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AV CPGs > Section 5.1: ALS Pharmacology > Flashcards

Section 5.1: ALS Pharmacology Flashcards

1
Q

Adrenaline – Presentation/s

A
  • 1mg in 1mL glass ampoule (1:1000)
  • 1mg in 10mL glass ampoule (1:10000)
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2
Q

Adrenaline – Pharmacology

A

A naturally occurring alpha and beta-adrenergic stimulant

Actions:

  • Increases HR by increasing SA node firing rate (Beta 1)
  • Increases conduction velocity through the A-V node (Beta 1)
  • Increases myocardial contractility (Beta 1)
  • Increases the irritability of the ventricles (Beta 1)
  • Causes bronchodilation (Beta 2)
  • Causes peripheral vasoconstriction (Alpha)
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3
Q

Adrenaline – Metabolism

A
  • By monoamine oxidase and other enzymes in the blood, liver and around nerve endings. Excreted by the kidneys
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4
Q

Adrenaline – Primary emergency indication/s

A
  1. Cardiac arrest – VF / VT, Asystole or PEA
  2. Inadequate perfusion (cardiogenic or non-cardiogenic / non-hypovolaemic)
  3. Bradycardia with poor perfusion
  4. Anaphylaxis
  5. Severe asthma – imminent life threat not responding to nebulised therapy, or unconscious with no BP
  6. Croup
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5
Q

Adrenaline – Contraindication/s

A
  1. Hypovolaemic shock without adequate fluid replacement
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6
Q

Adrenaline – Precaution/s

A

Consider reduced doses for:

  1. Elderly / frail Pts
  2. Pts with cardiovascular disease
  3. Pts on monoamine oxidase inhibitors
  • Higher doses may be required for Pts on beta blockers
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7
Q

Adrenaline – Route/s of administration

A
  • Nebulised
  • IM
  • IV
  • IV infusion
  • ETT
  • IO
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8
Q

Adrenaline – Side effects

A
  • Sinus tachycardia
  • Supraventricular arrhythmias
  • Ventricular arrhythmias
  • Hypertension
  • Pupillary dilation (mydriasis)
  • May increase size of the Myocardial Infarction
  • Feeling of anxiety / palpitations in the conscious Pt
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9
Q

Adrenaline – Special notes

A
  • IV Adrenaline should be reserved for life threatening situations
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10
Q

Adrenaline – Onset, Peak & Duration times (IV & IM)

A

IV effects:

  • Onset: 30sec
  • Peak: 3 – 5min
  • Duration: 5 – 10min

IM effects:

  • Onset: 30 – 90sec
  • Peak: 4 – 10min
  • Duration: 5 – 10min
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11
Q

Aspirin – Presentation/s

A
  • 300mg chewable tablets
  • 300mg soluble or water dispersible tablets
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12
Q

Aspirin – Pharmacology

A

An analgesic, antipyretic, anti-inflammatory and anti-platelet aggregation agent

Actions:

  • To minimize platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in Acute Coronary Syndrome
  • Inhibits the synthesis of prostaglandins – anti-inflammatory actions
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13
Q

Aspirin – Metabolism

A
  • Converted to salicylate in the gut mucosa and liver. Excreted mainly by the kidneys.
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14
Q

Aspirin – Primary emergency indication/s

A
  1. Acute Coronary Syndrome
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15
Q

Aspirin – Contraindication/s

A
  1. Hypersensitivity to aspirin / salicylates
  2. Actively bleeding peptic ulcers
  3. Bleeding disorders
  4. Suspected dissecting aortic aneurysm
  5. Chest pain associated with psychostimulant OD if SBP > 160mmHg
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16
Q

Aspirin – Precaution/s

A
  1. Peptic ulcer
  2. Asthma
  3. Pts on anticoagulants
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17
Q

Aspirin – Route/s of administration

A
  • Oral
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18
Q

Aspirin – Side effects

A
  • Heartburn
  • Nausea
  • Gastrointestinal bleeding
  • Increased bleeding time
  • Hypersensitivity reactions
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19
Q

Aspirin – Special notes

A
  • Aspirin is C/I for use in acute febrile illness in children and adolescents.
  • The anti-platelet effects of Aspirin persist for the natural life of platelets.
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20
Q

Aspirin – Onset, Peak & Duration times

A
  • Onset: N/A
  • Peak: N/A
  • Duration: 8 – 10days
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21
Q

Ceftriaxone – Presentation/s

A
  • 1g sterile powder in a glass vial
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22
Q

Ceftriaxone – Pharmacology

A
  • Cephalosporin antibiotic
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23
Q

