I. Anti-cranial pressure, dehydration, diuretics
1. Mannitol (Mannitolum, D-mannitol)
Pharmacological effect: hypertonic diuretic, lowering cranial pressure by producing tissue dehydration. It can scavenge free radicals, reduce blood viscosity and improve blood circulation in ischemic cerebrovascular disease.
Uses: (1) For the treatment of cerebral edema and glaucoma; (2) For edema caused by large area burns and scalds;
Dosage: 250-500ml of 20% solution in static drip at a rate of 10ml per minute, repeated every 4-6 hours as needed.
Precautions: (1) injecting too fast can cause transient headache, dizziness, pain at the injection site; (2) use with caution in cardiac and renal insufficiency; (3) allergic reactions; (4) easy to precipitate crystals when the temperature is low.
2.Glycerol fructose (10% Glycerosteril)
Pharmacological effects: (1) hypertonic dehydration;
(2) The energy generated by glycerol metabolism is used to improve metabolism, and has no adverse effect on electrolyte balance in the body.
Use: Dehydration and lowering cranial pressure
Dosage: 200-500ml per drip for adults, 1-2 times a day, 200ml should be finished in 2.5-3 hours.
Caution: Hemolysis and hemoglobinuria may occur if the drip is too fast.
3.Acetazolamide
Also known as Acetazolamide, Acetazolamide, Diamox
Pharmacological effect: It is a carbonic anhydrase inhibitor. It is well absorbed orally, with effects occurring 30 minutes after taking the drug, peaking at 2 hours and lasting 12 hours.
Uses: Cardiogenic edema, cerebral edema, grand and petit mal seizures
Usage: Treatment of cerebral edema 0.25g/time, bid-tid, good effect after breakfast
Precautions: (1) There are the following adverse reactions: granulocytopenia, drowsiness, facial and limb numbness, hypokalemia. (2) Avoid concomitant use of calcium, iodine and broad-spectrum antibiotics, and should not be combined with anticholinergics and procaine. (3) Patients with high calcium need to be on a low-calcium diet.
Plasma volume expansion drugs
1.Dextran 40/20
Pharmacological effects: (1) Increase plasma colloid osmotic pressure and maintain blood pressure; (2) Anti-platelet and red blood cell aggregation, reduce blood viscosity, thus improving microcirculation and preventing thrombosis. (3) D20 has a stronger effect on improving microcirculation than D40.
Uses: (1) Anti-shock; (2) Prevention and treatment of cerebral thrombosis and thrombo-occlusive vasculitis.
Dosage: 250-500ml, 20-40ml/min, within 15-30 minutes (for anti-shock). For patients with CVD, the drip should be given slowly, once daily for 7-14 days.
Caution: Allergic rash or asthmatic attacks may be seen, occasionally febrile reactions. Contraindicated in congestive heart failure and those with bleeding disorders.
Anti-platelet aggregation drugs
1.Ticlopidine (Ticlid, Tianxinlib)
These drugs are oral drugs, common adverse reactions are gastrointestinal symptoms and rash, can reduce the occurrence of taking after meals.
IV. Anticoagulation and thrombolytic drugs
1.Low-molecular heparin calcium (rapid coagulation avoidance)
Pharmacological effect: It is a kind of subcutaneous injection of heparin. It has anticoagulant effect and antithrombotic effect.
Use: Used for the prevention and treatment of thromboembolic disease or thrombosis.
Usage and dosage: Deep subcutaneous injection, 5000-10,000u/time.
Precautions: (1) Subcutaneous injection should be deep into the subcutaneous fat layer. The injection site should be constantly changed. Do not move the needle when injecting and should not be rubbed during injection.
(2) Small local hematoma can be caused at the injection site after injection, which can disappear on its own after several days.
(3) Contraindicated with drugs containing phosphate buffer.
2.Tissue-type fibrinolytic plasminogen activator t-PA
Pharmacological effect: It is a kind of glycoprotein. It binds to fibrin through its lysine residue and activates the transformation of fibrinogen bound to fibrin into fibrinolytic enzyme. It is rapidly cleared from the blood after intravenous injection of t-PA.
Uses: Acute myocardial infarction, acute pulmonary embolism, acute cerebral embolism, cerebral thrombosis, intracranial venous sinus thrombosis.
