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AV CPGs > Section 5.3: Complete AV Pharmacology > Flashcards

Section 5.3: Complete AV 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
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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
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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:
  • 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
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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
  3. Systolic blood pressure
  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
  7. VT
  8. Inferior STEMI with systolic BP
  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)
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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)
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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
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80
Q

Ipratropium Bromide – Onset, Peak & Duration times

A

Nebulised effects:

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

Lignocaine 1% (IM administration) – Presentation/s

A
  • 50mg in 5mL amp (1%)
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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)
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83
Q

Lignocaine 1% (IM administration) – Metabolism

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

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

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

Lignocaine 1% (IM administration) – Contraindication/s

A
  1. Known hypersensitivity
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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
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87
Q

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

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

Lignocaine 1% (IM administration) – Side effects

A
  • Nil – unless inadvertent IV administration
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89
Q

Lignocaine 1% (IM administration) – Special notes

A

N/A

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90
Q

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

A

IM effects:

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

Methoxyflurane – Presentation/s

A
  • 3mL glass bottle
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92
Q

Methoxyflurane – Pharmacology

A
  • Inhalational analgesic agent at low concentrations
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93
Q

Methoxyflurane – Metabolism

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

Methoxyflurane – Primary emergency indication/s

A
  1. Pain relief
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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
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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
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97
Q

Methoxyflurane – Route/s of administration

A
  • Self administration under supervision using the hand held Penthrox inhaler
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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
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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.
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100
Q

Methoxyflurane – Onset, Peak & Duration times

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

Metoclopramide – Presentation/s

A
  • 10mg in 2mL polyamp
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102
Q

Metoclopramide – Pharmacology

A

Antiemetic

Actions:

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

Metoclopramide – Metabolism

A
  • By the liver; excreted by the kidneys
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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
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105
Q

Metoclopramide – Contraindication/s

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

Metoclopramide – Precaution/s

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

Metoclopramide – Route/s of administration

A
  • IV
  • IM
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108
Q

Metoclopramide – Side effects

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

Metoclopramide – Special notes

A
  • Not effective for established motion sickness.
  • Not effective for nausea prophylaxis in the setting of opioid administration.
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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
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111
Q

Midazolam – Presentation/s

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

Midazolam – Pharmacology

A

Short acting CNS depressant

Actions:

  • Anxiolytic
  • Sedative
  • Anti-convulsant
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113
Q

Midazolam – Metabolism

A
  • By the liver; excreted by the kidneys
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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
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115
Q

Midazolam – Contraindication/s

A
  1. Known hypersensitivity to benzodiazepines
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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
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117
Q

Midazolam – Route/s of administration

A
  • IM
  • IV
  • IV infusion
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118
Q

Midazolam – Side effects

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

Midazolam – Special notes

A

N/A

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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
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121
Q

Misoprostol – Presentation/s

A
  • 200mcg tablet
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122
Q

Misoprostol – Pharmacology

A

A synthetic prostaglandin

Actions:

  • Enhances uterine contractions
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123
Q

Misoprostol – Metabolism

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

Misoprostol – Primary emergency indication/s

A
  1. PPPH
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125
Q

Misoprostol – Contraindication/s

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

Misoprostol – Precaution/s

A
  1. Hx of asthma
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127
Q

Misoprostol – Route/s of administration

A
  • Oral
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128
Q

Misoprostol – Side effects

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

Misoprostol – Special notes

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

Misoprostol – Onset, Peak & Duration times

A

Oral effects:

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

Morphine – Presentation/s

A
  • 10mg in 1mL glass ampoule
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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
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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

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

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

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

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
  • 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

188
Q

Water for Injection – Side effects

189
Q

Water for Injection – Special notes

190
Q

Water for Injection – Onset, Peak & Duration times

191
Q

Adenosine – Presentation/s

A
  • 6mg in 2mL glass ampoule
192
Q

Adenosine – Pharmacology

A

A naturally occurring purine nucleoside found in all body cells

Actions:

  • Slows conduction through the A-V node, resulting in termination of re-entry circuit activity within or including the A-V nodal pathway
193
Q

