ADRENALIN CHLORIDE

CHEMICAL NAME :- EPINEPHRINE HYDROCHLORIDE

TRADE NAME :- ADRENALIN CHLORIDEBRONKAID MISTONETERDYSNELNHAL, EPIFRIN

ACTIONS :-

Naturally occurring catecholamine obtained from animal adrenal glands, also prepared
synthetically.
Acts directly on both alpha and beta receptors.
Strengthens myocardial contraction
Increases systolic but may decrease diastolic pressure
Increases cardiac rate and cardiac output
Constrict bronchial arterioles and inhibits histamine release thus reducing congestion and
edema and increasing tidal volume and vital capacity
Constrict arterioles, particularly in skin neucores membrane and kidneys but dilates skeletal
muscle blood vessels
Relaxes uterine smooth musculature and inhibits uterine contractions

USES :-

Temporary relief of bronchospasm

Acute asthamatic attack
Hypersensitivity and anaphylactic reactions
Syncope due to heart block or carotid sinus hypersensitivity
To restore cardiac rhythm in cardiac bleeding
Relaxes myom

ROUTE AND DOSAGE :-

ANAPHYLAXIS –
Adults-SC: 0.1-0.5 ml of 1:1000 q 10-15 min prn
IV: 0.1-o.25 ml of 1:1000 q 10-15 min
Childs-SC: 0.1 ml/kg of 1:1000 q 10-15 min prn
IV: 0.01 ml/kg of 1:1000 q 10-15 min

CARDIAC ARREST:-
Adult- IV: 0.1-1 mg (1-10 ml of 1:10,000) q 5 min as needed Intra-cardiac: 0.1 – 1 mg Child- IV:
0.01 mg/kg (0.1 ml/kg of 1:10,000) q 5 min as neededIntra-cardiac 0.05 – 0.1 mg/kg

ASTHMA:-Adult- SC 0.1-0.5 ml of 1:1000 q 20 min – 4 hourlyInhalation q 4h prn

Child-SC 0.01 ml/kg of 1:1000 q 20 min – 4 hrlyInhalation q 4h prn

GLAUCOMA :-

Adult- Topical 1-2 drops 0.25-2 % solution bid

Child- Topical 1-2 drops 0.25-2 % solution bid

OCULAR MYDRIASIS, NASAL HEMOSTASIS:-

Adult- Topical 1-2 drops 0.1 % ophthalmic or 0-1 % nasal solution

Child- Topical 1-2 drops 0.1 % ophthalmic or 0.1 % nasal solution.

CONTRAINDICATIONS & PRECAUTIONS:-

Contraindicated in-
Hemorrhagic,
traumatic or cardiogenic shock
Cardiac dilatation
Cerebral arteriosclerosis
Coronary insufficiency
Organic heart or brain disease
During IInd stage of labour.

Cautious use in –

Pstatic hypertrophy
Hypertension
Diabetes mellitus
Hyperthyroidism
Parkinson’s disease
Tuberculosis
Emphysema
ADVERSE/ SIDE EFFECTS:-

Nasal use-
Dryness of nasal mucosa
Sneezing
Rebound congestion

Ophthalmic use-
Transient stinging or burning of eyes
Lacrimation
Headache
Melan in like deposit on lids, conjunctiva and cornea
Corneal edema
Maculopathy

Systemic reactions-
Nervousness
Restlessness
Sleeplessness
Cerebro vascular accident

DRUG INTERACTIONS:-

May increase hypotension in circulatory collapse or hypotension caused by phenothiazines

Additive toxicities with other sympathornimetic (phenylpropanolamine)Alpha and beta odenergic
blocking agents (eg propranolol) antagonize effects of epinephrine.

NURSING IMPLICATION:-

Administration-
Parenteral (SC q IV)
A tuberculin syringe may ensure greater accuracy in measurement of parenteral
doses.Epinephrine injection should be protected from exposure to light at all timesBefore
withdrawing epinephrine suspension into syringe, shake vial or ampul, thoroughly to disperse
particles, then inject promptly
Drug absorption can be hastened by massaging the injection site.Vascular constriction from
repeated injections may cause tissue necrosis, Rotate injection sites and observe for signs of
blanchingI/V administration. Give each 1 mg over /min or longer may give more rapidly in
cardiac arrest.As a maintenance dose, dilute in 500ml 5 % dextrose.

Assessment of Drug Effects:-

Parenteral-
Following I/V administration monitor BP, pulse, respiration and urinary output and observe
patient closely. Epinephrine may widen pulse pressure. If disturbances in cardiac rhythm occur,
withhold epinephrine and notify physician immediately keep the physician informed of any
changes in take out put ratio.Patients receiving epinephrine IV should be on cardiac monitor,
have full crash cart immediately available.When epinephrine is administered I/V blood pressure
should be checked repeatedly during first 5 min then checked q 3-5 min until stabilized

.Inhalation-
Advise patient to report bronchial irritation, nervousness or sleeplessness. Dosage should be
reduced.
AMINOPHYLLINE ( THEOPHYLLINE ETHYLENEDIAMIDE )

CHEMICAL NAME : THEOPHYLLINE ETHYLENEDIANIDE

TRADE NAME : COROPHYLLIN, PALADRON,TRUPHYLLINE, SOMOPHYLLIN

CLASSIFICATION : BRONCHODILATER ( RESPIRATORY SMOOTH MUSCLERELAXANT ).

