Nursing consideration Action Drug name

Assess patient's mentation, response to

ventilation therapy .
compliance, O2 saturation, peak
pressures), vital signs and
hemodynamic status.
.Communicate desired outcome with
patient/family.

Sedation for a patient
receiving mechanical
ventilation in a critical
care setting
Propofol

Assess history of Hypersensitivity
Do not administer intra-arterially, which
may produce arteriospasm or gangrene.
Do not use small veins (dorsum of hand
or wrist) for IV injection.
o Administer IM injections deep
into muscle.
o Monitor IV injection site
for extravasation.
o Arrange to reduce dose
of midazolam if patient is also
being given opioid analgesics;
reduce dosage by at least 50% and
monitor patient closely.
o Monitor level of consciousness
prior to, during, and for at least 2
6 hr after administration
of midazolam.
o Carefully monitor P, BP, and
respirations carefully during
administration.
Induction of general
anesthesia

Continuous sedation
of intubated and
mechanically
ventilated patients as
a component of
anesthesia or during
treatment in the
critical care setting.

Midazolam
-Repeated intraoperative doses can cause
respiratory depression to persist into the
postoperative period.
- Fentanyl interferes with respiratory
function and pupilreaction , both of which
are essential parts of neurological
assessment.
- Assess the therapeutic response and in
breakthrough cancer pain consider
adjustment of background analgesia where
this is appropriate.
- Excessive heat may increase absorption
from patches so local heat should not be
applied and patients with fever should be


To provide analgesia
for mechanically-
ventilated intensive care
unit patients

Fentanyle
carefully monitored.

1-Observe IV site closely and avoid
extravasation. Dobutamine can cause
inflammatory response and tissue
ischaemia.
2- Monitor for adverse reactions
3- Continuous blood pressure monitoring
4- Continuous cardiorespiratory monitoring
5- Document vital signs hourly and PRN
6- Monitor fluid balance

Used for congestive
heart failure to increase
cardiac output
Intropic support for
patient with lft ventrical
dysfunction

Dobutamine

1-Patients must be cardiac monitored whilst
Dopamine infusion is in progress.
2- Report tachycardia, hypertension and
arrhythmias immediately.
3- Obtain an accurate patient weight to
calculate dose in mcg/kg/min.
4- Monitor urine flow closely during
infusion



Treatment of
hypotension, low
cardiac output, poor
perfusion of vital
organs; used to increase
mean arterial pressure
in septic shock patient


Dopamine

1-Obtain careful medical history to rule out
allergies, asthma, and obstructive
pulmonary disease. Propranolol can cause
brochoilar constriction
2- Monitor apical pulse, respiration, BP and
circulation to extremities closely throughout
period of dose adjustment
3- Monitor I&O ratio and daily weight as
significant indexes for detecting fluid
retention and developing heart failure.
4- Be aware that drug may cause mild
hypotension (experienced as dizziness or
lightheadedness) in patients on prolonged
therapy. Make position changes slowly and
avoid prolonged standing.
- to treat high blood
pressure, prevent
angina (chest pain),
-to prevent migraine
headaches and atrial
fibrillation
-to treat essential
tremor, -to treat people
who have survived a
heart attack,
-to treat certain types of
tumors
-to treat a heart
condition known as
hypertrophic subaortic
stenosis.
Propranolol
(I nderal)
beta-blockers




Dont use prefilled units to mix drips]
Increases oxygen demand
MAO inhibitors potentiate the effect
Exacerbate the dysrhythmia's response
May be deactivated by alkaline sols.
Complications of IV epic are significant

Bronchial asthma
Acute allergic
reaction
Cardiac arrest
Profound
symptomatic

Epinephrine

Uncontrolled hypertension
Vomiting seizures dysrhythmia's

bradycardia



May cause fetal anoxia
Infuse through a large stable vein to
avoid necrosis
MAO inhibitors potentiate the effects
Can be deactivated by alkaline sols
May exacerbate dysrhythmia response


Cardiogenic shock
Neurogenic shock
Inotropic support
Hemodynamically
significant
hypotension
refractory to other
sympaths



Norepinephrine
Dilates the pupils
Follow ETT with several PPV s
Effects are enhanced by;
o Thiazides, antidepressants, ant
psychotics
o Antihistamines, Procainamide,
quinidine
Adverse reactions with concurrent
admin.
Dig, cholinergics, neostigmine

Symptomatic
bradycardia
Asystole
PEA
ACE inhibitor OD
Exercise induced
bronchospastic
disorders


Atropine


Keep resuscitation equipment readily
available during naloxone administration.
Administer drug by I.V. route whenever
possible.
Give repeat doses as prescribed,
depending on patients response.
Anticipate that rapid reversal of opioid
effects can cause diaphoresis, nausea, and
vomiting.
WARNING Watch for withdrawal
symptoms, especially when giving naloxone
to opioiddependent patient.

