivity)
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
Name 2 indications for Cholrphenamine
Severe anaphylactic reaction
Severe allergic reaction which causes the patient distress e.g. severe itching
How does Chlorphenamine work?
Antihistamine which blocks the histamine receptors reducing hypersensitivity reaction. Also has anticholinergic properties (hence side effects)
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?
IV
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?
IM
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
