Emergency

Medication
Under supervision
Dr. Shrief Saber
Dr. Mohamed Sobhy
 Participants
❖Hossam Abdurrahman Abdelfattah
❖Hassan Gamal Hassan
❖Hasan Mohamad Hasan
❖Zyad Bushra Hemeda
❖Abdurrahman Emad Fawzy
❖Abdurrahman Mohamad Mostafa
❖Eman Salah Basha
❖Eman Assem Ali
❖Aya Mohamad Hasan
❖Aya Hesham Elyan
❖ Basmla Youssef Saleh
❖ Khadra Esmaeel
❖ Rozzaline Abdullah Yousef
❖ Abla Bakry Mohammed
❖ Zainab Hosney Mohamad
❖ Zahra Ali Idrees
❖ Sara Khaled Fahmy
❖ Shimaa Ahmed Ebrahem
❖ Shimaa Taj-al-serr Mohamad
❖ Sabreen Seraj Omar
Objectives:
at the end of Presentation , each student will be able to :
 ▪ Adrenaline
▪ Noradrenaline
▪ Dopamine
▪ Dobutamine
▪ Tridil
Outlines ▪ Atropine
▪ Streptokinase
▪ KCL
▪ Epanutin
▪ Lasix, mannitol, Aldactone
Adrenaline (Epinephrine)
 Adrenaline (Epinephrine)
1. Action:
• Epinephrine, an active principle of the adrenal medulla, is a direct-acting
sympathomimetic (are agents which in general mimic responses due to
stimulation of sympathetic nerves).
• Itstimulates α- and β-adrenergic receptors resulting in relaxation of smooth
muscle of the bronchial tree, cardiac stimulation and dilation of skeletal muscle
vasculature.
• has a greater affinity for beta receptors in small doses. However, large doses
produce selective action on alpha receptors.
 Adrenaline (Epinephrine)

Indications:

Anaphylactic Acute asthma 1st or 2nd degree

Cardiac arrest
shock attack heart blocks

Topically to
Local anesthesiaý
Wide-angled control bleeding
Septic
Glaucoma (e.g., nasal
shock
hemostasis)
 Adrenaline (Epinephrine)
3.Side effect
• Cardiac: hypertension, tachycardia, palpitations, angina , Ventricular
Fibrillation (VF),
• Neurological: restlessness, nervousness, anxiety, tremors, headache, rowdiness,
fear, dizziness, impaired memory.
• Respiratory: pulmonary edema , Respiratory difficulties
• Skin: necrosis from vasoconstriction
• Gastrointestinal : nausea, vomiting
• Other: hemorrhage at injection site
 Adrenaline (Epinephrine)
4. Nursing intervention
• Monitor BP, pulse, respirations, and urinary output.
• •observe patient closely following IV administration.
• Do not use a peripheral vein (risk of extravasation)
• Give via a central vein via accurate infusion pump
• Dilute with normal saline or (Dx 5%)
• Continuous hemodynamic used monitoring
• Epinephrine may widen pulse pressure. If disturbances in cardiac
rhythm occur, withhold epinephrine and notify physician immediately.
 Adrenaline (Epinephrine)
4.Nursing intervention
• Use cardiac monitor with patients receiving epinephrine
IV. Have full crash cart immediately available.
• Check BP repeatedly when epinephrine is administered
IV during first 5 min, then q3–5min until stabilized.
Maintain continuous ECG monitoring
• Advise patient to report to physician if symptoms are not
relieved in 20 min or if they become worse following
inhalation.
 Adrenaline (Epinephrine)
4. Nursing intervention
• Advise patient to report bronchial irritation, nervousness, or
sleeplessness or headache Dosage should be reduced.
• Monitor blood glucose & HbA1c for loss of glycemic control
if diabetic.
• Never interrupt an intravenous infusion of medication to
administer an IVPB or other medication.
• Extravasation of epinephrine may cause tissue necrosis to
skin. Therefore, monitor IV site every hour.
Noradrenaline
 Noradrenaline
1.Mechanism of action:
• Norepinephrine functions as a peripheral
vasoconstrictor by acting on alpha-
adrenergic receptors. It is also an inotropic
stimulator of the heart and dilator of
coronary arteries as a result of its activity at
the beta-adrenergic receptors.
 2. Indication:

Noradrenaline • Mainly used to treat patients in vasodilatory

shock states such as septic shock and neurogenic
shock and has shown a survival benefit over
dopamine. Also used as a vasopressor
medication for patients with critical
hypotension.
 3. Side effects:

1.CNS: Headache, anxiety, insomnia and tremors.

Noradrenaline 2. CVS system: Reflex bradycardia, severe hypertension

,arrhythmia and severe vasoconstriction.
3.Skin: Irritation, extravasation and necrosis.
4. Respiratory system: Respiratory difficulty (dyspnea).
5. Gu system: Urine retention.
6. Metabolism: Hyperglycemia.
 Noradrenaline
4.Nursing management:
• Check blood pressure every 2 minutes until
desired pressure is achieved.
• Recheck every 5 minutes for duration of infusion.
• Dilute with normal saline or glucose 5%.
(Preferable to use glucose 5%).
• Don't leave patient unattended during infusion.
• Don't connect to CVP lumen used for monitoring
central venous pressure.
 Noradrenaline
4. Nursing management:
• Don't discontinue drug abruptly.
• Don't use a peripheral vein (risk of extravasation).
• Give via a central vein via accurate infusion
pump.
• Assess urine output carefully.
• Assess blood glucose level frequently and manage
for hyperglycemia.
Dopamine
 Dopamine
1. Action :
• Is a neurotransmitter made in the brain .
• Basically , It acts as a chemical messenger between
neurons .
• It acts on D, Beta 1,Alpha 1reseptors "depending on
the dose administrated ".
• It doesn't acting alone .
• it works with other neurotransmitter and hormones
such as sertonin, adrenaline.
 Dopamine

2. Dopamine dose
• 2-5μg/kg/min increases renal and mesenteric blood
flow by stimulating dopamine receptors.
• 5-10μg/kg/min: b 2 effects The renal blood flow
results in increase GFR and renal sodium excretion.
• stimulating cardiac contractility and HR .
• >10μg /kg/min: alpha effects causing arterial
vasoconstriction and -increasing BP
 Dopamine
3.Indication of Dopamine:
• mild or moderate liver impairment
• Renal failure
• Correction of imbalances present in:
o A_ Shock syndrome due to myocardial infarction
o B_ Trauma
o C_ Endotoxic septicemia
 Indication of Dopamine:

Hypotension
Dopamine
decreased Cardiac output

poor perfusion of vital organs

Bradycardia
 Dopamine

Side effect of dopamine:

darkening or
Chest pain. Dyspnea. Anxious Headache.
skin changes

Hyperglycemia Nausea, Irritation at

Hypotension. Vasoconstriction
vomiting. injection site.
 Dopamine
5. Nursing care:
• Correct hypovolemia with fluid resuscitation before
initiating dopamine infusion.
• Continuous hemodynamic monitoring (BP,HR,CVP,
peripheral pulse) every 15 minutes.
• Assess urine output every hour.
• ECG monitoring and blood pressure.
• Recheck every 5 minutes for duration.
• Assess blood glucose level.
• Monitor infusion site for extravasation.
Dobutamine
 Mechanism of action:

• Primarily activates β1 receptors of the heart , increasing

contractility ( positive inotropic effect ) , Thus increases
Dobutamine cardiac output , but has minor or no chronotropic effect (
without significantly increase in heart rate ) .
• •Minor β2 , α1 stimulation .
 Indication:

• Dobutamine is indicated for patients who require

positive inotropic support in the treatment of cardiac
decompensation due to depressed myocardial
contractility ( cardiogenic shock ) resulting from either
organic heart disease or from cardiac surgery.
Dobutamine
• Dobutamine stimulates heart muscle and improves blood
flow by helping the heart pump better. Dobutamine is
usually given after other heart medicines have been tried
without success.
 1- Heart:
• Increase heart rate
• Increase blood pressure
• Chest pain
• Palpitation
Dobutamine 2- Local: Inflammation of vein
Side Effects
3- GIT : Nausea and vomiting

4- CNS :
• Headache • Tremors
• Mild leg cramps • Nervousness
• Paresthesia • Fatigue (overdose)
 Dobutamine

Nursing Intervention

Heart rate. Assess for hypovolemia; if Monitor Monitor ECG

present, correct before hemodynamics continuously and note
Blood pressure. continuously : arrhythmias.
beginning treatment with
CVP. dobutamine.
 Nursing Intervention:

• Monitor peripheral pulse before, during and after

therapy.

Dobutamine • Monitor intake & output ( urinary output ) .

• Weigh patient daily.

• Monitor potassium concentration , because may cause

hypokalemia.

• Assess skin reactions may occurs with hypersensitivity.

• Observe for side effects.
Tridail
Tridail
1. Action
• Nitroglycerin works by relaxing the smooth muscle and
blood vessels in your body. This increases the amount of
blood and oxygen that reaches your heart. In turn, your
heart doesn’t work as hard. This reduces chest pain.
• Dilation of both arteries and veins; veins initially dilated
reducing preload; higher doses dilate arterioles reducing
myocardial workload and oxygen demand
• Dilation of coronary arteries
Tridail
2. Indication :
• Chest pain
o Stable angina–reduces oxygen demand of myocardium by reducing
preload
o Variant angina–enhances oxygen supply to myocardium by relaxing
and dilating coronary arteries
o Heart failure associated with acute myocardial infarction (MI)
• Pulmonary edema
o Hypertension uncontrolled by ordinary antihypertensive drugs.
o Intraoperative Complications.
o Esophageal Spasm
Tridail
3. Side effect.
• Nitroglycerin may cause the following side effects:
• headache
• vertigo (a major symptom of balance disorder)•
dizziness
• Weakness
• heart palpitations (unusual awareness of the heartbeat
• low blood pressure upon rising from a seated position
 Tridail
Side effect.

nausea and
Sweating Paleness
vomiting

flushing (warm other skin

fainting or red condition reactions that
of your skin) may be severe
Tridail
4. Nursing care :
• Check blood pressure and pulse before each
administration of NTG
• Do not discontinue NTG intravenous infusion
abruptly–it may result in precipitous rebound
hypertension, angina, or coronary artery vasospasms
• Do not discontinue NTG intravenous infusion
abruptly–it may result in precipitous rebound
hypertension, angina, or coronary artery vasospasms
warn the patient not to chew the tablets or capsules; do
not crush these preparations.
Tridail
4. Nursing care :
• WARNING: Arrange to withdraw drug gradually. 4–6 wk is
the recommended withdrawal period for the transdermal
preparations
• Report blurred vision, persistent or severe headache, rash,
more frequent or more severe angina attacks, fainting
• When taking nitroglycerin tablets, you should sit down and
stand up slowly. This eliminates the risk of falling due to
dizziness or lightheadedness
• Call your doctor or seek emergency treatment if the pain
persists after taking three tablets in a 15-minute period
Atropine
 •tropine is a prescription medicine used
to treat the symptoms of Anesthesia -
Premedication, Sinus
Bradycardia (ACLS), Bronchospasm,
and Organophosphate or
Carbamate Poisoning. Atropine may be
Atropine used alone or with other medications.

