Drug Doses and Emergency Medicine Extra Things

Question 1

Low dose aspirin is?

Answer 1

75 mg

Question 2

High dose aspirin is?

Answer 2

300 mg

Question 3

Dose of aspirin for secondary prevention of stroke, cardiovascular disease or pre-eclampsia?

Answer 3

low dose aspirin - 75mg

Question 4

Dose of aspirin used in management of a STEMI or NSTEMI?

Answer 4

300 mg

Question 5

After ischaemic stroke anti platelets?

Answer 5

300 mg aspirin for 14 days plus clopidogrel 75 mg lifelong

Question 6

Dose of aspirin for fever/ pain?

Answer 6

300-600mg every 4-6 hours, max 2.4 g

Question 7

What is the first line statin?

Answer 7

atorvastatin

Question 8

Primary prevention dose of statin (i.e. those who have never had a cardiac event before) ?

Answer 8

start at 10mg (sometimes 20mg) can be increased up to 80 mg

Question 9

Secondary prevention dose of statin following a MI?

Answer 9

80 mg

Question 10

Dose of clopidogrel in cardiac disease?

Answer 10

300 mg for 4 weeks to 12 months

Question 11

Dose of clopidogrel following strokes?

Answer 11

75 mg lifelong (first line)

Question 12

First line anti platelet post strokes?

Answer 12

clopidogrel

Question 13

Ibuprofen dosing?

Answer 13

400mg 3x daily (6 tablets)
max dose = 1.2 g

Question 14

Paracetamol dosing?

Answer 14

1g 4x daily (8 tablets)
max dose = 4g

Question 15

Adrenaline dosing in a cardiac arrest?

Answer 15

Adrenaline dose = 1mg
In non shockable give ASAP
In shockable give once chest compressions have restarted after the 3rd shock
Repeat 1mg every 3-5mg whilst ALS continues

Question 16

Amiodarone dosing in cardiac arrest?

Answer 16

Amiodarone dose = 300mg or 150mg
amiodarone is not used in non-shockable rhythms
In shockable give 300mg amiodarone after 3 shocks with the adrenaline
after 5 shocks give 150mg

Question 17

Anaphylaxis adrenaline dosing?

Answer 17

IM injection - best site - anterolateral thigh

adult dose = 500 micrograms - 0.5ml of 1 in 1000
6-12 years = 300 micrograms
6M - 6years = 150 micrograms
< 6 M = 100 -150 micrograms

Adrenaline can be repeated every 5 minutes if necessary

Question 18

Opioid overdose naloxone dosing?

Answer 18

400 micrograms, then 800 micrograms up to 2 doses, 2mg for 1 dose, if still no response review diagnosis

Question 19

Hypoglycaemia management?

Answer 19

Im community:
10-20g oral glucose
IM glucagon pen if available

Hospital:
oral glucose as above
10% glucose if no responding (150-160ml)
20% if unconsciousness (75-80ml)

Question 20

Cardiac arrest shockable drugs?

Answer 20

give 1 mg adrenaline after 3rd shock
give adrenaline every 3-5 minutes
give 300mg amiodarone after 3rd shock
give 150 mg amiodarone after 5th shock

Question 21

Cardiac arrest non shockable drugs?

Answer 21

give 1mg adrenaline ASAP
Give adrenaline every 3-5 minutes

Question 22

In adult tachycardia anyone who is haemodynamically unstable gets?

Answer 22

synchronised shocks

Question 23

VT with a pulse acute management?

Answer 23

amiodarone 300mg over 10-60 minutes and then shock if needed
in torsades de pointes give magnesium

Question 24

SVT acute management?

Answer 24

1. Vagal manœuvres
2. IV adenosine (have to give as a fast bolus or it will not work first try 6mg, then 12mg, then 18mg)
3. verapamil or a beta blocker
4. synchronised shocks

Question 25

Difference between synchronised and unsynchronised shocks?

Answer 25

synchronised shocks - timed with the ECG pattern - should give in any rhythm where a patient is conscious, basically tachycardias originating in the atria and in VT with a pulse unsynchronised shocks are not timed with the ECG pattern - give this in rhythm where patient is unconsciousness - pulseless VT and VF

Question 26

Acute AF management?

Answer 26

1. beta blocker 2. digoxin 3. amiodarone

Question 27

Management of adult bradycardia?

Answer 27

anyone who is haemodynamically unstable should be treated 1. 500 micrograms IV, can be repeated up to 3mg 2. Adrenaline, isoprenaline or transcutaneous pacing

Question 28

Anti cholinergic toxidrome?

Answer 28

Increased: heart rate, BP No change to respiratory rate Decreased bowel sounds and sweating dilated pupils

Question 29

Cholinergic toxidrome

Answer 29

No change to resp rate, heart rate, BP, temperature increased bowel sounds, sweating pinpoint pupils

Question 30

Opioid toxidrome?

