Pharmacology Flashcards
1
Q
Adrenaline
Pharmacology
A
A naturally occurring alpha and beta adrenergic stimulant.
Actions:
- increase HR by increasing SA node firing rate (beta 1)
- increasing conduction velocity through AV node (beta 1)
- increasing myocardial contractility (beta 1)
- increase irritability of the ventricles (beta 1)
- causes bronchodilation (beta 2)
- causes peripheral vasoconstriction (alpha)
2
Q
Adrenaline
Primary Indications
A
- Cardiac arrest VF, VT, asystole or PEA
- Inadequate perfusion: cardiogenic, non cardiogenic, non hypovolaemic
- Bradycardia with poor perfusion
- Anaphylaxis
- Severe asthma, imminent life threat not responding to neb therapy or unconscious with no BP
- Croup
3
Q
Adrenaline
Contraindications
A
Hypovolaemic shock without adequate fluid replacement.
4
Q
Adrenaline
Precautions
A
- Elderly/frail
- Patients with CVD
- Patients on MAOIs
- Higher doses may be required for patients on beta blockers
5
Q
Adrenaline
Side Effects
A
- Sinus tachycardia
- Supraventricular arrhythmias
- Ventricular arrhythmias
- Hypertension
- Pupillary dilation
- May increase size of MI
- Feeling of anxiety/palpitations in the conscious patient
6
Q
Aspirin
Pharmacology
A
An analgesic, antipyretic, anti inflammatory and anti platelet aggregation agent
Actions:
1. Minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS
- Inhibits synthesis of prostoglandins - anti inflammatory actions
7
Q
Aspirin
Contraindications
A
- Hypersensitivity to aspirin/salicylates
- Actively bleeding peptic ulcer
- Bleeding disorders
- Suspected dissection aortic aneurysm
- Chest pain assoc with psychostimulant OD with BP > 160
8
Q
Aspirin
Precautions
A
- Peptic ulcer
- Asthma
- Patients on anti coagulants
9
Q
Aspirin
Side effects
A
- Heartburn, nausea, gastrointestinal bleeding
- Increased bleeding time
- Hypersensitivity reactions
10
Q
Dexamethasone
Pharmacology
A
A corticosteroid secreted by the adrenal cortex
Actions
- relieves inflammation
- provided immunosuppression
11
Q
Dexamethasone
Primary Indications
A
- Bronchospasm associated with acute resp distress not responding to neb therapy
- Moderate-severe croup
- Acute exacerbation of COPD
- Adult stridor (non-foreign body obstruction)
12
Q
Dexamethasone
Contraindications
A
Known hypersensitivity
13
Q
Dexamethasone
Precautions
A
Solutions which are not clear or are contaminated should be discarded
14
Q
Fentanyl
Pharmacology
A
A synthetic opioid analgesic agent
Actions CNS - depression leading to analgesia - resp depression leading to apnoea - dependance leading to addiction
CV
- decrease conduction velocity through the AV node
15
Q
Fentanyl
Primary indications
A
- Sedation to facilitate intubation RSI modified or paed IFS
- Sedation to maintain intubation
- Sedation to facilitate transthoracic pacing
- Sedation to facilitate sync cardioversion
- CPR interfering patient ALS
- Analgesia IV/IN
- history of hypersensitivity or allergy to morphine
- known renal impairment/failure
- short duration of action desirable
- hypotension
- nausea and vomiting
- severe headache
16
Q
Fentanyl
Containdications
A
- History of hypersensitivity
2. Late second stage labour
17
Q
Fentanyl
Precautions
A
- Elderly/frail
- Impaired hepatic function
- Resp depression: COPD
- Current asthma
- Patients on MAOI
- Known addiction to opioids
- Rhinitis, rhinorrhea, or facial trauma (IN)
18
Q
Fentanyl
Side Effects
A
- Respiratory depression
- Apnoea
- Rigidity of diaphragm and intercostal muscles
- Bradycardia
19
Q
GTN
Phamacology
A
Principally a smooth muscle relaxant
Action
- venous dilation promotes venous pooling and reduces venous return to the heart (reduced preload)
- arterial dilation reduces systemic vascular resistance and arterial pressures (reduced afterload)
The effects of above
- reduced myocardial 02 demand
- reduces sys,dia and MAP whilst usually maintaining coronary perfusion pressure
- mild collateral coronary arterial dilation may improve blood supply to ischaemic areas of myocardium
- mild tachycardia secondary to slight drop in BP
- preterm labour: uterine quiescence in pregnancy
