Pharma Flashcards
(176 cards)
1
Q
Adrenaline presentation
A
1mg in 1ml
1mg in 1000ml
2
Q
Adrenaline pharmacology
A
A naturally occurring alpha and beta adrenergic stimulant.
- increases HR by increasing SA node firing (B1)
- increase conduction velocity through AV node (B1)
- increase myocardial contractility (B1)
- increase irritability of ventricles (B1)
- causes bronchodilation (B2)
- causes peripheral vasoconstriction (Alpha)
3
Q
Adrenaline metabolism
A
monoamine oxidase and other enzymes in blood, liver and around nerve endings
excreted by kidneys
4
Q
Adrenaline PEIs
A
- cardiac arrest - VF/VT, asystole, PEA
- inadequate perfusion
- bradycardia with poor perfusion
- anaphylaxis
- severe asthma - imminent life threat not responding to nebulised therapy, or unconscious with no BP
- croup
5
Q
Adrenaline contras
A
hypovolaemic shock without adequate fluid replacement
6
Q
Adrenaline precautions
A
Consider reduced doses for:
- elderly/frail
- cardiovascular disease
- monamine oxidase inhibitors
- higher doses may be required for pts on beta blockers
7
Q
Adrenaline side effects
A
sinus tach supraventricular arrhythmias ventricular arrhythmias hypertension pupil dilation may increase size of MI feeling of anxiety/palpitations in conscious pt
8
Q
Adrenaline notes
A
IV onset: 30s peak: 3-5mins duration: 5-10mins IM onset: 30-90s peak: 4-10m duration: 5-10m
9
Q
Aspirin presentation
A
300mg
10
Q
Aspirin pharmacology
A
An analgesia, antipyretic, antiinflammatory, antiplatelet aggregation agent.
Minimises platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS.
Inhibits synthesis of prostaglandins - anti-inflammatory action
11
Q
Aspirin metabolism
A
converted to salicylate in the gut mucosa and liver
excreted by kidneys
12
Q
Aspirin PEIs
A
ACS
13
Q
Aspirin contras
A
- hypersensitivity to aspirin/salicylates
- actively bleeding peptic ulcers
- bleeding disorders
- suspected dissecting aortic aneurysm
- chest pain associated with psychostim OD if SBO greater than 160
14
Q
Aspirin precautions
A
- peptic ulcer
- asthma
- pts on anticoagulants
15
Q
Aspirin side effects
A
heartburn, nausea, GI bleeding
increased bleeding time
hypersensitivity reactions
16
Q
Aspirin duration
A
8 days - natural life of platelets
17
Q
Ceftriaxone presentation
A
1g
18
Q
Ceftriaxone pharmacology
A
cephalosporin antibiotics
19
Q
Ceftriaxone metabolism
A
excreted unchanged in urine and bile
20
Q
Ceftriaxone PEIs
A
- suspected meningococcal septicaemia
2. severe sepsis (consult only)
21
Q
Ceftriaxone contras
A
Allergy to cephalosporin antibiotics
22
Q
Ceftriaxone precautions
A
Allergy to penicillin antibiotics
23
Q
Ceftriaxone side effects
A
nausea
vomiting
skin rash
24
Q
Dexamethasone presentation
A
8mg in 2ml
25
Dexamethasone pharmacology
A corticosteroid secreted by adrenal cortex
- relieves inflammatory reactions
- provides immunosuppression
26
Dexamethasone metabolism
liver and excreted by kidneys
27
Dexamethasone PEIs
1. bronchospasm assoc with acute respiratory distress not responsive to nebulised Salbutamol
2. moderate-severe croup
3. acute exacerbation of COPD
4. adult stridor (non-foreign body obstruction)
28
Dexamethasone contras
Known hypersensitivity
29
Dexamethasone precautions
Solutions which are unclear or contaminated should be discarded
30
Dexamethasone side effects
nil
31
Dexamethasone notes
IV onset: 30-60m
peak: 2hrs
duration: 36-72hrs
32
Fentanyl presentation
100mcg in 2ml
| 250mcg in 1ml
33
Fentanyl pharmacology