Adenosine – Metabolism

A
  • By adenosine deaminase in red blood cells and vascular endothelium
194
Q

Adenosine – Primary emergency indication/s

A
  1. AVNRT with adequate or inadequate perfusion but not deteriorating rapidly
  2. AVRT and associated Wolff-Parkinson-White (WPW) or other accessory tract SVT with adequate or inadequate perfusion but not deteriorating rapidly
195
Q

Adenosine – Contraindication/s

A
  1. Second or third degree A-V block (may produce prolonged sinus arrest / A-V blockade)
  2. Atrial fibrillation
  3. Atrial flutter
  4. Ventricular tachy-arrhythmias
  5. Known hypersensitivity
196
Q

Adenosine – Precaution/s

A
  1. Adenosine may provoke bronchospasm in the asthmatic Pt
  2. Adenosine is antagonized by methylxanthines (e.g. caffeine or theophyllines). The drug may not be effective in Pts with large caffeine intake or those on high doses of theophylline medication
197
Q

Adenosine – Route/s of administration

198
Q

Adenosine – Side effects

A

Usually brief and transitory:

  • Transient arrhythmia (including asystole, bradycardia or ventricular ectopy) may be experienced following reversion
  • Chest pain
  • Dyspnoea
  • Headache or dizziness
  • Nausea
  • Skin flushing
199
Q

Adenosine – Special notes

A
  • Adenosine has a very short half life. It should be administered through an IV as close to the heart as practicable, such as the cubital fossa
200
Q

Adenosine – Onset, Peak & Duration times

A

IV effects:

  • Onset: N/A
  • Peak: N/A
  • Duration:
201
Q

Amiodarone – Presentation/s

A
  • 150mg in 3mL glass ampoule
202
Q

Amiodarone – Pharmacology

A
  • Class III anti-arrhythmic agent
203
Q

Amiodarone – Metabolism

A
  • By the liver
204
Q

Amiodarone – Primary emergency indication/s

A
  1. VF / pulseless VT refractory to cardioversion
  2. Sustained or recurrent VT
205
Q

Amiodarone – Contraindication/s

A
  1. VF / pulseless VT refractory to cardioversion:
    * Nil of significance in this indication

2. VT (conscious):

  • Inadequate perfusion
  • Pregnancy

3. Tri-cyclic Antidepressant (TCA) Overdose

206
Q

Amiodarone – Precaution/s

A
  1. Following Fentanyl administration
207
Q

Amiodarone – Route/s of administration

208
Q

Amiodarone – Side effects

A
  • Hypotension
  • Bradycardia
209
Q

Amiodarone – Special notes

A
  • Amiodarone is incompatible with saline. Glucose 5% must be used as dilutant when preparing an IV infusion.
  • An IV infusion of Amiodarone may be required during inter-hospital transfer. This will be prescribed by the referring physician and will normally be at a dose of 10 – 20mg / kg run over 24hrs.
210
Q

Amiodarone – Onset, Peak & Duration times

A

IV effects (bolus):

  • Onset: 2min
  • Peak: 20min
  • Duration: 2hr
211
Q

Atropine – Presentation/s

A
  • 0.6mg in 1mL polyamp
  • 1.2mg in 1mL polyamp
212
Q

Atropine – Pharmacology

A

An anti-cholinergic agent

Actions:

  • Inhibits the actions of acetylcholine on post-ganglionic cholinergic nerves at the neuro-effector site, e.g. as a vagal blocker, and allows sympathetic effect to:
    • Increase HR by increasing SA node firing rate
    • Increase the conduction velocity through the A-V node
  • Antidote to reverse the effects of cholinesterase inhibitors (e.g. organophosphate insecticides) at the post-ganglionic neuro-effector sites of cholinergic nerves to:
    • Reduce the excessive salivary, sweat, GIT and bronchial secretions; and
    • Relax smooth muscles
213
Q

Atropine – Metabolism

A
  • By the liver. Excreted mainly by the kidneys.
214
Q

Atropine – Primary emergency indication/s

A
  • Bradycardia with poor perfusion
  • Organophosphate poisoning with excessive cholinergic effects
215
Q

Atropine – Contraindication/s

A
  • Officially, nil of significance in the above indications
  • ? Known hypersensitivity to Atropine or its derivatives.
216
Q

Atropine – Precaution/s

A
  1. Atrial flutter
  2. Atrial fibrillation
  3. Do not increase HR above 100bpm except in children under 6 years
  4. Glaucoma
217
Q

