Atropine Sulfate 1mg/10ml

Classification: Anticholinergic, Antimuscarini, Parasympatholytic, Antiparkinsonian

Indication: Restoration of cardiac rate and arterial pressure during anesthesia, Relief of
bradycardia and syncope due to hyperactive carotid sinus reflex, Antidote for CV collapse from
overdose of parasympathomimetic drugs or cholinesterase inhibitors, Acute cholinergic/
oranophosphate poisoning

Mechanism of Action: Competitively blocks the effects of acetylcholine at muscarinic cholinergic

receptors that mediate the effects of parasympathetic postganglionic impulses, depressing
salivary and bronchial secretions, dilating the bronchi, inhibiting vagal influences on the heart,
relaxing the GI and GU tracts, inhibiting gastric acid secretion (high doses; also blocks the
effects of acetylcholine in the CNS.

Nursing Responsibility

a.) Monitor vital signs. HR is a sensitive indicator of patient's response to atropine. Be alert to
changes in quality, rate, and rhythm of HR and respiration and to changes in BP and
temperature.
b.)Initial paradoxical bradycardia following IV atropine usually lasts only 12 min; it most likely
occurs when IV is administered 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.
c.)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. Monitor I&O, especially in older adults and patients who
have had surgery. Palpate lower abdomen for distention. Have patient void before giving
atropine
Adenosine 6mg/2cc

Classification: Antiarrhythmic agent

Indication: Indicated for conversion to sinus rhythm of paroxysmal supraventricular tachycardia

(PSVT), including that associated with accessory bypass tract

Mechanism of Action: Slows conduction through AV node; can interrupt reentry pathways
through AV node and restore normal sinus rhythm.

Nursing Responsibility

a.) Do not administer if solution is cloudy or sediment is present.

b.) Monitor BP and cardiac rhythm during and after administration. Monitor for transient
asystole.
c.) Hypertension and/or hypotension may occur. Use with caution in autonomic dysfunction,
stenotic valvular heart disease, pericarditis or pericardial effusions, stenotic carotid artery
disease with cerebrovascular insufficiency, or uncorrected hypovolemia because of the risk of
hypotensive complications in these patients.
d.) May cause respiratory alkalosis. Adenosine inhalation has been reported to cause
bronchoconstriction in asthmatic patients. Use with caution in patients with obstructive lung
disease not associated with bronchoconstriction (eg, bronchitis, emphysema) and avoid use in
patients with bronchoconstriction or bronchospasm (eg, asthma). Discontinue in any patient who
develops severe respiratory difficulties.
Calcium Chloride 1gm/10ml

Classification: Mineral

Indication: Treatment hypocalcemic tetany; hyperkalemia with ECG changes; magnesium

intoxication due to over dosage of magnesium sulfate; cardiac resuscitation when epinephrine
has failed to improve weak or ineffective myocardial contractions; Insect bites or stings.

Mechanism of Action: Slows conduction through AV node; can interrupt reentry pathways
through AV node and restore normal sinus rhythm.

Nursing Responsibility

a.) Monitor HR for bradycardia especially when administered rapidly

b.) Monitor BP for hypotension
c.) Monitor calcium serum value for signs of hypercalcemia
Epinephrine 1:1000/ 1ml

Classification: Adrenergic Agonist Agent; Bronchodilator; Antidot, Symphathomimetic

Indication: Bronchospasms, anaphylactic reactions, cardiac arrest

Mechanism of Action: Stimulates alpha-, beta-, and beta2-adrenergic receptors resulting

in relaxation of smooth muscle of the bronchial tree, cardiac stimulation, and dilation of
skeletal vasculature; small doses can cause vasodilation via beta2-vascular receptors;
large doses may produce constriction of skeletal and vascular smooth muscle;
decreases production of aqueous humor and increases aqueous outflow; dilates the
pupil by contracting the dilator muscle

