ER Meds

Drug Name: Aminophylline (theophylline ethylenediamide)
Classification: Xanthine Derivative, Bronchodilator
Mechanism of Action:
Aminophylline
Acts on
Sympathetic Nervous System
Which stimulates the
Adrenal Medulla
Which releases
Epinephrine
Which causes
BRONCHODILATION
Drug Name: Amiodarone Hydrochloride
Classification: Antiarrhythmic
Mechanism of Action:
Dosage: !" m#$ %ml
Amiodarone hydrochloride
A delay in the rate at &hich the heart's electrical system (rechar#es(
a)ter the heart contracts (repolari*ation)
A prolon#ation in the electrical phase durin# &hich the heart's
muscle cells are electrically stimulated (action potential)
A slo&in# o) the speed o) electrical conduction (ho& )ast each
individual impulse is conducted throu#h the heart's electrical
system)
A reduction in the rapidity o) )irin# o) the normal #enerator o)
electrical impulses in the heart (the heart's pacema+er)
A slo&in# o) conduction throu#h various speciali*ed electrical
path&ays (called accessory path&ays) &hich can ,e responsi,le )or
arrhythmias-
Dosage: .!"m#$"ml in/ection
Indications:
- 0o prevent and relieve symptoms o) acute ,ronchial asthma-
.- 0reatment o) ,ronchospasm associated &ith chronic ,ronchitis and
emphysema-
%- As a respiratory stimulant in 1heyne2Sto+es respiration-
3- 4or treatment o) apnea and ,radycardia in premature in)ants-
!- As cardiac stimulant and diuretic in treatment o) 1H4-
Adverse ffect:
• CN!: Nervousness, restlessness, depression, insomnia, irrita,ility, headache,
di**iness, muscle hyperactivity, convulsions
• C": 1ardiac arrhythmias, tachycardia (&ith rapid 56), hyperventilation,
chest pain, severe hypotension, cardiac arrest
• #I: Nausea, vomitin#, anorexia, hematemesis, diarrhea, epi#astric pain
Contraindication:
- Hypersensitivity to xanthine derivatives or to
ethylenediamine component.
.- Cardiac arrhythmias.
Nursing Res$onsi%ilities:
- Observe patients receiving parenteral drug closely for signs
of hypotension, arrhythmias, and convulsions until serum
theophylline stabilizes within the therapeutic range.
.- Monitor & record vital signs and &O. ! sudden, sharp,
unexplained rise in heart rate may indicate toxicity.
%- "se of tobacco tends to increase elimination of this drug
#shortens half$life%, necessitating higher dosage or shorter
intervals than in non$smo&ers.
3- 'izziness is a relatively common side e(ect, particularly in
older adults) ta&e necessary safety precautions.
!- *eport excessive nervousness or insomnia.
Indication : 7i)e threatenin# ventricular arrhythmias
Adverse ffect:
- Di**iness 8- Bradycardia
.- 4ati#ue 9- Asystole
%- Headache :- 1ardiac arrest
3- 5nsomnia ;- 0hrom,ocytopenia
!- Sleep distur,ances ."- Hepatic dys)unction
8- 5nvoluntary movements .- Adult respiratory distress syndrome
9- Hypotension ..- <ulmonary edema
:- Heart )ailure .%- 4lushin#
;- Worsenin# arrhythmia .3- <hotosensitivity
"- A6 ,loc+ .!- A,normal taste and smell
- 6entricular tachycardia .8- Edema
.- <apilledema .9- Stevens2=ohnson Syndrome
%- Nausea and vomitin#
3- 1onstipations
!- 1oa#ulation a,normalities
Contraindication:
- Hypersensitivity to dru# and its components includin# iodine-
.- 1ardio#enic shoc+
%- .
nd
or %
rd
de#ree A6 ,loc+
3- Mar+ed sinus ,radycardia
!- Breast)eedin#
8- Neonates
Nursing Res$onsi%ilities:
- 5n)orm patient that dru# may cause serious adverse reactions, instruct to
report these immediately-
.- Monitor E1> continuously durin# loadin# dose and &hen dosa#e is
chan#ed-
%- 0ell patient to ta+e oral doses &ith meals- Advise him to divide daily dose
into t&o doses i) dru# causes >5 upset-
3- !ssess for signs and symptoms of lung in+ammation.
,. nform patient that he-ll undergo regular blood testing, eye
examinations, chest x$ray and pulmonary function tests
during therapy.
.. /ell patient that adverse reactions are most common with
high doses and may become more fre0uent after . months of
Drug Name: Atropine Sul)ate (Atropair , Atropisol, 5sopto Atropine)
Classification: Autonomic Nervous System A#ent? Anticholiner#ic (<ara2
Sympatholytic)? Antimuscarinic
Mechanism of Action:
Dosage: "-!2 m# 56
Indications:
- Ad/unct in symptomatic treatment o) >5 disorders and spastic disorders o)
,iliary tract- @elaAes upper >5 tract and colon durin# hypotonic radio#raphy-
.- 0o supress salivation, perspiration, and respiratory tract secretions-
%- 0o reduce incidence o) laryn#ospasm, re)leA ,radycardia arrhythmia and
hypotension durin# #eneral anesthesia-
Adverse ffect:
• CN!: Blurred vision, mydriasis, cyclople#ia, photopho,ia, increased 5B<,
headache, )lushin#, nervousness, &ea+ness, di**iness-
• C": <alpitations, ,radycardia (lo& doses), tachycardia (hi#her doses)
Drug Name: Budesonide
Classification: 1orticosteroid
Mechanism of Action:
Dosage:
Nasal inhalation
• ADC70S AND <A05EN0S D 8 E@
 5nitial dose, 83 mc#$day #iven as spray in each nostril mornin# and
evenin#- A)ter desired clinical e))ect is achieved, reduce dose to the
smallest dose possi,le to maintain the control o) symptoms- >enerally ta+es
%F9 days to achieve maAimum clinical e))ect-
• #&: Crinary hesitancy and retention
Contraindication:
- Hypersensitivity to ,elladonna al+aloids
.- Synechiae
%- An#le2closure #laucoma
3- <arotitis
!- B,structive uropathy
8- 5ntestinal atony
9- <aralytic ileus
:- B,structive diseases o) >5 tract
;- Severe ulcerative colitis
"- 0oAic me#acolon
- 0achycardia secondary to cardiac insu))iciency or thyrotoAicosis
.- Acute hemorrha#e
Nursing Res$onsi%ilities:
1. Monitor vital signs. H* is a sensitive indicator of patient2s
response to atropine.
