EMERGENCY DRUGS -Angina pectoris

CARDIAC DRUGS -CHF associated with AMI

ATROPINE SULFATE -Cardiac load reducing agent
Isopto Atropine -Hypertensive Crisis

Classification Side effects

Anticholinergics -CNS: headache, throbbing, dizziness, weakness.
-GI: nausea, vomiting
Dosage -Skin: Rash
- Bradycardia: 0.5 mg IV every 3-5 mins, max of 0.04 mg/kg Adverse Reactions
-Cardiac Arrest: 1 mg every 3-5 mins
-CV: orthostatic hypotension, flushing, fainting.
-Nerve and Organophosphate symptoms: may repeat in 2 mg -EENT: sublingual burning.
increments q 3 mins titrated to relief symptoms -Skin: Cutaneous vasodilation, contact dermatitis (patch)

Indication Contraindications
-Pre-op meds/pre-anesthetic meds -Contraindicated in patients hypersensitive to nitrates
-To restore cardiac rate and arterial pressure during anesthesia -With early MI. (S.L. form), severe anemia, increase ICP angle-closure
when vagal glaucoma, IV nitroglycerine is contraindicated in patients with
-To lessen the degree of A-V heart block hypovolemia, hypotension, orthostatic hypotension, cardiac
-To overcome severe carotid sinus reflex tamponade restrictive cardiomyopathy, constrictive pericarditis.
-Antidote for cholinergic toxicity
Nursing Management
Side effects -Record characteristics and precipitating factors of anginal pain.
         CNS: restlessness, ataxia, disorientation, hallucinations, -Monitor BP and apical pulse before administration and periodically
delirium, coma, insomnia, agitation, confusion. after dose.
         CV: tachycardia, angina, arrhythmias, flushing. -Have client sit or lie down if taking drug for the first time.
-Client must have continuing EKG monitoring for IV administration
         EENT: photophobia, blurred vision, mydriasis.
-Cardioverter/ defibrillator must not be discharged through paddle
         GI: dry mouth, constipation, vomiting.
electrode overlying
         GU: urine retention.
-Nitro-Bid ointment or the Transderm-Nitro Patch. Assist with
         Hematologic: leukocytosis
ambulating if dizzy.
         Other: anaphylaxis
-Instruct to take at first sign of anginal pain.
-May be repeated q 5 minutes to max. of 3 doses.
Adverse effects -If the client doesn’t experience relief, advise to seek medical
- CNS: headache, excitement. assistance immediately.
- CV: palpitations -Keep in a dark colored container
- GI: thirst, nausea
MORPHINE SULFATE
Contraindications Immediate-release tablets:
MSIR
-Hypersensitivity
Timed-release:
-With acute angle closure glaucoma, obstructive uropathy, Kadian, M-Eslon (CAN), MS Contin, Oramorph SR
obstructive disease of GI tract, paralytic ileus, toxic megacolon, Oral solution:
intestinal atony, unstable CV status in acute hemorrhage, asthma, or MSIR, Rescudose, Roxanol, Roxanol T
myasthenia gravis. Rectal suppositories:
- Pregnant women. RMS
Injection:
Nursing Management Astramorph PF, Duramorph, Epimorph (CAN)
- Monitor VS. Preservative-free concentrate for microinfusion devices for
intraspinal use:
- Report  HR Infumorph
- Monitor for constipation, oliguria.
- Instruct to take 30 mins before meals Classification
- Eat foods high in fiber and drink plenty fluids. -Opioid Agonist Analgesic
- Can cause photophobia
- Instruct client not to drive a motor vehicle or participate in Dosage
activities requiring alertness. -Oral: 10–30 mg q 4 hr PO. Controlled-release: 30 mg q 8–12 hr PO
or as directed by physician; Kadian: 20–100 mg PO daily–24-hr
-Advise to use hard candy, ice chips, etc. for dry mouth.
release system; MS Contin: 200 mg PO q 12 hr.

-SC and IM:10 mg (5–20 mg)/70 kg q 4 hr or as directed by

NITROGLYCERINE physician.
Nitrostat
-IV:2.5–15 mg/70 kg of body weight in 4–5 mL water for injection
Classification administered over 4–5 min, or as directed by physician. Continuous
-Antianginal IV infusion: 0.1–1 mg/mL in 5% dextrose in water by controlled
-Nitrate infusion device.
-Vasodilator,
-Coronary
-Rectal:10–30 mg q 4 hr or as directed by physician.

