Emergency Drugs

Drug Action Indications Adverse Effects Contraindications Nursing Management

It inhibits actions of  Pre-op  CNS:  Hypersensitivity  Monitor VS.
ATROPINE SULFATE acetylcholine at meds/pre- restlessness,  With acute angle  Report  HR
Isopto Atropine postganglionic anesthetic meds ataxia, closure glaucoma,  Monitor for
parasympathetic  To restore disorientation, obstructive constipation,
Classification : neuroeffector sites, cardiac rate and hallucinations, uropathy, oliguria.
Anticholinergics primarily at arterial pressure delirium, coma, obstructive  Instruct to take
muscarinic receptors. during insomnia, disease of GI 30 mins before
Dosage Small doses inhibit anesthesia agitation, tract, paralytic meals
 Bradycardia: 0.5 mg salivary and when vagal confusion. ileus, toxic  Eat foods high in
IV every 3-5 mins, bronchial secretions,  To lessen the  CV: tachycardia, megacolon, fiber and drink
max of 0.04 mg/kg moderate doses degree of A-V angina, intestinal atony, plenty fluids.
 Cardiac Arrest: 1 mg dilate pupils and heart block arrhythmias, unstable CV  Can cause
every 3-5 mins increase heart rate.  To overcome flushing. status in acute photophobia
 Nerve and Large doses decrease severe carotid  EENT: hemorrhage,  Instruct client not
Organophosphate GI motility, inhibit sinus reflex photophobia, asthma, or to drive a motor
symptoms: may gastric acid  Antidote for blurred vision, myasthenia vehicle or
repeat in 2 mg secretion. Blocked cholinergic mydriasis. gravis. participate in
increments q 3 mins vagal effects result in toxicity  GI: dry mouth,  Pregnant women. activities
titrated to relief positive chronotropy constipation, requiring
symptoms and positive vomiting. alertness.
dromotropy (limited  GU: urine  Advise to use
or no inotropic retention. hard candy, ice
effect). In emergency  Hematologic: chips, etc. for dry
care, it is primarily leukocytosis mouth.
used to increase the  Other:
heart rate in life- anaphylaxis
threatening
bradycardias.
Drug Action Indications Adverse Effects Contraindications Nursing Management
  Relaxes the  Angina pectoris  CNS:  Contraindicated in  Record characteristics
NITROGLYCERINE vascular  CHF associated headache, patients and precipitating factors
Nitrostat smooth with AMI throbbing, hypersensitive to of anginal pain.
system  Cardiac load dizziness, nitrates  Monitor BP and apical
Classification reducing agent weakness.  With early MI. pulse before
 Antianginal  Reduces  Hypertensive  GI: nausea, (S.L. form), severe administration and
 Nitrate myocardial Crisis vomiting anemia, increase periodically after dose.
 Vasodilator, oxygen  Skin: Rash ICP angle-closure  Have client sit or lie
 Coronary consumption  Adverse glaucoma, IV down if taking drug for
 Reduces left Reactions nitroglycerine is the first time.
Dosage ventricular  CV: contraindicated in  Client must have
 0.3-0.4 mg SL q 5 workload orthostatic patients with continuing EKG
min, max 3 doses.  Reduces hypotension, hypovolemia, monitoring for IV
 Every 6 hrs except arterial BP flushing, hypotension, administration
for midnight  Reduces fainting. orthostatic  Defibrillator must not
(cream) venous  EENT: hypotension, be discharged through
 Wear 12 hrs a day return sublingual cardiac paddle electrode
for skin patch burning. tamponade overlying
 Skin: restrictive  Nitro-Bid ointment or
Cutaneous cardiomyopathy, the Transderm-Nitro
vasodilation, constrictive Patch. Assist with
contact pericarditis. ambulating if dizzy.
dermatitis  Instruct to take at first
(patch) 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.
Drug Action Indications Adverse Effects Contraindications Nursing Management
  Acts as  Relief of  CNS: Light-headedness,  Hypersensitivity Interventions
MORPHINE SULFATE agonist at moderate to dizziness, sedation, to opioid  Caution patient
specific severe acute and euphoria, dysphoria,  Diarrhea caused not to chew or
Classification opioid chronic pain delirium, insomnia, by poisoning until crush
Opioid Agonist Analgesic receptors in  Preoperative agitation, anxiety, fear, toxins are controlled-
the CNS to medication hallucinations, eliminated release
Dosage produce  Analgesic disorientation,  During labor or preparations.
 Oral: 10–30 mg q analgesia, adjunct during drowsiness, lethargy, delivery of a  Tell patient to lie
