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Emergency Drugs: Cardiac Drugs Atropine Sulfate
Emergency Drugs: Cardiac Drugs Atropine Sulfate
CARDIAC DRUGS
ATROPINE SULFATE
Isopto Atropine
Classification
Anticholinergics
Dosage
Bradycardia: 0.5 mg IV every 3-5 mins, max of 0.04 mg/kg
Cardiac Arrest: 1 mg every 3-5 mins
Nerve and Organophosphate symptoms: may repeat in 2 mg increments q 3 mins titrated to relief
symptoms
Indication
Pre-op meds/pre-anesthetic meds
To restore cardiac rate and arterial pressure during anesthesia when vagal
To lessen the degree of A-V heart block
To overcome severe carotid sinus reflex
Antidote for cholinergic toxicity
Side effects
CNS: restlessness, ataxia, disorientation, hallucinations, delirium, coma, insomnia, agitation, confusion.
CV: tachycardia, angina, arrhythmias, flushing.
EENT: photophobia, blurred vision, mydriasis.
GI: dry mouth, constipation, vomiting.
GU: urine retention.
Hematologic: leukocytosis
Other: anaphylaxis
Adverse effects
CNS: headache, excitement.
CV: palpitations
GI: thirst, nausea
Contraindications
Hypersensitivity
With acute angle closure glaucoma, obstructive uropathy, obstructive disease of GI tract, paralytic ileus,
toxic megacolon, intestinal atony, unstable CV status in acute hemorrhage, asthma, or myasthenia gravis.
Pregnant women.
Nursing Management
Monitor VS.
Report HR
Monitor for constipation, oliguria.
Instruct to take 30 mins before meals
Eat foods high in fiber and drink plenty fluids.
Can cause photophobia
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.
NITROGLYCERINE
Nitrostat
Classification
Antianginal
Nitrate
Vasodilator,
Coronary
Dosage
0.3-0.4 mg SL q 5 min, max 3 doses.
Every 6 hrs except for midnight (cream)
Wear 12 hrs a day for skin patch
Action
Relaxes the vascular smooth system
Indication
Angina pectoris
CHF associated with AMI
Cardiac load reducing agent
Hypertensive Crisis
Side effects
CNS: headache, throbbing, dizziness, weakness.
GI: nausea, vomiting
Skin: Rash
Adverse Reactions
CV: orthostatic hypotension, flushing, fainting.
EENT: sublingual burning.
Skin: Cutaneous vasodilation, contact dermatitis (patch)
Contraindications
Contraindicated in patients hypersensitive to nitrates
With early MI. (S.L. form), severe anemia, increase ICP angle-closure glaucoma, IV nitroglycerine is
contraindicated in patients with hypovolemia, hypotension, orthostatic hypotension, cardiac tamponade
restrictive cardiomyopathy, constrictive pericarditis.
Nursing Management
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.
Instruct to take at first sign of anginal pain.
May be repeated q 5 minutes to max. of 3 doses.
If the client doesn’t experience relief, advise to seek medical assistance immediately.
Keep in a dark colored container
MORPHINE SULFATE
Immediate-release tablets:
MSIR
Timed-release:
Kadian, M-Eslon (CAN), MS Contin, Oramorph SR
Oral solution:
MSIR, Rescudose, Roxanol, Roxanol T
Rectal suppositories:
RMS
Injection:
Astramorph PF, Duramorph, Epimorph (CAN)
Preservative-free concentrate for microinfusion devices for intraspinal use:
Infumorph
Classification
Opioid Agonist Analgesic
Dosage
Oral: 10–30 mg q 4 hr PO. Controlled-release: 30 mg q 8–12 hr PO or as directed by physician; Kadian: 20–
100 mg PO daily–24-hr release system; MS Contin: 200 mg PO q 12 hr.
IV:2.5–15 mg/70 kg of body weight in 4–5 mL water for injection administered over 4–5 min, or as directed
by physician. Continuous IV infusion: 0.1–1 mg/mL in 5% dextrose in water by controlled infusion device.
Action
Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation
Indication
Relief of moderate to severe acute and chronic pain
Preoperative medication
Analgesic adjunct during anesthesia
Component of most preparations that are referred to as Brompton's cocktail or mixture
Intraspinal use with microinfusion devices for the relief of intractable pain
Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary edema
Side Effects
GI: dry mouth, constipation.
Skin: Tissue irritation and induration (SC injection).
