Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Epinephrine

Bronchodilator / Autonomic Nervous System Agent / Alpha and Beta Adrenergic Agonist- It increases heart rate, contracts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system.

A. InitialResuscitationManagement (bolus)-Cardiac Arresta. Vasopressin may be used instead in some protocolsb. Symptomatic-Bradycardiaa. Unresponsive toOxygenationb. Ventilation-Hypotensionnot related to volume depletionB. Post-ResuscitationStabilization (Infusion)-Poor systemic perfusion orHypotensiondespitea. Intravascular volume replacement ANDb. Stable rhythm-SignificantBradycardia

The effects of epinephrine may wear off after 10 or 20 minutes. The patient may need to receive further treatment and observation.

For adults: Injection, solution 1:10,000 (0.1 mg/mL) as hydrochloride

Recommended that epinephrine doses not exceed 0.07 mg/kg. Less serious side effects may include:

-sweating-nausea and vomiting-pale skin-feeling short of breath-dizziness-weakness/tremors-headache-feeling nervous or anxious.

-Before using this medication, check if the patient has heart disease or high blood pressure, a heart rhythm disorder, coronary artery disease, Parkinson's disease, diabetes, or a thyroid disorder.

-Before using epinephrine a second time, call the doctor if the first injection caused a serious side effect such as increased breathing difficulty, or dangerously high blood pressure.

-Use extreme caution when preparing.Epinephrine is a very potent drug; small errors in dosage can cause serious adverse effects. - Monitor BP, pulse, respirations, and urinary output and observe patient closely following IV administration. -Epinephrine may widen pulse pressure. If disturbances in cardiac rhythm occur, withhold epinephrine and notify physician immediately. Keep physician informed of any changes in intake-output ratio. Check BP repeatedly when epinephrine is administered IV during first 5 min, then q35min until stabilized. Monitor blood glucose & HbA1c for loss of glycemic control if diabetic.

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Tramadol /Tramal

AnalgesicTramadol is a narcotic like pain reliever. It is used to treat moderate to severe pain. Its extended-release is used to treat moderate to severe chronic pain when treatment is needed around the clock.It inhibits reuptake of norepinephrine, serotonin and enhances serotonin release. It alters perception and response to pain by binding to mu-opiate receptors in the CNS.

PO Moderate to severe pain 50-100 mg 4-6 hourly.Max: 400 mg/day

Extended release: 50-100mg/dayMax: 300 mg/day

IV/IM Moderate to severe pain 50-100mg 4-6 hourly.Get emergency medical help if you have any of these signs of an allergic reaction: -DOB welling of your face, lips, tongue, or throat.-Stop using tramadol and call the doctor at once if patient has of these serious side effects:

hallucinations, fever, tachycardia overactive reflexes, N&V diarrhea, loss of coordination, faintingseizure (convulsions)- Tramadol can be taken with or without food, but take it the same way each time.

-Do not crush, chew, or break a tramadol tablet. Swallow it whole.

-Breaking the pill may cause too much of the drug to be released at one time.

-This medicine is for oral (by mouth) use only. Powder from a crushed tablet should not be inhaled or diluted with liquid and injected into the body. -Using this medicine by inhalation or injection can cause life-threatening side effects, overdose.- May be taken with or without food

- Watch out for overdosage

-Monitor pain scale as necessary

- Be aware that tramadol shouldnt be given to patients with a history of anaphylactoid reactions to codein or other opiods.

- Avoid giving tramadol to patients with acute abdominal conditions because it may mask evidence and disrupt assessment of the abdomen.

- If patient has respiratory depression, assess respiratory status often, and expect to give non opiod analgesic not tramadol.

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Ketorolac Tromethamine / Toradol

Chemical class: Acetic acid derivative

Therapeutic class: Analgesic, Anti inflammatory Ketorolac is in a group of drugs called non-steroidal anti-inflammatory drugs (NSAIDs).

It works by reducing hormones that cause inflammation and pain in the body.

-Used for short-term (5 days or less) to treat moderate to severe pain.

Adults ages to 16 to 64. Initial 20 mg dose, followed by 10 mg every 4 to 6 hours prn, up to 4 times a day.

