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155 Cards in this Set
- Front
- Back
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Presentation of Acetylsalicylic Acid (Aspirin)?
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- 300mg chewable tablets
- 300mg soluable or water dispersible tablets |
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Pharmacology of Acetylsalicylic Acid (Aspirin)
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An analgesic, antipyretic, anti-inflammatory and antiplatelet aggregation agent
- Reduces platelet aggregation - Inhibits synthesis of prostaglandins |
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Metabolism of Acetylsalicylic Acid (Aspirin)
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Converted to salicylate in the gut mucosa and liver, excreted mainly by the liver
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Primary Emergency Indication of Acetylsalicylic Acid
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To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in acute coronary syndrome
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Contraindications of Acetylsalicylic Acid (Aspirin)
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1. Hypersensitivity to Aspirin/Salicylates
2. Actively bleeding peptic ulcer 3. Bleeding disorders 4. Suspected dissecting aortic aneurysm 5. Chest pain associated with pyschostimulant overdose if BP > 160 |
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Precautions of Acetylsalicylic Acid (Aspirin)
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1. Peptic ulcer
2. Asthma 3. Patients on anti-coagulants |
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Side effects of acetylsalicylic acid (aspirin)
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- Heartburn, nausea, gastrointenstinal bleeding
- Increased bleeding time - Hypersenstive reactions |
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Acetylsalicylic Acid (Aspirin) Duration
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8-10 days
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Adrenaline Presentation
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1mg in 1ml amp (1:100)
1mg in 10ml amp (1:10,000) |
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Adrenaline Pharmacology
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A naturally occuring alpha and beta-adrenergic stimulant
Actions - - Increases pulse rate by increasing S.A node firing rate (B1) - Increases conduction velocity through the A.V. node - Increases myocardial contractility - Increases the irritability of the ventricles(B1) - Causes bronchodilation (B2 - Causes peripheral vasoconstriction(alpha) |
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Adrenaline Metabolism
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By monoamine oxidase and other enzymes in blood, liver, and around nerve endings and excreted by the kidneys
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Primary Emergency Indications of Adrenaline
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1. Persistent ventriculat fibrillation or uncontrolled pulseless ventricular tachycardia
2. Asystole 3. Electro-mechanical dissociation / PEA 4. Inadequate perfusion (cardiogenic) 5. Inadequate perfusion (non cardiogenic - non hypovolaemic) 6. Anaphylactic reactions 7. Severe asthma 8. Unconscious asthma with no recordable BP 9. Croup or suspected croup 10. Bradycardia with poor perfusion |
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Adrenaline Contraindications
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Hypovolaemic shock without adequate fluid replacement
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Adrenaline Precautions
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1. Elderly patients
2. Patients with cardiovascular disease 3. Patients on monoamine oxidase inhibitors 4. Patients on betablockers as higher doses may be required |
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Adrenaline Side Effects
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Sinus tachycardia
Supraventricular tachycardia Ventricular arrhythmias Hypertension Pupullary dilation May increase size of infarction Feeling of anxiety/palpitations conscous patients |
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Adrenaline Onset / Peak / Duration times
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IV
Onset 30 seconds Peak 3-5 minutes Duration 5-10 minutes IM Onset - 30-90 seconds Peak 4-10min Duration 5-10 min |
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Ceftriaxone Presentation
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1g sterile powder in vial
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Ceftriaxone Metabolism
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Excreted unchanged in urine (33-67% and in bile
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Ceftriaxone Pharmacology
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Cephalosporin Antibiotic
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Ceftriaxone Primary Emergency Indications
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1. Suspected Meningococcal Septicaemia
2. Severe sepsis |
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Ceftriaxone Contraindications
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Allergy to Cephalosporin Antibiotics
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Ceftriaxone Precautions
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Allergy to Penicillin Antibiotics
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Ceftriaxone route of administration
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Intravenous route (preferred)
Intramuscular route (if IV access unable to be obtained) |
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Ceftriaxone side effects
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Nausea and vomitting
Skin rash |
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Ceftriaxone special notes
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Usual dose: Adult 1g, Child 50mg/kg
Ceftriaxone IV must be made up to 10ml using sterile water and dose administered over 2min Ceftriaxone IM must be made up to 4ml using 1%lignocaine and dose administered in lateral upper thigh |