Ceftriaxone – Metabolism

A
  • Excreted unchanged in urine (33% - 67%) and in bile
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24
Q

Ceftriaxone – Primary emergency indication/s

A
  1. Suspected meningococcal septicaemia
  2. Severe sepsis (consult only)
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25
Q

Ceftriaxone – Contraindication/s

A
  1. Allergy to Cephalosporin antibiotics
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26
Q

Ceftriaxone – Precaution/s

A
  1. Allergy to Penicillin antibiotics
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27
Q

Ceftriaxone – Route/s of administration

A
  • IV (preferred)
  • IM (if IV access unavailable)
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28
Q

Ceftriaxone – Side effects

A
  • Nausea
  • Vomiting
  • Skin rash
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29
Q

Ceftriaxone – Special notes

A

Usual dose:

  • Adult 1g
  • Child 50mg / kg (max. 1g)

Ceftriaxone IV must be made up to 10mL using sterile water and dose administered over 2min

Ceftriaxone IM must be made up to 4mL using 1% Lignocaine and dose administered in lateral upper thigh

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30
Q

Ceftriaxone – Onset, Peak & Duration times

A

IM / IV effects:

  • Onset: N/A
  • Peak: N/A
  • Duration: N/A
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31
Q

Dextrose 10% – Presentation/s

A
  • 25g in 250mL infusion soft pack
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32
Q

Dextrose 10% – Pharmacology

A

A slightly hypertonic crystalloid solution

Composition:

  • Sugar – 10% dextrose
  • Water

Actions:

  • Provides a source of energy
  • Supplies body water
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33
Q

Dextrose 10% – Metabolism

A

Dextrose:

  • Broken down in most tissues
  • Stored in the liver and muscle as glycogen

Water:

  • Distributed throughout total body water, mainly in the extracellular fluid compartment
  • Excreted by the kidneys
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34
Q

Dextrose 10% – Primary emergency indication/s

A
  1. Diabetic hypoglycaemia (BGL analysis < 4mmol/L) in Pts with an altered conscious state who are unable to self-administer oral glucose
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35
Q

Dextrose 10% – Contraindication/s

A
  • Nil of significance in the above indication
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36
Q

Dextrose 10% – Precaution/s

A
  • Nil of significance in the above indication
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37
Q

Dextrose 10% – Route/s of administration

A
  • IV infusion
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38
Q

Dextrose 10% – Side effects

A
  • Nil of significance in the above indication
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39
Q

Dextrose 10% – Special notes

A

Officially - none, however (see Special Notes under Hypoglycaemia CPG A0702):

  • Ensure IV is patent before administering Dextrose. Extravasation of Dextrose can cause tissue necrosis.
  • All IVs should be well flushed before and after Dextrose administration (minimum 10mL Normal Saline).
  • Further dose of Dextrose 10% may be required in some hypoglycaemic episodes. Consider consultation if BGL remains < 4mmol / L and unable to administer oral carbohydrates.
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40
Q

Dextrose 10% – Onset, Peak & Duration times

A

IV infusion effects:

  • Onset: 3min
  • Peak: N/A
  • Duration: Depends on severity of hypoglycaemic episode
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41
Q

Fentanyl – Presentation/s

A
  • 100mcg in 2mL glass ampoule
  • 200mcg in 1mL glass vial (IN use only)
  • 600mcg in 2mL glass vial (IN use only)
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42
Q

Fentanyl – Pharmacology

A

A synthetic opioid analgesic

Actions:

CNS effects:

  • CNS depression – leading to analgesia
  • Respiratory depression – leading to apnoea
  • Dependence (addiction)

Cardiovascular effects:

  • Decreases conduction velocity through the AV node
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43
Q

Fentanyl – Metabolism

A
  • By the liver; excreted by the kidneys
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44
Q

Fentanyl – Primary emergency indication/s

A
  1. Sedation to facilitate intubation
  2. Sedation to maintain intubation
  3. Drug facilitated intubation
  4. Analgesia – IV / IN
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45
Q

Fentanyl – Contraindication/s

A
  • Known hypersensitivity
  • IV Amiodarone
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46
Q

Fentanyl – Precaution/s

A
  1. Elderly / frail patients
  2. Impaired renal / hepatic function
  3. Respiratory depression, eg COPD
  4. Current asthma
  5. Pts on monoamine oxidase inhibitors
  6. Known addiction to opioids
  7. Rhinitis, rhinorrhea or facial trauma (IN route)
  8. Oral Amiodarone
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47
Q

