python3 -c " import pdfplumber with pdfplumber.open('/home/daytona/workspace/at…

mkdir -p /home/daytona/workspace/emergency-drugs && ls /home/daytona/workspace/e…

~/emergency-drugs/build_table.py

import openpyxl
from openpyxl.styles import (
    Font, PatternFill, Alignment, Border, Side, GradientFill
)
from openpyxl.utils import get_column_letter

wb = openpyxl.Workbook()
ws = wb.active
ws.title = "Emergency Drugs"

# ── colour palette ──────────────────────────────────────────────────────────
HDR_BG   = "1F4E79"   # dark navy header
HDR_FG   = "FFFFFF"   # white text
CAT_BG   = "2E75B6"   # mid-blue category rows
CAT_FG   = "FFFFFF"
ROW_A    = "DEEAF1"   # light blue alternating
ROW_B    = "FFFFFF"   # white alternating
BORDER_C = "ADB9CA"   # soft border colour

def side(c=BORDER_C): return Side(style="thin", color=c)
def full_border():    return Border(left=side(), right=side(), top=side(), bottom=side())
def hdr_border():     return Border(left=side("FFFFFF"), right=side("FFFFFF"),
                                    top=side("FFFFFF"), bottom=side("FFFFFF"))

# ── column definitions ───────────────────────────────────────────────────────
HEADERS = [
    "Drug / Agent",
    "Category",
    "Dosage Forms",
    "Indications",
    "Bolus / Loading Dose",
    "Infusion Dilution",
    "Infusion Dose",
    "Clinical Pearl / Danger",
]
COL_WIDTHS = [28, 22, 36, 48, 48, 48, 36, 60]

# ── drug data ────────────────────────────────────────────────────────────────
# Each tuple: (Drug, Category, DosageForms, Indications, Bolus/Loading, InfusionDilution, InfusionDose, Pearl)
drugs = [
    # ── SEDATION / INDUCTION ─────────────────────────────────────────────────
    ("Etomidate", "Sedation / Induction",
     "2 mg/mL ampoule (20 mg/10 mL)",
     "RSI induction – hemodynamically unstable patients",
     "0.2–0.3 mg/kg IV push over 30–60 sec",
     "Not used as infusion",
     "Not applicable",
     "Adrenocortical suppression after single dose is clinically irrelevant; causes myoclonus"),

    ("Ketamine", "Sedation / Induction",
     "50 mg/mL vial (10 mL, 20 mL)",
     "RSI induction, procedural sedation, refractory status epilepticus, hypotension",
     "RSI: 1–2 mg/kg IV push | Procedural: 0.5–1 mg/kg IV",
     "500 mg in 50 mL NS (10 mg/mL) – syringe pump",
     "0.5–3 mg/kg/hr titrated",
     "Preserves airway reflexes and BP; avoid in suspected raised ICP"),

    ("Propofol", "Sedation / Induction",
     "10 mg/mL emulsion (20 mL, 50 mL, 100 mL vials)",
     "RSI induction, ICU sedation, refractory status epilepticus",
     "RSI: 1–2 mg/kg IV push | Procedural: 0.5–1 mg/kg",
     "Undiluted (10 mg/mL) – syringe pump",
     "ICU sedation: 5–50 mcg/kg/min (0.3–3 mg/kg/hr)",
     "Dose-dependent hypotension & pain on injection; propofol infusion syndrome with high doses >48 hr"),

    ("Midazolam", "Sedation / Induction",
     "1 mg/mL, 5 mg/mL ampoules (2 mL, 5 mL, 10 mL)",
     "Status epilepticus, procedural sedation, ICU sedation",
     "Status: 0.1–0.2 mg/kg IV slow (max 5 mg/dose) | Procedural: 1–2 mg IV",
     "50 mg in 50 mL NS (1 mg/mL) – syringe pump",
     "ICU sedation: 0.5–2 mg/hr (0.01–0.03 mg/kg/hr)",
     "Hypotension & respiratory depression risk with opioids; active metabolite accumulates in renal failure"),

    ("Fentanyl", "Sedation / Analgesia",
     "50 mcg/mL, 100 mcg/2 mL ampoules (2 mL, 5 mL, 10 mL)",
     "Pain, RSI analgesia, ICU sedation, procedural sedation",
     "Pain: 0.5–1 mcg/kg IV slow | RSI: 1–3 mcg/kg",
     "250–500 mcg in 50 mL NS (5–10 mcg/mL) – syringe pump",
     "0.5–3 mcg/kg/hr (0.5–5 mcg/kg/hr in ICU)",
     "Chest wall rigidity with rapid high-dose bolus; causes bradycardia, minimal hypotension"),

    ("Morphine", "Sedation / Analgesia",
     "10 mg/mL, 15 mg/mL ampoules (1 mL)",
     "Acute severe pain, cardiogenic pulmonary edema",
     "2–5 mg IV slow over 2–5 min",
     "50 mg in 50 mL NS (1 mg/mL) – syringe pump",
     "1–5 mg/hr",
     "Avoid in hypotension, biliary colic, head injury; histamine release → hypotension"),

    ("Dexmedetomidine", "Sedation / Induction",
     "100 mcg/mL ampoule (2 mL)",
     "ICU sedation (intubated or non-intubated), delirium, agitation",
     "0.5–1 mcg/kg IV over 10 min (optional – often omitted)",
     "200 mcg in 50 mL NS (4 mcg/mL) – syringe pump",
     "0.2–0.7 mcg/kg/hr (up to 1.5 mcg/kg/hr in ICU)",
     "Bradycardia & hypotension; preserves respiratory drive; good for extubation"),

    # ── NEUROMUSCULAR BLOCKERS ───────────────────────────────────────────────
    ("Rocuronium", "Neuromuscular Blockade",
     "10 mg/mL vial (5 mL, 10 mL, 50 mL)",
     "RSI paralysis, ICU paralysis",
     "RSI: 0.6–1.2 mg/kg IV push",
     "500 mg in 50 mL NS (10 mg/mL) – syringe pump",
     "ICU: 8–12 mcg/kg/min (0.48–0.72 mg/kg/hr)",
     "Onset 45–60 sec; lasts 30–60 min; reversible with sugammadex"),

    ("Succinylcholine (Suxamethonium)", "Neuromuscular Blockade",
     "50 mg/mL vial (2 mL, 5 mL, 10 mL)",
     "RSI – rapid onset paralysis (full stomach, high aspiration risk)",
     "1–1.5 mg/kg IV push",
     "Not routinely used as infusion",
     "Not applicable",
     "Hyperkalemia risk (avoid in renal failure, crush injury, burns >24 hr); malignant hyperthermia trigger"),

    ("Atracurium", "Neuromuscular Blockade",
     "10 mg/mL vial (5 mL, 10 mL)",
     "ICU paralysis in ventilated patients",
     "0.3–0.5 mg/kg IV push",
     "250–500 mg in 50 mL NS (5–10 mg/mL) – syringe pump",
     "5–10 mcg/kg/min (0.3–0.6 mg/kg/hr)",
     "Histamine release at high doses; Hofmann elimination → safe in renal/hepatic failure"),

    ("Glycopyrrolate", "Adjunct / Airway",
     "0.2 mg/mL injection",
     "Airway secretion reduction, ketamine hypersalivation, reversal with neostigmine",
     "0.1–0.2 mg IV/IM slow push",
     "Not commonly used",
     "Not routinely used",
     "Less tachycardia/CNS effects than atropine; does not cross BBB"),

    # ── CARDIAC ARREST / RESUSCITATION ──────────────────────────────────────
    ("Adrenaline (Epinephrine)", "Cardiac Arrest / Resuscitation",
     "1 mg/1 mL ampoule; 1:10,000 (0.1 mg/mL) prefilled syringe",
     "Cardiac arrest, anaphylaxis, severe bradycardia, vasodilatory shock",
     "Cardiac arrest: 1 mg IV q3–5 min | Anaphylaxis: 0.3–0.5 mg IM",
     "Syringe pump: 1 mg in 50 mL NS (20 mcg/mL) | Bag: 1 mg in 250 mL NS (4 mcg/mL)",
     "0.05–0.5 mcg/kg/min (1–20 mcg/min) titrated",
     "Increases myocardial O₂ demand; extravasation → ischemia (phentolamine for rescue)"),

