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AV CPG's > Pharmacology > Flashcards

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)
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2
Q

Adrenaline

Primary Indications

A
  1. Cardiac arrest VF, VT, asystole or PEA
  2. Inadequate perfusion: cardiogenic, non cardiogenic, non hypovolaemic
  3. Bradycardia with poor perfusion
  4. Anaphylaxis
  5. Severe asthma, imminent life threat not responding to neb therapy or unconscious with no BP
  6. Croup
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3
Q

Adrenaline

Contraindications

A

Hypovolaemic shock without adequate fluid replacement.

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4
Q

Adrenaline

Precautions

A
  1. Elderly/frail
  2. Patients with CVD
  3. Patients on MAOIs
  4. Higher doses may be required for patients on beta blockers
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5
Q

Adrenaline

Side Effects

A
  1. Sinus tachycardia
  2. Supraventricular arrhythmias
  3. Ventricular arrhythmias
  4. Hypertension
  5. Pupillary dilation
  6. May increase size of MI
  7. Feeling of anxiety/palpitations in the conscious patient
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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

  1. Inhibits synthesis of prostoglandins - anti inflammatory actions
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7
Q

Aspirin

Contraindications

A
  1. Hypersensitivity to aspirin/salicylates
  2. Actively bleeding peptic ulcer
  3. Bleeding disorders
  4. Suspected dissection aortic aneurysm
  5. Chest pain assoc with psychostimulant OD with BP > 160
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8
Q

Aspirin

Precautions

A
  1. Peptic ulcer
  2. Asthma
  3. Patients on anti coagulants
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9
Q

Aspirin

Side effects

A
  1. Heartburn, nausea, gastrointestinal bleeding
  2. Increased bleeding time
  3. Hypersensitivity reactions
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10
Q

Dexamethasone

Pharmacology

A

A corticosteroid secreted by the adrenal cortex

Actions

  • relieves inflammation
  • provided immunosuppression
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11
Q

Dexamethasone

Primary Indications

A
  1. Bronchospasm associated with acute resp distress not responding to neb therapy
  2. Moderate-severe croup
  3. Acute exacerbation of COPD
  4. Adult stridor (non-foreign body obstruction)
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12
Q

Dexamethasone

Contraindications

A

Known hypersensitivity

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13
Q

Dexamethasone

Precautions

A

Solutions which are not clear or are contaminated should be discarded

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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

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15
Q

Fentanyl

Primary indications

A
  1. Sedation to facilitate intubation RSI modified or paed IFS
  2. Sedation to maintain intubation
  3. Sedation to facilitate transthoracic pacing
  4. Sedation to facilitate sync cardioversion
  5. CPR interfering patient ALS
  6. 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
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16
Q

Fentanyl

Containdications

A
  1. History of hypersensitivity

2. Late second stage labour

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17
Q

Fentanyl

Precautions

A
  1. Elderly/frail
  2. Impaired hepatic function
  3. Resp depression: COPD
  4. Current asthma
  5. Patients on MAOI
  6. Known addiction to opioids
  7. Rhinitis, rhinorrhea, or facial trauma (IN)
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18
Q

Fentanyl

Side Effects

A
  1. Respiratory depression
  2. Apnoea
  3. Rigidity of diaphragm and intercostal muscles
  4. Bradycardia
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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
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20
Q

GTN

Primary indications

A
  1. Chest pain with ACS
  2. Acute LVF
  3. Hypertension associate with ACS
  4. Autonomic dysreflexia
  5. Preterm labour (consult)
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21
Q

GTN

Contraindications

A
  1. Known hypersensitivity
  2. Systolic BP < 110 (tablet)
  3. Systolic BP <90 (patch)
  4. Sildenafil (viagra), vardenafil (levitra) in the last 24hours, or tadalafil (cialis) in the last 4 days
  5. HR > 150bpm
  6. Bradycardia <50 except autonomic dysreflexia
  7. VT
  8. Inferior STEMI with BP < 160
  9. Right ventricular MI
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22
Q

GTN

Precautions

A
  1. No previous administration
  2. Elderly patients
  3. Recent MI
  4. Concurrent use with other tocolytics
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23
Q

GTN

Side effects

A
  1. Tachycardia
  2. Hypotension
  3. Headache
  4. Skin flushing (uncommon)
  5. Bradycardia
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24
Q

