Prescribing Essentials guide

Drugs and Doses you need to know for Respiratory Emergencies

Guide only: Consult local policies and procedures. Do not rely on any doses from this site.

Patient ID  Mr Andres Aardvark 1/1/32   1 Zoo Street                                        Allergies NKDA Timbuktu Hospital no: 123456                                                                         Respiratory:  ASTHMA
Date	Time	Drug	Dose	Route	Special Instructions
1/1/09	0800	OXYGEN	15 litres/minute	inh	via rebreathe mask
High flow O2
1/1/09	0800	Salbutamol	5mg	nebulised (via Oxygen)	repeat as necessary back to back (see PRN chart)
Acute Asthma dose. Remember its often nebulised via AIR in COPD
1/1/09	0800	Ipratropium Bromide	500micrograms	nebulised (via Oxygen)	Via high flow O2
1/1/09	0800	Hydrocortisone	200mg	IV Stat
1/1/09	0800	Prednisolone	40mg	PO
Steroid therapy is given IV AND PO. Oral steroids take several hours to start taking effect
1/1/09	0800	Magnesium Sulphate	2g over 20 minutes	IV	over 20 minutes
This is in the BTS Guidelines for severe Asthma
1/1/09	0800	0.9% NORMAL SALINE	500ml	IV	STAT
For hypotension, given as a “stat” dose

In an exam, remember to think about reversible causes. The examiner may ask you one test that will provide a reversible cause.

A chest X-ray will do this: a CRX will identify a pneumothorax which is a potentially life threatening complication of acute asthma.

Patient ID  Mr Andres Aardvark 1/1/32   1 Zoo Street                                        Allergies NKDA Weight 80kg  Timbuktu Hospital no: 123456                                                                         Respiratory:  Pulmonary Embolism
Date	Time	Drug	Dose	Route	Special Instructions
1/1/09	0800	OXYGEN	15 litres/minute	inh	via rebreathe mask
High flow O2
1/1/09	0800	Enoxaparin	120mg	s/c	1.5mg/kg (once daily)
Dose for P.E. differs between LMWH. Consult product literature. Dose here is 1.5mg/kg (80kg on chart)
1/1/09	0800	Diamorphine	2.5mg	IV	Titrate to pain –maximum 2.5mg each hour as needed.
1/1/09	0800	Cyclizine	50mg	IV	Max 8 hourly
Remember to give an anti-emetic with the diamorphine. Another alternative is metoclopramide.

Drugs and Doses you need to know for Ischaemic Heart Disease

Patient ID  Mr Andres Aardvark 1/1/32     1 Zoo Street                                        Allergies NKDA Timbuktu Hospital no: 123456                                                                         Cardiology: Acute Coronary Syndrome
Date	Time	Drug	Dose	Route	Special Instructions
1/1/09	0800	OXYGEN	15 litre/min	inh	via rebreathe mask
High flow O2
1/1/09	0800	Diamorphine	2.5mg	IV	Titrate to pain –maximum 2.5mg 4 hourly.
1/1/09	0800	Cyclizine	50mg	IV	max 8 hourly
1/1/09	0800	Clopidogrel	300mg	PO
1/1/09	0800	Aspirin	300mg	PO
1/1/09	0800	Enoxaparin	1mg/kg (e.g. 80mg)	SC	then 12 hourly for 72 hours (depending on clinical situation)
1/1/09	0800	GTN Spray	2 Puffs	S/L	PRN for chest pain –maximum 2 puffs every 5 minutes for 10 minutes then call doctor.
+/- Nitrate Infusion/ GP2b3a inhibitors for refractory pain

Patient ID  Mr Andres Aardvark 1/1/32      1 Zoo Street                                        Allergies NKDA Timbuktu Hospital no: 123456                                                                         Cardiology: STEMI
Date	Time	Drug	Dose	Route	Special Instructions
1/1/09	0800	OXYGEN	15 litres/minute	inh	via rebreathe mask
High flow O2
1/1/09	0800	Diamorphine	2.5mg	IV	Titrate to pain – maximum 2.5mg 4 hourly.
1/1/09	0800	Cyclizine	50mg	IV	Max 8 hourly
1/1/09	0800	Aspirin	300mg	PO
1/1/09	0800	GTN Spray	2 Puffs	S/L	PRN for chest pain –maximum 2 puffs every 5 minutes for 10 minutes then call doctor.
1/1/09	0800	Thrombolysis: See local Protocols		I.V.
+/- Clopidogel 300mg/ Nitrate Infusion/ GP2b3a inhibitors for refractory pain/ Emergency PCI

Patient ID  Mr Andres Aardvark 1/1/32       1 Zoo Street                                        Allergies NKDA Timbuktu Hospital no: 123456                                                                         Cardiology: Post STEMI Drugs
Date	Time	Drug	Dose	Route	Special Instructions
1/1/09	0800	Ramipril	2.5mg	PO	Monitor renal function Day 3 and to continue as dose titrated
Reduction Mortality
1/1/09	0800	Simvastatin	40mg	PO	Nocte Monitor liver function tests
1/1/09	0800	Bisoprolol	2.5mg	PO
1/1/09	0800	Aspirin	75mg	PO
New potential roles for omega 3 etc.

