DTPs Flashcards
(121 cards)
1
Q
Haloperidol metabolism
A
Metabolism in the liver exerted by urine, bile and faeces
2
Q
Haloperidol indication
A
Acute psychosis
3
Q
haloperidol dosage
Adult
A
Intramuscular injection only IMI
> equal 50yo 5mg max 5mg
< 50yo 10mg max 10mg
4
Q
Haloperidol contraindications
A
KSAR
Parkinson’s disease
5
Q
Haloperidol precautions
A
Dystonic reaction Neuroleptic malignant syndrome NMS Tardive dyskinesia Elderly debilitated patients Etoh or drugs - hypotension Aloc
6
Q
Haloperidol side effects
A
Lethargy & drowsiness Hypotension Respiratory depression Extra pyramidal reaction Anxiety euphoria
7
Q
Haloperidol presentation
A
5mg : 1ml
8
Q
Haloperidol drug action times
A
Onset : 5 minutes (peak 20 min)
Duration : 2-3 hours
Half life : 20 hours
9
Q
Benzotropine pharmacology
A
Synthesized from components of atropin and diphenhydramine drug molecules . Possesses anti-histamine, anti cholinergic properties while inhibiting dopamine re-uptake. These drugs enable restoration of the balance between ach and dopamine in the CNS, thereby alleviating acute dystonia .
10
Q
Benztropine metabolism
A
Hepatic
11
Q
Benztropine indications
A
Acute dystonic reaction
12
Q
Haloperidol Pharmacology
A
Strong activity against delusions and hallucinations, most likely due to an effective dopaminergic receptor blockage in the mesocortex and the limbic system of the brain .
13
Q
Benztropine precautions
A
Sedative effects of other drugs maybe enhanced
Children <12 years
14
Q
Benztropine side effects
A
Dilated pupils Dry mouth Tachycardia Urinary retention Nausea & vomiting Toxic psychosis confusion and visual hallucinations
15
Q
Benztropine presentation
A
2mg:2ml cogentin
16
Q
Benztropine time onset
A
Onset : 1-2 minutes
Duration : 1-2 hours
Half life : 16 hours
17
Q
Benztropine dose
Adult
A
IVI & IMI 1-2 mg single dose only
18
Q
Promethazine pharmacology
A
A phenothiazine derivative with potent antihistamine & sedative/hypnotic effect. It also possess antiemetic, anti motion sickness, anti vertigo, anti cholinergic properties and local LA action. It competitively an reversibly antagonizes the effects of histamine at the H1 receptor site on effector cells .
19
Q
Promethazine metabolism
A
Hepatic
20
Q
Promethazine contraindications
A
KSAR
Lactating women
Patients < 2 years
21
Q
Promethazine indications
A
Nausea & vomiting
Motion sickness
Symptomatic rash / moderate allergic reaction
22
Q
Teneteplase times
A
onset 15min
duration several hours
1/2 life 2 hours
23
Q
Promethazine precautions
A
Co-comitant use of promethiazines
History of dystonia
May potentials the effects of ETOH
24
Q
Promethazine side effects
A
Dry mouth
Hypotension
Dizziness
Sedation
25
Promethazine presentation
50mg: 2ml
26
Promethazine time onset
Onset 3-5mina
Duration 6-12 hours
1/2 life 7-14 hours
27
Promethazine dose
| Adult
Nausea and vomiting
Motion sickness
> equal 16 yo 12.5 mg (0.5ml) slow push 1 min single dose only.
Symptomatic rash / moderate allergic reaction
12.5mg slow push 1min single dose only
28
Ondansetron metabolism
Majority metabolized by liver excreted kidneys
29
Ondansetron pharmacology
A serotonin 5HT3 receptor antagonist used primarily as an antiemetic . It works both periphery and centrally. reduces the activity of the vagus nerve, which activates the vomiting centre in the mendulla oblongata, and also blocks serotonin in the CTZ .
