EMERGENCY DRUGS

Advise to use hard candy, ice chips, etc.
for dry mouth.
CARDIAC DRUGS
ATROPINE SULFATE
Isopto Atropine
Classification
Anticholinergics
Dosage
 Bradycardia: 0.5 mg IV every 3-5 mins,
max of 0.04 mg/kg
 Cardiac Arrest: 1 mg every 3-5 mins
 Nerve and Organophosphate symptoms:
may repeat in 2 mg increments q 3 mins
titrated to relief symptoms
Indication
 Pre-op meds/pre-anesthetic meds
 To restore cardiac rate and arterial
pressure during anesthesia when vagal
 To lessen the degree of A-V heart block
 To overcome severe carotid sinus reflex
 Antidote for cholinergic toxicity
Side effects
 CNS: restlessness, ataxia,
disorientation, hallucinations, delirium,
coma, insomnia, agitation, confusion.
 CV: tachycardia, angina, arrhythmias,
flushing.
 EENT: photophobia, blurred vision,
mydriasis.
 GI: dry mouth, constipation, vomiting.
 GU: urine retention.
 Hematologic: leukocytosis
 Other: anaphylaxis
Adverse effects
 CNS: headache, excitement.
 CV: palpitations
 GI: thirst, nausea
NITROGLYCERINE
Nitrostat
Classification
 Antianginal
 Nitrate
 Vasodilator,
 Coronary
Dosage
 0.3-0.4 mg SL q 5 min, max 3 doses
 Every 6 hrs except for midnight (cream)
 Wear 12 hrs a day for skin patch
Action





Relaxes the vascular smooth system
Reduces myocardial oxygen
consumption
Reduces left ventricular workload
Reduces arterial BP
Reduces venous return
Indication
 Angina pectoris
 CHF associated with AMI
 Cardiac load reducing agent
 Hypertensive Crisis
Side effects
 CNS: headache, throbbing, dizziness,
weakness
 GI: nausea, vomiting
 Skin: Rash
Adverse Reactions
 CV: orthostatic hypotension, flushing,
fainting.
 EENT: sublingual burning.
 Skin: Cutaneous vasodilation, contact
dermatitis (patch)
Contraindications
 Hypersensitivity
 With acute angle closure glaucoma,
obstructive uropathy, obstructive
disease of GI tract, paralytic ileus,
toxic megacolon, intestinal atony,
unstable CV status in acute
hemorrhage, asthma, or myasthenia
gravis.
 Pregnant women.
Contraindications
 Contraindicated in patients
hypersensitive to nitrates
 With early MI. (S.L. form), severe
anemia, increase ICP angle-closure
glaucoma, IV nitroglycerine is
contraindicated in patients with
hypovolemia, hypotension,
 orthostatic hypotension, cardiac
tamponade restrictive cardiomyopathy,
 constrictive pericarditis.
Nursing Management
 Monitor VS
 Report é HR
 Monitor for constipation, oliguria.
 Instruct to take 30 mins before meals
 Eat foods high in fiber and drink plenty
fluids.
 Can cause photophobia
 Instruct client not to drive a motor
vehicle or participate in activities
requiring alertness.
Nursing Management
 Record characteristics and
precipitating factors of anginal pain.
 Monitor BP and apical pulse before
administration and periodically after
dose.
 Have client sit or lie down if taking
drug for the first time.
 Client must have continuing EKG
monitoring for IV administration






Cardioverter/ defibrillator must not be
discharged through paddle electrode
overlying
Nitro-Bid ointment or the TransdermNitro Patch. Assist with ambulating if
dizzy.
Instruct to take at first sign of anginal
pain.
May be repeated q 5 minutes to max.
of 3 doses.
If the client doesn’t experience relief,
advise to seek medical assistance
immediately.
Keep in a dark colored container
MORPHINE SULFATE
Immediate-release tablets:
MSIR
Timed-release:
Kadian, M-Eslon (CAN), MS Contin, Oramorph
SR
Oral solution:
MSIR, Rescudose, Roxanol, Roxanol T
Rectal suppositories:
RMS
Injection:
Astramorph PF, Duramorph, Epimorph (CAN)
Preservative-free concentrate for microinfusion
devices for intraspinal use:
Infumorph
Classification
Opioid Agonist Analgesic
Dosage
 Oral: 10–30 mg q 4 hr PO. Controlledrelease: 30 mg q 8–12 hr PO or as
directed by
physician; Kadian:
20–100 mg PO daily–24-hr 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 physician.
 IV:2.5–15 mg/70 kg of body weight in
4–5 mL water for injection
administered over 4–
5 min, or as
directed by physician. Continuous IV
infusion: 0.1–1 mg/mL in 5%dextrose
in water by controlled infusion device.