    ("Amiodarone", "Antiarrhythmic",
     "150 mg/3 mL, 50 mg/mL ampoule",
     "Shock-refractory VF/pVT, stable wide-complex VT, AF with rapid rate",
     "Cardiac arrest: 300 mg IV push | Stable VT: 150 mg over 10 min",
     "900 mg in 250 mL D5W (3.6 mg/mL) – bag | Syringe pump: 900 mg in 50 mL D5W (18 mg/mL)",
     "1 mg/min × 6 hr, then 0.5 mg/min × 18 hr",
     "Hypotension (rapid push), bradycardia, QT prolongation; central line preferred for infusion"),

    ("Lidocaine", "Antiarrhythmic",
     "20 mg/mL (2%) ampoule (5 mL, 10 mL, 20 mL)",
     "Shock-refractory VF/pVT (if amiodarone unavailable), stable VT, local anesthetic",
     "Cardiac arrest: 100 mg IV push (1–1.5 mg/kg)",
     "1 g in 250 mL NS/D5W (4 mg/mL) – bag | 200 mg in 50 mL NS (4 mg/mL) – syringe pump",
     "1–4 mg/min (20–50 mcg/kg/min)",
     "Toxicity: perioral numbness, seizures, metallic taste; reduce dose in heart failure"),

    ("Magnesium Sulfate", "Electrolyte / Antiarrhythmic",
     "500 mg/mL (50%) vial – 2 mL, 5 mL, 10 mL",
     "Torsades de pointes, severe asthma, eclampsia, hypomagnesemia",
     "Torsades: 1–2 g IV over 1–2 min | Eclampsia: 4 g IV over 15 min",
     "Eclampsia: 20 g in 500 mL NS (40 mg/mL)",
     "Torsades/Eclampsia maintenance: 1–2 g/hr",
     "Flushing, hypotension, respiratory depression (high doses); monitor DTRs"),

    ("Calcium Gluconate", "Electrolyte",
     "100 mg/mL (10%) – 10 mL ampoule",
     "Hyperkalemia, hypocalcemia, calcium channel blocker overdose",
     "1–2 g (10–20 mL) IV over 2–5 min",
     "Not routinely infused in emergency",
     "Not applicable for emergency",
     "Central line preferred for calcium chloride; gluconate less irritating peripherally; lasts 30–60 min"),

    ("Sodium Bicarbonate", "Electrolyte",
     "7.5% or 8.4% – 50 mL, 100 mL vials (1 mEq/mL)",
     "Severe metabolic acidosis (pH <7.1), TCA overdose, hyperkalemia (adjunct)",
     "1 mEq/kg IV slow push over 1–2 min",
     "100 mEq in 1 L D5W (0.1 mEq/mL) – run over 1–2 hr",
     "Not used as maintenance infusion",
     "Worsens intracellular acidosis and CO₂ retention; not for cardiac arrest unless hyperkalemia or TCA"),

    ("Atropine", "Antiarrhythmic / Anticholinergic",
     "0.6 mg/mL, 1 mg/1 mL ampoule",
     "Symptomatic bradycardia, organophosphate poisoning",
     "Bradycardia: 0.5 mg IV q3–5 min (max 3 mg) | OP poisoning: 1–3 mg q5–15 min",
     "Not routinely infused",
     "Not applicable",
     "Ineffective in cardiac transplant; causes tachycardia, delirium, urinary retention"),

    ("Vasopressin", "Vasopressor",
     "20 units/mL ampoule (1 mL)",
     "Cardiac arrest (alternative to adrenaline), vasodilatory shock (adjunct)",
     "Cardiac arrest: 40 units IV once",
     "Syringe pump: 40 units in 50 mL NS (0.8 units/mL) | Bag: 40 units in 250 mL NS (0.16 units/mL)",
     "0.01–0.04 units/min (0.4–1.8 units/hr)",
     "Splanchnic ischemia, hyponatremia; not first-line in septic shock (rescue only)"),

    # ── VASOPRESSORS / INOTROPES ─────────────────────────────────────────────
    ("Noradrenaline (Norepinephrine)", "Vasopressor",
     "2 mg/mL ampoule (4 mg/2 mL)",
     "Septic shock, vasodilatory shock, post-ROSC hypotension",
     "NOT given as IV bolus",
     "Syringe pump: 4 mg in 50 mL NS/D5W (80 mcg/mL) | Bag: 4 mg in 250 mL NS/D5W (16 mcg/mL)",
     "0.05–0.5 mcg/kg/min (2–20 mcg/min) titrated to MAP",
     "Central line preferred; extravasation → ischemia (phentolamine rescue)"),

    ("Dobutamine", "Inotrope",
     "12.5 mg/mL vial (250 mg/20 mL)",
     "Cardiogenic shock (low CO with adequate MAP), acute heart failure",
     "NOT given as IV bolus",
     "250 mg in 50 mL NS (5 mg/mL) – syringe pump | 250 mg in 250 mL NS (1 mg/mL) – bag",
     "2.5–10 mcg/kg/min (up to 20 mcg/kg/min) titrated",
     "Causes tachycardia, hypotension (if hypovolemic); do NOT mix with bicarbonate"),

    ("Dopamine", "Vasopressor / Inotrope",
     "40 mg/mL, 80 mg/mL ampoules (5 mL, 10 mL)",
     "Hemodynamically significant bradycardia (atropine-resistant), cardiogenic shock (low-dose)",
     "NOT given as IV bolus",
     "Syringe pump: 200 mg in 50 mL NS (4 mg/mL) | Bag: 200 mg in 250 mL NS (0.8 mg/mL)",
     "Low: 2–5 mcg/kg/min | Mid: 5–10 mcg/kg/min | High: 10–20 mcg/kg/min",
     "Tachycardia, arrhythmias; no mortality benefit over noradrenaline"),

    ("Milrinone", "Inotrope",
     "1 mg/mL vial (10 mL, 20 mL, 50 mL)",
     "Acute decompensated heart failure, cardiogenic shock, post-cardiotomy low output",
     "50 mcg/kg IV over 10 min (optional – often omitted)",
     "20 mg in 50 mL NS (0.4 mg/mL) – syringe pump | 20 mg in 250 mL NS (0.08 mg/mL) – bag",
     "0.125–0.75 mcg/kg/min",
     "Hypotension (avoid loading if hypotensive), thrombocytopenia (prolonged use), avoid in severe renal failure"),

    # ── ANTIARRHYTHMICS (extended) ───────────────────────────────────────────
    ("Adenosine", "Antiarrhythmic",
     "3 mg/mL vial (6 mg/2 mL, 12 mg/4 mL prefilled syringe)",
     "Narrow-complex SVT (AVNRT, AVRT), undifferentiated regular tachyarrhythmia",
     "6 mg rapid IV push → if no effect, 12 mg (+ 20 mL NS flush)",
     "Not used as infusion",
     "Not applicable",
     "Half-life <10 sec; causes transient asystole, flushing, chest tightness, bronchospasm"),

    ("Metoprolol / Esmolol", "Antiarrhythmic / Beta-Blocker",
     "Metoprolol: 1 mg/mL (5 mg/5 mL) | Esmolol: 10 mg/mL (100 mg/10 mL, 2500 mg/250 mL)",
     "Stable narrow-complex tachycardia (AF, flutter, SVT), thyrotoxicosis, aortic dissection",
     "Metoprolol: 2.5–5 mg IV over 1–2 min q5min (max 15 mg) | Esmolol: 500 mcg/kg over 1 min",
     "Esmolol only: 2500 mg in 250 mL NS (10 mg/mL)",
     "Esmolol: 50–300 mcg/kg/min titrated",
     "Avoid in acute decompensated HF, severe bradycardia, hypotension, reactive airway disease"),

    ("Diltiazem", "Antiarrhythmic / CCB",
     "5 mg/mL vial (25 mg/5 mL, 50 mg/10 mL)",
     "Rate control for AF/flutter, narrow-complex SVT (adenosine-refractory)",
     "0.25 mg/kg IV over 2 min → repeat 0.35 mg/kg after 15 min if needed",
     "125 mg in 125 mL NS (1 mg/mL) – bag | 125 mg in 50 mL NS (2.5 mg/mL) – syringe pump",
     "5–15 mg/hr",
     "Avoid in wide-complex tachycardia, WPW with AF, hypotension, systolic HF; causes bradycardia"),

