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**CPGs 2020 > Pharmacology* > Flashcards

Pharmacology* Flashcards

1
Q

What are the pharmacological actions of Adrenaline?

A

A naturally occurring beta and alpha adrenergic stimulant
1. Increases HR by increasing SA node firing rate (B1)
2. Increases conduction velocity through AV node (B1)
3. Increases myocardial contractility (B1)
4. Increases irritability of ventricles (Beta 1)
5. Causes bronchodilatation (B2)
6. Causes peripheral vasoconstriction (Alpha)

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2
Q

What are the C/I and Precautions of Adrenaline?

A

C/I: Hypovolaemic shock without adequate fluid replacement
Precautions: Consider reduced doses for:
1. Elderly/frail
2. Pt with cardiovascular disease
3. Pt on monoamine oxidase inhibitors
4. Higher doses may be required for pt on beta blockers

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3
Q

What are the side effects for Adrenaline?

A

Side effects:
1) sinus tachycardia
2) supraventricular arrhythmias
3) ventricular arrhythmias
4) hypertension
5) pupillary dilatation
6) may increase size of MI
7) feeling of anxiety/palpitations in conscious pt

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4
Q

What are onset times for Adrenaline?

A

IV: onset 30secs, peak 3-5mins, duration 5-10mins
IM: 30-90secs, peak 4-10mins, duration 5-10mins

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5
Q

What is the pharmacological action of Aspirin?

A

Analgesic, anti-pyretic, anti-inflammatory and anti-platelet aggregation agent
- minimise platelet aggregation and thrombus formation in order to retard progress of coronary artery thrombosis
- Inhibits synthesis of prostaglandins - anti-inflammatory actions

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6
Q

What are the C/I of Aspirin?

A
  1. Hypersensitivity to aspirin/salicylates
  2. Actively bleeding peptic ulcer
  3. Bleeding disorders
  4. Suspected dissecting aortic aneurysm
  5. Chest pain associated with psychostimulant OD if SBP >160
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7
Q

What are the precautions for Aspirin?

A
  1. Peptic ulcer
  2. Asthma (aspirin can induce asthma reaction)
  3. Pt on anticoagulants
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8
Q

What are the side effects for Aspirin?

A

Side effects:
1. Heartburn, nausea, GIT bleeding
2. Increased bleeding time
3. Hypersensitivity reactions

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9
Q

What are the C/I and Precautions for Ceftriaxone?

A

C/I: Allergy to Cephalosporin antibiotics
Prec: Allergy to Penicillin antibiotics

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10
Q

What are the side effects and preparation of Ceftriaxone?

A

Side effects: N/V, skin rash
Special notes: IV made to 10mL with sterile water administered over 2mins, IM made up to 4mL with 1% Lignocaine

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11
Q

What is the presentation and pharmacology of Dexamethasone?

A

Pres: 8mg in 2mL
Pharma: corticosteroid secreted by adrenal cortex - relieves inflammatory reactions and provides immunosuppression

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12
Q

What are the C/I and Precautions of Dexamethasone?

A

C/I: Known hypersensitivity
Prec: Solutions which are not clear or are contaminated should be discarded

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13
Q

What are the special notes and onset times for Dexamethasone?

A

Admin IV admin over 1-3mins
IV onset 30-60mins, peak 2hrs, duration 36-72hrs

Doesn’t contain antimicrobial agent, so should be used immediately and discarded

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14
Q

Dextrose 10%:
- Pres
- Pharma
- Special notes

A
  • Pres: 25g in 250mL
  • Pharma: slightly hypertonic crystalloid solution - composed of sugar 10% dextrose and water
  • Special notes: onset 3mins, duration depends on severity of hypoglycaemic episode
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15
Q

What is the presentation and pharmacology of Droperidol?

A

Presentation: 10mg in 2mL
Pharma: dopamine antagonist - antipsychotic medication with sedative effects

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16
Q

What are the C/I and Precautions of Droperidol?

A

C/I: Nil
Prec: 1. Elderly/frail more susceptible to adverse reactions
2. Parkinson’s disease
3. Lewy body dementia
4. Long QT

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17
Q

What are the adverse effects of Droperidol?

