EMERGENCY DRUGS USED IN THE EMERGENCY ROOM 1.

Morphine sulfate BRAND NAME: Avinza DRUG CLASSIFICATION: opioid analgesic MECHANISM OF ACTION: Relieves pain by stimulating opiate receptors in CNS; also causes respiratory depression, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting and increased bladder tone. ADVERSE REACTION: shallow breathing, slow heartbeat; seizure (convulsions); cold, clammy skin; confusion; severe weakness or dizziness; or feeling light-headed, fainting. NURSING RESPONSIBILITY: Caution patient not to chew or crush controlled-release preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects. Tell patient to lie down during IV administration. Keep opioid antagonist and facilities for assisted or controlled respiration readily available during IV administration.

2. Dobutamine hydrochloride BRAND NAME: Dobutrex DRUG CLASSIFICATION: Inotropic MECHANISM OF ACTION: Enhancing the force of myocardial contraction; increases HR, CO, and SV with minor effects to HR. elevated ventricular filling pressure and helps AV node conduction. ADVERSE REACTION: CV: angina, hypertension, hypotension, increased heart rate, nonspecific chest pain, phlebitis, PVCs. GI: nausea and vomiting. Respiratory: asthma attacks, shortness of breath. Others: anaphylaxis. NURSING RESPONSIBILITY: Monitor CVP to assess vascular volume and cardiac pumping efficiency. (Elevated CVP may indicate disruption on CO, as in pump failure or Pulmonary edema; low CVP may indicate hypovolemia) Monitor ECG and BP continuously during drug administration; Record I&O Monitor glucose in diabetes patients; Drug is administered IV to improve cardiac

function thus increasing BP and improving urine output. Report any chest pain, increase SOB, headaches or IV site pain.

3. Atropine sulfate BRAND NAME: Isopto Atropine DRUG CLASSIFICATION: Anticholinergics MECHANISM OF ACTION: cholinergic receptor sites so response to acetylcholine is decreased ADVERSE REACTION: CNS: restlessness, ataxia, disorientation, hallucinations, delirium, coma, insomnia, agitation, confusion. CV: tachycardia, angina, arrhythmias, flushing. EENT: photophobia, blurred vision, mydriasis. GI: dry moth, constipation, vomiting. GU: urine retention. Hematologic: leukocytosis Other: anaphylaxis NURSING RESPONSIBILITY Monitor for constipation, oliguria. Atrophine could result in CNS stimulation (confusion, excitement) or drowsiness Instruct to take 30 mins before meals Eat foods high in fiber and drink plenty fluids. Avoid OTC antihistamines. Instruct client not to drive a motor vehicle or participate in activities requiring alertness.

4. Epinephrine BRAND NAME: Adrenalin Chloride DRUG CLASSIFICATION: Beta2 Adrenergic Agonists MECHANISM OF ACTION: Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity BP, HR, PR; Decreases airway resistance. ADVERSE REACTION nervousness, tremor, vertigo, pain, widened pulse pressure, hypertension nausea NURSING RESPONSIBILITY: 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 parenteral suspension into buttocks. Gas gangrene may occur ;Massage site after IM injection to counteract

possible vasoconstriction. Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop

5. Furosemide BRAND NAME: Lasix DRUG CLASSIFICATION: Loop Diuretics MECHANISM OF ACTION inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henlen ADVERSE REACTION : vertigo, headache, paresthesia, orthostatic hypotension, thrombophlebitis, abdominal pain, Hypokalemia, anemia, muscle spasm NURSING RESPONSIBILITY: Monitor serum glucose, and electrolyte D iet- K+ for all except aldactone I ntake and Output, daily weight U ndesirable effects; Fluid and electrolyte imbalance R eview HR, BP and electrolytes E lderly-Careful T ake with or after meals and in AM I ncrease risk of orthosthatic hypotension; move slowly C ancel alcohol

