Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations

Action

Generic Name: Lidocaine alters  This medication is  Heart block, ADULTS: CNS excitation:  Before using lidocaine,
LIDOCAINE signal conduction used on the skin to second or third Infusion solution nervousness, agitation, tell your doctor or
in neurons by stop itching and degree (without in D5W anxiety, apprehension, pharmacist if you are
prolonging the
pain from certain pacemaker)  100mg/100mL tingling around the allergic to it; or to other
Brand Name: inactivation of the  200mg/100mL mouth (circumoral amide type anesthetics
skin conditions  Severe sinoatrial
Lidamantle fast voltage-gated  400mg/100mL paraesthesia), (e.g., bupivacaine,
(e.g., scrapes, block (without
Na+ channels in the  800mg/100mL headache,
prilocaine); or if you have
Classification: neuronal cell minor pacemaker) any other allergies
membrane burns, eczema, ins  Serious adverse hyperesthesia, tremor,  Before using this
Antidysrhythmics
responsible for ect bites) and to drug reaction to Injectable
dizziness, pupillary medication, tell your
action potential treat minor lidocaine or amide solution changes, psychosis, doctor or pharmacist your
propagation. With  10mg/mL euphoria, medical history,
discomfort local anesthetics
sufficient blockage,  20mg/mL hallucinations, and especially of: broken
the voltage-gated and itching caused  Hypersensitivity to
seizures. skin/infection in the area
sodium channels by hemorrhoids an corn and corn- where lidocaine is to be
CNS depression with
will not open and d certain other related products increasingly heavier used, heart disease, liver
an action potential problems of the (corn-derived disease, a certain blood
exposure:
will not be genital/anal area dextrose is used in disorder
drowsiness, lethargy,
generated. Careful (e.g., anal fissures, the mixed (methemoglobinemia).
slurred speech,
titration allows for
itching around injections) hypoesthesia, confusion,  If you are going to have
a high degree of an MRI test, tell testing
the vagina/rectum)  Concurrent disorientation, loss of
selectivity in the personnel that you are
. treatment consciousness,
blockage of sensory using this product. Some
respiratory depression
neurons, whereas  Some forms of this with quinidine, flec brands of this medication
and apnoea.
higher medication are ainide, disopyramid may contain metals that
concentrations also also used to
Cardiovascular:
e, procainamide (cl hypotension, can cause serious burns
affect other types decrease during an MRI and should
ass I bradycardia,
of neurons. The discomfort or pain not be used before MRI
antiarrhythmic arrhythmias, flushing,
same principle during certain imaging.
agents) venous insufficiency,
applies for this medical
 Prior use increased defibrillator
drug's actions in the procedures/exams
threshold, edema, and/or
heart. A blocking (e.g., of amiodarone
cardiac arrest – some of
sodium channel in sigmoidoscopy, hydrochloride which may be due to
the conduction cystoscopy).
system, as well as  Lidocaine is a  Adams-Stokes hypoxemia secondary to
the muscle cells of local anesthetic syndrome respiratory depression.
the heart, raises the that works by  Wolff-Parkinson- Respiratory:
depolarization causing temporary bronchospasm, dyspnea,
White syndrome
threshold, making numbness/loss of respiratory depression or
the heart less likely feeling in the skin  Lidocaine viscous
arrest.
to initiate or and mucous is not Gastrointestinal:
conduct early membranes. recommended by metallic taste, nausea,
action potentials the FDA to treat vomiting.
that may cause an teething pain in Ears: tinnitus
arrhythmia children and Eyes:
infants. local burning,
conjunctival
hyperemia, corneal
epithelial
changes/ulceration,
diplopia, visual
changes
(opacification).
Skin:
itching,
depigmentation, rash,
urticaria, edema,
angioedema, bruising,
inflammation of the
vein at the injection
site, irritation of the
skin when applied
topically
Blood:
methemoglobinemia
Allergy
 Therapeutic Indication Contraindication Dosage Adverse Nursing Considerations
Action Reaction

