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NZ Paramedic Pharmacology
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- 1Adrenaline - Mechanism of ActionAdrenaline is a naturally occurring catecholamine in the body. It acts on Alpha and Beta receptors predominantly A1, B1 and B2.
A1 - smooth muscle contraction, vasoconstriction, stimulation of glyconeogenesis and glycogenolysis.
B1 - Increased Inotropy, Chronotropy, Dromotropy within the heart
B2 - Smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation and stabilisation of mast cells = reduced histamine release. - 2Adrenaline - Indications for useCardiac Arrest
Anaphylaxis
Severe Asthma
Moderate to Severe Stridor
Clinically significant Epistaxis
Clinically Significant wound bleeding - 3Adrenaline - Contraindications and CautionsNo Contraindications
Caution in Myocardial Ischaemia and Tachydysrhythmia - 4Adrenaline - Adverse EffectsTachycardia
Tachydysrhythmia
Myocardial Ischaemia
Ventricular Ectopy
Hypertension
Nausea and Vomiting
Tremor, Anxiety, Sweating
Hyperglycaemia - 5Adrenaline - AdministrationTopical - dilute 1mg to 10ml, apply topically with direct pressure
Intranasal - dilute 1mg to 10ml, 2ml into each nostril
Nebulised - undiluted
IM - undiluted
IV - undiluted for cardiac arrest - 6Adrenaline - DosesCardiac Arrest - 1mg every 3-5 minutes, children - children 0.05mg (5kg), 0.1mg (10kg), 0.2mg (20kg), 0.3mg (30kg), 0.4mg (40kg).
Nebulised - 5mg
IM - adults 0.5mg, children - same as Cardiac Arrest - 7Amiodarone - Mechanism of ActionAmiodarone is a class III antidysrhythmic.
It prolongs the action potential, reduces automaticity and prolongs refractory period.
Reduced chronotropy, dromotropy and inotropy, sabilises SA and AV nodes.
Small increase in coronary blood flow and reduced myocardial oxygen consumption - 8Amiodarone - Indications for useCardiac Arrest
- 9Amiodarone - Contraindications and CautionsNone in Cardiac Arrest
- 10Amiodarone - Dose and AdministrationDose - 300mg IV, additional 150mg if VF or VT persists. Children - 25mg (5kg), 50mg (10kg), 100mg (20kg), 150mg (30kg), 200mg (40kg).
Administration - Undiluted in Cardiac Arrest - 11Amoxicillin/Clavulanic Acid - Mechanism of ActionAmoxicillin/clavulanic acid is a beta-lactam antibiotic with broad spectrum activity (gram negative, positive and some anaerobic bacteria)
Amoxicillin is the active ingredient, part of penicillin class. It inhibits production of bacterial cell wall.
Clavulanic acid inhibits beta-lactamase which is an enzyme some bacteria produce making them resistant to amoxicillin. - 12Amoxicillin/clavulanic acid - Indications for useClinical diagnosis of meningococcal septicaemia
Septic shock over 30 mins from hospital
Cellulitis in patients being referred to primary care and they have a delay in seeing a doctor - 13Amoxicillin/clavulanic acid - Contraindications and cautionsContraindications - Known severe allergy
Known severe allergy to penicillins
Anaphylaxis to beta-lactam antibiotics
Cautions - None - 14Amoxicillin/clavulanic acid - AdministrationIV - dissolve 1.2g using 5ml of 0.9% to dilute to 10ml (120mg/ml). Administer in a running line over 1-2 minutes.
IM - Dissolve 1.2g using 2ml of 0.9%, shake well, administer into lateral thigh. - 15Amoxicillin/clavulanic acid - DoseAdults - 1.2g
Children - 150mg (5kg), 300mg (10kg), 600mg (20kg), 900mg (30kg), 1.2g (40kg). - 16Aspirin - Mechanism of ActionAspirin is a Non-steroidal anti-inflammatory drug (NSAID).
It has antiplatelet, antipyretic, anti-inflammatory, analgesic effects.
