Emergency Drugs

1. Emergency Drugs Presented by: Maha Subih

2. Adenosine (Adenocard) Mechanism of action Slows conduction through the AV node Can interrupt reentrant pathways The drug of choice for reentry SVT Indications Most forms of stable narrow-complex SVT Contraindications Bronchoconstrictive or bronchospastic lung disease Adverse reactions Generally short duration and mild Considerations Evaluate elderly for signs of dehydration

3. Amiodarone (Cordarone, Pacerone) Mechanism of action Delays repolarization and increases the duration of action potential Indications Ventricular fibrillation Contraindications Known hypersensitivity to amiodarone or iodine Cardiogenic shock Adverse reactions Dizziness, fatigue, malaise Congestive heart failure Considerations Pregnancy safety: Category D Monitor patient for hypotension.

4. Atropine Sulfate Mechanism of action Increases heart rate in life-threatening bradydysrhythmias Indications Hemodynamically unstable bradycardia Contraindications Tachycardia, hypersensitivity Adverse reactions Drowsiness, confusion, headache, tachycardia, palpitations Considerations Pregnancy safety: Category C Moderate doses may cause pupillary dilation.

5. Calcium Chloride Mechanism of action Increases cardiac contractile state Indications Hypocalcemia, hyperkalemia, hypermagnesemia Contraindications Hypercalcemia, ventricular fibrillation, digitalis toxicity Adverse reactions Syncope, cardiac arrest, dysrhythmia, bradycardia Considerations Pregnancy safety: Category C Do not use routinely in cardiac arrest.

6. Calcium Gluconate Mechanism of action Counteracts the toxicity of hyperkalemia Indications Hyperkalemia, hypocalcemia Contraindications Ventricular fibrillation, digitalis toxicity, hypercalcemia Adverse reactions Syncope, cardiac arrest, dysrhythmia, bradycardia Considerations Pregnancy safety: Category C Do not administer by IM or SQ

7. Dexamethasone Sodium Phosphate (Decadron) Mechanism of action Suppresses acute and chronic inflammation Indications Anaphylaxis, asthma, spinal cord injury Contraindications Hypersensitivity, use caution in suspected systemic sepsis Adverse reactions Headache, restlessness, euphoria, psychoses Considerations Pregnancy safety: Category C Protect medication from heat. Toxicity and side effects occur with long-term use.

8. Digoxin (Lanoxin) Mechanism of action Increases force of myocardial contraction Indications Congestive heart failure, reentry SVTs, ventricular rate control in atrial flutter and atrial fibrillation Contraindications Ventricular fibrillation, ventricular tachycardia, digitalis toxicity Adverse reactions Fatigue, headache, blurred yellow or green vision, seizures Considerations Pregnancy safety: Category C Patient receiving IV digoxin must be on a monitor

9. Diltiazem (Cardizem) Mechanism of action Reduces myocardial oxygen demand Indications Controls rapid ventricular rates Contraindications Hypotension Sick sinus syndrome Adverse reactions Dizziness, weakness, headache, dyspnea Considerations Pregnancy safety: Category C Use with caution in patients with renal or hepatic dysfunction.

10. Dobutamine Hydrochloride (Dobutrex) Mechanism of action Increased myocardial contractility, stroke volume, and increased cardiac output Indications Cardiogenic shock, CHF Contraindications Tachydysrhythmias, severe hypotension Adverse reactions Headache, dyspnea, tachycardia, hypertension, chest pain Considerations Pregnancy safety: Category B Monitor blood pressure closely.

11. Dopamine Hydrochloride (Intropin) Mechanism of action Increases myocardial contractility and stroke volume Indications Cardiogenic and septic shock, hypotension with low cardiac output states Contraindications Hypovolemic shock, pheochromocytoma, tachydysrhythmias Adverse reactions Headache, anxiety, dyspnea, dysrhythmias Considerations Pregnancy safety: Category C Effects are dose-dependent

12. Epinephrine (Adrenalin) Mechanism of action Blocks histamine receptors Indications Cardiac arrest, symptomatic bradycardia Contraindications Hypertension, hypothermia, pulmonary edema Adverse reactions Nervousness, restlessness, headache, tremor Considerations Pregnancy safety: Category C May cause syncope in asthmatic children

13. Epinephrine Racemic (Micronefrin) Mechanism of action Reduces airway resistance Indications Bronchial asthma, prevention of bronchospasm, croup Contraindications Hypertension, underlying cardiovascular disease, epiglottitis Adverse reactions Headache, anxiety, fear, nervousness, respiratory weakness Considerations May cause tachycardia and other dysrhythmias Monitor vital signs.

