er-drug study

Generic Name

Brand Name Classification Action Indication Dose Nursing Responsibilities

Diazepam Valium Antianxiety agents, anticonvulsants, sedative/hyptonics, skeletal muscle relaxants (centrally acting)

- Depress the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.- Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways.- Has anticonvul-sant properties due to enhanced presynaptic inhibi-tion.Therapeutic effects:(1) Relief of Anxiety(2) Sedation(3) Amnesia(4) Skeletal muscle relaxant(5) Decreased seizure activity

-Adjunct in the management of:1) Anxiety2) Preoperative sedation3) Conscious sedation- Provides light anesthesia and anterograde amnesia- Treatment of status epilepticus/ uncontrolled seizures- Skeletal muscle relaxant- Management of the symptoms of alcohol withdrawal

CONTRAINDICATIONS:- Hypersensitivity- Cross-sensitivity with other benzodiazepines may occurs- Comatose patients- Pre-existing CNS depression- Uncontrolled severe painUse cautiously in:1) Hepatic dysfunction2) Severe renal impairment3) History of suicide attempt or drug dependence

10 mg IM

- Monitor BP, PR,RR prior to periodically throughout therapy and frequently during IV therapy.- Assess IV site frequently during administration, diazepam may cause phlebitis and venous thrombosis.- Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient. Observe depressed patients closely for suicidal tendencies.- Observe and record intensity, duration and location of seizure activity. The initial dose of diazepam offers seizure control for 15-20 min after administration.- IM injections are painful and erratically absorbed. If IM route is used, inject deeply into

deltoid muscle for maximum absorption.- Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.- Effectiveness of therapy can be demonstrated by decrease anxiety level; control of seizures; decreased tremulousness.

Generic Name Brand Name Classification Action Indication Dose Nursing Responsibilities

diphenhydramine Benadryl Antihistamine, anticholinergic antiparkinson agent

Antagonizes the effect of histamine at H1 receptor sites; does not bind or inactivate histamine, Antihistamines prevent the physiological actions of histamine by preventing histamines from reaching H1- and H2-receptor sites. Antihistamines provide short-lived benefits and provide only symptomatic relief. Antihistamine is specific for conditions in which histamine excess is present (for examle, acute urticaria) but is adjunctive therapy in the treatment of anaphylactic shock because epinephrine is more effenctive. Antihistamines are quite specific for reversing extrapyramidal

parkinsonism or drug-induced extrapyramidal effects, Symptomatic relief of allergies Allergic reactions Anaphylaxis Acute dystonic reactions

Contraindications

Lower respiratory diseases such as astma attacks Patients taking MAOIs Hypersensitivity Narrow-angle glaucome

Tablet: 25, 50 mg Capsule: 25, 50 mg Elixir: 12.5 mg/5 ml Parenteral: 10, 50 mg/ml vials, prefilled syringe Adult:

The standard dose of diphenhydramine is 25-50 mg, either IM or IV.

Pediatric: 5 mg/kg/24 hr q 6 hr PO. 2-5 mg/kg IV or IM.

Onset & Duration

Onset: Maximal effects 1-3 hr Duration: 6-12 hr

Caution the client that the medication may cause drowsiness, creating difficulties or hazards or other activities that require alertness.• Tell the client to take the medication with food to decrease GI upset.• Explain to the client that arising quickly form a lying or sitting position may cause orthostatic hypotension.• When taking these medications, the client needs to have blood cells counts, renal function, hepatic function, and blood pressure monitored.• Adverse effects of these drugs occur more commonly in elderly clients.• Explain to the client that use of these drugs in warm weather may increase the likelihood

reactions and are probably efficacious as drying agents in upper respiratory and sinus conditions

of heatstroke.

Generic Name Brand Name

Classification Action Indication Dose Nursing Responsibilities

NALBUPHINE HYDROCHLORIDE

Nubaine Narcotic agonist-antagonist analgesic, Opioid Agonist-Antagonist

Nalbuphine acts as an agonist at specific opioid receptors in the CNS to produce analgesia, sedation but also acts to cause hallucinations and is an antagonist at µ receptors

Relief of moderate to severe pain

Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery.

