DAVY K.

BEKICAN EMERGENCY DRUGS

1. Atropine sulfate Classification: Anticholinergic Agent Action: Atropine sulfate is a potent parasympatholytic. It inhibits actions of acetylcholine at postganglionic parasympathetic neuroeffector sites, primarily at muscarinic receptors. Small doses inhibit salivary and bronchial secretions, moderate doses dilate pupils and increase heart rate. Large doses decrease GI motility, inhibit gastric acid secretion. Blocked vagal effects result in positive chronotropy and positive dromotropy (limited or no inotropic effect). In emergency care, it is primarily used to increase the heart rate in life-threatening bradycardias. You can think of the effects of atropine as being 'anti-SLUDGE'. Indications: Hemodynamically significant bradycardia Asystole PEA Organophosphate poisoning (drug of choice) Pretreatment in pediatric patients receiving RSI. Management: Atropine is a highly potent drug and due care is essential to avoid overdosage, especially with intravenous administration. Children are more susceptible than adults to the toxic effects of anticholinergic agents. Atropine I.V. decreased the rate of mexiletine absorption without altering the relative oral bioavailability; this delay in mexiletine absorption was reversed by the combination of atropine and intravenous metoclopramide during pretreatment for anesthesia. Atropine is not removed by dialysis. 2. Morphine sulfate Classification: Opioid agonist analgesic Indications: Relief of moderate to severe acute and chronic pain Preoperative medication to sedate and allay apprehension, facilitate induction of anesthesia, and reduce anesthetic dosage. Analgesic adjunct during anesthesia Component of most preparations that are referred to as Brompton's cocktail or mixture, an oral alcoholic solution that is used for chronic severe pain, especially interminal cancer patients Intraspinal use with microinfusion devices for the relief of intractable pain Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonaryedema Management: Caution patient not to chew or crush controlled-release preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects. Tell patient to lie down during IV administration. Keep opioid antagonist and facilities for assisted or controlled respiration readilyavailable during IV administration. Use caution when injecting SC or IM into chilled areas or in patients with hypotensionor in shock; impaired perfusion may delay absorption; with repeated doses, anexcessive amount may be absorbed when circulation is restored. Reassure patients that they are unlikely to become addicted; most patients whoreceive opioids for medical reasons do not develop dependence syndromes. Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives,tranquilizers, over-the-counter drugs. 3. Procainamide Classification: anti-sympathetic nervous system agents. Most agents in this class are beta blockers

Action: It blocks open sodium (Na+) channels and prolongs the cardiac action potential (outward potassium (K+) currents may be blocked). This results in slowed conduction, and ultimately the decreased rate of rise of the action potential, which may result in widening of QRS on electrocardiogram (ECG). Indications: This drug is used for both supraventricular and ventricular arrhythmias. For example, it can be used to convert newonset atrial fibrillation, though it is suboptimal for this purpose. It can also be used to treat Wolf-Parkinson-White syndrome by prolonging the refractory period of the accessory pathway. Typically use is secondary to lidocaine in patients who are allergic to lidocaine or dysrhythmias that are refractory to lidocaine. 4. Epinephrine Classification: -Sympathomimetic - Alpha-adrenergic agonist - Beta1 and beta2-adrenergic agonist - Cardiac stimulant - Vasopressor - Bronchodilator - Antasthmatic drug Action: Naturally occurring neurotransmitter, the effects of which are mediated by alpha or beta receptors in target organs. Effects on alpha receptors include vasoconstriction, contraction of dilator muscles of iris. Effects on beta receptors include positive chronotropic and inotropic effects on the heart (beta1 receptors); bronchodilation, vasodilation, and uterine Indications: Relief from respiratory distress of bronchial asthma, chronic bronchitis, emphysema, other COPDs Temporary relief from nasal and nasopharyngeal mucosal congestion due to a cold, sinusitis, hay fever, or other upper respiratory allergies; adjunctive therapy in middle ear infections by decreasing congestion around eustachian ostia. Management of open-angle (chronic simple) glaucoma, often in combination with miotics or other drugs Management: Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug; small errors in dosage can cause serious adverse effects. Doublecheck pediatric dosage. Use minimal doses for minimal periods of time; "epinephrine-fastness" (a form of drug tolerance) can occur with prolonged use. Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown solutions. Drug solutions should be clear and colorless (does not apply to suspension for injection). Shake the suspension for injection well before withdrawing the dose. Rotate SC injection sites to prevent necrosis; monitor injection sites frequently. Keep a rapidly acting alpha-adrenergic blocker (phentolamine) or a vasodilator (anitrate) readily available in case of excessive hypertensive reaction. Have an alpha-adrenergic blocker or facilities for intermittent positive pressure breathing readily available in case pulmonary edema occurs. Keep a beta-adrenergic blocker (propranolol; a cardioselective beta-blocker, such as atenolol, should be used in patients with respiratory distress) readily available in case cardiac arrhythmias occur. Do not exceed recommended dosage of inhalation products; administer pressurized inhalation drug forms during second half of inspiration, because the airways are open wider and the aerosol distribution is more extensive. If a second inhalation is needed, administer at peak effect of previous dose, 35 min.

