Av Cpg Drugs

Front 1

Aspirin Pharmacology

Back 1

an analgesic, antipyretic, anti-inflam and anti-platelet aggregator

Front 2

Aspirin Precautions

Back 2

to minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS

Front 3

Aspirin Contraindications (5)

Back 3

1-chest pain associated with psycho-stimulant OD if BP > 160
2- bleeding disorders - increases bleeding time through reduced platelet function.
3- actively bleeding peptic ulcers -- > GIT haemorrhage.
4- suspected dissecting aortic aneurysm -- no clotting
5- hypersensitivity to aspirin/salicylates

Front 4

Aspirin Precautions (4)

Back 4

1- peptic ulcers (histamine inhibition in GIT --> no mucosal barrier---> irritation --> bleeding)
2- ASTHMA ( > leukotreine activity)
3- pts on anti-coagulants - compounded bleeding time.
4 - Alcohol - increased bleeding associated with chronic alcoholism.

Front 5

Aspirin Side Effects (5)

Back 5

1. heartburn -- reduces mucosal barrier
2. nausea -- gut inflammation
3. GIT bleeding
4. > bleeding time
5. hypersensitivity reactions

Front 6

Aspirin Duration

Back 6

8-10 days, or life of the effected platelets.

Front 7

Adrenaline Pharmacology (6)

Back 7

a naturally occurring beta-adrenergic stimulant

actions:
1 > HR by > S.A node firing rate (b1)
2 > conduction velocity through A.V. node (b1)
3 > myocardial contractility (b1)
4 > irritability of ventricles (b1)
5 causes bronchodilation (b2)
6 causes peripheral vasoconstriction (a1)

Front 8

Adrenaline Indications (10)

Back 8

1. persistent VF or unconcious pulseless VT - inotrope/chronotrope/ alpha agonist
2. Asystole - inotrope/chronotrope / alpha agonist
3. PEA - inotrope/chronotrope/ alpha agonist
4. inadequate perfusion (cardiogenic) ??
5. inadequate perfusion (non-cardiogenic) - alpha agonist (sepsis)
6. anaphylactic reactions - alpha agonist/ > systemic BP
7. severe ASTHMA - B2 effects (bronco-dilation) a1 agonist ( > systemic BP --> > BP greater in inferior vena cava above thoracic pressure)
8. unconcious asthma with no recordable BP (as above)
9. croup or suspected croup (a1 effects, reduces laryngeal edema)
10. bradycardia with poor perfusion (chronotropic effects)

Front 9

Adrenaline Contraindications (1)

Back 9

hypovoleamic shock without adequate fluid replacement.

Front 10

Adrenaline Precautions (4)

Back 10

1. elderly pts - weaker heart muscle (less likely to compensate)
2. pts with CV disease --> weaker heart muscle (less likely to compensate).
3. pts on MAO inhibitors ---> less dose (breakdown by MAO enzyme is reduced --> greater amounts)
4. pts on B-blockers as higher doses may be required

Front 11

Adrenaline Side Effects (7)

Back 11

1. sinus tachycardia (B1)
2. supraventricular arrythmias (B1)
3. ventricular arrythmias (B1)
4. hypertension (A1)
5. pupillary dilation (A1)
6. may > size of myocardial infarction -- due to increased oxygen demand because of increased work of heart.
7. feeling of anxiety/palpitaion in the conscious pt

Front 12

Ceftriaxone Pharmacology

Back 12

broad spectrum cephalosporin AB

Front 13

Ceftriaxone Indications (2)

Back 13

1. suspected meningococcal septicaemia -- broad spectrum AB (kills the bacteria responsible)
2. severe sepsis (consult only) ??

