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Emergency drugs
- 2. DRUGS USED IN CRITICAL CARE
- 3. EMERGENCY DRUGS Purpose of Emergency Drugs Details of Emergency Drugs Mechanism of Action Indication and Dose of the Drug Drug Interaction Contraindications Adverse Effects of the Drug Introduction
- 4. 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
- 5. PURPOSE OF EMERGENCY DRUGS . To provide initial treatment for broard 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.
- 6. LIST OF DRUGS • Atropine • Sodium • Nitroprusside • Amiodarone • Aminophylline • Mannitol • Magnesium Sulfate • Epinephrine • Hydrocortisone • Heparin • Diazepam
- 7. ATROPINE Indications and dose of the drug • SINUS BRADYCARDIA: 0.5-1mg(or 5- 10ml of 0.1mg/ml) repeated every 3-5 min when necessary in adults. • BRONCHOSPASM: 0.025mg/kg in 2.5ml NS via nebulizer every 6-8hrs • Organophosphate poisoning: 2mg iv/im every 3 min. according to clinical response in adult. • Cardiac arrest: 1mg every 3-5 minutes
- 8. ATROPINE Mechanism of Action • It competitively blocks the muscarinic receptors in peripheral tissues (heart, intestines, bronchial muscles, iris, secretory glands) and relaxes the smooth muscles. • The main action of vagus nerve of the parasympathetic system on the heart is to slow it down and atropine blocks that action and speeds up the heart rate
- 9. ATROPINE Drug Interactions The effect of the drug increases with • Quinidine (Antiarrhythmic) • Amitriptyline (Antidepressants) • Diphenhydramine (antihistamine) • Meclizine (antihistamine)
- 10. ATROPINE Contraindications • Narrow Angle Glaucoma • Pyloric Stenosis • Prostatic Hypertrophy • Thyrotoxicosis • Cardiac Failure • Tachycardia
- 11. ATROPINE Adverse effects of drug • Palpitation • Dry mouth • Blurred vision • Urinary retention and constipation • Tachycardia • Dysphagia • Arrhythmias • Hallucinations • Raise intraocular pressure)
- 12. Indications and Dose of the drug Sodium Nitroprusside(Nitropress) Sodium nitroprusside is indicated for the immediate reduction of blood pressure of patients in hypertensive crises. Concomitant longer-acting antihypertensive medication should be administered so that the duration of treatment with sodium nitroprusside can be minimized. Dosage: 0.5-10 mcg/kg/min IV infusion
- 13. Mechanism Of Action Sodium Nitroprusside(Nitropress) The principal pharmacological action of sodium nitroprusside is relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins by producing Nitric Oxide thus reducing preload and afterload
- 15. Contraindications Sodium Nitroprusside(Nitropress) Hypersensitivit y Acute congestive heart failure with reduced peripheral vascular resistance Congenital (Leber's) optic atrophy Tobacco amblyopia
- 17. Amiodarone Indication and dose of the drug Frequently recurring ventricular fibrillation and hemodynamicall y unstable ventricular tachycardia 300mg IV after epinephrine dose if no response to defibrillation in VT/VF Intravenous amiodarone also can be used to treat patients with life threatening VT/VF
- 18. Amiodarone Indication and dose of the drug 150mg IV bolus in 10minutes,may repeat as necessary in hemodynamicall y unstable VT VT=VENTRICUL AR TACHYCARDIA VF= VENTRIFULAR FIBRILLATION
- 19. Amiodarone Mechanism of Action Amiodarone is generally considered a class III antiarrhythmic, which inhibits adrenergic stimulation; affects sodium, potassium and calcium channels; markedly prolongs action potential and repolarization and decreases AV conduction and sinus node function
- 20. Amiodarone Interactions Cimetidine: inhibits CYP3A4 and can increase serum amiodarone levels Warfarin Dofelitide Amitriptyline Propanolol Digoxi
- 21. Amiodarone Contraindications Hypersensitivity Avoid during breastfeeding Severe sinus node dysfunction Cardiogenic Shock 2 nd or 3rd degree AV block
- 22. Amiodarone Adverse Effects Hypotensi on AV BLOCK Congestive Heart Failure Bradycardi a Cardiogeni c Shock Impaired Memory
- 23. Aminophylline Indications and Dose of the Drug Acute exacerbations of the symptoms of reversible airflow obstruction associated with asthma and other chronic lung diseases, e.g.,emphysema and chronic bronchitis Dose: 5 – 7mg/kg IV/PO for over 20minutes
- 24. Aminophylline Mechanism Of Action • smooth muscle relaxation (i.e., bronchodilation) • suppression of the response of the airways to stimuli (i.e., nonbronchodilator prophylactic effects).
