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ER Drugs- Nursing Pharmacology Cheat Sheet by

Emergency Room Top 15 Drugs

Epinep­hrine Trade: Adrenalin

Category Class
Pharm: adrenergic Ther: anti asthmatic, bronch­odi­lator, vasopr­essor
Action
Affects both beta1 (cardiac) & beta2 (pulmo­nary) receptor sites. Produces bronch­odi­lator. Also has alpha adrenergic agonist properties which result in vasoco­nst­ric­tion.
Indica­tions
Severe allergic reactions, hypote­nsion assoc. w/ septic shock, adjunct in locali­zat­ion­/pr­olo­ngation of anesth­esia, Cardiac arrest (VF, pulseless VT, systole, PEA), asthma
Adverse effects
restle­ssness, tremor, angina, arrhyt­hmia, hypert­ension, tachyc­ardia, necrot­izing fasciitis, PARADO­XICAL BRONCH­OSPASM (EXCESSIVE USE OF INHALERS)
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: hypers­ens­iti­vity; Caution: CV disease, HTN, hypert­hyr­oidism, DM, cerebral arteri­osc­ler­osis, glaucoma, Parkin­son's, OB/lac­tation, geriatric (more suscep­tible to adverse reactions; may require decrease dose)
Intera­ctions
Additive adrenergic side effects w/ other adrenergic drugs; Decreased therap­eutic effects w/ adrenergic antago­nists (some antiHTNs); Anesth­etics can increase risk for dysrhy­thmias; MAOIs may cause life-t­hre­atening hypert­ensive crisis; Antihi­stamine & thyroid preps can ^ effects of adrene­rgics
Dosage
Anaphy­laxis: SubQ 0.3-0.5 mg repeated q10-15 min if required; Cardiac arrest: IV 1 mg q3-5 min if required
Nursing Interv­entions
Obtain past & present medication hx; Accurate dosing, use, pump settings ABG levels & ECG findings; Liver & renal function tests; Monitor IV infusion site; Assess RR, pulse, & BP before, during and after admin;

Adenosine Trade: Adenocard

Category Class
Action
Indica­tions
Contra­ind­ica­tions
Adverse Effects
Intera­ctions
Dosage
Nursing Interv­entions

Amiodarone Trade: Paceron

Category Class
Class III antiar­rhy­thmics
Action
Prolongs action potential duration and effective refractory period, noncom­pet­itive α- and β-adre­nergic inhibi­tion; increases PR and QT intervals, decreases sinus rate, decreases peripheral vascular resistance
Indica­tions
Hemody­nam­ically unstable Vtach, SVT, Vfib not controlled by 1st-line agents
Adverse Effects
visual distur­bances, photos­ens­iti­vity, BBW: hepato­tox­icity, pulmonary toxicity, proarh­ythmic effects
Contra­ind­ica­tions/ Precau­tions
CI: Pregna­ncy/BF, infants, severe sinus node dysfun­ction, hypers­ens­itivity to this produc­t/i­odi­ne/­benzyl alcohol, cardio­genic shock BLACK BOX WARNING: 2nd-3rd degree AV block, bradyc­ardia; Precau­tions: Goiter, Hashim­oto’s thyroi­ditis, electr­olyte imbala­nces, HF, severe respir­atory disease, children, torsades de pointes BLACK BOX WARNING: Cardiac arrhyt­hmias, pneumo­nitis, pulmonary fibrosis, severe hepatic disease
Intera­ctions
digoxin: increased blood levels, increased toxicity; Warfarin: increased bleeding, dabigatran
Dosage
IV: 150 mg over 10 min; PO: usual mainte­nance 200-600 mg/day
Nursing Interv­entions
monitor PT, INR if using warfarin; Monitor ECG, BP contin­uously; Monitor for adverse effects

