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UK Sky drugs
| Question | Answer |
|---|---|
| Activated Charcoal ACT indication? | Adults and children 1y/o +. Toxin ingestion less than 1h before attendance. |
| Activated Charcoal countraondications? | <1 y/o. Presented > 1h. Vomiting. Reduced gastrointestinal motility. |
| Activated Charcoal presentation? | 50g in 250ml. Granules or suspension. |
| Activated Charcoal route of administration? | Oral |
| Activated Charcoal max dose for adults and children? | Adults 50g in 250ml. Children 25g in 125ml unless large amounts ingested or risk of life. |
| Can Activated Charcoal be mixed with soft drinks? What about foods and ice cream? | Can be mixed with drinks such as fizz, juice. Foods reduce absorption capability of ACT. |
| Adrenaline 1:1000. Presentation and indication? ADM | Presentation: pre-filled syringe or ampoule containing 1mg in 1ml. Indication: anaphylaxis or life threatening asthma with failing ventilation and deterioration despite nebuliser therapy. |
| Adrenaline 1:1000 action? | Reverses allergic manifestationof acute anaphylaxis. Releaves acute bronhospasm in acute severe astma. |
| How does Adrenaline 1:000 work? | Sympathomimetic. Stimulating both Alfa and Beta adrenergic receptors. Increases peripheral resistance and improves perfusion pressures. |
| Adrenaline 1:1000 cautions? | Possible severe hypotension may occur if patient is on non-cardioselective beta-blockers. (Ex. Propranolol) Do not administer IV in cases of anaphylaxis. |
| Adrenaline 1:1000 max dose? Interval? Initial dose? | Max dose - no limit. No more that 10 doses? Interval - 5min. Initial dose - 12y/0+ 500mg, 6-11y/o 300mg, 0-6y/o 150mg. |
| Adrenaline 1:1000 route of administration? | IM. Antero-lateral aspect of thigh. |
| Adrenaline 1:10000 ADX presentation me indication? | Pre-filled syringe containing 1mg in 10ml. Indication: Cardiac Arrest |
| Adrenaline ADX 1:10000 cautions? | Possible severe hypotension. Do not administer if core T <30C. If T is between 30C-35C double the interval. |
| Adrenaline ADX 1:10000 shockable rhythm administration? | 3rd shock. After every alternate shock. 1mg for >12. |
| Amiodarone Hydrochloride AMO presentation? | Pre-filled syringe containing 300mg in 10ml. |
| Amiodarone Hydrochloride AMO indication? | Cardiac Arrest. Shockable rhythms. 3rd shock. Then on 5th to max dose. |
| Amiodarone Hydrochloride AMO max dose? | Max dose: adult 450mg. |
| Amiodarone Hydrochloride AMO actions? | Antiarrhythmic - lengthens cardiac action potential. Prolongs QT interval on ECG. Blocks Na and K channels in cardiac muscle. Stabilises and reduces electric irritability of cardiac muscle. |
| Amiodarone Hydrochloride AMO counter indication? | None in cardiac arrest context. |
| Amiodarone Hydrochloride AMO side effects? | Bradycardia. Bronchospasm. Vasodilation- hypotension, flushing. Arrhythmias - torsades de pointe |
| Amiodarone Hydrochloride AMO route of administration? And caution. | IV. Into LARGE vein. Rapid bolus. Flush with 0.9% NaCh. |
| Aspirin. ASP. Presentation? | 300mg tablet. Chewable or dispersible. |
| Aspirin ASP indication? | Clinical or ECG evidence of cardiac ischaemia or MI. Suspected TIA where symptoms fully resolved, not conveyed and referred to local TIA pathway. |
| Aspirin ASP action? | Antiplatelet action, reduces clot formation. |
| Aspirin ASP contra indications? | Known aspirin allergy. Known haemophilia or clotting disorder. Severe hepatic failure with jaundice. <16y/o. Active GI bleed. |
| Aspirin ASP cautions? | Be cautious of; Asthma, pregnancy, renal failure, moderate hepatic disease, gastric or duodenal ulcer, current treatment with anticoagulants. |
| Aspirin ASP side effects? | Increased risk of gastric bleed. Wheezing in some asthmatic patients. |
| Should Aspirin ASP be given in MI situation if was raked by the patient earlier? | In suspected MI administer 300mg of aspirin regardless of previous aspirin taken that day. |
| Aspirin ASP route of administration? Max dose? | Oral/Buccal. Needs to be chewed and absorbed by the gums! Max dose - 300mg |
| Atropine Sulphate ATR presentation? | Pre-filled syringe 1mg in 5ml/10ml, 3mg in 10ml. Ampoule 6mg in 1ml. |
| Atropine Sulphate ATR indication? | SYMPTOMATIC bcardia! Absolute bcardia <40bpm + post ROSC. Sbp below expected for the age. Inadequate perfusion causing confusion. Paroxysmal ventricular arrhythmias requiring suspension. |
| Atropine Sulphate ATR plus bcardia in children? | Bcardia in children is likely to be caused by hypoxia. Focus on ABC on Oxygen therapy. |
| Atropine Sulphate contra indications? | If bcardia caused by hypothermia. If patient had a cardiac transplant. |
| Atropine Sulphate ATR actions? | Reverses effects of vagal overdrive. Inc. HR in sinus bcardia, 2nd n 3rd degree heart block. Enhances A-V conduction. |
| Atropine Sulphate ATR side effects? | Dry mouth, visual blurring, pupil dilation. Confusion and hallucinations. Tcardia. Paradoxal bcardia if small (1mg) doses used. |
| Atropine Sulphate ATR- Caution in MI situation? | May induce Tcardia. In MI this will increase oxigen demand for cardiac muscle. Only administer if bcardia causes problems with perfusion! |
| Atropine Sulphate ATR route of administration? | IV or IO - rapid bolus. |
| Atropine Sulphate ATR initial dose? Repeat dose and interval? Max dose adult? | Initial dose: 600micrograms (0.6 milligrams). Interval: 3-5min. Max dose adult: 3milligrams (5*600micrograms). |
| Benzylpenicillin Sodium BPN presentation? | Injection vial containing 600 milligrams or 1.2g of powder. |
| Benzylpenicillin Sodium BPN indication? | Suspected meningococcal infection + - non-blanching rash. - signs n symptoms suggesting meningococcal septicaemia. |
| Benzylpenicillin Sodium BPN action? | Antibiotic - narrow spectrum. b-lactam antibacterial - inhibits peptidoglycan layer of the cell wall synthesis. |
| Contra indications for Benzylpenicillin Sodium BPN? | Known penicillin allergy that is more serious than a rash alone. |
| What should be done if more than 2ml is going to be administered? | Two sites for IM injection. |
| Benzylpenicillin Sodium BPN route of administration? | IV or IO by SLOW injection. |
| When to use IM route for Benzylpenicillin Sodium BPN administration? Site of administration? | When IV/IO access can’t be gained quickly. Antero-lateral aspect of thigh or upper arm, preferably in well perfused area. |
| Benzylpenicillin Sodium BPN IV/IO initial doses for adult? Concentration? Volume? Max dose? | For 10y/o plus: In.Dose: 1.2g Conc.: 1.2g in 20ml Vol.: 20ml Max dose: 1.2g |