4 hr PO. euphoria, anesthesia impaired mental and premature infant down during IV
Controlled- sedation  Component of physical performance,  After biliary tract administration.
release: 30 mg q most coma, mood changes, surgery or  Keep opioid
8–12 hr PO or as preparations weakness, headache, following surgical antagonist and
directed by that are referred tremor, seizures, miosis, anastomosis facilities for
physician to as Brompton's visual disturbances,  Pregnancy assisted or
 SC and IM:10 mg cocktail or suppression of cough  Labor controlled
(5–20 mg)/70 kg mixture reflex respiration
q 4 hr or as  Intraspinal use  CV: Facial flushing, readily available
directed by with peripheral circulatory during IV
physician. microinfusion collapse, tachycardia, administration.
 IV:2.5–15 mg/70 devices for the bradycardia, arrhythmia,  Use caution
kg of body weight relief of palpitations, chest wall when injecting
in 4–5 mL water intractable pain rigidity, hypertension, SC or IM into
for injection  Unlabeled use: hypotension, orthostatic chilled areas or
administered over Dyspnea hypotension, syncope in patients with
4–5 min, or as associated with  Respiratory:Respiratory hypotension or
directed by acute left depression, apnea, in shock
physician. ventricular circulatory depression,  Reassure
Continuous IV failure and respiratory arrest, shock, patients that
infusion: 0.1– pulmonary cardiac arrest they are unlikely
1 mg/mL in 5% edema to become
dextrose in addicted
water .
 Drug Action Indications Adverse Effects Contraindications Nursing Management
 Stimulates  Asthma Nervousness,  With angle- 1. Monitor V/S.
EPINEPHRINE beta receptors  Bronchitis tremor, vertigo, closure and check for
in lung.  Emphysema pain, widened glaucoma, cardiac
Classification  Relaxes  All cardiac pulse pressure, shock (other dysrrhythmias  
Beta2 Adrenergic bronchial arrest, hypertension than 2. Drug increases
Agonists smooth anaphylaxis nausea anaphylactic rigidity and
muscle.  Used for shock), tremor in
Dosage  Increases vital symptomatic organic brain patients with
 Cardiac arrest: 1 capacity bradycardia. damage, Parkinson’s
mg IV of  Increases BP,  Relief of cardiac disease
1:10,000  HR,  PR bronchospasm dilation, 3. Epinephrine
solution q 3-5  Decreases occurring arrhythmias, therapy
min; double airway during coronary interferes with
dose if resistance. anesthesia insufficiency, tests for
administering  Exercised- or cerebral urinary
via ET tube induced arterioscleros catecholamine
bronchospasm is. Also 4. Avoid IM use of
 Anaphylaxis: contraindicat parenteral
0.1- 1 mg SQ or ed in patient suspension into
IM of 1:1000 receiving buttocks. Gas
solution. general gangrene may
 Asthma: 0.1-0.3 anesthesia occur
mg SQ or IM of with 5. Massage site
1:10,000 halogenated after IM
solution hydrocarbons injection to
 Refractory or counteract
bradycardia and cyclopropane possible
hypotension: 2- and in vasoconstrictio
10ug/min patients in n.
labor (may 6. Observe
delay second patient closely
stage) for adverse
 In reactions.
conjunction Notify doctor if
with local adverse
anesthesia, reaction
epinephrine develop
is 7. If blood
contraindicat pressure
ed for use in increases
finger, toes, sharply, rapid-
ears, nose, acting
and genitalia. vasodilators
Drug Action Indications Adverse Effects Contraindications Nursing
Management
 Increase  Diabetes  CNS: tremor, Contraindications  Give 1-2
VASOPRESSIN permeability of Insipidus headache,  With chronic glass of H20
Pitressin renal tubular  Abdominal vertigo nephritis and to reduce
epithelium to Distention  CV: nitrogen retention adverse
Classification adenosine  GI bleeding vasoconstrictio  Hypersensitivity reactions
 Pituitary monophosphate  Esophageal n, arrhythmias, and
Hormones and water, the varices cardiac arrest, improve
 ADH epithelium myocardial therapeutic
promotes ischemia, response
Dosage reabsorption of circumollar  Warm
Prevent and treat water and pallor, vasopressin
abdominal concentrated decreased CO, in your
distention: initially 5 urine angina hands and
units IM gives  GI: abdominal mixed until
subsequent cramps it is
injections q3-4  GU:uterine distributed
hours increasing to cramps evenly in
10 units if needed.
 Respi: the solution
bronchoconstri  Monitor
ction urine Sp.
 Skin: Gravity and
diaphoresis, I&O to aid
gangrene and evaluation
urticaria of drug
effectivenes
s

