EMERGENCY DRUGS

Indication Listed in Dosage.

Dosage Adult: IV Bradycardia 500 mcg every 3-5 mins. Total: 3 mg. IV/IM
Organophosphorus poisoning 2 mg every 10-30 mins until muscarinic effects
disappear or atropine toxicity appears. IM/SC Premed in anesth 300-600 mcg 30-
60 mins before anesth. IV/IM/SC Poisoning or overdosage w/ compd having
muscarinic actions 0.6-1 mg, repeat 2 hrly. Ophth Inflammatory eye disorders As
0.5-1% soln: 1-2 drops 4 times/day. Eye refraction As 1% soln: 1 drop twice daily
for 1-2 days before procedure.
Click to view Dosage by Indications

Administration May be taken with or without food. (Take w/ food or water.)

Overdosage For action to be taken in the event of accidental overdose ... click to view

Contraindications Glaucoma, chronic respiratory disease, sick sinus syndrome, thyrotoxicosis,

cardiac failure, pyloric stenosis, prostatic hypertrophy.

Special
Reflux oesophagitis, elderly, infants and children. Pregnancy.
Precautions

Adverse Drug Dry mouth, dysphagia, constipation, flushing and dryness of skin, tachycardia,
Reactions palpitations, arrhythmias, mydriasis, photophobia, cycloplegia, raised intraocular
pressure. Toxic doses cause tachycardia, hyperpyrexia, restlessness, confusion,
excitement, hallucinations, delirium and may progress to circulatory failure and
resp depression. Eye drops: Systemic toxicity esp in children, on prolonged use
may lead to irritation, hyperaemia, oedema and conjunctivitis. Increased
intraocular pressure. Inhalation: Dryness of mouth, throat.
Potentially Fatal: Atrial arrhythmias, AV dissociation, multiple ventricular ectopics.

Drug Interactions Additive anticholinergic effects with quinidine, antidepressants and some
antihistamines.
Click to view more Drug Interactions

Pregnancy
Category (US FDA)

Category C: Either studies in animals have revealed adverse effects on the foetus
(teratogenic or embryocidal or other) and there are no controlled studies in
women or studies in women and animals are not available. Drugs should be given
 only if the potential benefit justifies the potential risk to the foetus.

Storage For special storage condition to ensure optimal shelf-life of medicine... click to
view

Mechanism of For details of the mechanism of action, pharmacology and pharmacokinetics and
Action toxicology ... click to view

MIMS Class Other Cardiovascular Drugs / Mydriatic Drugs / Antidotes, Detoxifying Agents &
Drugs Used in Substance Dependence

ATC Classification A03BA01 - atropine; Belongs to the class of belladonna alkaloids, tertiary amines.
Used in the treatment of functional gastrointestinal disorders.
S01FA01 - atropine; Belongs to the class of anticholinergics used in the treatment
of mydriasis and cyclopegia.

Atropine

Alteplase (Activase, TPA, Actilyse, Actiplas, Besopartin, Lysatecrt-PA)

Indicated for use in the management of acute myocardial infarction in adults for the improvement of
ventricular function following AMI, the reduction of the incidence of congestive heart failure, and the
reduction of mortality associated with AMI. Treatment should be initiated as soon as possible after the
onset of AMI symptoms

Route: IV

Dosage: For acute myocardial infarction 6 mg IV bolus followed by 54 mg within the first hour, followed
by 20 mg/hour for 2 hours for a total dose of 100 mg. Patients <65 kg should receive a total of 65 mg.
Alternatively: 15 mg IV bolus then 50 mg IV over 30 minutes, followed by 35 mg over 60 minutes ("front
loading" regimen).

Anistreplase (Eminase, Iminase)

Route: IV

Dosage: For acute myocardial infarction 30 units IV over 2-5 minutes

USES: This medication prevents blood from clotting. Studies have shown this medication to be effective
in reducing the risk of death following an acute heart attack.

HOW TO USE: This medication is given by injection into a vein as soon as possible after heart attack
symptoms occur. It will be given by a health care professional who will closely monitor your therapy.
SIDE EFFECTS: Bleeding and irregular heart rhythms may occur as a result of this drug. You will be
monitored closely for signs of these effects. Notify your doctor of: itching, flushing, skin rash, fever,
chills, headache, nausea, sweating, dizziness, muscle aches or tremor. If you notice other effects not
listed above, contact your doctor or pharmacist.

Atenolol (Tenormin, Atenil, Atenolan, Betatop, and others)

A medication that blocks the action of a portion of the involuntary nervous system that stimulates the
pace of the heartbeat. By blocking the action of these nerves, atenolol reduces the heart rate and is
useful in treating abnormally rapid heart rhythms. Atenolol also reduces the force of heart muscle
contraction, lowers blood pressure, and is helpful in treating angina. It is also used for the prevention of
migraine headaches and the treatment of certain types of tremors. The brand name is Tenormin.
Generic is available.

Route: IV

Dosage: Following acute myocardial infarction, 5 mg IV over 5 minutes every 10 minutes for a total IV
dose of 10 mg. Oral atenolol therapy should be initiated immediately after the second IV bolus with 50
mg, followed by another 50 mg oral dose 12 hours later. Oral maintenance therapy is continued with
100 mg daily for at least 10 days.

Benztropine (Cogentin)
Route: IV, IM, PO 

USES: This medication is used to treat symptoms of Parkinson's disease and similar drug-induced side
effects.

HOW TO USE: This drug must be administered as directed by your doctor. Use this drug as directed. It
may take a few weeks or months before the full benefits of this medication are observed. Do not stop
using this medication without your doctor's approval. Suddenly stopping the medication can sometimes
lead to a worsening of symptoms.

