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ASNSW ICP STUDY > Pharmacology Doses > Flashcards

Pharmacology Doses Flashcards

1
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1
Q

ADRENALINE - Dose

Cardiac Arrest

A

Patients ≥16 years of age

  • 1mg (10mL) 1:10,000 IV bolusRepeat every 2nd cycle (approx. 4 min)
  • 2mg (2mL) 1:1,000 ETT bolusRepeat every 2nd cycle (approx. 4 min) Maximum ETT dose: 10mg (10mL)

Following return of circulation post cardiac arrest
50mcg (0.5mL) 1:10,000 IV bolus every minute until systolic BP > 100mmHg or an adrenaline infusion is running

Patients < 16 years of age

  • 10mcg/kg (0.1mL/kg) 1:10,000 IV/IO bolus Repeat every 2nd cycle (approx. 4 min)
  • 100mcg/kg (0.1mL/kg) 1:1,000 ETT bolusRepeat every 2nd cycle (approx. 4 min) Maximum bolus dose 2mg (2mL) Maximum ETT dose: 5 total doses

ETT adrenaline must only be used if IV / IO access is unavailable

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2
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ADRENALINE - Dose

Adrenaline infusion

A

Patients >16 years of age

1mg (10mL) 1:10,000 diluted in 90mL Hartmann’s via burette with micro drip Commence 5mcg/min (30 drops per minute) and titrate whilst indications persist

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3
Q

ADRENALINE - Dose

Asthma & anaphylaxis

A

Patients≥ 16 years of age

500mcg (0.5mL) 1:1,000 IM into lateral aspect of thigh Repeat every 5 minutes whilst indications persist

100mcg (1mL) 1:10,000 IV bolus if unresponsive to IM injection
Repeat every minute whilst indications persist

Patients < 16 years of age

10mcg/kg (0.01mL/kg) 1:1,000 IM bolus into lateral aspect of thigh Repeat every 5 minutes whilst indications persist

10mcg/kg (0.1mL/kg) 1:10,000 IV bolus slowly if unresponsive to IM injection Maximum bolus dose 100mcg (1mL)
Repeat every 5 minutes whilst indications persist

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4
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ADRENALINE - Dose

Bradycardia

A

Patients ≥ 16 years of age

100mcg (1mL) 1:10,000 IV bolus

Repeat every minute until PR > 50 and perfusion is adequate or a continuous adrenaline infusion is running

ETT adrenaline must only be used if IV / IO access is unavailable

Patients < 16 years of age
10mcg/kg (0.1mL/kg) 1:10,000 IV/IO bolus slowly

Maximum bolus dose 100mcg
Repeat every 3 minutes whilst indications persist

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6
Q

ADRENALINE - Dose

Cardiogenic Shock

A

Patients ≥ 16 years of age

Adrenaline Infusion

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7
Q

ADRENALINE - Dose

Cardiogenic Shock

A

Patients ≥ 16 years of age

Adrenaline Infusion

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8
Q

ADRENALINE - Dose

Newborn care

A

Indication: HR < 60 per min despite effective CPR 10mcg/kg (0.1mL/kg) 1:10,000 IV/IO bolus Repeat every 4 minutes whilst indications persist

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9
Q

ADRENALINE - Dose

Severe croup

A

Patients < 16 years of age

500mcg/kg (0.5mL/kg) 1:1,000 Nebulised Maximum bolus dose: 5mg (5mL)
Repeat after 30 minutes whilst indications persist

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10
Q

AMIODARONE – dose

A

VF or pulseless VT

Patients ≥ 16 years of age
300mg (6mL) IV undiluted bolus
Repeat 150mg (3mL) IV undiluted bolus whilst indications persist Maximum dose: 450mg (9mL)

Patients < 16 years of age
5mg/kg (0.1mL/kg) undiluted IV bolus Repeat once whilst indications persist Maximum dose: 10mg/kg (0.2mL/kg)

Dysrhythmias - tachycardia

Patients ≥ 16 years of age
50mg (1mL) IV undiluted bolus
Repeat every 3 minutes whilst indications persist Maximum dose: 300mg (6mL)

