COMMON EMERGENCY

DRUGS IN CCU

PRESENTED BY:
RANJITA BEURA, M.Sc. In M.S.N
C/I , COLLEGE OF NURSING,
BERHAMPUR.
OUT LINES OF EMERGENCY DRUGS
 Introduction
 Purpose of Emergency Drugs
 Principles 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 broad
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.
 PRINCIPLES
7Rs – rt.patient , rt.drug, rt,dose , rt.rout,
rt.methods ,rt.time rt.documentation.
 Medications are administered by the registered nurse
or the person permitted by the law.
 Prepared medications are labeled prior to preparation
of a second drug.
 Patient is identified prior to administration.
 Medication is verified from the order prior to
administration
 High risk medications are well defined and care with
custody.
 Audit of prescribed medication about rational of
prescription.
 Expiry dates are checked prior to
dispensing/administering the drug.
 Patients are monitored after medication
administration.
 Refer policies and procedure guide for use of
narcotic drugs and psychotropic substances
 The drugs are handled by appropriate and
responsible personnel in accordance with the
documented procedure.
Medications are stored in a clean, safe and secure
environment, and incorporating manufacturer’s
recommendation.
Known drug allergies are ascertained before
prescribing/administering
EmergeThe list of emergency medications are
defined and stored in a uniform manner.
Emergency medications are replaced immediately
in the sub stock after use in order to meet the crisis
Orders are written only by the registered person
Medication orders are clear, legible, dated , timed ,
named , signed ,in a uniform location of drug book/
chart.
 LIST OF DRUGS
 Adenosine
 Atropine
 Albuterol
 Sodium Nitroprusside
 Amyl nitrite
 Amiodarone  Aspirin
 Aminophylline  Atenolol
 Mannitol  Calcium chloride
 Magnesium Sulfate  Digoxin (lanoxin)
 Epinephrine  Dobutamine hydrochloride
 Hydrocortisone (dobutrex):-
 Heparin  Diphenhydramine
 Diazepam  Dopamine hydrochloride
 Dextrose 50% (intropin)
 Glucagon (glucagen):  Furosemide (lasix)
 Morphin  Lidocaine 2%
 1.ATROPINE
Indications and dose :
 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.
 CONT…

Mechanism of Action:
 It competitively blocks the muscarinic
receptors(mAChRs/acetylecholine) 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.
Drug Interactions:
 The effect of the drug increases with-
 Quinidine (Antiarrhythmic)
 Amitriptyline (Antidepressants)
 Diphenhydramine (antihistamine)
 Meclizine (antihistamine)
Contraindications
 Narrow Angle Glaucoma
 Pyloric Stenosis
 Prostatic Hypertrophy
 Thyrotoxicosis
 Cardiac Failure
 Tachycardia
Adverse effects of drug:
 Palpitation
 Dry mouth
 Blurred vision
 Urinary retention and constipation
 Tachycardia
 Dysphagia
 Arrhythmias
 Hallucinations
 intraocular pressure
2.SODIUM
NITROPRUSSIDE(NITROPRESS)
Indications and Dose of the drug:
Immediate BP of hypertensive patients.
Dosage: 0.5-10 mcg/kg/min IV infusion.

Mechanism Of Action:
The principal pharmacological action is relaxation
of vascular smooth muscles
consequent dilatation of peripheral arteries and
veins by producing Nitric Oxide thus reducing
preload and after load
Drug Interactions:
Amlodipine(Calcium channel blocker)
Clevidipine
Nifedipine
Verapamil
Clonidine(Alpha angonist hypotensive agent)
Contraindications:
Hypersensitivity
Congenital (Leber's) optic atrophy
Tobacco amblyopia ( nutrional central vision loss)
 Acute congestive heart failure with reduced
peripheral vascular resistance
Adverse Effects
Excessive hypotension
Cyanide Toxicity
Thyroid Suppression
Thiocyanate Poisoning
Metabolic Acidosis
Raised intracranial Pressure
Bowel Obstruction
 3.AMIODARONE(cordarone)
Indication and doses:
Frequently recurring ventricular fibrillation 
Hemodynamically unstable ventricular tachycardia
 I.V use for 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
Mechanism of Action:
Amiodarone is a class III antiarrhythmic, which inhibits
adrenergic stimulation;
affects Na+, K+ and Ca channels; markedly prolongs action
potential and repolarization and AV conduction and SA node
function
Interactions:
Cimetidine: inhibits CYP3A4 and can increase serum
amiodarone levels
Warfarin
Dofelitide( class – III antiarrhythmaic agent )
Amitriptyline (tricyclic antidepressant)
Propanolol
Digoxin
Contraindications:
Hypersensitivity
2ndor 3rd degree AV block
Cardiogenic Shock
Severe sinus node dysfunction
Avoid during breastfeeding

Adverse Effects:
Hypotension
AV BLOCK
Congestive Heart Failure
Bradycardia
Cardiogenic Shock
Impaired Memory……..etc
 4.AMINOPHYLLIN
E
Indications and Doses:
 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

Mechanism Of Action:
 smooth muscle relaxation (i.e., bronchodilation)
 suppression of the response of the airways to
stimuli (i.e., non-bronchodilator prophylactic effects).
Interactions:
Dipyridamole
Febuxostat
Riociguat
Cimetidine
Ciprofloxacin
Cigarrete smoking
Contraindications:
Hypersensitivity
Active peptic ulcer disease
Underlying uncontrolled seizure disorder
Adverse Effect:
Serum Concentration< 20mcg/ml
Diarrhea,Nausea,Vomiting
Diuresis
Exfoliative Dermatitis
Skeletal Muscle Tremors
Tachycadia, Flutter
Serum Concentration>30mcg/ml
A.M.I
Seizures(resistant to anticonvulsants)
 5.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
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
Drug interaction
Tobramycin
Lurasidone( anti psychotic )
Nitroglycerin
Trobramycin inhaled
Contra-indication
Pulmonary oedema
Severe congestive heart failure
Severe dehydration
Renal failure

