EMERGENCY DRUGS Generic Name: Digoxin Brand Name: Lanoxin Class: Cardiac Glycosides Action: Inhibits the sodium-potassium

ATP pase, Indication: V-fib, V-flutter, CHF, pulmonary edema, atrial fibrillation and or flutter, and paroxysmal atrial contractions Dosage: 0.5-2.0 mg/ml TIV Nursing Responsibilities: Monitor K+, Mg++, ECG, liver/renal function tests, drug level (therapeutic level 0.5-2.0 mg/ml, toxicity is >2.0 mg/ml). Before each dose assess apical pulse for full minute, record and report changes in rate or rhythm. Withhold drug and contact provider if pulse is < 60/min. or >100 (adults) or < 110/minute (children) Weigh daily Monitor I&O and signs of CHF Health Education: Avoid giving with meals. Teach to take pulse correctly and report if pulse is out of parameter. Weigh every other day and record. Restrict alcohol, sodium, smoking. Consult with provider prior to taking OTC meds. Eat foods rich in potassium. Wear medical alert tag. Emphasize the importance of regular check-up Generic Name: Lidocaine Brand Name: Xylocaine Class: Antiarrythmic and Anesthetic Action: Decrease cardiac excitability, cardiac contraction is delayed in the atrium and ventricle Indication: Pulseless Ventricular dysarhythmias such as PVC Ventricular tachycardia Ventricular fibrillation Dosage:1-1.5 mg/kg IVP or ETT (double dose if giving via ET tube), may repeat q 5-10 min. max 3 mg/kg; If conversion successful start an infusion of 2-4 mg/min Nursing Responsibilities: Monitor EKG, BP, pulse, rhythm, continuously. Monitor serum lidocaine levels throughout theraphy; therapreutic range 1.5-5 mcg/ml Monitor intake and output Do not mix in the same syringe with amphoterin B or cefazolin Administer Lidocaine TIV. In case of circulatory depression have dopamine available.

Health Education: Instruct client and family about drug. Recommend client walk with another person due to dizziness and drowsiness. Generic Name: .Aminophylline Brand Name: Theophylline ethylenediamine Class: Bronchodilator, Xanthine Action: Inhibits phosphodeterase, an enzyme responsible for breaking down cyclic AMP, resulting in bronchodilation and reducing airway resistance Indication: Asthma, emphysema, chronic obstructive pulmonary disease (COPD), or chronic airway limitations (CAL) Dosage: 1.0 2.0 mg/ml q 3-8 TIV Nursing Responsibilities: Monitor ABGs and theophylline levels. Peak serum concentration should be taken 1 hour after I.V 1-2 hrs. following immediate release dose, 3-8 hours following extended release. Take through level just before next dose or 2 hrs. after meals. Monitor vital signs, respirations and breath sounds. Health Education: Instruct to avoid use of caffeine derivatives (chocolate, coffee, tea, cola, and cocoa). Caution not to take OTC meds that contain ephedrine or sympathomimetics Generic Name: Diphenhydramine Chloride Brand Name: Benadryl Class: Antihistamine Action: Blocks histamine release at H1 blockers Indication: Upper Respiratory allergic disorder Anaphylactic reaction Blood transfusion reaction Acute urticaria Motion sickness Extra pyramidal symptoms Dosage: 10-50 mg IV or deep IM up to 100 mg not to exceed 400 mg/24hr. Nursing Responsibilities: Monitor Vital Signs, Intake and output. If secretions are thick, use a humidifier. Health Education: Instruct client to take with food; drink a minimum of 8 glasses of fluid per day. Advice to do frequent mouth care; may use a sugarless gum, lozenges or candy. Notify provider if confusion or other undesirable effects occur. Instruct not to drive or operate machinery if drowsiness occurs or until response to drug has determined. For prophylaxis or motion sickness, recommend taking 30-60 minutes before traveling. Avoid alcohol and other CNS depressants.

Generic Name: Nifedipine Hydrochloride Brand Name: Procardia

Class: Calcium Channel Blockers Action: Blocks calcium access to the cells causing decrease in contractility decrease anterior constriction decrease PVR decrease BP Indication: Hypertension Vasopastic angina Classic chronic stable angina Atrial fibrillation of flutter Migraine headaches Dosage: 30-60 mg OD, P.O Nursing Responsibilities: Monitor hepatic and renal function studies. Monitor ECG and avoid giving when heart blocks are present. Have emergency equipment available with IV administration Protect the drug from light and moisture. Position client to decrease peripheral edema. Health Education: Instruct to increase dietary fiber, fluid intake, and exercise. Avoid overexertion when anginal pain is relieved. Encouraged to take with meals or milk. Recommend client not to chew or crush sustained-release Generic Name: Clonidine hydrochloride Brand Name: Catapres Class: Central Alpha2 Agonists Action: Decreases the release of adrenergic hormones from the brain, resulting in a decrease in the peripheral vascular resistance and blood pressure Indication: Hypertension Dosage: Tablet: >100 mcg b.i.d then increase in 100-200 mcg/day until desired response is desired Nursing Responsibilities: Monitor BP, heart rate, daily weight. CBC, ANA, renal function tests, urinalysis Health Education: Instruct how to take heart rate. If rate is > 20 bpm over normal, notify provider Report 5 lb weight gain Monitor and report muscle and joint aches, fever. Monitor bowel activities. Take with meals; for nausea eat unsalted crackers or dry toast. Report peripheral edema of hands and feet. Lie down if dizzy Generic Name: Epinephrine Brand Name: Adrenalin Class: Beta2 Adrenergic Agonists

