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EMERGENCY DRUGS CARDIAC DRUGS ATROPINE SULFATE

Isopto Atropine
Classification Anticholinergics Dosage Bradycardia: 0.5 mg IV every 3-5 mins, max of 0.04 mg/kg Cardiac Arrest: 1 mg every 3-5 mins Nerve and Organophosphate symptoms: may repeat in 2 mg increments q 3 mins titrated to relief symptoms

Instruct client not to drive a motor vehicle or participate in activities requiring alertness. Advise to use hard candy, ice chips, etc. for dry mouth.

NITROGLYCERINE
Nitrostat Classification Dosage Action Relaxes the vascular smooth system Reduces Reduces Reduces Reduces myocardial oxygen consumption left ventricular workload arterial BP venous return 0.3-0.4 mg SL q 5 min, max 3 doses. Every 6 hrs except for midnight (cream) Wear 12 hrs a day for skin patch Antianginal Nitrate Vasodilator, Coronary

Indication Pre-op meds/pre-anesthetic meds To restore cardiac rate and arterial pressure during anesthesia when vagal To lessen the degree of A-V heart block To overcome severe carotid sinus reflex Antidote for cholinergic toxicity

Side effects CNS: restlessness, ataxia, disorientation, hallucinations, delirium, coma, insomnia, agitation, confusion. CV: tachycardia, angina, arrhythmias, flushing. EENT: photophobia, blurred vision, mydriasis. GI: dry mouth, constipation, vomiting. GU: urine retention. Hematologic: leucocytosis Other: anaphylaxis Adverse effects CNS: headache, excitement. CV: palpitations GI: thirst, nausea Contraindications Hypersensitivity With acute angle closure glaucoma, obstructive uropathy, obstructive disease of GI tract, paralytic ileus, toxic megacolon, intestinal atony, unstable CV status in acute hemorrhage, asthma, or myasthenia gravis. Pregnant women. Nursing Management Monitor VS. Report HR Monitor for constipation, oliguria. Instruct to take 30 mins before meals Eat foods high in fiber and drink plenty fluids. Can cause photophobia

Indication Angina pectoris CHF associated with AMI Cardiac load reducing agent Hypertensive Crisis

Side effects CNS: headache, throbbing, dizziness, weakness. GI: nausea, vomiting Skin: Rash

Adverse Reactions CV: orthostatic hypotension, flushing, fainting. EENT: sublingual burning. Skin: Cutaneous vasodilation, contact dermatitis (patch)

Contraindications Contraindicated in patients hypersensitive to nitrates With early MI. (S.L. form), severe anemia, increase ICP angle-closure glaucoma, IV nitroglycerine is contraindicated in patients with hypovolemia, hypotension, orthostatic hypotension, cardiac tamponade restrictive cardiomyopathy, constrictive pericarditis.

Nursing Management 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 Cardioverter/ defibrillator must not be discharged through paddle electrode overlying Nitro-Bid ointment or the TransdermNitro Patch. Assist with ambulating if dizzy. Instruct to take at first sign of anginal pain. May be repeated q 5 minutes to max. of 3 doses. If the client doesnt experience relief, advise to seek medical assistance immediately. Keep in a dark colored container Action Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation

Indication Relief of moderate to severe acute and chronic pain Preoperative medication Analgesic adjunct during anesthesia Component of most preparations that are referred to as Brompton's cocktail or mixture Intraspinal use with microinfusion devices for the relief of intractable pain Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary edema

Side Effects GI: dry mouth, constipation. Skin: Tissue irritation and induration (SC injection). Other: sweating,physical tolerance and dependence, psychological dependence Adverse Effects CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm, bronchospasm, edema GI: Nausea, vomiting, anorexia, biliary tract spasm; increased colonic motility in patients with chronic ulcerative colitis GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency Respiratory: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest Contraindications Hypersensitivity to opioid Diarrhea caused by poisoning until toxins are eliminated During labor or delivery of a premature infant After biliary tract surgery or following surgical anastomosis

MORPHINE SULFATE
Immediate-release tablets: MSIR Timed-release: Kadian, M-Eslon (CAN), MS Contin, Oramorph SR Oral solution: MSIR, Rescudose, Roxanol, Roxanol T Rectal suppositories: RMS Injection: Astramorph PF, Duramorph, Epimorph (CAN) Preservative-free concentrate for microinfusion devices for intraspinal use: Infumorph Classification Opioid Agonist Analgesic Dosage Oral: 1030 mg q 4 hr PO. Controlledrelease: 30 mg q 812 hr PO or as directed by physician; Kadian: 20100 mg PO daily24-hr release system; MS Contin: 200 mg PO q 12 hr. SC and IM:10 mg (520 mg)/70 kg q 4 hr or as directed by physician. IV:2.515 mg/70 kg of body weight in 45 mL water for injection administered over 45 min, or as directed by physician. Continuous IV infusion: 0.11 mg/mL in 5% dextrose in water by controlled infusion device. Rectal:1030 mg q 4 hr or as directed by physician.

