EMERGENCY DRUGS: A drug study.

1) AMINOPHYLLINE

Brand Names: Phil Pharmawealth/Atlantic Aminophylline amp

Theofil amp
Classification: Antiasthmatic & COPD Preparations
Dosage: Initial: 225-450 mg twice daily, increased if needed. IV
Acute severe bronchospasm. Loading dose: 5 mg/kg (ideal body
wt). Maintenance: 0.5 mg/kg/hr. Rate should not exceed 25
mg/min.
Indication: PO Chronic bronchospasm as hydrate
Action: Increases the level of cAMP resulting in bronchodilation
Adverse Reactions: Nausea, vomiting, abdominal pain, diarrhea,
headache, insomnia, dizziness, anxiety, restlessness; tremor,
palpitations. Potentially Fatal: Convulsions, cardiac arrhythmias,
hypotension and sudden death after too rapid IV injection.
Nursing Measures:
• Administer to pregnant patients only when clearly needed—
neonatal tachycardia, jitteriness, and withdrawal apnea observed
when mothers received xanthines up until delivery.
• Caution patient not to chew or crush enteric-coated timed-
release forms.
• Give immediate-release, liquid dosage forms with food if GI
effects occur.
• Do not give timed-release forms with food; these should be
given on an empty stomach 1 hr before or 2 hr after meals.
• Maintain adequate hydration.
• Monitor results of serum theophylline levels carefully, and
arrange for reduced dosage if serum levels exceed therapeutic
range of 10–20 mcg/mL.
• Take serum samples to determine peak theophylline
concentration drawn 15–30 min after an IV loading dose.
• Monitor for clinical signs of adverse effects, particularly if serum
theophylline levels are not available.
• Ensure that diazepam is readily available to treat seizures.
• Take this drug exactly as prescribed; if a timed-release product
is prescribed, take this drug on an empty stomach, 1 hr before or
2 hr after meals.
• Do not to chew or crush timed-release preparations.
• Administer rectal solution or suppositories after emptying the
rectum.
• It may be necessary to take this drug around the clock for
adequate control of asthma attacks.
• Avoid excessive intake of coffee, tea, cocoa, cola beverages,
chocolate.
• Smoking cigarettes or other tobacco products impacts the
drug's effectiveness. Try not to smoke. Notify the care provider if
smoking habits change while taking this drug.
• Frequent blood tests may be necessary to monitor the effect of
this drug and to ensure safe and effective dosage; keep all
appointments for blood tests and other monitoring.
• These side effects may occur: Nausea, loss of appetite (taking
this drug with food may help if taking the immediate-release or
liquid dosage forms); difficulty sleeping, depression, emotional
lability (reversible).
• Report nausea, vomiting, severe GI pain, restlessness,
seizures, irregular heartbeat

2) AMIODARONE HYDROCHLORIDE

Brand Names: Anoion tab Cordarone Cordarone inj Sandoz

Amiodarone HCl tab
Classification: Cardiac Drugs
Dosage: PO Initial: 200 mg 3 times/day for 1 wk, reduce to 200
mg twice daily for a further wk. Maintenance: 200 mg/day or
lowest effective dose. IV Initial: 5 mg/kg infusion via central
venous catheter. Max: 1.2 g/24 hr.
Indication: Ventricular and supraventricular arrhythmias.
Action: Blocks potassium chloride leading to prolongation of
action potential duration.
Adverse Reactions: Blue-grey discoloration of skin,
photosensitivity, peripheral neuropathy, paraesthesia, myopathy,
ataxia, tremor, nausea, vomiting, metallic taste, hypothyroidism,
hyperthyroidism, alopecia, sleep disturbances, corneal
microdeposits, hot flushes, sweating. Heart block, bradycardia,
sinus arrest, hepatotoxicity, heart failure. Potentially Fatal:
Pulmonary toxicity including pulmonary fibrosis and interstitial
pneumonitis, hepatotoxicity, thyrotoxicity. Ventricular
arrhythmias, pulmonary alveolitis, exacerbation of arrhythmias
and rare serious liver injury. Generally in patients with high
doses and having preexisting abnormalities of diffusion capacity.
Nursing Measures:
• Monitor cardiac rhythm continuously.
• Monitor for an extended period when dosage adjustments are
made.
• Monitor for safe and effective serum levels (0.5–2.5 mcg/mL).
• Doses of digoxin, quinidine, procainamide, phenytoin, and
warfarin may need to be reduced one-third to one-half when
amiodarone is started.
• Give drug with meals to decrease GI problems.
• Arrange for ophthalmologic exams; reevaluate at any sign of
optic neuropathy.
• Arrange for periodic chest x-ray to evaluate pulmonary status
(every 3–6 mo).
• Arrange for regular periodic blood tests for liver enzymes,
thyroid hormone levels.
• Drug dosage will be changed in relation to response of
arrhythmias; you will need to be hospitalized during initiation of
drug therapy; you will be closely monitored when dosage is
changed.
• Have regular medical follow-up, monitoring of cardiac rhythm,
chest x-ray, eye exam, blood tests.
• These side effects may occur: Changes in vision (halos, dry
eyes, sensitivity to light; wear sunglasses, monitor light
exposure); nausea, vomiting, loss of appetite (take with meals;
eat small, frequent meals); sensitivity to the sun (use a
sunscreen or protective clothing when outdoors); constipation (a
laxative may be ordered); tremors, twitching, dizziness, loss of
coordination (do not drive, operate dangerous machinery, or
undertake tasks that require coordination until drug effects
stabilize and your body adjusts to it).
• Report unusual bleeding or bruising; fever, chills; intolerance to
heat or cold; shortness of breath, difficulty breathing, cough;
swelling of ankles or fingers; palpitations; difficulty with vision.

3) ATROPINE SULFATE

Brand Names: Anespin amp Atropol amp Euro-Med Atropine

Sulfate amp Isopto Atropine eye drops Phil
Pharmawealth/Atlantic Atropine amp
Classification: Other Cardiovascular Drugs, Muscle Relaxants,
Mydriatic Drugs, Antidotes, Detoxifying Agents & Drugs Used in
Substance Dependence
Indication/Dosage: IV Bradycardia 500 mcg every 3-5 mins.
Total: 3 mg. IV/IM Organophosphorus poisoning 2 mg every 10-
30 mins until muscarinic effects disappear or atropine toxicity
appears. IM/SC Premed in anesth 300-600 mcg 30-60 mins
before anesth. IV/IM/SC Overdosage w/ other compd having
muscarinic actions 0.6-1 mg, repeat 2 hrly. Ophth Inflammatory
eye disorders As 0.5-1% soln: 1-2 drops 4 times/day. Eye
refraction As 1% soln: 1 drop twice daily for 1-2 days before
procedure.
Action: An anti-cholinergic that inhibits acetylcholine at the
parasympathetic neuroeffector junction, enhances the conduction
of AV node and increases heart rate
Adverse Reactions: Dry mouth, dysphagia, constipation, flushing
and dryness of skin, tachycardia, palpitations, arrhythmias,
mydriasis, photophobia, cycloplegia, raised intraocular pressure.
Toxic doses cause tachycardia, hyperpyrexia, restlessness,
confusion, excitement, hallucinations, delirium and may progress
to circulatory failure and respiratory depression. Eye drops:
Systemic toxicity especially in children, on prolonged use may
lead to irritation, hyperemia, edema and conjunctivitis. Increased
intraocular pressure. Inhalation: Dryness of mouth, throat.
Potentially Fatal: Atrial arrhythmias, AV dissociation, multiple
ventricular ectopics.
Nursing Measures:
• Ensure adequate hydration; provide environmental control
(temperature) to prevent hyperpyrexia.
• Have patient void before taking medication if urinary retention
is a problem.
• When used preoperatively or in other acute situations,
incorporate teaching about the drug with teaching about the
procedure; the ophthalmic solution is used mainly acutely and
will not be self-administered by the patient; the following apply
to oral medication for outpatients:
• Take as prescribed, 30 min before meals; avoid excessive
dosage.
• Avoid hot environments; you will be heat intolerant, and
dangerous reactions may occur.
• These side effects may occur: Dizziness, confusion (use caution
driving or performing hazardous tasks); constipation (ensure
adequate fluid intake, proper diet); dry mouth (suck sugarless
lozenges; perform frequent mouth care; may be transient);
blurred vision, sensitivity to light (reversible; avoid tasks that
require acute vision; wear sunglasses in bright light); impotence
(reversible); difficulty in urination (empty the bladder prior to
taking drug).
• Report rash; flushing; eye pain; difficulty breathing; tremors,
loss of coordination; irregular heartbeat, palpitations; headache;
abdominal distention; hallucinations; severe or persistent dry
mouth; difficulty swallowing; difficulty in urination; constipation;
sensitivity to light.

