NAME OF THE DRUG Generic Name: Epinephrine Brand Name: Injection, OTC nasal solution: Adrenalin Chloride Ophthalmic

solution: Epifrin, Glaucon Insect sting emergencies: EpiPen AutoInjector (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

DOSAGE/ROUTE

ACTION/CLASSIFIC ATION Action: Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity BP, HR, PR Decreases airway resistance. Classification: Beta2 Adrenergic Agonists

Cardiac arrest: 1 mg IV of 1:10,000 solution q 3-5 min; double dose if administering via ET tube Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000 solution. Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution Refractory bradycardia and hypotension: 210ug/min

INDICATION/ CONTRAINDICATION S Indications: o Asthma o Bronchitis o Emphysema o All cardiac arrest, anaphylaxis o Used for symptomatic bradycardia. o Relief of bronchospasm occurring during anesthesia o Exercised-induced bronchospasm Contraindications: Contraindicate in patients with angle-closure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Also contraindicated in patient receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage) Some products containing sulfites and are contraindicated in patients with sulfite allergies except

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effects: nervousness, tremor, vertigo, pain, widened pulse pressure, hypertension nausea Side Effects: headache

NURSING RESPONSIBILITIES Monitor V/S. and check for cardiac dysrhythmias Drug increases rigidity and tremor in patients with Parkinsons disease y Epinephrine therapy interferes with tests for urinary catecholamine y Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur y Massage site after IM injection to counteract possible vasoconstriction. y Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop y If blood pressure increases sharply, rapid-acting vasodilators such as nitrates or alpha blockers can be

when drug is used for serious allergic reactions or in other emergency situations. In conjunction with local anesthesia, epinephrine is contraindicated for use in finger, toes, ears, nose, and genitalia. Use cautiously with longstanding bronchial asthma and emphysema, who have developed degenerative heart disease and in those with hyperthyroidism, CV disease, hypertension, psychoneurosis, or diabetes. In pregnant woman, drug is contraindicated. In breast feeding do not use the drug or stop breast feeding.

given to counteract

NAME OF THE DRUG Generic Name: Lidocane Brand Name: Xylocaine

DOSAGE/ROUTE

ACTION/CLASSIFICA TION Action: Decrease cardiac excitability, cardiac contraction is delayed in the atrium and ventricle Classification: Antiarrythmic and Anesthetic

1-1.5 mg/kg IVP or ETT (double dose if giving via ET tube), may repeat q 5-10 min. max 3 mg/kg; If conversion successful start an infusion of 24 mg/min

INDICATION/ CONTRAINDICATION S Indications: Decrease cardiac excitability, cardiac contraction is delayed in the atrium and ventricle Contraindications: Contraindicated in patients hypersensitive to amidetype local anesthetics and in those with Adams Stoke syndrome. WolffParkinsons-White Syndrome, or severe degrees of SA, AV, or intraventricular block in the absence of pacemaker.

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effects: CNS: Confusion, tremor, lethargy, somnolence, stupor, restlessness anxiety, hallucinations, nervousness, seizure. CV: hypotension, bradychardia, new or worsened arrhythmias EENT: tinnitus, blurred or double vision. Respiratory: Respiratory depression and arrest Skin: soreness at injection site Other: anaphylaxis, Side Effects: sensation of cold, vomiting

NURSING RESPONSIBILITIES Monitor EKG, BP, pulse, rhythm, continuously. Monitor serum lidocaine levels throughout theraphy; therapreutic range 1.55 mcg/ml Monitor intake and output Do not mix in the same syringe with amphoterin B or cefazolin Administer Lidocaine TIV. In case of circulatory depression have dopamine available

NAME OF THE DRUG Generic Name: Sodium Bicarbonate Brand Name: Arm and Hammer Pure Baking Soda, Citrocarbonate, Soda Mint

DOSAGE/ROUTE

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

INDICATION/ CONTRAINDICATION S Action: Indications: Neutralizes gastric acid o Hyperacidity o Peptic ulcer Decrease pepsin activity o Hyperkalemia o Tricyclic antidepressant Classification: Alkalizing OD Agent, Buffer, Antacid, o Shock associated with electrolyte severe diarrhea, dehydration, uncontrolled DM o Reflux esophagitis Contraindications: Contraindicated in patients with metabolic or respiratory alkalosis; patients who are losing chlorides from vomiting or continuous GI suction; patients taking diuretics known to produce hypochloremia alkalosis; and patients with hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart failure. Oral sodium bicarbonate is contraindicated in patients with acute ingestion of strong mineral acids.

ACTION/CLASSIFICA TION

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effects: GI: Gastric distention, belching, flatulence. Metabolic: metabolic alkalosis, hypernatremia, hypokalemia, hyperosmolarity (with overdose). Other: Pain and irritation at injection site.