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11
Q

ASPIRIN - Dose

A

Suspected acute coronary syndrome

Patients ≥ 16 years of age

** **300mg (1 tablet) chewed and swallowed, may be taken with a small amount of water if required

**Aspirin administration is not contraindicated by regular daily use of aspirin and/or warfarin **

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12
Q

ATROPINE - Dose Bradycardia

A

Patients ≥ 16 years of age
600mcg (1mL) IV undiluted bolus
Repeat every 60 seconds whilst indications persist Maximum dose: 3mg (5mL)

600mcg (1mL) IM undiluted bolus
Repeat every 3 minutes whilst indications persist Maximum dose: 3mg (5mL)

Patients < 16 years of age
20 mcg/kg (0.2mL/kg) IV/IO diluted bolus No repeat dose

20 mcg/kg (0.03mL/kg) IM undiluted bolus
No repeat dose

Paediatric initial bolus dose may exceed the bolus dose for ≥16 years of age

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13
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ATROPINE - Dose Organophosphate/nerve agent poisoning (auto injector)

A

Patients ≥ 16 years of age
2mg (AtroPen® Auto-Injector) IM bolus
Repeat every 3 minutes whilst indications persist Maximum dose: no maximum dose

Patients < 16 years of age
2mg (AtroPen® Auto-Injector) IM bolus
Repeat once after 30 minutes whilst indications persist Maximum dose: 4mg

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14
Q

CALCIUM GLUCONATE – dose

A

_ Hyperkalaemia_

Patients ≥ 16 years of age
1g (10mL) IV over 2 minutes

Patients < 16 years of age
20mg/kg (0.2mL/kg) IV/IO over 2 minutes Maximum bolus dose 1g (10mL)

Sodium bicarbonate and calcium gluconate precipitate when mixed together flush the line between administration of these drugs


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15
Q

FENTANYL - Dose

A

Adult and paediatric doses have been calculated to incorporate the dead space of the Mucosal Atomising Device (MAD), in the first administration (spray) which is 30mcg ‐ 0.1mL

Patients ≥16 years of age
240mcg IN spray in alternate nostrils

  • First spray 120mcg (0.4mL) ‐ patient receives 90mcg
  • Second spray 90mcg (0.3mL)
  • Third spray 60mcg (0.2mL)

Repeat 60mcg (0.2mL) every 5 minutes whilst indications persist

Patients with advanced age, smaller than average size and general debility should receive an initial dose of 120mcg IN spray in alternate nostrils

  • First spray 90mcg (0.3mL) ‐ patient receives 60mcg
  • Second spray 60mcg (0.2mL)

Repeat 60mcg (0.2mL) every 5 minutes whilst indications persist

Patients 6 to < 16 years of age

75mcg IN spray

  • First spray 105mcg (0.35mL) ‐ patient receives 75mcg
    • Repeat every 5 minutes 30mcg (0.1mL) whilst indications persist

Patients 4 to < 6 years of age

30mcg (0.1mL) IN

  • First spray 60mcg (0.2mL) ‐ patient receives 30mcg
    • Repeat every 5 minutes 30mcg (0.1mL) whilst indications persist
    • Maximum dose: 90mcg (0.3mL) total

This regime may be repeated after 30 minutes whilst indications persist

Patients 1 to < 4 years of age

30mcg (0.1mL) IN

  • First spray 60mcg (0.2mL) ‐ patient receives 30mcg
    • Repeat every 10 minutes 30mcg (0.1mL) whilst indications persist
    • Maximum dose: 90mcg (0.3mL) total

This regime may be repeated after 30 minutes whilst indications persist

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16
Q

FEXOFENADINE - Dose

A

Patients ≥ 12 years of age

180mg (1 tablet) PO

  • Maximum dose: 180mg (1 tablet) in 24 hours
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17
Q

FRUSEMIDE - Dose

A

Cardiogenic pulmonary oedema

**Patients ≥ 16 years of age **

40mg (4mL) IV/IM, for patients not taking oral diuretics
Repeat once after 10 minutes whilst indications persist
Maximum dose: 80mg (8mL)

80mg (8mL) IV/IM, for patients already taking oral diuretics
Repeat once after 10 minutes whilst indications persist
Maximum dose: 160mg (16mL)