.- Ensure adeGuate hydration? provide environmental control (temperature) to
prevent hyperpyreAia
%- Have patient void ,e)ore ta+in# medication i) urinary retention is a pro,lem-
3- 0a+e as prescri,ed, %" minutes ,e)ore meals? avoid eAcessive dosa#e-
'ulmicort Tur%uhaler
• ADC70S
 <reviously on inhaled corticosteroidsH 5nitially, .""F3"" mc# t&ice daily,
maAimum dose, :"" mc# ,id (3 inhalations)- <reviously on ,ronchodilators
aloneH .""F3"" mc# ,id- <reviously on oral corticosteroidsH 3""F:"" mc#
,id-
• <ED5A0@51 <A05EN0S
 1hildren D 8 yr previously on inhaled corticosteroidsH ."" mc# ,id-
 1hildren D 8 yr previously on ,ronchodilators aloneH ."" mc# ,id-
 1hildren D 8 yr previously on oral corticosteroidsH 3"" mc# ,id-
Res$ules
• <ED5A0@51 <A05EN0S . MBF: E@
 "-.!F m# once daily or in t&o divided doses o) @espules, usin# /et
ne,uli*er-
Oral
• ADC70S
 ; m#$day <B ta+en in the mornin# )or up to : &+- @ecurrent episodes may
,e retreated )or :2&+ periods-
Indications:
- @hinocort AGuaH Mana#ement o) symptoms o) seasonal o) perennial aller#ic
rhinitis in adults and children? nonaller#ic perennial rhinitis in adults-
.- 0ur,u,alerH Maintenance treatment o) asthma as prophylactic therapy in
adults and children a#e 8 year and older and )or patients reGuirin#
corticosteroids )or asthma-
%- 5nhalation suspensionH Maintenance treatment and prophylaAis therapy o)
asthma in . mo2: year-
3- BralH 0reatment and maintenance o) clinical remission )or up to % mo o) mild
to moderate active 1rohnIs disease involvin# the ileum and ascendin# colon-
Adverse ffect:
• CN!: headache, di**iness, lethar#y, )ati#ue, paresthesias, nervousness
• DRM: rash, edema, pruritus, alopecia
• NDO: 1ushin#Is syndrome &ith overdosa#e and systemic a,sorption
• #I: nausea, dyspepsia, dry mouth
Contraindication:
• 5nhalation
- 1ontraindicated &ith hypersensitivity to dru# or )or relie) o) acute
asthma or ,ronchospasm
.- Cse cautiously &ith 0B, systemic in)ections, lactation
• Bral
- 1ontraindicated &ith hypersensitivity to dru#, lactation
.- Cse cautiously &ith 0B, hypertension, dia,etes mellitus, osteoporosis,
peptic ulcer disease, #laucoma, cataracts, )amily history o) dia,etes or
#laucoma, other conditions in &hich #lucocorticosteroids may have
un&anted e))ects
• Nasal
- 1ontraindicated &ith hypersensitivity to dru#, nasal in)ections, nasal
trauma, nasal septal ulcers, recent nasal sur#ery
.- Cse cautiously &ith lactation, 0B, systemic in)ection
Nursing Res$onsi%ilities:
A!!!!MNT
- Histor(: untreated local nasal in)ections, nasal trauma, septal ulcers,
recent nasal sur#ery, lactation
.- 'h(sical: B<, <, auscultation? @, adventitious sounds? eAamination o)
nares
• Inhalation
 Blac) %o* +arning taper systemic steroids care)ully durin# trans)er to
inhalational steroids? deaths )rom adrenal insu))iciency have occurred-
- Arran#e )or use o) decon#estant nose drops to )acilitate penetration i)
edema, eAcessive secretions are present-
.- <rime unit ,e)ore use )or <ulmicort 0ur,uhaler? have patient rinse
mouth a)ter each use-
%- Cse aerosol &ithin 8 mo o) openin#- Sha+e &ell ,e)ore each use-
3- Store @espules upri#ht and protected )rom li#ht? #ently sha+e ,e)ore
use? open envelopes should ,e discarded a)ter . &+-
• Nasal Inhalation
- <rime pump : times ,e)ore )irst use- 5) not used )or . consecutive days,
reprime &ith spray or until )ine mist appears- 5) not used )or more
than 3 days, rinse applicator and reprime &ith . sprays or until )ine
mist appears-
Drug Name: Bumetanide
Classification: 7oop (hi#h ceilin#) diuretic
Mechanism of Action:
Dosage:
Indication:
- Edema associated &ith 1H4, cirrhosis, renal disease
.- Acute pulmonary edema (56)
%- Cnla,eled useH treatment o) adult nocturia (not e))ective in men &ith B<H)
Contraindication
- Aller#y to ,umetanide !- Hepatic coma ;- 7actation
.- Electrolyte depletion 8- S7E
%- Anuria 9- >out
3- Severe renal )ailure :- Dia,etes mellitus
Ascendin# lim, o) the
loop o) henle
<roAimal and distal
tu,ules
5nhi,its rea,sorption
o) Na and 1l
Na2rich diuresis
• Oral
- Ma+e sure patient does not cut, crush, or che& capsules? they must ,e
s&allo&ed &hole-
.- Administer the dru# once each day, in the mornin#? do not administer
&ith #rape)ruit /uice-
%- Encoura#e patient to complete )ull : &+ o) dru# therapy-
,ARNIN#: Monitor patient )or si#ns o) hypercorticismJacne, ,ruisin#, moon
)ace, s&ollen an+les, hirsutism, s+in striae, ,u))alo humpJ&hich could indicate
need to decrease dosa#e-
TACHIN# 'OINT!:
• Inhalation
- Do not use more o)ten than prescri,ed? do not stop &ithout consultin#
your health care provider-
.- 5t may ta+e several days to achieve #ood e))ects? do not stop i) e))ects
are not immediate-
%- Cse decon#estant nose drops )irst i) nasal passa#es are ,loc+ed-
3- <rime unit ,e)ore use )or <ulmicort 0ur,uhaler? rinse mouth a)ter each
use-
!- Store @espules upri#ht, protect )rom li#ht? discard open envelopes a)ter
. &+? #ently sha+e ,e)ore use-
8- Eou may eAperience these side e))ectsH 7ocal irritation (use your device
correctly), dry mouth (suc+ su#arless lo*en#es)-
9- @eport sore mouth, sore throat, &orsenin# o) symptoms, severe
snee*in#, eAposure to chic+enpoA or measles, eye in)ections-
• Oral
- 0a+e the dru# once a day in the mornin#- Do not cut, crush, or che& the
capsules, they must ,e s&allo&ed &hole-
.- 5) you miss a day, ta+e the capsules as soon as you remem,er them-
0a+e the neAt day's capsules at the re#ular time- Do not ta+e more than
three capsules in a day-
%- 0a+e the )ull course o) the dru# therapy (: &+ in most cases)-
Adverse ffect:
1. AsteriAis 9- 1ardiac arrhythmias
3. Di**iness :- 0hrom,ophle,itis
4. 6erti#o ;- Nausea and vomitin#
4. <aresthesia ."- AnoreAia
5. 1on)usion .- Diarrhea
6. 4ati#ue ..- >astric irritation and pain
7. Nysta#mus .%- Dry mouth
5. Wea+ness .3- Acute pancreatitis
6. Headache .!- =aundice
17. Dro&siness .8- <olyuria
11. Blurred vision .9- Nocturia
12. 0innitus .:- >lycosuria
13. 5rreversi,le hearin# loss .;- @enal )ailure
18. Brthostatic hypotension, %"- 7eu+openia
15. 6olume depletion %. Anemia,
1.. 0hrom,ocytopenia
Nursing Res$onsi%ilities:
- >ive &ith )ood or mil+ to prevent >5 upset-
.- Mar+ calendars or use reminders i) intermittent therapy is ,est )or treatin#
edema-
%- >ive sin#le dose early in day so increased urination &ill not distur, sleep-
3- Avoid 56 use i) oral use is possi,le-
!- Arran#e to monitor serum electrolytes, hydration, liver )unction durin# lon#2
term therapy-
8- <rovide diet rich in potassium or supplemental potassium-
Drug Name: 1aptopril