Atropine – Route/s of administration

218
Q

Atropine – Side effects

A
  • Tachycardia
  • Palpitations
  • Dry mouth
  • Dilated pupils
  • Visual blurring
  • Retention of urine
  • Confusion, restlessness (in large doses)
  • Hot, dry skin (in large doses)
219
Q

Atropine – Special notes

220
Q

Atropine – Onset, Peak & Duration times

A

IV effects:

  • Onset:
  • Peak:
  • Duration: 2 – 6hr
221
Q

Dexamethasone – Presentation/s

A
  • 8mg in 2mL glass vial
222
Q

Dexamethasone – Pharmacology

A

A corticosteroid secreted by the adrenal cortex

Actions:

  • Relieves inflammatory reactions
  • Provides immunosuppression
223
Q

Dexamethasone – Metabolism

A
  • By the liver and other tissues. Excreted predominantly by the kidneys
224
Q

Dexamethasone – Primary emergency indication/s

A
  1. Bronchospasm associated with acute respiratory distress not responsive to nebulised Salbutamol
  2. Anaphylaxis
  3. Acute exacerbation of COPD
225
Q

Dexamethasone – Contraindication/s

A
  1. Known hypersensitivity
226
Q

Dexamethasone – Precaution/s

A
  1. Solutions which are not clear or are contaminated should be discarded
227
Q

Dexamethasone – Route/s of administration

228
Q

Dexamethasone – Side effects

A
  • Nil of significance in the above indication
229
Q

Dexamethasone – Special notes

A
  • Does not contain an antimicrobial agent, therefore use the solution immediately and discard any residue
230
Q

Dexamethasone – Onset, Peak & Duration times

A

IV effects:

  • Onset: 30 – 60min
  • Peak: 2hr
  • Duration: 36 – 72hr
231
Q

Dextrose 5% – Presentation/s

A
  • 100mL infusion soft pack
232
Q

Dextrose 5% – Pharmacology

A

An isotonic crystalloid solution

Composition:

  • Sugar – 5% dextrose
  • Water

Actions:

  • Provides a small source of energy
  • Supplies body water
233
Q

Dextrose 5% – 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
234
Q

Dextrose 5% – Primary emergency indication/s

A
  1. Vehicle for dilution and administration of IV emergency drugs
235
Q

Dextrose 5% – Contraindication/s

A
  • Nil of significance in the above indication
236
Q

Dextrose 5% – Precaution/s

A
  • Nil of significance in the above indication
237
Q

Dextrose 5% – Route/s of administration

A
  • IV infusion
238
Q

Dextrose 5% – Side effects

A
  • Nil of significance in the above indication
239
Q

Dextrose 5% – Special notes

A

IV half life:

  • Approximately 20 – 40min
240
Q

Dextrose 5% – Onset, Peak & Duration times

A
  • Onset: N/A
  • Peak: N/A
  • Duration: N/A
241
Q

Enoxaparin (Clexane) – Presentation/s

A
  • 100mg in 1mL pre-filled syringe with graduated markings (SC injection)
  • 40mg in 0.4mL glass ampoule (IV bolus)
242
Q

Enoxaparin (Clexane) – Pharmacology

A
  • Binds to and accelerates the action of antithrombin III which inactivates clotting factors IIa (thrombin) and Xa, inhibiting the conversion of prothrombin to thrombin
243
Q

Enoxaparin (Clexane) – Metabolism

A
  • Metabolised by the liver
244
Q

Enoxaparin (Clexane) – Primary emergency indication/s

A
  1. Acute STEMI
245
Q

Enoxaparin (Clexane) – Contraindication/s

A
  1. Known allergy or hypersensitivity
  2. Active bleeding (eg peptic ulcer, intracranial haemorrhage)
  3. Bleeding disorders
  4. Severe hepatic impairment / disease
  5. Heparin-induced thrombocytopenia (HIT)
246
Q

Enoxaparin (Clexane) – Precaution/s

A
  1. Renal impairment
  2. If Pt > or = 75yo, omit the initial IV bolus dose and only administer 0.75mg / kg SC injection with a maximum 75mg SC
247
Q