NURSING RESPONSIBILITIES Monitor urinary pH, calcium, electrolytes and phosphate levels. Record amount and consistency of stools. Clients on low-sodium diets should evaluate sodium contents of antacids.

NAME OF THE DRUG Generic Name: Dopamine HCl. Brand Name: Intropin; Revimine

DOSAGE/ROUTE ACTION/CLASSIFICAT ION Adults: initially, 1 to 5 mcg/kg/minute by I.V. infusion. Adjust dose to desired hemodynamic or renal response, increase by 1 to 4 mcg/kg/minute at 10 to 30-minute intervals. Action Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system. Action is doserelated; large doses can cause mainly alpha stimulation. Classification: Inotropic, vasopressor

INDICATION/ CONTRAINDICATIONS Indications: To treat shock and correct hemodnamic imbalances, improve perfusion of vital organs, to increase cardiac output, and to correct hypotension. Contraindications: Contraindicated in patient with uncorrected tachyarrhythmias, pheocromocytoma, or ventricular fibrillation. - Use cautiously in patients with occlusive vascular disease, cold injuries, diabetic endarteritis, and arterial embolism; in pregnant woman; with a history of sulfite sensitivity; and in those taking MAO inhibitor.

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effects: Cv: anginal pain, arrythmias, bradycardia, conduction disturbances ectopic breasts,hypertension, hypotension, palpitations, tachycardia, vasoconstriction, widening of QRS complex. GI: vomiting. GU: azotemia Respiratory: asthma attacks, dyspnea Skin: necrosis,piloerection, tissue sloughing with extravasation. Other: anaphylaxis. Side Effects: CNS: headache GI: nausea

NURSING RESPONSIBILITIES Blood is not a substitute for blood or fluid volume deficit. If deficit occurs, replace fluid deficit first before giving meds. During infusion, frequently monitor ECG, BP, cardiac output, CVP, pulmonary artery wedge pressure, pulse rate, urine output, and color and temperature of the limbs. If diastolic pressure rises disproportionately, decrease perfusion rate and watch out carefully for further signs of vasoconstriction unless such action is desired. Observe for adverse reaction. Check for urine output. If urine flow is decrease without hypotension, notify physician.

After drug is stopped, Tamper dosage slowly to evaluate stability of blood pressure. Acidosis decrease effectiveness of dopamine.

NAME OF THE DRUG Generic Atrophine Sulfate Brand Isopto Atropine

DOSAGE/ROUTE ACTION/CLASSIFICAT ION Bradycardia: 0.5 1 mg IV (may give via ETT at double dose) q 3-5 min, max 0.04 mg/kg Cardiac arrest: 1 mg q 3-5 min, max 0.04 mg/kg Nerve gas and organophosphate symptoms, may repeat in 2 mg increments q 3 min tiltrated to relief symptoms. Action cholinergic receptor sites so response to acetylcholine is decreased Classification Anticholinergics

INDICATION/ CONTRAINDICATIONS Indication As an anti-sialagogue for preanesthetic medication to prevent or reduce secretions of the respiratory tract To restore cardiac rate and arterial pressure during anesthesia, when vagal stimulation produced by intra-abdominal surgical traction causes a sudden decrease in pulse rate and cardiac action To lessen the degree of atrioventricular (A-V) heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis To overcome severe carotid sinus reflex Antidote for cardiovascular collapse from the injudicious use of a cholinergic drug. Contraindication Contraindicated in patients hypersensitive to drug and those with acute angle closure glaucoma, obstructive uropathy,

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effects CNS: restlessness, ataxia, disorientation, hallucinations, delirium, coma, insomnia, agitation, confusion. CV: tachycardia, angina, arrhythmias, flushing. EENT: photophobia, blurred vision, mydriasis. GI: dry moth, constipation, vomiting. GU: urine retention. Hematologic: leukocytosis Other: anaphylaxis Side Effects CNS: headache, excitement. CV: palpitations GI: thirst, nausea.

NURSING RESPONSIBILITIES Monitor VS. Report HR

Monitor for constipation, oliguria. Atrophine could result in CNS stimulation (confusion, excitement) or drowsiness Instruct to take 30 mins before meals Eat foods high in fiber and drink plenty fluids. Avoid OTC antihistamines. Instruct client not to drive a motor vehicle or participate in activities requiring alertness. Advise to use hard candy, ice chips, etc. for dry mouth.

obstructive disease of GI tract, paralytic elius, toxic magacolon, intestinal atony, unstable CV status in acute hemorrhage, asthma, or myasthenia gravis. Also contraindicated in pregnant women.

NAME OF THE DRUG Generic Dobutamine Hydrochloride Brand Dobutrex

DOSAGE/ROUTE

ACTION/CLASSIFICA TION Action Enhancing the force of myocardial contraction HR, CO, and SV with minor effects to HR. elevated ventricular filling pressure and helps AV node conduction Classification Inotropic, Adrenergic

INDICATION/ CONTRAINDICATIONS Indication Short term treatment of cardiac decompensation in organic heart disease of cardiac surgical pressures. Contraindication Contraindication in patients hypersensitive to drug or any of its components and in those with idiopathic hypertrophic subaortic stenosis.