A

CNS: oversedation, dizziness
CVS: hypotension, tachycardia, QT prolongation
Extrapyramidal Sx

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18
Q

What’s the presentation and pharmacology of Fentanyl?

A

Pres: 100mcg in 2mL or 250mcg in 1mL IN
Pharm: synthetic opioid analgesis
Actions:
CNS: depression, resp depression, dependence
CV: decrease conduction velocity through AV node

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19
Q

What are the onset times and pregnancy/breastfeeding notes for Droperidol?

A

Onset 3-10mins, peak sedation 20-30mins, duration 2-4hrs

Pregnancy/breastfeeding: only if benefits outweigh risk

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20
Q

What are the C/I and Precautions of Fentanyl?

A

C/I: 1. Hypersensitivity 2. Late second stage of labour

Prec: A HARMER (fentanyl can be a harmer)
1) Current Asthma
2) Impaired Hepatic function
3) Known Addiction to opioids
4) Resp depression eg COPD
5) Pt on MAO inhibitors
6) Elderly/frail
7) Rhinitis, rhinorrhoea or facial trauma (IN route)

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21
Q

What are the side effects of Fentanyl?

A

1) Resp depression
2) Apnoea
3) Rigidity of diaphragm and IC muscles
4) Bradycardia

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22
Q

What are the onset times for IV and IN Fentanyl?

A

IV onset immediate, peak <5mins, duration 30-60mins
IN peak 2mins

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23
Q

Glucagon:
- Presentation
- Side effects
- Special notes incl onset times

A

Presentation: 1mg (IU) in 1mL
Side effects: N/V (rare)
Special notes: pt with inadequate glycogen stores in liver may not respond to it e.g. alcoholics and malnourished
Onset 5mins, duration 25mins

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24
Q

Pharmacology of GTN

A

Vascular smooth muscle relaxant.
1) Venous dilatation - reduces preload - promotes venous pooling
2) Arterial dilatation - reduces afterload - reduces systemic vascular resistance
Above leads to: reduce myocardial O2 demand, reduce BP while maintaining coronary perfusion pressure, mild collateral coronary artery dilatation may improve blood supply to ischaemic areas of myocardium, mild tachycardia secondary to drop in BP, uterine quiescence

