NZ Paramedic Pharmacology

Pregunta	Respuesta
Adrenaline - Mechanism of Action	Adrenaline 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.
Adrenaline - Indications for use	Cardiac Arrest Anaphylaxis Severe Asthma Moderate to Severe Stridor Clinically significant Epistaxis Clinically Significant wound bleeding
Adrenaline - Contraindications and Cautions	No Contraindications Caution in Myocardial Ischaemia and Tachydysrhythmia
Adrenaline - Adverse Effects	Tachycardia Tachydysrhythmia Myocardial Ischaemia Ventricular Ectopy Hypertension Nausea and Vomiting Tremor, Anxiety, Sweating Hyperglycaemia
Adrenaline - Administration	Topical - 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
Adrenaline - Doses	Cardiac 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
Amiodarone - Mechanism of Action	Amiodarone 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
Amiodarone - Indications for use	Cardiac Arrest
Amiodarone - Contraindications and Cautions	None in Cardiac Arrest
Amiodarone - Dose and Administration	Dose - 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
Amoxicillin/Clavulanic Acid - Mechanism of Action	Amoxicillin/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.
Amoxicillin/clavulanic acid - Indications for use	Clinical 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
Amoxicillin/clavulanic acid - Contraindications and cautions	Contraindications - Known severe allergy Known severe allergy to penicillins Anaphylaxis to beta-lactam antibiotics Cautions - None
Amoxicillin/clavulanic acid - Administration	IV - 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.
Amoxicillin/clavulanic acid - Dose	Adults - 1.2g Children - 150mg (5kg), 300mg (10kg), 600mg (20kg), 900mg (30kg), 1.2g (40kg).
Aspirin - Mechanism of Action	Aspirin 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
Aspirin - Indications for use	Myocardial ischaemia
Aspirin - Contraindications and cautions	Contraindications - Known severe allergy Third trimester of pregnancy Cautions - Known bleeding disorder, clinically significant bleeding, known worsening of bronchospasm with NSAIDs
Aspirin - Adverse effects	Increased bleeding Chronic administration can cause gastrointestinal symptoms (indigestion, bleeding, ulceration).
Aspirin - Dose and Administration	300mg dispersible (chewed or dissolved in water)
Fentanyl - Mechanism of Action	Fentanyl 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.
Fentanyl - Indications for use	Moderate to severe pain in patients who require intense pain relief for a short time (relocation). With clinically significant shock. If no IV access available.
Fentanyl - Contraindications and Cautions	Contraindications - 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)
Fentanyl - adverse reactions	Respiratory depression Bradycardia Hypotension Sedation Nausea and Vomiting Itching Euphoria
Fentanyl - Administration	IV - 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)
Fentanyl - Dose	IV - 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.
Gentamicin - Mechanism of Action	Gentamicin is an aminoglycoside antibiotic with broad activity against gram negative and some gram positive. It inhibits bacterial cell protein synthesis
Gentamicin - Indications for use	Septic Shock >30 minutes from hospital where the site of infection is known to be urinary, abdominal or unknown
Gentamicin - Contraindications and Cautions	Contraindications - Known severe allergy Pregnancy Cautions - None
Gentamicin - Administration	Administer 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
Gentamicin - Dose	Adults - 240mg <60kg 320mg 60-80kg 400 >80kg Children - 30mg (5kg), 60mg (10kg), 120mg (20kg), 160mg (30kg), 240mg (40kg)
Gentamicin - Adverse effects	None if administering at appropriate rate Renal impairment with repeated doses Ototoxicity (damage to inner ear) if administered too rapidly or prolonged dosing.
Glucagon - Mechanism of Action	Glucagon is a natural occurring hormone produced by the pancreas. It increases blood glucose by stimulating glycogenolysis (breakdown of glycogen into glucose) in the liver
Glucagon - Indications for use	Hypoglycaemia where the patient cannot swallow and IV access is unavailable
Glucagon - Contraindications and Cautions	Contraindications - Known severe allergy Cautions - None
Glucagon - Dose and Administration	Dose - 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.
Glucose Gel - Mechanism of Action	Glucose 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.
Glucose gel - Indications for use	Hypoglycaemia where the patient is conscious enough to swallow
Glucose gel - Dose and Administration	10-20g sachet, administer one sachet every 10 minutes if hypoglycaemia persists
Glyceral trinitrate (GTN) - Mechanism of Action	GTN 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.