Contraindications: hypersensitivity to nalbuphine, sulfites; lactation.Use cautiously with emotionally unstable clients or those with a history of narcotic abuse; pregnancy prior to labor, labor or delivery, bronchial asthma, COPD, respiratory depression,

Available Forms:

Injection – 10 mg/ml, 20mg/ml

Adults:

Usual dose is 10 mg/70kg, SC, IM or IV q 3-6h as necessary. Individualize dosage. In nontolerant patients, the recommended single maximum dose is 20mg, with a maximum total daily dose of 160mg. Patients dependent on

•Reassess patient’s level of pain at least 15 and 30 minutes after parenteral administration

•Nalbuphine acts as an opioid antagonist and may cause withdrawal syndrome. For patients who have received log-term opioids, give 25% of the usual dose initially. Watch for sings of withdrawal.

•Alert: Drug causes respiratory depression, which at 10mg is equal to respiratory depression produced by 10 mg

anoxia, increased intracranial pressure, acute MI when nausea and vomiting are present, biliary tract surgery.

narcotics may experience withdrawal symptoms.

Pediatric patients < 18 yr : Not recommended

Geriatric patients or patients with renal or hepatic impairment: Reduce dosage

Adults Subcutaneous / IM / IV 10 mg per 70 kg q 3 to 6 h as needed. Individualize dosage. In nontolerant patients, do not exceed 20 mg/dose or 160 mg/day

of morphine

•Monitor circulatory and respiratory status, bladder and bowel function. If respirations are shallow or rate is below 12 breaths/minute, withhold dose and notify prescriber

•Constipation is often severe with maintenance therapy. Make sure stool softener or other laxative is ordered.

•Psychological and physical dependence may occur with prolonged use.

• Remind patient not to confuse Nubain with Navane.



CLONIDINE HYDROCHLORIDE

Catapres, Catapres-TTS, Dixaril , Duraclon

cardiovascular agent; central-acting antihypertensive; analgesic

Centrally acting antiadrenergic derivative. Stimulates alpha2-adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release

Step 2 drug in stepped-care approach to treatment of hypertension, either alone or with diuretic or other antihypertensive agents. Epidural administration as adjunct therapy for severe pain.

CONTRAINDICATIONPregnancy (category C), lactation. Use of clonidine patch in polyarteritis nodosa, scleroderma, SLE

HypertensionAdult: PO 0.1 mg b.i.d. or t.i.d., may increase by 0.1–0.2 mg/d until desired response is achieved (max: 2.4 mg/d) Transdermal 0.1 mg patch once q7d, may increase by 0.1 mg q1–2 wkGeriatric: PO Start with 0.1 mg once dailyChild: PO 5–10 mcg/kg/d divided q8–12h, may increase to 5–25 mcg/kg/d divided q6h (max: 0.9 mg/d)

Severe PainAdult: Epidural start infusion at 30 mcg/h and titrate to response. Use rates >40 mcg/h

Assessment & Drug Effects

Monitor BR closely. Determine positional changes (supine, sitting, standing).

With epidural administration, frequently monitor BP and HR. Hypotension is a common side effect that may require intervention.

Monitor BP closely whenever a drug is added to or withdrawn from therapeutic regimen.

Monitor I&O during period of dosage adjustment. Report change in I&O ratio or change in voiding pattern.

Determine weight

from kidneys. with cautionChild: Epidural start infusion at 0.5 mcg/kg/h and titrate to response

ADDHChild: PO 5 mcg/kg/d in 4 divided doses (average dose, 0.15–0.2 mg/d) Transdermal 0.2–0.3 mg/d q5–7d

daily. Patients not receiving a concomitant diuretic agent may gain weight, particularly during first 3 or 4 d of therapy, because of marked sodium and water retention.

Supervise closely patients with history of mental depression, as they may be subject to further depressive episodes.

Generic Name Brand Name Classification Action Indication Dose Nursing ResponsibilitiesFUROSEMIDE Lasix

Electrolytic and water balance agent; loop diuretic

Rapid-acting potent sulfonamide “loop” diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not

Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for

Tablets: 20, 40, and 80mg. Oral solution: 10 mg/ml, 40 mg/5

Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported.

clearly defined; decreases renal vascular resistance and may increase renal blood flow.

management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis.

ml. Injection: 10 mg/ml

Monitor BP during periods of diuresis and through period of dosage adjustment.

Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician.

Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter.

Monitor for S&S of hypokalemia (see

Appendix F).

Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions.

Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.

Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving

sympatholytic agents.



DOPAMINE HYDROCHLORIDE

Dopastat, Intropin, Revimine

autonomic nervous system agent; alpha- and beta-adrenergic agonist (sympathomimetic)

Naturally occurring neurotransmitter and immediate precursor of norepinephrine. Major cardiovascular effects produced by direct action on alpha- and beta-adrenergic receptors and on specific dopaminergic receptors in mesenteric and renal vascular

To correct hemodynamic imbalance in shock syndrome due to MI (cardiogenic shock), trauma, endotoxic septicemia (septic shock), open heart surgery, and CHF.