Action: Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity BP, HR, PR Decreases airway resistance. Indication: Asthma Bronchitis Emphysema All cardiac arrest, anaphylaxis Used for symptomatic bradycardia. Relief of bronchospasm occurring during anesthesia Exercised-induced bronchospasm Dosage: Cardiac arrest: 1 mg IV of 1:10,000 solution q 3-5 min; double dose if administering via ET tube Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000 solution. Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution Refractory bradycardia and hypotension: 2-10ug/min Nursing Responsibilities: Monitor V/S. and check for cardiac dysrhythmias Health Education: Caution against overuse. Notify provider before taking other meds or if symptoms are not relieved. Demonstrate the correct use of inhaler or nebulizers. Teach about metered dose inhalers (MDI). When two puffs are needed 1-3 min. should lapse between two puffs. A spacer may be used to increase the delivery of the medication. If the glucocorticoid inhalant is to be used with a bronchodilator, wait 5-15 minutes before using the inhaler containing the steroid for the bronchodilator effect. Assist client in identifying the cause of acute bronchial attack Generic Name: Hydrocortisone sodium succinate Brand Name: Solu-cortef Class: Corticosteroids Action: Synthesize by adrenal cortex Exhibits anti-inflammatory properties Suppresses the normal immune response Increase carbohydrate, fats and protein metabolism Indication: Anti-inflammatory Immunosuppressant Replacement in adrenal cortical sufficiency Dosage: IM. IV 100-500 mg: then nay be repeated at 2-, 4-, and 6 hr. intervals depending on the response and severity of conditions. Nursing Responsibilities: Monitor V/S, BP, weight, blood glucose, electrolytes, EKG, and TB

skin test results Health education: Instruct to administer oral drugs with food or milk early in the morning Withdraw medication slowly. Follow-up visits and lab test are essential. Avoid infection Taper off gradually under medical supervision. Report visual disturbance or severe GI distress, sudden weight gain, swelling sore throat, fever or signs of infection. Wounds may heal slowly. Avoid crowds and known infection Do not receive vaccination. Dont take aspirin or any medication without consulting provider. Discuss a diet that low in sodium, high in Vit. D, protein and potassium. Inform provider of therapy. Dont overuse For topical applications, apply after shower. Do not cover. Generic Name: Heparin Sodium Brand Name: Heparin Class: Anticoagulant Action: Combines with antithrombin III to retard thrombin activity Indication: Thrombosis. Reduces the risk of myocardial infarction (MI), CVA, clots associated with atrial fibrillation Pulmonary edema Peripheral embolism Dosage: Deep SC General Heparin Dosage Initial loading dose:10, 000-20,000 units Maintenance:8,000- 10,000 units q 8 hr or 15,000-20,000 units q 12 hr. Use concentrated solution Intermittent IV General heparin dosage Initial loading dose: 10,000 units undiluted or in 50-100 ml saline; then 5,000-10,000 units q 4-6 hr undiluted or in 50-100 ml saline. Nursing Responsibilities: Monitor PTT (usually 1.5-2.5 times control values) and platelet count. Monitor for signs of unsual bleeding (petechiae, hematuria, GI bleeding, gum bleeding). Initiate bleeding protocol measures (use electric razor, hold pressure for 5 minutes with venipunctures, soft toothbrushes) Monitor IV site carefully. Heparin has short half-life ,therefore with discontinuation. PTT will return to baseline within 1-2 hrs. Health Education:

Explain bleeding protocol precautions Explain the needs for several PTT evaluations Teach signs of unusual bleeding Avoid activities with risk of injury Caution with sharp utensils while cooking and eating Avoid salicylates or any OTC medication without approval from provider. Wear identification that notes anticoagulant therapy. Generic Name: Magnesim Sulfate Class: Electrolyte, Anticonvulsant Action: Reduces striated muscle contractions due to the depressant effect on the CNS Blocks neuromuscular transmission BP, PR, and RR Indication: Control of convulsions in pre-eclampsia or eclampsia. Hypomagnesemia, or hypothyrodism Torsades de pointes Severe asthma VF refractory to lidocaine Digoxin induced VT-VF. Dosage: Hypomagnesemia:0.5-1 g/hr TIV Cardiac Arrest:1-2 g IVF Torsades de Pointes: (non cardiac) load with 1-2 g/hr continous infusion not to exceed 40 g/24 hr. Nursing Responsibilities: Monitor serum levels. Normal serum concentration are 1.6 to 2.6 mEq/ L. Monitor knee jerk reflex before repeated parenteral administration Maintain urine output at a level of 100 ml q 4hrs. during parenteral administration Antidote is Calcium Gluconate Generic Name: Furosemide Brand Name: Lasix Class: Loop Diuretics Action: Inhibit sodium, chloride, and water reabsorption in the proximal portion of the ascending loop of Henle Indication: Edema associated with CHF Cirrhosis with ascites or renal dysfunction For hypertension or in combination with other antihypertensive medications. ICP, nephritic syndrome, hepatic cirrhosis Dosage: 0.5-1 mg/kg slow IVP over 1-2 min, may repeat once at 2 mg/kg slow IVP over 1-2 mins. Nursing Responsibilities: Monitor serum glucose, and electrolyte D iet- K+ for all except aldactone I ntake and Output, daily weight

