Emergency Drugs

Medicines

Item name, Package, Quantity per kit

1 Furosemide 40 mg Tablets 30000

2 Methyl dopa 250 mg Ampoule 1 500

3 Hydralazine 25 mg injection Ampoule 1 000

4 Cimetidine 200 mg injection Ampoule 2 000

5 Promethazine 25mg/ml 2ml Ampoule 2 000

6 Morphine 50 mg/ml Ampoule 2 000

7 Pethidine 50 mg/ml Ampoule 10 000

8 Pentazocine 50 mg injection Ampoule 10 000

9 Chlorpromazine 25mg/ml Ampoule 1 000

10 Phenobarbitone 200 mg Ampoule 2 000

11 Amoxicillin + Ampicillin 500mg Cap 100 000

12 Cloxacillin 500mg Ampoule 10 000

13 Chloramphenicol 250mg, 1g Vial 10 000

14 Dextrose 5% IV sol. in saline 1L Bags 10 000

15 Atropine 1% eye drops Bot 5 000

16 Lignocaine 1-2% Vial 3 000

17 Lignocaine 5% spinal Vial 1 000

18 Neostigmine 2.5mg Ampoule 20 000

19 Suxamethonium 50 or 100 mg/ml Ampoule

Common drugs used in the Emergency Room

By Henry Feldman, ‘2001

(Edited by Lewis Nelson, MD)

Routes of administration

IV

Intravenous administration is when the drug is given in liquid form directly into a vein. This is often

done by placing a venous catheter to allow easy administration.

IM

Direct injection into the muscle. Often a painful mode of administration, and provides a slow route

of absorption.

PO

By mouth (Per Orum). Typically intermediate between IM and IV in speed of absorption. (is this

true?)

PR

Rectal administration (Per Rectum). The rectum is actually a very quick method of drug

administration as the rectum is highly vascular. This route is often used in children.

ET

Certain drugs can be given down an endotracheal tube. The drugs are given at 2-2.5 times normal

IV dose. Drugs are followed with a saline bolus of ~10ml. The acronym for drugs that can go down

an ET tube is ALONE:

• A – Atropine

• L – Lidocaine

• O – Oxygen

• N – Naloxone (Narcan)

• E – Epinephrine

Drug List

Lidocaine

Lidocaine has 2 uses: It is a local anesthetic when injected subcutaneously (and it can be used

for a nerve block). It is also an antidysrhythmic drug when injected IV (used to treat cardiac

dysrhythmias). Anesthetic preparations come in 2 forms: with and without epinephrine. The

epinephrine is added to reduce absorption and prolong the effect. A classic question by the

resident/attending is: What is the toxic dose when used as a local anesthetic (Answer: 5mg/kg for

lidocaine without epi, and 7mg/kg with epi.)

Epinephrine

Epinephrine is a natural substance produced by the adrenal gland (a.k.a. adrenaline).

Epinephrine is used in emergencies to stimulate the heart or to dilate the bronchial tree. Its use is

limited by cardiac side effects. It is also mixed with lidocaine to prolong lidocaine’s effect and to

control bleeding.

Furosemide (Lasix)

Lasix is a diuretic, which is given IV or PO, which causes the patient to produce more urine. This

is often given to reduce the fluid overload in patients with congestive heart failure (a.k.a. CHF) or

hypertension.

Diazepam (Valium)

Diazepam is a benzodiazepine that is used both as a powerful sedative and as an anticonvulsant

for patients with seizures. You will see it used for alcohol withdrawal, cocaine toxicity,

and status epilepticus (i.e. uncontrolled seizures). Diazepam may produce respiratory depression.

Midazolam (Versed)

Versed is a very powerful short acting benzodiazepine type of sedative and is used to sedate

patients for painful procedures. Excessive dosing may produce respiration depression (when

given i.v.) or coma.

Haloperidol (Haldol)

Haldol is a antipsychotic with powerful sedative properties. It is often used for patients who are

acting in a psychotic manner. It should not be used to treat alcohol withdrawal or cocaince toxicity.

In sufficient quantities it will render the patient unconscious.

Succinylcholine

Often called “sux” (pronounced sucks), it is a paralytic, resulting in total muscular paralysis. It will

most often be used for “rapid-sequence-intubation” to make tracheal intubation easier and to

allow the patient to be mechanically ventilated. It has no analgesic properities and paralyzed

patients see, hear and feel everything - like a zombie! - thus it is never used without sedation.

Atropine

Atropine is used for several purposes, including inducing the heart to beat faster (i.e.

chronotropy) as well as an antidote for certain organophosphate poisonings. It is sometimes

used as a drug for patients with severe asthma. It can also be dripped into the eyes to produce

dilation of the pupil (although this is a different formulation). Can also be used to dry up respiratory

secretions during procedures.

Heparin

Heparin is an anticoagulant used to prevent blood from clotting. It is used in patients suspected

of having a myocardial infarction and to prep the syringe for an arterial-blood-gas for the same

reason.

Valproic Acid

Valproic Acid is used as an anticonvulsant medication. It is not typically used in the emergency

treatment of seizures, but toxicity can often be seen with seizure patients who have taken too

much.

Phenobarbital

Phenobarbital is a barbiturate which is used either as a sedative and/or anticonvulsant

medication.

Pentobarbital

Similar to phenobarbital but much faster acting and with a duration of effect. It is used as an

anticonvulsant medication and to treat severe alcohol withdrawal. Often used in a continuous

drip for patients who continue to seize.

