Drugs and compromise levels Flashcards
(33 cards)
Asthma levels of comprimise
Mild-moderate
- SOB
- able to speak in sentences
- usually have a loud wheeze
- no significant chest/neck indrawing
- normal SPO2
- normal LOC
Severe asthma
- very SOB
- only speaking a few WPB
- may only have a quiet wheeze
- significant chest/neck indrawing
- tripod positioning
- SPO2 usually above 90%
- may be agitated
Immediately life threatening
- extremely SOB
- unable to speak
- may not have wheeze
- marked indrawing, unless exhausted
- rapidly falling SPO2
- severe agitation
- falling LOC
COPD levels of severity
Mild to Moderate -SOB -able to speak in sentences -usually have wheeze -usually have some chest/neck indrawing -SPO2 near normal level -normal LOC Severe -very SOB -only able to speak a few WPB -may not have a wheeze -usually have severe chest/neck indrawing -tripod positioning -SPO2 significantly below normal level -may have agitation
Imminent respiratory Arrest
- extremely SOB
- unable to speak
- may not have a wheeze
- may not have chest/neck in-drawing as to fatigued
- SPO2 rapidly falling
- severe agitation or falling LOC.
Cardiovascular Comprimise
NOT Comprimised -normal vital signs -no symptoms of myocardial ischaemia -looks status 4 MILDLY comprimised -near normal vital signs e.g near normal BP and CRT, normal LOC, , normal or near normal breathing -mild symptoms of myocardial ischaemia -looks status 3 MODERATELY comprimised -abnormal vital signs e.g hypotension, prolonged CRT, altered LOC however can still obey commands, moderate SOB, significant symptoms of myocardial ischaemia -looks status 2. SEVERE comprimise -markedly abnorma;l vital signs e.g severe hypotension, inability to obey commands, severe SOB -high risk of CA -looks status 1.
compensating vs decompensated shock
COMPENSATING shock
-increased HR, RR, prolonged, pale clammy, diaphoretic, possibly agitated
However sympathetic NS response is maintaining and systolic BP has not dropped
DECOMPENSATED
fall in systolic BP, delayed CRT, very weak radial, increased HR, possible worsening agitation or dropping LOC.
Irreversible
metabolic acidosis, organ failure.
unconcious, HR dropping, BP unrecordable, periarrest.
Valporate
I- status EP, with no response to 2x dose midaz
C-severe allergy
A-is an anticonvulsant, it blocks sodium channels and enhances activity of GABA at GABA receptors
R-IV only
D- 1200mg
S-none
Tranexamic acid
I- PPH
-Hypovalemia from uncontrolled bleeding
-any other bleeding severe enough to need sodium fluids
C-known severe allergy
-trauma where administration will occur more than 3 hours after injury
A-it is an antifibriolytic.
It blocks the conversion of plasmogin to plasmin. (When plasmogin has been activated by a stimulus to convert to plasmin it begins to break fibrin clots).
R-IV
D-1g (10ml/1g)
S-none
Tenecteplase
I-STEMI- when PCI is not chosen reperfusion strategy
A- fibronylictic- accelerates breakdown of clots, by causing plasmogin to be converted to plasmin which breaks down fibrin within clots.
S-bleeding and dysrhythmia (commonly can cause accelerated idioventricular)
Sodium Bicarb 8.4%
I-release syndrome following crush injury
C-severe allergy, caution IV access in small vein
A-It is an alkalising agent and increases plasma bicarbonate levels by buffering H+ ions and it increases blood pH.
-sodium ions help protect cardiac cell membranes against effect of hyperkalemia
-a rise in pH causes a movement of potassium back into cells
-a rise in urinary pH results in less deposition in the kidneys
R-IV only- must be careful not to mix with other medications as can cause precipitation.
D-100mmol can repeat after 10-20 mins if signs of hyperkalemia persist.
S- none
Note- can also be used in TCA overdose if readily available
salbutamol
I- asthma COPD brochospasm secondary to smoke inhalation or airway burns or chest infection -release syndrome following crush injury C-severe allergy A- beta 2 agonist- causes brochodilation R- nebulised D- 5mg can repeat as required S- tachycardia, tremor
Ipratropium
I- asthma, COPD brochspasm secondary to airway burns, smoke inhalation or chest infection.
C- severe allergy
A- acts on antichollinergic receptors, so it blocks uptake of acetylcholine which causes inhibition of vagal stimulation and then bhronchdilation.
