EMERGENCY DRUGS: A drug study.

1) ATROPINE SULFATE Brand Names: Anespin amp Atropol amp Euro-Med Atropine Sulfate amp Isopto Atropine eye drops Phil Pharmawealth/Atlantic Atropine amp Classification: Other Cardiovascular Drugs, Muscle Relaxants, Mydriatic Drugs, Antidotes, Detoxifying Agents & Drugs Used in Substance Dependence Indication/Dosage: IV Bradycardia 500 mcg every 3-5 mins. Total: 3 mg. IV/IM Organophosphorus poisoning 2 mg every 10-30 mins until muscarinic effects disappear or atropine toxicity appears. IM/SC Premed in anesth 300-600 mcg 30-60 mins before anesth. IV/IM/SC Overdosage w/ other compd having muscarinic actions 0.6-1 mg, repeat 2 hrly. Ophth Inflammatory eye disorders As 0.5-1% soln: 1-2 drops 4 times/day. Eye refraction As 1% soln: 1 drop twice daily for 1-2 days before procedure. Action: An anti-cholinergic that inhibits acetylcholine at the parasympathetic neuroeffector junction, enhances the conduction of AV node and increases heart rate Adverse Reactions: Dry mouth, dysphagia, constipation, flushing and dryness of skin, tachycardia, palpitations, arrhythmias, mydriasis, photophobia, cycloplegia, raised intraocular pressure. Toxic doses cause tachycardia, hyperpyrexia, restlessness, confusion, excitement, hallucinations, delirium and may progress to circulatory failure and respiratory depression. Eye drops: Systemic toxicity especially in children, on prolonged use may lead to irritation, hyperemia, edema and conjunctivitis. Increased intraocular pressure. Inhalation: Dryness of mouth, throat. Potentially Fatal: Atrial arrhythmias, AV dissociation, multiple ventricular ectopics. Nursing Measures: Ensure adequate hydration; provide environmental control (temperature) to prevent hyperpyrexia. Have patient void before taking medication if urinary retention is a problem. When used preoperatively or in other acute situations, incorporate teaching about the drug with teaching about the procedure; the ophthalmic solution is used mainly acutely and will not be self-administered by the patient; the following apply to oral medication for outpatients: Take as prescribed, 30 min before meals; avoid excessive dosage. Avoid hot environments; you will be heat intolerant, and dangerous reactions may occur. These side effects may occur: Dizziness, confusion (use caution driving or performing hazardous tasks); constipation (ensure adequate fluid intake, proper diet); dry mouth (suck sugarless lozenges; perform frequent mouth care; may be transient); blurred vision, sensitivity to light (reversible; avoid tasks that require acute vision; wear sunglasses in bright light); impotence (reversible); difficulty in urination (empty the bladder prior to taking drug). Report rash; flushing; eye pain; difficulty breathing; tremors, loss of coordination; irregular heartbeat, palpitations; headache; abdominal distention; hallucinations; severe or persistent dry mouth; difficulty swallowing; difficulty in urination; constipation; sensitivity to light.