    ("Digoxin", "Antiarrhythmic",
     "0.25 mg/mL ampoule (2 mL = 0.5 mg)",
     "AF with rapid ventricular rate (beta-blocker/CCB ineffective), acute heart failure (low output)",
     "0.25–0.5 mg IV over 15–20 min (total load 10–15 mcg/kg IBW)",
     "Not routinely infused as maintenance",
     "Maintenance: 0.125–0.25 mg IV daily",
     "Toxicity: nausea, visual changes, bradyarrhythmias, hyperkalemia; reduce dose in renal failure"),

    # ── ANTIHYPERTENSIVES ────────────────────────────────────────────────────
    ("Labetalol", "Antihypertensive",
     "5 mg/mL ampoule (20 mL, 40 mL; 100 mg/20 mL)",
     "Hypertensive emergency, aortic dissection, preeclampsia/eclampsia, phaeochromocytoma",
     "20 mg IV over 1–2 min → repeat 20–80 mg q10 min (max 300 mg)",
     "200 mg in 200 mL NS/D5W (1 mg/mL)",
     "0.5–2 mg/min titrated",
     "Avoid in acute decompensated HF, asthma, bradycardia; causes bronchospasm"),

    ("Nitroglycerin (GTN)", "Antihypertensive / Antianginal",
     "5 mg/mL vial (50 mg/10 mL) for infusion | 0.4 mg/spray SL | 2% ointment",
     "ACS (UA/NSTEMI/STEMI), acute pulmonary edema, hypertensive emergency with ACS",
     "NOT as IV bolus (SL: 0.4 mg q5 min × 3)",
     "50 mg in 250 mL NS/D5W (200 mcg/mL) – bag | 50 mg in 50 mL NS (1 mg/mL) – syringe pump",
     "5–200 mcg/min (start 10–20 mcg/min, ↑ by 10 mcg/min q5–10 min)",
     "Tolerance after 24 hr; headache, hypotension; avoid in RV infarct, severe AS, sildenafil use"),

    ("Esmolol", "Antihypertensive / Beta-Blocker",
     "10 mg/mL vial (100 mg/10 mL, 2500 mg/250 mL)",
     "Hypertensive emergency (aortic dissection), thyrotoxicosis, perioperative hypertension",
     "500 mcg/kg (0.5 mg/kg) IV over 1 min",
     "2500 mg in 250 mL NS/D5W (10 mg/mL)",
     "50–300 mcg/kg/min titrated",
     "Half-life 9 min; bradycardia, hypotension; avoid in acute decompensated HF"),

    ("Hydralazine", "Antihypertensive",
     "20 mg/mL ampoule (1 mL = 20 mg)",
     "Hypertensive emergency in pregnancy (preeclampsia/eclampsia) not responding to labetalol",
     "5–10 mg IV over 1–2 min q20–30 min (max 20 mg)",
     "Not routinely infused",
     "Not applicable",
     "Reflex tachycardia (use with beta-blocker); lupus-like syndrome (prolonged use)"),

    ("Furosemide", "Diuretic",
     "10 mg/mL ampoule (2 mL, 10 mL, 20 mL; 100 mg/10 mL)",
     "Acute pulmonary edema, fluid overload (HF, renal failure), hypertensive emergency with volume overload",
     "20–40 mg IV push over 1–2 min (double dose if chronic use; max 80–120 mg)",
     "250 mg in 250 mL NS (1 mg/mL) – infusion bag",
     "10–40 mg/hr (if continuous – rare; intermittent preferred)",
     "Ototoxicity (rapid large dose), hypokalemia, metabolic alkalosis; nitroglycerin preferred in ACS"),

    ("Nitroprusside", "Antihypertensive",
     "10 mg/vial powder; 25 mg/mL concentrate",
     "Hypertensive emergency with aortic dissection or encephalopathy – ICU only",
     "NOT given as IV bolus",
     "50 mg in 250 mL D5W (200 mcg/mL) – protect from light",
     "0.25–4 mcg/kg/min (start low, titrate q5 min; max 10 mcg/kg/min)",
     "Cyanide toxicity >48 hr or >4 mcg/kg/min; reflex tachycardia; requires arterial line"),

    # ── THROMBOLYTICS / ACS ──────────────────────────────────────────────────
    ("Tenecteplase (TNK)", "Thrombolytic",
     "Vials: 30 mg, 35 mg, 40 mg, 45 mg, 50 mg powder",
     "STEMI (prehospital/hospital), acute ischemic stroke (selected protocols)",
     "STEMI weight-based single bolus: <60 kg=30 mg; 60–70=35 mg; 70–80=40 mg; 80–90=45 mg; >90=50 mg",
     "Not applicable (single bolus)",
     "Not applicable",
     "Lower non-cerebral bleeding vs alteplase; avoid if active bleeding, recent stroke, uncontrolled HTN"),

    ("Alteplase (tPA)", "Thrombolytic",
     "50 mg, 100 mg vial powder (1 mg/mL after reconstitution)",
     "Acute ischemic stroke (≤4.5 hr), massive PE (hemodynamically unstable), STEMI",
     "Stroke: 0.09 mg/kg IV push (max 9 mg) | PE: 10 mg IV push | STEMI: 15 mg IV push",
     "Stroke: remaining dose in 100 mL NS over 60 min | PE: 90 mg in 100 mL NS over 120 min",
     "Indication-specific (as above)",
     "Risk of intracranial hemorrhage; avoid if INR >1.7, glucose <50 or >400, uncontrolled HTN"),

    ("Aspirin", "Antiplatelet",
     "75 mg, 150 mg, 325 mg tablets (chewable preferred)",
     "Suspected acute MI, unstable angina, acute ischemic stroke (within 48 hr)",
     "300–325 mg chewed or crushed orally (non-enteric coated)",
     "Not applicable",
     "Not applicable",
     "Do not wait for diagnosis in suspected ACS; avoid if active bleeding or true aspirin allergy"),

    ("Clopidogrel / Ticagrelor", "Antiplatelet",
     "Clopidogrel: 75 mg, 300 mg tablets | Ticagrelor: 90 mg tablets",
     "ACS (with aspirin) – NSTEMI, STEMI (medical management or post-PCI)",
     "Clopidogrel: 300–600 mg oral | Ticagrelor: 180 mg oral",
     "Not applicable",
     "Maintenance: Clopidogrel 75 mg/day; Ticagrelor 90 mg twice daily",
     "Clopidogrel resistance (genetic); ticagrelor causes transient dyspnea (not allergy)"),

    ("Unfractionated Heparin (UFH)", "Anticoagulant",
     "1000 units/mL, 5000 units/mL, 25,000 units/5 mL vials",
     "ACS, massive PE, DVT/PE anticoagulation, post-cardiac arrest",
     "ACS/PE: 70–80 units/kg IV bolus (max 5000 units)",
     "25,000 units in 250 mL NS/D5W (100 units/mL)",
     "12–18 units/kg/hr; titrate to aPTT 1.5–2.5× control",
     "HIT risk (monitor platelets); reversal with protamine"),

    # ── REVERSAL AGENTS ──────────────────────────────────────────────────────
    ("Protamine", "Reversal Agent",
     "10 mg/mL vial (5 mL, 10 mL, 25 mL)",
     "Heparin reversal (UFH; partial for LMWH)",
     "1 mg per 100 units heparin given (max 50 mg over 10 min)",
     "Slow IV push – no routine infusion",
     "Not applicable",
     "Rapid push → hypotension, bradycardia, pulmonary HTN; allergic reactions (NPH insulin/fish allergy)"),

    ("Vitamin K (Phytomenadione)", "Reversal Agent",
     "10 mg/mL ampoule (1 mL = 10 mg)",
     "Warfarin reversal (elevated INR with bleeding or urgent surgery)",
     "5–10 mg IV over 10–20 min",
     "10 mg in 50–100 mL NS/D5W over 20–30 min",
     "Not applicable (single dose)",
     "IV route: risk of anaphylaxis (give slowly); onset 4–6 hr; use PCC or FFP for immediate reversal"),

    ("Tranexamic Acid (TXA)", "Haemostatic",
     "100 mg/mL ampoule (5 mL, 10 mL)",
     "Major trauma (within 3 hr – CRASH-2), postpartum hemorrhage, GI bleed (adjunct)",
     "Trauma/PPH: 1 g IV over 10 min",
     "1 g in 100–250 mL NS over 10 min",
     "Second dose 1 g over 8 hr (trauma protocol)",
     "Give within 3 hr of injury; ineffective after 3 hr; VTE risk"),