Contraindication:

Pheochromocytoma; tachyarrhythmias or ventricular fibrillation. Safe use during pregnancy (category C),

ShockAdult/Child: IV 2–5 mcg/kg/min increased gradually up to 20–50 mcg/kg/min if necessary

Renal FailureAdult: IV 2–5 mcg/kg/min

Dopamine Calculation:

Drip Rate=


Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed by physician. Precise measurements are essential for accurate titration of dosage. Report the following indicators promptly to physician for use

beds. lactation, or children is not established.

[(orders) x (kg) x (drip set)] / concentration in 1 mL

Conversion factor: 1mg=1000mcg

1kg=2.2lbs

in decreasing or temporarily suspending dose: Reduced urine flow rate in absence of hypotension; ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure (marked decrease in pulse pressure); signs of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints of tenderness, pain, numbness, or burning sensation).

Monitor therapeutic effectiveness. In addition to improvement in vital signs and urine flow, other indices of adequate

dosage and perfusion of vital organs include loss of pallor, increase in toe temperature, adequacy of nail bed capillary filling, and reversal of confusion or comatose state.

Generic Name


Nicardipine Cardene Calcium channel blocker (dihydropyridine).

Inhibits calciumion influx acrosscardiac andsmooth musclecells, thusdecreasingmyocardialcontractility andoxygen demandand coronararteries andarterioles.

Chronic stable

angina

Contraindication:

Patient who arehypersensitive tonicardipine

Initially

20 mg P.O Tid

hypertension20 to 40 mg P.Ot.i.d increasedosage dependson the patientsresponse

Patients with hepatic

impairment should

receive lower dose

Monitor blood pressure.

Allow atleast 3 days

between dosage

adjustment to achieve

steady plasma levels.

Advise patient to reportimmediately ifexperiencing chest pa

Generic Name

Brand Name


Mannitol Osmitrol, Resectisol

Diuretic It raises the osmotic pressure of the plasma

allowing water to be drawn out of body tissues

In the oliguric phase of acute renal failure, Mannitol increases osmotic pressure (pressure needed to stop the absorption of something or osmosis) of the glumerular filtrate, thereby, promoting diuresis (treating

1. Acute oliguric renal failure

2. Toxic overdose

3. Edema

4. Increased intracranial pressure (ICP)

5. Intraocular pressure

6. (IOP)

7. Pulmonary congestion

or oedema; intracranial bleeding;

CHF; metabolic edema with abnormal capillary fragility; anuria due to severe renal disease; severe dehydration.

Adult

Oliguria: 50-100 g as a 5-25% solution.

Intracranial/Intraocular pressure: 0.25-2 g/kg as 15-25% solution administered for 30-60 minutes.

Children

Oliguria: 0.25-2 g/kg as a 15-20% solution for 2-6 hours

Intracranial/Intraocular pressure: 1-2 g/kg as a 15-20% solution administered for 30-60 minutes.

Assessment – Monitor the following:

1. 1. Vital signs2. 2. Intake and output

3. 3. Central venous pressure

4. Pulmonary artery pressure

5. Signs and symptoms of dehydration (e.g. poor skin turgor, dry skin, fever, thirst)

6. Signs of electrolyte imbalance/deficit (e.g. muscular weakness, paresthesia, numbness, confusion, tingling sensation of extremity and excessive thirst)

7. (for increase ICP) Neurologic status and intracranial

the oliguric phase of renal failure) and excretes toxic materials (management for toxic overdose).

It also elevates blood plasma osmolality thus, inhibiting the reabsorption of water and electrolytes (for relief of edema) and mobilizing fluids in the cerebral and ocular spaces (lowers intracranial or intraocular pressure).

pressure readings.

8. (for increase IOP) Elevating eye pain or decreased visual acuity.

Laboratory Tests

1. Renal function (BUN and Creatinine)

2. Serum Electrolyte (Sodium and Potassium)

Precaution

Pregnancy and lactation (safe use during these conditions is not established)

Interventions

1. Observe the IV site regularly for infiltration.

2. Administration rate for oliguria should be titrated to produce a urine output. (about 30-

50 ml/hr in adult and 2-6 hours in children)

Generic Name

Brand Name Classification Action Indication/Dose

•Active Duodenal UlcerAdults: PO 150mg b.i.d. or 300 mg at bedtime. Maintenance dose is 150 mg at bedtime. IM/IV/Intermittent IV 50 mg every 6 to 8 h.

