 Hypersensitivity

EMERGENCY DRUGS  With acute angle closure glaucoma, obstructive uropathy, obstructive
disease of GI tract, paralytic ileus, toxic megacolon, intestinal atony,
CARDIAC DRUGS unstable CV status in acute hemorrhage, asthma, or myasthenia
gravis.
 Pregnant women.
ATROPINE SULFATE
Nursing Management
Isopto Atropine  Monitor VS.
 Report  HR
Classification  Monitor for constipation, oliguria.
Anticholinergics  Instruct to take 30 mins before meals
 Eat foods high in fiber and drink plenty fluids.
Dosage
 Can cause photophobia
 Bradycardia: 0.5 mg IV every 3-5 mins, max of 0.04 mg/kg
 Instruct client not to drive a motor vehicle or participate in activities
 Cardiac Arrest: 1 mg every 3-5 mins
requiring alertness.
 Nerve and Organophosphate symptoms: may repeat in 2 mg
 Advise to use hard candy, ice chips, etc. for dry mouth.
increments q 3 mins titrated to relief symptoms

Indication
 Pre-op meds/pre-anesthetic meds NITROGLYCERINE
 To restore cardiac rate and arterial pressure during anesthesia when
vagal Nitrostat
 To lessen the degree of A-V heart block
 To overcome severe carotid sinus reflex Classification
 Antidote for cholinergic toxicity  Antianginal
 Nitrate
Side effects  Vasodilator,
 CNS: restlessness, ataxia, disorientation, hallucinations, delirium,  Coronary
coma, insomnia, agitation, confusion.
 CV: tachycardia, angina, arrhythmias, flushing. Dosage
 EENT: photophobia, blurred vision, mydriasis.  0.3-0.4 mg SL q 5 min, max 3 doses.
 GI: dry mouth, constipation, vomiting.  Every 6 hrs except for midnight (cream)
 GU: urine retention.  Wear 12 hrs a day for skin patch
 Hematologic: leukocytosis
 Other: anaphylaxis Action
 Relaxes the vascular smooth system
Adverse effects
 CNS: headache, excitement.  Reduces myocardial oxygen consumption
 CV: palpitations  Reduces left ventricular workload
 GI: thirst, nausea  Reduces arterial BP
 Reduces venous return
Contraindications
 Indication Immediate-release tablets:
 Angina pectoris MSIR
 CHF associated with AMI Timed-release:
 Cardiac load reducing agent Kadian, M-Eslon (CAN), MS Contin, Oramorph SR
 Hypertensive Crisis Oral solution:
MSIR, Rescudose, Roxanol, Roxanol T
Side effects Rectal suppositories:
 CNS: headache, throbbing, dizziness, weakness. RMS
 GI: nausea, vomiting Injection:
 Skin: Rash Astramorph PF, Duramorph, Epimorph (CAN)
 Adverse Reactions Preservative-free concentrate for microinfusion devices for intraspinal
 CV: orthostatic hypotension, flushing, fainting. use:
 EENT: sublingual burning. Infumorph
 Skin: Cutaneous vasodilation, contact dermatitis (patch)
Classification
Contraindications Opioid Agonist Analgesic
 Contraindicated in patients hypersensitive to nitrates
 With early MI. (S.L. form), severe anemia, increase ICP angle-closure Dosage
glaucoma, IV nitroglycerine is contraindicated in patients with  Oral: 10–30 mg q 4 hr PO. Controlled-release: 30 mg q 8–12 hr PO or as
hypovolemia, hypotension, orthostatic hypotension, cardiac directed by physician; Kadian: 20–100 mg PO daily–24-hr release
tamponade restrictive cardiomyopathy, constrictive pericarditis. system; MS Contin: 200 mg PO q 12 hr.

Nursing Management  SC and IM:10 mg (5–20 mg)/70 kg q 4 hr or as directed by physician.

