Common Drugs

Adrenaline 1:10,000

Adrenaline is a sympathomimetic that binds to beta 1 receptors mimicking the effects of the sympathetic nervous system while increasing heart rate specifically on the SA Node and myocardial contractility by increasing the inward Calcium current

It binds to alpha 1 receptors, once activated these receptors cause contractions of the smooth muscle within blood vessels resulting in vasoconstriction and an influx of Calcium ions

The above stimulates beta 2 receptors in the kidneys causing them to release renin causing an increase in bp

Adrenaline Route of Administration

Adrenaline is administered by IV or IO

Adrenaline 1:10,000 Indications

Cardiac arrest, post ROSC circulatory support, bradycardia not responsive to atropine sulfate

Adrenaline 1:10,000 Contraindications

Should not be given to treat bradycardia in suspected hypothermia

Cautions of Adrenaline 1:10,000

Severe hypertension may occur in patients on non-cardioselective beta-blockers, single dose only at under 30 degrees temp or if unrecordable

Dose of Adrenaline 1:10,000 (cardiac arrest) for patients 12 and over

For shockable rhythms administer after third shock and then alternative shocks, for non-shockable rhythms administer iv immediately

Initial dose is 1mg in 10ml with dose interval of 3-5 minutes

Dose of Adrenaline 1:10,000 (cardiac arrest when patients are hypothermic)

When patients temp is between 30-35 degrees double the period of time between doses only when hypothermia is thought to be the main cause of arrest

Alpha Blockers

Alpha blockers are antagonists of alpha adrenoreceptors, preventing sympathetic mediated vascular smooth muscle contraction leading to vasodilation

Examples of Alpha Blockers

Examples of alpha blockers include tamsulosin, doxazosin and other medications ending in -osin

Alpha Blockers route of administration

Alpha blockers are taken orally

Indications of Alpha Blockers

Indications of Alpha Blockers for adults include hypertension, benign prostatic hyperplasia and in children dysfunctional voiding

Contraindications of Alpha Blockers

Contraindications of Alpha Blockers include postural/orthostatic hypotension, upcoming cataract surgery, erectile dysfunction medications, kidney or circulatory disease and respiratory infections

Adverse effects of Alpha-blockers

Adverse effects of alpha blockers include dizziness and postural/orthostatic hypotension

ACE (Angiotensin-converting enzyme) inhibitors

Angiotensin-converting enzyme inhibitors inhibit the conversion of angiotensin I to angiotensin II by blocking the converting enzyme, this increases bradykinin levels resulting in vasodilation with a consequent reduction in peripheral resistance as well as a small change in heart rate, cardiac output and reduced sodium retention

ACE Inhibitors route of administration

ACE Inhibitors are taken orally

Examples of ACE inhibitors

Examples of ACE inhibitors include ramipril, lisinopril, captopril and enalapril

Indications of ACE Inhibitors

Indications of ACE inhibitors include hypertension (first line in T2D patients), cardiac failure and renal dysfunction (especially in diabetic patients to slow progression of diabetic or reduced renal functional neuropathy)

Contraindications of ACE inhibitors

Contraindications of ACE inhibitors include pregnancy, renovascular disease and aortic stenosis

Adverse effects of ACE Inhibitors

Adverse effects of ACE Inhibitors include a characteristic couch (caused by increased bradykinin levels), angioedema, hypotension, dizziness, headache, diarrhoea, muscle cramps and hyperkalaemia

Aspirin

Aspirin is an NSAID, anti-platelet, analgesic and anti-pyretic which -

blocks the COX1 enzyme stopping thromboxane being produced and therefore from occlusions from getting bigger

prevents platelet aggression (stops clots from forming)

irreversibly and permanently inhibits platelets for their lifespan (around 8-10 days)

Prohibits COX2 enzyme contributing to pain, inflammation and fever

Aspirin prohibiting COX2

Aspirin prohibits the COX2 enzyme contributing to -

pain by desensitising the CNS to painful substances

inflammation by increasing blood flow, chemotaxis

fever by preventing toxins and infectious agents from entering the circulatory system

Thromboxane

Thromboxane is a lipid produced from COX1 and COX2 enzymes which causes vasoconstriction and platelet activation/aggregation

