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Drug name Generic Name: Epinephrine Brand Name: Injection, OTC nasal solution: Adrenalin Chloride

Mechanism of action Classification: Beta2 Adrenergic Agonists Action: Stimulate s beta

Administration Dosage: 0.5-1mg Route: IV

Indication Asthma Bronchitis Emphysema All cardiac arrest, Anaphylaxis Used for

Contraindication patients with angleclosu re

Adverse effect nervousness, tremor, vertigo, pain, widened pulse pressure, hypertension nausea

Nursing responsibilities >Monitor V/S. and check for cardiac dysrhythmias >Drug increases rigidity and tremor in patients with Parkinsons disease > Epinephrine therapy interferes with tests for urinary catecholamine Avoid IM use of

glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Also contraindicated in patient receiving

receptors in lung. Relaxes

symptomatic bradycardia. Relief of

bronchial smooth muscle. Increases vital

bronchospasm occurring during anesthesia Exercisedinduced

capacity inc. BP, HR, PR airway resistance. Decrease s

bronchospasm

general anesthesia with halogenated hydrocarbons or

parenteral suspension into buttocks. Gas gangrene may

cyclopropane and in patients in labor (may delay second stage) Some products

occur Massage site

after IM injection to counteract possible vasoconstriction. > Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop

containing sulfites and are contraindicated in patients with sulfite allergies In pregnant woman,

drug is contraindicated. In breast feeding do not

use the drug or stop breast feeding.

Drug name Generic Name: Metoclopramide Brand Name: Maxolon

Mechanism of action Classification: Antiemetic, GI Stimulant Action: Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine;

Administration 1mg/mL Oral IM IV

Indication Disturbance s of

Contraindicatio n Contrain dicated with allergy to

Adverse effect restlessnes s,

Nursing responsibilities carefully during IV administration. >Monitor diabetic patients, arrange for alterations in insulin dose or timing if diabetic control is compromised by alterations in timing of food absorption.

GI motility Relief of

drowsiness, fatigue, insomnia, dizziness, anxiety transient

symptoms of acute and recurrent diabetic gastroparesis Nausea and

metoclopramid e GI hemorrh age Mechani cal

hypertension nausea and diarrhea

vomiting Metabolic

obstruction or perforation Epilepsy Use cautiousl y

diseases Short-term

therapy for adults with symptomatic

with previously

relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin

gastroesophageal reflux who fail to respond to conventional therapy.

detected breast cancer, lactation, pregnancy, fluid overload, renal impairment

Drug name Generic Name: Ranitidine Brand Name: Zantac/ Aciran

Mechanism of action Classification: H2 Receptor Blocker Antagonist Action: Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid

Administration 50mg IVTT Q8h

Indication Short-term

Contraindicatio n Contrain dicated

Adverse effect headache,

Nursing responsibilities 1. Administer oral drug with meals and at bedtime. 2. Decrease doses in renal and liver failure. 3. Provide concurrent antacid therapy to relieve pain. 4. Administer IM dose undiluted, deep into large muscle group. 5. Arrange for regular follow-up

treatment of active duodenal ulcer and benign gastric ulcer Maintenanc e

malaise, dizziness, somnolence, insomnia, vertigo tachycardia ,

with allergy to ranitidine, lactation Use cautiousl y

therapy for duodenal ulcer at reduced dosage. Short-term

with impaired

renal or hepatic bradycardia function, pregnancy rash,

alopecia constipatio n,

treatment for GERD. Pathologic

diarrhea, nausea and

Hypersecretory conditions (Zollinger-Ellison syndrome) Treatment

vomiting, abdominal pain,

secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin

of heartburn, acid indigestion, sour stomach

hepatitis

including blood test, to evaluate effects

Drug name Generic Names: Aminophylline Brand Names:

Mechanism of action Classification: Antiasthmatic & COPD Preparations Action:

Administration
Bronchospasm Adult: IV Loading Dose 6 mg/kg over 30 min IV Maintenance Dose nonsmoker, 0.5

Indication PO Chronic bronchospasm as hydrate

Contraindicatio n

Adverse effect Nausea, vomiting, abdominal pain, diarrhea, headache, insomnia,

Nursing responsibilities Give immediat e-release, liquid

dosage forms with food if GI effects occur.

