CPR- EMERGENCY DRUGS

COMPILED BY: MR. ASHISH ROY

1. Drugs used in CPR and Emergency Compiled By- Mr. Ashish H. Roy B .Sc Nsg . S.G.P.G.I.M.S, Lucknow ( Nursing Tutor ).

2. Receptors α –increases BP Beta –increase contractility , BP β 1-can cause tachy arrhythmias β2 -widely dispersed in the body Endotoxins - decrease α response Acidosis and prolonged pressor admn –decrease the response of receptors

3. Epinephrine class: adrenergic, catecholamine Method of action Indication Dose Contraindication Side effects Nsg resp Β 1 and β 2 agonist Increases cyclic AMP causing Bronchodilation ,cardiac and CNS stimulation Large doses causes vaso- constriction Small doses causes vasodilatation ( β 2) acute asthmatic attacks, hemostasis bronchospasm anaphylaxis, allergic reactions cardiac arrest vasopressor of last resort IC, IV, ET .1 to 1 mg repeat q 5 min Continuous infusion:8 mg in 250 ml dx5% or in N/S Hypersensitivity , narrow angle glaucoma Urinary retention ,tremors ,anxiety, anorexia ,n/v, dyspnoea ECG during admn. Vitals q 5 mins Give slowly ,diluted do not mix in alkaline soln. Increased dose of insulin in diabetics Inhalation can cause dryness of mouth Donot mix with alkaline agents must be used in diluted form

4. Nor epinephrine class :adrenergic, catecholamine Method of action Indication Dose Contraindication Side effects Nsg resp Stimulates β receptors in the heart, α receptors Increased contractility, HR, vasoconstriction Increases BP ,coronary blood flow, CO Acute hypotension ,shock, Used in presence of massive vasodilatation Very effective in low vascular resistance Higher doses required if receptors are down regulated 8-12 µ gm/min titrated to BP Available in 1mg/ml Onset of action –soon after administration Duration of action –5-10 mins after discontinuation Hypersensitivity, VF, Pheochromoc-ytomas Headache ,anxiety ,dizziness, palpitation, tachycardia, HTN, ectopic beats, angina, N/V, necrosis, gangrene, dyspnoea, decreased urine output I/O ratio ECG during admn. Titrate according to BP Vitals q 5 mins Correct hypovolumia Dilute with D5% or DNS

5. Atropine alkaloid,anti-cholinergic Method of action Indication Dose Contraindication Side effects Nsg resp Blocks Ach Increases CO, HR by blocking vagal response, dries secretion Bradycardia Anticholine esterase insectiside poisoning, for Bronchodilation , before surgery to decrease secretions Bolus .5 to 1 mg q 3-5 min Max 6 mg Can be given diluted or undiluted Hypersensitivity Glaucoma,GI obstructions MG, Thyrotoxicosis, ulcerative colitis, BPH, tachy cardia, asthma, myocardial ischemia, acute hemorrhage Retention of urine , hesitancy , impotence Headache, dizziness, involuntary movements anxiety, insomnia Dry mouth, n/v anorexia, paralytic ilius,constipation Tachycardia, ectopics,rash blurred vision I/O,w/f urinary retention ECG,bowel sounds Sugar free candy Not to perform heavy activity in heat Assess vitals

6. Dopamine Class:vasopressor,catecholamine Method of action Indication Dose Contraindication Side effects Nsg resp Acts on α , β 1 receptors causing vasoconstriction Highly dose dependent action Shock, hypotension 2-5µg/kg/min Titrate to patient response Maximum dose 20 µg/kg/min Hypersensitivity, VF,Tachyarrythmias, Pheochromcytomas Headache, palpitation ,tachycardia, HTN, ectopic beats,angina, wide QRS complex, peripheral vasoconstriction n/v/d Necrosis, gangrene Correct hypovolumia first Check O2 perfusion deficit, I/O ,ECG ,peripheries Give after dilution, infuse slowly Vitals q 5 mins

7. Dobutamine class: β 1 agonist,catacholamine Method of action Indication Dose Contraindication Side effects Nsg resp Acts on β 1. minor action on β 2 and α effects. Cardiac surgery , refractory heart failure, cardiac decompensation 2.5-10µg/kg/min Titrate acc to BP Hypersensitivity Idiopathic hypertrophic sub aortic stenosis Anxiety headache dizziness, palpitation ,tachycardia,HTN ,PVC, ,angina, heart burn ,n/v Correct hypovolumia Check O2 perfusion w/f heart failure I/O ECG BP /HR q 5- min Dilute and use Onset of action 1-2 mins Give slowly