Nursing Responsibility

a.) Check BP repeatedly when epinephrine is administered IV during first 5 min, then q3-5min
until stabilized
b.) 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
c.)Use extreme caution when calculating and preparing doses since epinephrine is a
very potent drug
d.)Use cardiac monitor with patients receiving epinephrine IV. Have full crash cart immediately
available
e.) Shake suspension well before withdrawing the drug
f.) Protect drug solutions from light and extreme heat and cold
g.) Advise patient to report bronchial irritation, nervousness, or sleeplessness. Dosage should
be reduced
 Amiodarone 150mg/3ml

Classification: III antiarrhythmic agent

Indication: Cardiac arrhythmias, ventricular rhythm disorders

Mechanism of Action: Increases the refractory period via sodium- and

potassium- channel effects, and slows intra-cardiac conduction of the cardiac
action potential, via sodium-channel effects which leads to a delay in the rate
at which the heart's electrical system "recharges" after the heart contracts
(repolarization) it also acts on peripheral smooth muscle to decrease peripheral
resistance.

Nursing Responsibility:

a.) Assess cardiovascular status before therapy and monitor blood pressure.
b.) Give drug with meals to decrease GI problems.
c.) Reserve use for life-threatening arrhythmias; serious toxicity, including
arrhythmias, pulmonary toxicity can occur.
d.) Arrange for regular periodic blood tests for liver enzymes, thyroid hormone
levels.
e.) Instruct patient that skin discoloration is reversible.
f.) Advice patient to wear sunglass for photophobia.
 Nitroglycerine 50mg/10ml

Classification: Nitrates, Antianginal, Vasodilator

Indication: Angina Pectoris, CHF associated with AMI

Mechanism of action: Dilates blood vessels that supply the areas of the heart
where there is not enough blood flow and oxygen thus decreases cardiac
workload and myocardial oxygen consumption

Nursing consideration:

a.) Contraindicated to patient with hypersensitivity to nitrates.

b.) Monitor blood pressure and heart rate before and after administration.
c.) Client must have continue EKG monitoring for IV administration.
d.) For sublingual tablets, instruct patient not to chew, crush or swallow.
e.) If patient experience no relief, advice to seek medical assistance
immediately.
 Sodium Bicarbonate 8.4%/50ml

Classification: Alkalizing Agent, Antacid

Indication: To treat hyperacidity; Peptic Ulcer

Mechanism of action: Short acting, potent systemic antacid that rapidly

neutralizes gastric acid to form sodium chloride, carbon dioxide, and water.
After absorption of sodium bicarbonate, plasma alkali reserve is increased and
excess sodium and bicarbonate ions are excreted in urine, thus rendering urine
less acid.

Nursing consideration:

a.) Monitor urinary pH.

b.) Monitor acid-base status such as the blood pH, Po2, Pco2, Hco3-, and
other electrolytes.
c.) Use cautiously in patient with CHF, liver cirrhosis, toxemia of pregnancy, or
renal impairment.
d.) Check for any allergic reactions and adverse effect of the medication.
 Dopamine 400mg/5ml

Classification: Vasopressor

Indication: To treat shock and hemodynamic imbalances; to correct

hypotension

Mechanism of action: Stimulates dopaminergic and alpha and beta receptors

of the sympathetic nervous system resulting in positive inotropic effect and
increase cardiac output.

Nursing consideration:

a.) Monitor blood pressure, heart rate, pulse pressure and cardiac output.
b.) Monitor urine output throughout administration.
c.) If hypotension occurs, administration fate should be increased.
d.) Check for allergies and any adverse reaction.
Dexamethasone 4mg/1ml

Brand Name: Cortastat, Dalalone, Decadrol, Decaject, Deronil,

Dexacorten, Dexameth, Dexasone, Dexone, Hexadrol,
Primethasone, Solurex

Classification: Long- acting corticosteroid

Indication:
1. Management of cerebral edema
2. Relieves inflammation
3. Allergic disorders
4. Asthma
5. Arthritis

Mechanism of Action: Dexamethasone suppresses inflammation and the normal

immune response. It prevents the release of substances in the body that causes
inflammation. Exact action is unknown.

