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305 Cards in this Set

  • Front
  • Back
What class of drug is adrenaline?
Sympathomimetic
What schedule drug is adrenaline?
1:1,000 is an S3 (therapeutic poison), 1:10,000 is unscheduled.
What is the presentation of adrenaline?
Amp, 1mg/ml (1:1,000) and Amp, 1mg/10mls (1,10:000)
What are the ICP routes of administration of adrenaline?
Neb, IM, IV, IO
What is the pharmacology of adrenaline?
Adrenaline is a naturally occurring catecholamine which primarily acts on alpha and beta adrenergic receptors which are located mainly in the tissues innervated by sympathetic nerves. The actions of these receptors cause an increase in heart rate (beta 1), bronchodilation (beta 2) and peripheral vasoconstriction (alpha 1)
How is adrenaline metabolised?
The majority of circulating adrenaline is metabolised by sympathetic nerve endings. It is subject to the process of mitochondrial enzymatic breakdown by monoamine oxidase at the synaptic level
What is the onset, duration and half life of adrenaline?
Onset, 30 secs (IV) 1 min (IM)
Duration 5 to 10 min (IV & IM)
Half life (2 mins)
What are the ICP indications for adrenaline?
Anaphylaxis or severe allergic reaction.
Severe life threatening bronchospasm or silent chest.
Bradycardia with poor perfusion unresponsive to atropine and/or pacing.
Cardiac arrest.
Croup with stridor at rest.
Shock (excluding haemorrhagic cause) that is unresponsive to fluid resuscitation.
What are the contraindications for adrenaline?
KSAR
What are the precautions for adrenaline?
Patients taking MAOIs.
Hypovolaemic shock.
Hypertension.
What are the side effects of adrenaline?
Anxiety.
Hypertension.
Palpitations / tachyarrhythmias.
Pupil dilation
What is the adult dose of adrenaline for anaphylaxis OR severe allergic reaction?
IM 250 to 500mcg (0.25 to 0.5mg) Repeated at 5 min intervals - no max dose
IV/IO 20 to 50mcg (0.02 to 0.05mg) Repeated at 1 min intervals – no max dose

Neb 5mg – single dose only may be administered for isolated minor facial and/or tongue swelling thought to be allergic in origin - if stridor present IM and/or IV Adrenaline must be administered
What is the adult dose of adrenaline for severe life threatening bronchospasm OR silent chest?
IM 250 to 500mcg (0.25 to 0.5mg) repeated at 5 min intervals - no max dose
IV/IO 20 to 50mcg (0.02 to 0.05mg) repeated at 1 min intervals – no max dose
What is the adult dose of adrenaline for bradycardia with poor perfusion that is unresponsive to atropine AND/OR TCP and shock (excluding haemorrhagic causes) that is unresponsive to adequate fluid resuscitation?
IV/IO 20 to 50mcg (0.02 to 0.05mg)
Repeated at 1 min intervals – no max dose
What is the adult dose of adrenaline in cardiac arrest?
1mg repeated at 3 to 5 min intervals – no max dose
What is the paediatric dose of adrenaline in anaphylaxis OR severe allergic reaction?
IM ≥10 kg (≥1 yr) 10 mcg/kg – single dose not to exceed 250mcg (0.25mg) Repeated at 5 min intervals – no max dose
<10 kg (<1yr) 100mcg Repeated at 5 min intervals – no max dose.
IV/IO 2 mcg/kg – single dose not to exceed 50mcg (0.05mg) Repeated at 2 min intervals - no max dose.
Neb 5mg – single dose only May be administered for isolated minor facial and/or tongue swelling thought to be allergic in origin – if stridor present IM and/or IV Adrenaline must be administered.
What is the paediatric dose of adrenaline in severe life threatening bronchospasm OR silent chest
IM 10 mcg/kg – single dose not to exceed 250mcg (0.25mg) repeated at 5 min intervals - no max dose
IV/IO 2 mcg/kg – single dose not to exceed 50mcg (0.05mg) repeated at 2 min intervals - no max dose
What is the paediatric dose of adrenaline in cardiac arrest?
IV/IO ≥10 kg (≥1 yr) 10 mcg/kg Repeated at 3 to 5 min intervals – no max dose
<10 kg (<1yr) 100mcg as a bolus Repeated at 3 to 5 min intervals – no max dose
What is the paediatric dose of adrenaline for croup with stridor at rest?
NEB 5mg – single dose only
What is the paediatric dose of adrenaline for shock (excluding haemorrhagic causes) that is unresponsive to adequate fluid resuscitation?
IV / IO 2 mcg/kg – single dose not to exceed 50mcg (0.05mg) Repeated at 2 min intervals - no max dose
What is the dose of adrenaline in paediatrics for bradycardia with poor perfusion that is unresponsive to atropine AND/OR TCP
Not approved.
What class of drug is amiodarone?
Anti-arrhythmic
What schedule of drug is amiodarone?
S4 (Restricted drugs)
What is the presentation of amiodarone?
Amp, 150mg/3mL Amiodarone (Cordarone X)
What are the QAS Authorised Routes of administration for amiodarone
IV & IO
What is the pharmacology of amiodarone?
Amiodarone prolongs the duration of the action potential and therefore the refractory period of atrial, nodal and ventricular tissues. It also reduces conduction across all cardiac tissue – including myocardial and conducting system cells. Amiodarone demonstrates electrophysiological properties across all Vaughan – Williams Class groups, which enables a broad spectrum of activity
How is amiodarone metabolised?
The majority of the drug is excreted by the liver, there may be some hepatic recirculation
What is the onset, duration and half life of amiodarone?
Onset 5mins, duration 30mins, half life 14 -110 days (chronic dosing)
What are the ICP indications for amiodarone?
Cardiac arrest patients with refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT)
What are the ICP contraindications for amiodarone?
In cardiac arrest patients with refractory VF or pulseless VT Nil
What are the ICP precautions for amiodarone?
In cardiac arrest patients with refractory VF or pulseless VT concomitant use of anti-arrhythmics that prolong the QT interval and Thyroid disease
What are the side effects of amiodarone?
