J.H.

CERILLES STATE COLLEGE

West Capitol Road, Balangasan District, Pagadian City

STUDENT NURSE: GOTUMAN, MARK LEE O. DATE : OCTOBER 12, 2022

YEAR LEVEL : 2ND YEAR CLINICAL INSTRUCTOR: ALFRED ZOMAR B. BONGOLAN RN, MN

DRUG STUDY

1. Adrenergic Agonist
a. Non-selective Agents
Epinephrine
Norepinephrine
Ephedrine
Dopamine

b. Selective Agents
Dobutamine
Phenylephrine
Clonidine
Dexmedetomidine
 2. Adrenergic Antagonist
a. Alpha Adrenergic Antagonist
Phenoxybenzamine
Phentolamine
Prazosin

b. Beta Adrenergic Antagonist

Propranolol
Metropolol
Esmolol
Atenolol
Nadolol
Pindolol
Labetalol
Carvedilol
 3. Cholinergic Agonist
a. Directly-acting Acetylcholine Receptor Agonist
Bethanecol

b. Acetylcholinesterase Inhibitor
Neostigmine
Physostigmine
Edrophonium
Pyridostigmine
Donepezil
4. Cholinergic Antagonist
Atropine
Glycopyrrolate
Scopolamine
Ipratropium
Tiotropium Bromide
Benzatropine
Oxybutynin
Generic Name,
Prescribed Dosage, Frequency,
Brand Name,
and Route of dministration
Classification
Generic Name: Anaphylaxis
Epinephrine ADULTS, ELDERLY: 0.2–
0.5 mg (0.2–0.5 mL of
Brand Name: 1:1,000 solution). May
repeat q5–15 min if
anaphylaxis persists.
Classification: CHILDREN: 0.01 mg/kg
PHARMACOTHERAPEUTIC: (0.01 mL/kg of a 1:1,000
Sympathomimetic (alpha-, solution) q5–15 min.
beta-adrenergic agonist) Maximum: 0.3–0.5 mg
q5–15 min.
Hypotension
(Shock)
IV infusion: ADULTS,
ELDERLY: Initially, 0.1-0.5
mcg/kg/min. Titrate to
desired response.
Cardiac Arrest
IV: ADULTS, ELDERLY:
Initially, 1 mg. May
repeat q3–5min as
needed.
CHILDREN: Initially, 0.01
mg/kg (0.1 mL/ kg of a
1:10,000 solution). May
repeat q3–5min as
needed.
Endotracheal: ADULTS,
ELDERLY: 2–2.5 mg q3–5
min as needed.
CHILDREN: 0.1 mg/kg
(0.1 mL/kg of a 1:1,000
solution). May repeat
q3–5min as needed.
Maximum single dose:
2.5 mg.
Mechanism of Action Indication Contraindication Adverse Reaction Nursing Responsibilities
Stimulates alpha- Anaphylaxis Contraindications: Excessive doses may cause INTERVENTION/EVALUATION
adrenergic receptors Hypersensitivity to acute hypertension, Monitor changes of B/P, HR.
(vasoconstriction, Hypotension EPINEPHrine. Note: arrhythmias. Assess lung sounds for rhonchi,
pressor effects), beta1- (Shock) There are no ab - solute Prolonged/excessive use wheezing, rales. Monitor ABGs. In
adrenergic receptors contraindications with may result in metabolic cardiac arrest, adhere to ACLS
(cardiac stimulation), Cardiac Arrest injectable EPINEPHrine acidosis due to increased protocols.
beta2-adrenergic in a life-threatening serum lactic acid. Metabolic PATIENT/FAMILY TEACHING •
receptors (bronchial situation. IV: Narrow- acidosis may cause Avoid excessive use of caffeine.
dilation, vasodilation). angle glaucoma, disorientation, fatigue, • Report any new symptoms
Therapeutic Effect: thyrotoxicosis, hyperventilation, (tachycardia, shortness of breath,
Relaxes smooth muscle diabetes, hypertension, headache, nausea, dizziness) immediately: may be
of bronchial tree, other cardiovascular vomiting, diarrhea systemic effects.
produces cardiac disorders. Inhalation:
stimulation, dilates Concurrent use or
skeletal muscle within 2 wks of MAOIs.
vasculature. Cautions: Elderly,
diabetes mellitus,
hypertension,
Parkinson’s disease,
thyroid disease,
cerebrovascular or
cardiovascular disease,
concurrent use of
tricyclic
antidepressants. History
of prostate
enlargement, urinary
retention.
Generic Name: ALERT Stimulates beta1- Acute Hypotension Hypersensitivity to Extravasation may BASELINE ASSESSMENT
Nonepeniphren If possible, blood, fluid adrenergic receptors, Unresponsive to Fluid norepinephrine. produce tissue necrosis, Assess ECG, B/P continuously
Brand Name: volume depletion should alpha-adrenergic Volume Replacement Hypotension related to sloughing. Overdose (be alert to precipitous B/P
Levophed be corrected before drug receptors, increasing hypovolemia (except in manifested as severe drop). Be alert to pt
Classification: is administered. contractility, heart rate emergency to maintain hypertension with violent complaint of headache.
PHARMACOTHERAPEUTIC: Acute Hypotension and producing coronary/cerebral headache (may be first INTERVENTION/EVALUATION
Alpha, beta agonist. Unresponsive to Fluid vasoconstriction. perfusion until volume clinical sign of overdose), Monitor IV flow rate
