MEDICAL SURGICAL NURSING

GROUP PRESENTATION ON,

CARDIAC EMERGENCY DRUGS.

Submitted by, Submitted to,

Alma Susan Prof.Maya P Joseph

Msc nursing 2nd year Vice principal

MTCON MTCON.
INTRODUCTION

Drugs having their major action on heart or blood vessels, or those used primarily for cardiovascular drugs. They can act directly on cardiovascular
structures or through autonomic or central nervous system, kidney, autacoids or hormones which regulate cardiovascular function. Emergency drugs are
chemical compounds used in patients during life threatening conditions so that the symptoms can be controlled and the life of a patient can be saved. For a drug
to be useful in emergency, it must have a short onset of action and be administered in such a way as to facilitate rapid onset of action.

PURPOSE OF EMERGENCY DRUGS

 To provide initial treatment for board spectrum of illness and injuries, most of which may be life threatening.

 To control the symptoms of patient.

 To save the life of the patient.

 To reach the site of action as soon as possible.

 To normalize the vital bodily functions.

 To diverge the patient from the possible risks.

LIST OF DRUGS

 Atropine

 Sodium Nitroprusside
 Amiodarone

 Aminophylline

 Mannitol

 Magnesium Sulfate

 Epinephrine

 Hydrocortisone

 Heparin

 Diazepam

 Dextrose 50%
 DRUG NAME MECHANISM OF INDICATIONS CONTRA ADVERSE EFFECTS NURSES
ACTION INDICATIONS RESPONSIBILITIES.

Generic Name: Chemical Effect: • Symptomatic • Contraindicated in • CNS: agitation, ataxia, • Have patient void
1.)Atropine Sulfate bradycardia, patients hypersensitive coma, confusion, before taking
Inhibits acetylcholine at bradyarrhythmia to the drug and its delirium, disorientation, medication if urinary
Brand Name: parasympatheti c component dizzeness, excitement, retention is a problem.
AtroPen AutoInjector, neuroeffector junction, • Anticholineste rase hallucination, headache,
SalTropine blocking vagal effects insecticide poisoning • Those with acute angle insomnia, restlessness • Take as prescribed, 30
on SA node, enhancing closure glaucoma, min before meals; avoid
Classification: conduction through AV • Preoperatively for obstructive uropathy, • CV: angina, excessive dosage.
Anticholinergic node decreasing secretions obstructive disease of arrhythmias, flushing,
Antimuscarinic and blocking cardiac GI tract, paralytic ileus, palpitations, tachycardia • Avoid hot
Parasympatholytic Therapeutic Effect: vagal reflexes toxic megacolon, environments; you will
Antiparkinsonian intestinal atony, • GI: Dry mouth, be heat intolerant, and
Increases heart rate, • Adjunct in peptic ulcer unstable CV status in nausea, vomiting, thirst dangerous reactions may
decreases secretions and disease; functional GI acute hemorrhage, occur.
slows GI motility. disorders such as asthma, myasthenia • GU: Urine retention;
Antidote for ant irritable bowel gravis • use caution driving or
cholinesterase syndrome. • HEMATOLOGIC: performing hazardous
insecticide poisoning. leukocytosis tasks

• Other: anaphylaxis • ensure adequate fluid

intake, proper diet

• suck sugarless
lozenges

• perform frequent
mouth care

• wear sunglasses in
bright light

• empty the bladder

prior to taking drug
 • Report if any of the
adverse effects is noted

Generic Name: • control of generalized • Contraindicated in • CNS: ataxia, •Patients taking

2.) Phenytoin sodium tonic-clonic (grand mal) patients who are confusion, dizziness, phenytoin should be
and complex partial hypersensitive to headaches, insomnia, advised of the
Brand Name: Produces a voltage and (psychomot or, temporal phenytoin or other nervousness, slurred importance of adhering
DILANTIN frequency dependent lobe) seizures hydantoins. speech, twitching strictly to the prescribed
blockade of sodium dosage regimen, and of
Classification: channels in rapidly • prevention and • SA block, adamsstroke • CV: Hypotension informing the physician
anticonvulsant discharging nerve cells. treatment of seizures syndrome of any clinical condition
Thus, it stops sustained occurring during or • EENT: blurred vision in which it is not
repetitive firing such as following neurosurger y possible to take the drug
that occurring during a • GI: nausea, vomiting orally as prescribed,
seizure. Because of this • status epilepticus e.g., surgery,
it prevents the spread of • HEMATOLOGIC:
seizure discharge anemia, leucopenia • Patients should also be
cautioned on the use of
• Metabolic: other drugs or alcoholic
hyperglycemia beverages without first
seeking the physician's
• Other: pain, necrosis advice.

