This document provides information on various drugs used in emergency situations: - Oxygen is essential to prevent brain death within 6 minutes of hypoxia. The ideal oxygen saturation is 95% or higher. - Nitroglycerin is a vasodilator used for angina and myocardial infarction. Morphine sulfate is used for chest pain associated with myocardial infarction. - Atropine sulfate, isoproterenol, and epinephrine are used to treat bradycardia, asystole, AV block, and hypotension. - Sodium bicarbonate is used for acidotic states from cardiac arrest. Antiarrhythmics include adenosine, amiodarone,

1. PHARMACIST:PHARMACIST:
RIDHA MOHAMMAD HAREKARIDHA MOHAMMAD HAREKA

2. OXYGEN
DRUGS FOR CARDIAC DISORDERS
DRUGS FOR POISONING
DRUGS FOR SHOCK
DRUGS FOR HYPERTENSIVE CRISIS
AND PULMONARY EDEMA

3. w/o OXYGEN - Brain death
within 6 min
Pulse oximeter – measures
oxygen saturation
WHAT’S THE IDEAL O2 SAT? 95%

5.  for severe physiologic stress
Shock
Traumatic injury
Acute myocardial infarction
Cardiac arrest

6. CAUTION IN COPD
PATIENTS
 May lose their hypoxic
respiratory drive

7. Emergency but no severe
stress (angina, arrhythmia)
Nasal cannula – 1-6L/min
Face tent (high O2 flow) -
children

9.  NITROGLYCERIN -
vasodilator
ANGINA PECTORIS
MYOCARDIAL INFARCTION
 SUBLINGUAL – 0.3-0.4 mg to be repeated after 5 min (max: 3 doses).
 IV infusion 50mg/10ml (dilute before use)
5mcg/min to 20mcg/min

10. NITROGLYCERIN – vasodilator
Should not be use along with
Sildenafil (VIAGRA)

11.  MORPHINE SULFATEMORPHINE SULFATE
Narcotic analgesic
 given for chest pain assoc with MI
Dose: 1-4mg IV over 1-5min to be
repeated q 5-30’ until chest pain is
relieved

12.  MORPHINE SULFATEMORPHINE SULFATE
 Adverse effects: respiratory
depression and hypotension
NALOXONE (NARCAN)
 Reverses the action of morphine

13.  ATROPINE SULFATEATROPINE SULFATE
 Inhibits action of VAGUS nerve
 for treatment of bradycardia,
asystole and AV block
 dose: 0.5-1mg q 3-5 min

14.  ISOPROTERENOLISOPROTERENOL
 beta adrenergic drug – increase
heart rate – for HYPOTENSION
 monitor heart rate

15. EPINEPHRINEEPINEPHRINE
 Improves perfusion of the
heart and brain,
bronchodilation

16. EPINEPHRINEEPINEPHRINE
 “E” drug for hypotension,
pulseless Vtach, V fibrillation,
status asthmaticus
 monitor cardiac and
hemodynamics

17. SODIUM BICARBONATE
For metabolic/respiratory acidotic
state associated with cardiac arrest
dose: 1meq/kg IV, maybe
repeated at 0.5meq/Kg every 10
min when required.

18. ADENOSINE
VERAPAMIL
DILTIAZEM
LIDOCAINE
AMIODARONE
PROCAINAMIDE

19. Amiodaron
. It is used in the treatment of both ventricular and atrial
arrhythmias.
Note: Amiodarone is incompatible with normal
saline solution.

20. Preparation: * Loading dose – Mix calculated loading
dose of amiodarone (5 mg per kg) in
250 ml of
dextrose 5%. Infuse for 1 to 2 hours (125 to 250 ml per
hour).
* Maintenance dose – Mix calculated
maintenance dose of amiodarone
(10 to 15 mg per kg) in 500 ml of dextrose 5%. Infuse for
24
hours (20 ml per hour).

21. Adenosine
Adenosine is a very short acting agent used in the
treatment of supraventricular tachycardia.
It is best given in incremental doses according to
response (usually 6 mg initially and if no response,
give 12 mg and if necessary followed by 18 mg).
 Adenosine should be given as a rapid intravenous bolus
followed by a 20 ml 0.9% saline flush.
In asthmatic patient --->bronchospasm ….
Antagonised by using Theophyllin.

22. Procainamide
Antiarrhythmic Agent, Class Ia.
IV: Loading dose: 15 to 18 mg/kg administered as
slow infusion over 25 to 30 minutes
or 100 mg/dose at a rate not to exceed 50
mg/minute repeated every 5 minutes as needed to a
total dose of 1 g.

23. Procainamide
Maintenance dose: 1 to 4 mg/minute by continuous
infusion. Maintenance infusions should be reduced
by one-third in patients with moderate renal or
cardiac impairment and by two-thirds in patients with
severe renal or cardiac impairment.
Dose must be titrated to patient's response

24.  MANNITOLMANNITOL
Osmotic diuretic – for cerebral
edema  may inc ICP
 initial dose – 0.5-1g/kg IV of 25%
solution
Note: highly irritating to the veins
 forms crystals

25. Mannitol
If crystals are present, redissolve by warming
solution. Use filter-type administration set for
infusion solutions containing mannitol ≥20%.

