VASOPRESSIN
CLASSIFICATION: Antidiuretic
DOSAGE:
Each mL contains: Vasopressin 20 units, Sodium Chloride 9 mg,
Chlorobutanol 0.5% (as a preservative), Water for
Injection q.s. pH (range 2.5 - 4.5) adjusted with Acetic Acid.
Vasopressin may be administered intramuscularly or
subcutaneously.
For intramuscular or subcutaneous use:
10 units per 0.5 mL multiple dose vial Boxes of 25
20 units per 1mL multiple dose vial Boxes of 25
200 units per 10 mL multiple dose vial Boxes of 10
ACTION:
Released from the anterior pituitary gland; regulates water
conservation by promoting reabsorption of water by increasing
the permeability of the collecting ducts in the kidney. Depending
on the concentration, the hormone acts on both V 1 and
V 2 receptors. Also causes vasoconstriction (pressor effect) of
the splanchnic and portal vessels (and to a lesser extent of
peripheral, cerebral, pulmonary, and coronary vessels). Also
increases the smooth muscular activity of the bladder, GI tract,
and uterus. IM, SC: Onset,variable; duration, 2-8 hr. t 1/2: 10-20
min. Effective plasma levels: 4.5-6 microunits.
INDICATION:
The antidiuretic action of vasopressin is ascribed to
increasing reabsorption of water by the renal tubules.
Vasopressin is indicated for prevention and treatment of
postoperative abdominal distention, in abdominal
roentgenography to dispel interfering gas shadows, and in
diabetes insipidus.
CONTRAINDICATIONS
Anaphylaxis or hypersensitivity to the drug or its components.
Vascular disease, especially when involving coronary arteries;
angina pectoris. Chronic nephritis until reasonable blood
nitrogen levels are attained. Never give the tannate IV.
SIDE EFFECTS:
Body as a Whole: anaphylaxia (cardiac arrest and/or shock) has
been observed shortly after injection of vasopressin.
Cardiovascular: cardiac arrest, circumoral pallor, arrhythmias,
decreasedcardiac output, angina,
myocardial ischemia, peripheral vasoconstruction andgangrene.
Gastrointestinal: abdominal cramps, nausea, vomiting, passage
of gas.
Nervous System: tremor, vertigo, "pounding" in head.
Respiratory: bronchial constriction.
Skin and Appendages: sweating, urticaris, cutaneous gangrene
NURSING CONSIDERATION:
You should not receive this medication if you have a chronic
kidney condition such as Bright's disease.
Before receiving vasopressin, tell your doctor if you are
allergic to any drugs, or if you have:
asthma;
kidney disease;
congestive heart failure;
coronary artery disease, hardening of the arteries;
circulation problems;
migraine headaches; or
epilepsy or other seizure disorder.
This medication may be harmful to an unborn baby. Tell your
doctor if you are pregnant or plan to become pregnant during
treatment.
Vasopressin may pass into breast milk and could harm a
nursing baby.
Do not receive this medication without telling your doctor if
you are breast-feeding a baby.
LIDOCAINE
CLASSIFICATION: Antiarrhythmic (Na Channel Blocker)
DOSAGE:
Preparations: IV: 100 mg/10 ml preload (10 mg/ml) 1%. 1
gm/250 D5W or NS premix at 4 mg/ml yield. SC for IV
starts: 2% nebules (without epinephrine) to a max of 0.5 ml.
Spray: 10 mg via Medical Directives. Gel/Topical: 30 ml (20
mg/ml). Adult: Loading: 1.5 mg/kg IV over 2 - 3 minutes,
may give additional bolus of 0.5 - 1 mg/kg every 5 – 10
minutes up to 5 mg/kg total or 400 mg. Maintenance: Initiate
at 2 mg/min if arrhythmias occur, give another bolus of 50
mg and increase infusion to 3 mg/min / if significant
arrhythmias recurs, give another bolus of 50 mg and increase
infusion to 4 mg/min. Pediatric: 1 mg/kg slow IV or IO over
2 minutes, repeat every 5 minutes PRN to a maximum of 5
mg/kg or 200 mg
ACTION:
Suppression of PVC’s and re-entry arrhythmias
Elevates the VF threshold
Local anesthetic
INDICATION:
Lidocaine hydrochloride injection administered intravenously or
intramuscularly, is specifically indicated in the acute
management of ventricular arrhythmias such as those occurring
in relation to acute myocardial infarction, or during cardiac
manipulation, such as cardiac surgery. Treatment of acute
ventricular tachyarrhythmias. Mitigates the bronchospastic
reactivity of the airways to the ETT in acute severe asthma and
blunts the intracranial pressure (ICP) response to intubation in
cases of elevated ICP. Local anesthetic prior to IV starts
CONTRAINDICATION:
Lidocaine hydrochloride is contraindicated in patients with a
known history of hypersensitivity to local anesthetics of the
amide type. Lidocaine hydrochloride should not be used in
patients with Stokes-Adams syndrome, Wolff-Parkinson-White
syndrome or with severe degrees of sinoatrial, atrioventricular or
intraventricular block in the absence of an artificial pacemaker.
SIDE EFFECTS:
Central Nervous System: CNS reactions are excitatory
and/or depressant and may be characterized by light-headedness,
nervousness, apprehension, euphoria, confusion, dizziness,
drowsiness, tinnitus, blurred or double vision, vomiting,
sensations of heat, cold or numbness, twitching, tremors,
convulsions, unconsciousness, respiratory depression and arrest.
