Emergency Drugs by E. D. Perillo Jr.

EMERGENCY DRUGS  Eat foods high in fiber and drink plenty

fluids.
 Can cause photophobia
CARDIAC DRUGS  Instruct client not to drive a motor vehicle
or participate in activities requiring
ATROPINE SULFATE alertness.
Isopto Atropine  Advise to use hard candy, ice chips, etc. for
dry mouth.
Classification
Anticholinergics
NITROGLYCERINE
Dosage Nitrostat
 Bradycardia: 0.5 mg IV every 3-5 mins, max
of 0.04 mg/kg Classification
 Antianginal
 Cardiac Arrest: 1 mg every 3-5 mins  Nitrate
 Nerve and Organophosphate symptoms:  Vasodilator,
may repeat in 2 mg increments q 3 mins  Coronary
titrated to relief symptoms
Dosage
Indication
 0.3-0.4 mg SL q 5 min, max 3 doses.
Pre-op meds/pre-anesthetic meds
 Every 6 hrs except for midnight (cream)
To restore cardiac rate and arterial pressure
 Wear 12 hrs a day for skin patch
during anesthesia when vagal
To lessen the degree of A-V heart block Action
To overcome severe carotid sinus reflex  Relaxes the vascular smooth system
Antidote for cholinergic toxicity
 Reduces myocardial oxygen consumption
Side effects
 Reduces left ventricular workload
• CNS: restlessness, ataxia, disorientation,  Reduces arterial BP
hallucinations, delirium, coma, insomnia,  Reduces venous return
agitation, confusion.
• CV: tachycardia, angina, arrhythmias, Indication
flushing.  Angina pectoris
• EENT: photophobia, blurred vision, mydriasis.  CHF associated with AMI
 Cardiac load reducing agent
• GI: dry mouth, constipation, vomiting.
 Hypertensive Crisis
• GU: urine retention.
• Hematologic: leukocytosis Side effects
• Other: anaphylaxis  CNS: headache, throbbing, dizziness,
weakness.
Adverse effects  GI: nausea, vomiting
CNS: headache, excitement.  Skin: Rash
CV: palpitations  Adverse Reactions
GI: thirst, nausea  CV: orthostatic hypotension, flushing,
fainting.
Contraindications  EENT: sublingual burning.
Hypersensitivity
 Skin: Cutaneous vasodilation, contact
With acute angle closure glaucoma, dermatitis (patch)
obstructive uropathy, obstructive disease of
GI tract, paralytic ileus, toxic megacolon, Contraindications
intestinal atony, unstable CV status in acute  Contraindicated in patients hypersensitive to
hemorrhage, asthma, or myasthenia gravis. nitrates
Pregnant women.  With early MI. (S.L. form), severe anemia,
increase ICP angle-closure glaucoma, IV
Nursing Management nitroglycerine is contraindicated in patients
 Monitor VS. with hypovolemia, hypotension, orthostatic
 Report  HR hypotension, cardiac tamponade restrictive
 Monitor for constipation, oliguria. cardiomyopathy, constrictive pericarditis.
 Instruct to take 30 mins before meals
Nursing Management

