Epinephrine

A hormone and neurotransmitter. That participates in the "fight or flight" response of the sympathetic nervous system. It is a catecholamine, a sympathomimetic monoamine produced by the adrenal glands from the amino acids phenylalanine and tyrosine.

Epinephrine
a powerful action, "fight or flight", hormone and also plays a central role in the short-term stress reaction. It is released from the adrenal glands when danger threatens or in an emergency, hence an Adrenaline rush. Such triggers may be threatening, exciting, or environmental stressor conditions such as high noise levels, or bright light and high ambient temperature.

Epinephrine
MOA:
Epinephrine's actions are mediated through adrenergic receptors. Epinephrine is a nonselective agonist of all adrenergic receptors. It activates 1, 2, 1, and 2 receptors to different extents

Epinephrine
INDICATIONS:
It increases heart rate and stroke volume, dilates the pupils, and constricts arterioles in the skin and gastrointestinal tract while dilating arterioles in skeletal muscles. It elevates the blood sugar level by increasing catabolism of glycogen to glucose in the liver, and at the same time begins the breakdown of lipids in fat cells. Like some other stress hormones, epinephrine has a suppressive effect on the immune system

Epinephrine
SIDE EFFECTS:
Adverse reactions to epinephrine include palpitations, tachycardia, arrhythmia, anxiety, headache, tremor, hypertension, and acute pulmonary edema.

CONTRAINDICATION:
Use is contraindicated for patients on nonselective -blockers because severe hypertension and even cerebral hemorrhage may result.

Hydrocortisone Sodium Succinate

Mechanism of Action:
Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability

Use: Labeled Indications

Management of adrenocortical insufficiency; relief of inflammation of corticosteroid-responsive dermatoses (low and medium potency topical corticosteroid); adjunctive treatment of ulcerative colitis

Hydrocortisone Sodium Succinate

Use: Dental
Treatment of a variety of oral diseases of allergic, inflammatory, or autoimmune origin

Contraindications:
Hypersensitivity to hydrocortisone or any component of the formulation; serious infections, except septic shock or tuberculous meningitis; viral, fungal, or tubercular skin lesions; I.M. administration contraindicated in idiopathic thrombocytopenia purpura Rectal suspension: Systemic fungal infections; ileocolostomy during the immediate or early postoperative period

Hydrocortisone Sodium Succinate

Adverse Reactions:
Systemic: Frequency not defined: Cardiovascular: Edema, hypertension Central nervous system: Delirium, euphoria, hallucinations, headache, insomnia, nervousness, pseudotumor cerebri, psychoses, seizure, vertigo Dermatologic: Bruising, hyperpigmentation, skin atrophy

Hydrocortisone Sodium Succinate

Endocrine & metabolic: Adrenal suppression, alkalosis, amenorrhea, Cushing's syndrome, diabetes mellitus, glucose intolerance, growth suppression, hyperglycemia, hyperlipidemia, hypokalemia, pituitary-adrenal axis suppression, sodium and water retention Gastrointestinal: Abdominal distention, appetite increased, indigestion, nausea, pancreatitis, peptic ulcer, ulcerative esophagitis, vomiting

Hydrocortisone Sodium Succinate

Hematologic: Leukocytosis (transient) Neuromuscular & skeletal: Arthralgia, fractures, muscle weakness, osteoporosis Ocular: Cataracts, glaucoma Miscellaneous: Avascular necrosis, hypersensitivity reactions, infection, secondary malignancy

Sodium Bicarbonate
THERAPEUTIC USE:
Sodium bicarbonate is used in an aqueous solution as an antacid taken orally to treat acid indigestion and heartburn. It may also be used in an oral form to treat chronic forms of metabolic acidosis such as chronic renal failure and renal tubular acidosis.

Sodium Bicarbonate
Sodium bicarbonate may also be useful in urinary alkalinization for the treatment of aspirin overdose and uric acid renal stones. It is used as well for treatment of hyperkalemia. Since sodium bicarbonate can cause alkalosis, it is sometimes used in to treat aspirin overdoses. Aspirin requires an acidic environment for proper absorption, and the basic environment diminishes aspirin absorption in the case of an overdose. Sodium bicarbonate has also been used in the treatment of tricyclic antidepressant overdose. It can also be applied topically as a paste, with three parts baking soda to one part water, to relieve insect bites.

