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UK Paramedic Drugs

UK Ambulance Service Paramedic Drugs JRCALC 2013

QuestionAnswer
Adrenaline- Presentation Pre Filled syringe or ampule containing 1mg in 1ml (1:1000) Pre Filled syringe or ampule containing 1mg in 10ml (1:10000)
Adrenaline- Indications Cardiac Arrest, Anaphylaxis, Life threatening asthma with failing ventilation and continued deterioration, despite nebuliser therapy
Adrenaline- Actions A sympathomimetic that stimulates both alpha and beta adrenergic receptors. Therefore myocardial and cerebral blood flow is enhanced, due to increased peripheral resistance which improves perfusion pressures
Adrenaline- Contra-indications Do not give repeated doses to hypothermic patients
Adrenaline- Cautions Hypo tension may occur in pts on beta-blockers, therefore give half doses For pts on tricyclic antidepressants, half doses used for anaphylaxis
Adrenaline- Cardiac Arrest Dosage Cardiac Arrest- 1:10000- IV- 1mg (10ml)- every 3-5 mins Shockable rhythm - after 3rd shock then after every alternative (ie 5th, 7th etc) Non Shockable rhythm- after IV access gained, then alternative loops
Adrenaline- Anaphylaxis and Life threatening Asthma Dosage 1:1000- IM - 0.5ml- every 5 mins
Amiodarone- Presentation Pre filled syringe containing 300mg in 10ml
Amiodarone- Indications Cardiac Arrest- Shockable rhythm
Amiodarone- Actions Anti-arrhythmic- lengthens cardiac action potential- prolongs QT interval on ECG Blocks sodium and potassium channels in cardiac muscle Acts to stabilise and reduce electrical irritability of cardiac muscle
Amiodarone- Contra-indications None in cardiac arrest
Amiodarone- Side Effects Bradycardia, Hypotension, Bronchospasm, Arrhythmias- Torsades de pointes
Amiodarone- Cautions Administer into large vein as extravastion can cause burns
Amiodarone- Dosage 300mg IV/IO after 3rd shock- repeated 150mg after 5th shock
Aspirin- Presentation 300mg tablet
Aspirin- Indications Adults with clinical or ECG evidence of MI or ischemia
Aspirin- Actions Anti-platelet action to reduce clot formation, Analgesic, Anti-pyretic, Anti-inflammatory
Aspirin- Contra-indications Known allergy, Children under 16, GI Bleeding, Haemophilia, Severe hepatic disease
Aspirin- Side Effects Gastric bleeding, Wheezing in some asthmatics
Aspirin- Cautions As the benefits outweigh the risk, can be given to pts with Asthma, Pregnancy, Kidney or liver failure, Gastric or duodenal ulcers, Current treatment with anticoagulants
Aspirin- Dosage 300mg chewed. Can be given regardless of how much aspirin taken that day
Atropine- Presentation 1mg in 1ml
Atropine- Indications Absolute bradycardia (less than 40bpm), Hypotension, ventricular arrhytmias, inadequate perfusion causing confusion (Note hypoxia is biggest cause of bradycardia in children. Give O2 first)
Atropine- Actions May reverse the effects of vagal overdrive, May increase heart rate by blocking vagal nerve activity in bradycardia or second or third degree heart block, Enhances AV conduction
Atropine- Contra-indications Should not be used in Hypothermic pts
Atropine- Cautions None
Atropine- Side effects Dry mouth, blurred vision, dilated pupils, Confusion, hallucinations, Tachycardia, urine retention
Atropine- Dosage 0.6 mg IV/IO - repeated 3-5 mins. Max dose 3mg
Benzylpenicillin (Pen G)- Presentation Ampoule containing 600mg Pen G as powder. To be dissolved in WFI
Benzylpenicillin (Pen G)- Indications Suspected meningococcal disease with non-blanching rash and S&S suggestive of meningococcal septicaemia
Benzylpenicillin (Pen G)- Actions Broad spectrum antibiotic
Benzylpenicillin (Pen G)- Contra-indications Known Severe penicillin allergy (more than simple rash)
Benzylpenicillin (Pen G)- Cautions None
Benzylpenicillin (Pen G)- Dosage IV- 1.2g dissolved with 20ml WFI- Given while on-route to hospital IM- 1.2g dissolved with 4ml WFI- Slow injection- Given while on-route to hospital
Chlorphenamine - Presentation Ampoule containing 10mg in 1ml
Chlorphenamine - Indications Severe anaphylactic reactions, reactions causing distress ie severe itching
