Emergency Drugs Plain

8/2/2019 Emergency Drugs Plain

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EMERGENCY DRUGS: A drug study.

1) AMINOPHYLLINE

Brand Names: Phil Pharmawealth/Atlantic Aminophylline amp Theofil ampClassification: 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 15

30 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


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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 fora 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 includingpulmonary 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.

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.


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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 light exposure); 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


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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 tasks); constipation (ensure adequate fluid intake, proper

diet); dry mouth (suck sugarless lozenges; perform frequent mouth care; may betransient); 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

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.


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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 tosunlight (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 ampClassification: 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. Hypercalcaemia characterised 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.


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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 mgtwice 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: 6.25

mg/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:

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


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that may contain ingredients that will interact with ACE inhibitors. Consult your


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 AntihypertensivesIndication/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 theeye; fluid or electrolyte imbalance, GI upset, paralytic ileus, orthostatic

hypotension, 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 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


Avoid over-the-counter medications, especially cough, cold, allergy medications

that may contain ingredients that will interact with ACE inhibitors. Consult your


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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; restrict intake 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) 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 activity

Adverse Reaction: drowsiness,dysarthria, slurred speech, tremor, transient

amnesia, fatigue, ataxia, headache, insomnia, paradoxical anxiety, hallucination

Nursing Measures:


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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: Inotropics

Dosage: 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 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


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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

hypertension

Action: 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, emphysema and 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,


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urinary retention, ocular side effects, cough, local irritation, bronchoconstriction,

skin rash, angioedema, urticaria, laryngospasm, anaphylactic reactions.

Nursing Measures:

Protect solution for inhalation from light. Store unused vials in foil pouch.

Use nebulizer mouthpiece instead of face mask to avoid blurred vision or

aggravation of narrow-angle glaucoma.

Can mix albuterol in nebulizer for up to 1 hr.

Ensure adequate hydration, control environmental temperature to prevent

hyperpyrexia.

Have patient void before taking medication to avoid urinary retention.

Teach patient proper use of inhalator.

29) FENOTEROL/IPRATROPIUM BROMIDE

Brand name: BerodualClassification: Antiasthmatic & COPD Preparations

Dosage: Berodual inhalation soln Adult (including elderly) & adolescent >12 yr

Treatment of 1 mL for immediate symptom relief. Intermittent & long-term

treatment 1-2 mL for each administration, up to qid. Moderate bronchospasm or

w/ assisted ventilation 0.5 mL. Childn 6-12 yr Treatment of attacks 0.5-1 mL.

Intermittent & long-term treatment 0.5-1 mL for each administration, up to qid.

Moderate bronchospasm or w/ assisted ventilation 0.5 mL. Childn


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hyperpyrexia.



30) BUDESONIDE

Brand name: Symbicort

Classification: Corticosteroids

Dosage: 80/4.5 mcg x 60 doses; 160/4.5 mcg x 60 doses; 320/9 mcg x 60 doses

Indication: regular treatment of asthma where use of a combination (inhaled

corticosteroid and long acting beta 2 agonist) is appropriate

Action: work by reducing inflammation, which helps with several conditions

ranging from asthma to allergies toCrohns disease

Adverse Reactions: Abdominal pain, conjunctivitis (pinkeye), cough, diarrhea, earinfection or inflammation, fever, fungal infection in mouth, headache, nasal or

sinus inflammation, nosebleed, pain, rash, respiratory infection, stomach or

intestinal inflammation, throat inflammation, viral infection, vomiting, wheezing

Nursing Measures:

Taper systemic steroids carefully during transfer to inhalational steroids; deaths

from adrenal insufficiency have occurred.

Arrange for use of decongestant nose drops to facilitate penetration if edema,

excessive secretions are present.

Prime unit before use for Pulmicort Turbuhaler; have patient rinse mouth after

each use. Use aerosol within 6 mo of opening. Shake well before each use.

Store Respules upright and protected from light; gently shake before use; open

envelopes should be discarded after 2 wk.

31) ALBUTEROL AND IPRATROPIUM INHALATION

Brand name: Combivent

Classification: Bronchodilators

Stock: 2.5 mL

Dose: MDI Adult 2 puffs tid-qid. Max 12 puffs/day. Unit dose vial Adult & childn

>12 yr 1 vial every 6-8 hr. Childn 2-12 yr 3 drops/kg/dose (max: 2500 mcg of

salbutamol) every 6-8 hr.

