Pharma Flashcards
Adrenaline presentation
1mg in 1ml
1mg in 1000ml
Adrenaline pharmacology
A naturally occurring alpha and beta adrenergic stimulant.
- increases HR by increasing SA node firing (B1)
- increase conduction velocity through AV node (B1)
- increase myocardial contractility (B1)
- increase irritability of ventricles (B1)
- causes bronchodilation (B2)
- causes peripheral vasoconstriction (Alpha)
Adrenaline metabolism
monoamine oxidase and other enzymes in blood, liver and around nerve endings
excreted by kidneys
Adrenaline PEIs
- cardiac arrest - VF/VT, asystole, PEA
- inadequate perfusion
- bradycardia with poor perfusion
- anaphylaxis
- severe asthma - imminent life threat not responding to nebulised therapy, or unconscious with no BP
- croup
Adrenaline contras
hypovolaemic shock without adequate fluid replacement
Adrenaline precautions
Consider reduced doses for:
- elderly/frail
- cardiovascular disease
- monamine oxidase inhibitors
- higher doses may be required for pts on beta blockers
Adrenaline side effects
sinus tach supraventricular arrhythmias ventricular arrhythmias hypertension pupil dilation may increase size of MI feeling of anxiety/palpitations in conscious pt
Adrenaline notes
IV onset: 30s peak: 3-5mins duration: 5-10mins IM onset: 30-90s peak: 4-10m duration: 5-10m
Aspirin presentation
300mg
Aspirin pharmacology
An analgesia, antipyretic, antiinflammatory, antiplatelet aggregation agent.
Minimises platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS.
Inhibits synthesis of prostaglandins - anti-inflammatory action
Aspirin metabolism
converted to salicylate in the gut mucosa and liver
excreted by kidneys
Aspirin PEIs
ACS
Aspirin contras
- hypersensitivity to aspirin/salicylates
- actively bleeding peptic ulcers
- bleeding disorders
- suspected dissecting aortic aneurysm
- chest pain associated with psychostim OD if SBO greater than 160
Aspirin precautions
- peptic ulcer
- asthma
- pts on anticoagulants
Aspirin side effects
heartburn, nausea, GI bleeding
increased bleeding time
hypersensitivity reactions
Aspirin duration
8 days - natural life of platelets
Ceftriaxone presentation
1g
Ceftriaxone pharmacology
cephalosporin antibiotics
Ceftriaxone metabolism
excreted unchanged in urine and bile
Ceftriaxone PEIs
- suspected meningococcal septicaemia
2. severe sepsis (consult only)
Ceftriaxone contras
Allergy to cephalosporin antibiotics
Ceftriaxone precautions
Allergy to penicillin antibiotics
Ceftriaxone side effects
nausea
vomiting
skin rash
Dexamethasone presentation
8mg in 2ml
Dexamethasone pharmacology
A corticosteroid secreted by adrenal cortex
- relieves inflammatory reactions
- provides immunosuppression
Dexamethasone metabolism
liver and excreted by kidneys
Dexamethasone PEIs
- bronchospasm assoc with acute respiratory distress not responsive to nebulised Salbutamol
- moderate-severe croup
- acute exacerbation of COPD
- adult stridor (non-foreign body obstruction)
Dexamethasone contras
Known hypersensitivity
Dexamethasone precautions
Solutions which are unclear or contaminated should be discarded
Dexamethasone side effects
nil
Dexamethasone notes
IV onset: 30-60m
peak: 2hrs
duration: 36-72hrs
Fentanyl presentation
100mcg in 2ml
250mcg in 1ml
Fentanyl pharmacology
Synthetic opioid analgesic
- depression leading to analgesia
- resp depression leading to apnoea
- dependence
- decreased CV through AV node
Fentanyl metabolism
liver and kidneys
Fentanyl PEIs
- sedation to facilitate intubation..RSI - modified or Paed IFS
- sedation to maintain intubation
- sedation to facilitate transthoracic pacing
- sedation to facilitate synchronised cardioversion
- CPR interfering pt
- analgesia
- hypersensitivity to morphine
- known renal impairment/failure
- short duration of action desirable
- hypotension
- nausea and/or vomiting
- severe headache
Fentanyl contras
- hypersensitivity
2. late second stage labour
Fentanyl precautions
- elderly/frail pts
- impaired hepatic function
- respiratory depression e.g. COPD
- current asthma
- pts on MAOI
