Common emergency drugs in medicine

COMMON
EMERGENCY DRUGS
IN MEDICINE
PRESENTED BY:
FAJUYIGBE KUNLE THOMAS
DAOMI KEHINDE MACDUFF
SHENNAIKE EVELYN ADEDOYIN
OLUSIYAN OLUWATOBI OLUSOLA

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
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
Drug Interactions:
AVANAFIL(Life Threatening Interaction)
Amlodipine
Clevidipine
Nifedipine
Verapamil
Clonidine

Sodium
Contraindications:
Hypersensitivity
Congenital (Leber's) optic atrophy
Tobacco amblyopia
 Acute congestive heart failure with reduced
peripheral vascular resistance

Sodium
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
 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
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
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
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
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
 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
 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
 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
 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
 Hypotension
 Fatigue
 Respiratory depression
 Blurred vision
 Headache
 Dysarthria

Dextrose 50%
 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%
 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.

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