ACHIEVERS UNIVERSITY, OWO

NURSING DEPARTMENT

GROUP 5 PROJECT

MATERNAL AND CHILD HEALTH

TOPIC: DRUGS USED IN NEONATAL

NSC 401
DRUGS USED IN NEONATAL RESUSITATION INCLUDE

1. EPINEPHRINE
2. ATROPINE
3. NALOXONE
4. SODIUM BICARBONATE

EPINEPHRINE
TRADE NAME: Adrenalin,
DRUG CLASS: Catecholamine, Sympathomimetic
MECHANISM OF ACTION
Epinephrine stimulates both α1 & α2 and β1 & β2 receptor subtypes on
sympathetic effector cells.
-When given i.v. it is a very potent vasoconstrictor and cardiac stimulant.
-The rise in systolic blood pressure results from a β1 mediated increase in
heart rate and ventricular contractility.
-The rise in diastolic pressure results from stimulation of α1 and α2
receptor mediated vasoconstriction in many vascular beds.
-Epinephrine also stimulates β2 receptors present in skeletal muscle blood
vessels, resulting in their dilation.
-Under physiological conditions, epinephrine released from the adrenal
gland functions as a hormone and, via activation of β2 receptors,
contributes to increased blood flow during exercise.
-β2 stimulation will cause bronchodilation in the lung and activate
glycogenolysis in the liver
-Bradycardia in newly born infants is usually the result of inadequate
aeration of lungs and ventilation or profound hypoxemia and acidosis
from prior poor placental perfusion. Hence, efective ventilation is the top
priority during delivery room resuscitation of the bradycardic newborn.
-Administration of epinephrine helps to increase the mean arterial
pressure and carotid blood flow in asphyxiated bradycardic newborn.
-Current resuscitation guidelines recommend that epinephrine should be
used if the newborn remains bradycardic with heart rate <60bpm after 30s
of what appears to be efective ventilation with chest rise, followed by 30s
of coordinated chest compressions and ventilations
OPTIMAL DOSE AND ROUTE OF ADMINISTRATION
OF EPINEPHRINE:
Epinephrine during neonatal CPR in the delivery room can be given by
three routes:
intravenous, endotracheal (ET), and intraosseous.
1. Intravenous
Preferred route and appear to be more efficacious than other routes
• Dose extrapolated from adult experience
• High-dose epinephrine offers no advantage and is associated with
increased postresuscitation adverse effects and increased mortality
• Dose escalation studies in neonatal animal model with transition
physiology are urgently needed
Dose: 0.01–0.03mg/kg
2. Endotracheal (ET)
. readily available and less time consuming than establishing an
intravenous or intraosseous access.
• Less effective than IV route
• Achieved plasma concentration is less and it peaks slower with ET
epinephrine compared to IV epinephrine.
• Can be used until IV access is available
Recommended dose: 0.05–1mg/kg
3. Intraosseous
• Limited evidence compared to IV route
• Providers frequently involved in newborn resuscitation feel more
comfortable with rapid umbilical venous catheter (UVC) insertion
compared to IO route.
Note: Intramuscular ( currently Not recommended for neonatal CPR)
• Very limited evidence reports indicate that intramuscular
epinephrine of 0.02mg/kg causes significant tissue damage at injection
site
DOSE: 0.01–0.03mg/kg
SIDE EFFECT
Common: tachycardia, tremor,hyperglycaemia
Serious: peripheral ischaemia, overdose or rapid administration can lead
to excessive increase in blood pressure, cerebral haemorrhage, renal
vascular ischemia, pulmonary oedema.
INTERACTION
DO NOT withhold adrenaline because of concerns about drug
interactions.
Adrenaline is an agonist at alpha and beta adrenoreceptors. It can cause
tachycardia, other arrhythmias, hypertension and vasoconstriction; risk is
increased by administration with other medications that also have these
effects.

