Drug Handbook

1.
AMANTADINE
Branded Name: Symmetrel
Generic Name: Amantadine
a. Dosage, Frequency, and Administration:
i. Dosage: The typical adult dosage for amantadine can vary depending on the
condition being treated. For Parkinson's disease, the initial dose is usually 100 mg
once daily, which may be increased gradually. For influenza prevention, 100 mg
once daily is recommended during an outbreak. For influenza treatment, it's
typically 100 mg twice daily.
ii. Frequency: The frequency of dosing may vary based on the indication. It can be
once daily or twice daily.
iii. Administration: Amantadine is usually taken orally as a tablet or capsule. It can
be taken with or without food, but taking it with food can help reduce stomach
upset.
b. Indication:
Amantadine is used for:
i. Parkinson's Disease: To help control symptoms of Parkinson's disease, such as
tremors, stiffness, and difficulty with movement.
ii. Influenza Prevention: To prevent influenza A virus infection, especially during
outbreaks or when there's a high risk of exposure.
iii. Influenza Treatment: To treat influenza A virus infection when taken within 48
hours of symptom onset.
c. Mode of Action: Amantadine's exact mechanism of action is not fully understood, but it
is thought to work by blocking the action of a neurotransmitter called dopamine and by
interfering with the replication of some viruses, including the influenza A virus.
d. Side Effects/Adverse Reactions:
i. Amantadine can have various side effects, including but not limited to:
● Nausea and vomiting
● Dizziness
● Insomnia
● Lightheadedness
● Dry mouth
● Blurred vision
● Confusion or hallucinations (more common in elderly patients)
● Peripheral edema (swelling in the legs and ankles)
These are not all the possible side effects, and some individuals may experience
different or more severe side effects. It's essential to report any unusual or severe
side effects to a healthcare provider.
e. Nursing Considerations for Amantadine:

i. Assessment: Nurses should assess patients for any known allergies to amantadine
or other contraindications. Monitoring of vital signs, mental status, and gait in
Parkinson's patients is essential.
ii. Medication Administration: Administer the medication as prescribed, and ensure
that the patient understands the dosing schedule and any potential side effects.
iii. Parkinson's Patients: In patients with Parkinson's disease, nurses should monitor
for improvements in motor function as well as the occurrence of any adverse
effects, such as confusion or hallucinations.
iv. Influenza Prevention/Treatment: When used for influenza prevention or
treatment, nurses should educate patients on the importance of adhering to the
prescribed dosage and duration, especially during outbreaks.
v. Fall Risk: Be cautious with elderly patients, as amantadine can cause dizziness
and unsteadiness, increasing the risk of falls.
vi. Psychiatric Effects: Monitor patients for changes in mood, behavior, or the
development of hallucinations, particularly in older adults, and report any concerns
to the healthcare provider.
vii. Education: Provide patient education regarding medication compliance, potential
side effects, and the importance of follow-up appointments.
viii. Renal Function: Be aware that amantadine is excreted primarily by the kidneys,
so patients with renal impairment may require dosage adjustments.
ix. Other Medications: Be alert to potential drug interactions, and ensure that
patients are not taking other medications that may interact adversely with
amantadine.
References:
Drug Information References: You can refer to drug information databases like the FDA's official website (www.fda.gov)
or the prescribing information provided by the pharmaceutical manufacturer for specific medication details.
Medical Textbooks: Textbooks like "Goodman & Gilman's Pharmacological Basis of Therapeutics" or "Nursing Drug
Handbook" can provide in-depth information on medications, including amantadine.
Medical Journals: To access the latest research articles and studies on amantadine, you can search medical databases
like PubMed (www.pubmed.gov).
Clinical Guidelines: Check for clinical practice guidelines from reputable medical organizations like the American
Medical Association, the World Health Organization (WHO), or the Centers for Disease Control and Prevention (CDC).
2. AMIODARONE
Branded Name: Cordarone (among others)
Generic Name: Amiodarone

i. Dosage: The typical oral dose of amiodarone for adults may vary, but a common
starting dose for maintenance therapy is 200 to 400 milligrams (mg) daily. Your
healthcare provider will determine the appropriate dosage for your specific
condition.
ii. Frequency: Amiodarone is usually taken once daily, but again, the exact
frequency can vary based on your doctor's instructions. In some cases, a healthcare
provider may recommend a loading dose, which involves taking a higher initial
dose for a short period (usually a few days) before switching to a lower
maintenance dose.
iii. Administration: Amiodarone is available in both oral and intravenous (IV) forms.
1. Oral administration: If you're prescribed the oral form of amiodarone, it's
typically taken with a meal or as directed by your healthcare provider.
Swallow the tablets whole with a full glass of water. Do not crush or chew
the tablets unless your doctor advises otherwise.
2. Intravenous (IV) administration: Intravenous amiodarone is usually
administered by healthcare professionals in a hospital or clinical setting. It is
given as a slow infusion over a specific duration, typically using a controlled
infusion pump.
b. Mode of Action: Amiodarone is an antiarrhythmic medication that works through

multiple mechanisms, including prolonging the action potential duration, inhibiting
adrenergic stimulation, and blocking potassium, sodium, and calcium channels in cardiac
cells.
c. Indication: Amiodarone is used to treat and prevent various types of serious, potentially
life-threatening ventricular arrhythmias (abnormal heart rhythms), including ventricular
fibrillation and ventricular tachycardia. It is also used for certain atrial arrhythmias, such
as atrial fibrillation or atrial flutter when other treatments have failed.

i. Common Side Effects: Nausea, vomiting, constipation, loss of appetite, taste
changes, and fatigue.
ii. Serious Side Effects: Pulmonary toxicity, hepatotoxicity, thyroid dysfunction,
bradycardia, heart block, corneal deposits, skin photosensitivity, and peripheral
neuropathy.
e, Nursing Considerations for Amiodarone:

i. Assessment: Assess baseline vital signs, ECG, and laboratory values, including
thyroid function tests and liver function tests, as amiodarone can affect these
parameters.
ii. Monitoring: Continuously monitor the patient's cardiac rhythm, blood pressure,
and ECG during IV infusions and regularly throughout therapy.
iii. Pulmonary Function: Monitor for signs and symptoms of pulmonary toxicity,
such as cough, dyspnea, or chest pain. Advise patients to report any new
respiratory symptoms promptly.
iv. Thyroid Function: Regularly assess thyroid function as amiodarone can cause
hypo- or hyperthyroidism. Patients with pre-existing thyroid conditions should be
closely monitored.
v. Photosensitivity: Advise patients to protect themselves from sunlight and UV
radiation due to the risk of photosensitivity reactions.
vi. Medication Education: Educate patients about the importance of adhering to the
prescribed dosage and schedule and the potential for drug interactions. Discuss
potential side effects and when to seek medical attention.
vii. Regular Follow-up: Schedule regular follow-up visits to monitor for drug efficacy
and adverse effects.
References:
Micromedex, Truven Health Analytics. (2021). Amiodarone. Retrieved from https://www.micromedexsolutions.com.

Lexicomp Online, Lexi-Drugs, Hudson, Ohio: Lexi-Comp, Inc. (2021).
American Heart Association. (2021). Amiodarone. Retrieved from https://www.heart.org.
3. BRETYLIUM
Branded Name: Bretylol
Generic Name: Bretylium

i. Dosage:
- The usual recommended adult dose of bretylium for ventricular arrhythmias is 5 to
10 mg/kg body weight.
- This dose is typically administered as an intravenous (IV) infusion.
ii. Frequency and Administration:
- Bretylium is administered in a hospital or clinical setting under the supervision of a
healthcare provider experienced in the management of cardiac arrhythmias.
- The medication is given as a slow intravenous infusion, which means it is diluted

in an appropriate IV solution and administered over a specified period of time.
- The infusion rate and duration of treatment can vary based on the specific
arrhythmia being treated and the patient's individual response.
b. Mode of Action: Bretylium's mode of action involves inhibiting the release of

norepinephrine, dampening the sympathetic nervous system, prolonging the cardiac
action potential duration, and stabilizing cardiac cell membranes. These actions help
prevent certain ventricular arrhythmias by reducing abnormal electrical activity in the
heart.
c. Indication: Bretylium sulfate is primarily used to treat life-threatening ventricular

arrhythmias, like ventricular fibrillation and tachycardia, when other antiarrhythmic
treatments fail. However, its use is decreasing due to serious side effects and better
alternatives. Healthcare professionals decide its use in specific cases. Consult a
healthcare provider for appropriate treatment options.

i. Common Side Effects:
■ Nausea,
■ vomiting, and
■ dizziness
ii. Serious Side Effects:
■ Hypotension (low blood pressure),
■ bradycardia (slow heart rate), and
■ exacerbation of arrhythmias.
■ It can also lead to chest pain, bronchoconstriction (in individuals with
asthma), and
■ gastrointestinal bleeding.
e. Nursing Considerations for Bretylium:

i. Assessment: Assess baseline vital signs, cardiac rhythm, blood pressure, and ECG.
Continuous monitoring of these parameters is crucial during and after bretylium
administration.
ii. IV Administration: Administer bretylium as a slow IV infusion as prescribed,
usually over a period of 1 to 2 minutes. Be prepared to respond quickly to any adverse
reactions.
iii. Cardiac Monitoring: Continuously monitor the patient's cardiac rhythm and blood
pressure throughout bretylium infusion and during the post-infusion period.
iv. Iv. Hypotension: Be alert for signs of hypotension, which can be severe, and be
prepared to administer appropriate interventions, such as intravenous fluids or
vasopressor medications, if necessary.
v. Respiratory Status: Monitor respiratory function, especially in patients with a history
of asthma or other respiratory conditions, as bretylium can cause bronchoconstriction.
vi. Medication Education: Educate the patient about the purpose of the medication,
potential side effects, and the importance of adhering to the prescribed dosage and
schedule.
vii. Patient Safety: Ensure a safe environment for the administration of bretylium, with
emergency equipment and personnel readily available due to its use in life-threatening
situations.
References:
Lexicomp Online, Lexi-Drugs, Hudson, Ohio: Lexi-Comp, Inc. (2021).
Micromedex, Truven Health Analytics. (2021). Bretylium. Retrieved from https://www.micromedexsolutions.com.
American Heart Association. (2021). Advanced Cardiovascular Life Support (ACLS) Provider Manual. Retrieved from
https://www.heart.org.
4. CISATRACURIUM
Branded Name: Nimbex
Generic Name: Cisatracurium
i. Dosage
● The initial recommended dosage of cisatracurium for most adults is typically in the
range of 0.1 to 0.2 milligrams per kilogram (mg/kg) of body weight.
● Pediatric dosing may vary depending on the child's age, weight, and specific
clinical situation.
ii. Frequency
● The frequency of administration depends on the patient's response and the
requirements of the surgical or medical procedure.
● Cisatracurium is typically administered as an intravenous (IV) infusion and may be
given intermittently as needed to maintain muscle relaxation during the procedure.
● The dosage and frequency should be adjusted to achieve the desired level of
muscle relaxation while minimizing the risk of over-paralysis.
iii. Administration
● Cisatracurium is administered by a healthcare professional, typically in a hospital
or clinical setting.
● It is given as an IV infusion, which means it is diluted in an appropriate IV solution
and administered continuously through an IV line.
● The rate of infusion can be adjusted to maintain the desired level of muscle
relaxation, which is monitored by neuromuscular function monitoring devices.
● The use of neuromuscular monitoring helps guide the administration and titration
of cisatracurium to ensure optimal muscle relaxation without excessive paralysis.
b. Mechanism of Action: Cisatracurium is a non-depolarizing neuromuscular blocking

agent. It works by competitively blocking the action of acetylcholine at the
neuromuscular junction, leading to muscle relaxation and paralysis.
c. Indication: Cisatracurium is primarily used as an adjunct to general anesthesia to provide

skeletal muscle relaxation during surgery or mechanical ventilation in the intensive care
unit (ICU). It helps facilitate endotracheal intubation and surgical procedures.

