Emergency Drug Part 2

Drug

Generic Name: Sodium Bicarbonate

Brand name: Arm and Hammer Pure Baking Soda

Route of Administration: PO, IV

Dosage: ½ tsp in glass of water q 2 hr

0.325-2 grams 1-4 times per

General Action

Alkalinizing agent, Antacid, Electrolyte

Mechanism of action The antacid action is due to neutralization of HCL by forming NaCl and Co2. Provides temporary relief of peptic ulcer pain and of discomfort associated with indigestion. Although widely used by the public, sodiumbicarbonate is rarely prescribed as antacid because of its high sodiumcontent, short duration of action, and ability to cause alkalosis. Is also a systemic and urinary alkalinizer by increasing plasma and urinary bicarbonate, respectively

Contraindications

Chloride loss due to vomiting or from continous GI suction. With diuretics known to produce a hypochloremic alkalosis. Metabolic and respiratory alkalosis. Hypocalcemia in which alkalosis may cause tetany. HPN, convulsions, CHF, and other situations where administration of sodium can be dangerous. As a systemic alkalinizer when used as a neutralizing additive solution. As an antidote for strong mineral acids bec. CO2 is formed, which may cause

Indications

Hyperacidity, severe diarrhea, alkalization of the urine to treat drug toxicity, treatment of acute mild to moderate metabolic acidosis due to shock severe dehydration, anoxia, uncontrolled diabetes, renal disease, cardiac arrest, extracorporeal circulation of blood, severe primary lactic acidosis, prophylaxis of renal calculi in gout, during sulfonamide therapy to prevent renal calculi and nephrotoxicity, neutralizing solution to decrease chemical phlebitis and client discomfort due to vein irritation at or near the site of

Side Effects

Rebound hyperacidity, milk, alkali syndrome, hypercalcemia, metabolic alkalosis, tetany, diminished breathing, renal dysfunction, systemic alkalosis after prolonged use, hypernatremia, alkalosis, hyperirritability, fluid or solute overload

Nursing Responsibilities 1.hypertonic solutions must be administered by trained personel. 2.deteremind IV dose by arterial blood ph, 3.administer isotonic solutions lowly 4.note reasons for therapy, any history of renal impairment or CHF 5.assess for edema, which may indicate inability to utilize sodium bicarbonate 6. record input and output 7. do not exceed a rate of administration of 8 Meq/kg/day in

day

discomfort and even infusion of IV acid perforation. solutions.

Drug

General Action

Mechanism of action

Contraindications

Indications

infants with cardiac arrest to guard against hypernatremia

Side Effects

Nursing Responsibilities

Generic Name: Morphine Sulfate

Brand Name: Morin

Route of Administration: IM, IV, Oral, SC

Dosage:

5-20 mg IM/SC q 4 hr

2-10 mg/70 kg IV

5-30 mg oral

Analgesics

Morphine is the prototype for opiate analgesics. Morphine combines with specific receptors located in the CNS to produce various effects. The mechanism is believed to involve decreased permeability of the cell membrane to sodium, which results in diminished transmission of pain impulses and therefore analgesia

Post-biliary tract surgery or surgical anastomosis. Comatose. Resp depression & obstructive airways disease, acute bronchial asthma, heart failure secondary to chronic pulmonary disease, acute alcoholism, head injuries, raised intracranial pressure & convulsive states ie status epilepticus, tetanus or strychnine poisoning. Lactation.

Relief of moderate to severe pain not responsive to nonnarcotic 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.

Lightheadedness, dizziness, sedation, nausea, vomiting, constipation & sweating.

1. Do not confuse morphine with hydromorphone 2. 2. The contents of the immediate release capsule may be delivered through an NG or a gastric tube 3. Give intrathecally only in the lumbar region, 4. To reduce chance of side effects with intrathecal administration , do not give more than 2 ml of the 1 mg/ml product 5. For infumorph, duramorph, and astromorph PF use epidural doses of 20 mg or more

Drug

General Action

Generic Name: Anticoagulant Heparin NA

Brand Name: Britton Heparin Na® [vial]

Route of administration: SC, IV

Dosage: IV inj 5,000 u followed by SC conc soln 10,000-20,000 u

Mechanism of action Do not dissolve previously formed clots bu they do forestall their enlargement and prevent new clots from forming. It potentiates the inhibitory action of antithrombin ill on various coagulation factors including factors IIa, IXa, Xa, Xia and XIIa. This occurs due to the formation of a complex with antithrombin III and causing a conformational change in the antighrombin III molecule, inhibiton of factor Xa tesults in interference with thrombin generation thus the action of thrombin in coagulation is inhibited.