Adults individualized: 2.515 mcg/kg/min. Rate of administration and duration of therapy depend on the response of client as determined by HR, presence of activity, BP and urine flow

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effects CV: angina, hypertension, hypotension, increased heart rate, nonspecific chest pain, phlebitis, PVCs. GI: nausea and vomiting. Respiratory: asthma attacks, shortness of breath. Others: anaphylaxis. Side Effects CNS: headache Musculoskeletal: mild leg crams or tingling sensation.

NURSING RESPONSIBILITIES Monitor CVP to assess vascular volume and cardiac pumping efficiency. (Elevated CVP may indicate disruption on CO, as in pump failure or Pulmonary edma; low CVP may indicate hypovolemia) Monitor ECG and BP continuously during drug administration Record I&O Monitor glucose in diabetes patients Drug is administered IV to improve cardiac function thus increasing BP and improving urine output. Report any chest pain, increase SOB, headaches or IV site pain.

NAME OF THE DRUG Generic Morphine Sulfate

DOSAGE/ROUTE

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

INDICATION/ CONTRAINDICATIONS Indication Relief of moderate to severe acute and chronic pain Preoperative medication to sedate and allay apprehension, facilitate induction of anesthesia, and reduce anesthetic dosage Analgesic adjunct during anesthesia Component of most preparations that are referred to as Brompton's cocktail or mixture, an oral alcoholic solution that is used for chronic severe pain, especially in terminal cancer patients Intraspinal use with microinfusion devices for the relief of intractable pain Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary edema Contraindication

ADULTS Oral One-third to onesixth as effective as Brand parenteral Immediateadministration release tablets: because of first-pass MSIR metabolism; 10 Timed-release: 30 mg q 4 hr PO. Kadian, MControlled-release: Eslon (CAN), 30 mg q 812 hr PO MS Contin, or as directed by Oramorph SR physician; Kadian: Oral solution: 20100 mg PO MSIR, daily24-hr release Rescudose, system; MS Contin: Roxanol, 200 mg PO q 12 hr. Roxanol T SC and IM Rectal 10 mg (520 mg)/70 suppositories: kg q 4 hr or as RMS directed by Injection: physician. Astramorph PF, IV Duramorph, 2.515 mg/70 kg of Epimorph body weight in 45 (CAN) mL water for Preservativeinjection free concentrate administered over for 45 min, or as microinfusion directed by devices for physician. intraspinal use: Continuous IV Infumorph infusion: 0.1 1 mg/mL in 5% dextrose in water by

Classification Opioid agonist analgesic

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effect CNS: Lightheadedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope

NURSING RESPONSIBILITIES Assessment History: Hypersensitivity to opioids; diarrhea caused by poisoning; labor or delivery of a premature infant; biliary tract surgery or surgical anastomosis; head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression; acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction; pregnancy; lactation Physical: T; skin color,

Contraindicated with hypersensitivity to opioids;

controlled infusion device. Rectal 1030 mg q 4 hr or as directed by physician. Epidural Initial injection of 5 mg in the lumbar region may provide pain relief for up to 24 hr. If adequate pain relief is not achieved within 1 hr, incremental doses of 12 mg may be given at intervals sufficient to assess effectiveness, up to 10 mg/24 hr. For continuous infusion, initial dose of 24 mg/24 hr is recommended. Further doses of 1 2 mg may be given if pain relief is not achieved initially. Intrathecal Dosage is usually one-tenth that of epidural dosage; a single injection of 0.21 mg may provide satisfactory pain relief for up to 24 hr. Do not inject > 2 mL of the

diarrhea caused by poisoning until toxins are eliminated; during labor or delivery of a premature infant (may cross immature bloodbrain barrier more readily); after biliary tract surgery or following surgical anastomosis; pregnancy; labor (respiratory depression in neonate; may prolong labor). Use cautiously with head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression, hypoxia, hypercapnia (may decrease respiratory drive and increase airway resistance); lactation (wait 46 hr after administration to nurse the baby); acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis,

Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm, bronchospasm, edema GI: Nausea, vomiting, anorexia, biliary tract spasm; increased colonic motility in patients with chronic ulcerative colitis GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency Respiratory: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest Side Effects GI: dry mouth, constipation. Skin: Tissue irritation and

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

5 mg/10 mL ampule or > 1 mL of the 10 mg/10 mL ampule. Use only in the lumbar area. Repeated intrathecal injections are not recommended; use other routes if pain recurs. For epidural or intrathecal dosing, use preservative-free morphine preparations only. PEDIATRIC PATIENTS Do not use in premature infants. SC or IM 0.050.2 mg/kg (up to 15 mg per dose) q 4 hr or as directed by physician. GERIATRIC PATIENTS OR IMPAIRED ADULTS Use caution. Respiratory depression may occur in the elderly, the very ill, those with respiratory problems. Reduced dosage may be necessary.

