Pharmocolgies Flashcards
Adrenaline - Actions
Action
- Stimulates the ALPHA and BETA receptors of the sympathetic nervous system to produce the “Fight” or “Flight” reaction
- ALPHA stimulation causes peripheral vasoconstriction. It raises the perfusion pressure of vital organs during cardiac arrest and it decreases capillary permeability and increases blood pressure in anaphylaxis
- BETA 1 stimulation causes increased myocardial excitability, tachycardia, and increased myocardial contractility
- BETA 2 stimulation causes bronchodilation
Adrenaline - Uses
Use
C3 - Cardiac arrest C7 - Bradycardia C6 - Cardiogenic shock M4 - Asthma M16 - Anaphylaxis M7 - Croup O6 - Newborn resuscitation
Adrenaline - Adverse Effects
Adverse Effects
Tachycardia Dysrhythmias, including ventricular fibrillation Hypertension Pupillary dilation Anxiety Nausea and vomiting
Adrenaline - Preparation and Onset, Peak, Duration
Preparation
1mg in 1mL ampoule (1:1,000)
1mg in 10mL ampoule (1:10,000)
Onset Peak Duration IM 30-90 sec 4-10 min 5-10 min IV 30 sec 3-5 min 5-10 min NEB 1-5 min n/a Up to 20 min
Adrenaline - Infusion
Adrenaline infusion
Patients ≥ 16 years of age
Preparation: 1mg (10mL) 1:10,000 diluted in 90mL compound sodium lactate via burette with micro drip
Commence 5mcg/min (30 drops per min) and titrate whilst indicated
Adrenaline - Cardiac Arrest >16yrs
Cardiac arrest
Patients ≥ 16 years of age
1mg (10mL) 1:10,000 IV bolus
Repeat every 2nd cycle (approx. 4 min)
Maximum dose: no max
Note: During interhospital transports paramedics unable to obtain IV access may use existing IO access, if available.
2mg (2mL) 1:1,000 ETT bolus
Repeat every 2nd cycle (approx. 4 min)
Maximum 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.
Adrenaline - Cardiac Arrest <16yrs
Patients < 16 years of age
10mcg/kg (0.1mL/kg) 1:10,000 IV/IO bolus
Repeat every 2nd cycle (approx. 4 min)
Maximum dose: No max
100mcg/kg (0.1mL/kg) 1:1,000 ETT¹ bolus Repeat every 2nd cycle (approx. 4 min) Maximum bolus dose 2mg (2mL) Maximum ETT dose: 5 total doses ¹ Patients < 1 year of age should have ETT dose diluted to 1mL in total with sodium chloride 0.9%
Adrenaline - Severe/life threatening asthma
Severe / life threatening asthma
Patients ≥ 16 years of age
500mcg (0.5mL) 1:1,000 IM into lateral aspect of thigh
Repeat every 5 minutes whilst indicated
Maximum dose: no max
100mcg (1mL) 1:10,000 IV bolus if unresponsive to IM injection
Repeat every minute whilst indicated
Maximum dose: no max
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 indicated
Maximum dose: No max
10mcg/kg (0.1mL/kg) 1:10,000 IV bolus slowly if unresponsive to IM injection
Repeat every 5 minutes whilst indicated
Maximum bolus dose 100mcg (1mL)
Maximum dose: No max
Adrenaline - Anaphylaxis Severe/ Life Threatening
Severe / life threatening anaphylaxis
Patients ≥ 16 years of age
500mcg (0.5mL) 1:1,000 IM² bolus into lateral aspect of thigh
Repeat every 5 minutes whilst indicated
Maximum dose: no max
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 indicated
Maximum dose: No max
*Adrenaline infusion is indicated for all patients ≥ 16 years of age unresponsive to a mininum of 4 IM injections (Authorised Paramedics Only)
Adrenaline - Croup
Severe croup
Patients < 16 years of age
500mcg/kg (0.5mL/kg) 1:1,000 NEB
Repeat 30 minutes if indicated
Maximum bolus dose: 5mg (5mL)
Maximum dose: No maximum
Aspirin - Type, action, onset, peak, duration, uses
Type: Non-steroidal anti-inflammatory drug
Action
