Common Emergency&critical care medications

1. Emergency
Medications
EMERGENCY AND CRITICAL CARE NURSING DEPARTMENT
DIVISION 3 - GROUP 1
Cairo University
Faculty of Nursing
2022-2023
Under Supervision of : Dr.Saadia

2. prepared by:
1- Ibrahim Hassan Abdel Fattah
2- Ahmed Gomaa Rabie abdelkader
3- Israa Saeed Mahmoud
4-Ahmed El-Sayed Abdullah mehany
5- Ahmed Mohamed Abdel Latif Al-Sawy
6-Islam Mahmoud Muhammad
7-Ahmed Ashour Madkour Abdul Qadir
8- Esraa Ragab Farid
9- Esraa Fathy
10- Ahmed Salem Khamis Salem
11- Asmaa Adel Ahmed
12 Asmaa Hassan Abdel-Azim
13- Asma aAbdul Rahman Hassan
14- Asmaa Afifi Gomaa Ali
15- Ibrahim Al-Desouki Abdul Hamid Ali
16- Abdullah Ali Abdul Naeem Manna
17- Abu Bakr Muhammad Abkar Suleiman
18- Ahmed Salah Salem Muhammad
19- Ahmed Mohamed Mahmoud Mohamed
20- Asmaa Tarek

3. Outlines
Introduction
Receptors
Adrenaline
Noradrenaline
Dopamine
Dobutamine
Tridil
Atropine
streptokinase
KCL
Epanutin
Lasix
Mannitol
Aldactone

4. Introduction

5. 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
 To provide initial treatment for broad 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.
Purpose of Emergency Drugs

6. Receptors
Receptors are macromolecules involved in chemical signaling between and within cells; they may
be located on the cell surface membrane or within the cytoplasm that specifically bind a ligand .
Activated receptors directly or indirectly regulate cellular biochemical processes (eg, DNA
transcription, enzymatic activity).
A ligand may activate or inactivate a receptor; activation may increase or
decrease a particular cell function.
❖ Agonists
are the drugs that activates a receptor to produce a biological response.
❖ Antagonists:
a drug that stops the action or effect of another substance.

7. Receptors
β1 - receptor: in the heart, Stimulation of B1-receptors increases the rate and force of
contraction, resulting in an increase in cardiac output
β2 -receptors: Stimulation of B2 causes bronchodilatation and, vasodilatation in
certain vascular beds (skeletal muscles).
Alpha 1-receptor: Stimulation of alpha 1-receptor causes peripheral vasoconstriction,
and an increase in peripheral resistance and systemic arterial blood pressure which
increases the systolic BP
Dopaminergic receptors: dopamine-1 receptors present in the renal and mesenteric
vascular beds.

8. Adrenaline
Epinephrine

9. Adrenaline Action:
It acts on beta 1,beta 2, and alpha 1 receptors.
Indications:
❏ Low cardiac output states
❏ During cardiac arrest
❏ Anaphylactic shock
❏ Local anesthetic
❏ Septic shock
❏ Acute asthmatic attacks

10. Adrenaline Side Effects:
CNS: nervousness, anxiety, tremor, vertigo,headache, disorientation, agitation,
drowsiness, fear, dizziness,cerebral hemorrhage, cerebrovascular accident (CVA).
•CV: palpitations, widened pulse pressure hypertension, tachycardia, angina, ECG
changes,ventricular fibrillation.
•Skin: urticaria, pallor, diaphoresis.
•GIT: nausea, vomiting.
•RS: dyspnea.
•Other: Adrenaline convert glucose from glycogen and raises blood
sugar(Hyperglycemia).
Pupillary dilation (mydriasis) occurs.

11. Adrenaline Nursing Care:
❖ Not to use a peripheral vein (risk for extravasation) and give via a central vein via
accurate infusion pump.
❖ Dilute with normal saline or (Dx 5%).
❖ Continuous hemodynamic monitoring.
❖ Do not connect to CVP lumen used for monitoring central venous pressure.
❖ Assess urine output carefully.
❖Assess blood glucose level frequently and manage for hyperglycemia.
❖ Don't discontinue drug abruptly.
❖ Check blood pressure every 2 minutes until desired pressure is achieved.

12. Adrenaline Nursing Care:
❖ Recheck every 5 minutes for duration of infusion.
❖ Maintain continuous ECG monitoring and blood pressure monitoring.
❖ Be aware that headache may signal extreme hypertension and overdose.
❖ Monitor infusion site for extravasation.
❖ Watch for signs and symptoms of peripheral vascular insufficiency (decreased
capillary refill, pale to cyanotic to black skin color).
❖ Never leave patient unattended during infusion.
❖ Use coloured sticker for lables of drug data.

