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Meds Flashcards

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1
Q

What is the presentation of Dexamethasone?

A

8mg/2ml

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2
Q

What is dexamethasone?

A

It’s a corticosteroid secreted by the adrenal cortex.

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3
Q

What is the action of dexamethasone?

A

1) relieves inflammatory reactions
2) provides immunosepression

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4
Q

What are the contraindications of dexamethasone?

A

Known hypersensitivity

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5
Q

What are the precautions of dexamethasone?

A

Solutions which are not clear or contaminated should be discarded

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6
Q

What are the side effect of dexamethasone?

A

None

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7
Q

What is the peak time of IV dexamethasone?

A

2 hours

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8
Q

What is the onset time of IV dexamethasone?

A

30-60mins

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9
Q

What is the duration of dexamethasone?

A

36-72 hours

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10
Q

What is the presentation for fentanyl?

A

100mcg/2ml or 250mcg cartridge

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11
Q

What is fentanyl?

A

A synthetic opioid analgesic

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12
Q

What is the action of fentanyl?

A

1) CNS depression leading to analgesia
2) Respiratory depression leading to apnoea
3) Dependance (addiction)
4) Decreased conduction velocity through AV node

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13
Q

What is the metabolism of fentanyl?

A

Secreted by liver, excreted by kidneys

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14
Q

What are the contraindications of fentanyl?

A

Hypersensitivity
Late 2nd stage labour

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15
Q

What are the precautions of fentanyl?

A

-Elderly/frail
-Impaired hepatic function
-Respiratory depression eg COPD
-Current asthma
-Patients on monoamine oxidase inhibitors
-Known addiction to opioids
-Rhinitis, Rhinorrea or facial trauma (IN route)

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16
Q

What are the side effects of fentanyl

A

Respiratory depression
Apnoea
Rigidity of diaphragm & intercostal muscles
Bradycardia

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17
Q

What is the onset of IV Fentanyl?

A

Immediate

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18
Q

What is the peak of IV Fentanyl?

A

<5mins

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19
Q

What is the duration of IV fentanyl?

A

30-60mins

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20
Q

What is the peak time for IN fentanyl?

A

2mins

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21
Q

What is Glyceryl Trinitrate?

A

An organic nitrate that relaxes vascular smooth muscle

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22
Q

What is Glyceryl Trinitrate’s action?

A

Relaxes vascular smooth muscle
1) Venodilation promotes venous pooling & reduces venous return to the heart (decreased preload)
2) Arteriodilation reduces SVRI and arterial pressure (reduced afterload

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23
Q

What are the expected effects of GTN?

A

1) Reduced myocardial 02 demand
2) Reduces systolic, diastolic and MAP whilst maintaining coronary perfusion pressure
3) Mild collateral coronary artery dilation may improve blood supply to ischaemic areas of heart
4) Mild tachycardia secondary to fall in BP
5) Preterm labour: uterine quiescence (contractility) in pregnancy

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24
Q

What are the indications of GTN?

A

Chest pain in ACS
Acute cardiogenic pulmonary oedema (full field or mid zone fine crackles & hx CCF/HF)
HTN in ACS
Autonomic dysreflexia
Preterm labour (consult for patch)

