drugs used in emergency cases

PHARMACIST: PHARMACIST: RIDHA MOHAMMAD HAREKARIDHA MOHAMMAD HAREKA

OXYGENDRUGS FOR CARDIAC DISORDERSDRUGS FOR POISONINGDRUGS FOR SHOCKDRUGS FOR HYPERTENSIVE CRISIS

AND PULMONARY EDEMA

w/o OXYGEN - Brain death within 6 min

Pulse oximeter – measures oxygen saturation WHAT’S THE IDEAL O2 SAT? 95%

for severe physiologic stressShockTraumatic injuryAcute myocardial infarctionCardiac arrest

CAUTION IN COPD PATIENTS

May lose their hypoxic respiratory drive

Emergency but no severe stress (angina, arrhythmia)Nasal cannula – 1-6L/minFace tent (high O2 flow) - children

NITROGLYCERIN - vasodilatorANGINA PECTORISMYOCARDIAL INFARCTION

SUBLINGUAL – 0.3-0.4 mg to be repeated after 5 min (max: 3 doses). IV infusion 50mg/10ml (dilute before use) 5mcg/min to 20mcg/min

NITROGLYCERIN – vasodilatorShould not be use along with Sildenafil (VIAGRA)

MORPHINE SULFATEMORPHINE SULFATENarcotic analgesic given for chest pain assoc with MI

Dose: 1-4mg IV over 1-5min to be repeated q 5-30’ until chest pain is relieved

MORPHINE SULFATEMORPHINE SULFATE Adverse effects: respiratory

depression and hypotension

NALOXONE (NARCAN) Reverses the action of morphine

ATROPINE SULFATEATROPINE SULFATE Inhibits action of VAGUS nerve for treatment of bradycardia,

asystole and AV block dose: 0.5-1mg q 3-5 min

ISOPROTERENOLISOPROTERENOL beta adrenergic drug – increase

heart rate – for HYPOTENSION monitor heart rate

EPINEPHRINEEPINEPHRINE Improves perfusion of the

heart and brain, bronchodilation

EPINEPHRINEEPINEPHRINE “E” drug for hypotension,

pulseless Vtach, V fibrillation, status asthmaticus

monitor cardiac and hemodynamics

SODIUM BICARBONATEFor metabolic/respiratory acidotic state associated with cardiac arrest

dose: 1meq/kg IV, maybe repeated at 0.5meq/Kg every 10 min when required.

ADENOSINEVERAPAMILDILTIAZEMLIDOCAINEAMIODARONEPROCAINAMIDE

Amiodaron

. It is used in the treatment of both ventricular and atrial arrhythmias.

Note: Amiodarone is incompatible with normal saline solution.

Preparation: * Loading dose – Mix calculated loading

dose of amiodarone (5 mg per kg) in 250 ml of

dextrose 5%. Infuse for 1 to 2 hours (125 to 250 ml per hour).

* Maintenance dose – Mix calculated

maintenance dose of amiodarone

(10 to 15 mg per kg) in 500 ml of dextrose 5%. Infuse for 24

hours (20 ml per hour).

Adenosine

Adenosine is a very short acting agent used in the treatment of supraventricular tachycardia.

It is best given in incremental doses according to response (usually 6 mg initially and if no response, give 12 mg and if necessary followed by 18 mg).

Adenosine should be given as a rapid intravenous bolus followed by a 20 ml 0.9% saline flush.

In asthmatic patient --->bronchospasm …. Antagonised by using Theophyllin.

Procainamide

Antiarrhythmic Agent, Class Ia.

IV: Loading dose: 15 to 18 mg/kg administered as slow infusion over 25 to 30 minutes

or 100 mg/dose at a rate not to exceed 50 mg/minute repeated every 5 minutes as needed to a total dose of 1 g.

Procainamide

Maintenance dose: 1 to 4 mg/minute by continuous infusion. Maintenance infusions should be reduced by one-third in patients with moderate renal or cardiac impairment and by two-thirds in patients with severe renal or cardiac impairment.

Dose must be titrated to patient's response

MANNITOLMANNITOLOsmotic diuretic – for cerebral

edema may inc ICP initial dose – 0.5-1g/kg IV of 25%

solutionNote: highly irritating to the veins

forms crystals

Mannitol

If crystals are present, redissolve by warming solution. Use filter-type administration set for infusion solutions containing mannitol ≥20%.

