Pharmacology For Ambulance Victoria Acos

Front 1

Glyceryl Trinitrate (Anginine) Contraindications (6)

Back 1

Known hypersensitivity. BP < 110. HR < 60 or > 150. Viagra or Levitra in previous 24 hours. Cialis in previous 4 days. Pale/grey moist skin.

Front 2

Glyceryl Trinitrate (Anginine) Indications

Back 2

Cardiac chest pain/discomfort

Front 3

Glyceryl Trinitrate (Anginine) Side Effects

Back 3

Hypotension. Tachycardia. Headache.

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Glyceryl Trinitrate (Anginine) Precautions

Back 4

No previous administration of GTN. Elderly patient.

Front 5

Glyceryl Trinitrate (Anginine) Dose & Route

Back 5

0.6 mg (full tablet) if previously administered OR 0.3 mg (half tablet) if first time. Tablet given sub-lingually. Repeat dose every 5 minutes if all okay – keep monitoring VSS.

Front 6

Glyceryl Trinitrate (Anginine) Action

Back 6

Causes arterial and venous dilation so more blood returns to the heart. The heart doesn’t need to work so hard. Blood pressure is decreased but sufficient blood supply to heart is ensured.

Front 7

Glyceryl Trinitrate (Anginine) Special Notes

Back 7

Keep tablets tightly sealed in original container. Discard tablets 3 months after opening. Don’t use patient’s own GTN – may not have been stored properly. Monitor vital signs after administration. Pain score should reduce.

Front 8

Ipratropium Bromide (Atrovent) Dose & Route

Back 8

Pt < 15 yrs old 250 mcg in 1ml nebule. Pt > 15 yrs old 500 mcg = 2 nebules. Nebulised with Salbutamol and O2 at 8 ltrs per minute. Only one dose.

Front 9

Ipratropium Bromide (Atrovent) Contraindications

Back 9

Known hypersensitivity to Atropine or its derivatives.

Front 10

Ipratropium Bromide (Atrovent) Indications

Back 10

Severe asthma OR Lasts longer than 10 minutes with Salbutamol.

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Ipratropium Bromide (Atrovent) Side Effects

Back 11

Headache. Skin rash. Nausea. Dry mouth. Rare Tachycardia. Palpitations. Acute angle closure glaucoma secondary to direct eye contact.

Front 12

Ipratropium Bromide (Atrovent) Precautions

Back 12

Glaucoma. Avoid contact with eyes.

Front 13

Ipratropium Bromide (Atrovent) Special Notes

Back 13

Must not contact eyes – nebuliser mask must be fitted properly. Must be nebulised with salbutamol and O2 at 8 ltrs per minute. Only one dose.

Front 14

Ipratropium Bromide (Atrovent) Action

Back 14

Anticholinergic bronchodilator. Stops bronchoconstriction so salbutamol can dilate the airways.

Front 15

Glucagon Dose & Route

Back 15

> 8 years - 1 mg in 1ml saline – in hypokit. < 8 years – half dose. Swab, then - Intramuscular injection – deltoid.

Front 16

Glucagon Contraindications

Back 16

Nil for diabetic hypoglycaemia

Front 17

Glucagon Indications

Back 17

Diabetic hypoglycaemia: BGL < 4 mmol / litre AND Altered Conscious State AND not responding to instructions.

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Glucagon Side Effects

Back 18

Nausea and vomiting

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Glucagon Precautions

Back 19

Nil for diabetic hypoglycaemia

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Glucagon Special Notes

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Takes 20 minutes to work. Not all patients respond to glucagon – ensure early transport or paramedic backup in all cases of hypoglycaemia.

Front 21

Glucagon Action

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Converts glycogen which is stored in the liver to glucose thus providing emergency glucose supply. Can only work if there is a supply of glycogen in the liver. May not work with children the malnourished or alcoholics.

Front 22

Glucose Paste Dose & Route

Back 22

15 g in tube, squeezed into mouth.

Front 23

Glucose Paste Contraindications

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Inability to swallow due to Altered Conscious State.

Front 24

Glucose Paste Indications

Back 24

Diabetic hypoglycaemia: BGL < 4 mmol per litre AND Altered Conscious State BUT able to follow instructions.

Front 25

Glucose Paste Side Effects

Back 25

Nausea and vomiting.

Front 26

Glucose Paste Precautions

Back 26

Nil for diabetic hypoglycaemia.

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Glucose Paste Special Notes

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Not all patients respond to glucose paste – ensure early transport or paramedic backup in all cases of hypoglycaemia.

Front 28

Glucose Paste Action

Back 28

Provides glucose directly to the body without using the body’s stores of eg glycogen.

Front 29

Aspirin Dose & Route

Back 29

300 mg chewable tablet given orally.

Front 30

Aspirin Contraindications

Back 30

Hypersensitivity to aspirin/salicylates. Active bleeding peptic ulcers. Bleeding disorders. Suspected aortic aneurism (bilateral BPs may differ).

Front 31

Aspirin Indications

Back 31

Cardiac chest pain / discomfort.

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Aspirin Side Effects

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Heartburn. Nausea. GI bleeding. Increased bleeding time. Hypersensitivity reactions.

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Aspirin Precautions

Back 33

Nil for cardiac chest pain / discomfort

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Aspirin Special Notes

Back 34

ACOs may only use aspirin for cardiac chest pain / discomfort.

Front 35

Aspirin Action

Back 35

Anti-platelet aggregation. Inhibits synthesis of prostaglandins. Analgesic; anti-pyretic; anti-inflammatory.