SIDE EFFECTS: May cause drowsiness, dizziness, headache, loss of appetite, stomach upset, vision
changes, sleeplessness or trembling of the hands. These effects should subside as your body adjusts to
the medication. If they persist or become bothersome, inform your doctor. May cause dizziness
especially when rising quickly from a seated or lying position. Change positions slowly and be careful on
stairs. May decrease your sweating ability making you more prone to heat stroke. Use caution during
exercise and hot weather. Notify your doctor if you develop: vomiting, difficulty swallowing, difficulty
urinating, uncontrollable movements, chest pain, rapid heart rate, skin rash, mood or mental changes. If
you notice other effects not listed above, contact your doctor or pharmacist.

Benztropine (Cogentin)

PRECAUTIONS: Tell your doctor your medical history, especially of: glaucoma, irregular heartbeat,
urination problems, allergies (especially drug allergies). Alcohol can aggravate drowsiness. Limit alcohol
use. This drug should be used during pregnancy only if clearly needed. Discuss the risks and benefits
with your doctor. Because this medication appears in breast milk, consult with your doctor before
breast-feeding.

STORAGE: Store at room temperature away from sunlight.

Dalteparin sodium (Fragmin)

Route: SC

Dosage: For patients undergoing abdominal surgery who are at risk of thromboembolic complications
2500 IU SC daily

 WARNING: Tell your doctor you are using this medication before undergoing any procedure involving
spinal puncture/anesthesia. Using this medication before these procedures has caused major bruising or
bleeding (epidural or spinal hematoma) inside your body. This may leave you paralyzed, maybe
permanently. Tell your doctor immediately if you have any of these serious side effects: tingling,
weakness, numbness, difficulty urinating or pain. This risk is increased when you use other "blood
thinning" medications (e.g., aspirin, clopidogrel, warfarin), NSAIDs (e.g., ibuprofen, naproxen), or when
certain medication delivery devices (indwelling epidural catheters) are used. You will be monitored
closely while you are on this medication.

USES: This medication is a "blood thinner" (anticoagulant). It is used to help prevent blood clots in
persons undergoing surgery.

Dalteparin (Fragmin)

HOW TO USE: Inject under the skin (subcutaneously), usually 1 to 2 hours before surgery, then once a
day for 5 to 10 days after the surgery. According to the Canadian manufacturer, an alternative dosing
schedule includes skipping the dose of dalteparin before surgery and beginning treatment 4-8 hours
after surgery (if no surgical bleeding problems exist). Do not inject into a muscle (intramuscularly). If you
are uncertain how this medication should be used, ask your doctor or pharmacist to explain it to you.

SIDE EFFECTS: Irritation or pain may occur at the injection site. If these effects become severe, inform
your doctor. Notify your doctor if you experience: unusual bleeding or bruising, blood in the urine or
stool, fever. If you have had a spinal procedure along with this drug, promptly report: weakness,
numbness, pain. In the unlikely event you have an allergic reaction to this drug, seek immediate medical
attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing.
If you notice other effects not listed above, contact your doctor or pharmacist.

STORAGE: Store this at room temperature between 68 and 77 degrees F (20 and 25 degrees C) away
from heat and light. Do not freeze. Properly discard of needles and syringes after use.
Diltiazem (Cardizem)

Route: IV

DRUG CLASS AND MECHANISM: Diltiazem is a drug that is used for treating heart pain (angina), high
blood pressure, and abnormal heart rhythms. It belongs to a class of drugs called calcium channel
blockers (CCBs), which includes amlodipine (Norvasc), verapamil (Calan, Isoptin), nifedipine (Adalat,
Procardia) as well as others. CCBs block the entry of calcium into muscle cells that make up the heart
and that surround the arteries. It is the entry of calcium into these cells that causes the cells to contract,
allowing the heart to pump blood, and the arteries to narrow. By blocking the entry of calcium, diltiazem
decreases the force of contraction of the heart and its rate of contraction. It also relaxes the muscles
surrounding the arteries, allowing the arteries to widen (dilate). In order to pump blood, the heart needs
oxygen. The harder the heart works, the more oxygen it requires. Angina occurs when the supply of
oxygen to the heart is inadequate for the amount of work the heart must do. By dilating arteries,
diltiazem reduces the pressure in the arteries into which the heart must pump blood, and, as a result,
the heart needs to work less and requires less oxygen. By reducing the heart's need for oxygen,
diltiazem relieves or prevents angina. Dilation of the arteries also reduces blood pressure. The FDA
approved diltiazem in 1982.

PREPARATIONS: Tablets (immediate release): 30, 60, 90, and 120 mg. Tablets (extended release): 120,
180, 240, 300, 360, 420 mg. Capsules (extended release): 60, 90, 120, 180, 240, 300, 360, 420 mg.
Injection: 5 mg/ml. Powder for injection: 25 mg.

STORAGE: Tablets, capsules and powder for injection should be stored at room temperature, 15-30 C
(59-86 F). Solution for injection should be stored at 2-8 C (36-46 F).

Diltiazem (Cardizem)

DOSING: Adult oral doses range between 120 and 480 mg daily. Immediate release tablets are
administered up to 4 times a day. Extended release formulations are administered once daily at
approximately the same time each day and should not be crushed or chewed.

SIDE EFFECTS: Side effects include constipation, nausea, headache, rash, edema (swelling of the legs
with fluid), low blood pressure, drowsiness, and dizziness. Liver dysfunction and overgrowth of the gums
also may occur. Diltiazem can cause mildly abnormal liver tests that usually return to normal with
discontinuation of the medication. When diltiazem is given to individuals with heart failure, symptoms of
heart failure may worsen because these drugs reduce the ability of the heart to pump blood. Like other
drugs for high blood pressure, diltiazem is associated with sexual dysfunction.

