DRUGS

DEXTROSE WATER
Strength : 5%, 10%, 25%, 50%
Indications:
•Hypoglycemia Fluid replacement
•Parenteral nutrition
•With insulin for hyperkalemia
Dose: 4 ampules
Check BSR (blood sugar random) if needed can give
more ampules.
Contraindications :
•Hyperglycemia
•Fluid overload
Side effects:
•Thrombosis
•Thrombophlebitis
•Volume over load
•Note:(1 mg IM stat glucagon
Can b given for hypoglycemia)
 KCL
Indication :
•Hypokalemia
Contraindication:
•Hyperkalemia
•Renal failure
Side effects:
•Rapid infusion can cause
fatal arythmias
•Chloride replace
bicarbonate and cause
acidosis
Note:
1. never give iv stat
2. max. 20 mmol/
hour
 Hydrocortisone(cortisol)
Uses :
•Axute severe asthma
•Hypersensitivity reaction
•Addison disease
Advese effects;
•Glaucoma
•Cataract
•HTN
•DM
•Obesity
•Cushing syndrome
•Osteoporosis
•Immunocompromised
•Peptic ulcer
 NOTE
Dexamethasone 26.6 times more potent than the naturally occurring
 hormone hydrocortisone.
 and 6.6 times more potent than prednisone .
So roughly.
 100mg hydrocortisone=20mg prednisone=5mg dexamethasone
But why we prefer hydrocortisone over dexamethasone ??
Reason is that prednisone and dexamethasone are prodrugs and takes times to
Convert into active hydrocortisone………………………………………………..
So when we want rapid affect ..we use hydrocortisone
And when we want long term treatment we use dexamethasone..
Dexamethasone slowly decrease inflammation without fibrosis.

Note:
Dexamethasone used in
1. tuberculosis meningitis
2. Raised ICP
3. Pericarditis
 Calcium gluconate
(cardiac membrane stabilizer )
Uses:
1. Hypocalcemia
2. Hyperkalemia
3. Megnatium sulphate over doses
Dose :
10 % 10 ml in 10 min
Side effects:
1. Nausia, constipation
2. Cardiac arrythmias
3. Hypotention
4. Bradycardia
Precautions:
Do not give with bicarbonate from
same line at same time.
or first wash iv with normal saline
otherwise calcium carbonate will form
and precipitate.
 SODIUM BICARBONATE
(8.4 % in 20 ml of ampule)

• Indications:
1. hyperkalemia;
2. Diabetic ketoacidosis;
3. Cocaine toxicity;
4. Tricyclic antidepressant, diphenhydramine, or acetylsalicylic acid
overdose;
5. Metabolic acidosis;
6. Shock associated with severe diarrhea.
• Dose:
1 mEq/kg IV, may repeat 0.5 mEq/kg every 10 min.
note :1ml in the ampule have of 1mEq sodium bicarbonate.
preferly give in central venous line as it causes thrombophlebitis.
• Side Effects: Hypokalemia, metabolic alkalosis, seizures, tetany
arythmias.
• Note :use bicarbonate only when ph. is <7.1 or bicarbonate is <15
mEq/L
 MAGNESIUM SULFATE
• Indications:
1. Torsade de pointes,
2. VF refractory to lidocaine,
3. digoxin-induced VT/VF.
4. Eclampsia
5. Status asthamaticous
6. Wheat pill poisoning ??
• Dose:
1. Cardiac arrest (in hypomagnesaemia or torsade de pointes) 1–2 g (2–4 mL of a 50%
solution) diluted in 10 mL of D5W IV.
2. Digoxin-induced VT or VF 1–2 g IVP.
3. Eclampsia 2 g stat iv
4. Status asthamaticous 2 g/20min

• Side Effects:
Hypotension, bradycardia, cardiac arrest, respiratory depression, altered level of
consciousness (LOC), flushed skin, diaphoresis.
• Precautions:
Renal insufficiency, occasional fall in BP with rapid administration. Monitor serum
magnesium level
 MORPHINE

