H. APPLICATIONS. Medicines
Acetazolamide
Class – carbonic anhydrase inhibitors.
Pharmacological action – inhibits the release of hydrogen ions in the renal tubules, increases the release of sodium, potassium, bicarbonate and water.
Indications – acute mountain sickness.
Contraindications – presence of hypokalemia/hyponatremia, hypersensitivity to acetazolamide or sulfate, liver or kidney disease, cirrhosis, long-term use in patients with chronic, non-congestive acute-angle glaucoma.
Paracetamol
Class – analgesic, antipyretic, other.
Pharmacological effect – has a peripheral effect in the form of blocking the generation of pain impulses; can also suppress the synthesis of prostaglandins in the CNS.
Indications – analgesia, fever control.
Contraindications – hypersensitivity, liver disease.
Acetic acid (vinegar)
Class is different.
Pharmacological action – deactivates the nematocysts of jellyfish, which are not common in the USA, and accordingly provides pain relief.
Indications – analgesia for jellyfish stings (outside the US).
Contraindications – may increase the activity of nematocysts of jellyfish, which are widespread near the shores of the USA, so it cannot be used when stung by such jellyfish.
Acetylcysteine
Class – Antidote, as well as other (mucolytic).
Pharmacological effect – acts as a donor of a sulfhydryl group to restore hepatic glutathione; may also scavenge free radicals and prevent delayed hepatotoxicity as an antioxidant; accelerates the metabolism of paracetamol by sulfation channels.
Indications – antidote for paracetamol overdose.
Contraindications – bronchial asthma (without sputum).
CAUTION: nausea and vomiting are typical adverse effects after oral administration of the drug.
Activated charcoal
Class – The antidote is different.
Pharmacological action – absorbs various narcotic drugs and chemicals (due to physical binding of the molecule to the surface of coal particles); purification of the attached compounds can take place only under the conditions of an excessive advantage of the concentration of coal over the toxin.
Indications – overdose and poisoning.
Contraindications – unprotected airways (possible aspiration), use of caustic substances, intestinal obstruction.
Adenosine
Class – Antiarrhythmic.
Pharmacological effect – slows the conduction of the atrioventricular bundle and limits the conduction channels of the bundle, which leads to the restoration of sinus rhythm.
Indications – stable tachycardia with narrow complexes – stable supraventricular tachycardia (SVT) or regular, monomorphic tachycardia with wide complexes in the aspect of SVT with aberrations.
Contraindications – hypersensitivity, atrioventricular blockade of the 2nd or 3rd degree (except in cases of presence of a pacemaker), sinus node weakness syndrome, atrial fibrillation or flutter, ventricular tachycardia.
Salbutamol
Class – Beta-2 antagonist.
Pharmacological action – beta-2 receptor antagonist with certain beta-1 activity; relaxes smooth bronchial muscles with minimal impact on heart rate.
Indications – bronchospasm.
Contraindications – hypersensitivity, tachycardia, as a manifestation of cardiac pathology.
Amiodarone
Class is a class 3 antiarrhythmic drug.
Pharmacological action – class 3 antiarrhythmic agent that suppresses adrenergic stimulation; affects sodium, potassium and calcium channels; significantly prolongs the action potential and repolarization; reduces atrioventricular conduction and sinus node function.
Indications – control of regular wide-complex tachycardia in stable patients, irregular wide-complex tachycardia in stable patients, and as an antiarrhythmic agent to control ventricular fibrillation and pulseless ventricular tachycardia during CPR.< /p>
Contraindications – hypersensitivity, acute dysfsinus node dysfunction, 2nd or 3rd degree blockade or bradycardia that caused syncope (except in cases of functioning artificial cardiostimulator), cardiogenic shock.
CAUTION: Avoid use if breastfeeding.
Amyl nitrite
Class is an antidote to cyanide.
Pharmacological action – reacts with hemoglobin and forms methemoglobin, which is an oxidized form of hemoglobin that cannot carry oxygen but has a high ability to add cyanide. Therefore, cyanide attaches to methemoglobin, and not to cytochrome a3, forming non-toxic cyanidehemoglobin.
Indications – acute cyanide poisoning.
Contraindications – absent in case of suspected pure cyanide poisoning, documented hypersensitivity, suspected or confirmed smoke inhalation and/or carbon monoxide poisoning.
CAUTION: there is a risk of worsening hypoxia due to the formation of methemoglobin.
Acetylsalicylic acid
Class – antiplatelet agent, nonsteroidal anti-inflammatory drug.
Pharmacological action – stimulates prostaglandin synthesis by cyclooxygenase; accelerates the formation of blood clots; has antipyretic and analgesic activity.
Indications – acute coronary syndrome.