i. Common Side Effects: Hypotension (low blood pressure) and bronchospasm
(especially in patients with a history of asthma)
ii. Serious Side Effects: Prolonged neuromuscular blockade, anaphylactic reactions
(rare), and histamine release leading to flushing and hypotension (less common).
e. Nursing Considerations for Cisatracurium:

i. Assessment: Assess baseline vital signs, including blood pressure and heart rate, as
well as the patient's neuromuscular function and response to stimulation.
ii. IV Administration: Administer cisatracurium as an IV infusion according to the
prescribed dosage and rate. Ensure proper dilution and compatibility with other
medications being administered simultaneously.
iii. Neuromuscular Monitoring: Continuously monitor neuromuscular function using
train-of-four (TOF) monitoring or other appropriate monitoring techniques to assess the
depth of muscle relaxation. Adjust the infusion rate as needed to achieve the desired level
of neuromuscular blockade.
iv. Respiratory Status: Be vigilant for bronchospasm and closely monitor the patient's
respiratory function, especially in individuals with a history of asthma or other
respiratory conditions.
v. Hypotension: Monitor for hypotension during cisatracurium administration, and be
prepared to administer appropriate interventions, such as fluids or vasopressor
medications, if needed.
vi. Anesthesia Providers: Collaborate closely with anesthesia providers and surgical
teams to ensure proper dosing and timing of cisatracurium during surgical procedures.
vii. Patient Safety: Ensure a safe environment for the administration of cisatracurium,
and be prepared to manage any potential complications or emergencies related to
neuromuscular blockade.
References: Lexicomp Online, Lexi-Drugs, Hudson, Ohio: Lexi-Comp, Inc. (2021).

Micromedex, Truven Health Analytics. (2021). Cisatracurium. Retrieved from
https://www.micromedexsolutions.com.
5. DIAZEPAM
Branded Name: Valium
Generic Name: Diazepam
a. Dosage, Frequency, Administration
i. Dosage: Diazepam is available in various dosage forms including tablets, capsules, and
injectable solutions. Dosage can vary depending on the condition being treated. Typical
oral doses for adults range from 2 mg to 10 mg, taken 2 to 4 times daily. For intravenous
use, the typical dose ranges from 2 mg to 10 mg, administered slowly.
ii. Frequency: The frequency of administration can vary depending on the indication and
the patient's response. It can be taken 2 to 4 times daily for oral use, or as directed by a
healthcare provider. Intravenous administration may be done in healthcare settings as
needed.
iii. Administration: Diazepam can be taken orally with or without food. For intravenous
administration, it should be administered slowly to avoid adverse reactions.
b. Mechanism of Action: Diazepam is a benzodiazepine that acts on the central nervous

system (CNS). It enhances the effects of a neurotransmitter called gamma-aminobutyric
acid (GABA) in the brain, leading to increased inhibitory neurotransmission. This results
in sedative, anxiolytic (anxiety-reducing), muscle relaxant, and anticonvulsant effects.
c. Indication: Diazepam is used to treat a variety of conditions, including anxiety disorders,

alcohol withdrawal symptoms, muscle spasms, and as an adjunctive treatment for certain
types of seizures. It is also used in procedural sedation and as an anticonvulsant during
status epilepticus.

i. Common side effects may include:
● Drowsiness
● Dizziness
● Fatigue
● Muscle weakness
● Ataxia (loss of coordination)
● Memory problems
ii. Less common but more severe side effects may include:
● Respiratory depression (especially when used with other central nervous system
depressants)
● Paradoxical reactions (e.g., increased anxiety, agitation)
● Allergic reactions
● Dependence and withdrawal symptoms with prolonged use
e. Nursing Considerations
i. Assess the patient's medical history, including any history of substance abuse or
addiction.
ii. Monitor vital signs, especially respiratory rate and blood pressure, during
administration, especially if administered intravenously.
iii. Educate the patient about the potential for dependence and withdrawal symptoms
with long-term use.
iv. Advise the patient to avoid alcohol and other central nervous system depressants
while taking diazepam.
v. Monitor for signs of paradoxical reactions, and report them to the healthcare
provider.
vi. Provide emotional support and reassurance to patients experiencing anxiety or
withdrawal symptoms.
vii. For intravenous administration, ensure that proper dilution and administration
guidelines are followed to prevent adverse reactions.
References:
Lexi-Drugs Online, Diazepam. (2021). Lexicomp. Retrieved from https://online.lexi.com
Valium (diazepam) prescribing information. (2019). Roche. Retrieved from https://www.accessdata.fda.gov
Please note that medication information can change over time, and it's essential to consult the most recent and
authoritative sources, as well as a healthcare professional, for the latest guidance on medication administration and safety.
6. DILTIAZEM
Branded Name: Cardizem (among others, as there are multiple brand names)
Generic Name: Diltiazem
i. Dosage: Diltiazem is available in various formulations, including tablets and capsules
with different strengths, as well as intravenous formulations. Dosage can vary depending
on the condition being treated and the specific product used. The typical oral dose for
adults with hypertension ranges from 180 mg to 360 mg daily, usually divided into
multiple doses. For intravenous use, dosages may vary but are typically administered in a
healthcare setting.
ii. Frequency: The frequency of administration can vary depending on the indication and
the healthcare provider's instructions. For oral use, it is typically taken 2 to 4 times daily.
Intravenous administration is done as needed and under medical supervision.
iii. Administration: Diltiazem should be taken with or without food as directed by a
healthcare provider. For intravenous use, it is administered by a healthcare professional.
b. Mechanism of Action: Diltiazem is a calcium channel blocker. It works by inhibiting the

influx of calcium ions into cardiac and smooth muscle cells, which results in the
relaxation of blood vessels and reduced workload on the heart. This leads to the dilation
of coronary and systemic arteries, decreased blood pressure, and decreased myocardial
oxygen consumption.
c. Indication: Diltiazem is primarily used to treat hypertension (high blood pressure) and
angina (chest pain) caused by coronary artery disease. It is also sometimes used to
manage certain heart rhythm disorders, such as atrial fibrillation or atrial flutter.

● Dizziness
● Headache
● Flushing
● Swelling of the ankles or legs (peripheral edema)
● Constipation or diarrhea
● Nausea
● Bradycardia (slow heart rate)
● Hypotension (low blood pressure)
● Heart rhythm abnormalities
● Liver function abnormalities
● Peripheral neuropathy (rare)
e. Nursing Considerations:
i. Monitor the patient's blood pressure and heart rate regularly, especially during the
initial period of treatment and dosage adjustments.
ii. Advise the patient not to stop taking diltiazem suddenly, as it may lead to rebound
hypertension or worsening of angina.
iii. Educate the patient about the potential for side effects, especially dizziness and
edema, and encourage them to report any unusual symptoms.
iv. Caution patients against consuming grapefruit or grapefruit juice while taking
diltiazem, as it can interact with the medication.
v. For intravenous administration, closely monitor vital signs and administer
according to hospital protocols.
vi. Assess for signs of heart rhythm abnormalities, especially in patients with
preexisting cardiac conditions.
vii. Ensure that patients with liver impairment are closely monitored for changes in
liver function.
References:
Cardizem (diltiazem hydrochloride) prescribing information. (2021). Pfizer Inc. Retrieved from
https://www.accessdata.fda.gov
Lexi-Drugs Online, Diltiazem. (2021). Lexicomp. Retrieved from https://online.lexi.com
As with any medication, it's important to consult the most recent and authoritative sources and work
closely with healthcare professionals for specific patient care.
7. DOBUTAMINE
Branded Name: Dobutrex
Generic Name: Dobutamine
i. Dosage: Dobutamine is typically administered intravenously (IV) in a clinical setting,
such as a hospital. The dosage and rate of administration are highly variable and depend
on the patient's specific condition and response to treatment. Healthcare providers
determine the appropriate dosage based on the patient's weight, cardiac function, and the
desired hemodynamic effect. It is important to emphasize that dobutamine is
administered by healthcare professionals in controlled clinical settings.
ii. Frequency: The frequency of administration depends on the patient's clinical
condition and the healthcare provider's assessment. It may be administered as a
continuous infusion.
iii. Administration: Dobutamine is administered through an intravenous (IV) line,
usually as a continuous infusion. It is typically diluted in a compatible IV solution and
carefully titrated to achieve the desired hemodynamic effect. Continuous monitoring of
the patient's vital signs and cardiac function is crucial during administration.
b. Mechanism of Action: Dobutamine is a synthetic catecholamine that primarily
stimulates beta-1 adrenergic receptors in the heart. It has inotropic (increases myocardial
contractility) and chronotropic (increases heart rate) effects. By selectively activating
these receptors, dobutamine increases cardiac output and is used to improve cardiac
function in conditions such as heart failure or during certain medical procedures.
c. Indication: Dobutamine is primarily indicated for short-term treatment of heart failure to

improve cardiac output in situations where conventional therapies may be inadequate. It
is also used in cardiac stress testing to assess coronary artery disease and in certain cases
of low cardiac output following cardiac surgery.

