This document discusses various emergency drugs used in oral surgery. It provides classifications of emergency drugs as injectables, non-injectables, primary and secondary advanced cardiac support drugs. It then discusses 20 individual emergency drugs in detail including their introduction, indications, contraindications, trade names, dosages and adverse effects. The drugs discussed include adrenaline, atropine, dopamine, metoclopramide, phenaramine maleate, hydrocortisone, dexamethasone, diazepam, fortwin-pentazocin, furosemide, pancuronium bromide, styptochrome, and ethamsylate.

1. EMERGENCY DRUGS
USED IN ORAL SURGERY
KUMAR
R.ANIL
4 TH BDS

2. CONTENTS
* Introduction
* Classification of the emergency drugs
* Individual emergency drug
* Drug interactions

4. EMERGENCY DRUGS USED IN ORAL
SURGERY
1. Adrenaline
11. Pancuronium bromide
2. Atropine
12. Styptochrome
3. Dopamine
13. Ethamsylate
4. Metoclopramide
5. Phenaramine maleate
14. Ketorolac
15. Aminophylline
6. Hydrocortisone
16. Succinyl choline
7. Dexamethasone
17. Dextrose
8. Diazepam
18. Sodium bicarbonate
9. Fortwin-pentazocin
19. Calcium gluconate
10. Furosemide
20. Chlorphenaramine maleate

5. CLASSIFICATION
Emergency drugs
Injectables
Non Injectables
Oxygen
Vasodilators
Respiratory stimulants
Anti Hypoglycaemic agents
Bronchodilators
Primary
Secondary
advanced cardiac
support
Drug for
life
1)
Adrenaline
1)
Analgesic
1) Lidocaine
2)
Antihistamine
2)
Vasopressor
2) Atropine
3)
Anti convulsant
3)
Corticosteroid
3) Sodium bicarbonate
4)
Narcotic antagonist 4)
Antihypoglycaemic

6. ADRENALINE
INTRODUCTION :
- It is an adrenergic drug.
- It increases heart rate,force of contraction and cardiac output.
- It constricts blood vessels.
- It increases mean BP.
- Potent bronchodilator
- It causes mydriases in eye that is pupil dilatation.
INDICATIONS :
- Anaophylactic shock
- In bronchial asthma
- In cardiac arrest
- With local anaesthesia
- To control post extraction haemorrhage
- To treat open angle glaucoma

7. CONTRAINDICATIONS
- Hypersensitivity
- Hyperthyroidism
- Hypertension
- Angina pectoris
- Diabetes mellitus
TRADE NAME : Adrenor, Asmotone
DOSAGE : 0.2-0.5 mg s.c ,
0.5 % aerosol
in case of im /iv – in conc of 1:10,000 to 1:1,00,000
ADVERSE EFFECTS
- Marked increase in BP
- photosensitivity, skin rashes
- palpitation, arrythmias
-anginal pain, ventricular failure

8. ATROPINE
INTRODUCTION
- It is a parasympathetic drug
-Anticholinergic action
- Antispasmodic action
- Antisecretory action
- Anti muscarinic action
- It causes tachycardia
- Anti dote for organo phosphate poisoning.
INDICATIONS
- Motion sickness
- Colics and dysmenorrhoea
- Anti parkinsonism
- Pre operatively to reduce secretions & salivation
- In bronchial asthma
- Severe sinus bradycardia

9. CONTRAINDICATIONS
- Hypersensitivity to belladona alkaloid
- Glaucoma
- Prostatic hypertrophy
- Cardiac failure
- Thyrotoxicosis
TRADE NAME : Atro, Tropine, Atropine sulphate
DOSAGE : Children : oral – 0.2 mg/kg
inj --0.3-0.6 mg i.m
Adults : 0.6- 2 mg/ml i.m
ADVERSE EFFECTS
- Dry mouth, decreased salivation
- Decreased sweating
- Constipation
- Tachycardia, palpitations, arrythmias
- Mydriasis and cycloplegia

10. DOPAMINE
INTRODUCTION
- Potent sympathomimetic agent
- Agonist for dopamine receptors in CNS,renal and other vascular beds
- Agonist for beta adreno receptors in heart
- At high doses it causes vasoconstriction
- At low doses it causes increase in renal blood flow, GFR, and sodium excretion.
INDICATIONS
- Cardiogenic shock
- Septic shock
- Septicaemia
- Congestive heart failure
- Renal failure
- Heart failure
- In parkinsonism

