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drug therapy protocols Flashcards

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1
Q

Drug class for adrenaline

A

Sympathomimetic

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2
Q

Pharmacology of adrenaline

A

Adrenaline is a naturally occurring catacholemine that acts primarily on the alpha and beta adrenoreceptors. The action of the receptors combine to cause increase in heart rate (b1), increase in force of myocardial contraction (b1), increase in irritability of the ventricles, bronchodilation (b2) and peripheral vasoconstriction (a1).

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3
Q

Metabolism of adrenaline

A

The majority of circulating adrenaline is metabolised by sympathetic nerve endings. It is subject to mitochondrial enzymatic breakdown by monoamine oxidase at the synaptic level.

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4
Q

Indications for adrenaline

A
  1. Anaphylaxis or severe allergic reaction
  2. Severe life threatening bronchospasm or silent chest - pt must be able to speak in only single words AND / OR have haemodynamic compromise AnD / OR have an ALOC.
  3. Cardiac arrest
  4. Croup with stridor at rest
  5. Bradycardia with poor perfusion unresponsive to atropine and top
  6. Shock excluding hemorrhagic causes unresponsive to adequate fluid therapy
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5
Q

Contraindications for adrenaline

A

KSAR

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6
Q

Precautions for adrenaline

A
  1. Pts taking monoamine oxidase inhibitors
  2. Hypovolemic shock
  3. Hypertension
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7
Q

Side effects of adrenaline

A
  1. Tacharrythmias / palpatations
  2. Hypertension
  3. Anxiety
  4. Pupillary dilation
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8
Q

Presentation of adrenaline

A

1mg in 1ml

1mg in 10mls

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9
Q

Onset, duration and half life of adrenaline including IM / IV onsets

A

Onset = IVI 30 secs IMI 60 secs
Duration 5-10 mins
Half life 2 mins

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10
Q

Schedules of adrenaline

A

1: 1000 s3
1: 10000 unscheduled

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11
Q

Special notes of adrenaline

A

1:1000 adrenaline should be used for all nebuliser doses
1:10000 adrenaline should be used for all low dose IV injections, e.g paediatric arrest
Repeated Im doses in the same location may cause tissue necrosis and Ischaemia
All cannulae must be flushed after admin

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12
Q

Adult doses of adrenaline

A

Anaphylaxis or severe allergic reaction = 250- 500mcg IMI repeatable every five mins whilst still indicated, neb = 5 mg single dose only for isolated facial swelling / angioedema with no stridor at rest.
Severe life threatening bronchospasm = 250 - 500 mcg IMI repeatable at 5 min intervals NMD
Cardiac arrest = 1mg IVI repeatable at 3-5 mins NMD

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13
Q

Paediatric doses of adrenaline

A

Anaphylaxis or severe allergic reaction = 1 y/ o 10 mcg / kg IMI repeatable every 5 mins whilst still indicated. Isolated facial swelling or angioedema with no stridor at rest = 5 mg nebuliser, single dose only.
Severe life threatening bronchospasm = 1 y/ o 10 mcg / kg IMI repeatable every 5 mins whilst still indicated.
Cardiac arrest = < 1 = 100 mcg bolus IVI, > 1 = 10 mcg / kg repeatable every 3-5 mins NMD
Croup with stridor at rest = 5 mg nebulised single dose only.

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14
Q

Drug class for aspirin

A

Anti platelet

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15
Q

Pharmacology for aspirin

A

Aspirin inhibits platelet aggregation by irreversibly inhibiting cyclo-oxygenase, reducing the synthesis of thrombaxane A2 for the life of the platelet. This anti platelet activity prevents platelets aggregating on exposed collagen fibres at the site of vascular injury.

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16
Q

Metabolism of aspirin

A

Converted to salicyclic acid in many tissues but primarily the gastrointestinal mucousa and liver, excreted by the kidneys.