Children 1 mon -16 y/o: PO 2 to 4 mg/kg twice daily (max, 300 mg/day).

•Maintenance therapy for Duodenal and Gastric UlcersAdults: 150mg P.O at bedtime

Children 1 mon -16 y/o: PO 2 to 4 mg/kg daily up to 150mg daily

•Pathologic Hypersecretory ConditionsAdults: PO 150 mg twice daily. Individualize.

Nursing Responsibilities

Ranitidine HCL

Zantac GASTROINTESTINAL AGENT; ANTISECRETORY (H2-RECEPTOR ANTAGONIST)

Completely inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretions

•Instruct patient on proper use of OTC preparation as indicated.

•Instruct patient on proper use of OTC preparation as indicated.

•Assess patient for abdominal pain. Note presence of blood in emesis, stool, or gastric aspirate

•Ranitidine may be added to total parenteral nutrition solution

•Remind patient to take once daily prescription drug at bedtime for best results

•Instruct patient to take without regard to meals because absorption isn’t affected by food

•GERD and Erosive EsophagitisAdults: PO 150mg b.i.d.

Children 1 mon -16 y/o: PO 5 to 10 mg/kg daily usually given in 2 divided doses.

•Erosive Esophagitis: Maintenance dosage is 150mg P.O. q.i.d.

•HeartburnAdults and Children 1 mon -12 y/o and older: 75mg of Zantac 75 P.O. as symptoms occur, up to 150mg daily, not to exceed 2 weeks of continuous treatment.

CONTRAINDICATION

•Contraindicated in patients hypersensitive to drug and those with porphyria

•Use cautiously in patients with hepatic dysfunction. Adjust dose in patients with impaired renal function

• Remind patient not to confuse ranitidine with rimantadine: don’t confuse Zantac with Xanax or Zyrtec

Generic Name


Calcium Gluconate

Calcium supplements

Calcium is essential for the functional integrity of the nervous, muscular, and skeletal systems. It plays a role in normal cardiac function, renal function, respiration, blood coagulation, and cell membrane and capillary permeability. Also, calcium helps to regulate the release and storage of neurotransmitters and hormones, the uptake and binding of amino acids, absorption of vitamin B 12, and gastrin secretion. The major fraction (99%) of calcium is in the skeletal structure

Parenteral administration of calcium is indicated where the pharmacological action of a high calcium ion concentration is required, as for example, in acute hypocalcaemia, cardiac resuscitation and some cases of neonatal tetany. Intravenous injections of calcium have been used in the treatment of the acute colic of lead poisoning, and as an adjunct in the treatment of acute fluoride poisoning. Also, for the prevention of hypocalcaemia in

primarily as hydroxyapatite, Ca 10(PO 4) 6(OH) 2; small amounts of calcium carbonate and amorphous calcium phosphates are also present.

exchange transfusions

Contraindication: Hypercalcaemia (e.g. in hyperparathyroidism, hypervitaminosis D, neoplastic disease with decalcification of bone), severe hypercalciuria, severe renal failure, patients receiving cardiac glycosides.

Adverse Reactions: If Calcium Gluconate Injections is administered too rapidly, nausea, vomiting, hot flushes, sweating, hypotension and vasomotor collapse, possibly fatal, may occur. Soft tissue calcification due to

extravasation of calcium solutions has been reported

Generic Name


Potassium Chloride

Electrolyte Potassium chloride is used to prevent or to treat low blood levels of potassium (hypokalemia). Potassium levels can be low as a result of a disease or from taking certain medicines, or after a prolonged illness with diarrhea or vomiting.

Potassium deficiency.

Contraindication: Excess of potassium ions produces depression of the heart and may cause cardiac arrest. Poisoning may occur from the intravenous injection of even small doses of potassium ions when excretion is delayed, as in the presence of

renal insufficiency.

Adverse Reactions: nausea, vomiting, diarrhea, stomach ache, and flatulence.

Generic Name


Salbutamol Beta-2 agonist Salbutamol is chemically related to isoprenaline. It is not metabolised by COMT and MAO, therefore the action of the drug lasts longer than isoprenaline. It acts by stimulating the Beta-2 receptor cells of the smooth muscles in the bronchioles and uterus. It has minimal cardiac stimulant

Indications: It is used for relief of bronchospasm in patients with reversible obstructive airway disease and relaxation of uterine smooth muscle to delay threatened abortion.

effect and does not cause hypertension.

Contraindication: It is contraindicated in patients with hypersensitivity to the drug and thyrotoxicosis.

