2. Emergency Drugs
Introduction
Purpose of Emergency Drugs
Details of Emergency Drugs
-Mechanism of Action
-Indication and Dose of the Drug
-Drug Interaction
-Contraindications
-Adverse Effects of the Drug
3. Introduction
Emergency drugs are chemical compounds
used in patients during life threatening
conditions so that the symptoms can be
controlled and the life of a patient can be saved.
For a drug to be useful in emergency, it must
have a short onset of action and be
administered in such a way as to facilitate rapid
onset of action
4. Purpose of Emergency Drugs
To provide initial treatment for broard
spectrum of illness and injuries, most of
which may be life threatening.
To control the symptoms of patient.
To save the life of the patient.
To reach the site of action as soon as
possible.
To normalize the vital bodily functions.
To diverge the patient from the possible
risks.
6. Atropine
Indications and dose of the drug:
SINUS BRADYCARDIA: 0.5-1mg(or 5-
10ml of 0.1mg/ml) repeated every 3-5
min when necessary in adults.
BRONCHOSPASM: 0.025mg/kg in
2.5ml NS via nebulizer every 6-8hrs
Organophosphate poisoning: 2mg iv/im
every 3 min. according to clinical
response in adult.
Cardiac arrest: 1mg every 3-5 minutes.
7. Atropine
Mechanism of Action:
It competitively blocks the muscarinic receptors
in peripheral tissues (heart, intestines, bronchial
muscles, iris, secretory glands) and relaxes the
smooth muscles.
The main action of vagus nerve of the
parasympathetic system on the heart is to slow
it down and atropine blocks that action and
speeds up the heart rate.
8. Atropine
Drug Interactions:
The effect of the drug increases with-
Quinidine (Antiarrhythmic)
Amitriptyline (Antidepressants)
Diphenhydramine (antihistamine)
Meclizine (antihistamine)
11. Sodium
Nitroprusside(Nitropress)
Indications and Dose of the drug:
Sodium nitroprusside is indicated for the
immediate reduction of blood pressure of
patients in hypertensive crises. Concomitant
longer-acting antihypertensive medication
should be administered so that the duration of
treatment with sodium nitroprusside can be
minimized
Dosage: 0.5-10 mcg/kg/min IV infusion
12. Sodium
Nitroprusside(Nitropress)
Mechanism Of Action:
The principal pharmacological action
of sodium nitroprusside is relaxation of
vascular smooth muscle and
consequent dilatation of peripheral arteries
and veins by producing Nitric Oxide thus
reducing preload and afterload
16. Amiodarone
Indication and dose of the drug:
Frequently recurring ventricular fibrillation and
hemodynamically unstable ventricular tachycardia
Intravenous amiodarone also can be used to treat
patients with life threatening VT/VF
300mg IV after epinephrine dose if no response to
defibrillation in VT/VF
150mg IV bolus in 10minutes,may repeat as
necessary in hemodynamically unstable VT
VT=VENTRICULAR TACHYCARDIA
VF= VENTRIFULAR FIBRILLATION
17. Amiodarone
Mechanism of Action:
Amiodarone is generally considered a
class III antiarrhythmic, which inhibits
adrenergic stimulation; affects sodium,
potassium and calcium channels;
markedly prolongs action potential and
repolarization and decreases AV
conduction and sinus node function
21. Aminophylline
Indications and Dose of the Drug:
Acute exacerbations of the symptoms of
reversible airflow obstruction associated
with asthma and other chronic lung
diseases, e.g.,emphysema and
chronic bronchitis.
Dose: 5 – 7mg/kg IV/PO for over
20minutes
22. Aminophylline
Mechanism Of Action:
smooth muscle relaxation
(i.e., bronchodilation)
suppression of the response of the
airways to stimuli (i.e., non-
bronchodilator prophylactic effects).
26. Mannitol
Mechanism Of Action:
Mannitol is an osmotic diuretic. It
induces diuresis by elevating the
osmolarity of the glomerular filtrate and
thereby hindering tubular reabsorption
of water. Excretion of chloride and
sodium is also enhanced
27. Mannitol
Indication and dose of the drug:
Cerebral oedema: by IV infusion, as
1.5-2g/kg infused over 30-60minutes
Raised intracranial or intraocular
pressure: by IV infusion as 1.5-2g/kg
infused over 30-60minutes
31. Magnesium Sulfate
Indications and Dosage:
Convulsions (treatment) - Intravenous
magnesium sulfate (magnesium sulfate
(magnesium sulfate injection) injection) is
indicated for immediate control of life-threatening
convulsions in the treatment of severe toxemias
(pre-eclampsia and eclampsia) of pregnancy
1 to 4 g magnesium sulfate (magnesium sulfate
(magnesium sulfate injection) injection) may be
given intravenously in 10% to 20% solution
32. Magnesium Sulfate
Mechanism Of Action:
It produces anticonvulsant effect by
decreasing the amount of acetylcholine
released at end plate by motor nerve
impulse
Promotes movement of
calcium,potassium and sodium in and out
and stabilizes excitable membranees
36. HEPARIN
Indications And Dosage:
INDICATION ;Deep Vein Thrombosis
,thrombosis, emboli, unstable angina
Dose ;Treatment of deep-vein thrombosis and
pulmonary embolism ; by injection Adult loading
dose of 500units [in severe pulmonary embolism
1000 units
Prophylaxis in general surgery ,by SC injection
Adult 2000units before surgery and then every 8-
12hrs for 7 days.
