EMERGENCY DRUGS USED

IN DIFFERENT CASES
EMERGENCY DRUGS
FOR

CARDIOVASCULAR
DISORDERS
 Atropine Sulfate

Description:
Atropine sulfate is a belladonna
alkaloid that has the broadest clinical
application of any drug in this class. It
stimulates or depresses CNS, depending on
the dose. It is available in oral and
parenteral form.
 Atropine Sulfate
Action:
Its action may be stimulating or
depressing, depending on the target
organ. As a preanesthesia
medication, atropine reduces
secretion and minimizes vagal
reflexes.
 Atropine Sulfate
Indication:
indicated in the treatment of bradycardia,
spastic condition of the GI tract,and
occasionally, asthma.
Side Effects:
headache, dizziness, excitement, irritability,
and convulsion, drowsiness, fatigue, and mental
depression. Hypertension, hypotension, palpitations,
and tachycardia may also occur when this drug is
administered.
Atropine Sulfate

Nursing Responsibility:
Vital signs and CNS status must be
monitored when administering Atropine
Sulfate. Infants, small children and older
adults must also be monitored for atropine
fever which increases the risk of
heatstroke.
Nitroglycerin
Description: Nitroglycerin is a nitrate that relieves acute
and persistent angina pectoris or chest pain, which is
caused by less oxygen supply in the myocardium. It is also
used for long- term angina prevention. It is a vasodilator,
dilating coronary artery for smooth flow of blood in ischemic
myocardium.
Action: Nitroglycerin acts directly on vascular smooth
muscle. It dilates systemic vein decreasing venous return to
the heart wherein more blood remains in the peripheral
venous circulation. This causes the reduction of ventricular
size and wall tension, reducing the myocardial demand for
oxygen needed to pump blood out of the ventricle.
 Nitroglycerin
Indication:
Nitroglycerin is used to treat angina
pectoris. It also improves blood flow to an
ischemic myocardium.

Side Effects:
Most side effects of Nitroglycerin are
caused by changes in the cardiovascular
system. During the initial days of therapy, there
is an occurrence of pounding headaches,
dizziness, and flushing of the face.
Nitroglycerin
Nursing Responsibility:
Nurses must review the patient’s history for preexisting
conditions that contraindicates the use of nitrates such as
known hypersensitivity.
Patients must be assessed for headache.
Assess degree of severity and consult physicians if there is a
need for analgesics and dosage adjustment.
Be alert for symptoms of toxicity such as hypotension,
tachycardia, flushed skin becoming cold and cyanotic,
headache, palpitation, confusion, nausea, vomiting, moderate
fever, and paralysis.
 Lidocaine
Indication:
Lidocaine is the primary drug used to treat
Description:
ventricular arrhythmias such as premature
Lidocaine is a local anesthetic that is frequently
ventricular contraction,
prescribed for short- term ventricular tachycardia
arrhythmia control. The
andis ventricular
drug fibrillation.
used primarily It is situations
in emergency also used as
when
surface infiltration
ventricular anesthesia
arrhythmia and for
poses a threat nerve
to life.
  block including cardiac and spinal block
anesthesia and to relieve local discomfort of
skin and mucus membrane
 Lidocaine

Route Pharmacodynamics:
Onset Peak Duration

IM 5-10minutes 5-15minutes 2hours

Lidocaine exerts antiarrhythmic actions by
suppressing
IV automaticity
Immediate in His-10-20minutes
Immediate Purkinje
system and Minimal
Topical
by elevating electrical
Systemic Absorption
stimulation threshold of ventricle during
diastole.
Lidocaine
Side Effect:
Hypotension, conduction disturbances,
bradycardia and heart block are cardiovascular
problems that may occur during therapy with
lidocaine. Drowsiness, disorientation, slight
deafness or paresthesias provide early clues to
the toxic effect of lidocaine. Higher lidocaine at
brain sites can cause depression and inhibitory
influences on motor pathways, and convulsion,
coma, or respiratory arrest may occur.
Lidocaine
Nursing Responsibility:
When lidocaine is administered,
nurse must monitor and assess signs
and symptoms of lidocaine toxicity
such as confusion, drowsiness,
hearing impairment, cardiac
conduction defects, myocardial
depression, muscle twitching, and
seizures. BP and ECG must be
monitored constantly
 Sodium Bicarbonate

Description:
Indication:
Bicarbonate is an antacid
Sodium Bicarbonate is used
used toto relieve
treat
heartburn
metabolicand acid indigestion.
acidosis Your doctor
related to cardiac arrest
also mayasprescribe
as well metabolic sodium
acidosis bicarbonate
from chronic to
makerenal
your failure
blood or urine
and less
other acidic in Itcertain
disorders. is
commonly used conditions.
as home remedy for relief of
This medication
occasional is sometimes
heartburn, prescribed
indigestion, or sourfor
other uses; ask your doctor or pharmacist for
stomach.
more information.
Sodium Bicarbonate

