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Drugs Flashcards

1
Q

Adrenaline 1:1,000 (1mg/1mL) is indicated in:

A

Life-threatening asthma
Anaphylaxis

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2
Q

Adrenaline 1:10,000 (1mg/10mL) is indicated in:

A

Cardiac arrest
Post-ROSC circulatory support

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3
Q

Amiodarone is indicated in:

A

Cardiac arrest with VF or pulseless VT if unresponsive to 3 x DCCS

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4
Q

Aspirin is indicated in:

A

Clinical or ECG evidence suggestive of myocardial ischaemia or infarction

Suspected TIA where all symptoms have resolved AND the patient is not being conveyed to hospital AND the patient has been referred to the local TIA pathway

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4
Q

Atropine is indicated in:

A

Symptomatic bradycardia with ANY of the following:
Pulse < 40 bpm
SBP below average for age
Paroxysmal ventricular arrythmia requiring suppression
Confusion secondary to impaired cerebral perfusion
Bradycardia following ROSC

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5
Q

Benzylpenicillin is indicated in:

A

Suspected meningococcal disease + non-blanching rash and/or signs of sepsis

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5
Q

Chlorphenamine is indicated in:

A

Symptomatic allergic reaction (falling short of anaphylaxis) that causes the patient distress and/or alleviating distressing cutaneous symptom only after emergency
treatment with adrenaline and the patient is stable

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6
Q

Dexamethasone is indicated in:

A

Croup

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6
Q

Diazepam (5mg/1mL) is indicated in:

A

Status epilepticus
Eclamptic seizures if initial seizure lasts 2 - 3 minutes or if recurrent
Cocaine toxicity with cardiac presentation

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7
Q

Diazepam emulsions (5mg/1mL) is indicated in:

A

Status epilepticus
Eclamptic seizures if initial seizure lasts 2 - 3 minutes or if recurrent
Cocaine toxicity with cardiac presentation

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8
Q

Diazepam stesolid (2.5mg/1.25mL or 5mg/2.5mL) is indicated in:

A

Status epilepticus
Eclamptic seizures if initial seizure lasts 2 - 3 minutes or if recurrent

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9
Q

Glucagon is indicated in:

A

Hypoglycaemia
Clinically suspected hypoglycaemia where PO glucose is inappropriate

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10
Q

Glucose 10% INF is indicated in:

A

Hypoglycaemia
Clinically suspected hypoglycaemia where PO glucose is inappropriate

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11
Q

Glucose gel is indicated in:

A

Hypoglycaemia

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12
Q

Glyceryl trinitrate is indicated for:

A

Cardiac chest pain due to angina or myocardial infarction, when systolic blood pressure is greater than 90mmHg.

Consider administering GTN in Acute Heart Failure with ischaemia or uncontrolled hypertension.

Patients with suspected cocaine toxicity presenting with chest pain

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13
Q

Hydrocortisone is indicated in:

A

Severe or life-threatening asthma.

Acute exacerbation of COPD.

Adrenal crisis (including Addisonian crisis) which is a time-critical medical emergency with an associated mortality.

Prevention of Adrenal crisis in patients who suffer trauma or acute illness and are on long-term steroid therapy, either:
as replacement therapy for adrenal insufficiency from any cause, in long-term therapy at doses of 5+ mg prednisolone, e.g. for immune suppression.

Administer hydrocortisone to:
1. Patients in an established adrenal crisis (IV or IM administration preferable). Ensure parenteral hydrocortisone is given prior to transportation.
2. Patients with suspected adrenal insufficiency or on long-term steroid therapy who have become unwell, to prevent them having an adrenal crisis (IM administration is usually sufficient).
3. Pregnant women with known Addison’s Disease who are in established labour (regular painful contractions).

NB If in doubt about adrenal insufficiency, it is better to administer hydrocortisone.

Can be considered in post ROSC patients that may have arrested due to adrenal crisis.

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14
Q

Ibuprofen is indicated in:

A

Mild to moderate pain
Pyrexia with associated discomfort
Soft tissue injuries

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14
Q

Misoprostol is indicated in:

A

For the treatment of primary postpartum haemorrhage (>500 mL blood loss within first 24 hours after birth)

For the treatment of life threatening bleeding following a confirmed diagnosis of miscarriage.

