PME1 Medications Flashcards
Contraindications for Adrenaline
Nil
Indications for Adrenaline
- Cardiac Arrest
- Anaphylaxis or severe allergic reaction
- Severe life-threatening bronchospasm or silent chest
- Shock unresponsive to adequate fluid resuscitation
- Bradycardias with poor perfusion
- Moderate to severe Croup
Presentation of Adrenaline
- Ampoule – 1mg/1ml
- Ampoule – 1mg/10ml
- Epipen Autoinjector – 300 microg adrenaline
- Epipen Jr Auto-injector – 150 microg adrenaline
Doses for Adrenaline
IM - Adult for Anaphylaxis – 500 microg
- Child 1 year – 6 years for Anaphylaxis – 150 microg
- Child 6 months – 1 year – 100 microg
- Child less than 6 months – 50 microg
NEB – 5mg
No Max dose
Clinical Features of Anaphylaxis
Cutaneous
- Urticaria (Rash)
- Angioedema (Swelling)
- Pruritus (Itch)
- Flushed skin
Respiratory
- Difficulty breathing
- Wheeze
- Upper airway swelling
- Rhinitis (runny nose)
Cardiovascular
- Hypotension
- Dizziness
- Bradycardia
- Tachycardia
- Collapse
Abdominal
- Nausea
- Vomiting
- Diarrhoea
- Abdominal pain
Definition of Anaphylaxis
Any acute onset illness with typical skin features such as, urticaria – Hives, erythema – redness and/or angioedema – facial and neck swelling PLUS involvement of respiratory and/or cardiovascular and/or persistent gastrointestinal symptoms OR any acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis is considered possible even if skin features are not present
Definitions of Seizures
Transient disturbance of cerebral function caused by abnormal neuronal activity in the brain.
Definition of Focal Seizure
Abnormal neuronal activity originated but is limited to one hemisphere of the cerebral cortex. Seizure symptoms are characterized by the area of the cerebral cortex where the activity exists.
Focal seizure activity does not impair awareness or responsiveness whereas focal dyscognitive seizure activity causes the level of awareness or responsiveness to be reduced but consciousness not lost.
Definition of a generalized seizure
where abnormal neuronal activity engaged both hemispheres of the cerebral cortex.
Definition of Status Epilepticus
Seizure activity >5 minutes or recurrent seizure activity where the patient does not recover to a GCS 15 before another seizure.
Definition of Psychogenic Non-epileptic Seizures
Episodic behavioral events mimicking seizures but not epileptic. If there is doubt the administration of Midazolam is still appropriate.
Recognizable causes of Seizures
- Hypoxia
- Hypercarbia
- Hypotension
- Hypoglycemia
- Hyperemia
- Hypocalcemia
- Hyperthyroidism
- Uremia
- Pregnancy Eclampsia
- Meningitis/Encephalitis
- Hyperthermia/febrile convulsions
- Drugs/Toxins – intoxication or withdrawal
- Cerebral pathology e.g., stroke, tumor, trauma
Clinical Features of Seizures
- Visual hallucinations
- Localized twitching of muscles without impaired consciousness
- Localized tingling and numbness
- Nonsensical speech
- Disorientated movements
- Sudden pause in activity or fixed gaze
- Nystagmus
- Automatism
- Increase or loss of tone
- Alternating tonic/clonic posturing
- Incontinence
- Post-ictal confusion, fatigue, headache, nausea
Clinical Features for prolonged seizures/status epilepticus
