Pharmacology Flashcards
1
Q
Adrenaline Presentation
A
1mg in 1ml
1mg in 10ml
2
Q
Adrenaline Pharmacology
A
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)
3
Q
Adrenaline Metabolism
A
By monoamine oxidase and other enzymes in the blood, liver and around nerve endings; excreted by the kidneys
4
Q
Adrenaline Primary Emergency Indications
A
- 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
5
Q
Adrenaline Contraindications
A
- Hypovolaemic shock without adequate fluid replacement
6
Q
Adrenaline Precautions
A
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
7
Q
Adrenaline Route of admin
A
IV, IM, ETT, Nebulised, IV infusion, IO
8
Q
Adrenaline Side Effects
A
Sinus tachycardia Supraventricular Arrhtymias Ventricular Arrhythmias Hypertension Pupillary dilation May increase size of MI Feeling of anxiety/ palpitations in the conscious pt
9
Q
Adrenaline IV effects
A
Onset: 30 seconds
Peak: 3-5 Mins
Duration: 5-10 mins
10
Q
Adrenaline IM effects
A
Onset: 30-90 seconds
Peak: 4-10 mins
Duration: 5-10 mins
11
Q
Aspirin Presentation
A
300mg chewable tablets
300mg soluble or water dispersible tablets
12
Q
Aspirin Pharmacology
A
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
13
Q
Aspirin Metabolism
A
Converted to salicylate in the gut mucosa and liver; excreted mainly by the kidneys
14
Q
Aspirin Primary Emergency Indications
A
ACS
15
Q
Aspirin Contraindications
A
- Hypersensitivity to aspirin/ salicylates
- Actively bleeding peptic ulcers
- Bleeding disorders
- Suspected dissecting aortic aneurysm
- Chest pain associated with psychostimulant OD if SBP > 160
16
Q
Aspirin Precautions
A
- Peptic Ulcer
- Asthma
- Pts on anticoagulants
17
Q
Aspirin route of admin
A
Oral
18
Q
Aspirin Side effects
A
Heartburn, nausea, GI bleeding
Increased bleeding time
Hypersensitivity reactions
19
Q
Aspirin Special notes
A
Onset: N/A
Peak: N/A
Duration: 8-10days
20
Q
Ceftriaxone Presentation
A
1g sterile powder
21
Q
Ceftriaxone Pharmacology
A
Cephalosporin anti biotic
22
Q
Ceftriaxone Metabolism
A
Excreted unchanged in urine and in bile
23
Q
Ceftriaxone Primary Emergency Indications
A
- Suspected meningococcal septicaemia
2. Severe Sepsis (consult only)
24
Q
Ceftriaxone Contraindications
A
- Allergy to Cephalosporin antibiotics
25
Ceftriaxone Precautions
1. Allergy to penicillin anti biotics
26
Ceftriaxone Route of admin
IV (preferred)
| IM
27
Ceftriaxone Side Effects
Nausea
Vomiting
Skin Rash
28
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
29
Ceftriaxone IM/IV effects
Onset: n/a
Peak: n/a
Duration: n/a
30
Dextrose 10% Presentation
25g in 250ml infusion soft pack
31
Dextrose 10% Pharmacology
```
A slightly hypertonic crystalloid solution
Composition:
- Sugar 10%
- Water
Actions:
- Provides a source of energy
- Supplies body water
```
32
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
```
33
Dextrose 10% Primary Emergency Indications
1. Diabetic hypoglycaemia (BGL < 4) in pts with an altered conscious state who are unable to self- administer oral glucose
34
Dextrose 10% Contraindications
1. Nil
35
Dextrose 10% Precautions
Nil
36
Dextrose 10% Route of Admin
IV infusion
37
Dextrose 10% Side Effects
Nil
38
Dextrose 10% IV Effects (Special Notes)
Onset: 3 mins
Peak: n/a
Duration: Depends on severity of hypoglycaemic episode
39
Fentanyl Presentation
100mcg in 2ml
| 200mcg in 1ml (IN only)
40
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
41
Fentanyl Metabolism
By the liver; excreted by the kidneys
42
Fentanyl Primary Emergency Indications
1. Sedation to facilitate intubation
2. Sedation to maintain intubation
3. 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
43
Fentanyl Contraindications
1. History of hypersensitivity
| 2. Late second stage of labour
44
Fentanyl Precautions
1. Eldery/ frail pts
2. Impaired hepatic function
3. Respiratory depression e.g. COPD
4. Current asthma
5. Pts on monoamine oxidase inhibitors
6. Known addiction to opioids
7. Rhintis, rhinorrhea or facial trauma (IN route only)
45
Fentanyl Route of admin
IV, IN, IV infusion
46
Fentanyl Side Effects
Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles
Bradycardia
47