Atropine

Category Class
Pharm: antich­oli­nergic Ther: antiar­rhy­thmics
Action
Blocks acetyl­choline at parasy­mpa­thetic neuroe­ffector sites; increases cardiac output, heart rate by blocking vagal stimul­ation in heart; dries secretions by blocking vagus
Indica­tions
Bradyc­ardia, bradyd­ysr­hyt­hmia, reversal of antich­oli­nes­terase agents, decreasing secretions before surgery, antisp­asmodic with GU and biliary surgery, bronch­odi­lator, AV heart block, rapid-­seq­uence intubation
Adverse Effects
tachyc­ardia, dysrhy­thmias, consti­pation, sedation, urinary retention
Contra­ind­ica­tions/ Precau­tions
angle-­closure glaucoma; caution: severe renal/­hepatic dysfun­ction, hiatal hernia assoc. w/ reflux esopha­gitis, intestinal atony, GI/GU obstru­ction, severe ulcerative colitis
Intera­ctions
additive anti-c­hol­inergic effects w/ other drugs that possess same side effects (amant­adine, antihi­sta­mines, tricyclic antide­pre­ssa­nts); increased effects of digoxin when combined
Dosage
IV 0.5- 1 mg q3-5 min (max 3 mg)
Nursing Interv­entions
Monitor I&O ratio; Monitor ECG; Monitor for bowel sounds; Monitor respir­atory status & cardiac status; Beers: Avoid in older adults

Dopamine

Category Class
Ther: ­Ago­nist, vasopr­essor, inotropic agent Pharm:­ Ca­tec­hol­amine
Action
Causes increased cardiac output; acts on β1- and α-rece­ptors, causing vasoco­nst­riction in blood vessels; when low doses are admini­stered, causes renal and mesenteric vasodi­lat­ation; β1 stimul­ation produces inotropic effects with increased cardiac output
Indica­tions
Shock; to increase perfusion; hypote­nsion, cardio­gen­ic/­septic shock
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: Hypers­ens­iti­vity, Vfib, tachyd­ysr­hyt­hmias, pheoch­rom­ocy­toma, hypovo­lemia; Precau­tions: OB/Lac­tation, geriatric, arterial embolism, PVD, sulfite hypers­ens­iti­vity, acute MI; BLACK BOX WARNING: Extrav­asation
Adverse Effects
Palpit­ations, tachyc­ardia, HTN, ectopic beats, angina, wide QRS complex, Necrosis, tissue sloughing w/extr­ava­sation, gangrene, headache, diarrhea
Intera­ctions
α-Adre­nergic & β-adre­nergic blockers: decreased action of Dopamine; Anesth­etics (general): increased dysrhy­thmias; Antide­pre­ssants (tricy­clic): increased pressor response; MAOIs: increased HTN (severe), do not use within 2 wk; Oxytocics: increased BP; Phenytoin: bradyc­ardia, hypote­nsion
Dosage
IV 1-50 mcg/kg/min
Nursing Interv­entions
• Monitor ECG for dysrhy­thmias; also monitor PCWP, CVP, CO2, urinary output; Assess for HF; Assess for oxygen­ation or perfusion deficit; Monitor BP & HR q5min during inf; if BP drops 30 mmHg, stop inf & call prescr­iber; BBW: Check for extrav­asa­tion: if this occurs, admin phento­lamine mixed w/0.9% NaCl

