Section 5.1: ALS Pharmacology Flashcards
(190 cards)
1
Q
Adrenaline – Presentation/s
A
- 1mg in 1mL glass ampoule (1:1000)
- 1mg in 10mL glass ampoule (1:10000)
2
Q
Adrenaline – Pharmacology
A
A naturally occurring alpha and beta-adrenergic stimulant
Actions:
- Increases HR by increasing SA node firing rate (Beta 1)
- Increases conduction velocity through the A-V node (Beta 1)
- Increases myocardial contractility (Beta 1)
- Increases the irritability of the ventricles (Beta 1)
- Causes bronchodilation (Beta 2)
- Causes peripheral vasoconstriction (Alpha)
3
Q
Adrenaline – Metabolism
A
- By monoamine oxidase and other enzymes in the blood, liver and around nerve endings. Excreted by the kidneys
4
Q
Adrenaline – Primary emergency indication/s
A
- Cardiac arrest – VF / VT, Asystole or PEA
- Inadequate perfusion (cardiogenic or non-cardiogenic / non-hypovolaemic)
- Bradycardia with poor perfusion
- Anaphylaxis
- Severe asthma – imminent life threat not responding to nebulised therapy, or unconscious with no BP
- Croup
5
Q
Adrenaline – Contraindication/s
A
- Hypovolaemic shock without adequate fluid replacement
6
Q
Adrenaline – Precaution/s
A
Consider reduced doses for:
- Elderly / frail Pts
- Pts with cardiovascular disease
- Pts on monoamine oxidase inhibitors
- Higher doses may be required for Pts on beta blockers
7
Q
Adrenaline – Route/s of administration
A
- Nebulised
- IM
- IV
- IV infusion
- ETT
- IO
8
Q
Adrenaline – Side effects
A
- Sinus tachycardia
- Supraventricular arrhythmias
- Ventricular arrhythmias
- Hypertension
- Pupillary dilation (mydriasis)
- May increase size of the Myocardial Infarction
- Feeling of anxiety / palpitations in the conscious Pt
9
Q
Adrenaline – Special notes
A
- IV Adrenaline should be reserved for life threatening situations
10
Q
Adrenaline – Onset, Peak & Duration times (IV & IM)
A
IV effects:
- Onset: 30sec
- Peak: 3 – 5min
- Duration: 5 – 10min
IM effects:
- Onset: 30 – 90sec
- Peak: 4 – 10min
- Duration: 5 – 10min
11
Q
Aspirin – Presentation/s
A
- 300mg chewable tablets
- 300mg soluble or water dispersible tablets
12
Q
Aspirin – Pharmacology
A
An analgesic, antipyretic, anti-inflammatory and anti-platelet aggregation agent
Actions:
- To minimize platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in Acute Coronary Syndrome
- Inhibits the synthesis of prostaglandins – anti-inflammatory actions
13
Q
Aspirin – Metabolism
A
- Converted to salicylate in the gut mucosa and liver. Excreted mainly by the kidneys.
14
Q
Aspirin – Primary emergency indication/s
A
- Acute Coronary Syndrome
15
Q
Aspirin – Contraindication/s
A
- Hypersensitivity to aspirin / salicylates
- Actively bleeding peptic ulcers
- Bleeding disorders
- Suspected dissecting aortic aneurysm
- Chest pain associated with psychostimulant OD if SBP > 160mmHg
16
Q
Aspirin – Precaution/s
A
- Peptic ulcer
- Asthma
- Pts on anticoagulants
17
Q
Aspirin – Route/s of administration
A
- Oral
18
Q
Aspirin – Side effects
A
- Heartburn
- Nausea
- Gastrointestinal bleeding
- Increased bleeding time
- Hypersensitivity reactions
19
Q
Aspirin – Special notes
A
- Aspirin is C/I for use in acute febrile illness in children and adolescents.
- The anti-platelet effects of Aspirin persist for the natural life of platelets.