Volume Replacement Therapeutic Effect: replaced), mesenteric/ arrhythmias, diligently. Assess for
IV infusion: ADULTS, Increases systemic B/P, peripheral vascular photophobia, extravasation characterized
ELDERLY: Initially, coronary blood flow. thrombosis (unless it is retrosternal or by blanching of skin over
administer at 8–12 lifesaving procedure) pharyngeal pain, pallor, vein, coolness (results from
mcg/min. Adjust rate of diaphoresis, vomiting. local vasoconstriction); color,
flow to desired response. Prolonged therapy may temperature of IV site
Average maintenance result in plasma volume extremity (pallor, cyanosis,
range: 2–4 mcg/min depletion. Hypotension mottling). Assess nailbed
(varies greatly based on may recur if plasma capillary refill. Monitor I&O;
clinical situation). volume is not measure output hourly,
CHILDREN: Initially, 0.05– maintained. report urine output less than
0.1 mcg/kg/min; titrate 30 mL/hr. Once B/P
to desired effect. parameter has been reached,
Maximum: 2 IV infusion should not be
mcg/kg/min. Dosage in restarted unless systolic B/P
Renal/Hepatic falls below 90 mm Hg.
Impairment No dose
adjustment.
Generic Name: ALERT timulates adrenergic and Hemodynamic Support Hypersensitivity to High doses may produce BASELINE ASSESSMENT
Dopamine Effects of DOPamine are dopaminergic receptors. dopamine, sulfites. ventricular arrhythmias, Pt must be on continuous
Brand Name: dose dependent. Titrate Effects are dose Pheochromocytoma, tachycardia. Pts with cardiac monitoring. Determine
to desired response. dependent. Lower ventricular fibrillation. occlusive vascular weight (for dosage calculation).
Classification: Doses greater than 20 dosage stimulates Uncorrected disease are at high risk Obtain initial B/P, heart rate,
PHARMACOTHERAPEUTIC: mcg/kg/min may not dopaminergic receptors, tachyarrhythmias. for further compromise respirations. Assess patency of
Sympathomimetic have beneficial effect on causing renal Cautions: Ischemic heart of circulation to IV access. Canadian trade name
(adrenergic agonist). BP and may increase risk vasodilation. Higher disease, occlusive extremities, which may Non-Crushable Drug High Alert
of tachyarrhythmias. doses stimulate both vascular disease, result in gangrene. drug D
dopaminergic and beta1- hypovolemia, recent use Tissue necrosis with doravirine/lamivudine/tenofovir
Hemodynamic Support adrenergic receptors, of MAOIs (within 2–3 sloughing may occur 361
IV infusion: ADULTS, causing cardiac with extravasation of IV INTERVENTION/EVALUATION
ELDERLY, CHILDREN: stimulation and renal solution Continuously monitor for
Range: 2–20 vasodilation. Higher cardiac arrhythmias. Measure
mcg/kg/min. Titrate to doses stimulate alpha- urinary output frequently. If
desired response. May adrenergic receptors, extravasation occurs,
gradually increase by 5– causing vasoconstriction, immediately infiltrate affected
10 mcg/kg/min increased B/P. tissue with 10–15 mL 0.9% NaCl
increments. Maximum: solution containing 5–10 mg
50 mcg/kg/min. Therapeutic Effect: phentolamine mesylate.
NEONATES: 2–20 Low dosage (1–5 Monitor B/P, heart rate,
mcg/kg/min. Titrate mcg/kg/ min): Increases respirations q15min during
gradually by 5–10 renal blood flow, urinary administration (more often if
mcg/kg/min to desired flow, sodium excretion. indicated). Assess cardiac
response. Low to moderate output, pulmonary wedge
dosage (5–10 mcg/kg/ pressure, or central venous
min): Increases pressure (CVP) frequently.
myocardial contractility, Assess peripheral circulation
stroke volume, cardiac (palpate pulses, note
output. High dosage color/temperature of
(greater than 10 extremities). Immediately notify
mcg/kg/ min): Increases physician of decreased urinary
peripheral resistance, output, cardiac arrhythmias,
vasoconstriction, B/P. significant changes in B/P, heart
rate, or failure to respond to
increase or decrease in infusion
rate, decreased peripheral
circulation (cold, pale, mottled
extremities). Taper dosage
before discontinuing (abrupt
cessation of therapy may result
in marked hypotension). Be
alert to excessive
vasoconstriction (decreased
urine output, increased heart
rate, arrhythmias,
disproportionate increase in
diastolic B/P, decrease in pulse
pressure); slow or temporarily
stop infusion, notify physician.
SELECTIVE AGENTS