ACTIONS:-

Aminophylline is a salt of theophylline with effects similarto those of other xanthenes e.g.
caffeine and theobromine.Action is dependent on theophiline content (approximately 80%) and
is measured as theophylline in the serum.

USES :-

To prevent and relieve symptoms of acute bronchial asthma and treatment of bronchospasm
associated with chronic bronchitis and emphysema

ROUTE AND DOSAGE:-

BRONCHOSPASM ( all doses based on ideal body weight)

Adult- Loading dose 6mg/kg IV over 30 minMaintenance dose IV by continuous infusionPO
divided q 6hNon
smoker PO/IV 0.5 mg/kg/hrSmoker PO/IV 0.75 mg/kg/hr With CHF or cirrhosis PO/IV 0.25
mg/kg/h
Child- Loading dose 6 mg/kg IV over 30 min.Maintenance dose IV by continuous infusionPO
divided 96 h :> 9y 0.75 mg/kg/hr1 9 9y 1 mg/kg/h
Infant- PO/IV 6-11 mm, 0.87 g/kg/h2 – 6 mo 0.5 mg/kg/h
NeonatePO/IV 0.16 mg/kg/h

CONTRAINDICATIONS & PRECAUTIONS:-

Contraindicated in-
Hypersensitivity to xanthine derivatives or to ethylenediamine component.
Cardiac arrhythmias
Cautious use in –
Severe hypertension
Cardiac discareImpaired sepatic function
Diabetes melliteus
Hyperthyroidism
Glaucoma
Prostatic hypertrophy
History of peptic ulcer

ADVERSE/ SIDE EFFECTS:-

CNS-
Nervousness
Restlessness
Depression
Insomnia
Irritability
Convulsions

CV-
Cardiac arythmias
Tachycardia
G-1-
Hematemesis
Epigastric pain
Diarrhea

DRUG INTERACTIONS:-

Increases lithium excretion, lowering lithium levels

Cimetidine high dose allopurinol 600 mg/dl
Troleandomycin can significantly increase therapylline
Levels.
NURSING IMPLICATIONS:-

Administration-
Oral drug is absorbed faster if taken with a full glass of water on an empty stomach (1/2 – 1 hr
before or 2 hour aftermeals)
Absorption is delayed but is not reduced by presence of food in stomach
G-I symptoms may be minimized by taking immediately after a meal or with food.Rectol
preparations are generally ordered when the patient must fast or cannot tolerate the drug orally.
Drug absorption is enhanced if rectum is empty.

ASSESSMENT AND DRUG EFFECTS :-

Toxic effects are generally reated to theophylline serum levels over 20 ug/ml (therapeutic range
10-20 ug/ml).High incidence of toxicity is associatedwith rectal suppository use because of
erratic rate of absorption.Patients receiving parenteral aminophyline should be closely observed
for signs of hypotension, arrhythmias and convulsions until serum theophylline stabilizes within
the therapeutic range.Monitor vital signs, measure and record 1 q0 improvements in quality and
rate of pulse and arespiration as well as dieresis are expected clinical effects.
A sudden, sharp, unexplained rise in heart rate is a useful clinical indicator of toxicity.Children
appear to be more susceptible than adults to be CNS stimulating effects of xanthenes
(nervousness, restlessness, insomnia, hyperactive reflexes, twitching, convulsions)
 CALCIUM GLUCONATE

CHEMICAL NAME : CALCIUM GLUCONATE

TRADE NAME : KALCINATE
CLASSIFICATION : ELECTROLYTIC AND WATER BALANCE AGENTREPLACEMENT
SOLUTION

ACTIONS :-

Calcium is an essential element for regulating the excitation threshold of nerves and muscles.
For blood clotting mechanism cardiac function (thythm, tonicity, contractility)
Maintenance of renal function
For body skeleton of teeth.

USES :-

Osteoporosis
Osteomalacia
Negative calcium balance ( as in neonatal tetany hypoparathyoidism, Vit.D deficiency alkalosis)
To over come cardiac toxicity of hyperkalamia for cardio pulmonary resuscitation
To prevent hypocalcemia during transfusion of citrated blood

ROUTE AND DOSAGE :-

All doses are in terms of elemental calcium : 1 g calcium gluconate = 10 mg (4.5 m E q)

elemental calcium
Supplement for osteoporosis
Adult-PO 1-2 g bid to qid, IV 7 m Eq ql – 3 d
Child – PO 45-65 mg/kg/d in divided doses, IV 1-7m Eq ql – 3 d
Neonate - PO 50-150 mg/kg/d, IV 1 m Eq ql – 3d

CONTRAINDICAATIONS :-

Contraindicated in :-
Ventricular fibrillation
Melastatic bone disease
Injection into myocardium
Administration by Sc or IM routes
Predisposition to hypercalcemia