14. Furosemide (Lasix) Mechanism of action Causes increased urine output Indications CHF, pulmonary edema, hypertensive crisis Contraindications Hypovolemia, anuria, hypotension Adverse reactions Dizziness, headache, ECG changes, weakness Considerations Pregnancy safety: Category C Ototoxicity, deafness, and projectile vomiting can occur with rapid administration.

15. Heparin Sodium Mechanism of action Affects clotting factors IX, XI, XII, plasmin; does not lyse existing clots Indications Acute myocardial infarction, prophylaxis and treatment of thromboembolic disorders Contraindications Hypersensitivity, active bleeding Adverse reactions Pain, anaphylaxis, shock, hematuria Considerations Pregnancy safety: Category C Heparin does not lyse existing clots.

16. Hydrocortisone Sodium Succinate (Solu-Cortef) Mechanism of action Anti-inflammatory; immunosuppressive with salt-retaining actions Indications Shock due to acute adrenocortical insufficiency, anaphylaxis, asthma, and COPD Contraindications Systemic fungal infections, premature infants Adverse reactions Headache, vertigo, pulmonary tuberculosis Considerations Pregnancy safety: Category C May be used in status asthmaticus as a second-line drug

17. Lidocaine Hydrochloride (Xylocaine) Mechanism of action Decreases automaticity Indications Alternative to amiodarone in cardiac arrest from ventricular tachycardia Contraindications Hypersensitivity, second- or third-degree AV block in the absence of an artificial pacemaker Adverse reactions Anxiety, drowsiness, confusion, seizures Considerations Apnea induced with succinylcholine may be prolonged with high doses of lidocaine. Exceedingly high doses can result in coma or death.

18. Magnesium Sulfate Mechanism of action Reduces striated muscle contractions Indications Seizures of eclampsia, torsades de pointes, hypomagnesemia Contraindications Heart block, myocardial damage Adverse reactions Drowsiness, CNS depression, respiratory depression Considerations Pregnancy safety: Category A Recommended that the drug not be administered in the 2 hours before delivery, if possible

19. Mannitol (Osmitrol) Mechanism of action Decreases cerebral edema and intracranial pressure Indications Cerebral edema Contraindications Hypotension, pulmonary edema, severe dehydration, intracranial bleeding, CHF Adverse reactions Headache, confusion, seizures, pulmonary edema Considerations Pregnancy safety: Category C May crystallize at low temperatures; store at room temperature Have ventilatory support available.

20. Naloxone Hydrochloride (Narcan) Mechanism of action Reverses respiratory depression secondary to opiate drugs Indications Opiate overdose, complete or partial reversal of central nervous system and respiratory depression induced by opioids Contraindications Use with caution in narcotic-dependent patients Adverse reactions Restlessness, seizures, dyspnea, pulmonary Considerations Pregnancy safety: Category C

21. Nitroglycerin (Nitrostat, Nitro-Bid, Tridil) Mechanism of action Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestinal smooth muscle Indications Acute angina pectoris, ischemic chest pain Contraindications Hypotension, hypovolemia, intracranial bleeding or head injury Adverse reactions Headache, dizziness, weakness, reflex tachycardia Considerations Pregnancy safety: Category C Hypotension more common in the elderly

22. Phenytoin (Dilantin) Mechanism of action Promotes sodium efflux from neurons Indications Prophylaxis and treatment of major motor seizures Contraindications Hypersensitivity, bradycardia Adverse reactions Ataxia, agitation, dizziness, headache, drowsiness Considerations Pregnancy safety: Category D Carefully monitor vital signs.

23. Sodium Bicarbonate Mechanism of action Buffers metabolic acidosis and lactic acid buildup Indications Metabolic acidosis during cardiac arrest, tricyclic antidepressant, aspirin Contraindications Metabolic/respiratory alkalosis, hypokalemia, electrolyte imbalance Adverse reactions Hypernatremia, metabolic alkalosis, tissue sloughing, cellulitis Considerations Pregnancy safety: Category C Repeat as needed in tricyclic antidepressant overdose until QRS narrows

24. Verapamil Hydrochloride (Isoptin, Calan) Mechanism of action Prolongs AV nodal refractory period, dilates coronary arteries and arterioles Indications Paroxysmal supraventricular tachycardia, atrial flutter, and atrial fibrillation with rapid ventricular response Contraindications Wolff-Parkinson-White syndrome, Lown-Ganong-Levine syndrome Adverse reactions Dizziness, headache, pulmonary edema Considerations Pregnancy safety: Category C Closely monitor patient’s vital signs.