Aspirin route of administration

Aspirin is given orally

Aspirin ADME

Aspirin is rapidly absorbed by the stomach, distributed by passing through the stomach lining via simple diffusion into the blood stream, it is metabolised in the liver and excreted via the kidneys in urine

Indications of Aspirin

Indications of Aspirin include adults with clinical or ECG suggestions of myocardial infarction or ischemia, a suspected TIA as long as symptoms are fully resolved, the patient is nor being conveyed to hospital and have been referred into a local TIA pathway

Contraindications of Aspirin

Contraindications of Aspirin include known allergies or sensitivity, children under 16, active gastrointestinal bleeding, haemophilia or other known clotting disorders, severe hepatic failure with jaundice

Aspirin Cautions

As the likely benefits of a single 300mg aspirin outweigh the potential risks aspirin may still be given to patients with asthma, pregnancy, renal failure, moderate hepatic disease without jaundice, gastric duodenal ulcer and current treatment with anticoagulants

Adverse effects of Aspirin

Adverse effects of Aspirin include increased risk of gastric bleed, wheezing and bronchospasm in some asthmatics and dyspepsia

Aspirin Doses

300mg of Aspirin must be given unless the patient has already had 300mg for this episode, if a patient has had a dose smaller than 300mg that day a dose of 300mg should be given

Beta Blockers

Beta Blockers 1 (predominantly found in the heart) and 2 (found mainly in smooth muscle of the arteries, veins etc.) are either non-selective or cardiac-specific. The aim of using is to block beta-adrenoreceptors in the heart causing fall of heart rate, systolic blood pressure, cardiac contractility and myocardial oxygen demand

Beta-Blocker route of administration

Beta-blockers can be oral or intravenous

Examples of beta-blockers depending on their indications

Angina and post myocardial infarction (bisoprolol, atenolol), arrhythmias (metoprolol, bisoprolol), hypertension (bisoprolol, atenolol, labetalol), thyrotoxicosis and anxiety (propranolol), glaucoma (timolol)

Contraindications of Beta-Blockers

Non-selective beta-blockers such as propranolol cannot be given to asthmatic patients as at a high dose the beta 1 adrenoreceptor antagonists lose their selectivity, bradycardia, hypotension and Atrioventricular (AV) block

Adverse effects of Beta-Blockers

Adverse effects of Beta-Blockers include bronchospasm, fatigue and insomnia, dizziness, cold extremities, bradycardia, heart block, hypotension and decreased glucose tolerance in diabetic patients

Calcium Channel Inhibitors/Blockers

Calcium channel blockers block voltage gated Ca channels on heart and vascular smooth muscle decreasing contractility and vascular tone causing vasodilation

Examples of Calcium Channel Blockers

Examples of Calcium Channel Blockers include Amlodipine, Nifedipine, Felodipine, Verapamil and Diltiazem

Two types of Calcium Channel Blockers

The two types of Calcium Channel Blockers are rate limiting and Dihydropyridine

Rate-Limiting Ca Channel blockers

Rate-Limiting Ca Channel blockers blocks calcium channels into the heart and vascular smooth muscles, thereby reducing calcium entry into cardiac and vascular cells which decreases cardiac contractility, heart rate and causes vasodilation - mainly used for hypertension, angina, and heart arrhythmias such as atrial fibrillation

Examples of Rate-Limiting Ca Channel blockers

Examples of Rate-Limiting Ca Channel blockers include verapamil and diltiazem

Dihydropyridine Ca Channel Blockers

Dihydropyridine Ca Channel Blockers do not affect cardiac contractility or AVN conduction, all beneficial effects are caused by increased coronary flow and peripheral vasodilation - mainly used for angina, hypertension, Raynaud’s syndrome and cerebral vasospasm prevention

Dihydropyridine Ca Channel Blocker Examples

Examples of Dihydropyridine Ca Channel Blockers include amlodipine, nifedipine, felodipine

Route of administration for Ca channel blockers

Calcium channel blockers are given orally

Indications of Ca Channel Blockers

Indications of Ca Channel Blockers include hypertension, angina, atrial fibrillation and Raynaud’s Syndrome

Contraindications of Calcium Channel Blockers

Dihydropyridine are contraindicated in advanced aortic stenosis and rate-blocking ca channel blockers should not be given to patients with severe cardiac failure, patients who already take beta blockers or with severe bradycardia