Synthetic opioid analgesic
- depression leading to analgesia
- resp depression leading to apnoea
- dependence
- decreased CV through AV node
34
Fentanyl metabolism
liver and kidneys
35
Fentanyl PEIs
1. sedation to facilitate intubation..RSI - modified or Paed IFS
2. sedation to maintain intubation
3. sedation to facilitate transthoracic pacing
4. sedation to facilitate synchronised cardioversion
5. CPR interfering pt
6. analgesia
- hypersensitivity to morphine
- known renal impairment/failure
- short duration of action desirable
- hypotension
- nausea and/or vomiting
- severe headache
36
Fentanyl contras
1. hypersensitivity
| 2. late second stage labour
37
Fentanyl precautions
1. elderly/frail pts
2. impaired hepatic function
3. respiratory depression e.g. COPD
4. current asthma
5. pts on MAOI
6. known addiction to opioids
7. rhinitis, rhinorrhea or facial trauma (IN route)
38
Fentanyl side effects
respiratory depression
apnoea
rigid diaphragm and intercostal muscles
bradycardia
39
Fentanyl notes
IV onset: immediate
peak: less than 5mins
duration: 30-60mins
IN peak: 20mins
40
GTN presentation
0.3mg tablet
0.6mg tablet
50mg patch
41
GTN pharmacology
vascular smooth muscle relaxant
- venous dilation promotes venous pooling and reduces venous return to the heart
- arterial dilation reduces systemic vascular resistance and arterial pressure
- reduced myocardial O2 demand
- reduced systolic, diastolic and mean arterial pressure whilst maintaining coronary perfusion pressure
- mild collateral coronary artery dilation may improve blood supply to ischaemic areas of myocardium
- mild tachycardia secondary to slight fall in BP
- preterm labour - uterine quiescence
42
GTN metabolism
liver
43
GTN PEIs
1. chest pain with ACS
2. acute LVF
3. hypertension assoc with ACS
4. autonomic dysreflexia
5. preterm labour
44
GTN contras
1. known hypersensitivity
2. SBP less than 110 tablet
3. SBP less than 90 patch
4. viagra or levitra in 24hrs or cialis in 4days
5. VT
6. HR less than 50 - exclude autonomic dysreflexia
7. HR greater than 150
8. suspected dissecting aortic aneurysm
9. right ventricular MI
45
GTN Precautions
1. no previous admin
2. elderly/frail
3. recent MI
4. concurrent use with tocolytics
46
GTN side effects
```
tachycardia
hypotension
headache
skin flushing (uncommon)
bradycardia (occasionally)
```
47
GTN notes
```
S/L onset: 30s-2m
peak: 5-10m
duration: 15-30m
Transdermal onset: up to 30m
peak: 2hrs
```
48
Atrovent presentation
250mcg in 1ml
49
Atrovent pharmacology
anticholinergic bronchodilator
| - allows bronchodilation by inhibiting cholinergic bronchomotor tone
50
Atrovent metabolism
excreted by kidneys
51
Atrovent PEIs
1. severe resp distress associated with bronchospasm
| 2. exacerbation of COPD irrespective of severity
52
Atrovent contras
known hypersensitivity to Atropine or derivatives
53
Atrovent precautions
1. glaucoma
| 2. avoid contact with eyes
54
Atrovent side effects
```
headache
nausea
dry mouth
skin rash
tachycardia (rare)
palpitations (rare)
acute angle closure glaucoma secondary to direct eye contact (rare)
```
55
Atrovent notes
onset: 3-5m
peak: 1.5-2hrs
duration: 6hrs
56
Ketamine presentation
200mg in 2ml
57
Ketamine pharmacology
Anaesthetic agent with analgesic properties at lower doses.
Works as an antagonist at N-methyl-D-aspartate NDMA receptors, also interacting with opioid, muscarinic and other receptors.
Produces a trance-like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes.