Generic Name


Aluminum magnesium hydroxide

Maalox peptic, gastric, duodenal ulcers, hyperphosphatemia in chronic failure, reflux esophagitis, hyperacidity, heart burn, GERD

ADULT- suspension 5-10 ml 1 hr after meal at bedtime ORAL Administration: 600 mg 1 hr after meal at bedtime, chewed with milk or water. GI bleeding: Infant: Oral administration 2-5 ml/ dose every 1-2 hrs. Children Oral Administration: 5-

15 ml/dose every 1-2 hours. hyperphosphatemia in renal failure: Adult: suspension 500 mg- 2 2x- 4x a dayPharmacodynamics: Onset: Varies Peak: Unknown Duration: 20- 60 minutes (Fasting) 3 hours ( taken 1 hour after meal)

Generic Name


Atropine sulfate

atropine sulfate

administration prior to anesthesia to reduce or prevent secretions of respiratory tract; teratment

For IV administration ADULT 0.4-0.6 mg every 4-6 hrs.PEDIA 0.1-0.6 mg depending on weightAs Antidote 1-2 mg every 20-30 mins until the skin is flushed

of parkinsonism; irritation or inflammation of stomach; treatment of alcohol withdrawal symptoms; relief of motion sickness;short treatment has and prevention of bronchospasm associated with chronic bronchial asthma, bronchitis and COPD. therapy for certain bradycardias and heart blocks.

and dry, the pupils are dilated and tachycardia has developedADULT by subQ injection 0.5 mg 4-6 hrly.PEDIA < 12 yrs, subQ 0.01 mg/kg body-weightREFRACTION; adult 1-2 drpos 1 hr before refracting

Generic Name


Magnesium Sulfate

Elin magnesium

used as anti- convulsan, lowers

Magnesium deficiency

sulfate intracranial pressure, prevention and control of seizures in toxemia, acute nephritis in children and other conditions like epilepsy, glomerulonephritis or hypothyroidism, also use for arrythmias such as atypical ventricular tachycardia.

2 ml injection IM.

Pre- eclampsia 8-10 ml added into 250 ml of 5 % dextrose or 0.9% sodium chloride

injectionPedia Depression of Seizures 0.08-0.16ml/kg BW of 25% solution IM

Generic Name Brand Name Classification Action Indication Dose Nursing ResponsibilitiesPHENOBARBITAL SODIUM

Luminal Sodium central nervous system agent; anticonvulsant; sedative-hypnotic; barbiturate

Long-acting barbiturate. Sedative and hypnotic effects of barbiturates appear to be due primarily to interference with impulse transmission of cerebral cortex by inhibition of

Long-term management of tonic-clonic (grand mal) seizures and partial seizures; status epilepticus, eclampsia, febrile convulsions in young children. Also

AnticonvulsantAdult: PO 100–300 mg/d IV/IM 200–600 mg up to 20 mg/kgChild: PO/IV 3–8


Observe patients receiving large doses closely for at least 30 min to ensure that sedation is not excessive. Keep patient under constant

reticular activating system. CNS depression may range from mild sedation to coma, depending on dosage, route of administration, degree of nervous system excitability, and drug tolerance. Initially, barbiturates suppress REM sleep, but with chronic therapy REM sleep returns to normal.

used as a sedative in anxiety or tension states; in pediatrics as preoperative and postoperative sedation and to treat pylorospasm in infants

CONTRAINDICATION:

Sensitivity to barbiturates; manifest hepatic or familial history of porphyria; severe respiratory or kidney disease; history of previous addiction to sedative hypnotics; uncontrolled pain; pregnancy (particularly early pregnancy) (category D), lactation; sustained release formulation for children <12 y of age.

mg/kg or 125 mg/m2/dNeonate: PO/IV 3–4 mg/kg/d (max: 5 mg/kg/d)

Status EpilepticusAdult/Child: IV 15–18 mg/kg in single or divided doses (max: 20 mg/kg)Neonate: IV 15–20 mg/kg in single or divided doses

SedativeAdult: PO 30–120 mg/d IV/IM 100–200 mg/dChild: PO 6 mg/kg/d or 180 mg/m2 in 3 divided doses IV/IM 16–100 mg/d (1–3 mg/kg)

observation when drug is administered IV, and record vital signs at least every hour or more often if indicated.

Lab tests: Obtain liver function and hematology tests and determinations of serum folate and vitamin D levels during prolonged therapy.

