PHARMACOLOGY-BLS CPD

Objectives
• By the end of this CPD Activity, you are expected to know the basic
principles of pharmacology and have learned the use of:
o [Link] Salicylic Acid (Aspirin)
o [Link] Bromide - Inhaled
o 3.β2-stimulants (Salbutamol) - Inhaled
o [Link] (Penthroxyflurane) – Inhaled
o [Link] for injection - inhaled
o 6. Oral glucose powder/gel
o [Link] oxide – inhaled
o 8. Medical oxygen
o 9. Activated Charcoal
 What is Pharmacology??

• Pharmacology is, basically, the field of study concerning medications

(drugs).
• For our purposes, we need to explore some of the basic concepts of
pharmacology, namely:
oPharmacokinetics –what the body does to a drug (absorption,
distribution, metabolism, and excretion)
oPharmacodynamics –the effect of the drug and its mechanism of
action (what it does and how it works, i.e., classification and
pharmacological action)
oIndications –when to use a particular drug
oContraindications –when NOT to use a particular drug
oRelative contraindication / Caution –when to consider using the risk
vs. benefit evaluation
• Absorption
• The route of administration
• Enteral (by mouth)
• Parenteral (example: injection or intravenous)
• Inhalation (breathing)
• Absorption (through the skin or mucous membranes)
• Defined by the drug being present in the blood
plasma
• Distribution
• Where it goes once administered
• Blood plasma; Fat; Extracellular fluid; Intracellular
fluid)
• Metabolism
• Drug is chemically modified by the body
• Most drugs are metabolized in the liver and changed to
make it more water-soluble so that it is excreted by the
kidneys in urine
• Excretion
• How the body gets rid of the drug
• The two main ways are hepatobiliary (bile) and renal
(urine)
 Pharmacodynamics - Terms and definitions
(cont.)
• Agonist –stimulates/causes a response (either directly or indirectly)
• Antagonist –suppresses/stops a response (either directly or indirectly)
• Primary effect –the desired response to the drug (reason for administering/indication)
• E.g.: Bronchodilation when administering β2-stimulant for asthma
• Secondary effect –may be undesirable (side-effect)
• E.g.: Increased heart rate when administering β2-stimulant for asthma
• Potency –how “strong” a drug is
• Some drugs require only a low dose for a response, e.g., adrenaline
• Other drugs require a larger dose to be effective
• Therapeutic index/window
• This is at which dose the drug becomes effective (lowest dose required) to which dose the drug
becomes toxic (maximum dose)
• CAUTION: Toxicity can quickly become an issue in patients with liver and/or kidney
disease
Pharmacodynamics - Terms and definitions (cont.)
Pharmacodynamics - Terms and definitions (cont.)
 Pharmacodynamics -Terms and definitions (cont.)

• Polypharmacy
• Describes a patient using multiple different medications –common in the older
population
• Drug interaction (common with polypharmacy)
• Some drugs enhance the effect of others, and some drugs supress the effect of
others (antagonistic interaction), and some combinations can cause severe side-
effects or adverse events
• Some drugs can affect the pharmacokinetics of others and interfere with their effect
or excretion
• Check interactions as far as possible – Consult when you are not sure!
• Additive effect
• The sum of effects of two or more drugs
• Synergistic
• When two drugs are given at the same time, they enhance each other’s effect so
that the total effect is greater than the additive effect
 Pharmacodynamics–Terms and definitions (cont.)

• Tolerance
• Decreased responsiveness can develop over time (chronic medication) –e.g.:
patient can present with hypertension even when on treatment if they haven’t
been to their doctor regularly for check-up
• Placebo effect
• Some effect or response which is not related to a drug’s properties –sometimes
if a patient is experiencing pain, for example from a fractured arm, the patient
will experience pain relief when oxygen via facemask is administered

Please view the video titled “Pharmacodynamics” in the Course Videos folder on the website.
 Pharmacology: Indications and Contra-indications