Aspirin inhibits cyclooxygenase which reduces formation of prostaglandins and thromboxane = reduce formation of blood clots - 17Aspirin - Indications for useMyocardial ischaemia
- 18Aspirin - Contraindications and cautionsContraindications - Known severe allergy
Third trimester of pregnancy
Cautions - Known bleeding disorder, clinically significant bleeding, known worsening of bronchospasm with NSAIDs - 19Aspirin - Adverse effectsIncreased bleeding
Chronic administration can cause gastrointestinal symptoms (indigestion, bleeding, ulceration). - 20Aspirin - Dose and Administration300mg dispersible (chewed or dissolved in water)
- 21Fentanyl - Mechanism of ActionFentanyl is an opiate analgesic which binds to opiate receptors in the brain and spinal cord. Its predominant action is on mu receptors causing analgesia, respiratory depression, miosis, euphoria, reduced GI motility and physical dependence. It is also pharmacologically active on kappa and delta receptors to a lesser extent.
Fentanyl does not stimulate as much histamine release as morphine so there is less effect on the cardiovascular system. - 22Fentanyl - Indications for useModerate to severe pain in patients who require intense pain relief for a short time (relocation). With clinically significant shock. If no IV access available.
- 23Fentanyl - Contraindications and CautionsContraindications - Known severe allergy
Unable to obey commands
Current respiratory depression
Cautions - Age less than 1 year
High risk for respiratory depression (CORD, obesity)
Labour (opiates cross the placenta) - 24Fentanyl - adverse reactionsRespiratory depression
Bradycardia
Hypotension
Sedation
Nausea and Vomiting
Itching
Euphoria - 25Fentanyl - AdministrationIV - dilute 100mcg to a total of 10ml (10mcg/ml)
IN (children) - undiluted, half dose in 2x 1ml syringes, additional 0.1ml to fill atomiser, administer rapidly
IN (adult) - undiluted, no need to add more to fill atomiser (insignificant amount) - 26Fentanyl - DoseIV - 10 to 50 mcg every 3 to 5 minutes, lower end dose for small, frail or cardiovascularly unstable.
Children - 2.5mcg (5kg), 5mcg (10kg), 10mcg (20kg), 15mcg (30kg), 20mcg (40kg)
IN - 100mcg (<80kg), further 50mcg every 10 mins, 200mcg (>80kg), further 100mcg ever 10 mins
Children - 10mcg (5kg) & 5mcg subsequent, 20mcg (10kg) & 10mcg , 40mcg (20kg) & 20mcg, 60mcg (30kg) & 30mcg, 80mcg (40kg) & 40mcg. - 27Gentamicin - Mechanism of ActionGentamicin is an aminoglycoside antibiotic with broad activity against gram negative and some gram positive.
It inhibits bacterial cell protein synthesis - 28Gentamicin - Indications for useSeptic Shock >30 minutes from hospital where the site of infection is known to be urinary, abdominal or unknown
- 29Gentamicin - Contraindications and CautionsContraindications - Known severe allergy
Pregnancy
Cautions - None - 30Gentamicin - AdministrationAdminister Amoxicillin/clavulanic acid first
In a 1 litre bag of 0.9% (adults only) over 15-30 mins, a bag of 5% glucose (weight >20kg) 1-2 drops/sec over 15-30 mins, syringe via running line (usually children) diluted to 10ml and administer 1 ml every 2-3 minutes - 31Gentamicin - DoseAdults - 240mg <60kg
320mg 60-80kg
400 >80kg
Children - 30mg (5kg), 60mg (10kg), 120mg (20kg), 160mg (30kg), 240mg (40kg) - 32Gentamicin - Adverse effectsNone if administering at appropriate rate
Renal impairment with repeated doses
Ototoxicity (damage to inner ear) if administered too rapidly or prolonged dosing. - 33Glucagon - Mechanism of ActionGlucagon is a natural occurring hormone produced by the pancreas.
It increases blood glucose by stimulating glycogenolysis (breakdown of glycogen into glucose) in the liver - 34Glucagon - Indications for useHypoglycaemia where the patient cannot swallow and IV access is unavailable
- 35Glucagon - Contraindications and CautionsContraindications - Known severe allergy
Cautions - None - 36Glucagon - Dose and AdministrationDose - 1mg >5years
0.5mg <5years
Once only
Administration - Dissolve the powder using the syringe provided in the kit, administer IM preferred in the lateral thigh. - 37Glucose Gel - Mechanism of ActionGlucose is a monosaccharide and is one of the preferred forms of energy for the cells. In this gel it is easily swallowed and rapidly absorbed.