Misoprostol can be administered as a second-line drug treatment after Syntometrine® or as an alternative firstline drug treatment if Syntometrine® is contraindicated or unavailable

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14
Q

Morphine is indicated in

A

Severe pain including pain associated with myocardial infarction

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15
Q

Naloxone is indicated in:

A

Respiratory depression or arrest secondary to opioid overdose

Patients exposed to high-potency veterinary or anaesthetic preparations should be given naloxone if ALOC or exposure within 10 minutes even if asymptomatic

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15
Q

Naloxone IV is indicated in:

A

Opioid overdose producing
respiratory/cardiovascular/central nervous system depression

Loss of consciousness with respiratory depression

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15
Q

Nitric oxide is indicated in:

A

Moderate - severe pain including labour pains

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15
Q

Ondansetron is indicated in:

A

Nausea and vomiting

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15
Q

Paracetamol (tablet) is indicated for:

A

Mild - moderate pain
Febrile

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15
Q

Paracetamol (suspension) is indicated for:

A

Mild - moderate pain
Febrile

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15
Q

Paracetamol (INF) is indicated for:

A

Mild - moderate pain
Febrile

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15
Q

Salbutamol (NEB) is indicated for:

A

Acute asthma attacks
Expiratory wheeze associated with allergy, anaphylaxis, smoke inhalation, beta-blocker overdose or lower airway cause
Exacerbation of COPD

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15
Q

Sodium chloride is indicated in:

A

Medical-related conditions +/- haemorrhage
Trauma-related haemorrhage
Burns
Crush injury
Sepsis
As a flush for cannulas

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16
Q

Syntometrine is indicated for:

A

Primary or secondary post-partum haemorrhage (PPH*) where there is excessive bleeding from the birth canal. See PPH guidance for definitions of primary and secondary PPH.

Confirmed miscarriage (or termination of pregnancy) with excessive bleeding (e.g. where a patient has gone home with medical management and starts to bleed). See Vaginal Bleeding during Pregnancy up to 20 weeks Gestation for the definition of confirmed miscarriage.

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17
Q

Tranexamic acid is indicated for:

A

Prevention and treatment of significant haemorrhage following trauma

Head injury patients, age 18 and over with a Glasgow Coma Score (GCS) of 12 or less;

Post-partum haemorrhage after the administration of a uterotonic drug or where a uterotonic medicine is contraindicated. N.B. A post-partum haemorrhage may start within 4 but up to 24 hours after delivery

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18
Q

Adrenaline (1mg/1mL) cautions include

A

Severe hypertension in patients on non-cardio-selective beta-blockers (propanolol)

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19
Q

Adrenaline (1mg/1mL) dose and administration:

A

Adults - 500 mcg (0.5 mL) every 5 minutes NMD

Paediatrics (6 - 11 years) - 300 mcg (0.3 mL) every 5 minutes NMD

Paediatrics (birth - 6 years) - 150 mcg (0.15 mL ever 5 minutes NMD

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20
Q

Asthmatics taking non-cardio-selective beta-blockers (propranolol) who receive IM or IV adrenaline may develop:

A

Severe hypertension

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21
Q

The correct adrenaline IM dose for a 4 year old with life-threatening asthma is:

A

150 mcg / 0.15mL

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22
Q

Adrenaline 1:10,000 is permitted to be administered as per normal when a patient is hypothermic. True or false

A

False - adrenaline cannot be administered in a core body temperature < 30 degrees

For patients with a core body temperature of 30 - 35 degrees, drug dose intervals must be doubled.

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23
Q

Adrenaline 1:10,000 dose and administration

A

Cardiac arrest (>12 years) - 1mg/10 mL every 3 - 5 minutes NMD
See JRCALC for patients < 12 years

Post ROSC circulatory support (All ages) - 50 mcg/0.5mL repeated at 50 mcg - 100 mcg every 3 - 5 minutes NMD
A 20 mL NaCl flush is required after all doses

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24
Q

Adrenaline (1mg/10mL) dose in shockable and non-shockable rhythms:

A

Shockable rhythms - administer adrenaline after the 3rd shock, and then after every second shock (5th, 7th, 9th…)

Non-shockable rhythms - immediate administration following access

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25
Q

Maximum dose of adrenaline (1mg/10mL) in cardiac arrest

A

There is no maximum

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26
Q

What is the one contra-indication for repeat doses of adrenaline in cardiac arrest?

