1

Atropine
MOA:antiarrhythmics, anticholinergics, antimuscarinics. Increased HR,
decreased GI and respiratory secretions. Reverses muscarinic effects. Inhibit
acetylcholine sites in smooth muscle, secretory glands, CNS. Low doses
decrease Sweating, Salivation, Respiratory secretions. Intermediate doses:
Mydriasis, Cycloplegia. ^HR; GI & GU motility.
Indications: IM: Preoperatively for oral & respiratory secretions. IV:sinus
bradycardia and heart block, Reversal of adverse muscarinic effects of
anticholinesterase agents. IM:IV: anticholinesterase poisoning. Inhalan:
bronchospasm
Contraindications: Hypersensitivity; Angle-closure glaucoma; Acute hemorrhage;
Tachycardia secondary to cardiac insufficiency or thyrotoxicosis; Obstructive
disease of the GI tract.
Adverse Reactions:tachycardia, blurred vision, dry mouth, urinary hesitancy,
drowsiness
Dose:
PREANESTHESIA:
IM, IV: Subcut(Adults): 0.4–0.6 mg 30–60 min preop
BRADYCARDIA:
IV: 0.5–1 mg; may repeat PRN q5 min, not to exceed total of 2 mg
MUSCARINIC EFFECTS:
0.6–12 mg for each 0.5–2.5 mg of neostigmine or 10–20 mg of pyridostigmine
BRONCHOSPASM:
0.025–0.05 mg/kg/dose q4-6HR PRN
Nursing Considerations: Assess VS, ECG during IV. Report HR, BP. I&O’s
(urinary retention). Abd distention and bowel sounds.
Lab Values: Overdose treated with physostigmine.
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Midazolam || Nayzilam, Seizalam

MOA: antianxiety agents, anticonvulsants, sedative/hypnotics. Short-term
sedation, postoperative amnesia. Terminate seizure activity. Causes CNS
depression. Mediated by GABA.
Indications: PO:pre procedure anxiolysis. IM:IV: preoperative
sedation/anxiolysis/amnesia: Status epilepticus. Intranasal: acute seizure
activity.
Contraindications: Cross-sensitivity with other benzodiazepines may occur;
Shock; Comatose patients or those with pre existing CNS depression;
Uncontrolled severe pain; Acute angle-closure glaucoma.
Adverse Reactions: CARDIC ARREST, SUICIDAL THOGUHTS, APNEA, LARYNGOSPASM,
RESPIRATORY DEPRESSION Phlebitis.
Dose:
PREOPERATIVE SEDATION/ANXIOLYSIS/AMNESIA
IM (<60yr) 0.07–0.08 mg/kg 1 hr before surgery
IM (>60yr, chronically ill) 0.02–0.03 mg/kg 1 hr before surgery
CONSCIOUS SEDATION (SHORT)
IV (>12yr, <60yr)1–2.5 mg initially; dosage may be ↑ further PRN. Total doses
>5 mg are rarely needed
IV Geriatric, Chronically Ill 1–1.5 mg initially; dose may be ↑ further PRN.
Total doses >3.5 mg are rarely needed
STATUS EPILEPTICUS
IM 10 mg single dose
SEIZURE CLUSTERS
IM 10 mg single dose
INDUCTION
IV 300–350 mcg/kg initially (up to 600 mcg/kg total)
IV Geriatric >55yr 150–300 mcg/kg as initial dose. May give additional dose of
25% of initial dose if needed.
IV Debilitated 150–250 mcg/kg initial dose
SEDATION cc
IV 0.01 -- 0.05 mg/kg (0.5 -- 4 mg in most adults) initially if a loading
dose. Repeat q10-15 pRN. Follow up infusion 0.02–0.1 mg/kg/hr
Nursing Considerations: Asses level of sedation 2-6hr post administration.
Monitor BP, pulse, RR. O2 and CPR equipment available. Risk for addiction,
abuse, misuse.
Lab Values: W/ overdose, monitor pulse, RR, BP. Patent airway. Hypotension
treated w/ IV fluid, repositioning, and vasopressors. Reversed w/ flumazenil.
 3