Generic Name:  Epinephrine  This medication is  Acute myocardial Adults And  palpitations  Do not administer
EPINEPHRINE acts on nearly used in emergencies infarction, angina, Children 30 kg  tachycardia repeated injections of
all body to treat very serious cardiac arrhythmias, (66 lbs) Or More:  arrhythmia epinephrine at the same
cardiac disease,  0.3 to 0.5 mg
tissues. Its allergic reactions  anxiety site, as the resulting
Brand Name: actions vary by coronary artery (0.3 to 0.5 mL) vasoconstriction may
to insect stings/bites, disease,  panic attack
Adrenaline tissue type and of undiluted cause tissue necrosis.
foods, drugs, or hemorrhagic shock,  headache, tremor
tissue other hypovolemia, Adrenalin  hypertension  Do not inject into
Classification:
expression substances. Epineph pulmonary edema, administered  acute pulmonary buttock. Injection into
Alpha- and beta-
adrenergic agonists
of adrenergic rine acts quickly to shock. ... intramuscularly edema. the buttock may not
(sympathomimetic receptors. For improve breathing,  Sulfite or provide effective
agents). example, high hypersensitivity. subcutaneously treatment
stimulate the heart,
levels of  Closed-angle in the of anaphylaxis and has
raise a glaucoma.
epinephrine anterolateral been associated with the
dropping blood  Extravasation,
causes smooth aspect of the development of
muscle relaxati pressure, infection, thigh, up to a Clostridial infections
reverse hives, and intraarterial
on in the maximum of 0.5 (gas gangrene).
reduce swelling of administration.
airways but mg (0.5 mL) per  Do not inject into digits,
causes the face, lips, and injection, hands, or
contraction of throat repeated every 5 feet. Epinephrine is a
the smooth to 10 minutes as strong vasoconstrictor.
muscle that necessary. Accidental injection into
lines Monitor the digits, hands or feet
most arterioles. clinically for may result in loss of
 Epinephrine reaction blood flow to the
acts by binding severity and affected area and tissue
to a variety cardiac effects. necrosis.
of adrenergic
receptors. Children Less
 Its actions are Than 30 kg (66
to increase lbs):
peripheral
resistance  mg/kg (0.01
via α1 receptor mL/kg) of
- undiluted
dependent vaso Adrenalin
constriction an administered
d to intramuscularly
increase cardia or
c output via its subcutaneously
binding to in the
β1 receptors. anterolateral
The goal of aspect of the
reducing thigh, up to a
peripheral maximum of 0.3
circulation is mg (0.3 mL) per
to increase injection,
coronary and repeated every 5
cerebral to 10 minutes as
perfusion necessary.
pressures and Monitor
therefore clinically for
increase reaction
oxygen severity and
exchange at the cardiac effects.
cellular level.
 Therapeutic Action Indication Contraindication Dosage Adverse Reaction Nursing Considerations

Generic Name:  Atropine inhibits  The 2 mg Atropine  Atropine Usual Adult Dose 
dry mouth,  Monitor apical pulse
ATROPINE SULPHATE the muscarinic autoinjector is is contraindicated for 
blurred vision, prior to administration.
actions of indicated for the in patients pre- Bradyarrhythmia: 
sensitivity to light,  Cardiac monitor should
acetylcholine on 0.4 to 1 mg, IV, 
lack of sweating,
treatment of disposed to be used on patients

dizziness,
structures poisoning by narrow angle every 1 to 2 hours receiving atropine IV
Brand Name: 
nausea,
innervated by susceptible glaucoma as needed boluses.
Isopto Atropine 
loss of balance,
postganglionic organophosphorou 
hypersensitivity  Doses of 0.5 mg or less
cholinergic s nerve agents Usual Adult Dose reactions (such as may result in paradoxical
Classification:
nerves, and on having for Anesthesia: skin rash), and slowing of heart rate.
anticholinergic or
smooth muscles, 0.4 mg to 0.6 mg,  rapid heartbeat
antiparasympathetic cholinesterase  Eye preparations
(parasympatholytic) which respond to IV, (tachycardia).
activity as well as generally used only for
drug endogenous intramuscularly,
organophosphorou procedures and have only
acetylcholine but or subcutaneously
s or carbamate localized effects on optic
are not so
innervated. As insecticides in Usual Adult Dose muscles. Chronic use of
with other adults and for eye preparations may
antimuscarinic pediatric patients Anticholinesterase result in systemic
agents, the major weighing over 90 Poisoning: anticholinergic symptoms
action of atropine lbs [41 kg] 0.4 mg to 0.6 mg, which may be hazardous
is a competitive or (generally over 10 IV, in infants and children.
surmountable years of age). intramuscularly,  Atropine can be
antagonism, or subcutaneously administered via
which can be endotracheal tube in dose
overcome by of 2-3 mg diluted in 10 ml
increasing the H2O, but intraosseous
concentration of route is preferred over
acetylcholine at endotracheal tube if IV
receptor sites of access cannot be
the effector organ achieved.
(e.g., by using
anticholinesterase
agents, which
 inhibit the  Monitor temperature in
enzymatic infants and children for
destruction of "atropine fever".
acetylcholine).  Measures to relieve dry
 The receptors mouth: adequate fluid
antagonized by hydration, oral hygiene
atropine are the (don't use alcohol based
peripheral mouthwashes), ice chips,
structures that are sugarless gum, or hard
stimulated or candies to suck on.
inhibited by
 Avoid driving or
muscarine, (i.e.,
operating heavy
exocrine glands
machinery while under
and smooth and
cardiac muscle). the influence of atropine.
Responses to  Reduce lighting to
postganglionic decrease photophobia.
cholinergic nerve  Monitor GI motility (BMs
stimulation may and flatus) and urine
also be inhibited output while patient is
by atropine, but receiving atropine.
this occurs less  Atropine is a common
readily than with pre-operative agent, and
responses to can be given IM, SC, PO,
injected or IV.
(exogenous)
choline esters.
 Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations
Action

