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Paramedic Revision > SAAS paramedic drugs > Flashcards

SAAS paramedic drugs Flashcards

Mechanism of action, indications, and contraindications of drugs administered within a paramedic scope of practice

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1
Q

Adrenaline mechanism of action

A

stimulates sympathetic alpha and beta adrenoreceptors
alpha 1 - receptors in blood vessels
- peripheral vasoconstriction
beta 1- receptors of the heart
- chronotropic (increased HR through ^ firing of SA node)
- dromotropic (increased conductivity through AV node)
- inotropic (increased force of contraction by myocardium)
- increased ventricular irritability
beta 2 - receptors of the bronchi
- brochodilation

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2
Q

adrenaline onset, peak, and duration

A
  • Onset: IM 30-90 seconds, IV 30 seconds
  • Peak: IM 5 – 10 minutes, IV 2 minutes
  • Duration: IM 10-15 minutes, IV 5-10 minutes
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3
Q

indications of adrenaline

A

cardiac arrest - shockable: after 2nd shock and then every second loop, non-shockable: immediately and then every second loop
bronchospasm - life threatening asthma, repeat every 5 mins prn
anaphylaxis - deemed anaphylaxis when 2 or more body systems involved
croup - severe or life threatening, repeat prn
vasopressor support (ICP’s)

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4
Q

contraindications of adrenaline

A

hypersensitivity
phaeochromocytoma
(caution in patients with HTN, coronary insufficiency, IHD, cardiovascular disease, congestive coronary failure, and those on MAOI’s)

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5
Q

what type of drug is adrenaline

A

sympathomimetic adrenergic receptor agonist

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6
Q

what type of drug is amiodarone?

A

class III anti arrhythmic (K+ channel blocker)

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7
Q

mechanism of action of amiodarone

A

works by blocking potassium rectifier currents responsible for the repolarization of the heart in phase three of cardiac action potential > slowing the efflux of k+. Results in an increased action potential duration and prolonged refractory period. Myocyte excitability is reduced during this period preventing re-entry mechanism and ectopic foci from causing tachyarrhythmias.

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8
Q

indications of amiodarone

A

VF and VT cardiac arrest (given after third shock, ICP’s can give additional dose)
Dysrhythmias - mainly conscious VT (ICP’s)

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9
Q

contraindications of amiodarone

A

Hypersensitivity to amiodarone or iodine
Second and third-degree AV block
Symptomatic bradycardia
Sick sinus syndrome

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10
Q

what type of drug is aspirin?

A

non-steroidal anti-inflammatory drug (NSAID)

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11
Q

mechanism of action of aspirin

A

inhibits the aggregation of platelets through inhibition of the COX pathway - inhibits the production of thromboxane A2, TXA2 is produced by activated platelets at sites of vascular injury perpetuating platelet aggregation

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12
Q

indications of aspirin

A

ischaemic chest pain

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13
Q

contraindications of aspirin

A

hypersensitivity
bleeding disorders
late pregnancy
gastric/duodenal ulcers
active asthma
hepatic/renal disease
reyes syndrome
paediatrics

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14
Q

what type of drug is benzylpenicillin?

A

narrow spectrum penicillin antibiotic

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15
Q

mechanism of action of benzylpenicillin

A

binds to receptors on the bacterial cell surface inhibiting bacterial wall synthesis

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16
Q

indications of benzypenicillin

A

suspected meningococcal disease
- febrile, altered GCS, appears septic, acute onset non-blanching purpuric rash

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17
Q

contraindications of benzylpenicillin

A

hypersensitivity to any penicillin

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18
Q

mechanism of action of co-phenylcaine forte

A

anaesthetic - binding to Na+ channels inhibits influx of Na+, therefore no action potential is propagated and pain impulses are blocked
vasoconstrictor - localised alpha 1 receptor stimulation

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19
Q

indications of co-phenylcaine forte

A

Prior to NPA insertion to limit pain and haemorrhage

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20
Q

contraindications of co-phenylcaine forte

A

Hypersensitivity
Precaution with coronary artery disease – can have sympathetic alpha and beta affects
Precaution with hypertension

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21
Q

what type of drug is droperidol?

A

first generation (typical) antipsychotic

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22
Q

mechanism of action of droperidol

A

potent agonism to dopamine receptors and minor antagonistic effects on alpha-1 adrenergic receptors cause CNS depression at subcortical level of the brain, mid-brain, and brainstem reticular formation. Causes tranquillisation and sedation inducing a state of detachment and indifference while maintaining reflex alertness.