Nursing Management Interventions Caution patient not to chew or crush controlled-release preparations. Dilute and administer slowly Tell patient to lie down during IV administration. Keep opioid antagonist and facilities for assisted or controlled respiration readily available during IV administration. Use caution when injecting SC or IM into chilled areas or in patients with hypotension or in shock Reassure patients that they are unlikely to become addicted

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 Contraindications Hypersensitivity Sick sinus syndrome 2nd or 3rd degree AV block CHF Cardiogenic shock Concurrent IV beta-blocker

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

Teaching points Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives, tranquilizers, over-thecounter drugs. Swallow controlled-release preparation (MS Contin, Oramorph SR) whole; do not cut, crush, or chew them. Do not take leftover medication for other disorders, and do not let anyone else take your prescription. These side effects may occur: Nausea, loss of appetite, constipation, dizziness, sedation, drowsiness, impaired visual acuity Report severe nausea, vomiting, constipation, shortness of breath or difficulty breathing, rash.

DILTIAZEM
Cardizem, Dilacor, Novo-Diltiazem, Tiamate and Tiazac Classification Anti-anginals Antiarrhythmics Antihypertensive Ca channel blocker Dosage Action Inhibits calcium transport into myocardial smooth muscle cells Systemic and coronary vasodilation PO: 30-120 mg, 3-4x daily or 60-120 mg twice daily as SR capsules IV: 0.25 mg/kg

VERAPAMIL
Calan, Isoptin, Verelan, Covera HS Classification Anti-anginal Anti-arrhythmics Anti-hypertensive Vascular headache suppressants

Indication Hypertension Angina Pectoris Supraventricular Arrhythmia Atrial flutter/fibrillation

Dosage PO 80-120 mg 3x daily, increases as needed Action Inhibits calcium transport into myocardial smooth muscle cells Decreases SA and AV conduction and prolongs AV node refractory period in conduction tissue

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

Indication Hypertension Angina Pectoris Supraventricular Arrhythmia Atrial flutter/fibrillation

Side Effects and Adverse Reactions CNS:abnormal dreams, anxiety, confusion, dizziness and headache Hypersensitivity

Sick sinus syndrom2nd or 3rd degree AV block CHF Cardiogenic shock Concurrent IV beta-blocker

AMIODARONE
Cordarone Classification Anti-arrhythmics Dosage Recurrent ventricular arrhythmias: PO800-1600 mg/day for 1-2 wks PSVT, symptomatic atrial flutter: PO 600-800 mg/day for 1 month Arrhythmias with CHF: 200 mg/day Ventricular dysrrhythmias: 150 mg over the 1st 10 mins then slow 360 mg over the next 6 hrs

Nursing Management Monitor BP and pulse before therapy, during titration and therapy Monitor I&O and weight Assess for CHF Routine serum digoxin monitoring

LIDOCAINE
Xylocaine Classification CV drugs: Anti-arrhythmics Anesthetic

Action Blocks Na channels, prolonging myocardial cell action potential and refractory period Non competitive alpha and beta adrenergic blockage

Dosage Arrhythmia: IV: 0.7-1.4 mg/kg body weight. No more than 200 mg within 1 hour period IM: 4-5 mg/kg body weight Action Increases electrical stimulation of ventricle and His-purkinje system by direct action on tissues, resulting to decrease depolarization, automaticity and excitability in ventricles during diastolic phase Indication Anesthesia Arrhythmias Control of Status epilepticus refractory to other treatments

Indication Life threatening recurrent arrhythmias Ventricular fibrillation Ventricular tachycardia

Side Effects and Adverse Reactions Exacerbation of arrhythmias, bradycardia, SA node dysfunction, heart block, sinus arrest; flushing, fatigue, malaise, abnormal involuntary movements, ataxia, dizziness, paresthesia, decreased libido, insomnia, headache, sleep disturbances, visual impairment, blindness, corneal microdeposits, photophobia, abnormal taste, nausea, vomiting, constipation, anorexia, abdominal pain, abnormal salivation, coagulation abnormalities, non-specific hepatic disorders, pulmonary inflammation, dyspnea, toxicosis, death, edema, hypo and hyperthyroidism Contraindications Severe sinus node dysfunction 2nd or 3rd degree AV block Hypersensitivity

