EMERGENCY
DRUGS
:Jocelyn Lauro, MAN, RN
AMIODARONE
HYDROCHORIDE
AMIODARONE
HYDROCHORIDE
Amiodarone is intended for
use only in patients with lifethreatening recurrent
ventricular fibrillation or
recurrent hemodynamically
unstable ventricular
tachycardia unresponsive to
adequate doses of other
antiarrhythmics or when
alternative drugs can't be
tolerated
Indications& Dosages
PREVENTION OF RECURRENT LIFE-THREATENING
VENTRICULAR ARRHYTHMIAS, SUCH AS
VENTRICULAR FIBRILLATION OR
HEMODYNAMICALLY UNSTABLE VENTRICULAR
TACHYCARDIA.
IV DOSAGES: 50 MG/ML, 150 MG/100ML, 360
MG/200ML
Preparation
• 1 ampoule = 150 mg (3mL
• LOADING DOSE : 1
ampule ( 150 mg/ 3 mL)
+ 12 mL D5W
• A. MAINTANENCE
DOSE : 360 mg in 6
hours
& Computation
4. 360 mg x 3 mL = 7.2 ml
150 mg
5. 7.2 mL ( amiodarone) + 42.
8 mL D5%W = 50 mL = 8.3
mL/hr
6. 540 mg x 3 ml = 10.8 mL
150 mg
7. 10.8 mL (amiodarone) +
39.2 mL D5%W = 2.7 mL/hr
Precautions
• Avoid use in with Wolff-
Adverse
Reactions
• CNS: Fatigue, Malaise,
Parkinson White syndrome
Tremor, Peripheral
and preexcited atrial
neuropathy, Ataxia,
fibrillation or flutter.
Paresthesia, Insomnia, Sleep
• Dialyzable drug: No.
disturbance, Headache,
• Overdose S&S: AV block,
Dizziness.
bradycardia, hypotension,
• CV: Hypotension, Asytole,
cardiogenic shock,
Atrial Fibrillation, Bradycardia,
hepatotoxicity
Arrhythmias, HF, Heart block,
Sinus arrest, Edema, Flushing.
Precautions
• Avoid use in with Wolff-
Adverse
Reactions
• EENT: Asymptomatic
Parkinson White syndrome
corneal microdeposits, Visual
and preexcited atrial
disturbance, optic
fibrillation or flutter.
neuropathy or neuritis
• Dialyzable drug: No.
resulting in visual impairment,
• Overdose S&S: AV block,
abnormal smell
bradycardia, hypotension,
cardiogenic shock,
hepatotoxicity
HEPARIN
SODIUM
HEPARIN SODIUM
ia heterogeneous group of straight-chain anionic
mucopolysaccharides, called glycosaminoglycans that
have anticoagulant properties used to help prevent clot
formation (for example, venous thrombosis, pulmonary
embolisms, coagulopathies and coronary artery clots).
Indications& Dosages
Full-dose continuous I.V infusion therapy
for DVT or PE.
Adults: 5,000 units subcut, every 8 to 12 hours for a minimum of 7
days or for 10 to 14 days for patients undergoing total hop
arthroplasty, or hip fracture surgery according to American College
of Chest Physicicans guidelines
Preparation & Computation
1 ampule : 25,000 IU/ 5mL
Rate of Infusion
Desired dose x Quantity
Drug Concentration
PREPARATION
Example
:45 mL NSS + 25,000 (5mL)
Heparin
100 units x 50 = 0.2 mL/hr
25,000 units
Precautions
• Dialyzable drugs: Unknown
• Overdose S&S: Blood in
Adverse
Reactions
• CNS: Fever EENT: Rhinitis
Hematologic: Hemorrhage,
stools or urine, excessive
overly prolonged clotting
bruising, persistent oozing
time, thrombocytopenia,
from superficial injuries,
white clot syndrome.
excessive menstrual
Metabolic: Hyperkalemia,
bleeding, melena, petechiae.
hypoaldosterism
• Musculoskeletal:
Osteoporosis
Precautions
• Dialyzable drugs: Unknown
• Overdose S&S: Blood in
Adverse
Reactions
• Skin: Irritation, mild pain,
hematoma, ulceration,
stools or urine, excessive
cutaneous or subcutaneous
bruising, persistent oozing
necrosis, pruritus, urticaria,
from superficial injuries,
transient alopecia.
excessive menstrual
bleeding, melena, petechiae.
• Other: Hypersensitivity
reactions, including chills,
anaphylactic reactions
reactions.