4) BUMETANIDE

Brand Names: Burinex amp Burinex tab

Classification: Sulfonamide Diuretics
Indication/Dosage: PO edema 1 mg once daily, 2nd dose 6-8 hr
later if needed. Refractory edema Initial: 5 mg/day, may increase
dose depending on response. Max: 10 mg/day. HTN 0.5-1
mg/day. Max: 5 mg/day. IV Pulmonary edema 1-2 mg, repeat 20
mins. later if needed. IV/IM Emergency edema 0.5-1 mg, then
adjust according to response.
Action: inhibits Sodium and Chloride reabsorption at the
ascending loop of Henle
Adverse Reactions: Muscle cramps, dizziness, hypotension,
headache, nausea, impaired hearing, pruritus, ECG changes,
musculoskeletal pain, rash, chest discomfort, renal failure,
premature ejaculation, thrombocytopenia, hypokalemia,
hypomagnesaemia, hyponatremia, hyperuricemia,
hyperglycemia, hypocalcaemia.
Nursing Measures:
• Give with food or milk to prevent GI upset.
• Mark calendars or use reminders if intermittent therapy is best
for treating edema.
• Give single dose early in day so increased urination will not
disturb sleep.
• Avoid IV use if oral use is possible.
• Arrange to monitor serum electrolytes, hydration, liver function
during long-term therapy.
• Provide diet rich in potassium or supplemental potassium.
• Record alternate day or intermittent therapy on a calendar or
dated envelopes.
• Take the drug early in day so increased urination will not
disturb sleep; take with food or meals to prevent GI upset.
• Weigh yourself on a regular basis, at the same time, and in the
same clothing; record the weight on your calendar.
• These side effects may occur: Increased volume and frequency
of urination; dizziness, feeling faint on arising, drowsiness (avoid
rapid position changes; hazardous activities, such as driving; and
alcohol consumption); sensitivity to sunlight (use sunglasses,
sunscreen, wear protective clothing); increased thirst (suck
sugarless lozenges; use frequent mouth care); loss of body
potassium (a potassium-rich diet, or supplement will be needed).
• Report weight change of more than 3 lb in 1 day; swelling in
ankles or fingers; unusual bleeding or bruising; nausea,
dizziness, trembling, numbness, fatigue; muscle weakness or
cramps.

5) CALCIUM GLUCONATE

Brand Names: Phil Pharmawealth/Harson Calcium Gluconate amp

Classification: Electrolytes
Indication/Dosage: PO Hypocalcaemia 10-50 mmol/day. IV
Hypocalcaemic tetany 2.25 mmol via slow inj , then 58-77 mL of
10% soln diluted and administered as a continuous IV infusion.
Antidote in severe hypermagnesaemia; Severe hyperkalaemia 10
mL of 10% soln, repeat every 10 mins if needed.
Action: replaces Calcium and maintains Calcium level
Adverse Reactions: GI irritation; soft-tissue calcification, skin
sloughing or necrosis after IM/SC inj. Hypercalcaemia
characterised by anorexia, nausea, vomiting, constipation,
abdominal pain, muscle weakness, mental disturbances,
polydipsia, polyuria, nephrocalcinosis, renal calculi; chalky taste,
hot flushes and peripheral vasodilation. Potentially Fatal: Cardiac
arrhythmias and coma.
Nursing Measures:
• Make sure prescriber specifies form of calcium to be given;
crash carts may contain both calcium gluconate and calcium
chloride.
• Tell patient to take oral calcium 1 to 11/2 hours after meals if
GI upset occurs.
• Give I.M. injection in gluteal region in adults and in lateral thigh
in infants. Use I.M. route only in emergencies when no I.V. route
is available bec. of irritation of tissue by calcium salts.
• Tell patient to take oral calcium with a full glass of water.
• Monitor calcium levels frequently. Hypercalcemia may result
after large doses in chronic renal failure. Report abnormalities.

6) CAPTOPRIL

Brand Names: Ace-Bloc tab Capomed tab Capotec tab Capoten

tab Captor tab Captril tab Cardiovaz tab Conamid tab Hartylox
tab Normil tab Phil Pharmawealth/Panion & BF Captopril tab
Prelat tab Primace tab Retensin tab Spec-Ace tab Tensoril tab
Unihype tab Vasostad tab
Classification: ACE Inhibitors
Indication/Dosage: PO HTN Initial: 12.5 mg twice daily.
Maintenance: 25-50 mg twice daily. Max: 50 mg 3 times/day.
Heart failure Initial: 6.25-12.5 mg 2-3 times/day. Max: 50 mg 3
times/day. Post MI Start 3 days after MI. Initial: 6.25 mg/day,
may increase after several wk to 150 mg/day in divided doses if
needed and tolerated. HTN in diabetic nephropathy 75-100
mg/day in divided doses.
Action: inhibits ACE, reduces Sodium and water retention, lowers
blood pressure
Adverse Reactions: Hypotension, tachycardia, chest pain,
palpitations, pruritus, hyperkalaemia. Proteinuria; angioedema,
skin rashes; taste disturbance, nonproductive cough, headache.
Potentially Fatal: Neutropenia, usually occurs within 3 mth of
starting therapy especially in patients with renal dysfunction or
collagen diseases. Hyperkalaemia. Anaphylactic reactions.
Nursing Measures:
• Administer 1 hr before or 2 hr after meals.
• Alert surgeon and mark patient's chart with notice that
captopril is being taken; the angiotensin II formation subsequent
to compensatory renin release during surgery will be blocked;
hypotension may be reversed with volume expansion.
• Monitor patient closely for fall in BP secondary to reduction in
fluid volume (excessive perspiration and dehydration, vomiting,
diarrhea); excessive hypotension may occur.
• Reduce dosage in patients with impaired renal function.
• Take drug 1 hr before or 2 hr after meals; do not take with
food. Do not stop without consulting your health care provider.
• Be careful of drop in blood pressure (occurs most often with
diarrhea, sweating, vomiting, dehydration); if light-headedness
or dizziness occurs, consult your health care provider.
• Avoid over-the-counter medications, especially cough, cold,
allergy medications that may contain ingredients that will interact
with ACE inhibitors. Consult your health care provider.
• These side effects may occur: GI upset, loss of appetite,
change in taste perception (limited effects, will pass); mouth
sores (perform frequent mouth care); rash; fast heart rate;
dizziness, light-headedness (usually passes after the first few
days; change position slowly, and limit your activities to those
that do not require alertness and precision).
• Report mouth sores; sore throat, fever, chills; swelling of the
hands, feet; irregular heartbeat, chest pains; swelling of the
face, eyes, lips, tongue, difficulty breathing.

7) CLONIDINE

Brand Names: Catapin amp Catapres amp Catapres tab

Classification: Other Antihypertensives
Indication/Dosage: PO HTN Initial: 50-100 mcg 3 times/day.
Max: 2,400 mcg/day. Menopausal flushing; Migraine prophylaxis
50 mcg twice daily, up to 75 mg twice daily. IV Hypertensive
crisis 150-300 mcg via slow inj. Max: 750 mcg over 24 hr.
Epidural Severe cancer pain Initial: 30 mcg/hr as continuous
infusion in combination w/ an opioid. Transdermal HTN As patch
releasing 100-300 mcg clonidine base/day at constant rate:
Apply once wkly.
Action: stimulates alpha 2 receptors and inhibits central
vasomotor centers, lowers peripheral vascular resistance, blood
pressure, and heart rate
Adverse Reactions: Dry mouth, drowsiness, dizziness, headache,
constipation, impotence, vivid dreams, urinary retention; dry,
itching, burning sensation in the eye; fluid or electrolyte
imbalance, GI upset, paralytic ileus, orthostatic hypotension,
weakness, sedation, pruritus, myalgia, urticaria, nausea,
insomnia, arrhythmias, agitation. Reduced GI motility at times
may cause paralytic ileus. Potentially Fatal: Transient
hypertension or profound hypotension, respiratory depression,
convulsion. Clonidine withdrawal syndrome could be life
threatening. Bradycardia, coma and disturbances in conduction
(in individuals with preexisting diseases of SA/AV nodes,
overdose or on digitalis).
Nursing Measures:
• Take drug 1 hr before or 2 hr after meals; do not take with
food. Do not stop without consulting your health care provider.
• Be careful of drop in blood pressure (occurs most often with
diarrhea, sweating, vomiting, dehydration); if light-headedness
or dizziness occurs, consult your health care provider.
• Avoid over-the-counter medications, especially cough, cold,
allergy medications that may contain ingredients that will interact
with ACE inhibitors. Consult your health care provider.
• These side effects may occur: GI upset, loss of appetite,
change in taste perception (limited effects, will pass); mouth
sores (perform frequent mouth care); rash; fast heart rate;
dizziness, light-headedness (usually passes after the first few
days; change position slowly, and limit your activities to those
that do not require alertness and precision).
• Report mouth sores; sore throat, fever, chills; swelling of the
hands, feet; irregular heartbeat, chest pains; swelling of the
face, eyes, lips, tongue, difficulty breathing.
• Take this drug exactly as prescribed. Do not miss doses. Do not
discontinue the drug unless so instructed. Do not discontinue
abruptly; life-threatening adverse effects may occur. If you
travel, take an adequate supply of drug.
• Use the transdermal system as prescribed; refer to directions in
package insert, or contact your health care provider with
questions. Be sure to remove old systems before applying new
ones.
• Attempt lifestyle changes that will reduce your BP: stop
smoking and using alcohol; lose weight; restrict intake of sodium
(salt); exercise regularly.
• Use caution with alcohol. Your sensitivity may increase while
using this drug.
• These side effects may occur: Drowsiness, dizziness, light-
headedness, headache, weakness (often transient; observe
caution driving or performing other tasks that require alertness
or physical dexterity); dry mouth (suck on sugarless lozenges or
ice chips); GI upset (eat small, frequent meals); dreams,
nightmares (reversible); dizziness, light-headedness when you
change position (get up slowly; use caution climbing stairs);
impotence, other sexual dysfunction, decreased libido (discuss
with care providers); breast enlargement, sore breasts;
palpitations.
• Report urinary retention, changes in vision, blanching of
fingers, rash.

