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AT Drug Therapy Protocols > Indications and Contraindications > Flashcards

Indications and Contraindications Flashcards

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1
Q

Adenosine Presentation

A

6mg in 2ml amp

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2
Q

Adenosine Pharmacology

A

AV nodal anti-arrhythmic

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3
Q

Adenosine Metabolism

A

Adenosine is rapidly cleared from the circulation via cellular uptake

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4
Q

Adenosine Indications (2)

A

1- Regular Supra-ventricular Tachycardia (SVT) ((narrow complex QRS <0.12s))

2 - Regular Supra-ventricular Tachycardia with ventricular aberrancy of conduction (SVT-A)

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5
Q

Adenosine Contraindications (4)

A

1 - History of second or third degree heart block or sick sinus syndrome (except for patients with a functioning artificial pacemaker)

2 - Sinus node disease, such as sick sinus syndrome

3 - Chronic obstructive lung disease eg. Asthma

4 - Known hypersensitivity to Adenosine. (Very rare)

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6
Q

Adenosine Precautions (2)

A

1 - Current dipyramole (anitplatelet agent) therapy (Asantin, Persantin)

2 - Pts on carbamazepine (tegretol)

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7
Q

Adenosine Route of Administration

A

Intravenous (rapid push bolus)

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8
Q

Adenosine Side Effects

A

Adenosine has an extremely short half life: 6 to 10 seconds. Thus any adverse effects are self rectifying.
- Facial Flushing
- Dyspnoea
- Headache
- Anxiety
- Bronchospasm
- Hypotension

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9
Q

Adenosine Special Notes

A

Adenosine is not effective in converting atrial fibrillation, atrial flutter or ventricular tachycardia.

If adenosine is administered for atrial fibrillation in a patient with Wolf-Parkinson-White syndrome (perhaps previously undiagnosed) the blockade of the AV node may lead to increased conduction via AV accessory pathway(s) and initiate ventricular fibrillation. Thus the field indications for adenosine include regular SVT only.

Interactions

  • Caffeine, aminophylline and theophylline block the adenosine receptors and the full incremental dosage may be required.
  • Carbamazepine (‘Tegretol’) can increase the level of atrioventricular block. Reduced dosage by half should be considered.
  • Dipyramole (a platelet aggregation inhibitor) increases the plasma levels and cardiovascular effects of Adenosine. Reducing dose by half should be considered.
  • Heart Transplant recipients should receive half doses.
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10
Q

Adrenaline Presentation

A

1mg in 1ml amp (1:1,000)

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11
Q

Adrenaline Pharmacology

A

A naturally occurring Alpha and Beta-adrenergic stimulant

Actions:
- Increases pulse rate by increasing S.A. Node firing rate (Beta 1)
- Increases conduction velocity through the A.V. Node (Beta 1)
- Increases myocardial contractility (Beta 1)
Increases the irritability of the ventricles (Beta 1)
- Causes bronchodilatation (Beta 2)
- Causes peripheral vasoconstriction (Alpha)

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12
Q

Adrenaline Metabolism

A

By monoamine oxidase and other enzymes in blood, liver and around nerve endings and excreted by the kidneys

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13
Q

Adrenaline Indications (10)

A

1 - Persistent ventricular fibrillation or unconscious pulseless ventricular tachycardia

2 - Asystole

3 - Electro‑mechanical dissociation/PEA

4 - Inadequate perfusion (Cardiogenic)

5 - Inadequate perfusion (Non Cardiogenic – Non Hypovolaemic)

6 - Anaphylactic reactions

7 - Severe asthma

8 - Unconscious asthma with no blood pressure

9 - Croup or suspected croup/ epiglottitis.

10 - Bradycardia with poor perfusion

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14
Q

Adrenaline Contraindications (1)

A

Hypovolaemic shock without adequate fluid replacement

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15
Q

Adrenaline Precautions

A

1 Elderly Pts

2 - Pts with cardiovascular disease

3 - Pts on monoamine oxidase (MAO) inhibitors

4 - Pts on Beta blockers as higher doses may be required

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16
Q

Adrenaline Route of Administration

A
  • Intravenous
  • Intramuscular
  • Endotracheal
  • Nebuliser
  • Intravenous Infusion
  • Intraosseous
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17
Q

Adrenaline Side Effects

A
  • Sinus tachycardia
  • Supraventricular arrhythmias
  • Ventricular arrhythmias
  • Hypertension
  • Pupillary dilatation
  • May increase size of myocardial infarction
  • Feeling of “anxiety/palpitations” in the conscious Pt
  • Muscle tremor
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18
Q

Adrenaline Special Notes

A

Intravenous Adrenaline should be reserved for life threatening situations.

