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Common drugs used in the

Emergency
Routes of administration
IV
Intravenous administration is when the drug is given in liquid form directly into
a vein. This is often
done by placing a venous catheter to allow easy administration.
IM
Direct injection into the muscle. Often a painful mode of administration, and
provides a slow route
of absorption.
PO
By mouth (Per Orum). Typically intermediate between IM and IV in speed of
absorption. (is this
true?)
PR
Rectal administration (Per Rectum). The rectum is actually a very quick
method of drug
administration as the rectum is highly vascular. This route is often used in
children.
ET
Certain drugs can be given down an endotracheal tube. The drugs are given
at 2-2.5 times normal
IV dose. Drugs are followed with a saline bolus of ~10ml. The acronym for
drugs that can go down
an ET tube is ALONE:
• A – Atropine
• L – Lidocaine
• O – Oxygen
• N – Naloxone (Narcan)
• E – Epinephrine

This is solutiom are important in Emergency:


NS:
NS stands for Normal Saline, which is 0.9% Sodium Chloride, and is the usual
fluid given to a
patient who needs fluid due to dehydration. It is approximately isotonic.

LR:
LR stands for Lactated Ringers, which is Normal Saline with other
electrolytes. Due to the presence of the other electrolytes, there is a limit to
how much can be administered within aspecific period of time.

D5, D10, D25 and D50:


The D stands for Dextrose, which is a stable form of glucose. This solution is
given IV to give
the patient glucose. This is never given IM, as high concentrations of glucose
cause tissue death
outside the vasculature.

Common Indications
Drugs
Adrenaline(Epinephrin) Anaphylaxis or cardiac arrest.

Nor-epinephrin Hypotension&shock

Adenosine antidysrhythmic

Lidocaine local anesthetic&antidysrhythmic

Dopamine Hypotension

Dobutamin Short term management of cardiac decompensation result from depressed


contractility
Digoxin slow conduction the heart( atrial-fibrillation).

Diltiazem(Cardizem) slow the heart down in patients with certain


types of tachycardias (atrial fibrillation).
Frusemide Relief of pulmonary oedema associated with LVF

Diamorphine Severe pain or acute left ventricular failure

Atropine Bradycardia&sever asthma

Streptokinase thrombolytic agent. blood clots in patients with


myocardial infarction(heart attacks), non-hemorrhagic CVA’s (strokes)&
pulmonary emboli
Heparin anticoagulant

Morphine Sulfate analgesic

Naloxone (Narcan) antidote to narcotic

Diazepam(valum) anticonvulsant

Glucagon Hypoglycaemia

Flumazenil Reversal of benzodiazepine induced respiratory depression

Furosemide (Lasix) diuretic

NTG Ischemia chest pain


Druge Route Dose Action Side effect
Epinephri I.V& 0.01-0.2 mcg/kg/min beta1, beta 2 & alpha H.T.N-tachycardia
ETT agonist,cardiac
stimulation, relax bronchial muscles
Norepinephrin I.V 0.01-0.2 mcg/kg/min Stimulates beta1 & alpha Bradyycardia-
adrenergic hyperglacemia-
receptors; incr. Contractility & HR, decrease urine output
vasoconstriction, incr SBP
Adenosine I.V 100mcg/kg; Interrupts reentry pathway through S.O.B-Chest pressure
max12mg AV
node; for PSVT
Lidocaine I.V& 20-50 mcg/kg/min Suppress automaticity of Confusion- decrease
ETT conduction tissue, liver function.
incr. elect. threshold of ventricle,
Dopamine I.V 3-12 mcg/kg/min Stimulate adrenergic and Tachycardia-
dopaminergic hyperglacemia
receptors, positive inotrope, renal
vasodilation
Dobutamin I.V 3-10 mcg/kg/min Stimulate beta 1 receptors, incr. H.T.N
contractility &
heart rate, minor effect on alph and
beta 2
receptors
Digoxin I.V 0.5-1mg Cardiac glycoside thate incr. cardiac Arrhythmia-N\V
contractility Action(positive
inotropic)&slows conduction in the AV
node(negative dromotropic effects)
Diltiazem I.V 30-200mg Produce coronary vascular smooth H.F- Arrhythmia-
(Cardizem) muscke relaxation& lower BP.slow hypotension
HR.and AVnode conduction
Frusemide I.V 20-50mg An ultra short acting beta-adrenergic Hypotension-nausea-
blocker used to lower BP&HR GI_distrubuance
Diamorphine I.V 5-10mg Prevent conversion of angiotensionI to Hypotension-nausea-
angiotensionII resulte in dilation of GI_distrubuance
arteries &veins.

Atropine I.V& 0.02 mg/kg/dose; Anti-cholinergic agent; vagally Urine retention-dry


ETT minimum dose induced mouth-blurred vision.
0.1mg symptomatic bradycardia;
symptomatic
bradycardia refractory to
oxygenation,ventilation
&epinephrine
Streptokinase I.V 250000unit over30minut Thrombolytic drugs thate breake down Hemorrhage
existing clotes.
Heparin I.V 10.000 unit\ml Anticoagulant enhances inhibitory Bleeding-
effect of antithrombin,its GI_distrubuance
prevents clote from enlarging
but can,t dissolve those already
formed.
Morphine I.V 0.05 mg Opoid receptors in spinal cord&the Constipation-
Sulfate CNS decrease bowel sound

Naloxone I.V& 0.1 mg/kg; Reversal of respiratory and H.T.N-pain-N\V-


(Narcan) ETT minimum dose 0.01 neurologic
mg depression due to opiate
intoxication
Diazepam I.V 10 mg
(valum) Its anticonvulsive effect is due Hypotension-
to enhancement of the resp.depression
inhibitory neurotransmitted
gamma-aminobutyric acid to
neurons in the brain
Glucagon I.V 0.5-1 mg Glucagon increases plasma Hepatic impairment-
glucose by stimulating hypcalemia
glycogenolysis and
gluconeogenesis in the liver.
An additional action is
inhibition of glycogen synthesis
and
glucose oxidation. In adipose
and hepatic tissues, glucagon
causes lipolysis, resulting
in the production of fatty acids
which further increase
gluconeogenesis
Flumazenil I.V 200 mcg Blocke benzodiazepine Seizure
over 15 seconds, then reseptores& antagonizes the
100 mcg at 60-second action of benzodiazepine on the
intervals to a maximum CNS
of 1 mg, if required.

Furosemide I.V 20-50mg reduce the fluid overload in patients Hypcalemia-


(Lasix) with hypotension-
congestive heart failure (CHF) or dizzness-headach
hypertension
NTG I.V 0.5-4 mcg/kg/min Dilates coronary artery, relax Hypotension-
vascular smooth headach-N\V
muscle; decr. left vent. pressure &
systemic
vascular resistanc

By: hatem alsrour


King Saud University
College of Nursing