PHENYLEPHRINE HYDROCHLORIDE

(fen-ill-ef'rin)
AK-Dilate Ophthalmic, Alconefrin, Isopto Frin, Mydfrin, Neo-Synephrine, Nostril, Rhinall, Sinarest Nasal,
Sinex
Classifications: EYE AND NOSE PREPARATION; ALPHA-ADRENERGIC AGONIST; MYDRIATIC; DECONGESTANT;
THERAPEUTIC: DECONGESTANT; MYDRIATIC; VASOCONSTRICTOR
Prototype: Methoxamine
Pregnancy Category: C

Availability
10 mg chewable tablet; 0.125%, 0.16%, 0.5%, 1% nasal solution; 0.12%, 2.5%, 10% ophthalmic solution; 10 mg/mL
injection

Action
Potent, synthetic, direct-acting sympathomimetic with strong alpha-adrenergic and weak beta-adrenergic cardiac
stimulant actions. Produces little or no CNS stimulation. Elevates systolic and diastolic pressures through arteriolar
constriction. Reduces intraocular pressure by increasing outflow and decreasing rate of aqueous humor secretion.

Therapeutic Effect
Topical applications to eye produce vasoconstriction and prompt mydriasis of short duration, usually without causing
cycloplegia. Nasal decongestant action qualitatively similar to that of epinephrine but more potent and has longer
duration of action.

Uses
Parenterally to maintain BP during anesthesia, to treat vascular failure in shock, and to overcome paroxysmal
supraventricular tachycardia. Used topically for rhinitis of common cold, allergic rhinitis, and sinusitis; in selected
patients with wide-angle glaucoma; as mydriatic for ophthalmoscopic examination or surgery, and for relief of
uveitis.

Contraindications
Severe coronary disease, severe hypertension, atrial fibrillation, atrial flutter, cardiac arrhythmias; cardiac disease,
cardiomyopathy; uncontrolled hypertension; ventricular fibrillation or tachycardia; acute MI, angina; cerebral
arteriosclerosis, MAOI; narrow-angle glaucoma (ophthalmic preparations); labor, delivery; pregnancy (category C).

Cautious Use
Hyperthyroidism; diabetes mellitus; older adult patients; 21 d before or following termination of MAO inhibitor
therapy; lactation. Ophthalmic solution (10%): Cardiovascular disease; diabetes mellitus; hypertension; aneurysms;
infants.

Route & Dosage

Hypotension
Adult: IM/SC 1–10 mg (initial dose not to exceed 5 mg) q10–15min as needed IV 0.1–0.18 mg/min until BP stabilizes;
then 0.04–0.06 mg/min for maintenance
Ophthalmoscopy

See Appendix A

Supraventricular Tachycardia
Adult: IV 0.25–0.5 mg bolus, then 0.1–0.2 mg doses (total max: 1 mg)

Vasoconstrictor
Adult: Ophthalmic See Appendix A–1 Intranasal Small amount of nasal jelly placed into each nostril q3–4h as needed
or 2–3 drops or sprays of 0.25–0.5% solution q3–4h as needed
Child: Intranasal <6 y, 2–3 drops or sprays of 0.125% solution q3–4h as needed; 6–12 y, 2–3 drops or sprays of
0.25% solution q3–4h as needed

Administration
Instillation

 Nasal preparations: Instruct patient to blow nose gently (with both nostrils open) to clear nasal passages before
administration of medication.
 Instillation (drops): Tilt head back while sitting or standing up, or lie on bed and hang head over side. Stay in
position a few minutes to permit medication to spread through nose. (Spray): With head upright, squeeze
bottle quickly and firmly to produce 1 or 2 sprays into each nostril; wait 3–5 min, blow nose, and repeat dose.
(Jelly): Place in each nostril and sniff it well back into nose.
 Clean tips and droppers of nasal solution dispensers with hot water after use to prevent contamination of
solution. Droppers of ophthalmic solution bottles should not touch any surface including the eye.
 Ophthalmic preparations: To avoid excessive systemic absorption, apply pressure to lacrimal sac during and
for 1–2 min after instillation of drops.

