Drug Charts

ACS

The management of ACS seems to differ in different trusts.

Give stat:

• Oxygen (100% in a non-rebreathe mask): there may be a special section on the drug chart to prescribe oxygen
• Aspirin 300mg
• Clopidogrel 300mg: some trusts so not give for ST-elevation MI
• Morphine 5mg IV
• Metoclopramide 10mg IV
• GTN 2 puffs s/l
• Clexane 1mg/kg
• Atorvastatin 40mg

Regular:

• Aspirin 75mg po od 
• Clopidogrel 75mg po od: see note above
• Atenolol 50 mg po od: contra-indicated in acute heart failure and asthma
• Clexane 1mg/kg s/c bd
• Atorvastatin 40mg po od nocte. (next day)
• Consider:
• Ramipril 1.25mg po od (following day, check rensal)
• GTN infusion 1-10mg/hr IV infusion. to keep BP > 100 sys): given if recurrent pain. this is written on the infusion chart
• Insulin sliding scale

When needed:

• GTN 2 puffs s/l
• Morphine sulphate 2.5-5mg IV 4 hrly
• Metoclopramide 10mg IV/po tds (or cyclizine 50mg IV/po tds)

Heart Failure

• Diamorphine 2.5-5mg IV
• Metoclopramide 10mg IV
• Furosemide 40mg IV slowly
• Oxygen 100% non-rebreathe
• (if secondary to AF: digoxin 500 micrograms IV. also 6h after first dose.)

Regular:

• Furosemide 40mg IV
• Ramipril 1.25mg po od (following day, check renal)
• TED stockings
• Consider
• (Digoxin 125 micrograms po)
• (Aspirin 75mg: if IHD)
• (GTN infusion 1-10mg/hr IV infusion. to keep BP > 100 sys): only if non-responsive to furosemide): on infusion chart

Asthma

Give stat:

• Oxygen 100% inh via non-breathing bag
• Salbutamol 5mg nebs back-to-back
• Ipratropium bromide 0.5mg nebs
• Hydrocortisone 200mg IV

Regular:

• Salbutamol 2.5mg 4 hourly nebs
• Ipratropium bromide 0.5mg nebs 6 hourly
• Prednisolone 30mg po od
• (Regular medication)

When needed:

• Salbutamol nebs 5mg

COPD

The same as asthma except:

• Give stat: prednisolone 30mg po od
• Oxygen 24% venturi mask: COPD patients retain carbon dioxide. If they are hyper-oxygenated their breathing slows down and they retain dangerously high levels of carbon dioxide.
• Abx as per local protocal: e.g. benzylpenicillen 1.2g qds IV. 
• If on Regular spirevon=long acting muscarinic antagonist you need to cross it off while they are on iprat meds

Hyperkalaemia

• Calcium gluconate 10ml of 10% IV over 2min
• (Dextrose 50ml 50%, 15 units actrapid given over 30min):fluid chart
• nebs salbutamol 5mg
• (Calcium resonium and lactulose)

Pneumonia

Give stat:

• Oxygen 100% non-rebreath IV fluids, abx

Regular

• Abx: look at trust protocal: should be provided
• TEDS
• Oxygen: enough to keep sats > 95%

When needed:

• Paracetamol 1g qds max qds