| Benzylpenicillin Sodium BPN IV/IO initial doses for children? Concentration? Volume? Max dose? | For in.dose 1-9y/o 600mg. <1y/o 300mg. Conc. 600mg in 10ml. 600mg in 10ml. Vol. 10ml. 5ml. Max dose. 600mg n 300mg respectively. |
| Benzylpenicillin Sodium BPN IM initial dose, max dose for adult, children. | In.dose: 10y/o+ 1.2g. 1-10y/o 600mg. 0-1y/o 300mg. Max.dose: 1.2g. 600mg n 300mg respectively. |
| Benzylpenicillin Sodium BPN concentration for IM and IV/IO administration? For ALL age groups. | IM conc.: 300mg/ml IV/IO conc.: 60mg/ml |
| Chlorphenamine CPH presentation? | Ampoule: 10mg in 1ml. Oral solution: 2mg in 5ml. Oral tablet: 4mg |
| Chlorphenamine CPH indication? | Symptomatic allergic reaction. Less severe than anaphylaxis. But causing patient distress. |
| Chlorphenamine CPH action? | Antihistamine. Blocks histamine release during hypersensitivity reaction. |
| Chlorphenamine CPH contra indications? | Known hypersensitivity. If patient had monoamine oxidase inhibitors (MAOI’s) in last 14 days. |
| Chlorphenamine CPH cautions? | Pregnancy n titfeeding. Hypotension. Epilepsy. Glaucoma. Severe liver disease. |
| Chlorphenamine CPH side effects? | Sedation. Dry mouth. Headache. Blurred vision. Urinary retention. Psychomotor impairment. GI disturbance. Convulsions. |
| Who is more likely to suffer side effects from Chlorphenamine CPH? | Children and elderly. |
| Why patients taking Chlorphenamine CPH should be warned off? | To avoid any driving or any other activity requiring complex psychomotor activity. Due to sedative side effect risk. (Ex. driving, machinery, playing jenga) |
| Chlorphenamine CPH IM standard concentration for all ages? | 1m/o+ conc.: 10mg in 1ml. |
| Chlorphenamine CPH IM max dose for all ages? | 1-3m/o - 1mg. 0.5-5y/o - 2.5mg. 6-11y/o - 5mg. 12y/o+ 10mg. |
| Chlorphenamine CPH IM volume for all ages? | 1-3m/o - 0.1ml. 0.5-5y/o - 0.25ml. 6-11y/o - 0.5ml. 12y/o+ - 1ml. |
| Chlorphenamine CPH IM minimum age? | 1 month old. |
| Chlorphenamine CPH initial dose for all ages? | 1-3m/o - 1mg. 0.5-5y/o - 2.5mg. 6-11y/o - 5mg. 12y/o+ - 10mg. |
| Chlorphenamine CPH Oral 4mg tablet minimum age? | 6y/o+ |
| Chlorphenamine CPH 4mg oral tablet initial n max dose for all ages? Amounts? | 6-11y/o - 2mg - 0.5 of a 4mg tablet. 12y/o+ - 4mg - 1 4mg tablet. |
| Chlorphenamine CPH 2mg/5ml oral solution minimum age? | 1 month. |
| Chlorphenamine CPH ORAL SOLUTION concentration? | 2mg in 5ml |
| Chlorphenamine CPH oral solution initial dose and volume for all age groups? | 1m/o-5y/o - 1mg 2.5ml. 6-11y/o - 2mg 5ml. 12y/o+ - 4mg 10ml. |
| Chlorphenamine CPH oral solution max dose for all age groups, | 1m/o-5y/o - 1mg 2.5ml. 6-11y/o - 2mg 5ml. 12y/o+ - 4mg 10ml. |
| Clopidogrel CLO presentation? | Tablet containig: 75mg 300mg |
| Clopidogrel CLO indication. | Acute STEMI if: - not already on Clopidogrel. - anticipated or receiving thrombolytic treatment - anticipated PPCI. |
| Clopidogrel CLO action? | Inhibits platelet aggregation. |
| Name contra indications for Clopidogrel CLO? | Known allergy or hypersensitivity. Known severe liver impairment. Active pathological bleeding (Ex. ICH, peptic ulcer). |
| What are cautions for Clopidogrel CLO? | - pregnancy. - NSAID’s. - renal impairment. |
| Name side effects for Clopidogrel CLO? | Dyspepsia. Abdominal pain. Diarrhoea. Bleeding (GI or ICH) |
| Clopidogrel CLO dosage for children? | Not suitable for under 18’s. |
| Is dosage of Clopidogrel CLO dependent on patient care pathway? | Yes. Dosages for thrombolysis and PPCI pathways differ. |
| Clopidogrel CLO Thrombolysis pathway initial dose? Max dose? | In.Dose: 300mg Max.Dose: 300mg |
| Clopidogrel CLO PPCI pathway initial dose? Max dose? | In.Dose: 600mg Max.Dose: 600mg |
| Clopidogrel CLO route of administration? | Oral. |
| Clopidogrel CLO should be administered in conjunction with which drug? Unless? | Aspirin. Unless known to be allergic or sensitive to aspirin. |
| Dexamethasone DEX presentation? | Oral solution: 2mg in 5ml. Soluble tablets: 2mg per tablet |
| For Dexamethasone DEX with form of presentation is preferable? Why? | Oral solution. In children with croup for accurate dosage! |
| Name indications for Dexamethasone DEX? | Mild/Moderate/Severe croup. |
| What score should be used to determine if Dexamethasone DEX is to be administered in children with croup? | Modified Taussig Score is used to determine severity of croup. |
| Dexamethasone DEX action? | Corticosteroid - reduces subglottic inflammation |
| Name contra indications for Dexamethasone DEX. | Impending respiratory failure. |
| Name cautions for Dexamethasone DEX. | Be aware that airway compromise can be worsened by any procedures causing distress to the child. Including medication administration. |
| Name side effects for Dexamethasone DEX? | GI upset. Hypersensitivity and anaphylactic reaction. |
| What should be done if a second dose of Dexamethasone DEX is required for the same episode? | Seek senior clinical advice. |
| Under what circumstances a second dose of Dexamethasone DEX can be administered? | A second dose of Dexamethasone DEX can be administered if child vomited within 30min after first dose was administered. |
| In general. What is the dose for Dexamethasone DEX? | Generally 0.15mg/kg. |
| Dexamethasone DEX route of administration? | Oral |
| Dexamethasone DEX concentration? Oral solution? Oral tablet? | Oral solution conc.: 2mg/5ml Oral tablet conc.: 2mg/tablet |
| Maximum age for Dexamethasone DEX administration? | 11y/o |
| Dexamethasone DEX initial and maximum dose for 9-11y/o? | Initial dose: 6mg Maximum dose: 6mg |
| Dexamethasone DEX oral solution initial and maximum dose for 7-8y/o? | Initial dose: 4mg Maximum dose: 4mg |
| Dexamethasone DEX oral solution initial and maximum dose for 4-6y/o? | Initial dose: 3.2mg Maximum dose: 3.2mg |
| Dexamethasone DEX oral tablet initial and maximum dose for 4-8y/o? | Initial dose: 4mg Maximum dose: 4mg |
| Dexamethasone DEX oral solution initial and maximum dose for 3y/o? | Initial dose: 2.4mg Maximum dose: 2.4mg |
| Dexamethasone DEX oral solution initial and maximum dose for 1-2y/o? | Initial dose: 2mg. Maximum dose: 2mg. |
| Dexamethasone DEX oral solution initial and maximum dose for 6-9m/o? | Initial dose: 1.6mg Maximum dose: 1.6mg |
| Dexamethasone DEX oral solution initial and maximum dose for 3m/o? | Initial dose: 1.2mg Maximum dose: 1.2mg |
| Dexamethasone DEX oral solution initial and maximum dose for 1m/o? | Initial dose: 0.8mg Maximum dose: 0.8mg |
| Dexamethasone DEX minimum age and maximum age? | 1 month old to 11y/o. |
| Dexamethasone DEX oral tablet initial and maximum dose for 1m/o - 3y/o? | Initial dose: 2mg Maximum dose: 2mg |
