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Drug Therapy Protocols Flashcards

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1
Q

Indications for Adrenaline

A
  • Cardiac Arrest
  • Severe Anaphylaxis
  • Severe Life-threatening Bronchospasm
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2
Q

Contraindications for Adrenaline

A

Nil

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3
Q

Adult Dosages for Adrenaline - Cardiac Arrest, Severe Bronchospasm Anaphylaxis (IV & IM)

A

Cardiac arrest:
- (IV) 1mg repeated at 3-5 min intervals (NO MAX)

Anaphylaxis/ Severe Bronchospasm:

  • (IM - Epipen) 300mcg single dose ONLY
  • (IM) 500mcg repeated at 5 min intervals (NO MAX)
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4
Q

Paed Dosages for Adrenaline - Cardiac Arrest, Anaphylaxis and Severe Bronchospasm (IV & IM)

A

Cardiac Arrest:

  • (IV) 10kg or more (over 1 year) 10mcg/kg repeated at 3-5 min intervals (NO MAX)
  • (IV) Less than 10kg (excl. newborn) 100mcg repeated at 3-5 min intervals (NO MAX)
  • (IV) Newborn 50mcg repeated at 3-5 min intervals (NO MAX)

Anaphylaxis/ Severe Bronchospasm:

  • (IM - Epipen) >6 YO 300mcg single dose
  • (IM - Epipen) <6 YO 150mcg single dose
  • (IM) >6 YO 300mcg repeated at 5 min intervals (NO MAX)
  • (IM) 1-6 YO 150mcg repeated at 5 min intervals (NO MAX)
  • (IM) 6mnths - 1 YO 100mcg repeated at 5 min intervals (NO MAX)
  • (IM) <6mnths - 50mcg repeated at 5 min intervals (NO MAX)
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5
Q

Indications for Aspirin

A
  • Suspected ACS

- Acute Cardiogenic Pulmonary Oedema

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6
Q

Contraindications for Aspirin

A
  • Allergy or adverse reaction to aspiring or any NSAID
  • Chest pain associated with psychostimulant OD
  • Bleeding or clotting disorders
  • Current GI bleeding or peptic ulcers
  • Patients <18 YO
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7
Q

Adult Dosages for Aspirin (PO)

A
  • (PO) 300mg (Daily max 300-450mg)
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8
Q

Indications for Ceftriaxone

A
  • Suspected meningococcal septicaemia
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9
Q

Contraindications for Ceftriaxone

A
  • Allergy or adverse drug reaction to cephalosporin antibiotics
  • Known immediate or severe hypersensitivity to penicillin or carbapenem based drugs
  • Patient >1mnth (consult)
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10
Q

Adult Dosages for Ceftriaxone (IM & IV)

A
  • (IM) 2g (2x1g injections) single dose only
  • (IV) 2g over 20 mins single dose only
    • Refer document for more details & paeds concentration
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11
Q

Indications for Clopidogrel

A
  • Patients with STEMI who have been accepted for pPCI
    EITHER:
    (as an adjunct medication to aspirin and heparin) WHEN the cardiologist requests clopidogrel
    (patients who have received tenecteplase and have been administered aspirin and enoxaparin)
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12
Q

Contraindications for Clopidogrel

A
  • Allergy or adverse drug reaction
  • Patients contraindications for pre-hospital fibrinolysis
  • Current clopidogrel OR ticagrelor therapy
  • Patients <18 YO
  • Active bleeding
  • Prior intracranial haemorrhage
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13
Q

Adult Doses for Clopidogrel for request of intervening cardiologist and in addition to enoxaparin, aspirin and tenecteplase (PO)

A
  • (PO) 600mg - where the intervening cardiologist has requested clopidogrel - pPCI (adjunct with aspirin and heparin)
  • (PO) 300mg - patients who have received tenecteplase, enoxaparin and aspirin
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14
Q

Indications for Dexamethasone

A
  • Croup
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15
Q

Contraindications for Dexamethasone

A
  • Allergy or adverse drug reaction
  • Children >6mnths or <6 YO (consult)
  • Steroids within 4/24
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16
Q

Paed Dosage for Dexamethasone (PO)

A
  • (PO) 6mnths - 6YO 0.3mg/kg (rounded to nearest 0.5ml)

