Precautions Flashcards
Adrenaline Precautions
BECM
B higher doses may be required for patients on beta blockers
E Elderly / frail
C pt w/cardiovascular disease
M pt taking monoanime oxidase inhibitors
Aspirin Precautions
PAP
Peptic Ulcer
Asthma
patients on anticoagulants
Ceftriaxone Precautions
Allergy to penicillin antibiotics
Dexamethasone Precautions
Solutions which are not clear or are contaminated should be discarded
Dextrose Precautions
Nil of significance
Droperidol Precautions
PEL Q
Parkinson’s disease: may worsen symptoms
Elderly frail: susceptible to SE
Lewy body dementia: may increase agitation
QT prolongation has been reported rarely. Provide ECG monitoring after sedation
Fentanyl Precautions
MORE RAH
M pts on monoamine oxidase inhibitors
O Known addiction to opioids
R Respiratory depression (COPD)
E Elderly/frail pts
R Rhinitis, rhinorrhea or facial trauma (IN route)
A Current asthma
H Impaired hepatic function
Glucagon Precautions
Nil of significance
GTN Precautions
P Preterm Labour
U Use lower doses (i.e. 300mcg) in patients who are elderly (age >60) and have no previous admin. Or with recent MI and they may be more susceptible to adverse effects
R Right myocardial MI or inferior STEMI with systolic BP <160 - use cautiously due to risk of severe hypotension from preload reduction
Hydrocortisone Precautions
NIL
Ipratroprium Bromide Precautions
- Glaucoma
- Avoid contact with eyes
Ketamine Precautions
May exacerbate cardiovascular conditions (e.g. uncontrolled hypertension, stroke, recent MI, cardiac failure) due to effects on HR and BP
Lignocaine Precautions
- IM and local infiltration- inadvertent intravascular administration may result in systemic toxicity
- IO - impaired CV function (e.g. hypotension, bradycardia, poor perfusion, heart block, heart failure)
Methoxyflurane Precautions
- Pt should not be administered >6ml of Methoxyflurane in 24hrs due to increased risk of kidney damage
- To limit occupational exposure, Methoxyflurane should not be administered in a confined space. Ensure adequate ventilation in ambulance. Place used Penthrox inhalers in closed plastic bag when not in use.
Midazolam Precautions
CAME
C Can cause severe respiratory depression in Pts with COPD
A CNS depressant effects of benzodiazepines are enhanced in the presence of narcotics and other tranquillisers including Alcohol
M Pts with myasthenia gravis
E Reduced doses may be required for the elderly, Pts with chronic renal failure, congestive cardiac failure or shock
Morphine Precautions
MORE RAAH
M Pts on monoamine oxidase inhibitors
O Known addiction to opioids
R Respiratory depression (COPD)
E Elderly/frail pts
R Respiratory tract burns
A Current asthma
A Acute alcoholism
H Hypotension
Naloxone Precautions
- If pt is known to be physically dependent on opioids, be prepared for a combative pt after administration
- Neonates
Normal Saline Precautions
None
Olanzapine Precautions
Olanzapine may be less effective if patient agitation is due to drug intox (especially stimulants) or alcohol withdrawals. Benzodiazepines are considered first-line agents in these patients
Elderly / frail patients and children are more susceptible to adverse effects
Ondansetron Precautions
SLOP
S. Severe hepatic disease (cirrhosis) limit daily dose to 8mg
L. Congenital Long QT syndrome - Ondansetron causes QT prolongation and increases risk of torsaades de pointes. Unlikely but best to avoid large doses
O. Ondansetron ODT may contain aspartame which should be avoided in patients with phenylketonuria. Injection can be administered if appropriate
P. Pregnancy 1st trimester - consult with receiving hospital
Oxytocin Precautions
Nil
Paracetamol Precaution
HH
H Hepatoxicity can occur with overdose (4g 24 hours)
H Risky of Hepatoxicity is increased in the follow circumstances
- impaired hepatic function
- elderly / frail
- malnourishment
Prochlorperazine Precautions
PE
Parkinson’s disease (can worsen symptoms of Parkinson’s disease avoid if possible)
Elderly patients (more susceptible to adverse effects)
Salbutamol Precautions
Large doses of salbutamol have been reported to cause intracellular metabolic acidosis