Generic Name: Cardiac Direct-action inotropic • Cardiac • Hypersensitivity to Overdose may produce BASELINE ASSESSMENT
DOBUTamine Decompensation agent act ing primarily Decompensation dobutamine. severe tachycardia, Pt must be on continuous
(Hemodynamic Support) on myocardial beta1- (Hemodynamic Hypertrophic severe hypertension. cardiac moni toring.
Brand Name: adrenergic receptors. Support cardiomyopathy Determine weight (for dosage
Dobutrex IV infusion: Therapeutic Effect: with outflow cal culation). Obtain initial
• ADULTS, ELDERLY: Enhances myocardial obstruction. B/P, heart rate, respirations.
Classification: Initially, 0.5–2.5 contractil ity, increases Correct hypovolemia before
• PHARMACOTHERAPEUTIC: mcg/kg/min. heart rate. • Cautions: Atrial drug therapy.
Adrenergic agonists Maintenance: 2–20 fibrillation,
• CLINICAL: Cardiac mcg/kg/min titrated hypovolemia, post- INTERVENTION/EVALUATION
stimulant to desired response. MI, concurrent use Continuously monitor for
May be infused at a of MAOIs, elderly cardiac rate, arrhythmias.
rate of up to 40 Maintain accurate I&O;
mcg/kg/min to measure urinary output
increase cardiac frequently. Assess serum
output. potassium, plasma
• NEONATES, DOBUTamine (therapeutic
INFANTS, range: 40–190 ng/mL).
CHILDREN, Mon itor B/P continuously
ADOLESCENTS: (hypertension risk greater in
Initially, 0.5–1 mcg/ pts with preexisting
kg/min. Titrate hyperten sion). Check
gradually every few cardiac output, pulmonary
minutes until wedge pressure/central
desired response. venous pressure (CVP)
Usual Range: 2–20 frequently. Immediately
mcg/kg/minute. notify phy sician of
decreased urinary output,
Dosage in cardiac arrhythmias,
Renal/Hepatic significant increase in B/P,
Impairment heart rate, or less commonly,
No dose adjustment hypotension.
Generic Name:
Phenylephrine
Brand Name:
K-Dilate, Mydfrin, Neo-
Synephrine, Sudafed PE
Classification:
• PHARMACOTHERAPEUTIC:
Alpha-adrenergic agonist.
• CLINICAL: Nasal
decongestant, mydriatic,
vasopressor.
Nasal Decongestant Acts on alpha-adrenergic Nasal decongestant: Hypersensitivity to Large doses may BASELINE ASSESSMENT
receptors of vascular Topical application to phenylephrine. produce tachycardia, Obtain baseline
ALERT: Do not use for smooth muscle. Causes nasal mucosa reduces • Injection: Severe palpitations (particularly symptomology, vital signs.
more than 3 days. vaso constriction of nasal secretion, hypertension, in pts with cardiac Question history of
arterioles of nasal promoting drainage of ventricular disease), dizziness, hypertension, cardiac
Intranasal: mucosa/conjunctiva; sinus secretions. tachycardia. nausea, vomiting. disease, asthma, recent use
• ADULTS, ELDERLY, produces systemic Parenteral: Vascular • Oral: Use within 14 Overdose in pts older of MAOI therapy.
CHILDREN 12 YRS arterial vasoconstriction. failure in shock, days of MAOI than 60 yrs. may result
AND OLDER: 2–3 supraventricular therapy. in hallucinations, CNS INTERVENTION/EVALUATION
drops or 2–3 sprays Therapeutic Effect: tachycardia, depression, seizures. Monitor B/P, heart rate. For
of 0.25%–0.5% Decreases mucosal hypotension. Cautions: Prolonged nasal use severe hypo tension or shock
solu tion into each blood flow, relieves • Injection: Elderly, may produce chronic states, monitor central
nostril q4h as congestion. Increases hyperthyroidism, swelling of nasal venous pressure noninvasive
needed. B/P. Re duces heart rate bradycardia, partial mucosa, rhinitis. If hemodynamic monitoring
• CHILDREN 6–11 YRS: due to decrease in heart block, cardiac phenylephrine 10% systems.
2–3 drops or 2–3 cardiac output. disease, HF, ophthalmic is instilled
sprays of 0.25% cardiogenic shock, into denuded/damaged
solution into each hypertension. corneal epithelium,
nostril q4h as corneal clouding may
needed. • Oral: Asthma, bowel result.
• CHILDREN 2–5 YRS: obstruction, cardiac
1 drop of 0.125% disease, ischemic
solution (dilute 0.5% heart disease,
solution with 0.9% hypertension,
NaCl to achieve increased intraocular
0.125%) in each pressure, elderly,
nostril. Repeat q2– prostatic hyperplasia
4h as needed.
PO:
• ADULTS, ELDERLY,
CHILDREN 13 YRS
AND OLDER: 10 mg
q4h as needed for
up to 7 days.
Maximum: 60
mg/day.
• CHILDREN 6–11 YRS:
5 mg q4h as needed
for up to 7 days.
Maximum: 30 mg/
day. CHILDREN 4–5
YRS: 2.5 mg q4h as
 needed for up to 7
days. Maximum: 15
mg/day.

