Emergency medications

Dr.Olfat El-Shafiey
Assistant Professor
Critical Care
Assiut University

Drugs used during the management of

a cardiac arrest
Oxygen:
high concentration oxygen should be given to
all patients in cardiac arrest
Oxygen in sufficient concentration to provided
arterial oxygen saturation of >95% should be
given to all patients and must be humidified
because dry oxygen is not right for the patient

Drugs used during the management of

a cardiac arrest
Oxygen pressure:
modified oxygen pressure is very important
Oxygen pressure between (5-8ml of oxygen
pressure)stimulate the respiratory center of the brain
Oxygen pressure between (10-15ml of oxygen pressure )
irritate the respiratory center of the brain
Oxygen pressure between(15-20ml of oxygen pressure)
cause paralysis of the respiratory center of the brain
Oxygen pressure between (20-30ml of oxygen pressure
cause damage for the respiratory center of the brain

Drugs used during the management of

a cardiac arrest
Epinephrine(adrenaline)
Indications:is the first drug used in cardiac
arrest of any etiology
Dose:during cardiac arrest ,the initial IV dose
is I mg ,followed by 2-3mg ,diluted into a
volume of 10ml of sterile water may be given
via the tracheal tube

Drugs used during the management of

a cardiac arrest
Action of epinephrine:
is a directly-acting sympathomimetic amine
that possess both alpha and beta adrenergic
activity.epinephrine stimulates both a1 and a2
receptors to produce vasoconstriction.this
increase systemic vascular resistance during
CPR resulting in a relative increase in cerebral
and coronary perfusion.

Drugs used during the management of

a cardiac arrest
Action of epinephrine:in the beating heart
effect of epinephrine mediated through the B1
receptors ,is to increase heart rate and force of
contraction.
Epinephrine increases myocardial excitability
Use:available in two dilutions:1 in 10,000 (10ml
of this solution contains 1mg of epinephrine)
and 1 in 1,000 (1ml of a 1 in 10,000 is the more
usual dilution used in cardiac arrest

Drugs used during the management of

a cardiac arrest
Atropine
Indications:
in systole
In Pulseless electrical activity with a
rate<60b\min
In sinus ,atrial bradycardia
Dose: blocks the effect of the vagus nerve on
both the (SA ) node and (AV)node conduction

Drugs used during the management of

a cardiac arrest
Aminodarone
Indications:pulseless,ventricular fibrillation
Dose:IV of 300mg aminodarone ,diluted in 5%
dextrose to a volume of 20ml
Side effects:bradycardia,hypotension

Drugs used during the management of

a cardiac arrest
Magnesium sulphate:
shock in the presence of possible
hypomagnesaemia
Lidocaine:
ventricular fibrillation\pulseless
Dose:100mg and an addition of 50mg can be
given if necessary

Drugs used during the management of

a cardiac arrest
Sodium bicarbonate:
Indication:severe metabolic
acidosis,hyperkalemia
Dose:50 mmol given IV ,the dose can be repeated
as necessary
Actions:
cardiac arrest results in combined respiratory
and metabolic acidosis due to cessation of
pulmonary gas exchange

Drugs used during the management of

a cardiac arrest
Vasopression:
is a powerful vasoconstrictor that acts by
stimulation of smooth muscle
Fluids:
normal saline or lactated ringer`s is the
preferred crystalloid
Calcium:
pulseless electrical activity caused
by:hyperkalemia,hypocalcemia,overdose of
calcium channel blocking drugs

Drugs used during the management of

a cardiac arrest
Calcium:
Actions:
play a vital role in the cellular mechanisms
underlying myocardial contraction

Digoxin
Antiarrhythmic
Cardiotonic
Brand names:
digitoxin
digoxin
lanoxin
digitaline

Digoxin-side effects
Adult:
anxiety,blurred or yellow
vision,confusion,dizziness,mental
depression,headache,loss of
appetite,visual auditory
hallusinations,diarrhea,lower stomach
pain,nausea,palpitation

Digoxin-side effects
Children:
stomach upset,loss of appetite
Rare side effects:
skin rash,bleeding gums

Digoxin overdose
Visual and auditory hallucinations
Tinning of the ear
Disturbances of vision
Yellowish coloration surrounded by
witch coloration

Medical problems may affect the use of

digitalis
Electrolyte disturbances
Lung disease
Kidney disease
Liver disease
Overactive thyroid

The following medication should not be

used at all with Digoxin
Amphetamine
Appetite suppressant
Medication for asthma
Medication for cold,sinus problems
Calcium channel blocking
(adalet,isoptin)
Beta-adrenergic blocking gents
diuretics

Precautions before receiving digoxin

Count radial pulse if it was below 60beats\min
stop receiving medicine and report
Instruct your patient in the morning when get
up to concentrate his vision on a source of light
when he watch yellowish coloration surrounded
by whitch coloration,tinning or roaring of the
ear ,low of concentration ,headache must call
his doctor (digitalis toxicity)

Precautions before receiving digoxin

Every 4 months patient must test the
concentration of the drug in his blood to avoid
digitalis toxicity and to change the dose
Avoid diarrhea
Avoid constipation
Avoid abdominal cramps
Avoid coughing
Receive fruits and vegetables rich in potassium

Nitroglycerin and anginal pain

Nitrates :
brand name:isordil

Nitroglycerin and anginal pain

Are used to treat the symptoms of angina (chest
pain)
Are used to treat angina in three ways:
1-to relieve an attack
2-to prevent attacks from occurring by using
the medication just before an attack is expected
to occur
3-to reduce the number of attack that occur by
using the medicine regularly on a long term
basis

Nitroglycerin and anginal pain

Nitrates work by
relaxing blood vessels
and increasing the
supply of blood and
oxygen to the heart while
reducing its workload

Certain medications should not be

used with nitroglycerin at all
antihypertensive

Nitroglycin should not be used with certain

Medical problems
Anemia
Glaucoma
Head injury

Corticosteroids
Brand names :
hydrocortisone,betamethasone,
cortisone,dexamethasone,prednisolone,
predispose
Category:anti-inflammatory,antiemetic in
cancer chemotherapy ,

Corticosteroids
Description:
are used to provide relief for inflamed
areas of the body,
lessen swelling,redness,itching,and
allergic reactions,asthma.

Corticosteroids
Before using this medicine:follow a low
salt diet,a potassium rich diet,add extra
protein to diet
Pregnancy:birth defects with
corticosteroids
Breast-feeding:corticosteroids pass into
breast milk and may cause problems with
growth

Corticosteroids
Older adults:develop high blood pressure
,osteoporosis

Medications should not be used with

corticosteroids
Antacids
Barbiturates
Tegretol
Dilantin
Depakine
Antidiabetic agents(corticosteroids may
increase blood glucose level)
Cyclosporine (cause seizures)

Medications should not be used with

corticosteroids
Digitalis glycosides (corticosteroids decrease
the amount of potassium in the blood),digitalis
can increase the risk of having an irregular
heartbeat or other problem if the amount of
potassium in the blood gets too low
Diuretics(using corticosteroids with diuretics
may cause the diuretic to be less effective)Also
corticosteroids may increase the risk of low
blood potassium

Medications should not be used with

corticosteroids
Diuretics(potassium supplements or a different
type of diuretic is used in treating high blood
pressure in those people who have problems
keeping their blood potassium at a normal
level.
Immunization while patient are being treated
with this medicine and even after stop taking
it,do not have any immunization without
doctor`s approval.

Medications should not be used with

corticosteroids
Immunization Also other people living in the
patient`s home should not receive the oral polio
vaccine,since there is a chance they could pass
the polio virus on to patient
In addition ,patient should avoid close contact
with other people at school or work who have
recently taken the oral polio vaccine.

Medications should not be used with

corticosteroids
Skin test injections
corticosteroids may
cause false results in
skin tests.

Medical problems may affect the use of

corticosteroids
Acquired immunodeficiency syndrome
Fungus infection
Herpes simplex infection of the eye
Recent surgery or serious injury(delay healing
of operative wound)
TB (delay healing)
Diabetes mellitus(corticosteroides may cause a
loss of control of diabetes by increasing blood
sugar level

Medical problems may affect the use of

corticosteroids
Stomach ulcer
Intestinal problems
Ulcerative colitis
Glaucoma (corticosteroids increase intraocular
pressure
Liver disease
Heart disease
Under active thyroid

Medical problems may affect the use of

corticosteroids
Osteoporosis:corticosteroids may worsen bone
disease because they cause the body to lose
more calcium
Psychosis:this condition may be made worse
Systemic lupus erythematosus:

Proper use of corticosteroides

Take this medicine with food to prevent stomach upset
Do not stop using corticosteroide without doctor`s
order and it must be reduced gradually
Low-salt diet
High potassium intake(tomato,banana,apricot,apple,fig
,nuts)
Low animal fat
Low caffeine intake
Low sweet or artificial sweet
No spicy food

If patient will be using corticosteroids

for a long time
Follow a low salt diet
Follow a potassium rich diet
Watch calories to prevent weight gain
Add extra protein to diet
Eye examination by ophthalmologist (for
intraocular pressure)-before during treatment
Carry a card stating that you are using this
medicine

If patient will be using corticosteroids

for a long time
Tell the doctor in charge that you are using this
medicine:
-before having skin tests
Before having any kind of surgery including
dental surgery or emergency treatment
If you get a serious infection or injury
Avoid close contact with anyone who has
chickenpox or measles.

If patient will be using corticosteroids

for a long time
For patients with diabetes:this medicine may
affect blood glucose levels.if you notice a
change in the results of your blood or urine
sugar tests or if you have any questions,check
with doctor.
For patients having this medicine injected into
their joints:if this medicine is injected into one
of your joints,patient should be careful not to
put too much stress or strain on that joint for a
while ,even if it begins to feel better.

If patient will be using corticosteroids for a

long time
If redness or swelling
occurs at the place of
injection ,check with
your doctor.

Side effects of corticosteroids

May lower the patient`s resistance to infections
Any infection get may be harder to treat
Less common side effects:
decreased or blurred vision,increased thirst
Rare side effects:
blindness ,burning ,numbness ,pain or tingling
at near place of
injection,confusion,excitement,hallucinations.

Side effects of corticosteroids

Rare side effects:mental depression,abdominal
pain,bloody or black ,tarry stools ,change in
vision,eye pain ,headache,irregular
heartbeat,menstrual problems,muscle
cramps ,muscle weakness,pain in
arms,back,hips,legs,ribs,or shoulders ,redness
of eyes,sensitivity of eyes to light ,unusual
increase in hair growth,unusual tiredness or
weakness ,vomiting ,weight gain,wounds that
will not heal.

Side effects of corticosteroids

More common side effects:
Increased appetite ,nervousness or restlessness
or loss of appetite
Less common or rare side effects:
Darkening or lightening of skin
color,dizziness ,flushing of face or cheeks
,increased joint pain

Anticoagulant
Description:
decrease the clotting ability of the blood
and help to prevent harmful clots from
forming in the blood vessels,called blood
thinners,they also will not dissolve clots
that already have formed but they may
prevent the clots from becoming larger
Warfarin,Dicumarol

Anticoagulant and pregnancy

Warfarin,Dicumarol may cause birth
defects,physical or mental growth of the
fetus or newborn baby
Use this medicine during the last 6 months of
pregnancy may increase the chance of
severe possibly fatal,bleeding in the fetus

Anticoagulant and pregnancy

Warfarin,Dicumarol if taken during the last
few weeks of pregnancy
Anticoagulants may cause severe bleeding in
both fetus and the mother before or during
delivery and in the newborn infant

Anticoagulant
Warfarin,Dicumarol and breast-feeding :not
likely to cause problems if pass into breast
milk
Older adults:increase the chance of bleeding
during treatment

Anticoagulants and certain medicines

should not be used together at all
Cordarone
Tagamet
Flagel
Anabolic steroid
Antifungals medicine for overactive
thyroid
Aspirin or other salicylates
cephalosporins

Anticoagulants and certain medication does

not use together at all
Narcotics
Thyroid hormones
Depakene
Barbiturates
Tegretol
Dilantin
Vitamin K

medical problems may affect the use of

anticoagulants
Aneurysm(swelling in a blood vessel)
Bleeding in the brain
Low platelet count
Cancer
Childbirth
Pericarditis
Hemophilia
Hypertension
Liver disease
Peptic ulcer
Wound open

Dose of anticoagulants

Dicumarol For preventing or treating

harmful blood clots..adult dose is 25 to 200
milligrams per day ,adjusted according to
blood tests.
Warfarin for preventing or treating harmful
blood clots..adult dose is usually 2 to 5
milligrams per day for two to four days

Precautions while using anticoagulant

It is important for the patient to carry
identification card stating that he is using
this medicine
Avoid sports and activities that may cause
the patient to be injured
Be careful to avoid cutting patient himself
Brushing teeth or shaving taking special
care

Precautions while using anticoagulant

Vitamin K is present in green,leafy vegetables
(such as broccoli,cabbage,collard
greens,kale,lettuce,spinach)
Avoid diarrhea because it change electrolytes

Side effects of anticoagulants

Watch for signs of unusual bleeding from
gums when brushing teeth,blood in
urine,nosebleeds,pinpoint red spots on
skin,unusually heavy bleeding or oozing
from cuts or wounds ,unexpected or
unusually menstrual bleeding

Side effects of anticoagulants

Less common side effects:
cough of hoarseness,fever,or chills,lower back
or side pain ,painful or difficult
urination,itching
Rare side effects:
itching on skin,blue or purple toes,dark
urine,pain in toes,painful red sores on skin
especially on thighs ,beasts,penis or buttocks
,sores ,ulcers or white spots in mouth or
throat ,sudden increase or decrease in amount
of urine,swelling of face,feet or lower legs
,trouble in breathing ,yellow eyes or skin

Muscle relaxant
Uses: -in case of muscle contraction,
strain and sprain of ligament,facilitate tracheal
intubations,used during surgery,

facilitate mechanical ventilation

Narcotic Analgesics
Are used to relieve pain before or during an
operation and act in the central nervous
system to relieve pain
To help the anesthetic work better
Codeine are used to relieve coughing

Narcotic Analgesics
Category:
Analgesic(codeine-methadone-morphine)
Anesthesia(morphine)
Antidiarrheal(codeine-morphine)
Antitussive(codeine-hydrocodronemorpgine-methadone)
Pulmonary edema therapy

Drug overdose of Narcotic Analgesics

Clod clammy skin
Confusion
Seizures
Dizziness
Drowsiness
Low blood pressure
Nervousness or restlessness
Pinpoint pupils of eyes,slow heartbeat,slow
breathing

Side effects of Narcotic Analgesics

Less common or rare side effects:
dark urine,fast slow heart
beat,hallucination,itching or skin
rash,increased sweating,irregular
breathing,mental depression,redness or
flushing of face.ringing in the ears,shortness of
breath ,uncontrolled muscle movements,yellow
eyes or skin

Side effects of Narcotic Analgesics

More common side effects:
nausea.vomiting
Less common side effects:
blurred vision,constipation,decreased amount
of urine,difficult or painful urination,dry
mouth,frequent urination,headache,loss of
appetite,nervousness

Dose of Narcotic Analgesics oral

Codeine for pain:
adult-15-60mg usually 30mg every 3 to 6 hourschildren-0.5mg per KG of body weight every 4
to 6 hours
For cough:
adult 16-20mg every 4 to 6 hours
children:up to 2 years not recommended
children 2years 3mg every 4 to 6 hours up to a
maximum of 12 mg a day

Dose of Narcotic Analgesics oral

Children 3years 3.5mg every 4 to 6 hours
maximum 14mg a day
Children 4 years 4 mg every 4 to 6 hours
maximum 16mg a day
Children 5 years 4-5mg maximum 18mg
Children 6 to 12 years 5 to 10mg every 4 to 6
hours maximum 60mg

Dose of Narcotic Analgesics injection

For pain
Adults-15 to 0mg usually injected into a muscle or
vein or under the skin
Children 0.5mg per KG of body weight injected
into a muscle

Insulin

Insulin
Brand Names
Humulin 50
Humulin L
Humulin N
Lente
Novolin
NPH
Regular insulin
Regular insulin

Insulin Description
Insulin is one of many hormones that
helps the body turn the food we eat into
energy ,also insulin helps us store energy
that we use later.After we eat ,insulin
works by causing sugar (glucose) to go
from the blood into our body`s cells to
make fat, sugar and protein.

Insulin Description
When we need more energy between
meals ,insulin will help us use the
fat,sugar ,and protein that we have
stored.this occurs whether we make our
own insulin in the pancreas gland or take
it by injection.

Diabetes mellitus
Is a condition in which the body does not
make enough insulin to meet its needs or
does not properly use the insulin it
makes.Without insulin ,glucose can not
get into the body`s cells ,without
glucose ,the cells will not work properly.

Before using insulin

Pregnancy:blood sugar can reduce the
chance of baby gaining too much
weight,having birth defects ,or having
high or low blood sugar
Breast feeding:insulin does not pass into
breast milk and will not affect the
nursing infant.

Certain medications should not be used with

insulin at the same time

Beta-adrenergic blocking agents (inderal)

Beta-adrenergic blocking agents may
increase the chance of developing low blood
sugar levels.
Corticosteroids(prednisone or cortisone)
Increase blood sugar level
Anti-epileptic medication
Increase blood sugar level

Certain medications should not be used with

insulin at the same time

Antihypertensive medication
Increase blood sugar level

Medical problems and insulin

The presence of the following medical problems
may affect the dose of insulin
-changes in female hormones (during
puberty,pregnancy,menstruation)
Severe infection
Mental stress
Diarrhea
Vomiting
Intestinal blockage

Medical problems and insulin

The presence of the following medical problems
may affect the dose of insulin
Kidney disease
Liver disease
Injury
Overactive thyroid
Underactive pitutary gland

hypoglycemia
Can cause low blood sugar
Symptoms of low sugar can include:
Confusion,blurred vision,cold clammy skin,pale
skin,difficulty in
concentration,drowsiness,excessive hunger,fast
heartbeat,headache,nervousness,slurred speech
and unusual tiredness or weakness

hypoglycemia
Causes of hypoglycemia
-delaying of meal
Exercising more than usual
Using too much insulin
Receive actual dose of insulin but forget to
eat,or eat very minimal amount of food
Superficial breathing

hypoglycemia
Management of hypoglycemia
Fruit juice
Honey (1 tablespoon)
Cheese or crackers ,half a sandwich,or drink a
glass of milk
Do not use chocolate because its fat slows down
the sugar entering into the blood stream
Glucagon is used in emergency situations such
as unconsciousness (1unit of glucagon=20kg of
body weight)

Hyperglycemia
Causes of hyperglycemia
nfection
Severe vomiting-diarrhea

Hyperglycemia
Symptoms of mild high blood sugar
Blurred vision,drowsiness,dry
mouth,flushed and dry skin,fruit like
breath odor,increased urination,loss of
appetite ,stomachache,nausea or vomiting
,tiredness ,troubled breathing (rapid and
deep) and unusual thirst

Hyperglycemia
Symptoms of severe high blood sugar
Flushed and dry skin,fruit-like breath
odor,ketones in urine,troubled breathing
(rapid and deep)

Side effects of insulin

Side effects more common
Low blood sugar (mild) including anxious
feeling,behavior change ,blurred vision,cold
clammy skin,confusion,pale cool
skin,difficulty in concentrating,drowsiness
,excessive hunger ,fast heart
beat,headache,nausea,nervousness,unusual
tiredness ,weight gain

Side effects of insulin

Rare Side effects
Swelling of face ,fingers ,feet or ankles

Insulin and food interaction

Avoid excessive animal fat intake
Avoid excessive spicy food
Avoid high salt intake
Avoid high caffeine intake

Antihistaminic and decongestants

Category:antihistaminic
Description:are used to treat the nasal
congestion ,sneezing ,preventing the effects
of histamine

Antihistaminic - decongestants and

pregnancy and breast -feeding
Cause jaundice and muscle tremors in a few
newborn infants whose mothers received
phenothiazines during pregnancy
Small amounts pass into breast milk but it
cause unusual excitement or
irritability,decrease breast milk

Antihistaminic - decongestants and

children
Increases in blood pressure,nightmares or
unusual excitement,nervousness
,restlessness or irritability

Antihistaminic - decongestants and

older adults
Confusion,difficult and painful urination
,dizziness,drowsiness,dryness of mouth or
convulsions

Certain medications should not be used be used at all

with Antihistaminic - decongestants

Medicine for abdominal or stomach spasms or

cramps cause dryness of mouth ,irregular
heartbeat
Antiepileptic medications
Antidepressants
Amphetamines
Appetite suppressants
caffeine

Certain medications should not be used at all with

Antihistaminic - decongestants

Medicine for asthma or other breathing

problems
Medicine for colds ,sinus problems
Beta-adrenergic blocking agents(may cause
high blood pressure
aspirin

The presence of other medical problems with

Antihistaminic - decongestants

Diabetes
Enlarged prostate
Urinary tract blockage or difficult urination
Glaucoma
High blood pressure
Kidney disease
Liver disease
Overactive thyroid

Proper use of Antihistaminic - decongestants

With food or glass of water or milk to lessen the

irritation
Antihistamines may cause dryness of the mouth
.nose and throat for temporary relief use
sugarless

Overdose of antihistamine
Convulsions,drowsiness,dryness of
mouth,hallusinations,headache,shortness
of breath,irregular heartbeat

Side effects of antihistamines

Rare side effects:
muscle spasms(especially of neck and
back),restlessness,jerky movements of
head
Less common side effects:blurred
vision,confusion,difficult or painful
urination,dryness of mouth,loss of
appetite

Beta-Adrenergic Blocking Agents and

Diuretic
Brand names:inderal
Category:antihypertensive
Description:beta-adrenergic blocking agent
(beta-blockers)and thiazide diuretic
combination, to reduce the work load on the
heart for controlling high blood pressure and to
reduce the amount of fluid pressure in the body
by increasing the flow of urine

Beta-Adrenergic Blocking Agents and

Diuretic
Description:high blood pressure adds to
the work load of the heart and arteries,if
it continues for a long time,the heart and
arteries may not function properly,this
can damage the blood vessels of the
brain,heart and kidneys ,resulting in a
stroke ,heart failure,or kidney failure

Beta-blockers diuretics and pregnancy

Associated with low blood sugar levelbreathing problems-slower heart rate
and low blood pressure ,jaundice ,low
potassium in the newborn infant

Beta-blockers diuretics and breast

-feeding
Pass into breast milk
and may decrease the
flow of breast milk.

Medications should not be used at all

with Beta-blockers diuretics
Aminophylline
Caffeine
Theophylline
Antidiabetics(drugs taken by mouth)
Insulinthere is an increased risk of
hyperglycemia or hypoglycemia ,increase in
pulse rate
Calcium channel blockers

Medications should not be used at all with

Beta-blockers diuretics
Digitalis glycosides
can cause high blood
level of digoxin
,which may increase
the chance of side
effects.

The presence of the following medical problems may

affect the use of Beta-blockers diuretics

Allergy
Asthma
Fever
Bronchitis
Emphysema
Bradycardia
Diabetes mellitus

The presence of the following medical problems may

affect the use of Beta-blockers diuretics

Gout
Pancreatitis
Kidney disease
Liver disease
Mental depression
Overactive thyroid

Proper use of Beta-blockers diuretics

Control weight
Avoid high sodium
Avoid spicy food
Avoid high animal fat
Check pulse rate regularly if it was less
than 50 beats per minute call your doctor
Avoid high caffeine intake

Proper use of Beta-blockers diuretics

Control weight
Avoid high sodium
Avoid spicy food
Avoid high animal fat
Check pulse rate regularly if it was less
than 50 beats per minute call your doctor
Avoid high caffeine intake

Proper use of Beta-blockers diuretics

Increase in the amount of urine or
frequency of urination ,these effects
should reduced
Receive vegetables and fruits rich with
potassium (tomato,fig,apricot ,apple)

Precautions while using of Betablockers diuretics

Do not stop taking this medicine
suddenly or without doctor`s order.
Patient must carry medical identification
stating that he is taking this medicine
Before having any kind of surgery
including dental surgery or emergency
medicine ,patient must inform that he is
receiving this medicine

Precautions while using of Betablockers diuretics

For diabetic patient: this medicine may
increase or decrease blood sugar level
This medicine cause loss of potassium patient
must eat or drink foods that have a high
potassium content
Beta blockers tend to decrease blood
circulation in the skin ,fingers and toes .dress
warmly during cold weather and be careful
during prolonged exposure to cold

Precautions while using of Betablockers diuretics

This medicine may cause skin to be more
sensitive to sunlight than it is normally
Exposure to sunlight ,even for brief
periods of time ,may cause a skin
rash,itching,redness or other
discoloration of the skin ,or severe
sunburn

Precautions while using of Betablockers diuretics

When patient begin taking this medicine: stay
out of direct sunlight,especially between the
hours of 10 am and 3pm if possible.
Wear protective clothing including a hat,wear
sunglasses
Apply a sun block product that has a skin
protection factor
Apply a sun block lipstick

Side effects of Beta-blockers diuretics

Less common side effects:
breathing difficulty and wheezing ,cold hands
and feet ,mental depression,slow heartbeat(less
than 50 beats\min)-swelling of ankles,feet and
lower legs.
Rare side effects:
black ,tarry stools,blood in urine or stools,chest
pain ,dark urine ,fever,hallucinations ,joint
pain ,lower back pain,stomach pain with
nausea and vomiting ,unusual bleeding ,yellow
eyes or skin

Side effects of Beta-blockers diuretics

Signs and symptoms of too much potassium or
sodium loss:
confusion,convulsions,dryness of
mouth,increased thirst,irregular
heartbeats,irritability,muscle cramps ,unusual
tiredness

Signs and symptoms of overdose of Betablockers diuretics

Slow heartbeat,
dizziness, severe
fainting,difficulty in
breathing,bluishcolored fingernails or
palms of
hands,convulsions

Side effects of beta-blockers and

diuretics
More common side effects:
decreased sexual
ability,dizziness,drowsiness,constipation,diarrh
ea,increased sensitivity of skin to sunlight,loss
of appetite,numbness or tingling of fingers and
toes

Calcium Supplements
Category
Antacid(calcium carbonate)
Antihyperkalemic(calcium chloride )
Antihypermagnesemic
Antihyperphosphatemic
Cardiotonic
Nutritional supplement

Calcium Supplements
Category
Antacid..calcium carbonate
Antihyperkalemic..calcium chloride
Antihypermagnesemic..calcium chloride
Antihyperphodphatemic..calcium citrate
Cardiotonic..calcium chloride
Nutritional supplement..

Calcium Supplements
Description
Calcium supplements are taken by individuals
who are unable to get enough calcium in
their regular diet or who have a need for
more calcium
They are used to prevent or treat several
conditions that may cause hypocalcemia
The body needs calcium to make strong bones

Calcium Supplements
Description
Calcium is also needed
for the heart,muscles
and nervous system
to work properly.

Some calcium rich foods

Nonfat dry milk
Lowfat ,skim or whole milk
Yogurt
Sardines with bones
Ricotta cheese
Salmon
Cheese white

Vitamin D and calcium

Vitamin D helps calcium loss from the
bone it is sometimes called the sunshine
vitamin
Expose the body 15-30minutes every
day ,get all the vitamin D the body need.
Do not use bone meal as a source of
calcium (it is a wrong knowledge)

Dietary supplement(pregnant womanfetus)

The healthy growth and development of
the fetus depend on a steady supply of
nutrients from the mother
Taking large amounts of a dietary
supplement during pregnancy may be
harmful to the mother and fetus and
should be avoided

Dietary supplement(pregnant womanfetus)

Breast feeding:
It is important to receive the right
amount of calcium ,but taking large
amounts of a dietary support while
breast-feeding may be harmful to the
mother or baby and should be avoided.

Medications or other dietary supplements

should not be used together at all

Digitalis glycosides (increase the chance of

irregular heartbeat)
Didronel(is used to prevent or treat
problems after hip replacement surgery)use
with calcium may decrease the effects of
didronel should not be taken within 2 hours
of calcium supplements

Medications or other dietary supplements

should not be used together at all

Magnesium sulfate(use with calcium

supplements may cause medicine to be
less effective.
Dilantin or depakine use with calcium
supplements may decrease the effects of
both medicine,calcium supplements
should not be taken within 1 to 3 hours of
depakine

Medications or other dietary supplements

should not be used together at all

Tetracyclines use with calcium

supplements may decrease the effects of
tetracycline calcium supplements should
not be taken within 1 to 3 hours of
tetracyclines

Medical problems may affect the use of

calcium supplements

Diarrhea
Stomach or intestinal problems
Heart disease
Hypercalcemia
Hyperparathyroidism
Kidney disease or stones

Proper use for calcium supplement

Drink a full glass of
water or juice when
taking a calcium
supplement but with
full stomach.

Side effects of calcium supplement

More common side effects :
dizziness ,irregular heartbeat,nausea or
vomiting,skin redness ,or burning at
injection site ,tingling sensation
Rare side effects:
painful urination,drowsiness,nausea or
vomiting

Side effects of overdose of calcium

supplement
Early signs of overdose:
constipation ,dryness of mouth
,headache,increased thirst,loss of appetite
,mental depression
Late signs of overdose:
confusion,drowsiness,irregular fast or
slow heartbeat

Salicylates
Brand name:aspirin
Category:
Analgesic
Anti-inflammatory ,nonsteroidal
Antipyretic
Antirheumatic
antithrombotic

Salicylates
Category:
Myocardial infarction
Platelet aggregation inhibitor
Description:
salicylates are used to relive pain and
reduce fever

Salicylates and diet

Low sodium in diet
Very low fat intake
Avoid caffeine intake

Salicylates and pregnancy

Too much use of aspirin late in
pregnancy may cause a decrease in the
newborn`s weight and possible death of
the fetus or newborn infant
May cause unwanted effects on the heart
or blood flow in the fetus or in the
newborn infant.