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25
What are the contraindications of GTN?
HR< <50bpm (except in AD) or >150bpm VT SBP <100mmHg Riociguat PDE5 inhibitors (Levitra, cialis & viagra)
26
What are the precautions of GTN?
1) Use lower doses (300mcg) in pts who are elderly, have no previous exposure to GTN or with recent MI as they may be more susceptible to adverse effects 2) Right ventricular MI or inferior STEMI with SBP<160, use cautiously due to risk of severe hypotension from preload reduction 3) Preterm labour - concurrent use with other tocolytics
27
What are the adverse effects of GTN?
CVS: Hypotension, tachycardia, bradycardia (occasionally) CNS: HA, dizzy, syncope Other: Skin flushing
28
What routes is GTN available for administration?
Sublingal & transdermal
29
What are the presentations for GTN?
SL: 300mcg tablets Transdermal: 50mg patch- 400mcg/hr
30
What are the onset times for GTN SL & transdermal?
SL: 1-3mins TD: Up to 30mins
31
What are the peak times for GTN?
SL: 5mins TD: 2hrs
32
What is the duration of action for GTN?
SL: At least 25mins TD: continues for 5 days until patch removed.
33
What is Ipratropium Bromide?
An anticholinergic bronchodilator
34
What is Ipratropium Bromide's action?
Allows bronchodilation by inhibiting cholinergic bronchomotor tone (blocks vagal reflexes which mediate bronchoconstriction)
35
What are the indications of Ipratropium Bromide?
Severe respiratory distress associated with bronchospasm Exacerbation of COPD irrespective of severity
36
What are the contraindications of Ipratropium Bromide?
Known hypersensitivity to Atropine or its derivatives
37
What are the precautions of Ipratropium Bromide
1) Glaucoma (vision loss due to damaged optic nerve) 2) Avoid contact with eyes
38
What are the side effects of Ipratropium Bromide?
1) Headache 2) Nausea 3) Dry mouth 4) Skin rash 5) Tachycardia (rare) 6) Palpitations (rare) 7) Acute angle closure glaucoma secondary to direct eye contact (rare)
39
What is the onset of Ipratropium Bromide?
3-5mins
40
What is the peak of Ipratropium Bromide?
1.5-2 hours
41
What is the duration of Ipratropium Bromide?
6 hours
42
What is adrenaline?
An endogenous catecholamine, an alpha and beta adrenergic stimulant
43
What is the action of adrenaline?
BETA 1: -Increases HR why increasing SA node firing rate -Increases conduction velocity through the AV node -Increases myocardial contractility -Increases the irritability of the ventricles BETA 2: -Causes bronchodilation ALPHA: -Peripheral vasoconstriction
44
How is Adrenaline metabolised & excreted?
By monoamine oxidase (enzyme removes neurotransmitters from brain) & other enzymes in the blood, liver and around nerve endings. Excreted by the kidneys
45
What are the contraindications of Adrenaline?
Hypovolaemic shock without adequate fluid replacement
46
What are the precautions of Adrenaline?
Elderly/frail, those with cardiovascular disease, those on monoamine oxidase inhibitors (Antidepressant), higher doses may be required for those on beta blockers.
47
What are the side effects of Adrenaline?
Sinus Tachycardia Supraventricular arrhythmias Ventricular arrhythmias HTN Pupillary dilation May increase size of MI Feeling of anxiety/palpitations in the conscious patient
48
What is the onset time for IV & IM Adrenaline?
IV: 30 secs IM: 30-90 secs
49
What is the peak time for IV/IM Adrenaline?
IV: 3-5 mins IM: 4-10 mins
50
What is the duration of IV/IM Adrenaline?
IV: 5-10 mins IM: 5-10 mins
51
What is Ketamine?
An anaesthetic agent with analgesic properties at lower doses
52
What is Ketamine's action?
Exact action is unknown but primarily works as an antagonist at NMDA receptors. Ketamine may also interact with opioid, muscarinic and other receptors. Produces a trance like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes.
53
What are the contraindications for Ketamine?
Suspected non-traumatic brain injury with severe hypertension (SBP >180)
54
What are the precautions of Ketamine?
May exacerbate cardiovascular conditions (uncontrolled HTN, stroke, recent MI, cardiac failure) due to its effects on HR & BP.
55
What are the adverse effects of Ketamine?
CVS: HTN, Tachycardia CNS: Emergence reactions (vivid dreams, restlessness, confusion, hallucinations, irrational behaviour), increased skeletal muscle tone (may resemble seizures) RESP: Transient respiratory depression and apnoea (rare) GI: Nausea & vomiting Other: Injection site pain, lacrimation (flow of tears), hypersalivation, diplopia (double vision), nystagmus
56
What is the presentation of ketamine?
200mg/2ml
57
What are the routes of Ketamine?
IV, IM, IN
58
What is the onset of action for Ketamine?
IV: 30 secs IM: 3-4 mins IN: 5 mins
59
What is the peak time for IN Ketamine?
20mins
60
What is the duration of action of Ketamine?
IV: 5-10 mins IM: 12-25 mins IN: 45 mins
61
What is methoxyflurane?
Inhaled anaesthetic which produces analgesia at low concentrations
62
What is the action of methoxyflurane?
The exact action is unknown
63
Contraindications of Methoxyflurane?
1) Pre-existing renal disease 2) Known or genetic susceptibility to malignant hyperthermia
64
What are the precautions for Methoxyflurane?
Patients shouldn't be administered >6ml in 24h due to nephrotoxicity To limit occupational exposure, it shouldn't be administered in a confined space
65
What are the adverse effects of Methoxyflurane?
CNS: Dizziness, drowsiness CVS: Hypotension GIT: Nausea & vomiting
66
What is the presentation of Methoxyflurane?
3ml bottle
67
What is the route of Methoxyflurane?
Inhalation via Penthrox inhaler device
68
What is the onset of Methoxyflurane?
6-10 breaths
69
What is the duration of action of Methoxyflurane?
Effects last 3-5 mins after stopping inhalation. One vial can provide up to 25mins analgesia
70
In the Methoxyflurane medication card, what does pre-existing renal disease include?
Current or past renal impairment or failure. Not including kidney stones or renal colic
