EMERGENCY DRUGS FOR EMERGENCY DRUGS FOR

POISONING CARDIAC DISORDERS

EMERGENCY DRUGS FOR EMERGENCY DRUGS FOR SHOCK
NEUROSURGICAL DISORDERS
EMERGENCY DRUGS FOR HYPERTENSIVE
CRISES AND PULMONARY EDEMA
 NITROGLYCERIN
A: Dilates coronary arteries and improves blood flow.
I: Treatment of choice for ANGINA PECTORIS (chest pain) &
MYOCARDIAL INFARCTION (heart attack).
CI: Hypersensitivity, hypotension, uncorrected hypovolemia.
SE: Hypotension, Tachycardia.
NR: Assess location, duration, intensity & precipitating factors of chest
pain. ; Monitor heart rate.

MORPHINE SULFATE
A: Dilates venous vessels, reduces the workload on the heart.
I: A narcotic agent used to treat CHEST PAIN associated with an AMI.
CI: Hypersensitivity, pregnancy, epilepsy, anastomoses
SE: Respiratory distress, Hypotension
NR: Assess pain; location, type, character, intensity. ; Monitor intake &
output status.
***ANTIDOTE: Naloxone (Narcan)
ATROPINE SULFATE
A: To increase heart rate by inhibiting the action of the vagus nerve.
I: Treatment for significant BRADYCARDIA (slow heart rate) & some types
of HEART BLOCK (AV block at nodal level).
CI: Hypersensitivity, narrow-angle glaucoma, tachycardia, renal disease.
SE: Cardiac dysrrythmias, Tachycardia, Myocardial ischemia,
Restlessness, Anxiety, Mydriasis, Thirst, Urinary retention.
NR: Monitor cardiac rate, rhythm & character. ; Monitor respirator status. ;
Monitor intake & output ratio.

ISOPROTERENOL
A: To increase heart rate
I: Given to client with refractory hemodynamically significant
BRADYCARDIA.
SE: Myocardial ischemia, Tachycardia, Life-threatening dysrrythmias.
NR: Monitor heart rate BP.

VERAPAMIL ( Isoptin )
A: It slows conduction (negative chronotropic) through the heart and has
negative inotropic and vasodilating effects.
I: Treatment of NARROW COMPLAEX PAROXYSMAL
SUPRAVENTRICULAR TACHCARDIA (PSVT) is alternative to adenosine
in clients with normal blood pressure and adequate left ventricular function.
CI: Simultaneous use of calcium channel blockers and beta-blockers,
preexisting heart block or sick sinus syndrome in the client without a
pacemaker, Wolff-Parkinson-White syndrome and heart failure.
SE: Cardiac conduction disturbances, Profound hypotension.
NR: Carefully monitor heart rate & rhythm as well as blood pressure.
 ADENOSINE
A: Slows impulse conduction through the heart’s atrioventricular node,
interrupts dysrhythmia-producing reentry pathways, & restores normal
rhythm in clients with PSVT.
I: First-line drug of choice to treat PAROXYSMAL SUPRAVENTRICULAR
TACHYCARDIA (PSVT).
CI: With poison- or drug-related tachycardia, second- and third-degree
heart block, clients with sick sinus syndrome, except those with functioning
pacemakers.
SE: Transient, Ventricular ectopy, Bradycardia, Flushing, Chest pain,
Dyspnea.
NR: Continuous cardiac monitoring. ; Frequent assessment of vital signs.

DILTIAZEM ( Cardizel )
A: To slow the ventricular response rate in arterial fibrillation or flutter.
I: Treat PSVT.
CI: Simultaneous use of calcium channel blockers and beta-blockers,
preexisting heart block or sick sinus syndrome in the client without a
pacemaker, Wolff-Parkinson-White syndrome and heart failure.
SE: Arrhythmias, Bradycardia, Heart block, Hypotension.
NR: Must carefully monitor blood pressure, heart rate and rhythm.