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17
Q

Indications for aspirin

A
  1. ACS
  2. Acute cardiogenic pulmonary oedema

Old
1. Suspected AMI or myocardial ischaemia

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18
Q

Contraindications for aspirin

A
  1. KSAR to aspirin or NSAIDs
  2. Bleeding disorders
  3. Current GI bleed or peptic ulcers
  4. pts < 18
  5. Chest pain to secondary to psychostimulant overdose
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19
Q

Precautions of aspirin

A
  1. Suspected aortic aneurysm or other condition requiring surgery
  2. Hx of GI bleed or peptic ulcers
  3. pregnancy
  4. Pts on concomitant anticoagulant therapy except for clopidogrel
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20
Q

Side effects of aspirin

A
  1. GI bleeding
  2. NSAID induced bronchospasm
  3. Nausea / vomiting
  4. Epigastric pain / discomfort
  5. gastritis
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21
Q

Presentation of aspirin

A

300 mg tablet

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22
Q

Onset, duration and half life of aspirin

A

Onset 10 mins variable, duration = anti platelet action lasting 7-10 days, half life 3.2 hours 300- 650 mg

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23
Q

Aspirin schedule

A

S2 therapeutic poisons

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24
Q

Dose for aspirin

A

300 mg tablet sinle dose PO

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25
Q

Special notes for aspirin

A
  1. In suspected ACS or acute cardiogenic pulmonary oedema aspirin should be administered following the initial dose of GTN.
  2. Aspirin administration is indicated in ACS or acute cardiogenic Apo even if pt is pain free
  3. Pts whom have had < 300 mg of aspirin in the last 24 hrs should be administered a dose that equates to a total daily dose of 300-450 mg of aspirin
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26
Q

Ceftriaxone drug class

A

Antibiotic

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27
Q

Pharmacology of ceftriaxone

A

Ceftriaxone is a third generation cephalosporin antibiotic used in the treatment of meningococcal septicaemia

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28
Q

Indications for ceftriaxone

A

Suspected meningococcal septicaemia with non blanching petechial or purpuric rash

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29
Q

Contraindications for ceftriaxone

A

KSAR to cephalosporin drug

Known anaphylaxis or severe allergic reaction to penicillin based antibiotics

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30
Q

Precautions of ceftriaxone

A

Nil

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31
Q

Side effects of ceftriaxone

A
  1. Nausea / vomiting

2. Intense pain at site of injection

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32
Q

Presentation of ceftriaxone

A

1 g vial of powder

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33
Q

Onset, duration and half life of ceftriaxone

A

Onset = 30 secs IVI 60 secs IMI, duration = 5-10 mins, half life = 2 mins

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34
Q

Schedule for ceftriaxone

A

S4 restricted drugs

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35
Q

Adult doses for ceftriaxone

A

IMI 1 g mixed with 3.6 mls of water for injection

IVI 1 g mixed with 9.6 mls of water for injection

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36
Q

Paediatric doses for ceftriaxone

A

IMI all doses mixed with 3.6 mls of water for injection, 50 mg / kg = 0-5 kg 250mg, 5-10kg 500 mg, 10-15 kg 750 mg, >20 kg 1gm
IVI all doses mixed with 9.6 mls of water for injection, 50 mg / kg = 0-5 kg 250mg, 5-10kg 500 mg, 10-15 kg 750 mg, >20 kg 1gm

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37
Q

Special notes for ceftriaxone

A

All cannulae should be flushed with saline following administration

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38
Q

Glucagon drug class

A

Hyperglycaemic

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39
Q

Pharmacology of glucagon

A

Glucagon is a hyperglycaemic agent that mobilises hepatic stores of glycogen to be used as glucose in the blood.

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40
Q

Metabolism of glucagon

A

Liver, kidneys and plasma

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41
Q

Indications for glucagon

A

Symptomatic hypoglycaemia in a pt unable to self administer oral glucose

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42
Q

Contraindications of glucagon

A

KSAR

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43
Q

Precautions of glucagon

A

Nil

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44
Q

Side effects of glucagon

A

Nil

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45
Q

Presentation of glucagon

A

Glycogen hypokit, 1 mg freeze dried powder with 1 ml of diluting solution

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46
Q

Onset, duration and Half life of glucagon

A

Onset = 4-7 mins, duration variable, half life = 3-6 mins

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47
Q

Doses for glucagon

A

< 25 kg = 0.5 mg, > 25 kg = 1 mg single dose only

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48
Q

Glucagon special notes

A
  1. Glucagon may be ineffective in pts that have no hepatic stores of glycogen ( e.g. Alcoholic pts with impaired liver function and neonates )
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49
Q

Drug class of glucose 10%

A

Hyperglycaemic

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50
Q

Pharmacology of glucose 10%

A

Glucose is a sugar that is the principle energy source for the body’s cells, especially the brain

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51
Q

Contraindications for glucose 10%

A

Nil

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52
Q

Indications for glucose 10%

A

Symptomatic hypoglycaemia in a pt unable to self administer oral glucose

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53
Q

Precautions for glucose 10%

A

Tissue / vascular necrosis secondary to extravasation

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54
Q

Side effects to glucose 10%

A

Nil

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55
Q

Presentation of glucose 10%

A

500 ml via flex container

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56
Q

Onset, duration and half life of glucose 10%

A

Onset = rapid, duration N/A, half life n/a.