A

Hypothermia (core temp < 30 degrees)

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27
Q

Oxygen is indicated for:

A

Significant injury or illness
Hypoxaemia
COPD
Cardiac arrest
Major trauma
Sepsis
Shock
CO poisoning
Seizures
Hypothermia

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28
Q

Amiodarone MOA

A

Antiarrhythmic; lengthens cardiac action potential and therefore effective refractory period. Prolongs QT interval on ECG.

Blocks sodium and potassium channels in cardiac muscle.

Acts to stabilise and reduce electrical irritability of cardiac muscle.

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29
Q

Contraindications to amiodarone

A

Hypothermia (core body temp < 30 degrees)

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30
Q

Amiodarone administration can result in:

A

Bradycardia
Vasodilation causing hypotension and cutaneous flushing
Bronchospasm
Torsades

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31
Q

Amiodarone dose and administration:

A

Cardiac arrest unresponsive to 3 x DCCS (adult) - 300 mg / 10 mL (pre-filled syringe) with a 20mL NaCl flush. Repeated at 150 mg after 5th shock for a maximum dose of 450 mg

See JRCALC for patients < 12 years

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32
Q

Amiodarone must be administered via…

A

Large bore cannula as extravasation can cause burns

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33
Q

Which medicine guideline includes a second dose that is the same as the first in children but halved in adults?

A

Amiodarone

34
Q

Aspirin is contraindicated for patients with:

A

Known allergy
Patients less than 16 years old
Active GIT bleeding
Haemophilia or other known clotting disorders
Severe hepatic failure with jaundice

35
Q

Aspirin may be given to patients with asthma, pregnancy, renal failure, hepatic failure without jaundice, ulcers, and concurrent anticoagulant treatment because…

A

The likely benefits outweigh potential risks

36
Q

Aspirin administration may result in:

A

Increased risk of GIT bleeding and wheezing in some asthmatics

37
Q

Reye’s syndrome can be caused by aspirin given to a child and has a mortality rate of:

A

50%

38
Q

Atropine is permitted to be administered in response to bradycardia in the hypothermia patient. True or false?

A

False

39
Q

Bradycardia in the patient with a heart transplant can be treated with atropine. True or false

A

False - Do NOT give atropine sulfate to patients with cardiac transplants; their hearts will not respond to vagal blocking by atropine and paradoxical high degree AV block or sinus arrest may result.

40
Q

Contraindications to atropine include:

A

Hypothermia
Patients with cardiac transplants

41
Q

Atropine MOA

A

Reverses effects of vagal overdrive.
Increases heart rate by blocking vagal activity in sinus bradycardia, second or third degree heart block.
Enhances A-V conduction

42
Q

Atropine may result in:

A

Dry mouth, visual blurring and pupil dilation.
Confusion and occasional hallucinations.
Tachycardia.
Do not use small (<100 micrograms) doses as they may cause paradoxical bradycardia.

43
Q

Atropine should be administered as a…

A

Rapid bolus

44
Q

Which drug may reverse the effects of vagal overdrive, increase the heart rate and enhance A-V conduction?

A

Atropine

45
Q

Can atropine increase the heart rate by blocking vagal activity in third degree heart block?

A

Yes

46
Q

Which drug can result in urine retention in the elderly?

A

Atropine

47
Q

Benzylpenicillin MOA

A

Narrow-spectrum ABx

48
Q

Contraindications to benzylpenicillin:

A

Known severe penicillin reaction (more than a rash alone)

49
Q

Do IV/IO and IM doses of benzylpenicillin have different or the same concentrations and volumes of administration?

A

Different - check JRCALC

50
Q

What is the dose of intravenous benzylpenicillin for an adult with meningococcal septicaemia?

