Emergency Drugs
Emergency Drugs
Emergency Drugs
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For use in all medical
Steel cylinders (green); E tanks,
Oxygen emergencies where hypoxemia
690 L
may be present
Ampules: 1 mg
Acute allergic reactions Acute
Epinephrine asthma (not responding to Vials: 1 and 30 mg
adrenergic inhaler) Syringes: 0.3 and 1 mg
Tablets (sublingual): 0.15, 0.3,
Angina pectoris, Acute 0.4, and 0.6 mg
Nitroglycerin
myocardial infarction
Spray: 0.4 mg/actuation
can be delivered to the spontaneously breathing patient via full face mask, nasal
cannulae, or nasal hood.
6
is mandatory for the treatment of cardiac arrest and overwhelming anaphylaxis.
However, it must be emphasized that these extreme conditions are the m situations that would
require its use in the dental office emergency. There are a few clinicians who maintain the
mistaken belief that epinephrine is the drug of choice in shock or shocklike states. There are
three principal reasons for disputing this belief.
First, in shock from almost any cause there is decreased venous return to the heart because of
peripheral venous pooling. Because the peripheral action of epinephrine is primarily on the
arterial side, there is little gain in promoting peripheral vasoconstrictions, which is already
present because of the massive release of endogenous catecholamines (epinephrine and
norepinephrine). At this point administration of epinephrine may further decrease venous return
and tissue perfusion. Second, a possible deleterious effect is an increase in selective ischemia
that takes place in certain viscera such as the kidney. Here, as in peripheral vessels, the blood
supply is constricted in a compensatory effort to increase blood flow to the more vital brain and
heart tissues. Perpetuation of this condition could be undesirable. Third, the possible
precipitation of ventricular fibrillation in the ischemic and irritable myocardium is an important
factor. This could be especially disastrous in the dental office where defibrillation equipment is
usually not available. In early treatment of shock states the patient will benefit more from
measures aimed at correction of the primary cause such as hypovolemia rather than misdirected
attempts at pharmacologic correction.
Desirable properties of this agent include a rapid onset of action; potent action as a bronchial
smooth muscle dilator (beta2 properties); antihistaminic actions; vasopressor actions; and its
actions on the heart, which include an increased heart rate (21%), increased systolic blood
pressure (5%), decreased diastolic blood pressure (14%), increased cardiac output (51%), and
increased coronary blood flow. Undesirable actions include its tendency to predispose the heart
to dysrhythmias and its relatively short duration of action.
Epinephrine is an important drug during cardiac arrest because no other drug is capable of
maintaining coronary artery blood flow while CPR is in progress, which is essential for
preserving the chances of survival from cardiac arrest. Epinephrine also preserves blood flow to
the brain. In the absence of drug therapy, cerebral blood flow during CPR is minimal; most blood
enters the common carotid artery and flows into the external carotid branch, not the internal
carotid artery. Following administration of a drug with a-adrenergic properties, such as
epinephrine, cerebral blood flow is significantly increased.
Because of its profound bronchodilating effects, epinephrine is also indicated for the treatment of
acute asthmatic attacks unrelieved by b2-adrenergic sprays or aerosols.
Sideeffects,cm trai dicatim s,a drecautim s: Tachydysrhythmias, both supraventricular and
ventricular, may develop. Epinephrine should be used with caution in pregnant women because it
decreases placental blood flow and may induce premature labor. When used, all vital signs must
be monitored frequently.
Antihistamines will be of value in the treatment of the delayed allergic response and in the
definitive management of the acute allergic reaction (administered after epinephrine has
terminated the acute life-threatening phase of the reaction). Antihistamines act as competitive
antagonists of histamine. They do not prevent the release of histamine from cells in response to
injury, drugs, or antigens, but do prevent access of histamine to its receptor site in the cell and
thereby block the response of the effector cell to histamine. Thus, antihistamines are more potent
in preventing the actions of histamine than in reversing these actions once they develop.
cVasodilators are used in the immediate management of chest pain (such as may
occur with angina pectoris or acute myocardial infarction). Two varieties of vasodilator are
available: nitroglycerin (TNG) as a tablet and a spray, and an inhalant, amyl nitrite. A patient
with a history of angina pectoris will usually carry a supply of nitroglycerin. Tablets remain the
most popular form of TNG, although most patients prefer the translingual spray once they have
used it. .
Amyl nitrite, another vasodilator, is available for use as an inhalant. It is supplied in a yellow
vaporole or a gray cardboard vaporole with yellow printing in a dose of 0.3 mL, which when
crushed between one's finger and held under the victim's nose will act in about 10 seconds to
produce a profound vasodilation. The duration of action of amyl nitrite is shorter than that of
TNG; however, the shelf life of the vaporole is considerably longer. Side effects occur with all
vasodilators but they are more significant with amyl nitrite.
Sideeffects,cm trai dicatim s,a drecautim s:Side effects of nitroglycerin include a transient
pulsating headache, facial flushing, and a degree of hypotension (noted especially if the patient is
in an upright position). Because of its mild hypotensive actions, nitroglycerin is contraindicated
in patients who are hypotensive, but may be used with some degree of effectiveness in the
management of acute hypertensive episodes. Side effects of amyl nitrite are similar to but more
intense than those of nitroglycerin. These include facial flushing, pounding pulse, dizziness,
intense headache, and hypotension. Amyl nitrite should not be administered to patients who are
in an upright position because the patient may feel dizzy and suffer a fall.
ë ectabe
Anticonvulsant Midazolam Versed Diazepam
Analgesic Morphine Meperidine
Vasopressor Methoxamine Vasoxyl Phenylephrine
Antihypoglycemic 50% Dextrose sol. Glucagon
Hydrocortisone Solu-
Corticosteroid Cortef sodium Dexamethasone
succinate
Antihypertensive Labetalol HC Normodyne
Anticholinergic Atropine
m i ectabes
Respiratory stimulant Aromatic Ammonia
Carbohydrate
Antihypoglycemic Many
Decorative icing
Bronchodilator Albuterol Ventolin, Proventil Metaproterenol
Antihypertensive Nifedipine Procardia
c Seizures that may require acute medical intervention may be associated with
epilepsy, hyperventilation episodes, cerebrovascular accidents, hypoglycemic reactions, or
vasodepressor syncope. Local anesthetic overdoses or accidental intravascular injection may also
require the administration of an anticonvulsant. Current management of a seizure that interferes
with ventilation or persists for longer than 5 minutes includes the use of an intravenous
benzodiazepine such as diazepam or midazolam.
With its introduction, diazepam became the preferred anticonvulsant. Because seizure disorders
are characterized by a stimulation of the central nervous and cardiorespiratory and cardiovascular
systems, followed by a period of depression of these same systems, drugs that depress the
systems at therapeutic does are more likely to produce postseizure complications. When
barbiturates are administered to terminate seizure activity, the degree of postseizure depression is
accentuated and its duration prolonged because of the pharmcologic action of the barbiturate.