71
What is midazolam?
A benzodiazepine, a short acting CNS depressant
72
What is the action of Midazolam?
Anxiolytic (reduce anxiety), sedative, anticonvulsant
73
How is midazolam metabolised & excreted?
Metabolised in the liver, excreted by the kidneys
74
What are the contraindications of Midazolam?
Known sensitivity to benzodiazepines
75
What are the precautions of Midazolam?
1) Reduced doses for elderly/frail, chronic renal failure, CCF or shock 2) The CNS depressan effects are enhanced in presence of narcotics/alcohol 3) Can cause severe resp depression in COPD patients 4) Patients with myasthenia gravis (A weakness and rapid fatigue of muscles under voluntary control- resp depression)
76
What are the side effects of Midazolam?
Depressed level of consciousness Respiratory depression Loss of airway control Hypotension
77
What is the onset time for Midazolam IV/IM?
IV: 1-3mins IM: 3-5mins
78
What is the peak time for Midazolam IV/IM?
IV: 10mins IM: 15mins
79
What is the duration of action of Midazolam IV/IM?
IV: 20mins IM: 30mins
80
What is morphine?
An opioid analgesic
81
What is morphines action?
CNS effects: -Depression leading to analgesia -Respiratory depression -Depression of cough reflex -Stimulation (changes of mood/euphoria/dysphoria/vomiting/pinpoint -Dependence (addiction CVS effects: -Vasodilation -Decreases conduction velocity through the AV node (the speed at which action potentials are distributed throughout the tissue
82
How is Morphine metabolised & excreted?
Metabolised by the liver & excreted by the kidneys
83
What are the contraindications of Morphine?
Hx of hypersensitivity Renal impairment/failure Late 2nd stage labour
84
What are the precautions of Morphine?
Elderly/frail Hypotension Respiratory depression Current asthma Respiratory tract burns Known addiction to opioids Acute alcoholism Patients on monoamine oxidase inhibitors (?)
85
What are the side effects of Morphine?
CNS effects: Drowsiness Respiratory depression Euphoria Nausea & vomiting Addiction Pin point pupils CVS: Hypotension Bradycardia
86
What is the onset time for Morphine IV/IM?
IV: 2-5mins IM: 10-30mins
87
What is the peak time for Morphine IV/IM?
IV: 10mins IM: 30-60mins
88
What is the duration of action of Morphine IV/IM?
IV: 1-2hrs IM: 1-2hrs
89
What drug might you see wheals (red skin) in the line of the vein being used for IV injection & what is it caused by?
Morphine & it's ahistamine reaction
90
What is normal saline?
An isotonic crystalloid solution
91
What is the composition & action of normal saline?
Composition: Electrolytes (sodium & chloride in similar concentration to extracellular fluid Action: Increases the volume of the intravascular compartment
92
What are the contraindications & precautions of Normal saline?
None
93
What is the IV half life of normal saline?
30-60mins
94
What is ondansetron?
A 5-HT3 (5-hydroxytryptamine) antagonist (stops creation/release of serotonin which is thought to trigger vomiting reflex)
95
What is the action of ondansetron?
The actions not fully known. It is thought the release of serotonin (5-HT) is thought to trigger a vomiting reflex in both peripheral (GIT) and central nervous system.
96
What are the contraindications of Ondansetron?
Apomorphine (used for parkinsons)- causes profound hypotension/decreased consciousness.
97
What are the precautions of Ondansetron?
Pregnancy 1st trimester (consult with receiving hospital) Congenital Long QT syndrome (increased risk of torsades in QT>500ms) Severe hepatic disease (cirrhosis) Limit 8mg/day Ondansetron ODT may contain aspartame- avoid in pts with phenylketonuria (A birth defect that causes an amino acid called phenylalanine to build up in the body.)
98
What are the adverse effects of Ondansetron?
CNS: Headache, dizziness CVS: Prolonged QT (rare) GIT: Constipation Other: Visual disturbance including transient loss of vision (rare, fast push)
99
Presentation of Ondansetron?
ODT 4mg, 8mg/4ml ampoule
100
How long do you inject Ondansetron over IV?
30secs (preferrably 3-5mins)
101
What is the peak time for IV/IM & ODT ondansetron?
IV/IM: 10mins ODT: 30mins
102
What is the duration of action of Ondansetron?
Several hours
103
What is paracetamol?
An analgesic and antypyretic (An antipyretic is a substance that reduces fever)
104
What is the action of Paracetamol?
Exact mechanism is unclear, thought to inhibit prostaglandin synthesis in the CNS
105
What are the contraindications of Paracetamol?
Children <1month age
106
What are the precautions of Paracetamol?
Hepatotoxicity can occur with overdose (do not administer if given in past 4/24 or >4g in 24hrs) Risk of hepatotoxicity is increased in impaired hepatic function or liver disease, elderly/frail patients, malnourishment
107
What are the adverse effects of paracetamol?
Hypersensitivity reactions including severe skin rashes (rare) Haematological reactions (rare) Hypotension has been reported with IV infusion
108
What are the presentations of paracetamol?
500mg tablets Oral liquid 24mg/ml
109
t is the onset of action of paracetamol?
Oral: 30mins
110
What is the duration of action of paracetamol?
4 hrs
111
What is the max paediatric dose of paracetamol in 24hrs?
60mg/kg
112
What is Salbutamol & whats it's action?
A synthetic beta adrenergic stimulant with primarily beta 2 effects Action: causes bronchodilation
113
How is Salbutamol metabolised & excreted?
Metabolised by liver, excreted by kidneys
114
What are the contraindications of Salbutamol?
Nil
115
What are the precautions of salbutamol?
Large doses have been reported to cause metabolic acidosis
116
What are the side effects of Salbutamol?
Sinus tachycardia Muscle tremor
117
What are the routes of Salbutamol?
pMDI, nebulised
118
What is the onset of nebulised Salbutamol?
5-15mins
119
What is the duration of nebulised salbutamol?
15-50mins

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