paramedic drugs Flashcards
Amiodarone
I- Paramedics-cardiac arrest, after Adrenaline
administration.
-ICP, Sustained awake VT
C-Severe allergy,
-severe allergy to iodine
-VT secondary to cyclic antidepressant poisoning
Cautions- none if in cardiac arrest
A-class 3 antiarrythmia, pottasium channel blocker, lengthens refractory period in phase three of action potential
R- IV - if VT, VF persists further 150mg can be given.
D- First dose 300mg second dose 150mg
s-hypotension, nausea, vomiting, light-headiness, bradydysrythmias
Comes in 150mg in 3ml solution
Amoxicillin/clauvanic acid
I-A clinical diagnosis of menigincocal septicaemia
-septic shock if the patient is more than 30 minutes away from hospital
-cellulitis- if pt is being referred to a Dr and there may be a delay in seeing DR given as single IV dose.
C-severe allergy
-clearly severe allergy to penicillin
-anaphylaxis to any beta-lactum antibiotic (penicllins cephalosporis
Cautions-none
A- Amoxicillin is abeta -lactum antibiotic. Acts against gram negative and positive bacteria, it inhibits production of cell wall causing bacteria to die
Clauvanic acid has no antibacterial properties, however it stops resistant bacteria from affecting amoxicillin.
R-IV or IM, no repeat.
D-1.2g dissolved in 2mls of sodium chloride. Final volume should be 2.4mls.
S-none
onset-30-60 mins
Getamincin
`I-Pt with septic shock that is more than 30 mins from hospital and site of infection is UTI, abdomen or unknown, administered with Amoxicillin/clauvanic acid.
C-allergy, pregnacy
cautions-none
A-aminoglyside antibiotic- activity against gram positive and negative bacteria. Works by inhibiting bacterial cell production.
R- Via litre of 0.9% sodium chloride or 5% glucose or via syringe into running IV.
D- less than 60kg 240mg
60-80kgs 320mg
greater than 80kgs 400mg
S- renal impairment, ototoxicity.
30-60 min onset
80mg in 2mls
fentanyl
I-moderate to severe pain when intense relief is needed over a short period of time (joint relocation), the pt has clinically significant shock or IV access cannot be gained (IN access).
C- severe allergy, unable to obey commands, (exceptions: administration for RSI, agitated delirium and post incubation), current respiratory depression
Cautions, age less than one, Pts with high risk off respiratory depression, labor.
A-Binds to opiate receptors in brain and spinal cord and has analgesic effects.
R-IV and IN
D- IV 10-50mcg every 3-5 minutes for adult
IN 100mcg in adult weighting less than 80kgs- further doses of 50mcg may be administered every 10 minutes
For over 80kgs 200mcg can be administered with further doses of 100mcg every 10 minutes.
S-respiratory depression, bradycardia, hypotension, sedation, nausea vommiting, itch, euphoria.
ketamine
I-severe pain (in addition to other medicines), Dissociation ( cardioversion, re-alignment, relocation) agitated delerium, RSI, significant movement during CPR.
C- severe allergy, age less than one year, current MI.
Cautions, unable to obey commands, active psychosis, hypertension, clinical conditions that may be made worse by hypertension.
A-Has analgesic effects, blocks the NMDA receptors, which stops excitary neurotransmitters reaching the brain.
R-Can be IV, IM or PO
D- For analgesia 10-50mg IV
1 mg per kg for PO and IM
For dissociation most patients will need apprx 0.5mgs per Kg.
For agitated delirium 50-100mg IV every 3-5mins
For movement during CPR- one dose of 50mg.
S-hypertension, tachycardia, apnoea, sedation, vommiting, halucinations.
Midazolam
I-prolonged seizures, moderate agitated delirium, ICP only pain associated with muscle spasm,sedation, sedation post intubation, severe anxiety associated with CORD.
C-containdications-none
Cautions- Concurrent administration with ketamine and opiates as will have advanced effect, elderly, intoxication.
A-benzodiazapine-increases activity of GABA receptors which results in anticonvolsant activity, sedation, amnesia and muscle relaxation.
