Name of the Drug
Contraindications
Generic Name:
epinephrine
Brand Name:
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
Dosage/Route
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/Classification
Action:
Stimulates beta receptors in
lung.
Relaxes bronchial smooth
muscle.
Increases vital capacity
 BP,  HR,  PR
Decreases airway resistance.
Classification:
Beta2 Adrenergic Agonists
Indication/
Indications:
o Asthma
o Bronchitis
o Emphysema
o All cardiac arrest,
anaphylaxis
o Used for
symptomatic
bradycardia.
o Relief of
bronchospasm
occurring during
anesthesia
o Exercised-induced
bronchospasm
Contraindications:
Contraindicate in patients
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)
Some products containing
sulfites and are
contraindicated in patients
Adverse Effects/ Side Effects
Adverse Effects:
nervousness, tremor, vertigo,
pain, widened pulse pressure,
hypertension nausea
Side Effects:
headache
Nursing Responsibilities
Monitor V/S. and check for
cardiac dysrhythmias
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
1
with sulfite allergies except
when drug is used for serious
allergic reactions or in other
emergency situations.

In conjunction with local

anesthesia, epinephrine is
contraindicated for use in
finger, toes, ears, nose, and
genitalia.

Use cautiously with long-

standing bronchial asthma and
emphysema, who have
developed degenerative heart
disease and in those with
hyperthyroidism, CV disease,
hypertension, psychoneurosis,
or diabetes.

In pregnant woman, drug is

contraindicated.

In breast feeding do not use

the drug or stop breast
feeding.

2
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing Responsibilities
Contraindications
Generic Name: 1-1.5 mg/kg IVP or ETT Action: Indications: Adverse Effects: Monitor EKG, BP, pulse,
lidocane (double dose if giving via ET Decrease cardiac excitability, rhythm, continuously.
Decrease cardiac excitability, CNS: Confusion, tremor,
tube), may repeat q 5-10 min. cardiac contraction is delayed
Brand Name: max cardiac contraction is delayed in the atrium and ventricle lethargy, somnolence, stupor, Monitor serum lidocaine
Xylocaine 3 mg/kg; If conversion in the atrium and ventricle restlessness anxiety, levels throughout theraphy;
successful start an infusion of Contraindications: hallucinations, nervousness, therapreutic range 1.5-5
2-4 mg/min Classification: Contraindicated in patients mcg/ml
seizure. CV: hypotension,
Antiarrythmic and Anesthetic hypersensitive to amide-type
local anesthetics and in those bradychardia, new or Monitor intake and output
with Adams –Stoke syndrome. worsened arrhythmias EENT:
Wolff-Parkinsons-White tinnitus, blurred or double Do not mix in the same
Syndrome, or severe degrees syringe with amphoterin B or
vision.
of SA, AV, or intraventricular cefazolin
block in the absence of Respiratory: Respiratory
pacemaker. depression and arrest
Administer Lidocaine TIV.
Skin: soreness at injection site
Other: anaphylaxis,
In case of circulatory
depression have dopamine
Side Effects:
available
sensation of cold, vomiting

3
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing Responsibilities
Contraindications
Generic Name: 0.5-1 mg/kg slow IVP over 1- Action: Indications: Adverse Effects: Monitor serum
furosemide 2 min, may repeat once at 2 inhibits sodium and chloride Edema associated with CHF vertigo, headache, paresthesia, glucose, and electrolyte
Brand Name: mg/kg slow IVP over 1-2 reabsorption at the proximal orthostatic hypotension, D iet- K+ for all
mins. and distal tubules and the Cirrhosis with ascites or renal thrombophlebitis, abdominal except aldactone
Apo-Furosemide ascending loop of Henlen dysfunction pain, Hypokalemia, anemia, I ntake and Output,
muscle spasm daily weight
Furoside Classification: For hypertension or in U ndesirable effects;
Loop Diuretics combination with other Fluid and electrolyte
Lasix antihypertensive medications. imbalance
R eview HR, BP and
Lasix Speacial  ICP, nephritic syndrome, electrolytes
hepatic cirrhosis E lderly-Careful
Novosemide T ake with or after
Contraindications: meals and in AM
Uritol I ncrease risk of
Contraindicated to patients orthosthatic hypotension;
hypersensitive to drug or any move slowly
of its components and in those C ancel alcohol
with anuria.