- 38Glucose gel - Indications for useHypoglycaemia where the patient is conscious enough to swallow
- 39Glucose gel - Dose and Administration10-20g sachet, administer one sachet every 10 minutes if hypoglycaemia persists
- 40Glyceral trinitrate (GTN) - Mechanism of ActionGTN is a universal vasodilator. It acts on vascular smooth muscle causing vasodilation predominantly on veins.
GTN converts to nitric oxide which relaxes smooth muscle cells and causes vasodilation.
Vasodilation reduces venous return (preload), reduces cardiac output which reduces myocardial oxygen demand.
Arterial dilation reduces peripheral resistance (afterload), reduces force required to eject blood, reduces oxygen demand.
Dilation of coronary arteries increases coronary blood flow. - 41GTN - Indications for useMyocardial ischaemia
Cardiogenic pulmonary oedema
Hypertension associated with autonomic dysreflexia - 42GTN - ContraindicationsSystolic BP <100
Heart rate <40
Heart rate >130 or >150 in autonomic dysreflexia
VT - 43GTN - cautionsSTEMI with right side involvement
Small, frail physiologically unstable pts
Poor Perfusion
Dysrhythmia
Erectile dysfunction drugs used in last 24hrs
Known Aortic or Mitral stenosis - 44GTN - doseMyocardial Ischaemia - 0.4mg every 3 to 5 mins, increase to 10 mins if cautions.
Cardiogenic Pulmonary oedema - 0.8mg every 3 to 5 mins, increase to 10 mins if cautions. Can increase dose and frequency if patient is not improving.
Autonomic Dysreflexia - 0.4 to 0.8mg every 3 to 5 mins. - 45GTN - AdministrationDeliver as sprays sublingually
If delivered in presence of a caution:
pt lying flat
IV access
Increase dosing interval
Prepare to administer 0.9% if required - 46GTN - Adverse effectsHypotension
Flushing
Headache
Tachycardia
Light-headedness - 47Ibuprofen - Mechanism of ActionNSAID
Inhibits prostaglandin production resulting in reduced inflammation and therefore reduced pain. - 48Ibuprofen - Indications for useMild to moderate pain relief
particulary headache, soft tissue or musculoskeletal
Can be used in combination with other pain relief for more severe pain - 49Ibuprofen - Contraindications and CautionsContraindications - Known severe allergy and third trimester
Cautions -
Ibuprofen in last 4 hours
Abdominal pain, unwell/vomiting
Age >75
Dehydration or Shock
Known renal impairment
Known bleeding disorder
Clinically significant bleeding
Known worsening of Bronchospasm
Taking warfarin
Pregnancy - 50Ibuprofen - Dose and AdministrationDose - 600mg > 80kg
400mg < 80kg
Child - N/A (5kg), 100mg (10kg, 20kg), 200mg (30kg), 300mg (40kg).
Administration - PO, can crush tablets in soft food (eg: jam) - 51Ibuprofen - adverse effectsRenal impairment
Increased bleeding
Gastrointestinal symptoms (chronic use) - 52Ipatropium - Mechanism of ActionIpatropium is an anticholinergic agent with antimuscarinic activity.
Blocks acetylcholine which is a neurotransmitter for the parasympathetic nervous system, resulting in bronchodilation - 53Ipratropium - Indications for useBronchospasm associated with Asthma or COPD
Prominent Bronchospasm associated with smoke inhalation or airway burns - 54Ipratropium - Contraindications and cautionsContraindicated in known severe allergy
No Cautions - 55Ipratropium - Dose and AdministrationDose - 0.5mg once only for adults and children
Administered via nebuliser in combination with Salbutamol - 56Ipratropium - Adverse effectsTachycardia
Dry mouth
Blurred vision - 571% Lignocaine - Mechanism of actionLignocaine is a local anaesthetic.