Nursing consideration:

a.) Monitor intake and output of patient.

b.) Observe the patient for peripheral edema, steady weight gain, rales or crackles or
dyspnea. Notify the physician immediately if these clinical manifestations are noted.

c.) For patients with cerebral edema, assess then for level of consciousness changes
and headache during the therapy.

d.) Guaiac-test stools should be carried out. Guaiac-positive stools should be reported
to the physician immediately.

e.) Instruct patient to avoid people with known infection and contagious illnesses as
corticosteroids causes immunosuppression and may mask symptoms of infection.
Epinephrine 1:10,000/ 10ml

Brand Name: Adrenaclick, Adrenalin, Adrenalin Chloride,

Auvi-Q, Epipen, Twinject

Classification: alpha- and beta-adrenergic agonists

Indication:
1. Anaphylaxis.
2. Bronchospasm.
3. Angioedema.
4. Serum sickness.

Mechanism of action: It activates an adrenergic receptive mechanism on effector cells

and imitates all actions of the sympathetic nervous system except those on the arteries
of the face and sweat glands. Epinephrine acts on both alpha and beta receptors and is
the most potent alpha receptor activator. Epinephrine relaxes the smooth muscle of the
bronchi and iris and is a physiologic antagonist of histamine. The drug also produces
an increase in blood sugar and glycogenolysis in the liver.

Nursing consideration:

1.) 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.

2.) Keep physician informed of any changes in intake-output ratio.

3.) Use cardiac monitor with patients receiving epinephrine. Have full crash cart
immediately available.

4.) Check BP repeatedly when epinephrine is administered during first 5 min, then
q35min until stabilized.

5.) Advise patient to report to physician if symptoms are not relieved in 20 min or if
they become worse following inhalation.

6.) Advise patient to report bronchial irritation, nervousness, or sleeplessness. Dosage

should be reduced.

7.) Monitor blood glucose & HbA1c for loss of glycemic control if diabetic.
Digoxin 0.5mg/2ml

Brand Name: Digitek, Lanoxicaps, Lanoxin

Classification: Cardiac glycoside, Cardiotonic

Indication:
1. CHF
2. Atrial fibrillation

Mechanism of action: Acts as a cardiac glycoside which has positive inotropic activity
characterized by an increase in the force of myocardial contraction. It also reduces the
conductivity of the heart through the atrioventricular (AV) node. Digoxin also exerts
direct action on vascular smooth muscle and indirect effects mediated primarily by the
autonomic nervous system and an increase in vagal activity.
Adverse Effect: anorexia, nausea and vomiting, Diarrhea, confusion, dizziness,
drowsiness, restlessness, nervousness, agitation and amnesia, visual disturbances,
gynecomastia, local irritation (IM/SC inj), Cardiac arrhythmias in combination with
heart block.

Nursing consideration:

a.) Be familiar with patients baseline data (e.g., quality of peripheral pulses, blood
pressure, clinical symptoms, serum electrolytes, creatinine clearance) as a foundation
for making assessments.

b.) Take apical pulse for 1 full min noting rate, rhythm, and quality before
administering. If changes are noted, withhold digoxin, take rhythm strip if patient is
on ECG monitor, notify physician promptly.

c.) Withhold medication and notify physician if apical pulse falls below ordered
parameters (e.g., >50 or 60/min in adults and >60 or 70/min in children).

d.) Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually
reliable signs of early toxicity. Early indicators in adults (anorexia, nausea, vomiting,
diarrhea, visual disturbances) are rarely initial signs in children.

e.) Monitor I&O ratio during digitalization, particularly in patients with impaired
renal function. Also monitor for edema daily and auscultate chest for rales.
Diphenhydramine 50mg/1ml

Brand Name: Benadryl

Classification: Antiparkinsonian drug

Indication:

1. Relief of allergic symptoms caused by histamine release including:

o Anaphylaxis,
o Allergic dermatoses.