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Compound Sodium lactate presentation
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500ml and 1000ml infusion soft pack
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Compound Sodium Lactate Pharmacology
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An isotonic crystalloid solution
composition - Electrolytes - In similar concentration to that of extra cellular fluid - Water Action: Temporarily increases the volume of the intravascular fluid compartment |
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Compound Sodium Lactate Metabolism
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Excreted by the kidneys, distributed throughout total body water, mainly in the extracellular fluid compartent
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Compound Sodium Lactate Primary Emergency Indications
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1. As a replacement fluid in volume-depleted pts
2. To expand intravascular volume in the non-cardiac, non-hypovolaemic hypotensive pt. e.g Anahalaxis, burns, sepsis 3. As a fluid challenge in unresponsive non-hypovolaemic hypotensive pts, other then LVF E.g electro-mechanical dissociation, asthma, 4. vehicle for diluting and intravenous administration of drugs 5. fluid to keep vein open for IV administation of drugs |
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Compound Sodium Lactate Contraindications
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Ceftriaxone
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Compound Sodium Lactate Route of Administration
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Intravenous infusion
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Compound Sodium Lactate Side Effects
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Excessive administration will provide fluid overload and may cause pulmonary oedema
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Compound Sodium Lactate Half Life
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Intravascular half-life approximately 30-60min
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Dextrose 10% Presentation
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50g in 500ml Infusion Soft Pack
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Dextrose 10% Pharmacology
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A slightly hypertonic crystalloid solution
composition - Sugar - 10% dextrose - Water Actions - Provides a source of energy - Supplies body water |
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Dextrose 10% Metabolism
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Dextrose
- Broken down in most tissues - Stored in liver and muscle as glycogen Water - Extreted by the kidneys - Distributed throughout total body water, mainly in the extracellular fluid compartment |
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Dextrose 10% Primary Emergency Indications
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Diabetic hypoglycaemic (random blood gluse analysis <4mmol/l in Pts with an altered conscious state who was unable to self administer oral glucose
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Dextrose 10% Contraindications
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Nil of significance in above indication
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Dextrose 10% Precautions
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Nil of significance in above indication
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Dextrose 10% Route of Administration
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Intravenous infusion
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Dextrose 10% Side Effects
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nil of significance in above indication
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Dextrose 10% Special Notes
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Intravenous Effects
Onset 3 minutes Duration: Depends on severity of episode |
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Fentanyl Presentation
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100mcg in 2ml amp, 600mcg in 2ml
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Fentanyl Pharmacology
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A synthetic narcotic analgesic
actions: Central nervous system effects - Depression - leading to analgesia - Respiratory depression - leading to apnoea - Dependence (addiction) Cardiovascular effects - Decreases conduction velocity through the A.V. node |
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Fentanyl Metabolism
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By the Liver and excreted by the kidneys
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Fentanyl Primary Emergency Indications
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Sedation to facilitate intubation
Sedation to maintain intubation Drug facilitated intubation Analgesia - IV/IN |
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Fentanyl Contraindications
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Known hypersensitivity
IV Amiodarone |
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Fentanyl Precautions
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Elderly patients
Impaired renal/hepatic function Respiratory depression, E.g COPD Current asthma Pts on Monoamine oxidase inhibitors Known addiction to narcotics Rhinitis, rhiorrhea or facial trauma(IN use) Oral amiodarone |
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Fentanyl Route of Administration
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Intravenous
Intranasal |
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Fentanyl Side Effects
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Respiratory Depression
Apnoea Rigidity of the diaphram and intercoastal muscles Bradycardia |
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Fentanyl Special notes
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Fentanyl is a Schedule 8 drug under the Poisons Act and its use must be carefully controlled. with accountability and responsiblity.
