Paramedicine DTPs (PAR102)

Drug Therapy Protocols from the QAS CPM. ACP2 scope, as per PAR102 content.

Adrenaline: drug class

Sympathomimetic

Adrenaline: pharmacology

Naturally occurring catecholamine that primarily acts on Alpha and Beta adrenergic receptors.

Adrenaline: effects

Increased heart rate, increased force of myocardial contraction, increased irritability of ventricles, bronchodilation, and peripheral vasoconstriction

Adrenaline: metabolism

Majority metabolised by sympathetic nerve endings, undergoes mitochondrial enzymatic breakdown by monoamine oxidase at the synaptic level

Adrenaline: indications

Cardiac arrest

Anaphylaxis

Severe life-threatening bronchospasm OR silent chest

Shock unresponsive to adequate fluid resuscitation

Bradycardia with poor perfusion (unresponsive to atropine and/or transcutaneous pacing)

Croup (moderate to severe)

Adrenaline: contraindications

Nil

Adrenaline: precautions

Hypertension

Hypovolaemic shock

Concurrent MAOI therapy

Quetiapine toxicity

Adrenaline: side effects

Anxiety

Hypertension

Palpitations/tachyarrhythmias

Pupil dilation

Tremor

Adrenaline: presentation

Ampoule, 1mg/mL (1:1000)

Ampoule, 1mg/10mL (1:10000)

Pre-filled syringe EpiPen Auto-injector, 300 microg

Pre-filled syringe EpiPen Auto-injector, 150 microg

Adrenaline: onset, duration, half-life

Onset: 30sec (IV), 60sec (IM)

Duration: 5-10min

Half-life: 2min

Adrenaline: schedule

S3

Adrenaline: routes of administration (ACP2)

NEB

NM

IV

IV INF

Adrenaline: adult dosage (cardiac arrest)

IV: 1mg, repeated at 3-5min intervals. No max dose

Adrenaline: adult dosage (anaphylaxis)

IM: 500 microg, repeated at 5min intervals. No max dose

NEB: 5mg, single dose only

IV INF (clinical consult required): 1-2 drops per sec (6-12 microg/min)

Adrenaline: adult dosage (severe life-threatening bronchospasm OR silent chest)

IM: 500 microg, repeated at 5 min intervals. No max dose

IV INF: 1-2 drops per sec (6-12 microg/min)

Adrenaline: adult dosage (shock unresponsive to adequate fluid resuscitation)

IV INF (clinical consult required): 1-2 drops per sec (6-12 microg/min)

Adrenaline: paediatric dosage (cardiac arrest)

Adrenaline: paediatric dosage (anaphylaxis)

IM: >6 years 300 microg, repeated at 5 min intervals, no maximum dose

1-6 years 150 microg, repeated at 5 min intervals, no maximum dose

6 months-1 year 100 microg, repeat at 5 min intervals, no maximum dose

<6 months 50 microg, repeat at 5 min intervals, no maximum dose

NEB: 5 mg, single dose only

Adrenaline: paediatric dosage (severe life-threatening bronchospasm OR silent chest)

IM: >6 years 300 microg, repeated at 5 min intervals, no maximum dose

1-6 years 150 microg, repeated at 5 min intervals, no maximum dose

6 months-1 year 100 microg, repeat at 5 min intervals, no maximum dose

<6 months 50 microg, repeat at 5 min intervals, no maximum dose

Adrenaline: paediatric dosage (croup (moderate to severe))

NEB: 5 mg, single dose only

Aspirin: drug class

Antiplatelet

Aspirin: pharmacology

Inhibits platelet aggregation by irreversibly inhibiting cyclo-oxygenase, reducing the synthesis of thromboxane A2

Aspirin: metabolism

Converted into salicylic acid in many tissues, but primarily in the GI mucosa and liver. Excreted by kidneys.

Aspirin: indications

Suspected ACS

Acute cardiogenic pulmonary oedema

Aspirin: contraindications

Allergy AND/OR adverse drug reaction to aspirin or any non-steroidal anti-inflammatory drug (NSAID)

Bleeding OR clotting disorders

Current GI bleeding OR peptic ulcers

Patients <18 years of age

Aspirin: precautions

Possible aortic aneurysm or any other condition that may require surgery

Pregnancy

History of GI bleeding or peptic ulcers

Concurrent coagulant therapy (e.g. warfarin)

Aspirin: side effects

Epigastric pain/discomfort

Nausea and/or vomiting

Gastritis

GI bleeding

NSAID induced bronchospasm

Aspirin: presentation

Tablet (white), 300 mg

Aspirin: onset, duration, half-life

Onset: 10 minutes (variable)

Duration: 1 week (antiplatelet)

Half-life: 3.2 hours (300-650 mg)