Ipratropium Bromide

Pharmacology

A

Anticholinergic bronchodilator

Action

Allows bronchodilation by inhibiting cholinergic bronchomotor tone i.e. blocks vagal reflexes which mediate bronchoconstriction

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25
Q

Ipratropium Bromide

Primary indications

A
  1. Severe resp distress assoc with bronchospasm

2. Exacerbation of COPD irrespective of severity

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26
Q

Ipratropium Bromide

Contraindications

A

Known hypersensitivity to atropine or its derivatives

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27
Q

Ipratropium Bromide

Precautions

A
  1. Glaucoma

2. Avoid contact with eyes

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28
Q

Ipratropium Bromide

Side Effects

A
  1. Headache
  2. Dry mouth
  3. Palpitations
  4. Tachycardia
  5. Skin rash
  6. Nausea
  7. Acute angle glaucoma secondary to direct contact with eyes
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29
Q

Ketamine

Pharmacology

A

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.

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30
Q

Ketamine

Primary indications

A
  1. Intubation
  2. Analgesia
  3. Sedation, agitation and movement during CPR
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31
Q

Ketamine

Contraindications

A

Suspected non-traumatic brain injury with severe hypertension BP > 180

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32
Q

Ketamine

Precautions

A

May exacerbate cardiovascular conditions e.g. uncontrolled hypertension, stroke, recent MI, cardiac failure due to effects of HR and BP

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33
Q

Ketamine

Adverse effects

A

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

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34
Q

Lignocaine

Pharmacology

A

Sodium channel blocker. Interrupts impulse conduction in peripheral nerves and stabilises excitable cell membranes

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35
Q

Lignocaine

Indications

A

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
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36
Q

Lignocaine

Contraindications

A

Known hypersensitivity to lignocaine or related local anaesthetic (bupuvacaine, levobupivacaine, prilocaine, ropivacaine)

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37
Q

Lignocaine

Precautions

A
  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
Q

Lignocaine

Adverse effects

A
  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
Q

Lignocaine

AVOID trail indications

A

Investigational agent for patients enrolled in the AVOID trial
- pain associated with suspected STEMI

40
Q

Lignocaine
AVOID trial
Contraindications

A
  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
Q

Methoxyflurane

Pharmacology

A

Inhalation analgesic agent at low concentrations

42
Q

Methoxyflurane

Contraindications

A
  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
Q

Methoxyflurane

Precautions

A
  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
Q

Methoxyflurane

Side effects

A
  1. Drowsiness
  2. Decrease in BP and bradycardia
  3. Exceeding the max dose of 6ml in 24 hours may cause renal toxicity
45
Q

Midaz

Pharmacology

A

Short acting CNS depressant

Actions

  • anxiolytic
  • sedative
  • anti-convulsant
46
Q

Midaz

Indications

A
  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
Q

Midaz

Contraindications

A

Known hypersensitivity to benzodiazepines

48
Q

Midaz

Precautions

A
  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
Q

Midaz

Side Effects

A
  1. Depressed level of consciousness
  2. Resp depression
  3. Loss of airway control
  4. Hypotension
50
Q

Morphine

Pharmacology

A

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
Q

Morphine

Indications

A
  1. Pain relief
  2. Sedation to maintain intubation
  3. Sedation to facilitate intubation ( where fentanyl not appropriate for RSI - modified or paed IFS)
52
Q

Morphine

Contraindications

A
  1. History of hypersensitivity
  2. Renal impairment/failure
  3. Late second stage labour
53
Q

Morphine

Precautions

A
  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
Q

Morphine

Side effects

A

CNS

  • drowsiness
  • resp depression
  • euphoria
  • nausea, vomiting
  • addiction
  • pin point pupils

CV

  • hypotension
  • bradycardia
55
Q

Naloxone

Pharmacology

A

An opioid antagonist

Actions
Prevents or reverses the effects of opioids

56
Q

Naloxone

Indications

A

Altered conscious state and resp depression secondary to administration of opioids or related drugs.

57
Q

Naloxone

Contraindications

A

Nil of significance in the above setting

58
Q

Naloxone

Precautions

A
  1. If patient is known to be physically dependant on opioids, be prepared for a combative patient after administration
  2. Neonates
59
Q

Naloxone

Side effects

A

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
Q

Olanzapine

Pharmacology

A

An atypical antipsychotic - antagonist at multiple receptor sites, particularly serotonin (5-ht3), dopamine and histamine.