2. Parkinson's disease and dystonic reactions from medications.

Mechanism of action: Diphenhydramine competes with free histamine for binding at

HA-receptor sites. This antagonizes the effects of histamine on HA-receptors, leading
to a reduction of the negative symptoms brought on by histamine HA-receptor
binding.

Nursing consideration:

a.) Monitor cardiovascular status especially with pre-existing cardiovascular disease.

b.) Monitor for adverse effects especially in children and the older adult.
c.)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.
d.) Advise to increase fluid intake, if not contraindicated; drug has an atropine-like
drying effect (thickens bronchial secretions) that may make expectoration difficult.
 Diphenhydramine Hydrochloride (Benadryl) 50mg/1ml

Classification: Antihistamines & Antiallergics

Indications: For perennial and seasonal (hay fever) allergic rhinitis; vasomotor rhinitis,
allergic conjunctivitis due to inhalant allergens and foods; amelioration of allergic reactions
to blood or plasma, dermatographism; as therapy for anaphylactic reactions adjunctive to
epinephrine and other standard measures after the acute manifestations have been
controlled.
Mechanism of Action: Diphenhydramine HCl is an antihistamine with anticholinergic
(drying) and sedative side effects. Antihistamines appear to compete with histamine for cell
receptor sites on effector cells.
A single oral dose of diphenhydramine HCl is quickly absorbed, with maximum activity
occurring in approximately 1 hr. The duration of activity following an average dose of
Benadryl AH is from 4-6 hrs.
Nursing Responsibilities:
a) Give full prophylactic dose 30min. prior to travel if used as a prophylaxis for motion sickness
b) Take similar doses with meals and at bedtime
c) Do not use more than 2 weeks to treat insomnia
d) For IV, may give undiluted
e) Do not exceed IV rate of 25mg/minute
f) Drug causes drowsiness. Avoid activities requiring mental alertness
g) Use sun protection as it may cause photosensitivity
h) Use sugarless candy/gum to diminish dry mouth effects
i) Avoid alcohol and other CNS depressants
j) Stop therapy 72-96 hr. prior to skin testing. Report adverse effect and lack of response
 Glucagon Emergency Kit (Glucagon, Human Recombinant)

Classification: Glucose Regulation, Antihypoglycemic, Diagnostic aid adjunct

Indications: It is an emergency medicine used to treat severe hypoglycemia (low blood
sugar) in patients with diabetes who have passed out or cannot take some form of sugar by
mouth.
Glucagon is also used during x-ray tests of the stomach and bowels to improve test results
by relaxing the muscles of the stomach and bowels.
Mechanism of Action: Promotes hepatic glycogenolysis and gluconeogenesis. Stimulates
adenylate cyclase to produce increased cyclic adenosine monophosphate (cAMP), which is
involved in a series of enzymatic activities. The resultant effects are increased
concentrations of plasma glucose, a relaxant effect on smooth musculature, and a positive
chronotropic and inotropic myocardial effect. Hepatic stores of glycogen are necessary for
glucagon to elicit an antihypoglycemic effect.
Nursing Responsibilities:
a) After the end of the diagnostic procedure, give oral carbohydrates to patients who have
been fasting, if this is compatible with the diagnostic procedure.
b) Inform patients that generalized allergic reactions have been reported with Glucagon
treatment including generalized rash, and in some cases anaphylactic shock with breathing
difficulties, and hypotension. Advise patients to monitor and report any signs or symptoms
of a hypersensitivity reaction
c) Inform patients that hypoglycemia has occurred with treatment with Glucagon. Inform
patients of the symptoms of hypoglycemia and how to treat it. Advise patients to avoid
driving or operating machinery until ingesting a meal. Advise patients to inform their health
care provider if hypoglycemia occurs so that treatment may be given if necessary
d) Inform patients with diabetes mellitus that treatment with Glucagon for Injection may
increase their risk of hyperglycemia
e) Inform patients with cardiac disease that treatment with Glucagon for Injection may increase
their risk of a transient increase in blood pressure and heart rate
 Vasopressin 20 units/cc

