EMERGENCY DRUGSCARDIAC DRUGSATROPINE SULFATEIsopto Atropine
Classification Anticholinergics
Dosage N Bradycardia: 0.5 mg IV every 3-5 mins, max of 0.04
mg/kgN Cardiac Arrest: 1 mg every 3-5 minsN Nerve and
Organophosphate symptoms: may repeat in 2 mg increments q 3 mins
titrated to relief symptoms
Indication [ Pre-op meds/pre-anesthetic meds[ To restore cardiac
rate and arterial pressure during anesthesia when vagal[ To lessen
the degree of A-V heart block[ To overcome severe carotid sinus
reflex[ Antidote for cholinergic toxicity
Side effects CNS: restlessness, ataxia, disorientation,
hallucinations, delirium, coma, insomnia, agitation, confusion. CV:
tachycardia, angina, arrhythmias, flushing. EENT: photophobia,
blurred vision, mydriasis. GI: dry mouth, constipation, vomiting.
GU: urine retention. Hematologic: leukocytosis Other:
anaphylaxis
Adverse effects [ CNS: headache, excitement.[ CV: palpitations[
GI: thirst, nausea
Contraindications[ Hypersensitivity[ With acute angle closure
glaucoma, obstructive uropathy, obstructive disease of GI tract,
paralytic ileus, toxic megacolon, intestinal atony, unstable CV
status in acute hemorrhage, asthma, or myasthenia gravis.[ Pregnant
women.
Nursing ManagementN Monitor VS.N Report HRN Monitor for
constipation, oliguria.N Instruct to take 30 mins before mealsN Eat
foods high in fiber and drink plenty fluids.N Can cause
photophobiaN Instruct client not to drive a motor vehicle or
participate in activities requiring alertness.N Advise to use hard
candy, ice chips, etc. for dry mouth.
NITROGLYCERINE Nitrostat
ClassificationN AntianginalN NitrateN Vasodilator,N Coronary
DosageN 0.3-0.4 mg SL q 5 min, max 3 doses.N Every 6 hrs except
for midnight (cream)N Wear 12 hrs a day for skin patch
Action N Relaxes the vascular smooth system
N Reduces myocardial oxygen consumptionN Reduces left
ventricular workload N Reduces arterial BPN Reduces venous
return
IndicationN Angina pectorisN CHF associated with AMIN Cardiac
load reducing agentN Hypertensive Crisis
Side effectsN CNS: headache, throbbing, dizziness, weakness.N
GI: nausea, vomitingN Skin: RashN Adverse ReactionsN CV:
orthostatic hypotension, flushing, fainting.N EENT: sublingual
burning.N Skin: Cutaneous vasodilation, contact dermatitis
(patch)
ContraindicationsN Contraindicated in patients hypersensitive to
nitrates N With early MI. (S.L. form), severe anemia, increase ICP
angle-closure glaucoma, IV nitroglycerine is contraindicated in
patients with hypovolemia, hypotension, orthostatic hypotension,
cardiac tamponade restrictive cardiomyopathy, constrictive
pericarditis.
Nursing ManagementN Record characteristics and precipitating
factors of anginal pain.N Monitor BP and apical pulse before
administration and periodically after dose.
N Have client sit or lie down if taking drug for the first
time.N Client must have continuing EKG monitoring for IV
administrationN Cardioverter/ defibrillator must not be discharged
through paddle electrode overlyingN Nitro-Bid ointment or the
Transderm-Nitro Patch. Assist with ambulating if dizzy.N Instruct
to take at first sign of anginal pain.N May be repeated q 5 minutes
to max. of 3 doses. N If the client doesnt experience relief,
advise to seek medical assistance immediately.N Keep in a dark
colored container
MORPHINE SULFATEImmediate-release tablets: MSIRTimed-release:
Kadian, M-Eslon (CAN), MS Contin, Oramorph SROral solution: MSIR,
Rescudose, Roxanol, Roxanol TRectal suppositories: RMSInjection:
Astramorph PF, Duramorph, Epimorph (CAN)Preservative-free
concentrate for microinfusion devices for intraspinal use:
Infumorph
ClassificationOpioid Agonist Analgesic
DosageN Oral: 1030mg q 4 hr PO. Controlled-release: 30mg q 812
hr PO or as directed by physician; Kadian: 20100 mg PO daily24-hr
release system; MS Contin: 200mg PO q 12 hr.
