EMERGENCY DRUGSleo macaraan

CARDIAC DISORDERS

NITROGLYCERIN

Classification: CARDIOVASCULAR AGENT; NITRATE VASODILATOR

NITROGLYCERIN

Dilates coronary arteries and improves blood flow to ischemic myocardium. It is therefore the treatment of choice for angina pectoris and myocardial infarction.

NURSES ROLEInstruct patient to sit or lie down upon first indication of oncoming anginal pain and to place tablet under tongue or in buccal pouch (hypotensive effect of drug is intensified in the upright position).

NURSES ROLEIf pain is not relieved after 1 tablet, additional tablets may be taken at 5 min intervals, but not more than 3 tablets should be taken in a 15 min period. Taking more tablets than necessary can further decrease coronary blood flow by producing systemic hypotension.

NURSES ROLEMoisture on sublingual tissue is required for dissolution of sublingual tablet. However, because chest pain typically leads to dry mouth, a patient may be unresponsive to sublingual nitroglycerin.

NURSES ROLETransdermal unit is applied at the same time each day, preferably to skin site free of hair and not subject to excessive movement. Avoid abraded, irritated, or scarred skin. Clip hair if necessary.Change application site each time to prevent skin irritation and sensitization.

NURSES ROLEAssess for headaches. Approximately 50% of all patients experience mild to severe headaches following nitroglycerin. Transient headache usually lasts about 5 min after sublingual administration and seldom longer than 20 min. Assess degree of severity and consult as needed with physician about analgesics and dosage adjustment.

NURSES ROLE

Any local burning or tingling from the sublingual form has no clinical significance.

NURSES ROLEOverdose symptoms include hypotension, tachycardia; warm, flushed skin becoming cold and cyanotic; headache, palpitations, confusion, nausea, vomiting, moderate fever, and paralysis. Tissue hypoxia leads to coma, convulsions, cardiovascular collapse. Death can occur from asphyxia.

MORPHINE SULFATE

Classification: CNS AGENT; ANALGESIC; NARCOTIC (OPIATE) AGONIST

MORPHINE SULFATEUsed to treat the chest pain associated with acute myocardial infarction. It relieves pain, dilates venous vessels, and reduces the workload of the heart.

NURSES ROLEThe nurse must be aware that respiratory depression and hypotension are common adverse effects; close client monitoring is essential.RR < 12/min and miosis are signs of toxicity.

NURSES ROLEAlways have narcotic antagonist naloxone (Narcan) available at bedside.

ATROPINE SULFATE

Classifications: AUTONOMIC NERVOUS SYSTEM AGENT; ANTICHOLINERGIC (PARASYMPATHOLYTIC); ANTIMUSCARINIC

ATROPINE SULFATEIt is indicated in the treatment of hemodynamically significant bradycardia and heart block, as well as asystole.

NURSES ROLEMonitor vital signs. HR is a sensitive indicator of patient's response to atropine. Be alert to changes in quality, rate, and rhythm of HR and respiration and to changes in BP and temperature.

NURSES ROLEAtropine may contribute to the problem of urinary retention. Palpate lower abdomen for distention. Monitor I&O. Have patient void before giving atropine.

VERAPAMIL

Classifications: CARDIOVASCULAR AGENT; CALCIUM CHANNEL BLOCKER

VERAPAMILIt is indicated for the treatment of tachycardia originating above the ventricles (supraventricular tachycardia). It slows conduction through the heart and has a negative inotropic and vasodilating effects.

NURSES ROLEThe nurse must carefully monitor heart rate and rhythm as ell as blood pressure. Transient asymptomatic hypotension may accompany IV bolus. Instruct patient to remain in recumbent position for at least 1 h after dose is given to diminish subjective effects of hypotension.

LIDOCAINE

Classifications: CARDIOVASCULAR AGENT; ANTIARRHYTMIC; CNS AGENT; LOCAL ANESTHETIC

LIDOCAINEIt is primarily used to treat ventricular dysrhythmias, such as premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation. It exerts a local anesthetic effect on the heart, thus decreasing myocardial irritability.

NURSES ROLEContinuous cardiac monitoring and assessment for signs and symptoms of lidocaine toxicity (confusion, drowsiness, hearing impairment, cardiac conduction defects, myocardial depression, muscle twitching and siezures).

EPINEPHRINEClassifications: AUTONOMIC NERVOUS SYSTEM AGENT; ALPHA- AND BETA-ADRENERGIC AGONIST; BRONCHODILATOR

EPINEPHRINEIndications for administration of intravenous epinephrine include profound bradycardia, asystole, pulseless ventricular tachycardia, and ventricular fibrillation. It is thought to improve perfusion of the heart and brain in cardiac arrest states through constriction of peripheral blood vessels.

NURSES ROLEMonitor BP, pulse, respirations, and urinary output and observe patient closely following IV administration. Epinephrine may widen pulse pressure. If disturbances in cardiac rhythm occur, withhold epinephrine and notify physician immediately.