● Increased heart rate (tachycardia)
● Increased blood pressure
● Arrhythmias (heart rhythm disturbances)
● Headache
● Palpitations
● Myocardial ischemia (reduced blood flow to the heart muscle)
● Hypertension (high blood pressure)
● Ventricular arrhythmias
● Shortness of breath
● Chest pain
i. Continuous monitoring of the patient's heart rate, blood pressure, and cardiac
rhythm is essential during dobutamine administration.
ii. Titrate the infusion rate carefully to achieve the desired hemodynamic effect while
minimizing side effects.
iii. Be prepared to adjust the infusion rate or discontinue dobutamine if adverse
reactions occur.
iv. Inform the patient about the potential side effects and the necessity of close
monitoring during treatment.
v. Dobutamine should be administered using a controlled infusion pump.
vi. Assess and document the patient's response to dobutamine therapy regularly.
vii. Observe for signs of myocardial ischemia or other cardiac complications.
viii. Report any significant changes in the patient's condition to the healthcare provider
promptly.
References:
Dobutrex (dobutamine) prescribing information. (2021). Fresenius Kabi USA, LLC.
Retrieved from https://www.accessdata.fda.gov
Lexi-Drugs Online, Dobutamine. (2021). Lexicomp. Retrieved from
https://online.lexi.com
As with any medication, it's crucial to consult the most recent and authoritative sources
and work closely with healthcare professionals for specific patient care. Dobutamine is
typically used in a hospital or clinical setting under the supervision of healthcare
providers due to its potential for significant hemodynamic effects.
8. DOPAMINE
Branded Name: levodopa
Generic Name: Dopamine
i. Dosage: Dopamine is administered as an intravenous (IV) infusion. The dosage and
infusion rate are highly variable and depend on the patient's specific condition and
response to treatment. Healthcare providers determine the appropriate dosage based on
the patient's weight, blood pressure, cardiac function, and clinical needs. Dopamine is
typically diluted in an IV solution (such as normal saline) and administered via a
controlled infusion pump.
condition and the healthcare provider's assessment. It is usually administered as a
continuous infusion.
iii. Administration: Dopamine is administered intravenously (IV) using an infusion
pump. It should be administered via a central venous catheter or a large peripheral vein to
minimize the risk of tissue damage or extravasation.
b. Mechanism of Action: Dopamine is a naturally occurring neurotransmitter and a
precursor to norepinephrine and epinephrine. When administered intravenously, it acts as
an inotropic agent, meaning it increases the force of cardiac contractions. The mechanism
of action depends on the dose:
i. At low doses, dopamine primarily stimulates dopamine receptors, leading to renal
and mesenteric vasodilation, and increasing blood flow to these areas.
ii. At moderate doses, it stimulates both dopamine and beta-1 adrenergic receptors,
resulting in increased cardiac contractility and heart rate.
iii. At higher doses, it additionally stimulates alpha-1 adrenergic receptors, causing
vasoconstriction and an increase in systemic blood pressure.
c. Indication: Dopamine is indicated for the treatment of severe hypotension (low blood
pressure) and shock, where there is inadequate blood flow to vital organs. It is used to increase
blood pressure and improve cardiac output in critically ill patients.

i. Common adverse/ side effect:
● Arrhythmias (heart rhythm disturbances)
● Headache
● Skin necrosis (if extravasation occurs)
● Peripheral vasoconstriction leading to tissue ischemia
● Extravasation at the IV site, potentially causing tissue damage
i. Continuous monitoring of the patient's heart rate, blood pressure, and cardiac rhythm
is essential during dopamine administration.
ii. Titrate the infusion rate carefully to achieve the desired hemodynamic effect while
iii. Be prepared to adjust the infusion rate or discontinue dopamine if adverse reactions
occur.
iv. Inform the patient or their family about the potential side effects and the necessity of
close monitoring during treatment.
v. Dopamine should be administered using a controlled infusion pump.
vi. Assess and document the patient's response to dopamine therapy regularly.
vii. Observe for signs of tissue ischemia, especially at the IV site.
viii. Report any significant changes in the patient's condition to the healthcare provider
promptly.
References:
Dopamine Hydrochloride Injection prescribing information. (2021). Baxter Healthcare Corporation. Retrieved
from https://www.accessdata.fda.gov
Lexi-Drugs Online, Dopamine. (2021). Lexicomp. Retrieved from https://online.lexi.com
Dopamine is a potent medication with significant hemodynamic effects and should be administered by
healthcare professionals in critical care settings. Consult the most recent and authoritative sources and
collaborate closely with healthcare providers for specific patient care.
9. ENALAPRILAT
Branded Name: Enalaprilat
Generic Name: Enalaprilat
i. Dosage: Enalaprilat is typically administered intravenously (IV) in a clinical setting,
such as a hospital. The dosage and infusion rate are highly variable and depend on the
patient's specific condition, blood pressure, and clinical needs. Healthcare providers
determine the appropriate dosage based on individual patient factors.
ii. Frequency: Enalaprilat is administered as a continuous intravenous infusion.
iii. Administration: Enalaprilat is administered intravenously by a healthcare
professional. It is usually diluted in an IV solution (such as normal saline) and
administered via a controlled infusion pump. The rate of infusion is adjusted to achieve
the desired blood pressure reduction.
b. Mechanism of Action: Enalaprilat is an angiotensin-converting enzyme (ACE) inhibitor.
It works by inhibiting the conversion of angiotensin I to angiotensin II, a potent
vasoconstrictor. By blocking this conversion, enalaprilat leads to vasodilation (widening
of blood vessels), reducing blood pressure, and reducing the workload on the heart.
c. Indication: Enalaprilat is used in the acute management of hypertension when oral
therapy is not feasible or when rapid blood pressure reduction is required. It may also be
used to improve cardiac output in certain heart failure situations.
● Elevated serum creatinine (a marker of kidney function)
● Hyperkalemia (high levels of potassium in the blood)
● Cough
● Nausea
● Angioedema (swelling of deeper layers of the skin)
● Changes in kidney function
● Neutropenia (a decrease in a type of white blood cell)
i. Continuous monitoring of the patient's blood pressure and renal function is
essential during enalaprilat administration.
ii. Titrate the infusion rate carefully to achieve the desired blood pressure reduction
while minimizing the risk of hypotension.
iii. Be alert to potential side effects such as hyperkalemia and renal function changes.
iv. Enalaprilat should be administered using a controlled infusion pump.
v. Assess and document the patient's response to enalaprilat therapy regularly.
vi. Inform the patient about potential side effects and the need for close monitoring
during treatment.
vii. Be prepared to administer other medications or interventions as needed to manage
hypotension or other adverse reactions.
References:
Enalaprilat prescribing information. (2021). West-Ward Pharmaceuticals Corp. Retrieved

from https://www.accessdata.fda.gov
Lexi-Drugs Online, Enalaprilat. (2021). Lexicomp. Retrieved from
https://online.lexi.com
10. EPHEDRINE
Branded Name: Ephedrine
Generic Name: Ephedrine
i. Dosage: The dosage of ephedrine can vary depending on the specific indication and
patient's response. It is available in various dosage forms, including oral tablets, oral
liquid preparations, and injectable solutions. Dosages typically range from 25 mg to 50
mg orally every 4 to 6 hours for the treatment of hypotension. Intravenous administration
is also possible with a recommended dose of 5 mg to 25 mg slowly injected.
ii. Frequency: The frequency of administration depends on the indication and the
patient's clinical condition. It is usually administered multiple times daily for oral forms
and as needed for intravenous use.
iii. Administration: Ephedrine is administered orally as tablets or liquid solutions. For
intravenous administration, it should be administered slowly and under the supervision of
a healthcare professional.
b. Mechanism of Action: Ephedrine is a sympathomimetic amine that acts primarily by
stimulating the release of norepinephrine and directly stimulating adrenergic receptors. It
has both alpha and beta adrenergic effects, resulting in increased heart rate, increased
cardiac output, and vasoconstriction, which can help raise blood pressure.
c. Indication: Ephedrine is used to treat hypotension (low blood pressure), especially in
situations where there is a risk of cardiovascular collapse. It may also be used as a
bronchodilator in the treatment of asthma or bronchospasm.
● Restlessness
● Tremors
● Headache
● Cardiac arrhythmias
● Palpitations
● Anxiety
● Exacerbation of preexisting heart conditions
i. Monitor the patient's blood pressure, heart rate, and cardiac rhythm regularly
during ephedrine administration.
ii. Titrate the dosage carefully to achieve the desired blood pressure response while
iii. Be cautious of potential adverse effects, especially in patients with cardiovascular
conditions.
iv. Educate the patient about potential side effects and the importance of close
v. Ephedrine should be administered with caution in patients with a history of
hypertension or heart disease.
vi. For intravenous administration, ensure that proper dilution and administration
guidelines are followed to prevent adverse reactions.
References:
Ephedrine. In: Lexi-Drugs Online. Lexi-Comp, Inc. Hudson, OH. Available at: https://online.lexi.com.
Accessed September 19, 2023.
Ephedrine sulfate injection prescribing information. (2021). Fresenius Kabi USA, LLC. Retrieved from
https://www.accessdata.fda.gov.
11. EPINEPHRINE
Branded Name: Epinephrine
Generic Name: Epinephrine
i. Dosage: Epinephrine is available in various forms, including auto-injectors, prefilled
syringes, and vials for injection. Dosages and administration methods vary depending on
the specific indication. For the treatment of anaphylaxis, a common dosage for adults and
children is 0.3 mg (0.3 mL of 1:1000 solution) injected intramuscularly into the outer
thigh. For cardiac arrest, the dosage may vary and is administered intravenously by
healthcare professionals.
patient's clinical condition. Epinephrine for anaphylaxis is typically administered as a
single dose when needed. In cardiac arrest situations, it may be administered as needed
during resuscitation efforts.
iii. Administration: Epinephrine for anaphylaxis is typically administered
intramuscularly in the lateral thigh. For cardiac arrest, it is administered intravenously by
healthcare professionals.
b. Mechanism of Action: Epinephrine is a naturally occurring hormone and
neurotransmitter. It acts on both alpha and beta adrenergic receptors in the sympathetic
nervous system. Its mechanism of action includes:
i. Increasing heart rate and myocardial contractility (beta-1 adrenergic effect).
ii. Relaxing bronchial smooth muscle (beta-2 adrenergic effect).
iii. Causing vasoconstriction in peripheral blood vessels (alpha-adrenergic effect).
iv. Redistributing blood flow to vital organs.
C. Indication:
● Epinephrine is used for various medical purposes, including:
● The emergency treatment of severe allergic reactions (anaphylaxis).
● Cardiac arrest to restore a regular heart rhythm and blood pressure.
● Bronchospasm during asthma attacks and allergic reactions.
● Treatment of life-threatening bradycardia (slow heart rate).
● Elevated blood pressure
● Palpitations
● Tremors
● Anxiety
● Headache
● Nausea
● Cerebral hemorrhage (rare)
● Pulmonary edema (rare)
i. Administer epinephrine promptly in emergency situations, such as anaphylaxis or cardiac
arrest.
ii. Monitor vital signs, cardiac rhythm, and oxygen saturation during administration.
iii. Be prepared to perform cardiopulmonary resuscitation (CPR) when using epinephrine in
cardiac arrest situations.
iv. Educate patients with severe allergies on how to use epinephrine auto-injectors for self-
administration.
v. Be cautious of potential side effects and interactions with other medications.
vi. Document the timing, dosage, and response to epinephrine administration.
vii. Follow institutional protocols and guidelines for the administration of epinephrine in
specific clinical settings.
References:
Epinephrine injection prescribing information. (2021). Amphastar Pharmaceuticals, Inc. Retrieved from
Epinephrine. In: Lexi-Drugs Online. Lexi-Comp, Inc. Hudson, OH. Available at: https://online.lexi.com.
Accessed September 19, 2023.
12. ESMOLOL
Branded Name: Brevibloc
Generic Name: Esmolol
i. Dosage: Esmolol is available in different formulations, including intravenous (IV)
solutions and is administered as an IV infusion. The dosage and infusion rate are highly
individualized and depend on the patient's specific condition and response to treatment.
Healthcare providers determine the appropriate dosage based on factors such as heart
rate, blood pressure, and the clinical situation. Common initial doses for atrial fibrillation
or atrial flutter are 0.5 mg/kg over 1 minute followed by a continuous infusion at 50-300
µg/kg/min.
ii. Frequency: Esmolol is typically administered as a continuous IV infusion and can be
titrated as needed to achieve the desired heart rate and blood pressure control.
iii. Administration: Esmolol is administered intravenously by healthcare professionals.
It should be diluted in a compatible IV solution and administered via a controlled
infusion pump.
b. Mechanism of Action: Esmolol is a selective beta-1 adrenergic receptor blocker. It acts
by competitively blocking the effects of norepinephrine and epinephrine at beta-1
receptors in the heart. This leads to a reduction in heart rate and myocardial contractility,
making it effective in controlling tachycardias and managing conditions such as atrial
fibrillation or atrial flutter.
c. Indication: Esmolol is used for the rapid control of supraventricular tachycardias