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25
What are the C/I for GTN?
1. BP < 100 2. HR > 150 3. HR < 50 (except in autonomic dysreflexia) 4. Ventricular tachycardia 5. PDE5 inhibitors (current/recent use) - -fil e.g. avanafil, sildenafil, vardenafil, tadalafil 6. Riociguat (current use) - Rx pulmonary hypertension i.e. Adempas
26
What are the precautions for GTN?
1. Lower doses in elderly, no previous exposure or recent MI 2. Right ventricular MI or inferior STEMI with SBP < 160 3. Preterm labour - concurrent use with other tocolytics (anti-contraction)
27
What are the side effects of GTN?
CV: hypotension, tachycardia, bradycardia CNS: headache, dizziness, syncope Other: skin flushing
28
What are the onset times of GTN?
SL: onset 1-3mins, peak 5, at least 25mins Transdermal: onset up to 30mins, peak 2hrs, duration continually releases until removed
29
What is the presentation and pharmacology of Hydrocortisone?
Presentation: 100mg powder Pharma: corticosteroid with equal gluco and mineralocorticoid effects
30
Hydrocortisone special notes
IV doses delivered as slow push over 30secs - 100mg reconstitued with 2mL NaCl or water
31
Ipratropium Bromide - Presentation - Pharmacology - C/I
Presentation: 250mcg in 1mL Pharmacology: Anticholinergic bronchodilator C/I: Hypersensitivity to Atropine
32
What are the precautions for Ipratropium Bromide?
1. Glaucoma 2. Avoid contact with eyes
33
What are the side effects of Ipratropium Bromide?
1) Headache 2) Nausea 3) Dry mouth 4) Skin rash 5) Tachycardia (rare) 6) Palpitations (rare) 7) Acute angle closure glaucoma secondary to direct eye contact (rare)
34
What are the onset times for Ipratropium Bromide?
Onset 3-5mins Peak 1.5-2hrs Duration 6hrs
35
What is the mode of action of Ketamine?
Anaesthetic agent with analgesic properties at lower doses Primarily works as antagonist at NMDA - trance like dissociative state with amnesia, preserving laryngeal and pharyngeal reflexes
36
What is the presentation, C/I and precaution of Ketamine?
Presentation: 200mg in 2mL C/I: suspected non-traumatic brain injury with SBP>180 Prec: may exacerbate cardiovascular conditions due to effects on HR and BP
37
What are the adverse effects of Ketamine?
1) CV: HTN, tachycardia 2) CNS: emergence reactions, increased skeletal muscle tone 3) Respiratory: transient resp depression and apnoea 4) GI: N/V 5) Other: Injection site pain, lacrimation, hyper-salivation, diplopia, nystagmus
38
What are the onset times for Ketamine?
IN: Onset 5mins, Peak 20mins, Duration 45mins IM: Onset 3-4mins, Duration 12-25mins
39
What is the presentation and mode of action of Lidocaine?
50mg in 5mL Pharmacology: sodium channel blocker - interrupts impulse conduction in peripheral nerves and stabilises excitable cell membranes
40
What are the C/I and precautions for Lignocaine?
C/I: hypersensitivity to lidocaine or related local anaesthetics Prec: IM and local infiltration: inadvertent intravascular admin may result in systemic toxicity
41
What are the adverse effects of Lidocaine?
Allergic reactions (rare) - localised oedema, urticaria, bronchospasm, anaphylaxis Systemic toxicity s/s: CNS: tinnitus, blurred vision, change in CS, agitation, convulsions CV: hypotension, bradycardia, arrhythmias, cardiac arrest
42
What are the C/I and precautions for Methoxy?
C/I: 1. Renal disease/impairment (doesn't include kidney stones/renal colic) 2. Hx or fam hx of malignant hyperthermia Prec: 1. Pt not administered >6mL in 24hrs due to risk of nephrotoxicity 2. Limit occupation exposure by not administering in confined space
43
What are the side effects and special notes for Methoxy?
Side effects: CNS: dizziness, drowsiness CV: hypotension GIT: N/V Special notes: 3mL provide about 25mins analgesia , commences after 6-10 breaths. Effects last 3-5mins after stopping inhalation.
44
Midazolam presentation and pharmacology?
Pres: 5mg in 1mL Pharma: short acting CNS depressant - anxiolytic, sedative, anti-convulsant
45
Midazolam C/I and Prec?
C/I: hypersensitivity to benzos Prec: 1. Reduced dose for elderly/frail, renal failure, CCF or shock 2. CNS depressant effects enhanced in presence of other narcotics and tranquillisers including alcohol 3. Can cause resp depression in COPD 4. Pt with myasthenia gravis (neuromuscular disease: weakness and rapid fatigue of muscles under voluntary control)
46
What are the side effects Midazolam?
HARD 1. Hypotension 2. Loss of Airway control 3. Respiratory depression 4. Depressed level of consciousness
47
What are the IM onset times of Midaz?
Onset 3-5mins Peak 15mins Duration 30mins
48
What is the pharmacology of Morphine?