Other: sweating,physical tolerance and dependence, psychological dependence
Adverse Effects
CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety,
fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma,
mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough
reflex
CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations,
chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope
Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm, bronchospasm, edema
GI: Nausea, vomiting, anorexia, biliary tract spasm; increased colonic motility in patients with chronic
ulcerative colitis
GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect,
reduced libido or potency
Respiratory:Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest
Contraindications
Hypersensitivity to opioid
Diarrhea caused by poisoning until toxins are eliminated
During labor or delivery of a premature infant
After biliary tract surgery or following surgical anastomosis
Pregnancy
Labor
Nursing Management
Interventions
Caution patient not to chew or crush controlled-release preparations.
Dilute and administer slowly
Tell patient to lie down during IV administration.
Keep opioid antagonist and facilities for assisted or controlled respiration readily available during IV
administration.
Use caution when injecting SC or IM into chilled areas or in patients with hypotension or in shock
Reassure patients that they are unlikely to become addicted
Teaching points
Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives, tranquilizers, over-the-
counter drugs.
Swallow controlled-release preparation (MS Contin, Oramorph SR) whole; do not cut, crush, or chew
them.
Do not take leftover medication for other disorders, and do not let anyone else take your prescription.
These side effects may occur: Nausea, loss of appetite, constipation, dizziness, sedation, drowsiness,
impaired visual acuity
Report severe nausea, vomiting, constipation, shortness of breath or difficulty breathing, rash.
VERAPAMIL
Classification
Anti-anginal
Anti-arrhythmics
Anti-hypertensive
Vascular headache suppressants
Dosage
PO 80-120 mg 3x daily, increases as needed
Action
Inhibits calcium transport into myocardial smooth muscle cells
Decreases SA and AV conduction and prolongs AV node refractory period in conduction tissue
Indication
Hypertension
Angina Pectoris
Supraventricular Arrhythmia
Atrial flutter/fibrillation
Contraindications
Hypersensitivity
Sick sinus syndrome
2nd or 3rd degree AV block
CHF
Cardiogenic shock
Concurrent IV beta-blocker
Nursing Management
Monitor BP and pulse before therapy, during titration and therapy
Monitor ECG, I&O, serum potassium and weight.
Assess for CHF
DILTIAZEM
Classification
Anti-anginals
Antiarrhythmics
Antihypertensive
Ca channel blocker
Dosage
PO: 30-120 mg, 3-4x daily or 60-120 mg twice daily as SR capsules
IV: 0.25 mg/kg
Action
Inhibits calcium transport into myocardial smooth muscle cells
Systemic and coronary vasodilation
Indication
Hypertension
Angina Pectoris
Supraventricular Arrhythmia
Atrial flutter/fibrillation
Contraindications
Hypersensitivity
Sick sinus syndrome
2nd or 3rd degree AV block
CHF
Cardiogenic shock
Concurrent IV beta-blocker
Nursing Management
Monitor BP and pulse before therapy, during titration and therapy
Monitor I&O and weight
Assess for CHF
Routine serum digoxin monitoring
LIDOCAINE
Xylocaine
Classification
CV drugs: Anti-arrhythmics
Anesthetic
Dosage
Arrhythmia:
IV: 0.7-1.4 mg/kg body weight. No more than 200 mg within 1 hour period
IM: 4-5 mg/kg body weight
Action
Increases electrical stimulation of ventricle and His-purkinje system by direct action on tissues, resulting to
decrease depolarization, automaticity and excitability in ventricles during diastolic phase
Indication
Anesthesia
Arrhythmias
Control of Status epilepticus refractory to other treatments
Contraindications
Hypersensitivity
Heart block
Hypovolemia
Adams stroke syndromes
Infection at site of injection
Nursing Management
Assess pt before and after therapy
Pts infusion must be on cardiac monitor
Monitor ECG, if QT or QRS increases by 50% or more, withhold the drug
Monitor BP, check for rebound HPN after 1-2 hrs
Assess respiratory status, oxygenation and pulse deficits
Assess renal and liver function
Monitor CNS symptoms
Monitor blood levels
AMIODARONE
Cordarone
Classification
Anti-arrhythmics
Dosage
Recurrent ventricular arrhythmias:
PO800-1600 mg/day for 1-2 wks
PSVT, symptomatic atrial flutter: PO 600-800 mg/day for 1 month
Arrhythmias with CHF: 200 mg/day
Ventricular dysrrhythmias: 150 mg over the 1st 10 mins then slow 360 mg over the next 6 hrs
Action
Blocks Na channels, prolonging myocardial cell action potential and refractory period
Non competitive alpha and beta adrenergic blockage
Indication
Life threatening recurrent arrhythmias
Ventricular fibrillation
Ventricular tachycardia
Contraindications
Severe sinus node dysfunction
2nd or 3rd degree AV block
Hypersensitivity
Nursing Management
Assess cardiovascular status before therapy
Assess pulmonary, hepatic and thyroid function before and during therapy
Monitor fluid and electrolytes, I&O, K, Na and Cl
Monitor ECG, BP
Assess vision
PROCAINAMIDE
Classification
Antiarrhythmics
Dosage
Arrhythmias: 50 mg/kg/day in divided doses 3-6 hourly
Action
Blocks open Na channels and prolongs the cardiac action potential. This results in slowed conduction and
ultimately the decreased rate of rise of the action potential may result on the widening of QRS on ECG
Indication
Supraventricular and ventricular arrhythmias.
