Emergency Drugs

Drug Generic name: Streptokinase

General Action Thrombolytic enzyme

Mechanism of action Acts with plasminogen to produce a new activator complex which enhances the conversion of of plasminogen to plasmin. Plasmin then beaks down fibrinogen, fibrin clots, and other plasma protein promoting the dissolution of he insoluble fibrin trapped in intravascular emboli and thrombi. Also, inhibitors of streptokinase such as alpha-2macroglobulin are rapidly inactivated by streptokinase,

Contraindications

Indications

Side effect

Any condition presenting a risk of hemorrhage, such as recent surgery or biopsies, delivery within 10 days, ulcerative disease. Arterial emboli originating from left of the heart. Also hepatic or renal insufficiency, tuberculosis, recent cerebral embolism, thrombosis, hemorrhage, SBE, rheumatic valvular disease, thrombocytopenia. Streptokinase resistance in excess of q million IU. Use to restore patency to IV catheters.

Arterial thrombosis and embolism, acute evolving tansmural MI. pulmonary embolism, clearing of occluded arteriovenous and IV cannulae,

General Action

Mechanism of action Inceases the force and velocity of myocardial contraction by increasing the refractory period of the AV node and increasing total peripheral resistance. This effect is due to

Contraindications

Indications

Minor bleeding at invaded or disturbed sites, major bleeding, fever, shivering in acute MI. CV: superficial bleeding, minor bleeding at invaded or disturbed sites. Severe and internal bleeding involving GI, GU, retroperitoneal or intracerebral sites. Allergic: Nausea, headache, breathing difficulties, fever, shivering, bronchospasm, angioneurotic edema, urticaria, itching, flushing, musculoskeletal pain, vasculitis, interstitial nephritis, respiratory depression, back pain Side effect

Ventricular fibrillation or tachycardia(unless congestive failure supervenes after protracted episode not due to digitalis), in presence of digoxin toxicity, hypersensitivity to cardiac glycosides,

CHF, including that due to venous congestion, edema, dyspnea, orthopnea, and cardiac arrhythmia. May be drug of choice for CHF

Tachycardia, headache, dizziness, mental disturbances, diarrhea, anorexia, blurred or yellow vision, hypokalemia CV: changes in the heart rate, rhythm and irritability of the heart and the mechanism of the

Brand Name: Streptase Route of Administration: IV Dosage: 250,000 IU/ 30 min

Drug Generic name: Digoxin Brand Name: Digitek, digoxin injection, Lanoxicaps, Lanoxin Route of Administration:

Cardiac Glycoside

Nursing responsibilities 1.NaCl injectioin or D5W is the preffered diluent for IV use. 2. For AV cannulae, dilute 250,000 units with 2 ml of NaCl injection or D5W. 3. reconstitute gently, a directed without shaking the vial. 4. use within 24 hour of reconstitution 5. use an electronic infusion device to administer streptokinase and do not add any other medications to the line. Note any redness and or pain at the site 6. Do not add any medication to streptokinase. 7. Identify other drugs taking such as aspirin or NSAIDs that could increase bleeding times. Nursing responsibilities 1.note any drugs prescribed that would adversely interact with digoxin and monitor 2. Assess for hyper or hypothyroidism 3. monitor vital signs 4. monitor weighs and input and output 6. if taking non-K-

Drug

General Action

Generic Name: Atropine Sulfate

Cholirgenic blocking drug

Band name: Atropen, Atropair, atropine sulfate ophthalmic, Route of administration: Oral, parenteral, ophthalmic Dosage: 0.3-1.2 mg q 4-6 hr

Mechanism of action

Contraindica tions

Indications

Side effect

Nursing responsibilities

Blocks acetylcholine effects on prostaganglionic receptors in smooth muscle, cardiac muscle, exocrine glands, urinary bladder, and the AV and SA nodes of the heart. Ophthalmologically blocks acetylcholine effects n the sphincter muscle of the iris and the accommodative muscle of the ciliary body. This results in dilation of the pupil and paralysis f the muscles required to accommodate for close vision

