PPIYs

Nurciirrg,

Drug (-Edton
)no
Guide zD8-2009

-- s table consists of the readily available agents used as antidotes. Data have been reviewed and updated
on the clinical experience and researches conducted by the toxicology staff of the National Poison
=--ed
-:ntrol and lnformation Service.

.t:tivated
:harcoal

.-acetylcysteine

Non-specific adsorbent of poisons

rrvvr
iron,
rr vr
lithium,
Except cyanide,
vJsr
-^--Fr
caustics and alcohol

Absorption of drug in gastric and intestinal

tracts and interruption of entero-hepatic cycle
with multiple dose MDAC)

Paracetamol, "watusi"
(dancing fire cracker), zinc
phosphide, carbon tetrachloride, chloroform, penny

Restores depleted glutathione stores

Protects against renal and hepatic
failure

acute hepatic failure; may displace

amatoxin from protein-binding sites
allowing increased renal excretion;
may also inhibit penetration of amatoxin to hepatocytes.
3romocriptine

Neuroleptic malignant
syndrome caused by
neuroleptic drugs or
levodopa withdrawal

Dopamine agonist

3alcium folinate

Folic acid antagonists:

Methotrexate
Trimethoprim
Methanol (formate)
Adjunct: Ethylene glycol
poisoning

Bypasses blocked folate metabolism

Calcium salts

Fluoride ingestion
Black widow spider
envenomation
Hypocalcemia from oxalate
ingestion or citrate l.V.
(anticoagulant of fresh frozen
plasma/whole blood)

Rapidly complexes with fluoride ion

Directly antagonistic to the cardiotoxic
effects of hyperkalemia
Maintains adequate amount of ionized
calcium to prevent hypocalcemia

Glucagon**

Calcium channel blocker or

B-receptor blocker toxicity;
Cardiac depression caused
by la and lc antiarrhythmic
drugs;
Empiric use in patients with

Stimulates formation of adenyl cyclase

causing intracellular increase in
cyclic AMP and enhanced glycogenolysis and elevated serum glucose
concentration.

-eucovorin
calcium
(Folinic acid
or citrovorum
factor)

Not available in the Philippines

Table of Antidotes

myocardial depression
(bradycardia, hypotension,
low cardiac output)
Ergotamine

Reverses hypercoagulable state by

interacting with antithrombin lll to
produce a heparin-antithrombinthrombin complex.
Used in combination with vasodilator
phentolamine or nitroprusside to preve':
local thrombosis and ischemia

Hydroxocobalamin**
(followed by
sodium
thiosulfate)

Cyanide and cyanide

derivatives
Cyanogenic compounds
(e.9. acetonitrile)
Prevention of nitroprussideinduced cyanide toxicity

Forms cyanocobalamin, a non-toxic

metabolite that is easily excreted
through the kidneys

Methylene blue

Chemicals producing severe

methemoglobinemia;
lfosfamide-induced
encephalopathy

Reduces methemoglobin to hemoglobir

at therapeutic doses, methylene blue
is reduced by nicotinamide adenine
dinucleotide phosphate dependent
enzymes system to leucomethylene
blue which rapidly converts methemoglobin back to hemoglobin

Narcotics, opioids
Opioids with long duration of
action

Pure antagonist, act as competitive

inhibitor at opiate receptor sites
(p, x, a receptors) within the central
nervous system

Neostigmine

Anticholinergic drugs with

tachycardia
Competitive neuromuscular
blockers (non-depolarizing)

Anticholinesterase which causes

accumulation of acetylcholine at
cholinergic receptor sites

Nitrite, sodium
(intravenous)
and glyceryltrinitrate/nitrogylcerin (ointment or patch)

Cyanide, cyanogenic
compounds
N itroprusside-induced
cyanide toxicity
Hydrogen sulfide

Oxidizes hemoglobin to methemoglobir'

which binds with free cyanide and car^
enhance endothelial cyanide detoxification by producing vasodilatation

