Drug Study 3rd Wk

Drug Study

Generic Name Classification Indication Dosage Nursing Responsibilities

Acetaminophen Non-Opioid Analgesic/Antipyretic

Mild to moderate pain.

Fever control.

100 mg/mL, 160 mg/5 mL

ROUTE ONSET PEAK DURATIONPO 0.5–1 hr 1–3 hr 3–8 hr†IV w/in 30 min 30 min 4–6 hr

Half-life: Neonates: 2–5 hr. Adults: 1–3 hr.

PO (Adults and Children >12 yr): 325–650 mg q 4–6 hr or 1 g 3–4 times daily or 1300 mg q 8 hr (not to exceed 4 g or 2.5 g/24 hr in patients with hepatic/renal impairment).PO (Children 1–12 yr): 10–15 mg/kg/dose q 4–6 hr as needed (not to exceed 5 doses/24 hr).PO (Infants): 10–15 mg/kg/dose q 4–6 hr as needed (not to exceed 5 doses/24 hr).

Monitor liver and kidney function, and CBC periodically for clients on long-term therapy.

Can cause psychologic dependence. Antidote: Acetylcysteine (Mucomyst)

Trade Name Mechanism of Action Contraindication Adverse Effects Actual Patient Response

Tylenol Analgesia: inhibits formation ofprostaglandins involved with pain. Analgesia also occurs by action of hypothalamus and blocking generation of pain impulses.

Antipyretic: inhibits formation ofprostaglandins in production of fever. It acts on the hypothalamus to produce vasodilation.

Does not have anti-inflammatory or antiplatelet action.

Hypersensitivity Severe hepatic

impairment/active liver disease.

Rash Thrombocytopenia Liver Toxicity (toxicity can occur 2–24 hours after

ingestion)

N/A

Chong Hua HospitalDon Mariano Cui St. corner J. Llorente St., Cebu City, Philippines 6000Office of the Critical Care Services Tel. # 255.8000 loc. 7465Education, Training & Research

Drug Study


Morphine Sulfate

Opioid Analgesic/ Agonist

Relief of moderate to severe pain.

Preoperative and/or postoperative medication.

Pain relief in MI, relief of dyspnea occurring in pulmonary edema or acute left ventricularfailure.

10 mg/mL, 25 mg/mL

Half-life: Adults: 2–4 hr.

ROUTE ONSET PEAK DURATIONIM 10–30 min 30–60 min 4–5 hrSubcut 20 min 50–90 min 4–5 hrIV rapid 20 min 4–5 hrEpidural 6–30 min 1 hr up to 24 hrIT rapid (min) unknown up to 24 hr

Epidural (Adults): Intermittent injection—5mg/day (initially); if relief is not obtained at 60 min, 1–2 mg increments may be made; (total dose not to exceed 10 mg/day)

Continuous infusion—2–4 mg/24 hr; may ↑by 1–2 mg/day (up to 30 mg/day);

Assess client’s pain before giving medication. Evaluate effectiveness of analgesic including onset and

duration of response to medication. Observe for signs of tolerance with prolonged use. Monitor respiratory rate and depth before giving drug, and

periodically thereafter. Encourage sighing, coughing, and deep breathing. Warn ambulatory clients to avoid activities that require

alertness. Advise client to change position slowly. Check for signs of urinary retention. Keep stool record and institute measures to prevent

constipation - e.g., fluids, foods high in fiber, and activity as tolerated.

Have narcotic antagonist (naloxone[Narcan]) available for reversal of effects if necessary.


MOS Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resultingin inhibition of gastric acid secretion.

Hypersensitivity sedation confusion euphoria impaired coordination dizziness urinary retention constipation hyperglycemia respiratory depression hypotension tachycardia, bradycardia nausea & vomiting allergic reactions pupil constriction

N/A


Drug Study


Naloxone Hydrochloride

Opioid Anatagonist Postoperative respiratory depression caused by narcotics.

Therapy in suspected orconfirmed narcotic overdose.

0.4 mg/mL, 1 mg/mL

Half-life: 60–90 min (up to 3 hr in neonates).

