EMERGENCY DRUGS
CARDIAC DRUGS
ATROPINE SULFATE
Isopto Atropine
Classification
Anticholinergics
Dosage
N Bradycardia: 0.5 mg IV every 3-5 mins, max of 0.04 mg/kg
N Cardiac Arrest: 1 mg every 3-5 mins
N Nerve and Organophosphate symptoms: may repeat in 2 mg increments q 3 mins titrated to relief symptoms
Indication
[ Pre-op meds/pre-anesthetic meds
[ To restore cardiac rate and arterial pressure during anesthesia when vagal
[ To lessen the degree of A-V heart block
[ To overcome severe carotid sinus reflex
[ Antidote for cholinergic toxicity
Side effects
· CNS: restlessness, ataxia, disorientation, hallucinations, delirium, coma, insomnia, agitation, confusion.
· CV: tachycardia, angina, arrhythmias, flushing.
· EENT: photophobia, blurred vision, mydriasis.
· GI: dry mouth, constipation, vomiting.
· GU: urine retention.
· Hematologic: leukocytosis
· Other: anaphylaxis
Adverse effects
[ CNS: headache, excitement.
[ CV: palpitations
[ GI: thirst, nausea
Contraindications
[ Hypersensitivity
[ With acute angle closure glaucoma, obstructive uropathy, obstructive disease of GI tract, paralytic ileus, toxic megacolon, intestinal atony, unstable CV status in acute hemorrhage, asthma, or myasthenia gravis.
[ Pregnant women.
Nursing Management
N Monitor VS.
N Report é HR
N Monitor for constipation, oliguria.
N Instruct to take 30 mins before meals
N Eat foods high in fiber and drink plenty fluids.
N Can cause photophobia
N 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
Classification
N Antianginal
N Nitrate
N Vasodilator,
N Coronary
Dosage
N 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 consumption
N Reduces left ventricular workload
N Reduces arterial BP
N Reduces venous return
Indication
N Angina pectoris
N CHF associated with AMI
N Cardiac load reducing agent
N Hypertensive Crisis
Side effects
N CNS: headache, throbbing, dizziness, weakness.
N GI: nausea, vomiting
N Skin: Rash
N Adverse Reactions
N CV: orthostatic hypotension, flushing, fainting.
N EENT: sublingual burning.
N Skin: Cutaneous vasodilation, contact dermatitis (patch)
Contraindications
N 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 Management
N 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 administration
N Cardioverter/ defibrillator must not be discharged through paddle electrode overlying
N 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 doesn’t experience relief, advise to seek medical assistance immediately.
N Keep in a dark colored container
MORPHINE SULFATE
Immediate-release tablets:
MSIR
Timed-release:
Kadian, M-Eslon (CAN), MS Contin, Oramorph SR
Oral solution:
MSIR, Rescudose, Roxanol, Roxanol T
Rectal suppositories:
RMS
Injection:
Astramorph PF, Duramorph, Epimorph (CAN)
Preservative-free concentrate for microinfusion devices for intraspinal use:
Infumorph
Classification
Opioid Agonist Analgesic
Dosage
N Oral: 10–30 mg q 4 hr PO. Controlled-release: 30 mg q 8–12 hr PO or as directed by physician; Kadian: 20–100 mg PO daily–24-hr release system; MS Contin: 200 mg PO q 12 hr.
N SC and IM:10 mg (5–20 mg)/70 kg q 4 hr or as directed by physician.
N IV:2.5–15 mg/70 kg of body weight in 4–5 mL water for injection administered over 4–5 min, or as directed by physician. Continuous IV infusion: 0.1–1 mg/mL in 5% dextrose in water by controlled infusion device.
N Rectal:10–30 mg 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
Indication
N Relief of moderate to severe acute and chronic pain
N Preoperative medication
N Analgesic adjunct during anesthesia
N Component of most preparations that are referred to as Brompton's cocktail or mixture
N Intraspinal use with microinfusion devices for the relief of intractable pain
N Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary edema
Side Effects
N GI: dry mouth, constipation.
