GENERIC NAME CLASSIFICATION

ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATION

DIAZEPAM

BRAND NAMEValium

DOSAGEAdult: 250-500mg every 8 hoursChildren: 20-40mg/kg/day divided dosage given every 8 hrs

CENTRAL NERVOUS SYSTEM DRUGS-Anti-anxiety(Anticonvulsant/Hypnotics/Sedatives/Anxiolytics)

Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety, promote calmness and sleep

Symptomatic relief of anxiety, agitation, tension

Hypersensitivity. Dependence, withdrawal symptoms

Hypersensitivity: cardiorespiratory insufficiency, pregnancy, lactation

Dizziness, fatigue, blurred vision, dependence, withdrawal reactions

> inform pt. that drug may be taken with food>advice pt. not to abruptly discontinue drug after long term use>advice pt. to avoid driving and activities that require alertness bec, drug can cause drowsiness>inform pt. that smoking may decrease effect

GENERIC NAME

CLASSIFICATIONACTION INDICATION

CONTRAINDICATION SIDE EFFECTS

NURSING CONSIDERATION

Salbutamol

BRAND NAMEVentolin vilmax

DOSAGEAdult: 8mg tablet BIDPedia: 3-12 yrs4mg tab BID

ANTI-ASTHMA Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety, promote calmness and sleep

Reversible airway obstruction including bronchial asthma, chronic bronchitis

Hypersensitivity Hyperthyroidism,DM, cardiovascular disease

Fine tremor of skeletal muscle, feeling of tension, a compensory small increase in heart rate, headache, muscle cramps

> drug may be decrese sensitivity of spirometry used for diagnosis of asthma>syrup may be taken as young as age 2>monitor for evidence of allergic rxn

GENERIC NAMECLASSIFICATI

ON ACTION INDICATIONCONTRAINDICATIO

N SIDE EFFECTSNURSING

CONSIDERATIONmetropolol

BRAND NAMENeobloc

DOSAGEAdult : 50mg BID or 100 mg OD

CARDIOVASCULAR DRUGS- BETA-BLOCKERS

Exerts mainly beta-1 adrenergic blocking activity but also blocks beta-2 receptors at high doses

Hypertension, chronic angina pectoris

AV blocks, cardiogenic shock, sinus bradycardia

Slowing of heart rate, occasionally severe bradycardia may lead to vertigo

Occasionally fatigue, dizziness, headache, GI disturbance, skin rashes nausea

>tablet may be crashed or swallowed whole> instruct pt to take with meals >inform the pt that drug only controls but does not cure the disorder>tell the pt. not to discontinue drug abruptly can worsen angina

GENERIC NAME CLASSIFICATION

ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATION

Atropine SO4

BRAND NAME

Dose/Route:

0.5-1.0 mg IVP Q3-5min max of 0.04mg/kg (ETT 2-2.5 x dosage)

OPP: 2-5mg Q10-15 min (Peds 0.05mg/kg)

Pediatric: 0.02mg/kg (minimum 0.1mg

Anticholinergic Helps to reduce saliva and fluid in the respiratory tract.May also be used to treat a slow heartbeat or insecticide or mushroom poisoning

- Antidote to overdosage with cholinergic substances (nerve gases, poisonous mushroom)

- Pre-op medication to reduce salivary and resp. tract secretions.

Contraindicated in patients with glaucoma, pyloric stenosis or prostatic hypertrophy, except in doses ordinarily used for preanesthetic medication.

