Precautions

Question 1

Adrenaline
3reduce
1increase

Answer 1

Consider reduced doses for:

1. Elderly / frail patients
2. Patients with cardiovascular disease
3. Patients on monoamine oxidase inhibitors
4. Higher doses may be required for patients on beta blockers

Question 2

Aspirin

P.A.P.

Answer 2

1. Peptic ulcer
2. Asthma
3. Patients on anticoagulants

Question 3

Ceftriaxone

Answer 3

1. Allergy to Penicillin antibiotics

Question 4

Dexamethasone

Answer 4

1. Solutions which are not clear or are contaminated should be discarded

Question 5

Dextrose 10%

Answer 5

1. Nil of significance in the above indication

Question 6

Fentanyl

P.R.I.C.K.E.R

Answer 6

Patients on monoamine oxidase inhibitors
Rhinitis, rhinorrhea or facial trauma (IN route)
Impaired hepatic function
Current asthma
Known addiction to opioids
Elderly/frail patients
Respiratory depression, e.g. COPD

Question 7

Glucagon

Answer 7

1. Nil of significance in the above indication

Question 8

Glyceryl Trinitrate

N.E.R.C.

Answer 8

1. No previous administration
2. Elderly patients
3. Recent MI
4. Concurrent use with other tocolytics

Question 9

Heparin

Answer 9

1. Renal impairment

Question 10

Ipratropium Bromide

Answer 10

1. Glaucoma

2. Avoid contact with eyes

Question 11

Ketamine

Answer 11

May exacerbate cardiovascular conditions (e.g. uncontrolled hypertension, stroke, recent MI,
cardiac failure) due to effects on HR and BP

Question 12

Lidocaine (Lignocaine)

Answer 12

IM and local infiltration – inadvertent intravascular administration may result in systemic toxicity
(see below)
IO – impaired CV function (e.g. hypotension, bradycardia, poor perfusion, heart block, heart
failure)

Question 13

Lidocaine (Lignocaine) – AVOID-2

Answer 13

Nil

Question 14

Methoxyflurane

P.O.P.

Answer 14

1. The Penthrox™ inhaler must be hand-held by the patients so that if
   unconsciousness occurs it will fall from the patient’s face.
   Occasionally the operator may need to assist but must continuously
   assess the level of consciousness
2. Pre-eclampsia
3. Concurrent use with Oxytocin may cause hypotension

Question 15

Midazolam

R.B.Reps.Peradactals

Answer 15

1. Reduced doses may be required for the elderly/frail, patients with
   chronic renal failure, CCF or shock
2. The CNS depressant effects of benzodiazepines are enhanced in the
   presence of narcotics and other tranquillisers including alcohol
3. Can cause severe respiratory depression in patients with COPD
4. Patients with myasthenia gravis (weakness or rapid fatigue of muscle under voluntary control.)

Question 16

Morphine

H.E.R C.R.A.A.P.

Answer 16

1. Elderly/frail patients
2. Hypotension
3. Respiratory depression
4. Current asthma
5. Respiratory tract burns
6. Known addiction to opioids
7. Acute alcoholism
8. Patients on monoamine oxidase inhibitors

Question 17

Naloxone

Answer 17

1. If patient is known to be physically dependent on opioids, be prepared
   for a combative patient after administration
2. Neonates

Question 18

Olanzapine

Answer 18

. Olanzapine may be less effective if patient agitation is due to drug
intoxication (especially stimulants) or alcohol withdrawal. Benzodiazepines
are considered first-line agents in these patients2
2. Elderly / frail patients and children are more susceptible to adverse effects1

Question 19

Ondansetron

L.D.P.C.P.

Answer 19

1. Patients with liver disease should not receive more than 8 mg of
   Ondansetron per day
2. Care should be taken with patients on diuretics who may have an
   underlying electrolyte imbalance
3. Ondansetron contains aspartame and should not be given to patients
   with phenylketonuria
4. Concurrent use of Tramadol
5. Pregnancy

Question 20

Oxytocin

HYPOS

Answer 20

1. If given IV may cause transient hypotension

2. Concurrent use with Methoxyflurane may cause hypotension

Question 21

Paracetamol

IME

Answer 21

1. Impaired hepatic function or liver disease
2. Elderly / frail
3. Malnourished

Question 22

Prochlorperazine (Stematil)

HEP

Answer 22

1. Hypotension
2. Epilepsy
3. Pts affected by alcohol or on anti-depressants

Question 23

Salbutamol

Answer 23

1. Large doses of Salbutamol have been reported to cause intracellular
   metabolic acidosis

Question 24

Tenecteplase

Answer 24

1. Age ≥ 75 years
2. Non-compressible vascular puncture
3. History of liver disease
4. SBP > 160 mmHg or DBP > 110 mmHg
5. Low body weight
6. Active peptic ulcer
7. Anaemia
8. Acute pericarditis or subacute bacterial endocarditis
9. Traumatic or prolonged (>10 mins) CPR
10. Pregnant or within 1 week post-partum
11. HR > 120 bpm