Patients age 65, renally impaired, and/or weight < 50 kg (110 lbs): 10 mg PO once followed by 10 mg q4-6 hours prn not > 40 mg/day

Stop taking ketorolac and seek medical attention or call your doctor if patient have any of these serious side effects:

chest pain, weakness, shortness of breath, slurred speech, problems with vision or balanceblack, bloody, or tarry stoolscoughing up blood or vomit that looks like coffee groundsswelling or rapid weight gain.Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.

Take the medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Ketorolac is not for treating minor aches and pains.

Ketorolac is usually given first as an injection, and then as an oral (by mouth) medicine.

Ketorolac injection is given through a needle into a muscle or a vein.

Store ketorolac tablets at room temperature away from moisture and heat. Read Ketorolac label carefully. Dont use IM form for I.V. Route. Know that ketorolac isnt for intrathecal or epidural use.

- Inject IM ketorolac slowly, deep into a large muscle mass. Monitor site for bleeding, bruising or hematoma.

- Give I.V. injection over at least 15 seconds.

- Notify prescriber if pain relief is inadequate or if break through pain occurs between doses because supplemental doses of an opiod analgesic may required.

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Metoclopramide hydrochloride / Plasil

Chemical class: Benzamide

Therapeutic class: Anti emetic, upper GI stimulantMetoclopramide increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines.

It is used for short-term to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief of symptoms.

It also used to treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis), which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals.

Metoclopramide is not approved by the FDA for postoperative nausea and vomiting in pediatric patients; however, the following doses have been studied:

DOSAGE Adult: 10mg3x/dayPedia: 15-20yrs5-10mg 3x/day5-14yrs: 2.5-5mg3x/day3-4yrs: 3mg 2-3x/day1-2yrs: 1mg 2-3x/dayUnder 1 yr: 1mg2x/daySIGNS OF A SERIOUS MOVEMENT DISORDER: -tremors or shaking in your arms or legsuncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); orany new or unusual muscle movements you cannot control.

Keep the tablet in its bottle or blister pack until the patient is ready to take the medicine. Make sure your hands are dry before handling a tablet. If the tablet breaks or melts in your hand, throw it away and use a new tablet.

Place the tablet on the patients tongue. It will begin to melt right away. Do not let the client swallow the tablet whole. Allow it to melt in the mouth without chewing.-Advice pt. to avoid alcohol and other CNS depressant that enhance sedating properties of this drug.

-Use metoclopramide cautiously in patients with hypertension because it may increase catecholamine levels.

- Assess patients for signs of intestinal obstruction, such as abnormal bowel sounds, vomiting.

-For IV use you need not dilute doses of 10 mg or less. Give drug over 1 to 2 minutes. For doses larger than 10 mg, dilute in 50 ml normal saline solution, half normal (0.45) saline solution.

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Bupivacaine (Sensorcaine)

Amide Local AnaesthesiaBupivacaine is an anesthetic (numbing medicine) that blocks the nerve impulses that send pain signals to your brain.

Is used as a local (in only one area) anesthetic for a spinal block.

It may also be used for purposes other than those listed in this medication guide.

For the production of local or regional anesthesia or analgesia for surgery, for oral surgery procedures, for diagnostic and therapeutic procedures, and for obstetrical procedures.

During epidural administration of Bupivacaine Hydrochloride, 0.5% and 0.75% solutions should be administered in incremental doses of 3 mL to 5 mL with sufficient time between doses to detect toxic manifestations of unintentional intravascular or intrathecal injection.

Mild dizziness or drowsiness. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; changes in hearing; chest pain; excitement; irregular heartbeat; nausea; numbness that lasts for more than a few hours; tremors; vomiting.

Injections should be made slowly, with frequent aspirations before and during the injection to avoid intravascular injection.

Sensorcaine (bupivacaine HCl) is contraindicated in obstetrical paracervical block anesthesia. Its use by this technique has resulted in fetal bradycardia and death.

Sensorcaine is contraindicated in patients with a known hypersensitivity to it or to any local anesthetic agent of the amide type or to other components of bupivacaine solutions.

-When appropriate, patients should be informed in advance that they may experience temporary loss of sensation and motor activity, usually in the lower half of the body following proper administration of caudal or lumbar epidural anesthesia.

Also, the physician should discuss other information including adverse reactions in the Sensorcaine package insert.

Inform the patient before using this medication, to tell his/her doctor or pharmacist of all prescription and nonprescription/herbal products he/she may use. Do not start or stop any medicine without doctor or pharmacist approval.