Sodium Bicarbonate
ADVERESE EFFECTS:
Adverse reactions to the administration of sodium bicarbonate can include metabolic alkalosis, edema due to sodium overload, congestive heart failure, hyperosmolar syndrome, hypervolemic hypernatremia, and hypertension due to increased sodium. In patients who consume a high calcium or dairy-rich diet, calcium supplements, or calcium-containing antacids such as calcium carbonate (e.g., Tums), the use of sodium bicarbonate can cause milkalkali syndrome, which can result in metastatic calcification, kidney stones, and kidney failure.

Sodium Bicarbonate
CONTRAINDICATIONS:
Pre-existing heart disease, kidney disease, liver disease, high blood pressure, any allergies. Because this medication contains a large amount of sodium, remind your doctor if you are on a low sodium diet. This medication should be used only if clearly needed during pregnancy. Discuss the risks and benefits with your doctor. Since small amounts of this medication appear in breast milk, consult your doctor before breast-feeding.

Sodium Bicarbonate
DENTAL USE:
Sodium bicarbonate is also used as an ingredient in some mouthwashes. It works as a mechanical cleanser on the teeth and gums, neutralizes the production of acid in the mouth and also as an antiseptic to help prevent infections occurring

Diphenydramine (Benadryl)
MOA
Competitively blocks the effects of histamine at peripheral H1 receptor sites; has anticholinergic (atropine-like) and sedative effects.

Contraindications
Allergy to any antihistamines Asthmatic attack Not to be used in neonates

Diphenydramine (Benadryl)
Therapeutic Effects
Relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis; mild, uncomplicated urticaria and angioedema Amelioration of allergic reactions to blood or plasma Dermatographism - skin disorder seen in 45% of the population and is one of the most common types of urticaria, in which the skin becomes raised and inflamed when stroked or rubbed with a dull object Adjunctive therapy in anaphylactic reactions Mild nighttime sedation Prevention of motion sickness Antinauseant Topical anesthetic Treatment of antipsychotic induced extrapyramidal symptoms

Diphenydramine (Benadryl)
Adverse Effects
Drowsiness, dizziness, dryness of mouth, nausea and nervousness may occur. Other infrequently reported effects are vertigo, palpitation, blurring of vision, headache, restlessness, insomnia and thickening of bronchial secretions. Allergic reactions, diarrhea, vomiting and excitation may also occur

Dose: 5ml/IV

Aromatic Spirits of Ammonia

MOA
Respiratory stimulantAromatic ammonia spirit is a reflex respiratory stimulant that acts by causing peripheral irritation of the sensory receptors in the nasal mucous membranes, esophageal mucosa, and fundus of the stomach has antacid and carminative properties

Contraindications
Eye problems Respiratory disease or impairment Flushed face (when associated with syncope, flushed face may indicate the presence of cardiovascular disease or cerebrovascular disturbance)

Aromatic Spirits of Ammonia

Therapeutic Uses
Syncope (Fainting) - loss of consciousness generally caused by insufficient oxygen in the brain either through cerebral hypoxia or through hypotension, but possibly for other reasons.

Adverse Effects
Cough, diarrhea, difficulty in breathing, headache, and vomiting Inhaling high concentrations of ammonia can cause severe lung damage If aromatic ammonia spirit comes into contact with the eyes or skin, burns and irritation may occur. Burns in the eyes may lead to blindness.

Dose: 1 capsule, by inhalation

Glyceryl Trinitrate (Nitroglycerin)

MOA
Antianginal or cardiac loadreducing agentNot specifically known but thought to cause a reduction of myocardial oxygen demand. This is attributed to a reduction in left ventricular preload and afterload because of venous (predominantly) and arterial dilation with a more efficient redistribution of blood flow within the myocardium.

Contraindications
Obstructive hypertrophic cardiomyopathy, pronounced hypovolemia, inferior myocardial infarction with right ventricular involvement, raised intracranial pressure, cardiac tamponade

Therapeutic Uses
Angina Pectoris (Anti-anginal) Antihypertensive Congestive heart failure Treatment of chronic anal fissures

Glyceryl Trinitrate (Nitroglycerin)

Adverse Effects
Facial flushing Fast heartbeat Dizziness Mild headache Nausea

Dose: 1 tablet, sublingually

Morphine Sulfate
Action:
Chemical effect: Binds with opioid receptors in CNS, altering both perception of and emotional response to pain through unknown mechanism

Therapeutic Effect:
Relieves pain

Effects on Lab Results:

May increase amylase level May decrease platelet count

Morphine Sulfate
Indications:
Severe pain Moderate to Severe Pain, requiring continuous, around-the-clock opiod Management of pain not responsive to nonnarcotic analgesics Dyspnea associated with acute left ventricular failure and pulmonary edema Preoperative sedation; adjunct to anesthesia; analgesia during labor

Morphine Sulfate
Pharmacokinetics:
Absorption: Variable when given by mouth; unkown for other routes Distribution: Wide. Morphine distributes to skeletal muscle, kidneys, liver, intestinal tract, lungs, spleen, and brain; crosses the placental membrane and is found in breast milk. Metabolism: Primarily in Liver. Excretion: In urine and bile. Half-life: 2 to 3 Hours

Morphine Sulfate
Contraindications
Hypersensitivity to opiates upper airway obstruction acute asthma diarrhea caused by poisoning or toxins Injection: Heart failure secondary to chronic lung disease; cardiac arrhythmias; brain tumor; acute alcoholism; delirium tremens; idiosyncrasy to the drug; convulsive states (eg, status epilepticus, tetanus, strychnine poisoning).

Morphine Sulfate
Immediate-release oral solution: Respiratory insufficiency; severe CNS depression; heart failure secondary to chronic lung disease; cardiac arrhythmias; increased intracranial or cerebrospinal pressure; head injuries; brain tumor; acute alcoholism; delirium tremens; convulsive disorders; after biliary tract surgery; suspected surgical abdomen; surgical anastomosis; idiosyncrasy to the drug; concomitantly with MAOIs or within 14 days of such treatment.

Morphine Sulfate

Intrathecal/epidural Infection at injection site: anticoagulation; bleeding condition; parenteral corticosteroids within past 2 wk; any other drug or condition that would contraindicate intrathecal/epidural therapy.

Morphine Sulfate
Side effects/Adverse reactions
CNS: sedation, somnolence, clouded sensorium, euphoria, dizziness, choeric movements, seizures, headache, insomnia, agitation, light-headedness, syncope CV: hypotension, arrhythmias, bradycardia, shock, cardiac arrest, palpitations, edema EENT: visual disturbances GI: nausea, vomiting, constipation, ileus, dry mouth, anorexia, biliary tract spasm. GU: urine retention

Morphine Sulfate
Respiratory: respiratory depression, respiratory arrest Skin: Diaphoresis, pruritus urticaria Other: physical dependence, pain at injection site, tissue irritation, induration, decreased libido

Dextrose Phenylephrine
Action
vasoconstrictor Chemical effect: Mainly stimulates alphaadrenergic receptors in sympathetic nervous system

Therapeutic Effect
Raises blood pressure and stops paroxysmal suprventricular tachycardia

Dextrose Phenylephrine
Pharmacokinetics
Absorption: Unknown Distribution: Unknown Metabolism: Metabolized in Liver and intestines. Excretion: Unknown

Dextrose Phenylephrine
Indications
Mild to Moderate hypotension Severe hypotension and shock (including druginduced) Paroxymal supraventricular tachycardia Hypotensive emergencies during spinal anesthesia Maintainance of blood pressure during spinal or inhalation anesthesia Prolongation of spinal anesthesia Vasoconstrictor for regional anesthesia

Dextrose Phenylephrine
Side Effects/Advese Reactions
CNS: euphoria, dizziness, seizures, headache, anxiety, nervousness, weakness, excitability CV: hypertension, arrhythmias, bradycardia, Respiratory: asmathic episodes Skin: Tissue sloughing with extravasation Other: anaphylaxis

Dextrose 5% in water
Action
A simple water-soluble sugar that minimizes glycogenesis and promotes anabolism inpatients whose oral caloric intake is limited

Pharmacokinetics:
Metabolism: Glucose use depends on metabolic rate. It is stored in the liver and muscle as glycogen. Excretion: Water use depends on clinical state of patient, body temperature and renal function. Excreted through the skin, lungs, and kidney.

Dextrose 5% in water
Therapeutic Effects
Provides calories for some metabolic needs. Each 100 mL provides 5 gm of Dextrose. Depending on the presence of insulin, glucose enters cells and is broken down to pyruvate. With adequate oxygen, it enters the Kreb's cycle in the mitochondria and is converted into energy (A.T.P.), CO2 and H2O. The brain and gonads do not require insulin for glucose metabolism Spares body protein by providing carbohydrate for metabolism.

Dextrose 5% in water
Supplies body water for hydration. Osmolarity of D5W is 252 mOsm/L. The fluid is isotonic when in the container. After administration, the dextrose is quickly metabolized in the body, leaving only water - a hypotonic fluid. The pH range is 3.5 - 6.5. Capable of producing diuresis depending on clinical state of the patient.