Fentanyl- 100mcg is equivalent to ? Morphine
10mg
48
Fentanyl IV effects
Onset: immediate
Peak: <5 mins
Duration: 30-60 mins
49
Fentanyl IN effects
Peak: 2 mins
50
Glucagon Presentation
1mg (IU) in 1ml hypokit
51
Glucagon Pharmacology
A hormone normally excreted by the pancreas
Actions:
- Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose
52
Glucagon Metabolism
Mainly by the liver, also by the kidneys and in the plasma
53
Glucagon Primary Emergency Indications
1. Diabetic hypoglycaemia (BGL < 4) in pts with an altered conscious state who are unable to self administer oral glucose
54
Glucagon Contraindications
Nil
55
Glucagon Precautions
Nil
56
Glucagon Route of admin
IM
57
Glucagon Side Effects
Nausea and vomiting
58
Glucagon IM effects
Onset: 5 mins
Peak: n/a
Duration: 25 mins
59
GTN Presentation
0.6mg tablets
| Transdermal GTN patch (50mg 0.4mg/hr)
60
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
61
GTN Metabolism
By the liver
62
GTN Primary Emergency Indication
1. Chest pain with ACS
2. Acute LVF
3. Hypertension associated with ACS
4. Autonomic dysreflexia
5. Preterm Labour (consult only)
63
GTN Contraindications
1. Known hypersensitivity
2. Systolic BP <110 tablet
3. Systolic BP<90 patch
4. Viagra or Levitra administration in the previous 24hr or Cialis administration in the last 4 days
5. Heart rate >150
6. Heart rate <50 (excl. autonomic dysreflexia)
7. VT
8. Inferior STEMI with systolic BP <160
9. Right ventricular MI
64
GTN Precautions
1. No previous admin
2. Elderly pts
3. Recent Mi
4. Concurrent use with other tocolytics
65
GTN Route of admin
SL, buccal, transdermal, infusion (interhospital transfers only)
66
GTN Side Effects
```
Tachycardia
Hypotension
Headache
Skin Flushing
Bradycardia
```
67
GTN S/L effects
Onset: 30s-2mins
Peak: 5-10mins
Duration: 15-30mins
68
GTN Transdermal effect
Onset: up to 30 mins
Peak: 2 hours
69
Ipratropium Bromide Presentation
250mcg in 1ml
70
Ipratropium Bromide Pharmacology
Anti cholinergic bronchodilator
Actions:
- Allows bronchodilation by inhibiting cholinergic bronchomotor tone (i.e. blocks vagal reflexes which mediate bronchoconstriction)
71
Ipratropium Bromide Metabolism
Excreted by the kidneys
72
Ipratropium Bromide Primary Emergency Indications
1. Severe respiratory distress associated with bronchospasm
| 2. Exacerbation of COPD irrespective of severity
73
Ipratropium Bromide Contraindications
1. Known hypersensitivity to atropine or its derivatives
74
Ipratropium Bromide Precautions
1. Glaucoma
| 2. Avoid contact with the eyes
75
Ipratropium Bromide Route of admin
Nebulised (in conjunction with salbutamol)
76
Ipratropium Bromide Side Effects (HANDSPT)
```
Headache
Acute angle closure glaucoma secondary to direct eye contact (rare)
Nausea
Dry Mouth
Skin Rash
Palpitations (rare)
Tachycardia (rare)
```
77
Ipratropium Bromide Special notes
Onset: 3-5 mins
Peak: 1.5-2 hrs
Duration: 6 hours
78
Ketamine Prensentation
200mg in 2ml
79
Ketamine Pharmacology
A rapid acting dissociative anaestethic agent (primarily an NMDA receptor antagonist)
Actions:
- Produces a dissociative state characterised by:
- a trance- like state with eyes open but not responsive
- nystagmus
- profound analgesia
- normal pharyngeal and laryngeal reflexes
- normal or slightly enhanced skeletal muscle tone
- occasionally a transient and minimal respiratory depression
80
Ketamine Metabolism
By the liver and excreted by kidneys
81
Ketamine Primary Emergency Indications
1. Rapid sequence intubation
2. Extreme traumatic pain refractory to opioid analgesia
3. Extreme agitation
82
Ketamine Contraindications
1. Known hypersensitivity
| 2. Severe hypertension (SBP>180)
83
Ketamine Precautions
1. Any condition where significant elevation of BP would be hazardous eg. - Hypertension, CVA, Recent AMI, CCg
2. If being administered for analgesia, inject slowly over 1min to minimise risk of respiratory depression and hypertension
84
Ketamine Route of admin
IV, IO, IM
85
Ketamine Side Effects
```
Cardiovascular:
Increase in HR and BP
CNS:
Respiratory depression and apnoea
Emergence reactions (nightmares, restlessness, vivid dreams, confusion, hallucinations, irrational behaviour)