Hypotension.
Bradycardia.
Nausea and/or vomiting.
Peripheral paraesthesia.
What is the adult dose of amiodarone in cardiac arrest patients with refractory VF or pulseless VT
IV / IO 300mg (undiluted) - slow push over 2 min
Repeated once at 150mg after 5 min – total max dose 450mg
What is the paediatric dose of amiodarone in cardiac arrest patients with refractory VF or pulseless VT
IV / IO 5 mg/kg - slow push over 2 min – single dose only
* Mix 150mg (3mL) of amiodarone with 12mL of glucose 10% (totalling 15mL) in a 20mL syringe to achieve a final concentration of 10mg/mL
In QAS practice what class of drug is aspirin?
Antiplatelet
What schedule of drug is aspirin?
S2 (Therapeutic poisons)
What is the presentation of aspirin?
Tab (white), 300mg Aspirin
What is the pharmacology of aspirin?
Aspirin inhibits platelet aggregation by irreversibly inhibiting cyclo-oxygenase, reducing the synthesis of thromboxane A2 (an inducer of platelet aggregation) for the life of the platelet. This action forms the basis of preventing platelets from aggregating to exposed collagen fibres at the site of vascular injury.
How is aspirin metabolised?
Converted to salicyclic acid in many tissues, but primarily in the GI mucosa and liver, excreted by the kidneys.
What is the onset, duration and half life of aspirin?
Onset 10 mins (variable), duration 7 - 10 days (antiplatelet), half life 3.2 hours (300 to 650mg)
In QAS practice what are the indictions for aspirin?
Suspected AMI OR myocardial ischaemia
What are the contraindications for aspirin?
KSAR to Aspirin or NSAIDs.
Chest pain associated with psychostimulant overdose.
Bleeding disorders.
Current GI bleeding or peptic ulcers.
Patients <18 yrs
What are the precautions for aspirin?
Possible aortic aneurysm or other condition that may require surgery.
Pregnancy.
History of GI bleeding or peptic ulcers.
Concomitant anticoagulant therapy (excluding Clopidogrel)
What are the side effects of aspirin?
Epigastric pain/discomfort.
Nausea and/or vomiting.
Gastritis.
GI bleeding.
NSAID induced bronchospasm.
What is the dose of aspirin?
300mg – chewed and followed by small sip water (where possible). If pt is on daily aspirin total max dose of 450mg.
What class of drug is atropine?
Antichloinergic (antimuscarinic)
What schedule drug is atropine?
S4 (Restricted drugs)
What is the presentation of atropine?
Amp, 1.2 mg/1mL Atropine
What are the routes of administration of atropine?
IM,IV,IO
What is the pharmacology of atropine?
Atropine works by inhibiting the action of the parasympathetic nervous system allowing for an unchallenged sympathetic response. It successfully blocks the action of the vagus nerve on the heart, increases the rate of the SA node and conduction through the AV node and blocks exocrine gland activity causing decreased salivary, bronchial, gastric and sweat secretion.
How is atropine metabolised?
Metabolised by the liver and excreted mainly by the kidneys.
What is the onset, duration of action and half life of atropine?
Onset 1 - 2 mins (peak 15 - 50 mins). Duration up to 5 hours. Half life 3 - 4hours.
What are the indications for atropine?
Bradycardia with poor perfusion.
Envenomation associated with increased parasympathetic activity (eg. airway secretions or
bradycardia).
Hypersalivation associated with Ketamine administration
Organophosphate toxicity with cardiac AND/OR respiratory compromise (eg. profuse oral and/or bronchial secretions)
What are the contraindications for atropine?
KSAR
What are the precautions with atropine?
Atrial flutter and atrial fibrillation.
AMI (so as to not excessively increase myocardial workload).
Glaucoma.
What are the side effects of atropine?
Agitation/hallucinations
Dilated pupils
Dry mouth/dry skin
Tachycardia
What is the adult dose of atropine for bradycardia with poor perfusion?
IV/IO 600mcg (0.6mg) repeated once after 2 min – total max dose 1.2mg
What is the adult dose of atropine for Organophosphate toxicity with cardiac AND/OR respiratory compromise (eg. profuse oral and/or bronchial secretions) and Envenomation associated with increased parasympathetic activity (eg. airway secretions or bradycardia)
1.2mg Repeated every 5 min until atropinisation is achieved – no max dose
What is the paediatric dose of atropine for bradycardia with poor perfusion?
IV / IO 20 mcg/kg – single dose not to exceed 600mcg Repeated once after 2 min – total max dose 40 mcg/kg
What is the paediatric dose of atropine for Organophosphate toxicity with cardiac AND/OR respiratory compromise (eg. profuse oral and/or bronchial secretions) and envenomation associated with increased parasympathetic activity (eg. airway secretions or bradycardia)
IM / IV / IO 20 mcg/kg – single dose not to exceed 600mcg Repeated every 5 min until Atropinisation is achieved – no max dose
What is the adult dose of atropine for Hypersalivation associated with Ketamine administration
600mcg – single dose only
What is the paediatric dose of atropine for hypersalivation associated with ketamine administration
20 mcg/kg – not to exceed 600mcg – single dose only
What class of drug is benztropine?
Anticholinergic
What schedule drug is benztropine?
S4 (Restricted drugs)
What is the presentation of benztropine?
Amp, 2.0mg/2mL Benztropine (Cogentin®)
What are the ICP authorised routes of administration for benztropine?
IM & IV
What is the pharmacology of benztropine?
Benztropine is a synthetic compound resulting from the combining of Atropine and diphenhydramine which possesses both anticholinergic and antihistamine actions. It counteracts the unopposed activity of acetylcholine which causes excessive muscle stimulation, resulting in dystonic reactions.
How is benztropine metabolised?
Hepatic.
What is the onset, duration and half life of benztropine?
Onset 1 to 2 mins, duration 1 to 2 hours, half life approx 16 hours
What are the indications for benztropine?
Acute dystonic reaction.
What are the contraindications for benztropine?
KSAR.