Respiratory depression can be refused with Naloxone Hydrochloride. 100mcg fentanyl is equivalent in analgesic acivity to 10mg morphine. Intravenous effects onset immediate peak <5min duration 30-60min Intranasal peak 2min |
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Glucagon presentation
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1mg (IU) in 1ml hypokit
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Glucagon Pharmacology
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A hormone normally secreted by the pancreas
actions: Cuases an inrease in blood glucose concentration by coverting stored liver glycogen to glucose |
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Glucagon Metabolism
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Mainly by the liver, also by the kidney's and in the plasma
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Glucagon Primary Emergency Indications
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Diabetic hypglycaemic (BGL <4mmol/l) in Pts with an altered conscous state who are unable to self-administer oral glucose.
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Glucagon Contraindications
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Nil of significance
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Glucagon Precautions
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Nil of significance
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Glucagon Route of Administration
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Intramuscular
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Glucagon Side Effects
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Nausea and vomiting (rare)
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Glucagon speacial notes
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Not all pts will respond to glucagon, for example those with inadequate glucogen storage in the liver - alcholics, malnourishment
intramuscular effects: onset -35 min durations 12-25 min |
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Glyceryl Trinitrate (GTN)presentation
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0.6mg tablet, transdermal GTN patch (0.4mg/hr)
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Gylceryl Trinitrate (GTN) Pharmacology
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Principally: a vascular smooth muscle relaant
Actions: - Venous dilation promotes venous pooling and reduces venous return to the heart (reduces preload) - Arterial dilation reduces systemic vascular resistance and arterial pressure(reduces afterload) the effect of the above are - Reduced myocardial oxygen demand - Reduced systolic, diastolic and maean arterial pressure, whilst usually maintinain coronary perfusion pressure - Mild collateral coronary arterial dilation may improve blood supply to ischaemic areas of myocardiam - Mild tachycardia seonadry to sligh fall in blood pressure - Preturm labour : uterine quiescence in pregnancy |
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Gylceryl Tinitrate (GTN) Metabolism
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By the liver
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Gylceryl Trinitrate (GTN) Primary Emergency Indicatons
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1. Chest pain asssociated with acute coronary syndome
2. Acute left ventricular failure 3. Hypertension associated with acute coronary syndrome 4. Autonomic dysreflexia 5. Preterm labour (consult) |
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Gylceryl Trinitrate (GTN) Contraindications
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1. Known hypersensitivity
2. Systolic blood presure <110 tablet 3. Systolic blood pressure <90 patch 4. Sildenafil Citrate "Viagra or Vardenafil "Levitra" administration in the prevous 24hr or Tadalafil "Cialis" administration in the prevous 4 days (PEA5 Inhibitors) 5. Heart rate > 160 6. Bradycardia HR <50 (excluding autonomic dysreflexia) 7. Ventricular tachycardia 8. Inferior STEMI with systolic BP <160 9. Right ventricular infarct |
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Gylceryl Trinitrate (GTN) Precautions
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1. No previous administration
2. Elderly patients 3. Recent acute myocardial infarction 4. Concurrent use with other Tocolytics |
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Gylceryl Trinitrate (GTN) Route of Adminisrations
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Buccal, Sublingual transdermal infursion (interhospital transfer only)
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Gylceryl Trinitrate (GTN) Side Effects
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Tachycardia
Hypotension Headache Skin flushing (uncommon) Bradycardia (occasionally) |
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Gylceryl trinitrate (GTN) special notes
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Storage: GTN is susceptible to heat and moisture. make sure that tablets are stored in their original light resistant, tightly sealed bottles, the foil pack of the patches should be in tact. discard tablets after 1 month of opening bottle. patches should be discarded by expirary date.
