10 EMERGENCY DRUGS

SUBMITTED TO: SIR RODERICK ORTEGA SUBMITTED BY: CECILE ANN N. ESTEBAN

Generic Name Atropine Sulfate

Brand Name AtroPen, Sal-Tropine Anespin Isopto Atropine

Pharmacokinetics Absorption: Well absorbed after oral administration, IM injection, inhalation, or endotracheal administration. Distribution: Well distributed throughout the body and crosses into the CNS, across the placenta, and can distribute into the milk in small quantities. Metabolization: In the liver Elimination: Excreted into the urine. Approximately 30-50% of a dose is excreted unchanged into the urine. Half life: The plasma half-life in humans has been reported to be between 2-3 hours. Peak: After IV administration, peak effects in heart rates occur within 3-4 minutes. Absorption: Epinephrine is well absorbed following IM or SQ administration. IM injections are slightly faster absorbed than SQ administration. Distribution: Does not cross the blood-brain barrier, but does cross the placenta and is distributed into milk. Metabolization: In the GI tract and liver after oral administration and is not effective via this route. Metabolism takes place in both the liver and other tissues by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) to inactive metabolites. Epinephrines actions are ended primarily by the uptake and metabolism of the drug into sympathetic nerve endings. Onset: Following SQ injection, the onset of action is generally within 5-10 minutes.

Structural Formula

Epinephrine hydrochlori de

Insect-sting emergencies: EpiPen AutoInjector (delivers 0.3 mg IM adult dose), EpiPen Jr. AutoInjector (delivers 0.15 mg IM for children) OTC solutions for nebulization: AsthmaNefrin, microNefrin, Nephron, S2

Dobutamine Dobutrex Hydrochlori Cardomin de Dobucard

Metabolism: Metabolized rapidly in the liver and other tissues and has a plasma half-life of approximately 2 minutes in humans. Onset: 2 minutes Peak: 10 minutes

Dopamine Hydrochlori de

Intropin Revimine Dopaqard

Distribution: Dopamine can travel to various parts of the body and is thus widely distributed. Despite this fact, dopamine does not cross the blood-brain barrier. Metabolization: Dopamine is metabolized, or broken down, in the liver, kidneys and plasma. It is broken down into other substances, such as homovanillic acid. Elimination: Homovanillic acid and other derivatives of dopamine are excreted in the urine. Half-life: Dopamine has a half-life of two minutes. This means that two minutes after administering this drug, only half the administered dosage will be left in the body.

Sodium Bicarbonate

Arm and Hammer Pure Baking Soda, Citrocarbonate, Soda Mint Hospira

Sodium bicarbonate in water dissociates to provide sodium (Na+) and bicarbonate (HC03-) ions. Sodium is the principal cation of the extracellular fluid. Bicarbonate is a normal constituent of body fluids and the normal plasma level ranges from 24 to 31 mEq/L. Plasma concentration is regulated by the kidney. Bicarbonate anion, at a proper concentration of hydrogen ion (H+), may be converted to carbonic acid (H2CO3), then to its volatile form, carbon dioxide (CO2) excreted by the lung. Normally, a ratio of 1:20 (carbonic acid:bicarbonate) is present in the extracellular fluid. In a healthy adult with normal kidney function, practically all the glomerular filtered bicarbonate ion is reabsorbed; less than 1% is excreted in the urine.

Furosemide

ApoFurosemide, Furosemide Special, Lasix

Absorption: Mean bioavailability is 64% with the tablet and 60% with the oral solution. Distribution Protein binding is 91% to 99% (albumin). Metabolism The major metabolite is furosemide glucuronide. Elimination The t 1/ 2 is about 2 h; furosemide is excreted in urine. Onset: PO 1 h, IV 5 min. Peak: PO 1 to 2 h, IV 30 min. Duration: PO 6 to 8 h, IV 2 h.

Adenosine

Cardiovert

Half-life: Normal: 0.6-1.5 seconds Metabolism: Intracellular adenosine is rapidly metabolized either via phosphorylation to adenosine monophosphate by adenosine kinase, or via deamination to inosine by adenosine deaminase in the cytosol.

Naloxone

Narcan

Absorption: Naloxone is only minimally absorbed when given orally as it is rapidly destroyed in the GI tract. Distribution: Naloxone is distributed rapidly throughout the body with high levels found in the brain, kidneys, spleen, skeletal muscle, lung and heart. The drug also readily crosses the placenta. Metabolism: Naloxone is metabolized in the liver, principally via glucuronidative conjugation with metabolites Elimation: Excreted into the urine. In humans, the serum half-life is approximately 60-100 minutes. Onset: When given IV - 1-2 minutes If given IM - 5 minutes Duration: From 45-90 minutes, but may act for up to 3 hours. Absorption: Midazolam is rapidly absorbed following IM administration with a bioavailability >90%. Distribution: Midazolam is widely distributed in the body including cerebrospinal fluid and brain. It is extensively bound to plasma proteins (97%). Metabolism: Midazolam is rapidly metabolized to 1-hydroxymethyl midazolam and 4-hydroxy midazolam. The pharmacological activity of these metabolites is negligible as compared to that of the parent compound. Elimination: Midazolam is excreted mainly through the renal route as glucuronide conjugates. Less than 0.03% of an IV dose is excreted unchanged. The elimination t of midazolam is about 2.5 hrs. Peak: Via IM injection: The peak plasma effect is reached within 1560 min Metabolization: Lidocaine is approximately 95% metabolized (dealkylated) in the liver by CYP3A4 to the pharmacologicallyactive metabolites monoethylglycinexylidide(MEG X) and then subsequently to the inactive glycine xylidide. Elimination: The elimination half-life of lidocaine is approximately 90120 minutes in most patients. This may be prolonged in patients

Midazolam Hydrochlori de

Apo-Midazolam Sedoz

Lidocaine

Xylocaine

with hepatic impairment(average 343 minutes) or congestive heart failure (average 136 minutes)