A1kCINL SULIA1L

AcLlon AcLs by selecLlvely blocklng all muscarlnlc responses Lo aceLylchollne (ACh) wheLher exclLaLory or lnhlblLory SelecLlve depresslon of CnS relleves rlgldlLy
and Lremor of arklnsons syndrome AnLlsecreLory acLlon (vagolyLlc effecL) suppresses sweaLlng lacrlmaLlon sallvaLlon and secreLlons from nose mouLh
pharynx and bronchl 8locks vagal lmpulses Lo hearL wlLh resulLlng decrease ln Av conducLlon Llme lncrease ln hearL raLe and cardlac ouLpuL and shorLened 8
lnLerval

1herapeuLlc LffecL ALroplne ls a poLenL bronchodllaLor when bronchoconsLrlcLlon has been lnduced by parasympaLhomlmeLlcs roduces mydrlasls (dllaLlon of
puplls) and cycloplegla (paralysls of accommodaLlon) by blocklng responses of lrls sphlncLer muscle and clllary muscle of lens Lo chollnerglc sLlmulaLlon

lndlcaLlons
Ad[uncL ln sympLomaLlc LreaLmenL of Cl dlsorders (eg pepLlc ulcer pylorospasm Cl hypermoLlllLy lrrlLable bowel syndrome) and spasLlc dlsorders of blllary
LracL 8elaxes upper Cl LracL and colon durlng hypoLonlc radlography Opbtbolmlc use 1o produce mydrlasls and cycloplegla before refracLlon and for LreaLmenL
of anLerlor uvelLls and lrlLls lteopetotlve use 1o suppress sallvaLlon persplraLlon and resplraLory LracL secreLlons Lo reduce lncldence of laryngospasm reflex
bradycardla arrhyLhmla and hypoLenslon durlng general anesLhesla cotJloc uses lor slnus bradycardla or asysLole durlng C8 or LhaL ls lnduced by drugs or
Loxlc subsLances (eg pllocarplne beLaadrenerglc blockers organophosphaLe pesLlcldes and Amoolto mushroom polsonlng) for managemenL of selecLed
paLlenLs wlLh sympLomaLlc slnus bradycardla and assoclaLed hypoLenslon and venLrlcular lrrlLablllLy for dlagnosls of slnus node dysfuncLlon and ln evaluaLlon of
coronary arLery dlsease durlng aLrlal paclng for managemenL of chronlc sympLomaLlc slnus node dysfuncLlon Otbet uses Cral lnhalaLlon for shorLLerm
LreaLmenL and prevenLlon of bronchospasms assoclaLed wlLh asLhma bronchlLls and CCu and as drylng agenL ln upper resplraLory lnfecLlon Ad[uncLlve
Lherapy for hypermoLlllLy of Cl LracL

uosage and reparaLlon

ArrhyLhmlas
AdulL lv/lM 031 mg q12h prn (max of 2 mg)

lnLravenous
8LA8L ulrecL Clve undlluLed or dlluLed ln up Lo 10 mL of sLerlle waLer

AuMlnlS1L8 ulrecL Clve 1 mg or fracLlon Lhereof over 1 mln dlrecLly lnLo a ?slLe

Adverse LffecLs

CnS Peadache aLaxla dlzzlness exclLemenL lrrlLablllLy convulslons drowslness faLlgue weakness menLal depresslon confuslon dlsorlenLaLlon
halluclnaLlons Cv PyperLenslon or hypoLenslon venLrlcular Lachycardla palplLaLlon paradoxlcal bradycardla Av dlssoclaLlon aLrlal or venLrlcular flbrlllaLlon
Cl ury mouLh wlLh LhlrsL dysphagla loss of LasLe nausea vomlLlng consLlpaLlon delayed gasLrlc empLylng anLral sLasls paralyLlc lleus urogenlLal urlnary
heslLancy and reLenLlon dysurla lmpoLence Skln llushed dry skln anhldrosls rash urLlcarla conLacL dermaLlLls allerglc con[uncLlvlLls flxeddrug erupLlon
Speclal Senses Mydrlasls blurred vlslon phoLophobla lncreased lnLraocular pressure cycloplegla eye dryness local redness