ADVERSE SIDE EFFECTS :-

Hypercalcemia IV injection – tingling sensation

Rapid Iv - sense of oppression or heat waves (vasodilatation)
Local reactions-Tissue irritation
Burning
Cellulitis
Soft tissue calcification
PO preparation :-
Constipation
Increased gastric acid secretion

DRUG INTERACTIONS :-

Digoxin - may enhance inotropic and toxic effects of digoxin

Magnesium - may comnpete for GI absorption-decreases absorption of tetracycline

NURSING IMPLICATIONS :-

Administration :-
Oral calcium preparations are best utilized when administered 2-3 hrs after mealI/V calcium
shouldbe administered slowly through a small – bore needle into a large vein to avoid possibility
of extravasation and resultant necrosis.
If calcium is administered to children, scalp veins should be avoided
IV injection IV solution may be given undiluted direct IV at a rate of 0.5 ml or a fraction there of
over 1 min.
IV infusion IV solution may be diluted in 1 l of Ns and given over 12-24 hrs.

ASSESSMENT AND DRUG EFFECTS ;-

Direct IV injection may be accompanied by cutaneous burning sensations and peripheral
vasodilatation with moderate fall in the BP. Injection should be stopped if patient complains of
any discomfort. Patient should be advised to remain in bed for 15-30 min or more following
injection, depending on response.During IV administration, ECG is monitored to detect evidence
of hypercalcemia decreased QT interval associated with inverted T wave.
Observe IV site closely. Extravasation may result in tissue irritation and necrosis.Monitor for
hypocalcemia and hypercalcemia.
 DOPAMINE HYDROCHLORIDE

CHEMICAL NAME : DOPAMINE HYDROCHLORIDE

TRADE NAME : DOPASTAT, INTROPIN, REVIMINE

CLASSIFICATION : AUTONOMIC NERVOUS SYSTEM AGENT, ALPHA &BETA

ADRENERGIC AGONIST

ACTIONS :-

Naturally occurring neurotransmitter and immediate precussor of nor epinephrineMajor

cardiovascular effects produced by direct action on alpha & beta adrenergic receptors and on
specific depaminergic receptors in mesenteric and renal vascular beds.Increase cardiac out put
with increase in systolic and pulse pressure and little or no effect on diastolic pressure.
Improves circulation to renal vascular bed by decreasing renal vascular resistance with resulting
increase in glomerular filtration rate and urinary output

USES :-
To correct hemodynamic imbalance in shock syndrome due to MI (cardiogenic shock)Trauma
Endotoxic septicemia ( septic shock)Open heart surgeryCNF

ROUTE AND DOSAGE :-

SHOCK :-
Adult- IV 2-5 ug/kg/min – increased gradually up to 20-50 ug/kg/min if necessaryChild - IV 2-5
ug/kg/min – increased gradually up to 20-50 ug/kg/min if necessaryRenal failure-Adult- IV 2-5
ug/kg/min

CONTRAINDICATIONS :-

Contraindicated in:-
Pheochromocytoma
Tachyarrythmias
Ventricular fibrillation

ADVERSE SIDE EFFECTS :-

CV :-Hypotension
Tachycardia
Amginal pain
Palpitation

GI :-
Nausea
Vomiting

Other :-
Headache
NecrosisGangrene

DRUG INTERACTIONS :-

Furazolicdine increases alpha adrenergic effects (headache hyperpyrexia,

hypertension)Guanethidine, phynytoin may decrease dopamine actionBeta blockers antagonize
cardiac effect

NURSING IMPLICATIONS :-

Before initiation of dopamine therapy, hypovolemia should be corrected if possible with either
whole blood or plasma.
Dilution should be made just prior to administration although reportedly the solution may remain
stable for 24 hrs after dilution.
IV infusion rate and guidelines for adjusting rate of flow in relation to changes in blood pressure
will be prescribed by physician. Microdrip or other reliable metoring device should be used for
accuracy of flow rate.Protect dopamine from light. Discolored solution shoud not be used.
Reconstituted solution is stabale for 48 hr when stored at 2-25 c (36-59f ) or 6 h at room
temperature 15-30 c ( 59-86 f)

Assessment and drug effects :-

Monitor blood pressure, pulse, peripheral pulses and urinary out put at intervals prescribed by
physician.precise measurements are essential for accurate filtration of dosageClose observttion
is critical when patient is receiving dopamine. The following indications are used for decreasing
or temporarily suspending dose.Reduced urine flow rate in absence of
hypotensionDysrhythmias Disproportionate rise in diastolic pressureSigns of peripheral
ischemia
 POTTASIUM CHLORIDE

CHEMICAL NAME : POTTASIUM CHLORIDE

TRADE NAME : K-10,KCL 50% & 20%, K-LONG,KALIUM, SLO POT, KLOR-10%, KLOTRIX

CLASSIFICATION : ELECTROLYTE & WATER BALANCE AGENT,REPLACEMENT

SOLUTION

ACTIONS :-

Potassium the principal intracellular action essential for maintenance of intracellular isotenicity ,
transmission of nerve impulses. Contraction of cardiac, skeletal and smooth
muscles.Maintenance of normal renal function
For enzyme activity
Plays a prominent roll in both genesis and correction of imbalances in acid base
metabolismPotassium salts assume special importance as therapeutic agents but are also
dangerous if improperly