It blocks the initiation and transmission of nerve impulses by blocking the movement of sodium ions across the nerve cell membrane - 581% Lignocaine - indications for useSubcutaneous injection prophylactically for pain associated with IV cannulation
Subcutaneous injection for digital ring block analgesia. - 591% Lignocaine - Contraindications and cautionsContraindicated in known severe allergy
Caution in local infection at injection site - 601% Lignocaine - Dose and AdministrationMaximum of 20ml, may be repeated after 1 hour.
Children - max 1.5ml (5kg),3ml (10kg), 6ml (20kg), 9ml (30kg), 12ml (40kg).
Administer SC, for IV administer at the site of cannulation, raise a bleb, wait 1 minute.
For ring block, administer 1-2ml into tissue on either side of the web space. - 611% Lignocaine - adverse effectsStinging at time of injection (can warm it up in your hand or pocket to reduce this)
- 62Loratadine - Mechanism of actionLoratadine is a non-sedating antihistamine
It blocks peripheral histamine receptors, reduces effect of histamine which reduces itching and redness - 63Loratadine - Indications for useMinor allergic reactions confined to skin involvement
Prominent itch associated with anaphylaxis provided all systemic symptoms have resolved - 64Loratadine - Containdications and CautionsContraindicated in Known severe allergy
Age less than 1 year
Caution in Pregnancy (balance risk vs benefit) - 65Loratadine - Dose and AdministrationDose 10mg for adult or child >12
5mg for child 1-11years
Administered PO, May be crushed in soft food (eg: Jam) - 66Methoxyflurane - Mechanism of actionInhaled analgesic. Alters tissue excitability by reducing conduction at the gap junction, results in muscle relaxation and reduced pain sensation
- 67Methoxyflurane - Indications for useModerate to severe pain
- 68Methoxyflurane - ContraindicationsKnown severe allergy
Known renal impairment
Personal or family history of malignant hyperthermia
Unable to obey commands
Had methoxyflurane within last 7 days - 69Methoxyflurane - CautionsAge >75
Pre-eclampsia
Administration in a confined space - 70Methoxyflurane - Dose and AdministrationMax 6ml (2 doses) >12years
Max 3ml (one dose) <12 years
Self administered, inhaled in and out through the mouthpiece to limit exposure to ambulance personnel - 71Methoxyflurane - Adverse effectsSedation
Light-headedness
Nausea
Dislike of taste or smell - 72Midazolam - Mechanism of actionMidazolam is a benzodiazapine
It enhances GABA (inhibitory neurotransmitter) at GABA receptors in the CNS resulting in anticonvulsant, sedation, amnesia, anxiolysis and muscle relaxation - 73Midazolam - indications for useProlonged seizures (IV and IM)
Moderate aggitated delerium (IM) - 74Midazolam - Contraindications and CautionsContraindicated in known severe allergy
Cautions - concurrent administration of opiates or ketamine
Intoxication
Elderly - 75Midazolam - DoseIV - 5mg adults (reduced to 2-3mg if small, frail or physiologically unstable)
Children - 0.5mg, 1mg, 2mg, 3mg, 4mg
IM - 10mg adults (reduced to 5mg if small, frail or physiologically unstable)
Children - 1mg, 2mg, 4mg, 6mg, 8mg
Limit to 2 doses max via either route. - 76Midazolam - AdministrationMidazolam comes in 15mg/3ml
IV - dilute 2ml up to 10ml with 0.9% (1mg/ml), administer as bolus.
IM - administer undiluted, later thigh is preferred - 77Midazolam - Adverse effectsSedation
Respiratory depression
Hypotension
Amnesia - 78Morphine - Mechanism of actionMorphine is an opiate analgesic
It binds to opiate receptors in the CNS.
Main effect is on mu receptors but also has effect on delta and kappa receptors.
