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<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br /><span style="color:#0000ff;">QAS Drug Class</span>
<span style="color:#0000ff;">Antiplatelet</span>
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br /><span style="color:#000000;">Schedule</span>
<span style="color:#000000;">S2 (Therapeutic poisons)</span>
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Pharmacology?
<span style="color:#000000;">Aspirin inhibits platelet aggregation by irreversibly inhibiting the cyclo-oxygenase, reducing the synthesis of thromboxane A2 (an inducer of platelet aggregation) for the life of the platelet.<br /><br />This action forms the basis of preventing platelets from aggregating to exposed collagen fibers at the site of the vascular injury.<br /></span>
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Metabolism?
Converted to salicylic acid in many tissues, but primarily in the GI mucosa and liver, excreted by the kidneys
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Onset (PO)?
Approx 10 mins
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Duration (PO)?
7 to 10 days (Antiplatelet)
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Half Life (elimination)
3.2 hours (300 to 650 mg)
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Indications (2)
1. Suspected AMI<br /><br />2. Suspected myocardial ischaemia<br />
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Contraindications (5)
1. KSAR to Aspirin or NSAID’s<br /><br />2. Chest pain associated with psychostimulant overdose <br /><br />3. Bleeding disorders<br /><br />4. Current GI bleeding or peptic ulcers<br /><br />5. Patients &lt; 18 yrs<br />
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Precautions (4)
1. Possible aortic aneurysm or other condition that may require surgery<br /><br />2. Pregnancy <br /><br />3. History of GI bleeding or peptic ulcers<br /><br />4. Concomitant anticoagulant therapy (excluding Clopidogrel) <br />
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Side effects (5)
1. Epigastric pain/discomfort <br />2. Nausea and/or vomiting<br />3. Gastritis<br />4. GI bleeding<br />5. NSAID induced bronchospasm <br />
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Special notes (3)
1. In suspected AMI or myocardial ischaemia Aspirin should be administered following the initial dose of GTN (if indicated)<br /><br />2. Aspirin administration is indicated for patients with suspected AMI or myocardial ischaemia even of pain free<br /><br />3. Patients who have had &lt;300 mg Aspirin in the previous 24 hours and who present with suspected AM or myocardial ischaemia should be administered a dose of Aspirin that equates to a total daily dose of 300 – 450 mg <br />
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Adult Dosage P1/P2/ACP
• &lt;or = 18 – 300mg chewed and followed by a small sip of water (where possible)<br /><br />• &lt;18 yrs – NOT APPROVED<br />
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />Paediatric Dosage P1/P2/ACP
NOT APPROVED
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />QAS Drug Class
Glucose regulatory hormone
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Schedule
S3 (Therapeutic poisons)
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />QAS Presentation
Vials (powder &amp; solvent), 1mg Glucagon (GlucaGen Hypokit)
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Pharmacology
Glucagon is a hyperglycaemic agent that mobilises hepatic glycogen, which is released into the blood as glucose
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Metabolism
By the liver, kidneys and in the plasma
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Onset (IM)
4 to 7 mins
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Duration (IM)
Variable
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Half Life (elimination)
3 to 6 mins
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Indications
Known or suspected hypoglycaemia in patients unable to self administer oral glucose
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Contraindications (1)
KSAR
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Precautions
Nil
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Side effects
Nil
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Special notes (6)<br />
1. Glucagon may be ineffective in patients lacking stored glycogen (eg. Alcoholic patients with imparted liver function).<br /><br />2. The administration of Glucagon for hypoglycaemia is calculated on body weight not age<br /><br />3. Oral carbohydrates should be given when the patient has responded to Glucagon treatment to restore live glycogen and prevent secondary hypoglycaemia <br /><br />4. IM should only be administered if IV Glucose 10% is unable to be administered in a suitable timeframe<br /><br />5. Although no high quality evidence exists it is clear that IV Glucose works faster than IM Glucagon once the treatment has been administered<br /><br />6. The glucagon powder should be protected from light
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Adult Dosage P1/P2/ACP/ICP
• 1 mg single dose only
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Paediatric Dosage P1/P2/ACP/ICP
• &gt; 25kg – 1mg single dose only<br /><br />• ≤ 25 kg – 0.5mg – single dose only<br />
<span style="font-weight:600;">Aspirin</span><br /><br />(23/08/2010)<br /><br />QAS Presentation
Tab (white), 300mg Aspirin
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />QAS Drug Class
Hyperglycaemic
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Schedule
Unscheduled
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />QAS Presentation
Tube, 15g Glucose (Glutose 15™)
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Pharmacology
Glucose gel is a form of pure glucose that is absorbed quickly in the intestinal tract after ingestion. In the live glucose is turned into glycogen, the storage form of glucose in the body