Generic Name:  Low dose (<3  Shock: Moderate  Tachy- IV Infusion:  Hypotension,  Correct hypovolemia with
DOPAMINE mcg/kg/min): doses enhance dysrhythmias Begin at 2 – 5 hypertension, fluid resuscitation before
activates dopamine contractility  Ventricular mcg/kg/min and tachycardia initiating dopamine
rgic receptors in increasing fibrillation titrate to blood  Anginal pain, infusion
Brand Name:
kidneys producing cardiac output;  Pheochromocytoma pressure ectopic beats,  Monitor blood pressure,
intropen
renal artery High doses  Safety during according to vasoconstriction pulse, and peripheral
dilation. produce pregnancy, desired response (cold extremities) pulses every 15 minutes.
Classification:  Mod dose (3 – 10 vasoconstriction lactation or with to a maximum of  Nausea, vomiting,  Monitor hourly urine
Beta-adrenergic & mcg/kg/min): to enhance blood children not 20 mcg/kg/min headache output.
alpha-adrenergic primarily pressure. established.  Tissue necrosis  Cardiac monitor should be
agonist activates β1adrener  Heart and sloughing if used on patients receiving
gic receptors in Failure: At extravasation dopamine infusion.
heart increasing moderate doses, occur  Notify physician
heart rate (positive dopamine immediately if 1) oliguria
chronotropic enhances develops; 2) tachy-
agent), contractility contractility. Hig dysrhythmias develop; 3)
(positive inotropic her doses diastolic pressure rises
agent exacerbate heart reducing pulse pressure;
 High dose (10 – 20 failure by 4) hypotension continues
mcg/kg/min): increasing to exist at maximum dose
activates α- afterload and of 20 mcg/kg/min; 5) signs
adrenergic producing of peripheral ischemia
receptors producin additional (purple extremities, cold
g vasoconstriction workload on the extremities, diminished
(increasing systemi heart. peripheral pulses)
c vascular  Bradycardia: Do  Weigh patient daily to
resistance or left pamine is a 2nd determine accurate
ventricular line drug after infusion dose.
afterload.
atropine for  Calculate infusion drips
bradycardias. and doses
carefully. Double-check
calculations with another
nurse or pharmacist. IV
site should not be used for
any other infusions or IV
therapies.
 Extravasation of dopamine
may cause tissue necrosis
to skin. Therefore,
monitor IV site every
hour. Have phentolamine
(Regitine®) close to the
bedside of the patient.
 Therapeutic Indication Contraindication Dosage Adverse Nursing Considerations
Action Reaction

Generic Name:  Sodium bicarbonate  Sodium 

Contraindicated in  Oral antacid:  GI: gastric  With I.V. infusion, watch
SODIUM is an alkalinizing bicarbonate reduce patients with 325 mg to 2 g distention, for irritation and
BICARBONATE agent that s stomach acid. It is metabolic or 1-4 times per belching, infiltration; extravasation
dissociates to used as an antacid respiratory day. flatulence can cause tissue damage
provide to alkalosis; in those  Metabolic: metab and necrosis. Addition of
bicarbonate ion. treat heartburn, ind who are losing olic calcium salts may cause
Brand Name:
Alka-Seltzer Bicarbonate in igestion, and upset chlorides by alkalosis, hypern precipitate; bicarbonate
Heartburn Relief excess of that stomach. vomiting or from atremia, may inactivate
needed to buffer Sodium bicarbonat continuous GI increased serum catecholamines in solution
Classification: hydrogen ions e is a very quick- suction; in those lactate levels, (epinephrine,
Antacid causes systemic acting antacid. It receiving diuretics hyperosmolarity phenylephrine, and
alkalinization and, should be used only known to produce (with overdose). dopamine).
when excreted, for temporary hypochloremic  Skin: local pain  Discourage use as an oral
urine alkalinization relief. If you need to alkalosis; and in and irritation at antacid because of
as well. treat long- patients with injection site. hazardous excessive
 Oral antacid term stomach acid hypocalcemia in systemic absorption.
action: Taken problems (such which alkalosis may  Drug may be used as an
orally, sodium as peptic ulcer produce tetany, adjunct to treat
bicarbonate disease, GERD) hypertension, hyperkalemia (with
neutralizes stomach  seizures, or heart dextrose and insulin)
acid by the above failure.  Monitor blood pH, partial
mechanism. Orally administered pressure of arterial
sodium bicarbonate oxygen, partial pressure of
is contraindicated in arterial carbon dioxide,
patients with acute and serum electrolytes.
ingestion of strong  Assess patient for milk-
mineral acids. alkali syndrome if drug
 Use extreme caution use is long-term.
when giving drug to
patients with heart  Monitor vital signs
failure, renal regularly; when drug is
insufficiency, or used as urine alkalinizer,
other edematous or monitor urine pH.
sodium-retaining Pregnant patients
conditions.  Safety hasn’t been
established for use during
pregnancy.
Breast-feeding patients
 It isn’t known if sodium
bicarbonate appears in
breast milk. Use cautiously
in breast-feeding women.
Pediatric patients
 Avoid rapid infusion (10
ml/minute) of hypertonic
solutions in children
younger than age 2.
Geriatric patients
 Elderly patients with heart
failure or other fluid-
retaining conditions are at
greater risk for increased
fluid retention; use drug
cautiously.
 CARDIAC DRUGS

Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations

Action

Generic Name:  Dilation of both Chest pain  Hypotension  PO: (sustained  Headache  Check blood pressure and
NITROGLYCERINE arteries and veins;  Stable angina– (Systolic BP < 90 release tablet  Orthostatic pulse before each
veins initially reduces oxygen mm Hg or more than or capsule) hypotension administration of NTG–
dilated reducing demand of 30 mm Hg below  SL: 0.3 – 0.4  Reflex tachycardia blood pressure can drop
preload; higher myocardium by baseline) mg tablet q 5  Flushing precipitously after a single
Brand Name: doses dilate reducing preload  Recent use of minutes for a  Lightheadedness, dose. Hold dose if systolic
arterioles  Variant angina– phosphodiesterase total of 3 doses dizziness, syncope BP < 90 mm Hg or more
nitroglycerin
reducing enhances oxygen inhibitors (sildenafil  Intravenous than 30 mm Hg below
myocardial supply to [Viagra] or Drip: Begin at baseline.
Classification: workload and myocardium by vardenafil [Levitra]) 5 mcg/min and  NTG is highly unstable
Organic Nitrate– oxygen demand relaxing and within past 24 hours titrate every 3-5 and should be stored in
Vasodilator  Dilation of dilating coronary  Recent use of minutes to light resistant container in
coronary arteries arteries phosphodiesterase therapeutic cool environment (not the
inhibitor (tadalafil response and refrigerator).
[Cialis]) within past stable vital  If SL tablets are not bitter,
48 hours signs. Titrate they have probably lost
 Right ventricular NTG infusion their potency.
infarction (inferior until relief of  Tolerance occurs during
wall MI) chest pain or continuous administration
maximum of of NTG; blood vessels do
200 mcg/min not respond as well to
dose is NTG. Therefore, patches
achieved. or topical ointments are
 Topical: Trans removed for 12 hours
dermal patch q every day to reduce
24 hours for tolerance.
10-12 hour  Acute chest pain is treated
duration (with with either SL tablets or
at least 12 spray or with IV infusion
hours NTG free of NTG.
out of each 24  Maintenance therapy to
hour period) prevent angina is managed
with topical applications
or sustain-released oral
medication.
 Intravenous infusion of
NTG requires special glass
bottles and IV tubing
(regular plastic tubing will
absorb 40-80% of NTG).
 Do not discontinue NTG
intravenous infusion
abruptly–it may result in
precipitous rebound
hypertension, angina, or
coronary artery
vasospasms.
 Acetaminophen is
generally given PO for
relief of headache
secondary to NTG therapy.
 Therapeutic Indication Contraindication Dosage Adverse Nursing Considerations
Action Reaction

Generic Name:  Dilation of veins;  Chest pain  Hypersensitivity to  PO: 10-30 mg  Drowsiness,  Monitor blood pressure
MORPHINE moderate dilation associated with opiates q 4 hours mental clouding, prior to
SULFATE of arteries acute coronary  Elevated (adults) anxiety reduction, administration. Hold if
 Analgesia syndrome intracranial  Intravenous: euphoria, systolic BP < 100 mm Hg
through  Acute pressure (head 2 – 10 mg disorientation or 30 mm Hg below
Brand Name: interaction with cardiogenic injuries) slow IV push q  Orthostatic baseline.
Roxanol mu receptor site pulmonary edema  Convulsive disorder 4 hour prn; hypotension  Monitor patient's
 Acute alcoholism (cardiac) 2 – 4  Respiratory respiratory rate prior to
 Acute bronchial mg slow IV depression administration.
Classification: asthma push, repeat  Constipation  Reassess pain after
Opioid analgesic  Prostatic dose at 5 – 15  Urinary retention administration of
hypertrophy minute (sphincter morphine.
 Post biliary tract intervals constriction)  Monitor for respiratory
surgery  Intramuscular  Cough depression and
 Pancreatitis (IM): (not suppression hypotension frequently up
 Acute ulcerative appropriate  Biliary colic to 24 hours after
colitis for cardiac (constriction of administration of
 Addison's disease intervention) 5 the Sphincter of morphine.
 Hypothyroidism – 20 mg IM q Oddi)  Place call light signal
4 hours prn  Nausea, emesis close to
 Miosis patient. Accompany
(constricted patient if need to get out of
pupils) bed to minimize risk of
falls.
 Drug interactions: CNS
depression potentiated
with other narcotics,
alcohol, barbiturates, &
benzodiazepines.
 Drug
interactions: Anticholiner
gic effects potentiated with
antihistamines, tricyclic
antidepressants, and
atropine–these can worsen
constipation and urinary
retention.
 Drug
interactions: Hypotension
can result if combined with
anti-hypertensive drugs or
vasodilators.
 Treatment for overdose
includes ventilatory
support (manual
ventilation with a bag-
valve-mask resuscitator)
and administration of an
opiate antagonist (e.g.,
naloxone).
 Tolerance, a condition
requiring larger doses to
achieve the same
therapeutic effect, can
result from prolonged use
 Physical dependence,
resulting from prolonged
use, may create the risk of
withdrawal symptoms if
drug is completely
discontinued.
 Avoid alcohol and other
CNS depressants while
under the influence of
morphine
 Avoid tasks requiring
alertness like driving and
operating heavy
machinery while under
the influence of morphine.
 Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations
Action