Norepinephrine || Levophed
MOA: Vasopressors. Increase BP, CO. stimulate alpha-adrenergic receptors in
blood vessels (vasoconstriction). Minor beta-adrenergic activity.
Indications: Produces vasoconstriction and myocardial stimulation after
hypotension & shock.
Contraindications: Vascular, mesenteric, or peripheral thrombosis; Hypoxia;
Hypercarbia; Hypotension secondary to hypovolemia. Bisulfite hypersensitivity.
Adverse Reactions: anxiety, dizziness, headache, insomnia, restlessness,
tremor, weakness. dyspnea. arrhythmias, bradycardia, chest pain, hypertension.
↓ urine output, renal failure. hyperglycemia. metabolic acidosis.
Dose:
IV 0.5–1 mcg/min initially, followed by maintenance infusion of 2–12 mcg/min
titrated by BP response
Nursing Considerations: Monitor BP q2-3 min until stabilized. Then q5
thereafter. Maintain systolic 80-100 mmHG. ECG, CVP, intra-arterial pressure,
pulmonary artery diastolic pressure, pulmonary capillary wedge pressure, and
CO. Urine output. Assess IV site for phlebitis.
Lab Values: Overdose, discontinue and administer fluid and electrolytes.
Alpha-adrenergic blocking agent treats hypertension.
 4

Fentanyl (parenteral) || Sublimaze

MOA: Opioid analgesics. Anesthesia supplement. Analgesic. Bind to opiate
receptors in CNS, produces CNS depression.
Indications: supplement general anesthesia. Induction/maintenance of
anesthesia. Regional/local anesthetic. Preoperative and postoperative pain.
Contraindications: Hypersensitivity; cross-sensitivity among agents may occur;
Known intolerance.
Adverse Reactions: APNEA, LARYNGOSPASM, respiratory depression. Arrhythmias,
bradycardia, hypotension. Facial itching. Blurred vision. N/V. Confusion,
paradoxical excitation/delirium.
Dose:
PREOPERATIVE
IM, IV 50–100 mcg 30–60 min before surgery
GENERAL ANESTHESIA ADJUNCT
IM, IV Low dose–minor surgery—2 mcg/kg. Moderate dose–major surgery—2–20
mcg/kg. High dose–major surgery—20–50 mcg/kg
POSTOPERATIVE
IM, IV 50–100 mcg; may repeat in 1–2 hr
GENERAL ANESTHESIA
IV 50–100 mcg/kg
SEDATION/ANALGESIA
IV 0.5–1 mcg/kg/dose, may repeat after 30–60 min.
Nursing Considerations: Assess pain before and after administration. BP, RR
b/c respiratory depression. May cause sleep-related breathing disorders.
Assess risk of opioid addiction, abuse, misuse.
Lab Values: May elevate serum amylase and lipase.
 5

Sodium Bicarbonate || Bell-Ans, Citrocarbonate,

Neut, Soda Mint
MOA: antiulcer. Alkalinizing agent. Alkalinization. Neutralization of gastric
acid. Releases bicarb, neutralizing gastric acid.
Indications: PO, IV: metabolic acidosis, alkalinize urine. PO: antacid
Contraindications: Metabolic or respiratory alkalosis; Hypocalcemia;
Hypernatremia; Excessive chloride loss; As an antidote following ingestion of
strong mineral acids; Patients on sodium-restricted diets; Renal failure; abd
pain of unknown cause.
Adverse Reactions: metabolic alkalosis
Dose:
ALKALIZATION OF URINE
PO 48 mEq (4 g) initially. Then 12–24 mEq (1–2 g) every 4 hr (max 48 q4hr)
ANTACID
PO Tablets/powder—325 mg–2 g 1–4 times daily or ½ tsp every 2 hr as needed.
Effervescent powder—3.9–10 g in water after meals; patients >60 yr should
receive 1.9–3.9 g after meals.
SYSTEMIC ALKALINIZATION/CARDIAC ARREST
IV Cardiac arrest/urgent situations— 1 mEq/kg; may repeat 0.5 mEq/kg every 10
min. Less urgent situations—2 5 mEq/kg as a 4–8 hr infusion
RENAL TUBULAR ACIDOSIS
PO 0.5–2 mEq/kg/day in 4–5 divided doses.
Nursing Considerations: Assess fluid balance (I&O’s, weight, edema). Acidosis
signs (disorientation, headache, weakness, dyspnea, hyperventilation),
alkalosis (confusion, irritability, paresthesia, tetany, altered breathing
pattern), hypernatremia (edema, weight gain, hypertension, tachycardia, fever,
flushed skin, mental irritability), or hypokalemia (weakness, fatigue, U wave
on ECG, arrhythmias, polyuria, polydipsia). IV extravasation. Epigastric/abd
pain; frank or occult blood in stool, emesis, gastric aspirate.
Lab Values: Monitor serum sodium, potassium, calcium, bicarbonate
concentrations, serum osmolarity, acid-base balance, and renal function prior;
ABGs; urine pH.
 6

