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Name of the Drug

Dosage/Route

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic Name:

Cardiac arrest:

Action:

Indications:

Adverse Effects:

Monitor V/S. and check for cardiac dysrhythmias

epinephrine

1 mg IV of 1:10,000 solution q 3-5 min; double dose if administering via ET tube

Stimulates beta receptors in lung.

o

Asthma

o

Bronchitis

 

Brand Name:

 

o

Emphysema

nervousness, tremor, vertigo,

 

Injection, OTC nasal solution:

Relaxes bronchial smooth muscle.

o

All cardiac arrest, anaphylaxis

Used for symptomatic bradycardia.

Relief of bronchospasm occurring during anesthesia

pain, widened pulse pressure, hypertension nausea

Drug increases rigidity and tremor in patients with Parkinson’s disease Epinephrine therapy interferes with tests for urinary catecholamine Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur Massage site after IM injection to counteract possible vasoconstriction. Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop If blood pressure increases sharply, rapid-acting vasodilators such as nitrates or alpha blockers can be given to counteract

Adrenalin Chloride

Anaphylaxis: 0.1- 1 mg SQ or IM of 1:1000 solution.

o

Ophthalmic solution:

Increases vital capacity BP, HR, PR

Side Effects:

Epifrin, Glaucon

Asthma: 0.1-0.3 mg SQ or IM of 1:10,000 solution

o

headache

Decreases airway resistance.

Insect sting emergencies:

 

EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for children) OTC solutions for

nebulization:

Refractory bradycardia and hypotension: 2-10ug/min

Classification:

Beta2 Adrenergic Agonists

o

Exercised-induced bronchospasm

Contraindications:

Contraindicate in patients with angle-closure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Also contraindicated in patient receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage)

Some products containing sulfites and are contraindicated in patients

AsthmaNefrin, microNefrin, Nephron, S 2

with sulfite allergies except when drug is used for serious allergic reactions or in other
with sulfite allergies except
when drug is used for serious
allergic reactions or in other
emergency situations.
In conjunction with local
anesthesia, epinephrine is
contraindicated for use in
finger, toes, ears, nose, and
genitalia.
Use cautiously with long-
standing bronchial asthma and
emphysema, who have
developed degenerative heart
disease and in those with
hyperthyroidism, CV disease,
hypertension, psychoneurosis,
or diabetes.
In pregnant woman, drug is
contraindicated.
In breast feeding do not use
the drug or stop breast
feeding.

Name of the Drug

Dosage/Route

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic Name:

1-1.5 mg/kg IVP or ETT (double dose if giving via ET tube), may repeat q 5-10 min. max 3 mg/kg; If conversion successful start an infusion of 2-4 mg/min

Action:

Indications:

Adverse Effects:

Monitor EKG, BP, pulse, rhythm, continuously.

Monitor serum lidocaine levels throughout theraphy; therapreutic range 1.5-5 mcg/ml

lidocane

Brand Name:

Decrease cardiac excitability, cardiac contraction is delayed in the atrium and ventricle

Decrease cardiac excitability, cardiac contraction is delayed in the atrium and ventricle

CNS: Confusion, tremor, lethargy, somnolence, stupor, restlessness anxiety, hallucinations, nervousness, seizure. CV: hypotension, bradychardia, new or worsened arrhythmias EENT:

tinnitus, blurred or double vision. Respiratory: Respiratory depression and arrest Skin: soreness at injection site Other: anaphylaxis,

Xylocaine

 

Contraindications:

Classification:

Contraindicated in patients hypersensitive to amide-type local anesthetics and in those with Adams –Stoke syndrome. Wolff-Parkinsons-White Syndrome, or severe degrees of SA, AV, or intraventricular block in the absence of pacemaker.

 

Antiarrythmic and Anesthetic

 

Monitor intake and output

Do not mix in the same syringe with amphoterin B or cefazolin

Administer Lidocaine TIV.

 

In case of circulatory

Side Effects:

depression have dopamine available

sensation of cold, vomiting

Name of the Drug

Dosage/Route

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic Name:

0.5-1 mg/kg slow IVP over 1- 2 min, may repeat once at 2 mg/kg slow IVP over 1-2 mins.

