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GAP 2018 > Pharma > Flashcards

Pharma Flashcards

1
Q

Adrenaline presentation

A

1mg in 1ml

1mg in 1000ml

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2
Q

Adrenaline pharmacology

A

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)
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3
Q

Adrenaline metabolism

A

monoamine oxidase and other enzymes in blood, liver and around nerve endings
excreted by kidneys

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4
Q

Adrenaline PEIs

A
  1. cardiac arrest - VF/VT, asystole, PEA
  2. inadequate perfusion
  3. bradycardia with poor perfusion
  4. anaphylaxis
  5. severe asthma - imminent life threat not responding to nebulised therapy, or unconscious with no BP
  6. croup
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5
Q

Adrenaline contras

A

hypovolaemic shock without adequate fluid replacement

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6
Q

Adrenaline precautions

A

Consider reduced doses for:

  1. elderly/frail
  2. cardiovascular disease
  3. monamine oxidase inhibitors
  4. higher doses may be required for pts on beta blockers
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7
Q

Adrenaline side effects

A 
sinus tach
supraventricular arrhythmias
ventricular arrhythmias 
hypertension 
pupil dilation 
may increase size of MI 
feeling of anxiety/palpitations in conscious pt
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8
Q

Adrenaline notes

A 
IV onset: 30s
peak: 3-5mins
duration: 5-10mins 
IM onset: 30-90s
peak: 4-10m
duration: 5-10m
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9
Q

Aspirin presentation

A

300mg

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10
Q

Aspirin pharmacology

A

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

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11
Q

Aspirin metabolism

A

converted to salicylate in the gut mucosa and liver

excreted by kidneys

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12
Q

Aspirin PEIs

A

ACS

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13
Q

Aspirin contras

A
  1. hypersensitivity to aspirin/salicylates
  2. actively bleeding peptic ulcers
  3. bleeding disorders
  4. suspected dissecting aortic aneurysm
  5. chest pain associated with psychostim OD if SBO greater than 160
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14
Q

Aspirin precautions

A
  1. peptic ulcer
  2. asthma
  3. pts on anticoagulants
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15
Q

Aspirin side effects

A

heartburn, nausea, GI bleeding
increased bleeding time
hypersensitivity reactions

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16
Q

Aspirin duration

A

8 days - natural life of platelets

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17
Q

Ceftriaxone presentation

A

1g

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18
Q

Ceftriaxone pharmacology

A

cephalosporin antibiotics

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19
Q

Ceftriaxone metabolism

A

excreted unchanged in urine and bile

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20
Q

Ceftriaxone PEIs

A
  1. suspected meningococcal septicaemia

2. severe sepsis (consult only)

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21
Q

Ceftriaxone contras

A

Allergy to cephalosporin antibiotics

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22
Q

Ceftriaxone precautions

A

Allergy to penicillin antibiotics

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23
Q

Ceftriaxone side effects

A

nausea
vomiting
skin rash

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24
Q

Dexamethasone presentation

A

8mg in 2ml

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25
Q

Dexamethasone pharmacology

A

A corticosteroid secreted by adrenal cortex

  • relieves inflammatory reactions
  • provides immunosuppression
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26
Q

Dexamethasone metabolism

A

liver and excreted by kidneys

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27
Q

Dexamethasone PEIs

A
  1. bronchospasm assoc with acute respiratory distress not responsive to nebulised Salbutamol
  2. moderate-severe croup
  3. acute exacerbation of COPD
  4. adult stridor (non-foreign body obstruction)
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28
Q

Dexamethasone contras

A

Known hypersensitivity

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29
Q

Dexamethasone precautions

A

Solutions which are unclear or contaminated should be discarded

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30
Q

Dexamethasone side effects

A

nil

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31
Q

Dexamethasone notes

A

IV onset: 30-60m

peak: 2hrs
duration: 36-72hrs

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32
Q

Fentanyl presentation

A

100mcg in 2ml

250mcg in 1ml

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33
Q

Fentanyl pharmacology

A

Synthetic opioid analgesic

  • depression leading to analgesia
  • resp depression leading to apnoea
  • dependence
  • decreased CV through AV node
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34
Q

