Pharmocology

Question 1

Adrenaline type

Answer 1

Sympathomimetic

Question 2

Adrenaline action

Answer 2

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

Question 3

Adrenaline use

Answer 3

C3 - Cardiac arrest
C7 - Bradycardia
C6 - Cardiogenic shock
M4 - Asthma
M16 - Anaphylaxis & Allergic Reactions
M7 - Croup
OP4 - Newborn resuscitation
C16 - Return of Spontaneous Circulation

Question 4

Adrenaline adverse effects

Answer 4

x Tachycardia
x Dysrhythmias, including
ventricular fibrillation
x Hypertension
x Pupillary dilation
x Anxiety
x Nausea & vomiting

Question 5

Adrenaline dose cardiac arrest >16 and <16

Answer 5

≥ 16 IV 1mg (1:10,000) bolus
2nd Cycle
(Approx 4 min)
No maximum
ICP ETT 2mg (1:1,000) 10mg

< 16 ALS+ IV/IO 10mcg/kg (1:10,000) bolus No maximum
ICP ETT 100mcg/kg (1:1,000) bolus*(Max bolus: 2mg) 5 doses

Question 6

Adrenaline dose Asthma

Answer 6

≥ 16 IM 500mcg 1:1,000 bolus
into lateral aspect of thigh 5 min No maximum
IV 50mcg 1:10,000 bolus
(If unresponsive to IM) 1 min No maximum

< 16 IM 10mcg/kg 1:1,000 bolus into lateral aspect of
thigh (Max bolus: 500mcg) 5 min No maximum
IV/IO 2mcg/kg 1:10,000 bolus (Max bolus: 50mcg) 2 min No maximum

Question 7

Adrenaline dose anaphylaxis

Answer 7

≥ 16 IM 500mcg 1:1,000 bolus lateral aspect of thigh rpt 5 min No maximum
Adrenaline infusion (ALS+) is indicated for all patients ≥ 16 years of age unresponsive to a minimum
of 4 IM injections - Adrenaline Infusion - 1mg 1:10,000 diluted in 90mL compound sodium lactate via
burette with micro drip. Commence 5mcg/min (30 drops per minute) and titrate whilst indicated

< 16 IM
10mcg/kg 1:1,000 bolus lateral aspect of
thigh(Max bolus: 500mcg)5 min No maximum

Question 8

Amiodarone hydrochloride type and action

Answer 8

Type: Antiarrhythmic
Action: x Slows the sinus rate and increases the refractory period of the AV node
x Decreases peripheral vascular resistance

Question 9

Amiodarone use (2)

Answer 9

C3 - Cardiac arrest

C8 - Dysrhythmias - Tachycardia

Question 10

Amiodarone Adverse effects (3)

Answer 10

Hypotension
Bradycardia
Dysrhythmias

Question 11

Amiodarone dose

Answer 11

CARDIAC ARREST
Indication - VF or Pulseless VT
≥ 16 ICP IV 300mg bolus Rpt Once 150mg Max 450mg
< 16 ICP IV/IO 5mg/kg(Max bolus: 300mg)
Rpt Once 5mg/kg (Max total dose not to exceed 450mg)  10mg/kg (Max total dose not to
exceed 450mg)
DYSRHYTHMIA’s—TACHYCARDIA
≥ 16 ICP IV 50mg bolus 3 min 300mg

Question 12

Amiodarone contraindication (1)

Answer 12

Torsades de Pointes

Question 13

Aspirin type and action

Answer 13

Type: Non-Steroidal Anti-Inflammatory
Action: Inhibits platelet aggregation thereby limiting thrombus enlargement in acute
coronary syndrome
Reduces production of prostaglandins thereby relieving pain and fever

Question 14

Aspirin use (1)

Answer 14

C1 - Acute coronary syndrome

Aspirin administration is not contraindicated in patients with regular daily use of aspirin and/or warfarin

Question 15

Aspirin adverse effects

Answer 15

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

Question 16

Aspirin contraindications (4)

Answer 16

Allergy or hypersensitivity to aspirin
Active, suspected or known bleeding tendency
Patients < 16 years of age
Patients meeting protocol T1 trauma criteria

Question 17

Atropine sulfate monohydrate type

Answer 17

Anticholinergic

Question 18

Atropine action

Answer 18

Antagonises the parasympathetic effects of acetylcholine on muscarinic receptors
resulting in: Increased heart rate via increasing intrinsic rate of the sino-atrial node and
conduction through the atrio-ventricular node
Reducing smooth muscle contraction resulting in pupillary dilation, reduced
gastrointestinal motility and reduced bladder tone
Blocks exocrine gland activity causing decreased salivary, bronchial, gastric
and sweat secretions

Question 19

Atropine use (3)

Answer 19

C7 - Dysrhythmias - Bradycardia
DT7 - Organophosphates
DT5 - Nerve Agent Poisoning

Question 20

Atropine adverse effects

Answer 20

Dry mouth
Blurred vision
Tachycardia
Nausea & vomiting
Hyperthermia
Dysrhythmias
Agitation, delirium, hallucinations,
seizure and coma may occur in high
doses
Urinary retention

Question 21

Atropine dose bradycardia

Answer 21

≥ 16 IV 600mcg undiluted bolus 1 min 3mg
IM 600mcg undiluted bolus 3 min 3mg
< 16 IV/IO 20mcg/kg diluted bolus Nil 20mcg/kg
IM 20mcg/kg undiluted bolus Nil 20mcg/kg

Question 22

Atropine dose Organophosphate

Answer 22

Indication - All ages - PR<80/min and/or SBP <80mmHg and/or ↑ secretions/crackles or chest crepitation

> 16 IV 600mcg undiluted bolus Rpt 1 min No maximum
IM 2mg undiluted bolus Rpt 3 min No Maximum
< 16 IV/IO 20mcg/kg diluted bolus (Max bolus: 600mcg)
Rpt 1 min No maximum
IM 20mcg/kg undiluted bolus(Max bolus: 600mcg)
Rpt 3 min No maximum

Question 23

Benzylpenicillin sodium Type and Action

Answer 23

Type: Narrow spectrum antibiotic

Action: Bactericidal; Inhibits bacterial cell wall synthesis and causes cytolysis when the
bacterium tries to divide

Question 24

Benzylpenicillin sodium Use

Answer 24

M13 - Meningococcal disease

Question 25

Benzylpenicillin sodium Adverse and Contraindications

Answer 25

Adverse Effects: Hypersensitivity reactions may occur (including urticaria, angio-oedema, convulsions and anaphylaxis)

Contraindications: Life threatening allergic reaction to penicillin

Question 26

Benzylpenicillin sodium Dose

Answer 26

MENINGOCOCCAL SEPTICAEMIA
≥ 10 IV/IO/IM 1200mg Nil Rpt
≥ 1 - <10 IV/IO/IM 600mg Nil Rpt
< 1 IV/IO/IM 300mg Nil Rpt