If the doctor is not adapt at recognizing and managing this situation, the patient may be worse off
after the seizure than during it. The benzodiazepines, unlike barbiturates, will usually terminate
seizure activity without the pronounced depression of the respiratory and cardiovascular systems.
medications will be useful during emergency situations in which acute pain or anxiety
is present. In most instances the presence of pain or anxiety will cause an increase in the
workload of the heart (and an increased myocardial oxygen requirement) that may prove
detrimental to the well-being of the patient. Two such circumstances are acute myocardial
infarction and congestive heart failure. The choice of analgesic drugs includes the narcotic
agonists morphine sulfate and meperidine (Demerol).
Side effects, cm trai dicatim s, a d recautim s: Narcotic agonists are potent CNS and
respiratory depressants. Vigilant monitoring of vital signs is mandatory whenever these agents
are used. Use of narcotic agonists is contraindicated in victims of head injury and multiple
trauma; they should be used with care in persons with compromised respiratory function.
ÿ
c In most emergency situations in which a vasopressor is indicated in the dental
office, an agent such as epinephrine will not be the drug of choice. Epinephrine will be used
primarily in the management of acute allergic reactions and is rarely employed in cases of
clinically mild to moderate hypotension. One reason for this is that epinephrine elicits an
extreme antihypotensive response. In addition to an increase in blood pressure, epinephrine
causes an increase in the workload of the heart through its effect on heart rate and cardiac
contraction; it also increases the irritability of the myocardium by sensitizing it to dysrhythmias.
Methoxamine is a clinically useful vasopressor with sustained action and little effect on the
myocardium or central nervous system. Its vasopressor action is associated with a marked
increase in peripheral resistance and no increase in cardiac output. A compensatory bradycardia
accompanies the rise in blood pressure produced by methoxamine. The onset of the pressor
action is almost immediate following IV administration and may persist for up to 60 minutes.
After IM injection the response occurs within 15 minutes and persists for 90 minutes.
Phenylephrine acts in a similar fashion, with a 5-mg IM dose causing a 30-mm Hg elevation of
systolic blood pressure and a 20-mm Hg elevation of diastolic blood pressure, with the response
persisting for 50 minutes. As with methoxamine, a pronounced and persistent bradycardia will be
noted (average decline in heart rate from 70 to 44 beats per minute).
cGlucose preparations are used to treat hypoglycemia that results either from
fasting or insulin use in a patient with diabetes mellitus. If the patient is conscious, oral
carbohydrates such as chocolate bar, cake icing, or cola drink will act rapidly to restore
circulating blood sugar. On the other hand, if the patient is unconscious and acute hypoglycemia
is suspected, intravenous administration of 50% dextrose solution is the treatment of choice.
will be administered in the management of an acute allergic reaction, but only
after the acute phase has been brought under control through the use of basic life support,
epinephrine, and antihistamines. The primary value of the corticosteroids is in the prevention of
recurrent episodes of anaphylaxis. Corticosteroids are also important in the management of acute
adrenal insufficiency.
Hydrocortisone sodium succinate is considered the drug of choice for the dental emergency kit.
Corticosteroids are considered second-line drugs primarily because of their slow onset of action.
6
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Oral drugs, such as nifedipine or nitroglycerin, may be administered in most situations to provide
a minor depression of blood pressure. The inclusion of a drug in this category is in response to
state requirements for general anesthesia permits (and in a few states for parenteral sedation,
too).
c Atropine, a parasympathetic blocking agent, is recommended for the
management of symptomatic bradycardia (adult heart rate of <60 beats per minute). By
enhancing discharge from the sinoatrial (SA) node, atropine may provoke tachycardia (adult
heart rate>100 beats per minute). Atropine will be of benefit in situations in which the patient
has an overload of parasympathetic activity on the heart. Extremely fearful patients are likely
candidates for this response.
Atropine is also considered an essential drug in advanced cardiac life support (ACLS), in which
it is employed in the management of bradydysrhythmias (hemodynamically significant heart
block and asystole).
Sideeffects,cm trai dicatim s,a drecautim s:Large doses of atropine (>2.0 mg) may produce
clinical signs of overdosage, including: hot, dry skin; headache; blurred near vision; dryness of
the mouth and throat; disorientation; and hallucination. Administration of atropine is
contraindicated in patients with glaucoma or prostatic hypertrophy. However, in life-threatening
situations the benefits of atropine administration usually outweigh the possible risks.
d
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After oxygen, aromatic ammonia is the most commonly used drug in the
emergency situation. It is available in a silver-gray vaporole, which is crushed and placed under
the victim's nose until respiratory stimulation is effected. Aromatic ammonia has a noxious odor
and acts by irritating the mucous membrane of the upper respiratory tract, thereby stimulating the
respiratory and vasomotor centers of the medulla; this in turn increases respiration and blood
pressure. Movement of the arms and legs often occurs in response to inhalation of ammonia.
This too acts to increase the return of blood from the periphery and aids in raising blood
pressure, especially if the patient has been positioned properly.
Sideeffects,cm trai dicatim s,a drecautim s:Ammonia should be employed with caution in
persons with chronic obstructive pulmonary disease (COPD) or asthma because its irritating
effects on the mucous membranes of the upper respiratory tract may precipitate bronchospasm.
c agents will be useful in the management of hypoglycemic reactions
occurring in patients with diabetes mellitus or in the nondiabetic patient with hypoglycemia (low
blood sugar). The diabetic patient will usually carry a ready source of carbohydrate such as a
candy bar or hard candy. Such items should also be available in the dental office for use in the
conscious patient with hypoglycemia.
!
cAsthmatic patients and patients with allergic reactions manifested primarily by
respiratory difficulty will require the use of bronchodilator drugs. Although epinephrine remains
the drug of choice in the management of bronchospasm, its wide ranging actions on systems
other than the respiratory tract has resulted in the introduction of newer, more specific agents
known as b2-adrenergic agonists. These agents, of which albuterol is an example, have specific
bronchial smooth muscle-relaxing properties (b2 ) with little or no stimulatory effect on the
cardiovascular and gastrointestinal systems (b1) . In the dental situation in which the patient's
true cardiovascular status may be unknown, b2 agonists appear more attractive for management
of the acute asthmatic episode than agents that have both b1 and b2 agonist properties, such as
epinephrine and isoproterenol.
Side effects, cm trai dicatim s, a d recautim s: Albuterol, like other b2 agonists, may have a
clinically significant cardiac effect in some patients. This response is less likely to develop with
albuterol than with other bronchodilators, thus its selection for the emergency kit.
Metaproterenol, epinephrine, and isoproterenol mistometers are more likely to produce
cardiovascular side effects, including tachycardia and ventricular dysrhythmias.
