DRUGS

• Regular (soluble) insulin

• It is a buffered neutral pH solution of unmodified insulin stabilized by a small amount of zinc. At
the concentration of the injectable solution, the insulin molecule self aggregate to form hexamers
around zinc ions.
• After sub-cutaneous injection, insulin monomers are released gradually by dilution, so that
absorption occurs slowly.
• Peak action is produced only after 2–3 hours and action continues upto 6–8 hours.
• When injected s.c. just before a meal, this pattern often creates a mismatch between need and
availability of insulin to result in early postprandial hyperglycaemia and late postprandial
hypoglycaemia. It is generally injected ½-1 hour before a meal.
• The slow onset of action is not applicable to i.v. injection, because insulin hexamer dissociates
rapidly to produce prompt action. Hence used in patients with diabetic ketoacidosis.
• Uses of insulin- control of blood sugars, hyperkalaemia
• Side-effects- hypoglycaemia, lipodystrophy, local reactions
• Metoprolol is the prototype of cardio selective(b1) blockers.
• Uses- Hypertension, angina, cardiac arrythmias, congestive heart failure,
• Side-effects- Bradycardia, impaired glucose levels, sudden withdrawal causes rebound
hypertension,
• Dose- 10ml of 10%w/v of calcium gluconate
• Uses- tetany, hyperkalemia
• Should be given as slow iv form over 15-20 minutes since sudden rise in
calcium levels can alter the cardiac membrane potentials leading to fatal
arrythmias.
• In tetany, it increases the plasma calcium levels thereby, improving the
symptoms
• In hyperkalemia, it stabilises the cardiac calcium channels thereby
preventing the effect of potassium through Na-K channels.
• Optineuron is a vitamin B complex injection.
• Contains 100mg thiamine (vitamin B1) , 100mg pyridoxine (vitamin B6) , 1000mcg
cyanocobalamin (vitamin B12), 5mg riboflavin (vitamin B2), 100mg nicotinamide (vitamin
B5)
• Uses- vitamin B12 deficiency- megaloblastic anemia and sub-acute combined degeneration,
pernicious anemia
• In vitamin B12 deficiency patients it is given as six 1000-µg IM injections of
hydroxocobalamin given at 3- to 7-day intervals. More frequent doses are usually used in
patients with cobalamin neuropathy. For maintenance therapy, 1000 µg hydroxocobalamin
IM once every 3 months is satisfactory.
• Thiamine deficiency causes beri-beri that is commonly seen in alcoholics and malnourished
patients.
• Dry beriberi: Neurological symptoms are prominent- polyneuritis with numbness, tingling,
hyperesthesia, muscular weakness and atrophy resulting in ‘wrist drop’, ‘foot drop’,
paralysis of whole limb, mental changes, sluggishness, poor memory, loss of appetite and
constipation.
• Wet beriberi: Cardiovascular system is primarily affected- palpitation, breathlessness, high
output cardiac failure and ECG changes. Protein deficiency is commonly associated and
adds to the generalised anasarca due to CHF.
• Replacement of thiamine deficiency is done by giving i.v. injection of 100mg of thiamine
that is initially given thrice a day followed by twice a day followed by oral replenishment.
• Adrenaline is a sympathomimetic that acts on 1, 2, 1, 2 receptors
• Ratio of 1:1000 is equivalent to 1mg/ml and 1:10000 is equivalent to 0.1mg/ml
• Uses- cardiac arrest given as i.v. in a preparation of 1:10000, anaphylaxis given as i.m. in
a preparation of 1:1000
• Side-effects- Transient restlessness, headache, palpitation, anxiety, tremor and pallor may
occur after s.c./ i.m. injection
• Marked rise in BP leading to cerebral haemorrhage, ventricular tachycardia/fibrillation,
angina, myocardial infarction are the hazards of large doses or inadvertent i.v. injection of
adrenaline
• Atropine is a parasympatholytic that blocks muscarinic receptors
• Uses- Atropine is the specific antidote for organophosphorus poisoning (anti ChE) and early
mushroom poisoning.
• All cases of anti-ChE (carbamate or organophosphate) poisoning must be promptly given atropine
2 mg i.v. repeated every 10 min till dryness of mouth or other signs of atropinisation appear
• Side- effects- Dry mouth, difficulty in swallowing and talking.
• Dry, flushed and hot skin (especially over face and neck), fever, difficulty in micturition, decreased
bowel sounds.
• Dilated pupil, photophobia, blurring of near vision, palpitation.
• Excitement, psychotic behaviour, ataxia, delirium, dreadful visual hallucinations. Hypotension,
weak and rapid pulse, cardiovascular collapse with respiratory depression. Convulsions and coma
occur only in severe poisoning.