 Record characteristics and precipitating factors of anginal pain.
 Monitor BP and apical pulse before administration and periodically after  IV:2.5–15 mg/70 kg of body weight in 4–5 mL water for injection
dose. administered over 4–5 min, or as directed by physician. Continuous IV
infusion: 0.1–1 mg/mL in 5% dextrose in water by controlled infusion
 Have client sit or lie down if taking drug for the first time. device.
 Client must have continuing EKG monitoring for IV administration
 Cardioverter/ defibrillator must not be discharged through paddle  Rectal:10–30 mg q 4 hr or as directed by physician.
electrode overlying
 Nitro-Bid ointment or the Transderm-Nitro Patch. Assist with ambulating if  Action
dizzy.  Acts as agonist at specific opioid receptors in the CNS to produce
 Instruct to take at first sign of anginal pain. analgesia, euphoria, sedation
 May be repeated q 5 minutes to max. of 3 doses.
 If the client doesn’t experience relief, advise to seek medical assistance Indication
immediately.  Relief of moderate to severe acute and chronic pain
 Keep in a dark colored container  Preoperative medication
 Analgesic adjunct during anesthesia
 Component of most preparations that are referred to as Brompton's
cocktail or mixture
MORPHINE SULFATE
 Intraspinal use with microinfusion devices for the relief of intractable  Keep opioid antagonist and facilities for assisted or controlled
pain respiration readily available during IV administration.
 Unlabeled use: Dyspnea associated with acute left ventricular failure  Use caution when injecting SC or IM into chilled areas or in patients with
and pulmonary edema hypotension or in shock
 Reassure patients that they are unlikely to become addicted
Side Effects Teaching points
 GI: dry mouth, constipation.  Take this drug exactly as prescribed. Avoid alcohol, antihistamines,
 Skin: Tissue irritation and induration (SC injection). sedatives, tranquilizers, over-the-counter drugs.
 Other: sweating,physical tolerance and dependence, psychological  Swallow controlled-release preparation (MS Contin, Oramorph SR)
dependence whole; do not cut, crush, or chew them.
 Do not take leftover medication for other disorders, and do not let
Adverse Effects anyone else take your prescription.
 CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria,  These side effects may occur: Nausea, loss of appetite, constipation,
delirium, insomnia, agitation, anxiety, fear, hallucinations, dizziness, sedation, drowsiness, impaired visual acuity
disorientation, drowsiness, lethargy, impaired mental and physical  Report severe nausea, vomiting, constipation, shortness of breath or
performance, coma, mood changes, weakness, headache, tremor, difficulty breathing, rash.
seizures, miosis, visual disturbances, suppression of cough reflex
 CV: Facial flushing, peripheral circulatory collapse, tachycardia,
bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, VERAPAMIL
hypotension, orthostatic hypotension, syncope
 Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm,
Calan, Isoptin, Verelan, Covera HS
bronchospasm, edema
 GI: Nausea, vomiting, anorexia, biliary tract spasm; increased colonic Classification
motility in patients with chronic ulcerative colitis  Anti-anginal
 GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or  Anti-arrhythmics
hesitancy, oliguria, antidiuretic effect, reduced libido or potency  Anti-hypertensive
 Respiratory:Respiratory depression, apnea, circulatory depression,  Vascular headache suppressants
respiratory arrest, shock, cardiac arrest
Dosage
Contraindications PO 80-120 mg 3x daily, increases as needed
 Hypersensitivity to opioid
 Diarrhea caused by poisoning until toxins are eliminated Action
 During labor or delivery of a premature infant  Inhibits calcium transport into myocardial smooth muscle cells
 After biliary tract surgery or following surgical anastomosis  Decreases SA and AV conduction and prolongs AV node refractory
 Pregnancy period in conduction tissue
 Labor
Indication
Nursing Management  Hypertension
Interventions  Angina Pectoris
 Caution patient not to chew or crush controlled-release preparations.  Supraventricular Arrhythmia
 Dilute and administer slowly  Atrial flutter/fibrillation
 Tell patient to lie down during IV administration.
 Side Effects and Adverse Reactions Indication
 Hypertension
 CNS:abnormal dreams, anxiety, confusion, dizziness and headache  Angina Pectoris
 EENT: blurred vision, epistaxis and tinnitus  Supraventricular Arrhythmia
 CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and  Atrial flutter/fibrillation
palpitations
 GU: dysuria, nocturia and polyuria Side Effects and Adverse and Reactions
 GI: abnormal liver function, anorexia, constipation, diarrhea, nausea  CNS:abnormal dreams, anxiety, confusion, dizziness and headache
and vomiting  EENT: blurred vision, epistaxis and tinnitus
 CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and
Contraindications palpitations
 Hypersensitivity  GU: dysuria, nocturia and polyuria
 Sick sinus syndrome  GI: abnormal liver function, anorexia, constipation, diarrhea, nausea
 2nd or 3rd degree AV block and vomiting
 CHF
 Cardiogenic shock Contraindications
 Concurrent IV beta-blocker  Hypersensitivity
 Sick sinus syndrome
Nursing Management  2nd or 3rd degree AV block
 Monitor BP and pulse before therapy, during titration and therapy  CHF
 Monitor ECG, I&O, serum potassium and weight.  Cardiogenic shock
 Assess for CHF  Concurrent IV beta-blocker