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57
Q

Adult doses of glucose 10%

A

150 ml bonus repeatable at 5 mins with 100 ml boluses until BSL > 4 mol/L NMD

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58
Q

Paediatric doses of glucose 10%

A

2.5 mls/ kg repeatable every 5 mins at 1 ml/kg until BSL greater than 4 mol/L

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59
Q

Drug class of glucose gel

A

Hyperglycaemic

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60
Q

Pharmacology of glucose gel

A

Glucose gel is a form of pure glucose that is rapidly absorbed into the gastrointestinal mucousa and used as glucose in the blood, in the liver it is converted to glycogen the storage form of glucose. It is the principle source of energy especially for the brain.

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61
Q

Indications for glucose gel

A

Symptomatic hypoglycaemia in a pt able to ingest oral glucose

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62
Q

Contraindications of glucose gel

A
  1. KSAR
  2. Unconscious pts
  3. Pts with difficulty swallowing
  4. Pts < 2 yrs old
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63
Q

Precautions for glucose gel

A

Nil

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64
Q

Side effects of glucose gel

A

Diarrhoea

Nausea / vomiting

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65
Q

Presentation of glucose gel

A

15 g in a tube

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66
Q

Onset, duration and half life of glucose gel

A

Onset 10 mins variable, duration variable, half life n/a

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67
Q

Schedule for glucose gel

A

Unscheduled

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68
Q

Doses of glucose gel, adult and paediatric

A

15 gms repeatable at 10 mins total max dose 30 g

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69
Q

Special notes for glucose gel

A

Pts are to swallow the entire contents of the tube where possible to maximise the rise in blood glucose levels.

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70
Q

Drug class of glyceryl trinitrate

A

Vasodilator

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71
Q

Pharmacology of GTN

A

Glyceryl trinitrate is a potent vasodilator that decreases preload by increasing venous capacity, pooling venous blood in the peripheral veins, reducing ventricular filling pressures and decreasing arterial blood pressure ( after load ). Because of this cascade it also causes vasodilation in coronary arteries that are in spasm and may assist the redistribution of blood flow through collateral channels of the heart.

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72
Q

Metabolism of GTN

A

Readily absorbed and metabolised but the liver

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73
Q

Indications for GTN

A
  1. Suspected ACS
  2. Acute cardiogenic pulmonary oedema
  3. Autonomic dysreflexia with a systolic >= 160 mmHg
  4. Irrukandji syndrome with a systolic >= 160 mmHg
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74
Q

Contraindications for GTN

A
  1. KSAR
  2. Bp < 100 mmHg
  3. Heart rate < 50 or >150 bpm
  4. Erectile dysfunction medications in last 24 hrs
  5. Acute CVA
  6. Head trauma
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75
Q

Precautions of GTN

A
  1. Cerebral vascular disease
  2. Risk of hypotension / syncope
  3. Intoxicated pts
  4. Erectile dysfunction medications in last 4 days
  5. Suspected inferior AMI
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76
Q

Side effects of GTN

A
  1. Dizziness
  2. Hypotension
  3. Syncope
  4. Reflex tachycardia
  5. Vascular headache
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77
Q

Presentation of GTN

A

Sublingual spray 400 mcg metered aerosol 200 doses

Ampoules 50 mg in 10 mls

78
Q

Onset, duration and half life of GtN

A

Onset < 2 mins, duration 20-30 mins, half life 5 mins

79
Q

Special notes for GtN

A
  1. GTN is the first line treatment for ACS, however IV GTN should be considered for all pts unresponsive to sublingual GTN, narcotics and betablockers.
  2. Some pts with normal or low left ventricular filling pressures may be hypersensitive to GTN.
  3. GTN is the first line treatment for autonomic dysreflexia however morphine should be considered as part of the management regime.
  4. All annular and lines must be flushed with saline.
80
Q

Methoxyflurane drug class

A

Analgesic ( at low doses )

81
Q

Pharmacology of methoxyflurane

A

Methoxyflurane is an inhalation agent that provides analgesia at low doses. Methoxyflurane is more susceptible to metabolism than other halogenated ethers and has a greater propensity to diffuse into fatty tissue.

