PHECC meds Flashcards
(335 cards)
1
Q
Amiodarone class and descriptions
A
class 3 antiarrythmic used to treat ventricular arrythmias
2
Q
Amiodarone presentation
A
150 mg 3 ml solution
pre filled syringes 10ml (30mg/ml)
3
Q
Amiodarone administration
A
IV/IO
4
Q
Amiodarone indications
A
VF and pulseless VT
Symptomatic tachycardia >150bpm
5
Q
Amiodarone contraindications
A
known hypersensitivity to iodine
known severe allergic reaction
6
Q
Amiodarone dose
A
Adult - VT/VF: 5mg/kg IV/IO with a loading dose of 300mg and one supplimental dose of 150mg
Paeds - VT/VF: 5mg/kg IV/IO
7
Q
Amiodarone pharmacology/action
A
Antiarrhythmic Prolongs action potential Prolongs refactory period Prolongs atrioventricular conduction Prolongs QT interval
8
Q
Amiodarone side effects
A
Inflammation of peripheral veins
Bradycardia
AV conduction abnormalities
9
Q
Amiodarone notes
A
If dilution needed, dilute with Dextrose 5% (for infusion use 100mL D5W)
Can be flushed with NaCl
Cardiac arrest - nil dilution, follow with flush
Paed calcs - Add 2ml D5W making concentration 150mg/5ml
10
Q
Asprin class and description
A
Platelet aggregation inhibitor
anti inflammatory agent and inhibitor of platelet function
Useful agent in the treatment of various thrombo-embolotic disease such as AMI
11
Q
Asprin presentation
A
300mg dispersable tablet
12
Q
Asprin administration
A
orally - dispersed in water or chewed if not dispersible form
13
Q
Asprin indications
A
cardiac chest pain or suspected MI
14
Q
Asprin contraindications
A
active, symptomatic gastrointestinal (GI) ulcer
Bleeding disorder (e.g. haemophillia)
Known sever allergic reaction
pts
15
Q
Asprin doses
A
Adult - 300 mg tablet
Paeds - Contraindicated
16
Q
Asprin pharmacology/action
A
Antithrombotic
inhibits the formation of thromboxane A2, which stimulates platelet aggregation and artery constriction. this reduces clot/throbus formation in AMI
17
Q
Asprin side effects
A
SHORT TERM epigastric pain/discomfort bronchospasm gastrointestinal haemorrhage LONG TERM mild and infrequent but incidence of gastro-intestinal irritation with slight asymptomatic blood loss, increased bleeding time, bronchospasm and skin reaction in hypersensitive pts
18
Q
Asprin info
A
indicated regardless of patient is on anticoagulants or asprin
enteric coated with nil chewing - regard as nil administration
19
Q
Atropine class and description
A
Anticolinergic (parasympatholytic) that is derived from the atropa belladonna plant
20
Q
Atropine presentation
A
pre-filled disposable syringe - 1mg/10ml
ampoule - 0.6mg/1ml
21
Q
Atropine administration
A
IV/IO
22
Q
Atropine indications
A
symptomatic bradycardia
cholinergic poisioning with bradycardia and salivation
23
Q
Atropine contraindications
A
known severe allergic reaction
post - cardiac transplantation
24
Q
Atropine dose
A
ADULT - cholinergic poisoning with bradycardia/salivation
1mg IV, repeat 5 min intervals to ensure minimal salivation
symptomatic bradycardia - 0.6mg IV repeat 3-5 min intervals to a max of 3 mg
NOT INDICATED FOR PAEDS
25
Atropine pharmacology/action
```
Anticolinergic agent
blocks acetylcholine receptors
- enhances SA !ode automaticity
- enhances AV node conduction
- increases HR
```
26
Atropine side effects
tachycardia
dry mouth
dilated pupils
accidental exposure to the eyes can cause blurred vision
27
Benzylpenicillin class and description
antibiotic and antibacterial agent
28
Benzylpenicillin presentation
600mg powder in vial reconsitution
29
Benzylpenicillin administration
IV/IO
IM if no IV access possible
IV/IO : reconsitute each 600mg vial with 4ml water for injection and give slow push over 3-5min
IM : reconsitute each 600mg vial with 2ml water for injection
30
Benzylpenicillin indications
severe sepsis - adult
| suspected/confirmed meningococcal sepsis - paeds
31
Benzylpenicillin contraindications
known severe allergic reaction
32
Benzylpenicillin dose
Adult : 1200mg IV/IO/IM
Paeds: >8 yrs:1200mg IV/IO/IM
1-8 yrs: 600mg IV/IO/IM
33
Benzylpenicillin pharmacology and action
antibacterial
| Gram positive cocci antibiatoic
34
Benzylpenicillin side effects
gastro interstinal disturbances
| hypersensitivity reactions
35
Clopidogrel class and description
Platelet aggregation inhibitor that inhibts platelet function
36
Clopidogrel presentation
300mg tablet
| 75 mg tablet
37
Clopidogrel administration
Oral
38
Clopidogrel indications
STEMI where pt not suitable for PPCI
39
Clopidogrel contraindications
known sever adverse reaction
Active pathological bleeding
severe liver impairement
40
Clopidogrel dose
Adult: 300mg PO
> 75 yrs; 75mg PO
Paeds: not indicated
41
Clopidogrel pharmacology/action
selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor and the subsequent ADP-mediated activation of GPIIb/IIa complex therby inhibiting platelet aggregation. Biotransformation of clopidogrel is necessary to produce inhibition of platelet aggregation. clopidogrel acts by irreversibly modifying the platelet ADP receptor
42
Clopidogrel side effects
abdo pain
dysprepsia
diarrhoea
43
clopidogrel notes
should not have clopidogrel if other anti platelet medication previously administered (other than asprin)
44
cyclizine class and description
Antiemetic used for management of nausea and vomiting
45
cyclizine presentation
50mg/1ml ampoule
46
cyclizine administration
IV/IO
47