N Skin: Tissue irritation and induration (SC injection).
N Other: sweating,physical tolerance and dependence, psychological dependence
Adverse Effects
N CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex
N CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope
N Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm, bronchospasm, edema
N GI: Nausea, vomiting, anorexia, biliary tract spasm; increased colonic motility in patients with chronic ulcerative colitis
N GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency
N Respiratory:Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest
Contraindications
N Hypersensitivity to opioid
N Diarrhea caused by poisoning until toxins are eliminated
N During labor or delivery of a premature infant
N After biliary tract surgery or following surgical anastomosis
N Pregnancy
N Labor
Nursing Management
Interventions
N Caution patient not to chew or crush controlled-release preparations.
N Dilute and administer slowly
N 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 shock
N Reassure patients that they are unlikely to become addicted
Teaching points
N 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 acuity
N Report severe nausea, vomiting, constipation, shortness of breath or difficulty breathing, rash.
VERAPAMIL
Calan, Isoptin, Verelan, Covera HS
Classification
N Anti-anginal
N Anti-arrhythmics
N Anti-hypertensive
N Vascular headache suppressants
Dosage
PO 80-120 mg 3x daily, increases as needed
Action
N Inhibits calcium transport into myocardial smooth muscle cells
N Decreases SA and AV conduction and prolongs AV node refractory period in conduction tissue
Indication
N Hypertension
N Angina Pectoris
N Supraventricular Arrhythmia
N Atrial flutter/fibrillation
Side Effects and Adverse Reactions
N CNS:abnormal dreams, anxiety, confusion, dizziness and headache
N EENT: blurred vision, epistaxis and tinnitus
N CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and palpitations
N GU: dysuria, nocturia and polyuria
N GI: abnormal liver function, anorexia, constipation, diarrhea, nausea and vomiting
Contraindications
N Hypersensitivity
N Sick sinus syndrome
N 2nd or 3rd degree AV block
N CHF
N Cardiogenic shock
N Concurrent IV beta-blocker
Nursing Management
N Monitor BP and pulse before therapy, during titration and therapy
N Monitor ECG, I&O, serum potassium and weight.
N Assess for CHF
DILTIAZEM
Cardizem, Dilacor, Novo-Diltiazem, Tiamate and Tiazac
Classification
§ Anti-anginals
§ Antiarrhythmics
§ Antihypertensive
§ Ca channel blocker
Dosage
§ PO: 30-120 mg, 3-4x daily or 60-120 mg twice daily as SR capsules
§ IV: 0.25 mg/kg
Action
§ Inhibits calcium transport into myocardial smooth muscle cells
§ Systemic and coronary vasodilation
Indication
§ Hypertension
§ Angina Pectoris
§ Supraventricular Arrhythmia
§ Atrial flutter/fibrillation
Side Effects and Adverse and Reactions
§ CNS:abnormal dreams, anxiety, confusion, dizziness and headache
§ EENT: blurred vision, epistaxis and tinnitus
§ CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and palpitations
§ GU: dysuria, nocturia and polyuria
§ GI: abnormal liver function, anorexia, 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 Reactions
GI disturbances, bradycardia, hypotension, convulsion, numbness of tongue, muscle twitching, restlessness, nervousness, dizziness, tinnitus, blurred vision, fetal intoxication, light headedness, drowsiness, apprehension, euphoria, vomiting, sensation of heat, respiratory arrest and CV collapse
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
Classification
Anti-arrhythmics
Dosage
Recurrent ventricular arrhythmias:
§ POà800-1600 mg/day for 1-2 wks
§ PSVT, symptomatic atrial flutter: POà 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 Reactions
Exacerbation of arrhythmias, bradycardia, SA node dysfunction, heart block, sinus arrest; flushing, fatigue, malaise, abnormal involuntary movements, ataxia, dizziness, paresthesia, decreased libido, insomnia, headache, sleep disturbances, visual impairment, blindness, corneal microdeposits, photophobia, abnormal taste, nausea, vomiting, constipation, anorexia, abdominal pain, abnormal salivation, coagulation abnormalities, non-specific hepatic disorders, pulmonary inflammation, dyspnea, toxicosis, death, edema, hypo and hyperthyroidism
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
PROCAINAMIDE
Pronestyl, Procan-SR, Procanbid
Classification
Antiarrhythmics
Dosage
Arrhythmias: 50 mg/kg/day in divided doses 3-6 hourly
Action
Blocks open Na channels and prolongs the cardiac action potential. This results in slowed conduction and ultimately the decreased rate of rise of the action potential may result on the widening of QRS on ECG
Indication
§ Supraventricular and ventricular arrhythmias.
