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Dose, Route, Frequency Generic Available Name: Forms: IV Lidocaine injectionhydrochlorid 300mg/3mL; e direct injection: 10, Brand Name:

20mg/ml; IV Anesticaine, injection: 40, Anesticon, 100, Laryng-O200mg/mL Jet , Lidodan, Lidoderm, Lidomax, LidoPen AutoInjector, LTA Pediatric, Lurocaine, Xylocaine, XylocaineMPF, Xylocard

Drug

Classificati on Pharmacol ogic class: Amide Therapeuti c class: Antiarrhythm ic (class IB), local anesthetic

Mechanism of Action Local anesthetic: blocks the generation and conduction of action potentials in sensory nerves by reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity.

Indication As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtrachea l injection; topical anesthetic for skin disorders and accessible mucous membranes.

Side Effects GI: nausea, vomiting, CV: hypotension, cardiac arrest vasodilation CNS: fatigue, drowsiness, unconscious ness, tremors, vision changes, convulsion.

Contraindic ations Allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second or third degree heart block

Nursing responsibili ties check drug concentratio n carefully; many concentratio ns are available Reduce dosage with hepatic or renal failure. Monitor for malignant hyperthermi a; have life support equipment and IV dantrolene on standby. Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patient. Monitor fluid load carefully; more concentrated

solutions can be used to treat arrhythmias in patients on fluid restrictions.

Drug
Generic Name: Epinephrine Brand Name: Bronkaid Mist, Epi-E-Zpen, Epinephrine Pediatric, EpiPen AutoInjector, Primatene Mist Suspension

Dose, Route, Frequency


0.1 to 0.5 ml of 1:1,000 solution subcutaneousl y or I.M.

Classificati on
Pharmacolo gic class: Sympathomi metic (direct acting) Therapeutic class: Bronchodilato r, mydriatic

Mechanism of Action
Naturally occurring catecholamin e obtained from animal adrenal glands; also prepared synthetically. Acts directly on both alpha and beta receptors; the most potent activator of alpha receptors. Strengthens myocardial contraction; increases systolic but may decrease diastolic blood pressure;

Indication
Temporary relief of bronchospas m, acute asthmatic attack, mucosal congestion, hypersensitivi ty and anaphylactic reactions, syncope due to heart block or carotid sinus hypersensitivi ty, and to restore cardiac rhythm in cardiac arrest. Ophthalmic preparation is used in

Side Effects
Special Senses: Nasal burning or stinging, dryness of nasal mucosa, sneezing, rebound congestion. Transient stinging or burning of eyes, lacrimation, browache, headache, rebound conjunctival hyperemia, allergy, iritis; with prolonged use: melaninlike deposits on lids,

Contraindic ations
Hypersensitivit y to sympathomim etic amines; narrow-angle glaucoma; hemorrhagic, traumatic, or cardiogenic shock; cardiac dilatation, cerebral arteriosclerosi s, coronary insufficiency, arrhythmias, organic heart or brain disease; during second stage of labor; for local anesthesia of fingers, toes, ears, nose,

Nursing responsibili ties


Monitor BP, pulse, respiration s, and urinary output and observe patient closely following IV administra tion. Epinephrin e may widen pulse pressure. If disturbanc es in cardiac rhythm occur, withhold epinephrin

increases cardiac rate and cardiac output.

management of simple (open-angle) glaucoma, generally as an adjunct to topical miotics and oral carbonic anhydrase inhibitors; also used as ophthalmic decongestant. Relaxes myometrium and inhibits uterine contractions; prolongs action and delays systemic absorption of local and intraspinal anesthetics. Used topically to control superficial bleeding.

conjunctiva, and cornea; corneal edema; loss of lashes (reversible); maculopathy with central scotoma in aphakic patients (reversible). Body as a Whole: Nervousness, restlessness, sleeplessness, fear, anxiety, tremors, severe headache, cerebrovascul ar accident, weakness, dizziness, syncope, pallor, sweating, dyspnea. Digestive: Nausea, vomiting. Cardiovascul ar: Precordial pain, palpitations, hypertension, MI, tachyarrhyth mias including ventricular fibrillation.

