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Drug Study

Drug Study



|Views: 8,711 |Likes:
Published by Lizeth Querubin
1. Dobutamine Hydrochloride
2. Dopamine Hydrochloride
3. Midazolam
4. Meperidine Hydrochloride
5. Ca Gluconate
1. Dobutamine Hydrochloride
2. Dopamine Hydrochloride
3. Midazolam
4. Meperidine Hydrochloride
5. Ca Gluconate

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Published by: Lizeth Querubin on Oct 10, 2008
Copyright:Attribution Non-commercial


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Generic NameDosageTherapeutic ActionClassificationContraindicationSide EffectsNursingResponsibility1. DobutamineHydrochloride
Adults: 2.5 – 10mcg/kg/min IV isusual rate to increasecardiac output; rarelyrates up to 40mcg/kg/min needed.Positive inotropiceffects are mediatedby betaadrenergicreceptors in the heart:increases the force of mycardial contracionwith relatively minorseffects on heart rate,arrythmogenesis: hasminor effects of bloodvessels.SympathomimeticBeta1-selectiveadrenergic agonist
Contraindicatedwith IHSS;hypovolemia; acuteMI; generalanesthesia withhalogenatedhydrocarbons orcyclopropane,which sensitize themyocardium tocatecholamine;pregnancy.
Use cautiously withdiabetes mellitus;lactation; allergy tosulfites morecommon inasthmatic patients.
CNS: Headaches
CV: Increase inheart rate,increase insystolic BP,increase inventricularectopic beats(PVC’s), anginalpain,palpitations,shortness of breath
GI: Nausea
Arrange todigitalizepatients whohave atrialfibrillation with arapid ventricularrate beforegivingbobutamine-dobutaminefacilitates ACconduction
Monitor urineflow, cardiacoutput,pulmonarywedge pressure,ECG, and BPclosely duringinfusion; adjustdose and rateaccordingly.
2. DopamineHydrochloride
Adults:Patients likely torespond to themodest increments of cardiac contractilityand renal perfusion:Initially 2-5mcg/kg/min IV.Patients who are moreseriously ill: Initially, 5mcg/kg/min IV.Increase inincrements of 5-10mcg/kg/min up to rateof 20-50 mcg/kg/min.Check urine outputfrequently if doses>16 mcg/kg/min.Drug acts directly andby the release of norepinephrine fromsympathetic nerveterminals;dopaminergicreceptors mediatedilation of vessels inthe renal andsplanchnic beds,which maintains renalperfusion andfunction; alphareceptors, which areactivated by higherdoses of dopamine,mediatevasoconstriction,which can overridethe vasodilatingeffects; beta1receptors mediate apositive inotropiceffect on the heart.SympathomimeticAlpha-adrenergicagonistBeta1-selectiveadrenergic agonistDopaminergic drug
Contraindicatedwithpheochromocytoma, Tachyarrythmias,ventricularfibrillation,hypovolemia,general anesthesiawith halogenatedhydrocarbons orcyclopropane whichsensitize themyocardium tocatecholamines.
Use cautiously withatherosclerosis,arterial embolism,Raynaud’s disease,cold injury,frostbite, diabeticendarteritis,Buerger’s disease(monitor the colorand temperature of CV: Ectopic bets,tachycardia, anginalpain, palpitations,hypotension,vasoconstriction,dyspnea, bradycardia,hyper tension,widened QRS.GI: Nausea, vomitingOther: Headache,piloerection,azotemia, gangrenewith prolonged use.
Monitor bloodpressure, pulse,peripheralpulses, andurinary output atintervalsprescribed byphysician.Precisemeasurementsare essential foraccuratetitration of dosage.
Report thefollowingindicatorspromptly tophysician for usein decreasing ortemporarilysuspendingdose: Reducedurine flow rate in
extremities),pregnancy,lactation.absence of hypotension;ascendingtachycardia;dysrhythmias;disproportionaterise in diastolicpressure(markeddecrease inpulse pressure);signs of peripheralischemia (pallor,cyanosis,mottling,coldness,complaints of tenderness,pain, numbness,or burningsensation).
Monitortherapeuticeffectiveness. Inaddition toimprovement invital signs andurine flow, otherindices of adequatedosage andperfusion of vitalorgans includeloss of pallor,increase in toetemperature,adequacy of nailbed capillaryfilling, andreversal of confusion orcomatose state.
3. Midazolam
Preoperativesedation,anxiety,amnesia: <60yr: 70-80mcg/kgExact mechanism of action notunderstood; actsmainly at the limbicsystem and reticularBenzodiazepine(short-acting)CNS depressant
Contraindicatedwithhypersensitivity tobenzodiazepines;psychoses, acuteBlurred vision;changes in bloodpressure, breathing,and heartbeats;coughing; dizziness;
Do not usesmall veins for IVinjection.
Administer IMinjections deep
IM 1 hr beforesurgery (usualdose 5 mg). >60yr or debilitated:20-50 mcg/kg IM1 hr beforesurgery (usualdose, 1-3 mg).
Conscioussedation forshortprocedures: <60yr: 1-1.5 mg IVinitially,maintenancedose of 25% of initial dose. >60yr: 1-2.5 mg IVinitially,maintenancedose of 25%initial dose.
Induction of anesthesia: <55yr: 300-350mcg/kg IV (up toa total of 600mcg/kg). >55 yr:150-300 mcg/kgIV as initial dose.
Sedation incritical careareas: 10-50mcg/kg (0.5-4mg usual dose)as loading dose:may repeat q10-15 min untildesired effect isseen; continuousinfusion of 20-100mcg/kg/hr tosustain effect.formation; potentiatesthe effects of GABA,an inhibitoryneurotransmitter;anxiolytic andamnesia effects occurat doses below thoseneeded to causesedation, ataxia; haslittle effect on corticalfunction.narrow-angleglaucoma, shock,coma, acutealcoholicintoxication;pregnancy;neonates.
Use cautiously inelderly ordebilitated patients;with impaired liveror renal function,lactation.drowsiness; drymouth; headache;hiccups; low bloodpressure (children);nausea; pain duringinjection; pain,redness, ortenderness at theinjection site; short-term memory loss;slurred speech;vomiting.Severe allergicreactions (rash; hives;difficulty breathing;tightness in the chest;swelling of the mouth,face, lips, or tongue);agitation; chest pain;combativeness;irregular breathingpatterns; pain,swelling, or rednessat the injection site;slow or difficultbreathing; unusual orinvoluntary musclemovements or muscletremor.into muscle.
Monitor IVinjection site forextravasation.
Arrange toreduce dosageof midazolam if patient is alsobeing givenoploidanalgesics;reduce dosageby at least 50%and monitorpatient closely.
Monitor level of consciousnessbefore, during,and for at least2-6 hr afteradministration of midazolam.
Carefullymonitor P, BP,and respirationsduringadministration.
4. MeperidineHydrochloride
Relief of pain:individualizeActs as agonist atspecific opioidreceptors in the CNSto produce analgesia,Opioid agonistanalgesic
Contraindicatedwith hypersensitivity to Transienthallucinations,transient hypotension(high doses), visual
Administer tolactating women4-6 hr before

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