DRUG ORDER

Generic Name:
Epinephrine

Brand Name:
Aerosol

Classification:
Sympathomi
metic
Alphaadrenergic
agonist
Beta1- and
beta2adrenergic
agonist
Cardiac
stimulant
Vasopressor
Bronchodilat
or
Antasthmatic
Nasal
decongestant
Mydriatic

MECHANISM OF ACTION

A direct-acting
sympathomimetic. It
stimulates - and -adrenergic
receptors resulting in
relaxation of smooth muscle of
the bronchial tree, cardiac
stimulation and dilation of
skeletal muscle vasculature. It
is frequently added to local
anaesthetics to retard diffusion
and limit absorption, to
prolong the duration of effect
and to lessen the danger of
toxicity.

INDICATIONS

treatment and
prophylaxis of
cardiac arrest
acute
hypersensitivity
(anaphylactoid)
reactions
syncope due to
carotid sinus
syndrome
urticarial
angioneurotic
edema
acute asthmatic
attacks

CONTRAINDICATION

Preexisting
hypertension
occlusive
vascular disease
angle-closure
glaucoma
hypersensitivity
cardiac
arrhythmias
tachycardia

ADVERSE
EFFECTS

epigastric
pain
urinary
retention
dyspnea
hyperglycae
mia
sweating
hypersalivati
on
weakness
tremors
coldness of
extremities
hypokalaemi
a

NURSING INTERVENTIONS

Use caution when calculating

and preparing doses
Use minimal doses for minimal
periods of time; "epinephrinefastness" (a form of drug
tolerance) can occur with
prolonged use.
Protect drug solutions from
light, extreme heat, and
freezingShake the suspension
for injection well before
withdrawing the dose.
Rotate subcutaneous injection
sites to prevent necrosis;
monitor injection sites
frequently.
Keep a rapidly acting alphaadrenergic blocker
(phentolamine) or a vasodilator
(a nitrate) readily available in
case of excessive hypertensive
reaction.
Have an alpha-adrenergic
blocker or facilities for
intermittent positive pressure
breathing readily available in
case pulmonary edema occurs
Do not exceed recommended
dosage

DRUG ORDER

Generic Name:
Lidocaine
Brand Name:
LidoPen
Xylocaine
Classification:

Antiarrhythm
ic
Local
anesthetic

MECHANISM OF ACTION

INDICATIONS

When administered
intramuscularly or
intravenously, Lidocaine
suppresses the automaticity
and spontaneous
depolarization of the ventricles
during diastole by altering the
flux of sodium ions across the
cell membrane with little or no
effect on the heart. Locally, it
produces local anesthesia
effect by inhibiting the
transport of ions across the
neural membranes. Thus,
initiation and conduction of
normal nerve impulses is
prevented.

Intravenous
ventricular
arrhythmias
Intramuscular
self-injected or
when IV is
unavailable
during transport
to local facilities
Local
infiltration or
mucosal or
topical
anesthetic
Patch used
when pain is
present due to
post-herpetic
neuralg

CONTRAINDICATION

Hypovolemia
Advanced AV
block

ADVERSE
EFFECTS

Drowsiness
Dizziness
Nervousness
Decreased
or absent
gag reflex
Bradycardia
Hypotension
Burning
sensation

NURSING INTERVENTIONS

When Lidocaine is administered

as an antiarrhythmic the nurse
should monitor the ECG
continuously.
Blood pressure and respiratory
status should be monitored
frequently during the drug
administration.
When administered as an
anesthetic, the numbness of the
affected part should be
assessed.
If signs of overdose occur, stop
the infusion immediately and
monitor the patient closely.
For throat sprays, make sure
that the patients gag reflex is
intact before allowing the patient
to eat or drink.
When IM injections are used,
the medication should be
administered in the deltoid
muscle only while frequently
aspirating to prevent IV
injection.
Undiluted IV loading dose of
Lidocaine is administered at 1
mg/kg at a rate of 25 to 50 mg

over 1 minute. The dose may be

repeated after 5 minute

DRUG ORDER
Generic Name:
furosemide
Brand Name:
Furomide
Lasix
Classification:
electrolytic and
water balance agent
loop diuretic

MECHANISM OF ACTION
Rapid-acting potent
sulfonamide loop diuretic
and antihypertensive with
pharmacologic effects and
uses almost identical to
those of ethacrynic acid.
Exact mode of action not
clearly defined; decreases
renal vascular resistance
and may increase renal
blood flow.

