COMMON EMERGENCY

DRUGS IN MEDICINE
PRESENTED BY:
JUSTIN CARAG
 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
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
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.
List of Drugs
  Atropine
  Sodium Nitroprusside
  Amiodarone
  Aminophylline
  Mannitol
  Magnesium Sulfate
  Epinephrine
  Hydrocortisone
  Heparin
  Diazepam
  Dextrose 50%
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.
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.
Atropine
Drug Interactions:
 The effect of the drug increases with
 Quinidine (Antiarrhythmic)
 Amitriptyline (Antidepressants)
 Diphenhydramine (antihistamine)
 Meclizine (antihistamine)
Atropine
Contraindications
 Narrow Angle Glaucoma
 Pyloric Stenosis
 Prostatic Hypertrophy
 Thyrotoxicosis
 Cardiac Failure
 Tachycardia
 Atropine
Adverse effects of drug:
 Palpitation
 Dry mouth
 Blurred vision
 Urinary retention and constipation
 Tachycardia
 Dysphagia
 Arrhythmias
 Hallucinations
 Raise intraocular pressure
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 administered
so that the duration of treatment with sodium
nitroprusside can be minimized
Dosage: 0.5-10 mcg/kg/min IV infusion
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
Sodium Nitroprusside(Nitropress)
 Drug Interactions:
AVANAFIL(Life Threatening Interaction)
Amlodipine
Clevidipine
Nifedipine
Verapamil
Clonidine
Sodium Nitroprusside(Nitropress)
Contraindications:
 Hypersensitivity
 Congenital (Leber's) optic atrophy
 Tobacco amblyopia
 Acute congestive heart failure with reduced
peripheral vascular resistance
Sodium Nitroprusside(Nitropress)
Adverse Effects
Excessive hypotension
Cyanide Toxicity
Thyroid Suppression
Thiocyanate Poisoning
Metabolic Acidosis
Raised intracranial Pressure
Bowel Obstruction
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
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
Amiodarone
Interactions:
Cimetidine: inhibits CYP3A4 and can increase serum
amiodarone levels
Warfarin
Dofelitide
Amitriptyline
Propanolol
Digoxin
Amiodarone
Contraindications:
Hypersensitivity
2nd or 3rd degree AV block
Cardiogenic Shock
Severe sinus node dysfunction
Avoid during breastfeeding
Amiodarone
Adverse Effects:
Hypotension
AV BLOCK
Congestive Heart Failure
Bradycardia
Cardiogenic Shock
Impaired Memory……..etc
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
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).
Aminophylline
Interactions:
Dipyridamole
Febuxostat
Riociguat
Cimetidine
Ciprofloxacin
Cigarrete smoking
Aminophylline
 Contraindications:
Hypersensitivity
Active peptic ulcer disease
Underlying uncontrolled seizure disorder
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)
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
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
Mannitol
 Drug interaction
Tobramycin
Lurasidone
Nitroglycerin
Trobramycin inhaled
Mannitol
 Contra-indication
Pulmonary oedema
Severe congestive heart failure
Severe dehydration
Renal failure
Mannitol
 Adverse effect
Fluid and electrolyte imbalance
Circulatory overload
Chills
Fever
chest pain
Acute renal failure(Large doses)
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
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
Magnesium Sulfate
 Interactions:
Doxycycline
Tetracycline
Minocycline
Ciprofloxacin
Magnesium Sulfate
 Contraindication:
Hypersensitivity
Myocardial damage
Heart block
Hypermagnesemia
Hypercalcemia
Pregnancy Category: D
Magnesium Sulfate
 Adverse Effects:
Circulatory Collapse
Respiratory paralysis
Hypotension
Flushing
Depressed cardiac function
Drowsiness
HEPARIN
 Indications And Dosage:
INDICATION ;Deep Vein Thrombosis ,thrombosis,
emboli, unstable angina
Dose ;Treatment of deep-vein thrombosis and
pulmonary embolism ; 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.
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
HEPARIN
 Interactions:
Interaction;
Argatroban
Bivalirudin
Dabigatran
Desirudin
HEPARIN
 Contraindication:
Haemophilia
Thrombocytopenia
Peptic ulcer
Cerebral haemorrhage
Severe hypertension
Renal & liver disease
HEPARIN
 Adverse Effects:
Heparin Induced Thrombocytopenia
Hematoma
Hemorrhage
Erythema
Immune hypersensitivity reaction
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.
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.
Epinephrine
 Drug Interactions:
 Tranylcypromine
 Quinidine
 Amiodarone
 Amitriptyline
 Chlorpromazine
 Phenelzine
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.
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.
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.
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.
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.
Hydrocortisone
 Contraindications:
  Premature infants
  Systemic fungal infections
  Hypersensitivity
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
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.
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
Diazepam
 Drug interactions:
 Sodium Oxybate
 Carbamezipine
 Cimetidine
 Clamithromycin
 Rifampin
Diazepam
 Contraindications:
 Hypersensitivity
 Acute alcohol intoxication
 Children < 6 months
 Breastfeeding
 Sleep Apnea
 Severe Respiratory Depression
Diazepam
 Adverse effects of the drug:
 Hypotension
 Fatigue
 Respiratory depression
 Blurred vision
 Headache
 Dysarthria
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.
Dextrose
 50% Drug interaction:
 Minor interactions include:
 Magnesium Chloride
 Magnesium citrate
 Magnesium Hydroxide
Dextrose
 50% Contrainidications:
 Hyperglycemia
Anuria
Intracranial or Intraspinal haemorrhage
Diabetic coma
Dextrose
 50% Adverse effects of the drug:
 Hyperosmolarity
 Edema
 Phlebitis at injection site
 Hyperglycemia and glycosuria
 Fluid overload
 Cerebral Haemorrhage
References:
  Baynes, J., Dominiczak, M., Medical Biochemistry. Elsevier
Limited; Third Edition (2009)
  Goodman E (2010). Ketchum J, Kirby R. ed. Historical
Contributions to the Human Toxicology of Atropine. Eximdyne. pp.
120.
  Britto MR, Hussey EK, Mydlow P, et al. Effect of enzyme inducers
on ondansetron (OND) metabolism in humans. Clin Pharmacol
Ther 1997;61:228.
  Villikka K, Kivisto KT, Neuvonen PJ. The effect of rifampin on the
pharmacokinetics of oral and intravenous ondansetron. Clin
Pharmacol Ther 1999;65:377-381.
  Bryan E, Bledsoe; Robert S. Porter, Richard A. Cherry (2004). "Ch.
3". Intermediate Emergency Care. Upper Saddle River, NJ: Pearson
Prentice Hill. pp. 26.
☻Thank you ☻