EMERGENCY DRUGS Contraindications

 Hypersensitivity
CARDIAC DRUGS  With acute angle closure glaucoma, obstructive
uropathy, obstructive disease of GI tract,
ATROPINE SULFATE paralytic ileus, toxic megacolon, intestinal
atony, unstable CV status in acute hemorrhage,
Isopto Atropine asthma, or myasthenia gravis.
 Pregnant women.
Classification
Anticholinergics Nursing Management
 Monitor VS.
Dosage  Report  HR
 Bradycardia: 0.5 mg IV every 3-5 mins, max of  Monitor for constipation, oliguria.
0.04 mg/kg  Instruct to take 30 mins before meals
 Cardiac Arrest: 1 mg every 3-5 mins  Eat foods high in fiber and drink plenty fluids.
 Nerve and Organophosphate symptoms: may  Can cause photophobia
repeat in 2 mg increments q 3 mins titrated to  Instruct client not to drive a motor vehicle or
relief symptoms participate in activities requiring alertness.
 Advise to use hard candy, ice chips, etc. for dry
Indication mouth.
 Pre-op meds/pre-anesthetic meds
 To restore cardiac rate and arterial pressure
during anesthesia when vagal NITROGLYCERINE
 To lessen the degree of A-V heart block
 To overcome severe carotid sinus reflex Nitrostat
 Antidote for cholinergic toxicity
Classification
Side effects  Antianginal
 CNS: restlessness, ataxia, disorientation,  Nitrate
hallucinations, delirium, coma, insomnia,  Vasodilator,
agitation, confusion.  Coronary
 CV: tachycardia, angina, arrhythmias, flushing.
 EENT: photophobia, blurred vision, mydriasis. Dosage
 GI: dry mouth, constipation, vomiting.  0.3-0.4 mg SL q 5 min, max 3 doses.
 GU: urine retention.  Every 6 hrs except for midnight (cream)
 Hematologic: leukocytosis  Wear 12 hrs a day for skin patch
 Other: anaphylaxis
Action
Adverse effects  Relaxes the vascular smooth system
 CNS: headache, excitement.
 CV: palpitations  Reduces myocardial oxygen consumption
 GI: thirst, nausea  Reduces left ventricular workload
 Reduces arterial BP
 Reduces venous return  May be repeated q 5 minutes to max. of 3
doses.
Indication  If the client doesn’t experience relief, advise to
 Angina pectoris seek medical assistance immediately.
 CHF associated with AMI  Keep in a dark colored container
 Cardiac load reducing agent
 Hypertensive Crisis

Side effects MORPHINE SULFATE

 CNS: headache, throbbing, dizziness, weakness.
 GI: nausea, vomiting Immediate-release tablets:

 Skin: Rash MSIR

 Adverse Reactions Timed-release:

 CV: orthostatic hypotension, flushing, fainting. Kadian, M-Eslon (CAN), MS Contin, Oramorph

 EENT: sublingual burning. SR

 Skin: Cutaneous vasodilation, contact Oral solution:

dermatitis (patch) MSIR, Rescudose, Roxanol, Roxanol T

Rectal suppositories:

Contraindications RMS

 Contraindicated in patients hypersensitive to Injection:

nitrates Astramorph PF, Duramorph, Epimorph (CAN)

 With early MI. (S.L. form), severe anemia, Preservative-free concentrate for

increase ICP angle-closure glaucoma, IV microinfusion devices for intraspinal use:

nitroglycerine is contraindicated in patients Infumorph

with hypovolemia, hypotension, orthostatic

hypotension, cardiac tamponade restrictive Classification

cardiomyopathy, constrictive pericarditis. Opioid Agonist Analgesic

Nursing Management Dosage

 Record characteristics and precipitating factors  Oral: 10–30 mg q 4 hr PO. Controlled-release:

of anginal pain. 30 mg q 8–12 hr PO or as directed by

 Monitor BP and apical pulse before physician; Kadian: 20–100 mg PO daily–24-hr

administration and periodically after dose. release system; MS Contin: 200 mg PO q 12 hr.

 Have client sit or lie down if taking drug for the  SC and IM:10 mg (5–20 mg)/70 kg q 4 hr or as

first time. directed by physician.

