Pharmacology Flashcards

1
Q

Adrenaline Presentation

A

1mg in 1ml

1mg in 10ml

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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)

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3
Q

Adrenaline Metabolism

A

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

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4
Q

Adrenaline Primary Emergency Indications

A
  1. Cardiac arrest- VF/VT, Asystole or PEA
  2. Inadequate perfusion (cardiogenic or non- cardiogenic/ non hypovolaemic)
  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 Contraindications

A
  1. Hypovolaemic shock without adequate fluid replacement
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6
Q

Adrenaline Precautions

A

Consider reduced doses for:

  1. Elderly/ frail pts
  2. Pts with cardiovascular disease
  3. Pts on monoamine oxidase inhibitors
  4. Higher doses may be required for pts on beta blockers
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7
Q

Adrenaline Route of admin

A

IV, IM, ETT, Nebulised, IV infusion, IO

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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
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9
Q

Adrenaline IV effects

A

Onset: 30 seconds
Peak: 3-5 Mins
Duration: 5-10 mins

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10
Q

Adrenaline IM effects

A

Onset: 30-90 seconds
Peak: 4-10 mins
Duration: 5-10 mins

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11
Q

Aspirin Presentation

A

300mg chewable tablets

300mg soluble or water dispersible tablets

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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

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13
Q

Aspirin Metabolism

A

Converted to salicylate in the gut mucosa and liver; excreted mainly by the kidneys

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14
Q

Aspirin Primary Emergency Indications

A

ACS

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15
Q

Aspirin Contraindications

A
  1. Hypersensitivity to aspirin/ salicylates
  2. Actively bleeding peptic ulcers
  3. Bleeding disorders
  4. Suspected dissecting aortic aneurysm
  5. Chest pain associated with psychostimulant OD if SBP > 160
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16
Q

Aspirin Precautions

A
  1. Peptic Ulcer
  2. Asthma
  3. Pts on anticoagulants
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17
Q

Aspirin route of admin

A

Oral

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18
Q

Aspirin Side effects

A

Heartburn, nausea, GI bleeding
Increased bleeding time
Hypersensitivity reactions

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19
Q

Aspirin Special notes

A

Onset: N/A
Peak: N/A
Duration: 8-10days

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20
Q

Ceftriaxone Presentation

A

1g sterile powder

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21
Q

Ceftriaxone Pharmacology

A

Cephalosporin anti biotic

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22
Q

Ceftriaxone Metabolism

A

Excreted unchanged in urine and in bile

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23
Q

Ceftriaxone Primary Emergency Indications

A
  1. Suspected meningococcal septicaemia

2. Severe Sepsis (consult only)

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24
Q

Ceftriaxone Contraindications

A
  1. Allergy to Cephalosporin antibiotics
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25
Q

Ceftriaxone Precautions

A
  1. Allergy to penicillin anti biotics
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26
Q

Ceftriaxone Route of admin

A

IV (preferred)

IM

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27
Q

Ceftriaxone Side Effects

A

Nausea
Vomiting
Skin Rash

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28
Q

Ceftriaxone Special Notes

A

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

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29
Q

Ceftriaxone IM/IV effects

A

Onset: n/a
Peak: n/a
Duration: n/a

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30
Q

Dextrose 10% Presentation

A

25g in 250ml infusion soft pack

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31
Q

Dextrose 10% Pharmacology

A
A slightly hypertonic crystalloid solution 
Composition: 
- Sugar 10%
- Water 
Actions: 
- Provides a source of energy
- Supplies body water
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32
Q

Dextrose 10% Metabolism

A
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
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33
Q

Dextrose 10% Primary Emergency Indications

A
  1. Diabetic hypoglycaemia (BGL < 4) in pts with an altered conscious state who are unable to self- administer oral glucose
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34
Q

Dextrose 10% Contraindications

A
  1. Nil
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35
Q

Dextrose 10% Precautions

A

Nil

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36
Q

Dextrose 10% Route of Admin

A

IV infusion

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37
Q

Dextrose 10% Side Effects

A

Nil

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38
Q

Dextrose 10% IV Effects (Special Notes)

A

Onset: 3 mins
Peak: n/a
Duration: Depends on severity of hypoglycaemic episode

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39
Q

Fentanyl Presentation

A

100mcg in 2ml

200mcg in 1ml (IN only)

