emergency drugs

Drug Mechanism of action

Contraindications

Indications Side effect Nursing responsibilities

Brand Name: Hizon epinephrine

Generic Name: Epinephrine

ClassificationBeta2 Adrenergic Agonists

Dosage: 0.5 mL IM

Stimulates beta receptors in lung.Relaxes bronchial smooth muscle. Increases vital capacityIncreases BP, HR, PR Decreases airway resistance.

-With angle-closure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis-In conjunction with local anesthesia, epinephrine is contraindicated for use in finger, toes, ears, nose, and genitalia.-In pregnant woman, drug is contraindicated.-In breast feeding do not use the drug or stop breast feeding.

Advanced cardiac life support, anaphylactic shock, ocular hypertension, open-angle glaucoma, asthmatic attacks

epigastric pain; CV disorders; difficulty in micturition with urinary retention; dyspnoea; hyperglycaemia; sweating; hypersalivation; weakness, tremors; coldness of extremities; hypokalaemia. Gangrene, tissue necrosis and sloughing (extravasation) when used in addition to local anaesthetics. Eye drops: Severe smarting, blurred vision, photophobia; naso-lachrymal ducts obstruction. Oedema, hyperaemia and inflammation of the eyes with repeated administration.

1. note indications for therapy, onset, characteristics of signs and symptoms. 2. monitor v/s 3. document disease onset, subtype, other agents trialed and outcome.4. take extra precaution on the patients with following conditions: CV diseases; hyperthyroidism; DM; Parkinson's disease; elderly; pregnancy, lactation.

Drug Mechanism of Action

Contraindications Indications Side Effects Nursing responsibilities

Brand name:Dolcet

Generic Name: Tramadol hydrochloride

Route of administration:Oral

Classification :Analgesic

Dosage: 50-100mg q 4-6 hrs. prn

The analgesic effect is only partially antagonized by the antagonist naloxone. Causes significantly less respiratory depression than morphine. In contrast to morphine, tramadol does not cause release of histamine. Produces dependence of the mu-opioid type how ever there is little evidence of abuse. Tolerance occurs but is relatively mild; the withdrawal syndrome is not as severe as with other opiates

Hypersensitivity to tramadol, in acute intoxication with alcohol, hypnotics, centrally acting analgesics, opiates or psychotropic drugs. Use in cleitns with past r resent addictin or opiate dependence or in those with a prior history of allergy to codeine or opiates. Use for obstetric preoperative medicatin of postdelivery analgesia In nursing mothers.

Moderate to moderately severe pain.

Dizziness, headache, CNS stimulation, ataxia, sedation, vertigo, itching, constipation, nausea, seizures, paresthesia, cognitive dysfunction, hallucinations, tremor, amnesia, concentration difficulty, abnormal gait, migraine, nausea, constipation, vomiting, dyspepsia, dry mouth, diarrhea, anorexia

1.do not confuse Ultram with Ultrase

2. List reasons for therapy, location, onset, triggers, characteristics of S and S. use a pin-rating scale to rate pain.

3. Assess for history of drug addiction, allergy to opiates or codeine, seizures; drug may increase the risk of convulsions


Contraindications

Indications Side Effects Nursing Responsibilities

Brand Name: Calcibloc

Generic Name: Nifedipine

Classification:Calcium channel blocker

Route of administration:Oral

Dosage:Capsules: 10-20 mg 3x a dayTablets: 30-60 mg per day

. It blocks the calcium or "slow" channels and inhibits entry of calcium ions into vascular smooth muscles particularly of resistance vessels and coronary arteries. Dilates coronary and peripheral arteries, as well as veins. Coronary arterial vasodilation increases coronary blood flow in the ischemic post-stenotic areas, while dilation of the peripheral arteries lowers arterial blood pressure and reduces left ventricular afterload. Some renal artery dilatation may stimulate mild diuresis.

Cardiovascular shock, severe aortic stenosis or in patients known to be hypersensitive to nifedipine. Care is needed in patients with very low blood pressure (severe hypotension with systolic pressure <90 mmHg) or decompensated heart failure.

Treatment of vasospastic angina, chronic stable angina, hypertension.

