UNIT-6: MISCELLANEOUS

DRUGS USED FOR

DEADDICTION

DR.BANDARI SRUJANA ROJAPTHI

ASSOCIATE PROFESSOR
 DE-ADDICTION

De-addiction means a treatment for addiction

towards drugs, alcohol or tobacco.

It is intended to remove the physiological effects of

the addictive substances and also neutralize the
toxic properties which affect the functioning of the
human body.
 ROLE OF NURSE

The role of nurses in addiction treatment includes:

v Initial assessments: Addiction nurses assess

patients with substance use disorders.

v Proper drug managament: Monitor the patient for

proper intake of advised medication.
v Evaluation and monitoring: They evaluate and
monitor patient progress throughout the
recovery process.

v Relapse prevention and follow-up care: Nurses

provide ongoing support and guidance to help
individuals maintain sobriety (quality, not drunk).
DRUGS USED IN CPR &
EMERGENCY

DR. BANDARI SRUJANA ROJAPATHI

ASSOCIATE PROFESSOR
 DRUGS USED IN CPR
• Cardiopulmonary resuscitation is an emergency
procedure consisting of chest compressions often
combined with artificial ventilation in an effort
to manually preserve intact brain function until
further measures are taken to restore
spontaneous blood circulation and breathing
in a person who is in cardiac arrest.

• The drugs which supports CPR are follows.

 ADRENALINE

• COMPOSITION: Epinephrine.

• ACTION: Sympathomimetric,vasoconstrictor and bronchodilator.

• DOSAGE: Variable, based on indication, usually administered in micrograms.

(0.01MG/KG)

• ROUTE: Intramuscular, Intravenous, Subcutaneous.

• INDICATIONS: Anaphylaxis, Cardiac arrest, Severe asthma.

• CONTRAINDICATIONS: Hypersensitivity, certain cardiac conditions.

• DRUG INTERACCTIONS: Monoamine oxidase inhibitors (MAOIs), Beta-blockers.

• SIDE EFFECTS: Increased heart rate, hypertension anxiety.

 CHLORPHENIRAMINE
• COMPOSITION: Anti-histaimne.

• ACTION: Blocks histamine receptors, reducing allergic symptoms.

• DOSAGE: Typically 4mg every 4-6 hours.

• ROUTE: Oral, Intramuscular, Intravenous.

• INDICATIONS: Allergic rhinitis, allergic reactions.

• CONTRAINDICATIONS: Hypersensitivity, acute asthma attacks.

• DRUG INTERACCTIONS: CNS depressants, Monoamine oxidase inhibitors (MAOIs).

• SIDE EFFECTS: Drowsiness, dry mouth, blurred vision.

 HYDROCORTISONE
• COMPOSITION: Corticosteroid.

• ACTION: Anti- inflammatory, immunosuppresive.

• DOSAGE: Variable depending on condition, often administered in milligrams.

• ROUTE: Oral, topical, Intravenous.

• INDICATIONS: Inflammatory conditions, adrenal insufficiency.

• CONTRAINDICATIONS: Systemic fungal infections, live vaccines.

• DRUG INTERACCTIONS: Nonsteroidal anti-inflammatory drugs (NSAIDs),

anticoagulants.

• SIDE EFFECTS: Increased risk of infection, adrenal suppression.

 DEXAMETHASONE

• COMPOSITION: Corticosteroid

• ACTION: Anti-inflammatory, immunosuppresive

• DOSAGE: Variable depending on condition, often administered in milligrams.

(Dexamethasone: 10 mg/m)

• ROUTE: Oral, Intramuscular, Intravenous,

• INDICATIONS: Inflammatory conditions, certain cancers, cerebral edema.

• CONTRAINDICATIONS: Systemic fungal infections, live vaccines

• DRUG INTERACCTIONS: NSAIDs, anticoagulants.

• SIDE EFFECTS: Increased risk of infection, hyperglycemia.

 (Pulseless Electric Activity)

(Vagus nerve activity)

 ACTIvATED CHARCOAL
• Mechanism of action – Absorbs toxic substances from the
gastrointestinal tract.
• Indications – Most oral poisonings/ medication overdoses.
• Contraindications – Oral administration to comatose
patients.
• Adverse reactions – If aspirated, can induce fatal form of
pneumonitis – Bowel obstruction.
• Considerations – Mix contents well before administration. –
Does not absorb cyanide, lithium, iron, lead, or arsenic.
DRUGS USED IN EMERGENCY

DR. BANDARI SRUJANA ROJAPATHI

ASSOCIATE PROFESSOR
 DRUGS USED IN EMERGENCY
• A patient may unexpectedly experience a medical emergency
needs to have the equipment to deal with that emergency
efficiently.

