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StJA(WA) > Everyday drugs > Flashcards

Everyday drugs Flashcards

1
Q

AspirinPresentation

A

300mg white tablet

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2
Q

Aspirin
Use

A
  • Chest pain / discomfort of presumed cardiac origin..
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3
Q

Aspirin
Type

A
  • Analgesic
  • Antipyretic
  • Anti-inflammatory
  • Anti-platelet aggregation agen.
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4
Q

Aspirin
Actions

A

Reduces mortality significantly in Acute Myocardial Infarction by minimising platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis.

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5
Q

Aspirin
Contraindications

A
  • Known hypersensitivity to aspirin / salicylates.
  • Children < 16 years of age..
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6
Q

Aspirin
Adverse effects

A
  • Heart burn, nausea, GI bleeding.
  • Increased bleeding time.
  • Anaphylactic reaction (some patients, especially asthmatics) exhibit notable sensitivity to aspirin, which may provoke various hypersensitivity / allergic reactions)
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7
Q

Aspirin
Precautions

A
  • Actively bleeding peptic ulcers.
  • Suspected AAA.
  • Aspirin / salicylate-sensitive asthmatics
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8
Q

GTN
Presentation

A

Spray bottle containing 200x atomised sprays.
(0.4mg per spray)

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9
Q

GTN
Use(conditions/ Indications)

A
  • Chest pain/discomfort of presumed cardiac origin not relieved by rest and reassurance with systolic BP > 90mmHg.
  • Acute Cardiac Pulmonary Oedema with systolic BP >90mmHg.
  • Autonomic Dysreflexia with systolic BP > 160mmHg..
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10
Q

GTN
Type

A

Nitrate.

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11
Q

GTN
Actions

A

Nitrates cause the relaxation of vascular smooth muscle resulting in:
- Vasodilation
- Peripheral pooling and reduced venous return
- Reduced left ventricular and diastolic pressure (preload)
- Reduced systemic vascular resistance (afterload)
- Reduced myocardial energy and oxygen requirements
- Relaxes spasm of coronary arteries

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12
Q

GTN
Contraindications

A
  • Hypersensitivity
  • Hypotension < 90mmHg
    Recent use of medications used for erectile dysfunction:
  • Sildenafil (Viagra®) or Vardenafil (Levitra®) or Avanafil (Spedra®) use in the previous 24 hours
    Tadalafil (Cialis®) use in the previous 3 days
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13
Q

GTN
Adverse effects

A
  • Hypotension (rare)
  • Tachycardia
  • Flushing
  • Headache.
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14
Q

GTN
Precautions

A
  • Nitrates are an early intervention and should not be delayed until on the stretcher or inside the ambulance.
  • Administer to the patient in a seated or semi-recumbent position.
  • Do not shake GTN bottle prior to administration.
  • Assess BP before every dose.
  • Severe hypotension is an uncommon side effect..
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15
Q

Methoxyfluorane
Presentation

A

3mL ampoule for inhalation via Penthrox inhaler.

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16
Q

Methoxyfluorane
Use

A
  • Pain.
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17
Q

Methoxyfluorane
Type

A

halogenated ether that produces powerful modification of the awareness of pain with an associated light headed sensation..

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18
Q

Methoxyfluorane
(inc onset & offset) Actions

A
  • 6-8 breaths/ 1-2 min onset with maximum level after 2-4 minutes..
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19
Q

Methoxyfluorane
Contraindications

A
  • Patients who are unable to understand or co-operate.
  • Patients with severe renal impairment.
  • Patients with head injury and altered consciousness that prevents co-operation with its use.
  • Hypersensitivity e.g. malignant hyperthermia.
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20
Q

Methoxyfluorane
Adverse effects

A
  • Lightheaded
  • Dizziness
  • Drowsy
  • Nausea
  • Malignant hyperthermia.
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21
Q

Methoxyfluorane
Precautions

A

Use with charcoal filter attached
- Where administration in transit is necessary, the rear extractor fan must be used and the rear facing seat should remain vacant
- Instruct the patient to breathe in through their mouth and out through their mouth via the inhaler. For maximum effect cover the air dilutor hole.
- Initial breath is strong and may cause the patient to cough, so advise to take gently
- Watch for drowsiness
- If oxygen is required deliver separately
- Place in a sealed plastic bag when not in use .