Treatment of Wolf-Parkinson-White Syndrome
Contraindications
Heart block
Heart failure
Hypotension
Myesthenia gravis
Digoxin toxicity
Lactation
Nursing Management
Assess cardiovascular status before therapy
Assess pulmonary, hepatic and thyroid function before and during therapy
Monitor fluid and electrolytes, I&O, K, Na and Cl
Monitor ECG, BP
Assess vision
EPINEPHRINE
Classification
Beta2 Adrenergic Agonists
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
Action
Stimulates beta receptors in lung.
Relaxes bronchial smooth muscle.
Increases vital capacity
Increases 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
Contraindications
With angle-closure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac
dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Also contraindicated in patient
receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor
(may delay second stage)
In conjunction with local anesthesia, epinephrine is contraindicated for use in finger, toes, ears, nose, and
genitalia.
In pregnant woman, drug is contraindicated.
In breast feeding do not use the drug or stop breast feeding.
Nursing Management
1. Monitor V/S. and check for cardiac dysrrhythmias
2. Drug increases rigidity and tremor in patients with Parkinson’s disease
3. Epinephrine therapy interferes with tests for urinary catecholamine
4. Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur
5. Massage site after IM injection to counteract possible vasoconstriction.
6. Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop
7. If blood pressure increases sharply, rapid-acting vasodilators such as nitrates or alpha blockers can be
given to counteract
VASOPRESSIN
Pitressin
Classification
Pituitary Hormones
ADH
Dosage
Prevent and treat abdominal distention: initially 5 units IM gives subsequent injections q3-4 hours increasing
to 10 units if needed.
Action
Increase permeability of renal tubular epithelium to adenosine monophosphate and water, the epithelium
promotes reabsorption of water and concentrated urine
Indication
Diabetes Insipidus
Abdominal Distention
GI bleeding
Esophageal varices
Contraindications
With chronic nephritis and nitrogen retention
Hypersensitivity
Nursing Management
Give 1-2 glass of H20 to reduce adverse reactions and improve therapeutic response
Warm vasopressin in your hands and mixed until it is distributed evenly in the solution
Monitor urine Sp. Gravity and I&O to aid evaluation of drug effectiveness
MAGNESIUM SO4
Classification
Anti-convulsant
Anti-arrhythmics
Dosage
Arrhythmia: IV 1-6 grams over several minutes, then continuous IV infusion 3-20 mg/min for 5-48 hours.
Action
Decreased acetylcholine released
Indication
Mg replacement
Arrhythmia
Contraindications
Heart block and myocardial damage
Toxemia of pregnancy
Nursing Management
Monitor I&O. make sure urine output is 100 ml or more in 4 hrs pd before each dose
Take appropriate seizure precautions
Keep IV Ca gluconate at bedside
Na HCO3
Classification
Alkalinizers
Dosage
Metabolic Acidosis: Usually 2-5 meq/kg IV infuse over 4-8 hr period
Cardiac Arrest: 1 meq/kg IV of 7.5 or 8.4% sol, then 0.5 meq/kg IV q 10 mins depending on ABG
Action
Restore buffering capacity of the body and neutralizes excessive acid
Indication
Metabolic Acidosis
Cardiac Arrest
Contraindications
Metabolic and respiratory alkalosis
Pt losing Cl because of vomiting or continuous GI suction or those receiving diuretics that produces
hypochloremic alkalosis
Nursing Management
Obtain blood pH, PaO2, PaCo2 and electrolyte levels
SIVP
HYPERTENSIVE CRISIS
Na NITROPRUSSIDE
Nittropress
Classification