Penicillamine

Copper, gold, lead, mercury,

zinc, arsenic

Chelation of metal ions

Propranolol (oral)
Esmolol (lV)
(NOT compatible with sodium
bicarbonate
solution)

B-ad renoreceptor sti mu lants

Propranolol, a non-selective B-adreno

receptor drug and Esmolol, a cardioselective agent, suppress sympathebc
overactivity and rate-related myocaro;a
ischemia

Ephedrine, cocaine
Theophylline, caffeine
Thyroxine
Excessive myocardial
sensitivity (freons, chloral
hydrate, chlorinated
hydrocarbons)
Organophosphates and some
carbamates with nicotinic
effects including organophosphate nerve warfare
agents

Reactivates phosphorylated cholinesterase enzymes and protects enzyme

from further inhibition when given
belore acetylcholinesterase has
been irreversibly bound; must always
be used in combination with atropine
**

620
|

Not available in the

Philimr=

Table of Antidotes

=yridoxine

!soniazid, theophylline
Monomethyl hydrazine,
hydrazine
Adjunctive therapy in
ethylene glycol poisoning

Reverses acute pyridoxine deficiency

by promoting GABA synthesis;
promotes the conversion of toxic
metabolite glycolic acid to glycine

notamine sulfate

Heparin

Neutralizes heparin by combining with

heparin and forming an inactive salt

Sodium

!ron
Cardiotoxic drugs affecting fast
sodium channel (tricyclic antidepressant, cocaine, Type !a
and lc anti-arrythmic agents,
diphenydramine)
Weak acids

Prevents conversion of ferrous to ferric

Decreases affinity of cardiotoxic drug
to the fast sodium channel

bicarbonate

Chlorine gas inhalational

poisoning

Promotes ionization of weak acids

(salicylates, phenobarbital, chlorpropamide, chlorophenoxy-herbicides,
methotrexate, lNH, etc.)
Neutralization of hydrochloric acid
formed when chlorine gas reacts with
water in the airways

Sodium calcium
edetate**

Lead

Chelation of lead ions and endogenous metals (zinc, manganese,

iron, copper)

Snake anti-venin

Cobra bite

Neutralizes venom by binding with

circulating venom components and
with locally deposited venom by
accumulating at the bite site

Sodium
thiosulphate

Cyanide and cyanide

derivatives
Cisplatin

Replenishes depleted thiosulphate

stores by acting as sulfur donor
necessary for the conversion of
CN-O to thiocyanate through the
action of sulfur transferase enzyme
rhodanese

Thiamine

Alcohol
Wernicke-Korsakoff Synd rome
in alcoholic and
malnourished patients
Adjunctive in ethylene glycol

Reverses acute thiamine deficiency

Vitamin C
(Ascorbic acid)

Chemicals causing
methemoglobinemia in
patients with G6PD deficiency

Reduces methemoglobin to
hemoglobin

Vitamin Kr
(Phytomenadione)

Anticoagulant drugs
(coumarin, indanedione
derivatives)
Anticoagu lant rodenticides
Vitamin K deficiency
(hemorrhagic disease of the
newborn) with coagulopathy
Hypoprothrombinemia from
salicylate/white or yellow
phosphorus i ntoxication

Bypasses inhibition of Vitamin K

epoxide reductase enzyme

Enhances detoxification of glyoxylic acid

As replacement for Vitamin K,

orepared by: Maramba, NPC and Panganiban LR: University of the Philippines Nationa! Poison Management
and Control Center

Not available in the Philippines

PPIIs

2rrt
and COPD. Ophthalmic Preparations: Prc---,:
(a'troe-peen)