(abnormally fast heart rhythms originating above the ventricles), including atrial
fibrillation and atrial flutter, especially when there is hemodynamic instability or in
preparation for surgery.
I. Common side effects may include:
● Headache
● Dizziness
● Heart block
● Bronchospasm (in individuals with preexisting lung conditions)
● Hypoglycemia (low blood sugar)
i. Continuous monitoring of the patient's heart rate, blood pressure, and cardiac
rhythm is essential during esmolol administration.
ii. Titrate the infusion rate carefully to achieve the desired heart rate control while
iii. Be cautious of potential bradycardia and hypotension, especially in patients with
compromised cardiac function.
iv. Educate the patient about potential side effects and the importance of close
v. Esmolol should be administered using a controlled infusion pump.
vi. Assess and document the patient's response to esmolol therapy regularly.
vii. Be prepared to discontinue the infusion or administer antidotes in case of severe
adverse reactions.
References:
Brevibloc (esmolol hydrochloride) prescribing information. (2021). Baxter Healthcare
Corporation. Retrieved from https://www.accessdata.fda.gov.
Lexi-Drugs Online, Esmolol. (2021). Lexicomp. Retrieved from https://online.lexi.com.
13. HALDOL
Branded Name: Haldol
Generic Name: Haloperidol
i. Dosage: The dosage of Haldol (haloperidol) can vary widely depending on the specific
condition being treated, the patient's age, and individual response to the medication. It is
available in oral tablets, oral liquid solutions, and injectable forms. Dosages are typically
started low and gradually increased as needed. Common initial doses for adults may
range from 0.5 mg to 5 mg orally, 2 to 3 times daily.
condition and the specific psychiatric disorder being treated. It is usually administered 2
to 3 times daily for oral forms. Injectable forms may be administered less frequently.
iii. Administration: Haldol is available in both oral and injectable forms. Oral tablets or
liquid solutions are taken by mouth. Injectable Haldol is typically administered
intramuscularly (IM) or intravenously (IV) by healthcare professionals.
b. Mechanism of Action: Haloperidol is a first-generation antipsychotic medication that
works by blocking dopamine receptors (especially D2 receptors) in the brain. By
inhibiting excessive dopamine activity, it helps to reduce the positive symptoms of
psychotic disorders (such as hallucinations and delusions) and can also be used to
manage various behavioral disturbances.
c. Indication: Haldol (haloperidol) is indicated for the management of various psychiatric
conditions, including schizophrenia, acute psychotic episodes, and other psychotic
disorders. It can also be used to control severe behavioral problems in patients with
Tourette's syndrome and severe agitation in the hospital setting.
● Drowsiness or sedation
● Extrapyramidal symptoms (e.g., tremors, muscle stiffness, restlessness)
● Dry mouth
● Blurred vision
● Constipation
● Dizziness
● Tardive dyskinesia (involuntary movements)
● Neuroleptic malignant syndrome (a rare but serious reaction)
● Prolonged QT interval on ECG
● Low blood pressure
● Seizures
i. Monitor the patient for extrapyramidal symptoms (EPS), especially during the
initial phase of treatment.
ii. Assess and document the patient's mental status, behavior, and response to
haloperidol therapy.
iii. Be aware of potential side effects and adverse reactions, especially tardive
dyskinesia and neuroleptic malignant syndrome.
iv. Educate the patient and their family about the medication, its purpose, and
potential side effects.
v. Administer the medication as prescribed and observe for any signs of improvement
or worsening of symptoms.
vi. Ensure appropriate monitoring of cardiac parameters, especially in patients with
cardiovascular risk factors.
vii. Follow institutional protocols for the use of haloperidol in specific clinical settings.
References:
Haldol (haloperidol) prescribing information. (2021). Ortho-McNeil-Janssen Pharmaceuticals, Inc.

Retrieved from https://www.accessdata.fda.gov.
Lexi-Drugs Online, Haloperidol. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Haldol (haloperidol) is a potent antipsychotic medication used to manage various psychiatric disorders.
It should be administered under the supervision of healthcare professionals with expertise in psychiatric
care. Consult the most recent and authoritative sources and collaborate closely with healthcare providers
for specific patient care.
14. HYDRALAZINE
Branded Name: There are various branded formulations of hydralazine, including
Apresoline.
Generic Name: Hydralazine
i. Dosage: The dosage of hydralazine can vary depending on the specific indication,
patient age, and response to treatment. It is available in oral tablet and injectable forms.
Common dosages for adults may include 10 mg to 50 mg orally, 3 to 4 times daily.
condition and the specific indication. It is typically administered 3 to 4 times daily for
oral forms.
iii. Administration: Hydralazine is administered orally as tablets. Injectable forms are
administered intravenously (IV) or intramuscularly (IM) by healthcare professionals.
b. Mechanism of Action: Hydralazine is a vasodilator that works by relaxing the smooth
muscle in the blood vessels, particularly the arterioles. It causes vasodilation, leading to a
reduction in systemic vascular resistance and a decrease in blood pressure. The exact
mechanism of hydralazine's vasodilatory effect is not fully understood.
c. Indication: Hydralazine is used to treat hypertension (high blood pressure) and
hypertensive crises. It may also be used in combination with other medications to manage
heart failure and improve cardiac function.
● Headache
● Reflex tachycardia (increased heart rate)
● Flushing of the skin
● Gastrointestinal upset
● Lupus-like syndrome (rare immune reaction)
● Blood cell disorders
● Palpitations
● Chest pain
● Monitor the patient's blood pressure regularly during hydralazine therapy.
● Educate the patient about potential side effects, especially reflex tachycardia, and
the importance of compliance with the prescribed regimen.
● Be cautious with patients who have a history of systemic lupus erythematosus
(SLE) or other autoimmune disorders, as hydralazine can trigger a lupus-like
syndrome.
● Monitor for signs of hypotension, especially when starting therapy or adjusting the
dosage.
● Administer the medication as prescribed and ensure the patient's understanding of
the treatment plan.
● Assess and document the patient's response to hydralazine therapy, including
changes in blood pressure and overall well-being.
References:
Hydralazine prescribing information. (2021). Teva Pharmaceuticals USA, Inc. Retrieved from
Lexi-Drugs Online, Hydralazine. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Hydralazine is an antihypertensive medication used to lower blood pressure. It should be administered as
directed by a healthcare provider and monitored closely, especially when initiating therapy. Consult the most
recent and authoritative sources and collaborate closely with healthcare providers for specific patient care.
15. ISOPROTERENOL
Branded Name: Isuprel (Isoproterenol is also available under other brand names.)
Generic Name: Isoproterenol
i. Dosage: The dosage of isoproterenol can vary widely depending on the specific
indication, patient age, and clinical response. It is available in injectable form. Dosages
are typically determined by healthcare providers based on the patient's heart rate, blood
pressure, and clinical condition. The usual starting dose for adults with bradycardia is 1 to
2 mcg/minute via continuous intravenous (IV) infusion, which can be titrated as needed.
ii. Frequency: Isoproterenol is administered as a continuous IV infusion, and the
infusion rate is adjusted based on the patient's response.
iii. Administration: Isoproterenol is administered intravenously by healthcare professionals
using an infusion pump.
b. Mechanism of Action: Isoproterenol is a synthetic catecholamine that acts primarily as a
non-selective beta-adrenergic receptor agonist. It stimulates both beta-1 and beta-2
adrenergic receptors in the heart and lungs. Its mechanism of action includes:
i. Increasing heart rate (positive chronotropic effect).
ii. Increasing myocardial contractility (positive inotropic effect).
iii. Relaxing bronchial smooth muscle (bronchodilation).
iv. Indication: Isoproterenol is used in emergency situations to treat bradycardia (slow
heart rate), heart block, and certain cases of cardiac arrest. It is also used as a
bronchodilator in some respiratory conditions.
c. Side Effects/Adverse Reactions:

● Palpitations
● Tremors
● Anxiety
● Headache
● Nausea
● Hypokalemia (low potassium levels)
i. Continuous monitoring of the patient's heart rate, blood pressure, and cardiac rhythm is
essential during isoproterenol administration.
ii. Titrate the infusion rate carefully to achieve the desired heart rate and hemodynamic
effects while minimizing side effects.
iii. Be cautious of potential adverse reactions, especially arrhythmias and myocardial
ischemia.
iv. Administer the medication using a controlled infusion pump.
v. Educate the patient and their family about potential side effects and the need for close
vi. Be prepared to discontinue the infusion or administer antidotes in case of severe adverse
reactions.
References:
Isoproterenol injection prescribing information. (2021). Mylan Institutional LLC. Retrieved from
Lexi-Drugs Online, Isoproterenol. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Isoproterenol is a potent medication used in critical care and emergency settings. It should be administered by
healthcare professionals with expertise in cardiac care and closely monitored during its use. Consult the most
recent and authoritative sources and collaborate closely with healthcare providers for specific patient care.
16. LABETALOL
Branded Name: Labetalol is available under various brand names, including Trandate
and Normodyne.
Generic Name: Labetalol
i. Dosage: The dosage of labetalol can vary depending on the specific indication, patient
age, and clinical response. It is available in oral tablet and injectable forms. Dosages are
typically determined by healthcare providers based on the patient's blood pressure and
clinical condition. Common dosages for adults with hypertension may range from 100
mg to 200 mg orally, 2 times daily. Intravenous dosages for hypertensive emergencies
may start at 20 mg, with repeat doses as needed.
ii. Frequency: Labetalol is typically administered 2 times daily for oral forms. In
hypertensive emergencies, the intravenous form may be administered as needed.
iii. Administration: Labetalol is available in both oral and injectable forms. Oral tablets
are taken by mouth. Injectable labetalol is administered intravenously by healthcare
professionals.
b. Mechanism of Action: Labetalol is a non-selective beta-blocker with alpha-1 blocking

activity. Its mechanism of action includes:
i. Blockade of beta-1 adrenergic receptors in the heart, leading to decreased heart rate
and myocardial contractility.
ii. Blockade of beta-2 adrenergic receptors in the lungs, resulting in bronchial
constriction.
iii. Blockade of alpha-1 adrenergic receptors in the peripheral vasculature, leading to
vasodilation and reduced blood pressure.
c. Indication: Labetalol is used to treat hypertension (high blood pressure) and hypertensive
emergencies. It can also be used to manage certain heart conditions.

I. Common side effects may include:
● Dizziness
● Fatigue
● Nausea
● Headache
● Orthostatic hypotension (drop in blood pressure upon standing)
● Heart block
● Hepatic dysfunction
during labetalol therapy.
ii. Educate the patient about potential side effects, especially dizziness and orthostatic
hypotension, and advise them to rise slowly from sitting or lying positions.
iii. Be cautious with patients who have a history of asthma or other lung conditions, as
labetalol can cause bronchospasm.
iv. Administer the medication as prescribed and ensure the patient's understanding of
the treatment plan.
v. Assess and document the patient's response to labetalol therapy, including changes
in blood pressure and overall well-being.
vi. Follow institutional protocols for the use of labetalol in specific clinical settings.
References:
Labetalol prescribing information. (2021). Par Pharmaceutical. Retrieved from https://www.accessdata.fda.gov.
Lexi-Drugs Online, Labetalol. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Labetalol is a medication commonly used to manage hypertension and hypertensive emergencies. It should be
administered under the supervision of healthcare professionals and monitored closely, especially when initiating
therapy. Consult the most recent and authoritative sources and collaborate closely with healthcare providers for
specific patient care.
17. LEVETIRACETAM
Branded Name: Labetalol is available under various brand names, including Trandate
and Normodyne.
Generic Name: Labetalol
i. Dosage: The dosage of labetalol can vary depending on the specific indication, patient
age, and clinical response. It is available in oral tablet and injectable forms. Dosages are
typically determined by healthcare providers based on the patient's blood pressure and
clinical condition. Common dosages for adults with hypertension may range from 100
mg to 200 mg orally, 2 times daily. Intravenous dosages for hypertensive emergencies
may start at 20 mg, with repeat doses as needed.
ii. Frequency: Labetalol is typically administered 2 times daily for oral forms. In
hypertensive emergencies, the intravenous form may be administered as needed.
iii. Administration: Labetalol is available in both oral and injectable forms. Oral tablets
are taken by mouth. Injectable labetalol is administered intravenously by healthcare
professionals.
b. Mechanism of Action: Labetalol is a non-selective beta-blocker with alpha-1 blocking

activity. Its mechanism of action includes:
i. Blockade of beta-1 adrenergic receptors in the heart, leading to decreased heart rate
and myocardial contractility.
ii. Blockade of beta-2 adrenergic receptors in the lungs, resulting in bronchial
constriction.
iii. Blockade of alpha-1 adrenergic receptors in the peripheral vasculature, leading to
vasodilation and reduced blood pressure.
c. Indication: Labetalol is used to treat hypertension (high blood pressure) and hypertensive
emergencies. It can also be used to manage certain heart conditions.

● Dizziness
● Fatigue
● Nausea
● Headache
● Orthostatic hypotension (drop in blood pressure upon standing)
● Heart block
during labetalol therapy.
ii. Educate the patient about potential side effects, especially dizziness and orthostatic
hypotension, and advise them to rise slowly from sitting or lying positions.
iii. Be cautious with patients who have a history of asthma or other lung conditions, as
labetalol can cause bronchospasm.
iv. Administer the medication as prescribed and ensure the patient's understanding of
the treatment plan.
v. Assess and document the patient's response to labetalol therapy, including changes
in blood pressure and overall well-being.
vi. Follow institutional protocols for the use of labetalol in specific clinical settings.
References:
Labetalol prescribing information. (2021). Par Pharmaceutical. Retrieved from https://www.accessdata.fda.gov.
Lexi-Drugs Online, Labetalol. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Labetalol is a medication commonly used to manage hypertension and hypertensive emergencies. It should be
administered under the supervision of healthcare professionals and monitored closely, especially when initiating
therapy. Consult the most recent and authoritative sources and collaborate closely with healthcare providers for
18. LIDOCAINE
Branded Name: Lidocaine is available under various brand names, including Xylocaine.
Generic Name: Lidocaine
i. Dosage: The dosage of lidocaine can vary widely depending on the specific indication,
patient age, and the form of administration (topical or injectable). Lidocaine is available
in various forms, including topical creams, gels, ointments, and injectable solutions.
Dosages are typically determined by healthcare providers based on the patient's condition
and the specific procedure or use. For instance, the dose for local anesthesia may range
from 1% to 2% lidocaine, applied topically or injected as needed.
patient's clinical condition. It can vary from one-time use for minor procedures to
continuous infusions for certain cardiac arrhythmias.
iii. Administration: Lidocaine can be administered through various routes:
● Topical: Applied directly to the skin or mucous membranes.

● Injectable: Administered intravenously (IV), intramuscularly (IM), or
subcutaneously (SC) by healthcare professionals.
● Epidural: Administered into the epidural space for regional
anesthesia.
b. Mechanism of Action: Lidocaine is a local anesthetic that works by blocking nerve
signals in the body. It does this by inhibiting the influx of sodium ions into nerve cells,
which prevents the generation and propagation of action potentials. This blockade of
nerve conduction leads to temporary loss of sensation in the affected area.
c. Indication: Lidocaine is used for various purposes, including:
i. Local anesthesia for minor surgical procedures and dental work.
ii. Topical relief of itching, burning, and pain associated with skin conditions.
iii. Treatment of certain cardiac arrhythmias (intravenous lidocaine).
iv. Nerve block for regional anesthesia, such as epidural anesthesia during labor.
● Localized skin reactions (topical use)
● Nausea or vomiting (intravenous use)
● Dizziness or lightheadedness
● Headache
● Drowsiness
● Seizures (with high systemic concentrations)
● Cardiac arrhythmias (with high systemic concentrations)
i. Monitor the patient for local adverse reactions (e.g., skin irritation) when lidocaine
is applied topically.
ii. When administering intravenous lidocaine, closely monitor the patient's cardiac
rhythm, blood pressure, and neurological status.
iii. Be aware of potential systemic absorption and toxicity, especially with excessive
doses or rapid administration.
iv. Educate the patient about potential side effects and the importance of reporting any
unusual sensations or adverse reactions.
v. Administer the medication as prescribed, following appropriate dilution and
administration guidelines.
vi. Assess and document the patient's response to lidocaine therapy, especially during
procedures requiring anesthesia.
References:
Xylocaine (lidocaine) prescribing information. (2021). AstraZeneca Pharmaceuticals LP. Retrieved from
Lexi-Drugs Online, Lidocaine. (2021). Lexicomp. Retrieved from https://online.lexi.com.\
Lidocaine is a versatile medication used for local anesthesia, pain relief, and the management of certain cardiac
arrhythmias. It should be administered as directed by a healthcare provider and monitored closely for
effectiveness and potential side effects. Consult the most recent and authoritative sources and collaborate
closely with healthcare providers for specific patient care.
19. MANNITOL
Branded Name: Lidocaine is available under various brand names, including Xylocaine.
Generic Name: Lidocaine
i. Dosage: The dosage of lidocaine can vary widely depending on the specific indication,
patient age, and the form of administration (topical or injectable). Lidocaine is available
in various forms, including topical creams, gels, ointments, and injectable solutions.
Dosages are typically determined by healthcare providers based on the patient's condition
and the specific procedure or use. For instance, the dose for local anesthesia may range
from 1% to 2% lidocaine, applied topically or injected as needed.
patient's clinical condition. It can vary from one-time use for minor procedures to
continuous infusions for certain cardiac arrhythmias.
iii. Administration: Lidocaine can be administered through various routes:
● Topical: Applied directly to the skin or mucous membranes.
● Epidural: Administered into the epidural space for regional anesthesia.
b. Mechanism of Action: Lidocaine is a local anesthetic that works by blocking nerve
signals in the body. It does this by inhibiting the influx of sodium ions into nerve cells,
which prevents the generation and propagation of action potentials. This blockade of
nerve conduction leads to temporary loss of sensation in the affected area.
c. Indication: Lidocaine is used for various purposes, including:
i. Local anesthesia for minor surgical procedures and dental work.
ii. Topical relief of itching, burning, and pain associated with skin conditions.
iii. Treatment of certain cardiac arrhythmias (intravenous lidocaine).
iv. Nerve block for regional anesthesia, such as epidural anesthesia during labor.
● Localized skin reactions (topical use)
● Nausea or vomiting (intravenous use)
● Headache
● Drowsiness
● Seizures (with high systemic concentrations)
● Cardiac arrhythmias (with high systemic concentrations)
i. Monitor the patient for local adverse reactions (e.g., skin irritation) when lidocaine
is applied topically.
ii. When administering intravenous lidocaine, closely monitor the patient's cardiac
rhythm, blood pressure, and neurological status.
iii. Be aware of potential systemic absorption and toxicity, especially with excessive
doses or rapid administration.
iv. Educate the patient about potential side effects and the importance of reporting any
unusual sensations or adverse reactions.
vi. Assess and document the patient's response to lidocaine therapy, especially during
procedures requiring anesthesia.
References:
Xylocaine (lidocaine) prescribing information. (2021). AstraZeneca Pharmaceuticals LP. Retrieved from
Lexi-Drugs Online, Lidocaine. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Lidocaine is a versatile medication used for local anesthesia, pain relief, and the management of certain cardiac
arrhythmias. It should be administered as directed by a healthcare provider and monitored closely for
effectiveness and potential side effects. Consult the most recent and authoritative sources and collaborate
20. MILRINONE
Branded Name: Milrinone is available under various brand names, including Primacor.
Generic Name: Milrinone
i. Dosage: The dosage of milrinone can vary depending on the specific indication, patient
weight, and clinical condition. Milrinone is available in intravenous (IV) form. Dosages
are typically determined by healthcare providers based on the patient's cardiac status and
response to treatment. Common dosages for adults with congestive heart failure may
involve an initial loading dose followed by a continuous infusion, with loading doses
ranging from 50 to 75 mcg/kg administered over 10 minutes, and maintenance infusion
rates ranging from 0.375 to 0.75 mcg/kg/min.
i. Frequency: Milrinone is administered as a continuous IV infusion, and the infusion
rate is adjusted based on the patient's response and tolerance.
ii. Administration: Milrinone is administered intravenously by healthcare professionals
using an infusion pump. It should be diluted in a compatible IV solution before
administration.
b. Mechanism of Action: Milrinone is a phosphodiesterase III inhibitor. It works by