Drug Action Indications Adverse Effects Contraindications Nursing Management

 Decreased  Mg  CNS:  Heart block  Monitor
MAGNESIUM SO4 acetylcholine replacement drowsiness, and I&O. make
released  Arrhythmia depressed myocardial sure urine
Classification reflexes, flaccid damage output is
 Anti- paralysis,  Toxemia of 100 ml or
convulsant hypothermia pregnancy more in 4
 Anti-  CV: hrs pd
arrhythmics hypotension, before each
flushing, dose
Dosage bradycardia,  Take
 Arrhythmia: IV circulatory appropriate
1-6 grams over collapse, seizure
several depressed precautions
minutes, then cardiac function  Keep IV Ca
continuous IV  EENT: diplopia gluconate at
infusion 3-20  Respiratory: bedside
mg/min for 5- respiratory
48 hours. paralysis
 Metabolic:
hypocalcemia
 Skin:
diaphoresis
 Drug Action Indications Adverse Effects Contraindications Nursing Management

Na HCO3  Restore  Metabolic  CNS: tetany  Metabolic and  Obtain

Arm and Hammer; buffering Acidosis  CV: edema respiratory blood pH,
Baking Soda capacity of the  Cardiac Arrest  GI: gastric alkalosis PaO2,
body and distention,  Pt losing Cl PaCo2 and
Classification neutralizes belching and because of electrolyte
Alkalinizers excessive acid flatulence vomiting or levels
 Metabolic: continuous GI  SIVP
Dosage hypokalemia, suction or those
 Metabolic metabolic receiving
Acidosis: Usually alkalosis, diuretics that
2-5 meq/kg IV hypernatremia, produces
infuse over 4-8 hyperosmolarity hypochloremic
hr period with overdose alkalosis
 Cardiac Arrest: 1  Skin: pain @
meq/kg IV of 7.5 injection site
or 8.4% sol, then
0.5 meq/kg IV q
10 mins
depending on
ABG

Drug Action Indications Adverse Effects Contraindications Nursing Management

 While the  For  CNS: seizures,  Hypersensitivity  Assess
NALOXONE HCL mechanism of suspected tremors  Use cautious with respiratory
Narcan action is not opioid  CV: ventricular cardiac irritability status
fully induced fibrillation, or opiod addiction. frequently
Classification understood, the respiratory tachycardia,  Respiratory
Miscellaneous preponderance depression HPN with rate increases
antagonists and of evidence higher within 1-2 mins
antidotes suggests that  For recommended
naloxone postoperativ doses,
Dosage antagonizes the e opiod hypotension
 For suspected opioid effects by depression  GI: nausea and
opioid induced competing for vomiting
respiratory the same  Respiratory:
depression: 0.4 to 2 receptor sites. pulmonary
mg IV, IM and SQ. edema
repeat doses q 2-3  Skin:
mins PRN diaphoresis
 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
 Drug Action Indications Adverse Effects Contraindications Nursing Management
 Antagonizes the  Benzodiazepine-  Nausea, vomiting,  Control of ICP 1. Must individualize
FLUMAZENIL effects of induced palpitations, or status dosage. Give only
Romazicon benzodiazepines depression of the sweating, epilepticus. smallest amount
ventilatory flushing, dry  Signs of serious effective.
Classification responses to mouth, tremors, cyclic 2. Give through
 Benzodiazepine hypercapnia and insomnia, antidepressant freely running IV
receptor hypoxia dyspnea, overdose infusion into large
antagonists hyperventilation, vein to minimize
blurred vision, pain at injection
Dosage headache, pain at site
 2 ml IV given over injection site 3. Note history of
15 seconds seizure or panic
disorder
4. Assess evidence
of increased ICP
5. Note evidence of
sedative and
benzodiazepine
dependence
6. Instruct to avoid
alcohol and non-
prescription drugs
for 1-24 hrs
 Drug Action Indications Adverse Effects Contraindications Nursing Management
Stimulates  To treat shock  CNS: headache  Hypersensitivity  Most patients
DOPAMINE dopaminergic and and correct an anxiety  With uncorrect received less than
Intropine alpha and beta hemodynamic  CV: tachy, tachyarrhythmias 20 mcg/kg/min
receptors of the imbalances angina,  Pheochromocyto  Drugs isn’t
Classification sympathetic nervous  To correct palpitations and ma substitute for
Adrenergic drugs system resulting in hypotension vasoconstriction  Ventricular blood or fluid
positive inotropic  GI: nausea and Fibrillation volume deficit
Dosage effect and increased  To improve vomiting  During infusion,
Initially 2-5 CO. perfusion of monitor ECG, BP,
mcg/kg/min by IV vital organs CO, PR and color
and temp of the
 To increase CO limbs
 Do not confuse
dopamine to
dobutamine
 Check urine
output often

