Pharmacology* Flashcards
What are the pharmacological actions of Adrenaline?
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)
What are the C/I and Precautions of Adrenaline?
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
What are the side effects for Adrenaline?
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
What are onset times for Adrenaline?
IV: onset 30secs, peak 3-5mins, duration 5-10mins
IM: 30-90secs, peak 4-10mins, duration 5-10mins
What is the pharmacological action of Aspirin?
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
What are the C/I of Aspirin?
- Hypersensitivity to aspirin/salicylates
- Actively bleeding peptic ulcer
- Bleeding disorders
- Suspected dissecting aortic aneurysm
- Chest pain associated with psychostimulant OD if SBP >160
What are the precautions for Aspirin?
- Peptic ulcer
- Asthma (aspirin can induce asthma reaction)
- Pt on anticoagulants
What are the side effects for Aspirin?
Side effects:
1. Heartburn, nausea, GIT bleeding
2. Increased bleeding time
3. Hypersensitivity reactions
What are the C/I and Precautions for Ceftriaxone?
C/I: Allergy to Cephalosporin antibiotics
Prec: Allergy to Penicillin antibiotics
What are the side effects and preparation of Ceftriaxone?
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
What is the presentation and pharmacology of Dexamethasone?
Pres: 8mg in 2mL
Pharma: corticosteroid secreted by adrenal cortex - relieves inflammatory reactions and provides immunosuppression
What are the C/I and Precautions of Dexamethasone?
C/I: Known hypersensitivity
Prec: Solutions which are not clear or are contaminated should be discarded
What are the special notes and onset times for Dexamethasone?
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
Dextrose 10%:
- Pres
- Pharma
- Special notes
- 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
What is the presentation and pharmacology of Droperidol?
Presentation: 10mg in 2mL
Pharma: dopamine antagonist - antipsychotic medication with sedative effects
What are the C/I and Precautions of Droperidol?
C/I: Nil
Prec: 1. Elderly/frail more susceptible to adverse reactions
2. Parkinson’s disease
3. Lewy body dementia
4. Long QT
What are the adverse effects of Droperidol?
CNS: oversedation, dizziness
CVS: hypotension, tachycardia, QT prolongation
Extrapyramidal Sx
What’s the presentation and pharmacology of Fentanyl?
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
What are the onset times and pregnancy/breastfeeding notes for Droperidol?
Onset 3-10mins, peak sedation 20-30mins, duration 2-4hrs
Pregnancy/breastfeeding: only if benefits outweigh risk
What are the C/I and Precautions of Fentanyl?
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)
What are the side effects of Fentanyl?
1) Resp depression
2) Apnoea
3) Rigidity of diaphragm and IC muscles
4) Bradycardia
What are the onset times for IV and IN Fentanyl?
IV onset immediate, peak <5mins, duration 30-60mins
IN peak 2mins
Glucagon:
- Presentation
- Side effects
- Special notes incl onset times
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
Pharmacology of GTN
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
What are the C/I for GTN?
- BP < 100
- HR > 150
- HR < 50 (except in autonomic dysreflexia)
- Ventricular tachycardia
- PDE5 inhibitors (current/recent use) - -fil e.g. avanafil, sildenafil, vardenafil, tadalafil
- Riociguat (current use) - Rx pulmonary hypertension i.e. Adempas
What are the precautions for GTN?
- Lower doses in elderly, no previous exposure or recent MI
- Right ventricular MI or inferior STEMI with SBP < 160
- Preterm labour - concurrent use with other tocolytics (anti-contraction)
What are the side effects of GTN?
CV: hypotension, tachycardia, bradycardia
CNS: headache, dizziness, syncope
Other: skin flushing
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
What is the presentation and pharmacology of Hydrocortisone?
Presentation: 100mg powder
Pharma: corticosteroid with equal gluco and mineralocorticoid effects
Hydrocortisone special notes
IV doses delivered as slow push over 30secs
- 100mg reconstitued with 2mL NaCl or water
Ipratropium Bromide
- Presentation
- Pharmacology
- C/I
Presentation: 250mcg in 1mL
Pharmacology: Anticholinergic bronchodilator
C/I: Hypersensitivity to Atropine
What are the precautions for Ipratropium Bromide?
- Glaucoma
- Avoid contact with eyes
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)
What are the onset times for Ipratropium Bromide?
Onset 3-5mins
Peak 1.5-2hrs
Duration 6hrs
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
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
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
What are the onset times for Ketamine?
IN: Onset 5mins, Peak 20mins, Duration 45mins
IM: Onset 3-4mins, Duration 12-25mins
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
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
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
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
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.
Midazolam presentation and pharmacology?
Pres: 5mg in 1mL
Pharma: short acting CNS depressant - anxiolytic, sedative, anti-convulsant
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)
What are the side effects Midazolam?
HARD
1. Hypotension
2. Loss of Airway control
3. Respiratory depression
4. Depressed level of consciousness
What are the IM onset times of Midaz?
Onset 3-5mins
Peak 15mins
Duration 30mins
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
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
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
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
What is the presentation and pharmacology of Naloxone?
Pres - 0.4mg in 1mL
Pharma - opioid antagonist - prevents/reverses the effects of opioids
What is the C/I and precautions of Naloxone?
C/I: Nil
Precautions: 1. expect a combative pt 2. Neonates
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
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
What is the presentation and pharmacology of Olanzapine?
5mg ODT - atypical antipsychotic: antagonist at multiple receptor sites (serotonin, dopamine, histamine)
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
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
What are onset times of Olanzapine?
Onset 15mins
Duration 12-24hrs
What are the C/I of Ondansetron?
- Apomorphine
What are the precautions of Ondansetron?
- Pt with liver disease (e.g. cirrhosis) should not receive more than 8mg of Ondansetron/day
- Pregnancy 1st trimester - consult with receiving hospital
- Contains aspartame, so don’t give to pt with PKU
- Long QT
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)
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
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
What are the C/I and Precautions of Oxytocin?
C/I: Nil - provided all babies have been delivered
Prec: Nil
What are the adverse effects of Oxytocin?
GI: N/V
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
What are the side effects of Paracetamol?
- Hypersensitivity reactions including severe skin rashes (rare)
- Haematological reactions (rare)
- Hypotension reported with IV infusion, particularly in critically unwell pt
What is the mode of action of Prochlorperazine?
Dopamine antagonist - antiemetic effects primarily due to D2 receptor blockade
What are the C/I of Prochlorperazine?
- CNS depression (unconscious or severely intoxicated) 2. <21yrs (children more susceptible to extrapyramidal reactions)
What are the precautions of Prochlorperazine?
- Elderly pt
- Parkinson’s disease - avoid if possible
What are the side effects of Prochlorperazine?
CNS: sedation, blurred vision
CV: postural hypotension, QT prolongation (rare)
Other: extrapyramidal reactions
What are the onset times of Prochlorperazine?
Onset 10-20mins
Duration 3-4hrs
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
What are the side effects of Salbutamol?
- Sinus tachycardia
- Muscle tremor (common)
What are the onset times of Salbutamol?
Onset 5-15mins
Duration 15-50mins