Philippine brand/s; Euro-Med Atropine Sulfate, Hizon

Atropine Sulfate, lsopto Atropine
Australia brand/s: Atropt, Ptizer Atropine lnj., Astrazeneca Atropine, Fawns & Mcallan Atropine, Minims
Atropine, RPS Atropine, Min-l-Jet Atropine
Canada brand/s: Akorn Atropine AK, Alveda Atropine,
Alcon Atropine, Atropinum, Dioptic's Atropine Solution,
Hospira Atropine, lsopto Atropine, lsopto Homatropine, Minim Atropine, Sandoz Atropine
UK brand/s; lnternational Medication System Atropine
lnj., Minims Atropine Wockhardt Atropine
US brandls; Atropen

Action: lnhibits acetylcholine at parasympathetic

neuro effector junction, blocking vagal effect on the
heart (SA node), exocrine glands, smooth muscles
and urinary bladder. Drug increases heart rate, dries
secretions, decreases sweating and salivation in low
doses. Mydriasis (dilatation of the pupil) and cycloplegia (failure to accommodate for close vision) occur at
moderate doses. Motility of Gl and GU systems are
affected at high doses.

Pharmacokinetics

Absorption
Distribution
Metabolism

Excretion

Half-life

Well absorbed (PO, lM),

unknown (SC)
Throughout body including CNS
Liver
Kidneys, unchanged (70%-90%)
13-40 hrs

tar.- 1:i,
+-' -:

flushed and dry, the pupils dilated and

has developed. Adult: By subcutaneous (SC) 0.5 mg 4-6 hrly. Pedia <12 yrs: SC 0
body-weight. Refraction: Adull l-2 drops i -'

-;--

refracting.

Contraindication: Hypersensitivity to anticFo .F.-rr :

narrow-angle glaucoma; adhesions betwee- -:i i"':

lens; prostatic hypertrophy; obstructive uropa:-,
cardial ischemia; unstable cardiac status c;:r"
hemorrhage; tachycardia; myasthenia grav s

or intestinal obstruction; asthma; hypertf'r-1

:,*

renal disease; hepatic disease; toxic me:,:::

intestinal atony or paralytic ileus.

Precaution: Pregnancy (Category C). PateCHF, COPD, hypertension, hyperthyroidis-

v,'-'

:{':

:':"
ulcer, spastic paralysis and in infants, smal
=.
elderly or debilitated patients. lf given pre-ope-:- ,:
it should be administered 30 mins before inc-.,- :

anesthesia. Prostatic enlargement. Corona-, - i

ficiency or heart failure. Estimate depth of a-':anterior chamber to avoid inducing angle-: :=-'
.

Adverse Reactions: Palpitations, bI?o.rli'l

tachycardia, orthostatic hypotension, hea=?:'
nervousness, drowsiness, weakness, d z: -*

confusions, insomnia, fever, excitabilit!, rest e:*r-=,

tremor, allergic reactions, urticaria, rash. '-:- nasal congestion, altered taste, xerostomia. -.:-.'*'"
vomiting, dysphagia, heartburn, constipation lrrlE:'"
.

Ophth
PO IM/SC lV
Onset Yz hr 15 mins 2-4 mins lz hr
Peak Vz-1 hr 30 mins 2-4 mins 30-60 mins
Duration 4-6 hrs 4-6 hrs 4-6 hrs 1-2 wks
to

reduce or prevent secretions of respiratory tract; to

control rhinorrhea; treatment of parkinsonism; restoration of cardiac rate and arterial pressure in some
situations; treatment of peptic ulcers; management of
hypersecretion, irritation or inflammation of stomach,
intestines or pancreas; treatment of diarrhea; relief
of infant colic; management of spasms of bile tract;
treatment of hypertonicity of small intestine and uterus;
management of hypermotility of colon; prevention of
spasm of pylorus, biliary tree, ureters, and bronchi;
treatment of frequent urination and bedwetting; therapy
for certain bradycardias and heart blocks; treatment

of closed head injury with acetylcholine release; reduction of laughing and crying associated with brain
lesions; treatment of alcohol withdrawal symptoms;
relief of motion sickness. Antidote for cardiovascular
collapse in certain overdoses or poisonings. Shortterm treatment and prevention of bronchospasm
associated with chronic bronchial asthma, bronchitis

622

l,*'f

glaucoma.

