Emergency Drugs

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EMERGENCY DRUGS CARDIAC DRUGS ATROPINE SULFATE Isopto Atropine Classification Anticholinergics Dosage



Bradycardia: 0.5 mg IV every 3-5 mins, max of 0.04 mg/kg



Cardiac Arrest: 1 mg every 3-5 mins



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 Management

 Monitor VS.



Report  HR

 Monitor for constipation, oliguria.  Instruct to take 30 mins before meals

 Eat foods high in fiber and drink plenty fluids.

 Can cause photophobia

 Instruct client not to drive a motor vehicle or participate in activities requiring alertness.

 Advise to use hard candy, ice chips, etc. for dry mouth. NITROGLYCERINE Nitrostat Classification  Antianginal  Nitrate  Vasodilator,  Coronary Dosage

 0.3-0.4 mg SL q 5 min, max 3 doses.  Every 6 hrs except for midnight (cream)  Wear 12 hrs a day for skin patch

Action

 Relaxes the vascular smooth system  Reduces myocardial oxygen consumption  Reduces left ventricular workload  Reduces arterial BP

 Reduces venous return

Indication

 Angina pectoris

 CHF associated with AMI  Cardiac load reducing agent  Hypertensive Crisis

Side effects



CNS: headache, throbbing, dizziness,

weakness.



GI: nausea, vomiting



Skin: Rash

 Adverse Reactions



CV: orthostatic hypotension, flushing,

fainting.



EENT: sublingual burning.



Skin: Cutaneous vasodilation, contact

dermatitis (patch)

Contraindications

 Contraindicated in patients hypersensitive to nitrates

 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.

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 Record characteristics and precipitating factors of anginal pain.

 Monitor BP and apical pulse before administration and periodically after dose.  Have client sit or lie down if taking drug for

the first time.

 Client must have continuing EKG monitoring for IV administration

 Cardioverter/ defibrillator must not be

discharged through paddle electrode overlying  Nitro-Bid ointment or the Transderm-Nitro

Patch. Assist with ambulating if dizzy.  Instruct to take at first sign of anginal pain.  May be repeated q 5 minutes to max. of 3

doses.

 If the client doesn’t experience relief, advise to seek medical assistance immediately.  Keep in a dark colored container

MORPHINE SULFATE

Immediate-release tablets:

MSIR

Timed-release:

Kadian, M-Eslon (CAN), MS Contin, Oramorph SR

Oral solution:

MSIR, Rescudose, Roxanol, Roxanol T

Rectal suppositories:

RMS

Injection:

Astramorph PF, Duramorph, Epimorph (CAN)

Preservative-free concentrate for

microinfusion devices for intraspinal use:

Infumorph

Classification

Opioid Agonist Analgesic

Dosage



Oral: 10–30 mg q 4 hr PO.

Controlled-release: 30 mg q 8–12 hr PO or as directed by physician; Kadian: 20–100 mg PO daily– 24-hr release system; MS Contin: 200 mg PO q 12 hr.



SC and IM:10 mg (5–20 mg)/70 kg q 4 hr

or as directed by physician.



IV:2.5–15 mg/70 kg of body weight in 4–5

mL water for injection administered over 4–5 min, or as directed by physician. Continuous IV infusion: 0.1–1 mg/mL in 5% dextrose in water by controlled infusion device.



Rectal:10–30 mg q 4 hr or as directed by

physician.  Action

 Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation

Indication

 Relief of moderate to severe acute and chronic pain

 Preoperative medication

 Analgesic adjunct during anesthesia  Component of most preparations that are

referred to as Brompton's cocktail or mixture  Intraspinal use with microinfusion devices for

the relief of intractable pain

 Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary edema

Side Effects



GI: dry mouth, constipation.



Skin: Tissue irritation and induration (SC

injection).



Other: sweating,physical tolerance and

dependence, psychological dependence

Adverse Effects



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 reflex



CV: Facial flushing, peripheral circulatory

collapse, tachycardia, bradycardia,

arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope



Dermatologic: Pruritus, urticaria, Respiratory:

laryngospasm, bronchospasm, edema



GI: Nausea, vomiting, anorexia, biliary tract

spasm; increased colonic motility in patients with chronic ulcerative colitis



GU: Ureteral spasm, spasm of vesical

sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency



Respiratory:Respiratory depression, apnea,

circulatory depression, respiratory arrest, shock, cardiac arrest

 Hypersensitivity to opioid

 Diarrhea caused by poisoning until toxins are eliminated

 During labor or delivery of a premature infant  After biliary tract surgery or following surgical

anastomosis  Pregnancy  Labor

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Nursing Management Interventions

 Caution patient not to chew or crush controlled-release preparations.  Dilute and administer slowly  Tell patient to lie down during IV

administration.

 Keep opioid antagonist and facilities for assisted or controlled respiration readily available during IV administration.  Use caution when injecting SC or IM into

chilled areas or in patients with hypotension or in shock

 Reassure patients that they are unlikely to become addicted

Teaching points

 Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives,

tranquilizers, over-the-counter drugs.  Swallow controlled-release preparation (MS

Contin, Oramorph SR) whole; do not cut, crush, or chew them.