Indication: management of reversible bronchospasm associated with obstructive

airway diseases in patients who require more than a single bronchodilator

Action: muscles in the airways and increase air flow to the lungs


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Adverse Reactions: Fine tremor of skeletal muscle; palpitations; headache,

dizziness, nervousness; dryness of mouth, throat irritation; urinary retention

Nursing Measures:

Use nebulizer mouthpiece instead of face mask to avoid blurred vision or

aggravation of narrow-angle glaucoma.

Can mix albuterol in nebulizer for up to 1 hr.


hyperpyrexia.



32) SALBUTAMOL

Brand name: Aero-Vent

Classification: bronchodilatorStock: 1 mg/1 mL

Dose: Adult & childn 2.5-5 mg. May repeat qid by hlebitis. Delivery of aerosol

may be by face mask of T piece. Use undiluted. For prolonged delivery time,

dilute w/ sterile water or normal saline for inj.

Indication: treatment of acute, severe asthma and in routine management of

chronic bronchospasm unresponsive to conventional therapy

Action: used with anti-inflammatory medication to prevent asthma attacks, Some

of these medicines are used to treat the symptoms of asthma, chronic bronchitis,

emphysema, and other lung diseases, while others are used to prevent the

symptomsAdverse Reactions: Dizziness, severe; feeling of choking, irritation, or swelling in

throat; flushing or redness of skin; hives; increased shortness of breath; skin

rash; swelling of face, lips, or eyelids; tightness in chest or wheezing, troubled

breathing

Nursing Measures:

Assess lung sounds, pulse, and blood pressure before administration and

during peak of medication. Note amount, color, and character of sputum

produced.

Monitor pulmonary function tests before initiating therapy and periodically

throughout course to determine effectiveness of medication.

Observe for paradoxical bronchospasm (wheezing). If condition occurs,

withhold medication and notify physician or other health care professional

immediately.

Instruct mother to take missed dose as soon as remembered, spacing

remaining doses at regular intervals. Do not double doses or increase the dose


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or frequency of doses.

Inform the mother not to smoke near the child and to avoid respiratory irritants.

Advise the mother to rinse the childs mouth with water after each inhalation

dose to minimize dry mouth.

33) TERBUTALINE SULFATE

Brand name: Pulmonyl

Classification: Antiasthmatic/ Brochodilator

Stock: 2.5 mg/ml

Dose: Adult 5-10 mg, Children 2-5mg

Indication: relief of bronchospasm in obstructive airway diseases

Action: It works by dilating (opening) the bronchioles of the lungs by relaxing the

muscles around them. This allows for easier airflow into and out of the lungs

Adverse Reactions: Headache, nausea, vomiting, palpitations, tachycardia,sweating & drowsiness

Nursing Measures:

Use minimal periods of time; drug tolerance can occur with prolonged use.

Keep beta-adrenergic blocker readily available in case cardiac arrhythmias

occur.

Do not recommended dosage.

34) HEPARIN SODIUM

Brand name: Britton Heparin NaClassification: Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)

Dosage: 5000 iu/1 mL; 25000 iu/1 mL

Indication: treatment and prophylaxis of thromboembolic disorders

Action: Accelerates formation of antithrombin III-thrombin complex and

deactivates thrombin, preventing conversion of fibrinogen to fibrin

Adverse Reactions: Slight fever, headache, chills, nausea, vomiting, constipation,

epistaxis, bruising, slight haematuria, skin necrosis (SC inj), osteoporosis,

alopecia. Hypersensitivity reactions include urticaria, conjunctivitis, rhinitis,

asthma, angioedema and anaphylactic shock. Priapism. Potentially Fatal:

Heparin-induced thrombocytopenia with or without thrombosis; bleeding

Nursing Measures:

Baseline blood coagulation tests, Hct, Hgb, RBC and platelet counts prior to

initiation or therapy and at regular intervals throughout therapy

Monitor APTT levels closely

Draw blood for coagulation tests 30 min before each scheduled SC or


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intermittent IV dose and approximately q4h for pts receiving continuous IV

heparin during dosage adjustments period. After dosage is established, tests

may be done once daily

Pts vary widely in their reaction to heparin; risk of hemorrhage appears greatest

in women, all patients > 60 y, and patients with liver disease or renal

insufficiency.