Action:

Indications:

Adverse Effects:

Monitor serum glucose, and electrolyte

furosemide

inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henlen

Edema associated with CHF

vertigo, headache, paresthesia, orthostatic hypotension, thrombophlebitis, abdominal pain, Hypokalemia, anemia, muscle spasm

Brand Name:

D

iet- K+ for all

Cirrhosis with ascites or renal dysfunction

except aldactone

Apo-Furosemide

 

ntake and Output, daily weight

I

Furoside

Classification:

For hypertension or in combination with other antihypertensive medications.

 

U

ndesirable effects;

Loop Diuretics

Fluid and electrolyte

Lasix

imbalance

 

R

eview HR, BP and

Lasix Speacial

ICP, nephritic syndrome, hepatic cirrhosis

electrolytes

E

lderly-Careful

Novosemide

 

T

ake with or after

Contraindications:

meals and in AM

Uritol

I

ncrease risk of

Contraindicated to patients hypersensitive to drug or any of its components and in those with anuria.

Use cautiously in patient with hepatic cirrhosis.

orthosthatic hypotension;

move slowly

C

ancel alcohol

 

Patients with allergies to sulfonamides may also be allergic to furosemide.

In pregnant woman, use only if benefits outweighs the risk to the fetus.

In breast feeding woman, do not use drug.

Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing

Name of the Drug

Dosage/Route

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic Name:

Adults: For rapid digitalization, give 0.4 to 0.6 mg I.V. initially, followed by 0.1 to 0.3 mg I.V. every 4 hours, as needed and tolerated, for 24 hours.

Action:

Indications:

Adverse Effects:

Monitor K+, Mg++, ECG, liver/renal function tests, drug level (therapeutic level 0.5-2.0 mg/ml, toxicity is >2.0 mg/ml).

digoxin

Inhibits the sodium- potassium ATP phase.

V-fib, V-flutter, CHF, pulmonary edema, atrial fibrillation and or flutter, and paroxysmal atrial contractions

CNS: hallucinations, paresthesia, stupor, vertigo. CV: Arrythmias, heart failure, hypotension. EENT: blurred vision, diplopia, light flashes, photophobia, yellow-green halos around visual images. GI: anorexia, diarrhea, nausea, vomiting.

Side Effects:

CNS: agitation, dizziness, fatigue, generalized weakness, headache, malaise. GI: Nausea

Brand Name:

Lanoxin, Digoxin, Lanoxicap

Classification:

Cardiac Glycosides

   
 

Contraindications:

Before each dose assess apical pulse for full minute, record and report changes in rate or rhythm.

Withhold drug and contact provider if pulse is < 60/min. or >100 (adults) or < 110/minute (children)

Children: digitalizing dose is based on child’s age and is given in three or more divided doses over the first 24 hours. First dose is 50% of total dose; subsequent dose are given q 4 to 8 hours as needed and tolerated.

Contraindicated in patients hypersensitive to the drug or any of its components and in those with digitalis-induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure.

Children age 10 years and older: For rapid digitalization, give 8 to 12 mcg/kg I.V. over

Use cautiously in patients with acute MI, in complete Av block, sinus bradycardia, PVCs,, chronic constrictive pericarditis, hyperthropic cardiomyopathy, renal insufficiency, severe pulmonary disease, or hypothyroidism.

Weigh daily Monitor I&O and signs of CHF

24

hours, divided as above,

 

Maintenance dose is 25% to 35% of total digitalizing dose, given daily as a single dose.

Children ages 5 to 10: For rapid digitalization, give 15 to

30

mcg/kg I.V. over 24 hours

 

divided as above. Maintenance dose is 25% to 35% of total digitalizing dose, divided and given in two or three equal portions daily.