• Indication(s)
• This is the reason why a drug IS administered to a patient
• If there is/are no indications, a drug should not be given to a patient
• E.g.: A patient complaining of a headache and has no history of allergy to aspirin.
There is no indication for aspirin administration (we do not give it for headache!),
even though there are no contra-indications.
• Contra-indication(s)
• This is a reason NOT to administer a drug to a patient
• If there is a contra-indication present in the patient Hx or presentation, then a drug should
not be given even if indications are also present
• E.g.: A patient complaining of chest discomfort and having all the signs and
symptoms of myocardial infarction, but has a history of allergy to aspirin. The contra-
indication weighs more, and Aspirin should not be administered to this patient.
Pharmacology: Indications and Contra-indications

• This term informs the practitioner that a careful

consideration of the risk vs. benefit of administering a
drug needs to be made.
• It means that if certain conditions are present, the
administration of a drug may result in an adverse effect,
and risk of that effect to the patient must be weighed
against the possible benefit of the drug for that patient.
Two examples using β2-stimulants (special caution if HR
is greater than 120bpm):
1. A 48-year-old male patient with a history of asthma presents with an
acute exacerbation (he ran out of his usual medication about 3 weeks
ago and has not taken anything for this episode). SpO2 is 91% on
room air and bilateral inspiratory and expiratory wheezes are present
with BR: 28/min, HGT is 4.6mmol/ℓ, BP is 130/90mmHg, and HR is
106b/min. The patient is awake and oriented and can speak phrases.
He has no known allergies or sensitivities to any medication.
2. A 48-year-old male patient with a history of asthma presents with an
acute exacerbation (he ran out of his usual medication about 3 weeks
ago and has not taken anything for this episode). SpO2is 91% on
room air and bilateral inspiratory and expiratory wheezes are present
with BR: 28/min, HGT is 4.6mmol/ℓ, BP is 130/90mmHg, and HR is
136/min. The patient is awake and oriented and can speak phrases.
He has no known allergies or sensitivities to any medication.
 Pharmacology: Indications and Contra-indications

• In the 1st example clear indications are present for the administration of β2-stimulants
and there are no contra-indications or precautions. You can continue to administer the
medication with regular monitoring for changes.
• In the 2nd example clear indications are present for the administration of β2-stimulants
and there are no contra-indications; however, the HR of 136bpm now presents a special
caution. This is due to the known adverse effects of the drug, which could increase the
tachycardia and introduce other stressors on an already stressed heart –this in turn
could lead to deadly arrhythmias, acute myocardial infarction, or cardiac arrest (hypoxic
arrest).
• You now must evaluate whether the benefit of treatment (bronchodilation, improved air
exchange and oxygenation) outweighs the risk (stressing an already stressed heart)
• You must consider alternatives (in this case it could be administering humidified oxygen via
nebulizer mask) to evaluate if the condition causing the caution (tachycardia) can be managed –
if giving oxygen increases SpO2 and/or reduces HR, it is a good indication that the patient will
respond well to β2-stimulants
• Another option is to consider taking the risk of administering β2-stimulants and closely
monitoring the heart rate, rhythm, and signs & symptoms of cardiac incompetence
 Acetyl Salicylic Acid (Aspirin)

• Description: Platelet aggregation inhibitor

• Classification: Platelet aggregation inhibitor; Non-opioid analgesic;
Non-steroidal anti-inflammatory; Antipyretic
• Schedule: 0
• Qualification protocol: BAA, AEA, ECT, ECA, ANT, ECP
• Pharmacological Action:
• Obstructs the enzyme cyclo-oxygenase in one of the main clotting
pathways, thus stopping clot formation
• Pharmacokinetics:
• Metabolized by the liver; Inactive metabolites excreted by kidneys; Crosses
placenta; Excreted in breastmilk. Half-life is 15-20 minutes up to 9 hours in a
large dose.
 Acetyl Salicylic Acid (Aspirin) (Cont.)