R-Nebulised
D-0.5mg- only one dose to be administered with salbutamol
S-dry mouth
Fentanyl
I- moderate to severe pain, severe anxiety in CPO, symptom control in end of life care.
C–severe allergy, respiratory depression, unable to obey commands
Cautions at risk of respiratory depression, concurrent administration of other opiates, age less than 1, labour, signs shock, elderly or frail.
A- Stimulates (agonises) opiate receptors within the CNS and causes analgesia.
R-IV 10-50mcg every 5 mins
IM 50-100mcg repeat 1x 20 mins
IN <80kgs 100mcg subsequent dose 50mcg
>80kgs 200mcg subsequent dose 100mcg When administering 200mcg administer 1 ml in each nostrila nd then wait 5 minutes before administering the last 2 mls.
repeat 10mins
S-euphoria, respiratory depression, nausea/vomiting, bradycardia, hypotension, sedation, itch
Aspirin
I- MI
C- severe allergy, third trimester pregnancy Cautions, clin sig bleeding, known bleeding disorder, bronchospasm from NSAIDS
A- antiplatelet, antipyretic, anti inflammatory, analgesic. Blocks production of cyclooxygenase which reduces formation of prostaglandin and thromboxane.
R 300mg
Adrenaline
I-
clinically significant bleeding- topical
Anaphylaxis- 0.5mg repeat after 10 mins or earlier if required
Asthma-0.5mg repeat 10 mins if deteriorating
Epistaxis- IN 0.2mg in each nostril
cardiac arrest- 1mg every four mins, after amiodarone
Moderate to severe stridor-5mg Neb
C- none
Cautions, Myocardial ischaemia, tachydysrhythmia
A- Stimulates alpha and Beta receptors
Alpha- vasoconstriction of blood vessels, smooth muscle contraction, stimulates gluconeogenesis and glycogenolysis.
Beta 1- increases HR (chronotropy), cardiac contractility (inotropy), electrical conductivity (dromotropy)
Beta 2- smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation, stabilisation of mast cells, reducing histamine release
S anxiety, tremor, tachycardia, tachydysrhythmia, MI, ventricular ectopy, nausea, vomiting, hyperglycaemia.
Amoxiciclav
I- sepsis and
-more than 30 mins form hospital
-over 12 yrs old
- one or more high risk factor
Cellulitis with delay in seeing Dr
C- severe allergy, severe allergy to penicillin, anaphylaxis to betalactam antibiotics such as penicillins and cephalosphorins.
A- amoxicillin is a beta-lactam antibiotic. With a broad activity against gram negative a positive bacteria. It inhibits the production of bacteria cell walls, causing bacteria to die.
Clavuanic acid- inhibits a enzyme which is responsible for antibiotic resistance
R- IV dissolve using 4mls of saline and dilute to 10mls
D 1.2g- over 2 mins, preferable into a running line.
Amiodorone
I- VT/VF in cardiac arrest after first dose of adrenaline
C-known severe allergy, severe allergy to iodine, VT secondary to TCA overdose
A- amiodarone is a class 3 anti-dysrhythmic with a broad range of activity.
It prolongs cardiac action potential, prolongs refractory period and reduces automaticity.
This decreases abnormal electrical activity. It also reduces electrical conduction, HR and stabilises SA and Av nodes
It also reduces myocardial oxygen consumption by reducing inotropy (cardiac contractility), although this is usually clinically insignificant.
R- IV
D-300mg second dose 150mg
S- hypotension, bradydysrhythmia
Ceftriaxone
I-suspected meningococcal septicaemia
C-anaphylaxis to cephalosporins
A- ceftriaxone is a cephalosporin antibiotic with a broad range of activity against gram negative and gram positive bacteria. It inhibits bacterial cell wall production causing the bacteria to die.
R-IV add 4 ml of saline and dilute to 10 ml
IM add 4ml of saline and mix then draw up into 2 syringes and give into lateral thigh
D 2g
Droperidol
I-Mild to moderate risk to safety when age over 12 years and olanzapine hasn’t been administered oh has been and is ineffective
C-severe allergy
Cautions, elderly, concurrent administration of other drugs, alcohol intoxication, Parkinson’s disease
A- Droperidol blocks dopamine and alpha receptors centrally, resulting in sedation and reduced agitation and a state of mental detachment.
R- IV or IM. Administer of 1-2 mins if IV.
D- 10mg or 5mg if pt is frail.