Hypotension, Shock
IV infusion:
• ADULTS, ELDERLY:
0.5–6 mcg/kg/min.
Titrate to desired
response.
• CHILDREN: Initially,
0.1–0.5 mcg/kg/min.
Titrate to desired
effect.
Generic Name: Hypertension Stimulates alpha2- • Hypertension Hypersensitivity to Overdose produces BASELINE ASSESSMENT
clonidine adrenergic receptors in • Acute Hypertension cloNIDine. profound hypoten sion, Obtain B/P immediately
PO: the brainstem, reducing • Attention-Deficit • Epidural: irritability, bradycardia, before each dose is
Brand Name: • ADULTS: sympathetic outflow Hyperactivity Contraindicated in respiratory depression, administered, in addition to
Catapres, Catapres-TTS, (Immediate- from the CNS. Disorder (ADHD) pts with bleeding hypothermia, miosis regular monitoring (be alert
Dixarit , Duraclon, Kapvay Release): Initially, • Severe Pain diathesis or infection (pupil lary constriction), to B/P fluctuations).
0.1 mg twice a day. • Epidural: Prevents at the injection site; arrhythmias, apnea.
Classification: Increase by 0.1 pain signal pts receiving Abrupt withdrawal may INTERVENTION/EVALUATION
• PHARMACOTHERAPEUTIC: mg/day at wkly transmission to anticoagulation result in rebound Monitor B/P, pulse, mental
Alpha2- adrenergic intervals. Dosage brain and produces therapy. hypertension associated status. Monitor daily pattern
agonist. range: 0.1–0.8 analgesia at pre- and with nervous ness, of bowel activity, stool
• CLINICAL: mg/day in 2 divided post-alpha- Cautions: agitation, anxiety, con sistency. If cloNIDine is
Antihypertensive. doses. Maximum: adrenergic receptors • Depression, elderly. insomnia, pares thesia, to be withdrawn, discontinue
2.4 mg/day. Usual in spinal cord. Severe coronary tremor, flushing, concurrent beta-blocker
dose range: 0.1–0.2 • ADHD: Mechanism insufficiency, recent diaphoresis. May therapy several days before
mg twice daily. of action unknown. MI, cerebrovascular produce sedation in pts discontinuing cloNIDine
• ELDERLY: Initially, disease, chronic with acute CVA. (prevents cloNIDine
0.1 mg at bedtime. Therapeutic Effect: renal impairment, with drawal hypertensive
May increase Reduces peripheral preexisting crisis). Slowly reduce
gradually. resistance; de creases bradycardia, sinus cloNIDine dosage over 2–4
• CHILDREN 12 YRS B/P, heart rate. node dysfunction, days
AND OLDER: Initially, Produces analgesia conduction
0.2 mg/day in 2 disturbances;
divided doses. May concurrent use with
increase gradually at digoxin, diltiaZEM,
7-day intervals in 0.1 metoprolol,
mg/day increments. verapamil.
Maximum: 2.4
mg/day.