INDICATIONS
1. A drug of choice for treatment of acute anaphylactic reactions
(hypersensitivity reactions to drugs, animal serums and other allergens).
Its therapeutic effects in this setting include:
-beta-2 mediated bronchodilation
-beta-2 mediated decrease in release of inflammatory mediators by mast
cells & basophils
-alpha-1 & alpha-2 mediated vasoconstriction & resulting decrease of
mucosal edema in the upper airway
-increased blood pressure (to counteract histamine-induced hypotension)
2. A secondary drug for treatment of acute asthmatic attacks to relieve
bronchospasm (selective beta-2 agonists such as albuterol are considered
1st line drugs for this indication, since they have fewer side
effects)
3. Treatment and prophylaxis of cardiac arrest and attacks of transitory
atrioventricular (A-V) heart block with syncopal seizures (Stokes-Adams
Syndrome).
4. Combined with many local anesthetics to reduce the systemic
absorption of anesthetic, and increase their duration of action.
CONTRAINDICATION
-Epinephrine should be used cautiously in
patients with hyperthyroidism, hypertension and cardiac arrhythmias
SIDE EFFECT
Transient and minor side effects of:
-Anxiety
-Tachycardia
-Headache
-Fear and palpitations occur with systemic therapeutic doses
-Adverse effects such as cardiac arrhythmias and excessive rise in blood
pressure may also occur with therapeutic doses or inadvertent overdosage
-Side effects are more likely to be observed in hyperthyroid individuals
NURSING RESPONSIBILITIES
_ monitor Heart Rate (prompt increase is more sensitive indicator for
efficacy),
Breathing , Tone, Oxygen level. _If the heart rate remains below 60 bpm
despite adequate ventilation and 60 seconds of chest compressions,
administration of epinephrine is indicated.
_ Ensure The preferred route of administration which is the intravenous
route is used, at a dose of 0.01 mg/kg (equivalent to 0.1 mL/kg of
1:10,000 concentration) should be followed with a
0.5-1 mL flush of normal saline.
_administration of 0.01 to 0.03 mg/kg doses given intravenously (IV)
every 3 to 5 minutes.
_using endotracheal administration, a number of positive pressure breaths
should be provided to ensure the drug has been effectively dispersed.
_Epinephrine should be Store at room temperature (25°C), And Protect it
from light.
ATROPINE
GROUP: Anticholinergic, Antispasmodic Agents.
SIDE EFFECTS
i. dry mouth,
ii. blurred vision,
iii. sensitivity to light,
iv. lack of sweating,
v. dizziness,
vi. nausea,
vii. loss of balance,
viii. hypersensitivity reactions (skin rash), and
ix. rapid heartrate
INDICATIONS AND DOSAGE
Intramuscular, Intravenous
Organophosphorus poisoning
Child: Infants and children: Initially, 0.05-0.1 mg/kg via IV/IM inj
every 5-10 minutes repeated until muscarinic signs and symptoms
subside.
Ophthalmic
Iritis, Uveitis
Child: <3 kg: 0.1 mg; 7-9 kg: 0.2 mg; 12-16 kg: 0.3 mg; >20 kg: 0.4-
0.6 mg. All doses to be given via IM/SC inj administered 30-60
minutes before anaesthesia.
ADMINISTRATION
May be taken with or without food
NURSING RESPONSIBILITY
1) Reduce lighting to decrease photophobia.
2) Monitor GI motility (BMs and flatus) and urine output while patient is
receiving atropine.
2) Atropine is a common pre-operative agent, and can be given IM, SC,
PO, or IV.

NALOXONE
GENERIC NAME: Naloxone
BRAND NAME: Evzio, Narcan
DRUG CLASS: Opioid Antagonists
ACTIONS
Analog of oxymorphone. A "pure" narcotic antagonist, essentially free of
agonistic (morphine-like) properties. Thus, it produces no significant
analgesia, respiratory depression, psychotomimetic effects, or miosis
when administered in the absence of narcotics and possesses more potent
narcotic antagonist action.
THERAPEUTIC EFFECTS
Reverses the effects of opiates, including
respiratory depression, sedation, and hypotension.
INDICATION
i. Emergency treatment of known or suspected opioid (narcotic) overdose
ii.complete or partial reversal of opioid depression
iii.mild to severe respiratory depression induced by natural and synthetic
opioids including propoxyphene,methadone and certain mixed agonist-
antagonist analgesics.
CONTRAINDICATIONS
Hypersensitivity to Naloxone
SIDE EFFECTS
Side effects of naloxone include:
* Abdominal cramps
* Body aches
* Cardiac arrest
* Diarrhea
* Excess fluid in the lungs (pulmonary
edema)
* Fever
* Goose bumps
* Irritability
* Nervousness
* Restlessness
* Runny nose
* Shivering or trembling
* Shortness of breath
* Sneezing
* Stomach cramping
* Ventricular fibrillation
* Weakness
* Withdrawal reaction precipitated
Yawning
ADVERSE EFFECTS
Body as a Whole: Reversal of analgesia, tremors, hyperventilation, slight
drowsiness, sweating. CV: Increased BP, tachycardia. GI: Nausea,
vomiting.
Hematologic: Elevated partial thromboplastin time.
ROUTE OF ADMINISTRATION
Naloxone is for intravenous, intramuscular or subcutaneous injection. It
may also be administered by intravenous infusion.
DOSAGE OF NALOXONE
Adult and Pediatric Dosage Forms and Strengths
Injectable solution
* 0.4 mg/mL
* 1 mg/mL
IM/SC auto-injector
* 20 mg
Injection, powder for reconstitution
* Neonates: 0.01 mg/kg intravenously (IV)
into umbilical vein/IM/SC; give subsequent
dose of 0.1 mg/kg if needed
* Children: 0.01 mg/kg IV x1; may repeat
with 0.1 mg/kg
NURSING RESPONSIBILITIES
1.Observe patient closely; duration of action of some narcotics may
exceed that of naloxone. Keep physician informed; repeat naloxone dose
may be necessary.
2.May precipitate opiate withdrawal if administered to a patient who is
opiate dependent.
Note: Narcotic abstinence symptoms induced by naloxone generally start
to diminish 20–40 min after administration and usually disappear within
90 min.
3.Monitor respirations and other vital signs.
4.Monitor surgical and obstetric patients closely for bleeding. Naloxone
has been associated with abnormal coagulation test results. Also observe
for reversal of analgesia, which may be manifested by nausea, vomiting,
sweating, tachycardia.