Drugs and Doses you need to know for Anaphylaxis

Patient ID  Mr Andres Aardvark 1/1/32      1 Zoo Street                                        Allergies NKDA Timbuktu Hospital no: 123456                                                                         Anaphylaxis
Date	Time	Drug	Dose	Route	Special Instructions
1/1/09	0800	Adrenaline	0.5mg	IM	Upper outer quadrant of thigh. Can Repeat x1.   Do NOT give IV unless specially trained and patient is in an intensive care environment with senior anaesthetist
The does of adrenaline is different in anaphylaxis and a cardiac arrest   Adrenaline comes in strengths of: 1 in 1000   (1mg a ml) And 1 in 10 000 (1mg in 10ml) [ the strength used in cardiac arrests IV]   The Anaphylaxis dose is therefore 0.5ml of Adrenaline 1 in 1000 IM.   You MUST know this for your exams. It is one of the few things where there is not time to “look it up”
1/1/09	0800	Prednisolone	40mg	PO	Stat
1/1/09	0800	Hydrocortisone	200mg	IV	Stat
Rapid Acting steroid
1/1/09	0800	Chlorphenamine	10mg	IV	Stat
Antihistamine
1/1/09	0800	Salbutamol	5mg	nebulised (via Oxygen)	repeat as necessary back to back (see PRN chart)
1/1/09	0800	Ipratropium Bromide	500 micrograms	nebulised (via Oxygen)	Via high flow O2
1/1/09	0800	Oxygen	15 litres/minute	Inh.	Via Re-breathe Mask
High flow oxygen – caution in patients with COPD who may retain CO2

Drugs and Doses you need to know for Heart Failure

Patient ID  Mr Andres Aardvark 1/1/32      1 Zoo Street                                        Allergies NKDA Timbuktu Hospital no: 123456                                                                         Cardiology: Pulmonary Oedema
Date	Time		Drug	Dose	Route		Special Instructions
1/1/09	0800		Oxygen	15 litres/minute	Inh.		Via Re-breathe Mask
High Flow Via Re-breathe
1/1/09	0800	Furosemide   If Systolic BP allows  (e.g.>100mmHg)		50-100mg	IV	Give via slow IV injection over 10 minutes. Can give higher doses in renal failure. Be aware it CAN be given IM in cases of extremis. Side effects include ototoxicity.
1/1/09	0800	GTN Spray If Systolic BP allows (e.g.>100mmHg)		2Puffs	S/L
1/1/09	0800	Nitrate Infusion E.g. Isosorbide dinitrate 0.05%		2-10ml per hour	IV		Titrate to Systolic Blood pressure. Increase as tolerated maintaining SBP>100mmHg
CPAP: Continuous Positive Airways Pressure has a benefit of the treatment of Pulmonary oedema in patients who do not have contraindications to treatment (e.g. low GCS/ Pneumothorax/ etc).   Drugs that DO NOT have a role in the treatment of acute pulmonary oedema caused by heart failure include: Beta blockers (specialist use only) ACE inhibitors (chronic management)   Management depends on BP. If patient has low blood pressure and pulmonary oedema this represents cardiogenic shock. Management is on Critical Care unit / Coronary Care Unit using inotropes etc.

Patient ID  Mr Andres Aardvark 1/1/32      1 Zoo Street                                        Allergies NKDA Timbuktu Hospital no: 123456                                                                         Cardiology: HEART FAILURE

l Management should proceed along the following lines Diuretic (e.g. Furosemide 80mg) orally ACE inhibitor at maximum dose –with regular monitoring of renal function (e.g. Perindopril 8mg) * Spirinolactone (e.g. 50mg Daily) – Survival Benefit Beta Blockade (e.g. bisoprolol 5mg Daily)   Other treatments used include Angiotensin II Receptor Blockers (e.g. Losartan) if ACE not tolerated Digoxin  – survival benefit

Stat Drugs, Infusions and Sliding Scales and Insulin

Guide only: Consult local policies and procedures. Do not rely on any doses form this site.

Patient ID                                                                            Allergies NKDA Mr Andres Aardvark 1/1/32 1 Zoo Street Timbuktu Hospital no:123456
Date	Time	Drug	Dose	Route	Special Instructions
1/1/09	0800	Aspirin	300mg	PO
This is the dose in ACS as well as STEMI as well as proven ischaemic stroke
1/1/09	0800	Salbutamol	5mg	nebulised (via Oxygen)
Acute Asthma dose. Remember its often nebulised via AIR in COPD
1/1/09	0800	Diamorphine	2.5mg	IV	Maximum of 2.5mg every one hour to control pain
Acute pain: e.g. MI
1/1/09	0800	0.9% NORMAL SALINE	500ml	IV	over 20 minutes
Fluid challenge in hypotensive patient
1/1/09	0800	Digoxin	500 micrograms	orally
Loading dose of digoxin. For normal patients (normal renal function <70) the dose is 500micrograms, then 500 micrograms 12 hours later, then maintenance dose (typical = 125 micrograms)
1/1/09	0800	Novorapid Insulin	6 (six) units	S/C	Check BM one hour post-dose
Acute one off dose for hyperglycaemia in a diabetic (e.g. type2DM post iv steroid)
1/9/09		Sliding Scale of Insulin: 50(fifty)  units of actrapid in 50 ml of normal saline IV as per sliding scale chart	see sliding scale chart	IV	Monitor BM minimum 1 hourly or more frequently if BM low
SLIDING SCALE OF INSULIN		BM (glucose)   <3.5 3.5-5 5-7 7-10 10-15 15-19 >19	Units (Ml) Per Hour   0 and call doctor/ treat as needed 0 1 2 3 4 6 and inform  Dr
This is an example of the insulin sliding scale format: adapted to infuse as many units per hour of insulin as needed depending on the serum glucose. Given IV e.g. for type 2 diabetics not eating  due to fasting pre op. Remember type I diabetics need exogenous insulin to survive: if they are NBM use a “type I DM” sliding scale.