2) CALCIUM GLUCONATE Brand Names: Phil Pharmawealth/Harson Calcium Gluconate amp Classification: Electrolytes Indication/Dosage: PO Hypocalcaemia 10-50 mmol/day. IV Hypocalcaemic tetany 2.25 mmol via slow inj , then 58-77 mL of 10% soln diluted and administered as a continuous IV infusion. Antidote in severe hypermagnesaemia; Severe hyperkalaemia 10 mL of 10% soln, repeat every 10 mins if needed. Action: replaces Calcium and maintains Calcium level Adverse Reactions: GI irritation; soft-tissue calcification, skin sloughing or necrosis after IM/SC inj. Hypercalcaemia characterised by anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria, nephrocalcinosis, renal calculi; chalky taste, hot flushes and peripheral vasodilation. Potentially Fatal: Cardiac arrhythmias and coma. Nursing Measures: Make sure prescriber specifies form of calcium to be given; crash carts may contain both calcium gluconate and calcium chloride. Tell patient to take oral calcium 1 to 11/2 hours after meals if GI upset occurs. Give I.M. injection in gluteal region in adults and in lateral thigh in infants. Use I.M. route only in emergencies when no I.V. route is available bec. of irritation of tissue by calcium salts. Tell patient to take oral calcium with a full glass of water. Monitor calcium levels frequently. Hypercalcemia may result after large doses in chronic renal failure. Report abnormalities. 3) CAPTOPRIL Brand Names: Ace-Bloc tab Capomed tab Capotec tab Capoten tab Captor tab Captril tab Cardiovaz tab Conamid tab Hartylox tab Normil tab Phil Pharmawealth/Panion & BF Captopril tab Prelat tab Primace tab Retensin tab Spec-Ace tab Tensoril tab Unihype tab Vasostad tab Classification: ACE Inhibitors Indication/Dosage: PO HTN Initial: 12.5 mg twice daily. Maintenance: 25-50 mg twice daily. Max: 50 mg 3 times/day. Heart failure Initial: 6.25-12.5 mg 2-3 times/day. Max: 50 mg 3 times/day. Post MI Start 3 days after MI. Initial: 6.25 mg/day, may increase after several wk to 150 mg/day in divided doses if needed and tolerated. HTN in diabetic nephropathy 75-100 mg/day in divided doses. Action: inhibits ACE, reduces Sodium and water retention, lowers blood pressure Adverse Reactions: Hypotension, tachycardia, chest pain, palpitations, pruritus, hyperkalaemia. Proteinuria; angioedema, skin rashes; taste disturbance, nonproductive cough, headache. Potentially Fatal: Neutropenia, usually occurs within 3 mth of starting therapy especially in patients with renal dysfunction or collagen diseases. Hyperkalaemia. Anaphylactic reactions.

Nursing Measures: Administer 1 hr before or 2 hr after meals. Alert surgeon and mark patient's chart with notice that captopril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion. Monitor patient closely for fall in BP secondary to reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea); excessive hypotension may occur. Reduce dosage in patients with impaired renal function. Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop without consulting your health care provider. Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if light-headedness or dizziness occurs, consult your health care provider. Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will interact with ACE inhibitors. Consult your health care provider. These side effects may occur: GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth sores (perform frequent mouth care); rash; fast heart rate; dizziness, light-headedness (usually passes after the first few days; change position slowly, and limit your activities to those that do not require alertness and precision). Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing. 4) DIAZEPAM Brand name: Valium Classification: Anxiolytics Dosage: 10mg/2ml Indication: relief of anxiety, agitation & tension due to psychoneurotic states & transient situational disturbances Action: a benzodiazepine that probably potentiates the effects of GABA, depresses the CNS & suppresses the spread of seizure activity Adverse Reaction: drowsiness,dysarthria, slurred speech, tremor, transient amnesia, fatigue, ataxia, headache, insomnia, paradoxical anxiety, hallucination Nursing Measures: Do not administer intra-arterially; may produce arteriospasm, gangrene. Change from IV therapy to oral therapy as soon as possible. Do not use small veins (dorsum of hand or wrist) for IV injection. Reduce dose of narcotic analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated.