renal or hepatic dysfunction. induration (SC injection). Other: sweating,physical tolerance and dependence, psychological dependence

chilled areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored. Reassure patients that they are unlikely to become addicted; most patients who receive opioids for medical reasons do not develop dependence syndromes Teaching points Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives, tranquilizers, over-the-counter drugs. Swallow controlledrelease preparation (MS Contin, Oramorph SR) whole; do not cut, crush, or chew them. Do not take leftover medication for other disorders, and do not let anyone else take your prescription. These side effects may

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

occur: Nausea, loss of appetite (take with food, lie quietly); constipation (use laxative); dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness and visual acuity). Report severe nausea, vomiting, constipation, shortness of breath or difficulty breathing, rash.

NAME OF THE DRUG Generic Name: Diphenhydrami ne HCl Brand Name: Benadryl

DOSAGE/ROUTE ACTION/CLASSIFICAT ION Action High sedative, anticholinergic, and antiemetic effects Classification antihistamine

INDICATION/ CONTRAINDICATIONS Indication High fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug sensitization, serum & penicillin reaction, contact dermatitis, atopic eczema, other allergic dermatoses, pruritus, food sensitivity, parkinsonism, motion sickness.

Contraindication Premature & newborn infants; asthma attack; lactation.

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effect CV & CNS effects. Blood disorders. GI disturbances. Antimuscarinic effects. Allergic reactions. Drowsiness, constipation, diarrhea, dizziness, dry mouth, nose, throat, headache, anorexia, anxiety, GI upset, asthenia

NURSING RESPONSIBILITIES 1. note reasons fo therapy, signs and symptoms of charactgeristics, other agents trialed, triggers, outcome 2. do not confuse diphenhydramine with desipramine with dimenhydrinate 3. take 30 minutes before travel 4. use sugarless gum, candy to diminish dry mouth effects. 5. avoid alcohol and any other CNS depressants unless prescrived 6. Stop therapy 72-96 hour before skin testing

NAME OF THE DRUG

DOSAGE/ROUTE

Generic Name: Dosage: PO Initial: Amiodarone 200 mg 3 times/day Hydrochloride for 1 wk, reduce to 200 mg twice daily Brand Names: for a further wk. Anoion tab Maintenance: 200 Cordarone mg/day or lowest Cordarone inj effective dose. IV Sandoz Initial: 5 mg/kg Amiodarone infusion via central HCl tab venous catheter. Max: 1.2 g/24 hr.

ACTION/CLASSIFICATION INDICATION/ ADVERSE CONTRAINDICATIONS EFFECTS/ SIDE EFFECTS Action Indication Adverse Effect Blocks potassium chloride Ventricular and Blue-grey leading to prolongation of supraventricular discoloration of action potential duration. arrhythmias. skin, photosensitivity, Classification peripheral Cardiac Drugs Contraindication 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,

NURSING RESPONSIBILITIES y 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 onethird 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

pulmonary alveolitis, exacerbation of arrhythmias and rare serious liver injury. Generally in patients with high doses and having preexisting abnormalities of diffusion capacity.

periodic chest xray 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.

Name of the Drug Generic Name: Calcium Gluconate

Dosage/Route

Action/Classification Action Replaces Calcium And Maintains Calcium Level Classification Electrolytes

PO Hypocalcaemia 10-50 mmol/day. IV Hypocalcaemic tetany Brand Names: 2.25 mmol via slow inj, Phil then 58-77 mL of 10% Pharmawealth/Harson soln diluted and Calcium Gluconate administered as a continuous IV infusion. Antidote in severe hypermagnesaemia; Severe hyperkalaemia 10 mL of 10% soln, repeat every 10 mins if needed.

Indication/ Contraindications Indication

Contraindication

Adverse Effects/ Side Effects Adverse Effect GI irritation; softtissue 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 Responsibilities y Make sure prescriber specifies form of calcium to be given; crash carts may contain both calcium gluconate and calcium chloride. y Tell patient to take oral calcium 1 to 11/2 hours after meals if GI upset occurs. y 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. y Tell patient to take oral calcium with a full glass of water. y Monitor calcium

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

NAME OF THE DRUG Generic Name: Magnesium Sulfate Brand Name: Elin Magnesium Sulfate

DOSAGE/ROUTE

ACTION/CLASSIFI CATION Action May Decrease Acetylcholine Released By Nerve Impulses, But Its Anticonvulsant Mechanism Is Unknown. Classification Anticonvulsant

Dosage: 250 mg/10 mL Route:

INDICATION/ CONTRAINDICATI ONS 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 Contraindication .