82
Q

Metabolism of methoxyflurane

A

By the liver and excreted mainly by the lungs

83
Q

Indications for methoxyflurane

A

Pain

84
Q

Contraindications for methoxyflurane

A
  1. KSAR
  2. Hx of malignant hyperthermia
  3. Hx of signicant liver or renal disease
  4. Pts under 1 yrs old
85
Q

Precautions for methoxyflurane

A
  1. ALOC

2. Intoxicated or drug affected patients

86
Q

Side effects of methoxyflurane

A
  1. Cough
  2. ALOC
  3. Hepatic or renal failure following repeated high doses
87
Q

Presentation of methoxyflurane

A

3 ml glass bottle

88
Q

Onset, duration and half life of methoxyflurane

A

Onset 1-3 mins, duration 5-10 mins, half life not available

89
Q

Schedule of methoxyflurane

A

S4 restricted drug

90
Q

Doses of methoxyflurane for adults and paediatrics

A 
Adults = 3 mls repeatable after 20 mins, max dose 6 mls
Paediatrics = 3 mls non repeatable
91
Q

Special notes for methoxyflurane

A
  1. The manufacturer recommends use on children who can self monitor their own pain scale and self administer.
  2. Deep sedation has been identified in pts < 5 yrs old
  3. At no time should unconsciousness be deliberately induced by administration
  4. At no time should a pt self administering methoxyflurane by left unattended.
  5. The lowest dose should be used to achieve analgesia
  6. If the pt prefers simultaneous administration through nose and mouth a face mask can be connected prior to administration
  7. Total weekly dose should not exceed 15 mls
  8. Only 1 in the back of the vehicle, 2 per shift per officer
92
Q

Drug class: metochlopramide

A

Antiemetic

93
Q

Pharmacology of metochlopramide

A

Metochlopramide hydrochloride is a dopamine receptor antagonist, it works by inhibiting gastric smooth muscle relaxation, accelerating gastrointestinal transit and gastric emptying, further it raises the chemoreceptors threshold in the floor of the fourth ventricle.

94
Q

Indications for metochlopramide

A
  1. Significant nausea / vomiting

2. Prophylactic use with pts who have Hx of nausea / vomiting with narcotic administration.

95
Q

Contraindications for metochlopramide

A
  1. KSAR
    2, patients < 16 years
  2. Hx of dystonic reaction
  3. Pts whom have had phenothiazines in the last 6 hrs
96
Q

Precautions for metochlopramide

A
  1. GI haemorrhage

2. Pts with bowel obstruction / perforation

97
Q

Side effects for metochlopramide

A
  1. Drowsiness / lethargy
  2. Dry mouth
  3. Dystonic reaction
  4. Occulogyric crisis
98
Q

Presentation of metochlopramide

A

10 mg in 2 mls

99
Q

Onset, duration and half life of metochlopramide

A

Onset 1-3 mins IVI, 10-15 IMI, duration 1-2 hrs, half life 2.5 - 5 hrs

100
Q

Schedule for metochlopramide

A

S4 restricted drugs

101
Q

Doses for metochlopramide

A

10-20 mg IMI and IVI ( slow push for 1-2 mins )

102
Q

Drug class midazolam

A

Short acting benzodiazepine

103
Q

Pharmacology of midazolam

A

Midazolam hydrochloride is a short acting central nervous system depressant that induces amnesia, anaesthesia, hypnosis and sedation. It achieves this by enhancing the action of inhibitory neurotransmitter gamma amino butyric acid ( GABA ). Depressant effects occur at all levels of the CNS.

104
Q

Metabolism of midazolam

A

By the liver, excreted by the kidneys

105
Q

Indications of midazolam

A
  1. Seizures / convulsions
  2. Sedation for :
    Maintenance of ett
    Severely agitated head injured pts
    Pts with trauma requiring fracture reduction, splinting or extrication distressed and agitated by pain despite 0.1 mg / kg - 0.2 mg / kg morphine
    Pts with burns distressed and agitated despite 0.2-0.3 mg / kg morphine
    Procedures (tcp or cardioversion)
    Ketamine disinhibition or emergence
106
Q