Contraindications

Hypersensitivity. Severe thrombocytopenia.

Indications

Treatment & prophylaxis of thromboembolic disorders.

Side Effects

Hemorrhage, local irritation, erythema, mild pain, hematoma or ulceration. Generalized hypersensitivity, chills, fever, urticaria, asthma, rhinitis, lacrimation & anaphylactoid reactions. Osteoporosis, aldosterone synthesis suppression, delayed transient alopecia, & priapism & rebound hyperlipidemia on discontinuation.

Nursing Responsibilities 1.do not administer IM 2. administer by deep SC through the Ztrack method 3. do not massage site 4. may be diluted in dextrose 5. note reasons for therapy. Identify any bleeding incidents 6. perform test dose 1000 units SC on clients with multiple allergies or asthma history 3. review drug profile to ensure one interact unfavorably otherwise anticipate heparin dosage adjustment

4. assess for defects in clotting mechanism or any capillary fragility: obtain baseline coagulation values.

Drug

General Action

Mechanism of action

Contraindications

Indications

Side Effects

Nursing Responsibilities

Generic Name: Paracetamol

Brand name: Acet® [-ES tab]

Route of administration: oral

Dosage: 325-1000 mg 4-6 hrly.for less than 12 y/o

10-20 mg/kg 46 hrly. For children

Analgesic, Antipyretic

paracetamol reduces the production of prostaglandins (proinflammatory chemicals). Aspirin also inhibits the production of prostaglandins, but, unlike aspirin, paracetamol has little anti-inflammatory action. Likewise, whereas aspirin inhibits the production of the pro-clotting chemicals thromboxanes, paracetamol does not. Aspirin is known to inhibit the cyclooxygenase (COX) family of enzymes, and, because of paracetamol's partial similarity of aspirin's action, much research has focused on whether paracetamol also inhibits COX. It is now clear that paracetamol acts via at least two pathways.[

Hypersensitivity.

Mild to moderate pain eg headache, toothache, myalgias. Fever. As alternative to aspirin in patients w/ viral infection, peptic ulcer disease, bronchial asthma & bleeding disorders.

Hypersensitivity reactions eg skin rashes, drug fever. Acute overdosage produce a dosedependent potentially fatal hepatocellular damage.

1. note reasons for therapy, signs and symptoms 2. review drug profile to determine if the patient takes any drugs that could interact with paracetamol 3. monitor vital signs

Drug

Generic Name: Omeprazole

Brand Name: Acifre® [cap

Route of administration: Oral

Dosage:

10-20 mg daily for 2-4 wk

General Action

Proton pump inhibitor

Mechanism of action Omeprazole is rapidly but variably absorbed following oral administration. It is acid-labile and pharmacokinetics may vary between the various formulations developed to improve oral bioavailability. The absorption of omeprazole also appears to be dosedependent. Increasing the dosage >40 mg has been reported to increase the plasma concentration in a non-linear fashion because of saturable first hepatic metabolism.

Contraindications

Lactation, use as maintenance therapy for duodenal ulcer disease. OTC use in those who have trouble or pain swallowing food, are vomiting blood or excreting bloody or black stools

Indications

Conditions where inhibition of gastric acid secretion may be beneficial including aspiration syndromes, dyspepsia, GERD, peptic ulcer disease, Zollinger-Ellison syndrome.

Side Effects

Headache, diarrhea and skin rashes; they have sometimes been severe enough to require discontinuation of treatment. Other effects rarely include athralgia and myalgia, paresthesia, aggression, blurred vision, taste, disturbance, peripheral edema, hyponatremia, blood disorders including agranulocytosis, leucopenia and thrombocytopenia, interstitial nephritis and hepatotoxicity.

Nursing Responsibilities 1.efficacy for more than 8 weeks has not been determined. However, if a client does not respond to 8 weeks of therapy, an additional 4 weeks may help. 2. consider dosage adjustment in those with impaired hepatic function especially when used for maintaining clients with erosive esophagitis. 3. can repeat OTC therapy once ever 4 months 4. store capsules and powder for oral suspension packets in

a tight container protected from light and moisture.

Drug

General Action

Mechanism of action Bronchodilator.