Action:
Sodium Bicarbonate rapidly
neutralizes gastric acid to form
sodium chloride, carbon dioxide, and
water. After absorption of the drug,
plasma alkali reserved is increased
and excess sodium and bicarbonate
ions are excreted in the urine, thus
rendering urine less acid.
 Sodium Bicarbonate
Side effects:
Administration of sodium bicarbonate may
cause gastric distention, flatulence, electrolyte
imbalance, sodium overload, hypokalcemia,
hypokalemia, and dehydration.occurrence of
severe tissue damage may also develop
following extravasation of IvV solution.
Sodium Bicarbonate
Nursing Responsibility:
Monitor then patient’s urinary pH as a
guide to dosage.

Monitor patient by observation of

clinical condition.

Measure acid base status and

electrolyte daily. Observe for signs of
alkalosis.
MAGNESIUM SULFATE (mag-nes’I-um)

Description
Magnesium Sulfate is commonly employed for
control of seizures that occur during preeclampsia and
eclampsia. The drug is administered parenterally for
control of the generalized convulsive seizures.

Indication
Magnesium sulfate is use primarily as an
anticonvulsant in preeclampsia or eclampsia. It is also
used for treatment of hypomagnesemic seizures.
Side Effect
]
Administration of Magnesium Sulfate produces
flushing and sweating. Side effects usually depend
on drug dosage, rapidity of administration, and the
serum magnesium level. Higher level may cause
loss of deep tendon reflexes, hypotension, CNS
depression, respiratory paralysis, and cardiac arrest.
Nursing Responsibility

Check the patient’s BP and pulse every 10 0r 15

minutes. Plasma magnesium level and respiratoy rate
must also be monitored. If the respiratory rate falls
below 12, report it immediately. Check the patient’s
urinary output, especially in patient’s with impaired
kidney function.
EMERGENCY DRUGS
FOR
NEUROLOGICAL
DISORDER
Mannitol

Description:
Mannitol is an osmotic
agent employed for the
control of fluid accumulation.
Mannitol is employed
parenterally for short-term
control of fluid accumulation.
Mannitol
Indication:
Mannitol is used in oliguria or in the prevention of
acute renal failure. It is also used to treat increased
intracranial pressure, increased intraocular pressure, and
drug intoxication from secobarbital, impiramin, aspirin, or
carbon tetrachloride. Mannito li also used with sorbitol as a
urogenital irrigation for patients experiencing a transutheral
prostatic resection; this combination minimizes the
hemolytic effect of water.
Mannitol
Action:
Mannitol as an osmotic diuretics acts by
increasing the osmolality of the plasma, glomerular
filtrate,a nd tubular fluid. This decreases the
resorption of fluid and electrolytes, increasing the
excretion of water, chloride, and sodiumand
slightly increasing the excretion of potassium. It is
therapeutically effective because it is filtered freely
at the glumeruli and are absorbed somewhat by the
renal tubes, thus maintaining high concentration
levels there.
Mannitol
Side Effect:
Transient expansion of plasma volume during infusion,
resulting in circulatory overload and tachycardia, electrolyte
imbalances, volume depletion, cellular dehydration, headache,
nausea and vomiting.
cause rebound increased intracranial pressure 8 to 12 hours
after diuresis and anginalike chest pain, blurred vision, rhinitis,
thirst, and urine retention.
 Mannitol
Nursing Responsibility:
Review the patient’s history for preexisting conditions
The fluid intake
that contraindicates andofoutput
the use mannitolofsuch as severe
CHF, the patient
severe must also
dehydration, be hypersensitivity to
or known
documented therapy must be
this drug.
Thedocumented
nurse must also take note
hourly of the patient’s
because
preexisting
therapycondition thaton
is based require
hourlycautious
urine use of this
drug such as pregnancy.
fllow rate.
Measure the patient’s vital signs hourly during
Monitoroffor
administration any side effects
mannitol.
that may occur
EMERGENCY
DRUGS
FOR
SHOCK
 Norepinephrine
Description:
It stimulates the alpha receptors; thus, no
vasodilation is observed in response to small
doses of this drug, and no hypotension occurs
before the blood pressure returns to normal.
Indications:
Restoration of BP in controlling certain acute
hypotensive states (pheochromocytomectomy,
sympathectomy, poliomyelitis, spinal anesthesia, MI,
septicemia, blood transfusion and drug
reactions).Adjunct in the treatment of cardiac arrest
and profound hypotension.
 Norepinephrine
Adverse effects:
In CNS, headache is experienced and in CV,
hypertension and bradycardia. Other significant
adverse effects are myocardial ischemia, dysrhythmias,
and impaired organ perfusion.