11. CONTRAINDICATIONS
- Atrial/venticular tachy arrythmias
- Hyperthyroidism
- Pheochromocytoma
TRADE NAMES : Dopamine, Dopinga, Dopapins, Dopar, Dopat.
DOSAGE : Children – 2-20 microgram/kg/min i.v
Adults
-- 2-50 micrograms/kg/min i.v
ADVERSE EFFECTS
- Nausea , vomitting
- Tachycardia
- Palpitation
- Anginal pain
- Atopic beats

12. METOCLOPRAMIDE
INTRODUCTION
- It is a pro kinetic drug -- causes forward propulsion of contents of stomach
- Centrally acting dopamine antagonist
- Acts on chemoreceptor trigger zone
- Peripherally acts to enhance the effect of A-ch at muscarinic receptors in gut
INDICATIONS
- As an anti emetic – in nausea, vomitting
post operative vomitting
drug/disease induced vomitting
radiation sickness
morning/ motion sickness
- Gastritis
- Reflux oesophagitis
- Gastroenterology

13. CONTRAINDICATIONS
- Gastro intestinal perforation/ obstruction
- Epilepsy
- Parkinsonism
- Breast cancer
TRADE NAMES : Reglan, Perinorm, Metaclop, Emenil, Vominil
DOSAGE : oral – 5-10 mg TDS
INJ. – 2 ml TDS
ADVERSE EFFECTS
- Dizziness
- Diarrhoea
- Trismus,
- Tremors
- Gynaecomastia,
- Galactorrhoea

14. PHENARAMINE MALEATE
INTRODUCTION
-It is an alkylamine derivative
- Antihistaminic
- Anti cholinergic property
- Anti muscarinic property
- Central sedative property
INDICATIONS
- In allergies – urticaria
itching
angioedema
dermatitis
- Common cold
- Motion sickness
- Insect bite
- To decrease the BP

15. CONTRAINDICATIONS
-Hypersensitivity
-Acute porphyria
TRADE NAME : Avil, Avil Retard
DOSAGE : Children-- syrup ------- 1-3 yrs : 2.5 ml TDS
3-12 yrs: 5 ml TDS
Inj ------- 0.6 – 2 ml i.m OD/BD
Adults -- oral ---- 25 – 50 mg TDS
inj ---- 1.2 ml i.m TDS
ADVERSE EFFECTS
- Abuse potential
- Dry mouth
- Blurred vision
- Constipation
- Retention of urine

16. HYDROCORTISONE
INTRODUCTION
- It is a glucocorticoid ( corticosteroid)
- It causes adreno pituitary axis suppression
- They maintain fluid electrolyte balance
- They maintain functional status of skeletal, muscles and nervous system
INDICATIONS
- Acute allergic reactions
- Anaphylactic shock
- Status asthmaticus
- Addison’s disease
- Rheumatoid arthritis
- Pruritis
- Tubercular meningitis
- Infective eczema

17. CONTRAINDICATIONS
- Neonates , infants
- Local/systemic infections
- Herpetic/fungal keratitis
- Cataract
TRADE NAMES : Corts, Lycortin, Primacort, Lutisoft cream, Neosporin – H
DOSAGES :
Anaphylaxis –
100-150 mg/sec i.m 6 hourly
Status asthmaticus – 100-200 mg i.v 6 hourly
ADVERSE EFFECTS
- Hyperglycaemia
- Hyperkalemia
- Delayed wound healing
- Water and sodium retention
- Osteoporosis
- Calcium deposition

18. DEXAMETHASONE
INTRODUCTION
- Corticosteroid derivative
- Long acting, very potent, highly selective glucocorticoid
- It causes marked pituitary adrenal suppression
- Anti-inflammatory and anti-allergic properties
INDICATIONS
- Allergic conditions
- Overwhelming infection
- Inflammation in eye disorder
- Shock due to trauma
- Rheumatoid arthritis
- Adjuvant anti emetic
- Adrenal crisis

19. CONTRAINIDICATIONS
-Diabetes mellitus
- Congestive heart failure
- Renal failure
- Tuberculosis
- Pyschosis
- Osteoporosis
TRADE NAME : Dexona, Dexavin, Decadan
DOSAGES : Children - 0.1 – 0.5 mg/kg/fay
Adults
- 4-20 mg/day s.c/i.m/i.v
ADVERSE EFFECTS
- Hyperglycaemia, glycosuria
- Delayed wound healing
- Osteoporosis
- Cushing syndrome