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23
Q

indications of droperidol

A

aged 18-64 and SAT >+2 from likely or apparent non-medical cause
under physical restraint
nausea/vomiting unresponsive to ondansetron

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24
Q

contraindication of droperidol

A

under 16 - more likely to experience extrapyramidal adverse effects
over 64 - more likely to display challenging behaviours as a result of an organic cause
hypersensitivity
history of neuroleptic malignant syndrome
Parkinson’s disease
pheochromocytoma
CNS depression/ comatose states
TBI
precaution - long QT-syndrome (antiemetic dose is okay), pregnant or breastfeeding mothers

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25
Q

what type of drug is fentanyl?

A

highly concentrated opioid agonist

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26
Q

what type of drug is fentanyl?

A

highly concentrated opioid agonist

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27
Q

mechanism of action of fentanyl

A

binds to opioid receptors (*Mu, Kappa, Delta and Sigma) found throughout the CNS causing analgesic and other side effects
opioid receptors are g coupled protein receptors > inhibit adenylate cyclase and reduce intracellular cAMP levels > increased efflux of K+ = hyper polarisation of membrane, decreased Ca+ influx = decreased neurotransmitter release > inhibition of pain impulses at cellular level

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28
Q

indications of fentanyl

A

uncontrolled pain

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29
Q

contraindications of fentanyl

A

hypersensitivity
occluded nasal passages or epistaxis
labour
consider HR, Rhythm, BP, sedation prior to administration
(precautions - elderly, renal/hepatic impairment, COAD, bradycardia, pregnancy, patients on MAOI’s, active asthma)

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30
Q

what type of drug is fexofenadine?

A

competitive histamine-1 receptor antagonist

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31
Q

mechanism of action of fexofenadine

A

binds to H1 receptors blocking the action of histamine > limitation of histamine mediated symptoms

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32
Q

indications of fexofenadine

A

mild/moderate anaphylactic features
- skin rash
- itchiness
- urticaria
- allergic rhinitis

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33
Q

contraindications of fexofenadine

A

hypersensitivity

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34
Q

what type of drug is glucagon?

A

synthetic form of an endogenous hormone which increases BGL

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35
Q

mechanism of action of glucagon

A

glycogenolysis - breakdown of hepatic glycogen resulting in the release of glucose into circulation
gluconeogenesis - conversion of non-carbohydrate based molecules into glucose (e.g. amino acids, lactate, glycerol)
inhibition of insulin secretions - decreased uptake of glucose into cells & decreased glycogenesis (conversion of glucose to stored glycogen)

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36
Q

indications for glucose

A

hypoglycaemia
(ICP’s can administer for oesophageal spasm, beta-blocker OD and calcium channel blocker OD)

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37
Q

contraindications for glucose

A

hypersensitivity
phaeochromocytoma
insulinoma
glucagonoma

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38
Q

indications for glucose

A

hypoglycaemia (IV glycose - severe hypoglycaemia with decreased conscious state)
(ICP’s can administer for decreased ICP, oedema due to delirium tremors, and acute alcohol intox)

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39
Q

contraindications for glucose

A

hypersensitivity (including to corn and corn products)
hyperglycaemia
insulinoma

40
Q

what type of drug is GTN?

A

glycerine trinitrate is an organic nitrate (enzymatically converted to nitric oxide)

41
Q

mechanism of action of GTN

A

nitrates are taken up by vascular smooth muscle cells and metabolised by the sulfhydryl group to form nitric oxide > nitric oxide binds with haemoglobin in guanylate cyclase > binding activates the enzyme > activation increases 2nd messenger cGMP > decreased intracellular Ca > smooth muscle relaxation and vasodilation > increased venous pooling and decreased venous return > decrease in preload and after load > decreased cardiac workload and O2 demand

42
Q

indications for GTN

A

cardiac chest pain
ACPO
(ICP’s autonomic dysreflexia with SBP >160mmHg)

43
Q

contraindications of GTN

A

recent use of PDE-5 inhibitors (24 hours: sildenafil, vardenafil, avanafil; 48 hours: tadalafil)
hypovolaemic states that cannot be corrected
SBP <100mmHg
extreme Brady/tachycardia
preload dependant rhythms
increased ICP

44
Q

effects of vessel dilation with GTN administration

A

dilation of veins > venous pooling > decreased venous return > decreased preload > decreased ventricular filling > decreased stretch and force of contraction > decreased workload > decreased O2 demand

dilation of arterioles > decreased peripheral vascular resistance > decreased force of contraction to eject blood > decreased workload > decreased O2 demand

dilation of coronary vessels > increased coronary perfusion > increased O2 supplied to myocardium

45
Q

what type of drug is ibuprofen?