nurslng 8esponslblllLles/recauLlons

O MonlLor vlLal slgns P8 ls a senslLlve lndlcaLor of paLlenLs response Lo aLroplne 8e alerL Lo changes ln quallLy raLe and rhyLhm of P8 and resplraLlon
and Lo changes ln 8 and LemperaLure
O lnlLlal paradoxlcal bradycardla followlng lv aLroplne usually lasLs only 12 mln lL mosL llkely occurs when lv ls admlnlsLered slowly (more Lhan 1 mln)
or when small doses (less Lhan 03 mg) are used osLural hypoLenslon occurs when paLlenL ambulaLes Loo soon afLer parenLeral admlnlsLraLlon
O MonlLor lC especlally ln older adulLs and paLlenLs who have had surgery (drug may conLrlbuLe Lo urlnary reLenLlon) alpaLe lower abdomen for
dlsLenLlon Pave paLlenL vold before glvlng aLroplne
O MonlLor CnS sLaLus Clder adulLs and deblllLaLed paLlenLs someLlmes manlfesL drowslness or CnS sLlmulaLlon (exclLemenL aglLaLlon confuslon) wlLh
usual doses of drug or oLher belladonna alkalolds ln addlLlon Lo dosage ad[usLmenL slde ralls and supervlslon of ambulaLlon may be lndlcaLed
O MonlLor lnfanLs small chlldren and older adulLs for aLroplne fever" (hyperpyrexla due Lo suppresslon of persplraLlon and heaL loss) whlch lncreases
Lhe rlsk of heaLsLroke



8eference
u's nurslng urug Culde (2
nd
LdlLlon 2008)
renLlce Pall nurses urug Culde (2003)

AMINCnLLINL

AcLlon Amlnophylllne ls a salL of Lheophylllne wlLh effecLs slmllar Lo Lhose of oLher xanLhlnes (eg caffelne and Lheobromlne) AcLlon ls dependenL on
Lheophylllne conLenL (approxlmaLely 80) and ls measured as Lheophylllne ln Lhe serum

1herapeuLlc LffecL lL ls a resplraLory smooLh muscle relaxanL LhaL resulLs ln bronchodllaLlon

lndlcaLlon 1o prevenL and relleve sympLoms of acuLe bronchlal asLhma and LreaLmenL of bronchospasm assoclaLed wlLh chronlc bronchlLls and emphysema

uosage and reparaLlon

8ronchospasm
AdulL lv Loadlng uose 6 mg/kg over 30 mln lv MalnLenance uose nonsmoker 03 mg/kg/h smoker 073 mg/kg/h CPl or clrrhosls 023 mg/kg/h C
nonsmoker 03 mg/kg/h Llmes 24 h ln 4 dlvlded doses smoker 073 mg/kg/h Llmes 24 h ln 4 dlvlded doses CPl or clrrhosls 023 mg/kg/h Llmes 24 h ln 4
dlvlded doses

8LA8L lv lnfuslon ulluLe loadlng dose ln 100200 mL nS u3W u3/nS or 8L lor conLlnuous or lnLermlLLenL lnfuslon dlluLe ln 3001000 mL - uo noL use
amlnophylllne soluLlons lf dlscolored or lf crysLals are presenL

AuMlnlS1L8 lv lnfuslon lnfuse aL a raLe noL Lo exceed 23 mg/mln

lnCCMA1l8lLl1lLS SoluLlon/addlLlve amlkaclnbleomyclnCLPALCSC8lnS chlorpromazlneclprofloxaclncllndamyclncodelne
phosphaLedlmenhydrlnaLedobuLamlnedopamlnedoxapramdoxorublclneplnephrlnehydralazlnehydroxyzlnelnsullnlsoproLerenollevor
phanolmeperldlnemeLhadonemeLhylprednlsolonemorphlnenafcllllnnoreplnephrlneoxyLeLracycllnepapaverlnepenlclllln
CpenLazoclneprocalneprochlorperazlnepromazlnepromeLhazlneLeLracycllneverapamllvlLamln 8 complex wlLh C ?slLe amlodaronecodelne
phosphaLeclprofloxaclncllndamyclnPLnC1PlAZlnLS (chlorpromazlneprochlorperazlne eLc)
eplnephrlnedobuLamlnedopamlnelevorphanolmorphlnemeperldlnemeLhadonenoreplnephrlneverapamll