Inhibits platelet aggregation thereby limiting thrombus enlargement in acute coronary syndrome
Reduces production of prostaglandins thereby relieving pain and fever
Route Onset Peak Duration
PO 2-10 min N/A 3-6 hrs
Use
C1 - Acute coronary syndrome
Aspirin - Adverse Effects, Contraindications, Prep
Adverse effects
Allergic reactions, e.g. asthma, angioneurotic oedema, rhinitis, urticaria, laryngeal oedema and shock. Always check for history of previous reaction
Aggravation of any bleeding tendency
Gastric irritation (unlikely to be significant with one tablet)
Bleeding may take longer to stop
Contraindications
Allergy or hypersensitivity to aspirin
Active, suspected or known bleeding tendency
Patients < 16 years of age
Patients meeting T1 Major Trauma criteria
Preparation
300mg tablet
Aspirin - Dose
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
No repeat
Maximum dose: 1 dose
Aspirin administration is not contraindicated in patients with regular daily use of aspirin and/or warfarin.
Benzyl Penicillin - Type, Action, Use, Adverse Effects
Benzyl Penicillin
Type: Antibiotic active against a range of bacteria
Action
Inhibits bacterial cell wall synthesis and causes cytolysis when the bacterium tries to divide
Use
M13 - Meningococcal septicaemia
Adverse effects
Hypersensitivity reactions may occur (including urticaria, angio-oedema, convulsions and anaphylaxis)
Benzyl Penicillin - Contraindications, Prep
Contraindication
Life threatening allergic reaction to penicillin
Preparation
600mg as a powder
IV/IO Administration: Dissolve 600mg in 10mL sodium chloride 0.9%
IM Administration: Dissolve 600mg in 2mL sodium chloride 0.9%
Note: Volume may vary after reconstitution
Benzyl Penicillin - Dose
Meningococcal septicaemia
Age Route Dose Volume
<1 year IV/IO 300mg 5mL
1-<10 years IV/IO 600mg 10mL
≥10 years IV/IO 1200mg 20mL
Age. Route Dose Volume
<1 year. IM 300mg 1mL
1-<10 years IM 600mg 2mL
≥10 years IM 1200mg 4mL
All ages: No repeat dose, maximum dose: 1 dose
Clopidogrel - Type, Action, OPD, Uses
Clopidogrel
Type: Platelet receptor antagonist
Actions
Clopidogrel is a specific and potent inhibitor of platelet aggregation and limits propagation of thrombus by selectively inhibiting the binding of ADP to its platelet receptor
Clopidogrel is absorbed from the stomach and upper small bowel and begins to inhibit platelet function within 30 minutes
Route Onset Peak Duration
PO 2-10 min N/A 3-6 hrs
Uses
C13 - Cardiac reperfusion - Prehospital thrombolysis
Clopidogrel - Adverse Effects, Contraindications, Prep
Adverse effects
Allergic reactions (e.g. asthma, angioneurotic oedema, rhinitis, urticaria, laryngeal oedema and shock). Always check for history of previous reaction Aggravation of any bleeding tendency Gastric irritation (unlikely to be significant with current doses) Bleeding may take longer to stop
Contraindications
Active or suspected or known bleeding tendency
Allergy or hypersensitivity to clopidogrel
Any exclusion via pre thrombolysis checklist
Patients < 18 years of age
Pregnancy or breastfeeding
Preparation
75mg tablet
Clopidogrel - Dose
Acute STEMI thrombolysis
Patients ≥ 18 - < 74 years of age
300mg (4 tablets) PO
No repeat
Maximum dose: 1 dose
Patients ≥ 74 years of age
75mg (1 tablet) PO
No repeat
Maximum dose: 1 dose
Warfarin and regular daily use of clopidogrel is not a contraindication to clopidogrel administration
Compound Sodium Lactate - Type, Action, Uses
Compound Sodium Lactate
Type: Crystalloid solution containing sodium chloride, calcium and potassium and lactate.