Diphenhydramine (Benadryl)

Route: IM, IV, PO

Dosage: For acute dystonic reactions secondary to neuroleptic drugs, 10-50 mg (up to 100 mg if
required) deep IM or IV push.
For adjunctive treatment of anaphylaxis, 10-50 mg (up to 100 mg if required) deep IM or IV push.

DRUG CLASS AND MECHANISM: Diphenhydramine is an antihistamine used for treating allergic
reactions. Histamine is released by the body during several types of allergic reactions and--to a lesser
extent--during some viral infections, such as the common cold. When histamine binds to its receptors on
cells, it stimulates changes within the cells that lead to sneezing, itching, and increased mucus
production. Antihistamines compete with histamine for cell receptors; however, when they bind to the
receptors they do not stimulate the cells. In addition, they prevent histamine from binding and
stimulating the cells. Diphenhydramine also blocks the action of acetylcholine (anticholinergic effect)
and is used as a sedative because it causes drowsiness.

PREPARATIONS: Capsules: 25 and 50 mg. Tablets: 12.5, 25, and 50 mg. Strips: 12.5 and 25 mg. Elixir, oral
solution, liquid: 12.5 mg per teaspoon (5 mL). Suspension: 25 mg per 5 ml. Injection: 50 mg per ml

Diphenhydramine should be stored at room temperature, 15° to 30°C (59° to 86°F), and protected
injection from freezing and light.

Diphenhydramine (Benadryl)

PRESCRIBED FOR: Diphenhydramine is used for the relief of nasal and non-nasal symptoms of various
allergic conditions such as seasonal allergic rhinitis. It is also used to alleviate cold symptoms and chronic
urticaria (hives). Although antihistamines are the preferred class of drugs in allergic rhinitis, they only
reduce symptoms by 40%-60%. Diphenhydramine also is used for allergic reactions involving the eyes
(allergic conjunctivitis), to prevent or treat active motion sickness, and for mild cases of Parkinsonism,
including drug-induced Parkinsonism. The last two uses (motion sickness and Parkinsonism) are based
on the anticholinergic effects of diphenhydramine, and not its antihistamine effects. Diphenhydramine is
also used for treating insomnia.

DOSING: Diphenhydramine has its maximal effect about one hour after it is taken. When used to combat
insomnia, it is prescribed at bedtime. Patients over the age of 60 years are especially sensitive to the
sedating and anticholinergic effects of diphenhydramine, and the dose should be reduced. Doses vary
depending on formulation. A common regimen for treating adult allergic reaction is 25-50 mg every 4-6
hours not to exceed 300 mg daily.

SIDE EFFECTS: Diphenhydramine can commonly cause sedation, tiredness, sleepiness, dizziness,
disturbed coordination, drying and thickening of oral and other respiratory secretions, and stomach
distress. Diphenhydramine may also cause low blood pressure, palpitations, increased heart rate,
confusion, nervousness, irritability, blurred vision, double vision, tremor, loss or appetite, or nausea.
Diphenhydramine should be used with caution (if at all) in persons with narrow-angle glaucoma,
prostatic hypertrophy (enlarged prostate gland), hyperthyroidism, cardiovascular disease, hypertension,
and asthma.

Ephedrine
Route: IM, SC, IV

Dosage: For hypotension associated with spinal anesthesia, sympathectomy overdosage with ganglionic-
blocking or antiadrenergic drugs, penile erection during spinal anesthesia for transurethral resection of
the prostate. The usual dose is 25-50 mg IM or SC. The IV route (slow IV push) may be used if an
immediate effect is required. Alternatively, 10-25 mg may be given slow IV push. Additional doses may
be given at 5-10 minute intervals up to a maximum of 150 mg.

WARNING: This drug should not be used in combination with other stimulant products (e.g., caffeine),
other cough-and-cold products, or as a dietary supplement for the purpose of weight loss or body
building. Doing so may increase your risk of unlikely but potentially fatal side effects including: stroke,
heart attack, seizures, or severe mental disorders (see Side Effects section and Precautions section).
Exceeding recommended ephedrine doses increases your risk of the side effects noted above. For
detailed information, consult your pharmacist.

USES: Ephedrine injection is a central nervous system stimulant used to treat low blood pressure
(hypotension) during certain surgical procedures, severe allergic-type reactions (e.g., bronchospasm or
bronchial asthma), certain heart rhythm problems (e.g., Stokes-Adams syndrome), narcolepsy, and
myasthenia gravis.

Ephedrine

HOW TO USE: Inject this medication into a vein (IV), into a muscle (IM), or under the skin (SC-
subcutaneously) as directed by the doctor. When given IV, the dose is injected slowly and may be
repeated in 5 to 10 minutes, if necessary. The dosage is based on your medical condition and response
to therapy. Do not exceed 150 mg (adults) or 3 mg per kg (children) in 24 hours. When used for an
extended period, this medication may not work as well and may require different dosing. Talk with your
doctor if this medication stops working well. Before using, check this product visually for particles or
discoloration. If either is present, do not use the liquid. Learn how to store and discard needles and
medical supplies safely. Consult your pharmacist.

