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CPG Pharmacology

Aspirin - Presentation 300mg water dispersible or chewable tablet
Aspirin - Pharmacology An antipyretic, anti-inflammatory, anti-platlet aggregation agent
Aspirin - Metabolism Converted to salicylate in the gut mucose, excreted by the kidneys
Aspirin - Primary Emergency Indications To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in Acute Coronary Syndrome
Aspirin - Contraindications 1. Hypersensitivity to Aspirin and salicylates 2. Suspected dissecting Aortic Aneurysm 3. Actively Bleeding Peptic Ulcers 4. Bleeding Disorders 5. Chest pain associated with psychostimulant OD, BP >160
Aspirin - Precautions 1. Peptic Ulcer 2. Asthma 3. Pts on anti coagulants, ie Warfarin
Aspirin - Route of Administration Oral
Aspirin - Side Effects - Heart Burn. Nausea, GI bleeding - Hypersensitivity reactions - Increased Bleeding time
Aspirin - Special Notes - Aspirin is contraindication for use in acute febrile illness in children and adolescents. - Anti-platelet effects last for the natural life of the platelets, Duration: 8-10 days
Adrenaline - Presentation 1mg:1000 1mg:10000
Adrenaline - Pharmacology A naturally occurring α and β adrenergic stimulant
Adrenaline - Actions Actions: - ↑ pulse rate by increasing SA node firing rate (β1) - ↑ conduction velocity through the AV node (β1) - ↑ myocardial contractility (β1) - ↑ Ventricular irritability (β1) - Bronchodilation (β2) - Peripheral vasoconstriction (α)
Adrenaline - Metabolism By Monamine Oxidase and other enzymes in blood, liver and around nerve endings, excreted by the kidneys
Adrenaline - Primary Emergency Indications 1. VF or persistant pulseless VT 2. Asystole 3. PEA/EMD 4. Inadequate Perfusion (Cardiogenic) 5. Inadequate Perfusion (Non-Cardiogenic) 6. Anaphylaxis 7. Severe Asthma 8. U/C asthma no BP 9. Croup or suspected croup 10. Bradycardia with poor perf
Adrenaline - Contrindications Hypovolaemic shock without adequate fluid replacement
Adrenaline - Precautions 1. Elderly 2. Pts with CV disease 3. Pts on MAOI's 4. Pts on Beta-blockers, higher doses may be required
Adrenaline - Route of Administration IM, IV, IV infusion, ETT, Neb, IO
Adrenaline - Side Effects Sinus Tachycardia Ventricular Arrhythmias Supraventricular Arrhythmias HTN Pupillary dilatation May ↑ size of AMI Anxiety and palpitations in the conscious pt
Adrenaline - Special Notes IV adrenaline should be reserved for life threatening situations
Adrenaline - Therapeutic Effects IM: onset = 30-90s, peak = 5-10mins, duration = 4-10mins IV: onset = 30sec, peak= 3-5mins, duration = 5-10mins
Ceftriaxone - Presentation 1g sterile powder in vial
Ceftriaxone - Pharmacology A cephalasporin antibiotic
Ceftriaxone - Metabolism Excreted unchanged in urine (33%-67%), and in bile
Ceftriaxone - Primary Emergency Indication 1. Meningococcal Septicaemia 2. Severe Sepsis (consult)
Ceftriaxone - Contraindications Allergy to cephalasporin antibiotics
Ceftriaxone - Precautions Allergy to Penicillin
Ceftriaxone - Route of Administraion IV (preferred) IM
Ceftriaxone - Side Effects N/V Skin Rash
Ceftriaxone - Special Notes Adult Dose = 1g, Paediatric dose = 50mg/kg IV - doses made up to 10mls using sterile water given over 2mins IM - does made up with 4ml 1% Lignocaine - admin to Upper Lateral Thigh
Dextrose 10% - Presentation 50g in 500ml infusion soft pack
Dextrose 10% - Pharmacology Slightly hypertonic crystalloid solution Composition: Sugar and water Actions: source of energy, supplies total body water
Dextrose 10% - Metabolism Dex: broken down in most tissues and stored in liver and muscle as glycogen Water: Excreted by kidneys, distributed through body water, mainly in ECF compartment
Dextrose 10% - Primary Emergency Indications Diabetic hypoglycaemia with random BSL of <4mmol, in pts with ACS or unable to self administer oral glucose.