Antiarrhythmicsc
Ventricular tachycardia, pulseless, ventricular
Lidocaine
tachycardia, or ventricular fibrillation
Ventricular tachycardia, pulseless ventricular
Procainamide
tachycardia or ventricular fibrillation
Ventricular tachycardia, pulseless ventricular
Bretylium
tachycardia or ventricular fibrillation
Atrial flutter or atrial fibrillation, paroxysmal
Verapamil, diltiazem
supraventricular tachycardia
Adenosine Paroxysmal supraventricular tachycardia
Bradycardia, asystole, first-degree and Mobitz
Atropine type I atrioventricular block, Mobitz type II and
third-degree block
Magnesium Torsades de pointes, ventricular fibrillation
Atrial flutter or atrial fibrillation, refractory
ß blockers (e.g., propranolol) ventricular tachycardia or ventricular
fibrillation
ënotropesc
Ventricular fibrillation, asystole, pulseless,
Epinephrine
electrical activity, bradycardia
Norepinephrine Refractory hypotension
Dopamine Bradycardia, hypotension
Dobutamine Congestive heart failure
Isoproterenol Refractory bradycardia
Digitalis Atrial flutter, fibrillation
Amrinone Refractory congestive heart failure
ÿasodilators/Antihypertensivesc
Nitroprusside Hypertension, acute heart failure
Hypertension, acte heart failure, anginal pain
Nitroglycerin
thersc
Hyperkalemia, metabolic acidosis with
Sodium bicarbonate
bicarbonate loss, hypoxic lactic acidosis
Furosemide Acute pulmonary edema
Morphine Acute pulmonary edema, pain and anxiety
Thrombolytic agents (e.g., anistreplase) Acute myocardial thrombosis
c% c
cc
Narcotic antagonist Naloxone Narcan Nalbuphine
Benzodiazepine
Flumazenil Mazicon
antagonist
Antiemergence
Physostigmine Antilirium
delirium
Vasodilator Procaine Novocain
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Epinephrine (Adrenalin)-
anaphylaxis, cardiac arrest 0.5 ml intravenously
1:1000
Methylprednisolone sodium cardiac arrest, anaphylaxis,
125 mg intravenously, given
succinate (Solu-Medrol)-125 acute adrenocortical
slowly
mg Monovile insufficiency
1 mEq/kg intravenously
Sodium bicarbonate±7.5% cardiac arrest initially, then half this every 10
minutes
acute allergic reaction,
Diphenhydramine (Benadryl)
extrapyramidal reaction to 5 ml intravenously
10 mg/ml
phenothiazine
Aromatic spirits of ammonia-
syncope one ampule, by inhalation
crush ampules
Glyceryl trinitrate±0.6 mg
angina pectoris one tablet sublingually
tablet
1 ml subcutaneously or
Morphine sulfate±15mg/ml myocardial infarction
intravenously
Phenylephrine hydrochloride
toxic reaction to local
(Neo-Synephrine 1 to 2 ml intravenously
anesthetic
Hydrochloride) ± 1:500
hypovolemia, IV route for drug
Dextrose in water±5% 1000 ml IV drip
administration
severe or prolonged convulsion
Diazepam± 5 mg/ml as in toxic reaction to local 1 to 8 ml intravenously (titrated)
anesthetic
Naloxone
1 ml intravenously or
hydrochloride(Narcan) ±0.4 narcotic depression
intramuscularly
mg/ml
Isoproterenol hydrochloride
bronchospasm one or two inhalations
aerosol±0.25%
Physostigmine salicylate ± CNS depression following 0.5 to 2 ml intravenously (slow
1mg/ml diazepam administration titration)
Atropine sulphate±0.1 mg/ml bradycardia with hypotension 0.5 - 1.0 mg IV
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Dosage: Initial: 225-450 mg twice daily, increased if needed. IV Acute severe bronchospasm.
Loading dose: 5 mg/kg (ideal body wt). Maintenance: 0.5 mg/kg/hr. Rate should not exceed 25
mg/min.
Adverse Reactions: Nausea, vomiting, abdominal pain, diarrhea, headache, insomnia, dizziness,
anxiety, restlessness; tremor, palpitations. Potentially Fatal: Convulsions, cardiac arrhythmias,
hypotension and sudden death after too rapid IV injection.
Nursing Measures:
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Brand Names: Anoion tab Cordarone Cordarone inj Sandoz Amiodarone HCl tab
Dosage: PO Initial: 200 mg 3 times/day for 1 wk, reduce to 200 mg twice daily for a further wk.
Maintenance: 200 mg/day or lowest effective dose. IV Initial: 5 mg/kg infusion via central
venous catheter. Max: 1.2 g/24 hr.
Nursing Measures:
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Brand Names: Anespin amp Atropol amp Euro-Med Atropine Sulfate amp Isopto Atropine
eye drops Phil Pharmawealth/Atlantic Atropine amp
Indication/Dosage: IV Bradycardia 500 mcg every 3-5 mins. Total: 3 mg. IV/IM
Organophosphorus poisoning 2 mg every 10-30 mins until muscarinic effects disappear or
atropine toxicity appears. IM/SC Premed in anesth 300-600 mcg 30-60 mins before anesth.
IV/IM/SC Overdosage w/ other compd having muscarinic actions 0.6-1 mg, repeat 2 hrly. Ophth
Inflammatory eye disorders As 0.5-1% soln: 1-2 drops 4 times/day. Eye refraction As 1% soln: 1
drop twice daily for 1-2 days before procedure.
Adverse Reactions: Dry mouth, dysphagia, constipation, flushing and dryness of skin,
tachycardia, palpitations, arrhythmias, mydriasis, photophobia, cycloplegia, raised intraocular
pressure. Toxic doses cause tachycardia, hyperpyrexia, restlessness, confusion, excitement,
hallucinations, delirium and may progress to circulatory failure and respiratory depression. Eye
drops: Systemic toxicity especially in children, on prolonged use may lead to irritation,
hyperemia, edema and conjunctivitis. Increased intraocular pressure. Inhalation: Dryness of
mouth, throat. Potentially Fatal: Atrial arrhythmias, AV dissociation, multiple ventricular
ectopics.
Nursing Measures:
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Indication/Dosage: PO edema 1 mg once daily, 2nd dose 6-8 hr later if needed. Refractory
edema Initial: 5 mg/day, may increase dose depending on response. Max: 10 mg/day. HTN 0.5-1
mg/day. Max: 5 mg/day. IV Pulmonary edema 1-2 mg, repeat 20 mins. later if needed. IV/IM
Emergency edema 0.5-1 mg, then adjust according to response.
Action: inhibits Sodium and Chloride reabsorption at the ascending loop of Henle
Adverse Reactions: Muscle cramps, dizziness, hypotension, headache, nausea, impaired hearing,
pruritus, ECG changes, musculoskeletal pain, rash, chest discomfort, renal failure, premature
ejaculation, thrombocytopenia, hypokalemia, hypomagnesaemia, hyponatremia, hyperuricemia,
hyperglycemia, hypocalcaemia.
Nursing Measures:
Classification: Electrolytes
Nursing Measures:
Vc Make sure prescriber specifies form of calcium to be given; crash carts may contain both
calcium gluconate and calcium chloride.
Vc Tell patient to take oral calcium 1 to 11/2 hours after meals if GI upset occurs.
Vc Give I.M. injection in gluteal region in adults and in lateral thigh in infants. Use I.M.
route only in emergencies when no I.V. route is available bec. of irritation of tissue by
calcium salts.
