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69 Cards in this Set
- Front
- Back
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5% Glucose Qualification level
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ALS
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5% Glucose Ingredient
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250mL (100mL) bag with 5% concentration of glucose
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5% Glucose Indications
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Infusion containing amiodarone for pulse producing VT, atrial flutter, atrial fibrillation.
Infusion containing magnesium sulphate for severe asthma. Dilutent for ketamine |
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5% Glucose Contraindications
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Uncontrolled hyperglycaemia
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5% Glucose Administration Intravenous as an infusion for delivery of:
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amiodarone or magnesium
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5% Glucose Documentation
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Document on the patient report: dosage, time, method of administration and effect
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10% Glucose Qualification level
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ILS
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10% Glucose Ingredient
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500mL bag with 10% concentration of glucose
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10% Glucose Indications
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Hypoglycaemia < 3.5mmol/L (section 5.1)
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10% Glucose Contraindications
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None
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10% Glucose Administration
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Adults: 100mL IV
Children: 2mL/kg Repeat as necessary to achieve BGL in normal range (3.5 - 7 mmol/L) |
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10% Glucose Documentation
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Document on the patient report: dosage, time, method of administration and effect
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Adenosine (ADENOCOR)
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6 mg/ 2 mL solution for intravenous infusion. Adenocor is a sterile solution for intravenous injection (rapid bolus), provided in clear glass vials. Each vial contains 6 mg of adenosine in 2 mL of a 0.9% w/v solution of sodium chloride in sterile water for injections.
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Adenosine (ADENOCOR)Mechanism of Action
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Adenocor administered by rapid intravenous injections depresses conduction through the AV node. This action can interrupt re-entry circuits involving the AV node and restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardias and paroxysmal supraventricular tachycardias associated with Wolff-Parkinson-White Syndrome. Once the circuit has been interrupted, the tachycardia stops and normal sinus rhythm is reestablished. By transiently slowing AV conduction, atrial activity is easier to evaluate from ECG recordings and therefore Adenocor can aid the diagnosis of broad or narrow QRS complex tachycardias. Adenocor may be useful during electrophysiological studies to determine the site of AV block or to determine, in some cases of pre-excitation, whether conduction is occurring by an accessory pathway or via the AV node.
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Adenosine (ADENOCOR)Haemodynamics
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The usual intravenous bolus dose of 3 or 6 mg Adenocor usually has no systemic haemodynamic effects. Rarely significant hypotension and tachycardia have been observed. When larger doses are given by infusion, adenosine decreases blood pressure by decreasing peripheral resistance.
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Adenosine (ADENOCOR)Pharmacokinetics
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Intravenously administered Adenocor (adenosine) is removed from the circulation very rapidly. Following an intravenous bolus, adenosine is taken up by erythrocytes and vascular endothelial cells. The half-life of intravenous adenosine is estimated to be less than 10 seconds. Adenosine enters the body pool and is primarily metabolised to inosine and adenosine monophosphate (AMP).AUT 2012 Page 10
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Adenosine (ADENOCOR) Hepatic and Renal Failure
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Hepatic and renal failure should have no effect on the activity of a bolus Adenocor (adenosine) injection. Since Adenocor (adenosine) has a direct action, hepatic and renal function are not required for the activity or metabolism of a bolus adenosine injection.
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Adenosine (ADENOCOR)INDICATIONS
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Rapid conversion to a normal sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory bypass tracts (Wolff-ParkinsonWhite syndrome).