Subcutaneous/Intramuscular

 Give undiluted.

Intravenous

 Note: Ensure patency of IV site prior to administration.

PREPARE: Direct: Dilute each 1 mg in 9 mL of sterile water. IV Infusion: Dilute each 10 mg in 500 mL D5W or NS
(concentration: 0.02 mg/mL).

ADMINISTER: Direct: Give a single dose over 60 sec. IV Infusion: Titrate to maintain BP.

INCOMPATIBILITIES Solution/additive: Phenytoin Y-site: Propofol, thiopental.

 Protect from exposure to air, strong light, or heat, any of which can cause solutions to change color to brown,
form a precipitate, and lose potency.

Adverse Effects ( 1%)

Special Senses: Transient stinging, lacrimation, brow ache, headache, blurred vision, allergy (pigmentary deposits
on lids, conjunctiva, and cornea with prolonged use), increased sensitivity to light. Rebound nasal congestion
(hyperemia and edema of mucosa), nasal burning, stinging, dryness, sneezing. CV: Palpitation, tachycardia,
bradycardia (overdosage), extrasystoles, hypertension. Body as a Whole: Trembling, sweating, pallor, sense of
fullness in head, tingling of extremities, sleeplessness, dizziness, light-headedness, weakness, restlessness, anxiety,
precordial pain, tremor, severe visceral or peripheral vasoconstriction, necrosis if IV infiltrates.

Interactions
Drug: ERGOT ALKALOIDS, guanethidine, reserpine, TRICYCLIC ANTIDEPRESSANTS increase pressor effects of
phenylephrine; halothane, digoxin increase risk of arrhythmias; MAO INHIBITORS cause hypertensive crisis; oxytocin
causes persistent hypertension; ALPHA BLOCKERS, BETA BLOCKERS antagonize effects of phenylephrine.

Pharmacokinetics
Onset: Immediate IV; 10–15 min IM/SC. Duration: 15–20 min IV; 30–120 min IM/SC; 3–6 h topical. Metabolism:
In liver and tissues by monoamine oxidase.

Nursing Implications
Assessment & Drug Effects

 Monitor infusion site closely as extravasation may cause tissue necrosis and gangrene. If extravasation does
occur, area should be immediately injected with 5–10 mg of phentolamine (Regitine) diluted in 10–15 mL of
NS.
 Monitor pulse, BP, and central venous pressure (q2–5min) during IV administration.
 Control flow rate and dosage to prevent excessive dosage. IV overdoses can induce ventricular dysrhythmias.
 Observe for congestion or rebound miosis after topical administration to eye.

Patient & Family Education

 Be aware that instillation of 2.5–10% strength ophthalmic solution can cause burning and stinging.
 Do not exceed recommended dosage regardless of formulation.
 Inform the physician if no relief is experienced from preparation in 5 d.
 Be aware that systemic absorption from nasal and conjunctival membranes can occur, though infrequently (see
ADVERSE EFFECTS). Discontinue drug and report to the physician if adverse effects occur.
 Wear sunglasses in bright light because after instillation of ophthalmic drops, pupils will be large and eyes
may be more sensitive to light than usual. Stop medication and notify physician if sensitivity persists beyond
12 h after drug has been discontinued.
 Be aware that some ophthalmic solutions may stain contact lenses.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug
name; Prototype drug
NITROPRUSSIDE SODIUM
(nye-troe-pruss'ide)
Nitropress
Classifications: NONNITRATE VASODILATOR; ANTIHYPERTENSIVE; THERAPEUTIC: ANTIHYPERTENSIVE;
NONNITRATE VASODILATOR
Prototype: Hydralazine
Pregnancy Category: C

Availability
50 mg injection

Action
Potent, rapid-acting hypotensive agent with effects similar to those of nitrates. Acts directly on vascular smooth
muscle to produce peripheral vasodilation, with consequently marked lowering of arterial BP that is associated with
slight increase in heart rate, mild decrease in cardiac output, and moderate lowering of peripheral vascular resistance.