U ndesirable effects; Fluid and electrolyte imbalance R eview HR, BP and electrolytes E lderly-Careful T ake with or after meals and in AM I ncrease risk of orthosthatic hypotension; move slowly C ancel alcohol Health Education: Report changes in hearing, irritability, vomiting, anorexia, nausea, diarrhea, twitching or tetany. Generic Name: Isosorbide Dinitrate Brand Name: Isordil Class: Coronary Vasodilator, Osmotic Diuretics, Antanginal Action: Increases osmotic pressure of glomerular filtrate; thus preventing reabsorption of water. Increases excretion of sodium and chloride. Indication: Oliguria ,Edema, Increased Intracranial Pressure, Treat certain drug toxicities Dosage: Sublingual tablet: Acute attack: 2.5-5 mg q 2-3 hr as required. The dose can be titrated upward until anginal is relieved or side effects occur. Nursing Responsibilities: Monitor renal function tests, serum and urine K+ and Na+ levels, CVP, and V/S. Watch for rapid in BP and symptoms of sympathetic overactivity (ex. HR, tremor and agitation) Solutions given via an in line filter. IV solutions may crystallize Redissolve before infusing by warming bottle. Never give solutions with undissolve crystals. Health Education: Advise client that glycerin and isosorbide dinitrate are for reduction of Intracranial pressure and should be monitored by the provider of care frequently Generic Name: Ranitidine hydrochloride Brand Name: Zantac Class: H2 Histamine Antagonists Action: Reduces gastric acid secretions Prevent histamine induced acid release by competing with histamine for H2, receptors in the stomach. Indication: Hypersecretion of stomach acids Gastroesophangeal refux Short-term treatment of duodenal ulcers Long term prophylaxis of duodenal ulcers Prevention of upper GI bleed in critically ill clients. Dosage: Adults:150 mg b.i.d IM, IV:

Maintenance and treatment for duodenal ulcer, hypersecretory conditions and esophangeal reflux. Adults: IM: 50 mg q 6-8 hr. Intermittent IV injection or infusion: 50 mg q 6-8 hr not to exceed 400 mg/day Continuous IV infusion: 6.25 mg/hr. Nursing Responsibilities: Monitor GI discomfort Periodic evaluation of blood count Gastric Acid Secretion Test Renal and hepatic function tests Be alert that the elderly need a decrease in the drug dosage. Health Education: Avoid antacids for 1 hour before taking drug. Advice to take with meals. Take Zantac, Pepcid, or Axid at 6 pm for better suppression of nocturnal acid secretion To assist in acid refux, advise client to elevate the head of the bed with 6 inch blocks during sleep Wear loose clothing No meal intake prior to hours of sleep. Eliminate caffeine, alcohol, harsh spices, chocolate, peppermint from diet Stop smoking No ASA or NSAIDS Notify provider of blood in emesis or stool or an in the abdominal pain Generic Name: Albuterol Brand Name: Ventolin Class: Bronchodilator, Beta2 Adrenergic Agonists Action: Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity Decreases airway resistance. Indication: Reversible airway restriction due to acute bronchospasm Asthma Chronic Obstructive Pulmonary Disease Dosage: 1.25- 5 mg nebulized in 3 ml saline Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution Nursing Responsibilities: Monitor breath sounds Sensorium levels for confusion and restlessness due to hypoxia Monitor V/S. Check for cardiac dysrhythmias Health Education: Caution against overuse.

Notify provider before taking other meds or if symptoms are not relieved. Demonstrate the correct use of inhaler or nebulizers. Teach about metered dose inhalers (MDI). When two puffs are needed 1-3 min. should lapse between two puffs. A spacer may be used to increase the delivery of the medication. If the glucocorticoid inhalant is to be used with a bronchodilator, wait 5-15 minutes before using the inhaler containing the steroid for the bronchodilator effect. Assist client in identifying the cause of acute bronchial attack. Generic Name: Sodium Bicarbonate Class: Alkalizing Agent, Buffer, Antacid, electrolyte. Action: Neutralizes gastric acid Decrease pepsin activity Indication: Hyperacidity Peptic ulcer Hyperkalemia Tricyclic antidepressant OD Shock associated with severe diarrhea, dehydration, uncontrolled DM Reflux esophagitis Dosage: 1 mEq/kg IVP, may repeat 0.5 mEq/kg 10 min. Nursing Responsibilities: Monitor urinary pH, calcium, electrolytes and phosphate levels. Record amount and consistency of stools. Clients on low-sodium diets should evaluate sodium contents of antacids. Health Education: Instruct to shake suspension well before taking, follow with water. Take 1-3 hours after meal Do not take within 1-2 hrs. of eating fiber rich foods. Do not combine with other antacid. Generic Name: Nitroglycerin Brand Name: Nitrostat Class: Antianginal, Nitrate, Vasodilator, Coronary Action: Relaxes the vascular smooth system Myocardial oxygen consumption left ventricular workload arterial BP venous return Indication: Angina pectoris CHF associated with AMI Cardiac load reducing agent Hypertensive Crisis Dosage: 0.3-0.4 mg SL q 5 min, max 3 doses. Nursing Responsibilities: Record characteristics and precipitating factors of anginal pain. Monitor BP and apical pulse before administration and periodically after dose. Have client sit or lie down if taking drug for the first time.

Client must have continuing EKG monitoring for IV administration Cardioverter/ defibrillator must not be discharged through paddle electrode overlying Nitro-Bid ointment or the Transderm-Nitro Patch. Assist with ambulating if dizzy. Health Education: Avoid alcohol Teach to recognize e symptoms of hypotension. Advise to make position changes slowly to avoid prolonged standing. Teach about the form of nitroglycerin prescribed. Oral: Instruct to take an empty stomach with a full glass of water. Do not chew tablet. Sublingual: Instruct to take at first sign of anginal pain. May be repeated q 5 minutes to max. of 3 doses. If the client doesnt experience relief, advise to seek medical assistance immediately. Transderm nitro Patch Instruct to apply OD, usually in Am. Rotation of sites are necessary. Generic Name: Calcium Chloride Class: Minerals, Electrolytes, Calcium Salt Indication: Hypocalcemia Hypocalcemic tetany Hyperkalemia with cardiac toxicity Hypermagnesemia Dosage: Antidote to calcium channel blocker 2-4 mg/kg TIV, may be repeated as needed; given prophylactically prior to IV calcium channel blockers 8-16 mg/kg IV Hyperkalemia: 2.25-14 mEq. Nursing Responsibilities: May administer IM or SC. May give undiluted IV push. Generic Name: Calcium Gluconate Class: Minerals, Electrolytes, Calcium Salt Indication: Hypocalcemia Hypocalcemic tetany Hyperkalemia with cardiac toxicity Hypermagnesemia Dosage: Hypocalcemia 7-14 mEq IV; Hypocalcemic tetany 4.5-16 mEq IV, may repeat until symptoms are controlled; Hyperkalemia with cardiac toxicity 2.25-14 mEq IV, may repeat 1-2 min; Hypermagnesemia 4.5-9 mEq IV. Nursing Responsibilities: If a precipitate is noted in the syringe, do not use. If precipitate is noted in the vials or ampules, heat to 80 C in a dry heat oven for 1 hr to dissolve. Shake vigorously and allow to cool room temperature.