10

 Record characteristics and precipitating
factors of anginal pain.
 Monitor BP and apical pulse before
administration and periodically after dose.
 Have client sit or lie down if taking drug for
the first time.
 Client must have continuing EKG monitoring
for IV administration
 Cardioverter/ defibrillator must not be
discharged through paddle electrode overlying
 Nitro-Bid ointment or the Transderm-Nitro
Patch. Assist with ambulating if dizzy.
 Instruct to take at first sign of anginal pain.
 May be repeated q 5 minutes to max. of 3
doses.
 If the client doesn’t experience relief, advise
to seek medical assistance immediately.
 Keep in a dark colored container
MORPHINE SULFATE
Immediate-release tablets:
MSIR
Timed-release:
Kadian, M-Eslon (CAN), MS Contin, Oramorph
SR
Oral solution:
MSIR, Rescudose, Roxanol, Roxanol T
Rectal suppositories:
RMS
Injection:
Astramorph PF, Duramorph, Epimorph (CAN)
Preservative-free concentrate for
microinfusion devices for intraspinal use:
Infumorph
Classification
Opioid Agonist Analgesic
Dosage
 Oral: 10–30 mg q 4 hr PO. Controlled-
release: 30 mg q 8–12 hr PO or as directed
by physician; Kadian: 20–100 mg PO daily–
24-hr release system; MS Contin: 200 mg
PO q 12 hr.
 SC and IM:10 mg (5–20 mg)/70 kg q 4 hr
or as directed by physician.
 IV:2.5–15 mg/70 kg of body weight in 4–5
mL water for injection administered over
4–5 min, or as directed by physician.
Continuous IV infusion: 0.1–1 mg/mL in 5%
dextrose in water by controlled infusion
device.
 Rectal:10–30 mg q 4 hr or as directed by
physician.
 Action
10
Emergency Drugs by E. D. Perillo Jr.
 Acts as agonist at specific opioid receptors
in the CNS to produce analgesia, euphoria,
sedation
Indication
 Relief of moderate to severe acute and
chronic pain
 Preoperative medication
 Analgesic adjunct during anesthesia
 Component of most preparations that are
referred to as Brompton's cocktail or mixture
 Intraspinal use with microinfusion devices for
the relief of intractable pain
 Unlabeled use: Dyspnea associated with
acute left ventricular failure and pulmonary
edema
Side Effects
 GI: dry mouth, constipation.
 Skin: Tissue irritation and induration (SC
injection).
 Other: sweating,physical tolerance and
dependence, psychological dependence
Adverse Effects
 CNS: Light-headedness, dizziness, sedation,
euphoria, dysphoria, delirium, insomnia,
agitation, anxiety, fear, hallucinations,
disorientation, drowsiness, lethargy, impaired
mental and physical performance, coma,
mood changes, weakness, headache, 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
 Emergency Drugs by E. D. Perillo Jr.
Nursing Management  EENT: blurred vision, epistaxis and tinnitus
Interventions
 Caution patient not to chew or crush
 CV: arrhythmia, CHF, chest pain,
bradycardia, hypotension and palpitations
controlled-release preparations.
 Dilute and administer slowly  GU: dysuria, nocturia and polyuria
 Tell patient to lie down during IV  GI: abnormal liver function, anorexia,
administration. constipation, diarrhea, nausea and vomiting
 Keep opioid antagonist and facilities for
assisted or controlled respiration readily Contraindications
available during IV administration.  Hypersensitivity
 Use caution when injecting SC or IM into  Sick sinus syndrome
chilled areas or in patients with hypotension  2nd or 3rd degree AV block
or in shock  CHF
 Reassure patients that they are unlikely to  Cardiogenic shock
become addicted  Concurrent IV beta-blocker
Teaching points
 Take this drug exactly as prescribed. Avoid Nursing Management
alcohol, antihistamines, sedatives,  Monitor BP and pulse before therapy, during
tranquilizers, over-the-counter drugs. titration and therapy
 Swallow controlled-release preparation (MS  Monitor ECG, I&O, serum potassium and
Contin, Oramorph SR) whole; do not cut, weight.
crush, or chew them.
 Assess for CHF
 Do not take leftover medication for other
disorders, and do not let anyone else take
your prescription. DILTIAZEM
 These side effects may occur: Nausea, loss Cardizem, Dilacor, Novo-Diltiazem, Tiamate and
of appetite, constipation, dizziness, Tiazac
sedation, drowsiness, impaired visual acuity
 Report severe nausea, vomiting, Classification
constipation, shortness of breath or difficulty ♣ Anti-anginals
breathing, rash.
♣ Antiarrhythmics
♣ Antihypertensive
VERAPAMIL ♣ Ca channel blocker
Calan, Isoptin, Verelan, Covera HS
Dosage
Classification ♣ PO: 30-120 mg, 3-4x daily or 60-120 mg
 Anti-anginal twice daily as SR capsules
 Anti-arrhythmics ♣ IV: 0.25 mg/kg
 Anti-hypertensive
 Vascular headache suppressants Action
♣ Inhibits calcium transport into myocardial
Dosage smooth muscle cells
PO 80-120 mg 3x daily, increases as needed ♣ Systemic and coronary vasodilation

