PARAMEDIC drugs

• What is the MOA for AMIODARONE?

  It is an antidysrhythmic. It has class 3 activity and prolongs action potential duration and prolongs the refractory period of atrial, nodal and ventricular tissues. Results in a reduction of abnormal electrical activity, electrical conduction, heart rate and stabilisation of SA and AV nodes. Small increase in coronary blood flow.
• What are the indications for AMIODARONE?

  • cardiac arrest with VF or VT after first dose of adrenaline (PARA)
  • adults with sustained VT and no cardiac arrest (CCP)
  • adults with mild cardiovascular compromise from fast atrial flutter or fibrillation (CCP)
• What are the contraindications for AMIODARONE?

  • known severe allergy
  • allergy to iodine
  • VT from cyclic antidepressant poisoning
• What are the cautions for AMIODARONE?

  • none if the pt is in cardiac arrest
  • poor perfusion or low cardiac output
  • HoTN
  • atrial fibrillation from sepsis
  • known sick sinus syndrome without pacemaker
  • previous second or third degree heart block without pacemaker
  • pregnancy
• What is the dose for AMIODARONE?

  cardiac arrest:

  • 300mg for adult (2 ampoules)
  • VF or VT persists second 150mg once
  • ampoule with 150mg in 3ml
• Adverse effects, interactions, onset and duration of AMIODARONE?

  adverse effects:

  • HoTN
  • lightheadedness
  • bradydysrhythmia

  interactions:

  • cyclic antidepressants
  • beta blockers
  • calcium channel blockers

  onset:

  • 5-10mins

  duration:

  • 1-4hr after single dose
• What is the MOA for CLOPIDOGREL?

  Has antiplatelet activity. Antagonises the binding of ADP to platelets and impairs function.
• What are the indications + contraindications for CLOPIDOGREL?

  • STEMI with fibrinolytic treatment

  contraindications:

  • known severe allergy
• What are the cautions for CLOPIDOGREL?

  • clinically significant bleeding
  • at risk of bleeding
  • pregnancy
• What is the dose of CLOPIDOGREL?

  • 300mg if pt less than 75yr (4 tablets)
  • 75mg if pt equal or older than 75yr
• What are the adverse effects, interactions, onset and duration of CLOPIDOGREL?

  adverse effects:

  • increased bleeding

  interactions:

  • anticoagulants

  onset:

  • 30-60min

  duration:

  • 3-5 days
• What is the MOA for DROPERIDOL?

  Blocks dopamine and alpha receptors centrally. Results in sedation, reduced agitation, state of mental detachment and antiemetic action.
• Indications for DROPERIDOL?

  • pt equal or older than 12yr with acute behaviour disturbance causing mild to moderate risk to safety when olanzapine is not effective.
  • moderate to severe pain associated with chronic or complex pain, chronic use of opiates, severe headache, severe pain associated with agitation, pain with severe nausea or vomiting.
  • management of pain or agitation that does not respond to opiates in end of life care
  • nausea or vomiting despite ondansetron
• What are the contraindications for DROPERIDOL?

  • known severe allergy
  • age less than 12yr
  • pregnancy
• What are the cautions for DROPERIDOL?

  • ALOC
  • Parkinson's disease
  • concurrent administration of ketamine or midazolam
  • age greater or equal to 75yr
  • signs of shock
• What is the dose for DROPERIDOL?

  analgesia:

  • 1.25mg IV for adult once. Consider reducing to 0.625mg IV if caution present.

  acute behavioural disturbance:

  • 10mg IM or IV.
  • consider reducing to 5mg if cautioned
  • may be repeated after 20min

  afterlife care:

  • 2.5mg IV/IM/SC
  • repeat as required

  nausea + vomiting:

  • 0.625mg IV/IM once
• What is the administration for DROPERIDOL?

  2.5mg in 1ml ampoule

  acute behavioural disturbance?

  • draw up dose in 10ml syringe, dilute to 10ml using 0.9% NaCl
  • give over 1-2min IV

  nausea + vomiting:

  • draw 2.5mg into a 5ml syringe and dilute to 4ml using 0.9% NaCl. This gives a 0.625mg/ml solution.
  • administer via bolus

  IM:

  • administer undiluted

  SC:

  • undiluted into the abdominal wall
• What are the adverse effects, interactions, onset and duration of DROPERIDOL?

  adverse effects:

  • HoTN

  interactions:

  • intoxication
  • sedative drugs

  onset:

  • IV/IM = 5-10min

  duration:

  • 4-6hr
• What is the MOA for HEPARIN?

  Is an anticoagulant, and it increases the activity of antithrombin III. This causes inhibition of multiple coagulation factors
• What are the indications + contraindications for HEPARIN?

  indications:

  • STEMI with fibrinolytic treatment

  contraindications:

  • known severe allergy
  • age greater or equal to 75yr
• What are the cautions for HEPARIN?