SODIUM BICARBONATE
BRAND NAME: Bakin Soda, Bell-Ans,
Citrocarbonate, Neut, Soda Mint
DRUG CLASS- Alkalinizing agent, Anti ulcer agent
INDICATION- treatment of metabolic acidosis,
At birth for babies who do not start breathing spontaneously
-Management of metabolic acidosis
-Used to alkalinize urine and promote excretion of certain drugs in over
dosage situations
-Used as an antacid
MECHANIS OF ACTION
Sodium Bicarbonate acts as an alkalinizing agent by releasing
bicarbonate ions.
Following oral administration of thismedication, it releases bicarbonate
which is capable of neutralizing gastric acid.
CONTRAINDICATION
-Metabolic or respiratory alkalosis
-Hypocalcemia
-Excessive chloride loss
-It is not recommended as an antidote following ingestion of strong
mineral acids
-Patients on sodium restricted diet
-Renal failure
-Severe abdominal pain of unknown cause especially if associated with
fever
Used cautiously in patients with:
-Congenital heart failure
-Concurrent corticosteroid therapy
-Children with diabetic ketoacidosis because taking sodium bicarbonate
may increase the risk of cerebral edema
-Chronis use as an antacid because it may result to metabolic alkalosis
and possible sodium overload

ROUTE OF ADMINISTRATION -
For neonate it may be administered via the umbilical vein,
Dilute to a maximum concentration of 0.5Eq/mL in a compatible
injection solution.
Administer over 4 to 8 hours in patients with non life threatening
metabolic acidosis.
Infusion rate should generally not exceed 1 mEq/kg/hour
Other route including
Oral route
Intravenous route
Subcutaneous route
SIDE EFFECTS
Frequent urge to urinate
Headache
Loss of appetite
Restlessness
dry nose
DOSE/DOSAGE
For pediatric it is 1mmol/kg slow IV injection(1ml/kg 8.4%).
In premature infant and neonate the 8.4% solution is diluted 1:1 with 5%
dextrose
NURSING RESPONSIBILITIES
1. Assess the client’s fluid balance throughout the therapy. This
assessment includes intake and output, daily weight,
edema and lung sounds.
2. Symptoms of fluid overload should be reported such as hypertension,
edema, difficulty breathing or dyspnea, rales or
crackles and frothy sputum.
3. Signs of acidosis should be assessed such as disorientation, headache,
weakness, dyspnea and hyperventilation.
4. Assess for alkalosis by monitoring the client for confusion, irritability,
paresthesia, tetany and altered breathing pattern.
5. Hypernatremia clinical manifestations should be assessed and
monitored which includes: edema, weight gain, hypertension,
tachycardia, fever, flushed skin and mental irritability.
6. Hypokalemia should also be assessed by monitoring signs and
symptoms such as: weakness, fatigue, U wave on ECG, arrhythmias,
polyuria and polydipsia.
7. IV sites should be observed closely. Extravasation should be avoided
as tissue irritation or cellulitis may occur when taking sodium
bicarbonate.
8. If infiltration occurs, the physician should be notified immediately.
Confer with the doctor or other health care staff regarding warm
compresses and infiltration site with lidocaine or hyaluronidase.
9. Monitor the client’s serum calcium, sodium, potassium, bicarbonate
concentrations, serum osmolarity, acid-base balance and renal function
before and throughout the therapy.
10. For clients taking the medication as a treatment for peptic ulcers it
may be administered 1 and 3 hours after meals and at bedtime.