Tardive Dyskinesia.
Children <3 yrs
What are the precautions with benztropine?
Sedative effects of other drugs may be enhanced.
Children <12 yrs
What are the side effects of benztropine?
Dilated pupils.
Dry mouth.
Nausea and/or vomiting.
Tachycardia.
Toxic psychosis including confusion and visual hallucinations.
Urinary retention and/or dysuria
What is the adult dose of benztropine?
IM / IV, 1 to 2mg – single dose only.
What is the paediatric dose of benztropine?
IM / IV, ≥3 yrs 20 mcg/kg - single dose only
What class of drug is box jelly fish anti-venom?
Anti-venom
What schedule drug is box jelly fish antivenom?
S4 (Restricted drugs)
What is the presentation of box jelly fish antivenom?
Amp, 20 000 units box jellyfish antivenom
What are the routes of administration for box jelly fish anti-venom
IM & IV
What is the pharmacology of box jelly fish anti-venom?
Box Jellyfish antivenom contains concentrated immunoglobulin that acts to neutralise the toxins present in the venom of the Box Jellyfish (Chironex fleckeri)
How is box jelly fish anti-venom metabolised?
In muscle tissue and the liver
What is the onset, duration and half life of box jelly fish anti-venom?
Not known.
What are the indications for box jelly fish anti-venom?
Box Jellyfish envenomation associated with any of the following:
Cardiac arrest.
Decreased level of consciousness.
Cardiac AND/OR respiratory distress or collapse.
Total surface area affected greater than half the surface area of one limb.
Intractable pain unrelieved by icepacks, Methoxyflurane AND/OR Morphine
What are the contraindications to box jelly fish anti-venom
KSAR
What are the precautions with box jelly fish anti-venom?
The antivenom is a foreign protein which can cause sensitisation, allergic reaction or anaphylaxis
How is box jelly fish anti-venom metabolised?
In muscle tissue and the liver
What is the onset, duration and half life of box jelly fish anti-venom?
Not known.
What are the indications for box jelly fish anti-venom?
Box Jellyfish envenomation associated with any of the following:
Cardiac arrest.
Decreased level of consciousness.
Cardiac AND/OR respiratory distress or collapse.
Total surface area affected greater than half the surface area of one limb.
Intractable pain unrelieved by icepacks, Methoxyflurane AND/OR Morphine
What are the contraindications to box jelly fish anti-venom
KSAR
What are the precautions with box jelly fish anti-venom?
The antivenom is a foreign protein which can cause sensitisation, allergic reaction or anaphylaxis
What are the side effects of box jelly fish anti-venom?
Allergic reaction including anaphylactic shock and delayed serum sickness (≥1/100).
Intense stinging sensation on injection
What is the adult dose of box-jelly fish anti-venom
In cardiac arrest IM not indicated, IV 20 000 units drawn up to 20mL of Sodium Chloride 0.9% and given by slow IV push (over 2 to 5 min), repeated immediately up to 2 times (total max dose 60 000 units).
All other cases IM 60 000 units – single dose only. IV 20 000 units drawn up to 20mL of Sodium Chloride 0.9% and given by slow IV push (over 10 min) – single dose only
What class of drug is calcium?
Electrolyte.
What schedule drug is calcium?
Unscheduled
What is the presentation of calcium?
Amp, 0.953g/10mL Calcium Gluconate 10%
What is the pharmacology of calcium?
Calcium Gluconate 10% plays an integral role in the muscular and neural systems. It is involved in skeletal muscle contraction, excitation coupling in cardiac and smooth muscle and acts as an intracellular 2nd messenger. These effects combine to exert a positive inotropic effect in the post cardiac arrest patient.
How is calcium metabolised?
Most of the calcium filtered by the renal glomeruli is reabsorbed, the remainder is excreted in faeces.
What is the onset, duration and half life of calcium.
Onset 1 to 3 mins, duration 30 to 60 mins (in hyperkalaemia), half life not applicable.
What are the indications for calcium?
Cardiac arrest where the underlying aetiology is likely to be hyperkalaemia.
Severe hyperkalaemia with haemodynamic compromise OR significant cardiac rhythm disturbance.
Calcium channel blocker toxicity Hypotension associated with a Magnesium infusion that fails to respond to intravenous fluid therapy
What are the contraindications to calcium?
KSAR.
Digoxin (Digitalis) overdose.
What are the precautions for calcium?
Respiratory acidosis
What are the side effects of calcium?
In cardiac arrest where the underlying aetiology is likely to be hyperkalaemia nil.
Other QAS indications rapid IV administration may cause: syncope, hypotension, bradycardia, cardiac dysrhythmias, cardiac arrest
What is the adult dose of calcium?
IV / IO, 10mL of 10% - slow push over 2 to 5 min Repeated once at 10 min
What is the paediatric dose of calcium?
IV / IO, 0.2 mL/kg of 10% - slow push over 2 to 5 min Repeated once at 10 min
What class of drug is ceftriaxone?
Antibiotic (third generation cephalosporin)
What schedule drug is ceftriaxone?
S4 (Restricted drugs)
What is the presentation of ceftriaxone?
Vial (powder), 1g Ceftriaxone (Rocephin)
What are the ICP authorised routes of administration for ceftriaxone?
IM, IV & IO
What is the pharmacology of ceftrioxone?
Ceftriaxone is a third generation broad spectrum cephalosporin antibiotic used in the treatment of meningococcal infections.
How is ceftriaxone metabolised?
Variable hepatic metabolism, significant amounts excreted unchanged in urine.
what is the onset, duration and half life of ceftriaxone?
Onset is dose and route variable. Duration is approximately 1 day. Half life is 5.8 to 8.7 hrs (healthy subjects)
What are the indications for ceftriaxone?
Suspected meningococcal septicaemia with non-blanching petechial OR purpuric rash and other significant symptoms that may include: myalgia; headache; nausea and/or vomiting; severe lethargy; fever; or clinical evidence of shock.
What are the contraindication for ceftriaxone?
KSAR to cephalosporin drugs.