• A crash cart contains all emergency equipment and medications

that would be required to treat a patient in the golden hours or so
of a medical emergency.
 ACTIvATED CHARCOAL
• Mechanism of action – Absorbs toxic substances from the
gastrointestinal tract.
• Indications – Most oral poisonings/ medication overdoses.
• Contraindications – Oral administration to comatose
patients.
• Adverse reactions – If aspirated, can induce fatal form of
pneumonitis – Bowel obstruction.
• Considerations – Mix contents well before administration. –
Does not absorb cyanide, lithium, iron, lead, or arsenic.
 ADENOSINE
• Mechanism of action – Slows conduction through the AV node – Can

interrupt reentrant pathways – The drug of choice for reentry SVT. (Supra

Ventricular Tachycardia).

• Dosage - Initial dose: 6 mg IV bolus over 1 to 2 seconds

• Repeat dose: If initial dose fails to eliminate supraventricular tachycardia

within 1 to 2 minutes: 12 mg IV bolus over 1 to 2 seconds; may repeat a

second time if required

• Maximum dose: 12 mg .
 ADENOSINE
• Indications – Most forms of stable narrow -
complex SVT.
• Contraindications – Bronchoconstrictive or
bronchospastic lung disease.
• Adverse reactions – Generally short duration and
mild.
• Considerations – Evaluate elderly for signs of
dehydration.
 ALbUTEROL
o Mechanism of action – Results in smooth-muscle relaxation in
the bronchial tree.
o Dosage:
2 to 12 years: Less than 15 kg: 0.1 to 0.15 mg/kg/dose (one 3 mL unit-
dose vial of 1.25 mg or 0.63 mg inhalation solution) by nebulization
13 years or older:
Inhalation solution 0.5% (5 mg/mL): 2.5 mg (0.5 mL diluted with 2.5
mL of sterile saline solution) three or four times a day by nebulization,
over approximately 5 to 15 minutes
 ALbUTEROL
o Contraindications – Hypersensitivity reactions to
albuterol, lessthan 4 year orolder
o Adverse reactions – Often dose-related and
include headache, fatigue, lightheadedness,
irritability, restlessness
o Considerations – Pregnancy safety: Category C –
May precipitate angina pectoris and dysrhythmias.
 ALTEPLASE
Mechanism of action – Restores perfusion.
Dosage: for Myocardial Infarction: 15 mg IV bolus, followed by 0.75
mg/kg (not to exceed 50 mg) infused over the next 30 minutes and then 0.5
mg/kg (not to exceed 35 mg) infused over the next 60 minutes.
For 3 hour infusion method:
Pulmonary Embolism : 50 mg/hour IV over 2 hours for a total dose of
100 mg. Heparin is usually started near the end or immediately following
this infusion when partial thromboplastin time or thrombin time falls to
twice the normal value or less.
Ischemic Stroke: 0.9 mg/kg (up to 90 mg) IV over 60 minutes with 10%
of the total dose administered as an initial IV bolus over the first minute.
 ALTEPLASE
Indications – Acute myocardial infarction, STEMI, massive
pulmonary emboli, acute ischemic cerebrovascular accident.

Contraindications – Active internal bleeding – Recent surgery.

Adverse reactions – Intracranial bleeding, reperfusion

dysrhythmias, chest pain, hypotension, GI bleeding, nausea,
abdominal pain.

Considerations – Monitor vital signs closely. – Observe for

bleeding.
 AMIODARONE
Mechanism of action – Delays repolarization and increases
the duration of action potential.
Dosage:for Arrhythmias:
IV: Initial dose: 1000 mg over the first 24 hours of therapy,
delivered by the following infusion regimen:
-Loading infusions: 150 mg over the first 10 minutes (15
mg/min), followed by 360 mg over the next 6 hours (1
mg/min)
-Maintenance infusion: 540 mg over the remaining 18 hours
(0.5 mg/min)
 AMIODARONE

Indications – Ventricular fibrillation.