    ("Idarucizumab", "Reversal Agent",
     "2.5 g/50 mL vial (ready-to-use)",
     "Dabigatran reversal (life-threatening bleeding or urgent surgery)",
     "5 g IV (two 2.5 g vials sequentially over 5–10 min)",
     "Ready-to-use – no dilution needed",
     "Not applicable (single dose)",
     "Specific for dabigatran ONLY; immediate onset; no prothrombotic risk"),

    ("Andexanet Alfa", "Reversal Agent",
     "100 mg/vial powder (multiple vials per dose)",
     "Apixaban or rivaroxaban reversal (life-threatening bleeding)",
     "Low-dose: 400 mg at 30 mg/min | High-dose: 800 mg at 30 mg/min",
     "Infusion immediately after bolus: 4 mg/min × 120 min (low) or 8 mg/min × 120 min (high)",
     "As above (post-bolus infusion mandatory)",
     "Prothrombotic risk (stroke, MI, DVT); very expensive; NOT for edoxaban or dabigatran"),

    ("PCC (Prothrombin Complex Concentrate)", "Reversal Agent",
     "500 IU vial powder (4-factor PCC preferred)",
     "Warfarin reversal (life-threatening bleed, ICH, urgent surgery)",
     "25–50 units/kg IV (max 5000 units) – INR-dependent",
     "Slow IV push over 10–15 min (2–5 min per 1000 units)",
     "Not applicable (single dose)",
     "Prothrombotic risk; 4-factor PCC preferred (includes Factor VII)"),

    # ── ANTIBIOTICS ──────────────────────────────────────────────────────────
    ("Piperacillin–Tazobactam (Pip-Taz)", "Antibiotic",
     "2.25 g, 3.375 g, 4.5 g vials (piperacillin:tazobactam 8:1)",
     "Severe CAP, intra-abdominal infection, sepsis of unknown source, HCAP",
     "3.375–4.5 g IV over 30 min (or 4–5 min slow IV push)",
     "Intermittent infusion over 30 min; extended 4-hr infusion in ICU (for resistant organisms)",
     "3.375–4.5 g q6–8h (renal adjust if CrCl <40 mL/min)",
     "Hypokalemia, thrombocytopenia, platelet dysfunction; monitor CrCl"),

    ("Ceftriaxone", "Antibiotic",
     "250 mg, 500 mg, 1 g, 2 g vials powder",
     "CAP, meningitis, sepsis (community), UTI, gonorrhea",
     "1–2 g IV push over 2–5 min",
     "50–100 mL NS over 15–30 min (can also give as IV push)",
     "1–2 g q12–24h (meningitis: 2 g q12h)",
     "Avoid with IV calcium (precipitation risk); biliary sludging (pseudolithiasis)"),

    ("Meropenem", "Antibiotic",
     "500 mg, 1 g vials powder",
     "Severe sepsis (HCAP), intra-abdominal infection, meningitis, febrile neutropenia, MDR organisms",
     "1 g IV over 3–5 min (or 15–30 min infusion)",
     "Standard: 15–30 min; extended 3-hr infusion in ICU for resistant organisms",
     "1–2 g q8h (renal adjust if CrCl <50; meningitis: 2 g q8h)",
     "Seizure risk (dose-dependent, less than imipenem); dose adjust in renal failure"),

    ("Vancomycin", "Antibiotic",
     "500 mg, 1 g, 1.25 g, 1.5 g vials powder",
     "Sepsis (MRSA coverage), HCAP, meningitis, endocarditis, CRBSI",
     "25–30 mg/kg IV (max 3 g) – single loading dose",
     "500 mg–1.5 g in 100–250 mL NS/D5W over 60 min (NO rapid IV push)",
     "15–20 mg/kg q8–12h (renal adjust); target trough 10–20 mcg/mL",
     "Red man syndrome (rapid infusion); nephrotoxicity (especially with pip-taz); monitor levels"),

    ("Metronidazole", "Antibiotic",
     "500 mg/100 mL ready-to-use infusion; 5 mg/mL vial",
     "Anaerobic coverage – intra-abdominal, PID, aspiration pneumonia; C. difficile (oral only)",
     "500 mg IV over 5–10 min",
     "500 mg in 100 mL (ready-to-use) over 30–60 min",
     "500 mg q8–12h",
     "Disulfiram-like reaction with alcohol; metallic taste; peripheral neuropathy (prolonged)"),

    ("Linezolid", "Antibiotic",
     "2 mg/mL ready-to-use infusion (600 mg/300 mL bag)",
     "MRSA pneumonia (better lung penetration than vancomycin), VRE, resistant Gram-positive infections",
     "600 mg IV over 30–60 min",
     "Ready-to-use – no dilution needed; infuse over 30–60 min",
     "600 mg q12h",
     "Serotonin syndrome (avoid with serotonergic drugs); myelosuppression; optic neuritis (>28 days)"),

    ("Colistin", "Antibiotic",
     "150 mg vial powder (1 mg = 30,000 units colistimethate)",
     "MDR Gram-negatives (Acinetobacter, Pseudomonas, KPC) – last line",
     "300 mg (9 MU) IV over 30 min",
     "150 mg in 50–100 mL NS over 30–60 min",
     "150 mg q12h (critical renal adjustment); trough 0.5–2 mcg/mL",
     "Nephrotoxicity (common, dose-dependent); neurotoxicity (paresthesia, apnea); not for routine use"),

    # ── RESPIRATORY ──────────────────────────────────────────────────────────
    ("Salbutamol (Albuterol) Neb", "Bronchodilator",
     "1 mg/mL respule (2.5 mg/2.5 mL); 5 mg/mL concentrate",
     "Acute severe asthma, COPD exacerbation, hyperkalemia (adjunct – nebulized)",
     "Nebulization: 2.5–5 mg in 2–3 mL NS over 5–10 min",
     "Intermittent: 2.5–5 mg q20 min × 3 then q1–4h | Continuous: 5–10 mg/hr",
     "5–20 mg/hr (continuous)",
     "Tachycardia, hypokalemia, tremor, lactic acidosis (high-dose continuous); monitor potassium"),

    ("Ipratropium Neb", "Bronchodilator",
     "250 mcg/mL (0.025%) respule (500 mcg/2 mL)",
     "Acute severe asthma, COPD exacerbation (additive to salbutamol)",
     "Nebulization: 500 mcg in 2–3 mL NS with salbutamol",
     "500 mcg q20 min × 3 then q4–6h",
     "Not applicable as standalone infusion",
     "Dry mouth, urinary retention (elderly); NOT for monotherapy – always combine with salbutamol"),

    ("Hydrocortisone / Methylprednisolone", "Corticosteroid",
     "Hydrocortisone: 100 mg, 250 mg, 500 mg vials | Methylprednisolone: 40 mg, 125 mg, 500 mg, 1 g vials",
     "Acute severe asthma, COPD exacerbation, croup, anaphylaxis (adjunct)",
     "Hydrocortisone: 100–200 mg IV push | Methylprednisolone: 40–125 mg IV push",
     "100 mg in 50–100 mL NS over 5–10 min (or slow IV push)",
     "Intermittent: hydrocortisone 50–100 mg q6h",
     "Hyperglycemia, hypokalemia; not for acute relief (delay 4–6 hr); IV in severe cases, oral step-down"),

    ("Adrenaline – IM / Neb (Anaphylaxis/Croup)", "Bronchodilator / Anaphylaxis",
     "1 mg/1 mL ampoule (1:1000)",
     "Anaphylaxis (IM), severe croup (nebulized), severe asthma refractory (nebulized – off-label)",
     "IM anaphylaxis: 0.3–0.5 mg | Nebulized croup: 3–5 mg (3–5 mL of 1:1000) undiluted",
     "Not applicable (IM or nebulized)",
     "Not applicable",
     "Use 1:1000 (NOT 1:10,000) for croup nebulization; monitor rebound phenomenon after 1–2 hr"),

    ("Aminophylline", "Bronchodilator",
     "25 mg/mL ampoule (10 mL = 250 mg)",
     "Severe asthma (refractory to nebulizations and magnesium) – third-line",
     "5–6 mg/kg IV over 20–30 min (if not on oral theophylline)",
     "250 mg in 250 mL NS (1 mg/mL) over 20–30 min",
     "0.5–0.7 mg/kg/hr (monitor levels)",
     "Narrow therapeutic index; nausea, vomiting, seizures, arrhythmias; avoid in elderly/liver/HF"),