20
Q
GTN
Primary indications
A
- Chest pain with ACS
- Acute LVF
- Hypertension associate with ACS
- Autonomic dysreflexia
- Preterm labour (consult)
21
Q
GTN
Contraindications
A
- Known hypersensitivity
- Systolic BP < 110 (tablet)
- Systolic BP <90 (patch)
- Sildenafil (viagra), vardenafil (levitra) in the last 24hours, or tadalafil (cialis) in the last 4 days
- HR > 150bpm
- Bradycardia <50 except autonomic dysreflexia
- VT
- Inferior STEMI with BP < 160
- Right ventricular MI
22
Q
GTN
Precautions
A
- No previous administration
- Elderly patients
- Recent MI
- Concurrent use with other tocolytics
23
Q
GTN
Side effects
A
- Tachycardia
- Hypotension
- Headache
- Skin flushing (uncommon)
- Bradycardia
24
Q
Ipratropium Bromide
Pharmacology
A
Anticholinergic bronchodilator
Action
Allows bronchodilation by inhibiting cholinergic bronchomotor tone i.e. blocks vagal reflexes which mediate bronchoconstriction
25
Ipratropium Bromide
| Primary indications
1. Severe resp distress assoc with bronchospasm
| 2. Exacerbation of COPD irrespective of severity
26
Ipratropium Bromide
| Contraindications
Known hypersensitivity to atropine or its derivatives
27
Ipratropium Bromide
| Precautions
1. Glaucoma
| 2. Avoid contact with eyes
28
Ipratropium Bromide
| Side Effects
1. Headache
2. Dry mouth
3. Palpitations
4. Tachycardia
5. Skin rash
6. Nausea
7. Acute angle glaucoma secondary to direct contact with eyes
29
Ketamine
| Pharmacology
Anaesthetic agent with analgesic properties at lower doses
Exact mechanisms of action is unclear, but primarily works as an antagonist at NMDA receptors.
Ketamine may also interact with opioids, muscarinic and other receptors. Produces a trance like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes.
30
Ketamine
| Primary indications
1. Intubation
2. Analgesia
3. Sedation, agitation and movement during CPR
31
Ketamine
| Contraindications
Suspected non-traumatic brain injury with severe hypertension BP > 180
32
Ketamine
| Precautions
May exacerbate cardiovascular conditions e.g. uncontrolled hypertension, stroke, recent MI, cardiac failure due to effects of HR and BP
33
Ketamine
| Adverse effects
CV: hypertension, tachycardia
CNS:
- emergence reactions (vivid dreams, restlessness, confusion, hallucinations, irrational behaviour).
- increased skeletal muscle tone (may resemble seizures)
Resp
- transient resp depression and apnoea
GI
- nausea and vomiting
Other
- injection site pain, lacrimation, hypersalivation, diplopia, nystagmus
34
Lignocaine
| Pharmacology
Sodium channel blocker. Interrupts impulse conduction in peripheral nerves and stabilises excitable cell membranes
35
Lignocaine
| Indications
Local anaesthetic to reduce pain associated with
- IM ceftriaxone
- chest decompression in patients with GCS > 10
- IO administration of medication or fluid in a conscious patient
36
Lignocaine
| Contraindications
Known hypersensitivity to lignocaine or related local anaesthetic (bupuvacaine, levobupivacaine, prilocaine, ropivacaine)
37
Lignocaine
| Precautions
1. IM and local infiltration - inadvertent IV administration may systemic toxicity
2. IO - impaired CV function (hypotension, bradycardia, poor perfusion, heart block, heart failure)
38
Lignocaine
| Adverse effects
1. Allergic reactions are rare and may present as localised oedema, urticaria, bronchospasm, and anaphylaxis
2. Signs of systemic toxicity include
- CNS: tinnitus, blurred vision, sudden change in conscious state, agitation, convulsions
- CV: hypotension, bradycardia, arrhythmias, (conduction blocks, ventricular tachyarrhythmias), cardiac arrest
39
Lignocaine
| AVOID trail indications
Investigational agent for patients enrolled in the AVOID trial
- pain associated with suspected STEMI
40
Lignocaine
AVOID trial
Contraindications
1. Known hypersensitivity to lignocaine
2. Bradycardia HR < 50
3. Cardiac arrest or cardiogenic shock BP <90
4. Past history of epilepsy, renal failure or liver failure
41
Methoxyflurane
| Pharmacology
Inhalation analgesic agent at low concentrations
42
Methoxyflurane
| Contraindications