8. Sodium bicarbonate class :alkaliniser Method of action Indication Dose Contraindication Side effects Nsg resp Increases plasma bicarbonate ,which buffers H† and reverses acidosis Acidosis, cardiac arrest alkalinasation antacid Acidosis 2-5 meq/kg over 4-8 hour depending on CO2, pH Cardiac arrest : IV bol 1mEq/ kg then .5 mEq/ KG over 10 mins then based on ABG Hypersensitivity, renal disease, peptic ulcers, hypocalcaemia Irritability, headache ,confusion, twitching, tetany,hyperreflexia ,convulsions of alkalosis Irregular pulse cardiac arrest, edema Distention ,paralytic illus Alkalosis Calculi shallow slow resp ,apnoea RR, HR, lung sounds Fluid balance Electrolyte, ABG Urine pH,UO w/f alkalosis s/s of ulcer perforation Donot exeed50 mEq/hr Na resriction

9. Calcium gluconate class :electrolyte replacement Method of action Indication Dose Contraindication Side effects Nsg resp Cation needed for normal NS, MS, ,enzymatic, cardiac contractility, coagulation of blood, secretory activity of exo and endocrine glands Prevention and rx of hypocalcemia Hypermagnesemia, Hypoparathyroidism , neonatal tetany, cardiac toxicity in hyperkalaemia,lead colic, hyperphosphatemia, vit D deficiency .5 -2g @.5 ml / min (10 %) soln. Hypercalcemia,digitalis toxicity, , VF, renal calculi Pain ,burning at IV site, thrombosis Hypercalcemia:coma, weakness, headache, anorexia, n/v Shortened QT interval, heart block , hypotension ,dysarrythmias, cardiac arrest , Assess ECG Calcium levels IV diluted or undiluted with equal amount of n/[email protected] -1 ml /hr Seizure precautions Prevent immobility

10. Amidarone class :anti dysarrythmic Method of action Indication Dose Contraindication Side effects Nsg resp Prolongs duration of action potential and effective refractory period Noncompetitive α , β adrenergic inhibition Severe VT SVT AF, VF not controlled by first line agents 150 mg IV loading dose (rapid) over 10 mins Then add 150 mg to 100 ml D5@ 100 mg /hr then slow 360 mg in the next 6 hr 900 mg maintenance over 18 hrs Caution in Thyroid diseases, pulmonary fibrosis Headache ,dizziness, involuntary movements, tremors, fatigue n/v/d anorexia, hepatic toxicity Hypotension bradycardia ,sinus arrest,CHF,dysarrythmias,rash pulmonary fibrosis, corneal deposits, blurred vision ,thyrotoxic I/O,electroytes, LFT , CxR, Continuous ECG Assess vitals Thyroid FT,Pulmonary toxicity BP monitoring for hypo /rebound hypertension Fluid levels

11. Lidocaine Anti dysarrythmic class IB Method of action Indication Dose Contraindication Side effects Nsg resp Increases electrical stimulation threshold of the conduction system which stabilizes cardiac membrane, decreases automaticity VT, ventricular dysarrythmias during cardiac sx,MI, digitalis toxicity, cardiac catheterization IV Bol 50- 100 mg (1mg /kg 0over 3-4 mins q 3-5 min not to exceed 300 mg in 1 hr IV inf @20- 50 µg/kg/ min Hypersensitivity to amides, severe heart block ,supraventricular dysarrythmias, Adams stokes syndrome , WPW Headache ,dizziness involuntary movements, confusion convulsions, tinnitus, blurred vision, n/v/a Hypotn, brady, CHB, Arrest,respiratory depression ,phlebitis ECG,BP ,I/O IV infusion using pump w/f malignant hyperthermia,resp status, lung fields w/f respiratory depression

12. Nitroglycerine class coronary vasodilator, antianginal Method of action Indication Dose Contraindication Side effects Nsg resp Decreases pre,afterloadand decreases LV ED pr,SVR, Dilates coronaries Chronic , stable angina pectoris, prophylaxis of angina, CHF of MI IV 5µg/min t hen increase by 5 /min q 3-5 mins until desired response Hypersensitivity, severe anemia, increased ICP, cerebral hemorrhage Postural hypotension , tachycardia, collapse, syncope, n/v Headache, flushing, dizziness Assess orthostatic BP/HR,tolerance Admn .diluted in D5/NS Slow position change ,avoid alcohol

13. THANKYOU FOR YOUR ACTIVE LISTENING AND ATTENTION.. IF ANY QUERY REGARDING THE TOPIC KINDLY ASK…. THE END