USES :-
To prevent and treat potassium deficit secondary to diuretic or corticosteroid therapy.Also
indicated when potassium is depleted by severe vomiting, diarrhea, intestinal drainage, fistulas
or mal-absorption prolonged dieresis diabetic acidosis.
Effective in the treatment of hypokalemic alkolsis (chloride not the gluconate)

ROUTE AND DOSAGE :-

HYPOKALEMIA :-
Adult- PO 10-1000 mtg/d in diluted doses IV 10-40m Eq/h diluted to atleast 10-20 meq/100 ml of
solution to a maximum of 200-400 meq/d. Monitor higher doses carefully.
Child- PO 1-3 meq/kg/d in divided dose, extended release tables not recommended in. IV up to
3 mEq/kg/24h at a rate <_ o.o2 meg/kg/min

PHARMACOKINETICS :-
Absorption : readily absorbed from upper GI tract.Elimination : 90% excreted in urine, 10% in
ffeces.

CONTRAINDICATIONS :-

Contraindicated in:-
Severe renal impairment
Severe lemolytic reactions
Untreated addisons’ disease
Crush syndrome

CAUTIOUS USE IN :-

Cardiac or renal diseaseSystemic acidosisSlow release potassium preparationsExtensive tissue

breakdown (such as reverse baurns)

ADVERSE SIDE EFFECTS : -

Abdominal distension
Oliguria
Hyperkalemia
Mental confusion
Irritability
Paresthesias of extrimities

DRUG INTERACTIONS :-

Potassium sparing diuretics

Angiotensin converting enzyme
Inhibitors may cause hyperkalemia
NURSING IMPLICATIONS :-

Administration:-
Some patients find it difficult to swallow the large sized KCL tablets. Administer while patient is
sitting up or standing to prevent drug induced esophagitis.
No potassium salts tablets should be crushed and then taken dry or chewed. Be certain patients
does not suck tablet whole tablet should be swallowed with large glass of water or fruit juice to
wash drug down and to start esophaged persistalsis.
An antacid may improve the tolerance of KCL by decreasing as irfitating effect on GI mucosa 10
ml KCL flavouredsyrup mixed with 15 ml antacid has given relief. Consult physician.If potassium
supplement is given in conjunction with a diuretic, it may be preferable to give the potassium on
days other than when diuretic is given

Assessment and Drug Effects.:-

Monitor I & O ratio and pattern in patients receiving the parenteral drug. If oliguria occurs stop
infusion promptly and notify physician.
Potassium intoxication may result from any therapeutic dosage and the patients may be
asymptomatic so monitoring of potassium is of extreme importance.
Irregular heart beat is usually the earliest clinical indication of hyperkalemia. Care of patient
receiving parenteral potassium demands close surveillance of the cardiac monitor.
The risk of hyperkalemia with potassium supplement increases
In the elderly because of decrease mental changes in kidney function associated with
going.When dietary intake of potassium suddenly increases.When renal function is significantly
compromised.
Use of extended release tablets reduces the danger of bowel ulceration and potential
compliance problems.
 SODIUM BICARBONATE

CHEMICAL NAME : SODIUM BICARBONATE ( NAHCO3)

CLASSIFICATION : GI AGENT, ANTACIDELECTROLYTE BALANCE AGENT

ACTIONS :-

Short acting, potent systemic antacid

Rapidly neutralizes gastric acid to form sodium chloride, carbon dioxide and water.
After absorption of sodium bicarbonate, plasma alkali reserve is increased and excess sodium
and bicarbonate ions are excreted in urine

USES :-

Systemic alkalinizer to correct metabolic acidosis ( as occurs in diabetic mellitus, shock, cardiac
arrest, vascular collapse)
To minimize uric acid crystallization associated with uricosuric agents.
Commonly used as home remedy for relief of occasional heart burn, indigestion or sour
stomach.Used topically as paste, bath or soak to relieve itching and minor skin irritations such
as sunburn, insect bites, prickly heat, poison or soak.
ROUTE & DOSAGE:-

ANTACID :-
Adult – PO 0.3-2 g 1-4 times/d or ½ tsp of powder in glass of water

URINARY ALKALINIZER
Adult –PO 4 g initially, then 1-2 g q 4h, Child- PO 84-840 mg/kg/d in divided doses

CARDIAC ARREST:-
METABOLIC ACIDOSIs

PHARMACOKINETICS :-
AbsorptionReadily absorbed from GI tractOnset – 15 minDuration – 1-2 hr.Elimination –
excreted in urine within 3-4 hr.

CONTRAINDICATIONS :-

Contraindicated in:-
Prolonged therapy with socium bicarbonate
Patients loosing chlorides ( as from vomiting, GI susction)
Heart disease
Cautious use in-
Edema
Sodium retaining disorders.

ADVERSE SIDE EFFECTS :-

Belching
Gastric distension
Flatulence
Metabolic
Electrolyte imbalance
Sodium ofer load
HypocalcemiA

NURSING IMPLICATIONS:-

Administration:-
Infusion should be stopped immediately if extravasation occurs.
IV infusion should not exceed 50 mEqq/h
Store in airtight containers. Note- expiration dateTopical use bath or soak 5-10 min. Paste 3
parts sodium bicarbonate to 1 part water solutions in water slowly decomposes decomnposition
is accelerated by warming the solution.