Front 14

Ceftriaxone Contraindications (1)

Back 14

1. allergy to cephalosporin AB

Front 15

Ceftriaxone Precautions (1)

Back 15

1. allergy to penicillin AB's

Front 16

Ceftriaxone Side Effects (3)

Back 16

nausea

vomiting

skin rash

Front 17

Dextrose 10% presentation

Back 17

50g in 500ml infusion soft pack

Front 18

Dextrose 10% pharmacology

Back 18

a slightly hypertonic crystaloid solution
composition:
- sugar - 10% dextrose
- water

Actions: provides a source of energy, supplies water to the body

Front 19

Dextrose Indications

Back 19

diabetic hypoglyceamia (BGL <4mmol/l) in pts with an altered conscious state who are unable to self administer oral glucose paste

Front 20

Dextrose Contraindications

Back 20

nil

Front 21

Dextrose Precaution

Back 21

nil

Front 22

Fentanyl Presentation

Back 22

100mcg in 2ml, 600mcg in 2ml

Front 23

Fentanyl Pharmacology

Back 23

a synthetic narcotic analgesic

Actions:
CNS:
1. Depression leading to analgesia
2. respiratory depression --> apnoea
3. dependence
CVS:
1. < conduction velocity through A.V. node

Front 24

Fentanyl Indications (1)

Back 24

1. analgesia

Front 25

Fentanyl Contraindications (3)

Back 25

1. known hypersensitivity
2. IV amiodarone
3. late second stage labor

Front 26

Fentanyl Precautions (8)

Back 26

1. pts on MAO inhibitors -- increases risk of 5ht toxicity.
2. respiratory depression e.g. COPD -- reduced sensitivity to CO2 in respiratory center.
3. rhinitis, rhinorrhea or facial trauma (IN only) -- ineffective
4. impaired renal/hepatic function
5. current ASTHMA -- respiratory depression.
6. elderly -- lower doses required.
7. known addiction to narcotics -- higher doses required.
8. oral amiodarone

other CNS depressants.

Front 27

Fentanyl Side Effects (4)

Back 27

1. bradycardia -- vagal stimulant
2. apnoea -- decreases respiratory center sensitivity to CO2.
3. respiratory depression -- decreases respiratory centers sensitivity to CO2
4. rigidity of intercostal muscles and diaphragm -- more common in pts with myasthenia gravis/ less likely to occur if given slowly.

Front 28

GTN presentation

Back 28

0.6mg tablet, transdermal GTN patch (0.4mg/hr)

Front 29

GTN Pharmacology

Back 29

a vascular smooth muscle relaxant

actions:
1. venous dilation promotes venous pooling and reduces venous return to the heart (< preload)
2. arterial dilation reduces systemic vascular resistance and arterial pao (< afterload)

the effects of the above are

1. < myocardial 02 demand
2. < systolic, diastolic, and mean arterial BP, whilst usually maintaining coronary perfusion pressure
3. mild collateral coronary arterial dilation may improve blood supply to ischeamic areas of myocardium
4. mild tachycardia secondary to slight fall in BP

Front 30

GTN Indications (5)

Back 30

1. chest pain associated with ACS
2. acute LVF
3. hypertension associated with ACS
4. autonomic dysreflexia
5. preterm labor (consult)

Front 31

GTN Contraindications (9)

Back 31

1. known hypersensitivity
2. right ventricular infarction
3. inferior STEMI with a systolic BP < 160.
4. systolic BP <110 tablet
5. systolic BP < 90 patch.
6. sildenafil citrate "viagra" or vardenafil "levitra" admin in the previous 24 hr. or tadalafil "cialis" admin in the previous 4 days (PED5 inhibitors) - block NO catabolism --> higher levels of NO.
7 HR > 150 - myocardium is supplied with O2 during diastole. if HR is high coronary BF reduced because filling time is reduced. by administering GTN you further reduce ventricular filling (preload) and further decrease O2 to myocardium.
8. bradycardia HR < 50 (EXCLUDING AUTONOMIC DYSREFLEXIA)
9. VT - same for HR > 150

Front 32

GTN Precautions (4)

Back 32

1. no previous administration
2. elderly pts
3.. recent acute myocardial infarction
4. concurrent use with other tocolytics

Front 33

GTN Side Effects (5)