•Atropine belongs to a class of drugs

called Anesthetic Premedication Agents;
Cholinergic, Toxicity Antidotes
 Mechanism of action:
• Atropine competitively blocks the effects of
acetylcholine, including excess acetylcholine due to
organophosphorus poisoning, at muscarinic cholinergic
receptors on smooth muscle, cardiac muscle, secretory
gland cells, and in peripheral autonomic ganglia and the
Atropine central nervous system.
• Classification: Anticholinergic, muscarinic antagonist.
• Dosage forms: injectable solution (0.05 mg/mL; 0.1
mg/mL; 0.4 mg/mL; 0.4 mg/mL-NaCl 0.9%; 1 mg/mL);
intramuscular solution (2 mg/0.7 mL); intravenous
solution (0.1 mg/mL; 0.4 mg/mL-NaCl 0.9%)
 Indication:

• Increases heart rate in symptomatic bradycardia,

atrioventricular (AV) block
• Preoperative decreases secretions
Atropine
• Promotes mydriasis for retinal examination
• Decreases intestinal hypertonicity and
hypermotility (diarrhea), biliary colic
• Muscarinic agonist poisoning (e.g., bethanechol,
cholinesterase inhibitors)
 Gastrointestinal (GI) problems—obstruction, ulcers,
Atropine colitis, gastroesophageal reflux disease (GERD)

Glaucoma, tachycardia, bladder obstruction (benign

prostatic hyperplasia [BPH])

Hyperthyroid, liver or renal disease, asthma,

Precautions hypertension
&
Contraindication On the Beers list avoid use in the geriatric patient
Streptokinase
 1.Action of streptokinase:
Streptok • Streptokinase (SK) is a thrombolytic medication and
enzyme. As a medication it is used to break down clots in

inase some cases of myocardial infarction (heart attack),

pulmonary embolism, and arterial thromboembolism. The
type of heart attack it is used in is an ST elevation
myocardial infarction . It is given by injection into a vein.
 headache, dizziness,
Side effects

bleeding from
low blood
mild fever, wounds or
pressure,
gums,

Streptok rash, itching, flushing,

inase
muscle or andallergic
shivering,
bone pain, reactions.

Streptase can
also cause nausea,
nerve damage.
 3.Indications:
Acute Evolving Transmural
Myocardial Infarction: Streptase,
Streptokinase, is indicated for use
Streptok in the management of acute
myocardial infarction (AMI) in
inase adults, for the lysis of
intracoronary thrombi, the
improvement of ventricular
function, and the reduction of
mortality associated with AMI,
 3. Indications:
when administered by either the
intravenous or the intracoronary
route, as well as for the reduction
Streptok of infarct size and congestive
heart failure associated with AMI
inase when administered by the
intravenous route. Earlier
administration of Streptokinase is
correlated with greater clinical
benefit.
 3.Indications:
Pulmonary Embolism: Streptase,
Streptokinase, is indicated for the lysis of
objectively diagnosed (angiography or lung
scan) pulmonary emboli, involving
Streptok obstruction of blood flow to a lobe or multiple
segments, with or without unstable
inase hemodynamics.
Deep Vein Thrombosis: Streptase,
Streptokinase, is indicated for the lysis of
objectively diagnosed (preferably ascending
venography), acute, extensive thrombi of the
deep veins such as those involving the
popliteal and more proximal vessels.
 3.Indications:
Arterial Thrombosis or Embolism: Streptase,
Streptokinase, is indicated for the lysis of
acute arterial thrombi and emboli.
Streptokinase is not indicated for arterial
Streptok emboli originating from the left side of the
heart due to the risk of new embolic
inase phenomena such as cerebral embolism.
Occlusion of Arteriovenous Cannula:
Streptase, Streptokinase, is indicated as an
alternative to surgical revision for clearing
totally or partially occluded arteriovenous
cannulae when acceptable flow cannot be
achieved.
 4.Nursing
management:
• Donot use infusion IV line for other
medications or therapies.
• Screen patient carefully for possible
Streptok contraindications prior to fibrinolytic
therapy.
inase • Obtain baseline lab data for aPTT, PT,
INR, Hct, Hgb, and platelets prior to
beginning streptokinase therapy
• Avoid any invasive procedures on patient
during therapy and for 2 hours following
therapy.
 4.Nursing
management:
• Monitor the patient for signs of bleeding
every 15 minutes during therapy and
Streptok
hourly for next 8 hours following
therapy.
inase • Notify physician STAT if signs of
anaphylaxis or allergic reaction begin to
occur.
• Maintain continuous cardiac monitoring
during therapy and at least for the next
eight hours to watch for reperfusion
dysrhythmias.
 4.Nursing management:
• Watch for neurological alterations (like
change in mental status, level of
consciousness, seizures,
hemiparesis/hemiplegia, changes in pupils,
Streptok etc.) which may indicate cerebral
hemorrhage.
inase • Do not give any injections, draw blood
specimens (especially not arterial), or
perform any other form of venipuncture
during fibrinolytic therapy.
• Do not use noninvasive blood pressure
monitoring on patient during fibrinolytic
therapy
KCL Drug
 1.Main action of KCL :

