Introduction

0 Emergency- an unforeseen occurrence or combination

of circumstances that calls for immediate action or
remedy
0 Drug – Substance or product that is used to modify or
explore physiological system or pathological states for
the benefit of the recipient
0 So emergency drug is….
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
 Indication of emergency drugs

0 To provide initial treatment for broad spectrum of

illness and injuries, most of which may be life
threatening
0 To control the symptoms of patient
0 To save the life of the patient
0 To reach the site of action as soon as possible
0 To normalize the vital bodily function
0 To diverge the patient from the possible risks
 Epinephrine
0 MOA:
0 Acts by stimulating α and β receptor of adrenergic
neurons of symphatetic nervous system
0 Its α adrenergic effects is much stronger than the β
adrenergic effects

Adrenoceptors Actions
α1- receptor Vasoconstriction, increased BP, mydriasis
α2- receptor Inhibits the release of noradrenaline, acetylcholine
and insulin
β1- receptor Tachycardia, increase lipolysis, myocardial
contractility and increase release of renin
β2- receptor bronchodilator, relaxes uterine smooth muscle,
increase release of glucagon
 Epinephrine
0 Indication and dose of the drug:
0 Cardiac arrest: 1 mg IV of 1:10.000 solution every 3-5 min
0 Anaphylaxis (type 1): iv bolus, 0,5-1,0 ml, may repeated as
necessary
0 Refractory bradycardia and hypotension: 2-10 mcg/min
0 Bronchospasm: 0,1-0,3 mg SC or IM of 1:10.000 solution
 Antihistamine
0 Drug of choice: Diphenhydramine
0 Alternative: Chlorpheniramine
0 MOA:
0 block histamin receptors that mediate cutaneous
reactions but not counter anaphylactoid events
0 Uses:
0 Non-life threatening allergic reaction/minor allergic
reaction: rash or urticaria with no evidence of airway
obstruction
0 Delayed allergic reaction
0 Dose: 50 mg/IM single dose in deltoid muscle
 Anticonvulsant
0 Diazepam
0 MOA:
0 Acts by binding to GABA- A receptors (post synaptic
receptors) and increases its frequency of opening, leading
to potentiate the GABA effects
0 This opening leads to an increased conductance to chloride
ions, which produces membran hyperpolarization, this
induces a neuronal inhibition which results in its sedative
action
0 Diazepam:
0 Indication:
0 Seizure disorders: 0,2 mg/kg repeat after 4-12 hrs
0 Muscle spasms: 5-10 mg IV/IM initially
0 Status epilepticus: 5-10 mg IV/IM not to exceed 30 mg
0 Sedation: midazolam is indicated for the sedation of
patients, including intubated patients receiving mechanical
ventilation
0 Adverse Effect:
0 Respiratory depression
 Anticonvulsant
0 Magnesium Sulfate
0 MOA:
0 Decreasing the amount of acetylcholine released at the end
plate by motor nerve impulse
0 Promotes movement of calsium, potassium and sodium in
and out and stabilizes excitable membranes
0 Indication and dose:
0 Immediate control of life-threatening convulsion in the
treatment of severe toxemias (pre-eclampsia and
eclampsia)of pregnancy
0 Dose: 1-4 g MgSO4 injection may be given IV in 10% to 20%
solution
 Antihypoglycemic
0 Dextrose 40%
0 Indication:
0 Documented hypoglycemia
0 Seizure of unknown etiology
0 Coma of unknown cause
0 Hyperkalemia
0 Dose: 25-50 gr D40 slow IV, repeat if needed
 Antiinflammation
0 Hydrocortisone:
0 MOA:
0 Reduces the inflammatory reaction by limiting the capillary
dilatation and permeability of the vascular structures
0 Restrict the accumulation of polymorphonuclear and
reduce the release of vasoactive kinins
0 Inhibit the release of destructive enzymes that attack the
injury debris and destroy normal tissue indiscriminately
0 Hydrocortisone:
0 Indication:
0 Acute adrenocortical insufficiency
0 Congenital adrenal hyperplasia
0 Dose:
0 100-500 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
 Anticoagulation
0 Heparin
0 MOA:
0 Prevents blood clotting by its antithrombim activity by
suppressing the activity of thrombin
0 Combines with antithrombin III and removes thrombin
from circulation
0 Inactivates the active form of other clotting factors like IX,
X, XI and XII
