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Name of Drug Lidocaine

Drug Dosage 300mg. May repeat in 6090min.

Drug Classification Amide Anesthetic; Antiarrhythmic, Anesthetic

Mechanism of Action Inhibits conduction of nerve impulses; causes temporary loss of feeling and sensation. Also an antiarrhythmic that decreases depolarization, automacity, excitability of the ventricle during diastole by direct action.

Indication Rapid control of Acute Ventricular Arrhythmia after an MI

Side Effects IM: pain at injection site. Topical: burning, stinging, tenderness at application site

Contraindication Adas-stokes syndrome, hypersensitivity to amide-type local anesthetics, septicemia, supraventricular arrhythmias, WolffParkinson-White syndrome.

Nursing Precaution Monitor EKG, v/s especially pulse and BP during and following drug administrat ion for cardiac performanc e. Inform physician if theres arrhythmia s Monitor for drowsiness . Its a sign for high serum levels of lidocaine

Epinephri ne

1mg. May repeat q35min

Sympathomimeti c; Bronchodilator; Cardiac Stimulant; Antihemmorrhagi c; Antiallergic

Stimulates alphaadrenergic receptors causing vasoconstriction and pressor effects, beta1-adrenergic receptors, rresulting in cardiac stimulation, and beta2-adrenergic receptors, resultin in bronchial dilation and vasodilation.

Cardiac arrest, Hypersensitivity, bronchospasm

Tachycardia, palpitations, nervousness

Cardiac arrythimias, cerebrovascular insufficiency, hypertension, hyperthyroidism, ischemic heart disease, narrowangle glaucoma, shock

Atropine

0.5-1mg q5min not to exceed 2mg or 0.4mg/kg

Acetylcholine antagonist; Antiarrythmic; Antispasmodic, Antidote

Inhibits the action of acetylcholine by competing with acetylcholine for common binding sites pn muscarinic receptors, which are located on exocrine glands, cardiac and smooth muscleganglia and intramural neurons. This action blocks all muscarinic effects.

Cardiopulmonar y resuscitation for treatment of sinus bradycardia accompanied by hemodynamic compromise

Dry mouth, nose and throat may be severe, decreases sweating, constipation, irritation at site of injection

Bladder neck obstruction due to prostatic hypertrophy, cardiospasm, intestinal atony, myasthenia gravis, narrow-angle glaucoma, obstructive disease of GI tract, paralytic ileus, tachycardia secondary to cardiac insufficiency or thyrotoxicosis.

Monitor for v/s changes. Monitor ABGs Monitor EKG and patients condition in Cardiac Arrest. Avoid use of excessive Caffeine derivatives Instruct pt to void before giving medication s Determine if patient is hypersensit ive to medication Monitor v/s and tachycardi a Monitor I&O and bowel movement. Maintain clear airway. Obtain weight of children to calculate drug

Narcan

IV, IM, Subcutaneo us: 0.4-2mg q2-3min as needed

Narcotic antagonist; Antidote.

Displaces opioids at opioid-occupied receptor sites in the CNS. Reverses opioid-induced sleep or sedation, increases RR, raises BP to normal range.

For opioid toxicity, opiodinduced respiratory depression.

None known; little or no pharmacologi c effect in absence of narcotics.

Respiratory depression due to nonopioid drugs

dosage. Monitor v/s. Assess for increase pain with reversal opiate. Observe pt for satisfactory response. Pitressin IV 5units initially. Subsequent doses: 10units q34h Posterior Pituitary Hormone, Vassopressor Causes peristalsis and vasoconstriction. Cardiac Arrest, Vasodilatroy shock, GI hemorrhage Pain at injection site, abdominal cramps, nausea, vomiting, diarrhea, dizziness, diaphoresis None known. Caution for seizure, mih=graine, asthma, vascular disease, renal/ cardiac disease, goiter Establish baselines for weight, BP, pulse, serum electrolytes, urine specific gravity. Monitor I&O Withhold medication and report if theres any chest pain or allergies. Assess Bp and apical pulse before administering . Withhold if pulse is 60 below or systolic BP is less than 90. Monitor for symptoms of pulmonary toxicity and dosage should be stopped or reduced if toxicity

Cordaron e

PO 8001600mg/day in 2-4 divided doses for 1-3 wks.

Cardiac agent, Antiarrhthmic

Prolongs duration of myocardial cell action potential and refractory period by acting directly on all cardiac tissue.

Life-threatening recurrent ventricular fibrillation, hemodynamicall y unstable ventricular tachycardia.

Corneal microdeposits if treatment is 6months. Hypotension, nausea, fever, bradychardia

Bradycardiainduced syncope, second- and thirddegree AV block, severe hepatic disease, severe sinus-node dysfunction.

Dopamin e

IV 1mcg/kg/min up to 50mcg/kg/mi n titrated to desired response.

Simpathomime tic; Cardiac stimulant, vasopressor.

Stimulates adrenergic receptors. Increses renal blood flow, urine flow, and sodium excretion. Increases myocardial contractility, stroke volume and cardiac output.

