Medications Flashcards
(213 cards)
1
Q
Adrenaline MOA
A
- Adrenaline stimulates the alpha and beta receptors with predominant effects occurring at alpha 1, beta 1 and beta 2 receptors
- Alpha 1 stimulation causes smooth muscle contraction, vasoconstriction of blood vessels and stimulation of glycogenolysis and gluconeogenesis
- Beta 1 stimulation causes an increase in inotropy (cardiac contractility), chronotropy (HR) and dromotopy (speed of electrical conduction within the heart).
2
Q
Scopes of practice adrenaline
A
EMTS: Nebulised, IM, IN and tropical adrenaline
Paramedics: All of the above and adrenaline IV for cardiac arrests
3
Q
Indications for adrenaline
A
Cardiac arrest
Anaphylaxis
Severe asthma
Imminent respiratory arrest from COPD
Severe bradycardia
BP support if unresponsive to to metaraminol
Septic shock, cardiogenic shock, and neurogenic shock unresponsive to 0.9% sodium chloride IV and metaraminol IV
Stridor causing moderate to severe respiratory distress
IN for clinically significant epistaxis
Topical for clinically significant bleeding from a wound
4
Q
Contraindications for adrenaline
A
Nil
5
Q
Cautions for adrenaline
A
Myocardial ischaemia. Adrenaline will increase myocardial oxygen consumption
Tachydysrhythmias. Adrenaline will usually make it worse
6
Q
Use in pregnancy adrenaline
A
Safe and should be administered when indicated
7
Q
Administration for adrenaline TOPICAL
A
Dilute each mg of adrenaline to a total of 10ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1mg/ml.
8
Q
Administration for adrenaline IN
A
Dilute each mg of adrenaline to a total of 10ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1mg/ml. Administer the appropriate dose into each bleeding nostril using a MAD
9
Q
Administration for adrenaline NEBULISED
A
5mg undiluted
10
Q
Administration for adrenaline IM
A
Undiluted. Preferred site is lateral thigh but if not suitable use upper arm
11
Q
Administration for adrenaline in cardiac arrest
A
Adults and children whose weight is >50kg, administer undiluted as a bolus
Children weighing <40kg, dilute 1mg to a total of 10ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1mg/ml. Draw up the dose from this solution and administer as an IV bolus.
12
Q
Usual onset of effect adrenaline
A
IV: 5-10 seconds
IM: 2-5 minutes
Nebulised, IN and topical: On contact with the target site
13
Q
Usual duration of effect adrenaline
A
The cardiovascular effects last 5-15 minutes
The mast cell membrane effects may last for several hours
14
Q
Usual preparation of adrenaline
A
Ampoule 1mg in 1ml
15
Q
Pharmacokinetics adrenaline
A
Adrenaline is metabolised by the liver and taken up by sympathetic nerve endings.
There are no significant effects from liver impairment on acute administration.
16
Q
Common interactions adrenaline
A
Increased doses may be required if the patient is taking a beta-blocker or a calcium channel blocker. This effect is particularly prominent in the setting of poisoning if a large dose of a beta-blocker and/or calcium channel blocker has been taken.
17
Q
Amiodarone MOA
A
Amiodarone is an antidysrhythmic with a broad spectrum of activity.
Amiodarone has class III activity. it prolongs the action potential duration, reduces the automaticity and prolongs the refractory period of atrial, nodal and ventricular tissues.
The electrophysiological effects result in a reduction in abnormal electrical activity (e.g ectopy), a reduction in electrical conduction, a reduction in HR and a stabilisation of the SA and AV nodes.
Amiodarone also causes a small increase in coronary blood flow (not usually clinically significant) and a reduction in myocardial oxygen consumption by reducing inotropy (force of cardiac contraction)
18
Q
Scopes of practice Amiodarone
A
Paramedics: Cardiac arrest
19
Q
Indications for amiodarone
A
Cardiac arrest with VF or VT at any time after the first dose of adrenaline
Adults with sustained VT in the absence of cardiac arrest
Adults with moderate cardiovascular compromise as a result of fast atrial fibrillation or atrial flutter
20
Q
Contraindications for amiodarone
A
Known severe allergy.
Known severe allergy to iodine.
VT secondary to cyclic antidepressant poisoning. In this setting amiodarone administration can be associated with severe worsening of shock without resolution of the rhythm
21
Q
Cautions for amiodarone
A
None if the patient is in cardiac arrest.