Action Indication
 Inhibits calcium transport into myocardial ♣ Hypertension
smooth muscle cells ♣ Angina Pectoris
 Decreases SA and AV conduction and ♣ Supraventricular Arrhythmia
prolongs AV node refractory period in ♣ Atrial flutter/fibrillation
conduction tissue
Side Effects and Adverse and Reactions
Indication
 Hypertension ♣ CNS:abnormal dreams, anxiety, confusion,
 Angina Pectoris dizziness and headache
 Supraventricular Arrhythmia ♣ EENT: blurred vision, epistaxis and tinnitus
 Atrial flutter/fibrillation ♣ CV: arrhythmia, CHF, chest pain,
bradycardia, hypotension and palpitations
Side Effects and Adverse Reactions ♣ GU: dysuria, nocturia and polyuria
 CNS:abnormal dreams, anxiety, confusion, ♣ GI: abnormal liver function, anorexia,
dizziness and headache constipation, diarrhea, nausea and vomiting

10
 Emergency Drugs by E. D. Perillo Jr.
Contraindications ♣ Monitor ECG, if QT or QRS increases by
♣ Hypersensitivity 50% or more, withhold the drug
♣ Sick sinus syndrome ♣ Monitor BP, check for rebound HPN after
♣ 2nd or 3rd degree AV block 1-2 hrs
♣ CHF ♣ Assess respiratory status, oxygenation
♣ Cardiogenic shock and pulse deficits
♣ Concurrent IV beta-blocker ♣ Assess renal and liver function
♣ Monitor CNS symptoms
Nursing Management ♣ Monitor blood levels
♣ Monitor BP and pulse before therapy,
during titration and therapy
♣ Monitor I&O and weight AMIODARONE
♣ Assess for CHF Cordarone
♣ Routine serum digoxin monitoring
Classification
Anti-arrhythmics
LIDOCAINE
Dosage
Xylocaine
Recurrent ventricular arrhythmias:
Classification ♣ PO800-1600 mg/day for 1-2 wks
♣ CV drugs: Anti-arrhythmics ♣ PSVT, symptomatic atrial flutter:
♣ Anesthetic PO 600-800 mg/day for 1 month
♣ Arrhythmias with CHF: 200 mg/day
Dosage
Arrhythmia: ♣ Ventricular dysrrhythmias: 150 mg
over the 1st 10 mins then slow 360 mg
♣ IV: 0.7-1.4 mg/kg body weight. No more
over the next 6 hrs
than 200 mg within 1 hour period
♣ IM: 4-5 mg/kg body weight Action
♣ Blocks Na channels, prolonging myocardial
Action cell action potential and refractory period
Increases electrical stimulation of ventricle and ♣ Non competitive alpha and beta adrenergic
His-purkinje system by direct action on tissues, blockage
resulting to decrease depolarization, automaticity
and excitability in ventricles during diastolic phase Indication
Indication ♣ Life threatening recurrent arrhythmias
♣ Anesthesia ♣ Ventricular fibrillation
♣ Arrhythmias ♣ Ventricular tachycardia
♣ Control of Status epilepticus refractory to
other treatments Side Effects and Adverse Reactions
Exacerbation of arrhythmias, bradycardia, SA
Side Effects and Adverse Reactions node dysfunction, heart block, sinus arrest;
GI disturbances, bradycardia, hypotension, flushing, fatigue, malaise, abnormal
convulsion, numbness of tongue, muscle involuntary movements, ataxia, dizziness,
twitching, restlessness, nervousness, paresthesia, decreased libido, insomnia,
dizziness, tinnitus, blurred vision, fetal headache, sleep disturbances, visual
intoxication, light headedness, drowsiness, impairment, blindness, corneal microdeposits,
apprehension, euphoria, vomiting, sensation photophobia, abnormal taste, nausea,
of heat, respiratory arrest and CV collapse vomiting, constipation, anorexia, abdominal
pain, abnormal salivation, coagulation
Contraindications abnormalities, non-specific hepatic disorders,
pulmonary inflammation, dyspnea, toxicosis,
♣ Hypersensitivity
death, edema, hypo and hyperthyroidism
♣ Heart block
♣ Hypovolemia Contraindications
♣ Adams stroke syndromes ♣ Severe sinus node dysfunction
♣ Infection at site of injection ♣ 2nd or 3rd degree AV block
♣ Hypersensitivity
Nursing Management
♣ Assess pt before and after therapy
♣ Pts infusion must be on cardiac monitor Nursing Management
♣ Assess cardiovascular status before therapy