Contraindications – Known hypersensitivity to amiodarone or
iodine – Cardiogenic shock.
Adverse reactions – Dizziness, fatigue, malaise – Congestive
heart failure.
Considerations – Pregnancy safety: Category D – Monitor
patient for hypotension.
 AMYL NITRITE

Mechanism of action – Converts hemoglobin Cyanide Poisoning

to methemoglobin to prevent toxic effects.
• 0.3 mL ampule crushed and contents poured
Dosage: Liquid for inhalation onto a gauze and placed in front of patient's
• 0.3 mL (0.85-103%) crushable glass ampule mouth or endotracheal tube, if patient intubated,
Acute Relief of Angina to inhale over 15-30 sec; repeat qMin until IV

• 0.3 mL by inhalation of crushed ampule, sodium nitrite available

may repeat q3-5min • Each ampul lasts ~3 min; separate

• Wave crushed ampule under nose multiple administration by at least 30 sec to allow patient
times for 2-6 nasal inhalations to adequate oxygenate
 AMYL NITRITE

Indications – Cyanide poisoning.

Contraindications – None in emergency settings.

Adverse reactions – Headache, dizziness, weakness.

Considerations – Pregnancy safety: Category X –

Highly flammable.
 ASPIRIN

Mechanism of action – Prevents platelets from clumping together and forming

emboli.
Dosage:
Osteoarthritis: Initial dose: 3 g orally per day in divided doses.
Maintenance: Adjust dose as needed for anti-inflammatory efficacy.
Rheumatoid Arthritis: Initial dose: 3 g orally per day in divided doses
Maintenance: Adjust dose as needed for anti-inflammatory efficacy
 ASPIRIN

Indications – New onset chest pain suggestive of acute myocardial infarction.

Contraindications – Relatively contraindicated in patients with active ulcer

disease or asthma.

Adverse reactions – Bronchospasm, anaphylaxis, wheezing in allergic patients,

prolonged bleeding.

Considerations – Pregnancy safety: Category D – Not recommended in

pediatric population.
 ATENOLOL
Mechanism of action – Decreases heart rate, myocardial contractility, and cardiac output.
Dosage for Hypertension
Initial dose: 50 mg orally once a day
Maintenance dose: 50 to 100 mg orally once a day
Maximum dose: 100 mg per day
Angina Pectoris Prophylaxis
Initial dose: 50 mg orally once a day.
Increase to 100 mg orally once a day after 1 week if optimal response not achieved
Maintenance dose: 50 to 200 mg orally once a day
Maximum dose: 200 mg per day
 ATENOLOL

Indications – To reduce myocardial ischemia and damage in

acute myocardial infarction patients.
Contraindications – Heart failure, cardiogenic shock,
bradycardia.
Adverse reactions – Dizziness, bronchospasm, bradycardia.
Considerations – Pregnancy safety: Category D – Atenolol
must be given slowly IV over 5 minutes – Should be used with
caution in patients with liver or renal dysfunction and COPD.
 ATROPINE SULfATE
Mechanism of action – Increases heart rate in life-
threatening bradydysrhythmias.
Dosage:
Bradyarrhythmia
• 0.4 to 1 mg, IV, every 1 to 2 hours as needed
• Larger doses, up to a maximum of 2 mg, may be required
Anesthesia
• 0.4 mg to 0.6 mg, IV, intramuscularly, or subcutaneously
Anticholinesterase Poisoning
• 0.4 mg to 0.6 mg, IV, intramuscularly, or subcutaneously
 ATROPINE SULfATE

Indications – Hemodynamically unstable

bradycardia.
Contraindications – Tachycardia, hypersensitivity.
Adverse reactions – Drowsiness, confusion,
headache, tachycardia, palpitations.
Considerations – Pregnancy safety: Category C –
Moderate doses may cause pupillary dilation.
 CALCIUM CHLORIDE
Mechanism of action – Increases cardiac contractile state.

Dosage: Hypocalcemia

Usual dose: 500 to 1000 mg by slow intravenous injection, every 1 to 3

days depending on response and/or serum calcium

Repeat injections may be needed because of rapid calcium excretion.

Hypermagnesemia

Initial dose: 500 mg by slow intravenous injection

 CALCIUM CHLORIDE

Indications – Hypocalcemia, hyperkalemia, hypermagnesemia.