30
Ondansetron contraindications
kSAR to ondamsetron or 5HT3 receptors
| Patients < 3 yo
31
Ondansetron indications
Nausea & vomiting
| Prophylactic use in patients who has previously experienced nausea and or vomiting with narcotics
32
Ondansetron side effects
```
Headache
Constipation
Sensation warmth and flushing
Extra pyramidal effects
Dysrrhythmias
```
33
Ondansetron presentation
4mg: 2ml Zofran
34
Ondansetron onset times
Onset : 5 minutes
Duration : several hours
1/2 life : 3-4 hours
35
Ondansetron dose
| Adult
IMI and IVI
| 4 mg : 2ml max dose
36
Midazolam pharmacology
Midaz plan hydrochloride is a short acting CNS depressant which induces amnesia, sedation, hypnosis and anesthesia. It achieves by enhancing the effects of the inhibitory neurotransmitter GABA gamma-amino butyric acid . Depressant effects occur at all levels of the CNS
37
Ondansetron complications
Hepatic impairment
| Intestinal obstruction
38
Midazolam indications
Seizure convulsion
Sedation :
> maintain ett
> severely Agitated patient
> agitate head injury to facilitate assessment and Tx
>procedure (tcp & sync cardio version )
> ketamine disinhibition or emergence
Patients with trauma # reduction or splinting or extrication distressed an agitated despite narcotic analgesia .
> patients with burns distressed and agitated by pain
39
Midazolam contraindications
KSAR to benzodiazepine s
40
Midazolam precautions
Reduce dosages maybe required in the elderly , ccf, chromic renal faiulre or shocked patients
Myasthenia gravies
Multiple sclerosis
Severe respiratory depression in patients with copd
41
Midazolam side effects
Hypotension
| Respiratory depression particularly when associated with etoh & narcotics
42
Midazolam presentation
5mg:1ml
43
Midazolam times onset
Onset : 5-15 min IM
Onset : 1-3 min IV
Duration : variable
1/2 life : 2.5hours
44
Midazolam dosages
| Adults seizures
Seizures/convulsion -
IMI - < 50 yo 5mg rep 10 minutes @ 5mg no MAX dose
IMI - >equal 50yo 2.5mg rep 10 min @ 2.5mg no MAX dose
IVI & IO - up to 2.5mg rep 5 min @ 2.5mg no MAX dose
45
Midazolam Dose
| Adult Maintain ETT
IVI 1- 2.5mg rep PRN consider administration of narcotics no MAX dose
46
Midazolam Dose
| Sedation agitated head injury requier assessment and treatment
IVI & IO 1-2.5mg rep at 5 min @ 1-2mg no MAX dose
47
Midazolam Dose
| Sedation for procedure (TCP & sync cardioversion)
1mg every 2 min no MAX dose
48
Midazolam dose
| for disinhibtion or emergence following ketamine administration
IVI 1-2.5mg PRN MAX 5mg
49
Midazolam dose
| Severely agitated patient
IMI < 50 yo 5mg rep at 10 min @ 5-10mg MAX 25mg
IMI > 50 yo 1-5mg rep at 10 min @ 1-5mg MAX 15mg
IVI < 50 yo 2.5mg-5mg rep at 5 min @ 2.5-5mg MAX 25mg
IVI >50 yo 1-5mg rep at 5 min @ 1-5mg MAX 25 mg
50
Midazolam dose
Pt with trauma requiring reduction, splinting or extrication who are distressed and agitated despite narcotic analgesia
Pt with burns
IVI 1-2mg total max dose 2mg
51
Calcium Gluconate presentation
10% 0.953g :10ml
52
Calcium Gluconate 10% Pharamcology
Calcium gluconate is a electrolyte which is vital to muscular and neuronal systems. It is involved in smooth muscle contraction, excitative coupling in cardiac and smooth muscle and as an intracellular secondary messenger. These effects combine to exert a positive inotropic effect in the post cardiac arrest patient and addiotinally has a role in cardiac membrane stabilization in hyperkalaemia.
53
Midazolam metabolism
By the liver excreted by kidneys
54
Benztropine contraindications
KSAR
Tardive dyskinesia
Children < 3 years
55
Calcium Gluconate 10% Metabolism
calcium is filtered by the renal glomeruli and reabsorbed, the remainder is excreted in faeces.