genitalia. Safety during pregnancy (category C) or lactation is not established.

e and notify physician immediatel y. Keep physician informed of any changes in intakeoutput ratio. Use cardiac monitor with patients receiving epinephrin e IV. Have full crash cart immediatel y available. Check BP repeatedly when epinephrin e is administer ed IV during first 5 min, then q3 5min until stabilized. Advise patient to report to

Respiratory: Bronchial and pulmonary edema. Urogenital: Urinary retention. Skin: Tissue necrosis with repeated injections. Metabolic: Metabolic acidoses, elevated serum lactic acid, transient elevations of blood glucose. Nervous System: Altered state of perception and thought, psychosis.

physician if symptoms are not relieved in 20 min or if they become worse following inhalation. Advise patient to report bronchial irritation, nervousne ss, or sleeplessn ess. Dosage should be reduced. Monitor blood glucose & HbA1c for loss of glycemic control if diabetic.

Drug
Generic Name: Atropine Sulfate

Dose, Route, Frequency


0.5 to 1 mg by I.V. push repeated q 3 to 5 minutes as

Classificati on
Pharmacologi c class: Anticholinergi c (antimuscarini

Mechanism of Action
Acts by selectively blocking all muscarinic responses to

Indication
Adjunct in symptomatic treatment of GI disorders (e.g., peptic

Side Effects
CNS: Headache, ataxia, dizziness, excitement,

Contraindic ations
Hypersensitivit y to belladonna alkaloids; synechiae;

Nursing responsibili ties


Monitor vital signs. HR is a sensitive indicator of

Brand Name: Atropair , Atropisol, Isopto Atropine

needed

c) Therapeutic class: Antiarrhythmi c

acetylcholine (ACh), whether excitatory or inhibitory. Selective depression of CNS relieves rigidity and tremor of Parkinson's syndrome. Antisecretory action (vagolytic effect) suppresses sweating, lacrimation, salivation, and secretions from nose, mouth, pharynx, and bronchi. Blocks vagal impulses to heart with resulting decrease in AV conduction time, increase in heart rate and cardiac output, and shortened PR interval.

ulcer, pylorospasm, GI hypermotility, irritable bowel syndrome) and spastic disorders of biliary tract. Relaxes upper GI tract and colon during hypotonic radiography. Ophthalmic Use: To produce mydriasis and cycloplegia before refraction and for treatment of anterior uveitis and iritis. Preoperative Use: To suppress salivation, perspiration, and respiratory tract secretions; to reduce incidence of laryngospasm , reflex bradycardia arrhythmia, and hypotension

irritability, convulsions, drowsiness, fatigue, weakness; mental depression, confusion, disorientation, hallucinations . CV: Hypertension or hypotension, ventricular tachycardia, palpitation, paradoxical bradycardia, AV dissociation, atrial or ventricular fibrillation. GI: Dry mouth with thirst, dysphagia, loss of taste; nausea, vomiting, constipation, delayed gastric emptying, antral stasis, paralytic ileus. Urogenital: Urinary hesitancy and retention, dysuria,

angle-closure glaucoma; parotitis; obstructive uropathy, e.g., bladder neck obstruction caused by prostatic hypertrophy; intestinal atony, paralytic ileus, obstructive diseases of GI tract, severe ulcerative colitis, toxic megacolon; tachycardia secondary to cardiac insufficiency or thyrotoxicosis; acute hemorrhage; myasthenia gravis. Safety during pregnancy (category C) or lactation is not established.