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effect flushing, sweating, hypotension, muscular weakness, sedation & confusion; decreased deep tendon reflexes; resp. paralysis

NURSING RESPONSIBILITIES y 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.

NAME OF THE DRUG Generic Name: Phenytoin y

DOSAGE/ROUTE

Adult Initially 100 mg tid. Maintenance: 300400 mg daily. Children 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

Brand Name: Dilantin

INDICATION/ CONTRAINDICATI ONS Action Indication May stabilize neuronal Tonic-clonic & membranes and limit complex partial seizure activity by (psychomotor, either by increasing temporal lobe), efflux or decreasing prevention & influx of Na ions across treatment of seizures cell membrane in the occurring during or motor cortex during following generation of nerve neurosurgery impulses . Contraindication Classification Anticonvulsants

ACTION/CLASSIFI CATION

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effect GI disturbances; ataxia, slurred speech; diplopia, nystagmus & mental confusion w/ headache, dizziness, gingival hyperplasia, hirsutism, hyperglycemia, osteomalacia

NURSING RESPONSIBILITIE S y 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

NAME OF THE DRUG Generic Name: Verapamil Hydrochloride Brand Name: Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM

DOSAGE/ROUTE

ACTION/CLASSIFI CATION Action Decreases myocardial contractility and oxygen demand, it also dilates coronary arteries and arterioles. Classification Calcium Antagonists

Isoptin tab Adult 4080 mg tid-qid. Max: 480 mg daily. Childn >6 yr 40-120 mg bidtid, up to 360 mg daily, childn 6 yr 40 mg bidtid. 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 bidtid

INDICATION/ CONTRAINDICATI ONS 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 Contraindication

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effect Constipation, dizziness, nausea. Rarely, vertigo, headache, hypotension, ankle edema, flushing, fatigue, nervousness, erythromelalgia, paraesthesia, neuropathy; bradycardiac arrhythmias, CHF. Dyspnea

NURSING RESPONSIBILITIE S y 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. y Ensure that patient swallows SR tablets whole: do not cut, crush, or chew them. y Monitor BP very carefully with concurrent doses of antihypertensives. y Monitor cardiac rhythm regularly during stabilization of dosage and periodically during

y y

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.

NAME OF THE DRUG Generic Name: Heparin Brand Name: Britton Heparin Na

DOSAGE/ROUTE

ACTION/CLASSIFI CATION Action Accelerates formation of antithrombin IIIthrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin. Classification Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)

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

INDICATION/ CONTRAINDICATI ONS Indication Treatment and prophylaxis of thromboembolic disorders. Contraindication

ADVERSE NURSING EFFECTS/ SIDE RESPONSIBILITIE EFFECTS S Adverse Effect y Baseline blood Slight fever, headache, coagulation tests, chills, nausea, Hct, Hgb, RBC vomiting, and platelet constipation, epistaxis, counts prior to bruising, slight initiation or haematuria, skin therapy and at necrosis (SC inj), osteoporosis, alopecia. regular intervals Hypersensitivity throughout reactions include therapy urticaria, conjunctivitis, rhinitis, y Monitor APTT levels closely asthma, angioedema y Draw blood for and anaphylactic shock. Priapism. coagulation tests Potentially Fatal: 30 min before Heparin-induced each scheduled thrombocytopenia SC or intermittent with or without IV dose and thrombosis; bleeding approximately q4h for pts receiving continuous IV heparin during dosage adjustments period. After dosage is established, tests may be done once daily y 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

NAME OF THE DRUG Generic Name: Hydrocortisone Sodium Succinate

DOSAGE/ROUTE

100 mg, 250 mg, 500 mg Sterile Powder for Injection (IM/IV)

Brand Name: (Solu-Cortef)

INDICATION/ ADVERSE CONTRAINDICATI EFFECTS/ SIDE ONS EFFECTS Action Indication Adverse Effect Hydrocortisone sodium -Tachycardia,tremor, succinate has the Contraindication petechiae same metabolic and Systemic fungal anti-inflammatory infections and known Side Effects:actions as hypersensitivity to the Headache,weakness, hydrocortisone. When drug or any nausea,drowsiness. given parenterally and component of in equimolar quantities, formulation. the two compounds are Administration of live equivalent in biologic or live, attenuated activity. Following the vaccines is intravenous injection of contraindicated in hydrocortisone sodium patients receiving succinate, immunosuppressive demonstrable effects doses of are evident within one corticosteroids hour and persist for a variable period. Excretion of the administered dose is nearly complete within 12 hours. Thus, if constantly high blood levels are required, injections should be made every 4 to 6 hours. This preparation is also rapidly absorbed when administered intramuscularly and is excreted in a pattern similar to that observed after intravenous injection.

