Drug Therapy Protocols v2.2

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coldy175
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209822
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Drug Therapy Protocols v2.2
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2013-06-26 09:01:40
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DTP v2
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Drug Therapy Protocols v2.2
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  1. adrenaline

    indications
    anaphylaxis or severe allergic reaction

    Severe life threatening bronchospasam
    or silent chest pt must only be able to speak single words + or haemodynamic compromise + or ALOC

    Bradycardia with poor perfusion unresponsive to atropine + or TCP

    Cardiac arrest

    Croup
    with stridor at rest

    Shock unresponsive to adequate fluid resuscitation excluding haemorrhagic cause

  2. adrenaline

    contraindications
    ksar
  3. adrenaline 

    precautions
    hypovolaemic shock

    hypertension

    pt taking monoamine oxidase inhibitors (MAOI`s)
  4. adrenaline

    side effects
    anxiety

    hypertension

    tachyarrhythmias / palpatations

    pupil dilation
  5. adrenaline

    presentation
    1mg / 1 ml amp  1:1000

    1mg / 10 ml amp + mini jet  1:10 000
  6. adrenaline 

    route
    Neb

    IM

    IV

    IO
  7. adrenaline

    onset,  duration, half life
    • onset
    • 30 secs IV , 60 secs IM

    • Duration
    • 5 - 10mins

    • Halflife
    • 2 mins
  8. adrenaline

    adult dose IM

    anaphylaxis or severe allergic reaction
    IM  500mcg repeated at 5 mins if no improvement as per ARC guide lines
  9. adrenaline

    adult dose  NEB

    anaphylaxisis or severe allergic reaction
    5mg neb single dose only

    may be given for minor face or tounge swelling thought to be allergic in origin. If stridor presemt IM adrenaline must be given.
  10. adrenaline

    adult dose  IV / IO

    anaphylaxisis or severe allergic reaction
    IV / IO. 

    20 - 50 mcg repeat at 1 min intervals

    no maximum dose

  11. adrenaline

    adult dose  IM





    IM  500mcg  repeated @ 5 mins if no improvement as per ARC guide lines
  12. adrenaline

    adult dose  IV / IO

    severe life threatening asthma or silent chest. pt must only be able to speak in single words + or have haemodynamic compromise + or an ALOC
    IV / IO  20mcg repeated @ 1 min intervals

    no max dose
  13. adrenaline

    adult dose IV / IO

    bradycardia with poor perfusion
    unresponsive to atropine + or TCP
    • IV / IO 20mcg repeate at 1 min intervals
    • no max dose
  14. adrenaline 

    adult dose   IV / IO

    Cardiac arrest  
    • IV / IO  1mg repeat at 3-5 min intervals
    • no max dose
  15. adrenaline

    adult dose   IV / IO 

    shock unresponsive to adequate fluid resuscitation excluding haemorrhagic cause
    • IV / IO 20 mcg repeat @ 1 mins intervals
    • no max dose
  16. adrenaline 

    paedi dose  IM

    anaphylaxis or severe allergic reaction
    IM  >6 yrs  300 mcg

         < 6 yrs 150 mcg

    repeated at 5 mins if no improvement
  17. adrenaline

    paedi dose Neb

    anaphylaxis or severe allergic reaction
    Neb  5mg single does only.

    may be given for minor face / tongue swelling thought to be allergic in origin. If stridor is present IM / IV adrenaline must be given
  18. adrenaline

    paedi dose IV / IO

    anaphylaxis or severe allergic reaction
    • IV / IO    2 mcg /kg
    • repeated at 2 min intervals
    • no max dose
  19. adrenaline

    paedi dose IM

    severe life threatening asthma or silent chest. pt must only be able to speak in single words + or have haemodynamic compromise + or an ALOC
    IM   >6 yrs  300 mcg 

         < 6 yrs 150 mcg

      repeated at 5 mins if no improvement
  20. adrenaline

    paedi dose IV / IO

    severe life threatening asthma or silent chest. pt must only be able to speak in single words + or have haemodynamic compromise + or an ALOC
    IV / IO   2mcg/kg  single dose not to exceed 50mcg

    • repeated @ 2min intervals
    • no max dose
  21. adrenaline

    paedi dose IO / IV 

    cardiac arrest
    IO /  IV   10mcg/kg

    • repeated every 3-5 mins
    • no max dose
  22. adrenaline 

    paedi dose

    croup with stridor @ rest
    5mg neb 

    single dose only
  23. adrenaline

    paedi dose  IV / IO

    shock unresponsive to adequate fluid resuscitation excluding haemorrhagic cause

    bradycardia with poor perfusion unresponsive to atropine + or TCP
    • IV / IO  2mcg/kg  
    • single dose not to exceed 50 mcg

    repeated @ 2 min  intervals

    no max dose
  24. adrenaline

    drug class  + schedule

    sympathomimetic

    1:1 000  s3 therapeutic poison

    1:10 000  unscheduled
  25. adrenaline

    pharmacololgy
    • a naturally occurring catecholamine acts on alpha and beta adrenergic receptors
    • increase in heart rate b1
    • increase contraction force b1
    • increase irritability of ventricles b1
    • bronchodilation b2
    • peripheralvasoconstriction a1
  26. adrenaline

    metabolism
    • symapthetic nerve endings
    • mitochondrial breakdown at synaptic level
  27. Amiodarone

    indications
    cardiac arrest (refactory VF or pulseless VT )
  28. Amiodarone

    contraindications
    nil in cardiac arrest
  29. Amiodarone

    precautions
    concomitant use of anti-arrythmic drugs that pro long QT interval