- known addiction to opioids
- rhinitis, rhinorrhea or facial trauma (IN route)
Fentanyl side effects
respiratory depression
apnoea
rigid diaphragm and intercostal muscles
bradycardia
Fentanyl notes
IV onset: immediate
peak: less than 5mins
duration: 30-60mins
IN peak: 20mins
GTN presentation
0.3mg tablet
0.6mg tablet
50mg patch
GTN pharmacology
vascular smooth muscle relaxant
- venous dilation promotes venous pooling and reduces venous return to the heart
- arterial dilation reduces systemic vascular resistance and arterial pressure
- reduced myocardial O2 demand
- reduced systolic, diastolic and mean arterial pressure whilst maintaining coronary perfusion pressure
- mild collateral coronary artery dilation may improve blood supply to ischaemic areas of myocardium
- mild tachycardia secondary to slight fall in BP
- preterm labour - uterine quiescence
GTN metabolism
liver
GTN PEIs
- chest pain with ACS
- acute LVF
- hypertension assoc with ACS
- autonomic dysreflexia
- preterm labour
GTN contras
- known hypersensitivity
- SBP less than 110 tablet
- SBP less than 90 patch
- viagra or levitra in 24hrs or cialis in 4days
- VT
- HR less than 50 - exclude autonomic dysreflexia
- HR greater than 150
- suspected dissecting aortic aneurysm
- right ventricular MI
GTN Precautions
- no previous admin
- elderly/frail
- recent MI
- concurrent use with tocolytics
GTN side effects
tachycardia hypotension headache skin flushing (uncommon) bradycardia (occasionally)
GTN notes
S/L onset: 30s-2m peak: 5-10m duration: 15-30m Transdermal onset: up to 30m peak: 2hrs
Atrovent presentation
250mcg in 1ml
Atrovent pharmacology
anticholinergic bronchodilator
- allows bronchodilation by inhibiting cholinergic bronchomotor tone
Atrovent metabolism
excreted by kidneys
Atrovent PEIs
- severe resp distress associated with bronchospasm
2. exacerbation of COPD irrespective of severity
Atrovent contras
known hypersensitivity to Atropine or derivatives
Atrovent precautions
- glaucoma
2. avoid contact with eyes
Atrovent side effects
headache nausea dry mouth skin rash tachycardia (rare) palpitations (rare) acute angle closure glaucoma secondary to direct eye contact (rare)
Atrovent notes
onset: 3-5m
peak: 1.5-2hrs
duration: 6hrs
Ketamine presentation
200mg in 2ml
Ketamine pharmacology
Anaesthetic agent with analgesic properties at lower doses.
Works as an antagonist at N-methyl-D-aspartate NDMA receptors, also interacting with opioid, muscarinic and other receptors.
Produces a trance-like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes.
Ketamine PEIs
- intubation
- analgesia
- sedation: agitation or CPR interfering pt
Ketamine contras
- Suspected non-traumatic brain injury with severe hypertension SBP over 180
Ketamine precautions
- May exacerbate cardiovascular conditions such as uncontrolled HT, CVA, recent MI, cardiac failure, due to the effects on HR and BP
Ketamine side effects
CV: HT and tachycardia
CNS: emergence reactions e.g. vivid dreams, restlessness, confusion, hallucinations, irrational behaviour, increased skeletal muscle tone
Respiratory: transient resp depression and apnoea - rare
GI: n+ v
other: injection site pain, lacrimation, hypersalivation, diplopia, nystagmus
Ketamine notes
IV onset: 30s duration: 5-10m IM onset: 3-4m duration: 12-25m IN onset: 5m peak: 20m duration:45m
Methoxyflurane presentation
3ml
Methoxy pharmacology
Inhalational analgesic agent at low concentrations
Methoxy metabolism
liver
excreted by lungs
Methoxy PEIs
pain relief
Methoxy contras
- pre-existing renal disease/impairment
- concurrent use of tetracycline antibiotics
- exceeding total dose of 6ml within 24hours
- personal or family hx of malignant hyperthermia
- muscular dystrophy
Methoxy precautions
- penthrox inhaler held by pt
- pre-eclampsia
- concurrent use with Oxytocin may cause hypotension
Methoxy side effects
drowsiness
decrease in BP and bradycardia (rare)
exceeding max dose can lead to renal toxicity
Methoxy notes
lasts approx 3-5mins after discontinued
provides 25 mins analgesia