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Drugs Flashcards

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1
Q

What are the indications for salbutamol?

A
  1. Respiratory distress with bronchospasm
    - Asthma
    - Severe allergic reactions
    - COPD
    - Smoke inhalation
    - Oleoresin capsicum spray exposure
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2
Q

What are the contraindications for salbutamol?

A

None

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3
Q

What is the dose and timing of Salbutamol?

A

Asthma

Mild/Moderate respiratory distress
- pMDI 4-12 doses @ 20/60 intervals until resolved (4 breaths per dose)

Asthma Severe or unimproved after 20/60

  • Salbutamol 10mg neb
  • Repeat 5mg neb @ 5/60

COPD exacerbation
- Salbutamol 10mg neb

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4
Q

What are the indications for Ipratropium Bromide?

A
  1. Severe respiratory distress associated with bronchospasm

2. Exacerbation of COPD irrespective of severity

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5
Q

What are the contraindications of Ipratropium bromide?

A
  1. Known hypersensitivity to atropine or its derivatives
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6
Q

What is the dose and timing of Ipratropium Bromide?

A

Severe Asthma

- 500mcg neb

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7
Q

What is the action of Dexamethasone?

A

Corticosteroid

  • relieves inflammatory reactions
  • provides immunosuppression
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8
Q

What are the indications for dexamethasone?

A
  1. Bronchospasm associated with acute respiratory distress not responsive to nebulised salbutamol
  2. moderate - severe croup
  3. Acute exacerbation of COPD
  4. Adult stridor (non-foreign body obstruction)
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9
Q

What are the contraindications for dexamethasone?

A

Known hypersensitivity

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10
Q

What is the dose and timing of dexamethasone?

A

Severe asthma
- 8mg PO/IV

Stridor
- 8mg IV/IM

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11
Q

What are the actions of GTN?

A
  • reduces preload
  • reduces after load
    Resulting in:
  • reduced myocardial O2 demand
  • Reduced systolic, diastolic, MAP,
  • Mild collateral coronary arterial dilatation may improve blood supply to ischaemic areas of myocardium
  • Mild tachycardia secondary to slight fall in BP
  • Preterm labour: uterine quiescence in pregnancy
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12
Q

What are the indications for GTN?

A
  1. Chest pain with ACS
  2. Acute LVF
  3. Hypertension associated with ACS
  4. Autonomic dysreflexia
  5. Preterm labour (consult)
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13
Q

What are the contraindications for GTN?

A
  1. Known hypersensitivity
  2. SBP < 110 (tablet)
  3. SBP <90 (patch)
  4. Sildenafil Citrate (Viagra) or Vardenafil (Levitra) administration in the previous 24hrs of Tadalafil (Cialis) administration in the previous 4 days
  5. Heart rate >150
  6. Bradycardia <5 bpm (excluding autonomic dysreflexia)
  7. VT
  8. Inferior STEMI with SBP <160
  9. Right ventricular MI
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14
Q

What is the dose and timing for GTN?

A

APO and ACS same admin

GTN 600mcg SL if SBP >110
or
GTN 300mcg SL if no prev admin, borderline BP or small (<60kg), elderly or frail

Repeat 300mcg or 600mcg SL @ 5 minute intervals titrated to pain or side effects

GTN Patch 50mg (0.4mg/hr)
- Remove if BP <90

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15
Q

What are the actions of Adrenaline?

A
  • increases HR by increasing SA node firing rate
  • increases conduction velocity and contractility
  • causes bronchodilation
  • causes peripheral constriction
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16
Q

What are the indications for Adrenaline?

A
  1. Cardiac arrest - VF, VT, Aystole, PEA
  2. Inadequate perfusion
  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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17
Q

What are the contraindications of Adrenaline?

A
  1. Hypovolaemic shock without adequate fluid replacement
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18
Q

What is the dose and timing for Adrenaline?

