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Foundations Of Para Res School > PME1 Medications > Flashcards

PME1 Medications Flashcards

1
Q

Contraindications for Adrenaline

A

Nil

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2
Q

Indications for Adrenaline

A
  • 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
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3
Q

Presentation of Adrenaline

A
  • Ampoule – 1mg/1ml
  • Ampoule – 1mg/10ml
  • Epipen Autoinjector – 300 microg adrenaline
  • Epipen Jr Auto-injector – 150 microg adrenaline
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4
Q

Doses for Adrenaline

A

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

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5
Q

Clinical Features of Anaphylaxis

A

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

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6
Q

Definition of Anaphylaxis

A

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

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7
Q

Definitions of Seizures

A

Transient disturbance of cerebral function caused by abnormal neuronal activity in the brain.

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8
Q

Definition of Focal Seizure

A

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.

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9
Q

Definition of a generalized seizure

A

where abnormal neuronal activity engaged both hemispheres of the cerebral cortex.

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9
Q

Definition of Status Epilepticus

A

Seizure activity >5 minutes or recurrent seizure activity where the patient does not recover to a GCS 15 before another seizure.

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10
Q

Definition of Psychogenic Non-epileptic Seizures

A

Episodic behavioral events mimicking seizures but not epileptic. If there is doubt the administration of Midazolam is still appropriate.

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11
Q

Recognizable causes of Seizures

A
  • 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
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12
Q

Clinical Features of Seizures

A
  • 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
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13
Q

Clinical Features for prolonged seizures/status epilepticus

A
  • Hypoxia
  • Hypercarbia
  • Progressive lactic and respiratory acidosis
  • Hyperthermia
  • Hypertension
  • Tachycardia
  • Hypo/hyperglycaemia
  • Hyperkalaemia
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14
Q

Indications for Midazolam

A

Generalized seizures
Focal seizure with a GCS of 12 or less

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15
Q

Contraindications for Midazolam

A

Allergy and/or adverse drug reaction

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16
Q

Presentation of Midazolam

A

Ampoule, 5mg/1ml

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17
Q

Midazolam doses

A

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

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18
Q

Midazolam onset

A

5-10 minutes IM or IN and 1-3minutes for IV
Duration variable

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19
Q

Definition of Hypoglycaemia

A

BGL < 4.0 mmol/L (Goal: BGL 4-8 mmol/L)

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20
Q

Clinical Features of Hypoglycaemia

A
  • Lethargy
  • Change in behaviour
  • Headache
  • Visual disturbance
  • Slurred Speech
  • Dizziness
  • ALOC
  • Seizures
  • Come
  • Mimicking intoxication or stroke
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21
Q

Indications for Glucose Gel

A

Symptomatic hypoglycaemia with the ability to self-administer oral glucose

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22
Q

Contraindications for Glucose Gel

A

Unconsciousness
Patients with difficulty swallowing
Patients less than 2 years old

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23
Q

Presentation of Glucose Gel

A

15g tube

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24
Q

Adult and Paediatric dose of Glucose Gel

A

Adult and Paediatric dose – 15g repeated once at 15minutes if BGL < 4.1 mmol/L – max dose 30g

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25
Q

Glucose Gel onset

A

10 minutes

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26
Q

Indications for Glucagon

A

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

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27
Q

Contraindications for Glucagon

A

Adverse and/or adverse drug reaction

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28
Q

Presentation for Glucagon

A

Vial - powder and solvent

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29
Q

Adult and Paediatric dose for Glucagon

A

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.

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30
Q

Onset for Glucagon

A

10 minutes

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31
Q

Definition of Hyperglycaemia

A

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.

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32
Q

Definition of Diabetic Ketoacidosis

A

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.

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33
Q

Definition of Hyperosmolar Hyperglycaemic Syndrome

A

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.

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34
Q

Clinical Features of Hyperglycaemia

A

Neurological
* Lethargy
* ALOC
* Seizure
* Coma
Cardiovascular
* Signs of hypovolaemia, hypotension, tachycardia
* Pale, cool or clammy or flushed and hot is febrile.

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35
Q

Definition of Acute coronery syndrome (ACS)

A

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

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36
Q

Clinical Features of ACS

A
  • 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
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37
Q

Indications of GTN

A

Suspected ACS with pain
Acute Cardiogenic Pulmonary Oedema
Autonomic dysreflexia -SBP > or equal to 160 mmHg
Irukandji syndrome – SBP > or equal to 160 mmHg

38
Q

Contraindications of GTN

A

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

39
Q

Presentation of GTN

A

Sublingual Spray 400 microg/dose

39
Q

GTN onset

A

<2 minutes

39
Q

Dose for GTN

A

1 400 microg spray every 5 minutes no max dose

39
Q

Indications for Aspirin

A

Suspected ACS
Acute Cardiogenic pulmonary Oedema

39
Q

Contraindications for Aspirin

A

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

40
Q

Presentation of Aspirin

A

300mg chewed tablet

41
Q

Aspirin dose

A

Patient can have max 450mg of aspirin, check the patients aspirin prescription if they have one

42
Q

Aspirin Onset

A

10 minutes

43
Q

Definition of Nausea and Vomiting

A

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.

