Precautions

Question 1

Paracetamol Precautions

Answer 1

Hepatotoxicity can occur with overdose in the following
- no dose if patient has already had it in past 4 hours or a total of 4 grams in 24 hours or 60mg/kg in children
- elderly/frail/malnourished
- Impaired hepatic function

Question 2

Ketamine Precautions

Answer 2

May exacerbate cardiovascular conditions ( ie uncontrolled hypertension, stroke, recent MI, cardiac failure) due to effects on HR and BP

Question 3

Morphine Precautions

Answer 3

8
1. Elderly / frail patients
2. Hypotension
3. Respiratory destress
4. Current Asthma
5. Respiratory tract burns
6. Known addiction to opiods
7. Acute acloholism
8. Patients on monoamine oxidase inhibitors

Question 4

Fentanyl Precautions

Answer 4

7
1. Elderly frail patients
2. Impaired hepatic function
3. Respiratory depression e.g. COPD
4. Current Asthma
5. Rhinitis, rhinorrhea or facial trauma (IN ROUTE)

Question 5

Methoxyflurane Precautions

Answer 5

• no more than 6ml in 24 hours
• administer in a open space to limit occupational exposure

Question 6

Aspirin Precautions

Answer 6

3
1. Peptic ulcer
2. Asthma
3. patients on anticoagulants

Question 7

Glyceryl Trinitrate GTN Precautions

Answer 7

• lower dose in patients who are elderly/frail/no previous administration/ recent MI
• right MI/ inferior STEMI with BP < 160 use with caution due to preload reduction
• preterm labour (concurrent use with other tocolytics)

Question 8

Heparin Precautions

Answer 8

Renal Impairment

Question 9

Ventolin Precautions

Answer 9

Large doses have been reported to cause intracellular metabolic acidosis

Question 10

Ipratropium Bromide (Atrovent) Precautions

Answer 10

2
1. Glaucoma
2. Avoid contacts with the eyes

Question 11

Dexamethasone Precautions

Answer 11

Solutions that are not clear or are contaminated should be discarded

Question 12

Na Saline Precautions

Answer 12

None

Question 13

Olanzapine Precautions

Answer 13

2
1. Olanzapine may be less effective if patient agitation is due to drug intoxication (especially stimulants) or alcohol withdrawal. Benzodiazepines are considered first line agents in these patients
2. Elderly / frail patients and Children are more susceptible to adverse effects

Question 14

Midazolam Precautions

Answer 14

4
1. Reduced doses may be required for the elderly / frail, patients with chronic renal failure, CCF or shock.
2. The CNS depressant effects of benzodiazepines are enhanced in the presence narcotics and other tranquillisers including alcohol
3. Can cause sever respiratory depression in patients with COPD
4. Patients with myasthenia gravis

Question 15

Adrenaline Precautions

Answer 15

4 consider reduced dose for
1. Elderly / frail patient
2. Patient with cardiovascular disease
3. Patients on monoamine oxidase inhibitors
4. Higher doses may be required for those on Beta Blockers

Question 16

Ondansetron Precautions

Answer 16

Patients with hepatic disease should not receive more then 8 mg in 24 hours

Avoid if patient has a history of congenital long QT even though it is rare wide QT may lead to torsades

Ondansetron contains aspartame and should not be given to patients with phenylketonuria

Pregnancy 1st trimester - consult with hospital

Question 17

Prochlorperazine Precautions

Answer 17

elderly patients more susceptible to side effects

Parkinson’s symptoms can be worsened, avoid is possible

Question 18

Oxytocin Precautions

Answer 18

None

Question 19

Naloxone Precautions

Answer 19

1. If patient is known to be physically dependent on opioids, be prepared for a combative patient
2. Neonates

Question 20

Droperidol

Answer 20

• Elderly patients more susceptible to adverse effects
  -Parkinson’s disease, symptoms may be worsened
• Lewy body dementia may experience increased agitation
• QT prolongation has been reported where possible ECG monitoring to be done post sedation

Question 21

Droperidol

Answer 21

• Elderly patients more susceptible to adverse effects
  -Parkinson’s disease, symptoms may be worsened
• Lewy body dementia may experience increased agitation
• QT prolongation has been reported where possible ECG monitoring to be done post sedation