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Adenosine (ADENOCOR)Diagnostic Indications
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Aid to diagnosis of broad or narrow QRS complex supraventricular tachycardias. Although Adenocor is not effective in converting atrial flutter, atrial fibrillation or ventricular tachycardia to sinus rhythm, the slowing of AV conduction helps diagnosis of atrial activity. Sensitisation of intracavity electrophysiological investigations
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Adenosine (ADENOCOR) CONTRAINDICATIONS
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Adenocor is contraindicated in patients with:
• known hypersensitivity to adenosine • sick sinus syndrome, second or third degree AV block (except in patients with a functioning artificial pacemaker) • chronic obstructive lung disease (such as asthma) • long QT syndrome • severe hypotension; decompensated states of heart failure. |
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Adenosine (ADENOCOR)PRECAUTIONS
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Adenosine is intended for use by physicians familiar with the product in a hospital setting with monitoring and cardio-respiratory resuscitation equipment available for immediate use if necessary. The occurrence of angina, severe bradycardia, severe hypotension, respiratory failure (potentially fatal), or asystole/cardiac arrest (potentially fatal), should lead to immediate discontinuation of administration. In patients with history of convulsions/seizures, the administration of adenosine should be carefully monitored. As dipyridamole is a known inhibitor of adenosine uptake, it may potentiate the action of adenosine administration. The use of Adenoscan infusion is contraindicated in patients receiving dipyridamole
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Adenosine (ADENOCOR)dosage
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Adenocor (adenosine) should be given as a rapid intravenous bolus. Adenosine is ineffective in the management of SVT when given as an infusion, rather than a bolus. This is most probably due to the different effect on sinus rate and atrioventricular nodal conduction.
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Adenosine (ADENOCOR) Hypotension
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Because it has the potential to cause significant hypotension, adenosine should be used with caution in patients with left main coronary stenosis, uncorrected hypovolaemia, stenotic valvular heart disease, left to right shunt, pericarditis or pericardial effusion, autonomic dysfunction or stenotic carotid artery disease with cerebrovascular insufficiency.
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Adenosine (ADENOCOR) Atrial Fibrillation
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Adenocor should be used with caution in patients with atrial fibrillation or flutter and especially in those with an accessory by-pass tract since particularly the latter may develop increased conduction down the anomalous pathway.
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Adenosine (ADENOCOR) Bradycardia
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Some cases of severe bradycardia have been reported. Some occurred in early post heart transplant patients; in other cases occult sino-atrial disease was present. The occurrence of severe bradycardia should be taken as a warning of underlying disease and could potentially favour the occurrence of torsades de pointes.
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Adenosine (ADENOCOR) Heart Block and Myocardial Infarction
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Adenocor (adenosine) exerts its effect by decreasing conduction through the AV node and may produce a short lasting first, second or third-degree heart block. In extreme cases, transient asystole may result (one case has been reported in a patient with atrial flutter who was receiving carbamazepine). Appropriate therapy should be instituted as needed. Patients who develop high level block on one dose of Adenocor should not be given additional doses. Because of the very short half-life of adenosine these effects are generally self-limiting. Adenocor should be used with caution in patients with recent myocardial infarction, heart failure, or in patients with minor conduction defects (first degree AV block, bundle branch block) that could be transiently aggravated during infusion.
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Adenosine (ADENOCOR) Arrhythmias at Time of Conversion
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At the time of conversion to normal sinus rhythm, a variety of new rhythms may appear on the electrocardiogram. They generally last only a few seconds without intervention and may take the form of premature ventricular contractions premature atrial AUT 2012 Page 12 contractions, atrial fibrillation, sinus bradycardia, sinus tachycardia, skipped beats, sinus pause and varying degrees of AV nodal block. Such findings were seen in 55% of patients. The induced bradycardia predisposes the patient to ventricular excitability disorders including ventricular fibrillation and torsades de pointes. Because of the possible risk of torsades de pointes, Adenocor should be used with caution in patients with a prolonged QT interval.
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Adenosine (ADENOCOR) Post Heart Transplantation
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In patients with recent heart transplantation (less than 1 year) an increased sensitivity of the heart to adenosine has been observed. Adenocor should be used with caution in such cases.
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Adenosine (ADENOCOR) Bronchoconstriction
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Adenosine administered by inhalation has been reported to cause bronchoconstriction in asthmatic patients, presumably due to mast cell degranulation and histamine release. These effects have not been observed in normal subjects. Adenosine has been administered to a limited number of patients with asthma and mild to moderate exacerbation of their symptoms has been reported. Adenocor should not be used in patients with asthma (see ’CONTRAINDICATIONS’). Respiratory compromise has occurred during adenosine infusion in patients with obstructive pulmonary disease. Adenocor should be used with caution in patients with obstructive lung disease not associated with bronchoconstriction (eg. emphysema, bronchitis, etc) and should be avoided in patients with bronchoconstriction or bronchospasm (eg. asthma). Adenocor should be discontinued in any patient who develops severe respiratory difficulties. Adenosine may precipitate or aggravate bronchospasm.