 Client must have continuing EKG monitoring for

IV administration  IV:2.5–15 mg/70 kg of body weight in 4–5 mL

 Cardioverter/ defibrillator must not be water for injection administered over 4–5 min,

discharged through paddle electrode overlying or as directed by physician. Continuous IV

 Nitro-Bid ointment or the Transderm-Nitro Patch. infusion: 0.1–1 mg/mL in 5% dextrose in water

Assist with ambulating if dizzy. by controlled infusion device.

 Instruct to take at first sign of anginal pain.

 Rectal:10–30 mg q 4 hr or as directed by
physician.
 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  GI: abnormal liver function, anorexia,
disorders, and do not let anyone else take your constipation, diarrhea, nausea and vomiting
prescription.
 These side effects may occur: Nausea, loss of Contraindications
appetite, constipation, dizziness, sedation,  Hypersensitivity
drowsiness, impaired visual acuity  Sick sinus syndrome
 Report severe nausea, vomiting, constipation,  2nd or 3rd degree AV block
shortness of breath or difficulty breathing, rash.  CHF
 Cardiogenic shock
 Concurrent IV beta-blocker
VERAPAMIL
Nursing Management
Calan, Isoptin, Verelan, Covera HS  Monitor BP and pulse before therapy, during
titration and therapy
Classification  Monitor ECG, I&O, serum potassium and weight.
 Anti-anginal  Assess for CHF
 Anti-arrhythmics
 Anti-hypertensive
 Vascular headache suppressants DILTIAZEM

Dosage Cardizem, Dilacor, Novo-Diltiazem, Tiamate

PO 80-120 mg 3x daily, increases as needed and Tiazac

Action Classification
 Inhibits calcium transport into myocardial  Anti-anginals
smooth muscle cells  Antiarrhythmics
 Decreases SA and AV conduction and prolongs  Antihypertensive
AV node refractory period in conduction tissue  Ca channel blocker

Indication Dosage
 Hypertension  PO: 30-120 mg, 3-4x daily or 60-120 mg twice
 Angina Pectoris daily as SR capsules
 Supraventricular Arrhythmia  IV: 0.25 mg/kg
 Atrial flutter/fibrillation
Action
Side Effects and Adverse Reactions  Inhibits calcium transport into myocardial
smooth muscle cells
 CNS:abnormal dreams, anxiety, confusion,  Systemic and coronary vasodilation
dizziness and headache
 EENT: blurred vision, epistaxis and tinnitus Indication
 CV: arrhythmia, CHF, chest pain, bradycardia,  Hypertension
hypotension and palpitations  Angina Pectoris
 GU: dysuria, nocturia and polyuria  Supraventricular Arrhythmia
 Atrial flutter/fibrillation
Side Effects and Adverse and Reactions
 CNS:abnormal dreams, anxiety, confusion,
dizziness and headache
 EENT: blurred vision, epistaxis and tinnitus
 CV: arrhythmia, CHF, chest pain, bradycardia,
hypotension and palpitations
 GU: dysuria, nocturia and polyuria
 GI: abnormal liver function, anorexia,
constipation, diarrhea, nausea and vomiting
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 Side Effects and Adverse Reactions

 Hypersensitivity GI disturbances, bradycardia, hypotension,
 Sick sinus syndrome convulsion, numbness of tongue, muscle
 2 nd
or 3 degree AV block
rd
twitching, restlessness, nervousness, dizziness,
 CHF tinnitus, blurred vision, fetal intoxication, light
 Cardiogenic shock headedness, drowsiness, apprehension,
 Concurrent IV beta-blocker euphoria, vomiting, sensation of heat,
respiratory arrest and CV collapse
Nursing Management
 Monitor BP and pulse before therapy, during Contraindications
titration and therapy  Hypersensitivity
 Monitor I&O and weight  Heart block
 Assess for CHF  Hypovolemia
 Routine serum digoxin monitoring  Adams stroke syndromes
 Infection at site of injection

LIDOCAINE Nursing Management

 Assess pt before and after therapy
Xylocaine  Pts infusion must be on cardiac monitor
 Monitor ECG, if QT or QRS increases by 50% or
Classification more, withhold the drug
 CV drugs: Anti-arrhythmics  Monitor BP, check for rebound HPN after 1-2
 Anesthetic hrs
 Assess respiratory status, oxygenation and
Dosage pulse deficits
Arrhythmia:  Assess renal and liver function
 IV: 0.7-1.4 mg/kg body weight. No more than  Monitor CNS symptoms
200 mg within 1 hour period  Monitor blood levels
 IM: 4-5 mg/kg body weight