20. DIAZEPAM
INTRODUCTION
- Prototype of benzodiazepine
- Sedative hypnotic action
- Skeletal muscle relaxant
- Anti convulsant actiond
- Potentiates the neural GABA mediated inhibition in CNS
INDICATIONS
- Anxiety, tension
- Psychosomatic and behaviour disturbances
- Status epilepticus
- Tetanus
-Dysmenorrhoea
- Termination of prolongd seizure
- Local anaesthetic seizure

21. CONTRAINDICATIONS
- Hypersensitivity to benzodiazepines
- Acute narrow angle glaucoma
- Myasthenia gravis
TRADE NAMES : Calmpose, Calmod, Placidox
DOSAGES : Oral - 5-20 mg/day i.m in divided doses
inj – 10mg/2ml i.v
ADVERSE EFFECTS
- Respiratory depression
- GIT disturbance
- Drug dependance and abuse

22. FORTWIN – PENTAZOCINE
INTRODUCTION
- Opioid analgesic
- Morphine like action
- It has agonist – antagonist type action that is weak antagonist and
marked agonist actions
INDICATIONS
- Chronic , recurrent, moderate to severe pain which is
assosciated with - - - surgery
trauma
fractures
labour pains
burns
cancer

23. CONTRAINDICATIONS
- Children below 12 years
- Hypertensives
- Ischaemia
- Myocardial infarction
TRADE NAMES : Fortwin, Fortagesic, Pentazocin, Pentawin
DOSAGES :
30 – 60 mg / ml i.v 3-4 hourly
ADVERSE EFFECTS
- Nausea, vomitting
- Euphoria
- Respiratory depression
- Hypertension, tachycardia, palpitation
- Withdrawl syndrome (rarely)

24. FUROSEMIDE
INTRODUCTION
- It is a diuretic
- It causes loss of Nacl, Ca, K, Mg, PO 4, Na, water loss
- It causes pooling of blood in peripheral deep veins
- This effect occurs before the diversion and is important for the treatment of
left ventricular failure and pulmonary edema
INDICATIONS
- Oedema in congestive heart failure, hepatic disease,
renal disease and pulmonary oedema
- Hypertension
- To treat hypercalcaemia
- To treat drug overdose ------ by inducing forced diuresis and
facilitate rapid elimination of drug

25. CONTRAINDICATIONS
- Hypovolaemia
- Hypotonia
- Hepatic coma
- Renal failure with anuria and potassium defenciency
TRADE NAMES : Lasix, Frusenex, Salinex
DOSAGES : Children : 20 – 40 mg / day
Adults : Oral -- 40 – 100 mg
Inj -- 20 mg / 2 ml inj
ADVERSE EFFECTS
- Fluid and electrolyte imbalance
- Visual impairment
- Hearing impairment, deafness
- Muscle cramps
- Paraesthesia

26. PANCURONIUM BROMIDE
INTRODUCTION
- Long acting, non depolarizing, peripherally acting
skeletal muscle relaxant
- Competitive antagonist of acetyl choline at neuro muscular junction
INDICATIONS
- Long acting skeletal muscle relaxant in surgical anaesthesia
- Assisted ventilation
CONTRAINDICATIONS
- Hypersensitivity
- Inadequate general aneasthesia
- Depressed ventilation

27. TRADE NAMES : Pavulon, Fancuron
DOSAGES : 2 mg/ ml i.v
ADVERSE EFFECTS
- Hypotension
- Bronchospasm
- Reduction in GI motility
- Wheel and flare reactions at site of injection

28. STYPTOCHROME
INTRODUCTION
- It is a haemostatic agent
- It is a preparation of adrenochrome mono semi carbazone
- It exerts haemostatic action by reducing capillary fragility
- It prevents microvessel bleeding
INDICATIONS
- Epistaxis
- Retinal haemorrhage
- Secondary haemorrhage from wounds
- Haematuria
- Menorrhagia
CONTRAINDICATIONS
- Hypersensitivity

29. TRADE NAMES : Styptochrome, Cadisper – c, Styptocid
DOSAGES : Pre operatively 2-6 ml at suitable intervals
Postoperatively 1-2 ml every 2 hours

