Pharmacology Emergency Drugs & Procedures Module #7

Chapter 23 Emergency Drugs

Emergency Situations Lost or altered consciousness Respiratory emergencies Cardiovascular emergencies Other emergency situations Drug-related emergencies

General Measures Training BLS CPR Phone numbers Emergency kit

Loss or Altered Consciousness Syncope Hypoglycemia Convulsions/ seizures

Syncope Symptoms Ashen/ gray color of skin Diaphoresis Fall in blood pressure Brought on by anxiety, fear, apprehension Steps in treatment Trendelenburg position (head down) Exhibit confidence Ammonia spirits

Hypoglycemia Symptoms Most often caused by too much insulin Failure to eat before appointment Rapid pulse, decreased respiration Dizziness, tremor, confusion Steps in treatment Oral glucose if conscious Intravenous dextrose if unconscious

Convulsions/ Seizures Symptoms Abnormal movements of body parts Patient may become unconscious Steps in treatment Protect patient from harm Move sharp objects Turn head to side to prevent aspiration Observation Diazepam for status epilepticus

Respiratory Emergencies Hyperventilation Asthma Anaphylactic shock Acute airway obstruction

Hyperventilation Symptoms Fast, shallow breathing Anxiety and SOB Steps in treatment Calm reassurance “Rebreathe” into a paper bag or unconnected face mask

Acute Asthma Attack Symptoms Wheezing with prolonged expiration Squeak Steps in treatment Patient’s own medication (inhalers) Oxygen administration Call 911 if no improvement

Anaphylactic Shock Symptoms Reaction within minutes to agent Weak, rapid pulse and profound drop in BP Dyspnea and severe bronchial constriction Steps in treatment Parenteral epinephrine immediately Albuterol inhalation Intravenous corticosteroids, intramuscular diphenhydramine, aminophylline

Acute Airway Obstruction Symptoms Foreign body in the pharynx or larynx Gasping for breath, coughing, cyanosis Steps in treatment Encourage coughing Pull tongue forward and clear pharynx if possible Heimlich maneuver if needed

CV Emergencies Angina pectoris Acute MI Cardiac arrest

Angina Pectoris Symptoms Chest pain radiating chest, left arm, mandible Feeling of heaviness in the chest Rapid pulse Can be brought on by stress, pain, fear Steps in treatment Sublingual nitroglycerine Call 911 if no response with 3 doses

Acute Myocardial Infarction Symptoms Severe pain, pressure, heaviness in chest Radiates other parts of body Sweating, nausea, vomiting Irregular rapid pulse, SOB, indigestion Steps in treatment Administration of oxygen Aspirin and opioid analgesic Call 911, transfer to hospital

Cardiac Arrest Symptoms Sudden circulatory/ respiratory collapse Absent pulse/ no BP In a few minutes, cyanotic/ fixed dilated pupils Steps in treatment Immediate CPR- brain damage in 4 minutes Call 911 Epinephrine and defibrillation for asystole

Other Emergencies Acute adrenocortical insufficiency Thyroid storm

Acute Adrenocortical Insufficiency Symptoms Patients taking high doses of steroids Severe acute stress Nausea, vomiting, abdominal pain, confusion Cardiovascular collapse, shock Steps in treatment Parenteral hydrocortisone Oxygen inhalation

Thyroid Storm Symptoms Hyperpyrexia, increased sweating, hyperactivity, mental agitation, shaking, nervousness, tachycardia Cardiovascular collapse may follow Steps in treatment Beta blockers Hydrocortisone

Drug Related Emergencies Opioid overdose Reaction to LA

Opioid Overdose Symptoms Respiratory depression Pinpoint pupils Steps in treatment Naloxone (Narcan)

Local Anesthesia Toxicity Symptoms CNS stimulation or depression Excitement or convulsions Drowsiness, unconsciousness, cardiac arrest Steps in treatment Symptomatic Convulsions- diazepam Hypotension- pressor agent Reflex bradycardia- atropine