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40
Q

Fentanyl Pharmacology

A

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

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41
Q

Fentanyl Metabolism

A

By the liver; excreted by the kidneys

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42
Q

Fentanyl Primary Emergency Indications

A
  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
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43
Q

Fentanyl Contraindications

A
  1. History of hypersensitivity

2. Late second stage of labour

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44
Q

Fentanyl Precautions

A
  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)
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45
Q

Fentanyl Route of admin

A

IV, IN, IV infusion

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46
Q

Fentanyl Side Effects

A

Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles
Bradycardia

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47
Q

Fentanyl- 100mcg is equivalent to ? Morphine

A

10mg

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48
Q

Fentanyl IV effects

A

Onset: immediate
Peak: <5 mins
Duration: 30-60 mins

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49
Q

Fentanyl IN effects

A

Peak: 2 mins

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50
Q

Glucagon Presentation

A

1mg (IU) in 1ml hypokit

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51
Q

Glucagon Pharmacology

A

A hormone normally excreted by the pancreas
Actions:
- Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose

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52
Q

Glucagon Metabolism

A

Mainly by the liver, also by the kidneys and in the plasma

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53
Q

Glucagon Primary Emergency Indications

A
  1. Diabetic hypoglycaemia (BGL < 4) in pts with an altered conscious state who are unable to self administer oral glucose
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54
Q

Glucagon Contraindications

A

Nil

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55
Q

Glucagon Precautions

A

Nil

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56
Q

Glucagon Route of admin

A

IM

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57
Q

Glucagon Side Effects

A

Nausea and vomiting

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58
Q

Glucagon IM effects

A

Onset: 5 mins
Peak: n/a
Duration: 25 mins

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59
Q

GTN Presentation

A

0.6mg tablets

Transdermal GTN patch (50mg 0.4mg/hr)

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60
Q

GTN Pharmacology

A

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

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61
Q

GTN Metabolism

A

By the liver

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62
Q

GTN Primary Emergency Indication

A
  1. Chest pain with ACS
  2. Acute LVF
  3. Hypertension associated with ACS
  4. Autonomic dysreflexia
  5. Preterm Labour (consult only)
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63
Q

GTN Contraindications

A
  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
Q

GTN Precautions

A
  1. No previous admin
  2. Elderly pts
  3. Recent Mi
  4. Concurrent use with other tocolytics
65
Q

GTN Route of admin

A

SL, buccal, transdermal, infusion (interhospital transfers only)

66
Q

GTN Side Effects

A
Tachycardia
Hypotension
Headache 
Skin Flushing 
Bradycardia
67
Q

GTN S/L effects

A

Onset: 30s-2mins
Peak: 5-10mins
Duration: 15-30mins

68
Q

GTN Transdermal effect

A

Onset: up to 30 mins
Peak: 2 hours

69
Q

Ipratropium Bromide Presentation

A

250mcg in 1ml

70
Q

Ipratropium Bromide Pharmacology

A

Anti cholinergic bronchodilator
Actions:
- Allows bronchodilation by inhibiting cholinergic bronchomotor tone (i.e. blocks vagal reflexes which mediate bronchoconstriction)

71
Q

Ipratropium Bromide Metabolism

A

Excreted by the kidneys

72
Q

Ipratropium Bromide Primary Emergency Indications

A
  1. Severe respiratory distress associated with bronchospasm

2. Exacerbation of COPD irrespective of severity

73
Q

Ipratropium Bromide Contraindications

A
  1. Known hypersensitivity to atropine or its derivatives
74
Q

Ipratropium Bromide Precautions

A
  1. Glaucoma

2. Avoid contact with the eyes

75
Q

Ipratropium Bromide Route of admin

A

Nebulised (in conjunction with salbutamol)

76
Q

Ipratropium Bromide Side Effects (HANDSPT)

A
Headache 
Acute angle closure glaucoma secondary to direct eye contact (rare) 
Nausea 
Dry Mouth 
Skin Rash
Palpitations (rare)
Tachycardia (rare)
77
Q