Dextrose 10% - Contraindications, Precautions, Side Effects Nil
Dextrose 10% - Route of Administration IV infusion
Dextrose 10% - Special Notes IV: Onset = 3mins, Duration = dependant on severity of hypoglycaemic episode
Fentanyl - Presentation 600mcg:2ml and 100mcg:2ml
Fentanyl - Pharmacology A synthetic narcotic analgesic
Fentanyl - Actions CNS - Depression (leading to analgesia) - Respiratory Depression (leading to apnoea) - Dependance (addiction) CV - decreases conduction velocity through the AV node
Fentanyl - Metabolism by the liver
Fentanyl - Primary Emergency Indications RSI Sedation to maintain intubation Sedation to enable intubation Analgesia - IV/IN
Fentanyl - Contraindications Known Hypersensitivity IV Amiodarone
Fentanyl - Precautions Elderly Impaired renal/hepatic function Respiratory Depression (COPD) Current Asthma Pts on MAOI's Narcotic addiction Rhinitis, Rhinorrhea or facial trauma Oral Amiodarone
Fentanyl - Route of Administration IV, IN
Fentanyl - Side Effects Respiratory Depression Apnoea Rigidity of diaphragm and intercostal Muscles Bradycardia
Fentanyl - Special Notes - Fentanyl = S8 drug (carefully controlled with accountability and responsibility) - can reverse effects with Naloxone Hydrochloride - 100mcg Fentanyl = 10mg Morphine IV: onset = 2mins, peak = <5mins, duration = 30-60mins IN: peak = 2mins
Glucagon - Presentation 1mg (IU) in 1ml hypokit
Glucagon - Pharmacology A hormone normally secreted by the pancreas Actions: causes increase in blood glucose concentration by converting stored liver glycogen to glucose
Glucagon - Metabolism By the liver mainly. Also by the kidneys and plasma
Glucagon - Primary Emergency Indications Diabetic hypoglycaemia with random BSL of <4mmol, in pts with ACS or unable to self administer oral glucose.
Glucagon - Contraindications and Precautions Nil
Glucagon - Route of Administration IM
Glucagon - Side Effects Nausea and Vomiting (rare)
Glucagon - Special Notes Not all pts will respond to Glucagon. Those with inadequate glycogen stores - ie alcoholics and malnutrition IM: Onset = 3-5mins, Duration = 12-25mins
Glyceryl Trinitrate - Presentation 0.6mg tablet, 0.4mg transdermal patch
Glyceryl Trinitrate - Pharmacology Principally a smooth muscle relaxant
Glyceryl Trinitrate - Actions Actions: - Venous dilatation promotes venous pooling and reduces venous return to the heart (reduces preload) - Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces afterload)
Glyceryl Trinitrate - Effects -↓ O2 demand -↓ sys, dias and mean arterial pres whilst maintained coronary artery perfusion pres -Mild coronary arterial dilatation may ↑ blood supply to ischaemic areas -Mild tachycardia 2° to fall in BP -Pre term labour: uterine quiscence in preg
Glyceryl Trinitrate - Metabolism The Liver
Glyceryl Trinitrate - Primary Emergency Indications 1. Chest Pain associated with acute coronary syndrome 2. Acute LVF 3. HTN associated with acute coronary syndrome 4. Autonomic Dysreflexia 5. Pre Term Labour (consult)
Glyceryl Trinitrate - Contraindications 1. Known hypersensitivity 2. BP <110 sys (tablets) 3. BP <90 sys (patch) 4. Viagra and Levitra in previous 24hrs or Cialis in previous 4 days 5. HR > 150 6. Bradycardia <50 (excl AD) 7. VT 8. Inferior STEMI BP < 160 9. RVI
Glyceryl Trinitrate - Precautions 1. no previous admin 2. recent AMI 3. Elderly 4. Concurrent use with other tocolytics
Glyceryl Trinitrate - Rout of Administration Buccal, S/L, Transdermal IV infusion (IHT)
Glyceryl Trinitrate - Side Effects Headache Tachycardia hTN Skin Flushing and Bradycardia (Rare)
Glyceryl Trinitrate - Special notes - Susceptible to heat and moisture - Do not administer pts own meds - quality may not be in optimum conditions - All pts should be asked about PED5 inhibiters as both sexes can take them - GTN infusion may be required for IHT - signed off by treating D
Glyceryl Trinitrate - Therapeutic effects Buccal: O = 30s-2mins, P = 5-10mins, D=10-30mins IV: O = 30s-1min, P = 3-5mins, D = 15-30mins Transdermal: O = up to 30mins, P=2hrs
Ipratropium Bromide - Presentation 250mcg:1ml (polyamp)
Ipratropium Bromide - Pharmacology Anticholinergic Bronchodilator Actions: - allows bronchoconstriction by inhibiting cholinergic bronchomotor tone (ie, blocks vagal reflex that mediate bronchoconstriction)