61
Q

Olanzapine

Indications

A

Mild agitation - patient can self administer

62
Q

Olanzapine

Contraindications

63
Q

Olanzapine

Precautions

A
  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
Q

Olanzapine

Significant interactions

A

Sedative medications/alcohol may lead to over sedation due to synergistic effects. Avoid combination where possible.

65
Q

Olanzapine

Side effects

A

CNS

  • sedation
  • drowsiness

OTHER
- extrapyramidal symptoms and QT prolongation are unlikely when administered at the approved dose.

66
Q

Ondansetron

Pharmacology

A

Anti-emetic

Actions
5-HT3 antagonist which blocks receptors both centrally and peripherally

67
Q

Ondansetron

Indications

A
  1. Undifferentiated nausea and vomiting
  2. Prophylaxis for spinally immobilised or eye injured patients
  3. Vestibular nausea in patients <21years
68
Q

Ondansetron

Contraindications

A
  1. Known hypersensitivity
  2. Concurrent apo-morphine use
  3. Known long QT syndrome
  4. Hypokalaemia or hypomagnesaemia
69
Q

Ondansetron

Precautions

A
  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
Q 
Ondansetron
Side effects (rare)
A
  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
Q

Ondansetron

Side effects common

A
  1. Constipation
  2. Headache
  3. Fever
  4. Dizziness
  5. Rise in liver enzymes
72
Q

Oxytocin

Pharmacology

A

A synthetic oxytocic

Actions
- stimulates smooth muscle of the uterus producing contractions

73
Q

Oxytocin

Indications

A

Primary post partum haemorrhage

74
Q

Oxytocin

Contraindications

A
  1. Previous hypersensitivity
  2. Severe toxaemia (pre-eclampsia)
  3. Exclude multiple pregnancy before administrations
  4. Cord prolapse
75
Q

Oxytocin

Precautions

A
  1. If given IV may cause transient hypotension

2. Concurrent use with methoxyflurane may cause hypotension

76
Q

Oxytocin

Side effects

A
  1. Tachycardia
  2. Bradycardia
  3. Nausea
77
Q

Paracetamol

Pharmacology

A

An analgesic, antipyretic agent

Actions
- exact mechanism of action is unknown, thought to inhibit prostaglandin synthesis in the CNS

78
Q

Paracetamol

Indications

A
  1. Mild pain

2. Headache

79
Q

Paracetamol

Contraindications

A
  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
Q

Paracetamol

Precautions

A
  1. Impaired hepatic function or liver disease
  2. Elderly/frail
  3. Malnourished
81
Q

Paracetamol

Side effects

A
  1. Hypersensitivity reactions including severe skin rashes (rare)
  2. Haematological reactions (rare)
82
Q

Prochlorperazine

Pharmacology

A

An anti-emetic agent

Actions
- acts on severe central neurotransmitter systems

83
Q

Prochlorperazine

Indications

A

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
Q

Prochlorperazine

Contraindications

A
  1. Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension)
  2. CNS depression
  3. Previous hypersensitivity
  4. Patients <21years
  5. Pregnancy
85
Q

Prochlorperazine

Precautions

A
  1. Hypotension
  2. Epilepsy
  3. Pts affected by alcohol or on anti-depressants
86
Q

Prochlorperazine

Side effects

A
  1. Drowsiness
  2. Blurred vision
  3. Hypotension
  4. Sinus tachycardia
  5. Skin rash
  6. Extrapyramidal reactions
87
Q

Salbutamol

Pharmacology

A

A synthetic bets adrenergic stimulant with primary beat 2 effects

Actions
- causes bronchodilation

88
Q

Salbutamol

Indications

A

Resp distress with suspected bronchospasm

  1. Asthma
  2. Severe allergic reaction
  3. COPD
  4. Smoke inhalation
  5. Oleoresin capsicum spray exposure
89
Q

Salbutamol

Contraindications

A

Nil of significant in the above setting

90
Q

Salbutamol

Precautions

A

Large doses have been reported to cause intracellular metabolic acidosis

91
Q

Salbutamol

Side effects

A
  1. Sinus tachycardia

2. Muscle tremor (common)

AV CPG's (11 decks)

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