- Hypoxia
- Hypercarbia
- Progressive lactic and respiratory acidosis
- Hyperthermia
- Hypertension
- Tachycardia
- Hypo/hyperglycaemia
- Hyperkalaemia
Indications for Midazolam
Generalized seizures
Focal seizure with a GCS of 12 or less
Contraindications for Midazolam
Allergy and/or adverse drug reaction
Presentation of Midazolam
Ampoule, 5mg/1ml
Midazolam doses
Adult
NAS/IM -5mg repeated every 10 minutes to a total max dose 20mg
IV - 5mg repeated every 5 minutes to a total max dose 20mg
Midazolam onset
5-10 minutes IM or IN and 1-3minutes for IV
Duration variable
Definition of Hypoglycaemia
BGL < 4.0 mmol/L (Goal: BGL 4-8 mmol/L)
Clinical Features of Hypoglycaemia
- Lethargy
- Change in behaviour
- Headache
- Visual disturbance
- Slurred Speech
- Dizziness
- ALOC
- Seizures
- Come
- Mimicking intoxication or stroke
Indications for Glucose Gel
Symptomatic hypoglycaemia with the ability to self-administer oral glucose
Contraindications for Glucose Gel
Unconsciousness
Patients with difficulty swallowing
Patients less than 2 years old
Presentation of Glucose Gel
15g tube
Adult and Paediatric dose of Glucose Gel
Adult and Paediatric dose – 15g repeated once at 15minutes if BGL < 4.1 mmol/L – max dose 30g
Glucose Gel onset
10 minutes
Indications for Glucagon
Symptomatic hypoglycaemia with the inability to self-administer oral glucose
Refractory anaphylaxis with persistent hypotension/shock unresponsible to 3x IM adrenaline injections and adequate fluid challenges
Contraindications for Glucagon
Adverse and/or adverse drug reaction
Presentation for Glucagon
Vial - powder and solvent
Adult and Paediatric dose for Glucagon
Adult dose 1mg reconstituted in 1ml of water for injection
Child >25kg – 1mg reconstituted in 1ml of water for injection
Child <25kg – 0.5mg reconstituted in 0.5ml of water. Reconstitute the full 1mg into 1ml of water and redraw to 0.5ml.
Onset for Glucagon
10 minutes
Definition of Hyperglycaemia
BGL of greater than 10 mmol/L can be DKA (Diabetic Ketoacidosis), HHS (Hyperosmolar Hyperglycaemic Syndrome) or asymptomatic. HHS will have BGL rates of >40mmol/L.
Definition of Diabetic Ketoacidosis
DKA is a complication usually seen in patients with Type 1 diabetes characterised by hyperglycaemia, ketosis and metabolic acidosis. It is caused by a absolute insulin deficiency causing water to be drawn out of cells resulting in cellular dehydration, high BGL in the kidney filtrate results in osmotic diuresis and polyuria leading to severe dehydration and hypovolaemia, alternative fuel sources are burned producing ketones which if allowed to accumulate can cause metabolic acidosis, dehydration and loss of potassium.
Definition of Hyperosmolar Hyperglycaemic Syndrome
HHS is usually a complication of type 2 diabetes and is characterised by hyperglycaemia, hyperosmolarity and severe dehydration. HHS is caused by a relative insulin deficiency where there is in sufficient insulin to limit ketones and progression to metabolic acidosis.
Clinical Features of Hyperglycaemia
Neurological
* Lethargy
* ALOC
* Seizure
* Coma
Cardiovascular
* Signs of hypovolaemia, hypotension, tachycardia
* Pale, cool or clammy or flushed and hot is febrile.
