Common drugs used in the Emergency Routes of administration IV Intravenous administration is when the drug is given in liquid form directly into a vein. This is often done by placing a venous catheter to allow easy administration. IM Direct injection into the muscle. Often a painful mode of administration, and provides a slow route of absorption. PO By mouth (Per Orum). Typically intermediate between IM and IV in speed of absorption. (is this true?) PR Rectal administration (Per Rectum). The rectum is actually a very quick method of drug administration as the rectum is highly vascular. This route is often used in children. ET Certain drugs can be given down an endotracheal tube. The drugs are given at 2-2.5 times normal IV dose. Drugs are followed with a saline bolus of ~10ml. The acronym for drugs that can go down an ET tube is ALONE: • A – Atropine • L – Lidocaine • O – Oxygen • N – Naloxone (Narcan) • E – Epinephrine This is solutiom are important in Emergency: NS: NS stands for Normal Saline, which is 0.9% Sodium Chloride, and is the usual fluid given to a patient who needs fluid due to dehydration. It is approximately isotonic. LR: LR stands for Lactated Ringers, which is Normal Saline with other electrolytes. Due to the presence of the other electrolytes, there is a limit to how much can be administered within aspecific period of time. D5, D10, D25 and D50: The D stands for Dextrose, which is a stable form of glucose. This solution is given IV to give the patient glucose. This is never given IM, as high concentrations of glucose cause tissue death outside the vasculature. Common Drugs Indications Adrenaline(Epinephrin)
Anaphylaxis or cardiac arrest.
Nor-epinephrin
Hypotension&shock
Adenosine
antidysrhythmic
Lidocaine
local anesthetic&antidysrhythmic
Dopamine
Hypotension
Dobutamin
Short term management of cardiac decompensation result from depressed contractility
Digoxin
slow conduction the heart( atrial-fibrillation).
Diltiazem(Cardizem)
slow the heart down in patients with certain types of tachycardias (atrial fibrillation).
Frusemide
Relief of pulmonary oedema associated with LVF
Diamorphine
Severe pain or acute left ventricular failure
Atropine
Bradycardia&sever asthma
Streptokinase
thrombolytic agent. blood clots in patients with myocardial infarction(heart attacks), non-hemorrhagic CVA’s (strokes)& pulmonary emboli
Heparin
anticoagulant
Morphine Sulfate
analgesic
Naloxone (Narcan)
antidote to narcotic
Diazepam(valum)
anticonvulsant
Glucagon
Hypoglycaemia
Flumazenil
Reversal of benzodiazepine induced respiratory depression
Furosemide (Lasix)
diuretic
NTG
Ischemia chest pain
Druge Epineph ri
Rout e I.V& ETT
Dose
Action
Side effect
0.01-0.2 mcg/kg/min
beta1, beta 2 & alpha agonist,cardiac stimulation, relax bronchial muscles Stimulates beta1 & alpha adrenergic receptors; incr. Contractility & HR, vasoconstriction, incr SBP Interrupts reentry pathway through AV node; for PSVT Suppress automaticity of conduction tissue, incr. elect. threshold of ventricle, Stimulate adrenergic and dopaminergic receptors, positive inotrope, renal vasodilation Stimulate beta 1 receptors, incr. contractility & heart rate, minor effect on alph and beta 2 receptors Cardiac glycoside thate incr. cardiac contractility Action(positive inotropic)&slows conduction in the AV node(negative dromotropic effects) Produce coronary vascular smooth muscke relaxation& lower BP.slow HR.and AVnode conduction
H.T.N-tachycardia
Norepin ephrin
I.V
0.01-0.2 mcg/kg/min
Adenosi ne
I.V
100mcg/kg; max12mg
Lidocain e
I.V& ETT
Dopami ne
I.V
3-12 mcg/kg/min
Dobuta min
I.V
3-10 mcg/kg/min
Digoxin
I.V
0.5-1mg
Diltiaze m (Cardize m)
I.V
30-200mg
Frusemi de
I.V
20-50mg
An ultra short acting beta-adrenergic blocker used to lower BP&HR
Hypotension-nauseaGI_distrubuance
Diamorp hine
I.V
5-10mg
Prevent conversion of angiotensionI to angiotensionII resulte in dilation of arteries &veins.
Hypotension-nauseaGI_distrubuance
Atropin e
I.V& ETT
0.02 mg/kg/dose; minimum dose 0.1mg
Anti-cholinergic agent; vagally induced symptomatic bradycardia; symptomatic bradycardia refractory to oxygenation,ventilation &epinephrine
Urine retention-dry mouth-blurred vision.
Strepto kinase
I.V
250000unit over30minut
Thrombolytic drugs thate breake down existing clotes.
Hemorrhage
Heparin
I.V
10.000 unit\ml
Anticoagulant enhances inhibitory effect of antithrombin,its prevents clote from enlarging but can,t dissolve those already formed.
Bleeding- GI_distrubuance
Morphin e Sulfate
I.V
0.05 mg
Opoid receptors in spinal cord&the CNS
Constipation- decrease bowel sound
Naloxon e (Narcan )
I.V& ETT
Reversal of respiratory and neurologic depression due to opiate intoxication
H.T.N-pain-N\V-
Diazepa m (valum)
I.V
0.1 m g/kg; minimum dose 0.01 mg 10 mg
Hypotension-resp.depression
Glucago n
I.V
0.5-1 mg
Flumaze nil
I.V
Furose mide (Lasix)
I.V
200 mcg over 15 seconds, then 100 mcg at 60-second intervals to a maximum of 1 mg, if required. 20-50mg
Its anticonvulsive effect is due to enhancement of the inhibitory neurotransmitted gammaaminobutyric acid to neurons in the brain Glucagon increases plasma glucose by stimulating glycogenolysis and gluconeogenesis in the liver. An additional action is inhibition of glycogen synthesis and glucose oxidation. In adipose and hepatic tissues, glucagon causes lipolysis, resulting in the production of fatty acids which further increase gluconeogenesis Blocke benzodiazepine reseptores& antagonizes the action of benzodiazepine on the CNS
Hypcalemia- hypotension-dizznessheadach
NTG
I.V
0.5-4 mcg/kg/min
reduce the fluid overload in patients with congestive heart failure (CHF) or hypertension Dilates coronary artery, relax
20-50 mcg/kg/min
Bradyycardia-hyperglacemiadecrease urine output S.O.B-Chest pressure Confusion- decrease liver function. Tachycardia- hyperglacemia
H.T.N
Arrhythmia-N\V
H.F- Arrhythmia-hypotension
Hepatic impairment-hypcalemia
Seizure
Hypotension- headach-N\V