cyclizine indications
management, prevention and treatment of nausea and vomiting
48
cyclizine contraindications
known severe adverse reaction
49
cyclizine dose
Adult: 50mg slow IV
Paed: not indicated
50
cyclizine pharmacology and action
Antiemetic
51
cyclizine side effects
tachycardia
dry mouth
sedation
52
Dextrose 10% Solution class and description
carbohydrate, used to describe the six-carbon sugar d-glucose, which is the principal form of carbohydrate used by the body D10W is hypertonic
53
Dextrose 10% Solution presentation
soft pack for infusion 250ml/500ml
54
Dextrose 10% Solution administration
IV Infusion / bolus
IO
paramedic can maintain once commenced
55
Dextrose 10% Solution indications
hypoglycemic emergency
| BGL
56
Dextrose 10% Solution pharmacolgy and action
hypertonic glucose solution
| dextrose is a redily utilisable energy source
57
Dextrose 10% Solution side effects
necrosis of tissue around infusion site
58
Dextrose 10% Solution notes
also called glucose
| cannula patency will reduce effect of tissue necrosis
59
Dextrose 5% solution class and description
carbohydrate
dextrose is sused to describe the six-carbon sugar d-glucose, which is the prinipal form of carbohydrate used by the bosy. D5W is a hypertonic solution and used as an infusion medium for amioderone
60
Dextrose 5% solution presentation
soft pack of infusion 100ml/500ml
61
Dextrose 5% solution administration
IV/IO
| paramedic can maintain infusion onced commenced
62
Dextrose 5% solution indications
used as a dilutant for amioderone
63
Dextrose 5% solution contraindications
known severe adverse reaction
64
Dextrose 5% solution dose
Adult: dilute appropriate dose of amiodarone
Paed: not indicated
65
Dextrose 5% solution pharlacology and action
Dextrose 5% (D5W) is used as an infusion medium for amiodarone
66
Dextrose 5% solution side effects
necrosis of tissue around IV access
67
Dextrose 5% solution notes
paraedics are authorised to conitinue infusion in absence of AP or DR
68
Diazapam injection class and description
benzodiazapine used to terminate seizures
69
Diazapam injection presentation
10mg/2ml ampoule
70
Diazapam injection administration
IV/IO
71
Diazapam injection indications
seizures
72
Diazapam injection contraindications
known severe adverse reaction
respiratory depression
shock
depressed vital signs or ETOH related altered GCS
73
Diazapam injection dose
Adult: 5mg IV/IO repeat X1 PRN
Paeds: 0.1mg/kg IV/IO repeat X 1 PRN
74
Diazapam injection pharmacolgy/action
benzodiazapine sedative
inhibits the fireing of the hyperexcitable neurons through the enhancement of the action of the inhibitory transmitter GABA
results in CNS depression, anticonvulsant, sedative, skeletal muscle relaxant effects
75
Diazapam injection side effects
```
SHORT TERM
hypotension
resp depression
drowsy/lightheaded (the next day)
LONG TERM
confusion and ataxia especially in elderly
amnesia
dependence,
paradoxial increase in aggression
muscle weakness
```
76
Diazapam injection notes
titrate to effect
| max dose includes any given by others prior to arrival
77
diazapam rectal solution class and description
benzodiazapine used to terminate seizures
78
diazapam rectal solution presentation
rectal tube
2.5mg/1.25 ml (2mg/ml)
5mg/2.5ml (2mg/ml)
10mg/2.5ml (4mg/ml)
79
diazapam rectal solution administration
PR
80
diazapam rectal solution indications
seizure
81
diazapam rectal solution contraindications
known severe adverse reaction
resp depression
shock
depressed vital signs or ETOH related altered GCS
82
diazapam rectal solution dose
Adult: 10mgPR repeat X1PRN max 20mg
Peads: 8 yrs 10mg PR
83
diazapam rectal solution pharmocology/action
benzodiazapine sedative
inhibits the fireing of the hyperexcitable neurons through the enhancement of the action of the inhibitory transmitter GABA
results in CNS depression, anticonvulsant, sedative, skeletal muscle relaxant effects
84
diazapam rectal solution side effects
```
SHORT TERM
hypotension
resp depression
drowsy/lightheaded (the next day)
LONG TERM
confusion and ataxia especially in elderly
amnesia
dependence,
paradoxial increase in aggression
muscle weakness
```
85
diazapam rectal solution notes
be aware of pt modesty
should be administered in presence of 2nd person
egg/soya beans used in manufacture and allergies may be encountered
max dose includes any meds given prior to arrival
86
epinepherine 1:10000 class and description
sympathetic agonist naturally occuring catecholamine. potent alpha and beta adrenergic stimulant however effects on beta receptors is more profound
87
epinepherine 1:10000 presentation
pre-filled syringe
| 1mg/10ml (1:10000) as 0.1mg/ml
88
epinepherine 1:10000 indications
Cardiac arrest
| Peadiatric bradycardia unresponsive to other measures
89
epinepherine 1:10000 contraindications
known severe adverse reaction
90
epinepherine 1:10000 dose
ADULT: CARDIAC ARREST: 1mg (1:10000) IV/IO repeat 3-5 mins
PAEDS: CARDIAC ARREST: 0.01mg/kg (10mcg/kg) (0.1ml/kg) repeat 3-5 mins
BRADYCARDIA: 0.01mg/kg (10mcg/kg) (0.1ml/kg) of 1:10000 IV/IO every 3-5 mins
91
epinepherine 1:10000 pharmacology/action
alpha and beta adrenergic stimulant
increase HR - chronotropic effect
increase myocardial contractions - inotropic effects
increase BP
Increase electrical activity in myocardium
increase cerebral / coronary blood flow