Poor perfusion or signs of low cardiac output. Amiodarone reduces inotropy and may cause a fall in cardiac output, particularly when administered rapidly.
Hypotension. Amiodarone causes vasodilation and may worsen hypotension, particularly when administered rapidly.
Atrial fibrillation associated with sepsis. May cause a significant fall in cardiac output.
Known sick sinus syndrome without an internal pacemaker in place. Amiodarone slows the HR and severe bradycardia may occur following reversion of the tachydysrhythmia.
Previous 2nd or 3rd degree heart block without an internal pacemaker in place. Amiodarone slows the heart rate and severe bradycardia may occur following reversion of a tachydysrhythmia.
Pregnancy
22
Q
Use in pregnancy amiodarone
A
May cause harm during pregnancy. Do not administer unless there is a strong clinical indication to.
May be administered if patient is breastfeeding. Advise pt stop breastfeeding and seek further advice from their lead maternity carer or GP.
23
Q
Dosage amiodarone
A
Cardiac arrest:
300mg for an adult, if VF/VT persists a second dose of 150mg may be administered.
Seek paed dose table for paed dosages
24
Q
Administration amiodarone
A
Cardiac arrest: administer IV undiluted as a bolus
25
Common adverse effects amiodarone
Hypotension
Lightheadedness
Bradydysrhythmia
26
Usual onset of effect amiodarone
5-10 minutes
27
Usual duration of effect amiodarone
1-4 hours after a single dose
Amiodarone is taken up into tissues and slowly released. This may result in a prolonged half-life, particularly when one or more doses have been administered.
28
Usual preparation amiodarone
Ampoule containing 150mg in 3ml.
29
Pharmacokinetics amiodarone
Metabolised in the liver.
No significant effects from liver impairment on acute administration.
30
Common interactions amiodarone
May potentiate the action of cyclic antidepressants in cyclic poisoning.
May cause bradydysrhythmia following reversion of dysrhythmia if the pt is taking a betablocker and/or centrally acting calcium channel blocker.
31
Aspirin MOA
Aspirin has antiplatelet, antipyretic, anti-inflammatory and analgesic effects. In the prehospital setting only administered for antiplatelet activity
Aspirin inhibits the enzyme cyclooxygenase which results in a reduction in the formation of prostaglandins and thromboxane.
32
Aspirin scopes
EMTS, paramedics, icps
33
Indications for Aspirin
Myocardial ischemia
STEMI
34
Contraindications for Aspirin
Known severe allergy.
Third trimester pregnancy.
35
Cautions for Aspirin
Known bleeding disorder. Aspirin will increase the risk of bleeding, however the balance of risk is usually in favour of administering aspirin.
Clinically significant bleeding.
Known worsening bronchospasm with NSAIDS.
36
Use in pregnancy Aspirin
May cause harm during pregnancy. Aspirin has been associated with premature delivery and premature closure of the ductus arteriosus when administered in the third trimester of pregnancy.
Likelihood of clinically important myocardial ischemia occurring in a woman who is pregnant is so low that the balance of risk is in favour of aspirin being withheld.
May be administered if breastfeeding.
37
Dosage for Aspirin
300mg tablet
38
Administration for Aspirin
Administer PO. Chew tablet or dissolved in water.
39
Usual onset of effect Aspirin
30-60 minutes
40
Usual duration of effect Aspirin
3-5 days for the antiplatelet activity. Platelets exposed to aspirin are impaired for the life of the platelet which is 7-10days.
41
Usual preparation Aspirin
300mg tablet
42
Pharmacokinetics Aspirin
Absorption occurs in the stomach and small intestine.
Aspirin is predominantly metabolised in the liver.
No significant effects from liver impairment on acute administration
43
Cefazolin MOA
Cefazolin is a first-generation cephalosporin antibiotic with activity against gram negative and gram-positive bacteria. It inhibits production of the bacterial cell wall causing bacteria to die.
44
Scopes of practice Cefazolin
Paramedics, ICPs and CCPs
45
Indications Cefazolin
Sepsis, where the source of the infection appears to be the soft tissues or joint and:
The patient is aged >12yrs
Has one or more clinical features indicating taking antibiotics and
Time to hospital is >30 minutes.
Cellulitis. In this setting a single dose may be administered if the patient is not being directly referred or transported to a medical facility.