1. Pre-existing renal disease/ renal impairment
2. Concurrent use of tetracycline antibiotics
3. Exceeding max dose of 6ml in 24hours
4. Personal or family history of malignant hyperthermia
5. Muscular dystrophy ( may lead to rhabdo)
43
Methoxyflurane
| Precautions
1. Inhaler must be held by the patient so that if unconsciousness occurs inhaler will fall away from face. If paramedic is holding the inhaler must continually monitor level of consciousness
2. Pre-eclampsia
3. Concurrent use of oxytocin may cause hypotension
44
Methoxyflurane
| Side effects
1. Drowsiness
2. Decrease in BP and bradycardia
3. Exceeding the max dose of 6ml in 24 hours may cause renal toxicity
45
Midaz
| Pharmacology
Short acting CNS depressant
Actions
- anxiolytic
- sedative
- anti-convulsant
46
Midaz
| Indications
1. Status epilepticus
2. Sedation to maintain intubation
3. Sedation to facilitate intubation (RSI modified or paed IFS)
4. Sedation to facilitate cardioversion
5. Sedation to facilitate sync cardioversion
6. Sedation of the agitated patient
7. Sedation of psychostimulant OD
47
Midaz
| Contraindications
Known hypersensitivity to benzodiazepines
48
Midaz
| Precautions
1. Reduced doses may be required for elderly/frail, patients with chronic renal failure, CCF or shock
2. The CNS depressant effects of benzo are enhanced in the presence of narcotics and other tranquillisers including alcohol.
3. Can cause severe resp depression in patients with COPD
4. Patients with myasthenia gravis
49
Midaz
| Side Effects
1. Depressed level of consciousness
2. Resp depression
3. Loss of airway control
4. Hypotension
50
Morphine
| Pharmacology
An opioid analgesic agent
```
Actions
CNS
- depression leading to analgesia
- resp depression
- depression of cough reflex
- stimulation (changes in mood, euphoria, dysphoria, vomiting, pin point pupils)
- dependence (addiction)
```
CV
- vasodilation
- decreased conduction velocity through AV node
51
Morphine
| Indications
1. Pain relief
2. Sedation to maintain intubation
3. Sedation to facilitate intubation ( where fentanyl not appropriate for RSI - modified or paed IFS)
52
Morphine
| Contraindications
1. History of hypersensitivity
2. Renal impairment/failure
3. Late second stage labour
53
Morphine
| Precautions
1. Elderly/frail
2. Hypotension
3. Respiratory depression
4. Current asthma
5. Respiratory tract burns
6. Known addiction to narcotics
7. Acute alcoholism
8. Patients on MAOI
54
Morphine
| Side effects
CNS
- drowsiness
- resp depression
- euphoria
- nausea, vomiting
- addiction
- pin point pupils
CV
- hypotension
- bradycardia
55
Naloxone
| Pharmacology
An opioid antagonist
Actions
Prevents or reverses the effects of opioids
56
Naloxone
| Indications
Altered conscious state and resp depression secondary to administration of opioids or related drugs.
57
Naloxone
| Contraindications
Nil of significance in the above setting
58
Naloxone
| Precautions
1. If patient is known to be physically dependant on opioids, be prepared for a combative patient after administration
2. Neonates
59
Naloxone
| Side effects
Symptoms of drug withdrawal
1. Sweating, goose flesh, tremor
2. Nausea and vomiting
3. Agitation
4. Dilation of pupils, excessive lacrimation
5. Convulsions
Naloxone should not be administered post opioid induced cardiac arrest.
Naloxone should not be given following a head injury. In both of these cases manage with ventilations.
60
Olanzapine
| Pharmacology
An atypical antipsychotic - antagonist at multiple receptor sites, particularly serotonin (5-ht3), dopamine and histamine.
61
Olanzapine
| Indications
Mild agitation - patient can self administer
62
Olanzapine
| Contraindications
Nil
63
Olanzapine
| Precautions
1. May be less effective if patient agitation is due to drug intoxication (especially stimulants) or alcohol withdrawal. Benzos are considered first line agents in these patients.
2. Elderly/frail and children are more susceptible to adverse effects
64
Olanzapine
| Significant interactions
Sedative medications/alcohol may lead to over sedation due to synergistic effects. Avoid combination where possible.
