DRUG NAME Generic Name: amiodarone hydrochloride

ACTION

INDICATION Only for treatment of the following documented lifethreatening recurrent ventricular arrhythmias that do not respond to other treatment

CONTRAINDICATION Contraindicated with allergy to amiodarone Sinus node dysfunction Heart block Severe bradycardia Hypokalemia Lactation Use cautiously with thyroid dysfunction and pregnancy.

ADVERSE REACTION CNS: malaise, fatigue, dizziness, tremors, ataxia, lack of coordination CV: cardiac arrhythmias, heart failure, cardiac arrest, hypotension GI: nausea and vomiting, anorexia, constipation, hepatotoxicity RESPIRATORY: pulmonary toxicity, pneumonitis

NURSING RESPONSIBILITIES Monitor cardiac rhythm continuously Monitor for an extended period when dosage adjustment is made. Give drug with meals to decrease GI problems. Arrange for ophthalmologic examinations; reevaluate at any sign of optic neuropathy. Arrange for period of cheat x-ray to evaluate pulmonary status( every3-6 months)

Type III antiarrhythmic: acts directly on cardiac cell membrane; prolong Brand Name: repolarization and Cordarone refractory period; increases ventricular Drug fibrillation threshold; acts Classification: on peripheral smooth Antiarrhythmic muscle to decrease Adrenergic blocker peripheral resistance.

DOSAGE

DRUG NAME Generic Name: adenosine Brand Name: Adenoscan Drug Classification: Antiarrhythmic Diagnostic agent

ACTION Acts rapidly to slow down conduction throughthe AV node via the alpha 1 receptors. It also mediates peripheral and coronary vasodilation by stimulating the alpha 2 receptor

INDICATION Treatment for paroxysmal supraventricular tachycardias Myocardial imaging

CONTRAINDICATION Contraindicated with 2nd or 3rd degree heart block and sick sinus syndrome Astma Hypersensitivity pregnancy

ADVERSE REACTION CV: facial flushing, palpitations, chest pain, bradycardia, sweating, hypotension

NURSING RESPONSIBILITIES Maintain emergency equipment on stand by and monitor continually. Have methylthines available as antidote

DOSAGE Adults: Initially 3 mg by rapid IV injection into a central or large peripheralvein over 2 sec with cardiac monitoring.

DRUG NAME Generic Name: atropine sulfate Brand Name: Sal-tropine Drug Classification: Anticholinergic antidote Antiparkinsonian Belladonna alkaloid parasympatholytic

ACTION Competitively blocks the effect of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympatheticpostgangl ionic impulses: also blocks th acethylcholine in the CNS

INDICATION

CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES

DOSAGE Adults: 0.4-0.6 mg PO, IM.IV or SQ. Surgery: 0.5 IMor IV or SQ before induction of anesthesia Antidote: for cholinesterase poisoning give large doses atleast 23 mg parenterally.

Treatment of Contraindicated with parkinsonism; glaucoma, adhesion between relieves tremors iris and lens, stenosing peptic and rigidity ulcer; bladder neck Restoration of obstruction; bronchial cardiac rate and asthma; cardiac arrhtymias; arterial pressure tachycardia during anesthesia Impaired when vagal metabolic,hepaticor renal stimulation function produce by intra Use cautiously with down abdominal traction syndrome, brain causes a decrease damage,spasticity, in pulse rate. hypertension and lactation. Relieve of bradycardia and syncope due to hyperactive carotid sinus reflex Relaxation of the spasm of biliary and ureteral colic and brochospasm Management of peptic ulcer Relaxation of uterine hypertonicity Antidote for cholinesterase inhibitors

CNS: Blurred vision, cyclopegia, Ensure adequate hydration; provide photophobia,increase IOP, environmental control (temperature) to headache, flushing, weakness, prevent hyperpyrexia. dizziness, mental confusion or Hve patient void before taking medication excitement. if urinary retention s problem. CV: palpitations, bradycardia(low Advise the patient to tkake drugs as dose), tachycardia (high Dose) prescribed, 30 minutes before meals; avoid excessive dosage GI: Dry mouth,altered taste Advise the patient to avoid hot perception, nausea, environment due to heat intolerance. vomiting,dysphagia, heartburn, Advise also to reportif theres rash , paralytic ileus flushing, difficulty of breathing, irregular heartbeat, palpitation, loss of coordination GU: Urinary hesitancy and and tremors. retention; impotence Other: decrease sweating and predisposition to heat prostration