• Patients should be
instructed to call their
physician if skin rash
develops.

• The importance of
good dental hygiene
should be stressed in
order to minimize the
development of gingival
hyperplasia and its
complications.
 • Do not use capsules
which are discoloured

Generic Name: • Cardiac dysrhythmias, • CNS: anxiety, Monitor vitals and

• Bronchospasm, angleclosure glaucoma, dizziness, fear, check for for cardiac
3.) Epinephrine hypersensitivity local anesthetic of headache, hemiplegia, dysrhythmias
hydrochloride Chemical Effect: reactions, anaphylaxis fingers and toes subarachnoid
hemorrhage, tremor, • Avoid IM use of
Brand Name: Stimulates alpha and • Hemostasis • General anesthesia weakness, restlessness parenteral suspension
Adrenalin Chloride beta receptors in with halocarbons or into buttocks. Gas
sympathetic nervous • Prolonging local cyclopropane, organic • CV: anginal pain, gangrene may occur
Classification: system anesthetic effect brain damage, labor, dysrhythmias,
adrenergic coronary insufficiency hypertension, • Massage site after IM
Bronchodilator Therapeutic Effect: • Restoring cardiac palpitations injection to counteract
Relaxes bronchial rhythm in cardiac arrest possible
smooth muscles, causes • GI: nausea, vomiting vasoconstriction.
cardiac stimulation,
relieves allergic signs • GU: urinary retention • Observe patient
and symptoms, helps closely for adverse
stop local bleeding, and • METABOLIC: reactions. Notify doctor
decreases pain glysuria, hyperglycemia if adverse reaction
sensation. develop
• RESP: respiratory
difficulty • If blood pressure
increases sharply,
• SKIN: hemorrhage at rapidacting vasodilators
injection site, pallor, such as nitrates or alpha
urticaria, blockers can be given to
counteract
Generic Name: •Acute nephritis •Contraindicated with CNS: weakness, •check if allergic to
allergy to Mg products; dizziness, fainting, MgSO4
4.) Magnesium Sulfate •control hypertension heart block, myocardial sweating, drowsiness,
Cofactor of many damage, abdominal hypothermia, paralysis, •monitor serum
Classification: enzyme systems •evacuation of the colon pain, nausea, vomiting; seizure, tetany, magnesium level during
involved in neurochemic for rectal and bowel fecal impaction, twitching parenteral therapy
Electrolyte al transmission and examination intestinal and biliary
Antiepileptic muscular excitability; tract obstruction, CV: palpitation, heart •monitor knee-jerk
Laxative prevents seizures by •prevent hypomagnesem hepatitis block, hypotension, reflex before repeated
blocking neuromuscul ar ia slow/weak pulse, parenteral
transmission; attracts •use cautiously with circulatory colapse administration
and retains water in the renal insufficiency
intestinal lumen and GI: excessive bowel •don’t give oral MgSO4
distends the bowel to activity, with abdominal pain
promote mass
movement and relieve METABOLIC: •monitor bowel function
constipation hypocalcemia
•maintain urine output at
RESPIRATORY: a level of 100ml q4h
respiratory paralysis during parenteral
administration
OTHER: diaphoresis,
flushing