ROUTE ONSET PEAK DURATIONIV 1–2 min unknown 45 minIM, Subcut 2–5 min unknown >45 min

IV (Adults): 0.02–0.2 mg q 2–3 min until response obtained; repeat q 1–2 hr if needed.

IV (Children): 0.01 mg/kg; may repeat q 2–3 minuntil response obtained. Additional doses may be given q 1–2 hr if needed.

Emergency resuscitative equipment needs to be available. Monitor VS, especially respirations. Monitor surgical clients for bleeding. Withdrawal symptoms will be seen in client addicted to narcotics

(vomiting, restlessness, abdominal cramps, increased BP, and temperature).

Patients who have been receiving opioids for >1 wk are extremely sensitive to the effects of naloxone. Dilute and administer carefully.

Administer undiluted for suspected opioid overdose. For opioid-induced respiratory depression, dilute with sterile water for injection. For children or adults weighing >40 kg, dilute 0.1 mg of naloxone in10 mL of sterile water or 0.9% NaCl for injection.

Administer over 30 seconds for patients with a suspected opioid overdose. For patients who develop opioid-induced respiratory depression, administer dilute solution of 0.4 mg/10 mL at a rate of 0.5 mL (0.02 mg) direct IV every 2 min.

Assess patient for level of pain after administration when used to treat postoperative respiratory depression. Naloxone decreases respiratory depression but also reverses analgesia.



Narcan Occupies opiate receptor sites and prevents or reverses effects of agonists.

Hypersensitivity hypertension tremors reversal of analgesia hyperventilation increases PTT In too-quick reversal: nausea, vomiting,

sweating, tachycardia.

N/A

Drug Study


Phenobarbital Sodium

Barbiturate/Sedative/Hypnotic/

Anti-convulsant

Pre-operative Sedation

Hypnosis

Seizure disorders

Tablets: 15 mg, 30 mg, 60 mg, 100 mgInjection: 65 mg/mL, 130 mg/mL

Half-life: Neonates: 1.8–8.3 days Infants: 0.8–5.5 days Children: 1.5–3 days Adults: 2–6 days

ROUTE ONSET PEAK DURATIONPO 30–60 min unknown >6 hrIM, subcut 10–30 min unknown 4–6 hrIV 5 min 30 min 4–6 hr

Preoperative sedation—1–3 mg/kg PO/IM/IV 1–1.5 Hours before the procedure.

High doses for long periods of time can cause physical dependence.

IV administration: client must be monitored constantly: take V/S frequently, have emergency equipment available, monitor for extravasation at infusion site.

Will cause restlessness in client in pain.



Luminal Hinders movement

of impulses from the thalamus to the brain cortex, thus creating depression in the CNS, which can range frommild to severe.

Inhibits transmission in the nervous system and raises the seizure threshold.

Considered a long-actingbarbiturate.

Hypersensitivity Comatose patients or

those with pre-existing CNS depression.

Severe respiratory disease with dyspnea or obstruction.

Uncontrolled severe pain.

Dizziness, “hang-over” ataxia drowsiness, anxiety, irritability, hand tremors vision difficulties insomnia bradycardia low blood pressure chest tightness wheezing apnea, respiratory depression nausea, vomiting constipation hypersensitivity reactions

N/A

Drug Study


Diazepam Antianxiety Agents/ Anticonvulsant/

Sedative/HypnoticsSkeletal Muscle Relaxant/

Benzodiazepine

Anxiety disorders

Muscle relaxant

Convulsive Disorders

Preoperative medication (sedation)

5 mg/mL

Half-life: Children 12–16 yr: 18–20 hr Adults: 20–50 hr

ROUTE ONSET PEAK DURATIONPO 30–60 min 1–2 hr up to 24 hrIM w/in 20 min 0.5–1.5 hr unknownIV 1–5 min 15–30 min 15–60 min†

Status Epilepticus/Seizure:IV (Adults): 5–10 mg, may repeat q 10–15 min toa total of 30 mg, may repeat again in 2–4 hr

IM, IV (Children ≥5 yr): 0.05–0.3 mg/kg/dosegiven over 3–5 min q 15–30 min to a total dose of

Do not mix with other drugs in the same syringe. Cautious IV use as drug can precipitate in IV solutions. Parenteral administration can cause low blood pressure,

increased heart rate, muscle weakness, and respiratory depression. Monitor I&O.


10 mg, repeat q 2–4 hr

Sleletal Muscle Relaxant:IM, IV (Adults): 5–10 mg; may repeat in 2–4 hr


Valium Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.

Produces skeletalmuscle relaxation by inhibiting spinal polysynaptic afferent pathways.

Has anticonvulsant properties due to enhanced presynaptic inhibition.

Hypersensitivity Myasthenia gravis Severe pulmonary

impairment Severe hepatic

Angle-closure glaucoma

Dry mouth constipation urinary retention photophobia and blurred vision hypotension tachycardia muscle weakness respiratory depression

N/A

Drug Study


Phenytoin Antiarrhythmic/Anticonvulsant/

Hydantoin

Tonic-clonic and complex partialSeizures

Status epilepticus

Prevention of seizures that accompany neurosurgery

50 mg/mL

Half-life: 22 hr (range 7–42 hr)

ROUTE ONSET PEAK DURATIONPO 2–24 hr 1.5–3 hr 6–12 hrIV 0.5–1 hr rapid 12–24 hr

IV (Adults): Status epilepticus loading dose—15–20 mg/kg. Rate not to exceed 25–50 mg/min.

Tablet can be crushed and should be mixed with food or fluid. Can turn urine pink, red, or red-brown. IM route not recommended. Do not mix with other drugs. Monitor CBC, liver, thyroid, and urine tests. Gingival hyperplasia seen most often in children and

adolescents. Stop drug immediately if a measles like rash occurs. May lead to

renal failure, rhabdomyolysis, or hepatic necrosis.



Dilantin Prevents dissemination of electrical discharges in motor cortex area of the brain.

Antiarrhythmic properties is a result of shortening the actionpotential and decreasing automaticity of the heart.

Hypersensitivity Alcohol intolerance Sinus bradycardia,

sinoatrial block, 2nd- or3rd-degree heart block

Confusion slurred speech slow physical movement blood dyscrasias nausea, vomiting constipation gingival hyperplasia hirsutism rash acne hypotension circulatory collapse cardiac arrest

N/A

Drug StudyGeneric Name Classification Indication Dosage Nursing Responsibilities

Propofol General Anesthetic Induction of general anesthesia in children and adults

Maintenance of balanced anesthesia when used with other agents

Initiation and maintenance of monitored anesthesiacare (MAC)

10 mg/mL

Half-life: 3–12 hr

ROUTE ONSET PEAK DURATION IV 40 sec unknown 3–5 min

IV (Adults ≤55 yr): Induction—40 mg q 10 sec until induction achieved (2–2.5 mg/kg total).Maintenance—100–200 mcg/kg/min. Rates of 150–200 mcg/kg/min are usually required during first 10–15 min after induction

Mac Sed: IV (Adults ≤55 yr): Initiation—100–150 mcg/kg/min infusion or 0.5 mg/kg as slow

Assess respiratory status, pulse, and BP continuouslythroughout propofol therapy (frequently causes apnea lasting 60 sec). Maintain patent airway and adequate ventilation.

Propofol should be used only by individuals experienced in endotracheal intubation, and equipment for this procedure should be readily available.

Assess level of sedation and level of consciousness throughout and following administration.

Do not discontinue abruptly - may cause rapid awakening with anxiety, agitation, and resistance to mechanical ventilation.


Sedation of intubated, mechanically ventilated patients in intensive care units (ICUs)

injection. Maintenance—25–75 mcg/kg/min infusion or incremental boluses of 10–20 mg.


Short-acting hypnotic.

Produces amnesia.

Has no analgesic properties.

Hypersensitivity to propofol, soybean oil, egg lecithin, or glycerol

dizziness headache APNEA abdominal cramping, nausea, vomiting

N/A

Drug Study


Bupivacaine Epidural Local Anesthetic Local or regional anesthesia or analgesia for surgical,obstetric, or diagnostic procedures.

Solution for injection (preservative-free):0.25%, 0.5%, 0.75%. In combination with: epinephrine 1:200,000

Half-life: 1.5–5 hr (after epidural use)

ROUTE ONSET PEAK DURATIONEpidural 10–30 min unknown 2-8 hr

Epidural (Adults and Children ≥12 yr): 10–20 mL of 0.25% (partial to moderate block), 0.5% (moderate to complete block), or 0.75% (complete block) solution. Administer in increments of 3–5 mL allowing sufficient time to detect toxic signs/symptoms of inadvertent IV or IT administration. A test dose of 2–3 mL of 0.5% with epinephrine solution is recommended prior to epidural blocks

Monitor for sensation during procedure and return of sensation after procedure.

Assess for systemic toxicity (circumoral tingling and numbness, ringing in ears, metallic taste, dizziness, blurred vision, tremors, slow speech, irritability, twitching, seizures, cardiac dysrhythmias) each shift. Report to health care professional.

Monitor BP, heart rate, and respiratory rate continuously while patient is receiving this medication. Mild hypotension is common because of the effect of local anesthetic block of nerve fibers on the sympathetic nervous system, causing vasodilation. Significant hypotension and bradycardia may occur, especially when rising from a prone position or following large dose increases or boluses.



Marcaine Local anesthetics inhibit initiation and conduction ofsensory nerve impulses by altering the influx of sodiumand efflux of potassium in neurons, slowing or stopping pain transmission.

Epidural administrationallows action to take place at the level of the spinalnerve roots immediately adjacent to the site of administration.

Hypersensitivity circumoral tingling and numbness ringing in ears metallic taste dizziness and blurred vision tremors slow speech irritability twitching seizures cardiac dysrhythmias nausea, vomiting urinary retention CARDIOVASCULAR COLLAPSE,

arrhythmias, bradycardia, hypotension,tachycardia.

N/A

Drug Study


Hydralazine Antihypertensive/Vasodilator

Moderate to severe hypertension

20 mg/mL

Half-life: 2–8 hr

ROUTE ONSET PEAK DURATIONIM 10–30 min 1 hr 3–8 hrIV 5–20 min 15–30 min 2–6 hr

IM, IV (Adults): Hypertension—5–40 mg repeated as needed. Eclampsia—5 mg q 15–20 min; if no response after a total of 20 mg, consider an alternative agent.

Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy.

May be administered concurrently with diuretics or beta blockers to permit lower doses and minimize side effects.



Apresoline Direct-acting peripheral arteriolar vasodilator

Hypersensitivity sodium retention, edema tachycardia drug-induced lupus syndrome dizziness, drowsiness, headache diarrhea, nausea, vomiting

N/A

Drug Study


Dantrolene Skeletal Muscle Relaxant PO: Treatment of spasticity associated with: Spinal cord injury, Stroke, Cerebral palsy, Multiple sclerosis.

Prophylaxis of malignant hyperthermia.

IV: Emergency treatment of malignant hyperthermia.

Capsules: 25 mg, 50 mg, 100 mgPowder for injection: 20 mg/vial

Half-life: 8.7 hr

ROUTE ONSET PEAK DURATIONPO 1 wk unknown 6–12 hrIV rapid rapid unknown

IV (Adults and Children): Treatment of malignant hyperthermia—at least 1 mg/kg (up to 3 mg/kg), continued until symptoms decrease or a cumulative dose of 10 mg/kg has been given. If symptoms reappear, dose may be repeated. Prevention of malignant hyperthermia—2.5 mg/kg before anesthesia.

Assess bowel function periodically. Persistent diarrhea may warrant discontinuation of therapy.

Assess neuromuscular status and muscle spasticity before initiating and periodically during therapy to determine response.

Assess previous anesthesia history of all surgical patients. Also assess for family history of reactions to anesthesia (malignant hyperthermia or perioperative death).

Monitor ECG, vital signs, electrolytes, and urine output continuously when administering IV for malignant hyperthermia.

Reconstitute each 20 mg with 60 mL of sterile water for injection Shake until solution is clear. Solution must be used within 6 hr. Administer without further dilution. Protect diluted solution from direct light.