Fentanyl – Route/s of administration

A
  • IV
  • IN
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48
Q

Fentanyl – Side effects

A
  • Respiratory depression
  • Apnoea
  • Rigidity of the diaphragm and intercostal muscles
  • Bradycardia
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49
Q

Fentanyl – Special notes

A
  • Fentanyl is a Schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility
  • Respiratory depression can be reversed with Naloxone
  • 100mcg Fentanyl is equivalent in analgesic activity to 10mg Morphine
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50
Q

Fentanyl – Onset, Peak & Duration times

A

IV effects:

  • Onset: Immediate
  • Peak: < 5min
  • Duration: 30-60min

IN effects:

  • Onset: N/A
  • Peak: 2min
  • Duration: N/A
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51
Q

Glucagon – Presentation/s

A
  • 1mg (IU) in 1mL hypokit
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52
Q

Glucagon – Pharmacology

A

A hormone normally secreted by the pancreas

Actions:

  • Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose
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53
Q

Glucagon – Metabolism

A
  • Mainly by the liver, also by the kidneys and in the plasma
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54
Q

Glucagon – Primary emergency indication/s

A
  1. Diabetic hypoglycaemia (BGL < 4mmol / L) in Pts with an altered conscious state who are unable to self-administer oral glucose
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55
Q

Glucagon – Contraindication/s

A
  • Nil of significance in the above indication
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56
Q

Glucagon – Precaution/s

A
  • Nil of significance in the above indication
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57
Q

Glucagon – Route/s of administration

A
  • IM
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58
Q

Glucagon – Side effects

A
  • Nausea and vomiting (rare)
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59
Q

Glucagon – Special notes

A
  • Not all Pts will respond to Glucagon, eg those with inadequate glycogen stores in the liver (alcoholics, malnourished)
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60
Q

Glucagon – Onset, Peak & Duration times

A

IM effects:

  • Onset: 5min
  • Peak: N/A
  • Duration: 25min
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61
Q

Glyceryl Trinitrate (GTN) – Presentation/s

A
  • 0.6mg tablets
  • Transdermal GTN Patch (50mg 0.4mg / hr release)
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62
Q

Glyceryl Trinitrate (GTN) – Pharmacology

A

Principally, a vascular smooth muscle relaxant

Actions:

  • Venous dilatation promotes venous pooling and reduces venous return to the heart (reduces preload)
  • Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces afterload)

The effects of the above are:

  • Reduced myocardial 02 demand
  • Reduced systolic, diastolic and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure
  • Mild collateral coronary arterial dilatation may improve blood supply to ischaemic areas of myocardium
  • Mild tachycardia secondary to slight fall in blood pressure
  • Preterm labour: Uterine quiescence in pregnancy
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63
Q

Glyceryl Trinitrate (GTN) – Metabolism

A
  • By the liver
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64
Q

Glyceryl Trinitrate (GTN) – Primary emergency indication/s

A
  1. Chest pain with ACS
  2. Acute LVF with SOB and audible fine crackles (bases, mid-zones or full field)
  3. Hypertension associated with ACS
  4. Autonomic dysreflexia
  5. Preterm labour (consult)
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65
Q

Glyceryl Trinitrate (GTN) – Contraindication/s

A
  1. Known hypersensitivity
  2. Systolic blood pressure < 110mmHg (tablet)
  3. Systolic blood pressure < 90mmHg (patch)
  4. Sildenafil Citrate (Viagra) or Vardenafil (Levitra) administration in the previous 24hr or Tadalafil (Cialis) administration in the previous 4 days (PDE5 inhibitors)
  5. Heart rate > 150bpm
  6. Bradycardia HR < 50bpm (excluding autonomic dysreflexia)
  7. VT
  8. Inferior STEMI with systolic BP < 160mmHg
  9. Right ventricular MI
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66
Q

Glyceryl Trinitrate (GTN) – Precaution/s

A
  1. No previous administration
  2. Elderly Pts
  3. Recent MI
  4. Concurrent use with other tocolytics
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67
Q

Glyceryl Trinitrate (GTN) – Route/s of administration

A
  • SL
  • Buccal
  • Transdermal
  • Infusion (inter-hospital transfer only)
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68
Q

Glyceryl Trinitrate (GTN) – Side effects

A
  • Tachycardia
  • Hypotension
  • Headache
  • Skin flushing (uncommon)
  • Bradycardia (occasionally)
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69
Q

Glyceryl Trinitrate (GTN) – Special notes

A

Storage:

  • GTN is susceptible to heat and moisture. Make sure that tablets are stored in their original light resistant, tightly sealed bottles. The foil pack of the patches should be intact.
  • Tablets should be discarded and replaced after 1 month
  • Patches should be discarded prior to the use-by date
  • Do not administer Pt’s own medication as its storage may not have been in optimum conditions or it may have expired

History taking:

  • Since both men and women can be prescribed Sildenafil Citrate (Viagra) or Vardenafil (Levitra) or Tadalafil (Cialis), all Pts should be asked if and when they last had the drug to determine if GTN is C/I
  • Tadalafil (Cialis) may also be prescribed to men for Rx of benign prostatic hypertrophy. This is a new indication for the drug and may lead to an increased number of Pts under this Rx regimen

Inter-hospital transfer:

  • GTN by IV infusion may be required for an inter-hospital transfer as per the treating doctor’s orders
  • The IV dose is to be prescribed and signed by the referring hospital medical officer. Infusions usually run in the range of 5mcg / min to 200mcg / min and increased 3 – 5mcg / min
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70
Q

Glyceryl Trinitrate (GTN) – Onset, Peak & Duration times

A

IV effects:

  • Onset: 30sec – 1min
  • Peak: 3 – 5min
  • Duration: 15 – 30min

S/L effects:

  • Onset: 30sec – 2min
  • Peak: 5 – 10min
  • Duration: 15 – 30min

Transdermal effects:

  • Onset: Up to 30min
  • Peak: 2hr
  • Duration: N/A
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71
Q

Ipratropium Bromide – Presentation/s

A
  • 250mcg in 1mL nebule or polyamp
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72
Q

Ipratropium Bromide – Pharmacology

A

Anticholinergic bronchodilator

Actions:

  • Allows bronchodilatation by inhibiting cholinergic bronchomotor tone (ie blocks vagal reflexes which mediate bronchoconstriciton
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73
Q

Ipratropium Bromide – Metabolism

A
  • Excreted by the kidneys
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74
Q

Ipratropium Bromide – Primary emergency indication/s

A
  1. Severe respiratory distress associated with bronchospasm
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75
Q

Ipratropium Bromide – Contraindication/s

A
  1. Known hypersensitivity to Atropine or its derivatives
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76
Q

Ipratropium Bromide – Precaution/s

A
  1. Glaucoma
  2. Avoid contact with eyes
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77
Q

Ipratropium Bromide – Route/s of administration

A
  • Nebulised (in combination with Salbutamol)
78
Q

Ipratropium Bromide – Side effects

A
  • Headache
  • Nausea
  • Dry mouth
  • Skin rash
  • Tachycardia (rare)
  • Palpitations (rare)
  • Acute angle closure glaucoma secondary to direct eye contact (rare)
79
Q

Ipratropium Bromide – Special notes

A
  • There have been isolated reports of ocular complications (dilated pupils, increased intraocular pressure, acute angle glaucoma, eye pain) as a result of direct eye contact of Ipratropium Bromide formulations
  • The nebuliser mask must therefore be fitted properly during inhalation and care taken to avoid Ipratropium Bromide solution entering the eyes
  • Ipratropium Bromide must be nebulised in conjunction with Salbutamol and is to be administered as a single dose only
80
Q

Ipratropium Bromide – Onset, Peak & Duration times

A

Nebulised effects:

  • Onset: 3 – 5min
  • Peak: 1.5 – 2hr
  • Duration: 6hr
81
Q

Lignocaine 1% (IM administration) – Presentation/s

A
  • 50mg in 5mL amp (1%)
82
Q

Lignocaine 1% (IM administration) – Pharmacology

A

A local anaesthetic agent

Actions:

  • Prevents initiation and transmission of nerve impulses causing local anaesthesia (1% solution)
83
Q

Lignocaine 1% (IM administration) – Metabolism

A
  • By the liver (90%)
  • Excreted unchanged by the kidneys (10%)
84
Q

Lignocaine 1% (IM administration) – Primary emergency indication/s

A
  1. Dilutent for Ceftriaxone for IM administration in suspected meningococcal disease
85
Q

Lignocaine 1% (IM administration) – Contraindication/s

A
  1. Known hypersensitivity
86
Q

Lignocaine 1% (IM administration) – Precaution/s

A
  1. When using Lignocaine 1% as dilutent for IM Ceftriaxone, it is important to rule out inadvertent IV administration due to potential CNS complications
87
Q

