meds

Timolol (Betimol, Timoptic, others)

Therapeutic Class: Antiglaucoma drug

Pharmacologic Class: Miotic; beta-adrenergic antagonist

Timolol lowers IOP by reducing aqueous humor production and is used for open-angle glaucoma; it is usually given twice daily, while Timoptic XE is once daily, with full effects in 2–4 weeks. Oral timolol is also used for HTN, angina, MI prevention, and migraines.

Propranolol (Inderal LA, InnoPran XL)

Therapeutic Class: Class II antidysrhythmic

Pharmacologic Class: Beta-adrenergic antagonist

Actions/Uses

Propranolol is a nonselective beta blocker that lowers HR, slows cardiac conduction, and decreases BP; it is used for HTN, angina, migraines, and MI prevention.

Administration Alerts

Do not stop suddenly. Taper over 1–2 weeks. Swallow extended-release tablets whole. Notify the provider if pulse <60 bpm.

Adverse Effects

⚠ Black Box Warning: Abrupt withdrawal can worsen ischemic heart disease, angina, or cause MI.

Treatment of Overdose

Treat hypotension with vasopressors and bradycardia with atropine or isoproterenol. IV glucagon can reverse beta-blocker cardiac depression.

Metoprolol (Lopressor, Toprol XL)

Therapeutic Class: Drug for heart failure and HTN

Pharmacologic Class: Beta1-adrenergic blocker

Actions/Uses

Metoprolol is a selective beta1 blocker that decreases sympathetic stimulation and cardiac workload. It is used for HF, HTN, angina, and reducing complications after MI.

Administration Alerts

Monitor ECG, BP, and pulse with IV use. Check BP and pulse before oral doses. Hold if pulse <60 bpm or hypotension. Use lower doses in older adults.

Adverse Effects

⚠ Black Box Warning: Do not stop suddenly because it can worsen angina or cause MI. Taper over 1–2 weeks.

Treatment of Overdose

Overdose can cause bradycardia, hypotension, and bronchospasm. Treat with vasopressors/volume expanders for low BP and atropine for bradycardia.

Doxazosin (Cardura)

Therapeutic Class: Drug for hypertension and benign prostatic hyperplasia

Pharmacologic Class: Alpha1-adrenergic blocker

Actions/Uses

Doxazosin is an alpha1 blocker that dilates blood vessels to lower BP and relaxes prostate smooth muscle to improve BPH symptoms.

Administration Alerts

Give at bedtime to prevent excessive hypotension and the first-dose phenomenon. Use caution in older adults due to increased risk of orthostatic hypotension.

Adverse Effects

Common effects include dizziness, fatigue, headache, and orthostatic hypotension.

Treatment of Overdose

Overdose causes hypotension; treat with IV fluids or a vasopressor.

Atenolol (Tenormin)

Therapeutic Class: Drug for angina, MI, and HTN

Pharmacologic Class: Beta-adrenergic blocker

Actions/Uses

Atenolol is a selective beta1 blocker that slows HR and decreases contractility, lowering myocardial oxygen demand. Used for HF, HTN, angina, and MI.

Administration Alerts

Check BP and pulse before giving. Hold if pulse <60 bpm or hypotension. Avoid during pregnancy/lactation unless benefits outweigh risks.

Adverse Effects

⚠ Black Box Warning: Do not stop abruptly in patients with ischemic heart disease. Taper over 1–2 weeks to prevent worsening angina or MI.

Treatment of Overdose

Overdose causes hypotension and bradycardia. Treat bradycardia with atropine or isoproterenol. Atenolol can be removed by hemodialysis.

Epinephrine (Adrenalin)

Therapeutic Class: Drug for anaphylaxis and shock

Pharmacologic Class: Nonselective adrenergic agonist; vasoconstrictor

Actions/Uses

Epinephrine is a nonselective alpha/beta agonist used mainly for anaphylaxis. Alpha1 raises BP, beta1 increases cardiac output, and beta2 causes bronchodilation.