Therapeutic Effect
Effective antihypertensive agent used for rapid reduction of high blood pressure.

Uses
Short-term, rapid reduction of BP in hypertensive crises and for producing controlled hypotension during anesthesia
to reduce bleeding.

Unlabeled Uses
Refractory CHF or acute MI.

Contraindications
Compensatory hypertension, as in atriovenous shunt or coarctation of aorta, and for control of hypotension in patients
with inadequate cerebral circulation; pregnancy (category C), lactation.

Cautious Use
Hepatic insufficiency, hypothyroidism, severe renal impairment, hyponatremia, older adult patients with low vitamin
B12 plasma levels or with Leber's optic atrophy.

Route & Dosage

Hypertensive Crisis
Adult: IV 0.3–0.5 mcg/kg/min (average 3 mcg/kg/min)
Child: IV 1 mcg/kg/min (average 3 mcg/kg/min) (max 5 mcg/kg/min)

Administration
Intravenous

PREPARE: Continuous: Dissolve each 50 mg in 2–3 mL of D5W. Further dilute in 250 mL D5W to yield 200
mcg/mL or 500 mL D5W to yield 100 mcg/mL. Lower concentrations may be desirable depending on patient weight.
Following reconstitution, solutions usually have faint brownish tint; if solution is highly colored, do not use it.
Promptly wrap container with aluminum foil or other opaque material to protect drug from light.

ADMINISTER: Continuous: Administer by infusion pump or similar device that will allow precise measurement of
flow rate required to lower BP. Give at the rate required to lower BP, usually between 0.5–10 mcg/kg/min. DO NOT
exceed the maximum dose of 10 mcg/kg/min nor give this dose for longer than 10 min.

INCOMPATIBILITIES Solution/additive: Amiodarone, propafenone. Y-site: Cisatracurium, haloperidol,

levofloxacin.

 Store reconstituted solutions and IV solution at 15°–30° C (59°–86° F) protected from light; stable for 24 h.

Adverse Effects ( 1%)

Body as a Whole: Diaphoresis, apprehension, restlessness, muscle twitching, retrosternal discomfort. Thiocyanate
toxicity (profound hypotension, tinnitus, blurred vision, fatigue, metabolic acidosis, pink skin color, absence of
reflexes, faint heart sounds, loss of consciousness). CV: Profound hypotension, palpitation, increase or transient
lowering of pulse rate, bradycardia, tachycardia, ECG changes. GI: Nausea, retching, abdominal pain. Metabolic:
Increase in serum creatinine, fall or rise in total plasma cobalamins. CNS: Headache, dizziness. Special Senses:
Nasal stuffiness. Other: Irritation at infusion site.

Interactions
No clinically significant interactions established.

Pharmacokinetics
Onset: Within 2 min. Duration: 1–10 min after infusion is terminated. Metabolism: Rapidly converted to cyanogen
in erythrocytes and tissue, which is metabolized to thiocyanate in liver. Elimination: Excreted in urine primarily as
thiocyanate. Half-Life: (thiocyanate): 2.7–7 d.

Nursing Implications
Assessment & Drug Effects

 Monitor constantly to titrate IV infusion rate to BP response.

 Relieve adverse effects by slowing IV rate or by stopping drug; minimize them by keeping patient supine.
 Notify physician immediately if BP begins to rise after drug infusion rate is decreased or infusion is
discontinued.
 Monitor I&O.
 Lab tests: Monitor blood thiocyanate level in patients receiving prolonged treatment or in patients with severe
kidney dysfunction (levels usually are not allowed to exceed 10 mg/dL). Determine plasma cyanogen level
following 1 or 2 d of therapy in patients with impaired liver function.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug
name; Prototype drug\