Generic Name 1.

Dobutamine Hydrochloride

Dosage Adults: 2.5 – 10 mcg/kg/min IV is usual rate to increase cardiac output; rarely rates up to 40 mcg/kg/min needed.

Therapeutic Action Positive inotropic effects are mediated by betaadrenergic receptors in the heart: increases the force of mycardial contracion with relatively minors effects on heart rate, arrythmogenesis: has minor effects of blood vessels.

Classification Sympathomimetic Beta1-selective adrenergic agonist 

Contraindication Contraindicated with IHSS; hypovolemia; acute MI; general anesthesia with halogenated hydrocarbons or cyclopropane, which sensitize the myocardium to catecholamine; pregnancy. Use cautiously with diabetes mellitus; lactation; allergy to sulfites more common in asthmatic patients.  

Side Effects CNS: Headaches CV: Increase in heart rate, increase in systolic BP, increase in ventricular ectopic beats (PVC’s), anginal pain, palpitations, shortness of breath GI: Nausea

Nursing Responsibility  Arrange to digitalize patients who have atrial fibrillation with a rapid ventricular rate before giving bobutaminedobutamine facilitates AC conduction  Monitor urine flow, cardiac output, pulmonary wedge pressure, ECG, and BP closely during infusion; adjust dose and rate accordingly.

2. Dopamine Hydrochloride

Adults: Patients likely to respond to the modest increments of cardiac contractility and renal perfusion: Initially 2-5 mcg/kg/min IV. Patients who are more seriously ill: Initially, 5 mcg/kg/min IV. Increase in increments of 5-10 mcg/kg/min up to rate of 20-50 mcg/kg/min. Check urine output frequently if doses >16 mcg/kg/min.

Drug acts directly and by the release of norepinephrine from sympathetic nerve terminals; dopaminergic receptors mediate dilation of vessels in the renal and splanchnic beds, which maintains renal perfusion and function; alpha receptors, which are activated by higher doses of dopamine, mediate vasoconstriction, which can override the vasodilating effects; beta1 receptors mediate a positive inotropic effect on the heart.

Sympathomimetic Alpha-adrenergic agonist Beta1-selective adrenergic agonist Dopaminergic drug

Contraindicated with pheochromocytoma , Tachyarrythmias, ventricular fibrillation, hypovolemia, general anesthesia with halogenated hydrocarbons or cyclopropane which sensitize the myocardium to catecholamines. Use cautiously with atherosclerosis, arterial embolism, Raynaud’s disease, cold injury, frostbite, diabetic endarteritis, Buerger’s disease (monitor the color and temperature of

CV: Ectopic bets, tachycardia, anginal pain, palpitations, hypotension, vasoconstriction, dyspnea, bradycardia, hyper tension, widened QRS. GI: Nausea, vomiting Other: Headache, piloerection, azotemia, gangrene with prolonged use.

Monitor blood
pressure, pulse, peripheral pulses, and urinary output at intervals prescribed by physician. Precise measurements are essential for accurate titration of dosage.

Report the
following indicators promptly to physician for use in decreasing or temporarily suspending dose: Reduced urine flow rate in

extremities), pregnancy, lactation.

absence of hypotension; ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure (marked decrease in pulse pressure); signs of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints of tenderness, pain, numbness, or burning sensation).

Monitor
therapeutic effectiveness. In addition to improvement in vital signs and urine flow, other indices of adequate dosage and perfusion of vital organs include loss of pallor, increase in toe temperature, adequacy of nail bed capillary filling, and reversal of confusion or comatose state. 3. Midazolam

Preoperative sedation, anxiety, amnesia: <60 yr: 70-80mcg/kg

Exact mechanism of action not understood; acts mainly at the limbic system and reticular

Benzodiazepine (short-acting) CNS depressant

Contraindicated with hypersensitivity to benzodiazepines; psychoses, acute

Blurred vision; changes in blood pressure, breathing, and heartbeats; coughing; dizziness;

Do not use small veins for IV injection. Administer IM injections deep

IM 1 hr before surgery (usual dose 5 mg). >60 yr or debilitated: 20-50 mcg/kg IM 1 hr before surgery (usual dose, 1-3 mg).  Conscious sedation for short procedures: <60 yr: 1-1.5 mg IV initially, maintenance dose of 25% of initial dose. >60 yr: 1-2.5 mg IV initially, maintenance dose of 25% initial dose. Induction of anesthesia: <55 yr: 300-350 mcg/kg IV (up to a total of 600 mcg/kg). >55 yr: 150-300 mcg/kg IV as initial dose.

