NAME OF DRUG GENERIC NAME: lidocaine hydrochloride (lignocaine HCl) TRADE NAME: LidoPen Auto-Injector, Xylocaine, Xylocard MAXIMUM

DOSE: 300mg IM then second IM dose 100mg IV bolus MINIMUM DOSE: 200mg IM, 500mg IV bolus AVAILABILITY: Infusion (premixed): 0.2% (2ng/mL), 0.4% (4mg/ml), 0.8% (8mg/mL) Injection (for direct IV use): 1% (10mg/mL), 2% (20mg/mL) Injection (for IM use): 300mg/3mLautomatic injection device Injection (for IV admixtures): 4% 940mg/mL), 10% (100mg/mL), 20% (200mg/mL)

CLASSIFICATION Cardiovascular System Drugs (Anti-Arrhythmics)

MECHANISM OF ACTION A class IB anti-arrhythmic that decreases the depolarization, automacity, and excitability in the ventricles during the diastolic phase by direct action on the tissues, especially the Perkinje networks.

INDICATION Ventricular Arrhytmias caused by MI, cardiac manipulation, or cardiac glycosides As an anesthetic agent

CONTRAINDICATION Contraindicated in patients hypersensitive to the amide type local anesthetics Contraindicated in those with Adam Stokes Syndrome, WoffParkinson-White Syndrome, and severe degrees of SA, AV, or intraventricular block in the absence of an artificial pacemaker Use cautiously and at reduced dosages in patients with complete or second degree heart block or sinus bradycardia, in those with heart failure or renal or hepatic disease, and in those weighing less than 50 kg (110 lbs.)

ADVERSE EFFECTS CNS: confusion, tremors, lethargy, somnolence, stupor, restlessness, anxiety, hallucinations,nervousness, lightheaded, paresthesia, CV: hypotension, bradycardia, new or worsened arrhythmias, cardiac arrest EENT: Tinnitus, blurred or double vision GI: vomiting, GU: darkened urine, polyuria, dysuria, cystitis, dyspareunia, dryness of vagina and vulva, vaginal candidiasis, vaginitis, genital pruritus HEMATOLOGIC: transient leukopenia, neutropenia MUSCULOSKELETAL: fleeting joint pains RESPIRATORY : Respiratory depression and arrest SKIN: Soreness at injection site OTHER: Anaphylaxis, sensation of cold

NURSING RESPONSIBILITIES BEFORE: 1) Monitor isoenzymes when using IM drug for suspected MI. 2) Ask patient for any hypersensitivity to drug. 3) Monitor BP and electrolytes, BUN and creatinine levels 4) Arrange fpr periodic monitoring of cardiac rhythm. 5) Monitor drug level. Therapeutic level 2-5 meq/mL). DURING 1) Lidocaine injections containing 40, 100, or 200 mg/ml are for the preparation of IV infusion. Solution only and must be diluted before use. 2) Avoid giving injections containing preservative IV. 3) Slowly infuse the drug. 4) Use a more concentrated solution of up to 8mg/mL if patient is fluid restricted. 5) Give Im injections in the deltoid muscles only. AFTER: 1) Tell patient to take drug exactly as prescribed. 2) Tell patient receiving lidocaine IM that drug may cause soreness at injection site. 3) Instruct patient to report adverse reactions promptly because toxicity can occur. 4) Evaluate patient response to the drug (stabilization of cardiac rhythm and output). 5) Provide emotional support.

CONTENT: Lidocaine Hydochloride PATIENTS DOSE: 50mg IV bolus @ 2050mg/min

SOURCE: NDH 2005 p. 245 Nurses Drug Guide 2004 p. 905

SOURCE: NDG 2004 p. 905

SOURCE: NDH 2005 p. 245

SOURCE: NDH 2005 p. 245

SOURCE: NDH 2005 p. 245

SOURCE: NDH 2005 p. 245

SOURCE: NDH 2005 p. 245

HERBERT ALMENDRAS HUYO

NAME OF DRUG GENERIC NAME: epinephrine hydrochloride TRADE NAME: Adrenalin Chloride MAXIMUM DOSE: 0.5mg IM q 10-15min MINIMUM DOSE: 0.1mg IM q 10-15min AVAILABILITY: Aerosol Inhaler: 160mcg, 200mcg,220mcg, 250mcg/metered spray Injection: 0.01mg/mL (1:100,000), 0.1mg/mL (1:10,000), 0.5mg/mL (1:2,000), 1mg/mL (1:1000) parenteral; 5mg/mL (1:200) parenteral suspension Nebulizer Inhaler: 1% (1:100),1.25%, 2.25% CONTENT: epinephrine HCl

