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Epinephrine (adrenaline)

Drugs classes Alphaadrenergic agonist Antashmatic Cardiac stimulant Mydriatic Nasal decongestant Sympathomim etic Vasopressor

Naturally occurring neurotransmitter, the effects of which are mediated by alpha or beta receptors in target organs. Effects on alpha receptors include vasoconstriction, contraction of dilator muscles positive chronotropic and otropic effects on the heart, bronchodilation, vasodilation and uterine relaxation; and decreased production of aqueous humor.

Injection: Relief from respiratory distress of bronchial asthma,chronic bronchitis,emphysema, other COPDs. Arerosol and solutions for nebulization: termporary relief from acute attacks of bronchial asthma, COPDs Topical nasal solution: Temporary relif from nasal and nasopharyngeal mucosal congestion due to a cold, sinusitis hay fever or othe upper respiratory allergies, adjunctive therapy in middle ear infections by decreasing congestion around euthachian ostia.

Contraindicated with allergy or hypersensitivity to epinephrine or components of preparation: narrowangle glaucoma;hypovolemia;general anesthesia with halogenated hydroacarbons or cyclopropane; organic brain damage. Use cautiously with prostatic hypertrophy, history of seixure disorders, psychoneurotic individuals, labor and delivery.

Drugs-drug Increased sympathomimetic effects with other TCAz Excessive hypertension with propranolol,betablockers,furazolidone .decreased cardio stimulating and bronchodilating effects with beta adrenergic blockers.

History of Allergy or hypersensitivity to epinephrine or components of drugs preparation. Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug; small errors in dosage can cause serious adverse effects. Double-check pediatric dosage. Use minimal doses for minimal periods of time epinephrinefastness a form of drug tolerance can occur with prolonged use.

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Nubain Nalburphrine Hydrochloride Drug class Opiod agonistantagonist analgesic

Nalbuphine acts as an agonist at specific opioid receptors in the CNS to produce analgesia and dedation but also acts to cause hallucianations and is an antagonist at mu receptors.

Relief of moderate to severe pain Preopetative analgesia as a supplement to surgical anesthesia and for obstetric analgesia during labor and deliver Unlabeled use: Prevention and treatment of intrathecal morphine- induced pruritus after cesarean section.

Contrainicated with hypersensitivity to nallbuphine, sulfites Use cautiously with emotionally unstable patients or those with a history of narcotic abuse; pregnancy prior to labor( neonatal withdrawal may occur if mothers used drug during pregnancy), labor or delivery use with caution during delivery of premature infants, who are especially sensitive to respiratory drpressant eddetcts of opioids), bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI when nausea and vomiting are presnt, biliary tract suryty.

Sedation, clamminess, sweating, headache,nervousne ss,restlessness,depr ession,crying,confusi on,faintness,hypoten sion,prutitus,nausea, vomiting,Resopirator y depression,asthma

History: hypersensitivity to nalbuphine,sulfites, lactation,emotional instability. Warning Taper dosage when discontinuing after prolonged use to avoid withdrawal symptoms Warning Keep opiod antagonist and facilities for assisted or controlled respiration available in case of respiratory depression. Reassure patient about addiction liability; most patients who receive opiates for medical reasons do not develop dependence syndromes.

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Naloxone Hydrochloride Narcan Drug classess Diagnostic agent Opioid antagonist

Pure opioid antagonist; reverses the effects of opioids, including respiratory depression, sedation, hypotension; can reverse the psychotomimetic and dysphoric effects of narcotic agonistantagonist, such as pentazocine.

Comple or partial reversal of opioid depressin,including respiratory depression induced by opioids,including natural and synthetic narcotics, propoxyphene, methadone,nalbuphine, butorphabil, pentazocine Diagnosis of suspected acute opioid oversose Unabled uses: improvement of circulation in refractory shock, reversal of alcoholic, coma, dementia of ALzaimers pf schizophrenic type

Contraindicated with allergy to opioid antagonists. Use cautiouslty with opioid assiction,CV disorders,pregnancy,lactation

Acute opioid abstinence syndrome: Nausea, vomiting, sweatomg, tachycardia, increased BP, tremulousness CNS: Reversal of analgesia and excitement CV: Hyotension, hypertension, ventricular tachycardia and fibrillation, pulmonary edema

History: Allery to opioid antagonists: piood addiction; CV disorders; lactation Monitor patient continuously after use of naloxone, repeat doses may be needed, depending on duration of opioid and time of last dose. Warning Maintain open airway and provide artificial ventilation, cardiac massage, vasopressor drugs if needed to counteract acute opioid overdose.