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18
Q

GLUCAGON - Dose

A

**Patients > 16 years of age **
1mg (1mL) of reconstituted solution SC/IM
Patients < 16 years of age
500mcg (0.5mL) of reconstituted solution SC/IM

When the patient regains consciousness give food to prevent recurrence of hypoglycaemia. Carbohydrates constitute the main source of energy for all body
functions especially the brain. Cereals, vegetables, fruits, rice, potatoes, legumes and flour products are the main source of carbohydrates

19
Q

GLUCOSE 10% - Dose

A

Patients ≥ 11 years of age

15g (150mL) IV bolus

  • Repeat every 3 minutes 10g (100mL) IV whilst indications persist
  • Maximum dose: no maximum dose

Patients < 11 years of age

  1. 5g/kg (5mL/kg) IV bolus
    * Maximum bolus dose 15g
    * Repeat 0.5g/kg (5mL/kg) IV bolus whilst indications persist
    * Maximum dose: no maximum dose

Newborn

Indication: BGL < 3mmol/L

  1. 25g/kg (2.5mL/kg) IV/IO bolus
    * Repeat whilst indications persist

**IV line must be flushed with 10ml 0.9% normal saline at the completion of administration or prior to the administration of other medications **

20
Q

GLUCOSE GEL - Dose

A

Hypoglycaemia

  • Patients ≥ 2 years of age

15g (37.5g tube) PO
Repeat once after 15 minutes whilst indications persist
Maximum dose: 30g

**Give the patient food to prevent recurrence of hypoglycaemia. Carbohydrates constitute the main source of energy for all body functions especially the brain. Cereals, vegetables, fruits, rice, potatoes, legumes and flour products are the main source of carbohydrates **

21
Q

GLYCERYLTRINITRATE - Dose

A

Suspected acute coronary syndrome

Patients ≥ 16 years of age_ _
600mcg (1 tablet) SL
Repeat every 5 minutes, monitor BP
Maximum dose: 1.8mg (3 tablets)
This regime can be repeated 30 minutes after last administration, if indicated

Cardiogenic pulmonary oedema
Patients ≥ 16 years of age
600mcg (1 tablet) SL
Repeat every 5 minutes, monitor BP closely
Maximum dose: 1.8mg (3 tablets)
This regime can be repeated 30 minutes after last administration, if indicated

Autonomic dysreflexia
Patients ≥ 16 years of age
300mcg (½ tablet) SL
Repeat every 5 minutes, monitor BP closely
Maximum dose: 900mcg (1.5 tablets)

**Note: Patients with advanced age, smaller than average size or general debility should receive an initial dose of 300mcg (half a tablet) with subsequent doses of either 300mcg or 600mcg depending on response to a max of 1.8mg (3 tablets) **

22
Q

HARTMANN’S - Dose

Burns

A

All Ages
Indication: TBSA > 25%
10mL/kg IV/IO bolus over one hour

Repeat every hour

23
Q

HARTMANN’S - Dose

Rehydration/Fluid Replacement

A

All ages

Newborns with failure to respond to CPR and adrenaline

10mL/kg IV or IO
No repeat dose

24
Q

HARTMANN’S - Dose

Keep IV patent and flush medications

A

All ages
Flush medications with 10-20mL IV

Use caution when flushing medications in patients < 16 years of age as excessive volume administration may inadvertently occur

25
Q

HARTMANN’S - Dose

Traumatic hypovolaemia (with head injury)

A

Patients ≥ 16 years of age
Indication: Systolic BP
250mL IV bolus

  • Repeat until systolic BP ≥100 mmHg
  • This regime should be repeated to maintain systolic BP ≥100 mmHg

Patients < 16 years of age

Indications:

≥ 13 years of age systolic BP ≤ 100mmHg

6 - 13 years of age systolic BP ≤ 90mmHg

1 – < 6 Year of age systolic BP ≤ 80mmHg

< 1 year of age systolic BP ≤ 70mmHg

5mL/kg IV bolus

  • Maximum bolus dose: 250mL
  • Repeat whilst indications persist to maintain BP of the age range
  • Maximum dose: no maximum dose