20
Q
Aspirin – Onset, Peak & Duration times
A
- Onset: N/A
- Peak: N/A
- Duration: 8 – 10days
21
Q
Ceftriaxone – Presentation/s
A
- 1g sterile powder in a glass vial
22
Q
Ceftriaxone – Pharmacology
A
- Cephalosporin antibiotic
23
Q
Ceftriaxone – Metabolism
A
- Excreted unchanged in urine (33% - 67%) and in bile
24
Q
Ceftriaxone – Primary emergency indication/s
A
- Suspected meningococcal septicaemia
- Severe sepsis (consult only)
25
Ceftriaxone – Contraindication/s
1. Allergy to Cephalosporin antibiotics
26
Ceftriaxone – Precaution/s
1. Allergy to Penicillin antibiotics
27
Ceftriaxone – Route/s of administration
* IV (preferred)
* IM (if IV access unavailable)
28
Ceftriaxone – Side effects
* Nausea
* Vomiting
* Skin rash
29
Ceftriaxone – Special notes
Usual dose:
* Adult 1g
* Child 50mg / kg (max. 1g)
**Ceftriaxone IV** must be made up to 10mL using sterile water and dose administered over 2min
**Ceftriaxone IM** must be made up to 4mL using **1% Lignocaine** and dose administered in lateral upper thigh
30
Ceftriaxone – Onset, Peak & Duration times
IM / IV effects:
* Onset: N/A
* Peak: N/A
* Duration: N/A
31
Dextrose 10% – Presentation/s
* 25g in 250mL infusion soft pack
32
Dextrose 10% – Pharmacology
A slightly hypertonic crystalloid solution
Composition:
* Sugar – 10% dextrose
* Water
Actions:
* Provides a source of energy
* Supplies body water
33
Dextrose 10% – Metabolism
Dextrose:
* Broken down in most tissues
* Stored in the liver and muscle as glycogen
Water:
* Distributed throughout total body water, mainly in the extracellular fluid compartment
* Excreted by the kidneys
34
Dextrose 10% – Primary emergency indication/s
1. Diabetic hypoglycaemia (BGL analysis \< 4mmol/L) in Pts with an altered conscious state who are unable to self-administer oral glucose
35
Dextrose 10% – Contraindication/s
* Nil of significance in the above indication
36
Dextrose 10% – Precaution/s
* Nil of significance in the above indication
37
Dextrose 10% – Route/s of administration
* IV infusion
38
Dextrose 10% – Side effects
* Nil of significance in the above indication
39
Dextrose 10% – Special notes
Officially - none, however (see Special Notes under Hypoglycaemia CPG A0702):
* Ensure IV is patent before administering **Dextrose**. Extravasation of **Dextrose** can cause tissue necrosis.
* All IVs should be well flushed before and after **Dextrose** administration (minimum **10mL Normal Saline**).
* Further dose of **Dextrose 10%** may be required in some hypoglycaemic episodes. Consider consultation if BGL remains \< 4mmol / L and unable to administer oral carbohydrates.