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19
Q

Adrenaline Times

A

IV
Onset 30sec
Peak 3 - 5min
Duration 5 - 10min

IM
Onset 30 - 90sec
Peak 4 - 10mins
Duration 5 - 10min

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20
Q

Amiodarone Presentation

A

150mg in 3ml amp

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21
Q

Amiodarone Pharmacology

A

A Class III anti-arrhythmic agent

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22
Q

Amiodarone Metabolism

A

By the liver

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23
Q

Amiodarone Indications (2)

A

1 - Ventricular Fibrillation/Pulseless Ventricular Tachycardia refractory to cardioversion

2 - Sustained or recurrent Ventricular Tachycardia

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24
Q

Amiodarone Contraindications

A

1- Ventricular Tachycardia
Inadequate perfusion and deteriorating rapidly
Pregnancy

2 - Known hypersensitivity to Amiodarone or Iodine.

3 - Tricyclic antidepressant medication Overdose

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25
Amiodarone Precautions
Nil significant
26
Amiodarone Route of Administration
IV
27
Amiodarone Side Effects
- Hypotension - Bradycardia
28
Amiodarone Times
Onset 2min Peak 20min Duration 120min
29
Amiodarone Special Notes
Amiodarone is incompatible with saline. Glucose 5% must be used as dilutant when administered to the conscious Pt.
30
Aspirin Presentation
300mg chewable tablets 300mg soluble or water dispersible tablets
31
Aspirin Pharmacology
An analgesic, antipyretic, anti-inflammatory and antiplatelet aggregation agent. Actions: - Reduces platelet aggregation - Inhibits synthesis of prostaglandins - anti-inflammatory actions
32
Aspirin Metabolism
Converted to salicylate in the gut mucosa and liver, excreted mainly by the kidneys
33
Aspirin Indication
To minimize platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in acute coronary syndrome
34
Aspirin Contraindications (5)
1 - Hypersensitivity to aspirin/salicylates 2 - Actively bleeding peptic ulcers 3 - Bleeding disorders 4 - Suspected dissecting aortic aneurysm 5 - Chest pain associated with psychostimulant overdose if BP > 160
35
Aspirin Route of Administration
Oral
36
Aspirin Precautions (3)
1 - Peptic ulcer 2 - Asthma 3 - Pts on anti-coagulants, e.g. Warfarin
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Aspirin Side Effects
- Heartburn, nausea, gastrointestinal bleeding - Increased bleeding time - Hypersensitivity reactions
39
Aspirin Special Notes
Aspirin is contra-indicated for use in acute febrile illness in pts less than 12 years of age as it may lead to renal function impairment and Reye’s syndrome. The anti-platelet effects of Aspirin persists for the natural life of platelets Aspirin is absorbed from the stomach and duodenum to reach peak levels within 15 mins and has a half-life of approximately 30 mins. It is therefore important to administer Aspirin for suspected AMI even if patient is on daily dose
40
Atropine Presentation
600mcg/1ml
41
Atropine Pharmacology
An anticholinergic agent Actions: - inhibits the actions of acetylcholine on post-ganglionic cholinergic nerves at the neuro-effector site, e.g. as a vagal blocker and allows sympathetic effect to: = increase pulse rate by increasing S.A. Node firing rate = increase the conduction velocity through the A.V. Node - antidote to reverse the effects of cholinesterase inhibitors, e.g. organophosphate insecticides, at the post-ganglionic neuro-effector sites of cholinergic nerves, i.e. reduces the excessive salivary, sweat, gastrointestinal, and bronchial secretions, and relaxes smooth muscles.
42
Atropine Metabolism
By the liver and excreted mainly by the kidneys
43
Atropine Indications (3)
1 - Bradycardia with less than adequate perfusion 2 - Organophosphate poisoning with excessive cholinergic effects 3 - Nerve agent poisoning
44
Atropine Contraindications
Nil significant
45
Atropine Precautions (4)