Fentanyl metabolism

A

liver and kidneys

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35
Q

Fentanyl PEIs

A
  1. sedation to facilitate intubation..RSI - modified or Paed IFS
  2. sedation to maintain intubation
  3. sedation to facilitate transthoracic pacing
  4. sedation to facilitate synchronised cardioversion
  5. CPR interfering pt
  6. analgesia
    - hypersensitivity to morphine
    - known renal impairment/failure
    - short duration of action desirable
    - hypotension
    - nausea and/or vomiting
    - severe headache
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36
Q

Fentanyl contras

A
  1. hypersensitivity

2. late second stage labour

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37
Q

Fentanyl precautions

A
  1. elderly/frail pts
  2. impaired hepatic function
  3. respiratory depression e.g. COPD
  4. current asthma
  5. pts on MAOI
  6. known addiction to opioids
  7. rhinitis, rhinorrhea or facial trauma (IN route)
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38
Q

Fentanyl side effects

A

respiratory depression
apnoea
rigid diaphragm and intercostal muscles
bradycardia

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39
Q

Fentanyl notes

A

IV onset: immediate
peak: less than 5mins
duration: 30-60mins
IN peak: 20mins

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40
Q

GTN presentation

A

0.3mg tablet
0.6mg tablet
50mg patch

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41
Q

GTN pharmacology

A

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
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42
Q

GTN metabolism

A

liver

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43
Q

GTN PEIs

A
  1. chest pain with ACS
  2. acute LVF
  3. hypertension assoc with ACS
  4. autonomic dysreflexia
  5. preterm labour
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44
Q

GTN contras

A
  1. known hypersensitivity
  2. SBP less than 110 tablet
  3. SBP less than 90 patch
  4. viagra or levitra in 24hrs or cialis in 4days
  5. VT
  6. HR less than 50 - exclude autonomic dysreflexia
  7. HR greater than 150
  8. suspected dissecting aortic aneurysm
  9. right ventricular MI
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45
Q

GTN Precautions

A
  1. no previous admin
  2. elderly/frail
  3. recent MI
  4. concurrent use with tocolytics
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46
Q

GTN side effects

A 
tachycardia
hypotension
headache
skin flushing (uncommon) 
bradycardia (occasionally)
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47
Q

GTN notes

A 
S/L onset: 30s-2m 
peak: 5-10m
duration: 15-30m
Transdermal onset: up to 30m
peak: 2hrs
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48
Q

Atrovent presentation

A

250mcg in 1ml

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49
Q

Atrovent pharmacology

A

anticholinergic bronchodilator

- allows bronchodilation by inhibiting cholinergic bronchomotor tone

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50
Q

Atrovent metabolism

A

excreted by kidneys

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51
Q

Atrovent PEIs

A
  1. severe resp distress associated with bronchospasm

2. exacerbation of COPD irrespective of severity

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52
Q

Atrovent contras

A

known hypersensitivity to Atropine or derivatives

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53
Q

Atrovent precautions

A
  1. glaucoma

2. avoid contact with eyes

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54
Q

Atrovent side effects

A 
headache
nausea
dry mouth
skin rash
tachycardia (rare)
palpitations (rare)
acute angle closure glaucoma secondary to direct eye contact (rare)
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55
Q

Atrovent notes

A

onset: 3-5m
peak: 1.5-2hrs
duration: 6hrs

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56
Q

Ketamine presentation

A

200mg in 2ml

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57
Q

Ketamine pharmacology

A

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.

