Pharmacology Flashcards
Adrenaline Presentation
1mg in 1ml
1mg in 10ml
Adrenaline Pharmacology
A naturally occurring alpha and beta adrenergic stimulant
Actions:
- Increases HR by increasing SA node firing rate (Beta 1)
- Increases conduction velocity through the AV node (Beta 1)
- Increases myocardial contractility (Beta 1)
- Increases the irritability of the ventricles (Beta 1)
- Causes bronchodilation (Beta 2)
- Causes peripheral vasoconstriction (Alpha)
Adrenaline Metabolism
By monoamine oxidase and other enzymes in the blood, liver and around nerve endings; excreted by the kidneys
Adrenaline Primary Emergency Indications
- Cardiac arrest- VF/VT, Asystole or PEA
- Inadequate perfusion (cardiogenic or non- cardiogenic/ non hypovolaemic)
- Bradycardia with poor perfusion
- Anaphylaxis
- Severe Asthma- imminent life threat not responding to nebulised therapy or unconscious with no BP
- Croup
Adrenaline Contraindications
- Hypovolaemic shock without adequate fluid replacement
Adrenaline Precautions
Consider reduced doses for:
- Elderly/ frail pts
- Pts with cardiovascular disease
- Pts on monoamine oxidase inhibitors
- Higher doses may be required for pts on beta blockers
Adrenaline Route of admin
IV, IM, ETT, Nebulised, IV infusion, IO
Adrenaline Side Effects
Sinus tachycardia Supraventricular Arrhtymias Ventricular Arrhythmias Hypertension Pupillary dilation May increase size of MI Feeling of anxiety/ palpitations in the conscious pt
Adrenaline IV effects
Onset: 30 seconds
Peak: 3-5 Mins
Duration: 5-10 mins
Adrenaline IM effects
Onset: 30-90 seconds
Peak: 4-10 mins
Duration: 5-10 mins
Aspirin Presentation
300mg chewable tablets
300mg soluble or water dispersible tablets
Aspirin Pharmacology
An analgesic, antipyretic, anti inflammatory and antiplatelet aggregation agent
Actions:
- To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS
- Inhibits synthesis of prostaglandins - anti inflammatory actions
Aspirin Metabolism
Converted to salicylate in the gut mucosa and liver; excreted mainly by the kidneys
Aspirin Primary Emergency Indications
ACS
Aspirin Contraindications
- Hypersensitivity to aspirin/ salicylates
- Actively bleeding peptic ulcers
- Bleeding disorders
- Suspected dissecting aortic aneurysm
- Chest pain associated with psychostimulant OD if SBP > 160
Aspirin Precautions
- Peptic Ulcer
- Asthma
- Pts on anticoagulants
Aspirin route of admin
Oral
Aspirin Side effects
Heartburn, nausea, GI bleeding
Increased bleeding time
Hypersensitivity reactions
Aspirin Special notes
Onset: N/A
Peak: N/A
Duration: 8-10days
Ceftriaxone Presentation
1g sterile powder
Ceftriaxone Pharmacology
Cephalosporin anti biotic
Ceftriaxone Metabolism
Excreted unchanged in urine and in bile
Ceftriaxone Primary Emergency Indications
- Suspected meningococcal septicaemia
2. Severe Sepsis (consult only)
Ceftriaxone Contraindications
- Allergy to Cephalosporin antibiotics
Ceftriaxone Precautions
- Allergy to penicillin anti biotics
Ceftriaxone Route of admin
IV (preferred)
IM
Ceftriaxone Side Effects
Nausea
Vomiting
Skin Rash
Ceftriaxone Special Notes
IV- must be made up to 10ml, using sterile water. administered over 2 mins
IM- must be made up to 4ml, using 1% Lignocaine and dose administered into upper lateral thigh
Ceftriaxone IM/IV effects
Onset: n/a
Peak: n/a
Duration: n/a
Dextrose 10% Presentation
25g in 250ml infusion soft pack
Dextrose 10% Pharmacology
A slightly hypertonic crystalloid solution Composition: - Sugar 10% - Water Actions: - Provides a source of energy - Supplies body water