10
 Emergency Drugs by E. D. Perillo Jr.
♣ Assess pulmonary, hepatic and thyroid Insect sting emergencies:
function before and during therapy EpiPen Auto-Injector (delivers 0.3 mg IM adult
dose), EpiPen Jr. Auto-Injector (delivers
♣ Monitor fluid and electrolytes, I&O, K, Na and
0.15 mg IM for children)
Cl
OTC solutions for
♣ Monitor ECG, BP
Nebulization:
♣ Assess vision AsthmaNefrin, microNefrin, Nephron, S2

Classification
PROCAINAMIDE Beta2 Adrenergic Agonists
Pronestyl, Procan-SR, Procanbid
Dosage
Classification
Cardiac arrest: 1 mg IV of 1:10,000
Antiarrhythmics
solution q 3-5 min; double dose if
administering via ET tube
Dosage
Arrhythmias: 50 mg/kg/day in divided doses 3-6
hourly Anaphylaxis: 0.1- 1 mg SQ or IM of
1:1000 solution.
Action Asthma: 0.1-0.3 mg SQ or IM of 1:10,000
Blocks open Na channels and prolongs the cardiac solution
action potential. This results in slowed conduction Refractory bradycardia and
and ultimately the decreased rate of rise of the hypotension: 2-10ug/min
action potential may result on the widening of QRS
on ECG Action
 Stimulates beta receptors in lung.
Indication
 Relaxes bronchial smooth muscle.
♣ Supraventricular and ventricular arrhythmias.  Increases vital capacity
♣ Treatment of Wolf-Parkinson-White Syndrome
 Increases BP,  HR,  PR
 Decreases airway resistance.
Side Effects and Adverse Reactions
♣ Severe hypotension, ventricular fibrillation Indication
and asystole.
 Asthma
♣ Drug induced SLE syndrome, blood disorders,  Bronchitis
fever, myocardial depression, heart failure,  Emphysema
agrunulocytosis, psychosis, angioedema,  All cardiac arrest, anaphylaxis
hepatomegaly, skin irritation,  Used for symptomatic bradycardia.
hypergammaglobulinemia, GI and CNS
 Relief of bronchospasm occurring during
effects
anesthesia
Contraindications  Exercised-induced bronchospasm
♣ Heart block
Side Effects/Adverse Reactions
♣ Heart failure Side Effects:
♣ Hypotension nervousness, tremor, vertigo, pain, widened
♣ Myesthenia gravis pulse pressure, hypertension nausea
♣ Digoxin toxicity Adverse Effects:
♣ Lactation headache

Nursing Management Contraindications

♣ Assess cardiovascular status before therapy  With angle-closure glaucoma, shock (other
♣ Assess pulmonary, hepatic and thyroid than anaphylactic shock), organic brain
damage, cardiac dilation, arrhythmias,
function before and during therapy
coronary insufficiency, or cerebral
♣ Monitor fluid and electrolytes, I&O, K, Na and arteriosclerosis. Also contraindicated in
Cl patient receiving general anesthesia with
♣ Monitor ECG, BP halogenated hydrocarbons or cyclopropane
♣ Assess vision and in patients in labor (may delay second
stage)
 In conjunction with local anesthesia,
EPINEPHRINE epinephrine is contraindicated for use in
Injection, OTC nasal solution: finger, toes, ears, nose, and genitalia.
Adrenalin Chloride  In pregnant woman, drug is
Ophthalmic solution: contraindicated.
Epifrin, Glaucon