Aspirin: schedule

S2

Aspirin: routes of administration

PO

Aspirin: adult dosage (suspected ACS, acute cardiogenic pulmonary oedema)

PO: 300 mg, chewed and followed by a small sip of water (where possible)

Glucagon: drug class

Hyperglycaemic

Glucagon: pharmacology

A hyperglycaemic agent that mobilises hepatic glycogen, which is released into the blood as glucose. Also has inotropic and chronotropic effects which are not mediated through beta-receptors

Glucagon: metabolism

Metabolised by the liver, kidneys, and in the plasma

Glucagon: indications

Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)

Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)

Glucagon: contraindications

Allergy AND/OR adverse drug reaction

Glucagon: precautions

Nil

Glucagon: side effects

Nil

Glucagon: presentation

Vials (powder and solvent), 1 mg

Glucagon: onset, duration, half-life

IM onset: 4-7 min

IM duration: variable

Half-life: 3-6 min

Glucagon: schedule

S3

Glucagon: routes of administration

IM

IV

Glucagon: adult dosage (symptomatic hypoglycaemia)

IM: 1 mg, single dose only (reconstitute 1 mg in 1 mL of water)

Glucagon: adult dosage (refractory anaphylaxis with persistent hypotension/shock)

IM: 1 mg, single dose only (reconstitute 1 mg in 1 mL of water), administered when IV access is not possible

IV: 1 mg, single dose only (reconstitute 1 mg in 1 mL of water)

Glucagon: paediatric dosage (symptomatic hypoglycaemia)

IM >25 kg: 1 mg, single dose only (reconstitute 1 mg in 1 mL of water)

IM <25 kg: 0.5 mg, single dose only (reconstitute 1 mg in 1 mL of water, decant 0.5 mL of prepared solution)

Glucagon: paediatric dosage (refractory anaphylaxis with persistent hypotension/shock)

IM >25 kg: 1 mg, single dose only (reconstitute 1 mg in 1 mL of water) administered when IV access is not possible

IM <25 kg: 0.5 mg, single dose only (reconstitute 1 mg in 1 mL of water, decant 0.5 mL of prepared solution) administered when IV access is not possible

IV >25 kg: 1 mg, single dose only (reconstitute 1 mg in 1 mL of water)

IV <25 kg: 0.5 mg, single dose only (reconstitute 1 mg in 1 mL of water, decant 0.5 mL of prepared solution)

Glucose gel: drug class

Hyperglycaemic

Glucose gel: pharmacology

Absorbed quickly in the intestinal tract after ingestion, main source of energy for body cells, especially the brain

Glucose gel: metabolism

Broken down in most tissues and distributed throughout total body water

Glucose gel: indications

Symptomatic hypoglycaemia (with the ability to tolerate oral medications)

Glucose gel: contraindications

Unconsciousness

Patients with difficulty swallowing

Glucose gel: precautions

Patients <2 years of age

Glucose gel: side effects

Nausea and/or vomiting

Diarrhoea

Glucose gel: presentation

Tube, 15g

Glucose gel: onset, duration, half-life

Onset: 10 minutes

Duration: variable

Half-life: not applicable

Glucose gel: schedule

Unscheduled

Glucose gel: routes of administration

PO

BUCC

Glucose gel: adult dosage (symptomatic hypoglycaemia)

PO: 15 g, repeated once at 15 min if BGL <4.0 mmol/L. Max dose 30g

Glucose gel: paediatric dosage (symptomatic hypoglycaemia)

PO >2 years: 15 g, repeated once at 15 min if BGL <4.0 mmol/L. Max dose 30 g

BUCC <2 years: 1 cm strip (approx. 0.2g) on gloved finger. Repeated every 5 min until BGL > 3.0 mmol/L

Glyceryl trinitrate: drug class

Vasodilator

Glyceryl trinitrate: pharmacology

A potent vasodilator that decreases preload by increasing venous capacity, pooling venous blood in the peripheral veins, reducing ventricular filling pressure and decreasing arterial blood pressure (after load). Because of this cascade it also causes vasodilation in coronary arteries that are in spasm and may assist the redistribution of blood flow along the collateral channels in the heart

Glyceryl trinitrate: metabolism

Readily absorbed and metabolised by the liver

Glyceryl trinitrate: indications

Suspected ACS (with pain)

Acute cardiogenic pulmonary oedema

Autonomic dysreflexia (with a systolic BP >160 mmHg)

Irukandji syndrome (with a systolic BP > 160 mmHg)

Glyceryl trinitrate: contraindications

Allergy AND/OR adverse drug reaction

Heart rate < 50 OR > 150 beats per min

Systolic BP < 100 mmHg

Active CVA

Head trauma

Phosphodiesterase 5 inhibitor medication administration

• Sildenafil OR vardenafil in the previous 24 hours

• Tadalafil in the previous 48 hours

Patients currently taking riociguat

Glyceryl trinitrate: precautions

Inferior AMI

Cerebral vascular disease

Risk of hypotension and/or syncope

Intoxication (GTN effects are enhanced)