65
Olanzapine
| Side effects
CNS
- sedation
- drowsiness
OTHER
- extrapyramidal symptoms and QT prolongation are unlikely when administered at the approved dose.
66
Ondansetron
| Pharmacology
Anti-emetic
Actions
5-HT3 antagonist which blocks receptors both centrally and peripherally
67
Ondansetron
| Indications
1. Undifferentiated nausea and vomiting
2. Prophylaxis for spinally immobilised or eye injured patients
3. Vestibular nausea in patients <21years
68
Ondansetron
| Contraindications
1. Known hypersensitivity
2. Concurrent apo-morphine use
3. Known long QT syndrome
4. Hypokalaemia or hypomagnesaemia
69
Ondansetron
| Precautions
1. Patients with liver disease should not receive more than 8mg per day
2. Care should be taken with patients on diuretics who may have an underlying electrolyte imbalance
3. Ondansetron contains aspartame and should not be given to patients with phenylketonuria ( a birth defect which causes a build up of amino acids)
4. Concurrent use of tramadol (they both act on the same receptor site so reduces the effectiveness of tramadol)
5. Pregnancy
70
```
Ondansetron
Side effects (rare)
```
1. Hypersensitivity reactions
2. QT prolongation
3. Widened QRS
4. Tachyarrhythmias (AF and SVT)
5. Seizures
6. Extrapyramidal reactions
7. Visual disturbances including transient lose of vision
71
Ondansetron
| Side effects common
1. Constipation
2. Headache
3. Fever
4. Dizziness
5. Rise in liver enzymes
72
Oxytocin
| Pharmacology
A synthetic oxytocic
Actions
- stimulates smooth muscle of the uterus producing contractions
73
Oxytocin
| Indications
Primary post partum haemorrhage
74
Oxytocin
| Contraindications
1. Previous hypersensitivity
2. Severe toxaemia (pre-eclampsia)
3. Exclude multiple pregnancy before administrations
4. Cord prolapse
75
Oxytocin
| Precautions
1. If given IV may cause transient hypotension
| 2. Concurrent use with methoxyflurane may cause hypotension
76
Oxytocin
| Side effects
1. Tachycardia
2. Bradycardia
3. Nausea
77
Paracetamol
| Pharmacology
An analgesic, antipyretic agent
Actions
- exact mechanism of action is unknown, thought to inhibit prostaglandin synthesis in the CNS
78
Paracetamol
| Indications
1. Mild pain
| 2. Headache
79
Paracetamol
| Contraindications
1. Hypersensitivity to paracetamol
2. Children <1month
3. Paracetamol already administered with past 4 hours
4. Total paracetamol intake in 24 hours exceeding 4g for adults and 60mg/kg for children
5. Chest pain assoc with acute coronary syndrome
80
Paracetamol
| Precautions
1. Impaired hepatic function or liver disease
2. Elderly/frail
3. Malnourished
81
Paracetamol
| Side effects
1. Hypersensitivity reactions including severe skin rashes (rare)
2. Haematological reactions (rare)
82
Prochlorperazine
| Pharmacology
An anti-emetic agent
Actions
- acts on severe central neurotransmitter systems
83
Prochlorperazine
| Indications
Treatment or prophylaxis for nausea and vomiting in:
1. Motion sickness
2. Planned aeromedical evac
3. Known allergy or C/I to ondansetron
4. Headache irrespective of nausea and vomiting
5. Vertigo >21years
84
Prochlorperazine
| Contraindications
1. Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension)
2. CNS depression
3. Previous hypersensitivity
4. Patients <21years
5. Pregnancy
85
Prochlorperazine
| Precautions
1. Hypotension
2. Epilepsy
3. Pts affected by alcohol or on anti-depressants
86
Prochlorperazine
| Side effects
1. Drowsiness
2. Blurred vision
3. Hypotension
4. Sinus tachycardia
5. Skin rash
6. Extrapyramidal reactions
87
Salbutamol
| Pharmacology
A synthetic bets adrenergic stimulant with primary beat 2 effects
Actions
- causes bronchodilation
88
Salbutamol
| Indications
Resp distress with suspected bronchospasm
1. Asthma
2. Severe allergic reaction
3. COPD
4. Smoke inhalation
5. Oleoresin capsicum spray exposure
89
Salbutamol
| Contraindications
Nil of significant in the above setting
90
Salbutamol
| Precautions
Large doses have been reported to cause intracellular metabolic acidosis
91
Salbutamol
| Side effects
1. Sinus tachycardia
| 2. Muscle tremor (common)