13. Noradrenaline
Norepinephrine

14. Noradrenaline Action
Direct-acting sympathomimetic amine identical to body catecholamine
norepinephrine. Acts directly and predominantly on alpha-adrenergic receptors; little
action on beta receptors except in heart (beta1 receptors). Vasoconstriction and
cardiac stimulation; also powerful constrictor action on resistance and capacitance
blood vessels.
Indication
❏ Emergency restoration of blood pressure in cases of acute hypotension.
❏ For blood pressure control in certain acute hypotensive states (e.g., poliomyelitis, spinal
anesthesia, myocardial infarction, septicemia,blood transfusion, and drug reactions).
❏ Adjunct in the treatment of cardiac arrest and profound hypotension.

15. Noradrenaline Side effects
•CNS: Headache, violent headache, cerebral hemorrhage, convulsions.
•CV: Reflex bradycardia, severe hypertension,arrhythmias, and severe
vasoconstriction.
•Skin: irritation with extravasation, necrosis.
•RS: respiratory difficulty.
•Metabolic: hyperglycemia.
Special Senses: Blurred vision, photophobia

16. Noradrenaline Nursing Care:
❖Don't use a peripheral vein ( Risk for extravasation ,tissue necrosis ).
❖Dilute in Glucose 5% .
❖Take baseline BP ,pulse before start a therapy.
❖Assess blood glucose level frequently and manage for hyperglycemia.
❖If patient is awake instruct them to report headaches, dizziness, or chest pain.
❖Frequent assessment of the blood pressure .
❖Be aware that headache may signal extreme hypertension and overdose.
❖Don't discontinue drug abruptly (may result in rebound hypotension due to tissue ischemia when discontinued).
❖Monitor EKG and CVP.
❖Assessment of peripheral circulation (peripheral pulses, color, temperature, capillary refill).

17. Dopamine

18. Dopamine Action
It is the immediate precursor of epinephrine in thebody.
It acts on D, b1, and alpha 1 receptors, depending on the dose
administered;(Dose dependent effects).
★ Renal dose (low dose): 2.5-5 mcg/kg/min.
★ Cardiac dose:5-10 mcg/kg/min.
★ Hypotension dose(High dose): >10 mcg/kg/min.

19. Dopamine indication
❏Cardiogenic shocks especially in M.I. associated with sever C.H.F.
❏ Hypotension due to poor cardiac output.
❏ Shock associated with septicemia, trauma, heartsurgery, renal
failure & C.H.F.
❏ Cardiomyopathy.
❏ In lower doses (2.5-5 Mcg/kg/min) used in renal failure.

20. Dopamine Side effects
•GIT: Nausea and vomiting.
•CV: Ectopic heart-beats, tachycardia or bradycardia,anginal pain, palpitation,
hypotension or hypertension,dyspnea, wide QRS complex.
•Others: headache.

21. Dopamine Nursing Care:
❖Administer only by IV INFUSION (Not IV bolus nor IM)
❖Drug must be diluted before use.
❖Administer drug through a central line or a big vein (vein in the anticupital fossa is
preferred over those in the hand).
❖Stop the drug by small increments.
❖Solution is stable for 24 hrs, protect it from light.
❖Monitor B.P. & ECG continuously during drug administration.
❖Monitor intake & output.
❖Monitor patient for occurrence of side effects.
❖Check I.V. site for signs of extravasations.
❖Drug should be administered through electronic infusion device.

22. Dobutrex
Dobutamine

23. Dobutrex Action
Primarily activates β1 receptors of the heart , increasing contractility ( positive
inotropic effect ) , Thus increases cardiac output , but has minor or no chronotropic
effect ( without significantly increase in heart rate ) .
Minor β2 , α1 stimulation .