Rectal:10–30 mg q 4 hr or as directed
by physician.
Action
Acts as agonist at specific opioid receptors in the
CNS to produce analgesia, euphoria, sedation
Indication
 Relief of moderate to severe acute and
chronic pain
 Preoperative medication
 Analgesic adjunct during anesthesia
 Component of most preparations that
are referred to as Brompton's cocktail
or mixture

Intraspinal use with microinfusion
devices for the relief of intractable
pain

Unlabeled use: Dyspnea associated
with acute left ventricular failure and
pulmonary
edema
Side Effects
 GI: dry mouth, constipation.
 Skin: Tissue irritation and induration
(SC injection).
 Other: sweating,physical tolerance and
dependence, psychological dependence
Adverse Effects
 CNS: Light-headedness, dizziness,
sedation, euphoria, dysphoria,
delirium, insomnia,
agitation,
anxiety, fear, hallucinations,
disorientation, drowsiness, lethargy,
mpaired mental and physical
performance, coma, mood changes,
weakness,
headache, tremor,
seizures, miosis, visual disturbances,
suppression of cough
reflex

CV: Facial flushing, peripheral
circulatory collapse, tachycardia,
bradycardia,
arrhythmia,
palpitations, chest wall rigidity,
hypertension, hypotension, orthostatic
hypotension, syncope
 Dermatologic: Pruritus, urticaria,
Respiratory: laryngospasm,
bronchospasm, edema

GI: Nausea, vomiting, anorexia,
biliary tract spasm; increased colonic
motility in
patients with chronic
ulcerative colitis
 GU: Ureteral spasm, spasm of vesical
sphincters, urinary retention or
hesitancy,
oliguria, antidiuretic
effect, reduced libido or potency
 Respiratory:Respiratory depression,
apnea, circulatory depression,
respiratory arrest,
shock,
cardiac arrest
Contraindications
 Hypersensitivity to opioid
 Diarrhea caused by poisoning until
toxins are eliminated
 During labor or delivery of a
premature infant
 After biliary tract surgery or following
surgical anastomosis
 Pregnancy
 Labor
Nursing Management
 Caution patient not to chew or crush
controlled-release preparations.
 Dilute and administer slowly
 Tell patient to lie down during IV
administration.
 Keep opioid antagonist and facilities
for assisted or controlled respiration
readily available during IV
administration.

Use caution when injecting SC or IM
into chilled areas or in patients with
hypotension
or in shock

Reassure patients that they are unlikely
to become addicted
Teaching points
 Take this drug exactly as prescribed.
Avoid alcohol, antihistamines,
sedatives,
tranquilizers, overthe-counter drugs.
 Swallow controlled-release preparation
(MS Contin, Oramorph SR) whole; do
not cut,
crush, or chew them.

Do not take leftover medication for
other disorders, and do not let anyone
else take your prescription.

These side effects may occur: Nausea,
loss of appetite, constipation,
dizziness, sedation,
drowsiness,
impaired visual acuity
 Report severe nausea, vomiting,
constipation, shortness of breath or
difficulty breathing,
rash.
VERAPAMIL
Calan, Isoptin, Verelan, Covera HS
Classification
Anti-anginal
Anti-arrhythmics
Anti-hypertensive
Vascular headache suppressants
Dosage
PO 80-120 mg 3x daily, increases as needed
Action