Narcan || Naloxone
MOA: opioid antidote. Reverse signs of opioid excess. Block opioid effects
(CNS and respiratory depression) w/o opioid-like effects.
Indications: Reversal of CNS depression and respiratory depression because of
suspected opioid overdose.
Contraindications: Hypersensitivity
Adverse Reactions: VENTRICULAR ARRHYTHMIAS, hypertension, hypotension. nausea,
vomiting.
Dose:
POSTOPERATIVE OPIOID-INDUCED RESPIRATORY DEPRESSION
IV 0.02–0.2 mg every 2–3 min until response obtained; repeat every 1–2 hr if
needed.
OPIOID-INDUCED RESPIRATORY DEPRESSION DURING CHRONIC USE
IV:IM:Subcut >40Kg 20–40 mcg (0.02–0.04 mg) given as small, frequent (every
min) boluses or as an infusion titrated to improve respiratory function
without reversing analgesia.
IV:IM:Subcut <40Kg 0.005–0.02 mg/dose given as small, frequent (every min)
boluses or as an infusion
OPIOID-INDUCED PRURITUS
IV 2 mcg/kg/hr continuous infusion, may ↑ by 0.5 mcg/kg/hr every few hrs if
pruritus continues.
OPIOID OVERDOSE
IV:IM:Subcut Patients not suspected of being opioid dependent —0.4 mg (10
mcg/kg); may repeat every 2–3 min (IV route is preferred). Some patients may
require up to 2 mg. Patients suspected to be opioid dependent—Initial dose
should be ↓ to 0.1–0.2 mg every 2–3 min.
Nursing Considerations: RR,rhythm, depth; pulse, ECG, BP; LOC q3-4 hr after
expected peak of blood concentration. Dilute and administer slowly. Assess
pain. Assess opioid withdrawal (restlessness, lacrimation, rhinorrhea,
yawning, perspiration, chills, myalgia, mydriasis, irritability, anxiety,
backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia,
vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart
rate).
Lab Values: monitor pain level; opioid levels.
 7

Flumazenil || Anexate, Romazicon

MOA: Antidote. Reverse benzodiazepine. derivative that antagonizes the CNS
depressant effects of benzodiazepine compounds.
Indications: Complete/partial reversal of effects of benzodiazepines used as
general anesthetics, or during diagnostic or therapeutic procedures.
Contraindications: Hypersensitivity to flumazenil or benzodiazepines; Patients
receiving benzodiazepines for life-threatening medical problems, including
status epilepticus or ↑ intracranial pressure; Serious cyclic antidepressant
overdose.
Adverse Reactions: SEIZURES, N/V, dizziness.
Dose:
REVERSAL OF CONSCIOUS SEDATION OR GENERAL ANESTHESIA
IV 0.2 mg. Additional doses may be given at 1-min intervals until desired
results are obtained, up to a total dose of 1 mg. If resedation occurs,
regimen may be repeated at 20-min intervals, not to exceed 3 mg/hr
SUSPECTED BENZODIAZEPINE OVERDOSE
IV 0.2 mg. Additional 0.3 mg may be given 30 sec later. Further doses of 0.5
mg may be given at 1-min intervals, if necessary, to a total dose of 3 mg.
Usual dose required is 1–3 mg. If resedation occurs, additional doses of 0.5
mg/min for 2 min may be given at 20-min intervals
Nursing Considerations: Asses LOC and respiratory status. Observe for 2 hrs
after administration for resedation. Hypoventilation. Seizure precautions. 15-
30 sec IV push.
Lab Values: Time and amount of benzodiazepine ingested.
 8

Dextrose 50% || Dextrose Monohydrate

MOA: glucose elevating agent. Resotres BG levels in hypoglycemia.
Indications: Insulin hypoglycemia (hyperinsulinemia or insulin shock). IV
infusion for calories in patients w/ oral intake restrictions and inadequate
nutritional requirements.
Contraindications: Intracranial/intraspinal hemorrhage; delirium tremens.
Blood products and D50% w/o electrolytes (pseudoagglutination).
Adverse Reactions: Hyperosmolar syndrome = mental confusion and/or loss of
consciousness. Febrile response, infection at injection site, VTE, phlebitis,
extravasation, hypervolemia.
Dose:
PIV: 0.5 g/kg/hr. Insulin-induced hypoglycemia 10-25g IV injection.
Nursing Considerations: Document VS, edema, lung sounds, heart sounds. Monitor
for fluid deficiency. Ideally administered through a central line.
Lab Values: Monitor blood glucose levels; hyperglycemia.
 9