46
Contraindications Cefazolin
Known severe allergy to cephalosporins.
47
Cautions Cefazolin
None
48
Use in pregnancy Cefazolin
Safe and should be administered if indicated.
49
Dosage Cefazolin
1G IV
50
Administration Cefazolin
Add 4ml of 0.9% Sodium Chloride to a 1G ampoule and shake until dissolved.
Draw up the ampoule contents and dilute to a total of 10ml.
Administer IV over 1-2 minutes preferably into a running line.
51
Common adverse effects Cefazolin
None
52
Usual onset of effect Cefazolin
30-60 minutes
53
Usual duration of effect Cefazolin
6-8 hours
54
Usual presentation Cefazolin
Ampoule containing 1g of Cefazolin as a powder for reconstitution
55
Pharmacokinetics Cefazolin
Cefazolin is predominantly excreted in the urine.
Clearance is prolonged if the patient has significant kidney impairment but does not alter the initial dose.
56
Common interactions Cefazolin
N/A
57
Ceftriaxone MOA
Ceftriaxone is a cephalosporin antibiotic with broad activity against gram-negative and gram-positive bacteria. It inhibits production of the bacterial cell wall, causing bacteria to die.
58
Delegated scopes Ceftriaxone
Paramedics, ICPs, CCPs
59
Indications Ceftriaxone
Suspected meningococcal septicaemia.
Sepsis, where Cefazolin is not indicated and:
Pt is aged >12 years.
One or more clinical features indicating antibiotics are present and
Time to hospital >30 mins.
60
Contraindications Ceftriaxone
Anaphylaxis to Cephalosporins
61
Cautions Ceftriaxone
None
62
Use in pregnancy Ceftriaxone
Safe and should be administered if indicated.
63
Dosage Ceftriaxone
2g IV for an adult
2 g IM for an adult if IV access cannot be immediately obtained (Meningococcal septicaemia only).
See paeds dose table for a child.
64
Administration Ceftriaxone
IV:
Add 4ml of 0.9% sodium chloride to a 2g ampoule, shake until dissolved.
Draw up the ampoule and dilute to a total of 10ml.
Discard unrequired volume before administration for a child.
Administer IV over 1-2 min preferably in a running line.
IM:
Add 4ml of 0.9% sodium chloride to a 2g ampoule, shake until dissolved.
Draw up the ampoule using 2 syringes with approximately half in each. Total volume will be 5ml.
Discard unrequired volume before administration for a child.
Administer one syringe into each lateral thigh.
65
Common adverse effects Ceftriaxone
None
66
Usual onset of effect Ceftriaxone
30-60 minutes
67
Usual duration of effect Ceftriaxone
24 hours
68
Usual preparation Ceftriaxone
Ampoule containing 2 g of ceftriaxone as a powder for reconstitution.
69
Pharmacokinetics Ceftriaxone
50% is excreted in urine and 50% in bile.
Neither renal impairment nor hepatic impairment after initial dose.
70
Clopidogrel MOA
Clopidogrel has antiplatelet activity.
Clopidogrel antagonises (blocks) the binding of adenosine diphosphate (ADP) to platelets and impairs platelet function. Clopidogrel provides significantly more antiplatelet activity than aspirin.
71
Delegated scopes Clopidogrel
Paramedics, ICPs, CCPs
72
Indications Clopidogrel
STEMI, in conjunction with fibrinolytic therapy
73
Contraindications Clopidogrel
Known severe allergy.
74
Cautions Clopidogrel
Clinically significant bleeding. Clopidogrel will increase bleeding.
At risk of bleeding, any cautions present within the fibrinolytic therapy checklist, personnel must seek advice.
Pregnancy.
75
Use in pregnancy Clopidogrel
Safety has not been demonstrated during pregnancy. Likelihood of STEMI in pregnancy is so low that personnel must seek clinical advice.
May be administered if pt is breastfeeding.
76
Dosage Clopidogrel
300mg if patient is aged <75.
75mg if the patient is aged >75.
77
Administration Clopidogrel
PO
78
Common adverse effects Clopidogrel
Increased bleeding
79
Usual onset of effect Clopidogrel
30-60 minutes
80
Usual duration of effect Clopidogrel
3-5 days. Refer to aspirin duration
81
Usual preparation Clopidogrel
75mg tablets
82
Pharmacokinetics Clopidogrel
A prodrug and must be metabolised to the active form of the liver.