METHYLPREDNISOLONEIndication: spinal cord injury/cerebral

edema* Contraindications:

HIV infection pregnancy Uncntrolled diabetes

Poisoning: Ingested Poisons May be corrosive (alkaline and acid

agents that cause tissue destruction) Alkaline productsAlkaline products: Lye, drain and

toilet bowl cleaners, bleach, non-phosphate detergents, button batteries

Acid products:Acid products: toilet bowl and metal cleaners, battery acid

Poisoning ManagementIngestion of corrosive poison give water or milk - for dilution

not attempted if patient has acute airway obstruction, or if with evidence of gastric or esophageal burn or perforation.

Ipecac syrup - induce vomiting in the alert patient Gastric lavage for the obtunded patient

aspirate is tested Activated charcoal administration if poison can be

absorbed by it Cathartic (clearance bowels)Cathartic (clearance bowels) - when appropriate

Ingested Poison Warnings!!!

Vomiting is NEVER induced after ingestion of caustic substances or petroleum distillates.

1. NALOXONE – anti-dote for opiates overdose

2. FLUMAZENIL – reverses respiratory depression secondary to benzodiazepines

3. ATROPINE - reverses organophosphate poisoning

DOPAMINEDOBUTAMINENOREPINEPRHINEEPINEPHRINEALBUTEROL

Epinephrine: α-adrenergic effects can increase

coronary and cerebral perfusion pressure by vasoconstriction

β-adrenergic can increase myocardial contractility

Given 1 mg per IV/IO every 3-5 minutes

Sympathomimetic For hypotension (shock) It can increase heart rate when

atropine has not been effective Dose: 1-20mcg/kg/min (in 250ml D5W) Wean patient gradually – can result

to severe hypotension if abruptly stopped

Assess IV site q1 hrExtravasation can lead to tissue necrosis

sympathomimetic with beta 1 effects (inc. heart rate)

no vasoconstriction, only increase cardiac output

dose: 250-1000mg in 250ml D5W or NSS

AN EXTREMELY POTENT VASOCONSTRICTOR

GIVEN WHEN DOPAMINE AND DOBUTAMINE HAVE FAILED

DOSE: 4-8mg to 250ml D5W or NSS and infused at 0.5-30mcg/min

ANAPHYLACTIC SHOCKALBUTEROL( salbutamol)

Reverses bronchoconstrictionBeta2 Agonist administered via nebulizer side effects: tremors, tachycardia, dysrhythmia, hypertension

ANAPHYLACTIC SHOCK

DIPHENHYDRAMINEAnti-histamineReduce histamine induced tissue

swelling and pruritus25-50mg IV or deep IM

DRUGS FOR HYPERTENSIVE CRISIS

Diastolic pressure that exceeds 110-120mmHg and pulmonary edema


LABETALOLBeta blockerLowers heart rate, BP, myocardial

contractility, and myocardial O2 consumption

Dose: 10mg IV push for 1-2 min(max dose: 150mg)

Contraindicated in patients with Asthma


SODIUM NITROPRUSSIDEReduces arterial BPEffect: immediate vasodilation and BP goes down but immediately goes up once the drug is stopped


SODIUM NITROPRUSSIDE inactivated by light – wrap in

aluminum foilBlue or brown discoloration –

means drug is degraded prolonged use – can lead to

cyanide poisoning


FUROSEMIDE loop diuretic For acute pulmonary edema due

to left ventricular dysfunction or hypertensive crisis

diuresis may start within 20 mins


FUROSEMIDEAdverse effects: hypotension, dehydration and electrolyte imbalances

can result to allergic reaction

Antiepileptic drugs

Phenytoin;must be given by slow intravenous injection.The infusion rate should not exceed 50 mg per minute

in adults or 1 mg per kg per minute in children.Preparation:. should be diluted in 0.9% saline only

(not 5% dextrose) so that the concentration is no greater than 5 mg per ml. Rapid infusion of concentrated solutions may cause hypotension. The usual loading dose is 15 mg per kg intravenously.

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drugs used in emergency cases

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