Drugs

Question 1

Morphine Contraindications

Answer 1

Known hypersensitivity, Late second stage labor and renal impairment/failure.

Question 2

Morphine Pre cautions

Answer 2

Elderly and frail patients, hypotension, respiratory depression, current asthma, respiratory tract burns, known opioid addiction, acute alcoholism, Pts. on MAO’s.

Question 3

Morphine dosage

Answer 3

Pain: up to 5mg IV repeat @ 5/60 max. 20 mg

Question 4

Adrenaline Contraindications

Answer 4

Hypovolaemic shock without adequate fluid replacement.

Question 5

Adrenaline Precautions

Answer 5

Elderly/frail pts., pts with cardiovascular disease, pts on MAO inhibitors,

Question 6

Adrenaline Side effects

Answer 6

Sinus tachycardia, supra-ventricular arrhythmia, ventricular arrhythmia’s, hypertension, pupillary dilation, may increase size of MI, feeling of anxiety/palpitations in the conscious patient.

Question 7

Adrenaline pharmacology

Answer 7

Beta 1 effects:
Increases HR by increasing SA node firing rate, increased conduction velocity through AV node, Increased myocardial contractility, increases irritability of ventricles.
Beta 2: bronchodilation
Alpha: peripheral vasoconstriction

Question 8

Aspirin contraindications

Answer 8

Hypersensitivity, actively bleeding peptic ulcers, bleeding disorders, suspected dissection aortic aneurism, chest pain associated with psychostimulant OD if BP >160

Question 9

Aspirin Precaution

Answer 9

Peptic ulcer, asthma, pts on anticoagulants.

Question 10

Aspirin side effects

Answer 10

Heartburn, nausea, GI bleeding, increased bleeding time, hypersensitivity reactions.

Question 11

Ceftriaxone Indication

Answer 11

Suspected meningococcal septicaemia: Adult dose - 1 g IV diluted to 10 mL with water for injection. 1g IM to 4mL with 1% Lignocaine.

Question 12

Ceftriaxone Contraindications

Answer 12

Allergy to cephalosporin antibiotics

Question 13

Ceftriaxone Precaution

Answer 13

Allergy to penicillin antibiotics

Question 14

Ceftriaxone Side effects

Answer 14

Nausea and vomiting, skin rash.

Question 15

Dexamethasone Indication

Answer 15

Bronchospasm w/ actute resp. distress unresponsive to neb. salbutamol, moderate to severe croup and acute exacerbation of COPD

Question 16

Dexamethsone Contra’s and Precautions

Answer 16

Contra: known hypersensitivity.
Precaution: solutions which are not clear or are contaminated should be discarded.

Question 17

Fentanyl Indication

Answer 17

Analgesia: IN 200 mcg repeat 50 mcg IN @ 5/60 (max. 400)
frail half initial dose.
IV: 50 mcg IV repeat 50 mcg @ 5/60 max. 200
CPR interfering pt.
25 mcg IV repeat 3-5 minutes

Question 18

Fentanyl contra’s

Answer 18

hypersensitivity, late second stage labour.

Question 19

Fentanyl precautions

Answer 19

elderly/frail pts., impaired hepatic function, respiratory depression, current asthma, pt. on MAO inhibitors, known addiction to opioids, facial trauma IN route.

Question 20

Fentanyl side effects

Answer 20

respiratory depression, apnoea, rigidity of diaphragm/intercostals, bradycardia.

Question 21

Glucagon

Answer 21

Indication: Diabetic hypoglycaemia adult dose 1 IU IM.
Contra’s: nil of significance
Precaution: nil of significance
side effects: nausea and vomiting rare

Question 22

Glyceryl Trinitrate indication

Answer 22

Chest pain with ACS (300 mcg S/L), acute LVF, hypertension with ACS, autonomic dysreflexia, and preterm labour (consult).