6. Digoxin BRAND NAME: Lanoxin DRUG CLASSIFICATION: Cardiac Glycosides MECHANISM OF ACTION: Inhibits the sodium-potassium ATP phase. ADVERSE REACTION : CNS: hallucinations, paresthesia, stupor, vertigo. CV: Arrythmias, heart failure, hypotension. EENT: blurred vision, diplopia, light flashes, photophobia, yellow-green halos around visual images. GI: anorexia, diarrhea, nausea, vomiting. NURSING RESPONSIBILITY : Monitor K+, Mg++, ECG, liver/renal function tests, drug level (therapeutic level 0.5-2.0 mg/ml, toxicity is >2.0 mg/ml). Before each dose assess apical pulse for full minute, record and report changes in rate or rhythm. Withhold drug and contact provider if pulse is < 60/min. or >100 (adults) or < 110/minute (children)

7. Sodium Bicarbonate BRAND NAME: Arm and Hammer Pure Baking Soda, Citrocarbonate, Soda Mint DRUG CLASSIFICATION: Alkalizing Agent, Buffer, Antacid, electrolyte MECHANISM OF ACTION: Neutralizes gastric acid; Decrease pepsin activity ADVERSE REACTION: GI: Gastric distention, belching, flatulence. Metabolic: metabolic alkalosis, hypernatremia, hypokalemia, hyperosmolarity (with overdose). Other: Pain and irritation at injection site. NURSING RESPONSIBILITY Monitor urinary pH, calcium, electrolytes and phosphate levels. Record amount and consistency of stools. Clients on low-sodium diets should evaluate sodium contents of antacids.

8. Dopamine HCL BRAND NAME: Arm Intropin; Revimine DRUG CLASSIFICATION: Inotropic, vasopressor MECHANISM OF ACTION: Neutralizes gastric acid; Decrease pepsin activity ADVERSE REACTION: Cv: anginal pain, arrythmias, bradycardia, conduction disturbances ectopic breasts,hypertension, hypotension, palpitations, tachycardia, vasoconstriction, widening of QRS complex. NURSING RESPONSIBILITY : Blood is not a substitute for blood or fluid volume deficit. If deficit occurs, replace fluid deficit first before giving meds. During infusion, frequently monitor ECG, BP, cardiac output, CVP, pulmonary artery wedge pressure, pulse rate, urine output, and color and temperature of the limbs.

9. Nitroglycerin BRAND NAME: Nitrostat DRUG CLASSIFICATION: Antianginal, Nitrate, Vasodilator, Coronary MECHANISM OF ACTION: Relaxes the vascular smooth system. Increases Myocardial oxygen consumption, left ventricular workload, arterial BP, venous return ADVERSE REACTION: CV: orthostatic hypotension, flushing, fainting. EENT: sublingual burning. Skin: Cutaneous vasodilation, contact dermatitis (patch)

 NURSING RESPONSIBILITY : Record characteristics and precipitating factors of anginal pain. Monitor BP and apical pulse before administration and periodically after dose. Have client sit or lie down if taking drug for the first time. Client must have continuing EKG monitoring for IV administration.

10. Lidocaine BRAND NAME: Xylocaine DRUG CLASSIFICATION: Antiarrythmic and Anesthetic MECHANISM OF ACTION: Decrease cardiac excitability, cardiac contraction is delayed in the atrium and ventricle ADVERSE REACTION: CNS: Confusion, tremor, lethargy, somnolence, stupor, restlessness anxiety, hallucinations, nervousness, seizure. CV: hypotension, bradychardia, new or worsened arrhythmias EENT: tinnitus, blurred or double vision. Respiratory: Respiratory depression and arrest ; Skin: soreness at injection site ;Other: anaphylaxis, NURSING RESPONSIBILITY Monitor EKG, BP, pulse, rhythm, continuously. Monitor serum lidocaine levels throughout theraphy; therapreutic range 1.5-5 mcg/ml; Monitor intake and output ; Do not mix in the same syringe with amphoterin B or cefazolin

SAINT LOUIS UNIVERSITY SCHOOL OF NURSING Baguio City

EMERGENCY DRUGS USED IN THE EMERGENCY ROOM

Submitted to: Mr. Roderick Ortega, R.N. Clinical Instructor

Submitted by: MONTENEGRO, PAOLO LUIS BSN-III-A3

April 19, 2012