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58
Q

Ketamine PEIs

A
  1. intubation
  2. analgesia
  3. sedation: agitation or CPR interfering pt
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59
Q

Ketamine contras

A
  1. Suspected non-traumatic brain injury with severe hypertension SBP over 180
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60
Q

Ketamine precautions

A
  1. May exacerbate cardiovascular conditions such as uncontrolled HT, CVA, recent MI, cardiac failure, due to the effects on HR and BP
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61
Q

Ketamine side effects

A

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

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62
Q

Ketamine notes

A 
IV onset: 30s
duration: 5-10m
IM onset: 3-4m
duration: 12-25m
IN onset: 5m
peak: 20m
duration:45m
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63
Q

Methoxyflurane presentation

A

3ml

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64
Q

Methoxy pharmacology

A

Inhalational analgesic agent at low concentrations

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65
Q

Methoxy metabolism

A

liver

excreted by lungs

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66
Q

Methoxy PEIs

A

pain relief

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67
Q

Methoxy contras

A
  1. pre-existing renal disease/impairment
  2. concurrent use of tetracycline antibiotics
  3. exceeding total dose of 6ml within 24hours
  4. personal or family hx of malignant hyperthermia
  5. muscular dystrophy
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68
Q

Methoxy precautions

A
  1. penthrox inhaler held by pt
  2. pre-eclampsia
  3. concurrent use with Oxytocin may cause hypotension
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69
Q

Methoxy side effects

A

drowsiness
decrease in BP and bradycardia (rare)
exceeding max dose can lead to renal toxicity

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70
Q

Methoxy notes

A

lasts approx 3-5mins after discontinued

provides 25 mins analgesia

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71
Q

Midaz presentation

A

5mg in 1ml

15mg in 3ml

72
Q

Midaz pharmacology

A

Short acting CNS depressant

  • anxiolytic
  • sedative
  • anti-convulsant
73
Q

Midaz metabolism

A

liver

excreted by kidneys

74
Q

Midaz PEIs

A
  1. status epilepticus
  2. sedation to maintain intubation
  3. sedation to facilitate intubation - RSI
  4. sedation to facilitate synchronised cardioversion
  5. sedation to facilitate transthoracic pacing
  6. sedation in agitated pt
  7. sedation in psychostimulant OD
75
Q

Midaz contras

A

hypersensitivity to benzodiazepines

76
Q

Midaz precautions

A
  1. reduced doses for elderly/frail, pts with chronic renal failure, CCF, shock
  2. CNS depressant effects are enhanced with narcotics and alcohol
  3. severe resp depression in COPD
  4. myasthenia gravis
77
Q

Midaz side effects

A
  • depressed level of consciousness
  • respiratory depression
  • loss of airway control
  • hypotension
78
Q

Midaz notes

A 
IM: onset: 3-5mins
peak: 15mins
duration: 30mins 
IV: onset: 1-3mins
peak: 10mins
duration: 20mins
79
Q

Morphine Presentation

A

10mg in 1ml

80
Q

Morphine pharma

A

opioid analgesic agent:

  • CNS depression causes analgesia
  • resp depression
  • depression of cough reflex
  • stimulation (euphoria, vomiting, pin point pupils)
  • dependence
  • vasodilation
  • decreased conduction velocity through AV node
81
Q

Morphine Indications

A
  1. pain relief
  2. sedation to maintain intubation
  3. sedation to facilitate intubation - where fentanyl not appropriate for RSI
82
Q

Morphine contras

A
  1. hypersensitivity
  2. late second stage labour
  3. renal impairment/failure
83
Q

Morphine precautions

A
  1. elderly/frail
  2. hypotension
  3. resp depression
  4. current asthma
  5. resp tract burns
  6. addiction
  7. acute alcoholism
  8. monoamine oxidase inhibitors
84
Q

Morphine side effects

A
  • drowsiness
  • resp depression
  • euphoria
  • nausea and vomiting
  • pin point pupils
  • addiction
  • hypotension
  • bradycardia
85
Q