    Thyroid disease
  30. Amiodarone

    side effects
    hypotension

    bradycardia

    nausea / vomiting

    peripheral paraesthesia (pins n needles)
  31. Amiodarone

    presentation
    150 mg in a 3 ml amp
  32. Amiodarone

    drug class + schedule
    anti-arrhythmic

    s4 restricted drug
  33. Amiodarone

    route
    • IV
    • IO
  34. Amiodarone

    dose adult
    300mg IV / IO slow push over 2 min (2 vials)

    repeat once @ 150mg after 5 mins   (1 vial)

    total max dose = 450mg
  35. Amiodarone

    paedi dose

       IV / IO
    5mg/kg slow push over 2 mins

    single dose only

    prep : take a 20ml syringe , 150mg (3ml) with 12ml glucose 10% (total 15ml) = final solution of  10mg/ml
  36. amiodarone

    pharmacology
    • prolongs duration of the action potential
    • reduces conduction across all cardiac cells
  37. Aspirin

    indications
    suspected ACS

    acute cardiogenic pulmonary oedema
  38. aspirin

    contraindications
    KSAR to aspirin and other NSAIDs

    chest pain associated with psych stimulant overdose

    bleeding disorders

    current GI bleed or peptic ulcers

    pts <12 yrs
  39. aspirin

    precautions
    possible aortic aneurysm or other condition that may require surgery

    pregnancy

    Hx of GI bleed or peptic ulcers

    concomitant anti coagulant therepy excluding clopidogrel
  40. aspirin 

    side effects
    epigastric pain / discomfort

    nausea / vomiting

    gastritis

    GI bleed

    NSAID induced bronchospasm
  41. aspirin

    presentation
    300mg white tablet
  42. aspirin

    dose
    300mg chewed with sip of water

    pts >12 yrs only

    if ? ACS or APO give even if pt is pain free
  43. aspirin

    onset

    duration

    half life
    o= ? 10 mins

    d= 1 week antiplatelet effect

    h= 3.2 hrs
  44. aspirin

    drug class + schedule
    anti platelet

    s2 therapeutic poison
  45. aspirin

    pharmacology
    • inhibits platelet aggregation irreversibly for the life of the platelet.
    • prevents platelets from aggregating to exposed collagen fibers at site of vascular injury.
  46. ceftriaxone

    indications
    suspected meningococcal septicaemia  (with non blanching petechial + / or purple rash
  47. ceftriaxone

    contra indications
    < 1 month old

    KSAR to cephalosporin  = <class of β-lactam antibiotics>

    KSAR / anaphylaxis to penicillin based drugs (minor rash from penicillin does not contraindicate use of ceftriaxone)
  48. ceftriaxone

    precautions
    nil
  49. ceftriaxone

    side effects
    pain @ IM site

    nausea / vomiting
  50. ceftriaxone

    presentation
    1g glass vial

    2g glass vial
  51. ceftriaxone

    drug class + schedule + pharmacology
    antibiotic

    s4

    Pharm: 3rd generation cephalosporin antibiotic with a bactericidal action
  52. ceftriaxone

    routes
    IM

    IV
  53. ceftriaxone

    dose  Adult  IM and IV
    4g IM  deep IM injection

    prep: 2x2g vials with 2.4ml water = 4g/4ml  =(1g/1ml)

    4g IV  slow push 3-5 mins

    prep: 2x2g vials with 8.4ml water = 4g/10ml <= 400mg/ml>
  54. ceftriaxone

    dose paedi
    •  IM:  100mg/kg  (>1month old)
    • prep:2g with 3.6ml water = 2g/4ml, <5oomg/ml)

    • IV:  100mg/kg slowly over 3-5 mins
    • prep: 2g with 9.6water = 2g/10ml (200mg/ml)
  55. fentanyl

    indications
    significant pain

    sedtion of maintanance of an established ETT
  56. fentanyl

    contraindications
    KSAR or hypersensitivity to fentanyl

    GCS under 14

    nasal admin : # nose, nasal obstruction
  57. fentanyl

    precautions
    elderly

    hypotension

    resp tract burns

    resp depression /failure

    known addiction to narcotics

    pts taking monoamine oxidase inhibitors (MAOIs) = <are one of the oldest classes of antidepressants and are typically used when other antidepressants have not been effective>
  58. fentanyl