 Do not take leftover medication for other disorders, and do not let anyone else take your prescription.

 These side effects may occur: Nausea, loss of appetite, constipation, dizziness,

sedation, drowsiness, impaired visual acuity  Report severe nausea, vomiting,

constipation, shortness of breath or difficulty breathing, rash.

VERAPAMIL

Calan, Isoptin, Verelan, Covera HS

Classification

 Anti-anginal  Anti-arrhythmics



Anti-hypertensive

 Vascular headache suppressants

Dosage

PO 80-120 mg 3x daily, increases as needed

Action

 Inhibits calcium transport into myocardial smooth muscle cells

 Decreases SA and AV conduction and prolongs AV node refractory period in conduction tissue Indication  Hypertension  Angina Pectoris  Supraventricular Arrhythmia  Atrial flutter/fibrillation

Side Effects and Adverse 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

 Hypersensitivity  Sick sinus syndrome



2nd_{or 3}rd_{degree AV block}

 CHF

 Cardiogenic shock

 Concurrent IV beta-blocker

 Monitor BP and pulse before therapy, during titration and therapy

 Monitor ECG, I&O, serum potassium and weight.

 Assess for CHF

DILTIAZEM

Cardizem, 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,

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♣ Hypersensitivity ♣ Sick sinus syndrome

♣

♣ CHF

♣ Cardiogenic shock

♣ Concurrent IV beta-blocker

♣ 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

GI 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

♣ Hypersensitivity ♣ Heart block ♣ Hypovolemia

♣ Adams stroke syndromes ♣ Infection at site of injection

♣

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

Classification

Anti-arrhythmics

Dosage

Recurrent ventricular arrhythmias:

♣

PO800-1600 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

Exacerbation 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

♣ Severe sinus node dysfunction

♣

♣ Hypersensitivity

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♣

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

PROCAINAMIDE

Pronestyl, Procan-SR, Procanbid

Classification

Antiarrhythmics

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

♣ 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

EPINEPHRINE

Injection, OTC nasal solution:

Adrenalin Chloride

Ophthalmic solution:

Epifrin, Glaucon

Insect sting emergencies:

EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for children)

OTC solutions for Nebulization:

AsthmaNefrin, microNefrin, Nephron, S2

Classification

Beta2 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

 Stimulates beta receptors in lung.  Relaxes bronchial smooth muscle.  Increases vital capacity



Increases BP,  HR,  PR  Decreases airway resistance.

Indication

 Asthma  Bronchitis  Emphysema

 All cardiac arrest, anaphylaxis  Used for symptomatic bradycardia.  Relief of bronchospasm occurring during

anesthesia

 Exercised-induced bronchospasm

Side Effects/Adverse Reactions Side Effects:

nervousness, tremor, vertigo, pain, widened pulse pressure, hypertension nausea

Adverse Effects:

headache

 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)

 In conjunction with local anesthesia, epinephrine is contraindicated for use in finger, toes, ears, nose, and genitalia.  In pregnant woman, drug is

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 In breast feeding do not use the drug or stop breast feeding.

1.

Monitor V/S. and check for cardiac dysrrhythmias

2. Drug increases rigidity and tremor in patients with Parkinson’s 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

VASOPRESSIN Pitressin 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

♣

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

♣ With chronic nephritis and nitrogen retention

♣

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

♣

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

♣

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 HCO3

Arm and Hammer; Baking Soda

Classification

Alkalinizers

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♣

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

♣ Obtain blood pH, PaO2, PaCo2 and electrolyte levels ♣ SIVP HYPERTENSIVE CRISIS Na NITROPRUSSIDE Nittropress Classification Antihypertensive, 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

Headache, dizziness, increased ICP, loss of consciousness, restlessness, bradycardia, nausea,

abdominal pain, methemoglodinemia, muscle twitching, pink-colored rash, irritation at infusion site

Hypersensitivity

Compensatory hypotension Inadequate cerebral circulation Acute heart failure with reduced PVR Congenital optic atrophy

Tobacco-induced ambylopia

1. Obtain VS before giving the drug 2. Place pt in supine

3.

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 FUROSEMIDE Lasix Classification Loop 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

Signs of hypotension, hypokalemia and hyperglycemia Contraindications Hypersensitivity Anuria Nursing Management 1. Monitor wt., BP and PR

2. Monitor fluid, I&O, electrolyte, BUN and CO2 levels frequently

3. WOF signs of hypokalemia 4. Monitor uric acid levels

5. Monitor glucose levels esp in DM pts

MORPHINE SO4

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NEUROSURGICAL DRUGS MANNITOL Osmitrol Classification Diuretics 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 TURP



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: chill Contraindications

♣ Anuria, severe pulmonary congestion, frank pulmonary edema, active

intracranial bleeding during craniotomy, severe dehydration, metabolic edema, progressive heart failure or pulmonary congestion after drug

♣ 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

POISONING NALOXONE HCL

Narcan

Classification

Miscellaneous antagonists and antidotes

Dosage

 For suspected opioid induced respiratory depression: 0.4 to 2 mg IV, IM and SQ. repeat doses q 2-3 mins PRN



For postoperative opiod depression: 0.01 to 0.2 mg IV q 2-3 mins, PRN. Repeat dose within 1-2 hr, if needed.