dilation of bronchioles
92
epinepherine 1:10000 side effects
in non cardiac arrest patients
palpatations
tachyarrythmias
hypertension
93
epinepherine 1:10000 notes
double check concentrations on packet prior to use
94
Fentanyl class and description
synthetic narcotic analgesic with rapid onset and short duration of action
half life of 6.5mins when IN route used
95
Fentanyl presentation
100mcg/2ml ampoule (0.1mg/2ml)
96
Fentanyl indications
acute severe pain in patients greater than/equal to 1 yr old
97
Fentanyl contraindications
```
known fentanyl hypersensitivity
ALoC (altered Level of conciousness)
Bilateral occluded nasel passage
Nasal trauma
epistaxis
hypovolemia
```
98
Fentanyl dose
ADULT: 0.1mg IN repeat once after 10mins PRN
PAED: 0.0015mg/kg (1.5mcg/kg) IN repeat once after 10 mins PRN
99
Fentanyl pharmacology/action
fentanyl provides some of the effects typical of other opioids through its agonism of the opioid receptors. it's strong potency in relation to that of morphine is largely due to its high lipophilicity. because of this, it can easily penetrate into the CNS.
fentanyl binds to u-opioid G-protein-coupled receptors which inhibit pain nuerotransmitter release by decreasing intracellular Ca2+ levels.
100
Fentanyl side effects
```
SHORT TERM
sedation
nausea
vomiting
LONG TERM
vomiting
resp depression
```
101
Fentanyl notes
USE IN CAUTION IF PT HAS TRANSDERMAL FENTANYL PATCH
include an aditional 0.1ml to allow for the dead space in the mucosal atomisation device (MAD) in the calculated volume required
Administer 50% volume into each nostril if more than 1ml
102
Frusomide injection class and description
a loop diuretic
103
Frusomide injection
2ml, 5ml and 25ml ampoule
| 10mg/ml per ampoule
104
Frusomide injection administration
IV
105
Frusomide injection indications
pulmonary oedema
106
Frusomide injection contraindications
pregnancy
hypokalaemia
known severe adverse reaction
107
Frusomide injection dose
adult : 40mg slow IV
| Paeds: not indicated
108
Frusomide injection pharmacology/action
Acts on the acending loop of henle by inhibiting the reabsorption of cloride and sodium ions into the interstitial fluid. results in reletive hypertonic state. water is therfore retained in the loop and eliminated via the bladder
causes venodilation which reduces venous return to the heart
109
Frusomide injection side effects
```
SHORT TERM
headache transient deafness
dizziness diarrhoea
hypotension nausea
arrhythmias vomiting
LONG TERM
hyperuricaemia gout
hypokaelemia hyperglycaemia
```
110
Frusomide injection notes
frusomide should be protected from light
111
Glucagon class and description
hormone and antihypoglaecaemic
Glucagon is a protein secreted by the alpha cells of the islets of langerhans in the pancreas. it is used to increase the blood glucose level in cases of hypoglycaemia in which an IV cannot immediatly be placed
112
Glucagon presentation
1mg vial powder and solution for reconstitution (1ml)
113
Glucagon asministration
IM
114
Glucagon indications
hypoglycaemia in patients unable to take oral glucose or unable to gain IV access with a BGL
115
Glucagon contraindications
known severe adverse reactions
| phaeochromocytoma
116
Glucagon dose
ADULT: 1mg IM
PAEDS: 8 1mg IM
117
Glucagon pharmacology/action
glycogenisis
| increases plasma glucose by mobilising gycogen stored within the liver
118
Glucagon side effects
rare, may cause hypertension, dizziness, headache, nausea, vomiting
119
Glucagon notes
may be ineffective in patients with low stored glycogen eg prior use in 24hrs, alcoholic patients or liver disease
store in refridgerator
protect from light
120
glucose gel class and description
antihypoglycaemic
| synthetic glucose paste
121
glucose gel presentation
glucose gel in a tube or sachet
122
glucose gel administration
buccal administration
| administer gel inside patients cheek and gently massage outside of cheek
123
glucose gel indications
hypoglycaemia
| BGL
124
glucose gel contraindications
known severe adverse reactions
125
glucose gel dose
ADULT: 10-20g buccal
repeat PRN
PAEDS 8 yrs 10-20g buccal
repeat PRN
126
glucose gel pharmacology and action
increase blood glucose levels
127
glucose gel side effects
may cause vomiting in pts
128
glucose gel notes
glucose gel will maintain glucose levels once raised but should be used secondary to Dextrose to reverse hypogycaemia
PROCEED WITH CAUTION
pts with airway compromise
pts with altered GCS
129
Glyceryl Trinitrate (GTN) clas snad description
Nitrate
special preperation of Glyceryl Trinitrate (In an aerosel form that delivers precisily 0.4mg of Glyceryl Trinitrate per spray
130
Glyceryl Trinitrate (GTN) presentation
aerosol spray: metered dose 0.4mg (400mcg)
131
Glyceryl Trinitrate (GTN) administration
Sublingual
hold pump spray vertically with valve uppermost
place as close to mouth as possible and spray under tongue
mouth should be closed after each dose
132
Glyceryl Trinitrate (GTN) indications
angina
suspected MI
Pulmonary oedema
133
Glyceryl Trinitrate (GTN) contraindications
SBP
134
Glyceryl Trinitrate (GTN) dose
ADULT: AMI/Angina - 0.4mg (400mcg) SL repeat 3-5 min intervals Max 1.2mg (3doses)
Pulmonary oedema 0.8mg (800mcg) SL repeat once
135
Glyceryl Trinitrate (GTN) pharmacology/action
vasodilator
releases nitric oxide which acts as a vasodilator.