CLASSIFICATION Autonomic Nervous System Agent (Alpha & Beta Adrenergic Agonist) & Respiratory Tract Drugs (Bronchodilators)

MECHANISM OF ACTION Naturally occurring cathecolamine that acts on both alpha & beta receptors. Most potent activator of alpha receptors. Strengthens myocardial contraction-increases systolic but may decrease diastolic BP; increases cardiac rate and cardiac output

INDICATION Bronchospasm; hypersensitivity reaction, anaphylaxis Hemostasis Acute Asthme Attack To prolong local anesthetic effect To restore cardiac rhythm in cardiac arrest

CONTRAINDICATION Contraindicated in patients with angleclosure glaucoma, shock (other than anaphylactic shock) organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency or cerebral arteriosclerosis Contraindicated in patients receiving general anesthesia with halogenated hydrocarbons or cyclopropane & in patients in labor (may delay second stage)

ADVERSE EFFECTS CNS: Nervousness,tremor, vertigo, pain, headache, disorientation, fear, drowsiness, dizziness, CVA, weakness, cerebral hemorrhage, altered state of perception and thought, psychosis CV: Palpitations, widened pulse pressure, hy[ertension, tachycardia, ventricular fibrillation, shock, anginal pain, altered ECG, including a decreased T-wave amplitude, MI GI: nausea, vomiting RESPIRATORY: Dyspnea, bromchial, and pulmonary edema DERM: Tissue necrosis with repeated injections, urticaria, pallor METABOLIC: Metabolic acidosis, elevated serum lactic acid, transient elevations of blood glucose OTHER: Tissue necrosis

NURSING RESPONSIBILITIES BEFORE: 1) Determine previous hypersensitivity to drug. 2) For bronchodilator: Assess respiratory pattern, before administration. 3) Monitor pulmonary function tests before initiating therapy and periodically throughout course to determine effectiveness of medication. 4) Vasopressor: monitor vital signs to get baseline status. 5) Epinephrine therapy interferes with tests for urinary cathecolamines; so test for urinary cathecolamines before epinephrine therapy. 6) Dont confuse epinephrine with ephedrine or norepinephrine. DURING: 1) Bronchospasm: medication should be administered promptly at onset of bronchospasm. 2) Use tuberculin syringe with a 26 gauge in needle for subcutaneous injection, to ensure that correct amount of medication is administered. 3) 1 mg equals 1 mL of 1:1,000 solution or 10 mL of 1:10,000 solution. 4) Epinephrine is the drug of choice in emergency treatment of acute anaphylactic reaction. 5) Direct IV: administer each 1 mg (10 mL) of 1:10,000 solution over at last one minute; more rapid administration may be used during cardiac resuscitation. AFTER: 1) Teach patient to perform oral; inhalation correctly. 2) Instruct patient to control health care professionals, immediately if shortness of breath is not relieved by medication. 3) Caution patient to avoid smoking and other respiratory irritants. 4) Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth. 5) Monitor patient for adverse reactions.

PATIENTS DOSE: No specific patient

SOURCE: NDH 2005 p. 623

SOURCE: NDG 2004 p.569

SOURCE: NDG 2004 pp. 570-571 Focus on Nursing Pharmacology 2006 p. 445

SOURCE: NDH 2005 p. 624

SOURCE: NDH 2005 p. 624

SOURCE: NDH 2005 p. 624

SOURCE: NDH 2005 p. 625 Davis Drug Guide p. 367

HERBERT ALMENDRAS HUYO

NAME OF DRUG GENERIC NAME: atropine sulfate TRADE NAME: Sal-Tropine, Atro-Pen MAXIMUM DOSE: 2mg PO, IV 1mg every 5-60 min MINIMUM DOSE: 0.2mg IV / IM every 30-60 min AVAILABILITY: Injection: 0.05mg/mL 0.1mg/mL 0.3 mg/mL 0.4 mg/mL 0.5 mg/mL 0.8 mg/mL CONTENT: atropine sulfate PATIENTS DOSE: No specific patient

CLASSIFICATION Cardiovascular System Drugs (Ant-arrhythmics)

MECHANISM OF ACTION An anticholinergic that inhibits acetylcholine at the parasympathetic neuro-effector junction, blocking vagal effects, on the SA & AV nodes, thereby enhancing conduction through the AV node and increasing the heart rate.