Vc Tell patient to take oral calcium with a full glass of water.
Vc Monitor calcium levels frequently. Hypercalcemia may result after large doses in chronic
renal failure. Report abnormalities.
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Brand Names: Ace-Bloc tab Capomed tab Capotec tab Capoten tab Captor tab Captril tab
Cardiovaz tab Conamid tab Hartylox tab Normil tab Phil Pharmawealth/Panion & BF
Captopril tab Prelat tab Primace tab Retensin tab Spec-Ace tab Tensoril tab Unihype tab
Vasostad tab
Indication/Dosage: PO HTN Initial: 12.5 mg twice daily. Maintenance: 25-50 mg twice daily.
Max: 50 mg 3 times/day. Heart failure Initial: 6.25-12.5 mg 2-3 times/day. Max: 50 mg 3
times/day. Post MI Start 3 days after MI. Initial: 6.25 mg/day, may increase after several wk to
150 mg/day in divided doses if needed and tolerated. HTN in diabetic nephropathy 75-100
mg/day in divided doses.
Action: inhibits ACE, reduces Sodium and water retention, lowers blood pressure
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Indication/Dosage: PO HTN Initial: 50-100 mcg 3 times/day. Max: 2,400 mcg/day. Menopausal
flushing; Migraine prophylaxis 50 mcg twice daily, up to 75 mg twice daily. IV Hypertensive
crisis 150-300 mcg via slow inj. Max: 750 mcg over 24 hr. Epidural Severe cancer pain Initial:
30 mcg/hr as continuous infusion in combination w/ an opioid. Transdermal HTN As patch
releasing 100-300 mcg clonidine base/day at constant rate: Apply once wkly.
Action: stimulates alpha 2 receptors and inhibits central vasomotor centers, lowers peripheral
vascular resistance, blood pressure, and heart rate
Adverse Reactions: Dry mouth, drowsiness, dizziness, headache, constipation, impotence, vivid
dreams, urinary retention; dry, itching, burning sensation in the eye; fluid or electrolyte
imbalance, GI upset, paralytic ileus, orthostatic hypotension, weakness, sedation, pruritus,
myalgia, urticaria, nausea, insomnia, arrhythmias, agitation. Reduced GI motility at times may
cause paralytic ileus. Potentially Fatal: Transient hypertension or profound hypotension,
respiratory depression, convulsion. Clonidine withdrawal syndrome could be life threatening.
Bradycardia, coma and disturbances in conduction (in individuals with preexisting diseases of
SA/AV nodes, overdose or on digitalis).
Nursing Measures:
Vc Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop without
consulting your health care provider.
Vc Be careful of drop in blood pressure (occurs most often with diarrhea, sweating,
vomiting, dehydration); if light-headedness or dizziness occurs, consult your health care
provider.
Vc Avoid over-the-counter medications, especially cough, cold, allergy medications that may
contain ingredients that will interact with ACE inhibitors. Consult your health care
provider.
Vc These side effects may occur: GI upset, loss of appetite, change in taste perception
(limited effects, will pass); mouth sores (perform frequent mouth care); rash; fast heart
rate; dizziness, light-headedness (usually passes after the first few days; change position
slowly, and limit your activities to those that do not require alertness and precision).
Vc Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular
heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.
Vc Take this drug exactly as prescribed. Do not miss doses. Do not discontinue the drug
unless so instructed. Do not discontinue abruptly; life-threatening adverse effects may
occur. If you travel, take an adequate supply of drug.
Vc Use the transdermal system as prescribed; refer to directions in package insert, or contact
your health care provider with questions. Be sure to remove old systems before applying
new ones.
Vc Attempt lifestyle changes that will reduce your BP: stop smoking and using alcohol; lose
weight; restrict intake of sodium (salt); exercise regularly.
Vc Use caution with alcohol. Your sensitivity may increase while using this drug.
Vc These side effects may occur: Drowsiness, dizziness, light-headedness, headache,
weakness (often transient; observe caution driving or performing other tasks that require
alertness or physical dexterity); dry mouth (suck on sugarless lozenges or ice chips); GI
upset (eat small, frequent meals); dreams, nightmares (reversible); dizziness, light-
headedness when you change position (get up slowly; use caution climbing stairs);
impotence, other sexual dysfunction, decreased libido (discuss with care providers);
breast enlargement, sore breasts; palpitations.
Vc Report urinary retention, changes in vision, blanching of fingers, rash.
c.)c/6cc
Classification: Anxiolytics
Dosage: 10mg/2ml
Indication: relief of anxiety, agitation & tension due to psychoneurotic states & transient
situational disturbances
Action: a benzodiazepine that probably potentiates the effects of GABA, depresses the CNS &
suppresses the spread of seizure activity
Nursing Measures:
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Classification: Inotropics
Dosage: 5mg/2ml
Indication: Cardiac failure accompanied by atrial fibrillation; management of chronic cardiac
failure where systolic dysfunction or ventricular dilatation is dominant; management of certain
supraventricular arrhythmias, particularly chronic atrial flutter & fibrillation.
Adverse Reaction: nausea, vomiting, anorexia, headache, facial pain, fatigue, weakness,
dizziness, drowsiness, disorientation, mental confusion, bad dreams, convulsions
Nursing Measures:
Vc Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or <
90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, hold drug and
notify prescriber. Note any change from baseline rhythm or rate.
Vc Check dosage and preparation carefully.
Vc Avoid IM injections, which may be very painful.
Vc Follow diluting instructions carefully, and use diluted solution promptly.
Vc Avoid giving with meals; this will delay absorption.
Vc Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, cardiac
monitor on standby in case toxicity develops.
Vc Monitor for therapeutic drug levels: 0.5±2 ng/mL.
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Classification: antihistamine
Dosage: 50mg/ml
Indication: Hay fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug sensitization,
serum & penicillin reaction, contact dermatitis, atopic eczema, other allergic dermatoses,
pruritus, food sensitivity, parkinsonism, motion sickness.
Action: prevents histamine mediated responses, drug provides local anesthesia and suppresses
cough reflex
Adverse Reaction: CV and CNS effects, blood disorders, GI disturbances, anti-muscarinic effects
and allergic reactions.
Nursing Measures:
Vc Monitor carefully, assess for confusion, delirium, other anticholinergic side effects and
fall risk. Institute measures to prevent falls.
Vc Assess movement disorder before and after administration.
Vc Caution patient not to use oral OTC diphenhydramine products with any other product
containing diphenhydramine, including products used topically.
Vc It can cause excitation in children. Caution parents or caregivers about proper dose
calculation; overdosage, especially in infants and children, can cause hallucinations,
seizures or death Inform patient that this drug may cause dry mouth. Frequent oral rinses,
good oral hygiene, and sugarless gum or candy may minimize this effect. Notify dentist
if dry mouth persists for more than 2 weeks.