Back 33

1. bradycardia (occasionally) -
2. skin flushing (peripheral dilation)
3. hypotension - smooth muscle dilation
4. headache - cerebral BV dilation
5. tachycardia - secondary to fall in BP

Front 34

Atrovent Pharmacology

Back 34

anti-cholinergic bronchodilator

actions:
allows broncho-dilatation by inhibiting cholinergic bronchomotor tone (blocks vagal reflexes which mediate broncho-constriction)

Front 35

Atrovent Indications (1)

Back 35

severe respiratory distress associated with broncho-spasm

Front 36

Atrovent Contraindications (1)

Back 36

known hypersensitivity to atropine or its derivatives

Front 37

Atrovent Precautions (2)

Back 37

1. glaucoma
2. avoid contact with eyes

Front 38

Atrovent Side Effects (7)

Back 38

1. skin rash
2. headache -- > BP
3. acute angle closure glaucoma secondary to direct eye contact -- blocks aqueous humour drainage
4. tachycardia (rare) -- PNS block
5. palpitation (rare) -- PNS block
6. dry mouth -- blocks salivary gland
7. nausea

Front 39

Methoxyflurane pharmacology

Back 39

inhalational analgesic agent at low concentrations

Front 40

Methoxyflurane Indications (1)

Back 40

pre-hospital pain relief

Front 41

Methoxyflurane Contraindications (3)

Back 41

1. pre-existing renal disease/renal impairment
2. concurrent use of tetracycline antibiootics
3. exceeding total dose of 6ml in 24 hours

Front 42

Methoxyflurane Precautions (2)

Back 42

1. the pentrox 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 by must continuously assess level of consciousness.
2. pre-eclampsia

Front 43

Methoxyflurane Side Effects (3)

Back 43

1. drowsiness
2. decrease in blood pressure and bradycardia
3. exceeding the max. total dose of 6ml in a 24hr period may lead to ranal toxicity

Front 44

Metoclopromide Pharmacology

Back 44

antiemetic which accelerates gastric empyting and peristalsis mild SHT3-receptor antagonist

Front 45

Metoclopromide Indications (7)

Back 45

nausea/vomitting associated with
1. chest pain/discomfort of a cardiac nature
2. cytotoxic or radiotherapy -- blocks noxious stimuli triggering CTZ
3. opioid administration for pain -- blocks noxious stimuli triggering CTZ
4. previously diagnosed migraine
5. severe gastroenteritis -- blocks VC from receiving input from the enteric NS in GIT.

prophylaxis for:
6. eye trauma - prevents increased ICP from emesis causing further eye trauma.
7. treatment or prophylaxis in awake spinal immobilised patients - prevents aspiration of emesis.

Front 46

Metoclopromide Contraindications (3)

Back 46

1. children - increased risk of dystonic reactions.
2. GIT haemorrhage - increases blood supply to GIT therefore chance of increased blood loss.
3. suspected bowl obstruction or perforation - increases gastric motility to the point of obstruction leading to possible perforation.

Front 47

Metoclopromide Precautions (3)

Back 47

1. Adolescent (<20yrs) - increased risk of dystonic reactions.
2. Undiagnosed abdominal pain - likely to indicate bowel obstruction/perforation.
3. Administer slowly over one minute to minimise risk of extrapyramidial reactions

Front 48

Metoclopramide Side Effects (5)

Back 48

1. drowsiness
2. dry mouth
3. lethargy
4. extrapyramidial reactions (usually the dyston
5. muscle tremor

Front 49

Metoclopramide special notes

Back 49

not effective for established motion sickness
not effective for nausea prophylaxis in the setting of narcotic administration

Front 50

Midazolam Presentation

Back 50

5mg in 1ml amp
15mg in 3ml amp

Front 51

Midazolam Pharmacology

Back 51

short acting entral nervous system depressant

Actions:
-anxiolytic - reduces anxiety
- sedative
-anti-convulsant

Front 52

Midazolam Indications (8)