PATIENT TEACHING
Inform patient or family that naloxone
will reverse opioid-induced adverse
reactions.
Urge opioid-dependent patient to seek
drug rehabilitation.

*To treat known or
suspected opioid
overdose
* To treat postoperative
opioid-induced
respiratory depression
* To reverse opioid-
induced asphyxia As
adjunct to treat
hypotension caused by
septic shock


Naloxone
(Narcan)

Assessment & Drug Effects
Establish baseline and continuing
data on BP, weight, fluid and
electrolyte balance, and blood
glucose.
Lab tests: Periodic serum electrolytes
blood glucose, Hct and Hgb, platelet
count, and WBC with differential.
Monitor for adverse effects. Older
adults and patients with low serum
albumin are especially susceptible to
adverse effects.
Be alert to signs of hypocalcemia (see
Appendix F).
Ophthalmoscopic examinations are
recommended every 23 mo,
especially if patient is receiving
ophthalmic steroid therapy.
Monitor for persistent backache or
chest pain; compression and
spontaneous fractures of long bones
and vertebrae present hazards.
Monitor for and report changes in
mood and behavior, emotional
instability, or psychomotor activity,
especially with long-term therapy.
Be alert to possibility of masked
infection and delayed healing
(antiinflammatory and
immunosuppressive actions).
Note: Dose adjustment may be
required if patient is subjected to
severe stress (serious infection,
surgery, or injury).
Note: Single doses of corticosteroids
or use for a short period (<1 wk) do
not produce withdrawal symptoms
when discontinued, even with
moderately large doses.




To treat severe
inflammation or acute
adrenal insufficiency

* To treat joint and
tissue inflammation
* As adjunct to treat
ulcerative proctitis of
the distal portion of the
rectum in patients who
cant retain
hydrocortisone or other
corticosteroid enemas
* To treat ulcerative
colitis

Hydrocortisone

Furosemide is often given in conjunction
with a potassium supplement or a
potassium-sparing diuretic to counteract
potassium loss.
- The medication has a rapid onset of effect
of about one hour when taken orally and
five minutes by injection.
- Duration of action is about six hours so it
is possible to use a twice daily dose if
necessary

Furosemide is primarily
used for the treatment
of hypertension and
edema
It is the first-line
agent in most people
with edema caused
by congestive heart
failure
It is also used for
hepatic cirrhosis,
renal impairment,
nephrotic syndrome.
in adjunct therapy
for
cerebral/pulmonary
edema where rapid
diuresis is required
(IV injection), and in
the management of
severe
hypercalcemia in
combination with
adequate
rehydration

Furosemide/
Lasix
allergic (hypersensitive) to calcium salts
or any of the ingredients
taking medicines for heart problems (e.g.
digitalis)
have low calcium levels due to kidney
problems
have an excess of calcium present in
either your blood or your urine
have breathing problems
Take special care with Calcium Chloride
Intravenous Infusion if:
have kidney problems
have heart problems
suffer from an inflammatory disorder
known as sarcoidosis





10% Calcium Chloride
Injection, USP is
indicated for the
treatment of
hypocalcemia in those
conditions requiring a
prompt increase in
plasma calcium levels.
A HYPERTONIC
SOLUTION IN A 10
ML UNIT OF USE
SYRINGE FOR
PROMPT
INTRAVENOUS
INJECTION.
CAUTION: This
solution must not be
injected
intramuscularly or
subcutaneously.
Administer only by slow
Ca chloride




injection
(not to exceed 1
mL/minute)

not use verapamil if patient have a
serious heart condition such as "sick
sinus syndrome" or "AV block" (unless
you have a pacemaker), severe heart
failure, slow heartbeats that have caused
you to faint, or certain heart rhythm
disorders of the atrium (the upper
chambers of the heart that allow blood to
flow into the heart).

Verapamil is used to
treat hypertension (high
blood pressure), angina
(chest pain), and certain
heart rhythm disorders.

