Comprehensive Guide on Essential Emergency Drugs for Pharmacy, Medical, and Nursing Students

1) Amiodarone

Uses: Treatment of ventricular arrhythmias and atrial fibrillation.

Mechanism: Class III antiarrhythmic that prolongs the action potential and refractory period in myocardial tissue.

S.E./A.E.: Pulmonary toxicity, thyroid dysfunction, hepatotoxicity, and corneal deposits.

D.I.: Warfarin, digoxin, and statins.

C.I.: Severe sinus-node dysfunction, 2nd or 3rd-degree AV block, and iodine allergy.

Dosing: For cardiac arrest, 300 mg IV push; for atrial fibrillation, 150 mg over 10 minutes, then 1 mg/min for 6 hours.

Monitoring: Liver function tests, thyroid function tests, chest X-ray, and pulmonary function tests.

Key Exam Tip: Long half-life (up to 60 days), requires loading doses to achieve therapeutic levels quickly.

2) Atropine

Uses: Treatment of bradycardia, asystole, and organophosphate poisoning.

Mechanism: Anticholinergic, blocks acetylcholine at parasympathetic sites in smooth muscle, secretory glands, & CNS.

S.E./A.E.: Dry mouth, blurred vision, urinary retention, tachycardia, and CNS disturbances.

D.I.: Antihistamines, antipsychotics, and other anticholinergics.

C.I.: Glaucoma, pyloric stenosis, and myasthenia gravis.

Dosing: For bradycardia, 0.5 mg IV every 3-5 minutes, up to a maximum of 3 mg.

Monitoring: Heart rate and ECG during administration.

Key Exam Tip: Atropine is ineffective in heart transplant patients due to denervation of the heart.

3) Calcium Gluconate

Uses: Treatment of hyperkalemia, hypocalcemia, and calcium channel blocker overdose.

Mechanism: Provides calcium ions essential for normal nerve, muscle function, and cardiac function.

S.E./A.E.: Nausea, vomiting, constipation, tissue necrosis if extravasation occurs.

D.I.: May interact with digoxin, thiazide diuretics, and tetracyclines.

C.I.: Hypercalcemia, ventricular fibrillation, hypersensitivity to calcium gluconate.

Dosing: 10-20 mL of 10% solution IV, repeated as needed based on clinical response.

Monitoring: Monitor serum calcium levels and signs of hypercalcemia during and after administration.

Key Exam Tip: In hyperkalemia, calcium gluconate is administered to stabilize the myocardium but does not lower potassium levels.

4) Dextrose 50%

Uses: Treatment of hypoglycemia and as a caloric supplement in parenteral nutrition.

Mechanism: Rapidly increases blood glucose levels.

S.E./A.E.: Hyperglycemia, phlebitis, and tissue necrosis with extravasation.

D.I.: Minimal drug interactions; monitor blood glucose closely.

C.I.: Hyperglycemia, delirium tremens with dehydration, and intracranial or intraspinal hemorrhage.

Dosing: 25-50 mL IV push for hypoglycemia.

Monitoring: Blood glucose levels, and signs of extravasation.

Key Exam Tip: Dextrose 50% is a high-osmolarity solution and should be administered via a large vein to prevent phlebitis. Lower concentrations like D10 are preferred for ongoing hypoglycemia management.

5) Diazepam

Uses: Management of anxiety, seizures, and muscle spasms.

Mechanism: Benzodiazepine that enhances the effect of GABA at the GABA-A receptor.

S.E./A.E.: Drowsiness, respiratory depression, and dependence.

D.I.: CNS depressants, alcohol, and antiepileptic drugs.

C.I.: Severe respiratory insufficiency, sleep apnea, and myasthenia gravis.

Dosing: 5-10 mg IV for status epilepticus, repeat every 10-15 minutes up to 30 mg.

Monitoring: Respiratory rate, sedation level, and blood pressure.

Key Exam Tip: Long-acting benzodiazepine with active metabolites; can cause prolonged sedation.

6) Epinephrine

Uses: Management of anaphylaxis, cardiac arrest, and severe asthma attacks.

Mechanism: Alpha and beta-adrenergic agonist causing vasoconstriction, increased heart rate, and bronchodilation.

S.E./A.E.: Hypertension, arrhythmias, anxiety, and hyperglycemia.

D.I.: Beta-blockers, MAO inhibitors, and tricyclic antidepressants.

C.I.: No absolute contraindications in emergency settings.

Dosing: For Anaphylaxis 0.3 to 0.5 mg IM or subcutaneously every 20 minutes for up to 3 doses if necessary; For Cardia Arrest 1 mg of 0.1 mg/mL (1:10,000) solution every 3-5 minutes during resuscitation.

Monitoring: Blood glucose, blood pressure, and signs of infection.

Key Exam Tip: Taper the dose gradually to avoid complications.

7) Heparin

Uses: Prevention and treatment of thromboembolic disorders.

Mechanism: Anticoagulant that inhibits thrombin and factor Xa.

S.E./A.E.: Bleeding, thrombocytopenia, and osteoporosis.

D.I.: NSAIDs, antiplatelet drugs, and other anticoagulants.