Magnesium Sulfate HIGH ALERT

Category Class
Func. class:­ ​E­lec­tro­lyte; antico­nvu­lsant, laxative, saline; antacid
Action
Increases osmotic pressure, draws fluid into colon, neutra­lizes HCl
Indica­tions
Consti­pation, bowel prep, antico­nvu­lsant, preterm labor, preecl­amp­sia­/ec­lam­psia; tx of torsades, adjunct tx for bronch­odi­lation in modera­te-­severe acute asthma
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: Hypers­ens­iti­vity, abdominal pain, N/V, obstru­ction, acute surgical abdomen, rectal bleeding, heart block, myocardial damage; Precau­tions: Pregnancy, renal diseas­e/c­ardiac disease
Adverse Effects
respir­atory depres­sio­n/p­ara­lysis, bradyc­ardia, hypote­nsion, hypoth­ermia, arrhyt­hmias, diarrhea, prolonged bleeding times, cramps
Intera­ctions
Antihy­per­ten­sives (CCB): increased hypote­nsion; Antiin­fec­tives (fluor­oqu­ino­lones, tetrac­ycl­ines): decreased absorp­tion; Neurom­uscular blockers: increased effects; Digoxin: decreased effect of digoxin; Nitrof­ura­ntoin: decreased absorption
Dosage
Seizur­es/HTN: IM/IV 1 g q6h for 4 doses prn; Torsades: IV (infants &c­hil­dren) 25-50 mg/kg/dose q4-6h prn; Bronch­odi­lation: IV (adults) 2 g single dose, (children) IV 25 mg/kg/­dose; Eclamp­sia­/Pr­eec­lam­psia: IV/IM 4-5 g infusion, concur­rently w/up to 5 g in each buttock, then 4-5 g IM q4h or IV inf 4 g followed by 1-2 g/h continuous infusion
Nursing Interv­entions
Monitor HR, BP, RR, & ECG freq throughout IV admin; Monitor neuro status, initiate seizure precau­tions; Assess patellar reflex before each IV dose: if absent, do not admin; Monitor I&O ratios; Monitor newborn for hypote­nsion, hypore­flexia, & respir­atory depres­sion; Monitor serum mag levels & renal functions period­ically

Sodium Bicarb­onate

Category Class
Pharm: alkali­nizing agent; Ther: anti ulcer agent
Action
acts as an alkali­nizing agent by releasing bicarb­onate ions; oral admin, releases bicarb­onate which neutra­lizes gastric acid
Indica­tions
management of metabolic acidosis, alkalinize urine & promote excretion of certain drugs in OD; antacid; stabil­ization of acid-base status in cardiac arrest; tx of life-t­hre­atening hyperk­alemia
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: Respir­ato­ry/­met­abolic alkalosis, hypoch­lor­emia, hypoca­lcemia; Precau­tions: Pregnancy, HF, cirrhosis, toxemia, renal disease, HTN, hypoka­lemia, lactation, hypern­atr­emia, Cushing’s syndrome, children
Adverse Effects
metabolic alkalosis, edema, tetany, gastric distention
Intera­ctions
Amphet­amines, anorex­iants, sympat­hom­ime­tics: increased blood levels; decreased effects of ketoco­nazole; urinary alkali­zation may decrease salicylate or barbit­urate blood levels; increase risk of crysta­lluria from quinol­ones; may negate protective effects of enteri­c-c­oated products (do not admin w/in 1-2 hr)
Dosage
Systemic Alkali­zat­ion­/Ca­rdiac Arrest: urgent- IV 1 mEq/ kg, may repeat 0.5 mEq/kg q10 min; less urgent- 2-5 mEq/kg as 4-8h infusion; Alkali­zation of Urine: PO (Adults) 48 mEq (4g) initially, then 12-24 mEq q4h, IV 2-5 mEq/kg as 4-8h infusion; Antacid tabs 325 mg- 2 g 1-4x/day
Nursing Interv­entions
Assess fluid balance, fluid overload, for s/s of acidosis, alkalosis, hypern­atr­emia, or hypoka­lemia; observe IV site closely for extrav­asa­tion; Assess for epigastric pain, bloody stools­/em­esi­s/g­astric aspirate; monitor ABGS, urine pH, renal function, gastric acid secretion test, electr­olyte levels, serum osmola­rity; advise pt to avoid milk products (milk-­alkali syndrome)
 