Dosage
Action
-0.3-0.4 mg SL q 5 min, max 3 doses.
-Acts as agonist at specific opioid receptors in the CNS to produce
-Every 6 hrs except for midnight (cream)
analgesia, euphoria, sedation
-Wear 12 hrs a day for skin patch

Indication
Action
-Relief of moderate to severe acute and chronic pain
-Relaxes the vascular smooth system
-Preoperative medication
-Reduces myocardial oxygen consumption
-Analgesic adjunct during anesthesia
-Reduces left ventricular workload          
-Component of most preparations that are referred to as
-Reduces arterial BP
Brompton's cocktail or mixture
-Reduces venous return
-Intraspinal use with microinfusion devices for the relief of
intractable pain
Indication
-Unlabeled use: Dyspnea associated with acute left ventricular -Hypertension
failure and pulmonary edema -Angina Pectoris
-Supraventricular Arrhythmia
Side Effects -Atrial flutter/fibrillation
-GI: dry mouth, constipation.
-Skin: Tissue irritation and induration (SC injection). Side Effects and Adverse Reactions
-Other: sweating,physical tolerance and dependence, psychological
dependence -CNS:abnormal dreams, anxiety, confusion, dizziness and headache
-EENT: blurred vision, epistaxis and tinnitus
Adverse Effects -CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and
- CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, palpitations
delirium, insomnia, agitation, anxiety, fear, hallucinations, -GU: dysuria, nocturia and polyuria
disorientation, drowsiness, lethargy, impaired mental and physical -GI: abnormal liver function, anorexia, constipation, diarrhea,
performance, coma, mood changes, weakness, headache, tremor, nausea and vomiting
seizures, miosis, visual disturbances, suppression of cough reflex 
-CV: Facial flushing, peripheral circulatory collapse, tachycardia, Contraindications
bradycardia, arrhythmia, palpitations, chest wall rigidity, -Hypersensitivity
hypertension, hypotension, orthostatic hypotension, syncope -Sick sinus syndrome
-Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm, nd rd
- 2 or 3 degree AV block
bronchospasm, edema -CHF
-GI: Nausea, vomiting, anorexia, biliary tract spasm; increased -Cardiogenic shock
colonic motility in patients with chronic ulcerative colitis -Concurrent IV beta-blocker
-GU: Ureteral spasm, spasm of vesical sphincters, urinary retention
or hesitancy, oliguria, antidiuretic effect, reduced libido or potency
Nursing Management
-Respiratory:Respiratory depression, apnea, circulatory depression,
-Monitor BP and pulse before therapy, during titration and therapy
respiratory arrest, shock, cardiac arrest
-Monitor ECG, I&O, serum potassium and weight.
-Assess for CHF
Contraindications
-Hypersensitivity to opioid
DILTIAZEM
-Diarrhea caused by poisoning until toxins are eliminated Cardizem, Dilacor, Novo-Diltiazem, Tiamate and Tiazac
-During labor or delivery of a premature infant
-After biliary tract surgery or following surgical anastomosis
-Pregnancy Classification
-Labor -Anti-anginals
  -Antiarrhythmics
Nursing Management -Antihypertensive   
Interventions -Ca channel blocker
-Caution patient not to chew or crush controlled-release
preparations. Dosage
-Dilute and administer slowly -PO: 30-120 mg, 3-4x daily or 60-120 mg twice daily as SR capsules
-Tell patient to lie down during IV administration. -IV:   0.25 mg/kg
-Keep opioid antagonist and facilities for assisted or controlled
respiration readily available during IV administration. Action
-Use caution when injecting SC or IM into chilled areas or in patients -Inhibits calcium transport into myocardial smooth muscle cells  
with hypotension or in shock Systemic and coronary vasodilation
-Reassure patients that they are unlikely to become addicted
Teaching points Indication
-Take this drug exactly as prescribed. Avoid alcohol, antihistamines, -Hypertension
sedatives, tranquilizers, over-the-counter drugs. - Angina Pectoris
-Swallow controlled-release preparation (MS Contin, Oramorph SR) -Supraventricular Arrhythmia
whole; do not cut, crush, or chew them.  -Atrial flutter/fibrillation
-Do not take leftover medication for other disorders, and do not let
anyone else take your prescription.
Side Effects and Adverse and Reactions
-These side effects may occur: Nausea, loss of appetite, constipation,
-CNS:abnormal dreams, anxiety, confusion, dizziness and headache
dizziness, sedation, drowsiness, impaired visual acuity
-EENT: blurred vision, epistaxis and tinnitus
-Report severe nausea, vomiting, constipation, shortness of breath
-CV: arrhythmia, CHF, chest pain, bradycardia, hypotension and
or difficulty breathing, rash.
palpitations
-GU: dysuria, nocturia and polyuria
VERAPAMIL -GI: abnormal liver function, anorexia, constipation, diarrhea,
Calan, Isoptin, Verelan, Covera HS nausea and vomiting

