EMERGENCY DRUGS: A drug study.

1) AMINOPHYLLINE

Brand Names: Phil Pharmawealth/Atlantic Aminophylline amp Theofil amp

Classification: Antiasthmatic & COPD Preparations

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.

Indication: PO Chronic bronchospasm as hydrate

Action: Increases the level of cAMP resulting in bronchodilation

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:

• Administer to pregnant patients only when clearly needed - neonatal

tachycardia, jitteriness, and withdrawal apnea observed when mothers
received xanthines up until delivery.

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

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

• Do not give timed-release forms with food; these should be given on an

empty stomach 1 hr before or 2 hr after meals.

• Maintain adequate hydration.

• Monitor results of serum theophylline levels carefully, and arrange for

reduced dosage if serum levels exceed therapeutic range of 10-20 mcg/mL.

• Take serum samples to determine peak theophylline concentration drawn 15–

30 min after an IV loading dose.

• Monitor for clinical signs of adverse effects, particularly if serum theophylline

levels are not available.

• Ensure that diazepam is readily available to treat seizures.

 • Take this drug exactly as prescribed; if a timed-release product is prescribed,
take this drug on an empty stomach, 1 hr before or 2 hr after meals.

• Do not to chew or crush timed-release preparations.

• Administer rectal solution or suppositories after emptying the rectum.

• It may be necessary to take this drug around the clock for adequate control
of asthma attacks.

• Avoid excessive intake of coffee, tea, cocoa, cola beverages, chocolate.

• Smoking cigarettes or other tobacco products impacts the drug's

effectiveness. Try not to smoke. Notify the care provider if smoking habits
change while taking this drug.

• Frequent blood tests may be necessary to monitor the effect of this drug and
to ensure safe and effective dosage; keep all appointments for blood tests
and other monitoring.

• These side effects may occur: Nausea, loss of appetite (taking this drug with
food may help if taking the immediate-release or liquid dosage forms);
difficulty sleeping, depression, emotional lability (reversible).

• Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular

heartbeat

2) AMIODARONE HYDROCHLORIDE

Brand Names: Anoion tab Cordarone Cordarone inj Sandoz Amiodarone HCl tab

Classification: Cardiac Drugs

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.

Indication: Ventricular and supraventricular arrhythmias.

Action: Blocks potassium chloride leading to prolongation of action potential

duration.

Adverse Reactions: Blue-grey discoloration of skin, photosensitivity, peripheral

neuropathy, paraesthesia, myopathy, ataxia, tremor, nausea, vomiting, metallic
taste, hypothyroidism, hyperthyroidism, alopecia, sleep disturbances, corneal
microdeposits, hot flushes, sweating. Heart block, bradycardia, sinus arrest,
hepatotoxicity, heart failure. Potentially Fatal: Pulmonary toxicity including
pulmonary fibrosis and interstitial pneumonitis, hepatotoxicity, thyrotoxicity.
Ventricular arrhythmias, pulmonary alveolitis, exacerbation of arrhythmias and rare
serious liver injury. Generally in patients with high doses and having preexisting
abnormalities of diffusion capacity.

Nursing Measures:

• Monitor cardiac rhythm continuously.

• Monitor for an extended period when dosage adjustments are made.

• Monitor for safe and effective serum levels (0.5–2.5 mcg/mL).

• Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need

to be reduced one-third to one-half when amiodarone is started.

• Give drug with meals to decrease GI problems.

• Arrange for ophthalmologic exams; reevaluate at any sign of optic

neuropathy.

• Arrange for periodic chest x-ray to evaluate pulmonary status (every 3–6
mo).

• Arrange for regular periodic blood tests for liver enzymes, thyroid hormone
levels.

• Drug dosage will be changed in relation to response of arrhythmias; you will

need to be hospitalized during initiation of drug therapy; you will be closely
monitored when dosage is changed.

• Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray,

eye exam, blood tests.

• These side effects may occur: Changes in vision (halos, dry eyes, sensitivity
to light; wear sunglasses, monitor light exposure); nausea, vomiting, loss of
appetite (take with meals; eat small, frequent meals); sensitivity to the sun
(use a sunscreen or protective clothing when outdoors); constipation (a
laxative may be ordered); tremors, twitching, dizziness, loss of coordination
(do not drive, operate dangerous machinery, or undertake tasks that require
coordination until drug effects stabilize and your body adjusts to it).

• Report unusual bleeding or bruising; fever, chills; intolerance to heat or cold;

shortness of breath, difficulty breathing, cough; swelling of ankles or fingers;
palpitations; difficulty with vision.

3) ATROPINE SULFATE
Brand Names: Anespin amp Atropol amp Euro-Med Atropine Sulfate amp Isopto
Atropine eye drops Phil Pharmawealth/Atlantic Atropine amp

Classification: Other Cardiovascular Drugs, Muscle Relaxants, Mydriatic Drugs,

Antidotes, Detoxifying Agents & Drugs Used in Substance Dependence

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.

Action: An anti-cholinergic that inhibits acetylcholine at the parasympathetic

neuroeffector junction, enhances the conduction of AV node and increases heart
rate

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:

• Ensure adequate hydration; provide environmental control (temperature) to

prevent hyperpyrexia.

• Have patient void before taking medication if urinary retention is a problem.

• When used preoperatively or in other acute situations, incorporate teaching

about the drug with teaching about the procedure; the ophthalmic solution is
used mainly acutely and will not be self-administered by the patient; the
following apply to oral medication for outpatients:

• Take as prescribed, 30 min before meals; avoid excessive dosage.