58
Ketamine PEIs
1. intubation
2. analgesia
3. sedation: agitation or CPR interfering pt
59
Ketamine contras
1. Suspected non-traumatic brain injury with severe hypertension SBP over 180
60
Ketamine precautions
1. May exacerbate cardiovascular conditions such as uncontrolled HT, CVA, recent MI, cardiac failure, due to the effects on HR and BP
61
Ketamine side effects
CV: HT and tachycardia
CNS: emergence reactions e.g. vivid dreams, restlessness, confusion, hallucinations, irrational behaviour, increased skeletal muscle tone
Respiratory: transient resp depression and apnoea - rare
GI: n+ v
other: injection site pain, lacrimation, hypersalivation, diplopia, nystagmus
62
Ketamine notes
```
IV onset: 30s
duration: 5-10m
IM onset: 3-4m
duration: 12-25m
IN onset: 5m
peak: 20m
duration:45m
```
63
Methoxyflurane presentation
3ml
64
Methoxy pharmacology
Inhalational analgesic agent at low concentrations
65
Methoxy metabolism
liver
| excreted by lungs
66
Methoxy PEIs
pain relief
67
Methoxy contras
1. pre-existing renal disease/impairment
2. concurrent use of tetracycline antibiotics
3. exceeding total dose of 6ml within 24hours
4. personal or family hx of malignant hyperthermia
5. muscular dystrophy
68
Methoxy precautions
1. penthrox inhaler held by pt
2. pre-eclampsia
3. concurrent use with Oxytocin may cause hypotension
69
Methoxy side effects
drowsiness
decrease in BP and bradycardia (rare)
exceeding max dose can lead to renal toxicity
70
Methoxy notes
lasts approx 3-5mins after discontinued
| provides 25 mins analgesia
71
Midaz presentation
5mg in 1ml
| 15mg in 3ml
72
Midaz pharmacology
Short acting CNS depressant
- anxiolytic
- sedative
- anti-convulsant
73
Midaz metabolism
liver
| excreted by kidneys
74
Midaz PEIs
1. status epilepticus
2. sedation to maintain intubation
3. sedation to facilitate intubation - RSI
4. sedation to facilitate synchronised cardioversion
5. sedation to facilitate transthoracic pacing
6. sedation in agitated pt
7. sedation in psychostimulant OD
75
Midaz contras
hypersensitivity to benzodiazepines
76
Midaz precautions
1. reduced doses for elderly/frail, pts with chronic renal failure, CCF, shock
2. CNS depressant effects are enhanced with narcotics and alcohol
3. severe resp depression in COPD
4. myasthenia gravis
77
Midaz side effects
- depressed level of consciousness
- respiratory depression
- loss of airway control
- hypotension
78
Midaz notes
```
IM: onset: 3-5mins
peak: 15mins
duration: 30mins
IV: onset: 1-3mins
peak: 10mins
duration: 20mins
```
79
Morphine Presentation
10mg in 1ml
80
Morphine pharma
opioid analgesic agent:
- CNS depression causes analgesia
- resp depression
- depression of cough reflex
- stimulation (euphoria, vomiting, pin point pupils)
- dependence
- vasodilation
- decreased conduction velocity through AV node
81
Morphine Indications
1. pain relief
2. sedation to maintain intubation
3. sedation to facilitate intubation - where fentanyl not appropriate for RSI
82
Morphine contras
1. hypersensitivity
2. late second stage labour
3. renal impairment/failure
83
Morphine precautions
1. elderly/frail
2. hypotension
3. resp depression
4. current asthma
5. resp tract burns
6. addiction
7. acute alcoholism
8. monoamine oxidase inhibitors
84
Morphine side effects
- drowsiness
- resp depression
- euphoria
- nausea and vomiting
- pin point pupils
- addiction
- hypotension
- bradycardia
85
Morphine notes
```
IV onset: 2-5mins
peak: 10mins
duration 1-2hours
IM onset: 10-30mins
peak:30-60mins
duration:1-2hours
```
86
Naloxone presentation
0.4mg in 1ml
87
Naloxone pharma
opioid antagonist - prevents and reverses the effects of opioids by competitively binding to opioid receptors
88
Naloxone indications
altered conscious state and resp depression secondary to admin of opioids or related drugs
89
Naloxone contras
nil
90
Naloxone precautions
1. known addiction
| 2. neonates
91
Naloxone side effects
withdrawal symptoms: sweating, gooseflesh, temors, nausea and vomiting, agitation, dilated pupils, excessive lacrimation, convulsions
92
Naloxone notes:
IV onset: 1-3mins
duration:30-45mins
IM onset:1-3mins
duration: 30-45mins
93
Ondansetron presentation
4mg tab or 8mg in 4ml
94
Ondansetron pharma
anti-emetic
| serotonin antagonist which blocks receptors both centrally and peripherally
95
Ondansetron indications
1. undifferentiated nausea and vomiting
2. prophylaxis for spinal or eye injured pts
3. vestibular nausea for pts under 21
96
Ondansetron contras
1. hypersensitivity
2. long QT syndrome
3. concurrent apomorphine use
4. hypokalaemia or hypomagnesaemia
97
Ondansetron precautions
1. pts with liver disease should not have more than 8mg a day
2. take care with pts on diuretics due to underlying electrolyte imbalance
3. do not give to pts with phenylketonuria
