Emergency Drugs

Emergency Drugs by E. D. Perillo Jr. EMERGENCY DRUGS

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CARDIAC DRUGS

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ATROPINE SULFATE Isopto Atropine

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Classification Anticholinergics

NITROGLYCERINE Nitrostat

Dosage  Bradycardia: 0.5 mg IV every 3-5 mins, max of 0.04 mg/kg  Cardiac Arrest: 1 mg every 3-5 mins

Classification  Antianginal  Nitrate  Vasodilator,  Coronary

 Nerve and Organophosphate symptoms:

may repeat in 2 mg increments q 3 mins titrated to relief symptoms

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

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

Action  Relaxes the vascular smooth system    

Side effects • CNS: restlessness, ataxia, disorientation, hallucinations, delirium, coma, insomnia, agitation, confusion. • CV: tachycardia, angina, arrhythmias, flushing. • EENT: photophobia, blurred vision, mydriasis.

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GI: dry mouth, constipation, vomiting.

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GU: urine retention. Hematologic: leukocytosis

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Other: anaphylaxis

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.

Reduces Reduces Reduces Reduces

myocardial oxygen consumption left ventricular workload arterial BP 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.

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.

 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  Monitor VS.  Report  HR  Monitor for constipation, oliguria.  Instruct to take 30 mins before meals

Nursing Management

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Emergency Drugs by E. D. Perillo Jr.  

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Record characteristics and precipitating factors of anginal pain. Monitor BP and apical pulse before administration and periodically after dose.

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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

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

Side Effects  GI: dry mouth, constipation.  Skin: Tissue irritation and induration (SC injection).  Other: sweating,physical tolerance and dependence, psychological dependence

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

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

Classification Opioid Agonist Analgesic Dosage  Oral: 10–30 mg q 4 hr PO. Controlledrelease: 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.

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

 Rectal:10–30 mg q 4 hr or as directed by physician.

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Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation

Action

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Emergency Drugs by E. D. Perillo Jr. 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 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.

 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

VERAPAMIL Calan, Isoptin, Verelan, Covera HS

Dosage ♣ PO: 30-120 mg, 3-4x daily or 60-120 mg twice daily as SR capsules ♣ IV: 0.25 mg/kg

Classification  Anti-anginal  Anti-arrhythmics  Anti-hypertensive  Vascular headache suppressants

Action ♣ Inhibits calcium transport into myocardial smooth muscle cells ♣ Systemic and coronary vasodilation

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 and Reactions ♣ CNS:abnormal dreams, anxiety, confusion, dizziness and headache ♣ EENT: blurred vision, epistaxis and tinnitus

Indication  Hypertension  Angina Pectoris  Supraventricular Arrhythmia  Atrial flutter/fibrillation

♣ CV: arrhythmia, CHF, chest pain,

bradycardia, hypotension and palpitations

Side Effects and Adverse Reactions

♣ GU: dysuria, nocturia and polyuria ♣ GI: abnormal liver function, anorexia,

 CNS:abnormal dreams, anxiety, confusion,

constipation, diarrhea, nausea and vomiting

dizziness and headache

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Emergency Drugs by E. D. Perillo Jr. ♣

Contraindications ♣ Hypersensitivity ♣ Sick sinus syndrome

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♣ 2nd or 3rd degree AV block ♣ ♣ ♣

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CHF Cardiogenic shock Concurrent IV beta-blocker

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

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

LIDOCAINE Xylocaine

Dosage Recurrent ventricular arrhythmias: ♣ PO800-1600 mg/day for 1-2 wks

Classification ♣ CV drugs: Anti-arrhythmics ♣ Anesthetic

♣ PSVT, symptomatic atrial flutter: PO 600-800 mg/day for 1 month Arrhythmias with CHF: 200 mg/day

♣ ♣ Ventricular dysrrhythmias: 150 mg

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

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

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 ♣ Life threatening recurrent arrhythmias ♣ Ventricular fibrillation ♣ Ventricular tachycardia

Indication ♣ Anesthesia ♣ Arrhythmias ♣ Control of Status epilepticus refractory to other treatments