SIDE EFFECTS: Nervousness, dizziness, headache, nausea, loss of appetite, or trouble sleeping may
occur. If any of these effects persist or worsen, notify your doctor promptly. Tell your doctor
immediately if any of these serious side effects occur: chest pain, unusually fast or irregular heartbeat,
vomiting, tremor/shakiness, sweating, severe weight loss, difficult or painful urination, stomach pain.
Tell your doctor immediately if any of these unlikely but serious side effects occur: severe mental/mood
changes, fever, trouble breathing, one-sided weakness, confusion, vision problems, slurred speech. If
you notice other effects not listed above, contact your doctor or pharmacist.

STORAGE: Store at room temperature between 59 and 86 degrees F (15 and 30 degrees C) away from
light.
Epinephrine (Adrenalin)

Route: IV, ET, SC

Dosage: Cardiac arrest (VF/unstable VT, EMD/PEA, asystole): 1 mg IV every 3-5 minutes (AHA guidelines)
Respiratory distress or hypersensitivity reactions: 0.3-0.5 mg (0.3-0.5 mL of 1:1,000 solution) IM or SC
every 20 minutes to 4 hours or 0.5-1.5 mg (0.1-0.3 mL of 1:200 suspension) every 6 hours. Shock: 1-4
æg/minute by continuous IV infusion.

USES: This medication opens breathing passages to make breathing easier. This medication is used to
treat acute breathing problems.

HOW TO USE: This medication is inhaled into the lungs using special breathing equipment. A health care
professional will demonstrate the proper way to prepare the medication and use the equipment. Make
sure you understand how to operate the device and ask any questions you may have. Use the solution
as

Epinephrine (Adrenalin)

directed. Do not increase your dose or use this more frequently than directed. Excessive use may lead to
a loss of effectiveness while increasing the chance for side effects. If you find yourself using this more
than usual, contact your doctor. Do not stop using this medication without first consulting your doctor.

SIDE EFFECTS: Tremor, nervousness, shakiness, headache, nausea, heartburn, lightheadedness, difficulty
sleeping, unusual taste in mouth, hoarseness or dry throat may occur the first several days as your body
adjusts to the medication. If any of these effects continue or become bothersome, inform your doctor.
Notify your doctor if you develop: a rash, rapid heartbeats, chest pain, dizziness, coughing, breathing
trouble. If you notice other effects not listed above, contact your doctor or pharmacist
STORAGE: Store the solution in a cool area protected from light. Do not store in the bathroom. Discard
the solution if it turns color or contains particles.

Heparin

Route: IV, SC

Dosage: Venous thrombosis: 75-100 units/kg (approximately 5,000-10,000 units) IV bolus followed by a
continuous IV infusion of 1,680 units/hour (use 1,240 units/hour if one or more of the following risk
factors for bleeding are present: Recent surgery or stroke (within last 2 weeks), thrombocytopenia,
history of peptic ulcer disease, GI hemorrhage, or genitourinary bleeding; other conditions that increase
the risk of bleeding (eg. hepatic failure or invasive lines)). Alternatively, a infusion rate of 18
units/kg/hour has also been used. Titrate to maintain APPT in range that corresponds to heparin
concentrations (by protamine titration) in the range of 0.2-0.4 units/mL (Hirsh J. Heparin. N Engl J Med
1991;324:1565-74). DVT prophylaxis: 5,000 units SC q 8-12 hours

USES: Heparin lock flush is used to clear (flush) IV lines or catheters to keep them open and flowing
freely. This form of heparin must not be used as a blood thinner.

Heparin

HOW TO USE: This medication is administered by injection directly in to the IV (intravenous) line or
catheter. It is usually given each time after the IV line or catheter is used.

SIDE EFFECTS: Because this medication is not administered directly to the body, no side effects are
anticipated. However, notify your doctor if you experience: fever, chills, itching or irritation at the line
site, unusual bruising or bleeding. If you notice other effects not listed above, contact your doctor or
pharmacist.

STORAGE: Store this medication in a secure, cool area as directed.

Ipecac syrup

Dosage: 15-30 mL followed by 3-4 glasses of water. Do not administer concurrently with activated
charcoal since activated charcoal will adsorb ipecac. If both are indicated, induce vomiting with ipecac
first then administer the charcoal.

 USES: Ipecac irritates the stomach and stimulates the vomiting center of the brain to cause vomiting.
This medication is used to empty the stomach to treat certain poisonings or drug overdoses.

HOW TO USE: This medication should only be taken when instructed to do so by your doctor, the poison
center or medical emergency personnel. In some poisoning situations, use of this medication may be
harmful. Follow the administration advice given by the health care professional. The patient should be
sitting upright with the head forward before giving this medication. Do not give this to a person who is
incoherent or unconscious. General dosing guidelines are as follows: Children 6 months to one year old
should be given 1 to 2 teaspoonfuls followed by one-half to one glass of water. Children 1 to 12 years
should be given 1 tablespoonful (15 ml) followed by 1 to 2 glasses of water. Adults should be given 1 to
2 tablespoonfuls (15-30 ml) followed by 3 to 4 glasses of water. In older children and adults, a second
dose may be necessary if vomiting does not occur within 20 minutes. If vomiting does not occur after
taking this medication, contact your doctor or the poison control center. Have the patient vomit into a
bowl, bucket or pan if possible. It is helpful to save the vomitus for inspection by a health care
professional so they can determine what was swallowed or if the ipecac was effective. Take this only
with water. Do not take with milk, juice or soda.

Ipecac syrup

SIDE EFFECTS: In addition to the expected effect of vomiting, this medication may cause drowsiness,
diarrhea, and stomach ache. If you notice other effects not listed above, contact your doctor or
pharmacist.