Adverse LffecLs

CnS nervousness resLlessness depresslon lnsomnla lrrlLablllLy headache dlzzlness muscle hyperacLlvlLy convulslons Cv Cardlac arrhyLhmlas Lachycardla
(wlLh rapld lv) hypervenLllaLlon chesL paln severe hypoLenslon cardlac arresL Cl nausea vomlLlng anorexla hemaLemesls dlarrhea eplgasLrlc paln


nurslng 8esponslblllLles/recauLlons

O MonlLor for SS of LoxlclLy (generally relaLed Lo Lheophylllne serum levels over 20 mg/mL) Cbserve paLlenLs recelvlng parenLeral drug closely for
slgns of hypoLenslon arrhyLhmlas and convulslons unLll serum Lheophylllne sLablllzes wlLhln Lhe LherapeuLlc range
O noLe Plgh lncldence of LoxlclLy ls assoclaLed wlLh recLal supposlLory use due Lo erraLlc raLe of absorpLlon
O MonlLor record vlLal slgns and lC A sudden sharp unexplalned rlse ln hearL raLe may lndlcaLe LoxlclLy
O Lab LesLs MonlLor serum Lheophylllne levels
O noLe Clder adulLs acuLely lll and paLlenLs wlLh severe resplraLory problems llver dysfuncLlon or pulmonary edema are aL greaLer rlsk of LoxlclLy due
Lo reduced drug clearance



8eference
u's nurslng urug Culde (2
nd
LdlLlon 2008)
renLlce Pall nurses urug Culde (2003)

ALIUM GLUCNA1L

AcLlon Calclum ls an essenLlal elemenL for regulaLlng Lhe exclLaLlon Lhreshold of nerves and muscles for blood cloLLlng mechanlsms cardlac funcLlon (rhyLhm
LonlclLy conLracLlllLy) malnLenance of renal funcLlon for body skeleLon and LeeLh Also plays a role ln regulaLlng sLorage and release of neuroLransmlLLers and
hormones regulaLlng amlno acld upLake and absorpLlon of vlLamln 812 gasLrln secreLlon and ln malnLalnlng sLrucLural and funcLlonal lnLegrlLy of cell
membranes and caplllarles Calclum gluconaLe acLs llke dlglLalls on Lhe hearL lncreaslng cardlac muscle Lone and force of sysLollc conLracLlons (poslLlve lnoLroplc
effecL)

1herapeuLlc LffecL 8apldly and effecLlvely resLores serum calclum levels ln acuLe hypocalcemla of varlous orlglns and effecLlve cardlac sLablllzer under
condlLlons of hyperkalemla or resusclLaLlon

lndlcaLlon negaLlve calclum balance (as ln neonaLal LeLany hypoparaLhyroldlsm vlLamln u deflclency alkalosls) Also Lo overcome cardlac LoxlclLy of
hyperkalemla for cardlopulmonary resusclLaLlon Lo prevenL hypocalcemla durlng Lransfuslon of clLraLed blood Also as anLldoLe for magneslum sulfaLe for
acuLe sympLoms of lead collc Lo decrease caplllary permeablllLy ln senslLlvlLy reacLlons and Lo relleve muscle cramps from lnsecL blLes or sLlngs Cral calclum
may be used Lo malnLaln normal calclum balance durlng pregnancy lacLaLlon and chlldhood growLh and Lo prevenL prlmary osLeoporosls Also ln osLeoporosls
osLeomalacla chronlc hypoparaLhyroldlsm rlckeLs and as ad[uncL ln LreaLmenL of myasLhenla gravls and LaLonLamberL syndrome

ConLralndlcaLlon venLrlcular flbrlllaLlon meLasLaLlc bone dlsease ln[ecLlon lnLo myocardlum admlnlsLraLlon by SC or lM rouLes renal calcull hypercalcemla
predlsposlLlon Lo hypercalcemla (hyperparaLhyroldlsm cerLaln mallgnancles) pregnancy (caLegory 8)

uosage and reparaLlon

C8 AdulL lv 2337 mLq x 1
Pyperkalemla wlLh Cardlac 1oxlclLy
AdulL lv 22314 mLq q 12 mln

lnLravenous 8LA8L ulrecL May be glven undlluLed lnLermlLLenL/ConLlnuous May be dlluLed ln 1000 mL of nS

AuMlnlS1L8 ulrecL Clve dlrecL lv aL a raLe of 03 mL or a fracLlon Lhereof over 1 mln uo noL exceed 2 mL/mln lnLermlLLenL/ConLlnuous Clve slowly noL Lo
exceed 200 mg/mln Lhrough a smallbore needle lnLo a large veln Lo avold posslblllLy of exLravasaLlon and resulLanL necrosls WlLh chlldren scalp velns should
be avolded Avold rapld lnfuslon Plgh concenLraLlons of calclum suddenly reachlng Lhe hearL can cause faLal cardlac arresL

lnCCMA1l8lLl1lLS SoluLlon/addlLlve AmphoLerlcln 8cefamandoledobuLamlnemeLhylprednlsolonemeLoclopramlde ?slLe AmphoLerlcln 8 cholesLeryl
complexfluconazolelndomeLhacln
Adverse LffecLs