Chlorphenamine - Actions Antihistamine, anticholinergic (relaxes smooth muscles) properties
Chlorphenamine - Contra-indications Children less than 1 year, Known hypersensitivity
Chlorphenamine - Cautions Hypotension, Epilepsy, Glaucoma, Hepatic or Prostatic disease
Chlorphenamine - Side effects Sedation, Dry mouth, Headache, Blurred vision, Psychomotor impairment, GI disturbance, Hypotension, convulsions, Elderly more likely to suffer side effects, Warn against driving
Chlorphenamine - Dosage IV 10mg (1ml) given slowly over 1 minute
Clopidogrel - Presentation Tablet containing 75mg or 300mg
Clopidogrel - Indications STEMI
Clopidogrel - Actions Inhibits platelet aggregation
Clopidogrel - Contra-indications Active bleeding, Known allergy, Liver impairment, Breastfeeding
Clopidogrel - Cautions As the benefits' outweigh the risk, can be given to pts with Pregnancy, Renal impairment, NSAIDs
Clopidogrel - Side effects Dyspepsia (indigestion), Abdo pain, Diarrhoea, Bleeding
Clopidogrel - Dosage 300mg oral tablet. Single dose
Diazepam - Presentation Ampoule containing 10mg in 2ml Rectal tube containing 2.5mg, 5mg or 10mg
Diazepam - Indications Fits longer than 5 mins and still fitting, Repeated fits, Status epilepticus, Eclamptic fits (if fits last more than 2-3 mins)
Diazepam - Actions Central Nervous System depressant (anticonvulsant and sedative)
Diazepam - Contra-indications None
Diazepam - Cautions Respiratory depression, Doses given by carers, If pt has used alcohol or other medications
Diazepam - Side effects Respiratory depression, Hypotension, Drowsiness, Confusion
Diazepam - Dosage IV- 10mg given slowly, titrated to response, further 10mg given after 5 mins. Max 20mg Rectal- Single tube. If dose given PR and then IV access gained, single dose can be given IV
Entonox - Presentation Nitrous oxide 50% and Oxygen 50%. Blue cylinder with white shoulders
Entonox - Indications Moderate to severe pain, Labour pain
Entonox - Actions Inhaled analgesic agent
Entonox - Contra-indications Severe head injuries, Decompression sickness (The bends), Violently disturbed psychiatric pts
Entonox - Cautions Pneumothorax, Poly trauma chest injuries
Entonox - Dosage Self administered 3-10 mins till effect is achieved.
Furosemide - Presentation Ampoules containing 50mg/5ml or 40mg/2ml Prefilled syringe containing 80mg
Furosemide - Indications Pulmonary oedema secondary to LVF
Furosemide - Actions Diuretic, rapid onset (within 30mins) and short duration
Furosemide - Contra-indications Pre comatose state secondary to liver cirrhosis, Severe renal failure with anuria
Furosemide - Cautions Hypokalaemia (low potassium)can induce arrhythmias, Pregnancy, Hypotension
Furosemide - Side effects Hypotension, GI disturbance
Furosemide - Dosage IV- 50mg slowly over 5 mins. Single dose. Give GTN first.
Glucagon - Presentation 1mg powder in vial made up with WFI
Glucagon - Indications Hypoglycaemia where oral glucose administration is not possible due to reduced LOC
Glucagon - Actions A hormone that converts glycogen to glucose in the liver thereby raising blood sugar levels
Glucagon - Contra-indications Low glycogen stores (recent use of glucagon), Hypoglycaemic seizures- IV Glucose 10% is preferred
Glucagon - Cautions Avoid IM administration of a drug if thrombolysis is required
Glucagon - Side effects Nausea, vomiting, diarrhoea, Hypersensitivity, Hypokalaemia, Hypotension
Glucagon - Dosage IM- 1mg (1 vial). Single dose.
Glucose 10% - Presentation 500ml bag of 10% glucose (50 grams)
Glucose 10% - Indications Hypoglycaemia where oral glucose administration is not possible due to reduced LOC
Glucose 10% - Actions Reversal of hypoglycaemia
Glucose 10% - Contra-indications None
Glucose 10% - Cautions Use large bore cannula into a large vein as glucose is an irritant
Glucose 10% - Side effects None
Glucose 10% - Dosage Large bore IV cannula- 10 grams (100ml) Repeated after 5 mins. Max dose 30 grams
Glucose Oral Gel - Presentation Plastic tube containing 25 grams 40% oral gel.
Glucose Oral Gel - Indications Hypoglycaemia where there is no risk of patient choking
Glucose Oral Gel - Actions Rapid increase of blood sugars due to buccal absorption
Glucose Oral Gel - Contra-indications None
Glucose Oral Gel - Cautions Reduced LOC, Soaking gauze swab and placing in between lip and gum may help absorption
Glucose Oral Gel - Side effects None
Glucose Oral Gel - Dosage Buccal route- 10grams repeated every 5 mins. No Limit.
GTN - Presentation Metered dose spray containing 0.4 mg per dose Tablets containing 2,3 or 5 mg
GTN - Indications Cardiac chest pain due to angina or MI Acute cardiogenic pulmonary oedema
GTN - Actions Potent vasodilator. Dilatation of coronary arteries/relief of coronary spasm. Dilations of systemic veins causing lower pre load. Reduced blood pressure
GTN - Contra-indications Hypo tension (Systolic less than 90mmHg), Hypovolaemia, Head trauma, Cerebral haemorrhage, Viagra type medications, Unconscious pt.
GTN - Cautions None
GTN - Dosage 1-2 spray (0.4-0.8 mg). No limit on doses as long as BP above 90mmHg
Hydrocortisone - Presentation Ampoule containing 100mg in 1ml vial Ampoule containing 100mg for reconstitution with up to 2ml WFI
Hydrocortisone - Indications Severe or Life-threatening asthma, where call to hospital time is greater than 30 mins Anaphylaxis Adrenal crisis
Hydrocortisone - Actions Glucocorticoid drug that reduces and suppresses the immune response
Hydrocortisone - Contra-indications Known Allergy
Hydrocortisone - Cautions None relevant to a single dose. Avoid IM administration if pt likely to need thrombolysis
Hydrocortisone - Dosage Asthma and Adrenal crisis- SLOW IV (over 2 mins) 100mg single dose Anaphylaxis - SLOW IV (over 2 mins) 200mg single dose
Ipratropium Bromide - Presentation Nebules containing 0.25mg in 1 ml or 0.5mg in 2ml
Ipratropium Bromide - Indications Acute severe or life threatening asthma, Acute asthma unresponsive to salbutamol. COPD unresponsive to salbutamol
Ipratropium Bromide - Actions Antimuscarinic bronchodilator. May provide short term relief in acute asthma, but beta 2 agonists (salbutamol) work quicker Considered of greater benefit in children and adults with COPD
Ipratropium Bromide - Contra-indications None in emergency setting
Ipratropium Bromide - Cautions Use with care in pts with Glaucoma, Pregnancy and breastfeeding, Prostatic hyperplasia
Ipratropium Bromide - Side effects Headache, Nausea & vomiting, Dry mouth, Tachycardia/Arrhythmia, Chest tightness, Reaction
Ipratropium Bromide - Dosage 0.5mg with 6-8 litres O2, single dose
Metoclopramide - Presentation Ampoule containing 10mg in 2ml
Metoclopramide - Indications Treatment of nausea or vomiting in pts aged 20 and above. Prevention of nausea and vomiting following Morphine
Metoclopramide - Actions Antiemetic which acts centrally as well as on the GI tract
Metoclopramide - Contra-indications Age less than 20, Renal failure, Tumour on adrenal gland, GI obstruction , GI problems
Metoclopramide - Cautions Avoid in cases of drug overdose
Metoclopramide - Side effects Drowsiness and restlessness, Cardiac abnormalities, Diarrhoea, Rash
Metoclopramide - Dosage IV- 10mg (2ml) given over 2 mins. Single dose
Morphine Sulphate - Presentation IV- Ampoules containing 10mg in 1ml Oral- Vials containing 10mg in 5ml
Morphine Sulphate - Indications Pain associated with MI, Severe pain
Morphine Sulphate - Actions Strong opioid analgesic, severe musculoskeletal and soft tissue pain. Produces sedation, euphoria and analgesia. It may both depress respiration and induce hypotension Histamine is released and this may contribute to the vasodilatory effect.
Morphine Sulphate - Contra-indications Child under 1 year Adult RR less than 10, Child RR less than 20 Hypotension. Adult less than 90 sys. Child less than 80 sys. Preschool less than 70 sys Head Injury with significantly impaired LOC (below P on AVPU, below 9 GCS) Known hypersensitivity
Morphine Sulphate - Cautions Severe renal or hepatic impairment-?small dose Extreme care if pregnant Caution with chest injury If DIB caused by pain, it may improve after analgesia Asthma, COPD Head Injury-hypoxia or pain Intoxication Meds may potentiate effects
Morphine Sulphate - Side effects Respiratory depression, Cardiovascular depression, Nausea and vomiting, Drowsiness, Pupil constriction
Morphine Sulphate - Additional Infomation Class A-CD-schedule 2 of the Misue of Drugs Regs 1985-must be stored and its prescription and admin documented properly Unused morphine discarded in the presence of witness Narcan can reverse the effects of morphine Consider Metoclopramide
Morphine Sulphate - Dosage Record pain score May take 2-3mins-peak between 10-20mins Diluted with saline 0.9%, to make a concentration of 10mg in 10ml (1mg/1ml) IV/IO route, given slowly approx 2mg/min IV 10mg repeated 5 mins. Max 20mg Oral 20mg repeated 60mins-Max 40mg
Naloxone - Presentation Ampoule containing 0.4mg/1ml
Naloxone - Indications Opioid overdose producing respiratory, cardiovascular and central nervous system depression Unconsciousness with respiratory depression of unknown cause Reversal of respiratory or central nervous system depression in a neonate following maternal use
Naloxone - Actions Antagonism of the effects of opiate drugs
Naloxone - Contra-indications Neonates born to opiate addicted mothers - can produce serious withdrawal effects. Emphasis on BVM and O2
Naloxone - Cautions None
Naloxone - Side effects Pts dependant on opiates may have violent withdrawal symptoms. Better to titrate dose to reverse the effects but to keep pt groggy
Naloxone - Dosage IV - 0.4mg repeated every 3 mins. Max dose 4.4mg IM-0.4mg repeated every 3 mins. Max dose 4.4mg. Vary injection site.
Paracetamol - Presentation Oral solution- 120mg/5ml Used from 3 months to 5 years 250mg/5ml Used from 5 years upwards Tablets- 500mg each
Paracetamol - Indications Relief of mild to moderate pain and/or high temp
Paracetamol - Actions Analgesic and antipyretic properties
Paracetamol - Contra-indications Known allergy Do not give if a paracetamol containing product has been given within 4 hrs, or 4grams with 24hrs
Paracetamol - Cautions None
Paracetamol - Side effects None
Paracetamol - Dosage As described
Salbutamol - Presentation Nebules containing 2.5mg /2.5ml or 5mg/2.5ml
Salbutamol - Indications Acute asthma, Expiratory wheeze due to allergy/ anaphylaxis/ smoke inhalation or other lower airway cause. Exacerbation of COPD, SOB due to LVF
Salbutamol - Actions A selective beta2 adrenareceptor stimulant. Relaxes smooth muscle in the medium and smaller airways
Salbutamol - Contra-indications None in emergency situation
Salbutamol - Cautions Used in care with Hypertension, Angina, overactive thyroid, late pregnancy, severe hypertension may occur on pts on beta blockers use half doses. If COPD limit neb to 6 mins
Salbutamol - Side effects Tremor, Tachycardia, Palpitations, Headache, Feeling of tension, Peripheral vasodilatation, Cramps, Rash
Salbutamol - Dosage 5mg Nebulised with 6-8l O2, given every 5 mins. No Limit.
0.9% Sodium Chloride - Presentation Various presentations of flushes and packs/bags
0.9% Sodium Chloride - Indications Adult and Child fluid therapy, Flush to confirm IV patency and/or following IV drug administration
0.9% Sodium Chloride - Actions Increases vascular fluid volume which raises cardiac output and improves perfusion
0.9% Sodium Chloride - Contra-indications None
0.9% Sodium Chloride - Cautions None
0.9% Sodium Chloride - Side effects Over infusion may precipitate pulmonary oedema and cause breathlessness
0.9% Sodium Chloride - Dosage Flush 2ml-10ml PRN Fluid challenge- 250ml repeated PRN max. Max dose 2 litres. Refer to JRCALC
Tranexamic Acid - Presentation Vial containing 500mg in 5ml
Tranexamic Acid - Indications Pts with time critical injury where significant internal or external haemorrhage is suspected
Tranexamic Acid - Actions Anti-fibrinolytic which reduces the breakdown of blood clots
Tranexamic Acid - Contra-indications Isolated head injury, Critical interventions required (they must be done first), Bleeding now stopped
Tranexamic Acid - Cautions None
Tranexamic Acid - Side effects Rapid injection might cause hypotension
Tranexamic Acid - Dosage IV- 1gram given slowly over 10 mins
Created by: 833227113