Verapamil/
I soptin

Watch for signs of I.V. infiltration and
gangrene ; elderly patients should be
cautioned not to increase their fluid intake
beyond that sufficient to satisfy their thirst
in order to avoid water intoxication and
hyponatremia; under experimental
conditions, the elderly have shown to have a
decreased responsiveness to vasopressin
with respect to its effects on water
homeostasis


Antidiuretic hormone,
also known as
vasopressin, is a nine
amino acid peptide
secreted from the
posterior pituitary.
Antidiuretic hormone
binds to receptors in the
distal or collecting
tubules of the kidney
and promotes
reabsorbtion of water
back into the
circulation
Vasopressine

Assessment
History: Hypersensitivity to amiodarone,
sinus node dysfunction, heart block,
severe bradycardia, hypokalemia,
lactation ,thyroid dysfunction,pregnancy
Physical: Skin color, lesions; reflexes,
gait ,eye examination; P, BP,
auscultation, continuous ECG
monitoring; R, adventitious sounds,
baseline chest X-ray; liver evaluation;
LFTs, serum electrolytes, T4 ,and T3
Monitor cardiac rhythm continuously.
Monitor for an extended period when
dosage adjustments are made.
WARNING: Doses of digoxin,
quinidine ,procainamide, phenytoin, and
warfarin may need to be reduced one-
third to one-half when amiodarone is
started.
miodarone is an oral
and injectable drug that
is used to correct
abnormal rhythms of
the heart. (It is an
antiarrhythmic
medication.) Although
amiodarone has many
side effects, some of
which are severe and
potentially fatal, it has
been successful in
treating many
arrhythmias when other
antiarrhythmic drugs
have failed.
Contraindicated with
hypersensitivity to
amiodarone, sinus node
Amiodrone
















Give drug with meals to decrease GI
problems.
Arrange for ophthalmologic
examinations ;reevaluate at any sign of
optic neuropathy.
Arrange for periodic chest X-ray to
evaluate pulmonary status (every 36
mo.)
Arrange for regular periodic blood tests
for liver enzymes, thyroid hormone
levels

dysfunction, heart
block, severe
bradycardia,
hypokalemia, lactation.
Use cautiously with
thyroid dysfunction ,
pregnancy










Amiodrone

Dont administer 2 hrs prior to delivery
IV calcium gluconate or CaCl should be
available as an antagonist
Convulsions may occur up to 48 hrs post
delivery.
The cure for toxemia is delivery of the
baby.

Use with caution in renal failure
CNS depressant effects may be
enhanced in the presence of other CNS
depressants

Convulsions
associated with pre-
eclampsia and
eclampsia of
pregnancy and to
control convulsions
associated with acute
nephritis in children.
Hypomagnesaemia
especially acute cases
accompanied by
signs of tetany.

MAGNESIUM
SULFATE is
indicated in uterine
tetany and
premature labour as
a myometrial
relaxant.


MAGNESI UM
SULFATE
Avoid for use in reperfusion dysrhythmia
Use with caution in
Hepatic disease/heart failure
Marked hypoxia
Respiratory depression
Hypovolemia/shock
complete HB, AF
If bradycardia is present treat PVCs with
Atropine



VT/VF
Wide complex
tachycardia of
uncertain origin
Significant
ventricular ectopy in
the setting of MI

Lidocaine

-When possible ABGs should be the guide
-Produces CO2 which may worsen cellular
acidosis
-May worsen CHF
-Must maintain adequate ventilation
-Cant be administered concomitantly with
Calcium.
-May deactivate vasopressors

Known bicarbonate
responsive acidosis
Intubated pt with
long arrest interval
PEA/DKA
TCA OD
Metabolic acidosis


Sodium
Bicarbonate
who are physically dependent on
benzodiazepines may suffer benzodiazepine
withdrawal symptoms, including seizure,
upon rapid administration of flumazenil.
It is not recommended for routine use in
those with a decreased level of
consciousness.
used as an antidote
in the treatment of
benzodiazepine
overdoses
Flumazenil
This medicine may cause dizziness and so
may affect your ability to drive

Patients on long-acting or transdermal
preparations commonly develop tolerance
and reduced therapeutic effects.
- Evaluate therapeutic response.
- Metal-containing transdermal systems
should be removed before cardioversion or
diathermy.
- Periodic blood pressure checks are
necessary.
- Most side-effects will reduce over time

used for the
treatment of angina,
acute myocardial
infarction, severe
hypertension and
coronary artery
spasms
Glycerine
trinitrate