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155 Cards in this Set

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Presentation of Acetylsalicylic Acid (Aspirin)?
- 300mg chewable tablets
- 300mg soluable or water dispersible tablets
Pharmacology of Acetylsalicylic Acid (Aspirin)
An analgesic, antipyretic, anti-inflammatory and antiplatelet aggregation agent
- Reduces platelet aggregation
- Inhibits synthesis of prostaglandins
Metabolism of Acetylsalicylic Acid (Aspirin)
Converted to salicylate in the gut mucosa and liver, excreted mainly by the liver
Primary Emergency Indication of Acetylsalicylic Acid
To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in acute coronary syndrome
Contraindications of Acetylsalicylic Acid (Aspirin)
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
Precautions of Acetylsalicylic Acid (Aspirin)
1. Peptic ulcer
2. Asthma
3. Patients on anti-coagulants
Side effects of acetylsalicylic acid (aspirin)
- Heartburn, nausea, gastrointenstinal bleeding
- Increased bleeding time
- Hypersenstive reactions
Acetylsalicylic Acid (Aspirin) Duration
8-10 days
Adrenaline Presentation
1mg in 1ml amp (1:100)
1mg in 10ml amp (1:10,000)
Adrenaline Pharmacology
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)
Adrenaline Metabolism
By monoamine oxidase and other enzymes in blood, liver, and around nerve endings and excreted by the kidneys
Primary Emergency Indications of Adrenaline
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
Adrenaline Contraindications
Hypovolaemic shock without adequate fluid replacement
Adrenaline Precautions
1. Elderly patients
2. Patients with cardiovascular disease
3. Patients on monoamine oxidase inhibitors
4. Patients on betablockers as higher doses may be required
Adrenaline Side Effects
Sinus tachycardia
Supraventricular tachycardia
Ventricular arrhythmias
Hypertension
Pupullary dilation
May increase size of infarction
Feeling of anxiety/palpitations conscous patients
Adrenaline Onset / Peak / Duration times
IV
Onset 30 seconds
Peak 3-5 minutes
Duration 5-10 minutes
IM
Onset - 30-90 seconds
Peak 4-10min
Duration 5-10 min
Ceftriaxone Presentation
1g sterile powder in vial
Ceftriaxone Metabolism
Excreted unchanged in urine (33-67% and in bile
Ceftriaxone Pharmacology
Cephalosporin Antibiotic
Ceftriaxone Primary Emergency Indications
1. Suspected Meningococcal Septicaemia
2. Severe sepsis
Ceftriaxone Contraindications
Allergy to Cephalosporin Antibiotics
Ceftriaxone Precautions
Allergy to Penicillin Antibiotics
Ceftriaxone route of administration
Intravenous route (preferred)
Intramuscular route (if IV access unable to be obtained)
Ceftriaxone side effects
Nausea and vomitting
Skin rash
Ceftriaxone special notes
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
Compound Sodium lactate presentation
500ml and 1000ml infusion soft pack
Compound Sodium Lactate Pharmacology
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
Compound Sodium Lactate Metabolism
Excreted by the kidneys, distributed throughout total body water, mainly in the extracellular fluid compartent
Compound Sodium Lactate Primary Emergency Indications
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
Compound Sodium Lactate Contraindications
Ceftriaxone
Compound Sodium Lactate Route of Administration
Intravenous infusion
Compound Sodium Lactate Side Effects
Excessive administration will provide fluid overload and may cause pulmonary oedema
Compound Sodium Lactate Half Life
Intravascular half-life approximately 30-60min
Dextrose 10% Presentation
50g in 500ml Infusion Soft Pack
Dextrose 10% Pharmacology
A slightly hypertonic crystalloid solution
composition
- Sugar - 10% dextrose
- Water