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

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

Contraindications ♣ Severe sinus node dysfunction

♣ 2nd or 3rd degree AV block ♣

Nursing Management ♣ Assess pt before and after therapy ♣ Pts infusion must be on cardiac monitor

Hypersensitivity

Nursing Management ♣ Assess cardiovascular status before therapy

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Emergency Drugs by E. D. Perillo Jr. ♣ Assess pulmonary, hepatic and thyroid ♣ ♣ ♣

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

function before and during therapy Monitor fluid and electrolytes, I&O, K, Na and Cl Monitor ECG, BP Assess vision

Classification Beta2 Adrenergic Agonists

PROCAINAMIDE Pronestyl, Procan-SR, Procanbid

Dosage Cardiac arrest: 1 mg IV of 1:10,000 solution q 3-5 min; double dose if administering via ET tube

Classification Antiarrhythmics Dosage Arrhythmias: 50 mg/kg/day in divided doses 3-6 hourly

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 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

Action   

Indication ♣ Supraventricular and ventricular arrhythmias. ♣ Treatment of Wolf-Parkinson-White Syndrome

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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

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

Contraindications ♣ Heart block ♣ Heart failure ♣ Hypotension ♣ Myesthenia gravis ♣ Digoxin toxicity ♣ Lactation

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.

Nursing Management ♣ Assess cardiovascular status before therapy

♣ Assess pulmonary, hepatic and thyroid ♣ ♣ ♣

Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity Increases BP,  HR,  PR Decreases airway resistance.

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

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Emergency Drugs by E. D. Perillo Jr. 

In breast feeding do not use the drug or stop breast feeding.

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

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, rapidacting 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

Action Decreased acetylcholine released

Classification Pituitary Hormones ADH

Indication ♣ Mg replacement ♣ Arrhythmia

Dosage Prevent and treat abdominal distention: initially 5 units IM gives subsequent injections q3-4 hours increasing to 10 units if needed.

Side Effects and Adverse Reactions ♣ CNS: drowsiness, depressed reflexes, flaccid paralysis, hypothermia ♣ CV: hypotension, flushing, bradycardia, circulatory collapse, depressed cardiac function ♣ EENT: diplopia

Action Increase permeability of renal tubular epithelium to adenosine monophosphate and water, the epithelium promotes reabsorption of water and concentrated urine Indication ♣ ♣ ♣ ♣

♣ Respiratory: respiratory paralysis ♣ Metabolic: hypocalcemia ♣ Skin: diaphoresis

Diabetes Insipidus Abdominal Distention GI bleeding Esophageal varices

Contraindications ♣ Heart block and myocardial damage ♣ Toxemia of pregnancy

Side Effects and Adverse Reactions ♣ CNS: tremor, headache, vertigo

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

♣ CV: vasoconstriction, arrhythmias, cardiac arrest, myocardial ischemia, circumollar pallor, decreased CO, angina GI: abdominal cramps

♣ ♣ GU:uterine cramps ♣ Respi: bronchoconstriction ♣ Skin: diaphoresis, gangrene and

Na HCO3 Arm and Hammer; Baking Soda

urticaria

Classification Alkalinizers

Contraindications ♣ With chronic nephritis and nitrogen retention ♣ Hypersensitivity

Dosage

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Emergency Drugs by E. D. Perillo Jr. ♣ Metabolic Acidosis: Usually 2-5 meq/kg IV

abdominal pain, methemoglodinemia, muscle twitching, pink-colored rash, irritation at infusion site

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

Action Restore buffering capacity of the body and neutralizes excessive acid Indication ♣ Metabolic Acidosis ♣ Cardiac Arrest

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

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

FUROSEMIDE Lasix Classification Loop Diuretics

Contraindications ♣ Metabolic and respiratory alkalosis

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

♣ 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

Action Inhibits Na and Cl reabsorption at the proximal and distal tubules and in the ascending loop of Henle

HYPERTENSIVE CRISIS

Indication Acute pulmonary edema Edema Hypertension

Na NITROPRUSSIDE Nittropress Classification Antihypertensive, Vasodilator

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

Dosage 0.25-0.3 mcg/kg/minute

Contraindications Hypersensitivity Anuria

Action Relaxes arteriolar and venous smooth muscle

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

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,

MORPHINE SO4 (Discussed earlier)

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Emergency Drugs by E. D. Perillo Jr. NEUROSURGICAL DRUGS Nursing Management ♣ Monitor VS,CVP,I&O, renal function fluid balance and urine K levels daily. ♣ Drug can be used to measure GFR

MANNITOL Osmitrol

♣ Do not give electrolyte free solutions with

Classification Diuretics

blood. If blood id given simultaneously, add at least 200 meq of NaCL to each liter

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

POISONING NALOXONE HCL Narcan

♣ To induced intraocular or intracranial ♣ ♣

Classification Miscellaneous antagonists and antidotes

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%

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

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  For suspected opioid induced respiratory 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  CN: seizures, headache and fever ♣ CV: edema, thrombophlebitis, hypotension and heart failure ♣ EENT: blurred vision and rhinitis

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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

♣ GI: thirst, dry mouth, nausea,

Contraindications  Hypersensitivity  Use cautious with cardiac irritability or opiod addiction.

vomiting and diarrhea GI: urine retention

♣ ♣ Metabolic: dehydration ♣ Skin: local pain ♣ Others: chill

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

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Emergency Drugs by E. D. Perillo Jr. Dosage 25-30 ml followed immediately by H2O

Notify doctor if caused swelling or pain in the stomach

Action Irritates the stomach lining and stimulate the vomiting center

FLUMAZENIL Romazicon

Indication Poisoning Overdose

Classification Benzodiazepine receptor antagonists Dosage 2 ml IV given over 15 seconds

Side Effects Diarrhea, drowsiness, stomach cramps, vomiting, itching, DOB, swelling of the mouth, rash and hives

Action Antagonizes the effects of benzodiazepines

Contraindications Hypersensitivity Given activated charcoal Unconcious Drowsy Severely drunk Having seizures With no gag reflex

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

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

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

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

SHOCK DOPAMINE Intropine

Side Effects Pain, melena, diarrhea, vomiting and constipation

Classification Adrenergic drugs

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

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

Nursing Management Do not mix with chocolate and together with ipecac syrup

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Emergency Drugs by E. D. Perillo Jr. Indication  To treat shock and correct hemodynamic imbalances  To correct hypotension 

To improve perfusion of vital organs

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To increase CO

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

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

GLUCAGON Classification Pancreatic Hormones

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

Dosage 0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN Action Binds with glucagon receptor

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

Indication Hypoglycemia Side Effects Nausea, vomiting, hypotension, tachycardia and hypertension Contraindications  Hypersensitivity  Pheochromocytoma  Insulinoma

DOBUTAMINE Dobutrex

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

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

ALBUTEROL Ventolin

Action Stimulates heart beta receptors to increase myocardial contractility and SV

Dosage 2 inhalations reputed q 4-6 hrs via neb

Classification Bronchodilator, Adrenergic

Action Activation of beta adrenergic receptors on airway smooth muscle

Indication  To increase CO  Treatment of cardiac decompensation

Indication  Asthma  Prevention of exercise induced spasms

Side Effects  CNS: headache

 CV: HPN, tachycardia, palpitations and 

Side effects Palpitations Tachycardia GI upset Nervousness

vasoconstriction GI: nausea and vomiting

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

Contraindications

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Emergency Drugs by E. D. Perillo Jr. Hypersensitivity

Indication  Allergic reactions  Motion sickness  Cough suppression  Sedation

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

Side Effects  Xerostomia  Urinary retention  Sedation

DIPHENHYDRAMINE HCL Benadryl

Contraindications Acute asthmatic attack

Classification Anti-histamine

Nursing Management Risk for photosensitivity- use sunscreen

Dosage 25-50 mg PO, IV or IM bid-tid

EPINEPHRINE (Discussed earlier)

Action Blocks the effects Hi receptor sites

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