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Drugs Flashcards

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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
Paracetamol (suspension) is indicated for:
Mild - moderate pain Febrile
15
Paracetamol (INF) is indicated for:
Mild - moderate pain Febrile
15
Salbutamol (NEB) is indicated for:
Acute asthma attacks Expiratory wheeze associated with allergy, anaphylaxis, smoke inhalation, beta-blocker overdose or lower airway cause Exacerbation of COPD
15
Sodium chloride is indicated in:
Medical-related conditions +/- haemorrhage Trauma-related haemorrhage Burns Crush injury Sepsis As a flush for cannulas
16
Syntometrine is indicated for:
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.
17
Tranexamic acid is indicated for:
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
18
Adrenaline (1mg/1mL) cautions include
Severe hypertension in patients on non-cardio-selective beta-blockers (propanolol)
19
Adrenaline (1mg/1mL) dose and administration:
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
20
Asthmatics taking non-cardio-selective beta-blockers (propranolol) who receive IM or IV adrenaline may develop:
Severe hypertension
21
The correct adrenaline IM dose for a 4 year old with life-threatening asthma is:
150 mcg / 0.15mL
22
Adrenaline 1:10,000 is permitted to be administered as per normal when a patient is hypothermic. True or false
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.
23
Adrenaline 1:10,000 dose and administration
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
24
Adrenaline (1mg/10mL) dose in shockable and non-shockable rhythms:
Shockable rhythms - administer adrenaline after the 3rd shock, and then after every second shock (5th, 7th, 9th...) Non-shockable rhythms - immediate administration following access
25
Maximum dose of adrenaline (1mg/10mL) in cardiac arrest
There is no maximum
26
What is the one contra-indication for repeat doses of adrenaline in cardiac arrest?
Hypothermia (core temp < 30 degrees)
27
Oxygen is indicated for:
Significant injury or illness Hypoxaemia COPD Cardiac arrest Major trauma Sepsis Shock CO poisoning Seizures Hypothermia
28
Amiodarone MOA
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.
29
Contraindications to amiodarone
Hypothermia (core body temp < 30 degrees)
30
Amiodarone administration can result in:
Bradycardia Vasodilation causing hypotension and cutaneous flushing Bronchospasm Torsades
31
Amiodarone dose and administration:
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*
32
Amiodarone must be administered via...
Large bore cannula as extravasation can cause burns
33
Which medicine guideline includes a second dose that is the same as the first in children but halved in adults?
Amiodarone
34
Aspirin is contraindicated for patients with:
Known allergy Patients less than 16 years old Active GIT bleeding Haemophilia or other known clotting disorders Severe hepatic failure with jaundice
35
Aspirin may be given to patients with asthma, pregnancy, renal failure, hepatic failure without jaundice, ulcers, and concurrent anticoagulant treatment because...
The likely benefits outweigh potential risks
36
Aspirin administration may result in:
Increased risk of GIT bleeding and wheezing in some asthmatics
37
Reye's syndrome can be caused by aspirin given to a child and has a mortality rate of:
50%
38
Atropine is permitted to be administered in response to bradycardia in the hypothermia patient. True or false?
False
39
Bradycardia in the patient with a heart transplant can be treated with atropine. True or false
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
Contraindications to atropine include:
Hypothermia Patients with cardiac transplants
41
Atropine MOA
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
Atropine may result in:
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
Atropine should be administered as a...
Rapid bolus
44
Which drug may reverse the effects of vagal overdrive, increase the heart rate and enhance A-V conduction?
Atropine
45
Can atropine increase the heart rate by blocking vagal activity in third degree heart block?
Yes
46
Which drug can result in urine retention in the elderly?
Atropine
47
Benzylpenicillin MOA
Narrow-spectrum ABx
48
Contraindications to benzylpenicillin:
Known severe penicillin reaction (more than a rash alone)
49
Do IV/IO and IM doses of benzylpenicillin have different or the same concentrations and volumes of administration?
Different - check JRCALC
50
What is the dose of intravenous benzylpenicillin for an adult with meningococcal septicaemia?
1.2 g
51
Chlorphenamine MOA
Antihistamine
52
Chlorphenamine contraindications
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
Chlorphenamine cautions include
Pregnancy and breastfeeding Hypotension Epilepsy Glaucoma Severe liver disease
54
Side effects of chlorphenamine:
Sedation, dry mouth, headache, blurred vision, urinary retention, psychomotor impairment, GIT upset, convulsions (anticholinergic)
55
Dexamethasone contraindications
Impending respiratory failure
56
Dexamethasone MOA
Corticosteroid that reduces subglottic inflammation
57
Upper airway compromise can be worsened by any procedure that distresses the child – this might include the administration of _______ medication.