4. concurrent use of tramadol
5. pregnancy
98
Ondansetron side effects
- constipation
- headache
- fever
- dizziness
- rise in liver enzymes
99
Ondansetron notes
tablet onset: 2mins
peak: 20mins
duration: 2hours
IV onset: 5mins
peak: 10mins
duration: 2.5 to 6.1 hours
100
Paracetamol presentation
500mg tablets
| 120mg in 5ml liquid
101
Paracetamol pharma
an analgesia and antipyretic agent
| -thought to inhibit prostaglandin synthesis in the CNS
102
Paracetamol indications
1. mild pain
| 2. headache
103
Paracetamol contras
1. hypersensitivity
2. admin in 4hours
3. children less than 1month old
4. total intake in 24 hours greater than 4g for adults and 60mg/kg for children
5. chest pain in suspected ACS
104
Paracetamol precautions
1. impaired hepatic or renal disease
2. malnourished
3. elderly/frail
105
Paracetamol side effects
hypersensitivity reactions
| haematological reactions
106
Paracetamol notes
onset: 30mins
duration: 4 hours
107
Stemetil presentation
12.5mg in 1ml
108
Stemetil pharma
an anti-emetic
| -acts on several central neurotransmitter systems
109
Stemetil indications
1. treatment or prophylaxis for nausea/vomiting:
- motion sickness
- vertigo
- known allergy or C/I to ondansetron
- planned aeromedical evac
- headache irrespective of severity
110
Stemetil contras
1. circulatory collapse
2. CNS depression
3. under 21 yrs
4. hypersensitivity
5. pregnancy
111
Stemetil precautions
1. hypotension
2. epilepsy
3. pts affected by alcohol or on anti-depressants
112
Stemetil side effects
```
drowsiness
blurred vision
hypotension
sinus tach
skin rash
extrapyrimidial reactions
```
113
Stemetil notes
onset: 20mins
peak: 40mins
duration: 6hours
114
Salbutamol presentation
pMDI
| 5mg in 2.5ml
115
Salbutamol pharma
Synthetic beta adrenergic stimulant within primarily beta 2 effects
-causes bronchodilation
116
Salbutamol indications
1. resp distress with suspected bronchospasm
- asthma
- severe allergic reaction
- COPD
- smoke inhalation
- capsicum spray exposure
117
Salbutamol contras
nil
118
Salbutamol precautions
large doses of Salbutamol can cause intracellular metabolic acidosis
119
Salbutamol side effects
sinus tach
| muscle tremor
120
Salbutamol notes
onset: 5-15mins
duration: 15-50mins
121
Tenecteplase presentation
50mg in glass vial with weight marked and pre-filled syringe containing water for IV admin
122
Tenecteplase Pharma
Fibrinolytic, a modified form of tissue plasminogen activator tPA that binds to fibrin and converts plasminogen to plasmin
123
Tenecteplase metabolism
Liver
124
Tenecteplase PEI
Acute STEMI
125
Tenecteplase Contras/exclusion criteria
1. Major surgery in the past 3 months
2. significant head injury in the past 3 months
3. Major trauma in the last 3 months
4. stroke/TIA in the past 3 months
5. ICH at any time
6. GI or genitourinary bleed in the past month
7. current bleeding disorder, active bleeding -excl menses- or bleeding tendencies
8. anticoagulants or glycoprotein IIb/IIIa inhibitors
9. allergy to tenecteplase or gentamicin
126
Tenecteplase Precautions
1. age greater than or equal to 75 years
2. non-compressible vascular puncture
3. hx of liver disease
4. SBP over 160 or DBP over 110
5. low body weight
6. active peptic ulcer
7. anaemia
8. acute pericarditis or subacute bacterial endocarditis
9. traumatic or prolonged CPR over 10mins
10. pregnant or within 1 week post partum
11. HR over 120
127
Tenecteplase route of admin
IV as a single bolus over 10 secs
| IO - consult
128
Tenecteplase side effects
Bleeding - including injection sites, ICH, internal bleeding
transient hypotension
Infrequent: allergic reactions including fever, chills, rash, nausea, headache, bronchospasm, vasculitis, nephritis and anaphylaxis
Rare: cholesterol embolism
129
Oxytocin Presentation
10 units in 1ml
130
Oxytocin Pharma
A synthetic oxytocic - stimulates smooth muscle of the uterus producing contractions
131
Oxytocin PEI
PPH - primary postpartum haemorrhage
132
Oxytocin Contras
1. previous hypersensitivity
2. severe toxaemia - pre eclampsia
3. exclude multiple pregnancy before drug admin
4. cord prolapse
133
Oxytocin Precautions
1. if given IV may cause transient hypotension
| 2. concurrent use with Methoxy may cause hypotension
134
Oxytocin route of admin
IM
135
Oxytocin side effects
Uncommon with IM:
tachycardia
bradycardia
nausea
136
Oxytocin notes
must be stored between 2-8 degrees
onset: 2-4 m
duration: 30-60m
137
Olanzapine presentation
10mg ODT
138
Olanzapine pharma
atypical antipsychotic - antagonist at multiple recept sites, particularly serotonin, dopamine and histamine
139
Olanzapine PEI
mild agitation
140
Olanzapine contras
nil
141
Olanzapine Precautions
1. may be less effective if agitation is due to drug intoxication or alcohol withdrawal. Benzos should be considered for these patients.