ACTION/CLASSIFI CATION

NURSING RESPONSIBILITIE S  Establish baseline and continuing data on BP, weight, fluid and electrolyte balance, and blood glucose.  Lab tests: Periodic serum electrolytes blood glucose, Hct and Hgb, platelet count, and WBC with differential.  Monitor for adverse effects. Older adults and patients with low serum albumin are especially susceptible to adverse effects.  Be alert to signs of hypocalcemia (see Appendix F).  Ophthalmoscopic examinations are recommended every 23 mo, especially if patient is receiving ophthalmic steroid therapy.

Classification: y Adrenal Glucocorticoid y Anti- Inflammatory y Corticosteroid weak y Otic Agent

Monitor for persistent backache or chest pain; compression and spontaneous fractu res of long bones and vertebrae present hazards. Monitor for and report changes in mood and behavior, emotional instability, or psychomotor activity, especially with long-term therapy. Be alert to possibility of masked infection and delayed healing (antiinflammatory and immunosuppressiv e actions). Note: Dose adjustment may be required if patient is subjected to severe stress (serious infection, surgery, or injury). Note: Single doses of corticosteroids

or use for a short period (<1 wk) do not produce withdrawal symptoms when discontinued , even with moderately large doses. Patient & Family Education  Expect a slight weight gain with improved appetite. After dosage is stabilized, notify physician of a sudden slow but steady weight increase [2 kg (5 lb)/wk].  Avoid alcohol and caffeine; may contribute to steroid-ulcer development in long-term therapy.  Do not ignore dyspepsia with hyperacidity. Report symptoms to physician and do NOT selfmedicate to find relief.  Do NOT use

aspirin or other OTC drugs unless prescribed specifically by the physician. Note: A high protein, calcium, and vitamin D diet is advisable to reduce risk of corticosteroidinduced osteoporosis. Notify physician of slow healing, any vague feeling of being sick, or return to pretreatment symptoms. Do not abruptly discontinue drug; doses are gradually reduced to prevent withdrawal symptoms. Report exacerbation of disease during drug withdrawal. Carry medical identification at all times. It needs to indicate medical diagnosis, drug therapy, and name

of physician. Apply topical preparations sparingly in small children. The hazard of systemic toxicity is higher because of the greater ratio of skin surface area to body weight. Check shelf-life date on topical corticosterone during long-term use. Do not breast feed while taking/using this drug without consulting physician

NAME OF THE DRUG Generic Name: Naloxone

DOSAGE/ROUTE

ACTION/CLASSIFI CATION Action Inhibits bacterial DNA gyrasethus preventing replication in susceptible bacteria. Classification Anti-InfectivesQuinolones

Brand name: Narcan

NARCAN (naloxone) may be administered intravenously, intramuscularly, or subcutaneously. The most rapid onset of action is achieved by intravenousadminist ration, which is recommended in emergency situations. Since the duration of action of some opioids may exceed that of NARCAN (naloxone) , the patient should be kept under continued surveillance. Repeated doses of NARCAN (naloxone) should be administered, as necessary

INDICATION/ CONTRAINDICATI ONS Indication NARCAN (naloxone) is indicated for the complete or partial reversal of opioid depression, including respiratory d epression, induced by natural and synthetic opioids, including propoxyphene, methad one and certain mixed agonist-antagonist analgesics: nalbuphine, pentazocine, butorphanol, and cyclazocine. NARCAN (naloxone) is also indicated for diagnosis of suspected or known acute opioid overdosage. NARCAN (naloxone) may be useful as an adjunctive agent to increase blood pressure in the management of septic shock

ADVERSE NURSING EFFECTS/ SIDE RESPONSIBILITIE EFFECTS S Adverse Effect y Assess pt for Common: previous Nausea,diarrhea, sensitivity vomiting, rash reaction Uncommon: y Assess pt forany Anorexia,headache,diz s/s of infection ziness, fever, GI and before& during abdominal treatment pain,flatulence,confusi y Assess for on, vertigo adverse reaction y Assess pt.& Side Effects familys knowledge of drug therapy

Contraindication Drugs that inhibit peristalsis. Infants and children,growing adolescents. Pregnancy and lactation.

NAME OF THE DRUG Generic Name: Protamine Sulfate

DOSAGE/ROUTE

ACTION/CLASSIFI CATION Action Protamine Sulfate is aweak anticoagulant which acts as a heparin antagonists. Classification Heparin Antagonist

Brand name:

Adults IV 1 mg for each 90 units of heparin derived from lung tissue or 115 units of heparin derived from intestinal mucosa. Because heparin disappears rapidly from circulation, the dose of protamine required decreases rapidly with time following IV injection of heparin. For example, if protamine is administered 30 min after heparin, the usual dose may be sufficient. The dose of protamine should be determined by blood coagulation studies.

INDICATION/ CONTRAINDICATI ONS Indication Protamine Sulfate (protamine (protamines) s) Injection, USP is indicated in the treatment of heparin overdosage. Contraindication Protamine sulfate (protamine (protamines) s) is contraindicated in patients who have shown previous intolerance to the drug.

