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  /Title (er-drugs-nursing-pharmacology.pdf)
  /Creator (Cheatography)
  /Author (paytonctrujillo)
  /Subject (ER Drugs- Nursing Pharmacology Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{ER Drugs- Nursing Pharmacology Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{paytonctrujillo} via \textcolor{DarkBackground}{\uline{cheatography.com/133065/cs/27045/}}}
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  \vspace{-2pt}paytonctrujillo \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 12th March, 2021.\\
   Updated 12th March, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Epinephrine Trade: Adrenalin}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Pharm: adrenergic Ther: anti asthmatic, bronchodilator, vasopressor \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
Action & Affects both beta1 (cardiac) \& beta2 (pulmonary) receptor sites. Produces bronchodilator. Also has alpha adrenergic agonist properties which result in vasoconstriction. \tn 
% Row Count 11 (+ 8)
% Row 2
\SetRowColor{LightBackground}
Indications & Severe allergic reactions, hypotension assoc. w/ septic shock, adjunct in \seqsplit{localization/prolongation} of anesthesia, Cardiac arrest (VF, pulseless VT, systole, PEA), asthma \tn 
% Row Count 19 (+ 8)
% Row 3
\SetRowColor{white}
Adverse effects & restlessness, tremor, angina, arrhythmia, hypertension, tachycardia, necrotizing fasciitis, PARADOXICAL BRONCHOSPASM (EXCESSIVE USE OF INHALERS) \tn 
% Row Count 26 (+ 7)
% Row 4
\SetRowColor{LightBackground}
\seqsplit{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) \tn 
% Row Count 36 (+ 10)
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\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Epinephrine Trade: Adrenalin (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
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 \textasciicircum{} effects of adrenergics \tn 
% Row Count 13 (+ 13)
% Row 6
\SetRowColor{white}
Dosage & Anaphylaxis: SubQ 0.3-0.5 mg repeated q10-15 min if required; Cardiac arrest: IV 1 mg q3-5 min if required \tn 
% Row Count 18 (+ 5)
% Row 7
\SetRowColor{LightBackground}
Nursing Interventions & Obtain past \& present medication hx; {\emph{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; \tn 
% Row Count 28 (+ 10)
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% Row 0
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\mymulticolumn{2}{x{8.4cm}}{Category Class} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Action} \tn 
% Row Count 2 (+ 1)
% Row 2
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Amiodarone Trade: Paceron}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Class III antiarrhythmics \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
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 \tn 
% Row Count 12 (+ 10)
% Row 2
\SetRowColor{LightBackground}
Indications & Hemodynamically unstable Vtach, SVT, Vfib not controlled by 1st-line agents \tn 
% Row Count 16 (+ 4)
% Row 3
\SetRowColor{white}
Adverse Effects & visual disturbances, photosensitivity, BBW: hepatotoxicity, pulmonary toxicity, proarhythmic effects \tn 
% Row Count 21 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\seqsplit{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 \tn 
% Row Count 41 (+ 20)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Amiodarone Trade: Paceron (cont)}}  \tn
% Row 5
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Interactions & digoxin: increased blood levels, increased toxicity; Warfarin: increased bleeding, dabigatran \tn 
% Row Count 5 (+ 5)
% Row 6
\SetRowColor{white}
Dosage & IV: 150 mg over 10 min; PO: usual maintenance 200-600 mg/day \tn 
% Row Count 8 (+ 3)
% Row 7
\SetRowColor{LightBackground}
Nursing Interventions & monitor PT, INR if using warfarin; Monitor ECG, BP continuously; Monitor for adverse effects \tn 
% Row Count 13 (+ 5)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Atropine}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Pharm: anticholinergic Ther: antiarrhythmics \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Action & Blocks acetylcholine at parasympathetic neuroeffector sites; increases cardiac output, heart rate by blocking vagal stimulation in heart; dries secretions by blocking vagus \tn 
% Row Count 10 (+ 8)
% Row 2
\SetRowColor{LightBackground}
Indications & Bradycardia, bradydysrhythmia, reversal of anticholinesterase agents, decreasing secretions before surgery, antispasmodic with GU and biliary surgery, bronchodilator, AV heart block, rapid-sequence intubation \tn 