Contraindications – hypersensitivity to acetylsalicylic acid or NSAIDs (related reactions include acetylsalicylic acid-induced rash or asthma), gastrointestinal bleeding, hemolytic anemia due to pyruvate kinase deficiency, and glucose-6- phosphate dehydrogenase (H6FD); hemophilia, hemorrhagic diathesis, hemorrhoids, breastfeeding, nasal polyps associated with asthma, sarcoidosis, thrombocytopenia, ulcerative colitis.
Atropine
Class is an anticholinergic drug, an antidote to toxins.
Pharmacological action – suppresses the action of acetylcholinesterase on autonomous effectors excited by postganglionic nerves.
Indications – control of nerve agents, symptomatic bradycardia (primary or secondary to toxin consumption), poisoning by organophosphate and carbamate insecticides.
CAUTION – not effective in hypothermic bradycardia.
Contraindications – no absolute indications for extended life support, documented hypersensitivity in situations of non-cardiac arrest/injury with nerve agents/poisoning with organophosphorus substances.
Relative contraindications: acute glaucoma, intestinal obstruction, acute ulcerative colitis, toxic megacolon, prostate adenoma, myasthenia, bleeding with cardiovascular instability, thyrotoxicosis.
Calcium chloride
Class – antidote, other; calcium salts.
Pharmacological action – part of bone minerals; one of the enzyme reaction factors; indispensable in neurotransmission, muscle tension, and in many signal transduction pathways.
Indications – with topical burns (hydrofluoric acid) or overdose with calcium channel blockers.
Contraindications – hyperkalemia, hypersensitivity, sudden stoppage of blood circulation due to hypokalemia.
CAUTION: there is a risk of digitalis poisoning. Be careful when using peripheral access due to the risk of necrosis at the injection site.
Calcium gluconate
Class – antidote, other; calcium salts.
Pharmacological action – part of bone minerals; one of the enzyme reaction factors; indispensable in neurotransmission, muscle tension, and in many signal transduction pathways.
Indications – with topical burns (hydrofluoric acid) or overdose with calcium channel blockers.
Contraindications – hyperkalemia, hypersensitivity, sudden stoppage of blood circulation due to hypokalemia.
CAUTION: there is a risk of digitalis poisoning. Be careful when using peripheral access due to the risk of necrosis at the injection site.
Cimetidine
Class is an antagonist of H2-histamine receptors.
Pharmacological action – blocks H-2 receptors of gastric parietal cells, leading to restriction of gastric secretion.
Indications – control of gastric or duodenal ulcers, gastroesophageal reflux, as an adjuvant drug in the treatment of urticaria and/or itching in allergic reactions.
Contraindications – hypersensitivity to H-2 receptor antagonists or cymetidine.
Dexamethasone
Class is a corticosteroid, anti-inflammatory drug.
Pharmacological action – a powerful glucocorticoid with minimal mineralocorticoid activity. Reduces inflammation by inhibiting the migration of polymorphonuclear leukocytes (PMNL) and reduces capillary permeability; stabilizes cell membranes and lysosomal membranes; enhances surfactant synthesis; increases serum concentration of vitamin A, suppresses prostaglandins and pro-inflammatory cytokinesis; suppresses the proliferation of lymphocytes using direct cytolysis; muffles mitosis, breaks granulocyte aggregates, improves pulmonary microcirculation.
Indications – control of croup and bronchospasm, control of high-altitude cerebral edema.
Contraindications – hypersensitivity, systemic fungal infection, cerebral malaria.
Glucose
Class – glucose production agent; metabolic and endocrine; another.
Pharmacological action – parenteral dextrose is oxidized to carbon dioxide and water and provides 3.4 kilocalories/gram of glucose.
Indication – control of hypoglycemia.
Contraindications – hyperglycemia, anuria, diabetic coma, intracranial or intraspinal bleeding, dehydration combined with delirium, glucose-galactose malabsorption syndrome, hypersensitivity.
Diazepam
Class – benzodiazepine, anticonvulsant, muscle relaxant, anxiolytic.
Pharmacological action – modulates the postsynaptic effect of GABA-A transmission, enhancing presynaptic inhibition. Acts as part of the limbic system, as well as the thalamus and hypothalamus, to produce the intoxicating effect.
Indications – excited or aggressive state, seizure control.
Contraindications – hypersensitivity, respiratory depression.
Diltiazem
Class – calcium channel blocker, class 4 antiarrhythmic.
Pharmacological action – increases the flow of extra cellular calcium to the membranes of myocardial cells and vascular smooth muscle cells, causing increased contractions of the smooth muscles of the heart and vessels, which in turn leads to the expansion of the main coronary and systemic arteries; does not affect serum calcium, has a strong accelerating effect on the cardiac electroconductive system; acts mainly in the atrioventricular bundle, sometimes in the sinus bundle.
