Student Drugs: their indications, dose, contraindications, and routes

What drugs can a student paramedic give?

Adrenaline 1:1000, aspirin, entonox, glucose 40% gel, glucagon, GTN, ibuprofen, ipratropium bromide, naloxone hydrochloride, paracetamol, salbutamol

What are the indications for adrenaline 1:1000?

Acute anaphylaxis

Life-threatening asthma that still deteriorates despite nebuliser therapy and with failing ventilation

What is the adult dose of adrenaline 1:1000?

500mcg (0.5 ml of 1mg/1ml)

What is the route of 1:1000 adrenaline?

IM injection

Whare cautions of adrenaline 1:1000?

Severe hypotension may occur in patients on non-cardioselective beta blockers

What are indications for aspirin?

Clinical or ECG evidence of myocardial infarction or ischaemia

Suspected TIA where symptoms have not resolved and patient is not being conveyed to hospital and patient is being referred to local TIA pathway

What is the dose of aspirin?

300mg, 1 tablet

What is the route of aspirin?

Oral

What are the contra-indications of aspirin?

Known aspirin allergy

Active gastrointestinal bleeding

Haemophilia or other known clotting disorders

Severe hepatic failure with jaundice

Children under 16

What are the side effects of aspirin?

Increased risk of gastric bleeding

Wheezing in some asthmatics

What are indications for entonox?

Moderate to severe pain

Labour pain

What is the route for entonox?

Via a face mask or mouthpiece

Takes effect after 3-5 minutes, but may need 5-10 to reach maximum effect

What are the contraindications for entonox?

Chest injury and clinically suspected pneumothorax

Severe head injury with reduced consciousness due to presense of intracranial air

Decompression sickness (consider anyone diving in the last 24 hours at risk)

Violently disturbed psychiatric patients

Intraocular injection of gas within the last eight weeks - check their leaflet

Abdominal pain where intestinal obstruction is expected

What is the indications for 40% glucose gel?

Known or suspected hypoglycemia in a conscious patient at no risk of aspiration or choking

What is the dose of 40% glucose gel?

Initial dose of 10-20 grams, repeat dose every 15 minutes of 10g

What is the route of 40% glucose gel?

Squeezed into the mouth between the teeth and gums

What is are the cautions for 40% glucose oral gel?

Altered consciousness increases risk of choking and aspiration so in such cases soak a guaze swab in the gel and place it between their lips and gums

What is the presentation of glucose 40% oral gel?

Plastic tube containing 25g glucose 40% oral gel

What is the indications for glucagon?

Hypoglycaemia when oral glucose gel and/or IV access to administer 10% glucose is not possible or ineffective

What is the dose of glucagon?

1 milligram with no repeat dose

What is the route of glucagon?

IM injection in the antero-lateral thigh or upper arm

What are the cautions for glucagon?

Low glycogen stores - e.g. recent use of glucagon or starvation

For hypoglycaemia seizures 10% IV glucose is preferred

What are the contra-indications for glucagon?

Pheochromocytoma (tumour in the adrenal glands)

Not to be given IV due to associations with increased vomiting

What is the indications for GTN?

Cardiac chest pain due to angina or MI when systolic blood pressure is greater than 90mmHg

Consider for acute heart failure with ischaemia or uncontrolled hypertension

Patients with spected cocaine toxicity presenting with chest pain

What is the dose for GTN?

For angina, myocardial infarction, or suspected cocaine toxicity: 600 micrograms repeating every 50-10 minutes at the same dose

For heart failure: 600 micrograms repeated every 5-10 minutes at the same dose until the maximum 1.8mg/3 tablets

What is the route for GTN?

Sublingual tablet/spray with moist oral mucosa (moisten if necessary)

What are the cautions for GTN?

Suspected posterior MI or right ventricular infarction

What are the contra indications for GTN?

Hypotension (systolic BP under 90 in angina/MI or under 110 in acute heart failure

Hypovolaemia

Head trauma

Cerebral haemorrhage

Sildenafril (viagra) or related drugs within the last 24 hours

Unconscious patients

Known severe aortic or mitral stenosis

What are the side effects of GTN?

Headache

Dizziness

Hypotension

What is the presentation of GTN?

Sublingual spray containing 400mcg GTN per metered dose

Sublingual tablet containing GTN 300, 500, or 600 mcg per tablet

What are the indications for ibuprofen?

Relief of mild-moderate pain

Pyrexia with discomfort

Soft tissue injuries

Best when used as part of a balanced analgesic regimen

What is the dose for ibuprofen?

400mg repeated at 8 hour intervals with another 400mg until maximum 1.2 grams per 24 hours

What is the route for ibuprofen?