Use topical nasal solutions only for acute states; do not use for longer than 35 days, and do not exceed recommended dosage. Rebound nasal congestion can occur after vasoconstriction subsides. Do not exceed recommended dosage; adverse effects or loss of effectiveness may result. Read the instructions that come with respiratory inhalant products, and consult your health care provider or pharmacist if you have any questions. To give eye drops: Lie down or tilt head backward, and look up. Hold dropper above eye; drop medicine inside lower lid while looking up. Do not touch dropper to eye, fingers, or any surface. Release lower lid; keep eye open, and do not blink for at least 30 sec. Apply gentle pressure with fingers to inside corner of the eye for about 1 min; wait at least 5 min before using other eye drops.

5. Dobutamine Classification: Vasopressor Action: Stimulates beta-1 receptors in the heart, causing more complete and forceful contractions (inotropy) without significantly increasing heart rate or BP. Indications: Treatment of cardiac decompensation caused by organic heart disease or cardiac surgical procedures. Management: Monitor vital signs, ECG, cardiac output, pulmonary capillary wedge pressure, central venous pressure, and urinary output carefully throughout infusion. Monitor patency and placement of IV catheter to reduce risk of extravasation and phlebitis. Consider monitoring serum potassium. 6. Benadryl Classification: Antihistamines Action: Competes with histamine for H1- receptor sites on effector cells. Indications: Rhinitis Allergy symptoms Motion sickness Parkinsons diseases sedation Management: Stop drug 4 days before patient undergoes diagnostic skin tests because antihistamines can prevent, reduce, or mask positive skin test response. Alternate injection sites to prevent irritation. Give I.M. injection deeply into large muscles 7. Nitroglycerine Classification: Antianginals Action: A nitrate that reduces cardiac oxygen demand by decreasing left ventricular endiastolic pressure (preload) and to a lesser extent, systemic vascular resistance (after-load) also increases blood flow through the collateral coronary vessels. Indications: Prophylaxis against chronic anginal attacks. Acute angina pectoris Hypertension from surgery.

Management: Closely monitor vital signs during infusion, particularly blood pressure Remove transdermal patch before defibrillation. When stopping transdermal treatment of angina, gradually reduce the dosage and frequency of application over 4 to 6 weeks. 8. Diltiazem Classification: Antianginals Action: A calcium channel blocker that inhibits calcium ion influx across cardiac and smooth- muscle cells, decreasing myocardial contractility and oxygen demand. Indications: To manage prinzmetals or variant angina or chronic stable angina pectoris Hypertension Atrail fibrillation or flutter; paroxysmal supraventricular tachycardia. Management: Monitor blood pressure and heart rate when starting therapy and during dosage adjustments. If systolic blood pressure and heart rate is below 90 mmHg or heart rate is below 60 beats/ min, withhold dose and notify the physician. 9. Amiodarone Classification: Antiarrythmics Action: effects results from blockade of potassium chloride leading to a prolongation of action potential duration. Indications: Life- threatening recurrent ventricular fibrillation Cardiac arrest, pulseless, ventricular tachycardia Supraventricular arrhythmias Management: Be aware of the high risk of adverse reactions. Obtain baseline pulmonary, liver, and thyroid function tests and baseline chest x-rays Give loading doses in a hospital setting and with continuous ECG monitoring . 10. Asthmanefrin Classification: Bronchodilators Action: Relaxes bronchial smooth muscle by stimulating beta2 receptors; also stimulates alpha and beta receptors in the sympathetic nervous system. Indications: Bronchospasm, hypersensitivity reacations, anaphylaxis Hemostatsis Acute asthma attacks To prolong anesthetic effect To restore cardiac rhythm in cardiac arrest. Management: Discard epinephrine solution after 24 hrs. Or if it discolored or contains precipitate. Observe patient closely for adverse reaction. Massage site after I.M. administration to counteract possible vasoconstriction.

