Emergency Drugs

(A Drug Study)

Submitted by:

Bajado, Marichu B.

OC: Group 19

Submitted to:

Mr. Wilfred Tanyag

 1) AMINOPHYLLINE

BRAND NAMES: Theofil amp

CLASSIFICATION: Antiasthmatic
DOSAGE: Initial: 225-450 mg twice daily, increased if needed. IV Acute severe bronchospasm. Loading
dose: 5mg/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 MANAGEMENT:
 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.
 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.
 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.
 Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular heartbeat.

2) ATROPINE SULFATE

BRAND NAMES: Anespin amp Atropol amp Euro-Med Atropine Sulfate amp
CLASSIFICATION: Other Cardiovascular Drugs, Muscle Relaxants, Mydriatic Drugs, Antidotes, Detoxifying
Agents, Drugs Used in Substance Dependence, anti-cholinergic
INDICATION/DOSAGE: IV Bradycardia 500 mcg every 3-5 mins. Total: 3 mg. IV/IM Organophosphorus
poisoning 2mg 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.
NURSING CONSIDERATION:
 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.

3) 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; antidote for magnesium sulfate toxicity
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 CONSIDERATIOn:
 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.

4) CAPTOPRIL

BRAND NAMES: Capomed tab; Capotec tab; Capoten tab; Captor tab; Captril tab; Cardiovaz tab
CLASSIFICATION: ACE Inhibitors
INDICATION/DOSAGE: 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 CONDSIDERATION:
 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 careprovider.

5) 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: 750mcg 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 consideration:
 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 lightheadedness 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.

6) 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 Consideration:
 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.

7) 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 considerations:
 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.
 8) 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.

9) 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, S 2
Classification: Sympathomimetic, Alpha-adrenergic agonist, Beta 1and 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 (beta 1 receptors);
bronchodilation,
vasodilation, and uterine relaxation (beta 2 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).

10) 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

11) 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.

12) 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 Consideration:
 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.

13) 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 considerations:
 Monitor BP and heart rate.
 Assess location, duration, intensity, and precipitating factors of anginal pain.

14) 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 consideration:
 Monitor BP and heart rate.
 Assess location, duration, intensity, and precipitating factors of anginal pain.

15) 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 consideration:
 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.
 16) 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 consideration:
 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.

17) METOCLOPRAMIDE

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

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 consideration:
 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).

18) 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 consideration:
 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.

19) 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
yr5-10 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 consideration:
 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.

20) 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 consideration:
 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

21) 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
4hrly. 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 CONSIDERATION:
 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.