Ipratropium Bromide Special notes

A

Onset: 3-5 mins
Peak: 1.5-2 hrs
Duration: 6 hours

78
Q

Ketamine Prensentation

A

200mg in 2ml

79
Q

Ketamine Pharmacology

A

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
Q

Ketamine Metabolism

A

By the liver and excreted by kidneys

81
Q

Ketamine Primary Emergency Indications

A
  1. Rapid sequence intubation
  2. Extreme traumatic pain refractory to opioid analgesia
  3. Extreme agitation
82
Q

Ketamine Contraindications

A
  1. Known hypersensitivity

2. Severe hypertension (SBP>180)

83
Q

Ketamine Precautions

A
  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
Q

Ketamine Route of admin

A

IV, IO, IM

85
Q

Ketamine Side Effects

A
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
Q

Ketamine IV Effects

A

Onset: 30s
Peak: n/a
Duration: 10mins

87
Q

Ketamine IM Effects

A

Onset: 3-4mins
Peak: n/a
Duration: 12-25mins

88
Q

Methoxyflurane Presentation

A

3ml glass bottle

89
Q

Methoxyflurane Pharmacology

A

Inhalational analgesic agent at low concentrations

90
Q

Methoxyflurane Metabolism

A

Excreted mainly by the lungs

By the Liver

91
Q

Methoxyflurane Primary Emergency Indications

A
  1. Pain Relief
92
Q

Methoxyflurane Contraindications

A
  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
Q

Methoxyflurane Precautions

A
  1. Penthorx inhaler must be hand held
  2. Pre eclampsia
  3. Concurrent use with oxytocin may cause hypotension
94
Q

Methoxyflurane Route of admin

A

Self administration under supervision

95
Q

Methoxyflurane Side Effects

A

Drowsiness
Decrease in blood pressure and bradycardia
Exceeding max dose of 6ml in 24hr period may lead to renal toxicity

96
Q

Methoxyflurane Analgesia effects

A

Commences after:
8-10 breaths
Lasts for:
approx. 3-5mins

97
Q

Midazolam Presentation

A

5mg in 1ml

15mg in 3ml

98
Q

Midazolam Pharmacology

A
Short acting CNS depressant 
Actions:
- Anxiolytic 
- Sedative 
- Anti convulsant
99
Q

Midazolam Metabolism

A

In the liver; excreted by the kidneys

100
Q

Midazolam Primary Emergency Indications

A
  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
Q

Midazolam Contraindications

A
  1. Known hypersensitivity to benzodiazepines
102
Q

Midazolam Precautions

A
  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
Q

Midazolam Route of admin

A

IM, IV, IV infusion

104
Q

Midazolam Side Effects

A

Depressed level of consciousness
Respiratory depression
Loss of airway control
Hypotension

105
Q

Midazolam IM Effects

A

Onset: 3-5mins
Peak: 15mins
Duration: 30mins

106
Q

Midazolam IV Effects

A

Onset: 1-3mins
Peak: 10mins
Duration: 20mins

107
Q

Morphine Presentation

A

10mg in 1ml

108
Q

Morphine Pharmacology

A
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
Q

Morphine Metabolism

A

By the liver; excreted by the kidneys

110
Q

Morphine Primary Emergency Indications

A
  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
Q

Morphine Contraindications

A
  1. History of hypersensitivity
  2. Renal impairment/ failure
  3. Late second stage labour
112
Q

Morphine Precautions

A
  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
Q

Morphine Route of admin

A

IV, IM, IV infusion

114
Q

Morphine Side Effects

A
CNS effects: 
- Drowsiness
- Respiratory depression
- Euphoria
- Nausea, vomiting 
- Addiction
- Pin- point pupils 
Cardiovascular effects: 
- Hypotension 
- Bradycardia
115
Q

Morphine IV effects

A

Onset: 2-5mins
Peak: 10mins
Duration: 1-2 hrs

116
Q

Morphine IM effects

A

Onset: 10-30mins
Peak: 30-60mins
Duration:1-2hrs

117
Q

Naloxone Presentation

A

0.4mg in 1ml

118
Q

Naloxone Pharmacology

A

An opioid antagonist
Actions:
- Prevents or reverses the effects of opioids

119
Q

Naloxone Metabolism

A

By the liver

120
Q

Naloxone Primary Emergency Indications

A
  1. Altered conscious state and respiratory depression secondary to administration of opioids or related drugs
121
Q

Naloxone Contraindications

A
  1. Nil
122
Q

Naloxone Precautions

A
  1. If pt is known to by physically dependant on opioids be prepared for a combative pt after administration
  2. Neonates
123
Q