| Diazepam DZP presentation? | Ampoule 10mg in an oil-in-water emulsion making up 2ml. Solution for injection 10mg/2ml Rectal tube containing 2.5/5/10mg. |
| Under what circumstances Diazepam DZP solution for injection should be used? And why? | Only if oil-in-water emulsion is not available. Emulsion form is less irritating. |
| Diazepam DZP indication? | Convulsions lasting >5min. Plus currently convulsing. 3+ convulsions in an hour. Plus currently convulsing. Eclamptic convulsions. Symptomatic cocaine toxicity. |
| For what type of convulsions Diazepam DZP in not indicated? | For convulsions secondary to hypoxia, hypoglycaemia etc. |
| Diazepam DZP action? | CNS depressant. Anticonvulsant and sedative. |
| When Diazepam DZP should be used with caution? | Any other CNS depressants taken (Ex alcohol, antidepressants). Enquire if any other Diazepam DZP has been administered by family/carers. |
| Name contra indications for Diazepam DZP. | Known hypersensitivity. |
| Name side effects for Diazepam DZP. | Respiratory depression. Hypotension. Light-headedness, unsteadiness, drowsiness, confusion, amnesia. |
| What should be done if patient is prescribed with buccal midazolam? | If available, can be administered according to prescription. |
| Should Diazepam DZP be given for preventative measures? | No! Only to be administered if convulsing for >5min or convulsions happen in quick succession without recovery! |
| Can Diazepam DZP be administered en-route? | Yes! In clearly unwell or sick/ill child. |
| Should buccal midazolam be given prior to IV Diazepam DZP? | Can be given as a first dose prior to gaining IV access. |
| What is preferred route for Diazepam DZP administration? | IV if can be gained rapidly. |
| For Diazepam DZP what should be considered if IV cannot be gained rapidly? | Buccal or PR route. Provided IV access will be sought after. |
| What should be considered when giving PR medication? | Dignity of the patient. |
| What should be done when PR route is considered for children? | Pt. dignity. Give full explanation to parents. |
| How many doses of Diazepam DZP should patients receive? | All patients who continue to convulse should receive a total of TWO doses (Midazolam or Diazepam). |
| What is the interval between two doses of Diazepam/Midazolam? | 10 minutes |
| When should a second dose of Diazepam DZP be administered PR? | Only if IV/IO access could not be gained in 10 min after the first dose |
| Actions if convulsions continue 10min after second dose of Diazepam DZP? | Seek clinical advice! |
| How far can PR Diazepam tubes be inserted? Adult? Children? | Adult: 4-5cm Children: 2.5cm |
| Diazepam DZP PR initial and maximum dose for 70y/o+? | Initial dose: 10mg Max. dose: 20mg |
| Diazepam DZP PR initial and maximum dose for 12-70y/o? | Initial dose: 20mg Maximum dose: 30mg |
| Diazepam DZP PR initial and maximum dose for 5-11y/o? | Initial dose: 10mg Max dose: 20mg |
| Diazepam DZP PR initial and maximum dose for 0.5-4y/o? | Initial dose: 5mg. Maximum dose: 10mg. |
| Diazepam DZP PR initial and maximum dose for 1-3m/o? | Initial dose: 2.5mg Maximum dose: 5mg |
| Diazepam DZP PR initial and maximum dose for under 1 month olds? | Initial dose: 1.25mg Max dose: 2.5mg |
| When administering Diazepam DZP IV/IO how should it be administered? Adults? Children? | SLOWLY! Adults: over 2 minutes Children: over 3-5 minutes |
| How should Diazepam DZP IV/IO be administered in patients with symptomatic cocaine toxicity? | Titrate slowly to response. |
| For adult <70y/o where first Diazepam DZP dose was administered PR. What route should be used for second dose? And what is the maximum dose in these circumstances? | If first dose was administered PR (20mg). Second dose (10mg) should be administered IV/IO. Maximum dose 30mg. |
| For adult <70y/o where first dose was administered IV/IO. What is the second dose? What is the maximum dose? | Second dose - 10mg. Maximum dose - 20mg. |
| Diazepam DZP IV/IO initial and maximum dose for Adults? | Initial dose: 10mg Maximum dose: 20mg. |
| Diazepam DZP IV/IO initial and maximum dose for 10-18y/o? | Initial dose: 10mg Maximum dose: 10mg |
| Diazepam DZP IV/IO initial and maximum dose for 9y/o? | Initial dose: 9mg Maximum dose: 18mg |
| Diazepam DZP IV/IO initial and maximum dose for 8y/o? | Initial dose: 8mg Max dose: 16mg |
| Diazepam DZP IV/IO initial and maximum dose for 7y/o? | Initial dose: 7mg Maximum dose: 14mg |
| Diazepam DZP IV/IO initial and maximum dose for 6y/o? | Initial dose: 6.5mg Maximum dose: 13mg |
| Diazepam DZP IV/IO initial and maximum dose for 5y/o? | Initial dose: 6mg Maximum dose: 12mg |
| Diazepam DZP IV/IO initial and maximum dose for 4y/o? | Initial dose: 5mg Maximum dose: 10mg |
| Diazepam DZP IV/IO initial and maximum dose for 3y/o? | Initial dose: 4.5mg Maximum dose: 9mg |
| Diazepam DZP IV/IO initial and maximum dose for 2y/o? | Initial dose: 4mg Maximum dose: 8mg |
| Diazepam DZP IV/IO initial and maximum dose for 18m/o? | Initial dose: 3.5mg Maximum dose: 7mg |
| Diazepam DZP IV/IO initial and maximum dose for 9-12m/o? | Initial dose: 3mg Maximum dose: 6mg |
| Diazepam DZP IV/IO initial and maximum dose for 6m/o? | Initial dose: 2.5mg Maximum dose: 5mg |
| Diazepam DZP IV/IO initial and maximum dose for 3m/o? | Initial dose: 2mg Maximum dose: 4mg |
| Diazepam DZP IV/IO initial and maximum dose for 1m/o? | Initial dose: 1.5mg Maximum dose: 3mg |
| Diazepam DZP IV/IO initial and maximum dose for under 1m/o? | Initial dose: 1mg Maximum dose: 2mg |
| Furosemide FRM presentation? | Ampoules: 20mg in 2ml 50mg in 5ml |
| Furosemide FRM indication? | Consider IV Furosemide for: -PO -Respiratory Distress due to Acute Heart Failure. |
| Furosemide FRM action? | Potent diuretic. Rapid onset (within 30 min). Short lasting. |
| Name contra indications for Furosemide FRM. | Reduced GCS with live cirrhosis. Cardiogenic shock. Renal Fail with anuria. Under 18s |
| Name cautions for Furosemide FRM. | Hypokalaemia. Could cause arrhythmia. Pregnancy. Hypotension patient. |
| Name side effects for Furosemide FRM. | Hypotension. GI disturbances. |
| Apart from indications, other circumstances to consider administering Furosemide FRM? | Consider when time to hospital is prolonged. |
| Furosemide FRM route of administration? | IV. |
| How should Furosemide FRM be administered? | Administer SLOWLY over 2 minutes according to appropriate dose. |
| Furosemide FRM initial and maximum dose for over 18y/o? | Initial dose: 40mg Maximum dose: 40mg |
| Glucagon GLU presentation? | Injection. 1mg of powder to be reconstituted with water for injection. |
| Glucagon GLU indication? | Hypoglycaemia. Unconscious patient where hypoglycaemia is considered to be a primary cause (BM <4mmol/L) |