Classification: A1E inhi,itor
Mechanism of Action:
Dosage:
Indication:
-hypertension
.- heart )ailure
%- dia,etic nephropathy
3- le)t ventricular dys)unction a)ter M5
Contraindication:
- contraindication &ith patients hypersensitive to the dru# or other A1E
inhi,itors-
3. use cautiously in patients &ith renal impairment or serous autoimmune
dse- And in patients eAposed to other dru#s +no&n to a))ect WB1
counts or immune response-
Drug Name: Dia*epam
Classification: AntianAiety a#ent, anticoa#ulants
Mechanism of Action:
Dosage: 5n/ection2!m#$ ml "m# 5M
Indication:
- Ad/unct in the mana#ement o)H
 AnAiety
 <reoperative sedation
 1onscious sedation
.- <rovides li#ht anesthesia and antero#rade amnesia
%- S+eletal muscle relaAant-
Dia*epam
<roduces anAiolytic e))ect and
1NS depression
By stimulatin# >ABA receptors
@elaAes s+eletal muscles o)
By inhi,itin# polysynaptic,
a))erent path&ays- 1ontrol sei*ures
By enhancin# presynaptic
Adverse ffect:
• CN!H di**iness, )aintin#, )ever
• C"H an#ina pectoris, heart )ailure, hypotension, pericarditis, tachycardia
• #I: anoreAia, dys#eusia
• #&H nephrotic syndrome, protenuria, renal impairment, urinary )reGuency
• HMATOLO#ICH a#ranulocytosis, leucopenia, pancytopenia,
throm,ocytopenia
• H'ATIC: cholestatic /aundice, elevated liver en*yme levels
• MTABOLICH hyper+alemia
• R!': cou#h
• !-INH maculopapular rash, pruritis, urticarial
• OTHRH an#ioedema
Nursing Res$onsi%ilities:
- Assess patients underlyin# condition ,e)ore therapy and re#ularly therea)ter-
.- Monitor ,lood pressure and pulse rate o)ten-
%- Monitor potassium level and renal )unction-
3- Monitor WB1 and di))erential counts ,e)ore therapy, every . &ee+s )or )irst %
months and periodically therea)ter-
!- Be alert )or adverse reactions and dru# interactions- 0ell patients to ta+e dru#
&ith )ood to minimi*e >5 distress-
8- Warn patients that dru# may cause mildto moderate di**iness and dro&siness at
)irst-
9- Advise patients to avoid ha*ardous activities until e))ects disappear (usually
&ithin %23days)-
:- Advise patients to have periodic eye eAaminations-
;- 0ell patient not to crush or che& capsules or their contents-
Adverse ffect:
• CN!H Di**iness, dro&siness, lethar#y, depression, restlessness, manic or
hypomanic episodes, tremor-
• C": Bradycardia, tachycardia, hypertension, hypotension, palpitation-
• #I: Nausea, vomitin#, #astric disorder, constipation, diarrhea-
• NT: Blurred vision, nasal con#estion, diplopia-
Contraindication:
- Hypersensitivity to dru#, other ,en*odia*epines, alcohol, or tartra*ine-
.- 1oma or 1NS depression-
%- Narro&2an#le #laucoma
Nursing Res$onsi%ilities:
- Monitor vital si#ns and respirator and neurolo#ic status-
.- Supervise am,ulation, especially in elderly patients-
%- Monitor 1B1 and +idney and liver )unction test results-
8. Avoid sudden dru# &ithdra&al- 0aper dosa#e #radually to termination o)
therapy-
Drug Name: 1alcium >luconate
Classification: 4luid and electrolytic and &ater ,alance a#ent-
Mechanism of Action:
Dosage:
• IN.CTABL: !""m#$m7
• TABLTH !" m#, !""m#, 8!"m#
• CA'!&L: !""m#
1alcium
re#ulates eAcitstion o) threshold o)
nerves and muscle
maintains renal )unction
re#ulates stora#e and release o)
neurotransmitter and hormones
acts li+e di#italis in heart
increasin# cardiac muscle tone and )orce
o) systolic contraction
positive inotropic
e))ect
Drug Name: Di#oAin
Classification: 1ardiac #lycoside? 1ardiotonic
Mechanism of Action:
Dosage:
Adults: 7oadin# doseH "-9!2-.! m# <B or "-.2"-.!m# 56
Maintenance doseH "-.!F"-.! m#$day <B-
7anoAicaps capsules
7oadin# doseH "-3 F"-8 m# <B
Maintenance doseH "- F"-% m#$day <B
Di#oAin
Acts ,y inhi,itin# the Na2K2A0<ase
pump in myocardial cells
5ncreased intracellular sodium
promotes sodium2calcium eAchan#e
leadin# to a rise in the intracellular
calcium concentration-
results in improved isolated myocyte
contractile per)ormance (increased
shortenin# velocity) and overall le)t
ventricular (76) systolic )unction-
Indication:
- 0o overcome cardiac toAicity in hyper+alemia
.- 4or cardiopulmonary resuscitation
%- 0o prevent hypocalcemia durin# trans)usion o) citrated ,lood
3- Antidote )or ma#nesium sul)ate
!- 4or acute symptoms )or lead colic , to decrease
Adverse ffect:
• ,HOL BOD/H tin#lin# sensation )aintin#
• #IH <B preparation , constipation, increase #astric acid secretion
• C"H ( &$ rapid in)usion) hypotension, ,radycardia , cardiac arrthymias ,
cardiac arrest
• !-INH pain and ,urnin# L 56 site , severe venous throm,osis, necrosis
slou#hin# ( &$ eAtravasation)
Contraindication:
- 6entricular )i,rillation
.- Metastatic ,one disease
%- 5n/ection into myocardium administration throu#h S1 or 5M
3- @enal calculi
!- Hypocalcemia
8- <redisposition to hypercalcemia-
Nursing Res$onsi%ilities:
- @eport s$s )or hypercalcemia promptly to your health care provider
.- Mil+ and mil+ products are the ,est sources o) calcium ( and phosphorus)
other #ood sources include #reen ve#eta,les, soy ,eans ,to)u canned )ish
&ith ,ones
%- 1alcium a,sorption can ,e inhi,ited ,y *inc rich )oods, nuts ,seeds , sprouts,
le#umes , soy products (to)u)
3- 1hec+ &ith physician ,e)ore sel)2medicatin# &ith a calcium supplements
!- DonIt ,reast)eed &hile ta+in# the dru# &ithout consultin# a physician
Indication:
- Heart )ailure
.- <aroAysmal supraventricular tachycardia
%- Atrial )i,rillation and )lutter
Adverse ffect:
CN!: )ati#ue, #enerali*ed muscle &ea+ness, a#itation, hallucinations,
C": arrhythmias, heart ,loc+-
NT: yello&2#reen halos around visual ima#es, ,lurred vision, li#ht )lashes,
photopho,ia, and diplopia-
#I: anoreAia, nausea
Contraindication:
- 1ontraindicated in patients hypersensitive to dru# and in those &ith di#italis2
induced toAicity, ventricular )i,rillation, or ventricular tachycardia unless
caused ,y heart )ailure-
.- <atients &ith Wol))2<ar+inson2White syndrome unless the conduction
accessory path&ay has ,een pharmacolo#ically or sur#ically disa,led-
%- Elderly patients and in those &ith acute M5, incomplete A6 ,loc+, sinus
,radycardia, <61s, chronic constrictive pericarditis
Nursing Res$onsi%ilities:
- Dru#2induced arrhythmias may increase the severity o) heart )ailure and
hypotension-
.- Be)ore #ivin# loadin# dose , o,tain ,aseline data (heart rate and rhythm, ,lood
pressure, and electrolytes)and as+ patient a,out use o) cardiac #lycosides
&ithin the previous . to % &ee+s-
%- 7oadin# dose is usually divided over the )irst .3 hours &ith approAimately
hal) the loadin# dose #iven in the )irst dose-
3- Be)ore #ivin# dru#, ta+e apical2radial pulse )or minute- @ecord and noti)y
prescri,er o) si#ni)icant chan#es-
!- Withold dru#H <C7SE @A0EH Belo+ 01 %eats2minute
8- Monitor si#ns o) DI#ITALI! TO3ICIT/: M4ati#ue, Malaise, Depression,
6omitin#, AnoreAia, NauseaN
9- !ignificant !ignH 1B7B@ED 65S5BN,XAN0B<S5AMEello&ish SpotsN
5. ANTIDOT:D5>BX5N 5MMCNE 4ABM Di#i,ind, Di#i4a,N
Drug Name: Diphenhydramine
Classification: Antihistamine
Mechanism of Action:
Dosage: <er BremH .!2!" m# 05D2 O5D , 56H "2!"m# up to ""m#$56
Indication:
- 0reatment o) hypersensitivity reactions
.- 0reatment o) motion sic+ness
%- 0reatment o) <ar+insonism
3- Ni#httime sleep aid
!- Antitussive
Adverse ffect:
Headache
Dro&siness
Di**iness
Dry mouth$nose$throat
AnoreAia
AnAiety
>5 upset
Bloc+s H2 receptors on e))ector cells
o) the >5 tract, ,lood vessels, and
respiratory tract
Decreases aller#ic response
Bloc+in# histamine
5ncrease heart rate and vasodilation
secretions
Drug Name: Do,utamine Hydrochloride
Classification: Beta2selective adrener#ic a#onist, Sympathomimetic
Mechanism of Action:
Dosage: !"m#$m7 (.!" m#$!m7)
Indication:
45 4or inotropic support in the short2term treatment o) adults &ith cardiac
decompensatin# due to depressed contractility, resultin# )rom either or#anic
heart disease or )rom cardiac sur#ical procedure-
Adverse ffect:
- CN!: Headache
.- C": 5ncrease in H@, increase in systolic B<, increase in ventricular ectopic
,eats (<61s), an#ina pain, palpitations, shortness o) ,reath
4. #IH Nausea
Stimulate Beta2adrener#ic receptors
5ncrease the )orce o) myocardial
contractility and stro+e volume
Decrease &or+load o) the heart
5ncrease cardiac output and heart rate
Decrease ,lood pressure
Contraindication:
- Cse &ith other products containin# diphenhydramine
.- Hypersensitivity to antihistamines
Nursing Res$onsi%ilities:
- >ive )ull prophylactic dose %"min- prior to travel i) used as a prophylaAis )or
motion sic+ness
.- 0a+e similar doses &ith meals and at ,edtime
%- Do not use more than . &ee+s to treat insomnia
3- 4or 56, may #ive undiluted
!- Do not eAceed 56 rate o) .!m#$minute
8- Dru# causes dro&siness-
9- Avoid activities reGuirin# mental alertness
:- Cse sun protection as it may cause photosensitivity
;- Cse su#arless candy$#um to diminish dry mouth e))ects
"- Avoid alcohol and other 1NS depressants
Contraindication:
- 1ontraindicated &ith 5HSS? hypovolemia? acute M5? #eneral anesthesia &ith
halo#enated hydrocar,ons or cyclopropane, &hich sensiti*e the myocardium
to catecholamines? pre#nancy-
.- Cse cautiously &ith dia,etes mellitus, lactation? aller#y to sul)ites, more
common in asthmatic patients
Nursing Res$onsi%ilities:
- MonitorH
 Crine )lo&
 1ardiac output
 <ulmonary &ed#e pressure
 E1>
 B<
.- Csed only in acute emer#encies-
4. Administer the dru# throu#h a lar#e vein to prevent eAtravasation-
Drug Name: Dopamine hydrocholride
Classification: positive inotropic a#ent
Mechanism of Action:
Dosage: 3"m#$ml .""m#$!ml
Indication:
- Bradycardia
.- Acute heart )ailure
%- cardio#enic shoc+
Contraindication:
- Hypersensitivity?
.- <heochromocytoma,
%- 6entricular )i,rillation
'opami
!cts in alpha1 and beta1
Causes peripheral
'ecrease myocardial oxygen
ncrease blood
ncrease heart
ncrease cardiac
Drug Name: Epinephrine
Classification: adrener#ic a#ent, inotropic
Mechanism of Action:
,indin# to a variety o) adrener#ic
receptorsincludin# the ma/or
su,types P, P., Q, Q., and Q%
tri##ers a num,er o) meta,olic chan#es
Bindin# to P2adrener#ic receptors
inhi,its insulin secretion ,y the pancreas
Stimulates #lyco#enolysis in the liver and muscle
Stimulates #lycolysis in muscle
Q2Adrener#ic receptor ,indin# tri##ers #luca#on secretion in
the pancreas
5ncreased adrenocorticotropic hormone (A10H) secretion
,y the pituitary #land
increased lipolysis ,y adipose
lead to increased ,lood #lucose and )atty acids
providin# su,strates )or ener#y production &ithin
cells throu#hout the ,ody
Adverse ffect:
- A,normal heart rhythm
.- Slo& heart rate
%- <alpitations
3- 1hest pain
!- 6asodilation
8- Di))iculty in ,reathin#
9- Nausea
:- 6omitin#
;- Headache
"- AnAiety
- <iloerection
.- >an#rene o) eAtremities
Nursing Res$onsi%ilities:
- Monitor patientIs vital si#ns, and E1> durin# in)usion, &atch )or
dysrrhythmias and ischemia- Also monitor <1W<, 16<, 1B., and urinary
output-
.- Monitor possi,le adverse reaction-
%- Assess )or heart )ailureH dyspnea, nec+ vein distention-
3- Assess )or oAy#enation and per)usion de)icit-
!- <alpate peripheral pulses and assess appearance o) eAtremities routinely
durin# dopamine administration- Noti)y physician i) Guality o) pulses
deteriorates or i) eAtremities ,ecome cold or mottled-
8- 5) hypotension occurs, administration rate should ,e increased- 5)
hypotension continues, more potent vasoconstrictors (norephinephrine) may
,e administered-
Dosage: Cardiac arrest: m# 56 o) H",""" solution G %2! min? dou,le dose i)
administerin# via E0 tu,e
Ana$h(la*is: "-2 m# SO or 5M o) H""" solution-
Asthma: "-2"-% m# SO or 5M o) H",""" solution
Refractor( %rad(cardia and h($otension: .2"u#$min
Indication:
- Asthma
.- Bronchitis
%- Emphysema
3- All cardiac arrest, anaphylaAis
!- Csed )or symptomatic ,radycardia-
8- @elie) o) ,ronchospasm occurrin# durin# anesthesia
9- EAercised2induced ,ronchospasm
Adverse ffect:
- Nervousness
.- 0remor
%- 6erti#o
3- <ain
!- Widened pulse 2 pressure
8- Hypertension
9- Nausea
Contraindication:
- contraindicated in patients &ith an#le2closure #laucoma
.- shoc+ (other than anaphylactic shoc+)
%- or#anic ,rain dama#e
3- cardiac dilation
!- arrhythmias
8- coronary insu))iciency
9- cere,ral arteriosclerosis
:- receivin# #eneral anesthesia &ith halo#enated hydrocar,ons or cyclopropane
and patients in la,or (may delay second sta#e)
Nursing Res$onsi%ilities:
- Monitor 6$S and chec+ )or cardiac dysrhythmmias- Dru# increases ri#idity
and tremor in patients &ith <ar+insonIs disease- Epinephrine therapy
inter)eres &ith tests )or urinary catecholamine-
.- Avoid 5M use o) parenteral suspension into ,uttoc+s- >as #an#rene may
occur-
%- Massa#e site a)ter 5M in/ection to counteract possi,le vasoconstriction-
3- B,serve patient closely )or adverse reactions-
!- Noti)y doctor i) adverse reaction develops-
.. 5) ,lood pressure increases sharply, rapid2actin# vasodilators such as
nitrates or alpha ,loc+ers can ,e #iven to counteract-
Drug Name: 9smolol
Classification: !ntiarrhythmic, antihypertensive
Mechanism of Action:
Dosage: 7oadH "-.!2"-! m#$+# 56< over min, then "-"!2"- m#$+#$min 56 )or 3
min
Indication:
- Supraventricular tachycardia
.- Sinus tachycardia or hypertension
Adverse ffect:
• CN!H anAiety, depression, di**iness, dro&siness, headache, a#itation,
)ati#ue, con)usion, speech disorders, asthenia
• C": peripheral ischemia, chest pain, ,radycardia, hypotension
• #I: nausea, vomitin#, heart,urn
• #&H urinary retention @espiratoryH &hee*in#, dyspnea
• !-IN: )lushin#, pallor, erythema
9smolol
Bloc+ ,eta adrenoreceptor in cardiac muscle
Guic+ly and only )or short period o) time
By ,loc+in# these ,eta adreno2receptor
Decrease heart rate
Drug Name: 4urosemide
Classification: 7oop diuretic
Mechanism of Action:
Dosage: 0a,lets .", 3", and :" m#
Indication:
- (oral, 56) edema associated &ith heart )ailure
.- @enal disease-
Adverse ffect:
- Di**iness
.- Brthostatic hypotension
%- <urpura
3- Nausea
!- <olyuria
8- Anemia
Contraindication:
- 1ontraindicated &ith aller#y to )urosemide, sul)onamides-
Nursing Res$onsi%ilities:
- Administer &ith )ood or mil+ to prevent >5 upset-
.- >ive early in day so that increased urination &ill not distur, sleep-
%- Do not eApose dru# to li#ht &hich may discolor ta,lets or solution-
3- Measure and record &ei#ht to monitor )luid chan#es-
!- Arran#e )or potassium rich diet as needed-
Ascendin# lim, o) the
loop o) henle
<roAimal and distal
tu,ules
5nhi,its rea,sorption o) Na
Na2rich diuresis
Contraindication:
- Hypersensitivity to dru#
.- Heart )ailure
%- Heart ,loc+ #reater than third de#ree
3- Sinus ,radycardia
!- 1ardio#enic shoc+
Nursing Res$onsi%ilities:
- EAplain to patient that dru# is an emer#ency measure to control ,lood
pressure, arrhythmias, or heart rate-
.- Ensure patient he'll ,e closely monitored throu#hout dru# therapy-
%- 0ell patient to report pain or redness at 5-6- site-
8. As appropriate, revie& all other si#ni)icant adverse reactions and
interactions, especially those related to the dru#s and her,s mentioned a,ove-
Drug Name: Hydrala*ine
Classification: Antihypertensive, 6asodilator (peripheral)
Mechanism of Action:
Dosage: Ta%lets: ",.!, !",""m#
In6ection: ."m#$m7
Indication:
- BralH Essential hypertension dose or in com,ination &ith other dru#s-
.- <arenteralH Severe essential hypertension &hen dru# cannot ,e #iven orally
or &hen need to lo&er B< is ur#ent-
%- Cnla,eled usesH @educes a)terload in the treatment o) heart )ailure-
Adverse ffect:
R 1NSH headache, di*iness, peripheral neuritis
R 16H palpitations, tachycardia, an#ina pectoris
R >5H anoreAia, nausea, vomitin#
R BtherH Nasal con#estion, )lushin#, edema, con/unctivitis
Acts directly on vascular smooth muscle
1ause vasodilation, primarily
arteriolar
Decrease peripheral resistance
Maintains or increases renal
and cere,ral ,lood )lo&
Drug Name: Hydrocortisone
Classification: adrenocortical steroid, #lucocorticoid
Mechanism of Action:
Dosage: !"m#$+# 5-6-
Indication:
- Shoc+
.- Severe in)lammation, adrenal insu))iciency
%- Ad/unct )or ulcerative colitis and proctitis
Adverse ffect:
- CN!: euphoria, insomnia, sei*ures
.- C": arrhythmias, edema, heart )ailure, hypertension
%- NT: cataracts, #laucoma
3- #I: >5 upset, increased appetite, pancreatitis
!- Meta%olic: car,ohydrate intolerance, hyper#lycema, hypo+alemia
.. Muscolos)eletal: #ro&th suppression in children, muscle &ea+ness,
osteoporosis
Hydrocortisone
Sta,ili*es leu+ocyte mem,ranes
Stimulate ,one marro& S
in)luence nutrient meta,olism
@educes in)lammation o)
the a))ected part
Contraindication:
- 1ontraindicated &ith hypersensitivity to hydrala*ine, tartra*ine(in "" m#
ta,lets mar+eted as Apresoline)? 1AD, mitral valvular rheumatic heart
disease(implicated in M5)
.- Cse cautiously &ith 16As? increased intracranial pressure
Nursing Res$onsi%ilities:
- 5nstruct the client to ta+e this dru# eAactly as prescri,ed-
.- 5nstruct to ta+e this &ith )ood-
%- Do not discontinue or reduce dosa#e &ithout consultin# your health care
provider-
8. 5nstruct the client to report persistent constipation? uneApalined )ever or
malaise? muscle or /oint achin#, chest pain, rash, num,ness or tin#lin#
sensation-
Contraindication:
- Hypersensitivity to dru# or any o) its components
.- Cse cautiously in patients &ith >5 Clcer, renal disease, hpn, dm,
osteoporosis, myasthenia #ravis, emotional insta,ility and recent M5-
Nursing Res$onsi%ilities:
- Monitor patientIs &ei#ht, ,p and electrolyte levels-
.- Monitor patientIs stress level-
%- 4or ,etter results and less toAicity #ive dru# in mornin#-
3- >ive oral dose &ith )ood-
!- >ive 5-M- in/ection deep in the #luteal muscles-
.. >ive potassium supplements
Drug Name: 5patropium ,romide
Classification: Anticholiner#ic, Antimuscarinic- Bronchodilator,
<arasympatholytic
Mechanism of Action:
Dosage:
CO'D7
R Adult: 5nhalation . inhalations o) MD5 G-i-d- at no less than 3 h intervals
(maAH . inhalations in .3 h)- Ne,uli*er !""mc# ( unit dose vial) G82: h-
R Child 89:4; (<: inhalation 2. inhalations t-i-d- (maA 8$day) Ne,uli*er
.!2.!" mc# t-i-d-
Rhinitis7
R Adult 8= ( or older)H intranasal . sprays o) "-"%T eachnostril ,-i-d- or
t-i-d
Common Cold7
R 5ntranasal . sprays o) "-"8T each nostril t-i-d- or G-i-d- up to 3 days
Indication:
- Bronchodilator )or maintenance treatment o) ,ronchospasm associated &ith
1B<D (solution aerosol), chronic ,ronchitis,a nd emphysema-
.- Nasal sprayH Symptomatic relie) o) rhinorrhea Associated &ith perennial
rhinitis, common cold, seasonal aller#ic rhinitis-
Anticholiner#ic related to
atropine
5nhi,ition o) acetylcholine
@educed va#al stimulation
Bronchodilation
Bloc+ade o) re)leA
,ronchoconstriction
Drug Name: 7idocaine Hydrochloride
Classification: Antiarrhythmic, 7ocal anesthetic
Mechanism of Action:
Dosage:
4or in)iltration or re#ional anesthesia, use "-!2.T solution in dosa#e o) %-!m#$+#
,ody &ei#ht in healthy individuals-
Indication:
- 7idocaine hydrochloride .T in/ection is recommended )or in)iltrations and
re#ional nerve ,loc+ anesthesia in #eneral sur#ical and dental procedures- 5t
is also suita,le )or topical mucosal anesthesia durin# sur#ery or
instrumentation-
Adverse ffect:
CN!: Di**iness or li#ht2headedness, )ati#ue, dro&siness, unconsciousness,
tremors, t&itchin#, vision chan#es-
C": 1ardiac arrhythmias, cardiac arrest, vasodilation, hypotension
#I: Nausea, vomitin#
7idocaine
Alters si#nal conduction in neurons
Bloc+s the )ast volta#e #ated sodium (NaU)
1reates the anaesthetic e))ect ,y not
merely preventin# pain si#nals )rom
propa#atin# to the ,rain ,ut ,y
a,ortin# their ,irth in the )irst place-
Adverse ffect:
R CN!: nervousness, di**iness, headache, )ati#ue, insomnia, ,lurred vision
R #I: diarrhea, nausea, dry mouth
R R!'IRATOR/: dyspnea, ,ronchitis, ,ronchospasm, C@5, cou#h,
