Xavier University- Ateneo de Cagayan

College of Nursing

Emergency Drugs

Submitted to:

Mrs. Nadine June M. Rizon, RN

Clinical Instructor

Submitted by:

Sheila Mae Faith V. Llano

BSN 4 NH
Digoxin

 Drug Classification: Inotropics

 Indication: Heart failure, Atrial fibrillation or flutter; paroxysmal
supraventricular tachycardia
 Contraindication: Hypersensitive to drug and in those with digitalis- induced
toxicity, ventricular fibrillation or ventricular tachycardia unless caused by heart
failure
 Adverse Effects: Fatigue, generalized muscle weakness, agitation, vertigo,
stupor, paresthesia, dizziness, blurred vision, anorexia, nausea, vomiting and
diarrhea
 Nursing Considerations:
- In elderly patients and in those with acute MI, sinus bradycardia, and PVCs
-Drug-induced arrhythmias may increase the severity of heart failure and
hypertension.
-Toxic effects on the heart may be life threatening and require immediate
attention

Metoprolol

 Drug Classification: Beta-adrenergic blocking agents

 Indication: Essential hypertension , Tachycardia , Coronary heart disease
(prevention of angina attacks)
 Contraindication: Hypersensitivity ,Sick-sinus syndrome , Pheochromocytoma,
Myocardial Infarction
 Adverse Effects: dizziness, lightheadedness, drowsiness, tiredness, diarrhea,
unusual dreams, ataxia, trouble sleeping, depression, and vision problems. It may
also reduce blood flow to the hands and feet, causing them to feel numb and cold;
smoking may worsen this effect.
 Nursing Considerations:
-may worsen the symptoms of heart failure in some patients.
-Instruct SO to immediately inform nurses if patients are having chest pain or
discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular
heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs;
weight gain; or wheezing.
Diltiazem

 Drug Classification: Antianginal

 Indication: Hypertension, Atrial fibrillation or flutter; paroxysmal
supraventricular tachycardia
 Contraindication: Hypersensitive to drug and in those with sick-sinus syndrome
or second or third degree Av block
 Adverse Effects: Headache, dizziness, somnolence, edema, arrhythmias,
hypotension, heart failure, Av block, abnormal ECG, nausea, constipation, and
acute hepatic injury
 Nursing Considerations:
-In elderly patients and in those with heart failure or impaired hepatic or renal
function
-Monitor BP and HR when starting therapy and during dosage adjustment
-Have client sit or lie down if taking drug for the first time.

Nitroglycerin

 Drug Classification: Antianginal

 Indication: Angina pectoris , CHF associated with MI, Cardiac load reducing
agent, Hypertensive Crisis
 Contraindication: Hypersensitive to nitrates and in those with early MI, severe
anemia, increase, ICP angle-closure glaucoma, IV nitroglycerine is
contraindicated in patients with hypovolemia, hypotension, orthostatic
hypotension, cardiac tamponade restrictive
cardiomyopathy, constrictive pericarditis.
 Adverse Effects: Orthostatic hypotension, flushing, fainting, sublingual
burning,contact dermatitis (patch) headache, throbbing, dizziness, weakness.
nausea, vomiting and skin rash
 Nursing Considerations:
-Record characteristics and precipitating factors of angina pain.
-Monitor BP and apical pulse before administration and periodically after dose.
-Have client sit or lie down if taking drug for the first time.
-Cardioverter/ defibrillator must not be discharged through paddle electrode
overlying
-Instruct to take at first 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
Diazepam

 Drug Classification: Anxiolytics

 Indication: Anxiety, Muscle spasm, Adjunctive treatment in seizure disorders,
Status epilepticus, severe recurrent seizures
 Contraindication: Hypersensitive to drug or soy protein; patients experiencing
shock, coma or acute withdrawal intoxication and in children younger than age 6
months.
 Adverse Effects: -Drowsiness, dysarthria, slurred speech, tremor, insomnia,
fatigue, ataxia, headache, hypotension, CV collapse, bradycardia, nausea,
constipation, blurred vision, incontinence, jaundice and skin rash
 Nursing Considerations:
-In patients with liver or renal impairment, depression, or chronic open-angle
glaucoma
-elderly and debilitated patients
-When using oral concentrate solution, dilute dose just before giving.
-Don’t mix injectable diazepam with other drugs and don’t store parenteral
solutions in plastic syringes.