§ Treatment of Wolf-Parkinson-White Syndrome
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
EPINEPHRINE
Injection, OTC nasal solution:
Adrenalin Chloride
Ophthalmic solution:
Epifrin, Glaucon
Insect sting emergencies:
EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for children)
OTC solutions for
Nebulization:
AsthmaNefrin, microNefrin, Nephron, S2
Classification
Beta2 Adrenergic Agonists
Dosage
[ Cardiac arrest: 1 mg IV of 1:10,000 solution q 3-5 min; double dose if administering via ET tube
[ Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000 solution.
[ Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution
[ Refractory bradycardia and hypotension: 2-10ug/min
Action
N Stimulates beta receptors in lung.
N Relaxes bronchial smooth muscle.
N Increases vital capacity
N Increases BP, é HR, é PR
N Decreases airway resistance.
Indication
N Asthma
N Bronchitis
N Emphysema
N All cardiac arrest, anaphylaxis
N Used for symptomatic bradycardia.
N Relief of bronchospasm occurring during anesthesia
N Exercised-induced bronchospasm
Side Effects/Adverse Reactions
Side Effects:
nervousness, tremor, vertigo, pain, widened pulse pressure, hypertension nausea
Adverse 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 Management
1. Monitor V/S. and check for cardiac dysrrhythmias
2. Drug increases rigidity and tremor in patients with Parkinson’s disease
3. Epinephrine therapy interferes with tests for urinary catecholamine
4. Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur
5. Massage site after IM injection to counteract possible vasoconstriction.
6. Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop
7. If blood pressure increases sharply, rapid-acting vasodilators such as nitrates or alpha blockers can be given to counteract
VASOPRESSIN
Pitressin
Classification
[ Pituitary Hormones
[ ADH
Dosage
Prevent and treat abdominal distention: initially 5 units IM gives subsequent injections q3-4 hours increasing to 10 units if needed.
Action
Increase permeability of renal tubular epithelium to adenosine monophosphate and water, the epithelium promotes reabsorption of water and concentrated urine
Indication
§ Diabetes Insipidus
§ Abdominal Distention
§ GI bleeding
§ Esophageal varices
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 HCO3
Arm and Hammer; Baking Soda
Classification
Alkalinizers
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
§ SIVP
HYPERTENSIVE CRISIS
Na NITROPRUSSIDE
Nittropress
Classification
Antihypertensive, Vasodilator
Dosage
0.25-0.3 mcg/kg/minute
Action
Relaxes arteriolar and venous smooth muscle
Indication
[ Hypertensive crisis
[ To produce controlled hypotension during anesthesia
[ To reduce preload and afterload in cardiogenic shock
Side Effects/Adverse Reactions
Headache, 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 Management
1. Obtain VS before giving the drug
2. Place pt in supine
3. Giving excessive doses of 500 mcg/kg delivered faster than 2 mcg/kg/min or using max infusion rate of 10 mcg/kg/min for more than 10 mins can cause cyanide toxicity
FUROSEMIDE
Lasix
Classification
Loop Diuretics
Dosage
[ Pulmonary edema: 40 mg IV
[ Edema: 20 to 80 mg PO every day in the morning
[ HPN: 40 mg PO bid. Dosage adjusted based on response
Action
Inhibits Na and Cl reabsorption at the proximal and distal tubules and in the ascending loop of Henle
Indication
[ Acute pulmonary edema
[ Edema
[ Hypertension
Side Effects/Adverse Reactions
Signs of hypotension, hypokalemia and hyperglycemia
Contraindications
[ Hypersensitivity
[ Anuria
Nursing Management
1. Monitor wt., BP and PR