    # ── NEUROLOGY / STATUS EPILEPTICUS ──────────────────────────────────────
    ("Lorazepam / Midazolam / Diazepam", "Antiepileptic – 1st line",
     "Lorazepam: 2 mg/mL, 4 mg/mL | Midazolam: 1 mg/mL, 5 mg/mL | Diazepam: 5 mg/mL",
     "Status epilepticus (first-line), acute seizure, alcohol withdrawal seizures",
     "Lorazepam: 0.1 mg/kg IV over 2–4 min (max 4 mg) | Midazolam: 0.1–0.2 mg/kg IM/IV | Diazepam: 5–10 mg IV",
     "Midazolam infusion: 50 mg in 50 mL NS (1 mg/mL) – syringe pump",
     "Midazolam: 0.05–0.2 mg/kg/hr (refractory status)",
     "Respiratory depression & hypotension; lorazepam longer duration; diazepam more phlebitis"),

    ("Levetiracetam", "Antiepileptic – 2nd line",
     "100 mg/mL vial (5 mL = 500 mg)",
     "Status epilepticus (2nd-line after benzodiazepines), seizure prophylaxis",
     "1000–3000 mg IV over 5–15 min",
     "1000–1500 mg in 50–100 mL NS over 15 min",
     "Maintenance: 500–1500 mg IV q12h",
     "Minimal drug interactions; no renal adjustment acutely; behavioral changes, sedation"),

    ("Phenytoin / Fosphenytoin", "Antiepileptic – 2nd line",
     "Phenytoin: 50 mg/mL vial | Fosphenytoin: 75 mg/mL (PE units)",
     "Status epilepticus (2nd-line), seizure prophylaxis post-neurosurgery/stroke",
     "Phenytoin: 15–20 mg/kg at max 50 mg/min | Fosphenytoin: 15–20 mg PE/kg at 100–150 mg PE/min",
     "Phenytoin: undiluted or in NS (NOT D5W) | Fosphenytoin: NS or D5W",
     "Phenytoin: 5 mg/kg/day ÷ q8h | Fosphenytoin: 4–6 mg PE/kg/day",
     "Phenytoin: purple glove syndrome, hypotension, bradycardia (rapid); fosphenytoin better tolerated, IM option"),

    ("Valproate Sodium", "Antiepileptic – 2nd/3rd line",
     "100 mg/mL vial (5 mL = 500 mg)",
     "Status epilepticus (2nd/3rd-line – refractory, post-anoxic, phenytoin-contraindicated)",
     "20–40 mg/kg IV over 5–15 min (max 3000 mg)",
     "500–1000 mg in 50–100 mL NS over 10 min",
     "Maintenance: 20–40 mg/kg/day ÷ q6–8h",
     "Thrombocytopenia, hyperammonemia, pancreatitis; avoid in pregnancy (neural tube defects), liver failure"),

    ("Phenobarbital", "Antiepileptic – 3rd line",
     "30 mg/mL, 60 mg/mL, 130 mg/mL ampoules (1 mL, 2 mL)",
     "Status epilepticus (3rd-line), alcohol withdrawal seizures, neonatal seizures",
     "10–20 mg/kg IV at max 50–100 mg/min",
     "500 mg in 50–100 mL NS over 10–20 min",
     "Maintenance: 1–4 mg/kg/day (60–120 mg q8h typical)",
     "Severe respiratory depression & hypotension (give slowly); long half-life (accumulates); Stevens-Johnson rash"),

    # ── RAISED ICP ────────────────────────────────────────────────────────────
    ("Mannitol", "Raised ICP",
     "10%, 15%, 20%, 25% solutions (100 mL, 250 mL, 500 mL); 20% most common",
     "Raised ICP (head trauma, ICH, cerebral edema, pre-neurosurgery), elevated IOP",
     "0.25–1 g/kg IV over 10–15 min (typical 0.5–1 g/kg)",
     "Give undiluted (20% solution) via infusion set with filter",
     "Intermittent bolus q4–6h as needed",
     "Contraindicated in acute renal failure, severe HF, anuria; monitor osmolality (stop if >320 mOsm/kg); rebound edema"),

    ("Hypertonic Saline", "Raised ICP",
     "3% (513 mEq/L), 5%, 23.4% (4 mEq/mL) – concentrated vials for ICU",
     "Raised ICP (refractory to mannitol), TBI, hyponatremia with severe symptoms (cerebral edema)",
     "3%: 250 mL IV over 15–30 min | 23.4%: 30 mL over 10 min (central line preferred)",
     "3% or 5% via peripheral; 23.4% requires central line",
     "3% continuous: 30–50 mL/hr (monitor sodium closely)",
     "Central line mandatory for 23.4%; osmotic demyelination if Na correction >10–12 mEq/L/24hr; monitor Na q1–2hr"),

    # ── METABOLIC / ENDOCRINE ────────────────────────────────────────────────
    ("Regular Insulin", "Metabolic / Endocrine",
     "100 units/mL vial (10 mL)",
     "Hyperkalemia (with dextrose), DKA, HHS",
     "Hyperkalemia: 5–10 units IV push (+ 25 g dextrose); DKA/HHS: infusion preferred (no bolus unless hyperkalemia)",
     "50 units in 50 mL NS (1 unit/mL) – syringe pump",
     "DKA/HHS: 0.1 units/kg/hr (5–10 units/hr); titrate to ↓ glucose 50–100 mg/dL/hr",
     "Only IV regular insulin for emergencies (NOT subcutaneous rapid analogs); hypoglycemia risk; monitor K⁺ hourly"),

    ("Dextrose 25% / 50%", "Metabolic / Endocrine",
     "D25: 50 mL prefilled syringe (12.5 g) | D50: 50 mL vial (25 g)",
     "Hypoglycemia (altered mentation, unable to take orally), hyperkalemia (with insulin)",
     "Hypoglycemia: D25: 50 mL IV push | D50: 25–50 mL IV push",
     "D10% maintenance: D50 50 mL in 450 mL NS = 500 mL D10%",
     "D10% at 50–100 mL/hr post-bolus to prevent rebound",
     "Give thiamine FIRST in malnourished/alcoholic patients (prevent Wernicke's); D50 causes phlebitis"),

    ("Potassium Chloride (KCl)", "Electrolyte",
     "2 mEq/mL concentrate (10 mL, 20 mL, 40 mL vials; 10 mL = 20 mEq)",
     "Severe hypokalemia (<2.5 mEq/L with ECG changes) – life-threatening arrhythmias, paralysis",
     "NEVER IV push (cardiac arrest risk) – slow infusion ONLY",
     "20–40 mEq in 250–500 mL NS (0.08–0.16 mEq/mL) – peripheral or central",
     "Peripheral: max 10 mEq/hr | Central: max 20 mEq/hr (monitor ECG)",
     "NEVER IV push; monitor magnesium (replete if low – refractory hypokalemia)"),

    ("Thiamine (Vitamin B1)", "Metabolic / Neurological",
     "100 mg/mL vial (2 mL = 200 mg; 10 mL = 1000 mg)",
     "Wernicke's encephalopathy, prevent Wernicke's before dextrose in malnourished/alcoholic patients",
     "Wernicke's: 500 mg IV over 30 min (some: 200–500 mg × 3 doses/day)",
     "500 mg in 50–100 mL NS over 30 min",
     "Not continuous (intermittent dosing)",
     "Always give BEFORE dextrose in at-risk patients; rare anaphylaxis; IM alternative if no IV access"),

    # ── TOXICOLOGY ───────────────────────────────────────────────────────────
    ("Activated Charcoal", "Toxicology",
     "Powder (25 g, 50 g packets); premixed suspension (25 g/250 mL)",
     "Acute oral poisoning within 1–2 hr (most drugs; NOT alcohols, metals, lithium, caustics, hydrocarbons)",
     "25–100 g oral/NG (adult typical: 50 g once)",
     "Not applicable (oral or NG tube)",
     "Not applicable (repeat dose may be used for sustained-release drugs)",
     "Airway protection first – aspiration risk; do NOT give in bowel obstruction or unprotected airway"),

