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1.
Adrenaline
' Epinephrine " : Sympathomimetics
Trade name:
Adrenaline
Class: Direct acting-adrenergic agent.
Pregnancy:
(Category C)
Action:
A natural hormone produced from adrenal medulla; induce
marked stimulation of alpha, β1
+ β2 receptors causing
cardiac stimulation, bronchodilation & decongestion.
Uses:
1-
Relief of respiratory distress due to
bronchospasm.
2-
Rapid relief of hypersensitivity
reactions.
3-
Cardiac arrest.
4-
Open- angle glaucoma.
5-
To prolong the action of anesthesia.
6-
Topically to stop bleeding.
Dose:
Available in ampoules of 1ml containing 1 mg
adrenaline
Can be given by I.M injection. I.V. &
S.C.
In CPR "A systole and PEA":
1 in 10 000
(100 micrograms/mL) is recommended in a dose of 10 mL by intravenous
injection, preferably through a central line.
If injected through a peripheral line, the
drug must be flushed with at least
20 mL sodium chloride 0.9% injection (to aid entry into the central
circulation).
In Acute anaphylaxis:
By
intramuscular injection (preferably midpoint in anterolateral thigh) (or by
subcutaneous injection " not generally recommended ' ) of 1 in 1000 (1 mg/mL) solution " when
there is doubt as to the adequacy of the circulation, by slow intravenous injection
of 1 in
10 000 (100 micrograms/mL) solution (extreme caution),
Dose:
IV:
10 micrograms/kg "
1 in 10 000 " as indicated: every 3-5 min"
If endotracheal route:
The used dose should be 3-10 times IV dose and
diluted.
IM injection
Adult 0.5 mg may be repeated several times if
necessary at 5- minute intervals according to blood pressure, pulse and
respiratory function
Infusion:
2-10 mic/min titrated to response.
Contraindications:
§
Narrow angle glaucoma.
§
Shock
§
Lactation.
§
Tachycardia
§
During labor (it may delay the 2nd
8 loge do labor).
Side effects:
§
Fatal ventricular fibrillation.
§
Cerebral hemorrhage
§
urinary retention,
§
headache,
§
necroses at injection side,
§
Blurring of vision, photophobia.
Nursing considerations:
- Never administer 1: 100 solutions IV. Use 1: 1000 mg sol. For I.V. use.
- Use tuberculin (1cc) syringe to measure adrenaline.
- Administer adrenaline using piggyback set to adjust the rate of infusion.
- Administer infusion by electronic infusion device for safety & accuracy.
- Closely monitor patients receiving I.V. adrenaline infusion.
- Note the client for signs of shock “loss of consciousness, clammy, cold skin, cyanosis…. etc.).
- Briskly massage site of S.C. or I.M. injection to hasten the action of the drug.
5.
Aluminium
hydroxide and magnesium hydroxide :
Trade name:
'' Allumag"
Class: Antacids
Pregnancy:
(Category B)
Action: neutralizing or reducing gastric acidity, thus
increasing the pH of the stomach and relieving hyperacidity. If the pH is
increased to 4, the activity of pepsin is inhibited.
Uses:
a. Treatment of hyperacidity. (Heart- burns).
b. Peptic ulcer
c. Duodenal ulcer.
d. Gastroesophaged reflux.
e. hiatus hernia
Dose: 10 mL 3 or 4 times daily of liquid
magnesium–aluminum antacids. Antacids are best given when symptoms occur or are
expected,
usually between meals and at bedtime, 4 or more times daily;
additional doses may be required up to once an hour.
Contraindications:
- Pregnancy
- Children less than 6 years of age.
- Chronic use of aluminum containing antacids may contribute to development of Alzheimer’s disease.
Side effects:
- Constipation, intestinal obstruction, bone pain, muscle weakness.
Nursing considerations:
- It is recommended that most antacids be taken at 3 hours after meals & at bed – time.
- Tablets should be thoroughly chewed before swallowing & followed by a glass of milk or water.
- Shake liquid suspensions thoroughly before pouring the medication .
- Client’s taking aluminum or calcium containing antacids should take 2500-3000 cc of fluids to prevent constipation.
- Advise clients to report persistent diarrhea or constipation physician.
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