Drug Action Indications Adverse Effects Contraindications Nursing Management

 Inhibits calcium  Hypertension  CNS:abnormal  Hypersensitivity  Monitor BP and
VERAPAMIL transport into  Angina dreams, anxiety,  Sick sinus pulse before
Calan, Isoptin, Verelan, myocardial Pectoris confusion, syndrome therapy, during
Covera HS smooth muscle  Supraventricul dizziness and  2nd or 3rd degree titration and
cells ar Arrhythmia headache AV block therapy
Classification  Decreases SA  Atrial  EENT: blurred  CHF  Monitor ECG, I&O,
 Anti-anginal and AV flutter/fibrilla vision, epistaxis  Cardiogenic shock serum potassium
 Anti-arrhythmics conduction and tion and tinnitus  Concurrent IV and weight.
 Anti-hypertensive prolongs AV  CV: arrhythmia, beta-blocker  Assess for CHF
 Vascular headache node refractory CHF, chest pain,
suppressants period in bradycardia,
conduction hypotension and
Dosage tissue palpitations
PO 80-120 mg 3x  GU: dysuria,
daily, increases as nocturia and
needed polyuria
 GI: abnormal liver
function, anorexia,
constipation,
diarrhea, nausea
and vomiting
 Drug Action Indications Adverse Effects Contraindications Nursing Management
Generic:  Calcium  Calcium  Hypertensive  Peripheral  Patients with
Nicardipine channel Antagonist emergencies or edema, hepatic
HCL blocker that urgencies, peri- headache, impairment
inhibits op & post-op tachycardia, should
Brand: Calcium ion HTN, palpitations, receive lower
Cardepine influx across hypertensive localized dose.
cardiac and states of NPO thrombophleb  Monitor
smooth patients. itis & blood
muscle cells, hypotension. pressure.
also dilates  Advise
coronary patient to
arteries and report
arterioles immediately
if
experiencing
chest pain

Name of
Action Indication Contraindication Adverse Effects Nursing Interventions
Drug
Tramadol  Inhibits  Moderat  Acute  CNS and GI  Assess for level of pain relief
HCl prostagla e to intoxication disturbances. and administer dose as needed
ndin severe with alcohol, Nausea, but not to exceed the
(Dolcet) sythetase pain hypnotics, dizziness. recommended total daily dose
to cause narcotics, Fatigue,
antipyreti centrally- constipation,  Discontinue drug and notify
c and acting dry mouth. the physician if s/sx of
anti- analgesics, hypersensitivity occur
inflamma opioids or
tory psychotropic  Take appropriate safety
effects: drugs. precautions.
 the exact Hypersensitivi
mechanis ty  To be taken with food to avoid
m is GI upset.
unknown.

Name of
Action Indication Contraindication Adverse Effects Nursing Interventions
Drug
Calcium  Repla  Hypocalcem  Hypercalcemi  GI irritation  Use cautiously in patients with
gluconate ces ia, a, ventricular  hemorrhage sarcoidosis and renal or
Calciu hypocalcem fibrillation,  constipation cardiac disease and in
(Kalcinate) m and ic tetany, renal  vomiting digitalized patients.
maint magnesium canaliculi  thirst
ains toxicity,  renal  Monitor blood calcium level
Calciu hypo canaliculi frequently
m parathyroid  hypercalcemia
level ism  polyuria

Name of Contraindicatio
Action Classification Adverse Effects Nursing Interventions
Drug n
Generic  Inhibits  Non  Contrain  Headache,  Administer drug with food or
Name: prostaglandin Steroidal dicated dizziness, after meals if GI upset occurs.
Diclofenac sythetase to Anti – with bsomnolence,
Sodium cause inflammator allergy insomnia, fatigue,  Arrange for ophthalmologic
antipyretic y Drugs to tiredness, exam during long-term
Brand and anti- NSAIDs, dizziness, tinnitus, therapy.
Name: inflammatory significa ophthalmic
Voltaren effects: the nt renal effects.  Institute emergency
exact impairm procedure if overdose occurs.
mechanism is ent,  Pruritus,
unknown. pregnan sweating, dry
 cy, mucous
lactation membranes,
. stomatitis.

 Use  Dysuria, renal

cautiousl impairment.
y with
impaired  Nausea,
hearing, dyspepsia, GI pain,
allergies, diarrhea,
hepatic, vomiting,
CV, GI constipation,
conditio flatulence.
ns, and
in  Bleeding, platelet
elderly inhibition with
patients. higher doses.