Contraindications – Hypercalcemia, ventricular fibrillation, digitalis

toxicity.

Adverse reactions – Syncope, cardiac arrest, dysrhythmia, bradycardia.

Considerations – Pregnancy safety: Category C – Do not use routinely

in cardiac arrest.
 CALCIUM GLUCONATE
Mechanism of action – Counteracts the toxicity of
hyperkalemia.
Dosage for Hypocalcemia
Initial dose: 1000 to 2000 mg intravenously (IV)
Subsequent doses (as needed):
IV bolus: 1000 to 2000 mg every 6 hours
Continuous IV infusion: Initiate at 5.4 to 21.5 mg/kg/hour
Maximum IV bolus infusion rate: 200 mg/min
 CALCIUM GLUCONATE
Indications – Hyperkalemia, hypocalcemia.
Contraindications – Ventricular fibrillation,
digitalis toxicity, hypercalcemia.
Adverse reactions – Syncope, cardiac arrest,
dysrhythmia, bradycardia.
Considerations – Pregnancy safety: Category C
– Do not administer by IM or SQ.
 CLOPIDOGREL
Mechanism of action – Inhibits platelet aggregation.

Dose for Acute Coronary Syndrome:

Unstable Angina /Non-ST-Elevation Myocardial Infarction (NSTEMI):

Loading dose: 300 mg orally once
Maintenance dose: 75 mg orally once a day

ST-Elevation Myocardial Infarction (STEMI):

Loading dose: 300 mg orally once (OPTIONAL)
Maintenance dose: 75 mg orally once a day, with or without thrombolytics
 CLOPIDOGREL

Indications – Acute coronary syndrome – Substitute for aspirin

in patients unable to take aspirin.

Contraindications – Active GI bleeding, intracranial

hemorrhage.

Adverse reactions – Severe neutropenia – Hemorrhaging.

Considerations – Pregnancy safety: Category B – Often given

with other anticoagulants.
 DEXAMETHASONE SODIUM
PHOSPHATE
Mechanism of action – Suppresses acute and chronic inflammation
Dose for Acute Mountain Sickness
Prevention of AMS (Acute mountain sickness) and HACE (High altitude cerebral
edema)
Usual dose: 2 mg orally every 6 hours OR 4 mg orally every 12 hours
Very High Risk Situations: 4 mg orally every 6 hours
Duration of Therapy: Should not exceed 10 days to prevent glucocorticoid toxicity or
adrenal suppression
Treatment of AMS: 4 mg orally/IV/IM every 6 hours
Treatment of HACE: 8 mg orally/IV/IM once; followed by 4 mg orally/IV/IM
every 6 hours
 DEXAMETHASONE SODIUM
PHOSPHATE

Indications – Anaphylaxis, asthma, spinal cord injury

Contraindications – Hypersensitivity, use caution in suspected

systemic sepsis

Adverse reactions – Headache, restlessness, euphoria, psychoses

Considerations – Pregnancy safety: Category C – Protect medication

from heat. Toxicity and side effects occur with long- term use.
 DEXTROSE

Mechanism of action – Rapidly increases serum glucose levels.

Indications – Hypoglycemia, altered level of consciousness.

Contraindications – Intracranial hemorrhage.

Adverse reactions – Cerebral hemorrhage – Cerebral ischemia –

Pulmonary edema.

Considerations – Pregnancy safety: Category C.

 DIAzEPAM

Mechanism of action – Raises the seizure threshold; induces amnesia and

sedation.
Dose for Anxiety
ORAL: 2 to 10 mg orally 2 to 4 times a day
PARENTERAL:
Moderate Anxiety Disorders and Symptoms: 2 to 5 mg IM or IV,
repeated in 3 to 4 hours if necessary
Severe Anxiety Disorders and Symptoms: 5 to 10 mg IM or IV, repeated
in 3 to 4 hours if necessary
 DIAzEPAM

