20 DRUGS HMCAS CPG

Class of Adenosine?

Answer:

"Antiarrhythmic"

MOA of Adenosine

Answer:

"Slows AV conduction time and is therefore able to interrupt re-entry circuits through the AV node, thus restoring normal sinus rhythm in patients experiencing paroxysmal SVT, including PSVT associated with WPW (Wolff-Parkinson-White Syndrome)."

How is Adenosine metabolized?

Answer:

"Rapidly cleared from the circulation via cellular uptake. Requires no hepatic or renal function to be activated or inactivated."

What are the indications for Adenosine?

Answer:

"Symptomatic SVT (narrow complex <0.12s)."

What are the contraindications of Adenosine?

Answer:

- Known hypersensitivity to Adenosine

- 2nd and 3rd degree heart block

- SSS (Sick Sinus Syndrome)/Sinus node disease

- Atrial Fibrillation (AF), including AF with accessory pathways (WPW).

What are precautions for Adenosine?

Answer:

- Asthmatic patients (due to mast cell degranulation and histamine release)

- Obstructive lung disease not associated with bronchoconstriction

- On Digoxin and/or Verapamil.

Side Effects of Adenosine

Answer:

- Bradycardia

- Hypotension

- Flushing

- Chest tightness

- Shortness of breath.

Route of Administration for Adenosine

Answer:

"IV, IO."

What is the adult dosing for Adenosine (Patient with SVT) via IV/IO

Answer:

"6mg - 1st dose, 12mg - 2nd dose (if required) via IV/IO"

What is the onset, duration, and half-life of Adenosine?

Answer:

"Onset: Rapid | Duration: Short | Half-life: < 10s"

What is the drug class of Adrenaline?

Answer:

"Sympathomimetic"

What is Adrenaline's mechanism of action?

Answer:

"α & β agonist → ↑ HR, ↑ contraction, bronchodilation, vasoconstriction, mast cell stabilization"

How is Adrenaline metabolized?

Answer:

"By monoamine oxidase and other enzymes in the blood, liver and nerve endings and is excreted by the kidneys."

What are the indications for Adrenaline/Epinephrine?

Answer:

- Cardiac Arrest

- Anaphylaxis

- Severe life-threatening bronchospasm

- Croup

- Non-traumatic shock unresponsive to fluid resuscitation

- Symptomatic bradycardia unresponsive to atropine and/or pacing.

What are contraindications for Adrenaline?

Answer:

"Nil in emergency setting."

What are precautions with Adrenaline?

Answer:

- Elderly patients

- Cardiac disease

- Hypertension

- Acute pulmonary oedema

- MAOI therapy

- Hypovolemic shock

List some side effects of Adrenaline

Answer:

- Anxiety

- Hypertension

- Palpitations/ tachyarrhythmias

- Tremors

- Pupil dilation

- Tissue necrosis from extravasation or repeated IM injections at the same site

What is the dose of Adrenaline for cardiac arrest (For adult)?

Answer:

"1mg IV/IO every 4 mins"

What is the dose of Adrenaline for an adult patient with Upper Airway Swelling?

"NEB: 5 mg (1:1000) every 5 minutes"

What is the IM dose of Adrenaline for an adult patient with anaphylaxis?

Answer:

"Via IM: 0.5mg (1:1000) every 5 mins"

What is Adrenaline's onset, duration, and half-life?

Answer:

"Onset: 30-60 sec | Duration: 5-10 mins | Half-life: 2 mins"

Routes for Adrenaline?

Answer:

"IV, IO, IV/IO INF, IM, NEB"

What is the Adrenaline dosage for an adult patient with Anaphylaxis (IV/IO)?

Answer:

"1 mcg/kg, max dose 50 mcg, every 1-10 minutes"

What is the Adrenaline dosage for Adult Patient with Severe Bronchoconstriction (IM)

Answer:

"IM: 0.5 mg (1:1000) every 5 minutes"

What is the Adrenaline dosage for (Adult) with Severe Bronchoconstriction (IV/IO)?

Answer:

"IV/IO: 1 mcg/kg, max dose 50 mcg, every 1-10 minutes"

(Adult) Adrenaline dosage for Bradycardia / Inotropic & Vasopressor Support (IV/IO infusion)?

Answer:

"IV/IO INF: 0.05-0.3 mcg/kg/min"

(Adult) Adrenaline dosage for Bradycardia / Inotropic & Vasopressor Support (IV/IO push dose)?

Answer:

"1 mcg/kg, max dose 50 mcg, every 1-2 minutes"

Class of Amiodarone?

Answer:

"Antiarrhythmic"

What is the MOA of Amiodarone?

Answer:

"Prolongs the duration of the action potential and therefore the refractory period of atrial, nodal and ventricular tissues. It reduces conduction across all cardiac tissue. Demonstrates electrophysiological properties across all Vaughan-Williams Class groups. Vasodilatory action decreases myocardial workload and myocardial oxygen demand.")

Metabolism of Amiodarone?

Answer:

"Metabolised by the cytochrome P450 enzyme in the liver and GI system. Excreted via the biliary system"

What are the indications for Amiodarone?

