Drug Name Epinephrine (Adrenalin, Sus-Phrine)

Class/Action Alpha and Beta Adrenergic Agonist (sympathomimetic)

Dosage 5-10 IV mcg/kg/min upto 20-50, pt response

Onset/ Duration

Side Effects Arrhythmias, hypertension, palpitations, angina, dyspnea, nausea, vomiting, constipation Arrhythmias, hypertension, palpitations, angina, dyspnea, nausea, vomiting, constipation Fear, anxiety, restlessness, pallor headache, nausea, urine formation Restlessness, apprehension, anxiety, pulmonary edema, cardiac arrhythmias, fear tachycarida, nausea Dizziness, vertigo, fatigue, gastric pain, flatulence, impotence, dyspnea bronchospasm, Acute and prolonged hypotensive episodes, nausea, myocardial infarctiontachycardia , arrhythmias Headache, fatigue, dizziness, postural dizziness, vertigo, tachycardia, edema, nausea, dyspepsia, diarrhea

Indications Treatment of shock Prolong effect regional anesthetic Bronchospasm

Nursing Considerations HR, B/P, ECG, RR, I/O, hepatic & liver function, serum electrolyte; baseline tachyarrhythmias or ventricular fibrillation HR, B/P, ECG, RR, I/O, hepatic & liver function, serum electrolyte; tachyarrhythmias or ventricular fibrillation Establish baseline, BP, HR, ECG, orientation, reflexes, vision, nausea, liver &kidney function Baseline, CV - HR, BP pulmonary hypertension Respiratory, blood sugar, I/O, hx of stroke, diabetes, thyroid, renal impairment, degenerative heart disease, ECG, eclampsia Bradycardia or heart blocks, baseline, HR, BP, CO, ECG, liver function, lung function, RR, GI activity, electrolytes CV diseases, baseline, orientation, affect, reflexes, HR, BP, CO, I/O, peripheral perfusion,

Dopamine (Intropin)

Alpha and Beta Adrenergic Agonist (sympathomimetic) Release norepinephrine, stimulate SNS Alpha-Specific Adrenergic Agonist Vasoconstriction, raising S&D B/P Beta-Specific Adrenergic Agonist Increased HR, conductivity, contractility, bronchodilation, increased blood flow skeletal muscles Nonselective Adrenergic Blocking Agent Block norepinephrine in SNS

0.5-1.0 mg IV acute, 0.3-0.5 SQ or IM resp distress; nebulizer or topical nasal drops

1-2 min / Length of infusion

Treatment of shock

Phenylephrine (Neo-Synephrine)

1-10mg PO SQ IV 0.1-0.5 1-2 gtt in eye 0.02-0.06mg (5mcg/min) 0.2 mg SQ, IM

Isoproterenol (Isuprel)

10-15min 30-120min / Immediate 15-20 min Immediate 1-2 min

Vascular failure in shock, drug induced hypotension, spinal anesthesia prolong Shock, MI, ventricular arrythmia, anesthesia -bronchospasm

Labetalol (Normodyne, Trandate)

Phentolamine (Regitine)

Nonselective AlphaAdrenergic Blocking Agents Vasodilation, blocks Alpha 1 and 2 receptors

100 mg PO b.i.d. initial 200-400 mg PO b.i.d. maintenance 20 mg IV, slowly, 10 min intervals, max. 300 mg 5 mg IV or IM 1-2 h before surgery; 5-10 mg in 10 mL of saline injected extravasation (12 h)

Varies, 1-2 hr, 8-12 h Immediate, 5 min, 5.5 h

Hypertension Off label: control BP pheochromocytoma,cl oidine-withdrawl hypertension Hypertensive RT pheochromocytoma test for, dermal necrosis RT IV extravasation

Doxazosin (Cardura)

Alpha 1-selective Adrenergic Blocking Agent/Reduce peripheral resistance, increases HDL, lower total cholesterol

1 mg/d PO upto 16 mg/d PO hypertension, 1-8 mg/d PO for BPH

IM rapid, 20 min, 30-45 min IV Immediate, 2 min, 15-30 min Varies, 2-3 h, not known

Hypertension, benign prostatic hypertrophy

Hepatic & renal function, baseline, orientation, affect, reflexes, HR, BP, CO, ECG, peripheral perfusion