* * Refer spreadsheet in database

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17
Q

Indications for Droperidol

A
  • Acute behavioural disturbance with SAT Score >2
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18
Q

Contraindications for Droperidol

A
  • Allergy or adverse drug reaction
  • Parkinson’s disease
  • Known lewy body dementia
  • Previous dystonic reaction to droperidol
  • Patients < 8 years
  • Suspected sepsis (consult)
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19
Q

Adult dosages for Droperidol (IV & IM)

A
  • (IM & IV) > 65 YO 5mg and can be repeated at 15 min (MAX 10mg)
  • (IM & IV) 16-65 YO 10mg and can be repeated at 15 min (MAX 20mg)
  • (IM & IV) 13-15 YO 0.1-0.2mg/kg (max 10mg) and can be repeated at 15 min (MAX 20MG)
    • Consult for >65 AND 13-15 YO
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20
Q

Indications for Enoxaparin

A
  • Patients with STEMI who have received tenecteplase (as an adjunct with aspirin and clopidogrel)
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21
Q

Contraindications for Enoxaparin

A
  • Allergy or adverse reaction

- Patients contraindicated for pre-hospital fibrinolysis

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22
Q

Adult dosage for Enoxaparin (IV)

A
  • (IV) loading dose of 30mg to be administered 15 mins before SUBCUT dose
  • (IV) maintenance dose (1mg/kg - not to exceed 100mg) to be administered 15 min after loading dose
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23
Q

Indications for Fentanyl

A
  • Significant Pain
  • Autonomic dysreflexia (SBP >160mmHg)
    • Morphine is preferred EXCEPT for haemodynamic instability, kidney disease, suspected ACS, allergy or adverse reaction
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24
Q

