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Anticholinergics Dosage Bradycardia: 0.5 mg IV every 3-5 mins, max of 0.04 mg/kg
Cardiac Arrest: 1 mg every 3-5 mins Nerve and Organophosphate symptoms: may
repeat in 2 mg increments q 3 mins titrated to relief symptoms Indication Pre-op
meds/pre-anesthetic meds To restore cardiac rate and arterial pressure during
anesthesia when vagal To lessen the degree of A-V heart block To overcome severe
carotid sinus reflex Antidote for cholinergic toxicity Side effects y CNS: restlessness,
ataxia, disorientation, hallucinations, delirium, coma, insomnia, agitation, confusion.
y CV: tachycardia, angina, arrhythmias, flushing. y EENT: photophobia, blurred
vision, mydriasis. y GI: dry mouth, constipation, vomiting. y GU: urine retention. y
Hematologic: leukocytosis y Other: anaphylaxis Adverse effects CNS: headache,
excitement. CV: palpitations GI: thirst, nausea Contraindications Hypersensitivity
With acute angle closure glaucoma, obstructive uropathy, obstructive disease of GI
tract, paralytic ileus, toxic megacolon, intestinal atony, unstable CV status in acute
hemorrhage, asthma, or myasthenia gravis. Pregnant women.
tremor, seizures, miosis, visual disturbances, suppression of cough reflex CV: Facial
flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia,
palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension,
syncope Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm, bronchospasm,
edema GI: Nausea, vomiting, anorexia, biliary tract spasm; increased colonic motility
in patients with chronic ulcerative colitis GU: Ureteral spasm, spasm of vesical
sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido
or potency Respiratory:Respiratory depression, apnea, circulatory depression,
respiratory arrest, shock, cardiac arrest Contraindications Hypersensitivity to opioid
Diarrhea caused by poisoning until toxins are eliminated During labor or delivery of a
premature infant After biliary tract surgery or following surgical anastomosis
Pregnancy Labor Nursing Management Interventions Caution patient not to chew or
crush controlled-release preparations. Dilute and administer slowly 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
Reassure patients that they are unlikely to become addicted Teaching points Take this
drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives, tranquilizers,
over-the-counter drugs. Swallow controlled-release preparation (MS Contin,
Oramorph SR) whole; do not cut, crush, or chew them. Do not take leftover
medication for other disorders, and do not let anyone else take your prescription.
These side effects may occur: Nausea, loss of appetite, constipation, dizziness,
sedation, drowsiness, impaired visual acuity Report severe nausea, vomiting,
constipation, shortness of breath or difficulty breathing, rash.
Dosage i PO: 30-120 mg, 3-4x daily or 60-120 mg twice daily as SR capsules IV:
0.25 mg/kg i Action i
i Indication i i i i
iii
Inhibits calcium transport into myocardial smooth muscle cells Systemic and coronary
vasodilation Hypertension Angina Pectoris Supraventricular Arrhythmia Atrial
flutter/fibrillation
Dosage Arrhythmia: i IV: 0.7-1.4 mg/kg body weight. No more than 200 mg within 1
hour period i IM: 4-5 mg/kg body weight Action Increases electrical stimulation of
ventricle and His-purkinje system by direct action on tissues, resulting to decrease
depolarization, automaticity and excitability in ventricles during diastolic phase
Indication
iiiii
Esophageal varices
Side Effects and Adverse Reactions i CNS: tremor, headache, vertigo i CV:
vasoconstriction, arrhythmias, cardiac arrest, myocardial ischemia, circumollar pallor,
decreased CO, angina i GI: abdominal cramps i GU:uterine cramps i Respi:
bronchoconstriction i Skin: diaphoresis, gangrene and urticaria Contraindications i
With chronic nephritis and nitrogen retention i Hypersensitivity Nursing Management
i Give 1-2 glass of H20 to reduce adverse reactions and improve therapeutic response
i Warm vasopressin in your hands and mixed until it is distributed evenly in the
solution i Monitor urine Sp. Gravity and I&O to aid evaluation of drug effectiveness
ii
Monitor I&O. make sure urine output is 100 ml or more in 4 hrs pd before each dose
Take appropriate seizure precautions Keep IV Ca gluconate at bedside
Indication i i
Mg replacement Arrhythmia
Side Effects and Adverse Reactions i CNS: drowsiness, depressed reflexes, flaccid
paralysis, hypothermia i CV: hypotension, flushing, bradycardia, circulatory collapse,
depressed cardiac function EENT: diplopia i Respiratory: respiratory paralysis i i
Metabolic: hypocalcemia i Skin: diaphoresis Contraindications i Heart block and
myocardial damage i Toxemia of pregnancy Nursing Management
iii
1. 2. 3. 4. 5.
Monitor wt., BP and PR Monitor fluid, I&O, electrolyte, BUN and CO2 levels
frequently WOF signs of hypokalemia Monitor uric acid levels Monitor glucose
levels esp in DM pts
NEUROSURGICAL DRUGS
MANNITOL Osmitrol Classification Diuretics Dosage i
Assess respiratory status frequently Respiratory rate increases within 1-2 mins
Nursing Management i Monitor VS,CVP,I&O, renal function fluid balance and urine
K levels daily. i Drug can be used to measure GFR i Do not give electrolyte free
solutions with blood. If blood id given simultaneously, add at least 200 meq of NaCL
to each liter
ii
ii
Test dose for marked oliguria or suspected inadequate renal function: 200 mg/kg or
12.5 gram as a 15% to 20% IV solution over 3-5 mins response is adequate if 30-50
ml of urine/hr is adequate, a second dose is nd given if still no response after 2 dose
stop the drug Oliguria: 50 over 90 mins to several hrs To induced intraocular or
intracranial pressure: 1.5-2 gram/kg as a 15 % to 20% IV solution over 3060 min
Diuresis in drug intoxication: 12.5% to 10% solutions up to 200 g IV Irrigating
solution during TURP: 2.55%
POISONING
NALOXONE HCL Narcan Classification Miscellaneous antagonists and antidotes
Dosage For suspected opioid induced respiratory depression: 0.4 to 2 mg IV, IM and
SQ. repeat doses q 2-3 mins PRN For postoperative opiod depression: 0.01 to 0.2 mg
IV q 2-3 mins, PRN. Repeat dose within 1-2 hr, if needed. Action Reverse the effects
of opiods, psychotomimetic and dysphoric effects of agonist-antagonists Indication
SHOCK
DOPAMINE Intropine Classification Adrenergic drugs Dosage Initially 2-5
mcg/kg/min by IV Action Stimulates dopaminergic and alpha and beta receptors of
the sympathetic nervous system resulting in positive inotropic effect and increased
CO Indication To treat shock and correct hemodynamic imbalances To correct
hypotension To improve perfusion of vital organs To increase CO Side Effects CNS:
headache an anxiety CV: tachy, angina, palpitations and vasoconstriction GI: nausea
and vomiting Contraindications Hypersensitivity With uncorrect tachyarrhythmias
Pheochromocytoma Ventricular Fibrillation Nursing Management Most patients
received less than 20 mcg/kg/min Drugs isn¶t substitute for blood or fluid volume
deficit During infusion, monitor ECG, BP, CO, PR and color and temp of the limbs
Do not confuse dopamine to dobutamine Check urine output often