Answer:

- Cardiac arrest with refractory VF or Pulseless VT

- Sustained VT with a pulse (haemodynamically stable).

Contraindication(s) for Amiodarone?

Answer:

- Known hypersensitivity to Amiodarone or Iodine

- 2nd and 3rd degree heart block

- Cardiogenic shock

- Severe sinus node dysfunction

List the precautions for Amiodarone.

Answer:

- Patients taking β-blockers, Calcium antagonists or Diltiazem

- Concurrent administration of Fentanyl and Amiodarone my exacerbate bradycardia, hypotension, and decreased cardiac output

- Patients with thyroid dysfunction

What are the Side Effects of Amiodarone?

Answer:

- Bradycardia

- Hypotension

- Nausea and/or vomiting

- Peripheral paraesthesia

Route of Administration for Amiodarone?

Answer:

"IV, IO, IV/IO INF."

Onset and Duration of Amiodarone.

Answer:

"Onset: 5 mins | Duration: 30 mins"

Adult dosages of Amiodarone?

Answer:

"Cardiac Arrest IV/IO: 300mg after 3rd shock, 150mg after 4th shock

VT with a pulse IV/IO INF: 300mg diluted in 50ml D5W (6mg/ml), Infuse at 200ml/hr (20mg/min) over 15 mins."

Dosages of Amiodarone for (Adult) patient with Cardiac Arrest?

Answer:

"300mg (IV/IO) after 3rd shock, 150mg after 4th shock"

Dosages of Amiodarone for (Adult) patient having VT with pulse?

Answer:

"Given via (IV/IO INF): 300mg in 50ml D5W (6mg/ml), infuse at 200ml/hr (20mg/min) over 15 minutes"

Class of Aspirin?

Answer:

"Antiplatelet"

Action of Aspirin?

Answer:

"Inhibits platelet aggregation by irreversibly inhibiting cyclo-oxygenase, reducing synthesis of thromboxane A2 and preventing aggregation at the site of vascular injury."

How is Aspirin Metabolised?

Answer:

"Converted to salicylate in the GI mucosa and liver; excreted by kidneys."

Indication(s) for Aspirin

Answer:

"Acute Coronary Syndromes"

Contraindication(s) for Aspirin

Answer:

- Known hypersensitivity to Aspirin/salicylates/NSAIDs

- Active GI bleeding

- Peptic ulcer with active bleeding

- Bleeding/clotting disorders

- Suspected dissecting aortic aneurysm

- Patients < 18 years old

Precautions for Aspirin?

Answer:

- History of GI bleeds or ulcers

- Asthma

- On anticoagulants (e.g. Warfarin)

- Impaired liver function

Side Effects of Aspirin?

Answer:

- Epigastric pain/discomfort

- GI bleeding

- Nausea and/or vomiting

- NSAID-induced bronchospasm

- Dizziness/Tinnitus

Route(s) for Aspirin?

Answer:

"PO" ONLY

Onset and Duration of Aspirin?

Answer:

"Onset: ≈ 10 minutes | Duration: ≈ 1 week"

Dosage(s) of Aspirin?

Answer:

"Give to Adult ONLY. 300mg PO (single dose)"

Class of Atropine?

Answer:

"Anticholinergic and muscarinic antagonist"

Action of Atropine

Answer:

"Blocks acetylcholine receptors at the neuro-effector site, increases the heart rate by increasing the rate of the sinoatrial node and increasing conduction through the atrioventricular node. Acts as an antidote to reverse the effects of cholinesterase inhibitors."

How is Atropine metabolised?

Answer:

"Metabolised by the liver and excreted by the kidneys."

Indication(s) for Atropine

Answer:

- Symptomatic bradycardia

- Organophosphate poisoning

Contraindication(s) for Atropine

Answer:

"Hypersensitivity to atropine"

List some precautions when giving Atropine.

Answer:

- Atrial fibrillation

- Atrial flutter

- Acute myocardial infarction (AMI)

- Glaucoma

Side Effect(s) of Atropine?

Answer:

- Tachycardia

- Palpitations

- Dry mouth/dry skin

- Reduced bronchial and gastric secretions

- Dilated pupils

- Urinary retention

- Agitation

- Hallucinations

- Heat intolerance or impaired temperature regulation in hot climates

Route(s) for Atropine?

Answer:

"IV, IO, IM"

Dosage of Atropine for Bradycardia (Adult)?

Answer:

"Given via IV/IO: 0.5mg every 3–5 minutes to a maximum of 3mg"

Dosage of Atropine for (Adult) with Organophosphate Toxicity?

Answer:

"Given via IV/IO/IM: 1mg every 5 minutes until clinical improvement"

Onset and Duration of Atropine?

Answer:

"Onset: 1 - 2 mins | Duration: Up to 5 hours"

Class of Calcium Chloride

Answer:

"Electrolyte"

Action of Calcium Chloride?

Answer:

"Moderates nerve and muscle performance via action potential excitation threshold regulation. Acts as a positive inotrope and is required for vasoconstriction in vascular smooth muscles."