8ody as a Whole 1lngllng sensaLlon WlLh rapld lv sensaLlons of heaL waves (perlpheral vasodllaLlon) falnLlng Cl C preparaLlon ConsLlpaLlon lncreased
gasLrlc acld secreLlon Cv (WlLh rapld lnfuslon) hypoLenslon bradycardla cardlac arrhyLhmlas cardlac arresL Skln aln and burnlng aL lv slLe severe venous
Lhrombosls necrosls and sloughlng (wlLh exLravasaLlon)

nurslng 8esponslblllLles/recauLlons

O Assess for cuLaneous burnlng sensaLlons and perlpheral vasodllaLlon wlLh moderaLe fall ln 8 durlng dlrecL lv ln[ecLlon
O MonlLor LCC durlng lv admlnlsLraLlon Lo deLecL evldence of hypercalcemla decreased C1 lnLerval assoclaLed wlLh lnverLed 1 wave
O Cbserve lv slLe closely LxLravasaLlon may resulL ln Llssue lrrlLaLlon and necrosls
O MonlLor for hypocalcemla and hypercalcemla
O Lab LesLs ueLermlne levels of calclum and phosphorus (Lend Lo vary lnversely) and magneslum frequenLly durlng susLalned Lherapy ueflclencles ln
oLher lons parLlcularly magneslum frequenLly coexlsL wlLh calclum lon depleLlon


8eference
u's nurslng urug Culde (2
nd
LdlLlon 2008)
renLlce Pall nurses urug Culde (2003)


AMICDAkCNL

AcLlon SLrucLurally relaLed Lo Lhyroxlne Class lll anLlarrhyLhmlc also has anLlanglnal and anLladrenerglc properLles 1oLally unrelaLed Lo oLher anLlarrhyLhmlcs
AcLs dlrecLly on all cardlac Llssues rolongs duraLlon of acLlon poLenLlal and refracLory perlod wlLhouL slgnlflcanLly affecLlng resLlng membrane poLenLlal

1herapeuLlc LffecL 8y dlrecL acLlon on smooLh muscle decreases perlpheral reslsLance and lncreases coronary blood flow 8locks effecLs of sympaLheLlc
sLlmulaLlon

lndlcaLlon rophylaxls and LreaLmenL of llfeLhreaLenlng venLrlcular arrhyLhmlas and supravenLrlcular arrhyLhmlas parLlcularly wlLh aLrlal flbrlllaLlon

ConLralndlcaLlon PypersenslLlvlLy Lo amlodarone cardlogenlc shock severe slnus bradycardla advanced Av block unless a pacemaker ls avallable severe llver
dlsease chlldren SafeLy durlng pregnancy (caLegory u) or lacLaLlon ls noL esLabllshed

uosage and reparaLlon

O ArrhyLhmlas

AdulL C Loadlng uose 8001600 mg/d ln 12 doses for 13 wk C MalnLenance uose 400600 mg/d ln 12 doses lv Loadlng uose 130 mg over 10
mln followed by 360 mg over nexL 6 h lv MalnLenance uose 340 mg over 18 h (03 mg/mln) may conLlnue aL 03 mg/mln ConverL lv Lo C uuraLlon
of lnfuslon 1 wk use 8001600 mg C 13 wk use 600800 mg C 3 wk use 400 mg C

Chlld C Loadlng uose 1013 mg/kg/d or 600800 mg/173 m2/d ln 12 dlvlded doses for 414 d cycle or unLll adequaLe conLrol of arrhyLhmla C
MalnLenance uose 3 mg/kg/d or 200400 mg/173 m2/d once dally may be able Lo reduce Lo 23 mg/kg/d 3 d per week