INDICATION Symptomatic bradycardia, bradyarrhythmia (junctional or escape rhythm) Antidote for anticholinesterase insecticide poisoning Preoperatively to diminish secretions and block cardio vagal reflexes Adjunct treatment of peptic ulcer disease, functional GI disturbances or disorders such as irritable bowel syndrome

CONTRAINDICATION Contraindicated in patients hypersensitive to drug Contraindicated in those with acute angle-closure glaucoma, obstructive uropathy, obstructive disease of GI tract, paralytic ileus, toxic megacolon, intestinal atony, unstable CV status in acute hemorrhage tachycardia, myocardial ischemia, asthma or myasthenia gravis Use cautiously in patients with Down Syndrome because they may be more sensitive to drug

ADVERSE EFFECTS CNS: Headache, restlessness, ataxia, disorientation, hallucinations, delirium, insomia, dizziness, excitement, agitation, fatigue, confusion, drowsiness CV: Palpitations, bradycardia, tachycardia, hypertension or hypotension GI: Dry mouth with thirst, dysphagia, loss of taste, nausea, vomiting, constipation, delayed gastric emptying, antral stasis, paralytic ileus GU: Urinary hesitancy& retention, dysuria, impotence EENT: Photophobia, blurred vision, mydriasis, cycloplegia, increased intraocular pressure. OTHER: anaphylaxis

NURSING RESPONSIBILITIES BEFORE: 1) Determine previous hypersensitivity to drug and its components. 2) Screen for impaired liver or kidney function which could alter the metabolism & excretion of the drug. 3) Include screening for baseline status before beginning therapy & for any potential adverse effects. 4) Screen for brain damage, hypertension & spasticity. 5) Screen for myasthenia gravis which could become much worse with further blocking of the cholinergic receptors. DURING: 1) Ensure proper administration of the drug. 2) Ensure adequate hydration & temperature control. 3) Watch for tachycardia in cardiac patients because it may lead to ventricular fibrillation. 4) Monitor fluid intake & output. Drug causes urine retention & urinary hesitancy. 5) Assess patient routinely for abdominal distention and auscultate for bowel sound. AFTER: 1) Instruct patient to take medication as directed, 2) Teach patient receiving oral form of drug, how to handle distressing anticholinergic effects. 3) Instruct patient to report serious or persistent adverse reactions promptly. 4) Instruct patient that oral rinsing & frequent oral hygiene can relieve dry mouth. 5) Tell patient about potential for sensitivity of the eyes to the sun & suggest use of sunglasses.

SOURCE: NDH 2005, p. 236

SOURCE: NDH 2005, p. 236

SOURCE: NDH 2005, p. 236

SOURCE: NDH 2005, p. 236

SOURCE: NDH 2005, p. 236

SOURCE: NDH 2005, p. 236

SOURCE: NDH 2005, p. 237 NDG 2004 p. 96

HERBERT ALMENDRAS HUYO

NAME OF DRUG GENERIC NAME: dopamine hydrochloride TRADE NAME: Doastat, Intropin, Revimine MAXIMUM DOSE: 10 mcg / kg / min IV MINIMUM DOSE: 2 mcg / kg / min IV AVAILABILITY: Injections: 40mg/mL, 80mg/mL, 160mg/mL parenteral concentrate for injection for IV infusion; 0.8mg/mL (200 or 400mg) in D5W; 1.6mg/mL (400 or 800mg) in D5W; 3.2mg/mL (800mg) in D5W parenteral injection for IV infusion CONTENT: dopamine hydrochloride PATIENTS DOSE: No specific patient

CLASSIFICATION Autonomic Nervous System Agent (Alpha & Beta Adrenergic Agonist)

MECHANISM OF ACTION Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system. Action is dose-related; large doses cause mainly alpha stimulation.

INDICATION To treat shock & correct hemodynamic imbalances, to improve perfusion to vital organs, to increase cardiac output, to correct hypotension To correct hemodynamic imbalance in shock syndrome due to MI (cardiogenic shock), open heart surgey, & CHF

CONTRAINDICATION Contraindicated in patients with uncorrected tachyarrhythmias, pheochromocytoma, or ventricular fibrillation Use cautiously in patients with occlusive vascular disease, cold injuries, diabetic endarteritis, & arterial embolism; in pregnant patients; in those with a history of sulfite sensitivity; and in those taking MAOI

ADVERSE EFFECTS CNS: headache CV: ectopic beats, tachycardia, angina, palpitations, hypotension GI: nausea, vomiting METABOLIC: azotemia, hyperglycemia RESPIRATORY: dyspnea, asthmatic episodes SKIN: necrosis and tissue sloughing with extravasation, piloerection OTHER: anaphylactic reaction