eAacer,ation o) symptoms, hoarseness, pharyn#itis-
R OTHR: ,ac+ pain, chest pain, aller#ic2type reactions, palpitations, rash-
Contraindication:
- 1ontraindicated &ith hypersentivity to atropine, or its derivatives, soy,ean or
peanut aller#ies (aerosol)-
.- Cse cautiously &ith narro& an#le #laucoma, prostatic hypertrophy, ,ladder
nec+ o,struction, pre#nancy, lactation-
Nursing Res$onsi%ilities:
- <rotect solution )or inhalation )rom li#ht- Store unused vials in )oil pouch-
.- Cse ne,uli*er mouthpiece instead o) )ace mas+ to avoid ,lurred vision or
a##ravation o) narro&2an#le >lucoma-
%- 1an miA &ith al,uterol ne,uli*er )or up to hr-
3- Ensure adeGuate hydration? control environment (temperature) to prevent
hypereAia-
!- Have patient void a)ter ta+in# medication to avoid urinary retention
8- 0each the patient the proper use o) inhaler-
Contraindication:
1. 1ontraindicated &ith aller#y to lidocaine or amide2type local anesthetics
3. 1H4
4. 1ardio#enic shoc+
8. Second2 or third2de#ree heart ,loc+ (i) no arti)icial pacema+er)
,. Wol))2<ar+inson2White syndrome
.. Sto+es2Adams syndrome-
Nursing Res$onsi%ilities:
- @esuscitative eGuipment and dru#s, includin# oAy#en? should ,e
immediately availa,le-
.- 0a+e caution &hen there is in)lammation and$or sepsis in the proposed
in/ection-
4. 7idocaine hydrochloride should also ,e used &ith caution in patients &ith
severe shoc+, heart ,loc+, or other conduction distur,ances-
Drug Name: Ma#nesium sul)ate
Classification: Anticonvulsant
Mechanism of Action:
Dosage: .-!# throu#h 56!# throu#h 5M at each ,uttoc+s G8
Indication:
- 56 or 5MH <reeclampsia or eclampsia
.- 0o correct or prevent hypoma#nesemia in patients or parenteral nutrition
Adverse ffect:
- =oint2s&ellin#,
.- 4ever,
%- Anemia,
3- A#ranulocytosis,
!- Hepatitis,
Ma#nesium Sul)ate
Anta#oni*e the increase in
intracellular calcium
<revents or controls
convulsions ,y ,loc+in#
0here)ore prevents or stops
sei*ures such as <reeclampsia
or eclampsia
Drug Name: Mannitol
Classification: Diuretics
Mechanism of Action:
Dosage: Adults and children older than a#e . H !" to "" # 56 as a !T to
.!T solution over ;" minutes to several hours
Indication:
Oliguria: 0o prevent oli#uria or acute renal )ailure-
0o reduce intraocular or intracranial pressure-
Diuresis in dru# intoAication-
I5"5 ADMINI!TRATION:0o redissolve crystalli*ed solution, &arm ,ottle or ,a#
in a hot &ater ,ath and sha+e vi#orously- 1ool to ,ody temperature , e) o re #ivin#- Don't
use solution &ith undissolved crystals- >ive as intermittent or continuous in)usion
at prescri,ed rate, usin# an inline )ilter and an in)usion pump-
Don't #ive as direct in/ection. 1hec+ 5-6- line patency at in)usion site ,e)ore and
a)ter ad m i n is tr a tion ..
5ncreases osmotic pressure o)
#lomerular )iltrate-
5nhi,it tu,ular
rea,sorption o) &ater and
Elevates plasma osmolality-
5ncreases &ater )lo& into
cellular )luid-
Contraindication:
- 1ontraindicated &ith aller#y to ma#nesium products
.- Heart ,loc+
%- Myocardial dama#e
3- 4ecal impaction
!- 5ntestinal ,iliary tract o,struction
8- Do not #ive durin# . hours precedin# delivery ,ecause o) ris+ o) ma#nesium
toAicity to the neonate-
Nursing Res$onsi%ilities:
- Assess possi,ility )or interactions &ithout her dru#s or her,al products the
patient may ,e ta+in# especially anythin# that may impact ,lood pressure
,e)ore start treatment-
3. Monitor patients closely durin# and )ollo&in# in)usions- B,serve orthostatic
Adverse ffect:
- CN!: sei*ures, di**iness, headache, )ever-
.- C": edema, throm,ophle,itis, hypotension, hypertension, heart )ailure,
tachycardia, an#ina2li+e chest pain, vascular overload-
%- NT: ,lurred vision, rhinitis-
3- #I: thirsty, nausea, vomitin#, diarrhea-
!- #&: urine retention-
8- Meta%olic: dehydration-
9- !)in: local pain, urticaria-
:- OtherH chills-
Contraindication:
- 1ontraindicated in patient hypersensitive to dru#-
.- 1ontraindicated in patients &ith anuria, severe pulmonary con#estion, )ran+
pulmonary edema, severe heart )ailure, severe dehydration, meta,olic
edema, pro#ressive renal disease or dys)unction, or active intracranial
,leedin#-
Nursing Res$onsi%ilities:
- Monitor vital si#ns, includin# central venous pressure and )luid inta+e and
output hourly- @eport increasin# oli#uria- 1hec+ &ei#ht, renal )unction, )luid
,alance, and serum and urine sodium and potassium levels daily-
.- Dru# can ,e used to measure #lomerular )iltration rate-
%- 0o relieve thirst, #ive )reGuent mouth care or )luids-
<A05EN0 0EA1H5N>
- 0ell patient that he may )eel thirsty or have a dry mouth and emphasi*e
importance o) drin+in# only the amount o) )luids ordered-
.- 5nstruct patient to promptly report adverse reactions and discom)ort at 5-6-
site-
Drug Name: Meperidine hydrochloride
Classification: Bpiod a#onist anal#esic
Mechanism of Action:
Dosage: Ta%let: !", "" m#
!(ru$: !"m#$!ml
In6ection: ", .!, !", 9!, "" m#$ml
Indication:
- Bral, parenteralH @elie) o) moderate to severe acute pain
.- <arenteralH preoperative medication, support o) anesthesia, and o,stetric
anal#esia-
Contraindication:
- 1ontraindicated &ith hypersensitivity to opoids, diarrhea caused ,y
poisonin#, ,ronchial asthma, 1B<D, cor pulmonale, respiratory distress,
anoAia, +yphoscoliosis, acute alcoholism, increased intracranial pressure,
pre#nancy, sei*ure disorder, renal impairment-
Meperidine H17
Acts on 1NS and or#ans
composed o) smooth
Anal#esia and sedation
<roduce less smooth muscle spasm,
constipation, and depression o) cou#h
re)leA
Drug Name: Mida*olam
Classification: Ben*odia*epine (short2actin#), 1NS depressant
Mechanism of Action:
Dosage: IM (adult): :7$57 mcg;&g
IV (adult): 7.,$1 mg
Indication:
- 56 or 5M? oral syrup )or childrenH Sedation, anAiolysis, and amnesia prior to
dia#nostic, therapeutic, or endoscopic procedures or sur#ery
Mida*olam
Acts mainly at the lim,ic
system and reticular )ormation
<otentiates the e))ects o) #amma2
amino,utyrate (>ABA), an inhi,itory
neurotransmitter
AnAiolytic and amnesia e))ects
occur
Doses ,elo& those
needed to cause
Adverse ffect:
- CN!: li#ht2headedness, di**iness, sedation, euphoria, dysphoria, delirium,
insomnia, a#itation, anAiety, )ear, hallucination, disorientation, dro&siness,
lethar#y, impaired mental and physical per)ormance, coma, mood chan#es,
&ea+ness, headache, tremor, sei*ures, visual distur,ance, suppression o)
cou#h re)leA-
.- DermatologicH <ruritus, urticaria, or other s+in rashes? s&eatin#? &heal and
)lare over the vein &ith 56 in/ection
%- #I: A,dominal pain? ,iliary tract spasm? constipation? dry mouth? nausea?