Use cautiously in patient with

hepatic cirrhosis.

Patients with allergies to

sulfonamides may also be
allergic to furosemide.

In pregnant woman, use only

if benefits outweighs the risk
to the fetus.

In breast feeding woman, do

not use drug.

4
Name of the Drug Dosage/Route
Generic Name: Adults: For rapid
digoxin digitalization, give 0.4 to 0.6
mg I.V. initially, followed by
Brand Name: 0.1 to 0.3 mg I.V. every 4
Lanoxin, Digoxin, Lanoxicap hours, as needed and
tolerated, for 24 hours.
Children: digitalizing dose is
based on child’s age and is
given in three or more divided
doses over the first 24 hours.
First dose is 50% of total
dose; subsequent dose are
given q 4 to 8 hours as needed
and tolerated.
Children age 10 years and
older: For rapid digitalization,
give 8 to 12 mcg/kg I.V. over
24 hours, divided as above,
Maintenance dose is 25% to
35% of total digitalizing dose,
given daily as a single dose.
Children ages 5 to 10: For
rapid digitalization, give 15 to
30 mcg/kg I.V. over 24 hours
divided as above.
Maintenance dose is 25% to
35% of total digitalizing dose,
divided and given in two or
three equal portions daily.
Action/Classification Indication/
Contraindications
Action: Indications:
Inhibits the sodium- V-fib, V-flutter, CHF,
potassium ATP phase. pulmonary edema, atrial
fibrillation and or flutter, and
Classification: paroxysmal atrial contractions
Cardiac Glycosides
Contraindications:
Contraindicated in patients
hypersensitive to the drug or
any of its components and in
those with digitalis-induced
toxicity, ventricular
fibrillation, or ventricular
tachycardia unless caused by
heart failure.
Use cautiously in patients
with acute MI, in complete Av
block, sinus bradycardia,
PVCs,, chronic constrictive
pericarditis, hyperthropic
cardiomyopathy, renal
insufficiency, severe
pulmonary disease, or
hypothyroidism.
Adverse Effects/ Side Effects
Adverse Effects:
CNS: hallucinations,
paresthesia, stupor, vertigo.
CV: Arrythmias, heart failure,
hypotension.
EENT: blurred vision,
diplopia, light flashes,
photophobia, yellow-green
halos around visual images.
GI: anorexia, diarrhea, nausea,
vomiting.
Side Effects:
CNS: agitation, dizziness,
fatigue, generalized weakness,
headache, malaise.
GI: Nausea
Nursing Responsibilities
Monitor K+, Mg++, ECG,
liver/renal function tests, drug
level (therapeutic level 0.5-2.0
mg/ml, toxicity is >2.0
mg/ml).
Before each dose assess apical
pulse for full minute, record
and report changes in rate or
rhythm.
Withhold drug and contact
provider if pulse is < 60/min.
or >100 (adults) or <
110/minute (children)
Weigh daily
Monitor I&O and signs of
CHF
5
Children ages 2 to 5: For rapid
digitalization: give 25 to 35
mcg/kg I.V. over 24 hours,
divided as above.
Maintenance dose is 25% to
35% of total digitalizing dose,
divided and given in two or
three equal portions daily.

Infants ages 1 month to 2

years: For rapid digitalization.
Give 30 to 50 mcg/kg I.V.
over 24 hours, divided as
above. Maintenance dose is
25% to 35% of the total
digitalizing dose, divided and
given in two or three equal
portions daily.