Generic Name:  Increases force of  Heart failure (left-  Digitalis  PO: (loading  Nausea, vomiting,  Monitor blood pressure
DIGOXIN myocardial sided or right- hypersensitivity dose) 10-15 anorexia, diarrhea and apical pulse prior to
contraction sided)  Ventricular mcg/kg in  Fatigue, visual administration.
(positive  Atrial fibrillation fibrillation divided doses disturbances (e.g.,  Cardiac monitor should be
inotropic) or Atrial flutter (to  Ventricular over 24 – 48 blurred vision, used on patients receiving
Brand Name:  Decreased decrease tachycardia hours yellow tinge to digoxin, especially loading
Lanoxin sympathetic tone ventricular rate)  Safety during  IV vision, halos doses.
 Increased urine  Supraventricular pregnancy, lactation bolus: (loading around lights)  Monitor serum digoxin
Classification: production tachycardia (Category A). dose) 10-15  Prolonged PR levels closely, especially if
Cardiac glycoside  Decreased renin mcg/kg (1 mg) interval, increased receiving antibiotic
releas in divided doses AV blocks therapy.
 Slows conduction over 24 hours  Confusion,  Monitor serum
through the AV  Maintenance drowsiness, electrolytes, especially
node Dose (IV or dizziness, potassium.
 Decreases PO): 0.1 – insomnia,  Check for toxicity if visual
automaticity in the 0.375 mg/day nightmares or GI disturbances occur.
SA node (negative  If DIGOXIN TOXICITY
chronotropic) occurs with
DYSRHYTHMIAS:
 1) Discontinue any
digitalis medications and
any potassium depleting
diuretics.
 2) Check serum potassium
level.
 3)Phenytoin or lidocaine
can be used as
antidysrhythmic
medications [Do Not Use
 Quinidine or
Amiodarone.].
 4) Atropine can be used
for bradycardias or AV
blocks.
 5) Fab antibody agents
(Digibind) can be
administered carefully
intravenously.
 Avoid electrical
cardioversion if patient is
receiving digoxin unless
condition is life-
threatening. Then use
lower doses (10-20 joules).
 Emphasize to patient the
importance of taking
digoxin as prescribed at
regular intervals and not
missing doses.
 Do not breast feed while
taking digoxin.
 HYPERTENSIVE CRISIS

Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations

Action

Generic Name:  Mannitol is an  Used for the  Hypersensitivity, Injectable  Dehydration Before
MANNITOL osmotic diuretic promotion of anuria, solution  Anuria  Check v/s and urine output
that is diuresis before severe pulmonary  Intracranial  Assess signs of
edema or heart  5% dehydration and muscle
metabolically inert irreversible renal bleeding
failure,  10%
in humans and failure becomes severe dehydration,  Headache weakness
 15%  Monitor neurologic status
occurs naturally, established, the metabolic edema, pr  Blurred vision
 20%
Brand Name: as a sugar or reduction of ogressive renal dz,  Nausea and vomiting and intracranial pressure
 25%
Osmitrol sugar alcohol, in intracranial active intracranial  Volume expansion
bleeding (except During
fruits and pressure, the  Chest pain
during craniotomy)  Administer over 30min
vegetables. treatment of
Classification:  Monitor urine output and
Mannitol elevates cerebral edema,
diuretics ,Osmotic refer in accordance with
blood plasma and the promotion
agent parameters set by
osmolality, of urinary
physician
resulting in excretion of toxic
 Ensure safety and report
enhanced flow of substances.
signs of electrolyte
water from tissues,
imbalance
including the brain
and cerebrospinal After
fluid, into  Check effectiveness of
interstitial fluid therapy
and plasma. As a  Continuosly monitor
result, cerebral neurologic status ans urine
edema, elevated output
intracranial  Reassess signs/symptoms
pressure, and of dehydration
cerebrospinal fluid  Watch out for abnormal
volume and responses
pressure may be
reduced. As a
diurectic mannitol
induces diuresis
because it is not
reabsorbed in the
renal tubule,
thereby increasing
the osmolality of
the glomerular
filtrate, facilitating
excretion of water,
and inhibiting the
renal tubular
reabsorption of
sodium, chloride,
and other solutes.
Mannitol promotes
the urinary
excretion of toxic
materials and
protects against
nephrotoxicity by
preventing the
concentration of
toxic substances in
the tubular fluid.
 Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations
Action

Generic Name:  Furosemide  Oral, IV: edema  Severe sodium and  Tablets 20-  fluid and electrolyte  Assess fluid status.
FUROSEMIDE promotes diuresis associated with water depletion, 40, 80 mg: and electrolyte Monitor daily weight,
by blocking CHF, cirrhosis, hypersensitivity to oral solution  rashes, intake and output ratios,
tubular renal dusease sulphonamides and 10 mg/dL photosensitivity ,
amount and location of
reabsorption of  IV: acute furosemide ,  50 mg/mL; nausea, diarrhea,
edema, lung sounds, skin
Brand Name: sodium and pulmonary edema hypokalemia, injection blurred vision,
turgor, and mucous
Lasix chloride in the  Oral: hyponatremia, 10mg/mL dizziness, headache,
proximal and hypertension precomatose states hypotension. membranes. Notify health
Classification: distal tubules, as associated with  Hyperglycemia, care professional if thirst,
Loop Diuretics well as in the thick liver cirrhosis, glycosuria, dry mouth, lethargy,
ascending loop of anuria or renal ototoxicity weakness, hypotension, or
Henle. This is failure addison’s  Potential Fatal : oliguria occurs.
achieved through disease. Rarely, sudden death  Monitor BP and pulse
competitive  Avoid with patients and cardiac arrest. before and during
inhibition of with alcohol administration. Monitor
sodium-potassium- intolerance frequency of prescription
chloride refills to determine
cotransporters compliance in patients
(NKCC2)
treated for hypertension.
expressed along
 Geri: Diuretic use is
these tubules in
associated with increased
the nephron,
resulting in risk for falls in older
excretion of water adults. Assess falls risk
along with sodium, and implement fall
chloride, prevention strategies.
magnesium, and  Assess patients receiving
calcium. digoxin for anorexia,
nausea, vomiting, muscle
 cramps, paresthesia, and
confusion. Patients taking
digoxin are at increased
risk of digoxin toxicity
because of the potassium-
depleting effect of the
diuretic. Potassium
supplements or potassium-
sparing diuretics may be
used concurrently to
prevent hypokalemia.
 Assess patient for tinnitus
and hearing loss.
Audiometry is
recommended for patients
receiving prolonged high-
dose IV therapy. Hearing
loss is most common after
rapid or high-dose IV
administration in patients
with decreased renal
function or those taking
other ototoxic drugs.
 Assess for allergy to
sulfonamides.
 Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations
Action