• Indications:
1. Chest pain unrelieved by nitroglycerin,
2. CHF and dyspnea associated with pulmonary
edema.
• Dose: 2–4 mg IVP (over 1–5 min) every 5–30 min.
• Contraindications:
Hypersensitivity, heart failure due to chronic lung
disease, respiratory depression, hypotension.
• Side Effects:
Respiratory depression, hypotension, nausea and
vomiting, bradycardia, altered SOC, seizures.
 ASPIRIN
• Indications:
1. Acute coronary syndrome,
2. symptoms suggestive of cardiac ischemia.
• Dose:
162–325 mg PO non-enteric coated for
antiplatelet effect
• Contraindications:
Known allergy to aspirin, peptic ulcer
pregnancy.
• Side Effects:
Anorexia, nausea, epigastric pain, anaphylaxis
 ATROPINE
• Indications:
1. Symptomatic sinus bradycardia,
2. PEA with rate 60 bpm,
3. cholinergic drug toxicity ( but nicotinic effects can not be reversed
with atropine …so use ventilator support if respiratory failure occurs .
Moreover use atropine till secretions becomes dry)
4. mushroom poisoning (antidote).
Note: atropine is useless in pulseless conditions.
• Dose:
Bradycardia 0.5–1.0 mg IV stat,,,,can repeat every 3–5 min, max.
0.03–0.04 mg/kg.
• Contraindications:
A-fib, A-flutter, glaucoma, asthma.
• Side Effects:
Tachycardia, headache, dry mouth, dilated pupils ,VF or VT.
bradycardia can occur if used less than 0.6mg of atropine.
 EPINEPHRINE (adrenaline)

• Indications:
1. Cardiac arrest: PEA, asystole, pulseless VT, VF;
2. severe hypotension;
3. symptomatic bradycardia;
4. anaphylaxis;
5. severe allergic reactions.
• Dose:
1. Cardiac arrest 1 mg IV-1 ampule stat (10 mL of 1:10,000 solution) ,,every 3-5
min
2. Profound bradycardia or hypotension 2–10 g/min IV
3. Anaphylaxis/asthma 0.1–0.5 mg SC or IM of 1:1000 solution every 5–15 min

• Side Effects:
Angina, HTN, tachycardia, VT, VF, nervousness,restlessness, tremors, weakness,
headache, nausea.
Note : It is first drug of CPR.
 Note

If peripheral pulses are not palpable ..start CPR and announce emergency
and call for help(other staff).
Four possibilities
 Asystole (No Ecg ….. no rhythm )
 PEA(pulseless electrical activity)—normal Ecg
 VT(ventricular tachycardia)
 VF(ventricular fibrillation)
Last two conditions are shock able rhythms …hence we can give
unsynchronized shock of 200J biphasic current.
Synchronized shock : only given with peak of R wave
ABC is currently changed into CAB
C-COMPRESSION
A-maintain airway
B-breathing
 ADENOSINE
• Indications:
1. Narrow-complex tachycardias
2. PSVT.
• Dose:
1. 6 mg rapid intravenous push (IVP) over 1–3 sec
followed by a 20-mL bolus of normal saline.
2. Give 12 mg by IVP in 1–2 min if needed, max. 30 mg.
• Side Effects: Flushing, dizziness, bronchospasm, chest
pain or tightness, bradycardia, AV block, asystole,
ventricular ectopic beats, VF.
• Precautions:
1. Patients receiving dipyridamole
2. Asthma
3. Unstable angina.
 AMIODARONE

• Indications:
1. polymorphic VT,
2. shock-refractory VF or pulseless VT,
3. SVT & PSVT.
• Dose:
1. Cardiac arrest 300 mg (diluted in 20–30 mL D5W) IVP;consider additional
150 mg IVP in 3–5 min.
2. Wide- and narrowcomplex tachycardia (stable) 150 mg IVP over first 10 min
(15mg/min)—may repeat infusion of 150 mg IVP every 10 min as needed;
slow infusion of 360 mg IV over next 6 hr (1 mg/min);maintenance infusion
of 540 mg over next 18 hr (0.5 mg/min).
3. Max. cumulative dose: 2.2 g IV in 24 hr.
• Side Effects: Vasodilation, hypotension, visual impairment,hepatotoxicity,
pulmonary toxicity, CHF; may prolong QTinterval, producing torsade de
pointes
 BETA BLOCKERS

• Common Agents:
Atenolol, esmolol, labetalol, metoprolol, propranolol.
• Indications:
MI, unstable angina, PSVT, A-fib, A-flutter, HTN.
• Dose:
See individual order and drug for route and dosage.
• Contraindications:
HR 60 bpm, systolic BP 100 mm Hg, 2nd- or 3rd-
degree AV block, left ventricular failure.
• Side Effects: Hypotension, dizziness, impotence
bradycardia, headache, nausea and vomiting.
 DIGOXIN
• Indications:
1. To slow ventricular response in A-fib or A-flutter,
2. as a positive inotrope
• Dose:
Loading dose of 10–15 g/kg, administered over 5 min
• Contraindications:
ABSOLUTE :WPW SYNDROME AND HOCM.
Hypersensitivity, uncontrolled ventricular arrhythmias, AV block, idiopathic
hypertrophic subaortic stenosis (IHSS), constrictive pericarditis.
• Side Effects:
Arrhythmias, particularly VF and AV block; bradycardia; fatigue; nausea and
vomiting; blurred or yellow vision(halos); headache; hypersensitivity;
hypokalemia. bigeminy
• Precautions:
Avoid electrical cardioversion of stable patients. If the patient’s condition is
unstable, use lower current settings such as 10–20 J.
 LIDOCAINE (lignocaine)