10
 Emergency Drugs by E. D. Perillo Jr.
 In breast feeding do not use the drug or
stop breast feeding. Nursing Management
♣ Give 1-2 glass of H20 to reduce adverse
Nursing Management reactions and improve therapeutic
1. Monitor V/S. and check for cardiac response
dysrrhythmias ♣ Warm vasopressin in your hands and
2. Drug increases rigidity and tremor in mixed until it is distributed evenly in the
patients with Parkinson’s disease solution
3. Epinephrine therapy interferes with tests ♣ Monitor urine Sp. Gravity and I&O to aid
for urinary catecholamine evaluation of drug effectiveness
4. Avoid IM use of parenteral suspension into
buttocks. Gas gangrene may occur
5. Massage site after IM injection to MAGNESIUM SO4
counteract possible vasoconstriction.
6. Observe patient closely for adverse Classification
reactions. Notify doctor if adverse reaction
♣ Anti-convulsant
develop
7. If blood pressure increases sharply, rapid- ♣ Anti-arrhythmics
acting vasodilators such as nitrates or
alpha blockers can be given to counteract Dosage
Arrhythmia: IV 1-6 grams over several
minutes, then continuous IV infusion 3-20
VASOPRESSIN mg/min for 5-48 hours.
Pitressin
Action
Classification Decreased acetylcholine released
Pituitary Hormones
ADH Indication
♣ Mg replacement
Dosage ♣ Arrhythmia
Prevent and treat abdominal distention: initially 5
units IM gives subsequent injections q3-4 hours Side Effects and Adverse Reactions
increasing to 10 units if needed. ♣ CNS: drowsiness, depressed reflexes,
flaccid paralysis, hypothermia
Action
Increase permeability of renal tubular epithelium
♣ CV: hypotension, flushing, bradycardia,
to adenosine monophosphate and water, the circulatory collapse, depressed cardiac
epithelium promotes reabsorption of water and function
concentrated urine ♣ EENT: diplopia
♣ Respiratory: respiratory paralysis
Indication
♣ Diabetes Insipidus ♣ Metabolic: hypocalcemia
♣ Abdominal Distention ♣ Skin: diaphoresis
♣ GI bleeding
♣ Esophageal varices Contraindications
♣ Heart block and myocardial damage
Side Effects and Adverse Reactions ♣ Toxemia of pregnancy
♣ CNS: tremor, headache, vertigo
Nursing Management
♣ CV: vasoconstriction, arrhythmias,
♣ Monitor I&O. make sure urine output is
cardiac arrest, myocardial ischemia,
100 ml or more in 4 hrs pd before
circumollar pallor, decreased CO,
each dose
angina
♣ Take appropriate seizure precautions
♣ GI: abdominal cramps
♣ Keep IV Ca gluconate at bedside
♣ GU:uterine cramps
♣ Respi: bronchoconstriction
Na HCO3
♣ Skin: diaphoresis, gangrene and Arm and Hammer; Baking Soda
urticaria
Classification
Contraindications Alkalinizers
♣ With chronic nephritis and nitrogen
retention Dosage
♣ Hypersensitivity

10
 Emergency Drugs by E. D. Perillo Jr.
♣ Metabolic Acidosis: Usually 2-5 meq/kg IV abdominal pain, methemoglodinemia, muscle
infuse over 4-8 hr period twitching, pink-colored rash, irritation at infusion
site
♣ Cardiac Arrest: 1 meq/kg IV of 7.5 or 8.4%
sol, then 0.5 meq/kg IV q 10 mins depending Contraindications
on ABG Hypersensitivity
Compensatory hypotension
Action
Inadequate cerebral circulation
Restore buffering capacity of the body and
Acute heart failure with reduced PVR
neutralizes excessive acid
Congenital optic atrophy
Indication Tobacco-induced ambylopia
♣ Metabolic Acidosis
Nursing Management
♣ Cardiac Arrest
1. Obtain VS before giving the drug
2. Place pt in supine
Side Effects/Adverse Reactions
3. Giving excessive doses of 500 mcg/kg
♣ CNS: tetany delivered faster than 2 mcg/kg/min or
♣ CV: edema using max infusion rate of 10 mcg/kg/min
♣ GI: gastric distention, belching and for more than 10 mins can cause cyanide
flatulence toxicity
♣ Metabolic: hypokalemia, metabolic
alkalosis, hypernatremia, hyperosmolarity FUROSEMIDE
with overdose Lasix
♣ Skin: pain @ injection site
Classification
Contraindications Loop Diuretics
♣ Metabolic and respiratory alkalosis
Dosage
♣ Pt losing Cl because of vomiting or
Pulmonary edema: 40 mg IV
continuous GI suction or those receiving
diuretics that produces hypochloremic Edema: 20 to 80 mg PO every day in the
alkalosis morning
HPN: 40 mg PO bid. Dosage adjusted
Nursing Management based on response
♣ Obtain blood pH, PaO2, PaCo2 and
electrolyte levels Action
Inhibits Na and Cl reabsorption at the proximal
♣ SIVP
and distal tubules and in the ascending loop of
Henle