dilates coronary arteries particularly if in spasm increasing blood flow to myocardium
dilates systemic veins reducing venous return to the heart (preload) and thus reducing hearts workload
reduces BP
136
Glyceryl Trinitrate (GTN) side effects
headache
transient HTN
flushing
dizziness
137
Glyceryl Trinitrate (GTN) notes
if new pump of 1/7 since last use, first spray should be administered into the air
138
Hartmann's Solution description and class
Isotonic crystalloid solution containing Sodium cloride 0.6%, Sodium lactate 0.25% Potassium chloride 0.04%, Calcium chloride 0.027%
139
Hartmann's Solution presentation
soft pack for infusion 500ml and 1000ml
140
Hartmann's Solution administration
IV/IO
141
Hartmann's Solution indications
when NaCl is unavailable it may be substituted with Hartmann's IV/IO, except for crush injuries, burns, renal failiure and hyperglycaemia
142
Hartmann's Solution contraindications
known severe adverse reactions
143
Hartmann's /NaCl Dose for Crush injury/suspension trauma/PEA/Asystole
20ml/kg IV/IO
| hypothermia
144
Hartmann's /NaCl Dose for hypothermia
| ADULTS and PAEDS
ADULTS: 250ml IV/IO (warm fluids to 40oC) repeat max 1L
PAEDS: 10ml/kg IV/IO (warm fluids to 40oC) repeat PRN X1
145
Hartmann's /NaCl dose for # NOF, sepsis, symptomatic bradycardia
250ml IV infusion
146
Hartmann's /NaCl dose for decompression illness, sepsis with poor perfusion
500ml IV/IO infusion
147
Hartmann's /NaCl dose for shock from blood loss
500ml IV/IO infusion. Repeat in 250ml bolus PRN to maintain SBP of 90-100mmHg
120mmHg for head injury GCS
148
Hartmann's /NaCl dose for Burns for adults
>25% TBSA and/or 1hr from time of injury to ED, 1000ml IV/IO infusion
>10% TBSA consider 500ml IV/IO
149
Hartmann's /NaCl dose for Burns for paeds
>25% TBSA and/or 1hr from time of injury to ED,
5-10 yrs 250ml IV/IO
.10 yrs 500ml IV/IO
150
Hartmann's /NaCl dose for adrenal insufficiency, Glycaemic emergency, Heat -related emergency, sickle cell crisis for adults
100ml IV/IO
151
Hartmann's /NaCl dose for adrenal insufficiency, Glycaemic emergency, Heat -related emergency, sickle cell crisis for paeds
20ml/kg IV/IO
152
Hartmann's /NaCl dose for anaphylaxis
ADULTS: 100ml IV/IO repeat X 1 PRN
PAEDS: 20ml/kg IV/IO repeat X 1 PRN
153
Hartmann's /NaCl dose for post resus care
ADULTS: 1000ml IV/IO infusin cooled to 4oC if persistant to maintain SBP > 90mmHg
PAEDS: 20ml/kg IV/IO infusion if persistant poor perfusion
154
Hartmann's pharmacology/action
increases extracellular volume
155
Hartmann's side effects
if admistered in large amounts can cause oedema
156
Hartmann's notes
observe in pts with phx of CCF
also called solium lactate or compound ringer lactate
warm prior to administration if possile
157
Hydrocortisone class and description
Potent Corticosteroid wth anti-inflammatory properties
158
Hydrocortisone presentation
powder and solvent for solution for injection or infusion. Vial conaining off-white powder and vial containing water forinjections. Prepare the olution aseptically by addin not more than 2ml of sterile water for injection to contnts of one 100g vial. Shake and withdraw use.