Methylprednisolone (Solumedrol)

Solu-medrol is a long acting corticosteroid. It is often used to prevent the recurrence of

anaphylaxis after the epinephrine has worn off and for patients with asthma. It has a half-life of

around 6 hours.

Albuterol (Proventil)

Albuterol is a bronchodilator, used in a nebulizer for asthma patients. Typically a drop (0.5 mg)

of albuterol is suspended in saline and nebulized with oxygen. Often referred to as “how many

nebs the patient got”.

Ampicillin/Sulbactam (Unasyn)

This is an antibiotic (ampicillin) with the second compound added to prevent bacterial ßlactamases

from working (which interfere with penicillins). This overcomes the antibiotic resistance

acquired by many bacteria.

Flouroscein

This is a fluorescent dye used to stain the cornea to look for scratches or ulcers. Scratches and

ulcers will selectively retain the dye, making them glow under the cobalt-blue light of an

opthalmoscope.

Ketorolac (Toradol)

Ketorolac is a powerful NSAID, used for severe headaches, musculo-skeletal pain, kidney

stones and inflammation.

Morphine Sulfate

Morphine is a powerful opiate (derived from opium and similar to heroin) that is used as a pain killer

(i.e. analgesic). However, as a side effect it can suppress respirations.

Naloxone (Narcan)

Narcan is the antidote to opioids such as heroin or morphine. It is very rapidly acting and

competes with the opioid for the opioid receptor. Be careful when administering this drug, as it

may cause withdrawal in opioid tolerant patients.

Prednisone

Prednisone is a corticosteroid that is given for asthma and as an anti-inflammatory. A side effect

of prolonged use is Cushing’s syndrome and often you may see tremors.

Rocuronium

Often called “rock”, it is a paralytic. Administration produces total muscular paralysis. It is most

often used for “rapid-sequence-intubation” to make tracheal intubation easier and to allow the

patient to be mechanically ventilated. It has no analgesic properities and paralyzed patients see,

hear and feel everything and should never used without sedation.

Pilocarpine

Pilocarpine is dripped into the eyes to produce constriction of the pupil in patients with glaucoma.

Dopamine

Dopamine is a mild pressor agent, which is administered IV to produce vasoconstriction and raise a

patient’s blood presure.

Phenytoin (Dilantin)

Dilantin is an anticonvulsant. As a side effect, when administered too fast, it can induce

hypotension.

N-Acetylcysteine (Mucomyst)

Mucomyst is given in cases of acetaminophen toxicity (e.g. Tylenol).

tPA

Tissue plasminogen activator is a thrombolytic agent, used to lyse blood clots in patients with

myocardial infarction (a.k.a. heart attacks), non-hemorrhagic CVA’s (a.k.a. strokes) and PE’s (a.k.a.

pulmonary emboli). Thrombolytics can cause hemorrhage and should be used with care.

Streptokinase

Streptokinase is a thrombolytic (note: discovered here at NYU) made by Streptococcus bacteria

which dissolves clots, similar to tPA (although through a different mechanism)

Diltiazem(Cardizem)

Diltiazem is a calcium channel blocker used to slow the heart down in patients with certain

types of tachycardias such as atrial fibrillation.

Metoprolol

Metoprolol is a beta-blocker which is used to slow down the heart and lower blood-pressure.

These drugs are not typically used in asthmatics, as they can induce bronchoconstriction.

Atenolol

Atenolol is a beta-blocker similar to metoprolol.

Adenosine

Adenosine (the A of ATP fame) is used as an antidysrhythmic to break certain cardiac

dysrhythmias; it is often used in patients with supraventricular tachycardia. The half life of the drug

is only a few seconds, and can often induce non-pathologic asystole (flat line on an EKG) for a few

seconds.

Digoxin

Digoxin (a derivative of the Foxglove plant) is a cardiac drug used to slow conduction through

the heart, especially in cases of atrial-fibrillation. As a side effect it can produce various

dysrhythmias including ventricular fibrillation and aystole.

Metronidazole (Flagyl)

Flagyl is an antibiotic used against anaerobic bacteria and certain parasites. As a side effect

patients can become violently ill to their stomachs from consuming alcohol with Flagyl (similar to

Antabuse)

Vancomycin

Vancomycin is the “last ditch” antibiotic, used for highly resistant bacteria. It is fairly toxic to the

patient, and often is a hobson’s choice to administer to a septic, shocky patient.

Trimethoprim/sulfamethoxazole (Bactrim)

Bactrim is a “sulfa” class antibiotic and is often used in urinary tract infections.

Ketamine

A sedative often used in conjuction with other sedatives (such as midazolam or diazepam).

Pepcid

Pepcid is a systemic antacid (H2 blocker) which takes 30-45 minutes to take effect, but lasts for

several hours. Similar to ranitidine (Zantac) and cimetidine (Tagamet).

NS

NS stands for Normal Saline, which is 0.9% Sodium Chloride, and is the usual fluid given to a

patient who needs fluid due to dehydration. It is approximately isotonic.

LR

LR stands for Lactated Ringers, which is Normal Saline with other electrolytes. Due to the

presence of the other electrolytes, there is a limit to how much can be administered within a

specific period of time.

D5, D10, D25 and D50

The D stands for Dextrose, which is a stable form of glucose. This solution is given IV to give

the patient glucose. This is never given IM, as high concentrations of glucose cause tissue death

outside the vasculature.

Other useful terms

QD

Once per Day

BID

Twice per day

TID

Three times per day

QID

Four times per day

QHS

At the hour of sleep

NPO

Nothing by mouth