Atlantic Aminophylline Theofil amp

Increases the level of cAMP resulting in bronchodilation

mg/kg/h; smoker, 0.75 mg/kg/h; CHF or cirrhosis, 0.25 mg/kg/h PO nonsmoker, 0.5 mg/kg/h times 24 h in 4 divided doses; smoker, 0.75 mg/kg/h times 24 h in 4 divided doses; CHF or cirrhosis, 0.25 mg/kg/h times 24 h in 4 divided doses Child: IV Loading Dose 6 mg/kg IV over 30 min IV Maintenance Dose 19 y, 1 mg/kg/h; >9 y, 0.75 mg/kg/h PO 19 y, 1 mg/kg/h times 24 h in 4 divided doses; >9 y, 0.75 mg/kg/h times

dizziness, anxiety, restlessness; tremor, palpitations. Potentially Fatal: Convulsions, cardiac arrhythmias, hypotension and sudden death after too rapid IV injection.

Maintain adequate hydration. Take serum samples to

determine peak theophylline concentration drawn 1530 min after an IV loading dose. Ensure that diazepam is readily

available to treat seizures.

24 h in 4 divided doses Infant: PO/IV 611 mo, 0.87 g/kg/h; 2 6 mo, 0.5 mg/kg/h Neonate: PO/IV 0.16 mg/kg/h Neonatal Apnea Neonate: PO/IV Loading Dose 5 mg/kg PO/IV Maintenance Dose 5 mg/kg/d divided q12

Drug name Generic: Nicardipine HCL Brand:

Mechanism of action Classification: Calcium Antagonist

Administration Oral
20mg 3 times daily

Indication Hypertensi ve emergenci es or

Contraindicatio n

Adverse effect Peripheral edema, headache, tachycardia,

Nursing responsibilities Patients with hepatic impairment should receive lower

Cardepine

Action: Calcium channel blocker That inhibits Calcium ion influx Across cardiac and smooth muscle cells, also dilates coronary Arteries and arterioles

urgencies, peri-op & post-op HTN, hypertensi ve states of NPO patients.

palpitations, localized thrombophle bitis & hypotension.

dose. Monitor blood pressure. Allow at least 3 days between dosage adjustments to achieve steady plasma levels. Advise patient to report immediately if experiencing chest pain

Drug name Generic Name: Sodium Bicarbonate Brand Name:

Mechanism of action Classification: Alkalizing Agent, Buffer, Antacid, electrolyte Action: Neutraliz es gastric

Administration Oral 250mg-500mg Q4h

Indication Hyperacidity

Contraindicatio n

Adverse effect GI: Gastric distention, belching, flatulence. Metabolic: metabolic

Nursing responsibilities Monitor urinary pH,

Peptic ulcer Hyperkalemia Tricyclic

calcium, electrolytes and phosphate levels. Record amount

antidepressant OD Shock

Soda Mint

acid Decrease pepsin activity

associated with severe diarrhea, dehydration, uncontrolled DM Reflux

alkalosis, hypernatremia , hypokalemia, hyperosmolarit y (with overdose). Other: Pain and irritation at injection site.

and consistency of stools. Clients on lowsodium

diets should evaluate sodium contents of antacids.

esophagitis

Drug name

Mech anis m of actio n Clas sific atio n: NonStero idal Anti infla

Administrati on

Indication

Contraindicati on

Adverse effect

Nursing responsibilities

Generic Name: Diclofenac Sodium Brand Name: Voltaren

Oral
100150 mg daily, given as 50 mg 2 or 3 times daily

Diclofenac is used for musculoskeletal complaints, especially arthritis, rheumatoid arthritis, polymyositis, dermatomyositis, osteoarthritis, dental pain, TMJ,spondylarthritis, ankylosing spondylitis, gout attacks,and pain management in cases of kidney stones and gallstones. An additional indication is the treatment of acute migraines.

Contrain dicat

ed with allergy to NSAIDs, significant renal

He ad ac he ,

Administe r drug with

food or after meals if GI upset occurs. Arrange for

dizziness , bsomnol ence, insomnia

ophthalmologic

mma tory Drug s Acti on: Inhibi ts prost aglan din Syth etase to caus e antip yreti c and anti infla mma tory effec ts: the exact mech anis m is unkn own.

impairment, pregnancy, lactation. Use

, fatigue, tiredness , dizziness , tinnitus, ophthal mic effects. pr uri tu s,

exam during long-term therapy. Institute emergenc y

cautiously with impaired hearing, allergies, hepatic, CV, GI conditions, and in elderly patients.

procedure if overdose uccurs.

sweating , dry mucous membra nes, stomatiti s. Dy su ria , re na

l impairme nt. Na us ea ,

dyspepsi a, GI pain, diarrhea, vomiting, constipat ion, flatulenc e. Bl ee di ng ,

platelet inhibition with higher doses.