Generic Name:  converts to nitric  Hypertensive  Compensatory IV Infusion:  Excessive  Drug

NITROPRUSSIDE oxide, a potent emergencies hypertension (e.g., 50 or 100 mg hypotension, Interactions: Potential
vasodilator  To reduce atriovenous shunt, in 250 ml D5W nausea, vomiting, hypotensive shock when
 Venous dilation afterload in heart coarctation of aorta continuous light-headedness, combined with other
reducing preload failure or acute  Use caution if infusion headache, sweating vasodilators, caution if
Brand Name:
Nitropress  Arteriolar dilation mitral valve patient has taken beginning at  Diaphoresis, patient is already taking
reducing afterload regurgitation phosphodiesterase 0.1 mcg/kg/min apprehension, phosphodiesterase
 Triggers retention  Controlled inhibitor (e.g., and titrating muscle twitching, inhibitor
Classification: of sodium and hypotension sildenafil) every 3 – 5 nasal stuffiness  Incompatibility in IV
Potent vasodilator water during anesthesia  Safety during minutes  Irritation at infusion infusion: Not compatible
 Minimal reflex to reduce bleeding pregnancy or according to site with amiodarone,
tachycardia lactation not desired blood dobutamine, propafenone,
established pressure up to cisatracurium, and
a dose of 5 – 10 haloperidol.
mcg/kg/min  Check blood pressure
every 3 – 5 minutes to
monitor patient response
to nitroprusside.
 Evaluate serum
thiocyanate level (should
be < 0.1 mg/ml) if patient
receives nitroprusside for
more than 3 days.
 Nitroprusside is degraded
in light, so IV bag &
tubing should be occlusive
to light (sometimes nurses
wrap IV tubing with
aluminum foil).
 Patient should be on
bedrest during
nitroprusside infusion.
 Calculate IV doses
carefully and double-check
with another nurse or
pharmacist.
 Weigh patient daily to
monitor accurate doses.
 SHOCK

Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations

Action

Generic Name:  Low dose (<3  Shock: Moderate  Tachy- IV Infusion:  Hypotension,  Correct hypovolemia with
DOPAMINE mcg/kg/min): doses enhance dysrhythmias Begin at 2 – 5 hypertension, fluid resuscitation before
activates dopamine contractility  Ventricular mcg/kg/min and tachycardia initiating dopamine
rgic receptors in increasing fibrillation titrate to blood  Anginal pain, infusion
Brand Name:
kidneys producing cardiac output;  Pheochromocytoma pressure ectopic beats,  Monitor blood pressure,
intropen
renal artery High doses  Safety during according to vasoconstriction pulse, and peripheral
dilation. produce pregnancy, desired response (cold extremities) pulses every 15 minutes.
Classification:  Mod dose (3 – 10 vasoconstriction lactation or with to a maximum of  Nausea, vomiting,  Monitor hourly urine
Beta-adrenergic & mcg/kg/min): to enhance blood children not 20 mcg/kg/min headache output.
alpha-adrenergic primarily pressure. established.  Tissue necrosis  Cardiac monitor should be
agonist activates β1adrener  Heart and sloughing if used on patients receiving
gic receptors in Failure: At extravasation dopamine infusion.
heart increasing moderate doses, occur  Notify physician
heart rate (positive dopamine immediately if 1) oliguria
chronotropic enhances develops; 2) tachy-
agent), contractility contractility. Hig dysrhythmias develop; 3)
(positive inotropic her doses diastolic pressure rises
agent exacerbate heart reducing pulse pressure;
 High dose (10 – 20 failure by 4) hypotension continues
mcg/kg/min): increasing to exist at maximum dose
activates α- afterload and of 20 mcg/kg/min; 5) signs
adrenergic producing of peripheral ischemia
receptors producin additional (purple extremities, cold
g vasoconstriction workload on the extremities, diminished
(increasing systemi heart. peripheral pulses)
c vascular  Bradycardia: Do  Weigh patient daily to
resistance or left pamine is a 2nd determine accurate
line drug after infusion dose.
ventricular atropine for  Calculate infusion drips
afterload. bradycardias. and doses
carefully. Double-check
calculations with another
nurse or pharmacist. IV
site should not be used for
any other infusions or IV
therapies.
 Extravasation of dopamine
may cause tissue necrosis
to skin. Therefore,
monitor IV site every
hour. Have phentolamine
(Regitine) close to the
bedside of the patient.
 Therapeutic Indication Contraindication Dosage Adverse Nursing Considerations
Action Reaction

