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Generic name: isosorbide dinitrate Brand name: Coronex, IsoBid Classification: cardiovascula r agent; nitrate vasodilator Route:
IV

Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumptio n.

Dinitrate: Treatm ent and prevention of angina pectoris

Contraindicated with allergy to nitrates, severe anemia, head trauma, cerebralhemorrhage,hypertrophiccardi omyopathy,narrowangleglaucoma,postduralhypotension

>CNS: Headache, apprehension, restlessness, weakness, vertigo, dizziness, faintness >CV: Tachycardia, retrosternald is comfort, palpitations, hypotension, syncope, collapse, orthostatic hypotension, angina, rebound hypertension, atrial fibrillation, postdural hypertension >Dermatologic: Rash, exfoliative dermatitis ,cutaneous vasodilation with flushing >GI: Nausea, vomiting, incontinence of urine and feces, abdominal pain, diarrhea

>Assess for pain:duration, timestarted, activitybeing performed,character,intensity >Assessorthostatichypotension, blood pressureat baseline andduring treatment

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Generic name: dopamine hydrochloride Brand name: Dopastat, Intropin, Revimine Classification: Autonomic nervous system agent; alpha and beta adrenergic agonist sympathomimitic Route: IV

Naturally occurring neurotransmitter and immediate precursor of norepinephrine. Major cardiovascular effects produced by direct action on alpha- and beta-adrenergic receptors and on specific dopaminergic receptors in mesenteric and renal vascular beds.

To correct hemodynamic imbalance in shock syndrome due to MI (cardiogenic shock), trauma, endotoxic septicemia (septic shock), open heart surgery, and CHF.

Pheochromocytoma; tachyarrhythmias or ventricular fibrillation. Safe use during pregnancy (category C), lactation, or children is not established.

CV: Hypotension, ectopic beats, tachycardia, anginal pain, palpitation, vasoconstriction, cold extremities; less frequent: bradycardia, widening of QRS complex, elevated blood pressure. GI: Nausea, vomiting. CNS: Headache. Skin: Necrosis, tissue sloughing with extravasation, gangrene, piloerection. Other: Azotemia, dyspnea, dilated pupils (high doses).

>Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed by physician. Precise measurements are essential for accurate titration of dosage. > Monitor therapeutic effectiveness

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Generic name: Mannitol Brand name: Osmitrol Drug Classification: Osmotic Diuretic Route: I.V. infusion Dosage: :0.5 to 2 g/kg I.V. infusion as 15% to 25% solution given over 30 or 60 minutes

Increases osmotic pressure of plasma in glomerular filtrate, inhibiting tubular reabsorption of water andelectrolytes (including sodium and potassium). These actions enhance water flow from various tissuesand ultimately decrease intracranial and intraocular pressures.

Test dose for marked oliguria or suspected inadequate renal function, prevent acute renal failure duringcardiovascular and other surgeries, acute renal failure, to reduce intracranial pressure and brain mass,reduce intraocular pressure, to promote dieresis in drug toxicity, irrigation during transurethralresection of prostate.

Active intracranial bleeding (except during craniotomy), anuria secondary to severe renal disease,progressive heart failure, pulmonary congestion, renal damage, or renal dysfunction after mannitoltherapy begins, severe pulmonary congestion or pulmonary edema, and severe dehydration.

CNS: dizziness, headache, seizures CV: chest pain, hypotension, hypertension, tachycardia, thrombophlebitis, heart failure, vascularoverload EENT: blurred vision, rhinitis GI: nausea, vomiting, diarrhea, dry mouth GU: polyuria, urinary retention, osmotic nephrosis Metabolic: dehydration, water intoxication, hypernatremia, hyponatremia, hypovolemia, hypokalemia, hyperkalemia, metabolic acidosis Respiratory: pulmonary congestionSkin: rash, urticariaOther: chills, fever, thirst, edema, extravasation with edema and tissue necrosi

>Assesss skin turgor, mucous membranes and mental status before administration of drug. >Assess signs for electrolyte imbalance.3. >Monitor Vital signs including central venous pressure and output. >Store at room temperature. Use a filter with concentrated mannitol (15%, 20% and 25%). >Be alert for adverse reactions and drug interactions. >Monitor hepatic and renal function during therapy. >Monitor IV site carefully to avoid extravasations and tissue necrosis9.