• Avoid hot environments; you will be heat intolerant, and dangerous reactions
may occur.

• These side effects may occur: Dizziness, confusion (use caution driving or
performing hazardous tasks); constipation (ensure adequate fluid intake,
 proper diet); dry mouth (suck sugarless lozenges; perform frequent mouth
care; may be transient); blurred vision, sensitivity to light (reversible; avoid
tasks that require acute vision; wear sunglasses in bright light); impotence
(reversible); difficulty in urination (empty the bladder prior to taking drug).

• Report rash; flushing; eye pain; difficulty breathing; tremors, loss of

coordination; irregular heartbeat, palpitations; headache; abdominal
distention; hallucinations; severe or persistent dry mouth; difficulty
swallowing; difficulty in urination; constipation; sensitivity to light.

4) BUMETANIDE

Brand Names: Burinex amp Burinex tab

Classification: Sulfonamide Diuretics

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:

• Give with food or milk to prevent GI upset.

• Mark calendars or use reminders if intermittent therapy is best for treating

edema.

• Give single dose early in day so increased urination will not disturb sleep.

• Avoid IV use if oral use is possible.

• Arrange to monitor serum electrolytes, hydration, liver function during long-

term therapy.

• Provide diet rich in potassium or supplemental potassium.

• Record alternate day or intermittent therapy on a calendar or dated

envelopes.
 • Take the drug early in day so increased urination will not disturb sleep; take
with food or meals to prevent GI upset.

• Weigh yourself on a regular basis, at the same time, and in the same
clothing; record the weight on your calendar.

• These side effects may occur: Increased volume and frequency of urination;
dizziness, feeling faint on arising, drowsiness (avoid rapid position changes;
hazardous activities, such as driving; and alcohol consumption); sensitivity to
sunlight (use sunglasses, sunscreen, wear protective clothing); increased
thirst (suck sugarless lozenges; use frequent mouth care); loss of body
potassium (a potassium-rich diet, or supplement will be needed).

• Report weight change of more than 3 lb in 1 day; swelling in ankles or

fingers; unusual bleeding or bruising; nausea, dizziness, trembling,
numbness, fatigue; muscle weakness or cramps.

5) CALCIUM GLUCONATE

Brand Names: Phil Pharmawealth/Harson Calcium Gluconate amp

Classification: Electrolytes

Indication/Dosage: PO Hypocalcaemia 10-50 mmol/day. IV Hypocalcaemic tetany

2.25 mmol via slow inj, then 58-77 mL of 10% soln diluted and administered as a
continuous IV infusion. Antidote in severe hypermagnesaemia; Severe
hyperkalaemia 10 mL of 10% soln, repeat every 10 mins if needed.

Action: replaces Calcium and maintains Calcium level

Adverse Reactions: GI irritation; soft-tissue calcification, skin sloughing or necrosis

after IM/SC inj. Hypercalcaemia characterised by anorexia, nausea, vomiting,
constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia,
polyuria, nephrocalcinosis, renal calculi; chalky taste, hot flushes and peripheral
vasodilation. Potentially Fatal: Cardiac arrhythmias and coma.

Nursing Measures:

• Make sure prescriber specifies form of calcium to be given; crash carts may
contain both calcium gluconate and calcium chloride.

• Tell patient to take oral calcium 1 to 11/2 hours after meals if GI upset occurs.

• 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.
 • Tell patient to take oral calcium with a full glass of water.

• Monitor calcium levels frequently. Hypercalcemia may result after large doses
in chronic renal failure. Report abnormalities.

6) CAPTOPRIL

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

Classification: ACE Inhibitors

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

Adverse Reactions: Hypotension, tachycardia, chest pain, palpitations, pruritus,

hyperkalaemia. Proteinuria; angioedema, skin rashes; taste disturbance,
nonproductive cough, headache. Potentially Fatal: Neutropenia, usually occurs
within 3 mth of starting therapy especially in patients with renal dysfunction or
collagen diseases. Hyperkalaemia. Anaphylactic reactions.

Nursing Measures:

• Administer 1 hr before or 2 hr after meals.

• Alert surgeon and mark patient's chart with notice that captopril is being
taken; the angiotensin II formation subsequent to compensatory renin
release during surgery will be blocked; hypotension may be reversed with
volume expansion.

• Monitor patient closely for fall in BP secondary to reduction in fluid volume

(excessive perspiration and dehydration, vomiting, diarrhea); excessive
hypotension may occur.

• Reduce dosage in patients with impaired renal function.

• Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop
without consulting your health care provider.
 • 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.

• 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.

• 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).

• 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.

7) CLONIDINE

Brand Names: Catapin amp Catapres amp Catapres tab

Classification: Other Antihypertensives

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:
 • Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop
without consulting your health care provider.

• 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.

• 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.

• 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).

• 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.

• 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.

• 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.

• Attempt lifestyle changes that will reduce your BP: stop smoking and using
alcohol; lose weight; restrict intake of sodium (salt); exercise regularly.

• Use caution with alcohol. Your sensitivity may increase while using this drug.

• 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.

• Report urinary retention, changes in vision, blanching of fingers, rash.

8) DIAZEPAM
Brand name: Valium

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

Adverse Reaction: drowsiness,dysarthria, slurred speech, tremor, transient amnesia,

fatigue, ataxia, headache, insomnia, paradoxical anxiety, hallucination

Nursing Measures:

• Do not administer intra-arterially; may produce arteriospasm, gangrene.