37. HEPARIN
Mechanism Of Action:
Prevents blood clotting by its antithrombin
activity. It directly suppresses the activity of
thrombin
Combines with antithrombin III (a protease
inhibitor present in circulation) and removes
thrombin from circulation
Inactivates the active form of other clotting
factors like IX, X, XI and XII
41. Epinephrine
Mechanism of action
It acts by stimulating the à and ß-receptors of
the adrenergic neurons of sympathetic nervous
system.
Its alpha adrenergic effects is much stronger
than the beta adrenergic effects
Adrenoceptors Actions
à1-receptors Vasoconstriction, increased BP, Mydriasis
à2-receptors Inhibits the release of noradrenaline, acetylcholine and insulin
ß1-receptors Tachycardia, increase lipolysis, myocardial contractility and renin.
ß2-receptors Vasodilation, bronchodilation, relaxes uterine smooth muscle.
42. Epinephrine
Indication and dose of the drug:
Cardiac Arrest: 1mg IV of 1:10000 solution
every 3-5 minutes or iv bolus(10ml)
Anaphylaxis (type 1): iv bolus, 0.5-1.0ml, may
be repeated when necessary
Refractory bradycardia and hypotension: 2-
10mcg/min.
Asthma: 0.1-0.3mg SC or IM of 1:10,000
solution.
44. Epinephrine
Contraindications:
Narrow angle glaucoma
Shock (other than anaphylactic shock)
Individuals with organic brain damage
Labor (may delay second stage)
Coronary insufficiency
Pregnant and breast feeding mothers.
45. Epinephrine
Adverse effects of the drug:
CNS: anxiety, fear, tension, headache, and tremor.
Hemorrhage: The drug may induce cerebral
hemorrhage as a result of a marked elevation of
blood pressure.
Pulmonary edema
Less serious side effects may include:
sweating, nausea and vomiting, pale skin, feeling
short of breath, dizziness, weakness or tremors,
headache, or feeling nervous or anxious.
46. Hydrocortisone
Mechanism of action:
It reduces the inflammatory reaction by
limiting the capillary dilatation and
permeability of the vascular structures.
It also restrict the accumulation of
polymorphonuclear leukocytes and
macrophages and reduce the release of
vasoactive kinins.
It also inhibit the release of destructive
enzymes that attack the injury debris and
destroy normal tissue indiscriminately.
47. Hydrocortisone
Indication and dose of the drug:
Acute adrenocortical insufficiency
Congenital Adrenal hyperplasia
*The initial dose of hydrocortisone is 100
mg to 500 mg, depending on the
severity of the condition. This dose may
be repeated at intervals of 2, 4 or 6
hours as indicated by the patient’s
response and clinical condition.
48. Hydrocortisone
Drug interactions:
Drugs such as phenobarbital, phenytoin
and rifampin induces hepatic enzymes and
increases the clearance of hydrocortisone.
Drugs such as troleandomycin and
ketoconazole may inhibit the metabolism of
hydrocortisone and thus decrease their
clearance.
When used with high dose aspirin,
clearance of asprin increases.
50. Hydrocortisone
Adverse effects of the drug:
Sodium retention
Congestive heart failure in susceptible patients
Potassium loss
Hypokalemic alkalosis
Hypertension
Convulsions
Headache
Abdominal distention
Loss of muscle mass
51. Diazepam
Mechanism of action:
It acts by binding to GABA –A receptors
(post synaptic receptors) and increases
it’s frequency of opening, leading to
potentiate the GABA effects.
This opening leads to a increased
conductance to chloride ions, which
produces membrane hyperpolarization,
this induces a neuronal inhibition which
results in its sedative action.
52. Diazepam
Indication and dose of the drug:
SEIZURE DISORDERS: 0.2mg/kg repeat after 4-
12 hrs
MUSCLE SPASMS:5-10mg IV/IM initially
STATUS EPILEPTICUS: 5-10mg IV/IM not to
exceed 30mg
Sedation—Midazolam is indicated for the
sedation of patients in intensive care settings,
including intubated patients receiving mechanical
ventilation
Anesthesia, general, adjunct
56. Dextrose 50%
Indication and dose of the drug:
Documented hypoglycemia
Seizures of unknown etiology
Cerebral/meningeal edema related to
eclampsia
Coma of unknown cause
Refractory cardiac arrest
Adult dose: 12.5 - 25 gm D50W slow IV,
repeat if needed.
59. Dextrose 50%
Adverse effects of the drug:
Hyperosmolarity
Edema
Phlebitis at injection site
Hyperglycemia and glycosuria
Fluid overload
Cerebral Haemorrhage
60. References:
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Limited; Third Edition (2009)
Goodman E (2010). Ketchum J, Kirby R. ed. Historical
Contributions to the Human Toxicology of Atropine.
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Britto MR, Hussey EK, Mydlow P, et al. Effect of enzyme
inducers on ondansetron (OND) metabolism in humans. Clin
Pharmacol Ther 1997;61:228.
Villikka K, Kivisto KT, Neuvonen PJ. The effect of rifampin on
the pharmacokinetics of oral and intravenous ondansetron.
Clin Pharmacol Ther 1999;65:377-381.
Bryan E, Bledsoe; Robert S. Porter, Richard A. Cherry
(2004). "Ch. 3". Intermediate Emergency Care. Upper
Saddle River, NJ: Pearson Prentice Hill. pp. 26.