Enoxaparin (Clexane) – Route/s of administration

A
  • Enoxaparin 30mg IV followed 15min later by 1mg / kg SC not exceeding 100mg SC
248
Q

Enoxaparin (Clexane) – Side effects

A
  • Bleeding
  • Bruising
  • Pain at injection site
  • Hyperkalaemia
  • Mild reversible thrombocytopenia

Infrequent

  • Transient elevation of liver aminotransferases
  • Severe thrombocytopenia

Rare

  • Skin necrosis at injection site
  • Osteoporosis with long term use
  • Allergic reactions including urticaria and anaphylaxis
  • Hypersensitivity reactions
249
Q

Enoxaparin (Clexane) – Special notes

A
  • STEMI – 12 lead ECG shows ST elevation > or = 1mm in two contiguous limb leads (I, II, III, aVR, aVL, aVF) or ST elevation > or = 2mm in two contiguous chest leads (V1, V2, V3, V4, V5, V6), new LBBB
250
Q

Enoxaparin (Clexane) – Onset, Peak & Duration times

A
  • Onset: Within 3hrs
  • Peak: 3 – 6hrs
  • Duration: > or = 12hrs
251
Q

Frusemide – Presentation/s

A
  • 40mg in 4mL glass ampoule
252
Q

Frusemide – Pharmacology

A

A diuretic

Actions:

  • Causes venous dilatation and reduces venous return
  • Promotes diuresis
253
Q

Frusemide – Metabolism

A
  • Excreted by the kidneys
254
Q

Frusemide – Primary emergency indication/s

A
  1. Acute LVF with SOB and audible fine crackles (bases, mid-zones or full field)
255
Q

Frusemide – Contraindication/s

A
  • Nil of significance in the above indication
256
Q

Frusemide – Precaution/s

A
  1. Hypotension
257
Q

Frusemide – Route/s of administration

258
Q

Frusemide – Side effects

A
  • Hypotension
259
Q

Frusemide – Special notes

A
  • The effect of vasopressor drugs will often be reduced after Rx with Frusemide
260
Q

Frusemide – Onset, Peak & Duration times

A

IV effects:

  • Onset: 5min
  • Peak: 20 – 60min
  • Duration: 2 – 3hr
261
Q

Ketamine – Presentation/s

A
  • 200mg in 2mL vial
262
Q

Ketamine – Pharmacology

A

A rapid acting dissociative anaesthetic agent (primarily an N-methyl-D-aspartate [NMDA] receptor antagonist)

Actions:

Produces a dissociative state characterised by:

  • A trance-like state with eyes open but not responsive
  • Nystagmus
  • Profound analgesia
  • Normal pharyngeal and laryngeal reflexes
  • Normal or slightly enhanced skeletal muscle tone
  • Occasionally a transient and minimal respiratory depression
263
Q

Ketamine – Metabolism

A
  • By the liver and excreted by the kidneys
264
Q

Ketamine – Primary emergency indication/s

A
  1. Rapid sequence intubation
  2. Intubation facilitated by sedation
265
Q

Ketamine – Contraindication/s

A
  1. Known hypersensitivity
  2. Severe hypertension (SBP > 180mmHg)
266
Q

Ketamine – Precaution/s

A
  1. Any condition where significant elevation of BP would be hazardous:
  • Hypertension
  • CVA
  • Recent AMI
  • CCF
  1. If being administered for analgesia, inject slowly over 1/60 to minimize risk of respiratory depression and hypertension
267
Q

Ketamine – Route/s of administration

268
Q

Ketamine – Side effects

A

Cardiovascular:

  • Increase BP and HR

CNS:

  • Respiratory depression or apnoea
  • Emergent reactions (nightmares, restlessness, vivid dreams, confusion, hallucinations, irrational behaviour)
  • Enhanced skeletal tone
  • Nausea and vomiting

Ocular:

  • Diplopia and nystagmus with slight increase in intraocular pressure

Other:

  • Local pain at injection site
  • Lacrimation
  • Salivation
269
Q

Ketamine – Special notes

270
Q

Ketamine – Onset, Peak & Duration times

A

IV / IO effects:

  • Onset: 30sec
  • Peak: 12 – 25min
  • Duration: N/A
271
Q

Lignocaine 1% (IO Administration) – Presentation/s

A
  • 50mg in 5mL amp (1%)
272
Q

Lignocaine 1% (IO Administration) – Pharmacology

A

A local anaesthetic agent

Actions:

  • Prevents initiation and transmission of nerve impulses (local anaesthesia)
273
Q

Lignocaine 1% (IO Administration) – Metabolism

A
  • By the liver (90%)
  • Excreted unchanged by the kidneys (10%)
274
Q

Lignocaine 1% (IO Administration) – Primary emergency indication/s

A
  1. To reduce the pain of IO drug and fluid administration in the responsive Pt
275
Q

Lignocaine 1% (IO Administration) – Contraindication/s

A
  1. Known hypersensitivity
276
Q

Lignocaine 1% (IO Administration) – Precaution/s

A
  1. Hypotension and poor perfusion
  2. Chronic LVF
  3. Liver disease
277
Q

Lignocaine 1% (IO Administration) – Route/s of administration

278
Q

Lignocaine 1% (IO Administration) – Side effects

A

CNS effects (common):

  • Drowsiness
  • Disorientation
  • Decreased hearing
  • Blurred vision
  • Change or slurring of speech
  • Twitching and agitation
  • Convulsions

Cardiovascular effects (uncommon):

  • Hypotension
  • Bradycardia
  • Sinus arrest
  • AV block

Respiratory effects (uncommon):

  • Difficulty in breathing
  • Respiratory arrest
279
Q

Lignocaine 1% (IO Administration) – Special notes

280
Q

Lignocaine 1% (IO Administration) – Onset, Peak & Duration times

A

IO effects:

  • Onset: 1 – 4min
  • Peak: 5 – 10min
  • Duration: 20min
281
Q

Oxytocin – Presentation/s

A
  • 10 units (IU) in 1mL glass ampoule
282
Q

Oxytocin – Pharmacology

A

A synthetic oxytocic

Action:

  • Stimulates smooth muscle of the uterus producing contractions
283
Q

Oxytocin – Metabolism

A
  • By the liver; excreted by the kidneys
284
Q

Oxytocin – Primary emergency indication/s

285
Q

Oxytocin – Contraindication/s

A
  1. Previous hypersensitivity
  2. Severe toxaemia (pre-eclampsia)
  3. Cord prolapse
  4. Exclude multiple pregnancy before drug administration
286
Q

Oxytocin – Precaution/s

A
  1. If given IV may cause transient hypotension
  2. Concurrent use with Methoxyflurane may cause hypotension
287
Q

Oxytocin – Route/s of administration

288
Q

Oxytocin – Side effects

A

Uncommon via IM route:

  • Tachycardia
  • Bradycardia
  • Nausea
289
Q

Oxytocin – Special notes

A

Concomitant use with prostaglandins (Misoprostol) may potentiate uterotonic effect

Must be stored between 2 – 8 °C

290
Q

Oxytocin – Onset, Peak & Duration times

A

IM effects:

  • Onset: 2 – 4 min
  • Peak: N/A
  • Duration: 30 – 60min
291
Q

Pancuronium – Presentation/s

A
  • 4mg in 2mL polyamp
292
Q

Pancuronium – Pharmacology

A

A non-depolarising neuromuscular blocking agent

Actions:

  • Blocks transmission of impulses at the neuromuscular junction of striated muscles resulting in skeletal muscle paralysis
  • Due to weak vagolytic action, a slight rise in HR and mean arterial pressure may be expected
293
Q

Pancuronium – Metabolism

A
  • By the kidneys; excreted mainly unchanged in the urine
294
Q

Pancuronium – Primary emergency indication/s

A
  1. To maintain skeletal muscle paralysis and allow mechanical ventilation in intubated Pts following IFS, RSI or during inter-hospital transfer of ventilated Pts.
295
Q

Pancuronium – Contraindication/s

A
  1. Pancuronium must not be given if continuous monitoring of Pt vital signs, including pulse oximetry and EtCO2 monitoring, is not available.
  2. Status epilepticus
296
Q

Pancuronium – Precaution/s

A
  1. Ensure patency of IV access
  2. Sedatives must always be administered prior to Pancuronium
  3. ETT placement, adequacy of ventilation, Sp02, EtCO2, HR and BP must be continuously monitored
  4. Pts with myasthenia gravis should be given much smaller doses and monitored carefully due to the potential of increased degree of neuromuscular block
  5. Care should be exercised in Pts with renal impairment
297
Q

