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KRISTINA PRADHAN 
INTERN
EMERGENCY DRUGS 
ATROPINE 
ADRENALINE 
MEPHENTERMINE 
EPHEDRINE 
XYLOCARD
ATROPINE 
 CLASS: ANTICHOLIGERNIC DRUGS. 
 BACKGROUND: A tertiary amine belladonna alkaloid, 
has a high affinity for muscarinic receptors.
ATROPINE 
MOA: binds competitively, 
preventing acetylcholine 
from binding to those sites 
Atropine acts both centrally 
and peripherally. 
Duration of action: Its 
general actions last about 4 
hours except when placed 
topically in the eye, where 
the action may last for days
ORGAN ACTION THERAPEUTIC USE 
EYE Dilation of 
. 
pupils(MYDRIASIS) 
Blurring of near 
vision(CYCLOPLEGIA); 
Dry eye 
Ophthalmic: permits the 
measurement of refractive 
errors without interference 
by the accommodative 
capacity of the eye. 
Shorter-acting 
antimuscarinics 
(cyclopentolante and 
tropicamide) have largely 
replaced atropine due to 
prolonged mydriasis. 
GASTROINTESTINAL Antispasmodic 
Gastric motility is 
reduced, hydrochloric acid 
production is not 
significantly affected 
URINARY BLADDER Reduce hypermotility 
states of urinary bladder. 
Occasionally used in 
enuresis among children.
ORGAN ACTION THERAPEUTIC USE 
Heart low doses—bradycardia. 
(due to central activation 
of vagal efferent outflow-- 
result from blockade of 
the M1 receptors on the 
inhibitory prejunctional 
(or presynaptic) neurons- 
- permitting increased 
acetylcholine 
release. 
Higher doses-- M2 
receptors on the SA node 
are blocked-- and the 
cardiac rate increases . 
(requires at least 1 mg of 
atropine) 
Bradycardia and partial 
heart block 
Secretions Sweat gland; salivary 
gland; lacrimal gland: 
Drying effect. 
Antisecretory.
ATROPINISATION IN OP POISONING
ATROPINISATION 
- Start with 0.05mg/kg in children 
0.6-2mg i.v. , repeat 10-25 min. 
Until atropinisation obtained.; Tachycardia 
D' s " 
Delirium (disorientation) 
Drowsiness 
Dilated pupils (The mydriasis along with cyclopegia 
causes blurring of vision) 
Dryness of mouth 
Dry, hot skin
ADVERSE EFFECTS
PREPARATION 
Available( ampule): 
1ml=0.6mg 
Dose: 0.01-0.02mg/kg 
Bradyarythmia : 
0.04mg/kg 
Onset: 1-2 min 
Duration of Action: 20- 
30 min(i.v) 
2-3 hrs (i.m.)
ADRENALINE 
Class :Direct acting sympathomimetic drugs. 
It interact with both alpha and beta receptors. 
At low dose , beta effect ( vasodilatation) on vascular 
system predominant. 
At high dose , alpha effect (vasoconstriction) are 
strongest
MODE OF ACTION 
Increase contractility of myocardium( Inotropic Effect , beta1 action) 
Increase HR( Choronotropic Effect ,beta 1 action) 
So, Increase In CO leads to Increase BP
ADRENALINE 
INDICATION ADVERSE EFFECTS CONTRAINDICATION 
BRONCHOSPASM CNS EFFECTS: ANXIETY, 
HEADACHE, TENSION, 
TREMOR. 
HYPERTHYROIDISM: 
INCREASED 
ADRENERGIC 
RECEPTOR ON 
VASCULATURE— 
HYPERSENSITIVE 
RESPONSE 
ANAPHYLACTIC SHOCK HEMORRHAGE: 
MARKED ELEVATION 
OF BP—CEREBRAL 
HEMORRHAGE 
COCAINE: PREVENT RE-UPTAKE 
OF 
CATECHOLAMINES— 
LONGER PERIOD OF 
TIME. 
GLAUCOMA(2%) PULMONARY EDEMA 
IN ANESTHETICS : TO 
INCREASE DURATION 
OF LOCAL
DOSING 
In cardiac arrest 
1 mg (10 mL 1:10,000 solution) 
IV push every 3 to 5 minutes. 
If this fails, higher doses of epinephrine (up to 
0.2mg/kg) are acceptable but not recommended (there 
is growing evidence that it may be harmful) 
In anaphylaxis: 3-5mcg/kg
PREPARATION 
Available in Ampule at concentration: 
1mg/ml(1:1000) 
Preparation: 
100mcg/ml 
10mcg/ml
MEPHENTERAMINE 
Class: Sympathomimetic ( Mixed action adrenergic 
agonist) 
Mechanism of action: 
- Acts indirectly by releasing norepinephrine from its 
storage sites and directly by exerting a slight effect on 
alpha and beta-1 receptors and a moderate effect on 
beta-2 receptors mediating vasodilation. Causes 
increased CO; also elicits slight CNS effects.