Neonates: for rapid

digitalization, give 20 to 30
mcg/kg I.V. over 24 hours,
divided as above.
Maintenance dose is 25% to
30% of the total digitalizing
dose, divided and given in two
or three equal portions daily.

Premature Infants: For rapid

digitalization, give 15 to 25
mcg/kg I.V. over 24 hours,
divided as above.
Maintenance dose is 20% to
30% of the total digitalizing
dose, divided and given into
two or three equal portions
daily.

6
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing Responsibilities
Contraindications
Generic Name: 1 mEq/kg IVP, may repeat 0.5 Action: Indications: Adverse Effects: Monitor urinary pH, calcium,
Sodium Bicarbonate mEq/kg 10 min. Neutralizes gastric acid o Hyperacidity GI: Gastric distention, electrolytes and phosphate
o Peptic ulcer belching, flatulence. levels.
Brand Name: Arm and Decrease pepsin activity o Hyperkalemia Metabolic: metabolic
Hammer Pure Baking Soda, o Tricyclic alkalosis, hypernatremia, Record amount and
Citrocarbonate, Soda Mint Classification: Alkalizing antidepressant OD hypokalemia, hyperosmolarity consistency of stools.
Agent, Buffer, Antacid, o Shock associated (with overdose).
electrolyte with severe diarrhea, Other: Pain and irritation at Clients on low-sodium diets
dehydration, injection site. should evaluate sodium
uncontrolled DM contents of antacids.
o Reflux esophagitis

Contraindications:
Contraindicated in patients
with metabolic or respiratory
alkalosis; patients who are
losing chlorides from
vomiting or continuous GI
suction; patients taking
diuretics known to produce
hypochloremia alkalosis; and
patients with hypocalcemia in
which alkalosis may produce
tetany, hypertension, seizures,
or heart failure. Oral sodium
bicarbonate is contraindicated
in patients with acute
ingestion of strong mineral
acids.

7
Name of the Drug Dosage/Route
Generic Name: Adults: initially, 1 to 5
Dopamine HCl. mcg/kg/minute by I.V.
infusion. Adjust dose to
Brand Name: desired hemodynamic or renal
Intropin; Revimine response, increase by 1 to 4
mcg/kg/minute at 10 to 30-
minute intervals.
Action/Classification
Action
Stimulates dopaminergic and
alpha and beta receptors of the
sympathetic nervous system.
Action is dose-related; large
doses can cause mainly alpha
stimulation.
Classification:
Inotropic, vasopressor
Indication/
Contraindications
Indications:
To treat shock and correct
hemodnamic imbalances,
improve perfusion of vital
organs, to increase cardiac
output, and to correct
hypotension.
Contraindications:
Contraindicated in patient
with uncorrected
tachyarrhythmias,
pheocromocytoma, or
ventricular fibrillation.
- Use cautiously in patients
with occlusive vascular
disease, cold injuries, diabetic
endarteritis, and arterial
embolism; in pregnant
woman; with a history of
sulfite sensitivity; and in those
taking MAO inhibitor.
Adverse Effects/ Side Effects
Adverse Effects:
Cv: anginal pain, arrythmias,
bradycardia, conduction
disturbances ectopic
breasts,hypertension,
hypotension, palpitations,
tachycardia, vasoconstriction,
widening of QRS complex.
GI: vomiting.
GU: azotemia
Respiratory: asthma attacks,
dyspnea
Skin: necrosis,piloerection,
tissue sloughing with
extravasation.
Other: anaphylaxis.
Side Effects:
CNS: headache
GI: nausea
Nursing Responsibilities
Blood is not a substitute for
blood or fluid volume deficit.
If deficit occurs, replace fluid
deficit first before giving
meds.
During infusion, frequently
monitor ECG, BP, cardiac
output, CVP, pulmonary artery
wedge pressure, pulse rate,
urine output, and color and
temperature of the limbs.
If diastolic pressure rises
disproportionately, decrease
perfusion rate and watch out
carefully for further signs of
vasoconstriction unless such
action is desired.
Observe for adverse reaction.
Check for urine output. If
urine flow is decrease without
hypotension, notify physician.
After drug is stopped, Tamper
dosage slowly to evaluate
stability of blood pressure.
Acidosis decrease
effectiveness of dopamine.
8
Name of the Drug Dosage/Route/Timing Action/Classification Indication/
Contraindications
Generic 0.3-0.4 mg SL q 5 min, max 3 Action: Indication:
Nitroglycerin doses. Relaxes the vascular smooth Angina pectoris
Brand system CHF associated with AMI
Nitrostat
 Myocardial oxygen Cardiac load reducing agent
consumption
Hypertensive Crisis
 left ventricular workload
 arterial BP Contraindication:
Contraindicated in patients
 venous return hypersensitive to nitrates and
in those with early MI. (S.L.
Classification form), severe anemia, increase
Antianginal, Nitrate, ICP angle-closure glaucoma,
Vasodilator, Coronary IV nitroglycerine is
contraindicated in patients
with hypovolemia,
hypotension, orthostatic
hypotension, cardiac
tamponade restrictive
cardiomyopathy, constrictive
pericarditis.
Adverse Effects/ Side Effects
Adverse Effects
CV: orthostatic hypotension,
flushing, fainting.
EENT: sublingual burning.
Skin: Cutaneous vasodilation,
contact dermatitis (patch)
Side Effects
CNS: headache, throbbing,
dizziness, weakness.
GI: nausea, vomiting.
Skin: Rash
Nursing Responsibilities
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
Transderm-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 doesn’t
experience relief, advise to
seek medical assistance
9
 immediately.