Side Effects and Adverse Reactions 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 Contraindications Hypersensitivity Heart block Hypovolemia Adams stroke syndromes Infection at site of injection Nursing Management 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

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

PROCAINAMIDE
Pronestyl, Procan-SR, Procanbid Classification Antiarrhythmics Dosage Arrhythmias: 50 mg/kg/day in divided doses 36 hourly Action Blocks open Na channels and prolongs the cardiac action potential. This results in slowed conduction and ultimately the decreased rate of rise of the action potential may result on the widening of QRS on ECG Indication Supraventricular and ventricular arrhythmias. Treatment of Wolf-Parkinson-White Syndrome

Classification Beta2 Adrenergic Agonists Dosage Action Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity Increases BP, HR, PR Decreases airway resistance. Cardiac arrest: 1 mg IV of 1:10,000 solution q 3-5 min; double dose if administering via ET tube Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000 solution. Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution Refractory bradycardia and hypotension: 2-10ug/min

Indication Asthma Bronchitis Emphysema All cardiac arrest, anaphylaxis Used for symptomatic bradycardia. Relief of bronchospasm occurring during anesthesia Exercised-induced bronchospasm

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

Side Effects/Adverse Reactions Side Effects: nervousness, tremor, vertigo, pain, widened pulse pressure, hypertension nausea Adverse Effects: headache Contraindications With angle-closure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Also contraindicated in patient receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage) In conjunction with local anesthesia, epinephrine is contraindicated for use in finger, toes, ears, nose, and genitalia. In pregnant woman, drug is contraindicated. In breast feeding do not use the drug or stop breast feeding.

Contraindications Heart block Heart failure Hypotension Myesthenia gravis Digoxin toxicity Lactation Nursing Management Assess cardiovascular status before therapy Assess pulmonary, hepatic and thyroid function before and during therapy Monitor fluid and electrolytes, I&O, K, Na and Cl Monitor ECG, BP Assess vision

EPINEPHRINE
Injection, OTC nasal solution: Adrenalin Chloride Ophthalmic solution: Epifrin, Glaucon Insect sting emergencies: EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for children) OTC solutions for Nebulization: AsthmaNefrin, microNefrin, Nephron, S2

Nursing Management 1.Monitor V/S. and check for cardiac dysrrhythmias 2.Drug increases rigidity and tremor in patients with Parkinsons disease 3.Epinephrine therapy interferes with tests for urinary catecholamine

4. Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur 5. Massage site after IM injection to counteract possible vasoconstriction. 6. Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop 7. If blood pressure increases sharply, rapid-acting vasodilators such as nitrates or alpha blockers can be given to counteract

MAGNESIUM SO4
Classification Anti-convulsant Anti-arrhythmics Dosage Arrhythmia: IV 1-6 grams over several minutes, then continuous IV infusion 3-20 mg/min for 5-48 hours.

VASOPRESSIN
Pitressin Classification Pituitary Hormones ADH Dosage Prevent and treat abdominal distention: initially 5 units IM gives subsequent injections q3-4 hours increasing to 10 units if needed. Action Increase permeability of renal tubular epithelium to adenosine monophosphate and water, the epithelium promotes reabsorption of water and concentrated urine Indication Diabetes Insipidus Abdominal Distention GI bleeding Esophageal varices Action

Decreased acetylcholine released

Indication Mg replacement Arrhythmia

Side Effects and Adverse Reactions CNS: drowsiness, depressed reflexes, flaccid paralysis, hypothermia CV: hypotension, flushing, bradycardia, circulatory collapse, depressed cardiac function EENT: diplopia Respiratory: respiratory paralysis Metabolic: hypocalcemia Skin: diaphoresis

Contraindications Heart block and myocardial damage Toxemia of pregnancy

Side Effects and Adverse Reactions CNS: tremor, headache, vertigo CV: vasoconstriction, arrhythmias, cardiac arrest, myocardial ischemia, circumollar pallor, decreased CO, angina GI: abdominal cramps GU:uterine cramps Respi: bronchoconstriction Skin: diaphoresis, gangrene and urticaria

Nursing Management Monitor I&O. make sure urine output is 100 ml or more in 4 hrs pd before each dose Take appropriate seizure precautions Keep IV Ca gluconate at bedside

Na HCO3
Arm and Hammer; Baking Soda Classification Alkalinizers Dosage Metabolic Acidosis: Usually 2-5 meq/kg IV infuse over 4-8 hr period Cardiac Arrest: 1 meq/kg IV of 7.5 or 8.4% sol, then 0.5 meq/kg IV q 10 mins depending on ABG