increasing intracellular levels of cyclic adenosine monophosphate (cAMP) within cardiac
muscle cells. This leads to increased contractility (inotropy) of the heart muscle, as well
as vasodilation. Milrinone's dual action on both inotropy and vasodilation makes it useful
in the treatment of heart failure.
c. Indication: Milrinone is indicated for the short-term treatment of acute decompensated
heart failure in patients who do not respond to conventional therapy. It is often used in
critical care settings.
● Headache
● Thrombocytopenia (reduced platelet count)
● Serious ventricular arrhythmias
● Hypokalemia (low potassium levels)
● Hypersensitivity reactions
i. Continuous monitoring of the patient's cardiac status, blood pressure, and ECG is
essential during milrinone therapy.
ii. Administer milrinone using a controlled infusion pump and follow institutional
guidelines for its proper dilution and administration.
iii. Educate the patient about potential side effects, especially hypotension and
arrhythmias, and the importance of close monitoring during treatment.
iv. Be cautious with patients who have a history of ventricular arrhythmias, as
milrinone can increase the risk.
v. Assess and document the patient's response to milrinone therapy, including
changes in cardiac function and blood pressure.
References:
Primacor (milrinone) prescribing information. (2021). Sanofi-Aventis U.S. LLC. Retrieved from
Lexi-Drugs Online, Milrinone. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Milrinone is a medication used for the short-term treatment of acute decompensated heart failure, primarily in
critical care settings. It should be administered by healthcare professionals with expertise in cardiac care and
closely monitored during its use. Consult the most recent and authoritative sources and collaborate closely with
healthcare providers for specific patient care.
21. MORPHINE
Branded Name: Morphine is available under various brand names, including MS
Contin, Kadian, and Avinza.
Generic Name: Morphine
i. Dosage: The dosage of morphine can vary widely depending on the specific indication,
patient's pain intensity, and route of administration. Morphine is available in various
forms, including immediate-release tablets, extended-release capsules, and injectable
solutions. Dosages are typically determined by healthcare providers based on the patient's
pain level and response to treatment. Common dosages for adults with moderate to severe
pain may range from 5 mg to 30 mg orally every 4 to 6 hours, as needed.
ii. Frequency: The frequency of morphine administration depends on the patient's pain
intensity and the specific formulation being used. Immediate-release forms are typically
taken every 4 to 6 hours, while extended-release forms are taken less frequently.
iii. Administration: Morphine can be administered through various routes:
● Oral: Immediate-release and extended-release forms are taken by mouth.
● Epidural or intrathecal: Administered into the epidural or intrathecal space for pain
management in specific clinical situations.
b. Mechanism of Action: Morphine is a potent opioid analgesic. It works by binding to
mu-opioid receptors in the central nervous system (CNS). This binding reduces the
perception of pain and alters the emotional response to pain. Morphine also has a
depressive effect on the CNS, leading to drowsiness and sedation.
c. ndication: Morphine is primarily used for the management of moderate to severe pain,
such as pain following surgery, injury, or in patients with chronic pain conditions. It is
also used in palliative care for the relief of severe pain associated with terminal illnesses.
● Drowsiness or sedation
● Constipation
● Respiratory depression (especially with high doses)
● Confusion or delirium
● Opioid dependence and addiction (with prolonged use)
i. Monitor the patient's pain intensity and response to morphine therapy regularly.
ii. Assess and document the patient's vital signs, especially respiratory rate and blood
pressure, during morphine administration.
iii. Educate the patient about potential side effects, especially the risk of respiratory
depression and the need for close monitoring during treatment.
iv. Be cautious with patients who have a history of opioid dependence or addiction, as
morphine can be habit-forming.
administration guidelines for injectable forms.
vi. Evaluate and document the patient's response to morphine therapy, including pain
relief and side effects.
References:
MS Contin (morphine sulfate) prescribing information. (2021). Purdue Pharma L.P. Retrieved from
Lexi-Drugs Online, Morphine. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Morphine is a potent opioid medication used primarily for pain management in various clinical settings. It
should be administered and monitored with caution due to its potential for respiratory depression and the risk of
dependence. Consult the most recent and authoritative sources and collaborate closely with healthcare providers
for specific patient care.
22. NICARDIPINE
Branded Name: Nicardipine is available under various brand names, including Cardene.
Generic Name: Nicardipine
i. Dosage: The dosage of nicardipine can vary depending on the specific indication,
patient's blood pressure, and clinical response. Nicardipine is available in intravenous
(IV) form. Dosages are typically determined by healthcare providers based on the
patient's blood pressure and the specific clinical situation. Common dosages for adults
with hypertension or hypertensive emergencies may involve an initial IV bolus dose
followed by a continuous infusion. Initial bolus doses may range from 20 mg to 30 mg,
followed by continuous infusion rates ranging from 1.25 mg/hour to 15 mg/hour.
ii. Frequency: Nicardipine is administered as a continuous IV infusion, and the infusion
rate is adjusted based on the patient's blood pressure response.
iii. Administration: Nicardipine is administered intravenously by healthcare
professionals using an infusion pump. It should be prepared and diluted as per
institutional protocols.
b. Mechanism of Action: Nicardipine is a calcium channel blocker of the dihydropyridine
class. It works by inhibiting the influx of calcium ions into vascular smooth muscle cells
and myocardial cells. By blocking calcium channels, nicardipine reduces calcium-
dependent contraction of smooth muscle in blood vessels, leading to vasodilation and a
decrease in systemic vascular resistance. This results in a reduction in blood pressure.
c. Indication: Nicardipine is primarily used for the treatment of hypertension (high blood
pressure) and hypertensive emergencies when rapid blood pressure control is necessary.
It is often used in critical care settings.
● Headache
● Nausea
● Arrhythmias
i. Monitor the patient's blood pressure and heart rate continuously during nicardipine
therapy.
ii. Assess and document the patient's response to treatment, including changes in
blood pressure and heart rate.
iii. Be cautious with patients who have pre-existing heart conditions, as nicardipine
can affect cardiac function.
iv. Educate the patient about potential side effects, especially hypotension, and the
importance of close monitoring during treatment.
vi. Ensure that the infusion pump is functioning properly and that the infusion site
remains patent.
References:
Cardene (nicardipine hydrochloride) prescribing information. (2021). Baxter Healthcare Corporation. Retrieved
from https://www.accessdata.fda.gov.
Lexi-Drugs Online, Nicardipine. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Nicardipine is a calcium channel blocker used for the management of hypertension and hypertensive
emergencies. It should be administered under the supervision of healthcare professionals and closely monitored,
especially when initiating therapy. Consult the most recent and authoritative sources and collaborate closely
with healthcare providers for specific patient care.
23. NITROGLYCERIN
Branded Name: Nitrostat, Nitro-Dur, and Nitro-Bid.
Generic Name: Nitroglycerin
i. Dosage: The dosage of nitroglycerin can vary depending on the specific indication,
patient's response, and form of administration. Nitroglycerin is available in various
forms, including sublingual tablets, topical patches, and intravenous (IV) solutions.
Dosages are typically determined by healthcare providers based on the patient's
condition. Common dosages for adults with angina may include sublingual tablets of 0.3
mg to 0.6 mg as needed for acute chest pain. For IV infusion, the initial rate may be 5 to
10 mcg/min, with gradual titration as needed.
ii. Frequency: The frequency of nitroglycerin administration depends on the patient's
angina symptoms and the specific formulation being used. Sublingual tablets can be
taken as needed during angina attacks. IV infusions may be continuous or intermittent, as
determined by the healthcare provider.
iii. Administration: Nitroglycerin can be administered through various routes:
● Sublingual: Tablets are placed under the tongue and allowed to dissolve.
● Topical: Transdermal patches are applied to the skin.
● Intravenous: Administered intravenously by healthcare professionals.
b. Mechanism of Action: Nitroglycerin is a vasodilator that works by releasing nitric oxide

(NO) in vascular smooth muscle. Nitric oxide relaxes blood vessels, leading to
vasodilation and increased blood flow. This mechanism reduces cardiac oxygen demand
and relieves angina symptoms by decreasing preload and afterload on the heart.
c. Indication: Nitroglycerin is primarily used for the management and relief of angina
pectoris (chest pain or discomfort) caused by coronary artery disease. It is also used in
emergency settings to treat or prevent angina attacks.
● Headache
● Tachycardia (rapid heart rate)
● Methemoglobinemia (rare, with high doses)
● Reflex tachycardia (with rapid withdrawal)
i. Educate the patient on proper sublingual administration techniques for
nitroglycerin tablets, including how to take them during an angina attack.
ii. Monitor the patient's blood pressure, heart rate, and symptoms before and after
nitroglycerin administration.
iii. Be aware of the potential for tolerance to nitroglycerin with prolonged use.
iv. Instruct patients to store nitroglycerin tablets in their original containers, away
from heat and light.
v. Administer IV nitroglycerin using a controlled infusion pump and follow
institutional guidelines for proper dilution and administration.
vi. Assess and document the patient's response to nitroglycerin therapy, including
symptom relief and any side effects.
References:
Nitrostat (nitroglycerin) prescribing information. (2021). Pfizer Inc. Retrieved from
Lexi-Drugs Online, Nitroglycerin. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Nitroglycerin is a medication commonly used for the management of angina pectoris and acute relief of angina
symptoms. It should be administered and monitored carefully, especially in patients with known coronary artery
disease. Consult the most recent and authoritative sources and collaborate closely with healthcare providers for
24. NITROPRUSSIDE
Branded Name: Nitropress.
Generic Name: Sodium Nitroprusside
i. Dosage: The dosage of nitroprusside can vary depending on the specific indication,
patient's blood pressure, and clinical response. Nitroprusside is available as an
intravenous (IV) solution. Dosages are typically determined by healthcare providers
based on the patient's blood pressure and the specific clinical situation. Common dosages
for adults with hypertensive emergencies may involve initial IV infusion rates ranging
from 0.3 mcg/kg/min to 10 mcg/kg/min, with titration as needed.
ii. Frequency: Nitroprusside is administered as a continuous IV infusion, and the
infusion rate is adjusted based on the patient's blood pressure response.
iii. Administration: Nitroprusside is administered intravenously by healthcare
b. Mechanism of Action: Nitroprusside is a potent vasodilator that acts directly on vascular

