Common emergency drugs in general PRACTISE

Common emergency drugs in medicine

1. COMMON EMERGENCY DRUGS IN MEDICINE PRESENTED BY: DR.VISHAL S WANI,

MBBS MD, DR.VISHWA MEDICAL COACHING SOLUTIONS..

2. Emergency Drugs Introduction Purpose of Emergency Drugs Details of Emergency

Drugs -Mechanism of Action -Indication and Dose of the Drug -Drug Interaction
-Contraindications -Adverse Effects of the Drug

3. Introduction Emergency drugs are chemical compounds used in patients during life
threatening conditions so that the symptoms can be controlled and the life of a patient can
be saved. 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

4. Purpose of Emergency Drugs To provide initial treatment for broard spectrum of illness
and injuries, most of which may be life threatening. To control the symptoms of patient. To
save the life of the patient. To reach the site of action as soon as possible. To normalize the
vital bodily functions. To diverge the patient from the possible risks.

5. List of Drugs Atropine Sodium Nitroprusside Amiodarone Aminophylline Mannitol

Magnesium Sulfate Epinephrine Hydrocortisone Heparin Diazepam Dextrose 50%

6. Atropine Indications and dose of the drug: SINUS BRADYCARDIA: 0.5-1mg(or 5- 10ml of
0.1mg/ml) repeated every 3-5 min when necessary in adults. BRONCHOSPASM:
0.025mg/kg in 2.5ml NS via nebulizer every 6-8hrs Organophosphate poisoning: 2mg iv/im
every 3 min. according to clinical response in adult. Cardiac arrest: 1mg every 3-5 minutes.

7. Atropine Mechanism of Action: It competitively blocks the muscarinic receptors in

peripheral tissues (heart, intestines, bronchial muscles, iris, secretory glands) and relaxes
the smooth muscles. The main action of vagus nerve of the parasympathetic system on the
heart is to slow it down and atropine blocks that action and speeds up the heart rate.

8. Atropine Drug Interactions: The effect of the drug increases with- Quinidine
(Antiarrhythmic) Amitriptyline (Antidepressants) Diphenhydramine (antihistamine)
Meclizine (antihistamine)

9. Atropine Contraindications Narrow Angle Glaucoma Pyloric Stenosis Prostatic

Hypertrophy Thyrotoxicosis Cardiac Failure Tachycardia

10. Atropine Adverse effects of drug: Palpitation Dry mouth Blurred vision Urinary
retention and constipation Tachycardia Dysphagia Arrhythmias Hallucinations Raise
intraocular pressure

11. Sodium Nitroprusside(Nitropress) Indications and Dose of the drug: Sodium

nitroprusside is indicated for the immediate reduction of blood pressure of patients in
hypertensive crises. Concomitant longer-acting antihypertensive medication should be

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administered so that the duration of treatment with sodium nitroprusside can be minimized
Dosage: 0.5-10 mcg/kg/min IV infusion

12. Sodium Nitroprusside(Nitropress) Mechanism Of Action: The principal pharmacological

action of sodium nitroprusside is relaxation of vascular smooth muscle and consequent
dilatation of peripheral arteries and veins by producing Nitric Oxide thus reducing preload
and afterload

13. Sodium Nitroprusside(Nitropress) Drug Interactions: AVANAFIL(Life Threatening

Interaction) Amlodipine Clevidipine Nifedipine Verapamil Clonidine

14. Sodium Nitroprusside(Nitropress) Contraindications: Hypersensitivity Congenital

(Leber's) optic atrophy Tobacco amblyopia Acute congestive heart failure with reduced
peripheral vascular resistance

15. Sodium Nitroprusside(Nitropress) Adverse Effects Excessive hypotension Cyanide

Toxicity Thyroid Suppression Thiocyanate Poisoning Metabolic Acidosis Raised intracranial
Pressure Bowel Obstruction

16. Amiodarone Indication and dose of the drug: Frequently recurring ventricular fibrillation
and hemodynamically unstable ventricular tachycardia Intravenous amiodarone also can be
used to treat patients with life threatening VT/VF 300mg IV after epinephrine dose if no
response to defibrillation in VT/VF 150mg IV bolus in 10minutes,may repeat as necessary in
hemodynamically unstable VT VT=VENTRICULAR TACHYCARDIA VF= VENTRIFULAR
FIBRILLATION

17. Amiodarone Mechanism of Action: Amiodarone is generally considered a class III

antiarrhythmic, which inhibits adrenergic stimulation; affects sodium, potassium and calcium
channels; markedly prolongs action potential and repolarization and decreases AV
conduction and sinus node function

18. Amiodarone Interactions: Cimetidine: inhibits CYP3A4 and can increase serum
amiodarone levels Warfarin Dofelitide Amitriptyline Propanolol Digoxin