• Change from IV therapy to oral therapy as soon as possible.

• Do not use small veins (dorsum of hand or wrist) for IV injection.

• Reduce dose of narcotic analgesics with IV diazepam; dose should be

reduced by at least one-third or eliminated.

• Carefully monitor P, BP, respiration during IV administration.

• Maintain patients receiving parenteral benzodiazepines in bed for 3 hr; do not

permit ambulatory patients to operate a vehicle following an injection.

• Monitor EEG in patients treated for status epilepticus; seizures may recur
after initial control, presumably because of short duration of drug effect.

• Monitor liver and kidney function, CBC during long-term therapy.

• Taper dosage gradually after long-term therapy, especially in epileptic

patients.

• Arrange for epileptic patients to wear medical alert ID indicating that they are
epileptics taking this medication.

• Discuss risk of fetal abnormalities with patients desiring to become pregnant.

9) DIGOXIN

Brand name: Digitek, Lanoxicaps, Lanoxin, Novo-Digoxin (CAN)

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.

Action: inhibits sodium-potassium activated adenosine triphosphate, promoting

movement of calcium from extracellular to intra-cytoplasm and strengthening
myocardial contraction, also acts on CNS to enhance vagal tone

Adverse Reaction: nausea, vomiting, anorexia, headache, facial pain, fatigue,

weakness, dizziness, drowsiness, disorientation, mental confusion, bad dreams,
convulsions

Nursing Measures:

• 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.

• Check dosage and preparation carefully.

• Avoid IM injections, which may be very painful.

• Follow diluting instructions carefully, and use diluted solution promptly.

• Avoid giving with meals; this will delay absorption.

• Have emergency equipment ready; have K+ salts, lidocaine, phenytoin,

atropine, cardiac monitor on standby in case toxicity develops.

• Monitor for therapeutic drug levels: 0.5–2 ng/mL.

10) DIPENHYDRAMINE

Brand name: Benadryl

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:

• Monitor carefully, assess for confusion, delirium, other anticholinergic side

effects and fall risk. Institute measures to prevent falls.

• Assess movement disorder before and after administration.

• Caution patient not to use oral OTC diphenhydramine products with any other
product containing diphenhydramine, including products used topically.

• 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.

11) EPINEPHRINE

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

Classification: Sympathomimetic, Alpha-adrenergic agonist, Beta1 and beta2-

adrenergic agonist, Cardiac stimulant, Vasopressor, Bronchodilator, Antasthmatic
drug, Nasal decongestant, Mydriatic, Antiglaucoma drug

Dosage: 1mg/ml

Indication: Acute asthmatic attacks, Advanced cardiac life support

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.
Adverse Reaction: drowsiness, headache, nervousness, tremors, cerebral
hemorrhage, dizziness, weakness, vertigo, pain

Nursing Measures:

• Monitor heart rate.

• Use extreme caution when calculating and preparing doses; epinephrine is a

very potent drug; small errors in dosage can cause serious adverse effects.
Double-check pediatric dosage.

• Use minimal doses for minimal periods of time; "epinephrine-fastness" (a

form of drug tolerance) can occur with prolonged use.

• Protect drug solutions from light, extreme heat, and freezing; do not use pink
or brown solutions. Drug solutions should be clear and colorless (does not
apply to suspension for injection).

• Shake the suspension for injection well before withdrawing the dose.

• Rotate SC injection sites to prevent necrosis; monitor injection sites

frequently.

• Keep a rapidly acting alpha-adrenergic blocker (phentolamine) or a

vasodilator (a nitrate) readily available in case of excessive hypertensive
reaction.

• Have an alpha-adrenergic blocker or facilities for intermittent positive

pressure breathing readily available in case pulmonary edema occurs.

• Keep a beta-adrenergic blocker (propranolol; a cardioselective beta-blocker,

such as atenolol, should be used in patients with respiratory distress) readily
available in case cardiac arrhythmias occur.

• Do not exceed recommended dosage of inhalation products; administer

pressurized inhalation drug forms during second half of inspiration, because
the airways are open wider and the aerosol distribution is more extensive. If
a second inhalation is needed, administer at peak effect of previous dose, 3–
5 min.

• Use topical nasal solutions only for acute states; do not use for longer than
3–5 days, and do not exceed recommended dosage. Rebound nasal
congestion can occur after vasoconstriction subsides.

• Do not exceed recommended dosage; adverse effects or loss of effectiveness

may result. Read the instructions that come with respiratory inhalant
 products, and consult your health care provider or pharmacist if you have
any questions.

• To give eye drops: Lie down or tilt head backward, and look up. Hold dropper
above eye; drop medicine inside lower lid while looking up. Do not touch
dropper to eye, fingers, or any surface. Release lower lid; keep eye open, and
do not blink for at least 30 sec. Apply gentle pressure with fingers to inside
corner of the eye for about 1 min; wait at least 5 min before using other eye
drops.

• These side effects may occur: Dizziness, drowsiness, fatigue, apprehension

(use caution if driving or performing tasks that require alertness); anxiety,
emotional changes; nausea, vomiting, change in taste (eat frequent small
meals); fast heart rate. Nasal solution may cause burning or stinging when
first used (transient). Ophthalmic solution may cause slight stinging when
first used (transient); headache or brow ache (only during the first few days).

• Report chest pain, dizziness, insomnia, weakness, tremor or irregular heart

beat (respiratory inhalant, nasal solution), difficulty breathing, productive
cough, failure to respond to usual dosage (respiratory inhalant), decrease in
visual acuity (ophthalmic).