C.I.: Active bleeding, severe thrombocytopenia, and history of heparin-induced thrombocytopenia.

Dosing: Initial IV bolus of 80 units/kg, followed by continuous infusion of 18 units/kg/hr.

Monitoring: Activated partial thromboplastin time (aPTT) every 6 hours until stable.

Key Exam Tip: Protamine sulfate is the antidote for heparin overdose.

8) Hydrocortisone

Uses: Management of adrenal insufficiency, severe asthma, and allergic reactions.

Mechanism: Corticosteroid that reduces inflammation and suppresses the immune system.

S.E./A.E.: Hyperglycemia, immunosuppression, hypertension.

D.I.: NSAIDs, anticoagulants.

C.I.: Systemic fungal infections.

Dosing: 100 mg IV every 8 hours.

Key Exam Tip: Monitor blood glucose levels in diabetic patients and Taper the dose gradually to avoid adrenal insufficiency.

9) Magnesium Sulfate

Uses: Treatment of eclampsia, torsades de pointes, and severe asthma.

Mechanism: Acts as a calcium antagonist, stabilizing excitable membranes.

S.E./A.E.: Flushing, hypotension, respiratory depression, and loss of deep tendon reflexes.

D.I.: Calcium channel blockers and neuromuscular blockers.

C.I.: Myasthenia gravis, renal failure, and heart block.

Dosing: For Eclampsia, Initial dose of 4-6 grams IV over 15-20 minutes, followed by a maintenance dose of 1-2 grams per hour; for Severe Asthma 2 grams IV over 20 minutes.

Monitoring: Blood pressure, heart rate, and ECG.

Key Exam Tip: Calcium gluconate can be used as an antidote.

10) Mannitol

Uses: Reduction of intracranial pressure and treatment of oliguric renal failure.

Mechanism: Osmotic diuretic that increases the osmolarity of the glomerular filtrate, inhibiting tubular reabsorption of water.

S.E./A.E.: Electrolyte imbalances, dehydration, and pulmonary edema.

D.I.: Lithium and other diuretics.

C.I.: Anuria, severe dehydration, and active intracranial bleeding.

Dosing: Initial Dose: 0.25 to 1 g/kg IV over 30 to 60 minutes and Maintenance Dose: May repeat every 6 to 8 hours as needed.

Monitoring: serum osmolality and electrolyte levels to avoid complications such as dehydration, electrolyte imbalances, and acute kidney injury.

11) Norepinephrine

Uses: Treatment of severe hypotension and shock, especially septic shock.

Mechanism: Acts on alpha-adrenergic receptors to induce vasoconstriction and increase blood pressure.

S.E./A.E.: Hypertension, bradycardia, arrhythmias, tissue necrosis if extravasation occurs.

D.I.: May interact with beta-blockers, MAO inhibitors, and tricyclic antidepressants, increasing the risk of hypertensive effects.

C.I.: Hypersensitivity to norepinephrine, hypotension due to blood volume deficit.

Dosing: Initial dose typically 0.01-0.03 mcg/kg/min, titrated to effect. The maintenance dose usually ranges from 0.01-3 mcg/kg/min.

Monitoring: Continuously monitor blood pressure and heart rate to avoid severe hypertension and arrhythmias.

Key Exam Tip: Norepinephrine is the first-line vasopressor for septic shock according to current guidelines.

12) Sodium Nitroprusside

Uses: Management of hypertensive emergencies and acute heart failure.

Mechanism: Vasodilator that acts on both arterioles and veins, reducing preload and afterload.

S.E./A.E.: Hypotension, cyanide toxicity, and methemoglobinemia.

D.I.: Antihypertensives, nitrates, and MAO inhibitors.

C.I.: Severe renal or hepatic impairment.

Dosing: Initial rate of 0.3 mcg/kg/min, titrate to response; maximum rate of 10 mcg/kg/min.

Monitoring: Blood pressure continuously, signs of cyanide toxicity (metabolic acidosis, altered mental status).

Key Exam Tip: Always protect from light to prevent degradation.

13) Tranexamic Acid (TXA)

Uses: Management of acute bleeding, especially in trauma, surgical patients, and heavy menstrual bleeding.

Mechanism: Inhibits fibrinolysis by blocking plasminogen activation, stabilizing the clots.

S.E./A.E.: Nausea, vomiting, diarrhea, rare risk of thrombosis.

D.I.: May interact with clotting agents and hormonal contraceptives, increasing the risk of thrombosis.

C.I.: Active intravascular clotting, subarachnoid hemorrhage, hypersensitivity to TXA.

Dosing: 1 gram IV over 10 minutes, followed by 1 gram over 8 hours for trauma. For heavy menstrual bleeding, 1-1.5 grams orally three times daily.

Monitoring: Monitor for signs of thromboembolism and assess renal function in patients with renal impairment.

Key Exam Tip: TXA should be administered as early as possible in trauma settings to maximize its efficacy in reducing mortality.

14) Conclusion: Comprehensive Emergency Drugs Guide

This detailed guide on emergency drugs is essential for medical, nursing, and pharmacy students, providing critical information on drug uses, mechanisms, side effects, interactions, and dosing. Mastering this knowledge ensures effective and safe patient care in emergency settings.

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