- 26. Aminophylline Contraindications Hypersensitivity Underlying uncontrolled seizure disorder Active peptic ulcer disease
- 28. Aminophylline Adverse Effect Serum Concentration>30mcg/ml Acute Myocardial Infarction Seizures(resistant to anticonvulsants)
- 29. Mannitol Mechanism Of Action Mannitol is an osmotic diuretic. It induces diuresis by elevating the osmolarity of the glomerular filtrate and thereby hindering tubular reabsorption of water. Excretion of chloride and sodium is also enhanced
- 30. Mannitol Indication and dose of the drug: Cerebral oedema: by IV infusion, as 1.5-2g/kg infused over 30-60minutes Raised intracranial or intraocular pressure: by IV infusion as 1.5-2g/kg infused over 30-60minutes
- 33. Mannitol Adverse effect Acute renal failure(Larg e doses) chest pain Fever Circulatory overload Chills Fluid and electrolyte imbalance
- 34. Magnesium Sulfate Indications and Dosage 1 to 4 g magnesium sulfate (magnesium sulfate (magnesium sulfate injection) injection) may be given intravenously in 10% to 20% solution Convulsions (treatment) - Intravenous magnesium sulfate (magnesium sulfate (magnesium sulfate injection) injection) is indicated for immediate control of life-threatening convulsions in the treatment of severe toxemias (pre-eclampsia and eclampsia) of pregnancy
- 35. Magnesium Sulfate Mechanism Of Action It produces anticonvulsant effect by decreasing the amount of acetylcholine released at end plate by motor nerve impulse Promotes movement of calcium,potassium and sodium in and out and stabilizes excitable membranees
- 38. Magnesium Sulfate Adverse Effects Flushing Drowsiness Depressed cardiac function Circulatory Collapse Respirator y paralysis Hypotensi on
- 39. HEPARIN Indications And Dosage Deep Vein Thrombosis ,thrombosis, emboli, unstable angina Treatment of deep-vein thrombosis and pulmonary embolism ; by injection Adult loading dose of 500units [in severe pulmonary embolism 1000 unit Prophylaxis in general surgery ,by SC injection Adult 2000units before surgery and then every 8- 12hrs for 7 days.