N SC and IM:10mg (520mg)/70 kg q 4 hr or as directed by
physician.
N IV:2.515mg/70 kg of body weight in 45 mL water for injection
administered over 45 min, or as directed by physician. Continuous
IV infusion: 0.11mg/mL in 5% dextrose in water by controlled
infusion device.
N Rectal:1030mg q 4 hr or as directed by physician.
N Action N Acts as agonist at specific opioid receptors in the
CNS to produce analgesia, euphoria, sedation
IndicationN Relief of moderate to severe acute and chronic painN
Preoperative medicationN Analgesic adjunct during anesthesiaN
Component of most preparations that are referred to as Brompton's
cocktail or mixtureN Intraspinal use with microinfusion devices for
the relief of intractable painN Unlabeled use: Dyspnea associated
with acute left ventricular failure and pulmonary edema
Side EffectsN GI: dry mouth, constipation.N Skin: Tissue
irritation and induration (SC injection).N Other: sweating,physical
tolerance and dependence, psychological dependence
Adverse EffectsN CNS: Light-headedness, dizziness, sedation,
euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear,
hallucinations, disorientation, drowsiness, lethargy, impaired
mental and physical performance, coma, mood changes, weakness,
headache, tremor, seizures, miosis, visual disturbances,
suppression of cough reflexN CV: Facial flushing, peripheral
circulatory collapse, tachycardia, bradycardia, arrhythmia,
palpitations, chest wall rigidity, hypertension, hypotension,
orthostatic hypotension, syncopeN Dermatologic: Pruritus,
urticaria, Respiratory: laryngospasm, bronchospasm, edemaN GI:
Nausea, vomiting, anorexia, biliary tract spasm; increased colonic
motility in patients with chronic ulcerative colitisN GU: Ureteral
spasm, spasm of vesical sphincters, urinary retention or hesitancy,
oliguria, antidiuretic effect, reduced libido or potencyN
Respiratory:Respiratory depression, apnea, circulatory depression,
respiratory arrest, shock, cardiac arrest
ContraindicationsN Hypersensitivity to opioidN Diarrhea caused
by poisoning until toxins are eliminatedN During labor or delivery
of a premature infantN After biliary tract surgery or following
surgical anastomosisN PregnancyN Labor Nursing
ManagementInterventionsN Caution patient not to chew or crush
controlled-release preparations.N Dilute and administer slowlyN
Tell patient to lie down during IV administration.N Keep opioid
antagonist and facilities for assisted or controlled respiration
readily available during IV administration.N Use caution when
injecting SC or IM into chilled areas or in patients with
hypotension or in shockN Reassure patients that they are unlikely
to become addictedTeaching pointsN Take this drug exactly as
prescribed. Avoid alcohol, antihistamines, sedatives,
tranquilizers, over-the-counter drugs.N Swallow controlled-release
preparation (MS Contin, Oramorph SR) whole; do not cut, crush, or
chew them.N Do not take leftover medication for other disorders,
and do not let anyone else take your prescription.N These side
effects may occur: Nausea, loss of appetite, constipation,
dizziness, sedation, drowsiness, impaired visual acuityN Report
severe nausea, vomiting, constipation, shortness of breath or
difficulty breathing, rash.