Inhibits calcium transport into
myocardial smooth muscle cells
Decreases SA and AV conduction and
prolongs AV node refractory period in
conduction tissue
Indication
Hypertension
Angina Pectoris
Supraventricular Arrhythmia
Atrial flutter/fibrillation
Side Effects and Adverse Reactions
 CNS:abnormal dreams, anxiety,
confusion, dizziness and headache
 EENT: blurred vision, epistaxis and
tinnitus
 CV: arrhythmia, CHF, chest pain,
bradycardia, hypotension and
palpitations
 GU: dysuria, nocturia and polyuria
 GI: abnormal liver function, anorexia,
constipation, diarrhea, nausea and
vomiting
Contraindications
Hypersensitivity
Sick sinus syndrome
2nd or 3rd degree AV block
CHF
Cardiogenic shock
Concurrent IV beta-blocker
Nursing Management
 Monitor BP and pulse before therapy,
during titration and therapy
 Monitor ECG, I&O, serum potassium
and weight.
 Assess for CHF
DILTIAZEM
Cardizem, Dilacor, Novo-Diltiazem, Tiamate
and Tiazac
Classification
Anti-anginals
Antiarrhythmics
Antihypertensive
Ca channel blocker
Dosage


PO: 30-120 mg, 3-4x daily or 60120 mg twice daily as SR capsules
IV:
0.25 mg/kg
Action


Inhibits calcium transport into
myocardial smooth muscle cells
Systemic and coronary
vasodilation
Indication
Hypertension
Angina Pectoris
Supraventricular Arrhythmia
Atrial flutter/fibrillation
Side Effects and Adverse and Reactions
 CNS:abnormal dreams, anxiety,
confusion, dizziness and headache
 EENT: blurred vision, epistaxis
and tinnitus
 CV: arrhythmia, CHF, chest pain,
bradycardia, hypotension and
palpitations
 GU: dysuria, nocturia and polyuria
 GI: abnormal liver function,
anorexia, constipation, diarrhea,
nausea and vomiting
Contraindications
Hypersensitivity
Sick sinus syndrome
2nd or 3rd degree AV block
CHF
Cardiogenic shock
Concurrent IV beta-blocker
Nursing Management
 Monitor BP and pulse before
therapy, during titration and
therapy
 Monitor I&O and weight
 Assess for CHF
 Routine serum digoxin monitoring
Arrhythmias with CHF: 200 mg/day
Ventricular dysrrhythmias: 150 mg over the
1st 10 mins then slow 360 mg over the
next
6 hrs
LIDOCAINE
Xylocaine
Classification
CV drugs: Anti-arrhythmics
Anesthetic
Dosage
Arrhythmia:
IV: 0.7-1.4 mg/kg body weight. No more
200 mg within 1 hour period
IM: 4-5 mg/kg body weight
Action


than
Action
Increases electrical stimulation of ventricle and
His-purkinje system by direct action on tissues,
resulting to decrease depolarization, automaticity
and excitability in ventricles during diastolic
phase
Indication
Anesthesia
Arrhythmias
Control of Status epilepticus
Side Effects and Adverse Reactions
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
Contraindications
Hypersensitivity
Heart block
Hypovolemia
Adams stroke syndromes
Infection at site of injection
Nursing Management
 Assess pt before and after therapy
 Pts infusion must be on cardiac
monitor
 Monitor ECG, if QT or QRS
increases by 50% or more,
withhold the drug
 Monitor BP, check for rebound
HPN after 1-2 hrs
 Assess respiratory status,
oxygenation and pulse deficits
 Assess renal and liver function
 Monitor CNS symptoms
 Monitor blood levels
AMIODARONE
Cordarone
Classification
Anti-arrhythmics
Dosage
Recurrent ventricular arrhythmias:
POà800-1600 mg/day for 1-2 wks
PSVT, symptomatic atrial flutter: POà 600-800
mg/day for 1 month
Blocks Na channels, prolonging
myocardial cell action potential
and refractory
period
Non competitive alpha and beta
adrenergic blockage
Indication
Life threatening recurrent arrhythmias
Ventricular fibrillation
Ventricular tachycardia
Side Effects and Adverse Reactions
Exacerbation of arrhythmias, bradycardia, SA
node dysfunction, heart block, sinus arrest;
flushing, fatigue, malaise, abnormal involuntary
movements, ataxia, dizziness, paresthesia,
decreased libido, insomnia, headache, sleep
disturbances, visual impairment, blindness,
corneal microdeposits, photophobia, abnormal
taste, nausea, vomiting, constipation, anorexia,
abdominal pain, abnormal salivation, coagulation
abnormalities, non-specific hepatic disorders,
pulmonary inflammation, dyspnea, toxicosis,
death, edema, hypo and hyperthyroidism
Contraindications
Severe sinus node dysfunction
2nd or 3rd degree AV block
Hypersensitivity
Nursing Management
 Assess cardiovascular status before
therapy
 Assess pulmonary, hepatic and
thyroid function before and during
therapy
 Monitor fluid and electrolytes,
I&O, K, Na and Cl
 Monitor ECG, BP
 Assess vision
PROCAINAMIDE
Pronestyl, Procan-SR, Procanbid
Classification
Antiarrhythmics
Dosage
Arrhythmias: 50 mg/kg/day in divided doses 3-6
hourly
Action
Blocks open Na channels and prolongs the
cardiac action potential. This results in slowed
conduction and ultimately the decreased rate of
rise of the action potential may result on the
widening of QRS on ECG
Indication