Contraindications of midazolam

A

KSAR to benzodiazepines

107
Q

Precautions of midazolam

A
  1. Reduced dosages may be required in elderly pts, pts with chronic renal failure, CCF, or shock
  2. Can cause severe respiratory depression in pts with COAD
  3. Myasthenia gravies
  4. Multiple sclerosis
108
Q

Side effects of midazolam

A
  1. Hypotension

2. Respiratory depression particularly when associated with alcohol or narcotics

109
Q

Presentation of midazolam

A

5 mg in 1 ml

110
Q

Onset, duration and half life of midazolam

A

Onset IV 1-3 mins, IM 5-15, duration variable, half life 2-5 hrs

111
Q

Schedule of midazolam

A

S4 restricted drugs

112
Q

Doses for midazolam ( adult )

A

> = 70 yrs 2.5 mg

113
Q

Paediatric doses of midazolam

A

Initial dose 200 mcg/ kg SMD 5 mg
Repeat at half the initial dose
@ 10mins TMD10mg

114
Q

Morphine drug class

A

Narcotic analgesic

115
Q

Pharmacology of morphine

A

Morphine is a narcotic analgesic that acts on the central nervous system by binding to opioid receptors and altering processes affecting pain perception and emotional response to pain. It also combines to cause respiratory depression, decreases in gag reflex, decreases in av node conduction and vasodilation.

116
Q

Metabolism of morphine

A

Liver, kidneys and lungs

117
Q

Indications for morphine

A
  1. Significant pain
  2. Autonomic dysreflexia with systolic bp > 160 mmHg
  3. Sedation to maintain or establish ett
118
Q

Contraindications of morphine

A

KSAR

119
Q

Precautions of morphine

A
  1. Elderly pts
  2. Hypotension
  3. Respiratory tract burns
  4. Respiratory depression and or failure
  5. Known addiction to narcotics
  6. Pts on monoamine oxidase inhibitors
120
Q

Side effects of morphine

A
  1. Bradycardia
  2. Drowsiness
  3. Hypotension
  4. Nausea / vomiting
  5. Pin point pupils
  6. Respiratory depression
121
Q

Presentation of morphine

A

10 mg in 1 ml

122
Q

Onset, duration and half life of morphine

A

Onset IM 5-10 mins/ IV 2-5 mins, duration 1-2 hrs; half life 2 hrs

123
Q

Schedule of morphine

A

S8 controlled drugs

124
Q

Doses morphine

A

Adult = IMI 2.5 - 10 mg repeat every 10 mins NMD
Adult IVI = 2.5 -5 mg repeat every five mins, NMD
Child IMI 100 - 200 mcg /kg repeat 10 mins, 200 mcg / kg max dose
Child IVI 100 mcg / kg repeat 5 mins at 50 mcg / kg max dose 200 mcg / kg

125
Q

Morphine special notes

A
  1. When morphine is administered to a hypotensive pt , acp must call icp backup where available
  2. In the setting of the hypotensive pt ( <90sbp) all incremental doses are to be no greater than 2.5 - 5 mg IV or 5 mg IMI
  3. For doses above 20 mg intravenous access must be established, if it cannot be established acp must consult.
  4. GTN is the first line treatment for autonomic dysreflexia, but morphine should be considered as part of the treatment regime
  5. All cannulae must be flushed with saline
126
Q

Naloxone drug class

A

Opioid antagonist

127
Q

Pharmacology of naloxone

A

Naloxone is an opioid antagonist that prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension. Naloxone antagonises the opioid effects by competing for the same receptor sites.

128
Q

Metabolism of naloxone

A

Hepatic

129
Q

Indications of naloxone

A

Respiratory depression secondary to narcotic administration.

130
Q

Contraindications of naloxone

A

KSAR

131
Q

Precautions of naloxone

A

Use with caution with pts with pre-existing cardiac disease

132
Q

Side effects of naloxone

A
  1. Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension
  2. May produce acute withdrawal convulsions in the chronic narcotic user
  3. Pulmonary oedema
133
Q

Presentation of naloxone

A

400 mcg in 1 ml

134
Q

Onset, duration and half life of naloxone

A

Onset IMI 3-5 mins, IV 1-3 mins, duration 60 mins, half life 60 mins

135
Q

Schedule for naloxone

A

S4 restricted drugs

136
Q

Naloxone special notes

A
  1. Naloxone should be administered following adequate ventilation and oxygenation
  2. Naloxone should be administered cautiously to pts that are known to have physical dependence to narcotics, this includes newborn infants.
  3. In the vast majority of cases naloxone should not be required and the pt will only need supportive therapy followed by Tx to hospital.
  4. The duration of the narcotic may outlast the duration of naloxone and renarcotisation is always a possibility
  5. There is no necessity for IV access unless they have sustained an injury or have another medical condition
  6. Administration of naloxone in the prehospital setting will unmask potentially unwanted side effects in the poly pharmacy setting.
137
Q