 Action

 Reverse the effects of opiods,

psychotomimetic and dysphoric effects of agonist-antagonists

Indication

 For suspected opioid induced respiratory depression

 For postoperative opiod depression

 CNS: seizures, tremors

 CV: ventricular fibrillation, tachycardia, HPN with higher recommended doses, hypotension

 GI: nausea and vomiting  Respiratory: pulmonary edema  Skin: diaphoresis

 Hypersensitivity

 Use cautious with cardiac irritability or opiod addiction.

 Assess respiratory status frequently  Respiratory rate increases within 1-2 mins

IPECAC SYRUP Classification

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Dosage

25-30 ml followed immediately by H2O

Action

Irritates the stomach lining and stimulate the vomiting center

Indication

Poisoning Overdose

Side Effects

Diarrhea, drowsiness, stomach cramps, vomiting, itching, DOB, swelling of the mouth, rash and hives

Hypersensitivity

Given activated charcoal Unconcious

Drowsy

Severely drunk Having seizures With no gag reflex

1. Don’t administer to unconscious 2. Pt should kept active and moving ff

administration

3.

If vomiting does not occur after 2nd_dose,

gastric lavage may be considered to remove ingested substance

ACTIVATED CHARCOAL Classification

Antidote

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

Cyanide, mineral acids, organic solvents, intestinal obstruction, bleeding with fructose intolerance, broken GI tract, concomitant use of charcoal with sorbitol

Do not mix with chocolate and together with ipecac syrup

Notify doctor if caused swelling or pain in the stomach

FLUMAZENIL

Romazicon

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

Control of ICP or status epilepticus. Signs of serious cyclic antidepressant overdose

1.

Must individualize dosage. Give only smallest amount effective.

2. Give through freely running IV infusion into large vein to minimize pain at injection site 3. Note history of seizure or panic disorder 4. Assess evidence of increased ICP 5. Note evidence of sedative and

benzodiazepine dependence

6. Instruct to avoid alcohol and non-prescription drugs for 1-24 hrs SHOCK DOPAMINE Intropine Classification Adrenergic 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

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Indication

 To treat shock and correct hemodynamic imbalances

 To correct hypotension

 To improve perfusion of vital organs  To increase CO

Side Effects



CNS: headache an anxiety



CV: tachy, angina, palpitations and

vasoconstriction



GI: nausea and vomiting Contraindications

 With uncorrect tachyarrhythmias  Pheochromocytoma

 Ventricular Fibrillation

 Most patients received less than 20 mcg/kg/min



Drugs isn’t substitute for blood or fluid volume deficit

 During infusion, monitor ECG, BP, CO, PR and color and temp of the limbs

 Do not confuse dopamine to dobutamine  Check urine output often

DOBUTAMINE

Dobutrex

Classification

Adrenergic drugs

Dosage

 0.5-1 mcg/kg/min IV infusion, titrating to optimum dosage of 2-20 mcg/kg/min

 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

 To increase CO

 Treatment of cardiac decompensation

Side Effects



CNS: headache



CV: HPN, tachycardia, palpitations and

vasoconstriction



GI: nausea and vomiting Contraindications

 Use cautiously in pts with hx of HPN and AMI



Before starting therapy, give a plasma volume expander to correct hypovolemia and a cardiac glycoside



Monitor ECG, BP, pulmonary artery wedge pressure and CO



Monitor electrolyte levels

 Don’t confuse dobutamine to dopamine

GLUCAGON Classification

Pancreatic Hormones

Dosage

0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN

Action

Binds with glucagon receptor

Indication

Hypoglycemia

Side Effects

Nausea, vomiting, hypotension, tachycardia and hypertension Contraindications  Hypersensitivity  Pheochromocytoma  Insulinoma Nursing Management

 Monitor V/S and blood sugar level  Response within 20 mins after injection

ALBUTEROL

Ventolin

Classification

Bronchodilator, Adrenergic

Dosage

2 inhalations reputed q 4-6 hrs via neb

Action

Activation of beta adrenergic receptors on airway smooth muscle

Indication

 Asthma

 Prevention of exercise induced spasms

Side effects Palpitations Tachycardia GI upset Nervousness Contraindications

(11)

Hypersensitivity

 Monitor therapeutic effectiveness

 Monitor HR, BP, ABG, s/sx of bronchospasm and CNS stimulation

 Instruct on how to use inhaler properly  Rinse mouth after use

DIPHENHYDRAMINE HCL Benadryl Classification Anti-histamine Dosage 25-50 mg PO, IV or IM bid-tid Action

Blocks the effects Hi receptor sites

Indication  Allergic reactions  Motion sickness



Cough suppression  Sedation Side Effects  Xerostomia  Urinary retention  Sedation Contraindications

Acute asthmatic attack

Risk for photosensitivity- use sunscreen

EPINEPHRINE