24. Dobutrex indication
❏ for patients who require positive inotropic support in the
treatment of cardiac decompensation due to :
• cardiogenic shock.
• cardiac surgery.
• stimulates heart muscle and improves blood flow by
helping the heart pump better
• Dobutamine is usually given after other heart medicines
have been tried without success

25. Dobutrex Side effects
• CNS: Headache , Tremors , Nervousness , Mild leg cramps
• CV: Increase in HR, increase in systolic BP, increase in
ventricular ectopic beats (PVCs), anginal pain, palpitations,
shortness of breath.
• GI: Nausea and vomiting
• Local: Inflammation of vein

26. Dobutrex Nursing Care:
• Arrange to digitalize patients who have atrial fibrillation with a rapid
ventricular rate before giving dobutamine—dobutamine facilitates AV conduction.
• Monitor peripheral pulse before, during and after therapy.
• Monitor potassium concentration
• Monitor intake & output ( urinary output ) .
Contraindication of dobutamine
1. Hypersensitivity to dobutamine or bisulfites
2. Idiopathic hypertrophic subaortic stenosis
3. Acute myocardial infarction
4. Unstable angina
5. Left main coronary artery disease (LMCAD)
6. Severe hypertension
7. Arrhythmias
8. Acute myocarditis or pericarditis
9. Hypokalemia

27. Tridil
Nitroglycerin

28. Tridil Action
Generic Name : nitroglycerin (NTG)
Main action
relaxes the vascular smooth muscle to decrease blood pressure and maintain an effective coronary
perfusion pressure
 QUICK
 Sublingual Tabs
 Translingual Spray
 SLOW
 Nitro-Bid (Patch)
 Nitro Oinments
 Sustained Release Tablets

29. Tridil Indication
• Hypertension
• Decompensated congestive heart failure (CHF)
• lung congestion
• Acute angina pectoris
• Ischemic chest pain
Side effects:
 Headache
 Hypotension
 Postural hypotension
 Facial flushing
 Tinnitus
 Tachycardia
 Sweating,

30. Tridil Contraindication
• Contraindicated with allergy to nitrates, severe anemia,
early MI, head trauma, cerebral hemorrhage,
pregnancy, lactation.
• Use cautiously with hepatic or renal disease,
hypotension or hypovolemia, increased intracranial
pressure, constrictive pericarditis.

31. Tridil Nursing care
• Monitor blood pressure
• Assess for orthostatic hypotension when aclient stands up
• Check medication refills for adherence
• Assess for angina
• Monitor for signs of overdose
• Instruct patient to notify a physician immediately if blurred
vision, confusion,severe dizziness/faintness / lightheadedness
when getting up suddenly from a lying or sitting position,
sweating and weakness
• Visit a physician regularly to check if the medication is
working properly

32. Tridil Nursing care
• Limit the amount of alcohol intake, standing for long periods of
time, exercise and
• exposure to hot weather when taking this medicine may cause
headaches.
• If severe pain occurs, consult a physician immediately
• Inform your physician if you want to discontinue the medication,
Do not stop abruptly
• Consult a physician immediately if severe allergic skin reactions
occur
• Avoid taking with other medicines especially over the counter
unless advised by the doctor

33. Atropine Action
It is a parasympatholytic agent which cause relaxation of smooth muscles &
inhibition of secretary glands.
Indication
❏ Adjunct in peptic ulcer treatment.
❏ Irritable bowel syndrome.
❏ Treatment of spastic disorders of biliary tract. ❏
Drug Receptors. During anesthesia to control salivation & bronchial secretions.
❏ Parkinsonism.
❏ Anti-arrhythmic (prophylaxis).
❏ Prophylaxis and treatment of toxicity due to cholinesterase inhibitor including
organophosphate pesticides.
❏ Ophthalmologic treatment of uveitis.

34. Atropine

35. Atropine Side Effects:
•CNS: Headache, dizziness, excitement, irritabilityconvulsions, drowsiness, fatigue,
weakness; mental depression, confusion,disorientation, hallucinations.
•CV: Hypertension or hypotension, ventricular tachycardia, palpitation, AV dissociation,
atrial or ventricular fibrillation.
•Urinary system: urinary retention.
•GlT: Dry mouth with thirst, dysphagia, loss of taste; nausea, vomiting, constipation,
delayed gastric emptying .
•Skin: Flushed, dry skin; rash, urticaria, contact dermatitis, allergic conjunctivitis, fixed-
drug eruption.
•Special Senses: Mydriasis, blurred vision, photophobia, increased intraocular pressure,
eye dryness, local redness.

36. Atropine Nursing care
❖Check dosage & measure the drug exactly.
❖Assess for history of asthma, glaucoma, ulcer... etc.
❖Determine the age of the client.
❖Frequent mouth care.
❖Assess client for change in pulse rate.
❖In case of blurring of vision, assist on ambulating & give
safety measures.