Pharmacodynamics

lndication: Administration prior to anesthesia

cycloplegia and mydriasis.

Dosage: For lV administration. Adult 0.4-0 6 -rl 1",;r'
4-6 hrs. Pedia 0.1-0.6 mg depending on
antidote: 1-2 mg every 20-30 mins until :-e .r "

feeling; paralytic ileus, urinary hesitancy and re:::::"

impotence, bronchospasm, suppression of la:':' decreased sweating.

Drug Interaction: Haloperidol: Worsened

>:-:

phrenic symptoms; decreased serum haloper,c:, : "

centrations. Phenothiazines: Decreased antips.r ::
effects and increased anticholinergic effects -e,
cur. Other anticholinergic agents: Additive En:,-i,: lergic effects. Antihistamines, TCADs, antipsy::,:' ::
antiarrhythmics, benzodiazepine, anti-anxie\
MAO inhibitors, meperidine, nitrates, methylpher,=r
orphenadrine, primidone and amantadine; gua-r-

7-r

dine, histamine and reserpine; adrenergic

:--:

levodopa; cyclopropane; metoclopramide.

Treatment of Overdose: Or, artificial ven:

:.

ECG, administer dopamine for circulatory depre-'-'

administer diazepam or thiopental for convuls c'sess need for antidysrhythmics
NU RSING CONSIDERATIONS
Assessnlterur

:"-

:'

Obtain patient's history of underlying conditrc,- :reassess regularly

Monitor patients, especially those receiving D:-

Do you want to report an Adverse Drug Reaction encountered?

Co to page 637 for the Confidential Report on Adverse Drug Experience form

calcium lolinate

t 2.4 to 0.6 mg, for paradoxical

bradycardia (effect
CNS). lt usually disappears within 2 mins.
t*cnilor cardiac rate, rhythm and character. Watch

Alcohol may also increase the dizziness and drowsiness.

Advise patient not to take OTC products without
approval of physician

cr tachycardia, it may cause ventricular fibrillalL'r.

ulonitor ECG for ectopic ventricular beats, PVC,

arycardia in cardiac patients
lbnitor respiratory status: rate, rhythm, cyanosis,
rneezing, dyspnea, engorged neck veins
tlonitor allergic/hypersensitivity reaction: rash,

-rraria

- tbnitor input-output

ratio; check for urinary reten-

Ophthalmic route
Teach patient method of instillation: pressure on
lacrimal sac for 1 min; do not touch dropper to

.
.

using other drops and not to blink more than

:on and daily output in elderly or postoperative

=bents
tlonitor for bowel sounds; check for constipation;
odominal distention and constipation may occur

$cnitor for increased intraocular pressure: eye pain,

rausea, vomiting, blurred vision, increased tearing;
jscontinue use if pain occurs (optic)

thnsnc Dracnosrs

. lecreased cardiac output

. ]sturbed visual sensory perception
- lonstipation
. (rowledge-deficit on drug therapy

eye
lnstruct patient that blurred vision will decrease with
repeated use of drug and to omit next instillation if
side effects are present
Advise patient to wait 5 mins after atropine before

usual.
lnstruct patients not to do hazardous task until able
to see. Use sunglasses to protect eyes
Everuerroru

Positive therapeutic outcome

.
.
.
.
.