8) DIAZEPAM

Brand name: Valium

Classification: Anxiolytics
Dosage: 10mg/2ml
Indication: relief of anxiety, agitation & tension due to
psychoneurotic states & transient situational disturbances
Action: a benzodiazepine that probably potentiates the effects of
GABA, depresses the CNS & suppresses the spread of seizure
activity
Adverse Reaction: drowsiness,dysarthria, slurred speech, tremor,
transient amnesia, fatigue, ataxia, headache, insomnia,
paradoxical anxiety, hallucination
Nursing Measures:
• Do not administer intra-arterially; may produce arteriospasm,
gangrene.
• Change from IV therapy to oral therapy as soon as possible.
• Do not use small veins (dorsum of hand or wrist) for IV
injection.
• Reduce dose of narcotic analgesics with IV diazepam; dose
should be reduced by at least one-third or eliminated.
• Carefully monitor P, BP, respiration during IV administration.
• Maintain patients receiving parenteral benzodiazepines in bed
for 3 hr; do not permit ambulatory patients to operate a vehicle
following an injection.
• Monitor EEG in patients treated for status epilepticus; seizures
may recur after initial control, presumably because of short
duration of drug effect.
• Monitor liver and kidney function, CBC during long-term
therapy.
• Taper dosage gradually after long-term therapy, especially in
epileptic patients.
• Arrange for epileptic patients to wear medical alert ID
indicating that they are epileptics taking this medication.
• Discuss risk of fetal abnormalities with patients desiring to
become pregnant.

9) DIGOXIN

Brand name: Digitek, Lanoxicaps, Lanoxin, Novo-Digoxin (CAN)

Classification: Inotropics
Dosage: 5mg/2ml
Indication: Cardiac failure accompanied by atrial fibrillation;
management of chronic cardiac failure where systolic dysfunction
or ventricular dilatation is dominant; management of certain
supraventricular arrhythmias, particularly chronic atrial flutter &
fibrillation.
Action: inhibits sodium-potassium activated adenosine
triphosphate, promoting movement of calcium from extracellular
to intra-cytoplasm and strengthening myocardial contraction,
also acts on CNS to enhance vagal tone
Adverse Reaction: nausea, vomiting, anorexia, headache, facial
pain, fatigue, weakness, dizziness, drowsiness, disorientation,
mental confusion, bad dreams, convulsions
Nursing Measures:
• Monitor apical pulse for 1 min before administering; 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.
• 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, cardiac monitor on standby in case toxicity
develops.
• Monitor for therapeutic drug levels: 0.5–2 ng/mL.

10) DIPENHYDRAMINE

Brand name: Benadryl

Classification: antihistamine
Dosage: 50mg/ml
Indication: Hay fever, urticaria, vasomotor rhinitis, angioneurotic
edema, drug sensitization, serum & penicillin reaction, contact
dermatitis, atopic eczema, other allergic dermatoses, pruritus,
food sensitivity, parkinsonism, motion sickness.
Action: prevents histamine mediated responses, drug provides
local anesthesia and suppresses cough reflex
Adverse Reaction: CV and CNS effects, blood disorders, GI
disturbances, anti-muscarinic effects and allergic reactions.
Nursing Measures:
• Monitor carefully, assess for confusion, delirium, other
anticholinergic side effects and fall risk. Institute measures to
prevent falls.
• Assess movement disorder before and after administration.
• Caution patient not to use oral OTC diphenhydramine products
with any other product containing diphenhydramine, including
products used topically.
• It can cause excitation in children. Caution parents or
caregivers about proper dose calculation; overdosage, especially
in infants and children, can cause hallucinations, seizures or
death Inform patient that this drug may cause dry mouth.
Frequent oral rinses, good oral hygiene, and sugarless gum or
candy may minimize this effect. Notify dentist if dry mouth
persists for more than 2 weeks.

11) EPINEPHRINE

Brand name:
Epinephrine Bitartrate
Aerosols: Primatene Mist
Epinephrine Borate
Ophthalmic solution: Epinal
Epinephrine Hydrochloride
Injection, OTC nasal solution: Adrenalin Chloride
Ophthalmic solution: Epifrin, Glaucon
Insect sting emergencies: EpiPen Auto-Injector (delivers 0.3 mg
IM adult dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for
children)
OTC solutions for nebulization: AsthmaNefrin, microNefrin,
Nephron, S2
Classification: Sympathomimetic, Alpha-adrenergic agonist,
Beta1and beta2-adrenergic agonist, Cardiac stimulant,
Vasopressor, Bronchodilator, Antasthmatic drug, Nasal
decongestant, Mydriatic, Antiglaucoma drug
Dosage: 1mg/ml
Indication: Acute asthmatic attacks, Advanced cardiac life
support
Action: Naturally occurring neurotransmitter, the effects of which
are mediated by alpha or beta receptors in target organs. Effects
on alpha receptors include vasoconstriction, contraction of dilator
muscles of iris. Effects on beta receptors include positive
chronotropic and inotropic effects on the heart (beta1 receptors);
bronchodilation, vasodilation, and uterine relaxation (beta2
receptors); decreased production of aqueous humor.
Adverse Reaction: drowsiness, headache, nervousness, tremors,
cerebral hemorrhage, dizziness, weakness, vertigo, pain
Nursing Measures:
• Monitor heart rate.
• Use extreme caution when calculating and preparing doses;
epinephrine is a very potent drug; small errors in dosage can
cause serious adverse effects. Double-check pediatric dosage.
• Use minimal doses for minimal periods of time; "epinephrine-
fastness" (a form of drug tolerance) can occur with prolonged
use.
• Protect drug solutions from light, extreme heat, and freezing;
do not use pink or brown solutions. Drug solutions should be
clear and colorless (does not apply to suspension for injection).
• Shake the suspension for injection well before withdrawing the
dose.
• Rotate SC injection sites to prevent necrosis; monitor injection
sites frequently.
• Keep a rapidly acting alpha-adrenergic blocker (phentolamine)
or a vasodilator (a nitrate) readily available in case of excessive
hypertensive reaction.
• Have an alpha-adrenergic blocker or facilities for intermittent
positive pressure breathing readily available in case pulmonary
edema occurs.
• Keep a beta-adrenergic blocker (propranolol; a cardioselective
beta-blocker, such as atenolol, should be used in patients with
respiratory distress) readily available in case cardiac arrhythmias
occur.
• Do not exceed recommended dosage of inhalation products;
administer pressurized inhalation drug forms during second half
of inspiration, because the airways are open wider and the
aerosol distribution is more extensive. If a second inhalation is
needed, administer at peak effect of previous dose, 3–5 min.
• Use topical nasal solutions only for acute states; do not use for
longer than 3–5 days, and do not exceed recommended dosage.
Rebound nasal congestion can occur after vasoconstriction
subsides.
• Do not exceed recommended dosage; adverse effects or loss of
effectiveness may result. Read the instructions that come with
respiratory inhalant products, and consult your health care
provider or pharmacist if you have any questions.
• To give eye drops: Lie down or tilt head backward, and look up.
Hold dropper above eye; drop medicine inside lower lid while
looking up. Do not touch dropper to eye, fingers, or any surface.
Release lower lid; keep eye open, and do not blink for at least 30
sec. Apply gentle pressure with fingers to inside corner of the eye
for about 1 min; wait at least 5 min before using other eye
drops.
• These side effects may occur: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that
require alertness); anxiety, emotional changes; nausea,
vomiting, change in taste (eat frequent small meals); fast heart
rate. Nasal solution may cause burning or stinging when first
used (transient). Ophthalmic solution may cause slight stinging
when first used (transient); headache or brow ache (only during
the first few days).
• Report chest pain, dizziness, insomnia, weakness, tremor or
irregular heart beat (respiratory inhalant, nasal solution),
difficulty breathing, productive cough, failure to respond to usual
dosage (respiratory inhalant), decrease in visual acuity
(ophthalmic).