• Indications:
1. VF or pulseless VT,
2. stable VT,
3. wide-complex tachycardia of uncertain origin,
4. wide-complex PSVT.
5. Local anesthetic.
• Dose:
• Cardiac arrest from VF or VT 1.0–1.5 mg/kg IV (or 2–4 mg/kg via ET tube)
• Stable VT, wide-complex tachycardia of uncertain origin use 0.5–0.75 mg/
kg and up to 1.0–1.5 mg/kg
• Generally 50-100 mg stat (2% lignocaine in 10ml ampule-it means 2
gm/2000mg in 100 ml. hence 20mg in 1ml of ampule)then 1-4 mg/min
infusion
• Side Effects:
Confusion, seizures, hypotension, bradycardia, cardiovascular collapse,
respiratory arrest.
 DOPAMINE

• Indications:
1. Symptomatic bradycardia and hypotension,
2. cardiogenic shock.
• Dose:
Continuous infusions (titrate to patient response): Low dose
1–5 g/kg/min; moderate dose 5–10 g/kg/min (cardiac doses);
high dose 10–20 g/kg/min (vasopressor doses).
• Contraindications:
Pheochromocytoma, uncorrected tachycardia, cardiogenic
shock with CHF.
• Side Effects:
Tachyarrhythmias, angina, hypotension, palpitations,
vasoconstriction, dyspnea, nausea and vomiting.
 FUROSEMIDE
(LASIX 10mg/ml) note 1 ampule is of 2 ml
• Indications:
1.CHF with acute pulmonary edema,
2.hypertensive crisis,
3.postarrest cerebral edema,
4.Fluid overload due to hepatic or renal disease.
5.Forced diuresis .
• Dose:
0.5–1.0 mg/kg slow IV over 1–2 min, may repeat at 2 mg/kg slow IV over 1–2
min.
• Side Effects:
Severe dehydration, hypovolemia, hypotension, hypokalemia, hyponatremia,
hypochloremia, hyperglycemia, dizziness, ototoxicity.
• Precautions:
Check B.P before giving
• Mechanism of action:
Loop diuretic
Act on TAL of  Henle
 Aminophylline
250mg/10ml
• Uses
1. Acute svere asthma
2. Ischemia-induced bradyasystole
3. COPD
• Side effects
1. an allergic reaction
2. Seizures
3. increased or irregular heartbeats (keep an eye on Ecg constantly)
4. severe nausea or vomiting.
• Dose
Loading dose: 250mg/10ml ampule in 100 ml micro burette in 20-30 min
Maintenance dose: 250mg/10ml ampule in 100 ml micro burette in next
6-9hours
Bradyasystole
 Ipratropium bromide
(Atrovent)
 Uses
1. Acute asthma
2. COPD
 OXYGEN

• Indications:
1. Cardiopulmonary emergencies with shortness of breath
and chest pain,
2. cardiac or respiratory arrest.
• Dose:
1. Nasal cannula 1–6 L/min (24%–44% oxygen),
2. Venturi mask 4–8 L/min (24%–40% oxygen),
3. simple mask 5–8 L/min (40%–60% oxygen),
4. partial rebreathing mask 6–15 L/min (35%–60% oxygen),
5. nonrebreathing mask 6–15 L/min (60%–90% oxygen),
6. bag-valve-mask 15 L/min (up to 100% oxygen).
• Contraindications: Emphysema (deliver 35% oxygen
unless severely hypoxic), hyperventilation.
 Dobutamine

Beta 1 agonist
Uses in cardiogenic shock
Increase heart contractility
Increase cardiac output
Dose:
in 70 kg man 12 micro drops
 Dopamine
•Dopamine induces natriuresis (sodium loss) in the kidneys, and has a
diuretic effect, potentially increasing urine output from 5 ml/kg/hr to 10 ml/
kg/hr.Dosages from 2 to 5 μg/kg/min are considered the "renal dose". At this
low dosage, dopamine binds D receptors, dilating blood vessels, increasing