dont use patients own medication. both men and women can be prescribed slenafil citrate, vardenafil, or tadalafil, all patients should be asked if and wheny they last used the drug. buccal effects onset 30sec - 2min peak 3-5min duration 15-30min intravenous effects onset 30seconds - 1 minute peak 3-5 min duration 15 - 30min transdermal effect onset up to 30min peak 2hr |
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Ipratropium Bromide (Atrovent) Presentation
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250mcg in 1 ml nebule or polyamp
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Ipratropium bromide (Atrovent) pharmacology
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anticholinergic bornchodilator
actions Allows bronchodilation by inhibiting cholinergic bronchmotor tone (I.e blocks vagal reflexes which mediate bronchoconstriction) |
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Ipratropium bromide (Atrovent)metabolism
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excreted by the kidneys
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Ipratropium bromide (Atrovent) primary emergency indciations
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sevre respiratory distresss associated with bronchospasm
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Ipratropium bromide (Atrovent) contrindication
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known hypersensitivity to atropine or its derivatives
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Ipratropium bromide (Atrovent) precautions
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1. Glaucoma
2. avoid contact with eyes |
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Ipratropium bromide (Atrovent)route of administration
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nebulised in combination with salbutamol
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Ipratropium bromide (Atrovent) side effects
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Headache
nausea dry mouth skin rash tachcardia(rare) palpitations(rare) acute angle closure glaucoma secondary to direct eye contract (rare) |
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Ipratropium bromide (Atrovent) special notes
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There have been isolated reports of ocular complications (mydriasis, increased intraocular pressure, acute angle glaucoma, eye pain) as a result of direct contact of ipratropium bromde formulations
the nebuliser mask mast be fitted properly during inhallation and care taken to avoid ipratropium bromide solution entering eyes ipratropium bromide must be nebulised in conduction with salbutamol and is to be administered as a single dose only onset 3-5 minutes peak 1.5hr - 2 hr duration - 6hour |
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Methoxyflurane Presentation
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3ml glass blottle with plastic seal
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Methoxyflurane pharmacology
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inhalational analgesic agent at low concentrations
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Methoxyflurane metabolism
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excreted mainly by the lungs, by the liver
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methoxyflurane primary emergency indications
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pre-hospital pain relief
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methoxyflurane contraindications
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pre-existing renal disease/renal impairment
concurrent use of tetracycline antibiootics exceeding total dose of 6ml in 24 hours |
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methoxyflurane precautions
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1. the pentrox inhaler must be hand-held by the pt so that if unconscousness occurs it will fall from the pt's face. occasionally the operator may need to assis by must continously assess level of consciousness.
2. preeclampsia |
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methoxyflurane route of administration
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self-administration under supervison using the hand held penthrox inhaller with oxygen supplementation
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methoxyflurane side effects
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drowsiness
decrease in blood pressure and bradycardia exceeding the max. total dose of 6ml in a 24hr period may lead to ranal toxicity |
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methoxyflurane special notes
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the max. initial priming dose for methoxyflurane is 3ml this will provide approximately 25min of analgesia and may be followedeby one further 3ml dose once the initial dose is exhasted if required.analgesia commences after 8-10 breaths and lasts for approximately 3-5min. once discontinued
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metoclopromide presentation
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10mg in 2ml ampoule
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metoclopromide pharmacology
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antiemetic which accelerates gastric empyting and peristalsis mild SHT3-receptor antagonist
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metoclopromide metabolism
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by the liver and excreted by the kidney's
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metoclopromide primary emergency indications
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nausea/vomitting associated with
- chest pain/discomfort of a cardiac nature -opioid administration for pain -cytotoxic or radiotherapy -previously diagnosed migraine -severe gastroenteritis -treatment or prophylaxis in awake spinal immobilised patients - eye trauma |
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metoclopromide contraindications
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1. children
2. suspected bowel obstruction or perforation 3. gastrointestinal haemorrhage |
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metoclopromide precautions
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1. Undiagnosed abdominal pain
2. Adolescent (<20yrs) 3. Administer slowly over one minute to minimise risk of extrapyramidial reactions |
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metoclopramide route of administration
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intravenous
intramuscular |
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metoclopramide side effects
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drowsiness
lethargy dry mouth muscle tremor extrapyramidial reactions (usually the dystonic type) |
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metoclopramide special notes