Generic Name:  Low dose (< 5  heart failure  Suspected IV Infusion:  (dose  Monitor blood pressure
DOBUTAMINE mcg/kg/min)  cardiogenic shock drug/poison-induced 2 – 20 related) headache and cardiac rhythm
primarily shock mcg/kg/min , tremors, continuously during
activates β1 recepto  Hypersensitivity to continuous paresthesias, mild therapy.
rs of heart other infusion by pump leg cramps,  Hemodynamic monitoring
Brand Name:
Dobutrex, Inotrex, increasing sympathomimetic nervousness of all parameters is
contractility amines  Increased blood recommended during
Classification: (positive inotropic  Ventricular pressure and dobutamine therapy.
Beta-adrenergic agent); slight to no tachycardia heart rate, angina  Correct hypovolemia with
agonist chronotropic effect  Idiopathic  Nausea, vomiting, fluid resuscitation prior to
 Higher doses ( 5 – hypertrophic nonspecific chest dobutamine therapy.
20 mcg/kg/min) subaortic stenosis pain, shortness of  Tolerance has been noted
stronger activation  Safe use during breath. during continuous or
of β1receptors still pregnancy, prolonged infusions.
primarily lactation, or  Check IV drug
producing positive children not calculations
inotropic effect; established. carefully. Double-check
β2activation calculations with another
producing nurse or pharmacist.
moderate arterial  Weigh patient daily in
dilation reducing order to maintain accurate
afterload (decrease dose calculations.
d SVR and PVR)
enhancing cardiac
output by reducing
workload on
ventricles
 Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations
Action

Generic Name:  It relieves nasal  to control and  Hypersensitivity to  PO Adults and  CNS:  Use minimal doses for
SALBUTAMOL congestion and prevent reversible adrenergic amines Children more Restlessness, minimal periods; drug
reversible airway obstruction  Hypersensitivity to than 12 years : apprehension, tolerance can occur with
prolonged use.
bronchospasm by caused by chronic fluorocarbons 2-4mg 3-4 anxiety, fear, CNS
 Maintain a beta-
relaxing the obstructive times a day or stimulation, adrenergic blocker
Brand Name: smooth muscles of pulmonary 4-8mg of hyperkinesia, (cardioselective beta-
Albuterol the bronchioles. disorder (COPD) extended dose insomnia, tremor, blocker, such as atenolol,
The relief from  quick relief for tablets twice a drowsiness, should be used with
nasal congestion bronchospasm day. irritability, respiratory distress) on
Classification: and  for the prevention  PO Geriatric weakness, vertigo, standby in case cardiac
Bronchodilator arrhythmias occur.
bronchiospasm is of exercise- Patients : headache
 Prepare solution for
made possible by induced initial dose  CV: Cardiac inhalation by diluting 0.5
the following bronchospasm should not arrhythmias, mL 0.5% solution with 2.5
mechanism that  long-term control exceed 2mh 3-4 tachycardia, mL normal saline; deliver
takes place when agent for patient times a day and palpitations, PVCs over 5–15 min by
salbutamol is with chronic or may be (rare), anginal nebulization.
administered. persistent increased pain  Do not exceed
recommended dosage;
bronchospasm carefully up to  Dermatologic:
administer pressurized
32mg/day Sweating, pallor, inhalation drug forms
 PO Children 2- flushing during second half of
6 years old :  GI: Nausea, inspiration, because the
0.1 mg/kg 3 vomiting, airways are open wider
times a day heartburn, unusual and the aerosol
distribution is more
or bad taste in
extensive.
mouth
 GU: Increased
incidence of
leiomyomas of
uterus when given
 in higher than
human doses in
preclinical studies
 Respiratory:
Respiratory
difficulties,
pulmonary edema,
coughing,
bronchospasm,
paradoxical
airway resistance
with repeated,
excessive use of
inhalation
preparations
 Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations
Action

Generic Name:  Diphenhydramin  temporarily relieves  Hypersensitivity ; ADULTS  CNS depression,  Administer with food if GI
DIPHENHYDRAMINE e blocks these symptoms due neonates, dizziness, upset occurs.
histamine H1- to hay fever or lactation.  Oral 25–50 headache,  Administer syrup form if
receptors on mg q 4–8 hr sedation; patient is unable to take
other upper
effector cells of PO. paradoxical tablets.
the GI tract, respiratory stimulation in  Monitor patient response,
Brand Name:  Motion
benadryl blood vessels allergies: children; dryness and arrange for
sickness: Give
and respiratory  runny nose full dose of mouth, adjustment of dosage to
Classification: tract. It also  sneezing prophylacticall thickened lowest possible effective
antihestamine causes sedation  itchy, watery eyes y 30 min before respiratory dose.
and has some exposure to secretion, blurring  Take as prescribed; avoid
anticholinergic  itching of the nose of vision, urinary excessive dosage.
motion, and
action. or throat retention; GI  Take with food if GI upset
repeat before
meals and at disturbances; occurs.
 temporarily relieves bedtime. blood dyscrasias.  Avoid alcohol; serious
these symptoms due  Nighttime sleep sedation could occur.
to the common aid: 25–50 mg  These side effects may
cold: PO at bedtime. occur: Dizziness,
 runny nose  Cough sedation, drowsiness (use
 sneezing suppression: caution driving or
25 mg q 4 hr performing tasks
PO, not to requiring alertness);
exceed 150 mg epigastric distress,
in 24 hr. diarrhea or constipation
Parenteral (take drug with meals);
 10–50 mg IV or dry mouth (use frequent
deep IM or up mouth care, suck
to 100 mg if sugarless lozenges);
required. thickening of bronchial
Maximum daily secretions, dryness of
dose is 400 mg. nasal mucosa (use a
humidifier).
 Report difficulty
breathing, hallucinations,
 PEDIATRIC tremors, loss of
PATIENTS > coordination, unusual
10 KG OR 20 bleeding or bruising,
visual disturbances,
LB
irregular heartbeat.
Oral