19. Amiodarone Contraindications: Hypersensitivity 2nd or 3rd degree AV block Cardiogenic

Shock Severe sinus node dysfunction Avoid during breastfeeding

20. Amiodarone Adverse Effects: Hypotension AV BLOCK Congestive Heart Failure

Bradycardia Cardiogenic Shock Impaired Memory……..etc

21. Aminophylline Indications and Dose of the Drug: Acute exacerbations of the symptoms
of reversible airflow obstruction associated with asthma and other chronic lung diseases,
e.g.,emphysema and chronic bronchitis. Dose: 5 – 7mg/kg IV/PO for over 20minutes

22. Aminophylline Mechanism Of Action: smooth muscle relaxation (i.e., bronchodilation)

suppression of the response of the airways to stimuli (i.e., non- bronchodilator prophylactic
effects).

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23. Aminophylline Interactions: Dipyridamole Febuxostat Riociguat Cimetidine Ciprofloxacin
Cigarrete smoking

24. Aminophylline Contraindications: Hypersensitivity Active peptic ulcer disease Underlying

uncontrolled seizure disorder

25. Aminophylline Adverse Effect: Serum Concentration< 20mcg/ml

Diarrhea,Nausea,Vomiting Diuresis Exfoliative Dermatitis Skeletal Muscle Tremors
Tachycadia, Flutter Serum Concentration>30mcg/ml Acute Myocardial Infarction
Seizures(resistant to anticonvulsants)

26. Mannitol Mechanism Of Action: Mannitol is an osmotic diuretic. It induces diuresis by

elevating the osmolarity of the glomerular filtrate and thereby hindering tubular reabsorption
of water. Excretion of chloride and sodium is also enhanced

27. Mannitol Indication and dose of the drug: Cerebral oedema: by IV infusion, as 1.5-2g/kg
infused over 30-60minutes Raised intracranial or intraocular pressure: by IV infusion as
1.5-2g/kg infused over 30-60minutes

28. Mannitol Drug interaction Tobramycin Lurasidone Nitroglycerin Trobramycin inhaled

29. Mannitol Contra-indication Pulmonary oedema Severe congestive heart failure Severe
dehydration Renal failure

30. Mannitol Adverse effect Fluid and electrolyte imbalance Circulatory overload Chills Fever
chest pain Acute renal failure(Large doses)

31. Magnesium Sulfate Indications and Dosage: Convulsions (treatment) - Intravenous

magnesium sulfate (magnesium sulfate (magnesium sulfate injection) injection) is indicated
for immediate control of life-threatening convulsions in the treatment of severe toxemias
(pre-eclampsia and eclampsia) of pregnancy 1 to 4 g magnesium sulfate (magnesium sulfate
(magnesium sulfate injection) injection) may be given intravenously in 10% to 20% solution

32. Magnesium Sulfate Mechanism Of Action: It produces anticonvulsant effect by

decreasing the amount of acetylcholine released at end plate by motor nerve impulse
Promotes movement of calcium,potassium and sodium in and out and stabilizes excitable
membranees

33. Magnesium Sulfate Interactions: Doxycycline Tetracycline Minocycline Ciprofloxacin

34. Magnesium Sulfate Contraindication: Hypersensitivity Myocardial damage Heart block

Hypermagnesemia Hypercalcemia Pregnancy Category: D

35. Magnesium Sulfate Adverse Effects: Circulatory Collapse Respiratory paralysis

Hypotension Flushing Depressed cardiac function Drowsiness

36. HEPARIN Indications And Dosage: INDICATION ;Deep Vein Thrombosis ,thrombosis,
emboli, unstable angina Dose ;Treatment of deep-vein thrombosis and pulmonary embolism

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; by injection Adult loading dose of 500units [in severe pulmonary embolism 1000 units
Prophylaxis in general surgery ,by SC injection Adult 2000units before surgery and then
every 8- 12hrs for 7 days.

37. HEPARIN Mechanism Of Action: Prevents blood clotting by its antithrombin activity. It
directly suppresses the activity of thrombin Combines with antithrombin III (a protease
inhibitor present in circulation) and removes thrombin from circulation Inactivates the active
form of other clotting factors like IX, X, XI and XII

38. HEPARIN Interactions: Interaction; Argatroban Bivalirudin Dabigatran Desirudin

39. HEPARIN Contraindication: Haemophilia Thrombocytopenia Peptic ulcer Cerebral

haemorrhage Severe hypertension Renal & liver disease

40. HEPARIN Adverse Effects: Heparin Induced Thrombocytopenia Hematoma Hemorrhage

Erythema Immune hypersensitivity reaction

41. Epinephrine Mechanism of action It acts by stimulating the à and ß-receptors of the
adrenergic neurons of sympathetic nervous system. Its alpha adrenergic effects is much
stronger than the beta adrenergic effects Adrenoceptors Actions à1-receptors
Vasoconstriction, increased BP, Mydriasis à2-receptors Inhibits the release of noradrenaline,
acetylcholine and insulin ß1-receptors Tachycardia, increase lipolysis, myocardial
contractility and renin. ß2-receptors Vasodilation, bronchodilation, relaxes uterine smooth
muscle.