Antihypertensive, Vasodilator
Dosage
0.25-0.3 mcg/kg/minute
Action
Relaxes arteriolar and venous smooth muscle
Indication
Hypertensive crisis
To produce controlled hypotension during anesthesia
To reduce preload and afterload in cardiogenic shock
Contraindications
Hypersensitivity
Compensatory hypotension
Inadequate cerebral circulation
Acute heart failure with reduced PVR
Congenital optic atrophy
Tobacco-induced ambylopia
Nursing Management
1. Obtain VS before giving the drug
2. Place pt in supine
3. Giving excessive doses of 500 mcg/kg delivered faster than 2 mcg/kg/min or using max infusion rate of
10 mcg/kg/min for more than 10 mins can cause cyanide toxicity
FUROSEMIDE
Lasix
Classification
Loop Diuretics
Dosage
Pulmonary edema: 40 mg IV
Edema: 20 to 80 mg PO every day in the morning
HPN: 40 mg PO bid. Dosage adjusted based on response
Action
Inhibits Na and Cl reabsorption at the proximal and distal tubules and in the ascending loop of Henle
Indication
Acute pulmonary edema
Edema
Hypertension
Contraindications
Hypersensitivity
Anuria
Nursing Management
1. Monitor wt., BP and PR
2. Monitor fluid, I&O, electrolyte, BUN and CO2 levels frequently
3. WOF signs of hypokalemia
4. Monitor uric acid levels
5. Monitor glucose levels esp in DM pts
MORPHINE SO4
(Discussed earlier)
NEUROSURGICAL DRUGS
MANNITOL
Osmitrol
Classification
Diuretics
Dosage
Test dose for marked oliguria or suspected inadequate renal function: 200 mg/kg or 12.5 gram as a
15% to 20% IV solution over 3-5 mins response is adequate if 30-50 ml of urine/hr is adequate, a second dose
is given if still no response after 2nd dose stop the drug
Oliguria: 50 over 90 mins to several hrs
To induced intraocular or intracranial pressure: 1.5-2 gram/kg as a 15 % to 20% IV solution over 30-60
min
Diuresis in drug intoxication: 12.5% to 10% solutions up to 200 g IV
Irrigating solution during TURP: 2.5-5%
Action
Increases osmotic pressure of glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes;
drug elevates plasma osmolarity, increasing water flow into extracellular fluid
Indication
Test dose for marked oliguria or suspected inadequate renal function
Oliguria
To induced intraocular or intracranial pressure
Diuresis in drug intoxication
Irrigating solution during TURP
Side Effects/Adverse Reactions
CN: seizures, headache and fever
CV: edema, thrombophlebitis, hypotension and heart failure
EENT: blurred vision and rhinitis
GI: thirst, dry mouth, nausea, vomiting and diarrhea
GI: urine retention
Metabolic: dehydration
Skin: local pain
Others: chill
Contraindications
Hypersensitivity
Anuria, severe pulmonary congestion, frank pulmonary edema, active intracranial bleeding during
craniotomy, severe dehydration, metabolic edema, progressive heart failure or pulmonary congestion
after drug
Nursing Management
Monitor VS,CVP,I&O, renal function fluid balance and urine K levels daily.
Drug can be used to measure GFR
Do not give electrolyte free solutions with blood. If blood id given simultaneously, add at least 200 meq
of NaCL to each liter
POISONING
NALOXONE HCL
Narcan
Classification
Miscellaneous antagonists and antidotes
Dosage
For suspected opioid induced respiratory depression: 0.4 to 2 mg IV, IM and SQ. repeat doses q 2-3 mins
PRN
For postoperative opiod depression: 0.01 to 0.2 mg IV q 2-3 mins, PRN. Repeat dose within 1-2 hr, if
needed.
Action
Reverse the effects of opiods, psychotomimetic and dysphoric effects of agonist-antagonists
Indication
For suspected opioid induced respiratory depression
Contraindications
Hypersensitivity
Use cautious with cardiac irritability or opiod addiction.