GTN - Indications for use	Myocardial ischaemia Cardiogenic pulmonary oedema Hypertension associated with autonomic dysreflexia
GTN - Contraindications	Systolic BP <100 Heart rate <40 Heart rate >130 or >150 in autonomic dysreflexia VT
GTN - cautions	STEMI with right side involvement Small, frail physiologically unstable pts Poor Perfusion Dysrhythmia Erectile dysfunction drugs used in last 24hrs Known Aortic or Mitral stenosis
GTN - dose	Myocardial 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.
GTN - Administration	Deliver 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
GTN - Adverse effects	Hypotension Flushing Headache Tachycardia Light-headedness
Ibuprofen - Mechanism of Action	NSAID Inhibits prostaglandin production resulting in reduced inflammation and therefore reduced pain.
Ibuprofen - Indications for use	Mild to moderate pain relief particulary headache, soft tissue or musculoskeletal Can be used in combination with other pain relief for more severe pain
Ibuprofen - Contraindications and Cautions	Contraindications - 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
Ibuprofen - Dose and Administration	Dose - 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)
Ibuprofen - adverse effects	Renal impairment Increased bleeding Gastrointestinal symptoms (chronic use)
Ipatropium - Mechanism of Action	Ipatropium is an anticholinergic agent with antimuscarinic activity. Blocks acetylcholine which is a neurotransmitter for the parasympathetic nervous system, resulting in bronchodilation
Ipratropium - Indications for use	Bronchospasm associated with Asthma or COPD Prominent Bronchospasm associated with smoke inhalation or airway burns
Ipratropium - Contraindications and cautions	Contraindicated in known severe allergy No Cautions
Ipratropium - Dose and Administration	Dose - 0.5mg once only for adults and children Administered via nebuliser in combination with Salbutamol
Ipratropium - Adverse effects	Tachycardia Dry mouth Blurred vision
1% Lignocaine - Mechanism of action	Lignocaine 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
1% Lignocaine - indications for use	Subcutaneous injection prophylactically for pain associated with IV cannulation Subcutaneous injection for digital ring block analgesia.
1% Lignocaine - Contraindications and cautions	Contraindicated in known severe allergy Caution in local infection at injection site
1% Lignocaine - Dose and Administration	Maximum 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.
1% Lignocaine - adverse effects	Stinging at time of injection (can warm it up in your hand or pocket to reduce this)
Loratadine - Mechanism of action	Loratadine is a non-sedating antihistamine It blocks peripheral histamine receptors, reduces effect of histamine which reduces itching and redness
Loratadine - Indications for use	Minor allergic reactions confined to skin involvement Prominent itch associated with anaphylaxis provided all systemic symptoms have resolved
Loratadine - Containdications and Cautions	Contraindicated in Known severe allergy Age less than 1 year Caution in Pregnancy (balance risk vs benefit)
Loratadine - Dose and Administration	Dose 10mg for adult or child >12 5mg for child 1-11years Administered PO, May be crushed in soft food (eg: Jam)
Methoxyflurane - Mechanism of action	Inhaled analgesic. Alters tissue excitability by reducing conduction at the gap junction, results in muscle relaxation and reduced pain sensation
Methoxyflurane - Indications for use	Moderate to severe pain
Methoxyflurane - Contraindications	Known severe allergy Known renal impairment Personal or family history of malignant hyperthermia Unable to obey commands Had methoxyflurane within last 7 days
Methoxyflurane - Cautions	Age >75 Pre-eclampsia Administration in a confined space
Methoxyflurane - Dose and Administration	Max 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
Methoxyflurane - Adverse effects	Sedation Light-headedness Nausea Dislike of taste or smell
Midazolam - Mechanism of action	Midazolam is a benzodiazapine It enhances GABA (inhibitory neurotransmitter) at GABA receptors in the CNS resulting in anticonvulsant, sedation, amnesia, anxiolysis and muscle relaxation
Midazolam - indications for use	Prolonged seizures (IV and IM) Moderate aggitated delerium (IM)
Midazolam - Contraindications and Cautions	Contraindicated in known severe allergy Cautions - concurrent administration of opiates or ketamine Intoxication Elderly
Midazolam - Dose	IV - 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.
Midazolam - Administration	Midazolam 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
Midazolam - Adverse effects	Sedation Respiratory depression Hypotension Amnesia
Morphine - Mechanism of action	Morphine 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)
Morphine - indications for use	Moderate to severe pain Cardiogenic pulmonary odema with severe anxiety / respiratory distress
Morphine - Contraindications and Cautions	Contraindications - 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)
Morphine - Dose	IV - 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
Morphine - Administration	Morphine 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)
Morphine - adverse effects	Respiratory depression Hypotension Sedation Nausea and vomiting Histamine release = itching
Naloxone - Mechanism of Action	Naloxone 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.