Monitor serum drug levels. Serum concentrations >50 mcg/mL may cause coma. Therapeutic serum concentrations of 15–40 mcg/mL produce anticonvulsant activity in most patients. These values are usually attained after 2 or 3 wk of therapy with a dose of 100–200 mg/d.

Expect barbiturates to produce restlessness when given to patients in pain because these drugs do not have analgesic action.

Be prepared for paradoxical responses and report promptly in older adult or debilitated patient and children (i.e., irritability, marked excitement [inappropriate tearfulness and aggression in children], depression, and confusion).

Name of the Drug Dosage/Route Action/Classification Indication/ Contraindications

Adverse Effects/ Side Effects


Generic Name:

epinephrine

Brand Name:

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

Cardiac arrest:

1 mg IV of 1:10,000 solution q 3-5 min; double dose if administering

via ET tube

Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000 solution.

Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution

Refractory bradycardia and hypotension: 2-10ug/min

Action:

Stimulates beta receptors in lung.

Relaxes bronchial smooth muscle.

Increases vital capacity

BP, HR, PR

Decreases airway resistance.

Classification:

Beta2 Adrenergic Agonists

Indications:

o Asthmao Bronchitiso Emphysemao All cardiac

arrest, anaphylaxis

o Used for symptomatic bradycardia.

o Relief of bronchospasm occurring during anesthesia

o Exercised-induced bronchospasm

Contraindications:

Contraindicate in patients 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

Adverse Effects:

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

Side Effects:

headache

Monitor V/S. and check for cardiac dysrhythmias

Drug increases rigidity and tremor in patients with Parkinson’s disease

Epinephrine therapy interferes with tests for urinary catecholamine

Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur

Massage site after IM injection to counteract possible vasoconstriction.

Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop

If blood pressure

anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage)

Some products containing sulfites and are contraindicated in patients with sulfite allergies except when drug is used for serious allergic reactions or in other emergency situations.

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

Use cautiously with long-standing bronchial asthma and emphysema,

increases sharply, rapid-acting vasodilators such as nitrates or alpha blockers can be given to counteract

who have developed degenerative heart disease and in those with hyperthyroidism, CV disease, hypertension, psychoneurosis, or diabetes.

In pregnant woman, drug is contraindicated.

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




Generic Name:

Sodium Bicarbonate

Brand Name: Arm and

1 mEq/kg IVP, may repeat 0.5 mEq/kg 10 min.

Action:

Neutralizes gastric acid

Decrease pepsin activity

Indications:

o Hyperacidityo Peptic ulcero Hyperkalemiao Tricyclic

antidepressant

Adverse Effects:

GI: Gastric distention, belching, flatulence.

Metabolic: metabolic alkalosis,

Monitor urinary pH, calcium, electrolytes and phosphate levels.

Record amount and

Hammer Pure Baking Soda, Citrocarbonate, Soda Mint

Classification: Alkalizing Agent, Buffer, Antacid, electrolyte

ODo Shock associated

with severe diarrhea, dehydration, uncontrolled DM

o Reflux esophagitis

Contraindications:

Contraindicated in patients with metabolic or respiratory alkalosis; patients who are losing chlorides from vomiting or continuous GI suction; patients taking diuretics known to produce hypochloremia alkalosis; and patients with hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart failure. Oral sodium bicarbonate is contraindicated in patients with acute ingestion of strong mineral acids.

hypernatremia, hypokalemia, hyperosmolarity (with overdose).

Other: Pain and irritation at injection site.

consistency of stools.

Clients on low-sodium diets should evaluate sodium contents of antacids.

Name of the Drug Dosage/Route/Timing Action/Classification Indication/ Contraindications



Generic

Nitroglycerin

Brand

Nitrostat

0.3-0.4 mg SL q 5 min, max 3 doses.

Action:

Relaxes the vascular smooth system

Myocardial oxygen consumption

left ventricular workload

arterial BP

venous return

Classification

Antianginal, Nitrate,

Indication:

Angina pectoris

CHF associated with AMI

Cardiac load reducing agent

Hypertensive Crisis

Contraindication:

Contraindicated in patients hypersensitive to nitrates and in those with early MI. (S.L. form), severe anemia, increase ICP angle-closure glaucoma, IV nitroglycerine is

Adverse Effects

CV: orthostatic hypotension, flushing, fainting.

EENT: sublingual burning.

Skin: Cutaneous vasodilation, contact dermatitis (patch)

Side Effects

CNS: headache, throbbing, dizziness, weakness.

GI: nausea, vomiting.

Skin: Rash

Record characteristics and precipitating factors of anginal pain.

Monitor BP and apical pulse before

administration and periodically after dose.