Hypotension in traumatic brain injury is associated with poorer outcomes

26
Q

HARTMANN’S - Dose

Traumatic hypovolaemia (no head injury)

A

Patients ≥ 16 years of age

Indication: Absent radial pulse

250mL IV bolus repeated until radial pulse is restored

  • Repeat whilst indications persist
  • Maximum dose: no maximum dose

Patients < 16 years of age

Indication:

≥ 13 years of age systolic BP ≤ 90mmHg

6 -

1 – < 6 Year of age systolic BP ≤ 70mmHg

< 1 year of age systolic BP ≤ 60mmHg

5mL/kg IV bolus

  • Repeat whilst indications persist
  • Maximum dose: no maximum dose
27
Q

HARTMANN’S - Dose

Non Traumatic Hypovolaemia

A

All Ages Indications:

  • ≥ 2 key signs of shock
  • suspected sepsis patient with hypotension
  • anaphylaxis with hypotension

20mL/kg IV bolus
Repeat whilst indications persist

Maximum dose: No maximum dose

28
Q

HARTMANN’S - Dose

Cardiogenic shock

A

Patients ≥ 16 years of age
Indication: Haemodynamic compromise and systolic BP

10mL/kg IV bolus
Repeat once 10mL/kg per hour whilst indications persist

29
Q

IPRATROPIUM BROMIDE - Dose

A

Moderate to severe asthma and COPD

Patients ≥ 6 years of age

500mcg (1mL) nebulised mixed with salbutamol

  • Repeat once whilst indications persist
  • Maximum dose: 1mg (2mL)

Patients < 6 years of age

250mcg (1mL) nebulised mixed with salbutamol

  • Repeat once whilst indications persist
  • Maximum dose: 500mcg (2mL)
30
Q

LIGNOCAINE – dose

A

VF or pulseless VT unresponsive to Amiodarone

  • Patients ≥ 16 years of age

100mg (5mL) Lignocaine 2% IV bolus Repeat once whilst indications persist Maximum dose: 200mg (10mL)

  • Patients < 16 years of age

1mg/kg (0.05mL/kg) Lignocaine 2% IV/IO bolus Repeat once whilst indications persist Maximum dose: 200mg (10mL)

For local anaesthesia prior to cannulation inject a small amount of lignocaine 1% subcutaneously until the skin is raised slightly

31
Q

METHOXYFLURANE - Dose

A

Patients ≥ 1 years of age

3mL inhaled via inhaler

  • May be repeated once whilst indications persist
  • Maximum dose: 6mL (daily), 15mL (weekly)

Do not put any more than 3mL in inhaler at any time as this increases risk of droplet inhalation. Do not use oxygen in conjunction with the inhaler

Methoxyflurane can only be administered twice in any one shift per paramedic. Only 3ml of methoxyflurane can be administered at any one time in
the back of the ambulance

32
Q

METOCLOPRAMIDE – Dose

A

Severe nausea or vomiting

patients greater than or equal to 16 years of age

10mg (2mL) IM/IV Bolus

maximum dose: 10mg (2 mL)

Metoclopramide is only to be administered if Ondansetron is contraindicated or ineffective after 10 minutes

33
Q

MIDAZOLAM -Dose

Seizures

A

Patients ≥ 16 years of age

2.5mg (2.5mL) IV diluted slow bolus

  • Repeat every 3 minutes whilst indications persist
  • Maximum dose: 15mg (15mL)

5mg (1mL) IM undiluted bolus

  • Repeat every 5 minutes whilst indications persist
  • Maximum dose: 15mg (3mL)

Patients < 16 years of age

0.3mg/kg (0.06mL/kg) IN undiluted bolus via mucosal atomising device

  • Maximum bolus dose 5mg (1mL)
  • IN bolus dose may not be repeated
  • Maximum dose: 0.3mg/kg (0.06mL/kg)

0.15mg/kg (0.03mL/kg) IM undiluted bolus if a vein is not available

  • Maximum bolus dose 5mg (1mL)
  • Repeat every 5 minutes whilst indications persist
  • Maximum of 3 doses (0.45mg/kg total)