1
blood flow to renal, mesenteric, and coronary arteries, thus increasing
overall renal perfusion.
•Intermediate dosages from 5 to 10 μg/kg/min, known as the "cardiac dose",
additionally have a positive inotropic and chronotropic effect through
increased β receptor activation. Dopamine is used in patients
1
with shock or heart failure to increase cardiac output and blood pressure.
Dopamine begins to affect the heart at lower doses, from about 3 μg/kg/min
IV.
•High doses from 10 to 20 μg/kg/min are the "pressor dose".This dose
causes vasoconstriction, increases systemic vascular resistance, and
increases blood pressure through α receptoractivation,but can cause the
1
vessels in the kidneys to constrict to the point that urine output is reduced.
•Does: 1 ampule in 100ml of micro burette
For 70 kg roughly
Renal dose:10 microdrops
Cardiac dose:15 microdrops
Pressor dose:20 microdrops
 VIT K
•Uses:
•Warfrin antidote
•Rat pill poisoning
•Optimization of patient with obstructive
jaundice prior of surgery
Dose: 1 ml ampule iv stat , daily for 3 days
 Diazepam
(Valium)
• Sedative
• In fits
 Contraindications
• Cardio respiratory suppressor
• CLD(give Lorazepam)
 Antidote:
Flumazenil 1mg/10ml ampule
Every 10 second…. can given 1 ml
 Dimenhydrinate
(Gravinate)
• Uses:
I. Antiemetic
II. Antinauseants
 Chlorphenamine

• (histamine H1 receptor antagonist)
• Uses
A. Sting bite
B. Allergic conditions
 NO-SPA (DROTAVERINE)

• USES
a)  antispasmodic
b)  treating renal colic.
 NOTE:
  It is selective inhibitor of
phosphodiesterase 4
and has no anticholinergic effects.
INSTRUMENTS
Feeding/Bladder wash syringe
• To chek placement of
NG tube
• NG Feeding
• To wash bladder
Microburette
• To infuse drugs in
microdrops
• Calculation of dosage
in microdrops
IV Cannula
• Different sizes
differntiated by
colours
• Parts of IV Cannula
• Procedure of IV
cannula insertion
Oropharyngeal Airway
• Maintain airway
patent
• Different sizes
differentiated by
colour
• Method pf placing an
airway
Endotracheal tube
• Different sizes
• Cuffed or not cuffed
• Procedure of its
placement
• Complications
• Indications of ETT
Laryngoscope
• For direct examination
of larynx
• For intubation during
anaesthesia
• For assisted ventilation
• PARTS
• Battery-containing
handle
• Blade consisting of
• Spatula
• Flange and
• tip
Tracheostomy Tube
• INDICATION

• COMPLICATION
• Tracheal stenosis
• Surgical emphysema in
neck
• Tube occlusion or
displacement
• Bleeding , Aspiration
Foley’s Catheter
• INDICATION
• Acute retention of urine
• Chronic retention of
urine with overflow
• In surgery involving
bladder and prostate
• To instill urinary
antiseptics and
chemotherapeutic
agents
• Carry out cysto/
urethrography
Nelaton Catheter
• Different colours for
different sizes
• Suctioning
• Urinary
catheterization
• Drainage tube in
different surgical
procedures
IV infusion set
• Parts of infusion set
• Calculation of drops
per min for given
infusion rate
• Different IV fluids and
their contents
Blood transfusion set
• Transfusion of blood
products
• Parts of BT set
• Prerequisits of blood
transfusion
• Complications of
blood transfusion and
its management
Spinal Needle
• Diagnosis and
confirmation of meningitis
• For giving spinal
anaesthesia
• For intrathecal
administration of
chemotherpeuitc agents
• COMPLICATION
• Traumatic lumbar
puncture
• Brain stem herniation
• CONTRAINDICATION
• Papilloedema ,Skin
infection,Bleeding disorder
NG Tube
• Diagnose pyloric
stenosis
• To know the rate of
gastric haemorrhage
• For gastric lavage
• In comatose patients,
for feeding and to
avoid aspriration
• Acute Abdomen
• PROCEDURE OF NG
INTUBATION
Trucut Biopsy Needle
• Renal biopsy
procedure
• Liver biopsy prcedure
• Biopsy of lump
• Difference bw trucut
and sure cut biopsy
needle
• Indications,
contraindications and
complications of renal
and liver biopsy
Sahli’s bone marrow biopsy needle

• Procedure of bone
marrow biopsy
• Indications and
complications of
bone marrow biopsy
• diffence bw
bonemarrow
aspiration and biosy
Abraham’s pleural biopsy needle
• Parts of needle
• Procedure of pleural
biopsy
• Indications,
contraindications and
complications of
pleural biopsy
Trephine biopsy needle
• Bone marrow biopsy
procedure
• Indication ,
contraindications and
complications of
bone marrrow biopsy
Peak flow meter
• Indications of peak
flow rate
measurement
• Method of
measurement
• Interpretation
Central venous line
• Parts of cvp line
• Procedureof its
insertion
• Indications and contra
indications of
insertion
• Measurement of cvp
pressure
• Complications of cvp
line insertion