Adverse effects of Ca channel blockers

Adverse effects of Ca channel blockers vary on the specific type but may include hypotension, rash, bradycardia, congestive cardiac failure, heart block and constipation

Clopidogrel

Diuretics

Diuretics are first-line therapy for patients with uncomplicated hypertension, they inhibit Na reabsorption in the kidney increasing water and salt excretion therefore decreasing blood volume and blood pressure

Three main types of Diuretics

Thiazides, loop diuretics and potassium-sparing diuretics

Thiazide Diuretics

Thiazide Diuretics are moderate diuretics but powerful anti-hypertensives, unlike other diuretics they increase the secretion of potassium while decreasing calcium excretion, which can help prevent kidney stones and protect bone density

Thiazide Diuretics Examples

Examples of Thiazide Diuretics include Bendroflumethiazide and Indapamide

Thiazide Diuretics Indications

Thiazide Diuretics are the third-line treatment for hypertension (have been shown to reduce the risk of heart attack and strokes with patients who suffer with hypertension)
mild heart failure (although Loop preferred)
occasionally for prophylaxis of calcium containing renal stones
may be preferred in elderly patients with osteoporosis due to the calcium retention

Thiazide Diuretics Contraindications

Addison disease, hypokalaemia, hyponatraemia, hypercalcaemia, high levels of urate and caution when patients have diabetes

Thiazide Diuretics Adverse effects

Thiazide Diuretics are better tolerated than loop diuretics but still increase urinary frequency, hypokalaemia, hyperuricaemia, hyponatraemia, hypermagnesemia, hypercalcaemia and metabolic alkalosis

Loop-Diuretic

Loop-Diuretics are powerful diuretics acting quicker than thiazide diuretics but are only moderate anti-hypertensives, calcium and magnesium reabsorption is inhibited alongside the increase of potassium secretion

Examples of Loop-Diuretics

Examples of Loop-Diuretics include Furosemide, Bumetanide and Torsemide

Indications of Loop-Diuretics

Loop-Diuretics are used predominantly in the treatment of salt and water overload associated with acute pulmonary oedema, hypertension, chronic heart failure, liver ascites and nephrotic syndrome

Contraindications of Loop-Diuretics

Loop-Diuretics should be given in caution to patients with cardiac glycosides due to the increase of induced arrhythmias, severe hyponatraemia, severe hypokalaemia, aminoglycoside antibiotics due to the increase of nephrotoxicity and potential hearing loss that can occur with these

Adverse effects of Loop-Diuretics

Adverse effects of Loop-Diuretics include hypokalaemia, hyponatraemia, hypotension, hypovolaemia, can exacerbate gout and diabetes and cause urinary retention in patients with prostatic hyperplasia

Potassium-sparing diuretics

the two types of potassium-sparing diuretics are sodium-channel blockers and aldosterone antagonists

Potassium-sparing diuretics route of administration

Potassium-sparing diuretics is administered orally

Examples of Potassium-sparing diuretics

Examples of Potassium-sparing diuretics include amiloride, triamterene, spironolactone and eplerenone

Indications of Potassium-sparing diuretics

Indications of Potassium-sparing diuretics include prolonging survival in patients with heart failure when used in conjunction with loop or thiazide diuretics, hyperaldosteronism, oedema, ascites, nephrotic syndrome and prevents hypokalaemia

Contraindications of Potassium-sparing diuretics

Contraindications of Potassium-sparing diuretics include patients with severe renal failure, hyperkalaemia, Addison’s disease, use of ACE inhibitors can increase risk of hyperkalaemia when used together

Adverse effects of Potassium-sparing diuretics

Adverse effects of Potassium-sparing diuretics include gastrointestinal disturbances, hyperkalaemia, hypokalaemia, hyponatraemia, menstrual disorders and male sexual dysfunction

Furosemide

a loop-diuretic with a rapid onset within 30 minutes and a short duration which inhibits the sodium-potassium-chloride cotransporter in the ascending loop of Henle,

meaning the lumen of the loop of Helne becomes more hypotonic (more sodium and chloride in the surrounding tissue) due to the prevention of sodium and chloride leaving

causing water to move in to the lumen from areas surrounding via passive transport resulting in more water being lost through urine output

Hypotonic

Hypotonic is a solution having lesser concentration of solute than another solution which it is compared