0.15mg/kg (0.15mL/kg) IV diluted bolus

  • Maximum bolus dose 2.5mg(2.5mL)
  • Repeat every 3 minutes whilst indications persist
  • Maximum 3 doses (0.45mg/kg total)
34
Q

MIDAZOLAM -Dose

Limb realignment/difficult extrication

A

Patients ≥ 16 years of age

1mg (1mL) IV diluted bolus

  • Repeat every 3 minutes whilst indications persist
  • Maximum dose: 5mg (5mL)
35
Q

MIDAZOLAM -Dose

Patient management

A

Patients ≥ 16 years of age

2.5mg (2.5mL) IV diluted bolus

  • Repeat every 3 minutes whilst indications persist
  • Maximum dose: 15mg (15mL)

5mg – 10mg (1mL – 2mL) IM undiluted bolus

  • Repeat every 5 minutes whilst indications persist
  • Maximum dose: 15mg (3mL)

Patients < 16 years of age

0.15mg/kg (0.03mL/kg) IM undiluted bolus if a vein is not available

  • Maximum bolus dose 5mg (1mL)
  • Repeat every 5 minutes whilst indications persist
  • Maximum dose: 3 doses total (0.45mg/kg total)

0.15mg/kg (0.15mL/kg) IV diluted bolus

  • Maximum bolus dose 2.5mg (2.5mL)
  • Repeat every 3 minutes whilst indications persist
  • Maximum dose: 3 doses total (0.45mg/kg total)
36
Q

MIDAZOLAM -Dose

Post intubation sedation

A

**10mg (1mL) MORPHINE mixed with 10mg (2mL) MIDAZOLAM and diluted with 7mL 0.9% normal saline to make MORPHINE/MIDAZOLAM SOLUTION (10mL) 1mL = 1mg morphine and 1 mg midazolam **

Patients ≥ 16 years of age

2.5mL IV morphine/midazolam solution every 3 minutes

  • Maximum dose: 15mL morphine/midazolam solution
  • This regime can be repeated every 20 minutes after last administration, whilst indications persist

5mL IM bolus morphine/midazolam solution if IV not available

  • May be repeated every 15 minutes, if indication persist
  • Maximum dose: 15mL morphine/midazolam solution

**Patients < 16 years of age **

0.1mL/kg IV/IO bolus morphine/midazolam solution

  • Repeat every 3 minutes whilst indications persist
  • Maximum dose: 3 doses total morphine/midazolam solution
  • This regime can be repeated every 20 minutes after last administration
  1. 1mL/kg IM bolus morphine/midazolam solution
    * Repeat every 15 minutes whilst indications persist
37
Q

MORPHINE - Dose

Pain Management

A

Patients ≥ 16 years of age

2.5mg – 5mg (2.5mL – 5mL) IV diluted bolus
Repeat every 2 minutes whilst indications persist
Maximum dose: 0.5mg/kg
This regime can be repeated 30 minutes after last administration

5mg-10mg (0.5mL-1mL) IM undiluted bolus
Repeat once after 15 minutes whilst indications persist
Maximum dose: 20mg (2mL)
IM morphine should only be used where IV access or IN fentanyl is not available

Patients ≥ 6months to < 16 years of age
100 mcg/kg (0.1mL/kg) IV/IO diluted bolus
Repeat every 5 minutes whilst indications persist
Maximum dose: 4 doses total
This regime can be repeated 30 minutes after last administration whilst indications persist
100mcg/kg (0.01mL/kg) IM undiluted bolus if IV access is not available
Repeat once after 15 minutes whilst indications persist

Paediatric dose is not to exceed adult dose

IM absorption may be delayed in hypovolaemia or burns with TBSA > 15% . Rapid absorption may occur when perfusion is restored


NOTE: Patients with head injuries, chronic airway limitation, advanced age smaller than average size or general debility must have their initial doses halved however maximum doses remains unchanged

38
Q

MORPHINE - Dose

Post intubation sedation

A

10mg (1mL) Morphine mixed with 10mg (2mL) Midazolam and diluted with 7mL 0.9% normal saline to make Morphine/Midazolam Solution (10mL)
1mL = 1mg morphine and 1 mg midazolam