  • clinically significant bleeding
  • at risk of bleeding
  • pregnancy
• What is the dose and administration for HEPARIN?

  Ampoule containing 5000 units

  dose:

  • 5000 units

  administration:

  • dilute to a total volume of 10ml using 0.9% NaCl
  • IV over 1-2min
• What are the adverse effects, interactions, onset and duration of HEPARIN?

  adverse effects:

  • increased bleeding

  interactions:

  • anticoagulants

  onset:

  • 5-15min

  duration:

  • 2-4hr
• What is the MOA of METOPROLOL TARTRATE?

  Immediate release beta blocker. It antagonises beta-1 receptors in the heart, causing a decrease in heart rate, cardiac output and BP
• What are the indications for METOPROLOL TARTRATE?

  • adults with mild or no cardiovascular compromise as a result of fast atrial flutter or fibrillation.
  • adults with moderate cardiovascular compromise as a result of fast atrial flutter or fibrillation if amiodarone is not available or contraindicated
• What are the contraindications for METOPROLOL TARTRATE?

  • known severe allergy
  • HoTN
• What are the cautions for METOPROLOL TARTRATE?

  • first degree heart block
  • known sick sinus syndrome without pacemaker
  • previous second or third degree heart block without pacemaker
  • Asthma or COPD
  • heart failure
  • pregnancy
• What is the dose for METOPROLOL TARTRATE?

  50mg tablets

  dose:

  • 50mg
• What are the adverse effects, interactions, onset and duration of METOPROLOL TARTRATE?

  adverse effects:

  • none

  interactions:

  • BP will be affected by other medicines that lower BP e.g. GTN, amiodarone
  • Heart rate effects will be increased with medicines that lower the heart rate e.g. amiodarone, calcium channel blockers.

  onset:

  • 10-20min

  duration:

  • 4-6hr
• What is the MOA for TICAGRELOR?

  Has antiplatelet activity, it produces reversible inhibition of ADP receptors on platelets. This decreases platelet aggregation.
• What are the indications, contraindications + cautions of TICAGRELOR?

  indications:

  • STEMI with primary PCI pathway when accepted by clinician

  contraindications:

  • known severe allergy

  cautions:

  • clinically significant bleeding
  • at risk of bleeding
  • pregnancy
• What is the dose + administration of TICAGRELOR:

  dose:

  • 90mg tablet (prep)
  • 180mg for adult

  administration:

  • PO
• What are the adverse effects, interactions, onset and duration of TICAGRELOR?

  adverse effects:

  • increased bleeding

  interactions:

  • anticoagulants

  onset:

  • 30-60min

  duration:

  • 24hr
• What is the MOA for OLANZAPINE?

  Is an atypical antipsychotic. It has actions at multiple receptors in the brain causing a reduction in agitation, sedation, anxiolysis and stabilisation of mood.
• What are the indications, contraindications + cautions for OLANZAPINE?

  indications:

  • greater or equal to 12yr with acute behavioural disturbance causing mild to moderate safety to risk.

  contraindications:

  • known severe allergy
  • poisoning with antipsychotic e.g. quetiapine, risperidone or olanzapine

  cautions:

  • pregnancy
  • intoxication
  • age greater or equal to 75yr
• What is the dose + administration for OLANZAPINE?

  usual prep: 5mg tablets

  dose:

  • 10mg PO
  • consider reducing to 5mg if cautioned
  • can be repeated once after 20min

  administration:

  • is dispersible and will dissolve in the mouth
• What are the adverse effects, interactions, onset and duration of OLANZAPINE?

  adverse effects:

  • sedation

  interactions:

  • intoxication
  • sedative drugs

  onset:

  • 10-20min

  duration:

  • 12-24hr
• What is the MOA for ENOXAPARIN?

  Is a low molecular weight heparin anticoagulant. It potentiates the activity of antithrombin 3, causing inhibition of multiple coagulation factors.
• What are the indications, contraindications + cautions for ENOXAPARIN?

  indications:

  • STEMI in conjunction with fibrinolytic therapy

  contraindications:

  • known severe allergy

  cautions:

  • clinically significant bleeding
  • at risk of bleeding
  • pregnancy
• What is the dose, administration + prep for ENOXAPARIN?

  Age <75yr:

  Dose + volume is 10mg/ml above estimated weight e.g. 60-69kg = 70.

  Age >75yr:

  Dose + volume is 10mg/ml below estimated weight (except <60kg = 45)

  
  

  Administration:

  subcutaneously into the abdominal wall

  Prep:

  pre-filled syringe containing 100mg in 1ml