    side effects
    drowsyness

    bradycardia

    hypotension

    nausea/vomiting

    pin point pupils

    resp depression

    muscular rigidity  (resp muscles)
  59. fentanyl

    presentation
    600mcg / 2ml  amp for IN

    100mcg/2ml amp for IV / IM
  60. fentanyl

    dose  adult  IN
    1.5mcg/kg intranasal

    repeat once at 1mcg/kg after 10 mins
  61. fentanyl

    adult doses

    IM / IV /  IO
    • IM  25-100mcg repeat up to 50mcg every 10 min
    • no max

    IV/IO 25-50mcg repeat up to 50mcg every 10 min.  no max
  62. fentanyl

     dose adult

    sedation /maitenance of established ETT
    IV / IO 25mcg

    consider use with midazolam

    prn

    no max dose
  63. fentanyl

    paedi  dose IN
    NASAL  pt must be 1yr or over

    1.5mcg/kg  repeat once @ 1mcg/kg @ 10 mins

    total max dose 100mcg
  64. fentanyl

    class + schedule
    narcotic analgesic

    s8 controlled drug
  65. glucagon

    indications
    hypoglycaemic with inability to self admin oral glucose
  66. glucagon

    contra
    KSAR
  67. glucagon

    precautions
    nil
  68. glucagon

    side effects
    nil
  69. glucagon

    presentation
    1mg powder vial with water
  70. glucagon

    adult dose
    1mg IM single dose only
  71. glucagon

    paedi dose
    > 25kg  1mg IM

    <25kg 500mcg  IM

    single dose only
  72. glucagon

    class + schedule
    hyperglycaemic

    s3
  73. Glucose 5%

    indications
    as a vechicle for drug delivery during iv drug infusion
  74. Glucose 5%

    contraindications
    nil
  75. Glucose 5%

    precautions
    hyperglycaemia
  76. Glucose 5%

    side effects
    nil
  77. Glucose 5%

    presentation
    500ml soft infusion pack
  78. Glucose 5%

    dose
    iv infusion max dose 1000ml
  79. Glucose 10%

    indications
    hypoglycaemia unable to self admin oral glucose
  80. Glucose 10%

    contraindications
    nil
  81. Glucose 10%

    precautions
    extravasation may cause tissue/vascular necrosis
  82. Glucose 10%

    side effects
    nil
  83. Glucose 10%

    presentation
    500ml soft infusion pack
  84. Glucose 10%

    route
    IV / IO
  85. Glucose 10%

    adult dose
    150ml IV / IO  repeat @ 100ml boluses every 5 mins until BSL > 4
  86. Glucose 10%

    paedi dose
    IV / IO   2.5ml / kg  repeat @ 1ml/kg every 5 until BSL >4
  87. Glucose Gel

    indications
    hypoglycaemic pt who can swallow
  88. Glucose Gel

    contraindications
    KSAR

    unconscious

    pts with swallowing difficulty

    pts < 2yrs
  89. Glucose Gel

    precautions
    nil
  90. Glucose Gel

    side effects
    nausea 

    d+v
  91. Glucose Gel

    presentation
    15g tube
  92. Glucose Gel

    dose`s
    adult + paedi   over 2 yrs old

    15g repeat once @ 15 mins if BSL <4

    max dose 30g
  93. GTN

    indications
    ACS

    APO cardiogenic

    autonomic dysreflexia with bp 160 or over

    irukandji syndrome with bp 160 or over
  94. GTN

    contraindications
    KSAR

    heart rate <50 or >150

    bp <100

    CVA

    head trauma

    erectil dysfunctiom drugs in last 24 hrs
  95. GTN

    precautions
    inferior AMI

    cerebral vascular disease

    risk of hypotension / syncopy

    intoxication

    erectile drugs in last 4 days
  96. GTN

    side effects
    dizzyness

    hypotension

    syncopy

    tachycardia

    headaches
  97. GTN

    presentation
    600mcg tablet
  98. GTN

    Onset Duration Half life
    O= < 2min

    D= 20-30 mins

    H= 5.5 mins
  99. GTN

    doses
    300 - 600mcg repeat every 5 mins

    no max dose
  100. GTN

    class and schedule
    vasodilator

    s3
  101. GTN

    pharmacology
    • ia a potent vasodilator that decreases preload and after load 
    • causes venous pooling of blood
    • vasodilation of coronary arteries helps with blood flow to the heart
  102. hydrocortisone  ICP

    indications
    modorate or severe asthma

    exacerbation of COAD with evidence of rep distress

    anaphylaxis or severe allergic reaction requiring adrenaline

    symptomatic adrenal insuffciency with hx of addison disease,congenital adrenal hyperplasis,pan-hypopituitarisim or long term steroid administration
  103. hydrocortisone  ICP

    contrindications
    KSAR
  104. hydrocortisone   ICP

    precautions
    hypertension
  105. hydrocortisone   ICP

    side effects
    nil
  106. hydrocortisone   ICP

    presentation
    100mg vial
  107. hydrocortisone   ICP

    route
    IM

    IV
  108. hydrocortisone   ICP

    onset  duration  halflife
    O=1-2 hrs

    D= 6-12 hrs

    H= 6-8 hrs
  109. hydrocortisone   ICP

    adult dose 

    asthma / COAD / anaphylaxis
    200mg IM or IV 

    single dose only
  110. hydrocortisone   ICP

    adult dose

    adrenal insufficiency
    100mg IM / IV  single dose only
  111. hydrocortisone   ICP

    paedi dose (all indications)
    5mg/kg IV / IM

    single dose only

    not to exceed 100mg
  112. hydrocortisone   ICP

    claas + schedule
    cortico steriod

    s4
  113. hydrocortisone

    pharmacology
    an adrenocortical steroid that produces anti-inflammatory response