159
Hydrocortisone administration
IV infuion - preffered for initial emergency use
| IM injection
160
Hydrocortisone indications
Sverof reoccurrent anaphylactic reactions
Asthma refactory to Salbutamol and Ipatropium Bromide
Exacerbation of COPD
Adreal insufficiency
161
Hydrocortisone contraindicatios
No acute containdications in acute management of anaphylaxis
162
Hydrocortisone dose for anaphylactic reactions
| ADULT: exacebation of COPD
ADULT: 200g IV (infsion in 100ml NaCl) or IM
PAEDS: 5 yrs100mg IV infusion in 100ml
163
Hydrocortisone dose for Asthma
ADULT: 100mg IV infusion in 100ml
PAEDS: 5 yrs100mg IV infusion in 100ml
164
Hydrocortisone pharmacology/action
Potent anti-inflammatory properties and inhibits many substances tha cause inflammaton
165
Hydrocortisone side effects
SHORT TERM
CCF nausea
Hypertension malaise
abdominal distension hiccups
vertigo headache
LONG TERM
Adrenal cortical atrophy develops during prolonged therepy and may persst for months after stopping treatment
166
Hydrocortisone notes
IM injection sould avoid deltoid area due to possibility of tissue atrophy
Dose should not be less thn 25mg
IV is perfered route for adrenal crisis
167
Ibuprofen class and description
Non-Steroial Anti-Inflammatory Drugs NSAIDS analgesic
168
Ibuprofen presentation
suspension 100mg/5ml
200mg tablet
400mg tablt
169
Ibuprofen administration
orally
170
Ibuprofen indications
Mild to Moderate pain
171
Ibuprofen contraindications
not suitabe for children
172
Ibuprofen dose
ADULT: 400mg PO
PAEDS: 10mg/kg PO
173
Ibuprofen pharmacology/action
Supresses prostaglandins which cause pai via the inhibition of cyclooxgenase (COX). Prostgrandlins are released by cell damage and inflammation
174
Ibuprofen side effects
SHORT TERM
skin rashes GIT intolerence
bleeding
LONG TERM
Occasional GIT bleeding an ulceration can occur. May be also cause of acute renal failure, intestitial nephritis and NSAIDS-associated nephropathy
175
Ibuprofen notes
if Ibuprofen given inperious 6 hrs, adjust dose downward by mount given by other sourcesresulting in max 10mg/kg
Caution with significant burns or poor perfusion due to risk of kidney failure
Caution ith oncurrent NSAID use
176
Ipratropium Bromide descripton and class
Anticholinergic
| Parasympatholytc bronchodilator that is chemically related to atropine
177
Ipratropium Bromide presentation
Nebuised solution 0.25mg (250mcg) in 1ml
178
Ipratropium Bromide administration
Nebulised (NEB) mixed with age specific dose of salbutamol
179
Ipratropium Bromide indications
Acute moderate asthma or exacerbation of COPD not responding to iniial sulbutamol dose
180
Ipratropium Bromide contraindications
Known severe adverse reaction
181
Ipratropium Bromide pharmacology/action
It bloks muscarinic receptors associated with prasympathetic stimulation of the bronchial air passageways. Thisresults in bronchiol dilation and reduced brochial secretions
182
Ipratropium Bromide side effects
transient dry mouth,
blurred vision,
tachycardia
headache
183
Lidocaine class and description
Ventricular antiarrhythmic agent
184
Lidocaine presentation
Lidocaine injection minijet 1%w/v 100mg/10ml
185
Lidocaine administration
IV/IO
186
Lidocaine indications
When amiodarone is not available it may bsubstituted with Lidocaine for VF/VT arrest
187
Lidocaine contraindications
Nil in cardiac arrests
188
Lidocaine dose
ADULT: 1-1.5mg/kg IV/IO
PAEDS: not indicated
189
Lidocaine pharmacolgy/actions
redces automacticity by decreasing rateof diastolic depolarisation. Stabalises the neuronal membranes and prevents the initiation and transmissin of nerve impulses, action is rapid and blockade an last up to 2 hrs
190
Lidocaine side effects
drowsiness dizziness twitching
paraesthesia convulsions bradycardia
resp depression
191
Lidocaine notes
Lidocaine cannot be dministered if Amiodarone has been administered
192
Lorazepam class and description
Benzodiazepine
| anxiolytic used as sedative
193
Lorazepam presentation
1mg tablet
194
Lorazepam administration
orally
195
Lorazepam indications
combative with hullucinations or paranoia and risk to self/others
196
Lorazepam contraindications
History f sensitivity to benzodiazapines
Severe hpatic or pulmonary insufficiency
suspected significant ETOH and/or other sedatives injested
Known severe adverse reaction
197
Lorazepam dose
ADULT: 2mg PO
PAEDS:not indicated
198
Lorazepam pharmacology/action
acts CNS receptors to potentiate the inhibitory action of GABA
199
Lorazepam side effects
Drowsiness confusion headache
dizziness blurred vision nausea/vomiting
RARE: hypotension
hypertension
200
Magnesium Sulphate injection description and class
Electrolyte and Tocolytic agent
| A salt that is essential element in numerous biochemical reactions that occur within the body
201
Magnesium Sulphate injection presentation
5g/10ml ampoule
202
Magnesium Sulphate injection administration
IV/IO
203
Magnesium Sulphate injection indications
Torsades de pointes
persistant brochospasm
seizure associated with eclampsia
204
Magnesium Sulphate injection contraindications
Nil in cardiac arrest
| Known severe adverse reaction
205
Magnesium Sulphate injection dose
pulseless torsades de pointes: 2g IV/IO Torsades de pointes/bronchospasm: 2g IV/IO infusion in 100ml NaCl
seizure associated with eclampsia: 4g IV/IO infusion in 100ml NaCl
Not indicated for Paeds
206
Magnesium Sulphate injection pharmacology/action
it acts as a physiological calcium channel blocker and blocks neurotransmitter transmission
207
Magnesium Sulphate injection side effects
decreased deep tendon reflexes
resp depression
bradycardia
hypothermia
208
Midazolam solution class and description
Benzodiazapine
| potent sedative agent 3-4 X more potent than diazapam
209
Midazolam solution presentation
```
10mg/2ml ampoule
10mg/5ml ampoule
Buccal liquid 50mg/5ml
pre-filled syringe 2.5mg/0.5ml
pre-filled syringe 5mg/1ml
pre-filled syringe 7.5mg/1.5ml
pre-filled syringe 10mg/2ml
pre-filled syringe 10mg/1ml
```
210
Midazolam solution administration
IN
buccal
IV/IO
IM
211
Midazolam solution indications
seizures
| combative with hullucinations/paranonia and risk to self/others
212
Midazolam solution contraindications
Shock
depressed vital signs or ETOH related altered GCS
Resp depression
known severe adverse reaction
213
Midazolam solution adult dose
seizure/combative pt
| 2.5 mg IV/IO or 10mg buccal or 5mg IN repeat X 1 PRN
214
Midazolam solution paeds dose
```
Seizure
10yrs: 10mg buccal
or
0.2mg/Kg IN or 0.1mg/kg IV/IO
repeat X1 PRN
```
215
Midazolam solution pharmacology/action
affects the activity of a chemical that transmits impulses across synapses called Gamma-AminioButyric Acid (GABA) GABA is an inhibitory neurotransmitter.