42. Epinephrine Indication and dose of the drug: Cardiac Arrest: 1mg IV of 1:10000 solution
every 3-5 minutes or iv bolus(10ml) Anaphylaxis (type 1): iv bolus, 0.5-1.0ml, may be
repeated when necessary Refractory bradycardia and hypotension: 2- 10mcg/min. Asthma:
0.1-0.3mg SC or IM of 1:10,000 solution.

43. Epinephrine Drug Interactions: Tranylcypromine Quinidine Amiodarone Amitriptyline

Chlorpromazine Phenelzine

44. Epinephrine Contraindications: Narrow angle glaucoma Shock (other than anaphylactic
shock) Individuals with organic brain damage Labor (may delay second stage) Coronary
insufficiency Pregnant and breast feeding mothers.

45. Epinephrine Adverse effects of the drug: CNS: anxiety, fear, tension, headache, and
tremor. Hemorrhage: The drug may induce cerebral hemorrhage as a result of a marked
elevation of blood pressure. Pulmonary edema Less serious side effects may include:
sweating, nausea and vomiting, pale skin, feeling short of breath, dizziness, weakness or
tremors, headache, or feeling nervous or anxious.

46. Hydrocortisone Mechanism of action: It reduces the inflammatory reaction by limiting the
capillary dilatation and permeability of the vascular structures. It also restrict the
accumulation of polymorphonuclear leukocytes and macrophages and reduce the release of
vasoactive kinins. It also inhibit the release of destructive enzymes that attack the injury
debris and destroy normal tissue indiscriminately.

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47. Hydrocortisone Indication and dose of the drug: Acute adrenocortical insufficiency
Congenital Adrenal hyperplasia *The initial dose of hydrocortisone is 100 mg to 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.

48. Hydrocortisone Drug interactions: Drugs such as phenobarbital, phenytoin and rifampin
induces hepatic enzymes and increases the clearance of hydrocortisone. Drugs such as
troleandomycin and ketoconazole may inhibit the metabolism of hydrocortisone and thus
decrease their clearance. When used with high dose aspirin, clearance of asprin increases.

49. Hydrocortisone Contraindications: Premature infants Systemic fungal infections

Hypersensitivity

50. Hydrocortisone Adverse effects of the drug: Sodium retention Congestive heart failure
in susceptible patients Potassium loss Hypokalemic alkalosis Hypertension Convulsions
Headache Abdominal distention Loss of muscle mass

51. Diazepam Mechanism of action: It acts by binding to GABA –A receptors (post synaptic
receptors) and increases it’s frequency of opening, leading to potentiate the GABA effects.
This opening leads to a increased conductance to chloride ions, which produces membrane
hyperpolarization, this induces a neuronal inhibition which results in its sedative action.

52. Diazepam Indication and dose of the drug: SEIZURE DISORDERS: 0.2mg/kg repeat
after 4- 12 hrs MUSCLE SPASMS:5-10mg IV/IM initially STATUS EPILEPTICUS: 5-10mg
IV/IM not to exceed 30mg Sedation—Midazolam is indicated for the sedation of patients in
intensive care settings, including intubated patients receiving mechanical ventilation
Anesthesia, general, adjunct

53. Diazepam Drug interactions: Sodium Oxybate Carbamezipine Cimetidine

Clamithromycin Rifampin

54. Diazepam Contraindications: Hypersensitivity Acute alcohol intoxication Children < 6

months Breastfeeding Sleep Apnea Severe Respiratory Depression

55. Diazepam Adverse effects of the drug: Hypotension Fatigue Respiratory depression
Blurred vision Headache Dysarthria

56. Dextrose 50% Indication and dose of the drug: Documented hypoglycemia Seizures of
unknown etiology Cerebral/meningeal edema related to eclampsia Coma of unknown
cause Refractory cardiac arrest Adult dose: 12.5 - 25 gm D50W slow IV, repeat if needed.

57. Dextrose 50% Drug interaction: Minor interactions include: Magnesium Chloride
Magnesium citrate Magnesium Hydroxide

58. Dextrose 50% Contrainidications: Hyperglycemia Anuria Intracranial or Intraspinal

haemorrhage Diabetic coma

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59. Dextrose 50% Adverse effects of the drug: Hyperosmolarity Edema Phlebitis at
injection site Hyperglycemia and glycosuria Fluid overload Cerebral Haemorrhage