26. METHYLPREDNISOLONE
Indication: spinal cord injury/cerebral
edema
* Contraindications:
 HIV infection
 pregnancy
 Uncntrolled diabetes

28. Poisoning:
Ingested Poisons
 May be corrosive (alkaline and acid
agents that cause tissue destruction)
 Alkaline productsAlkaline products: Lye, drain and
toilet bowl cleaners, bleach, non-
phosphate detergents, button
batteries
 Acid products:Acid products: toilet bowl and
metal cleaners, battery acid

30. Poisoning Management
Ingestion of corrosive poison
 give water or milk - for dilution
 not attempted if patient has acute airway obstruction,
or if with evidence of gastric or esophageal burn or
perforation.
 Ipecac syrup - induce vomiting in the alert patient
 Gastric lavage for the obtunded patient
 aspirate is tested
 Activated charcoal administration if poison can
be absorbed by it
 Cathartic (clearance bowels)Cathartic (clearance bowels) - when appropriate

31. Ingested Poison Warnings!!!
Vomiting is NEVER induced after
ingestion of caustic substances or
petroleum distillates.

32. 1. NALOXONE – anti-dote for opiates
overdose
2. FLUMAZENIL – reverses respiratory
depression secondary to
benzodiazepines
3. ATROPINE - reverses
organophosphate poisoning

33. DOPAMINE
DOBUTAMINE
NOREPINEPRHINE
EPINEPHRINE
ALBUTEROL

34. Epinephrine:
α-adrenergic effects can increase
coronary andcerebral perfusion
pressure by vasoconstriction
β-adrenergic can increase myocardial
contractility
Given 1 mg per IV/IO every 3-5
minutes

35.  Sympathomimetic
 For hypotension (shock)
 It can increase heart rate when
atropine has not been effective
 Dose: 1-20mcg/kg/min (in 250ml D5W)
 Wean patient gradually – can result
to severe hypotension if abruptly
stopped

36.  Assess IV site q1 hr
Extravasation can lead to
tissue necrosis

37.  sympathomimetic with beta 1
effects (inc. heart rate)
 no vasoconstriction, only
increase cardiac output
 dose: 250-1000mg in 250ml
D5W or NSS

38.  AN EXTREMELY POTENT
VASOCONSTRICTOR
GIVEN WHEN DOPAMINE AND
DOBUTAMINE HAVE FAILED
DOSE: 4-8mg to 250ml D5W or
NSS and infused at 0.5-30mcg/min

39. ANAPHYLACTIC SHOCK
ALBUTEROL( salbutamol)
 Reverses bronchoconstriction
Beta2 Agonist
 administered via nebulizer
 side effects: tremors, tachycardia,
dysrhythmia, hypertension

40. ANAPHYLACTIC SHOCK
DIPHENHYDRAMINE
Anti-histamine
Reduce histamine induced tissue
swelling and pruritus
25-50mg IV or deep IM

41. DRUGS FOR
HYPERTENSIVE CRISIS
DRUGS FOR
HYPERTENSIVE CRISIS
Diastolic pressure that
exceeds 110-120mmHg and
pulmonary edema

42. DRUGS FOR
HYPERTENSIVE CRISIS
DRUGS FOR
HYPERTENSIVE CRISIS
 LABETALOL
Beta blocker
Lowers heart rate, BP, myocardial
contractility, and myocardial O2
consumption
Dose: 10mg IV push for 1-2 min
(max dose: 150mg)
 Contraindicated in patients with
Asthma

43. DRUGS FOR
HYPERTENSIVE CRISIS
DRUGS FOR
HYPERTENSIVE CRISIS
SODIUM NITROPRUSSIDE
Reduces arterial BP
Effect: immediate vasodilation
and BP goes down but
immediately goes up once the
drug is stopped

44. DRUGS FOR
HYPERTENSIVE CRISIS
DRUGS FOR
HYPERTENSIVE CRISIS
 SODIUM NITROPRUSSIDE
 inactivated by light – wrap in
aluminum foil
Blue or brown discoloration –
means drug is degraded
 prolonged use – can lead to
cyanide poisoning

46. DRUGS FOR
HYPERTENSIVE CRISIS
DRUGS FOR
HYPERTENSIVE CRISIS
 FUROSEMIDE
 loop diuretic
 For acute pulmonary edema due
to left ventricular dysfunction or
hypertensive crisis
 diuresis may start within 20 mins

47. DRUGS FOR
HYPERTENSIVE CRISIS
DRUGS FOR
HYPERTENSIVE CRISIS
FUROSEMIDE
Adverse effects: hypotension,
dehydration and electrolyte
imbalances
 can result to allergic reaction

48. Antiepileptic drugs
Phenytoin;
must be given by slow intravenous injection.
The infusion rate should not exceed 50 mg per minute
in adults or 1 mg per kg per minute in children.
Preparation:. should be diluted in 0.9% saline only
(not 5% dextrose) so that the concentration is no greater
than 5 mg per ml. Rapid infusion of concentrated
solutions may cause hypotension. The usual loading
dose is 15 mg per kg intravenously.

49. Thanks