ACLS Drugs Flashcards
what are indications for ASA
Chest pain and other S/S of acute MI
unstable angina
pain discomfort fever in adult pt only
what are contraindications for ASA
bleedin ulcer, hemorrhagic state, hemophilia
hypersensitivity to salicylates or other non steroidal anti inflammatories that has led to hypotension and or bronchospasm
peds pts
what are adverse reactions associated with ASA
anaphylactic reactions in sensitive pts, skin eruptions
what is the normal onset of action for ASA
when are peak effects of ASA expected
20-30 mins
2 hours
what is the MOA of adenosine
slows conduction time through AV node, can interrupt re entrant pathways through the AV node
slows sinus rate
larger doses decrease bp by decreasing pvr
what are contraindications for adenosine
2nd 3rd degree block (except pts w/ functioning ventricular pacemaker
caution in pts with asthma
pts on theophylline and related methylxanthines
pts on dipyriamole or carbamazepine
known a fib or flutter
pregnancy
why are dipyridamole and carbamazepine contraindications for adenosine
block uptake and potentiate effects
what does theophylline and methyxanthines do to adenosine
decrease effectiveness
what is the peds dose of adenosine
- 1mg/kg
0. 2mg/kg
what is the duration of action of adenosine
10-12 seconds
what are CV adverse reactions associated with adenosine
transient dysrhythmias (occur in 55% of pts) palpitations chest pressure/pain hypotension transient hypertension facial flushing sweating
what are respiratory adverse reactions associated with adenosine
dyspnea
hyperventilation, bronchospasm
CNS adverse reactions associated with adenosine
lighheadedness, headache, dizziness, paresthesias, apprehension, blurred vision, neck-back pain
what are the indications of use for amiodarone
treatment of defib refractory vf/pvt, torsades,
control stable vtach when cardioversion unsuccessful
rate control in afib/flutter
what conditions contraindicate amiodarone
bradycardia 2nd 3rd degree block unless pacemaker is present cardiogenic shock hpotension pulmonary congestion
what potential adverse reactions are associated with amiodarone
bradycardia, hypotension, asystole, av block, torsades, CHF
nausea, vomiting, abnormal liver function tests
blue skin pigmentation
fever, headache, dizziness, flushing, abnormal salivation, photophobia
what drugs is amiodarone incompatible with
beta blockers, ca channel blockers, other anti arrhythmics can be pro arrhythmic
sodium bicarb, heparin, lasix
when amiodarone is given for VF/pVT how is it administered
IV push over 30-60 seconds
how is amiodarone given when used to treat wide complex tachycardias, afib/flutter, SVT w/cardioversion
mixed in 50ml bag D5W given over 10 mins, can repeat every 10 mins
what is the max dose of amiodarone for peds in a day
15mg/kg/day
what is the peds dose of amiodarone for VF/pVT and for VT w/ pulse
5mg/kg IV push can repeat every 5 mins twice
5mg/kg over 20 mins
what is the half life for amiodarone
may exceed 40 days
what temp must amiodarone be stored below
77F
amiodarone MOA
prolongs action potential, refractory period
ventricular automaticity K
slows membrane depolarization and impulse conduction NA
negative chrono activity in nodal tissue, antisympathetic activity, dilate coronary arteries CA, Beta
contraindications for atropine
2nd 3rd degree block renal and hepatic disease glaucoma (relative) obstructive GI disease asthma thyrotoxicosis
atropine is pregnancy risk category
C
what are the major adverse reactions associated with atropine
tachydysrythmias, flushing, ventricular irritability, exacerbation/initiation of angina, acute narrow angle glaucoma, blurred vision, mydriasis, agitation to delirium, bloating, constipation
what is the pediatric dose of atropine for bradycardia
0.02 mg/kg (minimum 0.1 mg)
what is the expected time until onset of action for atropine
1 min
what is the half life of atropine
what is the terminal half life of atropine
2-3 hours
12.5 hours
what are the indications of use for diltiazem
rapid ventricular rates associated with afib/flutter
psvt refractory to adenosine
what are the pharmacological efects of diltiazem
inhibits calcium influx during cardiac depolarization
