Drug name

epinephrine (adrenaline)

Indication
· IV: In ventricular standstill after other measures have failed to restore
circulation, given by trained personnel by intracardiac puncture and
intramyocardial injection; treatment and prophylaxis of cardiac arrest and attacks
of transitory AV heart block with syncopal seizures (Stokes-Adams syndrome);
syncope due to carotid sinus syndrome; acute hypersensitivity (anaphylactoid)
reactions, serum sickness, urticaria, angioneurotic edema; in acute asthmatic
attacks to relieve bronchospasm not controlled by inhalation or subcutaneous
injection; relaxation of uterine musculature; additive to local anesthetic solutions
for injection to prolong their duration of action and limit systemic absorption
· Injection: Relief from respiratory distress of bronchial asthma, chronic
bronchitis, emphysema, other COPDs
· Aerosols and solutions for nebulization: Temporary relief from acute attacks
of bronchial asthma, COPD
· Topical nasal solution: Temporary relief from nasal and nasopharyngeal
mucosal congestion due to a cold, sinusitis, hay fever, or other upper respiratory
allergies; adjunctive therapy in middle ear infections by decreasing congestion
around eustachian ostia
· 0.1% ophthalmic solution: Conjunctivitis, during eye surgery to control
bleeding, to produce mydriasis

Mechanism of action
Naturally occurring neurotransmitter, the effects of which are mediated by alpha or
beta receptors in target organs. Effects on alpha receptors include vasoconstriction,
contraction of dilator muscles of iris. Effects on beta receptors include positive
chronotropic and inotropic effects on the heart (beta1 receptors); bronchodilation,
vasodilation, and uterine relaxation (beta2 receptors); decreased production of
aqueous humor.

Side effects
Systemic administration
· CNS: Fear, anxiety, tenseness, restlessness, headache, light-
headedness, dizziness, drowsiness, tremor, insomnia, hallucinations,
psychological disturbances, seizures, CNS depression, weakness, blurred
vision, ocular irritation, tearing, photophobia, symptoms of paranoid
schizophrenia
· CV: Arrhythmias, hypertension resulting in intracranial hemorrhage, CV
collapse with hypotension, palpitations, tachycardia, precordial pain in
patients with ischemic heart disease
· GI: Nausea, vomiting, anorexia
· GU: Constriction of renal blood vessels and decreased urine formation
(initial parenteral administration), dysuria, vesical sphincter spasm resulting
in difficult and painful urination, urinary retention in males with prostatism
· Other: Pallor, respiratory difficulty, orofacial dystonia, sweating
Nasal solution
 · Local: Rebound congestion, local burning and stinging
Ophthalmic solutions
· CNS: Headache, brow ache, blurred vision, photophobia, difficulty with
night vision, pigmentary (adrenochrome) deposits in the cornea, conjunctiva,
or lids with prolonged use
· Local: Transitory stinging on initial instillation, eye pain or ache,
conjunctival hyperemia

Nursing consideration
Assessment
· History: Allergy or hypersensitivity to epinephrine or components of drug
preparation; narrow-angle glaucoma; shock other than anaphylactic shock;
hypovolemia; general anesthesia with halogenated hydrocarbons or cyclopropane;
organic brain damage, cerebral arteriosclerosis; cardiac dilation and coronary
insufficiency; tachyarrhythmias; ischemic heart disease; hypertension; renal
dysfunction; COPD; diabetes mellitus; hyperthyroidism; prostatic hypertrophy;
history of seizure disorders; psychoneuroses; labor and delivery; lactation; contact
lens use, aphakic patients (ophthalmic preparations)
· Physical: Weight; skin color, temperature, turgor; orientation, reflexes, IOP;
P, BP; R, adventitious sounds; prostate palpation, normal urine output; urinalysis,
renal function tests, blood and urine glucose, serum electrolytes, thyroid function
tests, ECG