Dosage and Administration: 50mg/pc. 100mg dissolved in 500ml saline and dosed within 3 hours as follows: 10mg in the first 2 minutes, 50mg in the next 60 minutes, and the remaining 40mg in the last 120 minutes. or 10% of 50mg by static push, and the remaining drug dissolved in 100ml saline and dosed within 1H.
Caution: It should not be paired with other drugs for sedation, and should not be used in the same IV as other drugs.
V. Cerebral vasodilator drugs
1.Calcium antagonist: nimodipine, nimoton
Pharmacological effect: It is the second generation of dihydropyridine calcium antagonist. It is used to prevent cerebral vasospasm. Recent studies have shown that it has the effect of protecting neurons.
Uses: Used for the prevention and treatment of cerebral vasospasm, migraine, ischemic cerebrovascular disease and senile dementia caused by SAH.
Usage and dosage: (1) For cerebral vasospasm, ischemic cerebrovascular disease, 10mg daily by sedation, avoid light.
(2) For migraine, 40mg/time orally, Tid.
Caution: Mild decrease in blood pressure, increased heart rate, facial flushing, phlebitis and increased transaminases may occur as side effects during sedation.
Sixth, nerve cell activator and nutritional drugs
1.Nerve cell activator.
(1) Piracetam (brain rehabilitation)
Pharmacological effect: direct action on the cerebral cortex, with the function of activation, protection and repair of nerve cells.
Use: Used for aging-induced memory impairment, cerebrovascular accidents, carbon monoxide toxic encephalopathy, dementia, etc.
2.Other drugs such as: Aniracetam (Sanlacil), Cytophosphorylcholine, Ducoxib, Xidezhen and other oral drugs.
3.Cholinesterase inhibitors: Aniracetam is used to treat mild to moderate Alzheimer’s type dementia.
4, neurotrophic drugs: brain activator, Avantage
VII. Anti-epileptic drugs
1.Carbamazepine
2.Sodium valproate, Depakene (tablets, injection)
3, phenytoin sodium
Eight, antipsychotic drugs
1.Haloperidol.
Uses: Schizophrenia, for involuntary movements due to the use of levodopa for extrapyramidal disorders.
Usage: (1) control acute excitement symptoms, intramuscular injection 5-10mg/day, 3-4 times a day, the elderly and children should reduce the amount.
(2) Treatment of involuntary movements: oral, general dose 1-2mg/time, 3 times a day.
IX. Antidepressants
1.Fluoxetine (Prozac).
Pharmacological effects: 5-hydroxytryptamine reuptake inhibitor SSRI
Dosage: 20mg/day, Qd-Bid
Precautions: Common adverse reactions include insomnia, nausea, agitation, headache, motor anxiety, nervousness, tremor, loss of appetite or hypogonadism with long-term medication.
Ten, anti-Parkinson drugs
1, benzhexol (Antan).
For the central striatal cholinergic receptor blocking agent. The main side effects are dry mouth, constipation, urinary retention, dilated pupils, blurred vision. It is prohibited for patients with glaucoma.
2, levodopa preparations: methadone, restorative amantadine
3.Pegolit (Xelianxing).
Dopamine D1D2 receptor agonist, often used in combination with levodopa preparations. Adverse effects are involuntary movements, hallucinations, postural hypotension, drowsiness, confusion, etc.
XI. Other drugs
1. Kingeran (naloxone hydrochloride injection).
Pharmacological effects: opioid receptor antagonist
Uses: Opioid overdose poisoning; Valium poisoning and acute alcohol poisoning; coma caused by cerebrovascular disease, traumatic brain injury, encephalitis and other diseases.
2.Fructose diphosphate sodium injection (FDP):
Pharmacological effect: By regulating the activity of several enzymes in sugar metabolism, increasing the concentration of intracellular ATP and creatine phosphate, and inhibiting free radicals, it can reduce the damage caused by hypoxia and ischemia in the organism.
Dosage: I.V., 50-100ml/time, 1-2 times daily, rate 4-7ml/min;
Caution: Occasional allergic reactions such as pain at the injection site, rash, dizziness, etc.; should be used alone and not dissolved in other drugs.