Enhanced skeletal tone
Nausea and vomiting
Other:
Diplopia and nystagmus with slight increase in intraocular pressure
Other:
Local pain at injection site
Lacrimation
Salivation
```
86
Ketamine IV Effects
Onset: 30s
Peak: n/a
Duration: 10mins
87
Ketamine IM Effects
Onset: 3-4mins
Peak: n/a
Duration: 12-25mins
88
Methoxyflurane Presentation
3ml glass bottle
89
Methoxyflurane Pharmacology
Inhalational analgesic agent at low concentrations
90
Methoxyflurane Metabolism
Excreted mainly by the lungs
| By the Liver
91
Methoxyflurane Primary Emergency Indications
1. Pain Relief
92
Methoxyflurane Contraindications
1. Pre existing renal disease/ renal impairment
2. Concurrent use of tetracycline antibiotics
3. Exceeding total dose of 6ml in 24hr period
4. Personal or family history of malignant hyperthermia
5. Muscular dystrophy
93
Methoxyflurane Precautions
1. Penthorx inhaler must be hand held
2. Pre eclampsia
3. Concurrent use with oxytocin may cause hypotension
94
Methoxyflurane Route of admin
Self administration under supervision
95
Methoxyflurane Side Effects
Drowsiness
Decrease in blood pressure and bradycardia
Exceeding max dose of 6ml in 24hr period may lead to renal toxicity
96
Methoxyflurane Analgesia effects
Commences after:
8-10 breaths
Lasts for:
approx. 3-5mins
97
Midazolam Presentation
5mg in 1ml
| 15mg in 3ml
98
Midazolam Pharmacology
```
Short acting CNS depressant
Actions:
- Anxiolytic
- Sedative
- Anti convulsant
```
99
Midazolam Metabolism
In the liver; excreted by the kidneys
100
Midazolam Primary Emergency Indications
1. Status epilepticus
2. Sedation to enable intubation (RSI/IFS)
3. Post intubation sedation
4. Sedation to enable synchronized cardioversion
5. Sedation in the agitated pt
6. Sedation in psychostimulant OD
101
Midazolam Contraindications
1. Known hypersensitivity to benzodiazepines
102
Midazolam Precautions
1. Reduced doses may be required for elderly/ frail, pts with chronic renal failure, CCF or shock
2. The CNS effects are enhanced in the presence of narcotics and other tranquillisers incl. alcohol
3. Can cause severe respiratory depression in pts with COPD
4. Pts with myasthenia gravis
103
Midazolam Route of admin
IM, IV, IV infusion
104
Midazolam Side Effects
Depressed level of consciousness
Respiratory depression
Loss of airway control
Hypotension
105
Midazolam IM Effects
Onset: 3-5mins
Peak: 15mins
Duration: 30mins
106
Midazolam IV Effects
Onset: 1-3mins
Peak: 10mins
Duration: 20mins
107
Morphine Presentation
10mg in 1ml
108
Morphine Pharmacology
```
An opioid analgesic
Actions:
CNS effects:
- Depression (leading to analgesia)
- Respiratory depression
- Depression of cough reflex
- Stimulation (changes of mood, euphoria or dysphoria, vomiting, pin- point pupils)
- Dependance (addiction)
Cardiovascular effects:
- Vasodilation
- Decreases conduction velocity through the AV node
```
109
Morphine Metabolism
By the liver; excreted by the kidneys
110
Morphine Primary Emergency Indications
1. Pain relief
2. Acute LVF with shortness of breath and full field crackles
3. Sedation to maintain intubation
4. Sedation to enable intubation
5. RSI
111
Morphine Contraindications
1. History of hypersensitivity
2. Renal impairment/ failure
3. Late second stage labour
112
Morphine Precautions
1. Elderly/ frail pts
2. Hypotension
3. Respiratory depression
4. Current asthma
5. Respiratory tract burns
6. Known addiction to opioids
7. Acute alcoholism
8. Pts on monoamine oxidase inhibitors
113
Morphine Route of admin
IV, IM, IV infusion
114
Morphine Side Effects
```
CNS effects:
- Drowsiness
- Respiratory depression
- Euphoria
- Nausea, vomiting
- Addiction
- Pin- point pupils
Cardiovascular effects:
- Hypotension
- Bradycardia
```
115
Morphine IV effects
Onset: 2-5mins
Peak: 10mins
Duration: 1-2 hrs
116
Morphine IM effects
Onset: 10-30mins
Peak: 30-60mins
Duration:1-2hrs
117
Naloxone Presentation
0.4mg in 1ml
118
Naloxone Pharmacology
An opioid antagonist
Actions:
- Prevents or reverses the effects of opioids
119
Naloxone Metabolism
By the liver
120
Naloxone Primary Emergency Indications