Can cause blurred vision, dilated pupils, dry mouth, palpitations urinary retention, tachycardia drowsiness, and confusion

monitor level of consciousness

do not sit up or stand up quickly

advise patient to stay out of bright light

chew sugarless gums and suck hard candies to avoid mouth dryness

use lubricating drops is wearing contact lenses

avoid extreme heat

GENERIC CLASSIFICATI ACTION INDICATION CONTRAINDICATIO SIDE EFFECTS NURSING

NAME ON N CONSIDERATIONDobutamine HCL

BRAND NAME

Dobutrex

Infusion rate: 2.5-10 mcg/kg/min

Andrenergics Stimulates heart’s beta1 receptors to increase myocardial contractility and stoke volume. At dosages, drug increases cardiac output by decreasing peripheral vascular resistance, Zeducing ventricular filling pressure and facilitating AV node therapeutic conduction

Increased cardiac output in short-term treat ment of cardiac decompensation caused by depressed contractility, such as during refractory heart failure; adjunctive therapy in cardiac surgery

Contra indicated in patients hypersensitive to drug and in those with idiopathic hypertrophic subaortic stenosisUse cautiously in patients with history of hypertension because drug may increase pressor responseUse cautiously in patients with history of sulfite sensitivity

.

Increased heart rate, hypertension,Angina, phlebitis, nonspecific chest pain, palpitations, hypotension, nausea, vomiting, shortness of breath, hypersensitivity reactions

Before starting dobutamine therapy: (1) give a plasma volume expander to correct hypovolemia (2) give cardiac glycoside

Continuously monitor ECG, blood pressure, pulmonary artery wedge pressure, cardiac output and urine output

Monitor Electrolyte levels. Drug may lower potassium level

Do not confuse with Dopamine

Tell patient to report adverse reactions promptly, especially labored breathing and drug-induced headache

Instruct patient to report discomfort at IV insertion site

GENERIC NAME CLASSIFICATI ACTION INDICATION CONTRAINDICATIO SIDE EFFECTS NURSING

ON N CONSIDERATIONFurosemide

BRAND NAME

Lasix

DOSAGEAdult:

Initially 1/2-1-2 tab/day Maintenance: 1/2-1 tab/day

20-40 mg IV/IM

Children: 2 mg/kg body/wt

Loop Diuretic

inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle

acute pulmonary edemaedemahypertension

Anuria hepatic coma &

precoma severe

hypokalemia &/or hyponatremia

hypovolemia w/ or w/o hypotension

Hypersensitivity to furosemide or sulfonamides

vertigo, dizziness, headache, paresthesia, orthostatic hypotension, thrombophlebitis, abdominal pain, hypokalemia, anemiamuscle spasm

To prevent nocturia, give preparation in the morning and early in the afternoon

Watch for signs of hpokalemia

do not confuse with Torsemide or Lasix with Lonox

advise patient to take drug with food to prevent GI upset

inform patient of possible need for potassium or magnesium supplements

GENERIC NAME CLASSIFICATI ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING

ON CONSIDERATION

Calcium gluconate

BRAND NAME

Kalcinate

DOSAGETablets 500 mg, 650 mg, 975 mg, 1 g (contains 90 mg elemental calcium/g)

Electrolytes and replacement solutions

Replaces and maintains calcium

Hypocalcemia, hypocalcemic tetany, magnesium toxicity, hypoparathyroidism

Hypercalcemia, ventricular fibrillation, renal canaliculi

GI irritationhemorrhageconstipationvomiting thirstrenal canaliculihypercalcemiapolyuria

Use cautiously in patients with sarcoidosis and renal or cardiac disease and in digitalized patients.

monitor blood calcium level frequently.

GENERIC NAME

CLASSIFICATION ACTION INDICATION CONTRAINDICATION

SIDE EFFECTS NURSING CONSIDERATION

Clonidine hydrochloride

BRAND NAME

Catapres

DOSAGE01-02 mg P.O B.

Antihypertensives

Inhibits central vasomotor centers, thereby decreasing sympatheric outflow.

Essential renal and malignant hypertension

Patient hypersensitive to clonidine

drowsinessdizziness fatigue sedationnervousnessheadacheorthostatic

hypotensionbradycardiaurine retetion impotence transient

glucose intolerance (after large dose)

constipationpruritis

dermatitis

Monitor blood pressure and pulse rate.

May be given rapidly lower blood pressure in some hypertensive emergencies.

Rising slowly and avoid sudden position change to prevent orthostatic hypotension.

Remove patch before defribrillation to prevent arcing

GENERIC NAME

CLASSIFICATION

ACTION INDICATION CONTRAINDICATION

SIDE EFFECTS NURSING CONSIDERATION

Nifedipine

BRAND NAME

Adalat

DOSAGEAdults:Initial: 10-30mg PO TIDMaximum: 120-180mg

Hypertension:30-60mg PO

Antianginals/ Calcium channel blocker

Thought to inhibit calcium ion influx across cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arteriole

•Vasospastic angina, classic chronic stable angina pectoris

•Hypertension

•Contraindicated in patients hypersensitive to drug

•Use cautiously in patients with heart failure or hypotension and in elderly patients. Use extended-release tablets cautiously in patients with severe GI narrowing

Dizziness, light-headedness, headache, weakness, peripheral edema, flushing, nausea, Syncope, nervousness, hypotension, palpitations, nasal congestion, diarrhea, constipation, abdominal discomfort, muscle cramps, dyspnea, pulmonary edema, cough, rash, puritus

Don’t give immediate-release form within 1 week of acute MI or in acute coronary syndrome

Alert: despite the previously widespread SL use nifedipine capsule, avoid this route of administration. Excessive hypotension, MI, and death may result

Monitor blood pressure regularly, especially in patients who take beta blockers or antihypertensive

Watch for symptoms of heart failure

GENERIC NAME

CLASSIFICATION ACTION INDICATION CONTRAINDICATION

SIDE EFFECTS NURSING CONSIDERATION

Nicardipine

BRAND NAME

Cardipine

DOSAGEInitially

20 mg P.O Tid

hypertension20 to 40 mg P.O t.i.d increase dosage depends on the patients response

Antianginals Inhibits calcium ion influx across cardiac and smooth muscle cells, thus decreasing myocardial contractility and oxygen demand and coronary arteries and arterioles.

Chronic stable angina

Patient who are hypersensitive to nicardipine

Headache Dizziness Paresthesis Drowsiness Peripheral

edema Palpitations Tachycardi

a Nausea Dry mouth Abdominal

discomfort Rash Flushing

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

GENERIC NAME CLASSIFICATION

ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATION

Dexamethasone

BRAND NAME

Dexon

DOSAGE

The initial dosage varies from 0.75 to 9 mg a day depending on the disease being treated

Corticosteroids

Diffuses across cell membrane and complexes with specific cytoplasmic receptors

Inflammation of corticosteroid-responsive dermatoses

anti-inflammatory effects in disorders of many organ systems

Patient had an allergic reaction previously.Have an active peptic ulcerHave an active herpes simplex fungal or mycobacterial infection ot the eye, ear infection

Active tuberculosis

Have psychoneurosis or psychosis

Increased appetiteWeight gainWater retentionIncreased WBCHypokalemiaSkin rashDizzinessInsomiaHeadache

Stop drug and notify doctor if patient develops signs of systemic absorption.

Before applying, gently wash skin to prevent damage to skin rub medication gently.

Treatment should be continued for a few days after clearing of lesions to prevent recurrence

Name of the Drug Classificati Action Indication Contraindications SIDE EFFECTS Nursing Responsibilities

on

Generic Name: epinephrine

Brand Name: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

Cardiac arrest: 1 mg IV of 1:10,000 solution q 3-5 min; double dose if administering via ET tube

Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000 solution.

Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution

Refractory bradycardia and hypotension: 2-10ug/min

Beta2 Adrenergic Agonists

Stimulates beta receptors in lung.

Relaxes bronchial smooth muscle.

Increases vital capacity BP, HR, PR

Decreases airway resistance.

o Asthmao Bronchiti

so Emphyse

mao All

cardiac arrest, anaphylaxis

o Used for symptomatic bradycardia.

o Relief of bronchospasm occurring during anesthesia

o Exercised-induced bronchospasm

Contraindicate in patients with angle-closure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Also contraindicated in patient receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage)

Some products containing sulfites and are contraindicated in patients with sulfite allergies except when drug is used for serious allergic reactions or in other emergency situations.

nervousness, tremor, vertigo, pain, widened pulse pressure, hypertension nausea

>Monitor V/S. and check for cardiac dysrhythmias >Drug increases rigidity and tremor in patients with Parkinson’s disease >Epinephrine therapy interferes with tests for urinary catecholamine > Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur >Massage site after IM injection to counteract possible vasoconstriction. >Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop >If blood pressure increases sharply, rapid-acting vasodilators such as nitrates or alpha blockers can be given to counteract

Name of the Drug Classification: Action Indications Contraindications Side Effects Nursing Responsibilities

Generic Name: lidocane

Brand Name: Xylocaine

Dosage/Route1-1.5 mg/kg IVP or ETT (double dose if giving via ET tube), may repeat q 5-10 min. max3 mg/kg; If conversion successful start an infusion of 2-4 mg/min

Antiarrythmic and Anesthetic

Decrease cardiac excitability, cardiac contraction is delayed in the atrium and ventricle

Decrease cardiac excitability, cardiac contraction is delayed in the atrium and ventricle

Contraindicated in patients hypersensitive to amide-type local anesthetics and in those with Adams –Stoke syndrome. Wolff-Parkinsons-White Syndrome, or severe degrees of SA, AV, or intraventricular block in the absence of pacemaker.

CNS: Confusion, tremor, lethargy, somnolence, stupor, restlessness anxiety, hallucinations, nervousness, seizure. CV: hypotension, bradychardia, new or worsened arrhythmias EENT: tinnitus, blurred or double vision. Respiratory: Respiratory depression and arrest Skin: soreness at injection site Other: anaphylaxis,

Monitor EKG, BP, pulse, rhythm, continuously.

Monitor serum lidocaine levels throughout theraphy; therapreutic range 1.5-5 mcg/ml

Monitor intake and output

Do not mix in the same syringe with amphoterin B or cefazolin Administer Lidocaine TIV.

In case of circulatory depression have dopamine available

Name of the Drug Classification Action Indication Contraindications Side Effects Nursing Responsibilities

Generic Name: digoxin

Brand Name:Lanoxin, Digoxin, Lanoxicap

Dosage/RouteInjection 500 mcg (0.5 mg) in 2 mL (250 mcg [0.25 mg] per mL)

Cardiac Glycosides

Inhibits the sodium-potassium ATP phase.

Indications:V-fib, V-flutter, CHF, pulmonary edema, atrial fibrillation and or flutter, and paroxysmal atrial contractions

Contraindicated in patients hypersensitive to the drug or any of its components and in those with digitalis-induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure.

Use cautiously in patients with acute MI, in complete Av block, sinus bradycardia, PVCs,, chronic constrictive pericarditis, hyperthropic cardiomyopathy, renal insufficiency, severe pulmonary disease, or hypothyroidism.

CNS: hallucinations, paresthesia, stupor, vertigo.CV: Arrythmias, heart failure, hypotension.EENT: blurred vision, diplopia, light flashes, photophobia, yellow-green halos around visual images.GI: anorexia, diarrhea, nausea, vomiting.

Monitor K+, Mg++, ECG, liver/renal function tests, drug level (therapeutic level 0.5-2.0 mg/ml, toxicity is >2.0 mg/ml).

Before each dose assess apical pulse for full minute, record and report changes in rate or rhythm.

Withhold drug and contact provider if pulse is < 60/min. or >100 (adults) or < 110/minute (children) Weigh dailyMonitor I&O and signs of CHF

Name of the Drug Classification Action Indications: Contraindications Side Effects Nursing Responsibilities

Generic Name: Dopamine HCl.

Brand Name:Intropin; Revimine

DosageAdults: initially, 1 to 5 mcg/kg/minute by I.V. infusion. Adjust dose to desired hemodynamic or renal response, increase by 1 to 4 mcg/kg/minute at 10 to 30-minute intervals.

Inotropic, vasopressor

Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system. Action is dose-related; large doses can cause mainly alpha stimulation.

To treat shock and correct hemodnamic imbalances, improve perfusion of vital organs, to increase cardiac output, and to correct hypotension.

Contraindicated in patient with uncorrected tachyarrhythmias, pheocromocytoma, or ventricular fibrillation.- Use cautiously in patients with occlusive vascular disease, cold injuries, diabetic endarteritis, and arterial embolism; in pregnant woman; with a history of sulfite sensitivity; and in those taking MAO inhibitor.

Cv: anginal pain, arrythmias, bradycardia, conduction disturbances ectopic breasts,hypertension, hypotension, palpitations, tachycardia, vasoconstriction, widening of QRS complex.

GI: vomiting.

GU: azotemiaRespiratory: asthma attacks, dyspnea

Skin: necrosis,piloerection, tissue sloughing with extravasation.

Other: anaphylaxis.

Blood is not a substitute for blood or fluid volume deficit. If deficit occurs, replace fluid deficit first before giving meds.

During infusion, frequently monitor ECG, BP, cardiac output, CVP, pulmonary artery wedge pressure, pulse rate, urine output, and color and temperature of the limbs.

If diastolic pressure rises disproportionately, decrease perfusion rate and watch out carefully for further signs of vasoconstriction unless such action is desired.

Acidosis decrease effectiveness of dopamine.

Name of the Drug Classification Action Indication Contraindications Side Effects Nursing Responsibilities

GenericMorphine Sulfate

BrandImmediate-release tablets: MSIRTimed-release: Kadian, M-Eslon (CAN), MS Contin, Oramorph SROral solution: MSIR, Rescudose, Roxanol, Roxanol TRectal suppositories: RMSInjection: Astramorph PF, Duramorph, Epimorph (CAN)Preservative-free concentrate for microinfusion devices for intraspinal use: InfumorphDosage/RouteADULTSOralOne-third to one-sixth as effective as parenteral administration because of first-pass metabolism; 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

Opioid agonist analgesic

Principal opium alkaloid; acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

Relief of moderate to severe acute and chronic pain

Preoperative medication to sedate and allay apprehension, facilitate induction of anesthesia, and reduce anesthetic dosage

Analgesic adjunct during anesthesia

Component of most preparations that are referred to as Brompton's cocktail or mixture, an oral alcoholic solution that is used for chronic severe pain, especially in terminal cancer patients

Contraindicated with hypersensitivity to opioids; diarrhea caused by poisoning until toxins are eliminated; during labor or delivery of a premature infant (may cross immature blood–brain barrier more readily); after biliary tract surgery or following surgical anastomosis; pregnancy; labor (respiratory depression in neonate; may prolong labor).

Use cautiously with head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression, hypoxia, hypercapnia (may decrease respiratory drive and increase airway resistance); lactation (wait 4–6 hr after administration to nurse the baby); acute abdominal conditions,

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,

AssessmentHistory: Hypersensitivity to opioids; diarrhea caused by poisoning; labor or delivery of a premature infant; biliary tract surgery or surgical anastomosis; head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression; acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction; pregnancy; lactationPhysical: T; skin color,

daily–24-hr release system; MS Contin: 200 mg PO q 12 hr.SC and IM10 mg (5–20 mg)/70 kg q 4 hr or as directed by physician.IV2.5–15 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.Rectal10–30 mg q 4 hr or as directed by physician.EpiduralInitial injection of 5 mg in the lumbar region may provide pain relief for up to 24 hr. If adequate pain relief is not achieved within 1 hr, incremental doses of 1–2 mg may be given at intervals sufficient to assess effectiveness, up to 10 mg/24 hr.

Intraspinal use with microinfusion devices for the relief of intractable pain

Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary edema

CV disease, supraventricular tachycardias, myxedema, seizure disorder, renal or hepatic dysfunction.

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

texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP, orthostatic BP, perfusion; R, adventitious sounds; bowel sounds, normal output; urinary frequency, voiding pattern, normal output; ECG; EEG; thyroid, liver, kidney function tests

InterventionsCaution 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 controlled respiration readily available during IV administration.