Indications – control of narrowly complex tachycardia.
Contraindications – hypersensitivity, Wolff-Parkinson-White syndrome, Lowne-Ganong-Levin syndrome, symptomatic severe hypotension (systolic pressure below 90 mmHg), sick sinus syndrome (in the absence of a pacemaker ), heart block of the 2nd and 3rd degrees (only in the absence of a pacemaker), complete heart block.
Contraindications for administration: use in newborns (due to benzyl alcohol), current therapy with beta-blockers, ventricular tachycardia (the nature must be determined – supraventricular or ventricular).
Diphenhydramine
Class – antihistamine (first generation).
Pharmacological effect – histamine antagonist of H-1 receptors of effector cells of the respiratory tract, blood vessels, smooth muscles of the gastrointestinal tract.
Indications – treatment of redness and/or itching during an allergic reaction, control of dystonia/akathisia.
Contraindications – hypersensitivity, diseases of the lower respiratory tract (for example – acute asthma), prematurely born children and newborns.
Dopamine
Class – inotropic agent, catecholamine pressor.
Pharmacological action – endogenous catecholamine, affects dopaminergic and adrenergic neurons. A small dose stimulates mainly dopaminergic receptors, causing renal and mesenteric vasodilation; a higher dose stimulates beta-1-adrenergic and dopaminergic receptors, causing cardiac stimulation and renal vasodilation; large doses stimulate alpha-adrenergic receptors.
Indications – pressor agent in shock control.
Contraindications – hypersensitivity, pheochromocytoma, ventricular fibrillation, untreated tachyarrhythmias.
WARNING: Dopamine has an inflammatory effect and can cause tissue damage in case of extravasation.
Droperidol
Class – antiemetic agent; antipsychotic.
Pharmacological action – Antiemez: blocks dopamine receptors in the brain, mainly dopamine-2 receptors. A strong anti-dopaminergic and anti-serotonergic reaction is manifested in the case of prevention of repeated recruitment. Droperidol reduces motor activity, fear, causes sedation; has adrenergic blocking, antifibrillator, antihistaminic and anticonvulsant characteristics.
Indications – delirium, psychosis.
Contraindications – hypersensitivity, suspicion of or presence of prolonged QT interval (interval longer than 450 msec in women; longer than 440 msec in men).
CAUTION: use with caution in bradycardia, heart disease, therapy with monoamine oxidase inhibitors, in combination with class 1 and 3 antidysrhythmics or other drugs that cause prolongation of the QT interval and cause electrolyte disturbances due to their adverse cardiovascular effects, i.e. QT prolongation, hypotension, tachycardia .
Epinephrine
Class – alpha/beta adrenergic agonists.
Pharmacological action – a strong alpha-adrenergic effect that causes an increase in cardiac output and heart rate, reduces renal perfusion and peripheral vascular tone, has various effects on blood pressure, causes systemic vasoconstriction and increases vascular permeability. Strong beta-1 and medium beta-2 adrenergic effects, which lead to relaxation of smooth muscles of the stomach, intestines, uterus, bladder.
Indications – control of anaphylactic reaction, shock, cardiac arrest, bradycardia; in nebulized form for croup, bronchiolitis; intravenously in refractory acute asthma.
Contraindications – hypersensitivity, cardiac dilatation and coronary insufficiency.
Famotidine
Class – Histamine H-2 antagonist.
Pharmacological action – blocks H-2 receptors of gastric parietal cells, leading to restriction of gastric secretions.
Indications – control of gastric or duodenal ulcers, gastroesophageal reflux, as an adjuvant drug in the treatment of urticaria and/or itching in allergic reactions.
Contraindications – hypersensitivity to H-2 receptor antagonists or famotidine.
Fentanyl
Class – synthetic opioid, analgesic.
Pharmacological action – narcotic antagonist – analgesic of opiate receptors; muffles the pain of the respiratory tract, thus changing the reaction to pain; raises the pain threshold; anesthetizes, sedates and causes respiratory deterioration.
Indications – control of acute pain.
Contraindications – hypersensitivity.
CAUTION: use with caution in elderly patients or in patients with hypotension, suspected gastrointestinal obstruction, head trauma, and CNS depressant therapy.
Glucagon
Klas – hypoglycemia antidote, glucose production stimulator; antidote (for example, in case of an overdose of beta blockers or calcium channel blockers).
Pharmacological action – insulin antagonist. Stimulates the synthesis of cyclic adenosine monophosphate to enhance hepatic glycogenolysis and glyconeogenolysis. It also relaxes the smooth muscles of the gastrointestinal tract.
Indications – control of hypoglycemia, symptomatic bradycardia after overdose in case of overdose with beta blockers or calcium channel blockers.
