2nd semester- Cardiology Flashcards
ADENOSINE (Adenocard)
Classification: Antidysrhythmic
Mechanism of Action: Adenosine can convert SVT to a normal sinus rhythm by blocking conduction through the atrioventricular (AV) node
Indications: paroxysmal supraventricular tachycardia (PSVT), supraventricular tachycardia (SVT) and SVT due Wolff-Parkinson-White (WPW) syndrome.
Contraindications: 2nd or 3rd degree heart block or sick sinus syndrome, A-fib/flutter, V-tach, hypersensitivity, poison-induced tachycardia.
Precautions: May cause prolonged sinus arrest; can induce bronchoconstriction in asthmatics and COPD patients. Lower doses may be ineffective if patient on Theophylline or excessive caffeine use. Pregnancy Category C.
Adverse Reactions: Facial flushing, chest pain, headache, nausea, hypotension.
Dosage/Route:
Adult: 1st dose 6mg, following doses 12mg (Max dose 30mg) Very short half-life (10-12 seconds) so must be given rapid IV push in most proximal port followed immediately by saline flush Pediatric: 0.1-0.2mg/kg (Max single dose 12mg)
AMIODARONE (Cordarone, Pacerone)
Classification: Antidysrhythmic
Mechanism of Action: Blocks sodium and potassium channels of myocardial cells thus prolongs the duration of the action potential and refractory period. Relaxes smooth muscles thus reducing peripheral vascular resistance and increasing coronary blood flow.
Indications: V-fib, Pulseless V-tach, unstable V-tach, and persistent supraventricular tachycardia’s (SVTs) unresponsive to other treatment.
Contraindications: Known hypersensitivity, cardiogenic shock, sinus bradycardia, and 2nd or 3rd degree atrioventricular (AV) block.
Precautions: Hepatic impairment, pregnancy, nursing mothers, children.
Adverse Reactions: Hypotension, bradycardia, prolongation of P-R, QRS, and Q-T intervals. Dosage/Route:
Adults:
V-Fib/Pulseless V-Tach – 300mg IVP/IO, Repeat 150mg IVP in 10 minutes
V-tach with a pulse – 150mg IV/IO infused over 10 minutes, repeat every 10 minutes (Max dose 2.2g/24hr)
Pediatrics:
V-Fib/Pulseless V-Tach -5mg/kg IVP/IO (Max single dose 300mg), Repeat every 10 minutes (Max dose 15mg/kg/24hr)
V-tach with a pulse - Loading dose of 5 mg/kg IV/IO over 20-60 min
(Max single dose 300mg). Can repeat dose up to a max of 15 mg/kg/day.
ATROPINE SULFATE (Atropine)
Classification: Parasympatholytic /Anticholinergic
Mechanism of Action: Inhibits action of acetylcholine at parasympathetic neuroeffector sites. Increases heart rate by blocking action of Vagus nerve.
Indications: Symptomatic sinus bradycardia, organophosphate poisoning
Contraindications: Hypothermic bradycardia; may not be effective in type II second-degree heart block or third-degree AV block; narrow angle glaucoma
Precautions: Myocardial ischemia and hypoxia because it can increase myocardial oxygen demand; Organophosphate poisoning may require excessive doses.
Adverse Effects: Anticholinergic symptoms (dry mouth, blurred vision, urinary retention); flushed, dry skin
Dosage:
Adult:
Unstable bradycardic - 0.5 mg IV/IO push, may repeat in 3-5 min, (Max dose 3mg). Organophosphate poisoning - 2-4 mg or higher may be needed.
Pediatric:
Unstable bradycardic - : 0.02 mg/kg via IV/IO push (Minimum dose .1mg)
Repeat once
(Max total dose – Child .5mg, Adolescent 1mg)
CALCIUM CHLORIDE
Classification: Electrolyte
Mechanism of Action: Calcium chloride increases myocardial contractile force and increases ventricular automaticity.