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Promethazine HCL / Phenergan

Anti-emetics, Antihistamines, Sedative/hypnotics

Promethazine works by changing the actions of chemicals in your brain.

It also acts as an antihistamine. It blocks the effects of the naturally occurring chemical histamine in your body.

It is used to treat allergy symptoms such as itching, runny nose, sneezing, itchy or watery eyes, hives, and itchy skin rashes.

Also to prevents motion sickness, and treats nausea and vomiting or pain after surgery. It is also used as a sedative or sleep aid.

Nausea and VomitingAdults: One 25mg tablet every 4 to 6hours to a maximum daily dose offour 25mg tablets.

Children 6-12 years: One 10mgtablet or 10mL of the elixir, every 4to 6 hours to a maximum daily doseof two 10mg tablets or 25mL of theelixir.

Children 2-5 years: 5mL of elixirevery 4 to 6 hours to a maximumdaily dose of 15mL.Phenergan may have unwanted sideeffects in some people. Stop using promethazine and call your doctor at once if you have any of these serious side effects:twitching, or uncontrollable movements of your eyes, lips, tongue, face, arms, or legstremor (uncontrolled shaking), drooling, trouble swallowing, problems with balance or walkingfeeling restless.Promethazine can be taken with or without food or milk.

Measure liquid medicine with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask the pharmacist for one.

This medication can cause to have unusual results with certain medical tests.

Store this medication at room temperature away from moisture, heat, and light.

-Monitor BP, pulse and respiratory rate frequently.

-Assess level of sedation after administration.

-Assess patient for nausea and vomiting before and after administration.

-Administer each 25mg slowly over at least 1 hr.

-Do not administer SQ, tissue necrosis may occur

-Arteriospasms and gangrene of artery may occur when administered intra-arterially.

-Reduce dosage of barbiturates given concurrently within promethazine by least half.

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Succinylcholine Anectine

Neuromuscular blocker, depolarizing ANECTINE (succinylcholine chloride) is an ultra short-acting depolarizing-type, skeletal muscle relaxant for intravenous (IV) administration.

Succinylcholine chloride is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.Normally given slow IV push.

Continuous infusion:2.5 mg/min (0.5 to 10 mg/min).Dilute to 1-2 mg/ml. Diluents: D5W, NS

Supplied: 20 and 50 mg/ml-10ml vial. 100 mg/ml-5,10,20ml vial.

Dosing:Adults: 0.6 mg/kg (0.3 to 1.1) over 10-30 seconds, up to 150mg total dose.Maintenance: 0.04 to 0.07 mg/kg q5-10min prn. The average dose required to produce neuromuscular blockade and to facilitate tracheal intubation is 0.6 mg/kg ANECTINE Injection given intravenously. The optimum dose will vary among individuals and may be from 0.3 to 1.1 mg/kg for adults. Following administration of doses in this range, neuromuscular blockade develops in about 1 minute; maximum blockade may persist for about 2 minutes, after which recovery takes place within 4 to 6 minutes.Adverse reactions to succinylcholine consist primarily of an extension of its pharmacological actions. Succinylcholine causes profound muscle relaxation resulting in respiratory depression to the point ofapnea; this effect may be prolonged. Hypersensitivity reactions, includinganaphylaxis, may occur in rare instances. The following additional adverse reactions have been reported: cardiac arrest, malignant hyperthermia, arrhythmias, bradycardia, tachycardia,hypertension,hypotension, hyperkalemia, prolonged respiratory depression or apnea, increasedintraocular pressure, muscle fasciculation, jaw rigidity, postoperative muscle pain,rhabdomyolysiswith possible myoglobinuricacute renal failure, excessive salivation, andrash.Depolarizing skeletal muscle blocker procedures of short duration such as endotracheal intubation.

Succinycholine should be used only by those skilled in the management of artificial respiration and only when facilities are instantly available for tracheal intubation and for providing intubation adequate ventilation of the patient. Including the administration of oxygen under positive pressure and elimination of carbon dioxide

To avoid distress to the patient, succinylcholine should not be administered before unconsciousness has been induced.

