Drugs

Question 1

What presentation does Adrenaline come in?

Answer 1

• 1mg in 1ml glass ampoule (1:1,000)
• 1mg in 10ml glass ampoule (1:10,000)

Question 2

What is the pharmacology of Adrenaline? and what are its actions?

Answer 2

• A naturally occuring alpha and beta-adrenergic stimulant

Actions: Beta 1, Beta 2 and Alpha
Beta 1 effects
* Increases HR by increasing SA node firing rate
* Increases conduction velocity throuygh the AV node
* Increases myocardial contractility
* Increases the irritability of the ventricles

Beta 2 effects
* causes bronchodilation

Alpha effects
* causes peripheral vasoconstriction

Question 3

How is Adrenaline metabolised?

Answer 3

• By monoamine oxidase and other enzymes in the blood, liver and around nerve endings
• It is excreted by the kidneys

Question 4

What are the 6 primary incidations of Adrenaline?

Answer 4

1. Cardiac arrest (VT, VF, Asystole or PEA)
2. Shock
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

Question 5

What are the contraindications to Adrenaline?

Answer 5

1. Hypovolaemic shock without adequate fluid replacement

Question 6

What are the 4 precautions for Adrenaline?

Answer 6

Consider reduced doses for
1. Elderly/frail patients
2. Patients with cardiovascular disease
3. Patients on monoamine oxidase inhibitors

Higher doses
4. Higher doses may be required for patients on beta blockers

Question 7

How can adrenaline be administered?

Route

Answer 7

• IV
• IM
• Nebulised
• IV infusion
• IO

Question 8

What are some side effects of Adrenaline?

Answer 8

• Sinus tachycardia
• SVT
• Ventricular arryhtmias
• HTN
• Pupillary dilation
• May increase size of MI
• Feeling of anxiety/palpitations in the conscious patient

Question 9

What is the ONSET time of IV Adrenaline?

Answer 9

30 seconds

Question 10

What is the PEAK time of IV Adrenaline?

Answer 10

3-5 mins

Question 11

What is the duration of IV Adrenaline?

Answer 11

5-10 mins

Question 12

What is the ONSET time of IM Adrenaline?

Answer 12

30-90 secs

Question 13

What is the PEAK time of IM Adrenaline?

Answer 13

4-10 mins

Question 14

What is the duration of IM Adrenaline?

Answer 14

5-10 mins

Question 15

What is the mode of action for Amiodarone?

Answer 15

• Class III antiarrhythmic
• Prolongs cardiac action potential and delays refractory period

Question 16

What are the indications of Amiodarone?

Answer 16

• VF/Pulseless VT refractory to defibrillation
• Sustained or recurrent VT

Question 17

What are the contraindications of Amiodarone?

Answer 17

• Tricyclic antidepressant toxicity
• QTc > 500 milliseconds
• VT following ondansetron administration
• Pregnancy (if not in cardiac arrest)

Question 18

What are the adverse effects of Amiodarone?

Answer 18

CVS
* rebound bradycardia
* hypotension
* phlebitis

GI
* nausea
* vomiting
* metallic taste in mouth

Question 18

What are some significant interactions of Amiodarone?

Answer 18

• infusion is only compatible with Dextrose 5% (sodium chloride 0.9% can be used to flush line for administration during cardiac arrest)
• Flush the line thoroughly prior to administration if the same line has been previously been used to administer dexamethasone, heparin, hydrocortisone or sodium bicarbonate

Question 19

Is Amiodarone safe during pregnancy?

Answer 19

• Avoid unless mother is in cardiac arrest
• Maternal use of amiodarone has been associated with congenital hypothyroidism or hyperthyroidism and neurologic abnormalities

Question 20

Can a mother breastfeed post administration of amiodarone?

Answer 20

No, the child should not be breast fed following administration without first consulting specialist physician

Question 21

How does amiodarone come?

Presentation

Answer 21

150mg in 3ml ampoule

Question 22

How can you administer amiodarone?

Answer 22

• IV
• IO

Question 23

What is the onset of action of Amiodarone?

Answer 23

2 mins

Question 24

What is the duration of action of Amiodarone?

Answer 24

2 hours

Question 25

What presentation does Aspirin come in?

Answer 25

* 300mg chewable tablets * 300mg soluble or water dispersible tablets

Question 26

What is the pharmacology of Aspirin?

Answer 26

* Analgesic * Antipyretic * Anti-inflammatory * Anti-platelet 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 conditions

Question 27

How is Aspirin metabolised?

Answer 27

Converted into salicylate in the gut mucosa and liver Excreted by mainly the kidneys

Question 28

What are the indications for aspirin?

Answer 28

ACS

Question 29

What are the contraindications of aspirin?

Answer 29

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

Question 30

When do you need to take precautions when administering Aspirin?

Answer 30

1. Peptic ulcer 2. Asthma 3. Patients on anticoagulants

Question 31

What are the side effects of Aspirin?

Answer 31

* heart burn * nausea * GIT bleeding * Increased bleeding time * Hypersensitivity reactions

Question 32

Can you give aspirin in acute febrille illness in children and adolescents?

Answer 32

No, it is contraindicated

Question 33

How long do the anti-platelet effects of aspirin persist?

Answer 33

* For the life of the platelets * Typically 7-10 days

Question 34

What is the onset time of Aspirin?

Answer 34

N/a

Question 35

What is the Peak time of aspirin?

Answer 35

N/a

Question 36

What is the duration of aspirin?

Answer 36

8-10 days