All medications Flashcards
(127 cards)
1
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 bronchodilator (Beta 2)
Causes peripheral vasoconstriction (Alpha)
2
Q
Adrenaline- indications
A
Cardiac arrest- VF/VT, Asystole, or PEA
Inadequate perfusion (cardiogenic or non-cardiogenic/non-hypovolaemic )
Bradycardia with poor perfusion
Anaphylaxis
Severe asthma- imminent life threat not responding to nebuliser therapy, or unconscious with no BP
Croup
3
Q
Adrenaline- contraindication
A
Hypovolaemic shock without adequate fluid replacement
4
Q
Adrenaline- precaution
A
Consider reduced doses for:
Elderly/frail patients
Patients with cardiovascular disease
Patients on monoamine oxidase inhibitors
Higher doses may be required for patents of beta blockers
5
Q
Adrenaline- side effects
A
Sinus tachycardia
Supraventricular arrhythmias
Ventricular arrhythmias
Hypertension
Pupillary dilation
May increase size of MI
Feelings of anxiety/palpitations in the conscious patient
6
Q
Aspirin- pharmacology
A
An analgesic, antipyretic, anti-inflammatory and anti platelet aggregation agent. Actions:
To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS
Inhibits synthesis of prostaglandins- anti-inflammatory actions
7
Q
Aspirin- indication
A
ACS
8
Q
Aspirin- contraindication
A
Hypersensitivity to aspirin/salicylates
Actively bleeding peptic ulcers
Bleeding disorders
Suspected dissecting aortic aneurysm
Chest pain associated with psychostimulant OD is SBP >160mmHg
9
Q
Aspirin- precaution
A
Peptic ulcer
Asthma
Patients on anticoagulants
10
Q
Aspirin- side effects
A
Heartburn, nausea, gastrointestinal bleeding
Increased bleeding time
Hypersensitivity reactions
11
Q
Ceftriaxone- pharmacology
A
Cephalosporin antibiotic
12
Q
Ceftriaxone- indications
A
Suspected meningococcal septicaemia
Severe sepsis
13
Q
Ceftriaxone- contraindications
A
Allergy to cephalosporin antibiotics
14
Q
Ceftriaxone- precautions
A
Allergy to penicillin antibiotics
15
Q
Ceftriaxone- side effects
A
Nausea
Vomiting
Skin rash
16
Q
Dexamethasone- pharmacology
A
A corticosteroid secreted by the adrenal cortex. Actions:
Relieves inflammatory reactions
Provided immunosuppression
17
Q
Dexamethasone- indications
A
Bronchospasm:
- Severe (adult) or critical (paediatric) asthma
- Anaphylaxis as additional therapy
Moderate- severe croup
Acute exacerbation of COPD
Adult stridor (non-foreign body obstruction)
18
Q
Dexamethasone- contraindications
A
Known hypersensitivity
19
Q
Dexamethasone- precautions
A
Solutions which are not clear or are contaminated should be discarded
20
Q
Dexamethasone- side effects
A
Nil of significance in above indication
21
Q
Dextrose- pharmacology
A
A slightly hypertonic crystalloid solution
Composition:
Sugar- 10% dextrose
Water
Actions:
Provides a source of energy
Supplies body water
22
Q
Dextrose- indications
A
Diabetic hypoglycaemia (BGL analysis < 4 mmol/L) in patients with an altered conscious state who are unable to self-administer oral glucose
23
Q
Dextrose- contraindications
A
Nil of significance in the above indication
24
Q
Dextrose- precautions
A
Nil of significance in the above indication
25
Dextrose- side effects
Nil of significance in the above indication
26
Droperidol- pharmacology
Dopamine antagonist- antipsychotic medication with sedative effects. Also blocks alpha adrenoceptors
27
Droperidol- indications
Moderate agitation or behavioural disturbance
28
Droperidol- contraindications
Nil
29
Droperidol- precautions
Elderly/frail patients are more susceptible to adverse effects
Parkinson’s disease. May experience worsening of Parkinson related symptoms
Lewy body dementia. May experience increase in agitation
QT prolongation has been reported rarely. Where possible provide ECG monitoring after sedation has been achieved
30
