Drug Cautions - JRCALC 2013 EEAST
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0.9% Sodium Chloride
- Salbutamol should be used with care in patients with:
- Overactive Thyroid
- Late Pregnancy (can relax uterus)
- Severe hypertension can occur in patients on beta-blockers and half doses should be used unless there is profound hypotension.
- Oxygen increases the fire hazard at the scene of an incident.
- Defibrillation - ensure pads are firmly applied to reduce spark hazard.
Morphine sulphate should be used with caution with patients with known severe renal or hepatic impairment - smaller doses may be used carefully and titrated to effect.
Use with extreme caution (minimal doses) during pregnancy. NOTE: Not to be used in labour pain where entonox is the analgesic of choice.
Use morphine WITH GREAT CAUTION in patients with chest injuries, particularly those with respiratory difficulty, although if respiration is inhibited by pain, analgesia may actually improve respiratory status.
Morphine should be used with caution in any patient with other respiratory problems, e.g. Asthma, COPD.
Morphine sulphate should be used with caution in patients suffering head injury, Agitation following head injury may be due to acute brain injury, hypoxia or pain. The decision to administer analgesia to an agitated head injured patient is a clinical one. It is vital that if such a patient receives opioids they are closely monitored since opioids can cause disproportionate respiratory depression, which may ultimately lead to an elevated intracranial pressure through a raised arterial pCO2
Morphine Sulphate should be used with caution in the case of acute alcohol intoxication. All opioid drugs potentiate the central nervous system depressant effects of alcohol and they should therefore be used with great caution in patients who have consumed significant quantities of alcohol
Morphine sulphate should be used with caution in patients prescribed antidepressants, sedatives or major tranquilisers as they may potentiate the effects of respiratory and cardiovascular depressant effects of morphine.
If a patient is likely to require thrombolysis then intramuscular administration should be avoided.
Ipratropium bromide should be used with care in patients with:
- Pregnancy and breast feeding.
- Prostatic hyperplasia.
- None relevant to a single dose of hydrocortisone.
- Avoid intramuscular administration if patient is likely to require thrombolysis.
There are no cautions related to the use of GTN
Glucose 40% Oral Gel
Altered level of consciousness – risk of chocking or aspiration (in such circumstances glucose gel can be administered by soaking a gauze swab and placing it between the patients lip and gum to aid absorption)
Administer via a large gauge cannula into a large vein – a 10% concentration of glucose solution is an irritant to veins (especially in extravasation)
Avoid intramuscular injection of any drug when a patient is likely to require thrombolysis.
- Hypokalaemia (low potassium) could induce arrhythmias.
- Hypotensive patient.
Any patient at risk of having a pneumothorax, pneumomediastinum and/or pneumoperitoneum e.g. polytrauma, penetrating torso injury.
- Respiratory Depression
- Should be used with caution if alcohol, antidepressants or other CNS depressants have been taken as side effects are more likely.
- Recent doses by carers/relatives should be taken in to account when calculating the maximum cumulative dose.
As the likely benefits of a single dose of Clopidogrel outweigh the potential risks, Clopidogrel may be administered in
- Patients taking non-steroidal anti-inflammatory drugs (NSAIDS)
- Patients with renal impairment.
- Hepatic disease
- Prostatic disease
Benzylpenicillin (Penicillin G)
There are no cautions to the use of Benzylpenicillin
There are no cautions to the use of Atropine in JRCALC 2013
- As the likely effects of a single 300 milligram aspirin outweigh the potential risks, aspirin may be given to patients with:
- Kidney or liver failure
- Gastric or duodenal ulcer
- Current treatment with anticoagulants.
No cautions in the context of treatment of cardiac arrest.
Severe hypertension may occur in patients taking beta-blockers and half doses should be administered unless there is profound hypotension.
For patients taking tricyclic antidepressants half doses should be administered for anaphylaxis
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