Pharmacology Flashcards
(81 cards)
1
Q
Indications for Fentanyl (2)
A
- Analgesia
- Sedation to maintain intubation.
2
Q
Contraindications for Fentanyl (4)
A
- Hypersensitivity
- Active labour
- Epistaxis or occluded nasal passages (IN)
- Pts <1yo.
3
Q
Side effects of Fentanyl (4)
A
- Resp depression
- Apnoea
- Rigidity of diaphragm and intercostal muscles
- Bradycardia
4
Q
Preference for Fentanyl over Morphine (4)
A
- Contraindication to Morphine
- Short duration of action desired (eg. dislocation)
- Hypotension
- Nausea and vomiting secondary to prev. Morphine administration.
5
Q
Indications for Morphine
A
- Pain relief
- Sedation to maintain intubation
6
Q
Contraindications for Morphine
A
- Known hypersensitivity
- Active labour
7
Q
Dose of Morphine
A
- 0.1mg/kg IM (max single dose 10mg) may repeat once after 20mins if required.
- 0.05mg/kg IV/IO (max 5mg) repeat after 5 mins titrated to pain or side effects (max total 20mg)
8
Q
Dose of Fentanyl
A
- up to 100mcg IN, repeat up to 50mcg IN after no less than 5mins, titrated to pain or side effects (total max 400mcg).
- 0.5mcg/kg IV/IO (max 50mcg). Repeat after no less than 5mins, titrated to pain or side effects (total max 200mcg).
- 1mcg/kg IM/SC (max dose of 100mcg) may repeat once after 20mins if required.
9
Q
Presentation of Morphine and Fentanyl
A
Morphine: 10mg/1
Fentanyl: 100mcg/2ml (amp), 250mcg/1ml (IN)
10
Q
Contraindications for Ondansetron (2)
A
- Hypersensitivity
- Age <2yo.
11
Q
Ondansetron Dose (adult)
A
4mg/2ml
12
Q
Methoxyflurane Indications
A
Moderate pain relief where narcotics are contraindicated or not appropriate.
13
Q
Methoxyflurane Contraindications (5)
A
- Renal disease
- Concurrent use of tetracycline antibiotics
- Family hx of malignant hyperthermia
- exceeded 6ml in 24hrs
- exceeded 15ml in 7days
14
Q
Aspirin indication
A
- ACS
300mg chewable tablet
15
Q
Aspirin contraindications (5)
A
- Hypersensitivity to Asprin and salicylates
- Bleeding disorders
- Actively bleeding peptic ulcer
- Suspected AAA rupture
- Chest pain associated with psychostimulant overdose and SBP >160
16
Q
Ondansetron Pharmacology
A
Serotonin 5-HT3 receptor antagonist in the CNS and PNS. Reduces activity of Vagus nerve which inhibits the vomiting reflex in the medulla oblongata and blocks serotonin receptors in the CTZ.
17
Q
Morphine Pharmacology
A
Binds to opioid receptors in the CNS resulting in analgesia, respiratory depression, vasodilation, decreased conduction through AV node, inhibition of coughing reflex, changes in mood, euphoria or dysphoria, vomiting, pin-point pupils, addiction.
18
Q
Fentanyl Pharmacology
A
Binds to opioid receptors in the CNS leading the analgesia, decreased conduction through the AV node, respiratory depression (can lead to apnoea), dependence and addiction.
19
Q
Ondansetron side effects (4)
A
- Headache
- Skin flushing
- Extra pyramidal effects
- Arrythmia
20
Q
Ondansetron precautions (4)
A
- Impaired hepatic function
- Elderly
- Pregnancy
- Lactation
21
Q
Methoxyflurane precautions (2)
A
- Hand held device so must be conscious and if becomes unconscious can fall of face. Occasionally operator can assist with administer but need to monitor consciousness.
- Pre-eclampsia
22
Q
Morphine precautions (8)
A
- Elderly
- Hypotension
- Respiratory depression
- Current Asthma
- Resp tract burns
- Narcotic addiction
- Acute alcoholism
- Pts on MAO inhibitors.
23
Q
Side effects for Morphine (8)
A
- Drowsiness
- Respiratory depression
- Euphoria
- N & V
- Pin-point pupils
- Addiction
- Hypotension
- Bradycardia
24
Q
GTN Indication
A
- Chest pain/Hypertension with ACS
- Autonomic Dysreflexia
- APO
25
GTN Contraindications (8)
- Hypersensitivity
- SBP <100 for buccal and SL
- SBP <120 IV
- HR >150
- HR <50
- VT
- RV infarct
- Erectile Dysfunction meds (Viagra or Levitra in prev. 24hrs, or Tadalafil/Cialis in prev. 4 days).