Morphine notes

A 
IV onset: 2-5mins
peak: 10mins
duration 1-2hours 
IM onset: 10-30mins
peak:30-60mins
duration:1-2hours
86
Q

Naloxone presentation

A

0.4mg in 1ml

87
Q

Naloxone pharma

A

opioid antagonist - prevents and reverses the effects of opioids by competitively binding to opioid receptors

88
Q

Naloxone indications

A

altered conscious state and resp depression secondary to admin of opioids or related drugs

89
Q

Naloxone contras

90
Q

Naloxone precautions

A
  1. known addiction

2. neonates

91
Q

Naloxone side effects

A

withdrawal symptoms: sweating, gooseflesh, temors, nausea and vomiting, agitation, dilated pupils, excessive lacrimation, convulsions

92
Q

Naloxone notes:

A

IV onset: 1-3mins
duration:30-45mins
IM onset:1-3mins
duration: 30-45mins

93
Q

Ondansetron presentation

A

4mg tab or 8mg in 4ml

94
Q

Ondansetron pharma

A

anti-emetic

serotonin antagonist which blocks receptors both centrally and peripherally

95
Q

Ondansetron indications

A
  1. undifferentiated nausea and vomiting
  2. prophylaxis for spinal or eye injured pts
  3. vestibular nausea for pts under 21
96
Q

Ondansetron contras

A
  1. hypersensitivity
  2. long QT syndrome
  3. concurrent apomorphine use
  4. hypokalaemia or hypomagnesaemia
97
Q

Ondansetron precautions

A
  1. pts with liver disease should not have more than 8mg a day
  2. take care with pts on diuretics due to underlying electrolyte imbalance
  3. do not give to pts with phenylketonuria
  4. concurrent use of tramadol
  5. pregnancy
98
Q

Ondansetron side effects

A
  • constipation
  • headache
  • fever
  • dizziness
  • rise in liver enzymes
99
Q

Ondansetron notes

A

tablet onset: 2mins

peak: 20mins
duration: 2hours

IV onset: 5mins

peak: 10mins
duration: 2.5 to 6.1 hours

100
Q

Paracetamol presentation

A

500mg tablets

120mg in 5ml liquid

101
Q

Paracetamol pharma

A

an analgesia and antipyretic agent

-thought to inhibit prostaglandin synthesis in the CNS

102
Q

Paracetamol indications

A
  1. mild pain

2. headache

103
Q

Paracetamol contras

A
  1. hypersensitivity
  2. admin in 4hours
  3. children less than 1month old
  4. total intake in 24 hours greater than 4g for adults and 60mg/kg for children
  5. chest pain in suspected ACS
104
Q

Paracetamol precautions

A
  1. impaired hepatic or renal disease
  2. malnourished
  3. elderly/frail
105
Q

Paracetamol side effects

A

hypersensitivity reactions

haematological reactions

106
Q

Paracetamol notes

A

onset: 30mins
duration: 4 hours

107
Q

Stemetil presentation

A

12.5mg in 1ml

108
Q

Stemetil pharma

A

an anti-emetic

-acts on several central neurotransmitter systems

109
Q

Stemetil indications

A
  1. treatment or prophylaxis for nausea/vomiting:
    - motion sickness
    - vertigo
    - known allergy or C/I to ondansetron
    - planned aeromedical evac
    - headache irrespective of severity
110
Q

Stemetil contras

A
  1. circulatory collapse
  2. CNS depression
  3. under 21 yrs
  4. hypersensitivity
  5. pregnancy
111
Q

Stemetil precautions

A
  1. hypotension
  2. epilepsy
  3. pts affected by alcohol or on anti-depressants
112
Q

Stemetil side effects

A 
drowsiness
blurred vision
hypotension
sinus tach
skin rash
extrapyrimidial reactions
113
Q

Stemetil notes

A

onset: 20mins
peak: 40mins
duration: 6hours

114
Q

Salbutamol presentation

A

pMDI

5mg in 2.5ml

115
Q

Salbutamol pharma

A

Synthetic beta adrenergic stimulant within primarily beta 2 effects
-causes bronchodilation

