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Flashcards in DTPS Deck (149)
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1

Adrenaline Indications

- Anaphylaxis OR severe allergic reaction

- Severe life-t)hreatening bronchospasm OR silent chest (patient must be only able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC

- Bradycardia with poor perfusion (unresponsive to atropine AND/OR TCP

- Cardiac arrest - Croup (with stridor at rest)

- Shock unresponsive to adequate fluid resuscitation (excluding haemorrhagic cause)

2

Adrenaline Contraindications

Nil

3

Adrenaline Precautions

- Hypertension

- Hypovolaemic shock

- Concurrent MAOI therapy

- Multiple sclerosis

4

Adrenaline Side effects

- Anxiety

- Hypertension

- Palpitations/tachyarrhythmias

- Pupil Dilation

- Tremor

5

Adrenaline Onset

IV - 30 seconds

IM - 60 seconds

6

Adrenaline Duration

5-10 minutes

7

Adrenaline Half-life

2 minutes

8

Adrenaline Adult Dosage

Anaphylaxis OR severe allergic reaction

9

Adrenaline

Adult Dosage

Severe Life Threatening Bronchospasm OR Silent Chest

10

Adrenaline

Adult Dosage

Bradycardia with poor perfusion (Unresponsive to Atropine AND/OT TCP)

11

Adrenaline

Adult Dosage

Cardiac Arrest

12

Adrenaline

Adult Dosage

Shock unresponsive to adequate fluid resuscitation (excluding haemorrhagic cause)

13

Amiodarone Indications

Cardiac Arrest (Refractory VF or pulseless VT)

Sustained conscious VT (haemodynamically stable)

14

Amiodarone Contraindications

- Cardiac Arrest (Refractory VF or pulseless VT)

- Nil

 - Sustained Conscious VT (haemodynamically stable)

- KSAR or hypersensitivity

- severe conduction disorders (unless pacemaker or AICD in situ)

-  Current amiodarone therapy

- Current anti-arrhythmic therapy that prolonges QT interval

- Pregnancy and/or lactation

15

Amiodarone Precautions

Cardiac arrest

- concurrent anti-arrhythmic therapy that prolongs QT interval

- thyroid disease

Sustained conscious VT

- hypotension

- thyroid disease

16

Amiodarone Side Effects

Hypotension

Bradycardia

Nausea and/or vomitting

Peripheral paresthesia

17

Amiodarone Onset

5 minutes

18

Amiodarone Duration

30 minutes

19

Amiodarone Half-Life

14-110 days (with chronic dosing)

20

Amiodarone Schedule

S4 (Restricted drugs)

21

Amiodarone Adult Dosages

Cardiac Arrest

22

Amiodarone Adult Dosages

Sustainded conscious VT

23

Aspirin Indications

Suspected ACS

Acute cardiogenic Pulmonary Oedema

24

Aspiring Contraindications

KSAR or hypersensitivity to aspirin or other NSAIDs

Chest pain associated with psychostimulant overdose

Bleeding OR clotting disorder

Current GI bleed or peptic ulcers

Patients <18 years

 

25

Aspirin Precautions

Possible aortic aneurysm, or other condition that may require surgery

Pregnancy

History of GI bleeds or peptic ulcers

Current anticoagulant therapy (e.g. warfarin)

26

Aspirin Side Effects

Epigastric pain / discomfort

Nausea and/or vomiting

Gastritis

GI bleed

NSAID induced bronchospasm

27

Aspirin Onset

approx. 10 minutes

28

Aspirin Duration

approx. 1 week

29

Aspirin Schedule

S2 (therapeutic poisons)

30

Aspirin Adult Dosage

31

Atropine Indications

Bradycarda (with poor perfusion)

Envenomation (with increased parasympathetic activity)

Hypersalivation (secondary to ketamine administration)

Organophosphate toxicity (with cardiac AND/OR respiratory compromise

32

Atropine Contraindications

KSAR or hypersensitivity to atropine

33

Atropine precautions

Atrial flutter

Atrial fibrillation

AMI

Glaucoma

34

Atropine Side Effects

Agitation

Hallucinations

Dilated Pupils

Dry mouth/ dry skin/ reduced bronchial and gastric secretion

Tachycardia

35

Atropine Onset

1-2 minutes

(peak 15-50 minutes)

36

Atropine Duration

Up to 5 hours

37

Atropine Schedule

S4 (restricted drugs)

38

Atropine Adult Dosages

Bradycardia

39

Atropine Adult Dosages

Envenomation

40

Atropine Adult Dosages

Hypersalivation

 

 

41

Atropine Adult Dosages

Organophosphate toxicity

42

Ceftriaxone Indications

 