A

1.2 g

51
Q

Chlorphenamine MOA

A

Antihistamine

52
Q

Chlorphenamine contraindications

A

Known hypersensitivity
Treatment with MOA - The anticholinergic properties of chlorphenamine are intensified by monoamine oxidase inhibitors (MAOIs). Chlorphenamine injection is therefore contraindicated in patients who have been treated with MAOIs within the last 14 days.

53
Q

Chlorphenamine cautions include

A

Pregnancy and breastfeeding
Hypotension
Epilepsy
Glaucoma
Severe liver disease

54
Q

Side effects of chlorphenamine:

A

Sedation, dry mouth, headache, blurred vision, urinary retention, psychomotor impairment, GIT upset, convulsions
(anticholinergic)

55
Q

Dexamethasone contraindications

A

Impending respiratory failure

56
Q

Dexamethasone MOA

A

Corticosteroid that reduces subglottic inflammation

57
Q

Upper airway compromise can be worsened by any procedure that distresses the child – this might include the administration of _______ medication.

A

Dexamethasone

58
Q

Side effects of dexamethasone:

A

GIT upset and anaphylactic reaction

59
Q

Diazepam (rectal) is indicated in:

A

Patients who have prolonged convulsions (lasting 5 minutes or more) OR repeated convulsion (three or more in an hour), and are CURRENTLY CONVULSING – (not secondary to an uncorrected hypoxic or hypoglycaemic episode)

Eclamptic convulsions (initiate treatment if seizure lasts over 2–3 minutes or if it is recurrent).

Symptomatic cocaine toxicity (severe hypertension, chest pain or convulsions).

60
Q

Contraindications to diazepam include:

A

Known hypersensitivity

61
Q

Side effects of diazepam include:

A

Respiratory depression is common with concurrent ETOH or opioids

Hypotension, light-headedness, unsteadiness, drowsiness, confusion, amnesia

62
Q

All patients who continue to convulse should receive a total of ___ doses of benzodiazepine (midazolam or diazepam) __ minutes apart, the second dose should be IV/IO if possible.

Only give a second rectal dose if IV/IO access cannot be obtained in the 10 minutes between the first and second doses. Seek clinical advice if the convulsion continues 10 minutes after the second dose.

A

2 doses, 10 minutes apart

63
Q

Adult dose > 70 years diazepam:

A

10 mg repeated at 10 mg after 10 minutes TMD 20 mg

64
Q

Adult dose < 70 years diazepam dose:

A

20 mg repeated at 10 mg after 10 minutes TMD 30 mg

65
Q

Paediatric dose 5 - 11 years diazepam

A

10 mg repeated at 10 mg after 10 minutes TMD 20 mg

66
Q

Paediatric dose < 4 years diazepam

A

5 mg repeated at 5 mg after 10 minutes TMD 10 mg

67
Q

Glucagon MOA

A

Converts glycogen to glucose

68
Q

Glucagon contraindications:

A

Pheochromocytoma (tumour on adrenal gland)

69
Q

Glucagon cautions:

A

Low glycogen stores (anorexia, ETOH)

70
Q

Side effects of glucagon include:

A

Nausea, vomiting, abdominal pain, hypokalaemia, hypotension (adults), diarrhoea (paeds), hypersensitivity

71
Q

Glucagon can be administered ____

A

Once, and may have already been administered by a carer

72
Q

Hypoglycaemic patients who are convulsing should preferably be given _____

A

Glucose 10% IV

73
Q

Glucose 10% is indicated in:

A

Hypoglycaemia where oral glucose is inappropriate and a rapid improvement is required

For the management of patients who have not responded to the administration of IM glucagon within 10 minutes

74
Q

Contraindications to glucose 10% are:

A

IM or SUBCUT injections

75
Q

Glucose poses a risk of extravasation. True or false

A

True - use large bore cannula and flush thoroughly

76
Q

Adult dose of glucose 10% is:

A

10g repeated at further 10g after 5 minutes. TMD 30g

77
Q

GTN is contraindicated in:

A

Hypotension (systolic blood pressure < 90mmHg in angina/myocardial infarction, or < 110 mmHg in acute heart failure).