IV should not exceed 0.5-2 ml/min Give an intermittent IV infusion at a rate not exceeding 200 mg/min. Can also be given by a continuous IV infusion. Generic Name: Pyridoxine Hydrochloride Brand Name: Vitamin B6 Class: Vitamin B Complex Action: A coenzyme necessary for many metabolic functions affecting carbohydrate, lipid, and protein utilization in the body. Indication: Pyridoxine deficiency Dosage: IM, IV Adults: 50-200 mg/day for 3 weeks followed by 25-100 mg/day as needed. Nursing Responsibilities: Monitor for improvement of nervous system abnormalities (anxiety, depression, insomia, peripheral numbness, and tremors) and skin lesions (may cause anemia/pheriperal neuritis) Health Education: Discomfort may occur at IM site. Foods rich in pyridoxine include avocado, bananas, bran, eggs, hazelnuts, legumes, organ meats, shrimp, tuna, and wheat germ

Generic Name: Potassium Chloride Brand Name: Kaochlor, K-Dur, K-Lor, K- Lyte Class: Mineral, Electrolyte Action: Necessary for many cellular metabolic processes Primary action intracellular. Conduct nerve impulses Contracts cardiac, skeletal and smooth muscle. Maintains normal renal function. Indication: Correct Potassium deficiency Strengthen cardiac and muscular activities Dosage: Hypokalemia (>2.5) up to 200 mEq/day as an infusion Hypokalemia (<2) up to 400 mEq/day as an infusion (rate should not be exceed 20 mEq/hr) Nursing Responsibilities: Monitor serum potassium levels (therapeutic 3.5-5.0 mEq/L), V/S, ECG and signs of hyper and hypokalemia. Assess signs of digitalis toxicity. Give IV infusions as dilute solution infuses slowly. Observe IV sites for infiltration so tissue necrosis will not occur. Potassium should never be given as an IV bolus or push. Potassium cannot be given IM. Monitor urine output. 80-90% K+ is excreted in a urine. Health Education: Recommend client to have serum potassium level checked at regular intervals.

Instruct to take oral preparation with at least 6-8 oz of water or juice and at mealtime. Medical follow up to the health related problem and medication is important. Review foods rich in potassium (bananas, cantaloupes, oranges, raisins, potatoes) Generic Name: Phenytoin Brand Name: Dilantin Class: Anticonvulsant Action: Reduces motor cortex activity by altering transport of ions. Indication: Grand mal Complex partial seizures. Prevention and treatment of seizures occurring during or following neurosurgery Dosage: Adults: Loading dose: 10-15 mg/kg at a rate not to exceed 50 mg/min; then, 100 mg PO or IV q 6-8 hr. Pediatric loading dose: 15-20 mg/kg in divided dose of 5-10 mg/kg given at a rate of 13 mg/kg/min. Nursing Responsibilities: Monitor serum drug levels (therapeutic range: 10-20 mcg/ml); labs related to renal and liver function. Provide safety during and after a seizure. If given in a suspension, shake well before pouring. If given intravenous (IV), it should administered slowly due to potential hypotension and dysrhythmias. Administer only through a saline line Do not mix with other drugs. Validate a good blood return Health Education: Instruct client regarding safety precautions while taking meds. Inform provider of any undesirable effects. Women taking oral contraceptives may need to use an additional method of contraception. Advice female clients considering getting pregnant to consult with provider of health care since drug may have a teraterogenic effect on a fetus. Do not abruptly stop the drug. Recommend preventative dental check-ups; use a soft toothbrush Advise client that the urine may be red/brown. Discuss the importance of wearing an alert ID card and or/ medical alert bracelet. Generic Name: Phenobarbital Brand Name: Solfoton Class: Sedative-hypnotic, barbiturate Action: Depressant and anticonvulsant effects may be related to its ability to increase and/or minimic the inhibitory activity of GABA on nerve synapses. Indication: Sedative/ hypnotic Anticonvulsant

Emergency control of acute seizure disorders due to status epilepticus, meningitis, tetanus, eclampsia, toxicity. Dosage: Sedation Adults: 30-120 mg/day in two to 3 divided doses. Preoperative sedation: Adults: 100-200 mg IM only, 60-90 min before surgery. Pediatric: 1-3 mg/kg IM or IV 60-90 min prior to surgery. Hypnotics: Adults: 100-320 mg IV or IM Acute Convulsions: Adults: 200-320 mg IM or IV may be repeated in 6 hr if needed. Nursing Responsibilities: Monitor V/s, CBC, liver and renal function test. Reduce dose with impairment and in debilitated/ elderly clients. Health Education: Take only as directed and do not stop abruptly. Store away from bedside and out of childs reach. May initially cause drowsiness; assess effects before performing tasks that require mental alertness. Phenobarbital may require an increase in Vit. D consumption. Drug decreases the effect of oral contraceptives; practice other nonhormonal forms of birth control. Avoid alcohol and OTC agent without approval. Brush teeth frequently and carefully to prevent gingivitis.