12) FUROSEMIDE

Brand name: Apo-Furosemide (CAN), Furoside (CAN), Lasix, Myrosemide (CAN)

Classification: loop diuretics

Dosage: 20mg/2ml

Indication: edema, hypertension

Action: inhibits Sodium and Chloride reabsorption at the proximal and distal tubules
and the ascending loop of Henle

Adverse Reaction: vertigo, headache, dizziness, paresthesia, weakness,

restlessness, fever, nocturia, oliguria, polyguria

Nursing Measures:

• Monitor BP after administration

• Administer with food or milk to prevent GI upset.

• Reduce dosage if given with other antihypertensives; readjust dosage

gradually as BP responds.

• Give early in the day so that increased urination will not disturb sleep.
 • Avoid IV use if oral use is at all possible.

• Do not mix parenteral solution with highly acidic solutions with pH below 3.5.

• Do not expose to light, may discolor tablets or solution; do not use discolored
drug or solutions.

• Discard diluted solution after 24 hr.

• Refrigerate oral solution.

• Measure and record weight to monitor fluid changes.

• Arrange to monitor serum electrolytes, hydration, liver function.

• Arrange for potassium-rich diet or supplemental potassium as needed.

13) HYDRALAZINE HYDROCHLORIDE

Brand name: Supres

Classification: antihypertension

Dosage: 20mg/ml

Indication: For hypertensive patient

Action: a direct acting peripheral vasodilator that relaxes arteriolar smooth muscles

Adverse Reaction: tachycardia, palpitation, angina pectoris, severe headache,

dizziness, weight gain, GI disturbances, pruritus, rashes, nausea and vomiting

Nursing Measures:

• 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).

• 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.

• Arrange for pyridoxine if patient develops symptoms of peripheral neuritis.

• Monitor patient for orthostatic hypotension which is most marked in the

morning and in hot weather, and with alcohol or exercise.
14) HYDROCORTISONE SODIUM SUCCINATE

Brand name: A-hydroCort, Solu-Cortef

Classification: corticosteroid hormones

Stock Dose:100 mg/ 2 mL, 250 mg/ 2 mL

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

Action: Decreases inflammation, mainly by stabilizing leukocyte lysosomal

membranes, suppresses immune response, stimulates bone marrow and influences
protein, fat, and carbohydrate metabolism

Adverse Reactions: fluid and electrolyte disturbances, decreased carbohydrate

tolerance, impaired wound healing, thin fragile skin, muscle weakness, steroid
myopathy, osteoporosis, aseptic necrosis, peptic ulceration w/ possible perforation,
cataracts, increased intraocular and intracranial pressure, growth retardation,
Cushingoid state, protein catabolism, psychic derangements, exophthalmos,
masking of infections, gasping syndrome, seizures, menstrual irregularities.

Nursing Measures:

• Give daily before 9 AM to mimic normal peak diurnal corticosteroid levels and
minimize HPA suppression.

• Space multiple doses evenly throughout the day.

• Do not give IM injections if patient has thrombocytopenic purpura.

• Rotate sites of IM repository injections to avoid local atrophy.

• Use minimal doses for minimal duration to minimize adverse effects.

• Taper doses when discontinuing high-dose or long-term therapy.

• Arrange for increased dosage when patient is subject to unusual stress.

• Use alternate-day maintenance therapy with short-acting corticosteroids

whenever possible.

• Do not give live virus vaccines with immunosuppressive doses of

hydrocortisone.
 • Provide antacids between meals to help avoid peptic ulcer.

15) ISOSORBIDE-5- MONONITRATE

Brand name: Imdur

Classification: anti- anginal drug

Stock Dose: SL: 5 mg/mL ; Oral: 30 mg, 60 mg

Indication: prophylactic treatment of angina pectoris

Action: Thought to reduce cardiac oxygen demand by decreasing preload and

afterload. Drug also may increase blood flow through the collateral coronary vessels

Adverse Reactions: headache, hypotension w/ dizziness and nausea, tachycardia

Nursing Measures:

• Monitor BP and heart rate.

• Assess location, duration, intensity, and precipitating factors of anginal pain.

16) ISOSORBIDE DINITRATE

Brand name: Isoket IV

Classification: anti – anginal drug

Stock: IV amp 10 mg/ 10 mL

Dose: 10 mg/10mL

Indication: unresponsive left ventricular failure secondary to acute MI, severe or

unstable angina pectoris

Action: Isosorbide dinitrate is a smooth muscle relaxant. It is particularly effective

on vascular and bronchial smooth muscle. Its systemic cardiovascular effects are
mainly due to a decrease in venous return (pooling of blood in the peripheral
venous system). Consequently, ventricular end-diastolic pressure and volume are
diminished, thus reducing cardiac work and implicitly myocardial oxygen
requirements. The arterial vessels are dilated as well, though to a lesser degree.
This results in a slight drop in aortic and systemic blood pressure relieving the
myocardium from a part of its afterload. These nitrate-induced changes account for
both the antianginal effects of isosorbide dinitrate and for its beneficial effects in
the treatment of congestive heart failure. Side effects/ adverse reactions: severe
cerebral flow deficiency and decreased coronary perfusion may develop, nitrate
headache and nausea.
Nursing Measures:

• Monitor BP and heart rate.

• Assess location, duration, intensity, and precipitating factors of anginal pain.