Children ages 2 to 5: For rapid digitalization: give 25 to 35 mcg/kg I.V. over
Children ages 2 to 5: For rapid
digitalization: give 25 to 35
mcg/kg I.V. over 24 hours,
divided as above.
Maintenance dose is 25% to
35% of total digitalizing dose,
divided and given in two or
three equal portions daily.
Infants ages 1 month to 2
years: For rapid digitalization.
Give 30 to 50 mcg/kg I.V.
over 24 hours, divided as
above. Maintenance dose is
25% to 35% of the total
digitalizing dose, divided and
given in two or three equal
portions daily.
Neonates: for rapid
digitalization, give 20 to 30
mcg/kg I.V. over 24 hours,
divided as above.
Maintenance dose is 25% to
30% of the total digitalizing
dose, divided and given in two
or three equal portions daily.
Premature Infants: For rapid
digitalization, give 15 to 25
mcg/kg I.V. over 24 hours,
divided as above.
Maintenance dose is 20% to
30% of the total digitalizing
dose, divided and given into
two or three equal portions
daily.
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing
Name of the Drug Dosage/Route Action/Classification Indication/ Adverse Effects/ Side Effects Nursing

Name of the Drug

Dosage/Route

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic Name:

1 mEq/kg IVP, may repeat 0.5 mEq/kg 10 min.

Action:

Indications:

Adverse Effects:

Monitor urinary pH, calcium, electrolytes and phosphate levels.

Sodium Bicarbonate

Neutralizes gastric acid

o

Hyperacidity

GI: Gastric distention,

 

o

Peptic ulcer

belching, flatulence.

Brand Name: Arm and Hammer Pure Baking Soda, Citrocarbonate, Soda Mint

Decrease pepsin activity

o

Hyperkalemia

Metabolic: metabolic

 

Classification: Alkalizing Agent, Buffer, Antacid, electrolyte

o

Tricyclic antidepressant OD

alkalosis, hypernatremia, hypokalemia, hyperosmolarity

Record amount and consistency of stools.

 

o

Shock associated with severe diarrhea, dehydration, uncontrolled DM

(with overdose). Other: Pain and irritation at injection site.

Clients on low-sodium diets should evaluate sodium contents of antacids.

 

o

Reflux esophagitis

Contraindications:

Contraindicated in patients with metabolic or respiratory alkalosis; patients who are losing chlorides from vomiting or continuous GI suction; patients taking diuretics known to produce hypochloremia alkalosis; and patients with hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart failure. Oral sodium bicarbonate is contraindicated in patients with acute ingestion of strong mineral acids.

Name of the Drug

Dosage/Route

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic Name:

Adults: initially, 1 to 5 mcg/kg/minute by I.V. infusion. Adjust dose to desired hemodynamic or renal response, increase by 1 to 4 mcg/kg/minute at 10 to 30- minute intervals.

Action Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system. Action is dose-related; large doses can cause mainly alpha stimulation.

Indications:

Adverse Effects:

Blood is not a substitute for blood or fluid volume deficit. If deficit occurs, replace fluid deficit first before giving meds.

During infusion, frequently monitor ECG, BP, cardiac output, CVP, pulmonary artery wedge pressure, pulse rate, urine output, and color and temperature of the limbs.

If diastolic pressure rises disproportionately, decrease perfusion rate and watch out carefully for further signs of vasoconstriction unless such action is desired.

Dopamine HCl.

To treat shock and correct hemodnamic imbalances, improve perfusion of vital organs, to increase cardiac output, and to correct hypotension.

Cv: anginal pain, arrythmias, bradycardia, conduction disturbances ectopic breasts,hypertension, hypotension, palpitations, tachycardia, vasoconstriction, widening of QRS complex.

Brand Name:

Intropin; Revimine

 

Classification:

Contraindications:

 

Inotropic, vasopressor

Contraindicated in patient with uncorrected tachyarrhythmias, pheocromocytoma, or ventricular fibrillation. - Use cautiously in patients with occlusive vascular disease, cold injuries, diabetic endarteritis, and arterial embolism; in pregnant woman; with a history of sulfite sensitivity; and in those taking MAO inhibitor.

GI: vomiting.