Contraindications With chronic nephritis and nitrogen retention Hypersensitivity

Nursing Management Give 1-2 glass of H20 to reduce adverse reactions and improve therapeutic response Warm vasopressin in your hands and mixed until it is distributed evenly in the solution Monitor urine Sp. Gravity and I&O to aid evaluation of drug effectiveness

Action Restore buffering capacity of the body and neutralizes excessive acid

Indication Metabolic Acidosis Cardiac Arrest

Side Effects/Adverse Reactions CNS: tetany CV: edema GI: gastric distention, belching and flatulence Metabolic: hypokalemia, metabolic alkalosis, hypernatremia, hyperosmolarity with overdose Skin: pain @ injection site Contraindications Metabolic and respiratory alkalosis Pt losing Cl because of vomiting or continuous GI suction or those receiving diuretics that produces hypochloremic alkalosis

FUROSEMIDE
Lasix Classification Loop Diuretics Dosage Pulmonary 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 Action Inhibits Na and Cl reabsorption at the proximal and distal tubules and in the ascending loop of Henle Indication Acute pulmonary edema Edema Hypertension

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

HYPERTENSIVE CRISIS
Na NITROPRUSSIDE
Nittropress Classification Antihypertensive, Vasodilator Dosage 0.25-0.3 mcg/kg/minute Action Relaxes arteriolar and venous smooth muscle Indication Hypertensive crisis To produce controlled hypotension during anesthesia To reduce preload and afterload in cardiogenic shock

Side Effects/Adverse Reactions Signs of hypotension, hypokalemia and hyperglycemia

Contraindications Hypersensitivity Anuria

Nursing Management 1. Monitor wt., BP and PR 2. Monitor fluid, I&O, electrolyte, BUN and CO2 levels frequently 3. WOF signs of hypokalemia 4. Monitor uric acid levels 5. Monitor glucose levels esp in DM pts MORPHINE SO4 (Discussed earlier)

Side Effects/Adverse Reactions Headache, dizziness, increased ICP, loss of consciousness, restlessness, bradycardia, nausea, abdominal pain, methemoglodinemia, muscle twitching, pink-colored rash, irritation at infusion site

NEUROSURGICAL DRUGS
MANNITOL
Osmitrol Classification Diuretics Dosage Test dose for marked oliguria or suspected inadequate renal function: 200 mg/kg or 12.5 gram as a 15% to 20% IV solution over 3-5 mins response is adequate if 30-50 ml of urine/hr is adequate, a second dose is given if still no response after 2nd dose stop the drug Oliguria: 50 over 90 mins to several hrs To induced intraocular or intracranial pressure: 1.5-2 gram/kg as a 15 % to 20% IV solution over 30-60 min Diuresis in drug intoxication: 12.5% to 10% solutions up to 200 g IV Irrigating solution during TURP: 2.55%

Contraindications Hypersensitivity Compensatory hypotension Inadequate cerebral circulation Acute heart failure with reduced PVR Congenital optic atrophy Tobacco-induced ambylopia

Nursing Management 1. Obtain VS before giving the drug 2. Place pt in supine 3. Giving excessive doses of 500 mcg/kg delivered faster than 2 mcg/kg/min or using max infusion rate of 10 mcg/kg/min for more than 10 mins can cause cyanide toxicity

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

Action Reverse the effects of opiods, psychotomimetic and dysphoric effects of agonist-antagonists

Indication For suspected opioid induced respiratory depression For postoperative opiod depression

Indication Test dose for marked oliguria or suspected inadequate renal function Oliguria To induced intraocular or intracranial pressure Diuresis in drug intoxication Irrigating solution during TURP

Side Effects/Adverse Reactions CNS: seizures, tremors CV: ventricular fibrillation, tachycardia, HPN with higher recommended doses, hypotension GI: nausea and vomiting Respiratory: pulmonary edema Skin: diaphoresis

Side Effects/Adverse Reactions CN: seizures, headache and fever CV: edema, thrombophlebitis, 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

Contraindications Hypersensitivity Use cautious with cardiac irritability or opiod addiction.