Drug name Tramadol HCl (Dolcet)

Mechanism of action Inhibits prostaglandin sythetase to cause antipyretic and antiinflammator y effects: the exact mechanism is unknown.

Administration Route of administration: Oral Dosage: 50-100mg q 46 hr prn

Indication Moderate to severe pain

Contraindicatio n Acute intoxication with alcohol, hypnotics, narcotics, centrally-acting analgesics, opioids or psychotropic drugs. Hypersensitivit y

Adverse effect CNS and GI disturbances. Nausea, dizziness. Fatigue, constipation, dry mouth.

Nursing responsibilities Assess for level of pain

relief and administer dose as needed but not to exceed the recommended total daily dose Discontinu e drug and

notify the physician if s/sx of hypersensitivity occur Take appropriat

e safety precautions. To be taken with food to avoid GI upset.

Drug name Calcium gluconate (Kalcinate)

Mechanism of action Replaces Calcium and maintains Calcium level

Administration
1000 to 1500 mg/day orally in divided doses.

Indication Hypocalcemia, hypocalcemic tetany, magnesium toxicity, hypo parathyroidism

Contraindicatio n Hypercalcemia, ventricular fibrillation, renal canaliculi

Adverse effect GI irritation hemorrhag e constipatio n vomiting thirst renal

Nursing responsibilities Use cautiously in patients

with sarcoidosis and renal or cardiac disease and in digitalized patients. Monitor

canaliculi hypercalce mia polyuria

blood calcium level frequently

Drug name Generic Terbutaline Brand: Brethine, Bricanyl

Mechanism of action Classification: Adrener gic inhalants, selective beta-2adrenoreceptor agonists Action: In low doses, act relatively, selectively at beta

Administrati on
2.5 to 7.5 mg orally every 6 hours.

Indication
Terbutaline is used as a fast-acting bronchodilator ( often used as a short-term asthma treatment) and as a tocolytic to delay premature labor. The inhaled form of terbutaline starts working within 15 minutes and can last up to 6 hours.

Contraindication Hypersensit ivity to the drug

Adverse effect Sweating, nausea, vomiting, lethargy, tinnitus, tachycardi a, palpitations , muscle cramps, headache, paradoxica l bronchosp asm

Nursing responsibilities Explain the drug to the patient Take Terbutaline exactly as directed by your doctor. Do not take more or less than instructed by your doctor. Continue taking Terbutaline even when you feel better.

adrenergic receptors

Transient hyperglyce mia, transient hypokaele mia.

Do not stop taking it unless instructed by your doctor

Drug name Generic name: Streptokinase Brand Name: Streptase

Mechanism of action Classification: Thrombolytic enzyme Action: Acts with plasminogen to produce a new activator complex which enhances the conversion of of plasminogen to

Administration Dosage: 250,000 IU/ 30 min Route: IV

Indication Arterial thrombosis and embolism, acute evolving tansmural MI. pulmonary embolism, clearing of occluded arteriovenous and IV cannulae,

Contraindicatio n Any condition presenting a risk of hemorrhage, such as recent surgery or biopsies, delivery within 10 days, ulcerative disease. Arterial emboli originating from

Adverse effect Minor bleeding at invaded or disturbed sites, major bleeding, fever, shivering in acute MI. CV: superficial bleeding, minor bleeding at invaded or disturbed sites. Severe and internal

Nursing responsibilities 1.NaCl injectioin or D5W is the preffered diluent for IV use. 2. For AV cannulae, dilute 250,000 units with 2 ml of NaCl injection or D5W. 3. reconstitute gently, a directed

plasmin. Plasmin then beaks down fibrinogen, fibrin clots, and other plasma protein promoting the dissolution of he insoluble fibrin trapped in intravascular emboli and thrombi. Also, inhibitors of streptokinase such as alpha-2macroglobulin are rapidly inactivated by streptokinase,

left of the heart. Also hepatic or renal insufficiency, tuberculosis, recent cerebral embolism, thrombosis, hemorrhage, SBE, rheumatic valvular disease, thrombocytope nia. Streptokinase resistance in excess of q million IU. Use to restore patency to IV catheters.

bleeding involving GI, GU, retroperitoneal or intracerebral sites. Allergic: Nausea, headache, breathing difficulties, fever, shivering, bronchospasm, angioneurotic edema, urticaria, itching, flushing, musculoskeletal pain, vasculitis, interstitial nephritis, respiratory depression, back pain

without shaking the vial. 4. use within 24 hour of reconstitution 5. use an electronic infusion device to administer streptokinase and do not add any other medications to the line. Note any redness and or pain at the site 6. Do not add any medication to streptokinase. 7. Identify other

drugs taking such as aspirin or NSAIDs that could increase bleeding times.