Administration Alerts

Extravasation can cause serious tissue injury. Monitor carefully after injection because effects can occur rapidly.

Adverse Effects

Common effects include nervousness, tremors, palpitations, tachycardia, dizziness, and headache. Serious effects include HTN and dysrhythmias.

Treatment of Overdose

Use alpha- and beta-blockers. A vasodilator may be given if BP remains high.

Norepinephrine (Levophed)

Therapeutic Class: Drug for shock

Pharmacologic Class: Nonselective adrenergic agonist: vasoconstrictor

Actions and Uses

Norepinephrine is a sympathomimetic that acts directly on alpha-adrenergic receptors in vascular smooth muscle to immediately raise blood pressure. To a lesser degree, it also stimulates beta1-receptors in the heart, thus producing a positive inotropic response that may increase cardiac output. Its primary indications are acute shock and cardiac arrest. Norepinephrine is a preferred vasoconstrictor for septic shock because it has been shown to decrease mortality. It is given by the IV route and has a duration of only 1 to 2 minutes after the infusion is terminated.

Administration Alerts

Start an infusion only after ensuring the patency of the IV and monitor the flow rate continuously.

If extravasation occurs, administer phentolamine to the area of infiltration as soon as possible.

Do not abruptly discontinue infusion. This drug causes fetal harm in pregnant laboratory animals; however, its effects on human pregnancy and lactation are not known.

Adverse Effects

Black Box Warning: Extravasation may cause serious skin and soft tissue injury; the affected area should be infiltrated immediately with 5–10 mg of phentolamine, an adrenergic blocker.

Treatment of Overdose

Discontinuing the infusion usually results in a rapid reversal of adverse effects, such as HTN.

Dopamine

Therapeutic Class: Drug for shock

Pharmacologic Class: Nonselective adrenergic agonist; inotropic drug

Actions/Uses

Dopamine is a dose-dependent adrenergic agonist used for hypovolemic and cardiogenic shock. Low doses increase renal blood flow, while higher doses increase cardiac output and BP.

Administration Alerts

Check IV patency and monitor continuously. If extravasation occurs, give phentolamine immediately.

Adverse Effects

⚠ Black Box Warning: Extravasation can cause serious tissue injury. Infiltrate the area immediately with 5–10 mg phentolamine.

Treatment of Overdose

Stop the infusion; adverse effects usually reverse quickly. Phentolamine may be used for severe HTN.

Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA, VoSpire ER)

Therapeutic Class: Bronchodilator

Pharmacologic Class: Beta2-adrenergic agonist

Actions/Uses

Albuterol is a SABA (beta2 agonist) used for rapid relief of acute asthma bronchospasm. It can also prevent exercise-induced bronchospasm when taken 15–30 minutes before exercise.

Administration Alerts

Oral forms are not for acute asthma attacks because they work more slowly. SABAs are not recommended for asthma prophylaxis.

Adverse Effects

Common effects include tremor, nervousness, restlessness, tachycardia, palpitations, headache, and throat irritation. Rare effects include paradoxical bronchospasm and allergic reactions.

Prazosin (Minipress)

Therapeutic Class: Antihypertensive

Pharmacologic Class: Adrenergic-blocking drug

Actions/Uses

Prazosin is a selective alpha1 blocker that decreases peripheral resistance and lowers BP. It is mainly used for HTN, often with other drugs.

Administration Alerts

Give a low first dose at bedtime to prevent severe hypotension. Usually taken 2–3 times daily.

Adverse Effects

Main effect is orthostatic hypotension, especially after the first dose. Other effects include dizziness, drowsiness, lightheadedness, nasal congestion, and reflex tachycardia.

Treatment of Overdose

Overdose causes hypotension. Treat with IV fluids or vasopressors such as dopamine or dobutamine.