- 40. HEPARIN Mechanism Of Action Prevents blood clotting by its antithrombin activity. It directly suppresses the activity of thrombin Combines with antithrombin III (a protease inhibitor present in circulation) and removes thrombin from circulation Inactivates the active form of other clotting factors like IX, X, XI and XII
- 42. HEPARIN Contraindication Haemophilia Severe hypertension Peptic ulcer Cerebral haemorrhage Thrombocytope nia Renal & liver disease
- 43. HEPARIN Adverse Effects Heparin Induced Thrombocytopenia Hematoma Hemorrhage Immune hypersensitivity reaction Erythema
- 44. Epinephrine Mechanism of action It acts by stimulating the à and ß-receptors of the adrenergic neurons of sympathetic nervous system Its alpha-adrenergic effects is much stronger than the beta-adrenergic effects Adrenoceptors Actions à1-receptors Vasoconstriction, increased BP , Mydriasis à2-receptors Inhibits the release of noradrenaline, acetylcholine and insulin ß1-receptors Tachycardia, increase lipolysis, myocardial contractility and renin
- 45. Epinephrine Indication and dose of the drug Cardiac Arrest: 1mg IV of 1:10000 solution every 3-5 minutes or iv bolus(10ml) Anaphylaxis (type 1): iv bolus, 0.5-1.0ml, may be repeated when necessary Refractory bradycardia and hypotension: 2- 10mcg/min Asthma: 0.1-0.3mg SC or IM of 1:10,000 solution
- 46. Epinephrine Drug Interactions Tranylcypromine Amiodarone Chlorpromazine Phenelzine Amitriptyline Quinidine
- 47. Epinephrine Contraindications Narrow angle glaucoma Shock (other than anaphylactic shock) Coronary insufficiency Pregnant and breast feeding mothers Labor (may delay second stage) Individuals with organic brain damage
- 48. Epinephrine Adverse effects of the drug CNS: anxiety, fear, tension, headache, and tremor Hemorrhage: The drug may induce cerebral hemorrhage as a result of a marked elevation of blood pressure Pulmonary edema sweating, nausea and vomiting, pale skin, feeling short of breath, dizziness etc
- 49. Hydrocortisone Adverse effects of the drug It reduces the inflammatory reaction by limiting the capillary dilatation and permeability of the vascular structures It also restrict the accumulation of polymorphonuclear leukocytes and macrophages and reduce the release of vasoactive kinins. It also inhibit the release of destructive enzymes that attack the injury debris and destroy normal tissue indiscriminately.
- 50. Hydrocortisone Indication and dose of the drug Acute adrenocortical insufficiency Congenital Adrenal hyperplasia The initial dose of hydrocortisone is 100 mg to 500 mg, depending on the severity of the condition. This dose may be repeated at intervals of 2, 4 or 6 hours as indicated by the patient’s response and clinical condition.
- 51. Hydrocortisone Drug interactions Drugs such as phenobarbital, phenytoin and rifampin induces hepatic enzymes and increases the clearance of hydrocortisone Drugs such as troleandomycin and ketoconazole may inhibit the metabolism of hydrocortisone and thus decrease their clearance When used with high dose aspirin, clearance of asprin increases.
- 52. Hydrocortisone Contraindications Premature infants Systemic fungal infections Hypersensitivity
- 53. Hydrocortisone Adverse effects of the drug Sodium retention Congestive heart failure in susceptible patients Hypertension Abdominal distention Loss of muscle mass Convulsions Potassium loss Hypokalemic alkalosis Headache
- 54. Diazepam Mechanism of action It acts by binding to GABA –A receptors (post synaptic receptors) and increases it’s frequency of opening, leading to potentiate the GABA effects This opening leads to a increased conductance to chloride ions, which produces membrane hyperpolarization, this induces a neuronal inhibition which results in its sedative action
- 55. Diazepam Indication and dose of the drug SEIZURE DISORDERS: 0.2mg/kg repeat after 4- 12 hrs MUSCLE SPASMS:5-10mg IV/IM initially STATUS EPILEPTICUS: 5-10mg IV/IM not to exceed 30mg Sedation—Midazolam is indicated for the sedation of patients in intensive care settings, including intubated patients receiving mechanical ventilation Anesthesia, general, adjunct
- 56. Diazepam Drug interactions Drug interactions Clamithromycin Cimetidine Carbamezipine Rifampin Drug interactions Carbamezipine
- 57. Diazepam Contraindications Hypersensitivity Acute alcohol intoxication Children < 6 months Breastfeeding Sleep Apnea Severe Respiratory Depression
- 58. Diazepam Adverse effects of the drug Headache Dysarthria Blurred vision Fatigue Respiratory depression Hypotension
- 59. BY JINCE THOMAS PROFESSOR SJB COLLEGE OF NURSING BANGALORE-60
- 60. THANK YOU