Ipratropium Bromide - Metabolism Liver and Kidneys
Ipratropium Bromide - Primary Emergency Indications Severe Respiratory Distress associated with bronchspasm
Ipratropium Bromide - Contraindications Known hypersensitivity to Atropine and its derivatives
Ipratropium Bromide - Precautions 1. Glaucoma 2. Avoid eye contact
Ipratropium Bromide - Route of Administration Nebulised in conjunction with Salbutamol
Ipratropium Bromide - Side Effects Headache Nausea Dry Mouth Skin Rash Tachycardia and palpitations (rare) Acute angle glaucoma secondary to eye contact (rare)
Ipratropium Bromide - Special Notes Isolated reports of ocular complications, increased intraocular pressure, acute angle glaucoma, eye pain due to eye contact. Ensure pt is upright and fitted correctly to pt to prevent this. Single dose only in conjunction with salbutamol
Ipratropium Bromide - Therapeutic Effects O=3-5mins, P1.5-2hrs, D=6hrs
Lignocaine - Presentation 50mg:5ml (1%) - for IM injection
Lignocaine - Pharmacology A local anaesthetic Actions: Prevents initiation and transmission of nerve impulses causing local anaesthesia (1% solution)
Lignocaine - Metabolism Liver - 90% Kidneys unchanged - 10%
Lignocaine - Primary Emergency Indications IM administration (1% solution) Dilutent for Ceftriaxone for IM administration in suspected meningococcal disease
Lignocaine - Contraindication Known hypersensitivity
Lignocaine - Precautions When using Lignocaine 1% as dilutent, care must be taken so to rule out inadvertent IV administration due to potential CNS complications
Lignocaine - Route of Administration IM (1% solution with Ceftriaxone only)
Lignocaine - Side Effects Nil - unless inadvertent IV administration
Lignocaine - Special Notes O= Rapid D = 60-90mins
Methoxyflurane - Presentation 3ml glass bottle with plastic seal
Methoxyflurane - Pharmacology Inhalational analgesic at low concentrations
Methoxyflurane - Metabolism Mainly by the kidneys and by the liver
Methoxyflurane - Primary Emergency Indication Pre Hospital Pain Relief
Methoxyflurane - Contraindication 1. Pre existing renal disease/impairment 2. Concurrent use of tetracycline antibiotics 3. Exceeding a total of 6ml in a 24hr period
Methoxyflurane - Precautions 1. The penthrox inhaler must be hand held by the pt. If the pt because U/C the inhaler will fall from the pts mouth. Occasionally the operator may have to assist whilst continuously assessing the pts level of consciousness 2. Pre Eclampsia
Methoxyflurane - Route of administration Self administration under supervision using the hand held penthrox inhaler with oxygen supplementation
Methoxyflurane - Side Effects 1. Drowsiness 2. Bradycardia/hTN 3. Exceeding max dose of 6ml in 24hr period may lead to renal toxicity
Methoxyflurane - Special Notes Max priming dose = 3ml providing ~25mins of analgesia and may be followed by one further 3ml dose once initial dose is exhausted if required. Analgesia commences after 8-10 breaths and lasts 3-5mins once discontinued
Metoclopramide - Presentation 10mg:2ml
Metoclopramide - Pharmacology An anti-emetic which accelerates gastric emptying and peristalsis. Mild STH3 receptor antagonist
Metoclopramide - Primary Emergency Indication N/V associated with - Chest pain/discomfort of a Cardiac nature - Opioid administration for pain - Cytotoxic or radiotherapy - Previously diagnosed migrane - Sever gastroenteritis - Treatment or prophylaxis for awake spinally immobilised pts - Eye
Metoclopramide - Contraindications 1. Children 2. Suspected bowl obstruction or perforation 3. GI haemorrhage
Metoclopramide - Precautions 1. Undiagnosed abdominal pain 2. Adolescents <20yrs 3. Administer slowly over 1min to minimise risk of extra pyramidal reactions
Metoclopramide - Route of Administration IV, IM
Metoclopramide - Side Effects Drowsiness Dry mouth Muscle Tremor Lethargy Extra Pyramidal reactions - usually the dystonic type
Metoclopramide - Special Notes Not effective for established motion sickness Not effective for nausea prophylaxis in setting of opioid administration IV: O = 1-3mins, D = 10-30mins IM: O = 10-15mins, D = 1-2hrs
Midazolam - Presentation 5mg:1ml, 15mg:3ml
Midazolam - Pharmacology A short acting central nervous system depressant Actions: anxiolytic, anticonvulsant, Sedative
Midazolam - Metabolism Liver - excreted by the kidneys
Midazolam - Primary Emergency Indications 1. Continuous recurrent seiz 2. Sedation to maintain Intub. 3. Sedation to enable intub. 4. RSI 5. Sedation for synchronised cardioversion 6. Sedation in the agitated pt 7. Sedation in psychostimulant OD 8. Convulsions associated with Lignocaine to
Midazolam - Contraindications Hypersensitivity to benzodiazepines
Midazolam - Precautions 1. ↓ doses may be required for the elderly, pts with chronic renal failure, cardiac failure or shock 2. CNS effects may be enhanced in presence of alcohol and other tranquilisers 3. Can cause severe resp depression in pts with COPD 4. Myasthenia Gravis
Midazolam - Route of Administration IM and IV
Midazolam - Side Effects 1. Depressed level of conciousness 2. Respiratory Depression 3. Loss of Airway control 4. hTN
MIdazolam - Special Notes Midaz not permitted for use in transportation of pts recommended under the Mental Health Act. If sedation required, must be administered by prescribed medical officer or RN IM: O = 3-5mins, P = 15mins, D = 30mins IV: O = 1-3mins, P = 10mins, D = 20min
Morphine - Presentation 10mg:1ml
Morphine - Pharmacology A Narcotic Analgesic CNS Actions: -Depression -Resp Depress -Depression of Cough Reflex -Stimulation (mood changes, Euphoria/Dysphoria, pin point pupils, V) -Dependance (addiction) CV effects - Vasodilatation - ↓ conduction velocity through AV
Morphine - Metabolism Liver, excreted by the kidneys
Morphine - Primary Emergency Indications 1. Pain Relief 2. Acute LVF with SOB and full field crackles 3. Sedation to maintain intubation 4. Sedation to enable intubation 5. RSI
Morphine - Contraindications 1. Known hypersensitivity 2. Late second stage labour
Morphine - Precautions 1. Elderly 2. hTN 3. Respiratory depression 4. Currant Asthma 5. Respiratory Tract burns 6. Addiction to narcotics 7. Acute Alcoholism 8. Pts on MAOI's
Morphine - Route of Administration IV, IV infusion, IM
Morphine - Side Effects CNS effects -Drowsiness -Resp Depression -Euphoria - N/V - Pin-point pupils - Addiction CV effects - hTN - Bradycardia
Morphine - Special Notes -Morphine is an S8 drug, use must be carefully controlled with accountability and responsibility - S/Es can be reversed with Narcan - Occasionally wheals can be seen in line of vein in IV admin = not an Ax, rather a histamine release
Morphine - Therapeutic Effects IM: O = 10-30 mins, P = 30-60mins, D = 1-2 hrs IV: O = 2-5mins, P = 10mins, D = 1-2hrs
Naloxone - Presentation 0.4mg:1ml 2mg in 5ml prepared syringe
Naloxone - Pharmacology A narcotic antagonist Actions: Prevents or reverses effects of narcotics
Naloxone - Metabolism By the liver
Naloxone - Primary Emergency Indication ACS or respiratory depression secondary to administration of narcotics or related drugs
Naloxone - Contraindications Nil
Naloxone - Precautions 1. If pt known to be physically dependant on narcotics, be prepared to deal with a combative pt 2. Neonates
Naloxone - Route of Administration IV, IM
Naloxone - Side Effects Symptoms of Narcotic withdrawal : - Sweating, goose flesh, tremor - N/V - Agitation - Dilation of pupils - Excessive lacrimation - Convulsions
Naloxone - Special Notes (1) -Since duration of NH shorter than narcs, rptd doses may be req -NH reverses narc effects with no actions produced by other narcotic antagonists -In absence of narcotics = no perceivable effects -Following narcotic arrest or HI, do not admin NH. Ventil
Naloxone - Special Notes (2) -In neonates, if mother has had narcotic analgesic within 1 hr prior to delivery, the baby may have narcotic related resp depression = diluted NH may be required upon consultation IV: O = 1-3mins, D = 30-45mins IM: O = 1-3mins, D = 30-45mins
Normal Saline - Presentation 10ml Polyamp, 1000ml and 500ml infusion soft pack
Normal Saline - Pharmacology An isotonic crystalloid solution Composition: -Electrolytes - Na & CL, similar to conc. of ECF -H20 Action: Transiently increases vol. of intravascular compartment
Normal Saline - Metabolism Electrolytes: Excreted by the kidneys H2O: excreted by the kidneys and distributed through total body H2O, mainly in ECF compartment.