Hypovolaemia.

Head trauma.

Cerebral haemorrhage.

Sildenafil (Viagra) and other related drugs – glyceryl trinitrate must not be given to patients who have taken sildenafil or related drugs within the previous 24 hours. Profound hypotension may occur.

Unconscious patients.

Known severe aortic or mitral stenosis

78
Q

Patients with suspected posterior myocardial infarction or right-ventricular infarction are cautioned for:

A

GTN

79
Q

Side effects of GTN are related to:

A

Potent vasodilation - headache, dizziness, hypotension

80
Q

Which medicine requires the oral mucosa to be moist for absorption and clinicians are advised to ‘moisten if necessary’?

A

GTN

81
Q

MI w/ RV) involvement in a patient who is haemodynamically stable is contraindicated in the administration of GTN. True or false

A

False - not a contraindication

82
Q

What is the age limit for GTN

A

No age limit

83
Q

Hydrocortisone is contraindicated for patients with:

A

Known allergy

84
Q

Hydrocortisone MOA:

A

Glucocorticoid drug that restores blood pressure, blood sugar, cardiac synchronicity and volume.

High levels are important to survive shock. Therapeutic actions include suppression of inflammation and immune response.

85
Q

Burning and stinging may be associated with hydrocortisone due to _____

A

Significant amounts of phosphate preservative within the solution.

86
Q

If there is any doubt about previous steroid administration, it is better to administer ______

A

Further hydrocortisone

87
Q

Contraindications to ibuprofen include:

A

Dehydration
Hypovolaemia
Renal insufficiency
Active GIT disturbance (peptic ulcer, dyspepsia)
Pregnancy within 3rd trimester
Paediatric with chicken pox
Known hypersensitivity to ibuprofen or NSAIDS (asthma, rhinitis, angioedema)
Patients with severe heart failure
Anticoagulant therapy
An elderly or frail adult with a fracture

88
Q

Ipratropium bromide is indicated in:

A

All forms of asthma
Exacerbation of COPD
Expiratory wheezing

89
Q

There are no contraindications to:

A

Ipratropium bromide

90
Q

Syntometrine is contraindicated in:

A

Severe hypertension
Known anaphylaxis to medication constituents
Pregnancy
Severe cardiac, liver, or kidney disease (unless bleeding is life-threatening)

91
Q

Morphine is contraindicated in:

A

Children < 1 year
Respiratory depression
Hypotension
Head injury with ALOC
Hypersensitivity to morphine
None apply to EOL care as benefits outweigh risk

92
Q

Neonates born to opioid addicted mothers can suffer from serious withdrawal effects. Emphasis should be on _____

A

Bag-valve-mask ventilation and oxygenation.

93
Q

Entonox is contraindicated in patients with:

A

Chest injury and suspected pneumothorax
Severe head injury
Decompression sickness
Psychiatric patients
An intraocular injection within last 8 weeks
Abdominal pain with query intestinal obstruction

Nitrous oxide may have a deleterious effect if administered to patients with closed body cavities containing air since nitrous oxide diffuses into such a space with a resulting increase in pressure

94
Q

Contraindications to ondansetron include

A

Known sensitivity
Paediatrics < 1 month old
Congenital long QT syndrome

95
Q

Ondansetron administration can result in:

A

Hiccups.
Constipation.
Flushing.
Hypotension.
Chest pain.
Arrhythmias.
Bradycardia.
Headache.
Seizures.
Movement disorders.
Injection site reactions

96
Q

Ondansetron should always be given in a separate syringe to ____

A

Morphine sulphate – the drugs must NOT be mixed.

97
Q

Paracetamol should not be administered to patients with:

A

A known paracetamol allergy

98
Q

Contraindications to salbutamol include:

A

None

99
Q

Salbutamol administration may result in:

A

Tremor, tachycardia, palpitations, headache, feeling of tension, peripheral vasodilation, muscle cramps, rash

100
Q

TXA should not be administered to patients with:

A

Known hypersensitivity
Bleeding > 3 hours old
Resolution of haemorrhage
Critical interventions required (airway management, haemorrhage control)

101
Q
A

mx (6 decks)

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