17) MAGNESIUM SULFATE

Brand name: Elin Magnesium Sulfate

Classification: anticonvulsant

Dosage: 250 mg/10 mL

Indication: treatment of hypomagnesemia accompanied by signs of tetany, control

of HTN, encephalophathy & convulsions, prevention & control of convulsions in
patients w/ preeclampsia or eclampsia, prevention of hypomagnesemia in patients
receiving TPN

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:

• 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.

18) MEPERIDINE HYDROCHLORIDE

Brand name: Demerol

Classification: antivertigo drug

Dosage: 100 mg/ 2mL

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:

• Make position changes slowly and in stages particularly from recumbent to

upright posture. Lie down immediately if light-headedness or dizziness
occurs.

• Lie down when feeling nauseated and to notify physician if this symptom
persists. Nausea appears to worsen with ambulation.

• 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.

• Do not take alcohol or other CNS depressants unless approved by physician.

• 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.

• Do not breast feed while taking this drug.

19) METOCLOPRAMIDE

Brand name: Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-Metoclopramide

(CAN), Octamide PFS, Reglan

Classification: antiemetic & anti-spasmodic

Dosage: 10 mg/ 2mL

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:

• Monitor BP carefully during IV administration.

• Monitor for extrapyramidal reactions, and consult physician if they occur.

• Monitor diabetic patients, arrange for alteration in insulin dose or timing if

diabetic control is compromised by alterations in timing of food absorption.

• Keep diphenhydramine injection readily available in case extrapyramidal

reactions occur (50 mg IM).

• Have phentolamine readily available in case of hypertensive crisis (most

likely to occur with undiagnosed pheochromocytoma).

20) MIDAZOLAM HYDROCHLORIDE

Brand name: Dormicum

Classification: hypnotics & sedatives

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:

• Do not administer intra-arterially, which may produce arteriospasm or

gangrene.

• Do not use small veins (dorsum of hand or wrist) for IV injection.

• Administer IM injections deep into muscle.

• Monitor IV injection site for extravasation.

• Arrange to reduce dose of midazolam if patient is also being given opioid

analgesics; reduce dosage by at least 50% and monitor patient closely.
 • Monitor level of consciousness prior to, during, and for at least 2–6 hr after
administration of midazolam.

• Carefully monitor P, BP, and respirations carefully during administration.

• Keep resuscitative facilities readily available; have flumazenil available as

antidote if overdose should occur.

• Keep patients in bed for 3 hr; do not permit ambulatory patients to operate a
vehicle following an injection.

• Arrange to monitor liver and kidney function and CBC at intervals during
long-term therapy.

• Establish safety precautions if CNS changes occur (use side rails, accompany
ambulating patient).

• Provide comfort measures and reassurance for patients receiving diazepam

for tetanus.

• Arrange to taper dosage gradually after long-term therapy.

• Provide patient with written information regarding recovery and follow-up

care. Midazolam is a potent amnesiac and memory may be altered.

21) MORPHINE SULFATE

Brand name: Morin

Classification: Analgesics (Opioid)

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.

Action: alters perception and emotional response to pain

Adverse Reactions: Lightheadedness, dizziness, sedation, nausea, vomiting,

constipation & sweating.

Nursing Measures:
 • Caution 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.

• 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.

22) NICARDIPINE HYDROCHLORIDE

Brand name: Cardepine

Classification: Calcium Antagonists

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

Adverse Reactions: Peripheral edema, headache, tachycardia, palpitations, localized

thrombophlebitis & hypotension.

Nursing Measures:

• 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 report immediately if experiencing chest pain

23) NTG PATCH

Brand name: Deponit, Minitran, Nitrek, Nitro-Dur, Nitrodisc, Transderm-Nitro

Classification: Anti-Anginal Drugs

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.

Indication: Prevention of angina pectoris due to coronary artery disease

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

Adverse Reactions: Headache. Transient episodes of lightheadedness. Infrequently,

hypotension. Syncope, crescendo angina, rebound HTN, allergic & anaphylactoid
reactions. Rarely severe, application site irritation.

Nursing Measures:

• 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.

• 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.

24) PARACETAMOL

Brand name: Aeknil

Classification: Analgesics (Non-Opioid) & Antipyretics

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

Adverse Reactions: Hematological, skin & other allergic reactions

Nursing Measures:
 • Use liquid form for children and patients who have difficulty swallowing.

• In children, don’t exceed five doses in 24 hours.

• 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.

• Advise patient or caregiver that many over the counter products contain
acetaminophen; be aware of this when calculating total dailydose.

• Warn patient that high doses or unsupervised long term use can cause liver
damage.

25) PHENYTOIN

Brand name: Dilantin

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:

• 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

26) TERBUTALINE

Brand name: Bricalin

Classification: Antiasthmatic & COPD Preparations

Dosage: Antiasthmatic & COPD Preparations

Indication: For reversible airways obstruction, in asthma, COPD. Decreases uterine

contractility & may be used to arrest premature labor

Action: relaxes bronchial smooth muscles by stimulating beta-2 receptors

Adverse Reaction: Fine tremor of skeletal muscle esp hands, palpitations,

tachycardia, nervous tension, headache, peripheral vasodilation.

Nursing Measures:

• Use minimal periods of time; drug tolerance can occur with prolonged use.

• Keep beta-adrenergic blocker readily available in case cardiac arrhythmias

occur.

• Do not recommended dosage.