% Row Count 20 (+ 10)
% Row 3
\SetRowColor{white}
Adverse Effects & tachycardia, dysrhythmias, constipation, sedation, urinary retention \tn 
% Row Count 24 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\seqsplit{Contraindications/} Precautions & angle-closure glaucoma; caution: severe renal/hepatic dysfunction, hiatal hernia assoc. w/ reflux esophagitis, intestinal atony, GI/GU obstruction, severe ulcerative colitis \tn 
% Row Count 32 (+ 8)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Atropine (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
Interactions & additive anti-cholinergic effects w/ other drugs that possess same side effects (amantadine, antihistamines, tricyclic antidepressants); increased effects of digoxin when combined \tn 
% Row Count 9 (+ 9)
% Row 6
\SetRowColor{white}
Dosage & IV 0.5- 1 mg q3-5 min (max 3 mg) \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{LightBackground}
Nursing Interventions & Monitor I\&O ratio; Monitor ECG; Monitor for bowel sounds; Monitor respiratory status \& cardiac status; Beers: Avoid in older adults \tn 
% Row Count 17 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Dopamine}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Ther: Agonist, vasopressor, inotropic agent Pharm: Catecholamine \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
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 \tn 
% Row Count 15 (+ 12)
% Row 2
\SetRowColor{LightBackground}
Indications & Shock; to increase perfusion; hypotension, cardiogenic/septic shock \tn 
% Row Count 18 (+ 3)
% Row 3
\SetRowColor{white}
\seqsplit{Contraindications/Precautions} & CI: Hypersensitivity, Vfib, tachydysrhythmias, pheochromocytoma, hypovolemia; Precautions: OB/Lactation, geriatric, arterial embolism, PVD, sulfite hypersensitivity, acute MI; BLACK BOX WARNING: Extravasation \tn 
% Row Count 28 (+ 10)
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & Palpitations, tachycardia, HTN, ectopic beats, angina, wide QRS complex, Necrosis, tissue sloughing w/extravasation, gangrene, headache, diarrhea \tn 
% Row Count 35 (+ 7)
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\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Dopamine (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
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 \tn 
% Row Count 13 (+ 13)
% Row 6
\SetRowColor{white}
Dosage & IV 1-50 mcg/kg/min \tn 
% Row Count 14 (+ 1)
% Row 7
\SetRowColor{LightBackground}
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 \tn 
% Row Count 28 (+ 14)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Magnesium Sulfate  {\emph{HIGH ALERT}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Func. \seqsplit{class: ​Electrolyte;} anticonvulsant, laxative, saline; antacid \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
Action & Increases osmotic pressure, draws fluid into colon, neutralizes HCl \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
Indications & Constipation, bowel prep, anticonvulsant, preterm labor, \seqsplit{preeclampsia/eclampsia;} tx of torsades, adjunct tx for bronchodilation in moderate-severe acute asthma \tn 
% Row Count 14 (+ 7)
% Row 3
\SetRowColor{white}
\seqsplit{Contraindications/Precautions} & CI: Hypersensitivity, abdominal pain, N/V, obstruction, acute surgical abdomen, rectal bleeding, heart block, myocardial damage; Precautions: Pregnancy, renal disease/cardiac disease \tn 
% Row Count 22 (+ 8)
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & respiratory depression/paralysis, bradycardia, hypotension, hypothermia, arrhythmias, diarrhea, prolonged bleeding times, cramps \tn 
% Row Count 28 (+ 6)
% Row 5
\SetRowColor{white}
Interactions & Antihypertensives (CCB): increased hypotension; Antiinfectives (fluoroquinolones, tetracyclines): decreased absorption; Neuromuscular blockers: increased effects; Digoxin: decreased effect of digoxin; Nitrofurantoin: decreased absorption \tn 
% Row Count 39 (+ 11)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Magnesium Sulfate  {\emph{HIGH ALERT}} (cont)}}  \tn
% Row 6
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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; \seqsplit{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 \tn 
% Row Count 15 (+ 15)
% Row 7
\SetRowColor{white}
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 \tn 