| When should Glucagon GLU be considered? | Only when: Oral Glucose 40% is not possible/ineffective IV Glucose 10% not possible |
| Glucagon GLU action? | Raises blood glucose levels. Glucagon is a hormone that induces conversion of glycogen into glucose in the liver. |
| Glucagon GLU contra indications? | Pheochromocytoma. |
| Should Glucagon GLU be administered IV? When? And why? | Should not be given IV. Increased vomiting associated with IV use. |
| Name cautions for Glucagon GLU. | Be cautious of possible low glucogen stores. (Ex. recent Glucagon use, starvation). For hypoglycaemic seizures, Glucose 10% IV is preferred intervention. |
| Name side effects for Glucagon GLU. | Nausea, Vomiting, Hypokalaemia, acute hypersensitivity. |
| Name some side effects experienced by adults when treated with Glucagon GLU. | Abdominal pain, hypotension. |
| Side effects experienced by children on Glucagon GLU? | Diarrhoea. |
| How many times Glucagon GLU can be administered? | Only once. Ensure Glucagon GLU was NOT administered earlier by “others”. |
| How to confirm effectiveness of Glucagon GLU treatment? | Check BM 10-15min after injection. |
| How long it takes for Glucagon GLU to “kick in”? | Can take up to 15min. |
| When might Glucagon GLU be ineffective? | In very young, older people, undernourished, hepatic disease. Ineffective once glycogen stores are depleted. |
| Name patient group that is particularly unresponsive to Glucagon GLU treatment? | Hypoglycaemic non diabetic children. Newborn babies have very limited amounts of stored glycogen. Alcohol induced hypoglycaemia. |
| What is preferred therapy for hypoglycaemic patients who are convulsing? Or unconscious? | IV Glucose 10% is preferred therapy in these circumstances. |
| What is preferred therapy for hypoglycaemic patients that are conscious and able to swallow? | Glucose 40% is first line therapy in these circumstances. |
| Glucagon GLU route of administration? | IM antero-lateral aspect of thigh or upper arm. |
| Name standard conc. of Glucagon GLU? | 1 milligram per vial. |
| Glucagon GLU initial and maximum dose for 8-12y/o plus group? | Initial dose: 1mg. Maximum dose: 1mg. |
| Glucagon GLU initial and maximum dose for ages 1m/o - 7y/o? | Initial dose: 500microgramms. Maximum dose: 500microgramms. |
| Glucagon GLU initial and maximum dose for under 1m/o? | Initial dose: 100microgramms Maximum dose: 100microgramms. |
| Glucose 10% GLX presentation? | 500ml pack of 10% glucose solution (50g) |
| Name indications for Glucose 10% GLX | Hypoglycaemia (BM <4mmol//L) or suspected hypoglycaemia where oral administration of Glucose 40% is not safe or possible. Unconscious where hypoglycaemia is likely cause. |
| Glucose 10% GLX action? | Reversal of hypoglycaemia By direct delivery of Glucose into circulation. |
| What should be done after IV Glucose 10% GLX administration? Why? | Ensure IV line is flushed throughly with Sodium Chloride 0.9%. To prevent vein irritation from residual glucose. |
| Contra indications for Glucose 10% GLX administration? | IM or subcutaneous injection. |
| Can Glucose 10% GLX be administered IO? Why? | Yes it can. Only if other options (IV, Glucose 40%, Glucagon) not possible / ineffective. Due to increased risk of osteomyelitis. |
| How to administer Glucose 10% GLX? | IV infusion. Either Peripherally or Centrally. |
| When can Glucose 10% GLX repeated? | After 5 minutes if no response seen to first dose. |
| Actions if after Glucose 10% GLX administration there is partial improvement? | Another dose can be tittered to response to restore a normal GCS. |
| Actions if a second Glucose 10% GLX dose did not lead to a response? | Pre-alert and rapid transport to the hospital. Consider alternative diagnosis or third dose. |
| Glucose 10% GLX initial dose and maximum dose for 12y/o +? | Initial dose: 10g. Maximum dose: 30g |
| Glucose 10% GLX initial and maximum dose for 11y/o? | Initial dose: 7g Maximum dose: 21g |
| Glucose 10% GLX initial and maximum dose for 10y/o? | Initial dose: 6.5g Maximum dose: 19.5g |
| Glucose 10% GLX initial and maximum dose for 9y/o? | Initial dose: 6g Maximum dose: 18g |
| Glucose 10% GLX initial and maximum dose for 7-8y/o? | Initial dose: 5g Maximum dose: 15g |
| Glucose 10% GLX initial and maximum dose for 5-6y/o? | Initial dose: 4g Maximum dose: 12g |
| Glucose 10% GLX initial and maximum dose for 3-4y/o? | Initial dose: 3g Maximum dose: 9g |
| Glucose 10% GLX initial and maximum dose for 2y/o? | Initial dose: 2.5g Maximum dose: 7.5g |
| Glucose 10% GLX initial and maximum dose for 9-18months? | Initial dose: 2g Maximum dose: 6g |
| Glucose 10% GLX initial and maximum dose for 6m/o? | Initial dose: 1.5g Maximum dose: 4.5g |
| Glucose 10% GLX initial and maximum dose for 1-3m/o? | Initial dose: 1g Maximum dose: 3g |
| Glucose 10% initial and maximum dose for under 1m/o? | Initial dose: 0.9g Maximum dose: 2.7g |
| Glucose 40% GLG presentation? | Plastic tube containing 25g of 40% glucose oral gel. |
| Indication for Glucose 40% GLG? | Known or suspected hypoglycaemia where ability to swallow is present and there is no risk of choking or aspiration. |
| Glucose 40% GLG action? | Rapid increase of blood glucose level through buccal absorption. |
| Glucose 40% GLG route of administration? How can Glucose 40% GLG be administered to patients with altered consciousness? | Buccal administration. Can be administered by soaking a gauze swab and placing it between patients lip n gum. |
| Glucose 40% GLG initial and maximum dose for under 12y/o? | Initial dose: 10g Max dose: 20g |
| Glucose 40% GLG initial and maximum dose for 12y/o plus? | Initial dose: 10g Max dose: 20g |
| Main principles for administration of Glucose 40% GLG? | Make sure the don’t choke. Take into account their weight. |
| GTN presentation? | Sublingual spray containing 400mg / metered dose Sublingual tablets 300, 500, 600mg per tablet |
| GTN indications? | Chest pain (angina, MI, etc) if systolic over 90mmHg Breathlessness due to pulmonary oedema in acute heart failure if s. BP is over 110mmHg Suspected cocaine toxicity and chest pain. |
| GTN action? | Vasodilation. Dilation of coronary artery / relief of coronary spasm. Dilation of systemic vein resulting in lower pre-load. Reduces BP |
| GTN cations? | Patients with suspected posterior MI or right ventricular infarction. Consider cross contamination. |
| GTN counter indications? | Hypotension, hypovolaemia. Head trauma and cerebral haemorrhage. Sildenafil n related drugs. Unconscious. Known severe aortic or mitral stenosis. |
| GTN side effects? | Headache. Dizziness. Hypotension. |
| How long can GTN be used for after opening? | 8 weeks |