Action AMIODARONE
 Cordarone
Classification
Anti-arrhythmics
Dosage
Recurrent ventricular arrhythmias:
 PO800-1600 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 1 10 mins then slow 360 mg over the next
st
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
Side Effects and Adverse Reactions
Exacerbation of arrhythmias, bradycardia, SA
node dysfunction, heart block, sinus arrest;
flushing, fatigue, malaise, abnormal
involuntary movements, ataxia, dizziness,
paresthesia, decreased libido, insomnia,
headache, sleep disturbances, visual
impairment, blindness, corneal microdeposits,
photophobia, abnormal taste, nausea,
vomiting, constipation, anorexia, abdominal
pain, abnormal salivation, coagulation
abnormalities, non-specific hepatic disorders,
pulmonary inflammation, dyspnea, toxicosis,
death, edema, hypo and hyperthyroidism
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
Pronestyl, Procan-SR, Procanbid
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
Side Effects and Adverse Reactions
 Severe hypotension, ventricular fibrillation and
asystole.
 Drug induced SLE syndrome, blood disorders,
fever, myocardial depression, heart failure,
agrunulocytosis, psychosis, angioedema,
  Increases vital capacity
hepatomegaly, skin irritation,
 Increases BP,  HR,  PR
hypergammaglobulinemia, GI and CNS effects  Decreases airway resistance.

Indication
Contraindications  Asthma
 Heart block  Bronchitis
 Emphysema
 Heart failure
 All cardiac arrest, anaphylaxis
 Hypotension  Used for symptomatic bradycardia.
 Myesthenia gravis  Relief of bronchospasm occurring during
anesthesia
 Digoxin toxicity  Exercised-induced bronchospasm
 Lactation
Side Effects/Adverse Reactions
Side Effects:
Nursing Management nervousness, tremor, vertigo, pain, widened
pulse pressure, hypertension nausea
 Assess cardiovascular status before therapy
Adverse Effects:
 Assess pulmonary, hepatic and thyroid headache
function before and during therapy
Contraindications
 Monitor fluid and electrolytes, I&O, K, Na and  With angle-closure glaucoma, shock (other than
Cl anaphylactic shock), organic brain damage,
cardiac dilation, arrhythmias, coronary
 Monitor ECG, BP insufficiency, or cerebral arteriosclerosis. Also
 Assess vision contraindicated in patient receiving general
anesthesia with halogenated hydrocarbons or
cyclopropane and in patients in labor (may
delay second stage)
EPINEPHRINE  In conjunction with local anesthesia, epinephrine
is contraindicated for use in finger, toes, ears,
nose, and genitalia.
Injection, OTC nasal solution:
 In pregnant woman, drug is contraindicated.
Adrenalin Chloride
 In breast feeding do not use the drug or stop
Ophthalmic solution:
breast feeding.
Epifrin, Glaucon
Insect sting emergencies:
Nursing Management
EpiPen Auto-Injector (delivers 0.3 mg IM adult
1. Monitor V/S. and check for cardiac
dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg
dysrrhythmias
IM for children)
2. Drug increases rigidity and tremor in patients
OTC solutions for
with Parkinson’s disease
Nebulization:
3. Epinephrine therapy interferes with tests for
AsthmaNefrin, microNefrin, Nephron, S2
urinary catecholamine
4. Avoid IM use of parenteral suspension into
Classification
buttocks. Gas gangrene may occur
Beta2 Adrenergic Agonists
5. Massage site after IM injection to counteract
possible vasoconstriction.
Dosage
6. Observe patient closely for adverse reactions.
 Cardiac arrest: 1 mg IV of 1:10,000 solution q
Notify doctor if adverse reaction develop
3-5 min; double dose if administering via ET
7. If blood pressure increases sharply, rapid-
tube
acting vasodilators such as nitrates or alpha
 Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000
blockers can be given to counteract
solution.
 Asthma: 0.1-0.3 mg SQ or IM of 1:10,000
solution
 Refractory bradycardia and hypotension: 2- VASOPRESSIN
10ug/min

Action Pitressin
 Stimulates beta receptors in lung.
 Relaxes bronchial smooth muscle.
 Classification MAGNESIUM SO4
 Pituitary Hormones
 ADH
Classification