Dextrose 10% Metabolism
Dextrose: - Broken down in most tissues - Stored in liver and muscle as glycogen Water: - Excreted by the kidneys - Distributed throughout total body water, mainly in extracellular fluid compartment
Dextrose 10% Primary Emergency Indications
- Diabetic hypoglycaemia (BGL < 4) in pts with an altered conscious state who are unable to self- administer oral glucose
Dextrose 10% Contraindications
- Nil
Dextrose 10% Precautions
Nil
Dextrose 10% Route of Admin
IV infusion
Dextrose 10% Side Effects
Nil
Dextrose 10% IV Effects (Special Notes)
Onset: 3 mins
Peak: n/a
Duration: Depends on severity of hypoglycaemic episode
Fentanyl Presentation
100mcg in 2ml
200mcg in 1ml (IN only)
Fentanyl Pharmacology
A synthetic opioid analgesic
CNS Effects:
- Depression- leading to analgesia
- Respiratory depression- leading to apnoea
- Dependance (addiction)
Cardiovascular effects:
- Decreases conduction velocity through the AV node
Fentanyl Metabolism
By the liver; excreted by the kidneys
Fentanyl Primary Emergency Indications
- Sedation to facilitate intubation
- Sedation to maintain intubation
- Analgesia IV/IN
- History of hypersensitivity or allergy to morphine
- Known renal impairment/ failure
- Short duration of action desirable
- Hypotension
- Nausea and/ or vomiting
- Severe headache
Fentanyl Contraindications
- History of hypersensitivity
2. Late second stage of labour
Fentanyl Precautions
- Eldery/ frail pts
- Impaired hepatic function
- Respiratory depression e.g. COPD
- Current asthma
- Pts on monoamine oxidase inhibitors
- Known addiction to opioids
- Rhintis, rhinorrhea or facial trauma (IN route only)
Fentanyl Route of admin
IV, IN, IV infusion
Fentanyl Side Effects
Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles
Bradycardia
Fentanyl- 100mcg is equivalent to ? Morphine
10mg
Fentanyl IV effects
Onset: immediate
Peak: <5 mins
Duration: 30-60 mins
Fentanyl IN effects
Peak: 2 mins
Glucagon Presentation
1mg (IU) in 1ml hypokit
Glucagon Pharmacology
A hormone normally excreted by the pancreas
Actions:
- Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose
Glucagon Metabolism
Mainly by the liver, also by the kidneys and in the plasma
Glucagon Primary Emergency Indications
- Diabetic hypoglycaemia (BGL < 4) in pts with an altered conscious state who are unable to self administer oral glucose
Glucagon Contraindications
Nil
Glucagon Precautions
Nil
Glucagon Route of admin
IM
Glucagon Side Effects
Nausea and vomiting
Glucagon IM effects
Onset: 5 mins
Peak: n/a
Duration: 25 mins
GTN Presentation
0.6mg tablets
Transdermal GTN patch (50mg 0.4mg/hr)
GTN Pharmacology
A vascular smooth muscle relaxant
Actions:
- Venous dilation promotes venous pooling and reduces venous return to the heart (reduces preload)
- Arterial dilation reduces systemic vascular resistance and arterial pressure (reduces after load)
Effects of above are:
- Reduced myocardial 02 demand
- Reduced systolic, diastolic and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure
- Mild collateral coronary artery dilatation may improve blood supply to ischaemic areas of myocardium
- Mild tachycardia secondary to slight fall in blood pressure
- Preterm labour: Uterine quiescence in pregnancy
GTN Metabolism
By the liver
GTN Primary Emergency Indication
- Chest pain with ACS
- Acute LVF
- Hypertension associated with ACS
- Autonomic dysreflexia
- Preterm Labour (consult only)