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Emergency DRUGS

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					De La Salle Health Sciences Institute Dasmariñas, Cavite College of Nursing and School of Midwifery Wilmalyn D.
Gongon            May 15, 2009 BSN31

–

group 4



EMERGENCY DRUGS: A drug study.

    1) AMINOPHYLLINE Brand Names

: Phil Pharmawealth/Atlantic Aminophylline amp Theofil amp

Classification

: Antiasthmatic & COPD Preparations

Dosage

: Initial: 225-450 mg twice daily, increased if needed. IV Acute severe bronchospasm. Loading dose: 5 mg/kg (ideal body
wt). Maintenance: 0.5 mg/kg/hr. Rate should not exceed 25 mg/min.

Indication

: PO Chronic bronchospasm as hydrate

Action

: Increases the level of cAMP resulting in bronchodilation

Adverse Reactions

: Nausea, vomiting, abdominal pain, diarrhea, headache, insomnia, dizziness, anxiety, restlessness; tremor, palpitations.
Potentially Fatal: Convulsions, cardiac arrhythmias, hypotension and sudden death after too rapid IV injection.

Nursing Measures

:



Administer to pregnant patients only when clearly needed

—

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



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

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



Do not give timed-release forms with food; these should be given on an empty stomach 1 hr before or 2 hr after meals.



Maintain adequate hydration.



 Monitor results of serum theophylline levels carefully, and arrange for reduced dosage if serum levels exceed
therapeutic range of 10

–

20 mcg/mL.





Take serum samples to determine peak theophylline concentration drawn 15

–

30 min after an IV loading dose.



Monitor for clinical signs of adverse effects, particularly if serum theophylline levels are not available.



Ensure that diazepam is readily available to treat seizures. 

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



Do not to chew or crush timed-release preparations.



Administer rectal solution or suppositories after emptying the rectum.



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



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

Smoking cigarettes or other tobacco products impacts the drug's effectiveness. Try not to smoke. Notify the care
provider if smoking habits change while taking this drug.



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



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



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

2) AMIODARONE HYDROCHLORIDE



Brand Names

: Anoion tab Cordarone Cordarone inj Sandoz Amiodarone HCl tab

Classification

: Cardiac Drugs

Dosage

: PO Initial: 200 mg 3 times/day for 1 wk, reduce to 200 mg twice daily for a further wk. Maintenance: 200 mg/day or
lowest effective dose. IV Initial: 5 mg/kg infusion via central venous catheter. Max: 1.2 g/24 hr.

Indication

: Ventricular and supraventricular arrhythmias.

Action

: Blocks potassium chloride leading to prolongation of action potential duration.

Adverse Reactions

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

Nursing Measures
:



Monitor cardiac rhythm continuously.



Monitor for an extended period when dosage adjustments are made.



Monitor for safe and effective serum levels (0.5

–

2.5 mcg/mL). 

Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need to be reduced one-third to one-half when
amiodarone is started.



Give drug with meals to decrease GI problems.



Arrange for ophthalmologic exams; reevaluate at any sign of optic neuropathy.



Arrange for periodic chest x-ray to evaluate pulmonary status (every 3

–

6 mo).



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



Drug dosage will be changed in relation to response of arrhythmias; you will need to be hospitalized during initiation of
drug therapy; you will be closely monitored when dosage is changed.



Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray, eye exam, blood tests.



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



 Report unusual bleeding or bruising; fever, chills; intolerance to heat or cold; shortness of breath, difficulty breathing,
cough; swelling of ankles or fingers; palpitations; difficulty with vision.

3) ATROPINE SULFATE



Brand Names

: Anespin amp Atropol amp Euro-Med Atropine Sulfate amp Isopto Atropine eye drops Phil Pharmawealth/Atlantic
Atropine amp

Classification

: Other Cardiovascular Drugs, Muscle Relaxants, Mydriatic Drugs, Antidotes, Detoxifying Agents & Drugs Used in
Substance Dependence

Indication/Dosage

: IV Bradycardia 500 mcg every 3-5 mins. Total: 3 mg. IV/IM Organophosphorus poisoning 2 mg every 10-30 mins until
muscarinic effects disappear or atropine toxicity appears. IM/SC Premed in anesth 300-600 mcg 30-60 mins before
anesth. IV/IM/SC Overdosage w/ other compd having muscarinic actions 0.6-1 mg, repeat 2 hrly. Ophth Inflammatory
eye disorders As 0.5-1% soln: 1-2 drops 4 times/day. Eye refraction As 1% soln: 1 drop twice daily for 1-2 days before
procedure.