Classification
-Anti-anginal
Contraindications
-Anti-arrhythmics
-Hypersensitivity
-Anti-hypertensive
-Sick sinus syndrome
-Vascular headache suppressants
-2nd or 3rd degree AV block
-CHF
Dosage -Cardiogenic shock
-PO 80-120 mg 3x daily, increases as needed -Concurrent IV beta-blocker

Action Nursing Management

-Inhibits calcium transport into myocardial smooth muscle cells -Monitor BP and pulse before therapy, during titration and therapy
-Decreases SA and AV conduction and prolongs AV node refractory -Monitor I&O and weight
period in conduction tissue -Assess for CHF
-Routine serum digoxin monitoring

LIDOCAINE
Indication Xylocaine
Classification Contraindications
CV drugs: Anti-arrhythmics Severe sinus node dysfunction
Anesthetic 2nd or 3rd degree AV block
Hypersensitivity
Dosage
Arrhythmia: Nursing Management
IV: 0.7-1.4 mg/kg body weight. No more than 200 mg within 1 hour Assess cardiovascular status before therapy
period Assess pulmonary, hepatic and thyroid function before and during
IM: 4-5 mg/kg body weight therapy
Monitor fluid and electrolytes, I&O, K, Na and Cl
Action Monitor ECG, BP
-Increases electrical stimulation of ventricle and His-purkinje system Assess vision
by direct action on tissues, resulting to decrease depolarization,
automaticity and excitability in ventricles during diastolic phase PROCAINAMIDE
Pronestyl, Procan-SR, Procanbid
Indication
Anesthesia Classification
 Arrhythmias -Antiarrhythmics
Control of Status epilepticus refractory to other treatments
Dosage
Side Effects and Adverse Reactions -Arrhythmias: 50 mg/kg/day in divided doses 3-6 hourly
-GI disturbances, bradycardia, hypotension, convulsion, numbness of
tongue, muscle twitching, restlessness, nervousness, dizziness,
tinnitus, blurred vision, fetal intoxication, light headedness,
drowsiness, apprehension, euphoria, vomiting, sensation of heat,
respiratory arrest and CV collapse
Action
Contraindications -Blocks open Na channels and prolongs the cardiac action potential.
 Hypersensitivity This results in slowed conduction and ultimately the decreased rate
of rise of the action potential may result on the widening of QRS on
 Heart block
ECG
Hypovolemia
 Adams stroke syndromes
Infection at site of injection Indication
Supraventricular and ventricular arrhythmias.
Treatment of Wolf-Parkinson-White Syndrome
Nursing Management
 Assess pt before and after therapy
Pts infusion must be on cardiac monitor Side Effects and Adverse Reactions
 Monitor ECG, if QT or QRS increases by 50% or more, withhold the Severe hypotension, ventricular fibrillation and asystole.
drug  Drug induced SLE syndrome, blood disorders, fever, myocardial
Monitor BP, check for rebound HPN after 1-2 hrs depression, heart failure, agrunulocytosis, psychosis, angioedema,
 Assess respiratory status, oxygenation and pulse deficits hepatomegaly, skin irritation, hypergammaglobulinemia, GI and CNS
Assess renal and liver function effects
Monitor CNS symptoms
 Monitor blood levels Contraindications
 Heart block
AMIODARONE  Heart failure
Cordarone  Hypotension
Myesthenia gravis
 Digoxin toxicity
Classification
-Anti-arrhythmics  Lactation

