Emergency drugs in anesthetic theater

University of Babylon 4th Years
College of Nursing Anesthesia Lec.8
Dr. Naji Yassesr Al-Mayyahi ____________________________________________________________
Emergency drugs in anesthetic theater
1- Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings, some types of slow heart rate, and to decrease saliva production during surgery. It is typically given intravenously or by injection into a muscle. Eye drops are also available which are used to treat uveitis and early amblyopia. The intravenous solution usually begins working within a minute and lasts half an hour to an hour. Large doses may be required to treat some poisonings.

Common side effects include a dry mouth, large pupils, urinary retention, constipation, and a fast heart rate. It should generally not be used in people with angle closure glaucoma. While there is no evidence that its use during pregnancy causes birth defects, it has not been well studied. It is likely safe during breastfeeding. It is an antimuscarinic (also known as an anticholinergic) that works by inhibiting the parasympathetic nervous system.
Atropine occurs naturally in a number of plants of the nightshade family including deadly nightshade, Jimson weed, and mandrake. It was first isolated in 1833.Atropine is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system. It is available as a generic medication and is not very expensive.A one-milligram vial costs between 0.06 and 0.44 USD, wholesale, in the developing world

2- Hydrocortisone, sold under the brand name Cortef among others, is the name for the hormone cortisol when supplied as a medication. Uses includes conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, rheumatoid arthritis, dermatitis, asthma, and COPD. It is the treatment of choice for adrenocortical insufficiency .It can be given by mouth or by injection. After long-term use, if stopped this should be done slowly.
Side effects may include mood changes, increased risk of infection, and swelling.With long-term use common side effects include osteoporosis, upset stomach, physical weakness, easy bruising, and yeast infections. While used, it is unclear if it is safe during pregnancy. It works as an antiinflammatory and by immune suppression.
Hydrocortisone was discovered in 1955. It is on the World Health Organization s List of Essential Medicines, the most important medications needed in a basic health system. It is available as a generic medication. The wholesale cost in the developing world is about 0.27 USD per day as of 2014 for the form taken by mouth. In the United States it costs less than 25 USD for a typical month of treatment.

3- Dexamethasone is a type of steroid medication. It is used in the treatment of many conditions, including rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, and along with antibiotics in tuberculosis. In adrenocortical insufficiency, it should be used together with a medication that has greater mineralocorticoid effects such as fludrocortisone. In preterm labor, it may be used to improve outcomes in the baby. It may be taken by mouth, as an injection into a muscle, or intravenously. The effects of dexamethasone are frequently seen within a day and last for about three days.
The long-term use of dexamethasone may result in thrush, bone loss, cataracts, easy bruising, or muscle weakness. It is pregnancy category C in the United States meaning use should be based on benefits being predicted to be greater than risks. In Australia, it is class A, meaning it has been frequently used in pregnancy and not been found to cause problems to the baby. It should not be taken when breastfeeding. Dexamethasone has anti-inflammatory and immunosuppressant effects.
Dexamethasone was first made in 1957. It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system. Dexamethasone is not expensive. In the United States a month of medication typically costs less than 25 USD. In India a course of treatment for preterm labor is about 0.5 USD. It is available in most areas of the world.
4- Intravenous sodium bicarbonate (trade names including Baros) is a solution for intravenous administration that increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises blood pH and reverses the clinical manifestations of acidosis
Indications:
Intravenous sodium bicarbonate is indicated in the treatment of metabolic acidosis, such as can occur in, for example, severe renal disease, diabetic ketoacidosis, circulatory insufficiency, extracorporeal circulation of blood, in hemolysis requiring alkalinization of the urine to avoid nephrotoxicity of blood pigments, and certain drug intoxications, such as by barbiturate overdose, salicylate poisoning, tricyclic antidepressant overdose or methanol poisoning.[1] In addition, sodium bicarbonate is indicated in severe diarrhea, where large amounts of bicarbonate may be lost. However, overall treatment should also strive to treat the underlying cause of the acidosis, such as giving insulin in case of diabetic ketoacidosis.