Action

: An anti-cholinergic that inhibits acetylcholine at the parasympathetic neuroeffector junction, enhances the conduction
of AV node and increases heart rate

Adverse Reactions

: Dry mouth, dysphagia, constipation, flushing and dryness of skin, tachycardia, palpitations, arrhythmias, mydriasis,
photophobia, cycloplegia, raised intraocular pressure. Toxic doses cause tachycardia, hyperpyrexia, restlessness,
confusion, excitement, hallucinations, delirium and may progress to circulatory failure and respiratory depression. Eye
drops: Systemic toxicity especially in children, on prolonged use may lead to irritation, hyperemia, edema and
conjunctivitis. Increased intraocular pressure. Inhalation: Dryness of mouth, throat. Potentially Fatal: Atrial arrhythmias,
AV dissociation, multiple ventricular ectopics.

Nursing Measures

:



Ensure adequate hydration; provide environmental control (temperature) to prevent hyperpyrexia.

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



When used preoperatively or in other acute situations, incorporate teaching about the drug with teaching about the
procedure; the ophthalmic solution is used mainly acutely and will not be self-administered by the patient; the following
apply to oral medication for outpatients:



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



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



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



Report rash; flushing; eye pain; difficulty breathing; tremors, loss of coordination; irregular heartbeat, palpitations;
headache; abdominal distention; hallucinations; severe or persistent dry mouth; difficulty swallowing; difficulty in
urination; constipation; sensitivity to light.

4) BUMETANIDE



Brand Names

: Burinex amp Burinex tab

Classification

: Sulfonamide Diuretics

Indication/Dosage

: PO edema 1 mg once daily, 2nd dose 6-8 hr later if needed. Refractory edema Initial: 5 mg/day, may increase dose
depending on response. Max: 10 mg/day. HTN 0.5-1 mg/day. Max: 5 mg/day. IV Pulmonary edema 1-2 mg, repeat 20
mins. later if needed. IV/IM Emergency edema 0.5-1 mg, then adjust according to response.

Action

: inhibits Sodium and Chloride reabsorption at the ascending loop of Henle

Adverse Reactions
: Muscle cramps, dizziness, hypotension, headache, nausea, impaired hearing, pruritus, ECG changes, musculoskeletal
pain, rash, chest discomfort, renal failure, premature ejaculation, thrombocytopenia, hypokalemia, hypomagnesaemia,
hyponatremia, hyperuricemia, hyperglycemia, hypocalcaemia.

Nursing Measures

:



Give with food or milk to prevent GI upset.



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



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



Avoid IV use if oral use is possible.



Arrange to monitor serum electrolytes, hydration, liver function during long-term therapy.



Provide diet rich in potassium or supplemental potassium.



Record alternate day or intermittent therapy on a calendar or dated envelopes.



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



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



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



Report weight change of more than 3 lb in 1 day; swelling in ankles or fingers; unusual bleeding or bruising; nausea,
dizziness, trembling, numbness, fatigue; muscle weakness or cramps.
5) CALCIUM GLUCONATE Brand Names

: Phil Pharmawealth/Harson Calcium Gluconate amp

Classification

: Electrolytes

Indication/Dosage

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

Action

: replaces Calcium and maintains Calcium level

Adverse Reactions

: GI irritation; soft-tissue calcification, skin sloughing or necrosis after IM/SC inj. Hypercalcaemia characterised by
anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria,
nephrocalcinosis, renal calculi; chalky taste, hot flushes and peripheral vasodilation. Potentially Fatal: Cardiac
arrhythmias and coma. Nursing Measures

:



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



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



 Give I.M. injection in gluteal region in adults and in lateral thigh in infants. Use I.M. route only in emergencies when no
I.V. route is available bec. of irritation of tissue by calcium salts.



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



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

6) CAPTOPRIL
Brand Names

: Ace-Bloc tab Capomed tab Capotec tab Capoten tab Captor tab Captril tab Cardiovaz tab Conamid tab Hartylox
tab Normil tab Phil Pharmawealth/Panion & BF Captopril tab Prelat tab Primace tab Retensin tab Spec-Ace tab
Tensoril tab Unihype tab Vasostad tab

Classification

: ACE Inhibitors

Indication/Dosage

: PO HTN Initial: 12.5 mg twice daily. Maintenance: 25-50 mg twice daily. Max: 50 mg 3 times/day. Heart failure Initial:
6.25-12.5 mg 2-3 times/day. Max: 50 mg 3 times/day. Post MI Start 3 days after MI. Initial: 6.25 mg/day, may increase
after several wk to 150 mg/day in divided doses if needed and tolerated. HTN in diabetic nephropathy 75-100 mg/day in
divided doses.