 Carefully monitor P, BP, respiration during IV administration. Maintain patients receiving parenteral benzodiazepines in bed for 3 hr; do not permit ambulatory patients to operate a vehicle following an injection. Monitor EEG in patients treated for status epilepticus; seizures may recur after initial control, presumably because of short duration of drug effect. Monitor liver and kidney function, CBC during long-term therapy. Taper dosage gradually after long-term therapy, especially in epileptic patients. Arrange for epileptic patients to wear medical alert ID indicating that they are epileptics taking this medication. Discuss risk of fetal abnormalities with patients desiring to become pregnant. 5) DIGOXIN Brand name: Digitek, Lanoxicaps, Lanoxin, Novo-Digoxin (CAN) Classification: Inotropics Dosage: 5mg/2ml Indication: Cardiac failure accompanied by atrial fibrillation; management of chronic cardiac failure where systolic dysfunction or ventricular dilatation is dominant; management of certain supraventricular arrhythmias, particularly chronic atrial flutter & fibrillation. Action: inhibits sodium-potassium activated adenosine triphosphate, promoting movement of calcium from extracellular to intra-cytoplasm and strengthening myocardial contraction, also acts on CNS to enhance vagal tone Adverse Reaction: nausea, vomiting, anorexia, headache, facial pain, fatigue, weakness, dizziness, drowsiness, disorientation, mental confusion, bad dreams, convulsions Nursing Measures: Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or < 90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, hold drug and notify prescriber. Note any change from baseline rhythm or rate. Check dosage and preparation carefully. Avoid IM injections, which may be very painful. Follow diluting instructions carefully, and use diluted solution promptly. Avoid giving with meals; this will delay absorption. Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, cardiac monitor on standby in case toxicity develops. Monitor for therapeutic drug levels: 0.52 ng/mL. 6) DIPENHYDRAMINE Brand name: Benadryl Classification: antihistamine

Dosage: 50mg/ml Indication: Hay fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug sensitization, serum & penicillin reaction, contact dermatitis, atopic eczema, other allergic dermatoses, pruritus, food sensitivity, parkinsonism, motion sickness. Action: prevents histamine mediated responses, drug provides local anesthesia and suppresses cough reflex Adverse Reaction: CV and CNS effects, blood disorders, GI disturbances, antimuscarinic effects and allergic reactions. Nursing Measures: Monitor carefully, assess for confusion, delirium, other anticholinergic side effects and fall risk. Institute measures to prevent falls. Assess movement disorder before and after administration. Caution patient not to use oral OTC diphenhydramine products with any other product containing diphenhydramine, including products used topically. It can cause excitation in children. Caution parents or caregivers about proper dose calculation; overdosage, especially in infants and children, can cause hallucinations, seizures or death Inform patient that this drug may cause dry mouth. Frequent oral rinses, good oral hygiene, and sugarless gum or candy may minimize this effect. Notify dentist if dry mouth persists for more than 2 weeks. 7) EPINEPHRINE Brand name: Epinephrine Bitartrate Aerosols: Primatene Mist Epinephrine Borate Ophthalmic solution: Epinal Epinephrine Hydrochloride Injection, OTC nasal solution: Adrenalin Chloride Ophthalmic solution: Epifrin, Glaucon Insect sting emergencies: EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for children) OTC solutions for nebulization: AsthmaNefrin, microNefrin, Nephron, S2 Classification: Sympathomimetic, Alpha-adrenergic agonist, Beta1and beta2-adrenergic agonist, Cardiac stimulant, Vasopressor, Bronchodilator, Antasthmatic drug, Nasal decongestant, Mydriatic, Antiglaucoma drug Dosage: 1mg/ml Indication: Acute asthmatic attacks, Advanced cardiac life support Action: Naturally occurring neurotransmitter, the effects of which are mediated by alpha or beta receptors in target organs. Effects on alpha receptors include vasoconstriction, contraction of dilator muscles of iris. Effects on beta receptors include positive chronotropic and inotropic effects on the heart (beta1 receptors); bronchodilation,