AMIODARONE
A: It has alpha- and beta-adrenergic blocking effects and acts on sodium,
potassium, and calcium channels.
I: Treatment of LIFE-THREATENING DYSRHYTHMIAS & CARDIAC
ARREST, pulse less, ventricular tachycardia and ventricular fibrillation,
hemodynamically stable ventricular tachycardia, PSVT refractory to
adenosine, ventricular rate control in atrial fibrillation and for pharmacologic
treatment of atrial fibrillation.
CI: Severe sinus-node dysfunction, second- or third-degree AV block,
hypersensitivity.
SE: Hypotension, Bradycardia.
NR: Slow the infusion rate to prevent or treat the adverse effects. ; Be
prepared to administer IV fluids, vasopressors and agents to increase heart
rate.

LIDOCAINE
A: Decreases automaticity, increases electrical threshold of ventricle.
I: Drug of choice for PREMATURE VENTRICULAR CONTRACTIONS.
Treat VENTRICULAR DYSRHYTMIAS (irregular heart beats),
VENTTRICULAR TACHYCARDIA, and VENTRICULAR FIBRILLATION.
CI: Hypersensitivity advanced atrioventricular block, CAUTION: Liver
disease, Heart failure, Elderly.
SE: Lidocaine toxicity such as confusion, drowsiness, hearing impairment,
cardiac conduction defects, myocardial depression, muscle twitching and
seizures.
NR: Continuous cardiac monitoring & assessment for signs and symptoms
of lidocaine toxicity.
 PROCAINAMIDE
A: An antidysrhythmic agent.
I: For VENTRICUALR TACHYCARDIA, PVCs, & RAPID
SUORAVENTRICULAR DYSRHYTHMIAS unresponsive to adenosine.
CI: Clients with torsades de pointes, an unusual polymorphic ventricular
tachycardia often associated with prolonged Q-T interval.
SE: Severe hypotension, Heart block, Rhythm disturbances, Cardiac
arrest.
NR: Monitor the vital signs & the ECG with particular attention to heart rate
and rhythm, as well as blood pressure &the width of the QRS complex.

MAGNESIUM SULFATE
A: May decrease acetylcholine released by nerve impulses, but
anticonvulsant mechanism is unknown.
I: Drug of choice for the treatment of TORSADES DE POINTES. Indicated
for clients with REFRACTORY VENTRICULAR TACHYCARDIA,
REFRACTORY VENTRICULAR FIBRILLATION, CARDIAC ARREST
associated with HYPOMAGNESEMIA (low serum magnesium level), and
LIFE-THREATENING VENTRICULAR DYSRHYTHMIAS from digitalis
toxicity.
CI: Patients with heart block or myocardial damage.
SE: Hypotension, Mild Bradycardia, Flush, Sweating.
NR: Monitor RR. ; Monitor for signs of magnesium toxicity like
disappearance of knee-jerk patellar reflexes.

EPINEPHRINE
A: A catecholamine with alpha- and beta-adrenergic effects.
I: Indicated to clients with PROFOUND BRADYCARDIA &
HYPOTENSION, ASYSTOLE, PULSELESS VENTRICULAR
TACHYCARDIA, & VENTRIBULAR FIBRILLATION. To improve
PERFUMOSION OF THE HEART & BRAIN in CARDIAC ARREST
STATES.
SE: Myocardial ischemia, Cardiac dysrhythmias.
NR: Constant cardiac & hemodynamic monitoring.

VASOPRESSIN
A: It increases coronary artery perfusion during cardiopulmonary
resuscitation (CPR) & to exhibit vasopressors effects.
I: Treatment for VENTRICULAR FIBRILLATION that is refractory to
defibrillation.
CI: Responsive clients who have coronary artery disease (CAD), that is,
clients with CAD who are not in cardiac arrest.
SE: Myocardial ischemia, Angina.
NR: Monitor vital signs. ; Monitor intake & output.
 SODIUM BICARBONATE
A: Reverses metabolic acidosis neutralizes gastric acid, which form water,
NaCl, CO2, raises blood pH.
I: Treat the METABOLIC ACIDOSIS that may accompany CARDIAC
ARREST & the HYPERKALEMIA & ACIDOTIC STATES to specific drug
overdose situations.
CI: Hypoventilation, Hypocalcaemia, severe kidney insufficiency.
SE: Hypernatremia, Serum hyperosmolarity.
NR: Careful monitoring of arterial blood gas analysis results.