VERAPAMILCalan, Isoptin, Verelan, Covera HS
ClassificationN Anti-anginalN Anti-arrhythmicsN
Anti-hypertensiveN Vascular headache suppressants
Dosage PO 80-120 mg 3x daily, increases as needed
Action N Inhibits calcium transport into myocardial smooth
muscle cellsN Decreases SA and AV conduction and prolongs AV node
refractory period in conduction tissue
Indication N HypertensionN Angina PectorisN Supraventricular
ArrhythmiaN Atrial flutter/fibrillation
Side Effects and Adverse Reactions
N CNS:abnormal dreams, anxiety, confusion, dizziness and
headacheN EENT: blurred vision, epistaxis and tinnitusN CV:
arrhythmia, CHF, chest pain, bradycardia, hypotension and
palpitationsN GU: dysuria, nocturia and polyuriaN GI: abnormal
liver function, anorexia, constipation, diarrhea, nausea and
vomiting
Contraindications N HypersensitivityN Sick sinus syndromeN 2nd
or 3rd degree AV blockN CHFN Cardiogenic shockN Concurrent IV
beta-blocker
Nursing ManagementN Monitor BP and pulse before therapy, during
titration and therapyN Monitor ECG, I&O, serum potassium and
weight.N Assess for CHF
DILTIAZEMCardizem, Dilacor, Novo-Diltiazem, Tiamate and
Tiazac
Classification Anti-anginals Antiarrhythmics Antihypertensive Ca
channel blocker
Dosage PO: 30-120 mg, 3-4x daily or 60-120 mg twice daily as SR
capsules IV: 0.25 mg/kg
Action Inhibits calcium transport into myocardial smooth muscle
cells Systemic and coronary vasodilation
Indication Hypertension Angina Pectoris Supraventricular
Arrhythmia Atrial flutter/fibrillation
Side Effects and Adverse and Reactions CNS:abnormal dreams,
anxiety, confusion, dizziness and headache EENT: blurred vision,
epistaxis and tinnitus CV: arrhythmia, CHF, chest pain,
bradycardia, hypotension and palpitations GU: dysuria, nocturia and
polyuria GI: abnormal liver function, anorexia, constipation,
diarrhea, nausea and vomiting
Contraindications Hypersensitivity Sick sinus syndrome 2nd or
3rd degree AV block CHF Cardiogenic shock Concurrent IV
beta-blocker
Nursing Management Monitor BP and pulse before therapy, during
titration and therapy Monitor I&O and weight Assess for CHF
Routine serum digoxin monitoring
LIDOCAINE Xylocaine
Classification CV drugs: Anti-arrhythmics Anesthetic
Dosage Arrhythmia: IV: 0.7-1.4 mg/kg body weight. No more than
200 mg within 1 hour period IM: 4-5 mg/kg body weight
Action Increases electrical stimulation of ventricle and
His-purkinje system by direct action on tissues, resulting to
decrease depolarization, automaticity and excitability in
ventricles during diastolic phase
Indication Anesthesia Arrhythmias Control of Status epilepticus
refractory to other treatments
Side Effects and Adverse ReactionsGI disturbances, bradycardia,
hypotension, convulsion, numbness of tongue, muscle twitching,
restlessness, nervousness, dizziness, tinnitus, blurred vision,
fetal intoxication, light headedness, drowsiness, apprehension,
euphoria, vomiting, sensation of heat, respiratory arrest and CV
collapse
Contraindications Hypersensitivity Heart block Hypovolemia Adams
stroke syndromes Infection at site of injection
Nursing Management Assess pt before and after therapy Pts
infusion must be on cardiac monitor Monitor ECG, if QT or QRS
increases by 50% or more, withhold the drug Monitor BP, check for
rebound HPN after 1-2 hrs Assess respiratory status, oxygenation
and pulse deficits Assess renal and liver function Monitor CNS
symptoms Monitor blood levels
AMIODARONE Cordarone
ClassificationAnti-arrhythmics
Dosage Recurrent ventricular arrhythmias: PO800-1600 mg/day for
1-2 wks PSVT, symptomatic atrial flutter: PO 600-800 mg/day for 1
month Arrhythmias with CHF: 200 mg/day Ventricular dysrrhythmias:
150 mg over the 1st 10 mins then slow 360 mg over the next 6
hrs
Action Blocks Na channels, prolonging myocardial cell action
potential and refractory period Non competitive alpha and beta
adrenergic blockage
Indication Life threatening recurrent arrhythmias Ventricular
fibrillation Ventricular tachycardia
Side Effects and Adverse ReactionsExacerbation of arrhythmias,
bradycardia, SA node dysfunction, heart block, sinus arrest;
flushing, fatigue, malaise, abnormal involuntary movements, ataxia,
dizziness, paresthesia, decreased libido, insomnia, headache, sleep
disturbances, visual impairment, blindness, corneal microdeposits,
photophobia, abnormal taste, nausea, vomiting, constipation,
anorexia, abdominal pain, abnormal salivation, coagulation
abnormalities, non-specific hepatic disorders, pulmonary
inflammation, dyspnea, toxicosis, death, edema, hypo and
hyperthyroidism
Contraindications Severe sinus node dysfunction 2nd or 3rd
degree AV block Hypersensitivity
Nursing Management Assess cardiovascular status before therapy
Assess pulmonary, hepatic and thyroid function before and during
therapy Monitor fluid and electrolytes, I&O, K, Na and Cl
Monitor ECG, BP Assess vision
PROCAINAMIDEPronestyl, Procan-SR, Procanbid
ClassificationAntiarrhythmics
Dosage Arrhythmias: 50 mg/kg/day in divided doses 3-6 hourly
Action Blocks open Na channels and prolongs the cardiac action
potential. This results in slowed conduction and ultimately the
decreased rate of rise of the action potential may result on the
widening of QRS on ECG
Indication Supraventricular and ventricular arrhythmias.