Prophylaxis and treatment for acute hypotension, shock, low cardiac output, CHF

Headache, ectopic beats, tachycardia, anginal pain, palpitations, vasoconstriction, hypotension, nausea, vomiting, dyspnea.

Pheocromocytoma , sulfite sensitivity, uncorrected tachyarrythmias, ventricular fibrillation.

occurs. Monitor EKG, serum AST, ALT, alkaline phosphatase for evidence of hepatic toxicity. Report Shortness of breath, cough Protect against photosensitivi ty. Monitor for cardiac arrhthmias. Measure urine output frequently. Immeadiately infiltrate the affected tissue if exravsation occurs. Monitor v/s q15 during administratio n. Assess cardiac output, pulmonary wedge pressure or CVP frequenlty. Be alert to excessive vasoconstricti on.

Amiodaro ne

PO 8001600mg/day in 2-4 divided doses for 1-3 wks.

Cardiac agent, Antiarrhthmic

Prolongs duration of myocardial cell action potential and refractory period by acting directly on all cardiac tissue.

Life-threatening recurrent ventricular fibrillation, hemodynamicall y unstable ventricular tachycardia.

Corneal microdeposits if treatment is 6months. Hypotension, nausea, fever, bradychardia

Bradycardiainduced syncope, second- and thirddegree AV block, severe hepatic disease, severe sinus-node dysfunction.

Assess Bp and apical pulse before administering . Withhold if pulse is 60 below or systolic BP is less than 90. Monitor for symptoms of pulmonary toxicity and dosage should be stopped or reduced if toxicity occurs. Monitor EKG, serum AST, ALT, alkaline phosphatase for evidence of hepatic toxicity. Report Shortness of breath, cough Protect against photosensitivity. Assess BP, pulse, respirations immediately before administrati on. Patient must remain recumbent for upto 3 hrs after parenteral

Diazepa m

ranges from a total of 6 milligrams (mg) to 40 mg per day

Benzodiazepi ne; anitconvulsa nt

Depresses all levels of the CNS by enhancing the action of gammaaminobutyric acid, a major inhibitory neurotransmitter in the brain.

For seizures

Pain with IM injection, somnolence, fatigue. ataxia

Angle-closure glaucoma, preexisting CNS depression, respiratory depression, severe uncontrolled pain.

Lasix

Tablets: 20 mg, 40 mg, 80 mg, 500 mg Oral solution: 10 mg/ml, 40 mg/5 ml Injection: 10 mg/ml

Loop Diuretics

furosemide acts by inhibiting the Na-K2Cl symporter in the thick ascending limb of the loop of Henle. The action on the distal tubules is independent of any inhibitory effect on carbonic anhydrase or aldosterone; it also abolishes the corticomedullary osmotic gradient and blocks negative as well as positive free water clearance

For Hypertensi on

Anemia, blood disorders, blurred vision, constipation, cramping, diarrhea, dizziness, dizziness upon standing, fever, headache, hearing loss, high blood sugar, hives, itching, loss of appetite, low potassium

anuria hepatic coma electrolyte imbalances caution if hypersens. to sulfonamides caution if diabetes mellitus caution if acute MI caution if arrhythmias caution if hearing impairment caution if concurrent ototoxic agents caution if SLE

admin. To reduce hypotensive effect. Observe recurrence of seizure activity. Promote safety precautions. Monitor weight, blood pressure, and pulse rate routinely with long-term use and during rapid diuresis. Furosemide can lead to profound water and electrolyte depletion. If oliguria or azotemia develops or increases, drug may need to be discontinued. Watch for signs of hypokalemia, such as muscle weakness and cramps. Consult doctor and dietitian about a high-potassium diet. Foods rich in potassium include citrus fruits, tomatoes, bananas, and dates. Monitor

blood glucose levels in diabetic patients. Furosemide may not be well absorbed orally in patient with severe heart failure. Drug may need to be given I.V. even if patient is taking other oral drugs. Monitor blood uric acid level Monitor elderly patients, Store tablets in light-resistant container to prevent discoloration (doesn't affect potency). Don't use discolored (yellow) injectable preparation. Refrigerate oral furosemide solution to ensure drug stability.

Morphine Sulfate

PO 10 to 30 mg every 4 h as needed. Avinza 45 to 120 mg once daily only in opioid-tolerant patients. Subcutaneous/IM 5 to 20 mg/70 kg every 4 h as needed. IV 2.5 to 15 mg per 70 kg in water for injection 4 to 5 mL over 5 min as needed.

Opioid analgesic

Relieves pain by stimulating opiate receptors in CNS; also causes respiratory depression, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting and increased bladder tone.

for the relief of moderate to severe pain.

Hypotension; orthostatic hypotension; bradycardia; tachycardia; palpitations. Lightheadedness; dizziness; drowsiness; sedation; euphoria; dysphoria; delirium; disorientation; incoordination.

Hypersensitivity to opiates; upper airway obstruction; acute asthma; diarrhea caused by poisoning or toxins.