Generic Name: Salbutamol sulfate

Brand Name: Aero-Vent

Anti-asthma

Patients with a history of Salbutamol is a βhypersensitivity to adrenergic any of the stimulant which has components of Aero-Vent. a highly selective action on the receptors in bronchial muscle and in therapeutic

Route of Administration: nasal, parenteral

Dosage: 2.5-5 mg. May repeat qid by nebuliser. Delivery of aerosol may be

Contraindications

doses, it has little or no action on the cardiac receptors.

Indications

Treatment of acute severe asthma and in routine management of chronic bronchospasm unresponsive to conventional therapy.

Side Effects

A small increase in heart rate may occur in patients who inhale a large dosage of salbutamol. This is not usually accompanied by any changes in the electrocardiogram. Other side effects which occur with very high doses of salbutamol by inhalation are peripheral vasodilatation and the fine tremor of skeletal muscle.

Nursing Responsibilities 1. Note reasons for therapy, signs and symptoms indicating the need for therapy 2. Monitor vital signs 3. Review drugs that interact with the nebule 4. Assess for any allergies regarding the content of the drug

by face mask of "T" piece. Use undiluted. For prolonged delivery time, dilute w/ sterile water or normal saline for inj.

Drug

General Action

Mechanism of action

Contraindication s

Indications

Side Effects

Nursing Responsibilities

Generic Name: Chlorpherinamin e maleate

Antihistamine s and antiallegies

Moderate anticholinergic and low sedative activity: no antiemetic activity

Lower resp tract disease. Newborn or premature infants.

Brand name: Antamin

Allergy, allergic rhinitis, bronchial asthma, vasomotor rhinitis, dermatoses of allergic etiology, urticaria, drug sensitization, serum sickness, anaphylactic shock, insect bites.

Constipation, diarrhea, dizziness, drowsiness, dry mouth/nose/throat, headache, anorexia, anxiety, insomnia, asthenia, GI upset

Route of Administration: Parenteral, IV, Oral

Dosage: Tab 1 tab tid. Syr Adult 2 tsp tid. Childn >12 yr 1 tsp tid. Inj 1/3-1 mL IM or IV daily. Drug

General Action

Mechanism of action

Contraindication s

Indications

Side Effects

1. Note indications for therapy, other agents trialed and outcome. Attempt to identify triggers/ causative agents. 2. Perform/documen t ENT findings; note any drainage in pharynx 3. Take as directed with a full glass of water. Food delays absorption 4. Report any mental status changes, adverse effects or lack of response. May cause drowsiness; use caution 5. Avoid alcohol in any form

Nursing Responsibilities

Generic Name: Hydrocortisone

Brand Name: Candacort

Route of administration: Oral, Topical, Parenteral Dosage: 20-240 mg/day in tablet Cream: apply sparingly IM, IV, SC 15-240 mg/day

Topical antiinfectives

Short-acting about Viral infections of 80-118 min. topical the skin, TB & products are acne rosacea. available without a prescription in strengths of 0.5 and 1 percent

Topical treatment of fungal & candidal infections, when these are accompanied by pronounced inflammatory symptoms & itching.

Stinging, burning, edema, vesication, desquamation, pruritus & urticaria.

1.check label of parenteral injection because IM and I preparations are not necessarily interchangeable 2. give reconstituted direc IV solution at a rate of 100 mg over 30 sec. 3. note reasons for therapy, type, location, onset characteristics of signs and symptoms 4. descrive clinical presentation: use photographs to document as indicated 5. identify any medical conditions that may preclude therapy 6 assess weight and VS

Drug

General Action

Mechanism of action

Contraindications

Indications

Side Effects

Nursing Responsibilities

Generic Name: Diazepam Brand Name: Valium

Route of administration: Oral, parenteral, IV

Dosage: Tab Adult 5-20 mg daily. Elderly Half the usual adult dose. Childn 0.1-0.3 mg/kg body wt daily. Inj Individualised dosage.

Anxiolytics

Diazepam is a member of the group of benzodiazepine tranquilizers which exert anxiolytic, sedative, musclerelaxant, anticonvulsant and amnesic effects. This is known to be the result of facilitating the action of γaminobutyric acid (GABA), the most important inhibitory neurotransmitter in the brain.

