Medications

for 2nd year paramed semester 1 exams

Adrenaline presentation

1mg in 1mL and 1mg in 10mL

Adrenaline MOA

Sympathetic agonist.

A1 activation = vasoconstriction = increased SVR, BP and blood flow, and smooth muscle contraction.

B1 activation = increased inotropy, chronotropy and dromotropy = increased CO

B2 activation = bronchodilation, smooth muscle relaxation, stabilization of mast cells.

Adrenaline Contraindications

Hypovolaemic shock without adequate fluid replacement

Adrenaline precautions

Elderly/frail, Patients with cardiovascular disease, Patients on MAOIs, higher doses needed for patients on beta blockers.

Adrenaline side effects

“H SPASM” Hypertension, Sinus tachycardia, pupillary dilation, anxiety/palpitations in the conscious patient, supraventricular arrhythmias, may increase size of MI.

Adrenaline doses

Cardiac arrest: 1mg IV every 2nd cycle (4 minutely)

Anaphylaxis: 500mcg IM (1:1,000) @5 mins Or nebulised 5mg

Asthma inadequate response: 500mcg IM (1:1,000) @ 5-10mins, max 1.5mg

Thunderstorm asthma: 20mcg IV (double diluted method) @ 2min intervals

Aspirin presentation

300mg chewable tablets or water soluble tablets

Aspirin MOA

Targets COX-1 and COX-2 thus inhibiting synthesis of prostaglandins = anti-inflammatory, analgesic, and antipyretic effect.

Inhibition of COX-1 = inhibiting platelet thromboxane A2 synthesis = inhibition of platelet aggregation and thrombus formation

Aspirin contraindications

Hypersensitivity, actively bleeding peptic ulcers, bleeding disorders, suspected dissecting aortic aneurysm, chest pain associated with psychostimulant OD if SBP>160

Aspirin precautions

Peptic ulcer, asthma, patients on anticoagulants

Aspirin side effects

“HIGH N” Heartburn, Increased bleeding time, GI bleeding, Hypersensitivity reactions, Nausea.

Aspirin doses

300mg oral

Ceftriaxone presentation

1g sterile powder in glass vial

Ceftriaxone MOA

Ceftriaxone is a Cephalosporin antibiotic

Ceftriaxone contraindications

Allergy to Cephalosporin antibiotics

Ceftriaxone precautions

Allergy to Penicillin antibiotics

Ceftriaxone side effects

“DNR” Diarrhoea, Nausea & vomiting, Rash

Ceftriaxone doses

1g IV slow injection over 2mins (diluted with water for injection to make 10mL)

1g IM (dilute with 3.5mL of 1% lignocaine to make 4 mL), give 2mL doses separately into the lateral thigh

Dexamethasone presentation

8mg in 2mL vial

Dexamethasone MOA

corticosteroid that targets bronchial epithelial cells to reduce inflammation of the airways and produce immunosuppression

Dexamethasone contraindications

Known hypersensitivity

Dexamethasone precautions

Solutions which are not clear or are contaminated should be discarded

Dexamethasone side effects

Nil

Dexamethasone doses

8mg IV/oral

Fentanyl presentation

100mcg in 2mL or IN cartridge (250mcg in 1mL)

Fentanyl MOA

Binds to opioid receptors (especially mu receptors), causes reduced cAMP concentrations, causing an influx of calcium ions into the cell, resulting in hyperpolarization of the cell and nerve inhibition

Fentanyl contraindications

History of hypersensitivity, late second stage labour, serotonin syndrome, MAOIs within 14days

Fentanyl precautions

Elderly/frail, impaired hepatic function, respiratory depression eg. COPD, current asthma, patients on MAOIs, opioid addiction, rhinitis/rhinorrhea or facial trauma (IN)

Fentanyl side effects

“BRAR” Bradycardia, Respiratory depression, Apnoea, Rigidity of diaphragm and intercostals