116
Q

Salbutamol indications

A
  1. resp distress with suspected bronchospasm
    - asthma
    - severe allergic reaction
    - COPD
    - smoke inhalation
    - capsicum spray exposure
117
Q

Salbutamol contras

118
Q

Salbutamol precautions

A

large doses of Salbutamol can cause intracellular metabolic acidosis

119
Q

Salbutamol side effects

A

sinus tach

muscle tremor

120
Q

Salbutamol notes

A

onset: 5-15mins
duration: 15-50mins

121
Q

Tenecteplase presentation

A

50mg in glass vial with weight marked and pre-filled syringe containing water for IV admin

122
Q

Tenecteplase Pharma

A

Fibrinolytic, a modified form of tissue plasminogen activator tPA that binds to fibrin and converts plasminogen to plasmin

123
Q

Tenecteplase metabolism

124
Q

Tenecteplase PEI

A

Acute STEMI

125
Q

Tenecteplase Contras/exclusion criteria

A
  1. Major surgery in the past 3 months
  2. significant head injury in the past 3 months
  3. Major trauma in the last 3 months
  4. stroke/TIA in the past 3 months
  5. ICH at any time
  6. GI or genitourinary bleed in the past month
  7. current bleeding disorder, active bleeding -excl menses- or bleeding tendencies
  8. anticoagulants or glycoprotein IIb/IIIa inhibitors
  9. allergy to tenecteplase or gentamicin
126
Q

Tenecteplase Precautions

A
  1. age greater than or equal to 75 years
  2. non-compressible vascular puncture
  3. hx of liver disease
  4. SBP over 160 or DBP over 110
  5. low body weight
  6. active peptic ulcer
  7. anaemia
  8. acute pericarditis or subacute bacterial endocarditis
  9. traumatic or prolonged CPR over 10mins
  10. pregnant or within 1 week post partum
  11. HR over 120
127
Q

Tenecteplase route of admin

A

IV as a single bolus over 10 secs

IO - consult

128
Q

Tenecteplase side effects

A

Bleeding - including injection sites, ICH, internal bleeding
transient hypotension
Infrequent: allergic reactions including fever, chills, rash, nausea, headache, bronchospasm, vasculitis, nephritis and anaphylaxis
Rare: cholesterol embolism

129
Q

Oxytocin Presentation

A

10 units in 1ml

130
Q

Oxytocin Pharma

A

A synthetic oxytocic - stimulates smooth muscle of the uterus producing contractions

131
Q

Oxytocin PEI

A

PPH - primary postpartum haemorrhage

132
Q

Oxytocin Contras

A
  1. previous hypersensitivity
  2. severe toxaemia - pre eclampsia
  3. exclude multiple pregnancy before drug admin
  4. cord prolapse
133
Q

Oxytocin Precautions

A
  1. if given IV may cause transient hypotension

2. concurrent use with Methoxy may cause hypotension

134
Q

Oxytocin route of admin

135
Q

Oxytocin side effects

A

Uncommon with IM:
tachycardia
bradycardia
nausea

136
Q

Oxytocin notes

A

must be stored between 2-8 degrees

onset: 2-4 m
duration: 30-60m

137
Q

Olanzapine presentation

138
Q

Olanzapine pharma

A

atypical antipsychotic - antagonist at multiple recept sites, particularly serotonin, dopamine and histamine

139
Q

Olanzapine PEI

A

mild agitation

140
Q

Olanzapine contras

141
Q

Olanzapine Precautions

A
  1. may be less effective if agitation is due to drug intoxication or alcohol withdrawal. Benzos should be considered for these patients.
  2. elderly/frail and children are more susceptible to adverse effects
142
Q

Olanzapine side effects

A

CNS: sedation, dizziness
other: extrapyrmidial symptoms and QT prolongation are unlikely when administered at approved doses