Action
Following intravenous infusion it is distributed throughout the extracellular fluid space, approximately 25% of the volume infused stays in the intravascular space for a variable period of time
Use
C6 - Cardiogenic shock C9 - Hyperkalaemia M8 - Dehydration M21 - Hyperglycaemia M25 - Medical hypoperfusion/hypovolaemia: M13 - Meningococcal septicaemia M16 - Anaphylaxis M23 - Sepsis E2 - Diving emergencies T10 - Traumatic hypovolaemia T23 - Trauma in pregnancy with any key sign of shock T12 - Burns T15 - Trapped patient
Compound Sodium Lactate - Adverse Effects, Prep, Admin
Adverse effects
Pulmonary oedema
Hypothermia
When given in excess can contribute to coagulopathies (hypothermic & dilutional) and exacerbate acidosis
Preparation
500mL bag
Administration
Patients ≥ 16 years of age via pump set
Patients < 16 years of age via autostart burette and pump set
Hartmanns - Dose - Burns, Traumatic Hypovolaemia
Burns
Indication:
> 20% TBSA - Patients ≥ 16 years of age > 10% TBSA - Patients < 16 years of age 10mL/kg IV bolus Repeat 10mL/kg per hour whilst indicated Maximum dose: No max
Traumatic hypovolaemia
Patients ≥ 16 years of age
Indication:
Absence of a radial pulse for non head injured patients and Systolic BP < 100mmHg in head injured patients
250mL IV bolus
Repeat 250mL bolus until radial pulse is restored (no head injury) or BP > 100mmHg sys (with head injury)
Patients ≤ 16 years of age
Indication:
Any key sign of shock
10mL/kg IV/IO bolus
Repeat 10mL/kg bolus to maintain BP within age range:
≥ 13 years of age:
100mmHg
6 - < 13 years of age:
90mmHg
1 - < 6 years of age:
80mmHg
< 1 year of age:
70mmHg
Maximum dose: No max
Hypotension in traumatic brain injury is associated with poor outcomes
Morphine basic info
Morphine
Type: Opioid analgesic
Action
Decreases pain perception and anxiety Causes peripheral vasodilation Route Onset Peak Duration IM 5-10 min 25-40 min 1-2 hrs IV 2-5 min 10 min 1-2 hrs Use
A6 - Pain management
Post intubation sedation
Adverse effects
↓ LOC Respiratory depression Hypotension Nausea and vomiting Contraindications Altered LOC (V,P or U with the exception of patients requiring post intubation sedation) Allergy or hypersensitivity to morphine < 40 weeks corrected age
Morphine prep and dose
Preparation
10mg in 1mL ampoule
10mg in 1mL ampoule diluted to 10mL with 9mL sodium chloride 0.9% (1mg:1mL)
Post intubation sedation: 10mg (1mL) morphine mixed with 10mg (2mL) midazolam and diluted with 7mL sodium chloride 0.9% to make morphine/midazolam solution (1mL = 1mg morphine and 1mg midazolam)
Note: During active labour morphine (IM dose only) may be administered if methoxyflurane is ineffective. Neonatal respiratory depression may occur therefore neonatal resuscitation equipment must be readily available.
Note: This pharmacology contains full doses. Consideration should be given to the administration of half the stated doses to patients with limited physiological reserves.
