Emergency Drugs

Presented by: Maha Subih

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

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.

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.

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.

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

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.

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

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.

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.

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

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

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.

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.

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.

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

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.

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

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.

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

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

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.

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

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.