Monitor vitals, report fever, drop in BP, rapid pulse and other S&S of

hemorrhage

Observe all needle sites daily for hematoma and signs of inflammation

Have on hand protamine sulfate, specific heparin antagonist

35) ESMOLOL HYDROCHLORIDE

Brand name: Brevibloc

Classification: Beta blockersDosage: 100mg/10ml

Indication: supraventricular tachycardia; post-operative tachycardia or

hypertension; non-compensatory sinus tachycardias; intra-operative tachycardia

or hypertension; unstable angina, non ST segment elevation MI

Action: A Class II antiarrythmic and ultra-short-acting selective beta blocker that

decreases heart rate, contractility and blood pressure

Adverse Reactions: Hypotension, bradycardia, heart failure, local irritation,

diaphoresis, peripheral ischaemia, dizziness, somnolence, confusion, fatigue,

paraesthesia, peripheral neuropathy, headache, weakness, irritability, dyspnoea,

nausea, vomiting, blurred vision, urinary retention, fever, rigor, muscular pain.Potentially Fatal: Profound bradycardia, AV block, cardiogenic shock, asystole,

bronchospasm.

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.

Monitor cardiac rhythm regularly during stabilization of dosage and periodically

during long-term therapy.

36) D 50-50

Brand name: Phil Pharmawealth/Atlantic 50% Dextrose

Classification: Intravenous & Other Sterile Solutions

Dosage: 50ml/vial

Indication: for hypoglycemia


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Action: A simple water soluble sugar that minimizes glyconeogenesis and

promotes anabolism in patients whose oral caloric intake is limited

Adverse Reactions: Local pain, vein irritation, thrombophlebitis & tissue necrosis

in the event of extravasation. Fluid & electrolyte imbalance eg hypokalemia,

hypomagnesemia & hypophosphatemia; edema or water intoxication

Nursing Measures:

Monitor infusion rate frequently; if signs of fluid overload, turn off IV drip.

Infusion may result in fluid overload.

Check IV site frequently and if infiltration is noted, turn off IV drip.

Watch out for signs of fluid overload (distended neck veins (JVD), rapid

respirations, shallow tidal volume, fine auscultatory crackles, dyspnea, and

peripheral edema)

Watch out for signs of infiltration (swelling and pain around IV site).

37) POTASSIUM CHLORIDE

Brand name: Phil Pharmawealth/Atlantic Potassium Chloride

Classification: Electrolytes

Dosage: 40 meqs/20 ml

Indication: for hypokalemia, acute MI

Action: Replaces potassium and maintains potassium level

Adverse Reactions: GI ulceration (sometimes with haemorrhage and perforation

or with late formation of strictures) following the use of enteric-coated K chloride

preparation; hyperkalaemia. Oral: Nausea, vomiting, phlebiti and abdominal

cramps. IV: Pain or phlebitis; cardiac toxicity.Nursing Measures:

Monitor serum potassium levels, renal function, and serum bicarbonate.

Explain to patient purpose of the medication and the need to take as

directed,especially when concurrent digoxin or diuretics are taken. A missed

dose should be taken as soon as remembered within 2 hr; if not, return to regular

doseschedule. Do not double dose.

Emphasize correct method of administration. GI irritation or ulceration may

result from chewing enteric-coated tablets or insufficient dilution of liquid or

powder forms. Some extended-release tablets are contained in a wax matrix that

may be expelled in the stool. This occurrence is not significant.

Instruct patient to avoid salt substitutes or low-salt milk or food unless approved

by health care professional.

Patient should be advised to read all labels to prevent excess potassium

intake.

Advise patient regarding sources of dietary potassium.


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Encourage compliance with recommended diet.

Instruct patient to report dark, tarry, or bloody stools; weakness; unusual

fatigue; or tingling of extremities.

Notify health care professional if nausea, vomiting, diarrhea, or stomach

discomfort persists.

Dosage may require adjustment. Emphasize the importance of regular follow-up

exams to monitor serum levels and progress.

38) LIDOCAINE HYDROCHLORIDE

Brand name: Abbott Lidocaine

Classification: Anaesthetics - Local & General

Dosage: 50 ml/vial

Indication: local or regional anesthesia

Action: A class IB antiarrythmic that decreases the depolarization, automaticity,and excitability in the ventricles during the diastolic phase by direct action on the

tissues especially the Purkinje network

Adverse Reactions: Restlessness, nervousness, dizziness, tinnitus, blurred

vision; GI upsets; muscle twitching, convulsions; numbness of the tongue;

hypotension, bradycardia; methemoglobinaemia; fetal intoxication.

Nursing Measures:

Check drug concentration carefully; many concentrations are available.

Reduce dosage with hepatic or renal failure.

Continuously monitor response when used as antiarrhythmic or injected as local

anesthetic. Keep life-support equipment and vasopressors readily available in case severe

adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.