Actions
- Provides a source of energy
- Supplies body water
Dextrose 10% Metabolism
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
Dextrose 10% Primary Emergency Indications
Diabetic hypoglycaemic (random blood gluse analysis <4mmol/l in Pts with an altered conscious state who was unable to self administer oral glucose
Dextrose 10% Contraindications
Nil of significance in above indication
Dextrose 10% Precautions
Nil of significance in above indication
Dextrose 10% Route of Administration
Intravenous infusion
Dextrose 10% Side Effects
nil of significance in above indication
Dextrose 10% Special Notes
Intravenous Effects
Onset 3 minutes
Duration: Depends on severity of episode
Fentanyl Presentation
100mcg in 2ml amp, 600mcg in 2ml
Fentanyl Pharmacology
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
Fentanyl Metabolism
By the Liver and excreted by the kidneys
Fentanyl Primary Emergency Indications
Sedation to facilitate intubation
Sedation to maintain intubation
Drug facilitated intubation
Analgesia - IV/IN
Fentanyl Contraindications
Known hypersensitivity
IV Amiodarone
Fentanyl Precautions
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
Fentanyl Route of Administration
Intravenous
Intranasal
Fentanyl Side Effects
Respiratory Depression
Apnoea
Rigidity of the diaphram and intercoastal muscles
Bradycardia
Fentanyl Special notes
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
Glucagon presentation
1mg (IU) in 1ml hypokit
Glucagon Pharmacology
A hormone normally secreted by the pancreas
actions: Cuases an inrease in blood glucose concentration by coverting stored liver glycogen to glucose
Glucagon Metabolism
Mainly by the liver, also by the kidney's and in the plasma
Glucagon Primary Emergency Indications
Diabetic hypglycaemic (BGL <4mmol/l) in Pts with an altered conscous state who are unable to self-administer oral glucose.
Glucagon Contraindications
Nil of significance
Glucagon Precautions
Nil of significance
Glucagon Route of Administration
Intramuscular
Glucagon Side Effects
Nausea and vomiting (rare)
Glucagon speacial notes
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
Glyceryl Trinitrate (GTN)presentation
0.6mg tablet, transdermal GTN patch (0.4mg/hr)
Gylceryl Trinitrate (GTN) Pharmacology
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
Gylceryl Tinitrate (GTN) Metabolism
By the liver
Gylceryl Trinitrate (GTN) Primary Emergency Indicatons
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)
Gylceryl Trinitrate (GTN) Contraindications
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
Gylceryl Trinitrate (GTN) Precautions
1. No previous administration
2. Elderly patients
3. Recent acute myocardial infarction
4. Concurrent use with other Tocolytics
Gylceryl Trinitrate (GTN) Route of Adminisrations
Buccal, Sublingual transdermal infursion (interhospital transfer only)
Gylceryl Trinitrate (GTN) Side Effects
Tachycardia
Hypotension
Headache
Skin flushing (uncommon)
Bradycardia (occasionally)
Gylceryl trinitrate (GTN) special notes
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
Ipratropium Bromide (Atrovent) Presentation
250mcg in 1 ml nebule or polyamp
Ipratropium bromide (Atrovent) pharmacology
anticholinergic bornchodilator
actions
Allows bronchodilation by inhibiting cholinergic bronchmotor tone (I.e blocks vagal reflexes which mediate bronchoconstriction)
Ipratropium bromide (Atrovent)metabolism
excreted by the kidneys
Ipratropium bromide (Atrovent) primary emergency indciations
sevre respiratory distresss associated with bronchospasm
Ipratropium bromide (Atrovent) contrindication
known hypersensitivity to atropine or its derivatives
Ipratropium bromide (Atrovent) precautions
1. Glaucoma
2. avoid contact with eyes
Ipratropium bromide (Atrovent)route of administration
nebulised in combination with salbutamol
Ipratropium bromide (Atrovent) side effects
Headache
nausea
dry mouth
skin rash
tachcardia(rare)
palpitations(rare)
acute angle closure glaucoma secondary to direct eye contract (rare)
Ipratropium bromide (Atrovent) special notes
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
Methoxyflurane Presentation
3ml glass blottle with plastic seal
Methoxyflurane pharmacology
inhalational analgesic agent at low concentrations
Methoxyflurane metabolism
excreted mainly by the lungs, by the liver
methoxyflurane primary emergency indications
pre-hospital pain relief
methoxyflurane contraindications
pre-existing renal disease/renal impairment
concurrent use of tetracycline antibiootics
exceeding total dose of 6ml in 24 hours
methoxyflurane precautions
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
methoxyflurane route of administration
self-administration under supervison using the hand held penthrox inhaller with oxygen supplementation
methoxyflurane side effects
drowsiness
decrease in blood pressure and bradycardia
exceeding the max. total dose of 6ml in a 24hr period may lead to ranal toxicity
methoxyflurane special notes
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
metoclopromide presentation
10mg in 2ml ampoule
metoclopromide pharmacology
antiemetic which accelerates gastric empyting and peristalsis mild SHT3-receptor antagonist
metoclopromide metabolism
by the liver and excreted by the kidney's
metoclopromide primary emergency indications
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
metoclopromide contraindications
1. children
2. suspected bowel obstruction or perforation
3. gastrointestinal haemorrhage
metoclopromide precautions
1. Undiagnosed abdominal pain
2. Adolescent (<20yrs)
3. Administer slowly over one minute to minimise risk of extrapyramidial reactions
metoclopramide route of administration
intravenous
intramuscular
metoclopramide side effects
drowsiness
lethargy
dry mouth
muscle tremor
extrapyramidial reactions (usually the dystonic type)
metoclopramide special notes
not effective for established motion sickness
not effective for nausea prophylaxis in the setting of narcotic administration
midazolam presentation
5mg in 1ml amp
15mg in 3ml amp
midazolam pharmacology
short acting entral nervous system depressant