DRUG NAME Generic Name: epinephrine Brand Name: Adrenaline chloride

ACTION Naturally occurring neurotransmitter. Effects on alpha receptors, vasoconstriction, contraction of the muscle dilator of the iris. Effects on Beta receptors includes positive chronotropic and inotropic effects of the heart (beta-1 receptor) bronchodilation, vasodilation and uterine relaxation (beta-2 receptors) DOSAGE Adults: Epinephrine ijection Cardiac arrest: 0.51mg(5-10ml of 1:10,000 solution) IV or intracardiac injection into left ventricular chamber, during resuscitation, 0.5 mg every 5 minutes. Inhalation (aerosol) Begin treatment at first symptom of bronchospasm.

INDICATION IV: Treatment & prophylaxis of cardiac arrest and attacks of transitory AV heart block with syncopal seizures ( stokes-adam syndrome) ; acute hypersensitivity (anaphylactoid) reactions,serum sickness, in acute asthmatic attacks to relieve bronchospasm not controlled b inahalation or subcutaneous injection. Injection: Relieffrom respiratory distress of bronchial asthma,chronic bronchitis and emphysema, other COPDs 0.1% ophthalmic solution: Cojunctivitis, during eye surgery to control bleeding.

CONTRAINDICATION Contraindicated with hypersensitivity to epinephrine. Narrow angle glaucoma Shock other than anaphylactic shock Hypovolemia General anesthesia with cyclopropane Organic brain damage Cardiac dilation and insufficiency DM Hyperthyroidism Lactation Use cautiously with prostatic hypertrophy (may cause bladder sphincter spasm, difficult and painful urination), Hiistory of seizure disorder, labor and delivery (may delay 2nd stage of labor, can accelerate fetal heart beat; may cause fetal and maternal hypoglycemia)

ADVERSE REACTION CNS: Fear, anxiety, restlessness, headache, lightheadedness, dizziness, drowsiness, tremor CV: Arrythmias, hypertension resulting in intracranial hemorrhage, CV collapse with hypotension, palpitations GI: nausea, vomiting, anorexia. GU:Constriction of renal blood vesselsand decrease urine formation, dysuria, vesical sphincter spasm Other: Pallor, respiratory difficulty, sweating Local injection Necrosis at site of repeat injection (due to intense vasoconstriction) Nasal Solution Rebound congestion, local burning and stinging

NURSING RESPONSIBILITIES Warning: Use extreme caution when calculatimng and preparing doses; epinephrine is very potent drug Use minimal doses for minimal periods of time Protect drug solution from light, extreme heat and freezing; DO NOT USE PINK OR BROWN SOLUTIONS. Drug solution should be clear and colorless Shake the suspension for injectionwell before withdrawing the dose Rotate SQ injection sites to prevent necrosis; monitor injection site frequently Do not exceed recommended dosage of inhalation products.

Drug Classification: Alpha-adrenergic agonist Antasmathic Beta-1 and Beta-2 adrenergic agonist Bronchodilator Cardiac stimulant Nasal decongestant Symphatomimetic vasopressor

DRUG NAME Generic Name: furosemide Brand Name: Lasix

ACTION Inhibits reabsorption of sodium and chloride from the proximal and distal tubules and ascending limb of the loop of henle, leading to a sodium-rich dieresis.

INDICATION Oral, IV: edema associated with heart failure, cirrhosis, renal disease IV: acute pulmonary edema Oral: Hypertension

CONTRAINDICATION Contraindicated with allergy to furosemide, sulfonamides, allergy to tartrazine, anurai, severe renal failure, hepatic coma, pregnancy; lactation Use Cautiosly with SLE, gout, DM.

ADVERSE REACTION CNS: Dizziness, vertigo, paresthesias, headache, drowsinees, fatigue, blurred vision, tinnitus CV: Orthostatic hypotension, volume deplation, cardiac arrhythmias, thrombophlebitis Dermatologic: Photosensitivity, rash, pruritus, urticaria GI: Nuausea, vomiting, anorexia, oral and gastric irritation,constipation GU: Urinary bladder spasm Other: muscle cramps and muscle spasm

NURSING RESPONSIBILITIES Adminester with food or milk to prevent GI upset Reduce dosage if given with other hypertensive; readjust dosage gradually as BP responds. Give early in the day so that increase urination will not disturb sleep. Avoid IV use if Oral use is all possible Do not expose to light, which may discolor tablets or solution. Discard diluted solution after 24hours Refrigerate oral solution Measure and monitor weight to monitor fluid changes Arrange for potassium rich diet or supplemental potassium as needed.