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not effective for established motion sickness
not effective for nausea prophylaxis in the setting of narcotic administration |
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midazolam presentation
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5mg in 1ml amp
15mg in 3ml amp |
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midazolam pharmacology
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short acting entral nervous system depressant
Actions: -anxiolytic - reduces anxiety sedative -anti-convulsant |
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midazolam primary emergency indications
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1. continous recurrent seizures
2. sediation to maintain intubation 3. sedation to enable intubation 4. rapid sequence intubation 5. sedation to enable synchronised cardioverision 6. sedation of the agitated pt 7. sedation in psychostimulat overdose 8. convulsions associated with lignocaine toxicity |
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midazolam contraindications
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known hypersensitivity to benzodiazepines
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midazolam precautions
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1. reduced doses may be reuqired for the elderly, pts with chronic renal failure, congestive cardiac history or shock
2. The CNS depressent effects of benzodiazepines are enhanced in the presence of narcotics and other tranquillisers including alcohol 3. Can cause severe respiratory depression in pts iwth COPD 4. patients with myasthenia gravis |
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midazolam route of administration
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intramuscular
intravenous |
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Midazolam side effects
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depressed level of consciousness
respiratory depression loss of airway control hypotension |
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Midazolam Special notes
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Midazolam is not permitted for use to facilitate the transport of pts who have been recommended for transport under the Mental ealth Act. If sedation is required in these circumstances then theAct requires that this only be administered by prescribed Medical Practitioners or Registered Nurse
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Morphine Presentation
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10mg in 1ml amp
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Mophine Pharmacology
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A Narcotic analgesic
Actions: central nervous system effects - Depression - Respiraotry depression - Depression of cough reflex - Stimulation - changes of moot, euphoria or dysphoria, vomiting, pin-point pupils - Dependence (addiction) cardiovascular effects: - Vasodilation - Decreases conduction velocity through the A.V. node |
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Morphine Metabolism
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By the liver and excreted by the kidneys
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Morphine Primary Emergency Indications
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1. Pain relief
2. Acute left ventricular failure with SOB and full feild crackles 3. Sedation to maintain intubation 4. Sedation to enable intubation 5. Rapid sequence intubation |
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Morphine Contraindications
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1. known hypersensitivity
2. late second stage labour |
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morphine precuations
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1.- Elderly patients
2.- Hypotension 3.- Respiratory depression 4.- Current asthma 5.- Respiratory tract burns 6.- Known addiction to narcotics 7. Acute alcoholism 8. Pts on monoamine oxidase inhibitors |
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Morphine Route of administration
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- Intravenous
- Intramuscular - Intravenous infusion |
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Morphine side effects
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Central Nervous system effects
- Drowsyness - Respiratorydepression - Euporia - Nausea, vomitting - Pin-point pupils - Addiction Cardiovascular effects - Hyotension - Bradycardia |
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morphine special notes
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Morphine sulphate is a schedule 8 drug under the poisons act and its use must be carefully controlled with accountability and responsibility
side effects of morphine sulphate can be reversed with naloxone hydrochoride |
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morphine onset/peak/duration times
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Intravenous Intramuscular
onset 2-5 minutes 10-30 minutes peak 10 minutes 30-60 minutes duration 1-2 hours 1-2 hours |
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Naloxone presentation
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0.4mg in 1ml
2mg in 5 ml (prepared syringe) |
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Naloxone pharmacology
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A Narcotic antagonist
Action: - Prevents or reverses the effects of narctoics |
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Naloxone metabolism
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by the liver
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Naloxone Primary emergency indications
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altered conscous state and respiratory depression secondary to administration of narcotics or related drugs
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Naloxone contraindications
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Nil of significance in above indication
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Naloxone precautions
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1. If patient is known to be physically dependent on narcotics, be prepared to beal with a combative pt after administration
2. neonates |
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Naloxone route of administration
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Intramuscular
Intravenous |
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Naloxone side effects
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- Symptoms of narcotic withdrawal
- Sweating, goose flesh, tremor - Nausea and vomiting - Agitiation - Dilation of pupils, escessive lacrimation - convulsions |
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Naloxone special notes
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Since the duration of action of Naloxone is often less than that of the narcotic used repeated doses may be required.