• Onset: Rapidly absorbed in the upper GI tract and results in measurable inhibition
of platelet function 45 minutes post-administration
• Duration: Although the half-life is short, the duration of effect on platelet
aggregation lasts for the lifetime of the platelets (~10 days) – new platelets are
produced every day and the new platelets will not be affected.
• Indications: Suspected myocardial infarction
• Contra-indications:
• Pregnancy 3rd trimester, or breastfeeding mothers (high dose)
• Children younger than 16 years
• Hypersensitivity to salicylates
• Active GI bleeding
• Blood disorders (Haemophilia, Thrombocytopenia, Agranulocytosis)
• Vitamin K deficiency
• Peptic ulcer
• Acute bronchospasm (asthma)
• Increased intracranial pressure and/or intracranial bleeding
• Urticaria
• Other anti-coagulation therapy (e.g. Warferin)
 Acetyl Salicylic Acid (Aspirin) (Cont.)
• Adverse effects:
• CNS: Stimulation, drowsiness, dizziness, confusion, seizures, headache, flushing, hallucinations, and coma.
• CV: Pulmonary oedema, tachycardia
• ENT: Tinnitus, hearing loss
• ENDOCRINE: Hypoglycaemia, hyponatremia, hypokalaemia
• GI: GI bleeding, GI ulcer, diarrhoea, nausea, vomiting, heartburn, anorexia, hepatitis
• HAEMATIC: Bleeding time increased, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, haemolytic
anaemia, increased prothrombin time
• INTEGUMENTARY: Urticaria, rash, bruising
• RESPIRATORY: Wheezing, bronchospasm, hyperpnoea
• SYSTEMIC: Anaphylaxis, Reye’s syndrome (children), laryngeal oedema)
• Precautions:
• Bleeding GI ulcers
• Haemolytic anaemia from pyruvate kinase and glucose-6-phosphate dehydrogenase deficiency
• Haemorrhagic tendencies and disorders
• Haemorrhoids
• Breastfeeding mother
• Nasal polyps associated with asthma (may develop aspirin sensitivity)
• Sarcoidosis; Thrombocytopenia; Ulcerative collitis
 Ipratropium bromide
• Classification: Bronchodilators - anticholinergic
• Schedule: 2
• Qualification protocol: BAA, AEA, ECT, ECA, ANT, ECP
• Pharmacological Action:
• Ipratropium bromide causes relaxation of bronchial muscles due to its
anticholinergic effects (blocks parasympathetic system).
• Its Broncho-dilation action is particularly effective in conjunction with ß2
stimulants.
• Anticholinergic (Para-sympatholytic) agent; inhibits vagally mediated reflexes by
antagonizing acetylcholine action; prevents increase in intracellular calcium
concentration that is caused by interaction of acetylcholine with muscarinic
receptors on bronchial smooth muscle. Metabolized in liver
• Pharmaco Kinetics:
• Onset of action: 15 minutes.
• Duration of action: 3-4 hours.
• Half Life: 2 hrs.
• Indications:
• To be used in conjunction with ß2 - stimulants for acute bronchospasm
 Ipratropium bromide (cont.)