HYPERTENSIVE CRISIS Indication

Acute pulmonary edema
Na NITROPRUSSIDE Edema
Nittropress Hypertension

Classification Side Effects/Adverse Reactions

Antihypertensive, Vasodilator Signs of hypotension, hypokalemia and
hyperglycemia
Dosage
0.25-0.3 mcg/kg/minute Contraindications
Hypersensitivity
Action Anuria
Relaxes arteriolar and venous smooth muscle
Nursing Management
Indication 1. Monitor wt., BP and PR
Hypertensive crisis 2. Monitor fluid, I&O, electrolyte, BUN and
To produce controlled hypotension CO2 levels frequently
during anesthesia 3. WOF signs of hypokalemia
To reduce preload and afterload in 4. Monitor uric acid levels
cardiogenic shock 5. Monitor glucose levels esp in DM pts

Side Effects/Adverse Reactions

Headache, dizziness, increased ICP, loss of MORPHINE SO4
consciousness, restlessness, bradycardia, nausea, (Discussed earlier)

10

NEUROSURGICAL DRUGS
MANNITOL
Osmitrol
Classification
Diuretics
Dosage
♣ 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 given if still no
response after 2nd 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 30-60 min
♣ Diuresis in drug intoxication: 12.5% to
10% solutions up to 200 g IV
♣ Irrigating solution during TURP: 2.5-
5%
Action
Increases osmotic pressure of glomerular
filtrate, inhibiting tubular reabsorption of
water and electrolytes; drug elevates plasma
osmolarity, increasing water flow into
extracellular fluid
Indication
♣ Test dose for marked oliguria or
suspected inadequate renal function
♣ Oliguria
♣ To induced intraocular or intracranial
pressure
♣ Diuresis in drug intoxication
♣ Irrigating solution during TURP
Side Effects/Adverse Reactions
 CN: seizures, headache and fever
♣ CV: edema, thrombophlebitis,
hypotension and heart failure
♣ EENT: blurred vision and rhinitis
♣ GI: thirst, dry mouth, nausea,
vomiting and diarrhea
♣ GI: urine retention
♣ Metabolic: dehydration
♣ Skin: local pain
♣ Others: chill
Contraindications
♣ Hypersensitivity
♣ Anuria, severe pulmonary congestion,
frank pulmonary edema, active
intracranial bleeding during craniotomy,
severe dehydration, metabolic edema,
progressive heart failure or pulmonary
congestion after drug
10
Emergency Drugs by E. D. Perillo Jr.
Nursing Management
♣ Monitor VS,CVP,I&O, renal function fluid
balance and urine K levels daily.
♣ Drug can be used to measure GFR
♣ Do not give electrolyte free solutions with
blood. If blood id given simultaneously,
add at least 200 meq of NaCL to each
liter
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
 For suspected opioid induced respiratory
depression
 For postoperative opiod depression
Side Effects/Adverse Reactions
 CNS: seizures, tremors
 CV: ventricular fibrillation, tachycardia,
HPN with higher recommended doses,
hypotension
 GI: nausea and vomiting
 Respiratory: pulmonary edema
 Skin: diaphoresis
Contraindications
 Hypersensitivity
 Use cautious with cardiac irritability or
opiod addiction.
Nursing Management
 Assess respiratory status frequently
 Respiratory rate increases within 1-2 mins
IPECAC SYRUP
Classification
Antidote
 Emergency Drugs by E. D. Perillo Jr.
Dosage Notify doctor if caused swelling or pain in
25-30 ml followed immediately by H2O the stomach

Action
Irritates the stomach lining and stimulate the FLUMAZENIL
vomiting center Romazicon

Indication Classification
Poisoning Benzodiazepine receptor antagonists
Overdose
Dosage
Side Effects 2 ml IV given over 15 seconds
Diarrhea, drowsiness, stomach cramps,
vomiting, itching, DOB, swelling of the mouth, Action
rash and hives Antagonizes the effects of benzodiazepines

Contraindications Indication
Hypersensitivity Benzodiazepine-induced depression of the
Given activated charcoal ventilatory responses to hypercapnia and
Unconcious hypoxia
Drowsy
Severely drunk Side Effects
Having seizures Nausea, vomiting, palpitations, sweating,
With no gag reflex flushing, dry mouth, tremors, insomnia,
dyspnea, hyperventilation, blurred vision,
Nursing Management headache, pain at injection site
1. Don’t administer to unconscious
2. Pt should kept active and moving ff Contraindications
administration Control of ICP or status epilepticus.
3. If vomiting does not occur after 2nd dose, Signs of serious cyclic antidepressant
gastric lavage may be considered to overdose
remove ingested substance
Nursing Management
1. Must individualize dosage. Give only smallest
ACTIVATED CHARCOAL amount effective.
2. Give through freely running IV infusion into
Classification large vein to minimize pain at injection site
Antidote 3. Note history of seizure or panic disorder
4. Assess evidence of increased ICP
Dosage 5. Note evidence of sedative and
30-100 g with at least 8 oz of water benzodiazepine dependence
6. Instruct to avoid alcohol and non-prescription
Action drugs for 1-24 hrs
Inhibits GI absorption of toxic substances
or irritants
Hyperosmolarity