Contraindications:
Intravenous sodium bicarbonate is contraindicated in patients who are losing chloride, such as by vomiting. Because of its sodium content, intravenous sodium bicarbonate should be used with great care, if at all, in patients with congestive heart failure and severe renal insufficiency, where low sodium intake is strongly indicated to prevent sodium retention.[1] By similar rationale, intravenous sodium bicarbonate should be given with caution to patients receiving corticosteroids.

5- Ephedrine is a medication used to prevent low blood pressure during spinal anesthesia.[1] It has also been used for asthma, narcolepsy, and obesity but is not the preferred treatment. It can be taken by mouth or by injection into a muscle, vein, or just under the skin. Onset with intravenous use is fast, while injection into a muscle can take 20 minutes, and by mouth can take an hour for effect. When given by injection it lasts about an hour and when taken by mouth it can last up to four hours.
side effects include trouble sleeping, anxiety, headache, hallucinations, high blood pressure, fast heart rate, loss of appetite, and inability to urinate. Serious side effects include stroke, heart attack, and abuse. While likely safe in pregnancy its use in this population is poorly studied. Use during breastfeeding is not recommended. Ephedrine works by turning on the ? and ? adrenergic receptors.

6- Aminophylline is a compound of the bronchodilator theophylline with ethylenediamine in 2:1 ratio. The ethylenediamine improves solubility, and the aminophylline is usually found as a dihydrate.
Aminophylline is less potent and shorter-acting than theophylline. Its most common use is in the treatment of airway obstruction from asthma or COPD. It is used off-label as a reversal agent during nuclear stress testing. Aminophylline is a nonselective adenosine receptor antagonist and phosphodiesterase inhibitor
Side effects:
Aminophylline can lead to theophylline toxicity. Aminophylline has been found to decrease the sedative effects of propofol and decrease topiramate antiseizure action.




7- Epinephrine, also known as adrenalin or adrenaline, is a hormone, neurotransmitter and medication. Epinephrine is normally produced by both the adrenal glands and certain neurons. It plays an important role in the fight-or-flight response by increasing blood flow to muscles, output of the heart, pupil dilation, and blood sugar. Epinephrine does this by its effects on alpha and beta receptors. It is found in many animals and some one cell organisms. Jokichi Takamine first isolated epinephrine in 1901.
As a medication it is used to treat a number of conditions, including anaphylaxis, cardiac arrest, and superficial bleeding. Inhaled epinephrine may be used to improve the symptoms of croup.It may also be used for asthma when other treatments are not effective. It is given intravenously, by injection into a muscle, by inhalation, or by injection just under the skin.
Side effects: include shakiness, anxiety, and sweating. A fast heart rate and high blood pressure may occur. Occasionally it may result in an abnormal heart rhythm. While the safety of its use during pregnancy and breastfeeding is unclear, the benefits to the mother must be taken into account.



8- Propranolol (Inderal) is a medication of the beta blocker type. It is used to treat high blood pressure, a number of types of irregular heart rate, thyrotoxicosis, capillary hemangiomas, performance anxiety, and essential tremors. It is used to prevent migraine headaches, and to prevent further heart problems in those with angina or previous heart attacks. It can be taken by mouth or by injection into a vein. The formulation that is taken by mouth comes in short acting and long acting versions. Propranolol appears in the blood after 30 minutes and has a maximum effect between 60 and 90 minutes when taken by mouth.
Common side effects include nausea, abdominal pain, and constipation. It should not be used in those with an already slow heart rate and most of those with heart failure. Quickly stopping the medication in those with coronary artery disease may worsen symptoms. It may worsen the symptoms of asthma. Greater care is recommended in those with liver or kidney problems. Propranolol may cause harmful effects in the baby if taken during pregnancy. Its use during breastfeeding is probably safe, but the baby should be monitored for side effects. It is a non-selective beta blocker which works by blocking ?-adrenergic receptors.