patient's response to atropine. Be alert to changes in quality, rate, and rhythm of HR and respiration and to changes in BP and temperatur e. Initial paradoxical bradycardia following IV atropine usually lasts only 12 min; it most likely occurs when IV is administere d slowly (more than 1 min) or when small doses (less than 0.5 mg) are used. Postural hypotensio n occurs when patient ambulates too soon after parenteral administrat

during general anesthesia. Cardiac Uses: For sinus bradycardia or asystole during CPR or that is induced by drugs or toxic substances (e.g., pilocarpine, betaadrenergic blockers, organophosph ate pesticides, and Amanita mushroom poisoning); for management of selected patients with symptomatic sinus bradycardia and associated hypotension and ventricular irritability; for diagnosis of sinus node dysfunction and in evaluation of coronary artery disease

impotence. Skin: Flushed, dry skin; anhidrosis, rash, urticaria, contact dermatitis, allergic conjunctivitis, fixed-drug eruption. Special Senses: Mydriasis, blurred vision, photophobia, increased intraocular pressure, cycloplegia, eye dryness, local redness.

ion. Note: Frequent and continued use of eye preparation s, as well as overdosage , can have systemic effects. Some atropine deaths have resulted from systemic absorption following ocular administrat ion in infants and children. Monitor I&O, especially in older adults and patients who have had surgery (drug may contribute to urinary retention). Palpate lower abdomen

during atrial pacing

for distention. Have patient void before giving atropine.

Drug Generic Name: Digoxin Brand Name: Apo-Digoxin

Dose, Route, Frequency

Classificati on Pharmacol ogic class: Cardiac glycoside Therapeuti c class: Inotropic, antiarrhythm ic

Mechanism of Action Increases force and velocity of myocardial contraction and prolongs refractory period of atrioventricu lar (AV) node by increasing calcium entry into myocardial cells. Slows conduction through sinoatrial and AV nodes and produces antiarrhythm ic effect.

Indication Heart failure; tachyarrhyth mias; atrial fibrillation and flutter; paroxysmal atrial tachycardia

Side Effects CNS: fatigue, headache, asthenia CV: bradycardia, ECG changes, arrhythmias EENT: blurred or yellow vision GI: nausea, vomiting, diarrhea GU: gynecomastia Hematologic : thrombocyt openia Other: decreased appetite

Contraindic ations Hypersensitiv ity to drug Uncontrolled ventricular arrhythmias AV block Idiopathic hypertrophic subaortic stenosis Constrictive pericarditis

Nursing responsibili ties Monitor apical pulse for 1 min before administerin g; hold dose if pulse < 60 in adult or < 90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, hold drug and notify prescriber. Note any change from baseline rhythm or rate. Take care to differentiate

Lanoxin caps from Lanoxin; dos age is very different Check dosage and preparation carefully. Avoid IM injections, which may be very painful. Follow diluting instructions carefully, and use diluted solution promptly. Avoid giving with meals; this will delay absorption. Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, and cardiac monitor on standby in

case toxicity develops. Monitor for therapeutic drug levels: 0.52 mg/ml

Drug Generic Name: Ketorolac Tromethami ne Brand Name: Torodol

Dose, Route, Frequency

Classificati on Pharmacol ogic class: Nonsteroidal antiinflammator y drug (NSAID) Therapeuti c class: Analgesic, antipyretic, antiinflammator y

Mechanism of Action Antinflammator y and analgesic activity inhibits prostaglandi ns and leukotriene synthesis.

Indication Moderately severe acute pain

Side Effects CHS: Headache, malaise, dizziness, somnolence, insomia GI: Contipation, diarrhea, nausea, vomiting, flatulence GU: Dysuria, renal impairement Dermatologi c: Rash, pruritus, sweating, dry mucous membranes, stomatitis Hematologic: Bleeding,

Contraindic ations Significant renal impairment, pregnancy, lactation; patients wearing soft contact lenses

Nursing responsibili ties Maintain emergency equipment on standby at time of initial dose, in case of severe hypersensitiv ity reaction. Protect drug vials from light. Administer every 6h to maintain serum levels and control pain.