CALCIUM
GLUCONATE
CALCIUM
GLUCONATE
used to treat conditions arising from calcium
deficiencies such as hypocalcemic tetany,
hypocalcemia related to hypoparathyroidism,
and hypocalcemia due to rapid growth or
pregnancy.
Indications& Dosages
• Calcium Gluconate should be administered intravenously
either directly or by infusion. The dose is dependent upon
the individual requirements of the patient.
• Calcium Gluconate should be administered
intravenously either directly or by infusion. The dose
is dependent upon the individual requirements of the
patient.
Preparation & Assessment
DIRECTIONS FOR DISPENSINGFROM 100 mLPHARMACYBULK
PACKAGE- NOT FOR DIRECT INFUSION.
• The 100 mL Pharmacy Bulk Package is for use in a Pharmacy
Admixture Service only
• The 100 mL Pharmacy Bulk Package should be suspended
(inverted) by its IV hang label in a laminar flow hood or biological
safety cabinet
• Prior to entering a Pharmacy Bulk Package remove the flip-off seal
and cleanse the rubber closure with a suitable antiseptic agent
• Entry into the Pharmacy Bulk Package must be made with a sterile
transfer set or other sterile dispensing device and the contents
dispensed in aliquots using aseptic technique
Preparation & Assessment
DIRECTIONS FOR DISPENSINGFROM 100 mLPHARMACYBULK
PACKAGE- NOT FOR DIRECT INFUSION.
5. Use of a syringe needle is not recommended as it may cause
leakage
6. ANY UNUSED PORTION MUST BE DISCARDED WITHIN 4
HOURS AFTER INITIAL ENTRY
7. The date and the time initially opened should be recorded in the
space provided on the Pharmacy Bulk Package label.
Precautions
• Contraindicated in cancer
Assessment
• CNS: Tingling sensation, sense
patients with bone metastases
of oppression, or heat waves
and in those with ventricular
with I.V; use syncope with rapid
fibrillation, hypercalcemia,
I.V. use
hypophosphatemia, or renal
calculi.
• CV: bradycardia, arrhythmias,
cardiac arrest with rapid I.V.
• Dialyzable drug: Yes
use, mild drop in BP,
• Overdose S&S: Hypercalcemia,
vasodilation.
confusion, delirium, stupor,
coma
Precautions
• Contraindicated in cancer
Assessment
• GI: constipation, irritation,
patients with bone metastases
chalky taste, hemorrhage,
and in those with ventricular
nausea, vomiting, thirst,
fibrillation, hypercalcemia,
abdominal pain
hypophosphatemia, or renal
• GU: polyuria, renal calculi
calculi.
• Metabolic: hypercalcemia
• Dialyzable drug: Yes
• Overdose S&S: Hypercalcemia,
• Skin: local reactions, including
burning necrosis, tissue
confusion, delirium, stupor,
sloughing, cellulitis, soft-tissue
coma
calcifications with I.M. uses.
VASOPRESSIN
VASOPRESSIN
a man-made form of hormone
called "anti-diuretic hormone"
that is normally secreted by
the pituitary gland used to
increase blood pressure in
adults with vasodilatory shock
who
remain
hypotensive
despite
fluids
and
cathecholamines
Indications& Dosages
Vasostrict® is indicated to increase blood pressure in adults with
vasodilatory shock who remain hypotensive despite fluids and
catecholamines.
Vasopressin is a polypeptide hormone that causes contraction of
vascular and other smooth muscles and antidiuresis. Vasostrict is a
sterile, aqueous solution of synthetic arginine vasopressin for
intravenous administration
Preparation & Assessment
1 ampoule = 20 units / 1mL
USUAL DOSE: 0.01 to 0.03 units/minute
PREPARATION: 20 units in 50mL NS
DRUG CONCENTRATION: 20 units/50mL = 0.4 units/mL
Rate of Infusion: Desired Dose x 60
Drug Concentration
• Example: 0.01 units/min x 60 = 1.5mL/h
0.4 units / mL
•
•
•
•
•
Precautions
Adverse
Reactions
• Contraindicated in patients
• CNS: headache, vertigo
allergic or hypersensitive to
• CV: hemorrhagic shock, HF,
8-arginine vasopressin or
atrial fibrillation, bradycardia,
chlorobutanol. Use in patients
vasoconstriction, myocardial
with an impaired cardiac
ischemia, decreased cardiac
response may worsen cardiac
output, distal limb ischemia.
output.