NURSES ROLEIt should never be administered in the same site as an alkaline solution such as sodium bicarbonate; it inactivates epinephrine.Acid-base imbalances should be corrected first to improve effectiveness of the drug.

SODIUM BICARBONATE

Classifications: GI AGENT; ANTACID; ELECTROLYTIC BALANCE AGENT

SODIUM BICARBONATE

Used to treat metabolic acidosis that often accompanies cardiac arrest.

NURSES ROLE

Stop infusion immediately if extravasation occurs. Severe tissue damage has followed tissue infiltration.

SHOCK

DOPAMINE HCLClassifications: AUTONOMIC NERVOUS SYSTEM AGENT; ALPHA- AND BETA-ADRENERGIC AGONIST (SYMPATHOMIMETIC)

DOPAMINE HCLUsed to treat hypotension in shock states that are not due to hypovolemia.

(dopaminergic effect): dilates the renal and messenteric blood vessels, producing an increase in urine output.

DOPAMINE HCL(alpha-adrenergic effect): enhances cardiac output by increasing myocardial contractility and increasing heart rate and elevates blood pressure through vasoconstriction.

NURSES ROLEMonitor ECG and BP continuously during administration. Note: Marked increases in blood pressure (systolic pressure is the most likely to be affected) and heart rate, or the appearance of arrhythmias or other adverse cardiac effects are usually reversed promptly by reduction in dosage.

NURSES ROLEObserve patients with pre-existing hypertension closely for exaggerated pressor response. Note: Tolerance has been observed with continuous or prolonged infusions; adverse reactions are no different than those seen with shorter infusions. Monitor I&O ratio and pattern. Urine output and sodium excretion generally increase because of improved cardiac output and renal perfusion.

NURSES ROLEFollow measures to relieve dry mouth: adequate hydration; small, frequent mouth rinses with tepid water; meticulous mouth and dental hygiene; gum chewing or sucking sugarless sourballs.

DOBUTAMINE HCLClassifications: AUTONOMIC NERVOUS SYSTEM AGENT; BETA-ADRENERGIC AGONIST; CATECHOLAMINE

DOBUTAMINE HCLIt enhances the force of myocardial contraction and increases the heart rate. Blood pressure is elevated only through the increase in cardiac output and has no vasoconstriction effects.

NURSES ROLEContinuous cardiac and blood pressure monitoring are required.

Adverse effects include myocardial ischemia, tachycardia, dysrythmias, headache, nausea, and tremors.

NOREPINEPHRINEClassifications: AUTONOMIC NERVOUS SYSTEM AGENT; ALPHA- AND BETA-ADRENERGIC AGONIST (SYMPATHOMIMETIC)

NOREPINEPHRINEExtremely potent vasoconstrictor actions. It is used in shock states, often when drugs such as dopamine and dobutamine have failed to produce adequate blood pressure.

NURSES ROLEContinuous cardiac monitoring and precise blood pressure monitoring are required.Watch out for extravasation. It may cause tissue necrosis. Infiltration with Phentolamine should be done in case of such.

HYPERTENSIVE CRISES

NICARDIPINE HCL

Classifications: CARDIOVASCULAR AGENT; CALCIUM CHANNEL BLOCKER; ANTIHYPERTENSIVE AGENT

NICARDIPINE HCLTherapeutic Effects It reduces BP at rest and during isometric and dynamic exercise.

Uses Either alone or with beta blockers for chronic, stable (effort-associated) angina; either alone or with other antihypertensives for essential hypertension.

NURSES ROLE

Establish baseline data before treatment is started including BP, pulse, and lab values of liver and kidney function.

NURSES ROLE Monitor BP during initiation and titration of dosage carefully. Hypotension with or without an increase in heart rate may occur, especially in patients who are hypertensive or who are already taking antihypertensive medication.

NURSES ROLE Avoid too rapid reduction in either systolic or diastolic pressure during parenteral administration. Discontinue IV infusion if hypotension or tachycardia develop.

NURSES ROLE

Rise slowly from a recumbent position; avoid driving or operating potentially dangerous equipment until response to nicardipine is known.

NURSES ROLE

Notify physician if any of the following occur: Irregular heart beat, shortness of breath, swelling of the feet, pronounced dizziness, nausea, or drop in BP.

FUROSEMIDE

Classifications: ELECTROLYTIC AND WATER BALANCE AGENT; LOOP DIURETIC

FUROSEMIDEUsed in the treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema.

NURSES ROLE Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment.

NURSES ROLENote: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving sympatholytic agents.

NURSES ROLE Ingest potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to reduce or prevent potassium depletion. Learn S&S of hypokalemia. Report muscle cramps or weakness to physician.

NURSES ROLE Make position changes slowly because high doses of antihypertensive drugs taken concurrently may produce episodes of dizziness or imbalance.

RESPIRATORY DISTRESS

ALBUTEROLClassifications: AUTONOMIC NERVOUS SYSTEM AGENT; BETA-ADRENERGIC AGONIST (SYMPATHOMIMETIC); BRONCHODILATOR (RESPIRATORY SMOOTH MUSCLE RELAXANT)

NURSES ROLEAdminister albuterol 2030 min.

