ACLS Flashcards
MOA of Epinephrine
May restore electrical activity in asystole.
During resuscitation causes heart to contract faster and more forcefully due to beta stimulation.
Vasoconstriction due to to alpha stimulation.
Bronchodilation due to beta2 effect.
What is epinephrine used for?
all types of cardiac arrest
anaphylaxis
acute asthmatic attacks
When should you be careful in administering epinephrine?
Use with caution in angina, hypertension, hyperthyroidism.
Patients over 40 years old with heart rate greater than 120/min.
When should you be careful in administering epinephrine?
Use with caution in angina, hypertension, hyperthyroidism.
Patients over 40 years old with heart rate greater than 120/min.
What is epinephrine used for?
All types of cardiac arrest
anaphylaxis
acute asthmatic attacks
dosing of epinephrine
1 mg every 3-5 minutes in adult cardiac arrest; follow each dose with a 20 ml flush.
Intraosseous administration
ET capable - 2 to 2.5 mg
epinephrine adverse drug reactions
tachycardia
increased blood pressure
How does epinephrine come?
1 mg in 10 ml
dosing of epinephrine
1 mg every 3-5 minutes in adult cardiac arrest; follow each dose with a 20 ml flush.
Intraosseous administration
ET capable - 2 to 2.5 mg
What is an alternative to epinephrine?
Vasopressin
MOA of Vasopressin
Potent vasoconstrictor effect
Increases contractility of smooth musculature especially of coronary arteries.
What is vasopressin used for?
Alternative vasoconstrictor to epinephrine.
ADRs of vasopressin
arrhythmias MI angioedema bronchoconstriction anaphylaxis
Dose of vasopressin
40 Units IV push
intraosseous administration
MOA of amiodarone
Affects sodium, potassium, and calcium channels which contributes to slowing of conductionand prolongs refractoriness in the AV node.
alpha and beta blocking properties
Lengthens cardiac…
ADR amiodarone
vasodilation
hypotension
negative inotropic effects.
dosing of amiodarone
….
MOA of atropine sulfate
Enhancement of conduction through AV junction by parasympathetic blockade.
What is amiodarone used for?
sinus bradycardia with pulse less than 60 bpm
when accompanied by PVCs , SBP less than 90 mmHg or other signs of decreased profusion.
ADRs of amiodarone
flushing of skin
dryness of mouth
tachycardia
pupillary dilation
dosing of atropine sulfate
500 mcg to 1 mg IV push in bradycardia…..
MOA of adenosine
decreases conduction of electrical impulse through AV node.
What is adenosine used for?
PSVT (narrow complex) refractory to normal vagal maneuvers.
Tachycardia (wide complex) of uncertain type post-lidocaine administration.
ADRs of Adenosine
facial flushing headache dizziness nausea chest pain or tightness brief episodes of bradycardia asystole
dose of amiodarone
6 mg rapid IV push (over 1-3 seconds)
Follow each bolus immediately with 20 ml flush of 0.9% sodium chloride.
What to watch for in amiodarone…
in 2nd to 3rd degree heard block
sick sinus syndrome
dysrhythmias other than PSVT
MOA for diltiazem
Inhibits the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle.
Ability to slow AV nodal conduction time and prolong AV nodal refractoriness.
ADRs of diltiazem
asymptomatic hypotension symptomatic hypotension site reactions vasodilation arrhythmia
diltiazem dose
0.25 mg/kg actual body weight as a bolus administered over 2 minutes - 20 mg is a reasonable dose for the average patient.
Second bolus dose should be 0.35 mg/kg actual body weight administered over 2 minutes - 25 mg is a reasonable dose for the average patient.
What to watch for in diltiazem…
Refractoriness that may rarely result in second- or third-degree AV block…
ADRs of diltiazem
asymptomatic hypotension symptomatic hypotension site reactions vasodilation arrhythmia
diltiazem dose
0.25 mg/kg actual body weight as a bolus administered over 2 minutes - 20 mg is a reasonable dose for the average patient.
Second bolus dose should be 0.35 mg/kg actual body weight administered over 2 minutes - 25 mg is a reasonable dose for the average patient.
Where does diltiazem need to be kept?
In the refrigerator. Not stable at room temperature.
verapamil dose
2.5 to 5 mg IV push over 2 minutes
repeat doses of 5 to 10 mg every 15 minutes to total maximum of 20 mg- alternative 5 mg bolus every 15 minutes……………
