List of Emergency Drugs & Their Doses

When seconds count, understanding the right tools can mean the difference between life and death. This concise guide explores the essential drugs used in emergencies, outlining their applications and the critical situations they address. From calming a heart in distress to clearing blocked airways, we’ll explore how these medications work their magic on a cellular level to restore vital functions. Remember, this is for educational purposes only. In a real emergency, always call emergency services or seek immediate medical attention. Let’s take a look at these powerful medications and explore how they combat various medical crises, from calming a racing heart to clearing a struggling airway. 

Hypertensive Emergencies

Hypertensive emergencies involve a rapid and severe increase in blood pressure that can damage organs. Medications are used to bring blood pressure down quickly and prevent complications.

Drug Class: Antihypertensive (various classes). 

• Sodium Nitroprusside (IV):
  • Dose: 20-300 mcg/min
  • Description: Preferred for predictable, immediate, and titratable (adjustable) relaxation of both arteries and veins, improving blood flow. Due to potential toxicity at higher doses, close monitoring is essential.
• Labetalol (for pregnancy-induced hypertension): This medication helps lower blood pressure in pregnant women.
• Esmolol (alternative to Labetalol injection): In situations where Labetalol injection is unavailable, Esmolol can be used for a similar effect.
• Nifedipine (sublingual capsule): If injectable medications are not available, nifedipine capsules placed under the tongue can be used for a rapid reduction in blood pressure.
• Phentolamine or Labetalol (for pheochromocytoma, cheese reaction, or clonidine withdrawal): These medications can help manage hypertensive episodes caused by these specific conditions.

Indications

• Systolic blood pressure higher than 220 mmHg or diastolic blood pressure higher than 120 mmHg with evidence of organ damage.

Mechanism of Action

Different medications work in various ways to relax blood vessels and lower blood pressure.

General Considerations

These medications should only be administered under the supervision of a medical professional in a healthcare setting due to the potential for rapid and significant blood pressure reductions.

Cardiovascular Emergencies

A variety of emergencies can affect the heart and blood vessels. Medications are used to address symptoms, improve blood flow, and prevent further complications.

Coronary Pain Syndromes

• Stable Angina: Chest pain caused by narrowed coronary arteries that restrict blood flow to the heart.
• Unstable Angina: Worsening or new chest pain that may indicate an increased risk of heart attack.
• Drug Class:
  • Nitrates (e.g., nitroglycerin)
  • Antiplatelet medications (e.g., aspirin)
• Indications:
  • Stable angina: Relief of chest pain.
  • Unstable angina: Relief of chest pain and possibly reducing the risk of heart attack.
• Mechanism of Action:
  • Nitrates: Relax blood vessels to improve blood flow to the heart, reducing chest pain.
  • Antiplatelet medications: Inhibit blood clot formation, which can help prevent heart attacks.
• General Considerations: Nitroglycerin is typically administered sublingually (under the tongue) for rapid relief of angina symptoms. Aspirin is usually taken orally as a preventive measure. Both medications can cause side effects such as headache and dizziness.

Related: Top 101 Common Medicines 

Myocardial Infarction (Heart Attack)

A complete blockage of a coronary artery causes heart muscle death.

• Drug Class:
  • Nitrates
  • Antiplatelet medications
  • Thrombolytics (clot busters)
• Indications: Treatment of a heart attack to improve blood flow, minimize heart muscle damage, and improve survival rates.
• Mechanism of Action:
  • It is the same as for angina (nitrates and antiplatelet medications).
  • Thrombolytics: Dissolve blood clots to reopen blocked arteries and restore blood flow to the heart muscle.
• General Considerations: Timely administration of medications is crucial to minimize heart damage. Nitrates and antiplatelet medications are typically given immediately. Thrombolytics have a narrow window of effectiveness and may not be suitable for everyone due to bleeding risks.

Cardiogenic Shock

A condition where the heart weakens and cannot pump blood effectively enough to meet the body’s needs.

• Drug Class:
  • Inotropes (e.g., dobutamine)
  • Vasodilators (e.g., nitroglycerin)
  • Diuretics (e.g., furosemide)
• Indications: Improve heart function and blood flow, reduce the workload on the heart, and eliminate excess fluid.
• Mechanism of Action:
  • Inotropes: Increase the force of heart contractions, improving blood circulation.
  • Vasodilators: Relax blood vessels, reducing blood pressure and workload on the heart.
  • Diuretics: Increase urine output to remove excess fluid and improve blood flow.
• General Considerations: These medications require close monitoring in a critical care setting due to their potent effects on blood pressure and heart function.