% Row Count 29 (+ 14)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Sodium Bicarbonate}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Pharm: alkalinizing agent; Ther: anti ulcer agent \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
Action & acts as an alkalinizing agent by releasing bicarbonate ions; oral admin, releases bicarbonate which neutralizes gastric acid \tn 
% Row Count 9 (+ 6)
% Row 2
\SetRowColor{LightBackground}
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 \tn 
% Row Count 18 (+ 9)
% Row 3
\SetRowColor{white}
\seqsplit{Contraindications/Precautions} & CI: Respiratory/metabolic alkalosis, hypochloremia, hypocalcemia; Precautions: Pregnancy, HF, cirrhosis, toxemia, renal disease, HTN, hypokalemia, lactation, hypernatremia, Cushing's syndrome, children \tn 
% Row Count 27 (+ 9)
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & metabolic alkalosis, edema, tetany, gastric distention \tn 
% Row Count 30 (+ 3)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Sodium Bicarbonate (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
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) \tn 
% Row Count 14 (+ 14)
% Row 6
\SetRowColor{white}
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 \tn 
% Row Count 26 (+ 12)
% Row 7
\SetRowColor{LightBackground}
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) \tn 
% Row Count 43 (+ 17)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Etomidate HIGH ALERT}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Pharm: nonbarbiturates; Ther: general anesthetics \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
Action & Hypnotic CNS depressant w/out analgesic activity \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
Indications & induction of general anesthesia; supplemental anesthesia w/other agents (nitrous oxide) for short procedures \tn 
% Row Count 11 (+ 5)
% Row 3
\SetRowColor{white}
\seqsplit{Contraindications/Precautions} & CI: Hypersensitivity, prolonged infusion not recommended (surpasses cortisol production), Pregnancy, L\&D; Precautions: severe stress (may require supplemental corticosteroids), geriatric, lactation, children \textless{} 10yr \tn 
% Row Count 21 (+ 10)
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & apnea, laryngospasm, transient skeletal muscle movements, hypo/hypertension, arrhythmias, hypo/hyperventilation \tn 
% Row Count 26 (+ 5)
% Row 5
\SetRowColor{white}
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 \tn 
% Row Count 38 (+ 12)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Etomidate HIGH ALERT (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
Dosage & IV 0.2-0.6 mg/kg (usual 0.3 mg/kg) for induction \tn 
% Row Count 3 (+ 3)
% Row 7
\SetRowColor{white}
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 \tn 
% Row Count 18 (+ 15)
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\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Succinylcholine Trade: Anectine, Quelicin}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Func. \seqsplit{class: ​Neuromuscular} blocker (depolarizing—ultra short) \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
Action & Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, antagonizing action of acetylcholine; causes release of histamine \tn 
% Row Count 10 (+ 7)
% Row 2
\SetRowColor{LightBackground}
Indications & Facilitation of endotracheal intubation, skeletal muscle relaxation during orthopedic manipulations \tn 
% Row Count 15 (+ 5)
% Row 3
\SetRowColor{white}
\seqsplit{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, \seqsplit{renal/hepatic/cardiac/respiratory} disease, hyperkalemia; BBW: Myopathy, rhabdomyolysis, children \textless{}2 yr \tn 
% Row Count 30 (+ 15)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Succinylcholine Trade: Anectine, Quelicin (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & Apnea, hyperkalemia, rhabdomyolysis, anaphylaxis, malignant hyperthermia, arrhythmias, bradycardia, hypotension, bronchospasm \tn 
% Row Count 6 (+ 6)
% Row 5
\SetRowColor{white}
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 \tn 
% Row Count 22 (+ 16)
% Row 6
\SetRowColor{LightBackground}
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) \tn 
% Row Count 31 (+ 9)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Succinylcholine Trade: Anectine, Quelicin (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
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 \tn 