Question 23

Glyceryl Trinitrate contra’s

Answer 23

hypersensitivity, SBP<110 (tablet), SBP<90 (patch), Sildenafil/vardenfil in last 24hours or Tadalafil in last 4 days, HR >150, HR <50, VT, inferior STEMI with SBP <160 mmHg and right ventricular infarction.

Question 24

Glyceryl Trinitrate Precautions

Answer 24

No previous administration, elderly Pts, recent MI and concurrent use with other tocolytics.

Question 25

Glyceryl Trinitrate side effects

Answer 25

tachycardia, hypotension, headache, skin flushing (uncommon) and bradycardia (occasionally)

Question 26

Ketamine Indications

Answer 26

RSI adult doses 1.5 mg/kg IV (max 200mg) | Extreme traumatic pain refractory to opioid analgesia, extreme agitation, CPR interfering patient.

Question 27

Ketamine Contra

Answer 27

Known hypersensitivity, severe hypertension (SBP>180)

Question 28

Ketamine precautions

Answer 28

any condition where significant elevation of BP would be hazardous e.g. hypertension, CVA, recent AMI and CCF. Admin. for analgesia to be injected slowly over 1 minute.

Question 29

Methoxyflurane indication

Answer 29

pain relief 3 mL via penthrox inhaler.

Question 30

Methoxyflurane contra's

Answer 30

pre-existing renal disease, tetracycline antibiotics, >6mL in 24 hours, personal or family Hx of malignant hyperthermia, muscular dystrophy.

Question 31

Methoxyflurane precautions

Answer 31

must self-administered, pre-eclampsia and use with oxytocin may cause hypotension.

Question 32

Methoxyflurane side effects

Answer 32

drowsiness, decrease in BP and HR (rare), renal toxicity.

Question 33

Midazolam Indications

Answer 33

Generalised convulsive status epilepticus, 10 mg IM repeat 10 mg IM @ 10 minutes. Also used for RSI

Question 34

Midazolam contra's

Answer 34

known hypersensitivity

Question 35

Midazolam precautions

Answer 35

reduced doses may be required for elderly, chronic renal failure, CCF or shock., the CNS depressant effects of benzo's are enhanced in the presence of narcotics and other tranquilisers including alcohol, can cause severe resp. depression in pts with COPD, pts. with myasthenia.

Question 36

Midazolam side effects

Answer 36

Loss of airway control, resp. depression, hypotension, depressed level of consciousness

Question 37

Naloxone indication

Answer 37

Opioid drug overdose: 1.6-2 mg IM heroin, 100 mcg IV other opioid.

Question 38

Naloxone contra's and precautions

Answer 38

Contra's: nil of significance. | Precautions: prepare for combative pt., should not be administered to newborns.

Question 39

Ondansetron indication

Answer 39

Nausea and vomiting, vestibular nausea, prophylaxis.

Question 40

Ondansetron contra's

Answer 40

hypersensitivity, concurrent apomorphine use, long QT syndrome, hypokalaemia or hypomagnesamia

Question 41

Ondansetron precautions

Answer 41

pts with liver disease whould not receive >8mg/day, care should be taken with pts. on diuretics, PKU, concurrent use of tramadol, pregnancy.

Question 42

Paracetamol indication

Answer 42

mild pain, headache. | 1000 mg oral

Question 43

Paracetamol contraindications

Answer 43

hypersensitivity, children < 1 month, paracetamol administerd in the past 4 hours, total paracetamol intake within last 24 hours excessing 4 g (adults) or 60mg/kg, suspected ischaemia chest pain.

Question 44

Paracetamol precautions

Answer 44

impaired, hepatic function, elderly/frail, malnourished

Question 45

Salbutamol indication

Answer 45

Resp distress with suspected bronchospasm: | asthma, severe allergic reactions, COPD, smoke inhalation, oleoresin capsicum spray.

Question 46

Salbutamol contra's

Answer 46

nil of significance

Question 47

Salbutamol precautions

Answer 47

large doses of salbutamol have been reported to cause intracellular metabolic acidosis

Question 48

Salbutamol effects

Answer 48

sinus tachycardia, muscle tremor (common)