| What is the minimum and maximum dose for GTN in suspected angina? For 18y/o+ Reassessment period + min BP | Initial dose spray: 400-800 Max: no limit Initial dose tablet: 1tablet any dose 300/500/600mg Max: no limit To be reassessed every 5 minutes 90mmgh |
| GTN min n max dose for 18y/o+? Reassessment period + min BP? | Initial dose spary: 400-800 Max: Spray 2.4mg 300micg - 6tablets. All other tablets 3. 5min 110mmHg |
| Heparin HEP presentation? | Ampoule containing 5000 units per ml |
| Heparin HEP indications? | STEMI. In conjunction with Tenecteplase to reduce risk of re-infarction. |
| Heparin HER actions? | Anticoagulant |
| Heparin HEP counter-indications? | Haemophilia. Thrombocytopenia. Recent cerebral haemorrhage. Severe HTN or liver disease. Oesophageal varices. Peptic ulcers. Motor trauma. Recent surgery to eye or NS. Acute bacterial endocarditis. Spinal or epidural anaesthesia. |
| Heparin HEP side effects? | Haemorrhage. |
| Heparin HEP initial and max dose for <67kg | Initial dose: 4000units 0.8ml 5000units/ml Maximum dose: 4000 units |
| Heparin HEP initial and maximum dose for >67kg | Both initial and maximum: 5000units 1ml 5000units/ml |
| Heparin HEP repeat dose for all? When to consider repeat dose? | 1000 units. To consider if Heparin infusion was not commenced 45min after initial bolus. |
| Hydrocortisone HYC presentation? | 1: Solution for injection. 100mg/1ml 2: Powder for reconstitution 100mg for up to 2ml 3: Ampoule 100mg for reconstitution with up to 2ml |
| Hydrocortisone HYC indications? | Severe or life threatening asthma. Adrenal crisis and insufficiency including Addisonian crisis. |
| If I’m doubt about adrenal insufficiency. To administer Hydrocortisone HYC or not? | Administrer if I’m doubt. |
| Hydrocortisone HYC actions? | Glucocorticoid. Restores BP, BM, cardiac synchronicity and volume. Suppression of inflammation n immune response. |
| Name counter-indications for Hydrocortisone HYC. | Known allergy to the product/excipients. Note in adrenal crisis - give any preparation available. |
| Hydrocortisone HYC cautions? | N/A for single dose. Avoid IM administration if thrombolysis is likely to be required. |
| Hydrocortisone HYC side effects? | Stinging / burning sensation. |
| Hydrocortisone HYC route of administration? | Slow IV - preferred. Over 2 min. IM if IV not possible. |
| Hydrocortisone HYC initial and maximum dose for 6y/o + ? | Initial: 100mg Maxi: 100mg Could be DIFFERENT volumes depending on presentation of the drug. |
| Hydrocortisone HYC initial and maximum dose for 6m/o - 5y/o? | Initial dose: 50mg Maximum dose: 50mg Could be DIFFERENT volumes depending on presentation of the drug. |
| Hydrocortisone HYC initial and maximum dose for 1-3m/o? | Initial dose: 25mg Maximum dose: 25mg |
| Hydrocortisone HYC initial and maximum dose for under 1m/o? | Initial dose: 10mg Maximum dose: 10mg |
| Ibuprofen IBP presentation? | Solution or suspension: 100mg in 5 ml /20mg in 1ml. Tablet: 200/400mg per tablet. |
| Ibuprofen IBP indications? | Pain (mild to moderate) Pyrexia Soft tissue injury. |
| Ibuprofen IBP actions? | Analgesic. Antipyretic. Anti-inflammatory |
| Ibuprofen IBP counter-indications? | Dehydration. Hypovolaemia. Renal insufficiency. Active GI disturbances. Last trimester of pregnancy. Child with chickenpox. Patient previously reacted to NSAID’s. Active peptic ulcer/haemorrhage. Severe renal/heart/liver failure. On anticoagulants. <3m/o |
| Should Ibuprofen IBP be offered to frail or elderly with fractures? | Do not offer NSAID’s to older adults or frail with fractures. |
| When to avoid giving MSAID’s? | If NSAID was offered within last 4 hours. If maximum cumulative dose has been given. |
| Where to use Ibuprofen IBP cautiously? | Asthma. Older people. Coagulation defects. Crohn’s or ulcerative colitis. Hypertension. In adults with established ischaemic heart disease, peripheral arterial disease, CVD, congestive heart failure. |
| Ibuprofen IBP side effects? | Nausea, vomiting, tinnitus. |
| Ibuprofen IBP dose interval? | 8 hours |
| Ibuprofen IBP initial and maximum dose for 3-9m/o? | Initial: 50mg Maximum: 150mg |
| Ibuprofen IBP initial and maximum dose for 1-3y/o? | Initial: 100mg Maximum: 300mg |
| Ibuprofen IBP initial and maximum dose for 4-6y/o? | Initial: 150mg Maximum: 450mg |
| Ibuprofen IBP initial and maximum dose for 7-9y/o? | Initial: 200mg Maximum: 600mg |
| Ibuprofen IBP initial and maximum dose for 10-11y/o? | |
| Initial dose: 300mg Maximum dose: 900mg | |
| Ibuprofen IBP initial and maximum dose for 12y/o+? | Initial dose: 400mg Maximum dose: 1200mg / 1.2g |
| Ipr. Bromide IPR presentation? | Nebuliser liquid / ampoule containing 250mcg / 1ml. |
| Ipr. Bromide IPR indication? | Acute / severe / life threatening asthma. Acute asthma unresponsive to Salbutamol. Exacerbation of COPD unresponsive to Salbutamol. |
| Ipr. Bromide IPR actions? | Antimuscarinic bronchodilator. |
| Ipr. Bromide IPR counter-indications? | None in emergency situation. |
| Ipr. Bromide IPR cautions? | Glaucoma. Pregnancy and breastfeeding. Prostatic hyperplasia. COPD. |
| Ipr. Bromide IPR caution when PMHx has Glaucoma? | Protect the eyes from mist. |
| Ipr. Bromide IPR cautions when PMHx COPD is possible? | Limit nebulisation with oxygen to 6min. |
| Ipr. Bromide IPR side effects? | Dry mouth (common) Nausea. Tachycardia / Arrhythmia. Paroxysmal tightness of the chest. Allergic reaction. |
| Ipr. Bromide IPR minimum age of administration? | 1m/o+ |
| Ipr. Bromide IPR initial and maximum dose for 1-12m/o? | Initial dose: 125-250mcg Maximum dose: 125-250mcg |
| Ipr. Bromide IPR initial and maximum dose for 18m/o to 11y/o? | Initial dose: 250mcg Maximum dose: 250mcg |
| Ipr. Bromide IPR initial and maximum dose for Adult? | Initial dose: 500mcg Maximum dose: 500mcg |
| Methoxyflurane (Penthrox) presentation? | 3ml vial containing the drug + inhaler. |
| Methoxyflurane (Penthrox) indications? | Emergency relief of moderate - severe pain in conscious adult with trauma and associated pain. |
| Is Methoxyflurane (Penthrox) licensed for use in under 18s? | Not licensed for use in under 18s. |
| Methoxyflurane (Penthrox) action? | Non-opioid inhaled analgesic. |
| Methoxyflurane (Penthrox) counter-indications? | <18s. Previous use (within a week). Known hypersensitivity/allergy. Known liver damage/impairment. CKD stage4/5. Altered level of consciousness (any reason). Resp. Depression. Malignant hyperthermia history/family history. |
| Exercise caution when administering Methoxyflurane (Penthrox) when? | Previously administered (last 3months). Avoid administering in confined spaces. Older adults. Pregnancy esp. 1st trimester and breastfeeding. |