2. elderly/frail and children are more susceptible to adverse effects
142
Olanzapine side effects
CNS: sedation, dizziness
other: extrapyrmidial symptoms and QT prolongation are unlikely when administered at approved doses
143
Olanzapine notes
onset: 15m
duration: 12-24hours
144
Lidocaine pharma
sodium channel blocker - interrupts impulse conduction in peripheral nerves and stabilises excitable cell membranes
145
Lidocaine PEI
local anaesthetic to reduce pain associated with:
- IM admin of ceftriaxone
- chest decompression in pts with GCS greater than 10 - MICA only
- IO admin of medication or fluid in conscious pt - MICA only
146
Lidocaine contras
Known hypersensitivity to lidocaine or related local anaesthetics
147
Lidocaine precautions
1. IM and local infiltration - inadvertent intravascular admin may result in systemic toxicity
2. IO - impaired CV function - ht, bradycardia, poor perfusion, heart block, heart failure
148
Lidocaine side effects
1. allergic reactions are rare and may present as localised oedema, urticaria, bronchospasm and anaphylaxis
2. signs of systemic toxicity include: CNS: tinnitus, blurred vision, sudden change in conscious state, agitation, convulsions
CV: ht, bradycardia, arrhythmias, cardiac arrest
149
Lidocaine presentation
50mg in 5ml polyamp
150
Lidocaine notes
onset: 5-15m
duration: 1-1.5hrs
151
Heparin presentation
5000 units in 5ml
152
Heparin pharma
anticoagulant - inactivates clotting factors IIa and Xa by binding to antithrombin III
153
Heparin metabolism
liver, excreted by kidneys
154
Heparin PEI
acute STEMI
155
Heparin contras
1. known allergy or hypersensitivity
2. active bleeding excl menses
3. oral anticoagulants
4. bleeding disorders
5. hx of heparin-induced thrombocytopaenia -HIT
6. severe hepatic impairment/disease including oesophageal varices
7. recent trauma or surgery less than 3 weeks
156
Heparin precautions
1. renal impairment
157
Heparin route of admin
IV
158
Heparin side effects
- bleeding
- bruising and pain at injection site
- hyperkalaemia
- thrombocytopaenia
159
Heparin notes
onset: immediate
duration: 3-6hrs
160
Glucagon presentation
1mg in 1l hypokit
161
Glucagon pharma
a hormone normally secreted by the pancreas - causes an increase in blood glucose concentration by converting stored liver glycogen to glucose
162
Glucagon PEI
1. diabetic hypoglycaemia BGL less than 4 in pts with altered conscious state who are unable to self-admin oral glucose
2. anaphylaxis where pt remains hypotensive following adrenaline therapy with phx of heart failure or pts taking beta blocker medication
163
Glucagon contras
nil
164
Glucagon precautions
nil
165
Glucagon route of admin
IM
166
Glucagon side effects
Nausea and vomiting - rare
167
Glucagon notes:
onset: 5m
duration: 25m
168
Dextrose presentation
25g in 250ml
169
Dextrose pharma
A slightly hypertonic crystalloid solution composing of sugar 10% and water.
Provides a source of energy and supplies body water
170
Dextrose metabolism
Dextrose - broken down in most tissues, stored in liver and muscle as glycogen
Water- excreted by kidneys, distributed throughout total body water
171
Dextrose PEI
diabetic hypoglycaemia BGL less than 4 in pts with an altered conscious state who are unable to self admin oral glucose
172
Dextrose contras
nil
173
Dextrose precautions
nil
174
Dextrose route of admin
IV
175
Dextrose side effects
nil
176
Dextrose notes
onset: 3m
duration: depends on severity of hypoglycaemic episode