Decreased dysrhythmias
lncreased heart rate
Decreased secretions, Gl and GU spasms
Bronchodilatation

Decrease in inflammation (iritis) or cycloplegic

ref

raction (ophthal mic)

r-lttuNG
Y route

Give !V undiluted or diluted with 10 mL sterile Hr0:

give at a rate of 0.06 mg/min; give through Y-tube
or 3 way stopcock; do not add to lV solution; may
cause paradoxic bradycardia lasting 2 mins
n ge com pati b i I itie s: Be nzq u i nam de, b uto rp h a'c,1. chlorpromazine, droperidol, cimetidine, dimenhyrnate, diphenhydramine, fentanyl, glycopyrrolate,
'eoarin, hydromorphone, hydroxyzine, meperidine,
-etoclopramide, midazolam, milrinone, morphine, nal:uphine, pentazocine, perphenazine, propiomazine,
scopolamine, sutentanil, vit B with C
=nitidine,
Y-site compatibilities: Amrinone, etomidate, famo:dine, heparin, hydrocortisone, sodium succinate,
leropenem, nafcillin, potassium chloride, sufentanil,
,1 B with c

\ri

(kal'see-uhm fole'ih-nate)
See Antineoplastics Drugs Section

Additive compatibilities: dobutamine, furosemce, meropenem, netilmicin, sodium bicarbonate,

rerapamil
PO route
Oral administration 30 mins before meals
Give increased bulk, water in diet if constipation
occurs (anticholinergic effect)

.
.

lM route
Expect atropine flush 15-20 mins after inj; it may

occur in children and is not harmful

!upleuentATroN
P ati e ntlf a m i ly ed u cati on
Advise patient not to perform strenuous activity in
high temperatures due to danger of heat stroke
lnstruct patient to take as prescribed and not to skip
doses
lnstruct patient to report blurring of vision, loss of
sight; troubled breathing, sweating, flushing, chest
pain, allergic reactions, constipation and urinary
retention
Advice patient not to drive, operate machines, or
perform other hazardous activities, atropine may

.
.
.
.

cause dizziness, drowsiness, or blurred vision.

To check

(dees'fe r-ox-ah-mee n)

Philippine brandls.' Desfera!

Australia brandls: Desferal, DBL Desferrioxamine,
Hospi ra Desferrioxamine

UK brand/s: Desteral, Hospira Desterrioxamine

Action: A chelate which has high affinity to ferric

iron. Removes both free iron and bound iron from
hemosiderin and ferritin, but not from hemoglobin,
transferrin, or cytochromes.

Pharmacokinetics

Absorption Poorlyabsorbed(oral),
Distribution
Metabolism

Excretion

Half-life

rapidly absorbed (lM,lV)

10% bound to plasma protein
Unknown
Urine, bile
1-2.4 hrs,5.6-4.6 hrs (lM),
20 mins (lV)

Pharmacodynamics

Onset
Peak

!V
rapid
hr hr
hrs
hrs

Ora!

IM

rapid
rapid
t
t hr
30 mins-1
hrs
6
Duration 6
lndication: Monotherapy iron chelation treatment for
chronic overload (e.9. transfusional hemosiderosis,

as seen in thalassaemia major and other chronic

anemias; idiopathic hemochromatosis in patients in
whom concomitant disorders preclude phlebotomy;
porphyria cutanea tarda in patients unable to tolerate
phlebotomy). Acute iron poisoning. Chronic aluminum
overload in renal patients on maintenance dialysis

(e.9. with aluminum-related bone disease and/or

encephalopathy. Test for iron or aluminum overload.

for Cardiac Resuscitation Drugs...go to Appendix Vll on page 635

naloxone
Dosage: Should be determined individually, depending on the indication and severity of condition. Chronic
iron overload: 20-60 mg/kg body weight per day. Acute
iron poisoning: Up to 80 mg/kglday. Chronic aluminum