Indications – Acute anxiety states and agitation, acute alcohol

withdrawal

Contraindications – Hypersensitivity, narrow- angle glaucoma

Adverse reactions – Dizziness, drowsiness, confusion, headache

Considerations – Pregnancy safety: Category D – Short duration

for anticonvulsant effect – Reduce dose by 50% in elderly patients
 DIGOXIN
Mechanism of action– Increases force of myocardial contraction.
Dose for Atrial Fibrillation:
Total loading dose: Administer one-half the total loading dose initially (all
formulations), then give one-fourth the total loading dose every 6 to 8
hours for two doses (IV and tablets), or give additional fractions every 4 to
8 hours (oral solution). Maintenance dose:
IV: 8 to 12 mcg/kg IV: 2.4 to 3.6 mcg/kg once a day
Tablets: 10 to 15 mcg/kg
Tablets: 3.4 to 5.1 mcg/kg once a day
Oral solution: 10 to 15 mcg/kg
Oral solution: 3.0 to 4.5 mcg/kg once a
day
 DIGOXIN
Mechanism of action– Increases force of myocardial contraction.
Indications– Congestive heart failure, reentry SVTs, ventricular rate
control in atrial flutter and atrial fibrillation.
Contraindications– Ventricular fibrillation, ventricular tachycardia,
digitalis toxicity.
Adverse reactions– Fatigue, headache, blurred yellow or green vision,
seizures.
Considerations– Pregnancy safety: Category C – Patient receiving IV
digoxin must be on a monitor.
 DOPAMINE HYDROCHLORIDE

Mechanism of action – Increases myocardial

contractility and stroke volume.
Dose for Cardiothoracic Surgery
Initial dose: 2 to 10 mcg/kg/min IV by
continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by
continuous infusion
 DOPAMINE HYDROCHLORIDE

Indications – Cardiogenic and septic shock,

hypotension with low cardiac output states.
Contraindications – Hypovolemic shock,
pheochromocytoma, tachydysrhythmias.
Adverse reactions – Headache, anxiety,
dyspnea, dysrhythmias.
Considerations – Pregnancy safety: Category
C – Effects are dose- dependent
 EPINEPHRINE (ADRENALIN)
Mechanism of action – Blocks histamine receptors.
Dose for Asystole:
Injectable Solution of 0.1 mg/mL (1:10,000):
IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort,
0.5 mg (5 mL) should be given IV every 5 minutes
Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection
into left ventricular chamber once
Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal
tube directly into bronchial tree once
 EPINEPHRINE (ADRENALIN)
Indications – Cardiac arrest, symptomatic bradycardia.

Contraindications – Hype rte nsion, hypothe rmia ,

pulmonary edema.

Adverse reactions – Nervousness, restlessness, headache,

tremor.

Considerations – Pregnancy safety: Category C – May

cause syncope in asthmatic children.
 fUROSEMIDE (LASIX)
Mechanism of action – Causes increased urine output.
Dose for Ascites:

IV/IM: Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat

with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until
the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or
twice a day.
Oral: Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20
or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect
has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice
a day (e.g., at 8 am and 2 pm).
Maximum dose: 600 mg/day in patients with clinically severe edematous states
 fUROSEMIDE (LASIX)
Mechanism of action – Causes increased urine output.

Indications – CHF, pulmonary edema, hypertensive crisis.

Contraindications – Hypovolemia, anuria, hypotension.

Adverse reactions – Dizziness, headache, ECG changes, weakness.

Considerations – Pregnancy safety: Category C – Ototoxicity,

deafness, and projectile vomiting can occur with rapid administration
 HYDROCORTISONE SODIUM
SUCCINATE
Mechanism of action – Anti-inflammatory; immunosuppressive with
salt-retaining actions.
Dose for Adrenocortical Insufficiency
Acute Adrenal Crisis:
100 mg IV followed by IV infusion of 200 mg over 24 hours OR
50 mg IV every 6 hours; then 100 mg IV the following day
Primary Adrenal Insufficiency (PAI):
15 mg to 25 mg orally in 2 or 3 divided doses per day
Highest dose should be given in the morning, then 2 hours after
lunch (2-dose/day regimen) or at lunch and afternoon (3-dose/day
regimen)
 HYDROCORTISONE SODIUM
SUCCINATE
Indications – Shock due to acute adrenocortical
insufficiency, anaphylaxis, asthma, and COPD.
Contraindications – Systemic fungal infections, premature
infants.
Adverse reactions – Headache, vertigo, pulmonary
tuberculosis.
Considerations – Pregnancy safety: Category C – May be
used in status asthmaticus as a second-line drug.
 INSULIN
Mechanism of action – Allows glucose transport into cells of all tissues.

