drug list 1

trade name:  actidose, charcola, superchar, instachar, charco-aide, liqui-char

classification:  adsorbent, antidote

action:  when certain chemicals and toxins are in proximity to the activated charcoal, the chemical will attach to the surface of the charcoal and become trapped.

indications:  oral poisonings, toxic ingestion

route:  oral, nasogastric tube, orogastric tube

contraindications:  corrosive materials, caustics (petroleum products), patients with active gastrointestinal bleeding

adverse effects:  nausea, vomiting, abdominal cramping, constipation, or diarrhea

pregnancy:  category C

special considerations:  charcoal may be mixed with sorbitol.  this mixture is used only on the first dose of charcoal.  sorbitol is a cathartic that speeds the transit time through the intestines.  charcoal only binds large molecules.  it is ineffective in binding aspirin, lithium, cyanide, iron, lead, and arsenic.

trade name:  aspergum, bayer, ecotrin, empirin

classification:  nonnarcotic analgesic, antipyretic, antiplatelet, salicylate

Action:  prevents the formation of the chemical thromboxane A2, which causes platelets to clump together, or aggregate, and form plugs that cause obstruction or constriction of small coronary arteries.

indications:  pain, discomfort, fever in adult patients only, chest pain or other signs/syptoms suggestive of an acute coronary syndrome (unless hypersensitive to aspirin) ECG changes suggestive of acute myocardial infarction, unstable angina

routes:  oral

contraindications:  known hypersensitivity to salicylates or other NSAID that has lead to hypotension and/or bronchospasm. bleeding ulcer, hemorrhagic states, bleeding disorders.  children and adolescents (not for kids)

adverse effects:  gastrointestinal bleeding, and phylaxis, angioedema, nausea, vomitting

pregnancy:  category C, except the last 3 months of pregnancy, when it is considered class D

special considerations:  large doses of salicylates have a hypoglycemic action and may enhance the effect of the oral hypoglycemics.  pediatric chewable aspirin is heat and light sensitive.

trade name:  nitrostat, nitrobid (sublingual), tridil (iv)

classification:  vasodilator, organic nitrate, antianginal

action:  relaxes smooth muscle, thereby dilating peripheral arteries and veins; this causes a pooling of venous blood and decreased venous return to the heart, which decreases preload;  nitroglycerine also reduces left ventricular systolic wall tension, which decreases afterload

indications:  sublingual spray or tablets; prophylaxis, treatment, and management of patients with angina pectoris.  pulmonary congestion from left ventricular failure.  
IV; ongoing ischemic chest discomfort.  management of hypertensive emergencies, particularly if related to volume overload.  management of pulmonary congestion from left ventricular failure

routes:  sublingual spray, tablet, IV

contraindications:  viagra (othe ED meds) use within 24-48 hrs.  suspected inferior wal myocardial infarction with possible right ventricular myocardial infarction.  hypotension (less than 90 or 30 less than baseline).  extreme bradycardia (less than 50 beats/min).  tachycardia (more than 100 beats/min).  increased intracranial pressure (head trauma).  uncorrected hypovolemia.  inadequate cerebral circulation.  constrictive pericarditis and precardial tamponade.  known sensitivity.  closed-angle glaucoma

adverse effects:  primary side effect hypotension; other side effects include tachycardia, bradycardia, headache, palpitations, and syncope

pregnancy:  category C

special considerations:  hypotension may worsen myocardial ischemia.  hypotension usually responds to admin of IV fluids.  establishing an IV before giving sublingual nitro is strongly recommended.  when giving nitro for ischemic chest discomfort, assess the patient's pain, duration, time started, activity being performed, quality.  document the patient's response to the meds.  monitor vitals and cardiac rhythm closely before, during, and after giving.  significant hypotension may occur in the presence of right ventricular infarction.  nitro tablets are light, moisture, and heat sensitive.  keep nitro in their original brown bottles.  replace cap quickly after opening.  tablets usually lose potency after 3-4 months.  when giving nitro spray, do not shake the canister before use.  shaking may produce bubbles within the canister, altering delivery of the med.

trade name:  proventil, ventolin

classification:  synthetic sympathomimetic, beta2 agonist, beta-adrenergic stimulator, bronchodilator

action:  binds and stimulates beta2 receptors, resulting in relaxation of bronchial smooth muscle

indications:  bronchospasm associated with chronic bronchitis, emphysema, asthma, anaphylaxis

routes:  nebulized by mouthpiece or inline by mask, metered-dose inhaler, inline by orotracheal or nasotracheal tube

contraindications:  hypersensitivity, cardiac dysrhythmias, angioedema

adverse effects:  dsyrhythmias, palpitations, tachycardia (w/ excessive use), hypertension, angina.  CNS: tremors, anxiety, insomnia, headache, dizziness, restlessness, flushing, irritability, nervousness.  gastrointestinal:  nausea, vomiting, heartburn, irritation of nose and throat.  hyperglycemia, hypocalcemia, hypertension

pregnancy:  category C

special considerations:  assess patient's respiratory rate, tidal volume, breath sounds, heart rate, and blood pressure before, during, and after admin.  ask the patient about meds taken already; if the patient has been using an inhaler, find out how often and when the last dose was taken; consult med direction