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22
Q

Ondansetron
Presentation

A
  • 4mg wafer.4mg in 2mL vial
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23
Q

Ondansetron
Use

A
  • Moderate to severe nausea
  • Active vomiting
  • Prophylaxis for eye and spinal injuries.
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24
Q

Ondansetron
Type

A
  • Anti-nauseant and anti-emetic
  • Selective 5-HT3 receptor antagonist .
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25
Q

Ondansetron
Actions(inc onset)

A

blocking serotonin centrally in the chemoreceptor trigger zone and peripherally on Vagus nerve terminals.
- Onset of action up to 30 minutes.

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26
Q

Ondansetron
Contraindications

A
  • Paediatrics less than 2 years old
  • Hypersensitivity.
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27
Q

Ondansetron
Adverse effects

A
  • Headache
  • Malaise/fatigue
  • Drowsiness
  • Dizziness
  • Rash/allergic reaction.
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28
Q

Ondansetron
Precautions

A

ral wafer is the preferred method of administration for ALL patients unless actively vomiting.
Administer IV Ondansetron slowly over 2 minutes (neat or diluted) to prevent blurred vision and dizzines

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29
Q
A

.

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30
Q

Oxygen
Use

A

Adult:
- Oxygen should be titrated to achieve oxygen saturations of between 94 - 98%, (or 88 - 92% for COPD patients). These are achieved through the use of different flow rates and oxygen masks.
Paediatric:- All paediatric patients with significant illness or injury should receive oxygen. Newborn resuscitation should ideally be commenced with room air for the first couple of breaths.

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31
Q

Oxygen
Type

A

.

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32
Q

Oxygen
Dose

A
  • Aim for target saturations of between 94 - 98% for critical conditions requiring supplemental oxygen, maintained via bag-valve-mask or reservoir bag.
  • In patients with COPD or other conditions requiring controlled or low-dose supplemental oxygen aim for target oxygen saturations range of 88 - 92% (or the patient’s prescribed range).
  • If the patient is hypoxaemic, oxygen saturations of between 94 - 98% should be maintained through the use of a mask or nasal cannulae as appropriate.
    At the correct flow rate the following devices will deliver the following approximate FiO2:Mask Fraction of Inspired O2 (FiO2) Flow-rateNasal cannulae 24 - 35% 1 - 4 litres per minuteSimple face mask 40 - 60% 5 - 8 litres per minuteNon-rebreather mask 60 - 100% 10 - 15 litres per minuteBag-valve-mask 100% 15 litres per minute .
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33
Q

Oxygen
Actions

A

.

34
Q

Oxygen
Contraindications

A
  • Explosive or flammable environments
  • Normoxia.
35
Q

Oxygen
Adverse effects

A
  • Patients with acute episodes of COPD are at risk of developing carbon dioxide retention if they are given excessive supplemental oxygen. This can cause acidosis and subsequent organ dysfunction.
  • High oxygen concentrations can lead to increased production of reactive free radicals resulting in cellular damage. This may be responsible for the detrimental effects observed with the use of high flow oxygen in myocardial infarction and stroke..
36
Q

Oxygen
Precautions

A
  • If the target saturations cannot be maintained with the nasal cannula or medium concentration mask then change to a non-rebreather oxygen mask.
  • Oxygen increases the toxicity in paraquat poisoning, target saturations of 88-92%
  • Remember that some conditions can affect SpO2 readings e.g. carbon monoxide poisoning and cold digits
37
Q

Paracetamol
Presentations

A
  • 500mg white tablets
  • 100mg/ml (2000mg/20ml) suspension.
38
Q

Paracetamol
Use

A
  • Mild to moderate pain
    o For example, headache, sprain/strain, toothache, etc.
    o As a component of a multimodal analgesic regime..
39
Q

Paracetamol
Type

A
  • Paracetamol is a p-aminophenol derivative that exhibits analgesic and antipyretic activity..
40
Q

Paracetamol
Actions(onset)

A

elayed onset of action with peak effect via oral route achieved in ≥ 60 minutes. .