Contraindications – hypersensitivity, pheochromocytoma, insulinoma.
CAUTION: Nausea and vomiting are typical side effects.
Haloperidol
Klas is a first-generation antipsychotic.
Pharmacological action – Antagonizes dopamine-1 and dopamine-2 receptors in the brain; suppresses the reticular activation system and suppresses the release of hypothalamic and pituitary hormones.
Indications – control of acute psychosis and/or aggressive behavior resistant to pharmacological interventions.
Contraindications – hypersensitivity, severe CNS depression (including coma), neuroleptic malignant syndrome, poorly controlled convulsions, Parkinson’s disease.
CAUTION: there is a possible risk of sudden death, pirouette tachycardia, prolongation of the QT interval when administering doses above the norm. Constant monitoring of heart rhythms is necessary during administration.
Helium and gas mixture
Class is an optional method of oxygen delivery.
Pharmacological action – less resistant than atmospheric oxygen, which can facilitate breathing by increasing laminar flow and reducing resistance to turbulent flow.
Indications – persistent or severe bronchospasm in herintubated patients with obstructive airway disease, children with croup that does not respond to other clinical interventions.
Contraindications – none.
Hydralazine
Class is a vasodilator.
Pharmacological action – a direct vasodilator at the level of arterioles with a minimal effect on veins. Reduces systematic tone.
Indications – acute hypertension with preeclampsia.
Contraindications – hypersensitivity, coronary artery disease, rheumatic disease of the mitral valve. Use with caution in renal diseases, hypotension and stroke.
Hydrocortisone succinate
Class – corticosteroid.
Pharmacological action – glucocorticoid; causes mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling protein synthesis, limiting migration of PMN leukocytes and fibroblasts, changes capillary permeability.
Indications – control of adrenal insufficiency.
Contraindications – untreated serious infections (except tuberculous meningitis or septic shock), Werlhoff disease (idiopathic thrombocytopenic purpura), intrathecal administration, hypersensitivity.
Hydromorphone
Class – synthetic opiate, opioid analgesic.
Pharmacological action – narcotic antagonist – analgesic of opiate receptors; muffles the pain of the respiratory tract, thus changing the reaction to pain; raises the pain threshold; anesthetizes, sedates and causes respiratory deterioration.
Indications – control of acute pain.
Contraindications – hypersensitivity.
CAUTION: use with caution in elderly patients or in patients with hypotension, suspected gastrointestinal obstruction, head trauma, and CNS depressant therapy.
Hydroxycobolamine
Class is an antidote to cyanide.
Pharmacological action – vitamin B12 with a hydroxyl group is conjugated to cobalt, which is displaced by cyanide and cyanocobalamin is formed, which is excreted by the kidneys.
Indications – control of cyanide poisoning.
Contraindications – hypersensitivity.
CAUTION: will cause skin and urine discoloration, may affect pulse oximetry readings. Due to the influence on certain test results, it is desirable to perform pre-hospital phlebotomy before the introduction of hydrocoxobalamin.
Ibuprofen
Class – NSCLC.
Pharmacological action – It suppresses the synthesis of prostaglandins in body tissues by suppressing at least 2 cyclooxygenase enzymes – COX-1 and COX2, It can suppress chemotaxis, change lymphocyte activity, reduce pro-inflammatory cytokinin activity, suppress neutrophil aggregation; these effects are due to the anti-inflammatory effect.
Indications – enhanced pain control or as an antipyretic.
Contraindications – allergy to aspirin; pain during coronary bypass surgery; prematurely born children with an untreated infection; bleeding with active brain hemorrhage or gastrointestinal bleeding; thrombocytopenia; coagulation defects, necrotic enterocolitis; serious kidney failure, congenital heart disease in which an open ductus arteriosus is necessary for pulmonary and systemic blood flow.
Ipratropium bromide
Class – respiratory effect, anticholinergic.
Pharmacological action – anticholinergic agent; suppresses vagal reflexes by counteracting the activity of acetylcholine; prevents an increase in the concentration of calcium inside cells, which is caused by the interaction of acetylcholine with muscarinic receptors of bronchial smooth muscles.
Indication – control of asthma and COPD.
Contraindications – hypersensitivity to ipratropium bromide, atropine or derivatives.
Isopropyl alcohol
Class – secondary alcohol.
Pharmacological action – antiseptic, can be used as an emetic.
Indications – nausea and vomiting.
Contraindications – none.
Ketamine
Class – general anesthetic, systematic action.
Pharmacological action – causes diasociative anesthesia. Blocks Nmethyl-D-aspartate (NMDA) receptors.
Indications – control of excited or aggressiveive patient.
Contraindications – hypersensitivity.
RELATIVE/CONTROVARY CONTRAINDICATIONS: head trauma, intracranial hemorrhage/mass, hypertension, angina, stroke, primary psychiatric disorders.