Generic Name: Atrophine Sulfate Brand Name: Isopto Atropine Class: Anticholinergics Action: Blocks cholinergic receptor sites so response to acetylcholine is decreased Indication: As an anti-sialagogue for preanesthetic medication to prevent or reduce secretions of the respiratory tract To restore cardiac rate and arterial pressure during anesthesia, when vagal stimulation produced by intra-abdominal surgical traction causes a sudden decrease in pulse rate and cardiac action To lessen the degree of atrioventricular (A-V) heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis To overcome severe carotid sinus reflex Antidote for cardiovascular collapse from the injudicious use of a cholinergic drug. Dosage: Bradycardia: 0.5 -1 mg IV (may give via ETT at double dose) q 3-5 min, max 0.04 mg/kg Cardiac arrest: 1 mg q 3-5 min, max 0.04 mg/kg Nerve gas and organophosphate symptoms, may repeat in 2 mg increments q 3 min tiltrated to relief symptoms. Nursing Responsibilities: Monitor VS. Report HR

Monitor for constipation, oliguria. Atrophine could result in CNS stimulation (confusion, excitement) or drowsiness Health Education: Instruct to take 30 mins before meals Eat foods high in fiber and drink plenty fluids. Avoid OTC antihistamines. Instruct client not to drive a motor vehicle or participate in activities requiring alertness. Advise to use hard candy, ice chips, etc. for dry mouth. Generic Name: . Amiodarone Brand Name: Cordarone Class: Antidysrhythmic Action: Blocks sodium channels at rapid placing frequencies, causing an increase in the duration of the myocardial cells action potential and refractory period Decreases sinus rate, Increases PR and QT intervals. Relaxes vascular smooth muscles, reduces peripheral vascular resistance and increases cardiac index slightly Indication: Wide and narrow-complex tachycardia Ventricular fibrillation Pulseless ventriculat tachycardia Dosage: IV Infusion: 150 mg over first 10 min, 360 mg over next 6 hr, 540 mg over next 18 hr. Nursing Responsibilities: Assess quality of respiration and breath sounds; note cardiac status, EKG, and CV findings. Note baseline VS and perfusion Assess vision for therapy. Obtain baseline CBC, electrolytes, CXR, renal and LFTs During Administration observe for PR and QRS intervals, arrythmias and Hr < 60 bpm. Health Education: Drug is used to control heart beat irregularities, so take as directed. Report if crystals develop on the skin, producing a bluish color, so dosage can be adjusted. Avoid direct exposure to sunlight. Wear protective clothing, sunglasses, and a sunscreen when exposed. Report all side effects, especially any abnormal swelling, bleeding, or bruising. Report CNS symptoms such as tremor, lack of coordination, nuimbness and dizziness. Generic Name: Hydralazine Brand Name: Apresoline Class: Vasodilators Action: Direct relaxation of vascular smooth muscle Producing vasodilation of arterioles which decreases afterload. Indication: Hypertension Nursing Responsibilities: Monitor BP, HR and daily weight, CBC, ANA titiers, Renal Function

Test, U/A Health Education: Instruct how to take HR. If rate is >20 bpm over normal, notify to the provider. Report 5 lb wt. gain Monitor and report muscle and joint aches, fever Monitor bowel activity. Take with Food, for nausea eat unsalted crackers or dry toasts Report peripheral edema of hands and feet. Lie down if dizzy Generic Name: Captopril Brand Name: Capoten Class: ACE Inhibitors, Antihypertensive Action: Suppresses rennin- angiostensin-aldosterone system Blocks conversion of angiostensin I to angiostensin II Indication: Hypertension Adjunctive Therapy for CHF Reduces development of severe heart failure following MI in clients with impaired left ventricular function Prevents kidney failure in Type II diabetes. Dosage: Tablets: Adults: Initial: 25 mg b.i.d-t.i.d. If satisfactory response after 1-2 weeks, increase to 50 mg bid-tid if still unsatisfactory after another 1-2 weeks, add a thiazide diuretic. May increase a dose to 100-150 mg bid-tid not to exceed 450 mg/day. Nursing Responsibilities: Obtain baseline and monitor serum/urine protein, BUN, Creatinine, Glucose, CBC with differential, potassium and sodium levels First dose syncope may occur in those with CHF. Provide mouth care; alteration in taste can occur. Health Education: Report any S/S of infection, bruising or bleeding, This meds will have reduced absorption if given with food. Instruct not to use potassium supplements or any food or substance containing a large amount of potassium Ex. Low-sodium milk, salt substances.,etc Generic Name: Atenolol Brand Name: Tenormin Class: Beta Adrenergic Blockers Action: Binds to Beta 1-(cardiac) and/or beta 2-(lungs) adrenergic receptor sites that prevents the release of cathecholamine. contractility in the heart rennin release in the kidney in the sympathetic output from the vasomotor canter of the brain Indication: Hypertension Unstable Angina Myocardial infarction Migraine Headache

Situational anxiety Thyrotoxic storm/crisis Upper GI bleed Familial tremors Assist in treatment of dysrhythmias Dosage: Initial: 50 mg/day either alone or with diuretics; if response is inadequate, 100 mg/day will not produce further beneficial effects. Maximum effects usually seen within 1-2 weeks. Angina: 50 mg/day if maximum response is not seen in 1 week, increase dose to 100 mg/day. IV: Acute MI: 5 mg over 5 min followed by second 5 mg dose in 10 min later. Nursing Responsibilities: Monitor blood sugar closely in clients with diabetes Monitor triglyceride and cholesterol level (LDL) Monitor BP and PR prior to administering If pulse is <60 or SBP < 90, withhold and notify provider of health care. Monitor any change in the cardiac rhythm or any signs of CHF. Generic Name: Quinapril Hydrochloride Brand Name: Accupril Class: ACE Inhibitors, Antihypertensive Action: Suppresses rennin- angiostensin-aldosterone system Blocks conversion of angiostensin I to angiostensin II Indication: Hypertension Adjunctive Therapy for CHF Reduces development of severe heart failure following MI in clients with impaired left ventricular function Prevents kidney failure in Type II diabetes