Nursing Management
DILTIAZEM  Monitor BP and pulse before therapy, during titration and therapy
 Monitor I&O and weight
Cardizem, Dilacor, Novo-Diltiazem, Tiamate and Tiazac  Assess for CHF
 Routine serum digoxin monitoring
Classification
 Anti-anginals
 Antiarrhythmics LIDOCAINE
 Antihypertensive
 Ca channel blocker Xylocaine

Dosage Classification
 PO: 30-120 mg, 3-4x daily or 60-120 mg twice daily as SR capsules  CV drugs: Anti-arrhythmics
 IV: 0.25 mg/kg  Anesthetic

Action Dosage
 Inhibits calcium transport into myocardial smooth muscle cells Arrhythmia:
 Systemic and coronary vasodilation  IV: 0.7-1.4 mg/kg body weight. No more than 200 mg within 1 hour
period
 IM: 4-5 mg/kg body weight Classification
Anti-arrhythmics
Action
Increases electrical stimulation of ventricle and His-purkinje system by Dosage
direct action on tissues, resulting to decrease depolarization, Recurrent ventricular arrhythmias:
automaticity and excitability in ventricles during diastolic phase  PO800-1600 mg/day for 1-2 wks
 PSVT, symptomatic atrial flutter: PO 600-800 mg/day for 1 month
Indication  Arrhythmias with CHF: 200 mg/day
 Anesthesia  Ventricular dysrrhythmias: 150 mg over the 1st 10 mins then slow 360
 Arrhythmias mg over the next 6 hrs
 Control of Status epilepticus refractory to other treatments
Action
Side Effects and Adverse Reactions  Blocks Na channels, prolonging myocardial cell action potential and
GI disturbances, bradycardia, hypotension, convulsion, numbness of refractory period
tongue, muscle twitching, restlessness, nervousness, dizziness, tinnitus,  Non competitive alpha and beta adrenergic blockage
blurred vision, fetal intoxication, light headedness, drowsiness,
apprehension, euphoria, vomiting, sensation of heat, respiratory arrest Indication
and CV collapse  Life threatening recurrent arrhythmias
 Ventricular fibrillation
Contraindications  Ventricular tachycardia
 Hypersensitivity
 Heart block Side Effects and Adverse Reactions
 Hypovolemia Exacerbation of arrhythmias, bradycardia, SA node dysfunction, heart
 Adams stroke syndromes block, sinus arrest; flushing, fatigue, malaise, abnormal involuntary
 Infection at site of injection movements, ataxia, dizziness, paresthesia, decreased libido, insomnia,
headache, sleep disturbances, visual impairment, blindness, corneal
Nursing Management microdeposits, photophobia, abnormal taste, nausea, vomiting,
 Assess pt before and after therapy constipation, anorexia, abdominal pain, abnormal salivation,
 Pts infusion must be on cardiac monitor coagulation abnormalities, non-specific hepatic disorders, pulmonary
 Monitor ECG, if QT or QRS increases by 50% or more, withhold the inflammation, dyspnea, toxicosis, death, edema, hypo and
drug hyperthyroidism
 Monitor BP, check for rebound HPN after 1-2 hrs
 Assess respiratory status, oxygenation and pulse deficits Contraindications
 Assess renal and liver function  Severe sinus node dysfunction
 Monitor CNS symptoms  2nd or 3rd degree AV block
 Monitor blood levels  Hypersensitivity

AMIODARONE Nursing Management

 Assess cardiovascular status before therapy
 Assess pulmonary, hepatic and thyroid function before and during
Cordarone
therapy
 Monitor fluid and electrolytes, I&O, K, Na and Cl  Assess pulmonary, hepatic and thyroid function before and during
 Monitor ECG, BP therapy
 Assess vision  Monitor fluid and electrolytes, I&O, K, Na and Cl
 Monitor ECG, BP
 Assess vision
PROCAINAMIDE