Monitor therapeutic effectiveness which is indicated by significant subjective improvement in pulmonary function within 6090 min after drug administration.

NURSES ROLEMonitor for: S&S of fine tremor in fingers, which may interfere with precision handwork; CNS stimulation, particularly in children 26 y, (hyperactivity, excitement, nervousness, insomnia), tachycardia, GI symptoms. Report promptly to physician.

TERBUTALINE SULFATE

Classifications: AUTONOMIC NERVOUS SYSTEM AGENT; BETA-ADRENERGIC AGONIST; BRONCHODILATOR

TERBUTALINE SULFATE

It is used subcutaneously as a bronchodilator in bronchial asthma and for reversible airway obstruction associated with bronchitis and emphysema

NURSES ROLE

Give SC injection into lateral deltoid area.

Assess vital signs: Baseline pulse and BP and before each dose.

NURSES ROLEMost adverse effects are transient, however, rapid heart rate may persist for a relatively long time. Be aware that muscle tremor is a fairly common adverse effect that appears to subside with continued use.

HYDROCORTISONE

Classifications: SKIN AND MUCOUS MEMBRANE AGENT; ANTIINFLAMMATORY; SYNTHETIC HORMONE; ADRENAL CORTICOSTEROIDS; GLUCOCORTICOID; MINERALOCORTICOID

HYDROCORTISONEIt has an anti-inflammatory, immunosuppressive, and metabolic functions in the body.

NURSES ROLEGive oral drug with food. Note: Dose adjustment may be required if patient is subjected to severe stress (serious infection, surgery, or injury).Establish baseline and continuing data on BP, weight, fluid and electrolyte balance, and blood glucose.

NURSES ROLENotify physician of slow healing, any vague feeling of being sick, or return to pre-treatment symptoms. Do not abruptly discontinue drug; doses are gradually reduced to prevent withdrawal symptoms.

NURSES ROLENote: A high protein, calcium, and vitamin D diet is advisable to reduce risk of corticosteroid-induced osteoporosis. Do NOT use aspirin or other OTC drugs unless prescribed specifically by the physician.

TRANEXAMIC ACID

Classifications: Hemostatic

TRANEXAMIC ACID

Acts as an inhibitor of fibrinolytic bleeding.

NURSES ROLECheck IV site at frequent intervals for extravasation. Observe for signs of thrombophlebitis.Change site immediately if extravasation or thrombophlebitis occurs.

OTHERS

MIDAZOLAM HCL

Classifications: CENTRAL NERVOUS SYSTEM AGENT; BENZODIAZEPINE ANXIOLYTIC; SEDATIVE-HYPNOTIC

MIDAZOLAM HCLThis calms the patient, relaxes skeletal muscles, and in high doses produces sleep.

NURSES ROLEMonitor for hypotension, especially if the patient is premedicated with a narcotic agonist analgesic. Be aware that overdose symptoms include somnolence, confusion, sedation, diminished reflexes, coma, and untoward effects on vital signs.

NURSES ROLEDo not drive or engage in potentially hazardous activities until response to drug is known. You may feel drowsy, weak, or tired for 12 d after drug has been given.

DIAZEPAM

Classifications: CENTRAL NERVOUS SYSTEM AGENT; BENZODIAZEPINE ANTICONVULSANT; ANXIOLYTIC

DIAZEPAM

Used to manage for restlessness.

NURSES ROLEObserve patient closely and monitor vital signs when diazepam is given parenterally; hypotension, muscular weakness, tachycardia, and respiratory depression may occur.

NURSES ROLESupervise ambulation. Adverse reactions such as drowsiness and ataxia are more likely to occur in older adults and debilitated or those receiving larger doses. Dosage adjustment may be necessary.

NURSES ROLENote: Smoking increases metabolism of diazepam; lowering clinical effectiveness. Heavy smokers may need a higher dose than the nonsmoker.

NURSES ROLENote: Psychic and physical dependence may occur in patients on long-term high dosage therapy, in those with histories of alcohol or drug addiction, or in those who self-medicate.

NURSES ROLEAvoid alcohol and other CNS depressants during therapy unless otherwise advised by physician. Concomitant use of these agents can cause severe drowsiness, respiratory depression, and apnea

NURSES ROLEDo not drive or engage in other potentially hazardous activities or those requiring mental precision until reaction to drug is known.

NALBUPHINE HCL

Classifications: CENTRAL NERVOUS SYSTEM AGENT; ANALGESIC; NARCOTIC (OPIATE) AGONIST-ANTAGONIST

NALBUPHINE HCL

It is used for symptomatic relief of moderate to severe pain. Also pre-operative sedation analgesia.

NURSES ROLE

Assess respiratory rate before drug administration. Withhold drug and notify physician if respiratory rate falls below 12.

NURSES ROLEAdminister with caution to patients with hepatic or renal impairment.

Monitor ambulatory patients; nalbuphine may produce drowsiness.

NURSES ROLEDo not drive or engage in potentially hazardous activities until response to drug is known. Avoid alcohol and other CNS depressants.

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