27) VERAPAMIL HYDROCHLORIDE

Brand name: Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM

Classification: Calcium Antagonists

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

Adverse Reactions: Constipation, dizziness, nausea. Rarely, vertigo, headache,

hypotension, ankle edema, flushing, fatigue, nervousness, erythromelalgia,
paraesthesia, neuropathy; bradycardiac arrhythmias, CHF. Dyspnea
Nursing Measures:

• 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.

• Ensure that patient swallows SR tablets whole: do not cut, crush, or chew
them.

• Monitor BP very carefully with concurrent doses of antihypertensives.

• Monitor cardiac rhythm regularly during stabilization of dosage and

periodically during long-term therapy.

• Administer sustained-release form in the morning with food to decrease GI

upset.

• Protect IV solution from light.

• Monitor patients with renal or hepatic impairment carefully for possible drug
accumulation and adverse reactions.

28) IPRATROPIUM INHALATION

Brand name: Atrovent

Classification: Antiasthmatic & COPD Preparations, anticholinergics or

antimuscarinics

Stock: 0.5 mg/2 mL

Dosage: Adult (including elderly) & adolescent >12 yr Acute attacks 1 vial, may
repeat doses until patient is stable. Maintenance: 1 vial tid-qid.

Indication: Bronchodilator for treatment of bronchospasm associated w/ COPD,

including chronic bronchitis, emphysema and asthma

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:
 • Protect solution for inhalation from light. Store unused vials in foil pouch.

• Use nebulizer mouthpiece instead of face mask to avoid blurred vision or

aggravation of narrow-angle glaucoma.

• Can mix albuterol in nebulizer for up to 1 hr.

• Ensure adequate hydration, control environmental temperature to prevent

hyperpyrexia.

• Have patient void before taking medication to avoid urinary retention.

• Teach patient proper use of inhalator.

29) FENOTEROL/IPRATROPIUM BROMIDE

Brand name: Berodual

Classification: Antiasthmatic & COPD Preparations

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:

• Protect solution for inhalation from light. Store unused vials in foil pouch.

• Use nebulizer mouthpiece instead of face mask to avoid blurred vision or

aggravation of narrow-angle glaucoma.
 • Can mix albuterol in nebulizer for up to 1 hr.

• Ensure adequate hydration, control environmental temperature to prevent

hyperpyrexia.

• Have patient void before taking medication to avoid urinary retention.

• Teach patient proper use of inhalator.

30) BUDESONIDE

Brand name: Symbicort

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:

• Taper systemic steroids carefully during transfer to inhalational steroids;

deaths from adrenal insufficiency have occurred.

• Arrange for use of decongestant nose drops to facilitate penetration if edema,

excessive secretions are present.

• Prime unit before use for Pulmicort Turbuhaler; have patient rinse mouth after
each use.

• Use aerosol within 6 mo of opening. Shake well before each use.

• Store Respules upright and protected from light; gently shake before use;
open envelopes should be discarded after 2 wk.

31) ALBUTEROL AND IPRATROPIUM INHALATION

Brand name: Combivent

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.

Indication: management of reversible bronchospasm associated with obstructive

airway diseases in patients who require more than a single bronchodilator

Action: muscles in the airways and increase air flow to the lungs

Adverse Reactions: Fine tremor of skeletal muscle; palpitations; headache,

dizziness, nervousness; dryness of mouth, throat irritation; urinary retention

Nursing Measures:

• Use nebulizer mouthpiece instead of face mask to avoid blurred vision or

aggravation of narrow-angle glaucoma.

• Can mix albuterol in nebulizer for up to 1 hr.

• Ensure adequate hydration, control environmental temperature to prevent

hyperpyrexia.

• Have patient void before taking medication to avoid urinary retention.

• Teach patient proper use of inhalator.

32) SALBUTAMOL

Brand name: Aero-Vent

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.

Indication: treatment of acute, severe asthma and in routine management of

chronic bronchospasm unresponsive to conventional therapy

Action: used with anti-inflammatory medication to prevent asthma attacks, Some of

these medicines are used to treat the symptoms of asthma, chronic bronchitis,
emphysema, and other lung diseases, while others are used to prevent the
symptoms
Adverse Reactions: Dizziness, severe; feeling of choking, irritation, or swelling in
throat; flushing or redness of skin; hives; increased shortness of breath; skin rash;
swelling of face, lips, or eyelids; tightness in chest or wheezing, troubled breathing

Nursing Measures:

• Assess lung sounds, pulse, and blood pressure before administration and
during peak of medication. Note amount, color, and character of sputum
produced.

• Monitor pulmonary function tests before initiating therapy and periodically

throughout course to determine effectiveness of medication.

• Observe for paradoxical bronchospasm (wheezing). If condition occurs,

withhold medication and notify physician or other health care professional
immediately.

• 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.

• Inform the mother not to smoke near the child and to avoid respiratory
irritants.

• Advise the mother to rinse the child’s mouth with water after each inhalation
dose to minimize dry mouth.

33) TERBUTALINE SULFATE

Brand name: Pulmonyl

Classification: Antiasthmatic/ Brochodilator

Stock: 2.5 mg/ml

Dose: Adult 5-10 mg, Children 2-5mg

Indication: relief of bronchospasm in obstructive airway diseases

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

Adverse Reactions: Headache, nausea, vomiting, palpitations, tachycardia, sweating

& drowsiness

Nursing Measures:

• Use minimal periods of time; drug tolerance can occur with prolonged use.
 • Keep beta-adrenergic blocker readily available in case cardiac arrhythmias
occur.

• Do not recommended dosage.

