Name of Drug for neonatal Resuscitations

Generic Name: Naloxone Trade Name: Narcan

Dosage/Frequency / Timing / Routine
IM, IV, Subcut (Neonates): 0.01 mg/kg; may repeat q 2– 3 min until response obtained. Additional
doses may be given q 1– 2 hr if needed.
Mechanism of Action
Competitively blocks the effects of opioids, including CNS and respiratory depression, without producing
any agonist (opioid-like) effects. Therapeutic Effects: Reversal of signs of opioid excess.
Indication
NARCAN (naloxone) is indicated for the complete or partial reversal of opioid depression, including
respiratory depression, induced by natural and synthetic opioids, including propoxyphene, methadone
and certain mixed agonist-antagonist analgesics: nalbuphine, pentazocine, butorphanol, and
cyclazocine.
Contraindication
NARCAN (naloxone) is contraindicated in patients known to be hypersensitive to naloxone hydrochloride
or to any of the other ingredients in NARCAN (naloxone) .
Adverse Effects
 Rapid Ventricular Heartbeat
 Ventricular Fibrillation, A Heart Rhythm Disorder
 Complete Stoppage of The Heart
 Fluid In the Lungs
 Seizures
 Trouble Breathing
 Decreased Oxygen In The Tissues Or Blood
Nursing Responsibility
 Each nurse is responsible for ensuring they have the appropriate supplies needed to administer
the Naloxone as per the clinical protocol. Each nurse is responsible for checking their Naloxone
supply on a regular basis to ensure that the medication has not expired.
 Be alert for any residual symptoms of respiratory depression, including decreased respiratory
rate, confusion, bluish color of the skin and mucous membranes, and difficult/labored breathing.
Monitor pulse oximetry and perform pulmonary function tests to document whether ventilation
and respiratory function have returned to normal levels.
 Assess vital signs
 Observe patient closely; duration of action of some narcotics may exceed that of naloxone.
Name of Drug for Neonatal Resuscitation
Drug Name: Atropine
Dosage/Frequency / Timing / Routine
Bradycardia
 IV: (Atropine): Neonates 0.02 mg/kg with a minimum of 0.1 mg to a maximum of 0.5 mg
as single dose. May repeat in 5 min. Maximum total dose: 1 mg
Mechanism of Action
Atropine is an antimuscarinic that works through competitive inhibition of postganglionic
acetylcholine receptors and direct vagolytic action, which leads to parasympathetic inhibition of
the acetylcholine receptors in smooth muscle. The end effect of increased parasympathetic
inhibition allows for preexisting sympathetic stimulation to predominate, creating increased
cardiac output and other associated antimuscarinic side effects as described herein.
Indication
Atropine or atropine sulfate carries FDA indications for:
 Anti-sialagogue/anti-vagal effect
 Organophosphate/muscarinic poisoning
 Bradycardia. It was originally synthesized from the plant Atropa belladonna which is
where the drug derives its name.
Contraindication
Atropine generally is contraindicated in patients with:
 Glaucoma
 Pyloric stenosis
 Thyrotoxicosis
 Fever
 Urinary tract obstruction and ileus.
Adverse Effects
 Overdose may produce: Tachycardia, palpitations, hot/dry/flushed skin, absence Of bowel
sounds, increased respiratory Rate, nausea, vomiting, confusion, drowsiness, slurred speech,
dizziness, CNS stimulation.
 Overdose may also produce Psychosis as evidenced by agitation, restlessness, rambling speech,
visual hallucinations nations, paranoid behavior, delusions, Followed by depression. Ophthalmic
Form may rarely produce increased IOP.
Nursing Responsibility
 Determine if pt is sensitive to atropine, Homatropine, scopolamine. Treatment With Atropine
auto injector may be instituted without waiting for lab results.
 Monitor changes in B/P, pulse, temperature. Observe for tachycardia if pt has Cardiac
abnormalities. Assess skin turgor, mucous membranes to evaluate hydration status (encourage
adequate fluid Intake unless NPO for surgery), bowel sounds for peristalsis. Be alert for fever
(increased risk of hyperthermia). Monitor I&O, palpate bladder for urinary retention. Monitor
daily pattern of bowel Activity, stool consistency.
Name of Drug for neonatal Resuscitation
Drug Name: Calcium Chloride
Dosage/Frequency / Timing / Routine
Cardiac Arrest
 IV (Calcium Chloride): Neonates 20 mg/kg. May repeat in 10 min as Necessary.
Mechanism of Action
Calcium chloride increased regional contraction, coronary blood flow, and oxygen consumption before
ischemia, whereas oxygen and lactate extraction were unchanged. After ischemia and reperfusion,
contraction was impaired and lactate extraction was reduced, but a similar response to CaCl2 was
observed.
Indication
Calcium Chloride is a mineral indicated in the immediate treatment of hypocalcemic tetany (abnormally
low levels of calcium in the body that cause muscle spasm). Calcium chloride injection is also used in
cardiac resuscitation, arrhythmias, hypermagnesemia, calcium channel blocker overdose, and beta-
blocker overdose.
Contraindication
 VFib during CPR
 Hypercalcemia
 Risk for digitalis toxicity
 Hypophosphatemia
 Renal calculi
 Intramuscular (IM) or subcutaneous (SC) administration
 Pulseless ventricular tachycardia
Adverse Effects
 Hypercalcemia: Early signs: Constipation, headache, dry mouth, increased thirst, irritability,
decreased appetite, mebotallic taste, fatigue, weakness, depression.

