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Common emergency drugs in medicine

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Common emergency drugs in medicine(TROPICAL MEDICINE)

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Common emergency drugs in medicine

  2. 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. 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. 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.
  5. 5. List of Drugs  Atropine  Sodium Nitroprusside  Amiodarone  Aminophylline  Mannitol  Magnesium Sulfate  Epinephrine  Hydrocortisone  Heparin  Diazepam  Dextrose 50%
  6. 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. 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. 8. Atropine Drug Interactions:  The effect of the drug increases with-  Quinidine (Antiarrhythmic)  Amitriptyline (Antidepressants)  Diphenhydramine (antihistamine)  Meclizine (antihistamine)
  9. 9. Atropine Contraindications  Narrow Angle Glaucoma  Pyloric Stenosis  Prostatic Hypertrophy  Thyrotoxicosis  Cardiac Failure  Tachycardia
  10. 10. Atropine Adverse effects of drug:  Palpitation  Dry mouth  Blurred vision  Urinary retention and constipation  Tachycardia  Dysphagia  Arrhythmias  Hallucinations  Raise intraocular pressure
  11. 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. 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
  13. 13. Sodium Nitroprusside(Nitropress) Drug Interactions: AVANAFIL(Life Threatening Interaction) Amlodipine Clevidipine Nifedipine Verapamil Clonidine
  14. 14. Sodium Nitroprusside(Nitropress) Contraindications: Hypersensitivity Congenital (Leber's) optic atrophy Tobacco amblyopia  Acute congestive heart failure with reduced peripheral vascular resistance
  15. 15. Sodium Nitroprusside(Nitropress) Adverse Effects Excessive hypotension Cyanide Toxicity Thyroid Suppression Thiocyanate Poisoning Metabolic Acidosis Raised intracranial Pressure Bowel Obstruction
  16. 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. 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
  18. 18. Amiodarone Interactions: Cimetidine: inhibits CYP3A4 and can increase serum amiodarone levels Warfarin Dofelitide Amitriptyline Propanolol Digoxin
  19. 19. Amiodarone Contraindications: Hypersensitivity 2nd or 3rd degree AV block Cardiogenic Shock Severe sinus node dysfunction Avoid during breastfeeding
  20. 20. Amiodarone Adverse Effects: Hypotension AV BLOCK Congestive Heart Failure Bradycardia Cardiogenic Shock Impaired Memory……..etc
  21. 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. 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).
  23. 23. Aminophylline Interactions: Dipyridamole Febuxostat Riociguat Cimetidine Ciprofloxacin Cigarrete smoking
  24. 24. Aminophylline Contraindications: Hypersensitivity Active peptic ulcer disease Underlying uncontrolled seizure disorder
  25. 25. Aminophylline Adverse Effect: Serum Concentration< 20mcg/ml Diarrhea,Nausea,Vomiting Diuresis Exfoliative Dermatitis Skeletal Muscle Tremors Tachycadia, Flutter Serum Concentration>30mcg/ml Acute Myocardial Infarction Seizures(resistant to anticonvulsants)
  26. 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. 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
  28. 28. Mannitol Drug interaction Tobramycin Lurasidone Nitroglycerin Trobramycin inhaled
  29. 29. Mannitol Contra-indication Pulmonary oedema Severe congestive heart failure Severe dehydration Renal failure
  30. 30. Mannitol Adverse effect Fluid and electrolyte imbalance Circulatory overload Chills Fever chest pain Acute renal failure(Large doses)
  31. 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. 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
  33. 33. Magnesium Sulfate Interactions: Doxycycline Tetracycline Minocycline Ciprofloxacin
  34. 34. Magnesium Sulfate Contraindication: Hypersensitivity Myocardial damage Heart block Hypermagnesemia Hypercalcemia Pregnancy Category: D
  35. 35. Magnesium Sulfate Adverse Effects: Circulatory Collapse Respiratory paralysis Hypotension Flushing Depressed cardiac function Drowsiness
  36. 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. 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
  38. 38. HEPARIN Interactions: Interaction; Argatroban Bivalirudin Dabigatran Desirudin
  39. 39. HEPARIN Contraindication: Haemophilia Thrombocytopenia Peptic ulcer Cerebral haemorrhage Severe hypertension Renal & liver disease
  40. 40. HEPARIN Adverse Effects: Heparin Induced Thrombocytopenia Hematoma Hemorrhage Erythema Immune hypersensitivity reaction
  41. 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. 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.
  43. 43. Epinephrine Drug Interactions:  Tranylcypromine  Quinidine  Amiodarone  Amitriptyline  Chlorpromazine  Phenelzine
  44. 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. 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. 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. 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. 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.
  49. 49. Hydrocortisone Contraindications:  Premature infants  Systemic fungal infections  Hypersensitivity
  50. 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. 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. 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
  53. 53. Diazepam Drug interactions:  Sodium Oxybate  Carbamezipine  Cimetidine  Clamithromycin  Rifampin
  54. 54. Diazepam Contraindications:  Hypersensitivity  Acute alcohol intoxication  Children < 6 months  Breastfeeding  Sleep Apnea  Severe Respiratory Depression
  55. 55. Diazepam Adverse effects of the drug:  Hypotension  Fatigue  Respiratory depression  Blurred vision  Headache  Dysarthria
  56. 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.
  57. 57. Dextrose 50% Drug interaction: Minor interactions include:  Magnesium Chloride  Magnesium citrate  Magnesium Hydroxide
  58. 58. Dextrose 50% Contrainidications:  Hyperglycemia Anuria Intracranial or Intraspinal haemorrhage Diabetic coma
  59. 59. Dextrose 50% Adverse effects of the drug:  Hyperosmolarity  Edema  Phlebitis at injection site  Hyperglycemia and glycosuria  Fluid overload  Cerebral Haemorrhage
  60. 60. References:  Baynes, J., Dominiczak, M., Medical Biochemistry. Elsevier Limited; Third Edition (2009)  Goodman E (2010). Ketchum J, Kirby R. ed. Historical Contributions to the Human Toxicology of Atropine. Eximdyne. pp. 120.  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.
  61. 61. ☻Thank you ☻