Transdermal:
• ADULTS, ELDERLY:
Initially, system
delivering 0.1 mg/24
hrs applied once
q7days. May
increase by 0.1 mg
at 1- to 2-wk
intervals. Usual
dosage range: 0.1–
0.3 mg once wkly.
Acute Hypertension

PO:
ADULTS: Initially, 0.1–
0.2 mg followed by 0.1
mg every hr if necessary,
up to maximum total
dose of 0.7 mg

Attention-Deficit
Hyperactivity Disorder
(ADHD)
Note: When
discontinuing, taper
gradually over 1–2 wks.
(Extended-Release
Tablets): Taper by 0.1
mg or less q3–7 days.

PO:
• CHILDREN
WEIGHING 45 KG OR
LESS: (Immediate-
Release): Initially
0.05 mg/day at
bedtime. May
increase in
increments of 0.05
mg/day q3–7days up
to 0.2 mg/day (27–
40.5 kg), 0.3 mg/day
(40.5– 45 kg).
• MORE THAN 45 KG:
(Immediate
Release): 0.1 mg at
bedtime. May
increase 0.1 mg/day
q3–7 days.
Maximum: 0.4
mg/day.
• Extended-Release
Tablet (Kapvay):
CHILDREN 6 YRS
 AND OLDER: Initially,
0.1 mg daily at
bedtime. May
increase in
increments of 0.1
mg/day at wkly
intervals (Maximum:
0.4 mg/day). Doses
should be taken
twice daily with
higher split dose
given at bedtime.

Severe Pain

Epidural:
• ADULTS, ELDERLY:
30–40 mcg/ hr.
• CHILDREN: Range:
0.5–2 mcg/kg/hr,
not to exceed adult
dose.

Dosage in
Renal/Hepatic
Impairment
No dose adjustment.
Generic Name: ICU Sedation Selective alpha2- • ICU Sedation Hypersensitivity to Significant bradycardia, BASELINE ASSESSMENT
Dexmedetomidine adrenergic agonist. dexmedetomidine. sinus arrest, cardiac Obtain baseline B/P, heart
IV: Inhibits norepinephrine arrest, AV block, SVT, rate. Recommend continuous
Brand Name: • ADULTS: Loading release. Cautions: ventricular tachycardia cardiac monitoring during
Precedex dose of 1 mcg/ kg Heart block, bradycardia, may occur and may be use. Assess mental status
over 10 min Therapeutic Effect: hepatic impairment, fatal. Transient prior to initiation. Obtain full
Classification: followed by Produces anesthetic, hypovolemia, diabetes, hypertension was medication history; screen for
• PHARMACOTHERAPEUTIC: maintenance sedative effects. hypotension, chronic reported during loading medications known to cause
Alpha2 agonist. infusion of 0.2–0.7 hypertension, severe doses. Atrial fibrillation, hypotension, bradycardia,
• CLINICAL: Sedative. mcg/kg/ hr. ventricular dysfunction, hypoxia, pleural effusion sedation. Question history of
• ELDERLY: May elderly, use of may occur with too- heart block, bradycardia,
require decreased vasodilators or drugs rapid IV infusion. severe ventricular
dosage. decreasing heart rate. Bradycardia, dysfunction; hepatic
hypotension may be impairment.
Dosage in Renal more pronounced in pts
Impairment with diabetes, INTERVENTION/EVALUATION
No dose adjustment. hypovolemia, Assess cardiac monitor for
hypertension, or who arrhythmia, bradycardia,
Dosage in Hepatic are elderly. Acute hypotension. Anticholinergic
Impairment respiratory distress agents (e.g., glycopyrrolate,
Use caution. syndrome (ARDS), atropine) may be effective in
respiratory failure, treating drug-induced
acidosis may occur with bradycardia. Monitor level of
prolonged infusion time sedation; respiratory rate,
greater than 24 hrs. rhythm. Monitor ventilator
settings. Discontinue once pt
is extubated.
Alpha Adrenergic Antagonist
Beta Adrenergic Antagonist