No significant effects from liver impairment on acute administration.
83
Common interactions Clopidogrel
The risk of bleeding will be increased if the patient is taking an anticoagulant.
84
Droperidol MOA
Droperidol blocks dopamine and alpha receptors centrally, resulting in sedation, reduced agitation and a state of mental detachment, and antiemetic action.
85
Delegated scopes Droperidol
Paramedics, ICPs, CCPs
86
Indications Droperidol
Patients aged >12 years with acute behavioural disturbance causing a mild to moderate risk to safety, when olanzapine has been administered or is ineffective.
Moderate to severe pain associated with one of the following despite opiate analgesia and ketamine not appropriate:
Chronic or complex pain
Chronic use of opiates
Severe headache
Severe pain associated with agitation
Pain associated with severe nausea and/or vomiting.
Management of agitation or pain that does not respond to an opiate during end of life care.
Nausea and/or vomiting that persists despite ondansetron or where motion sickness is a component of the patients nausea/vomiting.
87
Contraindications Droperidol
Known severe allergy.
Aged <12 years.
Pregnancy (analgesia and nausea/vomiting only).
88
Cautions Droperidol
ALOC. Increases and prolongs effects.
Parkinsons disease. Risk of worsening the movement disorder associated with parkinsons disease.
Concurrent administration of ketamine or midazolam. Increases and prolongs effects.
Aged >75 years, particularly if frail. Effects will be increased and prolonged.
Signs of shock. Droperidol will make shock worse.
89
Use in pregnancy
Likelihood of requiring droperidol for breastfeeding or pregnant patient with acute behavioural disturbance is very low, however, the balance of risk is such that it should be administered if indicated in this context.
In the context of analgesia and nausea and/or vomiting, the balance of risk is not in favour of administration of droperidol and therefore is contraindicated.
90
Dosage Droperidol
Analgesia: 1.25mg IV for an adult, once only. Consider reducing the dose to 0.625mg if a caution is present.
For ABD: 10 mg IV or IM, consider reducing to 5mg if a caution is present, can be repeated after 20 minutes.
End of life care: 2.5mg IV/IM/SC, dose may be repeated as required
Nausea and/or vomiting: 0.625mg IV/IM for an adult, once only.
91
Administration Droperidol
IV in ABD:
Draw up required dosage into 10ml syringe, dilute to total of 10ml using 0.9% sodium chloride. Administer over 1-2 minutes.
IV for nausea/vomiting:
Draw up 2.5mg into 5ml syringe and dilute to 4ml using 0.9% sodium chloride. This gives a 0.625mg/ml solution. Administer the required dose as an IV bolus.
IM:
Administer undiluted.
SC:
Administer undiluted subcutaneously into abdominal wall.
92
Common adverse effects Droperidol
Hypotension. May occur if a large IV dose is administered rapidly.
93
Usual onset of effect Droperidol
IV/IM: 5-10 minutes
94
Usual duration effect Droperidol
4-6 hours
95
Usual preparation Droperidol
Ampoule containing 2.5mg in 1ml
96
Pharmacokinetics Droperidol
Predominantly metabolised in the liver with metabolites being excreted in the urine.
There are no significant effects from liver impairment on acute administration.
97
Common interactions Droperidol
Intoxication: Increased sedative effects with alcohol or recreational drugs.
Sedative drugs: Concurrent administration with other sedative drugs (i.e Olanzapine or Midazolam) will result in increased sedative effect.
98
Enoxaparin MOA
A low molecular weight heparin anticoagulant.
Enoxaparin potentiates the activity of antithrombin III (naturally occuring anticoagulant) causing inhibition of multiple coagulation factors, particularly factor Xa.
99
Delegated scopes Enoxaparin
Paramedics, ICPs, CCPs
100
Indications Enoxaparin
STEMI in conjunction with fibrinolytic therapy.
101
Contraindications Enoxaparin
Known severe allergy.
102
Cautions Enoxaparin
Clinically significant bleeding. Clopidogrel will increase bleeding.
At risk of bleeding, any cautions present within the fibrinolytic therapy checklist, personnel must seek advice.
Pregnancy.
103
Use in pregnancy Enoxaparin
Safety has not been demonstrated during pregnancy. Likelihood of STEMI in pregnancy is so low that personnel must seek clinical advice.