Name of the Drug Dosage/Route
Generic Bradycardia: 0.5 -1 mg IV
Atrophine Sulfate (may give via ETT at double
dose) q 3-5 min, max 0.04
Brand mg/kg
Isopto Atropine Cardiac arrest: 1 mg q 3-5
min, max 0.04 mg/kg
Nerve gas and
organophosphate symptoms,
may repeat in 2 mg
increments q 3 min tiltrated to
relief symptoms.
Action/Classification
Action
cholinergic receptor sites so
response to acetylcholine is
decreased
Classification
Anticholinergics
Indication/
Contraindications
Indication
As an anti-sialagogue for
preanesthetic medication to
prevent or reduce secretions
of the respiratory tract
To restore cardiac rate and
arterial pressure during
anesthesia, when vagal
stimulation produced by intra-
abdominal surgical traction
causes a sudden decrease in
pulse rate and cardiac action
To lessen the degree of
atrioventricular (A-V) heart
block when increased vagal
tone is a major factor in the
conduction defect, as in some
cases due to digitalis
To overcome severe carotid
sinus reflex
Antidote for cardiovascular
collapse from the injudicious
use of a cholinergic drug.
Adverse Effects/ Side Effects
Adverse Effects
CNS: restlessness, ataxia,
disorientation, hallucinations,
delirium, coma, insomnia,
agitation, confusion.
CV: tachycardia, angina,
arrhythmias, flushing.
EENT: photophobia, blurred
vision, mydriasis.
GI: dry moth, constipation,
vomiting.
GU: urine retention.
Hematologic: leukocytosis
Other: anaphylaxis
Side Effects
CNS: headache, excitement.
CV: palpitations
GI: thirst, nausea.
Nursing Responsibilities
Monitor VS.
Re
port  HR
M
onitor for constipation,
oliguria.
Atr
ophine could result in CNS
stimulation (confusion,
excitement) or drowsiness
Instruct to take 30 mins before
meals
Eat foods high in fiber and
drink plenty fluids.
Avoid
OTC antihistamines.
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.

Contraindication
Contraindicated in patients
hypersensitive to drug and
those with acute angle closure
glaucoma, obstructive

10
uropathy, obstructive disease
of GI tract, paralytic elius,
toxic magacolon, intestinal
atony, unstable CV status in
acute hemorrhage, asthma, or
myasthenia gravis. Also
contraindicated in pregnant
women.