platelet inhibition with higher doses, neutropenia, leucopenia, aplastic anemia. Drug Generic Name: Morphine Sulfate Brand Name: Doloral, Morphitec Dose, Route, Frequency 30 mg P.O. q4h Classificati on Pharmacol ogic class: Opioid agonist Therapeuti c class: Opioid analgesic Mechanism of Action Indication Side Effects CNS: Lightheadedness, dizziness, sedation, euphoria, dyphoria, anxiety, fear, mood changes GI: Nausea, vomiting, dry mouth, anorexia, constipation CV: Facial flushing, tachycardia, bradycardia, arrhythmia, hypertension , hypotension, orthostatic hypotension GU: oliguria Contraindic ations Hypersensitiv ity to narcotics; 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 Nursing responsibili ties Caution patient not to chew or crush controlledrelease preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects. Direct patient to lie down during IV administratio n. Provide narcotic antagonist, facilities for assisted or

Principal Severe to opium moderate alkaloid; acts pain 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.

Major Hazards: Respiratory depression, apnea, respiratory arrest, shock

(respiratory depression in neonate; may prolong labor)

controlled respiration on standby during IV administratio n. Reassure patient about addiction liability; most patient who receive opiates for medical reasons do not develop dependence syndromes.

Drug Generic Name: Phenylephrin e Hydrochlorid e Brand Name: Parenteral: NeoSynephrine Oral: AHChew D Topical OTC

Dose, Route, Frequency 10 mg SQ

Classificati on Pharmacolo gic class: Sympathomi metic, alphaadrenergic agonist Therapeuti c class: Vasopressor, nasal decongestan t, ophthalmic vasoconstrict

Mechanism of Action Powerful postsynaptic a-adrenergic receptor stimulant that causes vasoconstrict ion and increased systolic and diastolic BP with little effect on the B-receptors

Indication Mild to moderate hypotension Severe hypotension and shock To prevent hypotension during spinal anesthesia Vasoconstri ctor for regional

Side Effects CNS: Fear, anxiety, tenseness, restlessness, headache, dizziness, lightheadedness CV: Cardiac arrhythmias GI: Nausea, vomiting, anorexia GU:

Nursing responsibili ties Hypersensit Protect ivity to parenteral phenylephrin solution from e; severe light; do not hypertension, administer ventricular unless tachycardia; solution is narrow-angle clear, glaucoma; discard pregnancy. unused Use portion. cautiously Monitor P, with BP thyrotoxicosi continuously

Contraindic ations

Nasal Decongesta nts: Alconefrin, Coricidin

or

of the heart. Anesthesia Topical Nasal application congestion causes vasoconstrict ion of the mucous membrane, which in turn relieves pressure and promotes drainage of the nasal passages.

decreased urine formation, dysuria, Local: Necrosis and sloughing if extravasatio n occurs with IV use. Other: Pallor, respiratory difficulty, sweating.

s, diabetes, hypertension, CV disorder, prostatic hypertrophy, unstable vasomotor syndrome; lactation

during parenteral administratio n. Do not administer ophthalmic solution that has turned brown or contains precipitates; prevent prolonged exposure to air and light. Do not administer other eye drops for at least 5 min after phenylephrin e. Monitor BP and cardiac response regularly in patients with any CV disorders. Nursing responsibiliti es Do not discontinue

Drug Generic Name:

Dose, Route, Frequency 40 mg P.O. b.i.d.

Classificati on Pharmacol ogic class:

Mechanism of Action Compititivel y blocks B-

Indication Angina pectoris

Side Effects CNS: Vertigo,

Contraindic ations Allergy to Bblocking

Propranolol Hydrochlorid e Brand Name: Betachron ER, Inderal, Novo-Pranol, PMSPropranolol

Betaadrenergic blocker (nonselectiv e) Therapeuti c class: Antianginal, antiarrhythm ic (class II), antihyperten sive, vascular headache suppressant

adrenergic receptors in the heart and juxtoglomer ular apparatus, decreasing the influence of the sympathetic nervous system on these tissue, the excitability of the heart, cardiac workload and oxygen consumption , and the release of renin and lowering BP; has membranestabilizing (local anesthetic) effects that contribute to its antiarrhythm ic action; acts in the CNS to reduce