    inhibits inflammatory cells gathering inflammation sites

    prevents and suppresses cell mediated immune reactions
  114. Ipratropium bromide

    indications
    severe asthma or silent chest : pt only able to speak single word + or have haemodynamic compromise + or an ALOC
  115. Ipratropium bromide

    contra indications
    KSAR to anticholineergis

    pt`s under 2yrs
  116. Ipratropium bromide

    precautions
    glaucoma

    prostatic hypertrophy
  117. Ipratropium bromide

    side effects
    dry mouth

    dilated puplis

    palpitations
  118. Ipratropium bromide

    presentation
    250mcg/1ml nebule
  119. Ipratropium bromide

    onset / duration / halflife
    O=1-3mins peaks in 1-2hrs

    D=4-6 hrs

    H= 2 hrs
  120. Ipratropium bromide

    route
    neb
  121. Ipratropium bromide

    adult dose
    500mcg neb    (2 vials)

    single dose only
  122. Ipratropium bromide

    paedi dose
    250 mcg neb  ( 1 vial)

    single dose only

    pt must be over 2 yrs
  123. Ipratropium bromide

    class + schedule
    anticholinergic

    s4
  124. Ipratropium bromide

    pharmacology
    antimuscarinic agent that promotes broncodilation by inhibiting broncomotor tone
  125. Methoxyflurane

    indications
    pain
  126. Methoxyflurane

    contraindications
    KSAR

    pts under 5 yrs

    pre eclampsia

    concurrent use of tetracyline antibiotics


    Hx severe liver or renal disease

    Hx malignant hyperthermia
  127. Methoxyflurane

    precautions
    ALOC

    intoxicated or drug effected pt
  128. Methoxyflurane

    presentation
    3ml bottle
  129. methoxyflurane

    side effects
    ALOC

    cough

    renal failure -following high dose exposure
  130. Methoxyflurane

    adult dose
    3ml  repeat @10 mins

    max dose 6ml
  131. Methoxyflurane

    paedi dose
    pt`s over 5 yrs

    3ml

    single dose only
  132. metoclopramide

    indications
    nausea / vomiting

    Hx nausea vomting with narcotic use or motion sickness

    spinal injury

    air med evac
  133. metoclopramide

    contraindications
    KSAR

    pt`s under 12

    Hx of dystonic reactions

    Gi haemorrhage

    bowel obstruction or perforation

    not to be given with in 6 hrs of phenothiazines eg stemitil
  134. metoclopramide

    precautions
    undiagnosed abdo pain
  135. metoclopramide

    side effects
    drowsiness

    dry mouth

    dystonic reaction

    oculogyric crisis
  136. metoclopramide

    presentation
    10 mg in a 2ml amp
  137. metoclopramide

    onset  duration  half life
    O=1-3 IV, 10- 15 IM

    D= 1-2 hrs

    H= 2-5 hrs
  138. metoclopramide

    dose
    10mg  IM / IV 

    single dose only
  139. metoclopramide

    class + schedule
    anti emetic

    s4
  140. Midazolam

    indications
    sezures / convultions

    sedation for :

    matainence of established ETT

    severely agitated pt -not due to pain

    agitated head injury

    proceducres TCP / cardioversion

    ketamine -agitated emergence
  141. Midazolam

    contraindications
    KSAR to benzodiazepines

    pt`s restrained in prone position
  142. Midazolam

    precautions
    pt`s that are elderly or chronic renal failure ,CCF or shock may require lower doses

    COAD -may cause sevsere resp depression

    multiple sclerosis

    myasthenia gravis  <neuromuscular disease>
  143. Midazolam

    side effects
    respiratory depression  -esp with intox or narcotic

    hypotension
  144. Midazolam

    presentation
    5mg / 1ml amp
  145. Midazolam

    onset duration halflife
    O=1-3 min IV , 5-15 IM

    D=variable

    H= 2.5 hrs
  146. Midazolam

    routes
    • IN
    • IM
    • IV
    • IO
  147. Midazolam

    adult dose seizure
    IN:  5mg prn @ 2min  max dose 10mg

    IM:  5mg
    prn @ 2min max dose 20mg

    IV:  2.5mg
    prn @ 5min  no max dose

    IO 4 ICP:
     1-2.5mg prn @ 5min no max dose
  148. Midazolam

    adult dose

    sedation 4 maintenance of ETT
    IV / IO  1 - 2.5mg 

    consider with morph /fentanyl

    repeat prn

    max dose 20mg
  149. Midazolam

    adult dose 

    agitated head injury
    IV / IO  up to 2.5mg prn @ 5 mins 

    max 20mg
  150. Midazolam

    adult dose

    sedation TPC ot Cardioversion
    1mg prn @ 2min

    max 20mg
  151. Midazolam

    adult dose

    severly agitated pt - not due to pain
    IM up to 5mg prn @ 10 mins max 20mg

    IV 
    up to 2.5mg prn @ 5mins max 20mg
  152. Midazolam

    adult dose

    ketamine emergence
    up to 2.5mg IV  

    max dose 5mg
  153. midazolam

    paedi dose

    seizures
    NAS :  5mg prn @ 2mins, max dose 10mg

    IM :  200mcg/kg (single dose not above       5mg) repeat @ half initial dose (max 2.5mg) @ 10 mins -- no max dose

    IV / IO : 100mcg/kg  single dose not to exceed 2.5mg. repeat @ 5min intervals--- no max dose
  154. midazolam

    paedi dose

    ketamine disinhibition
    IV / IO  50mcg/kg

    single dose not exceed 2.5mg

    repeat after 5mins

    total max  5mg
  155. midazolam

    paedi dose

    sedation/maintenance of ETT
    IV / IO   up to 100mcg/kg

    • single dose not above 2.5mg
    • consider with morphine

    • repeated after 5mins
    • no max dose
  156. midazolam

    paedi dose

    head injury / agitated
    consult needed

     IM / IV / IO    100mcg/kg

    single dose not over 2.5mg

    • repeat after 5mins
    • total max 5mg
  157. midazolam

    drug class / schedule / presentaion
    class: benzodiazepine

    sched:  s4 restricted drug

    pres: 5mg / 1ml amp
  158. midazolam

    pharmacology  and metabolisim
    • a short acting CNS depressant that induces
    • amnesia, anesthesia,hypnosis and sedation by enchaaning the action of GABA. Depresent effects all levels of the CNS

    metabolised by the liver and excreted by the kidneys
  159. midazolam

    onset / duration / half life
    O: 5-15 min IM and 1-3 mins  IV

    D: variable

    H : 2.5 hours
  160. Morphine

    indications
    significant pain

    autonomic dysreflexia with b/p 160 or over

    sedation for maintenance of an ETT
  161. morphine

    contra indications
    KSAR
  162. morphine

    precautions
    elderly pt`s

    hypotension

    resp depression / failure

    resp tract burns

    known addiction to narcotics

    pt`s on MAOIs
  163. morphine

    side effects
    bradycardia

    drowsiness

    hypotension

    nausea / vomiting

    rep depression

    pin point pupils
  164. morphine

    adult dose

    significant pain and autonomic dysreflexia

    IM  IV  IO
    IM : up to 10mg  repeated up to 5 mg @ 10 mins  max dose 20mg

    IV :  up to 5 mg repeat up to 5mg every 5mins tritating to pt responce  no max dose

    IO :  2.5  - 5mg repeat up to 5mg every 5mins titrate to pt responce no max dose
  165. morphine

    adult dose

    sedation for maintenance of an ETT
    IV / IO  :  2.5mg consider with midazolam  repeat prn

    no max dose
  166. morphine

    paedi dose

    pain / autonomic dysreflexia

    IM  IV  IO
    IM  over 1 yr old : 100--200mcg/kg single max dose 5mg -total max dose 200mcg/kg

    IV IO over 1 yr old : 100mcg/kg  single max dose 2.5mg repeat 50mcg/kg max 2.5mg @ 10 min intervals   no max dose.
  167. morhpine

    paedi dose

    maintenance of ETT
    • IV  IO : over 1yr , 100mcg/kg
    • single dose not above 2.5mg consider with midazolam,   no max dose
  168. morhpine

    drug class / schedule /  presentation
    class: narcotic analgesic

    sched: s8 controlled drug

    Pres: 10mg / 1ml amp
  169. morphine

    pharmacology / metabolism
    • narcotic analgesic acts on the CNS by binding to opioid receptors altering the pain perception and emotional response to pain 
    • causes resp depression
    • decrease in gag reflex
    • decrease in av node conduction
    • vasodialation
    • meabolised by liver,kidney and lungs.
  170. naloxone

    indications
    respiratory depression secondary to narcotics use
  171. naloxone

    contraindications
    KSAR
  172. naloxone

    precautions
    pt`s with pre existing cardiac disease
  173. naloxone

    side effects
    • combativeness
    • vomiting
    • sweating
    • tachycardia
    • hypertension
    • convulsions
    • pulmonary
    • oedema
  174. naloxone

    route
    IV

    IM

    IO
  175. naloxone

    adult dose
    IM  :  800mcg (2 amps) prn tritating to pt and airway  max dose 4mg

    • IV IO : 50mcg prn tritating to pt and airway
    •              no max dose
  176. naloxone

    paedi dose

    IM  IV  IO
    IM :  20mcg/kg single dose only not to exceed 800mcg

    • IV  IO : 20mcg/kg tritating to pt`s responce
    •                              no max dose
  177. naloxone

    drug class / schedule / metabolisim /

    presentation
    class : opioid antagonist

    sched: s4 restricted drug

    metab: hepatic

    pres: 400mcg/1ml amp
  178. ondansetron

    indications
    nausea / vomiting

    prophylactic use for pt`s  who previously experienced nausea/vomiting with narcotics

    spinal injury

    aero med evacuations
  179. ondansetron

    contraindications
    pts under 3 yrs

    KSAR
  180. ondansetron

    precautions
    hepatic liver impairment

    intestinal obstruction
  181. ondansetron

    side effects
    headache

    constipation

    dysrrythmias

    skin flushing / sense of warmth

    extrapyramidal effects  (slow movement /tremours/stiffness/ repetative movements )
  182. ondansetron

    presentation  and route
    4mg wafer

    orally disintegrating tablet -place directly on top of tongue will dissolve in seconds water not nessesary
  183. ondansetron

    adult dose  and paedi dose
    adult:  4mg single dose only

    paedi:  over 3 yrs  2mg single dose only
  184. ondansetron

    class / schedule / metabolism
    class : anti emetic

    sched: s4 restricted drug

    metab: liver excreted by kidneys
  185. paracetamol

    indications
    minor pain and fever
  186. paracetamol

    contraindications
    KSAR

    pt`s under 25kg       (6yr old)
  187. paracetamol

    precautions
    hepatic or renal dysfunction

    pt`s on anticoagulant medications
  188. paracetamol

    side effects
    nausea
  189. paracetamol

    adult dose
    0.5g -- 1gram

    repeated every 4 hrs

    total max dose 4 gram in 24hrs
  190. paracetamol

    paedi dose
    25kg or over (6yrs)