Tablet: Known history of hypersensitivity to benzodiazepines, severe respiratory and hepatic insufficiency, sleep apnea syndrome, myasthenia gravis. Benzodiazepines are not recommended for the primary treatment of psychotic illness. Benzodiazepines should not be used alone to treat depression or anxiety associated with depression as suicide may occur in such patients. Ampoule: Known history of hypersensitivity to benzodiazepines

symptomatic relief of anxiety, tension and other somatic or psychological complaints associated with the anxiety syndrome. It can also be useful as an adjunct to the treatment of anxiety or excitation associated with psychiatric disorders. is a useful adjunct for the relief of reflex muscle spasm due to local trauma (injury,inflammation). It can also be used to combat spasticity arising from damage to spinal and supraspinal interneurons eg, cerebral palsy and paraplegia, as well as in athetosis and stiffman syndrome.

The most commonly reported adverse reactions are fatigue, drowsiness and muscle weakness; they are usually doserelated. These phenomena occur predominantly at the start of therapy and usually disappear with prolonged administration : Ataxia, dysarthria, slurred speech, headache, tremor, dizziness. Anterograde amnesia may occur using therapeutic dosages, the risk increasing at higher dosages. Amnestic effects may be associated with inappropriate behavior.

1.mix intensol solution with beverages such as water, soda, and juices or soft foods such as applesauce or uddings. 2. except for the deltoid muscle, absorption from IM site is slow, erratic and painful and not generally recommended 3. IV route is preferred in the convulsing client; eeg monitoring of seizure may be helpful 4. parenteral administration may cause bradycardia, respiratory/cardiac arrest; have emergency equipment available

Drug

Generic Name: Phenytoin

Brand Name: Dilantin

Route of administration: Oral,

Dosage: 100 mg tid. <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

General Action

Anticonvulsant

Mechanism of action Acts in the motor cortex of the brain to reduce the spread of electrical discharges from the rapidly firing epileptic foci in this area. This is accomplished by stabilizing hyperexcitable cells possibly affecting sodium efflux. Also, phenytoin decreases activity of centers in the brain stem responsible for the tonic phase of grand mal seizures. Has few sedative effects.

Contraindications

History of hypersensitivity to phenytoin or other hydantoins.

Indications

Tonic-clonic & complex partial (psychomotor, temporal lobe), prevention & treatment of seizures occurring during or following neurosurgery.

Side Effects

GI disturbances; ataxia, slurred speech; diplopia, nystagmus & mental confusion w/ headache, dizziness, gingival hyperplasia, hirsutism, hyperglycemia, osteomalacia.

Nursing Responsibilities 1.full effectiveness of PO administered hydantoins is delayed and may take 6-9 days to be fully established 2. when hydantoins are substituted for or added to another antivconvulsant medication, their dosage is gradually increased, while dosage of the other drug isdecreased 3. avoid IM, SC or pervascular injections 4. list reasons for theray, onset, characteristics of signs and symptoms 5.note history and nature of seizures, addressing location,

doses.

frequency and duration

Drug

Generic Name: Lidocaine Hydochloride

Brand Name: Cathejel

Route of administration: IV, IM

Dosage: 50-100 mg at a rate of 25-50 mg/min

General Action

Antiarrhythmic

Mechanism of action Shortens the refractory period and suppresses the automaticity of ectopic foci without affecting conduction of impulses through cardiac tissue. Increases the eldctrical stimulation threshold of the ventricle during diastole. It doesn’t affect BP, CO, or myocardial contractility. Since lidocaine has little effect on conduction at normal antiarrhythmic doses, use in acute situations (instead of procainamide) in instances in w/c heart block might occur

Contraindications

Hypersensitivity to amide-type local anesthetics. Stokesadams syndrome, wolff-parkinson white syndrome, severe SA, Av, or intraventricular block

Indications

Acute ventricular arrhythmia. Ineffective against atrial arrhythmias.

Side Effects

N&V, nervousness, anxiety, dizziness, drowsiness, sensation of heat or cold numbness, injection site pain, malignant hyperthermia, euphoria, lightheadedness, nervousness, anxiety, drowsiness, confusion, changes in mood

Nursing Responsibilities 1.list reasons for therapy, any hypersensitivity to amide-type local anesthetics 2. those with hepatic or renal disease or who weigh less than 45.5 kg will need to be watched closely for adverse side effects; adjust dosage as directed. 3. Note CNS status. Report sudden changes in mental status, dizziness visual disturbances twitching, tremors, may precede convulsions 4. view monitor

strips for myocardial depression, variations of rhythm 5. IM use may increase CPR level