Establish safety precautions if CNS changes occur; have IV diazepam or short-

acting barbiturate (thiopental, thiamylal) readily available in case of seizures.

Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life -

support equipment and IV dantrolene on standby.

Titrate dose to minimum needed for cardiac stability, when using lidocaine as

antiarrhythmic.

Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV

block, and geriatric patients.

Monitor fluid load carefully; more concentrated solutions can be used to treat

arrhythmias in patients on fluid restrictions.

Have patients who have received lidocaine as a spinal anesthetic remain lying

flat for 612 hr afterward, and ensure that they are adequately hydrated to

minimize risk of headache.


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Check lidocaine preparation carefully; epinephrine is added to solutions of

lidocaine to retard the absorption of the local anesthetic from the injection site.

Be sure that such solutions are used

only to produce local anesthesia. These solutions should be injected cautiously

in body areas supplied by end arteries and used cautiously in patients with

peripheral vascular disease, hypertension, thyrotoxicosis, or diabetes.

Use caution to prevent choking. Patient may have difficulty swallowing following

use of oral topical anesthetic. Do not give food or drink for 1 hr after use of oral

anesthetic.

Treat methemoglobinemia with 1% methylene blue, 0.1 mg/kg, IV over 10 min.

Apply lidocaine ointments or creams to a gauze or bandage before applying to

the skin.

Monitor for safe and effective serum drug concentrations (antiarrhythmic use:

15 mcg/mL). Doses > 610 mcg/mL are usually toxic

39) SODIUM BICARBONATE

Brand name: Hospira Sodium Bicarbonate

Classification: Alkalinizers

Dosage: 10mEq/10ml; 50mEq/50ml

Indication: metabolic acidosis, systemic or urinary alkalinization, antacid, cardiac

arrest

Action: Restores buffering capacity of the body and neutralizes excess acid

Adverse Reaction: Tetany, edema, gastric distention, belching, flatulence,

hypokalemia, metabolic alkalosis, hypernatremia, chemical cellulitis because ofalkalinity, pain, irritation, tissue necrosis, ulceration or sloughing at the site of

infiltration

Nursing Measures:

do not take drug with milk to avoid hypercalcemia, abnormally high alkalinity in

tissues and fluids, or kidney stones.

do not give to patients with metabolic or respiratory alkalosis, and in those with

hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or

heart failure.

monitor for alkalosis by obtaining blood pH, PaO2, PCO2, and electrolyte levels

40) DOPAMINE

Brand name: Intropin

Classification: Adrenergics (Sympathomimetics)

Dosage: 40 mg/Ml; 80mg/mL; 160 mg/mL


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Indication : shock and hemodynamic imbalances, hypotension

Action: Stimulates dopaminergic and alpha beta receptors for the sympathetic

nervous system resulting in a positive inotropic effect and increased cardiac

output. Action is dose-related; large doses cause mainly alpha stimulation

Adverse Reaction: ectopic beats, tachycardia, anginal pain, palpitation,

hypotension, vasoconstriction, ventricular arrhythmias, hypertension, headache,

anxiety, dilated pupils, nausea, vomiting, decreased urine output, dyspnea

Nursing Measures:

Monitor vital signs and ECG closely throughout therapy.

Monitor I&O regularly; note decreases in urine output.

Monitor central venous pressure or pulmonary wedge pressure if possible

during infusion.

Note significant changes in vital signs, ECG changes, deterioration of peripheral

pulses, and/or cold, mottled extremities

41) DOBUTAMINE

Brand name: Dobatrey

Classification: Adrenergics

Dosage: 12.5 mg/mL

Indication: increased cardiac output in short term treatment of cardiac

decompensation caused by depressed contractility

Action: Stimulates hearts beta1 receptors to increase myocardial contractility

and stroke volume. Increases cardiac output by decreasing peripheral vascular

resistance, reducing ventricular filling pressure, and facilitating AV nodeconduction

Adverse Reaction: increased systolic BP, increased heart rate, chest pain,

increased number of premature ventricular beats, headache, tingling sensations,

paresthesia. nausea, vomiting, dyspnea, phlebitis, local inflammation after

infiltration, leg cramps

Nursing Measures:

Monitor vital signs, ECG, cardiac output, pulmonary capillary wedge pressure,

central venous pressure and urinary output carefully throughout infusion.

Monitor patency and placement of IV catheter to reduce risk of extravasation

and phlebitis.