Oral

What are the side effects of ibuprofen?

Nausea, vomiting

Tinnitus

What are cautions for ibuprofen?

Asthma - use with caution due to possible risk of hypersensitivity and bronchoconstriction, do not use if the have not previously used NSAIDs

Older people - cautions when over 65 and not used and tolerated NSAIDs recently

Coagulation defects

Avoid when ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, congestive heart failure is established

Hypotension

What are the contraindications for ibuprofen?

Dehydration

Hypovolaemic

Known to have renal insufficiency

Upper gastrointestinal disturbance

Last trimester of pregnancy

Chickenpox

Previously shown hypersensitivity reactions (asthma, rhinitis, etc.) in response

Active peptic ulcer/haemorrhage

Severe heart failure, renal failure, or hepatic failure

If also on anticoagulant drugs

What are the indications for Ipratropium Bromide?

Acute, severe, or life-threatening asthma

Acute asthma unresponsive to salbutamol

Exacerbation of COPD unresponsive to salbutamol

Expiratory wheeze

What are the cautions of ipratropium bromide?

glaucoma (protect the eyes from the mist)

pregnancy and breastfeeding

prostatic hyperplasia

What are side effects of Ipratropium Bromide?

Nausea

Dry mouth

Tachycardia/arrhythmia

Paroxysmal tightness of the chest

Allergic reaction

What route is Ipratroprium Bromide?

Nebuliser with 6-8 litres of oxygen

What is the adult dosage of Ipratropium Bromide?

500 micrograms with a concentration of 250 micrograms in 1ml, with no repeat dose

What are the indications for Naloxone Hydrochloride?

Reversal of acute opioid or opiate toxicity for respiratory arrest or respiratory depression

Unconsciousness associated with respiratory depression of unknown cause, where opioid overdose is a possibility

In cardiac arrest where opioid toxicity is considered the likely cause

what are the contra-indications of Naloxone Hydrochloride?

Neonates born to opioid addicted mothers can suffer serious withdrawal effects. Emphasis should be on bag-valve-mask ventilation and oxygenation

What are side-effects of Naloxone Hydrochloride?

Violent withdrawal symptoms - including cardiac arrhythmias (better to titrate the dose to reverse the cardiac/respiratory depression but leave the patient in a ‘groggy’ state)

Vomiting (very common so ensure access to suction)

What is the adult doses and routes for Naloxone Hydrochloride?

IV for respiratory arrest/depression - 400 micrograms, repeated every 3 minutes, maximum 4000 micrograms

IM for respiratory arrest/depression - 400 micrograms, repeated every 3 minutes, maximum 4000 micrograms

Intranasal for respiratory arrest/depression (use both nostrils) - 0.5ml (200 micrograms) to each nostril, repeated every 3 minutes, maximum 10ml (4000 micrograms)

IV for cardiac arrest with opioid toxicity the likely cause - 400 micrograms, repeated at 800 micrograms every 1 minute, maximum 10,000 micrograms

What are the indications for paracetamol?

Oral - relief of mild to moderate pain or high temperature with discomfort (not for high temperature alone)

IV - part of a balanced analgesic regimen for moderate to severe pain

What are contra-indications for paracetamol?

Known allergy

Already taken paracetamol containing drug within the last 4-6 hours

If the maximum cumulative daily dose has already been given

What is the adult dose of paracetamol?

Oral - 500mg to 1 gram, repeated every 4-6 hours, maximum 4 grams in 24 hours

IV - 1 gram (10 mg in 1 ml) given over 15 minutes, repeated every 4-6 hours, maximum 4 grams in 24 hours

What is the indication for salbutamol?

Acute asthma attack where normal inhaler therapy has failed to relieve symptoms

Expiratory wheezing associated with allergy, anaphylaxis, beta-blocker overdose, smoke inhalation, or other lower airway cause

Exacerbation of COPD

What are the cautions for salbutamol?

Use in care with:

• hypertension

• angina

• overactive thyroid

• late pregnancy (can relax the uterus)

• bronchomalacia/laryngomalacia/tracheomalacia (abnormal softening of the bronchial tubes, larynx, and trachea)

• beta-blockers (severe hypertension may occur and half doses should be used unless there is profound hypotension)

What are side-effects of salbutamol?

Tremor

Tachycardia

Palpitations

Headache

Feeling of tension

Peripheral vasodilation

Muscle cramps

Rash

What is the adult dosage of salbutamol?

5 milligrams (2.5mg in 2.5ml), repeated every 5 minutes, with no max dose

what is the route of salbutamol?

Nebulised with 6-8 litres of oxygen