    ("Naloxone", "Toxicology – Reversal",
     "0.4 mg/mL vial (1 mL); 1 mg/mL vial (2 mL, 10 mL)",
     "Opioid overdose (respiratory depression, coma, miosis)",
     "0.04–0.4 mg IV/IM/IN (titrate to respiratory effort – avoid precipitated withdrawal)",
     "2 mg in 500 mL NS (4 mcg/mL) – infusion bag",
     "0.5–1 mg/hr (titrate)",
     "Precipitates withdrawal (agitation, vomiting, HTN); shorter half-life than most opioids → re-sedation risk"),

    ("Flumazenil", "Toxicology – Reversal",
     "0.1 mg/mL vial (5 mL = 0.5 mg); 1 mg/mL vial (10 mL = 10 mg)",
     "Benzodiazepine overdose (pure – NOT in TCA co-ingestion, NOT in chronic BZD user)",
     "0.2 mg IV over 30 sec → repeat 0.3 mg q30–60 sec (max 3 mg)",
     "0.5 mg in 250 mL NS (2 mcg/mL) – infusion bag (rare)",
     "0.2–0.5 mg/hr (if used)",
     "Can precipitate seizures (chronic BZD users or TCA co-ingestion); do NOT use routinely"),

    ("N-Acetylcysteine (NAC)", "Toxicology – Antidote",
     "200 mg/mL vial (10 mL, 30 mL, 50 mL) – concentrate",
     "Paracetamol (acetaminophen) overdose – within 8–10 hr",
     "Loading: 150 mg/kg IV over 60 min",
     "Loading: 150 mg/kg in 200 mL D5W/60 min | 2nd: 50 mg/kg in 500 mL D5W/4 hr | 3rd: 100 mg/kg in 1000 mL D5W/16 hr",
     "Three-bag protocol (as above)",
     "Anaphylactoid reaction (flushing, rash, bronchospasm – stop temporarily, restart slower); nausea, vomiting"),

    ("Atropine – High-dose (OP Poisoning)", "Toxicology – Antidote",
     "0.6 mg/mL, 1 mg/1 mL ampoule (large quantities needed)",
     "Organophosphate poisoning (secretions, bradycardia, respiratory distress)",
     "1–3 mg IV push q5–15 min (doubling dose each time) until drying of secretions",
     "Intermittent boluses (infusion not standard)",
     "Not standard",
     "Endpoint = drying of secretions (NOT mydriasis/heart rate); massive doses often needed (10–100+ mg/day)"),

    ("Pralidoxime (2-PAM)", "Toxicology – Antidote",
     "1 g vial powder (1 g in 20 mL sterile water = 50 mg/mL)",
     "Organophosphate poisoning – reactivates acetylcholinesterase (give within 24–48 hr)",
     "1–2 g IV over 15–30 min",
     "1–2 g in 100–250 mL NS over 15–30 min",
     "500 mg/hr continuous (severe) or 1 g q6–8h intermittent",
     "NOT effective for carbamate poisoning; give early (<48 hr); hypertension, tachycardia, dizziness"),

    ("Hydroxocobalamin", "Toxicology – Antidote",
     "2.5 g/100 mL vial; 5 g/200 mL twin-pack ready-to-use",
     "Cyanide poisoning (smoke inhalation, industrial exposure)",
     "5 g IV over 15 min (repeat once if needed; max 10 g)",
     "Ready-to-use – no dilution needed",
     "Not applicable (single/repeat bolus)",
     "Turns urine/skin/mucous membranes red (harmless, fades 1–2 days); transient HTN, nausea, rash"),

    ("Sodium Thiosulfate", "Toxicology – Antidote",
     "250 mg/mL vial (50 mL = 12.5 g); 1 g/10 mL vial",
     "Cyanide poisoning (with hydroxocobalamin), nitroprusside-induced cyanide toxicity",
     "12.5 g IV over 10–30 min (after hydroxocobalamin)",
     "12.5 g in 50–250 mL NS over 10–30 min",
     "Not applicable (single dose)",
     "Slower onset than hydroxocobalamin – NEVER alone for severe cyanide poisoning; nausea, vomiting, hypernatremia"),

    ("Glucagon", "Toxicology – Antidote",
     "1 mg vial powder (1 mg/mL after reconstitution)",
     "Beta-blocker or calcium channel blocker overdose (refractory bradycardia/hypotension)",
     "3–10 mg IV over 1–2 min",
     "3–5 mg in 50–100 mL NS over 5–10 min",
     "2–5 mg/hr (if continuous – rare)",
     "Severe nausea/vomiting (pre-treat with antiemetic); expensive; works as inotrope/chronotrope; hypokalemia"),

    # ── OBSTETRIC ────────────────────────────────────────────────────────────
    ("Oxytocin", "Obstetric",
     "10 units/mL ampoule (1 mL = 10 units)",
     "Postpartum hemorrhage (PPH) – 3rd stage labor management, uterine atony",
     "3–10 units IM (preferred prophylaxis) or slow IV push over 1–2 min",
     "30 units in 500 mL NS (0.06 units/mL)",
     "10–40 units/hr (0.16–0.66 units/min) maintenance after bolus",
     "Rapid IV push → hypotension, tachycardia, myocardial ischemia; IM safer for prophylaxis"),

    ("Misoprostol", "Obstetric",
     "200 mcg, 600 mcg tablets (oral/vaginal/rectal)",
     "PPH (if oxytocin unavailable/ineffective), medical abortion, cervical ripening",
     "PPH: 800–1000 mcg sublingual or rectal (single dose)",
     "Not applicable (oral/sublingual/rectal route)",
     "Not applicable",
     "Sublingual fastest onset but more side effects (shivering, fever, diarrhea); avoid in previous uterine scar (for cervical ripening)"),

    # ── GI / GASTROINTESTINAL ────────────────────────────────────────────────
    ("Pantoprazole IV", "Gastrointestinal",
     "40 mg vial powder for reconstitution",
     "Stress ulcer prophylaxis (ICU), upper GI bleed, prevention of rebleeding post-endoscopy",
     "40 mg IV push over 2–5 min (80 mg for high-risk bleed)",
     "40 mg in 50–100 mL NS over 15–30 min (or slow IV push)",
     "Continuous: 8 mg/hr × 72 hr after endoscopic hemostasis (high-risk ulcer)",
     "C. difficile, pneumonia, hypomagnesemia, fractures with long-term use; no mortality benefit in low-risk ulcer"),

    ("Octreotide", "Gastrointestinal",
     "50 mcg/mL, 100 mcg/mL, 500 mcg/mL ampoules (1 mL)",
     "Variceal hemorrhage – acute esophageal variceal bleed (adjunct to endoscopy)",
     "50–100 mcg IV push over 1–2 min",
     "500 mcg in 50 mL NS (10 mcg/mL) – syringe pump | 500 mcg in 250 mL NS (2 mcg/mL) – bag",
     "25–50 mcg/hr continuous × 2–5 days",
     "Hyperglycemia, bradycardia, gallstones (prolonged use), nausea, abdominal pain; ↓ splanchnic blood flow"),

    ("Terlipressin", "Gastrointestinal",
     "1 mg vial powder (1 mg in 5–10 mL NS/sterile water)",
     "Variceal hemorrhage – first-line in many guidelines outside US",
     "2 mg IV push q4h × first 24 hr → then 1 mg q4h",
     "Not standard (intermittent IV boluses)",
     "Not applicable",
     "Contraindicated in CAD (vasoconstriction); myocardial/mesenteric/digital ischemia; hypertension, hyponatremia"),

    # ── PSYCHIATRY / AGITATION ───────────────────────────────────────────────
    ("Haloperidol", "Psychiatric / Agitation",
     "5 mg/mL ampoule (1 mL = 5 mg)",
     "Acute severe agitation (delirium, psychosis, mania) – chemical restraint",
     "2.5–5 mg IM (or slow IV over 1–2 min) – repeat q20–30 min prn (max 20 mg/day)",
     "Not routinely infused",
     "Not applicable",
     "QT prolongation (baseline ECG); dystonia (treat with diphenhydramine 25–50 mg IM/IV); rare NMS"),

    ("Olanzapine", "Psychiatric / Agitation",
     "10 mg vial powder for reconstitution (IM use only in emergency)",
     "Acute severe agitation (delirium, psychosis, mania)",
     "5–10 mg IM (repeat once if needed) – NOT IV in emergency",
     "Not applicable (IM route only in emergency)",
     "Not applicable",
     "Do NOT give IV (severe hypotension, bradycardia, respiratory depression, cardiac arrest – black box warning)"),