Etomidate HIGH ALERT

Category Class
Pharm: nonbar­bit­urates; Ther: general anesth­etics
Action
Hypnotic CNS depressant w/out analgesic activity
Indica­tions
induction of general anesth­esia; supple­mental anesthesia w/other agents (nitrous oxide) for short procedures
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: Hypers­ens­iti­vity, prolonged infusion not recomm­ended (surpasses cortisol produc­tion), Pregnancy, L&D; Precau­tions: severe stress (may require supple­mental cortic­ost­ero­ids), geriatric, lactation, children < 10yr
Adverse Effects
apnea, laryng­ospasm, transient skeletal muscle movements, hypo/h­ype­rte­nsion, arrhyt­hmias, hypo/h­ype­rve­nti­lation
Intera­ctions
Increase CNS depression w/other CNS depres­sants including antihi­sta­mine, antide­pre­ssants, sedati­ve/­hyp­notics, antips­ych­otics, and opioids (decrease dose of others); verapamil may increase anesthetic effect, which may increase risk of respir­atory depression & apnea
Dosage
IV 0.2-0.6 mg/kg (usual 0.3 mg/kg) for induction
Nursing Interv­entions
Assess respir­atory status, HR, & BP contin­uously; Maintain patent airway & adequate ventil­ation; Assess level of sedation & LOC throughout & following admin; May cause inj site pain; Monitor for toxicity OD; HIGH ALERT: should only used by indivi­duals experi­enced with endotr­acheal intuba­tion; have airway equip readily available

Succin­ylc­holine Trade: Anectine, Quelicin

Category Class
Func. class:­ ​N­eur­omu­scular blocker (depol­ari­zin­g—ultra short)
Action
Inhibits transm­ission of nerve impulses by binding with cholin­ergic receptor sites, antago­nizing action of acetyl­cho­line; causes release of histamine
Indica­tions
Facili­tation of endotr­acheal intuba­tion, skeletal muscle relaxation during orthopedic manipu­lations
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: Hypers­ens­itivity to succin­ylc­holine or parabens, malignant hypert­hermia; Precau­tions: Pregnancy, lactation, geriatric or debili­tated patients, severe burns, fractures, electr­olyte imbala­nces, neurom­uscular disease, glaucoma, renal/­hep­ati­c/c­ard­iac­/re­spi­ratory disease, hyperk­alemia; BBW: Myopathy, rhabdo­myo­lysis, children <2 yr
Adverse Effects
Apnea, hyperk­alemia, rhabdo­myo­lysis, anaphy­laxis, malignant hypert­hermia, arrhyt­hmias, bradyc­ardia, hypote­nsion, bronch­ospasm
Intera­ctions
Intensity &/or duration of paralysis may be prolonged by pretre­atment w/ general anesth­etics, aminog­lyc­osides, polymy­xinB, colistin, clinda­mycin, lidocaine, quinidine, procai­namide, beta blockers, lithium, cyclop­hos­pha­mide, phenel­zine, potass­ium­-losing diuretics, & magnesium salts; Increase risk of adverse CV reactions w/ opioid analgesics or digoxin
Dosage
Short proced­ures: IV 0.6 mg/kg up to 150 mg total dose, mainte­nance 0.3-0.6 mg/kg q5-10 min prn; Prolonged proced­ures: IV 2.5 mg/min infusion; IM dose up to 3-4 mg/kg (do not exceed 150 mg)
Nursing Interv­entions
Assess respir­atory status contin­uously; Monitor neurom­uscular response; Monitor ECG, HR, & BP; Assess for hx of malignant hypert­hermia before admin and monitor for signs throug­hout; Have airway equip readily available; monitor for hyperk­alemia; HIGH ALERT: admin w/out ventil­atory support results in serious harm and death, use caution and verify correct med and dosage