NITROGLYCERIN
SL: 0.3-0.4 mg
Translingual aerosol spray: 0.4 mg-meterd dose, up to 3 sprays in 15
min onto or under the tongue
IV: 10-20 mcg/min, increased 5-10 mcg/min q5-10 min (titrated)

MORPHINE SULFATE
IV: 1-4 mg q 5-30 min

ATROPINE SULFATE
IV or IO: 0.5-1 mg; can repeat up to 0.04 mg/kg or 3 mg (max)

ISOPROTERENOL
IV: 1mg diluted in 250 ml of 5% dextrose water or normal saline, at 2-
10 mcg/min titrated to heart rate

ADENOSINE
Adult IV: initially 6 mg then 12mg in 1-2 min if needed; may repeat
12mg x 1

VERAPAMIL ( Isoptin )
IV: age & weight dependent dosages; should not exceed 5mg; repeat
doses may be needed to max of 20 mg-30 mg

DILTIAZEM ( Cardizel )
IV: 0.25mg/kg; repeat in 15 min at 0.35 mg/kg
IV: drip 5-15 mg/h
 AMIODARONE
Adult IV with pulse: 150 mg over 10 min; then continuous infusion 1
mg/min for 6 h; then 0.5 mg/min over 18 h
Cardiac arrest: 300 mg diluted in 20-30 ml D5W rapidly followed by
continuous infusion as above; max: 2.2 g/d
Child IV without pulse: 5 mg/kg rapid IV. IO bolus
Child IV with pulse: 5 mg/kg IV/IO loading dose over 20-60 min;
repeated to max daily dose of 15 mg/kg

LIDOCAINE
Adult IV/IO: 1-1.5 mg/kg; may repear0.5 mg/kg q 5-10 min up to 3
mg/kg (max)
ETT*: 2-4 mg/kg
Child IV/IO: initially 1 mg/kg; maintenance 20-50 mcg/kg/min is
recommended after bolus
ETT*: 2-3 mg/kg

PROCAINAMIDE
IV: 20 mg/min; max: 17 mg/kg

MAGNESIUM SULFATE
Dilute 1-2 g (2-4 ml of a 50% solution) in 10 ml of D5W. Give IV/IO in
cardiac arrest over 5-20 min
Torsades de pointes: 1-2 g diluted in 50-100 ml of D5W given IV over
EPINEPHRINE
IV/IO: 0.5-1 mg; may be repeated q 3-5 min
ETT: 2.0-2.5 mg diluted in 10 ml normal saline

VASOPRESSIN
Adult IV/IO/ETT: single 40-units dose after epinephrine administration

SODIUM BICARBONATE
IV: initially 1 mEq/ kg; then 0.5 mEq/kg if needed q 10 min
 MANNITOL
A: Inhibition of reabsorption of electrolytes and water by affecting pressure
of glomerular filtrate.
I: Treat CEREBRAL EDEMA & INCREASED INTRACRANIAL
PRESSURE.
CI: Hypersensitivity, severe dehydration, CAUTION: Pregnancy,
breastfeeding, current intracranial bleeding.
SE: Temporary volume expansion, Hypo/Hpernatremia,
Hypo/Hyperkalemia, Dehydration, Blurred vision, Dry mouth
NR: Assess fluid volume status. ; Assess BP.

METHYLPREDNISOLONE
A: Reverses increased capillary permeability.
I: An option to clients with TRAUMATIC SPINAL CORD INJURIES.
CI: Hypersensitivity, penetrating trauma to the spinal cord, HIV infection,
severe infection, spinal cord injury more than 8 hour old, Pregnancy and
uncontrolled DM.
SE: Transient hypertension, Hyperglycemia.
NR: Monitor vital signs and blood sugar. ; Perform frequent and accurate
neurologic assessments pertinent to spinal cord injury.