Indications: Hypocalcemia, hyperkalemia, magnesium sulfate overdose, calcium channel blocker overdose
Contraindications: Hypercalcemia, ventricular fibrillation, digitalis toxicity.
Adverse Reactions: Bradycardia, hypotension, peripheral vasodilation, coronary artery spasm Dosage/Route:
Adult: 500 mg to 1,000 mg (5-10 mL of a 10% solution) IV/IO push.
Pediatric: 20 mg/kg (0.2 mL/kg) slow IV/IO push. Max 1g per dose; may repeat in 10 min
DILTIAZEM (Cardizem)
Classification: Calcium Channel Blocker, Antidysrhythmic
Mechanism of Action: Block influx of calcium ions into cardiac cells; prevents coronary artery spasm. Reduces preload and afterload by causing peripheral vasodilation.
Indications: atrial fibrillation with rapid ventricular rates in, atrial flutter, and re-entry SVT; angina pectoris.
Contraindications: Hypersensitivity, hypotension, sick sinus syndrome, 2nd-or 3rd-degree heart block, cardiogenic shock, wide-complex tachycardias, poison or drug induced tachycardias. Precautions: CHF (especially with beta blockers), conduction abnormalities, renal or hepatic impairment, the elderly; Pregnancy category C; not recommended for pediatrics
Adverse Reactions: Hypotension, bradycardia, blurred vision
Dosage/Route:
Adult: 0.25 mg/kg IV over 2 minutes. Repeat in 15 minutes with 0.35 mg/kg followed by a drip of 5 to 15 mg/hr
FUROSEMIDE (Lasix)
Classification: Loop Diuretic
Mechanism of Action: Inhibits electrolyte reabsorption and promotes excretion of sodium, potassium and chloride.
Indications: Congestive heart failure (CHF), pulmonary edema, hypertensive crisis. Contraindications: Hypovolemia, anuria, hypotension (relative contraindication), hypersensitivity, hepatic coma.
Adverse Reactions: Infants, elderly, hepatic impairment, nephritic syndrome, cardiogenic shock associated with acute MI, gout, patients receiving digitalis or potassium-depleting steroids. Precautions: Hypokalemia, EKG changes, hyponatremia, hyperglycemia (due to hemoconcentration) Dosage/Route:
Adult: 0.5-1.0 mg/kg IV over 1-2 min. No response, repeat and double the dose (2 mg/kg) Pediatric: 1 mg/kg IV/IO.
LABETOLOL (Normodyne)
Classification: Selective Alpha and non-selective Beta adrenergic blocker.
Mechanism of Action: Reduction of blood pressure without reflex tachycardia, decreases total peripheral resistance without affecting cardiac output.
Indications: Moderate to severe acute hypertension crisis.
Contraindications: Bronchial asthma, CHF, cardiogenic shock, 2nd-and 3rd-degree heart block, bradycardia.
Precautions: Pregnancy C, COPD, heart failure, hepatic impairment, diabetes, peripheral vascular disease.
Dosage/Route:
Adult: 10mg slow IV over 2 min; may repeat or double every 10 minutes (Max dose 150mg) Infusion: 2 mg/min titrated to acceptable supine blood pressure.
METOPROLOL (Lopressor)
Classification: Beta-adrenergic receptor blocking agent.
Mechanism of Action: Primarily Beta-1 blocking activity with Beta-2 blocking at higher doses. Indication: Suspected ACS, provided heart rate is >80 and systolic pressure >120 Contraindications: Heart rate <45 in setting of AMI, 2nd and 3rd degree heart blocks, systolic pressure <100 mm/Hg
Precautions: Pregnancy C, impaired hepatic function
Adverse Reactions: Vertigo, tiredness, headache, dizziness, dyspnea, nausea
Dosage:
Adults: 5mg IV over 1-2 minutes, may repeat every 5 minutes (Max dose 15mg)
NOREPINEPHRINE (Levophed)
Classification: Sympathomimetic
Mechanism of Action: Potent alpha-agonist resulting in intense vasoconstriction; positive chronotropic and increased inotropic effect with increased cardiac output
Indications Cardiogenic shock, significant hypotensive (<70 mm Hg) states (distributive shock, septic shock, etc.)