smooth muscle cells. It releases nitric oxide (NO) in the blood vessels, leading to
vasodilation and a decrease in systemic vascular resistance. This results in a rapid
reduction in blood pressure.
c. Indication: Nitroprusside is primarily used for the treatment of hypertensive emergencies
when rapid blood pressure control is necessary. It is often used in critical care settings.
● Cyanide toxicity (rare, with prolonged high-dose use)
● Thiocyanate toxicity (rare, with prolonged high-dose use)
● Reflex tachycardia (rapid heart rate)
● Cyanide toxicity symptoms (e.g., confusion, metabolic acidosis)
● Thiocyanate toxicity symptoms (e.g., confusion, visual disturbances)
● Monitor the patient's blood pressure continuously during nitroprusside therapy.
● Assess and document the patient's response to treatment, including changes in
● Be cautious with patients who have known hypersensitivity to nitroprusside or a
history of cyanide toxicity.
● Educate the patient about potential side effects and the importance of close
● Administer the medication as prescribed, following appropriate dilution and
● Ensure that the infusion pump is functioning properly and that the infusion site
remains patent.
References:
Nitropress (sodium nitroprusside) prescribing information. (2021). Hospira, Inc. Retrieved from
Lexi-Drugs Online, Sodium Nitroprusside. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Sodium nitroprusside is a potent medication used for the treatment of hypertensive emergencies when rapid
blood pressure reduction is required. It should be administered and monitored under the supervision of
healthcare professionals, especially in critical care settings. Consult the most recent and authoritative sources
and collaborate closely with healthcare providers for specific patient care.
25. NOREPINEPHRINE
Branded Name: Levophed.
Generic Name: Norepinephrine
i. Dosage: The dosage of norepinephrine can vary widely depending on the specific
indication, patient's blood pressure, and clinical response. Norepinephrine is available as
an intravenous (IV) solution. Dosages are typically determined by healthcare providers
based on the patient's blood pressure and the specific clinical situation. Common dosages
for adults with severe hypotension or shock may involve initial IV infusion rates ranging
from 0.1 mcg/kg/min to 0.5 mcg/kg/min, with titration as needed.
ii. Frequency: Norepinephrine is administered as a continuous IV infusion, and the
infusion rate is adjusted based on the patient's blood pressure response.
iii. Administration: Norepinephrine is administered intravenously by healthcare
b. Mechanism of Action: Norepinephrine is a potent sympathomimetic medication that acts

primarily as an alpha-adrenergic agonist. It stimulates alpha-adrenergic receptors on
vascular smooth muscle, causing vasoconstriction. This results in an increase in systemic
vascular resistance and an elevation in blood pressure. Norepinephrine also has some
beta-adrenergic activity, which can lead to increased heart rate and cardiac output.
c. Indication: Norepinephrine is primarily used for the treatment of severe hypotension and
shock, including septic shock, cardiogenic shock, and hypovolemic shock. It is often used
in critical care settings.

● Arrhythmias
● Extravasation (infiltration of the IV site)
● Decreased peripheral blood flow (cool extremities)
● Tissue necrosis (if extravasation occurs)
● Hypotension (if the infusion is abruptly stopped)
● Cerebral hemorrhage (rare)
● Continuously monitor the patient's blood pressure, heart rate, and signs of tissue
perfusion during norepinephrine therapy.
● Assess and document the patient's response to treatment, including changes in
● Be cautious with patients who have known hypersensitivity to norepinephrine or a
history of severe hypertension.
● Educate the patient and their family about potential side effects and the importance
of close monitoring during treatment.
● Ensure that the infusion pump is functioning properly and that the infusion site
remains patent.
References:
Levophed (norepinephrine bitartrate) prescribing information. (2021). Sanofi-Aventis U.S. LLC. Retrieved
Lexi-Drugs Online, Norepinephrine. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Norepinephrine is a potent medication used for the treatment of severe hypotension and shock. It should be
administered and monitored under the supervision of healthcare professionals, especially in critical care
settings. Consult the most recent and authoritative sources and collaborate closely with healthcare providers for
26. PHENTOLAMINE
Branded Name: Phentolamine is available under various brand names, including
Regitine and OraVerse.
Generic Name: Phentolamine
i. Dosage: The dosage of phentolamine can vary depending on the specific indication and
clinical response. Phentolamine is available in injectable form. Dosages are typically
determined by healthcare providers based on the patient's condition. Common dosages
for adults with the reversal of soft tissue anesthesia (e.g., from local dental procedures)
may involve intramuscular (IM) or subcutaneous (SC) injection of 5 to 10 mg.
ii. Frequency: The frequency of phentolamine administration depends on the specific
clinical situation and the need for anesthesia reversal.
iii. Administration: Phentolamine is administered by healthcare professionals through

IM or SC injection. It is used for the reversal of soft tissue anesthesia.
b. Mechanism of Action: Phentolamine is a non-selective alpha-adrenergic receptor

antagonist. It competitively blocks the effects of norepinephrine and other alpha-
adrenergic agonists on alpha-1 and alpha-2 adrenergic receptors. By blocking alpha-1
receptors on smooth muscle cells in blood vessels, phentolamine induces vasodilation,
leading to an increase in blood flow and a decrease in blood pressure. This mechanism is
useful for reversing the vasoconstrictive effects of local anesthetics.
c. Indication: Phentolamine is primarily used for the reversal of soft tissue anesthesia
induced by local dental procedures, particularly when vasoconstriction caused by local
anesthetics needs to be rapidly reversed.
● Palpitations (rapid heartbeat)
● Dizziness
● Arrhythmias
● Angina (chest pain)
● Tissue necrosis (if extravasation occurs)
● Administer phentolamine as directed by the healthcare provider, particularly when
anesthesia reversal is required.
● Continuously monitor the patient's vital signs, including blood pressure and heart
rate, during and after phentolamine administration.
● Educate the patient about potential side effects and the need for close monitoring
during anesthesia reversal.
● Be cautious with patients who have known hypersensitivity to phentolamine.
● Ensure that the injection site is monitored for signs of extravasation, as
phentolamine can cause tissue necrosis if it infiltrates.
References:
OraVerse (phentolamine mesylate) prescribing information. (2021). Novalar Pharmaceuticals, Inc. Retrieved
Lexi-Drugs Online, Phentolamine. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Phentolamine is primarily used for the reversal of soft tissue anesthesia induced by local dental procedures. It
should be administered under the supervision of healthcare professionals when needed for anesthesia reversal.
Consult the most recent and authoritative sources and collaborate closely with healthcare providers for specific
patient care.
27. PHENYLEPHRINE
Branded Name: Neo-Synephrine and Sudafed PE.
Generic Name: Phenylephrine
i. Dosage: The dosage of phenylephrine can vary depending on the specific indication
and formulation (e.g., oral, nasal, ophthalmic). Phenylephrine is available in multiple
forms, including oral tablets, nasal sprays, and ophthalmic drops. Dosages are typically
determined by healthcare providers based on the patient's age and condition. Common
dosages for adults with nasal congestion may involve intranasal administration of 2 to 3
sprays (10 to 15 mg/mL) every 4 hours.
ii. Frequency: The frequency of phenylephrine administration depends on the specific
product and the patient's symptoms. Nasal sprays are often used every 4 to 6 hours as
needed for congestion.
iii. Administration: Phenylephrine is administered through various routes:
● Oral: Tablets or capsules are taken by mouth.
● Nasal: Nasal sprays are administered intranasally.
● Ophthalmic: Ophthalmic drops are instilled into the eyes.
b. Mechanism of Action: Phenylephrine is a sympathomimetic medication that acts as a
selective alpha-adrenergic receptor agonist. It stimulates alpha-1 adrenergic receptors on
the smooth muscle of blood vessels and nasal passages, leading to vasoconstriction and a
reduction in nasal congestion. Phenylephrine's action helps relieve congestion and
increase blood pressure when used as a decongestant.
c. Indication: Phenylephrine is primarily used as a decongestant to relieve nasal congestion
associated with various upper respiratory conditions, such as the common cold, allergies,
or sinusitis. It is also used in ophthalmic formulations to dilate the pupil during eye
examinations.
● Nervousness or restlessness
● Increased heart rate
● Insomnia
● Dry mouth
● Severe hypertension (high blood pressure)
● Arrhythmias
● Palpitations
● Severe headache
i. Administer phenylephrine as directed by the healthcare provider, particularly when
treating nasal congestion.
ii. Monitor the patient's vital signs, especially blood pressure and heart rate, during
phenylephrine administration.
iii. Educate the patient about potential side effects, especially the risk of increased
blood pressure and the importance of following dosage instructions.
iv. Be cautious with patients who have preexisting hypertension or cardiovascular
conditions.
v. Administer the medication as prescribed, following appropriate administration
guidelines for the specific formulation.
vi. Ensure that the patient is aware of proper administration techniques for nasal
sprays or ophthalmic drops.
References:
Sudafed PE (phenylephrine) product information. (2021). McNeil Consumer Pharmaceuticals Co. Retrieved
from https://www.sudafed.com.
Lexi-Drugs Online, Phenylephrine. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Phenylephrine is commonly used as a decongestant to relieve nasal congestion and is available in various
formulations. It should be administered according to the healthcare provider's instructions and used cautiously
in patients with certain medical conditions. Consult the most recent and authoritative sources and collaborate
28. PROPAFENONE
Branded Name: Rythmol and Rythmol SR (sustained-release).
Generic Name: Propafenone
i. Dosage: The dosage of propafenone can vary depending on the specific indication,
patient's age, and response to treatment. Propafenone is available in immediate-release
and sustained-release (SR) formulations. Dosages are typically determined by healthcare
providers based on the patient's condition. Common dosages for adults with atrial
fibrillation or atrial flutter may involve immediate-release tablets of 150 mg to 300 mg
every 8 hours. The sustained-release formulation is typically dosed once or twice daily.
ii. Frequency: The frequency of propafenone administration depends on the specific
formulation being used and the patient's response to treatment.
iii. Administration: Propafenone is administered orally in the form of tablets or
capsules.
b. Mechanism of Action: Propafenone is classified as a class Ic antiarrhythmic medication.