0 Indication:
0 Deep Vein Thrombosis
0 Thrombosis
0 Emboli
0 Unstable angina
0 Dose: loading dose: 500 units (DVT)
1000 units (PE)
 Others
0 Atropine:
0 MOA:
0 Competitively blocks the muscarinic receptors in peripheral
tissues (heart, intestines, bronchial muscles, iris, secretory
glands) and relaxes the smooth muscles
0 Blocks the action of vagus nerve of parasympathetic system
on the heart and speed up the heart rate.
0 Atropine
0 Indication and dose:
0 Sinus bradycardia: 0,5 – 1mg repeated every 3-5 min when
necessary in adults
0 Bronchospasm: 0,025 mg/kg in 2,5 mL NS via nebulizer
every 6-8 hrs
0 Cardiac arrest: 1 mg every 3-5 min
0 Atropine
0 Indication:
0 Organophosphate poisoning:
Dose: start with 0,05 mg/kg in children
0,6-2 mg IV repeat every 10-25 min
Atropinisation obtained:
- D”s”: delirium (disorientation)
drowsiness
dilated pupils
dryness of mouth
dry and hot skin
0 Sodium Nitroprusside (Nitropress)
0 MOA:
0 Relaxes smooth muscle and consequent dilatation of
peripheral arteries and veins by producing NO
0 Reducing preload and afterload
0 Indication: Hypertension crisis
0 Dose: 0,5-10 mcg/kg/min IV infusion
0 Amiodarone
0 MOA:
0 Inhibits adrenergic stimulation
0 Affects sodium, potassium and calcium channel
0 Markedly prolongs action potential and repolarization
0 Decreases AV conduction and sinus node function
0 Indication:
0 Ventricular Tachycardi/Ventricular Fibrillation
0 Aminophylline
0 MOA:
0 Smoothe muscle relaxation (brochodilatation)
0 Suppresion of the response of the airways to stimuli
0 Indication and dose:
0 Acute exacerbation of the symptoms of reversible airflow
obstruction associated with asthma and other chronic lung
disease (COPD)
0 Dose: 5-7 mg/ kgIV/ PO for over 20 minutes
0 Mannitol
0 MOA:
0 Osmotic diuretic: induces diuresis by elevating the
osmolarity of the glomerular filtrate and thereby hindering
tubular reabsorpsion of water.
0 Enhance excretion of chloride and sodium
0 Indication:
0 Cerebral edema: 1.5-2 g/kg/ IV infusion infused over 30-60
min
0 Raised intracranial or intraocular pressure: 1.5-2 g/kg/ IV
infusion infused over 30-60 min
0 Nitroglycerin
0 MOA:
0 Dilating veins and reducing venous return (preload)
0 Indication:
0 Acute onset of chest pain
0 Contraindication:
0 Hypotensive (<90SBP), hypersensitivity and on sildenafil
medication
0 Dose:
0 3 doses of tablet 0,4 mg sublingual repeated over 15-20
minutes
0 Aspirin
0 MOA: Inhibit synthesis of thromboxane A2 by
irreversible acetylation of the enzyme cyclooxigenase
0 Indication:
0 Angina (chest pain), primary prophylaxis of myocardial
infarction
0 Dose:
0 4 tablet (@81mg) chew and swallow
0 Naloxon
0 MOA:
0 Acts as an opioid receptor antagonist
0 Indication:
0 Opioid antagonist
0 Dose:
0 Conventional dose: 0,4 mg (1 mL) and may be repeated in
30 minutes
0 Dopamine
0 MOA:
0 naturally occurring neurotransmitter and the precursor of
norepinephrine
0 Indication:
0 short-term management of acute systolic heart failure to augment
cardiac output and reduce ventricular filling pressure
0 Dose:
0 2 to 5 µg/kg/min : leads to vasodilation in the renal, mesenteric,
coronary, and cerebral beds
0 5 to 10 µg/kg/min : increases cardiac contractility and chronotropy.
0 10 to 20 µg/kg/min : mediated peripheral vasoconstriction
dominates
0 Dobutamine
0 MOA:
0 a synthetic catecholamine that stimulates β1 and β2
adrenergic receptors, but has little action on alpha-
receptors.
0 It has potent inotropic activity with only modest
chronotropic effect.
0 ↑ stroke volume and cardiac output, and ↓ pulmonary
capillary wedge pressure and systemic vascular resistance
0 Indication:
0 decompensated systolic heart failure and low cardiac output
0 Dose: generally initiated at 2 µg/kg/min and titrated to
optimize cardiac output (maximal dose: 40 µg/kg/min)
0 Adenosine
0 MOA:
0 In cardiac tissue, adenosine binds to type 1 (A1)
receptors, which are coupled to Gi-proteins → opens
potassium channels, which hyperpolarizes the cell
0 Indication:
0 an antiarrhythmic drug for the rapid treatment
of supraventricular tachycardias
0 Dose: 6 mg rapid push bolus iv