Dosage  Anti-convulsant

Prevent and treat abdominal distention: initially  Anti-arrhythmics

5 units IM gives subsequent injections q3-4

hours increasing to 10 units if needed. Dosage
 Arrhythmia: IV 1-6 grams over several minutes,

Action then continuous IV infusion 3-20 mg/min for 5-

Increase permeability of renal tubular 48 hours.

epithelium to adenosine monophosphate and

water, the epithelium promotes reabsorption of Action

water and concentrated urine  Decreased acetylcholine released

Indication Indication
 Diabetes Insipidus  Mg replacement

 Abdominal Distention  Arrhythmia

 GI bleeding
 Esophageal varices Side Effects and Adverse Reactions
 CNS: drowsiness, depressed reflexes, flaccid

Side Effects and Adverse Reactions paralysis, hypothermia

 CNS: tremor, headache, vertigo  CV: hypotension, flushing, bradycardia,

 CV: vasoconstriction, arrhythmias, cardiac circulatory collapse, depressed cardiac function

arrest, myocardial ischemia, circumollar pallor,  EENT: diplopia

decreased CO, angina  Respiratory: respiratory paralysis

 GI: abdominal cramps  Metabolic: hypocalcemia

 GU:uterine cramps  Skin: diaphoresis

 Respi: bronchoconstriction
 Skin: diaphoresis, gangrene and urticaria Contraindications
 Heart block and myocardial damage

Contraindications  Toxemia of pregnancy

 With chronic nephritis and nitrogen retention

 Hypersensitivity Nursing Management
 Monitor I&O. make sure urine output is 100 ml

Nursing Management or more in 4 hrs pd before each dose

 Give 1-2 glass of H20 to reduce adverse  Take appropriate seizure precautions

reactions and improve therapeutic response  Keep IV Ca gluconate at bedside

 Warm vasopressin in your hands and mixed

until it is distributed evenly in the solution
 Monitor urine Sp. Gravity and I&O to aid Na HCO3

evaluation of drug effectiveness

Arm and Hammer; Baking Soda
 Classification
Antihypertensive, Vasodilator
Classification
Alkalinizers Dosage
0.25-0.3 mcg/kg/minute

Dosage Action
Relaxes arteriolar and venous smooth muscle
 Metabolic Acidosis: Usually 2-5 meq/kg IV
infuse over 4-8 hr period Indication
 Hypertensive crisis
 Cardiac Arrest: 1 meq/kg IV of 7.5 or 8.4%
 To produce controlled hypotension during
sol, then 0.5 meq/kg IV q 10 mins depending anesthesia
on ABG  To reduce preload and afterload in cardiogenic
shock

Action Side Effects/Adverse Reactions

 Restore buffering capacity of the body and
neutralizes excessive acid
Indication
 Metabolic Acidosis
 Cardiac Arrest
Side Effects/Adverse Reactions
 CNS: tetany
 CV: edema
 GI: gastric distention, belching and flatulence
 Metabolic: hypokalemia, metabolic alkalosis,
hypernatremia, hyperosmolarity with overdose
 Skin: pain @ injection site
Headache, dizziness, increased ICP, loss of
consciousness, restlessness, bradycardia,
nausea, abdominal pain, methemoglodinemia,
muscle twitching, pink-colored rash, irritation
at infusion site
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

Contraindications
 Metabolic and respiratory alkalosis FUROSEMIDE
 Pt losing Cl because of vomiting or continuous
Lasix
GI suction or those receiving diuretics that
produces hypochloremic alkalosis Classification
Loop Diuretics

Nursing Management Dosage

 Obtain blood pH, PaO2, PaCo2 and electrolyte  Pulmonary edema: 40 mg IV
 Edema: 20 to 80 mg PO every day in the
levels morning
 SIVP  HPN: 40 mg PO bid. Dosage adjusted based on
response
HYPERTENSIVE CRISIS
Action
Inhibits Na and Cl reabsorption at the proximal
Na NITROPRUSSIDE and distal tubules and in the ascending loop of
Henle
Nittropress
Indication
 Acute pulmonary edema Action
 Edema
 Hypertension Increases osmotic pressure of glomerular
filtrate, inhibiting tubular reabsorption of water
Side Effects/Adverse Reactions
Signs of hypotension, hypokalemia and and electrolytes; drug elevates plasma
hyperglycemia osmolarity, increasing water flow into