37. Streptokinase

38. Streptokinase Action
It creates an active complex which promotes the cleavage of the
Arg/Val bond in plasminogen to form the proteolytic enzyme
plasmin. Plasmin in turn degrades the fibrin matrix of the thrombus,
thereby exerting its thrombolytic action
Indication
❏ Deep venous thrombosis (DVT).
❏ Myocardial infarction (MI).
❏ To clear occluded arteriovenous or IV canula .
Side effects
•GIT: Nausea.
•CNS: headache,dizziness.
•CV: Hypotension,Rapid Heart beat.
•Other: Allergic reaction ,Bleeding.

39. Streptokinase Contraindications
 trauma (eg facial or head trauma) or traumatic procedures
(eg surgery, biopsy or invasive diagnostic procedure)
 Several uncontroled hypertension.
 Potential for internal bleeding (eg peptic ulcer)
 Pronounced hepatic and renal dysfunction.

40. Streptokinase Nursing care
❖Before using Streptokinase, Do not use infusion IV line for other
medications or therapies.
❖Screen patient carefully for possible contraindications prior to
fibrinolytic therapy.
❖Obtain baseline lab data for aPTT, PT, INR, Hct, Hgb,and platelets
prior to beginning streptokinase therapy.
❖During, Avoid any invasive procedures on patient during therapy
and for 2 hours following therapy.
❖Maintain continuous cardiac monitoring during therapy and at
least for the next eight hours to watch for reperfusion
dysrhythmias.
❖After treatment, monitor the patient for signs of bleeding every
15 minutes during therapy and hourly for next 8 hours following
therapy.
❖Notify physician STAT if signs of anaphylaxis or allergic reaction

41. K CL
Potassium chloride

42. KCL Indication
used to treat or prevent low amounts of potassium in the blood. A normal level of
potassium in the blood is important. Potassium helps your cells, kidneys, heart,
muscles, and nerves work properly
Side effects
 Arrhythmias
 Bleeding
 Diarrhea
 Indigestion
 High blood potassium (hyperkalemia)
 Nausea
 Rash
 Vomiting
Contraindication
• HypersensitivityUntreated
• Addison disease
• Hyperkalemia
• Renal failure

43. KCL Nursing care
 Assess History: Allergy to tartrazine, aspirin; severe renal
impairment; untreated Addison’s disease; hyperkalemia; adynamia
episodica hereditaria; acute dehydration; heat cramps, GI disorders
that cause delay in passage in the GI tract, cardiac disorders,
lactation
 Physical: Skin color, lesions, turgor; injection sites; P, baseline ECG;
bowel sounds, abdominal examination; urinary output; serum
electrolytes, serum bicarbonate
 Arrange for serial serum potassium levels before and during therapy.
 Administer liquid form to any patient with delayed GI emptying.
 Administer oral drug after meals or with food and a full glass of
water to decrease GI upset.
 Caution patient not to chew or crush tablets; have patient swallow
tablet whole.

44. KCL Nursing care
 Mix or dissolve oral liquids, soluble powders, and effervescent
tablets completely in 3–8 oz of cold water, juice, or other suitable
beverage, and have patient drink it slowly.
 Arrange for further dilution or dose reduction if GI effects are
severe.
 Agitate prepared IV solution to prevent “layering” of potassium; do
not add potassium to an IV bottle in the hanging position.
 Monitor IV injection sites regularly for necrosis, tissue sloughing,
phlebitis.Monitor cardiac rhythm carefully during IV administration.
 Caution patient that expended wax matrix capsules will be found in
the stool.
 Caution patient not to use salt substitutes

45. Epanutin
Phenytoin

46. Epanutin Action
It acts in the motor cortex of the brain to reduce the spread of electrical discharges
from the rapidly firing epileptic foci in this area. Also activity of centers in the brain
stem responsible for the tonic phase of grand mal seizures.
Indication
❏ Treat epilepsy.
❏ Generalized tonic-colonic seizures.
❏ Complex partial seizures.
❏ Status epilepticus.
Side effects
•GIT: nausea,vomiting.
•CNS: Headache,Dizziness,Transient nervousness,Insomnia ,Mental confusion.
❏ Prevention of seizures during neurosurgery.
❏ Trigeminal neuralgia, and behavior disorders.
❏ Ventricular arrhythmia with heart block (anti-arrhythmic)
❏ Treatment of digoxin toxicity and tricyclic antidepressant toxicity.