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Brand name: Epinephrine Bitartrate Aerosols: Primatene Mist Epinephrine Borate Ophthalmic
solution: Epinal Epinephrine Hydrochloride 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
Dosage: 1mg/ml
Action: Naturally occurring neurotransmitter, the effects of which are mediated by alpha or beta
receptors in target organs. Effects on alpha receptors include vasoconstriction, contraction of
dilator muscles of iris. Effects on beta receptors include positive chronotropic and inotropic
effects on the heart (beta1 receptors); bronchodilation, vasodilation, and uterine relaxation (beta
2 receptors); decreased production of aqueous humor.
Nursing Measures:
Dosage: 20mg/2ml
Action: inhibits Sodium and Chloride reabsorption at the proximal and distal tubules and the
ascending loop of Henle
Nursing Measures:
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Classification: antihypertension
Dosage: 20mg/ml
Adverse Reaction: tachycardia, palpitation, angina pectoris, severe headache, dizziness, weight
gain, GI disturbances, pruritus, rashes, nausea and vomiting
Nursing Measures:
Vc Give oral drug with food to increase bioavailability(drug should be given in a consistent
relationship ti ingestion of food for consistent response to therapy).
Vc Drug may cause a syndrome resembling systemic lupus erythematosus (SLE). Arrange
for CBC, LE cell preparations, and ANA titers before and periodically during prolonged
therapy, even in the asymptomatic patient. Discontinue if blood dyscrasias occur.
Reevaluate therapy if ANA or LE tests are positive.
Vc Arrange for pyridoxine if patient develops symptoms of peripheral neuritis.
Vc Monitor patient for orthostatic hypotension which is most marked in the morning and in
hot weather, and with alcohol or exercise.
Indication: endocrine, hematologic, rheumatic & collagen disorders, dermatologic, ophth, GI,
resp & neoplastic diseases, edematous states, control of severe incapacitating allergic conditions,
TB meningitis w/ subarachnoid block or impending block when used concurrently with
appropriate anti-TB chemotherapy, shock secondary to adrenocortical insufficiency or shock
unresponsive to conventional therapy when adrenocortical insufficiency may be present
Nursing Measures:
Vc Give daily before 9 AM to mimic normal peak diurnal corticosteroid levels and minimize
HPA suppression.
Vc Space multiple doses evenly throughout the day.
Vc Do not give IM injections if patient has thrombocytopenic purpura.
Vc Rotate sites of IM repository injections to avoid local atrophy.
Vc Use minimal doses for minimal duration to minimize adverse effects.
Vc Taper doses when discontinuing high-dose or long-term therapy.
Vc Arrange for increased dosage when patient is subject to unusual stress.
Vc Use alternate-day maintenance therapy with short-acting corticosteroids whenever
possible.
Vc Do not give live virus vaccines with immunosuppressive doses of hydrocortisone.
Vc Provide antacids between meals to help avoid peptic ulcer.
&)c d!6&cd6cc
Action: Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug
also may increase blood flow through the collateral coronary vessels
Nursing Measures:
,)c d!6cd6cc
Dose: 10 mg/10mL
Indication: unresponsive left ventricular failure secondary to acute MI, severe or unstable angina
pectoris
Nursing Measures:
Classification: anticonvulsant
Action: may decrease acetylcholine released by nerve impulses, but its anticonvulsant
mechanism is unknown
Adverse Reactions: flushing, sweating, hypotension, muscular weakness, sedation & confusion;
decreased deep tendon reflexes; resp. paralysis
Nursing Measures:
Vc Monitor the following: I.V.: Rapid administration: ECG monitoring, vital signs, deep
tendon reflexes; magnesium, calcium, and potassium levels; renal function during
administration. Obstetrics: Patient status including vital signs, oxygen saturation, deep
tendon reflexes, level of consciousness, fetal heart rate, maternal uterine activity. Oral:
Renal function; magnesium levels; bowel movements.
.)c66d6c*(d*#d6c
Indication: relief of moderate to severe pain, pre-op medication, support of anesth & obstet
analgesia
Action: binds with opiate receptors in the CNS, altering perception of and emotional response to
pain
Adverse Reactions: resp. depression, circulatory depression, resp arrest, shock, cardiac arrest, GI
disturbance, light headedness, dizziness, sedation, nausea, vomiting, sweating, euphoria,
dysphoria, weakness, headache, tremor, agitation, uncoordinated muscle movements, severe
convulsions, transient hallucinations & disorientation, visual disturbance, flushing, tachycardia,
bradycardia, palpitation, hypotension, syncope, phlebitis, urinary retention, allergic reactions,
pain at injection site and local tissue irritation.
Nursing Measures:
Vc Make position changes slowly and in stages particularly from recumbent to upright
posture. Lie down immediately if light-headedness or dizziness occurs.
Vc Lie down when feeling nauseated and to notify physician if this symptom persists.
Nausea appears to worsen with ambulation.
Vc Avoid driving and other potentially hazardous activities until reaction to drug is known.
Codeine may impair ability to perform tasks requiring mental alertness and therefore to.
Vc Do not take alcohol or other CNS depressants unless approved by physician.
Vc Hyperactive cough may be lessened by avoiding irritants such as smoking, dust, fumes
and other air pollutants. Humidification of ambient air may provide some relief.
Vc Do not breast feed while taking this drug.
0)c6#d6cc
Indication: disturbances of GI motility, nausea & vomiting of central & peripheral origin
associated w/ surgery, metabolic diseases, infectious & drug induced diseases, facilitate small
bowel intubation & radiological procedures of GIT
Action: stimulates motility of upper GI tract, increases lower esophageal sphincter tone, and
blocks dopamine receptors at the chemoreceptor trigger zone
Adverse Reactions: extrapyramidal reactions, drowsiness, fatigue & lassitude, anxiety, less
frequently, insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, bowel
disturbances.
Nursing Measures:
2)c/#c*(d*#d6cc
Dosage: 5mg/5mL
Indication: tab: disturbances of sleep rhythm, insomnia esp difficulty in falling asleep either
initially or after premature awakening, tab/inj: sedation in premed before surgical or diagnostic
procedures, induction & maintenance of anesth.
Action: may potentiate the effects of GABA, depress the CNS, and suppress the spread of
seizure activity
Adverse Reactions: rarely cardioresp adverse events, nausea, vomiting, headache, hiccoughs,
laryngospasm, dyspnoea, hallucination, oversedation, drowsiness, ataxia, rash, paradoxical
reactions, amnesic episodes.
Nursing Measures:
c)cd*6c #+6cc
Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe or chronic pain Childn 10 mg IM/SC 4 hrly, range:
5-20 mg; 6-12 yr 5-10 mg, 1-5 yr 2.5-5 mg, 1-12 mth 200 mcg/kg, <1 mth 150 mcg/kg 4 hrly.
Max: 15 mg. Analgesic effect Ped 100-200 mcg/kg SC 4 hrly, max: 15 mg/dose; or 50-100
mcg/kg slow IV. Pre-op 50-100 mcg/kg IM, max: 10 mg/dose.
Indication: Relief of moderate to severe pain not responsive to non-narcotic analgesics. Premed.
Analgesic adjunct in general anesth esp in pain associated w/ cancer, MI & surgery. Alleviates
anxiety associated w/ severe pain. Hypnotic for pain-related sleeplessness.