• Adverse effects:
• With larger / repeated dosages, it is absorbed from the lungs into the systemic
circulation resulting in systemic anti-cholinergic effects.
• Tachycardia
• Dry, hot skin
• Mydriasis
• Urinary retention
• Contra-Indications:
• Known hypersensitivity to ipratropium bromide or other anti-cholinergic drugs.
• Do not use in neonates. 63
• Precautions:
• The onset of action is only after 20 minutes, which is much longer than the ß2
stimulants; peak effectiveness at 60-90 minutes.
• The duration of action is 4-6 hours, which is also longer than the ß2 stimulants.
• Packaging:
• Unit dose vial (UDV) containing 0.25 mg/2ml or 0.5 mg/2ml
• Metered Dose Inhaler (300 doses) 40 μg / inhalation (0.04 mg)
• Nebulizer solution (bottle) 0.25 mg/ml
 Ipratropium bromide (cont.)
• Dosage and Administration:
• Adults:
• UDV:
• Ipratropium bromide 0.5 mg + appropriate ß2 stimulant + balance of N/S to a total of 5ml solution, Nebulised.
• 2.5 mL (500 mcg) every 6-8 hrs (COPD)
• Aerosol:
• The patient or paramedic may administer this during an episode. Two puffs of ipratropium bromide are
administered if no improvement occurs following ß2 stimulant administration.
• Use of a spacer device is recommended.
• Children >5 years:
• Ipratropium bromide 0.5 mg + appropriate ß2 stimulant + balance of N/S to a total of 5ml solution,
nebulised.
• Children 1 to 5 years:
• Ipratropium bromide 0.25 mg + appropriate ß2 stimulant + balance of N/S to a total of 5ml solution,
nebulised.
• Children 1 month to 1 year:
• Ipratropium bromide 0.125 mg + appropriate ß2 stimulant + balance of N/S to a total of 5ml solution,
nebulised.
 Beta-2 Adrenergic Stimulants
Salbutamol (Inhaled)
• Classification: Bronchodilators
• Schedule: 2 – Aerosol; 3 – Inhalant solutions and unit dose vials; 4 – Ampoules
• Qualification protocol: BAA, AEA, ECT, ECA, ANT, ECP
DOSAGE AND ADMINISTRATION
Unit Dose Vials:
• UDV + N/S diluted up to 5 ml
Aerosol:
• 6 – 10 puffs should be administered during an episode, which may then
be repeated every 15 minutes, using a spacer
 Beta-2 Adrenergic Stimulants (cont.)
• Pharmacological Action:
• Hexoprenaline & Salbutamol are selective Beta2 stimulants acting on the ß2
receptors in the lungs: bronchial smooth muscle: Broncho-dilation
• At higher/repeated dosages, the systemic absorption progressively increases, thus
acting on other organs with ß2 receptors e.g.
• Skeletal muscle: contraction
• Vascular smooth muscle: vasodilation
• Bladder smooth muscle: relaxation
• Intestinal smooth muscle: decreased peristalsis
• Uterine smooth muscle: tocolysis
• Glycogen stores: break down of glycogen to glucose
• At higher/repeated dosages, the selectivity is also progressively lost and ß1 effects
(myocardium) are experienced:
• Positive inotrope
• Positive chronotrope
• Positive dromotrope
• Increased myocardial oxygen consumption
Beta-2 Adrenergic Stimulants (cont.)
• Pharmaco Kinetics:
• Onset of action: 5-15 minutes
• Duration of action: 3-6 hours
• Indications:
• Acute bronchospasm
• Premature or obstructed labour
• Suspected hyperkalaemia on ECG rhythm strip
• Adverse Effects:
• Tremors, restlessness, anxiety, confusion, headache,
• Hypotension, Tachycardia, palpitations
• Cramps
• Nausea, vomiting
• Urinary retention
• Tocolysis
• Hyperglycaemia
• Hypokalaemia
 Beta-2 Adrenergic Stimulants (cont.)
• Contra-Indications:
• Known hypersensitivity / allergy to ß2 stimulants, and Neonates
• Precautions:
• Special caution must be used when pulse rate exceeds 120 beats / minute
• Intravenous ß2 stimulants should be used with caution in patients with:
• Ischaemic heart disease, cardiac arrhythmias, cardiac failure