Salicylates and problems during and after

delivery

Cause severe bleeding in the mother

before,during or after delivery
Do not take aspirin during the last three
months of pregnancy
Caffeine causes birth defects when given in
very large doses

Salicylates and problems during and after

delivery

Breast-feeding:
salicylates pass into the breast milk in small
amounts have not been reported to cause
problems in nursing babies.

Medications should not be used with

salicylates
Anticoagulants
Depakine
Heparin
Anti-inflammatory
Pain relief medication
Antidiabetics
bronchodialators

Medications should not be used with

salicylates
Tetracyclines
Methotrexate
Urinary alkalizers
Antihypertensive medications

Do not use salicylates in the following medical

problems
Anemia
Overactive thyroid
Stomach ulcer
Asthma
Hypertension
Kidney disease
Liver disease
Gout
hemophilia

Proper use of salicylates

Do not use salicylates with vinegar

Do not place salicylate or aspirin directly on
a tooth or gum surface
If you are to take any medicine that contains
aspirin within 7 days after having
tonsillitis ,a tooth pulled or other dental or
mouth surgery.do not receive aspirin during
this time.

Proper use of salicylates

Drink a full glass of water after taking this

medicine
Salicylates liquid may be mixed with fruit
juice before taking
Check with your medical or dentist:if you
are taking this medicine to relive pain and
the pain lasts for more than 10 days (5 days
for children)

Proper use of salicylates

Or if the pain gets worse ,if new symptoms
occur or if redness or swelling is present.these
could be signs of a serious condition that needs
medical or dental treatment.
If you are taking this medicine to bring down a
fever and fever lasts for more than 3 days or
returns ,if fever gets worse ,if new symptoms
occur,or if redness or swelling is present .these
could be signs of a serious condition that needs
treatment.

Proper use of salicylates

If you are taking this medicine for a sore

throat ,and the sore throat is very painful
lasts for more than 2 days or occurs together
with or is followed by fever ,headache,skin
rash,nausea or vomiting.

Proper use of salicylates

If you are taking this medicine regularly as

for arthritis and you notice a ringing in ears
or continuing headaches,these are often the
first signs that too much salicylates is being
taken

Proper use of salicylates

Do not take aspirin for 5 days before any

surgery..taking aspirin during this time may
cause bleeding problems
If you are taking a laxative containing
cellulose ,take the salicylate at least 2 hours
before or after you take laxative.taking
these medicine too close together may
lessen the effects of the salicylate

Proper use of salicylates

For diabetic patients
False urine sugar
tests result may
occur

Side effects of salicylates

Get emergency help if any of the following side
effects occur:any loss of hearing,bloody
urine,confusion,convulsions ,severe continuous
diarrhea,difficulty in swallowing ,drowsiness
,fast or deep breathing redness in the skin
,hallucinations ,nausea,vomiting ,tightness in
chest ,stomach pain ,swelling of eyelids,face or
lips ,disturbances of vision.

Side effects of salicylates

Less common side effects
Abdominal pain,cramming,bloody or black
tarry stools,ringing in ears,vomiting of blood
like coffee grounds.
More common side effects
Abdominal cramps nausea or vomiting

Vitamin K
Category: 1-antidote to drug-induced
hypoprothrombinemia
2-antihemorrhagic
3-nutritional supplement
Description:vitamin K is found in various foods
including green leafy vegetables ,meat and
dairy products
Vitamin K is routinely given to newborn infants
to prevent bleeding problems

Vitamin K and pregnancy

Vitamin K has not been reported to cause
birth defects or other problems in
humans.the use of vitamin K supplements
during pregnancy is not recommended
because it has been reported to cause
jaundice or other problems in the baby

Vitamin K and breast-feeding

Vitamin K taken by the mother has not
been reported to cause problems in
nursing babies

Vitamin K and medications should not be

used together
Antidiabetic
Adomet
Sulfonamides
Anticoagulants
Aspirin
Cefobid
Presantine
Depakene
Heparin
induced

The presence of other medical problems or

recent delivery may affect the use of vitamin K
Cystic fibrosis or other diseases affecting the pancreas
Diarrhea (prolonged)
High blood pressure
Liver disease
Stroke
Surgery within the last two months
Intestinal problemsthese conditions may interfere with
absorption of vitamin K into the body
Bleeding tendency
Brain disease ,tumor

Patient must tell doctor if have recently

had any of the following conditions:
-falls or blows to the body or head or any
injury
-injections into a blood vessel
Placement of any tube into the body
surgery including dental surgery

Dosing
Adult and children :the usual dose is 5 to
10milligrams a day
For prevention of bleeding in newborns:the
usual dose is 0.5 to 1mg injected into a
muscle or under the skin ,right after
delivery .the dose may be repeated after six
to eight hours if needed.

Side effects of vitamin K

Less common side effects:decreased
appetite,decreased movement or
activity ,difficulty in breathing,enlarged
liver,general body
swelling,irritability,muscle stiffness
More common side effects:bleeding or
oozing from cuts ,gums,wounds or around
the place of injection,fever,low blood
pressure

Side effects of vitamin K

Rare side effects:agitation,blue or purple
toes,blurred vision,changes in facial skin
color,chest pain,or
discomfort,chills,darkened
urine,decreased urine
output,depression,double vision,faster
irregular breathing,gangrenous finger or
toes

ValiumDiazepam

Why is this medication prescribed?