30. ETHAMSYLATE
INTODUCTION
- It is a haemostatic agent
- It decreases capillary bleeding when platelets are adequate
- It inhibits PGI 2 production
- It corrects abnormal platelet function
INDICATIONS
- Epistaxis
- After tooth extraction
- Hematuria
- Malena
- After abortion
- Menorrhagia
- Post surgical conditions

31. CONTRAINDICATIONS
- Hypersensitivity
- Porphyria
- History of thrombocytopenia
purpura
haemophillia
TRADE NAMES : Ethamsyl, Hemsyl, Stat
DOSAGES : Oral -- 500 mg tab post operatively
inj -- pre operatively - - 1-2 ampules 1 hour before surgery
postoperatively - - 1-2 ampules 4 to 6 hourly
ADVERSE EFFECTS
- Nausea , headache
- Skin rashes
- Fall in BP after i.v injection

32. KETOROLAC
INTRODUCTION
- It is a non steroidal anti inflammatory drug (NSAID)
- It is a pyrrolo-pyrrole derivative of non selective cox inhibitor (conventional NSAID)
- It is a potent analgesic, antipyretic, and anti inflammatory agent
- It relieves pain by peripheral mechanism
INDICATIONS
- Management of acute pain
- Post operative and acute musculoskeletal pain
- Renal colic
- Migraine
- Pain due to bony metastasis
- Post operative --inflammation
itching
allergy

33. CONTRAINDICATIONS
- Hypersensitivity
- After ocular surgery
- Peptic ulcer
-Coagulation disorder
TRADE NAMES : Ketorol, Ketotifen, Ketanov, Cadolac
DOSAGES : Oral - - 20 – 40 mg/day
Inj - - 4 – 6 ml i.m
ADVERSE EFFECTS
- Gastric disturbances
- Ocular irritation
- Wound healing abnormalities
- Superficial keratitis

34. AMINOPHYLLINE
INTRODUCTION
- It is a bronchodilator
- Stable mixture of theophylline and ethylene di amine
- Directly relaxes smooth muscles of bronchi and lungs
- Stimulates CNS
- induces diuresis
- Increases gastric acid secretion
INDICATIONS
- Reversible airway obstruction
- Severe acute asthma
CONTRAINDICATIONS
- Hypersensitivity
- Hypertension
- Peptic ulcer

35. TRADE NAMES : Aminophylline, Deriphylline, Minophyl
DOSAGES : Oral - - 200-300 mg 3-4 times a day
Inj - - 200-500 mg slowly over 20 minutes
ADVERSE EFFECTS
- Tachycardia
- GI disturbance
- Convulsions
- Severe hyperventilation

36. SUCCINYL CHOLINE
INTRODUCTION
- It is an ultra short actiong ,peripherally acting , neuro muscular blocking
skeletal muscles relaxant
INDICATIONS
- During General Anaesthesia
- During seizures
- Respiratory arrest during tracheal intubation
CONTRAINDICATION
- Glaucoma
- Myasthenia gravis
- In case of burns
- History of malignant hyperthermia

37. TRADE NAMES : Scoline, Scolax, Succinyl chloride, Succin inj
DOSAGES : 20- 100 mg
ADVERSE EFFECTS
- Hypertension
- Hyperkalemia
- Hyperthermia
- Raised intra cranial pressure
- Muscle pain
- Respiratory depression

38. DEXTROSE
INTRODUCTION
- It is a hyperglycemic agent
- It rapidly elevates the blood glucose level by mobilizing hepatic
glycogen and converting it to glucose
INDICATIONS
- Severe hypoglycaemia
- Diagnostic tool in unconsciousness and
seizures of unknown origin
- Cardiogenic shock (rarely)
CONTRAINDICATIONS
- Chronic hypoglycaemia
- Hyperglycaemia
- Starvation states

39. TRADE NAMES : Glucagon
DOSAGES : 1md dry powder + 1 ml diluent
(50 ml bottle for emergency kit – 50 % dextrose)
ADVERSE EFFECTS
- Nausea, vomitting
- Allergic reaction
- Tissue necrosis if there is infiltration