40
Dextrose 10% – Onset, Peak & Duration times
IV infusion effects:
* Onset: 3min
* Peak: N/A
* Duration: Depends on severity of hypoglycaemic episode
41
Fentanyl – Presentation/s
* 100mcg in 2mL glass ampoule
* 200mcg in 1mL glass vial (IN use only)
* 600mcg in 2mL glass vial (IN use only)
42
Fentanyl – Pharmacology
A synthetic opioid analgesic
Actions:
CNS effects:
* CNS depression – leading to analgesia
* Respiratory depression – leading to apnoea
* Dependence (addiction)
Cardiovascular effects:
* Decreases conduction velocity through the AV node
43
Fentanyl – Metabolism
* By the liver; excreted by the kidneys
44
Fentanyl – Primary emergency indication/s
1. Sedation to facilitate intubation
2. Sedation to maintain intubation
3. Drug facilitated intubation
4. Analgesia – IV / IN
45
Fentanyl – Contraindication/s
* Known hypersensitivity
* **IV Amiodarone**
46
Fentanyl – Precaution/s
1. Elderly / frail patients
2. Impaired renal / hepatic function
3. Respiratory depression, eg COPD
4. Current asthma
5. Pts on monoamine oxidase inhibitors
6. Known addiction to opioids
7. Rhinitis, rhinorrhea or facial trauma (IN route)
8. **Oral Amiodarone**
47
Fentanyl – Route/s of administration
* IV
* IN
48
Fentanyl – Side effects
* Respiratory depression
* Apnoea
* Rigidity of the diaphragm and intercostal muscles
* Bradycardia
49
Fentanyl – Special notes
* **Fentanyl** is a Schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility
* Respiratory depression can be reversed with **Naloxone**
* 100mcg **Fentanyl** is equivalent in analgesic activity to 10mg **Morphine**
50
Fentanyl – Onset, Peak & Duration times
IV effects:
* Onset: Immediate
* Peak: \< 5min
* Duration: 30-60min
IN effects:
* Onset: N/A
* Peak: 2min
* Duration: N/A
51
Glucagon – Presentation/s
* 1mg (IU) in 1mL hypokit
52
Glucagon – Pharmacology
A hormone normally secreted by the pancreas
Actions:
* Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose
53
Glucagon – Metabolism
* Mainly by the liver, also by the kidneys and in the plasma
54
Glucagon – Primary emergency indication/s
1. Diabetic hypoglycaemia (BGL \< 4mmol / L) in Pts with an altered conscious state who are unable to self-administer oral glucose
55
Glucagon – Contraindication/s
* Nil of significance in the above indication
56
Glucagon – Precaution/s
* Nil of significance in the above indication
57
Glucagon – Route/s of administration
* IM
58
Glucagon – Side effects
* Nausea and vomiting (rare)
59
Glucagon – Special notes
* Not all Pts will respond to **Glucagon**, eg those with inadequate glycogen stores in the liver (alcoholics, malnourished)
60
Glucagon – Onset, Peak & Duration times
IM effects:
* Onset: 5min
* Peak: N/A
* Duration: 25min
61
Glyceryl Trinitrate (GTN) – Presentation/s
* 0.6mg tablets
* Transdermal GTN Patch (50mg 0.4mg / hr release)
62
Glyceryl Trinitrate (GTN) – Pharmacology
Principally, a vascular smooth muscle relaxant
Actions:
* Venous dilatation promotes venous pooling and reduces venous return to the heart (reduces preload)
* Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces afterload)
The effects of the above are:
* Reduced myocardial 02 demand
* Reduced systolic, diastolic and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure
* Mild collateral coronary arterial dilatation may improve blood supply to ischaemic areas of myocardium
* Mild tachycardia secondary to slight fall in blood pressure
* Preterm labour: Uterine quiescence in pregnancy
63
Glyceryl Trinitrate (GTN) – Metabolism
* By the liver
64
Glyceryl Trinitrate (GTN) – Primary emergency indication/s
1. Chest pain with ACS
2. Acute LVF _with SOB and audible fine crackles (bases, mid-zones or full field)_
3. Hypertension associated with ACS
4. Autonomic dysreflexia
5. Preterm labour (consult)
65
Glyceryl Trinitrate (GTN) – Contraindication/s
1. Known hypersensitivity
2. Systolic blood pressure \< 110mmHg (tablet)
3. Systolic blood pressure \< 90mmHg (patch)
4. Sildenafil Citrate (Viagra) or Vardenafil (Levitra) administration in the previous 24hr or Tadalafil (Cialis) administration in the previous 4 days (PDE5 inhibitors)
5. Heart rate \> 150bpm
6. Bradycardia HR \< 50bpm (excluding autonomic dysreflexia)
7. VT
8. Inferior STEMI with systolic BP \< 160mmHg
9. Right ventricular MI
66
Glyceryl Trinitrate (GTN) – Precaution/s
1. No previous administration
2. Elderly Pts
3. Recent MI
4. Concurrent use with other tocolytics
67
Glyceryl Trinitrate (GTN) – Route/s of administration
* SL
* Buccal
* Transdermal
* Infusion (inter-hospital transfer only)
68
Glyceryl Trinitrate (GTN) – Side effects
* Tachycardia
* Hypotension
* Headache
* Skin flushing (uncommon)
* Bradycardia (occasionally)
69
Glyceryl Trinitrate (GTN) – Special notes
**Storage:**
* GTN is susceptible to heat and moisture. Make sure that tablets are stored in their original light resistant, tightly sealed bottles. The foil pack of the patches should be intact.