1 - Atrial flutter 2 - Atrial fibrillation 3 - Do not increase heart rate above 100/min except in children under 6 years 4 - Glaucoma
46
Atropine Route of Administration
IV IM IO
47
Atropine Side Effects
- Tachycardia - Palpitations - Dry mouth - Dilated pupils - Visual blurring - Retention of urine - Confusion, restlessness (in large doses) - Hot, dry skin (in large doses)
48
Atropine Times
Onset < 2min Peak < 5min Duration 2 – 6hrs
49
Ceftriaxone Presentation
1g sterile powder in vial
50
Ceftriaxone Pharmacology
Cephalosporin Antibiotic
51
Ceftriaxone Metabolism
Excreted unchanged in urine (33% - 67%) and in bile
52
Ceftriaxone Indications (2)
1 - Suspected Meningococcal Septicaemia 2 - Severe Sepsis (Consult only)
53
Ceftriaxone Contraindications
Allergy to Cephalosporin Antibiotics
54
Ceftriaxone Precautions
Allergy to Penicillin Antibiotics
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Ceftriaxone Routes of Administration
Intravenous route (preferred) Intramuscular route (if IV access unable to be obtained)
56
Ceftriaxone Side
Nausea and Vomiting Skin Rash
57
Ceftriaxone Adult vs Paediatric Doses
Adult 2g IV or IM Paediatric 50mg/kg IV or IM (Max = 2g IV or IM)
58
Ceftriaxone Special Notes
Ceftriaxone IV must be made up to 10ml using normal saline and administrered over 2 minutes. Ceftriaxone IM must be made up to 4ml using 1% Lignocaine and administered in the lateral upper thigh. (Ceftriaxone without Lignocaine is extremely painful) Expect possible deterioration in a subgroup of patients following Ceftriaxone administration
59
Clopidogrel Presentation
300mg tablet
60
Clopidogrel Pharmacology
Clopidogrel is an antiplatelet medication that inhibits platelet aggregation by irreversibly binding to the adenosine diphosphate receptor (P2Y12) on platelets, thereby preventing activation of the ADP mediated glycoprotein GP IIb/IIIa complex, which is necessary for platelet aggregation.
61
Clopidogrel Metabolism
Hepatic with renal and faecal excretion
62
Clopidogrel Indication
Pts with STEMI who have been approved for thrombolysis by the Ambulance Tasmania Retrieval Consultant
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Clopidogrel Contraindications (2)
1 - Allergy to clopidogrel 2 - Patients who are contraindicated as per the Ambulance Tasmania Reperfusion Checklist
64
Clopidogrel Precautions
Renal impairment
65
Clopidogrel route of administration
Oral
66
Clopidogrel side effects
Haemorrhage
67
Dexamethasone Presentation
8mg in 2ml Glass Vial
68
Dexamethasone Pharmacology
A corticosteroid secreted by the adrenal cortex Actions: Relieves inflammatory reactions and provides immunosuppression
69
Dexamethasone Metabolism
By the liver and other tissues, and excreted predominantly by the kidneys
70
Dexamethasone Indications (4)
1 - Bronchospasm associated with acute respiratory distress not responsive to nebulised Salbutamol 2 - Acute Exacerbation of COPD 3 - Suspected Croup 4 - Severe COVID-19
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Dexamethasone Contraindications
Known hypersensitivity to Dexamethasone or other corticosteroids
73
Dexamethasone Precautions
Usually only relevant with prolonged use and high doses
74
Dexamethasone route of administration
IV IM Oral (paediatric pts)
75
Dexamethasone Side effects
Except for allergic reactions, adverse effects are usually only associated with prolonged use and high doses
76
Dexamethasone special notes
Does not contain an antimicrobial agent, therefore use solution immediately and discard any residue Dexamethasone can be administered orally to paediatric patients where IV access is not appropriate or feasible. Consider mixing the medication with a small volume of a sweet drink/yoghurt to aid administration.
77
Dexamethasone times
Onset 30 – 60min Peak 2hrs Duration 36 – 72hrs
78
Diazepam Presentation
5mg tablets
79
Diazepam Pharmacology
Is a member of the benzodiazepines family and exhibits anxiolytic and sedative effects
80
Diazepam Metabolism