41
Q

Paracetamol
Contraindications

A
  • Known hypersensitivity to Paracetamol.
  • Do not give if patient has had Paracetamol in the preceding 4 hours.
  • Cannot exceed the maximum allowed single dose or exceed the maximum allowed paracetamol daily dose (24hrs).
42
Q

Paracetamol
Adverse effects

A
  • Nil known at therapeutic doses..
43
Q

Paracetamol
Precautions

A
  • There is no evidence that fever itself worsens the course of an illness. The primary goal should be to improve overall comfort [1]
  • SJA do not support the use of paracetamol in infants < 6 months.
  • 20 ml Paracetamol suspension bottle is single patient use only.
  • Only used enteral syringe/dropper with suspension.
44
Q

Adrenaline
Presentation

A

1mg in 1ml (1:1000)

45
Q

Fentanyl
Presentations

A

Fentanyl: 450mcg in 1.5ml (300mcg/ml); intra-nasal administration only
Fentanyl Citrate: 100mcg in 2ml ampoule (50mcg/ml); IV/IO only
Fentanyl Citrate: 500mcg in 10ml ampoule (50mcg/ml); IV/IO only

46
Q

Fentanyl
Use

A
  • Moderate to severe pain.
  • Acute Coronary Syndromes where GTN has been ineffective.
47
Q

Fentanyl
Type

A

A short acting synthetic narcotic analgesic

48
Q

Fentanyl
Actions

A

.

49
Q

Fentanyl
Contraindications

A
  • Hypersensitivity to Fentanyl
  • Less than 1 year of age (IV / IO only)
  • Occluded nasal passages or epistaxis (intranasal only).
50
Q

Fentanyl
Adverse effects

A

Adopt a low threshold to engage with the ED team if pain remains difficult to control
- Nausea/vomiting
- Respiratory depression; monitor pulse oximetry for all patients having IV / IN Fentanyl
- Cardiovascular effects:
o Bradycardia
o Hypotension (rare).

51
Q

Fentanyl
Precautions

A

RISK GROUPS:
Elderly patients
Respiratory depression: especially those at risk e.g. patients with severe COPD
Patients on MAO inhibitors
Caution in larger doses of women in active labour
ADMINISTRATION:
Use of IV Ketamine as analgesic prior to minimum (age dependant) dose of IV Fentanyl requires ASMA authorisation:
Paediatric: 100mcg
Adult < 70 years old: 200mcg
Adult > 70 (or frail): 100mcg
Administer slowly
Cease administration prior to calculated dose if desired effect is obtained.

Patients under extended care (e.g. ‘ramped’ patients) who have already been administered pain relief should have careful consideration with regards to the dosages of fentanyl administered, titrating only to effect.

52
Q

NS Presentation

A
  • Normal saline (NaCl 0.9%) in 1000ml soft plastic bag
  • Normal saline (NaCl 0.9%) in 250ml soft plastic bag
  • 10 ml plastic vial.
53
Q

NS
Use

A
  • Fluid replacement (volume expansion) for the treatment of shock, fluid loss, and cardiac arrest..
54
Q

NS
Type

A

sterile isotonic crystalloid solution.

55
Q

NS
Actions

A

.

56
Q

NS
Contraindications

A
  • Severe Pulmonary Oedema.
57
Q

NS
Adverse effects

A

Hypervolemia.

58
Q

NS
Precautions

A
  • Adult patients with penetrating trauma, ectopic pregnancy or aortic aneurysm with hypotension and signs of impaired organ perfusion may benefit from permissive hypotension (systolic blood pressure of 70mmHg).
59
Q

Presentation - Olanzapine

A

5mg Oral Dispersible tablets in blister pack

60
Q

Use - Olanzapine

A

Disturbed and Abnormal Behaviour (RASS 1 ~ 2) where risk to safety is evident and the patient is able to tolerate or self-administer an oral wafer
Preferred first line sedation agent in frail patients and those with Dementia

61
Q

Type - Olanzapine

A

second generation antipsychotic agent that acts on multiple receptors (incl. serotonin and dopamine receptors), resulting in sedation

62
Q

Actions - Olanzapine

A

Onset of effect usually ~ 10 mins.