Results in analgesia, respiratory depression, miosis, euphoria, reduced GI motility and physical dependence (mu) - 79Morphine - indications for useModerate to severe pain
Cardiogenic pulmonary odema with severe anxiety / respiratory distress - 80Morphine - Contraindications and CautionsContraindications - Known severe allergy, Unable to obey commands, Current respiratory depression
Cautions - Age <1year, High risk of respiratory depression (CORD, Obesity), Labour (opiates cross the placenta) - 81Morphine - DoseIV - 1 to 5mg every 3 to 5 mins (lower end if small, frail or physiologically unstable)
Children - 0.25mg, 0.5mg, 1mg, 1.5mg, 2mg
IM - 5 to 10mg, repeated once after 10mins (lower end if small, frail or physiologically unstable)
Children - 1mg, 2mg, 4mg, 6mg, 8mg
CPO - 1 to 2mg IV sparingly - 82Morphine - AdministrationMorphine comes in 10mg/1ml ampoules
IV - dilute to 10ml using 0.9% (1mg/ml) administer as a bolus
IM - undiluted, lateral thigh preferred
don't use this route if patient is shocked, IN fentanyl preferred (can follow after 2x IM doses), Can give IV if access gained after (with caution) - 83Morphine - adverse effectsRespiratory depression
Hypotension
Sedation
Nausea and vomiting
Histamine release = itching - 84Naloxone - Mechanism of ActionNaloxone is a competitive opiate receptor antagonist, it blocks opiate receptors therefore reversing effects of opiates. In high concentrations it will displace opiate agonists from receptors.
- 85Naloxone - Indications for useSuspected opiate poisoning with significantly impaired level of consciousness or significantly impaired breathing.
Excess adverse effects from opiate administration. - 86Naloxone - Contraindications and CautionsContraindications - known severe allergy
Cautions - Chronic opiate use (adverse psychological effects from withdrawl) - 87Naloxone - Dose and AdministrationIV - 0.1 to 0.4mg every 3 to 5 mins
Children - 0.05mg, 0.1mg, 0.2mg, 0.3mg, 0.4mg
IM - 0.8mg repeated every 10 minutes
Children - 0.1mg, 0.2mg, 0.4mg, 0.6mg, 0.8mg
Administration is preferred IV, dilute to total of 4ml (0.1mg/ml), minimum dose to produce improvement
IM administered undiluted - 88Naloxone - adverse effectsSweating
Tachycardia
Hypertension - 89Olanzapine - Mechanism of actionOlanzapine is an atypical anti-psychotic
Binds to multiple different receptors in the brain (alpha 1, dopamine, histamine H1, muscarinic, and serotonin type 2). Relieves both positive and negative symptoms.
Results in a reduction in agitation, sedation, anxiolysis and stabilisation of mood. - 90Olanzapine - Indications for useMild aggitated delerium
- 91Olanzapine - Contraindications and CautionsContraindicated in Known severe allergy
Age less than 12 years
Cautions in pregnancy and the elderly - 92Olanzapine - Dose and AdministrationDose - 10mg >80kg
5mg <80kg
Repeat once after 20 minutes
Administer PO, dispersable tablet, can be dissolved in liquid (water, tea, coffee) - 93Ondansetron - Mechanism of actionOndansetron is an anti-emetic
It blocks serotonin receptors in the brain and gastrointestinal tract resulting in a reduction of nausea and vomiting - 94Ondansetron - Indications for useClinically significant nausea and/or vomiting
- 95Ondansetron - Contraindications and CautionsContraindicated in known severe allergy
Age < 1 year
Caution in Known prolonged QT syndrome - 96Ondansetron - Dose and AdministrationOral (wafers) - 8mg >12 years
Children - N/A, 2mg, 4mg, 6mg, 8mg
IV/IM - 4mg >12 years
Children - N/A, 1mg, 2mg, 3mg, 4mg
Can administer 2x IV/IM doses in addition to one PO dose - 97Ondansetron - Adverse effectsHeadache
Flushing
Metallic taste - 98Oxytocin - Mechanism of ActionOxytocin is a synthetic version of a naturally occurring hormone released from the pituitary gland.
It stimulates oxytocin receptors causing an increase in sodium permeability in uterine smooth muscle cells. Resulting in increased frequency and amplitude of uterine contractions, leading to reduction of blood loss. - 99Oxytocin - Indications for useFollowing normal birth
Postpartum haemorrhage - 100Oxytocin - Contraindications and CautionsContraindicated in known severe allergy
No Cautions - 101Oxytocin - Dose and AdministrationDose - 10 units IM
Administer undiluted, preferred lateral thigh.
In normal birth, after the last baby.