12) FUROSEMIDE

Brand name: Apo-Furosemide (CAN), Furoside (CAN), Lasix,

Myrosemide (CAN)
Classification: loop diuretics
Dosage: 20mg/2ml
Indication: edema, hypertension
Action: inhibits Sodium and Chloride reabsorption at the proximal
and distal tubules and the ascending loop of Henle
Adverse Reaction: vertigo, headache, dizziness, paresthesia,
weakness, restlessness, fever, nocturia, oliguria, polyguria
Nursing Measures:
• 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.

13) HYDRALAZINE HYDROCHLORIDE

Brand name: Supres

Classification: antihypertension
Dosage: 20mg/ml
Indication: For hypertensive patient
Action: a direct acting peripheral vasodilator that relaxes
arteriolar smooth muscles
Adverse Reaction: tachycardia, palpitation, angina pectoris,
severe headache, dizziness, weight gain, GI disturbances,
pruritus, rashes, nausea and vomiting
Nursing Measures:
• Give oral drug with food to increase bioavailability(drug should
be given in a consistent relationship ti ingestion of food for
consistent response to therapy).
• Drug may cause a syndrome resembling systemic lupus
erythematosus (SLE). Arrange for CBC, LE cell preparations, and
ANA titers before and periodically during prolonged therapy, even
in the asymptomatic patient. Discontinue if blood dyscrasias
occur. Reevaluate therapy if ANA or LE tests are positive.
• Arrange for pyridoxine if patient develops symptoms of
peripheral neuritis.
• Monitor patient for orthostatic hypotension which is most
marked in the morning and in hot weather, and with alcohol or
exercise.

14) HYDROCORTISONE SODIUM SUCCINATE

Brand name: A-hydroCort, Solu-Cortef

Classification: corticosteroid hormones
Stock Dose:100 mg/ 2 mL, 250 mg/ 2 mL
Indication: endocrine, hematologic, rheumatic & collagen
disorders, dermatologic, ophth, GI, resp & neoplastic diseases,
edematous states, control of severe incapacitating allergic
conditions, TB meningitis w/ subarachnoid block or impending
block when used concurrently with appropriate anti-TB
chemotherapy, shock secondary to adrenocortical insufficiency or
shock unresponsive to conventional therapy when adrenocortical
insufficiency may be present
Action: Decreases inflammation, mainly by stabilizing leukocyte
lysosomal membranes, suppresses immune response, stimulates
bone marrow and influences protein, fat, and carbohydrate
metabolism
Adverse Reactions: fluid and electrolyte disturbances, decreased
carbohydrate tolerance, impaired wound healing, thin fragile
skin, muscle weakness, steroid myopathy, osteoporosis, aseptic
necrosis, peptic ulceration w/ possible perforation, cataracts,
increased intraocular and intracranial pressure, growth
retardation, Cushingoid state, protein catabolism, psychic
derangements, exophthalmos, masking of infections, gasping
syndrome, seizures, menstrual irregularities.
Nursing Measures:
• Give daily before 9 AM to mimic normal peak diurnal
corticosteroid levels and minimize HPA suppression.
• Space multiple doses evenly throughout the day.
• Do not give IM injections if patient has thrombocytopenic
purpura.
• Rotate sites of IM repository injections to avoid local atrophy.
• Use minimal doses for minimal duration to minimize adverse
effects.
• Taper doses when discontinuing high-dose or long-term
therapy.
• Arrange for increased dosage when patient is subject to
unusual stress.
• Use alternate-day maintenance therapy with short-acting
corticosteroids whenever possible.
• Do not give live virus vaccines with immunosuppressive doses
of hydrocortisone.
• Provide antacids between meals to help avoid peptic ulcer.

15) ISOSORBIDE-5- MONONITRATE

Brand name: Imdur

Classification: anti- anginal drug
Stock Dose: SL: 5 mg/mL ; Oral: 30 mg, 60 mg
Indication: prophylactic treatment of angina pectoris
Action: Thought to reduce cardiac oxygen demand by decreasing
preload and afterload. Drug also may increase blood flow through
the collateral coronary vessels
Adverse Reactions: headache, hypotension w/ dizziness and
nausea, tachycardia
Nursing Measures:
• Monitor BP and heart rate.
• Assess location, duration, intensity, and precipitating factors of
anginal pain.

16) ISOSORBIDE DINITRATE

Brand name: Isoket IV
Classification: anti – anginal drug
Stock: IV amp 10 mg/ 10 mL
Dose: 10 mg/10mL
Indication: unresponsive left ventricular failure secondary to
acute MI, severe or unstable angina pectoris
Action: Isosorbide dinitrate is a smooth muscle relaxant. It is
particularly effective on vascular and bronchial smooth muscle.
Its systemic cardiovascular effects are mainly due to a decrease
in venous return (pooling of blood in the peripheral venous
system). Consequently, ventricular end-diastolic pressure and
volume are diminished, thus reducing cardiac work and implicitly
myocardial oxygen requirements. The arterial vessels are dilated
as well, though to a lesser degree. This results in a slight drop in
aortic and systemic blood pressure relieving the myocardium
from a part of its afterload. These nitrate-induced changes
account for both the antianginal effects of isosorbide dinitrate
and for its beneficial effects in the treatment of congestive heart
failure.
Side effects/ adverse reactions: severe cerebral flow deficiency
and decreased coronary perfusion may develop, nitrate headache
and nausea.
Nursing Measures:
• Monitor BP and heart rate.
• Assess location, duration, intensity, and precipitating factors of
anginal pain.

17) MAGNESIUM SULFATE

Brand name: Elin Magnesium Sulfate

Classification: anticonvulsant
Dosage: 250 mg/10 mL
Indication: treatment of hypomagnesemia accompanied by signs
of tetany, control of HTN, encephalophathy & convulsions,
prevention & control of convulsions in patients w/ preeclampsia
or eclampsia, prevention of hypomagnesemia in patients
receiving TPN
Action: may decrease acetylcholine released by nerve impulses,
but its anticonvulsant mechanism is unknown
Adverse Reactions: flushing, sweating, hypotension, muscular
weakness, sedation & confusion; decreased deep tendon
reflexes; resp. paralysis
Nursing Measures:
• Monitor the following: I.V.: Rapid administration: ECG
monitoring, vital signs, deep tendon reflexes; magnesium,
calcium, and potassium levels; renal function during
administration. Obstetrics: Patient status including vital signs,
oxygen saturation, deep tendon reflexes, level of consciousness,
fetal heart rate, maternal uterine activity. Oral: Renal function;
magnesium levels; bowel movements.

18) MEPERIDINE HYDROCHLORIDE

Brand name: Demerol

Classification: antivertigo drug
Dosage: 100 mg/ 2mL
Indication: relief of moderate to severe pain, pre-op medication,
support of anesth & obstet analgesia
Action: binds with opiate receptors in the CNS, altering
perception of and emotional response to pain
Adverse Reactions: resp. depression, circulatory depression, resp
arrest, shock, cardiac arrest, GI disturbance, light headedness,
dizziness, sedation, nausea, vomiting, sweating, euphoria,
dysphoria, weakness, headache, tremor, agitation, uncoordinated
muscle movements, severe convulsions, transient hallucinations
& disorientation, visual disturbance, flushing, tachycardia,
bradycardia, palpitation, hypotension, syncope, phlebitis, urinary
retention, allergic reactions, pain at injection site and local tissue
irritation.
Nursing Measures:
• Make position changes slowly and in stages particularly from
recumbent to upright posture. Lie down immediately if light-
headedness or dizziness occurs.
• Lie down when feeling nauseated and to notify physician if this
symptom persists. Nausea appears to worsen with ambulation.
• Avoid driving and other potentially hazardous activities until
reaction to drug is known. Codeine may impair ability to perform
tasks requiring mental alertness and therefore to.
• Do not take alcohol or other CNS depressants unless approved
by physician.
• Hyperactive cough may be lessened by avoiding irritants such
as smoking, dust, fumes and other air pollutants. Humidification
of ambient air may provide some relief.
• Do not breast feed while taking this drug.

19) METOCLOPRAMIDE

Brand name: Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-

Metoclopramide (CAN), Octamide PFS, Reglan
Classification: antiemetic & anti-spasmodic
Dosage: 10 mg/ 2mL
Indication: disturbances of GI motility, nausea & vomiting of
central & peripheral origin associated w/ surgery, metabolic
diseases, infectious & drug induced diseases, facilitate small
bowel intubation & radiological procedures of GIT
Action: stimulates motility of upper GI tract, increases lower
esophageal sphincter tone, and blocks dopamine receptors at the
chemoreceptor trigger zone
Adverse Reactions: extrapyramidal reactions, drowsiness, fatigue
& lassitude, anxiety, less frequently, insomnia, headache,
dizziness, nausea, galactorrhea, gynecomastia, bowel
disturbances.
Nursing Measures:
• Monitor BP carefully during IV administration.
• Monitor for extrapyramidal reactions, and consult physician if
they occur.
• Monitor diabetic patients, arrange for alteration in insulin dose
or timing if diabetic control is compromised by alterations in
timing of food absorption.
• Keep diphenhydramine injection readily available in case
extrapyramidal reactions occur (50 mg IM).
• Have phentolamine readily available in case of hypertensive
crisis (most likely to occur with undiagnosed
pheochromocytoma).

