EMERGENCY DRUGS: A drug study. after meals.

Do not to chew or crush timed-release preparations.

1) AMINOPHYLLINE
Administer rectal solution or suppositories after emptying the rectum.
It may be necessary to take this drug around the clock for adequate
Brand Names: Phil Pharmawealth/Atlantic Aminophylline amp Theofil
control of asthma attacks.
amp
Avoid excessive intake of coffee, tea, cocoa, cola beverages,
Classification: Antiasthmatic & COPD Preparations
chocolate.
Dosage: Initial: 225-450 mg twice daily, increased if needed. IV Acute
Smoking cigarettes or other tobacco products impacts the drug's
severe bronchospasm. Loading dose: 5 mg/kg (ideal body wt).
effectiveness. Try not to smoke. Notify the care provider if smoking
Maintenance: 0.5 mg/kg/hr. Rate should not exceed 25 mg/min.
habits change while taking this drug.
Indication: PO Chronic bronchospasm as hydrate
Frequent blood tests may be necessary to monitor the effect of this
Action: Increases the level of cAMP resulting in bronchodilation
drug and to ensure safe and effective dosage; keep all appointments for
Adverse Reactions: Nausea, vomiting, abdominal pain, diarrhea,
blood tests and other monitoring.
headache, insomnia, dizziness, anxiety, restlessness; tremor,
These side effects may occur: Nausea, loss of appetite (taking this
palpitations. Potentially Fatal: Convulsions, cardiac arrhythmias,
drug with food may help if taking the immediate-release or liquid
hypotension and sudden death after too rapid IV injection.
dosage forms); difficulty sleeping, depression, emotional lability
Nursing Measures:
(reversible).
Administer to pregnant patients only when clearly neededneonatal
Report nausea, vomiting, severe GI pain, restlessness, seizures,
tachycardia, jitteriness, and withdrawal apnea observed when mothers
irregular heartbeat
received xanthines up until delivery.
Caution patient not to chew or crush enteric-coated timed-release
2) AMIODARONE HYDROCHLORIDE
forms.
Give immediate-release, liquid dosage forms with food if GI effects
Brand Names: Anoion tab Cordarone Cordarone inj Sandoz
occur.
Amiodarone HCl tab
Do not give timed-release forms with food; these should be given on
Classification: Cardiac Drugs
an empty stomach 1 hr before or 2 hr after meals.
Dosage: PO Initial: 200 mg 3 times/day for 1 wk, reduce to 200 mg
Maintain adequate hydration.
twice daily for a further wk. Maintenance: 200 mg/day or lowest
Monitor results of serum theophylline levels carefully, and arrange
effective dose. IV Initial: 5 mg/kg infusion via central venous catheter.
for reduced dosage if serum levels exceed therapeutic range of 1020
Max: 1.2 g/24 hr.
mcg/mL.
Indication: Ventricular and supraventricular arrhythmias.
Take serum samples to determine peak theophylline concentration
Action: Blocks potassium chloride leading to prolongation of action
drawn 1530 min after an IV loading dose.
potential duration.
Monitor for clinical signs of adverse effects, particularly if serum
Adverse Reactions: Blue-grey discoloration of skin, photosensitivity,
theophylline levels are not available.
peripheral neuropathy, paraesthesia, myopathy, ataxia, tremor, nausea,
Ensure that diazepam is readily available to treat seizures.
vomiting, metallic taste, hypothyroidism, hyperthyroidism, alopecia,
Take this drug exactly as prescribed; if a timed-release product is
sleep disturbances, corneal microdeposits, hot flushes, sweating. Heart
prescribed, take this drug on an empty stomach, 1 hr before or 2 hr
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 (0.52.5 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
36 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: 0.52 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, Beta1and
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 (beta2 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- Myrosemide (CAN)
blocker, such as atenolol, should be used in patients with respiratory Classification: loop diuretics
distress) readily available in case cardiac arrhythmias occur. Dosage: 20mg/2ml
Do not exceed recommended dosage of inhalation products; Indication: edema, hypertension
administer pressurized inhalation drug forms during second half of Action: inhibits Sodium and Chloride reabsorption at the proximal and
inspiration, because the airways are open wider and the aerosol distal tubules and the ascending loop of Henle
distribution is more extensive. If a second inhalation is needed, Adverse Reaction: vertigo, headache, dizziness, paresthesia, weakness,
administer at peak effect of previous dose, 35 min. restlessness, fever, nocturia, oliguria, polyguria
Use topical nasal solutions only for acute states; do not use for longer Nursing Measures:
than 35 days, and do not exceed recommended dosage. Rebound Monitor BP after administration
nasal congestion can occur after vasoconstriction subsides. Administer with food or milk to prevent GI upset.
Do not exceed recommended dosage; adverse effects or loss of Reduce dosage if given with other antihypertensives; readjust dosage
effectiveness may result. Read the instructions that come with gradually as BP responds.
respiratory inhalant products, and consult your health care provider or Give early in the day so that increased urination will not disturb
pharmacist if you have any questions. sleep.
To give eye drops: Lie down or tilt head backward, and look up. Hold Avoid IV use if oral use is at all possible.
dropper above eye; drop medicine inside lower lid while looking up. Do not mix parenteral solution with highly acidic solutions with pH
Do not touch dropper to eye, fingers, or any surface. Release lower lid; below 3.5.
keep eye open, and do not blink for at least 30 sec. Apply gentle Do not expose to light, may discolor tablets or solution; do not use
pressure with fingers to inside corner of the eye for about 1 min; wait discolored drug or solutions.
at least 5 min before using other eye drops. Discard diluted solution after 24 hr.
These side effects may occur: Dizziness, drowsiness, fatigue, Refrigerate oral solution.
apprehension (use caution if driving or performing tasks that require Measure and record weight to monitor fluid changes.
alertness); anxiety, emotional changes; nausea, vomiting, change in Arrange to monitor serum electrolytes, hydration, liver function.
taste (eat frequent small meals); fast heart rate. Nasal solution may Arrange for potassium-rich diet or supplemental potassium as
cause burning or stinging when first used (transient). Ophthalmic needed.
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 13) HYDRALAZINE HYDROCHLORIDE
inhalant), decrease in visual acuity (ophthalmic).
Brand name: Supres
12) FUROSEMIDE Classification: antihypertension
Dosage: 20mg/ml
Brand name: Apo-Furosemide (CAN), Furoside (CAN), Lasix, 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 26
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 10 mg/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, dont 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 monitored 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: 240-480 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 toCrohns 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 childs 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, phlebiti 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 612 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: 15 mcg/mL). Doses > 610 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; 80mg/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 depressed contractility
Action: Stimulates hearts 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 12mo 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 cant 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 rapid respirations, shallow tidal volume, fine auscultatory crackles,
IV drip. Infusion may result in fluid overload. dyspnea, and peripheral edema)
Check IV site frequently and if infiltration is noted, turn off IV drip. Watch out for signs of infiltration (swelling and pain around IV site).
Watch out for signs of fluid overload (distended neck veins (JVD),