Principal intracellular cation of most body

KCL
tissues, participates in a number of
physiologic processes—maintaining
intracellular tonicity, transmission of nerve
impulses, contraction of cardiac, skeletal,
and smooth muscle, maintenance of
normal renal function; also plays a role in
carbohydrate metabolism and various
enzymatic reactions
 2. Indications :

• Prevention
KCL and correction of potassium
deficiency; when associated with alkalosis,
use potassium chloride

• IV:Treatment of cardiac arrhythmias due to

cardiac glycosides
 3. Adverse effects

KCL • Dermatologic: Rash

• GI: Nausea, vomiting, diarrhea, abdominal discomfort,
GI obstruction, GI bleeding, GI ulceration or
perforation
• Hematologic: Hyperkalemia—increased serum K+,
ECG changes (peaking of T waves, loss of P waves,
depression of ST segment, prolongation of QTc interval
• Local: Tissue sloughing, local necrosis, local phlebitis,
and vasospasm with injection
 4. Contraindications:

• Contraindicated
KCL with allergy to tartrazine, aspirin
(tartrazine is found in some preparations marketed as
Kaon-Cl, Klor-Con); severe renal impairment with
oliguria, anuria, azotemia; untreated Addison’s disease;
hyperkalemia; adynamic episodical hereditarian; acute
dehydration; heat cramps; GI disorders that delay
passage in the GI tract.
• Use cautiously with cardiac disorders, especially if
treated with digitalis, pregnancy, lactation
 5. Nursing considerations:

Assessment:
KCL • History: Allergy to tartrazine, aspirin; severe renal
impairment; untreated Addison’s disease; hyperkalemia;
adynamia episodica hereditaria; acute dehydration; heat
cramps, GI disorders that cause delay in passage in the GI
tract, cardiac disorders, lactation.

• Physical: Skin color, lesions, turgor; injection sites; P,

baseline ECG; bowel sounds, abdominal examination;
urinary output; serum electrolytes, serum bicarbonate
 5. Nursing considerations:

Interventions:

KCL • Arrange for further dilution or dose reduction if GI effects are severe.
• Agitate prepared IV solution to prevent “layering” of potassium; do not
add potassium to an IV bottle in the hanging position.
• Monitor IV injection sites regularly for necrosis, tissue sloughing,
phlebitis.
• Monitor cardiac rhythm carefully during IV administration.
• Caution patient that expended wax matrix capsules will be found in the
stool.
• Caution patient not to use salt substitutes.
 5. Nursing considerations:

Interventions:

KCL • Arrange for serial serum potassium levels before and during therapy.
• Administer liquid form to any patient with delayed GI emptying.
• Administer oral drug after meals or with food and a full glass of water
to decrease GI upset.
• Caution patient not to chew or crush tablets; have patient swallow
tablet whole.
• Mix or dissolve oral liquids, soluble powders, and effervescent tablets
completely in 3–8 oz of cold water, juice, or other suitable beverage,
and have patient drink it slowly.
 5. Nursing considerations:

Teaching points:
KCL
• Take drug after meals or with food and a full glass of water
to decrease GI upset. Do not chew or crush tablets, swallow
tablets whole. Mix or dissolve oral liquids, soluble powders,
and effervescent tablets completely in 3–8 ounces of cold
water, juice, or another suitable beverage, and drink it
slowly. Take the drug as prescribed; do not take more than
prescribed.
 5. Nursing considerations:
Teaching points:
KCL • Do not use salt substitutes.
• You may find wax matrix capsules in the stool. The wax
matrix is not absorbed in the GI tract.
• Have periodic blood tests and medical evaluation.
• You may experience these side effects: Nausea, vomiting,
diarrhea (taking the drugs with meals, diluting them
further may help).
Epanutin
 1.Main action of epanutin:
• Epanutin ( Phenytoin) acts by slowing down
impulses in the brain that cause seizures.
• can used to control seizures but doesn't treat
all types of seizures.
Epanutin • Stabilize the CNS nerve membranes by
decreasing the excitability and
hyperexcitability of ionic channels in the
cell membrane to stimulation.
• Decreasing the conduction through nerve
pathways reduce the tonic-clonic, muscular,
and emotional responses to stimulation.
 Indications:

- Control of tonic-clonic and

psychomotor seizures, prevention
of seizures during neurosurgery,
Epanutin control of status epilepticus.

- children who is more sensitive

to the sedating effects of the drugs
so frequent and close monitoring
is required.
 2. Indications:
• Less likely to cause sedation which makes
them the drug of choice for patients who
are not willing to tolerate sedation and
Epanutin
drowsiness.

• adults who taking this drug are encouraged

to wear Medic Alert identification during
emergency instances.
 Epanutin
3. COMMON SIDE EFFECTS:
• Nausea, vomiting.
• Mental confusion.
• Dizziness, headache.
• Tremor.
• Transient nervousness.
• Insomnia.
RARE SIDE Peripheral
Rashes.
EFFECTS: neuropathy.

Gingival
hypertrophy and
Fever. Hepatitis
tenderness.- Acne
and hirsutism.
Epanutin
Lupus Toxic epidermal
Lymphadenopathy.
erythematosus. necrolysis.

Hematological
effects.
 3.NURSING ROLE:
• Doses should be adjusted carefully,
starting with low doses and
increasing gradually until seizures
are controlled or there are overdose
effects.
Epanutin
• Leukopenia that is severe,
progressive or associated with
clinical symptoms requires
withdrawal.
• Side-effects such as acne or
hirsutism may be particularly
undesirable in adolescent patients.
 3. NURSING ROLE:
• Monitoring plasma concentration
greatly assists adjustment. A few
missed doses or a small change in
absorption may result in a marked
change in plasma concentration.
Epanutin Small dosage increases in some
patients may produce large rises in
plasma concentrations with acute
toxic side effects.
• Ataxia, slurred speech, nystagmus and
blurred vision are signs of overdose.
• Avoid sudden withdrawal.
 4.PATIENT TEACHING
• Take after or preferably with
food.
• Patients or their careers should
Epanutin be told how to recognize signs
of blood or skin disorders and
advised to seek immediate
medical attention if symptoms
such as fever, sore throat, rash,
mouth ulcers, bruising or
bleeding develop.
LASIX
 1.Main action of Lasix :
Inhibits reabsorption from the ascending loop of
Henle in the renal tubule.
2. Common side-effects:
Lasix • Hyponatremia, hypokalemia, hypomagnesaemia.
• Hypochloremia alkalosis.
• Increased calcium excretion.
• Hypotension.
• Nausea.
• Dizziness
 3. Indications:

❑Pulmonary oedema due to left ventricular failure.

❑Chronic heart failure.
Lasix ❑Diuretic-resistant oedema, except for lymphoedema or
oedema due to peripheral venous stasis or calcium-
channel blockers.

❑Hypertension resistant to thiazide therapy.

❑Oliguria due to renal failure
 4. Intervention:
❑Furosemide is often given in conjunction with a potassium
supplement or a potassium-sparing diuretic to counteract potassium
loss.

❑The medication has a rapid onset of effect of about one hour when
Lasix
taken orally and five minutes by injection.