20) MIDAZOLAM HYDROCHLORIDE

Brand name: Dormicum

Classification: hypnotics & sedatives
Dosage: 5mg/5mL
Indication: tab: disturbances of sleep rhythm, insomnia esp
difficulty in falling asleep either initially or after premature
awakening, tab/inj: sedation in premed before surgical or
diagnostic procedures, induction & maintenance of anesth.
Action: may potentiate the effects of GABA, depress the CNS,
and suppress the spread of seizure activity
Adverse Reactions: rarely cardioresp adverse events, nausea,
vomiting, headache, hiccoughs, laryngospasm, dyspnoea,
hallucination, oversedation, drowsiness, ataxia, rash, paradoxical
reactions, amnesic episodes.
Nursing Measures:
• Do not administer intra-arterially, which may produce
arteriospasm or gangrene.
• Do not use small veins (dorsum of hand or wrist) for IV
injection.
• Administer IM injections deep into muscle.
• Monitor IV injection site for extravasation.
• Arrange to reduce dose of midazolam if patient is also being
given opioid analgesics; reduce dosage by at least 50% and
monitor patient closely.
• Monitor level of consciousness prior to, during, and for at least
2–6 hr after administration of midazolam.
• Carefully monitor P, BP, and respirations carefully during
administration.
• Keep resuscitative facilities readily available; have flumazenil
available as antidote if overdose should occur.
• Keep patients in bed for 3 hr; do not permit ambulatory
patients to operate a vehicle following an injection.
• Arrange to monitor liver and kidney function and CBC at
intervals during long-term therapy.
• Establish safety precautions if CNS changes occur (use side
rails, accompany ambulating patient).
• Provide comfort measures and reassurance for patients
receiving diazepam for tetanus.
• Arrange to taper dosage gradually after long-term therapy.
• Provide patient with written information regarding recovery and
follow-up care. Midazolam is a potent amnesiac and memory may
be altered.

21) MORPHINE SULFATE

Brand name: Morin

Classification: Analgesics (Opioid)
Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe or chronic pain
Childn 10 mg IM/SC 4 hrly, range: 5-20 mg; 6-12 yr 5-10 mg, 1-
5 yr 2.5-5 mg, 1-12 mth 200 mcg/kg, <1 mth 150 mcg/kg 4
hrly. Max: 15 mg. Analgesic effect Ped 100-200 mcg/kg SC 4
hrly, max: 15 mg/dose; or 50-100 mcg/kg slow IV. Pre-op 50-
100 mcg/kg IM, max: 10 mg/dose.
Indication: Relief of moderate to severe pain not responsive to
non-narcotic analgesics. Premed. Analgesic adjunct in general
anesth esp in pain associated w/ cancer, MI & surgery. Alleviates
anxiety associated w/ severe pain. Hypnotic for pain-related
sleeplessness.
Action: alters perception and emotional response to pain
Adverse Reactions: Lightheadedness, dizziness, sedation,
nausea, vomiting, constipation & sweating.
Nursing Measures:
• 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 not
develop dependence syndromes.

22) NICARDIPINE HYDROCHLORIDE

Brand name: Cardepine

Classification: Calcium Antagonists
Dosage: IV infusion Dilute to 10-20 mg/100 mL (conc of 1.01-
0.02%). Initial infusion rate: 5 mg/hr; titrate dose up to 15
mg/hr until desired therapeutic response is achieved (DBP <95
mmHg, SBP <140 mmHg). Maintenance rate: Can be tapered
down to ≤10 mg/hr. IV bolus inj 2-7 mg w/out dilution given
over 1-2 min.
Indication: Hypertensive emergencies or urgencies, peri-op &
post-op HTN, hypertensive states of NPO patients.
Action: a Calcium channel blocker that inhibits Calcium ion influx
across cardiac and smooth muscle cells, also dilates coronary
arteries and arterioles
Adverse Reactions: Peripheral edema, headache, tachycardia,
palpitations, localized thrombophlebitis & hypotension.
Nursing Measures:
• Patients with hepatic impairment should receive lower dose.
• Monitor blood pressure.Allow atleast 3 days between dosage
adjustment to achieve steady plasma levels.
• Advise patient to report immediately if experiencing chest pain

23) NTG PATCH

Brand name: Deponit, Minitran, Nitrek, Nitro-Dur, Nitrodisc,

Transderm-Nitro
Classification: Anti-Anginal Drugs
Dosage: Starting dose: 0.2-0.4 mg/hr. Dosing schedule: Daily
patch-on period of 12-14 hr & daily patch-off period of 10-12 hr.
Indication: Prevention of angina pectoris due to coronary artery
disease
Action: a nitrate that reduces cardiac oxygen demand by
decreasing left ventricular end diastolic pressure and to a lesser
extent, systemic vascular resistance, also increases blood flow
through collateral coronary vessels
Adverse Reactions: Headache. Transient episodes of
lightheadedness. Infrequently, hypotension. Syncope, crescendo
angina, rebound HTN, allergic & anaphylactoid reactions. Rarely
severe, application site irritation.
Nursing Measures:
• Administer transdermal systems to skin site free of hair and not
subject to much movement. Shave areas that have a lot of hair.
Do not apply to distal extremities. Change sites slightly to
decrease the chance of local irritation and sensitization. Remove
transdermal system before attempting defibrillation or
cardioversion.
• To use transdermal systems, you may need to shave an area
for application. Apply to a slightly different area each day. Use
care if changing brands; each system has a different
concentration.

24) PARACETAMOL

Brand name: Aeknil

Classification: Analgesics (Non-Opioid) & Antipyretics
Dosage: Adult & childn ≥10 yr 2-3 mL, ≤10 yr 1-2 mL.
Depending on severity of case, dose may be repeated 4 hrly. In
severe cases, dose may be administered by IV very slowly
Indication: Pyrexia of unknown origin. Fever & pain associated w/
common childhood disorders, tonsillitis, upper resp tract
infections post-immunization reactions, after tonsillectomy &
other conditions. Prevention of febrile convulsion. Headache,
cold, sinusitis, muscle pain, arthritis & toothache
Action: produce analgesia by blocking pain impulses by inhibiting
synthesis of prostaglandin in CNS, relieves fever
Adverse Reactions: Hematological, skin & other allergic reactions
Nursing Measures:
• Use liquid form for children and patients who have difficulty
swallowing.
• In children, don’t exceed five doses in 24 hours.
• Advise patient that drug is only for short term use and to
consult the physician if giving to children for longer than 5 days
or adults for longer than 10 days.
• Advise patient or caregiver that many over the counter
products contain acetaminophen; be aware of this when
calculating total dailydose.
• Warn patient that high doses or unsupervised long term use
can cause liver damage.

25) PHENYTOIN

Brand name: Dilantin

Classification: Anticonvulsants
Dosage: Adult Initially 100 mg tid. Maintenance: 300-400 mg
daily. Childn ≥6 yr Initially 100 mg tid, subsequent dosage
should be adjusted according to therapeutic response, <6 yr 30
mg bid, may be increased to 30 mg tid or qid. Pedia 5 mg/kg/day
Initially in 2-3 equally divided doses. Max: 300 mg daily.
Maintenance: 4-8 mg/kg/day
Indication: Tonic-clonic & complex partial (psychomotor,
temporal lobe), prevention & treatment of seizures occurring
during or following neurosurgery
Action: may stabilize neuronal membranes and limit seizure
activity by either by increasing efflux or decreasing influx of Na
ions across cell membrane in the motor cortex during generation
of nerve impulses
Adverse Reactions: GI disturbances; ataxia, slurred speech;
diplopia, nystagmus & mental confusion w/ headache, dizziness,
gingival hyperplasia, hirsutism, hyperglycemia, osteomalacia
Nursing Measures:
• Assess location, duration, frequency, and characteristics of
seizure activity. EEG may be monitored periodically throughout
therapy, Assess oral hygiene. Vigorous oral cleaning beginning
within 10 days of initiation of phenytoin therapy may help control
gingival hyperplasia.