40. SODIUM BICARBONATE
INTRODUCTION
- It is an antacid n used to correct acidosis assosciated with hypoxia
cardiorespiratory arrest
metabolic acidosis
- Adequate ventilation is necessary whenever sodium bicarbonate is given because
carbon di oxide is produced in this procedure
INDICATIONS
- Reversal of metabolic acidosis occurring during anaerobic metabolism in
cardiopulmonary arrest
- Calcium and vitamin D defeciency states
- Pregnancy and lactation
- Bladder washes
- Auricular lavage
- Bronchial lavage

41. CONTRAINDICATIONS
- In alkalosis
- Respiratory depression
- Hypocalcaemia
- Sodium overload
TRADE NAMES : Sodium bicarbonate
DOSAGES : 90 – 180 mEq / lit
ADVERSE EFFECTS
- Metabolic alkalosis with impairment of release of oxygen from Hb
- Sodium and water overload
- Local pain
- Venous irritation

42. CALCIUM GLUCONATE
INTRODUCTION
- Essential for cardiac function
muscle contraction
nerve activity and
blood coagulation
- To maintain standard integrity of all membranes
- It causes neuro transmitter release
DEFENCIENCY SIGNS AND SYMPTOMS :
- Osteoporosis
- Pathologic fracture
- Brittle nails and hair

43. INDICATIONS
ORAL
INJECTIONS
Mild hypocalcaemia
Severe hypocalcaemia
Growing children
Hypoparathyroidism
Pregnancy
Hyperkalemia
Lactation
Cardiac arrest
Post menopausal women
Rickets
Osteomalacia
Every fourth bottle of
blood transfusion

44. CONTRAINDICATIONS
- Renal calculi
- Hypophosphataemia
- Hypercalcemia
- Hypoparathyroidism
TRADE NAMES : Calciium sandoz, Calcid, Calcibom
DOSAGES : Oral -- 1 gram
Inj -- 10 % inj
ADVERSE EFFECTS
- Constipation
- Abdominal discomfort
- Bloating
- Dyspepsia
-Excess gas

46. Common drug interactions in oral surgical practice
Drug
Interacting Drug
Drug Interaction
1)Antihistamine
CNS depressants
2) Salicylates
1)
Anticoagulants
Increased risk of bleeding
2)
Antacids
Premature release of aspirin
3)
Corticosteroid
Increased risk of gastroitestinal bleeding
4)
Methotrexate
Increased risk of methotrexate toxicity
5)
Oral
hypoglycaemics
Potentiates hypoglycaemic drugs effect
6)
Phenytoin
Increased drowsiness and sedation
Increased effect of antiepileptics

47. 3) Atropine
1) Alcohol
Impaired motor performance and increased
drowsiness.
4) Carbamazepine
1) Alcohol
Depressed CNS
2) Barbiturates,
Depressed CNS
doxy cycline
oral
hypoglycemics
steroids
5) Corticosteroids
Retarded effect of drug
Increased carbamazepine isoniazid plasma
level resulting in sedation
3) Erythromycin
1) Anti diabetic drugs
Corticosteroids may exacerbate diabetic
state by hypoglycemic action
Antagonism due to fluid retention
2) Anti hypertensives
3) Oral cotraceptives
Increased anti-inflammatory response to
topical steroids

48. 6) Cotrimoxazole
1) Diuretics
Increased risk of thrombocytopenia in
elderly
Potentiate action of these agents
7)Diazepam
2) Anti coagulants,
anti epileptics,
oral hypoglycemics
CNS depressants
8) Doxy cycline
1) Penicillin
Reduced effect of penicillin
2) Barbiturates,
antiepileptics
Possiblility of reduced plasma concentration
of Doxy cycline.
1) Alcohol
Antagonism, therefore alcohol should be
avoided
2) Antiepileptics
Incereased risk of toxicity of phenytoin
9) Metronidazole
3) Anticoagulants
4) Barbiturates
Intensified sedative effects
Potentiated anticoagulant effect
Reduced plasma level of metronidazole

49. 10)Penicillin
oral Contraceptives
Increased bleeding, possibly with
contraceptive failure
11)Tetracyclines
Oral contraceptives
Increased bleeding due to contraceptive
faliure
Oral hypoglycemic
Increased hypoglycemic effect
Methotrexate
Incerased methotrexate toxicity

50. References :
1. Essentials of medical pharmacology
(By K.D.Tripathi).
2. A text book of pharmacology (Satoskar).
3. A text book of Oral and Maxillofacial surgery
(By B. Srinivasan).
4. Contemporary Oran and Maxillofacial Surgery
(By Peterson).