Pharmacology

• 1mg in 1ml glass ampoule
• 1mg in 10ml glass ampoule

Naturally occurring alpha & bea-adrenergic stimulant with actions of:

Beta 1 effects: 

• Increases HR by increasing SA node firing rate
• Increases conduction velocity through AV node
• Increases myocardial contractility
• Increases irritability of ventricles

Beta 2 effects:

• Causes bronchdilation 
• Stabilizes mast cells

Alpha effects:

         Causes peripheral vasoconstriction

By monoamine oxidase and other enzymes in the blood, liver and around nerve endings.

Excreted by the kidneys

• Cardiac arrest (VF/VT, Asysole or PEA)
• Anaphylaxis
• Severe Asthma (not responsive to nebulised therapy, unconscious with no BP)
• Croup
• MICA - Bradycardia with poor perfusion
• MICA - Inadequate perfusion

Hypovolaemic shock without adequate fluid replacement

• Elderly/frail pts
• Pts with cardiovascular disease
• Pts on MAO inhibitors
• Higher doses may be required for pts on beta-blockers

• IM
• IV
• Nebulised

• Sinus tachycardia
• Supraventricular tachycardias
• Ventricular tachycardia
• Hypertension
• Pupil dilation
• May increase size of MI
• Anxiety/palpitations in conscious pt

• Onset: 30-90 seconds
• Peak:  3-5 minutes
• Duration:  5-10 minutes

• Onset: 30 seconds
• Peak: 3-5 minutes
• Duration: 5-10 minutes

300mg chewable tablets

An analgesic, antipyretic, anti-inflammatory & antiplatelet aggregation agent.

Actions:

to minimize platelet aggregtion and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS

inhibits synthesis of prostaglandins - anti-inflammatory actions

Acute coronary syndrome

• Hypersensitivity
• Actively bleeding peptic ulcers
• Bleeding disorders
• Suspected dissecting AAA
• Chest pain associated with psychostimulant OD with SBP >160

• Peptic ulcer
• asthma
• pts on anticoagulants

• Heartburn
• Nausea
• GI bleeding
• Increased bleeding times
• Hypersensitivity reactions

• Onset: n/a
• Peak: n/a
• Duration: 8-10 days

1g sterile powder in glass vial

Cephalosporin antibiotic

Excreted unchanged in urine and bile

Allergy to cephalosporin antibiotics

Allergy to penicillin antibiotics

• IV (adults) - made up to 10ml using sterlie water and administered over 2 minutes
• IM (paeds or unable to get IV access) - made up to 4ml using 1% lignocaine and administered in lateral upper thigh

• Nausea
• Vomiting
• Skin rash

8mg in 2ml glass vial

A corticosteroid secreted by the adrenal cortex

Actions:

• Relieves inflammatory reactions
• Provides immunosuppression

• By the liver and other tissues
• Exceted by kidneys

• Bronchospasm associated with acute respiratory distress ont responsive to Salbutamol nebs
• Exacerbation of COPD
• Croup

Known hypersensitivity

Ensure solution is clear. Discard if not.

• IV (administered over 1-3 minutes)
• Oral

Nil of significance

• Onset:  30-60 minutes
• Peak:  2 hours
• Duration:  36-72 hours

25g in 250ml infusion soft pack

Slightly hypertonic crystalloid solution comprising 10% dextrose and water.

• Broken down in tissues
• Store in liver and muscle as glycogen

Diabetic hypoglycaemia (BGL <4) in pts with altered conscious state and unable to self-administer oral glucose

Nil of significance

IV infusion

nil of significance

• Onset: 3 minutes
• Peak: n/a
• Duration: depends on severity of hypoglycaemic episode

• 100mcg in 2ml glass ampoule
• 250mcg in 1ml glass ampoule or cartridge

A synthetic opioid analgesic

Actions:

• Depression leading to analgesia
• Respiratory depression leading to apnoea
• Dependence (addiction)

Decreases conduction velocity through the AV node

• Analgesia (where pt has allergy to morphine, known renal impairment, hypotension, nausea/vomiting or a short duration of action is desirable)
• Severe headache
• Sedation to facilitate intubation (MICA)
• Sedation to maintain intubation (MICA)

