CPG Pharmacology
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| Aspirin - Presentation | 300mg water dispersible or chewable tablet
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| Aspirin - Pharmacology | An antipyretic, anti-inflammatory, anti-platlet aggregation agent
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| Aspirin - Metabolism | Converted to salicylate in the gut mucose, excreted by the kidneys
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| 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
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| 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
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| Aspirin - Precautions | 1. Peptic Ulcer
2. Asthma
3. Pts on anti coagulants, ie Warfarin
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| Aspirin - Route of Administration | Oral
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| Aspirin - Side Effects | - Heart Burn. Nausea, GI bleeding
- Hypersensitivity reactions
- Increased Bleeding time
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| 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
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| Adrenaline - Presentation | 1mg:1000
1mg:10000
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| Adrenaline - Pharmacology | A naturally occurring α and β adrenergic stimulant
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| 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)
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| Adrenaline - Metabolism | By Monamine Oxidase and other enzymes in blood, liver and around nerve endings, excreted by the kidneys
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| 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
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| Adrenaline - Contrindications | Hypovolaemic shock without adequate fluid replacement
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| Adrenaline - Precautions | 1. Elderly
2. Pts with CV disease
3. Pts on MAOI's
4. Pts on Beta-blockers, higher doses may be required
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| Adrenaline - Route of Administration | IM, IV, IV infusion, ETT, Neb, IO
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| Adrenaline - Side Effects | Sinus Tachycardia
Ventricular Arrhythmias
Supraventricular Arrhythmias
HTN
Pupillary dilatation
May ↑ size of AMI
Anxiety and palpitations in the conscious pt
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| Adrenaline - Special Notes | IV adrenaline should be reserved for life threatening situations
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| Adrenaline - Therapeutic Effects | IM: onset = 30-90s, peak = 5-10mins, duration = 4-10mins
IV: onset = 30sec, peak= 3-5mins, duration = 5-10mins
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| Ceftriaxone - Presentation | 1g sterile powder in vial
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| Ceftriaxone - Pharmacology | A cephalasporin antibiotic
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| Ceftriaxone - Metabolism | Excreted unchanged in urine (33%-67%), and in bile
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| Ceftriaxone - Primary Emergency Indication | 1. Meningococcal Septicaemia
2. Severe Sepsis (consult)
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| Ceftriaxone - Contraindications | Allergy to cephalasporin antibiotics
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| Ceftriaxone - Precautions | Allergy to Penicillin
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| Ceftriaxone - Route of Administraion | IV (preferred)
IM
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| Ceftriaxone - Side Effects | N/V
Skin Rash
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| 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
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| Dextrose 10% - Presentation | 50g in 500ml infusion soft pack
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| Dextrose 10% - Pharmacology | Slightly hypertonic crystalloid solution
Composition: Sugar and water
Actions: source of energy, supplies total body water
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| 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
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| Dextrose 10% - Primary Emergency Indications | Diabetic hypoglycaemia with random BSL of <4mmol, in pts with ACS or unable to self administer oral glucose.
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| Dextrose 10% - Contraindications, Precautions, Side Effects | Nil
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| Dextrose 10% - Route of Administration | IV infusion
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| Dextrose 10% - Special Notes | IV: Onset = 3mins, Duration = dependant on severity of hypoglycaemic episode
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| Fentanyl - Presentation | 600mcg:2ml and 100mcg:2ml
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| Fentanyl - Pharmacology | A synthetic narcotic analgesic
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| Fentanyl - Actions | CNS
- Depression (leading to analgesia)
- Respiratory Depression (leading to apnoea)
- Dependance (addiction)
CV
- decreases conduction velocity through the AV node
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| Fentanyl - Metabolism | by the liver
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| Fentanyl - Primary Emergency Indications | RSI
Sedation to maintain intubation
Sedation to enable intubation
Analgesia - IV/IN
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| Fentanyl - Contraindications | Known Hypersensitivity
IV Amiodarone
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| 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
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| Fentanyl - Route of Administration | IV, IN
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| Fentanyl - Side Effects | Respiratory Depression
Apnoea
Rigidity of diaphragm and intercostal Muscles
Bradycardia
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| 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
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| Glucagon - Presentation | 1mg (IU) in 1ml hypokit
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| Glucagon - Pharmacology | A hormone normally secreted by the pancreas
Actions: causes increase in blood glucose concentration by converting stored liver glycogen to glucose
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| Glucagon - Metabolism | By the liver mainly. Also by the kidneys and plasma
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| Glucagon - Primary Emergency Indications | Diabetic hypoglycaemia with random BSL of <4mmol, in pts with ACS or unable to self administer oral glucose.