26
GTN precautions (6)
- no prev. admin
- Elderly
- Recent AMI
- Inferior STEMI SBP<160
- Avoid skin contact
- Always reduce BP slowly rather than aggressive ( IV)
27
GTN side effects (5)
- Tachycardia
- Hypotension
- Headache
- Skin flushing (uncommon)
- Bradycardia
28
Midazolam Pharmacology
Benzodiazapine- short acting CNS depressant acts by increasing affinity of GABA through GABA-A receptors resulting in suppression of neuronal excitation leading to sedation and skeletal muscle relaxation. Effects are anxiolytic, anticonvulsant, hypnotic and amnesic effects.
29
Dose of Midazolam (seizures)
Age over 60: 0.05mg/kg IM max 10mg
Age under 60 0.1mg/kg IM max 10mg
Can only repeat if seizure continues over 10mins (once only)
ICP's IV, can also repeat after 5mins early call for ICP!
30
Adrenaline Pharmacology
Stimulant- non selective Alpha and Beta Adrenergic effects
A1- Increases BP by peripheral vasoconstriction
B1- increases HR by increasing SA node firing and AV conduction. Also increases myocardial contractility
B2- decreases airway resistance through stimulating Bronchodilation
31
Adrenaline Indications (10)
1) VF & unconscious VT
2) asystole
3) PEA
4) Inadequate perfusion (cardiogenic)
5) Inadequate perfusion (non-cardiogenic)
6) anaphylaxis
7) Severe Asthma
8) Unconscious Asthma (no BP)
9) Croup/suspected epiglottis
10) Bradycardia- poor perfusion
32
Adrenaline contraindications
Hypovolemic shock without adequate fluid replacement
33
Adrenaline precautions
Elderly, cardiovascular disease, MAO inhibitors, Beta blockers as higher doses may be required.
34
Adrenaline side effects
Tachycardia, SVT and ventricular rhythms, hypertension, pupil dilation, increase size of myocardial infarct, palpitations, muscle tremors
35
Aspirin pharmacology
Inhibits (COX2) enzymes leading to reduced synthesis of the platelet aggregation factor thromboxane A2 (TXA2) and prostaglandins. This results in analgesic, antipyretic, anti-inflammatory and antiplatelet effects.
36
Aspirin side effects
- Heartburn, nausea and GI bleeding
- Increased bleeding time
- Hypersensitivity reactions
37
Diazepam indication
Acute Behavioural disturbance with SAT score of >0
38
Diazepam presentation
5mg tablets
39
Diazepam pharmacology
Benzodiazapine-Reduces neural activity by increasing effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) through GABA-A within the brain causing sedation, suppressed electrical activity and relaxation of skeletal muscle. Primary effect for AT is anxiolytic with mild sedative effects.
40
Diazepam contraindications (2)
- Hypersensitivity to benzodiazapines
| - Myasthenia Gravis
41
Diazepam Precautions (5)
1) Elderly and children
2) CNS depression and ingestion of CNS depressing agents ie. Alcohol
3) Hypotension
4) Renal or hepatic insufficiency
5) Respiratory insufficiency
42
Diazepam side effects
Extrapyramidal effects eg. Dystonic reactions (rare)
43
Droperidol indication
Acute Behavioural disturbance with SAT score +2 or +3
44
Droperidol presentation
10mg/2ml
45
Droperidol pharmacology
- antipsychotic
- inhibits dopamine mediated neurotransmission in cerebrum and basal ganglia
- also inhibited CTZ in the medulla
46
Droperidol contraindications (4)
1) known allergy
2) Parkinson's disease
3) Previous dystonic reaction to Droperidol
4) Pt's <8yo.
47
Droperidol precautions
Concomitant use of CNS depressants
48
Droperidol side effects
Extrapyramidal effects eg. Dystonic reactions
49
Fentanyl precautions (5)
1) Elderly
2) Respiratory depression eg. COPD
3) Current Asthma
4) Known addiction to narcotics
5) Pt's on MAO inhibitors
50
Diazepam dose
10mg oral, 5mg if >60yo. May repeat at 60min. As required. Max total dose 40mg
51
Droperidol dose
IV 5mg, may repeat 5mg once after 10mins SAT score >0, max dose 20mg or 10mg if >60yo. Or <50kg
IM- 10mg or 5mg is age >60yo. or weight <50kg. May repeat once if SAT >0 and after 15mins. Therefore, max dose is 20mg or 10mg if >60yo. or age <50kg.
52
Glucagon presentation
1mg (IU) in 1ml Hypokit
53
Glucagon pharmacology
Glucagon is a hormone normally secreted by the pancreas
It causes an increase in blood glucose concentration by converting stores of live gylcogen to glucose.
Has a weak chronotropic and inotropic action.
54
Glucagon indication
Hypoglycaemia (BGL <4.0mmol/L) in pts with an altered conscious state who are unable to self administer oral glucose. No IV Access.
No precautions or contraindications
Be aware that PTS with Inadequate liver storage or glycogen and alcoholics/malnourishment will not respond.