Propofol Trade: Diprivan

Category Class
Ther: general anesth­etics Func: hypnotic
Action
Produces dose-d­epe­ndent CNS depression by activation of GABA receptor; short-­acting hypnotic; produces amnesia
Indica­tions
Induction or mainte­nance of anesthesia as part of balanced anesthetic technique; sedation in mechan­ically ventilated patients
Contra­ind­ica­tio­ns/­Pre­cau­tions
Hypers­ens­itivity to product or soybean oil, egg, benzyl alcohol, OB/Lac­tation; Precau­tions: CV disease, lipid disorders, increased ICP, cerebr­ova­scular disorder, hypovo­lemia, pediat­rics, geriatrics
Adverse Effects
apnea, bradyc­ardia, hypo (more common­)/h­ype­rte­nsion, green urine, burning pain or stinging at IV site, PROPOFOL INFUSION SYNDROME
Intera­ctions
Additive CNS & respir­atory depression w/ alcohol, antihi­sta­mine, opioid analge­sics, & sedati­ve/­hyp­notics; Theoph­ylline may antagonize CNS effect of propofol; Cardio­res­pir­atory instab­ility w/ acetaz­ola­mide; serious bradyc­ardia w/ fentanyl use in children; increase risk hypert­rig­lyc­eri­demia w/ intrav­enous fat emulsion
Dosage
ICU sedation Adult: ​IV 5 mcg/kg/min over 5 min; may increase by 5-10 mcg/kg/min over 5-10 min until desired response
Nursing Interv­entions
Assess respir­atory status, pulse, & BP contin­uously; airway mainte­nance equip readily available; assess level of sedation & LOC throughout & following admin; ICU sedation: wake-up & assess CNS function daily, abrupt d/c may cause rapid awakening w/ anxiety and mechanical ventil­ation resist­ance; assess for propofol infusion syndrome

Naloxone Trade: Narcan

Category Class
Ther: antidote; Pharm: opioid antagonist
Action
Compet­ively blocks effects of opioids, including CNS & respir­atory depres­sion, without producing any agonist (opioi­d-like) effects
Indica­tions
Reversal of CNS & respir­atory depression because of suspected opioid OD
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: Hypers­ens­itivity ; Precau­tions: CV disease, pt physically dependent on opioids, OB/lac­tation, pediatrics
Adverse Effects
Ventri­cular arrhyt­hmias, hypo/h­ype­rte­nsion, N/V
Intera­ctions
Can precip­itate withdrawal in pts physically dependent on opioids; larger doses may be required to reverse effects of bupren­orp­hine, butorp­hanol, or nalbup­hine; antago­nizes post-op opioid analgesics
Dosage
Opioid OD tx: IV 0.4-2 mg, repeat 2-8 min prn; Post-op anesthesia reversal: IV 0.1-0.2 mg, repeat at 2-3 min intervals
Nur
Monitor respir­atory status, pulse, ECG, BP, & LOC frequently for 3-4h after the expected peak of blood concen­tra­tions; pt receiving opioids >1wk have increased sensit­ivity to effects, dilute & admin in slow increm­ents; Assess pain level in post-op respir­atory depres­sion; Assess s/s of withdrawal

Diltiazem Trade: Cardizem

Category Class
Pharm: CCB; Ther: antian­ginal, Class IV antiar­rhy­thmics, antihy­per­tensive
Action
Inhibits transport of calcium into myocardial & vascular smooth muscle cells resulting in inhibition of excita­tio­n-c­ont­raction coupling and subsequent contra­ction; produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node conduction times, dilates peripheral arteries
Indica­tions
HTN; angina pectoris & vasosp­astic (Prinz­men­tal's) angina; Suprav­ent­ricular tachya­rrh­ythmias and rapid ventri­cular rates in atrial flutter or fibril­lation
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: Sick sinus syndrome, 2nd- or 3rd-degree heart block, Systolic BP < 90, recent MI or pulmonary conges­tion; Precau­tions: OB/Lac­tat­ion­/Pedi, HF, severe renal/­hepatic disease, ventri­cular dysfun­ction, geriatric
Adverse Effects
peripheral edema, arrhyt­hmias, HF, SJS, tachyc­ard­ia/­bra­dyc­ardia, hypote­nsion, dyspnea
Intera­ctions
Increase hypote­nsion may occur w/ fentanyl, other antihy­per­ten­sives, nitrates, alcohol ingestion, or quinidine; Antihy­per­tensive effects may decrease w/ NSAIDS; Beta Blockers may result in bradyc­ardia & AV block; Increase digoxin levels; Statins increase risk for statin toxicity; azole antifu­ngals, clarit­hro­mycin, erythr­omycin, HIV drugs may decrease metabolism resulting in elevated levels & effects of CCBs; cyclos­porine increase risk of toxicity to either drug
Dosage
PO initial dose 30 mg qid; range of 120-360 mg divided in 3-4 doses; ER: 120-320 mg/day; IV 0.25mg/kg, may repeat in 15 min w/dose of 0.35 mg/kg. May follow w/ continuous infusion at 10 mg/h (range 5-15 mg/h) for up to 24h.
Nursing Interv­entions
Monitor BP & pulse before, throug­hout, & after; Monitor ECG period­ically w/ prolonged therapy; Monitor I&O ratios & daily weights; Assess signs of HF; Assess for SJS; Assess location, duration, intensity, & precip­itating factors of angina; Report bradyc­ardia or prolonged hypote­nsion immedi­ately, emergency equip & medication readily available; Monitor serum potassium, renal/­hepatic functions period­ically