Haloperidol || Haldol Haldol Decanoate

MOA: antipsychotic. Diminished signs and symptoms of psychoses. Improved
behavior in children with Tourette’s syndrome or other behavioral problems.
Alters dopamine’s effect in the CNS; anticholinergic and alpha-adrenergic
blocking.
Indications: schizophrenia, manic states, drug-induced psychoses. aggressive
or agitated patients. Tourette’s syndrome. N/V from surgery or chemotherapy.
Contraindications: Hypersensitivity; Angle-closure glaucoma; Bone marrow
depression; CNS depression; Parkinsonism. Severe liver or cardiovascular
disease (QT interval prolonging conditions); Some products contain tartrazine,
sesame oil, or benzyl alcohol and should be avoided in patients with known
intolerance or hypersensitivity; Lactation
Adverse Reactions: TORSADES DE POINTES, AGRANULOCYTOSIS, SEIZURES, NEUROLEPTIC
MALIGNANT SYNDROME blurred vision, dry eyes, constipation, dry mouth,
extrapyramidal reactions.
Dose:
PO Adult 0.5–5 mg 2–3 times daily
PO Geriatric 0.5–2 mg twice daily initially; may be gradually ↑ as needed.
IM Adult Haloperidol lactate—2–5 mg every 1–8 hr (not to exceed 100 mg/day)
IV Adult Haloperidol lactate—0.5–5 mg, may be repeated every 30 min
(unlabeled)
Nursing Considerations: Assess mental status (orientation, mood, behavior).
Positive (hallucination, delusions) and negative (social isolation) symptoms
of schizophrenia. Weight and BMI. Monitor BP (sitting, standing, lying) and
pulse prior to and frequently during the period of dose adjustment. May cause
QT interval changes on ECG. Med is truly administered. I&O’s (dehydration in
geriatric patients). Assess fluid intake and bowels. Akathisia (restlessess).
Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face,
and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled
chewing; rapid or worm-like movements of tongue, excessive eye blinking).
Report immediately; may be irreversible. Monitor for development of
neuroleptic malignant syndrome (fever, respiratory distress, tachycardia,
seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe
muscle stiffness, loss of bladder control). Report symptoms immediately. May
also cause leukocytosis, elevated liver function tests, elevated CK. Fall
risk.
Lab Values: Monitor CBC with differential and liver function tests
periodically during therapy.
 10

Benadryl || Diphenhydramine
MOA: allergy, cold, cough remedy, antihistamine, antitussives. Decreased
symptoms of histamine excess (sneezing, rhinorrhea, nasal and ocular pruritus,
ocular tearing and redness, urticaria). Relief of acute dystonic reactions.
Prevention of motion sickness. Suppression of cough. Antagonizes histamine
effects at H1 receptor sites. CNS depressant and anticholinergic properties.
Indications: Relief of allergic symptoms caused by histamine release
including: Anaphylaxis, Seasonal and perennial allergic rhinitis, Allergic
dermatoses. Parkinson’s disease and dystonic reactions from medications. Mild
nighttime sedation. Prevention of motion sickness. Antitussive
Contraindications: Hypersensitivity; Acute attacks of asthma; Lactation; EtOH
intolerance.
Adverse Reactions: anorexia, dry mouth, drowsiness.
Dose:
PO Adult
Antihistamine/antiemetic/antivertiginous—25–50 mg every 4–6 hr, not to exceed
300 mg/day. Antitussive—25 mg every 4 hr as needed, not to exceed 150 mg/day.
Antidyskinetic—25–50 mg every 4 hr (not to exceed 400 mg/day).
Sedative/hypnotic—50 mg 20–30 min before bedtime
IM, IV Adult
25–50 mg every 4 hr as needed (may need up to 100-mg dose, not to exceed 400
mg/day).
IV push 25 mg/min
Topical Adult
Apply to the affected area up to 3–4 times daily.
Nursing Considerations: determine indication. May cause sedation and
confusion. Monitor delirium, anticholinergic side effects, fall risk. Assess
for urticaria and airway patency; nasal stuffiness, rhinorrhea, sneezing;
movement disorders; sleep patterns; N/V, bowel sounds, abd pain; cough nature,
sputum, lung sounds; itching.
Lab Values: May ↓ skin response to allergy tests. Discontinue 4 days before
skin testing