Nursing Measures:
cc
)cd6c*(d*#d6cc
Dosage: IV infusion Dilute to 10-20 mg/100 mL (conc of 1.01-0.02%). Initial infusion rate: 5
mg/hr; titrate dose up to 15 mg/hr until desired therapeutic response is achieved (DBP <95
mmHg, SBP <140 mmHg). Maintenance rate: Can be tapered down to 10mg/hr. IV bolus inj 2-
7 mg w/out dilution given over 1-2 min.
Indication: Hypertensive emergencies or urgencies, peri-op & post-op HTN, hypertensive states
of NPO patients.
Action: a Calcium channel blocker that inhibits Calcium ion influx across cardiac and smooth
muscle cells, also dilates coronary arteries and arterioles
Nursing Measures:
Vc Patients with hepatic impairment should receive lower dose.
Vc Monitor blood pressure.Allow atleast 3 days between dosage adjustment to achieve
steady plasma levels.
Vc Advise patient to report immediately if experiencing chest pain
")cc*cc
Dosage: Starting dose: 0.2-0.4 mg/hr. Dosing schedule: Daily patch-on period of 12-14 hr &
daily patch-off period of 10-12 hr.
Action: a nitrate that reduces cardiac oxygen demand by decreasing left ventricular end diastolic
pressure and to a lesser extent, systemic vascular resistance, also increases blood flow through
collateral coronary vessels
Nursing Measures:
Vc Administer transdermal systems to skin site free of hair and not subject to much
movement. Shave areas that have a lot of hair. Do not apply to distal extremities. Change
sites slightly to decrease the chance of local irritation and sensitization. Remove
transdermal system before attempting defibrillation or cardioversion.
Vc To use transdermal systems, you may need to shave an area for application. Apply to a
slightly different area each day. Use care if changing brands; each system has a different
concentration.
%)cd6#cc
Dosage: Adult & childn 10 yr 2-3 mL, 10 yr 1-2 mL. Depending on severity of case, dose
may be repeated 4 hrly. In severe cases, dose may be administered by IV very slowly
Indication: Pyrexia of unknown origin. Fever & pain associated w/ common childhood disorders,
tonsillitis, upper resp tract infections post-immunization reactions, after tonsillectomy & other
conditions. Prevention of febrile convulsion. Headache, cold, sinusitis, muscle pain, arthritis &
toothache Action: produce analgesia by blocking pain impulses by inhibiting synthesis of
prostaglandin in CNS, relieves fever
Nursing Measures:
Vc Use liquid form for children and patients who have difficulty swallowing.
Vc In children, don¶t exceed five doses in 24 hours.
Vc Advise patient that drug is only for short term use and to consult the physician if giving
to children for longer than 5 days or adults for longer than 10 days.
Vc Advise patient or caregiver that many over the counter products contain acetaminophen;
be aware of this when calculating total dailydose.
Vc Warn patient that high doses or unsupervised long term use can cause liver damage.
&)c*6(cc
Classification: Anticonvulsants
Dosage: Adult Initially 100 mg tid. Maintenance: 300-400 mg daily. Childn 6 yr Initially 100
mg tid, subsequent dosage should be adjusted according to therapeutic response, <6 yr 30 mg
bid, may be increased to 30 mg tid or qid. Pedia 5 mg/kg/day Initially in 2-3 equally divided
doses. Max: 300 mg daily. Maintenance: 4-8 mg/kg/day
Indication: Tonic-clonic & complex partial (psychomotor, temporal lobe), prevention &
treatment of seizures occurring during or following neurosurgery
Action: may stabilize neuronal membranes and limit seizure activity by either by increasing
efflux or decreasing influx of Na ions across cell membrane in the motor cortex during
generation of nerve impulses
Adverse Reactions: GI disturbances; ataxia, slurred speech; diplopia, nystagmus & mental
confusion w/ headache, dizziness, gingival hyperplasia, hirsutism, hyperglycemia, osteomalacia
Nursing Measures:
Vc Assess location, duration, frequency, and characteristics of seizure activity. EEG may be
onitored periodically throughout therapy, Assess oral hygiene. Vigorous oral cleaning
beginning within 10 days of initiation of phenytoin therapy may help control gingival
hyperplasia
,)c6d! #6c
Indication: For reversible airways obstruction, in asthma, COPD. Decreases uterine contractility
& may be used to arrest premature labor
Adverse Reaction: Fine tremor of skeletal muscle esp hands, palpitations, tachycardia, nervous
tension, headache, peripheral vasodilation.
Nursing Measures:
Vc Use minimal periods of time; drug tolerance can occur with prolonged use.
Vc Keep beta-adrenergic blocker readily available in case cardiac arrhythmias occur.
Vc Do not recommended dosage.
-)cÿ6d#c*(d*#d6cc
Brand name: Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM
Dosage: Isoptin tab Adult 40-80 mg tid-qid. Max: 480 mg daily. Childn >6 yr 40-120 mg bid-tid,
up to 360 mg daily, childn 6 yr 40 mg bid-tid. Isoptin SR 180 Coronary insufficiency 1 tab bid.
Usual daily dose: 40-480 mg. Hypertension 1 tab in the morning. Isoptin SR 240 1 tab in the
morning. If required after 2 wk, increase dose to 2 tab daily. Isoptin amp 5 mg slow IV, if
required, 5 mg after 5-10 min. Then, if required, continuous drip infusion of 5-10 mg/hr up to
100 mg/day. Angina pectoris & rapid elimination of tachyarrhythmias 1-2 amp IV, if required
bid-tid
Indication: Isoptin/Isoptin SR 180 Essential hypertension, chronic coronary insufficiency, angina
pectoris, paroxysmal supraventricular tachycardia, tachyarrhythmias, long-term treatment after
MI. Isoptin SR 240 Essential hypertension
Action: decreases myocardial contractility and oxygen demand, it also dilates coronary arteries
and arterioles
Nursing Measures:
Vc Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being titrated to
therapeutic dose. Dosage may be increased more rapidly in hospitalized patients under
close supervision.
Vc Ensure that patient swallows SR tablets whole: do not cut, crush, or chew them.
Vc Monitor BP very carefully with concurrent doses of antihypertensives.
Vc Monitor cardiac rhythm regularly during stabilization of dosage and periodically during
long-term therapy.
Vc Administer sustained-release form in the morning with food to decrease GI upset.
Vc Protect IV solution from light.
Vc Monitor patients with renal or hepatic impairment carefully for possible drug
accumulation and adverse reactions.
.)cdd c*#c
Dosage: Adult (including elderly) & adolescent >12 yr Acute attacks 1 vial, may repeat doses
until patient is stable. Maintenance: 1 vial tid-qid.
Action: it works by binding to specific receptors (called muscarinic receptors) in the airway,
helping to relax the smooth muscle of the airway. When used to treat a runny nose, it works by
decreasing the production of fluid in the glands that line the nasal passages
Adverse Reaction: Headache, nausea, dry mouth, increased heart rate & palpitations, ocular
accommodation disturbances, GI motility disturbances, urinary retention, ocular side effects,
cough, local irritation, bronchoconstriction, skin rash, angioedema, urticaria, laryngospasm,
anaphylactic reactions.