vomitin#
8. CARDIO: Bradycardia? )lushin# o) the )ace? hypotension? orthostatic
hypotension? palpitation? syncope? tachycardia-
Nursing Res$onsi%ilities:
- 5nstruct patients that i) dose is missed, it should ,e ta+en as soon as possi,le
unless close to time o) neAt dose- Do not dou,le up doses-
.- 5) medication is #iven lon# term, eAplain that dosa#e &ill ,e tapered
#radually ,e)ore stoppin# to prevent &ithdra&al symptoms-
%- 5nstruct patients to avoid sudden position chan#es to avoid orthostatic
hypotension-
3- 0ell patients to avoid the inta+e o) alcoholic ,evera#es or other 1NS
depressants (e#, sleepin# pills, antihistamines)-
,. Advise patients that the dru# may cause dro&siness and impair mental and$or
physical a,ilities and to use caution &hile drivin# or per)ormin# other
Adverse ffect:
- CN!: sedation, depression, lethar#y, apathy, )ati#ue, li#ht2headedness,
disorientation, restlessness, con)usion, cryin#, delirium, headache, slurred
speech, dysarthria, stupor, ri#idity, tremor, dystonia, verti#o, nervousness,
vivid dreams, psychomotor retardation, eAtrapyramidal symptoms, visual and
auditory distur,ances, diplopia, nysta#mus
.- C": Bradycardia, tachycardia, 16 collapse, hypertension, hypotension,
palpitations, edema
%- Dermatologic: Crticaria, pruritus, s+in rash, dermatitis
3- #I: 1onstipation, diarrhea, dry mouth, salivation, nausea, anoreAia,
vomitin#, di))iculty in s&allo&in#, #astric disorders
!- #&: 5ncontinence, urinary retention, chan#es in li,ido, menstrual
irre#ularities
8- Hematologic: Decreased hematocrit, ,lood dyscrasias
9- Other: <hle,itis and throm,osis at 56 in/ection sites, hiccups, )ever,
diaphoresis, paresthesias, muscular distur,ances, #ynecomastia? pain,
,urnin#, and redness a)ter 5M in/ection
Contraindication:
- 1ontraindicated &ith hypersensitivity to ,en*odia*epines? psychoses, acute
narro&2an#le #laucoma, shoc+, coma, acute alcoholic intoAication?
pre#nancy (cle)t lip or palate, in#uinal hernia, cardiac de)ects, microcephaly,
Drug Name: Morphine sulphate
Classifcation: central nervous system a#ent? anal#esic? narcotic (opiate)
a#onist
Mechanism of Action:
Dosage: Adult: <B "F%" m# G3h prn or !F%" m#
Child: 56 "-"!F"- m#$+# G3h or "-".!F.-8 m#$+#$h
Neonate: 56$5M$S1 "-"! m#$+# G3F:h (maAH "- m#$+#)
Indication:
- Symptomatic relie) o) severe acute and chronic pain a)ter no narcotic
anal#esics have )ailed and as pre2anesthetic medication-
3. Csed to relieve dyspnea o) acute le)t ventricular )ailure and pulmonary
Morphine
5nteract &ith opiod receptor sites had a role in
the eApression o) anal#esic e))ects
0he mechanism o) respiratory depression involves
a reduction in the responsiveness o) the ,rain stem
respiratory centers to increase in car,on dioAide
5t has ,een sho&n that morphine ,inds to and
inhi,its >ABA inhi,itory interneurons-
0hese interneurons normally inhi,it the si#nals
descendin# pain inhi,ition path&ay
Drug Name: <henytoin
Classification: !nticonvulsant, C<= agent
Mechanism of Action:
Dosage: AD&LT!: 5nitially "" m# <-B, 5ncrease in increments o) "" m#- .23
&ee+s until desire response o,tain
CHILD: !m#$m. <-B divided- MaAimum daily dose is %"" m#
Indication:
1. 1ontrol o) tonic2clonic and compleA partial sei*ures- 4or a patient reGuirin# a
loadin# dose
Adverse ffect:
- <ruritus, rash, urticaria, edema, hemorrha#ic urticaria (rare), s&eatin#,
s+eletal muscle )laccidity? cold, clammy s+in, hypothermia-
.- CN!H Euphoria, insomnia, disorientation, visual distur,ances, dysphoria,
convulsions Bradycardia, palpitations, syncope? )lushin# o)
)ace,nec+,orthostatic hypotension-
%- #I: 1onstipation, anoreAia, dry mouth, ,iliary colic, nausea, vomitin#-
3- Infants and child: decreased cou#h re)leA, dro&siness, di**iness, deep
sleep, coma, elevated-
Contraindication:
- Hypersensitivity to opiates
.- 5ncreased intracranial pressure
%- 1onvulsive disorders
3- @espiratory depression
!- <rostatic hypertrophy
8- Severe liver or renal insu))iciency
9- AddisonIs disease
:- Hypothyroidism
;- 7actation-
Nursing Res$onsi%ilities:
- B,tain ,aseline respiratory rate, depth, and rhythm and si*e o) pupils ,e)ore
administer the dru# )or si#ns o) toAicity-
.- Be alert to elevated <@ or @@, restlessness, anoreAia, or dra&n )acial
eApression that may indicate need )or anal#esia-
%- Encoura#e chan#es in position, deep ,reathin#, and cou#hin# unless
contraindicated-
3- Assess depress cou#h and si#h re)leAes and thus may induce atelectasis,
especially in postop- pts-
!- Encoura#es the pt- to void at least G3h- <alpate lo&er a,domen to detect
,ladder distention-
8- Avoid alcohol and other 1NS depressants
Adverse ffect:
- AtaAia
.- Slurred speech
%- Headache
3- Mental con)use
!- Diplopia
8- Hyper#lycemia
9- 0oAic hepatitis
:- >in#ival hyperplasia
;- Nausea
17. <urpuric dermatitis
Contraindication:
1. 1ontraindicated in patient hypertensive to hydantion and those &ith sinus
,radycardia,
3. SA ,loc+, second or third de#ree, A6 ,loc+ or Adams2stro+e syndrome-
Nursing Res$onsi%ilities:
- Cse cautiously in patient &ith hepatic dys)unction, hypotension, myocardial
in)arction, or respiratory depression-
.- Elderly tends to meta,oli*es phenytoin slo&ly and may,e reduce dosa#e
%- <henytoin usually increases dosa#e durin# pre#nancy-
3- Stop dru# i) rash occurs-
!- Cse only clear solution )or in/ection- Warn patient not to stop dru# a,ruptly
,ecause sei*ure may ,e &orsen-
Drug Name: <otassium 1hloride
Classification: Ma/or mineral (electrolyte)
Mechanism of Action:
Dosage: ta, 05D 8 doses
Indication: Hypo+alemia
Adverse ffect:
- @enal 5nsu))iciency
.- Hyper+alemia
A mem,rane2,ound en*yme, sodium2potassiumF
activated adenosine triphosphatase (Na UK UA0<ase),
actively transports or pumps sodium out and potassium
into cells to maintain these concentration #radients-
0he intracellular to eAtracellular potaaessium #radients
