COMMONLY USED DRUGS IN ICU

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-aesthetic meds
• To restore cardiac rate and arterial pressure during anaesthesia 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: leucocytosis
• Other: anaphylaxis

Adverse effects

• CNS: headache, excitement.
• CV: palpitations
• GI: thirst, nausea

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 haemorrhage, asthma, or myasthenia gravis.
• Pregnant women.

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.
• Advise to use hard candy, ice chips, etc. for dry mouth.

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

• Contraindicated in patients hypersensitive to nitrates
• With early MI. (S.L. form), severe anaemia, increase ICP angle-closure glaucoma, IV nitroglycerine is contraindicated in patients with hypovolemia, hypotension, orthostatic hypotension, cardiac tamponade restrictive cardiomyopathy, constrictive pericarditis.

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 Transdermal-Nitro 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 does not experience relief, advise to seek medical assistance immediately.
• Keep in a dark coloured 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. Controlled-release: 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, impaired 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

Nursing Management

Interventions

• 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, over-the-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 60-120 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, diarrhoea, nausea and vomiting

Contraindications

• Hypersensitivity
• Sick sinus syndrom2nd 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

LIDOCAINE

Xylocaine

Classification

• CV drugs: Anti-arrhythmics
• Anesthetic

Dosage

Arrhythmia:

• IV: 0.7-1.4 mg/kg body weight. No more than 200 mg within 1 hour period
• IM: 4-5 mg/kg body weight

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

• Anaesthesia
• Arrhythmias
• Control of Status epilepticus refractory to other treatments

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
• Arrhythmias with CHF: 200 mg/day
• Ventricular dysrrhythmias: 150 mg over the 1st 10 mins then slow 360 mg over the next 6 hrs

Action

• 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-Parkinson-White 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

1. Monitor V/S. and check for cardiac dysrrhythmias
2. Drug increases rigidity and tremor in patients with Parkinson's disease
3. Epinephrine therapy interferes with tests for urinary catecholamine
4. Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur
5. Massage site after IM injection to counteract possible vasoconstriction.
6. Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop
7. 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 5-48 hours.

Action

• Decreased acetylcholine released

Indication

• Mg replacement
• Arrhythmia

Side Effects and Adverse Reactions

• CNS: drowsiness, depressed reflexes, flaccid paralysis, hypothermia
• 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

NaHCO₃

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

Contraindications

• Metabolic and respiratory alkalosis
• Pt losing Cl because of vomiting or continuous GI suction or those receiving diuretics that produces hypochloremic alkalosis

Nursing Management

• Obtain blood pH, PaO2, PaCo2 and electrolyte levels
• SIVP

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 anaesthesia
• 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
• 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 patient 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

Contraindications

• Hypersensitivity
• Anuria

Nursing Management

1. Monitor wt., BP and PR
2. Monitor fluid, I&O, electrolyte, BUN and CO2 levels frequently
3. WOF signs of hypokalemia
4. Monitor uric acid levels
5. Monitor glucose levels esp in DM pts

MANNITOL

Osmitrol

Classification

• Diuretics

Dosage

• 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 30-50 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

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

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

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, hypotension
• 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
• Respiratory rate increases within 1-2 mins

IPECAC SYRUP

Classification

• Antidote

Dosage

• 25-30 ml followed immediately by H2O

Action

• Irritates the stomach lining and stimulate the vomiting center

Indication

• Poisoning
• Overdose

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

1. Don't administer to unconscious
2. Pt should kept active and moving ff administration
3. 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

1. Must individualize dosage. Give only smallest amount effective.
2. Give through freely running IV infusion into large vein to minimize pain at injection site
3. Note history of seizure or panic disorder
4. Assess evidence of increased ICP
5. Note evidence of sedative and benzodiazepine dependence
6. Instruct to avoid alcohol and non-prescription drugs for 1-24 hrs

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 imbalances
• To correct hypotension
• To improve perfusion of vital organs
• To increase CO

Side Effects

• CNS: headache an 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

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

DIPHENHYDRAMINE HCL

Benadryl

Classification

• Anti-histamine

Dosage

• 25-50 mg PO, IV or IM bid-tid

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