Pronestyl, Procan-SR, Procanbid EPINEPHRINE

Classification Injection, OTC nasal solution:

Antiarrhythmics Adrenalin Chloride
Ophthalmic solution:
Dosage Epifrin, Glaucon
Arrhythmias: 50 mg/kg/day in divided doses 3-6 hourly Insect sting emergencies:
EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-
Action Injector (delivers 0.15 mg IM for children)
Blocks open Na channels and prolongs the cardiac action potential. OTC solutions for
This results in slowed conduction and ultimately the decreased rate of Nebulization:
rise of the action potential may result on the widening of QRS on ECG AsthmaNefrin, microNefrin, Nephron, S2

Indication Classification
 Supraventricular and ventricular arrhythmias. Beta2 Adrenergic Agonists
 Treatment of Wolf-Parkinson-White Syndrome
Dosage
Side Effects and Adverse Reactions  Cardiac arrest: 1 mg IV of 1:10,000 solution q 3-5 min; double dose if
 Severe hypotension, ventricular fibrillation and asystole. administering via ET tube
 Drug induced SLE syndrome, blood disorders, fever, myocardial  Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000 solution.
depression, heart failure, agrunulocytosis, psychosis, angioedema,  Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution
hepatomegaly, skin irritation, hypergammaglobulinemia, GI and CNS  Refractory bradycardia and hypotension: 2-10ug/min
effects
Action
Contraindications  Stimulates beta receptors in lung.
 Heart block  Relaxes bronchial smooth muscle.
 Heart failure  Increases vital capacity
 Hypotension  Increases BP,  HR,  PR
 Myesthenia gravis  Decreases airway resistance.
 Digoxin toxicity
 Lactation Indication
 Asthma
Nursing Management  Bronchitis
 Assess cardiovascular status before therapy  Emphysema
 All cardiac arrest, anaphylaxis
 Used for symptomatic bradycardia.  ADH
 Relief of bronchospasm occurring during anesthesia
 Exercised-induced bronchospasm Dosage
Prevent and treat abdominal distention: initially 5 units IM gives
Side Effects/Adverse Reactions subsequent injections q3-4 hours increasing to 10 units if needed.
Side Effects:
nervousness, tremor, vertigo, pain, widened pulse pressure, Action
hypertension nausea Increase permeability of renal tubular epithelium to adenosine
Adverse Effects: monophosphate and water, the epithelium promotes reabsorption of
headache water and concentrated urine

Contraindications Indication
 With angle-closure glaucoma, shock (other than anaphylactic shock),  Diabetes Insipidus
organic brain damage, cardiac dilation, arrhythmias, coronary  Abdominal Distention
insufficiency, or cerebral arteriosclerosis. Also contraindicated in  GI bleeding
patient receiving general anesthesia with halogenated hydrocarbons  Esophageal varices
or cyclopropane and in patients in labor (may delay second stage)
 In conjunction with local anesthesia, epinephrine is contraindicated for Side Effects and Adverse Reactions
use in finger, toes, ears, nose, and genitalia.  CNS: tremor, headache, vertigo
 In pregnant woman, drug is contraindicated.  CV: vasoconstriction, arrhythmias, cardiac arrest, myocardial
 In breast feeding do not use the drug or stop breast feeding. ischemia, circumollar pallor, decreased CO, angina
 GI: abdominal cramps
Nursing Management  GU:uterine cramps
1. Monitor V/S. and check for cardiac dysrrhythmias  Respi: bronchoconstriction
2. Drug increases rigidity and tremor in patients with Parkinson’s disease  Skin: diaphoresis, gangrene and urticaria
3. Epinephrine therapy interferes with tests for urinary catecholamine
4. Avoid IM use of parenteral suspension into buttocks. Gas gangrene Contraindications
may occur  With chronic nephritis and nitrogen retention
5. Massage site after IM injection to counteract possible  Hypersensitivity
vasoconstriction.
6. Observe patient closely for adverse reactions. Notify doctor if adverse Nursing Management
reaction develop  Give 1-2 glass of H20 to reduce adverse reactions and improve
7. If blood pressure increases sharply, rapid-acting vasodilators such as therapeutic response
nitrates or alpha blockers can be given to counteract  Warm vasopressin in your hands and mixed until it is distributed evenly
in the solution
 Monitor urine Sp. Gravity and I&O to aid evaluation of drug
VASOPRESSIN effectiveness

