5. Atenolol :6. Atorvastatin:7. Atracrium:8. Atropine sulfate:

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5.      Atenolol :

Trade name: Normatin

Class: Beta-adrenergic blocking agent   

   Pregnancy: (Category D)

      

 Action: Beta-adrenoceptor blocking " anti hypertensive, anti anginal"

Uses:

·         Hypertension.     

·         Angina pectoris.      

Dose: by mouth, Hypertension, 50 mg daily (higher doses rarely necessary)
Angina, 100 mg daily in 1 or 2 doses                                                
Arrhythmias, 50–100 mg daily      
 By intravenous injection, arrhythmias, 2.5 mg at a rate of                                            1 mg/minute, repeated at 5-minute intervals to a max. Of 10 mg

Contraindications:

·         Bradycardia, C.H.F., cardiogenic shock, diabetes, thyrotoxicosis, chronic bronchitis, asthma, bronchospasm, emphysema.

Side effects:

·         Bradycardia, C.H.F., hypotension, cold extremities (due to peripheral vasoconstriction), edema, dyspnia, shortness of breath, nausea, vomiting, hepatomegaly and bronchospasm.

Nursing considerations:

• For IV use, the drug may be diluted in sodium chloride, dextrose, on dextrose saline.
• Instruct patient/family to take blood pressure and pulse.
• Provide written instructions as when to call physician (e.g. HR below 50 beat/min).
• Instruct patient to dress warmly during cold weather.

• Diabetic patient should be very careful about symptoms of hypoglycemia.

• Report any asthma-like symptoms.

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6.      Atorvastatin:

Trade name: Lipitor

Class: Antihyperlipidemic Statins  

Pregnancy: (Category X)

Action: lowers the level of cholesterol in the blood by reducing the production of cholesterol by the liver.

Uses:

·         Preventing and treating atherosclerosis.

Dose

Primary hypercholesterolemia and combined hyperlipidaemia,                                    usually 10 mg once daily     
   Familial hypercholesterolemia, initially 10 mg daily, increased                                   at intervals of at least 4 weeks to 40 mg once daily; if necessary,                                  further increased to max. 80 mg once daily

Contraindications:

·         Allergy to atorvastatin, fungal byproducts, active liver disease or unexplained and persistent elevations of transaminase levels, pregnancy, lactation.

·         Use cautiously with impaired endocrine function

Side effects:

·         CNS: Headache, asthenia

·         GI: Flatulence, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver failure

·         Respiratory: Sinusitis, pharyngitis.

·         Other: Rhabdomyolysis with acute renal failure, arthralgia, myalgia

Nursing considerations:

• Obtain liver function tests as a baseline and periodically during therapy.
• Withhold atorvastatin in any acute, serious condition (severe infection, hypotension, major surgery, trauma, severe metabolic or endocrine disorder, seizures)
• Ensure that patient has tried cholesterol-lowering diet regimen for 3---6 mo before beginning therapy.
• Administer drug without regard to food, but at same time each day.
• Consult dietitian regarding low-cholesterol diets.
• Ensure that patient is not pregnant and has appropriate contraceptives available during therapy; serious fetal damage has been associated with this drug.

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7.      Atracrium:

Trade name: Tracrium

Pregnancy: (Category C)

Action: muscle relaxant

Uses:

·         It is used as an adjunct to general anesthesia or sedation in the intensive care unit (ICU), to relax skeletal muscles, and to facilitate tracheal intubations and mechanical ventilation.            

 Dose    :  intravenous injection:  0.3–0.6 mg/kg

                 Maintenance" intravenous infusion" (0.3–0.6 mg/kg hour)
Contraindications:

·         Hypersensitive to atracurium, cisatracurium or benzenesulfonic acid.

Side effects:

·         Skin flushing, mild reduction in blood pressure, and difficulty in breathing.

·         Very rarely anaphylaxis, a severe allergic reaction, can occur when given with one or more anesthetic agents. There have been rare reports of seizures (fits) in ICU patients who usually also had a medical condition that makes them predisposed to having fits, e.g. head injury or brain disease.

Nursing considerations:

·         Always assess past history of surgeries and response to anesthesia

·         Assess past history, allergies, and medications.

·         Assess use of alcohol, illicit drugs, and opioids.

·         Close and frequent observation of the patient and all body systems

          monitor vital signs, ABCs.

·         Monitor for cardiovascular depression, respiratory depression, and complications of anesthesia.

·         Implement safety measures.

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8.      Atropine sulfate:

Trade name: atropine

Class: Cholinergic blocking agent

     Pregnancy: (Category C)

           

Action: It is a parasympatholytic agent which cause relaxation of smooth muscles & inhibition of secretary glands

Uses:

·         Adjunct in peptic ulcer treatment.

·         Irritable bowel syndrome.

·         Treatment of spastic disorders of biliary tract.

·         During anesthesia to control salivation & bronchial secretions.

·         Parkinsonism.

·         Anti-arrhythmic (prophylaxis).

·         Prophylaxis and treatment of toxicity due to cholinesterase inhibitor including organophosphate pesticides.

·         Ophthalmologic treatment of uveitis.

  Dose

Bradydysrhythmia :Adult  0.5-1 mg IV may repeated at 5 min                                      intervals until desired rate achieved " max 0.03- 0.04 mg / kg "          Pediatric 0.02 mg/kg " min dose 0.1 mg , max                                              single dose 0.5 mg for a child and 1 mg for an adolescent.

Asystole & PEA: Adult 1 mg IV may repeated every 3-5 min                                        "max 0.03- 0.04 mg / kg, complete vagal block"

  Pediatric unknown efficacy.

 Endotracheal route: 30 mic/kg diluted in 5 ml NS

Anticholinesterase poisoning: Adult 1-2 mg push every 5-15                                                                        minutes to dry secretions, no max dose

     Pediatric 0.05 mg/kg/dose every 5-15 min

NB

Possible paradoxical bradycardia when pushed slowly or                                               when used at doses less than 0.5 mg

Contraindications:

§  Glaucoma, tachycardia, myocardial ischemia.

§  Prostate hypertrophy, myasthenia gravis, paralytic ileus.

§  Mental impairment, lactation, hepatic disease.

Side effects:

§  Nausea, vomiting, dry mouth, constipation, heartburn,

§  dizziness, drowsiness, headache, insomnia, blurring of vision,

§  Photophobia, flashing, euphoria, hallucination flushing of the skin.

Nursing considerations:

§  Check dosage & measure the drug exactly.

§  Assess for history of asthma, glaucoma, ulcer... etc.

§  Determine the age of the client.

§  Frequent mouth care.

§  Assess client for change in pulse rate.

§  In case of blurring of vision, assist on ambulating & give safety measures.

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