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| Glucagon - Contraindications and Precautions | Nil
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| Glucagon - Route of Administration | IM
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| Glucagon - Side Effects | Nausea and Vomiting (rare)
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| 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
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| Glyceryl Trinitrate - Presentation | 0.6mg tablet, 0.4mg transdermal patch
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| Glyceryl Trinitrate - Pharmacology | Principally a smooth muscle relaxant
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| 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)
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| 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
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| Glyceryl Trinitrate - Metabolism | The Liver
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| 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)
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| 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
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| Glyceryl Trinitrate - Precautions | 1. no previous admin
2. recent AMI
3. Elderly
4. Concurrent use with other tocolytics
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| Glyceryl Trinitrate - Rout of Administration | Buccal, S/L, Transdermal
IV infusion (IHT)
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| Glyceryl Trinitrate - Side Effects | Headache
Tachycardia
hTN
Skin Flushing and Bradycardia (Rare)
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| 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
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| 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
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| Ipratropium Bromide - Presentation | 250mcg:1ml (polyamp)
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| Ipratropium Bromide - Pharmacology | Anticholinergic Bronchodilator
Actions:
- allows bronchoconstriction by inhibiting cholinergic bronchomotor tone (ie, blocks vagal reflex that mediate bronchoconstriction)
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| Ipratropium Bromide - Metabolism | Liver and Kidneys
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| Ipratropium Bromide - Primary Emergency Indications | Severe Respiratory Distress associated with bronchspasm
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| Ipratropium Bromide - Contraindications | Known hypersensitivity to Atropine and its derivatives
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| Ipratropium Bromide - Precautions | 1. Glaucoma
2. Avoid eye contact
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| Ipratropium Bromide - Route of Administration | Nebulised in conjunction with Salbutamol
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| Ipratropium Bromide - Side Effects | Headache
Nausea
Dry Mouth
Skin Rash
Tachycardia and palpitations (rare)
Acute angle glaucoma secondary to eye contact (rare)
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| 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
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| Ipratropium Bromide - Therapeutic Effects | O=3-5mins, P1.5-2hrs, D=6hrs
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| Lignocaine - Presentation | 50mg:5ml (1%) - for IM injection
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| Lignocaine - Pharmacology | A local anaesthetic
Actions:
Prevents initiation and transmission of nerve impulses causing local anaesthesia (1% solution)
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| Lignocaine - Metabolism | Liver - 90%
Kidneys unchanged - 10%
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| Lignocaine - Primary Emergency Indications | IM administration (1% solution)
Dilutent for Ceftriaxone for IM administration in suspected meningococcal disease
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| Lignocaine - Contraindication | Known hypersensitivity
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| Lignocaine - Precautions | When using Lignocaine 1% as dilutent, care must be taken so to rule out inadvertent IV administration due to potential CNS complications
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| Lignocaine - Route of Administration | IM (1% solution with Ceftriaxone only)
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| Lignocaine - Side Effects | Nil - unless inadvertent IV administration
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| Lignocaine - Special Notes | O= Rapid
D = 60-90mins
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| Methoxyflurane - Presentation | 3ml glass bottle with plastic seal
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| Methoxyflurane - Pharmacology | Inhalational analgesic at low concentrations
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| Methoxyflurane - Metabolism | Mainly by the kidneys and by the liver
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| Methoxyflurane - Primary Emergency Indication | Pre Hospital Pain Relief
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| Methoxyflurane - Contraindication | 1. Pre existing renal disease/impairment
2. Concurrent use of tetracycline antibiotics
3. Exceeding a total of 6ml in a 24hr period
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| 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
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| Methoxyflurane - Route of administration | Self administration under supervision using the hand held penthrox inhaler with oxygen supplementation
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| Methoxyflurane - Side Effects | 1. Drowsiness
2. Bradycardia/hTN
3. Exceeding max dose of 6ml in 24hr period may lead to renal toxicity
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| 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
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| Metoclopramide - Presentation | 10mg:2ml
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| Metoclopramide - Pharmacology | An anti-emetic which accelerates gastric emptying and peristalsis.