8LA8L lv lnfuslon llrsL rapld loadlng dose lnfuslon Add 130 mg (3 mL) amlodarone Lo 100 mL u3W Lo yleld 13 mg/mL Second lnfuslon durlng flrsL 24 h
(slow loadlng dose and malnLenance lnfuslon) Add 900 mg (18 mL) amlodarone Lo 300 mL u3W Lo yleld 18 mg/mL MalnLenance lnfuslons afLer Lhe flrsL
24 h repare concenLraLlons of 16 mg/mL amlodarone noLe use cenLral llne Lo glve concenLraLlons 2 mg/mL)
AuMlnlS1L8 lv lnfuslon 8apldly lnfuse lnlLlal 130 mg dose over Lhe flrsL 10 mln aL a raLe of 13 mg/mln Cver nexL 6 h lnfuse 360 mg aL a raLe of 1 mg/mln
Cver Lhe remalnlng 18 h lnfuse 340 mg aL a raLe of 03 mg/mln AfLer Lhe flrsL 24 h lnfuse malnLenance doses of 720 mg/24 h aL a raLe of 03 mg/mln
lnCCMA1l8lLl1lLS SoluLlon/addlLlve sodlum blcarbonaLe ?slLe amlnophylllnecefamandolecefazollnheparln mezlocllllnsodlum blcarbonaLe
Adverse LffecLs

CnS erlpheral neuropaLhy ( muscle weakness wasLlng numbness Llngllng) faLlgue abnormal galL dysklneslas dlzzlness paresLhesla headache Cv
8radycardla hypoLenslon (lv) slnus arresL cardlogenlc shock CPl arrhyLhmlas Av block Speclal Senses Corneal mlcrodeposlLs blurred vlslon opLlc
neurlLls opLlc neuropaLhy permanenL bllndness corneal degeneraLlon macular degeneraLlon phoLosenslLlvlLy Cl Anorexla nausea vomlLlng
consLlpaLlonhepaLoLoxlclLy MeLabollc PyperLhyroldlsm or hypoLhyroldlsm may cause neonaLal hypo or hyperLhyroldlsm lf Laken durlng pregnancy
8esplraLory (ulmonary LoxlclLy) AlveollLls pneumonlLls (fever dry cough dyspnea) lnLersLlLlal pulmonary flbrosls faLal gasplng syndrome wlLh lv ln
chlldren Skln SlaLeblue plgmenLaLlon phoLosenslLlvlLy rash CLher WlLh chronlc use angloedema

nurslng 8esponslblllLles/recauLlons

O MonlLor 8 carefully durlng lnfuslon and slow Lhe lnfuslon lf slgnlflcanL hypoLenslon occurs bradycardla should be LreaLed by slowlng Lhe lnfuslon or
dlsconLlnulng lf necessary MonlLor hearL raLe and rhyLhm and 8 unLll drug response has sLablllzed reporL prompLly sympLomaLlc bradycardla
SusLalned monlLorlng ls essenLlal because drug has an unusually long halfllfe
O MonlLor for SS of Adverse effecLs parLlcularly conducLlon dlsLurbances and exacerbaLlon of arrhyLhmlas ln paLlenLs recelvlng concomlLanL
anLlarrhyLhmlc Lherapy (reduce dosage of prevlous agenL by 3030 several days afLer amlodarone Lherapy ls sLarLed) druglnduced
hypoLhyroldlsm or hyperLhyroldlsm (see Appendlx l) especlally durlng early LreaLmenL perlod pulmonary LoxlclLy (progresslve dyspnea faLlgue
cough pleurlLlc paln fever) LhroughouL Lherapy
O Lab LesLs 8asellne and perlodlc assessmenLs should be made of llver lung Lhyrold neurologlc and Cl funcLlon urug may cause Lhyrold funcLlon LesL
abnormallLles ln Lhe absence of Lhyrold funcLlon lmpalrmenL
O MonlLor for elevaLlons of AS1 and AL1 lf elevaLlons perslsL or lf Lhey are 23 Llmes above normal basellne readlngs reduce dosage or wlLhdraw drug
prompLly Lo prevenL hepaLoLoxlclLy and llver damage
O AusculLaLe chesL perlodlcally or when paLlenL complalns of resplraLory sympLoms Check for dlmlnlshed breaLh sounds rales pleurlLlc frlcLlon rub
observe breaLhlng paLLern uruglnduced pulmonary funcLlon problems musL be dlsLlngulshed from CPl or pneumonla keep physlclan lnformed
O AnLlclpaLe posslble CnS sympLoms wlLhln a week afLer amlodarone Lherapy beglns roxlmal muscle weakness a common slde effecL lnLenslfled by
Lremors presenLs a greaL hazard Lo Lhe ambulaLlng paLlenL Assess severlLy of sympLoms Supervlslon of ambulaLlon may be lndlcaLed

8eference
u's nurslng urug Culde (2
nd
LdlLlon 2008)
renLlce Pall nurses urug Culde (2003)