Unit 9B - Emergency Drug Kit

Question 1

What drugs are inside an animal emergency kit?

Answer 1

epinephrine, atropine, furosemide, an emetic like apomorphine or xylazine, an anticonvulsant like diazepam
a narcotic analgesic like hydromorphone AND antagonist like naloxone
narcotics must still be locked up

Question 2

What is the large animal standard emergency drug kit?

Answer 2

Epinephrine, atropine, antihistamine
calcium and magnesium parenteral solutions
A2 agonist ex. xylazine
Local anesthetic ex. bupivacaine
Analgesic - can be narcotic (butorphanol) or non-narcotic (flunixin)
A narcotic antagonist must be available if narcotics are used

Question 3

What are some additional drugs that may be present in an emergency drug kit?

Answer 3

anti-arrhythmic - lidocaine neat
bronchodilator - aminophylline
Steroid - dexamethasone
Needles, syringes, catheters
ET tubes
Supplemental O2 (anesthetic machine, ambu bag
Chart of precalculated drug dosages

Question 4

What do we need to make in regards to the emergency kit, why?

Answer 4

SOP!!
Ensure everyone knows where it is, restock after every use, check contents against an inventory list at least monthly, watch expiry takes, assign someone the task

Question 5

What are the biggest reasons why we reach for the emergency drug kit?

Answer 5

cardiac arrest, cardiac arrhythmias
resp arrest, anaphylaxis
serizures
cerebral edema > inc intracrandial pressure
Pleural effusion/pulmonary edema > poor oxygenation
severe asthma/COPD
toxin ingestion

Question 6

What routes are you generally going to use to give emerg drugs?

Answer 6

IV - best route bc best onset of action
in the trachea, rectum and transmucosal

Question 7

What is atropine?

Answer 7

anticholinergic drug
binds to and blocks ACH receptors > blocks PNS response
net result is overall inc in sympathetic tone
Inc HR, blocks peripheral vasodilation (skin and GI) w/ slight inc BP, and moves blood to support heart, lungs, kidney and brain
bronchodilator
mydriasis, dec secretions

Question 8

how is atropine used as an emergency drug

Answer 8

to treat bradycardia/cardiac arrest, give IV
treat organophosphate toxicity - o-phos inhibits ACH-ase leading to inc circulating ACH
Atropine blocks ACH from binding the cholinergic receptors (both muscarinic and nicotinic), which blocks PS signs and blocks the muscle rigidity/paralysis seen w/ overstimulation of nicotinic receptors

Question 9

What is lidocaine?

Answer 9

anti-arrythmic
MOA: sodium channel blocker
binds to and dec flow of NA ions into cardiac cells
slows down rate of depolarization and extends refractory period
decs HR
also by slowing spontaneous depolarization occur abnormally in the heart, the SA node is able to regain control of the heart rate and rhythm

Question 10

What are the emergency uses of lidocaine

Answer 10

Antiarrhythmic when given IV
used to tx ventricular arrhythmias like PVCs and V-fib
systemic OD can cause anything from sedation/ataxia (slight overdose), seizure and collapse (moderate overdose) to sinus arrest and death
Must only use lidocaine neat - other form (lidocaine + epinephrine only used as local anesthetic agent

Question 11

What is epinephrine?

Answer 11

non-selective adrenergic agonist (epinephrine, ephedrine, dobutamine)
binds and activatea A1, B2 and B3 adrenergic receptors
dobutamine is most frequently used in cases of acute heart failure
Epinephrine has slight inc B1 activity compared to is activity on other adrenergic receptors
Main effect: in HR
also causes peripheral vasoconstriction > inc BP > inc airway diameter > pupil dilation

Question 12

What are the emergency uses of epinephrine?

Answer 12

CPR drug - cardiac resuscitation (high dose of 0.1mg/kg IV or IT every 2-5 m)
anaphylaxis - low dose of 0.01mg/kg, IV, SQ or IM depending on how emergent and symptoms, too rapid IV can cause arrhythmias

Question 13

What is doxapram?

Answer 13

resp stimulant
MOA: centrally acting (works on the brain to stimulate an inc resp rate and tidal volume
S/e - due to non-specific brain stimulation : aggression, tremors, seizure, also inc BP and arrhythmias

Question 14

What are some emergency uses of doxapram?