Contraindications for Fentanyl

A
  • Allergy or adverse reaction
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25
Adult dosages for Fentanyl (IM, IV & NAS)
- (IM & NAS) >70 YO 25-50mcg repeated at up to 50mcg every 10 mins (MAX 100mcg) - (IM & NAS) <70 YO 25-100mcg repeated at up to 50mcg every 10 mins (MAX 200mcg) - (IV) >70 YO 25mcg repeated at 15mcg every 5 mins (MAX 100mcg) - (IV) <70 YO 25-50mcg repeated at up to 50mcg every 5 mins (MAX 200mcg)
26
Paed dosages for Fentanyl (NAS, IM, IV)
- (NAS) >1 YO 1.5mcg/kg (single max 50mcg) repeated once at 1mcg/kg at 10 mins (MAX 100mcg) - (IM) >1 YO 1-2mcg/kg (single max 50mcg) (MAX 2mcg/kg) - (IV) >1 YO 1mcg/kg (single max 25mcg) repeated at 0.5mcg/kg at 5 min intervals (MAX 2mcg/kg)
27
Indications for Glucagon
- Symptomatic hypoglycaemia (inability to self administer glucose) - Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3x IM adrenaline and fluid challenge)
28
Contraindications for Glucagon
- Allergy or adverse reaction
29
Adult dosage for Glucagon with symptomatic hypoglycaemia and refractory anaphylaxis (IM & IV)
- (IM & IV) 1mg single dose only, reconstitute 1mg with 1ML of water for injection in 3mL syringe
30
Paed dosage for Glucagon with symptomatic hypoglycaemia and refractory anaphylaxis (IM)
- (IM & IV) >25kg 1mg single dose, reconstitute 1mg with 1ml of water in 3mL syringe - (IM & IV) <25kg 0.5mg single dose, reconstitue 1mg with 2ml of water in 3ml syringe for concentration of (1mg/2mL - give 0.5mg/1mL)
31
Indications for Glucose Gel
- Symptomatic hypoglycaemia with ability to self admin
32
Contraindications for Glucose Gel
- Unconciousness - Patients with difficulty swallowing - Patients <2 YO
33
Adult & Paed dosages for Glucose Gel (PO)
- (PO) 15g repeated once at 15 min if BGL <4.0mmol/L (MAX 30G)
34
Indications for Glucose 10%
- Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
35
Contraindications for Glucose 10%
- Nil
36
Adult Dosage for Glucose 10% (IV)
- (IV) 15g (150mL) repeated at 10g/100mL boluses every 5 mins until BGL >4.0mmol/L
37
Indications for Glyceryl Trinitrate
- Suspected AC (with pain) - Acute cardiogenic pulmonary oedema - Autonomic dysreflexia (SPB >160mmHg) - Irukandji Syndrome (SBP >160mmHg)
38
Contraindications for Glyceryl Trinitrate
- Allergy or adverse reaction - HR <50 or >150 bpm - SBP <100mmHg - Acute CVA - Head trauma - Phosphodiesterase 5 inhibitor medication admin (sildenafil, vardenafil 24/24 and tadalafil 48/24)
39
Indications for Heparin
- Patients with STEMI who have been accepted for pPCI (adjunct medication with aspirin and EITHER ticagrelor or clopidogrel)
40
Contraindications for Heparin
- Allergy or adverse drug reaction - Patient <18 YO - Active bleeding or clotting problem - Prior intracranial haemorrhage - Current use of anticoagulants e.g. warfarin
41
Adult dosages for Heparin (IV)
- (IV) 5000 units (or dose requested by the intervening cardiologist)
42
Indications for Hydrocortisone
- Asthma - Acute exacerbation of COPD (evidence of respiratory distress) - Refractory Anaphlyaxis with persistent wheeze (unresponsive to 3x IM adrenaline) - Symptomatic adrenal insufficiency
43
Adult dosages of Hydrocortisone for refractory anaphylaxis, COPD and adrenal insufficiency (IM & IV)
COPD & Adrenal Insufficiency: - (IM & IV) 100mg single dose only Refractory Anaphylaxis: - (IM & IV) 200mg single dose only
44
Paed dosages of Hydrocortisone for refractory anaphylaxis, COPD and adrenal insufficiency (IM & IV)
Asthma & Refractory Anaphlyaxis: - (IM & IV) 4mg/kg single dose only, not to exceed 100mg Symptomatic Adrenal Insufficiency: - (IM & IV) 0-4 YO 25mg single dose - (IM & IV) 5-10 YO 50mg single dose - (IM & IV) >10 YO 100mg single dose
45
Indications for Ibuprofen
- Moderate pain due to acute inflammation and tissue injury
46
Contraindications for Ibuprofen
- Allergy or adverse reaction to any NSAID or aspirin - Concomitant NSAID therapy - Current GI bleeding or peptic ulcers - Dehydration and or hypovolaemia - Renal impairment - NSAID induced asthma
47
Adult dosages for Ibuprofen (PO)
- (PO) 200-400mg not to be administered within 6 hours of previous admin
48
Indications for Ipratropium Bromide
- Moderate bronchospasm (unresponsive to QAS salbutamol NEB) | - Severe bronchospasm