Drug Classification: Loop diuretic

DOSAGE Adults Edema: initially 20-80 mg/day PO as a single dose. Hypertension: 40mg bid PO. Pediatric Edema: initially, 2mg/kg/day PO. If needed, increase 1-2 mg/kg in 6-8 hr. Do not exceed 6mg/kg.

DRUG NAME Generic Name: Lidocaine hydrochloride Brand Name: Xylocaine Drug Classification: Antiarrhythmic Local anesthetic

ACTION Type 1 antiarryhtmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells: increase ventricular fibrillation threshold. Local anesthetic: block the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of action potential, increasing excitation threshold and slowing conduction velocity. DOSAGE Adults IM: arrhythmia; use only 10% solution for injection. 300 mg in deltoid or thigh muscle

INDICATION As antiarrhythmic: management of acute ventricular arrhythmias during cardiac surgery and MI(IV use). Use IM when IV administration is not possible or when ECG moinitoring is not available and the danger of ventricular arrhythmia is great. As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia As local analgesiabefore venipuncture or peripheral IV cannulation when applied to intact skin in children 3-18 years old.

CONTRAINDICATION Contraindicated with allergy to lidocaine or amide-type local anesthesia, heart failure Cardiogenic shock 2nd or 3rd degree heart block Stokes-adam syndrome Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection(loa=cal anesthetic)

ADVERSE REACTION Antiarrhythmic with systemic effects: CNS: Dizziness or lightheadedness, fatigue, drowsiness CV: cardiac arrhythmias, hypotension GI: Nausea, Vomiting Hypersensitivity: Rash Injectable local anesthetic for caudal epidural anesthesia: CNS: headache, Backache CV: hypotension due to sympathetic block GU: urinary retention, urinary or fecal incontinence. Topical local anesthetic: Dermatologic: Urticaria., pruritus Local: Burbing, stinging, tenderness, swelling, tissue irritation

NURSING RESPONSIBILITIES Reduce dosage with hepatic or renal failure Continuously monitor response when use as antiarrythmitic or injected as local anesthesia. Use caution to prevent choking. Patient may have difficulty swallowing after using oral topical anesthesia Have patients who 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.

DRUG NAME Generic Name: Magnesium sulfate Brand Name:

ACTION Prevents and control seizures by blocking neuromuscular transmission; Attracts and retains water in the Intestinal lumen and distends the bowel to promote mass movement and relieve constipation.

INDICATION Acute nephritis(children), to control hypertension IV: hypomagnesemia, replacement therapy IV or IM: preeclampsia and eclampsia PO: short term treatment of constipation PO: evacuation of the colon for rectal and bowel examinations To correct or prevent hypomagnesemia in patient on parenteral nutrition

CONTRAINDICATION Contraindicated with allergy to magnesium products; heart block myocardial damage, abdominal pain, nausea Other symptoms of appendicitis Fecal impaction Intestinal and billiary tract obstruction Hepatitis

ADVERSE REACTION CNS: weakness, dizziness, CV: palpitations GI: excessive bowel activity, perianal irritation(PO)

NURSING RESPONSIBILITIES Reserve IV use in preeclampsia for immediate life threatening situations. Give IM route by deep IM injection of the undiluted (50%) solution for adult Do not give oral magnesium sulfate with abdominal pain, nausea, or vomiting Monitor bowel function; if diarrhea or cramping occur discontinue oral drug Maintain urine output at a level of 100 ml every 4hr during parenteral administration.

Drug Classification: Antiepileptic Electrolyte laxative

DOSAGE Adults Parenteral nutrition: 8-24 mEq/day IV Eclampsia, sever pre eclampsia: total initial dose of 10-14 g. May infuse 4-5 g in 250 ml 5% dextrose injection or 0.9% sodium chloride while giving IM doses up to 10g(5g or 10ml of undiluted 50% solution in each buttocks)

DRUG NAME Generic Name: Magnesium sulfate Brand Name:

ACTION Prevents and control seizures by blocking neuromuscular transmission; Attracts and retains water in the Intestinal lumen and distends the bowel to promote mass movement and relieve constipation.