Flushing, nausea, dizziness, headache, tiredness, sedation, leg edema and other manifestations of peripheral vasodilation.

1. dot not confuse nifedipine with nicardipine2. do not exceed a single dose3. before increasing dose, carefully monitor BP4. use only the sustained release tablets to treat hypertension5. concomitant therapy with beta renergic blocking agents may be used6. clients withdrawn from beta blockers may manifest symptoms of increased angina which cannot be prevented by nifedipine; in fact nifedipine may increase the severity of angina situation

Drug Data Mechanism of Action

Indication Contraindications Side Effects Nursing Responsibilities

Brand Name Enters target cells -Replacement Hepatitis B,Vaccinia CNS: Vertigo,

Solu-Cortef

Generic Name Hydrocortisone

Dosage20-240 mg/day in single dose or divided doses

Classification :Adrenal cortical steroidCorticosteroidGlucocorticoid

and binds to cytoplasmic receptor; initiates many complex reactions that are responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions..

therapy in adrenal cortical insufficiency- Allergic states – severe or incapacitating allergic conditions- Hematologic disorders- Ulcerative colitis

or varicella,Antibiotic-resistant infections,ImmunosuppressionSpecial Precaution- Kidney disease- Liver disease- Cirrhosis- Hypothyroidism- Ulcerative colitis with - Hypertension- Heart failure- Thromboembolic tendencies- Osteoporosis- Convulsive disorders- Metastatic carcinoma

headache, paresthesias, insomnia, seizures, psychosis, EENT: Cataracts, glaucoma, increased IOPEndocrine: Amenorrhea, irregular mens, growth retardation, decreased GI: Peptic or esophageal ulcer, pancreatitis, Hematologic: Na and fluid retention, hypocalcemia, increased blood sugar, Musculoskeletal: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis.

- Assess for contraindications.- Assess body weight, skin color, V/S, urinalysis, serum electrolytes, X-rays, CBC. - Arrange for increased dosage when patient is subject to unusual stress.- Do not give live vaccines with immunosuppressive doses of hydrocortisone.- Observe the 15 rights of drug administration..- Space multiple doses evenly throughout the day.- Use minimal doses for minimal duration to minimize adverse effects.

- Do not give IM injections ifpatient has thrombocytopenic purpura.


Contraindications


Brand Name: Zantac

Generic Name: Ranitidine

Classification :Anti-ulcer agents

Dosage:150 – 300 mg

. • Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.

• In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori.

•Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance.

Special Precaution::

• Renal impairment• Geriatric patients (moresusceptible to adverse CNS reactions)• Pregnancy or Lactation

Used in management of various gastro intestinal disorders such as dyspepsia, gastroesophageal reflux disease,peptic ulcer and Zollinger-Ellison syndrome.

• CNS:Confusion, dizziness, drowsiness, hallucinations, headache• CV:Arrhythmias• GI:Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea• GU:Decreased sperm count, impotence• ENDO:Gynecomastia• HEMAT:Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia• LOCAL:Pain at IM site• MISC:Hypersensitivity reactions, vasculitis

.

1. Use caution in presence of renal or hepatic impairment

2. Assess potential interactions with other pharmacological agents patient maybe taking.

3. Monitor AST,ALT,serum creatinine,when used to prevent stress-related

GI bleeding


Contraindications


Brand Name: Phyllocontin

Generic Name: Aminophylline

Classification :Bronchodilator

Route of administration:IV,Oral

Dosage:Tablets—100, 200 mg; liquid—105 mg/5 mL; injection—250 mg/10 mL; suppositories—250, 500 mg

. Relaxes bronchial smooth muscle, causing bronchodilation and increasing vital capacity, which has been impaired by bronchospasm and air trapping; in higher concentrations, it also inhibits the release of slow-reacting substance of anaphylaxis (SRS-A) and histamine.

-Contraindicated with hypersensitivity to any xanthine or to ethylenediamine, peptic ulcer, active gastritis; rectal or colonic irritation or infection (use rectal preparations).

-Use cautiously with cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale, severe hypertension, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor, lactation.