Pitressin
MAGNESIUM SO4
Classification
 Pituitary Hormones
 Classification Dosage
 Anti-convulsant  Metabolic Acidosis: Usually 2-5 meq/kg IV infuse over 4-8 hr period
 Anti-arrhythmics  Cardiac Arrest: 1 meq/kg IV of 7.5 or 8.4% sol, then 0.5 meq/kg IV q 10
mins depending on ABG
Dosage
 Arrhythmia: IV 1-6 grams over several minutes, then continuous IV Action
infusion 3-20 mg/min for 5-48 hours.  Restore buffering capacity of the body and neutralizes excessive acid

Action Indication
 Decreased acetylcholine released  Metabolic Acidosis
 Cardiac Arrest
Indication
 Mg replacement Side Effects/Adverse Reactions
 Arrhythmia  CNS: tetany
 CV: edema
Side Effects and Adverse Reactions  GI: gastric distention, belching and flatulence
 CNS: drowsiness, depressed reflexes, flaccid paralysis, hypothermia  Metabolic: hypokalemia, metabolic alkalosis, hypernatremia,
 CV: hypotension, flushing, bradycardia, circulatory collapse, hyperosmolarity with overdose
depressed cardiac function  Skin: pain @ injection site
 EENT: diplopia
 Respiratory: respiratory paralysis Contraindications
 Metabolic: hypocalcemia  Metabolic and respiratory alkalosis
 Skin: diaphoresis  Pt losing Cl because of vomiting or continuous GI suction or those
receiving diuretics that produces hypochloremic alkalosis
Contraindications
 Heart block and myocardial damage Nursing Management
 Toxemia of pregnancy  Obtain blood pH, PaO2, PaCo2 and electrolyte levels
 SIVP
Nursing Management
 Monitor I&O. make sure urine output is 100 ml or more in 4 hrs pd HYPERTENSIVE CRISIS
before each dose
 Take appropriate seizure precautions
 Keep IV Ca gluconate at bedside Na NITROPRUSSIDE

Nittropress
Na HCO3
Classification
Antihypertensive, Vasodilator
Arm and Hammer; Baking Soda
Dosage
Classification 0.25-0.3 mcg/kg/minute
Alkalinizers
Action
 Relaxes arteriolar and venous smooth muscle Inhibits Na and Cl reabsorption at the proximal and distal tubules and
in the ascending loop of Henle
Indication
 Hypertensive crisis Indication
 To produce controlled hypotension during anesthesia  Acute pulmonary edema
 To reduce preload and afterload in cardiogenic shock  Edema
 Hypertension
Side Effects/Adverse Reactions
Headache, dizziness, increased ICP, loss of consciousness, restlessness, Side Effects/Adverse Reactions
bradycardia, nausea, abdominal pain, methemoglodinemia, muscle Signs of hypotension, hypokalemia and hyperglycemia
twitching, pink-colored rash, irritation at infusion site
Contraindications
Contraindications  Hypersensitivity
 Hypersensitivity  Anuria
 Compensatory hypotension
 Inadequate cerebral circulation Nursing Management
 Acute heart failure with reduced PVR 1. Monitor wt., BP and PR
 Congenital optic atrophy 2. Monitor fluid, I&O, electrolyte, BUN and CO2 levels frequently
 Tobacco-induced ambylopia 3. WOF signs of hypokalemia
4. Monitor uric acid levels
Nursing Management 5. Monitor glucose levels esp in DM pts
1. Obtain VS before giving the drug
2. Place pt in supine
3. Giving excessive doses of 500 mcg/kg delivered faster than 2 MORPHINE SO4
mcg/kg/min or using max infusion rate of 10 mcg/kg/min for more
than 10 mins can cause cyanide toxicity (Discussed earlier)