• Occlusive vascular disorders, hypertension, hypotension
• Hyperthyroidism, diabetes mellitus
• Prostate hypertrophy
• Packaging:
• Fenoterol has been removed from the drug formulary as it has been found to have a
greater effect on hypokalemia and heart rate than salbutamol.
• Salbutamol inhalation is preffered, as it causes less hypokalemia and QT prolongation
and literature supports its use for continuous nebusisation in acute asthma exercebations.
• Salbutamol: Ventolin aerosol: 100 μg
• Resp. solution: 5 mg/ml
• UDV: 2.5 mg/2.5ml or 5 mg/2.5ml
• IV solution: 0.5 mg/ml or 1 mg/ml
 Penthroxyflurane
• Description: Halogenated ether volatile inhalational anaesthetic.
• Classification: Analgesic.
• Schedule: 4
• Qualification protocol: BAA, AEA, ECT, ECA, ANT, ECP
• Pharmacological Action:
• Methoxyflurane (2.2-dichloro-1.1-difluoro-1-methoxyethane) belongs to the halogenated
hydrocarbon group of volatile anaesthetic agents. The mechanism of action of
Methoxyflurane in analgesia has not been elucidated. It is unclear why Methoxyflurane is
the only member of the halogenated inhalational anaesthetic class of compounds to
display analgesic properties at sub-anaesthetic doses. Potential factors contributing to the
analgesic activity of Methoxyflurane include effects on substance P and beta-endorphin.
Inhaled doses of Methoxyflurane are rapidly absorbed into the bloodstream to provide
analgesia.
• Pharmacokinetics:
• Approximately 60% of Methoxyflurane uptake is excreted in the urine as organic fluorine,
fluoride and oxalic acid; the remainder is exhaled unaltered or as carbon dioxide.
• Onset: 5min
• Duration: 20-25 min (single dose), 50-55 min (Double dose, Max)
 Penthroxyflurane (cont.)
• Indications:
• PENTHROX (Methoxyflurane) is indicated for short-term relief of moderate to severe acute pain,
associated with trauma or interventional medical procedures, in conscious adult patients.
• Adverse Effects:
• CNS: Amnesia, Anxiety, Depression, Dizziness, Dysarthria, Dysgeusia, Euphoria, Headache,
Sensory neuropathy, Somnolence.
• CV: Hypotension
• Resp: Coughing
• GI: Dry mouth, Nausea
• MISC.: Feeling Drunk, Sweating
• Packaging:
• 3ml inhalation vapour, liquid.
• Dosage and Administration:
• PENTHROX (Methoxyflurane) use should be self-administered under supervision of a healthcare
practitioner, trained in its administration, using the hand-held PENTHROX Inhaler.
• One 3ml bottle of PENTHROX to be vaporised in a PENTHROX Inhaler. On finishing the 3ml dose,
another 3ml may be used, if needed. The dose of PENTHROX should not exceed 6ml in a single
administration, or over the first day of treatment. The lowest effective dosage of PENTHROX to
provide analgesia should be used.
 Penthroxyflurane (cont.)
• Contra-indications:
• An altered level of consciousness, due to any cause, including head injury, drugs, or alcohol.
• Clinically significant renal impairment
• A history of liver dysfunction after previous Methoxyflurane use or other halogenated anaesthetics
• Hypersensitivity to Methoxyflurane or other halogenated anaesthetics or to any ingredient in
• Known or genetically susceptible to malignant hyperthermia or a history of severe adverse
reactions in either patient or relatives
• Clinically evident hemodynamic instability
• Clinically evident respiratory impairment
• Children <18yrs of age
• Labour (Not enough evidence)
• Use of PENTHROX as an anaesthetic agent is contraindicated
• Precautions:
• Renal Disease, Liver disease, cardiovascular system depression / Use in elderly, Central nervous
system effects.
• Patients over the age of 65yrs –could result in Bradycardia and Hypotension.
How to use Penthroxyflurane