26) TERBUTALINE

Brand name: Bricalin

Classification: Antiasthmatic & COPD Preparations
Dosage: Antiasthmatic & COPD Preparations
Indication: For reversible airways obstruction, in asthma, COPD.
Decreases uterine contractility & may be used to arrest
premature labor
Action: relaxes bronchial smooth muscles by stimulating beta-2
receptors
Adverse Reaction: Fine tremor of skeletal muscle esp hands,
palpitations, tachycardia, nervous tension, headache, peripheral
vasodilation.
Nursing Measures:
• Use minimal periods of time; drug tolerance can occur with
prolonged use.
• Keep beta-adrenergic blocker readily available in case cardiac
arrhythmias occur.
• Do not recommended dosage.

27) VERAPAMIL HYDROCHLORIDE

Brand name: Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR,

Verelan, Verelan PM
Classification: Calcium Antagonists
Dosage: Isoptin tab Adult 40-80 mg tid-qid. Max: 480 mg daily.
Childn >6 yr 40-120 mg bid-tid, up to 360 mg daily, childn ≤6 yr
40 mg bid-tid. Isoptin SR 180 Coronary insufficiency 1 tab bid.
Usual daily dose: 240-480 mg. Hypertension 1 tab in the
morning. Isoptin SR 240 1 tab in the morning. If required after 2
wk, increase dose to 2 tab daily. Isoptin amp 5 mg slow IV, if
required, 5 mg after 5-10 min. Then, if required, continuous drip
infusion of 5-10 mg/hr up to 100 mg/day. Angina pectoris &
rapid elimination of tachyarrhythmias 1-2 amp IV, if required bid-
tid
Indication: Isoptin/Isoptin SR 180 Essential hypertension, chronic
coronary insufficiency, angina pectoris, paroxysmal
supraventricular tachycardia, tachyarrhythmias, long-term
treatment after MI. Isoptin SR 240 Essential hypertension
Action: decreases myocardial contractility and oxygen demand, it
also dilates coronary arteries and arterioles
Adverse Reactions: Constipation, dizziness, nausea. Rarely,
vertigo, headache, hypotension, ankle edema, flushing, fatigue,
nervousness, erythromelalgia, paraesthesia, neuropathy;
bradycardiac arrhythmias, CHF. Dyspnea
Nursing Measures:
• Monitor patient carefully (BP, cardiac rhythm, and output) while
drug is being titrated to therapeutic dose. Dosage may be
increased more rapidly in hospitalized patients under close
supervision.
• Ensure that patient swallows SR tablets whole: do not cut,
crush, or chew them.
• Monitor BP very carefully with concurrent doses of
antihypertensives.
• Monitor cardiac rhythm regularly during stabilization of dosage
and periodically during long-term therapy.
• Administer sustained-release form in the morning with food to
decrease GI upset.
• Protect IV solution from light.
• Monitor patients with renal or hepatic impairment carefully for
possible drug accumulation and adverse reactions.

28) IPRATROPIUM INHALATION

Brand name: Atrovent

Classification: Antiasthmatic & COPD Preparations,
anticholinergics or antimuscarinics
Stock: 0.5 mg/2 mL
Dosage: Adult (including elderly) & adolescent >12 yr Acute
attacks 1 vial, may repeat doses until patient is stable.
Maintenance: 1 vial tid-qid.
Indication: Bronchodilator for treatment of bronchospasm
associated w/ COPD, including chronic bronchitis, emphysema
and asthma
Action: it works by binding to specific receptors (called
muscarinic receptors) in the airway, helping to relax the smooth
muscle of the airway. When used to treat a runny nose, it works
by decreasing the production of fluid in the glands that line the
nasal passages
Adverse Reaction: Headache, nausea, dry mouth, increased heart
rate & palpitations, ocular accommodation disturbances, GI
motility disturbances, urinary retention, ocular side effects,
cough, local irritation, bronchoconstriction, skin rash,
angioedema, urticaria, laryngospasm, anaphylactic reactions.
Nursing Measures:
• Protect solution for inhalation from light. Store unused vials in
foil pouch.
• Use nebulizer mouthpiece instead of face mask to avoid blurred
vision or aggravation of narrow-angle glaucoma.
• Can mix albuterol in nebulizer for up to 1 hr.
• Ensure adequate hydration, control environmental temperature
to prevent hyperpyrexia.
• Have patient void before taking medication to avoid urinary
retention.
• Teach patient proper use of inhalator.

29) FENOTEROL/IPRATROPIUM BROMIDE

Brand name: Berodual

Classification: Antiasthmatic & COPD Preparations
Dosage: Berodual inhalation soln Adult (including elderly) &
adolescent >12 yr Treatment of 1 mL for immediate symptom
relief. Intermittent & long-term treatment 1-2 mL for each
administration, up to qid. Moderate bronchospasm or w/ assisted
ventilation 0.5 mL. Childn 6-12 yr Treatment of attacks 0.5-1
mL. Intermittent & long-term treatment 0.5-1 mL for each
administration, up to qid. Moderate bronchospasm or w/ assisted
ventilation 0.5 mL. Childn <6 yr (<22 kg body wt) Up to 0.5 mL
up to tid. Berodual F UDV Adult & childn >12 yr Acute asthma
episodes 1 vial, in very severe cases, 2 vials are needed.
Intermittent & long-term treatment 1 vial up to qid.
Indication: prevention and treatment of symptoms in chronic
obstructive airway disorders with reversible bronchospasm
Action: for the prevention and treatment of reversible
bronchospasm associated with bronchial asthma and especially
chronic bronchitis with or without emphysema
Adverse Reactions: Fine tremor of skeletal muscles, nervousness,
restlessness, palpitations; less frequently tachycardia, dizziness
or headache. Dry mouth, throat irritation or allergic reactions,
cough, paradoxical bronchoconstriction (rare). Urinary retention
may occur in particular, in patients w/ preexisting outflow tract
obstruction.
Nursing Measures:
• Protect solution for inhalation from light. Store unused vials in
foil pouch.
• Use nebulizer mouthpiece instead of face mask to avoid blurred
vision or aggravation of narrow-angle glaucoma.
• Can mix albuterol in nebulizer for up to 1 hr.
• Ensure adequate hydration, control environmental temperature
to prevent hyperpyrexia.
• Have patient void before taking medication to avoid urinary
retention.
• Teach patient proper use of inhalator.

30) BUDESONIDE

Brand name: Symbicort

Classification: Corticosteroids
Dosage: 80/4.5 mcg x 60 doses; 160/4.5 mcg x 60 doses; 320/9
mcg x 60 doses
Indication: regular treatment of asthma where use of a
combination (inhaled corticosteroid and long acting beta 2
agonist) is appropriate
Action: work by reducing inflammation, which helps with several
conditions ranging from asthma to allergies toCrohn’s disease
Adverse Reactions: Abdominal pain, conjunctivitis (pinkeye),
cough, diarrhea, ear infection or inflammation, fever, fungal
infection in mouth, headache, nasal or sinus inflammation,
nosebleed, pain, rash, respiratory infection, stomach or intestinal
inflammation, throat inflammation, viral infection, vomiting,
wheezing
Nursing Measures:
• Taper systemic steroids carefully during transfer to inhalational
steroids; deaths from adrenal insufficiency have occurred.
• Arrange for use of decongestant nose drops to facilitate
penetration if edema, excessive secretions are present.
• Prime unit before use for Pulmicort Turbuhaler; have patient
rinse mouth after each use.
• Use aerosol within 6 mo of opening. Shake well before each
use.
• Store Respules upright and protected from light; gently shake
before use; open envelopes should be discarded after 2 wk.

31) ALBUTEROL AND IPRATROPIUM INHALATION

Brand name: Combivent

Classification: Bronchodilators
Stock: 2.5 mL
Dose: MDI Adult 2 puffs tid-qid. Max 12 puffs/day. Unit dose vial
Adult & childn >12 yr 1 vial every 6-8 hr. Childn 2-12 yr 3
drops/kg/dose (max: 2500 mcg of salbutamol) every 6-8 hr.
Indication: management of reversible bronchospasm associated
with obstructive airway diseases in patients who require more
than a single bronchodilator
Action: muscles in the airways and increase air flow to the lungs
Adverse Reactions: Fine tremor of skeletal muscle; palpitations;
headache, dizziness, nervousness; dryness of mouth, throat
irritation; urinary retention
Nursing Measures:
• Use nebulizer mouthpiece instead of face mask to avoid blurred
vision or aggravation of narrow-angle glaucoma.
• Can mix albuterol in nebulizer for up to 1 hr.
• Ensure adequate hydration, control environmental temperature
to prevent hyperpyrexia.
• Have patient void before taking medication to avoid urinary
retention.
• Teach patient proper use of inhalator.