Pain management
Patients ≥ 16 - < 65 years of age
2.5 - 5mg (2.5 - 5mL) IV diluted bolus
Repeat every 5 min whilst indicated
Maximum dose: 0.5mg/kg
This regime may be repeat 30 min after last administration if indicated
5 - 10mg (0.5 - 1mL) IM undiluted bolus
Repeat once after 15 min whilst indicated
Maximum dose: 2 doses
IM morphine should only be used where IV access or IN fentanyl is not available
Patients ≥ 65 years of age
1.25 - 2.5mg (1.25 - 2.5mL) IV diluted bolus
Repeat every 5 min whilst indicated
Maximum dose: 0.25mg/kg
This regime may be repeated 30 min after last administration if indicated
2.5 - 5mg (0.25 - 0.5mL) IM undiluted bolus
Repeat once after 15 min whilst indicated
Maximum dose: 2 doses
IM morphine should only be used where IV access or IN fentanyl is not available
Patients ≥ 1 - < 16 years of age
100mcg/kg (0.1mL/kg) IV/IO diluted bolus
Repeat every 5 min whilst indicated
Maximum dose: 0.5mg/kg
This regime may be repeated 30 min after last administration if indicated
100mcg/kg (0.01mL/kg) IM undiluted bolus
Repeat once after 15 min whilst indicated
Maximum dose: 2 doses
Patients Birth to < 1 year of age
100mcg/kg (0.1mL/kg) IM diluted bolus
Repeat once after 30 min whilst indicated
Maximum dose: 2 doses
Paramedics should adopt a conservative approach to the administration of analgesia in patients < 1 year of age. Where ever possible the patients actual weight should be ascertained to support medication calculation
Post intubation sedation
Patients ≥ 16 years of age
2.5mL IV morphine/midazolam solution bolus
Repeat every 3 min whilst indicated
Maximum dose: 15mL morphine/midazolam solution
This regime may be repeated 20 min after last administration if indicated
5mL IM morphine/midazolam solution if IV not available
Repeat every 15 min whilst indicated
Maximum dose: 15mL morphine/midazolam solution
Patients ≥ 6 months to < 16 years of age
0.1mL/kg IV/IO morphine/midazolam solution bolus
Repeat every 3 min whilst indicated
Maximum dose: 3 doses
This regime may be repeated 20 min after last administration if needed
0.1mL/kg IM morphine/midazolam solution bolus
Repeat every 15 min whilst indicated
Maximum dose: 3 doses
Clopidogrel
Type
Clopidogrel
Type: Platelet receptor antagonist
Actions
Clopidogrel is a specific and potent inhibitor of platelet aggregation and limits propagation of thrombus by selectively inhibiting the binding of ADP to its platelet receptor
Clopidogrel is absorbed from the stomach and upper small bowel and begins to inhibit platelet function within 30 minutes
Clopidogrel - uses, adverse effects
Uses
C13 - Cardiac reperfusion - Prehospital thrombolysis
Adverse effects
Allergic reactions (e.g. asthma, angioneurotic oedema, rhinitis, urticaria, laryngeal oedema and shock). Always check for history of previous reaction Aggravation of any bleeding tendency Gastric irritation (unlikely to be significant with current doses) Bleeding may take longer to stop
Clopidogrel - contraindications, prep
Contraindications
Active or suspected or known bleeding tendency
Allergy or hypersensitivity to clopidogrel
Any exclusion via pre thrombolysis checklist
Patients < 18 years of age
Pregnancy or breastfeeding
Preparation
75mg tablet
Clopidogrel - dose
Acute STEMI thrombolysis
Patients ≥ 18 - < 74 years of age
300mg (4 tablets) PO
No repeat
Maximum dose: 1 dose
Patients ≥ 74 years of age
75mg (1 tablet) PO
No repeat
Maximum dose: 1 dose
Warfarin and regular daily use of clopidogrel is not a contraindication to clopidogrel administration
Sodium compound lactate - type, action
Compound Sodium Lactate
Type: Crystalloid solution containing sodium chloride, calcium and potassium and lactate.