56
Calcium Gluconate 10% indications
Suspected hyperkalaemic cardiac arrest
Severe Hyperkalaemia (haemodynamic compromise or significant cardiac rhthym disturbance
Calcium channel blocker toxicity
Hypotension associated with magnesium infusion (that fails to repsond to addequate fluid therapy)
57
Calcium Gluconate 10% contraindications
```
KSAR
Digoxin (digitalis) overdose
```
58
Tenecteplase Contraindications
identical to those listed in the CAR checklist
59
Calcium Gluconate 10% Precautions
Respiratory acidosis
60
Calcium Gluconate 10% side effects
```
Suspected hyperkalaemic ccardiac arrest
NIL
All other QAS indications
bradycardia
cardiac dysrrhythmias
hypotension
Syncope
cardiac arrest
```
61
Calcium Gluconate 10% time of onset
onset - 1-3 min
Duration 30-60 minutes ( in hyperkalaemia)
1/2 life nil applicable
62
Calcium Gluconate 10% dose
| ADULT
IV & IO 10ml slow push over 2-5 minutes rep once at 10 minutes
63
Clopidogrel Pharmacology
specific and potent platelet aggregation inhibitor, it selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptors, thereby inhibiting platelet aggregation.
64
Clopidogrel metabolism
hepatic metabolism with near equal amounts excreted in faeces and urine
65
Clopidogrel indications
For patients with STEMI (as defined by the QAS CAR checklist) and who:
> have been accepted for PCI (as an adjunct therapy to aspirin and heparin)
>have received fibrinolysis therapy (as an adjunct therapy to aspirin, enoxoparin, tenectaplase)
66
Clopidogrel Contraindications
KSAR
pts < 18 years
pts currently taking clopidogrel
Identical to the CAR checklist unless otherwise specifically authorized under LWI
67
Clopidogrel Precautions
Sever renal impairment
68
Clopdogrel Side effects
```
Haemorrhage
Headache / dizziness
Stomach upset and or pain
Constipation
Diarrhoea
```
69
Clopidogrel onset times
Onset : 30 min
Duration : 7- 10 days
1/2 life: 8 hours
70
Clopidogrel Dose
PCI - 600mg (8tabs)
| Fibrinolysis - 300mg (6tabs) (lower dose due to increase risk of haemorrhage)
71
Clopidogrel Presentation
75mg pink tablet ISCOVER
72
Enoxaparin pharmacology
several actions on the clotting pathway which occur due to binding to antithrombin III. the antithrombotic activity is related to inhibition of thrombin generation and inhibition of two ket ccoagulation factors: Xa andd thrombin.
73
Enoxaparin Metabolism
metabolised by the liver but mostly excreted unchanged
74
Enoxaparin Indications
Pts with STEMI as defined by the QAS CAR checklist who will receive QAS Fibrinolytic therapy as an adjunct therapy to aspirin, clopidogrel, tenectaplase.
75
Enoxaparin Contraindications
KSAR to enoxaparin or heparin
| Identical to those listed in the QAS CAR checklist, unless otherwise sepcifically authorised under relevant LWI.
76
Enoxaparin Precautions
```
renal hepatic impairment
history of GI ulcerations
Diabetic retinopathy
low body weight (women < 57 kg)
Elderly
Pregnancy and lactating women
```
77
Enoxaparin side effects
thombocytopenia
| Haemorrhage
78
Enoxaparin presentation
IV 40mg:0.4ml
| SC 100mg :1ml weight adjusted dose
79
Enoxaparin dose
| ADULT
Loading dose 30mg followed 15 minutes later by
| Maintenance dose 1mg/kg max 100mg
80
Heparin pharmacology
Heparin is an anticoagulant agent which combines with anti-thrombin III to inhibit X and the conversion of pro-thrombin to thrombin. Heparin therefore reduces the propensity for new clot formation and also inhibits other process in the clotting cascade.
81
Heparin metabolism
metabolised via biotransformation in the liver and reticulo-endothelial system. metabolites are excreted in urine.