 Free State College of Emergency Care

Oral glucose powder/gel
 Oral glucose powder/gel
DESCRIPTION:
• Classification : Carbohydrate
• Schedule : 1

PHARMACOLOGICAL ACTION:
Administration of an oral glucose solution / preparation provides a source
of soluble carbohydrates to the tissues in order to raise the blood glucose
Levels

ADVERSE EFFECTS:
Hyperglycaemia
 Oral glucose powder/gel
INDICATIONS:
• Acute management of hypoglycaemia
• Blood glucose < 3.5mmol/L and patient is clinically symptomatic

CONTRA-INDICATIONS:
No absolute contra-indications

PRECAUTIONS:
• Patient must be lateral if unconscious
• Avoid aspiration

PACKAGING:
• 25g and 50g powder sachet
• 25g and 50g gel
 Oral glucose powder/gel

DOSAGE AND ADMINISTRATION:

• 25g of gel applied to the oral mucosa of the patient with a gloved
finger
• Preferably dilute powder in glass of water if patient is conscious
• Repeat after 5 minutes should blood glucose remain < 3.5mmol/L
• Should patient be unconscious, “liquid powder” may be administered
via NG tube, if no IV access or glucagon IM is available
 Nitrous Oxide - Entonox (Inhaled)

DESCRIPTION:
• Classification : Analgesic gas
• Schedule : 4

PHARMACOLOGICAL ACTION:
• Colourless, sweet-smelling, non-irritant gas
• Heavier than room air / oxygen
• Nitrous oxide has mild analgesic and anaesthetic effects depending on
the dose inhaled
• When inhaled it depresses the central nervous system causing anaesthesia
• In addition, the high concentration of oxygen delivered along with the
nitrous oxide increases oxygen tension in the blood, thereby reducing
hypoxia
• It provides rapid, easily reversible relief of mild to moderate pain
 Nitrous Oxide - Entonox (Inhaled)
PHARMACO-KINETICS:
• Extremely blood-insoluble
• Not metabolised by the body
• Eliminated via lungs (small amounts are eliminated through the skin)
• Onset of action: 30-60 seconds (maximum 3-4 minutes)
ADVERSE EFFECTS:
• Light-headedness
• Drowsiness
• Nausea and vomiting
INDICATIONS:
• Relief of pain from:
- Acute myocardial infarction
- Musculoskeletal trauma
- Burns - not including burns of the respiratory tract
- Active labour
- Any other condition requiring pain relief provided there are no
contra-indications present
 Nitrous Oxide – Entonox (Inhaled)
CONTRA-INDICATIONS:
• Neurological impairment:
- Any altered level of consciousness
- Inability to comply with instructions
- Head injuries
• Air entrapment:
- COPD/asthma patient during an acute episode
- Acute pulmonary oedema
- Chest injuries
- Abdominal trauma
- Diving accidents (specifically Acute Decompression Illness)
- Burns to the respiratory tract
• Other limitations:
- Hypotension (SBP < 90 mmHg)
- Major facial trauma (anatomic)
 Nitrous Oxide - Entonox (Inhaled)
PRECAUTIONS:
• The constituent gases nitrous oxide and oxygen disassociate at < 4°C. It is
imperative that the cylinder is inverted a few times and then placed
horizontal when used in cold conditions as the patient will otherwise inhale
pure nitrous oxide.
• Nitrogen has decreased solubility in blood. Once in a gas-containing space
the gas dissociates, and nitrogen diffuses out slower than nitrous oxide
diffuses in, and there is a net increase in gas volume.
• When the mask is removed after prolonged use, the gas will come out of
solution in the lungs and displace the oxygen in the alveoli, causing hypoxia
• In order to prevent this, the mask must not be strapped to the patient’s face,
and the patient must receive oxygen for ± 5-10 minutes, especially after
prolonged use
• Nitrous oxide is a non-explosive gas.
 Nitrous Oxide - Entonox (Inhaled)
PACKAGING:
• Pressurised cylinders containing a mixture of 52% nitrous oxide and 48% Oxygen (N2O+O2
52% : 48%)

DOSAGE AND ADMINISTRATION

• Entonox is predominantly a self-administered gas
• The administration procedure is to be explained to the patient carefully beforehand to
prevent unnecessary complications
• Once the patient has inhaled enough Entonox to control the pain, they will remove the mask
thereby preventing any chances of overdosing
• Registered paramedics are entitled to administer Entonox to a patient, but this requires
careful monitoring of the patient in order to prevent complications arising
• If the patient becomes drowsy, remove the Entonox and replace immediately with oxygen
 Medical Oxygen

DESCRIPTION:
Classification : Naturally occurring atmospheric gas

PHARMACOLOGICAL ACTION:
• Oxygen is an odourless, tasteless, colourless gas present in the atmosphere
at a concentration of approximately 21% of local atmospheric
pressure
• It reverses the deleterious effects of hypoxaemia on the brain, heart
and other vital organs
• Expired air contains 16-17% oxygen
• During optimal active CPR only 25-30% of the normal cardiac output
is maintained and for these reasons supplemental oxygen should be
Administered
 Medical Oxygen
INDICATIONS:
• Glasgow Coma Scale < 15/15
• PAO2 or SAO2 < 90%
• Any patient with abnormal vital signs
• Any respiratory insufficiency or arrest
• Acute decompensation of COPD / Asthma
• Confirmed or suspected hypoxia
• Severe anaemia
• Chest pain of medical or trauma origin
• Multiple or severe trauma
• Cardiac arrest / cardiac failure
• Toxic inhalations
• Prophylactically during air transportation
• Scuba diving accidents
 Medical Oxygen
CONTRA-INDICATIONS:
There are no absolute contra-indications for the use of oxygen in the
emergency setting
PRECAUTIONS:
• High concentrations of oxygen may reduce the respiratory drive of a
COPD patient; therefore, careful monitoring of the patient is required.
Do not withhold oxygen from these patients if their prevailing condition
is such that oxygen is required.
• Long exposures to high concentrations of oxygen may result in
retrolental fibroplasia in neonates and pulmonary fibrosis
• Neonates with a patent ductus arteriosus (PDA); should cyanosis and
signs of hypoxia develop after oxygen administration, remove oxygen.
In some infants with a PDA and congenital heart disease, the presence
of the PDA may be lifesaving because of ductal-dependent systemic or
pulmonary blood flow. Increased oxygen concentration tends to
constrict the foetal ductus arteriosus.
 Medical Oxygen