 Later signs: Confusion, drowsiness, hypertension, photosensitivity, arrhythmias, nausea,

vomiting, painful urination.
Nursing Responsibility
 Assess B/P, EKG and cardiac rhythm, renal Function, serum magnesium, phosphate, Potassium.
 Monitor serum BMP, calcium, ionized Calcium, magnesium, phosphate; B/P, Cardiac rhythm,
renal function. Monitor For signs of hypercalcemia.
Name of Drug for neonatal Resuscitation
Drug Name: Dopamine
Dosage/Frequency / Timing / Routine
Acute Hypotension, Shock
 IV Infusion: (Dopamine) NEONATES: 1–20 mcg/kg/min. Titrate to desired response.
Mechanism of Action
Dopamine is a precursor to norepinephrine in noradrenergic nerves and is also a
neurotransmitter in certain areas of the central nervous system. Dopamine produces positive
chronotropic and inotropic effects on the myocardium, resulting in increased heart rate and
cardiac contractility.
Indication
 Hypotension
 Low Cardiac Output
 Poor Perfusion of Vital Organs
Contraindication
Dopamine is contraindicated in patients with:
 Pheochromocytoma
 Uncorrected tachyarrhythmias
 Ventricular fibrillation
 Ventricular tachycardia.
 Reduce the dopamine dose if an increased number of ectopic beats is observed.
Adverse Effects
 High doses may produce ventricular arrhythmias. Pts with occlusive vascular disease
are at high risk for further compromise of circulation to extremities, which may result
in gangrene. Tissue necrosis with sloughing may occur with extravasation of IV
solution.
Nursing Responsibility
 Determine weight (for dosage calculation). Obtain initial B/P, heart rate, respirations.
Assess potency of IV access.
 Continuously monitor for cardiac arrhythmias.
 Assess cardiac output, pulmonary wedge pressure, or central venous pressure (CVP)
frequently.
 Assess peripheral circulation (palpate pulses, note color/temperature of extremities).
 Taper dosage before discontinuing (abrupt cessation of therapy may result in marked
hypotension).
 Be alert to excessive vasoconstriction (decreased urine output, increased heart rate,
arrhythmias, disproportionate increase in diastolic B/P, decrease in pulse pressure); slow or
temp.
Name of Drug for neonatal Resuscitation
Drug Name: Epinephrine
Dosage/Frequency / Timing / Routine
Asystole/Pulseless Arrest (Off-label)
 1:10,000 solution: 0.01 mg/kg (0.1 mg/mL) IO/IV; not to exceed 1 mg; repeat q3-5min
until return of spontaneous circulation
 0.1 mg/kg (0.1 mL/kg of 1:1000 solution; 1 mg/mL) endotracheal; not to exceed 2.5
mg q3-5min until IO/IVP access established or spontaneous circulation achieved;
flush with 5 mL of normal saline immediately after administration
Symptomatic Bradycardia (Off-label)
Neonates (aged <28 days): 0.01-0.03 mg/kg IVP (1:10,000 solution) q3-5min; higher doses
not recommended
Neonate: IV access not available: 0.05-0.1 mg/kg endotracheal tube (1:10,000 soluiton);
lower doses not effective; follow each dose with at least 5 mL isotonic sodium chloride
injection
Mechanism of Action
Initially it was believed that epinephrine causes return of spontaneous circulation (ROSC) in
cardiac arrest via its myocardial stimulant effects (β adrenergic effects: chronotropic and
inotropic). In the 1960s, Redding demonstrated in dogs that the pure α-agonist, methoxamine,
was as effective as epinephrine in achieving ROSC during CPR, whereas the pure β-agonist,
isoproterenol, was no more effective than CPR alone. Otto et al. who used pretreatment with α-
adrenergic blockade (phenoxybenzamine) and β-adrenergic blockade (propranolol) before
infusing epinephrine confirmed that α-adrenergic stimulation is the most important action of
epinephrine for ROSC in CPR.
Indication
 Adjuvant therapy in pts with primary breast Cancer. OFF-LABEL; Esophageal, gastric, Soft
tissue sarcoma; uterine sarcoma.
Contraindication
Hypersensitivity to Epirubicin, previous treatment with anthracyclines up to maximum cumulative
Dose, recent MI, cardiomyopathy and/or HF, severe arrhythmias. Cautions: Renal/
Hepatic/cardiac impairment
Adverse Effects
Excessive doses may cause:
 Acute hypertension
 Arrhythmias
Prolonged/excessive Use may result in metabolic acidosis due to increased serum lactic acid.
Metabolic Acidosis may cause:

 Disorientation
 Fatigue
 Hyperventilation
 Headache
 Nausea
 Vomiting
 Diarrhea
Nursing Responsibility
  Monitor changes of B/P, HR. Assess lung Sounds for rhonchi, wheezing, rales.
 Monitor ABGs. In cardiac arrest, adheret to ACLS protocols.
PATIENT/FAMILY TEACHING
 Avoid excessive use of caffeine.
 Report any new symptoms (tachycardia, Shortness of breath, dizziness) immediately: may
be systemic effects.

Name of Drug for neonatal Resuscitation

Drug Name: Sodium Bicarbonate
Dosage/Frequency / Timing / Routine
Cardiac Arrest
<ALERT> Routine use not recommended.
 IV: (Infants): Initially, 0.5–1 mEq/Kg. Repeat in 10 min one time, or as indicated by pt’s
acid-base status.
Mechanism of Action
The main therapeutic effect of sodium bicarbonate administration is increasing plasma
bicarbonate levels, which are known to buffer excess hydrogen ion concentration, thereby raising
solution pH to combat clinical manifestations of acidosis.
Indication
 Management of metabolic acidosis, gastric hyperacidity. Alkalinization agent for urine;
hyperkalemia treatment; management of overdose of tricyclic antidepressants and
aspirin. OFF-LABEL: Prevention of contrast-induced nephropathy
Contraindication
 Hypernatremia, unknown abdominal pain, hypocalcemia, Severe pulmonary edema
Cautions: HF, Edematous states, renal insufficiency, Cirrhosis.
Adverse Effects
Hypersensitivity reactions including angioedema, Stevens-Johnson syndrome reported. Acute
pancreatitis occurs rarely.
Nursing Responsibility
 Check serum glucose concentration before administration. Assess renal function.
Discuss lifestyle to determine extent of learning, emotional needs. Ensure Follow-up
instruction if pt, family do not Thoroughly understand diabetes management, glucose-
testing technique.
 PATIENT/FAMILY TEACHING:
 Diabetes mellitus requires lifelong control.
 Prescribed diet, exercise are principal part of treatment; do not skip, delay Meals.
 Continue to adhere to dietary Instructions, regular exercise program, Regular
testing of serum glucose. 
 When Taking combination drug therapy or when Glucose demands are altered
(fever, infection, trauma, stress, heavy physical activity), have source of glucose
available to Treat symptoms of hypoglycemia.
 Report nausea, vomiting, anorexia, severe Abdominal pain, pancreatitis.
Name of Drug for neonatal Resuscitation
Drug Classification: Lung Surfactant Generic Name: Calfactant
Dosage/Frequency / Timing / Routine
Respiratory Distress Syndrome (RDS)
 Intratracheal: NEONATES: 3 ml/kg of Birth weight administered as soon as Possible after
birth in 2 doses of 1.5 ml/Kg. Repeat 3-ml/kg doses, up to a total of 3 doses given 12 hrs
apart
Mechanism of Action
Reduces alveolar surface tension, stabilizing the alveoli. Therapeutic Effect:
 Restores surface activity to infant lungs,
 Improves lung compliance
 Respiratory Gas exchange.
Indication
Prevention of respiratory distress syndrome (RDS) in premature infants Younger than 29 wks of
gestational age; Treatment of premature infants younger Than 72 hrs of age who develop RDS
and Require endotracheal intubation.
Contraindication
 Hypersensitivity

Adverse Effects
>10%
Cyanosis (65%)
Airway obstruction (39%)
Bradycardia (34%)
Reflux into ETT (21%)
Requirement for manual ventilation (16%)

1-10%
Reintubation (3%)

Nursing Responsibility