CBRNE - Vesicants, Mustard - Hd, Hn1-3, H Medication

Updated: Jan 02, 2018
  • Author: Daniel J Dire, MD, FACEP, FAAP, FAAEM; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to neutralize toxicity, reduce morbidity, and prevent complications.

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Cycloplegics and mydriatics

Class Summary

Instillation of long-acting cycloplegic agents can relax any ciliary muscle spasm that can cause a deep aching pain and photophobia.

Homatropine (AK-Homatropine, Isopto-Homatropine)

Contains homatropine hydrobromide, which blocks action of certain parasympathetic nerves and cholinergic drugs; used in ophthalmology for mydriatic and cycloplegic effects; peripheral effects are much weaker than those of atropine; preferred to atropine for diagnostic purposes because its action is more rapid, less prolonged, and is controlled readily by physostigmine; effect is exerted in 15-30 min and passes off in 12-24 h; usually does not produce complete paralysis of accommodation in children.

Atropine ophthalmic (Isopto, Atropair, Atropisol)

For use as long-acting mydriatic and cycloplegic; most potent ophthalmic parasympatholytic available; by paralyzing sphincter pupillae muscle, helps dilate pupil; also paralyzes ciliary muscle; effect lasts 7-10 d; also indicated to decrease GI motility.

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GI antispasmodic/antimotility agents

Class Summary

Thought to work centrally by suppressing conduction in vestibular cerebellar pathways. They may have an inhibitory effect on the parasympathetic nervous system.

Atropine IV/IM (Atropair, Isopto, Atropisol)

Acts at parasympathetic sites in smooth muscle and decreases GI motility.

Dosage may require reduction in elderly patients due to possible occurrence of cardiovascular and CNS adverse effects.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained burns.

Morphine sulfate (Duramorph, Astramorph, MS Contin)

DOC for narcotic analgesia because of its reliable and predictable effects, safety profile, and ease of reversibility with naloxone; morphine sulfate administered IV may be dosed in a number of ways and commonly is titrated until desired effect is obtained.

Meperidine (Demerol)

Narcotic analgesic with multiple actions similar to those of morphine; may produce less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

Drug combination indicated for relief of moderate to severe pain.

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Bronchodilators

Class Summary

Primary action is to decrease muscle tone in both small and large airways in the lungs, thus increasing airflow and ventilation. This category includes beta-adrenergic, methylxanthine, and anticholinergic medications.

Albuterol (Proventil, Ventolin)

Bronchodilator in reversible airway obstruction due to asthma; relaxes bronchial smooth muscle by action on beta 2-receptors with little effect on heart rate.

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Antibiotics

Class Summary

Topical and ophthalmic antibiotics routinely are used for dermal and ocular burns, respectively. Injured tissues lose many of their protective mechanisms and are at increased risk of infection.

Silver sulfadiazine (Silvadene)

Used topically for dermal burns and useful in prevention of infections from second-degree or third-degree burns; has bactericidal activity against many gram-positive and gram-negative bacteria, including yeast.

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Toxoids

Class Summary

Used to induce active immunity against tetanus in selected patients.

Tetanus toxoid adsorbed or fluid

Immunizing agents of choice for most adults and children >7 y are tetanus and diphtheria toxoids. Necessary to administer booster doses to maintain tetanus immunity throughout life.

Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.

In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site of administration is mid thigh laterally.

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Antitussives

Class Summary

Indicated for control of excessive cough.

Codeine/guaifenesin (Robitussin AC, Guiatuss AC, Mytussin AC, Brontex liq)

Treats minor cough resulting from bronchial and throat irritation.

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Corticosteroid creams

Class Summary

Indicated for inflammation of skin.

Hydrocortisone 1% (Cortaid, Dermacort, Westcort)

Adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity.

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