Known anaphylaxis or severe allergic reaction to penicillin based drugs - (isolated minor drug rash attributed to penicillin does not contraindicate the use of Ceftriaxone)
What are the precautions for ceftriaxone?
Nil
What are the side effects of ceftriaxone?
Nausea/vomiting.
Pain at the IM administration site
What is the adult dose of ceftriaxone?
IM, 1g
* Reconstitute 1gm with 3.6mL of Water for Injection to achieve a final concentration of 1g/4mL (250mg/mL).
IV, 1g slow push over 3 to 5 min
* Reconstitute 1gm with 9.6mL of Water for Injection in a 10mL syringe to achieve a final concentration of 1g/10mL (100 mg/mL).
What is the paediatric dose of ceftriaxone?
IM, 50 mg/kg (rounded up to the nearest 5kg)
* Reconstitute 1g of Ceftriaxone with 3.6mL of Water for Injection to achieve a final concentration of 1g/4mL (250mg/mL).
IV, 50 mg/kg (rounded up to the nearest 5kg) slow push over 3 to 5 min
* Reconstitute 1g of Ceftriaxone with 9.6mL of Water for Injection in a 10mL syringe to achieve a final concentration of 1g/10mL (100 mg/mL).
What class of drug is clopridogrel?
Antiplatelet
What schedule drug is clopridogrel?
S4 (Restricted drugs)
What is the presentation of clopridogrel?
Tab (pink), 75mg, Clopidogrel (Iscover)
What is the QAS authorised routes of administration for clopridogrel?
Oral
What is the pharmacology of clopridogrel?
Clopidogrel is a specific and potent platelet aggregation inhibitor. It selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor thereby inhibiting platelet aggregation.
How is clopridogrel metabolised?
Hepatic
What is the onset of action, duration and half life of clopridogrel?
Onset, ~30 min (within 5 hrs of a 300mg loading dose 80% platelet will be inhibited), duration, 7 to 10 days (antiplatlet), half life, 8 hrs.
What are the indications for clopridogrel?
For patients with STEMI AND: Who have been accepted for acute PCI (as an adjunct medication to Aspirin and Heparin), OR who have received fibrinolytic therapy (as an adjunct medication to Aspirin, Enoxaparin and Tenecteplase)
What are the contraindications for cloprodogrel?
Identical to the contraindication list for prehospital fibrinolysis and anticoagulation, unless specifically authorised under the relevant LWI (refer to QAS Coronary Artery Reperfusion Checklist and LWI)
KSAR
Patients currently taking Clopidogrel
Patients <18 yrs
What are the precautions for clopridogrel?
Severe renal impairment
What are the side effects of clopridogrel?
Haemorrhage
Stomach upset and/or pain
Diarrhoea
Constipation
Headache and/or dizziness
What is the dose of clopridogrel?
300mg as part of thrombolysis protocol.
600mg as part PCI protocol.
What class of drug is enoxaparin?
Anticoagulant.
What schedule drug is enoxaparin?
S4 (Restricted drugs)
What is the presentation of enoxaparin?
Amp, 40mg/0.4mL Enoxaparin Sodium (Clexane)
Inj (prefilled syringe with graduated markings)
100mg/1mL Enoxaparin Sodium (Clexane)
What is the pharmacology of enoxaparin?
Enoxaparin sodium has several actions on the coagulation pathway through its binding to antithrombin III. The antithrombotic activity is related to inhibition of thrombin generation and inhibition of two key coagulation factors: factor Xa and thrombin.
How is enoxaparin metabolised?
Limited metabolism at the liver but mostly eliminated unchanged
What is the onset, duration and half life of enoxaparin?
Onset, Immediate (peak 3 hrs). Duration, 12 to 24 hrs. Half life, 4.4 hrs for 40mg dose.
What are the indications for enoxaparin?
Patients with STEMI (as defined in the QAS Coronary Artery Reperfusion Checklist) AND who will
receive QAS fibrinolytic therapy (as an adjunct medication to Aspirin, Clopidogrel and T enecteplase)41
What are the contraindication for enoxaparin?
KSAR to Enoxaparin or Heparin.
Identical to the contraindication list for prehospital fibrinolysis, unless specifically authorised under the relevant LWI (see Tenecteplase DTP and QAS Coronary Artery Reperfusion Check List)
What are the precautions for enoxaparin?
Renal/hepatic impairment.
History of GI ulceration.
Diabetic retinopathy.
Low bodyweight (<45 kg women and <57 kg men).
Elderly.
Pregnancy and/or lactation.
What are the side effects of enoxaparin?
Thrombocytopenia.
Haemorrhage.
What is the dose of enoxaparin?
IV 30mg (loading dose – to be administered prior to Tenecteplase). Mix 40mg (0.4mL) of Enoxaparin with 3.6mL Sodium Chloride 0.9% (totalling 4mL) in a 5 mL syringe to achieve a final concentration of 10mg/mL. Discard 1mL of the prepared solution to achieve a final presentation of 30mg/3mL.
Subcutaneous injection dose, 1mg/kg (max dose 100mg) – to be administered 15 min following loading dose
What are the authorised routes of administration of glucagon?
IM
What is the pharmacology of glucagon?
Glucagon is a hyperglycaemic agent that mobilises hepatic glycogen, which is released into the blood as glucose
How is glucagon metabolised?
By the liver, kidneys and in the plasma
What is the onset, duration and half life of glucagon?
Onset 4 - 7 mins, duration variable and half life 3 - 6mins.
What are the indications for glucagon?
Suspected or known hypoglycaemia in patients unable to self administer oral glucose
What are the contraindications for glucagon?
KSAR
What are the precautions for glucagon?
Nil
What are the side effects of glucagon?
Nil
What is the dose of glucagon?
IM >25 kg 1mg - single dose only
≤25 kg 0.5mg - single dose only
What class of drug is glucose 10%?
Hypertonic crystalloid solution
What schedule drug is glucose 10%?
Unscheduled
What is the presentation of glucose 10%?
Viaflex plastic container, 500mL Glucose 10%
What are the ICP authorised routes of administration for glucose?
