HIGH ALERT DRUG AND EMERGENCY DRUG

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HIGH ALERT DRUG AND EMERGENCY DRUG
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HIGH ALERT DRUG

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ADRENALINE (EPINEPHRINE)

• -Alpha/Beta Agonist
• USE Broncospasms
• Anaphylactic reaction
• Cardiac arrest
• Open-angle glaucoma
• Added to local anesthetics to systemic
  absorption
• duration of action
• toxicity

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• Ventricular fibrillation (VF)
• Pulseless ventricular trachycardia (VT)
  unresponsive to defebrillatory shock
• Symtomatic bradycardia or heart block
  unresponsive to atropine
• Asystole
• CONTRAINDICATION Cardiac arrhythmias
• Angle-closure glaucoma
• WARNING/PRECAUTIONS Elderly Pt.
• DM
• Cardiovascular (angina,trachycardia,
  MI)
• Thyroid diseases

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• STABILITY Sensitive to light and air-
  protection from light
• Oxidation turn drug pink brown
  color
• Parenteral admixt. At 4 or 25 ?c 24
  hr
• DOSAGE Broncodilator I.M., SC.0.1-0.5 mg q
  10-15 min to 4 hr
• Hypersensitive reaction 0.3-0.5 mg q
  15-20 min if hypotention occurred 0.1
  mg I.V. slowly over 5-10 min
• then cont. infusion 1-10 mcg/min
• Asystole I.V.1 mg q3-5 min
• Critical point for notified Doctor EKG VT, VF,
  frequent PVC
• HR gt 120 BPM
• BP gt 140/90 mmHg

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• MONITORING Resuscitation ???? HR ????V/S q 10
  min and adjust dose
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• If BP gt 90/60 mmHg ????V/S q 10 min ?????? 2
  ????? ???
• stable V/S q 2-4 hr
• If BP lt 90/60 mmHg or HR gt 120 BPM ????V/S
  q
• 10 min ?????? 1????? ???????????????
• Rapid IV infusion may cause death from
  cerebrovascular hemorrhage or cardiac
  arrhythmias
• Standard diluent 1 mg/250 ml NS

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ATROPINE

• -Anticholinergic agent
• -Antidote for Organophosphate poisoning
• -Antispasmodic agent
• -Broncodilator
• -Mydriatic agent
• USE Symtomatic sinus brady cardia, AV block,
  Ventricular asystole
• Antidote for Organophosphate poisoning
• Preoperative med. to inhibit salivation
  and secretion

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• CONTRAINDICATION Asthma
• Thyrotoxicosis
• Narrow-angle glaucoma
• Trachycardia
• Obstructive GI diseases
• Myastinia gravis
• WARNING/PRECAUTIONS Elderly Pt.
• Prostatic hyperplasia
• Hyperthyroidism
• CHF, cardiac arrhythmias

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• WARNING/PRECAUTIONS Chronic lung diseases
• Biliary tract diseases
• STABILITY Protection from light, Store injection
  at 15-30 ?c
• DOSAGE Asystole or Brady cardiaI.V.1 mg q 3-5
  min , 0.4mg /kg (orlt3 mg)dilute in 10 ml NS
  may give intratracheal
• Organophosphate or carbamate poisoning
  I.V. 2 mg
• q 15 min until atropinization
• Critical point for notified Doctor HR gt 120 BPM
• BP gt 140/90 mmHg

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• MONITORING ??? HR q 5 min ??? HR gt120 BPM
  ??????????????
• If BP gt 90/60 mmHg
  ????V/S q 10 min ?????? 2 ????? ???
• stable V/S q 2-4 hr
• If BP lt 90/60 mmHg or HR gt 120 BPM ????V/S
  q
• 10 min ?????? 1????? ???????????????
• Administer undilute by rapid I.V.injection,
  slow injection may result in paradoxical
  bradycardia.
• Observe for trachycardia if pt. has cardiac
  problems

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POTASSIUM CHLORIDE (KCl)

• -Electrolyte Supplement
• USE Treatment or prevention of hypokalemia
• CONTRAINDICATION Severe renal impairment
• Addisons disease
• Severe tissue trauma
• WARNING/PRECAUTIONS Pt. with cardiac diseases
• Severe renal impairment
• Hyperkalemia

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• STABILITY Store injection at room temp, no
  freezing .use only clear solution and
  within 24 hr
• DOSAGE Normal dairy requirement 40-80
  mEq/day
• Hypokalemia IV 5-10 mEq/hr, not exceed
  40 mEq/hr and
• max at 400 mEq/day
• Guideline Serum Kgt2.5 mEq/L Max infusion
  rate10mEq/hr
• Max conc.40mEq/L
• Max 24 hr dose200mEq
• Serum Klt2.5 mEq/L Max infusion
  rate40mEq/hr
• Max conc.80mEq/L
• Max 24 hr dose400mEq

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• Critical point for notified Doctor Serum Klt
  2.5mEq/L or gt 5mEq/L
• MONITORING Arrhythmia (EKG if
  infusiongt10mEq/hr)
• Hyperkalemia (serum K ????????????)
• Administer with plenty of fluid and food
  because of stomach irritation and discomfort
• Dilute in NS only (No glucose ,amino acid
  ,manitol or blood)

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CALCIUM GLUCONATE

• -Electrolyte Supplement
• USE Treatment or prevention of hypocalcemia
• Treatment of tetany
• Cardiac disturbances of hyperkalemia
• Cardiac resuscitation when adrenaline
  failed to improve
• Calcium channel blocker toxicity
• CONTRAINDICATION Ventricular fibrillation
• Renal or cardiac diseases