* Tablets should be discarded and replaced after 1 month
* Patches should be discarded prior to the use-by date
* Do not administer Pt’s own medication as its storage may not have been in optimum conditions or it may have expired
**History taking:**
* Since both men and women can be prescribed Sildenafil Citrate (Viagra) or Vardenafil (Levitra) or Tadalafil (Cialis), all Pts should be asked if and when they last had the drug to determine if GTN is C/I
* Tadalafil (Cialis) may also be prescribed to men for Rx of benign prostatic hypertrophy. This is a new indication for the drug and may lead to an increased number of Pts under this Rx regimen
**Inter-hospital transfer:**
* GTN by IV infusion may be required for an inter-hospital transfer as per the treating doctor’s orders
* The IV dose is to be prescribed and signed by the referring hospital medical officer. Infusions usually run in the range of 5mcg / min to 200mcg / min and increased 3 – 5mcg / min
70
Glyceryl Trinitrate (GTN) – Onset, Peak & Duration times
IV effects:
* Onset: 30sec – 1min
* Peak: 3 – 5min
* Duration: 15 – 30min
S/L effects:
* Onset: 30sec – 2min
* Peak: 5 – 10min
* Duration: 15 – 30min
Transdermal effects:
* Onset: Up to 30min
* Peak: 2hr
* Duration: N/A
71
Ipratropium Bromide – Presentation/s
* 250mcg in 1mL nebule or polyamp
72
Ipratropium Bromide – Pharmacology
Anticholinergic bronchodilator
Actions:
* Allows bronchodilatation by inhibiting cholinergic bronchomotor tone (ie blocks vagal reflexes which mediate bronchoconstriciton
73
Ipratropium Bromide – Metabolism
* Excreted by the kidneys
74
Ipratropium Bromide – Primary emergency indication/s
1. Severe respiratory distress associated with bronchospasm
75
Ipratropium Bromide – Contraindication/s
1. Known hypersensitivity to **Atropine** or its derivatives
76
Ipratropium Bromide – Precaution/s
1. Glaucoma
2. Avoid contact with eyes
77
Ipratropium Bromide – Route/s of administration
* Nebulised (in combination with Salbutamol)
78
Ipratropium Bromide – Side effects
* Headache
* Nausea
* Dry mouth
* Skin rash
* Tachycardia (rare)
* Palpitations (rare)
* Acute angle closure glaucoma secondary to direct eye contact (rare)
79
Ipratropium Bromide – Special notes
* There have been isolated reports of ocular complications (dilated pupils, increased intraocular pressure, acute angle glaucoma, eye pain) as a result of direct eye contact of **Ipratropium Bromide** formulations
* The nebuliser mask must therefore be fitted properly during inhalation and care taken to avoid **Ipratropium Bromide** solution entering the eyes
* **Ipratropium Bromide** must be nebulised in conjunction with **Salbutamol** and is to be administered as a single dose only
80
Ipratropium Bromide – Onset, Peak & Duration times
Nebulised effects:
* Onset: 3 – 5min
* Peak: 1.5 – 2hr
* Duration: 6hr
81
Lignocaine 1% (IM administration) – Presentation/s
* 50mg in 5mL amp (1%)
82
Lignocaine 1% (IM administration) – Pharmacology
A local anaesthetic agent
Actions:
* Prevents initiation and transmission of nerve impulses causing local anaesthesia (1% solution)
83
Lignocaine 1% (IM administration) – Metabolism
* By the liver (90%)
* Excreted unchanged by the kidneys (10%)
84
Lignocaine 1% (IM administration) – Primary emergency indication/s
1. Dilutent for **Ceftriaxone** for IM administration in suspected meningococcal disease
85
Lignocaine 1% (IM administration) – Contraindication/s