Dosage Nursing Management

Recurrent ventricular arrhythmias: Assess cardiovascular status before therapy
 PO800-1600 mg/day for 1-2 wks Assess pulmonary, hepatic and thyroid function before and during
 PSVT, symptomatic atrial flutter: PO 600-800 mg/day for 1 therapy
month Monitor fluid and electrolytes, I&O, K, Na and Cl
  Arrhythmias with CHF: 200 mg/day Monitor ECG, BP
Ventricular dysrrhythmias: 150 mg over the 1st 10 mins then slow  Assess vision
360 mg over the next 6 hrs
EPINEPHRINE
Injection, OTC nasal solution:
Action
Adrenalin Chloride
 Blocks Na channels, prolonging myocardial cell action potential
Ophthalmic solution:
and refractory period
Epifrin, Glaucon
Non competitive alpha and beta adrenergic blockage
Insect sting emergencies:
EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr.
Indication Auto-Injector (delivers 0.15 mg IM for children)
Life threatening recurrent arrhythmias OTC solutions for
 Ventricular fibrillation Nebulization:
 Ventricular tachycardia AsthmaNefrin, microNefrin, Nephron, S2

Side Effects and Adverse Reactions Classification

-Exacerbation of arrhythmias, bradycardia, SA node dysfunction, -Beta2 Adrenergic Agonists
heart block, sinus arrest; flushing, fatigue, malaise, abnormal
involuntary movements, ataxia, dizziness, paresthesia, decreased
Dosage
libido, insomnia, headache, sleep disturbances, visual impairment,
-Cardiac arrest: 1 mg IV of 1:10,000 solution q 3-5 min; double dose
blindness, corneal microdeposits, photophobia, abnormal taste,
if administering via ET tube
nausea, vomiting, constipation, anorexia, abdominal pain, abnormal
-Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000 solution.
salivation, coagulation abnormalities, non-specific hepatic disorders,
-Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution
pulmonary inflammation, dyspnea, toxicosis, death, edema, hypo
-Refractory bradycardia and hypotension: 2-10ug/min
and hyperthyroidism
 With chronic nephritis and nitrogen retention
Action Hypersensitivity
-Stimulates beta receptors in lung.
-Relaxes bronchial smooth muscle. Nursing Management
-Increases vital capacity Give 1-2 glass of H20 to reduce adverse reactions and improve
-Increases BP,  HR,  PR therapeutic response
-Decreases airway resistance.  Warm vasopressin in your hands and mixed until it is distributed
evenly in the solution
Indication Monitor urine Sp. Gravity and I&O to aid evaluation of drug
-Asthma effectiveness
-Bronchitis
-Emphysema MAGNESIUM SO4
-All cardiac arrest, anaphylaxis
-Used for symptomatic bradycardia. Classification
-Relief of bronchospasm occurring during anesthesia Anti-convulsant
-Exercised-induced bronchospasm Anti-arrhythmics

Side Effects/Adverse Reactions Dosage

Side Effects: -Arrhythmia: IV 1-6 grams over several minutes, then continuous IV
-nervousness, tremor, vertigo, pain, widened pulse pressure, infusion 3-20 mg/min for 5-48 hours.
hypertension nausea
Adverse Effects:
Action
-headache
-Decreased acetylcholine released

Contraindications
Indication
-With angle-closure glaucoma, shock (other than anaphylactic
shock), organic brain damage, cardiac dilation, arrhythmias, g replacement
coronary insufficiency, or cerebral arteriosclerosis. Also Arrhythmia
contraindicated in patient receiving general anesthesia with
halogenated hydrocarbons or cyclopropane and in patients in labor Side Effects and Adverse Reactions
(may delay second stage)  CNS: drowsiness, depressed reflexes, flaccid paralysis,
-In conjunction with local anesthesia, epinephrine is contraindicated hypothermia
for use in finger, toes, ears, nose, and genitalia. CV: hypotension, flushing, bradycardia, circulatory collapse,
In pregnant woman, drug is contraindicated. depressed cardiac function
-In breast feeding do not use the drug or stop breast feeding.  EENT: diplopia
Respiratory: respiratory paralysis
Nursing Management Metabolic: hypocalcemia
-Monitor V/S. and check for cardiac dysrrhythmias    Skin: diaphoresis
-Drug increases rigidity and tremor in patients with Parkinson’s
disease Contraindications
-Epinephrine therapy interferes with tests for urinary catecholamine Heart block and myocardial damage
-Avoid IM use of parenteral suspension into buttocks. Gas gangrene Toxemia of pregnancy
may occur
-Massage site after IM injection to counteract possible Nursing Management
vasoconstriction. Monitor I&O. make sure urine output is 100 ml or more in 4 hrs pd
-Observe patient closely for adverse reactions. Notify doctor if before each dose
adverse reaction develop Take appropriate seizure precautions
-If blood pressure increases sharply, rapid-acting vasodilators such  Keep IV Ca gluconate at bedside
as nitrates or alpha blockers can be given to counteract 