Administer each single dose by rapid continuous IV push through Y-tubing or 3-way stopcock. Follow immediately with subsequent doses as indicated. Medication is very irritating to tissues; observe infusion site frequently to avoid extravasation.



Dantrium Interferes with calcium release from the muscle, which causes a decrease in muscle contraction.

Prevents intense catabolic process associated with malignant hyperthermia.

No contraindications to IV form in treatment of hyperthermia

drowsiness muscle weakness malaise diarrhea hepatotoxicity (in extended use at high

doses)

N/A

Drug Study



Epinephrine Nonselective (Alpha and Beta) Agonists/

Bronchodilators/Vasopressor/

Adrenergic

Treatment of anaphylaxis andbronchospasm

Cardiac resuscitation

Control or prevention of low blood pressure during spinalanesthesia, lengthening effects of local anesthesia

Promotion of mydriasis,

Treatment of acute hypotension

0.1 mg/mL (1:10,000), 1 mg/mL (1:1000)

Half-life: Unknown

ROUTE ONSET PEAK DURATIONSubcut 5–10 min 20 min <1–4 hrIM 6–12 min unknown <1–4 hrIV rapid 20 min 20–30 min

IV (Adults): Severe anaphylaxis—0.1–0.25 mgq 5–15 min; may be followed by 1–4 mcg/min continuous infusion; cardiopulmonary resuscitation1 mg q 3–5 min; bradycardia - 2–10 mcg/min

IV (Children): Severe anaphylaxis—0.1 mg (lessin younger children); may be followed by 0.1 mcg/kg/min continuous infusion (may give up to 1.5mcg/kg/min); symptomatic bradycardia/pulselessarrest 0.01 mg/kg, may be repeated q 3–5 min higher doses (up to 0.1–0.2 mg/kg) may be considered.

Use great caution in preparing and calculating doses as this is a potent drug.

Protect solutions from light, heat, and freezing. Have a fast-acting alpha-adrenergic blocker such as

phentolamine (Regitine) or vasodilator such as nitrite available for excessive hypertensive reaction.

Have an alpha-adrenergic blocker available for pulmonary edema.

Have a beta-adrenergic blocker available for cardiac arrhythmias.

Monitor BP, pulse, ECG, and respiratory rate frequently during IV administration. Continuous ECG, hemodynamic parameters, and urine output should be monitored continuously during IV administration.


Adrenaline It increases the force of myocardial contraction

Increases systolic blood pressure, cardiac rate and output

Relaxes bronchial smooth muscle

Inhibits histamine release Prevents insulin release and

raises blood sugar Constricts arterioles in kidneys,

mucous membranes, and skin Dilates blood vessels in

skeletal muscle Lowers intraocular pressure

and decreases formation of aqueous humor

Hypersensitivity nervousness restlessness tremor angina arrhythmias hypertension tachycardia

N/A

Drug Study



Norepinephrine Vasopressor Revives blood pressure in acute hypotensive states (sympathectomy, spinalanesthesia, poliomyelitis, septicemia, bloodtransfusion, drug reactions) Adjunct in treatment of cardiac arrest.

1 mg/mL in 4-mL ampules

Half-life: Unknown

ROUTE ONSET PEAK DURATIONIV immediate rapid 1–2 min

IV (Adults): 0.5–1 mcg/min initially, followed by maintenance infusion of 2–12 mcg/min titrated by BP response (average rate 2–4 mcg/min, up to 30mcg/min for refractory shock have been used).

Do not mix drug in 100% saline solutions (NS) as oxidation will occur. Mix in 5% dextrose solution or 5% dextrose in salinesolution.

Give into large vein to prevent extravasation. Check blood pressure every 2 minutes after start of infusion until

desired blood pressure is attained; then check blood pressure every 5 minutes if infusion continued.

Monitor IV site for extravasation. Have phentolamine (Regitine) available in case of extravasation.

5–10 mg of phentolamine (Regitine) in 10–15 mL of saline should be infiltrated into area.

Drug solution should be clear and colorless.


Levophed Is an alpha and beta-1 receptor agonist and has no effect on beta-2 receptors.