CAUTION: overdose can lead to panic attacks and aggression; rarely causes convulsions, increases intracranial pressure, stops the heart. Very similar in chemical action to phencyclidine, but less toxic and with a shorter active action.
Ketorolac
Class – NSCLC.
Pharmacological action – It suppresses the synthesis of prostaglandins in body tissues by suppressing at least 2 cyclooxygenase enzymes – COX-1 and COX2, It can suppress chemotaxis, change lymphocyte activity, reduce pro-inflammatory cytokinin activity, suppress neutrophil aggregation; these effects are due to the anti-inflammatory effect.
Indications – enhanced control of acute pain.
Contraindications – allergy to aspirin, ketorolac or other NSAIDs; during active childbirth or breastfeeding; serious impairment of kidney function associated with serious loss of fluid volume; previous or current history of gastrointestinal bleeding; intracranial bleeding; coagulation disorders; patients with a high risk of bleeding.
Labetalol
Class – Beta and alpha blocker.
Pharmacological action – non-selective beta blocker with clear sympathomimetic activity; is also an alpha blocker.
Indications – severe hypertension with symptoms of preeclampsia.
Contraindications – asthma or obstructive disease of the respiratory tract, severe bradycardia, heart block of the 2nd or 3rd degree (no pacemaker), cardiogenic shock, bronchial asthma, uncompensated heart failure, hypersensitivity, sinus bradycardia, patient syndrome sinus without a permanent pacemaker, the conditions are associated with prolonged and severe hypotension. Use the drug with caution in patients receiving calcium channel blockers. Possible onset of hypotension with or without loss of consciousness; so follow the patient. Consider pre-existing conditions such as sick sinus syndrome before starting therapy. Be careful if the patient has a history of strong anaphylactic reactions to allergens; patients taking beta blockers may be more sensitive to the recovery of old problems; epinephrine treatment of patients taking beta blockers may be ineffective and cause unwanted effects. Use with caution in the presence of myasthenia gravis or psychiatric disorders (may cause or worsen CNS depression).
Lidocaine
Class – class 1b antidysrhythmic.
Pharmacological action – combines with fast sodium channels and therefore dampens recovery after repolarization, leading to a decrease in myocardial tension and conduction velocity.
Indications – control of persistent or recurrent ventricular fibrillation or pulseless ventricular tachycardia.
Contraindications – hypersensitivity to lidocaine or amide local anesthetics; Adams-Stoke syndrome, subatrioventricular/atrioventricular/intraventricular heart block in the absence of an artificial pacemaker; acute congestive heart disease; cardiogenic shock; heart block of the 2nd or 3rd degree (without the presence of an artificial pacemaker); Wolff-Parkinson-White syndrome.
Lorazepam
Class – Anticonvulsant; anti-panic agent; anxiolytic agent; benzodiazepine.
Pharmacological action – sedative hypnotic action with rapid onset and relatively long duration; enhances the effects of gamma-aminobutyric acid (GABA), which is a major inhibitor of neurotransmission in the brain, lorazepam can inhibit all levels of the CNS, including the limbic and reticular formation.
Indications – seizure control, uncontrolled shivering in hypothermia, control of agitated or aggressive patients in behavioral emergencies.
Contraindications – hypersensitivity; acute acute angle glaucoma; severe respiratory distress; suffocation in sleep.
Magnesium sulfate
Class – class 5 antidysrhythmic; electrolyte.
Pharmacological action – depresses the central nervous system, blocks peripheral neuromuscular transmission, produces an anticonvulsant effect; reduces the volume of acetylcholine release by motor nerve impulses. It slows down the rate of formation of impulses of the sinoatrial node in the myocardium and lengthens conduction. Strengthens the movement of calcium, potassium and sodium from and into cells and stabilizes excitationmembranes.
Indications – control of pyreetic tachycardia or severe bronchoconstriction with subsequent respiratory arrest, seizure control during the 3rd trimester of pregnancy or after childbirth.
Contraindications – hypersensitivity, myocardial damage, diabetic coma, heart block, hypermagnesemia, hypercalcemia.
Metoclopramide
Class – antiemetic agent; prokinetic agent.
Pharmacological action – blocks dopamine (at large doses) and serotonin receptors in the chemoreceptor zone of the CNS; makes tissues more sensitive to acetylcholine; increases the mobility of the upper gastrointestinal tract, but does not increase secretion; reduces the tone of the lower esophageal sphincter.
Indications – control of nausea and vomiting.
Contraindications – hypersensitivity to metoclopramide or procainamide; gastrointestinal bleeding, mechanical obstruction or perforation; history of seizures; pheochromocytoma; other drugs that cause extrapyramidal symptoms (for example – phenothiazines, butyrophenones).