Suspected meningococcal septicaemia (with a non-blanching petchial AND/OR purpuric rash)

43

Ceftriaxone Contraindication

KSAR or Hypersensitivity to cephalosporin drugs

Known anaphylaxis or severe allergice reaction fo penicillin based drugs - (isolated minor drug rash attributed to penicillin does not contraindicate the use of ceftriaxone)

44

Ceftriaxone Precuation

Nil

45

Ceftriaxone Side effects

Nausea AND/OR vomiting

Pain at the IM administration site

46

Ceftriaxone Presentation

Vial (powder), 1g ceftriaxone

47

Ceftriaxone Onset

Duration

Half Life

Dose/route variable

Duration: approx. 1 day

Half Life: 5.8-8.7 hours

48

Ceftriaxone Schedule

S4 (restricted drugs)

49

Ceftriaxone Adult Dose

50

Fentalyn Indications

  • Severe Pain
  • Sedation (for maintenance of an established ETT)
  • Autonomic dysreflexia (with significant BP 160 mmHg)

51

Fentanyl Contraindications

KSAR or hypersensitivity to fentanyl

52

Fentanyl Precautions

  • Respiratory Tract burns
  • Respiratory depression and/or failure
  • Known addiction to narcotics
  • Current MAOI therapy
  • Elderly patients
  • Hypotension

53

Fentanyl Side Effects

  • Bradycardia
  • Hypotension
  • Drowsiness
  • Nausea and/or vomiting
  • pin point pupils
  • Respiratory depression
  • Muscular rigidity (particularly muscles of respiration.

54

Fentanyl Onset/Duration/Half Life

Onset: <3 minutes

Duration: 30-60 minutes

Half Life: 2-3 hours

55

Fentanyl Schedule

S8 (controlled drug)

56

Fentanyl Adult Dosage

Severe Pain

57

Fentanyl Adult Dosage

Severe Pain

Autonomic dysreflexia (Severe Hypertension BP 160 Hgmm)

58

Fentanyl Adult Dosage

Sedation (for maintenance of existing ETT)

59

Glucagon Indications

Symptomatic hypoglycaemia (with inability to self administer oral glucose)

60

Glucagon Contraindications

KSAR of hypersensitivity to glucagon

61

Glucagon Precautions

Nil

62

Glucagon side effects

Nil

63

Glucagon Onset/Duration/Half Life

Onset: 4-7 minutes

Duration:  Variable

Half-Life: 3-6 minutes

64

Glucagon Schedule

S3 (therapeutic poison)

65

Glucagon Adult Dosage

66

Glyceryl trinitrate Indications

Suspected ACS with Pain

Acute cardiogenic pulmonary oedema

Irukandji syndrome (with systolic BP greater than or equal to 160 mmHg)

Autonomic dysreflexia (with systolic BP greater than or equal to 160 mmHg)

67

GTN contraindications

KSAR or hypersensitivity to GTB

HR < 50 or >150

SBP <100

Acute CVA

Head trauma

Phosphodiesterase Inhibitor medication administration in previous 24 hours

68

GTN Precautions

Phosphodiesterase inhibitor medication administration in previous 48 hours

Suspected inferior AMI

Cerebral vascular disease

Risk of hypotension or syncope

Intoxication (GTN effects enhances)

69

GTN side effects

Dizziness

Syncope

Hypotension

Reflex tachycardia

Vascular headaches

70

GTN Onset/Duration/Half-Life

Onset: <2 minutes

Duration: 20-30 minutes

Half-Life: 5.5 minutes

71

GTN Schedule

Sublingual: S3 (therapeutic poisons)

Ampoule: S4 (restricted drugs)

72

GTN Dosages

73

Hydrocortisone Indications

  • Moderate or Severe Asthma
  • Acute exacerbation of COPD (with evidence of respiratory distress)
  • Severe allergic reaction OR anaphylaxis (requiring adrenaline administration)
  • Symptomatic adrenal insuficiency (with a known history of Adison's disease, congenital adrenal hyperplasia, pan-hypopertuitarism or long-term steroid administration)

74

Hydrocortisone Contraindications

KSAR or hypersensitivity to hydrocortisone

75

Hydrocortisone Precautions

Hypertesion

76

Hydrocortisone Side effects

Nil

77

Hydrocortisone Onset/Duration/Side Effects

Onset: 1-2 hours

Duration: 6-12 hours

Half life: 6-8 hours

78

Hydrocortisone Schedule

S4 (restricted drugs)