Indication SHOCK
Poisoning
DOPAMINE
Side Effects Intropine
Pain, melena, diarrhea, vomiting and
constipation Classification
Adrenergic drugs
Contraindications
Cyanide, mineral acids, organic solvents, Dosage
intestinal obstruction, bleeding with fructose Initially 2-5 mcg/kg/min by IV
intolerance, broken GI tract, concomitant
use of charcoal with sorbitol Action
Stimulates dopaminergic and alpha and beta
Nursing Management receptors of the sympathetic nervous system
Do not mix with chocolate and together with resulting in positive inotropic effect and increased
ipecac syrup CO

10
 Emergency Drugs by E. D. Perillo Jr.
Indication
 To treat shock and correct hemodynamic Nursing Management
imbalances  Before starting therapy, give a plasma
 To correct hypotension volume expander to correct hypovolemia
and a cardiac glycoside
 To improve perfusion of vital organs  Monitor ECG, BP, pulmonary artery wedge
pressure and CO
 To increase CO
 Monitor electrolyte levels
Side Effects  Don’t confuse dobutamine to dopamine
 CNS: headache an anxiety
 CV: tachy, angina, palpitations and GLUCAGON
vasoconstriction
 GI: nausea and vomiting Classification
Pancreatic Hormones
Contraindications
 Hypersensitivity Dosage
 With uncorrect tachyarrhythmias 0.5-1 mg SQ, IV, IM, repeat in 20 mins PRN
 Pheochromocytoma
Action
 Ventricular Fibrillation
Binds with glucagon receptor
Nursing Management
Indication
 Most patients received less than 20 Hypoglycemia
mcg/kg/min
 Drugs isn’t substitute for blood or fluid Side Effects
volume deficit Nausea, vomiting, hypotension, tachycardia
 During infusion, monitor ECG, BP, CO, PR and and hypertension
color and temp of the limbs
 Do not confuse dopamine to dobutamine Contraindications
 Check urine output often  Hypersensitivity
 Pheochromocytoma
 Insulinoma
DOBUTAMINE
Dobutrex Nursing Management
 Monitor V/S and blood sugar level
Classification  Response within 20 mins after injection
Adrenergic drugs

Dosage ALBUTEROL
 0.5-1 mcg/kg/min IV infusion, titrating to Ventolin
optimum dosage of 2-20 mcg/kg/min
 2.5 to 10 mcg/kg/min-usual effective range to Classification
increase CO Bronchodilator, Adrenergic

Action Dosage
Stimulates heart beta receptors to increase 2 inhalations reputed q 4-6 hrs via neb
myocardial contractility and SV
Action
Indication Activation of beta adrenergic receptors on airway
 To increase CO smooth muscle
 Treatment of cardiac decompensation
Indication
Side Effects  Asthma
 CNS: headache  Prevention of exercise induced spasms
 CV: HPN, tachycardia, palpitations and
Side effects
vasoconstriction
Palpitations
 GI: nausea and vomiting Tachycardia
GI upset
Contraindications
Nervousness
 Hypersensitivity
 Use cautiously in pts with hx of HPN and AMI Contraindications

10
 Emergency Drugs by E. D. Perillo Jr.
Hypersensitivity Indication
 Allergic reactions
Nursing Management  Motion sickness
 Monitor therapeutic effectiveness  Cough suppression
 Monitor HR, BP, ABG, s/sx of bronchospasm  Sedation
and CNS stimulation
 Instruct on how to use inhaler properly Side Effects
 Rinse mouth after use  Xerostomia
 Urinary retention
 Sedation
DIPHENHYDRAMINE HCL
Benadryl Contraindications
Acute asthmatic attack
Classification
Anti-histamine Nursing Management
Risk for photosensitivity- use sunscreen
Dosage
25-50 mg PO, IV or IM bid-tid
EPINEPHRINE
Action
(Discussed earlier)
Blocks the effects Hi receptor sites

10