Back 52

1. sediation to maintain intubation
2. sedation to enable intubation
3. sedation to enable synchronised cardioverision
4. sedation of the agitated pt
5. sedation in psychostimulat overdose
6. convulsions associated with lignocaine toxicity
7. rapid sequence intubation
8. continous recurrent seizures

Front 53

Midazolam Contraindications (1)

Back 53

known hypersensitivity to benzodiazepines

Front 54

Midazolam Precautions (8)

Back 54

1. myasthenia gravis
2. CCH - reduce
3. alcohol - > effect
4. narcotics - > effect
5. COPD --> cause severe resp depression
6. elderly - reduce
7. renal failure - reduce
8. shock - reduce

Front 55

Midazolam Side Effects (4)

Back 55

1. depressed level of consciousness
2. respiratory depression
3. loss of airway control
4. hypotension

Front 56

Midazolam Special notes

Back 56

Midazolam is not permitted for use to facilitate the transport of pts who have been recommended for transport under the Mental ealth Act. If sedation is required in these circumstances then theAct requires that this only be administered by prescribed Medical Practitioners or Registered Nurse

Front 57

Morphine Presentation

Back 57

10mg in 1ml amp

Front 58

Mophine Pharmacology

Back 58

A Narcotic analgesic
Actions:
central nervous system effects
1. Depression
2. Respiraotry depression
3. Depression of cough reflex
4. Dependence (addiction)
5. Stimulation - changes of mood, euphoria or dysphoria, vomiting, pin-point pupils

cardiovascular effects:
6. Vasodilation
7. Decreases conduction velocity through the A.V. node

Front 59

Morphine Indications (5)

Back 59

1. Pain relief
2. Acute left ventricular failure with SOB and full feild crackles
3. Sedation to maintain intubation
4. Sedation to enable intubation
5. Rapid sequence intubation

Front 60

Morphine Contraindications (2)

Back 60

1. known hypersensitivity
2. late second stage labour

Front 61

Morphine Precautions (8)

Back 61

1. hypotension
2. elderly
3. respiratory depression
4. known addiction to narcotics
5. current ASTHMA
6. respiratory tract burns
7. acute alcoholism
8. pts on MAO inhibitors

Front 62

Morphine Side Effects (8)

Back 62

CNS effects:
1. drowsiness
2. respiratory depression
3. euphoria
4. nausea and vomiting
5. pin-point pupils
6. addiction

CVS effects:
7. hypotension
8. bradycardia

wheals -- due to histamine release

Front 63

Naloxone Pharmacology

Back 63

A Narcotic antagonist

Action:
- Prevents or reverses the effects of narctoics

Front 64

Naloxone Indications (1)

Back 64

altered conscious state and respiratory depression secondary to administration of narcotics or related drugs

Front 65

Naloxone Contraindications

Back 65

NIL

Front 66

Naloxone Precautions (2)

Back 66

1. If patient is known to be physically dependent on narcotics, be prepared to deal with a combative pt after administration
2. neonates

Front 67

Naloxone Side Effects (7)

Back 67

symptoms of narcotic withdrawal

1. dilation of pupils, excessive lacrimation
2. convulsions
3. agitation
4. nausea and vomiting
5. goose flesh
6. sweating
7. tremor

Front 68

nalonxone special notes

Back 68

1. Since the duration of action of Naloxone is often less than that of the narcotic used repeated doses may be required.
2. Naloxone reverses the effects of narcotics with none of the actions produced by other narcotic antagonists when no narcotic is present on the body. ( E.g it does not depress respiration or cause pupillary constriction)
3. in the absence of narcotics, Naloxone has no perceivable effects
4.following a narcotic associated cardiac arrest Naloxone SHOULD NOT BE administered. maintain assisted ventilation
5. following head injury naloxone SHOULD NOT be administered maintain assisted ventilation
6. in neonates if the mother has had a narcotic analgesic within one hr. prior to delivery, the baby may have narcotic related respiratory depression for which diluted Naloxone may be advised on consultation.