10. Furosemide Classification: Diuretics Action: A potent loop diuretic that inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of henle. Indications: For acute pulmonary edema Edema hypertension Management: To prevent nocturia, give P.O. and I.M. preparations in the morning. Monitor weight, blood pressure, and pulse rate routinely with long term use and during rapid dieresis. Monitor fluid intake and output and electrolyte, BUN, and carbon dioxide level frequently. Watch for signs of hypokalemia . 11. Dopamine Classification: Adrenergics ( sympathomimetics) Action: Indications: To treat shock and correct hemodynamic imbalances, to improve perfusion to vital organs, to increase cardiac output, to correct hypotension. Management: During infusion, frequently monitor ECG, BP, cardiac output, CNS pressure, pulmonary artery wedge pressure, pulse rate, urine output and color and temperature of limbs. Observe patient closely for adverse reactions. Check urine output often. 12. Glucagon Classification: Antidiabetics and glucagon Action: Raises glucose level by promoting catalytic depolymerization of hepatic glycogen to glucose. Relaxes the smooth muscle of the stomach, duodenum, small bowel, and colon Indications: For hypoglycemic patient Diagnostic aid for radiologic examination Management: Use drug only in emergency situation Monitor glucose level before, during, and after administration Arouse patient from coma as quickly as possible and give additional hypoglycemic reactions. 13. Albuterol Classification: Bronchodilators Action: Relaxes bronchial, uterine, and vascular smooth muscle by stimulating beta2 receptors. Indications: To prevent or treat bronchospam in patients with reversible obstructive airway disease. Management: Patient may use tablets and aerosol for signs and symptoms of toxicity.

14. ACE inhibitor Action: Angiotensin-converting enzyme inhibitors reduce the activity of the renin-angiotensin-aldosterone system. One mechanism for maintaining the blood pressure is the release of a protein calledrenin from cells in the kidney (to be specific, the juxtaglomerular apparatus). This produces another protein,angiotensin, which signals the adrenal gland to produce a hormone called aldosterone. This system is activated in response to a fall in blood pressure (hypotension), as well as markers of problems with the salt-water balance of the body, such as decreased sodiumconcentration in the distal tubule of the kidney, decreased blood volume and stimulation of the kidney by the sympathetic nervous system. In such situations, the kidneys release renin, which acts as anenzyme and cuts off all but the first 10 amino acid residues of angiotensinogen (a protein made in the liver, and which circulates in the blood). These 10 residues are then known as angiotensin I. Angiotensin I is then converted to angiotensin II by angiotensin converting enzyme (ACE), which removes a further two residues, and is found in the pulmonary circulation, as well as in the endothelium of many blood vessels.[2] The system in general aims to increase blood pressure by increasing the amount of salt and water the body retains, although angiotensin is also very good at causing the blood vessels to tighten (a potent vasoconstrictor). Indications: treatment of hypertension (high blood pressure) and congestive heart failure Management: Potassium supplementation should be used with caution and under medical supervision owing to the hyperkalemic effect of ACE inhibitors 15. Ampicillin Classification: antibiotic Action: Semisynthetic broad-spectrum penicil- lin closely related to ampicillin. Binds to penicillin-binding proteins (PBP-1 and PBP-3) in the cytoplasmic membranes of bacteria, thus inhibiting cell wall synthesis. Cell division and growth are in- Antibiotic, penicillin hibited. Destroyed by penicillinase, acid Indications: Ampicillin is used to treat many different types of infections caused by bacteria, such as ear infections, bladder infections, pneumonia, gonorrhea, and E. coli or salmonella infection. Management: Childs dose should not exceed maxi-12 hr. For children, do not exceed the maximum adult dose. Clients with GFR of 1030 mL/min should receive 250 or 500 mg q 12 hr, depending on severity of infection. Those with GFR <10 mL/min should receive 250 or 500 mg q 24 hr, depending mg q 8 hr or 875 mg q 12 hr. on infection severity. Those on hemodi-alysis should receive 250 or 500 mg q: 40 24 hr, depending on infection severity; mg/kg/day in divided doses q 8 hr or 45 should receive an additional dose both mg/kg/day in divided doses q 12 hr. during and at end of dialysis.. The recommended upper dose of amoxicillin in neonates and infants 12weeks of age and younger is 30 grams as a single PO dose. mg/kg/day divided every 12 hours. 16. cefazolin Classification: cephalosporin Indications: Many kinds of bacterial infections, including severe or life-threatening forms. Management: Monitor for diarrhea and other adverse effect. Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

17. Lidocaine Classification: antiarrythmics Action: A class IB antiarrythmic that decreases the depolarization, automaticity, and excitability in the ventricles during the diastolic phase by direct action on the tissues, especially the purkenje network. Indications: Ventricular arrhythmias caused by MI, cardiac manipulation, or cardiac glycosides. Management: Give I.M. injections into the deltoid muscle. Monitor isoenzymes when using I.M drug for suspected I.M. Monitor drug level. 18. Disopyramide Classification: Antiarrythmics Action: A class 1A antiarrythmic that depresses phase 0 and prolongs the action potential. Indications: Ventricular tachycardia and life- threatening ventricular arrthymias. Management: Correct electrolyte abnormalities before starting therapy. Digitalized patients with atrail fibrillation or flutter before starting the drug. Check apical pulse before giving the drug. 19. Classification: Action: Indications: Management:

Classification: Action: Indications: Management: