Upload
bryne-boish
View
220
Download
0
Embed Size (px)
Citation preview
8/12/2019 Emergency 123
1/13
EMERGENCY DRUGS: A drug study.
1) AMINOPHYLLINE
Brand Names: Phil Pharmawealth/Atlantic Aminophylline amp Theofil amp
Classification: Antiasthmatic & COPD Preparations
Dosage: Initial: 225-450 mg twice daily, increased if needed. IV Acute severe bronchospasm. Loading dose: 5 mg/kg
(ideal body wt). Maintenance: 0.5 mg/kg/hr. Rate should not exceed 25 mg/min.Indication: PO Chronic bronchospasm as hydrate
Action: Increases the level of cAMP resulting in bronchodilation
Adverse Reactions: Nausea, vomiting, abdominal pain, diarrhea, headache, insomnia, dizziness, anxiety, restlessness;
tremor, palpitations. Potentially Fatal: Convulsions, cardiac arrhythmias, hypotension and sudden death after too rapid IV
injection.
Nursing Measures:
Administer to pregnant patients only when clearly neededneonatal tachycardia, jitteriness, and withdrawal apnea
observed when mothers received xanthines up until delivery.
Caution patient not to chew or crush enteric -coated timed-release forms.
Give immediate-release, liquid dosage forms with food if GI effects occur.
Do not give timed-release forms with food; these should be given on an empty stomach 1 hr before or 2 hr after meals.
Maintain adequate hydration.
Monitor results of serum theophylline levels carefully, and arrange for reduced dosage if serum levels exceed
therapeutic range of 1020 mcg/mL.
Take serum samples to determine peak theophylline concentration drawn 1530 min after an IV loading dose.
Monitor for clinical signs of adverse effects, particularly if serum theophylline levels are not available.
Ensure that diazepam is readily available to treat seizures.
Take this drug exactly as prescribed; if a timed -release product is prescribed, take this drug on an empty stomach, 1 hr
before or 2 hr after meals.
Do not to chew or crush timed-release preparations.
Administer rectal solution or suppositories after emptying the rectum. It may be necessary to take this drug around the clock for adequate control of asthma attacks.
Avoid excessive intake of coffee, tea, cocoa, cola beverages, chocolate.
Smoking cigarettes or other tobacco products impacts the drug's effectiveness. Try not to smoke. Notify the care
provider if smoking habits change while taking this drug.
Frequent blood tests may be necessary to monitor the effect of this drug and to ensure safe and effective dosage; keep
all appointments for blood tests and other monitoring.
These side effects may occur: Nausea, loss of appetite (taking this drug with food may help if taking the immediate-
release or liquid dosage forms); difficulty sleeping, depression, emotional lability (reversible).
Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular heartbeat
2) AMIODARONE HYDROCHLORIDE
Brand Names: Anoion tab Cordarone Cordarone inj Sandoz Amiodarone HCl tab
Classification: Cardiac Drugs
Dosage: PO Initial: 200 mg 3 times/day for 1 wk, reduce to 200 mg twice daily for a further wk. Maintenance: 200 mg/day
or lowest effective dose. IV Initial: 5 mg/kg infusion via central venous catheter. Max: 1.2 g/24 hr.
Indication: Ventricular and supraventricular arrhythmias.
Action: Blocks potassium chloride leading to prolongation of action potential duration.
Adverse Reactions: Blue-grey discoloration of skin, photosensitivity, peripheral neuropathy, paraesthesia, myopathy,
ataxia, tremor, nausea, vomiting, metallic taste, hypothyroidism, hyperthyroidism, alopecia, sleep disturbances, corneal
microdeposits, hot flushes, sweating. Heart block, bradycardia, sinus arrest, hepatotoxicity, heart failure. Potentially Fatal:Pulmonary toxicity including pulmonary fibrosis and interstitial pneumonitis, hepatotoxicity, thyrotoxicity. Ventricular
arrhythmias, pulmonary alveolitis, exacerbation of arrhythmias and rare serious liver injury. Generally in patients with high
doses and having preexisting abnormalities of diffusion capacity.
Nursing Measures:
Monitor cardiac rhythm continuously.
Monitor for an extended period when dosage adjustments are made.
Monitor for safe and effective serum levels (0.52.5 mcg/mL).
Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need to be reduced one -third to one-half when
amiodarone is started.
8/12/2019 Emergency 123
2/13
Give drug with meals to decrease GI problems.
Arrange for ophthalmologic exams; 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.
Drug dosage will be changed in relation to response of arrhythmias; you will need to be hospitalized during initiation of
drug therapy; you will be closely monitored when dosage is changed.
Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray, eye exam, blood tests.
These side effects may occur: Changes in vision (halos, dry eyes, sensitivity to light; wear sunglasses, monitor lightexposure); nausea, vomiting, loss of appetite (take with meals; eat small, frequent meals); sensitivity to the sun (use a
sunscreen or protective clothing when outdoors); constipation (a laxative may be ordered); tremors, twitching, dizziness,
loss of coordination (do not drive, operate dangerous machinery, or undertake tasks that require coordination until drug
effects stabilize and your body adjusts to it).
Report unusual bleeding or bruising; fever, chills; intolerance to heat or cold; shortness of breath, difficulty breathing,
cough; swelling of ankles or fingers; palpitations; difficulty with vision.
3) ATROPINE SULFATE
Brand Names: Anespin amp Atropol amp Euro-Med Atropine Sulfate amp Isopto Atropine eye drops Phil
Pharmawealth/Atlantic Atropine amp
Classification: Other Cardiovascular Drugs, Muscle Relaxants, Mydriatic Drugs, Antidotes, Detoxifying Agents & Drugs
Used in Substance Dependence
Indication/Dosage: IV Bradycardia 500 mcg every 3-5 mins. Total: 3 mg. IV/IM Organophosphorus poisoning 2 mg every
10-30 mins until muscarinic effects disappear or atropine toxicity appears. IM/SC Premed in anesth 300-600 mcg 30-60
mins before anesth. IV/IM/SC Overdosage w/ other compd having muscarinic actions 0.6-1 mg, repeat 2 hrly. Ophth
Inflammatory eye disorders As 0.5-1% soln: 1-2 drops 4 times/day. Eye refraction As 1% soln: 1 drop twice daily for 1-2
days before procedure.
Action: An anti-cholinergic that inhibits acetylcholine at the parasympathetic neuroeffector junction, enhances the
conduction of AV node and increases heart rate
Adverse Reactions: Dry mouth, dysphagia, constipation, flushing and dryness of skin, tachycardia, palpitations,arrhythmias, mydriasis, photophobia, cycloplegia, raised intraocular pressure. Toxic doses cause tachycardia,
hyperpyrexia, restlessness, confusion, excitement, hallucinations, delirium and may progress to circulatory failure and
respiratory depression. Eye drops: Systemic toxicity especially in children, on prolonged use may lead to irritation,
hyperemia, edema and conjunctivitis. Increased intraocular pressure. Inhalation: Dryness of mouth, throat. Potentially
Fatal: Atrial arrhythmias, AV dissociation, multiple ventricular ectopics.
Nursing Measures:
Ensure adequate hydration; provide environmental control (temperature) to prevent hyperpyrexia.
Have patient void before taking medication if urinary retention is a problem.
When used preoperatively or in other acute situations, incorporate teaching about the drug with teaching about the
procedure; the ophthalmic solution is used mainly acutely and will not be self-administered by the patient; the following
apply to oral medication for outpatients:
Take as prescribed, 30 min before meals; avoid excessive dosage.
Avoid hot environments; you will be heat intolerant, and dangerous reactions may occur.
These side effects may occur: Dizziness, confusion (use caution driving or performing hazardous tas ks); constipation
(ensure adequate fluid intake, proper diet); dry mouth (suck sugarless lozenges; perform frequent mouth care; may be
transient); blurred vision, sensitivity to light (reversible; avoid tasks that require acute vision; wear sunglasses in bright
light); impotence (reversible); difficulty in urination (empty the bladder prior to taking drug).
Report rash; flushing; eye pain; difficulty breathing; tremors, loss of coordination; irregular heartbeat, palpitations;
headache; abdominal distention; hallucinations; severe or persistent dry mouth; difficulty swallowing; difficulty in urination;
constipation; sensitivity to light.
4) BUMETANIDE
Brand Names: Burinex amp Burinex tab
Classification: Sulfonamide Diuretics
Indication/Dosage: PO edema 1 mg once daily, 2nd dose 6-8 hr later if needed. Refractory edema Initial: 5 mg/day, may
increase dose depending on response. Max: 10 mg/day. HTN 0.5-1 mg/day. Max: 5 mg/day. IV Pulmonary edema 1-2
mg, repeat 20 mins. later if needed. IV/IM Emergency edema 0.5-1 mg, then adjust according to response.
Action: inhibits Sodium and Chloride reabsorption at the ascending loop of Henle
8/12/2019 Emergency 123
3/13
Adverse Reactions: Muscle cramps, dizziness, hypotension, headache, nausea, impaired hearing, pruritus, ECG
changes, musculoskeletal pain, rash, chest discomfort, renal failure, premature ejaculation, thrombocytopenia,
hypokalemia, hypomagnesaemia, hyponatremia, hyperuricemia, hyperglycemia, hypocalcaemia.
Nursing Measures:
Give with food or milk to prevent GI upset.
Mark calendars or use reminders if intermittent therapy is best for treating edema.
Give single dose early in day so increased urination will not disturb sleep.
Avoid IV use if oral use is possible. Arrange to monitor serum electrolytes, hydration, liver function during long-term therapy.
Provide diet rich in potassium or supplemental potassium.
Record alternate day or intermittent therapy on a calendar or dated envelopes.
Take the drug early in day so increased urination will not disturb sleep; take with food or meals to prevent GI upset.
Weigh yourself on a regular basis, at the same time, and in the same clothing; record the weight on your calendar.
These side effects may occur: Increased volume and frequency of urination; dizziness, feeling faint on arising,
drowsiness (avoid rapid position changes; hazardous activities, such as driving; and alcohol consumption); sensitivity to
sunlight (use sunglasses, sunscreen, wear protective clothing); increased thirst (suck sugarless lozenges; use frequent
mouth care); loss of body potassium (a potassium-rich diet, or supplement will be needed).
Report weight change of more than 3 lb in 1 day; swelling in ankles or fingers; unusual bleeding or bruising; nausea,
dizziness, trembling, numbness, fatigue; muscle weakness or cramps.
5) CALCIUM GLUCONATE
Brand Names: Phil Pharmawealth/Harson Calcium Gluconate amp
Classification: Electrolytes
Indication/Dosage: PO Hypocalcaemia 10-50 mmol/day. IV Hypocalcaemic tetany 2.25 mmol via slow inj , then 58-77 mL
of 10% soln diluted and administered as a continuous IV infusion. Antidote in severe hypermagnesaemia; Severe
hyperkalaemia 10 mL of 10% soln, repeat every 10 mins if needed.
Action: replaces Calcium and maintains Calcium level
Adverse Reactions: GI irritation; soft-tissue calcification, skin sloughing or necrosis after IM/SC inj. Hypercalcaemiacharacterised by anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances,
polydipsia, polyuria, nephrocalcinosis, renal calculi; chalky taste, hot flushes and peripheral vasodilation. Potentially Fatal:
Cardiac arrhythmias and coma.
Nursing Measures:
Make sure prescriber specifies form of calcium to be given; crash carts may contain both calcium gluconate and calcium
chloride.
Tell patient to take oral calcium 1 to 11/2 hours after meals if GI upset occurs.
Give I.M. injection in gluteal region in adults and in lateral thigh in infants. Use I.M. route only in emergencies when no
I.V. route is available bec. of irritation of tissue by calcium salts.
Tell patient to take oral calcium with a full glass of water.
Monitor calcium levels frequently. Hypercalcemia may result after large doses in chronic renal failure. Report
abnormalities.
6) CAPTOPRIL
Brand Names: Ace-Bloc tab Capomed tab Capotec tab Capoten tab Captor tab Captril tab Cardiovaz tab Conamid tab
Hartylox tab Normil tab Phil Pharmawealth/Panion & BF Captopril tab Prelat tab Primace tab Retensin tab Spec-Ace tab
Tensoril tab Unihype tab Vasostad tab
Classification: ACE Inhibitors
Indication/Dosage: PO HTN Initial: 12.5 mg twice daily. Maintenance: 25-50 mg twice daily. Max: 50 mg 3 times/day.
Heart failure Initial: 6.25-12.5 mg 2-3 times/day. Max: 50 mg 3 times/day. Post MI Start 3 days after MI. Initial: 6.25mg/day, may increase after several wk to 150 mg/day in divided doses if needed and tolerated. HTN in diabetic
nephropathy 75-100 mg/day in divided doses.
Action: inhibits ACE, reduces Sodium and water retention, lowers blood pressure
Adverse Reactions: Hypotension, tachycardia, chest pain, palpitations, pruritus, hyperkalaemia. Proteinuria; angioedema,
skin rashes; taste disturbance, nonproductive cough, headache. Potentially Fatal: Neutropenia, usually occurs within 3
mth of starting therapy especially in patients with renal dysfunction or collagen diseases. Hyperkalaemia. Anaphylactic
reactions.
Nursing Measures:
8/12/2019 Emergency 123
4/13
Administer 1 hr before or 2 hr after meals.
Alert surgeon and mark patient's chart with notice that captopril is being taken; the angiotensin II formation subsequent
to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion.
Monitor patient closely for fall in BP secondary to reduction in fluid volume (excessive perspiration and dehydration,
vomiting, diarrhea); excessive hypotension may occur.
Reduce dosage in patients with impaired renal function.
Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop without consulting your health care provider.
Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if light-headedness or dizziness occurs, consult your health care provider.
Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will
interact with ACE inhibitors. Consult your health care provider.
These side effects may occur: GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth
sores (perform frequent mouth care); rash; fast heart rate; dizziness, light-headedness (usually passes after the first few
days; change position slowly, and limit your activities to those that do not require alertness and precision).
Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the
face, eyes, lips, tongue, difficulty breathing.
7) CLONIDINE
Brand Names: Catapin amp Catapres amp Catapres tab
Classification: Other Antihypertensives
Indication/Dosage: PO HTN Initial: 50-100 mcg 3 times/day. Max: 2,400 mcg/day. Menopausal flushing; Migraine
prophylaxis 50 mcg twice daily, up to 75 mg twice daily. IV Hypertensive crisis 150-300 mcg via slow inj. Max: 750 mcg
over 24 hr. Epidural Severe cancer pain Initial: 30 mcg/hr as continuous infusion in combination w/ an opioid. Transdermal
HTN As patch releasing 100-300 mcg clonidine base/day at constant rate: Apply once wkly.
Action: stimulates alpha 2 receptors and inhibits central vasomotor centers, lowers peripheral vascular resistance, blood
pressure, and heart rate
Adverse Reactions: Dry mouth, drowsiness, dizziness, headache, constipation, impotence, vivid dreams, urinary
retention; dry, itching, burning sensation in the eye; fluid or electrolyte imbalance, GI upset, paralytic ileus, orthostatichypotension, weakness, sedation, pruritus, myalgia, urticaria, nausea, insomnia, arrhythmias, agitation. Reduced GI
motility at times may cause paralytic ileus. Potentially Fatal: Transient hypertension or profound hypotension, respiratory
depression, convulsion. Clonidine withdrawal syndrome could be life threatening. Bradycardia, coma and disturbances in
conduction (in individuals with preexisting diseases of SA/AV nodes, overdose or on digitalis).
Nursing Measures:
Take drug 1 hr beforeor 2 hr after meals; do not take with food. Do not stop without consulting your health care provider.
Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if light -
headedness or dizziness occurs, consult your health care provider.
Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will
interact with ACE inhibitors. Consult your health care provider.
These side effects may occur: GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth
sores (perform frequent mouth care); rash; fast heart rate; dizziness, light-headedness (usually passes after the first few
days; change position slowly, and limit your activities to those that do not require alertness and precision).
Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the
face, eyes, lips, tongue, difficulty breathing.
Take this drug exactly as prescribed. Do not miss doses. Do not discontinue the drug unless so instructed. Do not
discontinue abruptly; life-threatening adverse effects may occur. If you travel, take an adequate supply of drug.
Use the transdermal system as prescribed;refer to directions in package insert, or contact your health care provider with
questions. Be sure to remove old systems before applying new ones.
Attempt lifestyle changes that will reduce your BP: stop smoking and using alcohol; lose weight; restrictintake of sodium
(salt); exercise regularly. Use caution with alcohol. Your sensitivity may increase while using this drug.
These side effects may occur: Drowsiness, dizziness, light -headedness, headache, weakness (often transient; observe
caution driving or performing other tasks that require alertness or physical dexterity); dry mouth (suck on sugarless
lozenges or ice chips); GI upset (eat small, frequent meals); dreams, nightmares (reversible); dizziness, light-headedness
when you change position (get up slowly; use caution climbing stairs); impotence, other sexual dysfunction, decreased
libido (discuss with care providers); breast enlargement, sore breasts; palpitations.
Report urinary retention, changes in vision, blanching of fingers, rash.
8/12/2019 Emergency 123
5/13
8) DIAZEPAM
Brand name: Valium
Classification: Anxiolytics
Dosage: 10mg/2ml
Indication: relief of anxiety, agitation & tension due to psychoneurotic states & transient situational disturbances
Action: a benzodiazepine that probably potentiates the effects of GABA, depresses the CNS & suppresses the spread of
seizure activityAdverse Reaction: drowsiness,dysarthria, slurred speech, tremor, transient amnesia, fatigue, ataxia, headache, insomnia,
paradoxical anxiety, hallucination
Nursing Measures:
Do not administer intra-arterially; may produce arteriospasm, gangrene.
Change from IV therapy to oral therapy as soon as possible.
Do not use small veins (dorsum of hand or wrist) for IV injection.
Reduce dose of narcotic analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated.
Carefully monitor P, BP, respiration during IV administration.
Maintain patients receiving parenteral benzodiazepines in bed for 3 hr; do not permit ambulatory patients to operate a
vehicle following an injection.
Monitor EEG in patients treated for status epilepticus; seizures may recur after initial control, presumably because of
short duration of drug effect.
Monitor liver and kidney function, CBC during long-term therapy.
Taper dosage gradually after long-term therapy, especially in epileptic patients.
Arrange for epileptic patients to wear medical alert ID indicating that they are epileptics taking this medication.
Discuss risk of fetal abnormalities with patients desiring to become pregnant.
9) DIGOXIN
Brand name: Digitek, Lanoxicaps, Lanoxin, Novo-Digoxin (CAN)
Classification: InotropicsDosage: 5mg/2ml
Indication: Cardiac failure accompanied by atrial fibrillation; management of chronic cardiac failure where systolic
dysfunction or ventricular dilatation is dominant; management of certain supraventricular arrhythmias, particularly chronic
atrial flutter & fibrillation.
Action: inhibits sodium-potassium activated adenosine triphosphate, promoting movement of calcium from extracellular to
intra-cytoplasm and strengthening myocardial contraction, also acts on CNS to enhance vagal tone
Adverse Reaction: nausea, vomiting, anorexia, headache, facial pain, fatigue, weakness, dizziness, drowsiness,
disorientation, mental confusion, bad dreams, convulsions
Nursing Measures:
Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or < 90 in infant; retake pulse in 1 hr.
If adult pulse remains < 60 or infant < 90, hold drug and notify prescriber. Note any change from baseline rhythm or rate.
Check dosage and preparation carefully.
Avoid IM injections, which may be very painful.
Follow diluting instructions carefully, and use diluted solution promptly.
Avoid giving with meals; this will delay absorption.
Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, cardiac monitor on standby in case
toxicity develops.
Monitor for therapeutic drug levels: 0.52 ng/mL.
10) DIPENHYDRAMINE
Brand name: Benadryl
Classification: antihistamine
Dosage: 50mg/ml
Indication: Hay fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug sensitization, serum & penicillin reaction,
contact dermatitis, atopic eczema, other allergic dermatoses, pruritus, food sensitivity, parkinsonism, motion sickness.
Action: prevents histamine mediated responses, drug provides local anesthesia and suppresses cough reflex
Adverse Reaction: CV and CNS effects, blood disorders, GI disturbances, anti-muscarinic effects and allergic reactions.
Nursing Measures:
8/12/2019 Emergency 123
6/13
Monitor carefully, assess for confusion, delirium, other anticholinergic side effects and fall risk. Institute measures to
prevent falls.
Assess movement disorder before and after administration.
Caution patient not to use oral OTC diphenhydramine products with any other product containing diphenhydramine,
including products used topically.
It can cause excitation in children. Caution parents or caregivers about proper dose calculation; overdosage, especially
in infants and children, can cause hallucinations, seizures or death Inform patient that this drug may cause dry mouth.
Frequent oral rinses, good oral hygiene, and sugarless gum or candy may minimize this effect. Notify dentist if dry mouthpersists for more than 2 weeks.
11) EPINEPHRINE
Brand name:
Epinephrine Bitartrate
Aerosols: Primatene Mist
Epinephrine Borate
Ophthalmic solution: Epinal
Epinephrine Hydrochloride
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
Classification: Sympathomimetic, Alpha-adrenergic agonist, Beta1and beta2-adrenergic agonist, Cardiac stimulant,
Vasopressor, Bronchodilator, Antasthmatic drug, Nasal decongestant, Mydriatic, Antiglaucoma drug
Dosage: 1mg/ml
Indication: Acute asthmatic attacks, Advanced cardiac life support
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 includepositive chronotropic and inotropic effects on the heart (beta1 receptors); bronchodilation, vasodilation, and uterine
relaxation (beta2 receptors); decreased production of aqueous humor.
Adverse Reaction: drowsiness, headache, nervousness, tremors, cerebral hemorrhage, dizziness, weakness, vertigo,
pain
Nursing Measures:
Monitor heart rate.
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 periodsof 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 SC 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.
Have an alpha-adrenergic blocker or facilities for intermittent positive pressure breathing readily available in case
pulmonary edema occurs.
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 i nhalation drug forms during secondhalf 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, 35 min.
Use topical nasal solutions only for acute states; do not use for longer than 35 days, and do not exceed recommended
dosage. Rebound nasal congestion can occur after vasoconstriction subsides.
Do not exceed recommended dosage; adverse effects or loss of effectiveness may result. R ead the instructions that
come with respiratory inhalant products, and consult your health care provider or pharmacist if you have any questions.
To give eye drops: Lie down or tilt head backward, and look up. Hold dropper above eye; drop medicine inside lower lid
while looking up. Do not touch dropper to eye, fingers, or any surface. Release lower lid; keep eye open, and do not blink
8/12/2019 Emergency 123
7/13
for at least 30 sec. Apply gentle pressure with fingers to inside corner of the eye for about 1 min; wait at least 5 min before
using other eye drops.
These side effects may occur: Dizziness, drowsiness, fatigue, apprehension (use caution if driving or performing tasks
that require alertness); anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small meals); fast
heart rate. Nasal solution may cause burning or stinging when first used (transient). Ophthalmic solution may cause slight
stinging when first used (transient); headache or brow ache (only during the first few days).
Report chest pain, dizziness, insomnia, weakness, tremor or irregular heart beat (respiratory inhalant, nasal solution),
difficulty breathing, productive cough, failure to respond to usual dosage (respiratory inhalant), decrease in visual acuity(ophthalmic).
12) FUROSEMIDE
Brand name: Apo-Furosemide (CAN), Furoside (CAN), Lasix, Myrosemide (CAN)
Classification: loop diuretics
Dosage: 20mg/2ml
Indication: edema, hypertension
Action: inhibits Sodium and Chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle
Adverse Reaction: vertigo, headache, dizziness, paresthesia, weakness, restlessness, fever, nocturia, oliguria, polyguria
Nursing Measures:
Monitor BP after administration
Administer with food or milk to prevent GI upset.
Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds.
Give early in the day so that increased urination will not disturb sleep.
Avoid IV use if oral use is at all possible.
Do not mix parenteral solution with highly acidic solutions with pH below 3.5.
Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions.
Discard diluted solution after 24 hr.
Refrigerate oral solution.
Measure and record weight to monitor fluid changes. Arrange to monitor serum electrolytes, hydration, liver function.
Arrange for potassium-rich diet or supplemental potassium as needed.
13) HYDRALAZINE HYDROCHLORIDE
Brand name: Supres
Classification: antihypertension
Dosage: 20mg/ml
Indication: For hypertensive patient
Action: a direct acting peripheral vasodilator that relaxes arteriolar smooth muscles
Adverse Reaction: tachycardia, palpitation, angina pectoris, severe headache, dizziness, weight gain, GI disturbances,
pruritus, rashes, nausea and vomiting
Nursing Measures:
Give oral drug with food to increase bioavailability(drug should be given in a consistent relationship ti ingestion of food
for consistent response to therapy).
Drug may cause a syndrome resembling systemic lupus erythematosus (SLE). Arrange for CBC, LE cell preparations,
and ANA titers before and periodically during prolonged therapy, even in the asymptomatic patient. Discontinue if blood
dyscrasias occur. Reevaluate therapy if ANA or LE tests are positive.
Arrange for pyridoxine if patient develops symptoms of peripheral neuritis.
Monitor patient for orthostatic hypotension which is most marked in the morning and in hot weather, and with alcohol or
exercise.
14) HYDROCORTISONE SODIUM SUCCINATE
Brand name: A-hydroCort, Solu-Cortef
Classification: corticosteroid hormones
Stock Dose:100 mg/ 2 mL, 250 mg/ 2 mL
Indication: endocrine, hematologic, rheumatic & collagen disorders, dermatologic, ophth, GI, resp & neoplastic diseases,
edematous states, control of severe incapacitating allergic conditions, TB meningitis w/ subarachnoid block or impending
8/12/2019 Emergency 123
8/13
block when used concurrently with appropriate anti-TB chemotherapy, shock secondary to adrenocortical insufficiency or
shock unresponsive to conventional therapy when adrenocortical insufficiency may be present
Action: Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes, suppresses immune response,
stimulates bone marrow and influences protein, fat, and carbohydrate metabolism
Adverse Reactions: fluid and electrolyte disturbances, decreased carbohydrate tolerance, impaired wound healing, thin
fragile skin, muscle weakness, steroid myopathy, osteoporosis, aseptic necrosis, peptic ulceration w/ possible perforation,
cataracts, increased intraocular and intracranial pressure, growth retardation, Cushingoid state, protein catabolism,
psychic derangements, exophthalmos, masking of infections, gasping syndrome, seizures, menstrual irregularities.Nursing Measures:
Give daily before 9 AM to mimic normal peak diurnal co rticosteroid levels and minimize HPA suppression.
Space multiple doses evenly throughout the day.
Do not give IM injections if patient has thrombocytopenic purpura.
Rotate sites of IM repository injections to avoid local atrophy.
Use minimal doses for minimal duration to minimize adverse effects.
Taper doses when discontinuing high-dose or long-term therapy.
Arrange for increased dosage when patient is subject to unusual stress.
Use alternate-day maintenance therapy with short-acting corticosteroids whenever possible.
Do not give live virus vaccines with immunosuppressive doses of hydrocortisone.
Provide antacids between meals to help avoid peptic ulcer.
15) ISOSORBIDE-5- MONONITRATE
Brand name: Imdur
Classification: anti- anginal drug
Stock Dose: SL: 5 mg/mL ; Oral: 30 mg, 60 mg
Indication: prophylactic treatment of angina pectoris
Action: Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug also may increase blood
flow through the collateral coronary vessels
Adverse Reactions: headache, hypotension w/ dizziness and nausea, tachycardiaNursing Measures:
Monitor BP and heart rate.
Assess location, duration, intensity, and precipitating factors of anginal pain.
16) ISOSORBIDE DINITRATE
Brand name: Isoket IV
Classification: antianginal drug
Stock: IV amp 10 mg/ 10 mL
Dose: 10 mg/10mL
Indication: unresponsive left ventricular failure secondary to acute MI, severe or unstable angina pectoris
Action: Isosorbide dinitrate is a smooth muscle relaxant. It is part icularly effective on vascular and bronchial smooth
muscle. Its systemic cardiovascular effects are mainly due to a decrease in venous return (pooling of blood in the
peripheral venous system). Consequently, ventricular end-diastolic pressure and volume are diminished, thus reducing
cardiac work and implicitly myocardial oxygen requirements. The arterial vessels are dilated as well, though to a lesser
degree. This results in a slight drop in aortic and systemic blood pressure relieving the myocardium from a part of its
afterload. These nitrate-induced changes account for both the antianginal effects of isosorbide dinitrate and for its
beneficial effects in the treatment of congestive heart failure.
Side effects/ adverse reactions: severe cerebral flow deficiency and decreased coronary perfusion may develop, nitrate
headache and nausea.
Nursing Measures:
Monitor BP and heart rate. Assess location, duration, intensity, and precipitating factors of anginal pain.
17) MAGNESIUM SULFATE
Brand name: Elin Magnesium Sulfate
Classification: anticonvulsant
Dosage: 250 mg/10 mL
Indication: treatment of hypomagnesemia accompanied by signs of tetany, control of HTN, encephalophathy &
8/12/2019 Emergency 123
9/13
convulsions, prevention & control of convulsions in patients w/ preeclampsia or eclampsia, prevention of
hypomagnesemia in patients receiving TPN
Action: may decrease acetylcholine released by nerve impulses, but its anticonvulsant mechanism is unknown
Adverse Reactions: flushing, sweating, hypotension, muscular weakness, sedation & confusion; decreased deep tendon
reflexes; resp. paralysis
Nursing Measures:
Monitor the following: I.V.: Rapid administration: ECG monitoring, vital signs, deep tendon reflexes; magnesium, calcium,
and potassium levels; renal function during administration. Obstetrics: Patient status including vital signs, oxygensaturation, deep tendon reflexes, level of consciousness, fetal heart rate, maternal uterine activity. Oral: Renal function;
magnesium levels; bowel movements.
18) MEPERIDINE HYDROCHLORIDE
Brand name: Demerol
Classification: antivertigo drug
Dosage: 100 mg/ 2mL
Indication: relief of moderate to severe pain, pre-op medication, support of anesth & obstet analgesia
Action: binds with opiate receptors in the CNS, altering perception of and emotional response to pain
Adverse Reactions: resp. depression, circulatory depression, resp arrest, shock, cardiac arrest, GI disturbance, light
headedness, dizziness, sedation, nausea, vomiting, sweating, euphoria, dysphoria, weakness, headache, tremor,
agitation, uncoordinated muscle movements, severe convulsions, transient hallucinations & disorientation, visual
disturbance, flushing, tachycardia, bradycardia, palpitation, hypotension, syncope, phlebitis, urinary retention, allergic
reactions, pain at injection site and local tissue irritation.
Nursing Measures:
Make position changes slowly and in stages particularly from recumbent to upright posture. Lie down immediately if light -
headedness or dizziness occurs.
Lie down when feeling nauseated and to notify physician if this symptom persists. Nausea appears to worsen with
ambulation.
Avoid driving and other potentially hazardous activities until reaction to drug is known. Codeine may impair ability toperform tasks requiring mental alertness and therefore to.
Do not take alcohol or other CNS depressants unless approved by physician.
Hyperactive cough may be lessened by avoiding irritants such as smoking, dust, fumes and other air pollutants.
Humidification of ambient air may provide some relief.
Do not breast feed while taking this drug.
19) METOCLOPRAMIDE
Brand name: Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-Metoclopramide (CAN), Octamide PFS, Reglan
Classification: antiemetic & anti-spasmodic
Dosage: 10 mg/ 2mL
Indication: disturbances of GI motility, nausea & vomiting of central & peripheral origin associated w/ surgery, metabolic
diseases, infectious & drug induced diseases, facilitate small bowel intubation & radiological procedures of GIT
Action: stimulates motility of upper GI tract, increases lower esophageal sphincter tone, and blocks dopamine receptors at
the chemoreceptor trigger zone
Adverse Reactions: extrapyramidal reactions, drowsiness, fatigue & lassitude, anxiety, less frequently, insomnia,
headache, dizziness, nausea, galactorrhea, gynecomastia, bowel disturbances.
Nursing Measures:
Monitor BP carefully during IV administration.
Monitor for extrapyramidal reactions, and consult physician if they occur.
Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is compromised by alterationsin timing of food absorption.
Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM).
Have phentolamine readily available in case of hypertensive crisis (most likely to occur with undiagnosed
pheochromocytoma).
20) MIDAZOLAM HYDROCHLORIDE
Brand name: Dormicum
8/12/2019 Emergency 123
10/13
Classification: hypnotics & sedatives
Dosage: 5mg/5mL
Indication: tab: disturbances of sleep rhythm, insomnia esp difficulty in falling asleep either initially or after premature
awakening, tab/inj: sedation in premed before surgical or diagnostic procedures, induction & maintenance of anesth.
Action: may potentiate the effects of GABA, depress the CNS, and suppress the spread of seizure activity
Adverse Reactions: rarely cardioresp adverse events, nausea, vomiting, headache, hiccoughs, laryngospasm, dyspnoea,
hallucination, oversedation, drowsiness, ataxia, rash, paradoxical reactions, amnesic episodes.
Nursing Measures: Do not administer intra-arterially, which may produce arteriospasm or gangrene.
Do not use small veins (dorsum of hand or wrist) for IV injection.
Administer IM injections deep into muscle.
Monitor IV injection site for extravasation.
Arrange to reduce dose of midazolam if patient is also being given opioid analgesics; reduce dosage by at least 50%
and monitor patient closely.
Monitor level of consciousness prior to, during, and for at least 26 hr after administration of midazolam.
Carefully monitor P, BP, and respirations carefully during administration.
Keep resuscitative facilities readily available; have flumazenil available as antidote if overdose should occur.
Keep patients in bed for 3 hr; do not permit ambulatory patients to operate a vehicle following an injectio n.
Arrange to monitor liver and kidney function and CBC at intervals during long-term therapy.
Establish safety precautions if CNS changes occur (use side rails, accompany ambulating patient).
Provide comfort measures and reassurance for patients receiving diazepam for tetanus.
Arrange to taper dosage gradually after long -term therapy.
Provide patient with written information regarding recovery and follow-up care. Midazolam is a potent amnesiac and
memory may be altered.
21) MORPHINE SULFATE
Brand name: Morin
Classification: Analgesics (Opioid)Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe or chronic pain Childn 10 mg IM/SC 4 hrly, range: 5-20 mg; 6-12 yr 5-10 mg,
1-5 yr 2.5-5 mg, 1-12 mth 200 mcg/kg,
8/12/2019 Emergency 123
11/13
Nursing Measures:
Patients with hepatic impairment should receive lower dose.
Monitor blood pressure.Allow atleast 3 days between dosage adjustment to achieve steady plasma levels.
Advise patient to report immediately if experiencing chest pain
23) NTG PATCH
Brand name: Deponit, Minitran, Nitrek, Nitro-Dur, Nitrodisc, Transderm-NitroClassification: Anti-Anginal Drugs
Dosage: Starting dose: 0.2-0.4 mg/hr. Dosing schedule: Daily patch-on period of 12-14 hr & daily patch-off period of 10-12
hr.
Indication: Prevention of angina pectoris due to coronary artery disease
Action: a nitrate that reduces cardiac oxygen demand by decreasing left ventricular end diastolic pressure and to a lesser
extent, systemic vascular resistance, also increases blood flow through collateral coronary vessels
Adverse Reactions: Headache. Transient episodes of lightheadedness. Infrequently, hypotension. Syncope, crescendo
angina, rebound HTN, allergic & anaphylactoid reactions. Rarely severe, application site irritation.
Nursing Measures:
Administer transdermal systems to skin site free of hair and not subject to much movement. Shave areas that have a lot
of hair. Do not apply to distal extremities. Change sites slightly to decrease the chance of local irritation and sensitization.
Remove transdermal system before attempting defibrillation or cardioversion.
To use transdermal systems, you may need to shave an area for application. Apply to a slightly different area each day.
Use care if changing brands; each system has a different concentration.
24) PARACETAMOL
Brand name: Aeknil
Classification: Analgesics (Non-Opioid) & Antipyretics
Dosage: Adult & childn 10 yr 2-3 mL, 10 yr 1-2 mL. Depending on severity of case, dose may be repeated 4 hrly. In
severe cases, dose may be administered by IV very slowlyIndication: Pyrexia of unknown origin. Fever & pain associated w/ common childhood disorders, tonsillitis, upper resp tract
infections post-immunization reactions, after tonsillectomy & other conditions. Prevention of febrile convulsion. Headache,
cold, sinusitis, muscle pain, arthritis & toothache
Action: produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in CNS, relieves fever
Adverse Reactions: Hematological, skin & other allergic reactions
Nursing Measures:
Use liquid form for children and patients who have difficulty swallowing.
In children, dont exceed five doses in 24 hours.
Advise patient that drug is only for short term use and to consult the physician if giving to chil dren for longer than 5 days
or adults for longer than 10 days.
Advise patient or caregiver that many over the counter products contain acetaminophen; be aware of this when
calculating total dailydose.
Warn patient that high doses or unsupervised long term use can cause liver damage.
25) PHENYTOIN
Brand name: Dilantin
Classification: Anticonvulsants
Dosage: Adult Initially 100 mg tid. Maintenance: 300-400 mg daily. Childn 6 yr Initially 100 mg tid, subsequent dosage
should be adjusted according to therapeutic response,
8/12/2019 Emergency 123
12/13
throughout therapy, Assess oral hygiene. Vigorous oral cleaning beginning within 10 days of initiation of phenytoin therapy
may help control gingival hyperplasia.
26) TERBUTALINE
Brand name: Bricalin
Classification: Antiasthmatic & COPD Preparations
Dosage: Antiasthmatic & COPD PreparationsIndication: For reversible airways obstruction, in asthma, COPD. Decreases uterine contractility & may be used to arrest
premature labor
Action: relaxes bronchial smooth muscles by stimulating beta-2 receptors
Adverse Reaction: Fine tremor of skeletal muscle esp hands, palpitations, tachycardia, nervous tension, headache,
peripheral vasodilation.
Nursing Measures:
Use minimal periodsof time; drug tolerance can occur with prolonged use.
Keep beta-adrenergic blocker readily available in case cardiac arrhythmias occur.
Do not recommended dosage.
27) VERAPAMIL HYDROCHLORIDE
Brand name: Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM
Classification: Calcium Antagonists
Dosage: Isoptin tab Adult 40-80 mg tid-qid. Max: 480 mg daily. Childn >6 yr 40-120 mg bid-tid, up to 360 mg daily, childn
6 yr 40 mg bid-tid. Isoptin SR 180 Coronary insufficiency 1 tab bid. Usual daily dose: 240-480 mg. Hypertension 1 tab in
the morning. Isoptin SR 240 1 tab in the morning. If required after 2 wk, increase dose to 2 tab daily. Isoptin amp 5 mg
slow IV, if required, 5 mg after 5-10 min. Then, if required, continuous drip infusion of 5-10 mg/hr up to 100 mg/day.
Angina pectoris & rapid elimination of tachyarrhythmias 1-2 amp IV, if required bid-tid
Indication: Isoptin/Isoptin SR 180 Essential hypertension, chronic coronary insufficiency, angina pectoris, paroxysmal
supraventricular tachycardia, tachyarrhythmias, long-term treatment after MI. Isoptin SR 240 Essential hypertensionAction: decreases myocardial contractility and oxygen demand, it also dilates coronary arteries and arterioles
Adverse Reactions: Constipation, dizziness, nausea. Rarely, vertigo, headache, hypotension, ankle edema, flushing,
fatigue, nervousness, erythromelalgia, paraesthesia, neuropathy; bradycardiac arrhythmias, CHF. Dyspnea
Nursing Measures:
Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being titrated to therapeutic dose. Dosage may
be increased more rapidly in hospitalized patients under close supervision.
Ensure that patient swallows SR tablets whole: do not cut, crush, or chew them.
Monitor BP very carefully with concurrent doses of antihypertensives.
Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy.
Administer sustained-release form in the morning with food to decrease GI upset.
Protect IV solution from light.
Monitor patients with renal or hepatic impairment carefully for possible drug accumulation and adverse reactions.
28) IPRATROPIUM INHALATION
Brand name: Atrovent
Classification: Antiasthmatic & COPD Preparations, anticholinergics or antimuscarinics
Stock: 0.5 mg/2 mL
Dosage: Adult (including elderly) & adolescent >12 yr Acute attacks 1 vial, may repeat doses until patient is stable.
Maintenance: 1 vial tid-qid.
Indication: Bronchodilator for treatment of bronchospasm associated w/ COPD, including chronic bronchitis, emphysemaand asthma
Action: it works by binding to specific receptors (called muscarinic receptors) in the airway, helping to relax the smooth
muscle of the airway. When used to treat a runny nose, it works by decreasing the production of fluid in the glands that
line the nasal passages
Adverse Reaction: Headache, nausea, dry mouth, increased heart rate & palpitations, ocular accommodation
disturbances, GI motility disturbances, urinary retention, ocular side effects, cough, local irritation, bronchoconstriction,
skin rash, angioedema, urticaria, laryngospasm, anaphylactic reactions.
Nursing Measures:
8/12/2019 Emergency 123
13/13