IV inf & IO inf
What is the pharmacology of glucose 10%?
Glucose 10% is a hypertonic crystalloid solution that provides the principal energy source for body cells, especially the brain
How is glucose 10% metabolised?
Broken down in most tissues, stored in the liver and muscle as glycogen and distributed throughout total body water
What is the onset, duration and half life of glucose 10%?
Onset is rapid and duration and half life is not applicable.
What are the indications for glucose 10%?
Symptomatic hypoglycaemia with the inability to self administer oral glucose
What are the contraindications to glucose 10%?
Nil
What are the precautions for glucose 10%?
Tissue and/or vascular necrosis secondary to extravasation.
Acute CVA
What are the side effects of glucose 10%
Nil
What is the adult dose of glucose 10%?
IV inf / IO 150mL repeated at 100mL boluses every 5 min until
BGL >4.0mmol
What is the paediatric dose of glucose 10%?
IV inf / IO 2.5 mL/kg repeated at 1 mL/kg boluses every 5 min until BGL >4.0mmol
What class of drug is glucose gel?
Hyperglycaemic
What schedule of drug is glucose gel?
Unscheduled
What is the presentation of glucose gel?
Tube, 15g Glucose.
What is the route of administration of glucose gel?
Oral
What is the pharmacology of glucose gel?
Glucose gel is a form of pure glucose that is absorbed quickly in the intestinal tract after ingestion. In the liver glucose is turned into glycogen, the storage form of glucose in the body
How is glucose gel metabolised?
Metabolised in muscle and other tissue.
What is the onset, duration and half life of glucose gel?
Onset around 10 mins, duration variable and half life not applicable.
What are the indications for glucose gel?
Symptomatic hypoglycaemia in the conscious patient.
What are the contraindications to glucose gel?
KSAR
Unconsciousness
Patients with difficulty swallowing
Patients <2 yrs
What are the precautions for glucose gel?
Nil.
What are the side effects of glucose gel?
Nausea and/or vomiting
Diarrhoea
What is the adult dose of glucose gel?
PO 15g repeated once at 15
mins if BGL ≤ 4mmol – total max dose 30g
What is the paediatric dose of glucose gel?
PO ≥2 yrs 15g may be repeated once at 15 min if BGL ≤ 4mmol – total max dose 30g
What class of drug is GTN?
Vasodilator
What schedule drug is GTN?
SUBLING spray - S3, (Therapeutic poisons)
What is the presentation of GTN?
Spray (sublingual), 400mcg/dose, 200 doses, Nitrolingual Pump Spray
What is the pharmacology of GTN?
GTN is a potent vasodilator that decreases preload by increasing venous capacity, pooling venous blood in the peripheral veins, reducing ventricular filling pressure and decreases arterial blood pressure (after load). Because of this cascade it also causes vasodilation in coronary arteries which are in spasm and may assist redistribution of blood flow along the collateral channels in the heart.
How is GTN metabolised?
Readily absorbed and metabolised in the liver
What is the onset, duration and half life of GTN?
Onset < 2 secs, duration 20 - 30 mins, half life 5.5 mins.
What are the indications for GTN?
Pain syndromes associated with suspected AMI OR myocardial ischaemia
Cardiogenic pulmonary oedema
Autonomic dysreflexia with a systolic BP ≥160 mmHg
Irukandji envenomation syndrome49 with a systolic BP ≥160 mmHg
What are the contraindications for GTN?
KSAR
Heart rate <50 OR >150 beats per minute
Systolic BP <100 mmHg
Acute CVA
Head trauma
Erectile dysfunction medication in the previous 24 hrs
What are the precautions to GTN?
Suspected inferior AMI
Cerebral vascular disease
Risk of hypotension and/or syncope
Intoxication (GTN effects enhanced)
Erectile dysfunction medication in the previous 4 days
What are the side effects of GTN?
Dizziness
Hypotension
Syncope
Reflex tachycardia
Vascular headaches
What is the adult dose of GTN?
SUBLING 400mcg Repeated at 5 min intervals – no max dose
What is the paediatric dose of GTN?
Not approved.
What class of drug is haloperidol?
Antipsychotic
What schedule of drug is haloperidol?
S4 (Restricted drugs)
How is haloperidol presented?
Amp, 5mg/1mL Haloperidol (Serenace)
What is the pharmacology of haloperidol?
Haloperidol possesses a strong activity against delusions and hallucinations, most likely due to an effective dopaminergic receptor blockage in the mesocortex and the limbic system of the brain.
How is haloperidol metabolised?
By the liver with excretion by the urine, bile and faeces
What is the onset duration and half life of haloperidol?
Onset 5 min (peak 20 min), duration 2 to 3 hours and half life 20 hours.
What are the indications for haloperidol?
Acute psychosis
What are the contraindications to haloperidol?
KSAR
Parkinson’s disease
What are the precautions with haloperidol?
Patients who have taken alcohol or other drugs may develop severe hypotension
ALOC
Elderly debilitated patients
History of dystonic reactions
Neuroleptic Malignant Syndrome (NMS)
Tardive Dyskinesia
What are the side effects of haloperidol.
Anxiety & euphoria • Extrapyramidal reaction
Hypotension
Lethargy & drowsiness
Respiratory depression
What is the adult dose of haloperidol?
IM ≥50 yrs 5mg – total max dose 5mg
<50 yrs 10mg – total max dose 10mg
What is the paediatric dose of haloperidol?
Not indicated.
What class of drug is heparin?
Anticoagulant.
What schedule drug is heparin?
S4 (Restricted drugs)
What is the presentation of heparin?
Amp, 5000 IU/5mL Heparin
What is the route of administration of heparin?
IV
What is the pharmacology of heparin?
Heparin is an anticoagulant agent which combines with anti-thrombin III to inhibit Factor X and the conversion of pro-thrombin to thrombin. Heparin (sodium) therefore reduces the propensity for new clot formation and also inhibits other processes in the clotting cascade. Heparin sodium is NOT a thrombolytic agent.
How is heparin metabolised?