    20mg/kg

    single dose only

    must not be given within  4 hrs of previous paracetamol
  191. paracetamol

    drug class / pharmacology / metabolism /

    schedule
    class : analgesic

    pharm: p-aminophenol derivative that produces analgesic and antipyretic effects -it does not possess significant anti-inflammatory activity

    metab: hepatic excreted by kidneys

    sched: s4 restricted drug
  192. salbutamol

    indications
    bronchospasm

    hyperkalaemia with widening QRS and or AV dissociation
  193. salbutamol

    contraindications
    KSAR

    pt`s under 2yrs
  194. salbutamol

    precautions
    APO

    ischaemic heart disease
  195. salbutamol

    side effects
    anxiety

    tachy arrhythmia's

    tremors

    hypokalaemia + metabolic acidosis
  196. salbutamol

    adult dose and paedi dose
    bronchospasm:  5mg neb prn no max dose

    hypokalaemia ; 10mg neb  repeated once only

    PAEDI asthma only : >2ys 5mg neb prn no max dose
  197. salbutamol

    class / metabolism / schedule
    class:  beta-adrenalic agonist

    met : hepatic excreted by kidneys

    sched : s4 restricted drug
  198. salbutamol

    pharmacology
    is a direct acting sympathomimetic mainly effects beta 2 adrenoceptors. primarly acts as a bronchodilator but also has inotropic and chronotropic actions.lowers serum potassium levels thru direct stimulation of of sodium/potassium pump drawing potassium into cells
  199. sodium bicarbonate 8.4%

    indications
    significant injury with potential for crush injury

    cardiac arrest : > 15mins duration

    TCA OD : (tricyclic anti depressant) with prolonged QRS.QT interval or seizures

    ? hyperkalaemia: (widening QRS / or AV discossiation)
  200. sodium bicarbonate 8.4%

    contraindications
    nil
  201. sodium bicarbonate 8.4%

    precautions
    sodium bicarbonate 8.4% in paedi resus may worsen respiratory acidosis
  202. sodium bicarbonate 8.4%

    side effects
    cerebral oedema

    congested heart failure
  203. sodium bicarbonate 8.4%

    presentation
    100ml bottle
  204. sodium bicarbonate 8.4%

    class / metabolism / schedule
    class: alkalising agent

    metabolised to Co2 + water

    sched: unscheduled
  205. sodium bicarbonate 8.4%

    adult doses

    all indications
    IV / IO : 100ml single dose only

    nb: injury with potential for crush for para 1

    all other indications para 3 only
  206. sodium bicarbonate 8.4%

    paedi dose
    IV / IO : 1ml/kg

    single dose only
  207. sodium bicarbonate 8.4%

    pharmacology
    • hypotonic alkalizing solution helps combating acidosis.
    • bicarbonate ion combine with hydrogen ion to form carbonic acid,which dissociates to carbon dioxide and water.
    • during administration the hydrogen ion levels in plasma falls ,further hydrogen comes out of the cells. To persevere electrical neutrality potassium moves into the cells thus reducing hyperkalaemia.
    • h+hco3 <-----> h2oco2 <---> co2 + h2o
  208. sodium chloride 0.9%

    indications
    hypovolaemic shock :

    cardiogenic shock :inadequate tissue perfusion

    burns : deep / full / >15%

    flush:

    dissolve / dilute drugs : IM / IV / IO
  209. sodium chloride 0.9%

    contraindications
    nil
  210. sodium chloride 0.9%

    precautions
    pt`s with hx /acute heart failure

    renal failure

    uncontrolled bleed : unless associated with severe head injury
  211. sodium chloride 0.9%

    pharmacology
    isotonic crystalloid, electrolyte replenisher for maintenance or replacement of fluid deficits
  212. sodium chloride 0.9%

    special notes
    uncontrolled haemorrhage use to maintain a radial pulse

    traumatic brain injury use to maintain systolic bp of 100-120/p in adult

    reassess every 250--500ml
  213. atropine

    indications
    bradycardia: with poor perfusion pre adrenaline

    envenomation: with increased parasympathetic activity

    organophospahate toxicity: with cardiac or resp compromise

    hypersalivation : with ketamine use
  214. atropine


    contraindications
    KSAR
  215. atropine

    precautions
    atrial flutter

    atrial fibrillation

    AMI

    glucoma
  216. atropine

    side effects
    agitation

    hallucinations

    dilated pupils

    dry mouth /skin 

    reduced broncho + gastric secretions

    tachycardia
  217. atropine


    presentaion
    600mcg/1ml amp
  218. atropine

    drug class
    antichlinergic  (antimuscarinic)
  219. atropine

    pharmacology
    • inhibits the action of the parasympathetic nervous system.
    • blocks the action of vagus nerve of the heart
    • increase rate of SA node
    • increases conduction thru AV node
    • blocks exocrine gland acitvity
  220. atropine