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Adenosine (ADENOCOR) Carcinogenicity / Mutagenicity
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Studies in animals have not been performed to evaluate the carcinogenic potential of Adenocor. Adenosine tested negative for mutation in the Salmonella/Mammalian Microsome Assay. Adenosine, like other nucleosides at millimolar concentrations present for several doubling times of cells in culture, is known to produce a variety of chromosomal alterations. In rats and mice, adenosine administered intraperitoneally once a day for 5 days at 50, 100 and 150 mg/kg caused decreased spermatogenesis and increased numbers of abnormal sperm.
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Adenosine (ADENOCOR) Use in Pregnancy
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Category B2 Animal reproductive studies have not been conducted with adenosine, nor have studies been performed on pregnant women. In the absence of evidence that adenosine does not cause foetal harm, Adenocor should not be used during pregnancy unless the physician considers the benefits outweigh the potential risks.AUT 2012 Page 13
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Adenosine (ADENOCOR) Use in Lactation
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Studies have not been performed in lactating animals or women. Therefore, adenosine should not be used during lactation. If adenosine treatment is considered essential by the physician, another form of infant feeding should be considered.
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Adenosine (ADENOCOR)Paediatric Use
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No data has been submitted from controlled studies in children.
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Adenosine (ADENOCOR) Interactions with other Medicines
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Intravenous Adenocor (adenosine) has been effectively administered in the presence of other cardioactive drugs, such as digitalis, quinidine, beta-adrenergic blocking agents, calcium-channel blocking agents and angiotensin-converting enzyme inhibitors, without any change in the adverse reaction profile. Adenosine may interact with drugs that tend to impair cardiac conduction. Aminophylline, theophylline and other xanthines are competitive adenosine antagonists and should be avoided for 24 hours prior to the administration of adenosine. Food and drinks containing xanthines (e.g. tea, coffee, chocolate and cola) should be avoided for at least 12 hours prior to the administration of adenosine. Nucleoside transport inhibitors such as dipyridamole inhibit adenosine cellular uptake and metabolism, and potentiate the action of adenosine. In one study dipyridamole was shown to produce a four-fold increase in adenosine activity. The use of Adenoscan infusion is contraindicated in patients receiving dipyridamole (see Adenoscan Product Information: ‘CONTRAINDICATION’). If the use of adenosine bolus injection (Adenocor) is judged to be essential, dipyridamole should be discontinued 24 hours beforehand or the dose of Adenocor should be significantly reduced. Carbamazepine has been reported to increase the degree of heart block produced by other agents. As the primary effect of adenosine is to decrease conduction through the AV node higher degrees of heart block may be produced in the presence of carbamazepine.
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Adenosine (ADENOCOR) ADVERSE EFFECTS Cardiovascular System
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Very common: bradycardia; sinus pause, skipped beats; atrial extrasystoles; A-V block; ventricular excitability disorders such as ventricular extrasystoles non-sustained ventricular tachycardia. Uncommon: sinus tachycardia; palpitations.
Very rare: atrial fibrillation; ventricular excitability including ventricular fibrillation and torsade de pointes; severe bradycardia not corrected by atropine and possibly requiring temporary pacing. |
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Adenosine (ADENOCOR) ADVERSE EFFECTS Respiratory System
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Very common: dyspnoea (or the urge to breathe deeply). Uncommon: hyperventilation.
Very rare: bronchospasm. |
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Adenosine (ADENOCOR) ADVERSE EFFECTS Central Nervous System
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Common: headache; dizziness, light-headedness.
Uncommon: head pressure; Very rare: transient and spontaneously rapidly reversible worsening of intracranial hypertension. |
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Adenosine (ADENOCOR) ADVERSE EFFECTS Gastrointestinal System
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Common: nausea.
Uncommon: metallic taste. |
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Adenosine (ADENOCOR) ADVERSE EFFECTS other
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Very common: flushing; chest pressure/pain, feeling of thoracic constriction/oppression. Common: apprehension; burning sensation. Uncommon: blurred vision; sweating; feeling of general discomfort/weakness/pain. Very rare: injection site reactions.