Anectine (succinylcholine) is a rapid acting agent (within 1 minute) with a short duration of action (3 to 10 minutes) depending on the amount given Contraindicated in patients with hypersensitivity to drug and in those with abnormally low plasma pseudocholinesterase, angle-closure glaucoma, malignant hyperthermia or penetrating eye Injuries Succinylcholine should be sued only by personnel skilled in airway management Keep airway clear. Have emergency respiratory support equipment immediately available. Frequently administered prior to intubation, and can be given either by bolus injection or continuous drip infusion when longer periods of muscle relaxation are required Do not use reversal agents.Use immediately after reconstitution Do not mix with alkaline solutions (thiopental sodium, sodium bicarbonate, or barbiturates)

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Diprivan / Propofol

General anesthesia Propofol slows the activity of your brain and nervous system.It is used to help you relax before and during general anesthesia for surgery or other medical procedure. Propofol is also used in critically ill patients who require a breathing tube connected to a ventilator (a machine that moves air in and out of the lungs when a person cannot breathe on their own).It may be used for other purposes not listed in this medication guide.

Initial Bolus:0.8-1.2 mg/kg(1-2 minutes after fentanyl)

Infusion:Start at 140-200 ug/kg/min

At 10 minutes: 100-140 ug/kg/minAfter 2 hours: 80-120 ug/kg/min

Turm off propofol infusion about 5-10 minutes prior to the desired time of emergence. Give 1-2 cc boluses as needed to keep patient asleep until the desired time of emeregence.Get emergency medical help if you have any of these signs of anallergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Serious side effect such as:pain, swelling, blisters, or skin changes where the medicine was injected, seizure (convulsions)

During maintenance of anesthesia or sedation, the rate of DIPRIVAN (propofol)

Injectable Emulsion administration should be adjusted according to the desired level of anesthesia or sedation and may be reduced in the presence of supplemental analgesic agents (e.g., nitrous oxide or opioids). Contraindicated in patients egg lecithin, soybean oil or when general anesthesia or sedation is contraindicated.

Propofol can support the growth of microorganisms.

Discard tubing and unused portions of drug after 12 hours.

Drug should be administered by trained personnel that are not involved in the surgical or diagnostic procedure.

Name of the drugGeneric/Brand ClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

NalbuphineHCL /

Nubain

Opioid agonist-antagonist analgesic;Antihistamine

>Treatment and prevention of motion sickness; prevention and control ofnausea and vomiting associated with anesthesia and surgery.

>Symptomatic relief of perennial and seasonal allergic rhinitis, vasomotorrhinitis, allergic conjunctivitis; mild,uncomplicated urticaria and angioedema; amelioration of allergic reactions to blood or plasma;dermatographism, adjunctive therapy.

>Preoperative, postoperative or obstetric sedation.>Adjunct to analgesics to control postoperative pain.

>Adjunctive IV therapy with reduced amounts of meperidine or othernarcotic analgesics in special surgical situations.

The usual recommended adult dose is 10 mg for a 70 kg individual, administered subcutaneously, intramuscularly or intravenously; this dose may be repeated every 3 to 6 hours as necessary. Dosage should be adjusted according to the severity of the pain, physical status of the patient, and other medications which the patient may be receiving.CNS effects:NervousnessDepressionRestlessnessCrying,euphoria,floating,hostility,unusual dreams,confusion,faintness,hallucinations,dysphoria,feeling ofheaviness,numbness,tingling,Unreality.

The incidence ofpsychotomimetic effects, such as unreality, depersonalization, delusions, dysphoria and hallucinations has been shown to be less than that which occurs with pentazocine.

Cardiovascular:Hypertension,hypotension,bradycardia,tachycardiaPulmonary edema.

Gastrointestinal:Cramps,dyspepsia,Bitter taste.Respiration:Depression,Dyspnea,Asthma.

Dermatological:ItchingBurningUrticariaGU:Urinary urgencyRESPIRATORY:Respiratory depression,DyspneaAsthma

Contraindicated with Hypersensitivityto nalbuphine or anycomponent including sulfites; pregnancy(prolonged use or high dosages at term)

>Keep opioids antagonist and facilities forassisted orcontrolled respiration readily available in case ofrespiratory depression.

>Assess the patient for history of drug addiction.

>Reassure patient about addiction liability; most patients who receive opiates formedical reasons do not develop dependence syndrome.

>Taper dosage when discontinuing after prolonged use to avoid withdrawal symptoms.

>Reassess patients level of pain at least 15 and 30 minutes after parenteral administration.

