Copyright © 2008 by F. A. Davis.
MEDS/LABS
Precautions: Use with caution in hypothyroidism, liver or renal impairment, increased ICP, and the elderly.
Nitroglycerin (Nitrostat®) (Antianginal, Nitrate) Indications: Angina, CHF associated with acute MI, cardiac load-reducing agent, hypertensive crisis. Dose: 0.3–0.4 mg SL q 5 min, maximum 3 doses. Contraindications: SBP ⬍90 mm Hg, severe bradycardia, severe tachycardia, Viagra® within 24 hr, RV infarction. Side Effects: Hypotension with secondary tachycardia, syncope, HA, flushed skin. Precautions: Do not mix with other medications, titrate IV form to maintain SBP ⬎90 mm Hg.
Pitocin® (Oxytocin) (Hormone) Indications: Postpartum hemorrhage. Dose: 10 units IM or 10–40 units in 1000 mL saline, LR, or D5W, and infuse at 0.02–0.1 units/min (titrate to effect). Contraindications: Known allergy, incomplete delivery. Side Effects: Anaphylaxis, dysrhythmias, HTN, seizure, coma, hypotension, postpartum hemorrhage, uterine rupture. Precautions: Evaluate for multiple births.
Potassium Chloride (Mineral/Electrolyte) Indications: Hypokalemia. Dose: Hypokalemia (⬎2.5) up to 200 mEq/day as an infusion (not to exceed 20 mEq/hr or a concentration of 40 mEq/L via peripheral line) (up to 80 mEq/L has been used via central line [unlabeled]). Hypokalemia (⬍2) up to 400 mEq/day as an infusion (rate should generally not exceed 20 mEq/hr). Contraindications: Hyperkalemia, severe renal impairment, untreated Addison’s disease, severe tissue trauma. Side Effects: Dysrhythmias including heart block, abdominal pain, N&V, diarrhea, confusion, restlessness, weakness, respiratory paralysis, irritation at IV site. Precautions: Monitor HR, BP, RR, and ECG throughout infusion. Severe pain and tissue necrosis with extravasation. Use with caution in the elderly with cardiac or renal disease.
Procainamide (Pronestyl®) (Antidysrhythmic) Indications: VT, PSVT refractory to adenosine and vagal stimulation, rapid atrial fibrillation in WPW, paroxysmal atrial tachycardia, stable wide-complex tachycardia of uncertain type, maintenance after conversion. Dose: 20 mg/min, maximum 17 mg/kg; maintenance of 1–4 mg/min. Contraindications: 2nd- or 3rd-degree HB, torsades de pointes, lupus, myasthenia gravis, digoxin toxicity, hypersensitivity.
196