Treatment of Wolf-Parkinson-White Syndrome
Side Effects and Adverse Reactions Severe hypotension,
ventricular fibrillation and asystole. Drug induced SLE syndrome,
blood disorders, fever, myocardial depression, heart failure,
agrunulocytosis, psychosis, angioedema, hepatomegaly, skin
irritation, hypergammaglobulinemia, GI and CNS effects
Contraindications Heart block Heart failure Hypotension
Myesthenia gravis Digoxin toxicity Lactation
Nursing Management Assess cardiovascular status before therapy
Assess pulmonary, hepatic and thyroid function before and during
therapy Monitor fluid and electrolytes, I&O, K, Na and Cl
Monitor ECG, BP Assess vision
EPINEPHRINEInjection, OTC nasal solution: Adrenalin
ChlorideOphthalmic solution: Epifrin, GlauconInsect sting
emergencies: EpiPen Auto-Injector (delivers 0.3mg IM adult dose),
EpiPen Jr. Auto-Injector (delivers 0.15mg IM for children)OTC
solutions for Nebulization: AsthmaNefrin, microNefrin, Nephron,
S2
ClassificationBeta2 Adrenergic Agonists
Dosage [ Cardiac arrest: 1 mg IV of 1:10,000 solution q 3-5 min;
double dose if administering via ET tube[ Anaphylaxis: 0.1- 1 mg SQ
or IM of 1:1000 solution.[ Asthma: 0.1-0.3 mg SQ or IM of 1:10,000
solution[ Refractory bradycardia and hypotension: 2-10ug/min
Action N Stimulates beta receptors in lung.N Relaxes bronchial
smooth muscle. N Increases vital capacityN Increases BP, HR, PR N
Decreases airway resistance.
Indication N AsthmaN BronchitisN EmphysemaN All cardiac arrest,
anaphylaxisN Used for symptomatic bradycardia.N Relief of
bronchospasm occurring during anesthesiaN Exercised-induced
bronchospasm
Side Effects/Adverse ReactionsSide Effects:nervousness, tremor,
vertigo, pain, widened pulse pressure, hypertension nauseaAdverse
Effects: headache
Contraindications N With angle-closure glaucoma, shock (other
than anaphylactic shock), organic brain damage, cardiac dilation,
arrhythmias, coronary insufficiency, or cerebral arteriosclerosis.
Also contraindicated in patient receiving general anesthesia with
halogenated hydrocarbons or cyclopropane and in patients in labor
(may delay second stage)N In conjunction with local anesthesia,
epinephrine is contraindicated for use in finger, toes, ears, nose,
and genitalia.N In pregnant woman, drug is contraindicated.N In
breast feeding do not use the drug or stop breast feeding.
Nursing Management1. Monitor V/S. and check for cardiac
dysrrhythmias2. Drug increases rigidity and tremor in patients with
Parkinsons disease 3. Epinephrine therapy interferes with tests for
urinary catecholamine 4. Avoid IM use of parenteral suspension into
buttocks. Gas gangrene may occur 5. Massage site after IM injection
to counteract possible vasoconstriction. 6. Observe patient closely
for adverse reactions. Notify doctor if adverse reaction develop 7.
If blood pressure increases sharply, rapid-acting vasodilators such
as nitrates or alpha blockers can be given to counteract
VASOPRESSINPitressin
Classification[ Pituitary Hormones[ ADH
Dosage Prevent and treat abdominal distention: initially 5 units
IM gives subsequent injections q3-4 hours increasing to 10 units if
needed.