MANNITOL
Adult IV: initially 1 g/kg of 20%-25% solution as a bolus High
individualized

METHYLPREDNISOLONE
IV bolus dose: 30 mg/kg in 100 ml NSS; then 5.4 mg/kg/h (23 h) or 48 h
for SCI >3 h but < 8 h old

NALOXONE ( Narcan )
A: May displace opiod analgesics from their receptors to reverse it effects.
I: Clients who have taken an OVERDOSE OF OPIATE DRUGS, those
experiencing RESPIRATORY or CARDIOVASCULAR DEPRESSION from
therapeutic doses of opiates given in health care setting, & those brought
to emergency department in a COMA of UNKNOWN ETIOLOGY.
CI: Respiratory depression due to non-opioid drugs.
SE: No major side effects but ccan precipitate withdrawal symptoms and
rarely cause anaphylaxis.
NR: Monitor closely for signs & symptoms of recurrent opiate effects like
respiratory depression & hypotension.
 FLUMAZENIL
A: Inhibits the activity at the benzodiazepine receptor.
I: Reversal agent RESPIRATORY DEPRESSANT & SEDATIVE EFFECTS
OF BENZODIAZEPINE MEDICATIONS.
CI: Hypersensitivity.
SE: Anxiety, Palpitaion.
NR: Careful assessment of RR & effort, BP & mental status.

ACTIVATED CHARCOAL
I: To PREVENT ABSORPTION OF TOXINS INTO THE BODY .
CI: Intestinal obstruction, anatomically-broken GI tract, hemorrhage, GI
perforation.
SE: Vomiting.
NR: Do not administer with milk products because they decrease its
adsorptive properties.

NALOXONE
IV/IM/IO/subQ: 0.4-2 mg; repeat every 2-3 min as indicated

FLUMAZENIL
IV: initial dose 0.2 mg over 15 sec. Additional doses of 0.3-0.5 mg over
30 sec every 1 min as indicated. For re-sedation, may be repeated at
20-min intervals to a total dose of no more than 3 mg

ACTIVATED CHARCOAL
A&C: 1-2 g/kg PO

DOPAMINE
A: Causes vasoconstriction.
I: To treat HYPOTENSION IN SHOCK STATES not caused by
HYPOVOLEMIA.
CI: Patients with phaechromocytoma or hyperthyroidism.
SE: Tachycardia, Dysrhythmias, Myocardial ischemia, Nausea & Vomiting.
NR: Continuous heart and BP monitoring. ; Carefully document the vital
 DOBUTAMINE
A: Causes mild vasodilation.
I: Enhances the force of MYOCARDIAL CONTRACTION & INCREASE
HEART RATE.
CI: Patients with marked obstruction of cardiac ejection such as idiopathic
hypertrophic subaortic stenosis.
SE: Myocardial ischemia, Tachycardia, Dysrhythmias, Headache, Nausea
& Tremors.
NR: Carefully monitor intake & output. ; Assess for signs & symptoms of
myocardial ischemia such as chest pain or development of dysrhythmias.

NOREPINEPHRINE
A: A catecholamine with extremely potent vasoconstrictor actions.
I: Used in SHOCK STATES.
CI: Not be used to teat hypotension in hypovolemic clients.
SE: Myocardial ischemia, Dysrhythmias, Impaired organ perfusion.
NR: Continuous cardiac monitoring and precise BP monitoring are
required.