Emergency Drugs – Level 1 Epinephrine Anaphylaxis Cardiac arrest Acute asthma Diphenhydramine (Benadryl) Allergic reactions Oxygen Most emergencies – especially respiratory Nitroglycerin Angina pectoris Glucose Hypoglycemia – conscious Albuterol - bronchodilation Asthma Anaphylaxis

Emergency Drugs – Level 2 Benzodiazapines Convulsions Aromatic spirits of ammonia Syncope Morphine Myocardial infarction Atropine Hypotension Hydrocortisone Allergic reaction Anaphylaxis Adrenal crisis Dextrose Hypoglycemia – unconscious Naloxone (Narcan) Opioid induced apnea Narcotic overdose

Review Drug Interactions

Concepts Drug interaction Reaction between 2 or more drugs Generally an extension of the pharmacologic effects Potentiation (synergism) An increased effect of 2 drugs that is greater than just adding their effects together Antagonism A decreased effect of 1 &/or the other drug

Types of Drug Interactions Pharmacokinetic Gastro-intestinal absorption Distribution Drug metabolism Excretion Pharmacodynamic Involves the receptor sites

Gastro-intestinal Absorption Reduced absorption due to interaction with nutrients or other drugs Example: Fluoride supplement with milk Tetracycline with antacid

Distribution Drugs are distributed by blood vessels. They can bind with albumin and other substances. 2 or more drugs may compete for the same binding sites Increased free drug gives increased effect Example: Indocin & warfarin – causes increased bleeding

Drug metabolism Drug metabolism occurs mainly in the liver. Some drugs can increase the activity of liver cells. Example: Barbiturates increase action of microsomal enzymes; this increases the metabolism of doxycycline

Excretion The primary site of excretion for most drugs is the kidney. Some drugs can increase or decrease excretion rates. Age and disease of the kidney can delay excretion of a drug and lead to toxicity Example: Probenecid & penicillin- increased levels of antibiotic in the blood

Pharmacodynamic Effects can be antagonism, synergism, or additive Examples Tricyclic antidepressants antagonize guanethidine (antihypertensive) by blocking its uptake by the receptor site.

Aspirin Drug Interactions With warfarin Increase effect- Potential for bleeding/ hemorrhage With probenecid (Benemid) Reduce effect- Increased uric acid in blood Acute attack of gout

NSAID Drug Interactions With ACE inhibitors Reduce effect- high blood pressure With diuretics Reduce effect- fluid retention/ high BP

Antibiotic Drug Interactions With oral contraceptives Reduce effectiveness

Tetracycline Drug Interactions With oral antacids Reduced effect- take 1 hour before or 2 hours after With dairy products Reduced effect- take 1 hour before or 2 hours after

Metronidazole Drug Interactions With alcohol Disulfiram-like reaction Nausea, vomiting Also avoid alcohol containing mouthrinses

Epinephrine Drug Interactions With tricyclic antidepressants Hypertension Beta-adrengeric blockers Hypertension Reflex bradycardia

Important Dental-related Drug Interactions (Box 25-1) ASA/ NSAIDs and warfarin Metronidazole and alcohol Ibuprofen and lithium Epinephrine and beta blockers Tetracycline and calcium Epinephrine and TCA ASA/ NSAIDs and APAP Oral contraceptives and antibiotics

Chris Chrome Significant factors PCN allergy Gout Classification of probenecid Uricosuric Effect of ASA Acute gout attack Pharmacokinetic interaction Excretion of uric acid is decreased

Victor Violet Premedication Amoxicillin Prescription 500 mg tablets; 4 tabs 1 hour before tx Rapidly advancing periodontitis Tetracycline No – antagonist to amoxicillin Interactions Amoxicillin & tetracycline – pharmacodynamic Tums & tetracycline – gastrointestinal

Activities Look at first aid kit Video rQN8LON-cE rQN8LON-cE