overload: 5 mg/kg body weight once weekly. Desferrioxamine test for iron overload: 500 mg. Desferrioxamine infusion test for aluminum overload: 5 mg/kg
body weight.
Contrai nd ication : Hypersensitivity.
Precaution: Pregnancy (Category C). Renal dysfunction. May exacerbate aluminum-related encephalopathy and precipitate seizures. An increased susceptibility to infection, particularly with Yersinia species, has
been reported in patients with iron overload treated
with desferrioxamine. Severe fungal infections have
also been reported, predominantly in patients undergoing dialysis. lf infection is suspected, treatment with
desferrioxamine should be stopped and appropriate
antimicrobial treatment given. Monitoring of urinary
excretion and periodic ophthalmological and audiological examinations are recommended for patients
on long-term therapy. lnappropriately high dosage
in children with low ferritin levels may retard growth,
therefore regular checks on height and weight are
recommended.
Adverse Reactions: Rapid intravenous injection may
cause flushing, urticaria, hypotension, and shock. Local pain may occurwith subcutaneous or intramuscular
injections and pruritus, erythema, and swelling have
occu rred after prolon ged subcutaneous ad m nistration.
Gastro-intestinal disorders, dysuria, fever, allergic skin
rashes, tachycardia, cardiac arrhythm ias, convu lsions,
and leg cramps have been reported. Visual disturbances, including retinal changes, and hearing loss
may occur and may be reversible if desferrioxamine is
withdrawn. Cataract formation has also been reported.
May retard groMh in very young children.
Drug lnteraction: Prochlorperazine, vitamin C, Gallium-67-imaging.
Treatment of Overdose: Acute overdosage of desferrioxamine may be remove by haemodialysis.
i

NURSING CONSIDERATIONS
Assessuerur
Obtain patient history and hypersensitivity to other
drugs

lM route
lM is preferred and should be used for all pai"-:
who are not in shock.
The reconstituted solution may be adminis::'=:

.
.

undiluted.

lV route

.
.

Given by lV infusion

lV infusion for patient with cardiovascular la -'-_..

or shock. The required amount of reconstr:--::

solution is added to 0.9% NaCl dextrose in na=

or Lactated Ringer's solution and administer?: .
the rate of 15 mg/kg/hr for the first 100 mg. s^,rr- l
not exceed 125 mg/hr.
SC route
For chronic iron overload, it may be adminis:==:

.
.

by slow subcutaneous infusion.

-i-'

The rate of infusion must be individualized.

effective dose range is 20-60 mg/kg given ove'
hrs or over 24 hrs in some patients.

:-

lnltpleuenrATroN
P atienUf am i ly

ed ucati on
lnform patient that pain and induration at the s:. injection may occur.
Discuss with patient that visual disturbances s- ras blurred vision, night blindness, impairment :,- ,:,..
of color vision may occur but it usually partia : =completely resolve following discontinuance :'
drug.
lnstruct patient to attend regular check up on . S*i'
auditory every 3 mos.
Warn patient to avoid ascorbic acid upc- Si:--':,
the therapy.
lnstruct patient to inform physician if preE-,=-:
suspected or if breastfeeding.
lnstruct patient not to drive or engage in a^.
ardous task that required mental, visual d-,r =- tr
alertness.
Warn patient to avoid prochlorperazine, as
rary loss of consciousness may occur.
Evauuanoru

.
.

--

.
.
.
.

'i

:?-

Positive therapeutic outcome

Treat toxicity

.
.
.
.
.

Monitor patient for ocular effects during the

therapy
Monitor if patient experience diarrhea and abdominal pain during therapy, appropriate stool samples,
blood testing and/or serologic testing is required.
Monitor for abrupt increase and decrease of blood
pressure of patient.
Monitor visual acuity test, funduscopic examina-

Philippine brand/s: Narcan

Australia brandls: DBL Naloxone HCl,

UK brands/s: Hospira Naloxone, lnter-:- :-

Naloxone

US brandls: Hospira Naloxone HCl,

Dracruoses

lnte-=':-

Action: May displace opioid analgesics f':,receptors (competitive antagonism) to re'.:=

effects.

Pharmacokinetics

Given by lM injection, by slow lV infusion

Powder should be stored at temperature less than

Absorption Well (SC, lM),

Distribution Rapid

25..C

Metabolism

Reconstituted solutions are stable for 1 wk at room

temperature.