Precautions: continued
Oxygen supports combustion - do not use in the presence of fire,
smoke or cigarette smoking
• High pressure oxygen should not be used with oil or grease based
substances
as it causes an exothermic reaction with the risk of explosion
• Production of superoxide radicals in the presence of paraquat
(herbicide) – paraquat and oxygen enhance each other’s toxicity,
causing severe pulmonary injury.
• Remove oxygen source to one metre away from defibrillation pads /
paddles.
PACKAGING:
Pressurised cylinder containing 100% medical oxygen
 Medical Oxygen

DOSAGE AND ADMINISTRATION: At the correct flow rate the following devices will deliver the following
Administered via: approx. FiO2:
- Oxygen masks - Simple face mask = 35 - 60% at 6 - 10 L/minute
- Nasal cannulae - Venturi mask = 24 – 50% at 4 - 12 L/minute
- Bag-valve-mask / tube-reservoir (manufacturer’s instructions)
device
- Nasal cannulae = 21 - 40% at 1 - 6 L/minute
- Nebulizer device
- Partial re-breather mask = 35 - 70% at 6 - 10 L/minute
- Jet insufflation
- Non-re-breather mask = 60 - 100% at 6 - 15 L/minute
- Bag-valve-mask/tube = 50% at 12 - 15 litres/minute
- Bag-valve-mask/
tube-reservoir device = 95 – 100% at 15 L/minute
(Adequate flow rate = Reservoir bag inflated > 1/3 of its volume at all
times)
 Activated Charcoal
DESCRIPTION:
• Classification : Carbon
• Schedule : 1

PHARMACOLOGICAL ACTION:
• Activated charcoal adsorbs many poisonous compounds to its
surface, thereby reducing their absorption by the GIT

ADVERSE EFFECTS:
The patient may experience mild constipation

INDICATIONS:
To assist in the treatment of certain cases of overdoses and poisonings
where the agent/s was/were orally ingested – within first hour of ingestion

CONTRA-INDICATIONS:
• SHOULD NOT BE USED IN POISONING WITH iron, organophosphates,
ethanol, lithium, boric acid, cyanide, ethylene glycol, methanol,
petroleum products, strong acids and alkalis
• Unprotected airway in a patient with decreased level of consciousness
• Do not use if the container was not properly sealed (de-activation due
to moisture exposure)
 Activated Charcoal

PRECAUTIONS:
• Patients with a decreased level of consciousness need to be intubated
before activated charcoal can be administered via a nasogastric tube

PACKAGING:
Fine black powder in bottles of 25g and 50g

DOSAGE AND ADMINISTRATION:

Adult and Paediatric: 0.5g/kg - 1g/kg mixed with water, given orally or
administered via the nasogastric tube
 Water for Injection-inhaled

Scheduling Status
S1
WATER FOR INJECTIONS FRESENIUS:
Is a solvent, used to dissolve and dilute other sterile medicines that require mixing with
water before they can be administered into your body.

Other medicines and WATER FOR INJECTIONS FRESENIUS

There are no known interactions with WATER FOR INJECTIONS FRESENIUS.

Driving and using machines

WATER FOR INJECTIONS FRESENIUS does not have any known effect on your
ability to drive a vehicle and use machines.
 Water for Injection-inhaled
Possible side effects
There are no known side effects for WATER FOR INJECTIONS FRESENIUS

How to store WATER FOR INJECTIONS FRESENIUS

Store at or below 25 °C.
Store all medicines out of reach of children.
Discard unused portion.
Do not use unless solution is clear.
Do not use after the expiry date printed on the container.
Do not dispose of unused medicine in drains and sewerage systems (e.g. toilets).

What WATER FOR INJECTIONS FRESENIUS contains

Each ampoule contains 2 ml, 5 ml, 10 ml or 20 ml of water for injection 100 % v/v. No other
ingredients included.

What WATER FOR INJECTIONS FRESENIUS looks like and contents of the pack
Clear, colourless, sterile water for injection
 References
1. Sanders, M.J., Lewis, L.M., McKenna, K. and Quick, G., 2012. Mosby's
paramedic textbook. Jones & Bartlett Publishers.
2. SAHPRA REPOSITRY, [Link]
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