Infants less than 3 months of age, primary glaucoma or a tendency toward glaucoma, adhesions between the iris and the lens, geriatric clients and others where undiagnosed glaucoma or excessive pressure in the eye may be present, in children who have had a previous severe systemic reaction to atropine

Peptic ulcer treatments, pylorospasm, biliary and ureteral colic spasm and bronchial spasms, preanesthetic to control salivation and bronchial secretions, restoration of CR during anesthesia, decrease degree of AV heart block, severe bradycardia and syncope,

dry mouth, urinary hesitancy, headache, flushing, constipation, heartburn, blurred vision, stinging, increased intraocular pressure,

1. Do not use 3 AtroPen injections unless under supervision of trained medical provider 2. note indications for therapy 3.check for glaucoma before ophthalmic administration 4. obtain VS and ECG; monitor CV status during the therapy. 5.use the ATropen auto injector as soon as symptoms of organosphosphorus or carbamate poisoning appear. 6. After instillation of ophthalmic ointment, compress the lacrimal sac by digital pressure for 1-3 min to decrease systemic effects.

Drug

Generic Name: Epinephrine Brand Name: epinephrine Amp, adrenin amp,

General Action

Mechanism of action

Epinephrine, an Antiglaucoma active principle of preparations the adrenal medulla, is a direct-acting sympathomimetic. It stimulates α- and β-adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation and dilation of skeletal muscle vasculature. It is frequently added to local anaesthetics to retard diffusion and limit absorption, to prolong the duration of effect and to lessen the danger of toxicity.

Contraindicatio ns

Indications

Side effect

Nursing responsibilities

Preexisting hypertension; occlusive vascular disease; angle-closure glaucoma (eye drops); hypersensitivity; cardiac arrhythmias or tachycardia. When used in addition to local anaesthetics: Procedures involving digits, ears, nose, penis or scrotum.

Advanced cardiac life support, anaphylactic shock, ocular hypertension, open-angle glaucoma, asthmatic attacks

epigastric pain; CV disorders; difficulty in micturition with urinary retention; dyspnoea; hyperglycaemia; sweating; hypersalivation; weakness, tremors; coldness of extremities; hypokalaemia. Gangrene, tissue necrosis and sloughing (extravasation) when used in addition to local anaesthetics. Eye drops: Severe smarting, blurred vision, photophobia; naso-lachrymal ducts obstruction. Oedema, hyperaemia and inflammation of the eyes with repeated administration.

1. note indications for therapy, onset, characteristics of signs and symptoms. 2. monitor v/s 3. document disease onset, subtype, other agents trialed and outcome. 4. take extra precaution on the patients with following conditions: CV diseases; hyperthyroidism; DM; Parkinson's disease; elderly; pregnancy, lactation.

Drug

Generic Name: Konakion Brand Name: Konakion MM Route of administration: Parenteral, oral Dosage: Therapy: 10 mg (up to 20 mg) Oral: 2 mg

General Action Haemostatics

Mechanism of action

Contraindications

Indications

Side effects

Nursing responsibilites

As a component of a liver carboxylase system, it is involved in the carboxylation of the coagulation factors II (prothrombin), VII, IX and X, and of the coagulation inhibitors protein C and protein S in the post-ribosomal phase. Anticoagulants of the dicoumarol type inhibit reduction of vitamin K1 (quinone form) to vitamin K1 hydroquinone and also prevent the vitamin K1 epoxide which arises after the carboxylation reaction from being reduced to the quinone form. Phytomenadione is thus an antagonist of Marcouman and similar anticoagulants. It does not, however, inhibit the action of heparin;.

Hypersensitivity to any of the constituents of Konakion MM/MM Pediatric. Pronounced allergic diathesis.

Hemorrhage or threatened hemorrhage as a result of severe hypoprothrombi nemia (ie, deficiency of coagulation factors II, VII, IX, X) due, for instance, to overdosage of anticoagulants of the dicoumarol type or their combination with phenylbutazone or to other forms of hypovitaminosis K; Prophylaxis and treatment of hemorrhagic disease of the newborn.

severe, shocklike reactions. In rare cases, anaphylactoid reactions have been reported after parenteral use of konakion MM Pediatric. Local irritation may occur at the injection site, but is unlikely due to the small injection volume.

