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SAAS paramedic drugs Flashcards

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

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
what type of drug is fentanyl?
highly concentrated opioid agonist
26
what type of drug is fentanyl?
highly concentrated opioid agonist
27
mechanism of action of fentanyl
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
28
indications of fentanyl
uncontrolled pain
29
contraindications of fentanyl
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)
30
what type of drug is fexofenadine?
competitive histamine-1 receptor antagonist
31
mechanism of action of fexofenadine
binds to H1 receptors blocking the action of histamine > limitation of histamine mediated symptoms
32
indications of fexofenadine
mild/moderate anaphylactic features - skin rash - itchiness - urticaria - allergic rhinitis
33
contraindications of fexofenadine
hypersensitivity
34
what type of drug is glucagon?
synthetic form of an endogenous hormone which increases BGL
35
mechanism of action of glucagon
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)
36
indications for glucose
hypoglycaemia (ICP's can administer for oesophageal spasm, beta-blocker OD and calcium channel blocker OD)
37
contraindications for glucose
hypersensitivity phaeochromocytoma insulinoma glucagonoma
38
indications for glucose
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)
39
contraindications for glucose
hypersensitivity (including to corn and corn products) hyperglycaemia insulinoma
40
what type of drug is GTN?
glycerine trinitrate is an organic nitrate (enzymatically converted to nitric oxide)
41
mechanism of action of GTN
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
indications for GTN
cardiac chest pain ACPO (ICP's autonomic dysreflexia with SBP >160mmHg)
43
contraindications of GTN
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
effects of vessel dilation with GTN administration
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
what type of drug is ibuprofen?
oral non-steroid anti-inflammatory drug (NSAID)
46
indications of ibuprofen
pain (as a part of a multimodal approach)
47
contraindications of ibuprofen
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
common ACE inhibitors
benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril
49
common ARB's
candesartan, azilsartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan
50
mechanism of action of ibuprofen
works on COX-1 and COX-2 pathways to inhibit conversion of arachidonic acid into thromboxane, prostaglandins, and prostacyclins
51
what type of drug is clonazepam
benzodiazepine
52
indications of clonazepam
under consultation palliative care anxiety delirium in combination with haloperidol
53
contraindications of clonazepam
nil - cautionary use in patients with respiratory depression or reduced respiratory drive
54
mechanism of action of clonazepam
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
what type of drug is haloperidol?
parenteral antipsychotic and antiemetic
56
indications for haloperidol
under consultation - end of life kit delirium and anxiety nausea and vomiting including with bowel obstruction augmented sedation with benzodiazepine
57
contraindications for haloperidol
Parkinson's disease if extrapyramidal side effects are distressing
58
mechanism of action of haloperidol
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
what type of drug is hyoscine butylbromide (buscopan)?
palliative care parenteral anticholinergic
60
indications for hyoscine butylbromide
under consultation delirium and anxiety nausea and vomiting including with bowel obstruction augmented sedation with benzodiazepine
61
mechanism of action of Hyoscine Butylbromide
- blocks muscarinic receptors in the GI tract causing smooth muscle relaxation - binding to nicotinic receptors induces a ganglion-blocking effect
62
what type of drug is iprotroprium
a non-selective anticholinergic - parasympathetic muscarinic receptor antagonist
63
mechanism of action of ipratroprium
blocks the action of acetylcholine at muscarinic receptors > inhibits parasympathetic Bronchoconstriction and mucous secretion
64
indications for ipratroprium
management of moderate to severe bronchospasm in conjunction with salbutamol
65
contraindications for ipratroprium
known hypersensitivity to ipratroprium or its derivatives
66
what type of drug is ketorolac
parenteral non-steroidal anti inflammatory drug (NSAID)
67
mechanism of action of ketorolac
works on COX-1 and COX-2 pathways to inhibit conversion of arachidonic acid into thromboxane, prostaglandins, and prostacyclins
68
Indications for ketorolac
pain - as a part of a multi modal approach
69
contraindications of ketorolac
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
what type of drug is lorazepam?
benzodiazepine
71
mechanism of action of lorazepam
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
indications for lorazepam
challenging behaviour severe anxiety
73
contraindications for lorazepam
consult for under 16 years use caution when patient has respiratory depression
74
what type of drug is methoxyflurane?
inhaled analgesic/ volatile anaesthetic with analgesic properties
75
mechanism of action of methoxyflurane
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
indications for methoxyflurane
uncontrolled pain - as a part of a multimodal approach
77
contraindications of methoxyflurane
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
what type of drug is
pro kinetic agent/ in SAAS setting palliative care antiemetic
79
indications of metoclopramide
under consult - nausea and vomiting (pal-care) - poor gastric emptying - nausea due to constipation - nausea and vomiting due to chemoreceptor trigger zone causes
80
contraindications of metoclopramide
contraindicated in intestinal obstruction or perforation avoid in Parkinson's where possible as symptoms may worsen
81
what type of drug is midazolam
benzodiazepine
82
mechanism of action of midazolam
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
indications for midazolam
prolonged/repeated seizures mental health transfer with SAT > +2 (under consult) CPR induced consciousness (CPRIC)
84
contraindications of midazolam
nil - patients with respiratory disease or the elderly/frail are more susceptible to midazolam induced respiratory depression
85
what type of drug is morphine
opiate agonist
86
mechanism of action of morphine
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
indications of morphine
uncontrolled pain
88
contraindications of morphine
hypotension (SBP <100mmHg) sedation score =/> 2 (consider physiological picture e.g. if BP slightly higher but tachycardia, pre-existing respiratory disease, etc.)
89
what type of drug is naloxone
competitive opioid antagonist
90
mechanism of action of naloxone
competitively displaces opioids from opioid receptor sites, reversing the effects of the opioid
91
indications for naloxone
opioid overdose
92
contraindications for naloxone
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
what type of drug is ondansetron
highly selective 5-HT3 receptor antagonist
94
mechanism of action of ondansetron
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
indications of ondansetron
nausea and vomiting
96
contraindications of ondansetron
- 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
what type of drug is

Paramedic Revision (22 decks)

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