NEUROSURGICAL DRUGS
FUROSEMIDE

MANNITOL
Lasix

Classification Osmitrol
Loop Diuretics
Classification
Dosage Diuretics
 Pulmonary edema: 40 mg IV
 Edema: 20 to 80 mg PO every day in the morning Dosage
 HPN: 40 mg PO bid. Dosage adjusted based on response  Test dose for marked oliguria or suspected inadequate renal
function: 200 mg/kg or 12.5 gram as a 15% to 20% IV solution over 3-5
Action mins response is adequate if 30-50 ml of urine/hr is adequate, a
second dose is given if still no response after 2nd dose stop the drug
 Oliguria: 50 over 90 mins to several hrs NALOXONE HCL
 To induced intraocular or intracranial pressure: 1.5-2 gram/kg as a 15
% to 20% IV solution over 30-60 min Narcan
 Diuresis in drug intoxication: 12.5% to 10% solutions up to 200 g IV
 Irrigating solution during TURP: 2.5-5% Classification
Miscellaneous antagonists and antidotes
Action
Increases osmotic pressure of glomerular filtrate, inhibiting tubular Dosage
reabsorption of water and electrolytes; drug elevates plasma  For suspected opioid induced respiratory depression: 0.4 to 2 mg IV, IM
osmolarity, increasing water flow into extracellular fluid and SQ. repeat doses q 2-3 mins PRN
 For postoperative opiod depression: 0.01 to 0.2 mg IV q 2-3 mins, PRN.
Indication Repeat dose within 1-2 hr, if needed.
 Test dose for marked oliguria or suspected inadequate renal function  Action
 Oliguria  Reverse the effects of opiods, psychotomimetic and dysphoric effects
 To induced intraocular or intracranial pressure of agonist-antagonists
 Diuresis in drug intoxication
 Irrigating solution during TURP Indication
Side Effects/Adverse Reactions  For suspected opioid induced respiratory depression
 CN: seizures, headache and fever
 CV: edema, thrombophlebitis, hypotension and heart failure  For postoperative opiod depression
 EENT: blurred vision and rhinitis
 GI: thirst, dry mouth, nausea, vomiting and diarrhea Side Effects/Adverse Reactions
 GI: urine retention  CNS: seizures, tremors
 Metabolic: dehydration  CV: ventricular fibrillation, tachycardia, HPN with higher recommended
 Skin: local pain doses, hypotension
 Others: chill  GI: nausea and vomiting
Contraindications  Respiratory: pulmonary edema
 Hypersensitivity  Skin: diaphoresis
 Anuria, severe pulmonary congestion, frank pulmonary edema,
active intracranial bleeding during craniotomy, severe dehydration, Contraindications
metabolic edema, progressive heart failure or pulmonary congestion  Hypersensitivity
after drug  Use cautious with cardiac irritability or opiod addiction.

Nursing Management Nursing Management

 Monitor VS,CVP,I&O, renal function fluid balance and urine K levels  Assess respiratory status frequently
daily.  Respiratory rate increases within 1-2 mins
 Drug can be used to measure GFR
 Do not give electrolyte free solutions with blood. If blood id given
simultaneously, add at least 200 meq of NaCL to each liter IPECAC SYRUP

POISONING Classification
 Antidote  Inhibits GI absorption of toxic substances or irritants
 Hyperosmolarity
Dosage
25-30 ml followed immediately by H2O Indication
 Poisoning
Action
Irritates the stomach lining and stimulate the vomiting center Side Effects
 Pain, melena, diarrhea, vomiting and constipation
Indication
 Poisoning Contraindications
 Overdose  Cyanide, mineral acids, organic solvents, intestinal obstruction,
bleeding with fructose intolerance, broken GI tract, concomitant use
Side Effects of charcoal with sorbitol
Diarrhea, drowsiness, stomach cramps, vomiting, itching, DOB,
swelling of the mouth, rash and hives Nursing Management
 Do not mix with chocolate and together with ipecac syrup
Contraindications  Notify doctor if caused swelling or pain in the stomach
 Hypersensitivity
 Given activated charcoal
 Unconcious FLUMAZENIL
 Drowsy
 Severely drunk Romazicon
 Having seizures
 With no gag reflex Classification
 Benzodiazepine receptor antagonists
Nursing Management
1. Don’t administer to unconscious Dosage
2. Pt should kept active and moving ff administration  2 ml IV given over 15 seconds
3. If vomiting does not occur after 2nd dose, gastric lavage may be
considered to remove ingested substance Action
 Antagonizes the effects of benzodiazepines