• Dialyzable drug: Unknown
• Hematologic:
thrombocytopenia.
Precautions
• Overdose S&S:
Adverse
Reactions
• GI: mesenteric ischemia.
Hyponatremia, ventricular
• GU: acute renal insufficiency.
arrhythmias, rhabdomyolysis,
• Metabolic: hyponatremia
nonspecific GI symptoms,
• Skin: cutaneous gangrene
peripheral, mesenteric, or
coronary ischemia
OPIUM
TINCTURE
OPIUM TINCTURE
belongs to the same class of medicines as the narcotic
pain relievers. However, this medicine is used to
decreased the number and frequency of bowel
movements. It is used to treat diarrhea.
Indications & Dosages
•
•
•
•
For oral dosage form (tincture):
For diarrhea:
Adults—0.6 milliliters (mL) four times a day
Children—Use is not recommended.
Preparation &
Assessment
• The dose of this medicine will be
different for different patients. Follow
your doctor's orders or the directions
on the label. The following information
includes only the average doses of this
medicine. If your dose is different, do
not change it unless your doctor tells
you to do so
• This medicine is to be taken by mouth
even if it comes in a dropper bottle.
The amount you should take is to be
measured with the special dropper
provided with your prescription and
diluted with water just before you take
each dose
• The
amount
of
medicine that you take
depends
on
the
strength
of
the
medicine. Also, the
number of doses you
take each day, the
time allowed between
doses, and the length
of time you take the
medicine depend on
the medical problem
for which you are using
the medicine.
Precautions
• Opium should be used with
caution in the elderly, in
debilitated individuals, and in
patients with increased
intracranial pressure,
cerebral arteriosclerosis,
hepatic cirrhosis or liver
insufficiency,
gastrointestinal
hemorrhage, myxedema,
emphysema, and bronchial
asthma
Adverse
Reactions
• Constipation
• Nausea and vomiting may
occur in some patients.
• Pruritus
• Urticaria
Precautions
• When preparations containing
opium are administered in
combination with other drugs,
the cautions applicable to each
ingredient should be borne in
mind.
• Reduced dosage is indicated in
poor-risk patients, in the very
young or very old patient, and in
those who are receiving other
central nervous system
depressants
Adverse
Reactions
• Constipation
• Nausea and vomiting may
occur in some patients.
• Pruritus
• Urticaria
LIDOCAINE
(XYLOCAINE)
LIDOCAINE(XYLOCAINE)
an over-the-counter and prescription medicine used to
treat the symptoms of skin irritation, premature
ejaculation, and as an anesthetic intubation or urethra in
urologic procedure. Xylocaine may be used alone with
other medications.
Indications & Dosages
Xylocaine (lidocaine HCl) 2% Jelly is indicated for prevention and
control of pain in procedures involving the male and female urethra,
for topical treatment of painful urethritis, and as an anesthetic
lubricant for endotracheal intubation (oral and nasal).
For Surface AnesthesiaOf The Male&Female Adult Urethra
When using Xylocaine 2% Jelly 30 mL tubes, sterilize the plastic
cone for 5 minutes in boiling water, cool, and attach to the tube. The
cone may be gas sterilized or cold sterilized, as preferred
Preparation & Computation
Example calculation - Lidocaine when administered
without vasoconstriction
• The total dose that can be used
⚬ The maximum dose of lidocaine (plain,
without vasoconstrictor) is 4.5 mg/kg (not to
exceed 300 mg)
⚬ Example patient weight - 10 kg
⚬ Total dose that can be used for this patient =
4.5 mg/kg x 10 kg = 45 mg
Preparation & Computation
Example calculation - Lidocaine when administered
without vasoconstriction
• Maximum volume of lidocaine administered
⚬ Depends on concentration (see conversion
table below)
⚬ E.g. for 1% lidocaine: contains 10 mg of
lidocaine per 1 mL
⚬ Max volume of 1% lidocaine that can be
administered to a 10 kg patient = 45 mg /
10mg/mL = 4.5 mL
Precautions
Adverse
Reactions
• Contraindicated in patients
• CNS: Confusion, tremor,
hypersensitive to amide-
stupor, restlessness,
type local anesthetics.
lightheadedness, seizures,
• Contraindicated in those with
lethargy, somnolence,
Adams-Stokes syndrome,
anxiety, hallucinations,
Wolff-Parkinson-White
nervousness, paresthesia,
syndrome, and severe
muscle twitching
degrees of SA, AV, or
• CV: Hypotension,
intraventricular block in the
bradycardia, new or
absence of an artificial
worsened
pacemaker
Precautions
• Dialyzable drug: No
• Overdose S&S: Circulatory
Adverse
Reactions
• EENT: Blurred or double
vision, tinnitus
depression, change in level of
• GI: Vomiting
consciousness, seizures,
• Respiratory: Respiratory
hypoventilation
depression and arrest
• Skin: Soreness at the
injection site
• Other: Anaphylaxis,
sensation of cold.