vasodilation, and uterine relaxation (beta2 receptors); decreased production of aqueous humor. Adverse Reaction: drowsiness, headache, nervousness, tremors, cerebral hemorrhage, dizziness, weakness, vertigo, pain Nursing Measures: Monitor heart rate. Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug; small errors in dosage can cause serious adverse effects. Double-check pediatric dosage. Use minimal doses for minimal periods of time; "epinephrine-fastness" (a form of drug tolerance) can occur with prolonged use. Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown solutions. Drug solutions should be clear and colorless (does not apply to suspension for injection). Shake the suspension for injection well before withdrawing the dose. Rotate SC injection sites to prevent necrosis; monitor injection sites frequently. Keep a rapidly acting alpha-adrenergic 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. Keep a beta-adrenergic blocker (propranolol; a cardioselective beta-blocker, such as atenolol, should be used in patients with respiratory distress) readily available in case cardiac arrhythmias occur. Do not exceed recommended dosage of inhalation products; administer pressurized inhalation drug forms during second half of inspiration, because the airways are open wider and the aerosol distribution is more extensive. If a second inhalation is needed, administer at peak effect of previous dose, 35 min. Use topical nasal solutions only for acute states; do not use for longer than 35 days, and do not exceed recommended dosage. Rebound nasal congestion can occur after vasoconstriction subsides. Do not exceed recommended dosage; adverse effects or loss of effectiveness may result. Read the instructions that come with respiratory inhalant products, and consult your health care provider or pharmacist if you have any questions. To give eye drops: Lie down or tilt head backward, and look up. Hold dropper above eye; drop medicine inside lower lid while looking up. Do not touch dropper to eye, fingers, or any surface. Release lower lid; keep eye open, and do not blink for at least 30 sec. Apply gentle pressure with fingers to inside corner of the eye for about 1 min; wait at least 5 min before using other eye drops. These side effects may occur: Dizziness, drowsiness, fatigue, apprehension (use caution if driving or performing tasks that require alertness); anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small meals); fast heart rate. Nasal solution may cause burning or stinging when first used (transient). Ophthalmic

solution may cause slight stinging when first used (transient); headache or brow ache (only during the first few days). Report chest pain, dizziness, insomnia, weakness, tremor or irregular heart beat (respiratory inhalant, nasal solution), difficulty breathing, productive cough, failure to respond to usual dosage (respiratory inhalant), decrease in visual acuity (ophthalmic). 8) FUROSEMIDE Brand name: Apo-Furosemide (CAN), Furoside (CAN), Lasix, Myrosemide (CAN) Classification: loop diuretics Dosage: 20mg/2ml Indication: edema, hypertension Action: inhibits Sodium and Chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle Adverse Reaction: vertigo, headache, dizziness, paresthesia, weakness, restlessness, fever, nocturia, oliguria, polyguria Nursing Measures: Monitor BP after administration Administer with food or milk to prevent GI upset. Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds. Give early in the day so that increased urination will not disturb sleep. Avoid IV use if oral use is at all possible. Do not mix parenteral solution with highly acidic solutions with pH below 3.5. Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions. Discard diluted solution after 24 hr. Refrigerate oral solution. Measure and record weight to monitor fluid changes. Arrange to monitor serum electrolytes, hydration, liver function. Arrange for potassium-rich diet or supplemental potassium as needed. 9) MAGNESIUM SULFATE Brand name: Elin Magnesium Sulfate Classification: anticonvulsant Dosage: 250 mg/10 mL Indication: treatment of hypomagnesemia accompanied by signs of tetany, control of HTN, encephalophathy & convulsions, prevention & control of convulsions in patients w/ preeclampsia or eclampsia, prevention of hypomagnesemia in patients receiving TPN Action: may decrease acetylcholine released by nerve impulses, but its anticonvulsant mechanism is unknown

Adverse Reactions: flushing, sweating, hypotension, muscular weakness, sedation & confusion; decreased deep tendon reflexes; resp. paralysis Nursing Measures: Monitor the following: I.V.: Rapid administration: ECG monitoring, vital signs, deep tendon reflexes; magnesium, calcium, and potassium levels; renal function during administration. Obstetrics: Patient status including vital signs, oxygen saturation, deep tendon reflexes, level of consciousness, fetal heart rate, maternal uterine activity. Oral: Renal function; magnesium levels; bowel movements.