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Metabolism
Metabolised in the muscle and other tissue
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Onset (PO)
Approx 10 min
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Duration (PO)
Variable
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Half Life (elimination)
Not applicable
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Indications
Symptomatic hypoglycaemia in the conscious patient
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Contraindications (4) <br />
1. KSAR <br />2. Unconsciousness<br />3. Patients with difficulty swallowing<br />4. Patients &lt; 2yrs
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Precautions
Nil
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Side effects (2)
1. Nausea and/or vomiting<br />2. Diarrhoea <br />
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Special notes (1)
Patients are to swallow the contents of the tube to achieve administration<br /><br />
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Adult Dosage P1/P2/ACP/ICP
• 15g – repeated once at 15 mins of BGL ≤ 4mmol – total max dose 30g<br /><br />
<span style="font-weight:600;">Glucagon</span><br /><br />(23/08/2010 )<br /><br />Paediatric Dosage P1/P2/ACP/ICP
• ≥ 2 yrs 15g – repeated once at 15 mins of BGL ≤ 4mmol – total max dose 30g<br /><br />• &lt; 2yrs – NOT APPROVED<br />
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />QAS Drug Class
Vasodilator
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Schedule
• SUBLING spray – S3 (Therapeutic poisons)<br />• 50mg/10mL amp – S4 (Restricted drugs)<br />
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />QAS Presentation
• Spray (sublingual), 400mcg/dose, 200 doses<br />• Amp, 50mg/10ml Glyceryl Trinitrate <br />
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Pharmacology
GTN is a potent vasodilator that decreases preload by increasing venous capacity, pooling venous blood in the peripheral veins, reducing ventricular filling pressure and decrease arterial blood pressure (afterload).<br /><br />Because of this cascade it also causes vasodilatation in coronary arteries which are in spasm and may assist redistribution of blood flow along collateral channels in the heart <br />
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Metabolism
Rapidly absorbed and metabolised in the liver
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Onset (subling)
&lt; 2 mins
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Duration (subling)
5 to 10 mins
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Half Life (elimination)
1 to 4 mins
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Indications (4)
1. Pain syndromes associated with suspected AMI or myocardial ischaemia <br /><br />2. Cardiogenic pulmonary oedema <br /><br />3. Cardiac chest pain unresponsive to sublingual nitrates, narcotics AND/OR βeta blockes (ESoR Aeromedical only)<br /><br />4. Autonomic dysreflexia with systolic BP ≥ 160 mmHg<br />
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Contraindications (6)
1. KSAR <br /><br />2. Heart rate &lt; 50 OR &gt; 150 beats per minute<br /><br />3. Systolic BP &lt;100 mmHg<br /><br />4. Acute CVA<br /><br />5. Head trauma<br /><br />6. Erectile dysfunction medication in the previous 24 hours<br />
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Precautions (5) <br />
1. Suspected inferior AMI<br /><br />2. Cerebral vascular disease<br /><br />3. Risk of hypotension and/or syncope <br /><br />4. Intoxication (drug effects enhanced)<br /><br />5. Erectile dysfunction medication in the previous 4 days
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Side effects (5)
1. Dizziness<br /><br />2. Hypotension<br /><br />3. Syncope<br /><br />4. Reflex tachycardia<br /><br />5. Vascular headaches<br />
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Special notes (2)
1. Cardiac monitoring is required for all patients that have been administered GTN<br /><br />2. Patients with myocardial ischaemia sound be administered an initial dose of sublingual GTN prior to Aspirin <br /><br /><br />
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Adult Dosage P1/P2/ACP/ICP
• 400mcg – repeated at 5 min intervals whilst symptoms and continue systolic BP &gt; 100mmHg – <span style="font-weight:600;">no max dose</span>
<span style="font-weight:600;">Glyceryl Trinitrate (GTN)</span><br /><br />(23/08/2010)<br /><br />Paediatric Dosage P1/P2/ACP/ICP
•<span style="font-weight:600;"> NOT APPROVED</span>
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />QAS Drug Class
Inhaled analgesic (when inhaled at low doses)
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Schedule
S4 (Restricted drugs)
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />QAS Presentation
Bottle, 3ml, Methoxyflurane
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Pharmacology
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. <br />
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Metabolism
By the liver and excreted by the lungs
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Onset (INH)
1 to 3 mins
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Duration (INH)
5 to 10 mins
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Half Life (elimination)
Not available
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Indications (1)
1. Pain relief
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Contraindications (4)
1. KSAR<br /><br />2. Children &lt; 1yrs<br /><br />3. History of significant liver or renal disease<br /><br />4. Malignant Hyperthermia<br /><br />
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Precautions (2)
1. ALOC<br /><br />2. Intoxicated patients or drug affected patients<br />
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Side effects (3)