Dose for Diabetes Type 1

Note: Regular human insulin is available in 2 concentrations: 100 units of insulin

per mL (U-100) and 500 units of insulin per mL (U-500)

Doses should be individualized based on patient's metabolic needs, blood

glucose monitoring results, and glycemic goals

Total daily insulin requirements are generally between 0.5 to 1 unit/kg/day

 INSULIN
Insulin U-100 (Humulin R; Novolin R):
SUBCUTANEOUS Administration: Inject subcutaneously approximately 30
minutes prior to a meal.
INTRAVENOUS Administration: Administer only under medical supervision with
close monitoring of blood glucose and serum potassium.
Humulin R: Dilute to a concentration of 0.1 to 1 unit/mL in an infusion system
using polyvinyl chloride infusion bags; this insulin is stable in normal saline.
Novolin R: Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system
using polypropylene infusion bags; this insulin is stable in normal saline, 5%
dextrose, or 10% dextrose with 40 mmol/L potassium chloride.
 INSULIN

Insulin U-500 (Humulin R U-500): For subcutaneous

administration only

• Administer U-500 insulin subcutaneously 2 to 3 times a day

approximately 30 minutes prior to start of a meal

• The safety and efficacy in combination with other insulins has

not been determined.
 INSULIN
Indications – Not used in emergency prehospital setting.

Contraindications – Hypoglycemia, hypokalemia.

Adverse reactions – Weakness, fatigue, confusion,

headache.

Considerations – Pregnancy safety: Category B – Insulin is

the drug of choice for control of diabetes in pregnancy.
 MAGNESIUM SULfATE
Mechanism of action – Reduces striated muscle
contractions.
Indications – Seizures of eclampsia,
hypomagnesemia.
Contraindications – Heart block, myocardial damage.
Adverse reactions – Drowsiness, CNS depression,
respiratory depression.
 MAGNESIUM SULfATE
Dose for Hypomagnesemia

• 1 gram IM every 6 hours for 4 doses (mild

hypomagnesemia) or as much as 250 mg/kg IM
within a 4-hour period (severe hypomagnesemia)
OR
• 5 grams in 1 liter of appropriate diluent IV over 3
hours
• Do not exceed IV infusion rate of 150 mg/minute
 MANNITOL

Mechanism of action – Decreases cerebral edema and intracranial

pressure.
Indications – Cerebral edema.
Contraindications – Hypotension, pulmonary edema, severe
dehydration, intracranial bleeding, CHF.
Adverse reactions – Headache, confusion, seizures, pulmonary
edema.
 MANNITOL

Dose for Cerebral Edema

• 0.25 to 2 g/kg as a 15 to 20% solution IV over
a t l e a s t 3 0 m i n a d m i n i s t e re d n o t m o re
frequently than every 6 to 8 hrs.
• In small &/or debilitated(weak) patients 500
mg/kg may be sufficient.
 ONDANSETRON HYDROCHLORIDE

Mechanism of action – Blocks action of serotonin.

Indications – Prevention and control of nausea or

vomiting.

Contraindications – Known allergy to ondansetron.

Adverse reactions – Headache, malaise, wheezing.

 ONDANSETRON HYDROCHLORIDE

Dose for Nausea/Vomiting - Chemotherapy Induced

Oral: Highly Emetogenic Cancer Chemotherapy (HEC):

Recommended dose: 24 mg orally 30 minutes before the start of single-day
HEC (including cisplatin doses of 50 mg/m2 or greater)

Moderately Emetogenic Cancer Chemotherapy (MEC):

Recommended dose: 8 mg orally twice a day, with the first dose
administered 30 minutes before the start of chemotherapy and the
subsequent dose 8 hours later; then 8 mg orally 2 times a day for 1 to 2
days after the completion of chemotherapy
 ONDANSETRON HYDROCHLORIDE

Parenteral:
Recommended dose: 0.15 mg/kg IV, with the first dose (infused
over 15 minutes) 30 minutes before the start of emetogenic
chemotherapy and subsequent doses given 4 and 8 hours after the
first dose.
Maximum dose: 16 mg per dose
 PHENYTOIN
M e c h a n i s m o f a c t i o n – P r o m o t e s s o d i u m e ff l u x
(component) from neurons.

Indications – Prophylaxis and treatment of major motor

seizures.