Fentanyl doses

IV: Up to 50mcg @ 5mins, max 200mcg before consult

IN: 200mcg, repeat up to 50mcg @ 5mins, max. 400mcg

Elderly/frail IN: 100mcg, repeat up to 50mcg @ 5mins, max. 200mcg

IM: 100mcg, repeat 50mcg @ 15mins, once only

Elderly/frail IM: 1mcg/kg, no repeat

Glucagon presentation

1mg in 1mL hypokit

Glucagon MOA

a hormone that causes an increase in blood glucose concentration by converting stored liver glycogen to glucose

Glucagon contraindications

nil

Glucagon precautions

nil

Glucagon side effects

Nausea and vomiting (rare)

Glucagon routes and doses

IV / IM: 1mg, repeat @ 5mins, once only

GTN presentation

Sublingual: 300mcg sublingual tablet

Transdermal: 50mg patch (released 0.4mg/hr or 10mg/24hrs)

GTN MOA

An organic nitrate.

Enters mitochondria, produced nitric oxide (NO), NO potentiates cGMP, reduces calcium available to muscle cells, causing muscle relaxation and veno- & aterio-dilation = venous pooling (reduced preload), reduces SVR (reduced after load), reducing myocardial workload and oxygen demand, reduced BP, and increases perfusion/blood supply, resulting in lowered angina.

GTN routes and doses

S/L: 600mcg (or 300mcg is no prev. use, borderline BP or elderly/frail), repeat 300 or 600mcg @ 5mins, titrated to pain or side effects.

Patch: 50mg (0.4mg/hr) upper body, remove when BP <100

GTN contraindications

BP<100

HR>150

HR<50 (except in autonomic dysreflexia)

VT

PDE5 inhibitor use

Riociguat current use

Bleeding in pregnancy

GTN precautions

Lower doses for elderly/frail, no previous GTN exposure or recent MI

Right ventricular MI or inferior STEMI with SBP<160

Preterm labour

GTN side effects

“SHyT SHeD” Syncope, Hypotension, Tachycardia, (occasionally bradycardia), Skin flushing, Headache, Dizziness.

Ipratropium Bromide presentation

250mcg in 1mL

Ipratropium Bromide MOA

Blocks muscarinic acetylcholine receptors in the lungs, causing inhibition of parasympathetic NS, causing bronchodilation and reduced airway secretions.

Ipratropium Bromide contraindications

Known hypersensitivity to Atropine or its derivatives

Ipratropium Bromide precautions

Glaucoma

Avoid eye contact

Ipratropium Bromide side effects

“PT HANDS”: palpitations, tachycardia, headache, acute angle closure glaucoma secondary to direct eye contact (rare).nausea, dry mouth, skin rash.

Ipratropium Bromide routes and doses

Nebulised: 500mcg (2mL) with salbutamol, no repeat

Ketamine presentation

200mg in 2mL

Ketamine MOA

NMDA receptor antagonist. May also interact with opioid, muscarinic and other receptors. Causing a trance-like dissociative state with amnesia.

Ketamine contraindications

Suspected non-traumatic brain injury with severe hypertension (SBP >180)

Ketamine precautions

may exacerbate CV conditions (uncontrolled hypertension, stroke, recent MI, cardiac failure etc.) due to effects on HR and BP.

Ketamine side effects

“HTN TaN SHIELD” Hypertension, Transient respiratory depression and apnoea, Nausea and vomiting, Tachycardia, Nystagmus, Skeletal muscle tone, Hypersalivation, Injection site pain, Emergence reactions (vivid dreams, restlessness, confusion, hallucinations, irrational behaviour), Lacrimation, Diplopia, .

Ketamine routes and doses

IN: 75mg, repeat 50mg @ 20mins, no max.

(Elderly/frail) IN: 50mg, repeat 25mg @20mins, no max.