are necessary )or the conduction o) nerve impulses in
such speciali*ed tissues as the heart, ,rain, and s+eletal
muscle, and )or the maintenance o) normal renal )unction
and acid2,ase ,alance-
Hi#h intracellular potassium concentrations
are necessary )or numerous cellular meta,olic
processes
Drug Name: Sal,utamol
Classification: Bronchodilator (therapeutic)? adrener#ics (pharmacolo#ic)
Mechanism of Action:
Dosage: ORAL 3mg;,ml
Nebu: ,mg;3.,ml
Indication:
- 0o control and prevent reversi,le air&ay o,struction caused ,y asthma or
chronic o,structive pulmonary disorder (1B<D)
.- Ouic+ relie) )or ,ronchospasm
%- 4or the prevention o) eAercise2induced ,ronchospasm
3- 7on#2term control a#ent )or patients &ith chronic or persistent
,ronchospasm
Contraindication:
- Hypersensitivity to adrener#ic amines
.- Hypersensitivity to )luorocar,ons
Binds to ,eta. Fadrener#ic receptors
5n the air&ay o) the smooth muscles
1yclic %I!I adenosine
monophosphate (cAM<)
Activation o) the adenyl
cyclase
5nhi,tion o)
phosphorylation o)
myosin
5ntracellular
calcium
@elaAation o)
smooth muscle air&ays
Nursing Res$onsi%ilities:
- Watch out )or levels o) potassium electrolyte level to prevent
hyper+alemia
.- Arran#e )or serial serum potassium levels ,e)ore and durin# therapy-
%- Administer liGuid )orm to any patient &ith delayed >5 emptyin#-
3- Administer oral dru# a)ter meals or &ith )ood and a )ull #lass o) &ater
to decrease >5 upset-
!- 1aution patient not to che& or crush ta,lets? have patient s&allo&
ta,let &hole-
8- MiA or dissolve oral liGuids, solu,le po&ders, and e))ervescent ta,lets
completely in %F: o* o) cold &ater, /uice, or other suita,le ,evera#e,
and have patient drin+ it slo&ly
9- Arran#e )or )urther dilution or dose reduction i) >5 e))ects are severe-
:- A#itate prepared 56 solution to prevent Vlayerin#W o) potassium? do not
add potassium to an 56 ,ottle in the han#in# position-
6. 1aution patient not to use salt su,stitutes-
Adverse ffect:
- -Nervousness
.- @estlessness
%- 0remor
3- Headache
!- 5nsomnia
8- 1hest pain
9- <alpitations
:- An#ina
;- Arrhythmias
"- Hypertension
- Nausea and vomitin#
.- Hyper#lycemia
%- Hypo+alemia
Nursing Res$onsi%ilities:
- Assess lun# sounds, <@ and B< ,e)ore dru# administration and durin# pea+
o) medication-
.- B,serve )ore paradoAical spasm and &ithhold medication and noti)y
physician i) condition occurs-
%- Administer <B medications &ith meals to minimi*e #astric irritation-
3- EAtended2release ta,let should ,e s&allo&ed2&hole- 5t should not ,e crushed
or che&ed-
!- 5) administerin# medication throu#h inhalation, allo& at least minute
,et&een inhalation o) aerosol medication-
8- Advise the patient to rinse mouth &ith &ater a)ter each inhalation to
minimi*e dry mouth-
:. 5n)orm the patient that Sal,utamol may cause an unusual or ,ad taste
Drug Name: Sodium ,icar,onate
Classification: Antacid, electrolyte, systemic and urinary al+ali*er
Mechanism of Action:
Dosage: Tablet 43,, ,37, .,7 mg
In6ection: "-!, "-8, "-;, -" mEG$ml
Indication:
- Mana#ement o) meta,olic acidosis
.- Csed to al+alini*e urine and promote eAcretion o) certain dru#s in over dosa#e
situations
%- Csed as an antacid
Sodium Bicar,onate
5ncrease hydro#en ion concentration
@educin# ,icar,onate ion concentration
5ncrease dissolved 1B. concentration
5ncrease amount o) 1B. #as eAhaled
Neutrali*e or @educed Stomach Acid
Csed as antacid
0reat heart,urn, indi#estion and upset stomach
Drug Name: 0er,utaline
Classification:
Mechanism of Action:
Dosage:
,77mcg;dose dry powder inhaler
<harmacolo#ic e))ects o)
ter,utaline
Stimulation throu#h ,eta2adrener#ic receptors
o) intracellular adenyl cyclase
1onversion o) adenosine triphosphate
(A0<) to cyclic2 %',!'2 adenosine
monophosphate
5ncreased c2AM< levels are associated &ith relaAation o)
,ronchial smooth muscle and inhi,ition o) release o) mediators o)
immediate hypersensitivity )rom cells, especially )rom mast cells-
0his dru# relaAes smooth muscle and inhi,its uterine
contractions, ,ut may also cause some cardiostimulatory
e))ects and 1NS stimulation-
Adverse ffect:
- #IH #astric rupture )ollo&in# in#estion
.- HMATOLO#IC: Susytemic al+alosis, (headache, nausea, irrati,ility,
&ea+ness, tetany, con)usion)- Hypo+alemis secondary to intracellular
shi)tin# o) potassium, hypernatremia
%- LOCALH 1hemical cellulitis, tissue necrosis, ulceration amd slou#hin# at
the side o) )iltration (parenteral)
Contraindication:
- Meta,olic or respiratory al+alosis
.- Hypocalcemia
%- EAcessive chloride loss
3- 5t is not recommended as an antidote )ollo&in# in#estion o) stron# mineral
acids
!- <atients on sodium restricted diet
8- @enal )ailure
9- Severe a,dominal pain o) un+no&n cause especially i) associated &ith )ever
Nursing Res$onsi%ilities:
- Assess the clientIs )luid ,alance throu#hout the therapy- 0his assessment
includes inta+e and output, daily &ei#ht, edema and lun# sounds-
.- 0a,lets must ,e ta+en &ith a )ull #lass o) &ater-
%- 4or clients ta+in# the medication as a treatment )or peptic ulcers it may ,e
administered and % hours a)ter meals and at ,edtime- Indication:
- Asthma
.- Bronchitis and emphysema-
Adverse ffect:
• CN!: 0remor, nervousness, di**iness, headache and dro&siness-
• HART: <alpitations and )ast heart rate-
• R!'IRATOR/: 1hest discom)ort and di))iculty in ,reathin#-
• #I: Nausea$vomitin#-
!/!TMIC: Wea+ness, )lushed )eelin#, s&eatin# and pain at in/ection site-
Contraindication:
- Hypersensitivity
Nursing Res$onsi%ilities:
- 1aution should ,e eAercised in patients &ith history o) heart disease,
irre#ular heart,eat, hi#h ,lood pressure, overactive thyroid, su#ar, sei*ures,
adrenal #land tumor, any aller#y, &ho are ta+in# other medications, durin#
pre#nancy and ,reast)eedin#- 5t may cause dro&siness or di**iness,
3. Do not drive a car or operate machinery &hile ta+in# this medication-