Have client sit or lie down if taking drug for the first time.

Client must have continuing EKG monitoring for IV administration

Vasodilator, Coronary contraindicated in patients with hypovolemia, hypotension, orthostatic hypotension, cardiac tamponade restrictive cardiomyopathy, constrictive pericarditis.

Cardioverter/ defibrillator must not be discharged through paddle electrode overlying

Nitro-Bid ointment or the Transderm-Nitro Patch. Assist with ambulating if dizzy.

Instruct to take at first sign of anginal pain.

May be repeated q 5 minutes to max. of 3 doses.

If the client doesn’t experience relief, advise to seek medical assistance immediately.

Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Nursing

Contraindications Effects Responsibilities

Generic

Atrophine Sulfate

Brand

Isopto Atropine

Bradycardia: 0.5 -1 mg IV (may give via ETT at double dose) q 3-5 min, max 0.04 mg/kg

Cardiac arrest: 1 mg q 3-5 min, max 0.04 mg/kg

Nerve gas and organophosphate symptoms, may repeat in 2 mg increments q 3 min tiltrated to relief symptoms.

Action

cholinergic receptor sites so response to acetylcholine is decreased

Classification

Anticholinergics

Indication

As an anti-sialagogue for preanesthetic medication to prevent or reduce secretions of the respiratory tract

To restore cardiac rate and arterial pressure during anesthesia, when vagal

stimulation produced by intra-abdominal surgical traction causes a sudden decrease in pulse rate and cardiac action

To lessen the degree of atrioventricular (A-V) heart block when increased vagal tone is a major factor in the conduction defect, as in

Adverse Effects

CNS: restlessness, ataxia, disorientation, hallucinations, delirium, coma, insomnia, agitation, confusion.

CV: tachycardia, angina, arrhythmias, flushing.

EENT: photophobia, blurred vision, mydriasis.

GI: dry moth, constipation, vomiting.

GU: urine retention.

Hematologic: leukocytosis

Other: anaphylaxis

Side Effects

CNS: headache,

Monitor VS.

Report HR

Monitor for constipation, oliguria.

Atrophine could result in CNS stimulation (confusion, excitement) or drowsiness

Instruct to take 30 mins before meals

Eat foods high in fiber and drink plenty fluids.

Avoid OTC antihistamines.

Instruct client not to drive a motor vehicle or

some cases due to digitalis

To overcome severe carotid sinus reflex

Antidote for cardiovascular collapse from the injudicious use of a cholinergic drug.

Contraindication

Contraindicated in patients hypersensitive to drug and those with acute angle closure glaucoma, obstructive uropathy, obstructive disease of GI tract, paralytic elius, toxic magacolon, intestinal atony, unstable CV status in acute hemorrhage, asthma, or myasthenia gravis. Also contraindicated in

excitement.

CV: palpitations

GI: thirst, nausea.

participate in activities requiring alertness.

Advise to use hard candy, ice chips, etc. for dry mouth.

pregnant women.




Generic

Morphine Sulfate

Brand

Immediate-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

ADULTSOralOne-third to one-sixth as effective as parenteral administration because of first-pass metabolism; 10–30 mg q 4 hr PO. Controlled-release: 30 mg q 8–12 hr PO or as directed by physician; Kadian: 20–100 mg PO daily–24-hr release system; MS Contin: 200 mg PO q 12 hr.SC and IM10 mg (5–20 mg)/70 kg q 4 hr or as directed by physician.IV2.5–15 mg/70 kg of body weight in 4–5 mL water for injection administered over 4–5 min, or as directed by physician. Continuous

Action

Principal opium alkaloid; acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

Classification

Opioid agonist analgesic

Indication

Relief of moderate to severe acute and chronic pain

Preoperative medication to sedate and allay apprehension, facilitate induction of anesthesia, and reduce anesthetic dosage

Analgesic adjunct during anesthesia

Component of most preparations that are referred to as Brompton's cocktail or mixture, an oral alcoholic solution that is used for chronic severe pain, especially in terminal cancer patients