• By the liver
• Excreted by kidneys

• Hypersensitivity
• Late second stage labour

• Elderly/frail pts
• Impaired hepatic function
• Respiratory depression
• Current asthma
• Pts on MAO inhibitors
• Known Addiction
• Rhinitis, rhinorrhea or facial trauma (for IN)

• IV
• IN

• Respiratory depression
• Apnoea
• Rigidity of diaphragm and intercostal muscles
• Bradycardia

Peak: 2 minutes

• Onset: Immediate
• Peak: <5 minutes
• Duration: 30-60 minutes

1mg (IU) in a 1ml hypokit

A hormone normally secreted by the pancreas

Action:

Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose

• Mainly by liver.
• Also by kidneys and in the plasma

Diabetic hypoglycaemia (BGL <4) in pts with altered conscious state unable to self-administer oral glucose

Nil of significance

IM

Nausea & vomiting (rare)

• Onset: 5 mins
• Peak: n/a
• Duration: 25 mins

• 300mcg tablets
• Transdermal GTN Patch (50mg, 0.4mg/hr)

Smooth muscle relaxant

Actions:

• Venous dilation promotes venous pooling reducing venous return (reduces preload)
• Arterial dilation reduces systemic vascular resistance and arterial pressure (reduces afterload)

The effects of this are:

• reduced myocardial O2 demand
• reduced systolic, diastolic and MAP whilst maintaining coronary artery perfusion
• mild collateral coronary artery dilation 
• mild tachycardia
• uterine quiescence in pregnancy

by the liver

• Chest pain with ACS
• Acute LVF
• Autonomic Dysreflexia
• Preterm Labour (consult)
• Hypertension associated with ACS

• Hypersensitivity
• SBP <110 for tablet
• SBP <90 for patch
• HR >150 bpm
• HR<50 (excluding Autonomic Dysreflexia)
• VT
• Inferior STEMI with SBP<160
• Right Ventricular MI
• Viagra (Citrate) or Levitra (Vardenafil) in last 24hr or Cialis (Tadalafil) in last 4 days

• Nil previous admin
• Elderly pts
• Recent MI
• Concurrent use with other tocolytics

• SL / Buccal
• Transdermal
• Infusion (IHT only)

• Tachycardia
• Hypotension
• Headache
• Skin flushing (rare)
• Bradycardia (rare)

• Onset: 30 secs - 2 mins
• Peak: 5-10 mins
• Duration: 15-30 mins

• Onset: Up to 30 mins
• Peak: 2 hours
• Duration: n/a

250mcg in 1ml polyamp

Anticholinergic bronchdilator

Actions:

Allows bronchodilation by inhibiting cholinergic bronchomotor tone (ie blocks vagal reflexes which mediate bronchoconstriction).

Excreted by kidneys

• Severe respiratory distress associated with bronchospasm
• Exacerbation of COPD irrespective of severity

Known hypersensitivity to Atropine or its derivatives

• Glaucoma
• Avoid contact with eyes

Nebulised

• Headache
• Nausea
• Dry mouth
• Skin rash
• Tachcardia (rare)
• Palpitations (rare)
• Acute angle closure glaucoma (rare)

• Onset: 3-5 mins
• Peak: 1.5-2 hrs
• Duration: 6 hours

200mg in 2ml vial

A rapid acting dissociative anaesthetic agent (NMDA receptor antagonist)

Actions - Produces a dissociative state characterised by:

• trance-like state with eyes open but not responsive
• nystagmus
• profound analgesia
• normal pharyngeal and laryngeal reflexes
• normal or slightly enhanced skeletal muscle tone
• occassionally a transient and minimal respiratory depression

• By the liver
• Excreted by the kidneys

• Extreme Agitation
• Rapid sequence intubation (MICA)
• Extreme traumatic pain refractory to opioid analgesia (MICA)

• Known hypersensitivity
• Severe hypertension (SBP >180)

Condition where significant elevation of BP would be hazardous, eg:

• Hypertension
• CVA
• Recent AMI
• CCF

• IM
• IV (MICA)
• IO (MICA)