Drug name Generic Name: Atropine Sulfate Band name: Atropen, Atropair, atropine sulfate ophthalmic,

Mechanism of action Classification: Cholirgenic blocking drug Action: effects on prostaganglionic receptors in smooth muscle, cardiac muscle, exocrine glands, urinary bladder, and the AV

Administration Route: Oral, parenteral, ophthalmic Dosage: 0.3-1.2 mg q 4-6 hr

Indication Peptic ulcer treatments, pylorospasm, biliary and ureteral colic spasm and bronchial spasms, preanesthetic to control salivation and bronchial

Contraindicatio n Infants less than 3 months of age, primary glaucoma or a tendency toward glaucoma, adhesions between the iris and the lens, geriatric

Adverse effect dry mouth, urinary hesitancy, headache, flushing, constipation, heartburn, blurred vision, stinging, increased intraocular pressure,

Nursing responsibilities 1. Do not use 3 AtroPen injections unless under supervision of trained medical provider 2. note indications for therapy 3.check for glaucoma before ophthalmic

and SA nodes of the heart. Ophthalmologicall y blocks acetylcholine effects n the sphincter muscle of the iris and the accommodative muscle of the ciliary body. This results in dilation of the pupil and paralysis f the muscles required to accommodate for close vision

secretions, restoration of CR during anesthesia, decrease degree of AV heart block, severe bradycardia and syncope,

clients and others where undiagnosed glaucoma or excessive pressure in the eye may be present, in children who have had a previous severe systemic reaction to atropine

administration 4. obtain VS and ECG; monitor CV status during the therapy. 5.use the ATropen auto injector as soon as symptoms of organosphospho rus or carbamate poisoning appear. 6. After instillation of ophthalmic ointment, compress the lacrimal sac by digital pressure for 1-3 min to

decrease systemic effects. Drug name Generic Name: Konakion Brand Name: Konakion MM Mechanism of action Classification: Haemostatics Action: As a component of a liver carboxylase system, it is involved in the carboxylation of the coagulation factors II (prothrombin), VII, IX and X, and of the coagulation inhibitors protein C and protein S in the postribosomal phase. Administration Route: Indication Hemorrhage or Contraindicatio n Hypersensitivit y to any of the constituents of Konakion MM/MM Pediatric. Pronounced allergic diathesis. Adverse effect severe, shocklike reactions. In rare cases, anaphylactoid reactions have been reported after parenteral use of konakion MM Pediatric. Local irritation may occur at the injection site, but is unlikely due to the small injection Nursing responsibilities 1. The 10 mg/mL mixed-micelle ampoule must not be given to infants <1 year old 2. Parenteral administration may be associated with an increased risk of kernicterus in premature infants weighing <2.5 kg. 3. At the time of use, the

Parenteral, oral threatened Dosage: 10 mg (up to 20 mg) hemorrhage as a result of severe hypoprothrombi nemia (ie, deficiency of coagulation factors II, VII, IX, X) due, for instance, to overdosage of anticoagulants of the dicoumarol type or their combination with

Anticoagulants of the dicoumarol type inhibit reduction of vitamin K1 (quinone form) to vitamin K1 hydroquinone and also prevent the vitamin K1 epoxide which arises after the carboxylation reaction from being reduced to the quinone form. Phytomenadione is thus an antagonist of Marcouman and similar anticoagulants. It

phenylbutazone or to other forms of hypovitaminosis K; Prophylaxis and treatment of hemorrhagic disease of the newborn.

volume.

ampoule solution must be clear. Improper storage can cause turbidity or phase separation. In this case, the ampoule must not be used.

does not, however, inhibit the action of heparin;.

Drug name Generic Name: Ketorolac tromethamine Brand Name: Acular

Mechanism of action Classification: Nonsteroidal antiinflammatory Action: Posseses antiinflammatoy, analgesic, and antipyretic effects

Administration Route of Administration IM, IV, PO, ophthalmic Dosage: 60 mg for less than 65 years old, IM 30 mg for IV 60 mg PO 1gtt 4x a day for ophthalmic

Indication Severe, acute pain in adults, itching causzed by seasonal allergic conjunctivitis, , post operative inflammation following cataract surgery, reduce ocular pain, burining

Contraindicatio n Hypersenstivty to the drug or allergic symtpms to aspirin or other NSAIDs. Active peptic ulcer disease, recent GI bleeding or perforatin, history