Pancuronium – Route/s of administration

298
Q

Pancuronium – Side effects

A
  • Slight increase in HR
  • Slight increase in mean arterial pressure
  • Localised reaction at injection site (rare)
299
Q

Pancuronium – Special notes

A
  • Allergic reactions such as urticaria, laryngeal oedema, bronchospasm and anaphylactic shock have been reported.
  • Pancuronium infusions required during inter-hospital transfers are to be prescribed and signed by the referring hospital medical officer. The initial dose is usually 0.1mg / kg.
300
Q

Pancuronium – Onset, Peak & Duration times

A

IV effects:

  • Onset: 2 – 3min
  • Peak: 8 – 10min
  • Duration: 35 – 45min
301
Q

Sodium Bicarbonate 8.4% – Presentation/s

A
  • 50mL prepared syringe
  • 100mL glass bottle
302
Q

Sodium Bicarbonate 8.4% – Pharmacology

A

A hypertonic crystalloid solution

Composition:

  • Contains sodium and bicarbonate ions in a solution of high pH

Action:

  • Raises pH
303
Q

Sodium Bicarbonate 8.4% – Metabolism

A
  • Sodium: Excreted by the kidneys
  • Bicarbonate: Excreted by the kidneys as bicarbonate ion and by the lungs as CO2
304
Q

Sodium Bicarbonate 8.4% – Primary emergency indication/s

A
  1. Cardiac arrest, after 15min of AV CPR
  2. Symptomatic TCA OD
305
Q

Sodium Bicarbonate 8.4% – Contraindication/s

A
  1. Hypothermia
306
Q

Sodium Bicarbonate 8.4% – Precaution/s

A
  1. Administration of Sodium Bicarbonate 8.4% must be accompanied by effective ventilation and ECC if required
  2. Since Sodium Bicarbonate 8.4% causes tissue necrosis, care must be taken to avoid leakage of the drug into the tissues
  3. Because of the high pH of this solution, do not mix or flush any other drug or solution with Sodium Bicarbonate 8.4%
307
Q

Sodium Bicarbonate 8.4% – Route/s of administration

308
Q

Sodium Bicarbonate 8.4% – Side effects

A
  • Sodium overload may provoke pulmonary oedema
  • Excessive doses of Sodium Bicarbonate 8.4%, especially without adequate ventilation and circulation, may cause an intracellular acidosis
309
Q

Sodium Bicarbonate 8.4% – Special notes

310
Q

Sodium Bicarbonate 8.4% – Onset, Peak & Duration times

A

IV effects:

  • Onset: 1 – 2min
  • Peak: N/A
  • Duration: Depends on cause and Pt’s perfusion
311
Q

Suxamethonium – Presentation/s

A
  • 100mg in 2mL polyamp
312
Q

Suxamethonium – Pharmacology

A

Depolarising neuromuscular blocking agent

Actions:

  • Short acting muscular relaxant
313
Q

Suxamethonium – Metabolism

A
  • Pseudo-cholinesterase in plasma
314
Q

Suxamethonium – Primary emergency indication/s

A
  1. Complete muscle relaxation to allow endotracheal intubation
315
Q

Suxamethonium – Contraindication/s

A
  1. Known hypersensitivity
  2. Known history of Suxamethonium apnoea
  3. Known history of malignant hyperthermia
  4. Upper airway obstruction
  5. Severe respiratory distress
  6. Penetrating eye injury
  7. Burns > 24hr post injury
  8. Ruptured AAA
  9. Organophosphate poisoning
  10. ECG signs of hyperkalaemia in conditions such as muscle necrosis and renal failure
316
Q

Suxamethonium – Precaution/s

A
  1. Elderly Pts
  2. Liver disease
  3. Crush injuries
  4. Pts who have not fasted
  5. Airway trauma
317
Q

Suxamethonium – Route/s of administration

318
Q

Suxamethonium – Side effects

A
  • Muscular fasciculation
  • Increased intraocular pressure
  • Increased intragastric pressure
  • Elevated serum potassium levels
319
Q