11
Name of the Drug Dosage/Route
Generic Adults individualized: 2.5-15
Dobutamine Hydrochloride mcg/kg/min.
Brand Rate of administration and
Dobutrex duration of therapy depend on
the response of client as
determined by HR, presence
of activity, BP and urine flow
Action/Classification
Action
Enhancing the force of
myocardial contraction
 HR,  CO, and  SV
with minor effects to HR.
 elevated ventricular filling
pressure and helps AV node
conduction
Classification
Inotropic, Adrenergic
Indication/
Contraindications
Indication
Short term treatment of
cardiac decompensation in
organic heart disease of
cardiac surgical pressures.
Contraindication
Contraindication in patients
hypersensitive to drug or any
of its components and in those
with idiopathic hypertrophic
subaortic stenosis.
Adverse Effects/ Side Effects
Adverse Effects
CV: angina, hypertension,
hypotension, increased heart
rate, nonspecific chest pain,
phlebitis, PVCs.
GI: nausea and vomiting.
Respiratory: asthma attacks,
shortness of breath.
Others: anaphylaxis.
Side Effects
CNS: headache
Musculoskeletal: mild leg
crams or tingling sensation.
Nursing Responsibilities
Monitor CVP to assess
vascular volume and cardiac
pumping efficiency.
(Elevated CVP may indicate
disruption on CO, as in pump
failure or
Pulmonary edma; low CVP
may indicate hypovolemia)
Monitor ECG and BP
continuously during drug
administration
Record I&O
M
onitor glucose in diabetes
patients
Drug is administered IV to
improve cardiac function thus
increasing BP and improving
urine output.
Report any chest pain,
increase SOB, headaches or
IV site pain.
12
Name of the Drug
Generic
Morphine Sulfate
Brand
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
Dosage/Route
ADULTS
Oral
One-third to one-sixth as
effective as parenteral
administration because of
first-pass metabolism; 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.
Epidural
Initial injection of 5 mg in the
lumbar region may provide
pain relief for up to 24 hr. If
Action/Classification
Action
Principal opium alkaloid; acts
as agonist at specific opioid
receptors in the CNS to
produce analgesia, euphoria,
sedation; the receptors
mediating these effects are
thought to be the same as
those mediating the effects of
endogenous opioids
(enkephalins, endorphins).
Classification
Opioid agonist analgesic
Indication/
Contraindications
Indication
Relief of moderate to severe
acute and chronic pain
Preoperative medication to
sedate and allay apprehension,
facilitate induction of
anesthesia, and reduce
anesthetic dosage
Analgesic adjunct during
anesthesia
Component of most
preparations that are referred
to as Brompton's cocktail or
mixture, an oral alcoholic
solution that is used for
chronic severe pain, especially
in terminal cancer patients
Intraspinal use with
microinfusion devices for the
relief of intractable pain
Unlabeled use: Dyspnea
associated with acute left
ventricular failure and
pulmonary edema
Contraindication
Adverse Effects/ Side Effects
Adverse Effect
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
Nursing Responsibilities
Assessment
History: Hypersensitivity to
opioids; diarrhea caused by
poisoning; labor or delivery of
a premature infant; biliary
tract surgery or surgical
anastomosis; head injury and
increased intracranial
pressure; acute asthma,
COPD, cor pulmonale,
preexisting respiratory
depression; acute abdominal
conditions, CV disease,
supraventricular tachycardias,
myxedema, seizure disorders,
acute alcoholism, delirium
tremens, cerebral
arteriosclerosis, ulcerative
colitis, fever, kyphoscoliosis,
Addison's disease, prostatic
hypertrophy, urethral stricture,
recent GI or GU surgery, toxic
psychosis, renal or hepatic
dysfunction; pregnancy;
lactation
Physical: T; skin color,
texture, lesions; orientation,
reflexes, bilateral grip
strength, affect; P,
auscultation, BP, orthostatic