Adverse effect Headache, dizziness, rdrowsiness, diarrhea, nausea, dyspepsia, indigestion, epigastric pain, edema, transient burning stinging upon administration, ocular irritation,

Nursing responsibilities 1. use as a part of a regular analgesic schedule rather than on an asneeded basis 2. if given p.r.n, basis, base size of repeat dose. If pain returns within 3-5 hr,

route

and stinging after corneal refractive surgery, reduction of ocular pain and photophobia following incisional refractive surgery,

of peptic ulcer disease, advanced renal impairment and in those at risk for renal failure due to volume depletion, suspected or confirmed cerebrovaxcula bleeding, hemorrhagic diathesis, or incomplete hemostasis and in those with high risk of bleeding.

the enxt dose can be increased by up to 50 percent 3. shortening the dosing intervals recommended will lead to an increased frequency and duation of side effects.

Drug name Generic Name: Diphenhydrami ne HCl Brand Name: Benadryl

Mechanism of action Classification: antihistamine Action: High sedative, anticholinergic, and antiemetic effects

Administration 1ampule IV PRN

Indication Hay fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug sensitization, serum & penicillin reaction, contact dermatitis, atopic eczema, other allergic dermatoses, pruritus, food sensitivity,

Contraindicatio n Premature & newborn infants; asthma attack; lactation.

Adverse effect CV & CNS effects. Blood disorders. GI disturbances. Antimuscarinic effects. Allergic reactions. Drowsiness, constipation, diarrhea, dizziness, dry mouth, nose, throat, headache, anorexia, anxiety, GI

Nursing responsibilities 1. note reasons fo therapy, signs and symptoms of charactgeristics, other agents trialed, triggers, outcome 2. do not confuse diphenhydramin e with desipramine with

parkinsonism, motion sickness.

upset, asthenia

dimenhydrinate 3. take 30 minutes before travel 4. use sugarless gum, candy to diminish dry mouth effects. 5. avoid alcohol and any other CNS depressants unless prescrived 6. Stop therapy 7296 hour before skin testing

Drug name Generic Name: Isosorbide dinitrate Brand Name: Isordil

Mechanism of action Classification: Anti-angina, coronary vasodilator Action: Relaxes vascular smooth muscle by stimulatng production of intracellular cyclic guanosine monophosphate. Dilation of post capillary vessels decreases venous return to the heart due to pooling of

Administration Route of administration: Sublingual, oral Dosage: Oral 5-30 mg qid. Sublingual 5-10 mg 2-3 hrly. Acute CHF Oral 10-40 mg qid. Sublingual 5-10 mg 2 hrly. Chronic CHF Initially 5-10 mg/day 2 hrly sublingually. Maintenance: 20-

Indication Angina pectoris, acute and chronic CHF

Contraindicatio n Use to abort anginal attacks

Adverse effect Headache, vascular headache, lightheadedness, hypotension.

Nursing responsibilities 1.note reasons fo therapy; include onset, location, characteristics of chest pain; pain levels 2.assess VS and ECGT; note stress thallium, catheterization, or IVUS findins as well as CAD history/interventi on s. 3. store at room

blood; thus LV end-diastolic pressure is educed. Elaxation of arteriololes results in a decreased systemic vascular resistance and arterial pressure.

40 mg qid orally.

temperature protected from light. Keep bottles tighly closed. Dipense in alight resistant tight contaainer

Drug name Generic Name: Nifedipine Brand Name:

Mechanism of action Classification: Calcium channel blocker Action: It blocks the

Administration Route of administration: Oral Dosage:

Indication All forms of hypertension, primary or secondary.

Contraindicatio n Cardiovascular shock, severe aortic stenosis or in patients

Adverse effect mild, transient and relatively infrequent. These

Nursing responsibilities 1. dot not confuse nifedipine with nicardipine 2. do not exceed

Calcibloc

calcium or "slow" channels and inhibits entry of calcium ions into vascular smooth muscles particularly of resistance vessels and coronary arteries. dilates coronary and peripheral arteries, as well as veins. Coronary arterial vasodilation increases coronary blood flow in the ischemic poststenotic areas, while dilation of the

