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قديم 24-11-2012, 10:32 AM   رقم المشاركة : 11
الكاتب

آية بسمله


الملف الشخصي









آية بسمله غير متواجد حالياً


افتراضي

Digoxin

Trade name: Lanoxicaps, Lanoxin, Novo-Digoxin (CAN)

Drug classes
Cardiac glycoside
Cardiotonic agent
Pregnancy: (Category C)

Therapeutic actions
Increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization via a sodium---potassium pump mechanism; this increases force of contraction (positive inotropic effect), increases renal perfusion (seen as diuretic effect in patients with CHF),decreases heart rate (negative chronotropic effect), and decreases AV node conduction velocity

Indications
CHF
Atrial fibrillation
Atrial flutter
Paroxysmal atrial tachycardia

Dose

by mouth, rapid digitalization, 1–15 mg in divided doses over 24 hours; less urgent digitalization, 250–500 micrograms daily (higher dose may be divided), Maintenance, 625–500 micrograms daily (higher dose may be divided) according to renal function and, in atrial fibrillation, on heart-rate response; usual range, 125–250 micrograms daily (lower dose may be appropriate in elderly)
Emergency loading dose by intravenous infusion, 075–1 mg over at least 2 hours then maintenance dose by mouth on the following day

Contraindications
Contraindications: allergy to digitalis preparations, ventricular tachycardia, ventricular fibrillation, heart block, sick sinus syndrome, IHSS, acute MI, renal insufficiency and electrolyte abnormalities (decreased K+, decreased Mg++, increased Ca++)
Use cautiously with pregnancy and lactation

Side effects
CNS: Headache, weakness, drowsiness, visual disturbances
GI: GI upset, anorexia
CV: Arrhythmias

Nursing Considerations
Monitor apical pulse for 1 min before administering; hold dose if pulse <60 in adult or <90 in infant, retake pulse in 1 h If adult pulse remains <60 or infant <90, hold drug and notify prescriber Note any change from baseline rhythm or rate
Check dosage and preparation carefully
Avoid IM injections, which may be very painful
Follow diluting instructions carefully, and use diluted solution promptly
Avoid giving with meals; this will delay absorption
Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, and cardiac monitor on standby in case toxicity develops
Monitor for therapeutic drug levels: 05---2 ng/mL


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قديم 24-11-2012, 10:32 AM   رقم المشاركة : 12
الكاتب

آية بسمله


الملف الشخصي









آية بسمله غير متواجد حالياً


افتراضي

Dobutamine hydrochloride

Trade name: Dobutrex
Drug classes:
• Sympathomimetic
• β1-selective adrenergic agonist
Pregnancy: Category B

Therapeutic actions
Positive inotropic effects are mediated by β1- adrenergic receptors in the heart; increases the force of myocardial contraction with relatively minor effects on heart rate, arrhythmogenesis; has minor effects on blood vessels

Indications
For inotropic support in the short-term treatment of adults with cardiac decompensation due to depressed contractility, resulting from either organic heart disease or from cardiac surgical procedures
Investigational use in children with congenital heart disease undergoing diagnostic cardiac catheterization, to augment CV function

Dosage
Available Forms: Injection 125 mg/mL
Administer only by IV infusion
Titrate on the basis of the patient's homodynamic/renal response
Close monitoring is necessary

Adult
25---15 µg/kg/min IV is usual rate to increase cardiac output; rarely, rates up to 40 µg/kg per minute are needed

IV facts
Preparation: Reconstitute by adding 10 mL Sterile Water for Injection or 5% Dextrose Injection to 250-mg vial If material is not completely dissolved, add 10 mL of diluent Further dilute to at least 50 mL with 5% Dextrose Injection, 09% Sodium Chloride Injection, or Sodium Lactate Injection Store reconstituted solution under refrigeration for 48 h or at room temperature for 6 h Store final diluted solution in glass or via flex container at room temperature Stable for 24 h Do not freeze (Note: drug solutions may exhibit a color that increases with time; this indicates oxidation of the drug, not a loss of potency

Infusion: May be administered through common IV tubing with dopamine, lidocaine, tobramycin, nitroprusside, potassium chloride, or protamine sulfate Titrate rate based on patient response--P, BP, rhythm; use of an infusion pump is suggested
Incompatibilities: Do not mix drug with alkaline solutions, such as 5% Sodium Bicarbonate Injection; do not mix with hydrocortisone sodium succinate, cefazolin, cefamandole, neutral cephalothin, penicillin, sodium ethacrynate; sodium heparin
Y-site Incompatibilities: Do not mix with acyclovir, alteplase, aminophylline, foscarnet

Adverse effects

CNS: Headache
GI: Nausea
CV: Increase in heart rate, increase in systolic blood pressure, increase in ventricular ectopic beats (PVCs), anginal pain, palpitations, shortness of breath

Clinically important interactions
Drug-drug
Increased effects with TCAs (eg, imipramine), furazolidone, methyldopa
Risk of severe hypertension with β-blockers
Decreased effects of guanethidine with dobutamine

Nursing Considerations
Arrange to digitalize patients who have atrial fibrillation with a rapid ventricular rate before giving dobutamine--dobutamine facilitates AV conduction
Monitor urine flow, cardiac output, pulmonary wedge pressure, ECG, and BP closely during infusion; adjust dose/rate accordingly


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قديم 30-06-2013, 06:38 PM   رقم المشاركة : 13
الكاتب

نور الزهراء


الملف الشخصي









نور الزهراء غير متواجد حالياً


افتراضي

موضوع في قمة الروعه
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