 12.5–25 mg
tid–qid PO or 5
mg/kg/day PO
or 150 mg/m2
per day PO.
Maximum daily
dose 300 mg.
 Motion
sickness: Give
full dose
prophylacticall
y 30 min before
exposure to
motion and
repeat before
meals and at
bedtime.
Cough
suppression:
 2–6 yr: 6.25 mg
q 4 hr, not to
exceed 25 mg
in 24 hr.
 6–12 yr: 12.5
mg q 4 hr PO,
not to exceed
75 mg in 24 hr.
 Therapeutic Indication Contraindication Dosage Adverse Reaction Nursing Considerations
Action

Generic Name:  Hydrocortisone  Replacement therapy  Viral/fungal ADULTS AND  Sodium and fluid  WARNING: Give daily
HYDROCORTISONE is a in adrenal cortical infections, PEDIATRIC retention. before 9 AM to mimic
corticosteroid insufficiency tubercular or PATIENTS Potassium and normal peak diurnal
used for its anti-  Allergic states— syphilitic lesions, calcium depletion. corticosteroid levels and
inflammatory severe or bacterial  IV, IM or Muscle wasting, minimize HPA
Brand Name: and incapacitating infections unless subcutaneous weakness, suppression.
hydrocortisone, immunosuppress allergic conditions used in (hydrocortison osteoporosis. GI  Space multiple doses
hydrocortisone acetate ive effects. Its  Hypercalcemia conjunction with e and disturbances and evenly throughout the day.
anti- associated with appropriate hydrocortisone bleeding.  Do not give IM injections
inflammatory cancer chemotherapy. sodium Increased appetite if patient has
Classification: action is due to  Short-term phosphate) and delayed thrombocytopenic
corticosteroid the suppression inflammatory and 20–240 mg/day wound healing. purpura.
of migration of allergic disorders, usually in Bruising, striae,  Rotate sites of IM
polymorphonucl such as rheumatoid divided doses q hirsutism, acne, repository injections to
ear leukocytes arthritis, collagen 12 hr. flushing. Raised avoid local atrophy.
and reversal of diseases (SLE),  IM, IV intracranial  Use minimal doses for
increased dermatologic (hydrocortison pressure, minimal duration to
capillary diseases e sodium headache, minimize adverse effects.
permeability. It (pemphigus), status succinate) depression,  Taper doses when
may also be used asthmaticus, and Reduce dose, psychosis, discontinuing high-dose or
as replacement autoimmune based on menstrual long-term therapy.
therapy in disorders condition and irregularities.  Arrange for increased
adrenocortical  Hematologic response, but Hyperglycaemia, dosage when patient is
insufficiency. disorders— give no less glycosuria, DM, subject to unusual stress.
thrombocytopenic than 25 obesity, moon-  Ensure that adequate
purpura, mg/day. face, buffalo amount of Ca2+ is taken if
erythroblastopenia Retention hump. Suppression prolonged administration
 Trichinosis with enema of pituitary- of steroids.
neurologic or (hydrocortisone adrenocortical  Use alternate-day
myocardial ): 100 mg system. Growth maintenance therapy with
involvement nightly for 21 retardation in short-acting
 Ulcerative colitis, days. childn (prolonged corticosteroids whenever
acute exacerbations  Intrarectal therapy). possible.
of MS, and palliation foam Increased
 in some leukemias (hydrocortison susceptibility for  WARNING: Do not give
and lymphomas e acetate) infection. Topical live virus vaccines with
 Intra-articular or 1 applicator use: Dermal immunosuppressive doses
soft-tissue daily or bid for atrophy, local of hydrocortisone.
administration: 2 wk and every irritation,  Provide antacids between
Arthritis, psoriatic second day folliculitis, meals to help avoid peptic
plaques thereafter. hypertrichosis. ulcer.
 Retention enema:  Intra-articular, Inhaled Topical dermatologic
For ulcerative intralesional corticosteroids: administration
colitis, proctitis (hydrocortison May cause  Use caution with occlusive
 Dermatologic e acetate) hoarseness, dressings; tight or plastic
preparations: To 5–25 mg, candidiasis of diapers over affected area
relieve inflammatory depending on mouth and throat. can increase systemic
and pruritic joint or soft- Topical absorption.
manifestations of tissue injection application to the  Avoid prolonged use,
dermatoses that are site. eye: Can produce especially near eyes, in
steroid responsive  Topical corneal ulcers, genital and rectal areas,
 Anorectal cream, dermatologic raised IOP and on face, and in skin
suppositories: To preparations reduced visual creases.
relieve discomfort of Apply sparingly function.
hemorrhoids and to affected area Intralesional
perianal itching bid–qid. injection: Local
hypopigmentation
of deeply
pigmented skin.
Intra-articular
injection: Joint
damage, fibrosis
esp in load
bearing joints.
 Potentially Fatal:
Abrupt withdrawal
leading to acute
adrenal
insufficiency.