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Oxyticin Drug classes Hormone Oxytocic

Synthetic form of an endogenous hormone produced in the hypothalamus and stored in the posterior pituitary: stimulates the uterus,especially the gravid uterus just before parturition and causes myoepithelium of the lacteal glads to contract, which results in milk ejection in lactating women.

Antepartum: to initaiate or improve uterine contractions to achieve early vaginal delivery: stimulation of renforcement of labor in selected cases of uterine inertia: management of inevitable or incomplete abortion; second trimester abortion Postpatum: To produce uterine contractions during the third stage of labor or hemorrhage Lactation deficiency Unlabeled use: to evaluate Fetal distress, treatment of breast engorgement.

Contraindicated with significant cephalopelvic disproportion, unfavorable fetal positions or presentations, obstetric emergencies that favor surgical intervention, prolonged use in severe toxemia, uterine inertia, hypertonic uterine patterns, induction or augmentation of labor when vaginal delivery is contraindicated, previous cesarean section pregnancy.

Cardiac arrhythmias, PVCs, hypertension, subarachnoid hemorrhage Fetal effects: Fetal bradycardia, neonatal jaundice, low Apgar scores. GI: Nausea,vomiting GU: Postpartum hemorrhage,uterine rupture,pelvic hematoma Other: Maternal and featla deaths when used in induce labor or in first or second stages of labor Afibrinogenemia; severe water intoxicatin.

Ensure fetal position and size and absence of complications that are contraindicated with oxytocin before therapy. Health teaching The patient receiving parenteral oxytocin is usually receiving it as part of an immediate medical situation, and the drug teaching should be incorporated into the teaching about delivery. The patient needs to know the name of the drug and what she can expect after it is administered.

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Contraindication and caution Known hypersensitivity to atracurium besylate or any ingredient in the formulation. Warnings

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Tracrium Generic Name: Atracurium Besylate

Actions Produces skeletal muscle relaxation by causing a decreased response to acetylcholine (ACh) at the myoneural (neuromuscular) junction of skeletal muscle. Exhibits high affinity for ACh receptor sites and competitively blocks access of ACh to motor end-plate of myoneural junction; may affect ACh release. Blocks the effects of both the small quantities of ACh that maintain muscle tone and the large quantities of ACh that produce voluntary skeletal muscle contraction; does not alter the resting electrical potential of the motor endplate or cause muscular contractions. Exhibits minimal cardiovascular effects

Uses for Tracrium Skeletal Muscle Relaxation Production of skeletal muscle relaxation during surgery after general anesthesia has been induced. Facilitation of endotracheal intubation. however, succinylcholine generally is preferred in emergency situations where rapid intubation is required. A single dose should not be used in place of succinylcholine for rapid sequence induction of anesthesia (crash intubation). Treatment to increase pulmonary compliance during assisted or

Common Adverse Effects Skin flush.

Adjust dosage carefully according to individual requirements and response. Assess neuromuscular blockade and recovery in patients undergoing anesthesia; a peripheral nerve stimulator is recommended to accurately monitor the degree of muscle relaxation and to minimize the possibility of overdosage. To avoid patient distress, administer only after unconsciousness has been induced.

Respiratory Effects Potential for severely compromised respiratory function and respiratory paralysis. Should be used only by individuals experienced in the use of neuromuscular blocking agents and in the maintenance of an adequate airway and respiratory support. Facilities and personnel necessary for intubation, administration of oxygen, and assisted or controlled respiration should be immediately available. IV cholinesterase inhibitor (e.g., neostigmine, pyridostigmine, edrophonium) should be readily available. (See Reversal of Neuromuscular Blockade

Class: Neuromuscular Blocking Agents

controlled respiration after general anesthesia has been induced. Has been used for facilitation of mechanical ventilation in intensive care settings

under Dosage and Administration.) Use with caution in patients with pulmonary impairment or respiratory depression. Sensitivity Reactions Hypersensitivity Reactions Serious hypersensitivity reactions, including anaphylactic or anaphylactoid reactions, reported. Use with caution and at lower initial doses in patients with a history of severe anaphylactoid reactions.