Intraspinal use with microinfusion devices

Adverse Effect

CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex

CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope

AssessmentHistory: Hypersensitivity to opioids; diarrhea caused by poisoning; labor or delivery of a premature infant; biliary tract surgery or surgical anastomosis; head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression; acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease,

for intraspinal use: Infumorph

IV infusion: 0.1–1 mg/mL in 5% dextrose in water by controlled infusion device.Rectal10–30 mg q 4 hr or as directed by physician.EpiduralInitial injection of 5 mg in the lumbar region may provide pain relief for up to 24 hr. If adequate pain relief is not achieved within 1 hr, incremental doses of 1–2 mg may be given at intervals sufficient to assess effectiveness, up to 10 mg/24 hr. For continuous infusion, initial dose of 2–4 mg/24 hr is recommended. Further doses of 1–2 mg may be given if pain relief is not achieved initially.IntrathecalDosage is usually one-tenth that of epidural dosage; a single injection of 0.2–1 mg may provide satisfactory pain relief for up to 24 hr. Do not

for the relief of intractable pain

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

Contraindicated with hypersensitivity to opioids; diarrhea caused by poisoning until toxins are eliminated; during labor or delivery of a premature infant (may cross immature blood–brain barrier more readily); after biliary tract surgery or following surgical anastomosis; pregnancy; labor (respiratory depression in neonate; may prolong labor).

Use cautiously with head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression, hypoxia, hypercapnia (may decrease

Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm, bronchospasm, edema

GI: Nausea, vomiting, anorexia, biliary tract spasm; increased colonic motility in patients with chronic ulcerative colitis

GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency

Respiratory: Respiratory

depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest

Side Effects

GI: dry mouth, constipation.

prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction; pregnancy; lactation

Physical: T; skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP, orthostatic BP, perfusion; R, adventitious sounds; bowel sounds, normal output; urinary frequency, voiding pattern, normal output; ECG; EEG; thyroid, liver, kidney function tests

InterventionsCaution patient not to chew or crush controlled-release preparations.

Dilute and administer slowly IV to minimize likelihood of adverse effects.

Tell patient to lie down during IV administration.

inject > 2 mL of the 5 mg/10 mL ampule or > 1 mL of the 10 mg/10 mL ampule. Use only in the lumbar area. Repeated intrathecal injections are not recommended; use other routes if pain recurs. For epidural or intrathecal dosing, use preservative-free morphine preparations only.

PEDIATRIC PATIENTSDo not use in premature infants.SC or IM0.05–0.2 mg/kg (up to 15 mg per dose) q 4 hr or as directed by physician.

GERIATRIC PATIENTS OR IMPAIRED ADULTSUse caution. Respiratory depression may occur in the elderly, the very ill, those with respiratory problems. Reduced dosage may be necessary.

respiratory drive and increase airway resistance); lactation (wait 4–6 hr after administration to nurse the baby); acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction.

Skin: Tissue irritation and induration (SC injection).

Other: sweating,physical tolerance and dependence, psychological dependence

Keep opioid antagonist and facilities for assisted or controlled respiration readily available during IV administration.

Use caution when injecting SC or IM into chilled areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored.Reassure patients that they are unlikely to become addicted; most patients who receive opioids for medical reasons do not develop dependence syndromes

Teaching points

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

EpiduralUse extreme caution; injection of < 5 mg in the lumbar region may provide adequate pain relief for up to 24 hr.IntrathecalUse lower dosages than recommended for adults above.

sedatives, tranquilizers, over-the-counter drugs.

Swallow controlled-release preparation (MS Contin, Oramorph SR) whole; do not cut, crush, or chew them.

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

These side effects may occur: Nausea, loss of appetite (take with food, lie quietly); constipation (use laxative); dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness and visual acuity).

Report severe nausea, vomiting, constipation, shortness of breath or difficulty breathing, rash.

Generic Brand Name Classification Action Indication Dose Nursing Responsibilities

NameOmeprazole

Tansinel Antisecretorydrug

Gastric-acidpumpinhibitor:suppressesgastric acidsecretion byspecificinhibition ofthehydrogenpotassiumATPaseenzymesystem atthesecretorysurface ofthe gastricparietal cells; blocksthe finalstep of acidproduction.

Short-termtreatment ofactive duodenalcancerShort-termtreatment ofactive benigngastric ulcerEradication ofHelicobacterPyloriFirst-linetherapy fortreatment ofheartburn orsymptoms of GERD.

20 mg1 capfortwoweeks

Assessment:1. History:hypersensitivity toomeprazole or any ofits components;pregnancy, lactation2. Physical: skinlesions; reflexes;urinary output;abdominalexamination;respiratoryauscultationInterventions:1. Administer beforemeals.2. Administerantacids with, if needed.3. Have regularmedical follow-upvisits.4. Report severeheadache, worseningof symptoms, fever,

chills.

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LACAMPUINGAN, JOEMAR M.ADAMSON UNIVERSITYCollege of NursingBLOCK 403

er-drug study

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