-Symptomatic relief or prevention of bronchial asthma and reversible bronchospasm associated with chronic bronchitis and emphysema

-Unlabeled uses: Respiratory stimulant in Cheyne-Stokes respiration; treatment of apnea and bradycardia in premature babies

-CNS: Irritability (especially

children); restlessness,

dizziness, severedepression-CV: Palpitations,

sinustachycardia,

ventricular tachycardia, life

,circulatory failure-GI: Loss of

appetite, hematemesis, epigastric pain, gastroesophageal reflux during sleep-

GU: RBCs;urinary retention in men with prostate enlargement

-Respiratory: Tachypnea, respiratory arrest

-Administer to pregnant patients only when clearly needed.

-Caution patient not to chew or crush enteric-coated timed-release forms.

-Give immediate-release, liquid dosage forms with food if GI effects occur.

-Maintain adequate hydration.

-Monitor for clinical signs of adverse effects

-Ensure that diazepam is readily available to treat seizures.


Contraindications


Brand Name: Voltaren

Generic Name: Diclofenac sodium

Classification :Anti-inflammatory

Route of administration:oral

Dosage:50 mg

.

Inhibits prostaglandin synthesis to cause antipyretic and anti-inflammatory effects; the exact mechanism is unknown.

Contraindicated with allergy to NSAIDs, significant renal impairment, pregnancy, lactation.

Use cautiously with impaired hearing, allergies, hepatic, cardiovascular, and GI conditions

. Acute or long-term treatment of mild to moderate pain, including dysmenorrheaRheumatoid arthritisOsteoarthritisAnkylosing spondylitisTreatment of actinic keratosis in conjunction with sun avoidanceOphthalmic: Postoperative inflammation from cataract extraction

. CNS: Headache,dizziness,somnolence,insomnia, fatigue,tiredness, tinnitus,ophthalmologiceffectsDermatologic: Rash,pruritus, sweating,dry mucousmembranes,stomatitisGI:

Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence

GU: Dysuria, renal impairment

Hematologic: Bleeding, platelet inhibition with higher doses

1.Take drug with food or meals if GI upset occurs.2.Take only the prescribed dosage.These side effects may occur: Dizziness, drowsiness (avoid driving or using dangerous machinery while using this drug).3.Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers, changes in vision; black, tarry stools.


Contraindications


Brand Name: Diazepam

Generic Name: Valium

ClassificationAnti-convulsant

Dosage: Tab Adult 5-20 mg daily

Depresses the CNS, probably by potentiating gamma-aminobutyric acid, an inhibitory neurotransmitter, produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways, has anticonvulsant properties due to enhanced presynaptic inhibition. It also relieves anxiety. It is used also as sedative, skeletal muscle relaxation, cessation of seizure activity.

Dependence on other substances including alcohol except in management of acute withdrawal reactions. Severe chronic hypercapnia.

Management of anxiety, Preoperative sedation, light anesthesia, amnesia, treatment of status epilepticus, skeletal muscle relaxant Management of the symptoms of alcohol withdrawal.

Special Precaution: Cardiorespi. insufficiency; pregnancy, lactation; myasthenia gravis

CNS: dizziness, drowsiness, lethargy, hangover, paradoxical excitation, mental depression, headache EENT: blurred vision Resp: respiratory depression CV: hypotension (IV only) GI: nausea, vomiting, diarrhea, constipation Derm: rashes Local: venous thrombosis, phlebitis (IV) Misc: tolerance, psychological dependence, physical dependence

1.Don't mix injectable diazepam with other drugs, and don't store parenteral solution in plastic syringes.

2. Avoid mixing with any other drugs or solutions, and avoid infusion sets or containers made from polyvinyl chloride.


Contraindications


Brand Name: Lasix

Generic Name: Furosemide

ClassificationDiuretic,Antihypertensive

Dosage: Injection –10 mg/dlOral Solution-10 mg/mlTablet-20 mg

Ihibits sodium and chloride reabsorption at the proximal tubules, distal tubules and ascending loop of Henley leading to excretion of water, together with sodium, chloride and potassium.