1. Altered conscious state and respiratory depression secondary to administration of opioids or related drugs
121
Naloxone Contraindications
1. Nil
122
Naloxone Precautions
1. If pt is known to by physically dependant on opioids be prepared for a combative pt after administration
2. Neonates
123
Naloxone Route of admin
IM, IV
124
Naloxone Side Effects
Symptoms of opioid withdrawal:
- Sweating, goose flesh, tremor
- Nausea and vomiting
- Agitation
- Dilation of pupils, excessive lacrimation
- Convulsions
125
Naloxone IV Effects
Onset: 1-3mins
Peak: n/a
Duration: 30-45mins
126
Naloxone IM Effects
Onset: 1-3mins
Peak: n/a
Duration: 30-45mins
127
Ondansetron Presentation
4mg orally dissolving tablet
128
Ondansetron Pharmacology
Anti- emetic
Action:
- 5HT3 antagonist which blocks receptors both centrally and peripherally
129
Ondansetron Metabolism
By the liver
130
Ondansetron Primary Emergency Indications
1. Undifferentiated nausea and vomiting
2. Prophylaxis for spinally immobilised or eye injured pts
3. Vestibular nausea in pts <21 years of age
131
Ondansetron Contraindications
1. Known hypersensitivity
2. Concurrent apomorphine use
3. Known long Q-T syndrome
4. Hypokalaemia or hypomagneseamia
132
Ondansetron Precautions
1. Pts with liver disease should not receive more than 8mg per day
2. Care should be taken with pts on diuretics who may have an underlying electrolyte imbalance
3. Ondansetron contains aspartame and should not be given to pts with phenylketouria
4. Concurrent use of tramadol
5. Pregnancy
133
Ondansetron Route of admin
Oral
134
Ondansetron Side Effects
```
Rare:
- Hypersensitivity reactions
- QT prolongation
- Widened QRS complex
- Tachyarrythmias (incl. AF & SVT)
- Seizures
- Extrapyramidal Reactions
- Visual disturbances (incl. transient loss of vision)
Common:
- Constipation
- Headache
- Fever
- Dizziness
- Rise in liver enzymes
```
135
Ondansetron times
Onset: 2mins
Peak: 20mins
Duration: 120 mins
136
Paracetamol Presentation
500mg tablets
| 120mg in 5ml oral liquid
137
Paracetamol Pharmacology
An analgesic and anti- pyretic agent
Actions:
- Exact mechanism of action unclear; thought to inhibit prostaglandin synthesis in the CNS
138
Paracetamol Metabolism
By the liver; excreted by the kidneys
139
Paracetamol Primary Emergency Indication
1. Mild pain
| 2. Headache
140
Paracetamol Contraindications
1. Hypersensitivity to paracetamol
2. Children < 1 month old
3. Paracetamol already administered in past 4 hours
4. Total paracetamol intake within past 24 hrs exceeding 4g adults, 60mg/kg for children
5. Chest pain in suspected acute coronary syndrome
141
Paracetamol Precautions
1. Impaired hepatic function or liver disease
2. Elderly/ frail
3. Malnourished
142
Paracetamol Route of admin
Oral
143
Paracetamol Side Effects
1. Hypersensitivity reactions incl. severe skin rashes (rare)
2. Haematological reactions (rare)
144
Paracetamol Onset times
Onset: 30mins
Peak: n/a
Duration: 4 hrs
145
Prochlorperazine Presentation
12.5mg in 1ml
146
Prochlorperazine Pharmacology
Anti- emetic
Actions:
- Acts on several central neurotransmitter systems
147
Prochlorperazine Metabolism
By the liver; excreted by the kidneys
148
Prochlorperazine Primary Emergency Indications
1. Treatment or prophylaxis of nausea/ vomiting for:
- Motion sickness
- Planned aeromedical evacuation
- Known allergy or c/i to ondansetron
- Headache irrespective or nausea/ vomiting
- Vertigo
149
Prochlorperazine Contraindications
1. Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension)
2. CNS depression
3. Previous hypersensitivity
4. Children
5. Pregnancy
150
Prochlorperazine Precautions
1. Hypotension
2. Epilepsy
3. Pts affected by alcohol or on anti depressants
151
Prochlorperazine Route of admin
IM
152
Prochlorperazine Side Effects
```
Drowsiness
Blurred vision
Hypotension
Sinus tachycardia
Skin rash
Extrapyramidal reactions (usually the dystonic type)
```
153
Prochlorperazine IM Effects
Onset: 20mins
Peak: 40mins
Duration: 6hrs
154
Salbutamol Presentation
5mg in 2.5ml
155
Prochlorperazine Pharmacology
A synthetic beta adrenergic stimulant with primarily beta 2 effects
Action:
- Causes bronchodilation