Normal Saline - Primary Emergency Indications 1. Replacement fluid for vol-depleted pts 2. Expand intravascular vol in non-cardiac, non-hypovol hTN pt ie. anaphyl, burns, sepsis 3. Fluid challenge in unresponsive non-hypovolaemic hTN pts other than LVF, ie asthma, PEA 4. Emerg Drug dilution 5. TK
Normal Saline - Contraindications, Precautions and Side Effects Nil
Normal Saline - Route of Administration IV
Normal Saline - Special Notes Intravascular half life ~30-60mins
Prochlorperazine - Presentation 12.5mg:1ml
Prochlorperazine - Pharmacology An anti-emetic Actions: Acts on several central neurotransmitter systems
Prochlorperazine - Metabolism By the liver, excreted by the kidneys
Prochlorperazine - Primary Emergency Indications Treatment prophylaxis for N/V associated with: 1. Vertigo 2. Motion Sickness 3. Allergy or Contraindication to Metoclopramide 4. Planned aeromedical evacuation 5. Headache - irrespective of N/V
Prochlorperazine - Contraindications 1. Previous Hypersensitivity 2. Children 3. CNS depression 4. CV collapse
Prochlorperazine - Precautions 1. Epilepsy 2. hTN 3. Pts affected by alcohol or on antidepressants
Prochlorperazine - Route of Administration IM
Prochlorperazine - Side Effects Skin Rash Sinus Tachycardia hTN Extra pyramidal reactions (dystonic type) Drowsiness Bradycardia
Prochlorperazine - Special Notes Onset: 20mins Peak: 40mins Duration: 6Hrs
Salbutamol - Presentation 5mg:2.5ml nebule/polyamp 5mg:5ml amp 500mcg:1ml amp
Salbutamol - Pharmacology A β-adrenergic stimulant with primarily 2 effects Actions : - cause bronchodilatation
Salbutamol - Metabolism Liver and kidneys
Salbutamol - Primary Emergency Indications Respiratory Distress with suspected bronchospasm - Asthma - Pulmonary Oedaema - COPD - Severe allergic reactions - Smoke Inhalation - Oleoresin Capsicum Spray Exposure
Salbutamol - Contraindication Nil
Salbutamol - Precautions 1. Between doses, oxygen must be administered continuously 2. Large doses of IV salbutamol known to cause intracellular metabolic acidosis
Salbutamol - Route of Administration IV, Neb, ETT, pMDI, IV infusion
Salbutamol - Side Effects Muscle Tremor Sinus Tachycardia
Salbutamol - Special Notes - IV salbutamol has no advantage over Neb salbutamol, provided adequate ventilation is occurring. - Nebules/polyamps = 1mo shelf life - IV infusion may be required for IHT for premature labour = signed off by referring hospital medical officer
Salbutamol - Therapeutic Effects Nebulised: O = 5-15mins, D = 15-50mins IV: 1-2mins, D = 10-60mins
Water for Injection - Presentation 10ml ampoule/polyamp
Water for Injection - Pharmacology A Sterile, Clear, Colourless, Tasteless, Odourless, Particle free solution pH = 5.6 - 7.7 containing no antimicrobial agents
Water for Injection - Primary Emergency Indication Used for dilutent of Ceftriaxone for IV injection
Water for Injection - Contraindication, Precaution, Side Effects, Special Notes Nil
Water for Injection - Route of Administration IV
Misoprostol - Presentation 200mcg chewable tablet
Misoprostol - Pharmacology A synthetic prostaglandin
Misoprostol - Metabolism Converted to active metabolite, Misoprostol Acid in blood Metabolised in tissues, excreted by the kidneys
Misoprostol - Primary Emergency Indications Primary Post Partum Haemorrhage
Misoprostol - Contraindications 1. Allergy to prostaglandins 2. Exclude multiple pregnancies before administration
Misoprostol - Precautions Asthma
Misoprostol - Rout of Administration Oral
Misoprostol - Side Effects Hyper-pyrexia Abdominal Cramping Diarrhoea Shivering
Misoprostol - Special Notes Side Effects noted with dose >600mcg oral dose O: 8-10mins, D: 2-3hrs
Created by: 573285069



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