Answer 30

decreased bowel sounds, temperature, sweating, heart rate, rest rate, blood pressure pinpoint pupils

Question 31

Sympathomimetic toxidrome?

Answer 31

dilated pupils increased everything

Question 32

Sedative hypnotic toxidrome?

Answer 32

no change in pupils decreased everything

Question 33

Who with a paracetamol overdose gets n-acetylcysteine?

Answer 33

- anyone who hits the line on treatment threshold curve after four hours - anyone who presents with an unclear/ staggered overdose (taken paracetamol over more than 1 hr) - anyone who presents within 8-24 hours who has taken more than 150mg/ kg - anyone who presents after 24 hours with AST/ ALT above normal, hepatic tenderness or clear jaundice

Question 34

In acute liver failure who gets a transplant?

Answer 34

hypoglycaemia ph < 7.3 or bicarb < 18 mmcl/l AKI or oliguria metabolic acidosis encephalopathy

Question 35

Management of a patient with acute asthma who is not responding to medical treatment and becoming acidotic?

Answer 35

intubation and ventilation

Question 36

Salicylate overdose blood gas picture?

Answer 36

mixed primary respiratory alkalosis (presents first) and metabolic acidosis (presents later)

Question 37

Adenosine dosing for SVT?

Answer 37

6mg, then 12mg, then 18mg

Question 38

All patients with a new diagnosis of anaphylaxis?

Answer 38

should be referred to a specialist allergy clinic

Question 39

VT/ VF should be treated with a shock when?

Answer 39

as soon as identified

Question 40

C peptide?

Answer 40

is only present in endogenous insulin not insulin you inject

Question 41

When should IV adrenaline be considered in anaphylaxis?

Answer 41

after two failed doses of IM adrenaline (refractory anaphylaxis) if they still have respiratory or cardiovascular issues

Question 42

In ALS if IV access cannot be obtained drugs should be delivered by?

Answer 42

intraosseous route

Question 43

Single most important factor for liver transplantation in paracetamol overdose?

Answer 43

arterial pH

Question 44

When thinking about pre-op assessment good glycemic control is defined as?

Answer 44

HbA1c < 69 mmol/l

Question 45

Those with good glycemic control going for elective/ minor procedures with diabetes on insulin?

Answer 45

can manage on the day with adjustment of usual regime Once daily insulins (Lantus, Levemir) : day before and day or reduce dose by 20% Twice daily or ultra long (Humulin M3, Novomir): no change on day before, halve the morning dose, leave evening dose unchanged

Question 46

Other diabetic drugs what to do on day of surgery and before?

Answer 46

all other diabetic drugs take as normal on the day before SGLT2i should be omitted on day of surgery sulfonylureas omit morning dose but can take afternoon dose, if afternoon surgery omit both morning and afternoon dose metformin, if take 3x daily omit lunch dose, if only take 1 or 2 then take as normal DPP4 (gliptins) and GLPS (glitides) taken as normal

Question 47

COCP guidelines before surgery?

Answer 47

VTE risk stop 4 weeks before surgery, wait 2 weeks after surgery

Question 48

Antiplatelets guidelines before surgery?

Answer 48

stop 7-10 days before although this is being challenged

Question 49

Anticoagulants guidelines?

Answer 49

stop 2-4 days before if high risk of clotting could then give LMWH up until day before

Question 50

ACEi guidelines?

Answer 50

stop day of/ omit dose day of

Question 51

Main agents that cause malignant hyperthermia?

Answer 51

suxamethonium and halothane

Question 52

Presentation of malignant hyperthermia?

Answer 52

increased body temperature, increased CO2 production, tachycardia, muscle rigidity, acidosis, hyperkalaemia

Question 53

What is malignant hyperthermia treated with?

Answer 53

dantrolene

Question 54

Isolated fever in a well patient in the first 24 hours following surgery?

Answer 54

physiological reaction to operation

Question 55

Anastomotic leak?

Answer 55

surgical emergency, return to theatre

Question 56

What is ketamine good for?

Answer 56

anaesthetic agent for HD unstable patients, has good analgesia and doesn't cause a drop in BP so is good for trauma

Question 57

What can etomidate result in?

Answer 57

adrenal suppression

Question 58

What anaesthetic has a strong analgesic effect?

Answer 58

ketamine

Question 59

Use of what drug can slow bone healing?

Answer 59

NSAIDs

Question 60

Prednisolone should be replaced with what during surgery?

Answer 60

hydrocortisone

Question 61

ECG abnormality in tricyclic overdose?

Answer 61

widened QRS

Question 62

In CPR if PE is suspected what should be considered alongside normal drugs?

Answer 62

thrombolytic therapy - alteplase