INDICATIONS

Oral, IV: Edema

associated with
CHF, cirrhosis, renal
disease
IV: Acute pulmonary
edema
Oral: Hypertension

CONTRAINDICATION

Severe sodium and

water depletion
hypersensitivity to
sulphonamides and
furosemide
hypokalaemia
hyponatraemia
precomatose states
associated with liver
cirrhosis
anuria
Addisons disease

ADVERSE EFFECTS

Fluid and electrolyte

imbalance.

Rashes

Photosensitivity

Nausea

Diarrhea

blurred vision

dizziness

headache

hypotension

Bone marrow
depression

hepatic dysfunction.

Hyperglycaemia

NURSING
INTERVENTIONS
Reduce dosage if
given with other
antihypertensives;
readjust dosage
gradually as BP
responds.
Administer with food
or milk to prevent GI
upset.
Give early in the day

so that increased
urination will not disturb
sleep.
Do not mix

parenteral solution with

highly acidic solutions
with pH below 3.5.
Discard diluted

solution after 24 hr.

Measure and record

weight to monitor fluid

changes.
Arrange to monitor
serum electrolytes,

hydration, liver and renal

function.

DRUG ORDER

Generic Name:
Digoxin
Brand Name:
Digitek,
Lanoxicaps,
Lanoxin
Classification:
Cardiac glycoside
Cardiotonic

MECHANISM OF ACTION
Digoxin is a cardiac
glycoside which has
positive inotropic activity
characterized by an
increase in the force of
myocardial contraction. It
also reduces the
conductivity of the heart
through the atrioventricular
(AV) node. Digoxin also
exerts direct action on
vascular smooth muscle
and indirect effects
mediated primarily by the
autonomic nervous system
and an increase in vagal
activity

INDICATIONS

CHF
Atrial fibrillation
Treatment of SVT
Treatment of
cardiogenic shock
Prophylaxis and
treatment of recurrent
paroxysmal atrial
tachycardia with
paroxysmal AV
junctional rhythm

CONTRAINDICATIONS

Ventricular fibrillation
Ventricular tachycardia
Presence of digoxin
toxicity
Hypersensitivity
Beriberi heart disease
Hypersensitive
carotid sinus syndrome

ADVERSE EFFECTS

Tachycardia
Headache
Dizziness
N&V
Diarrhea
Anorexia
Blurred vision
Acute hemorrhage
Convulsions
Angioneurotic edema

NURSING INTERVENTIONS

Assess cardiac

function
Measure liquids

precisely
Assess for signs of

toxicity, especially in
children and the
elderly
Give IV slowly over 5

minutes
Assess for

hyperthyroidism or
hypothyroidism
Obtain ECG
Obtain written heart

rate parameters for

drug administration
as drug may cause
extreme bradycardia
Do not administer if
HR is <50. Hold if HR

is 90-110 bpm in
children

DRUG ORDER

Generic Name:
DopamineHydrochlorid
e
Brand Name: Dopastat,
Intropin, Revimine

Classification:
Sympathomimetic
Alpha-adrenergic agonist
Beta1-selectiveadrenergic
agonist

MECHANISM OF
INDICATIONS
ACTION
Drug acts directly and by

Manag
the release of norepinephri
ement of
ne from sympathetic
metabolic
nerve
acidosis
terminals;dopaminergic

Used
receptors mediate dilation
to alkalinize
of vessels inthe renal
urine and
and splanchnic
promote
beds,which maintains
excretion of
renal perfusion and
certain
function; alpha
drugs in
receptors, which are
over
activated by higher doses of
dosage
dopamine,mediate
situations
vasoconstriction ,which

Used
can override the
as an
vasodilating effects;
antacid
beta1receptors mediate a
positive in otropic
effect on the heart

CONTRAINDICATIONS
Contraindicated with
pheochromocytoma,
Tachyarrythmias,ventricular
fibrillation,hypovolemia,gener
al anesthesia with
halogenated hydrocarbons or
cyclopropane which sensitize
the myocardium to
catecholamines.
Use cautiously with
atherosclerosis,arterial
embolism,Raynauds
disease,cold
injury,frostbite, diabetic
endarteritis,Buergers
disease(monitor the
color)

ADVERSE EFFECTS

CV: Ectopic bets,tachycardia, angina

pain, palpitations,hypotension,vasoconstriction,dyspn
ea, bradycardia,hyper tension,widened QRS.GI:
Nausea, vomitingOther:
Headache,piloerection,azotemia, gangrenewith
prolonged use

NURSING INTERVENTIONS

Monitor bloodpressure,
pulse,peripheralpulses,
andurinary output
atintervalsprescribed
byphysician.Precisemeasureme
ntsare essential
foraccuratetitration of dosage.