Front 36

Adrenaline Tartrate - Epipen Dose & Route

Back 36

300 mcg (0.3 mg) for > 5 yrs old or > 20 Kg YELLOW 150 mcg (0.15 mg) for < 5 yrs old or < 20 Kg GREEN Epipen autoinjector into outer thigh

Front 37

Adrenaline Tartrate - Epipen Contraindications

Back 37

Nil for anaphylaxis / severe allergic reaction.

Front 38

Adrenaline Tartrate - Epipen Indications

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Anaphylaxis / severe allergic reaction. I.e. Systemic AND other symptoms e.g. urticaria/ edema/ vomiting/ nausea/ diarrhoea/ abdominal cramps

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Adrenaline Tartrate - Epipen Side Effects

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Tachycardia Hypertension Dilated Pupils Anxiety / palpitations (an awareness of your heartbeat)

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Adrenaline Tartrate - Epipen Precautions

Back 40

Nil for anaphylaxis / severe allergic reaction

Front 41

Adrenaline Tartrate - Epipen Special Notes

Back 41

Can give second dose after 10 minutes after consulting clinician or paramedic

Front 42

Adrenaline Tartrate - Epipen Actions (4)

Back 42

A natural alpha & beta adrenergic stimulant. Alpha creates peripheral vasoconstriction shunting blood to organs where it is needed. Beta 1 makes heart beat faster harder stronger. Beta 2 relaxes bronchoconstriction. Also reduces capillary permeability. Blood shunting & Bronchodilation & Reduced capillary permeability.

Front 43

Methoxyflurane (Penthrane) Dose & Route

Back 43

3 ml in Penthrane inhaler.

Front 44

Methoxyflurane (Penthrane) Contraindications

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Pre-existing kidney disease. Pts taking tetracycline antibiotics. Maximum 6 ml in any 24 hours.

Front 45

Methoxyflurane (Penthrane) Indications

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Pre-hospital pain relief – cardiac / non-cardiac & any age.

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Methoxyflurane (Penthrane) Side Effects

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Drowsiness. Kidney damage if overdose.

Front 47

Methoxyflurane (Penthrane) Precautions

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Pre-eclampsia (in pregnancy). Penthrox inhaler must be held by patient so it falls from face if they go unconscious. Pt must be supervised at all times during methoxyflurane administration.

Front 48

Methoxyflurane (Penthrane) Special Notes

Back 48

Analgesia after 8 – 10 breaths. Tastes odd. Breathe in through mouth, out through nose.

Front 49

Methoxyflurane (Penthrane) Action

Back 49

Analgesic.

Front 50

Salbutamol Dose & Route

Back 50

Initial dose 2 x 5 mg nebules (= 10 mg) via nebuliser mask with O2 @ 8 litres per minute. Then, 5 mg (= 1 nebule) every five minutes – until Pt breathing normally or handover to hospital or paramedic.

Front 51

Salbutamol Contraindications

Back 51

Nil for Asthma / breathing difficulty with a wheeze.

Front 52

Salbutamol Indications

Back 52

Breathing difficulty with a wheeze +/ history of asthma. No relief from Pt’s own ventolin. Also for anaphylaxis with breathing difficulties.

Front 53

Salbutamol Side Effects

Back 53

Tachycardia. Muscle tremor.

Front 54

Salbutamol Precautions

Back 54

Continue to administer oxygen between doses.

Front 55

Salbutamol Special Notes

Back 55

May need to give Ipratropium bromide (Atrovent) if no relief after 10 minutes. Unused nebules left in pack at completion of case should be disposed of. Store nebules at < 30 degrees.

Front 56

Salbutamol Action

Back 56

Synthetic beta-adrenergic stimulant causing bronchodilation. Primarily beta 2 effects.

Front 57

Oxygen Dose & Route

Back 57

Moderate concentration (40 – 60%) via face mask at 8 litres per minute. High concentration (60 – 95%) via bag valve mask at 8 – 15 LPM for resuscitation – i.e. actively pushing O2 into lungs.

Front 58

Oxygen Contraindications

Back 58

Nil for hypoxia/ hypoxemia or assisting with organ oxygenation in patients with illness/injury.

Front 59

Oxygen Indications

Back 59

Treatment of hypoxia / hypoxemia. To assist organ oxygenation in Pts with illness / injury. E.g. Chest pain/ asthma/ anxiety/ hyperventilation/ emphysema/ chronic bronchitis/ anaphylaxis.

Front 60

Oxygen Side Effects

Back 60

Drying of mucous membranes of upper airway.

Front 61

Oxygen Precautions

Back 61

Beware of fire or explosive hazards.

Front 62

Oxygen Special Notes

Back 62

Minimum flow through face mask – 6 LPM. Maximum flow through nasal prongs - 3 LPM.

Front 63

Oxygen Bottles

Back 63

“C” cylinder – 440 litres “D” cylinder – 1550 litres Pin indexed valve outlet on white cylinder (for medical O2 since 2009)

Front 64

What is a drug?

Back 64

A substance which - when taken into an organism’s body - alters the functioning of that organism.

Front 65

What are the five Rights of drug administration?

Back 65

Right drug. Right dose. Right route. Right patient. Right time.

Front 66

What is a drug product?

Back 66

The actual dosage form of the drug – e.g. tablet/ capsule/ transdermal patch/ solution etc.

Front 67

What is a parenteral route?

Back 67

A route used to administer a drug which does NOT use the gastro-intestinal tract. Often used to mean ‘by injection’.

Front 68

What is an enteral route?

Back 68

A route used to administer a drug which involves the Gastrointestinal tract – eg sublingual/ oral/ rectal

Front 69

What is the ‘presentation’ of a drug?

Back 69

The form and strength of a drug – as administered by AV.