Action

: inhibits ACE, reduces Sodium and water retention, lowers blood pressure

Adverse Reactions

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

Nursing Measures

:



Administer 1 hr before or 2 hr after meals.



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



 Monitor patient closely for fall in BP secondary to reduction in fluid volume (excessive perspiration and dehydration,
vomiting, diarrhea); excessive hypotension may occur.



Reduce dosage in patients with impaired renal function.



Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop without consulting your health care
provider. 
Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if light-
headedness or dizziness occurs, consult your health care provider.



 Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will
interact with ACE inhibitors. Consult your health care provider.



 These side effects may occur: GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth
sores (perform frequent mouth care); rash; fast heart rate; dizziness, light-headedness (usually passes after the first few
days; change position slowly, and limit your activities to those that do not require alertness and precision).



 Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of
the face, eyes, lips, tongue, difficulty breathing.

7) CLONIDINE



Brand Names

: Catapin amp Catapres amp Catapres tab

Classification

: Other Antihypertensives

Indication/Dosage

: PO HTN Initial: 50-100 mcg 3 times/day. Max: 2,400 mcg/day. Menopausal flushing; Migraine prophylaxis 50 mcg twice
daily, up to 75 mg twice daily. IV Hypertensive crisis 150-300 mcg via slow inj. Max: 750 mcg over 24 hr. Epidural Severe
cancer pain Initial: 30 mcg/hr as continuous infusion in combination w/ an opioid. Transdermal HTN As patch releasing
100-300 mcg clonidine base/day at constant rate: Apply once wkly.

Action

: stimulates alpha 2 receptors and inhibits central vasomotor centers, lowers peripheral vascular resistance, blood
pressure, and heart rate

Adverse Reactions

: Dry mouth, drowsiness, dizziness, headache, constipation, impotence, vivid dreams, urinary retention; dry, itching,
burning sensation in the eye; fluid or electrolyte imbalance, GI upset, paralytic ileus, orthostatic hypotension, weakness,
sedation, pruritus, myalgia, urticaria, nausea, insomnia, arrhythmias, agitation. Reduced GI motility at times may cause
paralytic ileus. Potentially Fatal: Transient hypertension or profound hypotension, respiratory depression, convulsion.
Clonidine withdrawal syndrome could be life threatening. Bradycardia, coma and disturbances in conduction (in
individuals with preexisting diseases of SA/AV nodes, overdose or on digitalis).

Nursing Measures
:



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

Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if light-
headedness or dizziness occurs, consult your health care provider.



 Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will
interact with ACE inhibitors. Consult your health care provider.



 These side effects may occur: GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth
sores (perform frequent mouth care); rash; fast heart rate; dizziness, light-headedness (usually passes after the first few
days; change position slowly, and limit your activities to those that do not require alertness and precision).



 Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of
the face, eyes, lips, tongue, difficulty breathing.



Take this drug exactly as prescribed. Do not miss doses. Do not discontinue the drug unless so instructed. Do not
discontinue abruptly; life-threatening adverse effects may occur. If you travel, take an adequate supply of drug.



Use the transdermal system as prescribed; refer to directions in package insert, or contact your health care provider
with questions. Be sure to remove old systems before applying new ones.



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



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



 These side effects may occur: Drowsiness, dizziness, light-headedness, headache, weakness (often transient; observe
caution driving or performing other tasks that require alertness or physical dexterity); dry mouth (suck on sugarless
lozenges or ice chips); GI upset (eat small, frequent meals); dreams, nightmares (reversible); dizziness, light-headedness
when you change position (get up slowly; use caution climbing stairs); impotence, other sexual dysfunction, decreased
libido (discuss with care providers); breast enlargement, sore breasts; palpitations.


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

8) DIAZEPAM



Brand name

: Valium

Classification

: Anxiolytics

Dosage

: 10mg/2ml

Indication

: relief of anxiety, agitation & tension due to psychoneurotic states & transient situational disturbances Action

: a benzodiazepine that probably potentiates the effects of GABA, depresses the CNS & suppresses the spread of seizure
activity

Adverse Reaction

: drowsiness,dysarthria, slurred speech, tremor, transient amnesia, fatigue, ataxia, headache, insomnia, paradoxical
anxiety, hallucination

Nursing Measures

:



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



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



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



Reduce dose of narcotic analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated.



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

 Maintain patients receiving parenteral benzodiazepines in bed for 3 hr; do not permit ambulatory patients to operate a
vehicle following an injection.



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



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



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



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



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

9) DIGOXIN



Brand name

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

Classification

: Inotropics

Dosage

: 5mg/2ml

Indication

: Cardiac failure accompanied by atrial fibrillation; management of chronic cardiac failure where systolic dysfunction or
ventricular dilatation is dominant; management of certain supraventricular arrhythmias, particularly chronic atrial flutter
& fibrillation.

Action

: inhibits sodium-potassium activated adenosine triphosphate, promoting movement of calcium from extracellular to
intra-cytoplasm and strengthening myocardial contraction, also acts on CNS to enhance vagal tone

Adverse Reaction
: nausea, vomiting, anorexia, headache, facial pain, fatigue, weakness, dizziness, drowsiness, disorientation, mental
confusion, bad dreams, convulsions

Nursing Measures

:



 Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or < 90 in infant; retake pulse in 1
hr. If adult pulse remains < 60 or infant < 90, hold drug and notify prescriber. Note any change from baseline rhythm or
rate.



Check dosage and preparation carefully.



Avoid IM injections, which may be very painful.



Follow diluting instructions carefully, and use diluted solution promptly.



Avoid giving with meals; this will delay absorption.



 Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, cardiac monitor on standby in case
toxicity develops.



Monitor for therapeutic drug levels: 0.5

–

2 ng/mL.

10) DIPENHYDRAMINE Brand name

: Benadryl

Classification

: antihistamine

Dosage

: 50mg/ml

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

Action

: prevents histamine mediated responses, drug provides local anesthesia and suppresses cough reflex

Adverse Reaction

: CV and CNS effects, blood disorders, GI disturbances, anti-muscarinic effects and allergic reactions.

Nursing Measures

:



Monitor carefully, assess for confusion, delirium, other anticholinergic side effects and fall risk. Institute measures to
prevent falls.



Assess movement disorder before and after administration.



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



 It can cause excitation in children. Caution parents or caregivers about proper dose calculation; overdosage, especially
in infants and children, can cause hallucinations, seizures or death Inform patient that this drug may cause dry mouth.
Frequent oral rinses, good oral hygiene, and sugarless gum or candy may minimize this effect. Notify dentist if dry mouth
persists for more than 2 weeks.

11) EPINEPHRINE Brand name

: Epinephrine Bitartrate Aerosols: Primatene Mist Epinephrine Borate Ophthalmic solution: Epinal Epinephrine
Hydrochloride Injection, OTC nasal solution: Adrenalin Chloride Ophthalmic solution: Epifrin, Glaucon Insect sting
emergencies: EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for
children) OTC solutions for nebulization: AsthmaNefrin, microNefrin, Nephron, S

2



Classification

: Sympathomimetic, Alpha-adrenergic agonist, Beta

1

and beta
2

-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 (beta

1

receptors); bronchodilation, vasodilation, and uterine relaxation (beta

2

receptors); decreased production of aqueous humor.

Adverse Reaction

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

Nursing Measures

:



Monitor heart rate.



 Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug; small errors in dosage
can cause serious adverse effects. Double-check pediatric dosage.



Use minimal doses for minimal periods of time; "epinephrine-fastness" (a form of drug tolerance) can occur with
prolonged use.



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

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



Rotate SC injection sites to prevent necrosis; monitor injection sites frequently.



Keep a rapidly acting alpha-adrenergic blocker (phentolamine) or a vasodilator (a nitrate) readily available in case of
excessive hypertensive reaction.



Have an alpha-adrenergic blocker or facilities for intermittent positive pressure breathing readily available in case
pulmonary edema occurs.



Keep a beta-adrenergic blocker (propranolol; a cardioselective beta-blocker, such as atenolol, should be used in patients
with respiratory distress) readily available in case cardiac arrhythmias occur. 

 Do not exceed recommended dosage of inhalation products; administer pressurized inhalation drug forms during
second half of inspiration, because the airways are open wider and the aerosol distribution is more extensive. If a
second inhalation is needed, administer at peak effect of previous dose, 3

–

5 min.



Use topical nasal solutions only for acute states; do not use for longer than 3

–

5 days, and do not exceed recommended dosage. Rebound nasal congestion can occur after vasoconstriction subsides.



 Do not exceed recommended dosage; adverse effects or loss of effectiveness may result. Read the instructions that
come with respiratory inhalant products, and consult your health care provider or pharmacist if you have any questions.



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



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



 Report chest pain, dizziness, insomnia, weakness, tremor or irregular heart beat (respiratory inhalant, nasal solution),
difficulty breathing, productive cough, failure to respond to usual dosage (respiratory inhalant), decrease in visual acuity
(ophthalmic).

12) FUROSEMIDE Brand name

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

Classification

: loop diuretics

Dosage

: 20mg/2ml

Indication

: edema, hypertension

Action

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

Adverse Reaction

: vertigo, headache, dizziness, paresthesia, weakness, restlessness, fever, nocturia, oliguria, polyguria

Nursing Measures

:



Monitor BP after administration



Administer with food or milk to prevent GI upset. 

Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds.



Give early in the day so that increased urination will not disturb sleep.



Avoid IV use if oral use is at all possible.


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



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



Discard diluted solution after 24 hr.



Refrigerate oral solution.



Measure and record weight to monitor fluid changes.



Arrange to monitor serum electrolytes, hydration, liver function.



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

13) HYDRALAZINE HYDROCHLORIDE Brand name

: Supres

Classification

: antihypertension

Dosage

: 20mg/ml

Indication

: For hypertensive patient

Action

: a direct acting peripheral vasodilator that relaxes arteriolar smooth muscles

Adverse Reaction

: tachycardia, palpitation, angina pectoris, severe headache, dizziness, weight gain, GI disturbances, pruritus, rashes,
nausea and vomiting

Nursing Measures

:


 Give oral drug with food to increase bioavailability(drug should be given in a consistent relationship ti ingestion of food
for consistent response to therapy).



Drug may cause a syndrome resembling systemic lupus erythematosus (SLE). Arrange for CBC, LE cell preparations, and
ANA titers before and periodically during prolonged therapy, even in the asymptomatic patient. Discontinue if blood
dyscrasias occur. Reevaluate therapy if ANA or LE tests are positive.



Arrange for pyridoxine if patient develops symptoms of peripheral neuritis.



Monitor patient for orthostatic hypotension which is most marked in the morning and in hot weather, and with alcohol
or exercise.

14) HYDROCORTISONE SODIUM SUCCINATE



Brand name

: A-hydroCort, Solu-Cortef

Classification

: corticosteroid hormones

Stock Dose

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

Indication

: endocrine, hematologic, rheumatic & collagen disorders, dermatologic, ophth, GI, resp & neoplastic diseases,
edematous states, control of severe incapacitating allergic conditions, TB meningitis w/ subarachnoid block or
impending block when used concurrently with appropriate anti-TB chemotherapy, shock secondary to adrenocortical
insufficiency or shock unresponsive to conventional therapy when adrenocortical insufficiency may be present

Action

: Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes, suppresses immune response,
stimulates bone marrow and influences protein, fat, and carbohydrate metabolism

Adverse Reactions

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

:



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



Space multiple doses evenly throughout the day.



Do not give IM injections if patient has thrombocytopenic purpura.



Rotate sites of IM repository injections to avoid local atrophy.



Use minimal doses for minimal duration to minimize adverse effects.



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



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



Use alternate-day maintenance therapy with short-acting corticosteroids whenever possible.



Do not give live virus vaccines with immunosuppressive doses of hydrocortisone.



Provide antacids between meals to help avoid peptic ulcer.

15) ISOSORBIDE-5- MONONITRATE



Brand name

: Imdur

Classification

: anti- anginal drug
Stock Dose

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

Indication

: prophylactic treatment of angina pectoris

Action

: Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug also may increase blood flow
through the collateral coronary vessels

Adverse Reactions

: headache, hypotension w/ dizziness and nausea, tachycardia

Nursing Measures

:



Monitor BP and heart rate.



Assess location, duration, intensity, and precipitating factors of anginal pain. 16) ISOSORBIDE DINITRATE Brand name

: Isoket IV

Classification

: anti

–

anginal drug

Stock

: IV amp 10 mg/ 10 mL

Dose

: 10 mg/10mL

Indication

: unresponsive left ventricular failure secondary to acute MI, severe or unstable angina pectoris

Action

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

Nursing Measures

:



Monitor BP and heart rate.



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

17) MAGNESIUM SULFATE



Brand name

: Elin Magnesium Sulfate

Classification

: anticonvulsant

Dosage

: 250 mg/10 mL

Indication

: treatment of hypomagnesemia accompanied by signs of tetany, control of HTN, encephalophathy & convulsions,
prevention & control of convulsions in patients w/ preeclampsia or eclampsia, prevention of hypomagnesemia in
patients receiving TPN

Action

: may decrease acetylcholine released by nerve impulses, but its anticonvulsant mechanism is unknown

Adverse Reactions

: flushing, sweating, hypotension, muscular weakness, sedation & confusion; decreased deep tendon reflexes; resp.
paralysis

Nursing Measures:


 Monitor the following: I.V.: Rapid administration: ECG monitoring, vital signs, deep tendon reflexes; magnesium,
calcium, and potassium levels; renal function during administration. Obstetrics: Patient status including vital signs,
oxygen saturation, deep tendon reflexes, level of consciousness, fetal heart rate, maternal uterine activity. Oral: Renal
function; magnesium levels; bowel movements.

18) MEPERIDINE HYDROCHLORIDE



Brand name

: Demerol

Classification

: antivertigo drug

Dosage

: 100 mg/ 2mL

Indication

: relief of moderate to severe pain, pre-op medication, support of anesth & obstet analgesia

Action

: binds with opiate receptors in the CNS, altering perception of and emotional response to pain

Adverse Reactions

: resp. depression, circulatory depression, resp arrest, shock, cardiac arrest, GI disturbance, light headedness, dizziness,
sedation, nausea, vomiting, sweating, euphoria, dysphoria, weakness, headache, tremor, agitation, uncoordinated
muscle movements, severe convulsions, transient hallucinations & disorientation, visual disturbance, flushing,
tachycardia, bradycardia, palpitation, hypotension, syncope, phlebitis, urinary retention, allergic reactions, pain at
injection site and local tissue irritation.

Nursing Measures

:



 Make position changes slowly and in stages particularly from recumbent to upright posture. Lie down immediately if
light-headedness or dizziness occurs.



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


Avoid driving and other potentially hazardous activities until reaction to drug is known. Codeine may impair ability to
perform tasks requiring mental alertness and therefore to.



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



Hyperactive cough may be lessened by avoiding irritants such as smoking, dust, fumes and other air pollutants.
Humidification of ambient air may provide some relief.



Do not breast feed while taking this drug.

19) METOCLOPRAMIDE Brand name

: Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-Metoclopramide (CAN), Octamide PFS, Reglan

Classification

: antiemetic & anti-spasmodic Dosage

: 10 mg/ 2mL

Indication

: disturbances of GI motility, nausea & vomiting of central & peripheral origin associated w/ surgery, metabolic diseases,
infectious & drug induced diseases, facilitate small bowel intubation & radiological procedures of GIT

Action

: stimulates motility of upper GI tract, increases lower esophageal sphincter tone, and blocks dopamine receptors at the
chemoreceptor trigger zone

Adverse Reactions

: extrapyramidal reactions, drowsiness, fatigue & lassitude, anxiety, less frequently, insomnia, headache, dizziness,
nausea, galactorrhea, gynecomastia, bowel disturbances.

Nursing Measures

:



Monitor BP carefully during IV administration.



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


Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is compromised by
alterations in timing of food absorption.



Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM).



Have phentolamine readily available in case of hypertensive crisis (most likely to occur with undiagnosed
pheochromocytoma).

20) MIDAZOLAM HYDROCHLORIDE



Brand name

: Dormicum

Classification

: hypnotics & sedatives

Dosage

: 5mg/5mL

Indication

: tab: disturbances of sleep rhythm, insomnia esp difficulty in falling asleep either initially or after premature awakening,
tab/inj: sedation in premed before surgical or diagnostic procedures, induction & maintenance of anesth.

Action

: may potentiate the effects of GABA, depress the CNS, and suppress the spread of seizure activity

Adverse Reactions

: rarely cardioresp adverse events, nausea, vomiting, headache, hiccoughs, laryngospasm, dyspnoea, hallucination,
oversedation, drowsiness, ataxia, rash, paradoxical reactions, amnesic episodes.

Nursing Measures

:



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



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


Administer IM injections deep into muscle.



Monitor IV injection site for extravasation.



Arrange to reduce dose of midazolam if patient is also being given opioid analgesics; reduce dosage by at least 50% and
monitor patient closely. 

Monitor level of consciousness prior to, during, and for at least 2

–

6 hr after administration of midazolam.



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



Keep resuscitative facilities readily available; have flumazenil available as antidote if overdose should occur.



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



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



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



Provide comfort measures and reassurance for patients receiving diazepam for tetanus.



Arrange to taper dosage gradually after long-term therapy.



Provide patient with written information regarding recovery and follow-up care. Midazolam is a potent amnesiac and
memory may be altered.

21) MORPHINE SULFATE



Brand name
: Morin

Classification

: Analgesics (Opioid)

Dosage

: Adult 5-20 mg IM/SC 4 hrly. Severe or chronic pain Childn 10 mg IM/SC 4 hrly, range: 5-20 mg; 6-12 yr 5-10 mg, 1-5 yr
2.5-5 mg, 1-12 mth 200 mcg/kg, <1 mth 150 mcg/kg 4 hrly. Max: 15 mg. Analgesic effect Ped 100-200 mcg/kg SC 4 hrly,
max: 15 mg/dose; or 50-100 mcg/kg slow IV. Pre-op 50-100 mcg/kg IM, max: 10 mg/dose.

Indication

: Relief of moderate to severe pain not responsive to non-narcotic analgesics. Premed. Analgesic adjunct in general
anesth esp in pain associated w/ cancer, MI & surgery. Alleviates anxiety associated w/ severe pain. Hypnotic for pain-
related sleeplessness.

Action

: alters perception and emotional response to pain

Adverse Reactions

: Lightheadedness, dizziness, sedation, nausea, vomiting, constipation & sweating.

Nursing Measures

:



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



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



Tell patient to lie down during IV administration.



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

Use caution when injecting SC or IM into chilled areas or in patients with hypotension or in shock; impaired perfusion
may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored.



Reassure patients that they are unlikely to become addicted; most patients who receive opioids for medical reasons do
not develop dependence syndromes.

22) NICARDIPINE HYDROCHLORIDE
Brand name

: Cardepine

Classification

: Calcium Antagonists

Dosage

: IV infusion Dilute to 10-20 mg/100 mL (conc of 1.01-0.02%). Initial infusion rate: 5 mg/hr; titrate dose up to 15 mg/hr
until desired therapeutic response is achieved

(DBP <95 mmHg, SBP <140 mmHg). Maintenance rate: Can be tapered down to ≤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, don’t exceed five doses in 24 hours.





Advise patient that drug is only for short term use and to consult the physician if giving to children for longer than 5
days or adults for longer than 10 days.



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



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

25) PHENYTOIN



Brand name

: Dilantin

Classification
: Anticonvulsants

Dosage

: Adult Initially 100 mg tid. Maintenance: 300-400 mg daily.

Childn ≥6 yr

 Initially 100 mg tid, subsequent dosage should be adjusted according to therapeutic response, <6 yr 30 mg bid, may be
increased to 30 mg tid or qid. Pedia 5 mg/kg/day Initially in 2-3 equally divided doses. Max: 300 mg daily. Maintenance:
4-8 mg/kg/day Indication

: Tonic

-

clonic & complex partial (psychomotor, temporal lobe), prevention &

treatment of seizures occurring during or following neurosurgery



Action

:



may stabilize neuronal membranes and limit seizure activity by either by

increasing ef

flux or decreasing influx of Na ions across



cell membrane in the motor

cortex during generation of nerve impulses



Adverse R

eactions

: GI disturbances; ataxia, slurred speech; diplopia, nystagmus &

mental confusion w/ headache, dizziness, gingival hyperplasi

a, 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



Indicatio

n

:



For reversible airways obstruction, in

asthma

,

COPD

. Decreases uterine

contractility & may b

e 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 Mea

sures

:







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 nam

e:

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 morni

ng. 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 c

oronary

insufficiency,

angina pectoris

,

paroxysmal supraventricular tachycardia
,

tachyarrhythm

ias, 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 R

eactions

: Constipation, dizziness, nausea. Rarely, vertigo, hea

dache,

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.







M

onitor 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 hepati

c 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

-

qi

d.



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 mu

scle 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 disturba

nces, 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. Stor

e 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 prev

ent

hyperpyrexia.







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



Teach patient proper use of inhalator.




29) FENOTEROL/IPRATROPIUM BROMIDE




Brand name

: Berodua

l




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 cas

es, 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 bronch

ospasm associated with

bronchial asthma and especially chronic bronchitis with or without emphysema



Adverse R

eactions
:



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 unu

sed 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

h

yperpyrexia.







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 m

cg x 60 doses
Indication

:

regular treatment of asthma where use of a combination (inhaled

corticosteroid and long acting beta 2 agonist) is appropriate



Action

: work by reducing inflammation, which helps with several conditions ranging

from



asthma



to



allergies



to

Crohn

’

s disease



Adverse Re

actions

: Abdominal pai

n, 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, vir
a

l 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,

e

xcessive 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 u

se; 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

: muscle

s in the airways and increase air flow to the lungs



Adverse R

eactions

: Fine tremor of skeletal muscle; palpitations; headache, dizziness,

nervousness; dryness of mouth, throa

t 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 t

o 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 R

eactions

: Dizziness, s

evere; 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 effecti

veness of medica

tion.







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 remainin

g

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 t

o avoid respiratory irritants.




Advise the mother to rinse the child’s mouth with water after each inhalation do

se

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 R

eactions

: 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 R

eactions

: Slight fever, headache, chi

lls, nausea, vomiting, constipation,

epistaxis, bruising, slight haematuria, skin necrosis (SC inj), osteoporosis, alopecia.

Hypersensitivity reactions include urticaria, conjunctivitis, rhinitis, asthma, angioedema

an

d anaphylactic shock. Priapism.