| Methoxyflurane (Penthrox) side-effects? | Drowsiness. Nausea. Cough. Sweating. BP drop. Bradycardia. |
| Methoxyflurane (Penthrox) dose interval? | 10 minutes. |
| Methoxyflurane (Penthrox) initial and maximum dose? | Initial dose: 3ml Maximum dose: 6ml |
| Methoxyflurane (Penthrox) analgesic onset time? | Can be felt 6-10 inhalations after. Full effect in 5-10minutes. |
| When administering Methoxyflurane (Penthrox) to patients with high BMI. Be aware of? | Methoxyflurane is highly lipophilic. Absorbed by fat. Allow longer time for analgesic onset. |
| Metoclopramide Hydrochloride MTC presentation? | Solution for injection ampoules containing: - 10mg/2ml - 5mg/2ml |
| Metoclopramide Hydrochloride MTC indication? | Nausea or vomiting in 18y/o + Prevention of nausea and vomiting when administering Morphine Sulphate. |
| Metoclopramide Hydrochloride MTC action? What it acts on? | Anti-emetic. Acts on CNS and GI tract. |
| Metoclopramide Hydrochloride MTC counter-indications? | <18s, renal failure, phaeochromocytoma, GI obstruction, perforation or haemorrhage 3-4 days past GI surgery, cases of drug overdose. |
| Mateclopramide Hydrochloride MTC caution? | If thrombolysis is likely to be required - AVOID any IM injections of ANY drug. |
| Metoclopramide Hydrochloride MTC side effects? | Drowsiness, restlessness, cardiac conduction abnormalities following IV administration, diarrhoea, rash. |
| Can you use same syringe for administering metoclopramide MTC and morphine? | No! The drugs should not be mixed! |
| Metoclopramide Hydrochloride MTC administration route? | IM. IV - slow over 3 minutes. |
| Metoclopramide Hydrochloride MTC initial and maximum dose for 18y/o+? For under 18s? | Initial and maximum dose: 10mg Not suitable for under 18y/o’s! |
| Midazolam MDZ presentation? | Oral-mucosal solution containing 5mg/ml. Pre-filled syringes various amounts. |
| Midazolam MDZ indication? | Prolonged convulsions (5min +). Repeated convulsions and CURRENTLY CONVULSING. Convulsions continuing 10min after initial medication. |
| When Midazolam MDZ should not be administered? | |
| Should not be administered if convulsions are caused by uncorrected hypoxia or hypoglycaemia. | |
| Midazolam MDZ action? | Short action benzodiazepines with anxiolytic, sedative and anticonvulsant properties. |
| Onset of Midazolam MDZ action is dependent on? | Depending on route of administration. Buccal time of onset is around 5min. |
| How long Midazolam MDZ sedative effects last for? | Sedative effect decreases after 15min onwards. |
| When administering Midazolam MDZ be cautious of? | Dose. Possible respiratory depression and arrest. Enhanced side effects of alcohol or other sedatives are present. |
| Name counter-indications for Midazolam MDZ? | None. |
| Midazolam MDZ side effects? | Respiratory depression. Hypotension. Reduced LOC. Confusion. Amnesia. |
| How to administer Midazolam MDZ if pati has a treatment plan or Epilepsy Passport? | Aim to follow the treatment plan as closely as possible when effective. |
| Midazolam MDZ route of administration? | Buccal |
| Midazolam MDZ initial and maximum dose for for 10-11y/o? Dose interval? What to be aware of? | Initial 10mg. Maximum 20mg. Interval 10min. If epilepsy passport present - give as prescribed. |
| Midazolam MDZ initial and maximum dose for adult? Dose interval? | Initial 10mg. Maximum 10mg Interval 10min |
| Midazolam MDZ initial and maximum dose for 5-9y/o? Dose interval? Be aware of? | Initial 7.5mg. Maximum 15mg. Interval 10min. Be aware of epilepsy passport |
| Midazolam MDZ initial and maximum dose for 1-4y/o? Interval? Be aware of? | Initial 5mg. Maximum 10mg. Interval 10min. Epilepsy passport. |
| Midazolam MDZ initial and maximum dose for 6-9m/o? Interval? Be aware of? | Initial 2.5mg. Maximum 5mg. Interval 10min. Epilepsy passport. |
| Midazolam MDZ initial and maximum dose for 3m/o and less? Interval? Be aware of? | For dosages see passport. Interval 10min. |
| Misoprostol MIS presentation? | Tablet containing 200mcg. |
| Misoprostol MIS indications? | PPH within 24h of birth where bleeding is not controlled by uterine massage or Syntometrine. Life threatening obstetric bleeding less than 24 weeks. |
| Misoprostol MIS can be administered for obstetric bleeding. Under what circumstances? | Less than 24 weeks pregnant. Where miscarriage is CONFIRMED. |
| What is defined as life-threatening bleeding the context of obstetrics? | More that 500ml blood loss OR signs of shock are present. |
| Misoprostol MIS should be used when other oxytocin’s are unavailable. True or False? | True. |
| Misoprostol MIS should be used if other oxitocics where ineffective after 15min. True or False. | True. |
| What is first-line drug for treatment of PPH in pre-eclampsia? | Misoprostol MIS |
| Misoprostol MIS is a first line treatment for PPH in hypertensive patients if BP is over 140/90mmHq? Or systolic alone over 150mmHq? True or False? | True for both. |
| Syntometrine is counter-indicated in hypertension. True or False? | True |
| Misoprostol MIS action? Time of onset? | Stimulates uterine contraction. Time of onset: 7-10min |
| Misoprostol MIS counter-indications? | Any bleeding in pregnancy if there is suspicion that the embryo/fetus in utero. Prior to birth in labour (ensure all delivered). Known hypersensitivity. Secondary PPH (bleeding past 24h) |
| Misoprostol MIS side effects? | Abdominal pain. Nausea. Vomiting. Diarrhoea. Pyrexia. Shivering. |
| Oxytocin and Misoprostol MIS reduce bleeding from pregnant uterus through different pathways and there if one is ineffective after 15min. Another one should be used? True or False | True |
| Misoprostol MIS route of administration? | Sublingual. |
| Misoprostol MIS route of administration if sublingual is not possible? | PR |
| Can Misoprostol MIS sublingual tablets be administered PR? | Yes. Separate PR Misoprostol MIS preparation is not invented yet. Lol |
| Misoprostol MIS initial and maximum dose for adult? Which route? | Initial: 800mcg - 4 tablets. Maximum: 800mcg - 4 tablets. Regardless of the route. |
| Morphine Sulfate MOR presentation? | Solution for injection 10mg/ml Oral solution 2mg/ml |
| Morphine Sulfate MOR main indications? | Pain associated with MI (first choice). Severe pain as a component. End of life. |
| When to use MOR Morphine Sulfate in context of end of life and ambulance service? | Patient has no own meds prescribed for pain or SOB. Patient own meds are not available yet. |
| Morphine Sulfate MOR actions? | Strong opioid analgesic. Sedation, euphoria and analgesia. Respiratory depression & hypotension. Particularly useful (End of life adult) in MSK & soft tissue pain + distress due to SOB. |