Nursing Management Assess respiratory status frequently Respiratory rate increases within 1-2 mins

Contraindications Hypersensitivity Anuria, severe pulmonary congestion, frank pulmonary edema, active intracranial bleeding during craniotomy, severe dehydration, metabolic edema, progressive heart failure or pulmonary congestion after drug

IPECAC SYRUP
Classification Antidote Dosage 25-30 ml followed immediately by H2O Action Irritates the stomach lining and stimulate the vomiting center Indication Poisoning Overdose Side Effects Diarrhea, drowsiness, stomach cramps, vomiting, itching, DOB, swelling of the mouth, rash and hives Contraindications Hypersensitivity Given activated charcoal Unconcious Drowsy Severely drunk Having seizures With no gag reflex

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

POISONING
NALOXONE HCL
Narcan Classification Miscellaneous antagonists and antidotes Dosage For suspected opioid induced respiratory depression: 0.4 to 2 mg IV, IM and SQ. repeat doses q 2-3 mins PRN For postoperative opiod depression: 0.01 to 0.2 mg IV q 2-3 mins, PRN. Repeat dose within 1-2 hr, if needed.

Nursing Management 1. Dont administer to unconscious 2. Pt should kept active and moving ff administration 3. If vomiting does not occur after 2nd dose, gastric lavage may be considered to remove ingested substance

Nursing Management

ACTIVATED CHARCOAL
Classification Antidote Dosage 30-100 g with at least 8 oz of water Action Inhibits GI absorption of toxic substances or irritants Hyperosmolarity

1. Must individualize dosage. Give only smallest amount effective. 2. Give through freely running IV infusion into large vein to minimize pain at injection site 3. Note history of seizure or panic disorder 4. Assess evidence of increased ICP 5. Note evidence of sedative and benzodiazepine dependence 6. Instruct to avoid alcohol and nonprescription drugs for 1-24 hrs

Indication Poisoning Side Effects Pain, melena, diarrhea, vomiting and constipation

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

Contraindications Cyanide, mineral acids, organic solvents, intestinal obstruction, bleeding with fructose intolerance, broken GI tract, concomitant use of charcoal with sorbitol

Nursing Management Do not mix with chocolate and together with ipecac syrup Notify doctor if caused swelling or pain in the stomach

Indication To treat shock and correct hemodynamic imbalances To correct hypotension To improve perfusion of vital organs To increase CO

FLUMAZENIL
Romazicon Classification Benzodiazepine receptor antagonists Dosage 2 ml IV given over 15 seconds Action Antagonizes the effects of benzodiazepines Indication Benzodiazepine-induced depression of the ventilatory responses to hypercapnia and hypoxia

Side Effects CNS: headache an anxiety CV: tachy, angina, palpitations and vasoconstriction GI: nausea and vomiting

Contraindications Hypersensitivity With uncorrect tachyarrhythmias Pheochromocytoma Ventricular Fibrillation

Side Effects Nausea, vomiting, palpitations, sweating, flushing, dry mouth, tremors, insomnia, dyspnea, hyperventilation, blurred vision, headache, pain at injection site

Nursing Management Most patients received less than 20 mcg/kg/min Drugs isnt substitute for blood or fluid volume deficit During infusion, monitor ECG, BP, CO, PR and color and temp of the limbs Do not confuse dopamine to dobutamine Check urine output often

Contraindications Control of ICP or status epilepticus. Signs of serious cyclic antidepressant overdose

DOBUTAMINE
Dobutrex Classification Adrenergic drugs 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

Monitor V/S and blood sugar level Response within 20 mins after injection

ALBUTEROL
Ventolin Classification Bronchodilator, Adrenergic Dosage 2 inhalations reputed q 4-6 hrs via neb Action Activation of beta adrenergic receptors on airway smooth muscle Indication Asthma Prevention of exercise induced spasms

Action Stimulates heart beta receptors to increase myocardial contractility and SV Indication To increase CO Treatment of cardiac decompensation Side Effects CNS: headache CV: HPN, tachycardia, palpitations and vasoconstriction GI: nausea and vomiting

Side effects Palpitations Tachycardia GI upset Nervousness Contraindications Hypersensitivity Nursing Management Monitor therapeutic effectiveness Monitor HR, BP, ABG, s/sx of bronchospasm and CNS stimulation Instruct on how to use inhaler properly Rinse mouth after use

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

Nursing Management 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

DIPHENHYDRAMINE HCL
Benadryl Classification Anti-histamine Dosage 25-50 mg PO, IV or IM bid-tid Action Blocks the effects Hi receptor sites Indication Allergic reactions Motion sickness Cough suppression Sedation Side Effects Xerostomia Urinary retention Sedation Contraindications Acute asthmatic attack Nursing Management Risk for photosensitivity

GLUCAGON
Classification Pancreatic Hormones Dosage 0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN Action Binds with glucagon receptor Indication Hypoglycemia Side Effects Nausea, vomiting, hypotension, tachycardia and hypertension Contraindications Hypersensitivity Pheochromocytoma Insulinoma Nursing Management - use sunscreen