Suxamethonium – Special notes

A
  • Sedation is required prior to use
  • Atropine 600mcg should be administered prior to Suxamethonium administration in adult Pts with a HR
  • Atropine 20mcg / kg should be administered prior to Suxamethonium administration in children
  • A second dose of Suxamethonium usually causes profound bradycardia
  • Refrigeration of Suxamethonium is required – requires weekly rotation or disposal when not refrigerated
  • Usual dosage:
    • Adults: 1.5mg / kg IV (max. dose 150mg)
320
Q

Suxamethonium – Onset, Peak & Duration times

A

IV effects:

  • Onset: 20 – 40sec
  • Peak: 60sec
  • Duration: 4 – 6min
321
Q

Tenecteplase (Metalyse) – Presentation/s

A
  • 50mg in glass vial with weight marked and pre-filled syringe containing water for IV administration (must reconstitute all drug then discard unwanted amount according to weight)
322
Q

Tenecteplase (Metalyse) – Pharmacology

A
  • Fibrinolytic, a modified form of tissue plasminogen activator (tPA) that binds to fibrin and converts plasminogen to plasmin
323
Q

Tenecteplase (Metalyse) – Metabolism

A
  • By the liver
324
Q

Tenecteplase (Metalyse) – Primary emergency indication/s

A
  1. Acute STEMI
325
Q

Tenecteplase (Metalyse) – Contraindication/s (Exclusion Criteria)

A
  1. Blood pressure Systolic > 180mmHg; or Diastolic > or = 110mmHg
  2. Known allergy or hypersensitivity to Tenecteplase or Gentamicin
  3. Anticoagulant therapy eg. Warfarin, Heparin, Dabigatran, Rivaroxaban, Apixaban
  4. Glycoprotein IIb / IIIa inhibitors eg. Abciximab, Eptifibatide, Tirofiban
  5. Active bleeding or bleeding tendency (excluding menses)
  6. GI bleed within last 1/12
  7. Active peptic ulcer
  8. Acute pancreatitis
  9. Suspected aortic dissection
  10. Non compressible vascular puncture
  11. Recent major surgery (
  12. Traumatic or prolonged (>10min) CPR
  13. Acute pericarditis
  14. Subacute bacterial endocarditis
  15. History of CNS damage eg neoplasm, aneurysm, spinal surgery
  16. New neurological symptoms
  17. Significant closed head or facial trauma in past 3/12
326
Q

Tenecteplase (Metalyse) – Precaution/s (Relative contraindications)

A
  1. Age > or = 75 years
  2. Low body weight
  3. Renal impairment
  4. Dementia
  5. History of stroke or TIA
  6. Diabetes
  7. Heart failure
  8. Tachycardia
  9. Pregnancy
  10. Within 1/52 post-partum
  11. Anaemia
  12. Advanced liver disease
  13. Blood pressure between 160 – 180mmHg systolic
  14. History of bleeding or known prolonged INR
  15. Peripheral vascular disease
  16. Administration of Enoxaparin 48 hours prior
  17. Recent invasive procedures associated with bleeding such as femoral artery puncture; right heart catheterisation
327
Q

Tenecteplase (Metalyse) – Route/s of administration

A
  • IV, using vial adapter on pre-prepared syringe, as single bolus over 10 seconds
328
Q

Tenecteplase (Metalyse) – Side effects

A
  • Bleeding – including injection sites, ICH, internal bleeding
  • Transient hypotension

Infrequent:

  • Allergic reactions including fever, chills, rash, nausea, headache, bronchospasm, vasculitis, nephritis and anaphylaxis

Rare:

  • Cholesterol embolism
329
Q

Tenecteplase (Metalyse) – Special notes

A
  • STEMI – 12 lead ECG shows ST Elevation > or = 1mm in two contiguous limb leads (I, II, III, aVR, aVL, aVF) or ST Elevation > or = 2mm in two contiguous chest leads (V1, V2, V3, V4, V5, V6), new LBBB
  • Weight optimised dosing improves efficacy and safety outcomes in drugs with narrow therapeutic index eg. Fibrinolytics
  • Other drugs which affect the clotting process may increase risk of bleeding associated with Tenecteplase
330
Q

Tenecteplase (Metalyse) – Onset, Peak & Duration times

A

IV effects:

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

AV CPGs (3 decks)

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