Classification: Haemostatics / Antidiuretics

Indications: Vasopressin is used to treat diabetes insipidus, which is caused by a lack of
this naturally occurring pituitary hormone in the body. It is also used to treat or prevent
certain conditions of the stomach after surgery or during abdominal x-rays.
Mechanism of Action: It exerts direct antidiuretic action on the kidneys by increasing
tubular reabsorption of water. Vasopressin also acts by constricting the peripheral blood
vessels and causes the smooth muscle of the intestine, gall bladder and urinary bladder to
contract.
Nursing Responsibilities:
a) Check patients alertness and orientation frequently during therapy. Lethargy and confusion
associated with headache may signal onset of water intoxication, which, although insidious
in rate of development, can lead to convulsions and terminal coma.
b) Monitor urine output, specific gravity, and serum osmolality while patient is hospitalized.
c) Withhold vasopressin, restrict fluid intake, and notify physician if urine-specific gravity is
<1.015.
d) Instruct Patient to avoid concentrated fluids (e.g., undiluted syrups), since these increase
urine volume.
 Dextrose 50gm/50ml

Classification: Caloric Agents

Indication: Providing fluids containing various amounts of sugars to body when patient is
not able to drink enough liquids or when additional fluids are needed. It may also be used as
a way to give other injectable medicines.
Mechanism of Action: Dextrose is a monosaccharide that is used as a source of calories
and water for hydration. It helps to reduce loss of body protein and nitrogen. It also
promotes glycogen deposition in the liver. When used with insulin, it stimulates the uptake of
potassium by cells, especially in muscle tissue, thus lowering serum potassium levels.
Nursing Responsibilities:
a) Suspend container from eyelet support.
b) Remove plastic protector from outlet port at bottom of container.
c) Attach administration set. Refer to complete directions accompanying set
d) Clinical evaluation and periodic laboratory determinations are necessary to monitor changes
in fluid balance, electrolyte concentrations, and acid base balance during prolonged
parenteral therapy or whenever the condition of the patient warrants such evaluation.
e) Lactated Ringers and 5% Dextrose Injection, USP should be used with caution. Excess
administration may result in metabolic alkalosis.
f) Caution must be exercised in the administration of parenteral fluids, especially those
containing sodium ions to patients receiving corticosteroids or corticotrophin.
g) Solution containing acetate should be used with caution as excess administration may result
in metabolic alkalosis.
h) If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute
appropriate therapeutic countermeasures
 Amiodarone 150mg/3ml

Classification: Antiarrhythmic, Adrenergic blocker

Indication: Only for treatment of the following documented life-threatening recurrent
ventricular arrhythmias that do not respond to other anti arrhythmics or when alternative
agents are not tolerated: Recurrent ventricular fibrillation, recurrent hemodynamically
unstable ventricular tachycardia. Serious and even fatal toxicity has been reported with this
drug; use alternative agents first; very closely monitor patient receiving this drug
Mechanism of Action: Amiodarone is a class III antiarrhythmic agent which inhibits
stimulation, prolongs action potential and refractory period in myocardial tissues. It also
decreases AV conduction and sinus node function. Sinus rate is reduced by 15-20%, PR
and QT intervals are increased. Amiodarone can cause marked sinus bradycardia or sinus
arrest and heart block. In acute IV doses, amiodarone may exert a mild negative inotropic
effect
Nursing Responsibilities:
a) Reserve use for life-threatening arrhythmias; serious toxicity, including arrhythmias,
pulmonary toxicity can occur
b) Monitor cardiac rhythm continuously.
c) Monitor for an extended period when dosage adjustments are made.
d) Monitor for safe and effective serum levels (0.52.5 mcg/mL).
e) Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need to be reduced
one-third to one-half when amiodarone is started.
f) Give drug with meals to decrease GI problems.
g) Arrange for ophthalmologic examinations; reevaluate at any sign of optic neuropathy.
h) Arrange for periodic chest X-ray to evaluate pulmonary status (every 36 mo).
i) Arrange for regular periodic blood tests for liver enzymes, thyroid hormone levels.