Hospital and clinical pharmacy

2. Life Saving and Emergency Drug
General Principle in Management of Medical Emergencie
 Check airway, breathing and circulation (ABC).
 Activate a crisis resource management plan:
Get help (e.g. other practice staff, ambulance professionals)
Assign roles (including leader, scribe, and timekeeper).
Facilitate teamwork. .
 Some history is better than no history: -
 Any drugs or allergies?
If available
Ask relatives and check medical records.
 Give oxygen supply (8 L/min)
 Intravenous drugs are generally given over 2-5 minutes

3.  Consult with an emergency dept for advice & patient transfer
 Practice safe sharps management and follow infection
control procedures.
 Take detailed notes and transcribe these to the patient's
medical record at the earliest opportunity. Keep copies of any
transfer of care letters.
 Arrange debriefing as appropriate for the patient (or
relatives) and for those involved in managing the emergency.
 Continuous assessment and management until stable.
 Observe patient once stable (especially if sedative drugs have
been administered).

4. Drugs Used in Anaphylactic Shock
1. Adrenergic Drugs: Epinephring(adrenaline).
2. Antihistamines: combination of H1- and H2-antagonists:
H1-antagonist: Diphenhydramine, hydroxyzine.
H2-antgonist: Cimetidine, ranitidine, famotidine.
3. Bronchodilators: Albuterol.
4. Corticosteroids: Prednisolone, methylprednisolone.
5. Positive Inotropic Agents: Glucagon.
6. Vasopressors: Dopamine.

5. Drugs used in Myocardial Infraction & Cardiogenic
Shock
1. Adrenergic agonist: Norepinephrine (noradrenaline).
2. Adrenergic activator: Isoproterenol.
3. alfa-and Beta-adrenergic activator: Dopamine,
dobutamine.
4. Cardioglycoside: Digitalis, digoxin.
5. Positive inotropic agents: Glucagon.
6. Vasodilator: Chlorpromazine and phentolamine.

6. Drugs Used in Peripheral Circulatory Collapse
1. Adenosine A1-antagonist: Pentoxifylline.
2. Platelet aggregation inhibitor: Cilostazol.
3. Antiplatelet agents: Aspirin, ticlopidine, clopidogrel.
4. Anticoagulant agents: Heparin, warfarin, enoxaparin.
5. Thrombolytics: Urokinase, streptokinase, alteplase,
reteplase
Drugs Used in Status Epilepticus
1. Benzodiazepines: Lorazepam, diazepam, midazolam.
2. Anticonvulcents: Phenytoin, fosphenytoin, valporic acid
3. Barbiturates: Phenobarbital, thiopental, pentobarbital
4. Anaesthetics: Propofol, ketamine.

7. Medicines for Hypertensive Crisis
 Class Ca2+ channel blocker = Nicardipine
 alfa & beta blocker Labetalol
 Beta-blocker = Esmolol
 Vasodilator = Hydralazine Sodium nitroprusside
 ACE inhibitors = Enalaprilat

8.  Antisnake Venom
 ASV is immunoglobulin (usually the enzyme refined F(ab)2
fragment of IgG) purified from the serum or plasma of a
horse or sheep that has been immunized with the venoms of
one or more species of snake
 1 ml of ASV neutralizes:
Cobra-0.6 mg Russels viper-0.6 mg
Common krait-0.45mg Saw scaled viper-0.45 mg

9. ASV administration:
 No ASV test dose must be administered.
 Recommended initial dosages are 100 ml (10 vials) of
polyvalent ASV for adults & children
 Initial dose must be calculated to neutralize the average
dose of venom injected.
1. Range of venom injected - 5mg to 147 mg
2. Suggested ASV dose = 100 to 250 ml
 Initial dose of 100 ml must be diluted in 100 ml of NS &
given over 1 hour.
 Patient should be carefully monitored for 2 hrs.
 Local administration of ASV near the bite site- SHOULD
NOT BE DONE