• Furosemide is an inhibitor of Na+-K+-2Cl¯ cotransporter
• The onset of action is prompt (i.v. 2–5 min., i.m.10–20 min., oral 20–40 min) and duration
short (3–6 hours).
• It is secreted in proximal tubule by organic anion transport and reaches ascending limb of
loop of Henle where it acts from luminal side of the membrane.
• Intravenous furosemide causes prompt increase in systemic venous capacitance and
decreases left ventricular filling pressure, even before the saluretic response is apparent
• Uses- edema due to cardiac/hepatic/renal failure, acute pulmonary edema, hypertension,
hypercalcemia of malignancy
• Nitrates are vasodilators that mainly cause pre-load reduction by pooling of blood in
systemic capacitance vessels to reduce ventricular end-diastolic pressure and volume.
• With reduction in size of ventricles, effectiveness of myocardial fibre shortening in causing
ejection of blood during systole improves (Laplace relationship).
• Uses- controlled i.v. infusion of glyceryl trinitrate affords rapid relief in acute left
ventricular failure, particularly that due to myocardial ischaemia/infarction. It is indicated
when the central venous pressure (CVP) is raised and in dilated cardiomyopathy.
• Side-effects- hypotension, occurrence of nitrate tolerance
• Dexamethasone is a highly potent and highly selective glucocorticoid. It is also long-
acting, causes marked pituitary-adrenal suppression.
• It can be used topically, orally and intravenously
• Uses- acute adrenal insufficiency, cerebral edema, diagnosis of cushing’s disease, covid-
19 illness, hypercalcemia due to granulomatous diseases
• Side-effects- sodium and water retention leading to edema and hypertension, cushingoid
habitus (moon face, buffalo hump, purple striae, obesity of trunk with relatively thin
limbs), proximal muscle weakness, skin fragility, susceptibility for infections,
osteoporosis, peptic ulcer disease
• Hydrocortisone is a steroid that acts rapidly but has short duration of action. In addition to
primary glucocorticoid, it has significant mineralocorticoid activity as well.
• Used for- adrenal insufficiency as a replacement therapy, allergic reactions, status
asthmaticus, topically and as suspension for enema in ulcerative colitis
• Side-effects- sodium and water retention leading to edema and hypertension, cushingoid
habitus (moon face, buffalo hump, purple striae, obesity of trunk with relatively thin
limbs), proximal muscle weakness, skin fragility, susceptibility for infections,
osteoporosis, peptic ulcer disease
• Theophylline is a bronchodilator that belongs to methylxanthine group.
• Three distinct cellular actions of methylxanthines have been defined—
• (a) Release of Ca2+ from sarcoplasmic reticulum, especially in skeletal and cardiac
muscle.
• (b) Inhibition of phosphodiesterase (PDE) which degrades cyclic nucleotides
intracellularly.

• (c) Blockade of adenosine receptors: adenosine acts as a local mediator in CNS, CVS and
other organs—contracts smooth muscles, especially bronchial; dilates cerebral blood
vessels, depresses cardiac pacemaker and inhibits gastric secretion.
• Uses- chronic obstructive pulmonary disease and asthma
• One litre of fluid contains : Glucose 50 grams
• 5% dextrose corrects dehydration and supplies energy. After consumption of glucose,
remaining water is distributed in all compartments of body proportionately. Therefore D-
5% is the best agent to correct intracellular dehydration. It is selected when there is need
of water but not electrolytes.
• Indications-
• Widely used fluid for prevention and treatment of dehydration due to inadequate water
intake or excessive water loss.
• Cheapest fluid to provide adequate calories to body
• For pre and post-operative fluid replacement.
• For i.v. administration of various drugs.
• For treatment or prevention of ketosis in starvation, diarrhoea, vomiting and high grade
fever.
• Correction of hypernatremia due to pure water loss e.g. diabetes insipidus.·
• Contra-indications-
• Cerebral oedema- Because of its hypotonic nature 5%dextrose aggravates cerebral oedema
• Neurosurgical procedures: As 5% dextrose increases intracranial pressure, it can cause
damage during neurosurgery and so must be avoided.
• Acute ischaemic stroke : Glucose containing fluid should not be used after acute
ischaemic stroke as hyperglycemia aggravate cerebral ischaemic brain damage.
• Blood transfusion : Dextrose solution and whole blood should not be administered through
the same i.v. line as haemolysis and clumping can occur.
• Uncontrolled diabetes and severe hyperglycemia.
• One litre of fluid contains : Sodium 154 mEq and Chloride 154 mEq. Each
100ml contains : Sodium Chloride 0.90 gm
• Sodium chloride is present chiefly in extracellular fluid maintaining
osmolality of ECF. So isotonic saline is used to provide major extracellular
electrolytes
• Indications-
• Water and salt depletion as in diarrhoea, vomiting, excessive diuresis or
excessive perspiration.