55
Glucagon side effect
Nausea and vomiting (rare)
56
Glucose 10% presentation
25g in 250ml infusion pack
57
Glucose 10% indication
Hypoglycaemia (<4.0mmol/L with an altered conscious state and inability to self-administer oral glucose with IV access.
No contraindications or precautions.
58
Glucagon dose
1ml (1IU) for adults and children over 25kg.
| Children <25kg 0.5 ml (0.5IU(
59
Glucose 10% dose for hypoglycaemia
Glucose 10%, 1g in 10ml.
Adults: 15g (150ml) titrate to response. Can repeat with 10g (100ml) after 3mins (remainder of bag) if GCS remains under 15. Continue to repeat every 5mins with 10g (100ml) until BGL >4.0mmol/L. Give 10ml flush each dose.
Children: 500mg/kg (5ml/kg) need ICP to repeat.
Give 10ml IV flush! Make sure vein patent to avoid tissue necrosis.
60
GTN dose
ACS: 400mcg @ 5mins if chest pain persists and SBP >100 or hypertension persists SBP >160 or DBP >100.
APO: 400mcg repeat @5mins if SBP remains over 100 until symptoms resolve, BP <160 or onset of side effects.
AD: if SBP >160mmHg give 400mcg and repeat @10mins until BP <160, symptoms resolve or side effects.
61
Ipratropium Bromide (Atrovent) presentation
500mcg/ml
| 21mcg PMDI spray
62
Ipratropium Bromide pharmacology
Anticholinergic Bronchodilator
- Antagonist to muscarinic receptors. Blockage of M3 receptors results decrease in smooth muscle contractility promoting bronchodilation. Also decreases secretion of mucus in the lower airways.
63
Ipratropium Bromide indication
Severe Respiratory distress associated with bronchospasm (severe asthma and COPD exacerbation)
64
Ipratropium Bromide contraindications
Hypersensitivity to Atropine or its derivatives
65
Ipratropium Bromide precautions
Glaucoma
Avoid contact with eyes- can cause mydriasis, increase ocular pressure worsening glaucoma) therefore make sure mask is fitted correctly and always nebulise with salbutamol
66
Ipratropium Bromide side effects (7)
```
Headache
Nausea
Dry Mouth
Skin Rash
Palpitations (rare)
Tachycardia (rare)
Acute angle closure glaucoma secondary to direct eye contact (rare)
```
67
Fentanyl IN doses
Age <65 4x sprays 100mcg. Repeat with 50mcg (2x sprays)
Age >65 2x sprays 50mcg, repeat with 50mcg after 5mins.
Total max for all 400mcg
68
Methoxyflurane side effects (3)
- Drowsiness
- Decrease in HR and BP (rare)
- Renal toxicity if exceeded 6ml in 24hrs or 15ml in 7 days.
69
Methoxyflurane onset
8-10 breaths required for analgesic effects. Lasts up to 25mins. Can repeat once expired only once. Avoid using in confined spaces. Always use with a filter.
70
Risk factors to consider reducing opioid doses
```
Age >65
Shocked pts
Frail pts
Cardiovascular compromise
Underlying lung disease or injury
Kidney or liver disease
```
71
Metoclopramide indication
Nausea or vomiting associated with narcotic pain relief or past hx of migraine
72
Metoclopramide presentation
10mg/2ml
73
Metoclopramide pharmacology
Dopamine 2 receptor antagonist-blocl in CNS and PNS results in antiemetic effect.
Inhibits gastric smooth muscle relaxation promoting gastric emptying and peristalsis.
74
Metoclopramide contraindication
- GIT haemorrhage, obstruction or perforation
- known sensitivity or intolerance
- age <16yo.
Precautions with any undiagnosed abdo pain
75
Metoclopramide side effects
- drowsiness
- lethargy
- dry mouth
- muscle tremor
- hypotension/hypertension
- extrapyramidal effects (dystonic)
- lowers seizure threshold
76
Metoclopramide dose
10mg IM/IV repeat once after 10mins (max 20mg). IV give slow push (1-2mins)
77
Midazolam indications
Continuous/repeated seizures
Sedation to maintain intubation (ICP)
Sedation to enable synchronized cardioversion (ICP)
Sedation in agitated pt (ICP)
Sedation in psychostimulant overdose (ICP)
Severe trauma (multiple fractures or burns) (ICP)
78
Midazolam contraindications
Known hypersensitivity to Benzodiazapines
79
Midazolam precautions
Reduced doses may be required in elderly, chronic renal failure, shock, and congestive heart failure.
Depressant effects enhanced with other CNS depressants, alcohol and tranquilisers
Can cause severe respiratory depression in COPD PTS
PTS with myasthenia gravis
80
Midazolam side effects
Depressed level on consciousness
Respiratory depression
Loss of airway control
Hypotension
81
Naloxone pharmacology
- Narcotic antagonist
| - prevents or reverses the effects of narcotics by blocking opioid receptors