R-IV,IM
D- For seizures IV- 5mg IM 10mg
For moderate agitation IV-2-5mg IM-10mg
S-sedation, respiratory depression, hypotension, amnesia.
Morphine
I-moderate to severe pain, CPO with severe anxiety, Sedation post intubation.
C-severe allergy, unable to obey commands (except agitated delirium and post intubation), current respiratory depression.
Cautions, age less than 1, Pts with high risk of respiratory depression, labour.
A- Opiate analgesic, binds to receptors in brain and spinal cord causing analgesia.
R-IV, IM
D- IV 1-5mg every 3-5 minutes
IM-5-10mg repeated after 10 minutes
S- respiratory depression, hypotension, sedation, nauea, vommiting, histamine release and itch.
Naloxone
I-Opiate poisoning if pt if impaired LOC and impaired breathing, excess adverse effects from administration of opiates.
C-none
cautions, chronic opiate use
A- opiate receptor antagonist, by blocking receptors it reverses the effects of opiates.
R-IV, IM
D- IV 0.1-0.4mg every 3-5 minutes
IM- 0.8mg, may be repeated every 10 mins.
S-sweating, tachycardia, hypertension.
olanzapine
I-mild agitation
C-severe allergy, age less than 12
Cautions, pregnancy, elderly.
A- anti-phycotic, has effect on multiple receptors in the brain which results in reduction of agitation, sedation and stabilisation of mood, anxiolysis.
R-PO
D- over 80kgs-10mg under 80kg 5mg, dose may be repeated once after 20 minutes.
S-sedation
Sodium Valporate
I- status epilectic that has not responded to 2 doses of midaz.
C-severe allergy. Cautions-none
A-Is an anticonvulsant, works by blocking sodium channels and also enhances activity of GABA receptors.
R-IV
D- 1200mg for an adult
S-none
Aspirin
300 mg tablet
I myocardial ischaemia
c severe allergy 3rd trimester pregnant
Cautions clin sign bleeding, known bleeding disorder, known worsening of bhroncospasm with nsaids
A is antipyretic, analgesic, antiinflammatory, antiplatelet inhibits cycloxegenase enzyme which inhibits prostaglandin formation
R po
D 300mg
S increased bleeding, GI stuff with chronic use
Tenecteplase
P 50mg tenecteplase powder with 10 ml of sterile water
I STEMI when PCI is not choose reperfusion strategy
C severe allergy, suspected aortic dissection, major surgery or trauma in last 6 weeks, intercranial surgery within last 6 months, ischaemic stroke in last 6 months, previous intracerebral hemorrhage, known cerebral aneurysm or tumor.
Cautions- clin Sig bleeding, more than 10 mins CPR, TIA, recent lumbar puncture or epidural, bleeding disorder, on blood thinners, bp over 180, pregnant or 2 weeks post partum.
A Fibrinlyotic that accelerates breakdown of blood clots. Converts plasminogen into plasmin which breaks down fibrin
R-IV
D- weight based
S-increased bleeding
Enoxaparin
I- STEMI in conjunction with Fibrinlyotic therapy
C-severe allergy
Cautions- clin Sig bleeding, yes to any fib checklist, pregnancy
A-lmwh anticoagulant, potentiates activity of antithrombin 3 which inhibits clotting factors
R-subcut no repeat
D- weight based
S-increased bleeding
100mg in 1ml
clopidogrel
I-STEMI in conjuction with fribriylotic therapy
C-severe allergy
Cautions clin sig bleeding YES to anything on fibrinylotic checklist, pregnancy
A-GPIIb/IIIa receptor inhibitor- anticoaculant
R-PO no repeat
D-75 under 300mg 75 and over 75mg
S-increased bleeding
preparation 75mg tablet
Heparin
I-STEMI in conjunction with fibrinylotic therapy
C- Severe allergy, age over 75
cautions pregancy, yes to FCL, clin sig bleeding
A-Is a anticoagulant, potentiates activity of antithromin III
R- IV no repeat
D-5000 units- dilute to 10mls and deliver as a bolus 15 after fibrinylotic therapy
S-increased bleeding