VASOPRESSIN
Pitressin 
Na HCO3
Classification Arm and Hammer; Baking Soda
-Pituitary Hormones
ADH Classification
-Alkalinizers
Dosage
-Prevent and treat abdominal distention: initially 5 units IM gives Dosage
subsequent injections q3-4 hours increasing to 10 units if needed. Metabolic Acidosis: Usually 2-5 meq/kg IV infuse over 4-8 hr
period
Action Cardiac Arrest: 1 meq/kg IV of 7.5 or 8.4% sol, then 0.5 meq/kg IV
-Increase permeability of renal tubular epithelium to adenosine q 10 mins depending on ABG
monophosphate and water, the epithelium promotes reabsorption
of water and concentrated urine Action
-Restore buffering capacity of the body and neutralizes excessive
Indication acid
-Diabetes Insipidus
-Abdominal Distention Indication
-GI bleeding Metabolic Acidosis
-Esophageal varices Cardiac Arrest

Side Effects and Adverse Reactions Side Effects/Adverse Reactions

 CNS: tremor, headache, vertigo CNS: tetany
CV: vasoconstriction, arrhythmias, cardiac arrest, myocardial CV: edema
ischemia, circumollar pallor, decreased CO, angina GI: gastric distention, belching and flatulence
GI: abdominal cramps Metabolic: hypokalemia, metabolic alkalosis, hypernatremia,
GU:uterine cramps hyperosmolarity with overdose
Respi: bronchoconstriction Skin: pain @ injection site
Skin: diaphoresis, gangrene and urticaria
Contraindications
Contraindications Metabolic and respiratory alkalosis
Pt losing Cl because of vomiting or continuous GI suction or those NEUROSURGICAL DRUGS
receiving diuretics that produces hypochloremic alkalosis MANNITOL

Nursing Management Classification

Obtain blood pH, PaO2, PaCo2 and electrolyte levels -Diuretics
SIVP
Dosage
HYPERTENSIVE CRISIS Test dose for marked oliguria or suspected inadequate renal
Na NITROPRUSSIDE function: 200 mg/kg or 12.5 gram as a 15% to 20% IV solution over
Nittropress 3-5 mins response is adequate if 30-50 ml of urine/hr is adequate, a
second dose is given if still no response after 2nd dose stop the drug
Classification Oliguria: 50 over 90 mins to several hrs
-Antihypertensive, Vasodilator To induced intraocular or intracranial pressure: 1.5-2 gram/kg as a
15 % to 20% IV solution over 30-60 min
Dosage Diuresis in drug intoxication: 12.5% to 10% solutions up to 200 g IV
0.25-0.3 mcg/kg/minute Irrigating solution during TURP: 2.5-5%