Capsules: 1020 mg 3x a day Tablets: 30-60 mg per day

Nifedipine is most effective for mild to moderate degrees of hypertension but the capsule may be bitten and swallowed for more rapid effects as in hypertensive crises. Hypertension in pregnancy (at any term of pregnancy). Coronary insufficiency with or without angina. Vasospastic angina (Prinzmetal's angina). To

known to be hypersensitive to

include flushing, nausea, dizziness, headache, tiredness,

a single dose 3. before increasing dose, carefully monitor BP 4. use only the sustained release tablets to treat hypertension 5. concomitant therapy with beta renergic blocking agents may be used 6. clients withdrawn from beta blockers may manifest symptoms of increased angina

nifedipine. Care sedation, leg edema is needed in and other patients with very manifestations of low blood pressure (severe hypotension with systolic pressure <90 mmHg) or decompensate d heart failure. peripheral vasodilation.

peripheral arteries lowers arterial blood pressure and reduces left ventricular afterload. Some renal artery dilatation may stimulate mild diuresis

increase heart rate in patients with sinus bradycardia and sick-sinus syndrome.

which cannot be prevented by nifedipine; in fact nifedipine may increase the severity of angina situation

Drug name
Generic name: MORPHINE SULFATE brand name: MSIR, Rescudose, Roxanol, Roxanol T

Mechanism of action
Classification -Opioid Agonist Analgesic Action -Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation

Administration
Dosage -Oral: 1030 mg q 4 hr PO.

Indication
Indication -Relief of moderate to severe acute and chronic pain -Preoperative medication

Contraindicatio n
Contraindication s -Hypersensitivity -Sick sinus syndrome 2nd or 3rd degree AV block
-

Adverse effect
-CNS:abnormal dreams, anxiety, confusion, dizziness and headache -EENT: blurred vision, epistaxis and tinnitus -CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and palpitations

Nursing responsibilities
Nursing Management -Monitor BP and pulse before therapy, during titration and therapy -Monitor ECG, I&O, serum potassium and weight. -Assess for CHF

-CHF -Cardiogenic shock

-Concurrent IV beta-blocker

-GU: dysuria, nocturia and polyuria -GI: abnormal liver function, anorexia, constipation, diarrhea, nausea and vomiting

Drug name
Generic name: DILTIAZEM brand name: Cardizem, Dilacor, Novo-Diltiazem, Tiamate and Tiazac

Mechanism of action
Classification -Anti-anginals -Antiarrhythmics -Antihypertensive -Ca channel blocker Action -Inhibits calcium transport into myocardial smooth muscle cells Systemic and coronary vasodilation

Administration
Dosage -PO: 30-120 mg, 3-4x daily or 60120 mg twice daily as SR capsules

Indication
-Hypertension
- Angina

Contraindicatio n
Contraindication s -Hypersensitivity -Sick sinus syndrome -2nd or 3rd degree AV block -CHF -Cardiogenic shock Non competitive alpha and beta adrenergic blockage

Adverse effect
-CNS:abnormal dreams, anxiety, confusion, dizziness and headache -EENT: blurred vision, epistaxis and tinnitus -CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and palpitations -GU: dysuria, nocturia and polyuria -GI: abnormal liver function, anorexia, constipation, diarrhea, nausea and vomiting

Nursing responsibilities
Assess cardiovascular status before therapy Assess pulmonary, hepatic and thyroid function before and during therapy Monitor fluid and electrolytes, I&O, K, Na and Cl Monitor ECG, BP Assess vision

Pectoris

-Supraventricular Arrhythmia -Atrial flutter/fibrillation

Drug name
Brand name: LIDOCAINE Generic name: Xylocaine

Mechanism of action
Classification CV drugs: Antiarrhythmics Anesthetic Action -Increases electrical stimulation of ventricle and Hispurkinje system by direct action on tissues, resulting to decrease depolarization, automaticity and excitability in ventricles during diastolic phase

Administration
IV: 0.7-1.4 mg/kg body weight. No more than 200 mg within 1 hour period

Indication
Anesthesia Arrhythmias Control of Status epilepticus refractory to other treatments

Contraindicatio n
Hypersensitivity Heart block Hypovolemia Adams stroke syndromes Infection at site of injection

Adverse effect
-GI disturbances, bradycardia, hypotension, convulsion, numbness of tongue, muscle twitching, restlessness, nervousness, dizziness, tinnitus, blurred vision, fetal intoxication, light headedness, drowsiness, apprehension, euphoria, vomiting, sensation of heat, respiratory arrest and CV collapse

Nursing responsibilities
Assess pt before and after therapy Pts infusion must be on cardiac monitor Monitor ECG, if QT or QRS increases by 50% or more, withhold the drug Monitor BP, check for rebound HPN after 1-2 hrs Assess respiratory status, oxygenation and pulse deficits Assess renal and liver function Monitor CNS symptoms Monitor blood levels