formation; potentiates the effects of GABA, an inhibitory neurotransmitter; anxiolytic and amnesia effects occur at doses below those needed to cause sedation, ataxia; has little effect on cortical function.

narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy; neonates. Use cautiously in elderly or debilitated patients; with impaired liver or renal function, lactation.

drowsiness; dry mouth; headache; hiccups; low blood pressure (children); nausea; pain during injection; pain, redness, or tenderness at the injection site; shortterm memory loss; slurred speech; vomiting. Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); agitation; chest pain; combativeness; irregular breathing patterns; pain, swelling, or redness at the injection site; slow or difficult breathing; unusual or involuntary muscle movements or muscle tremor.

into muscle. Monitor IV injection site for extravasation. Arrange to reduce dosage of midazolam if patient is also being given oploid analgesics; reduce dosage by at least 50% and monitor patient closely. Monitor level of consciousness before, during, and for at least 2-6 hr after administration of midazolam. Carefully monitor P, BP, and respirations during administration.

4. Meperidine Hydrochloride

Sedation in critical care areas: 10-50 mcg/kg (0.5-4 mg usual dose) as loading dose: may repeat q 10-15 min until desired effect is seen; continuous infusion of 20100mcg/kg/hr to sustain effect. Adults:  Relief of pain: individualize 

Acts as agonist at specific opioid receptors in the CNS to produce analgesia,

Opioid agonist analgesic

Contraindicated with hyper sensitivity to

Transient hallucinations, transient hypotension (high doses), visual

Administer to lactating women 4-6 hr before

dosage; 50150mg IM, subcutaneously or PO q 3-4hr as needed. Diluted solution may be give by slow IV injection. OM route is preferred for repeated injections. Preoperative medication: 50100 mg IMor subcutaneously, 30-90 min before beginning anesthesia. Support of anesthesia: Dilute to 10 mg/ml, and give repeated doses by slow IV injection, or dilute to 1mg/ml and infuse continuously. Individualize dosage. Obstetric analgesia: When contractions become regular, 50-100 mg IM or subcutaneously; repeat q 1-3 hr.

euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

5. Ca Gluconate

IV infusion preferred. 1g contains 90mg (4.5 mEq) calcium. 0.5-2g as required; daily dose 1-15g.

Essential elements of the body; helps maintain the functional integrity of the nervous and muscular systems; helps maintain cardiac function, blood coagulation; is an enzyme cofactor and affects the

Electrolyte Antacid

narcotics, diarrhea caused by poisoning (before toxins are eliminated), bronchial asthma, COPD, cor pulmonale, respiratory depression, anoxia, kyphoscoliosis, acute alcoholism, increased ICP, pregnancy, seizure disorder, renal dysfunction. Contraindicated to premature infants. Use cautiously with acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, Addison’s disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, labor or delivery, renal or hepatic dysfunction, lactation. Contraindicated with allergy to calcium, renal calculi, Hypercalcemia, ventricular fibrillation during cardiac resuscitation and patients with the risk of existing

disturbances. Active metabolite may accumulate in renal dysfunction, leading to an increased risk of CNS toxicity. Use with caution during lactation, in older, or debilitated clients. Use with extreme caution in clients with asthma. Atropine-like effects may aggravate glaucoma, especially when given with other drugs used with caution in glaucoma.

the next feeding to minimize the amount of milk.

Reduce dosage

of meperidine by 25%-50% in patients receiving phenothiazines or other tranquilizers. Give each dose of the oral syrup in half glass of water. If taken indiluted, it may effect on mucous membranes. Reassure patient that addiction is unlikely; most patients who receive opiates for medical reasons do not develop dependence syndromes.

CV: Slowed heart rate, tingling, “beat waves” (rapid administration); peripheral vasodilation, local burning, drop in BP. Local: Local irritations, severe necrosis. Sloughing, and abscess

Give drug hourly for first 2 wk when treating acute ulcer. During healing stage, administer 1-3 hr after meals and hs. Have patient remain

secretory activity of endocrine and exocrine glands; neutralizes or reduces gastric acidity (oral use).

digitalis toxicity. Use cautiously with renal dysfunction, pregnancy, lactation.

formation. Metabolic: Hypercalcemia, rebound hyperacidity and milk – alkalisyndrome.

recumbent for a short time after IV injection.

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