Lignocaine 1% (IM administration) – Route/s of administration

A
  • IM (1% solution with Ceftriaxone only)
88
Q

Lignocaine 1% (IM administration) – Side effects

A
  • Nil – unless inadvertent IV administration
89
Q

Lignocaine 1% (IM administration) – Special notes

A

N/A

90
Q

Lignocaine 1% (IM administration) – Onset, Peak & Duration times

A

IM effects:

  • Onset: Rapid
  • Peak: N/A
  • Duration: 1 – 1.5hr
91
Q

Methoxyflurane – Presentation/s

A
  • 3mL glass bottle
92
Q

Methoxyflurane – Pharmacology

A
  • Inhalational analgesic agent at low concentrations
93
Q

Methoxyflurane – Metabolism

A
  • Excreted mainly by the lungs
  • By the liver
94
Q

Methoxyflurane – Primary emergency indication/s

A
  1. Pain relief
95
Q

Methoxyflurane – Contraindication/s

A
  1. Pre-existing renal disease / renal impairment
  2. Concurrent use of tetracycline antibiotics
  3. Exceeding total dose of 6mL in a 24hr period
96
Q

Methoxyflurane – Precaution/s

A
  1. The Penthrox inhaler must be hand-held by the Pt so that if unconsciousness occurs it will fall from the Pt’s face. Occasionally the operator may need to assist but must continuously assess the level of consciousness
  2. Pre-eclampsia
  3. Concurrent use with Oxytocin may cause hypotension
97
Q

Methoxyflurane – Route/s of administration

A
  • Self administration under supervision using the hand held Penthrox inhaler
98
Q

Methoxyflurane – Side effects

A
  • Drowsiness
  • Decrease in blood pressure and bradycardia (rare)
  • Exceeding the maximum total dose of 6mL in a 24hr period may lead to renal toxicity
99
Q

Methoxyflurane – Special notes

A
  • The maximum initial priming dose for Methoxyflurane is 3mL. This will provide approximately 25min of analgesia and may be followed by one further 3mL dose once the initial dose is exhausted if required.
  • Analgesia commences after 8 – 10 breaths and lasts for approximately 3 – 5min once discontinued
  • Do not administer in a confined space. Ensure adequate ventilation in ambulance.
100
Q

Methoxyflurane – Onset, Peak & Duration times

A
  • Onset: After ~ 8 – 10 breaths
  • Peak: N/A
  • Duration: Continuous use ~25min; Once discontinued ~ 3 – 5min
101
Q

Metoclopramide – Presentation/s

A
  • 10mg in 2mL polyamp
102
Q

Metoclopramide – Pharmacology

A

Antiemetic

Actions:

  • Accelerates gastric emptying and peristalsis
  • Dopamine receptor antagonist
103
Q

Metoclopramide – Metabolism

A
  • By the liver; excreted by the kidneys
104
Q

Metoclopramide – Primary emergency indication/s

A
  1. Nausea / vomiting associated with:
  • Chest pain / discomfort of a cardiac nature
  • Opioid administration for pain
  • Cytotoxic or radiotherapy
  • Previously diagnosed migraine
  • Severe gastroenteritis
  1. Prophylaxis:
  • Awake, spinal immobilised Pts
  • Eye trauma
105
Q

Metoclopramide – Contraindication/s

A
  1. Children
  2. Suspected bowel obstruction or perforation
  3. Gastrointestinal haemorrhage
106
Q

Metoclopramide – Precaution/s

A
  1. Undiagnosed abdominal pain
  2. Adolescents (< 20yrs)
  3. Administer slowly over 1min to minimise risk of extrapyramidal reactions
107
Q

Metoclopramide – Route/s of administration

A
  • IV
  • IM
108
Q

Metoclopramide – Side effects

A
  • Drowsiness
  • Lethargy
  • Dry mouth
  • Muscle tremor
  • Extrapyramidal reactions (usually the dystonic type)
109
Q

Metoclopramide – Special notes

A
  • Not effective for established motion sickness.
  • Not effective for nausea prophylaxis in the setting of opioid administration.
110
Q

Metoclopramide – Onset, Peak & Duration times

A

IV effects:

  • Onset: 1 – 3min
  • Peak: N/A
  • Duration: 10 – 30min

IM effects:

  • Onset: 10 – 15min
  • Peak: N/A
  • Duration: 1 – 2hr
111
Q

Midazolam – Presentation/s

A
  • 5mg in 1mL glass ampoule
  • 15mg in 3mL glass ampoule
112
Q

Midazolam – Pharmacology

A

Short acting CNS depressant

Actions:

  • Anxiolytic
  • Sedative
  • Anti-convulsant
113
Q

Midazolam – Metabolism

A
  • By the liver; excreted by the kidneys
114
Q

Midazolam – Primary emergency indication/s

A
  • Status epilepticus
  • Sedation to enable intubation (RSI / IFS)
  • Post intubation sedation
  • Sedation to enable synchronized cardioversion
  • Sedation in the agitated Pt (including Pts under the Mental Health Act 2014)
  • Sedation in psychostimulant OD
115
Q

Midazolam – Contraindication/s

A
  1. Known hypersensitivity to benzodiazepines
116
Q

Midazolam – Precaution/s

A
  1. Reduced doses may be required for the elderly / frail, Pts with chronic renal failure, CCF or shock
  2. The CNS depressant effects of benzodiazepines are enhanced in the presence of narcotics and other tranquillisers including alcohol
  3. Can cause severe respiratory depression in Pts with COPD
  4. Pts with myasthenia gravis
117
Q

Midazolam – Route/s of administration

A
  • IM
  • IV
  • IV infusion
118
Q

Midazolam – Side effects

A
  • Depressed level of consciousness
  • Respiratory depression
  • Loss of airway control
  • Hypotension
119
Q

Midazolam – Special notes

A

N/A

120
Q

Midazolam – Onset, Peak & Duration times

A

IV effects:

  • Onset: 1 – 3min
  • Peak: 10min
  • Duration: 20min

IM effects:

  • Onset: 3 – 5min
  • Peak: 15min
  • Duration: 30min
121
Q

Misoprostol – Presentation/s

A
  • 200mcg tablet
122
Q

Misoprostol – Pharmacology

A

A synthetic prostaglandin

Actions:

  • Enhances uterine contractions
123
Q

Misoprostol – Metabolism

A
  • Converted to active metabolite misoprostol acid in the blood
  • Metabolised in the tissues and excreted by the kidneys
124
Q

Misoprostol – Primary emergency indication/s

A
  1. PPPH
125
Q

Misoprostol – Contraindication/s

A
  1. Allergy to prostaglandins
  2. Exclude multiple pregnancy before drug administration
126
Q

Misoprostol – Precaution/s

A
  1. Hx of asthma
127
Q

Misoprostol – Route/s of administration

A
  • Oral
128
Q

Misoprostol – Side effects

A
  • Hyperpyrexia
  • Shivering
  • Abdominal pain
  • Diarrhoea
129
Q

Misoprostol – Special notes

A
  • Side effects are more likely with > 600mcg oral dose
130
Q

Misoprostol – Onset, Peak & Duration times

A

Oral effects:

  • Onset: 8 – 10min
  • Peak: N/A
  • Duration: 2 – 3hr
131
Q

Morphine – Presentation/s

A
  • 10mg in 1mL glass ampoule
132
Q

Morphine – Pharmacology

A

An opioid analgesic

Actions:

CNS effects:

  • CNS depression (leading to analgesia)
  • Respiratory depression
  • Depression of cough reflex
  • Stimulation (changes of mood, euphoria or dysphoria, vomiting, pin-point pupils)
  • Dependence (addiction)

Cardiovascular effects:

  • Vasodilatation
  • Decreases conduction velocity through the AV Node
133
Q

Morphine – Metabolism

A
  • By the liver; excreted by the kidneys
134
Q

Morphine – Primary emergency indication/s

A
  1. Pain relief
  2. Acute LVF with shortness of breath and full field crackles
  3. Sedation to maintain intubation
  4. Sedation to enable intubation
  5. RSI
135
Q

Morphine – Contraindication/s

A
  1. Known hypersensitivity
  2. Late second stage of labour
136
Q

Morphine – Precaution/s

A
  1. Elderly / frail patients
  2. Hypotension
  3. Respiratory depression
  4. Current asthma
  5. Respiratory tract burns
  6. Known addiction to opioids
  7. Acute alcoholism
  8. Pts on monoamine oxidase inhibitors​
137
Q

Morphine – Route/s of administration

A
  • IM
  • IV
  • IV infusion
138
Q

Morphine – Side effects

A

CNS effects:

  • Drowsiness
  • Respiratory depression
  • Euphoria
  • Nausea / Vomiting
  • Addiction
  • Pin-point pupils

Cardiovascular effects:

  • Hypotension
  • Bradycardia
139
Q

Morphine – Special notes

A
  • Morphine is a schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility.
  • Side effects of Morphine can be reversed with Naloxone.
  • Occasional wheals are seen in the line of the vein being used for IV injection. This is not an allergy, only a histamine release.
140
Q

Morphine – Onset, Peak & Duration times

A

IV effects:

  • Onset: 2 – 5min
  • Peak: 10min
  • Duration: 1 – 2hr

IM effects:

  • Onset: 10 – 30min
  • Peak: 30 – 60min
  • Duration: 1 – 2hr
141
Q

Naloxone – Presentation/s

A
  • 0.4mg in 1mL glass ampoule
  • 2mg in 5mL (prepared syringe)
142
Q

Naloxone – Pharmacology

A

An opioid antagonist

Action:

  • Prevents or reverses the effects of opioids
143
Q

Naloxone – Metabolism

A
  • By the liver
144
Q

Naloxone – Primary emergency indication/s

A
  1. Altered conscious state and respiratory depression secondary to administration of opioids or related drugs.
145
Q

Naloxone – Contraindication/s

A
  • Officially - Nil of significance in the above indication

However (see Special Notes):

  • Following an opioid associated cardiac arrest, Naloxone should not be administered. Maintain assisted ventilation.
  • Following head injury, Naloxone should not be administered. Maintain assisted ventilation if required.
146
Q

Naloxone – Precaution/s

A
  1. If Pt is known to be physically dependent on opioids, be prepared for a combative Pt after adminisration.
  2. Neonates
147
Q

Naloxone – Route/s of administration

A
  • IM
  • IV
148
Q

Naloxone – Side effects

A

Symptoms of opioid withdrawal:

  • Sweating
  • Goose flesh
  • Tremor
  • Convulsions
  • Nausea & vomiting
  • Agitation
  • Dilatation of pupils
  • Excessive lacrimation
149
Q

Naloxone – Special notes

A
  • The duration of action of Naloxone is often less than that of the opioid used, therefore repeated doses may be required.
  • Naloxone reverses the effects of opioids with none of the actions produced by other opioid antagonists when no opioid is present in the body. (For example, it does not depress respiration or cause pupillary constriction). In the absence of opioids, Naloxone has no perceivable effects.
  • Following an opioid associated cardiac arrest, Naloxone should not be administered. Maintain assisted ventilation.
  • Following head injury, Naloxone should not be administered. Maintain assisted ventilation if required.
150
Q

Naloxone – Onset, Peak & Duration times

A

IV effects:

  • Onset: 1 – 3min
  • Peak: N/A
  • Duration: 30 – 45min

IM effects:

  • Onset: 1 – 3min
  • Peak: N/A
  • Duration: 30 – 45min
151
Q

Normal Saline – Presentation/s

A
  • 10mL or 30mL polyamp
  • 500mL and 1000mL infusion soft pack
152
Q

Normal Saline – Pharmacology

A

An isotonic crystalloid solution

Composition:

  • Electrolytes (sodium and chloride in a similar concentration to that of extracellular fluid)

Action:

  • Increases the volume of the intravascular compartment
153
Q

Normal Saline – Metabolism

A

Electrolytes:

  • Excreted by the kidneys

Water:

  • Distributed throughout total body water, mainly in the extracellular fluid compartment
  • Excreted by the kidneys
154
Q

Normal Saline – Primary emergency indication/s

A
  1. As a replacement fluid in volume depleted Pts
  2. To expand intravascular volume in the non-cardiac, non-hypovolaemic, hypotensive Pt. eg. Anaphylaxis, burns, sepsis
  3. As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive Pts (other than LVF) eg PEA; asthma
  4. Fluid for diluting and administering IV drugs
  5. Fluid TKVO for IV administration of emergency drugs
155
Q

Normal Saline – Contraindication/s

A

Officially, nil of significance in the above indications however see ‘Hypovolaemia CPG A0801: Modifying factors’.

Under the indication of ‘Replacement fluid in volume depleted Pts’, contraindications include:

  1. Penetrating trunk injury,
  2. Aortic aneurysm, or
  3. Uncontrolled external haemorrhage,

Accept palpable carotid pulse and Tx immediately

156
Q

Normal Saline – Precaution/s

A
  1. Consider modifying factors when administering for hypovolaemia
157
Q

Normal Saline – Route/s of administration

A
  • IV
  • IO
158
Q

Normal Saline – Side effects

A
  • Nil of significance in the above indications
159
Q

Normal Saline – Special notes

A

IV half life:

  • Approximately 30 – 60min
160
Q

Normal Saline – Onset, Peak & Duration times

A
  • Onset: N/A
  • Peak: N/A
  • Duration: N/A
161
Q

Prochlorperazine (Stemetil) – Presentation/s

A
  • 12.5mg in 1mL glass ampoule
162
Q

Prochlorperazine (Stemetil) – Pharmacology

A

An anti-emetic

Action:

  • Acts on several central neuro-transmitter systems
163
Q

Prochlorperazine (Stemetil) – Metabolism

A
  • By the liver; excreted by the kidneys
164
Q

Prochlorperazine (Stemetil) – Primary emergency indication/s

A
  1. Treatment or prophylaxis of nausea / vomiting for:
  • Motion sickness
  • Planned aeromedical evacuation
  • Known allergy or C/I to Metoclopramide administration
  • Headache irrespective of nausea / vomiting
  • Vertigo
165
Q

Prochlorperazine (Stemetil) – Contraindication/s

A
  1. Children
  2. Circulatory collapse
  3. CNS depression
  4. Previous hypersensitivity
166
Q

Prochlorperazine (Stemetil) – Precaution/s

A
  1. Hypotension
  2. Epilepsy
  3. Pts affected by alcohol or on anti-depressants
167
Q

Prochlorperazine (Stemetil) – Route/s of administration

A
  • IM
168
Q

Prochlorperazine (Stemetil) – Side effects

A
  • Drowsiness
  • Blurred vision
  • Hypotension
  • Sinus tachycardia
  • Skin rash
  • Extrapyramidal reactions (usually the dystonic type)
169
Q

Prochlorperazine (Stemetil) – Special notes

A

N/A

170
Q

Prochlorperazine (Stemetil) – Onset, Peak & Duration times

A

IM effects:

  • Onset: 20min
  • Peak: 40min
  • Duration: 6hr
171
Q

Salbutamol – Presentation/s

A
  • 5mg in 2.5mL polyamp
  • 500mcg in 1mL glass ampoule
  • 5mg in 5mL glass ampoule
  • pMDI (100mcg per actuation)
172
Q

Salbutamol – Pharmacology

A

A synthetic beta adrenergic stimulant with primarily beta 2 effects

Actions:

  • Causes bronchodilatation
173
Q

Salbutamol – Metabolism

A
  • By the liver; excreted by the kidneys
174
Q

Salbutamol – Primary emergency indication/s

A
  1. Respiratory distress with suspected bronchospasm:
  • Asthma
  • COPD
  • Severe allergic reactions
  • Smoke inhalation
  • Oleoresin capsicum spray exposure
175
Q

Salbutamol – Contraindication/s

A
  1. IV Salbutamol is no longer indicated for adult Pts
176
Q

Salbutamol – Precaution/s

A
  1. Large doses of IV Salbutamol have been reported to cause intracellular metabolic acidosis
177
Q

Salbutamol – Route/s of administration

A
  • pMDI
  • Nebulised
  • IV
  • IV infusion
  • ETT
  • IO
178
Q

Salbutamol – Side effects

A
  • Sinus tachycardia
  • Muscle tremor (common)
179
Q

Salbutamol – Special notes

A
  • IV Salbutamol has no advantage over nebulised Salbutamol provided that adequate ventilation is occurring.
  • Salbutamol nebules / polyamps have a shelf life of one month after the wrapping is opened. The date of opening of the packaging should be recorded and the drug should be stored in an environment of < 30°C
  • Although infrequently used, Salbutamol by IV infusion may be required during inter-hospital transfers of some women in premature labour. The dose is to be prescribed and signed by the referring hospital medical officer.
180
Q

Salbutamol – Onset, Peak & Duration times

A

IV effects:

  • Onset: 1 – 2min
  • Peak: N/A
  • Duration: 30 – 60min

Nebulised effects:

  • Onset: 5 – 15min
  • Peak: N/A
  • Duration: 15 – 50min
181
Q

Water for Injection – Presentation/s

A
  • 10mL polyamp
182
Q

Water for Injection – Pharmacology

A
  • Water for injection is a clear, particle free, colourless, odourless and tasteless liquid. It is sterile, with a pH of 5.6 – 7.7 and contains no antimicrobial agents.
183
Q

Water for Injection – Metabolism

A
  • Distributed throughout the body; excreted by the kidneys
184
Q

Water for Injection – Primary emergency indication/s

A
  1. Used to dissolve Ceftriaxone in preparation for IV injection
185
Q

Water for Injection – Contraindication/s

A
  • Nil in the above indication
186
Q

Water for Injection – Precaution/s

A
  • Nil in the above indication
187
Q

Water for Injection – Route/s of administration

A
  • IV
188
Q

Water for Injection – Side effects

A

None

189
Q

Water for Injection – Special notes

A

None

190
Q

Water for Injection – Onset, Peak & Duration times

A

N/A

AV CPGs (3 decks)

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