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Generic name: atropine sulfate Brand name: AtroPen, Minims (CAN), SalTropine Classification: Anticholinergic, Antimuscarinic Parasympatholytic Antiparkinsonian Antidote Route: Oral. IV Dosage: Tablets0.4 mg; injection0.05, 0.1, 0.3, 0.4, 0.5, 0.8, 1 mg/mL

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), relaxing the pupil of the eye (mydriatic effect),

Antisialagogue for preanesthetic medication to prevent or reduce respiratory tract secretions Treatment of parkinsonism; relieves tremor and rigidity Restoration of cardiac rate and arterial pressure during anesthesia when vagal stimulation produced by intra-abdominal traction causes a decrease in pulse rate, lessening the degree of AV block when increased vagal tone is a factor (eg, some cases due to digitalis) Relief of bradycardia and syncope due to hyperactive carotid sinus reflex

Contraindicated with hypersensitivity to anticholinergic drugs Contraindicated with glaucoma; adhesions between iris and lens; stenosing peptic ulcer; pyloroduodenal obstruction; paralytic ileus; intestinal atony; severe ulcerative colitis; toxic megacolon; symptomatic prostatic hypertrophy; bladder neck obstruction; bronchial asthma; COPD; cardiac arrhythmias; tachycardia; myocardial ischemia; impaired metabolic, liver, or kidney function; myasthenia gravis. Use cautiously with Down syndrome, brain damage, spasticity, hypertension, hyperthyroidism, lactation.

CNS: Blurred vision, mydriasis, cycloplegia, photophobia, increased IOP, headache, flushing, nervousness, weakness, dizziness, insomnia, mental confusion or excitement (after even small doses in the elderly), nasal congestion C V:Palpitations, bradycardia (low doses), tachycardia (higher doses) GI: Dry mouth, altered taste perception, nausea, vomiting, dysphagia, heartburn, constipation, bloated feeling, paralytic ileus, gastroesophageal reflux

>Ensure adequate hydration; provide environmental control (temperature) to prevent hyperpyrexia. >Have patient void before taking medication if urinary retention is a problem

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Generic name: nicardipinehydrochloride Brand name: cardene Classification: Calcium channel blocker (dihydropyridine) Route: Dosage: 20mg, 30mg; caps

Nicardipine inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle without changing serum calcium concentrations. The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. The effects of nicardipine are more selective to vascular smooth muscle than cardiac muscle. In animal models, nicardipine produced relaxation of coronary vascular smooth muscle at drug levels which cause little or no negative inotropic effect.

Chronic Advanced aortic stable angina stenosis Cardiac failure. Acute cerebral infarction or hemorrhage. Hepatic or renal impairment. Measure blood pressure 12 hrs and 8 hrs after dosing. Pregnancy (Cat.C). Nursing mothers: not recommended.

Increased angina, hypotension, flushing, headache, pedal edema, asthenia, dizziness, tachycardia, somnolence, GI upset, and insomnia.

>Monitor BP carefully >Monitor cardiac rhythm regularly >Advise patient to have a frequent meal if GI upset occurs

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Generic name: Dobutamine hydrochloride Brand name: Dobutrex Classification: autonomic nervous system agent; betaadrenergic agonist; catecholamine Route: IV Dosage: ampule

Stimulates heats beta1receptors to increase myocardial contractility and stroke volume. At therapeutic dosages, drug increases cardiac output by decreasing peripheral vascular resistance, reducing ventricular filling pressure, and facilitating AV node conduction

Increase cardiac output in shortterm treatment of cardiac decompensation cause by depressed contractility, such as during refractory heart failure; adjunctive therapy in cardiac surgery

Contraindicated n patients hypersensitive to drug or its components and in those w/idiopathic hypertrophic subaortic stenosis

CNS: headache CV: hypertension, increased heart rate

>Before starting therapy, give a plasma volume to correct hypovolemia an a cardiac glycoside >Continuously monitor ECG, blood pressure, pulmonary artery wedge pressure, cardiac output and urine output

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Generic name: amiodarone Brand name: Cordarone Classification: Antiarrhythmic Route: IV, Oral Dosage: Ventricular arrhythmias { adults} loading dose 300mg IVP,

Slows sinus rate, increases PR and QT intervals, decreases peripheral vascular resistance, increases refractory period of the AV node

Prophylaxis of frequently recurring VF and hemodynamically unstable VT in patients refractory to other therapy, indicated for patients who have been prescribed oral cordarone, but are unable to take oral medications.

Hypersensitivity to the Hypotension, tremors, drug, cardiogenic shock, fatigue, N/V, dyspnea marked sinus bradycardia, 2nd or 3rd degree AV block { unless a functioning pacemaker is available}

>Monitor BP carefully during infusion and slow the infusion if significant hypotension occurs >Monitor for elevations of AST and ALT. If elevations persist or if they are 23 times above normal baseline readings, reduce dosage or withdraw drug promptly to prevent hepatotoxicity and liver damage. > Auscultate chest periodically for respiratory symptoms.

