Pharmacology

• • KSAR to cephalosporin drugs
• • Known anaphylaxis or severe allergic reaction to penicillin based drugs - (isolated minor drug rashattributed to penicillin does not contraindicate the use of Ceftriaxone)19

• • Suspected meningococcal septicaemia with non-blanching petechial OR purpuric rash and othersignificant symptoms that may include:
• a. myalgia;
• b. headache;
• c. nausea and/or vomiting;
• d. severe lethargy;
• e. fever; or
• f. clinical evidence of shock.
• IM 50 mg/kg (rounded up to the nearest 5kg)* Reconstitute 1g of Ceftriaxone with 3.6mL of Sodium Chloride 0.9% to achieve a finalconcentration of 1g/4mL (250mg/mL).
• Weight (kg) Dose (mg) Vol (mL)
• <5kg 250mg 1mL
• 5kg to 10kg 500mg 2mL
• 10kg to 15kg 750mg 3mL
• >15kg 1g 4mL
• IV 50 mg/kg (rounded up to the nearest 5kg) slow push over 3 to 5 mins* Reconstitute 1g of Ceftriaxone with 9.6mL of Sodium Chloride 0.9% in a 10mL syringe toachieve a final concentration of 1g/10mL (100 mg/mL).
• Weight (kg) Dose (mg) Vol (mL)
• <5kg 250mg 2.5mL
• 5kg to 10kg 500mg 5mL
• 10kg to 15kg 750mg
• 7.5mL>15kg 1g 10mL

• • Seizures/convulsions
• ≥50 yrs 2.5mgRepeated at 10 min intervals until seizure is managed – no max doseIM
• <50 yrs 5.0mgRepeated at 10 min intervals until seizure is managed – no max dose

• • Seizures/convulsions
• IM 200 mcg/kg – single dose not to exceed 5 mg
• Repeated at half the initial dose (max 2.5mg) at 10 min intervals until seizure is managed –no max dose

• • Hypotension
• • Respiratory depression particularly when associated with alcohol or narcotics

• • Reduced dosages may be required in elderly patients, patients with chronic renal failure, congestivecardiac failure or shock
• • Can cause severe respiratory depression in patients with COAD
• • Myasthenia gravis
• • Multiple sclerosis

• • Significant pain (non cardiogenic)
• • Cardiogenic chest pain
• • Autonomic Dysreflexia

• • Elderly patients• Hypotension
• • Respiratory tract burns
• • Respiratory depression and failure
• • Known addiction to narcotics
• • Patients on Monoamine Oxidase Inhibitors (MAO’s)

• • Bradycardia
• • Drowsiness
• • Hypotension
• • Nausea & vomiting
• • Pin point pupils
• • Respiratory depression

• • Significant pain (non cardiogenic)
• • Autonomic Dysreflexia
• IM 2.5 to 10mgRepeated at up to 5mg every 10 mins until significant reduction in pain or onset of undesirable sideeffects – total max dose 20mg
• IV 2.5 to 5mgRepeated at up to 5mg every 5 mins until significant reduction in pain or onset of undesirable sideeffects – total max dose 20mg
• • Cardiogenic chest pain
• IM 5 to 10mgRepeated at up to 5mg every 10 min intervals until significant reduction in pain or onset of undesirableside effects (only when IV access not achieved) – total max dose 20mg
• IV 2.5mgRepeated at 2.5mg every 5 min intervals until significant reduction in pain or onset of undesirable sideeffects – total max dose 20mg

• • Significant pain (non cardiogenic)
• • Autonomic Dysreflexia

• IM ≥1 yr 200 mcg/kg (single max dose 5mg) – single dose only
• IM <1 yr Appropriate Medical Officer consultation and approval required in all situations
• IV ≥1 yr 100 mcg/kg (single max dose 2.5mg)Repeated at 50 mcg/kg increments (single max dose 2.5mg) every 5 mins –total max dose 200 mcg/kg
• IV<1 yr Appropriate Medical Officer consultation and approval required in all situations• Cardiogenic chest painNOT APPROVED

• Anaphylaxis OR Severe respiratory depression
• IM > 10KG 10mcg/KG - single dose only not to exceed 250mcg. Repeat at 5 min intervals
• IM < 10KG 100mcg repeat at 5 mins.