Furosemide ADME

Furosemide is given IV with bioavailability of 100%, protein bound in the blood stream, liver, in the urine via kidneys

Route of administration of Furosemide

Furosemide can be given orally, intravenous and intramuscular

Indications of Furosemide

Indications of Furosemide include resistant hypertension pulmonary oedema and/or respiratory distress due to heart failure or renal/hepatic failure

Contraindications of Furosemide

Contraindications of Furosemide include reduced GCS with liver cirrhosis, cardiogenic shock, severe renal failure with anuria and children under the age of 18

Cautions of Furosemide

Cautions of Furosemide include pregnancy, hypotensive patients and hypokalaemia could induce arrythmias

Adverse effects of oral prescribed Furosemide

Adverse effects of oral prescribed Furosemide include dizziness, fatigue, electrolyte imbalance, headache and nausea

Adverse effects of Furosemide according to JRCALC

Adverse effects of Furosemide include hypotension and gastrointestinal disturbances

Intravenous Furosemide dose/max dose

Intravenous Furosemide initial dose is 40mg which must be administered slowly over 2 minutes
Max dose 40mg

GTN (Glycerol Trinitrate)

GTN is a potent vasodilator using nitric oxide as an active element to activate cGMP and encourage intracellular Calcium to leave cells in the vascular smooth muscles to cause relaxation and vasodilation

which facilitates improved tissue perfusion where atherosclerotic plaques limit delivery of blood to tissues and the heart

as well as reducing preload and increasing the hearts oxygen supply

which reduces work of the left ventricle and relieves breathlessness associated with Left Ventricular Failure

Route of Administration for GTN

GTN is sublingual spray or buccal tablet

Indications of GTN

Indications of GTN include acute heart failure with ischaemia or uncontrolled hypertension, left ventricular failure, symptom relief of cardiac chest pain due to angina or myocardial infarction when systolic bp is greater than 90, suspected cocaine toxicity presenting with chest pain

Contraindications of GTN

Contraindications of GTN include hypotension (systolic under 90 in angina/MI or under 100 in acute heart failure), hypovolemia, head trauma, cerebral haemorrhage, sildenafil (viagra) taken in previous 24 hours, unconscious patients, known severe aortic or mitral stenosis

Cautions of GTN

GTN should be used cautiously in patients with STEMI and is not recommended as first line therapy regardless of MI location, nozzle not to come into contact with patients mouth to avoid cross-contamination

Adverse Effects of GTN

Adverse Effects of GTN include headache, dizziness, hypotension and tachycardia

GTN ADME

GTN is absorbed rapidly through the mucous membranes of the mouth, distributed into the blood stream, metabolised through cytochrome P450 in the liver then excreted in the urine via kidneys

GTN Dose if treating Angina, MI or suspected Cocaine Toxicity

If tablet one tablet of 600, 500 or 300mcg with a dose interval of 5-10 minutes, same dose can be given again with no dose limit

If spray 400-800mcg or 1-2 sprays with a dose interval of 5-10 minutes, same dose can be given again with no dose limit

GTN Dose if treating Acute Heart Failure

Same doses however max dose of 1.8mg or 6 sprays

Statins

Statins are the first line drug for high cholesterol which reversibly inhibits the beta-hydroxy-beta-methylglutaryl coenzyme A

which decreases the liver’s ability to synthesis cholesterol

the decrease in cholesterol synthesis increases the number of LDL receptors/uptake of LDLS from the blood stream to liver

overall decreasing LDL plasma levels

They have anti-atherosclerotic effects reducing inflammatory activity in and size of plaques

Route of administration for Statins

Statins are taken orally

Examples of Statins

Examples of Statins include atorvastatin, simvastatin, pravastatin and rosuvastatin

Indications of Statins

Indications of Statins include hyperlipidaemia resistant to dietary control and primary/secondary prevention of cardiovascular disease

Contraindications of Statins

Contraindications of Statins include pregnancy, breastfeeding and liver disease

Adverse effects of Statins

Adverse effects of Statins include reversible myositis and rhabdomyolysis, muscle aches, constipation, diarrhoea, abdominal pain and flatulence, nausea, headache, fatigue, insomnia and rash

Therapeutics of Statins

Statins are typically prescribed to be taken at night to reduce peak cholesterol synthesis in the early morning