% Row Count 17 (+ 17)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Propofol Trade: Diprivan}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Ther: general anesthetics Func: hypnotic \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Action & Produces dose-dependent CNS depression by activation of GABA receptor; short-acting hypnotic; produces amnesia \tn 
% Row Count 7 (+ 5)
% Row 2
\SetRowColor{LightBackground}
Indications & Induction or maintenance of anesthesia as part of balanced anesthetic technique; sedation in mechanically ventilated patients \tn 
% Row Count 13 (+ 6)
% Row 3
\SetRowColor{white}
\seqsplit{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 \tn 
% Row Count 22 (+ 9)
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & apnea, bradycardia, hypo (more common)/hypertension, green urine, burning pain or stinging at IV site, PROPOFOL INFUSION SYNDROME \tn 
% Row Count 28 (+ 6)
% Row 5
\SetRowColor{white}
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 \tn 
% Row Count 42 (+ 14)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Propofol Trade: Diprivan (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
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 \tn 
% Row Count 6 (+ 6)
% Row 7
\SetRowColor{white}
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 \tn 
% Row Count 21 (+ 15)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Naloxone  Trade: Narcan}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Ther: antidote; Pharm: opioid antagonist \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Action & Competively blocks effects of opioids, including CNS \& respiratory depression, without producing any agonist (opioid-like) effects \tn 
% Row Count 8 (+ 6)
% Row 2
\SetRowColor{LightBackground}
Indications & Reversal of CNS \& respiratory depression because of suspected opioid OD \tn 
% Row Count 12 (+ 4)
% Row 3
\SetRowColor{white}
\seqsplit{Contraindications/Precautions} & CI: Hypersensitivity ; Precautions: CV disease, pt physically dependent on opioids, OB/lactation, pediatrics \tn 
% Row Count 17 (+ 5)
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & Ventricular arrhythmias, hypo/hypertension, N/V \tn 
% Row Count 20 (+ 3)
% Row 5
\SetRowColor{white}
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 \tn 
% Row Count 29 (+ 9)
% Row 6
\SetRowColor{LightBackground}
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 \tn 
% Row Count 35 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Naloxone  Trade: Narcan (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
Nur & Monitor respiratory status, pulse, ECG, BP, \& LOC frequently for 3-4h after the expected peak of blood concentrations; pt receiving opioids \textgreater{}1wk have increased sensitivity to effects, dilute \& admin in slow increments; Assess pain level in post-op respiratory depression; Assess s/s of withdrawal \tn 
% Row Count 13 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diltiazem Trade: Cardizem}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Pharm: CCB; Ther: antianginal, Class IV antiarrhythmics, antihypertensive \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
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 \tn 
% Row Count 18 (+ 14)
% Row 2
\SetRowColor{LightBackground}
Indications & HTN; angina pectoris \& vasospastic (Prinzmental's) angina; Supraventricular tachyarrhythmias and rapid ventricular rates in atrial flutter or fibrillation \tn 
% Row Count 25 (+ 7)
% Row 3
\SetRowColor{white}
\seqsplit{Contraindications/Precautions} & CI: Sick sinus syndrome, 2nd- or 3rd-degree heart block, Systolic BP \textless{} 90, recent MI or pulmonary congestion; Precautions: OB/Lactation/Pedi, HF, severe renal/hepatic disease, ventricular dysfunction, geriatric \tn 
% Row Count 35 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diltiazem Trade: Cardizem (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & peripheral edema, arrhythmias, HF, SJS, \seqsplit{tachycardia/bradycardia}, hypotension, dyspnea \tn 
% Row Count 4 (+ 4)
% Row 5
\SetRowColor{white}
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 \tn 
% Row Count 25 (+ 21)
% Row 6
\SetRowColor{LightBackground}
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. \tn 
% Row Count 35 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diltiazem Trade: Cardizem (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
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 \tn 
% Row Count 18 (+ 18)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Aspirin}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Ther: antipyretic, nonopioid analgesic; Pharm: salicylates \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