Action Action
-Relaxes arteriolar and venous smooth muscle -Increases osmotic pressure of glomerular filtrate, inhibiting tubular
reabsorption of water and electrolytes; drug elevates plasma
Indication osmolarity, increasing water flow into extracellular fluid
-Hypertensive crisis
-To produce controlled hypotension during anesthesia Indication
-To reduce preload and afterload in cardiogenic shock  Test dose for marked oliguria or suspected inadequate renal
function
-OliguriaTo induced intraocular or intracranial pressure
Side Effects/Adverse Reactions
-Headache, dizziness, increased ICP, loss of consciousness, -Diuresis in drug intoxication
restlessness, bradycardia, nausea, abdominal pain, -Irrigating solution during TURP
methemoglodinemia, muscle twitching, pink-colored rash, irritation Side Effects/Adverse Reactions
at infusion site -CN: seizures, headache and fever
CV: edema, thrombophlebitis, hypotension and heart failure
 EENT: blurred vision and rhinitis
GI: thirst, dry mouth, nausea, vomiting and diarrhea
Contraindications
GI: urine retention
-Hypersensitivity
Metabolic: dehydration
-Compensatory hypotension
Skin: local pain
-Inadequate cerebral circulation
-Acute heart failure with reduced PVR  Others: chill
-Congenital optic atrophy Contraindications
-Tobacco-induced ambylopia  Hypersensitivity
Anuria, severe pulmonary congestion, frank pulmonary edema,
active intracranial bleeding during craniotomy, severe dehydration,
Nursing Management
metabolic edema, progressive heart failure or pulmonary congestion
1.       Obtain VS before giving the drug
after drug
2.       Place pt in supine
3.       Giving excessive doses of 500 mcg/kg delivered faster than 2
mcg/kg/min or using max infusion rate of 10 mcg/kg/min for more Nursing Management
than 10 mins can cause cyanide toxicity Monitor VS,CVP,I&O, renal function fluid balance and urine K levels
daily.
Drug can be used to measure GFR
FUROSEMIDE
Do not give electrolyte free solutions with blood. If blood id given
Lasix
simultaneously, add at least 200 meq of NaCL to each liter

Classification
POISONING
-Loop Diuretics
NALOXONE HCL
Narcan
Dosage
-Pulmonary edema: 40 mg IV
Classification
-Edema: 20 to 80 mg PO every day in the morning
Miscellaneous antagonists and antidotes
-HPN: 40 mg PO bid. Dosage adjusted based on response

Dosage
Action
For suspected opioid induced respiratory depression: 0.4 to 2 mg IV,
-Inhibits Na and Cl reabsorption at the proximal and distal tubules
-IM and SQ. repeat doses q 2-3 mins PRN
and in the ascending loop of Henle
-For postoperative opiod depression: 0.01 to 0.2 mg IV q 2-3 mins,-
PRN. Repeat dose within 1-2 hr, if needed.
Indication Action
-Acute pulmonary edema -everse the effects of opiods, psychotomimetic and dysphoric effects
-Edema of agonist-antagonists
-Hypertension
Indication
Side Effects/Adverse Reactions -For suspected opioid induced respiratory depression
Signs of hypotension, hypokalemia and hyperglycemia
-For postoperative opiod depression
Contraindications
-Hypersensitivity
Side Effects/Adverse Reactions
Anuria
-CNS: seizures, tremors
-CV: ventricular fibrillation, tachycardia, HPN with higher
Nursing Management recommended doses, hypotension
-Monitor wt., BP and PR -GI: nausea and vomiting
-Monitor fluid, I&O, electrolyte, BUN and CO2 levels frequently -Respiratory: pulmonary edema
-WOF signs of hypokalemia -Skin: diaphoresis
- Monitor uric acid levels
Monitor glucose levels esp in DM pts
Contraindications
-Hypersensitivity
-Use cautious with cardiac irritability or opiod addiction.
Action
Nursing Management -Antagonizes the effects of benzodiazepines
-Assess respiratory status frequently
-rate increases within 1-2 mins Indication
-Benzodiazepine-induced depression of the ventilatory responses to
IPECAC SYRUP hypercapnia and hypoxia

-Classification Side Effects

Antidote -Nausea, vomiting, palpitations, sweating, flushing, dry mouth,
tremors, insomnia, dyspnea, hyperventilation, blurred vision,
Dosage headache, pain at injection site
-25-30 ml followed immediately by H2O
Contraindications
Action -Control of ICP or status epilepticus.
-Irritates the stomach lining and stimulate the vomiting center -Signs of serious cyclic antidepressant overdose

Indication Nursing Management

-Poisoning -Must individualize dosage. Give only smallest amount effective.
-Overdose -Give through freely running IV infusion into large vein to minimize
pain at injection site
-Note history of seizure or panic disorder
Side Effects - Assess evidence of increased ICP
-Diarrhea, drowsiness, stomach cramps, vomiting, itching, DOB, -Note evidence of sedative and benzodiazepine dependence
swelling of the mouth, rash and hives -Instruct to avoid alcohol and non-prescription drugs for 1-24 hrs

Contraindications
-Hypersensitivity
SHOCK
-Given activated charcoal
DOPAMINE
-Unconcious
Intropine
-Drowsy
-Severely drunk
-Having seizures Classification
-With no gag reflex -Adrenergic drugs

