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What type of drug is Glucagon?
What is the presentation of glucagon?
Vial containing 1 international unit of glucagon - as a dry powder with a syringe of 1ml diluting solution.
What is the action of glucagon?
Causes the liver to metabolise store of glycogen to glucose resulting in the increase of blood glucose level. (provided liver glycogen is available)
How long does glucagon take to work?
IM 15-20 minutes
What is glucagon used for?
Treatment of hypoglycaemia, BGL <4mMol/L - when oral or IV glucose cannot be administered.
What are the possible adverse effects of glucagon?
- (Very Rare)
- Nausea and Vomiting
- Very occasional hypersensitivity
What are/is the contraindications of glucagon use?
What is the dose of glucagon?
- Adult (>20kg) 1 international unit IM
- Paeditric (<20kg) 1/2 international unit IM
- Single dose only.
What should patients who have been given glucagon do to prevent any further hypoglycaemia.
Eat carbohydrates. Re-check BGL.
What type of drug is glyceryl trinitrate?
Nitrate smooth muscle relaxant and vasodilator
What is the presentation of GTN?
600mcg sublingual tablet.
What are the actions of GTN?
- Arterial and venous vasodilation
- Dilation of collateral coronary vessels
What are the uses of GTN?
- Relieve cardiac pain of ischemic origin
- Relieve pulmonary oedema
What are the possible adverse effects of GTN use?
- flushing of skin
- occasionally breadycardia
What are the contraindications of GTN use?
- Do not administer if systolic BP < 90
- Do not administer if HR <50bpm
- Do not administer if Sildenafil (viagra) or vardenafil (levitra) has been taken in the last 24 hours.
- Following the last dose of Tadalafil (cialis) do not administer within 4-5days and in the elderly and those with renal impairment or 3-4days in all other patients.
- Known hypersensitivity.
What is the dose of GTN for chest pain?
- 600mcg tablet --> sublingual
- Repeat x 1 if necessary
- (of the patient systolic BP 90-100 or if the patient has never used any nitrate medication before give 1/2 tablet --> 300mcg)
What is the dose of GTN for APO?
600mcg tablet --> sublingual Repeat x 1 if necessary (of the patient systolic BP 90-100 or if the patient has never used any nitrate medication before give 1/2 tablet --> 300mcg)
How can you tell if GTN is still potent?
Tablet should fizz under the tongue - bottle needs to be dated when opened and discarded after 3 months.
What type of drug is ipratropium bromide?
What is the presentation of atrovent?
1ml plastic nebule containing 250mcg ipratropium bromide
What are the actions of Ipratropium Bromide
- blocks vagal reflexes which mediate bronchoconstriction
- possibly more effective when used in combination with salbutamol
- Onset - 3-5 minutes
- Duration 2-4 hours
What is ipratropium bromide used for?
Bronchospasm of any cause - used as an adjunct to salbutamol.
What is possible adverse effects of ipratropium bromide?
Rare with single use - occasional urinary retention
What are the precautions of ipratropium bromide use?
Care with patients with glaucoma
What is the dose of Ipratropium bromide?
- Adult - 500mcg mixed with 1st/3rd/5th... dose of salbutamol.
- or 4 x 21mcg (4 puffs) with MDI
- Paediatrics - 250mcg mixed with 1st/3rd/5th ... dose of salbutamol
- or 2 x 21mcg (2 puffs) with MDI
When should you use the MDI/spacer?
For mild - moderate respiratory distress, no hypoxia and familiar with use.
What type of drug is methoxyflurane?
Volatile inhalation anaesthetic and analgesic agent.
What is the presentation of methoxyflurane?
What is the action of methoxyflurane?
- Central Nervous system depressant
- Onset: 3-5 minutes
- Offset: 3-5 minutes
What is the indication for methoxyflurane use?
Pain of all origins.
What are the possible adverse effects of methoxyflurane use?
- Altered consciousness
- renal dysfunction
- (all rare with once only ambulance use)
What are the contraindications of methoxyflurane use?
- Depressed LOC (GCS <13)
- Known hypersensitivity
What precautions should be considered before using methoxyflurane?
