Paracetamol 3 Precautions
Hepatotoxicity can occur with overdose in the following:
- If patient has already had it in past 4 hours or a total of 4 grams in 24 hours or 60mg/kg in children
- elderly/frail/malnourished
- Impaired hepatic function
Ketamines 1 Precaution
May exacerbate cardiovascular conditions ( ie uncontrolled hypertension, stroke, recent MI, cardiac failure) due to effects on HR and BP(tachycardia and hypertension)
Morphine 8 Precautions
8
1. Elderly / frail patients
2. Hypotension
3. Respiratory destress
4. Current Asthma
5. Respiratory tract burns
6. Known addiction to opiods
7. Acute acloholism
8. Patients on monoamine oxidase inhibitors
Fentanyl 5 Precautions
5
1. Elderly frail patients
2. Impaired hepatic function
3. Respiratory depression e.g. COPD
4. Current Asthma
5. Rhinitis, rhinorrhea or facial trauma (IN ROUTE)
Methoxyflurane Precautions
- no more than 6ml in 24 hours
- administer in a open space to limit occupational exposure
Aspirin 3 Precautions
3
1. Peptic ulcer
2. Asthma
3. patients on anticoagulants
Glyceryl Trinitrate GTN 3 Precautions
- lower dose in patients who are elderly/frail/no previous administration/ recent MI
- right MI/ inferior STEMI with BP < 160 use with caution due to preload reduction
- preterm labour (concurrent use with other tocolytics)
Heparin Precautions
Renal Impairment
Ventolin Precautions
Large doses have been reported to cause intracellular metabolic acidosis
Ipratropium Bromide 2 (Atrovent) Precautions
2
1. Glaucoma
2. Avoid contacts with the eyes
Dexamethasone Precautions
Solutions that are not clear or are contaminated should be discarded
Na Saline Precautions
None
Olanzapine Precautions
2
1. Olanzapine may be less effective if patient agitation is due to drug intoxication (especially stimulants) or alcohol withdrawal. Benzodiazepines are considered first line agents in these patients
2. Elderly / frail patients and Children are more susceptible to adverse effects
Midazolam 4 Precautions
4
1. Reduced doses may be required for the elderly / frail, patients with chronic renal failure, CCF or shock.
2. The CNS depressant effects of benzodiazepines are enhanced in the presence narcotics and other tranquillisers including alcohol
3. Can cause sever respiratory depression in patients with COPD
4. Patients with myasthenia gravis
Adrenaline 4 Precautions
4 consider reduced dose for
1. Elderly / frail patient
2. Patient with cardiovascular disease
3. Patients on monoamine oxidase inhibitors
4. Higher doses may be required for those on Beta Blockers
Ondansetron 4 Precautions
Patients with hepatic disease should not receive more then 8 mg in 24 hours
Avoid if patient has a history of congenital long QT even though it is rare wide QT may lead to torsades
Ondansetron ODT may contain aspartame and should not be given to patients with phenylketonuria
Pregnancy 1st trimester - consult with hospital
Prochlorperazine 2 Precautions
elderly patients more susceptible to side effects
Parkinson’s symptoms can be worsened, avoid is possible
Oxytocin Precautions
None
Naloxone Precautions
- If patient is known to be physically dependent on opioids, be prepared for a combative patient
- Neonates
Droperidol 4 precautions
- Elderly patients more susceptible to adverse effects
-Parkinson’s disease, symptoms may be worsened - Lewy body dementia may experience increased agitation
- QT prolongation has been reported where possible ECG monitoring to be done post sedation
Ceftriaxone precautions
penicillin allergy
lignocaine 2 precaution
-IM and local infiltration- inadvertent intravascular injection may lead to systemic toxicity
-IO- impaired CV function ie bradycardia, hypotension, poor perfusion heart block or failure