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 \tn 
% Row Count 13 (+ 10)
% Row 2
\SetRowColor{LightBackground}
Indications & Inflammatory disorders including rheumatoid arthritis \& osteoarthritis; mild-moderate pain; fever; prophylaxis of TIAs \& MI \tn 
% Row Count 19 (+ 6)
% Row 3
\SetRowColor{white}
\seqsplit{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 \tn 
% Row Count 29 (+ 10)
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & GI Bleed, dyspepsia, epigastric distress, anaphylaxis, laryngeal edema, tinnitus \tn 
% Row Count 33 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Aspirin (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
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 \tn 
% Row Count 9 (+ 9)
% Row 6
\SetRowColor{white}
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 \tn 
% Row Count 18 (+ 9)
% Row 7
\SetRowColor{LightBackground}
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 \tn 
% Row Count 29 (+ 11)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Nitrogycerin}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Ther: ​Coronary vasodilator, antianginal; Pharm: ​Nitrate \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
Action & Decreases preload and afterload; Increases coronary blood flow by dilating coronary arteries \& improving collateral flow to ischemic regions; produces vasodilation (venous \textgreater{} arterial); reduced myocardial O2 consumption \tn 
% Row Count 13 (+ 10)
% Row 2
\SetRowColor{LightBackground}
Indications & Chronic stable angina pectoris, prophylaxis of angina pain, HF associated with acute MI, controlled hypotension in surgical procedures \tn 
% Row Count 19 (+ 6)
% Row 3
\SetRowColor{white}
\seqsplit{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 \tn 
% Row Count 33 (+ 14)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Nitrogycerin (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & dizziness, headache, hypotension, tachycardia \tn 
% Row Count 2 (+ 2)
% Row 5
\SetRowColor{white}
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 \tn 
% Row Count 16 (+ 14)
% Row 6
\SetRowColor{LightBackground}
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 \tn 
% Row Count 35 (+ 19)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Nitrogycerin (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
Nursing Interventions & Assess location, duration, intensity, \& precipitation factors of angina; Monitor BP \& pulse before/after; Continuous ECG \& BP monitoring for IV use \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Morphine HIGH ALERT}}  \tn
% Row 0
\SetRowColor{LightBackground}
Category Class & Ther: opioid analgesic Pharm: opioid agonist \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Action & Binds to opiate receptors in CNS, alters perception of \& response to painful stimuli while producing generalized CNS depression \tn 
% Row Count 8 (+ 6)
% Row 2
\SetRowColor{LightBackground}
Indications & Moderate to severe pain Unlabeled uses: Agitation, bone/dental pain, dyspnea in end-stage cancer or pulmonary disease, sedation induction, rapid-sequence intubation \tn 
% Row Count 16 (+ 8)
% Row 3
\SetRowColor{white}
\seqsplit{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 \seqsplit{cardio/pulmonary/renal/hepatic} disease, abrupt d/c, seizures; BBW: Accidental exposure, \seqsplit{epidural/intrathecal/IM/SubQ} administration, opioid-naive patients, substance abuse \tn 
% Row Count 33 (+ 17)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Morphine HIGH ALERT (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
Adverse Effects & Respiratory depression/arrest, bradycardia, hypotension, tolerance, dependance \tn 
% Row Count 4 (+ 4)
% Row 5
\SetRowColor{white}
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 \tn 
% Row Count 19 (+ 15)
% Row 6
\SetRowColor{LightBackground}
Dosage & PO regular-release Adult ≥50 kg: ​Initially, 10-30 mg q3-4hr prn; Adult \textless{}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 \textless{}50 kg/geriatric patient: ​May require lower doses and/or extended dosing intervals 0.1 mg/kg q3-4hr, titrate \tn 
% Row Count 40 (+ 21)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.36 cm} x{4.64 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Morphine HIGH ALERT (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
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 \textless{}12/min \tn 
% Row Count 19 (+ 19)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}