The excitatory reactions may be very brief or may not occur at
all, in which case, the first manifestation of toxicity may be
drowsiness, merging into unconsciousness and respiratory arrest.
Cardiovascular System: Cardiovascular reactions are
usually depressant in nature and are characterized by
bradycardia, hypotension and cardiovascular collapse, which
may lead to cardiac arrest.
Allergic reactions as a result of sensitivity to Lidocaine are
extremely rare and, if they occur, should be managed by
conventional means.
Neurologic: There have been reported cases of permanent
injury to extraocular muscles requiring surgical repair following
retrobulbar administration.
NURSING CONSIDERATIONS:
Monitor EKG, BP, pulse, rhythm, continuously.
Monitor serum lidocaine levels throughout theraphy;
therapreutic range 1.5-5 mcg/ml
Monitor intake and output
Do not mix in the same syringe with amphoterin B or
cefazolin
Administer Lidocaine TIV
In case of circulatory depression have dopamine available
FLUMAZENIL
CLASSIFICATION: Benzodiazepine antagonist.
DOSAGE:
0.2-0.3 mg IV over 30 seconds; repeated as needed to a
maximum dose of 1.0 mg.
ACTION:
Reverses effects of benzodiazepines.
INDICATION:
is used as an antidote for benzodiazepine overdose due to its
mechanism as a competitive antagonist at the benzodiazepine
site on the GABAA receptor. Flumazenil is very effective at
reversing the CNS depression associated with benzodiazepine
overdose in a very select population. Patients previously
benzodiazepine naïve prior to an acute overdose are appropriate
candidates for flumazenil. Flumazenil can be
extremely effective in acute benzodiazepine overdoses in
children. Likewise, in patients who have not recently taken
benzodiazepines chronically, flumazenil can be beneficial for
over sedated patients or for excessive drowsiness after
benzodiazepines are administered for diagnostic or therapeutic
procedures.
CONTRAINDICATION:
Flumazenil should not be used as a diagnostic agent for
Benzodiazepine overdose in the same manner Naloxone is used
for narcotic overdose. Known hypersensitivity to the drug.
Hypersensitivity. Patients receiving benzodiazepines for control
of a potentially life-threatening condition such as status
epilepticus and control of intracranial pressure. Severe
intoxication with tricyclic and related antidepressants.
SIDE EFFECTS:
seizures (convulsions);weak or shallow breathing; continued
drowsiness for longer than 2 hours after receiving flumazenil;
confusion, fear, panic attack; or fast or uneven heart rate. Less
serious side effects include: pain or irritation where the medicine
was injected; agitation or tremors (shaking); warmth, redness, or
tingly feeling under your skin; dizziness; sweating or shivering;
headache; blurred vision; or ringing in your ears.
NURSING CONSIDERATION:
Physicians are advised to discuss with patients or their
guardians, both before surgery and at discharge, that
although the patient may feel alert at the time of discharge,
the effects of the benzodiazepine (eg, sedation) may recur.
patient should be instructed, preferably in writing, that their
memory and judgment may be impaired and specifically
advised:
1. Not to engage in any activities requiring complete
alertness, and not to operate hazardous machinery or
a motor vehicle during the first 24 hours after
discharge, and it is certain no residual sedative effects
of the benzodiazepine remain.
2. Not to take any alcohol or non-prescription drugs
during the first 24 hours after flumazenil
administration or if the effects of the benzodiazepine
persist.
FUROSEMIDE
CLASSIFICATION: loop diuretic
DOSAGE:
20 to 80 mg given as a single dose. If needed, the same dose can
be administered 6 to 8 hours later or the dose may be increased.
The dose may be raised by 20 or 40 mg and given not sooner
than 6 to 8 hours after the previous dose until the desired
diuretic effect has been obtained.
ACTION:
Prevents your body from absorbing too much salt, allowing the
salt to instead be passed in your urine and treats fluid retention
in people with congestive heart failure, liver disease, or a kidney
disorder such as nephrotic syndrome. This medication is also
used to treat high blood pressure.
INDICATION:
For patient with Edema and Hypertension.
CONTRAINDICATION:
Furosemide is contraindicated in patients with anuria and in
patients with a history of hypersensitivity to furosemide.
SIDE EFFECTS:
Anemia, blood disorders, blurred vision, constipation, cramping,
diarrhea, dizziness, dizziness upon standing, fever, headache,
hearing loss, high blood sugar, hives, itching, loss of appetite,
low potassium (leading to symptoms like dry mouth, excessive
thirst, weak or irregular heartbeat, muscle pain or cramps),
muscle spasms, nausea, rash, reddish or purplish spots on the
skin, restlessness, ringing in the ears, sensitivity to light, skin
eruptions, skin inflammation and flaking, stomach or mouth
irritation, tingling or pins and needles, vertigo, vision changes,
vomiting, weakness, yellow eyes and skin.
NURSING CONSIDERATION:
Monitor BP after administration
Administer with food or milk to prevent GI upset.
Reduce dosage if given with other antihypertensives; readjust
dosage gradually as BP responds.
Give early in the day so that increased urination will not disturb
sleep.
Avoid IV 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 24 hr.
Refrigerate oral solution.
Measure and record weight to monitor fluid changes.
Arrange to monitor serum electrolytes, hydration, liver function.
Arrange for potassium-rich diet or supplemental potassium as
needed.