49
Contraindications for Ipratropium Bromide
- Allergy and or adverse reaction | - Patients less than 1 YO
50
Adult Dosages for Ipratropium Bromide (NEB)
- (NEB) 500mcg repeated at 20 minute intervals (MAX 1.5mg)
51
Adult Dosages for Ipratropium Bromide (NEB)
- (NEB) >6 YO 500mcg repeated at 20 minute intervals (MAX 1.5mg) - (NEB) 1-5 YO 250mcg repeated at 20 minute intervals (MAX 750mcg)
52
Indications for Loratadine
- Symptomatic urticaria (without evidence of anaphylaxis)
53
Contraindications for Loratadine
- Allergy or adverse drug reaction | - Anaphylaxis
54
Adult Dosages for Loratadine (PO)
- (PO) 10mg single dose & not to be administered within 24 hours of previous antihistamine
55
Paed Dosages for Loratadine (PO)
- (PO) > 8 YO 10mg single dose only
56
Indications for Methoxyflurane
- Pain
57
Contraindications for Methoxyflurane
- Allergy or adverse drug reaction - Patients <1 year - History of significant liver or renal disease - History of malignant hyperthermia
58
Adult Dosages for Methoxyflurane (INH)
- (INH) 3mL repeated once after 20 mins (MAX 6mL)
59
Paed Dosages for Methoxyflurane (INH)
- (INH) >1 YO 3mL single dose
60
Indications for Midazolam
- Generalised focal seizure (GCS <12)
61
Contraindications for Midazolam
- Allergy or adverse reaction
62
Adult dosages for Midazolam (NAS, IM, IV)
- (NAS, IM) 5mg repeated every 10 minutes (MAX 20mg) | - (IV) 5mg repeated every 5 minutes (MAX 20mg)
63
Paed Dosages for Midazolam (NAZ, & IM)
- (NAS, IM) 200mcg/kg (single dose not to exceed 5mg) repeated at half the initial dose (max 2.5mg) at 10 min intervals (MAX 10mg)
64
Indications for Morphine
- Significant pain - Sedation - Autonomic dysreflexia (SBP >160mmHg) * * Morphine is preferred EXCEPT for haemodynamic instability, kidney disease, suspected ACS, allergy or adverse reaction
65
Contraindications for Morphine
- Allergy or adverse reaction | - Kidney disease (renal failure)
66
Adult Dosages for Morphine (IV & IM)
- (IM) >70 YO 2.5-5mg repeated at up to 5mg every 10 mins (MAX 10mg) - (IM) <70 YO 2.5-10mg repeated at up to 5mg every 10 mins (MAX 20mg) - (IV) >70 YO 2.5mg repeated at up to 2.5mg every 5 minutes (MAX 10mg) - (IV) <70 YO 2.5-5mg repeated at up to 5mg every 5 mins (MAX 20mg)
67
Paed Dosages for Morphine (IM & IV)
- (IM) >1 YO 100-200mcg/kg (single max dose 5mg) (MAX 200mcg/kg) - (IV) >1 YO 100mcg/kg (single max dose 2.5mg)repeated at 50mcg/kg at 5 min intervals (MAX 200mcg/kg)
68
Indications for Naloxone
- Respiratory depression (secondary to the administration of narcotic drugs)
69
Contraindications for Naloxone
- Allergy or adverse drug reaction | - Newly born patient
70
Adult Dosages for Naloxone (IM)
- (IM) 1.6mg single dose only
71
Paed Dosages for Naloxone (IM)
- (IM) 20mcg/kg single dose only, not to exceed 800mcg
72
Indications for Ondansetron
- Significant nausea or vomiting
73
Contraindications for Ondansetron
- Allergy or adverse drug reaction - Congenital long QT syndrome - Current apomorphine therapy (used in severe Parkinson's disease) - Patients less than 2 YO
74
Adult Dosages for Ondansetron (IM, IV, PO)
- (PO & IM) 4-8mg with slow push over 2-3 min (MAX 8mg)
75
Paed Dosages for Ondansetron (PO, IM, IV)
- (PO) >5 YO 4mg single dose only - (PO) 2-4 YO 2mg single dose only - (IM) >2 YO 100mcg/kg (rounded to nearest 5kg) single dose not to exceed 4mg - (IV) >2 YO 100mcg/kg single dose only, not to exceed 4mg (slow push over 2-3 min)
76
Indications for Oxygen
- A wide range of conditions resulting in, or potentially resulting in systematic or localised hypoxia
77
Contraindications for Oxygen
- Known paraquat poisoning with SpO2 equal or greater than 88% - History of bleomycin therapy with SpO2 equal or greater than 88%
78
Adult & Paed Dosages for Oxygen (INH)
Intra-arrest, CO poisoning, cyanide poisoning, preoxygenation for RSI: - (INH) administer 100% O2 Paraquat toxicity, bleomycin treatment, obesity, COPD, CF, neuromuscular disease: - (INH) titrate oxygen to achieve 88-92% All other presentations: - (INH) titrate oxygen to achieve 92-96%
79
Indications for Oxytocin
- Active management of the third stage labour (following confirmed delivery of all foetuses) AND the prevention of primary post-partum haemorrhage - Management of uncontrolled primary or secondary post-partum haemorrhage