Assessment and Drug Effects :-

Long term use of oral preparation with milk or calcium can cause milk alkali syndrome, anorexia,
nausea vomiting, mental confusion, hypercalcemia, renal and uretral calcuI
 ATENOLOL

CLASSIFICATION(S):-
Therapeutic : antianginals, antihypertensives
Pharmacologic : beta blockers

AVAILABILITY:-

Tablets :25 mg Rx , 50 mg Rx , 100 mg Rx

Injection :500 mcg (0.5 mg)/ml Rx
In combination with :chlorthalidone (Tenoretic) Rx

ROUTE AND DOSAGE:-

PO (Adults):Antianginal —50 mg once daily; may be increased after 1 wk to 100 mg/day (up to
200 mg/day).
Antihypertensive —25–50 mg once daily; may be increased after 2 wk to 50–100 mg once daily.
MI —50 mg (given 10 min after last IV dose), then 50 mg 12 hr later, then 100 mg/day as a
single dose or in 2 divided doses for 6–9 days or until hospital discharge.

INDICATIONS:-

Management of hypertension Management of angina pectoris Prevention of MI.

ACTION:-

Blocks stimulation of beta 1 (myocardial)-adrenergic receptors. Does not usually affect beta 2
(pulmonary, vascular, uterine)-receptor sites.
Therapeutic Effects:
Decreased blood pressure and heart rate
Decreased frequency of attacks of angina pectoris
Prevention of MI.

PHARMACOKINETICS
Absorption : 50–60% absorbed after oral administration.
Distribution :Minimal penetration of CNS. Crosses the placenta and enters breast milk.
Metabolism and Excretion :40–50% excreted unchanged by the kidneys; remainder excreted in
feces as unabsorbed drug.
Half-life : 6–9 hr.

CONTRAINDICATIONS AND PRECAUTIONS:-

Contraindicated in:
Uncompensated CHF
Pulmonary edema
Cardiogenic shock
Bradycardia or heart block.
Use Cautiously in:
Renal impairment (dosage reduction recommended if CCr 35 ml/min)
Hepatic impairment Geriatric patients (increased sensitivity to beta blockers; initial dosage
reduction recommended)
Pulmonary disease (including asthma; beta selectivity may be lost at higher doses)
Diabetes mellitus (may mask signs of hypoglycemia)

ADVERSE REACTIONS AND SIDE EFFECTS:-

CNS : Fatigue ,weakness , anxiety, depression, dizziness, drowsiness, insomnia, memory

loss, mental status changes, nervousness, nightmares.
EENT : Blurred vision, stuffy nose.
Resp: bronchospasm, wheezing.
CV :Bradycardia ,CHF , pulmonary edema , hypotension, peripheral vasoconstriction.
GI : Constipation, diarrhea, liver function abnormalities, nausea, vomiting.
GU :Impotence , decreased libido, urinary frequency.
Derm : Rashes.
Endo : Hyperglycemia
 DIGOXIN

CLASSIFICATION(S):-
Therapeutic : Antiarrhythmics, Inotropics
Pharmacologic : Digitalis glycosides

AVAILABILITY:-

Tablets:0.125 mg Rx , 0.25 mg Rx , 0.5 mg Rx

Capsules:0.05 mg Rx , 0.1 mg Rx , 0.2 mg Rx
Pediatric elixir (lime flavor):0.05 mg/ml Rx
Injection:0.25 mg/ml Rx
Pediatric injection:0.1 mg/ml Rx .

ROUTE AND DOSAGE:-

For rapid effect, a larger initial loading/digitalizing dose should be given in several divided doses
over 12–24 hr. Maintenance doses are determined for digoxin by renal function. All dosing must
be evaluated by individual response. In general, doses required for atrial arrhythmias are higher
than those for inotropic effect. When determining dosage, consider that bioavailability of gelatin
capsules (Lanoxicaps) is greater than that of tablets.
IV (Adults):Digitalizing dose —0.6–1 mg (10–15 mcg/kg) given as 50% of the dose initially and
additional fractions given at 4–8-hr intervals.
IV (Children >10 yr):Digitalizing dose —8–12 mcg/kg given as 50% of the dose initially and
additional fractions given at 4–8-hr intervals.

INDICATIONS:-
Treatment of CHF
Tachyarrhythmias
Atrial fibrillation and atrial flutter (slows ventricular rate)
Paroxysmal atrial tachycardia.

ACTION:-

Increases the force of myocardial contraction

Prolongs refractory period of the AV node
Decreases conduction through the SA and AV nodes.
Therapeutic Effects:
Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative
chronotropic effect).

PHARMACOKINETICS
Absorption : 60–85% absorbed after oral administration of tablets; 75–80% absorbed after
administration of elixir. Absorption from liquid-filled capsules is 90–100%; 80% absorbed from
IM sites, but this route is not recommended because of extreme pain and irritation.
Distribution : Widely distributed; crosses the placenta and enters breast milk. Metabolism and
Excretion: Excreted almost entirely unchanged by the kidneys.
Half-life 36–48 hr (increased in renal impairment).