Dosage: Tablets:10-20 mg OD, then adjust dosage based on BP response at peak (2-6 hr) and trough blood levels. The dose should be adjusted at 2 weeks intervals. Nursing Responsibilities: Obtain baseline and monitor serum/urine protein, BUN, Creatinine, Glucose, CBC with differential, potassium and sodium levels First dose syncope may occur in those with CHF. Provide mouth care; alteration in taste can occur. Health Education: Report any S/S of infection, bruising or bleeding, This meds will have reduced absorption if given with food. Instruct not to use potassium supplements or any food or substance containing a large amount of potassium Ex. Low-sodium milk, salt substances.,etc.. Generic Name: Prednisone Brand Name: Deltasone, Orasone, Meticorten Class: Corticosteroids Action: Synthesize by adrenal cortex

Exhibits anti-inflammatory properties Suppresses the normal immune response Increase carbohydrate, fats and protein metabolism Indication: Anti-inflammatory Immunosuppressant Dermatological disorders Replacement in adrenal cortical sufficiency Dosage: Oral solution, syrup, tablets: Initial: 5-60 mg/day in four equally divided doses after meals and at bed time. Decreases gradually by 5-10 mg q 4-5 days to establish a minimum maintenance dosage (5-10 mg) or discontinue altogether until symptoms occur. Pediatric: 0.1-0.15 mg/kg/day Nursing Responsibilities: Monitor V/S, BP, weight, blood glucose, electrolytes, EKG, and TB skin test results Health Education: Instruct to administer oral drugs with food or milk early in the morning Withdraw medication slowly. Follow-up visits and lab test are essential. Avoid infection Taper off gradually under medical supervision. Report visual disturbance or severe GI distress, sudden weight gain, swelling sore throat, fever or signs of infection. Wounds may heal slowly. Avoid crowds and known infection Do not receive vaccination. Dont take aspirin or any medication without consulting provider. Discuss a diet that low in sodium, high in Vit. D, protein and potassium. Inform provider of therapy. Dont overuse For topical applications, apply after shower. Do not cover. Generic Name: Terbutaline Sulfate Brand Name: Bricanyl Class: Beta2 Adrenergic Antagonists Action: Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity BP, HR, PR Decreases airway resistance Indication: Asthma Bronchitis Emphysema All cardiac arrest, anaphylaxis Used for symptomatic bradycardia. Relief of bronchospasm occurring during anesthesia Exercised-induced bronchospasm Dosage:

Adults and Children over 15 years old: 5 mg tid q 6 hr during waking hours, not to exceed 15 mg q 24 hr. If disturbing side effects are observed dose can be reduced to 2.5 mg tid without loss of beneficial effects. Nursing Responsibilities: Sensorium levels for confusion and restlessness due to hypoxia Monitor V/S. Check for cardiac dysrhythmias Health Education: Caution against overuse. Notify provider before taking other meds or if symptoms are not relieved. Demonstrate the correct use of inhaler or nebulizers. Teach about metered dose inhalers (MDI). When two puffs are needed 13 min. should lapse between two puffs. A spacer may be used to increase the delivery of the medication. If the glucocorticoid inhalant is to be used with a bronchodilator, wait 515 minutes before using the inhaler containing the steroid for the bronchodilator effect. Assist client in identifying the cause of acute bronchial attack Generic Name: . Dopamine hydrochloride Brand Name: Intropin Class: Vasopressor, Inotropic Action: Stimulates receptors to cause cardiac stimulation and renal vasodilation Increases systemic vascular resistance at a higher dose ranges. Indication: Cardiogenic shock Myocardial infarction Trauma Endotoxic septicemia Open heart surgery Renal failure Chronic cardiac decomposition Dosage:Adults: IV Drip: 1-20ug/kg/min Nursing Responsibilities: Monitor VS, I&O, and ECG; titrate infusion to maintain SBP as ordered. Be prepared to monitor CVP and PAWP. Report ectopy, palpitations, anginal pain, or vasoconstriction. Health Education: Drug is administered IV to improve cardiac function thus increasing BP and improving output. Report any chest pain, increased SOB, headaches, or vasoconstriction. Generic Name: . Dobutamine Hydrochloride Brand Name: Dobutrex Class: Inotropic, Adrenergic Action: Enhancing the force of myocardial contraction HR, CO, and SV with minor effects to HR. elevated ventricular filling pressure and helps AV node conduction Indication: Short term treatment of cardiac decompensation in organic heart disease of cardiac surgical pressures. Dosage:

Adults individualized:2.5-15 mcg/kg/min. Rate of administration and duration of therapy depend on the response of client as determined by HR, presence of activity, BP and urine flow Nursing Responsibilities: Monitor CVP to assess vascular volume and cardiac pumping efficiency. Elevated CVP may indicate disruption on CO, as in pump failure or pulmonary edma; low CVP may indicate hypovolemia Monitor ECG and BP continuously during drug administration Record I&O Monitor glucose in diabetes patients Health Education: Drug is administered IV to improve cardiac function thus increasing BP and improving urine output. Report any chest pain, increase SOB, headaches or IV site pain. Generic Name: Diazepam Brand Name: Valium Class: Antianxiety, Benzodiazepines Action: Appears to enhance action og gamma-aminobutyric acid (GABA inhibitory neurotransmitter) Depress the limbic and subcortical CNS Indication: Anxiety Preoperative medication Skeletal muscle relaxant Treatment of seizures Short-term relief of symptoms of anxiety Dosage: Preoperative or diagnostic use. Adults: 10 mg IM 5-30 min before procedure. Moderate Anxiety: Adults: 2-5 mg IM or IV q 3-4hr if necessary. Severe Anxiety: Adults: 5-10 mg IV or IM q 3-4 hr PRN. Tablets, Oral solution Adults: 2-10 mg bid-qid Elderly: 2-2.5 mg 1-2 times/day. Pediatric, over 6 mos. Initial: 1-2.5 mg bid-tid. Nursing Responsibilities: Monitor VS, cardiovascular status, mental status. Liver function tests and blood counts with clients on long term therapy. Assess for symptoms of leucopenia Provide a restful environment if giving IV infusion If given IV, have respiratory equipment available; keep client recumbent Do not mix anti-anxiety drugs with other drugs in a syringe. Safety precautions for drowsiness. Health Education: Recommend small frequent meals