2. Monitor fluid, I&O, electrolyte, BUN and CO2 levels frequently
3. WOF signs of hypokalemia
4. Monitor uric acid levels
5. Monitor glucose levels esp in DM pts
MORPHINE SO4
(Discussed earlier)
NEUROSURGICAL DRUGS
MANNITOL
Osmitrol
Classification
Diuretics
Dosage
§ Test dose for marked oliguria or suspected inadequate renal function: 200 mg/kg or 12.5 gram as a 15% to 20% IV solution over 3-5 mins response is adequate if 30-50 ml of urine/hr is adequate, a second dose is given if still no response after 2nd dose stop the drug
§ Oliguria: 50 over 90 mins to several hrs
§ To induced intraocular or intracranial pressure: 1.5-2 gram/kg as a 15 % to 20% IV solution over 30-60 min
§ Diuresis in drug intoxication: 12.5% to 10% solutions up to 200 g IV
§ Irrigating solution during TURP: 2.5-5%
Action
Increases osmotic pressure of glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes; drug elevates plasma osmolarity, increasing water flow into extracellular fluid
Indication
§ Test dose for marked oliguria or suspected inadequate renal function
§ Oliguria
§ To induced intraocular or intracranial pressure
§ Diuresis in drug intoxication
§ Irrigating solution during TURP
Side Effects/Adverse Reactions
N CN: seizures, headache and fever
§ CV: edema, thrombophlebitis, hypotension and heart failure
§ EENT: blurred vision and rhinitis
§ GI: thirst, dry mouth, nausea, vomiting and diarrhea
§ GI: urine retention
§ Metabolic: dehydration
§ Skin: local pain
§ Others: chill
Contraindications
§ 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
POISONING
NALOXONE HCL
Narcan
Classification
Miscellaneous 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 PRN
N 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 Reactions
N CNS: seizures, tremors
N CV: ventricular fibrillation, tachycardia, HPN with higher recommended doses, hypotension
N GI: nausea and vomiting
N Respiratory: pulmonary edema
N Skin: diaphoresis
Contraindications
N Hypersensitivity
N Use cautious with cardiac irritability or opiod addiction.
Nursing Management
N Assess respiratory status frequently
N Respiratory rate increases within 1-2 mins
IPECAC SYRUP
Classification
Antidote
Dosage
25-30 ml followed immediately by H2O
Action
Irritates the stomach lining and stimulate the vomiting center
Indication
[ Poisoning
[ Overdose
Side Effects
Diarrhea, drowsiness, stomach cramps, vomiting, itching, DOB, swelling of the mouth, rash and hives
Contraindications
[ Hypersensitivity
[ Given activated charcoal
[ Unconcious
[ Drowsy
[ Severely drunk
[ Having seizures
[ With no gag reflex
Nursing Management
1. Don’t administer to unconscious
2. Pt should kept active and moving ff administration
3. If vomiting does not occur after 2nd dose, gastric lavage may be considered to remove ingested substance
ACTIVATED CHARCOAL
Classification
Antidote
Dosage
30-100 g with at least 8 oz of water
Action
[ Inhibits GI absorption of toxic substances or irritants
[ Hyperosmolarity
Indication
[ Poisoning
Side Effects
[ Pain, melena, diarrhea, vomiting and constipation
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
FLUMAZENIL
Romazicon
Classification
[ Benzodiazepine receptor antagonists
Dosage
[ 2 ml IV given over 15 seconds
Action
[ Antagonizes the effects of benzodiazepines
Indication
[ Benzodiazepine-induced depression of the ventilatory responses to hypercapnia and hypoxia
Side Effects
[ Nausea, vomiting, palpitations, sweating, flushing, dry mouth, tremors, insomnia, dyspnea, hyperventilation, blurred vision, headache, pain at injection site
Contraindications
[ Control of ICP or status epilepticus.