Patients ≥ 16 years of age

2.5mL IV morphine/midazolam solution every 3 minutes

Maximum dose: 15mL morphine/midazolam solution

This regime can be repeated every 20 minutes after last administration, whilst indications persist

5mL IM bolus morphine/midazolam solution if IV not available
May be repeated every 15 minutes, whilst indications persist

Maximum dose: 15mL morphine/midazolam solution

  • *Patients >6 months and < 16 years of age**
    0. 1mL/kg IV/IO bolus morphine/midazolam solution

Repeat every 3 minutes whilst indications persist

Maximum dose: 3 doses total morphine/midazolam solution

This regime can be repeated every 20 minutes after last administration

0.1mL/kg IM bolus morphine/midazolam solution
Repeat every 15 minutes whilst indications persist Maximum dose: 3 doses total morphine/midazolam solution

IM absorption may be delayed in hypovolaemia or burns with TBSA > 15% . Rapid absorption may occur when perfusion is restored


NOTE: Patients with head injuries, chronic airway limitation, advanced age smaller than average size or general debility must have their initial doses halved however maximum doses remains unchanged

39
Q

NALOXONE - Dose

Etorphine or Buprenorphine reversal

A

Patients ≥ 16 years of age
2mg (5mL) IV/IM undiluted bolus
Repeat every 5 minutes whilst indications persist

IV is the preferred route in this circumstance

Patients ≥ 30 days of age to < 16 years of age
10mcg/kg (0.10mL/kg) IM/IV diluted bolus

Repeat every 5 minutes whilst indications persist

IV is the preferred route in circumstances where large doses are required

40
Q

NALOXONE - Dose

Opioid Overdose

A

Patients ≥ 16 years of age
100mcg (1mL) IV diluted bolus
Repeat every 2 minutes whilst indications persis

Patients ≥ 30 days years of age to < 16 years of age
5mcg/kg (0.05mL/kg) IV/IM diluted bolus
Maximum bolus dose 100mcg (1mL)
Repeat every 5 minutes whilst indications persist

41
Q

NALOXONE - Dose

Life threatening opioid overdose

A

Patients ≥ 16 years of age
800mcg (2mL) IV/IM undiluted bolus

Repeat 400mcg (1mL) bolus every 2 minutes whilst indications persist

Maximum dose: 2mg (5mL)

Patients ≥ 30 days of age to < 16 years of age
10mcg/kg (0.10mL/kg) IV/IM diluted bolus
Maximum bolus dose 400mcg (4mL)
Repeat every 2 minutes whilst indications persist

42
Q

ONDANSETRON -Dose

A

Patients ≥ 8 years of age

4mg (2mL) IM/IV bolus

  • Maximum dose: 4mg (2mL)

Patients ≥ 2 years of age to < 8 years of age

2mg (1mL) IM/IV bolus

  • Maximum dose: 2mg (1mL)

Slow IV administration is preferred IM use only when IV not available

43
Q

SALBUTAMOL - Dose

A

Relieve bronchospasm

Patients ≥ 5 years of age

5mg (2.5mL) via nebuliser at 8 litres/min oxygen

Repeat whilst indications persist

Maximum dose: no maximum dose

Patients < 5 years of age

2.5mg (2.5mL) via nebuliser at 8 litres/min oxygen

Repeat whilst indications persist

Maximum dose: no maximum dose

If patient is severe/life threatening do not wait on scene for salbutamol to be effective

Because two concentrations are available, read the label carefully and check this with your partner

44
Q

SODIUM BICARBONATE – dose

A

_ Hyperkalaemia and try sc tricyclic overdose_

All patients
1mmol/kg (1mL/kg) IV bolus
Maximum bolus dose: 100mmol (100mL)

Sodium bicarbonate and calcium gluconate precipitate when mixed together. Flush the line between administrations of these drugs.


_ Generic_ -Tricyclic medications ‐ Brand
Amitriptyline Endep®, Tryptanol®
Clomipramine Anafranil®, Placil®
Dothiepin Dothep®, Prothiaden®
Doxepin Deptran®, Sinequan®
Imipramine Tolerade®, Tolfranil®
Nortriptyline Allegron®
Trimipramine Surmontil®

ASNSW ICP STUDY (10 decks)

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