• Increased BP
• Increased HR
• Respiratory Depression or Apnoea
• Emergence reactions (nightmares, restlessness, vivid dreams, confusion, hallucinations, irrational behaviour)
• Enhanced skeletal tone
• Nausea and vomiting
• Diplopia
• Nystagmus
• Lacrimation
• Salivation
• Pain at injection site

• Onset: 3-4 mins
• Peak: n/a
• Duration: 12-25 mins

50mg in 5ml amp

A local anaesthetic agent

Actions:

Prevents initiation and transmission of nerve impulses causing local anaesthesia

• By the liver.
• Excreted unchanged in the kidneys

Dilutent for Ceftriacone for IM administration in suspected meningococcal disease

Hypersensitivity

Avoid inadvertent IV administration due to potential CNS complications

IM (with Ceftriaxone only)

Nil (unless inadvertent IV administration)

• Onset: rapid
• Duration: 1-1.5 hours

3ml glass bottle

Inhalational analgesic agent at low concentrations

• By the liver
• Excreted mainly by the lungs

Pre-hospital pain relief

• Renal impairment
• Concurrent use of tetracycline antibiotics
• Exceeding total dose of 6ml in 24 hrs
• Personal or family hx of malignant hyperthermia
• Muscular dystrophy

• Penthrox inhaer must be hand-held by pt so that if unconsciousness occurs it will fall from the pt's face.
• Pre-eclampsia
• Concurrent use with Oxytocin

Self-administration under supervision using Penthrox inhaler

• Drowsiness
• Decrease in bp
• bradycardia (rare)
• Renal toxicity if 6ml in 24hrs exceeded

• 5mg in 1ml glass ampoule
• 15mg in 3ml glass ampoule (MICA)

Short acting CNS depressant.

Actions:

• Anxiolytic
• Sedative
• Anti-convulsant

• In the liver.
• Excreted by kidneys

• Status Epilepticus
• Sedation of Agitated Pt (under Mental Health Act 2014)
• Sedation in psychostimulant OD
• MICA - Sedation to enable itubation
• MICA - Sedation to enable synchronised
• cardioversion

Hypersensitivity to benzodiazepines

• Reduced doses may be required for elderly/frail, pts with renal failure, CCF or shock
• CNS depressant effects enhanced in presence of narcotics and other tranquillisers inc alcohol
• Can cause severe respiratory depression in pts with COPD
• Pts with Myasthenia Gravis

• IM
• IV (MICA)
• IV Infusion (MICA)

• Depressed GCS
• Respiratory depression
• Loss of airway control
• Hypotension

• Onset: 3-5 mins
• Peak: 15 mins
• Duration: 30 mins

200mcg tablet

A synthetic prostoglandin

Actions:

Enhances uterine contractions

• Converted to active metabolite misoprostol acid in the blood
• Metabolised in the tissues and excreted by the kidneys

Primary Postpartum Haemorrhage

• Allergy to prostaglandins
• Exclude multiple pregnancy

Hx of asthma

Oral

• Hyperpyrexia
• Shivering
• Abdominal Pain
• Diarrhoea

• Onset: 8-10 mins
• Peak: n/a
• Duration: 2-3 hrs

10mg in 1ml glass ampoule

An opioid analgesic.

Actions:

• Depression (leading to analgesia)
• Respiratory depression
• Depression of cough reflex
• stimulation (changes in mood, euphoria, dysphoria, vomiting, pin-point pupils)
• Dependenc (addiction)
• Vasodilation (hypotension)
• Decreases conduction velocity through AV node (bradycardia)

• By the liver
• Excreted by the kidneys

• Pain relief
• Acute LVF with SOB & full-field crackles
• MICA - Sedation to maintain intubation
• MICA - Sedation to enable intubation
• MICA - RSI

• Hypersensitivity
• Renal impairment
• Late second stage labour

• Elderly/frail pts
• Hypotension
• Respiratory depression
• Current asthma
• Respiratory tract burns
• Known addiction
• Acute alcoholism
• Pts on MAO inhibitors

• IV 
• IM

• Drowsiness
• Respiratory Depression
• Euphoria
• Nausea
• Vomiting
• Addiction
• Pin-point pupils
• Hypotension
• Bradycardia

