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
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 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
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
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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; 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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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.
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.
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.
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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