Opioid analgesic CNS effects: 1. Depression 2. Respiratory depression 3. Depression of cough reflex 4. Stimulation 5. Dependence CVS: 1. Vasodilation 2. Decrease conduction velocity through AV node
49
Morphine C/I and precautions?
C/I: 1. hypersensitivity 2. renal impairment/failure 3. late second stage of labour Prec: A CHARMER 1. Addiction to opioids (known) 2. Current asthma 3. Hypotension 4. Acute alcoholism 5. Respiratory depression 6. MAO inhibitors 7. Elderly/frail 8. Respiratory tract burns
50
Morphine side effects
CNS: PANDER 1. Pin point pupils 2. Addiction 3. N/V 4. Drowsiness 5. Euphoria 6. Respiratory depression CVS: 7. Hypotension 8. Bradycardia
51
Onset times for IV and IM Morphine
IV: onset 2-5mins, peak 10mins, duration 1-2hours IM: onset 10-30mins, peak 30-60mins, duration 1-2hours
52
What is the presentation and pharmacology of Naloxone?
Pres - 0.4mg in 1mL Pharma - opioid antagonist - prevents/reverses the effects of opioids
53
What is the C/I and precautions of Naloxone?
C/I: Nil Precautions: 1. expect a combative pt 2. Neonates
54
What are the side effects of Naloxone?
Sx of opioid withdrawal: 1. Sweating, goose flesh, tremor 2. N/V 3. Agitation 4. Dilation of pupils, excessive lacrimation 5. Convulsions
55
What are the special notes and onset times for Naloxone?
Naloxone should not be administered following opioid associated cardiac arrest or following head injury. IV/IM: onset 1-3mins, duration 30-45mins
56
What is the presentation and pharmacology of Olanzapine?
5mg ODT - atypical antipsychotic: antagonist at multiple receptor sites (serotonin, dopamine, histamine)
57
What are the C/I and precautions of Olanzapine?
C/I: nil Precautions: 1. Less effective if agitation due to drug intoxication or alcohol withdrawal 2. Elderly/frail and children are more susceptible to side effects
58
What are the significant interactions and adverse effects of Olanzapine?
Interactions: sedative medications and alcohol Adverse effects: 1. CNS - sedation, dizziness 2. Other - extrapyramidal sx and QT prolongation unlikely at approved doses
59
What are onset times of Olanzapine?
Onset 15mins Duration 12-24hrs
60
What are the C/I of Ondansetron?
1. Apomorphine
61
What are the precautions of Ondansetron?
1. Pt with liver disease (e.g. cirrhosis) should not receive more than 8mg of Ondansetron/day 2. Pregnancy 1st trimester - consult with receiving hospital 3. Contains aspartame, so don't give to pt with PKU 4. Long QT
62
What are the adverse effects of Ondansetron?
CNS: headache, dizziness CV: QT prolongation (rare) GI: Constipation Other: visual disturbance (incl. transient loss of vision rare-rapid IV admin)
63
What are the onset times of Ondansetron? And special notes IV?
Peak: 10mins IV/IM, 30mins Oral Duration: several hours IV slow injection over AT LEAST 30secs. Can use IM if other routes unsuitable
64
What is the presentation and pharmacology of Oxytocin?
Pres: 10 units (IU) in 1mL Pharma: synthetic pituitary hormone - stimulates smooth muscle of the uterus producing contractions
65
What are the C/I and Precautions of Oxytocin?
C/I: Nil - provided all babies have been delivered Prec: Nil
66
What are the adverse effects of Oxytocin?
GI: N/V
67
What are the C/I and precautions of Paracetamol?
C/I: Children <1month Precautions: 1. Hepatotoxicity can occur with overdose - Increased risk: impaired hepatic function, elderly/frail, malnourishment
68
What are the side effects of Paracetamol?
1. Hypersensitivity reactions including severe skin rashes (rare) 2. Haematological reactions (rare) 3. Hypotension reported with IV infusion, particularly in critically unwell pt
69
What is the mode of action of Prochlorperazine?
Dopamine antagonist - antiemetic effects primarily due to D2 receptor blockade
70
What are the C/I of Prochlorperazine?
1. CNS depression (unconscious or severely intoxicated) 2. <21yrs (children more susceptible to extrapyramidal reactions)
71
What are the precautions of Prochlorperazine?
1. Elderly pt 2. Parkinson's disease - avoid if possible
72
What are the side effects of Prochlorperazine?
CNS: sedation, blurred vision CV: postural hypotension, QT prolongation (rare) Other: extrapyramidal reactions
73
What are the onset times of Prochlorperazine?
Onset 10-20mins Duration 3-4hrs
74
What is the pharmacology, C/I and precaution of Salbutamol?
Pharma: synthetic beta adrenergic stimulant, primarily beta 2 effects C/I: Nil Precautions: large doses can cause intracellular metabolic acidosis
75
What are the side effects of Salbutamol?
1. Sinus tachycardia 2. Muscle tremor (common)
76
What are the onset times of Salbutamol?
Onset 5-15mins Duration 15-50mins

**CPGs 2020 (19 decks)

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