82
Heparin Indications
for patients with STEMI as defined by the QAS CAR checklist and LWI and who have been accepted for PCI
83
Heparin contraindication
KSAR
| identical to those listed in CAR checklist unless specifically authorised under the LWI
84
Heparin Complications
Renal impairment
85
Heparin Side effects
Thrombocytopenia
| Haemorrhage
86
Heparin Presentation
5000 units in 5 ml
87
Heparin time onset
Onset : 30 seconds
Duration : 3-6 hours
1/2 life: 1.5 hours
88
Heparin Dose
| ADULT
IV - single dose only 5000 units
89
Hydrocortisone Pharmacology
hydrocortisone is an adrenalcortical steriod that produces an anti-inflammatory process. this inhibits the accumulation of inflammatory cells, phagacytosis, lysomal enzyme release and synthesis & release of mediators of inflammation. additionally it supresses cell mediated immune reaction
90
Hydrocortisone Metabolism
Hepatic
91
Hydrocortisone Indications
Moderate - severe asthma
Acute exaccerbation of COPD with evidence of respiratory distress
Symptomatic adrenal insufficiency (with known history of addison's, congenital adrenal hyperplasia, pan-hypopituitarism or long term steroid administration)
QAS management plans
92
Hydrocortisone Contraindications
KSAR
93
Hydrocortisone Precautions
Hypertension
94
Hydrocotisone Side effects
NIL
95
Hydrocortisone presentation
100mg powder - to be dissolved with 2ml WFI
96
Hydrocortisone dose
| ADULT
```
asthma, COPD, allergic reaction/anaphylaxsis
200mg single dose only
Symptomatic adrenal insuffciency
100mg single dose only
QAS management plan
AS list on plan
```
97
Ibatropium Bromide Pharmacology
anti-cholinergic (antimuscarinic) agent which promotes bronchodilation through inhibition of cholinergic bronchomotor tone
98
Ipratropium bromide metabolism
hepatic and excretion by the kidneys
99
Ipratropium bromide indications
moderate to sever asthma
100
Ipratropium bromide contraindications
KSAR
| pt < 2 yo
101
Ipratropium bromide precautions
glucoma
| prostatic hypertrophy
102
Ipratropium bromide side effects
dilated pupils
dry mouth
palpitations
103
Ipratropium bromide presentations
250mcg: 1ml
104
Ipratropium bromide dose
| ADULT
500mcg single dose only
105
Ketamine pharmacology
ketamine is an anaesthetic agent which acts as a NMDA receptor antagonist. At lower doses this drug produces significant analgesia while the airway reflexes and respiratory drive are preserved. unlike other general anesthetics there is minimal haemodynamic compromise as ketamine acts as a sympathomimetic agent. however this may result in transient tachycardia & hypertension . ketamine produces a dissociative state which will potentially cause the patient to have significant issues with preception, resulting in disinhibition and emergence phenomenon
106
Ketamine metabolism
exstensive hepatic metabolism with approx 90% of the drug excreted in the urine as metabolites
107
Ketamine indications
severe traumatic pain (following narcotics) associated with;
> fracture reduction or splinting
>multiple or significant fractures requiring facilitated extrication
severe traumatic pain following burns (third line treatment) post narcotics and benzodiazipines
108
Ketamine contraindication
```
KSAR
age 180, Dys >110
known hydrocephaluas / raised intraoccular pressure
Age < 1 yo
Pt gcs less than or equal 12
ACS or acute heart failure
```
109
Ketamine precaution
age >65 y
midazolam or other cns depressant agents
hypovolemic shock (exaggerated effect prolonged onset)
globe injuries
pt exhibiting pyschosis
complex facial injuries or fractures
impaired respiratory function
110
Ketamine side effects
```
disinhibition
dissociated state
depression of consciousness
hypersalivation
hypertension
hypertonicity (clonus) nystagmus
nausea & vomiting
respiratory depression (rare)
laryngospasm
emergence
```
111
Ketamine presentation
200mg;2ml ketalar
112
hydrocortisone onset
onset 1-2hr
durations 6-12hr
1/2 life 6-8 hrs
113
Ketamine dose
10-20mg rep 2-3 min MAX 1mg/kg
114
Enoxaparin onset
immediate peak 3hr
12-24 hours
4.4 hr for 40mg
119
Tenecteplase pharmacology
Tenecteplase is a anti-thrombotic agent which combines to the fibrin components of the thrombus and converts thrombus-bound plasminogen to plasmin, which degrades the fibrin matrix of the thrombus.
120
Tenecteplase Metabolism
Hepatic
121
ketamine onset
onset 30sec
duration 5-20min
1/2life 10-15 min
122
Tenecteplase Precautions
NIL
123
Tenecteplase Side effects
haemorrhage
headache
reperfusion arrhythmia
Nausea and vomiting
124
Tenecteplase presentation
50mg in powder form with solvent -10000 IU graduated syringe weight adjusted dose
125
Tenecteplase Indications
Classic ongoing ischemic chest pain (atypical chest pain excluded) and ECG criteria suggesting STEMI who meet the QAS CAR checklist:
GCS15
ongoing ischemia chest pain < 6 hours
12 lead ecg with persistant ST segment elevation of >equal 2mm in 2 contiguous chest leads and >equal 1mm in 2 contiguous limb leads.
normal QRS width (< 75 YO
Systolic BP < 180 at all times during care
Diastolic BP < 110 at all times during care