Adverse effect
Fluid and electrolyte imbalance
Circulatory overload
Chills
Fever
chest pain
Acute renal failure(Large doses)
 6.MAGNESIUM SULFATE
Indications and Dosage:
Convulsions (treatment) - I.V magnesium sulfate
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 injection may be given
I.V in 10% to 20% solution
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
membranes
Interactions:
Doxycycline
Tetracycline
Minocycline
Ciprofloxacin
Contraindication:
Hypersensitivity
Myocardial damage
Heart block
Hyper magnesemia
Hyper calcemia
Pregnancy Category: D( evidence of positive fatal
risk to mother)
Adverse Effects:
CirculatoryCollapse
Respiratory paralysis
Hypotension
Flushing
Depressed cardiac function
Drowsiness
 7.HEPARIN
Indications And Dosage:
D.V.T thrombosis, pulmonary emboli, unstable angina
Treatment of D.V.T and pulmonary embolism ; by inj.
Adult loading dose of 500units (in severe pulmonary
embolism 1000 units)
Prophylaxis in general surgery ,by S/C inj. Adult
2000units before surgery and then every 8-12hrs for 7
days.
Mechanism Of Action:

Prevents blood clotting by its anti thrombin

activity. It directly suppresses the activity of thrombin
Combines with anti thrombin 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.
Interactions:
Argatroban
Bivalirudin
Dabigatran
Desirudin
Contraindication:
Haemophilia
Thrombocytopenia
Peptic ulcer
Cerebral haemorrhage
Severe hypertension
Renal & liver disease

Adverse Effects:
Heparin Induced Thrombocytopenia
Hematoma
Hemorrhage
Erythema
Immune hypersensitivity reaction
 8.EPINEPHRI
NE
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, BP, Mydriasis(dilation of pupil)

à2-receptors Inhibits the release of noradrenaline, acetylcholine and

insulin
ß1-receptors Tachycardia, lipolysis, myocardial contractility .

ß2-receptors Vasodilation, bronchodilation, relaxes uterine smooth

muscle.
Indication and doses:
 Cardiac Arrest: 1mg IV of 1:10000 solution every 3-5
minutes or iv bolus(10ml)
 Anaphylaxis (type 1): I.V bolus, 0.5-1.0ml, may be
repeated when necessary
 Refractory bradycardia and hypotension:
2-10mcg/min.
 Asthma: 0.1-0.3mg S/C or IM of 1:10,000 solution.

Drug Interactions:
 Tranylcypromine(non selective & irreversible
monoamine oxidase inhibiter/anti depresant )
 Quinidine ( antiarrhythmic)
 Amiodarone
 Amitriptyline( antideprssant)
 Chlorpromazine
 Phenelzine

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
Adverse effects of the drug:
 CNS: anxiety, fear, tension, headache, and
tremor.
 Hemorrhage: It may induce cerebral hemorrhage
and marked elevation of B.P
 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.
 9.HYDROCORTISON
E
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
granulocytes and macrophages and reduce
the release of vasoactive kinins(locally acting).
 It also inhibit the release of destructive
enzymes that attack the injury debris and
destroy normal tissue indiscriminately.
Indication and doses:
 Acute adeno cortical 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.
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.
Contraindications:
 Premature infants
 Systemic fungal infections
 Hypersensitivity

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
 10.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 hyper polarization, this induces a
neuronal inhibition which results in its sedative
action.
Indication and doses:
 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
Drug interactions:
 Sodium Oxybate
 Carbamezipine
 Cimetidine
 Clamithromycin
 Rifampicin

Contraindications:
 Hypersensitivity
 Acute alcohol intoxication
 Children < 6 months
 Breastfeeding
 Sleep Apnea
 Severe Respiratory Depression
Adverse effects of the drug:
 Hypotension
 Fatigue
 Respiratory depression
 Blurred vision
 Headache
 Dysarthria
 11.DEXTROSE 50%
Indication and doses:
 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.
Drug interaction:
Minor interactions include:
 Magnesium Chloride
 Magnesium citrate
 Magnesium Hydroxide

Contrainidications:
 Hyperglycemia
 Anuria
 Intracranial or Intraspinal haemorrhage
 Diabetic coma
Adverse effects of the drug:
 Hyperosmolarity
 Edema
 Phlebitis at injection site
 Hyperglycemia and glycosuria
 Fluid overload
 Cerebral Haemorrhage
12.DIGOXIN
(LANOXIN)
Mechanism of action
Increases force of myocardial contraction
Indications
Congestive heart failure,
 SVTs,(supra ventricular tachycardia)
ventricular rate control in atrial flutter and
atrial fibrillation
Contraindications
Ventricular fibrillation,
 ventricular tachycardia,
digitalis toxicity
Pregnancy safety: Category C
Patient receiving IV digoxin
Adverse effect of drug
Fatigue,
headache,
 blurred yellow or green vision,
seizures
13.DOBUTAMINE
HYDROCHLORIDE
(DOBUTREX)
 Mechanism of action
Increased myocardial contractility,
stroke volume, and increased cardiac
output
 Indications
Cardiogenic shock,
CHF
Contraindications
Tachydysrhythmias,
Severe hypotension
Pregnancy safety: Category B
Adverse effect
Headache,
Dyspnea,
 Tachycardia,
 Hypertension,
 Chest pain
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.