NURSING RESPONSIBILITIES BEFORE: 1) Determine hypersensitivity to drug or its components. 2) Drug isnt a substitute for blood or fluid volume deficit. If deficit exists, replace fluid before giving vasopressors. 3) Screen for presence of vascular disease in patients. 4) Monitor patients urine output & skin color. 5) Dont confuse dopamine with dobutamine. DURING: 1) Use extreme caution in calculating doses of drugs. 2) During infusion, frequently monitor ECG, BP, cardiac output, CVP, pulmonary artery wedge pressure. 3) Monitor urine output and color often. 4) If diastolic pressure rises disproportionately in a patient receiving dopamine, decrease infusion rate and watch carefully for further evidence of predominant vasoconstrictor activity. 5) Observe patient closely for adverse reactions, dosage may need to be adjusted or stopped. AFTER: 1) After drug is stopped, watch closely for sudden drop in BP. Taper dosage slowly to evaluate stability of BP. 2) Acidosis decreases effectiveness of dopamine. Monitor it. 3) Tell patient to report adverse reactions promptly. 4) Instruct patient to report discomfort at IV insertion site. 5) Advise patient to inform nurse immediately if chest pain, dyspnea, burning sensation of extremities occurs.

SOURCE: NDH 2005 p. 580 NDG 2004 p.526

SOURCE: NDG 2004 p.526

SOURCE: NDH 2005 p. 580

SOURCE: NDH 2005 p. 580 NDG 2004 p.526

SOURCE: NDH 2005 p. 580

SOURCE: NDH 2005 p. 580 NDG 2004 p.527

SOURCE: NDH 2005 p. 580 Davis Drug Guide p. 341

HERBERT ALMENDRAS HUYO

NAME OF DRUG GENERIC NAME: sodium bicarbonate TRADE NAME: Arm & Hammer Baking Soda, Neut, Soda Mint MAXIMUM DOSE: 2-5mEq / kg IV, 4-8 hours infusion MINIMUM DOSE: 0.5mEq / kg every 10 minutes AVAILABILITY: Injection: 4% (2.4mEq / 5mL) 4.2% (5mEq / 10mL), 5% (297.5mEq/500mL) 7.5% (8.92 mEq/10mL & 44.6mEq/50mL), 8.4% (10meq/10mL & 50mEq/50mL) Tablets: 325mg, 650mg CONTENT: sodium bicarbonate PATIENTS DOSE: No specific patient

CLASSIFICATION Fluids & Electrolytes Balance Drugs (Acidifiers) & (Alkalinizers)

MECHANISM OF ACTION Restores buffering capacity of the body and neutralizes excess acid.

INDICATION Cardiac Arrest Metabolic Acidosis Systemic or Urinary alkalinization Antacid

CONTRAINDICATION Contraindicated in patients with metabolic or respiratory alkalosis in those with hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart failure Also contraindicated in patients who are losing chlorides because of vomiting or continuous GI suction & in those receiving diuretics that produce hypochloremic alkalosis. Oral sodium bicarbonate is contraindicated for patients with acute ingestion of mineral acids Use with extreme caution in patients with renal insufficiency, heart failure, or other edematous or sodium-retaining condition

ADVERSE EFFECTS CNS: tetany CV: edema GI: gastric distention, belching, flatulence METABOLIC: Hypokalemia, metabolic alkalosis, hypernatremia, hyperosmolarity with overdose SKIN: Pain & irritation at injection site

NURSING RESPONSIBILITIES BEFORE: 1) Determine previous hypersensitivity to drugs & antacids. 2) Assess abdominal bowel sounds, to ensure GI motility. 3) Assess mucous membrane status to evaluate potential problems with absorption. 4) Screen for electrolyte disturbances that could be exacerbated by the effects of the drug & pregnancy and lactation which could require caution. 5) Screen for baseline data vital signs. DURING: 1) Administer the drug apart from any other oral medications. 2) Have patient chew tablets (PO) thoroughly and follow with water. 3) Periodically monitor serum electrolyte. 4) Assess patients for any signs of acid-base or electrolyte imbalance. 5) Administer direct IV push in arrest situation. Doses should be based on ABG results. AFTER: 1) Instruct patient to take medication as prescribed. 2) Review symptoms of electrolyte imbalance with patients on chronic therapy. 3) Advise patient not to take milk products concurrently with this medication. 4) Advise patient to avoid routine use of sodium bicarbonate for indigestion. 5) Instruct patient to notify nurse for signs of hypersensitivity to drug.

SOURCE: NDH 2005 p. 880

SOURCE: NDH 2005 p. 880

SOURCE: NDH 2005 p. 880

SOURCE: NDH 2005 p. 880

SOURCE: NDH 2005 p. 881

SOURCE: NDH 2005 p. 880

SOURCE: Davis Drug Guide p. 472

HERBERT ALMENDRAS HUYO