STORAGE: Store at room temperature between 59 and 86 degrees F (15 to 30 degrees C) away from
heat and light. All first aid kits should contain a bottle of ipecac. Parents of young children are advised to
have a bottle of ipecac at home and to keep a bottle in the diaper bag when traveling should an
emergency arise. Check the expiration date periodically and replace the bottle when necessary.
Ketorolac (Toradol)

Dosage: For post-operative pain, 30 mg (IM or IV) or 60 mg IM followed by 15-30 mg IM or IV every 6

hours.

DRUG CLASS AND MECHANISM: Ketorolac is a member of a class of drugs called nonsteroidal
antiinflammatory drugs (NSAIDs) that is used for treating inflammation and pain. Other drugs in this
class include ibuprofen (Motrin) and naproxen (Naprosyn, Aleve), but ketorolac is more effective than
other NSAIDs in reducing pain from both inflammatory and non-inflammatory causes. Ketorolac reduces
the production of prostaglandins, chemicals that cells of the immune system make that cause the
redness, fever, and pain of inflammation and that also are believed to be important in the production of
non-inflammatory pain. It does this by blocking the enzymes that cells use to make prostaglandins
(cyclooxygenase 1 and 2). As a result, pain as well as inflammation and its signs and symptoms - redness,
swelling, fever, and pain - are reduced

DOSING: Treatment should be started with ketorolac injection. Tablets are used only if treatment is
continued after patients begin to eat and drink. The total duration of therapy should not exceed 5 days
because of the potential for gastrointestinal bleeding and other side effects. The recommended adult
intravenous single dose is 15 to 60 mg. Multiple intravenous doses of 15 or 30 mg every 6 hours, not to
exceed 60 or 120 mg a day, also may be used. Following intravenous therapy, the recommended dose is
one or two tablets initially followed by 1 tablet every 4-6 hours, not to exceed 40 mg daily. The smaller
dose is used for patients with poor kidney function or those older than 65 years

Ketorolac (Toradol)

SIDE EFFECTS: Common side effects from ketorolac include rash, ringing in the ears, headaches,
dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation, heartburn, and fluid retention.
NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury. Ketorolac may
cause ulcers and bleeding in the stomach and intestines, particularly with use for more than five days.
Sometimes, stomach ulceration and intestinal bleeding can occur without any abdominal pain. Black
tarry stools, weakness, and dizziness upon standing may be the only signs of the bleeding. NSAIDs
reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most
likely to occur in patients with preexisting impairment of kidney function or congestive heart failure, and
use of NSAIDs in these patients should be done cautiously. Liver failure has also been associated with
ketorolac. People who are allergic to aspirin and other NSAIDs should not use ketorolac. Individuals with
asthma or nasal polyps are more likely to experience allergic reactions to NSAIDs.

PREPARATIONS: Tablets: 10 mg; Injection: 15 and 30 mg/ml.

STORAGE: Tablets should be stored at 15-30 C (59-86 F). Injectable solution should be stored at 15-30 C
(59° to 86 F) and protected from light.

Magnesium sulphate

Dosage: Seizure prevention and control in pre-eclampsia or eclampsia: 4-5 gm of 50% solution IM every
4 hours.

Metoprolol (Lopressor, Betaloc, Arbralene, Beprolo, and others)

Route: IV, PO
Dosage: Following acute myocardial infarction, 5 mg IV push every 2 minutes for a total IV dose of 15
mg. Oral metoprolol at a dose of 50 mg every 6 hours should be started 15 minutes after the last IV
bolus dose and continued for 48 hours. The maintenance dose is 100 mg twice daily for at least 3
months.
DRUG CLASS AND MECHANISM: Metoprolol is a beta-adrenergic blocking agent that is used for treating
high blood pressure, heart pain, abnormal rhythms of the heart, and some neurologic conditions.
Examples of beta-adrenergic blockers include propanolol (Inderal), atenolol (Tenormin), and timolol
(Blocadren). Metoprolol blocks the action of the sympathetic nervous system, a portion of the
involuntary nervous system, by blocking beta receptors on sympathetic nerves. Since the sympathetic
nervous system is responsible for increasing the rate with which the heart beats, by blocking the action
of these nerves metoprolol reduces the heart rate and is useful in treating abnormally rapid heart
rhythms.

Metoprolol also reduces the force of contraction of heart muscle and thereby lowers blood pressure. By
reducing the heart rate and the force of muscle contraction, metoprolol reduces the need for oxygen by
heart muscle. Since heart pain (angina pectoris) occurs when oxygen demand of the heart muscle
exceeds the supply of oxygen, metoprolol, by reducing the demand for oxygen, is helpful in treating
heart pain. The FDA approved metoprolol in August 1978.

Metoprolol (Lopressor, Betaloc, Arbralene, Beprolo, and others)

DOSING: Metoprolol should be taken before meals or at bedtime. The dose for treating hypertension is
100-450 mg daily in single or divided doses. Angina is treated with 100-400 mg daily in two divided
doses. Acute myocardial infarction is treated with three 5 mg injections administered 2 minutes apart
followed by treatment with 50 mg oral metoprolol every 6 hours for 48 hours. After 48 hours, patients
should receive 100 mg orally twice daily for at least 3 months.

SIDE EFFECTS: Metoprolol is generally well tolerated. Side effects include abdominal cramps, diarrhea,
constipation, fatigue, insomnia, nausea, depression, dreaming, memory loss, fever, impotence,
lightheadedness, slow heart rate, low blood pressure, cold extremities, sore throat, and shortness of
breath or wheezing. Metoprolol can aggravate breathing difficulties in patients with asthma, chronic
bronchitis, or emphysema.

PREPARATIONS: Tablets: 25, 50, and 100 mg. Tablets (extended release): 25, 50, 100, and 200 mg.
Injection: 1 mg/ml

STORAGE: Tablets should be stored between 15-30°C (59-86°F). They should be protected from
moisture and dispensed in tight, light-resistant container.