1. The 10 mg/mL mixed-micelle ampoule must not be given to infants <1 year old 2. Parenteral administration may be associated with an increased risk of kernicterus in premature infants weighing <2.5 kg. 3. At the time of use, the ampoule solution must be clear. Improper storage can cause turbidity or phase separation. In this case, the ampoule must not be used.

Drug

Generic Name: Ketorolac tromethamine Brand Name: Acular Route of Administration IM, IV, PO, ophthalmic Dosage: 60 mg for less than 65 years old, IM 30 mg for IV 60 mg PO 1gtt 4x a day for ophthalmic route

General Action

Mechanism of action

Contraindications

Indications

Nonsteroidal antiinflammatory

Posseses antiinflammatoy, analgesic, and antipyretic effects

Hypersenstivty to the drug or allergic symtpms to aspirin or other NSAIDs. Active peptic ulcer disease, recent GI bleeding or perforatin, history of peptic ulcer disease, advanced renal impairment and in those at risk for renal failure due to volume depletion, suspected or confirmed cerebrovaxcula bleeding, hemorrhagic diathesis, or incomplete hemostasis and in those with high risk of bleeding.

Severe, acute pain in adults, itching causzed by seasonal allergic conjunctivitis, , post operative inflammation following cataract surgery, reduce ocular pain, burining and stinging after corneal refractive surgery, reduction of ocular pain and photophobia following incisional refractive surgery,

Side Effects

Headache, dizziness, rdrowsiness, diarrhea, nausea, dyspepsia, indigestion, epigastric pain, edema, transient burning stinging upon administration, ocular irritation,

Nursing Responsibilities 1. use as a part of a regular analgesic schedule rather than on an asneeded basis 2. if given p.r.n, basis, base size of repeat dose. If pain returns within 3-5 hr, the enxt dose can be increased by up to 50 percent 3. shortening the dosing intervals recommended will lead to an increased frequency and duation of side effects.

Drug

Generic Name: Tramadol hydrochloride Brand name: Ultram, Ultram ER Route of administration: Oral Dosage: 50-100mg q 4-6 hr prn

General Action

Analgesic

Mechanism of Action

Contraindications

Indications

The analgesic effect is only partially antagonized by the antagonist naloxone. Causes significantly lesss respiratory depression than morphine. In contrast to morphine, tramadol does not cause release of histamine. Produces dependence of the mu-opioid type how ever there is little evidence of abuse. Tolerance occurs but is relatively mild; the withdrawal syndrome is not as severe as with other opiates

Hypersensitivity to tramadol, in acute intoxication with alcohol, hypnotics, centrally acting analgesics, opiates or psychotropic drugs. Use in cleitns with past r resent addictin or opiate dependence or in those with a prior history of allergy to codeine or opiates. Use for obstetric preoperative medicatin of postdelivery analgesia In nursing mothers.

Moderate to moderately severe pain.

Side Effects

Dizziness, headache, CNS stimulation, ataxia, sedation, vertigo, itching, constipation, nausea, seizures, paresthesia, cognitive dysfunction, hallucinations, tremor, amnesia, concentration difficulty, abnormal gait, migraine, nausea, constipation, vomiting, dyspepsia, dry mouth, diarrhea, anorexia

Nursing responsibilities 1.do not confuse Ultram with Ultrase 2. List easons for theapy, location, onset, trigges, characteristics of S and S. use a pinrating scale to rate pain. 3. Assess for history of drug addiction, allergy to opiates or codeine, seizures; drug may increase the risk of convulsions 4. Monitor VS, Iand O, renal and LFTs, reduce dose with dysfunction and if over 75 years old.

Drug

General action

Generic Name: antihistamine Diphenhydrami ne HCl Brand Name: Benadryl Route of administration: Oral, IV or IM Dosage: Cap Adult & childn ≥12 yr 25-50 mg tid-qid. Syr Adult & childn ≥12 yr 12.5-25 mg qid. Childn 6 yr-<12 yr 12.5 mg qid, 2-<6 yr 6.25 mg qid.