Watch out for symptoms of overdosage such as excessive hypertension,

tachycardia, nausea, vomiting, tremor, headache, chest pain

42) LIDOCAINE PREMIXED


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Brand name: Xylocaine

Classification: Antiarrhythmic agent, Local anesthetic

Dosage: 0.2% (2mg/ml); 0.4% (4g/ml); 0.8% (8g/ml)

Indication: ventricular arrhythmias caused by MI, cardiac manipulation or cardiac

glycosides

Action: Acts as an anesthetic by stabilizing the neuronal membrane by inhibiting

the ionic fluxes required for the initiation and conduction of impulses, thereby

effecting local anesthetic action. Also acts as an antiarrhythmic by decreasing the

depolarization, automaticity, and excitability in the ventricles during the diastolic

phase by a direct action on the tissues, especially the Purkinje network, without

involvement of the autonomic system. Neither contractility, systolic arterial blood

pressure, atrioventricular (AV) conduction velocity, nor absolute refractory period

is altered by usual therapeutic doses

Adverse Reaction: bradycardia, cardiac arrest, CV collapse, hypotension,

apprehension, confusion, dizziness, drowsiness, hallucinations, headache, light-headedness, mood changes, nervousness, tremors, conjunctival hyperemia,

corneal epithelial changes, diplopia, tinnitus, visual disturbances, nausea,

vomiting, erythema, petechiae, edema, injection-site reactions, including bruising,

burning, contusion, hemorrhage, local reactions, including soreness at IM

injection site, venous thrombosis or phlebitis, extravasation, burning, stinging,

sloughing, respiratory depression or arrest, hypersensitivity reactions

Nursing Measures:

Explain that adverse reactions related to the CNS (eg, drowsiness, confusion,

paresthesias, convulsions, respiratory arrest) can occur and are a result of CNS

toxicity. Advise patient that drug may cause dizziness or drowsiness and to avoid

getting out of bed or walking without assistance.

Advise patients that skin reactions, including erythema, petechiae, and edema,

may occur with intradermal injection.

Systemic effects can occur following topical use; use lowest possible dose to

avoid serious toxicity, shock, or heart block.

Do not use in patients with congenital or idiopathic methemoglobinemia or in

infants younger than 12mo of age who are receiving methemoglobin-inducingdrugs.

Use with caution and in lower doses in patients with CHF, reduced cardiac

output, digitalis toxicity, and in elderly patients

43) MANNITOL

Brand name: Osmitrol


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Classification: osmotic diuretic

Dosage: 5% , 10%, 15%, 20%, 25% in 500cc/1,000cc

Indication: test dose for marked oliguria or suspected inadequate renal function,

oliguria, to reduce intraocular or intracranial pressure, diuresis in drug

intoxication

Action: Increases osmotic pressure of glomerular filtrate; drug elevates plasma

osmolality

Adverse Reaction: Increased urination, nausea, runny nose, vomiting, severe

allergic reactions (rash, hives, itching, difficulty breathing, tightness in the chest,

swelling of the mouth, face, lips, or tongue), blurred vision, chest pain, chills or

fever, confusion, decreased alertness, difficulty urinating, extreme dizziness,

extreme thirst or dry mouth, fast or irregular heartbeat, headache, muscle

cramps, pain, redness, or swelling at the injection site, weakness

Nursing Measures:

Monitor vital signs, including CVP, and fluid intake and output. Monitor weight, renal function, and serum sodium and potassium levels daily

Watch out for symptoms of overdosage such as excessive hypertension,

tachycardia, nausea, vomiting, tremor, headache, chest pain

To relieve thirst, give frequent mouth care and fluids

44) DEXTROSE 5% IN WATER (D5W) SOLUTION

Brand name: None

Classification: Isotonic/Hypotonic Solution

Dosage: 250ml bottles (5g dextrose/100ml water)Indication: fluid replacement and caloric supplementation in patients who cant

maintain adequate oral intake or are restricted from doing so

Action: Provides some sugar for cellular metabolism and supplies body water

Adverse Reaction: Increases free water and may cause intracellular edema, fluid

overload, infiltration (swelling and pain at infusion site)

Nursing Measures:

Monitor infusion rate frequently; if signs of fluid overload, turn off IV drip.

Infusion may result in fluid overload.

Check IV site frequently and if infiltration is noted, turn off IV drip.

Watch out for signs of fluid overload (distended neck veins (JVD), rapid

respirations, shallow tidal volume, fine auscultatory crackles, dyspnea, and

peripheral edema)

Watch out for signs of infiltration (swelling and pain around IV site).

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Emergency Drugs Plain