May be administered if pt is breastfeeding.
104
Dosages Enoxaparin
Refer to guideline, varies from age and weight.
105
Administration Enoxaparin
Administer SC into abdominal wall.
Discard unwanted drug from the syringe before administration.
If an error is made in discarding the unwanted drug volume and the dose remaining in the syringe is less than planned, administer remaining dose.
106
Common adverse effects Enoxaparin
Increased bleeding.
107
Usual onset of effect Enoxaparin
10-30 minutes.
108
Usual duration of effect Enoxaparin
12-24 hours.
109
Usual preparation Enoxaparin
Pre-filled syringe containing 100mg in 1ml
110
Pharmacokinetics Enoxaparin
Predominately excreted in the urine.
Clearance is prolonged if the patient has significant renal impairment, but this does not alter the initial dose.
111
Common interactions Enoxaparin
Risk of bleeding will be increased if the patient is taking an anticoagulant.
112
Fentanyl MOA
Fentanyl is an opiate analgesic. It is an opiate agonist (or stimulator) that binds to opiate receptors of the brain and spinal cord causing analgesia.
113
Delegated scopes of practice Fentanyl
Paramedics, ICPs, CCPs
114
Indications Fentanyl
Moderate to severe pain
Cardiogenic pulmonary odema with severe anxiety
RSI
Sedation post intubation
Control of pain, agitation, or SOB during end of life care
115
Contraindications Fentanyl
Known severe allergy
116
Cautions Fentanyl
ALOC - Fentanyl may reduce LOC
Aged <1 year. Increased risk of respiratory depression following opiate administration
Respiratory depression or high risk of respiratory depression - E.g Severe COPD, morbid obesity, at home BiPAP.
Labour - Opiates cross the placenta and may cause drowsiness and/or respiratory depression in the baby
Concurrent administration of other opiates, ketamine or midazolam. May increase and prolong the effects.
Aged >75 years, particularly if frail - effects of fentanyl will be increased and prolonged in this cohort.
Signs of shock - fentanyl may make shock worse.
117
Use in pregnancy Fentanyl
Safety has not been demonstrated, should be administered if indicated.
May be administered if the pt is breastfeeding.
118
Dosage Fentanyl
IV for analgesia:
10-50mcg every 5 minutes for an adult.
Consider commencing an infusion using service guidelines.
Seek paed dosage table for a child.
IN for analgesia:
Children: Seek paed dosage table for children
Subsequent doses may be administered every 20 minutes up to a total of 3 doses.
Halve all doses if the patient has signs of shock.
IM and SC for analgesia:
Adult: 50-100mcg IM/SC
Same as IN
Children: Refer to paed drug dose tables
119
Administration Fentanyl
Preferred route of administration is IV
IV for analgesia: Dilute 100mcg to a total of 10ml using 0.9% sodium chloride for an adult or a child whose weight has been rounded up to 30kg or >. Final solution contains 10mcg/ml.
Dilute 100mcg to a total of 100ml for a child whose weight has been rounded to 20kg or <. This final solution contains 1mcg/ml.
IN for children:
Draw up undiluted, place half the total dose into two seperate 1ml syringes, additional 0.1ml and expel through the MAD to fill dead space.
Administer IN rapidly into each nostril, rapid injection required to achieve a fine mist, maximizing absorption.
IM administration: Administer undiluted.
SC administration:
Administer undiluted SC into the abdominal wall.
Pinch a fold of skin over the anterior abdominal wall between the thumb and forefinger. Introduce the entire length of the needle using the dart technique and inject.
120
Common adverse effects Fentanyl
Respiratory depression
Bradycardia
Hypotension
Sedation
Nausea and vomiting
Itch
Euphoria
121
Usual onset of effect Fentanyl
IV: 2-5 minutes.
IN: 5-10 minutes.
IM/SC: 5-10 minutes.
122
Usual duration of effect Fentanyl
30-60 minutes.
123
Usual preparation Fentanyl
Ampoule containing 100mcg in 2ml
124
Pharmacokinetics Fentanyl
Fentanyl is more lipophilic (fat soluble) than morphine, which is why fentanyl is well absorbed through the nasal mucosa.
Fentanyl may cause a small amount of histamine release. In combination with relief of pain this results in a small fall in BP.