Drug name

Mechanism of action

Administratio n

Indication

Contraindication

Adverse effect

Nursing responsibilities

Generic name: PROCAINAMIDE

Classification -Antiarrhythmics Action -Blocks open Na channels and prolongs the cardiac action potential. This results in slowed conduction and ultimately the decreased rate of rise of the action potential may result on the widening of QRS on ECG

Dosage -Arrhythmias: 50 mg/kg/day in divided doses 3-6 hourly

Supraventricular and ventricular arrhythmias. Treatment of WolfParkinson-White Syndrome

Heart block Heart failure Hypotension Myesthenia gravis Digoxin toxicity Lactation

Severe hypotension, ventricular fibrillation and asystole. Drug induced SLE syndrome, blood disorders, fever, myocardial depression, heart failure, agrunulocytosis, psychosis, angioedema, hepatomegaly, skin irritation, hypergammaglobuline mia, GI and CNS effects

Brand name:
Pronestyl, ProcanSR, Procanbid

Assess cardiovascular status before therapy Assess pulmonary, hepatic and thyroid function before and during therapy Monitor fluid and electrolytes, I&O, K, Na and Cl Monitor ECG, BP Assess vision

Drug name
Na HCO3

Mechanism of action
-Alkalinizers

Administration
Dosage Metabolic Acidosis: Usually 2-5 meq/kg IV infuse over 4-8 hr period Cardiac Arrest:

Indication
-Acute pulmonary edema -Edema -Hypertension

Contraindicatio n
-Hypersensitivity Anuria

Adverse effect
Signs of hypotension, hypokalemia and hyperglycemia

Nursing responsibilities
-Monitor wt., BP and PR -Monitor fluid, I&O, electrolyte, BUN and CO2 levels frequently -WOF signs of

1 meq/kg IV of 7.5 or 8.4% sol, then 0.5 meq/kg IV q 10 mins depending on ABG

hypokalemia - Monitor uric acid levels Monitor glucose levels esp in DM pts

Drug name Generic name:


VASOPRESSIN

Mechanism of action
Classification -Pituitary Hormones ADH Action -Restore buffering capacity of the body and neutralizes excessive acid

Administration
initially 5 units IM gives subsequent injections q3-4 hours increasing to 10 units if needed.

Indication
Metabolic Acidosis Cardiac Arrest

Contraindicatio n
Metabolic and respiratory alkalosis Pt losing Cl because of vomiting or continuous GI suction or those receiving diuretics that produces hypochloremic alkalosis

Adverse effect
CNS: tetany CV: edema GI: gastric distention, belching and flatulence Metabolic: hypokalemia, metabolic alkalosis, hypernatremia, hyperosmolarity with overdose Skin: pain @ injection site

Nursing responsibilities
Obtain blood pH, PaO2, PaCo2 and electrolyte levels SIVP

Brand name:
Pitressin

Drug name

Mechanism of action

Admi nistr ation


1.5-2 gram/k g as a 15 %

Indication

Contr aindi catio n


Hypers ensitivi

Adverse effect

Nursing responsibilities

MANNITOL

Classification -Diuretics

- Test dose for marked oliguria or suspected

-CN: seizures, headache and fever -CV: edema, thrombophlebitis,

Monitor VS,CVP,I&O, renal function fluid

Action -Increases osmotic pressure of glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes; drug elevates plasma osmolarity, increasing water flow into extracellular fluid

to 20% IV solutio n over 30-60 min

inadequate renal function -OliguriaTo induced intraocular or intracranial pressure -Diuresis in drug intoxication -Irrigating solution during TURP

ty Anuria, severe pulmon ary conges tion, frank pulmon ary edema, active intracra nial bleedin g during craniot omy, severe dehydr ation, metabo lic edema, progres sive heart failure or pulmon ary conges tion after drug

hypotension and heart failure - EENT: blurred vision and rhinitis -GI: thirst, dry mouth, nausea, vomiting and diarrhea -GI: urine retention -Metabolic: dehydration -Skin: local pain - Others: chill

balance and urine K levels daily. Drug can be used to measure GFR Do not give electrolyte free solutions with blood. If blood id given simultaneously, add at least 200 meq of NaCL to each liter

Drug name
Generic name:

Mechanism of action
Classification

Administration
-Pulmonary

Indication
-For suspected opioid

Contraindicatio n
-Hypersensitivity

Adverse effect
-CNS: seizures,

Nursing responsibilities
-Assess respiratory

-Loop Diuretics FUROSEMIDE Brand name: Lasix Action -Inhibits Na and Cl reabsorption at the proximal and distal tubules and in the ascending loop of Henle

edema: 40 mg IV -Edema: 20 to 80 mg PO every day in the morning -HPN: 40 mg PO bid. Dosage adjusted based on response

induced respiratory depression -For postoperative opiod depression -Use cautious with cardiac irritability or opiod addiction.