How is Calcium Chloride Metabolised?

Answer:

"Excreted by the kidneys"

Indication(s) for Calcium Chloride?

Answer:

- Suspected hyperkalaemic cardiac arrest

- Severe hyperkalaemia with haemodynamic compromise and/or significant cardiac rhythm disturbance

- Calcium channel and Beta blocker toxicity

- Magnesium toxicity with associated hypotension unresponsive to IV fluids.

Contraindications for Calcium Chloride

Answer:

- Hypersensitivity to Calcium chloride

- Not for routine use in cardiac arrest

- Digoxin toxicity

Precautions when giving Calcium Chloride?

Answer:

- Extravasation

- Rapid administration may cause bradycardia or asystole

- Respiratory acidosis

- Renal impairment

Side Effects of Calcium Chloride?

Answer:

- Local tissue necrosis following extravasation

- Thrombophlebitis

- Bradycardia, Arrhythmias, Hypotension, Syncope, Cardiac arrest

- Hot flush

- Dysgeusia

- GI irritation

Route(s) for Calcium Chloride

Answer:

"IV, IO"

Onset and Duration of Calcium Chloride?

Answer:

"Onset: Rapid | Duration: 30-60 mins"

Dosage of Calcium Chloride (Adult) for all listed indications?

Answer:

"Given via IV/IO: 1g (10ml) given slowly - Repeat PRN"

Class of Clopidogrel?

Answer:

"Antiplatelet"

What is the MOA of Clopidogrel?

Answer:

"A specific and potent platelet aggregation inhibitor. Selectively inhibits the binding of ADP to platelet receptors, inhibiting platelet aggregation."

Metabolism of Clopidogrel?

Answer:

"Metabolised by the liver. Inactive metabolites excreted in urine and faeces."

Indication(s) for Clopidogrel?

Answer:

- STEMI

- Primary antiplatelet agent for patients with true aspirin allergy

Contraindication(s) for Clopidogrel?

Answer:

- Hypersensitivity

- Active haemorrhage (excluding menses)

- Prior intracranial haemorrhage

- Patients < 18 years old

Precaution(s) when Clopidogrel?

Answer:

- Liver impairment

- Patients with increased risk of bleeding

Side Effect(s) of Clopidogrel

Answer:

"Haemorrhage"

Route(s) for Clopidogrel

Answer:

"PO" ONLY

Onset and Duration of Clopidogrel

Answer:

"Onset: ≈ 30 minutes | Duration: 7-10 days"

Dosage of Clopidogrel (Adult)

Answer:

"STEMI: 300mg PO (Single dose)"

Class of Dexamethasone

Answer:

"Corticosteroid"

Action of Dexamethasone

Answer:

""Long-acting synthetic corticosteroid producing anti-inflammatory and immunosuppressive effects."

Metabolism of Dexamethasone

Answer:

"Hepatic metabolism and renal excretion."

Indication(s) for Dexamethasone

Answer:

- Croup (mild, moderate and severe)

- Confirmed or suspected COVID-19 (≥18 y/o): with CPAP or requiring supplemental oxygen to maintain SpO2 >93%"

Contraindication(s) for Dexamethasone

Answer:

- Hypersensitivity to Dexamethasone

- Systemic fungal infections

Precaution(s) for Dexamethasone

Answer:

- None in the setting of croup

- Renal failure

- Patients with cirrhosis show exaggerated response to glucocorticoids

Side Effect(s) of Dexamethasone

Answer:

"Hypersensitivity reactions"

Route(s) for Dexamethasone

Answer:

"IV, IO, IM, PO"

Dosage of Dexamethasone (Adult) patient with suspected/confirmed COVID-19?

Answer:

"PO: 6mg (Single dose) | IV/IO/IM: 6mg (Single dose)"

Class of Dextrose

Answer:

"Carbohydrate/ Hyperglycaemic”

Action of Dextrose

Answer:

"Glucose is the primary source of energy for the body cells."

Metabolism of Dextrose

Answer:

"Broken down in most tissues and distributed throughout total body water. Stored in the liver and muscles as glycogen."

Indication(s) for Dextrose

Answer:

- Symptomatic hypoglycaemia:

RBS < 4mmol/L (paediatrics and adults)

RBS < 2.6mmol/L (newborns)

Contraindication(s) for Dextrose

Answer:

"Nil"

Precaution(s) for Dextrose

Answer:

"Hyperglycaemia"

Side Effect(s) of Dextrose

Answer:

"Nil"

Route(s) for Dextrose

Answer:

"PO, IV, IO"

Dosage(s) of Dextrose (Adult)?

Answer:

"PO: 15g tube (Repeat once if patient remains hypoglycaemic).

IV/IO: 15–20g D10W (150–200ml), 50ml D10W in cardiac arrest (Repeat if patient remains hypoglycaemic)."

Class of Diclofenac

Answer:

"Non-steroidal anti-inflammatory (NSAID)"

Action of Diclofenac

Answer:

"Inhibits prostaglandin synthesis. Produces anti-inflammatory, analgesic and antipyretic properties."