143
Q

Olanzapine notes

A

onset: 15m
duration: 12-24hours

144
Q

Lidocaine pharma

A

sodium channel blocker - interrupts impulse conduction in peripheral nerves and stabilises excitable cell membranes

145
Q

Lidocaine PEI

A

local anaesthetic to reduce pain associated with:

  • IM admin of ceftriaxone
  • chest decompression in pts with GCS greater than 10 - MICA only
  • IO admin of medication or fluid in conscious pt - MICA only
146
Q

Lidocaine contras

A

Known hypersensitivity to lidocaine or related local anaesthetics

147
Q

Lidocaine precautions

A
  1. IM and local infiltration - inadvertent intravascular admin may result in systemic toxicity
  2. IO - impaired CV function - ht, bradycardia, poor perfusion, heart block, heart failure
148
Q

Lidocaine side effects

A
  1. allergic reactions are rare and may present as localised oedema, urticaria, bronchospasm and anaphylaxis
  2. signs of systemic toxicity include: CNS: tinnitus, blurred vision, sudden change in conscious state, agitation, convulsions
    CV: ht, bradycardia, arrhythmias, cardiac arrest
149
Q

Lidocaine presentation

A

50mg in 5ml polyamp

150
Q

Lidocaine notes

A

onset: 5-15m
duration: 1-1.5hrs

151
Q

Heparin presentation

A

5000 units in 5ml

152
Q

Heparin pharma

A

anticoagulant - inactivates clotting factors IIa and Xa by binding to antithrombin III

153
Q

Heparin metabolism

A

liver, excreted by kidneys

154
Q

Heparin PEI

A

acute STEMI

155
Q

Heparin contras

A
  1. known allergy or hypersensitivity
  2. active bleeding excl menses
  3. oral anticoagulants
  4. bleeding disorders
  5. hx of heparin-induced thrombocytopaenia -HIT
  6. severe hepatic impairment/disease including oesophageal varices
  7. recent trauma or surgery less than 3 weeks
156
Q

Heparin precautions

A
  1. renal impairment
157
Q

Heparin route of admin

158
Q

Heparin side effects

A
  • bleeding
  • bruising and pain at injection site
  • hyperkalaemia
  • thrombocytopaenia
159
Q

Heparin notes

A

onset: immediate
duration: 3-6hrs

160
Q

Glucagon presentation

A

1mg in 1l hypokit

161
Q

Glucagon pharma

A

a hormone normally secreted by the pancreas - causes an increase in blood glucose concentration by converting stored liver glycogen to glucose

162
Q

Glucagon PEI

A
  1. diabetic hypoglycaemia BGL less than 4 in pts with altered conscious state who are unable to self-admin oral glucose
  2. anaphylaxis where pt remains hypotensive following adrenaline therapy with phx of heart failure or pts taking beta blocker medication
163
Q

Glucagon contras

164
Q

Glucagon precautions

165
Q

Glucagon route of admin

166
Q

Glucagon side effects

A

Nausea and vomiting - rare

167
Q

Glucagon notes:

A

onset: 5m
duration: 25m

168
Q

Dextrose presentation

A

25g in 250ml

169
Q

Dextrose pharma

A

A slightly hypertonic crystalloid solution composing of sugar 10% and water.
Provides a source of energy and supplies body water

170
Q

Dextrose metabolism

A

Dextrose - broken down in most tissues, stored in liver and muscle as glycogen
Water- excreted by kidneys, distributed throughout total body water

171
Q

Dextrose PEI

A

diabetic hypoglycaemia BGL less than 4 in pts with an altered conscious state who are unable to self admin oral glucose

172
Q

Dextrose contras

173
Q

Dextrose precautions

174
Q

Dextrose route of admin

175
Q

Dextrose side effects

176
Q

Dextrose notes

A

onset: 3m
duration: depends on severity of hypoglycaemic episode

GAP 2018 (13 decks)

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