Mechanism of Action High sedative, anticholinergic, and antiemetic effects

Contraindication

Indication

Premature & newborn infants; asthma attack; lactation.

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.

Side Effect

Nursing responsibilities CV & CNS effects. 1. note reasons fo Blood disorders. GI therapy, signs and disturbances. symptoms of Antimuscarinic charactgeristics, effects. Allergic other agents trialed, reactions. triggers, outcome Drowsiness, 2. do not confuse constipation, diphenhydramine diarrhea, dizziness, with desipramine dry mouth, nose, with throat, headache, dimenhydrinate anorexia, anxiety, GI 3. take 30 minutes upset, asthenia before travel 4. use sugarless gum, candy to diminish dry mouth effects. 5. avoid alcohol and any other CNS depressants unless prescrived 6. Stop therapy 7296 hour before skin testing

Drug Generic Name: Isosorbide dinitrate Brand Name: Isordil Route of administration: Sublingual, oral Dosage: Oral 5-30 mg qid. Sublingual 5-10 mg 2-3 hrly. Acute CHF Oral 10-40 mg qid. Sublingual 5-10 mg 2 hrly. Chronic CHF Initially 5-10 mg/day 2 hrly sublingually. Maintenance: 2040 mg qid orally.

General action Anti-angina, coronary vasodlator

Mechanism of Action Relaxes vascular smooth muscle by stimulatng production of intracellular cyclic guanosine monophosphate. Dilation of post capillary vessels decreases venous return to the heart due to pooling of blood; thus LV end-diastolic pressure is educed. Elaxation of arteriololes results in a decreased systemic vascular resistance and arterial pressure.

Contraindication Use to abort anginal attacks

Indication Angina pectoris, acute and chronic CHF

Side effect Headache, vascular headache, lightheadedness, hypotension.

Nursing responsibilities 1.note reasons fo therapy; include onset, location, characteristics of chest pain; pain levels 2.assess VS and ECGT; note stress thallium, catheterization, or IVUS findins as well as CAD history/intervention s. 3. store at room temperature protected from light. Keep bottles tighly closed. Dipense in alight resistant tight contaainer

Drug

Generic Name: Nifedipine Brand Name: Calcibloc Route of administration: Oral Dosage: Capsules: 10-20 mg 3x a day Tablets: 30-60 mg per day

General Action Calcium channel blocker

Mechanism of action . It blocks the calcium or "slow" channels and inhibits entry of calcium ions into vascular smooth muscles particularly of resistance vessels and coronary arteries. dilates coronary and peripheral arteries, as well as veins. Coronary arterial vasodilation increases coronary blood flow in the ischemic poststenotic areas, while dilation of the peripheral arteries lowers arterial blood pressure and reduces left ventricular afterload. Some renal artery dilatation may stimulate mild diuresis.

Contraindicatio ns Cardiovascular shock, severe aortic stenosis or in patients known to be hypersensitive to nifedipine. Care is needed in patients with very low blood pressure (severe hypotension with systolic pressure <90 mmHg) or decompensated heart failure.

Indications All forms of hypertension, primary or secondary. Nifedipine is most effective for mild to moderate degrees of hypertension but the capsule may be bitten and swallowed for more rapid effects as in hypertensive crises. Hypertension in pregnancy (at any term of pregnancy). Coronary insufficiency with or without angina. Vasospastic angina (Prinzmetal's angina). To increase heart rate in patients with sinus bradycardia and sick-sinus syndrome.

Side Effects Side effects are mild, transient and relatively infrequent. These include flushing, nausea, dizziness, headache, tiredness, sedation, leg edema and other manifestations of peripheral vasodilation.

Nursing Responsibilities 1. dot not confuse nifedipine with nicardipine 2. do not exceed a single dose 3. before increasing dose, carefully monitor BP 4. use only the sustained release tablets to treat hypertension 5. concomitant therapy with beta renergic blocking agents may be used 6. clients withdrawn from beta blockers may manifest symptoms of increased angina which cannot be prevented by nifedipine; in fact nifedipine may increase the severity of angina situation