GU: azotemia Respiratory: asthma attacks, dyspnea

Skin: necrosis,piloerection, tissue sloughing with extravasation.

Other: anaphylaxis.

Observe for adverse reaction.

Side Effects:

 

CNS: headache

Check for urine output. If urine flow is decrease without hypotension, notify physician.

After drug is stopped, Tamper dosage slowly to evaluate stability of blood pressure.

GI: nausea

Acidosis decrease effectiveness of dopamine.

Name of the Drug

Dosage/Route/Timing

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic

0.3-0.4 mg SL q 5 min, max 3 doses.

Action:

Indication:

Adverse Effects CV: orthostatic hypotension, flushing, fainting. EENT: sublingual burning. Skin: Cutaneous vasodilation, contact dermatitis (patch) Side Effects CNS: headache, throbbing, dizziness, weakness. GI: nausea, vomiting. Skin: Rash

Record characteristics and precipitating factors of anginal pain.

Nitroglycerin

Relaxes the vascular smooth system

Angina pectoris CHF associated with AMI

Brand

 

Nitrostat

     

Myocardial oxygen

Cardiac load reducing agent

Monitor BP and apical pulse before administration and periodically after dose.

consumption

Hypertensive Crisis

left ventricular workload

arterial BP

Contraindication:

 

venous return

Contraindicated in patients hypersensitive to nitrates and in those with early MI. (S.L. form), severe anemia, increase ICP angle-closure glaucoma, IV nitroglycerine is contraindicated in patients with hypovolemia, hypotension, orthostatic hypotension, cardiac tamponade restrictive cardiomyopathy, constrictive pericarditis.

Have client sit or lie down if taking drug for the first time.

Classification Antianginal, Nitrate, Vasodilator, Coronary

 

Client must have continuing EKG monitoring for IV administration

Cardioverter/ defibrillator must not be discharged through paddle electrode overlying Nitro-Bid ointment or the Transderm-Nitro Patch. Assist with ambulating if dizzy.

 

Instruct to take at first sign of anginal pain.

May be repeated q 5 minutes to max. of 3 doses.

If the client doesn’t experience relief, advise to seek medical assistance

immediately.
immediately.
immediately.
immediately.
immediately.

immediately.

Name of the Drug

Dosage/Route

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic

Bradycardia: 0.5 -1 mg IV (may give via ETT at double dose) q 3-5 min, max 0.04 mg/kg Cardiac arrest: 1 mg q 3-5 min, max 0.04 mg/kg

Action cholinergic receptor sites so response to acetylcholine is decreased

Indication As an anti-sialagogue for preanesthetic medication to prevent or reduce secretions of the respiratory tract

Adverse Effects CNS: restlessness, ataxia, disorientation, hallucinations, delirium, coma, insomnia, agitation, confusion. CV: tachycardia, angina, arrhythmias, flushing. EENT: photophobia, blurred vision, mydriasis. GI: dry moth, constipation, vomiting. GU: urine retention. Hematologic: leukocytosis Other: anaphylaxis

Monitor VS.

Atrophine Sulfate

Re

port HR

Brand

M

Isopto Atropine

Classification

onitor for constipation, oliguria.

Nerve gas and organophosphate symptoms, may repeat in 2 mg increments q 3 min tiltrated to relief symptoms.

Anticholinergics

To restore cardiac rate and arterial pressure during anesthesia, when vagal

Atr ophine could result in CNS stimulation (confusion, excitement) or drowsiness

stimulation produced by intra- abdominal surgical traction causes a sudden decrease in pulse rate and cardiac action

Instruct to take 30 mins before meals

 

To lessen the degree of atrioventricular (A-V) heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis

To overcome severe carotid sinus reflex Antidote for cardiovascular collapse from the injudicious use of a cholinergic drug.

Side Effects CNS: headache, excitement. CV: palpitations GI: thirst, nausea.

Eat foods high in fiber and drink plenty fluids.

Avoid OTC antihistamines. Instruct client not to drive a motor vehicle or participate in activities requiring alertness. Advise to use hard candy, ice chips, etc. for dry mouth.