Nursing Measures:
Vc Protect solution for inhalation from light. Store unused vials in foil pouch.
Vc Use nebulizer mouthpiece instead of face mask to avoid blurred vision or aggravation of
narrow-angle glaucoma.
Vc Can mix albuterol in nebulizer for up to 1 hr.
Vc Ensure adequate hydration, control environmental temperature to prevent hyperpyrexia.
Vc Have patient void before taking medication to avoid urinary retention.
Vc Teach patient proper use of inhalator.
cc
0)c+66d#3dd c!d6c
Dosage: Berodual inhalation soln Adult (including elderly) & adolescent >12 yr Treatment of 1
mL for immediate symptom relief. Intermittent & long-term treatment 1-2 mL for each
administration, up to qid. Moderate bronchospasm or w/ assisted ventilation 0.5 mL. Childn 6-12
yr Treatment of attacks 0.5-1 mL. Intermittent & long-term treatment 0.5-1 mL for each
administration, up to qid. Moderate bronchospasm or w/ assisted ventilation 0.5 mL. Childn <6
yr (<22 kg body wt) Up to 0.5 mL up to tid. Berodual F UDV Adult & childn >12 yr Acute
asthma episodes 1 vial, in very severe cases, 2 vials are needed. Intermittent & long-term
treatment 1 vial up to qid.
Indication: prevention and treatment of symptoms in chronic obstructive airway disorders with
reversible bronchospasm
Action: for the prevention and treatment of reversible bronchospasm associated with bronchial
asthma and especially chronic bronchitis with or without emphysema
Adverse Reactions: Fine tremor of skeletal muscles, nervousness, restlessness, palpitations; less
frequently tachycardia, dizziness or headache. Dry mouth, throat irritation or allergic reactions,
cough, paradoxical bronchoconstriction (rare). Urinary retention may occur in particular, in
patients w/ preexisting outflow tract obstruction.
Nursing Measures:
Vc Protect solution for inhalation from light. Store unused vials in foil pouch.
Vc Use nebulizer mouthpiece instead of face mask to avoid blurred vision or aggravation of
narrow-angle glaucoma.
Vc Can mix albuterol in nebulizer for up to 1 hr.
Vc Ensure adequate hydration, control environmental temperature to prevent hyperpyrexia.
Vc Have patient void before taking medication to avoid urinary retention.
Vc Teach patient proper use of inhalator.
cc
"2)c! 6 6c
Classification: Corticosteroids
Dosage: 80/4.5 mcg x 60 doses; 160/4.5 mcg x 60 doses; 320/9 mcg x 60 doses
Indication: regular treatment of asthma where use of a combination (inhaled corticosteroid and
long acting beta 2 agonist) is appropriate
Action: work by reducing inflammation, which helps with several conditions ranging from
asthma to allergies to Crohn¶s disease
Adverse Reactions: Abdominal pain, conjunctivitis (pinkeye), cough, diarrhea, ear infection or
inflammation, fever, fungal infection in mouth, headache, nasal or sinus inflammation,
nosebleed, pain, rash, respiratory infection, stomach or intestinal inflammation, throat
inflammation, viral infection, vomiting, wheezing
Nursing Measures:
Vc Taper systemic steroids carefully during transfer to inhalational steroids; deaths from
adrenal insufficiency have occurred.
Vc Arrange for use of decongestant nose drops to facilitate penetration if edema, excessive
secretions are present.
Vc Prime unit before use for Pulmicort Turbuhaler; have patient rinse mouth after each use.
Vc Use aerosol within 6 mo of opening. Shake well before each use.
Vc Store Respules upright and protected from light; gently shake before use; open envelopes
should be discarded after 2 wk.
")c#! 6d#ccdd c*#c
Classification: Bronchodilators
Stock: 2.5 mL
Dose: MDI Adult 2 puffs tid-qid. Max 12 puffs/day. Unit dose vial Adult & childn >12 yr 1 vial
every 6-8 hr. Childn 2-12 yr 3 drops/kg/dose (max: 2500 mcg of salbutamol) every 6-8 hr.
Action: muscles in the airways and increase air flow to the lungs
Nursing Measures:
Vc Use nebulizer mouthpiece instead of face mask to avoid blurred vision or aggravation of
narrow-angle glaucoma.
Vc Can mix albuterol in nebulizer for up to 1 hr.
Vc Ensure adequate hydration, control environmental temperature to prevent hyperpyrexia.
Vc Have patient void before taking medication to avoid urinary retention.
Vc Teach patient proper use of inhalator.
cc
Classification: bronchodilator
Stock: 1 mg/1 mL
Dose: Adult & childn 2.5-5 mg. May repeat qid by hlebitis. Delivery of aerosol may be by face
mask of ´T´ piece. Use undiluted. For prolonged delivery time, dilute w/ sterile water or normal
saline for inj.
Nursing Measures:
Vc Assess lung sounds, pulse, and blood pressure before administration and during peak of
medication. Note amount, color, and character of sputum produced.
Vc Monitor pulmonary function tests before initiating therapy and periodically throughout
course to determine effectiveness of medication.
Vc Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold
medication and notify physician or other health care professional immediately.
Vc Instruct mother to take missed dose as soon as remembered, spacing remaining doses at
regular intervals. Do not double doses or increase the dose or frequency of doses.
Vc Inform the mother not to smoke near the child and to avoid respiratory irritants.
Vc Advise the mother to rinse the child¶s mouth with water after each inhalation dose to
minimize dry mouth.
Action: It works by dilating (opening) the bronchioles of the lungs by relaxing the muscles
around them. This allows for easier airflow into and out of the lungs
Nursing Measures:
Vc Use minimal periods of time; drug tolerance can occur with prolonged use.
Vc Keep beta-adrenergic blocker readily available in case cardiac arrhythmias occur.
Vc Do not recommended dosage.
Adverse Reactions: Slight fever, headache, chills, nausea, vomiting, constipation, epistaxis,
bruising, slight haematuria, skin necrosis (SC inj), osteoporosis, alopecia. Hypersensitivity
reactions include urticaria, conjunctivitis, rhinitis, asthma, angioedema and anaphylactic shock.
Priapism. Potentially Fatal: Heparin-induced thrombocytopenia with or without thrombosis;
bleeding
Nursing Measures:
Vc Baseline blood coagulation tests, Hct, Hgb, RBC and platelet counts prior to initiation or
therapy and at regular intervals throughout therapy
Vc Monitor APTT levels closely
Vc Draw blood for coagulation tests 30 min before each scheduled SC or intermittent IV
dose and approximately q4h for pts receiving continuous IV heparin during dosage
adjustments period. After dosage is established, tests may be done once daily
Vc Pts vary widely in their reaction to heparin; risk of hemorrhage appears greatest in
women, all patients > 60 y, and patients with liver disease or renal insufficiency.