Phenylephrine (Neo-Synephrine, Vazculep)

Therapeutic Class: Nasal decongestant; mydriatic drug; antihypotensive

Pharmacologic Class: Adrenergic drug (sympathomimetic)

Actions/Uses

Phenylephrine is a selective alpha agonist that causes vasoconstriction. It is used as a nasal decongestant, eye dilator, and to treat hypotension.

Administration Alerts

Extravasation can cause tissue injury. Ophthalmic drops may damage contact lenses. Use caution during pregnancy.

Adverse Effects

Possible effects include burning, rebound congestion, narrow-angle glaucoma, reflex bradycardia, anxiety, restlessness, and tremors. High doses can cause HTN.

Treatment of Overdose

Overdose can cause tachycardia and HTN. Treat with an alpha blocker such as phentolamine.

Atropine (Atropen)

Therapeutic Class: Drug for treatment of bradycardia, antidote for anticholinesterase poisoning

Pharmacologic Class: Anticholinergic, muscarinic receptor blocker

Actions/Uses

Atropine is an anticholinergic/muscarinic blocker that increases HR, causes bronchodilation, decreases GI motility and secretions, and causes pupil dilation. Used for bradycardia, cholinergic poisoning, GI disorders, and pupil dilation.

Administration Alerts

Use atropine as an antidote for cholinergic poisoning, including organophosphate poisoning.

Adverse Effects

Common effects include dry mouth, constipation, urinary retention, and increased HR. Severe toxicity can cause delirium or coma.

Treatment of Overdose

Physostigmine is the antidote for atropine overdose. Diazepam or a short-acting barbiturate may be used for seizures.

Physostigmine

Therapeutic Class: Antidote for anticholinergic toxicity

Pharmacologic Class: Acetylcholinesterase inhibitor

Actions/Uses

Physostigmine is an acetylcholinesterase inhibitor that increases ACh and reverses severe anticholinergic toxicity, such as from atropine, diphenhydramine, and deadly nightshade.

Administration Alerts

Usually given IM or IV. It is not a first-line drug for anticholinergic toxicity.

Adverse Effects

May cause hypersensitivity or cholinergic crisis.

Treatment of Overdose

Keep atropine available to treat cholinergic crisis.

Ipratropium (Atrovent)

Therapeutic Class: Bronchodilator

Pharmacologic Class: Anticholinergic

Actions/Uses

Ipratropium is an anticholinergic bronchodilator used mainly for COPD bronchospasm. It can be combined with albuterol and used for severe asthma exacerbations. Nasal spray relieves runny nose but does not decongest.

Administration Alerts

Available by inhalation and intranasal routes. Nasal treatment is limited to 3 weeks.

Adverse Effects

Common effects include cough, dry mouth/nose, hoarseness, bitter taste, and nosebleeds (epistaxis).

Bethanechol (Duvoid, Urecholine)

Therapeutic Class: Drug to treat urinary retention

Pharmacologic Class: Muscarinic cholinergic receptor drug

Actions/Uses

Bethanechol is a direct cholinergic agonist that stimulates muscarinic receptors and increases smooth-muscle contraction. It is used for nonobstructive urinary retention and decreased GI motility.

Administration Alerts

Usually given orally. It is poorly absorbed from the GI tract.

Treatment of Overdose

Atropine is the specific antidote. Give subcutaneously, or IV in emergencies.

vitamin k

Reverse warfarin (Coumadin; another blood thinner) overdose

Protamine sulfate

Reverse heparin (a blood thinner) overdose

Naloxone (Narcan, Evzio)

Reverse opioid (ex. morphine, heroin, fentanyl) overdose

Flumazenil

Reverse “benzo”diazepine (ex. Xanax) overdose

Digoxin immune Fab (Digibind)

Reverse digoxin overdose

Acetylcysteine (Acetadote)

Reversal for acetaminophen (Tylenol) overdose