Action Increase permeability of renal tubular epithelium to
adenosine monophosphate and water, the epithelium promotes
reabsorption of water and concentrated urine
Indication Diabetes Insipidus Abdominal Distention GI bleeding
Esophageal varices
Side Effects and Adverse Reactions CNS: tremor, headache,
vertigo CV: vasoconstriction, arrhythmias, cardiac arrest,
myocardial ischemia, circumollar pallor, decreased CO, angina GI:
abdominal cramps GU:uterine cramps Respi: bronchoconstriction Skin:
diaphoresis, gangrene and urticaria
Contraindications With chronic nephritis and nitrogen retention
Hypersensitivity
Nursing Management Give 1-2 glass of H20 to reduce adverse
reactions and improve therapeutic response Warm vasopressin in your
hands and mixed until it is distributed evenly in the solution
Monitor urine Sp. Gravity and I&O to aid evaluation of drug
effectiveness
MAGNESIUM SO4
Classification Anti-convulsant Anti-arrhythmics
Dosage [ Arrhythmia: IV 1-6 grams over several minutes, then
continuous IV infusion 3-20 mg/min for 5-48 hours.
Action [ Decreased acetylcholine released
Indication Mg replacement Arrhythmia
Side Effects and Adverse Reactions CNS: drowsiness, depressed
reflexes, flaccid paralysis, hypothermia CV: hypotension, flushing,
bradycardia, circulatory collapse, depressed cardiac function EENT:
diplopia Respiratory: respiratory paralysis Metabolic: hypocalcemia
Skin: diaphoresis
Contraindications Heart block and myocardial damage Toxemia of
pregnancy
Nursing Management Monitor I&O. make sure urine output is
100 ml or more in 4 hrs pd before each dose Take appropriate
seizure precautions Keep IV Ca gluconate at bedside
Na HCO3Arm and Hammer; Baking Soda
ClassificationAlkalinizers
Dosage Metabolic Acidosis: Usually 2-5 meq/kg IV infuse over 4-8
hr period Cardiac Arrest: 1 meq/kg IV of 7.5 or 8.4% sol, then 0.5
meq/kg IV q 10 mins depending on ABG
Action [ Restore buffering capacity of the body and neutralizes
excessive acid
Indication Metabolic Acidosis Cardiac Arrest
Side Effects/Adverse Reactions CNS: tetany CV: edema GI: gastric
distention, belching and flatulence Metabolic: hypokalemia,
metabolic alkalosis, hypernatremia, hyperosmolarity with overdose
Skin: pain @ injection site
Contraindications Metabolic and respiratory alkalosis Pt losing
Cl because of vomiting or continuous GI suction or those receiving
diuretics that produces hypochloremic alkalosis
Nursing Management Obtain blood pH, PaO2, PaCo2 and electrolyte
levels SIVPHYPERTENSIVE CRISISNa NITROPRUSSIDENittropress
ClassificationAntihypertensive, Vasodilator
Dosage 0.25-0.3 mcg/kg/minute
Action Relaxes arteriolar and venous smooth muscle
Indication [ Hypertensive crisis[ To produce controlled
hypotension during anesthesia[ To reduce preload and afterload in
cardiogenic shock
Side Effects/Adverse ReactionsHeadache, dizziness, increased
ICP, loss of consciousness, restlessness, bradycardia, nausea,
abdominal pain, methemoglodinemia, muscle twitching, pink-colored
rash, irritation at infusion site
Contraindications [ Hypersensitivity[ Compensatory hypotension[
Inadequate cerebral circulation[ Acute heart failure with reduced
PVR[ Congenital optic atrophy[ Tobacco-induced ambylopia
Nursing Management1. Obtain VS before giving the drug2. Place pt
in supine3. Giving excessive doses of 500 mcg/kg delivered faster
than 2 mcg/kg/min or using max infusion rate of 10 mcg/kg/min for
more than 10 mins can cause cyanide toxicity
FUROSEMIDELasix
ClassificationLoop Diuretics
Dosage [ Pulmonary edema: 40 mg IV[ Edema: 20 to 80 mg PO every
day in the morning[ HPN: 40 mg PO bid. Dosage adjusted based on
response
Action Inhibits Na and Cl reabsorption at the proximal and
distal tubules and in the ascending loop of Henle
Indication [ Acute pulmonary edema[ Edema[ Hypertension
Side Effects/Adverse ReactionsSigns of hypotension, hypokalemia
and hyperglycemia
Contraindications [ Hypersensitivity[ Anuria
Nursing Management1. Monitor wt., BP and PR2. Monitor fluid,
I&O, electrolyte, BUN and CO2 levels frequently3. WOF signs of
hypokalemia4. Monitor uric acid levels5. Monitor glucose levels esp
in DM pts
MORPHINE SO4(Discussed earlier) NEUROSURGICAL DRUGSMANNITOL
Osmitrol
ClassificationDiuretics
Dosage Test dose for marked oliguria or suspected inadequate
renal function: 200 mg/kg or 12.5 gram as a 15% to 20% IV solution
over 3-5 mins response is adequate if 30-50 ml of urine/hr is
adequate, a second dose is given if still no response after 2nd
