Emergency Drugs by E. D. Perillo Jr.

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

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: leukocytosis
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
.
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
.
Antianginal
.
Nitrate
.
Vasodilator,
.
Coronary

Dosage
.
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
Action
.
Relaxes the vascular smooth system
.
Reduces myocardial oxygen consumption
.
Reduces left ventricular workload
.
Reduces arterial BP
.
Reduces venous return
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
10
.
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 Transderm-Nitro
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 doesn t experience relief, advise
to seek medical assistance immediately.
.
Keep in a dark colored container
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: 10 30 mg q 4 hr PO. Controlled-
release: 30 mg q 8 12 hr PO or as directed
by physician; Kadian: 20 100 mg PO daily
24-hr release system; MS Contin: 200 mg
PO q 12 hr.
.
SC and IM:10 mg (5 20 mg)/70 kg q 4 hr
or as directed by physician.
.
IV:2.5 15 mg/70 kg of body weight in 4 5
mL water for injection administered over
4 5 min, or as directed by physician.
Continuous IV infusion: 0.1 1 mg/mL in 5%
dextrose in water by controlled infusion
device.
.
Rectal:10 30 mg q 4 hr or as directed by
physician.
.
Action
Emergency Drugs by E. D. Perillo Jr.
.
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
.
Pregnancy
.
Labor

10
Nursing ManagementInterventions
.
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
Teaching points
.
Take this drug exactly as prescribed. Avoid
alcohol, antihistamines, sedatives,
tranquilizers, over-the-counter 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.
VERAPAMIL
Calan, Isoptin, Verelan, Covera HS
Classification
.
Anti-anginal
.
Anti-arrhythmics
.
Anti-hypertensive
.
Vascular headache suppressants

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

Indication
.
Hypertension
.
Angina Pectoris
.
Supraventricular Arrhythmia
.
Atrial flutter/fibrillation
Side Effects and Adverse Reactions
.
CNS:abnormal dreams, anxiety, confusion,
dizziness and headache

Emergency Drugs by E. D. Perillo Jr.

.
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
DILTIAZEM
Cardizem, Dilacor, Novo-Diltiazem, Tiamate and
Tiazac
Classification
§ Anti-anginals
§ Antiarrhythmics
§ Antihypertensive
§ Ca channel blocker

Dosage
§ PO: 30-120 mg, 3-4x daily or 60-120 mg
twice daily as SR capsules
§ IV: 0.25 mg/kg
Action
§ Inhibits calcium transport into myocardial
smooth muscle cells
§ Systemic and coronary vasodilation
Indication
§ Hypertension
§ Angina Pectoris
§ Supraventricular Arrhythmia
§ Atrial flutter/fibrillation
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
10
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 I&O and weight
§ Assess for CHF
§ Routine serum digoxin monitoring

LIDOCAINE
Xylocaine
Classification
§ CV drugs: Anti-arrhythmics
§ Anesthetic
DosageArrhythmia:
§ 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
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
Emergency Drugs by E. D. Perillo Jr.
§ 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

AMIODARONE
Cordarone
Classification
Anti-arrhythmics
DosageRecurrent ventricular arrhythmias:
.
PO.800-1600 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
Action
§ Blocks Na channels, prolonging myocardial
cell action potential and refractory period
§ Non competitive alpha and beta adrenergic
blockage
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
Nursing Management
.
Assess cardiovascular status before therapy
10
§ 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 3-6
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
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
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
10
Emergency Drugs by E. D. Perillo Jr.
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
Classification
Beta2 Adrenergic Agonists
Dosage
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
Action
.
Stimulates beta receptors in lung.
.
Relaxes bronchial smooth muscle.
.
Increases vital capacity
.
Increases BP, .
HR, .
PR
.
Decreases airway resistance.
Indication
.
Asthma
.
Bronchitis
.
Emphysema
.
All cardiac arrest, anaphylaxis
.
Used for symptomatic bradycardia.
.
Relief of bronchospasm occurring during
anesthesia
.
Exercised-induced bronchospasm
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.
Emergency Drugs by E. D. Perillo Jr.

.
In breast feeding do not use the drug or
stop breast feeding.
Nursing Management
1.
Monitor V/S. and check for cardiac
dysrrhythmias
2.
Drug increases rigidity and tremor in
patients with Parkinson s 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
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

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
Contraindications
§ With chronic nephritis and nitrogen
retention
§ Hypersensitivity
10
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
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.
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
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
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

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
Headache, dizziness, increased ICP, loss of
consciousness, restlessness, bradycardia, nausea,
10
Emergency Drugs by E. D. Perillo Jr.
abdominal pain, methemoglodinemia, muscle
twitching, pink-colored rash, irritation at infusion
site
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
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
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)
Emergency Drugs by E. D. Perillo Jr.

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%

Action
Increases osmotic pressure of glomerular
filtrate, inhibiting tubular reabsorption of
water and electrolytes; drug elevates plasma
osmolarity, increasing water flow into
extracellular fluid
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
.
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
.
Anuria, severe pulmonary congestion,
frank pulmonary edema, active
intracranial bleeding during craniotomy,
severe dehydration, metabolic edema,
progressive heart failure or pulmonary
congestion after drug
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.
.
Action
.
Reverse the effects of opiods,

psychotomimetic and dysphoric effects of

agonist-antagonists
Indication
.
For suspected opioid induced respiratory
depression
.
For postoperative opiod depression
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

Contraindications
.
Hypersensitivity
.
Use cautious with cardiac irritability or
opiod addiction.
Nursing Management
.
Assess respiratory status frequently
.
Respiratory rate increases within 1-2 mins
IPECAC SYRUP
Classification
Antidote
10
Emergency Drugs by E. D. Perillo Jr.

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
1.
Don t 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
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
Indication
Poisoning
Side Effects
Pain, melena, diarrhea, vomiting and
constipation
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
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
Nausea, vomiting, palpitations, sweating,
flushing, dry mouth, tremors, insomnia,
dyspnea, hyperventilation, blurred vision,
headache, pain at injection site
Contraindications
Control of ICP or status epilepticus.
Signs of serious cyclic antidepressant
overdose
Nursing Management
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 non-prescription
drugs for 1-24 hrs
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
10
Emergency Drugs by E. D. Perillo Jr.

Indication
.
To treat shock and correct hemodynamic
imbalances
.
To correct hypotension
.
To improve perfusion of vital organs
.
To increase CO
Side Effects
.
CNS: headache an anxiety
.
CV: tachy, angina, palpitations and
vasoconstriction
.
GI: nausea and vomiting

Contraindications
.
Hypersensitivity
.
With uncorrect tachyarrhythmias
.
Pheochromocytoma
.
Ventricular Fibrillation

Nursing Management
.
Most patients received less than 20
mcg/kg/min
.
Drugs isn t 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

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
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

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
.
Don t confuse dobutamine to dopamine
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
.
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
Side effects
Palpitations
Tachycardia
GI upset
Nervousness

Contraindications
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Emergency Drugs by E. D. Perillo Jr.

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
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-use sunscreen
EPINEPHRINE
(Discussed earlier)
10