Heparin is an anticoagulant agent which combines with anti-thrombin III to inhibit Factor X and the conversion of pro-thrombin to thrombin. Heparin (sodium) therefore reduces the propensity for new clot formation and also inhibits other processes in the clotting cascade. Heparin sodium is NOT a thrombolytic agent.
What is the duration, onset and half life of heparin?
Onset approx 30 seconds, duration 3 - 6 hours, half life 1.5 hours.
What are the indications for heparin?
For patients with STEMI (as defined in the QAS Coronary Artery Reperfusion Check List and LWI) AND who have been accepted for urgent PCI
What are the indications for heparin?
KSAR • Identical to contraindication list for prehospital fibrinolysis, unless specifically authorised under the
relevant LWI (see Tenecteplase DTP and QAS Coronary Artery Reperfusion Check List)
What are the precautions with heparin?
Renal impairment
What are the side effects of heparin?
Thrombocytopenia
Bleeding
What is the adult dose of heparin?
5000 units – single dose only
What is the paediatric dose of heparin?
Not approved
What class of drug is hydrocortisone?
Corticosteroid
What schedule drug is hydrocortisone?
S4 (Restricted drugs)
What is the presentation of hydrocortisone?
Vial, 100mg Hydrocortisone (Solu-Cortef)
What is the pharmacology of hydrocortisone?
Hydrocortisone Sodium Succinate is an adrenocortical steroid that produces an anti-inflammatory process. This inhibits the accumulation of inflammatory cells at inflammation sites, phagocytosis, lysosomal enzyme release and synthesis and/or release of mediators of inflammation. Additionally, it prevents and suppresses cell mediated immune reactions.
How is hydrocortisone metabolised?
Hepatic.
What is the onset, duration and half life of hydrocortisone?
Onset 1 to 2 hours, duration 6 - 12 hours, half life 6 - 8 hours.
What are the indications for hydrocortisone?
Moderate OR severe asthma
Severe allergic reaction OR anaphylaxis (requiring Adrenaline administration)
Symptomatic adrenal insufficiency (with a known history of Addison's disease, Congenital Adrenal Hyperplasia, Pan-hypopituitarism or long term steroid administration)
What are the contraindications for hydrocortisone?
KSAR.
What are the precautions for hydrocortisone?
Hypertension.
What are the side effects of hydrocortisone?
Nil
What is the adult dose of hydrocortisone in asthma, anaphylaxis and severe allergic reaction.
IM 200mg – single dose only.
IV 200mg – single dose only – slow IV push over 1 min
What is the paediatric dose of hydrocortisone in asthma, anaphylaxis and severe allergic reaction.
IM 5 mg/kg – single dose not to exceed 100mg
IV 5 mg/kg – single dose not to exceed 100mg – slow IV push over 1 min
What class of drug is ketamine?
Anaesthetic agent
Analgesic
What schedule drug is ketamine?
S8 (Controlled drugs)
What is the presentation of ketamine?
Vial, 200mg/2mL Ketamine (Ketalar).
What is the pharmacology of ketamine?
Ketamine is an anaesthetic agent that acts as a NMDA receptor antagonist. At lower doses this drug produces significant analgesia whilst the airway reflexes and respiratory drive are preserved. Unlike other general anaesthetics, there is minimal haemodynamic compromise as Ketamine acts as a sympathomimetic agent. Transient tachycardia and hypertension may result. Ketamine produces a dissociative state and this will cause the patient to potentially have significant issues with perception. This results in disinhibition or emergence phenomena in a small number of patients.
How is ketamine metabolised?
Ketamine undergoes extensive hepatic metabolism, approx 90% of the drug is excreted in the urine as metabolites.
What is the onset, duration and half life of ketamine?
Onset 30 secs, duration 5 - 20 mins (QAS doses), half life 10 - 15 minutes (dose variable).
What are the indications for ketamine?
Adjunct to Morphine (0.1 to 0.2 mg/kg) in patients with severe traumatic pain associated with: Fracture reduction and splinting
Multiple or significant fractures requiring facilitated extrication
What are the contraindications to ketamine?
KSAR
Age <1 yrs
GCS ≤12 yrs
Uncontrolled hypertension defined as SBP >180 mmHg and DBP >100 mmHg
Suspected acute coronary syndrome or acute heart failure
Known hydrocephalus or raised intra-ocular pressure
What are the precautions with ketamine?
Age >65 yrs
Patients who have been administered Midazolam or other CNS depressant medication
Patients with significant hypovolaemia – exaggerated effects and delayed onset of action
Globe injuries
Complex facial injuries and fractures
Patients who have impaired respiratory function
Patients exhibiting psychotic symptoms
What are the side effects of ketamine?
Dissociation and trance-like state – “Ketamine stare”
A number of patients will display transient hypertonicity and nystagmus. This does not require
intervention or treatment. This transient reaction should not be confused with significant disinhibition.
Disinhibition – disturbed perception during initial administration which may require a small dose of Midazolam to treat the patient if this does not settle with attempts to calm the patient. (Refer Sedation CPP)
Emergence – issues with distorted perception as the drug effects wear off. Generally these will settle
with removal of significant stimulation but small dose of midazolam may be required if this fails. (Refer Sedation CPP)
Hypertension, tachycardia
Depression of consciousness and rarely respiratory depression
Hypersalivation (uncommon but may require administration of Atropine – refer Sedation CPP)
Vomiting
Laryngospasm
What is the adult dose of ketamine?
IV 10 to 20mg Repeated every 2 to 3 min – total max dose 1 mg/kg
* Mix 200mg (2mL) of Ketamine with 18mL Sodium Chloride 0.9%10 OR Water for Injection10 in a 20mL syringe to achieve a final concentration of 10 mg/mL
What is the paediatric dose of ketamine?
IV ≥1 yr 100 mcg/kg (0.1mg/kg) Repeated every 2 to 3 min – total max dose 1 mg/kg
Mix 200mg (2mL) of Ketamine with 18mL Sodium Chloride 0.9%10 OR Water for Injection in a 20mL syringe to achieve a concentration of 10 mg/mL. Discard 18mL of the prepared solution and dilute with a further 18mL of diluent in a 20mL syringe to achieve a final concentration of 1 mg/ml.
