DrugIndicationMode of ActionSpecial Consideration

EpinephrineAsystole, PEA, PulselessVfib/VtachAnaphylaxis A direct acting sympathomimetic, stimulates alpha and beta adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation and dilatation of skeletal muscle vasculatureRAPID IV PUSHSHOULD NOT BE ADMINISTER THE SAME LINE WITH ALKALINE SOLUTIONS- may lose its potencyMONITOR CARDIAC rhythm

AtrophineSinus bradycardiaSymptomatic narrow QRS bradycardiaAsystoleCompetitively blocks the muscarinic receptors in peripheral tissues such as heart, intestines, bronchial muscles, iris and secretory glandsRAPID IV PUSH over 1 minSLOWER than 1 min may cause paradoxical bradycardia that may last 2 minutes

AdenosineSupraventricular TachycardiaHas (-) inotropic action that rapidly slows down conduction through the AV node via the Adenosine 1 rec. Mediates peripheral and coronary vasodil. by stimulating the Adenosine 2receptorsRAPID IV PUSH over 1-3 seconds into a CENTRAL or LARGE PERIPHERAL veinFollow each dose with 20cc SALINE FLUSH and elevate arm for 10-20secs to ensure injection reaches systemic circulation

AmiodaronePulseless ventriculat fibrillation or ventricular tachycardiaAtrial fibrillation or atrial tachycardiaA class III antiarrhythmic agent which inhibits stimulation, prolongs action potential and refractory period in myocardial tissueDecrease AV conduction and sinus node functionObtain serum electrolyte, use catiously in patients with uncorrected electrolyte imbalancesInitial dose diluted in 20-30ml D5W or NSS given as a single dose via rapid IV pushLoading infusion dose should be administered slowly at rate of 1mg/min

Calcium GluconateHypocalcemiaSevere hyperkalemiaSevere hypermagnesaemiaUsed to prevent or treat negative calcium balance. It also helps facilitate nerve and muscle performance as well as normal cardiac function by reducing the excitability of cardiomyocytesGiven through SMALL BORE NEEDLE into a LARGE VEIN to minimize phlebitisAdminister SLOW IV push over 2 minutes with CARDIAC MONITORING

Lidocaine CV drugs: Anti-arrhythmics Anesthetic AnesthesiaArrhythmiasControl of Status epilepticus refractory to other treatments

electrical stimulation of ventricle and His-purkinje system by direct action on tissues, resulting to depolarization, automaticity and excitability in ventricles during diastolic phaseCIHypersensitivityHeart blockHypovolemiaAdams stroke syndAssess pt pre & post tx Pts infusion must be on cardiac monitorMonitor ECG, if QT or QRSby 50% or more, withhold the drug BP, rebound HPN after 1-2 hrsAssess respiratory status, oxygenation and pulse deficitsAssess renal and liver functionMonitor CNS sx Monitor blood levels

vassopressinPituitary HormonesADHDiabetes InsipidusAbdominal DistentionGI bleedingEsophageal varices

permeability of renal tubular epithelium to ADMPH & H20, d epithelium promotes reabsorption of H20 & concentratedContraindications With chronic nephritis and nitrogen retentionNursing MgtGive 1-2 glass of H20 to reduce adverse reactions and improve therapeutic responseWarm vasopressin in your hands and mixed until it is distributed evenly in the solution Monitor urine Sp. Gravity and I&O to aid evaluation of drug effectiveness

NAHCO3Txt of hyperaciditySevere diarrhea Alkalization of the urine to tx drug toxicityTx of acute mild to moderate metabolic acidosis due to shock, severe DHN anoxia, DM, renal disease, cardiac arrest,extracorporeal circulation of blood, severe primary lactic acidosis.Prophylaxis of renal calculi in gout.During sulfonamide therapy to prevent renal calculi and nephrotoxicityMetabolic AcidosisCardiac Arrest

Contraindications Metabolic and respiratory alkalosis Pt losing Cl because of vomiting or continuous GI suction or those receiving diuretics that produces hypochloremic alkalosis