Answer 14

used in CPR and resuscitating puppies lost C-section (stimulates breathing if apnea (stopped) or bradypnea (very slow)
Reverses resp depression caused by CNS depressants (premeds or anesthetics)
Cause use w/ opioid-induced resp depression if antagonist not available
1- turn down anesthetic, 2 -manual ventilation, 3- reverse, 4 -doxapram
Doxapram is 2nd choice to true reversal
Naloxone is opioid premed or yohimbine if antisedan is a2 premed

Question 15

What is salbutamo?

Answer 15

b2 adrenergic agonist
MOA: turn on asymp bronchodilation by bind to and activated the b2 receptors
these drugs stabilize mast cells so less histamine release
s/e: stim of b1 receptors in heart (this is s/e is lessened w/ local administration)

Question 16

What are the emerg uses of salbutamol?

Answer 16

used to treat asthma/copd - bronchoconstriction caused by blocking of B2 adrenergic receptors in airways
Injectable available often given w/ MDI dispenser in anims
local admin dec dose and systemic s/e

Question 17

What is theophylline?

Answer 17

For bronchodilation (is a methylxanthine)
Is given systemically and comes w/ more systemic s/e

Question 18

What is diazepam

Answer 18

benzodiazepine class tranquilizer
MOA: inc GABA (inhib NT) in brain, if we inc an inhib NT, net result is inhib in brain
Store in dark, never in plastic, never mix with other drugs
Controlled drug
S/e: sedation, ataxia, may activate latent aggression, risk of liver failure inc ats

Question 19

What are the emergency uses of diazepam?

Answer 19

anti-convulsant
1. emerg at home drug in severe >5min seizure or >1 seizure in 24hr peiriod, administer rectally and give up to 2 doses 15m apart
2. emerg in clinic - cri or repeated IV bolus

Question 20

What is furosemide?

Answer 20

common used diuretic in all vet species
fastest and strongest acting of all diuretics that act on kidneys
causes water loss via acting on loop of henle > an lost into urine > water follows Na > at convoluted tubule, Na is exchanged for K (Na reabsorbed, K excreted, water stays in tubule)

Question 21

What are emergency uses of furosemide?

Answer 21

to tx cerebral edema, pulmon edema, pleural effusion, CHF, hypertension, drug toxicity (speeds up elimination)
used IV emerg situations - onset of action 5-15m

Question 22

What is mannitol/glycerin?

Answer 22

osmotic diuretics
lg sugars that stay in the vessels and draw water out of the interstitial spaces > then readily secreted into urine (not reabsorbed) > inc osmotic pressure in urine which also results in more water being retained in urin

Question 23

What are the emerg uses of mannitol/glycerin

Answer 23

used to dec intracranial pressure due to cerebral edema
used to dec intraocular pressure in acute glaucoma
in hospital emerg IV only

Question 24

What is diphenhydramine?

Answer 24

antihistamine
MOA: bind to histamine receptors and block them (stop histamine from binding)
more effective as prevention than treatment
cant kick histamine already bound
As histamine binds and unbinds, will eventually bind the receptors
S/e mild sedation, mild anticholinergic effects

Question 25

What do we see with histamine release?

Answer 25

acute inflam
vasodilation and edema
bronchoconstriction

Question 26

What are some emergency uses of diphenhydramine?

Answer 26

Used to tx/prevent anaphylaxis - vx reactions most common indication
used to tx asthma attacks - causes bronchodilator by preventing smooth muscle contraction in the bronchioles
Note: steroids and/or epinephrine would be used in cases of more severe anaphylaxis

Question 27

How is naloxone used as an emerg drug?

Answer 27

reversal for opioids
MOA: binds and blocks opioid receptors
used to tx opioid induced hyperthermia in cats
also used to tx resp depression caused by opioids

Question 28

What are fast acting steroids?

Answer 28

steroids are potent anti-inflam drugs
as allergy/anaphylaxis involves activating the inflam cascade, steroids can be very helpful in these cases
steroids can also be useful in any other condition that involves inflam - asthma, COPD, etc

Question 29

What are fast acting insulins?

Answer 29

ultra fast acting or fast acting insulin like humulin R
needs to be refrigerated, so not technically in emerg drug kit but good to have in clinic
used to tx acute diabetic ketoacidosis

Question 30

What emetic drugs are used in cases of toxin ingestion

Answer 30

Apomorphine - 1st choice in dogs
tablet form, can dissolve in sterile saline and squirt into conductive or whole tablet in conjunctival sac (flush eye bc irritating)
OR dissolved in saline and filtered via micro-filter (to sterilze ) then iv
Demedetomidine, xylaxine
A2 agonists, works well in cats