Encourage to rise slowly from supine position and dangle feet prior to standing. Avoid alcohol, smoking and other CNS depressant. Avoid activities needing a psychomotor coordination until CNS effects are known. Generic Name: Sodium Chloride Brand Name: Neut Class: Alkalinizing agent, antacid, electrolyte Action: Maintaining the fluid and electrolyte balance. Excess retention of sodium results in over hydration which is often treated with diuretics. Abnormally low levels of sodium result to dehydration Indication: Hyperacidity Peptic ulcer Reflux esophagitis Dosage: Individualized: Daily requirements of sodium and chloride can be met by administering 1 L of 0.9 % of NaCl. Ophthalmic Solution 2 % or 5% :1-2 gtt in eye q 3-4 hr. Ophthalmic Ointment 5%: A small amount to the inside affected eye q 3-4 hr. Nursing Responsibilities: Document indications for therapy: Monitor electrolytes, ECG, liver and renal function studies. Note level of consciousness; assess heart and lung sounds. Observe S&S of hypernatremia: flushed skin, elevated temperature, rough dry tongue, and edema. Symptoms of hyponatremia may include N&V, muscle cramps, dry mucous membranes, increased HR, and headaches. Monitor VS and I&O. When administering IV the 0.45% NaCl is hypotonic, the 0.9 % NaCl is Isotonic, and the 3% and 5% is hypertonic Generic Name: Mannitol Brand Name: Osmitrol Class: Osmotic Diuretics Action: Increases osmotic pressure of glomerular filtrate; thus preventing reabsorption of water. Increases excretion of sodium and chloride. Indication: Oliguria Edema Increased Intracranial Pressure Treat certain drug toxicities Dosage: IV infusion only Either 50 ml of a 25% solution, 75 ml of a 20% solution, or 100 ml of a 15% solution infused over 3-5 min. If urine flow is 30-50ml/hr, therapeutic dose can be given. Prevention of acute renal failure

Adults: 50-100 g, as of 5-25% of solution, given at a rate to maintain urine flow at least 30-50 ml/hr. Treatment of oliguria Adults: 50-100 g of a 15%-25% solution Reduction of Intracranial Pressure and brain mass: Adults: 1.5-2 g/kg as a 15%-25%, infusion over 30-60 min. Nursing Responsibilities: Monitor renal function tests, serum and urine K+ and Na+ levels, CVP, and V/S. Watch for rapid in BP and symptoms of sympathetic overactivity (ex. HR, tremor and agitation) Solutions given via an in line filter. IV solutions may crystallize Redissolve before infusing by warming bottle. Never give solutions with undissolve crystals. Health Education: Advise client that glycerin and mannitol are for reduction of Intracranial pressure and should be monitored by the provider of care frequently Generic Name: Aspirin Brand Name: Bayer, Bufferin, Ecotrin Class: Antiplatelet, NSAID Action: Platelet aggregation inhibitor Inhibits platelet synthesis of thromboxanne A2 A vasoconstrictor and inducer of platelet aggregation. Occurs at low doses and lasts for 8 days. Inhibits prostaglandin synthesis Resulting in analgesic, anti-inflammatory and antipyretic activities. Indication: TIAs and CVA with history of TIA due to fibrin platelet emboli. Reduces risk of death from MI in clients with a history of infarction or unstable angina. To reduces fever and inflammatory processes. Musculoskeletal disorder Analgesic for mild and moderate pain Dosage: Adults: 325-500 mg q 3hr, 325-600 mg q 4 hr, or 650-1,000 mg q 6 hr. As an alternative, the adult chewable tablet may be used in doses of 4-8 tablets q 4 hr as needed. Pediatric: 65 mg/kg/day in divided dose q 4-6 hr, not to exceed 3.6 g/day. Nursing Responsibilities: Monitor liver and renal function tests. CBC, clotting times, stool, blood drug levels, and VS. Health Education: Instruct to take drug with food and a full glass of water. Avoid alcohol and consult with provider about other meds. Advise not to take Aspirin or acetaminophen when taking NSAID. No driving or activities requiring a motor response until certain there is no dizziness. Discontinue this meds 5 to 7 days before any major procedure or surgery. Do not crush and do not chew sustained release preparations. Use only as recommended.

Initiate safety precautions to keep out of childrens reach since it can be very dangerously Generic Name: . Ketorolac Thromethamine Brand Name: Toradol Class: Non Steroidal Anti Inflammatory Drugs Action: Inhibits prostaglandin synthesis Resulting in analgesic, anti-inflammatory and antipyretic activities Indication: To reduces fever and inflammatory processes. Musculoskeletal disorder Analgesic for mild and moderate pain Dosage: IM Analgesic, single dose Adults: less than 65 years old: One 60 mg dose. Adults over 65 y/o in renal impairement, or weigh less than 50 kg: One 30 mg dose. IM,IV Analgesic, multiple dose: Adults: less than 65 years of age: 30 mg q6hr, not to exceed 120 mg daily. Adults: over 65 years of age, in renal impairement or weight less than 50 kg: 15 mg q 6 hr, not to exceed 60 mg daily. Nursing Responsibilities: Instruct to take drug with food and a full glass of water. Avoid alcohol and consult with provider about other meds. Advise not to take Aspirin or acetaminophen when taking NSAID. No driving or activities requiring a motor response until certain there is no dizziness. Discontinue this meds 5 to 7 days before any major procedure or surgery. Report if temperature does not subside, bleeding occurs, or inflammation does not decrease. Periodic eye exam for long term therapy. Inform dentist and other providers of drug therapy.