Naloxone - Indications for use	Suspected opiate poisoning with significantly impaired level of consciousness or significantly impaired breathing. Excess adverse effects from opiate administration.
Naloxone - Contraindications and Cautions	Contraindications - known severe allergy Cautions - Chronic opiate use (adverse psychological effects from withdrawl)
Naloxone - Dose and Administration	IV - 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
Naloxone - adverse effects	Sweating Tachycardia Hypertension
Olanzapine - Mechanism of action	Olanzapine 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.
Olanzapine - Indications for use	Mild aggitated delerium
Olanzapine - Contraindications and Cautions	Contraindicated in Known severe allergy Age less than 12 years Cautions in pregnancy and the elderly
Olanzapine - Dose and Administration	Dose - 10mg >80kg 5mg <80kg Repeat once after 20 minutes Administer PO, dispersable tablet, can be dissolved in liquid (water, tea, coffee)
Ondansetron - Mechanism of action	Ondansetron is an anti-emetic It blocks serotonin receptors in the brain and gastrointestinal tract resulting in a reduction of nausea and vomiting
Ondansetron - Indications for use	Clinically significant nausea and/or vomiting
Ondansetron - Contraindications and Cautions	Contraindicated in known severe allergy Age < 1 year Caution in Known prolonged QT syndrome
Ondansetron - Dose and Administration	Oral (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
Ondansetron - Adverse effects	Headache Flushing Metallic taste
Oxytocin - Mechanism of Action	Oxytocin 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.
Oxytocin - Indications for use	Following normal birth Postpartum haemorrhage
Oxytocin - Contraindications and Cautions	Contraindicated in known severe allergy No Cautions
Oxytocin - Dose and Administration	Dose - 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
Oxytocin - Adverse effects	Abdominal cramping Tachycardia Flushing
Paracetamol - Mechanism of Action	Inhibits prostaglandin production in the CNS resulting in a reduction in pain and fever.
Paracetamol - Indications for use	Mild to moderate pain Can be used in combination with other pain relief. Can be given for fever > 39 degrees and causing discomfort
Paracetamol - Contraindications and Cautions	Contraindicated in Known severe allergy Current paracetamol poisoning Caution - paracetamol in the last 4 hours Abdominal pain, unwell or vomiting Known severe liver disease
Paracetamol - Dose and Administration	Dose - 1.5g >80kg 1g <80kg Children (syrup) - 100mg, 200mg, 400mg, 600mg, 800mg Children (tablets) - 500mg (30kg), 750mg (40kg)
Prednisone - Mechanism of Action	Prednisone 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.
Prednisone - Indications for use	Bronchospasm associated with Asthma or COPD Prominent rash associated with Anaphylaxis provided systemic signs have resolved Minor allergy associated with rash
Prednisone - Contraindications and Cautions	Contraindicated in known severe allergy Age < 1 year Caution in age < 5 years (unless clear history or previously received oral steroids)
Prednisone - Dose and Administration	Adult - 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.
Prednisone - Adverse effects	Bitter taste Fatigue Sodium and water retention Gastrointestinal reflux
Salbutamol - Mechanism of Action	Salbutamol 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
Salbutamol - Indications for use	Bronchospasm associated with Asthma and COPD Prominent bronchospasm associated with smoke inhalation and airway burns
Salbutamol - Contraindications and Cautions	Contraindicated in known severe allergy No Cautions
Salbutamol - Dose and Administration	5mg Nebulised undiluted, initally combined with ipratropium then on its own thereafter.
Salbutamol - Adverse effects	Tremor and tachycardia
Sodium Valproate - Mechanism of action	Valproate is the active ingredient Valproate is an anticonvulsant, it blocks sodium channels and enhances the inhibitory neurotransmitter GABA at GABA receptors in the CNS
Sodium Valproate - Indications for use	Status epilepticus that does not respond to 2 doses of midazolam
Sodium Valproate - Contraindications and Cautions	Contraindicated in known severe allergy No Cautions
Sodium Valproate - Dose and Administration	1200mg 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.
Tramadol - Mechanism of action	Tramadol is an analgesic. It acts on the CNS by binding to mu opiate receptors and inhibiting re-uptake of noradrenaline and serotonin
Tramadol - Indications for use	Moderate pain, can be used in combination with other pain relief
Tramadol - Contraindications and Cautions	Contraindicated 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
Tramadol - Dose and Administration	50mg >12 years old Administer PO
Tramadol - Adverse effects	Nausea / vomiting Light-headedness, feeling unusual Sedation Dry mouth

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	Creado por Janelle Chambers hace alrededor de 6 años