63
Q

Contraindications - Olanzapine

A

Known Allergy
Known Parkinsons Disease
< 6 years of age

64
Q

Adverse effects - Olanzapine

A

Extrapyramidal effects / Dyskinesia
Increased falls risk
Hypotension
- Apply monitoring as soon as practicable

65
Q

Precautions - Olanzapine

A

Sedation of any patient < 16 years of age -should prompt a prior ASMA consult wherever practicable.
Organic causes such as suspected sepsis, traumatic brain injury or spontaneous intra-cranial event must be considered unlikely
“Agitated or Excited Delirium’, “Acute Behavioural Disturbance’ and “Drug Induced Psychosis’ are some alternative terms that may be used by other agencies
Effects may be amplified in patients with alcohol intoxication
Oral dispersible tablet may be dissolved in water (may slightly delay onset of action but still preferable in non-emergent cases)
Early monitoring as soon as practicable is required when administering Olanzapine; including SpO2, respiratory rate, pulse and blood pressure
SpO2 and etCO2 monitoring must be applied whenever level of consciousness drops (~RASS < 0)

66
Q

Dose - Aspirin

A

300mg oral administration, preferably chewed.
Administered even if patient has taken aspirin that day or on anticoagulants.

67
Q

Dose - GTN - Cardiac chest pain

A

400 microg (1 spray) sublingually.
If pain persists after 5 minutes and BP maintained, consider further sprays of GTN at 5 minute intervals
Should the first 3 doses provide some relief but symptoms persist, continue with further doses at 5 minute intervals if no contraindications

68
Q

Dose - GTN - ACPO

A

400 microg (1 spray) sublingually
If BP maintained, consider further sprays of GTN at 5 minute intervals
Should the first 3 doses provide some relief but symptoms persist, continue with further doses at 5 minute intervals if no contraindications

69
Q

Dose - GTN - Autonomic dysreflexia

A

400 microg (1 spray) sublingually.
Repeat doses at 5 minute intervals until symptoms resolve or systolic BP < 160mmHg.

70
Q

Dose - Methoxyflurane

A

Initial dose: 1 x 3ml ampoule.
Subsequent dose: 1 x 3ml ampoule after 15 minutes if still in severe pain or pain returns, once only.
Maximum dose: 6ml/24 hrs or 15ml (5 doses) per week

71
Q

Dose - Ondansetron
Adult & Paed

A

Adults:

Oral wafer (preferred):
4mg wafer.
Repeat dose after 30 minutes if required.
IM or slow IV:
4mg in 2ml.
Repeat the dose after 30 minutes if required.
Paediatric:

Oral wafer (preferred):
Weight Dose
<15kg 1/2 wafer
15 – 30kg 1 wafer
Over 30kg As per adult dose
IM (single dose only):
Age Dose
2 - 5 years 1mg in 0.5mL
6 - 9 years 2mg in 1mL
10 - 12 years 3mg in 1.5mL
>12 years or >40kg 4mg in 2mL

72
Q

Dose - Paracetamol
Adult & Paed

A

Adult:

500mg tablet; oral administration of 500-1000mg (1-2 tablets)
Max single dose 1000mg
Max dose not to exceed 4000mg over a 24 hour period
Paediatric:

100mg/ml (oral suspension)
6 months - 12 years old: 15mg/kg
Repeat every 4 to 6 hours
Maximum daily dose is 60mg/kg in divided doses of 15mg/kg (not to exceed 4000mg), over a 24 hour period

73
Q

Dose - Oxygen

A

Aim for target saturations of between 94 – 98% for critical conditions requiring supplemental oxygen, maintained via bag-valve-mask or reservoir bag.
In patients with COPD or other conditions requiring controlled or low-dose supplemental oxygen aim for target oxygen saturations range of 88 – 92% (or the patient’s prescribed range).
If the patient is hypoxaemic, oxygen saturations of between 94 – 98% should be maintained through the use of a mask or nasal cannulae as appropriate.
At the correct flow rate the following devices will deliver the following approximate FiO2:

Mask Fraction of Inspired O2 (FiO2) Flow-rate
Nasal cannulae 24 - 35% 1 - 4 litres per minute
Simple face mask 40 - 60% 5 - 8 litres per minute
Non-rebreather mask 60 - 100% 10 - 15 litres per minute
Bag-valve-mask 100% 15 litres per minut

74
Q

Dose - Fentanyl - IV/IO

A

Ramped patients must not have loading doses administered - maintenance doses (maximum 25 microg) to effect as required.
Adult < 70 years old:

Pre-hospital loading dose: titrate 1 microg/kg, slow push over 3-5 minutes (maximum single dose: 100 microg)
Subsequent dose: 25 microg to effect every 5 minutes, titrated to effect
Adult > 70 years old or frail:

Pre-hospital loading dose: titrate 0.5 microg/kg slow push over 3-5 minutes (maximum single dose: 50 microg)
Subsequent dose: 25 microg to effect every 5 minutes, titrated to effect
Paediatric:

Pre-hospital loading dose: titrate 0.5-1 microg/kg, slow push over 3-5 minutes (maximum single dose: 25 microg)
Subsequent dose: 1 microg/kg (up to 25 microg) every 5 minutes, titrated to effect

75
Q

Dose - Fentanyl - IN

A

Weight Initial Dose Subsequent at 5-10 minutes Subsequent IV Dose if required
< 20 kg 1 x 0.05 mL
(15 microg) 1 x 0.05 mL
(15 microg) Up to 1 microg/kg titrated to effect every 5 minutes
(Maximum bolus dose 25 microg each time)
21 - 30 kg 1 x 0.10 mL
(30 microg) 1 x 0.10 mL
(30 microg) Up to 1 microg/kg titrated to effect every 5 minutes
(Maximum bolus dose 25 microg each time).
31 - 40 kg 1 x 0.15 mL
(45 microg) 1 x 0.15 mL
(45 microg) Subsequent dose 25 microg titrated to effect every 5 minutes
Small / elderly / frail 2 x 0.2 mL
(120 microg) 1 x 0.2 mL
(60 microg) Subsequent dose 25 microg titrated to effect every 5 minutes
Adult 3 x 0.2 mL
(180 microg) 1 x 0.2 mL
(60 microg) Subsequent dose 25 microg titrated to effect every 5 minutes
Subsequent IN dosages can be administered every 5-10minutes, titrated to effect.

76
Q

Dose - Olanzapine
Adult <70, >70/frail, Paed >40kg, Paed <40kg

A

Adults < 70 years old:

10 mg
Repeat as necessary after 15 mins to maximum cumulative dose 20 mg/24 hrs (via all routes).
Adults > 70 years old or frail:

5 mg
Repeat as necessary after 15 mins to maximum cumulative dose 10 mg/24 hrs (via all routes).
Paediatric 6 - 15 years old, > 40kg:

5 - 10 mg
Repeat as necessary after 15 mins to maximum cumulative dose 20 mg/24 hrs (via all routes).
Paediatric < 40kg

ASMA consult required

77
Q

Dose - Normal saline - Shock/DKA/HHS

A

Adult:

250ml boluses to a maximum total of 2000ml
Small adult/elderly 250ml boluses up to maximum total of 1000ml
Paediatric:

10ml/kg over 5-10 minutes. Repeat once only

78
Q

Dose - NS - CA
Adult, Paed & Newborn

A

Adult / Paediatric:

20ml/kg bolus as a reversible cause of hypovolaemia
Newborn:

10ml/kg as a reversible cause of hypovolaemia

79
Q

Dose - NS Post-ROSC

A

Adult:

250ml boluses to a maximum total of 500ml with reassessment between each infusion
Paediatric:

10ml/kg, repeat once only with reassessment between each infusion (bolus max. 250ml)

80
Q

NS burns criteria adult & paed
Dose - NS - Burns
Timing

A

Apply modified Parkland Formula to patients that meet the following criteria:
Adults:

> 15% TBSA
Paediatrics:

≥ 18 months and > 10% TBSA OR
< 18 months and > 8% TBSA

Modified Parkland Formula:
2ml x %TBSA x weight of patient
50% of total amount over first 8 hours
50% of total amount over next 16 hours

StJA(WA) (8 decks)

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