Milrinone (Primacor, Corotrop, Corotrope)

Dosage: For short term management of congestive heat failure a loading dose of 50 æg/kg is infused IV
over 10 minutes followed by a continuous IV infusion in the range of 0.375 to 0.75 æg/kg/minute.

USES: This medication is for the short-term treatment of congestive heart failure (CHF).

HOW TO USE: This medication is given by injection into a vein. You will be monitored closely by means
of regular doctor visits and routine laboratory tests to ensure the effectiveness and safety of this
medication.

SIDE EFFECTS: This medication is generally well tolerated. Headache, chest pain and a slight fever have
been reported as a result of this medication. If these effects persist or worsen, inform your doctor
promptly. Contact your doctor immediately if you experience: irregular heartbeat. An allergic reaction to
this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction
include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above,
contact your doctor or pharmacist.

STORAGE: Store as directed away from heat and light.

Nalmefene (Revex)
Dosage: Postoperative opioid depression: 0.25 æg/kg IV every 2-5 minutes until the desired degree of
opiate reversal is attained.
Known or suspected opioid overdose: 0.5 mg/70 kg.

USES: This medication is used in the treatment of certain drug overdose situations.

HOW TO USE: This medication is administered by injection by a health care professional. It is used under
close medical supervision so the dose can be adjusted based on your condition and response.

SIDE EFFECTS: This medication is generally well tolerated. Nausea, dizziness, fever, headache, chills or
muscle aches have been reported. If these effects continue or become bothersome, inform your doctor.
Notify your doctor if you develop: vomiting, sweating, tremors, breathing trouble, mental confusion,
rapid pounding/irregular heartbeat. If you notice other effects not listed above, contact your doctor or
pharmacist

STORAGE: Store at room temperature between 59 and 86 degrees F (15 to 30 degrees C) as directed.
Keep this and all medication out of the reach of children.

Naloxone (Narcan, Narcanti)

Dosage: Postoperative opioid depression: 1.0 æg/kg IV every 2-5 minutes until the desired degree of
opiate reversal is attained.
Known or suspected opioid overdose: 0.4-2mg IV, may repeat up to 10 mg. Continuous IV infusion at 4-5
æg/kg/minute may be used.

USES: This medication is used to prevent or reverse the effects of narcotic pain relievers. It has also been
used in the treatment of shock, alcoholic coma, schizophrenia and Alzheimer's disease.

HOW TO USE: This medication is administered by injection into a vein or muscle. The dose may be
repeated as needed or this may be continuously infused depending on your condition and the purpose it
is being used. This medication must be used under close medical supervision so the dose can be
adjusted to the response.

SIDE EFFECTS: Nausea, stomach upset or drowsiness may occur. If these effects continue or become
bothersome, inform your doctor. Notify your doctor if you develop: vomiting, sweating, tremors,
breathing trouble, seizures, rapid/pounding/irregular heartbeat. If you notice other effects not listed
above, contact your doctor or pharmacist.

STORAGE: Store at room temperature between 59 and 86 degrees F (15 to 30 degrees C) as directed for
up to 24 hours. Check the expiration date on the label and properly discard of any unused medication
after that time.

Nicardipine (Cardene)

Dosage: For acute hypertensive episodes 5 mg/hour via continuous infusion. This initial dosage may be
increased by 2.5 mg/hour every 5-15 minutes up to a total of 15 mg/hour. Nicardipine has been
administered in small IV push doses in the range of 1.25-2.5 mg when immediate antihypertensive
action is required although this mode of administration is not FDA approved in the U.S..

 USES: This drug is a calcium channel blocker. Calcium is involved in blood vessel contraction. By blocking
calcium, nicardipine relaxes and widens the blood vessels. It is used to treat high blood pressure and
chest pain (angina). Ask your doctor or pharmacist about possible problems related to use of short-
acting calcium channel blockers.

Nicardipine (Cardene)

HOW TO USE: This medication should be swallowed whole and is best taken on an empty stomach with
a full glass of water unless your doctor directs you otherwise. This drug must be taken as directed if used
to prevent chest pain. It is not effective if taken only when chest pain occurs. Do not stop taking this
medication suddenly without your doctor's permission. Chest pain can occur if the medication is
stopped too fast. Your dose may need to be gradually decreased.

SIDE EFFECTS: This drug may cause dizziness and lightheadedness especially during the first few days.
Avoid activities requiring alertness. When you sit or lie down for a while, get up slowly to allow your
body to adjust and minimize dizziness. You may also experience fatigue or weakness, nausea, heartburn,
muscle cramps, headache or flushing. If any of these effects persist or worsen, inform your doctor.
Notify your doctor if you develop: breathing difficulties, swelling of the hands or feet, irregular
heartbeat. If you notice other effects not listed above, contact your doctor or pharmacist.

STORAGE: Store at room temperature away from sunlight and moisture.

Nimodipine (Nimotop)

Dosage: For subarachnoid hemorrhage begin 60 mg PO every 4 hours within 96 hours of SAH and
continue for 21 days.

USES: This medication is used to improve symptoms caused by spasms as a result of a brain hemorrhage
(ruptured blood vessels).

HOW TO USE: Take this medication exactly as prescribed. If the capsules can not be swallowed, the
liquid inside the capsule may be taken out and given through a feeding tube. For best results, this
medication must be started within 4 days of the brain hemorrhage and given every 4 hours for 3 weeks.