Front 69

Normal saline presentation

Back 69

10ml polyamp, 500ml + 1000ml infusion soft pack

Front 70

Normal saline Pharmacology

Back 70

An isotonic crystalloid solution
composition:
- Electrolytes - sodium and chloride in similar concentration to that of extracellular fluid
- water

Action: transiently increases the volume of the intravascular compartment

Front 71

Normal Saline Primary Emergency Indication

Back 71

1. as a replacement fluid in volume-depleted patients
2. to expand intravascular volume in non-cardicac, non-hypovolaemic hypotensivept e.g anaphylaxis, burns, sepsis
3. as a fluid challenge in unresponsive non-hypvolaemic hypotensive pts, other then LVF .g Asthma, PEA
4. Vehicle for diluting and intravenous administration of emergency drugs
5. Fluid to TKVO for IV administration of emergency drugs

Front 72

Normal saline Contraindications

Back 72

Nil of significance in above indication

Front 73

Normal saline precautions

Back 73

nil of significance in above indication

Front 74

Prochlorperazine Pharmacology

Back 74

An anti-emetic
Action: acts on several central neuro-transmitter systems (DA antagonist)

Front 75

Prochlorperazine Indications (5)

Back 75

Treatment or prophylaxis of nausea/vomiting for
1. Motion sickness - blocks vestibular impulses
2. Vertigo - blocks vestibular impulses
3. Planned aeromedical evacuation - blocks vestibular impulses
4. Known allergy or contraindicaiton to metoclopromide administration (can use if pt has bowel obstruction, perforation or GIT hemorrhage)
5. Headache irrespective of nausea/ vomiting

Front 76

Prochlorperazine Contraindcations (4)

Back 76

1. Circulatory collapse - alpha adrenergic antagonism properties --> hypo-tension.
2. CNS Depression -- effect on RAS which decreases consciousness.
3. Children - serious acute dystonic reactions.
4. Previous hypersensitivity

Front 77

Prochlorperazine Precautions (3)

Back 77

1. Hypotension - alpha adrenergic antagonism.
2. Epilepsy - lowers seizure threshold.
3. Pts effected by alcohol or on anti-depressants - RAS depression.

Front 78

Prochlorperazine Side Effects (6)

Back 78

1. blurred vision
2. sinus tachycardia
3. hypo-tension
4. extra pyramidal reactions, usually the dystonic type
5. drowsiness
6. skin rash

Front 79

Glucagon Pharmacology

Back 79

A hormone normally secreted by the pancreas. Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose

Front 80

Glucagon Indications

Back 80

Diabetic hypoglycemia (BGL under 4 in PTS with an altered consious state who cannot self admin oral glucose

Front 81

Glucagon Contraindications

Back 81

NIL

Front 82

Glucagon Precautions

Back 82

NIL

Front 83

Glucagon Side Effects (1)

Back 83

Nausea and Vomiting

Front 84

Salbutamol Pharmacology

Back 84

A synthetic beta adrenergic stimulant with primary beta 2 effects causing bronchodilation

Front 85

Salbutamol indications (4)

Back 85

Asthma

Severe COPD

Smoke Inhalation

Capsicum spray exposure

Front 86

Salbutamol Contraindications

Back 86

NIL

Front 87

Salbutamol Precautions (1)

Back 87

Large doses of IV salbutamol have been known to cause intracellular metabolic acidosis

Front 88

Salbutamol Side Effects (2)

Back 88

Sinus Tachycardia

Muscle Tremor

Front 89

Misoprostal Pharmacology

Back 89

A synthetic prostoglandin that causes uterine contractions

Front 90

Misoprostal Indications (1)

Back 90

PPPH

Front 91

Misoprostal Contraindications (2)

Back 91

Allergy to prostoglandins

Exclude Multiple pregnancy

Front 92

Misoprostal Precautions (1)

Back 92

History of Asthma

Front 93

Misoprostal side effects (4)

Back 93

Hyperplexia

Abdominal pain

shivering

Diarrhoea