It works by blocking sodium channels in cardiac cells, specifically the fast sodium
channels responsible for phase 0 of the cardiac action potential. By inhibiting sodium
influx, propafenone slows the conduction of electrical impulses in the heart, particularly
in the atria. This can help restore and maintain normal heart rhythms, making it useful in
the treatment of certain arrhythmias.
c. Indication: Propafenone is primarily used for the treatment and prevention of certain
types of irregular heart rhythms, including atrial fibrillation and atrial flutter. It is
classified as an antiarrhythmic agent.
● Dizziness
● Headache
● Fatigue
● Visual disturbances (e.g., blurred vision)
● Proarrhythmia (worsening of arrhythmias)
● Liver function abnormalities
i. Administer propafenone as directed by the healthcare provider, particularly when
treating arrhythmias.
ii. Monitor the patient's cardiac rhythm, blood pressure, and symptoms during and
after propafenone administration.
iii. Educate the patient about potential side effects and the importance of adhering to
the prescribed dosage regimen.
iv. Be cautious with patients who have known hypersensitivity to propafenone or a
history of certain arrhythmias.
v. Administer the medication as prescribed, and ensure the patient understands any
dosage adjustments when transitioning between immediate-release and sustained-
release formulations.
References:
Rythmol (propafenone hydrochloride) prescribing information. (2021). Arbor Pharmaceuticals, LLC. Retrieved
Lexi-Drugs Online, Propafenone. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Propafenone is an antiarrhythmic medication primarily used for the treatment of certain irregular heart rhythms,
such as atrial fibrillation and atrial flutter. It should be administered and monitored under the supervision of
healthcare professionals, especially in patients with arrhythmias. Consult the most recent and authoritative
sources and collaborate closely with healthcare providers for specific patient care.
29. PROPOFOL
Branded Name: Diprivan.
Generic Name: Propofol
i. Dosage: The dosage of propofol can vary widely depending on the specific indication,
patient's age, weight, and response to anesthesia. Propofol is administered intravenously
(IV) as an anesthesia induction and maintenance agent. Dosages are typically determined
by anesthesia providers based on the patient's needs. Common induction dosages for
adults may involve initial IV bolus doses of 1 to 2.5 mg/kg of body weight.
ii. Frequency: The frequency of propofol administration is determined by the duration of
the surgical or medical procedure. It is often administered as a continuous IV infusion
during anesthesia.
iii. Administration: Propofol is administered intravenously by healthcare professionals,
particularly anesthesiologists or nurse anesthetists. It should be prepared and
administered in accordance with strict aseptic techniques.
b. Mechanism of Action: Propofol is a general anesthetic agent that works primarily as a

gamma-aminobutyric acid (GABA) agonist. It enhances the inhibitory effect of GABA
neurotransmission in the central nervous system, leading to sedation, hypnosis, and loss
of consciousness. Propofol provides rapid onset and offset of anesthesia, making it
suitable for induction and maintenance of anesthesia.
c. Indication: Propofol is primarily used for the induction and maintenance of anesthesia
during surgical and medical procedures. It is also used for sedation in critical care
settings.
● Respiratory depression
● Pain or burning at the injection site
● Anaphylactic reactions
● Lipid metabolism abnormalities (with prolonged use)
● Propofol infusion syndrome (rare but serious)
i. Administer propofol under the supervision of anesthesia providers or critical care
specialists.
ii. Continuously monitor the patient's vital signs, including blood pressure, heart rate,
oxygen saturation, and respiratory rate during propofol administration.
iii. Maintain a patent IV access site for propofol infusion and monitor for signs of
extravasation.
iv. Ensure that the patient is adequately oxygenated and ventilated while under propofol
anesthesia.
v. Be vigilant for signs of propofol infusion syndrome (e.g., metabolic acidosis,
rhabdomyolysis) with prolonged or high-dose use.
vi. Educate the patient or family about the potential side effects and post-anesthesia
recovery.
References:
Diprivan (propofol) prescribing information. (2021). Fresenius Kabi USA, LLC. Retrieved from
Lexi-Drugs Online, Propofol. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Propofol is a potent anesthetic agent used for the induction and maintenance of anesthesia during surgical and
medical procedures. It should be administered and monitored by qualified anesthesia providers or healthcare
professionals. Consult the most recent and authoritative sources and collaborate closely with healthcare
providers for specific patient care.
30. VECURONIUM
Branded Name: Norcuron.
Generic Name: Vecuronium
i. Dosage: The dosage of vecuronium can vary depending on the specific indication,
patient's weight, and response to neuromuscular blockade. Vecuronium is administered
intravenously (IV) as a neuromuscular blocking agent. Dosages are typically determined
by anesthesia providers based on the patient's needs. Common intubation dosages for
adults may involve initial IV bolus doses of 0.08 to 0.1 mg/kg of body weight.
ii. Frequency: The frequency of vecuronium administration depends on the duration of

neuromuscular blockade required during surgery or medical procedures. Additional doses
may be given as needed to maintain neuromuscular blockade.
iii. Administration: Vecuronium is administered intravenously by healthcare

professionals, particularly anesthesia providers or nurse anesthetists. It should be
prepared and administered in accordance with institutional protocols for neuromuscular
blockade.
b. Indication: Vecuronium is primarily used as an adjunct to general anesthesia to induce

and maintain muscle relaxation during surgical and medical procedures. It is commonly
employed in surgeries requiring controlled ventilation, such as abdominal or thoracic
procedures.
c. Mechanism of Action: Vecuronium is a non-depolarizing neuromuscular blocking agent

that competes with acetylcholine for binding to nicotinic receptors at the neuromuscular
junction. By blocking the transmission of nerve impulses to skeletal muscles, vecuronium
induces muscle relaxation and paralysis. This effect is used to facilitate endotracheal
intubation and provide muscle relaxation during surgery.

● Respiratory depression
● Prolonged muscle weakness
● Postoperative residual curarization (PORC)
● Anaphylactic reactions
● Neuromuscular blockade reversal failure
● Administer vecuronium under the supervision of anesthesia providers or healthcare
professionals experienced in neuromuscular blockade management.
● Continuously monitor the patient's vital signs, including blood pressure, heart rate,
oxygen saturation, and respiratory rate during vecuronium administration.
● Assess neuromuscular blockade using neuromuscular monitoring devices and
titrate doses as needed to achieve the desired level of muscle relaxation.
● Be aware of the potential for residual neuromuscular blockade and take appropriate
measures to prevent and manage postoperative residual curarization (PORC).
● Educate the patient or family about the temporary nature of muscle paralysis and
the importance of mechanical ventilation during surgery.
● Ensure that reversal agents (e.g., neostigmine, sugammadex) are readily available
for the reversal of neuromuscular blockade.
References:
Norcuron (vecuronium bromide) prescribing information. (2021). Organon USA Inc. Retrieved from
Lexi-Drugs Online, Vecuronium. (2021). Lexicomp. Retrieved from https://online.lexi.com.
Vecuronium is a neuromuscular blocking agent used to induce and maintain muscle relaxation during surgical
and medical procedures. It should be administered and monitored by qualified anesthesia providers or
healthcare professionals experienced in neuromuscular blockade management. Consult the most recent and
authoritative sources and collaborate closely with healthcare providers for specific patient care.

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1.

e. Nursing Considerations for Amantadine:

a. Dosage, Frequency, and Administration:

b. Mode of Action: Amiodarone is an antiarrhythmic medication that works through

d. Side Effects/Adverse Reactions:

e, Nursing Considerations for Amiodarone:

Micromedex, Truven Health Analytics. (2021). Amiodarone. Retrieved from https://www.micromedexsolutions.com.

a. Dosage, Frequency, and Administration:

- The medication is given as a slow intravenous infusion, which means it is diluted

b. Mode of Action: Bretylium's mode of action involves inhibiting the release of

c. Indication: Bretylium sulfate is primarily used to treat life-threatening ventricular

d. Side Effects/Adverse Reactions:

e. Nursing Considerations for Bretylium:

b. Mechanism of Action: Cisatracurium is a non-depolarizing neuromuscular blocking

c. Indication: Cisatracurium is primarily used as an adjunct to general anesthesia to provide

d. Side Effects/Adverse Reactions:

e. Nursing Considerations for Cisatracurium:

References: Lexicomp Online, Lexi-Drugs, Hudson, Ohio: Lexi-Comp, Inc. (2021).

b. Mechanism of Action: Diazepam is a benzodiazepine that acts on the central nervous

c. Indication: Diazepam is used to treat a variety of conditions, including anxiety disorders,

d. Side Effects/Adverse Reactions:

b. Mechanism of Action: Diltiazem is a calcium channel blocker. It works by inhibiting the

d. Side Effects/Adverse Reactions:

c. Indication: Dobutamine is primarily indicated for short-term treatment of heart failure to

d. Side Effects/Adverse Reactions:

d. Side Effects/Adverse Reactions:

Enalaprilat prescribing information. (2021). West-Ward Pharmaceuticals Corp. Retrieved

c. Indication: Esmolol is used for the rapid control of supraventricular tachycardias

Haldol (haloperidol) prescribing information. (2021). Ortho-McNeil-Janssen Pharmaceuticals, Inc.

c. Side Effects/Adverse Reactions:

b. Mechanism of Action: Labetalol is a non-selective beta-blocker with alpha-1 blocking

d. Side Effects/Adverse Reactions:

b. Mechanism of Action: Labetalol is a non-selective beta-blocker with alpha-1 blocking

d. Side Effects/Adverse Reactions:

● Topical: Applied directly to the skin or mucous membranes.

b. Mechanism of Action: Milrinone is a phosphodiesterase III inhibitor. It works by

b. Mechanism of Action: Nitroglycerin is a vasodilator that works by releasing nitric oxide

b. Mechanism of Action: Nitroprusside is a potent vasodilator that acts directly on vascular

b. Mechanism of Action: Norepinephrine is a potent sympathomimetic medication that acts

d. Side Effects/Adverse Reactions:

iii. Administration: Phentolamine is administered by healthcare professionals through

b. Mechanism of Action: Phentolamine is a non-selective alpha-adrenergic receptor

b. Mechanism of Action: Propafenone is classified as a class Ic antiarrhythmic medication.

b. Mechanism of Action: Propofol is a general anesthetic agent that works primarily as a

ii. Frequency: The frequency of vecuronium administration depends on the duration of

iii. Administration: Vecuronium is administered intravenously by healthcare

b. Indication: Vecuronium is primarily used as an adjunct to general anesthesia to induce

c. Mechanism of Action: Vecuronium is a non-depolarizing neuromuscular blocking agent

d. Side Effects/Adverse Reactions:

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