A

Asthma (Inadequate response to salbutamol and ipratropium)

  • Adrenaline 500mcg IM (1:1000)
  • Repeat 500mcg IM @ 5/60 (Max 1.5mg)
  • Consult with Clinician for IV adrenaline if Thunderstorm asthma (unresponsive to at least 1 dose of IM adrenaline) or Orolingual oedema secondary to tPA infusion

Medical Cardiac Arrest
- 1mg IV every second cycle (or @ 4/60 intervals)

Stridor

  • 5mg neb
  • consult for repeat doses

Anaphylaxis
- 500mcg IM - repeat @ 5/60 intervals as requred

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19
Q

What is the pharmacology/action for aspirin?

A
  • Analgesic, antipyretic, anti-inflammatory and antiplatelet 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
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20
Q

Indications for aspirin?

A
  1. ACS
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21
Q

What are the contraindications for Aspirin?

A

BACHS

  1. Bleeding disorders
  2. Actively bleeding peptic ulcers
  3. Chest pain associated with Psycho-stimulant OD if SBP >160
  4. Hypersensitivity to aspirin/salicylates
  5. Suspected dissecting aortic aneurysm
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22
Q

What is the dose and timing for Aspirin?

A

300mg PO Aspirin if not already administered

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23
Q

What is the pharmacology of Heparin?

Study These Flashcards
A
  1. Anticoagulant

2. Inactivates clotting factors by binding to antithrombin

24
Q

What are the indications of Heparin?

