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 Drugs
Adrenaline(Epinephrin) Nor-epinephrin Adenosine Lidocaine Dopamine Dobutamin Digoxin Diltiazem(Cardizem) Frusemide Diamorphine Atropine Streptokinase

Indications
Anaphylaxis or cardiac arrest. Hypotension&shock antidysrhythmic local anesthetic&antidysrhythmic Hypotension Short term management of cardiac decompensation result from depressed contractility slow conduction the heart( atrial-fibrillation). slow the heart down in patients with certain types of tachycardias (atrial fibrillation). Relief of pulmonary oedema associated with LVF Severe pain or acute left ventricular failure Bradycardia&sever asthma thrombolytic agent. blood clots in patients with myocardial infarction(heart attacks), non-hemorrhagic CVA’s (strokes)& pulmonary emboli anticoagulant analgesic antidote to narcotic anticonvulsant Hypoglycaemia Reversal of benzodiazepine induced respiratory depression diuretic Ischemia chest pain

Heparin Morphine Sulfate Naloxone (Narcan) Diazepam(valum) Glucagon Flumazenil Furosemide (Lasix) NTG

Druge Epinephri Norepinephrin

Route I.V& ETT I.V

Dose 0.01-0.2 mcg/kg/min 0.01-0.2 mcg/kg/min

Action beta1, beta 2 & alpha agonist,cardiac stimulation, relax bronchial muscles Stimulates beta1 & alpha adrenergic receptors; incr. Contractility & HR, vasoconstriction, incr SBP Interrupts reentry pathway through AV node; for PSVT Suppress automaticity of conduction tissue, incr. elect. threshold of ventricle, Stimulate adrenergic and dopaminergic receptors, positive inotrope, renal vasodilation Stimulate beta 1 receptors, incr. contractility & heart rate, minor effect on alph and beta 2 receptors Cardiac glycoside thate incr. cardiac contractility Action(positive inotropic)&slows conduction in the AV node(negative dromotropic effects) Produce coronary vascular smooth muscke relaxation& lower BP.slow HR.and AVnode conduction An ultra short acting beta-adrenergic blocker used to lower BP&HR Prevent conversion of angiotensionI to angiotensionII resulte in dilation of arteries &veins. Anti-cholinergic agent; vagally induced symptomatic bradycardia; symptomatic bradycardia refractory to oxygenation,ventilation &epinephrine Thrombolytic drugs thate breake down existing clotes.

Side effect H.T.N-tachycardia Bradyycardiahyperglacemiadecrease urine output S.O.B-Chest pressure Confusion- decrease liver function. Tachycardiahyperglacemia H.T.N

Adenosine Lidocaine Dopamine

I.V I.V& ETT I.V

100mcg/kg; max12mg 20-50 mcg/kg/min 3-12 mcg/kg/min

Dobutamin

I.V

3-10 mcg/kg/min

Digoxin

I.V

0.5-1mg

Arrhythmia-N\V

Diltiazem (Cardizem) Frusemide Diamorphine

I.V I.V I.V

30-200mg 20-50mg 5-10mg

H.F- Arrhythmiahypotension Hypotension-nauseaGI_distrubuance Hypotension-nauseaGI_distrubuance Urine retention-dry mouth-blurred vision.

Atropine

I.V& ETT

0.02 mg/kg/dose; minimum dose 0.1mg

Streptokinase

I.V

250000unit over30minut

Hemorrhage

Heparin

I.V

10.000 unit\ml

Morphine Sulfate Naloxone (Narcan) Diazepam (valum)

I.V I.V& ETT I.V

0.05 mg 0.1 mg/kg; minimum dose 0.01 mg 10 mg

Anticoagulant enhances inhibitory effect of antithrombin,its prevents clote from enlarging but can,t dissolve those already formed. Opoid receptors in spinal cord&the CNS Reversal of respiratory and neurologic depression due to opiate intoxication Its anticonvulsive effect is due to enhancement of the inhibitory neurotransmitted gamma-aminobutyric acid to neurons in the brain Glucagon increases plasma glucose by stimulating 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 Blocke benzodiazepine reseptores& antagonizes the action of benzodiazepine on the CNS

BleedingGI_distrubuance

Constipationdecrease bowel sound H.T.N-pain-N\V-

Hypotensionresp.depression

Glucagon

I.V

0.5-1 mg

Hepatic impairmenthypcalemia

Flumazenil

I.V

200 mcg over 15 seconds, then 100 mcg at 60-second intervals to a maximum of 1 mg, if required. 20-50mg

Seizure

Furosemide (Lasix) NTG

I.V

I.V

0.5-4 mcg/kg/min

reduce the fluid overload in patients with congestive heart failure (CHF) or hypertension Dilates coronary artery, relax vascular smooth muscle; decr. left vent. pressure & systemic vascular resistanc

Hypcalemiahypotensiondizzness-headach Hypotensionheadach-N\V

By: hatem alsrour

King Saud University College of Nursing

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