Metoprolol
Class – beta-1 selective blocker, beta blocker.
Pharmacological action – Blocks the reaction to beta adrenergic stimulation; cardio is selective for beta-1 receptors at low doses, with minimal or no effect on beta-2 receptors.
Indications – control of narrowly complex tachycardia.
Contraindications – hypersensitivity. When administered for hypertension or angina: sinus bradycardia; atrioventricular blockade of the 2nd or 3rd degree; cardiogenic shock, sick sinus syndrome (only in the absence of an artificial pacemaker), severe disease of peripheral vessels, pheochromocytoma. When administered for myocardial infarction: acute sinus bradycardia with heart rate below 45 bpm, systolic pressure below 100 mmHg, severe heart block of the 1st degree (PR interval at least 0.24 sec), moderate-severe heart failure.
CAUTION: can cause atrioventricular blockade of the 1st, 2nd, 3rd degree.
Midazolam
Class – Anticonvulsant, other; anti-panic agent; anxiolytic; benzodiazepine.
Pharmacological action – sedative hypnotic action with rapid onset and relatively long duration; enhances the effects of gamma-aminobutyric acid (GABA), which is a major inhibitor of neurotransmission in the brain, lorazepam can inhibit all levels of the CNS, including the limbic and reticular formation.
Indications – seizure control, uncontrolled shivering in hypothermia, control of agitated or aggressive patients in behavioral emergencies.
Contraindications – hypersensitivity; acute acute angle glaucoma; severe respiratory distress; shortness of breath.
CAUTION: May cause difficulty breathing, stoppage or suffocation.
Morphine sulfate
Class – synthetic opiate, opioid analgesic.
Pharmacological action – narcotic antagonist – analgesic of opiate receptors; muffles the pain of the respiratory tract, thus changing the reaction to pain; raises the pain threshold; anesthetizes, sedates and causes respiratory deterioration.
Indications – control of acute pain.
Contraindications – Hypersensitivity, paralytic ileus, diarrhea due to intoxication, impaired breathing, acute or severe bronchial asthma, obstruction of the upper respiratory tract (epidural/intrathecal administration), obstruction of the gastrointestinal tract (long-term action). , hypercarbia (tablets/instant-acting solutions), heart failure due to chronic lung disease, head trauma, brain tumors, white fever, seizure disorders, during labor with premature birth (administration in the form of a solution), cardiac arrhythmia, increased intracranial or cerebrospinal pressure, severe alcoholism, use after gallbladder surgery, surgical anastomosis (introduction of the drug in the form of suppositories).
Naloxone
Class – Opioid antidote.
Pharmacological action – a strong antagonist of opioids; a synthetic copy of oxymorphone.
Indications – treatment of acute opioid poisoning.
Contraindications – hypersensitivity.
CAUTION: the administration of the drug can lead to a rapid cessation of the action of opioids (excitement, tachycardia, pulmonary edema, nausea, vomiting, in newborns – convulsions).
Nifedipine
Class – Blocker of calcium channels.
Pharmacological action – increases the flow of extra cellular calcium to the membranes of the heartocardial cells and vascular smooth muscle cells, causing increased contractions of the smooth muscles of the heart and vessels, which in turn leads to the expansion of the main coronary and systemic arteries; does not affect serum calcium. Vasodilation occurs with a simultaneous decrease in the tone of peripheral vessels and an increase in heart rate.
Indications – control of high-altitude pulmonary edema.
Contraindications – hypersensitivity to nifedipine or other calcium channel blockers; cardiogenic shock, simultaneous use with strong enhancers of CYP3A4 production (rifampin, rifabutin, phenobarbital, phenotoin, carbamazepine, St. John’s wort) seriously reduces the effectiveness of nifedipine; use in the form of fast-acting tablets (sublingually or orally) in hypertensive emergencies.
Glyceryl trinitrate
Class – Nitrate, anti-anginal.
Pharmacological action – organic nitrate can cause systemic venodilation, reducing cardiac congestion. Cellular mechanism: nitrate penetrates into vascular smooth muscles and is converted into sodium oxide, which leads to activation of cyclic guanosine monophosphate and vasodilation. Relaxation of smooth muscles occurs by dilation of arteries and veins to reduce the simultaneous recruitment and ejection of the heart, as well as the myocardial oxygen demand. Also improves concomitant coronary circulation. Lowers blood pressure, increases heart rate, sometimes paradoxical bradycardia is present.
Indications – as an anti-anginal agent to control chest pain, and also as a cardiac workload reducer in patients suffering from acute pulmonary edema.