Atropine sulfate

 Drug Classification: Antiarrhytmics

 Indication: Symptomatic bradycardia, bradyarrhytmia ( junctional or escape
rhythm), antidote for anticholinesterase insecticide poisoning
 Contraindication: Hypersensitive to drug and in those with acute angle closure
glaucoma, obstructive uropathy, obstructive disease of GI tract, paralytic ileus,
toxic megacolon and intestinal atony.
 Adverse Effects: Headache, restlessness, ataxia, disorientation, insomnia,
dizziness, palpitations, bradycardia, tachycardia, blurred vision, dry mouth,
nausea, vomiting and urine retention
 Nursing Considerations:
-In patients with down syndrome because they may be more sensitive to drug
-Watch for tachycardia in cardiac patients because it may lead to ventricular
fibrillation
-Monitor I & O. Drug causes urine retention and urinary hesitancy.
-Give IM injections in deltoid muscle only
Methylprednisolone

 Drug Classification: Corticosteroids

 Indication: Severe inflammation or immunosuppression ,Shock
 Contraindication: Hypersensitive to drug or its ingredients, in those with
systemic fungal infections, in premature infants, and in patients receiving
immunosuppressive doses together with live virus vaccines.
 Adverse Effects: Insomnia, vertigo, seizures, headache, heart failure,
hypertension, edema, cardiac arrest, cataracts, peptic ulceration, hypokalemia,
hypoglycemia, muscle weakness, growth suppression in children, nausea,
vomiting, delayed wound healing, hirsutism
 Nursing Considerations:
-In patients with GI ulceration, or renal disease, hypertension, osteoporosis, DM,
and cirrhosis.
-Determine whether patient is sensitive o other corticosteroids
-Most adverse reactions to corticosteroids are dose-or duration-dependent.
-Always adjust to lowest effective dose.

Epinephrine

 Drug Classification: Bronchodilators

 Indication: Bronchospasm, hypersensitivity reactions, anaphylaxis, To restore
cardiac rhythm in cardiac arrest, Acute asthma attacks
 Contraindication: Angle-closure glaucoma, shock, organic brain damage,
cardiac dilatation, arrhythmias, coronary insufficiency, or cerebral
arteriosclerosis.
 Adverse Effects: Nervousness, tremor, vertigo, headache, drowsiness,
palpitations, widened pulse pressure, hypertension, tachycardia, angina pain,
nausea, vomiting, dsypnea, and urticaria
 Nursing Considerations:
-In patients with long standing bronchial asthma or emphysema who have
developed degenerative heart disease.
-In elderly patients and in those with hyperthyroidism, CV disease, hypertension,
psychoneurosis and diabetes
-drug increases rigidity and tremor in patients with Parkinson’s disease
Lidocaine

 Drug Classification: Antiarrhythmics

 Indication: Ventricular arrhythmias caused by MI, cardiac manipulation or
cardiac glycoside
 Contraindication: Hypersensitive to the amide-type local anesthetics and in
those with Adam-Stokes syndrome and Wolff-Parkinson White-Syndrome
 Adverse Effects: Confusion, tremor, lethargy, hypotension, bradycardia,
vomiting, respiratory depression and arrest, sensation of cold
 Nursing Considerations:
-Use in reduced dosages in patients with complete or second degree heart block or
sinus bradycardia, in elderly patients, in those with heart failure or renal or
hepatic disease
-Give IM injections in deltoid muscle only

Valproic acid

 Drug Classification: Anticonvulsants

 Indication: Simple and complex absence seizures, mixed seizure types (including
absence seizures), Complex partial seizures
 Contraindication: Hypersensitive to drug and in those with hepatic disease or
significant hepatic dysfunction, and in patients with a urea cycle disorder.
 Adverse Effects: Sedation, emotional upset, muscle weakness, ataxia, tremor,
headache, dizziness, nausea, vomiting, indigestion, diarrhea, abdominal cramps,
petechiae, hemorrhage, leukopenia, toxic hepatitis, skin rash, alopecia and
pruritus
 Nursing Considerations:
-Obtain liver function test results, platelet count, and PT and INR before starting
therapy, and monitor these values periodically.
-Don’t give syrup to patients who need sodium restriction. Check with prescriber.
-Notify prescriber if tremors occur; a dosage reduction may be needed.
-Patient at high risk of hepatotoxicity include those with congenital disorders
Albuterol

 Drug Classification: Bronchodilators

 Indication: To prevent or treat bronchospasm in patients with reversible
obstructive airway disease
 Contraindication: Hypersensitive to drug or its ingredients
 Adverse Effects: -Tremor, nervousness, dizziness, insomnia, palpitations,
tachycardia, dry and irritated nose and throat, nasal congestion, heart burn,
nausea, vomiting, anorexia, bad taste, muscle cramps, cough, wheezing, and
dsypnea
 Nursing Considerations:
-In patients with CV disorders, hyperthyroidism, DM and in those who are
unusually responsive to adrenergics.
-Give extended release tablets cautiously to patients with GI narrowing.
-Patient may use tablets and aerosol together. Monitor these patients closely for
signs and symptoms of toxicity.
-do not exceed recommended dosage, administer pressurized inhalation drug
forms during second half of inspiration

Morphine Sulfate

 Drug Classification: Narcotics and opioid analgesics

 Indication: Severe pain
 Contraindication: Hypersensitive to drug or those with conditions that would
preclude administration of opioids by IV route and in patients with GI obstruction
 Adverse Effects: Sedation, somnolence, seizure, dizziness, nervousness,
hallucinations, hypotension, bradycardia, shock, cardiac arrest, nausea, vomiting,
constipation, thrombocytopenia, respiratory depression, respiratory arrest,
pruritus, skin flushing, and urinary tract infection
 Nursing Considerations:
-In elderly or debilitated patients and in tjose with head injury, increased
intracranial pressure, seizures and chronic pulmonary disease
-Reassess patient’s level of pain at least 15-30 minutes after parenteral
administration and 30 minutes after oral administration
-Don’t break crush or chew extended release tablets or sustained release capsules
Naloxone

 Drug Classification: Antagonists and Antidotes

 Indication: Known or suspected narcotic-induced respiratory depression
 Contraindication: Hypersensitive to drug
 Adverse Effects: Tremors, seizures, tachycardia, hypertension, nausea, vomiting,
pulmonary edema, and diaphoresis
 Nursing Considerations:
-In patients with cardiac irritability and opiate addiction.
-Respiratory rate increases within 1 to 2 minutes
-Monitor respiratory depth and rate. Be prepared to provide, oxygen, ventilation
and other resuscitation measures.

Furosemide

 Drug Classification: Diuretics

 Indication: Acute Pulmonary Edema, Edema, Hypertension
 Contraindication: Hypersensitive to drugs and in those with anuria.
 Adverse Effects: Vertigo, headache, dizziness, weakness, fever, orthostatic
hypotension, blurred or yellowed vision, abdominal discomfort and pain, diarrhea,
nausea, vomiting, nocturia, polyuria, anemia, volume depletion and dehydration,
hypokalemia, muscle spasm, dermatitis and purpura
 Nursing Considerations:
-In patients with hepatic cirrhosis
-To prevent nocturia, give PO and IM preparations in the morning. Give second
dose in early afternoon.
-Monitor weigth, blood pressure and pulse rate during rapid dieresis because it
can lead to water and electrolyte depletion.
-Watch for signs of hypokalemia such as muscle weakness and cramps.
-Monitor elderly patients, who are especially susceptible to excessive dieresis,
because circulatory collapse and thromboembolic complications are possible.
-measure and record weight to monitor fluid changes
Heparin