10) METOCLOPRAMIDE Brand name: Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-Metoclopramide (CAN), Octamide PFS, Reglan Classification: antiemetic & anti-spasmodic Dosage: 10 mg/ 2mL Indication: disturbances of GI motility, nausea & vomiting of central & peripheral origin associated w/ surgery, metabolic diseases, infectious & drug induced diseases, facilitate small bowel intubation & radiological procedures of GIT Action: stimulates motility of upper GI tract, increases lower esophageal sphincter tone, and blocks dopamine receptors at the chemoreceptor trigger zone Adverse Reactions: extrapyramidal reactions, drowsiness, fatigue & lassitude, anxiety, less frequently, insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, bowel disturbances. Nursing Measures: Monitor BP carefully during IV administration. Monitor for extrapyramidal reactions, and consult physician if they occur. Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is compromised by alterations in timing of food absorption. Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM). Have phentolamine readily available in case of hypertensive crisis (most likely to occur with undiagnosed pheochromocytoma).

11) MORPHINE SULFATE Brand name: Morin Classification: Analgesics (Opioid) Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe or chronic pain Childn 10 mg IM/SC 4 hrly, range: 5-20 mg; 6-12 yr 5-10 mg, 1-5 yr 2.5-5 mg, 1-12 mth 200 mcg/kg, <1 mth 150 mcg/kg 4 hrly. Max: 15 mg. Analgesic effect Ped 100-200 mcg/kg SC 4 hrly, max: 15

mg/dose; or 50-100 mcg/kg slow IV. Pre-op 50-100 mcg/kg IM, max: 10 mg/dose. Indication: Relief of moderate to severe pain not responsive to non-narcotic analgesics. Premed. Analgesic adjunct in general anesth esp in pain associated w/ cancer, MI & surgery. Alleviates anxiety associated w/ severe pain. Hypnotic for pain-related sleeplessness. Action: alters perception and emotional response to pain Adverse Reactions: Lightheadedness, dizziness, sedation, nausea, vomiting, constipation & sweating. Nursing Measures: Caution patient not to chew or crush controlled-release preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects. 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; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored. Reassure patients that they are unlikely to become addicted; most patients who receive opioids for medical reasons do not develop dependence syndromes.

12) PARACETAMOL Brand name: Aeknil Classification: Analgesics (Non-Opioid) & Antipyretics Dosage: Adult & childn 10 yr 2-3 mL, 10 yr 1-2 mL. Depending on severity of case, dose may be repeated 4 hrly. In severe cases, dose may be administered by IV very slowly Indication: Pyrexia of unknown origin. Fever & pain associated w/ common childhood disorders, tonsillitis, upper resp tract infections post-immunization reactions, after tonsillectomy & other conditions. Prevention of febrile convulsion. Headache, cold, sinusitis, muscle pain, arthritis & toothache Action: produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in CNS, relieves fever Adverse Reactions: Hematological, skin & other allergic reactions Nursing Measures: Use liquid form for children and patients who have difficulty swallowing. In children, dont exceed five doses in 24 hours. Advise patient that drug is only for short term use and to consult the physician if giving to children for longer than 5 days or adults for longer than 10 days. Advise patient or caregiver that many over the counter products contain

acetaminophen; be aware of this when calculating total dailydose. Warn patient that high doses or unsupervised long term use can cause liver damage.

13) LIDOCAINE HYDROCHLORIDE Brand name: Abbott Lidocaine Classification: Anaesthetics - Local & General Dosage: 50 ml/vial Indication: local or regional anesthesia Action: A class IB antiarrythmic that decreases the depolarization, automaticity, and excitability in the ventricles during the diastolic phase by direct action on the tissues especially the Purkinje network Adverse Reactions: Restlessness, nervousness, dizziness, tinnitus, blurred vision; GI upsets; muscle twitching, convulsions; numbness of the tongue; hypotension, bradycardia; methemoglobinaemia; fetal intoxication. Nursing Measures: Check drug concentration carefully; many concentrations are available. Reduce dosage with hepatic or renal failure. Continuously monitor response when used as antiarrhythmic or injected as local anesthetic. Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected. Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures. Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene on standby. Titrate dose to minimum needed for cardiac stability, when using lidocaine as antiarrhythmic. Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patients. Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictions. Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 612 hr afterward, and ensure that they are adequately hydrated to minimize risk of headache. Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from the injection site. Be sure that such solutions are used only to produce local anesthesia. These solutions should be injected cautiously in body areas supplied by end arteries and used cautiously in patients with peripheral