decreases SA and AV conduction and dilates coronary and peripheral arteries and arterioles
what are the clinical effects of diltizaem
slows RVR associated with afib/flutter
reduces coronary and peripheral vascular resistance
what are contraindications for diltiazem
hypotension acute mi cardiogenic shock Vtach 2nd 3rd block WPW SSS Beta blocker use
what is the adult dose of diltiazem
initial 0.25 mg/kg IVP over 2 mins
may repeat w/ 0.35 mg/kg IVP over 2 mins
maintenance infusion: 5-15 mg/hr
what is the pediatric dose for diltiazem
not used for kids
what is the expected onset of action for diltiazem
immediate
when are the peak effects of diltiazem
2 hours or less
when is administration of dopamine indicated
symptomatic bradycardia
hemodynamically significant hypotension in absence of hypovolemia
what are contraindications for dopamine
hypovolemia
phenochromocytoma
MAO inhibitors such as marplan nardil parnate
what adverse reactions are associated with dopamine
arrythmias (due to increased myocardial O2 demand) hypertension hypotension at low doses nausea/vomiting renal shutdown tissue necrosis
why is dopamine contraindicated in the presence of MAO inhibitors
will cause hypertensive crisis
dopamine is incompatible with any __________ solution
alkaline
dopamine: onset of action, peak effects, duration of action
almost immediate, upon intro to central circulation
5-10 mins
effects cease almost immediately when infusion is shut off
what are the adverse reactions associated with epinephrine
hypertension, ventricular disrhythmias, tachycardia, angine
anxiety, agitation
nausea/vomiting
what are the notes about incompatibilities/ drug interactions for epienephrine
potentiates other sympathomimetics
reacts with alkaline solutions, such as sodium bicarb, should not be mixed with alkaline agents
what is the pediatric dose of epinephrine for cardiac arrest
0.01 mg/kg 1:10,000 repeat every 3-5 minutes, max single dose of 1mg
in a cardiac arrest situation what is the dose of epinephrine that is administered via ET tube for peds and neonates
0.1 mg/kg 1:1,000
what is the MOA of lidocaine
decreases automaticity by slowing rate of spontaneous phase 4 depolarization
terminates re-entry by decreasing conduction in re-entrant pathways
increases v-fib threshold
what are the indication for use of lidocaine
suppression of ventricular arrhythmias
prevent recurrence of vtach/vfib
pain management after IO insertion
what are the contraindications for the use of lidocaine
hypersensitivity
2nd 3rd blocks warrant extreme caution
ectopic beats when HR is less than 60
what adverse reactions are associated with lidocaine
SA depression or conduction problems and hypotension in large doses or if given too rapidly
large doses can cause drowsiness, disorientation, paresthesias, decreased hearing acuity, muscle twitching, agitation, focal or generalized seizures
what is the dose of lidocaine for cardiac arrest
1-1.5 mg/kg every 3-5 minutes
ROSC: drug 2-4 mg/min
what is the dose of lidocaine for arrhythmias with a pulse
- 5-0.75 mg/kg initial
0. 5-0.75 additional every 5-10 minutes
what is the pediatric dose of lidocaine
1 mg/kg may repeat 1 time in 3-5 mins of vf/pvt or in 15 mins for refractory dysrhythmias with a pulse
what is the expected onset of action for lidocaine
5-10 minutes
what is the duration of action for lidocaine
20 mins (bolus only)
what is the MOA of verapamil
calcium blockade causes (-) inotropic effect
reduces coronary and peripheral vascular resistance
slows conduction and prolongs refractory period in the AV node
slows SA node discharge
what are the indication of use for verapamil
SVT
RVR associated with afib/flutter
what are contraindications for verapamil
AV block SSS wide complex tachycardia WPW shock severe CHF IV beta blocker hypotension
what adverse reactions are associated with verapamil
extreme bradycardia asystole AV block hypotension CHF
what drugs is verapmil incompatible with
beta blockers
what is the adult dose of verapamil
2.5-5 mg slow iv push over 2-3 mins may repeat in 15-30 mins with 5-10 mg max dose of 30mg
what is the pediatric dose of verapamil
not used for kids
what is the on set of action for verapamil
1-3 mins
what is the duration of action for verapamil
2-5 hours