 Drug Classification: Anticoagulants

 Indication: Consumptive coagulopathy, Full dose continuous IV infusion therapy
for DVT, MI and pulmonary embolism
 Contraindication: Hypersensitive to the drug, Active bleeding, blood dyscrasia
or bleeding tendencies such as haemophilia, thrombocytopenia, or hepatic disease
with hypoprothrombinemia
 Adverse Effects: Fever, rhinitis, hemorrhage, thrombocytopenia, skin irritation,
mild pain, hematoma, ulceration, pruritus, urticaria and white clot syndrome
 Nursing Considerations:
-In patients with mild hepatic or renal disease, alcoholism, occupations with high
risk of physical injury, or history of allergies, asthma or GI ulcerations.
-Draw blood to establish baseline coagulation parameters before therapy
-Drug may cause false elevations in some tests for thyroxine levels.
-Elderly patients should usually start at lower dosage.
-Check order and vial carefully; heparin comes in various concentrations

Ampicillin

 Drug Classification: Penicillins

 Indication: Bacterial meningitis or septicemia, Prophylaxis for GI and GU
procedures
 Contraindication: Hypersensitive to drug or other penicillins
 Adverse Effects: Lethargy, hallucinations, seizures, confusion, agitation,
thrombophlebitis, vein irritation, nausea, vomiting, diarrhea, abdominal pain,
anemia, hemolytic anemia, and eosinophila
 Nursing Considerations:
-In patients with other drug allergies because of possible cross sensitivity and in
those with mononucleosis because of high risk of maculopapular rash.
-Before giving drug, ask about allergic reaction to penicillin. A negative history of
penicillin allergy is no guarantee against a future allergic reaction.
-Dosage should be decreased in patients with impaired renal function
Dopamine

 Drug Classification: Adrenergics

 Indication: To treat shock and correct hemodynamic imbalances, to improve
perfusion to vital organs, to increase cardiac output, to correct hypertension
 Contraindication: Patients with uncorrected tachyarrhytmias,
pheochromocytoma or ventricular fibrillation
 Adverse Effects: Headache, ectopic beats, angina, palpitations, nausea, vomiting,
azotemia, hyperglycemia, dsypnea, asthmatic episodes and skin necrosis
 Nursing Considerations:
-In patients with occlusive vascular disease, cold injuries, diabetic endarteritis and
arterial embolism
-Observe patient closely for adverse reactions; dosage may need to be adjusted or
drug stopped
-Check urine output often. If urine flow decreases without hypotension, notify
prescriber because dosage may need to be reduced.

Magnesium sulfate

 Drug Classification: Anticonvulsant and Antiarrhythmic

 Indication: Treatment of ventricular fibrillation, ventricular tachycardia, torsades
de pointes, paroxysmal atrial tachycardia, acute myocardial infarction, and
asthma.
 Contraindication: Renal failure, hypermagnesemia; appendicitis, bowel
obstruction/perforation, Patients with heart block or myocardial damage
 Adverse Effects: flushing, sweating, muscle weakness, dizziness, drowsiness,
muscle weakness, slowed/shallow breathing or other breathing trouble.
 Nursing Considerations:
-Before using this drug, tell the doctor about patient’s medical history, including:
allergies (especially drug allergies), kidney or heart disease, low blood calcium,
myasthenia gravis.
-Avoid alcohol intake, since the possible drowsiness effect of this medication may
be increased. Caution when performing tasks requiring mental alertness.
Atenolol

 Drug Classification: Antianginal and Antihypertensive

 Indication: Treatment of angina pectoris due to coronary atherosclerosis,
hypertension, treatment of MI
 Contraindication: Sinus Bradycardia, second-or third degree heart block,
cardiogenic shock, heart failure
 Adverse Effects: laryngospasm, respiratory distress, bradycardia, heart failure,
cardiac arrhythmias, bronchaspasm, bronchial obstruction.
 Nursing Considerations:
-Monitor BP and apical pulse before administration and periodically after dose.
-Have client sit or lie down if taking drug for the first time.
-Client must have continuing EKG monitoring for IV administration
-Instruct to take at first 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