[ Signs of serious cyclic antidepressant overdose
Nursing Management
1. Must individualize dosage. Give only smallest amount effective.
2. Give through freely running IV infusion into large vein to minimize pain at injection site
3. Note history of seizure or panic disorder
4. Assess evidence of increased ICP
5. Note evidence of sedative and benzodiazepine dependence
6. Instruct to avoid alcohol and non-prescription drugs for 1-24 hrs
SHOCK
DOPAMINE
Intropine
Classification
Adrenergic drugs
Dosage
Initially 2-5 mcg/kg/min by IV
Action
Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system resulting in positive inotropic effect and increased CO
Indication
N To treat shock and correct hemodynamic imbalances
N To correct hypotension
N To improve perfusion of vital organs
N To increase CO
Side Effects
N CNS: headache an anxiety
N CV: tachy, angina, palpitations and vasoconstriction
N GI: nausea and vomiting
Contraindications
N Hypersensitivity
N With uncorrect tachyarrhythmias
N Pheochromocytoma
N Ventricular Fibrillation
Nursing Management
N Most patients received less than 20 mcg/kg/min
N Drugs isn’t substitute for blood or fluid volume deficit
N During infusion, monitor ECG, BP, CO, PR and color and temp of the limbs
N Do not confuse dopamine to dobutamine
N Check urine output often
DOBUTAMINE
Dobutrex
Classification
Adrenergic drugs
Dosage
N 0.5-1 mcg/kg/min IV infusion, titrating to optimum dosage of 2-20 mcg/kg/min
N 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 CO
N Treatment of cardiac decompensation
Side Effects
N CNS: headache
N CV: HPN, tachycardia, palpitations and vasoconstriction
N GI: nausea and vomiting
Contraindications
N Hypersensitivity
N Use cautiously in pts with hx of HPN and AMI
Nursing Management
N Before starting therapy, give a plasma volume expander to correct hypovolemia and a cardiac glycoside
N Monitor ECG, BP, pulmonary artery wedge pressure and CO
N Monitor electrolyte levels
N Don’t confuse dobutamine to dopamine
GLUCAGON
Classification
Pancreatic Hormones
Dosage
0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN
Action
Binds with glucagon receptor
Indication
Hypoglycemia
Side Effects
Nausea, vomiting, hypotension, tachycardia and hypertension
Contraindications
N Hypersensitivity
N Pheochromocytoma
N Insulinoma
Nursing Management
N Monitor V/S and blood sugar level
N Response within 20 mins after injection
ALBUTEROL
Ventolin
Classification
Bronchodilator, Adrenergic
Dosage
2 inhalations reputed q 4-6 hrs via neb
Action
Activation of beta adrenergic receptors on airway smooth muscle
Indication
N Asthma
N Prevention of exercise induced spasms
Side effects
[ Palpitations
[ Tachycardia
[ GI upset
[ Nervousness
Contraindications
Hypersensitivity
Nursing Management
N Monitor therapeutic effectiveness
N Monitor HR, BP, ABG, s/sx of bronchospasm and CNS stimulation
N Instruct on how to use inhaler properly
N Rinse mouth after use
DIPHENHYDRAMINE HCL
Benadryl
Classification
Anti-histamine
Dosage
25-50 mg PO, IV or IM bid-tid
Action
Blocks the effects Hi receptor sites
Indication
N Allergic reactions
N Motion sickness
N Cough suppression
N Sedation
Side Effects
N Xerostomia
N Urinary retention
N Sedation
Contraindications
Acute asthmatic attack
Nursing Management
Risk for photosensitivity- use sunscreen
EPINEPHRINE
(Discussed earlier)
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