    # ── ENDOCRINE EMERGENCIES ────────────────────────────────────────────────
    ("Hydrocortisone (Adrenal Crisis)", "Endocrine Emergency",
     "100 mg, 250 mg, 500 mg vials (hydrocortisone sodium succinate)",
     "Adrenal crisis, severe hypothyroidism with suspected adrenal insufficiency",
     "Adrenal crisis: 100 mg IV push (then 50–100 mg q6h)",
     "100 mg in 50–100 mL NS over 5–10 min (or slow IV push)",
     "50–100 mg q6h (intermittent)",
     "In hypothyroidism: give BEFORE thyroid hormone to prevent precipitating adrenal crisis; hyperglycemia, hypokalemia"),

    ("Propranolol (Thyroid Storm)", "Endocrine Emergency",
     "1 mg/mL vial (1 mL = 1 mg)",
     "Thyroid storm (beta-blocker for tachycardia, HTN, agitation, tremor) – after ruling out HF",
     "0.5–1 mg IV over 1 min (repeat q5–10 min; max 5 mg)",
     "Not routinely infused",
     "Not applicable (oral maintenance after stabilization)",
     "Avoid in asthma, COPD, HF, cardiogenic shock; esmolol preferred if available (shorter half-life)"),

    ("PTU / Methimazole (Thyroid Storm)", "Endocrine Emergency",
     "PTU: 50 mg tablets (oral/NG) | Methimazole: 5 mg, 10 mg, 20 mg tablets (oral/NG)",
     "Thyroid storm – definitive treatment (reduce thyroid hormone synthesis)",
     "PTU: 600–1000 mg oral/NG loading (then 200–250 mg q4–6h) | Methimazole: 60–80 mg loading",
     "Not applicable (oral or NG only – NO IV form)",
     "Not applicable",
     "No IV form – use NG if unable to swallow; PTU preferred (also blocks T4→T3); hepatotoxicity (PTU > methimazole); agranulocytosis"),

    ("Dantrolene", "Emergency – Malignant Hyperthermia",
     "20 mg vial powder for reconstitution (sterile water for injection)",
     "Malignant hyperthermia (confirmed or suspected), NMS (off-label)",
     "2.5 mg/kg IV push (rapid) – repeat q5–10 min until symptoms resolve (max 10 mg/kg)",
     "Not routinely infused (bolus dosing; may repeat prn)",
     "Not applicable",
     "Requires large volume sterile water; muscle weakness, phlebitis, respiratory depression; monitor K⁺ and coagulation"),

    # ── ICU PREVENTATIVE ─────────────────────────────────────────────────────
    ("Enoxaparin (DVT Prophylaxis)", "ICU Preventive",
     "60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL prefilled syringes",
     "DVT prophylaxis in ICU (immobile, surgical, trauma, acute medical illness)",
     "40 mg SC once daily (or 30 mg SC if CrCl <30 mL/min)",
     "Not applicable (subcutaneous only)",
     "Not applicable",
     "Contraindicated in active bleeding, HIT; spinal/epidural hematoma risk; not fully reversed by protamine"),

    # ── IV FLUIDS ─────────────────────────────────────────────────────────────
    ("Normal Saline (0.9% NaCl)", "IV Fluid",
     "500 mL, 1000 mL bags/bottles",
     "Hypovolemia (hemorrhage, dehydration, sepsis), resuscitation, maintenance, drug dilution, DKA initial",
     "Shock: 500–1000 mL IV rapid push over 5–15 min (repeat as needed)",
     "Not applicable (given as is)",
     "Maintenance: 1–2 mL/kg/hr",
     "Large volumes → hyperchloremic metabolic acidosis; prefer balanced fluids in TBI; avoid in HF/renal failure"),

    ("Ringer Lactate (Hartmann's)", "IV Fluid",
     "500 mL, 1000 mL bags",
     "Hypovolemia (hemorrhage, burns, sepsis, trauma), resuscitation, intraoperative",
     "Shock: 500–1000 mL IV rapid push over 5–15 min (repeat as needed)",
     "Not applicable (given as is)",
     "Maintenance: 1–2 mL/kg/hr",
     "Preferred over NS in trauma/sepsis/DKA; contains K⁺ (avoid in severe hyperkalemia, renal failure); not in same line as blood"),

    ("Dextrose 5% (D5W)", "IV Fluid",
     "500 mL, 1000 mL bags",
     "DKA/HHS after glucose <250 mg/dL, maintenance with electrolytes; NOT for resuscitation",
     "NOT for resuscitation (D25 or D50 for acute hypoglycemia)",
     "Not applicable (given as is)",
     "Maintenance: 75–100 mL/hr with added electrolytes",
     "Hypotonic after dextrose metabolized → cerebral edema in brain injury; do NOT use for volume resuscitation"),

    ("DNS (D5 Normal Saline)", "IV Fluid",
     "500 mL, 1000 mL bags",
     "Maintenance fluid (post-DKA/HHS when glucose <250), hypovolemia with hypoglycemia risk",
     "NOT for initial resuscitation",
     "Not applicable (given as is)",
     "Maintenance: 75–100 mL/hr",
     "Not a resuscitation fluid; causes hyperglycemia; avoid in cerebral edema, stroke, brain injury"),

    # ── BLOOD PRODUCTS ────────────────────────────────────────────────────────
    ("PRBC (Packed Red Blood Cells)", "Blood Product",
     "250–350 mL per unit (haematocrit ~55–65%)",
     "Hemorrhagic shock, symptomatic anaemia (Hb <7 g/dL), ACS (Hb <8–9 g/dL)",
     "1 unit IV over 60–120 min (massive transfusion: 4 units rapid over 30 min)",
     "Not routinely diluted (can dilute with NS – NOT Ringer's)",
     "Not applicable (unit-based)",
     "Cross-match before transfusion (O-negative for emergency); febrile/hemolytic transfusion reactions; give through filter"),

    ("FFP (Fresh Frozen Plasma)", "Blood Product",
     "200–300 mL per unit (thaw 20–30 min before use)",
     "Coagulopathy with bleeding (INR >1.5–1.8), massive transfusion, DIC, warfarin reversal, liver failure",
     "10–15 mL/kg IV over 30–60 min (typical 2–4 units for adult)",
     "Not applicable (thawed plasma given as is)",
     "Not applicable (unit-based; may repeat based on INR)",
     "ABO-compatible required; thawing takes time (plan ahead); TRALI risk; volume overload"),

    ("Platelets", "Blood Product",
     "Single donor apheresis unit (200–300 mL) or pooled (4–6 units)",
     "Bleeding with platelets <10,000–20,000/mcL; active bleeding with <50,000/mcL; massive transfusion",
     "1 adult dose IV over 15–30 min",
     "Not applicable",
     "Not applicable (repeat based on platelet count/bleeding)",
     "ABO-compatible preferred but not mandatory; febrile non-hemolytic reactions; bacterial contamination risk (5-day shelf life)"),

    ("Cryoprecipitate", "Blood Product",
     "10–20 mL per unit (pooled 5–10 units for adult dose)",
     "Hypofibrinogenaemia with bleeding (fibrinogen <100–150 mg/dL) – DIC, massive transfusion, PPH",
     "10 units IV over 15–30 min",
     "Not applicable",
     "Not applicable (single dose – repeat based on fibrinogen)",
     "Contains fibrinogen, Factor VIII, XIII, vWF; NOT for warfarin reversal (no Factor II, VII, IX, X); ABO-compatible if possible"),

    # ── AIRWAY EQUIPMENT ─────────────────────────────────────────────────────
    ("ET Tubes (Endotracheal)", "Airway Equipment",
     "Adult: 6.0–8.5 mm ID (female 7.0–7.5, male 7.5–8.0) | Pediatric: uncuffed <8 yr (size = age/4 + 4)",
     "Definitive airway management – respiratory failure, airway protection (GCS ≤8), cardiac arrest, severe trauma",
     "N/A (equipment)",
     "N/A",
     "N/A",
     "Confirm by capnography (gold standard) + bilateral breath sounds; depth at lip: 21–23 cm (female), 23–25 cm (male)"),

    ("Bougie (Gum Elastic / Eschmann)", "Airway Equipment",
     "Standard reusable/disposable bougie",
     "Difficult airway – limited glottic view (Cormack-Lehane grade 3–4), anterior larynx, obesity, C-spine immobilization",
     "N/A (equipment)",
     "N/A",
     "N/A",
     "Insert blindly into trachea; feel tracheal clicks; hold-up at 30–40 cm = main bronchus (pull back); curve facing anterior"),