Contraindications – hypersensitivity, acute myocardial infarction, acute anemia, recent use of drugs against erectile dysfunction (sildenafil, tadanafil, vardenafil or other phosphodiesterase-5 inhibitors). There is a potential risk of severe hypotension, acute-angle glaucoma (controversial contraindication: the problem may not have strong clinical significance). Nitrates are contraindicated in the presence of hypotension (systolic pressure below 90 mmHg or more/equal to 30 mmHg), severe bradycardia (heart rate less than 50 beats/min), tachycardia in the absence of heart failure (C Fistula over 100 beats /min) and right ventricular infarction.
Noreepinephrine
Class – Alpha/beta adrenergic antagonists.
Pharmacological action – Strong beta-1 and moderate beta-2 adrenergic effects that cause an increase in cardiac output and heart rate, reduce renal perfusion and peripheral vascular tone, have various effects on blood pressure, cause systemic vasoconstriction and increases the permeability of blood vessels.
Indications – as a pressor agent to control shock.
Contraindications – hypersensitivity, hypotension due to blood loss, thrombosis of peripheral vessels (except for situations of emergency treatment).
RELATIVE CONTRAINDICATIONS: simultaneous use with other general anesthetics: chloroform, trichlorethylene, cyclopropane, halothane.
WARNING: norepinephrine has an inflammatory effect and can seriously damage tissues in case of extravasation. Do not administer it through the same port as alkaline solutions as they may inactivate it.
Nitrogen oxide
Class is a weak inhalation anesthetic.
Pharmacological action – opioid anesthetic in nature and may contain a certain amount of spinal neuromodulators. The anxiolytic effect is similar to benzodiazepine and can affect GABA receptors. The anesthetic effect can also affect GABA receptors and possibly N-methyl-D-aspartate receptors. In general, the effect of nitric oxide stops after inhalation and has no side effects.
Indications – Analgesia for patients who are able to take medication independently.
Contraindications – serious breathing disorder, suspicion of abnormal filling of cavities with air (for example – pneumothorax, gastric obstruction, air embolism).
RELATIVE CONTRAINDICATIONS: history of stroke, hypotension, pregnancy, problems with heart, vitamin B12 deficiency.
Olanzapine
Class – Antipsychotic of the second generation; antimanic agent.
Pharmacological action – can act through combined antagonism of dopamine and serotonin type 2 receptors.
Indications – control of agitated or aggressive patients in behavioral emergencies.
Contraindications – hypersensitivity.
CAUTION: There is a high risk of severe sedation (including coma) or delirium after each administration and patients should be observed for 3 hours in the waiting room. There is a very high risk onmoderate sedation when using olanzapine with benzodiazepines or in patients taking benzodiazepines.
Ondansetron
Class – Antiemetic, selective 5-HT3 antagonist.
Pharmacological effect – the mechanism is not fully described; selective antagonist of 5-HT3 receptors; binds to 5-HT3 receptors simultaneously in the PNS and CNS, the main site of action is the gastrointestinal tract. Does not affect dopamine receptors, therefore does not cause extrapyramidal symptoms.
Indications – control of nausea and vomiting.
IMPORTANT: monitoring of ECG indicators is recommended in case of electrolyte imbalance, acute heart failure, bradyarrhythmia or in patients taking other drugs that cause QT prolongation.
Contraindications – hypersensitivity, simultaneous administration with apomorphine, as this combination causes severe hypotension and loss of consciousness.
CAUTION: May cause QT prolongation in a dose-dependent manner, avoid use in patients with congenital long QT syndrome.
Oxymetazoline
Class – intranasal, anticongestant.
Pharmacological action – alpha-adrenergic antagonist; stimulates alpha-adrenergic receptors and provokes vasoconstriction in the arterioles of the nasal mucous membranes.
Indications – control of epistaxis with facial trauma.
Contraindications – hypersensitivity.
Potassium iodide
Class – Andidot; antithyroid agent.
Pharmacological action – protects the thyroid gland: systematically circulating potassium iodide is collected in the thyroid glands with the help of sodium/iodine in the basement membrane; blocks the radioactive iodine isotope from entering the gland; concentration gradient of thyroid glands to plasma 20-50:1.
Indications – prevention of radioactive isotopes of iodide entering the thyroid gland during natural disasters involving radiation.
Contraindications – sensitivity to iodide (however, allergy to radiocontrast media, contact dermatitis from iodide-containing antibacterial agents and allergy to sea products cannot be considered a sign of allergy to potassium iodide), hyperthyroidism, respiratory insufficiency.
Pralidoxime
Class – cholinergic, antidote to toxins.
Pharmacological action – combines with organophosphorus compounds and breaks the alkyl phosphate-cholinesterase bond to restore the activity of acetylcholinesterase.
Indications – control of intoxication with organophosphorus insecticides and nerve-paralyzing gases (tabun, sarin, soman).
Contraindications – hypersensitivity.