Oxygen drug class

A

Gas

138
Q

Pharmacology of oxygen

A

A colourless, odourless gas essential for the production of cellular energy, it constitutes 21% of the earth’s atmosphere

139
Q

Metabolism of oxygen

A

N/A

140
Q

Indications of oxygen

A

Hypoxia / hypoxaemia

To assist organ oxygenation in pts with poor perfusion

141
Q

Contraindications of oxygen

A

Known paraquat poisoning

Lung disease secondary to bleomycin therapy

142
Q

Precautions for oxygen

A

Prolonged exposure to premature neonates

High concentrations to COAD pts with hypoxia drive

143
Q

Side effects of oxygen

A

Drying of the mucous membranes of the airway

Hypoventilation in COAD pts with hypoxia drive

144
Q

Presentation of oxygen

A

C size cylinder = 450 L

D size cylinder = 1600 L

145
Q

Onset, duration and half life of oxygen

A

Onset immediate all else n/a

146
Q

Special notes for oxygen

A
  1. Underwater diving and diving accidents are not covered by this DTP, officers are to admin high flow oxygen.
  2. The administration of oxygen to correct hypoxaemia is evidence based. Severe hypoxaemia is harmful
  3. QAS spO2 monitors are unable to differentiate between carboxyhemoglobin and oxyhemoglobin, therefore in the setting of carbon monoxide poisoning officers are to administer high flow O2 irrespective of saturations.
  4. If a COAD pt sustains a critical illness / injury then the saturations for that treatment takes precedence.
  5. For pts with COAD nebulised salbutamol is to be delivered at 6 lpm.
147
Q

Paracetamol drug class

A

Analgesic

148
Q

Pharmacology of paracetamol

A

Paracetamol is a p-amino phenol derivative that exhibits mild analgesic and antipyretic effects. It does not possess significant anti-inflammatory properties.

149
Q

Metabolism of paracetamol

A

By the liver, excreted by the kidneys

150
Q

Indications for paracetamol

A

Mild pain and fever

151
Q

Contraindications of paracetamol

A
  1. KSAR

2. Pt <1 month old

152
Q

Precautions of paracetamol

A
  1. Hepatic or renal dysfunction

2. Pts on con commitment anticoagulant therapy excluding clopidogrel.

153
Q

Side effects of paracetamol

A

Nausea

154
Q

Presentation of paracetamol

A

500 mg tablet

120 mg in 5 ml acohol and sugar free elixir

155
Q

Onset, duration and half life of paracetamol.

A

Onset 10-60 mins dependent on stomach contents, duration 4 hrs, half life 2 hrs

156
Q

Schedule for paracetamol

A

S2 therapeutic poisons

157
Q

Doses for paracetamol

A

Adult 500 mg to 1 g every four hours

Paed 15 mg/ kg every four hours

158
Q

Special notes for paracetamol

A

Consider previous doses of paracetamol by pt, carer or guardian

159
Q

Salbutamol drug class

A

Beta adrenergic agonist

160
Q

Pharmacology of salbutamol

A

Salbutamol is a direct acting sympathomimetic agent that mainly affects the b2 adrenoreceptors. It primarily acts as a bronchodilator but also has inotropic and chrontropic actions. Additionally it also lowers serum potassium levels by it’s direct stimulation of the sodium / potassium pumps drawing potassium into the cells.