Contraindication Contraindicated in patients hypersensitive to drug and those with acute angle closure glaucoma, obstructive

 
uropathy, obstructive disease of GI tract, paralytic elius, toxic magacolon, intestinal atony, unstable CV status
uropathy, obstructive disease of GI tract, paralytic elius, toxic magacolon, intestinal atony, unstable CV status
uropathy, obstructive disease of GI tract, paralytic elius, toxic magacolon, intestinal atony, unstable CV status

uropathy, obstructive disease of GI tract, paralytic elius, toxic magacolon, intestinal atony, unstable CV status in acute hemorrhage, asthma, or myasthenia gravis. Also contraindicated in pregnant women.

atony, unstable CV status in acute hemorrhage, asthma, or myasthenia gravis. Also contraindicated in pregnant women.
atony, unstable CV status in acute hemorrhage, asthma, or myasthenia gravis. Also contraindicated in pregnant women.

Name of the Drug

Dosage/Route

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic Dobutamine Hydrochloride

Adults individualized: 2.5-15 mcg/kg/min.

Action Enhancing the force of myocardial contraction

Indication Short term treatment of cardiac decompensation in

Adverse Effects CV: angina, hypertension, hypotension, increased heart rate, nonspecific chest pain, phlebitis, PVCs. GI: nausea and vomiting. Respiratory: asthma attacks, shortness of breath. Others: anaphylaxis.

Monitor CVP to assess vascular volume and cardiac pumping efficiency.

Brand

Rate of administration and duration of therapy depend on the response of client as determined by HR, presence of activity, BP and urine flow

Dobutrex

HR, CO, and SV with minor effects to HR. elevated ventricular filling pressure and helps AV node conduction

organic heart disease of cardiac surgical pressures.

Contraindication Contraindication in patients hypersensitive to drug or any of its components and in those with idiopathic hypertrophic subaortic stenosis.

(Elevated CVP may indicate disruption on CO, as in pump failure or Pulmonary edma; low CVP may indicate hypovolemia)

 

Classification Inotropic, Adrenergic

Side Effects CNS: headache Musculoskeletal: mild leg crams or tingling sensation.

Monitor ECG and BP continuously during drug administration

 

Record I&O

M

onitor glucose in diabetes patients

Drug is administered IV to improve cardiac function thus increasing BP and improving urine output.

Report any chest pain, increase SOB, headaches or IV site pain.

Name of the Drug

Dosage/Route

Action/Classification

Indication/

Adverse Effects/ Side Effects

Nursing Responsibilities

Contraindications

Generic

ADULTS

Action Principal opium alkaloid; acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

Indication Relief of moderate to severe acute and chronic pain

Adverse Effect CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex

Assessment History: Hypersensitivity to opioids; diarrhea caused by poisoning; labor or delivery of a premature infant; biliary tract surgery or surgical anastomosis; head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression; acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction; pregnancy; lactation

Morphine Sulfate

Oral

One-third to one-sixth as

Brand Immediate-release tablets:

effective as parenteral administration because of

Preoperative medication to sedate and allay apprehension, facilitate induction of anesthesia, and reduce anesthetic dosage

MSIR

first-pass metabolism; 10–

Timed-release:

30

mg q 4 hr PO. Controlled-

Kadian, M-Eslon (CAN), MS Contin, Oramorph SR Oral solution:

release: 30 mg q 8–12 hr PO or as directed by physician; Kadian: 20–100 mg PO daily–24-hr release system; MS Contin: 200 mg PO q 12 hr. SC and IM

MSIR, Rescudose, Roxanol, Roxanol T Rectal suppositories:

Analgesic adjunct during anesthesia

RMS

Classification

Component of most preparations that are referred to as Brompton's cocktail or mixture, an oral alcoholic solution that is used for chronic severe pain, especially in terminal cancer patients

 

Injection:

10

mg (5–20 mg)/70 kg q 4 hr

Opioid agonist analgesic

CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope

Dermatologic: Pruritus, urticaria, Respiratory:

Astramorph PF, Duramorph, Epimorph (CAN) Preservative-free concentrate for microinfusion devices for intraspinal use:

Infumorph

or as directed by physician.