1. Known hypersensitivity
86
Lignocaine 1% (IM administration) – Precaution/s
1. When using **Lignocaine 1%** as dilutent for IM **Ceftriaxone**, it is important to rule out inadvertent IV administration due to potential CNS complications
87
Lignocaine 1% (IM administration) – Route/s of administration
* IM (1% solution with **Ceftriaxone** only)
88
Lignocaine 1% (IM administration) – Side effects
* Nil – unless inadvertent IV administration
89
Lignocaine 1% (IM administration) – Special notes
N/A
90
Lignocaine 1% (IM administration) – Onset, Peak & Duration times
IM effects:
* Onset: Rapid
* Peak: N/A
* Duration: 1 – 1.5hr
91
Methoxyflurane – Presentation/s
* 3mL glass bottle
92
Methoxyflurane – Pharmacology
* Inhalational analgesic agent at low concentrations
93
Methoxyflurane – Metabolism
* Excreted mainly by the lungs
* By the liver
94
Methoxyflurane – Primary emergency indication/s
1. Pain relief
95
Methoxyflurane – Contraindication/s
1. Pre-existing renal disease / renal impairment
2. Concurrent use of tetracycline antibiotics
3. Exceeding total dose of 6mL in a 24hr period
96
Methoxyflurane – Precaution/s
1. The Penthrox inhaler must be hand-held by the Pt so that if unconsciousness occurs it will fall from the Pt’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
97
Methoxyflurane – Route/s of administration
* Self administration under supervision using the hand held Penthrox inhaler
98
Methoxyflurane – Side effects
* Drowsiness
* Decrease in blood pressure and bradycardia (rare)
* Exceeding the maximum total dose of 6mL in a 24hr period may lead to renal toxicity
99
Methoxyflurane – Special notes
* The maximum initial priming dose for **Methoxyflurane** is 3mL. This will provide approximately 25min of analgesia and may be followed by one further 3mL dose once the initial dose is exhausted if required.
* Analgesia commences after 8 – 10 breaths and lasts for approximately 3 – 5min once discontinued
* Do not administer in a confined space. Ensure adequate ventilation in ambulance.
100
Methoxyflurane – Onset, Peak & Duration times
* Onset: After ~ 8 – 10 breaths
* Peak: N/A
* Duration: Continuous use ~25min; Once discontinued ~ 3 – 5min
101
Metoclopramide – Presentation/s
* 10mg in 2mL polyamp
102
Metoclopramide – Pharmacology
Antiemetic
Actions:
* Accelerates gastric emptying and peristalsis
* Dopamine receptor antagonist
103
Metoclopramide – Metabolism
* By the liver; excreted by the kidneys
104
Metoclopramide – Primary emergency indication/s
1. Nausea / vomiting associated with:
* Chest pain / discomfort of a cardiac nature
* Opioid administration for pain
* Cytotoxic or radiotherapy
* Previously diagnosed migraine
* Severe gastroenteritis
2. Prophylaxis:
* Awake, spinal immobilised Pts
* Eye trauma
105
Metoclopramide – Contraindication/s
1. Children
2. Suspected bowel obstruction or perforation
3. Gastrointestinal haemorrhage
106
Metoclopramide – Precaution/s
1. Undiagnosed abdominal pain
2. Adolescents (\< 20yrs)
3. Administer slowly over 1min to minimise risk of extrapyramidal reactions
107
Metoclopramide – Route/s of administration
* IV
* IM
108
Metoclopramide – Side effects
* Drowsiness
* Lethargy
* Dry mouth
* Muscle tremor
* Extrapyramidal reactions (usually the dystonic type)
109
Metoclopramide – Special notes
* Not effective for established motion sickness.
* Not effective for nausea prophylaxis in the setting of opioid administration.