32) SALBUTAMOL

Brand name: Aero-Vent

Classification: bronchodilator
Stock: 1 mg/1 mL
Dose: Adult & childn 2.5-5 mg. May repeat qid by hlebitis.
Delivery of aerosol may be by face mask of “T” piece. Use
undiluted. For prolonged delivery time, dilute w/ sterile water or
normal saline for inj.
Indication: treatment of acute, severe asthma and in routine
management of chronic bronchospasm unresponsive to
conventional therapy
Action: used with anti-inflammatory medication to prevent
asthma attacks, Some of these medicines are used to treat the
symptoms of asthma, chronic bronchitis, emphysema, and other
lung diseases, while others are used to prevent the symptoms
Adverse Reactions: Dizziness, severe; feeling of choking,
irritation, or swelling in throat; flushing or redness of skin; hives;
increased shortness of breath; skin rash; swelling of face, lips, or
eyelids; tightness in chest or wheezing, troubled breathing
Nursing Measures:
• Assess lung sounds, pulse, and blood pressure before
administration and during peak of medication. Note amount,
color, and character of sputum produced.
• Monitor pulmonary function tests before initiating therapy and
periodically throughout course to determine effectiveness of
medication.
• Observe for paradoxical bronchospasm (wheezing). If condition
occurs, withhold medication and notify physician or other health
care professional immediately.
• Instruct mother to take missed dose as soon as remembered,
spacing remaining doses at regular intervals. Do not double
doses or increase the dose or frequency of doses.
• Inform the mother not to smoke near the child and to avoid
respiratory irritants.
• Advise the mother to rinse the child’s mouth with water after
each inhalation dose to minimize dry mouth.

33) TERBUTALINE SULFATE

Brand name: Pulmonyl

Classification: Antiasthmatic/ Brochodilator
Stock: 2.5 mg/ml
Dose: Adult 5-10 mg, Children 2-5mg
Indication: relief of bronchospasm in obstructive airway diseases
Action: It works by dilating (opening) the bronchioles of the
lungs by relaxing the muscles around them. This allows for easier
airflow into and out of the lungs
Adverse Reactions: Headache, nausea, vomiting, palpitations,
tachycardia, sweating & drowsiness
Nursing Measures:
• Use minimal periods of time; drug tolerance can occur with
prolonged use.
• Keep beta-adrenergic blocker readily available in case cardiac
arrhythmias occur.
• Do not recommended dosage.

34) HEPARIN SODIUM

Brand name: Britton Heparin Na

Classification: Anticoagulants, Antiplatelets & Fibrinolytics
(Thrombolytics)
Dosage: 5000 iu/1 mL; 25000 iu/1 mL
Indication: treatment and prophylaxis of thromboembolic
disorders
Action: Accelerates formation of antithrombin III-thrombin
complex and deactivates thrombin, preventing conversion of
fibrinogen to fibrin
Adverse Reactions: Slight fever, headache, chills, nausea,
vomiting, constipation, epistaxis, bruising, slight haematuria,
skin necrosis (SC inj), osteoporosis, alopecia. Hypersensitivity
reactions include urticaria, conjunctivitis, rhinitis, asthma,
angioedema and anaphylactic shock. Priapism. Potentially Fatal:
Heparin-induced thrombocytopenia with or without thrombosis;
bleeding
Nursing Measures:
• Baseline blood coagulation tests, Hct, Hgb, RBC and platelet
counts prior to initiation or therapy and at regular intervals
throughout therapy
• Monitor APTT levels closely
• Draw blood for coagulation tests 30 min before each scheduled
SC or intermittent IV dose and approximately q4h for pts
receiving continuous IV heparin during dosage adjustments
period. After dosage is established, tests may be done once daily
• Pts vary widely in their reaction to heparin; risk of hemorrhage
appears greatest in women, all patients > 60 y, and patients with
liver disease or renal insufficiency.
• Monitor vitals, report fever, drop in BP, rapid pulse and other
S&S of hemorrhage
• Observe all needle sites daily for hematoma and signs of
inflammation
• Have on hand protamine sulfate, specific heparin antagonist

35) ESMOLOL HYDROCHLORIDE

Brand name: Brevibloc

Classification: Beta blockers
Dosage: 100mg/10ml
Indication: supraventricular tachycardia; post-operative
tachycardia or hypertension; non-compensatory sinus
tachycardias; intra-operative tachycardia or hypertension;
unstable angina, non ST segment elevation MI
Action: A Class II antiarrythmic and ultra-short-acting selective
beta blocker that decreases heart rate, contractility and blood
pressure
Adverse Reactions: Hypotension, bradycardia, heart failure, local
irritation, diaphoresis, peripheral ischaemia, dizziness,
somnolence, confusion, fatigue, paraesthesia, peripheral
neuropathy, headache, weakness, irritability, dyspnoea, nausea,
vomiting, blurred vision, urinary retention, fever, rigor, muscular
pain. Potentially Fatal: Profound bradycardia, AV block,
cardiogenic shock, asystole, bronchospasm.
Nursing Measures:
• Monitor patient carefully (BP, cardiac rhythm, and output) while
drug is being titrated to therapeutic dose. Dosage may be
increased more rapidly in hospitalized patients under close
supervision.
• Monitor cardiac rhythm regularly during stabilization of dosage
and periodically during long-term therapy.

36) D 50-50

Brand name: Phil Pharmawealth/Atlantic 50% Dextrose

Classification: Intravenous & Other Sterile Solutions
Dosage: 50ml/vial
Indication: for hypoglycemia
Action: A simple water soluble sugar that minimizes
glyconeogenesis and promotes anabolism in patients whose oral
caloric intake is limited
Adverse Reactions: Local pain, vein irritation, thrombophlebitis &
tissue necrosis in the event of extravasation. Fluid & electrolyte
imbalance eg hypokalemia, hypomagnesemia &
hypophosphatemia; edema or water intoxication
Nursing Measures:
• Monitor infusion rate frequently; if signs of fluid overload, turn
off IV drip. Infusion may result in fluid overload.
• Check IV site frequently and if infiltration is noted, turn off IV
drip.
• Watch out for signs of fluid overload (distended neck veins
(JVD), rapid respirations, shallow tidal volume, fine auscultatory
crackles, dyspnea, and peripheral edema)
• Watch out for signs of infiltration (swelling and pain around IV
site).
37) POTASSIUM CHLORIDE

Brand name: Phil Pharmawealth/Atlantic Potassium Chloride

Classification: Electrolytes
Dosage: 40 meqs/20 ml
Indication: for hypokalemia, acute MI
Action: Replaces potassium and maintains potassium level
Adverse Reactions: GI ulceration (sometimes with haemorrhage
and perforation or with late formation of strictures) following the
use of enteric-coated K chloride preparation; hyperkalaemia.
Oral: Nausea, vomiting, phlebiti and abdominal cramps. IV: Pain
or phlebitis; cardiac toxicity.
Nursing Measures:
• Monitor serum potassium levels, renal function, and serum
bicarbonate.
• Explain to patient purpose of the medication and the need to
take as directed,especially when concurrent digoxin or diuretics
are taken. A missed dose should be taken as soon as
remembered within 2 hr; if not, return to regular doseschedule.
Do not double dose.
• Emphasize correct method of administration. GI irritation or
ulceration may result from chewing enteric-coated tablets or
insufficient dilution of liquid or powder forms. Some extended-
release tablets are contained in a wax matrix that may be
expelled in the stool. This occurrence is not significant.
• Instruct patient to avoid salt substitutes or low-salt milk or food
unless approved by health care professional.
• Patient should be advised to read all labels to prevent excess
potassium intake.
• Advise patient regarding sources of dietary potassium.
• Encourage compliance with recommended diet.
• Instruct patient to report dark, tarry, or bloody stools;
weakness; unusual fatigue; or tingling of extremities.
• Notify health care professional if nausea, vomiting, diarrhea, or
stomach discomfort persists.
• Dosage may require adjustment. Emphasize the importance of
regular follow-up exams to monitor serum levels and progress.

38) LIDOCAINE HYDROCHLORIDE

Brand name: Abbott Lidocaine
Classification: Anaesthetics - Local & General
Dosage: 50 ml/vial
Indication: local or regional anesthesia
Action: A class IB antiarrythmic that decreases the
depolarization, automaticity, and excitability in the ventricles
during the diastolic phase by direct action on the tissues
especially the Purkinje network
Adverse Reactions: Restlessness, nervousness, dizziness,
tinnitus, blurred vision; GI upsets; muscle twitching, convulsions;
numbness of the tongue; hypotension, bradycardia;
methemoglobinaemia; fetal intoxication.
Nursing Measures:
• Check drug concentration carefully; many concentrations are
available.
• Reduce dosage with hepatic or renal failure.
• Continuously monitor response when used as antiarrhythmic or
injected as local anesthetic.
• Keep life-support equipment and vasopressors readily available
in case severe adverse reaction (CNS, CV, or respiratory) occurs
when lidocaine is injected.
• Establish safety precautions if CNS changes occur; have IV
diazepam or short-acting barbiturate (thiopental, thiamylal)
readily available in case of seizures.
• Monitor for malignant hyperthermia (jaw muscle spasm,
rigidity); have life-support equipment and IV dantrolene on
standby.
• Titrate dose to minimum needed for cardiac stability, when
using lidocaine as antiarrhythmic.
• Reduce dosage when treating arrhythmias in CHF, digitalis
toxicity with AV block, and geriatric patients.
• Monitor fluid load carefully; more concentrated solutions can be
used to treat arrhythmias in patients on fluid restrictions.
• Have patients who have received lidocaine as a spinal
anesthetic remain lying flat for 6–12 hr afterward, and ensure
that they are adequately hydrated to minimize risk of headache.
• Check lidocaine preparation carefully; epinephrine is added to
solutions of lidocaine to retard the absorption of the local
anesthetic from the injection site. Be sure that such solutions are
used
• only to produce local anesthesia. These solutions should be
injected cautiously in body areas supplied by end arteries and
used cautiously in patients with peripheral vascular disease,
hypertension, thyrotoxicosis, or diabetes.
• Use caution to prevent choking. Patient may have difficulty
swallowing following use of oral topical anesthetic. Do not give
food or drink for 1 hr after use of oral anesthetic.
• Treat methemoglobinemia with 1% methylene blue, 0.1 mg/kg,
IV over 10 min.
• Apply lidocaine ointments or creams to a gauze or bandage
before applying to the skin.
• Monitor for safe and effective serum drug concentrations
(antiarrhythmic use: 1–5 mcg/mL). Doses > 6–10 mcg/mL are
usually toxic

