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)