Potent

ially 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 da

ily







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







O

bserve 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

:

supraventricula

r 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 R

eactions

: Hypotension, bradycardia, heart failure, local irritation,

diaphoresis, peripheral ischaemia, dizziness, somnolence, confusion, fatigue,

paraesthesia, peripheral neurop

athy, headache, weakness, irritability, dyspnoea,

nausea, vomiting, blurred vision, urinary retention, fever, rigor, muscular pain.

Potentially Fatal:



Profound bradycardia, AV block, cardiogeni

c shock, asystole,

bronchospasm.



Nursing Measures

:




Monitor pati

ent 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 peri

odically

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 gl

yconeogenesis and promotes

anabolism in patients whose oral caloric intake is limited



Adverse R

eactions

: Local pain, vein irritation, thrombophlebitis & tissue necrosis in the

event of extravasation. Fluid & electrolyte imbalance eg hypokalemia, hypomagne

semia

& 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 I

V 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) POT

ASSIUM 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



A

dverse



R

eactions

: GI ulceration (s

ometimes with haemorrhage and perforation or

with late formation of strictures) following the use of enteric

-

coated K chloride

preparation; hyperkalaemia. Oral: Nausea, vomiting,
p

hlebiti



and abdominal cramps. IV:

Pain or

p

hlebitis

; cardiac toxicity.



Nursi

ng 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 so

on 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.







Pa

tient 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; unusu

al 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 progres

s.




38) LIDOCAINE H

YDROCHLORIDE



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



Ad

verse R

eactions

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

upsets; muscle twitching, convulsions; numbness of the tongue; hypotension,

bradycardia; methemo
globinaemia; 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 sev

ere

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 mal

ignant 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, digita

lis toxicity with AV block,

and geriatric patients.







Monitor fluid load carefully; more concentrated solutions can be used to treat

arrhythmias in patients on fluid restrictions.




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

flat for 6

–

12 hr afterward, and ensure that they are adequately hydrated to

minimize risk of headache.







Check lidocaine preparation carefully; epinephrine is added to solutions of

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



site.

Be sure that such solutions are used







only to produce local anesthesia. These solutions should be injected cautiously in

body areas supplied by end arteries and used cautiously in patients with

peripheral vascular disease, hypertension, thyrotoxicos

is, or diabetes.







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

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



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



over 10 min.







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

the skin.







Monitor for safe and effective serum drug concentrations (antiarrhythmic use: 1

–

5 mcg/mL). Doses > 6

–

10 mcg/mL are usually toxic




39) SODIUM BICARBONATE




B

rand 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 ex

cess 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 infil

tration



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 alkalo

sis may produce tetany, hypertension, seizures, or

heart failure.







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




40) DOPAMINE




Brand name

: Intropin



Classification

: Adrenergics (Sympathomimetics)



Dosage

: 40 mg/Ml; 80

 

mg/mL

;

160 mg/mL
Indication



:



shock and hemodynamic imbalances, hypotension



Action

: Stimulates dopaminergic and alpha beta receptors for the sympathetic nervous

system resulting in a positive inotropic effect and increased cardiac output. Action is

dose

-

r

elated; 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 significa

nt 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 treat

ment of cardiac decompensation

caused by depressed contractility



Action

: Stimulates heart’s beta

1



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, phlebit

is, 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 o

f 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

: Ant

iarrhythmic 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 inhibit

ing 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 p

hase 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 alte

red 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, venou

s 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, an

d edema,

may occur with intradermal injection.




Systemic effects can occur following topical use; use lowest possible dose to

avoid serious toxicity, shock, or heart block.







Do not use in patients with congenital or idiopathic methemoglobinemia or in

infants



younger than 12

 

mo of age who are receiving methemoglobin

-

inducing

drugs.







Use with caution and in lower doses in patients with CHF, reduced cardiac

output, digitalis toxicity, and in elderly patients




43) MANNITOL




Brand name

: Osmitrol



Classification
: osmotic diuretic



D

osage

: 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 t

ongue), 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 sit

e, 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, n

ausea, vomiting, tremor, headache, chest pain







To relieve thirst, give frequent mouth care and fluids




44) DEXTROSE 5% IN WATER (D5W) SOLUTION




Brand name

: None
Classificat

ion

: Isotonic/Hypotonic Solution



Dosage

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



Indi

cation

:



fluid replacement and caloric supplementation in patients who can’t

maintain adequate oral intake or are restricted from doing so



Action

: Provides some sugar for cellular metabolism and supplies body water



Adverse Reaction

: Increases free water and



may cause intracellular edema, fluid

overload, infiltration (swelling and pain at infusion site)



Nursing



Measures

:




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

may

result in fluid overload.







Check IV site frequen

tly 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)
.