Medications

Question 1

Adrenaline intro

Answer 1

1mg/1ml ampule. Naturally occurring sympathomimic agent, causes peripheral vasoconstriction, simulates cardiac conduction increasing contractions, bronchodilation and dilation of of blood vessels in muscles. 30seconds IV, 60 seconds IM

Question 2

Adrenaline indication

Answer 2

• Anaphylaxis
• Life threatening asthma
• Cardiac arrest
• Post ROSC
• Severe croup
• Haemorrhage control post cricothyroidotomy

Question 3

Adrenaline contraindications

Answer 3

Nil absolute contraindications

Question 4

Adrenaline precautions

Answer 4

ischaemic heart disease, hypertension, hypovolaemia, do not walk pre or post administration in anaphylaxis 1 hour post 1 dose, 4 hours post >1 dose

Question 5

Adrenaline special considerations

Answer 5

tachyarrhythmias, palpitations, pupil dilation, tremor and anxiety

Question 6

Amiodarone intro

Answer 6

Class III antidysrhythmic agent that prolongs the action potential duration and hence the refractory period of atrial, nodal and ventricular tissue thereby giving very broad spectrum of activity. Immediate onset

Question 7

Amiodarone indications

Answer 7

• Cardiac arrest with persistent/shock resistance ventricular fibrillation/pulseless ventricular tachycardia, post 3rd shock

Question 8

Amiodarone contraindication

Answer 8

no contraindication in cardiac arrest, and not compatible with saline

Question 9

Amiodarone precautions

Answer 9

heart failure, thyroid dysfunction, only indicated in shock resistance or recurrent VF or pVT and do not dilute with saline

Question 10

Amiodarone special considerations

Answer 10

bradycardia, hypotension, polymorphic tachycardias, nausea, tremor, dizziness, paraesthesia, headache and phlebitis.

Question 11

Aspirin intro

Answer 11

Analgesic, antipyretic, anti inflammatory and anti platelet aggregation. Reduces mortality significantly in acute myocardial infarction by minimising platelet aggregation and thrombus formation in order to retard the progression of the coronary artery thrombosis.

Question 12

Aspirin indications

Answer 12

suspected acute coronary syndrome

Question 13

Aspirin contraindications

Answer 13

hypersensitivity, children <16

Question 14

Aspirin precautions

Answer 14

actively bleeding peptic ulcers, suspected AAA and aspirin sensitive asthmatics

Question 15

Aspirin special considerations

Answer 15

heart burn, nausea, GI bleed, increase bleeding time, anaphylactic reaction in notable sensitivity to aspirin

Question 16

Atropine intro

Answer 16

Anticholinergic agent that inhibits the action of acetylcholine on post ganglionic nerves at the neuroeffector site. Blocks vagal stimulation to allow sympathetic response to increase pulse rate by increasing SA node firing rate, and increasing the conduction velocity through the AV node. Antidote to reverse effects of cholinesterase inhibitors.

Question 17

Atropine indication

Answer 17

• Sympathetic bradycardia haemodynamically unstable due to bradycardia and associated with poor signs of perfusion (hypotension, altered conscious state, diaphoresis, shortness of breath, cyanosis and syncope)
• Organophosphate poisoning with cholinergic effects

Question 18

Atropine contraindications.

Answer 18

hypersensitivity and cardiac transplant

Question 19

Atropine precaution

Answer 19

may not be effective in 3rd degree AV block, do not give in traumatic bradycardia, 12 leads prior, in children usually hypoxia or vagal stimulation cause, may effect glaucoma

Question 20

Atropine special consideration

Answer 20

tachycardia, palpitation, dilated pupil/blurred vision, dry mouth, urinary retention, confusion, restlessness and dry skin

Question 21

cophenylcaine intro

Question 22

Cophenylcaine indication

Question 23

Cophenylcaine contraindication

Question 24

Cophenylcaine precaution & special consideration

Question 25

GTN intro

Answer 25

Nitrates cause relaxation of vascular smooth muscles resulting in vasodilation, peripheral pooling, reduced venous return, reduced left ventricular end diastolic pressure (preload), reduced systemic vascular resistance (after load), reduced myocardial energy and oxygen requirements and relaxes spasm of coronary arteries.