Dextrose 5% in water
Indications
Fluid replacement and caloric supplementation in patients who cant maintain adequate oral intake or are restricted from doing so Dehydration Hyperkalemia Spares body protein; provides nutrition

Dextrose 5% in water
Contraindications
Patients at risk for increased I.C.P. Patients who have an acute neurological dysfunction. Hypovolemic states. Patients at risk for third-space fluid shifts. Elevated blood glucose concentrations.

Dextrose 5% in water
Side Effects/Adverse Reactions
CNS: Fever, confusion, unconsciousness in hyperosmolar hyperglycemic nonketotic stndrome CV: worsened hypertension and heart filure with fluid overload in susceptible patients, phlebitis, venous sclerosis, tissue necrosis with prolonged or concentrated infusions, especially when given peripherally

Dextrose 5% in water
Metabolic: hypovolemia, hypervolemia, hyperglycemia, dehydration, and hyperosmolarity with rapid infusion of concentration solution or prolonged infusions,; hypoglycemia from rebound hyperinsulinemia with rapid termination of longterm infusions GU: Glycosuria, osmotic diuresis Respiratory: Pulmonary edema Skin: Tissue and sloughing necrosis if travasation occurs with concentrated solutions

Anticonvulsant
Individual choice Indications:
Severe or prolonged convulsion as in toxic reaction to local anesthetic

Dose and route:

1 mL IV / IM

Anticonvulsant (Diazepam *VALIUM*)

MOA:
Affect GABA receptors (trigger)

Therapeutic use for dentistry:

relieve pre-op tension and anxiety Sedative, amnesiac anticonvulsant

Dose and Route

1- 8 mL IV (titrated)

Anticonvulsant (Diazepam *VALIUM*)

Adverse Effects:
drowsiness and confusion

Contraindications:
do not take with Flumazenil pregnant women liver disease narrow angle glaucoma Alcohol intake Other CNS depressants

Anticonvulsant (Phenobarbital *NEMBUTAL*)

Dose and route:
1mL IV ( careful titration)

MOA:
interaction with GABA receptors

Therapeutic use for dentistry:

commonly used for sedation Anesthesia Anticonvulsant anti-anxiety

Anticonvulsant (Phenobarbital *NEMBUTAL*)

Adverse Effects:
drowsiness, impaired concentration, mental and physical sluggishness, drug hangover, drug dependence

Contraindications:
Hypovolemia; Anemia; borderline hypoadrenal function cardiac or respiratory disease patients with nephritis or severe respiratory dysfunction; severe liver disease

Naloxone HCL
Indication:
Narcotic depression

Dose and route: 1 mL IV/Im MOA:

has an extremely high affinity for -opioid receptors in the central nervous system. Naloxone is a -opioid receptor competitive antagonist, and its rapid blockade of those receptors often produces rapid onset of withdrawal symptoms. Naloxone also has an antagonist action, though with a lower affinity, at - and -opioid receptors.

Naloxone HCL
Therapeutic use in dentistry :
effective in reversing respiratory depression due to opiate-derived drugs

Adverse effect:
agitation nausea and vomiting pulmonary edema Hypotension cardiac arrhythmias seizures.

Naloxone HCL
Contraindications:
hypersensitivity to Naloxone hydrochloride or to any of the other ingredients contained in the formulation

Isoproterenol HCL Aerosol

Indication:
bronchospasm

Dose and route:

1 / 2 inhalations

MOA:
Produces bronchodilation by relaxing bronchial smooth muscle through beta-2 receptor stimulation; increases heart rate and myocardial contractility by stimulating cardiac beta-1 receptors, which increases cardiac output

Isoproterenol HCL Aerosol

Therapeutic use:
Management of bronchospasm during anesthesia; adjunctive treatment for shock

Adverse effects:
Palpitations; tachycardia; BP changes; arrhythmias; Adams-Stokes attacks; cardiac arrest. Tremor; dizziness; nervousness; drowsiness; headache; insomnia. Nausea; GI distress.

Isoproterenol HCL Aerosol

Cough; throat irritation; bronchitis; sputum increase; pulmonary edema. Parotid gland swelling with prolonged use; saliva discoloration; sweating; skin flushing.

Contraindications:
Cardiac arrhythmias associated with tachycardia; tachycardia or heart block caused by digitalis intoxication; angina; ventricular arrhythmias requiring inotropic therapy.