Repeat 20 mins
S-hypotension- especially is administered rapidly
Gentamicin
I-sepsis with site of infection abdomen, urinary tract of unknown, and;
-more than 30 mins from hospital
-age over 12
-1 or more high risk factor present
C-severe allergy, pregnancy
A- gentamicin is an amino-glycoside antibiotic it has broad acitivity against gram negative bacteria. It inhibits bacterial cell protein synthesis.
R- IV, dilute to 10-12mls and give over 2 mins- preferably into running line.
D- <60kg 240mg
60-80kg 320mg
>80kg 400mg
S ototoxixity, renal impairment
Glucagon
I- Hypoglycaemia when Iv or oral glucose cannot be given
C-severe allergy
A-Glucagon increase blood glucose levels by stimulating glycogenolysis which is the breakdown of glycogen into glucose, predominantly from the liver.
R IM
D 1mg 0.5mg for under 5 year old
S none
GTN
I- MI, CPO, HTN in autonomic dysreflexia, and control of HTN in STEMI.
C- HR less than 40 or above 150
systolic BP less than 100
VT
severe allergy
Cautions, STEMI (however if left sided and HTN is present administer without caution) , small, frail or physiologically unstable, mitral or aortic stenosis, erectyle dysfunction medication, poor perfusion
A-GTN is a potent vasodilator. It decreases venous return to the heart which decreases preload and reduces afterload which reduces myocardial oxygen demand in the heart. It also vasodilates coronary arteries which increases coronary blood flow, however this is thought to be not clinically significant.
R-SL
D MI 0.4 every 3-5 mins or 10 mins if caution
CPO 0.8mg- dose and frequency can be increased provided the systolic BP is greater than 100.
AD 0.4-0.8mg
HTN 0.4-0.8mg
S-hypotension, headache, tachycardia, lightheaded
GTN patch
CPO not responding to GTN SL control of hypertension in -Autonomic dysreflexia -STEMI, prior to fibrinolysis -Interhospital transfer of STEMI -Interhospital transfer of Stroke
Dose 1 patch 0.5mg per hour
Apply patch to lateral upper arm
Effects from the patch will dissipate apprx 10-20 mins after patch has been removed.
Ketamine
I- severe pain (in addition to the pain relief) for pain that is not controlled by opiates.
C- severe allergy, age less than 1
Cautions HTN, condidtions made worse by HTN, MI, active psychosis, concurrent administration of other drugs, elderly/frail, unable to obey commands
A- Ketamine is an analgesic. It is an NMDA receptor antagonist. NMDA is one of the bodies main excitory neurotransmitters. Inhibition of this results in analgesia at low doses, in higher doses it causes amnesia, sedation and anaesthesia.
R-Analgesia
IV 50-80 kg 20mg over 15 mins
>80kg 30mgs over 15 mins
IM/ PO 0.5mg per kg up to 50mg repeat 1x after 20mins
Severe Agitated delirium
50-80kg 200mg IM repeat 1x after 20 mins
>80kg 400mg
1mg/kg IV up to 100
S- HTN, tachycardia, apnoea, sedation, hallucinations, nausea vomiting
Lignocaine
I- IO pain, prophylaxis of pain from IV cannulation, digit ring blocks
C-severe allergy, infection at site of injection. Caution on an anticoagulant (ring blocks only)
A- Lignocaine is a local anaesthetic it blocks the transmission of nerve impulses by blocking the movement of sodium ions across the nerve cell membrane.
R- IO, SC
D- IO upto 50mg 1x repeat after 15 mins. Administer over 1-2 mins and wait a further minute before infusing fluid.
SC up to 200mg. For ring block 1-2mls either side of digit. Repeat x1 after 30mins.
S-stinging at site of injection
Midazolam
I- prolonged seizure, mild to moderate risk to safety agitated delirium when droperidol is not available or ineffective.
C-severe allergy Caution, concurrent administration of sedatives, elderly or frail, intoxication.
A- Midazolam is a benzodiazepine. It enhances GABA at GABA receptors within the CNS. GABA is one of the bodies inhibitory neurotransmitters. This results in anticonvulsant activity, sedation, anxiolysis, amnesia and muscle relaxant.
R- seizures IV 3-5 mg repeat 1x after 5 mins
IM 5- 10-mg repeat 1x after 10 mins
Agitated delirium 10mg IM
S-sedation, respiratory depression, hypotension, amnesia.