. Hypersensitivity to sulfonyureas;Anuria

Special

Precaution:

Elderly patients,

diabetes mellitus

severe hepatic

disease, pregnant

or breastfeeding

patients, neonates

For acute pulmonary edema,Edema caused by heart failure, hepatic cirrhosis and renal disorder

CNS:dizziness,headache,vertigo,weakness,lethargy,paresthesiaCV: hypotension,light-headedness,necrotizing angiitis,thrombolebitis, arrythmiasEENT: blurred vision,hearing loss,tinittusGI: acute pancreatitisGU: oliguria,intestinal nephritisHEMATOLOGIC:Leucopenia,thrombocytopenia,hemolytic anemiaHEPATIC: jaundiceMUCOSKELETAL:muscle pain,muscle crampsSKIN: erythema multiformeOTHER: fever,trancient pain

1.Avoid driving and other hazardous activities until he knows how drug effects concentration and alertness.2.Caution the patient to stop to avoid alcohol and herbs while taking this drug.3. Inform patient that he will regularly undergo blood testing therapy.


Contraindications


Brand Name: Aeknil

Generic Name: Paracetamol

ClassificationAnalgesic , Antipyretic

Dosage: ≤10 years old 1-2 mlAdult and children ≥ 10yr.2-3 ml

Paracetamol produces analgesia by raising threshold of the pain center of the brain and by obstructing imulpses at the pain-mediating chemoreceptors.The drug produces antipyresia by an action of hypothalamus ; heat dissipation,is increased as a result of vasodilation and ↑ peripheral blood flow

Nephropathy.

Special

Precaution:Renal and hepatic failure

For sympmtomatic relief of fever and pain associated with common childhood disorders,tonsillitis,URTI,post immunization reactions

HEMATOLOGIC: luekopenia,thrombocytopeniaSKIN skin eruption

1. Instruct patient to take with meals.2. Have plenty of water when taking this drug.


Contraindications


Brand Name: Chlorphenamine

Generic Name: Antamin

ClassificationAntihistamines,Antiallergies

Dosage: Adult: 1 tab/ 3x a day

Competes with histamine for H 1- receptor site on effector cells; decreases allergic response by blocking histamine.

. Newborn or

premature infants,

hyperthyroidism,

hypertension.

acute asthma

attack,

active peptic ulcer,

tuberculosis

Special

Precaution:

Liver

disease,epilepsy,c

hronic respiratory

disorders, hepatic

disease,pregnant

or breastfeeding

pts.

Treatment for allergic disorders of allergic rhinitis, bronchial asthma,food and drug allergy, measles, asthma , pains, headaches,common cold, anaphylactic shock.

Dry mouth, constipation, blurred vision, delirium , agitation, jaundice, ventricular tachycardia, drowsiness, nasal stuffiness, cardiac arrhythmias, cardiac failure, skin rashes.

1Assess patient’s condition before after therapy and regularly after.2. Assess for hypersensitivity reaction: fever,skin rash.3. Tell patient to report adverse effect.4. Advise patient that drug may cause photosensitivity.5. Avoid driving and other hazardous activities because drowsiness may occur, observe until drug’s effect are known.


Contraindications


Brand Name: Hemostan

Generic Name: Tranexamic acid

ClassificationHaemostatics

Dosage: Oral-(15 to 25 mg) 2 to 4 x a day

.Inhibits breakdown of fibrin clots.It acts primarily by blocking the binding of plasminogen and plasmin to fibrin; direct inhibition of plasmin occurs only to a limited degree.

Hypersensitivity to drugs, patients with intravascular clotting because of the risk of thrombosis.Severe renal insuffiency , patients with microscopic hematuria.

Special

Precaution:

Patients with pre

disposition to

thrombosis,

hematuria, renal

impairment,pregna

nt or breastfeeding

pts.

Treatment and prophylaxis of hemorrhage associated with excessive fibrinolysis.

.Gastrointestinal disturbances, hypotension, disturbance color vision, thrombotic complication.

1. Perform blood tests, liver function tests, eye examination, and obtain prothrombine time.2. Reduced dosage for patients with renal impairment.3. Advice patient to report visual abnormalities to the physician.