Cardiac Arrhythmias

Abnormal heart rhythms can affect heart rate and blood flow.

• Drug Class: Antiarrhythmics (various classes)
• Indications: Vary depending on the specific arrhythmia and its severity.
• Mechanism of Action: Different medications work in various ways to regulate heart rate and electrical impulses within the heart.
• General Considerations: Antiarrhythmics can have complex effects on the heart and require careful monitoring and adjustment by a medical professional.

Cardiac Arrest

The heart stops beating completely, resulting in loss of consciousness and breathing.

• Treatment: Immediate cardiopulmonary resuscitation (CPR) and defibrillation with an automated external defibrillator (AED) are essential to restart the heart. Medications may also be used in advanced cardiac life support measures.

Respiratory Emergencies

Conditions that impair breathing and oxygen delivery to the body. Medications can help open airways, reduce inflammation, and improve breathing.

Asthma

A chronic inflammatory airway disease that causes recurrent episodes of wheezing, shortness of breath, chest tightness, and cough.

• Drug Class:
  • Bronchodilators (e.g., albuterol)
  • Corticosteroids (e.g., prednisone)
• Indications:
  • Bronchodilators: Relieve bronchospasm (airway narrowing) during an asthma attack, improving airflow.
  • Corticosteroids: Reduce inflammation in the airways for long-term asthma management.
• Mechanism of Action:
  • Bronchodilators: Relax muscles around the airways, allowing them to open wider and improve airflow.
  • Corticosteroids: Suppress inflammation in the airways, reducing airway narrowing and irritation.
• General Considerations: Bronchodilators are typically inhaled for rapid relief of asthma symptoms. Corticosteroids may be administered orally or inhaled for long-term control. Both medications can cause side effects.

Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)

A progressive lung disease that causes airflow obstruction.

• Drug Class:
  • Bronchodilators (similar to those used for asthma)
  • Corticosteroids (may be used in severe cases)
• Indications: Similar to asthma, medications may be needed on a more frequent basis due to the progressive nature of COPD.
• Mechanism of Action: Same as for asthma medications.
• General Considerations: Management focuses on relieving symptoms and slowing disease progression.

Epiglottitis

A sudden inflammation of the epiglottis (upper part of the larynx) that can block the airway.

• Treatment: Immediate medical attention is crucial to secure the airway and prevent suffocation. Medications may be used to reduce inflammation.

Pulmonary Edema

A buildup of fluid in the lungs that makes breathing difficult.

• Drug Class:
  • Diuretics (e.g., furosemide)
  • Oxygen therapy
• Indications: Diuretics help eliminate excess fluid from the lungs, while oxygen therapy improves oxygen delivery to the body.
• Mechanism of Action:
  • Diuretics: Increase urine output to remove excess fluid from the body, including the lungs.
  • Oxygen therapy: Delivers supplemental oxygen to the bloodstream

Neurologic Emergencies

Conditions affecting the brain and nervous system. Medications can help control seizures, reduce muscle stiffness and combat infections.

• Seizures

Uncontrolled electrical activity in the brain causes abnormal movements, altered consciousness, or sensory experiences.

• Drug Class: Anticonvulsants (various classes)
• Indications: To stop or prevent seizures.
• Mechanism of Action: Various mechanisms generally work to stabilize electrical activity in the brain.
• General Considerations: The specific anticonvulsant chosen depends on the type of seizure and individual factors. These medications can cause drowsiness and other side effects.

Tetanus

A severe infection that causes muscle stiffness and painful spasms.

• Drug Class:
  • Muscle relaxants (e.g., baclofen)
  • Tetanus immune globulin (antitoxin)
• Indications:
  • Muscle relaxants: Manage muscle spasms and improve comfort.
  • Tetanus immune globulin: Neutralize tetanus toxin produced by the bacteria.
• Mechanism of Action:
  • Muscle relaxants: Decrease nerve impulses to muscles, reducing spasticity.
  • Tetanus immune globulin: Binds to tetanus toxin, preventing it from affecting the nervous system.

Meningitis

Inflammation of the meninges (membranes surrounding the brain and spinal cord) is often caused by infection.

• Drug Class: Antibiotics (for bacterial meningitis)
  • Corticosteroids (to reduce inflammation)
• Indications:
  • Antibiotics: Eliminate bacterial infection.
  • Corticosteroids: Reduce inflammation around the brain and spinal cord, potentially improving outcomes.
• Mechanism of Action:
  • Antibiotics: Target and kill specific bacteria causing the infection.
  • Corticosteroids: Suppress the inflammatory response of the immune system.