Make sure specifies

Generic Name: • Hypocalcemic Contraindicated in CNS: pain, sense of form of calcium to be
emergency patients with ventricular oppression, tingling given; crash carts may
5.) Calcium Gluconate fibrillation, contain both calcium
Chemical Effect: • Hypocalcemic tetany hypercalcemia, CV: bradycardia, gluconate and calcium
Brand Name: hypophosphatemia, or cardiac arrest, mild chloride.
Phil Pharmawealth Replaces and maintains • Adjunct in cardiac renal calculi decrease in blood
/Harson calcium. Reduces total arrest pressure, vasodilation • Tell patient to take oral
load in GI tract, elevates calcium 1 to 11/2 hours
Calcium Gluconate amp gastric PH to reduce • Adjunct in magnesium GI: constipation, after meals if GI upset
Classification pepsin activity, intoxication Nausea, vomiting, thirst occurs.
strengthens gastric
Calcium supplement, mucosal barrier and • During exchange GU: polyuria, renal • Give I.M. injection in
antiarrhythmic increases esophageal transfusion calculi gluteal region in adults
sphincter tone and in lateral thigh in
METABOLIC: infants. Use I.M. route
Therapeutic Effect: • Hyperphosphatemia in hypercalcemia only in emergencies
endstage renal failure when no I.V. route is
Raises calcium level and available bec. of
relieves mild gastric • Gastric hyperacidity SKIN: burning, irritation of tissue by
discomfort cellulitis, necrosis, soft- calcium salts.
tissue calcification
• Tell patient to take oral
OTHER: vein irritation calcium with a full glass
with IV use of water.

• Monitor calcium levels

frequently.

Generic Name: • Severe, acute pain • Contraindicated to • CNS: dizziness, Hypercalcemia may
patients hypersensitive euphoria, nightmares, result after large doses
6.) Morphine Sulfate • Moderate to severe to the drug or any of its sedation, seizures, in chronic renal failure.
pain requiring components somnolence Report abnormalities.
Brand Name: Avinza, continuos, aroundthe-
Duramorph, Kadian, Binds with opioid clock opioid therapy • Those with bronchial • CV: Bradycardia, • Avoid alcohol and
MSIR, MS Contin, receptors in CNS, asthma or Upper airway cardiac arrest, flushing, other CNS depressants
Oramorph SR, Roxanol altering both perception • Pain following major obstruction hypotension, shock while receiving
100, Roxanol, Roxanol- of and emotional surgery morphine.
T, RMS, Statex response to pain through • Use cautiously in • GI: Constipation, ileus,
unknown mechanism. It • Anesthesia adjunct for patients with head nausea, vomiting • Do not use OTC drug
Classification: CNS relieves pain. preoperative sedation injury, increased unless approved by
agent, analgesic, intracranial pressure, • GU: Urine retention physician
narcotic (opiate) agonist seizures, chronic
pulmonary disease, • HEMATOLOGIC: • Do not smoke or
thrombocytopenia ambulate without
• Renal disease, acute assistance after
abdominal condition • RESPIRATORY: receiving drug. Bedside
 respiratory arrest, rails are advised
respiratory depression
• Use caution or avoid
• SKIN: pruritus tasks requiring alertness
(eg. Driving a car) until
• OTHER: physical response to drug is
dependence known since drug may
cause drowsiness,
dizziness, or blurred
vision

• Do not breast feed

while taking this drug.

Nitroglycerin is Contraindicated to • fast, slow, pounding, Inform prescriber of all

indicated for the acute patients hypersensitive or uneven heart rate; prescriptions, OTC
relief of an attack or to nitrates and those medications, or herbal
Generic Name: Works by relaxation of acute prophylaxis of with early MI, severe • blurred vision or dry products you are taking,
7.) Nitroglycerin smooth muscle, angina pectoris due to anemia, increased mouth; and any allergies you
producing a vasodilator coronary artery disease. intracranial pressure, have.
Brand Name: Anginine effect on the peripheral orthostatic hypotension, • feeling light-headed,
Nitradisc veins and arteries with allergy to adhesives, and nausea, vomiting, • Do not take any new
more prominent effects to patients with sweating, pale skin medication during
Classification: on the veins. Primarily hypovolemia, fainting; or therapy unless approved
Antianginal, vasodilator reduces cardiac oxygen hypotension by prescriber. Take as
demand by decreasing • fever, sore throat, and per directions.
preload (left ventricular headache with a severe
end-diastolic pressure); blistering, peeling, and • Do not change brands
may modestly reduce red skin rash. without consulting
afterload; dilates prescriber. Do not
coronary arteries and • mild burning or discontinue abruptly.
improves collateral flow tingling with the tablet
 to ischemic regions in your mouth; • Keep medication in
original container,
• warmth, redness, or tightly closed. If anginal
tingly feeling under chest pain is unresolved
your skin; or in 15 minutes, seek
emergency medical help
• feeling weak or dizzy. at once. Daily use may
cause dizziness or
lightheadedness (use
caution when driving or
engaging in hazardous
activities until response
to drug is known);
headache; hypotension;

GI disturbances. Report
acute headache, rapid
heartbeat, unusual
restlessness or dizziness,
muscular weakness, or
blurred vision or seeing
abnormal colors.