Mild STH3 receptor antagonist
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| 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
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| Metoclopramide - Contraindications | 1. Children
2. Suspected bowl obstruction or perforation
3. GI haemorrhage
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| Metoclopramide - Precautions | 1. Undiagnosed abdominal pain
2. Adolescents <20yrs
3. Administer slowly over 1min to minimise risk of extra pyramidal reactions
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| Metoclopramide - Route of Administration | IV, IM
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| Metoclopramide - Side Effects | Drowsiness
Dry mouth
Muscle Tremor
Lethargy
Extra Pyramidal reactions - usually the dystonic type
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| 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
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| Midazolam - Presentation | 5mg:1ml, 15mg:3ml
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| Midazolam - Pharmacology | A short acting central nervous system depressant
Actions: anxiolytic, anticonvulsant, Sedative
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| Midazolam - Metabolism | Liver - excreted by the kidneys
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| 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
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| Midazolam - Contraindications | Hypersensitivity to benzodiazepines
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| 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
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| Midazolam - Route of Administration | IM and IV
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| Midazolam - Side Effects | 1. Depressed level of conciousness
2. Respiratory Depression
3. Loss of Airway control
4. hTN
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| 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
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| Morphine - Presentation | 10mg:1ml
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| 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
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| Morphine - Metabolism | Liver, excreted by the kidneys
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| 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
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| Morphine - Contraindications | 1. Known hypersensitivity
2. Late second stage labour
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| 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
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| Morphine - Route of Administration | IV, IV infusion, IM
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| Morphine - Side Effects | CNS effects
-Drowsiness
-Resp Depression
-Euphoria
- N/V
- Pin-point pupils
- Addiction
CV effects
- hTN
- Bradycardia
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| 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
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| Morphine - Therapeutic Effects | IM: O = 10-30 mins, P = 30-60mins, D = 1-2 hrs
IV: O = 2-5mins, P = 10mins, D = 1-2hrs
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| Naloxone - Presentation | 0.4mg:1ml
2mg in 5ml prepared syringe
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| Naloxone - Pharmacology | A narcotic antagonist
Actions: Prevents or reverses effects of narcotics
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| Naloxone - Metabolism | By the liver
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| Naloxone - Primary Emergency Indication | ACS or respiratory depression secondary to administration of narcotics or related drugs
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| Naloxone - Contraindications | Nil
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| Naloxone - Precautions | 1. If pt known to be physically dependant on narcotics, be prepared to deal with a combative pt
2. Neonates
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| Naloxone - Route of Administration | IV, IM
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| Naloxone - Side Effects | Symptoms of Narcotic withdrawal :
- Sweating, goose flesh, tremor
- N/V
- Agitation
- Dilation of pupils
- Excessive lacrimation
- Convulsions
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| 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
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| 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
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| Normal Saline - Presentation | 10ml Polyamp, 1000ml and 500ml infusion soft pack
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| Normal Saline - Pharmacology | An isotonic crystalloid solution
Composition:
-Electrolytes - Na & CL, similar to conc. of ECF
-H20
Action: Transiently increases vol. of intravascular compartment
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| Normal Saline - Metabolism | Electrolytes: Excreted by the kidneys
H2O: excreted by the kidneys and distributed through total body H2O, mainly in ECF compartment.