INDICATION Acute nephritis(children), to control hypertension IV: hypomagnesemia, replacement therapy IV or IM: preeclampsia and eclampsia PO: short term treatment of constipation PO: evacuation of the colon for rectal and bowel examinations To correct or prevent hypomagnesemia in patient on parenteral nutrition

CONTRAINDICATION Contraindicated with allergy to magnesium products; heart block myocardial damage, abdominal pain, nausea Other symptoms of appendicitis Fecal impaction Intestinal and billiary tract obstruction Hepatitis

ADVERSE REACTION CNS: weakness, dizziness, CV: palpitations GI: excessive bowel activity, perianal irritation(PO)

NURSING RESPONSIBILITIES Reserve IV use in preeclampsia for immediate life threatening situations. Give IM route by deep IM injection of the undiluted (50%) solution for adult Do not give oral magnesium sulfate with abdominal pain, nausea, or vomiting Monitor bowel function; if diarrhea or cramping occur discontinue oral drug Maintain urine output at a level of 100 ml every 4hr during parenteral administration.

Drug Classification: Antiepileptic Electrolyte laxative

DOSAGE Adults Parenteral nutrition: 8-24 mEq/day IV Eclampsia, sever pre eclampsia: total initial dose of 10-14 g. May infuse 4-5 g in 250 ml 5% dextrose injection or 0.9% sodium chloride while giving IM doses up to 10g(5g or 10ml of undiluted 50% solution in each buttocks)

DRUG NAME Generic Name: Morphine sulfate Brand Name: Astramorph PF Drug Classification: Opioid agonist analgesic

ACTION Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation.

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 Treatmenyt of pain following major surgery, ER liposome injection for single dose administration by epidural route at lumbar level

CONTRAINDICATION Contraindicated with hypersensitivity to opioids ; during labor and delivery of a premature infant Pregnancy Labor: respiratory depression in neonate: may prolong labor

ADVERSE REACTION CNS: lightheadedness, dizziness , sedation CV: peripheral circulatory collapse, tachycardia, bradycardia and palpitations Dermatologic: pruritus, urticaria, laryngo spasm, edema GI: nausea, vomiting, dry mouth, anorexia GU: urine retention or hesitancy, oliguria, antidiuretic effect Other: sweating

NURSING RESPONSIBILITIES Dilute and administer slowly IV to minimize likelihood of adverse effect Tell patient to lie downduroing IV administration Reassure patients that they are unlikely to become addicted; most patients who receives opiates for medical reason do not develop dependence syndrome.

DOSAGE Adults IM or SQ: 10mg (range 5-20 mg)/70 kg every 4 hr or as directed by the physician IV: 2.5-15mg/70 kg of body weight in 4-5 ml water for injection administered over 4-5 minutes.

DRUG NAME Generic Name: Naloxone HCL Brand Name: Narcan Drug Classification: Diagnostic agent Opioid antagonist

ACTION Pure opioid antagonist ; reverses the effects of opioids, including respiratory depression, sedation, hypotention

INDICATION Complete or partial reversal of opioid depression induced by opioids, including natural and synthetic narcotics Diagnosis of suspected acute opioid overdose Unlabeled uses: Improvement of circulation in refractory shock, reversal of alcoholic coma.

CONTRAINDICATION Contraindiacated with allergy to opioid antagonist Use cautiously with opioid addiction, CV disorders, pregnancy, lactation.

ADVERSE REACTION CNS: Reversal of analgesia an excitement Acute opioid abstenance syndrome: Nausea, vomiting, sweating, tachycardia, increased BP, tremulousness. CV: Hypotension, hypertension, ventricular tachycardai

NURSING RESPONSIBILITIES Monitor patient continuously after iuse of naloxone; reoeat doses maybe needed, depending on duration of opioid and time of last dose Ask thepatient to report sweating, feelings of tremulousness.

DOSAGE Adults Opioids overdose: Initial dose is 0.01 mg/kg IV. Post operative opioids depression: inject in increments of 0.005-0.01 mg IV at 2-3 min intervals to the desired degree of reversal