BP, perfusion; R, adventitious
13
adequate pain relief is not
achieved within 1 hr,
incremental doses of 1–2 mg
may be given at intervals
sufficient to assess
effectiveness, up to 10 mg/24
hr. For continuous infusion,
initial dose of 2–4 mg/24 hr is
recommended. Further doses
of 1–2 mg may be given if
pain relief is not achieved
initially.
Intrathecal
Dosage is usually one-tenth
that of epidural dosage; a
single injection of 0.2–1 mg
may provide satisfactory pain
relief for up to 24 hr. Do not
inject > 2 mL of the 5 mg/10
mL ampule or > 1 mL of the
10 mg/10 mL ampule. Use
only in the lumbar area.
Repeated intrathecal
injections are not
recommended; use other
routes if pain recurs. For
epidural or intrathecal dosing,
use preservative-free
morphine preparations only.
PEDIATRIC PATIENTS
Do not use in premature
infants.
SC or IM
0.05–0.2 mg/kg (up to 15 mg
per dose) q 4 hr or as directed
by physician.
Contraindicated with
hypersensitivity to opioids;
diarrhea caused by poisoning
until toxins are eliminated;
during labor or delivery of a
premature infant (may cross
immature blood–brain barrier
more readily); after biliary
tract surgery or following
surgical anastomosis;
pregnancy; labor (respiratory
depression in neonate; may
prolong labor).
Use cautiously with head
injury and increased
intracranial pressure; acute
asthma, COPD, cor
pulmonale, preexisting
respiratory depression,
hypoxia, hypercapnia (may
decrease respiratory drive and
increase airway resistance);
lactation (wait 4–6 hr after
administration to nurse the
baby); acute abdominal
conditions, CV disease,
supraventricular tachycardias,
myxedema, seizure disorders,
acute alcoholism, delirium
tremens, cerebral
arteriosclerosis, ulcerative
colitis, fever, kyphoscoliosis,
Addison's disease, prostatic
hypertrophy, urethral stricture,
recent GI or GU surgery, toxic
psychosis, renal or hepatic
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
Side Effects
GI: dry mouth, constipation.
Skin: Tissue irritation and
induration (SC injection).
Other: sweating,physical
tolerance and dependence,
psychological dependence
sounds; bowel sounds, normal
output; urinary frequency,
voiding pattern, normal
output; ECG; EEG; thyroid,
liver, kidney function tests
Interventions
Caution patient not to chew or
crush controlled-release
preparations.
Dilute and administer slowly
IV to minimize likelihood of
adverse effects.
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; impaired
perfusion may delay
absorption; with repeated
doses, an excessive amount
may be absorbed when
circulation is restored.
Reassure patients that they are
unlikely to become addicted;
most patients who receive
opioids for medical reasons do
14
 dysfunction. not develop dependence
GERIATRIC PATIENTS syndromes
OR IMPAIRED ADULTS
Use caution. Respiratory Teaching points
depression may occur in the
elderly, the very ill, those with Take this drug exactly as
respiratory problems. prescribed. Avoid alcohol,
Reduced dosage may be antihistamines, sedatives,
necessary. tranquilizers, over-the-counter
Epidural drugs.
Use extreme caution; injection
of < 5 mg in the lumbar Swallow controlled-release
region may provide adequate preparation (MS Contin,
pain relief for up to 24 hr. Oramorph SR) whole; do not
Intrathecal cut, crush, or chew them.
Use lower dosages than
recommended for adults Do not take leftover
above. medication for other disorders,
and do not let anyone else take
your prescription.

These side effects may occur:

Nausea, loss of appetite (take
with food, lie quietly);
constipation (use laxative);
dizziness, sedation,
drowsiness, impaired visual
acuity (avoid driving or
performing tasks that require
alertness and visual acuity).

Report severe nausea,

vomiting, constipation,
shortness of breath or
difficulty breathing, rash.

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