161
Q

Metabolism of salbutamol

A

By the liver excreted by the kidneys

162
Q

Indications for salbutamol

A
  1. Bronchospasm

2. Suspected hyperkalaemia with QRS widening and / or av disassociation

163
Q

Contraindications of salbutamol

A
  1. KSAR

2. Pts <2 yrs

164
Q

Precautions of salbutamol

A
  1. Acute pulmonary oedema

2. Ischaemic heart disease

165
Q

Side effects of salbutamol

A
  1. Anxiety
  2. Tacharrythmias
  3. Muscle tremors
  4. Hypokalaemia and metabolic acidosis
166
Q

Presentation of salbutamol

A

5 mg in 2.5 ml nebule

500 mcg in 1 ml ampoule

167
Q

Onset, duration and half life of salbutamol

A

Onset = 2-5 mins neb, 1-3 mins IV , duration 16-60 neb, 10-20 IV, half life 1.6 hrs

168
Q

Schedule of salbutamol

A

S4 restricted drugs

169
Q

Dose for salbutamol

A

PRN

170
Q

Special notes for salbutamol

A
  1. Indifferent preparations of salbutamol are used for the IV and nebulised routes, do not mix
  2. COAD pts = 6
  3. Discard foil contents three months from opening
171
Q

Sodium chloride 0.9% drug class

A

Isotonic crytalloid solution

172
Q

Pharmacology of sodium chloride

A

Sodium chloride 0.9% is an isotonic crytalloid solution that acts as a vehicle for many parental drugs and as an electrolyte replenishes for maintenance or replacement of body fluid deficits.

173
Q

Metabolism of sodium chloride 0.9%

A

This drug has 100% bioavailability, excess sodium is excreted by the kidneys

174
Q

Indications of sodium chloride 0.9%

A
  1. Inadequate tissue perfusion / shock
  2. Hypovolemia
  3. To dissolve or dilute drugs
  4. As a flush following parental drug administration
175
Q

Contraindications for sodium chloride

A

Nil

176
Q

Precautions of sodium chloride

A
  1. Pts with acute or Hx of heart failure
  2. Pre-existing renal failure
  3. Uncontrolled haemorrhage ( unless associated with severe head injury )
177
Q

Side effects of sodium chloride

A

Excessive administration will result in fluid overload

178
Q

Presentation of sodium chloride

A

10 ml ampoule

1000 ml via flex container

179
Q

Onset, duration and half life of sodium chloride

A

Onset immediate, duration variable, half life n/a

180
Q

Schedule of sodium chloride

A

Unscheduled

181
Q

Sodium chloride special notes

A
  1. Use of volume expansion in uncontrolled haemorrhage without concurrent brain injury is associated with poor outcomes. Paramedics are to administer the minimum amount of fluid to maintain a radial pulse.
  2. Hypotension with a concurrent brain injury is associated with poor outcomes. Paramedics are to administer the minimum amount of fluid to maintain a systolic bp of 100 - 120 mmHg.
  3. Excessive fluid administration may lead to neurogenic pulmonary oedema in the spinal injured patient.
  4. too rapid fluid infusion in a patient without a fluid deficit or with pre-existing cardiac disease may cause pulmonary oedema or congestive heart failure.
  5. A gentle fluid challenge may be considered with pts suspected of having a right ventricular infarct following v4r, and with no left ventricular involvement e.g pulmonary oedema.
  6. Adult pts should be reassessed after every 250-500mls.
  7. Paediatric pts should be reassessed after every 10 mls per kg
182
Q

Doses for sodium chloride

A 
Adult = PRN
Paediatric = 10-20 mls pre kg CONSULT IN ALL SITUATIONS
183
Q

Water for injection drug class

A

Not applicable

184
Q

Pharmacology of water for injectio

A

Water for injection is sterile water used to dilute or dissolve drugs

185
Q

Metabolism of water for injection

A

Not applicable

186
Q

Contraindications, precautions and side effects of water for injection

A

Nil

187
Q

Presentation of water for injection

A

Ampoule, 20 ml water for injection

188
Q

Onset, duration and half life of water for injection

A

Not applicable

189
Q

Schedule for water for injection

A

Unscheduled

190
Q

1 yo, 2 yo, 3 yo, 4 yo, 5 yo, 6 yo, 7 yo and 8 yo doses of paracetamol

A 
1 = 10 kg = 150 mg / 6.25 mls
2 = 13 kg = 195 mg / 8.125 mls
3 = 15 kg = 225 mg / 9.375 mls
4 = 17 kg = 255 mg / 10.625 mls
5 = 19 kg = 285 mg / 11.875 mls
6 = 21 kg = 315 mg / 13.125 mls
7 = 23 kg = 345 mg / 14.375 mls
8 = 25 kg = 375 mg / 15.625 mls

Please note to quick fix the millage, multiply kg x 0.625

191
Q

name 3 diagnostic settings for 12 lead ECG

A
  1. Speed
  2. Amplitude
  3. Frequency

From Flashcardlet (28 decks)

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