. Instruct patient to take oral preparations with food or juice if GI upset occurs. Tell patient not to crush or chew controlledrelease tablets. Caution patient to avoid sudden position changes to prevent orthostatic hypotension. Instruct patient to avoid intake of alcoholic beverages and other CNS depressants. Advise patient that drug may cause drowsiness, dizziness or blurred vision and to use caution while driving or performing other tasks requiring mental alertness.

Nitroglyce rin

starting dose is between 0.2 mg/hr*, and 0.4 mg/hr

Nitrate

Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

For chest pain and pulmonary edema

Headache, hypotension, lightheadedness, rebound hypertension

Use of Transderm-Nitro (nitroglycerin) transdermal system is contraindicated in patients using Viagra (sildenafil) because sildenafil may amplify the vasodilatory effects of Transderm-Nitro resulting in severe hypotension.

Give sublingual preparations under the tongue or in the buccal pouch. Encourage patient not to swallow. Administer transdermal systems to skin site free of hair and not subject to much movement. Report blurred vision, persistent or severe headache, rash, more frequent or more severe angina attacks, fainting. Monitor BP and cardiac rhythm during and after administration. Monitor for transient asystole. Inform patient to report the following symptoms to health care provider: chest pressure, dizziness, facial flushing, headache, lightheadedness,

Adenosin e

6mg initial dose

Antiarrhyth mic agent, In vivo diagnostic aid

Adenosine is an endogenous purine nucleoside that modulates many physiological processes. Cellular signaling by adenosine occurs through four known adenosine receptor subtypes (A1, A2A, A2B, and A3)

Conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (WolffParkinson-White Syndrome)

temporary rash on the chest, lightheadedness, diaphoresis, or nausea after administration of adenosine due to its vasodilatory effects. Metallic taste is a hallmark side effect of adenosine administration.

Second- or third-degree AV block (except in patients with functioning artificial pacemaker); sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with functioning artificial pacemaker); known hypersensitivity to adenosine; known or suspected bronchoconstrictive or bronchospastic lung disease (when use as a diagnostic aid).

numbness or nausea, shortness of breath, tingling in arms.

Digoxin

Tablets, oral 125 mcg (0.125 mg) - Tablets, oral 250 mcg (0.25 mg) - Solution, pediatric, oral 50 mcg/mL (0.05 mg/mL)

Cardiac glycoside

Heparin

The dosage of heparin sodium should be adjusted according to the patients coagulatio n test results.

Anticoagula nt

Digoxin increases the strength and vigor of heart contractions, and is useful in the treatment of heart failure. It is extracted from the leaves of a plant called digitalis lanata. Digoxin increases the force of contraction of the muscle of the heart by inhibiting the activity of an enzyme (ATPase) that controls movement of calcium, sodium and potassium into heart muscle. Increases the production of antithrombin (blood products that prevent blood from clotting) and prevents trombin from working. Thrombin is a blood component that causes clotting.

Digoxin is used for mild to moderate congestive heart failure and for treating an abnormal heart rhythm called atrial fibrillation.

nausea, vomiting, headache, dizziness, skin rash, and mental changes.

Ventricular fibrillation; hypersensitivity to digoxin or to other digitalis preparations.

This medication is best taken on an empty stomach one hour before or two hours after meals. It may be taken with food if stomach upset occurs. Tell your doctor if you have a history of: liver or kidney disease, lung disease, thyroid problems, rheumatic fever.

Atrial fibrillation with embolization

This medication may cause irritation, pain, redness or swelling at the injection site.

Should not be used by: People with active bleeding. People with bleeding disorders such as hemophilia. Pregnant women with threatened abortion.

Avoid IM administration. Subcutaneous administration should be deep, preferably into fatty layers of abdomen. Use small-gauge needle to minimize tissue trauma. Bunch

up tissue without pinching and insert needle at 90% angle to skin. Inject slowly. Do not aspirate to check entry into blood vessel. Apply gentle pressure to puncture site for approximately 1 min; do not massage. Rotate injection sites frequently and keep record. IV administration may be given undiluted over 1 min.

Coumadi ne

Depends on the lab results

oral anticoagula nt

inhibits the synthesis of clotting factors, thus preventing blood clot formation. Blood clots can occur in the veins of the lower extremities, usually after periods of immobility. These clots can break off and become lodged in the blood vessels of the lung (pulmonary embolism),

th blood clots in the lower extremities to prevent extension of the clot, and to reduce the risk of pulmonary embolism.

bleeding and necrosis (gangrene) of the skin.

Anticoagulation is contraindicated in any localized or general physical condition or personal circumstance in which the hazard of hemorrhage might be greater than the potential clinical benefits of anticoagulation, such as:

Warfarin takes about three days to produce its full effect, so when treating deep vein thrombosis or pulmonary embolism, a faster-acting injectable anticoagulant such as a heparin will be used initially. - The anticoagulant

causing shortness of breath, chest pain, and even life-threatening shock

effect of warfarin needs to be measured regularly (by INR blood test) and the dose of warfarin will be adjusted as necessary to make the INR fall into the appropriate range for a particular condition. - Baseline blood tests should be taken before treatment starts, but treatment should not be delayed by waiting for the results.

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