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• CONTRAINDICATION Renal calculi
• Hypophosphatemia
• WARNING/PRECAUTIONS Respiratory failure or
  acidosis , Hyperphosphatemia may
  produce cardiac arrest
• STABILITY Store injection at room temp, no
  freezing .use solution within 24 hr
• DOSAGE Calcium antagonist toxicity, magnesium
  intoxication, or cardiac arrest from
  hypocalcemia or hyperkalemiaIV
  10calcium gluconate 10-20 ml in 2-5 min

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• Critical point for notified Doctor HR lt 60 BPM
• BP lt 90/60 mmHg V/S q 15 min
• MONITORING Bradycardia
• Hypotension
• Cardiac arrest

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SODIUM BICARBONATE

• -Alkalinizing agent
• USE Management of metabolic acidosis
• Treatment of hyperkalemia
• CONTRAINDICATION Alkalosis, Hyper Na, Hypo Ca
• Severe pulmonary edema
• WARNING/PRECAUTIONS May cause sodium retention
• CHF , edema, cirrhosis or renal
  failure

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• STABILITY Store injection at room temp, protect
  from heat and freezing use only clear
  solution
• DOSAGE IV. 7.5 NaHCO3 50-100 ml over 5 min
• IV infusion for metabolic acidosis dosage
  should based on
• blood gases and pH measurement( max.
  conc. 0.5mEq/ml in
• dextrose solution and infuse over 2 hr)
• Cardiac arrest Routine use of NaHCO3 is not
  recommended

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DOPAMINE

• -Adrenergic agonist agent
• -Sympathomimatic agent
• USE Treatment of shock(eg MI, Renal failure,
  cardiac decompensation)
• CONTRAINDICATION Pheochromocytoma
• Ventricular fibrillation (VF)
• WARNING/PRECAUTIONS Cardiovasculardiseases
• Cardiac arrhythmia
• Post-MI pt.

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• STABILITY Protection from light, darker than
  slightly yellow solution should not
  be use
• DOSAGE IV infusion 1-20 mcg/kg/min
• 11 ?? 250 mg(1vial) ????????????????? 250 ml
• 21 ?? 500 mg(2vial) ????????????????? 250 ml
  
• ????? 24 hr ?????????? D5W, NSS
• Critical point for notified Doctor EKG VT, VF,
  frequent PVC
• HR gt 120 BPM
• BP gt 140/90 mmHg or lt
  90/60mmHg

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• MONITORING Trachycardia
• Hypertension
• Ventricular ectopic beat
• - V/S q 10 min ????????????????????
• If BP gt 90/60 mmHg ????V/S q 10 min
  ?????? 2 ????? ???stable V/S q 2-4 hr
• If BP lt 90/60 mmHg or HR gt 120 BPM ????V/S q
  10 min ??? ??? 1????? ???????????????

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DIAZEPAM

• -Antianxiety agent
• -Anticonvulsant
• -Sedative
• USE Anxiety disorder
• Alcohol withdrawal symtoms
• Muscle relaxant
• Convulsive disorder

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• CONTRAINDICATION Narrow-angle glaucoma
• Not use for Childrenlt 6 month (oral) and
• lt 1 month (pareteral)
• Pregnancy (D)
• WARNING/PRECAUTIONS Elderly pt.
• Hepatic diseases (include
  alcoholic)
• Renal impairment
• Respiratory diseases
• Depression pt.(suicidal risk)
• CNS depression

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• STABILITY Protection from light, stable at pH
  4-8, hydrolysis at pH 3
• Dont mix with other medication
• DOSAGE Status epilepticus I.V.
• 1mo-5yr 0.05-0.3mg/kg/dose over 2-3 min q2-4
  hr, max dose 5 mg
• gt 5yr 0.05-0.3mg/kg/dose over 2-3 min q2-4 hr,
  max dose 10 mg
• Adult 5-10 mg q 10-20 min, may repeat 2-4 hr
  as needed (Agitated)
• Critical point for notified Doctor RR gt 10
  BPM/ Apnea
• BP lt 90/60mmHg
• MONITORING Respiratory depression
• Hypotension
• - V/S q 10 min 3 ??????????????
• Many drug interaction

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MORPHINE SULFATE

• -Analgesic , Narcotic
• USE Relief of moderate to severe acute and
  chronic pain
• Relief of pain of MI
• Relief of dyspnea of acute ventricular
  failure and pulmonary edema
• CONTRAINDICATION Severe respiratory depression
• Acute or severe asthma
• Paralytic ileus,acute/postoperative pain
• (SR tab.)

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• WARNING/PRECAUTIONS Elderly (CNS depress
  constipation effect)
• lt3 mo (Respiratory depression)
• Hepatic dysfunction
• Impaired respiratory function
• STABILITY Protection from oxygen, stable at pH
  lt4 darkening sol. Should not be use
• Usual conc. Of cont. IV infusion 0.1-1mg/ml in
  D5W
• DOSAGE gt6 mo andlt50 kg IV. 0.05mg/kg q 3-4 hr
• IV.infusion 10-30 mcg/kg/hr
• gt12 yr IV.3-4 mg and repeat in 5 min
  if necessary

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• DOSAGE Adult IV. Initial2.5-5 mg q3-4 hr up to
  5 min if needed
• repeat small dose(1-4 mg) and high frequent
• Critical point for notified Doctor RR lt 10
  BPM/ Apnea
• BP lt 90/60mmHg
• MONITORING Respiratory depression
• Hypotension
• - ??????????????? V/S q 10 min 3
  ??????????????
• - ??????????? V/S q 2 min in 15 min then
  q 5 min until
• end process

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