Contraindications


Brand Name: Buscopan plus

Generic Name: Hyoscine/ Paracetamol

ClassificationAntispasmodic

Dosage: Infants:5 mL , initial dose TIDChildren:1-6 yrs. 5-10 mL , initial dose TIDChildren:7- 14 yrs. 15 mL,Initial dose TIDAdult:15-45 mL TID

Causes an influx of fluid in the intestinal tract by increasing the osmotic pressure within the intestinal lumen.Bacterial metabolism of the drug to lactate and other acids which are only partially abvsorbed in the distal ileum and colon augments the osmotic effect of lactulose.

.Patients who require to low lactose diet, galactosaemia or disaccharide deficiency , intestinal obstruction.

Special

Precaution:

Diabetes mellitus

elderly,pregnant or

breastfeeding pts. ,

do not use if

presence of

adominal pain ,

nausea,vomiting,

fever,.

Constipation, salmonellosis, treatment for hepatic encephalopathy.

Abdominal discomfort associated with flatulence and intestinal cramps, nausea, vomiting, diarrhea on prolonged use.

1..For patient with hepatic encephalopathy, regularly assess mental condition and ammonia level.2. Monitor for possible GI reactions: nausea, vomiting, abdominal cramps, blenching, diarrhea , flatulence, and distention.3. Monitor for increased glucose levels for diabetic patient.


Contraindications


Brand Name: Plasil

Generic Name: Metocloperamide

ClassificationAntiemetic, GI regulator, anti-inflammatory, antiflatulents

Route:IM, slow IV injection over 1-2 mins.

Dosage: Pedia:5 -10 mg TIDAdult:10 mg TID

Dopamine agonist that acts by increasing receptor sensitivity and response of upper GI tissues to acetycholine. This causes the contraction of gastric smooth muscles, relaxation of pyloric sphincter and duodenal bulb and increased peristalsis without stimulating gastric,biliary and pancreatic secretions.It also produces sedation and induces releases of prolactin.

.Patients in whom increased GI might be dangerous ,hypersensitivity to drugs, children, lactation, patients with breast cancer, epileptic patients.

Special

Precaution:

Patients with

Parkinsonism and

history of mental

illness,epileptics,el

derly ,pregnant or

breastfeeding pts.

Gastrointestinal motility disturbances.Nausea and vomitingof central and peripheral origin associated with surgery , metabolic diseases, infectious diseases, and drug induced.

Sedation, restlessness, fatigue diarrhea, insomnia, headache, dizziness, nervousness, menstrual disorders, drowsiness, bowel upsets.

1..Frequently monitor blood pressure of patients taking IV form of drug.2. Assess mental status during treatment : depression,anxiety, irritability.3. Assess patient’s and family’s knowledge of drug therapy.


Contraindications


Brand Name: Isordil

Generic Name: Isosorbide dinitrate/mononitrate

ClassificationAnti- anginal

Route:Oral

Dosage: 40 mg OD

Increases supply of oxygen to the heart by dilating both the arteries and veins which supply the heart itself.

Acute myocardial infarction ; with low filling pressures , except in the intensive care unit with continuous haemodynamic monitoring; left heart failure with low filling pressures ; shock; very low blood pressure ..Special

Precaution:

Pregnant or

breastfeeding

patients, acute

myocardial

infarction,

constrictive

pericarditis.

.Preventive and long term treatment of angina pectoris, congestive heart failure, arterial vasodilators, pulmonary hypertension.

Transient hypoxemia,headache, ↓ blood pressure, ↑ pulse rate, dizziness and weakness, nausea,vomiting, allergic skin reactions.

1.Assess for pain: duration, time started, activity being performed, character, intensity.2. Monitor B/.P, pulse at baseline and during treatment.3. Caution pt. to make position changes slowly to prevent orthostatic hypotension.4. Instruct pt. to swallow sustained released tablet whole, do not chew; SL tablet should be dissolved under the tongue ,do not swallow chewable tablet should be chewed thoroughly.

EMERGENCY DRUGS

Submitted by: Mary Anne E. Elepaño

BSN – Ш C

Submitted to: Ms. Silgrid Villanueva Clinical Instructor

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