SIDE EFFECTS: Nausea, stomach upset, diarrhea, headache, slowed pulse or flushing may occur the first
several days as your body adjusts to the medication. If any of these effects continue or become
bothersome, inform your doctor. Notify your doctor if you develop: depression, mood changes, skin
rash, swelling hands or feet, shortness of breath, wheezing, muscle cramps, unusual bruising or
bleeding. If you notice other effects not listed above, contact your doctor or pharmacist.

STORAGE: Store this medication at room temperature between 59 and 86 degrees F (15 and 30 degrees
C) away from heat and light. Do not store in the bathroom. Keep this and all medications out of the
reach of children.

Phenytoin (Dilantin, Fenantoin, Di-Hydan, Epanutin, Epilan-D, and others)

Dosage: For status epilepticus, a loading dose of 15-20 mg/kg (approximately 1 gm) IV at a rate not to
exceed 50 mg/minute should be given.

DRUG CLASS AND MECHANISM: Phenytoin is an oral and injectable anti-seizure medication first
synthesized in 1908. Phenytoin was originally approved by the FDA in 1939.

Physostigmine (Antilirium) Route: IM, IV

Dosage: For life-threatening toxicity secondary to anticholinergic agents, 2 mg IM or IV over 2 minutes. A
second dose may be given if no reversal has occurred and if cholinergic signs and symptoms are not
present.

PREPARATIONS: Tablets (triangular; yellow), 50mg; capsules (white with colored band): 30mg (pink
band); 100mg (red band). It also is available as a suspension (125mg per 5mL).

Phenytoin (Dilantin, Fenantoin, Di-Hydan, Epanutin, Epilan-D, and others)

DOSING: The dosing of phenytoin is very patient- specific. It may be given once, twice, or three times
daily. Doses are often adjusted to find the optimal dose, based on measurement of blood levels. Taking
phenytoin with food may reduce some of the side effects. Elderly patients, debilitated persons, and
patients with certain kidney or liver diseases may need lower doses. The suspension should not be given
at the same time as tube feedings.

SIDE EFFECTS: Many varied adverse effects can occur during phenytoin therapy including dizziness,
drowsiness, difficulty focusing (vision), unsteady gate, tiredness, abnormal involuntary movements,
nausea, vomiting, constipation, abdominal pain, and loss of appetite. Children and young adults can
develop overgrowth of the gums during long-term therapy which requires regular treatment by a
dentist. Good oral hygiene and gum massage may reduce the risk. Rashes can occur in between 1 in 20
and 1 in 10 persons; some may be severe. Additionally, darkening coloration of the skin may develop
(more commonly in women). Phenytoin can produce unusual growth of hair in some patients. This
reaction most commonly affects the arms and legs but can also affect the trunk and face; it may be
irreversible.
STORAGE: Tablets, capsules, and suspension should be kept at room temperature, 15-30°C (59-86°F).

Streptokinase (Kabikinase, Streptase)

Dosage: For acute myocardial infarction 1.5 million units IV over 1 hour

USES: This medication is an enzyme which works to break up and dissolve blood clots which can block
arteries. It is used in the treatment of heart attack or lung blood clots (pulmonary embolism) as well as
leg blood clots (deep venous thrombosis-DVT).

HOW TO USE: This medication is given by injection by a health care professional. It is important this
medication be used as prescribed. It is most effective when administered as soon as possible (within 6
hours after symptoms (e.g., chest pain) appear.

SIDE EFFECTS: Nausea, dizziness, low blood pressure or mild fever may occur. It can also cause nerve
damage. If any of these effects persist or worsen, notify your doctor promptly. Notify your doctor
promptly if you develop: easy bruising, headache, flushing, rapid or abnormal heartbeat, chest pain. A
serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs.
Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, trouble
breathing. Immediately report any signs of bleeding to your doctor. If you notice other effects not listed
above, contact your doctor or pharmacist.

STORAGE: Store in a cool area as directed. Discard any unused medication after the expiration date on
the label. Reconstituted solution may be refrigerated between 36 to 46 degrees F (2 to 8 degrees C) if
used within 8 hours. Discard unused portion.

Urokinase (Abbokinase, Alphakinase, Actosolv, Uronase, and others)

 WARNING: Internal bleeding may be more difficult to control with this medication than with other
anticoagulant therapy. This medication must be used in a hospital setting. It should be started as soon as
possible after lung blood clots have been noticed (pulmonary embolism), preferably within 7 days.
Urokinase should be given within 6 hours of the first symptoms of a heart attack associated with
evolving myocardial infarction.

USES: This medication is a protein (enzyme) which works to break up and dissolve blood clots which can
block arteries. It is used in the treatment of very serious blood clots in lung blood vessels (pulmonary
embolism).

HOW TO USE: This medication is given by injection by a health care professional. It is important this
medication be used as prescribed. It is most effective when administered as soon as possible after
symptoms appear (e.g., within 6 hours of onset of chest pain).

Urokinase (Abbokinase, Alphakinase, Actosolv, Uronase, and others)

SIDE EFFECTS: Dizziness, fever, headache, or nausea may occur shortly after the drug is given by vein
(infusion reaction). Notify the doctor immediately if any of these effects occur, as the drug infusion may
need to be stopped, or medication to treat the reaction may need to be given. Notify your doctor
immediately if you experience: easy bruising or bleeding (e.g., pink urine, bleeding gums, black or bloody
stools), a rapid or abnormal heartbeat, chest pain, tingling or numbness of the hands/feet. An allergic
reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an
allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing. Rare (possibly fatal)
cholesterol blood clots (emboli) may occur while using medicines that dissolve blood clots. Report
immediately any of the following symptoms: change in amount of urine, severe stomach/abdominal
pain, unexplained muscle pain, discolored toes or fingers. If you notice other effects not listed above,
contact your doctor or pharmacist.