Endocrine Emergencies

Conditions involving hormonal imbalances. Medications can help regulate hormone levels and restore normal functioning.

• Hypoglycemia

A sudden drop in blood sugar levels that can cause confusion, dizziness, and seizures.

• Drug Class: Glucose (sugar)
• Indications: Raise blood sugar levels quickly.
• Mechanism of Action:  Provides a direct source of sugar for the body to use as energy.
• General Considerations:  Oral glucose is preferred if the person is conscious and able to swallow. Glucagon injection may be necessary in severe cases or if the person is unconscious.

Diabetic Ketoacidosis (DKA)

A severe lack of insulin causes a life-threatening complication of diabetes.

• Drug Class:
  • Intravenous fluids
  • Insulin
• Indications:
  • Fluids: Restore hydration and electrolyte balance.
  • Insulin: Promote glucose uptake into cells and lower blood sugar levels.
• Mechanism of Action:
  • Fluids: Replenish lost fluids and electrolytes.
  • Insulin: Unlocks cells for glucose entry, lowering blood sugar levels.

This is just a selection of emergency drugs and their uses. Remember, this information is for educational purposes only and should not be used for self-treatment.

Treatment of Specific Poisons

In cases of poisoning, prompt identification of the poisonous substance is crucial for determining the most effective treatment. Here are general approaches for some common poisonings:

• Opioids: (e.g., heroin, oxycodone)
  • Antidote: Naloxone reverses the effects of opioids on breathing.
• Paracetamol (Acetaminophen):
  • Antidote: N-acetylcysteine (NAC) helps prevent liver damage from high paracetamol doses.
• Organophosphates (Insecticides):
  • Antidote: Atropine counteracts the nervous system effects of organophosphates.
• Oral Anticoagulants (Warfarin, Rat Poison):
  • Treatment: Vitamin K helps restore blood clotting function inhibited by these medications.

Important Note: This list is not exhaustive, and there are specific antidotes for many other poisons. If you suspect someone has been poisoned, call emergency services immediately.

General Drug Classes Used in Emergencies

Several drug classes play a vital role in emergency medicine:

• Anticonvulsants: As mentioned earlier, these medications control seizures by stabilizing electrical activity in the brain.
• Anticholinergics: These medications can counteract the effects of cholinergic drugs (used in anesthesia) or certain types of poisoning.
• Antianginals: These medications help relieve chest pain associated with angina pectoris by improving blood flow to the heart. (Examples: nitrates, calcium channel blockers)
• Antiarrhythmics: A diverse group of medications used to regulate abnormal heart rhythms. The specific type chosen depends on the type of arrhythmia.
• Bronchodilators: Relax muscles surrounding the airways, improving airflow in asthma, COPD, and other conditions with airway narrowing.
• Corticosteroids: Powerful anti-inflammatory medications used to reduce inflammation in various conditions, including asthma, COPD, and allergic reactions.
• Diuretics: Promote increased urine output to eliminate excess fluid from the body, used in heart failure, pulmonary edema, and high blood pressure.
• Inotropes: Drugs that strengthen the force of heart contractions, improving blood circulation in conditions like cardiogenic shock.
• Vasodilators: Relax blood vessels, lower blood pressure, and reduce the workload on the heart.
• Oxygen Therapy: Delivers supplemental oxygen to the bloodstream, improving oxygen delivery to tissues in various conditions like respiratory failure and heart attack.

Remember, this information is for educational purposes only. In an emergency, never hesitate to call emergency services or proceed to the nearest emergency department.

Bottom Line

Emergency drugs are critical in restoring vital bodily functions. While this guide provides an overview of their uses, the dosages mentioned are for informational purposes only and should never be used for self-treatment. In an emergency, always call emergency services or seek immediate medical attention.

Reference

• National Institutes of Health (NIH) – Emergency Cardiovascular Care for Adults: https://international.heart.org/our-courses/2020-handbook-of-emergency-cardiovascular-care-for-healthcare-providers/
• National Institutes of Health (NIH) – The National Asthma Education and Prevention Program (NAEPP): https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates
• National Institutes of Health (NIH) – PubMed Central – Anticonvulsant Medications for the Treatment of Seizures: https://www.ncbi.nlm.nih.gov/books/NBK482269/