>Assess the patient for hypersensitivity reaction to Nalbuphine

>Assess for any adverse reactions

>Assess the patient and familys knowledge ofdrug therapy

>Instruct the patient not to drink alcohol while you are using this medication. Alcohol can increase some of the side effects of nalbuphine.

>Use cautiously if the patient is emotionally unstable or twith a history ofnarcotic abuse; bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI when nausea and vomiting are present, biliary tract surgery.

Name of the drugGeneric / BrandClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Atropine Sulfate /

Atropair , Atropisol,Isopto Atropine

Autonomic Nervous System Agent; Anti-cholinergic

Preoperative Use:To suppress salivation, perspiration, and respiratory tract secretions; to reduce incidence oflaryngo spasm, reflex bradycardia arrhythmia, and hypotension during general anesthesia.

Preanesthesia

Adult:IV/IM/SC0.21 mg 3060min beforesurgeryChild:IV/IM/SC

5 kg,0.010.02 mg/kg3060 min before surgery

CNS:Headache, ataxia, dizziness,excitement, irritability, convulsions, drowsiness, fatigue, weakness; mental depression, confusion, disorientation, hallucinations

GI:Dry mouth with thirst, dysphagia, loss of taste; nausea, vomiting, constipation, delayed gastric emptying, antral stasis, paralytic ileus.

CV:Hypertension orhypotension, ventricular tachycardia, palpitation, paradoxical bradycardia, AV dissociation, atrial or ventricular fibrillation.

Hypersensitivity to belladonna alkaloids; synechiae; angle-closure glaucoma; parotitis; obstructiveuropathy, e.g., bladder neck obstruction caused by prostatic hypertrophy; intestinal atony, paralytic ileus, obstructive diseases ofGI tract, severe ulcerative colitis, toxic mega colon; tachycardia secondary to cardiac insufficiency orthyrotoxicosis; acute hemorrhage; myasthenia gravis. Safety during pregnancy (category C)or lactation is note stablished.>Monitor vital signs. HR is a sensitive indicator ofpatient's response to atropine. Be alert to changes in quality, rate, and rhythm of HR and respiration and to changes in BP and temperature.

>Initial paradoxical bradycardia following IV atropine usually lasts only 12 min; it mostlikely occurs when IV isadministered slowly (more than 1 min) or when small doses (less than0.5 mg) are used. Postural hypotension occurs when patient ambulates too soon after parenteral administration

Note: Frequent and continued use of eye preparations, as well as over dosage, can have systemic effects. Some atropine deaths have resulted from systemic absorption following ocular administration in infants and children

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Neostigmine / Prostigmin,Prostigmin Bromide

Anticholinesterase agent > Neostigmine is used for the symptomatic treatment of myasthenia gravis by improving muscle tone.

> Is a cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. By inhibiting acetylcholinesterase, more acetylcholine is available in the synapse, therefore, more of it can bind to the fewer receptors present in myasthenia gravis and can better trigger muscular contraction.Myasthenia gravis: Diagnosis: I.M.:Children: 0.04 mg/kg as a single doseAdults: 0.02 mg/kg as a single dose

>Increased salivation and sweating, nausea and vomiting, abdominal cramps, diarrhoea, allergic reactions, rash (bromide salt), miosis, increased bronchial secretions, bradycardia, bronchospasm, weakness, muscle cramps, fasciculation, hypotension.

Potentially Fatal:Anaphylaxis.>Mechanical GI or urinary tract obstruction, peritonitis.

> Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis. > Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.

> In the diagnosis of myasthenia gravis, all anticholinesterase medications should be discontinued for at least 8 hours before administering neostigmine

> Administer without regard to meals. Administer with food if GI upset occurs.

> Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

Name of the drugGeneric / BrandClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Calan/Verapamil

Calcium Chanel Blockers> Is a calcium ion influx inhibitor (calcium entry blocker or calcium ion antagonist). The mechanism of the antianginal and antiarrhythmic effects of verapamil is believed to be related to its specific cellular action of selectively inhibiting transmembrane influx of calcium in cardiac muscle, coronary and systemic arteries and in cells of the intracardiac conduction system. >This results in a reduction of free calcium ions available within cells of the above tissues.