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effect Cardiovascular Hypotension; bradycardia; circulatory collapse. CNS Lassitude. GI Nausea; vomiting. Respiratory Shortness of breath; pulmonary edema; acute pulmonary hypertension. Miscellaneous Anaphylaxis (severe respiratory distress, circulatory collapse, capillary leak, noncardiogenic pulmonary edema); transient flushing and feeling of warmth; back pain.

NURSING RESPONSIBILITIE S y Instruct patient to notify health care provider immediately if any bleeding occurs. y Tell patient to report the following symptoms to health care provider: Shortness of breath, dizziness, or swelling. y Advise patient to avoid activities that could damage blood vessels or precipitate bleeding (eg, shaving, vigorous brushing of teeth, ambulation) until risk of hemorrhage has passed

NAME OF THE DRUG Generic Name: Sodium Luminal

DOSAGE/ROUTE

ACTION/CLASSIFI CATION Action

INDICATION/ CONTRAINDICATI ONS Indication Long-term management of tonicclonic (grand mal) seizures and partial seizures; status epilepticus, eclampsia, febrile convulsions in young children. Also used as a sedative in anxiety or tension states; in pediatrics as preoperative and postoperative sedation and to treat pylorospasm in infants.

ADVERSE EFFECTS/ SIDE EFFECTS Adverse Effect

Brand name: Phenobarbiturates

Anticonvulsant Adult: PO 100300 mg/d IV/IM 200600 mg up to 20 mg/kg Child: PO/IV 38 mg/kg or 125 mg/m2/d Neonate: PO/IV 34 mg/kg/d (max: 5 mg/kg/d)

Body as a Whole: Myalgia, neuralgia, CNS depression, coma, and death. CNS: Somnolence, nightmares, insomnia, "hangover," headache, anxiety, thinking abnormalities, Status Epilepticus dizziness, nystagmus, Adult/Child: IV 1518 irritability, paradoxic mg/kg in single or excitement and divided doses (max: 20 exacerbation of mg/kg) hyperkinetic behavior Neonate: IV 1520 (in children); mg/kg in single or confusion or divided doses Contraindication depression or marked excitement (older Sedative Sensitivity to adult or debilitated Adult: PO 30120 barbiturates; manifest patients); ataxia. CV: mg/d IV/IM 100200 hepatic or familial Bradycardia, mg/d history of porphyria; syncope, Child: PO 6 mg/kg/d or severe respiratory or 180 mg/m2 in 3 divided Classification kidney disease; history hypotension. GI: doses IV/IM 16100 CENTRAL NERVOUS of previous addiction to Nausea, vomiting, constipation, mg/d (13 mg/kg) SYSTEM AGENT; sedative hypnotics; diarrhea, epigastric ANTICONVULSANT; uncontrolled pain; SEDATIVEpregnancy (particularly pain, liver damage. Hematologic: HYPNOTIC; early pregnancy) BARBITURATE (category D), lactation; Megaloblastic anemia, Long-acting barbiturate. Sedative and hypnotic effects of barbiturates appear to be due primarily to interference with impulse transmission of cerebral cortex by inhibition of reticular activating system. CNS depression may range from mild sedation to coma, depending on dosage, route of administration, degree of nervous system excitability, and drug tolerance. Initially, barbiturates suppress REM sleep, but with chronic therapy REM sleep returns to normal.

NURSING RESPONSIBILITIE S y Observe patients receiving large doses closely for at least 30 min to ensure that sedation is not excessive. y Keep patient under constant observation when drug is administered IV, and record vital signs at least every hour or more often if indicated. y Lab tests: Obtain liver function and hematology tests and determinations of serum folate and vitamin D levels during prolonged therapy. y Monitor serum drug levels. Serum concentrations >50 mcg/mL may cause coma. Therapeutic serum concentrations of 1540 mcg/mL produce anticonvulsant activity in most

sustained release formulation for children <12 y of age.

agranulocytosis, thrombocytopenia. Metabolic: Hypocalcemia, osteomalacia, rickets. Musculoskeletal: Folic acid deficiency, vitamin D deficiency. Respiratory: Respiratory depression. Skin: Mild maculopapular, morbilliform rash; erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis (rare). .

patients. These values are usually attained after 2 or 3 wk of therapy with a dose of 100200 mg/d. y Expect barbiturates to produce restlessness when given to patients in pain because these drugs do not have analgesic action. y Be prepared for paradoxical responses and report promptly in older adult or debilitated patient and children (i.e., irritability, marked excitement [inappropriate tearfulness and aggression in children], depression, and confusion).

