indications/contra/precau

Question 1

salbutamol

Answer 1

indication: respiratory distress with bronchospasm: asthma or COPD
contras: nil
precautions: large doses may cause intracellular metabolic acidosis

Question 1

ipratropium bromide

Answer 1

indications: severe respiratory distress with broncospasm or exacerbation of COPD irrespective of severity
contra: hypersensitivity to atropine or its derivatives
precaut: avoid contact with the eyes, glaucoma

Question 2

dexamethasone

Answer 2

indica: bronchospasm associated with acute respiratory distress not responding to nebulised salbutamol
contra: hypersensitivity
precau: solutions not clear or contaminated should be discarded

Question 3

adrenaline

Answer 3

indica: severe asthma: not responding to nebulised therapy or unconscious with no BP
contra: hypovolaemic shock without adequate fluid replacement
precaut: elderly/frail

Question 4

aspirin

Answer 4

indic: ACS
contra: hypersensitivity to aspirin, actively bleeding peptic ulcers, bleeding disorders, suspected dissecting aortic aneurysm, chest pain associated with psychostimulant OD if SBP >160
prec: asthma, pts on anticoagulants

Question 5

GTN contras

Answer 5

1. hypersensitivity
2. SBP <110 - tablet
3. SBP <90 - patch
4. viagra or levitra administration in prev 24hrs or Cialis administration in prev 4 days
5. HR >150bpm
6. bradycardia HR <50bmp
7. VT
8. inferior STEMI with SBP <160
9. right ventricular MI

Question 6

GTN indications + precautions

Answer 6

indi: chest pain with ACS
prec: no previous administration

Question 7

morphine

Answer 7

indi: paint relief
conta: hypersensitivity, renal impairment or failure, late second stage of labour
prec: respiratory depression, asthma, addiction to opioids, acute alcoholism

Question 8

fentanyl

Answer 8

indic: analgesia
contra: hypersensitivity, late second stage of labour
prec: respiratory depression, known addiction to opioids, facial trauma

Question 9

methoxyflurane

Answer 9

indic: pain relief
contra: pre-existing renal disease/impairment, concurrent use of tetracycline antibiotics, exceeding max dose of 6ml, personal or family hx of malignant hyperthermia, muscular dystrophy
prec: pts must be conscious to hold own inhaler

Question 10

paracetamol

Answer 10

indi: mild pain, headache
contra: hypersensitivity, <1month of age, already administered within 4 hours, total intake within 24hrs exceeding 4g (adults) or 60mg/kg (children), chest pain suspected ACS
prec: malnourished, elderly

Question 11

naloxone

Answer 11

indic: altered conscious state + respiratory depression secondary to administration of opioids or related drugs
contra: nil
prec: if pt is dependant on opioids be prepared for combative pt after administration

Question 11

dextrose 10%

Answer 11

indic: diabetic hypoglycaemia (BGL <4) in pts with altered conscious state who are unable to self-administer oral glucose
contra: nil
prec: nil

Question 12

ketamine

Answer 12

indic: intubation, analgesia, sedation
contra: suspected non-traumatic brain injury with severe hypotension
prec: may exacerbate cardiovascular conditions due to effects on HR and BP

Question 13

glucagon

Answer 13

indic: diabetic hypoglycaemia (BGL <4) in pts with an altered conscious state unable to self-administer oral glucose
contra: nil
prec: nil