110
Metoclopramide – Onset, Peak & Duration times
IV effects:
* Onset: 1 – 3min
* Peak: N/A
* Duration: 10 – 30min
IM effects:
* Onset: 10 – 15min
* Peak: N/A
* Duration: 1 – 2hr
111
Midazolam – Presentation/s
* 5mg in 1mL glass ampoule
* 15mg in 3mL glass ampoule
112
Midazolam – Pharmacology
Short acting CNS depressant
Actions:
* Anxiolytic
* Sedative
* Anti-convulsant
113
Midazolam – Metabolism
* By the liver; excreted by the kidneys
114
Midazolam – Primary emergency indication/s
* Status epilepticus
* Sedation to enable intubation (RSI / IFS)
* Post intubation sedation
* Sedation to enable synchronized cardioversion
* Sedation in the agitated Pt (including Pts under the Mental Health Act 2014)
* Sedation in psychostimulant OD
115
Midazolam – Contraindication/s
1. Known hypersensitivity to benzodiazepines
116
Midazolam – Precaution/s
1. **Reduced doses** may be required for the elderly / frail, Pts 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 Pts with COPD
4. Pts with myasthenia gravis
117
Midazolam – Route/s of administration
* IM
* IV
* IV infusion
118
Midazolam – Side effects
* Depressed level of consciousness
* Respiratory depression
* Loss of airway control
* Hypotension
119
Midazolam – Special notes
N/A
120
Midazolam – Onset, Peak & Duration times
IV effects:
* Onset: 1 – 3min
* Peak: 10min
* Duration: 20min
IM effects:
* Onset: 3 – 5min
* Peak: 15min
* Duration: 30min
121
Misoprostol – Presentation/s
* 200mcg tablet
122
Misoprostol – Pharmacology
A synthetic prostaglandin
Actions:
* Enhances uterine contractions
123
Misoprostol – Metabolism
* Converted to active metabolite misoprostol acid in the blood
* Metabolised in the tissues and excreted by the kidneys
124
Misoprostol – Primary emergency indication/s
1. PPPH
125
Misoprostol – Contraindication/s
1. Allergy to prostaglandins
2. Exclude multiple pregnancy before drug administration
126
Misoprostol – Precaution/s
1. Hx of asthma
127
Misoprostol – Route/s of administration
* Oral
128
Misoprostol – Side effects
* Hyperpyrexia
* Shivering
* Abdominal pain
* Diarrhoea
129
Misoprostol – Special notes
* Side effects are more likely with \> 600mcg oral dose
130
Misoprostol – Onset, Peak & Duration times
Oral effects:
* Onset: 8 – 10min
* Peak: N/A
* Duration: 2 – 3hr
131
Morphine – Presentation/s
* 10mg in 1mL glass ampoule
132
Morphine – Pharmacology
An opioid analgesic
Actions:
CNS effects:
* CNS depression (leading to analgesia)
* Respiratory depression
* Depression of cough reflex
* Stimulation (changes of mood, euphoria or dysphoria, vomiting, pin-point pupils)
* Dependence (addiction)
Cardiovascular effects:
* Vasodilatation
* Decreases conduction velocity through the AV Node
133
Morphine – Metabolism
* By the liver; excreted by the kidneys
134
Morphine – Primary emergency indication/s
1. Pain relief
2. Acute LVF with shortness of breath and full field crackles
3. Sedation to maintain intubation
4. Sedation to enable intubation
5. RSI
135
Morphine – Contraindication/s
1. Known hypersensitivity
2. Late second stage of labour
136
Morphine – Precaution/s
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. Pts on monoamine oxidase inhibitors
137
Morphine – Route/s of administration
* IM
* IV
* IV infusion
138
Morphine – Side effects
CNS effects:
* Drowsiness
* Respiratory depression
* Euphoria
* Nausea / Vomiting
* Addiction
* Pin-point pupils
Cardiovascular effects:
* Hypotension
* Bradycardia
139
Morphine – Special notes
* **Morphine** is a schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility.
* Side effects of **Morphine** can be reversed with **Naloxone**.
* Occasional wheals are seen in the line of the vein being used for IV injection. This is not an allergy, only a histamine release.