INDICATION AND DOSING 
INDICATION DOSING 
Hypotension due to anesthesia IV, Adults: 30-45 mg; 30-mg doses may 
be repeated as required; or, IV 
infusion, Adults and children: 0.1% (1 
mg/mL) mephentermine in D5W with 
the rate of infusion and duration 
dependent on response. IV, Pediatric: 
0.4 mg/kg (12 mg/m2) as a single dose. 
Prophylaxis of hypotension in spinal 
anesthesia. 
IM, Adults: 30-45 mg 10-20 min before 
anesthesia. IM, Pediatric: 0.4 mg/kg 
(12 mg/m2) as a single dose. 
Haemorrhage (only as emergency 
treatment until blood or blood 
substitutes can be given). 
Not recommended, but IV infusion of 
0.1% in D5W may maintain BP until 
blood volume is replaced.
PREPARATION 
Available: 1ml=30mg 
Preparation: 1ml+4ml NS= 6mg/ml
EPHEDRINE 
Class: Sympathomimetic ( Mixed action adrenergic 
agonist) 
Action: longer duration of action; excellent oral 
absorption and penetrates into cns. 
Elimination: unchanged in urine.
EPHEDRINE 
Mechanism of action: 
Stimulates both alpha-and beta-receptors, causing 
increased heart rate, enhanced cardiac output and 
increased BP. 
Raises systolic and diastolic blood pressure by 
vasoconstriction and cardiac stimulation. 
Also causes bronchodilation but is less effective than 
epinephrine.
DOSING AND PHARMACOKINETICS 
Onset:30-60sec 
Duration of action: 
60min 
Available: 
1ml=30mg 
DOSAGE: 3-6 mg 
I.V.
SOME COMMON SIDE 
EFFECTS OF ADRENERGIC 
AGONISTS.
XYLOCARD 
 Class: Antiarrhythmics class I B 
 Mechanism of action: 
Sodium channel blocker : It acts by passing 
through the nerve membrane to attach or block the 
sodium conducting ion channels thereby inhibiting 
the nerve impulses.
ONSET OF ACTION:45- 
90 SECONDS 
DOSING: INDICATION: 
DURATION: 10-20 MINS 1.5-2MG/KG FOLLOWED 
BY INFUSION AT A RATE 
OF 1-4 MG/MIN. 
VENTRICULAR 
TACHYARRYTHMIA. 
AVAILABLE 
AS 
LOXICARD: 
2% : 
1ML=20MG
REFERENCE 
http://depts.washington.edu/opchild/images/ach.jpg-http:// 
www.lifehugger.com/moc/828/Atropinization_s 
igns_symptoms 
http://www.healthdigest.org/topics/category/1403- 
mephentermine-sulfate-dosage-interactions-side-effects- 
how-to-use-MEPHERTERMINE DOSING. 
LIPPINCOTT PHARMACOLOGY 
AJAY YADAV- SHORT TEXTBOOK OF 
ANAESTHESIA.

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Emergency drugs used in anaesthesia

  • 2. EMERGENCY DRUGS ATROPINE ADRENALINE MEPHENTERMINE EPHEDRINE XYLOCARD
  • 3. ATROPINE  CLASS: ANTICHOLIGERNIC DRUGS.  BACKGROUND: A tertiary amine belladonna alkaloid, has a high affinity for muscarinic receptors.
  • 4. ATROPINE MOA: binds competitively, preventing acetylcholine from binding to those sites Atropine acts both centrally and peripherally. Duration of action: Its general actions last about 4 hours except when placed topically in the eye, where the action may last for days
  • 5. ORGAN ACTION THERAPEUTIC USE EYE Dilation of . pupils(MYDRIASIS) Blurring of near vision(CYCLOPLEGIA); Dry eye Ophthalmic: permits the measurement of refractive errors without interference by the accommodative capacity of the eye. Shorter-acting antimuscarinics (cyclopentolante and tropicamide) have largely replaced atropine due to prolonged mydriasis. GASTROINTESTINAL Antispasmodic Gastric motility is reduced, hydrochloric acid production is not significantly affected URINARY BLADDER Reduce hypermotility states of urinary bladder. Occasionally used in enuresis among children.
  • 6. ORGAN ACTION THERAPEUTIC USE Heart low doses—bradycardia. (due to central activation of vagal efferent outflow-- result from blockade of the M1 receptors on the inhibitory prejunctional (or presynaptic) neurons- - permitting increased acetylcholine release. Higher doses-- M2 receptors on the SA node are blocked-- and the cardiac rate increases . (requires at least 1 mg of atropine) Bradycardia and partial heart block Secretions Sweat gland; salivary gland; lacrimal gland: Drying effect. Antisecretory.
  • 8. ATROPINISATION - Start with 0.05mg/kg in children 0.6-2mg i.v. , repeat 10-25 min. Until atropinisation obtained.; Tachycardia D' s " Delirium (disorientation) Drowsiness Dilated pupils (The mydriasis along with cyclopegia causes blurring of vision) Dryness of mouth Dry, hot skin
  • 10. PREPARATION Available( ampule): 1ml=0.6mg Dose: 0.01-0.02mg/kg Bradyarythmia : 0.04mg/kg Onset: 1-2 min Duration of Action: 20- 30 min(i.v) 2-3 hrs (i.m.)