Actions:
-anxiolytic - reduces anxiety
sedative
-anti-convulsant
midazolam primary emergency indications
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
midazolam contraindications
known hypersensitivity to benzodiazepines
midazolam precautions
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
midazolam route of administration
intramuscular
intravenous
Midazolam side effects
depressed level of consciousness
respiratory depression
loss of airway control
hypotension
Midazolam Special notes
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
Morphine Presentation
10mg in 1ml amp
Mophine Pharmacology
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
Morphine Metabolism
By the liver and excreted by the kidneys
Morphine Primary Emergency Indications
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
Morphine Contraindications
1. known hypersensitivity
2. late second stage labour
morphine precuations
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
Morphine Route of administration
- Intravenous
- Intramuscular
- Intravenous infusion
Morphine side effects
Central Nervous system effects
- Drowsyness
- Respiratorydepression
- Euporia
- Nausea, vomitting
- Pin-point pupils
- Addiction

Cardiovascular effects
- Hyotension
- Bradycardia
morphine special notes
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
morphine onset/peak/duration times
Intravenous Intramuscular
onset 2-5 minutes 10-30 minutes
peak 10 minutes 30-60 minutes
duration 1-2 hours 1-2 hours
Naloxone presentation
0.4mg in 1ml
2mg in 5 ml (prepared syringe)
Naloxone pharmacology
A Narcotic antagonist

Action:
- Prevents or reverses the effects of narctoics
Naloxone metabolism
by the liver
Naloxone Primary emergency indications
altered conscous state and respiratory depression secondary to administration of narcotics or related drugs
Naloxone contraindications
Nil of significance in above indication
Naloxone precautions
1. If patient is known to be physically dependent on narcotics, be prepared to beal with a combative pt after administration
2. neonates
Naloxone route of administration
Intramuscular
Intravenous
Naloxone side effects
- Symptoms of narcotic withdrawal
- Sweating, goose flesh, tremor
- Nausea and vomiting
- Agitiation
- Dilation of pupils, escessive lacrimation
- convulsions
Naloxone special notes
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
naloxone onset/peak/duration times
intravenous/intramuscular effects:
onset 1-3 min
peak
duration 30-45min
Normal saline presentation
10ml polyamp, 500ml + 1000ml infusion soft pack
Normal saline Pharmacology
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
Normal saline metabolism
electrolytes
- Excreted by the kidneys

water:
- excreted by the kidneys
- distributed throughout total body water, mainly in the extracellular fluid compartment
Normal Saline Primary Emergency Indication
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
Normal saline Contraindications
Nil of significance in above indication
Normal saline precautions
nil of sgnificance in above indication
Normal saline route of administration
intravenous
Normal saline side effects
nil of significance in above indication
Normal saline Half Life
Approximately 30-60 minutes
prochlorperazine presentation
12.5 in 1ml amp
Prochlorperazine Pharmacology
An anti-emetic
Action: acts on several central neuro-transmitter systems
Prochlorperazine Metabolism
Metabolised by the liver and excreted by the kidneys
Prochlorperazine Primary Emergency Indications
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
Prochlorperazine Contraindcations
1. Circulatroy collapse
2. CNS Depreson
3. Previous hypersensitivity
4. Children
Prochlorperazine Precautions
1. Hypotension
2. Epilepsy
3. Pts effected by alcohol or on anti-depressants
Route of Administration
Intramuscular
Prochlorperazine Side Effects
- Drowsiness
- Blurred vision
- Hypotension
- Sinus tachycardia
- Skin rash
- Extrapyramidal reactions, usually the dystonic type
prochlorperazine onset / peak / duration
Intramuscular effect
Onset: 20min
Peak: 40min
Duration: 6Hr
salbutamol presentation
5mg in 2.5ml nebule/polyamp
500mcg in 1ml amp
5mg in 5l amp
Salbutamol Pharmacology
A synthetic beta-adrenergic stimulant, wiht primarily beta 2 effects
Action: causes bronchodilatation
Salbutamol Metabolism
By the liver and excreted by the kidneys
Salbutamol Primary Emergency Indications
Respiratory distress with suspected bronchospasm
- Asthma
- Pulomonary oedma
- Severe allergic reactions
- COPD
- Smoke inhalation
- Oleoresin capsicum spray exposure
Salbutamol Contraindications
Nil of signicance in above indications
Salbutamol Precautions
1. Between doeses, oxygen must be administered continuously
2. Large doses of IV Salbutamol have been reported to cause intracellular metabolic acidosis
Salbutamol Route of Administration
Nebulised
Intravenous
Intravenous infusion
Endotracheal
Pressurised metered dose inhaler (pMDI)
Salbutamol Side Effects
Sinus Tachycardia
Muscle tremor (common)
Salbutamol Onset / Peak / Duration
Nebulised Effects
Onset: 5-15 min
Peak:
Duration: 15-50min

Intravenous effects
Onset 1-2min
Peak
Duration: 30-60min
Fentanyl Onset / Peak / Duration
Intravenous effects
Onset immediate
Peak <5min
Duration 30-60min

Intranasal effects
Peak 2min
Glyceryl Trinitrate (GTN) Onset / Peak / Duration
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
Glucagon Onset / Peak / Duration
Intramuscular effects:
Onset - 3-5 min
Durations - 12-25 min
Ipratropium Bromide (Atrovent)
Onset 3-5 minutes
Peak 1.5 hr - 2 hr
Duration - 6 hour