Phosphodiesterase 5 inhibitor medication administration (e.g. tadalafil, sildenafil, vardenafil) administration in the previous 4 days

Glyceryl trinitrate: side effects

Dizziness

Hypotension

Syncope

Reflex tachycardia

Vascular headaches

Glyceryl trinitrate: presentation

Spray (SUBLING), 400 microg/dose, 200 doses

Glyceryl trinitrate: onset, duration, half-life

Onset: < 2 min

Duration: 20-30 min

Half-life: 5.5 min

Glyceryl trinitrate: schedule

S3

Glyceryl trinitrate: routes of administration

SUBLING

Glyceryl trinitrate: adult dosages (suspected ACS)

SUBLING: 400 microg, repeated at 5 min intervals. No max dose

Glyceryl trinitrate: adult dosages (acute cardiogenic pulmonary oedema)

SUBLING: 400 microg, repeated at 5 min intervals. No max dose

Glyceryl trinitrate: adult dosages (autonomic dysreflexia (with a systolic BP > 160 mmHg)), (Irukandji syndrome (with a systolic BP > 160 mmHg))

SUBLING: 400 microg, repeated at 5 min intervals. No max dose

Glyceryl trinitrate: paediatric dosages (autonomic dysreflexia (with a systolic BP > 160 mmHg)), (Irukandji syndrome (with a systolic BP > 160 mmHg))

QAS Clinical Consultation and Advice Line approval required for all situations

Ibuprofen: drug class

Non-steroidal anti-inflammatory drug (NSAID)

Ibuprofen: pharmacology

A non-selective NSAID that inhibits the synthesis of prostaglandins resulting in analgesic, antipyretic, and anti-inflammatory actions

Ibuprofen: metabolism

Metabolised by the liver and excreted mainly by the kidneys

Ibuprofen: indications

Moderate pain due to acute inflammation and tissue injury

Ibuprofen: contraindications

Allergy AND/OR adverse drug reaction to any NSAID or aspirin

Concurrent NSAID therapy

Current GI bleeding OR peptic ulcers

Dehydration AND/OR hypovolaemia

Renal impairment

NSAID induced asthma

Heart failure

Pregnancy

Angiotensin converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) therapy

Patients <13 years OR >65 years of age

Patients taking anticoagulant medications

Diuretic treatment

Ibuprofen: precautions

Asthma

Hepatic dysfunction

History of GI bleeding or peptic ulcers

Ibuprofen: side effects

Nausea

Dyspepsia

GI bleeding

Dizziness

Ibuprofen: presentation

Tablet, 200 mg

Ibuprofen: onset, duration, half-life

Onset: 15 mins

Duration: 4-6 hours

Half-life: 2 hours

Ibuprofen: schedule

S2

Ibuprofen: routes of administration

PO

Ibuprofen: adult dosages (moderate pain due to acute inflammation and tissue injury)

PO: 200-400 mg, must not be administered within 6 hours of previous ibuprofen administration

Methoxyflurane: drug class

Analgesic (at low concentrations)

Methoxyflurane: pharmacology

A fluorinated hydrocarbon anaesthetic that provides analgesia when inhaled at low concentrations. The precise mechanism of action is not established but may involve modulation of excitation and inhibitory ion channel activity in the brain and spinal cord

Methoxyflurane: metabolism

Extensive hepatic metabolism (50-70%) with urinary (~30%) and exhalation (~20%) excretion

Methoxyflurane: indications

Pain (with the ability to self-administer)

Methoxyflurane: contraindications

Allergy AND/OR adverse drug reaction

Patients <1 year of age

Known liver OR renal disease

Malignant hyperthermia (known or genetic susceptibility)

Methoxyflurane: precautions

ALOC

Intoxicated or drug affected patients

Cardiac instability

Respiratory depression

Methoxyflurane: side effects

ALOC

Dizziness

Cough

Methoxyflurane: presentation

Bottle, 3 mL

Methoxyflurane: onset, duration, half-life

Onset: 1 min

Duration: 25 min (with continuous inhalation)

Half-life: 3.2 hr

Methoxyflurane: schedule

S4

Methoxyflurane: routes of administration

INH

Methoxyflurane: adult dosage (moderate to severe pain)

INH: 3 mL, repeated once after 20 minutes. Total max dose 6 mL in 24 hrs, 15 mL in 7 days

Methoxyflurane: paediatric dosage (moderate to severe pain)

INH: 3 mL, repeated once after 20 minutes. Total max dose 6 mL in 24 hrs, 15 mL in 7 days