  • 11. ADRENALINE Class :Direct acting sympathomimetic drugs. It interact with both alpha and beta receptors. At low dose , beta effect ( vasodilatation) on vascular system predominant. At high dose , alpha effect (vasoconstriction) are strongest
  • 12. MODE OF ACTION Increase contractility of myocardium( Inotropic Effect , beta1 action) Increase HR( Choronotropic Effect ,beta 1 action) So, Increase In CO leads to Increase BP
  • 13. ADRENALINE INDICATION ADVERSE EFFECTS CONTRAINDICATION BRONCHOSPASM CNS EFFECTS: ANXIETY, HEADACHE, TENSION, TREMOR. HYPERTHYROIDISM: INCREASED ADRENERGIC RECEPTOR ON VASCULATURE— HYPERSENSITIVE RESPONSE ANAPHYLACTIC SHOCK HEMORRHAGE: MARKED ELEVATION OF BP—CEREBRAL HEMORRHAGE COCAINE: PREVENT RE-UPTAKE OF CATECHOLAMINES— LONGER PERIOD OF TIME. GLAUCOMA(2%) PULMONARY EDEMA IN ANESTHETICS : TO INCREASE DURATION OF LOCAL
  • 14. DOSING In cardiac arrest 1 mg (10 mL 1:10,000 solution) IV push every 3 to 5 minutes. If this fails, higher doses of epinephrine (up to 0.2mg/kg) are acceptable but not recommended (there is growing evidence that it may be harmful) In anaphylaxis: 3-5mcg/kg
  • 15. PREPARATION Available in Ampule at concentration: 1mg/ml(1:1000) Preparation: 100mcg/ml 10mcg/ml
  • 16. MEPHENTERAMINE Class: Sympathomimetic ( Mixed action adrenergic agonist) Mechanism of action: - Acts indirectly by releasing norepinephrine from its storage sites and directly by exerting a slight effect on alpha and beta-1 receptors and a moderate effect on beta-2 receptors mediating vasodilation. Causes increased CO; also elicits slight CNS effects.
  • 17. INDICATION AND DOSING INDICATION DOSING Hypotension due to anesthesia IV, Adults: 30-45 mg; 30-mg doses may be repeated as required; or, IV infusion, Adults and children: 0.1% (1 mg/mL) mephentermine in D5W with the rate of infusion and duration dependent on response. IV, Pediatric: 0.4 mg/kg (12 mg/m2) as a single dose. Prophylaxis of hypotension in spinal anesthesia. IM, Adults: 30-45 mg 10-20 min before anesthesia. IM, Pediatric: 0.4 mg/kg (12 mg/m2) as a single dose. Haemorrhage (only as emergency treatment until blood or blood substitutes can be given). Not recommended, but IV infusion of 0.1% in D5W may maintain BP until blood volume is replaced.
  • 18. PREPARATION Available: 1ml=30mg Preparation: 1ml+4ml NS= 6mg/ml
  • 19. EPHEDRINE Class: Sympathomimetic ( Mixed action adrenergic agonist) Action: longer duration of action; excellent oral absorption and penetrates into cns. Elimination: unchanged in urine.
  • 20. EPHEDRINE Mechanism of action: Stimulates both alpha-and beta-receptors, causing increased heart rate, enhanced cardiac output and increased BP. Raises systolic and diastolic blood pressure by vasoconstriction and cardiac stimulation. Also causes bronchodilation but is less effective than epinephrine.
  • 21. DOSING AND PHARMACOKINETICS Onset:30-60sec Duration of action: 60min Available: 1ml=30mg DOSAGE: 3-6 mg I.V.
  • 22. SOME COMMON SIDE EFFECTS OF ADRENERGIC AGONISTS.
  • 23. XYLOCARD  Class: Antiarrhythmics class I B  Mechanism of action: Sodium channel blocker : It acts by passing through the nerve membrane to attach or block the sodium conducting ion channels thereby inhibiting the nerve impulses.
  • 24. ONSET OF ACTION:45- 90 SECONDS DOSING: INDICATION: DURATION: 10-20 MINS 1.5-2MG/KG FOLLOWED BY INFUSION AT A RATE OF 1-4 MG/MIN. VENTRICULAR TACHYARRYTHMIA. AVAILABLE AS LOXICARD: 2% : 1ML=20MG
  • 25. REFERENCE http://depts.washington.edu/opchild/images/ach.jpg-http:// www.lifehugger.com/moc/828/Atropinization_s igns_symptoms http://www.healthdigest.org/topics/category/1403- mephentermine-sulfate-dosage-interactions-side-effects- how-to-use-MEPHERTERMINE DOSING. LIPPINCOTT PHARMACOLOGY AJAY YADAV- SHORT TEXTBOOK OF ANAESTHESIA.