CONTRAINDICATIONS:-

Contraindicated in:
Hypersensitivity
Uncontrolled ventricular arrhythmias
AV block
Idiopathic hypertrophic subaortic stenosis
Constrictive pericarditis
Known alcohol intolerance (elixir only).
Use Cautiously in:
Electrolyte abnormalities (hypokalemia, hypercalcemia, and hypomagnesemia may predispose
to toxicity) Geriatric patients (very sensitive to toxic effects)
MI

ADVERSE REACTIONS AND SIDE EFFECTS:-

CNS :Fatigue , headache, weakness.

EENT : Blurred vision, yellow vision.
CV :Arrhythmias ,bradycardia , ECG changes.
GI :Anorexia ,nausea , vomiting , diarrhea.
Endo : Gynecomastia. Hemat : Thrombocytopenia.
NURSING IMPLICATIONSASSESSMENT:-

Monitor apical pulse for 1 full min before administering. Withhold dose and notify physician if
pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant. Also notify
physician or health care professional promptly of any significant changes in rate, rhythm, or
quality of pulse.
Monitor blood pressure periodically in patients receiving IV digoxin. Monitor ECG throughout IV
administration and periodically during therapy. Notify physician or health care professional if
bradycardia or new arrhythmias occur.
Observe IV site for redness or infiltration; extravasation can lead to tissue irritation and
sloughing. Monitor intake and output ratios and daily weights. Assess for peripheral edema, and
auscultate lungs for rales/crackles throughout therapy.
Before administering initial loading dose, determine whether patient has taken any digitalis
preparations in the preceding 2–3 wk.
 DOBUTAMINE

CLASSIFICATION(S):-
Therapeutic : Inotropics
Pharmacologic : Adrenergics

AVAILABILITY:-

Injection:12.5 mg/ml in 20-ml vial Rx .

ROUTE AND DOSAGE:-

IV (Adults and Children): Start with low infusion rates (0.5–1 mcg/kg/min), titrated at intervals of
a few minutes, guided by the patient's response (range 2–20 mcg/kg/min, up to 40 mcg/kg/min).

ACTION:-

Stimulates beta 1 (myocardial)-adrenergic receptors with relatively minor effect on heart rate or
peripheral blood vessels.
Therapeutic Effects:Increased cardiac output without significantly increased heart rate.

INDICATIONS:-

Short-term (<48 hr) management of heart failure caused by depressed contractility from organic
heart disease or surgical procedures.

PHARMACOKINETICS
Absorption : Administered by IV infusion only, resulting in complete bioavailability.
Distribution : Unknown.
Metabolism and Excretion: Metabolized by the liver and other tissues.
Half-life : 2 min.

CONTRAINDICATIONS AND PRECAUTIONS:-

Contraindicated in:
Hypersensitivity to dobutamine or bisulfites Idiopathic hypertrophic subaortic
stenos

ADVERSE REACTIONS AND SIDE EFFECTS:-

CNS : Headache.
Resp : Shortness of breath.
CV :Hypertension ,increased heart rate , premature ventricular contractions , angina pectoris,
arrhythmias, hypotension, palpitations.
GI : Nausea, vomiting.
Local : Phlebitis.
Misc : Hypersensitivity reactions including skin rash, fever, bronchospasm or eosinophilia,
nonanginal chest pain. .

NURSING IMPLICATIONSASSESSMENT:-

Monitor blood pressure, heart rate, ECG, pulmonary capillary wedge pressure (PCWP), cardiac
output, CVP, and urinary output continuously during the administration. Report significant
changes in vital signs or arrhythmias. Consult physician for parameters for pulse, blood
pressure, or ECG changes for adjusting dosage or discontinuing medication.
Palpate peripheral pulses and assess appearance of extremities routinely throughout
dobutamine administration. Notify physician if quality of pulse deteriorates or if extremities
become cold or mottled.
Lab Test Considerations:Monitor potassium concentrations during therapy; may cause
hypokalemia. Monitor electrolytes, BUN, creatinine, and prothrombin time weekly during
prolonged therapy.
Toxicity and Overdose:If overdose occurs, reduction or discontinuation of therapy is the only
treatment necessary because of the short duration

DIAZEPAM
CLASSIFICATION(S):-

Therapeutic: Antianxiety agents, Anticonvulsants, Sedative/hypnotics, Skeletal muscle

Relaxants (centrally acting)
Pharmacologic: Benzodiazepine

AVAILABILITY:-

Tablets:2 mg Rx , 5 mg Rx , 10 mg Rx
Injection:5 mg/ml (contains 10% alcohol and 40% propylene glycol) Rx
Rectal gel delivery system:2.5 mg Rx , 10 mg Rx , 15 mg Rx , 20 mg Rx
Sterile emulsion for injection:5 mg/ml (contains egg phospholipids and soybean oil) Rx .

ROUTE AND DOSAGE:-

Antianxiety/Anticonvulsant
PO (Adults): 2–10 mg 2–4 times daily.
PO (Children >6 mo): 1–2.5 mg 3–4 times daily; may be increased.