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Adenosine (ADENOCOR) Therapeutic Dose
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Adults Initial dose: 3 mg given as a rapid intravenous bolus (over 2 seconds). Second dose: If the first dose does not result in the elimination of supraventricular tachycardia within 1 or 2 minutes, 6 mg should be given also as a rapid intravenous bolus. Third dose: If the second dose does not result in the elimination of supraventricular tachycardia within 1 or 2 minutes, 12 mg should be given also as a rapid intravenous bolus. Children No controlled paediatric study has been undertaken. Published uncontrolled studies show similar effects of adenosine in adults and children effective doses for children were between 0.0375 and 0.25 mg/kg. Elderly See dosage recommendations for adults.
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Adenosine (ADENOCOR) OVERDOSAGE
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As the half-life of adenosine is very short (less than 10 seconds), adverse effects are generally rapidly self-limiting. Treatment of any prolonged adverse effects should be individualised and be directed toward the specific symptoms.
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ADRENALINE (Epinephrine)Qualification level
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BLS - Croup (neb)
ILS - IM: Asthma, Anaphylaxis, CORD, IV: Cardiac Arrest ALS - IV: Asthma, Anaphylaxis, CORD, Bradycardia, Septic Shock |
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ADRENALINE (Epinephrine)Ingredient
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Adrenaline (1:1000) 1mg/1ml ampoule
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ADRENALINE (Epinephrine)Indications
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Cardiac Arrest Asthma CORD Bradycardia Anaphylaxis Septic Shock
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ADRENALINE (Epinephrine)Contraindications
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Known hypersensitivity Shock(except anaphylactic and septic) cardai dilation organic brain damage
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ADRENALINE (Epinephrine)Administration
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Administration varies between adults, paediatrics, and indications for use. For specific dose, concentration and route of administration, refer to the specific guideline / paediatric drug chart
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ADRENALINE (Epinephrine)Documentation
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Document on the patient report: dosage, time, method of administration and effect
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ADRENALINE (Epinephrine) Action: Adrenaline is a direct-acting sympathomimetic agent exerting its effect on alpha and beta adrenoreceptors. Major effects are increased systolic blood pressure
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reduced diastolic pressure, tachycardia, hyperglycaemia and hypokalaemia. It is a powerful cardiac stimulant. It has vasopressor properties an antihistaminic action and is a bronchodilator. Its action is rapid in onset and short in duration.AUT 2012 Page 18
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ADRENALINE (Epinephrine)Cautions
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Prefibrillatory rhythm, tachycardia, myocardial infarction phenothiazine induced circulatory collapse and prostatic hypertrophy. Administer slowly with caution to elderly patients and to patients with hypertension, diabetes mellitus,hyperthyroidism and psychoneurosis. Extreme caution in patients with long-standing bronchial asthma and emphysema who have developed degenerative heart disease. Anginal pain may be induced when coronary insufficiency is present. Adrenaline may delay the second stage of labour by inhibiting contractions of the uterus. Intramuscular injection into the buttocks should be avoided as gas gangrene is a possibility. Local ischaemic necrosis can occur from repeated injections in one site. Syncope has occurred following administration to asthmatic children.
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ADRENALINE (Epinephrine) Use in Pregnancy
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(Category A).
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ADRENALINE (Epinephrine)Use in Lactation
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Adrenaline is excreted in breast milk.
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ADRENALINE (Epinephrine)Interactions
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Severe hypertension and bradycardia may occur with non-selective beta-blocking drugs. The risk of cardiac arrhythmias is higher when adrenaline is given to patients receiving digoxin or quinidine.
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ADRENALINE (Epinephrine)Time of onset
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The onset of action is rapid (seconds).
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ADRENALINE (Epinephrine) Half-life
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approximately 5-10 minutes.