• Treatment of hypovolemic shock.
• Treatment of alkalosis (e.g. vomiting) with dehydration.
• In severe salt depletion or hyponatremia when rapid correction of sodium is
necessary.
• Contra-indications-
• Cautious use or avoid in hypertensive or preeclamptic patients and in
patients with oedema due to congestive heart failure, renal disease and
• One litre of fluid contains- Glucose 50 gm Chloride 154 mEq Sodium 154 mEq
• Each 100 ml contains : Glucose 5.0 gm and Sodium chloride 0.90 gm
• This fluid has advantage of both 5% dextrose (to provide energy} and isotonic saline (to provide salt). So
DNS is useful to supply major extracellular electrolytes. (sodium and chloride) and energy along with fluid
to correct dehydration
• Indications-
• Correction of salt depletion and hypovolemia with supply of energy.
• Correction of vomiting or nasogastric aspiration induced alkalosis and hypochloremia along with supply of
calories.
• Fluid compatible with blood transfusion.
• Contra-indications-
• Anasarca : Cautious use in anasarca of cardiac, hepatic and renal disease.
• Hypovolemic shock: Not preferred in severe hypovolemic shock, when rapid replacement with larger
volume of fluid is required.
• Rapid infusion of DNS can cause hyperglycemia and osmotic diuresis even in presence of fluid deficit. So
the simple logic to use DNS for supplying salt solution to correct shock and providing energy
simultaneously is not correct.
• One liter of fluid supplies- 130 mEq sodium, 4 mEq potassium, 109 mEq chloride, 28 mEq bicarbonate
• Each 100 ·ml contains : Sodium lactate 320 mg, Sodium chloride 600 mg, Potassium chloride 40 mg. and
calcium chloride 21 mg
• Because of high sodium concentration, Ringer lactate rapidly expands intravascular volume and so it is
very effective in treatment of severe hypovolemia. Ringer's lactate is the most physiological fluid as its
electrolyte content (i.e. Na, K and Ca) 'is nearly similar to the free concentration in plasma. So even larger
amount of RL can be infused rapidly without risk of electrolyte imbalance.
• Indications-
• Correction of severe hypovolemia rapidly with large fluid volume.
• For replacing fluid in postoperative patients, burns, fractures,peritoneal irrigation etc
• Diarrhoea induced hypovolemia with hypokalemic metabolic acidosis is effectively treated. with RL. RL is
the fluid of choice for initial treatment of diarrhoea induced dehydration even in paediatric practice
• In diabetic ketoacidosis, RL provides glucose free water, so corrects metabolic acidos.is with added
advantage of supplying potassium
• For maintaining normal ECF fluid and electrolyte balance during and after surgery
• Contra-indications-
• Addisons disease
• In liver disease, severe hypoxia and shock, lactate metabolism is severely impaired.
Hence, RL can lead to lactic acidosis in such patients
• In vomiting or continuous nasogastric aspiration : Here hypovolemia·is associated with
metabolic alkalosis. As RL provides bicarbonate, it can worsen metabolic alkalosis and,
therefore, is not preferred .
• Along with blood transfusion : Calcium in RL binds. with the citrate anticoagulant in
blood transfusion. This can inactivate the anticoagulant and promote the formation of clots
in donor blood . For this reason simultaneous infusion of RL and blood product in one l.V.
line Is contraindicated.
• The calcium in RL binds with certain drugs (i.e. amphotericin, thiopental, ampicillin.,
doxycycline etc.), and reduces their bioavailability and efficiency.
• Available as 25 ml ampoule and 100 ml infusion bottle.100 ml·of 25% dextrose contains
25 gm glucose.
• Dextrose supplies energy and prevents catabolism. 25% dextrose is a concentrated form,
so it is useful when faster replacement of glucose is needed
• Indications-
• Rapid correction of hypoglycemia or hypoglycemic coma.
• To provide nutrition to patient on maintanence fluid therapy.
• For the treatment of hyperkalemia, with 10 units of regular insulin, 25%-dextrose 100 ml
is infused to prevent hypoglycemia
• Contra-indications-
• 25% dextrose is contraindicated in dehydrated patient with anuria, intracranial or
intraspinal haemorrhage and in delerium tremens.
• To be avoided in diabetic patient unless there is severe hypoglycemia.
• 3% NaCl contains 512 mEq of sodium
• 3% NaCl is mainly used for correcting severe, acute hyponatremia
• In patients with true, acute hyponatremia that present with CNS
manifestations like drowsiness, seizures this fluid is used
• Sodium should not be corrected more than 1.5-2 mEq in first 3-4 hours and
not more than 10-12 mEq in 24 hours