    ("LMA (Laryngeal Mask Airway)", "Airway Equipment",
     "Sizes 3–5 (adult female 3–4, male 4–5); cuffed LMA preferred",
     "Rescue airway (failed mask ventilation but unable to intubate), planned procedure (fasting patient), difficult airway algorithm",
     "N/A (equipment)",
     "N/A",
     "N/A",
     "NOT a definitive airway (does not protect against aspiration); contraindicated: full stomach, obstruction below cords, morbid obesity"),

    ("Cricothyrotomy Set", "Airway Equipment",
     "Scalpel (#11 or #10), tracheal hook/dilator, 6.0 cuffed ETT or Shiley trach (size 4–6), syringe, gauze",
     "Cannot intubate, cannot ventilate (CICV) – failed RSI, airway obstruction (trauma, anaphylaxis, foreign body)",
     "N/A (procedure)",
     "N/A",
     "N/A",
     "Landmark = cricothyroid membrane (between thyroid and cricoid cartilage); vertical incision if uncertain, horizontal if clear anatomy"),

    # ── PROTOCOLS ────────────────────────────────────────────────────────────
    ("ACLS Algorithm", "Protocol",
     "Defibrillator (200J biphasic), epinephrine 1 mg ampoules, amiodarone/lidocaine, ETT/LMA, bag-valve mask",
     "Adult cardiac arrest (VF/pVT, PEA, asystole)",
     "1. CPR (30:2, 100–120/min, 5–6 cm depth) | 2. Defibrillate VF/pVT (200J) | 3. Adrenaline 1 mg q3–5 min | 4. Advanced airway | 5. Reversible causes (4H4T)",
     "N/A",
     "N/A",
     "Minimize CPR interruptions; resume CPR immediately after defibrillation for 2 min before rhythm check; post-ROSC: TTM, PCI, O₂ 94–98%, normocapnia"),

    ("Hyperkalemia Protocol", "Protocol",
     "Calcium gluconate, insulin, dextrose, salbutamol neb, furosemide, NaHCO₃, dialysis",
     "K⁺ ≥6.5 mEq/L with ECG changes (peaked T waves, wide QRS, sine wave, loss of P wave) or severe weakness",
     "1. Stabilize: Ca gluconate 1–2 g IV over 2–5 min | 2. Shift: Insulin 5–10 U + D25 50 mL; Salbutamol neb 10–20 mg; NaHCO₃ 50 mEq if acidotic | 3. Remove: Furosemide/Dialysis",
     "N/A (as per individual drug dilutions)",
     "N/A",
     "Calcium works in minutes but lasts only 30–60 min; repeat if ECG changes recur; monitor glucose hourly with insulin-dextrose"),

    ("DKA Protocol", "Protocol",
     "NS/0.45NS bags, regular insulin (50U/50mL), KCl, NaHCO₃ (optional), D5W",
     "DKA: glucose >250 mg/dL, pH <7.3, HCO₃ <18, anion gap >12, ketonemia",
     "1. NS 1–2 L first hr → 250–500 mL/hr | 2. Insulin 0.1 U/kg/hr | 3. KCl if K <5.2 | 4. NaHCO₃ only if pH <6.9 | 5. Monitor glucose q1h, electrolytes q2–4h",
     "N/A (per individual drug dilutions)",
     "N/A",
     "Correct glucose slowly (50–75 mg/dL/hr); cerebral edema risk if too fast; continue insulin until anion gap closed even if glucose normal"),

    ("Sepsis Bundle (Hour-1)", "Protocol",
     "Blood culture bottles, broad-spectrum antibiotics, NS/RL bags, noradrenaline, lactate measurement kit",
     "Suspected/confirmed sepsis with qSOFA ≥2 or SOFA increase ≥2",
     "1. Measure lactate | 2. Blood cultures before antibiotics | 3. Broad-spectrum antibiotics within 1 hr | 4. 30 mL/kg crystalloid for hypotension or lactate ≥4 | 5. Noradrenaline for MAP <65 mmHg",
     "N/A (per individual drug dilutions)",
     "N/A",
     "Time zero = triage time; antibiotics within 1 hr reduces mortality; reassess volume status after initial bolus; noradrenaline can start peripherally"),

    ("Massive Transfusion Protocol (MTP)", "Protocol",
     "PRBC, FFP, Platelets (1:1:1 ratio); tranexamic acid; calcium gluconate; blood warmer",
     "Hemorrhagic shock requiring ≥10 units PRBC/24 hr or ongoing bleeding with unstable vitals",
     "1:1:1 ratio – 6 PRBC : 6 FFP : 1 apheresis platelet pool | + TXA 1 g IV over 10 min (within 3 hr) | + Calcium gluconate 1–2 g after every 4–6 units PRBC",
     "N/A (per individual product/drug dilutions)",
     "N/A",
     "Warm blood via blood warmer; hypothermia worsens coagulopathy; labs after every 6 units (CBC, INR, fibrinogen, calcium, ABG); activate early, deactivate late"),
]

# ── write header ─────────────────────────────────────────────────────────────
for col_idx, (header, width) in enumerate(zip(HEADERS, COL_WIDTHS), start=1):
    cell = ws.cell(row=1, column=col_idx, value=header)
    cell.font      = Font(name="Arial", bold=True, color=HDR_FG, size=10)
    cell.fill      = PatternFill("solid", fgColor=HDR_BG)
    cell.alignment = Alignment(horizontal="center", vertical="center",
                                wrap_text=True)
    cell.border    = hdr_border()
    ws.column_dimensions[get_column_letter(col_idx)].width = width

ws.row_dimensions[1].height = 32

# ── write data ────────────────────────────────────────────────────────────────
current_category = None
row_idx = 2

for drug_tuple in drugs:
    drug_name, category, dosage_forms, indications, bolus, infusion_dil, infusion_dose, pearl = drug_tuple

    # Insert category separator row
    if category != current_category:
        current_category = category
        for col in range(1, len(HEADERS) + 1):
            c = ws.cell(row=row_idx, column=col)
            if col == 1:
                c.value = f"▶  {category.upper()}"
            c.font      = Font(name="Arial", bold=True, color=CAT_FG, size=9)
            c.fill      = PatternFill("solid", fgColor=CAT_BG)
            c.alignment = Alignment(vertical="center", horizontal="left")
            c.border    = full_border()
        ws.row_dimensions[row_idx].height = 18
        row_idx += 1

    # Alternating row fill
    fill_color = ROW_A if (row_idx % 2 == 0) else ROW_B
    row_data = [drug_name, category, dosage_forms, indications,
                bolus, infusion_dil, infusion_dose, pearl]

    for col, value in enumerate(row_data, start=1):
        c = ws.cell(row=row_idx, column=col, value=value)
        c.font      = Font(name="Arial", size=9,
                           bold=(col == 1))          # bold drug name
        c.fill      = PatternFill("solid", fgColor=fill_color)
        c.alignment = Alignment(vertical="top", wrap_text=True,
                                horizontal="left")
        c.border    = full_border()

    ws.row_dimensions[row_idx].height = 60
    row_idx += 1

# ── freeze pane & auto-filter ────────────────────────────────────────────────
ws.freeze_panes = "A2"
ws.auto_filter.ref = f"A1:{get_column_letter(len(HEADERS))}1"

# ── title row above headers ───────────────────────────────────────────────────
ws.insert_rows(1)
title_cell = ws.cell(row=1, column=1,
    value="EMERGENCY DRUGS – Quick Reference Table")
title_cell.font      = Font(name="Arial", bold=True, color="FFFFFF", size=13)
title_cell.fill      = PatternFill("solid", fgColor="1B2A4A")
title_cell.alignment = Alignment(horizontal="center", vertical="center")
ws.merge_cells(start_row=1, start_column=1,
               end_row=1, end_column=len(HEADERS))
ws.row_dimensions[1].height = 36

# ── save ─────────────────────────────────────────────────────────────────────
output_path = "/home/daytona/workspace/emergency-drugs/Emergency_Drugs_Reference.xlsx"
wb.save(output_path)
print(f"Saved: {output_path}")
print(f"Total drug entries: {len(drugs)}")

python3 /home/daytona/workspace/emergency-drugs/build_table.py