DopamineAcute heart failureStimulates dopaminergic receptors at lower doses producing renal and mesenteric vasodilation while at higher doses stimulate both dopaminergic and beta adrenergice receptors producing cardiac stimulationMonitor Urine outputPalpate peripheral pulses and assess appearance of extremities routinelyAdminister into a LARGE VEIN via INFUSION PUMP, rate is TITRATED

DobutamineAcute heart failureIncreases contractility and heart rate by stimulating Beta adrenergic receptors in cardiac tissuesPalpate peripheral pulses and assess eppearace of extremities routinely BP and HRAdminister into a LARGE VEIN via INFUSIONPUMP, rate is TITRATED according to patients response

Noradrenaline

Dormicum IV or IM: Sedation, anxiolysis, prior to dx, therapeutic, or endo proc. or sx Continuous sedation of intubated MV pts Tx of epileptic seizure or refractory status epilepticus

Acts mainly at the limbic system and reticular formation; potentiates the effects of GABA, an inhibitory neurotransmitter; anxiolytic and amnesia effects occur at doses below those needed to cause sedation, ataxia; has little effect on cortical function.Precautions:COPD, CHF, chronc renal failure, chills, debilitated, neonates

Flumazenil Benzodiazepine receptor antagonistsBenzodiazepine-induced depression of the ventilatory responses to hypercapnia and hypoxiaContraindications Control of ICP or status epilepticus. Signs of serious cyclic antidep.overdoseGive through freely running IV infusion into large vein Instruct to avoid alcohol and non-prescription drugs for 1-24 hrs.

FurosemideHypertensionEdemaInhibits reabsorption of Na and chloride mainly in the medullary portion of the ascending loop of HenleSLOW IV PUSH over 1-2 minutesDO NOT MIX WITH HIGHLY ACIDIC solutionDO NOT EXPOSE TO LIGHT

Dextrose 50%HypoglycemiaHyperkalemiaSource of calories and water for hydrationPromotes glycogen deposition in liverWhen used with insulin, it stimulates the uptake of potassium by cells, esp. in muscle tissue, thus lowering serum potassium levelsAdminister SLOW IV PUSH into a LARGE PERIPHERAL VEIN to prevent phlebitis and sclerosis of veinMONITOR CAPILLARY BLOOD GLUCOSE

MgSO4Anti-convulsantAnti-arrhythmics

Decreased acetylcholine releasedContraindications Heart block and myocardial damage Toxemia of pregnancyManagement Monitor I&O. make sure urine output is 100 ml or more in 4 hrs pd before each doseTake appropriate seizure precautions Keep IV Ca gluconate at bedside

Naloxone Narcotic antagonist; Antidote. suspected opioid induced respiratory depressionReverses opioid-induced sleep or sedation, increases RR, raises BP to normal range.Adjunctive agent to increase blood pressure in the management of septic shockMaintain clear airway. Obtain weight of children to calculate drug dosage.Monitor v/s.Assess for increase pain with reversal opiate.

KCL hypok+, c / s metabolicalkalosis; in dig .intox prevention risk if hypokalemia e.g., dig. pts /pts w/sig cardiac arrhythmias.

intracellular cation of tissues, participates in a no, of physio processmaintain intracel.tonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscle, maintenance of normal renal function; also plays a role in carbohydrate metabolism and various enzymatic reactionsCI w/ allergy to aspirinCaution patient that expanded wax matrix capsules will be found in the stoolReport tingling of the hands or feet, unusual tiredness or weakness, feeling of heaviness in the legs, severe nausea, and vomiting, abdominal pain, black or tarry stools.Monitor cardiac rhythm carefully during IV administration

DiazepamPartial & Generalized tonic clonic seizuresSevere AnxietyEnhances the effect of neurotransmitter GABA leading to CNS depressionSLOW IV PUSH over a minimum of 1 minute into a LARGE PERIPHERAL VEIN to prevent venous irritationObserve safety measure

Propofol