Midazolam works by increasing the effect of GABA at these receptors
216
Midazolam solution side effects
resp depression
headache
hypotension
drowsiness
217
Midazolam solution notes
titrate to effect
ensure resus equipment and 02 available prior to administration
no more than 2 doses by practitioners
take into account doses given prior to paramedic arrival
contraindications other than KSAR refer to non seizing pts
218
Morphine Sulphate class and description
Narcotic analgesic
| CNS depressant and potent analgesic with haemodynamic properties that make it extremely usefull in emergency medicine
219
Morphine Sulphate presentation
10mg/1ml ampoule (dilute with 9ml NaCl to make 10mg/10ml
| suspension 10mg/5ml
220
Morphine Sulphate administration
PO
IM
IV/IO
221
Morphine Sulphate indications
ADULT: severe pain > 7/10
PAEDS: severe pain > 7/10
222
Morphine Sulphate contraindications
PO
223
Morphine Sulphate adult dose
2mg IV/IO
| repeat at not
224
Morphine Sulphate paeds dose
0.3mg/kg (300mcg/kg) PO max dose 10mg
0.05 mg/kg (50mcg/kg) IV/IO
repeat not at
225
Morphine Sulphate pharmacology/action
Opiate analgesic
acts on central nervous system to reduce pain/anxiety
vasodilation resulting in reduced preload to myocardium
226
Morphine Sulphate side effects
```
resp depression
drowsiness
nausea/vomiting
constipation
long term use can lead to drug dependence
```
227
Morphine Sulphate notes
use with extreme caution particularly with elderly/young
caution with acute resp depression
caution with reduced GCS
not recommended for headache
controlled under Misuse of drugs act (1977,1984)
228
Naloxone class and description
narcotic analgesic which is effective in management and reversal of overdose caused by narotic or sythetic narotic agents
229
Naloxone presentation
0.4mg/1ml (400mcg/1ml) ampoule or pre loaded syringe
230
Naloxone administration
IN
SC
IM
IV/IO
231
Naloxone indications
inadequate respirations and/or altered GCS following known or suspected narcotic overdose
232
Naloxone contraindications
known severe adverse reaction
233
Naloxone adult dose
0.4mg (400mcg) IV/IO/IM/SC
0.8mg (800mcg) IN
repeat dose after 3 min PRN max 2mg
234
Naloxone paeds dose
0.01mg/kg (10mcg) IV/IO,IM/SC
0.02mg/kg (20mcg) IN
Repeat dose PRN to maintain opioid reversal to max 0.1mg/kg or 2mg
235
Naloxone pharmacology/action
narcotic antagonist that reverses the resp and analgesic effects of narcotics
236
Naloxone side effects
acute reversal of narotic effects ranging from nausea/vomiting to agitation and seizures
237
Naloxone notes
use in caution with pregnancy
administer with caution to patients who have taken large doses of narcotics or are physically dependant
prepare to deal with aggressive pts
238
Nifedipine class and description
tocolytic agent
| dihydropyridine calcium channel blocker
239
Nifedipine presentation
20mg tablet
240
Nifedipine administration
PO
241
Nifedipine indications
prolapsed cord
242
Nifedipine contraindications
hypotension
| known severe adverse reaction
243
Nifedipine dose
20mg PO
| not indicated in paeds
244
Nifedipine pharmacology/action
inhibits muscle contraction by interfering with the movement of calcium ions through the slow channels of active cell membranes
245
Nifedipine side effects
hypotension
headache
bradycardia
nausea/vomiting
246
Nifedipine notes
close monitoring of maternal pulse/BP is required
| continous fetal monitoring should be carried out if possible
247
Entonox class and description
potent analgesic gas contains a mix of nitous oxide and oxygen
248
Entonox presentation
cylinder, coloured blue with white and triangles on cylinder shoulders
medical gas Nitrous Oxide 50% Oxygen 50%
249
Entonox administration
self administered
250
Entonox indications
pain relief
251
Entonox contraindications
```
altered GCS
chest injury/pneumothorax
shock
recent scuba dive
decompression sickness
intestinal obstruction
inhalation injury
Carbon monixide poisoning
known sever adverse reaction
```
252
Entonox dose
adults and paeds
| self administer until pain relieved
253
Entonox pharmacology and action
analgesic agent gas
CNS depressant
pain relief
254
Entonox side effects
disinhibition
decreased GCS
lightheadedness
255
Entonox notes
dont use if patient cannot understand instructions
in cold temp warm cylinder and invert to ensure gas mixture
AP can use with descretion for minor chest injuries
brand name Entonox
has addictive properties
caution in using > 1 hr for sickle cell crisis
256
Ondansetron class and description
Antiemetic used in management of nausea/vomiting
| potent, highly selective 5 HT3 receptor antagonist