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ADRENALINE (Epinephrine)Adverse Effects
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Common symptomatic adverse events include anxiety, restlessness, tachycardia, tremor, weakness, dizziness,headache, dyspnoea, cold extremities, pallor, sweating, nausea, vomiting, sleeplessness, hallucinations and flushing or redness of face and skin. Psychomotor agitation, disorientation, impaired memory and psychosis may occur. The potentially severe adverse effects of adrenaline arise from its effect upon blood pressure and cardiac rhythm. Ventricular fibrillation may occur and severe hypertension may lead to cerebral haemorrhage and pulmonary oedema
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AMIODARONE HYDROCHLORIDE (Cordarone X)Qualification level
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ILS - Cardiac Arrest ALS - Broad complex tachycardia, atrial fibrillation or atrial flutter
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AMIODARONE HYDROCHLORIDE (Cordarone X)Ingredient
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Amiodarone 150mg/3mL ampoule
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AMIODARONE HYDROCHLORIDE (Cordarone X)Indications
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Cardiac Arrest Broad complex tachycardia with significant compromise Atrial fibrillation or atrial flutter with significant compromise
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AMIODARONE HYDROCHLORIDE (Cordarone X)Contraindications
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pregnancy or latation known hypersensitivity or allergy to iodine of amiodarone
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AMIODARONE HYDROCHLORIDE (Cordarone X)Administration
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Cardiac arrest (VF/VT): Adult: 300mg IV/IO on third cycle once only Child: 5mg/kg IV/IO on third cycle once only Broad complex tachycardia (without significant compromise)Adult: 300mg IV/IO infusion over 30 minutes (dilute in 250mL of 5% glucose)Child: Consult
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AMIODARONE HYDROCHLORIDE (Cordarone X)Documentation
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dosage, time, method of administration and effect
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AMIODARONE HYDROCHLORIDE (Cordarone X)Type
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Class III antiarrhythmic agent.
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AMIODARONE HYDROCHLORIDE (Cordarone X)Action
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Prolongs the action potential duration and refractory period of atrial, nodal and ventricular tissues, thereby giving a very broad spectrum of activity. The effect on the atrium and A-V node results in a reduction in the frequency of stimuli reaching the ventricle thus giving the ventricular cell mass time to repolarise in cases where there has been desynchronisation of the refractory periods. A lengthening of the refractory period of the His-Purkinje system and ventricular contractile fibres reduces or prevents micro re-entry.AUT 2012 Page 20 Amiodarone increases coronary blood flow decreases cardiac oxygen requirements without producing negative inotropic effects and suppresses ectopic pacemakers. This is beneficial in arrhythmias associated with ischaemic damage.
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AMIODARONE HYDROCHLORIDE (Cordarone X)Cautions
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Pacemakers/implantable defibrillators, heart failure, history of atypical ventricular tachycardia induced by another antiarrhythmic agent, hepatic failure/disease, renal failure.
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AMIODARONE HYDROCHLORIDE (Cordarone X)Use in Pregnancy
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(Category C).
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AMIODARONE HYDROCHLORIDE (Cordarone X)Use in Lactation
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Amiodarone is excreted in breast milk.
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AMIODARONE HYDROCHLORIDE (Cordarone X)Interactions
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It has been shown that there is a physical incompatibility of heparin and aminophylline with amiodarone when mixed in an infusion administration set. It is recommended that amiodarone for infusion not be mixed with other medicines.
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AMIODARONE HYDROCHLORIDE (Cordarone X)Time of onset / duration of action
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Rapid onset/duration 14 to 59 days.
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AMIODARONE HYDROCHLORIDE (Cordarone X)Adverse Effects
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Moderate and transient reduction in blood pressure, and circulatory collapse may be precipitated by too rapid administration or overdosage. Temporary hot flushes, sweating, and nausea have been reported with intravenous amiodarone. Amiodarone has been reported to cause frequent and potentially serious toxicity. Most of the adverse effects are also related to dosage and duration of amiodarone, concurrent use of other antiarrhythmic agents severity of underlying disease state, and individual variation in pharmacokinetic profile of the medicine. May cause atypical Ventricular Tachycardia (torsade de pointes), bradycardia, cardiac failure, sinus arrest, intrahisian block, vomiting. Other complications may be inflammation of veins following intravenous infusion. Injection site reactions such as pain, erythema oedema, necrosis, extravasation, infiltration, inflammation, induration, thrombophlebitis, phlebitis, cellulitis,infection, pigmentation changes.
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