Fentanyl is metabolised in the liver
No significant effects from liver impairment on acute administration
125
Common interactions Fentanyl
Effects will be increased in the presents of other opiates and sedatives.
126
Glucagon MOA
Glucagon increases the blood glucose level by stimulating glycogenolysis (the breakdown of glycogen into glucose), predominantly within the liver.
127
Glucagon Scopes
EMTs, Paramedics, ICPs, and CCPs
128
Indications Glucagon
Hypoglycaemia when the patient cannot safely swallow glucose/food and IV access cannot be obtained.
129
Contraindications Glucagon
Known severe allergy.
130
Cautions Glucagon
None
131
Use in pregnancy Glucagon
Safe and should be administered if indicated
132
Dosage glucagon
1mg IM once for an adult or child aged greater than or equal to 5 years old
0.5mg IM once for a child aged <5 years
133
Administration Glucagon
Dissolve the powder using the syringe within the kit and administer IM.
Preferred site lateral thigh as it has the best absorption
134
Common adverse effects Glucagon
None
135
Usual onset of effects Glucagon
5-10 minutes
136
Usual duration of effect Glucagon
15-60 minutes
137
Usual preparation Glucagon
Ampoule containing 1mg as a powder
138
Pharmacokinetics Glucagon
Predominantly excreted unchanged into bile and urine
No significant effects from liver or kidney impairment on acute administration
139
Glucose Gel MOA
Provides a source of glucose that can be easily swallowed and rapidly absorbed.
140
Delegated scopes Glucose gel
All
141
Indications Glucose gel
Hypoglycemia in adults and children provided the patient is conscious enough to be able to swallow safely.
Hypoglycemia in neonates
142
Contraindications Glucose gel
None
143
Cautions Glucose gel
None
144
Use in pregnancy Glucose gel
Safe and should be administered if indicated
145
Dosage Glucose gel
10-20g for all ages
Administer one sachet and repeat every 10 minutes if hypoglycemia persists or recurs.
146
Administration Glucose gel
Administer PO
May be spread on the gums, tongue or inside the cheeks of a baby or small child.
147
Common adverse effects Glucose gel
None
148
Usual onset of effect Glucose gel
5-10 minutes
149
Usual duration of effect Glucose gel
30-60 minutes
150
Usual preparation Glucose gel
Multitude of different brands
Most are a sachet containing 10-20g glucose
151
Pharmacokinetics Glucose gel
Absorbed in the stomach and small intestine
Rapidly metabolised by cells
152
Common interactions Glucose gel
None
153
GTN (Glyceryl Titrate) Spray MOA
GTN is a vasodilator. Acts on vascular smooth muscle to cause venous and arterial vasodilation, with the predominant effect being on the veins.
MOA is unclear. It appears that GTN results in the formation of nitric oxide which is a vasodilator. GTN causes:
A reduction in venous return (preload) to the heart. This reduces ventricular filling and cardiac output which reduces myocardial oxygen demand.
Arterial Dilation which reduces peripheral resistance (afterload). This reduces the force the left ventricle must overcome to eject blood into the arteries which reduces myocardial oxygen demand.
Dilation of the coronary arteries which may increase coronary blood supply, though this is not usually clinically significant
154
Scopes GTN (Glyceryl Titrate) Spray
EMTs, Paramedics, ICPs, CCPs
155
Indications GTN (Glyceryl Titrate) Spray
Myocardial ischaemia
Cardiogenic pulmonary odema
Control of HTN associated with autonomic dysreflexia
Control of HTN (usually in conjunction with labetalol) prior to fibrinolytic treatment for STEMI
Control of HTN (usually in conjunction with labetalol) during inter-hospital transfer for STEMI.
STEMI
156
Contraindications (usually in conjunction with labetalol) GTN (Glyceryl Titrate) Spray
Known severe allergy
Systolic BP <110mmHg
HR <40/min
HR >150/min
VT
157
Cautions GTN (Glyceryl Titrate) Spray
STEMI - Involvement of R ventricle. GTN causes a significant fall in CO.
The pt is frail
Signs of shock. Reduced CO may fall further with GTN.
Dysrhythmia. Same as above
Has taken a phosphodiesterase inhibitor in the last 24 hours.
Known aortic or mitral stenosis. With aortic or mitral stenosis CO may be reduced as a result of the narrowed valve and fall in preload may cause further fall in CO.