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Generic name: potassium chloride Brand name: Kaylixir, Kay Ciel, Klorvess, Klotrix Classification: Electrolyte Route: IV, Oral

Principal intracellular cation of most body tissues, participates in a number of physiologic processes maintaining intracellular tonicity; transmission of nerveimpulses; contraction of cardiac, skeletal, and smooth muscle; maintenance of normal renal function; also plays a role in carbohydrate metabolism

Prevention and correction of potassium deficiency, when associated withalkalosis, use potassium chloride; when associated with acidosis, usepotassium acetate, bicarbonate, citrate, or gluconate.

Hyperchloraemia, severe renal or adrenal insufficiency.

Dermatologic: Rash GI: Nausea, vomiting, diarrhea, abdominal discomfort, GI obstruction, GIbleeding, GI ulceration or perforation Hematologic: Hyperkalemia increased serum potassium, ECG changes(peaking of T waves, loss of P waves, depression of ST segment, prolongation of QTc interval) Local: Tissue sloughing, local necrosis, local phlebitis, and venospasm withinjection

Warning: Do not administer undiluted. Dilute in dextrose solution to 4080mEq/L Arrange for serial serum potassium levels before and during therapy. Administer liquid form to any patient with delayed GI emptying. Administer oral drug after meals or with food and a full glass of water to decreaseGI upset. Caution patient not to chew or crush tablets; have patient swallow tablet whole.

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Generic name: nitroglycerin Brand name: Sublingual NitroQuick, Nitrostat Transdermal: Deponit, Minitran, Nitrek, Nitro-Dur, Nitrodisc, Transderm-Nitro Translingual: Nitrolingual Classification: Antianginal Nitrate

Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

Sublingual, translingual preparations: Acute angina, Oral SR, sublingual, topical, transdermal, translingual, transmucosal preparations: Prophylaxis of angina, IV: Angina unresponsive to recommended doses of organic nitrates or betablockers, IV: Perioperative hypertension

Contraindicated with allergy to nitrates, severe anemia, early MI, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, pregnancy, lactation.

CNS: Headache, apprehension, restlessness, weakness, vertigo, dizziness, faintness C V: Tachycardia, retrosternal discomfort, palpitations, hypotension, syncope, collapse, orthostatic hypotension, angina Dermatologic: Rash, exfoliative dermatitis, cutaneous vasodilation with flushing, pallor, perspiration, cold sweat, contact dermatitistransdermal preparations, topical allergic reactionstopical nitroglycerin ointment GU: incontinence of urine and feces, abdominal pain

>Give sublingual preparations under the tongue or in the buccal pouch. Encourage patient not to swallow. Ask patient if the tablet "fizzles" or burns. Always check the expiration date on the bottle; store at room temperature, protected from light. >Administer transdermal systems to skin site free of hair and not subject to much movement.

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Generic name: epinephrine Brand name: epinephrine bitartrate Classification: Sympathomimetic drug Alpha-adrenergic agonist Beta1- and beta2adrenergic agonist Cardiac stimulant Vasopressor Bronchodilator Antasthmatic Nasal decongestant Mydriatic Antiglaucoma drug Route: Inhalation, injection, ophthalmic

Naturally occurring neurotransmitter, the effects of which are mediated by alpha or beta receptors in target organs. Effects on alpha receptors include vasoconstriction, contraction of dilator muscles of iris. Effects on beta receptors include positive chronotropic and inotropic effects on the heart (beta1 receptors); bronchodilation, vasodilation, and uterine relaxation (beta2 receptors); decreased production of aqueous humo

Relief from respiratory distress of bronchial asthma, chronic bronchitis, emphysema, other COPDs

Contraindicated with allergy or hypersensitivity to epinephrine or components of preparation, narrow-angle glaucoma; shock other than anaphylactic shock; hypovolemia; general anesthesia with halogenated hydrocarbons or cyclopropane; organic brain damage, cerebral arteriosclerosis; cardiac dilation and coronary insufficiency; tachyarrhythmias; ischemic heart disease; hypertension; renal dysfunction (drug may initially decrease renal blood flow); COPD patients who have developed degenerative heart disease; diabetes mellitus; hyperthyroidism; lactation. Opthalmic preparations are contraindicated for those wearing contact lenses (drug may discolor the contact lens), aphakic patients (maculopathy with decreased visual acuity may occur).

CNS: Fear, anxiety, tenseness, restlessness, headache, lightheadedness, dizziness CV: Arrhythmias, hypertension resulting in intracranial hemorrhage GI: Nausea, vomiting, anorexia GU: Constriction of renal blood vessels and decreased urine Other: Pallor, respiratory difficulty, orofacial dystonia, sweating

>WARNING: Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug; small errors in dosage can cause serious adverse effects. Double-check pediatric dosage.