Definition of Acute coronery syndrome (ACS)
Spectrum of conditions resulting from myocardial ischemia including STEMI, NSTEMI, unstable angina. Will usually present with chest pain and/or discomfort however some groups of patients may have atypical symptoms
Clinical Features of ACS
- Chest pain and/or discomfort – usually burning, pressure or tightness
- Referred pain – e.g., radiating into arms, jaw or teeth
- Dyspnoea
- Diaphoresis
- Nausea and/or vomiting
- Feeling of impending doom
Indications of GTN
Suspected ACS with pain
Acute Cardiogenic Pulmonary Oedema
Autonomic dysreflexia -SBP > or equal to 160 mmHg
Irukandji syndrome – SBP > or equal to 160 mmHg
Contraindications of GTN
Allergy and/or adverse drug reaction
Heart Rate < 50 or >150 BPM
Systolic BP <100 mmHg
Acute CVA
Head Trauma
Viagra medications within the last 48 hours
Sildenafil or Vardenafil in last 24 hours
Tadalafil in last 48 hours
Presentation of GTN
Sublingual Spray 400 microg/dose
GTN onset
<2 minutes
Dose for GTN
1 400 microg spray every 5 minutes no max dose
Indications for Aspirin
Suspected ACS
Acute Cardiogenic pulmonary Oedema
Contraindications for Aspirin
Allergy and/or adverse drug reaction to aspirin OR any non-steroidal anti-inflammatory
Bleeding or clotting disorders
Current GI bleeding or peptic ulcers
Patients <18 years of age
Presentation of Aspirin
300mg chewed tablet
Aspirin dose
Patient can have max 450mg of aspirin, check the patients aspirin prescription if they have one
Aspirin Onset
10 minutes
Definition of Nausea and Vomiting
Common nonspecific symptoms caused by a myriad of medical conditions. The sensation of nausea occurs due to changes to normal gastric rhythm or vestibular input while vomiting occurs as a result of retroperistalsis, oesophageal-stomach sphincter relaxation and skeletal muscle contraction. Nausea and vomiting us usually mediated by the medulla oblongata.
Clinical Features of Nausea and Vomiting
- Hypersalivation
- Retching
- Clamminess
- Sweating
- Pallor
- Abdominal discomfort
Indications of Ondansetron
Significant Nausea and/or vomiting
Contraindications of Ondansetron
Absolute:
Allergy and/or adverse drug reaction
Congenital long QT syndrome
Current apomorphine therapy
Patients less than 2 years of age
Relative:
First trimester pregnancy – only to be administered in extreme and uncontrolled hyperemesis
Presentation of Ondansetron
Ampoule, 4mg/2ml ondansetron or orally disintegrating tablets 4mg ondansetron
Adult and Pediatric doses of Ondansetron
Must not be given within 8 hours of previous ondansetron administration.
Adult - PO/IM – 4-8mg
Onset of Ondansetron
5 minutes
Definition of UTI
Can be a lower tract infection where bacteria enters the urethra and travels to the bladder or a upper tract infection where bacteria may proliferate within the bladder and travel up ureters to the kidney.
Lower UTI Clinical Features
- Strong urge to urinate.
- Pain often stinging or burning while urinating.
- Cloudy urine or haematuria
- Urine has a unusual or offensive odour
- Lower abdominal or back pain
- Unlikely to have a fever unless severe or elderly.
Upper UTI Clinical Features
- Fever
- Headache
- Chills
- Night sweats
- Flushed Skin
- Nausea and Vomiting
- Deep aching pain in flank, back or one or both sides
Renal Colic Definition
The most common presentation of urolithiasis (urinary stones within the urinary tact). May cause a partial or complete blockage.
Clinical Presentation of Renal Colic
- Restless, may be pacing, unable to sit still
- Reduced urine output due to reduced flow
- Dark concentrated urine
- Haematuria not always visibly obvious
- Hypertension
- Tachycardia
- Sweating due to pain
- Nausea and vomiting
- Fever – Red flag
- Sudden onset of severe sharp, tearing, ripping, scratching pain
- May develop flank pain due to kidney stress from backup of urine increasing pressure and development of infection from not clearing bacteria from blood
- Unilateral pain left loin to groin, radiating the whole way down or felt to move over time
ALOC definition
Patient GCS less than 15
ALOC Clinical Features
- Unable to around and respond appropriately to stimuli from the environment
- Confused
- Delirious
- Somnolent (e.g., sleepy)
- Obtunded (e.g., Slower psychomotor response)
- Stuporous (e.g., sleep like state with little or no spontaneous activity)
- Comatose (unable to rouse, no response to stimuli)
Indications for Paracetamol
Mild to moderate pain
Fever
Contraindications for Paracetamol
Allergy and/or adverse drug reaction
Patients less than 1 month old
Presentation of Paracetamol
Tablet 500mg or Elixir, 120mg/5ml
Doses of Paracetamol
Adult - 0.5g-1g must not be administered within 4 hours of previous paracetamol administration.