158
Use in pregnancy GTN (Glyceryl Titrate) Spray
Safety has not been demonstrated. The likelihood of a pregnant or breastfeeding patient requiring GTN is very low but should be administered if indicated
159
Dosage GTN (Glyceryl Titrate) Spray
Myocardial Ischaemia: 0.4mg every 5 minutes. Consider incr dosing to 10 minute intervals if a caution is present.
STEMI: 0.4mg with caution, withhold if signs of poor perfusion are present.
Cardiogenic pulmonary odema: 0.8mg every 5 minutes. Consider increasing dosing to 10 minute intervals if a caution is present.
Control of HTN: 0.4mg every 5 minutes
160
Administration GTN (Glyceryl Titrate) Spray
Spray under the tongue, if unable to be achieved spray in mouth.
If administered with a caution present
The patient should be laying flat
IV access should have been obtained whenever possible
Dosing should be increased to 10 minutes
Be ready to administer 0.9% sodium chloride if there is a significant fall in CO or blood pressure
161
Common adverse effects GTN (Glyceryl Titrate) Spray
Hypotension
Flushing
Headache
Tachycardia
Feeling lightheaded
162
Usual onset of effect GTN (Glyceryl Titrate) Spray
1-2 minutes
163
Usual duration of effect GTN (Glyceryl Titrate) Spray
15-30 minutes
164
Usual preparation GTN (Glyceryl Titrate) Spray
Metered dose bottle delivering 0.4mg doses
165
Pharmacokinetics GTN (Glyceryl Titrate) Spray
GTN is rapidly absorbed from the oral mucosa and reaches the vascular system without passing through the liver.
GTN is predominantly metabolised in the liver.
There are no significant effects from liver impairment on acute administration.
166
Common interactions GTN (Glyceryl Titrate) Spray
The effects may be increased if the patient is taking an antihypertensive medication.
Severe and/or prolonged hypotension may occur if a phosphodiesterase inhibitor has been taken within the last 24 hours
167
Mechanism of action Heparin
An anticoagulant. It potentiates the activity of thrombon III (a naturally occuring anticoagulant) causing inhibition of multiple coagulation factors
168
Scopes Heparin
Paramedics, ICPs, CCPs
169
Indications Heparin
Stemi in conjunction with Fibrinolytic therapy
170
Contraindications Heparin
Known severe allergy
Aged >75 years. When heparin is administered in combination with fibrinolytic therapy in patients aged greater than or equal to 75 years, there is an increased risk of intracerebral hemorrhage
171
Cautions Heparin
Clinically significant bleeding
At risk of bleeding
Pregnancy
172
Use in pregnancy Heparin
Safety has not been demonstrated during pregnancy. Seek clinical advice
May be administered if pt is breastfeeding
173
Dosage Heparin
5000 units.
174
Administration Heparin
Dilute to a total volume of 10ml using 0.9% sodium chloride
Administer IV over 1-2 minutes
175
Common adverse effects Heparin
Increased bleeding
176
Usual onset of effect Heparin
5-15 minutes
177
Usual duration of effect Heparin
2-4 hours
178
Usual preparation Heparin
Ampoule containing 5000 units
179
Pharmacokinetics Heparin
It is unclear how heparin is cleared
180
Common interactions Heparin
The risk of bleeding will be increased if the patient is taking an anticoagulant
181
Mechanism of action Ibuprofen
A non steroidal anti-inflammatory drug that is predominantly used for treating pain.
Inhibits the activity of the enzyme prostaglandin synthetase, reducing prostaglandin production and causing a reduction in inflammation, pain and fever.
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Delegated scopes of practice Ibuprofen
EMTs, Paramedics, ICPs and CCPs
183
Indications Ibuprofen
Mild to moderate pain, usually in combination with paracetamol.
Moderate to severe pain, usually in combination with other medications.
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Contraindications Ibuprofen
Known severe allergy.
Pregnancy.
The presence of sepsis, dehydration, shock or clinically significant bleeding. Ibuprofen can worsen renal impairment, and increase the risk of bleeding.
Known worsening bronchospasm with NSAIDs. Some patients with asthma or COPD have known worsening bronchospasm with NSAIDs.
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Cautions Ibuprofen
The patient has taken Ibuprofen within the last 4 hours.
Abdominal pain, particularly if the patient is very unwell or vomiting, the possibility of significant intraabdominal pathology exists and oral medications should be withheld.