Droperidol- adverse effects
CNS: oversedation, dizziness
CVS: hypotension, tachycardia, QT prolongation
Extrapyramidal symptoms (rare)
31
Fentanyl- pharmacology
A synthetic opioid analgesic
Actions:
CNS effects:
Depression- leading to analgesia
Respiratory depression- leading to apnoea
Dependence (addiction)
Cardiovascular effects:
Decreases conduction velocity through the A-V node
32
Fentanyl- indications
Sedation to facilitate intubation
Sedation to maintain intubation
Sedation to facilitate transthoracic pacing
Sedation to facilitate synchronised cardioversion
CPR interfering patient- ALS
Analgesia IV/IN:
History of hypersensitivity or allergy to morphine
Known renal impairment/failure
Short duration of action desirable
Hypotension
Nausea and/or vomiting
Severe headache
33
Fentanyl- contraindications
- History of hypersensitivity
- Late second stage of labour
- Serotonin syndrome
- Monoamine oxidase inhibitors (MAOIs) within previous 14 days
34
Fentanyl- precautions
Patients on monoamine oxidase inhibitors
Impaired hepatic function
Current asthma
Known addiction to opioids
Elderly/frail patients
Respiratory depression, e.g. COPD
Rhinitis, rhinorrhea or facial trauma (IN route)
35
Fentanyl- side effects
Bradycardia
Apnoea
Rigidity of the diaphragm and intercostal muscles
Respiratory depression
36
Glucagon- pharmacology
A hormone normally secreted by the pancreas
Actions:
Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose
37
Glucagon- indications
Diabetic hypoglycaemia (BGL < 4mmol/L) in patients with an altered conscious state who are unable to self administer oral glucose
Anaphylaxis (adult) where patients remain hypotensive following adrenaline therapy with past history of heart failure or patients taking beta-blocker medication
38
Glucagon- contraindications
Nil of significance in the above indication
39
Glucagon- precautions
Nil of significance in the above indication
40
Glucagon- side effects
Nausea and vomiting (rare)
41
Glyceryl Trinitrate- pharmacology
Organic nitrate- relaxes smooth muscle
Venodilation promotes venous pooling and reduces venous return the the heart (reduces preload)
Ateriodilation reduces systemic vascular resistance and arterial pressure (reduced afterload)
Effects include:
Reduced myocardial oxygen demand
Reduced systolic, diastolic and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure
Mild collateral coronary artery dilation may improve blood supply to ischaemic areas of myocardium
Mild tachycardia secondary to slight fall in BP
Preterm labour: uterine quiescence in pregnancy
42
Glyceryl Trinitrate- indications
Chest pain in acute coronary syndrome
Hypertension associated with acute coronary syndrome
Acute cardiogenic pulmonary oedema
Autonomic dysreflexia
Preterm labour (consult for GTN patch)
43
Glyceryl Trinitrate- contraindications
BP <100mmhg
HR > 150 bpm
HR < 50 (excluding autonomic dysreflexia)
Ventricular tachycardia
PDE5 inhibitors (current/recent use)
Riociguat (current use)
Bleeding in pregnancy
44
Glyceryl Trinitrate- precautions
Use lower doses (i.e 300mcg) in patients who are elderly (age > 60), have no previous exposure to GTN, or with recent MI as they may be more susceptible to adverse effects
Right ventricular MI or inferior STEMI with systolic BP < 160mmHg- use cautiously due to risk of severe hypotension from preload reduction
Preterm labour- concurrent use with other tocolytics
45
Glyceryl Trinitrate- adverse effects
CV: hypotension, tachycardia, bradycardia (occasionally)
CNS: headache, dizziness, syncope
Other: skin flushing
46
Glyceryl Trinitrate- significant interactions
Phosphodiesterase 5 (PDE5) inhibitors including avanafil (Spedra), sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). GTN increases the effects of PDE5 inhibitors resulting in profound hypotension. Do not administer GTN within:
12 hours since the last dose of avanafil OR
23 hours for sildenafil or vardenafil OR
48 hours for tadalafil
Riociguat (Adempas)- usd for pulmonary arterial hypertension. GTN increases the hypotensive effects of riociguat. Do not administer to patients currently taking this medication
47
Heparin- pharmacology
Anticoagulant
Inactivates clotting factors IIa (thrombin) and Xa by binding to antithrombin III
48
Heparin- indications
Acute STEMI
49
Heparin- contraindications
Known allergy or hypersensitivity
Active bleeding (excluding menses)
Oral anticoagulants
Bleeding disorders
History of Heparin induced Thrombocytopaenia (HIT)
Severe hepatic impairment/ disease, including oesophageal varices
Recent trauma or surgery (< 3 weeks)
50
Heparin- precautions
Renal impairment
51
Heparin- side effects
Bleeding
Bruising and pain at injection site
Hyperkalaemia
Thrombocytopaenia (mild to severe)
52
Hydrocortisone- pharmacology
Corticosteroid with approximately equal glucocorticoid and mineralocorticoid
53
Hydrocortisone- indications
Acute adrenal insufficiency
54
Hydrocortisone- contraindications
Nil of significance
55
Hydrocortisone- precautions
Nil of significance
56
Hydrocortisone- adverse effects
Nil of significance when used for the approved AV indication
57
Ipratropium Bromide- pharmacology
Anticholinergic bronchodilator
Actions:
Allows bronchodilation by inhibiting cholinergic bronchomotor tone (i.e. blocks vagal reflexes which mediate bronchoconstriction)
58
Ipratropium Bromide- indications
Severe respiratory distress associated with bronchospasm
Exacerbation of COPD irrespective of severity
59
Ipratropium Bromide- contraindications
Known hypersensitivity to atropine or its derivatives
60
Ipratropium Bromide- precautions
Glaucoma
Avoid contact with eyes
61
Ipratropium Bromide- side effects
Headache
Nausea
Dry mouth
Skin rash
Tachycardia (rare)
Palpitations (rare)
Acute angle closure glaucoma secondary to direct eye contact (rare)
62
Ketamine- pharmacology
Anaesthetic agent with analgesic properties at lower doses.
Exact mechanism of action is unclear but primarily works as an antagonist at NMDA receptors. Ketamine may also interact with opioid, muscarinic and other receptors. Produces a trance-like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes
63
Ketamine- indications
Intubation
Analgesia
Sedation:
Agitation
Patient movement during CPR
64
Ketamine- contraindications
Suspected non-traumatic brain injury with severe hypertension (SBP > 180)
65
Ketamine- precautions
May exacerbate cardiovascular conditions (e.g. uncontrolled hypertension, stroke, recent mI, cardiac failure) due to effects on HR and BP
66
Ketamine- adverse effects
CV: hypertension, tachycardia
CNS: emergence reactions (e.g. vivid dreams, restlessness, confusion, hallucinations, irrational behaviour); increased skeletal muscle tone (may resemble seizures)
Respiratory: transient respiratory depression and apnoea (rare)
GI: nausea and vomiting
Other: injection site pain, lacrimation, hypersalivation, diplopia, nystagmus
67
Methoxyflurane- pharmacology
Inhaled anaesthetic- produces analgesia at low concentrations, however the exact mode of action is unknown
68
Methoxyflurane- indications
Analgesia
69
Methoxyflurane- contraindications
Pre-existing renal disease
Known (or genetic susceptibility) to malignant hyperthermia
70
Methoxyflurane- precautions
Patients should not be administered > 6 mL of methoxyflurane in a 24 hour period, due to increased risk of nephrotoxicity
To limit occupational exposure, methoxyflurane should not be administered in a confined space. Ensure adequate ventilation in the ambulance. Place used Penthrox inhalers in a closed plastic bag when not in use.