Dexamethasone
58
Side effects of dexamethasone:
GIT upset and anaphylactic reaction
59
Diazepam (rectal) is indicated in:
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
Contraindications to diazepam include:
Known hypersensitivity
61
Side effects of diazepam include:
Respiratory depression is common with concurrent ETOH or opioids Hypotension, light-headedness, unsteadiness, drowsiness, confusion, amnesia
62
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.
2 doses, 10 minutes apart
63
Adult dose > 70 years diazepam:
10 mg repeated at 10 mg after 10 minutes TMD 20 mg
64
Adult dose < 70 years diazepam dose:
20 mg repeated at 10 mg after 10 minutes TMD 30 mg
65
Paediatric dose 5 - 11 years diazepam
10 mg repeated at 10 mg after 10 minutes TMD 20 mg
66
Paediatric dose < 4 years diazepam
5 mg repeated at 5 mg after 10 minutes TMD 10 mg
67
Glucagon MOA
Converts glycogen to glucose
68
Glucagon contraindications:
Pheochromocytoma (tumour on adrenal gland)
69
Glucagon cautions:
Low glycogen stores (anorexia, ETOH)
70
Side effects of glucagon include:
Nausea, vomiting, abdominal pain, hypokalaemia, hypotension (adults), diarrhoea (paeds), hypersensitivity
71
Glucagon can be administered ____
Once, and may have already been administered by a carer
72
Hypoglycaemic patients who are convulsing should preferably be given _____
Glucose 10% IV
73
Glucose 10% is indicated in:
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
Contraindications to glucose 10% are:
IM or SUBCUT injections
75
Glucose poses a risk of extravasation. True or false
True - use large bore cannula and flush thoroughly
76
Adult dose of glucose 10% is:
10g repeated at further 10g after 5 minutes. TMD 30g
77
GTN is contraindicated in:
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
Patients with suspected posterior myocardial infarction or right-ventricular infarction are cautioned for:
GTN
79
Side effects of GTN are related to:
Potent vasodilation - headache, dizziness, hypotension
80
Which medicine requires the oral mucosa to be moist for absorption and clinicians are advised to 'moisten if necessary'?
GTN
81
MI w/ RV) involvement in a patient who is haemodynamically stable is contraindicated in the administration of GTN. True or false
False - not a contraindication
82
What is the age limit for GTN
No age limit
83
Hydrocortisone is contraindicated for patients with:
Known allergy
84
Hydrocortisone MOA:
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
Burning and stinging may be associated with hydrocortisone due to _____
Significant amounts of phosphate preservative within the solution.
86
If there is any doubt about previous steroid administration, it is better to administer ______
Further hydrocortisone
87
Contraindications to ibuprofen include:
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
Ipratropium bromide is indicated in:
All forms of asthma Exacerbation of COPD Expiratory wheezing
89
There are no contraindications to:
Ipratropium bromide
90
Syntometrine is contraindicated in:
Severe hypertension Known anaphylaxis to medication constituents Pregnancy Severe cardiac, liver, or kidney disease (unless bleeding is life-threatening)
91
Morphine is contraindicated in:
Children < 1 year Respiratory depression Hypotension Head injury with ALOC Hypersensitivity to morphine *None apply to EOL care as benefits outweigh risk*
92
Neonates born to opioid addicted mothers can suffer from serious withdrawal effects. Emphasis should be on _____
Bag-valve-mask ventilation and oxygenation.
93
Entonox is contraindicated in patients with:
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
Contraindications to ondansetron include
Known sensitivity Paediatrics < 1 month old Congenital long QT syndrome
95
Ondansetron administration can result in:
Hiccups. Constipation. Flushing. Hypotension. Chest pain. Arrhythmias. Bradycardia. Headache. Seizures. Movement disorders. Injection site reactions
96
Ondansetron should always be given in a separate syringe to ____
Morphine sulphate – the drugs must NOT be mixed.
97
Paracetamol should not be administered to patients with:
A known paracetamol allergy
98
Contraindications to salbutamol include:
None
99
Salbutamol administration may result in:
Tremor, tachycardia, palpitations, headache, feeling of tension, peripheral vasodilation, muscle cramps, rash
100
TXA should not be administered to patients with:
Known hypersensitivity Bleeding > 3 hours old Resolution of haemorrhage Critical interventions required (airway management, haemorrhage control)
101

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