Precautions

Question 1

Adrenaline

Answer 1

Consider reduced doses for:
1. Elderly/frail
2. Pts with CVD
3. Pts on MOIs
Consider higher doses for:
1. Pts on beta blockers

Question 2

Aspirin

Answer 2

PAP
1. Peptic ulcers
2. Asthma
3. Pts on anticoagulants

Question 3

Ceftriaxone

Answer 3

1. Allergy to Penicillin antibiotics

Question 4

Dexamethasone

Answer 4

1. Unclear solutions should be discarded

Question 5

Dextrose

Answer 5

Nil

Question 6

Fentanyl

Answer 6

PORK RICE
1. Pts on MOIs
o.
2. Respiratory depression
3. Known addiction to opiods
4. Rhinitis, rhinorrhea or facial trauma (IN)
5. Impaired hepatic function
6. Current asthma
7. Elderly/frail

Question 7

Glucagon

Answer 7

Nil

Question 8

GTN

Answer 8

NERC
1. No previous admin - lower dose
2. Elderly/frail - lower dose
3. Recent MI - lower dose
4. Right MI or inferior STEMI with BP <160 - lower dose
5. Concurrent use with other tocolytics

Question 9

Ipratropium Bromide

Answer 9

1. Glaucoma
2. Avoid contact with eyes

Question 10

Ketamine

Answer 10

1. May exacerbate cardiac conditions ( HT, recent MI, cardiac failure) due to effects on HR and BP

Question 11

Lignocaine

Answer 11

1. IM- inadvertent IV may result in systemic toxicity
2. IO- Impaired CV function (decreased BP and HR)

Question 12

Methoxyflurane

Answer 12

1. Pts should not get >6ml in 24hrs - risk of nephrotoxicity
2. Occupational exposure - ensure ventilation

Question 13

Midazolam

Answer 13

CRAP
1. Can cause severe respiratory distress in pts with COPD
2. Reduced doses may be required for elderly/frail, pts with renal failure, CCF or shock
3. Alcohol - CNS effects enhanced when administered with alcohol
4. Pts with myasthenia gravis

Question 14

Morphine

Answer 14

HEAR CRAP
1. Hypotension
2. Elderly/frail
3. Acute alcoholism
4. Respiratory depression
5. Current asthma
6. Respiratory tract burns
7. Addiction to opioids
8. Pts on MOIs

Question 15

Naloxone

Answer 15

1. If pt is known to be dependent on opioids, be prepared for a combative pt after administration
2. Neonates

Question 16

Olanzapine

Answer 16

1. May be less effective if agitation is due to drug intoxication - especially stimulants or alcohol withdrawal. Benzos are preferred first line of action in this case.
2. Elderly/frail or children
3. Sedative medications & alcohol may cause over sedation.

Question 17

Ondansetron

Answer 17

1. Pts with liver disease should not exceed 8mg per day
2. Long QT syndrome - risk of Torsades
3. ODT should not be given to pts with phenylketonuria - contains aspartame
4. 1st trimester pregnancy - consult

Question 18

Paracetamol

Answer 18

1. Hepatotoxicity can occur with overdose
2. Already administered within past 4 hrs or total paracetamol intake within past 24hrs exceeds 4g in adults or 60mg/kg in children (4 doses)
3. Consider lower dose - Increased risk of hepatotoxicity in:
   - Elderly/frail
   -Malnourished
   -Impaired hepatic function

Question 19

Prochlorperazine

Answer 19

1. Elderly patients - more prone to side effects
2. Parkinson’s - worsens symptoms

Question 20

Salbutamol

Answer 20

1. Large doses can cause intracellular metabolic acidosis

Question 21

Tenecteplase

Answer 21

Relative Contraindications
1. Age 75 or older
2. Non compressible vascular puncture
3. Hx of liver disease
4. SBP >160 or DBP >110
5. Low body weight
6. Active peptic ulcer
7. Anemia
8. Acute pericarditis or subacute bacterial endocarditis
9. Traumatic or prolonged CPR (>10min)
10. Pregnant or < 1 week PP
11. HR >120

Question 22

Heparin

Answer 22

1. Renal impairment

Question 23

Oxytocin

Answer 23

nil

Question 24

Hydrocortisone

Answer 24

nil

Question 25

Droperidol

Answer 25

1. Elderly/frail - more prone to side effects 2. Parkinsons - worsens symptoms 3. Lewy body dementia - increases agitation 4. QT prolongation - ECG monitor if possible