Emergency Drugs

These are the drugs you usually see in an emergency cart. During an acute attack of a patient of whatever reasons, this is one of the equipment they pull with them together with resuscitation equipment. It contains drugs that are given to a patient during an attack. Before administration of the drug, the nurse must be aware of the mechanism of action, (MOA), indication (IN) and nursing consideration (NC) thus reducing the risk of mortality and untoward complications. The nurse should be alert in every crisis and should pay attention to what the physician orders when the going gets tough.

1. Adenosine : Antidysrhythmic MOA: Slows conduction through AV node, can interrupt reentry pathways through AV node and can restore normal sinus rhythm in patients with supraventricular tachycardia IN: SVT, as a diagnostic aid to assess myocardial perfusion defects in coronary artery disorders NC: I&O ratio, Electrolytes (K, Na, Cl), B/P, RR, PR, ECG intervals, check for transient dysrhythmias (PVCs, PACs, sinus tachycardia, AV Block)
   
2. Amidarone (Calcium Chloride) : Antidysrhythmic MOA: Increase cardiac contractile state IN: Acute hyperkalemia, Hypocalcemia, Calcium Channel Blocker adverse effects NC: ECG for decreased QT and T wave inversion, Calcium levels (Normal=8.5-11.5 g /dl), Cardiac status: PR, Rhythm, CVP (PWP, PAWP if being monitored)
3. Atropine : Antidysrhytmnic, Anticholinergic, Parasympatholytic, Antimuscarinic MOA: Blocks acetylcholine neuroeffector sites; increase cardiac output, heart rate by blocking vagal stimulation in heart; dries secretions by blocking vagus IN: Bradycardia, bradydysrhythmia, reversal of anticholinesterase agents, insecticide poisoning, blocking cardiac vagal reflexes, decreasing secretions before surgery, antispasmodic with gastric ulcer, biliary surgery, bronchodilator NC: I&O, check for urinary retention, daily output, ECG, bowel sounds, respiratory status, increased ocular pressure, cardiac rate
   
4. Epinephrine : Bronchodilator, Non-selective adrenergic agonist vasopressor MOA: Beta 1 and Beta 2 agonist causing increased levels of cyclic adenosine monophosphate producing bronchodilation, cardiac, and CNS stimulation; large doses cause vasoconstriction via alpha-receptors; small doses can cause vasodilation via beta 2 vascular receptors IN: Acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis, allergic reactions, cardiac arrest, adjunct in anesthesia, shock NC: ECG during administration continuously; if B/P increases, drug is decreased; B/P and PR checked every 5 mins. after parental route; if possible CVP, ISVR, PCWP during infusion, inadvertent high arterial B/P can result to angina, aortic rupture, cerebral hemorrhage, injection site should be checked for tissue sloughing (give phentolamine with NS)
5. Lasix : Loop diuretic MOA: Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the Loop of Henle IN: Pulmonary edema, edema in CHF, hepatic disease, nephrotic syndrome, ascites, hypertension NC: Signs of metablic alkalosis: drowsiness, restlessness Signs of hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness I&O to determine fluid loss, B/P lying and standing, skin integrity, turgor, edema, check mucous membranes of mouth and nose, allergies to drug
6. Lidocaine : Antidysrhythmic MOA: Increases electrical stimulation threshold of ventricle, His-Purkinje system which stabilizes cardiac membrane, decreases automaticity IN: Ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, myocardial infarction, digitalis toxicity, cardiac catheterization NC: ECG and determine increased PR or QRS segments, B/P, infusion pump must run at less than 4 mg/min., therapeutic level (normal=1.5-5 mcg/mL), I&O, respiratory status must be checked, check for malignant hyperthermia and CNS effects.
7. Magnesium Sulfate : Electrolyte, anticonvulsant, saline laxative, antacid MOA: Increases osmotic pressure, draws fluid into colon, neutralizes HCl IN: Constipation, bowel preparation before surgery or exam, anticonvulsant in preeclampsia, eclampsia, electrolyte imbalance NC: I&O Magnessium toxicity: thirst, confusion, decrease in reflexes
8. Morphine : Opioid analgesic MOA: Decreases pain impulse transmission at the spinal cord level by interacting with opioid receptors IN: Severe pain NC: Pain level and location, bowel status, I&O, cardiopulmonary status, CNS changes: dizziness, drowsiness, hallucination, euphria, level of consciousness, pupil reaction, allergies to drug
9. Naloxone : Opioid antagonist, antidote MOA: Competes with opioids at opiate receptor sites IN: Respiratory depression induced by opioids, pentazocine, propoxyphene, refractory circulatory shock, asphyxia neonatorum NC: Withdrawal symptms: cramping, hypertension, anxiety, vomiting V/S every 3-5 mins. ABGs, cardiopulmonary status, pain level
10. Nitroglycerine : Coronary vasodilator, antianginal MOA: Decreases preload, afterload, which is responsible for decreasing left ventricular end-diastolic pressure, systemic vascular resistance; dilates coronary arteries, improves blood flow through coronary vasculature, dilates arterial, venous beds systemically IN: Chronic stable angina pectoris, prophylaxis of angina pain, CHF associated with acute MI, controlled hypotension in surgical procedures NC: Orthostatic B/P, PR, pain: duration, level, time started, activity performed, character, headache, light-headedness, decreased B/P may indicate a need to decrease dosage
11. Vasopressin : Pituitary hormone MOA: Promotes reabsorption of water by action on renal tubular epithelium; causes vasoconstriction IN: Diabetes insipidus (nonephrogenic/nonpsychogenic) abdominal distention postoperatively, bleeding esophageal varices NC: PR, B/P when given IV r IM for irritation, I&O, daily weights, check for edema, water intoxication: lethargy, behavioral changes, disorientation, neuromascular excitability