Contraindications extracellular fluid

 Hypersensitivity
 Anuria
Indication
Nursing Management  Test dose for marked oliguria or suspected
1. Monitor wt., BP and PR inadequate renal function
2. Monitor fluid, I&O, electrolyte, BUN and CO2
levels frequently  Oliguria
3. WOF signs of hypokalemia  To induced intraocular or intracranial pressure
4. Monitor uric acid levels
 Diuresis in drug intoxication
5. Monitor glucose levels esp in DM pts
 Irrigating solution during TURP
Side Effects/Adverse Reactions
MORPHINE SO4  CN: seizures, headache and fever
 CV: edema, thrombophlebitis, hypotension
(Discussed earlier)
and heart failure
NEUROSURGICAL DRUGS  EENT: blurred vision and rhinitis
 GI: thirst, dry mouth, nausea, vomiting and
MANNITOL diarrhea
 GI: urine retention
Osmitrol  Metabolic: dehydration
 Skin: local pain
Classification  Others: chill
Diuretics Contraindications
 Hypersensitivity
Dosage  Anuria, severe pulmonary congestion, frank
 Test dose for marked oliguria or pulmonary edema, active intracranial bleeding
suspected inadequate renal function: 200 during craniotomy, severe dehydration,
mg/kg or 12.5 gram as a 15% to 20% IV metabolic edema, progressive heart failure or
solution over 3-5 mins response is adequate if pulmonary congestion after drug
30-50 ml of urine/hr is adequate, a second
dose is given if still no response after 2nd dose Nursing Management
stop the drug  Monitor VS,CVP,I&O, renal function fluid
 Oliguria: 50 over 90 mins to several hrs balance and urine K levels daily.
 To induced intraocular or intracranial  Drug can be used to measure GFR
pressure: 1.5-2 gram/kg as a 15 % to 20% IV  Do not give electrolyte free solutions with
solution over 30-60 min blood. If blood id given simultaneously, add at
 Diuresis in drug intoxication: 12.5% to least 200 meq of NaCL to each liter
10% solutions up to 200 g IV
 Irrigating solution during TURP: 2.5-5%
POISONING
 NALOXONE HCL
Classification
Antidote
Narcan
Dosage
25-30 ml followed immediately by H2O
Classification
Miscellaneous antagonists and antidotes Action
Irritates the stomach lining and stimulate the
vomiting center
Dosage
Indication
 For suspected opioid induced respiratory  Poisoning
depression: 0.4 to 2 mg IV, IM and SQ. repeat  Overdose
doses q 2-3 mins PRN
Side Effects
 For postoperative opiod depression: 0.01 to 0.2 Diarrhea, drowsiness, stomach cramps,
mg IV q 2-3 mins, PRN. Repeat dose within 1-2 vomiting, itching, DOB, swelling of the mouth,
rash and hives
hr, if needed.
 Action Contraindications
 Hypersensitivity
 Reverse the effects of opiods, psychotomimetic  Given activated charcoal
and dysphoric effects of agonist-antagonists  Unconcious
 Drowsy
 Severely drunk
Indication  Having seizures
 For suspected opioid induced respiratory  With no gag reflex

depression Nursing Management

1. Don’t administer to unconscious
2. Pt should kept active and moving ff
 For postoperative opiod depression administration
3. If vomiting does not occur after 2nd dose,
gastric lavage may be considered to remove
Side Effects/Adverse Reactions
ingested substance
 CNS: seizures, tremors
 CV: ventricular fibrillation, tachycardia, HPN with
higher recommended doses, hypotension ACTIVATED CHARCOAL
 GI: nausea and vomiting
 Respiratory: pulmonary edema Classification
 Skin: diaphoresis Antidote

Dosage
Contraindications 30-100 g with at least 8 oz of water
 Hypersensitivity
Action
 Use cautious with cardiac irritability or opiod  Inhibits GI absorption of toxic substances or
addiction. irritants
 Hyperosmolarity

Nursing Management Indication

 Poisoning
 Assess respiratory status frequently
 Respiratory rate increases within 1-2 mins Side Effects
 Pain, melena, diarrhea, vomiting and
constipation