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Generic name: norepinephrine Brand name: Levophed

Norepinephrine stimulates alpha and beta-1 adrenergic receptors in a doserelated fashion. At lower doses (less than 2 mcg Classification: per minute), stimulation autonomic of beta-1 receptors nervous system agent; alpha- and results in a positive inotropic and beta-adrenergic chronotropic effect. At agonist (sympathomimetic higher doses (greater than 4 mcg per minute), ) the alpha adrenergic Route: effect predominates, IV drip only resulting in elevated total peripheral resistance. Chronotropy diminishes as a result of baroreceptor-mediated vagal stimulation.

B/P less than 70mm Hg after other vasopressors have been unsuccessful, septic, and neurogenic shock.

Patients with heart disease or with hypovolemia.

Nausea and vomiting, headache, decreases in urinary output, hypertension, and anxiety.

> Monitor constantly while patient is receiving norepinephrine. > Adjust flow rate to maintain BP at low normal (usually 80100 mm Hg systolic) in normotensive patients. > Monitor I&O. Urinary retention and kidney shutdown are possibilities, especially in hypovolemic patients.

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Generic name: furosemide Brand name: Fumide , Furomid, Lasix, Luramide Classification: Loop diuretic Route:

Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow

Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis

History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation.

CV: Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes. Metabolic: Hypovolemia, dehydration, hyponatremia hypokalemia, hypochloremia metabolic alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN, hyperuricemia. GI: Nausea, vomiting, oral and gastric burning, Hematologic: Anemia, leukopenia, thrombocytopenic purpura Skin: Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarde, necrotizing angiitis (vasculitis). Body as a Whole: Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness; thrombophlebitis, pain at IM injection site.

>Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. >Monitor BP during periods of diuresis and through period of dosage adjustment.

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Generic name: Sodium bicarbonate Brand name: Bakin Soda, Bell-Ans, Citrocarbonat e, Neut, Soda Mint Classification: antiulcer agents, alkalinizing agent Route:

Sodium Bicarbonate acts as an alkalinizing agent by releasing bicarbonate ions. Following oral administration of this medication, it releases bicarbonate which is capable of neutralizing gastric acid.

Management of metabolic acidosis Used to alkalinize urine and promote excretion of certain drugs in over dosage situations Used as an antacid

Metabolic or respiratory alkalosis, Hypocalcemia, Excessive chloride loss, It is not recommended as an antidote following ingestion of strong mineral acids, Patients on sodium restricted diet, Renal failure, Severe abdominal pain of unknown cause especially if associated with fever

Edema, Flatulence, Gastric distention, Metabolic alkalosis, Hypernatremia, Hypocalcemia, Hypokalemia, Sodium and water retention, Irritation at IV site, Tetany

>Symptoms of fluid overload should be reported such as hypertension, edema, difficulty breathing or dyspnea, rales or crackles and frothy sputum. Sigs of acidosis should be assessed such as disorientation, headache, weakness, dyspnea and hyperventilation. Hypernatremia >clinical manifestations should be Hypokalemia should also be assessed by monitoring signs and symptoms IV sites should be observed closely. >Extravasation should be avoided as tissue irritation or cellulitis may occur when taking sodium bicarbonate. >Tablets must be taken with a full glass of water. For clients taking the medication as a treatment for peptic ulcers it may be administered 1 and 3 hours after meals and at bedtime.

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Generic name: norepinephrine Brand name: Levophed

Norepinephrine stimulates alpha and beta-1 adrenergic receptors in a doserelated fashion. At lower doses (less than 2 mcg Classification: per minute), stimulation autonomic of beta-1 receptors nervous system agent; alpha- and results in a positive inotropic and beta-adrenergic chronotropic effect. At agonist (sympathomimetic higher doses (greater than 4 mcg per minute), ) the alpha adrenergic Route: effect predominates, IV drip only resulting in elevated total peripheral resistance. Chronotropy diminishes as a result of baroreceptor-mediated vagal stimulation.

B/P less than 70mm Hg after other vasopressors have been unsuccessful, septic, and neurogenic shock.

Patients with heart disease or with hypovolemia.

Nausea and vomiting, headache, decreases in urinary output, hypertension, and anxiety.

> Monitor constantly while patient is receiving norepinephrine. > Adjust flow rate to maintain BP at low normal (usually 80100 mm Hg systolic) in normotensive patients. > Monitor I&O. Urinary retention and kidney shutdown are possibilities, especially in hypovolemic patients.