Excretion

Half-life

complete (lV

Liver
Kidneys
60-90 mins. (adults)

6241

Medication Naloxone HCl, Suboxone, Wc,:, - . -'

Medication Naloxone HCI

lron toxicity
Aluminum toxicity

1.,

Naloxone, Narcan Neonatal, Hospira Naloxc,^*

Canada brand/s: Sandoz Naloxone

therapy.

PuaNnrnc

.
.

(nal-oks'one)

tion and audiometry periodically during chronic

Nunsnc

.
.

!:"irl:1:':i'^t:l::"::i.liy:a;lministratior'

naloxone
3 hrs (neonates)

lupleuexrATroN

Pharmacodynamics

PatienUlamily education

IV

1-2 mins
Jnset
reak
Unknown
Juration Varies

IM/SC
2-5 mins
Unknown
Varies

lndication: Narcotic overdose. Post-op narcotic

tepression

Dosage: Adult Narcotic overdose: lnitially 0.4-2 mg

V, may repeat al2-3 mins intervals. Post-op narcotic
-pression lnitial increments of 0.1-0.2 mg lV at 2-3
rins intervals. Pedia Narcotic overdose: Initially 0.01

Explain to patienUfamilythe reason forand expected

results of medication.
lnstruct patient to report adverse redction.

Eveluanon
Positive therapeutic outcome

.
.
.

Reversal of respiratory depression

Patient does not develop adverse drug reactions.

Patient and family state understanding of drug

therapy.
!
a
t

rdkg

BW lV. Post-op narcoticdepression: lnitial increrents of 0.005-0.01 mg !V in 2-3 mins intervals.

Contraindication: Respiratory depression due to
-on-opioid drugs.

Precaution: Pregnancy (Category C). Post-op

:atients especially w/ pre-existing CV disorders or
'eceiving potentially cardiotoxic drugs. Newborns
mothers known or suspected to be physically

ld

-pendent on opioids.
Adverse Reactions: Tachycardia, increase BP,
-rpotension tremulousness, seizures, cardiac arrest,
:ulmonary edema.
'i U RSING
AssessueNr

CONSIDERATIONS

. Assess patient's opioid use before starting therapy,

and reassess regularly to-monitor drug's effectiveness. Duration of opioid may exceed that of
naloxone, causing relapse of depression.
Assess for signs of opioid withdrawa! in drug-dependent individual that may occur up to 2 hrs after
administration: cramping, hypertension, anxiety,
vomiting
Assess cardiac status and monitor vital signs during
herapy: ECG abnormalities, tachycardia and hypertension. Monitor also patient's oxygen saturation.
Assess for pain: duration, intensity, location before
and afteradministration; may be used for respiratory
depression
Assess patient's respiration to identify depression:
character, rate and rhythm. Respiration <1O/min is
most probably due to opioid overdose.
Assess patient's and family's knowledge on drug
therapy.
tfunsrxc Dncxoses

.
.

.
.

lneffective breathing pattern related to opioid overdose.

. lneffective coping related to underlying condition

. Acute pain related to adverse drug reaction
. Knowledge-deficit related to drug therapy.
>-ANNING

V route

. Give undiluted
.

by direct lV, give 0.4 mg or less over

15 sec or titrate infusion to response
Give continuous lV infusion further diluted with DsW

J.9% NaCl
Give only with resuscitative equipment and oxygen

rearby

. Jse only solution prepared within 24 hrs

. Store at room temp in darkness
\ri n ge co m pati bi I ities: Benzq u nam ide, hepa ri n
i

'

site compatibilities:.

Propofo!

rilitive com patibi I ities: Ve rapam

Do you want to convert gallon or pint to fluidounce (fl.oz.)?

Co to Anncndiv Ylll'Tahle

of Fnttitralpntc nn nc.,a AiA

l,,u