Dosage: For acute myocardial infarction, 2 million units IV bolus followed by 1 million units over 60
minutes.
Route: IV

STORAGE: Store powder vial in refrigerator at 36-46 degrees F (2 to 8 degrees C). Reconstituted solution
should be used immediately after reconstituting. Discard any unused portion.

Verapamil

DRUG CLASS AND MECHANISM: Verapamil belongs to a class of medications called calcium channel
blockers. These medications block the movement of calcium into the muscle cells of the coronary
arteries (the arteries supplying the heart) as well as the other arteries of the body. Since calcium is what
triggers contraction of muscles, blocking entry of calcium relaxes the arterial muscles. This relaxation
allows the arteries to become larger so that more blood can flow through them. Thus, verapamil is
useful in treating and preventing chest pain (angina) resulting from spasm (contraction) of the coronary
arteries that reduces the flow of blood to the heart. Relaxing the muscles lining the arteries in the rest of
the body lowers blood pressure and thereby reduces the pressure against which the heart must pump
blood. As a result, the heart works less and requires less oxygen-carrying blood. This allows the heart to
work with the reduced flow of blood caused by coronary artery disease and prevents angina (which
occurs whenever the flow of blood to the heart is inadequate). For more detailed information related to
coronary artery disease, please read the Chest Pain, Cholesterol, and Heart Attack articles. Verapamil
also decreases the conduction of electrical impulses through the heart that control the coordination of
contraction. As a result, the rate of contraction slows. Verapamil was approved by the FDA in March,
1982.

PREPARATIONS: Immediate release tablets: 40, 80, 120 mg; sustained release caplets: 120, 180, 240,
360 mg; extended release tablets: 100, 120, 180, 200, 240, 300 mg; Injection: 2.5 mg/mL

Verapamil

SIDE EFFECTS: Side effects from verapamil generally are mild and transient. It can cause dizziness,
weakness or fainting because of a slow heart rate or low blood pressure. Other side effects include
swelling of the lower extremities, rash, headache, and constipation. Verapamil also can cause mildly
abnormal liver tests that usually return to normal with discontinuation of the medication.
Verapamil may reduce the heart rate. Verapamil also can cause excessive lowering of blood pressure in
rare instances. Verapamil can aggravate heart failure, especially in patients with poor function of their
heart muscle.

Route: IV

DOSING: The usual oral dose is 180-480 mg/day. Verapamil may be given once, twice or three times
daily depending on the formulation used. Verapamil can be taken with food.

Dosage: For Supraventricular tachyarrhythmias 5-10 mg IV push over 2 minutes. A second bolus dose of
10 mg may be administered after 30 minutes if the response to the first bolus was not adequate.
Although not an FDA approved route of administration, verapamil has been administered via continuous
IV infusion at a rate of 5 mg/hour.

STORAGE: Store at room temperature 15° to 30°C (59° to 86°F) in tight, light- resistant

Flumazenil

Indication

Listed in Dosage.

Dosage

Adult: IV Benzodiazepine-induced sedation Initial: 200 mcg followed by 100-200 mcg at intervals of 60
seconds to a max total of 1 mg if needed. Usual range: 0.3-1 mg. Benzodiazepine overdose Initial: 200
mcg; an additional dose of 300 mcg can be given 30 sec later followed by doses of 500 mcg at 1-min
intervals if needed, up to a total dose of 3 mg.
Click to view Dosage by Indications

Contraindications
Hypersensitivity. Patients receiving benzodiazepines for control of a potentially life-threatening
condition such as status epilepticus and control of intracranial pressure. Severe intoxication with tricyclic
and related antidepressants.

Special Precautions

Should only be used until the effects of neuromuscular blockade have been fully reversed. Risk of raising
intracranial pressure, precipitating convulsions or altering cerebral blood flow in patients with head
injuries. Increased risk of seizures in high-risk patients. May provoke panic attacks in patient with a
history of panic disorder. Hepatic impairment. Pregnancy and lactation.

Adverse Drug Reactions

Nausea, vomiting, dizziness, blurred vision, headache, flushing; anxiety, fear and agitation (following too
rapid reversal of sedation); seizures (especially in epileptics); transient increases in BP and heart rate.

Drug Interactions

Toxic effects with cyclic antidepressants. Reverses effects of benzodiazepines.

Click to view more Drug Interactions

Pregnancy Category (US FDA)

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or
embryocidal or other) and there are no controlled studies in women or studies in women and animals
are not available. Drugs should be given only if the potential benefit justifies the potential risk to the
foetus.

Storage

For special storage condition to ensure optimal shelf-life of medicine... click to view

Mechanism of Action

For details of the mechanism of action, pharmacology and pharmacokinetics and toxicology ... click to
view

MIMS Class

Antidotes, Detoxifying Agents & Drugs Used in Substance Dependence

ATC Classification

V03AB25 - flumazenil; Belongs to the class of antidotes. Used in hypnotics and sedatives overdose.
LIGNOCAINE

Indications

Local anesth of mucous membrane.

Dosage

Endoscopy & cytoscopy Instill 6-11 g.

Contraindications

Open wounds.

Adverse Drug Reactions

Local paleness, redness.

View ADR Monitoring Form

Pregnancy Category (US FDA)

As LA & cardiac drug.

Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no
controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect
(other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1 st
trimester (and there is no evidence of a risk in later trimesters).

MIMS Class

Anaesthetics - Local & General

ATC Classification
D04AB01 - Lidocaine ; Belongs to the class of topical anesthetics used in the treatment of pruritus.