IPECAC SYRUP Contraindications

 Cyanide, mineral acids, organic solvents,
intestinal obstruction, bleeding with fructose
intolerance, broken GI tract, concomitant use Classification
of charcoal with sorbitol Adrenergic drugs
Nursing Management
 Do not mix with chocolate and together with Dosage
ipecac syrup
 Notify doctor if caused swelling or pain in the Initially 2-5 mcg/kg/min by IV
stomach
Action
Stimulates dopaminergic and alpha and beta
FLUMAZENIL
receptors of the sympathetic nervous system
Romazicon resulting in positive inotropic effect and
increased CO
Classification
 Benzodiazepine receptor antagonists
Indication
Dosage
 2 ml IV given over 15 seconds  To treat shock and correct hemodynamic
imbalances
Action
 To correct hypotension
 Antagonizes the effects of benzodiazepines

Indication  To improve perfusion of vital organs

 Benzodiazepine-induced depression of the
ventilatory responses to hypercapnia and
hypoxia  To increase CO

Side Effects
 Nausea, vomiting, palpitations, sweating, Side Effects
flushing, dry mouth, tremors, insomnia,
 CNS: headache an anxiety
dyspnea, hyperventilation, blurred vision,
headache, pain at injection site  CV: tachy, angina, palpitations and
vasoconstriction
Contraindications
 Control of ICP or status epilepticus.  GI: nausea and vomiting
 Signs of serious cyclic antidepressant overdose

Nursing Management Contraindications

1. Must individualize dosage. Give only smallest  Hypersensitivity
amount effective.
 With uncorrect tachyarrhythmias
2. Give through freely running IV infusion into
large vein to minimize pain at injection site  Pheochromocytoma
3. Note history of seizure or panic disorder  Ventricular Fibrillation
4. Assess evidence of increased ICP
5. Note evidence of sedative and benzodiazepine
dependence Nursing Management
6. Instruct to avoid alcohol and non-prescription
drugs for 1-24 hrs  Most patients received less than 20 mcg/kg/min
 Drugs isn’t substitute for blood or fluid volume
deficit

SHOCK  During infusion, monitor ECG, BP, CO, PR and

color and temp of the limbs
DOPAMINE  Do not confuse dopamine to dobutamine
 Check urine output often
Intropine
 DOBUTAMINE
Classification
Dobutrex Pancreatic Hormones

Classification Dosage
Adrenergic drugs 0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN

Dosage Action
 0.5-1 mcg/kg/min IV infusion, titrating to Binds with glucagon receptor
optimum dosage of 2-20 mcg/kg/min
 2.5 to 10 mcg/kg/min-usual effective range to Indication
increase CO Hypoglycemia

Action Side Effects

Stimulates heart beta receptors to increase Nausea, vomiting, hypotension, tachycardia
myocardial contractility and SV and hypertension

Indication Contraindications
 To increase CO  Hypersensitivity
 Treatment of cardiac decompensation  Pheochromocytoma
 Insulinoma
Side Effects
 CNS: headache Nursing Management
 CV: HPN, tachycardia, palpitations and  Monitor V/S and blood sugar level
vasoconstriction  Response within 20 mins after injection
 GI: nausea and vomiting

Contraindications ALBUTEROL
 Hypersensitivity
 Use cautiously in pts with hx of HPN and AMI Ventolin

Nursing Management Classification

 Before starting therapy, give a plasma volume Bronchodilator, Adrenergic
expander to correct hypovolemia and a cardiac
glycoside Dosage
 Monitor ECG, BP, pulmonary artery wedge 2 inhalations reputed q 4-6 hrs via neb
pressure and CO
 Monitor electrolyte levels Action
 Don’t confuse dobutamine to dopamine Activation of beta adrenergic receptors on
airway smooth muscle

GLUCAGON Indication
 Asthma
 Prevention of exercise induced spasms
Dosage
Side effects 25-50 mg PO, IV or IM bid-tid
 Palpitations
 Tachycardia Action
 GI upset Blocks the effects Hi receptor sites
 Nervousness
Indication
Contraindications  Allergic reactions
Hypersensitivity  Motion sickness
 Cough suppression
Nursing Management  Sedation
 Monitor therapeutic effectiveness
 Monitor HR, BP, ABG, s/sx of bronchospasm and Side Effects
CNS stimulation  Xerostomia
 Instruct on how to use inhaler properly  Urinary retention
 Rinse mouth after use  Sedation

Contraindications
DIPHENHYDRAMINE HCL Acute asthmatic attack

Benadryl Nursing Management

Risk for photosensitivity- use sunscreen
Classification
Anti-histamine