Naloxone reverses the effects of narcotics with none of the actions produced by other narcotic antagonists when no narcotic is present on the body. ( E.g no respiratory depression |
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naloxone onset/peak/duration times
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intravenous/intramuscular effects:
onset 1-3 min peak duration 30-45min |
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Normal saline presentation
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10ml polyamp, 500ml + 1000ml infusion soft pack
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Normal saline Pharmacology
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An isotonic crystalloid solution
composition: - Electrolytes - sodium and chloride in similar concentration to that of extracellular fluid - water Action: transiently increases the volume of the intravascular compartment |
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Normal saline metabolism
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electrolytes
- Excreted by the kidneys water: - excreted by the kidneys - distributed throughout total body water, mainly in the extracellular fluid compartment |
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Normal Saline Primary Emergency Indication
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1. as a replacement fluid in volume-depleted patients
2. to expand intravascular volume in non-cardicac, non-hypovolaemic hypotensivept e.g anaphylaxis, burns, sepsis 3. as a fluid challenge in unresponsive non-hypvolaemic hypotensive pts, other then LVF .g Asthma, PEA 4. Vehicle for diluting and intravenous administration of emergency drugs 5. Fluid to KVO for IV administration of emergency drugs |
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Normal saline Contraindications
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Nil of significance in above indication
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Normal saline precautions
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nil of sgnificance in above indication
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Normal saline route of administration
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intravenous
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Normal saline side effects
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nil of significance in above indication
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Normal saline Half Life
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Approximately 30-60 minutes
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prochlorperazine presentation
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12.5 in 1ml amp
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Prochlorperazine Pharmacology
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An anti-emetic
Action: acts on several central neuro-transmitter systems |
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Prochlorperazine Metabolism
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Metabolised by the liver and excreted by the kidneys
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Prochlorperazine Primary Emergency Indications
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Treatment or prophylaxis of nausea/vomiting for
- Motion sickness - Planned aeromedical evacuation - Known allergy or contraindicaiton to metoclopromide administration - Headache irrespective of nausea/ vomiting - Vertigo |
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Prochlorperazine Contraindcations
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1. Circulatroy collapse
2. CNS Depreson 3. Previous hypersensitivity 4. Children |
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Prochlorperazine Precautions
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1. Hypotension
2. Epilepsy 3. Pts effected by alcohol or on anti-depressants |
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Route of Administration
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Intramuscular
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Prochlorperazine Side Effects
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- Drowsiness
- Blurred vision - Hypotension - Sinus tachycardia - Skin rash - Extrapyramidal reactions, usually the dystonic type |
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prochlorperazine onset / peak / duration
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Intramuscular effect
Onset: 20min Peak: 40min Duration: 6Hr |
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salbutamol presentation
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5mg in 2.5ml nebule/polyamp
500mcg in 1ml amp 5mg in 5l amp |
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Salbutamol Pharmacology
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A synthetic beta-adrenergic stimulant, wiht primarily beta 2 effects
Action: causes bronchodilatation |
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Salbutamol Metabolism
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By the liver and excreted by the kidneys
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Salbutamol Primary Emergency Indications
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Respiratory distress with suspected bronchospasm
- Asthma - Pulomonary oedma - Severe allergic reactions - COPD - Smoke inhalation - Oleoresin capsicum spray exposure |
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Salbutamol Contraindications
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Nil of signicance in above indications
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Salbutamol Precautions
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1. Between doeses, oxygen must be administered continuously
2. Large doses of IV Salbutamol have been reported to cause intracellular metabolic acidosis |
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Salbutamol Route of Administration
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Nebulised
Intravenous Intravenous infusion Endotracheal Pressurised metered dose inhaler (pMDI) |
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Salbutamol Side Effects
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Sinus Tachycardia
Muscle tremor (common) |
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Salbutamol Onset / Peak / Duration
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Nebulised Effects
Onset: 5-15 min Peak: Duration: 15-50min Intravenous effects Onset 1-2min Peak Duration: 30-60min |
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Fentanyl Onset / Peak / Duration
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Intravenous effects
Onset immediate Peak <5min Duration 30-60min Intranasal effects Peak 2min |
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Glyceryl Trinitrate (GTN) Onset / Peak / Duration
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Buccal effects
Onset 30sec - 2min Peak 3-5min Duration 15-30min Intravenous effects Onset 30seconds - 1 minute Peak 3-5 min Duration 15 - 30min Transdermal effect Onset up to 30min Peak 2hr |
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Glucagon Onset / Peak / Duration
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Intramuscular effects:
Onset - 3-5 min Durations - 12-25 min |
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Ipratropium Bromide (Atrovent)
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Onset 3-5 minutes
Peak 1.5 hr - 2 hr Duration - 6 hour |