Nursing Management Dosage

-Don’t administer to unconscious -Initially 2-5 mcg/kg/min by IV
-Pt should kept active and moving ff administration
-If vomiting does not occur after 2nd dose, gastric lavage may be Action
considered to remove ingested substance -Stimulates dopaminergic and alpha and beta receptors of the
sympathetic nervous system resulting in positive inotropic effect and
ACTIVATED CHARCOAL increased CO

Classification Indication
Antidote -To treat shock and correct hemodynamic imbalances
-To correct hypotension
-To improve perfusion of vital organs
Dosage
-To increase CO
-30-100 g with at least 8 oz of water

Side Effects
Action
-CNS: headache an anxiety
-Inhibits GI absorption of toxic substances or irritants
-CV: tachy, angina, palpitations and vasoconstriction
-Hyperosmolarity
-GI: nausea and vomiting

Indication
Contraindications
-Poisoning
- Hypersensitivity
-With uncorrect tachyarrhythmias
Side Effects - Pheochromocytoma
-Pain, melena, diarrhea, vomiting and constipation -Ventricular Fibrillation

Contraindications Nursing Management

-Cyanide, mineral acids, organic solvents, intestinal obstruction,
bleeding with fructose intolerance, broken GI tract, concomitant use
of charcoal with sorbitol
Nursing Management
-Do not mix with chocolate and together with ipecac syrup
-Notify doctor if caused swelling or pain in the stomach
-Most patients received less than 20 mcg/kg/min
-Drugs isn’t substitute for blood or fluid volume deficit
-During infusion, monitor ECG, BP, CO, PR and color and temp of the
limbs
-Do not confuse dopamine to dobutamine
-Check urine output often

FLUMAZENIL DOBUTAMINE
Romazicon Dobutrex 

Classification Classification
-Benzodiazepine receptor antagonists -Adrenergic drugs

Dosage Dosage
-2 ml IV given over 15 seconds
-0.5-1 mcg/kg/min IV infusion, titrating to optimum dosage of 2-20 -Monitor therapeutic effectiveness
mcg/kg/min -Monitor HR, BP, ABG, s/sx of bronchospasm and CNS stimulation
-2.5 to 10 mcg/kg/min-usual effective range to increase CO -Instruct on how to use inhaler properly
-Rinse mouth after use
Action
-Stimulates heart beta receptors to increase myocardial contractility DIPHENHYDRAMINE HCL
and SV Benadryl

Indication Classification
-To increase CO -Anti-histamine
-Treatment of cardiac decompensation
Dosage
Side Effects -25-50 mg PO, IV or IM bid-tid
-CNS: headache
-CV: HPN, tachycardia, palpitations and vasoconstriction Action
-GI: nausea and vomiting -Blocks the effects Hi receptor sites

Contraindications Indication
-Hypersensitivity -Allergic reactions
-Use cautiously in pts with hx of HPN and AMI -Motion sickness
-Cough suppression
Nursing Management -Sedation
-Before starting therapy, give a plasma volume expander to correct
hypovolemia and a cardiac glycoside Side Effects
-Monitor ECG, BP, pulmonary artery wedge pressure and CO -Xerostomia
-Monitor electrolyte levels -Urinary retention
-Don’t confuse dobutamine to dopamine -Sedation

GLUCAGON Contraindications
Acute asthmatic attack
Classification
-Pancreatic Hormones Nursing Management
-Risk for photosensitivity- use sunscreen
Dosage
-0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN

Action
-Binds with glucagon receptor

Indication
-Hypoglycemia

Side Effects
-Nausea, vomiting, hypotension, tachycardia and hypertension

Contraindications
-Hypersensitivity
-Pheochromocytoma
-Insulinoma

Nursing Management
-Monitor V/S and blood sugar level
-Response within 20 mins after injection

ALBUTEROL
Ventolin

Classification
-Bronchodilator, Adrenergic

Dosage
-2 inhalations reputed q 4-6 hrs via neb

Action
-Activation of beta adrenergic receptors on airway smooth muscle

Indication
-Asthma
-Prevention of exercise induced spasms

Side effects
-Palpitations
-Tachycardia
-GI upset
-Nervousness

Contraindications
-Hypersensitivity

Nursing Management