Download - Drugs used in emergency cases
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PHARMACIST: PHARMACIST: RIDHA MOHAMMAD HAREKARIDHA MOHAMMAD HAREKA
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OXYGENDRUGS FOR CARDIAC DISORDERSDRUGS FOR POISONINGDRUGS FOR SHOCKDRUGS FOR HYPERTENSIVE CRISIS
AND PULMONARY EDEMA
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w/o OXYGEN - Brain death within 6 min
Pulse oximeter – measures oxygen saturation WHAT’S THE IDEAL O2 SAT? 95%
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for severe physiologic stressShockTraumatic injuryAcute myocardial infarctionCardiac arrest
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CAUTION IN COPD PATIENTS
May lose their hypoxic respiratory drive
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Emergency but no severe stress (angina, arrhythmia)Nasal cannula – 1-6L/minFace tent (high O2 flow) - children
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NITROGLYCERIN - vasodilatorANGINA PECTORISMYOCARDIAL 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
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NITROGLYCERIN – vasodilatorShould not be use along with Sildenafil (VIAGRA)
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MORPHINE SULFATEMORPHINE SULFATENarcotic 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
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MORPHINE SULFATEMORPHINE SULFATE Adverse effects: respiratory
depression and hypotension
NALOXONE (NARCAN) Reverses the action of morphine
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ATROPINE SULFATEATROPINE SULFATE Inhibits action of VAGUS nerve for treatment of bradycardia,
asystole and AV block dose: 0.5-1mg q 3-5 min
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ISOPROTERENOLISOPROTERENOL beta adrenergic drug – increase
heart rate – for HYPOTENSION monitor heart rate
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EPINEPHRINEEPINEPHRINE Improves perfusion of the
heart and brain, bronchodilation
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EPINEPHRINEEPINEPHRINE “E” drug for hypotension,
pulseless Vtach, V fibrillation, status asthmaticus
monitor cardiac and hemodynamics
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SODIUM BICARBONATEFor metabolic/respiratory acidotic state associated with cardiac arrest
dose: 1meq/kg IV, maybe repeated at 0.5meq/Kg every 10 min when required.
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ADENOSINEVERAPAMILDILTIAZEMLIDOCAINEAMIODARONEPROCAINAMIDE
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Amiodaron
. It is used in the treatment of both ventricular and atrial arrhythmias.
Note: Amiodarone is incompatible with normal saline solution.
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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).
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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.
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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.
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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
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MANNITOLMANNITOLOsmotic diuretic – for cerebral
edema may inc ICP initial dose – 0.5-1g/kg IV of 25%
solutionNote: highly irritating to the veins
forms crystals
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Mannitol
If crystals are present, redissolve by warming solution. Use filter-type administration set for infusion solutions containing mannitol ≥20%.
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METHYLPREDNISOLONEIndication: spinal cord injury/cerebral
edema* Contraindications:
HIV infection pregnancy Uncntrolled diabetes
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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
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Poisoning ManagementIngestion 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
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Ingested Poison Warnings!!!
Vomiting is NEVER induced after ingestion of caustic substances or petroleum distillates.
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1. NALOXONE – anti-dote for opiates overdose
2. FLUMAZENIL – reverses respiratory depression secondary to benzodiazepines
3. ATROPINE - reverses organophosphate poisoning
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DOPAMINEDOBUTAMINENOREPINEPRHINEEPINEPHRINEALBUTEROL
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Epinephrine: α-adrenergic effects can increase
coronary and cerebral perfusion pressure by vasoconstriction
β-adrenergic can increase myocardial contractility
Given 1 mg per IV/IO every 3-5 minutes
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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
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Assess IV site q1 hrExtravasation can lead to tissue necrosis
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sympathomimetic with beta 1 effects (inc. heart rate)
no vasoconstriction, only increase cardiac output
dose: 250-1000mg in 250ml D5W or NSS
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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
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ANAPHYLACTIC SHOCKALBUTEROL( salbutamol)
Reverses bronchoconstrictionBeta2 Agonist administered via nebulizer side effects: tremors, tachycardia, dysrhythmia, hypertension
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ANAPHYLACTIC SHOCK
DIPHENHYDRAMINEAnti-histamineReduce histamine induced tissue
swelling and pruritus25-50mg IV or deep IM
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DRUGS FOR HYPERTENSIVE CRISIS
Diastolic pressure that exceeds 110-120mmHg and pulmonary edema
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DRUGS FOR HYPERTENSIVE CRISIS
LABETALOLBeta blockerLowers 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
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DRUGS FOR HYPERTENSIVE CRISIS
SODIUM NITROPRUSSIDEReduces arterial BPEffect: immediate vasodilation and BP goes down but immediately goes up once the drug is stopped
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DRUGS FOR HYPERTENSIVE CRISIS
SODIUM NITROPRUSSIDE inactivated by light – wrap in
aluminum foilBlue or brown discoloration –
means drug is degraded prolonged use – can lead to
cyanide poisoning
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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
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DRUGS FOR HYPERTENSIVE CRISIS
FUROSEMIDEAdverse effects: hypotension, dehydration and electrolyte imbalances
can result to allergic reaction
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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.
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Thanks