Naloxone Route of admin

A

IM, IV

124
Q

Naloxone Side Effects

A

Symptoms of opioid withdrawal:

  • Sweating, goose flesh, tremor
  • Nausea and vomiting
  • Agitation
  • Dilation of pupils, excessive lacrimation
  • Convulsions
125
Q

Naloxone IV Effects

A

Onset: 1-3mins
Peak: n/a
Duration: 30-45mins

126
Q

Naloxone IM Effects

A

Onset: 1-3mins
Peak: n/a
Duration: 30-45mins

127
Q

Ondansetron Presentation

A

4mg orally dissolving tablet

128
Q

Ondansetron Pharmacology

A

Anti- emetic
Action:
- 5HT3 antagonist which blocks receptors both centrally and peripherally

129
Q

Ondansetron Metabolism

A

By the liver

130
Q

Ondansetron Primary Emergency Indications

A
  1. Undifferentiated nausea and vomiting
  2. Prophylaxis for spinally immobilised or eye injured pts
  3. Vestibular nausea in pts <21 years of age
131
Q

Ondansetron Contraindications

A
  1. Known hypersensitivity
  2. Concurrent apomorphine use
  3. Known long Q-T syndrome
  4. Hypokalaemia or hypomagneseamia
132
Q

Ondansetron Precautions

A
  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
Q

Ondansetron Route of admin

A

Oral

134
Q

Ondansetron Side Effects

A
Rare: 
- Hypersensitivity reactions 
- QT prolongation
- Widened QRS complex
- Tachyarrythmias (incl. AF &amp; SVT)
- Seizures 
- Extrapyramidal Reactions 
- Visual disturbances (incl. transient loss of vision) 
Common: 
- Constipation
- Headache 
- Fever
- Dizziness
- Rise in liver enzymes
135
Q

Ondansetron times

A

Onset: 2mins
Peak: 20mins
Duration: 120 mins

136
Q

Paracetamol Presentation

A

500mg tablets

120mg in 5ml oral liquid

137
Q

Paracetamol Pharmacology

A

An analgesic and anti- pyretic agent
Actions:
- Exact mechanism of action unclear; thought to inhibit prostaglandin synthesis in the CNS

138
Q

Paracetamol Metabolism

A

By the liver; excreted by the kidneys

139
Q

Paracetamol Primary Emergency Indication

A
  1. Mild pain

2. Headache

140
Q

Paracetamol Contraindications

A
  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
Q

Paracetamol Precautions

A
  1. Impaired hepatic function or liver disease
  2. Elderly/ frail
  3. Malnourished
142
Q

Paracetamol Route of admin

A

Oral

143
Q

Paracetamol Side Effects

A
  1. Hypersensitivity reactions incl. severe skin rashes (rare)
  2. Haematological reactions (rare)
144
Q

Paracetamol Onset times

A

Onset: 30mins
Peak: n/a
Duration: 4 hrs

145
Q

Prochlorperazine Presentation

A

12.5mg in 1ml

146
Q

Prochlorperazine Pharmacology

A

Anti- emetic
Actions:
- Acts on several central neurotransmitter systems

147
Q

Prochlorperazine Metabolism

A

By the liver; excreted by the kidneys

148
Q

Prochlorperazine Primary Emergency Indications

A
  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
Q

Prochlorperazine Contraindications

A
  1. Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension)
  2. CNS depression
  3. Previous hypersensitivity
  4. Children
  5. Pregnancy
150
Q

Prochlorperazine Precautions

A
  1. Hypotension
  2. Epilepsy
  3. Pts affected by alcohol or on anti depressants
151
Q

Prochlorperazine Route of admin

A

IM

152
Q

Prochlorperazine Side Effects

A
Drowsiness
Blurred vision
Hypotension
Sinus tachycardia 
Skin rash
Extrapyramidal reactions (usually the dystonic type)
153
Q

Prochlorperazine IM Effects

A

Onset: 20mins
Peak: 40mins
Duration: 6hrs

154
Q

Salbutamol Presentation

A

5mg in 2.5ml

155
Q

Prochlorperazine Pharmacology

A

A synthetic beta adrenergic stimulant with primarily beta 2 effects
Action:
- Causes bronchodilation