Action
Following intravenous infusion it is distributed throughout the extracellular fluid space, approximately 25% of the volume infused stays in the intravascular space for a variable period of time
Sodium compound lactate - uses
Use
C6 - Cardiogenic shock C9 - Hyperkalaemia M8 - Dehydration M21 - Hyperglycaemia M25 - Medical hypoperfusion/hypovolaemia: M13 - Meningococcal septicaemia M16 - Anaphylaxis M23 - Sepsis E2 - Diving emergencies T10 - Traumatic hypovolaemia T23 - Trauma in pregnancy with any key sign of shock T12 - Burns T15 - Trapped patient
Compound sodium lactate - adverse effects, prep
Adverse effects
Pulmonary oedema
Hypothermia
When given in excess can contribute to coagulopathies (hypothermic & dilutional) and exacerbate acidosis
Preparation
500mL bag
Administration
Patients ≥ 16 years of age via pump set
Patients < 16 years of age via autostart burette and pump set
Compound sodium lactate - dose
Burns
Indication:
> 20% TBSA - Patients ≥ 16 years of age > 10% TBSA - Patients < 16 years of age 10mL/kg IV bolus Repeat 10mL/kg per hour whilst indicated Maximum dose: No max
Traumatic hypovolaemia
Patients ≥ 16 years of age
Indication:
Absence of a radial pulse for non head injured patients and Systolic BP < 100mmHg in head injured patients
250mL IV bolus
Repeat 250mL bolus until radial pulse is restored (no head injury) or BP > 100mmHg sys (with head injury)
Patients ≤ 16 years of age
Indication:
Any key sign of shock
10mL/kg IV/IO bolus
Repeat 10mL/kg bolus to maintain BP within age range:
≥ 13 years of age:
100mmHg
6 - < 13 years of age:
90mmHg
1 - < 6 years of age:
80mmHg
< 1 year of age:
70mmHg
Maximum dose: No max
Hypotension in traumatic brain injury is associated with poor outcomes
Trauma in pregnancy
Indication:
Trauma with any key sign of shock
Patients all ages:
250mL IV bolus
Repeat whilst indicated to maintain BP > 90mmHg
Maximum dose: No max
Medical hypoperfusion/hypotension
Patients all ages:
Indications:
≥ 2 key signs of shock Meningococcal septicaemia Suspected sepsis patient with hypotension Moderate to severe anaphylaxis 20mL/kg IV bolus Repeat whilst indicated Maximum dose: No max
Cardiogenic shock
Patients ≥ 16 years of age
Indication:
Haemodynamic compromise and systolic BP < 90mmHg
10mL/kg IV bolus
Repeat once 10mL/kg per hour whilst indicated and Pt is unresponsive to adrenaline infusion
Maximum dose: 2 doses
Trapped patients / hyperkalaemia / hypergylcaemia
Patients all ages:
10mL/kg IV bolus
Repeat whilst indicated
Maximum dose: No max
Dehydration
All patients:
10mL/kg IV bolus
No repeat
Maximum dose: 1 dose
Newborn resusciation
Newborn patients:
Indication:
Pt unresponsive to CPR and adrenaline
10mL/kg IV/IO bolus
No repeat
Maximum dose: 1 dose
Use caution when flushing medications in patients < 16 years of age as excessive volume administration may inadvertently occur.
Droperidol - type, action, onset
Droperidol
Type: Neuroleptic
Action
Droperidol produces marked tranquillisation and sedation
May ↓ BP due to direct vasodilatory effect and alpha block
Droperidol potentiates other CNS depressants, e.g. narcotic analgesics such as fentanyl and benzodiazepines such as midazolam
Route Onset Peak Duration
IM 3-10 min Up to 30 min 2-4 hours
Droperidol - adverse effects, contraindications
Extrapyramidal reactions
Rarely, neuroleptic malignant syndrome (characterised by muscular rigidity, fever, hyperthermia, altered consciousness, and autonomic instability)
Contraindications
Patients with known or suspected hypersensitivity to droperidol
Patients with known or suspected or potential head injury
Patients < 14 years of age
Patients with Parkinson’s disease