NAME OF THE DRUG Generic Name: Vasopressin

DOSAGE/ROUTE

ACTION/CLASSIFI CATION Action Vasopressin is a posterior pituitary hormone which may be synthetically prepared or extracted from animals. It exerts direct antidiuretic action on the kidneys by increasing tubular reabsorption of water. Vasopressin also acts by constricting the peripheral blood vessels and causes the smooth muscle of the intestine, gall bladder and urinary bladder to contract. Vasopressin is given parenterally or intranasally in the form of argipressin or lypressin. Argipressin is a synthetic type of vasopressin derived from most mammals (including man but excluding pig) while lypressin is vasopressin from pig. Classification Antidiuretics / Haemost atics

Brand Name:

Intravenous Initial control of variceal bleeding Adult: As argipressin: 20 units in 100 ml of glucose 5% infused over 15 min. Parenteral cranial diabetes insipidus Adult: As argipressin: 5-20 units SC/IM every 4 hr.

INDICATION/ ADVERSE CONTRAINDICATI EFFECTS/ SIDE ONS EFFECTS Indication Adverse Effect Contraindication Hypersensitivity. Vascular disease especially coronary artery disease; chronic nephritis (until reasonable bloodnitrogen conc attained). Pallor, vomiting, nausea, belching, abdominal cramps, tremour, pounding headache, vertigo, fluid retention, hyponatraemia, hypersensitivity reaction, sweating, urticaria, gangrene, desire to defecate, arrhythmias, bradycardia, angina, MI and bronchoconstriction. Potentially Fatal: Anaphylaxis; cardiac arrest or shock

NURSING RESPONSIBILITIE S y Heart failure; migraine; epilepsy; asthma or other conditions which might be exacerbated by fluid retention; renal impairment; hypertension or other conditions that may worse with BP increase. Adjust fluid intake to avoid fluid overload. Lactation, pregnancy (especially 3rd trimester as it may have oxytocic effect).

NAME OF THE DRUG Generic Name: Famotidine

Brand Name:
y y

Pepcid Pepcid AC

INDICATION/ ADVERSE NURSING CONTRAINDICATI EFFECTS/ SIDE RESPONSIBILITIE ONS EFFECTS S For oral dosage forms Action Indication Adverse Effect y (suspension, tablets): Famotidine is used to Along with its To treat stomach treat stomach ulcers Contraindication needed effects, a ulcers: (gastric and duodenal), medicine may cause Adults20 milligrams erosive esophagitis some unwanted (mg) one or two times (heartburn or acid effects. Although per day or 40 mg once indigestion), and not all of these side a day at bedtime. gastroesophageal reflux effects may occur, if Teenagers and children disease (GERD). they do occur they above 1 year of age GERD is a condition may need medical Dose is based on body where the acid in the attention. weight and must be stomach washes back determined by your up into the esophagus. Check with your doctor. The starting It is also used to treat doctor immediately dose is usually 0.5 certain conditions if any of the milligram (mg) per where there is too following side effects kilogram (kg) of body much acid in the occur: weight per day, given stomach (e.g., as a single dose at Zollinger-Ellison Rare bedtime or divided in syndrome, endocrine y Bleeding gums two doses. The total tumors). y blistering, dose is usually not peeling, or more than 40 mg per Classification loosening of the day. skin To treat y blood in the gastroesophageal reflux urine or stools disease (GERD): y bloody, black, or Adults20 milligrams tarry stools (mg) two times per day. y chest pain Teenagers and children y chills above 1 year of age y cough or Dose is based on body hoarseness weight and must be y diarrhea determined by your y fever doctor. The starting y fever with or dose is usually 1

DOSAGE/ROUTE

ACTION/CLASSIFI CATION

milligram (mg) per kilogram (kg) of body weight per day, divided and given two times per day. The total dose is usually not more than 40 mg two times per day. Infants 3 months to 1 year of ageDose is based on body weight and must be determined by your doctor. The usual dose is 1 milligram (mg) per kilogram (kg) of body weight per day, divided and given two times per day. Infants younger than 3 months of ageDose is based on body weight and must be determined by your doctor. The usual dose is 0.5 milligram (mg) per kilogram (kg) of body weight per day, given as a single dose once a day. To treat erosive esophagitis (heartburn): Adults10, 20, or 40 milligrams (mg) two times per day. Teenagers and children above 1 year of age Dose is based on body weight and must be

y y y y y

y y y y

y y y

y y y

without chills general feeling of tiredness or weakness high fever itching joint or muscle pain lower back or side pain painful or difficult urination pale skin pinpoint red spots on the skin red, irritated eyes red skin lesions, often with a purple center shortness of breath sore throat sores, ulcers, or white spots on the lips or in the mouth swollen glands unusual bleeding or bruising unusual tiredness or weakness

determined by your doctor. The starting dose is usually 1 milligram (mg) per kilogram (kg) of body weight per day, divided and given two times per day. The total dose is usually not more than 40 mg two times per day. To treat too much stomach acid (Zollinger-Ellison syndrome): Adults20 milligrams (mg) every 6 hours. Your doctor may adjust your dose as needed. ChildrenUse and dose must be determined by your doctor.