tremors -CV: ventricular fibrillation, tachycardia, HPN with higher recommended doses, hypotension -GI: nausea and vomiting -Respiratory: pulmonary edema -Skin: diaphoresis

status frequently

-rate increases
within 1-2 mins

Drug name
Generic name: FLUMAZENIL Brand name: Romazicon

Mechanism of action
Classification -Benzodiazepine receptor antagonists Action -Antagonizes the effects of benzodiazepines

Administration
-2 ml IV given over 15 seconds

Indication
-Benzodiazepineinduced depression of the ventilatory responses to hypercapnia and hypoxia

Contraindicatio n
-Control of ICP or status epilepticus. -Signs of serious cyclic antidepressant overdose

Adverse effect
-Nausea, vomiting, palpitations, sweating, flushing, dry mouth, tremors, insomnia, dyspnea, hyperventilation, blurred vision, headache, pain at injection site

Nursing responsibilities
-Must individualize dosage. Give only smallest amount effective. -Give through freely running IV infusion into large vein to minimize pain at injection site -Note history of seizure or panic disorder - Assess evidence of increased ICP -Note evidence of sedative and benzodiazepine

dependence -Instruct to avoid alcohol and nonprescription drugs for 1-24 hrs

Drug name
IPECAC SYRUP

Mechanism of action
-Classification Antidote Action -Irritates the stomach lining and stimulate the vomiting center

Administration
Dosage -25-30 ml followed immediately by H2O

Indication
-Poisoning -Overdose

Contraindicatio n
-Hypersensitivity -Given activated charcoal -Unconcious -Drowsy -Severely drunk -Having seizures -With no gag reflex

Adverse effect
-Diarrhea, drowsiness, stomach cramps, vomiting, itching, DOB, swelling of the mouth, rash and hives

Nursing responsibilities
-Dont administer to unconscious -Pt should kept active and moving ff administration -If vomiting does not occur after 2nd dose, gastric lavage may be considered to remove ingested substance

Drug name
Generic name

Mechanism of action
Classification

Administration
Dosage

Indication
-To treat shock and

Contraindicatio n
- Hypersensitivity

Adverse effect
-CNS: headache an

Nursing responsibilities
-Monitor therapeutic

-Initially 2-5 mcg/kg/min by IV SHOCK DOPAMINE Brand name: Intropine -Adrenergic drugs Action -Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system resulting in positive inotropic effect and increased CO

correct hemodynamic imbalances -To correct hypotension -To improve perfusion of vital organs -To increase CO -With uncorrect tachyarrhythmias

anxiety -CV: tachy, angina, palpitations and vasoconstriction -GI: nausea and vomiting

effectiveness -Monitor HR, BP, ABG, s/sx of bronchospasm and CNS stimulation -Instruct on how to use inhaler properly -Rinse mouth after use

Drug name
Generic name DOBUTAMINE Brand name: Dobutrex

Mechanism of action
Classification -Adrenergic drugs Action -Stimulates heart beta receptors to increase myocardial contractility and SV

Administration
Dosage -0.5-1 mcg/kg/min IV infusion, titrating to optimum dosage of 2-20 mcg/kg/min -2.5 to 10 mcg/kg/min-usual effective range to increase CO

Indication
-To increase CO -Treatment of cardiac decompensation

Contraindicatio n
-Hypersensitivity -Use cautiously in pts with hx of HPN and AMI

Adverse effect
-CNS: headache -CV: HPN, tachycardia, palpitations and vasoconstriction -GI: nausea and vomiting

Nursing responsibilities
-Before starting therapy, give a plasma volume expander to correct hypovolemia and a cardiac glycoside -Monitor ECG, BP, pulmonary artery wedge pressure and CO -Monitor electrolyte levels -Dont confuse dobutamine to dopamine

Drug name
Generic name: DIPHENHYDRAMIN E HCL Brand name: benadryl

Mechanism of action
Classification -Anti-histamine Action -Blocks the effects Hi receptor sites

Administration
Dosage -25-50 mg PO, IV or IM bid-tid

Indication
-Allergic reactions -Motion sickness -Cough suppression -Sedation

Contraindicatio n
Acute asthmatic attack

Adverse effect
-Xerostomia -Urinary retention -Sedation

Nursing responsibilities
-Risk for photosensitivityuse sunscreen