140
Morphine – Onset, Peak & Duration times
IV effects:
* Onset: 2 – 5min
* Peak: 10min
* Duration: 1 – 2hr
IM effects:
* Onset: 10 – 30min
* Peak: 30 – 60min
* Duration: 1 – 2hr
141
Naloxone – Presentation/s
* 0.4mg in 1mL glass ampoule
* 2mg in 5mL (prepared syringe)
142
Naloxone – Pharmacology
An opioid antagonist
Action:
* Prevents or reverses the effects of opioids
143
Naloxone – Metabolism
* By the liver
144
Naloxone – Primary emergency indication/s
1. Altered conscious state and respiratory depression secondary to administration of opioids or related drugs.
145
Naloxone – Contraindication/s
* Officially - Nil of significance in the above indication
However (see Special Notes):
* Following an _opioid associated cardiac arrest_, **Naloxone should not be administered**. Maintain assisted ventilation.
* Following _head injury_, **Naloxone should not be administered**. Maintain assisted ventilation if required.
146
Naloxone – Precaution/s
1. If Pt is known to be physically dependent on opioids, be prepared for a combative Pt after adminisration.
2. Neonates
147
Naloxone – Route/s of administration
* IM
* IV
148
Naloxone – Side effects
Symptoms of opioid withdrawal:
* Sweating
* Goose flesh
* Tremor
* Convulsions
* Nausea & vomiting
* Agitation
* Dilatation of pupils
* Excessive lacrimation
149
Naloxone – Special notes
* The duration of action of **Naloxone** is often less than that of the opioid used, therefore repeated doses may be required.
* **Naloxone** reverses the effects of opioids with none of the actions produced by other opioid antagonists when no opioid is present in the body. (For example, it does not depress respiration or cause pupillary constriction). In the absence of opioids, **Naloxone** has no perceivable effects.
* Following an _opioid associated cardiac arrest_, **Naloxone should not be administered**. Maintain assisted ventilation.
* Following _head injury,_ **Naloxone should not be administered**. Maintain assisted ventilation if required.
150
Naloxone – Onset, Peak & Duration times
IV effects:
* Onset: 1 – 3min
* Peak: N/A
* Duration: 30 – 45min
IM effects:
* Onset: 1 – 3min
* Peak: N/A
* Duration: 30 – 45min
151
Normal Saline – Presentation/s
* 10mL or 30mL polyamp
* 500mL and 1000mL infusion soft pack
152
Normal Saline – Pharmacology
An isotonic crystalloid solution
Composition:
* Electrolytes (sodium and chloride in a similar concentration to that of extracellular fluid)
Action:
* Increases the volume of the intravascular compartment
153
Normal Saline – Metabolism
Electrolytes:
* Excreted by the kidneys
Water:
* Distributed throughout total body water, mainly in the extracellular fluid compartment
* Excreted by the kidneys
154
Normal Saline – Primary emergency indication/s
1. As a replacement fluid in volume depleted Pts
2. To expand intravascular volume in the non-cardiac, non-hypovolaemic, hypotensive Pt. eg. Anaphylaxis, burns, sepsis
3. As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive Pts (other than LVF) eg PEA; asthma
4. Fluid for diluting and administering IV drugs
5. Fluid TKVO for IV administration of emergency drugs
155
Normal Saline – Contraindication/s
Officially, nil of significance in the above indications however see ‘Hypovolaemia CPG A0801: Modifying factors'.