34) HEPARIN SODIUM

Brand name: Britton Heparin Na

Classification: Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)

Dosage: 5000 iu/1 mL; 25000 iu/1 mL

Indication: treatment and prophylaxis of thromboembolic disorders

Action: Accelerates formation of antithrombin III-thrombin complex and deactivates

thrombin, preventing conversion of fibrinogen to fibrin

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:

• Baseline blood coagulation tests, Hct, Hgb, RBC and platelet counts prior to
initiation or therapy and at regular intervals throughout therapy

• Monitor APTT levels closely

• 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

• 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.

• Monitor vitals, report fever, drop in BP, rapid pulse and other S&S of
hemorrhage

• Observe all needle sites daily for hematoma and signs of inflammation

• Have on hand protamine sulfate, specific heparin antagonist

35) ESMOLOL HYDROCHLORIDE

Brand name: Brevibloc

Classification: Beta blockers

Dosage: 100mg/10ml

Indication: supraventricular tachycardia; post-operative tachycardia or

hypertension; non-compensatory sinus tachycardias; intra-operative tachycardia or
hypertension; unstable angina, non ST segment elevation MI

Action: A Class II antiarrythmic and ultra-short-acting selective beta blocker that

decreases heart rate, contractility and blood pressure

Adverse Reactions: Hypotension, bradycardia, heart failure, local irritation,

diaphoresis, peripheral ischaemia, dizziness, somnolence, confusion, fatigue,
paraesthesia, peripheral neuropathy, headache, weakness, irritability, dyspnoea,
nausea, vomiting, blurred vision, urinary retention, fever, rigor, muscular pain.

Potentially Fatal: Profound bradycardia, AV block, cardiogenic shock, asystole,

bronchospasm.

Nursing Measures:

• 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.

• Monitor cardiac rhythm regularly during stabilization of dosage and

periodically during long-term therapy.

36) D 50-50

Brand name: Phil Pharmawealth/Atlantic 50% Dextrose

Classification: Intravenous & Other Sterile Solutions

Dosage: 50ml/vial

Indication: for hypoglycemia

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:
 • Monitor infusion rate frequently; if signs of fluid overload, turn off IV drip.
Infusion may result in fluid overload.

• Check IV site frequently and if infiltration is noted, turn off IV drip.

• Watch out for signs of fluid overload (distended neck veins (JVD), rapid
respirations, shallow tidal volume, fine auscultatory crackles, dyspnea, and
peripheral edema)

• Watch out for signs of infiltration (swelling and pain around IV site).

37) POTASSIUM CHLORIDE

Brand name: Phil Pharmawealth/Atlantic Potassium Chloride

Classification: Electrolytes

Dosage: 40 meqs/20 ml

Indication: for hypokalemia, acute MI

Action: Replaces potassium and maintains potassium level

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:

• Monitor serum potassium levels, renal function, and serum bicarbonate.

• Explain to patient purpose of the medication and the need to take as

directed,especially when concurrent digoxin or diuretics are taken. A missed
dose should be taken as soon as remembered within 2 hr; if not, return to
regular doseschedule. Do not double dose.

• Emphasize correct method of administration. GI irritation or ulceration may

result from chewing enteric-coated tablets or insufficient dilution of liquid or
powder forms. Some extended-release tablets are contained in a wax matrix
that may be expelled in the stool. This occurrence is not significant.

• Instruct patient to avoid salt substitutes or low-salt milk or food unless

approved by health care professional.

• Patient should be advised to read all labels to prevent excess potassium

intake.
 • Advise patient regarding sources of dietary potassium.

• Encourage compliance with recommended diet.

• Instruct patient to report dark, tarry, or bloody stools; weakness; unusual

fatigue; or tingling of extremities.

• Notify health care professional if nausea, vomiting, diarrhea, or stomach

discomfort persists.

• Dosage may require adjustment. Emphasize the importance of regular

follow-up exams to monitor serum levels and progress.

38) LIDOCAINE HYDROCHLORIDE

Brand name: Abbott Lidocaine

Classification: Anaesthetics - Local & General

Dosage: 50 ml/vial

Indication: local or regional anesthesia

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

Adverse Reactions: Restlessness, nervousness, dizziness, tinnitus, blurred vision; GI

upsets; muscle twitching, convulsions; numbness of the tongue; hypotension,
bradycardia; methemoglobinaemia; fetal intoxication.

Nursing Measures:

• Check drug concentration carefully; many concentrations are available.

• Reduce dosage with hepatic or renal failure.

• Continuously monitor response when used as antiarrhythmic or injected as

local anesthetic.

• Keep life-support equipment and vasopressors readily available in case

severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is
injected.

• Establish safety precautions if CNS changes occur; have IV diazepam or short-

acting barbiturate (thiopental, thiamylal) readily available in case of seizures.
 • Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-
support equipment and IV dantrolene on standby.

• Titrate dose to minimum needed for cardiac stability, when using lidocaine as
antiarrhythmic.

• Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV

block, and geriatric patients.

• Monitor fluid load carefully; more concentrated solutions can be used to treat
arrhythmias in patients on fluid restrictions.

• Have patients who have received lidocaine as a spinal anesthetic remain

lying flat for 6–12 hr afterward, and ensure that they are adequately hydrated
to minimize risk of headache.

• Check lidocaine preparation carefully; epinephrine is added to solutions of

lidocaine to retard the absorption of the local anesthetic from the injection
site.

• Be sure that such solutions are used only to produce local anesthesia. These
solutions should be injected cautiously in body areas supplied by end arteries
and used cautiously in patients with peripheral vascular disease,
hypertension, thyrotoxicosis, or diabetes.