What class drug is lignocaine?
Antiarrhythmic (Vaughan-William class Ib)
Local anaesthetic
What schedule drug is lignocaine?
S4 (Restricted drugs)
What are the authorised routes of administration for lignocaine?
IV & IO
What is the pharmacology of lignocaine?
Lignocaine stabilises all potentially excitable membranes and prevents the initiation and transmission of nerve impulses. It is for this reason that it is successful in decreasing excitability of the cardiac muscle and conduction velocity through the AV node. Furthermore, it is also used as a local anaesthetic.
How is lignocaine metabolised?
80% metabolised by the liver and remainder excreted by the kidneys.
What is the onset, duration and half life of lignocaine?
Onset 1 to 3 minutes, duration, 20 to 30 mins, half life 1 to 2 hours.
What are the indication for lignocaine.
Conscious VT without haemodynamic compromise
To reduce the pain associated with IO drug and fluid administration for patients in which an EZ-IO® needle has been inserted (when the patient is not in cardiac arrest)
What are the contraindications for lignocaine?
Conscious VT without haemodynamic compromise, KSAR, Bradycardia, Current heart failure, Heart block or conduction defects, Torsades de Pointes.
To reduce the pain associated with IO drug and fluid administration for patients in which an EZ-IO® needle has been inserted (when patient is not in cardiac arrest), KSAR.
What are the precautions with lignocaine?
Conscious VT without haemodynamic compromise
Hypotension and poor perfusion
To reduce the pain associated with IO drug and fluid administration for patients in which an EZ-IO® needle has been inserted (when patient is not in cardiac arrest)
Nil
What are the side effects of lignocaine?
Convulsions
Hypotension
Nausea
Tinnitus
What is the adult dose of lignocaine in conscious VT without haemodynamic compromise?
IV 1 to 1.5 mg/kg - slow IV push over 2 to 3 mins (not to exceed 25 to 50mg/min) Repeated once at half the initial dose at 10 min - total max dose 300mg
What is the adult dose of lignocaine in EZIO use when the patient is not in cardiac arrest?
60mg (40mg Lignocaine 2% followed by a rapid Sodium Chloride 0.9% 10mL flush, followed by an additional 20mg Lignocaine 2%)58 - total max dose 60mg
What is the paediatric dose of lignocaine in conscious VT without haemodynamic compromise?
Not approved
What is the paediatric dose of lignocaine in EZIO use when the patient is not in cardiac arrest?
Up to 20 mg – single dose only - max dose 1 mg/kg
What drug class is magnesium sulphate?
Electrolyte
What schedule drug is magnesium sulphate?
Unscheduled
What is the presentation of magnesium sulphate?
Amp, 10 mmol (2.47g) /5mL, Magnesium Sulphate
What are the routes of administration of magnesium sulphate?
IV & IO
What is the pharmacology of magnesium sulphate?
Magnesium plays a vital role in neurochemical transmission and is essential for neurochemical functioning
How is magnesium sulphate excreted?
Filtered in the kidneys and excreted in urine
What is the onset, duration and half life of magnesium?
Onset immediate (IV inf), duration 30 mins (IV inf), half life variable.
What are the indications for magnesium sulphate?
Box Jellyfish envenomation unresponsive to antivenom therapy
Eclampsia
Irukandji envenomation syndrome
Torsades de Pointes
Severe life threatening asthma (only in patients who have required IV Salbutamol OR IM/IV Adrenaline)
What are the contraindications for magnesium sulphate?
KSAR
Heart block
Renal failure
What are the precautions with magnesium sulphate?
Renal impairment
What are the side effects of magnesium sulphate?
Pain at the cannulation site
Where hyper-magnesaemia occurs, CNS depression, Hypotension, Muscle weakness and/or paralysis, Nausea and vomiting
Respiratory depression and/or paralysis
What is the adult dose of magnesium sulphate in Eclampsia, Irukandji envenomation syndrome and Box Jellyfish envenomation unresponsive to antivenom therapy
IV, Loading dose - 20 mmol - slow IV push over 10 minutes (SPRINGINFUSOR® use is highly
IV inf recommended) - followed by maintenance infusion listed below
Maintenance infusion (immediately following loading dose) – Inject 20 mmol of Magnesium Sulphate in a 1000mL bag of Sodium Chloride 0.9%. Ensure bag Is appropriately labelled.4 Administer infusion over 60 mins – total max dose 40mmol (loading dose and maintenance Infusion dose)
What is the paediatric dose of magnesium sulphate in Irukandji envenomation syndrome and Box Jellyfish envenomation unresponsive to antivenom therapy
IV 0.1 mmol/kg (rounded up to the nearest 0.5 mmol) – slow IV push over 10 mins
(SPRINGINFUSOR® use is highly recommended) – single dose not to exceed 5 mmol - Repeated once at 10 mins (only if indicated for ongoing treatment) – total max dose 10 mmol
What is the adult dose of magnesium sulphate in torsades de pointe.
10 mmol - slow IV push over 10 minutes (SPRINGINFUSOR® use is highly recommended) –
Repeated once at 10 mins (only if indicated for ongoing treatment) – total max dose 20 mmol
What is the adult dose of magnesium sulphate in severe life threatening asthma?
10 mmol - slow IV push over 10 minutes (SPRINGINFUSOR® use is highly recommended) –
single dose only
What is the paediatric dose of magnesium sulphate in torsades de pointe?
0.1 mmol/kg (rounded up to the nearest 0.5 mmol) – slow IV push over 10 mins
(SPRINGINFUSOR® use is highly recommended) – single dose not to exceed 5 mmol - Repeated once at 10 mins (only if indicated for ongoing treatment) – total max dose 10 mmols
What is the paediatric dose of magnesium sulphate in severe life threatening asthma?
0.1 mmol/kg (rounded up to the nearest 0.5 mmol) – slow IV push over 10 mins (SPRINGINFUSOR® use is highly recommended) – single dose is not to exceed 5 mmol – single dose only
What class of drug is methoxyflurane?
