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Emergency neuropsychiatric drugs
Related Subjects: |Emergency Drugs |Emergency Drug Antidotes |Emergency Cardiac Drugs |Emergency Endocrine Drugs |Emergency Gastrointestinal Drugs |Emergency Haematology Drugs |Emergency Neuropsychiatric drugs |Emergency Pain drugs |Emergency Respiratory drugs |Emergency Obstetric and Gynaecology Drugs |Emergency Paediatric Drugs
Check all doses with BNF or equivalent UK guidelines
| DRUG (UK Name) | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION / CAUTION |
|---|---|---|---|---|---|
| Diazepam | Enhances inhibitory effects of GABA at benzodiazepine receptors | 2–10 mg IV/IM every 6 h PRN | 2–10 mg PO every 6 h PRN | Seizure management, alcohol withdrawal, agitation, muscle spasm | Respiratory depression, hypotension, caution in pregnancy (Preg D) |
| Droperidol | Dopamine and alpha receptor antagonist | 1.25–2.5 mg IV every 4 h PRN | N/A | Antiemetic, treatment of migraine-associated nausea | QT prolongation (risk of Torsades), NMS, EPS; caution in pregnancy (Preg C) |
| Fosphenytoin | Prodrug of phenytoin; stabilises neuronal Na+ channels, stopping seizure activity | 15–20 mg PE/kg IV loading at ≤150 mg PE/min (PE = phenytoin equivalents) | N/A | Status epilepticus | Rapid infusion can cause hypotension/dysrhythmias; monitor ECG and BP, caution in pregnancy (Preg D) |
| Haloperidol | Dopamine receptor antagonist (D1/D2) | 5–10 mg PO/IM/IV every 2 h PRN (max 100 mg/day) | N/A | Agitation, psychosis | Dementia-related psychosis, NMS, EPS, QT prolongation; caution in pregnancy (Preg C) |
| Ketamine | NMDA receptor antagonist providing dissociative anaesthesia |
Subdissociative: 0.1–0.5 mg/kg IV
Procedural sedation: 0.5–1 mg/kg IV RSI induction: ~2 mg/kg IV |
N/A | Analgesia, sedation, RSI induction | Emergence reactions (may use benzodiazepines), laryngospasm, raised IOP/ICP, tachycardia, hypertension; caution in pregnancy (Preg D) |
| Methohexital | Ultra-short acting barbiturate producing sedation and hypnosis | 1 mg/kg IV, then 0.5 mg/kg every 2–5 min PRN | N/A | Procedural sedation | Laryngospasm (treat with additional methohexital), respiratory depression, hypotension; caution in pregnancy (Preg B) |
| Midazolam | Enhances inhibitory effects of GABA (benzodiazepine) |
RSI: ~0.1 mg/kg IV
Infusion: 1–10 mg/h Procedural sedation: 0.02–0.04 mg/kg IV |
N/A | Seizure control, procedural sedation, ventilator sedation, RSI induction | Respiratory depression, hypotension; caution in pregnancy (Preg D) |
| Nimodipine | Calcium channel blocker selective for cerebral arteries | N/A | 60 mg PO every 4 h | Prevention of vasospasm post subarachnoid haemorrhage | Hypotension; caution in pregnancy (Preg C) |
| Olanzapine | Antagonist at dopamine, histamine, alpha1, and 5-HT2 receptors | 5–10 mg IM/day (max 30 mg/day) | 5–10 mg ODT/day (max 30 mg/day) | Agitation, psychosis | Not for dementia-related psychosis, NMS, EPS, orthostatic hypotension, QT prolongation; no IV form; caution in pregnancy (Preg C) |
Neurology Drugs
| DRUG (UK Name) | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION / CAUTION |
|---|---|---|---|---|---|
| Lorazepam | Enhances inhibitory effects of GABA (benzodiazepine) | Bolus: 1–2 mg IV
Infusion: 1–10 mg/h |
N/A | Delirium tremens, status epilepticus, serotonin syndrome, agitation | Respiratory depression, hypotension; caution in pregnancy (Preg D) |
| Mannitol | Osmotic diuretic increasing plasma osmolarity, reducing ICP | 1 g/kg IV once (may be repeated as per protocol) | N/A | Elevated ICP, impending cerebral herniation | May cause dehydration, electrolyte imbalance, osmotic nephrosis |
| Phenobarbital | Barbiturate causing sedation, hypnosis, and can suppress seizures | 20 mg/kg IV loading; may repeat 5–10 mg/kg in 20 min (max 30 mg/kg total); max infusion 50 mg/min | N/A | Status epilepticus | Respiratory depression, hypotension; caution in pregnancy (Preg D) |
| Levetiracetam (Keppra) | Modulates SV2A protein and inhibits neurotransmitter release, preventing seizures | 20–40 mg/kg IV loading (often 1–2 g IV over ~15 min) | 500–1500 mg PO twice daily (adjust dose per response) | Seizure prophylaxis and treatment | Generally well-tolerated; sedation, irritability, rare psychosis; caution in pregnancy (Preg C) |
| Phenytoin | Stabilises voltage-dependent neuronal Na+ channels |
Loading: 15–20 mg/kg IV at ≤50 mg/min
Maintenance: ~100 mg IV every 6–8 h |
~100 mg PO three times daily (adjust based on levels) | Status epilepticus, seizure prophylaxis | Hypotension, arrhythmias with rapid infusion, CNS side effects (nystagmus, ataxia), CYP interactions; caution in pregnancy (Preg D) |
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