Vc Monitor vitals, report fever, drop in BP, rapid pulse and other S&S of hemorrhage
Vc Observe all needle sites daily for hematoma and signs of inflammation
Vc Have on hand protamine sulfate, specific heparin antagonist
"&)c6 ##c*(d*#d6c
Dosage: 100mg/10ml
Action: A Class II antiarrythmic and ultra-short-acting selective beta blocker that decreases heart
rate, contractility and blood pressure
Nursing Measures:
Vc Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being titrated to
therapeutic dose. Dosage may be increased more rapidly in hospitalized patients under
close supervision.
Vc Monitor cardiac rhythm regularly during stabilization of dosage and periodically during
long-term therapy.
",)cc&2&2cc
Dosage: 50ml/vial
Action: A simple water soluble sugar that minimizes glyconeogenesis and promotes anabolism
in patients whose oral caloric intake is limited
Adverse Reactions: Local pain, vein irritation, thrombophlebitis & tissue necrosis in the event of
extravasation. Fluid & electrolyte imbalance eg hypokalemia, hypomagnesemia &
hypophosphatemia; edema or water intoxication
Nursing Measures:
Vc Monitor infusion rate frequently; if signs of fluid overload, turn off IV drip. Infusion may
result in fluid overload.
Vc Check IV site frequently and if infiltration is noted, turn off IV drip.
Vc Watch out for signs of fluid overload (distended neck veins (JVD), rapid respirations,
shallow tidal volume, fine auscultatory crackles, dyspnea, and peripheral edema)
Vc Watch out for signs of infiltration (swelling and pain around IV site).
"-)c c*#d6cc
Classification: Electrolytes
Dosage: 40 meqs/20 ml
Adverse Reactions: GI ulceration (sometimes with haemorrhage and perforation or with late
formation of strictures) following the use of enteric-coated K chloride preparation;
hyperkalaemia. Oral: Nausea, vomiting, phlebitis and abdominal cramps. IV: Pain or phlebitis;
cardiac toxicity.
Nursing Measures:
".)c#6c*(d*#d6c
Dosage: 50 ml/vial
Action: A class IB antiarrythmic that decreases the depolarization, automaticity, and excitability
in the ventricles during the diastolic phase by direct action on the tissues especially the Purkinje
network
Nursing Measures:
Classification: Alkalinizers
Action: Restores buffering capacity of the body and neutralizes excess acid
Nursing Measures:
Vc do not take drug with milk to avoid hypercalcemia, abnormally high alkalinity in tissues
and fluids, or kidney stones.
Vc do not give to patients with metabolic or respiratory alkalosis, and in those with
hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart
failure.
Vc monitor for alkalosis by obtaining blood pH, PaO2, PCO2, and electrolyte levels
c%2)c6c
Action: Stimulates dopaminergic and alpha beta receptors for the sympathetic nervous system
resulting in a positive inotropic effect and increased cardiac output. Action is dose-related; large
doses cause mainly alpha stimulation
Nursing Measures:
%)c! 6cc
Classification: Adrenergics
Indication: increased cardiac output in short term treatment of cardiac decompensation caused
by epressed contractility
Action: Stimulates heart¶s beta1 receptors to increase myocardial contractility and stroke
volume. Increases cardiac output by decreasing peripheral vascular resistance, reducing
ventricular filling pressure, and facilitating AV node conduction
Adverse Reaction: increased systolic BP, increased heart rate, chest pain, increased number of
premature ventricular beats, headache, tingling sensations, paresthesia. nausea, vomiting,
dyspnea, phlebitis, local inflammation after infiltration, leg cramps
Nursing Measures:
Vc Monitor vital signs, ECG, cardiac output, pulmonary capillary wedge pressure, central
venous pressure and urinary output carefully throughout infusion.
Vc Monitor patency and placement of IV catheter to reduce risk of extravasation and
phlebitis.
Vc Watch out for symptoms of overdosage such as excessive hypertension, tachycardia,
nausea, vomiting, tremor, headache, chest pain
%)c#6cd616c
Action: Acts as an anesthetic by stabilizing the neuronal membrane by inhibiting the ionic
fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic
action. Also acts as an antiarrhythmic by decreasing the depolarization, automaticity, and
excitability in the ventricles during the diastolic phase by a direct action on the tissues, especially
the Purkinje network, without involvement of the autonomic system. Neither contractility,
systolic arterial blood pressure, atrioventricular (AV) conduction velocity, nor absolute
refractory period is altered by usual therapeutic doses
Vc Explain that adverse reactions related to the CNS (eg, drowsiness, confusion,
paresthesias, convulsions, respiratory arrest) can occur and are a result of CNS toxicity.
Vc Advise patient that drug may cause dizziness or drowsiness and to avoid getting out of
bed or walking without assistance.
Vc Advise patients that skin reactions, including erythema, petechiae, and edema, may occur
with intradermal injection.
Vc Systemic effects can occur following topical use; use lowest possible dose to avoid
serious toxicity, shock, or heart block.
Vc Do not use in patients with congenital or idiopathic methemoglobinemia or in infants
younger than 12 mo of age who are receiving methemoglobin-inducing drugs.
Vc Use with caution and in lower doses in patients with CHF, reduced cardiac output,
digitalis toxicity, and in elderly patients
%")c#cc
Indication: test dose for marked oliguria or suspected inadequate renal function, oliguria, to
reduce intraocular or intracranial pressure, diuresis in drug intoxication
Action: Increases osmotic pressure of glomerular filtrate; drug elevates plasma osmolality
Adverse Reaction: Increased urination, nausea, runny nose, vomiting, severe allergic reactions
(rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips,
or tongue), blurred vision, chest pain, chills or fever, confusion, decreased alertness, difficulty
urinating, extreme dizziness, extreme thirst or dry mouth, fast or irregular heartbeat, headache,
muscle cramps, pain, redness, or swelling at the injection site, weakness
Nursing Measures:
Vc Monitor vital signs, including CVP, and fluid intake and output.
Vc Monitor weight, renal function, and serum sodium and potassium levels daily
Vc Watch out for symptoms of overdosage such as excessive hypertension, tachycardia,
nausea, vomiting, tremor, headache, chest pain
Vc To relieve thirst, give frequent mouth care and fluids
%%)c61d 6c&4cc56dc6&5)c # cc
Indication: fluid replacement and caloric supplementation in patients who can¶t maintain
adequate oral intake or are restricted from doing so
Action: Provides some sugar for cellular metabolism and supplies body water
Adverse Reaction: Increases free water and may cause intracellular edema, fluid overload,
infiltration (swelling and pain at infusion site)
Nursing Measures:
Vc Monitor infusion rate frequently; if signs of fluid overload, turn off IV drip. Infusion may
result in fluid overload.
Vc Check IV site frequently and if infiltration is noted, turn off IV drip.
Vc Watch out for signs of fluid overload (distended neck veins (JVD), rapid respirations,
shallow tidal volume, fine auscultatory crackles, dyspnea, and peripheral edema)
Vc Watch out for signs of infiltration (swelling and pain around IV site).