Interventions
· WARNING: Use extreme caution when calculating and preparing doses;
epinephrine is a very potent drug; small errors in dosage can cause serious
adverse effects. Double-check pediatric dosage.
· Use minimal doses for minimal periods of time; "epinephrine-fastness" (a
form of drug tolerance) can occur with prolonged use.
· Protect drug solutions from light, extreme heat, and freezing; do not use
pink or brown solutions. Drug solutions should be clear and colorless (does not
apply to suspension for injection).
· Shake the suspension for injection well before withdrawing the dose.
· Rotate subcutaneous injection sites to prevent necrosis; monitor injection
sites frequently.
· Keep a rapidly acting alpha-adrenergic blocker (phentolamine) or a
vasodilator (a nitrate) readily available in case of excessive hypertensive reaction.
· WARNING: Have an alpha-adrenergic blocker or facilities for intermittent
positive pressure breathing readily available in case pulmonary edema occurs.
· WARNING: Keep a beta-adrenergic blocker (propranolol; a cardioselective
beta-blocker, such as atenolol, should be used in patients with respiratory
distress) readily available in case cardiac arrhythmias occur.
· Do not exceed recommended dosage of inhalation products; administer
pressurized inhalation drug forms during second half of inspiration, because the
airways are open wider and the aerosol distribution is more extensive. If a second
inhalation is needed, administer at peak effect of previous dose, 3–5 min.
· Use topical nasal solutions only for acute states; do not use for longer than
3–5 days, and do not exceed recommended dosage. Rebound nasal congestion
can occur after vasoconstriction subsides.
Drug name:
promethazine hydrochloride(phenergan
Indications
· Symptomatic relief of perennial and seasonal allergic rhinitis,
vasomotor rhinitis, allergic conjunctivitis; mild, uncomplicated urticaria and
angioedema; amelioration of allergic reactions to blood or plasma;
dermatographism, adjunctive therapy (with epinephrine and other measures)
in anaphylactic reactions
· Treatment and prevention of motion sickness; prevention and control of
nausea and vomiting associated with anesthesia and surgery
· Preoperative, postoperative, or obstetric sedation
· Adjunct to analgesics to control postoperative pain
· Adjunctive IV therapy with reduced amounts of meperidine or other
opioid analgesics in special surgical situations, such as repeated
bronchoscopy, ophthalmic surgery, or in poor-risk patients
Mechanism of action

Selectively blocks H1 receptors, diminishing the effects of histamine on cells of the

upper respiratory tract and eyes and decreasing the sneezing, mucus production,
itching, and tearing that accompany allergic reactions in sensitized people exposed
to antigens; blocks cholinergic receptors in the vomiting center that are believed to
mediate the nausea and vomiting caused by gastric irritation, by input from the
vestibular apparatus (motion sickness, nausea associated with vestibular neuritis),
and by input from the chemoreceptor trigger zone (drug- and radiation-induced
emesis); depresses the RAS, including the parts of the brain involved with
wakefulness.

Adverse effects
· CNS: Dizziness, drowsiness, poor coordination, confusion, restlessness,
excitation, seizures, tremors, headache, blurred vision, diplopia, vertigo,
tinnitus
· CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles
· Dermatologic: Urticaria, rash, photosensitivity, chills
· GI: Epigastric distress, nausea, vomiting, diarrhea, constipation
· GU: Urinary frequency, dysuria, urinary retention, decreased libido,
impotence
· Hematologic: Hemolytic anemia, hypoplastic anemia,
thrombocytopenia, leukopenia, agranulocytosis, pancytopenia
· Respiratory: Thickening of bronchial secretions; chest tightness; dry
mouth, nose, and throat; respiratory depression; suppression of cough reflex,
potential for aspiration
· Other: Tingling, heaviness and wetness of the hands
Nursing considerations
Assessment
· History: Hypersensitivity to antihistamines or phenothiazines, severe
CNS depression, bone marrow depression, vomiting of unknown cause,
concomitant therapy with MAOIs, lactation, lower respiratory tract disorders,
glaucoma, prostatic hypertrophy, CV disease or hypertension, breast cancer,
thyrotoxicosis, pregnancy, history of sleep apnea or a family history of SIDS,
child with Reye's syndrome
· Physical: Weight, T; reflexes, orientation, IOP; P, BP, orthostatic BP; R,
adventitious sounds; bowel sounds and normal output, liver evaluation;
urinary output, prostate size; CBC; urinalysis; LFTs, renal and thyroid function
tests

Interventions
· Do not give tablets, rectal suppositories to children < 2 yr.
· Give IM injections deep into muscle.
· Do not administer subcutaneously; tissue necrosis may occur.
· WARNING: Do not administer intra-arterially; arteriospasm and
gangrene of the limb may result.
· Reduce dosage of barbiturates given concurrently with promethazine by
at least half; arrange for dosage reduction of opioid analgesics given
concomitantly by one-fourth to one-half.