• Onset: 2-5 mins
• Peak: 10 mins
• Duration: 1-2 hours

• Onset: 10-30 mins
• Peak: 30-60 mins
• Duration: 1-2 hours

400mcg in 1 ml glass ampoule

An opioid antagonist

Actions:

Prevents or reverses the effects of opioids

By the liver

Altered conscious state and respiratory depression secondary to administration of opioids or related drugs

Nil of significance

• Be prepared for a combative pt if pt known to be physically dependent on opioids
• Neonates

• IM
• IV

Symptoms of opioid withdrawal:

• sweating
• goose flesh
• tremor
• nausea
• vomiting
• agitation 
• dilation of pupils
• lacrimation
• convulsions

• Onset: 1-3 mins
• Peak: n/a
• Duration: 30-45 mins

(same for both IM & IV)

• 4mg oral tablet
• 8mg in 4m glass ampoule

Anti-emetic

Action:

5HT3 antagonist which blocks receptors both centrally and peripherally

By the liver

• Undifferentiated nausea and vomiting
• Prophylaxis for spinally immobilised or eye inured pts
• Vestibular nausea in pts <21 years of age

• Hypersensitivity
• Concurrent Apomorphine use
• Known Long QT syndrome
• Hypokalaemia
• Hypomagnesaemia

• Pts with liver disease should not receive more that 8mg per day
• Pts on diuretics who may have an underlying electrolyte imbalance
• Should not be given to pts with phenylketonuria
• Concurrent use of Tramadol
• Pregnancy

• Oral
• IV

• Constipation
• Headache
• Fever
• Dizziness
• Rise in liver enzymes

Rare:

• Hypersensitivity reactions
• Prolonged QT
• Widened QRS
• Tachyarrythmias
• Seizures
• Extrapyramidal reactions
• Visual disturbances

• Onset: 2 mins
• Peak: 20 mins
• Duration: 2 hrs

• 500mg tablets
• 120mg in 5ml oral liquid

An analgesic and antipyretic agent

Actions:

Thought to inhibit prostaglandin synthesis in the CNS although exact mechanism of action unclear.

• By the liver
• Excreted by the kidneys

• Mild pain
• Headache

• Hypersensitivity
• Children <1 mth old
• Already administered in past 4 hrs
• Total in past 24 hrs exceeding 4g (adults) or 60mg/kg (children)
• Chest pain in ACS

• Impaired hepatic function or liver disease
• Elderly/frail
• Malnourished

oral

• Hypersensitivity reactions (rare)
• Haematological reactions (rare)

• Onset: 30 mins
• Duration: 4 hours

12.5mg in 1ml glass ampoule

An anti-emetic

Actions:

Acts on several central neuro-transmitter systems

• By the liver
• Excreted by kidneys

Treatment or prophylaxis of nausea / vomitng for:

• Motion sickness
• Planned aeromedical evacuation
• Known allergy or C/I to Ondansetron
• Headache irrespective of nausea / vomiting
• Vertigo

• Circulatory collapse
• CNS depression
• Hypersensitivity
• Children
• Pregnancy

• Hypotension
• Epilepsy
• Pts affected by alcohol or on anti-depressants

IM

• Drowsiness
• Blurred vision
• Hypotension
• Sinus tachycardia
• Skin rash
• Extrpyramidal reactions (dystonic type)

• Onset: 20 mins
• Peak: 40 mins
• Duration: 6 hours

• 5mg in 2.5ml polyamp
• pMDI (100mcg per actuation)

A synthetic beta adrenergic stimulant with primarily beta 2 effects

Action:

Causes bronchodilatation

• By the liver
• Excreted by kidneys

Respiratory distress with suspected bronchospasm:

• Asthma
• Severe allergic reactions
• COPD
• Smoke Inhaltion
• Capsicum Spray exposure

Nil of significance

Large doses have been reported to cause intracellular metabolic acidosis

• Nebulised
• pMDI

• Sinus tachycardia
• Muscle tremor

• Onset: 5-15 mins
• Peak: n/a
• Duration: 15-50 mins