Its biggest action is seen on the cardiovascular system, where the following happens: -an increase in total peripheral resistance -increased force, rate, and impulse conduction of the heart, which is usually overridden by activation of baroreceptors, thus causingbradycardia.

Other actions are mydriasis andelevated blood glucose and insulin

Vascular, mesenteric, or peripheral thrombosis

bradycardia cardiac arrhythmias headache

N/A

Drug Study



Phenylephrine Non – Selective Beta agonist Stabilizes blood pressure duringAnesthesia, vascular failure in shock

Subdues paroxysmal supraventricular tachycardia

For IV infusion, check blood pressure, pulse, and central venous pressure every 2–5 minutes.

IV overdose can cause ventricular arrhythmias. Phentolamine (Regitine) should be available for hypertensive crisis seen in IV administration.

Wash hands after handling drug as blurred vision and unequal pupil size can result if drug-contaminated finger rubs eye.


Neo-Synephrine Produces vasoconstriction and increased bloodpressure

Hypersensitivity headache, browache blurred vision increased sensitivity to light palpitations, tachycardia, bradycardia (overdose) hypertension trembling, sweating feeling of fullness in the head sleeplessness dizziness, light-headedness tingling in extremities

N/A

Drug Study



Dopamine Non – Selective Beta agonist Adjunct to standard measures to improve: BP, cardiac output, urine output in treatment of shock unresponsiveto fluid replacement.

Increase renal perfusion(low doses).

200 mg/250 mL, 400 mg/250 mL

Half-life: 2 min

ROUTE ONSET PEAK DURATIONIV 1–2 min up to 10 min <10 min

IV (Adults): Dopaminergic (renal vasodilation) effects—1–5 mcg/kg/min. Beta-adrenergic (cardiac stimulation) effects—5–15 mcg/kg/ min. Alpha- adrenergic (increased peripheral vascular resistance) effects—>15 mcg/kg/min- infusion rate may be increased as needed.

Must be administered cautiously as even small errors can produce deleterious effects.

Do not mix with other drugs. Protect drug from light. Infuse into large vein. Monitor for extravasation and

have phentolamine (Regitine) available if this occurs. Closely check blood pressure, urine output, and

cardiac output. Infusion must be administered via infusion pump to

ensure precise amount delivered. Titrate to response (BP, heart rate, urine output, peripheral perfusion, presence of ectopic activity, cardiac index). Decrease rate gradually when discontinuing to prevent marked decreases in BP.


Intropin Small doses (0.5–3 mcg/kg/min) stimulate dopaminergic receptors, producing renal vasodilation

Larger doses (2–10 mcg/kg/min) stimulate dopaminergic and beta1-adrenergic receptors, producing cardiac stimulation and renal vasodilation.

Doses greater than 10 mcg/kg/min stimulate alpha-adrenergic receptors and may cause renal vasoconstriction.

Hypersensitivity Tachyarrhythmias Pheochromocytoma

tachycardia palpitations hypotension nausea, vomiting dyspnea headache

N/A


Drug StudyGeneric Name Classification Indication Dosage Nursing Responsibilities

Dobutamine Inotropic/Adrenergic

Short-term (<48 hr) management of heart failurecaused by depressed contractility from organic heartdisease or surgical procedures.

250 mg/250 mL, 500 mg/250 mL

Half-life: 2 min.ROUTE ONSET PEAK DURATIONIV 1–2 min 10 min brief (min)

IV (Adults and Children): 2.5–15 mcg/kg/min titrate to response (up to 40 mcg/kg/min)

Monitor BP, heart rate, ECG, cardiac output, CVP, and urinary output continuously during the administration. Report significant changes in vital signs or arrhythmias.

Palpate peripheral pulses and assess appearance of extremities routinely throughout dobutamine administration. Notify physician if quality of pulsedeteriorates or if extremities become cold or mottled.


Dobutrex Stimulates beta1 adrenergic receptorswith relatively minor effect on heart rate or peripheral blood vessels

Hypersensitivity hypertension, increased heart rate, premature ventricular contractions

N/A

Drug Study 3rd Wk

Documents

Transcript of Drug Study 3rd Wk