    adult dose

    bradycardia poor perfusion
    IV / IO :  600mcg repeated once @ 2min

    max dose 1.2mg
  221. atropine

    adult dose

    envenomation and organophosphate poisioning
    IM  IV  IO :   1.2mg  (2 amps)

    repeat at 5 min intervals 

    no max dose
  222. atropine

    adult dose

    hypersalivation
    IV  IO :   600mcg 

    single dose only
  223. atropine

    paedi dose

    bradycardia poor perfusion
    IV  IO : 20mcg/kg single dose not above 600mcg ( 2 amps)

    repeat once

    total max dose 40mcg/kg
  224. atropine

    paedi dose

    envenomation and organophosphate
    IM  IO  IV :

    20mcg/kg

    repeat @ 5min intervals

    no max dose
  225. atropine

    paedi dose

    hypersalivation
    IV  IO :  20mcg/kg

    single dose only - not to exceed 600mcg ( 2 amps)
  226. atropine

    onset / duration / half life
    O: 1-2 min peaks 15-20min

    D:  up to 5 hrs

    H: 3-4 hrs
  227. calcium gluconate 10%

    drug class /  presentation  / schedule  /

    metabolisim
    class: electrolyte

    pres: 0.953gram / 10ml amp

    sched: unscheduled

    met: renal glomeruli reabsorbs most of it,remained excreted by faeces
  228. calcium gluconate 10%

    indications
    hyperkalaemic cardiac arrest:

    severe hyperkalaemia: with haemodynamic compromise + or cardiac rhythm disturbance

    calcium channel blocker toxicity:

    hypotension assoc with magnesium infusion: that fails to respoond to IV fluids
  229. calcium gluconate 10%

    contraindications
    KSAR

    digoxin OD
  230. calcium gluconate 10%

    precautions
    respiratory acidosis
  231. calcium gluconate 10%


    side effects
    cardiac arrest : nil

    • all other indications :
    • syncope

    hypotenision

    bradycardia

    cardia dysrrhythmias

    cardiac arrest
  232. calcium gluconate 10%

    adult dose :all indications
    IV  IO:   10ml slow push over 2mins

    repeat once @ 10mins
  233. calcium gluconate 10%

    paedi dose  all
    IV  IO: 

    0.2ml/kg

    slow push over 2mins

    repeat once @ 10min
  234. calcium gluconate 10%

    pharmacology


    • electrolyte that plays role in muscular and neural systems.
    • involved in skeletal muscle contractions,excites coupling in cardiac and smooth muscle
    • intracellular 2nd messenger
    • these effects combine to exert a positive inotropic effect in cardiac arrest pt`s
    • has a role in cardiac membrane stabilisation in hyperkalaemia
  235. frusemide 

    pharmacology  and  drug class
    loop diuretic inhibits sodium and chloride absorption in the ascending loop of henle. (proxmial and distal tubes)
  236. frusemide 

    indications
    Congestive Cardiac Failure

    fluid overload

    oliguria: after correction of hypotension and hypovolaemia
  237. frusemide 

    contraindications
    KSAR

    pt`s under 12yrs
  238. frusemide 

    precautions
    hypotension
  239. frusemide 

    side effects
    can lead to hypotension

    potassium loss may cause dysrrhythmias
  240. frusemide 

    presentation
    20mg / 2ml amp
  241. frusemide 

    onset / duration / half lifeschedule
    O: 3-5mins peals in 30 min

    D: 2hrs

    H: 100 mins

    Sched:  s4
  242. frusemide 

    dose adult only
    IV :  40mg (2 amps) consider repeat @ 5min

    max total 80mg (4 amps)
  243. ketamine

    indications
    pain : servere burns following morphine 

    •        : multipal or significant #`s (requiring         extraction) post morphine up to 0.3mg/kg
    •        
    •        :# reduction / splinting (post morphine)
  244. ketamine

    contraindications
    KSAR

    Pt`s under 5yrs

    GCS 12 or under

    ACS

    hypertension: sbp of 180 or over or dbp of 110 or over 

    known hydrocephalus or raised intra-ocular pressure
  245. ketamine

    precautions
    pt`s over 65yrs

    pt`s had midazolam or other CNS depressents

    hypovolaemia : exaggerated effects n delayed onset

    globe injury: eye

    complex face injury / #s

    impaired resp fuction

    psychotic symptoms in pt`s
  246. ketamine

    side effects
    dissociation / trance like state

    nystagmus

    disinhibition

    emergance: 10% more in adults

    hypertension

    tachycardia

    decrease GCS

    hypersalivation

    nausea/vomting

    laryngospasm

    resp depression:rare
  247. ketamine

    presentation
    200mg / 2ml vial
  248. ketamine

    adult dose
    IV  IO :  10-20mg repeated every 2-3 mins

    total max dose 1mg/kg

    prep:  mix 1 vial (200mg/2ml) with 18ml saline in 20ml syringe = 10mg/ml
  249. ketamine