39) SODIUM BICARBONATE

Brand name: Hospira Sodium Bicarbonate

Classification: Alkalinizers
Dosage: 10mEq/10ml; 50mEq/50ml
Indication: metabolic acidosis, systemic or urinary alkalinization,
antacid, cardiac arrest
Action: Restores buffering capacity of the body and neutralizes
excess acid
Adverse Reaction: Tetany, edema, gastric distention, belching,
flatulence, hypokalemia, metabolic alkalosis, hypernatremia,
chemical cellulitis because of alkalinity, pain, irritation, tissue
necrosis, ulceration or sloughing at the site of infiltration
Nursing Measures:
• do not take drug with milk to avoid hypercalcemia, abnormally
high alkalinity in tissues and fluids, or kidney stones.
• do not give to patients with metabolic or respiratory alkalosis,
and in those with hypocalcemia in which alkalosis may produce
tetany, hypertension, seizures, or heart failure.
• monitor for alkalosis by obtaining blood pH, PaO2, PCO2, and
electrolyte levels

40) DOPAMINE

Brand name: Intropin

Classification: Adrenergics (Sympathomimetics)
Dosage: 40 mg/Ml; 80 mg/mL; 160 mg/mL
Indication : shock and hemodynamic imbalances, hypotension
Action: Stimulates dopaminergic and alpha beta receptors for the
sympathetic nervous system resulting in a positive inotropic
effect and increased cardiac output. Action is dose-related; large
doses cause mainly alpha stimulation
Adverse Reaction: ectopic beats, tachycardia, anginal pain,
palpitation, hypotension, vasoconstriction, ventricular
arrhythmias, hypertension, headache, anxiety, dilated pupils,
nausea, vomiting, decreased urine output, dyspnea
Nursing Measures:
• Monitor vital signs and ECG closely throughout therapy.
• Monitor I&O regularly; note decreases in urine output.
• Monitor central venous pressure or pulmonary wedge pressure
if possible during infusion.
• Note significant changes in vital signs, ECG changes,
deterioration of peripheral pulses, and/or cold, mottled
extremities

41) DOBUTAMINE

Brand name: Dobatrey

Classification: Adrenergics
Dosage: 12.5 mg/mL
Indication: increased cardiac output in short term treatment of
cardiac decompensation caused by depressed contractility
Action: Stimulates heart’s beta1 receptors to increase myocardial
contractility and stroke volume. Increases cardiac output by
decreasing peripheral vascular resistance, reducing ventricular
filling pressure, and facilitating AV node conduction
Adverse Reaction: increased systolic BP, increased heart rate,
chest pain, increased number of premature ventricular beats,
headache, tingling sensations, paresthesia. nausea, vomiting,
dyspnea, phlebitis, local inflammation after infiltration, leg
cramps
Nursing Measures:
• Monitor vital signs, ECG, cardiac output, pulmonary capillary
wedge pressure, central venous pressure and urinary output
carefully throughout infusion.
• Monitor patency and placement of IV catheter to reduce risk of
extravasation and phlebitis.
• Watch out for symptoms of overdosage such as excessive
hypertension, tachycardia, nausea, vomiting, tremor, headache,
chest pain

42) LIDOCAINE PREMIXED

Brand name: Xylocaine

Classification: Antiarrhythmic agent, Local anesthetic
Dosage: 0.2% (2mg/ml); 0.4% (4g/ml); 0.8% (8g/ml)
Indication: ventricular arrhythmias caused by MI, cardiac
manipulation or cardiac glycosides
Action: Acts as an anesthetic by stabilizing the neuronal
membrane by inhibiting the ionic fluxes required for the initiation
and conduction of impulses, thereby effecting local anesthetic
action. Also acts as an antiarrhythmic by decreasing the
depolarization, automaticity, and excitability in the ventricles
during the diastolic phase by a direct action on the tissues,
especially the Purkinje network, without involvement of the
autonomic system. Neither contractility, systolic arterial blood
pressure, atrioventricular (AV) conduction velocity, nor absolute
refractory period is altered by usual therapeutic doses
Adverse Reaction: bradycardia, cardiac arrest, CV collapse,
hypotension, apprehension, confusion, dizziness, drowsiness,
hallucinations, headache, light-headedness, mood changes,
nervousness, tremors, conjunctival hyperemia, corneal epithelial
changes, diplopia, tinnitus, visual disturbances, nausea,
vomiting, erythema, petechiae, edema, injection-site reactions,
including bruising, burning, contusion, hemorrhage, local
reactions, including soreness at IM injection site, venous
thrombosis or phlebitis, extravasation, burning, stinging,
sloughing, respiratory depression or arrest, hypersensitivity
reactions
Nursing Measures:
• Explain that adverse reactions related to the CNS (eg,
drowsiness, confusion, paresthesias, convulsions, respiratory
arrest) can occur and are a result of CNS toxicity.
• Advise patient that drug may cause dizziness or drowsiness and
to avoid getting out of bed or walking without assistance.
• Advise patients that skin reactions, including erythema,
petechiae, and edema, may occur with intradermal injection.
• Systemic effects can occur following topical use; use lowest
possible dose to avoid serious toxicity, shock, or heart block.
• Do not use in patients with congenital or idiopathic
methemoglobinemia or in infants younger than 12 mo of age who
are receiving methemoglobin-inducing drugs.
• Use with caution and in lower doses in patients with CHF,
reduced cardiac output, digitalis toxicity, and in elderly patients

43) MANNITOL

Brand name: Osmitrol

Classification: osmotic diuretic
Dosage: 5% , 10%, 15%, 20%, 25% in 500cc/1,000cc
Indication: test dose for marked oliguria or suspected inadequate
renal function, oliguria, to reduce intraocular or intracranial
pressure, diuresis in drug intoxication
Action: Increases osmotic pressure of glomerular filtrate; drug
elevates plasma osmolality
Adverse Reaction: Increased urination, nausea, runny nose,
vomiting, severe allergic reactions (rash, hives, itching, difficulty
breathing, tightness in the chest, swelling of the mouth, face,
lips, or tongue), blurred vision, chest pain, chills or fever,
confusion, decreased alertness, difficulty urinating, extreme
dizziness, extreme thirst or dry mouth, fast or irregular
heartbeat, headache, muscle cramps, pain, redness, or swelling
at the injection site, weakness
Nursing Measures:
• Monitor vital signs, including CVP, and fluid intake and output.
• Monitor weight, renal function, and serum sodium and
potassium levels daily
• Watch out for symptoms of overdosage such as excessive
hypertension, tachycardia, nausea, vomiting, tremor, headache,
chest pain
• To relieve thirst, give frequent mouth care and fluids

44) DEXTROSE 5% IN WATER (D5W) SOLUTION

Brand name: None

Classification: Isotonic/Hypotonic Solution
Dosage: 250ml bottles (5g dextrose/100ml water)
Indication: fluid replacement and caloric supplementation in
patients who can’t maintain adequate oral intake or are restricted
from doing so
Action: Provides some sugar for cellular metabolism and supplies
body water
Adverse Reaction: Increases free water and may cause
intracellular edema, fluid overload, infiltration (swelling and pain
at infusion site)
Nursing Measures:
• Monitor infusion rate frequently; if signs of fluid overload, turn
off IV drip. Infusion may result in fluid overload.
• Check IV site frequently and if infiltration is noted, turn off IV
drip.
• Watch out for signs of fluid overload (distended neck veins
(JVD), rapid respirations, shallow tidal volume, fine auscultatory
crackles, dyspnea, and peripheral edema)
• Watch out for signs of infiltration (swelling and pain around IV
site).

Posted by Ray Mercado at 2:47 PM