• Use caution to prevent choking. Patient may have difficulty swallowing

following use of oral topical anesthetic. Do not give food or drink for 1 hr after
use of oral anesthetic.

• Treat methemoglobinemia with 1% methylene blue, 0.1 mg/kg, IV over 10

min.

• Apply lidocaine ointments or creams to a gauze or bandage before applying

to the skin.

• Monitor for safe and effective serum drug concentrations (antiarrhythmic use:
1–5 mcg/mL). Doses > 6–10 mcg/mL are usually toxic

39) SODIUM BICARBONATE

Brand name: Hospira Sodium Bicarbonate

Classification: Alkalinizers

Dosage: 10mEq/10ml; 50mEq/50ml

 Indication: metabolic acidosis, systemic or urinary alkalinization, antacid, cardiac
arrest

Action: Restores buffering capacity of the body and neutralizes excess acid

Adverse Reaction: Tetany, edema, gastric distention, belching, flatulence,

hypokalemia, metabolic alkalosis, hypernatremia, chemical cellulitis because of
alkalinity, pain, irritation, tissue necrosis, ulceration or sloughing at the site of
infiltration

Nursing Measures:

• do not take drug with milk to avoid hypercalcemia, abnormally high alkalinity
in tissues and fluids, or kidney stones.

• 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.

• monitor for alkalosis by obtaining blood pH, PaO2, PCO2, and electrolyte
levels

40) DOPAMINE

Brand name: Intropin

Classification: Adrenergics (Sympathomimetics)

Dosage: 40 mg/Ml; 80 mg/mL; 160 mg/mL

Indication: shock and hemodynamic imbalances, hypotension

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

Adverse Reaction: ectopic beats, tachycardia, anginal pain, palpitation, hypotension,

vasoconstriction, ventricular arrhythmias, hypertension, headache, anxiety, dilated
pupils, nausea, vomiting, decreased urine output, dyspnea

Nursing Measures:

• Monitor vital signs and ECG closely throughout therapy.

• Monitor I&O regularly; note decreases in urine output.

• Monitor central venous pressure or pulmonary wedge pressure if possible

during infusion.
 • Note significant changes in vital signs, ECG changes, deterioration of
peripheral pulses, and/or cold, mottled extremities

41) DOBUTAMINE

Brand name: Dobatrey

Classification: Adrenergics

Dosage: 12.5 mg/mL

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:

• Monitor vital signs, ECG, cardiac output, pulmonary capillary wedge pressure,
central venous pressure and urinary output carefully throughout infusion.

• Monitor patency and placement of IV catheter to reduce risk of extravasation

and phlebitis.

• Watch out for symptoms of overdosage such as excessive hypertension,

tachycardia, nausea, vomiting, tremor, headache, chest pain

42) LIDOCAINE PREMIXED

Brand name: Xylocaine

Classification: Antiarrhythmic agent, Local anesthetic

Dosage: 0.2% (2mg/ml); 0.4% (4g/ml); 0.8% (8g/ml)

Indication: ventricular arrhythmias caused by MI, cardiac manipulation or cardiac

glycosides

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

Adverse Reaction: bradycardia, cardiac arrest, CV collapse, hypotension,

apprehension, confusion, dizziness, drowsiness, hallucinations, headache, light-
headedness, mood changes, nervousness, tremors, conjunctival hyperemia, corneal
epithelial changes, diplopia, tinnitus, visual disturbances, nausea, vomiting,
erythema, petechiae, edema, injection-site reactions, including bruising, burning,
contusion, hemorrhage, local reactions, including soreness at IM injection site,
venous thrombosis or phlebitis, extravasation, burning, stinging, sloughing,
respiratory depression or arrest, hypersensitivity reactions

Nursing Measures:

• Explain that adverse reactions related to the CNS (eg, drowsiness, confusion,
paresthesias, convulsions, respiratory arrest) can occur and are a result of
CNS toxicity.

• Advise patient that drug may cause dizziness or drowsiness and to avoid
getting out of bed or walking without assistance.

• Advise patients that skin reactions, including erythema, petechiae, and

edema, may occur with intradermal injection.

• Systemic effects can occur following topical use; use lowest possible dose to
avoid serious toxicity, shock, or heart block.

• 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.

• Use with caution and in lower doses in patients with CHF, reduced cardiac
output, digitalis toxicity, and in elderly patients

43) MANNITOL

Brand name: Osmitrol

Classification: osmotic diuretic

Dosage: 5% , 10%, 15%, 20%, 25% in 500cc/1,000cc

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:

• Monitor vital signs, including CVP, and fluid intake and output.

• Monitor weight, renal function, and serum sodium and potassium levels daily

• Watch out for symptoms of overdosage such as excessive hypertension,

tachycardia, nausea, vomiting, tremor, headache, chest pain

• To relieve thirst, give frequent mouth care and fluids

44) DEXTROSE 5% IN WATER (D5W) SOLUTION

Brand name: None

Classification: Isotonic/Hypotonic Solution

Dosage: 250ml bottles (5g dextrose/100ml water)

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:

• Monitor infusion rate frequently; if signs of fluid overload, turn off IV drip.
Infusion may result in fluid overload.

• Check IV site frequently and if infiltration is noted, turn off IV drip.

• Watch out for signs of fluid overload (distended neck veins (JVD), rapid
respirations, shallow tidal volume, fine auscultatory crackles, dyspnea, and
peripheral edema)

• Watch out for signs of infiltration (swelling and pain around IV site).