ACTIVATED CHARCOAL Indication

 Benzodiazepine-induced depression of the ventilatory responses to
hypercapnia and hypoxia
Classification
Antidote Side Effects
 Nausea, vomiting, palpitations, sweating, flushing, dry mouth, tremors,
Dosage insomnia, dyspnea, hyperventilation, blurred vision, headache, pain
30-100 g with at least 8 oz of water at injection site

Action Contraindications
 Control of ICP or status epilepticus.  GI: nausea and vomiting
 Signs of serious cyclic antidepressant overdose
Contraindications
Nursing Management  Hypersensitivity
1. Must individualize dosage. Give only smallest amount effective.  With uncorrect tachyarrhythmias
2. Give through freely running IV infusion into large vein to minimize pain  Pheochromocytoma
at injection site  Ventricular Fibrillation
3. Note history of seizure or panic disorder
4. Assess evidence of increased ICP Nursing Management
5. Note evidence of sedative and benzodiazepine dependence  Most patients received less than 20 mcg/kg/min
6. Instruct to avoid alcohol and non-prescription drugs for 1-24 hrs  Drugs isn’t substitute for blood or fluid volume deficit
 During infusion, monitor ECG, BP, CO, PR and color and temp of the
limbs
 Do not confuse dopamine to dobutamine
SHOCK  Check urine output often

DOPAMINE
DOBUTAMINE
Intropine
Dobutrex
Classification
Adrenergic drugs Classification
Adrenergic drugs
Dosage
Initially 2-5 mcg/kg/min by IV Dosage
 0.5-1 mcg/kg/min IV infusion, titrating to optimum dosage of 2-20
Action mcg/kg/min
Stimulates dopaminergic and alpha and beta receptors of the  2.5 to 10 mcg/kg/min-usual effective range to increase CO
sympathetic nervous system resulting in positive inotropic effect and
increased CO Action
Stimulates heart beta receptors to increase myocardial contractility
Indication and SV
 To treat shock and correct hemodynamic imbalances
 To correct hypotension Indication
 To increase CO
 To improve perfusion of vital organs  Treatment of cardiac decompensation

 To increase CO Side Effects

 CNS: headache
Side Effects  CV: HPN, tachycardia, palpitations and vasoconstriction
 CNS: headache an anxiety  GI: nausea and vomiting
 CV: tachy, angina, palpitations and vasoconstriction
 Contraindications Ventolin
 Hypersensitivity
 Use cautiously in pts with hx of HPN and AMI Classification
Bronchodilator, Adrenergic
Nursing Management
 Before starting therapy, give a plasma volume expander to correct Dosage
hypovolemia and a cardiac glycoside 2 inhalations reputed q 4-6 hrs via neb
 Monitor ECG, BP, pulmonary artery wedge pressure and CO
 Monitor electrolyte levels Action
 Don’t confuse dobutamine to dopamine Activation of beta adrenergic receptors on airway smooth muscle

Indication
GLUCAGON  Asthma
 Prevention of exercise induced spasms

Side effects
Classification
 Palpitations
Pancreatic Hormones
 Tachycardia
 GI upset
Dosage
 Nervousness
0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN
Contraindications
Action
Hypersensitivity
Binds with glucagon receptor
Nursing Management
Indication
 Monitor therapeutic effectiveness
Hypoglycemia
 Monitor HR, BP, ABG, s/sx of bronchospasm and CNS stimulation
Side Effects  Instruct on how to use inhaler properly
Nausea, vomiting, hypotension, tachycardia and hypertension  Rinse mouth after use

Contraindications
 Hypersensitivity DIPHENHYDRAMINE HCL
 Pheochromocytoma
 Insulinoma Benadryl

Nursing Management Classification

 Monitor V/S and blood sugar level Anti-histamine
 Response within 20 mins after injection
Dosage
25-50 mg PO, IV or IM bid-tid
ALBUTEROL
Action
 Blocks the effects Hi receptor sites

Indication
 Allergic reactions
 Motion sickness
 Cough suppression
 Sedation

Side Effects
 Xerostomia
 Urinary retention
 Sedation

Contraindications
Acute asthmatic attack

Nursing Management
Risk for photosensitivity- use sunscreen

EPINEPHRINE

(Discussed earlier)