Supraventricular and ventricular
arrhythmias.
Treatment of Wolf-ParkinsonWhite Syndrome
Side Effects and Adverse Reactions
 Severe hypotension, ventricular
fibrillation and asystole.
 Drug induced SLE syndrome,
blood disorders, fever, myocardial
depression, heart failure,
agrunulocytosis, psychosis,
angioedema, hepatomegaly, skin
irritation
hypergammaglobulinemia, GI and
CNS effects
Contraindications
Heart block
Heart failure
Hypotension
Myesthenia gravis
Digoxin toxicity
Lactation
Nursing Management
 Assess cardiovascular status before
therapy
 Assess pulmonary, hepatic and
thyroid function before and during
therapy
 Monitor fluid and electrolytes,
I&O, K, Na and Cl
 Monitor ECG, BP
 Assess vision
EPINEPHRINE
Injection, OTC nasal solution:
Adrenalin Chloride
Ophthalmic solution:
Epifrin, Glaucon
Insect sting emergencies:
EpiPen Auto-Injector (delivers 0.3 mg IM adult
dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg
IM for children)
OTC solutions for
Nebulization:
AsthmaNefrin, microNefrin, Nephron, S2
Classification
Beta2 Adrenergic Agonists
Dosage
 Cardiac arrest: 1 mg IV of 1:10,000
solution q 3-5 min; double dose if
administering via
ET tube
 Anaphylaxis: 0.1- 1 mg SQ or IM of
1:1000 solution
 Asthma: 0.1-0.3 mg SQ or IM of
1:10,000 solution
 Refractory bradycardia and
hypotension: 2-10ug/min
Action
Stimulates beta receptors in lung.
Relaxes bronchial smooth muscle.
Increases vital capacity
Increases BP, é HR, é PR
Decreases airway resistance.
Indication
 Asthma
 Bronchitis
 Emphysema
 All cardiac arrest, anaphylaxis
 Used for symptomatic bradycardia.
 Relief of bronchospasm occurring
during anesthesia
 Exercised-induced bronchospasm
Side Effects:
nervousness, tremor, vertigo, pain, widened
pulse pressure, hypertension nausea
Adverse Effects:
headache
Contraindications
 With angle-closure glaucoma, shock
(other than anaphylactic shock),
organic brain damage, cardiac
dilation, arrhythmias, coronary
insufficiency, or cerebral
arteriosclerosis. Also contraindicated
in patient receiving general anesthesia
with halogenated hydrocarbons or
cyclopropane and in patients in labor
(may delay
second stage)
 In conjunction with local anesthesia,
epinephrine is contraindicated for use
in finger,
toes, ears, nose, and
genitalia.
 In pregnant woman, drug is
contraindicated.
 In breast feeding do not use the drug or
stop breast feeding.
Nursing Management
 Monitor V/S. and check for cardiac
dysrrhythmias
 Drug increases rigidity and tremor
in patients with Parkinson’s disease
 Epinephrine therapy interferes with
tests for urinary catecholamine
 Avoid IM use of parenteral
suspension into buttocks. Gas
gangrene may occur
 Massage site after IM injection to
counteract possible
vasoconstriction.
 Observe patient closely for adverse
reactions. Notify doctor if adverse
reaction
develop
 If blood pressure increases sharply,
rapid-acting vasodilators such as
nitrates or alpha
blockers can
be given to counteract
VASOPRESSIN
Pitressin
Classification
Pituitary Hormones
ADH