44
Q

Clinical Features of Nausea and Vomiting

A
  • Hypersalivation
  • Retching
  • Clamminess
  • Sweating
  • Pallor
  • Abdominal discomfort
45
Q

Indications of Ondansetron

A

Significant Nausea and/or vomiting

46
Q

Contraindications of Ondansetron

A

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

47
Q

Presentation of Ondansetron

A

Ampoule, 4mg/2ml ondansetron or orally disintegrating tablets 4mg ondansetron

48
Q

Adult and Pediatric doses of Ondansetron

A

Must not be given within 8 hours of previous ondansetron administration.

Adult - PO/IM – 4-8mg

49
Q

Onset of Ondansetron

A

5 minutes

50
Q

Definition of UTI

A

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.

51
Q

Lower UTI Clinical Features

A
  • 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.
52
Q

Upper UTI Clinical Features

A
  • Fever
  • Headache
  • Chills
  • Night sweats
  • Flushed Skin
  • Nausea and Vomiting
  • Deep aching pain in flank, back or one or both sides
53
Q

Renal Colic Definition

A

The most common presentation of urolithiasis (urinary stones within the urinary tact). May cause a partial or complete blockage.

54
Q

Clinical Presentation of Renal Colic

A
  • 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
55
Q

ALOC definition

A

Patient GCS less than 15

56
Q

ALOC Clinical Features

A
  • 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)
57
Q

Indications for Paracetamol

A

Mild to moderate pain
Fever

58
Q

Contraindications for Paracetamol

A

Allergy and/or adverse drug reaction
Patients less than 1 month old

59
Q

Presentation of Paracetamol

A

Tablet 500mg or Elixir, 120mg/5ml

60
Q

Doses of Paracetamol

A

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.

61
Q

Onset of Paracetamol

A

10-60 minutes

62
Q

Indications for Methoxyflurane

A

Pain

63
Q

Contraindications for Methoxyflurane

A

Allergy and/or adverse drug reaction
Patients less than 1 year of age
History of significant liver OR renal disease
History of malignant hyperthermia

64
Q

Presentation of Methoxyflurane

A

3ml bottle and whistle

65
Q

Dose of Methoxyflurane

A

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

66
Q

Onset of Methoxyflurane

A

1-3 minutes

67
Q

Indications for Ibuprofen

A

Moderate pain due to acute inflammation and tissue injury

68
Q

Contraindications for Ibuprofen

A

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

69
Q

Presentation of Ibuprofen

A

200mg tablet

70
Q

Onset of ibuprofen

A

15 minutes

71
Q

Doses for Ibuprofen

A

Adult dose – 200-400mg must not be administered within 6 hours of previous ibuprofen administration

Cannot administer to paediatrics

72
Q

Definition of Asthma

A

Obstructive respiratory disease characterised by chronic airway inflammation. Bronchial hyperresponsiveness and intermittent airway narrowing.

72
Q

Clinical Features of Asthma

A
  • Wheeze
  • Dyspnoea
  • Chest Tightness or cough
  • Tachypnoea
  • Tachycardia
  • Accessory muscle usage
  • Diaphoresis
  • Cyanosis (late sign)
73
Q

Indications for Salbutamol

A

Bronchospasm

74
Q

Contraindications for Salbutamol

A

Allergy and/or adverse drug reaction
Ischaemic heart disease

75
Q

Adult doses of Salbutamol

A

Adult dose – MDI – 1.2mg or 12 sprays – repeat every 10 minutes no max dose
Adult dose- NEB – 5mg – no max dose

76
Q

Ipratropium Bromide Indications

A

Moderate or Severe bronchospasm unresponsive to initial QAS salbutamol

77
Q

Contraindications for Ipratropium Bromide

A

Allergy and or adverse drug reaction
Patients less than 1 year

78
Q

Doses of Ipratropium Bromide

A

Adult dose – NEB – 500microg repeated at 20 minute intervals max dose 1.5mg.

79
Q

Onset for Ipratropium Bromide

A

1.5-3 minutes

80
Q

Indications for Hydrocortisone

A

Moderate or Severe Asthma

81
Q

Contraindications for Hydrocortisone

A

Allergy and/or adverse drug reaction

82
Q

Dose of Hydrocortisone

A

IM - 100mg

83
Q

Onset of Hydrocortisone

A

1-2 hours

84
Q

Definition of COPD

A

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.

85
Q

Clinical Features of COPD

A
  • 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
86
Q

Definition of Stroke (CVA)

A

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.

86
Q

Clinical Features of strokes and TIAs

A
  • 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

Foundations Of Para Res School (3 decks)

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