COMMON EMERGENCY DRUGS IN MEDICINEPRESENTED BY:FAJUYIGBE KUNLE THOMASDAOMI KEHINDE MACDUFFSHENNAIKE EVELYN ADEDOYINOLUSIYAN OLUWATOBI OLUSOLA

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

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

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.

List of Drugs Atropine Sodium Nitroprusside Amiodarone Aminophylline Mannitol Magnesium Sulfate Epinephrine Hydrocortisone Heparin Diazepam Dextrose 50%

AtropineIndications 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.

AtropineMechanism 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.

AtropineDrug Interactions: The effect of the drug increases with- Quinidine (Antiarrhythmic) Amitriptyline (Antidepressants) Diphenhydramine (antihistamine) Meclizine (antihistamine)

AtropineContraindications Narrow Angle Glaucoma Pyloric Stenosis Prostatic Hypertrophy Thyrotoxicosis Cardiac Failure Tachycardia

AtropineAdverse effects of drug: Palpitation Dry mouth Blurred vision Urinary retention and constipation Tachycardia Dysphagia Arrhythmias Hallucinations Raise intraocular pressure

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 minimizedDosage: 0.5-10 mcg/kg/min IV infusion

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

Sodium Nitroprusside(Nitropress)Drug Interactions:AVANAFIL(Life Threatening Interaction)AmlodipineClevidipineNifedipineVerapamilClonidine

Sodium Nitroprusside(Nitropress) Contraindications:HypersensitivityCongenital (Leber's) optic atrophyTobacco amblyopia  Acute congestive heart failure with reduced peripheral vascular resistance

Sodium Nitroprusside(Nitropress)Adverse EffectsExcessive hypotensionCyanide ToxicityThyroid SuppressionThiocyanate PoisoningMetabolic AcidosisRaised intracranial PressureBowel Obstruction

AmiodaroneIndication and dose of the drug:Frequently recurring ventricular fibrillation and hemodynamically unstable ventricular tachycardiaIntravenous amiodarone also can be used to treat patients with life threatening VT/VF300mg IV after epinephrine dose if no response to defibrillation in VT/VF150mg IV bolus in 10minutes,may repeat as necessary in hemodynamically unstable VTVT=VENTRICULAR TACHYCARDIAVF= VENTRIFULAR FIBRILLATION

AmiodaroneMechanism 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

AmiodaroneInteractions:Cimetidine: inhibits CYP3A4 and can increase serum amiodarone levelsWarfarinDofelitideAmitriptylinePropanololDigoxin

AmiodaroneContraindications:Hypersensitivity2nd or 3rd degree AV blockCardiogenic ShockSevere sinus node dysfunctionAvoid during breastfeeding

Amiodarone Adverse Effects:HypotensionAV BLOCKCongestive Heart FailureBradycardiaCardiogenic ShockImpaired Memory……..etc

AminophyllineIndications 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

AminophyllineMechanism Of Action: smooth muscle relaxation (i.e., bronchodilation) suppression of the response of the airways to stimuli (i.e., non-bronchodilator prophylactic effects).

AminophyllineInteractions:DipyridamoleFebuxostatRiociguatCimetidineCiprofloxacinCigarrete smoking

AminophyllineContraindications:HypersensitivityActive peptic ulcer diseaseUnderlying uncontrolled seizure disorder

AminophyllineAdverse Effect:Serum Concentration< 20mcg/mlDiarrhea,Nausea,VomitingDiuresisExfoliative DermatitisSkeletal Muscle TremorsTachycadia, FlutterSerum Concentration>30mcg/mlAcute Myocardial InfarctionSeizures(resistant to anticonvulsants)

MannitolMechanism 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

MannitolIndication and dose of the drug:Cerebral oedema: by IV infusion, as 1.5-2g/kg infused over 30-60minutesRaised intracranial or intraocular pressure: by IV infusion as 1.5-2g/kg infused over 30-60minutes

MannitolDrug interactionTobramycinLurasidoneNitroglycerinTrobramycin inhaled

MannitolContra-indicationPulmonary oedemaSevere congestive heart failureSevere dehydrationRenal failure

MannitolAdverse effectFluid and electrolyte imbalanceCirculatory overloadChillsFeverchest painAcute renal failure(Large doses)

Magnesium SulfateIndications 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 pregnancy1 to 4 g magnesium sulfate (magnesium sulfate (magnesium sulfate injection) injection) may be given intravenously in 10% to 20% solution

Magnesium SulfateMechanism Of Action:It produces anticonvulsant effect by decreasing the amount of acetylcholine released at end plate by motor nerve impulsePromotes movement of calcium,potassium and sodium in and out and stabilizes excitable membranees

Magnesium SulfateInteractions:DoxycyclineTetracyclineMinocyclineCiprofloxacin

Magnesium SulfateContraindication:HypersensitivityMyocardial damageHeart blockHypermagnesemiaHypercalcemiaPregnancy Category: D

Magnesium SulfateAdverse Effects:Circulatory CollapseRespiratory paralysisHypotensionFlushingDepressed cardiac functionDrowsiness

HEPARINIndications And Dosage:INDICATION ;Deep Vein Thrombosis ,thrombosis, emboli, unstable anginaDose ;Treatment of deep-vein thrombosis and pulmonary embolism ; by injection Adult loading dose of 500units [in severe pulmonary embolism 1000 unitsProphylaxis in general surgery ,by SC injection Adult 2000units before surgery and then every 8-12hrs for 7 days.

HEPARINMechanism Of Action: Prevents blood clotting by its antithrombinactivity. It directly suppresses the activity of thrombinCombines with antithrombin III (a proteaseinhibitor present in circulation) and removes thrombin from circulationInactivates the active form of other clotting factors like IX, X, XI and XII

HEPARINInteractions:Interaction;ArgatrobanBivalirudinDabigatranDesirudin

HEPARINContraindication:HaemophiliaThrombocytopeniaPeptic ulcerCerebral haemorrhageSevere hypertensionRenal & liver disease

HEPARINAdverse Effects:Heparin Induced ThrombocytopeniaHematomaHemorrhageErythemaImmune hypersensitivity reaction

EpinephrineMechanism 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 Actionsà1-receptors Vasoconstriction, increased BP, Mydriasisà2-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.

EpinephrineIndication 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.

EpinephrineDrug Interactions: Tranylcypromine Quinidine Amiodarone Amitriptyline Chlorpromazine Phenelzine

EpinephrineContraindications: 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.

EpinephrineAdverse 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.

HydrocortisoneMechanism 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.

HydrocortisoneIndication 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.

HydrocortisoneDrug 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.

HydrocortisoneContraindications: Premature infants Systemic fungal infections Hypersensitivity

HydrocortisoneAdverse 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

DiazepamMechanism 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.

DiazepamIndication 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

DiazepamDrug interactions: Sodium Oxybate Carbamezipine Cimetidine Clamithromycin Rifampin

DiazepamContraindications: Hypersensitivity Acute alcohol intoxication Children < 6 months Breastfeeding Sleep Apnea Severe Respiratory Depression

DiazepamAdverse effects of the drug: Hypotension Fatigue Respiratory depression Blurred vision Headache Dysarthria

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.

Dextrose 50%Drug interaction: Minor interactions include: Magnesium Chloride Magnesium citrate Magnesium Hydroxide

Dextrose 50%Contrainidications: HyperglycemiaAnuriaIntracranial or Intraspinal haemorrhageDiabetic coma

Dextrose 50%Adverse effects of the drug: Hyperosmolarity Edema Phlebitis at injection site Hyperglycemia and glycosuria Fluid overload Cerebral Haemorrhage

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.

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