25
What are the contraindications for Heparin?
SHARK BO 1. Severe hepatic impairment/ disease 2. History of heparin induced thrombocytopenia 3. Acute bleeding 4. Recent trauma or surgery in last 3/52 5. Known allergy or hypersensitivity 6. Bleeding disorders 7. Oral anticoagulants known allergy or hypersensitivity
26
What is the dose and timing for Heparin?
Heparin IV bolus 4000 IU Repeat IV bolus 1000 IU at 1 hour intervals ***Must call CCS prior to administering Heparin***
27
What is the pharmacology of Normal saline?
- Isotonic crystalloid | - Increases the volume of the intravascular compartment
28
What are the indications of Normal Saline?
1. Fluid replacement in volume depleted patients 2. Cardiac arrest secondary to hypovolaemia or where the patient may be fluid responsive 3. To expand intravascular volume in the non-cardiac, non-hypovolaemic hypotensive patient (e.g. anaphylaxis, burns, sepsis) 4. As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive patients other than LVF e.g. Asthma 5. Fluid for diluting and administering IV drugs 6. Fluid TKVO for IV admin of emergency drugs
29
What are the contraindications of Normal Saline?
None
30
What is the dose and timing for Normal Saline?
Medical arrest (if pt is suspected hypovolaemia, anaphylaxis or asthma - NaCl IV 20ml/kg + NaCl TKVO
31
What is the pharmacology of paracetamol?
Analgesia and antipyretic
32
What are the indications of Paracetamol?
1. Mild pain | 2. Headache
33
What are the contraindications of paracetamol?
CHANT 1. Chest pain in suspected ACS 2. Hypersensitivity 3. Already administered in past 4 hours 4. Neonate (<1 month old) 5. Total intake exceeding 4 grams in past 24/24
34
What is the dose and timing for Paracetamol?
1g PO or 500mg (<60kg/frail/elderly/malnourished/liver disease) Max dose 4g per day
35
What are the actions of Fentanyl?
Synthetic opioid analgesia Causes - CNS and resp depression
36
What are the indications of Fentanyl?
1. Sedation to facilitate - RSI, maintain intubation, transthoracic pacing, synchronised cardioversion 2. CPR interfering patient - ALS 3. Analgesia - History of hypersensitivity or allergy to morphine - Known renal impairment/failure - short duration of action desirable - Hypotension - Nausea and/or vomiting - Severe headache
37
Contraindications of fentanyl?
1. History of hypersensitivity | 2. Late second stage of labour
38
What is the dose and timing for fentanyl?
Pain relief IV - Up to 50mcg at 5 minute intervals up to 200mcg (consult after max dose) IN - 200mcg - Repeat up to 50mcg at 5 minute intervals if required - Max dose 400mcg IN or - 100mcg (<60kg/frail/elderly) - Repeat up to 50mcg at 5 min intervals if required (max 200mcg IN) ``` IM - 100mcg - repeat 50mcg after 15 mins if required (once only) or - 1mcg/kg (<60kg/frail/elderly) - No repeat dose ``` Patient interfering with CPR - 100mcg IV every 1-2mins (no max dose) - if no IV access Fentanyl 200mcg IM single dose
39
What is the action of morphine?
Opioid analgesic - CNS depression - Resp depression - Depression of cough reflex - Vasodilation
40
What are the primary indications for morphine?
1. Pain releif | 2. Sedation to facilitate and maintain intubation (where fentanyl not appropriate for RSI)
41
What are the contraindications for morphine?
1. History of hypersensitivity 2. Renal impairment/failure 3. Late second stage of labour
42
What is the dose and timing of morphine?
IV - Up to 5mg at 5 minute intervals - ALS consult after 20mg ``` IM - 10mg - Repeat 5mg after 15 mins if required (once only) or 0.1mg/kg (<60kg/frail/elderly) - No repeat dose ```
43
What is the action for Ketamine?
Anaesthetic agent
44
What are the indications of Ketamine?
- Intubation - Analgesia - Sedation
45
What are the contraindications for Ketamine?
- Suspected non-traumatic brain injury with severe hypertension (SBP>180)
46
What is the dose and timing of Ketamine?
``` IN - 75mg - repeat 50mg at 20/60 intervals - No max dose or - 50mg (<60kg/frail/elderly) - Repeat 25mg at 20min intervals - no max dose ``` - IN add 0.1ml to required volume to account for dead space in MAD) ALS must consult if wanting to give IV analgesic dose - 200mg in 20mls - 10-20mg at 5-10 min intervals
47
What is the action of Methoxyflurane?
Inhalational analgesia
48
What are the indications for Methoxyflurane?
1. Pain releif
49
What are the contraindications for Methoxyflurane?
MMERC 1. Malignant hyperthermia (personal or family hx) 2. Muscular dystrophy 3. Exceeding total dose 6ml in 24/24 4. Renal disease/impairment 5. Concurrent use of tetracycline antibiotics
50
What is the dose and timing for Methoxyflurane?
- Initial dose of 3ml - will provide 25 mins of analgesia - It may be followed by an additional 3ml if required - Analgesia commences after 8-10 breaths and lasts for 3-5 minutes once discontinued.
51
What are the indications for ondansetron?
1. Undifferentiated nausea and vomiting 2. Prophylaxis for spinally immobilised or eye injured patients 3. Vestibular nausea in patients <21 years old
52
What are the contraindications of Ondansetron?
HHAP 1. Hypersensitivity 2. Hypokalaemia or hypomagnesaemia 3. Apomorphine use 4. Prolonged QT syndrome
53
What is the dose and timing of ondansetron?
Undifferentiated nausea and vomiting - 4mg PO - repeat 4mg after 5-10 mins (Max 8mg) If pt unable to tol PO - 8mg IV
54
What is the class of Prochlorperazine?
Anti-emetic
55
What are the indications for Prochlorperazine?
1. Treatment of prophylaxis of nausea/vomiting for - motion sickness - planned aeromedical evacuation - Known allergy or C/I to ondansetron administration - Headache irrespective of nausea/vomiting - Vertigo
56
What are the contraindications for Prochlorperazine?
PPPCC 1. Previous hypersensitivity 2. Patients <21 years of age 3. Pregnancy 4. Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension) 5. CNS depression
57
What is the dose and timing for Prochlorperazine?
- 12.5mg IM | - once

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