Dosage
Prevent and treat abdominal distention: initially
5 units IM gives subsequent injections q3-4
hours increasing to 10 units if needed.
Action
Increase permeability of renal tubular epithelium
to adenosine monophosphate and water, the
epithelium promotes reabsorption of water and
concentrated urine
Indication
Diabetes Insipidus
Abdominal Distention
GI bleeding
Esophageal varices
Side Effects and Adverse Reactions
 CNS: tremor, headache, vertigo
 CV: vasoconstriction, arrhythmias,
cardiac arrest, myocardial
ischemia, circumollar pallor,
decreased CO, angina
 GI: abdominal cramps
 GU:uterine cramps
 Respi: bronchoconstriction
 Skin: diaphoresis, gangrene and
urticaria
Contraindications
 With chronic nephritis and nitrogen
retention
 Hypersensitivity
Nursing Management
 Give 1-2 glass of H20 to reduce
adverse reactions and improve
therapeutic response
 Warm vasopressin in your hands
and mixed until it is distributed
evenly in the
solution
 Monitor urine Sp. Gravity and I&O
to aid evaluation of drug
effectiveness
MAGNESIUM SO4
Classification
Anti-convulsant
Anti-arrhythmics
Dosage
Arrhythmia: IV 1-6 grams over several minutes,
then continuous IV infusion 3-20 mg/min for 548 hours.




CV: hypotension, flushing,
bradycardia, circulatory collapse,
depressed cardiac function
EENT: diplopia
Respiratory: respiratory paralysis
Metabolic: hypocalcemia
Skin: diaphoresis
Contraindications
Heart block and myocardial damage
Toxemia of pregnancy
Nursing Management
 Monitor I&O. make sure urine
output is 100 ml or more in 4 hrs
pd before each dose
 Take appropriate seizure
precautions
 Keep IV Ca gluconate at bedside
Na HCO3
Arm and Hammer; Baking Soda
Classification
Alkalinizers
Dosage


Metabolic Acidosis: Usually 2-5
meq/kg IV infuse over 4-8 hr
period
Cardiac Arrest: 1 meq/kg IV of 7.5
or 8.4% sol, then 0.5 meq/kg IV q
10 mins
depending on ABG
Action
Restore buffering capacity of the body and
neutralizes excessive acid
Indication
Metabolic Acidosis
Cardiac Arrest
Side Effects/Adverse Reactions
 CNS: tetany
 CV: edema
 GI: gastric distention, belching and
flatulence
 Metabolic: hypokalemia, metabolic
alkalosis, hypernatremia,
hyperosmolarity with overdose
 Skin: pain @ injection site
Action
Decreased acetylcholine released
Contraindications
 Pt losing Cl because of vomiting or
continuous GI suction or those
receiving
diuretics that
produces hypochloremic alkalosis
 Metabolic and respiratory alkalosis
Indication
Mg replacement
Arrhythmia
Nursing Management
Obtain blood pH, PaO2, PaCo2 and electrolyte
levels
Side Effects and Adverse Reactions
 CNS: drowsiness, depressed
reflexes, flaccid paralysis,
hypothermia
HYPERTENSIVE CRISIS
Na NITROPRUSSIDE
Nittropress
Classification
Antihypertensive, Vasodilator
Dosage
0.25-0.3 mcg/kg/minute
Action
Relaxes arteriolar and venous smooth muscle
Indication
 Hypertensive crisis
 To produce controlled hypotension
during anesthesia
 To reduce preload and afterload in
cardiogenic shock
Side Effects/Adverse Reactions
Headache, dizziness, increased ICP, loss of
consciousness, restlessness, bradycardia, nausea,
abdominal pain, methemoglodinemia, muscle
twitching, pink-colored rash, irritation at
infusion site
Contraindications
Hypersensitivity
Anuria
Nursing Management
 Monitor wt., BP and PR
 Monitor fluid, I&O, electrolyte,
BUN and CO2 levels frequently
 WOF signs of hypokalemia
 Monitor uric acid levels
 Monitor glucose levels esp in DM
pts
MORPHINE SO4
(Discussed earlier)
NEUROSURGICAL DRUGS
MANNITOL
Osmitrol
Classification
Diuretics
Dosage
Contraindications
Hypersensitivity
Compensatory hypotension
Inadequate cerebral circulation
Acute heart failure with reduced PVR
Congenital optic atrophy
Tobacco-induced ambylopia
Nursing Management
 Obtain VS before giving the drug
 Place pt in supine
 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
than 10 mins can cause cyanide
toxicity
FUROSEMIDE
Lasix
Classification
Loop Diuretics
Dosage
 Pulmonary edema: 40 mg IV