Propranolol (Inderal)

Nonselective BetaAndrenergic Blocking Agent Competitively blocks in juxtaglomerular apparatus and in heart Beta 1-Selective Adrenergic Blocking Agent Decrease excitability heart, CO, O2 consumption, decrease renin release, lower BP Direct-Acting Cholinergic Agonist Mimic effect of Ach, increase tone of detrusor muscle (bladder) Indirect-Acting Cholinergic Agonsist Increases level of Ach at neuromuscular junction

Dose varies widely based on indication

Oral 20-30 min, 60-90 min, 6-12 h IV immediate, 1 min, 4-6 h Oral Varies, 2-4 h, 24h IV Immediate, 5 min, 24 h

Atenolol (Tenormin)

Initially 50 mg/d, upto 1200 mg/d Decreased dose for elderly, renal or hepatic impairment

Allergic rx, bradycardia, heart failure, cardia arrhythmias, cerebrovascular accident, pulmonary edema Allergic rx, dizziness, bradycardia, HF, arrhythmias, gastic pain, flatulence, impotence, bronchospasm Abdominal discomfort, salivation, nausea, vomiting, sweating, flushing Bradycardia, cardiac arrest, tearing, miosis, salivation, dysphagia, nausea, vomiting, incontinence, increased bronchial secetrions Insomnia, fatigue, rash, nausea, vomiting, diarrhea, dyspepsia, abdominal pain, muscle cramps

Hypertension, angina pectoris, idiopathic hypertension subaortic stenosis, superventricular tachycardia Angina pectoris, hypertension, MI Off Label-migraine, alcohol withdrawl syndrome, superventricular tachycarida Acute postoperative or postpartum nonobstructive urinary retention, neurogenic atony of bladder with retention Myasthenia gravis, antidote for nondepolarizing neuromuscular junction blockers, increased survival after exposure to nerve gas Mild to moderate Alzheimers disease

Bradycardia, heart blocks, shock, HF, baseline, HR, BP, lungs, ECG, GI, electrolytes, adrenal & hepatic function, CO, perfusion Bradycardia, heart blocks, shock, HF, baseline, orientation, , sensation, HR, BP, ECG, RR, GI & lung auscultate

Bethanechol (Duvoid, Urecholine)

10-50 mg PO b.i.d. to q.i.d.

Oral 30-90 min, 60-90 min, 1-6 h

Acute pain GI, CO, impaired urinary elimination, blurred vision, diarrhea, lung baseline, I/O, HR, BP Arrhythmias, CAD, hypotension, urogenital or GI obstruction, peptic ulcer, baseline, orientation, affect, reflex, vision, BP, HR, ECG, perfusion, CO, hepatic and renal function Arrhythmias, CAD, hypotension, urogenital or GI obstruction, peptic ulcer, baseline, orientation, affect, reflex, vision, BP, HR, ECG, perfusion, CO, hepatic and renal function Glaucoma, stenosing peptic ulcer, intestinal atony, paralytic ileus, GI obstruction, baseline, orientation, papillary response, HR, BP, ECG, auscultate heart, bowel & lung, renal function, GU adverse effects

Pyridostigmine (Mestinon)

180-540 mg PO myasthenia 0.1-0.25 mg/kg IV antidote 30 mg q8h several hs before exposure 5-10 mg PO at bedtime

Oral 35-45 min, 3-6 h IM 15 min, 36 h, IV 5 min, 3-6 h

Donepezil (Aricept)

Indirect-Acting Cholinergic Agonist

Oral, varies, 2-4 h

Atropine (generic)

Anticholinergic Agents/ Parasympatholytic Competitively blocks acetylcholine muscarinic receptor block PNS response

0/4-0.6 mg IM SQ or IV Caution with elderly

IM 10-15 min, 30 min, 4h IV imm, 24 min, 4h, SQ varies, 1-2 h, 4h topical 510 min, 3-40 min, 7-14 d

Blurred vision, mydriasis, cycloplegia, photphobia, palpitation, bradycardia, dry mouth, altered taste,

Decrease secretion before surgery, parkinsonism, cardiac rate after vagal stimulation, antidote for cholinergic overdose