Is used to relive anxiety
Muscle spasms
Seizures and to control agitation
To treat irritable bowel syndrome

ValiumDiazepam
precautions should patient follow
Inform your doctor that you are receiving the
following:
Ativan
Tagamet
Digoxin
Lanoxin
Medication for depression
Depakene for Seizures
Medication to relieve Pain

ValiumDiazepam
precautions should patient follow
Inform your doctor that you are receiving the
following:
Medication for Parkinson`s disease
Medication for asthma
Muscle relaxant
Oral contraceptive
Inderal
zantic

ValiumDiazepam
precautions should patient follow
Inform your doctor that you are receiving the
following:
sedatives
Sleeping pills
Theophylline
Tranquillizers
vitamins (these medications may add to the
patient drowsing)

ValiumDiazepam
precautions should patient follow
If you use antacids take diazepam first then
wait one hour before taking the antacid
Tell your doctor if you have or have ever had
glaucoma (increase glomerular filtration rate)
Tell your doctor if you are pregnant,plan to
become pregnant or are breast feeding
If you are having surgery ,including dental
surgery ,this drug may make you drowsy

ValiumDiazepam
precautions should patient follow
Do not drive car or operate machinery until
you know how this drug affects
Cigarette smoking may decrease the
effectiveness of this drug

ValiumDiazepam
Side effects
Common side effects:
Drowsiness ,dizziness,tiredness,weakness,dry
mouth,diarrhea,upset stomach,change in
appetite
Tell your doctor if any of these symptoms are
severe:
restlessness,constipation,difficulty in
urination,blurred vision

ValiumDiazepam
Side effects
Call you doctor immediately in the following
conditions after receiving this drug:
Seizures,shuffling walk,persistent tremor or
inability to sit still,difficulty in breathing or
swallowing,severe skin rash,yellowing of the
skin or eyes ,Irregular heartbeat

Ventolin
Brand Names: isuprel.ventolin,
bronchometer

Bronchodilators
Adrenergic(inhalation) breathed through
the mouth to open up the bronchial tubes
(air passages ) of the lungs.
Are used to treat the symptoms of
asthma ,chronic bronchitis
Long acting bronchodilator that is used
with anti-inflammatory attack to prevent
asthma

Bronchodilators
Brand names:
Isuprel
Ventolin
bronkometer

Bronchodialators
The effects usually last about 12 hours
,doses should never be taken more than two
times a day effect
Children up to 4 years of age ,dose must be
determined by doctor.2 inhalations taken
15 to 30 min before start exercise

Bronchodialators-for preventing or treating

bronchospasm

Adult and children 12 years of age and older.

this medicine is used in nebulizer and is
taken by inhalation over 5 to 15 min.usual
dose is 2.5 milligrams taken every 4 to 6
hours of needed.

Bronchodialators-for preventing or treating

bronchospasm

Bronchodialators
For capsules (powder) :for preventing or
treating bronchospasm adult and children
4 years of age and older 200-400mg taken
by inhalation every 4 to 6 hours

Bronchodialators
Rare side effects:
dizziness,swelling in throat,redness of
skin,increased shortness of breath ,swelling
of face,lips,eyelids,tightness in chest or
wheezing
More common side effects:
fast heartbeat,headache,nervousness

Bronchodialators
Less common side
effects:
coughing,bronchial
irritation,dryness or
irritation of mouth

Bronchodialators
Aminophylline
Theophylline

Bronchodialators
Aminohylline ,theophylline used to treat
\prevent the symptoms of broncheal
asthma,chronic bronchitis and
emphysema.these medicine relive
cough,wheezing,shortness of breath

bronchodialators
Theophylline and pregnancy:
crosses the placenta cause unwanted effects
such as fast heartbeats,irritability
Breast-feeding:pass into the breast milk
may cause irritability in nursing babies of
mothers taking aminophylline ,theophylline

Certain medication should not be used at the

same time with:
Beta-adrenergic blocking agents(inderal) ,this
may prevent aminophylline,theophylline from
working properly
Tagamet
Coronary dialators
Erythromycin
Trental
Dilantin
Depakine

Bronchodialators should not be used with the

following medical problems:
Convulsions
Heart failure
Liver disease
Underactive thyroid

Proper use of bronchodialators

It works best when taken with a glass of
water on an empty stomach either 30 min to
one hour before meals or 2 hours after
meals.
In some case patient receive drug with
meals or right after meals to lessen stomach
upset

Proper use of bronchodialators

Check the level of drug in blood at regular
intervals ,to find out if dose needs to be
changed (it is very important)

Precautions while using of

bronchodialators
Check with doctor if the patient :
-have fever 38C or higher for at least 24
hours
- stop ,start smoking
-start or stop another medications
-change long term pattern of diet
-avoid caffeine containing food or beverages
such as chocolate ,coca,tea,coffee,cola

Side effects of bronchodialators

Less common side effects:
heartburn,vomiting,headache,fast heart
beat,increased
urination,nervousness,trouble in sleeping
Rare side effects:
skin rash