Edema: 20 to 80 mg PO every day in
the morning
 HPN: 40 mg PO bid. Dosage adjusted
based on response
Action
Inhibits Na and Cl reabsorption at the proximal
and distal tubules and in the ascending loop of
Henle
Indication
Acute pulmonary edema
Edema
Hypertension
Side Effects/Adverse Reactions
Signs of hypotension, hypokalemia and
hyperglycemia





Test dose for marked oliguria or
suspected inadequate renal
function: 200 mg/kg or
12.5
gram as a 15% to 20% IV solution
over 3-5 mins response is adequate
if 3050 ml of urine/hr is
adequate, a second dose is given if
still no response after 2nd
dose stop the drug
Oliguria: 50 over 90 mins to
several hrs
To induced intraocular or
intracranial pressure: 1.5-2
gram/kg as a 15 % to 20% IV
solution over 30-60 min
Diuresis in drug intoxication:
12.5% to 10% solutions up to 200
g IV
Irrigating solution during TURP:
2.5-5%
Action
Increases osmotic pressure of glomerular filtrate,
inhibiting tubular reabsorption of water and
electrolytes; drug elevates plasma osmolarity,
increasing water flow into extracellular fluid
Indication





Test dose for marked oliguria or
suspected inadequate renal
function
Oliguria
To induced intraocular or
intracranial pressure
Diuresis in drug intoxication
Irrigating solution during TURP
Side Effects/Adverse Reactions
 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
 GI: urine retention



Metabolic: dehydration
Skin: local pain
Others: chill
Respiratory rate increases within 1-2 mins
IPECAC SYRUP
Contraindications
 Hypersensitivity
 Anuria, severe pulmonary
congestion, frank pulmonary
edema, active intracranial bleeding
during craniotomy, severe
dehydration, metabolic edema,
progressive heart failure or
pulmonary congestion after drug
Classification
Antidote
Nursing Management
 Monitor VS,CVP,I&O, renal
function fluid balance and urine K
levels daily.
 Drug can be used to measure GFR
 Do not give electrolyte free
solutions with blood. If blood id
given simultaneously,
add
at least 200 meq of NaCL to each
liter
Indication
Poisoning
Overdose
POISONING
NALOXONE HCL
Narcan
Classification
Miscellaneous antagonists and antidotes
Dosage
 For suspected opioid induced
respiratory depression: 0.4 to 2 mg IV,
IM and SQ. repeat
doses q 2-3
mins PRN
 For postoperative opiod depression:
0.01 to 0.2 mg IV q 2-3 mins, PRN.
Repeat dose
within 1-2 hr, if
needed.
Action
Reverse the effects of opiods, psychotomimetic
and dysphoric effects of agonist-antagonists
Indication
 For suspected opioid induced
respiratory depression
 For postoperative opiod depression
Side Effects/Adverse Reactions
 CNS: seizures, tremors
 CV: ventricular fibrillation,
tachycardia, HPN with higher
recommended doses,
Hpotension
 GI: nausea and vomiting
 Respiratory: pulmonary edema
 Skin: diaphoresis
Contraindications
 Hypersensitivity
 Use cautious with cardiac irritability or
opiod addiction.
Nursing Management
Assess respiratory status frequently
Dosage
25-30 ml followed immediately by H2O
Action
Irritates the stomach lining and stimulate the
vomiting center
Side Effects
Diarrhea, drowsiness, stomach cramps, vomiting,
itching, DOB, swelling of the mouth, rash and
hives
Contraindications
Hypersensitivity
Given activated charcoal
Unconcious
Drowsy
Severely drunk
Having seizures
With no gag reflex
Nursing Management
 Don’t administer to unconscious
 Pt should kept active and moving ff
administration
 If vomiting does not occur after 2nd
dose, gastric lavage may be
considered to
remove
ingested substance
ACTIVATED CHARCOAL
Classification
Antidote
Dosage
30-100 g with at least 8 oz of water
Action


