Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Emergency Drugs |Emergency Drug Antidotes |Emergency Cardiac Drugs |Emergency Endocrine Drugs |Emergency Gastrointestinal Drugs |Emergency Haematology Drugs |Emergency Neuropsychiatric drugs |Emergency Pain drugs |Emergency Respiratory drugs |Emergency Obstetric and Gynaecology Drugs |Emergency Paediatric Drugs
DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION / CAUTION |
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Acetylcysteine (NAC) | Replenishes glutathione stores, acts as a glutathione substitute, and enhances sulphate conjugation of paracetamol |
Loading: 150 mg/kg in 200 mL 5% Glucose over 1 hr
Then 50 mg/kg in 500 mL 5% Glucose over 4 hrs Then 100 mg/kg in 1 L 5% Glucose over 16 hrs (total 21 hrs) May need continuous LFT and paracetamol levels |
140 mg/kg once, then 70 mg/kg every 4h for 17 doses (72 hrs total) | Paracetamol (Acetaminophen) overdose | Rare hypersensitivity reactions (slow infusion or switch to oral), check BNF for pregnancy advice (generally Category B in US) |
Atropine | Anticholinergic, reduces parasympathetic influence on the heart and secretions |
Organophosphate/carbamate poisoning: 1–6 mg IV every 3–5 min until secretions stop (can double doses as needed)
Paediatric bradycardia: 0.02 mg/kg IV once (max single 0.5 mg, max total 1 mg) Adult bradycardia: 0.5 mg IV every 3–5 min (max 3 mg) |
N/A | Organophosphate poisoning, symptomatic bradycardia | Use caution in hyperthermia, tachyarrhythmias; check BNF for pregnancy |
Fomepizole | Inhibits alcohol dehydrogenase, preventing toxic metabolite formation | 15 mg/kg IV loading dose, then 10 mg/kg every 12 h for 4 doses, then 15 mg/kg every 12 h until ethylene glycol <20 mg/dL and patient is stable with normal pH | N/A | Methanol or ethylene glycol poisoning | Generally well tolerated; check BNF for pregnancy advice (US Category C) |
Glucagon | Increases cAMP, stimulating glycogenolysis and gluconeogenesis independently of beta receptors |
Beta-blocker/CCB overdose: 3–10 mg IV bolus, then 1–10 mg/h infusion if effective
Hypoglycaemia: 1 mg IV/IM/SC |
N/A | Beta-blocker/CCB overdose, severe hypoglycaemia | Possible anaphylactoid reaction, hypotension, vomiting; check BNF for pregnancy advice (US Category B) |
Insulin (Regular) | Facilitates glucose uptake, shifts K+ intracellularly, can improve contractility in CCB overdose |
Hyperkalaemia: 5–10 units IV once (with glucose if needed)
CCB overdose: 1 unit/kg IV bolus + 25 g glucose if BG < 13.9 mmol/L (250 mg/dL), then 0.1–1 unit/kg/h infusion with glucose to maintain BG 5.5–11 mmol/L DKA/HHS: 0.1 unit/kg IV bolus, then 0.1 unit/kg/h infusion per protocol |
N/A | Hyperkalaemia, CCB overdose, DKA/HHS | Risk of hypokalaemia, hypoglycaemia; only use IV soluble (regular) insulin; consult BNF for pregnancy |
Protamine sulfate | Ionically binds heparin, neutralising its anticoagulant effect | 1 mg neutralises ~100 units of heparin (max 50 mg), give IV at ≤5 mg/min | N/A | Reversal of heparin-induced anticoagulation | Risk of anaphylaxis (especially with fish allergy), hypotension if given rapidly; check BNF for pregnancy advice |
Sodium bicarbonate | Increases bicarbonate, aiding in acid-base buffering | (1 mEq of bicarbonate = 1 mmol of bicarbonate)
Hyperkalaemia/met acidosis: 50 mEq (1 amp) IV once
TCA toxicity: 1–2 mEq/kg (mmol/L) IV bolus to achieve target pH 7.45–7.55 & narrow QRS Salicylate toxicity: 3 amps (150 mEq) in 1 L 5% glucose, bolus 10–20 ml/kg, then 2–3 ml/kg/h to keep urine pH 7.5–8.0 |
N/A | Hyperkalaemia, TCA toxicity, salicylate toxicity, metabolic acidosis | Caution in heart failure (fluid load, sodium load), risk of metabolic alkalosis, hypernatraemia; check BNF for pregnancy advice |