257
Ondansetron presentation
4mg/2ml ampoule
258
Ondansetron administration
IV
259
Ondansetron indications
management, preventiona and treatment of nausea/vomiting
260
Ondansetron contraindications
known severe adverse reaction
261
Ondansetron pharmacology/action
precise action in the control of nausea/vomiting is unknown
262
Ondansetron side effects
headache
sensation of warmth
flushing
hiccups
263
Oxygen class and description
odourless, colourless, tasteless gas necessary to life
264
Oxygen presentation
D, E, F cylinders coloured black with white shoulders
CD cylinder (White)
medicsl gas
265
Oxygen administration
```
inhalation via:
high concentration reservoir (non rebreather) mask
simple face mask
venturi mask
tracheostomy mask
nasal cannulae
BVM
```
266
Oxygen indications
adbsent/inadequate ventilation following acute medicsl or traumatic event
SpO2
267
Oxygen contraindications
bleomycin lung injury
268
Oxygen dose adults
cardiac, resp arrest, sicke cell crisis; 100%
life threats identified in primary survey 100% until reliable SpO2 reading obtained the titrate to achieve SpO2 of 94-98%
COPD exasebation administer O2 titrate to achive SpO2 92% or as specified on COPD O2 alert card
all other medical/trauma titrate to achive SpO2 94-98%
269
Oxygen dose paeds
cardiac, resp arrest, sicke cell crisis; 100%
life threats identified in primary survey 100% until reliable SpO2 reading obtained the titrate to achieve SpO2 of 96-98
all other medical/trauma titrate to achive SpO2 94-98%
270
Oxygen pharmacology/action
oxygenation of tissues/organs
271
oxygen side effects
Oxygen prolonged use of O2 in pts with chronic COPD may lead to reduction in venntilation stimulis
272
oxygen notes
written record of what O2 therepy administered to each pt
document sats with RA or on O2 as applicable
consider humidifier if 02 terepy for paeds > 30 mins duration
caution with paraquat poisoning -administerO2 if SpO2
273
Paracetamol class and description
analgesic and antipyretic used to reduce pain and body temperature
274
Paracetamol presentation
rectal suppository - 180mg, 90mg, 60mg
suspension - 120mg/5ml, 250mg/5ml
500mg tablet
275
Paracetamol administration
PO
| PR
276
Paracetamol indications
pyrexia
| minor to moderate pain 1-6/10 for adult/paeds
277
Paracetamol contraindications
known severe adverse reaction
| chronic liver disease
278
Paracetamol dose adult
1g (2xtablets) PO
279
Paracetamol Dose paeds
> 1mth
280
Paracetamol pharmacology/action
Analgesic - prostgrandlin inhibitor
| antipyretic - prevents a hypothalmus from synthesising prostgrandlin E, inhibiting the body temp from rising further
281
Paracetamol side effects
long term damage at high doses can cause liver damage and less frequently, renal damage
282
Paracetamol notes
paracetamol is contained in paracetamol suspension and other over the counter drugs
consult with parent/gaurdian in relation to medication prior to arrival on scene
PR- beware of modesty of pt, should be administered in presence of 2nd person
if paracetamol administered within previous 4 hrs, adjust dose downward by the amount given by other sources resulting in max dose 20mg/kg
283
Salbutamol class and description
sypathetic agonist that is selective to beta-2 adrenergic receptors
284
Salbutamol presentation
2.5mg/5ml nebule
5mg/2.5ml nebule
aerosol inhaler: metered dose 0.1mg (100mcg)
285
Salbutamol administration
nebuliser
| inhalation via aerosol inhaler
286
Salbutamol indications
bronchospasm
exacerbation of COPD
resp distress folowing submersion incident
287
Salbutamol contraindications
known severe adverse reaction
288
Salbutamol dose adult
```
5mg NEB (or 0.1mg metered aerosol spray) X5
repeat at 5 min intervals
```
289
Salbutamol dose paeds
5 yrs - 5mg NEB ( or 0.1mg metered aersosol spray X5)
| repeat at 2 mins PRN
290
Salbutamol pharmacolody/action
Beta-2 agonist
bronchodilation
smooth muscle relaxation
291
Salbutamol side effects
Tachycardia
tremors
tachyarrhymias
high doses can cause hypokalaemia
292
Salbutamol notes
more efficiant to use volumiser in conjuction with aerosol inhaler when administering salbutamol
if an 02 driven nebuliser is used to administer salbutamol fora patient with acute exaserbation of COPD, it should be limited to 6 mins max
293
Sodium Bicarbonate class and description
a salt that is an alkalinizing agent and electolyte supplement
294
Sodium Bicarbonate presentation
glass vial 8.4% in 100 ml
295
Sodium Bicarbonate administration
IV/IO
296
Sodium Bicarbonate indications
wide complex arrhythmias and/or seizures following trycyclic antidepresant (TCA) OD