Question 26

GTN indication

Answer 26

* chest pain of presumed cardiac origin not relieved by rest with SBP>90 AND heart rate between 50-100bpm, * acute cardiac pulmonary oedema with SBP >90 * autonomic dysreflexia with SBP >160

Question 27

GTN contraindications

Answer 27

* Hypersensitivity * Hypotension <90 * Ventricular tachycardia * Recent use of medication used for sexual dysfunction or specific regular medication used to treat pulmonary arterial hypertension (sildenafil 24 hours, tadalafil 3 days)

Question 28

GTN precautions

Answer 28

early intervention, seated or semi recumbent when administering, prime bottle, do not shake, assess BP every dose, severe hypotension is rare, intoxication can enhance effect.

Question 29

GTN special consideration

Answer 29

hypotension, tachycardia, flushing, headache and dizziness

Question 30

Droperidol intro

Question 31

Droperidol indication

Question 32

Droperidol contraindication

Question 33

Droperidol precaution

Question 34

Droperidol special considerations

Question 35

Fentanyl intro

Question 36

Fentanyl indication

Question 37

Fentanyl contraindication

Question 38

Fentanyl precaution

Question 39

Fentanyl special considerations

Question 40

Glucose 10% indication

Question 41

Glucose 10% precaution

Question 42

Glucose 10% special consideration

Question 43

Glucose gel indication

Question 44

Glucose gel contraindication

Question 45

Glucose 10% contraindication

Question 46

Glucose gel precaution & special considerations

Question 47

Heparin intro

Answer 47

Naturally occurring anticoagulant which inhibits the clotting of blood by enhancing the rate at which antithrombin III neutrilises thrombin and activated factor X

Question 48

Heparin indication

Answer 48

STEMI patients going directly to Cath lab as per receiving hospital interpretation

Question 49

Heparin contraindication

Answer 49

hypersensitivity, active bleeding or disease states with increase risk of bleeding

Question 50

Heparin precaution & special consideration

Answer 50

Precaution = haemorrhaging risk in case of trauma Special considerations = haemorrhage, hyoerkalaemia, thrombocytopenia

Question 51

Hydrocortisone intro

Question 52

Hydrocortisone indication

Question 53

Hydrocortisone contraindication

Question 54

Hydrocortisone precaution & special consideration

Question 55

Normal saline indications

Answer 55

fluid replacement for treatment of shock, fluid loss and cardiac arrest

Question 56

Normal saline contraindications

Answer 56

severe pulmonary oedema

Question 57

Normal saline precaution

Answer 57

penetrating trauma, ectopic pregnancy and aortic aneurysm rupture with hypotension and signs of impaired organ perfusion may benefit from permissive hypotension (70 SBP), fluid therapy for shock , DKA and HHS is directed towards expansion of intravascular, interstitial and intercellular volume, all of which are reduced in hyperglycaemia crises

Question 58

Ipratropium bromide intro

Answer 58

Anticholinergic bronchodilator. Inhibits vagal reflexes that mediate bronchospasm combined with beta 2 agonist produces significantly greater bronchodilation

Question 59

Ipratropium bromide indication

Answer 59

* Adult severe to life threatening asthma or COPD * Paediatric severe to life threatening asthma

Question 60

Ipratropium bromide contraindication

Answer 60

hypersensitivity

Question 61

Ipratropium bromide precaution & considerations

Answer 61

Precaution = glaucoma, avoid eyes Special considerations = headache, nausea, dizziness, dry mouth, taste disturbances and skin rash

Question 62

Ketamine intro

Question 63

Ketamine indication

Question 64

Ketamine contraindication

Question 65

Ketamine precaution & consideration

Question 66

Lignocaine intro.

Answer 66

Reversibly interrupt impulse conduction in peripheral nerves and stabilise excitable cell membranes by blocking sodium channels, onset 1-2 minutes

Question 67

Lignocaine indication

Answer 67

* Local anaesthesia (IV, IO, suture, finger thorscostomy) * Cardiac arrest (persistent VT/VF post 3rd shock, 5 shock after max Amiodarone)

Question 68

Lignocaine contraindication

Answer 68

Hypersensitivity

Question 69

Lignocaine precaution and considerations

Answer 69

Special considerations = tinnitus, dizziness, anxiety, confusion, perioral numbness, bradycardia, hypotension, dysrhythmia, cns effect and respiratory depression