OXYTOCIN
(PITOCIN)
OXYTOCIN (PITOCIN)
a prescription medicine used to treat the symptoms of
postpartum hemorrhage , labor induction, and
incomplete or inevitable abortion. Pitocin may be used
alone or with other medications.
Indications & Dosages
• Oxytocin is indicated for the initiation or
improvement of uterine contractions, where this is
desirable and considered suitable for reasons of
fetal or maternal concern, in order to achieve
vaginal delivery
• To reduce postpartum bleeding after expulsion
ofplacenta. Incomplete, inevitable, or elective
abortion.
Precautions
• The standard solution for
• Establish the infusion with a
infusion of Pitocin is prepared
separate bottle of physiologic
by adding 1 mL (containing 10
electrolyte solution not
units of oxytocin) to 1000 mL of
containing Pitocin.
0.9% aqueous sodium chloride
• Attach (piggyback) the
or Ringer's lactate. The
Pitocin-containing bottle with
combined solution containing 10
the infusion pump to the
milliunits (mU) of oxytocin/mL
infusion line as close to the
is rotated in the infusion bottle
infusion site as possible.
for thorough mixing.
Administration
The initial dose should be 0.5–1 mU/min (equal to 3–6
mL of the dilute oxytocin solution per hour). At 30–60
minute intervals the dose should be gradually increased in
increments of 1–2 mU/min until the desired contraction
pattern has been established. Once the desired frequency of
contractions has been reached and labor has progressed to
5–6 cm dilation, the dose may be reduced by similar
increments.
• May cause antidiuretic effect
Adverse
Reactions
• CNS: Subarachnoid
MATERNAL
Precautions
and risk of severe water
hemorrhage, seizures, coma
intoxication, seizures, or
• CV: arrhythmias, HTN, PVCs.
death, particularly with large
• GI: nausea, vomiting
doses or when given by slow
• GU: abruptio placentae, tetanic
infusion over 24 hrs and if the
uterine contractions,
patient is receiving fluids by
postpartum hemorrhage,
mouth.
uterine rupture, impaired uterine
blood flow, pelvic hematoma,
increased uterine motility.
• Dialyzable: Unknown
• Overdose S&S: Uterine
hypersensitivity, tumultuous
labor, uterine rupture, cervical
and vaginal lacerations,
postpartum hemorrhage,
uteroplacental
hypoperfusion, variable
decleration of fetal HR.
Adverse
Reactions
• CNS: Infant brain damage,
seizures.
• CV: bradycardia, arrhythmias,
PVCs.
• EENT: neonatal retinal
hemorrhage
• Hepatic: neonatal jaundice
FETAL
Precautions
DIGOXIN (IV)
DIGOXIN (IV)
indicated in the management of chronic cardiac failure
where the dominant problem is systolic function. The
therapeutic benefit of digoxin is greater in patients with
ventricular dilatation.
Indications & Dosages
• Each dose should be given by intravenous infusion
over of 10 - 20 minutes. The total loading dose
should be administered in divided doses with
approximately half of the total dose given as the
first dose and further fractions of the total dose
given at intervals of 4 - 8 hours.
Precautions
• Digoxin Injection is for
administration by slow
intravenous infusion
• The dose of digoxin for each
patient has to be tailored
individually according to age,
lean body weight, and renal
function. Suggested doses are
intended only as an initial guide
Administration
• Parenteral loading should only
be used in patients who have
not been given cardiac
glycosides within the
preceding two weeks.
• The total loading dose of
parenteral digoxin is 500 to
1000 micrograms (0.5 to 1.0
mg) depending on age, lean
body weight and renal
Precautions
Administration
• Each dose should be given by
• The total loading dose should be
intravenous infusion over a
administered in divided doses
period of 10 - 20 minutes.
with approximately half of the
total dose given as the first dose
and further fractions of the total
dose given at intervals of 4 - 8
hours.
• An assessment of clinical
response should be performed
before giving each additional
dose
Computation