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| 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
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| Normal Saline - Contraindications, Precautions and Side Effects | Nil
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| Normal Saline - Route of Administration | IV
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| Normal Saline - Special Notes | Intravascular half life ~30-60mins
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| Prochlorperazine - Presentation | 12.5mg:1ml
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| Prochlorperazine - Pharmacology | An anti-emetic
Actions: Acts on several central neurotransmitter systems
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| Prochlorperazine - Metabolism | By the liver, excreted by the kidneys
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| 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
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| Prochlorperazine - Contraindications | 1. Previous Hypersensitivity
2. Children
3. CNS depression
4. CV collapse
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| Prochlorperazine - Precautions | 1. Epilepsy
2. hTN
3. Pts affected by alcohol or on antidepressants
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| Prochlorperazine - Route of Administration | IM
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| Prochlorperazine - Side Effects | Skin Rash
Sinus Tachycardia
hTN
Extra pyramidal reactions (dystonic type)
Drowsiness
Bradycardia
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| Prochlorperazine - Special Notes | Onset: 20mins
Peak: 40mins
Duration: 6Hrs
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| Salbutamol - Presentation | 5mg:2.5ml nebule/polyamp
5mg:5ml amp
500mcg:1ml amp
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| Salbutamol - Pharmacology | A β-adrenergic stimulant with primarily 2 effects
Actions : - cause bronchodilatation
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| Salbutamol - Metabolism | Liver and kidneys
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| Salbutamol - Primary Emergency Indications | Respiratory Distress with suspected bronchospasm
- Asthma
- Pulmonary Oedaema
- COPD
- Severe allergic reactions
- Smoke Inhalation
- Oleoresin Capsicum Spray Exposure
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| Salbutamol - Contraindication | Nil
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| Salbutamol - Precautions | 1. Between doses, oxygen must be administered continuously
2. Large doses of IV salbutamol known to cause intracellular metabolic acidosis
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| Salbutamol - Route of Administration | IV, Neb, ETT, pMDI, IV infusion
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| Salbutamol - Side Effects | Muscle Tremor
Sinus Tachycardia
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| 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
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| Salbutamol - Therapeutic Effects | Nebulised: O = 5-15mins, D = 15-50mins
IV: 1-2mins, D = 10-60mins
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| Water for Injection - Presentation | 10ml ampoule/polyamp
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| Water for Injection - Pharmacology | A Sterile, Clear, Colourless, Tasteless, Odourless, Particle free solution
pH = 5.6 - 7.7 containing no antimicrobial agents
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| Water for Injection - Primary Emergency Indication | Used for dilutent of Ceftriaxone for IV injection
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| Water for Injection - Contraindication, Precaution, Side Effects, Special Notes | Nil
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| Water for Injection - Route of Administration | IV
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| Misoprostol - Presentation | 200mcg chewable tablet
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| Misoprostol - Pharmacology | A synthetic prostaglandin
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| Misoprostol - Metabolism | Converted to active metabolite, Misoprostol Acid in blood
Metabolised in tissues, excreted by the kidneys
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| Misoprostol - Primary Emergency Indications | Primary Post Partum Haemorrhage
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| Misoprostol - Contraindications | 1. Allergy to prostaglandins
2. Exclude multiple pregnancies before administration
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| Misoprostol - Precautions | Asthma
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| Misoprostol - Rout of Administration | Oral
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| Misoprostol - Side Effects | Hyper-pyrexia
Abdominal Cramping
Diarrhoea
Shivering
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| Misoprostol - Special Notes | Side Effects noted with dose >600mcg oral dose
O: 8-10mins, D: 2-3hrs
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