Adult dose is 80 mg 3 times a day. If required, the dose may be increased up to 160 mg 3 times a day. A maximum daily dose of 480 mg should not be exceeded.Cardiovascular:Hypotension, edema; CHF/pulmonary edema 1; bradycardia; AV block, total (first, second and third degree) or second and third degreeCNS:Dizziness, headache, fatigue Gastrointestinal:Constipation, nausea Cardiovascular:Flushing, angina pectoris, atrioventricular dissociation, chest pain, claudication, myocardial infarction, palpitations, purpura, syncopeCNS:Cerebrovascular accident, confusion, equilibrium disorders, insomnia, muscle cramps, paresthesia, psychotic symptoms, shakiness, somnolence, excitation, depression, Gastrointestinal:Diarrhea, dry mouth, gastrointestinal distressRespiratory:Dyspnea, bronchospasm.Urogenital:Gynecomastia, increased frequency of urination, spotty menstruation,

> Acute myocardial infarction; severe congestive heart failure and/or severe left ventricular dysfunction (unless secondary to a supraventricular tachycardia amenable to oral verapamil therapy); cardiogenic shock; severe hypotension; second or third degree AV block; sick sinus syndrome (see Warnings); marked bradycardia; hypersensitivity to the drug; patients with atrial flutter or atrial fibrillation and an accessory bypass tract (e.g. Wolff-Parkinson-White, Lown-Ganong-Levine syndromes)>Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being titrated to therapeutic dose. Dosage may be increased more rapidly in hospitalized patients under close supervision.

>Ensure that patient swallows SR tablets whole: do not cut, crush, or chew.

>Monitor BP very carefully with concurrent doses of anti-hypertensives.

>Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy.

>Administer sustained-release form in the morning with food to decrease GI upset.

>Protect IV solution from light.

>Monitor patients with renal or hepatic impairment carefully for possible drug accumulation and adverse reactions.

Name of the drugGeneric / BrandClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Terbutaline/ Brethaire

Adrenergic inhalants, selective beta-2-adrenoreceptor agonists> Beta- adrenergicreceptorblocking agents not only block thepulmonaryeffect of beta-agonists, such as terbutaline, but may produce severe bronchospasm inasthmatic patients

> Terbutaline sulfate injection is indicated for the prevention and reversal of bronchospasm in patients 12 years of age and older withasthmaand reversible bronchospasm associated withbronchitisandemphysema.

AcutebronchospasmAdult:Initially, 2.5 or 3 mg tid increased to 5 mg tid if necessary; as modified-release tablet: 7.5 mg bid.Child:75 mcg/kg tid; usual dose for >7 yr: 2.5 mg bid-tid.IntravenousSevere bronchospasmAdult:250-500 mcg SC, IM or slow IV Inj up to 4 times daily, or by IV infusion 3-5 mcg/ml run at a infusion rate of 0.5-1 mL/min.Child:>2 yrs: 10 mcg/kg by SC, IM or slow IV injection. Max total dose: 300mcg.Central Nervous SystemTremor, Nervousness, Dizziness, Headache, Drowsiness

CardiovascularPalpitations, Tachycardia

RespiratoryDyspnea, Chest discomfort

GastrointestinalNausea/vomiting

SystemicWeakness, Flushed feeling, Sweating, Pain at injection site> Terbutaline sulfate injection is contraindicated in patients known to be hypersensitive to sympathomimetic amines or any component of this drug product.

> Terbutaline sulfate is contraindicated in patients known to be hypersensitive to sympathomimetic amines or any component of this drug product.

>Monitor BP and HR.

> Parenteral form is only for S.C. use. Before using, the inhaler must be shaken well; assess lung sounds, pulse, and blood pressure before administration and during peak of medication; observe patient for wheezing after administration, if this occurs, call physician

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Diphenhydramine / Benadryl

Narcotic antitussive, Anticholinergic, Nonselective ethanolamine

Symptomatic relief of perennial and seasonal allergic rhinitis, vasomotor rhinitis and allergic conjunctivitis; temporary relief of runny nose and sneezing caused by common cold; dermatographism; treatment of urticaria and angioedema; amelioration of allergic reactions to blood or plasma; adjunct to epinephrine and other standard measures in anaphylaxis; relief of uncomplicated allergic conditions of immediate type when oral therapy is impossible or contraindicated (parenteral form); treatment and prophylactic treatment of motion sickness (injection only)Cough Suppressant (Syrup, Strips)AdultsPO 25 mg every 4 h (max, 150 mg per 24 h).Hypersensitivity Reactions, Type 1/Antiparkinsonism/Motion SicknessAdultsPO 25 to 50 mg every 4 to 6 h (max, 300 mg/day). IV/IM 10 to 50 mg IV at a rate not exceeding 25 mg/min or 100 mg deep IM if required (max, 400 mg/day).