IV

2.5–15 mg/70 kg of body weight in 4–5 mL water for

injection administered over 4– 5 min, or as directed by physician. Continuous IV infusion: 0.1–1 mg/mL in 5% dextrose in water by controlled infusion device.

 

Intraspinal use with microinfusion devices for the relief of intractable pain

Rectal

Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary edema Contraindication

laryngospasm, bronchospasm, edema

 

10–30 mg q 4 hr or as directed

Physical: T; skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP, orthostatic BP, perfusion; R, adventitious

by physician.

 

Epidural

GI: Nausea, vomiting, anorexia, biliary tract spasm; increased colonic motility in patients with chronic

Initial injection of 5 mg in the lumbar region may provide pain relief for up to 24 hr. If

adequate pain relief is not achieved within 1 hr, incremental doses of 1–2 mg may be given at intervals sufficient to assess effectiveness, up to 10 mg/24

hr. For continuous infusion, initial dose of 2–4 mg/24 hr is recommended. Further doses of 1–2 mg may be given if pain relief is not achieved initially. Intrathecal Dosage is usually one-tenth

Contraindicated with hypersensitivity to opioids; diarrhea caused by poisoning until toxins are eliminated; during labor or delivery of a premature infant (may cross immature blood–brain barrier more readily); after biliary tract surgery or following surgical anastomosis; pregnancy; labor (respiratory depression in neonate; may prolong labor).

ulcerative colitis

sounds; bowel sounds, normal output; urinary frequency, voiding pattern, normal output; ECG; EEG; thyroid, liver, kidney function tests

Interventions Caution patient not to chew or crush controlled-release preparations.

Dilute and administer slowly

GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency

Respiratory:

Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest

IV

to minimize likelihood of

 

adverse effects.

that

of epidural dosage; a

Use cautiously with head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression, hypoxia, hypercapnia (may decrease respiratory drive and increase airway resistance); lactation (wait 4–6 hr after administration to nurse the baby); acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic

 

single injection of 0.2–1 mg

Side Effects GI: dry mouth, constipation. Skin: Tissue irritation and induration (SC injection). Other: sweating,physical tolerance and dependence, psychological dependence

Tell patient to lie down during

may provide satisfactory pain relief for up to 24 hr. Do not inject > 2 mL of the 5 mg/10

mL

ampule or > 1 mL of the

IV

administration.

Keep opioid antagonist and facilities for assisted or controlled respiration readily available during IV administration.

Use caution when injecting

10 mg/10 mL ampule. Use only in the lumbar area. Repeated intrathecal injections are not recommended; use other routes if pain recurs. For

 

SC

or IM into chilled areas or

epidural or intrathecal dosing,

in patients with hypotension

use

preservative-free

or

in shock; impaired

morphine preparations only.

perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored. Reassure patients that they are unlikely to become addicted; most patients who receive opioids for medical reasons do

PEDIATRIC PATIENTS

Do

not use in premature

infants.

SC

or IM

0.05–0.2 mg/kg (up to 15 mg

per

dose) q 4 hr or as directed

by physician.

GERIATRIC PATIENTS OR IMPAIRED ADULTS Use caution. Respiratory depression may occur in the elderly, the very ill, those with respiratory problems. Reduced dosage may be necessary. Epidural Use extreme caution; injection of < 5 mg in the lumbar region may provide adequate pain relief for up to 24 hr. Intrathecal Use lower dosages than recommended for adults above.

dysfunction.

not develop dependence syndromes

Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives, tranquilizers, over-the-counter drugs.

Swallow controlled-release preparation (MS Contin, Oramorph SR) whole; do not cut, crush, or chew them.

Do not take leftover medication for other disorders, and do not let anyone else take your prescription.

 

These side effects may occur:

Nausea, loss of appetite (take with food, lie quietly); constipation (use laxative); dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness and visual acuity).

Report severe nausea, vomiting, constipation, shortness of breath or difficulty breathing, rash.