Aspirin

Category Class
Ther: antipy­retic, nonopioid analgesic; Pharm: salicy­lates
Action
Produce analgesia by Blocks pain impulses by blocking COX-1 in CNS; reduce inflam­mation by inhibiting prosta­glandin synthesis; antipy­retic action results from vasodi­lat­ation of peripheral vessels; decreases platelet aggreg­ation
Indica­tions
Inflam­matory disorders including rheumatoid arthritis & osteoa­rth­ritis; mild-m­oderate pain; fever; prophy­laxis of TIAs & MI
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: Hypers­ens­itivity to salicy­lates or NSAIDs, bleeding disorders or thromb­ocy­top­enia, pediat­rics; Precau­tions: hx of GI bleed or ulcer disease, chronic alcohol abuse, severe renal/­hepatic disease, OB/Lac­tation, geriatrics
Adverse Effects
GI Bleed, dyspepsia, epigastric distress, anaphy­laxis, laryngeal edema, tinnitus
Intera­ctions
Increase risk bleeding w/ heparin, warfarin, thromb­olytic agents; Ibuprofen may negate the cardio protective antipl­atelet effects; Combined use w/ steroids or non aspirin NSAIDS increases GI irritation
Dosage
MI prophy­laxis: PO 81-325 mg/day; Pain/F­ever: 325-1000 mg q4-6hr; Inflam­mation: PO 2.4 g/day initially, increase to mainte­nance dose of 3.6-5.4 g/day divided doses; TIA prophy­laxis: PO 50-325 mg/day
Nursing Interv­entions
Pt w/ asthma, allergies, nasal polyps, or allergic to tartrazine have increased risk hypers­ens­iti­vity; Assess pain type, location, intensity; Assess fever and signs; Monitor hepatic function, serum salicylate levels, hemato­crit, and bleeding times