Excreted in urine as inactive metabolites
81
Diazepam Indications (2)
1 - Acute Behavioural Disturbances (with SAT score >0) 2 - Palliative Care/End of Life Care
82
Diazepam Contraindications (2)
1 - Known allergy or adverse drug reaction to benzodiazepines 2 - Myasthenia gravis
83
Diazepam Precautions (5)
1 - CNS depression or ingestion of CNS depressing agents including alcohol 2 - Hypotension 3 - Use in children and the elderly 4 - Impaired renal or hepatic function 5 - Respiratory insufficency
84
Diazepam route of administration
oral
85
Diazepam side effects
Extrapyramidal effects e.g. dystonic reactions (rare)
86
Diazepam times
Rapidly absorbed via oral route Peak: 30 - 90 min
87
Droperidol Presentation
10mg in 2mL glass vial
88
Droperidol Pharmacology
Antipsychotic Actions: - Inhibit dopamine mediated neurotransmission in the cerebrum and basal ganglia. - Droperidol also inhibits the chemo-receptor trigger zone in the medulla.
89
Droperidol Metabolism
Hepatic metabolism with bilary/renal excretion as inactive metabolites
90
Droperidol Indications
Acute Behavioural Disturbances (with SAT score +2 or +3)
91
Droperidol Contraindications (4)
1 - Known allergy or adverse drug reaction 2 - Parkinson’s Disease 3 - Previous dystonic reaction to droperidol 4 - Patients <8 years
92
Droperidol Precautions
Concomitant use of CNS depressants
93
Droperidol Route of administration
IM or IV
94
Droperidol side effects
Extrapyramidal effects e.g. dystonic reactions (rare)
95
Droperidol times
Onset 5 - 15min Peak 4 - 6hrs There is no significant difference in the onset of effect following IM or IV injection
96
Enoxaparin presentation
60mg in 0.6mL enoxaparin prefilled syringe for IV use 100mg in 1mL enoxaparin prefilled syringe for SC use
97
Enoxaparin Pharmacology
Enoxaparin is an anticoagulant medication that binds to anti-thrombin III, causing inhibition of factor Xa and factor IIa. It is similar in structure and action to heparin. However, enoxaparin generally provides a greater safety profile and more predictable response when compared to heparin due to an increase in the ratio between anti factor Xa and anti-factor IIa.
98
Enoxaparin Metabolism
Hepatic
99
Enoxaparin Indications
Pts with STEMI who have been approved for thrombolysis by the Ambulance Tasmania Retrieval Consultant
100
Enoxaparin Contraindications (2)
1 - Allergy to enoxaparin 2 - Patients who are contraindicated as per the Ambulance Tasmania Reperfusion Checklist
101
Enoxaparin Precautions
Renal impairment
102
Enoxaparin route of administration
IV Subcut
103
Enoxaparin side effects
Haemorrhage
104
Enoxaparin special notes
Enoxaparin comes in prefilled syringes for IV/SC injection. Prepare the syringe by expelling unwanted medication before administration. For IV boluses, also expel the air bubble prior to administration.
105
Ergometrine Presentation
500 mcg in 1 ml 250 mcg in 1 ml – amp
106
Ergometrine Pharmacology
Causes contraction of the uterus and vascular smooth muscle General vasoconstriction
107
Ergometrine Metabolism
Principally by the liver
108
Ergometrine Indications
Post-partum and post-abortal haemorrhage greater than 600 mls, when it is certain that all foetuses have delivered
109
Ergometrine Contraindications (3)
1 - Known allergy 2 - Past Hx of pre-eclampsia (Pregnancy induced hypertension) 3 - Hypertension
110
Ergometrine Side Effects
Allergic reaction - anaphylaxis Hypertension
111
Ergometrine route of administration
IV Slow push
112
Ergometrine Special Notes
The human uterus becomes more sensitive to oxytocics in the course of pregnancy and becomes most sensitive near the time of parturition. Ergometrine produces a firm tonic contraction within 5 minutes lasting 90 mins. Storage: Refrigerated at between 2-8° C Ampoules should be individually wrapped in aluminium foil, and marked with an expiry date of five months from time it is removed from refrigeration
113

AT Drug Therapy Protocols (1 decks)

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