    paedi dose
    IV IO: 1yr or above  100mcg/kg (0.1mg/kg)

    repeat every 2-3 mins

    total max dose 1mg/kg

    • prep: mix 1 vial (200mg/2ml) with 18ml saline in 20ml syringe =10mg/ml
    • expel 18ml then dilute with another 18ml saline = 1mg/ml
  250. ketamine

    drug class
    anesthetic

    analgesic
  251. ketamine

    metabolism
    hepatic ~ 90% excreted in urine as metabolites
  252. ketamine

    pharmacology
    • anaesthetic agent acts as NMDAreceptor antagonist.
    • at low doses =significant analgesia preserves resp drive + airway reflexes
    • minimal haemodynamic compromise as acts as sympathomimetic agent
    • may result transient hypertension + tachycardia
    • pt may have issues with perception/dis-inhibition or emergence reaction
  253. Lignocaine 2%

    indications
    Conscious VT : with out haemodynamic compromise

    To reduce pain with ezyIO drug/fluid administration: when pt not in cardiac arrest

    local anaesthesia:
  254. Lignocaine 2%

    contraindications
    KSAR

    bradicardia

    current heart failure

    heart block or conduction defects

    Torsades de Pointes
  255. Lignocaine 2%

    precautions
    hypotension + poor pefusion in conscious VT
  256. Lignocaine 2%

    side effects
    convulsions

    hypotension

    nausea

    tinnitus
  257. Lignocaine 2%

    presentaion
    100mg / 5ml amp
  258. Lignocaine 2%

    routes
    • IV
    • IO
    • subcut
  259. Lignocaine 2%

    adult dose

    conscious VT
    IV :  1-1.5mg/kg slow push over 2 mins

    repeat once at half inital dose @ 10 min

    total max dose 300mg
  260. Lignocaine 2%

    adult dose

    EZ-IO
    IO : 60mg   - (40mg then rapid 10ml flush,followed by another 20mg)

    total max 60mg
  261. Lignocaine 2%

    paedi dose

    EZY IO
    IO:   1mg/kg single dose only

    max dose 20mg
  262. Lignocaine 2%

    drug class
    anti-arrhythmic

    local analesthetic
  263. Lignocaine 2%

    pharmocology / metabolisim
    • sodium channel blocker
    • stabilises all excitable membranes and prevents the transmission of nerve impulses
    • decreases cardiac muscle + conduction velocity thru AV node.

    also a local anaesthetic

    metabolisim: 80% by the liver remainder by kidneys
  264. Lignocaine 2%

    onset / duration / halflife /schedule
    O: 1-2 mins

    D: 20-30 mins

    H: 1-2 hrs

    Sced: s4 restricted drug
  265. magnsuim sulphate

    indications
    box jelly fish sting: unresponsive to viniger,ice,narcotics

    Eclampisa:

    Life threatening asthma: only in py`s requirng IM/IV adrenaline

    Torsades de Pointes:

    Irukandji sting: bp>160 pain unrekieved with narcotics
  266. magnsuim sulphate

    contraindications
    KSAR

    Heart block

    Renal failure
  267. magnsuim sulphate

    precautions
    renal impairment
  268. magnsuim sulphate

    side effects
    pain @ IV site

    magnesium toxicity: = hypotension,resp depression/loss of tendon reflexes
  269. magnsuim sulphate

    presentaion
    10mmol (2.47g) in 5ml ampoule
  270. magnsuim sulphate

    adult dose

    asthma
    IV  IO:   10mmol slow push over 10min

    single dose only
  271. magnsuim sulphate

    adult dose

    Torsades de pointes
    IV  IO:   10mmol slow push over 10min

    repeat once @ 10mins

    total max dose 20mmol
  272. magnsuim sulphate

    adult dose

    irukandji syndrome / eclampsia
    IV  IO:  20mmol slow push over 10mins

    repeat once if indicated at 10mins
  273. magnsuim sulphate

    adult dose 

    box jelly fish
    IV  IO: 20mmol slow push over 10mins

    single dose only
  274. magnsuim sulphate

    paedi dose

    life threat asthma
    IV  IO:  0.1mmol/kg

    • round up to nearest .05mmol
    • slow push over 10mins

    single dose only not to exceed 5mmol
  275. magnsuim sulphate

    paedi dose

    torsades de pointes
    IV IO:  0.1mmol/kg

    • round up to nearest 0.5mmol
    • slow push over 10mins

    • single dose not to exceed 5mmol
    • repeat once @ 10mins

    total max dose 10mmol
  276. magnsuim sulphate

    paedi dose

    box jelly / irukandji
    • IV IO:    0.1mmol/kg
    •  round up to nearest 0.5mmol

    slow push over 10mins

    single dose not to exceed 5mmol

    repeat once @ 10mins

    total max dose 10mmol
  277. magnsuim sulphate

    drug class / metabolisim
    Class:  electrolyte

    Met:  excreted mostly in urine small amounts in faeces and saliva
  278. magnsuim sulphate

    pharmocolgy
    causes vasodilation / bronchodilation thu inhibition of smooth muscle contraction

    also has anticonvulsant and anit-dysrrhythmic properties
  279. weight calculation
    paedi
    age x 3 + 7   =kg

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