Pharmacodynamics:
Route: IV
Duration: 1-2 minutes
 Norepinephrine

Nursing responsibilities:
Norepinephrine should not be used to treat hypotension
in hypovolemic clients, fluids, blood or both must be
administered to restore adequate volume first.

Taper the drug slowly

Use Phentolamine to treat extravasation

 Epinephrine
Description:
Epinephrine is ineffective if applied
to intact skin, but it produces marked
vasoconstriction if applied topically to the
mucous membranes or injected into
tissues. It is used to lessen vasodilation
and hyperemia of the conjunctiva and to
reduce congestion of the nasal mucous
membranes as well as following surgery
of the eye, ear, nose and throat.
 Epinephrine

Indications:
• Treatment of anaphylactic shock
• acute severe asthmatic attack
 Epinephrine
Action:
SIDE EFFECTS:
1.Increased heart
Any of the rate (chronotropic)
physiological actions listed under
2.Increased
epinephrine myocardial
1:10,000 contractilityIn(inotropic)
are indicated. addition, pallor,
nervousness, palpitations, anxiety, headache, sweating,
hypertension, elevated blood sugar, tachycardia,
arrhythmias, and CVAs. May cause dilation of pupils and
increased intraocular pressure which may be harmful in
patients with glaucoma. Hypertension may also be a
secondary effect. Epinephrine will worsen such
conditions as cerebral arteriosclerosis, hypertension,
shock, ventricular arrhythmias, and angina.
 Dextrose 50%
Description:
The term "dextrose" is used to describe the six carbon
sugar d-glucose, the principal form of carbohydrate
utilized by the body for energy production. D50 is used
in emergency care to treat hypoglycemia, and in the
management of coma of unknown origin.

Indication:
Hypoglycemia
Refractory cardiac arrest (controversial)
 
 Dextrose 50%
Pharmacodynamic:
Onset: <1 min
Duration: Depends on the degree of
hypoglycemia

Side Effects:
Warmth, pain, burning
from medication infusion,
thrombophlebitis
 Dextrose 50%
Nursing Responsibilities:
 
 Pregnancy Safety: Not established
 Draw blood sample prior to administration if possible
 Perform Dextrostix prior to administration if
possible.
 Extravasation may cause tissue necrosis; use large
vein and aspirate occasionally to ensure route patency.
 D50 may sometimes precipitate severe neurologic
symptoms (Wernicke’s encephalopathy) in thiamine
deficient patients, for example, alcoholics. (This can be
prevented by administering 100 mg of thiamine IV)
 Glucagon

Description:
Glucagon is a polypeptide that is a product of the
alpha cells of the Islets of Langerhans. It acts
directly on the liver to increase blood glucose by
inducing a breakdown of stored liver glycogen and
by stimulating liver gluconeogenesis from protein. In
this way it can increase hepatic glucose output even
in the absence of stored liver glycogen, a function
that becomes important in starvation.
 Glucagon
Indications:
Hypoglycemia: counteracts severe hypoglycemic reactions
in diabetic patients.
Diagnostic aid in the radiologic exam of the stomach,
duodenum, small bowel, or colon when a hypotonic state
is advantageous.
Unlabeled use: treatment of propranolol overdose and in
cardiac emergncies.
 
 Glucagon
Side Effects
GI: nausea and vomiting ; Hematologic: hypokalemia
in overdose ; Hypersensitivity: urticaria, respiratory
distress, hypotension.

Nursing Responsibilities
Assess the patient’s history for conditions that
contraindicate the use of glucagon, such as insulinoma,
pheochromocytoma, lactation and pregnancy.
EMERGENCY DRUGS
FOR
POISONING
 Naloxone
Description:
Naloxone is an opioid antagonist acting at all
three types of opioid receptors. It is indicated in
treating of opiate poisoning.

Indication:
Respiratory depression caused by narcotics
Narcotic-induced depressant effects and
narcotic overdose.
 Naloxone

Pharmacodynamics:
Onset of effect: Endotracheal, I.M., SubQ: Within 2-5
minutes. I.V.: Within 2 minutes
Duration: 20-60 minutes; since shorter than that of most
opioids, repeated doses are usually needed
Distribution: Vd: 2.7 L/kg; crosses the placenta
Metabolism: Primarily by glucuronidation in the liver to
naloxone 3-glucuronide
Half-life: Neonates: 1.2-3.5 hours; Adults: 1-1.5 hours
Elimination: In urine as metabolites
 Naloxone
Side-effects:
Hypertension and hypotension
Ventricular fibrillation
Ventricular tachycardia
Nausea and vomiting

