Precautions

Question 1

Adrenaline (epinephrine)

Answer 1

Hypertension
Hypovolaemic shock
Concurrent MAOI therapy
Quetiapine toxicity

Question 2

Amiodarone

Answer 2

For patients who are in cardiac arrest: Nil
For patients with sustained conscious VT (haemodynamically stable): Hypotension

Question 3

Aspirin

Answer 3

Possible aortic aneurysm or any other condition that may require surgery
Pregnancy
History of GI bleeding or peptic ulcers

Question 4

Box jellyfish antivenom

Answer 4

The antivenom is a foreign protein, which can cause sensitization, allergic reaction or anaphylaxis

Question 5

Ceftriaxone

Answer 5

Any allergy or hypersensitivity to penicillin or carbapenem - isolated minor drug attributed to penicillin does not contraindicate the use of ceftriaxone

Question 6

Clopidogrel

Answer 6

Severe renal impairment

Question 7

Dexamethasone

Answer 7

Nil in this setting

Question 8

Droperidol

Answer 8

Hypoperfused state
Concurrent use of CNS depressants

Question 9

Enoxaparin

Answer 9

Renal/hepatic impairment
Low bodyweight (women <45 kg and men <57 kg)
Older people

Question 10

Fentanyl

Answer 10

Hypotension
Respiratory tract burns
Respiratory depression and/or failure
Known addiction to narcotics
Current MAOI therapy

Question 11

Glucagon

Answer 11

Nil

Question 12

Glucose gel

Answer 12

Nil

Question 13

Glucose 10%

Answer 13

Hyperglycaemia

Question 14

Glyceryl trinitrate

Answer 14

Inferior AMI
Cerebral vascular disease
Risk of hypotension and/or syncope
Intoxication (GTN effects are enhanced)
Phosphodiesterase 5 inhibitor medication administration (e.g. tadalafil, sildenafil. vardenafil) in the previous 4 days

Question 15

Heparin

Answer 15

Renal impairment

Question 16

Hydrocortisone

Answer 16

Hypertension

Question 17

Hydroxocobalamin

Answer 17

Hypertension (substantial increases in blood pressure may occur following hydroxocobalamin therapy)
Pregnancy (There are no adequate and well-controlled studies of hydroxocobalamin administration in pregnant women. Hydroxocobalamin should be used during pregnancy ONLY if the potential benefits justifies the potential risk to the fetus

Question 18

Ibuprofen

Answer 18

Asthma
Hepatic dysfunction
History of GI bleeding or peptic ulcers

Question 19

Influenza vaccine

Answer 19

Nil

Question 20

Ipratropium bromide

Answer 20

Glaucoma

Question 21

Loratadine

Answer 21

Severe hepatic impairment
Increased risk of sedation and anticholinergic effects in older people

Question 22

Magnesium sulphate

Answer 22

Renal impairment

Question 23

Methoxyflurane

Answer 23

ALOC
Intoxicated or drug affected patients
Cardiovascular instability
Respiratory depression

Question 24

Midazolam

Answer 24

Reduced dosages must be considered in :
- Low body weight, older, cachectic or frail patients
- Patients with chronic renal failure, congestive cardiac failure or shock
Can cause severe respiratory depression in patients with COPD
Myasthenia gravis
Multiple sclerosis

Question 25

Morphine

Answer 25

Hypotension Respiratory tract burns Respiratory depression and/or failure Known addiction to narcotics Concurrent MAOI therapy Cardiac chest pain

Question 26

Naloxone

Answer 26

Use with caution on patients with pre-existing cardiac disease

Question 27

Ondansetron

Answer 27

Hepatic impairment Elderly patients Intestinal obstruction Patients with risk factors for QT interval prolongation or cardiac arrhythmias

Question 28

Oxygen

Answer 28

Patients with paraquat poisoning or bleomycin lung injury may be harmed by supplemental oxygen. Avoid oxygen unless the patient is hypoxaemic - target 88-92% Prolonged administration to premature neonates Newly born infants will have low Sp02 for the first 10 minutes following birth - refer to CPG: Resuscitation - Newly born. Patients with cyanotic heart disease may have saturation targets between 75% to 85%. Clinicians should attempt to ascertain optimal target saturation levels for these patients from carers or health professional. A BVM will not supply adequate oxygen unless IPPV is provided The use of high flow oxygen in an attempt to protect against subsequent hypoxaemia in the event of deterioration has the potential to delay the recognition of such a deterioration. This may provide a false reassurance that the patient is stable.

Question 29

Oxytocin

Answer 29

Myocardial ischaemia May potentiate hypotension when administered with analgesia

Question 30

Paracetamol

Answer 30

Hepatic dysfunction Soluble tablets: - Patients with sodium restriction (heart failure, chronic kidney disease) - Phenylketonuria

Question 31

Salbutamol

Answer 31

Acute pulmonary oedema Ischaemic heart disease

Question 32

Sodium chloride 0.9%

Answer 32

Patients with acute and/or history of heart failure Pre-existing renal failure Uncontrolled haemorrhage (unless associated with severe head injury)

Question 33

Sucrose 24%

Answer 33

Nil

Question 34

Tenecteplase

Answer 34

Nil

Question 35

Ticagrelor

Answer 35

Concurrent medication known to induce bradycardia (e.g. beta blockers, calcium channel blockers, digoxin) Symptomatic bradycardia (HR less than 60)

Question 36

Tranexamic acid

Answer 36

Nil

Question 37

Water for injection

Answer 37

Nil