71
Methoxyflurane- adverse effects
CNS: Dizziness, drowsiness
CV: Hypotension
GIT: Nausea and vomiting
72
Midazolam- pharmacology
Short acting CNS depressant
Actions:
Anxiolytic
Sedative
Anti-convulsant
73
Midazolam- indications
Status epilepticus
Sedation to maintain intubation
Sedation to facilitate intubation
Sedation to facilitate synchronised cardioversion
Sedation to facilitate transthoracic pacing
Sedation in the agitated patient
Sedation in the psychostimulant OD
Alcohol withdrawal syndrome
74
Midazolam- contraindications
Known hypersensitivity to benzodiazepines
75
Midazolam- precautions
Reduces doses may be required for the elderly/frail, patients with chronic renal failure, CCF or shock
The CNS depressant effects of benzodiazepines are enhanced in the presence of narcotics and other tranquilisers including alcohol
Can cause severe respiratory depression in patients with COPD
Patients with myasthenia gravis
76
Midazolam- side effects
Depressed level of consciousness
Respiratory depression
Loss of airway control
Hypotension
77
Morphine- pharmacology
An opioid analgesic. Actions:
CNS effects:
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:
Vasodilation
Decreases conduction velocity through the A-V node
78
Morphine- indications
Pain relief
Sedation to maintain intubation
Sedation to facilitate intubation (where fentanyl not appropriate)
79
Morphine- contraindications
History of hypersensitivity
Renal impairment/failure
Late second stage of labour
80
Morphine- precautions
Patients on monoamine oxidase inhibitors
Acute alcoholism
Current asthma
Known addiction to opioids
Hypotension
Elderly/frail patients
Respiratory depression
Respiratory tract burns
81
Morphine- side effects
CNS effects:
Drowsiness
Respiratory depression
Euphoria
Nausea, vomiting
Addiction
Pin-point pupils
Cardiovascular effects:
Hypotension
Bradycardia
82
Naloxone- pharmacology
An opioid antagonist
Actions:
Prevents or reverses the effects of opioids
83
Naloxone- indications
Altered conscious state and respiratory depression secondary to administration of opioids or related drugs
84
Naloxone- contraindications
Nil of significance in the above indication
85
Naloxone- precautions
If patient is known to be physically dependent on opioids, be prepared for a combative patient after administration
Neonates
86
Naloxone- side effects
Symptoms of opioid withdrawal:
Sweating, goose flesh, tremor
Nausea and vomiting
Agitation
Dilation of pupils, excessive lacrimation
Convulsions
87
Normal saline- pharmacology
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
88
Normal saline- indications
As a replacement in volume depleted-patients
Cardiac arrest secondary to hypovolaemia where the patient may be fluid responsive
To expand intravascular volume in the non-cardiac, non-hypovolaemic hypotensive patient e.g. anaphylaxis, burns, sepsis
As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive patients (other than LVF). e.g. asthma
Fluid for diluting and administering IV drugs
Fluid TKVO for IV administration of emergency drugs
89
Normal saline- contraindications
Nil of significance in the above indication
90
Normal saline- precautions
Nil of significance in the above indication
91
Normal saline- side effects
Nil of significance in the above indication
92
Olanzapine- pharmacology
Atypical antipsychotic- antagonist at multiple receptor sites, particularly serotonin, dopamine, and histamine
93
Olanzapine- indications
Mild agitation
94
Olanzapine- contraindications
Nil
95
Olanzapine- precautions
Olanzapine may be less effective if patient agitation is due to drug intoxication (especially stimulants) or alcohol withdrawal. Benzodiazepines are considered first-line agents in these patients.
Elderly/frail patients and children are more susceptible to adverse effects
96
Olanzapine- adverse effects
CNS: Sedation, dizziness
Other: Extrapyramidal symptoms and QT prolongation are unlikely when administered at the approved doses
97
Ondansetron- pharmacology
Serotonin antagonist- exact mode of action is not fully understood. Release of serotonin is thought to trigger a vomiting reflex in both the peripheral (GIT) and central nervous system
98
Ondansetron- indications
Undifferentiated nausea and vomiting
Prophylaxis where vomiting could be clinically detrimental (e.g. spinally immobilised, penetrate g eye trauma)
99
Ondansetron- contraindications
Apomorphine
100
Ondansetron- precautions
Pregnancy 1st trimester- consult with receiving hospital
Congenital long QT syndrome- ondansetron causes QT prolongation (dose-dependent effect) and increases the risk of Torsades de pointes in patients with a prolonged QT interval (QTC > 500 ms)
Severe hepatic disease (e.g.cirrhosis) - limit total daily dose to a maximum of 8mg
Ondansetron ODT may contain aspartame which should be avoided in patients with pheylketonuria. Ondansetron injection can be administered if appropriate.