Generic Name: Alprazolam Brand Name: Xanax Class: Antianxiety, Benzodiazepines Action: Appears to enhance action og gamma-aminobutyric acid (GABA inhibitory neurotransmitter) Depress the limbic and subcortical CNS Indication: Anxiety Preoperative medication Skeletal muscle relaxant Treatment of seizures Short-term relief of symptoms of anxiety

Dosage: Anxiety Disorder: Adults: 0.25-0.5 mg tid, then titrate to needs of client, with total dosage not to exceeed 4 mg. In elderly or debilitated : Initial: 0.25 mg bid-tid then adjust dosage to needs of client Nursing Responsibilities: Monitor VS, cardiovascular status, mental status. Liver function tests and blood counts with clients on long term therapy. Assess for symptoms of leucopenia Provide a restful environment if giving IV infusion If given IV, have respiratory equipment available; keep client recumbent Do not mix anti-anxiety drugs with other drugs in a syringe. Safety precautions for drowsiness. Health Education: Recommend small frequent meals Encourage to rise slowly from supine position and dangle feet prior to standing. Avoid alcohol, smoking and other CNS depressant. Avoid activities needing a psychomotor coordination until CNS effects are known. Providers including dentist should be advised that the client is taking this medication. Review methods to control excess stress and anxiety Generic Name: Amikacin Brand Name: Amikin Class: Aminoglycosides Action: Bactericidal Binds with 30s or 50s ribosomal subunit thus inhibiting protein synthesis Indication: Serious infection caused by ram-negative infections Used to treat methicillin-resistant, staphylococcus aureus Dosage: Adults, children, and older infants: 15 mg/kg/day in two to three equally divided doses q 8-12 hr for 7-10 days; maximum daily dose: 15 mg/kg. Nursing Responsibilities: Audiograms, BUN/ creatinine and vestibular function studies should also be monitored periodically during an extended high dose therapy over 10 days Adjust for renal insufficiency Monitor VS and peak and trough serum levels routinely. For IV administration, dilute and administer slowly over 60 minute to prevent toxicity. Monitor I&O, hydrate well before and during the therapy If prescribed oral drugs take a full course and drink plenty of fluids. If anorexia and nausea occurs, provide small frequent meals. Establish plan for safety, if vestibular nerves affect occur.

Health Education: Administer other antibiotics 1 hour before/after aminoglycosides. Recommended using sun block and protective clothing when exposed to the sun. Generic Name: Diclofenac Brand Name: Voltaren Class: Non Steroidal Anti Inflammatory Drugs Action: Inhibits prostaglandin synthesis Resulting in analgesic, anti-inflammatory and antipyretic activities. Indication: To reduces fever and inflammatory processes. Musculoskeletal disorder (e.g rheumatoid arthritis, osteoarthritis) Analgesic for mild and moderate pain Dosage:Adults: 50 mg tid of immediate release tablets. In some, an initial dose of 100 mg followed by 50 mg doses may achieve better results. After the first day, the total daily dose should not exceed 150 mg. Nursing Responsibilities: Instruct to take drug with food and a full glass of water. Avoid alcohol and consult with provider about other meds. Advise not to take Aspirin or acetaminophen when taking NSAID. No driving or activities requiring a motor response until certain there is no dizziness. Discontinue this meds 5 to 7 days before any major procedure or surgery. Report if temperature does not subside, bleeding occurs, or inflammation does not decrease. Periodic eye exam for long term therapy. Inform dentist and other providers of drug therapy. Health Education: Client will have pain relief, decrease temperature, and improved mobility without undesirable effects of drugs Generic Name: Erythromycin Brand Name: Erythrocin, E-Mycin, Erytab, Eryc, PCE, Ilotycin Class: Macrolide Antibiotic Action: Bacteriostatic Inhibit synthesis of protein in bacteria Indication: Clients who are allergic to penicillin. Gram-positive and some gram-negative organism Dosage:Opthalmic Ointments: Mild to moderate infections:0-5 in ribbon bid-tid Nursing Responsibilities: Periodic hepatic function studies for high-doses or prolonged IV therapy. Monitor bleeding times if taking warfarin If administered IV, dilute in an appropriate amount of solution as outlined in the drug book or circular. Health Education: Instruct client to save erythromycin 1 hour before or 2 hours after meals. Take with a full glass of water and not fruit juice. If GI upsets occurs, client may take with food. Chewable tablets should be chewed and not swallowed.

Report undesirable effects such as GI disturbance. Generic Name: . Ketoprofen Brand Name: Orudis, Oruvail Class: Non Steroidal Anti Inflammatory Drugs Action: Inhibits prostaglandin synthesis Resulting in analgesic, anti-inflammatory and antipyretic activities. Indication: To reduces fever and inflammatory processes. Musculoskeletal disorder Analgesic for mild and moderate pain Dosage: Tablets: OTC Adults: over 16 years of age: 12.5 mg with a full glass of liquid every 4 to 6 hr. If pain or fever persists after 1 hr follow with additional 12.5 mg. Experience may determine that an initial dose of 25 mg gives a better effect. Nursing Responsibilities: Instruct to take drug with food and a full glass of water. Avoid alcohol and consult with provider about other meds. Advise not to take Aspirin or acetaminophen when taking NSAID. No driving or activities requiring a motor response until certain there is no dizziness. Discontinue this meds 5 to 7 days before any major procedure or surgery. Report if temperature does not subside, bleeding occurs, or inflammation does not decrease. Periodic eye exam for long term therapy. Inform dentist and other providers of drug therapy. Health Education: Client will have pain relief, decrease temperature, and improved mobility without undesirable effects of drugs.