cardiac arret following TCA OD
cardiac arrest following harness induced suspension trauma
297
Sodium Bicarbonate contraindications
known severe adverse reaction
298
Sodium Bicarbonate pharmacology/action
TCA excretion is ehnaced by making the urine more alkaline ( raising pH)
299
Sodium Bicarbonate dose
1 mEq/kg (1ml/kg 8.4% solution) Max 50 mEq (50ml 8.4%)
300
Sodium Bicarbinate side effects
nil when used in emergency
301
Sodium Chloride 0.9% (NaCl) description and class
isotonic crystalloid solution of sodium and chloride
| known also as Normal saline
302
Sodium Chloride 0.9% (NaCl presentationn
soft pack for infusion 100ml, 500ml, 1000ml
| ampoules of 10ml
303
Sodium Chloride 0.9% (NaCl administration
IV infusion
IV flush
IO
304
Sodium Chloride 0.9% (NaCl indications
IV/IO Fluid for pre-hospital care
305
Sodium Chloride 0.9% (NaCl contraindications
known severe adverse reactions
306
Sodium Chloride 0.9% (NaCl pharmacology/action
Isotonic crystalloid solution
| fluid replacement
307
Sodium Chloride 0.9% (NaCl side effects
excessive volume replacement can lead to heart failure
308
Sodium Chloride 0.9% (NaCl notes
NACl is the IV/IO fluid of choice for pre-hospital emergency care
for TKVO use 500ml pack only
309
Syntometrine class and description
sythetic hormone
| ergometrine malaeate 0.5mg and sythetic oxytocin 5 units/ml
310
Syntometrine presentation
1ml ampoule
311
Syntometrine administration
IM
312
Syntometrine indications
control post-partum haemhorrage
313
Syntometrine contraindications
severe liver, kidney or cardiac dysfunction
sepsis
known severe adverse reaction
314
Syntometrine dose
1ml IM
| not indicated in paeds
315
Syntometrine pharmacology/action
causes rythmic contraction of uterine smooth muscle, thereby constricting uterine blood vessels
316
Syntometrine side effects
```
nausea/vomiting
abdo pain
headache
dizzines
cardiac arrhythmias
```
317
Syntometrine notes
ensure that a second foetus in not in uterus prior to administration
318
Ticagrelor class and description
platelet aggregation inhibitor
| inhibits platelet function
319
Ticagrelor presentation
90mg tablet
320
Ticagrelor administration
PO
321
Ticagrelor indications
identification of STEMI IF TRANSPORTING TO PPCI centre
322
Ticagrelor contraindications
hypersensitivity to the active substance (Ticagrelor) or to any other excipients
active pathological bleeding
Hx of intercranial haemhorrage
moderate to severe hepatic impairement
323
Ticagrelor dose
loading dose 180mg PO
| not indicated in paeds
324
Ticagrelor pharacology/action
selective adenosine diphosphate (ADP) receptor antagonist
acting on P2Y12 ADP-receptor which can prevent ADP- mediated platelet activation and aggregation.
Ticagrelor is orally active
reversibly interacts with platelet P2Y12 ADP receptor
Ticagrelor does not interact with ADP binding site itself, but interacts with platelet P2Y12 ADP receptor to prevent signal transduction
325
Ticagrelor side effects
COMMON:
dysponea, epistaxis, GIT haemhorrage, SC or dermal bleeding, bruising and procedual site haemhorrage
other undesirable effects include :
Intercranial bleeding, elevations of serum creatinine and uric acid levels
consult SmPC for full list
326
Ticagrelor notes
AP/P authoristed to administer Ticagrelor 180 mg PO following ID of STEMI and medical practitioner instructions
If pt has been loaded with antiplatelent medication (other than asprin) prior to arrival of practitioner, pt should not receive Ticagrelor
327
Tranexamic Acid description and class
Anti-fibrinolytic which reduces breakdown of clots
328
Tranexamic Acid presentation
500mg/5ml ampoule
329
Tranexamic Acid administration
IV
330
Tranexamic Acid indications
suspected significant internal/external haemhorrage assosciated with trauma
331
Tranexamic Acid contraindications
hypersensitivity to active substance or its excipients
Acute venous or arterial thrombosis
hx of convulsions
severe hepatic impairement
332
Tranexamic Acid dose
1g IV/IO infusion in 100ml NaCl
| not indicated for paediatrics
333
Tranexamic Acid pharmacology/action
TXA exerts an anti haemhorrage activity by inhibiting the activation of plasminogen to plasmin, by binding to specific sites of both plasminogen and plasmin, a molecule responsible for degradation of fibrin, a protein that forms the framework for blood clots
334
Tranexamic Acid side effects
COMMON: Diarrhoea, vomiting, nausea
| otehr undesirable effects include visual disturbances, impaired colour vision, dizziness and headache
335
Tranexamic Acid
caution with head injury