Action:
Blocks effects of narcotics by competing for the receptor sites
Nursing Responsibility:
•Monitor respiratory rate, rhythm and depth, pulse, ECG,
blood pressure, and level of consciousness frequently for 3-
4 hrs. after the expected peak of blood concentration.
•Patients who have been receiving opioids for >1 week are
extremely sensitive to the effects of naloxone . dilute and
administer carefully.
•Assess pt. For level of pain after administering naloxone to
treat postoperative respiratory depression.
•Assess pt. For s/sx of opioid withdrawal such as:
•-vomiting
•-restlessness
•-abdominal cramps
•-increased blood pressure
•-increased temperature
 Ipecac Syrup

Description:
Ipecac syrup is an emetic (an agent used to
induce vomiting ingested poisons). It is a
liquid OTC medication that is taken orally.
 Ipecac Syrup
Indication:
Oral poisoning

Action:
Ipecac induces vomiting by both gastric irritation and central
stimulation of the chemoreceptor trigger zone.

Pharmacodynamics:
Absorption: Not absorbed from GI tract
Metabolism: Not metabolized
Elimination: As charcoal in feces
 Ipecac Syrup
Side Effects:
•Convulsions
•Diarrhea
•Depression
•Prolonged vomiting
Nursing Implications:
•Instruct pt. To drink slowly.
•Shake well before administer.
•Avoid carbonated beverages, it may cause gastric
distention.
•Avoid ipecac before activated charcoal, it inactivate
its effect.
•If within 20 min the client does not vomit after two
doses, gastric lavage is necessary.
 Activated Charcoal
Description
A fine, black powder (premixed as a slurry), that
adsorbs many drugs and chemicals; acts by binding
toxic substances thereby inhibiting GI absorption,
enterohepatic circulation and therefore
bioavailability.

Indication
Acute ingested poisons. Poisoning following
emesis or when emesis is contraindicated.
 Activated Charcoal

Pharmacodynamics
Absorption: Not absorbed from GI tract
Metabolism: Not metabolized
Elimination: As charcoal in feces

Side Effects
Nausea, vomiting, and constipation.
 Activated Charcoal
Nursing Responsibility
Instruct patient to drink slowly, rapid
administration appears to increase frequency of
vomiting
for persistent vomiting, activated charcoal can be
administered as a continuous enteral infusion at
doses of 10-25 g/hour
fluid volume and sorbitol dosing must be
reviewed carefully
concentrated slurries may clog airway; stools will
turn black
vigorous shaking of the product is suggested
 Magnesium Sulfate
Description
Magnesium sulfate or citrate is given orally or via
gastric tube as a cathartic, an agent that speeds elimination
of stool and evacuates the bowel. It is often prescribed
following administration of activated charcoal.

Indication
Evacuate the bowel before surgery
Magnesium deficiency
 Action
As a laxative, magnesium sulfate attracts and retains
water in the intestine, softening stools and inducing the
urge to defecate.

Side Effects
•Abdominal cramps
•Nausea
•Diarrhea

Pharmacodynamic and Pharmacokinetic

Cathartic action begins 1-2 hrs. after ingestion
Typical oral dose: 10-30g with a glass of water
Oral dose: 100-300ml
Nursing Responsibility
•Take drug with ice or following it with citrus fruit
juice or citrus-flavored carbonated beverages to
make it more palatable.
•Chronic use of magnesium sulfate or any laxative
can lead to laxative dependence.
•Consume adequate amounts of fiber in your diet
such as bran, whole-grain cereals, fruit and
vegetables.
•It should be taken on a schedule that does not
interfere with activities or sleep, as it produces
watery stools within 3-6 hrs.
•It should be taken within 2 hrs. of taking other
medications.
•Monitor for dehydration and electrolyte imbalance.
EMERGENCY DRUGS
FOR
HYPERTENSIVE AND
PULMONARY EDEMA
 Morphine Sulfate

Description:
Relief of severe, acute, chronic pain; preop sedation;
anesthesia supplement; analgesia during labor. Drug
of choice for pain due to MI, dyspnea from pulmonary
edema not resulting from chemical respiratory irritant.

Indication:
Pain management.
 Morphine Sulfate
Side-effects :
Dizziness
lightheadedness
drowsiness
upset stomach
vomiting
constipation
stomach pain
rash
difficulty urinating
 Morphine Sulfate
Nursing Responsibility:
Pt should be in a recumbant position before drug is
given by parenteral route.
If respirations are less than or equal to 12/min (less
than or equal to 20/min in children), withhold
medication, contact physician.
Effect of medication is reduced if full pain recurs
before next dose.
Monitor vital signs 5-10 min after IV administration,
15-30 min after SubQ, IM. Be alert for decreased
respirations or B/P. Check for adequate voiding;
EMERGENCY DRUGS
Mijares, Audrey Concepcion B.
Mojica, Angelica Grace
Morales, Glaiza B.
Omagap, Dhan Arkay Charlemagne
BSN 31

Prof. Clement C. Belvis

Assistant Professor V, RN, RM, MPH
Thank You for
Listening!!!