dose stop the drug Oliguria: 50 over 90 mins to several hrs To
induced intraocular or intracranial pressure: 1.5-2 gram/kg as a 15
% to 20% IV solution over 30-60 min Diuresis in drug intoxication:
12.5% to 10% solutions up to 200 g IV Irrigating solution during
TURP: 2.5-5%
Action Increases osmotic pressure of glomerular filtrate,
inhibiting tubular reabsorption of water and electrolytes; drug
elevates plasma osmolarity, increasing water flow into
extracellular fluid
Indication Test dose for marked oliguria or suspected inadequate
renal function Oliguria To induced intraocular or intracranial
pressure Diuresis in drug intoxication Irrigating solution during
TURPSide Effects/Adverse ReactionsN CN: seizures, headache and
fever CV: edema, thrombophlebitis, hypotension and heart failure
EENT: blurred vision and rhinitis GI: thirst, dry mouth, nausea,
vomiting and diarrhea GI: urine retention Metabolic: dehydration
Skin: local pain Others: chillContraindications Hypersensitivity
Anuria, severe pulmonary congestion, frank pulmonary edema, active
intracranial bleeding during craniotomy, severe dehydration,
metabolic edema, progressive heart failure or pulmonary congestion
after drug
Nursing Management Monitor VS,CVP,I&O, renal function fluid
balance and urine K levels daily. Drug can be used to measure GFR
Do not give electrolyte free solutions with blood. If blood id
given simultaneously, add at least 200 meq of NaCL to each
liter
POISONINGNALOXONE HCLNarcan
ClassificationMiscellaneous antagonists and antidotes
Dosage N For suspected opioid induced respiratory depression:
0.4 to 2 mg IV, IM and SQ. repeat doses q 2-3 mins PRNN For
postoperative opiod depression: 0.01 to 0.2 mg IV q 2-3 mins, PRN.
Repeat dose within 1-2 hr, if needed.N Action N Reverse the effects
of opiods, psychotomimetic and dysphoric effects of
agonist-antagonists
Indication N For suspected opioid induced respiratory
depression
N For postoperative opiod depression
Side Effects/Adverse ReactionsN CNS: seizures, tremorsN CV:
ventricular fibrillation, tachycardia, HPN with higher recommended
doses, hypotensionN GI: nausea and vomitingN Respiratory: pulmonary
edemaN Skin: diaphoresis
Contraindications N HypersensitivityN Use cautious with cardiac
irritability or opiod addiction.
Nursing ManagementN Assess respiratory status frequentlyN
Respiratory rate increases within 1-2 mins
IPECAC SYRUP
ClassificationAntidote
Dosage 25-30 ml followed immediately by H2O
Action Irritates the stomach lining and stimulate the vomiting
center
Indication [ Poisoning[ Overdose
Side EffectsDiarrhea, drowsiness, stomach cramps, vomiting,
itching, DOB, swelling of the mouth, rash and hives
Contraindications [ Hypersensitivity[ Given activated charcoal[
Unconcious[ Drowsy[ Severely drunk[ Having seizures[ With no gag
reflex
Nursing Management1. Dont administer to unconscious2. Pt should
kept active and moving ff administration3. If vomiting does not
occur after 2nd dose, gastric lavage may be considered to remove
ingested substance
ACTIVATED CHARCOAL
ClassificationAntidote
Dosage 30-100 g with at least 8 oz of water
Action [ Inhibits GI absorption of toxic substances or
irritants[ Hyperosmolarity
Indication [ Poisoning
Side Effects[ Pain, melena, diarrhea, vomiting and
constipation
Contraindications [ Cyanide, mineral acids, organic solvents,
intestinal obstruction, bleeding with fructose intolerance, broken
GI tract, concomitant use of charcoal with sorbitol
Nursing Management[ Do not mix with chocolate and together with
ipecac syrup[ Notify doctor if caused swelling or pain in the
stomach
FLUMAZENILRomazicon
Classification[ Benzodiazepine receptor antagonists
Dosage [ 2 ml IV given over 15 seconds
Action [ Antagonizes the effects of benzodiazepines
Indication [ Benzodiazepine-induced depression of the
ventilatory responses to hypercapnia and hypoxia
Side Effects[ Nausea, vomiting, palpitations, sweating,
flushing, dry mouth, tremors, insomnia, dyspnea, hyperventilation,
blurred vision, headache, pain at injection site
Contraindications [ Control of ICP or status epilepticus.[ Signs
of serious cyclic antidepressant overdose
Nursing Management1. Must individualize dosage. Give only
smallest amount effective.2. Give through freely running IV
infusion into large vein to minimize pain at injection site3. Note
history of seizure or panic disorder4. Assess evidence of increased
ICP5. Note evidence of sedative and benzodiazepine dependence6.