If postpartum haemorrhage occurs after, another 10 units should be administered - 102Oxytocin - Adverse effectsAbdominal cramping
Tachycardia
Flushing - 103Paracetamol - Mechanism of ActionInhibits prostaglandin production in the CNS resulting in a reduction in pain and fever.
- 104Paracetamol - Indications for useMild to moderate pain
Can be used in combination with other pain relief.
Can be given for fever > 39 degrees and causing discomfort - 105Paracetamol - Contraindications and CautionsContraindicated in Known severe allergy
Current paracetamol poisoning
Caution - paracetamol in the last 4 hours
Abdominal pain, unwell or vomiting
Known severe liver disease - 106Paracetamol - Dose and AdministrationDose - 1.5g >80kg
1g <80kg
Children (syrup) - 100mg, 200mg, 400mg, 600mg, 800mg
Children (tablets) - 500mg (30kg), 750mg (40kg) - 107Prednisone - Mechanism of ActionPrednisone is a corticosteroid with anti-inflammatory and immunosuppressant actions.
It inhibits the production of inflammatory mediators including prostaglandins and leukotrienes resulting in a reduction in inflammatory and immune responses. - 108Prednisone - Indications for useBronchospasm associated with Asthma or COPD
Prominent rash associated with Anaphylaxis provided systemic signs have resolved
Minor allergy associated with rash - 109Prednisone - Contraindications and CautionsContraindicated in known severe allergy
Age < 1 year
Caution in age < 5 years (unless clear history or previously received oral steroids) - 110Prednisone - Dose and AdministrationAdult - 40mg PO
Children - N/A, N/A, 20mg, 30mg, 40mg
Do not administer if pt is taking prednisone already at an equal or higher dose.
Do not crush as the bitter taste may cause vomiting. - 111Prednisone - Adverse effectsBitter taste
Fatigue
Sodium and water retention
Gastrointestinal reflux - 112Salbutamol - Mechanism of ActionSalbutamol is a B2 selective bronchodilator
It stimulates beta 2 receptors in the lungs and lesser effect on beta 1 receptors in the heart.
It It causes relaxation of bronchial smooth muscle causing bronchodilation and the relief of bronchospasm - 113Salbutamol - Indications for useBronchospasm associated with Asthma and COPD
Prominent bronchospasm associated with smoke inhalation and airway burns - 114Salbutamol - Contraindications and CautionsContraindicated in known severe allergy
No Cautions - 115Salbutamol - Dose and Administration5mg Nebulised undiluted, initally combined with ipratropium then on its own thereafter.
- 116Salbutamol - Adverse effectsTremor and tachycardia
- 117Sodium Valproate - Mechanism of actionValproate is the active ingredient
Valproate is an anticonvulsant, it blocks sodium channels and enhances the inhibitory neurotransmitter GABA at GABA receptors in the CNS - 118Sodium Valproate - Indications for useStatus epilepticus that does not respond to 2 doses of midazolam
- 119Sodium Valproate - Contraindications and CautionsContraindicated in known severe allergy
No Cautions - 120Sodium Valproate - Dose and Administration1200mg for adults
Children - 150mg, 300mg, 600mg, 800mg, 1200mg
Adminster IV over 10 - 15 mins, preferably in a running line.
Dissolve the ampoule using 4ml 0.9%, dilute up to 10ml if needed and administer 1ml every 1-2 mins. - 121Tramadol - Mechanism of actionTramadol is an analgesic. It acts on the CNS by binding to mu opiate receptors and inhibiting re-uptake of noradrenaline and serotonin
- 122Tramadol - Indications for useModerate pain, can be used in combination with other pain relief
- 123Tramadol - Contraindications and CautionsContraindicated in known severe allergy
Age less than 12 years
Cautions - tramadol in last 4 hours
Abdominal pain, unwell and vomiting
Age > 75 years
Confusion
Pregnancy - 124Tramadol - Dose and Administration50mg >12 years old
Administer PO - 125Tramadol - Adverse effectsNausea / vomiting
Light-headedness, feeling unusual
Sedation
Dry mouth
Informationen
- Beschreibung
- Pharmacology of Medicines within Paramedic Scope of practice based on St John Ambulance NZ CPGs
- Erstellt von
- Janelle Chambers
- Aufrufe
- 77
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