A

oral non-steroid anti-inflammatory drug (NSAID)

46
Q

indications of ibuprofen

A

pain (as a part of a multimodal approach)

47
Q

contraindications of ibuprofen

A

chronic kidney disease
active peptic ulcer disease
GI bleeding
congestive cardiac failure
history of MI
presenting with ACS
pregnancy
hypo-perfused state
under 3 months old
(caution in patients with cardiovascular disease, pre-existing renal disease including nephrectomy, concurrent use of ACE inhibitors/ARB’s and diuretics
dehydration
aged >64)

48
Q

common ACE inhibitors

A

benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril

49
Q

common ARB’s

A

candesartan, azilsartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan

50
Q

mechanism of action of ibuprofen

A

works on COX-1 and COX-2 pathways to inhibit conversion of arachidonic acid into thromboxane, prostaglandins, and prostacyclins

51
Q

what type of drug is clonazepam

A

benzodiazepine

52
Q

indications of clonazepam

A

under consultation

palliative care anxiety
delirium in combination with haloperidol

53
Q

contraindications of clonazepam

A

nil - cautionary use in patients with respiratory depression or reduced respiratory drive

54
Q

mechanism of action of clonazepam

A

decreases electrical activity in the brain by acting as a positive allosteric modulator to GABA-A receptors > increases affinity for GABA binding > influx of chloride > decreased membrane potential > harder to stimulate action potential

55
Q

what type of drug is haloperidol?

A

parenteral antipsychotic and antiemetic

56
Q

indications for haloperidol

A

under consultation - end of life kit

delirium and anxiety
nausea and vomiting including with bowel obstruction
augmented sedation with benzodiazepine

57
Q

contraindications for haloperidol

A

Parkinson’s disease
if extrapyramidal side effects are distressing

58
Q

mechanism of action of haloperidol

A

antipsychotic: competitively black post-synaptic dopamine receptors in brain > eliminates dopamine neurotransmission > relief of delusions and hallucinations

antiemetic: peripheral antidopaminergic effects on the chemoreceptor trigger zone (CTZ) - works for CTZ induced vomiting such as medications, renal or lover failure, sepsis

59
Q

what type of drug is hyoscine butylbromide (buscopan)?

A

palliative care parenteral anticholinergic

60
Q

indications for hyoscine butylbromide

A

under consultation

delirium and anxiety
nausea and vomiting including with bowel obstruction
augmented sedation with benzodiazepine

61
Q

mechanism of action of Hyoscine Butylbromide

A
  • blocks muscarinic receptors in the GI tract causing smooth muscle relaxation
  • binding to nicotinic receptors induces a ganglion-blocking effect
62
Q

what type of drug is iprotroprium

A

a non-selective anticholinergic - parasympathetic muscarinic receptor antagonist

63
Q

mechanism of action of ipratroprium

A

blocks the action of acetylcholine at muscarinic receptors > inhibits parasympathetic Bronchoconstriction and mucous secretion

64
Q

indications for ipratroprium

A

management of moderate to severe bronchospasm in conjunction with salbutamol

65
Q

contraindications for ipratroprium

A

known hypersensitivity to ipratroprium or its derivatives

66
Q

what type of drug is ketorolac

A

parenteral non-steroidal anti inflammatory drug (NSAID)

67
Q

mechanism of action of ketorolac

A

works on COX-1 and COX-2 pathways to inhibit conversion of arachidonic acid into thromboxane, prostaglandins, and prostacyclins

68
Q

Indications for ketorolac

A

pain - as a part of a multi modal approach

69
Q

contraindications of ketorolac

A

chronic kidney disease
active peptic ulcer disease
GI bleeding
congestive cardiac failure
history of MI
presenting with ACS
pregnancy
hypo-perfused state
under 17 years old
(caution in patients with cardiovascular disease, pre-existing renal disease including nephrectomy, concurrent use of ACE inhibitors/ARB’s and diuretics
dehydration
aged >64)

70
Q

what type of drug is lorazepam?