- Renal disease
- anti-biotic or barbiturate use
- caution if unable to self administer
What is the dose of methoxyflurane?
- 3mls self administered (inhaled) using penthrox inhaler with up to 8lpm of oxygen
- Repeat x 1 as required
Dose should not exceed 6ml /day or 15mls/week
What type of drug is metoclopramide (Maxolon) ?
What is the presentation of maxolon?
10mg in 2ml ampoule
What is the action of maxolon?
- Antiemetic - acting centrally on the brain stem increasing gastric emptying
- Onset - 3-15mins IV
- Duration - 30 minutes
What is Maxolon used for?
- Prevent vomiting when:
- when narcotic analgesic is to be administered
- high spinal injury
- serious eye injury
- suspected ischemic chest pain
Treat nausea and vomiting
What are the possible adverse effects of maxolon use?
- (Uncommon with usual dose) Occasionally
- dry mouth
- oculogyric crisis/facial spasms
- speech difficulties
What are the contraindications of maxolon use?
- Known hypersensitivity (previous reaction)
- GI bleeding
What is the dose of maxolon?
- Adult - 10mg IV over 2 minutes
- or 10mg IM
Paediatrics not used.
Single dose only.
What type of drug is midazolam?
Anti-convulsant and sedative agent
What is the presentation of midazolam?
- 5mg in 5ml ampoule
- 15mg in 3ml ampoule
What are the actions of midazolam?
- Anticonvulsant - reduces seizure activity
- Minor tranquilliser
- Muscle relaxant
- Onset: (IV) 1-5 mins Duration 2-3 hours
- Onset (IM) 2-5 mins Duraiton ?2-3 hours
What is Midazolam used for?
- Status Epilepticus - in a patient who has continual or prolonged seizures.
- sedation to manage airway, RSI, sedation of previously intubated patientAdjunct to analgesia for injuries where significant muscle spasm is presentTo manage agitated and combative patients
- To manage autonomic hyperreflexia
What are the possible adverse effects of midazolam?
- Depression of level of consciousness which may lead to:
- respiratory depression
- loss of airway control
What are the contraindication of midazolam use?
What precautions should be considered with midazolam use?
- Haemodynamic instability
- respiratory depression
What is the dose of Midazolam for seizures?
- Adult Dose: 0.1mg/kg IM repeat x 1 after 10 minutes as necessary
- Up to 0.1mg/kg IV over 2minutes until fitting ceases. Repeat is fitting continues or recurs.
- Paeds Dose: 0.1mg/kg IM - repeat x1 after 10 minutes as necessary.
- Up to 0.1mg/kg IV over 2 minutes until fitting ceases. Repeat if fitting continues or recurs.
What type of drug is Morphine Sulphate?
Narcotic analgesic (S8)
What is the presentation of morphine?
10mg in 1 ml ampoule
What are the actions of Morphine?
- Decreases pain perception and anxiety.
- Onset: (IV) 2-5 minutes = Duration: 1-2 hours
- Onset: (IM) 5+ minutes = Duration: 2-3 hours
What is the indication for the use of Morphine?
- To relieve severe pain
- Acute pulmonary oedemaRSI
- Sedation of previously intubate patient
- Chest pain
What are the possible adverse effects of Morphine use?
- Nausea and vomiting
- Respiratory depression
What are the contraindications for Morphine use?
- Depressed Level of consciousness (GCS<13) --> pain relief only
- Respiratory Depression --> pain relief only
- BP <770mmHg --> pain relief only
- BP <90mmHg --> APO
- Acute Asthma attacks
What precautions need to be considered before Morphine administration?
- Known Hypersensitivity
- Elderly patients (may be sensitive)
- Patients with COPD
- Hypovolaemic patients (hypovolaemia should be corrected BEFORE morphine administration)
- Patients with systolic BP 70-90mmHg
- Children under 1 year old
- Pain management in labour
What is the dose of Morphine for pain relief?
- Adult: Up to 0.05mg/kg IV over 2 minutes
- May be repeated at 5 minute intervals (up to a maximum of 3x maximum calculated dose) until pain is managed. UNLESS pt BP <90mmHg [half calculated dose and fluids]
- Paeds: Up to 0.05mg/kg IV over 2 minutesMay be repeated at 5 minute intervals (up to a maximum of 3x maximum calculated dose) until pain is managed. UNLESS pt BP <70mmHg [half calculated dose and fluids]
- Use with caution if under 1 y/o
- Morphine can be used alternatively with Ketamine
When can/should Morphine be administered IM?
- Pain relief ONLY (NOT FOR ISCHEMIC CHEST PAIN)
- If no IV is available
- No hypotension
- Patient contact is estimated >20 minutes
What is the dose of IM Morphine?
- (Pain relief only) NOT FOR CHEST PAIN
- 0.1 mg/kg
- Repeat x1 after 30-45 minutes as required
What is the altered dose of Morphine for patients with 70mmHh >BP < 90mmHg?
- IV use only!
- hypovolemic patients must be receiving fluids
- up to half calculated (0.05mg/kg) given SLOWLY
- may be repeated as required with great care, and with appropriate interval b/w dose.
- No further doses if BP drops 10mmHg or more with half dose (even if remains >70mmHg)
What is the dose of morphine for pulmonary oedema?
- 0.05mg/kg IV over 2 minutes
- May be repeated x 1 after 10 minutes if required.
What is the dose of Morphine for a) maintenance of sedation post intubation? and b) when used with midazolam for RSI?
- a) 0.05 mg/kg IV SLOWLY
- b) Adult : 10mg IV fast push (dose adjusted for weight, age and BP) --> Paeds: 0.05mg/kg rapid push = repeat x 1 if required.
What are some special note that should be considered for morphine?
- A drug of dependence - must be checked by both members.
- Under the Drugs of Dependence Act, recording and accounting for its use is a legal requirement
- The unused portion of the dose must be appropriately disposed of and its disposal recorded.
- Side effects may be reversed by Naloxone, although it is desirable to avoid unless absolutely necessary
- Advanced age may be a better indicator of dose size than weight in the elderly.
What type of drug is Naloxone?
What are the actions of naloxone?
- Reverses the effects of narcotic analgesics.
- Onset (IV) 1-2 minutes
- Duration 30-45 minutes
- IM - unknown, but suspected to be longer than IV.
What are the indications for Naloxone use?
- drug overdose and poisoning
- Use in situations where there is significant decrease in level of consciousness where there is hypoventilation, and/or loss of protective reflexes and where overdose of narcotics cannot be excluded.
What are the possible adverse effects of naloxone use?
- may precipitate acute withdrawal syndrome in narcotic addicts
- occasional aggressive behaviour following reversal
- nausea and vomiting
What are the contraindications of naloxone use?
What is the dose of Naloxone?
- AP : 800mg IM --> single dose only
- Paeds IM --> 0.01mg/kg.
- ICP: 0.4mg IM then 0.4mg IV increments fast push--> may repeat IV dose x 3 (to max of 2mg)
- Paeds - 0.01mg IV fast push (max 3 doses)
ALL doses may be given IM or IV as situation demands.
What should be considered when treating a person with Naloxone? (Special notes)
- IV may rapidly wear off - if pt likely to refuse tx an IM dose is highly recommended.
- Special care is needed if long-acting agents are known or suspected to have been used. Larger IM dose and transport to hospital is recommended.
What is contained in normal saline?
0.9% sodium chloride solution - containing 151mMol sodium and 151mMol chloride per litre.
What are the actions of Normal Saline?
- Plasma volume expander
- expands interstitial fluid volume
- plasma volume effect is only temporary as most of the saline moves out of the blood vessels quickly.
What are the indications for normal saline use?
- Initial fluid replacement, in volume depleted or dehydrated patients. Volume depletion may be due to loss of blood, plasma, fluid or electrolytes.
- Maintainance of hydration during prolonged patient contact time
- TKVO as IV route for drugs.
What are the adverse effects of normal saline use?
What is the dose of Normal saline?