Total max dose – 4g in 24 hours
Paediatric - > or equal to 1 month – 15mg/kg, single max dose 1g, must not be administered within 4 hours of previous administration.
Onset of Paracetamol
10-60 minutes
Indications for Methoxyflurane
Pain
Contraindications for Methoxyflurane
Allergy and/or adverse drug reaction
Patients less than 1 year of age
History of significant liver OR renal disease
History of malignant hyperthermia
Presentation of Methoxyflurane
3ml bottle and whistle
Dose of Methoxyflurane
Adult dose – 3ml repeated once after 20 minutes if required total max dose 6ml
Paediatric > or equal to 1 year 3ml single dose. Max dose 3ml
Onset of Methoxyflurane
1-3 minutes
Indications for Ibuprofen
Moderate pain due to acute inflammation and tissue injury
Contraindications for Ibuprofen
Allergy and/or adverse drug reaction to and NSAID or Aspirin
Concurrent NSAID therapy
Current GI bleeding or peptic ulcers
Dehydration and/or hypovolaemia
Renal Impairment
NSAID induced asthma
Heart Failure
Pregnancy
Angiotensin converting enzyme inhibitor or andiotensin 2 receptor blocking therapy
Patients less than 13 years or older than 65 years
Patients taking anticoagulant medications
Diuretic treatment
Presentation of Ibuprofen
200mg tablet
Onset of ibuprofen
15 minutes
Doses for Ibuprofen
Adult dose – 200-400mg must not be administered within 6 hours of previous ibuprofen administration
Cannot administer to paediatrics
Definition of Asthma
Obstructive respiratory disease characterised by chronic airway inflammation. Bronchial hyperresponsiveness and intermittent airway narrowing.
Clinical Features of Asthma
- Wheeze
- Dyspnoea
- Chest Tightness or cough
- Tachypnoea
- Tachycardia
- Accessory muscle usage
- Diaphoresis
- Cyanosis (late sign)
Indications for Salbutamol
Bronchospasm
Contraindications for Salbutamol
Allergy and/or adverse drug reaction
Ischaemic heart disease
Adult doses of Salbutamol
Adult dose – MDI – 1.2mg or 12 sprays – repeat every 10 minutes no max dose
Adult dose- NEB – 5mg – no max dose
Ipratropium Bromide Indications
Moderate or Severe bronchospasm unresponsive to initial QAS salbutamol
Contraindications for Ipratropium Bromide
Allergy and or adverse drug reaction
Patients less than 1 year
Doses of Ipratropium Bromide
Adult dose – NEB – 500microg repeated at 20 minute intervals max dose 1.5mg.
Onset for Ipratropium Bromide
1.5-3 minutes
Indications for Hydrocortisone
Moderate or Severe Asthma
Contraindications for Hydrocortisone
Allergy and/or adverse drug reaction
Dose of Hydrocortisone
IM - 100mg
Onset of Hydrocortisone
1-2 hours
Definition of COPD
Airflow limitation that is not fully reversible. Airflow limitation is usually progressive and associated with abnormal inflammatory response of the lungs to noxious particles or gases.
Clinical Features of COPD
- Breathlessness on exertion
- Cough and sputum production
- Chest Tightness
- Wheeze
- Malnutrition and obesity are common
- Polypharmacy often with limited effect
- Older age group
Signs of advanced disease - Dynamic Chest hyperinflation
- Soft breath sounds, prolonged expiratory phase
- Hypoxia and hypercapnia
- Inactivity, poor appetite and weight loss
- History of long term O2 therapy
Definition of Stroke (CVA)
Blood flow to a portion of the brain is interrupted causing ischemia. Can be a Haemorrhagic stroke or a Ischaemic stroke. Haemorrhage stroke is caused by a break in the wall of a weakened blood vessel. An Ischaemic stoke is caused by either a embolic or thrombotic occlusion of a blood vessel.
Clinical Features of strokes and TIAs
- Sudden Loss of movement or weakness in part of the body, especially on one side
- Difficulty speaking
- Difficulty swallowing
- Visual disturbances
- Sudden onset headache with neurological symptoms
- ALOC