| Morphine Sulfate MOR contra-indications? | Under 1y/o. Respiratory depression (adult <10, children <20). Hypotension ( systolic adult <90, sc.children <80, pre-sc.children < 70) Head inj. + GCS<9 or AVPU <P Known hypersensitivity |
| Morphine Sulphate MOR contra-indications in EOL? | Contra-indications generally don’t apply. Up to clinician to weigh up benefits. |
| Morphine Sulfate MOR cautions? | Known severe renal or hepatic impairment (tit. to effect). Extreme caution during pregnancy. Chest injuries causing respiratory depression! Any other respiratory problems! |
| MOR cautions in context of head injuries? | Brain injury can cause pain, hypoxia. Very cautious approach due to respiratory depression effects. Monitor for increased ICP & pCO2! Not appropriate for migraines! |
| MOR cautions in the context of alcohol intoxication? | Opioids cause significant CNS depression! Alcohol also causes CNS depression in significant quantities. |
| MOR & prescribed meds cautions? | Cautious approach if pt is on sedatives, antiperspirants & major tranquillisers. |
| MOR consideration for pt <50kg? Frail & elderly? | Use smaller doses! |
| MOR cautions in context of EOL? | Cautious approach if sBP < 90. Where possible administer pt own “just in case”. Check for prior opioid use! |
| Morphine Sulfate MOR side-effects? | Respiratory & Cardiovascular depression. Nausea & vomiting. Drowsiness Pupillary constriction. |
| Morphine Sulfate MOR is a Class A controlled drug. So? | Must be used and discarded in a presence of a witness. Not licensed for use in children. But can be used under JRCALC guidance. |
| Naloxone Hydrochloride NLX presentation? | Ampoule containing 400 mcg in 1ml. |
| Naloxone Hydrochloride NLX indications? | Acute opioid toxicity for respiratory arrest or depression. |
| Naloxone Hydrochloride NLX actions? | Complete or partial reversal of respiratory depression effects of opioid drugs. Aim to restore respiratory not necessarily |
| Naloxone Hydrochloride NLX contra-indications? | Neonates born to junkies. Focus on BVM and oxygenation. |
| Naloxone Hydrochloride NLX side-effects? | Vomiting. |
| Nitrous Oxide NOO presentation? | Gas cylinder. 50/50 Nitrous Oxide/Oxygen. |
| Nitrous Oxide NOO indications? | Moderate to severe pain. Labour pain. |
| Nitrous Oxide NOO action? | Inhaled analgesic agent. |
| Nitrous Oxide NOO contra-indications? | Severe head injuries with impaired GCS/AVPU due to ? ICP / air present. Decompression sickness + diving last 24h. Violently disturbed pt’s. Intraocular gas injection last 4w. Abdominal pain due to suspected intestinal obstruction. |
| Nitrous Oxide NOO cautions? | Any pt at risk of: Pneumothorax. Pneumomediastinum Pneumoprtitoneum |
| Nitrous Oxide NOO side-effects? | Minimum |
| What is the risk of prolonged Nitrous Oxide NOO use? | B12 deficiency if used >24h or more frequently than every 4days. |
| Advantages of Nitrous Oxide NOO? | Rapid onset of analgesia / rapid “wear off” No cardio-respiratory depression. Self-administered. Contains 50% O2. Can be administered to “buy time” for other analgesic preparation. |
| What must be done before administration? | Apart from normal checks. Ensure that gases are properly mixed before use. |
| Ondasteron ODT presentation? | Ampoule typically containing 2mg / ml. |
| Ondasteron ODT indications for adults? | Prevention / treatment of opioid induced nausea and vomiting. Treatment of nausea and vomiting. |
| Ondasteron ODT indications for children? | Prevention/Treatment of opioid induced nausea and vomiting. Treatment of travel sickness associated with nausea and vomiting. |
| Ondasteron ODT actions? | Anti-emetic. 5HT antagonist. Both in CNS and in GI. |
| Ondasteron ODT counter-indications? | Known hypersensitivity. Infants under 1m/o. |
| Ondasteron ODT cautions? | Avoid administering along with QT prolonging drugs. Hepatic impairment. Pregnancy & Breastfeeding. |
| Ondasteron ODT side-effects? | Hiccups. Constipation. Flushing. Hypotension. Chest pain. Arrhythmias. Bradycardia. Headache. Seizures. Movement disorders. Injection site reactions. |
| Ondasteron ODT additional considerations? | Do not mix with Morphine Sulfate MOR! Do not use to ROUTINELY manage gastroenteritis. Be careful of vomiting + ondasteron + VNR!!!!!!’ Seek advice. |
| Oxygen OXG presentation? | Gas in a cylinder / tank / etc. |
| Oxygen OXG general indications for children? | Significant illness or injury. |
| Oxygen OXG general indications for adults? | Critical illness required high levels of sup. O2. Serious illness requiring moderate levels of sup. O2 COPD & other requiring low levels of sup. O2. Hypoxeamic patient. |
| Oxygen OXG actions? | Oxygen is required for cell metabolism. Reverses hypoxia provided that work of breathing is adequate. |
| Oxygen OXG contra-indications / cautions! | No physiological/pathophysiological contra-indications. COPD + hypoxic drive. Do not use in EXPLOSIVE environments! Fire hazard! Caution should be applied in “defibrillation” situation! |
| Oxygen OXG side-effects? | Non-humidified O2 irritates membranes over prolonged time. |
| Paracetamol PAR presentation? | Tablet 500mg / tablet. Oral solution (various concentrations). IV infusion (10mg / ml). |
| Oral Paracetamol PAR indications? | Pain relief (mild/moderate) Pyrexia causing pt discomfort. |
| IV Paracetamol PAR indications? | Severe pain. Balanced analgesia to reduce or to supplement opioid. |
| Paracetamol PAR action? | Analgesic and antipyretic drug. |
| Paracetamol PAR contra-indications? | Known hypersensitivity or allergy. If Paracetamol products been given in the last 4h or if renal failure present 6h. If maximum daily cumulative dose of Paracetamol has been met. |
| Paracetamol PAR cautions? | Be very careful not to OD the Pt! Check prior administration. Check for contra-indications! Be careful with dosage calculations. (Check concentration etc!!!) Extreme vigilance in Pt’s under 50kg! |
| Paracetamol PAR side-effects? | Very rare. Occasional hypotension if administered too quickly! |
| Prednisolone presentation? | Tablet 5mg/tablet Oral solution 1mg/ml |
| Prednisolone indication? | Provided Pt able to swallow! Treatment of moderate-severe asthma. Treatment of COPD exacerbation, |
| What is a moderate asthma attack? | Normal GCS and AVPU. Able to talk. BPM adult <110. child >5y/o <125. child 1-5y/o <140. RR adult <25. child>5y/o <30. child 1-5y/o <40. O2 => 92% PEF >50-75% |
| What is a severe asthma attack? | Can not talk in full sentences? BPM adult >110. child>5 >125. child1-5 >140. RR adult >25. child>5 >30. child1-5 >40. O2 =>92%. PEF >33-50%. |