A

benzodiazepine

71
Q

mechanism of action of lorazepam

A

binds to GABAa receptor > acts as positive modulator > increases receptor affinity for GABA binding > GABA binds > influx of chloride ions > decrease electrical charge of cell > hyper polarisation > increased threshold for AP propagation and cell firing

72
Q

indications for lorazepam

A

challenging behaviour
severe anxiety

73
Q

contraindications for lorazepam

A

consult for under 16 years
use caution when patient has respiratory depression

74
Q

what type of drug is methoxyflurane?

A

inhaled analgesic/ volatile anaesthetic with analgesic properties

75
Q

mechanism of action of methoxyflurane

A

multiple mechanisms
- binds to modulatory site of GABA receptor increasing affinity for binding > chloride influx causes cell hyperpolorisation
- activation of ligand gated K+ channels > efflux of K+ > hyperpolorisation of nerve cell (affecting Ash, dopamine, noradrenaline, and serotonin neurotransmission)
- interacts with neurone in the substantial gelatinous of the dorsal horn of the spinal cord > interrupts transmission of pain impulses along spinothalamic tract

76
Q

indications for methoxyflurane

A

uncontrolled pain - as a part of a multimodal approach

77
Q

contraindications of methoxyflurane

A

use caution in patients with renal impairment - severity of impairment not outlined in contraindication (probably don’t use if in failure or on dialysis)

78
Q

what type of drug is

A

pro kinetic agent/ in SAAS setting palliative care antiemetic

79
Q

indications of metoclopramide

A

under consult
- nausea and vomiting (pal-care)
- poor gastric emptying
- nausea due to constipation
- nausea and vomiting due to chemoreceptor trigger zone causes

80
Q

contraindications of metoclopramide

A

contraindicated in intestinal obstruction or perforation
avoid in Parkinson’s where possible as symptoms may worsen

81
Q

what type of drug is midazolam

A

benzodiazepine

82
Q

mechanism of action of midazolam

A

reduces activity in the brain
bind to GABAa receptor > increased affinity for GABA binding > GABA binding causes influx of Cl- > hyperpolorizes cell > more stimulus required to propagate action potential > decreased cell firing in the brain

83
Q

indications for midazolam

A

prolonged/repeated seizures
mental health transfer with SAT > +2 (under consult)
CPR induced consciousness (CPRIC)

84
Q

contraindications of midazolam

A

nil
- patients with respiratory disease or the elderly/frail are more susceptible to midazolam induced respiratory depression

85
Q

what type of drug is morphine

A

opiate agonist

86
Q

mechanism of action of morphine

A

opioid receptors are G protein coupled receptors which inhibit adenylate cyclase and reduce intracellular cAMP levels
- increased efflux of K+ > hyper polarisation of membrane > decreased action potential
- decreased influx of Ca2+ > decreased neurotransmitter release
overall inhibition at cellular level

  • activation of spinal receptors inhibits the release of substance P at the dorsal horn of the spinal cord, preventing transmission of nociceptive pain impulses along C pain fibres
87
Q

indications of morphine

A

uncontrolled pain

88
Q

contraindications of morphine

A

hypotension (SBP <100mmHg)
sedation score =/> 2
(consider physiological picture e.g. if BP slightly higher but tachycardia, pre-existing respiratory disease, etc.)

89
Q

what type of drug is naloxone

A

competitive opioid antagonist

90
Q

mechanism of action of naloxone

A

competitively displaces opioids from opioid receptor sites, reversing the effects of the opioid

91
Q

indications for naloxone

A

opioid overdose

92
Q

contraindications for naloxone

A

nil
- consider level of referral (babies, accidental OD in elderly - full reversal, OD via recreational use - effective ventilations)
- in newborns with opioid respiratory depression due to maternal use do not administer due to risk of seizure

93
Q

what type of drug is ondansetron

A

highly selective 5-HT3 receptor antagonist

94
Q

mechanism of action of ondansetron

A

inhibits 5-HT3 receptors in the chemoreceptor trigger zone and peripherally in the GI tract > inhibits the visceral afferent stimulation of the vomiting centre as well as directly inhibiting serotonin at the CTZ

vomiting centre receives input from; CTZ, vestibular apparatus, vagus nerve, enteric nervous system,

95
Q

indications of ondansetron

A

nausea and vomiting

96
Q

contraindications of ondansetron

A
  • long QT syndrome
  • previous dystonic reaction
  • hypersensitivity
  • use caution in patients taking apo-morphine (used in treatment of Parkinson’s) as can cause hypotension, LOC, bradycardia
97
Q

what type of drug is

A

Paramedic Revision (22 decks)

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