❑Duration of action is about six hours, so it is possible to use a twice

daily dose if necessary.

Assessment:
❑History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte
depletion anuria, severe renal failure; hepatic coma; SLE; gout;
diabetes mellitus; lactation, pregnancy
 4. Intervention:

❑BLACK BOX WARNING: profound diuresis with water and electrolyte

depletion can occur; careful medical supervision is required.

❑Administer with food or milk to prevent gi upset.

❑Reduce dosage if given with other antihypertensives; readjust dosage
Lasix 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.
❑Warning: 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.
Mannitol
 Mannitol
1.Action:
• When administered intravenously mannitol is confined to the
extracellular space, only slightly metabolized and rapidly
excreted by the kidneys. Approximately 80% of 100 g dose
appears in the urine in 3 hours. The drug is freely filtered by the
glomeruli with less than 10% tubular reabsorption; it is not
secreted by tubular cells. Mannitol induces diuresis by elevating
the osmolarity of the glomerular filtrate and thereby hindering
tubular reabsorption of water. Excretion of sodium and chloride
is also enhanced.
 Mannitol
2.Indication:
• Reduction of intracranial pressure and brain mass.-
Reduction of high intraocular pressure when the
pressure cannot be lowered by other means.-Promote
diuresis for acute renal failure to prevent or treat the
oliguric phase before irreversible damage.-Mannitol
can also promote diuresis to promote excretion of
toxic substances.
 Fluid and
Adverse Pulmonary
electrolyte
effects congestion.
imbalances.

electrolyte
acidosis. loss-dryness
of mouth.
thirst. Mannitol

marked
diuresis
 Mannitol
Adverse effects:

urinary retention

edema

headache

blurred vision.

convulsions.

nausea, vomiting.
 Nursing care:
monitor cardiac function as fluid shift can precipitate heart
failure.

Mannitol monitor urine output.

monitor electrolyte including sodium, potassium and

osmolality.

taking vital signs more frequently.

Aldactone
 1.Mechanism of action:
Spironolactone competitively inhibits
aldosterone dependent sodium potassium
exchange channels in the distal convoluted
Aldactone tubule. This action leads to increased
sodium and water excretion, but more
potassium retention. The increased
excretion of water leads to diuretic and
also antihypertensive effects.
 2. Indications:
• Treatment of class lll
• lV heart failure.-Management of edema
in cirrhotic adults not responsive to fluid
and sodium restrictions.
• Primary hyperaldosteronism short-term
Aldactone preoperatively.
• Hyperaldestorism long
• term in patients with aldosterone
producing adrenal adenomas.
• spironolactone has antiandrogenic
activity which can used for treatment of
hirsutism and female pattern hair loss.
 3. Adverse effects:
• Hyperkalemia.
• Men specifically may experience
gynecomastia, loss of libido, and general
feminization.
Aldactone • dehydration and hyponatremia.
• gastrointestinal problems(nausea,
vomiting, diarrhea or anorexia)
• neurologic abnormalities (headache,
drowsiness, asterixis, confusion or
coma).
 3. Nursing management:
• Monitor potassium levels.
• Assess vital signs.
• Monitor urine output.
Aldactone • monitor for gynecomastia in male
patients.
• monitor ECG changes.
• Monitor patient mental status.
• Monitor for signs of dehydration.
 Henry, J. (ed) (2004) The British Medical Association. New
Guide to Medicines and Drugs. London: Dorling Kindersley.

Mehta, D.K. et al (eds) (2005) British National Formulary.

London: BMA/Royal Pharmaceutical Society of Great Britain.

Prodigy (2005) Prodigy Knowledge. London: The Stationery

Office
References https://www.rnpedia.com/nursing-notes/pharmacology-drug-
study-notes/potassium-salts/

https://www.drugs.com/dopamine.html#side-effects

http://shadwige.sites.truman.edu/cardiac-
medications/hemodynamic-medications/dopamine-hcl/

https://www.rxlist.com/dopamine-drug.htm#precautions
Thank You