Under the indication of ‘Replacement fluid in volume depleted Pts’, contraindications include:
1. Penetrating trunk injury,
2. Aortic aneurysm, or
3. Uncontrolled external haemorrhage,
**Accept palpable carotid pulse and Tx immediately**
156
Normal Saline – Precaution/s
1. Consider modifying factors when administering for hypovolaemia
157
Normal Saline – Route/s of administration
* IV
* IO
158
Normal Saline – Side effects
* Nil of significance in the above indications
159
Normal Saline – Special notes
IV half life:
* Approximately 30 – 60min
160
Normal Saline – Onset, Peak & Duration times
* Onset: N/A
* Peak: N/A
* Duration: N/A
161
Prochlorperazine (Stemetil) – Presentation/s
* 12.5mg in 1mL glass ampoule
162
Prochlorperazine (Stemetil) – Pharmacology
An anti-emetic
Action:
* Acts on several central neuro-transmitter systems
163
Prochlorperazine (Stemetil) – Metabolism
* By the liver; excreted by the kidneys
164
Prochlorperazine (Stemetil) – Primary emergency indication/s
1. Treatment or prophylaxis of nausea / vomiting for:
* Motion sickness
* Planned aeromedical evacuation
* Known allergy or C/I to **Metoclopramide** administration
* Headache irrespective of nausea / vomiting
* Vertigo
165
Prochlorperazine (Stemetil) – Contraindication/s
1. Children
2. Circulatory collapse
3. CNS depression
4. Previous hypersensitivity
166
Prochlorperazine (Stemetil) – Precaution/s
1. Hypotension
2. Epilepsy
3. Pts affected by alcohol or on anti-depressants
167
Prochlorperazine (Stemetil) – Route/s of administration
* IM
168
Prochlorperazine (Stemetil) – Side effects
* Drowsiness
* Blurred vision
* Hypotension
* Sinus tachycardia
* Skin rash
* Extrapyramidal reactions (usually the dystonic type)
169
Prochlorperazine (Stemetil) – Special notes
N/A
170
Prochlorperazine (Stemetil) – Onset, Peak & Duration times
IM effects:
* Onset: 20min
* Peak: 40min
* Duration: 6hr
171
Salbutamol – Presentation/s
* 5mg in 2.5mL polyamp
* 500mcg in 1mL glass ampoule
* 5mg in 5mL glass ampoule
* pMDI (100mcg per actuation)
172
Salbutamol – Pharmacology
A synthetic beta adrenergic stimulant with primarily beta 2 effects
Actions:
* Causes bronchodilatation
173
Salbutamol – Metabolism
* By the liver; excreted by the kidneys
174
Salbutamol – Primary emergency indication/s
1. Respiratory distress with suspected bronchospasm:
* Asthma
* COPD
* Severe allergic reactions
* Smoke inhalation
* Oleoresin capsicum spray exposure
175
Salbutamol – Contraindication/s
1. **IV Salbutamol** is no longer indicated for adult Pts
176
Salbutamol – Precaution/s
1. Large doses of **IV Salbutamol** have been reported to cause intracellular metabolic acidosis
177
Salbutamol – Route/s of administration
* pMDI
* Nebulised
* IV
* IV infusion
* ETT
* IO
178
Salbutamol – Side effects
* Sinus tachycardia
* Muscle tremor (common)
179
Salbutamol – Special notes
* **IV Salbutamol** has no advantage over **nebulised Salbutamol** provided that adequate ventilation is occurring.
* **Salbutamol** nebules / polyamps have a shelf life of one month after the wrapping is opened. The date of opening of the packaging should be recorded and the drug should be stored in an environment of \< 30°C
* Although infrequently used, **Salbutamol by IV infusion** may be required during inter-hospital transfers of some women in premature labour. The dose is to be prescribed and signed by the referring hospital medical officer.
180
Salbutamol – Onset, Peak & Duration times
IV effects:
* Onset: 1 – 2min
* Peak: N/A
* Duration: 30 – 60min
Nebulised effects:
* Onset: 5 – 15min
* Peak: N/A
* Duration: 15 – 50min
181
Water for Injection – Presentation/s
* 10mL polyamp
182
Water for Injection – Pharmacology
* Water for injection is a clear, particle free, colourless, odourless and tasteless liquid. It is sterile, with a pH of 5.6 – 7.7 and contains no antimicrobial agents.
183
Water for Injection – Metabolism
* Distributed throughout the body; excreted by the kidneys
184
Water for Injection – Primary emergency indication/s
1. Used to dissolve **Ceftriaxone** in preparation for **IV injection**
185
Water for Injection – Contraindication/s
* Nil in the above indication
186
Water for Injection – Precaution/s
* Nil in the above indication
187
Water for Injection – Route/s of administration
* IV
188
Water for Injection – Side effects
None
189
Water for Injection – Special notes
None
190
Water for Injection – Onset, Peak & Duration times
N/A