79

Hydrocortisone Dosages

80

Ipratropium Bromide Indications

Moderate or Severe Bronchospasm

81

Ipratropium Bromide Contraindications

KSAR or hypersensitivity

Patient <2 yrs

82

Ipratropium bromide Precautions

Glaucoma

83

Ipratropium Bromide Side Effects

Dilated pupils

Dry mouth

Plpitations

84

Ipratropium Bromide Onset/Duration/Half-life

Onset: 1.5-3 minutes

Duration: 4-6 hours

Half-Life: 3 hours

85

Ipratropium bromide Schedule

S4

86

Ipratropium Bromide Adult Dosages

87

Ketamine Indications

  • Severe traumatic Pain (following 0.1-0.2 mg/kg of morphine OR 1-2 mcg/kg fentanyl) associated iwth:
    • Fracture reduction and splinting
    • Multiple significant fractures requiring facilitated extrication
    • patients with splinted fractures requiring ongoing narcotic analgesia for transport requirements
  • Severe traumatic pain associated with burns (following 0.2-0.3 mg/kg morphine OR 2-3 mcg/kg fentanyl AND 1-2 mg (adult or 0.05mcg/kg (paediatric) midazolam)
  • Induction of anaeshtesia
  • Ongoing traumatic pain unresponsiv eto narcotics (following 0.2-0.3 mg/kg morphine OR 2-3 mcg/kg Fentanyl)

 

88

Ketamine Contraindications 

Analgesia

  • KSAR or hypersensitivity
  • Age <1 yr
  • GCS 12 or less
  • Uncontrolled hypertension (SBP 180mmHg or less AND/OR DBP 110 mmHg or less)
  • Suspected acute ACS or acute heart failure
  • Known Hydrocephalus or raised intraocular pressure

89

Ketamine Contraindications

Induction of anaethsesia

KSAR or Hypersensitivity

90

Ketamine Precautions

  • Age >65
  • Patients hwo have been administered midaolam or other CNS depressant medications
  • Patients with significant hypovolaemia (exaggerated effects and a delayed onset of action)
  • Globe injuries
  • Complex facial injuries and fractures
  • Patients who have imparied respiratory function
  • Patients exhibiting psychotic symptoms

91

Ketamine Side Effects

  • Dissociation and trance-like state
  • transient hypertonicity and nystagmus
  • disinhibition
  • emergence
  • hypertension
  • tachycardia
  • depression of consciousness
  • hypersalivation
  • nausea and/or vomiting
  • laryngospam
  • respiratory depression (rare)

92

Ketamine Onset/Duration/Half Life

Schedule

Onset: 30 seconds

Duration 5-20 minutes

Half Life: 10-15 minutes

 

Schedule: S8 (controleld drugs)

93

Ketamine Adult Dosages

Severe Traumatic Pain

94

Ketamine Adult Dosage

Severe traumatic pain associated with burns

95

Ketamine Adult Dosages

Induction for Anaesthesia

96

Lignocaine Indications

  • Pain associated with IO drug and fluid administration following EZ-IO needle insertion
  • Local anaesthesia
    • radial artery line placeent
    • fish hook removal

97

Lignocaine Contraindications

KSAR or hypersensitivity to Lignocaine

98

Lignocaine Precautions

Inadvertent intravascular injection

99

Lignocaine Side effects

Convulsions

Hypotension

Nausea

Tinnitus

100

Lignocaine Onset/Duration/Half Life

Schedule

Onset: 1-3 minutes

Duration: 20-30 minutes

Half life: 1-2 hours

 

Schedule: S4 (Restricted drugs)

101

Lignocaine Dosages

102

Magnesium Sulphate Indications

  • Box jellyfish (Chironex fleckeri) evenomation (unresponsive to antivenom threapy)
  • Eclampsia
  • Irukandji sydrome (with intractable pain unreleived by narcotic analgesia AND/OR systolic BP > 160 mmHg)
  • Torsades de Pointes
  • Severe life-threatening asthma (only in patients who have required IV salbutamol AND/OR IM/IV adrenaline)

103

Magnesium Sulphate conraindications

  • KSAR or hypersensitivity to magnesium sulphate
  • AV block
  • Renal failure

104

Magnesium Sulphate Precautions

Renal impairment

105

Magnesium Sulphate Side Effects

  • Pain at cannulation site
  • Magnesium toxicity
    • hypotension/respiratory depression
    • loss of deep tendon reflexes