Nitrog­ycerin

Category Class
Ther: ­​Co­ronary vasodi­lator, antian­ginal; Pharm:­ ​N­itrate
Action
Decreases preload and afterload; Increases coronary blood flow by dilating coronary arteries & improving collateral flow to ischemic regions; produces vasodi­lation (venous > arterial); reduced myocardial O2 consum­ption
Indica­tions
Chronic stable angina pectoris, prophy­laxis of angina pain, HF associated with acute MI, controlled hypote­nsion in surgical procedures
Contra­ind­ica­tio­ns/­Pre­cau­tions
CI: hypers­ens­iti­vity, increased ICP, cerebral hemorr­hage, closed­-angle glaucoma, cardiac tamponade, hypovo­lemia, constr­ictive perica­rditis, severe anemia; Precau­tions: head trauma, cerebral hemorr­hage, glaucoma, cardio­myo­pathy, severe liver impair­ment, malabs­orption or hyper motility, cardio­ver­sion, OB/Lac­tat­ion­/Pedi
Adverse Effects
dizziness, headache, hypote­nsion, tachyc­ardia
Intera­ctions
Alcohol: increased hypote­nsion, CV collapse; Aspirin: increased nitrate level; Heparin: decreased effects (with IV nitrog­lyc­erin); Avanafil, silden­afil, tadalafil, varden­afil: increased fatal hypote­nsion, do not use together; Antihy­per­ten­sives, β-adre­nergic blockers, CCBs, diuretics: increased hypote­nsion
Dosage
Adult: ​SL dissolve tab under tongue when pain begins; may repeat q5min until relief; do not exceed 3 tab/15 min; use 1 tab prophy­lac­tically 5-10 min before activi­ties; TOP 1-2 inches q8hr; increase to 4 in q4hr prn; IV 5 mcg/min, then increase 5 mcg/min q3-5min; if no response after 20 mcg/min, increase 10-20 mcg/min until desired response; transd­ermal apply patch daily; remove patch at bedtime to avoid tolerance
Nursing Interv­entions
Assess location, duration, intensity, & precip­itation factors of angina; Monitor BP & pulse before­/after; Continuous ECG & BP monitoring for IV use

Morphine HIGH ALERT

Category Class
Ther: opioid analgesic Pharm: opioid agonist
Action
Binds to opiate receptors in CNS, alters perception of & response to painful stimuli while producing genera­lized CNS depression
Indica­tions
Moderate to severe pain Unlabeled uses: Agitation, bone/d­ental pain, dyspnea in end-stage cancer or pulmonary disease, sedation induction, rapid-­seq­uence intubation
Contra­ind­ica­tio­ns/­Pre­cau­tions
CONTRA­IND­ICA­TIONS Hypers­ens­iti­vity, addiction (opioi­d/a­lco­hol), hemorr­hage, bronchial asthma, increased ICP, paralytic ileus; BBW: Respir­atory depres­sion; Precau­tions: OB/Lac­tation, children, geriatric, acute MI, severe cardio­/pu­lmo­nar­y/r­ena­l/h­epatic disease, abrupt d/c, seizures; BBW: Accidental exposure, epidur­al/­int­rat­hec­al/­IM/SubQ admini­str­ation, opioid­-naive patients, substance abuse
Adverse Effects
Respir­atory depres­sio­n/a­rrest, bradyc­ardia, hypote­nsion, tolerance, dependance
Intera­ctions
Alcohol: increased effects with other CNS depres­sants; Rifampin: decreased analgesic action; Antips­ych­otics, opiates, sedati­ve-­hyp­notics, skeletal muscle relaxants: increased effects with other CNS depres­sants; MAOIs: unpred­ictable reaction may occur; avoid use; Chamomile, kava, St. John’s wort, valerian: increased CNS depression
Dosage
PO regula­r-r­elease Adult ≥50 kg: ​I­nit­ially, 10-30 mg q3-4hr prn; Adult <50 kg/ger­iatric patient: May require lower doses and/or extended dosing intervals, doses should be titrated carefully; IV/IM/­subcut Adult ≥50 kg: ​2.5-15 mg q2-6hr as needed, titrate or a loading dose of 0.05-0.1 mg/kg IV, followed by 0.8-10 mg/hr IV, titrate Adult <50 kg/ger­iatric patien­t: ​May require lower doses and/or extended dosing intervals 0.1 mg/kg q3-4hr, titrate
Nursing Interv­entions
Assess pain: location, type, character, intensity, give dose before pain becomes extreme; Monitor I&O, CNS changes; BBW: Abrupt discon­tin­uation: gradually taper to prevent withdrawal symptoms, Accidental exposure: if Duramorph or Infamorph gets on skin, remove contam­inated clothing and rinse affected area with water;­Assess respir­atory dysfun­ction: depres­sion, character, rate, rhythm; notify prescriber if respir­ations are <12/min
   
 

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