vascular disease, hypertension, thyrotoxicosis, or diabetes. Use caution to prevent choking. Patient may have difficulty swallowing following use of oral topical anesthetic. Do not give food or drink for 1 hr after use of oral anesthetic. Treat methemoglobinemia with 1% methylene blue, 0.1 mg/kg, IV over 10 min. Apply lidocaine ointments or creams to a gauze or bandage before applying to the skin. Monitor for safe and effective serum drug concentrations (antiarrhythmic use: 15 mcg/mL). Doses > 610 mcg/mL are usually toxic 14) SODIUM BICARBONATE Brand name: Hospira Sodium Bicarbonate Classification: Alkalinizers Dosage: 10mEq/10ml; 50mEq/50ml Indication: metabolic acidosis, systemic or urinary alkalinization, antacid, cardiac arrest Action: Restores buffering capacity of the body and neutralizes excess acid Adverse Reaction: Tetany, edema, gastric distention, belching, flatulence, hypokalemia, metabolic alkalosis, hypernatremia, chemical cellulitis because of alkalinity, pain, irritation, tissue necrosis, ulceration or sloughing at the site of infiltration Nursing Measures: do not take drug with milk to avoid hypercalcemia, abnormally high alkalinity in tissues and fluids, or kidney stones. do not give to patients with metabolic or respiratory alkalosis, and in those with hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart failure. monitor for alkalosis by obtaining blood pH, PaO2, PCO2, and electrolyte levels 15) DOPAMINE Brand name: Intropin Classification: Adrenergics (Sympathomimetics) Dosage: 40 mg/Ml; 80 mg/mL; 160 mg/mL Indication : shock and hemodynamic imbalances, hypotension Action: Stimulates dopaminergic and alpha beta receptors for the sympathetic nervous system resulting in a positive inotropic effect and increased cardiac output. Action is dose-related; large doses cause mainly alpha stimulation Adverse Reaction: ectopic beats, tachycardia, anginal pain, palpitation, hypotension, vasoconstriction, ventricular arrhythmias, hypertension, headache, anxiety, dilated pupils, nausea, vomiting, decreased urine output, dyspnea Nursing Measures: Monitor vital signs and ECG closely throughout therapy. Monitor I&O regularly; note decreases in urine output.

 Monitor central venous pressure or pulmonary wedge pressure if possible during infusion. Note significant changes in vital signs, ECG changes, deterioration of peripheral pulses, and/or cold, mottled extremities 16) DOBUTAMINE Brand name: Dobatrey Classification: Adrenergics Dosage: 12.5 mg/mL Indication: increased cardiac output in short term treatment of cardiac decompensation caused by depressed contractility Action: Stimulates hearts beta1 receptors to increase myocardial contractility and stroke volume. Increases cardiac output by decreasing peripheral vascular resistance, reducing ventricular filling pressure, and facilitating AV node conduction Adverse Reaction: increased systolic BP, increased heart rate, chest pain, increased number of premature ventricular beats, headache, tingling sensations, paresthesia. nausea, vomiting, dyspnea, phlebitis, local inflammation after infiltration, leg cramps Nursing Measures: Monitor vital signs, ECG, cardiac output, pulmonary capillary wedge pressure, central venous pressure and urinary output carefully throughout infusion. Monitor patency and placement of IV catheter to reduce risk of extravasation and phlebitis. Watch out for symptoms of overdosage such as excessive hypertension, tachycardia, nausea, vomiting, tremor, headache, chest pain