NEB 5mg single dose only - May be administered for isolated minor facial and/or tongue swelling thought to be allergic in origin - if stridor use IM

Asthma with severe life threatening bronchospasm ( pt's must either only be able to speak in singke words and/or have hemodynamic compromise and/or ALOC.

IM 10mcg/KG - single dose not to exceed 250 mcg. repeat at 5 min intervals.

• Cardiac Arrest
• IV >10KG - 10mck/KG - repeat at 3-5 min intervals - no max dose
• IV < 10KG - 100 mcg - repeat at 3-5 minutes

• Croup with stridor at rest
• NEB 5 mg - single dose only

Anaphylaxis or severe allergic reaction

• IM 250 - 500mcg repeat at 5 min
• NEB 5mg single dose only - may be administered for isolated minor facial and or tongue swelling thought to be allergic in origin - if stridor IM

Asthma with severe life threatening bronchoconstriction ( Pt's must be either speaking in single words and/or hemodynamically compromised and/or ALOC)

IM 250 - 500mcg repeat at 5mg

• Cardiac Arrest
• IV 1mg repeat at 3-5 mins

• - Pt's on monoamine oxidase inhibitors
• - Hypovolemic Shock
• - Hypertension

• - Anxiety
• - Hypertension
• - Palpitations/ tachyarrythmias
• - Pupil dilation

Naloxone is an opioid antagonist that prevents or reverses the effects of opioids including respiratorydepression, sedation and hypotension. Naloxone antagonises the opioid effects by competing for the samereceptor sites.

• • Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension
• • May produce acute withdrawal convulsions in the chronic narcotic user
• • Pulmonary oedema

• • Respiratory depression secondary to the administration of narcotic drugs
• IM 1.6mg – single dose only

• • Respiratory depression secondary to the administration of narcotic drugs
• IM 20 mcg/kg (single max dose 800mcg) – single dose only

• • Patients with acute and/or history of heart failure
• • Pre-existing renal failure
• • Uncontrolled haemorrhage (unless associated with severe head injury)

• • Inadequate tissue perfusion/shock (see Special notes)
• • Hypovolaemia
• • As a flush following IV drug administration

• • Suspected meningococcal septicaemia with non-blanching petechial OR purpuric rash and othersignificant symptoms that may include:
• a. myalgia;
• b. headache;
• c. nausea and/or vomiting;
• d. severe lethargy;
• e. fever; or
• f. clinical evidence of shock.

• KSAR to cephalosporin drugs• Known anaphylaxis or severe allergic reaction to penicillin based drugs - (isolated minor drug rashattributed to penicillin does not contraindicate the use of Ceftriaxone)

• • KSAR to Aspirin or NSAIDs
• • Chest pain associated with psychostimulant overdose
• • Bleeding disorders
• • Current GI bleeding or peptic ulcers
• • Patients <18 yrs

• • Possible aortic aneurysm or other condition that may require surgery
• • Pregnancy
• • History of GI bleeding or peptic ulcers
• • Concomitant anticoagulant therapy (excluding Clopidogrel)

• • Suspected meningococcal septicaemia with non-blanching petechial OR purpuric rash and othersignificant symptoms that may include:
• a. myalgia;
• b. headache;
• c. nausea and/or vomiting;
• d. severe lethargy;
• e. fever; or
• f. clinical evidence of shock.
• IM 1g* Reconstitute 1gm with 3.6mL of Sodium Chloride 0.9% to achieve a final concentration of1g/4mL (250mg/mL).
• IV 1g slow push over 3 to 5 min* Reconstitute 1gm with 9.6mL of Sodium Chloride 0.9% in a 10mL syringe to achieve a finalconcentration of 1g/10mL (100 mg/mL).