Hypertensi on To prevent migraine or vascular headache

fatigue, emotional depression, sleep disturbance, dizziness GI: Gastric pain, nausea, diarrhea, vomiting, anorexia, flatulence CV: CHF, bradycardia, hypotension GU: Impotence, decreased libido, dysuria, nocturia, frequency Dermatologi c: Rash, pruritis, sweating, dry skin

agents, sinus bradycardia, second or third degree heart block, cardiogenic shock, CHF, bronchial asthma, bronchospas m, COPD, lactation, pregnancy (neonatal bradycardia, hypoglycemi a and apnea)

drug abruptly after chronic therapy. Taper drug gradually over 2 wk with monitoring. Ensure that a-adrenergic blocker has been given before giving propranolol when treating patient with pheochromocy toma; endogenous catecholamine s secreted by the tumor can cause severe hypertension if vascular Breceptor are blocked without concomitant a blockade. Provide continuous cardiac and regular BP monitoring with IV foam. Give oral drug with food to facilitate absorption.

sympathetic outflow and vasoconstric tor tone. The mechanism by which it prevents migraine headaches is unknown. Drug Generic Name: Furosemide Brand Name: ApoFurosemide, furoside, Lasix, Myrosemide Dose, Route, Frequency 40 mg P.O. b.i.d. Classificati on Pharmacol ogic class: Sulfonamide loop diuretic Therapeuti c class: Diuretic, antihyperten sive Mechanism of Action Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis. Indication Acute pulmonary edema Hypertensi o Side Effects CHS: Headache, dizziness, vertigo, weakness, fatigue, blurred vision, irreversible hearing loss GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, jaundice CV: Volume depletion, thrombophle btis Nursing responsibili ties Allergy to Administer furosemide; with food or allergy to milk to tartrazine (in prevent GI oral solution); upset electrolyte Reduce depletion; dosages if anuria; given with severe renal other failure; antihyperten hepatic sives; coma; readjust pregnancy; dosages lactation. gradually as BP responds. Give early in the day so that increased urination will not disturb sleep. Avoid IV Contraindic ations

Hematologic: Leukopenia, thrombocyto penia, anemia GU: Polyuria, nocturia, urinary bladder spasm

use if oral use is at all possible. Do not mix parenteral solution with highly acidic solutions with pH below 3.5. Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions. Discard diluted solution after 24h. Refrigerate oral solution. Measure and record weight to monitor fluid changes. Arrange to monitor serum electrolytes, hydration, liver function.

Arrange for potassiumrich diet or supplementa l potassium as needed.

Drug Generic Name: hydralazine Brand Name: N-Hydral

Dose, Route, Frequency 10 mg P.O. q.i.d.

Classificati on Pharmacol ogic class: Peripheral vasodilator Therapeuti c class: Antihyperten sive

Mechanism of Action Acts directly on vascular smooth muscle to cause vasodilation, primarily arteriolar, decreasing peripheral resistance, maintains or increases renal and cerebral blood flow.

Indication Oral: Essential hypertension alone or in combination with other drugs. Parenteral: Severe essential hypertension when drug cannot be given orally or when need to lower BP is urgent.

Side Effects GI: Anorexia, nausea, vomiting, diarrhea, constipation CV: Palpitations, tachycardia, hypotension CNS: Headache, peripheral neuritis, dizziness, anxiety

Contraindic ations Contraindicat ed with hypersensitiv ity to hydralazine; CAD, mitral valvular rheumatic heart disease.

Nursing responsibili ties Give oral drug with food to increase bioavailabilit y. Monitor patient for orthostatic hypotension, which is most marked in the morning and in hot weather, and with alcoholic or exercise. Report persistent or severe constipation, unexplained

ever or malaise, muscle or joint aching, chest pain, rash; numbness.

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