Adrenaline
3reduce
1increase
Consider reduced doses for:
- Elderly / frail patients
- Patients with cardiovascular disease
- Patients on monoamine oxidase inhibitors
- Higher doses may be required for patients on beta blockers
Aspirin
P.A.P.
- Peptic ulcer
- Asthma
- Patients on anticoagulants
Ceftriaxone
- Allergy to Penicillin antibiotics
Dexamethasone
- Solutions which are not clear or are contaminated should be discarded
Dextrose 10%
- Nil of significance in the above indication
Fentanyl
P.R.I.C.K.E.R
Patients on monoamine oxidase inhibitors Rhinitis, rhinorrhea or facial trauma (IN route) Impaired hepatic function Current asthma Known addiction to opioids Elderly/frail patients Respiratory depression, e.g. COPD
Glucagon
- Nil of significance in the above indication
Glyceryl Trinitrate
N.E.R.C.
- No previous administration
- Elderly patients
- Recent MI
- Concurrent use with other tocolytics
Heparin
- Renal impairment
Ipratropium Bromide
- Glaucoma
2. Avoid contact with eyes
Ketamine
May exacerbate cardiovascular conditions (e.g. uncontrolled hypertension, stroke, recent MI,
cardiac failure) due to effects on HR and BP
Lidocaine (Lignocaine)
IM and local infiltration – inadvertent intravascular administration may result in systemic toxicity
(see below)
IO – impaired CV function (e.g. hypotension, bradycardia, poor perfusion, heart block, heart
failure)
Lidocaine (Lignocaine) – AVOID-2
Nil
Methoxyflurane
P.O.P.
- The Penthrox™ inhaler must be hand-held by the patients so that if
unconsciousness occurs it will fall from the patient’s face.
Occasionally the operator may need to assist but must continuously
assess the level of consciousness - Pre-eclampsia
- Concurrent use with Oxytocin may cause hypotension
Midazolam
R.B.Reps.Peradactals
- Reduced doses may be required for the elderly/frail, patients with
chronic renal failure, CCF or shock - The CNS depressant effects of benzodiazepines are enhanced in the
presence of narcotics and other tranquillisers including alcohol - Can cause severe respiratory depression in patients with COPD
- Patients with myasthenia gravis (weakness or rapid fatigue of muscle under voluntary control.)
Morphine
H.E.R C.R.A.A.P.
- Elderly/frail patients
- Hypotension
- Respiratory depression
- Current asthma
- Respiratory tract burns
- Known addiction to opioids
- Acute alcoholism
- Patients on monoamine oxidase inhibitors
Naloxone
- If patient is known to be physically dependent on opioids, be prepared
for a combative patient after administration - Neonates
Olanzapine
. 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 patients2
2. Elderly / frail patients and children are more susceptible to adverse effects1
Ondansetron
L.D.P.C.P.
- Patients with liver disease should not receive more than 8 mg of
Ondansetron per day - Care should be taken with patients on diuretics who may have an
underlying electrolyte imbalance - Ondansetron contains aspartame and should not be given to patients
with phenylketonuria - Concurrent use of Tramadol
- Pregnancy
Oxytocin
HYPOS
- If given IV may cause transient hypotension
2. Concurrent use with Methoxyflurane may cause hypotension
Paracetamol
IME
- Impaired hepatic function or liver disease
- Elderly / frail
- Malnourished
Prochlorperazine (Stematil)
HEP
- Hypotension
- Epilepsy
- Pts affected by alcohol or on anti-depressants
Salbutamol
- Large doses of Salbutamol have been reported to cause intracellular
metabolic acidosis
Tenecteplase
- Age ≥ 75 years
- Non-compressible vascular puncture
- History of liver disease
- SBP > 160 mmHg or DBP > 110 mmHg
- Low body weight
- Active peptic ulcer
- Anaemia
- Acute pericarditis or subacute bacterial endocarditis
- Traumatic or prolonged (>10 mins) CPR
- Pregnant or within 1 week post-partum
- HR > 120 bpm