- IV FLUID RESUSCITATION: Adult: 10 ml/kg lV – then reassess patient
- Aim to keep BP at about 90mmHg systolic.
- Haemorrhagic hypovolaemia aim to keep BP 80-90 systolic.
- TBI aim for >100 systolic.
No limit on amount, dependent on condition of patient.
- Paediatric: 10 ml/kg lV or IO – then reassess patient
- Paediatric cardiac arrest: 20 ml/kg
Adult & Paed: Sepsis & Anaphylaxis 20mls/kg IV or IO
- TKVO: Adult and Paediatric:
- 10 drops per minute (30ml/hr with a standard drip set).
What is the action of Obidoxime?
- Treat super toxic organophosphate poisoning by relieving the symptoms of skeletal neuromuscular blocking that occurs during a chollinergic crisis.
- Used in combination with atropine, in auto injector or with atropine separately administered
What are possible adverse effects of obidoxime use?
- Hypotension, menthol like sensation, warm feeling to face.
- Dull feeling to site of injection
What is the dose of obidoxime?
- Adult - Up to 660mg IM over 30 minutes (3 doses via auto injector)
- Paeds - 220mg IM (1 dose only)
- Preffered site is upper thigh
- Injector must be held in place for 10 seconds to ensure full dose administered.
What type of drug is Ondansetron?
Potent anti-nausea and antiemetic
What are the actions of ondansetron?
- Potent, highly selective histamine receptor antagonist
- precise mode of action not known - likely to have actions peripherally and in CNS
- Maximum effect is approximately 10 minutes following IV administration.
- Hepatic metabolism
What is the indication for ondansetron use?
for prevention and treatment of nausea and vomiting
What are the precautions of ondansetron use?
Not recommened for use during pregnancy.
What are possible adverse effects of ondansetron?
- headache, flushing of skin, occasional reaction at site, drowsiness, anxiety and agitation, transient visual disturbance.
What are the contraindications of ondansetron use?
What is the dose of ondansetron?
- Adult: 4mg IV slowly over 2 minutes
- Paeds: 0.1mg IV (to a total of 4 mg) --> slowly over 2 mins
- May be administered IM if necessary
- May repeat x 1 if required after 10 mins
What type of drug is paracetamol?
A simple analgesic/ antipyretic
What are the actions of paracetamol?
- Mild analgesic
What is the indication for paracetamol use?
- Pyrexia in children who have had or may have a febrile convulsion.
- >38.0 degrees C
What are the precautions that should be considered for paracetamol use?
- Impaired renal function
- Impaired hepatic function
What are the possible adverse effects of paracetamol use?
- Rare (none have been confirmed with casual use)
- dyspepsia, nausea, allergic and haematological reactions
What are the contraindications of paracetamol use?
- Known or suspected allergy
- previous paracetamol dose in the last 4 hours
- children who do not have a sufficient gag reflex to swallow measured dose
- Not to be given to children <1 month old
What is the dose of paracetamol?
- 20mg/kg orally with syringe
- or if paracetamol has been given in the last 48 hours 15mg/kg
- Do not exceed 60mg/kg in 24 hours
- (patient should not be left at home if paracetamol is administered)
What type of drug is salbutamol?
sympathetic beta 2 receptor stimulant
What are the actions of salbutamol?
- Relaxation of involuntary muscle
- Moves K+ from extra-cellular to intra-cellular space
- Onset (neb) 5 minutes
- Max Effect: 1-50 minutes
What are the indications for salbutamol use?
- Bronchospasm of any cause
- emergency treatment of suspected hyperkalaemia
What are the adverse effects of salbutamol use?
- Rare with nebulised therapeutic dose
What are the contraindications of salbutamol use?
What is the dose of salbutamol?
- Via nebuliser with O2 at 6-8lpm
- - Adult 5mg
- - Paed 2.5mg
- MDI with spacer (mild to moderate)
- - Adult = 10 x 100mcg (10 puffs)
- - Paed = 5 x 100mcg (5 puffs)
- Moderate to severe bronchospasm or suspected hyperkalaemia give continued nebulised salbutamol.
- Significant hypoxia administer with 100% oxygen