Contraindications: Hypotensive patients with hypovolemia, pregnancy (relative contraindication). Precautions: Hyperthyroidism, sever heart disease, elderly, MAO inhibitor therapy, patients receiving tricyclic antidepressants. Monitor blood pressure frequently and infuse the drug through the largest vein as it may cause tissue necrosis.
Adverse Reactions: Headache, arrhythmias, tachycardia, angina pectoris, hypertension Dosage:
Adult: 0.5-1mcg/min IV titrated to improve blood pressure (up to 30 mcg/min)
Pediatric: Pediatric: .1-2mcg/min IV infusion, titrated to response.
ASPIRIN (ASA)
Classification: Salicylate; Platelet inhibitor; anti-inflammatory
Mechanism of Action Aspirin inhibits agents that cause the production of inflammation, pain, and fever (Prostaglandin inhibition) with in the peripheral nervous system, lowers body temperature in fever, and inhibits platelet aggregation.
Indications: New onset chest pain suggestive of acute myocardial infarction (AMI) Contraindications: Hypersensitivity. Relatively contraindicated in patients with active peptic ulcer disease, allergy to other NSAID medications, and bleeding disorders.
Precautions: Children or teenagers with varicella or influenza-like symptoms (increases risk of Reye’s syndrome); Pregnancy Category D
Adverse Reactions: GI bleeding, nausea and vomiting
Dosage/Route:
Adult: 160 mg to 325 mg PO (chewed if possible).
NITROGLYCERIN
Classification: Vasodilator
Mechanism of Action: Rapid smooth muscle relaxant (Vasodilator) that also acts on bronchial, uterine, and intestinal smooth muscle; reduces preload and afterload (reduces peripheral vascular resistance) and blood pressure thereby reducing myocardial oxygen demand.
Indications: Acute angina pectoris, hypertension, CHF, pulmonary edema, ischemic chest pain. Contraindications: Hypotension, hypovolemia, intracranial bleeding or head injury, administration of Viagra, Revatio, Levitra (sildenafil), or Cialis (tadalafil) in last 24 hours.
Adverse Effects: Headache, hypotension, syncope, reflex tachycardia, diaphoresis, N/V. Precautions: Nitroglycerin is light sensitive and will lose potency when exposed to the air. Pregnancy Category C, Hypotension in Geriatric population.
Dosage:
Adult:
Tablets - 0.4 mg SL (repeat every 3-5 min to max 3 doses).
Spray - 0.4 mg under tongue (1-2 sprays).
IV infusions - begin at 10mcg/min and increase by 10mcg/min every 3-5 min until desired effect (Max dose 200mcg/min)
NITROPASTE
Classification: Vasodilator
Mechanism of Action: Rapid smooth muscle relaxant (Vasodilator) that also acts on bronchial, uterine, and intestinal smooth muscle; reduces preload and afterload (reduces peripheral vascular resistance) and blood pressure thereby reducing myocardial oxygen demand.
Indications: Acute angina pectoris, hypertension, CHF, pulmonary edema, ischemic chest pain. Contraindications: Hypotension, hypovolemia, intracranial bleeding or head injury, administration of Viagra, Revatio, Levitra (sildenafil), or Cialis (tadalafil) in last 24 hours.
Adverse Effects: Headache, hypotension, syncope, reflex tachycardia, diaphoresis, N/V. Precautions: Nitroglycerin is light sensitive and will lose potency when exposed to the air. Pregnancy Category C, Hypotension in Geriatric population.
Dosage:
Adult: 1/2 to 3/4 inch line (15-30mg) applied to anterior chest, cover with wrap, secure with tape. (Maximum 5 inch line)