ACTION:-

Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter

Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways Has
anticonvulsant properties due to enhanced presynaptic inhibition.
Therapeutic Effects:Relief of anxiety Sedation Amnesia Skeletal muscle relaxation Decreased
seizure action

PHARMACOKINETICS
Absorption: Rapidly absorbed from the GI tract. Absorption from IM sites may be slow and
unpredictable. Well absorbed (90%) from rectal mucosa.
Distribution: Widely distributed. Crosses the blood-brain barrier. Crosses the placenta; enters
breast milk. Metabolism and Excretion: Highly metabolized by the liver. Some products of
metabolism are active as CNS depressants.
Half-life: 20–70 hr (up to 200 hr for metabolites).

CONTRAINDICATIONS AND PRECAUTIONS:-

Contraindicated in:
Hypersensitivity
Cross-sensitivity with other benzodiazepines may occur
Comatose patients
Pre-existing CNS depression
Uncontrolled severe pain
Narrow-angle glaucoma
Pregnancy or lactation
Some products contain alcohol, propylene glycol, or tartrazine and should be avoided in patients
with known hypersensitivity or intolerance.

ADVERSE REACTIONS AND SIDE EFFECTS:-

CNS :Dizziness ,drowsiness , lethargy , depression, hangover, headache, paradoxical

excitation.
EENT : Blurred vision. Resp : Respiratory depression.
CV : Hypotension (IV only).
GI : Constipation, diarrhea, nausea, vomiting.
Derm: Rashes.
Local : Pain (IM), phlebitis (IV), venous thrombosis.
Misc : Physical dependence, psychological dependence, tolerance.

NURSING IMPLICATIONSASSESSMENT:-

General: Monitor blood pressure, pulse, and respiratory rate prior to and periodically throughout
therapy and frequently during IV therapy.
Assess IV site frequently during administration; diazepam may cause phlebitis and venous
thrombosis. Prolonged high-dose therapy may lead to psychological or physical dependence.
Restrict amount of drug available to patient. Observe depressed patients closely for suicidal
tendencies.
Anxiety: Assess degree of anxiety and level of sedation (ataxia, dizziness, slurred speech) prior
to and periodically throughout therapy.
Seizures: Observe and record intensity, duration, and location of seizure activity. The initial
dose of diazepam offers seizure control for 15–20 min after administration. Institute seizure
precautions.
Muscle Spasms: Assess muscle spasm, associated pain, and limitation of movement prior to
and throughout therapy.

DEXAMETHASONE
CLASSIFICATION(S):-

Therapeutic : Anti- inflammatories

ROUTE AND DOSAGE:-

Adults and children : 1 to 2 drops of suspension or solution or 1.25 to 2.5 cm of ointment into
conjuctival sac. I n sever disease, gives drops q 1 to 2 hours, tapering to end as condition
improves.

ACTION:-

Exerts anti- inflammatory action; suppress edema, fibrin deposition, capillary dilation, leukocyte
migration, capillary proliferation and collagen deposition.

INDICATIONS:-

• uveitis; iridocyclitis
• allergic conjuctivitis

CONTRAINDICATIONS AND PRECAUTIONS:-

Contraindicated in:
Hypersensitivity
Ocular tuberculosis
Fungal or viral diseases of cornea

ADVERSE REACTIONS AND SIDE EFFECTS:-

EENT : Increased intra ocular pressure, thininig of cornea, burning, redness of eye
OTHERS : Systemic effects, adrenal suppression

AMIODARONE
CLASSIFICATION:-

THERAPEUTIC :- anti arrthmics

AVAILABILITY:-

Tablets: 200 mgRx, 400 mgRx Cost: 200 mg $194.87/60 Injection: 50 mg/ml in 3-ml ampulesRx

ACTION:-

Prolongs action potential and refractory period

Inhibits adrenergic stimulation
Slows the sinus rate, increases PR and QT intervals, and decreases peripheral vascular
resistance (vasodilation).
Therapeutic Effects:
Suppression of arrhythmias.

INDICATIONS:-

Life-threatening ventricular arrhythmias unresponsive to less toxic agents.

Unlabelled Uses:
PO: Management of supraventricular tachyarrhythmias.
IV: As part of the Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support
(PALS) guidelines for the management of ventricular fibrillation/pulseless ventricular tachycardia
after cardiopulmonary resuscitation and defibrillation have failed; also for other life-threatening
tachyarrhythmias

PHARMACOKINETICS
Absorption: IV administration results in complete bioavailability. Slowly and variably absorbed
from the GI tract (35–65%).
Distribution: Distributed to and accumulates slowly in body tissues. Reaches high levels in fat,
muscle, liver, lungs, and spleen. Crosses the placenta and enters breast milk.
Protein Binding: 96% bound to plasma proteins. Metabolism and Excretion: Metabolized by the
liver, excreted into bile. Minimal renal excretion. One metabolite has antiarrhythmic activity.
Half-life: 13–107 days.

ROUTE AND DOSAGE:-

PO (Adults): 800–1600 mg/day in 1–2. .