EPINEPHRINE
A: Causes bronhodilation and vasoconstriction.
I: Treatment of ANAPHYLACTIC SHOCK.
SE: Excitability, Fear, Anxiety, & Restlessness
NR: Closely monitoring of tachycardia, cardiac dysrhythmias, hypertension
& angina.
ALBUTEROL
A: Causes bronchodilation.
I: Reverse bronchoconstiction in ANAPHYLACTIC SHOCK, ASTHMA, &
COPD.
CI: Hypersensitivity, Threatened abortion during the 1 st or 2nd trimester,
lactation.
SE: Tachycardia, Tremor, Nervousness, Cardiac dysrhythmias, &
Hypertension.
NR: Assess breath sounds before & after administration.
DIPHENHYDRAMINE
HYDROCHLORIDE
A: Decreases allergic response by blocking histamine.
I: Effective for treating the HISTAMINE-INDUCED TISSUE SWELLING &
PRURITUS common to severe allergic reactions.
CI: Hypersensitivity, History of sleep apnea.
SE: Drowsiness, Sedation, Confusion, Vertigo, Excitability, Hypotension,
Tachycardia, GI disturbances, & Dry mouth.
NR: Assess respiratory status. ; Monitor intake & output status. ; Assess
sleep patterns.
 DEXTROSE 50%
I: To treat INSULIN-INDUCED HYPOGLYCEMIA or INSULIN SHOCK
SE: Phlebitis
NR: Urine output should be accurately recorded
GLUCAGON
. A: A hormone produced from pancreas that elevates blood sugar by
stimulating glycogen breakdown
I: Treatment of SEVERE INSULIN-INDUCED HYPOGLYCEMIA or
INSULIN SHOCK
CI: Phaeochromocytoma, hypersensitivity

DOPAMINE
Adult IV: drip 2-20 mcg/kg/min (>10 mcg/kg/min may be ordered if
lower doses are ineffective)

DOBUTAMINE
IV: drip 2-20 mcg/kg/min

NOREPINEPHRINE
IV: drip 0.5-30 mcg/kg/min (titrated)

ALBUTEROL
Adult: nebulizer 0.5 ml of 0.5 % inhalation solution in 2.5 ml saline

DIPHENHYDRAMINE HYDROCHLORIDE
IM/IV: 25-50 mg

DEXTROSE 50%
Adult IV: 50 ml
Child: 0.5-1.0 g/kg IV of a dextrose 25% solution

GLUCAGON
subQ/Im/IV: 0.5-1 mg; may repeat x 1
 LABETALOL
A: Inhibits the effects of the sympathetic nervous system.
I: Indicated for the acute management of clinically significant
HYPERTENSION in the prescence of ISCHEMIC & HEMMORHAGIC
STROKE, as well as for HYPERTENSIVE CRISIS.
CI: Clients with bronchial asthma or COPD, severe bradycardia & apparent
heart failure.
SE: Hypotension, Dizziness, Ventricular dysrhthmias & Bronchospasm.
NR: Monitor BP accurately.
NITROPRUSSIDE SODIUM
A: It is immediate direct arterial and venous vasodilation..
I: To reduce ARTERIAL BLOOD PRESSURE in HYPERTENSIVE
EMERGENCIES
CI: Hypersensitivity, compensatory hypertension.
SE: Nausea, Headache, Restlessness, Muscle twitching, Palpitation,
Dizziness, Abdominal discomfort.
NR: Continuous & accurate BP measurement is requires.
FUROSEMIDE
A: Inhibits sodium & chloride reabsorption from the ascending loop of
Henle and the proximal & distal tubules.
I: For ACUTE PULMONARY EDEMA from LEFT VENTRICULAR
DYSFUNCTION & HYPERTENSIVE CRISIS.
CI: Hypersensitivity.
SE: Hypovolemia, Dehydration, & Electrolyte disturbances.
NR: Fluid and electrolyte status must be carefully assessed before and
after. ; Auscultation breath sound.

MORPHINE SULFATE
A: Produces venous bronchodilation that decreases cardiac preload.
I: For ACUTE PULMONARY EDEMA.
CI: Hypersensitivity, pregnancy, epilepsy, anastomoses.
SE: Respiratory distress, Hypotension.
NR: Assess pain; location, type, character, intensity. ; Monitor intake &
output status.

LABETALOL
IV: initial push 10-20 mg over 2 min, repeated or doubled q 10 min up
to a max of 300 mg; continuous infusion 2 mg.min
 NITROPRUSSIDE SODIUM
Adult IV: drip 0.25-5 mcg/kg/min; begin at 0.25 mcg/kg/min & titrate to
desired effect

FUROSEMIDE
IV: initial bolus of 0.5-1.0 mg/kg over 1-2 min, up to 2 mg/kg

MORPHINE SULFATE
IV: 1-4 mg q 5-30 min