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EMERGENCY DRUGS 1. Aminophylline Brand Name: (Aminosol) Classification: Anti-asthmatic and COPD Preparation Stock Dose: 25mg/10mg/amp Use: Treat the acute symptoms of asthma, bronchitis, emphysema, and other lung diseases in a hospital setting. Nursing Responsibilities: Advise to take this drug on an empty stomach, 1 hour before or 2 hours after meals. Do not to chew or crush timed-release preparations. It may be necessary to take this drug around-the-clock for adequate control of asthma attacks. Avoid excessive intake of coffee, tea, cocoa, cola beverages, and chocolate. Smoking cigarettes or other tobacco products impacts the drug’s effectiveness. Try not to smoke. Notify your health care provider if smoking habits change while taking this drug. Frequent blood tests may be necessary to monitor the effect of this drug and to ensure safe and effective dosage; keep all appointments for blood tests and other monitoring. Tell the patient that they may experience these side effects: Nausea, loss of appetite (taking this drug with food may help if taking the immediaterelease or liquid dosage forms); difficulty sleeping, depression, emotional lability (reversible). Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular heartbeat. 2. Amiodarone Brand Name: (Cordarone) Classification: Anti-arrhythmic Stock Dose: 150mg/amp Use: Ventricular Fibrillation or Pulseless Ventricular Tachycardia Ventricular Tachycardia with pulse Tachycardia rate control Nursing Responsibilities: Check pulse daily once stabilized, or as prescribed. Report a pulse <60. Take oral drug consistently with respect to meals. Become familiar with potential adverse reactions and report those that are bothersome to the physician. 3. Amlodipine Brand Name: (Norvasc) Classification: Anti-Anginal Stock Dose: 5mg/10mg/tab Use: Lower hypertension (high blood pressure) in adults and children. Nursing Responsibilities: Monitor patient carefully (BP, cardiac rhythm, and output) while adjusting drug to therapeutic dose; use special caution if patient has CHF. Monitor BP very carefully if patient is also on nitrates. Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy. Administer drug without regard to meals. 4. Atropine Sulfate Brand Name: (Isopto Atropine) Classification: Anticholinergic Stock Dose: 1mg/ml/amp Use: Symptomatic Bradycardia Specific toxins/overdose (e.g., organophosphates) Nursing Responsibilities: Advise to take as prescribed, 30 minutes before meals; avoid excessive dosage. Avoid hot environments; you will be heat intolerant, and dangerous reactions may occur. 5. Bumetanide Brand Name: (Burinex) Classification: Loop Diuretics Stock Dose: 2mg/4ml Use: Treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease. Nursing Responsibilities: Give with food or milk to prevent GI upset. Mark calendars or uses reminders if intermittent therapy is best for treating edema. Give single dose early in day so increased urination will not disturb sleep. Avoid IV use if oral use is possible. Arrange to monitor serum electrolytes, hydration, liver function during long-term therapy. Provide diet rich in potassium or supplemental potassium. 6. Calcium Gluconate Brand Name: (Calcinate) Classification: Electrolytes Stock Dose: 1gm/amp Use: Treat conditions arising from calcium deficiencies such as hypocalcemic tetany, hypocalcemia related to hypoparathyroidism, and hypocalcemia due to rapid growth or pregnancy. Nursing Responsibilities: Assess for cutaneous burning sensations and peripheral vasodilation, with moderate fall in BP, during direct IV injection. Monitor ECG during IV administration to detect evidence of hypercalcemia: decreased QT interval associated with inverted T wave. Observe IV site closely. 7. Captopril Brand Name: (Capomed) Classification: ACE Inhibitor Stock Dose: 25mg/tab Use: Used alone or together with other medicines to treat high blood pressure (hypertension). Nursing Responsibilities: Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. (for patients treated with hypertension). For patients treated with CHF, monitor weight and assess patient routinely for resolution of fluid overload. Signs of fluid overload are: peripheral edema, rales or crackles, dyspnea, weight gain and jugular vein distention. The nurse should keep in mind that Captopril may cause false-positive result for urine acetone. The drug should be administered 1 hour before or 2 hours after meals. It may be crushed if the patient has difficulty swallowing. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. 8. Clonidine HCl Brand Name: (Catapres) Classification: Anti-hypertensive Stock Dose: 75 mg; 150 mg tab Use: Used alone or with other medications to treat high blood pressure (hypertension). Nursing Responsibilities: Take this drug exactly as prescribed. Do not miss doses. Do not discontinue the drug unless so instructed. Do not discontinue abruptly; lifethreatening adverse effects may occur. If you travel, take an adequate supply of drug. 9. Coralan Brand Name: (Ivabradine) Classification: Anti-Anginal Stock Dose: 5mg;7.5 mg tab Use: Used to treat heart failure. Nursing Responsibilities: Instruct patient to take ivabradine as directed. Advise patient to avoid taking grapefruit juice during therapy; may increase risk of side effects. 10. Diazepam Brand Name: (Lorecam) Classification: Anxiolytic Stock Dose: 5mg/10mg/tab Use: To relieve anxiety and to control agitation caused by alcohol withdrawal. Nursing Responsibilities: Take this drug exactly as prescribed. Do not stop taking this drug (longterm therapy, antiepileptic therapy) without consulting your health care provider. 11. Digoxin Brand Name: (Lanoxin) Classification: Cardiac Drugs Stock Dose: 0.5 mg/2ml Use: To treat heart failure and abnormal heart rhythms (arrhythmias). Helps control your heart rate. Nursing Responsibilities: Report to physician if pulse falls below 60 or rises above 110 or if you detect skipped beats or other changes in rhythm, when digoxin is prescribed for atrial fibrillation. Suspect toxicity and report to physician if any of the following occur: Anorexia, nausea, vomiting, diarrhea, or visual disturbances. Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d. Take digoxin PRECISELY as prescribed, do not skip or double a dose or change dose intervals, and take it at same time each day. 12. Diphenhydramine Brand Name: (Soniphen) Classification: Antihistamine Stock Dose: 50mg/ml/amp Use: To relieve red, irritated, itchy, watery eyes; sneezing; and runny nose caused by hay fever, allergies, or the common cold. It is also used to relieve cough caused by minor throat or airway irritation. Nursing Responsibilities: Monitor cardiovascular status especially with pre-existing cardiovascular disease. Monitor for adverse effects especially in children and the older adult. Supervise ambulation and use side-rails as necessary. Drowsiness is most prominent during the first few days of therapy and often disappears with continued therapy. Older adults are especially likely to manifest dizziness, sedation, and hypotension. 13. Epinephrine Brand Name: (Epix) Classification: Cardiac drugs Stock Dose: 1mg/ml/amp Use: Anaphylaxis Symptomatic bradycardia Shock Cardiac Arrest Nursing Responsibilities: Take medication only as prescribed and immediately notify physician of onset of systemic effects of epinephrine. Discard discolored or precipitated solutions. Do not breast feed while taking this drug without consulting physician. 14. Furosemide Brand Name: (Lasix) Classification: Loop diuretics Stock Dose: 20mg/ml Use: Most commonly used both for acute and chronic heart failure Immediate decrease of pulmonary congestion and severe edema Nursing Responsibilities: Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds. Administer with food or milk to prevent GI upset. Give early in the day so that increased urination will not disturb sleep. Avoid IV use if oral use is at all possible. 15. Hydralazine Brand Name: (Aprezal) Classification: Anti-hypertensive Stock Dose: 20mg/ml/amp Use: Arteriolar dilator It is helpful in increasing cardiac output Nursing Responsibilities: Monitor the client’s blood pressure and pulse frequently during initial dosage adjustment and periodically throughout therapy. Report significant changes to the physician. Monitor frequency of prescription refills to determine adherence. Prior to and periodically during prolonged therapy the following lab values should be monitored: CBC, electrolytes, LE Cell Prep and ANA titer. IM or IV route should be used only when the drug cannot be given orally. 16. Hydrocortisone Brand Name: (Cortin) Classification: Corticosteroid Stock Dose: 100mg /vial Use: To treat a variety of skin conditions (such as insect bites, poison oak/ivy, eczema, dermatitis, allergies, rash, itching of the outer female genitals, anal itching). It reduces the swelling, itching, and redness that can occur in these types of conditions. Nursing Responsibilities: Do not ignore dyspepsia with hyperacidity. Report symptoms to physician and do NOT self-medicate to find relief. Do NOT use aspirin or other OTC drugs unless prescribed specifically by the physician. Note: A high protein, calcium, and vitamin D diet is advisable to reduce risk of corticosteroid-induced osteoporosis. 17. Isosorbide Dinitrate Brand Name: (Isordil), (Isoket) Classification: Anti Anginal Stock Dose: 5mg/tab, 10mg/10ml/amp Use: To prevent angina (chest pain) caused by coronary artery disease. Nursing Responsibilities: Make position changes slowly, particularly from recumbent to upright posture, and dangle feet and ankles before walking. Lie down at the first indication of light-headedness or faintness. Keep a record of anginal attacks and the number of sublingual tablets required to provide relief. Do not drink alcohol because it may increase possibility of lightheadedness and faintness. 18. Leviteracetam Brand Name: (Keppra) Classification: Anti-convulsant Stock Dose: 500mg/vial, 250mg, 500mg/tab Use: Used alone and along with other medications to control partial-onset seizures (seizures that involve only one part of the brain) in adults, children, and infants 1 month of age or older. Nursing Responsibilities: Do not drive or engage in potentially hazardous activities until response to drug is known. Do not abruptly discontinue drug. MUST use gradual dose reduction/taper. Notify physician of intention to become pregnant. Do not breast feed while taking this drug without consulting physician . 19. Losartan Brand Name: (Lifezar) Classification: Angiotensin II Antagonist Stock Dose: 100mg/tab Use: Consider this drug for patients intolerant to ACE inhibitors due to incessant cough Nursing Responsibilities: Notify physician of symptoms of hypotension (e.g., dizziness, fainting). Notify physician immediately of pregnancy. Do not breast feed while taking this drug. 20. Magnesium Sulfate Classification: Anti-convulsant Stock Dose: 250 mg/10ml/amp Use: Cardiac Arrest or pulseless Torsades Torsades de Pointes with pulse Nursing Responsibilities: Drink sufficient water during the day when drug is administered orally to prevent net loss of body water. Recommended daily allowances of magnesium are obtained in a normal diet. Rich sources are whole-grain cereals, legumes, nuts, meats, seafood, milk, most green leafy vegetables, and bananas. Do not breast feed while taking this drug without consulting physician. 21. Meperidine Brand Name: (Demerol) Classification: Analgesic (Opioid) Stock Dose: 100mg/2ml/amp Use: To relieve moderate to severe pain. Nursing Responsibilities: Do not smoke and walk without assistance after receiving the drug. Bed side rails may be advisable. Be aware nausea, vomiting, dizziness, and faintness associated with fall in BP are more pronounced when walking than when lying down (these symptoms may also occur in patients without pain who are given meperidine). Symptoms are aggravated by the head-up position. Do not drive or engage in potentially hazardous activities until any drowsiness and dizziness have passed. 22. Metoclopramide Brand Name: (Clomitene) Classification: Anti emetic Stock Dose: 10mg/2ml/amp Use: To treat the symptoms of slow stomach emptying (gastroparesis) in patients with diabetes. Nursing Responsibilities: Avoid driving and other potentially hazardous activities for a few hours after drug administration. Avoid alcohol and other CNS depressants. Report S&S of acute dystonia, such as trembling hands and facial grimacing, immediately. Do not breast feed while taking this drug without consulting physician. 23. Midazolam Brand Name: (Sedoz) Classification: Sedatives Stock Dose: 5mg/5ml/amp Use: Used before medical procedures and surgery to cause drowsiness, relieve anxiety, and prevent any memory of the event. It is also sometimes given as part of the anesthesia during surgery to produce a loss of consciousness. Nursing Responsibilities: Do not drive or engage in potentially hazardous activities until response to drug is known. You may feel drowsy, weak, or tired for 1–2 d after drug has been given. Be prepared for amnesia to prevent an upsetting postoperative period. Review written instructions to assure future understanding and compliance. Patient teaching during amnestic period may not be remembered. Even if dose is small and depth of amnesia is unclear, relearn information. 24. Morphine Sulfate Classification: Analgesic (Opioid) Stock Dose: 16mg/ml/amp Use: To help relieve moderate to severe pain. Nursing Responsibilities: Avoid alcohol and other CNS depressants while receiving morphine. Do not use of any OTC drug unless approved by physician. Do not smoke or ambulate without assistance after receiving drug. Bedside rails are advised. 25. Nicardipine Brand Name: (Cardepine) Classification: Calcium Antagonist Stock Dose: 10mg/10ml/amp Use: It is used by intravenous and intracerebral arterial infusion to prevent cerebral vasospasm associated with stroke. Nursing Responsibilities: Record and report any increase in frequency, duration, and severity of angina when initiating or increasing dosage. Keep a record of nitroglycerin use and promptly report any changes in previous anginal pattern. Increased incidence and severity of angina has occurred in some patients using nicardipine. Do not change dosage regimen without consulting physician. Be aware that abrupt withdrawal may cause an increased frequency and duration of chest pain. This drug must be gradually tapered under medical supervision. Rise slowly from a recumbent position; avoid driving or operating potentially dangerous equipment until response to nicardipine is known. 26. Norepinephrine Brand Name: (Norepin) Classification: Dyslipidemic Stock Dose: 4mg/4ml/amp Use: To treat life-threatening low blood pressure (hypotension) that can occur with certain medical conditions or surgical procedures. Nursing responsibilities: Monitor constantly while patient is receiving norepinephrine. Take baseline BP and pulse before start of therapy, then q2min from initiation of drug until stabilization occurs at desired level, then every 5 min during drug administration. Adjust flow rate to maintain BP at low normal (usually 80–100 mm Hg systolic) in normotensive patients. In previously hypertensive patients, systolic is generally maintained no higher than 40 mm Hg below preexisting systolic level. Observe carefully and record mental status (index of cerebral circulation), skin temperature of extremities, and color (especially of earlobes, lips, nail beds) in addition to vital signs. Monitor I&O. Urinary retention and kidney shutdown are possibilities, especially in hypovolemic patients. Urinary output is a sensitive indicator of the degree of renal perfusion. Report decrease in urinary output or change in I&O ratio. 27. NTG Patch Classification: Anti Anginal Stock Dose: 5mg Use: To prevent episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Nursing Responsibilities: Store tablet form in its original container. Sit or lie down upon first indication of oncoming anginal pain. Spit out the rest of your sublingual tablet as soon as pain is completely relieved, especially if you are experiencing unpleasant adverse effects such as headache. Relax for 15–20 min after taking tablet to prevent dizziness or faintness. Be aware that pain not relieved by 3 sublingual tablets over a 15-min period may indicate acute MI or severe coronary insufficiency. Contact physician immediately or go directly to emergency room. Note: Sublingual tablets may be taken prophylactically 5–10 min prior to exercise or other stimulus known to trigger angina (drug effect lasts 30–60 min). 28. Nubain Brand Name: (Nalbuphine HCl) Classification: Analgesic (Opioid) Stock Dose: 10mg/ml/amp Use: To treat moderate to severe pain. It is also used for treating pain just after surgery or childbirth. Nursing Responsibilities: Do not drive or engage in potentially hazardous activities until response to drug is known. Avoid alcohol and other CNS depressants. Do not breast feed while taking this drug without consulting physician. 29. Propofol Brand Name: (Spiva) Classification: Anesthetic Stock Dose: 10mg/ml Use: To help you relax before and during general anesthesia for surgery or other medical procedure. Nursing Responsibilities: Monitor hemodynamic status and assess for dose-related hypotension. Take seizure precautions. Tonic-clonic seizures have occurred following general anesthesia with propofol. Be alert to the potential for drug induced excitation (e.g., twitching, tremor, hyper clonus) and take appropriate safety measures. Provide comfort measures; pain at the injection site is quite common especially when small veins are used. 30. Tramadol Brand Name: (Tramal) Classification: Analgesic Stock Dose: 50mg/ml/amp Use: To relieve moderate to moderately severe pain, including pain after surgery. The extended-release capsules or tablets are used for chronic ongoing pain. Nursing Responsibilities Exercise caution with potentially hazardous activities until response to drug is known. Understand potential adverse effects and report problems with bowel and bladder function, CNS impairment, and any other bothersome adverse effects to physician. 31. Paracetamol Brand Name: (Aeknil) Classification: Analgesic Stock Dose: 300mg/2ml/amp Use: To treat aches and pain. It can also be used to reduce a high temperature. Nursing Responsibilities Do not take other medications (e.g., cold preparations) containing acetaminophen without medical advice; overdosing and chronic use can cause liver damage and other toxic effects. Do not self-medicate adults for pain more than 10 d (5 d in children) without consulting a physician. 32. Terbutaline Classification: Anti asthmatic Stock Dose: 1ml/amp Use: To prevent and treat wheezing, shortness of breath, and chest tightness caused by asthma, chronic bronchitis, and emphysema. It works by relaxing and opening the airways, making it easier to breathe. Nursing Responsibilities Adhere to established dosage regimen (i.e., do not change dose intervals or omit, increase, or decrease the dose). Inhalator therapy: Review instructions for use of inhalator (included in the package). Learn how to take your own pulse and the limits of change that indicate need to notify the physician. Advise to consult physician if breathing difficulty is not relieved or if it becomes worse within 30 min after an oral dose. 33. Verapamil Brand Name: (Isoptin) Classification: Calcium Antagonist Stock Dose: 5mg/2ml/amp Use: To treat high blood pressure and to control angina (chest pain). Nursing Responsibilities Monitor radial pulse before each dose, notify physician of an irregular pulse or one slower than established guideline. Adhere to established guidelines for exercise program. Do not drive or engage in potentially hazardous activities until response to drug is known. Decrease intake of caffeine-containing beverage (i.e., coffee, tea, chocolate). Change positions slowly from lying down to standing to prevent falls because of drug-related vertigo until tolerance to reduced BP is established. 34. Atrovent Nebule Brand Name: (Ipratropium Br) Classification: Anti Asthmatic Nursing responsibilities Note: This medication is not an emergency agent because of its delayed onset and the time required to reach peak bronchodilator. Review patient information sheet on proper use of nasal spray. Allow 30– 60 sec between puffs for optimum results. Do not let medication contact your eyes. Wait 5 min between this and other inhaled medications. Check with physician about sequence of administration. 35. Salbutamol Nebule Brand Name: (Hivent) Classification: Anti Asthmatic Nursing Responsibilities: Review directions for correct use of medication and inhaler. Avoid contact of inhalation drug with eyes do not increase number or frequency of inhalations without advice of physician. 36. Budenoside Nebule Brand Name: (Bronex) Classification: Anti Asthmatic Nursing Responsibilities: Notify the physician immediately for any of the following: itching, skin rash, fever, swelling of face and neck, difficulty breathing, or if you develop S&S of infection. 37. Heparin Classification: Anti-Coagulant Stock Dose: 5,000 I.U/vial, 25,000 I.U/vial Use: It is also used to prevent blood clotting during open-heart surgery, bypass surgery, kidney dialysis, and blood transfusions. Nursing Responsibilities Advice the patient to engage in normal activities such as shaving with a safety razor in the absence of a low platelet (thrombocyte) count. Usually, heparin does not affect bleeding time. Caution: Smoking and alcohol consumption may alter response to heparin and are not advised. Do not take aspirin or any other OTC medication without physician's approval. 38. Lidocaine Classification: Local Anesthetic Stock Dose: 20mg/ml/50ml/vial Use: Cardiac Arrest (Ventricular Fibrillation or Ventricular Tachycardia) Wide Complex Tachycardia with pulse Nursing Responsibilities Swish and spit out when using lidocaine solution for relief of mouth discomfort; gargle for use in pharynx, may be swallowed (as prescribed). Oral topical anesthetics (e.g., Xylocaine Viscous) may interfere with swallowing reflex. Do NOT ingest food within 60 min after drug application; especially pediatric, geriatric, or debilitated patients. Do not chew gum while buccal and throat membranes are anesthetized to prevent biting trauma.