• Promotion of diuresis Hypersensitivity to CV: Circulatory Assess urine output.

in the prevention or mannitol or any overload, Urine output of 30 ml/hr
Generic Name: treatment of the oliguric component or the following the test dose
Increases the osmotic phase of acute renal formulation; severe CNS: Headache, shows an adequate
8.) MANNITOL pressure of glomerular failure before renal disease (anuria); convulsions, headache, response.
filtrate, which inhibits irreversible renal failure dehydration; active chills, dizziness
Brand Name: Osmitrol tubular reabsorption of becomes established. intracranial bleeding; • · Do not give these
water and electrolytes severe pulmonary SKIN: Rash diuretics to clients who
Classification: Diuretic and increases urinary • Reduction of edema or congestion have heart failure, or
output intracranial pressure and METABOLIC: F and E who are severely
 brain mass. imbalance, water dehydrated. They
intoxication, increase the vascular
• Reduction of high dehydration and volume and may worsen
intraocular pressure hypovolemia secondary heart failure. These
when the pressure to rapid diuresis, drugs are not effective
cannot be lowered by hyponatremia unless extracellular
other means. volume is adequate.
• Promotion of urinary GI: Nausea, vomiting,
excretion of toxic xerostomia • · Administer mannitol
materials. GU: Polyuria, dysuria IV, diluting before use if
indicated.
Respi: Pulmonary
edema • · Administer urea IV
diluting in 100 ml of
Miscellaneous: Allergic D5W or D10W for
reactions every 30g of urea.
Administer no faster
than 4mL/min through a
filter.

• · Monitor VS, breath

sounds, and UOP.

• · D/C the drug if signs

of heart failure or
pulmonary edema
develop or if renal
function continues to
decline.

• rapid acting local Contraindicated in CNS: confusion, Assess the patients

anesthetic for patients hypersensitiv e depression, euphoria, condition before starting
Generic Name: procedures ranging from to amidetype local lethargy, therapy and regularly
As local anesthetic: infiltration to regional anesthesia and in those lightheadedness, muscle thereafter to monitor the
9.)Lidocaine Blocks the generation nerve block with adamsstroke twitching, paresthesia, drug’s effectiveness
Hydrochloride and conduction of action syndrome, restlessness, seizure,
potentials in sensory by • antiarrhythmic in the wolfparkinsonwhite slurred speech, • monitor patient’s
reducing sodium treatment of ventricular syndrome, or severe somnolence, tremor response, esp. ECG,
BrandName: permeability, reducing arrhythmias • treatment degree of SA,AV or blood pressure and
Xylocaine; Xylocard. sodium permeability, of status epilepticus intraventricul ar block in CV: bradycardia, electrolytes • check for
reducing height and rate (INVESTIGATIO absence of artificial cardiac arrest, therapeutic level
Classification: Local of rise of the action NAL) pacemaker. hypotension
anesthetic, antiarrhythmi potential, increasing • be alert for adverse
c excitation threshold, and • severe neuropathic EENT: blurred or effect reactions and drug
slowing conduction pain in patients double vision, tinnitus interaction
velocity. unresponsive to
standard medications. RESPIRATORY: • assess patient’s family
respiratory arrest, status about the drug therapy
asthmaticus

SKIN: diaphoresis

OTHER: anaphylaxis,
cold sensation, soreness
at injection site
CONCLUSION.

Drugs having their major action on heart or blood vessels, or those used primarily for cardiovascular drugs. They can act directly on cardiovascular
structures or through autonomic or central nervous system, kidney, autacoids or hormones which regulate cardiovascular function. Emergency drugs are
chemical compounds used in patients during life threatening conditions so that the symptoms can be controlled and the life of a patient can be saved. For a drug
to be useful in emergency, it must have a short onset of action and be administered in such a way as to facilitate rapid onset of action.

BIBLIOGRAPHY.

 K.D Tripathi. Essentials of medical pharmacology. 8th edition. Jaypee publications. Page number:521-604.

 American Heart Association. ACLS Provider Manual 2006 (with student CD). Dallas, TX: American Heart Association; 2006.

 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Management of symptomatic
bradycardia and tachycardia. Circulation. 2005;112(suppl 1):IV-67–IV-77.