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UK Paramedic Drugs
UK Ambulance Service Paramedic Drugs JRCALC 2013
| Question | Answer |
|---|---|
| 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 |
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