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91 Cards in this Set

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  • Back

Aspirin Presentation

300 mg chewable tablets
300 mg soluble or water dispersible tablets

Aspirin Pharmacology

An analgesic, antipyretic, anti-inflammatory, and antiplatelet aggregation agent
Actions:


- To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in acute coronary syndrome


- Inhibits synthesis of prostagladins - anti-inflammatory actions


Aspirin Primary Emergency Indication

Acute Coronary Syndrome

Aspirin Contraindications

1. Hypersensitivity to aspirin / salicylates
2. Actively bleeding peptic ulcers
3. Bleeding disorders
4. Suspected dissecting aortic aneurysm
5. Chest pain associated with psychostimulant OD if SBP >160 mmHg

Aspirin Precautions

1. Asthma


2. Peptic Ulcer


3. Pts on anti-coagulants

Aspirin Side Effects

1. Heart burn


2. Nausea


3. Gastrointestinal bleeding


4. Increased bleeding time


5. Hypersensitivity reactions

Adrenaline Presentation

1mg in 1mL glass ampoule


1mg in 10 mL

Adrenaline Pharmacology

A naturally occurring alpha and beta adrenergic stimulant



Actions:


- Increases HR by increased SA node firing Rate (Beta 1)


- Increases conduction velocity through the AV node (Beta 1)


- Increases myocardial contractility (Beta 1)


- Increases the irritability of the ventricles (Beta 1)


- Causes bronchodilation (Beta 2)


- Causes peripheral vassoconstriction (Alpha)

Adrenaline Primary Emergency Indications

1. Persistent VF or unconscious, pulseless, VT


2. Asystole


3. PEA


4. Inadequate perfusion (cardiogenic)


5. Inadequate perfusion (non cardiogenic – non hypovolaemic)


6. Anaphylaxis


7. Severe asthma


8. Unconscious asthma with no recordable BP


9. Croup


10. Bradycardia with poor perfusion

Adrenaline Contraindications

1. Hypovolaemic shock without adequate fluid replacement

Adrenaline Precautions

1. Elderly Pts
2. Pts with cardiovascular disease
3. Pts on monoamine oxidase inhibitors
4. Pts on beta blockers as higher doses may be required

Adrenaline Side Effects

1. Sinus Tachycardia


2. Supraventricular arrythmias


3. Ventricular arrythmias


4. Hypertension


5. Pupillary dilation


6. May increase size of MI


7. Feeling of anxiety/palpations in the conscious Pt

Ceftriaxone Presentation

1 g sterile powder in glass vial

Ceftriaxone Pharmacology

Cephalosporin antibiotic

Ceftriaxone Primary Emergency Indications

1. Suspected meningococcal septicaemia


2. Severe sepsis (consult only)

Ceftraixone Contrainidications

1. Allergy to Cephalosporin antibiotics

Ceftriaxone Precautions

1. Allergy to Penicillin antibiotics

Ceftriaxone Side Effects

1. Nausea and vomiting


2. Skin rash

Dextrose 10% Presentation

25 g in 250 mL infusion soft pack

Dextrose 10% Pharmacology

A slightly hypertonic crystalloid solution


Composition:


- Sugar - 10% dextrose
- Water
Actions:
- Provides a source of energy - Supplies body water

Dextrose 10% Primary Emergency Indication

1. Diabetic hypoglycaemia (BGL analysis < 4 mmol/L) in Pts with an altered conscious state who are unable to self-administer oral glucose

Fentanyl Presentation

100 mcg in 2 mL glass ampoule
600 mcg in 2 mL glass vial (IN use only)

Fentanyl Pharmacology

A synthetic opioid analgesic


Actions:


CNS effects:
- Depression – leading to analgesia
- Respiratory depression – leading to apnoea
- Dependence (addiction)
Cardiovascular effects:
- Decreases conduction velocity through the A-V node

Fentanyl Primary Emergency Indications

1. Sedation to facilitate intubation


2. Sedation to maintain intubation


3. Drug facilitated intubation
4. Analgesia – IV/IN

Fentanyl Contraindications

1. Known hypersensitivity


2. IV Amiodarone

Fentanyl Precautions

1. Elderly patients
2. Impaired renal / hepatic function
3. Respiratory depression, e.g. 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

Fentanyl Side Effects

1. Respiratory depression
2. Apnoea
3. Rigidity of the diaphragm and intercostal muscles Bradycardia

Glucagon Presentation

1 mg (IU) in 1 mL hypokit

Glucagon Pharmacology

A hormone normally secreted by the pancreas


Actions:
– Causes an increase in blood glucose concentration by converting stored liver


glycogen to glucose

Glucagon Primary Emergency Indication

1. Diabetic hypoglycaemia (BGL < 4 mmol/L) in Pts with an altered conscious state who are unable to self-administer oral glucose

Glucagon Side Effects

1. Nausea and vomiting (rare)

Glycerol Trinitrate (GTN) Presentation

0.6 mg tablets
Transdermal GTN Patch (50 mg 0.4 mg/hr release)

Glycerol 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 O2 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

Glycerol Trinitrate (GTN) Primary Emergency Inidications

1. Chest pain with ACS
2. Acute LVF
3. Hypertension associated with ACS


4. Autonomic dysreflexia
5. Preterm labour (consult)

Glycerol Trinitrate (GTN) Contrainidications

1. Known hypersensitivity


2. Systolic blood pressure < 110 mmHg tablet


3. Systolic blood pressure < 90 mmHg patch


4. Sildenafil Citrate (Viagra) or Vardenafil (Levitra) administration in the previous 24 hr or Tadalafil (Cialis) administration in the previous 4 days (PDE5 inhibitors)


5. Heart rate > 150 bpm Bradycardia


6. HR < 50 bpm (excluding autonomic dysreflexia) 7. VT


8. Inferior STEMI with systolic BP < 160 mmHg


9. Right ventricular MI

Glycerol Trinitrate (GTN) Precautions

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

Glycerol Trinitrate (GTN) Side Effects

1. Tachycardia


2. Hypotension


3. Headache
4. Skin flushing (uncommon)


5. Bradycardia (occasionally)

Ipratropium Bromide (Atrovent) Presentation

250 mcg in 1 mL nebule or polyamp

Ipratropium Bromide (Atrovent) Pharmacology

Anticholinergic bronchodilator


Actions:


- Allows bronchodilatation by inhibiting cholinergic bronchomotor tone (i.e. blocks vagal reflexes which mediate bronchoconstriction)

Ipratropium Bromide (Atrovent) Primary Emergency Indications

1. Severe respiratory distress associated with bronchospasm

Ipratropium Bromide (Atrovent) Contraindications

1. Known hypersensitivity to Atropine or its derivatives

Ipratropium Bromide (Atrovent) Precautions

1. Glaucoma
2. Avoid contact with eyes

Ipratropium Bromide (Atrovent) Side Effects

1. Headache
2. Nausea
3. Dry mouth
4. Skin rash
5. Tachycardia (rare)
6. Palpitations (rare)
7. Acute angle closure glaucoma secondary to direct eye contact (rare)

Methoxyflurane Presentation

3ml in glass bottle

Methoxyflurane Pharmacology

Inhalational analgesic agent at low concentrations

Methoxyflurane Primary Emergency Indication

1. Pain Relief

Methoxyflurane Contraindications

1. Pre-existing renal disease / renal impairment


2. Concurrent use of tetracycline antibiotics
3. Exceeding total dose of 6 mL in a 24 hr period

Methoxyflurane Precautions

1. The PenthroxTM 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

Methoxyflurane Side Effects

1. Drowsiness
2. Decrease in blood pressure and bradycardia (rare)


3. Exceeding the maximum total dose of 6 mL in a 24 hr period may lead to renal toxicity

Metoclopramide (Maxolon) Presentation

10mg in 2mL polyamp

Metoclopramide (Maxolon) Pharmacology

Antiemetic


Actions:
- Accelerates gastric emptying and peristalsis


- Dopamine receptor antagonist

Metoclopramide (Maxolon) Primary Emergency Indications

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

Metoclopramide (Maxolon) Contraindications

1. Children
2. Suspected bowel obstruction or perforation


3. Gastrointestinal haemorrhage

Metoclopramide (Maxolon) Precautions

1. Undiagnosed abdominal pain
2. Adolescents (< 20 yrs)
3. Administer slowly over 1 min to minimise risk of extrapyramidal reactions

Metoclopramide (Maxolon) Side Effects

1. Drowsiness
2. Lethargy
3. Dry mouth
4. Muscle tremor
5. Extrapyramidal reactions (usually the dystonic type)

Midazolam Presentation

5 mg in 1 mL glass ampoule


15 mg in 3 mL glass ampoule

Midazolam Pharmacology

Short acting CNS depressant


Actions:


- Anxiolytic
- Sedative
- Anti-convulsant

Midazolam Primary Emergency Indications

1. Continuous tonic-clonic seizures


2. Sedation to maintain intubation


3. Sedation to enable intubation
4. RSI


5. Sedation to enable synchronised cardioversion


6. Sedation in the agitated Pt
7. Sedation in psychostimulant OD

Midazolam Contraindications

1. Known hypersensitivity to benzodiazepines

Midazolam Precautions

1. Reduced doses may be required for the elderly, 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

Midazolam Side Effects

1. Depressed level of consciousness


2. Respiratory depression
3. Loss of airway control


4. Hypotension

Morphine Presentation

10 mg in 1 mL glass ampoule

Morphine Pharmacology

An opioid analgesic


Actions: CNS effects:


- 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 A-V Node

Morphine Primary Emergency Indications

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

Morphine Contraindictions

1. Known hypersensitivity
2. Late second stage of labour

Morphine Precautions

1. Elderly Pts
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

Morphine Side Effects

CNS effects:


- Drowsiness


- Respiratory depression


- Euphoria


- Nausea, vomiting


- Addiction


- Pin-point pupils


Cardiovascular effects:


- Hypotension


- Bradycardia

Naloxone Presentation

0.4 mg in 1 mL glass ampoule


2 mg in 5 mL (prepared syringe)

Naloxone Pharmacology

An opioid antagonist


Action:


- Prevents or reverses the effects of opioids

Naloxone Primary Emergency Indication

1. Altered conscious state and respiratory depression secondary to administration of opioids or related drugs.

Naloxone Precautions

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


2. Neonates.

Naloxone Side Effects

Symptoms of opioid withdrawal:


1. Sweating


2. goose flesh, tremor


3. Nausea and vomiting
4. Agitation


5. Dilatation of pupils, excessive lacrimation


6. Convulsions

Normal Saline Presentation

10 mL polyamp
500 mL and 1000 mL infusion soft pack

Normal Saline Pharmacology

An isotonic crystalloid solution


Composition:


- Electrolytes (sodium and chloride in a similar concentration to that of extracellular fluid)


Action:


- Increases the vol of the intravascular compartment

Normal Saline Primary Emergency Indications

1. As a replacement fluid in vol-depleted Pts


2. To expand intravascular vol in the non-cardiac, non-hypovolaemic hypotensive Pt e.g. anaphylaxis, burns, sepsis


3. As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive Pts (other than LVF). e.g. PEA; asthma


4. Fluid for diluting and administering IV drugs


5. Fluid TKVO for IV administration of emergency drugs

Normal Saline Precautions

1. Consider modifying factors when administering for hypovolaemia

Prochlorperazine (Stemetil) Presentation

12.5 mg in 1 mL glass ampoule

Prochlorperazine (Stemetil) Pharmacology

An anti-emetic


Action:


- Acts on several central neuro-transmitter systems

Prochlorperazine (Stemetil) Primary Emergency Indications

1. Rx 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

Prochlorperazine (Stemetil) Contraindications

1. Circulatory collapse
2. CNS depression
3. Previous hypersensitivity


4. Children

Prochlorperazine (Stemetil) Precautions

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

Prochlorperazine (Stemetil) Side Effects

1. Drowsiness
2. Blurred vision
3. Hypotension
4. Sinus tachycardia
5. Skin rash
6. Extrapyramidal reactions (usually the dystonic type)

Salbutamol Presentation

5 mg in 2.5 mL polyamp
500 mcg in 1 mL glass ampoule


5 mg in 5 mL glass ampoule


pMDI

Salbutamol Pharmocology

A synthetic beta adrenergic stimulant with primarily beta 2 effects


Action:


- Causes bronchodilatation

Salbutamol Primary Emergency Indications

1. Respiratory distress with suspected bronchospasm:


- asthma


- severe allergic reactions
- COPD
- smoke inhalation
- oleoresin capsicum spray exposure

Salbutamol Precautions

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

Salbutamol Side Effects

1. Sinus tachycardia


2. Muscle tremor (common)

PSA (Adequate Perfusion)

Skin - Warm, pink, dry


Pulse - 60 - 100 bpm


BP - > 100 mmHg systolic


Conscious State - Alert and orientated to time and place

PSA (Borderline Perfusion)

Skin - cool, pale, clammy


Pulse - 50 - 100 bpm


BP - 80 - 100 mmHg systolic


Conscious State - Alert and orientated to time and place

PSA (Inadequate Perfusion)

Skin - cool, pale, clammy


Pulse - < 50 bpm or > 100 bpm


BP - 60 - 80 mmHg systolic


Conscious State - Either alert and orientated to time and place or altered

PSA (Extremely Poor Perfusion)

Skin - cool, pale, clammy


Pulse - < 50 bpm or > 110 bpm


BP - < 60 mmHg systolic or unrecordable


Conscious State - altered or unconscious