47. Epanutin Nursing care
❖Doses should be adjusted carefully, Starting with low doses, and Increasing gradually until seizures
are controlled or there are overdose Effects.
❖Leukopenia that is severe, Progressive, or associated with Clinical symptoms requires withdrawal.
❖Ataxia, slurred speech, nystagmus, And blurred vision are signs of
Overdose. ❖Avoid sudden withdrawal.
❖Administer after or preferably with food.
❖Patients should be told how to recognize signs of blood or skin disorders and advised to seek
immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, bruising or
bleeding develop.
❖Administer IV slowly to prevent severe hypotension ❖Careful
cardiac monitoring is needed during and after administering intravenous Epanutin.
❖Monitor patient's cardiac rhythm and check BP frequently and regularly during IV infusion.
❖Discontinue drug if rash, depression of blood count, enlarged lymph nodes, hypersensitivity
reaction, signs of liver damage.
❖Monitor blood or urine sugar of patients with diabetes mellitus regularly.

48. L asix
Furosemide

49. Lasix Action
Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and
proximal and distal renal tubules, interfering with the chloride-binding cotransport
system, thus causing increased excretion of water, sodium, chloride, magnesium, and
calcium
Indication
 Lasix is indicated in adults and pediatric patients for the treatment
of edema associated with congestive heart failure, cirrhosis of the
liver, and renal disease, including the nephrotic syndrome.
 Lasix is particularly useful when an agent with greater diuretic
potential is desired.

50. Lasix Side Effects:
•CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision,
tinnitus, irreversible hearing loss.
•GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis,
jaundice. •CV: Orthostatic hypotension, volume
depletion, cardiac arrhythmias, thrombophlebitis.
Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances.
•GU: Polyuria, nocturia, glycosuria, urinary bladder spasm.
•Dermatologic: Photosensitivity, rash, pruritus urticaria, purpura, exfoliative dermatitis, erythema
multiforme.
•Other: Muscle cramps and muscle spasms.

51. Lasix Nursing care
 Monitor daily weight, intake and output ratios, amount and location of
edema, lung sounds, skin turgor, and mucous membranes.
 Notify health care professional if thirst, dry mouth, lethargy, weakness,
hypotension, or oliguria occurs.
 Monitor BP and pulse before and during administration.

52. Mannitol
Osmitrol

53. mannitol Action
Increase the osmolarity of the glomerular filtrate which decrease the reabsorption of
water while increasing the excretion of sodium and chloride.
Indication
❏ Acute renal failure
❏ Cerebral edema
❏ To decrease intracranial pressure
❏ Glaucoma
❏Rhabdomyolysis
❏ Hemolysis

54. mannitol Side effects
Contraindication
•CNS: dizziness, blurring of vision.
•CVS: hypotension, hypertension.
•Other :Hypernatremia , Hyponatremia , HyperKalemia electrolyte imbalance,
,Dehydration, dry mouth , thirst, pulmonary edema.
‒ CHF and pulmonary edema
‒ Anuria
‒ severe dehydration

55. mannitol Nursing care
Assess:
▪ Weight, I&O daily to determine fluid loss.
▪ Hydration including skin turgor, thirst, dry mucous membranes,
provide adequate fluids.
▪ B/P lying, standing; postural hypotension may occur
▪ Electrolytes: potassium, sodium, chloride; include BUN, CBC
▪ Hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps,
weakness, or hyperkalemia
❖Mannitol should not be added to other I.V. solutions nor should it be mixed with
other medications .
❖If blood is to be administered at the sometime , add 20 mEq of sodium chloride
to each liter of mannitol to prevent pseudo agglutination.
❖Observe for signs, & symptoms of pulmonary edema
(dyspnea, cyanosis, frothy sputum). “ Slow the rate & notify the physician”

56. Aldactone
Spironolactones

57. aldactone Action
It’s a mild diuretic that acts on the distal tubule to inhibit sodium exchange for
potassium which results in increased secretion of sodium and water & conservation
of potassium .
It is also aldosterone antagonist.
It has slight antihypertensive effect.
Indication
❏ Edema due to congestive heart failure
❏ liver cirrhosis.
❏ Nephrotic syndrome .
❏ Essential hypertension.
❏ Primary hyperaldosteronism.
❏ Hypokalemia (as in CHF) .

58. aldactone Side Effects:
•GIT: Vomiting , diarrhea, cramps.
•Skin: Skin rashes.
•Ohter: Hyperkalemia, hyponatremia ( dry mouth , lethargy, thirst & easy fatigability) ,Menstrual
irregularities, gynecomastia, hirsutism & deeping of voice , impotence, breast carcinoma .
aldactone Nursing care
❖Protect drug from light.
❖Food may increase absorption of aldactone.
❖Obtain serum electrolyte levels prior to starting therapy.
❖Record vital signs, intake & out put & body weight.
❖Advise the client to avoid food high in potassium.