CNS:drowsiness, dizziness, headache, paradoxical excitation (increased in children).EENT:blurred vision, tinnitus.CV:hypotension, palpitations.GI:anorexia,dry mouth, constipation, nausea.GU:dysuria, frequency, urinary retention.Derm:photosensitivity.Resp:chest tightness, thickened bronchial secretions, wheezing.Local:pain at IM site.Hypersensitivity to antihistamines; asthmatic attack; MAO inhibitor therapy; history of sleep apnea; use in newborn or premature infants and in nursing women; use as a local anesthetic.

Caution the client that the medication may cause drowsiness, creating difficulties or hazards or other activities that require alertness.

Adverse effects of these drugs occur more commonly in elderly clients.

Give cautiously to older adults who are taking other medications.

Monitor side effects, excessive sedation, dizziness, palpitations or urinary retentions.

Encourage a fluid intake of 2500-3500ml/day unless contraindicated.

Give Benadryl before blood transfusion, or diagnostic test that uses contrast media as ordered.

Name of the drugGeneric / BrandClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Suprane / Desflurane

General inhalation anesthetic.SUPRANE (desflurane, USP) is indicated as an inhalation agent for induction and/or maintenance of anesthesia for inpatient and outpatient surgery in adults (see PRECAUTIONS).SUPRANE (desflurane, USP) is not recommended for induction of anesthesia in pediatric patients because of a high incidence of moderate to severe upper airway adverse events (see WARNINGS). After induction of anesthesia with agents other than SUPRANE, and tracheal intubation, SUPRANE is indicated for maintenance of anesthesia in infants and children.

Induction and maintenance ofgeneral anaesthesiaAdult:Induction: 4-11% v/v, usually produces surgicalanaesthesiawithin 2-4 minutes, maintenance: 2-6% v/v with nitrous oxide or 2.5-8.5% v/v in O2or oxygen-enriched air. Concentrations >17% v/v Renal impairment:Recommended dosage in chronic impairment: 1-4% v/v in nitrous oxide/O2.Hepatic impairment:Recommended dosage in chronic impairment: 1-4% v/v in nitrous oxide/O2.Hypotension, respiratory depression, arrhythmias, nausea and vomiting; may provoke breath holding, apnoea, coughing, increased salivation, laryngospasm; rarely, malignant hyperthermia.Induction of anaesthesia in children. Known or suspected susceptibility to malignant hyperthermia.Monitor heart rate and arterial blood pressure remained within 20% of preinduction baseline values during administration of Suprane (desflurane, USP) 0.5-7.7% (average 3.6%) with 50-60% N2O.Monitor for increased incidence of respiratory adverse reactions, including coughing, laryngospasm and secretionsMonitor for cardiovascular arryhtmia, bigeminy abnormal eclectrocardiogram, myocardial ischemia, vasodilation, agitation, dizziness, asthma, dyspnea and hypoxia

Name of the drugClassificationIndicationsDosageSide / Adverse EffectsContraindication and PrecautionNursing Responsibilities

Sevoflurane / Sevorane

Halogenated hydrocarbons,General anesthetics.Used for induction and maintenance of general anesthesia in adult and pediatric patients for inpatient and outpatient surgery. Often, sevoflurane is used with other medications to induce or supplement anesthesia

CNS:Electroencephalogram (EEG): Sevoflurane causes a dose-dependent decrease in EEG activity.

Neuromuscular effects:Sevoflurane impairs neuromuscular conduction and decreases muscle contractility.

Respiratory system effects:Respiration: Sevoflurane depresses ventilation in a dose-dependent manner, with apnea.-Previously had any problems with a general anaesthetic.-Malignant hyperthermia (a rare type of severe fever).-general anaesthetic, or had more than one general anaesthetic over a short period of time-You have had Sevorane before and experienced an allergic reaction.-Growths or abnormalities in your brainCheck the name of the patient andthe time ofadministration.

Monitor vital signs.

Monitor all the body systems.Continuous monitoring of pulseoximetry.