IV (Adults): 150 mg over 10

ACTION:-

Prolongs action potential and refractory period

Inhibits adrenergic stimulation
Slows the sinus rate, increases PR and QT intervals, and decreases peripheral vascular
resistance (vasodilation).

CONTRAINDICATIONS AND PRECAUTIONS:-

Contraindicated in:
Severe sinus node dysfunction 2nd- and 3rd-degree AV block Bradycardia (has caused
syncope unless a pacemaker is in place) Products containing benzyl alcohol should not be used
in neonates Pregnancy and lactation.

ADVERSE REACTIONS AND SIDE EFFECTS:-

*CAPITALS indicate life threatening; underlines indicate most frequent.

CNS: dizziness, fatigue, malaise, headache, insomnia.
EENT: corneal microdeposits, abnormal sense of smell, dry eyes, optic neuritis, optic
neuropathy, photophobia.
Resp: ADULT RESPIRATORY DISTRESS SYNDROME (ARDS), PULMONARY FIBROSIS.
CV: CHF, WORSENING OF ARRHYTHMIAS, bradycardia, hypotension.
GI: LIVER FUNCTION ABNORMALITIES, anorexia, constipation, nausea, vomiting, abdominal
pain.
 VASOPRESSIN

PHARMACOLOGICAL NAME-Vasopressin

AVAILABILITY:-

Injection-20units/ml

ROUTE and DOSAGE:-

-IV adults, children 0.5m units/kg/hr

-IM initially 5 units
- Sub. 10units q3-4h

INDICATION:-

-cardiac arrest
-Diabetes insipidus
-Abdominal distension
-GI haemorrhage
-Vasodilators and shock

ACTIONS:-

cause peristalsis vasoconstriction. A posterior pituitary hormone that increases the reabsorption
of water by the renal tubules.
Stimulates the smooth muscles in the GI tract directly.
CONTRAINDICATIONS:-

none known

ADVERSE EFFECT:-

pain at injection site (with vasopressin tannate)abdominal cramps,dizziness,pale skin tremors

heacache
RARE- chest pain
confusion, allergic reaction, including rashes,MI water intoxication.
 ADENOSINE

CLASSIFICATION(S):-

Therapeutic: antiarrhythmics

ROUTE AND DOSAGE:-

IV (Adults and Children >50 kg): Antiarrhythmic —6 mg by rapid IV bolus; if no results, repeat
1–2 min later as 12-mg rapid bolus. This dose may be repeated (single dose not to exceed 12
mg). Diagnostic use —140 mcg/kg/min for 6 min (0.84 mg/kg total).
IV (Children <50 kg): Antiarrhythmic —0.05–0.1 mg/kg as a rapid bolus, may repeat in 1–2 min;
if response is inadequate, may increase by 0.05–0.1 mg/kg until sinus rhythm is established or
maximum dose of 0.3 mg/kg is used.

AVAILABILITY:-

Injection: 6 mg/2-ml vial Rx (Adenocard), 3 mg/1 ml in 30-ml vial Rx (Adenoscan).

ACTION:-

Restores normal sinus rhythm by interrupting re-entrant pathways in the AV node Slows
conduction time through the AV node Also produces coronary artery vasodilation.
Therapeutic Effects:
Restoration of normal sinus rhythm.

INDICATIONS:-

Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm when

vagal maneuvers are unsuccessful
As a diagnostic agent (with noninvasive techniques) to assess myocardial perfusion defects
occurring as a consequence of coronary artery disease.
CONTRAINDICATIONS AND PRECAUTIONS:-

Contraindicated in:Hypersensitivity 2nd- or 3rd-degree AV block or sick sinus syndrome, unless

a functional artificial pacemaker is present. Use Cautiously in: Patients with a history of asthma
(may induce bronchospasm) Unstable angina Pregnancy or lactation.

SIDE EFFECTS:-

*CNS: apprehension, dizziness, headache, head pressure, light-headedness.

EENT: blurred vision, throat tightness.
Resp: shortness of breath , chest pressure, hyperventilation.
CV: facial flushing , transient arrhythmias , chest pain, hypotension, palpitations.
GI: metallic taste, nausea.
Derm: burning sensation, facial flushing, sweating.
MS: neck and back pain. Neuro: numbness, tingling.
Misc: heaviness in arms, pressure sensation in groin.

NURSING IMPLICATIONS
ASSESSMENT:-

Monitor heart rate frequently (every 15–30 sec) and ECG continuously throughout therapy. A
short, transient period of 1st-, 2nd-, or 3rd-degree heart block or asystole may occur following
injection; usually resolves quickly due to short duration of adenosine. Once conversion to
normal sinus rhythm is achieved, transient arrhythmias (premature ventricular contractions,
atrial premature contractions, sinus tachycardia, sinus bradycardia, skipped beats, AV nodal
block) may occur, but generally last a few seconds. Monitor blood pressure during therapy.
Assess respiratory status (breath sounds, rate) following administration. Patients with history of
asthma may experience bronchospasm.

PATIENT/FAMILY TEACHING:-

Caution patient to change positions slowly to minimize orthostatic hypotension. Doses >12 mg
decrease blood pressure by decreasing peripheral vascular resistance.
Instruct patient to report facial flushing, shortness of breath, or dizziness.