Procainamide
Class – class 1a antidysrhythmic.
Pharmacological action – class 1a antidysrhythmic agent (membrane stabilizing), suppresses recovery after repolarization, which leads to a decrease in myocardial tension and conduction velocity. A direct membrane depressant that reduces conduction velocity, prolongs stability, reduces automaticity and repolarization abnormalities.
Indications – control of stable patients with regular, widely complex tachycardia.
Contraindications – hypersensitivity to procainomide or other ingredients, complete heart block, atrioventricular block 2nd or 3rd degree, systemic lupus erythematosus, torsades de pontes.
RELATIVE CONTRAINDICATIONS: QT prolongation.
Prochlorperazine
Class – Antiemetic agent; antipsychotic, phenothiazine.
Pharmacological action – Antiemetic agent: antidopaminergic effect, blocks dopamine receptors in the brain, blocks the vagus nerve in the gastrointestinal tract. Antipsychotic agent: blocks mesolimbic dopamine receptors, blocks alpha-adrenergic receptors (D1, D2) in the brain.
Indications – control of vomiting and nausea.
Contraindications – hypersensitivity to phenothiazines, coma, severe CNS depression, concurrent use with large doses of CNS depressants, poorly controlled seizure disorders, subcortical brain damage, pediatric surgery, children younger than 2 years or weighing less than 9 kg.
Sildenafil
Class – therapy of pulmonary arterial hypertension, PDE-5 inhibitor, PDE-5 (phosphodiesterase) enzyme inhibitor.
Pharmacological action – Inhibits PDE-5, increases the ability of guanosine monophosphate (Cgmp) to relaxI have smooth muscles.
Indications – as an additional tool during descent to control high-altitude pulmonary edema.
Contraindications – the use of nitrates in any form (glyceryl trinitrate, isosorbide) on a regular or periodic basis increases the risk of potentially fatal hypotension, hypersensitivity.
Sodium bicarbonate
Class – Antidote.
Pharmacological effect – increases the pH level in the blood and urine by releasing the bicarbonate ion, which neutralizes the concentration of hydrogen ions.
Indications – control of cardiac arrest in situations of overdose with tricyclic antidepressants or existing hyperkalemia, presence of QT prolongation.
Contraindications – hypersensitivity, severe pulmonary edema, alkalosis, hypernatremia, hypokalemia.
Sodium nitrite
Class is an antidote to cyanide.
Pharmacological action – nitrites create methemoglobin that binds cyanide.
Indications – control of cyanide poisoning.
Contraindications – hypersensitivity, suspected or confirmed smoke inhalation and/or carbon monoxide poisoning.
CAUTION: There is a risk of worsening hypoxia due to the formation of methemoglobin. In addition, sodium nitrite can cause serious adverse effects and death from hypotension and methemoglobin formation. Monitor the status of adequate perfusion and oxygenation during treatment with sodium nitrite.
Sodium thiosulfate
Class is an antidote to cyanide.
Pharmacological action – thiosulfate is a sulfur donor that is used by rhodanese to convert cyanide into the less toxic thiocyanate.
Indications – control of cyanide poisoning.
Contraindications – hypersensitivity.
Sorbitol
Class – laxative, osmotic.
Pharmacological action – polyalcohol sugar with hyperosmotic effects.
Indications – control of patients in case of poisoning after ingestion of something.
Contraindications – acute abdominal pain, nausea, vomiting, or other symptoms of appendicitis or undiagnosed abdominal pain, hypersensitivity.
Tadalafil
Class – therapy of pulmonary arterial hypertension, PDE-5 inhibitor, PDE-5 (phosphodiesterase) enzyme inhibitor.
Pharmacological action – Inhibits PDE-5, increases the ability of guanosine monophosphate (Cgmp) to relax the smooth muscles of pulmonary vascular cells and cause vasodilation of the pulsar vasculature.
Indications – as an additional tool during descent to control high-altitude pulmonary edema.
Contraindications – the use of nitrates in any form (glyceryl trinitrate, isosorbide) on a regular or periodic basis increases the risk of hypotension; hypersensitivity, including Stevens-Johnson syndrome and exfoliative dermatitis.
CAUTION: the possibility of hypotension due to vasodilatation.
Zyprasidone
Klas is a second-generation antipsychotic.
Pharmacological action – acts as an antagonist of dopamine-2 and serotonin receptors type-1 and type-2 (5HT1D, 5HT2A); 5HT1A serotonin receptor antagonist; indirectly suppresses reuptake of norepinephrine and serotonin; has an alpha-blocking and antihistamine effect.
Indications – control of agitated or aggressive patients in behavioral emergencies.
Contraindications – hypersensitivity, use of any drugs that prolong the QT interval, recent history of acute myocardial infarction, uncompensated heart failure.