Contraindications – Hypersensitivity, bradycardia.

Adverse reactions – Ataxia(lack of muscle coordination &

control), dizziness, headache, drowsiness.
 PHENYTOIN

Dose for Seizures:

Oral Loading dose: Only when indicated for IV: Do n o t exc e e d th e i nf u si o n rate o f
inpatients. 50 mg/min.
1g orally divided in 3 doses (400 mg, 300 mg, 300
Loading dose: 10 to 15 mg/kg IV slowly.
mg) given at 2 hour intervals.
Maintenance dose: 100 mg IV every 6 to 8 hours.
Then normal maintenance dosage started 24 hours
after loading dose.

Initial dose: 100 mg extended release orally 3 times

a day.

Maintenance dose: 100 mg orally 3 to 4 times a day.

DR. BANDARI SRUJANA ROJAPATHI
ASSOCIATE PROFESSOR
• ISOTONIC SOLUTIONS: A solution with the same
concentration of water and solutes as bosy fluids or a
cell’s cytoplasm. eg: Nacl or 5% Glucose.

• HYPOTONIC SOLUTIONS: A solution that has lower

concentration of solute than another solution or a
cell.

• HYPERTONIC SOLUTIONS: A solution with a higher

concentration of solutes and lower concentration of
water than body fluids.
ELECTROLYTES
 COMMON POISONS
DRUGS USED FOR TREATMENT OF
POISONING
DR.Bandari Srujana Rojapathi
Associate professor
• IPECAC
• ANTIDOTES
• SNAKE VENOM (VARIOUS TYPES)
• ACTIVATED CHARCOAL
 IPECAC

• Ipecac is a plant -derived substance used to

induce vomiting in cases of poisoning.

• Its active components, like emetine, stimulate

the vomiting center in the brain.

• The antidote for ipecac - induced poisoning is

typically activated charcoal, which helps absorb
the toxic substance and prevent its absorption
in the digestive system.
 ANTIDOTES

• Antidotes are substances that can

counteract the effects of a poison or
toxic substance.

• Here are some common antidotes and

their general actions:
1.Activated charcoal: Absorbs and binds to a variety of toxins
in the gastrointestinal tract, preventing their absorption into the
bloodstream.

2.Naloxone: Reverses the effects of opiod overdose by binding

to opioid receptors in the brain, blocking the effects of opioids.

3.Flumazenil: Reverses the effects of benzodiazepine overdose

by competitively binding to the benzodiazepine receptors in the
brain.
4. Atropine: Counteracts the toxic effects of organophosphate
poisoning by blocking the action of acetayl choline, a
neurotransmitter.

5. Vitamin-K: Reversed the effects of anticoagulant medications

like warfarin by promoting the systhesis of blood clotting factors.

6.N-acetylcystene(NAC): Counteracts the toxic effects of

acetaminophen (paracetamol) overdose by replenishing
glutathione, a substance that helps neutralisze toxic metabolites.
 SNAKE VENOM (VARIOUS TYPES)
• Snake venom poisoning occurs when venom from a snake
bite enters the bloodstream.

• Different snake venoms have varied effects, including

interference with blood clotting, tissue damage and
neurotoxic effects.

• There are various snake venoms with district compositions.

• For ex: Cobra venom contains neurotoxins, while viper

venom may have hemotoxins.
• Each species has its own venom with specific
effects on the human body.

• Action: Disrupts blood clotting, damages

tissues and affects the nervous system.

• Antidote: Antivenom specific to the snake

species.
 ACTIVATED CHARCOAL

• Activated charcoal is a form

of carbon that has been
treated to make it porous and
increase its surface area.

• it is used in medicine to
absorb toxins or chemicals in
the degestive tract.
• activated charcoal works by binding to the substances in the
gastrointestinal tract, preventing their absorption into the
blood stream.

• As an antidote, activated charcoal is often administered in

cases of poisoning to limit the absorption of toxic substances.
 USES/ INDICATIONS

• Many drugs and medications: Activated charcoal

can be useful in cases of drug overdose or
accidental ingestion.

• Certain chemicals and toxins: It may be used in

ca s e s o f p o i s o n i i i n g f ro m c h e m i c a l s l i ke
pesticides or household cleaners.

• Some plant and mushroom toxins: Activated

charcoal can help limit the absorption of certain
toxins found in plants and mushrooms.