101
Ondansetron- adverse effects
CNS: Headache, dizziness
CV: QT prolongation (rare)
GI: Constipation
Other: Visual disturbance, including transient loss of vision (rare, associated with rapid IV administration)
102
Oxytocin- pharmacology
Synthetic pituitary hormone- stimulates uterine muscle contraction. Uterine atony is the most common cause of PPPH
103
Oxytocin- indications
Primary postpartum haemorrhage (PPPH)
104
Oxytocin- contraindications
None, provided all babies have been delivered prior to administration
105
Oxytocin- precautions
Nil
106
Oxytocin- adverse effects
Nausea and vomiting
107
Paracetamol- pharmacology
Analgesic and antipyretic- exact mechanism of action is unclear; thought to inhibit prostaglandin synthesis in the CNS
108
Paracetamol- indications
Mild pain, or pain relief in combination with other analgesics
Headache
109
Paracetamol- contraindications
Children < 1 month of age
110
Paracetamol- precautions
Hepatotoxicity can occur with overdose
Do not administer if paracetamol has already been given within past 4 hours, or if total paracetamol intake within past 24 hours exceeds 4g (adults) or 60mg/lg (children)
Risk of hepatotoxicity is increased in the following circumstances:
Impaired hepatic function or liver disease
Elderly/frail patients
Malnourishment
111
Paracetamol- adverse effects
Hypersensitivity reactions including severe skin rashes (rare)
Haematological reactions (rare)
Hypotension has been reported with IV infusion, particularly in critically ill patients
112
Prochlorperazine- pharmacology
Dopamine antagonist- antiemetic effects are primarily due to D2 receptor blockade. Also acts on other neurotransmitter systems including histamine, cholinergic and a-adrenergic receptors
113
Prochlorperazine- indications
Nausea and vomiting in patient >21 years of age; sepcifically for
- Known allergy or C/I to ondansetron
- Vestibular nausea
Headache (irrespective of nausea/vomiting)
114
Prochlorperazine- contraindications
CNS Depression (i.e. unconscious or severely intoxicated)
Patients < 21 years of age
Children and young adults are more susceptible to extrapyramidal reactions with prochlorperazine
115
Prochlorperazine- precautions
Elderly patients- more susceptible to adverse effects
Parkinson's disease- can worsen symptoms of parkinson’s disease, avoid if possible
116
Prochlorperazine- adverse effects
CNS: Sedation, blurred vision
CV: Postural hypotension, QT prolongation (rare)
Other: Extrapyramidal reactions
117
Salbutamol- pharmacology
A synthetic beta adrenergic stimulant with primarily beta 2 effects. Actions: causes bronchodilation
118
Salbutamol- indications
Respiratory distress with suspected bronchospasm:
Asthma
Severe allergic reaction
COPD
Smoke inhalation
Oleoresin capsicum spray exposure
119
Salbutamol- contraindications
Nil of significance in the above indications
120
Salbutamol- precautions
Large doses of Salbutamol have been reported to cause intracellular metabolic acidosis
121
Salbutamol- side effects
Sinus tachycardia
Muscle tremor
122
Tenecteplase- pharmacology
Fibrinolytic, a modified form of tissue plasminogen activator (tPA) that binds to fibrin and converts plasminogen to plasmin
123
Tranexamic Acid- pharamcology
Antifibrinolytic- binds to plasminogen, decreasing conversion to plasmin, and thereby prevents fibrin degradation
124
Tranexamic Acid- Indications
Severe postpartum haemorrhage
Severely injured patients at risk of acute traumatic coagulopathy
125
Tranexamic Acid- Contrainidcations
Injury occured >2 hours prior to administration
126
Tranexamic Acid- Precautions
Rapid administration increases the risk of adverse effects
127
Tranexamic Acid- Adverse effects
CNS: Seizures
CVS: Hypotension, dizziness
GIT: Nausea, vomiting, diarrhoea