Inhaled analgesic (when inhaled at low doses).
What schedule drug is methoxyflurane?
S4.
What is the presentation of methoxyflurane?
Bottle, 3mL Methoxyflurane.
What is the pharmacology of methoxyflurane?
Methoxyflurane is an inhalation agent providing analgesia at low concentrations. Methoxyflurane is more susceptible to metabolism than other halogenated ethers and has a greater propensity to diffuse into fatty tissue.
How is methoxyflurane metabolised?
By the liver and excreted mainly by the lungs.
What is the onset, duration and onset of methoxyflurane?
Onset 1 to 3 mins, duration 5 to 10 mins, half life not available.
What are the indications for methoxyflurane?
Pain relief.
What are the contraindications for methoxyflurane?
KSAR
Children <1 yrs
History of significant liver or renal disease Malignant Hyperthermia
What are the precautions with methoxyflurane?
ALOC
Intoxicated patients or drug affected patients
What are the side effects of methoxyflurane?
ALOC
Cough
Renal/hepatic failure following repeated high dose exposure to Methoxyflurane
What is the adult dose of methoxyflurane?
3mL repeated once after 20 mins – total max dose 6mL
What is the paediatric dose of methoxyflurane?
≥1 yr 3mL – single dose only
<1 yr NOT APPROVED
What class of drug is metoclopramide?
Antiemetic
What schedule drug is metoclopramide?
S4 (Restricted drugs)
What is the presentation of metoclopramide?
Amp, 10mg/2mL Metoclopramide (Maxalon)
What is the pharmacology of metoclopramide?
Metoclopramide hydrochloride is used in this setting as an anti-emetic. It works by inhibiting gastric smooth muscle relaxation, accelerating intestinal transit and gastric emptying. Further, it raises the threshold of the chemoreceptor trigger zone in the floor of the fourth ventricle.
How is metoclopramide metabolised?
By the liver and excreted by the kidneys.
What is the onset, duration and half life of metoclopramide?
Onset 1 to 3mins (IV), 10to15min(IM)
Duration IM and IV 1 to 2 hours.
Half life 2.5 to 5 hours
What are the indications for metoclopramide?
Significant nausea AND/OR Vomiting
Use with Morphine if the patient has previously experienced nausea AND/OR vomiting with narcotics
What are the contraindications to metoclopramide?
KSAR
Children <16 yrs
History of dystonic reactions
Not to be given within 6 hrs of a phenothiazine administration (eg. Stemetil® (Prochlorperazine) /
Promethazine)
What are the precautions for metoclopramide?
GI haemorrhage
Patients with bowel obstruction or perforation
What are the side effects of metoclopramide?
Drowsiness
Lethargy
Dry mouth
Oculogyric crisis
Dystonic reaction (1%)
What is the adult dose of metoclopramide?
≥16 yrs IM / IV 10 to 20mg
What is the paediatric dose of metoclopramide?
Not approved.
What class of drug is midazolam?
Benzodiazepine (short acting)
What schedule drug is midazolam?
S4 (Restricted drugs)
What is the presentation of midazolam?
Amp, 5mg/1mL midazolam
What are the authorised routes of administration of midazolam for ICPs
IM, IV & IO.
What is the pharmacology of midazolam?
Midazolam hydrochloride is a short acting central nervous system depressant that induces amnesia, anaesthesia, hypnosis and sedation. It achieves this by enhancing the action of inhibitory neurotransmitter gamma-amino butyric acid (GABA). Depressant effects occur at all levels of the CNS.
How is midazolam metabolised?
By the liver and excreted by the kidneys.
What is the onset, duration and half life of midazolam.
Onset 5 to 15 min (IM) / 1 to 3 mins (IV).
Duration variable.
Half life 2.5 hours.
What are the indications for midazolam?
Seizures/convulsions
Sedation for:
a. Maintenance of established ETT
b. Severely agitated patients
c. Agitated head injuries to facilitate assessment and treatment
d. Patients with trauma requiring fracture reduction, splinting, extrication, or if distressed and
agitated by pain despite 0.1 to 0.2 mg/kg Morphine
e. Patients with burns distressed and agitated by pain despite 0.2 to 0.3 mg/kg Morphine
f. Procedures
g. Ketamine disinhibition or emergence
What are the contraindications to midazolam?
KSAR to benzodiazepines
What are the precautions with midazolam?
Reduced dosages may be required in elderly patients, patients with chronic renal failure, congestive cardiac failure or shock
Can cause severe respiratory depression in patients with COAD
Myasthenia gravis
Multiple sclerosis
What are the side effects of midazolam?
Hypotension
Respiratory depression particularly when associated with alcohol or narcotics
What is the adult dose of midazolam in seizures and convulsions.
IM ≥50 yrs 2.5mg Repeated at 10 min intervals until seizure is managed – no max dose

IV / IO ≥ 50 yrs up to 2.5mg Repeated at 5 min intervals until seizure is managed – no max dose

IM <50 yrs 5mg repeated at 10 min intervals until seizure is managed – no max dose

IV / IO < 50 yrs Up to 2.5mg Repeated at 5 min intervals until seizure is managed – no max dose
What is the adult dose of midazolam in adults to maintain an ETT
2.5mg repeated with 2.5mg Morphine IV PRN – no max dose
What is the adult dose of midazolam for sedation for severely agitated patients?
IM ≥ 50 yrs 1 to 5mg repeated at 1 to 5mg increments every 10 min to achieve moderate sedation (only if IV access not achievable) – total max dose 15mg.

IV ≥ 50 yrs 1 to 5mg Repeated at 1 to 5mg increments every 5 min to achieve moderate sedation – total max dose 25mg

IM < 50 yrs 5mg repeated at 5 to10 mg increments every 10 min to achieve moderate sedation (only if IV access not achievable) – total max dose 25mg

IV < 50 yrs 2.5 to 5mg Repeated at 2.5 to 5mg increments every 5 min to achieve moderate sedation – total max dose 25mg