Aminophylline

 Drug Classification: Bronchodilator

 Indication: symptomatic relief or prevention of bronchial ashtma and reversible
bronchospasm associated with chronic bronchitis and emphysema
 Contraindication: hypersensitivity to any xanthine or to ethylenediame, peptic
ulcer, active gastritis, rectal or caloric irritation or infection
 Adverse Effects: -Brain damage, sinus tachycardia, seizures, hyperglycemia,
cardiac arrythmias, hematemesis, increased AST
 Nursing Considerations:
-caution patient not to chew or cruch enteric-coated timed-release forms
-monitor results of serum theophylline levels carefully and arrange for reduced
dosage if serum levels exceed therapeutic range of 10-20mcg/ml
-monitor for clinical signs of adverse effects, particularly if serum theophylline
levels are not available
Nifedipine

 Drug Classification: Antianginal and antihypertensive

 Indication: angina pectoris due to coronary artery spasm(prinzmetal’s variant
angina), chronic stable angina
 Contraindication: allergy to nifedipine
 Adverse Effects: dizziness, peripheral edema, hypotension, nasal congestion,
shortness of breath, flushing
 Nursing Considerations:
-taper dose of beta blockers before nifedipine therapy
-Ensure patients do not chew or divide sustained- release tablets
-Special precautions to avoid falling
-report irregular heartbeat, shortness of breath, swelling of the hands or feet,
pronounced dizziness, constipation

Ibutilide fumarate

 Drug Classification: Antiarrythmic (predominantly class III)

 Indication: rapid conversion of atrial fibrillation or flutter of recent onset to sinus
rhythm.
 Contraindication: Hypersensitivity to ibutilide, second or third degree AV heart
block, prolonged with QTc intervals.
 Adverse Effects: Confusion, tremor, lethargy, hypotension, bradycardia,
vomiting, respiratory depression and arrest, sensation of cold
 Nursing Considerations:
-Use in reduced dosages in patients with complete or second degree heart block or
sinus bradycardia, in elderly patients, in those with heart failure or renal or
hepatic disease
-Give IM injections in deltoid muscle only
Dobutamine hydrochloride

 Drug Classification: Inotropic, Adrenergic

 Indication: Short term treatment of cardiac decompensation in organic heart
disease of cardiac surgical pressures.
 Contraindication: Hypersensitive to drug or any of its components and in those
with idiopathic hypertrophic subaortic stenosis.
 Adverse Effects: angina, hypertension, hypotension, increased heart
rate, nonspecific chest pain, phlebitis, PVCs, nausea and vomiting, asthma
attacks, shortness of breath, headache, mild leg cramps or tingling sensation.
 Nursing Considerations:
-Monitor CVP to assess vascular volume and cardiac pumping efficiency.
-Monitor ECG and BP continuously during drug administration
-Record I&O
-Monitor glucose in diabetes patients
-Drug is administered IV to improve cardiac function thus increasing BP and
improving urine output.
-Report any chest pain, increase SOB, headaches or IV site pain

Ketorolac

 Drug Classification: Non Steroidal Anti Inflammatory Drug (NSAID)

 Indication: Short term management of moderately severe, acute pain for single or
multiple dose treatment.
 Contraindication: Hypersensitive to drug and in those with active peptic
ulceration disease, recent GI bleeding, advanced renal impairment, and confirmed
cerebrovascular bleeding
 Adverse Effects: Drowsiness, headache, sedation, edema, hypertension,
palpitations, nausea, dyspepsia, GI pain, peptic ulceration, vomiting, constipation,
prolonged bleeding time, purpura, pruritus and skin rash
 Nursing Considerations:
-In patients with hepatic or renal impairment or cardiac decompensation
-This drug is not recommended for children
-Correct hypovolemia before giving ketorolac
-NSAID may mask signs and symptoms of infection because of their antipyretic
and anti-inflammatory actions.