106

Magnesium Sulphate Onset/Duration/Half Life

Schedule

Onset: immediate

Duration: 30 minutes

Half-life: variable

Schedule: unscheduled

107

Magnesium Sulphate Adult Dosages

Torsades do pointes

108

Magnesium Sulphate Adult Dosage

Box Jellyfish

109

Magnesium Sulphate Adult Dosage

Irukandji Syndrome 

110

Magnesium Sulphate Adult Dosage

Eclampsia

111

Methoxyfleurane Indications

Pain

112

Methoxyfleurane Contraindications

  • KSAR or hypersensitivity
  • Patient <1 yr
  • History of significat liver or renal disease
  • History of malignant hyperthermia

113

Methoxyfleurane Precautions

ALOC

Intoxicated or drug affected patients

114

Methoxyfleurane side effects

ALOC

Cough

Renal/hepatic failure (following repeated high dose exposure)

115

Methoxyfleurane Onset/Duration/Half-Lfe

Schedule

Onset: 1-3 minutes

Duration: 5-10 minutes

Half-life: not available

Schedule: S4 restricted drugs

116

Methoxyfleurane Adult Dosage

117

Morphine Indications

  • Significiant pain
  • Autonomic dysreflexia (with systolic BP >160mmHg)
  • Sedation for the maintenance of an established ETT

118

Morphine Contraindications

KSAR or hypersensitivity to morphine

Renal failure

119

Morphine Precautions

  • Elderpy patient
  • hypotension
  • respiratory tract burns
  • respiratory depression and/or failure
  • known addiction to narcotics
  • concurrent MAOI therapy
  • Cardiac chest pain

120

Morphine Side effects

  • Hypotension
  • Drowsiness
  • Nausea/vomiting
  • Bradycardia
  • Pin point pupils
  • Respiratory depression

121

Morphine Onset/Duration/Half-life

Schedule

Onset: (IM) 5-10 minutes (peak 20-30 minutes)

(IV) 2-5 minutes (peak 20 minutes)

Duration: 1-2 hours

Half-life: 2 hours

Schedule: S8 controlled drugs

122

Morphine Adult Dosages 

Significant Pain (ACP1)

123

Morphine Adult Dosage

Significant Pain

Autonomic Dysreflexia

124

Morphine Adult Dosages

Sedation

125

Naloxone Indications

Respiratory depression (secondary to administration of narcotic drugs)

126

Naloxone Contraindications

KSAR or hypersensitivity to naloxone

127

Naloxone Precautions

Use with caution on patients with preexisting cardiac disease

128

Naloxone side effects

  •  Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension
  • May produce acute withdrawal convulsions in the chronic narcotic user
  • Pulmonary oedema

129

Naloxone Onset/Duration/Half-life

Schedule

Onset: 3-5 min (IM)/1-3 min (IV)

Duration; approx. 60 min

Half-life: 60 min

Schedule: 24 (restricted drugs

130

Naloxone Adult Dosage

131

Ondansetron Indications

Nausea and/or vomiting

Prophylactic administration for patients presenting with ACS

132

Ondansetron contraindications

  • KSAR to ondansetron or other 50HY3 receptor antagonists
  • Congenital long QT syndrome
  • Patient <3 years

133

Ondansetron precautions

Hepatic impairment

Intestinal obstruction

Patients with risk factors for QT interval prologation or cardiac arrythmias

134

Ondansetron Side Effects

Headache

Constipation

Sensation of warmth or flushing

Dysrhythmias

135

Ondansetron Onset/Duration/Half-life

Onset: 5 minutes

Duration: several hours

Half-life: 3-4 hours

Schedule: S4 (restricted drugs)

136

Ondansetron Adult Dosages

137

Paracetamol Indications

Minor pain

Fever (causing distress)

138

Paracetamol Contraindications

KSAR of hypersensiticity to paracetamol

Patient < 1 month old

139

Paracetamol side effects

Nausea

140

Paracetamol Onset/Duration/Half Life

Schedule

Onset: 10-60 minutes

Duration: 4 hours

Half-life: approx. 2 hours

Schedule S2 (therapeutic poison)

141

Paracetamol Adullt Dosage

142

Salbutamol Indications

Bronchospasm

Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation

143

Paracetamol Contraindications

KSAR or hypersensitivity to salbutamol

Patient < 2 years

144

Salbutamol Precautions

Acute Pulmonary oedema

Ischaemic heart disease

145

Salbutamol Side effects

Anxiety

Tachyarrythmia

Tremors

Hypokalaemia and metabolic acidosis

 

146

Salbutamol Onset/Duration/Half Life

Onset: 2-5 minutes (NEB)/1-3 minutes (IV)

Duration: 16-60 minutes (NEB)/10-20 minutes (IV

Half Life: 1.6 hours

147

Salbutamol adult dosages

Bronchospasm

148

Salbutamol adult dosages

Suspected hyperkalaemia

149