Emergency Pharmacology: Key Definitions and Drug Uses in Critical Care

Generic name

The official, non-proprietary name of a drug based on its chemical or active ingredient.

Trade drug name (brand name)

The proprietary name given to a drug by the manufacturer; the same generic drug can have multiple trade names.

Indication

Reason why a medication should be given to a patient.

Contraindication

Reason that a medication should not be given to a patient because of the potential for harmful effects.

Drug action (mechanism of action)

The biochemical or physiological process by which a drug produces its effect in the body, typically describing how it interacts with receptors, enzymes, or cellular targets.

Interaction

A situation in which one drug's effects are altered by another drug, food, supplement, or substances; interactions can increase or decrease a drug's efficacy or toxicity.

Adverse effect

An unintended, harmful, or undesirable response to a drug taken at a normal therapeutic dose; differs from side effects in that they are specifically harmful.

Side effect

A secondary, usually unintended effect of a drug that occurs at normal therapeutic doses; side effects are not necessarily harmful and may simply be unwanted or inconvenient.

Dose

The specific amount of a drug administered at one time or over a defined period to achieve the therapeutic effects.

Route of administration

The path by which a drug is delivered into or onto the body; the route affects absorption, onset of action, and bioavailability.

Oral (PO)

Swallowed (tablets, capsules, liquids).

Intravenous (IV)

Injected directly into a vein.

Intramuscular (IM)

Injected into muscle.

Subcutaneous (SC)

Injected under the skin.

Topical

Applied to the skin or mucous membrane.

Inhalation

Breathed into the lungs.

Intranasal (IN)

Sprayed into the nasal cavity, absorbed through the mucous membrane.

Sublingual (SL)

Dissolved under the tongue.

Rectal (PR)

Administered via the rectum.

Oxygen

Indications include hypoxia or suspected hypoxia (SPO2 < 94%), respiratory distress, cardiac chest pain or suspected AMI, shock or major trauma, carbon monoxide poisoning, altered mental status of unknown cause, cardiopulmonary arrest, anaphylaxis, seizures.

Oxygen contraindications

No absolute contraindications in the emergency setting; use with caution in COPD patients.

Oxygen dose & route

Inhalation via nasal cannula, non-rebreather mask (NRB), or BVM depending on clinical need and patient tolerance.

Oxygen drug actions

Increases the partial pressure of oxygen in the alveoli, driving more oxygen across the capillary membrane and into the blood.

Oxygen adverse effects

Hypoxic drive suppression in COPD patients, oxygen toxicity, fire hazard.

Activated charcoal

Indications include poisoning by mouth (ingestion).

Activated charcoal contraindications

Altered mental status or inability to protect airway, ingestion of acids or alkalis, no gag reflex.

Activated charcoal dose & route

PO, mixed in water as a slurry, for adults and children, 1g/kg body weight.

Activated charcoal drug actions

Binds to certain poisons and prevents them from being absorbed into the body.

Activated charcoal adverse effects

Aspiration into the lungs if the patient vomits, bowel obstruction.

Oral glucose

Indications include altered mental status with a known history of diabetes.

Oral glucose contraindications

Unconscious or unresponsive patient, inability to swallow or protect airway.

Oral glucose dose & route

PO, administered inside the cheek as a gel or tablet chewed and swallowed.

Naloxone

Indications include suspected opioid overdose with respiratory depression or unresponsiveness.

Naloxone contraindications

Known hypersensitivity to naloxone.

Naloxone drug actions

Opioid antagonist that rapidly reverses respiratory depression, sedation, and analgesia caused by opioids.

Albuterol

Indications include acute bronchospasm due to asthma and COPD exacerbation.

Inhaled medication route

Inhaled via nebulizer or prescribed metered-dose inhaler (MDI)

Dosage for nebulizer

2.5mg in 3 mL with normal saline via nebulizer

Dosage for MDI

2 puffs via MDI

Beta-2 adrenergic agonist

Stimulates beta-2 receptors in the bronchial smooth muscle causing bronchodilation

Mild histamine release

A potential action of beta-2 adrenergic agonists

Drug interactions

Beta blockers, MAO inhibitors, tricyclic antidepressants, diuretics

Adverse effects of beta-2 agonists

Significant tachycardia, cardiac arrhythmia, paradoxical bronchospasm

Common side effects of beta-2 agonists

Tachycardia, tremors, nervousness or anxiety, headache, palpitations, hypokalemia with repeated doses

Generic names for epinephrine

EpiPen, EpiPen Jr, Adrenalin, Auvi-Q

Indications for epinephrine

Anaphylaxis, severe asthma unresponsive to albuterol

Adult dosage for epinephrine

0.3 mg of 1:1,000 concentration IM

Pediatric dosage for epinephrine

0.15 mg of 1:1,000 concentration IM

Actions of epinephrine

Stimulates both alpha and beta adrenergic receptors causing vasoconstriction, increased heart rate and contractility, and bronchodilation

Adverse effects of epinephrine

Hypertensive crisis, cardiac arrhythmias, myocardial ischemia, pulmonary edema, tissue necrosis if injected into a finger or hand

Common side effects of epinephrine

Tachycardia, anxiety and restlessness, pallor, tremor, headache, hypertension

Generic names for nitroglycerin

Nitrostat, Nitrolingual, NitroBid

Indications for nitroglycerin

Chest pain associated with suspected angina or acute coronary syndrome, acute pulmonary edema

Contraindications for nitroglycerin

Systolic blood pressure <100 mmHg, recent use of phosphodiesterase inhibitors, right-sided MI, head trauma, pediatric patients

Dosage for nitroglycerin

0.4 mg SL, may repeat every 3-5 min up to 3 doses if BP remains adequate

Actions of nitroglycerin

Relaxes vascular smooth muscle causing vasodilation thereby reducing preload/cardiac workload

Adverse effects of nitroglycerin

Hypotension, syncope, reflex tachycardia

Common side effects of nitroglycerin

Headache, burning sensation under tongue, flushing, dizziness

Generic names for glucagon

GlucaGen, Gvoke, Glucagon Emergency Kit

Indications for glucagon

Severe hypoglycemia in an unconscious or uncooperative patient

Contraindications for glucagon

Known hypersensitivity, adrenal gland tumor, recent insulin use, liver disease

Dosage for glucagon

1 mg IM (requires mixing)

Actions of glucagon

Stimulates the liver to convert stored glycogen into glucose

Adverse effects of glucagon

Vomiting with aspiration risk, hypokalemia, hypotension

Common side effects of glucagon

Nausea and vomiting, tachycardia, headache

Generic names for aspirin

Bayer Aspirin, Ecotrin, Bufferin

Indications for aspirin

Suspected acute myocardial infarction, unstable angina

Contraindications for aspirin

Known allergy to aspirin or NSAIDs, active GI bleeding, recent significant GI bleed

Dosage for aspirin

325 mg PO, chewed

Actions of aspirin

Inhibits platelet aggregation and clotting

Adverse effects of aspirin

Bronchospasm in aspirin-sensitive patients, GI bleeding, allergic reaction

Common side effects of aspirin

Nausea or upset stomach, mild GI irritation