| Prednisolone use in the context of COPD? | Only treat exacerbations unresponsive/poor response to nebulisers. Increased SOB affecting daily activities. |
| Prednisolone action? | Glucocorticoid that suppresses part of the immune system reducing inflammation and swelling. |
| Prednisolone contra-indications? | Prednisolone (any dose) in last 2h. Vomiting or inability to swallow. Known hypersensitivity to steroids. Pregnancy and breastfeeding. Known infection unless specific anti-infective therapy being used. Recent MI. Active PUD. Glaucoma. |
| Prednisolone side-effects? | GI disturbances. Altered mood. Anxiety. |
| Salbutamol SLB presentation. | Nebules containing 2.5mg/2.5ml. Or 5mg/2.5ml. |
| Salbutamol SLB indications? | Acute asthma attack where normal inhalers fail. Expiratory wheezing of any lower airway cause. Exacerbation of COPD. |
| Salbutamol SLB conter-indications? | None in emergency situation. |
| Salbutamol SLB cautions? | Hypertension. Angina. Overreactive thyroid (tachycardia). Broncho/laryngo/thracheo malacia (abnormal softening of these structures). Late pregnancy. B-blocked + severe hypertension. In COPD limit therapy to 6min! |
| Salbutamol SLB side-effects? | Tremor. Tachycardia. Palpitations. Headache. Feeling of tension. Peripheral vasodilation. Rash. Muscle cramps. |
| In acute / life threatening asthma unresponsive to Salbutamol SLB? | Try Ipratropium Bromide. |
| NaCl 0.9% SCP presentation? | 5ml & 10ml pre-filled syringes or ampoules for flushing. 100/250/500/1000 ml packs for IV. |
| NaCl 0.9% SCP indications in adult fluid therapy? | |
| Medical conditions with or without haemorrhage. Trauma. Burns. Limb crush injuries. | |
| NaCl 0.9% SCP indications in child fluid therapy? | Medical conditions. Trauma. Burns. |
| NaCl 0.9% SCP flush indications? | To check the potency of a cannula. Flush following drug administration. |
| NaCl 0.9% SCP action? | Increases vascular fluid volume. Raises CO. Improved perfusion pressures. |
| NaCl 0.9% SCP contra-indications? | Should NOT be administered solely for the purpose of keeping a vein open. |
| NaCl 0.9% SCP side-effects? | May precipitate PO and breathlessness if over-infused |
| Sodium Lactate Compound SLC indications? Other names for SLC? | 250/500/1000 ml packs for IV infusion. Hartmann’s solution aka Ringer’s Lactate Solution. |
| SLC indications? | To correct hypovolaemia and improve tissue perfusion is NaCl 0.9% SCP is NOT available. Dehydration, |
| SLC action? | Increase vascular fluid volume. Improving CO and perfusion. |
| SLC contra-indications? | Diabetic hyperglycaemic ketoacidotic coma and pre-coma. Administer NaCl 0.9% SCP only! Neonates. |
| SLC cautions? | Not to be used if NaCl 0.9% is available. Particularly in limb crush injuries. Liver failure. Renal failure. |
| SLC side-effects? | Can cause fluid overload and consequent HF, PO, etc. |
| Syntometrine SYN presentation? | An ampoule containing ergometrine 500mcg and oxytocin 5units in 1ml. |
| Syntometrine SYN indications? | PPH within 24h of delivery where bleeding failed to be stopped by uterine massage. Miscarriage with life threatening bleeding and a confirmed diagnosis. |
| Syntometrine SYN actions? | Stimulates contraction of uterus. Onset of action 7-10min. |
| Syntometrine SYN contra-indications? | Known hypersensitivity. In labour prior to birth. Severe cardiac, liver or kidney disease. Hypertension and severe pre-eclampsia. Possible multiple pregnancy/known or suspected fetid in utero. |
| Syntometrine SYN side-effects? | Nausea and vomiting. Abdominal pain. Headache. Hypertension and bradycardia. Chest pain. Anaphylaxis (rare). |
| If Misoprostol MIS did not work. When to administer Syntometrine SYN? | 15min post Misoprostol MIS administration. |
| Magnesium Sulfate MgS presentation? | MgS 20% solution for infusion. 10ml ampoules containing 2g. |
| MgS indications for use in >12y/o’s. | Severe asthma unresponsive to Salbutamol SLB nebulisers. Eclampsia. Severe pre-eclampsia. Torsades de Pointes |
| MgS indications for use in children 2-11y/o? | Sever asthma with continued deterioration and unresponsive to continuous Salbutamol SLB nebulisation. |
| MgS actions? | Relaxes bronchial muscles. Completely blocks entry of calcium into synaptic endings reducing neuromuscular transmission. |
| MgS contra-indications? | Known hypermagnesaemia |
| MgS cautions? | MgS available in different strengths. Rapid administration causes flushing and hypotension. Extravasation causes tissue damage. Renal impairment: increased risk of toxicity - avoid or reduce dose. |
| MgS side-effects? | Electrolyte imbalance. Hypocalcaemia. Hypersensitivity reaction. Bone demineralisation and osteopenia. |
| MgS side-effects in pregnant patient? | Excessive doses in third trimester cause neonatal respiratory depression. |
| Tenecteplase TNK presentation? | Vials for reconstruction with water for injections. |
| Tenecteplase TNK indications? | Acute STEMI within 6 hours of symptoms onset of PPCI is NOT available. |
| Tenecteplase TNK actions? | Fibrinolytic drug. Activated fibrinolytic system, including the break up of intravascular thrombi and emboli. |
| Tenecteplase TNK side-effects? | Bleeding (both major and minor). Arrhythmias. Anaphylaxis. Hypotension. |
| TXA presentation? | Vial containing 500mg tranexamic acid in 5ml. |
| TXA general indications? | Actual or suspected severe haemorrhage in: - major trauma. - head injury in pt >18y/o and GCS<12. - Pt with a TIME CRITICAL injury where significant internal or external haemorrhage is suspected. - PPH if Pt continues to bleed. ? Uterotonic drugs X. |
| TXA criteria for administration in major trauma? | Within 3h of bleeding starting. —sBP <90, X rad.pulse. or HR>110 — any Pt with heamoststic gauze, tourniquet applied etc. — traumatic CA. |
| TXA criteria for administration for head injury. | — within 3h — >18y/o — GCS <12 |
| Criteria for TXA administration for PPH? | Either of: - within 3h. PPH -500ml bl. and continues to bleed. - PPH where uterine trauma suspected. |
| TXA actions? | TXA is an anti-fibrinolytic - reduces blood clot formation. |
| TXA contra-indications? | Known allergy or hypersensitivity. Bleeding started >3h ago. Obvious resolution of bleeding. Critical interventions are needed. |
| TXA cautions? | History of convulsions - lower the dose, seek advice. History of acute venous or arterial thrombosis. Lower the dose. Renal impairment. Lower the dose. Rapid injection can cause hypovolaemia and LOC. Do not administer through same line as bl. or ABx |
| TXA side-effects. | Nausea. Vomiting. Diarrhoea. Hypersensitivity and anaphylaxis. Hypotension on rapid injection. Arterial or venous embolism at any site. |
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