Instruct to avoid alcohol and non-prescription drugs for 1-24
hrs
SHOCKDOPAMINE Intropine
ClassificationAdrenergic drugs
Dosage Initially 2-5 mcg/kg/min by IV
Action Stimulates dopaminergic and alpha and beta receptors of
the sympathetic nervous system resulting in positive inotropic
effect and increased CO
Indication N To treat shock and correct hemodynamic imbalancesN
To correct hypotension
N To improve perfusion of vital organs
N To increase CO
Side EffectsN CNS: headache an anxietyN CV: tachy, angina,
palpitations and vasoconstrictionN GI: nausea and vomiting
Contraindications N HypersensitivityN With uncorrect
tachyarrhythmiasN PheochromocytomaN Ventricular Fibrillation
Nursing ManagementN Most patients received less than 20
mcg/kg/minN Drugs isnt substitute for blood or fluid volume
deficitN During infusion, monitor ECG, BP, CO, PR and color and
temp of the limbsN Do not confuse dopamine to dobutamineN Check
urine output often
DOBUTAMINEDobutrex
ClassificationAdrenergic drugs
Dosage N 0.5-1 mcg/kg/min IV infusion, titrating to optimum
dosage of 2-20 mcg/kg/minN 2.5 to 10 mcg/kg/min-usual effective
range to increase CO
Action Stimulates heart beta receptors to increase myocardial
contractility and SV
Indication N To increase CON Treatment of cardiac
decompensation
Side EffectsN CNS: headacheN CV: HPN, tachycardia, palpitations
and vasoconstrictionN GI: nausea and vomiting
Contraindications N HypersensitivityN Use cautiously in pts with
hx of HPN and AMI
Nursing ManagementN Before starting therapy, give a plasma
volume expander to correct hypovolemia and a cardiac glycosideN
Monitor ECG, BP, pulmonary artery wedge pressure and CON Monitor
electrolyte levelsN Dont confuse dobutamine to dopamine
GLUCAGON
ClassificationPancreatic Hormones
Dosage 0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN
Action Binds with glucagon receptor
Indication Hypoglycemia
Side EffectsNausea, vomiting, hypotension, tachycardia and
hypertension
Contraindications N HypersensitivityN PheochromocytomaN
Insulinoma
Nursing ManagementN Monitor V/S and blood sugar levelN Response
within 20 mins after injection
ALBUTEROLVentolin
ClassificationBronchodilator, Adrenergic
Dosage 2 inhalations reputed q 4-6 hrs via neb
Action Activation of beta adrenergic receptors on airway smooth
muscle
Indication N AsthmaN Prevention of exercise induced spasms
Side effects[ Palpitations[ Tachycardia[ GI upset[
Nervousness
Contraindications Hypersensitivity
Nursing ManagementN Monitor therapeutic effectivenessN Monitor
HR, BP, ABG, s/sx of bronchospasm and CNS stimulationN Instruct on
how to use inhaler properlyN Rinse mouth after use
DIPHENHYDRAMINE HCLBenadryl
ClassificationAnti-histamine
Dosage 25-50 mg PO, IV or IM bid-tid
Action Blocks the effects Hi receptor sites
Indication N Allergic reactionsN Motion sicknessN Cough
suppressionN Sedation
Side EffectsN XerostomiaN Urinary retentionN Sedation
Contraindications Acute asthmatic attack
Nursing ManagementRisk for photosensitivity- use sunscreen
EPINEPHRINE(Discussed earlier)