Inhibits GI absorption of toxic
substances or irritants
Hyperosmolarity
Indication
Poisoning
Side Effects
Pain, melena, diarrhea, vomiting and
constipation
Contraindications
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
FLUMAZENIL
Romazicon
Classification
Benzodiazepine receptor antagonists
Dosage
2 ml IV given over 15 seconds
Action
Antagonizes the effects of benzodiazepines
Indication
Benzodiazepine-induced depression of the
ventilatory responses to hypercapnia and
hypoxia
Side Effects
Nausea, vomiting, palpitations, sweating,
flushing, dry mouth, tremors, insomnia, dyspnea,
hyperventilation, blurred vision, headache, pain
at injection site
Contraindications
Control of ICP or status epilepticus.
Signs of serious cyclic antidepressant overdose
Nursing Management
 Must individualize dosage. Give
only smallest amount effective.
 Give through freely running IV
infusion into large vein to minimize
pain at injection
site
 Note history of seizure or panic
disorder
 Assess evidence of increased ICP
 Note evidence of sedative and
benzodiazepine dependence
 Instruct to avoid alcohol and nonprescription drugs for 1-24 hrs
SHOCK
DOPAMINE
Intropine
Classification
Adrenergic drugs
Dosage
Initially 2-5 mcg/kg/min by IV
Action
Stimulates dopaminergic and alpha and beta
receptors of the sympathetic nervous system
resulting in positive inotropic effect and
increased CO
Indication
 To treat shock and correct
hemodynamic imbalance
 To correct hypotension
 To improve perfusion of vital organs
 To increase CO
Side Effects
 CNS: headache and anxiety
 CV: tachy, angina, palpitations and
vasoconstriction
 GI: nausea and vomiting
Contraindications
Hypersensitivity
With uncorrect tachyarrhythmias
Pheochromocytoma
Ventricular Fibrillation
Nursing Management
 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
DOBUTAMINE
Dobutrex
Classification
Adrenergic drugs
Dosage
 0.5-1 mcg/kg/min IV infusion, titrating
to optimum dosage of 2-20
mcg/kg/min
 2.5 to 10 mcg/kg/min-usual effective
range to increase CO
Action
Stimulates heart beta receptors to increase
myocardial contractility and SV
Indication
 To increase CO
 Treatment of cardiac decompensation
Side Effects
 CNS: headache
 CV: HPN, tachycardia, palpitations
and vasoconstriction
 GI: nausea and vomiting
Contraindications
 Hypersensitivity
 Use cautiously in pts with hx of HPN
and AMI
Nursing Management
 Before starting therapy, give a plasma
volume expander to correct



hypovolemia and a
cardiac
glycoside
Monitor ECG, BP, pulmonary artery
wedge pressure and CO
Monitor electrolyte levels
Don’t confuse dobutamine to
dopamine
DIPHENHYDRAMINE HCL
Benadryl
Classification
Anti-histamine
Dosage
25-50 mg PO, IV or IM bid-tid
GLUCAGON
Classification
Pancreatic Hormones
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
 Monitor therapeutic effectiveness
 Monitor HR, BP, ABG, s/sx of
bronchospasm and CNS stimulation
 Instruct on how to use inhaler properly
 Rinse mouth after use
Action
Blocks the effects Hi receptor sites
Indication
Allergic reactions
Motion sickness
Cough suppression
Sedation
Side Effects
Xerostomia
Urinary retention
Sedation
Contraindications
Acute asthmatic attack
Nursing Management
Risk for photosensitivity- use sunscreen
EPINEPHRINE
(Discussed earlier)