80
Contraindications for Oxytocin
- Allergy or adverse drug reaction | - Undelivered foetuses
81
Adult dosages for Oxytocin (IM & IV)
- (IM) 10 IU single dose only | - (IV) 10 IU slow push over 2-5 mins (may be given in addition to dose given for active management of 3rd stage)
82
Indications for Paracetamol
- Mild to moderate pain | - Fever (causing distress)
83
Contraindications for Paracetamol
- Allergy or adverse drug reaction | - Patients < 1 mnth old
84
Adult dosages for Paracetamol (PO)
- (PO) > 16 YO 0.5-1g repeated every 4 hours (MAX 4g in 24/24)
85
Paed Dosages for Paracetamol (PO)
- (PO) >1mnth 15mg/kg single dose only (Elixir) | - (PO) >7 YO 15mg/kg single dose only (Soluble tablets)
86
Indications for Salbutamol
- Bronchospasm | - Suspected Hyperkalaemia
87
Contraindications for Salbutamol
- Allergy or adverse drug reaction | - Patients less than 1 year old
88
Adult Dosages for Salbutamol (NEB)
- (NEB) 5mg repeated PRN (NO MAX)
89
Paed Dosages for Salbutamol (NEB)
- (NEB) 1-5 years 2.5mg single dose only | - (NEB) >6 YO 5mg single dose only
90
Indications for Sodium Chloride 0.9%
- Inadequate tissue perfusion/shock - Hypovolaemia - Significant burns (TBSA >20% for adults or >10% for paeds) - To dissolve and dilute drugs - As a flush following IV administration
91
Contraindications for Sodium Chloride 0.9%
- Nil
92
Adult doses for Sodium Chloride 0.9% (IV)
- (IV) PRN, titrate according to the patients physiological response to treatment - (IV) mL/hr to be infused = 15/mL/hr x TBSA (nearest 10%) if >100kg administer an additional 200mL/hr
93
Paed Dosages for Sodium Chloride 0.9%
- (IV) 10-20mL/kg, may be repeated twice if required (max dose 60mL/kg) * * Required Consult in all cases
94
Indications for Sucrose 24%
- Short term procedural pain management (IV cannulation) | - Distress due to pain
95
Contraindications for Sucrose 24%
- Patients >12 mnths of age - Sucrose intolerance (CSID) - Fructose intolerance - Glucose-galactose malabsorption - Concurrent muscle relaxant/ paralysis therapy
96
Paed Dosages for Sucrose 24% (PO)
- (PO) 0-1mth 0.1mL (2 drops) can be repeated once at 5 mins | - (PO) 2-12mnths 0.5mL (10 drops) can be repeated once at 5 mins
97
Indications for Tenecteplase
- Patient with STEMI who meet the criteria as defined by QAS coronary artery reperfusion checklist
98
Contraindications for Tenecteplase
- <18 or >75 YO - Uncontrolled hypertension (SBP >180mmHg OR DBP >100mmHG at any stage) - Allergy or adverse drug reaction to any of: tenecteplase, enoxaparin or clopidogrel - Left BB on 12-lead - Current OR history of thrombocytopenia - Active tuberculosis - Known cerebral disease - Previous intracranial haemorrhage - Ischaemic stroke or TIA within 3/12 - History of significant close head or facial trauma in last 3/12 - Suspected aortic dissection - History of major trauma or surgery within last 6/52 - Internal bleeding within last 6/52 (GI, UT) - Bleeding or clotting disorder - current use of anticoagulants (warfarin) - Non compressible vascular punctures - Prolonged (>10 mins) CPR - Known to be pregnant or delivered within last 2/52 - History of serious systemic disease - Resident of aged care facility requiring significant assistance - Acute MI in the setting of trauma
99
Adult Dosages for Tenecteplase (IV)
- (IV) weight calculated dose (refer chart) administered into a pre-existing IV line containing sodium chloride 0.9% over 10 sec
100
Indications for Ticagrelor
- Patients with STEMI who have been accepted for pPCI (in adjunct with aspirin and heparin where there cardiologist is requesting ticagrelor)
101
Contraindications for Ticagrelor
- Allergy or adverse drug reaction - Patient currently taking ticagrelor or clopidogrel - Patient less than 18 YO - Active bleeding - Prior intracranial haemorrhage - History of hepatic impairment
102
Adult Dosages for Ticagrelor (PO)
- (PO) >18 YO 180mg
103
Indications for Tranexamic Acid
- Recent Traumatic injuries (< 3 hours) with a COAST score >3 - Management of uncontrolled PPH (< 3 hours)
104
Contraindications for Tranexamic Acid
- Allergy or adverse drug reaction
105
Adult Dosages for Tranexamic Acid (IV)
- (IV) 1g slow push over 10 mins, single dose
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