Nursing Management
Assess respiratory status frequently
Respiratory rate increases within 1-2 mins
IPECAC SYRUP
Classification
Antidote
Dosage
25-30 ml followed immediately by H2O
Action
Irritates the stomach lining and stimulate the vomiting center
Indication
Poisoning
Overdose
Side Effects
Diarrhea, drowsiness, stomach cramps, vomiting, itching, DOB, swelling of the mouth, rash and hives
Contraindications
Hypersensitivity
Given activated charcoal
Unconcious
Drowsy
Severely drunk
Having seizures
With no gag reflex
Nursing Management
1. Don’t administer to unconscious
2. Pt should kept active and moving ff administration
3. If vomiting does not occur after 2nd dose, gastric lavage may be considered to remove ingested
substance
ACTIVATED CHARCOAL
Classification
Antidote
Dosage
30-100 g with at least 8 oz of water
Action
Inhibits GI absorption of toxic substances or irritants
Hyperosmolarity
Indication
Poisoning
Side Effects
Pain, melena, diarrhea, vomiting and constipation
Contraindications
Cyanide, mineral acids, organic solvents, intestinal obstruction, bleeding with fructose intolerance,
broken GI tract, concomitant use of charcoal with sorbitol
Nursing Management
Do not mix with chocolate and together with ipecac syrup
Notify doctor if caused swelling or pain in the stomach
FLUMAZENIL
Romazicon
Classification
Benzodiazepine receptor antagonists
Dosage
2 ml IV given over 15 seconds
Action
Antagonizes the effects of benzodiazepines
Indication
Benzodiazepine-induced depression of the ventilatory responses to hypercapnia and hypoxia
Side Effects
Nausea, vomiting, palpitations, sweating, flushing, dry mouth, tremors, insomnia, dyspnea,
hyperventilation, blurred vision, headache, pain at injection site
Contraindications
Control of ICP or status epilepticus.
Signs of serious cyclic antidepressant overdose
Nursing Management
1. Must individualize dosage. Give only smallest amount effective.
2. Give through freely running IV infusion into large vein to minimize pain at injection site
3. Note history of seizure or panic disorder
4. Assess evidence of increased ICP
5. Note evidence of sedative and benzodiazepine dependence
6. Instruct to avoid alcohol and non-prescription drugs for 1-24 hrs
SHOCK
DOPAMINE
Intropine
Classification
Adrenergic drugs
Dosage
Initially 2-5 mcg/kg/min by IV
Action
Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system resulting in
positive inotropic effect and increased CO
Indication
To treat shock and correct hemodynamic imbalances
To correct hypotension
To increase CO
Side Effects
CNS: headache an anxiety
CV: tachy, angina, palpitations and vasoconstriction
GI: nausea and vomiting
Contraindications
Hypersensitivity
With uncorrect tachyarrhythmias
Pheochromocytoma
Ventricular Fibrillation
Nursing Management
Most patients received less than 20 mcg/kg/min
Drugs isn’t substitute for blood or fluid volume deficit
During infusion, monitor ECG, BP, CO, PR and color and temp of the limbs
Do not confuse dopamine to dobutamine
Check urine output often
DOBUTAMINE
Dobutrex
Classification
Adrenergic drugs
Dosage
0.5-1 mcg/kg/min IV infusion, titrating to optimum dosage of 2-20 mcg/kg/min
2.5 to 10 mcg/kg/min-usual effective range to increase CO
Action
Stimulates heart beta receptors to increase myocardial contractility and SV
Indication
To increase CO
Treatment of cardiac decompensation
Side Effects
CNS: headache
CV: HPN, tachycardia, palpitations and vasoconstriction
GI: nausea and vomiting
Contraindications
Hypersensitivity
Use cautiously in pts with hx of HPN and AMI
Nursing Management
Before starting therapy, give a plasma volume expander to correct hypovolemia and a cardiac
glycoside
Monitor ECG, BP, pulmonary artery wedge pressure and CO
Monitor electrolyte levels
Don’t confuse dobutamine to dopamine
GLUCAGON
Classification
Pancreatic Hormones
Dosage
0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN
Action
Binds with glucagon receptor
Indication
Hypoglycemia
Side Effects
Nausea, vomiting, hypotension, tachycardia and hypertension
Contraindications
Hypersensitivity
Pheochromocytoma
Insulinoma
Nursing Management
Monitor V/S and blood sugar level
Response within 20 mins after injection
ALBUTEROL
Ventolin
Classification
Bronchodilator, Adrenergic
Dosage
2 inhalations reputed q 4-6 hrs via neb
Action
Activation of beta adrenergic receptors on airway smooth muscle
Indication
Asthma
Prevention of exercise induced spasms
Side effects
Palpitations
Tachycardia
GI upset
Nervousness
Contraindications
Hypersensitivity
Nursing Management
Monitor therapeutic effectiveness
Monitor HR, BP, ABG, s/sx of bronchospasm and CNS stimulation
Instruct on how to use inhaler properly
Rinse mouth after use
DIPHENHYDRAMINE HCL
Benadryl
Classification
Anti-histamine
Dosage
25-50 mg PO, IV or IM bid-tid
Action
Blocks the effects Hi receptor sites
Indication
Allergic reactions
Motion sickness
Cough suppression
Sedation
Side Effects
Xerostomia
Urinary retention
Sedation
Contraindications
Acute asthmatic attack
Nursing Management
Risk for photosensitivity- use sunscreen