Medicinal Drugs

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Written by NAME DELETED, RN

Please note that the following information is for fanfic only and must not be used as guidelines for treatment in any context other than the purely fictional. If you have a real-life medical problem or question, please go through the proper channels. (2008 note: It was also written in 1997, so the information could well be out of date.)

The following are some common medications that might be used for specific needs, such as for pain relief, fighting bacterial infestations, or for emergency resuscitation.


Painkillers:

Can be oral, intramuscular or intravenous. Oral is generally the slowest route, IV is the fastest. Whether it is given one way or another depends on the severity of the pain and where the patient is (eg home, hospital or Area 51). Only doctors, NP's, PA's, registered nurses and paramedics can give IV meds, and the nurse and the paramedic must have a doctor's order before giving it.

Intravenous Primer: IV's are started to provide access to a patient's veins, and allow almost immediate effect of the medication to be administered. One can either insert the syringe directly in the vein for a one-time injection, or establish an IV line with a bag of fluid to drip in and keep the vein from clotting off. Direct insertion is not always very easy (the metal needle on the syringe can be tough to get into the vein without going right out the other side), and if M or S were in bad shape, I recommend starting an IV as the prudent thing to do, assuming all the equipment was within reach. Some types of IV fluid which are commonly used are: D5W (dextrose 5% in water), D5 1/2NS (dextrose 5% in 0.45% Saline solution), D5LR (dextrose 5% with Lactated Ringer's solution), LR (lactated Ringers), and NS (normal saline, which is 0.9% saline solution).

If one of our intrepid agents happens to be in a coma or ill enough for prolonged hospitalization without being well enough to eat, you might see them using Total Parenteral Nutrition (TPN) which is a nutritious brew of minerals, fluids, sugars and some electrolytes, such as potassium. If you use TPN, the victim needs to have his or her IV be a 'central line' (in the clavicular or jugular area) rather than a peripheral line (in the hand or the wrist.)

Examples of painkillers:


Remedies

Overdoses of opiate narcotics can be reversed nearly instantaneously with the use of Narcan 0.4-2.0 mg IVP. Can also be given subcutaneously or intramuscularly. May repeat every 2-3 minutes as needed until effective. May put on continuous IV infusion, as Narcan is rapidly metabolized. The long-term effects of the narcotics will probably outlast the short-term effect of the Narcan, and the patient who appeared to be recovering might once again relapse.

Flumazemil is used to reverse the effects of respiratory depression caused by overdosing of Valium (diazepam) or other benzodiazepines.


Anti-Anxiety

Xanax (aprazolam), Ativan, Valium (diazepam), Librium (chlordiazepoxide HCl) and BusPar (buspirone HCl). Can be habit-forming. Ativan, valium and librium can also be given IV.


Sleeping Pills

Halcion (triazolam): 0.125-0.5 mg orally at bedtime. Hypnotic. Used as a sleeping pill. Causes dizziness, headache, rebound insomnia, amnesia, decreased coordination, confusion, depression, nausea or vomiting

Ambien (zolpidem tartrate): 5-20 mg at bedtime. Can cause nightmares and abnormal dreams, amnesia, nausea, vomiting and diarrhea. Is not supposed to cause a morning 'hangover'.

Restoril (temazepam): 7.5 - 30 mg at bedtime. Causes daytime sedation the morning after use.

Benadryl (diphenhydramine HCl): 50 mg at bedtime. This is the part of many cold pills that can cause drowsiness. Causes very dry mouth.


Antibiotics

Many and varied doses and uses; email me for specifics. (Email address deleted - 2008)

Ampicillin - ear infections

Penicillin - broad spectrum; used for gonorrhea, syphilis, some types of meningitis, some tetanus, diptheria, bacterial endocarditis, strep throat. Can be oral or intramuscular

Erythromycin - bronchitis

Bactrim - Septra

Rocephin

Tetracycline

Chloramphenicol - typhoid fever, streptococcal pneumonia, some meningitis

**this drug can cause severe blood disorders including irreversible bone marrow depression

Clindamycin when penicillin and erythromycin can not be used

**strep, pneumococcus, staph, anaerobic bacteria

Vancomycin - staph systemic infections, osteomyelitis, pneumonia

Keflex, keflin, ancef, ceclor, mefoxin, claforan, fortaz, cleocin, cipro, vibramycin - usually IV for 2-5 days, then orally for 5 - 14 days


Emergency Resuscitation

Licdocaine and bretylium are used IV to correct cardian arrythmias.

Procaine - treats PVC's, v-tach, atrial fibrillation. atrial tachy

Epinephrine aka adrenaline - treats cardiac arrest, allergic reactions. Can be given inhalant, subcutaneous, IV or intracardiac

Atropine - Speeds up a heart that is beating dangerously slow; used in bradycardia (probably heart rates below 45 or 50)

Verapamil paroxysmal supraventricular tachy - rapid heart rates (probably above 180) but not associated with vtach or vfib

Dopamine, nitroglycerine, digoxin, isuprel, nitroprusside etc. are more specialized critical care meds, and if you want to use them, email me (address deleted - sorry!) and I will send along detailed info on them.


Blood and Blood Products

Whole Blood - Sort of explanatory. About 450cc's, must be cross-matched to avoid allergic reaction. O- is pretty safe for just about anyone if there is no time to type and cross.

RBC - Just the red blood cells, if patient needs to increase oxygen carrying capacity, like in anemia.

Platelets - When the patient is at increased risk of hemorrhage due to the loss of clotting ability. Esp used when platelets are destroyed in chemo and radiation.

Plasma - The straw-colored bath that the white, red and platelets swim around in.

Plasma Expanders - Used in emergencies to keep blood volume and thus blood pressure up enough to avoid brain or organ damage until the patient can get to a trauma ER. Probably are synthetic. IV fluids in themselves can not augment the O2 carrying capacity of the blood, and at some point insufficient O2 will cause death


Nasty but Effective Murder Techniques

Give potassium IV push really fast, about 100mEq. Hurts dreadfully and burns on its way in, and the bolus will stop the heart in just a couple of seconds. Guess that kind of makes the burning irrelevant! If I am not mistaken, this is what Leonard Betts used on the woman EMT that he murdered.

Give succinylcholine or curare derivatives (pancuronium) IV and the person will be paralyzed. Immediately. They can't speak, move, or breathe. Their eyes may still be open, and your villain can watch them die a terrified and horrific death by suffocation without making a sound. The way to save the innocent victim of this nefarious technique is to intubate them and put them on a ventilator within about 2-4 minutes, and support their ventilations until they metabolize the drug. I guess that, out in the field, you would have to do really correct mouth-to-mouth or "bag the patient" with one of those ambu-bags. After initial signs of recovery, anticholines- terase agents such as neostigmine and edrophonium can be used to reverse the neuromuscular blockade.


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