Aged > 75 years, particularly if frail. In this setting, renal impairment is likely, and ibuprofen may worsen renal impairment.
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Use in pregnancy Ibuprofen
May cause fetal harm during pregnancy. Ibuprofen has been associated with premature delivery and premature closure of the ductus arteriosus when administered during the third trimester of pregnancy.
May be administered if breastfeeding.
187
Dosage Ibuprofen
600mg for an adult weighing >80kg.
400mg for an adult weighing <80kg
Seek paed dosages for paediatric
188
Administration Ibuprofen
Administer PO.
Children unable to swallow tablets may be administered ibuprofen syrup, or tablets that have been crushed and placed in soft food such as jam or honey.
189
Common adverse effects Ibuprofen
Renal impairment.
Increased bleeding.
Although indigestion, GI ulceration, and GI bleeding are listed as commonly listed as adverse effects, this is only associated with chronic administration.
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Usual onset of effect Ibuprofen
30-60 minutes.
191
Usual duration of effect Ibuprofen
4-6 hours.
192
Usual preparation Ibuprofen
200mg tablets
Syrup containing 20mg/ml.
193
Pharmacokinetics Ibuprofen
Ibuprofen is absorbed in the stomach and small intestine. The presence of food in the stomach will delay absorption, but this is not usually clinically significant.
Ibuprofen is metabolised by the liver.
There are no significant effects from liver impairment on acute administration.
194
Common interactions Ibuprofen
Warfarin. Ibuprofen displaces warfarin from binding sites and increases the activity of warfarin.
195
Mechanism of action Ipratropium
Ipratropium is a bronchodilator.
Ipratropium is an anticholinergic agent with predominantly antimuscarinic activity. It antagonises (blocks) acetylcholine receptors causing vagal inhibition resulting in bronchodilation.
196
Delegated scopes Ipratropium
EMTs, Paramedics, ICPs, and CCPs
197
Indications ipratropium
Bronchospasm secondary to asthma or COPD
Prominant bronchospasm secondary to airway burns, smoke inhalation, or chest infection.
198
Contraindications Ipratropium
Known severe allergy
199
Cautions ipratropium
None
200
Use in pregnancy Ipratropium
Has not been demonstrated but should be administered if indicated.
May be administered if the patient is breastfeeding.
201
Dosage Ipratropium
0.5mg for adults and children once only
202
Administration Ipratropium
Administer nebulised undiluted (in combination with salbutamol 5mg) using:
Air as the driving gas for COPD
Oxygen as the driving gas for asthma
203
Common adverse effects Ipratropium
Tachycardia
Dry mouth
Blurred vision. Usually only occurs in repeated doses
204
Usual onset of effect Ipratropium
2-5 minutes
205
Duration of effect ipratropium
6 hours
206
Usual preparation Ipratropium
Ampoule containing 0.5mg in 2ml
207
Pharmacokinetics Ipratropium
Only a small dose is absorbed, with most of the dose being absorbed into the atmosphere. The inhaled ipratropium is absorbed through the lungs and some is swallowed.
Excretion is predominantly via the urine.
Clearance is prolonged if the pt has significant kidney impairment. This does not alter the initial dose.
208
Mechanism of Action Ketamine
Has complex actions but is predominantly an N-methyl-d-aspartate (NMDA) receptor antagonist, resulting in inhibition of excitatory neurotransmitters in the brain.
Low doses cause analgesia, larger doses cause amnesia and dissociation. High doses cause anesthesia.
209
Scopes Ketamine
Para: Analgesia
210
Indications Ketamine
Severe pain that has not been adequately controlled with an opiate.
Inducing dissociation.
Acute behavioural disturbance causing severe to immediately life-threatening risk to safety.
RSI.
Significant movement during CPR that is interfering with resuscitation.
Asthma with severe agitation that is impairing the ability to safely provide treatment or transport.
211
Contraindications Ketamine
Known severe allergy.
Aged <1 year.
212
Cautions Ketamine
ALOC. Ketamine may reduce LOC.
Signs of shock, ketamine may make shock worse.
Current myocardial ischaemia, ketamine may increase myocardial oxygen demand.
Concurrent administration of opiates or midazolam will increase or prolong the effects.
Aged > or equal to 75 years, particularly if frail. Effects of ketamine will be increased or prolonged in this cohort.
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