1. ALOC<br /><br />2. Cough<br /><br />3. Renal/hepatic failure following repeated high dose exposure to Methoxyflurane<br />
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Special notes (8)
1. Use only by children who can self monitor pain and self administer – poor administration = ineffective analgesia<br /><br />2. Deep sedation has been identified with Methoxyflurane administration in patients &lt; 5yrs<br /><br />3. At no time should unconsciousness be deliberately induced <br /><br />4. At no time should the patient administering Methoxyflurane by left unattended <br /><br />5. The lowest dose to provide analgesia should be used<br /><br />6. If the patient prefers simultaneous inhalation through both nose and mouth, fit the inhaler shoulder adjacent to the mouthpiece into a standard anaesthetic face mask<br /><br />7. The total weekly dose should not exceed 15mls with administration on consecutive days not recommended <br /><br />8. OH&amp;S – reduce exposure // a) 1 dose/pt in ambulance b) no more than 2 inside ambulance per shift c) ensure adequate ventilation d) Oxygen through the inhaler should not be in a confined area<br /><br />
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Adult Dosage P1/P2/ACP/ICP
• 3ml repeated once after 20 mins – total max dose 6ml
<span style="font-weight:600;">Methoxyflurane (Penthrane)</span><br /><br />(23/08/2010)<br /><br />Paediatric Dosage P1/P2/ACP/ICP
• ≥ 1yr – 3ml – single dose only, max dose 3ml<br />• &lt; 1yr – NOT APPROVED<br />
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />QAS Drug Class
Analgesia<br />
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Schedule
S2 (Therapeutic poisons)
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Pharmacology
Paracetamol is a p-aminophenol derivative that exhibits analgesic and antipyretic activity. It does not possess anti-inflammatory activity
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Metabolism
By the liver and excreted by the kidneys
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Onset (PO)
10 to 60 mins
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Duration (PO)
4 hours
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Half Life (elimination)
~ 2 hrs
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Indications (1)
1. Relief of minor pain and fever
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Contraindications (2)
1. KSAR<br /><br />2. Children &lt; 1 month old<br />
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Precautions (2)
1. Hepatic or renal dysfunction<br /><br />2. Patients taking anticoagulant medications<br />
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Side effects (1)
1. Nausea
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Special notes (1)
1. Consider previous doses of paracetamol administered by the patient, parent or guardian <br /><br />
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Adult Dosage P1/P2/ACP/ICP
• PO 0.5 g to 1g- every 4 hours – max dose 4g in 24 hours
<span style="font-weight:600;">Paracetamol</span><br /><br />(23/08/2010)<br /><br />Paediatric Dosage P1/P2/ACP/ICP
• PO ≥ 1month, 15mg/kg – single dose only (not within 4 hrs of previous administration)<br /><br />• PO &lt; 1month – NOT APPROVED<br />
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />QAS Drug Class
βeta-adrenergic agent
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Schedule
S4 (Restricted drugs)
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />QAS Presentation
• Neb, 5mh/2ml Salbutamol <br /><br />• Amp, 500 mcg/1ml Salbutamol <br />
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Pharmacology
Salbutamol sulphate is a direct acting sympathomimetic agent which mainly effects β2 – adrenoceptors. As a predominately β2 – adrenoceptor stimulant, Salbutamol’s bronchodilating action is relatively more prominent than its cardiac effects.
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Metabolism
Hepatic with excretion by the kidneys
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Onset (NEB)
2 to 5 mins
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Duration (NEB)
16 to 60 mins
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Half Life (elimination)
1.6 hours
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Indications (2)
1. Bronchospasm<br />2. Suspected hyperkalaemia with QRS widening and/or AV dissociation <span style="font-weight:600;">(ICP only)</span><br />
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Contraindications (2)
1. KSAR<br /><br />2. Children &lt; 2 yrs<br />
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Precautions (2)
1. Acute pulmonary oedema <br /><br />2. Ischaemic heart disease <br />
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Side effects (4)
1. Anxiety<br /><br />2. Tachyarrhythmia’s<br /><br />3. Tremors<br /><br />4. Hypokalaemia and metabolic acidosis<br />
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Special notes (1)
1. Different preparations are used for nebulised and intravenous routes. The inappropriate administration of nebuliser Salbutamol solution intravenously will cause serious adverse effects<br /><br />2. The manufacturer recommends that nebules must be stored within the foil packet and are to be discarded three (3) months after opening. The date that the foil packet s opened should be clearly marked on the packet. Any remaining nebules should be discarded three (3) months after the packaging has been opened<br /><br />3. Cardiac monitoring is required for all patients on Salbutamol infusions <br /><br />
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Adult Dosage P1/P2/ACP/ICP
• NEB 5 mg, repeated PRN – no max dose
<span style="font-weight:600;">Salbutamol</span><br /><br />(23/08/2010)<br /><br />Paediatric Dosage P1/P2/ACP/ICP
• ≥ 2 yrs - NEB 5 mg, repeated PRN – no max dose <br /><br />• &lt;2 yrs – NOT AUTHORISED <br />