• add 0.1mL to required dose for dead space in MAD

Consult for IV

Methoxyflurane presentation

3mL bottle

Methoxyflurane MOA

Inhaled anesthetic causing analgesia at low doses. May have effect on decreasing junctional conductance

Methoxyflurane contraindications

pre-existing renal disease, known or genetic susceptibility to malignant hyperthermia

Methoxyflurane precautions

no more than 6mL in 24hr period, not administered in confined space

Methoxyflurane side effects

“DDH NaV” Dizziness, drowsiness, hypotension, nausea and vomiting.

Methoxyflurane routes and doses

3mL inhaled, repeat if required

Morphine presentation

10mg in 1mL ampoule

Morphine MOA

Opioid receptor agonist, block neurotransmitter release, blocking pain transmission pathway

Morphine contraindications

history of hypersensitivity, renal impairment/failure, late second stage labour

Morphine precautions

Elderly/frail, hypotension, respiratory depression, current asthma, respiratory tract burns, addiction to opioids, acute alcoholism, MAOIs

Morphine side effects

“HAND BERP”: Hypotension, addiction, nausea and vomiting, drowsiness, bradycardia, euphoria, respiratory depression, pin-point pupils.

Morphine routes and doses

IV: up to 5mg @ 5 mins, max 20mg.

IM: 10mg, repeat 5mg @ 15mins once only.

(Elderly/frail) IM: 0.1mg/kg, no repeat

Ondansetron presentation

4mg ODT, 8mg in 4mL ampoule

Ondansetron MOA

5HT3 antagonist, blocking vomiting center and CTZ

Ondansetron contraindications

Apomorphine

Ondansetron precautions

1st trimester pregnancy, congenital long QT syndrome, severe hepatic disease (max limit of 8mg), pts with phenylketonuria (avoid ODT)

Ondansetron side effects

“CVD HQ” Constipation, Visual disturbances, Dizziness, Headache, QT prolongation

Ondansetron routes and doses

ODT: 4mg, repeat @ 5-10mins, max. 8mg

IV: 8mg slow injection over 3-5mins

Paracetamol presentation

500mg tablet

Paracetamol MOA

analgesic and antipyretic. Inhibit COX enzyme, inhibits prostaglandin synthesis

Paracetamol contraindications

Children <1 month old

Paracetamol precautions

No more than 4g in 24hrs for adults, impaired hepatic function or liver disease, elderly/frail, malnourishment.

Paracetamol side effects

“HHH” Hypersensitivity reactions (skin rashes), haematological reactions, hypotension

Paracetamol routes and doses

Oral: 1000mg, no repeat

Elderly/frail/under 60kg = 500mg, no repeat

Prochlorperazine presentation

12.5mg in 1mL ampoule

Prochlorperazine MOA

D2 receptor antagonist causing inhibitory effects on CTZ and vomiting center. Also reduces headaches

Prochlorperazine contraindications

CNS depression (unconscious or severely intoxicated), patients <21 years of age

Prochlorperazine precautions

Elderly, Parkinsons disease

Prochlorperazine side effects

“SPExB QT” Sedation, Postural hypotension, Extrapyramidal reactions, Blurred vision, QT prolongation

Prochlorperazine routes and doses

IM: 12.5mg

Salbutamol presentation

5mg in 2.5mL polyamp or pMDI 100mcg per actuation

Salbutamol MOA

Beta 2 adrenergic receptor agonist causing smooth muscle relaxation = bronchodilation and reduces inflammation

Salbutamol contraindications

Nil

Salbutamol precautions

Large doses can cause intracellular metabolic acidosis

Salbutamol side effects

“SM” Sinus tachycardia, muscle tremor

Salbutamol routes and doses

Asthma = pMDI 4-12 doses @ 20min intervals (mild-moderate) or 10mg (5mL) nebulised repeat 5mg @ 5 mins once only (moderate - life-threatening)

COPD = 10mg (5mL) nebulised.

Anaphylaxis (for bronchospasm)= 5mg nebulised or 4-12 pMDI repeat @ 20min intervals