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Pharm Acute > Acute > Flashcards

Acute Flashcards

0
Q

CLASSIFICATION OF:

METOPROLOL (Lopressor)

A
  • Class II Antiarrhythmic

* Beta Blocker

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1
Q

Generic name for LOPRESSOR

A

METOPROLOL

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2
Q

USES FOR:

METOPROLOL (Lopressor)

A
  • Control of rapid VENTRICULAR RATES in ATRIAL FIBRILLATION/FLUTTER
  • Management of SINUS TACHYCARDIA and SUPRAVENTRICULAR DYSRHYTHMIAS
  • Early MI
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3
Q

ACTION OF:

METOPROLOL (Lopressor)

A
  • Blocks stimulation of Beta-1 adrenergic receptors (sympathetic nervous system)
  • Decreases heart rate and AV conduction
  • Decreases Myocardial contractility & automaticity
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4
Q

CONTRAINDICATIONS OF:

METROPROLOL (Lopressor)

A
  • CHF
  • Pulmonary Edema
  • Cardiogenic Shock
  • Bradycardia or Heart Block
  • Known alcohol intolerance
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5
Q

SIDE EFFECTS:

METOPROLOL (Lopressor)

A

CNS: fatigue; agitation; confusion; dizziness; weakness

CV: Second or Third Degree Heart Block; CHF; Cardiogenic Shock; HYPOtension; BRADYcardia; Peripheral Ischemia

GI: Nausea; vomiting

*****HYPERSENSITIVITY

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6
Q

ROUTE/DOSE:

METOPROLOL (Lopressor)

A

IV/PO - Adult: 3 bolus injections of 5 mg at 2 minute intervals FOLLOWED BY 50 mg PO q6 hours for 48 hours; FOLLOWED BY 10 mg bid

PO: 12.5-100 mg bid

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7
Q

NURSING CARE FOR:

METOPROLOL (Lopressor)

A

** Client must be on ECG monitoring

** Monitor BP & Pulse BEFORE and DURING administration

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9
Q

CLASSIFICATION OF:

PROCAINAMIDE (Pronestyl)

A
  • Class 1 Antiarrhythmics

* Class 1-A- Sodium channel blockers

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10
Q

USES FOR:

PROCAINAMIDE (Pronestyl)

A

Treatment of a wide variety of atrial and ventricular arrhythmias including: PVC, PAC, Ventricular tachycardia, and maintenance of normal sinus rhythm after conversion from atrial fibrillation or flutter.

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11
Q

ACTION OF:

PROCAINAMIDE (Pronestyl)

A
  • Decreases myocardial excitability
  • Slows conduction velocity
  • May depress myocardial contractility
  • Membrane stabilizer
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12
Q

CONTRAINDICATIONS OF:

PROCAINAMIDE (Pronestyl)

A
  • AV Block
  • Systemic Lupus

**Use cautiously with: MI, CHF, or renal or hepatic insufficiency

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13
Q

SIDE EFFECTS OF:

PROCAINAMIDE (Pronestyl)

A

*Seizures, asystole, heart block, ventricular dysrhythmias, blood disorders, diarrhea, GI symptoms

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14
Q

ROUTE/DOSE OF:

PROCAINAMIDE (Pronestyl)

A
  • IV: Administer 20mg/min until dysrhythmia is suppressed, hypotension occurs, or 1000 mg have been given. Follow with a 2-6mg/min continuous infusion
  • PO- 50mg/kg/day in divided doses
  • IM- only when IV or PO not feasible
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15
Q

NURSING CARE FOR:

PROCAINAMIDE (Pronestyl)

A

**Do not exceed recommended infusion rate. Dilution of 1gram/250= 4mg/ml

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16
Q

Generic name for XYLOCAINE

A

LIDOCAINE

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17
Q

CLASSIFICATION OF:

LIDOCAINE (Xylocaine)

A
  • Class 1 Antiarrhythmics

* Class 1B- Sodium channel blockers

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18
Q

USES FOR:

LIDOCAINE (Xylocaine)

A
  • Acute therapy for ventricular dysrhythmias

* Suppression and prevention of ventricular dysrhythmias

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19
Q

ACTION OF:

LIDOCAINE (Xylocaine)

A
  • Depresses excessive automaticity of ectopic impulses in the His-Purkinje system by its local anesthetic effects.
  • Very effective in suppressing premature ventricular beats that arise from ischemic cells.
  • Onset and peak are immediate, duration is 10-20 minutes
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20
Q

CONTRAINDICATIONS FOR:

LIDOCAINE (Xylocaine)

A
  • Hypersensitivity
  • AV Block
  • Wolff-Parkinson-White syndrome
  • Bradycardia
  • Adams-Stokes syndrome
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21
Q

SIDE EFFECTS FOR:

LIDOCAINE (Xylocaine)

A
  • CNS: dizziness, restlessness, confusion, unconsciousness, convulsions, blurred vision, slurred speech, numbness, lethargy, tremors
  • CV: hypotension, cardiac arrest, bradycardia
  • DERM: phlebitis at injection site
  • GI: nausea, vomiting
  • RESP: respiratory arrest
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22
Q

ROUTE/DOSE FOR:

LIDOCAINE (Xylocaine)

A
  • IV Bolus: 1mg/kg (May repeat 0.5 mg/kg q10 minutes up to a total of 3mg/kg total)
  • IV Infusion: 1-4 mg/min drip
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23
Q

NURSING CARE FOR:

LIDOCAINE (Xylocaine)

A
  • Administer IV bolus over 1-2 minutes

* Administer infusion through an infusion pump

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24
Q

Generic name for RHYTHMOL

A

PROPAFENONE

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25
Q

CLASSIFICATION OF:

PROPAFENONE (Rhythmol)

A
  • Class 1 Antiarrhythmics

* Class 1C- Sodium channel blockers

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26
Q

USE OF:

PROPAFENONE (Rhythmol)

A
  • Life-threatening ventricular arrhythmias
  • Paroxysmal atrial fibrillation
  • Paroxysmal supraventricular tachycardia
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27
Q

ACTION OF:

PROPAFENONE (RHYTHMOL)

A

*Slows conduction in cardiac tissues by altering transport of ions across cell membranes and depress depolarization

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28
Q

CONTRAINDICATIONS FOR:

PROPAFENONE (Rhythmol)

A
  • CHF
  • Less severe ventricular arrhythmias
  • Heart blocks
  • Sick sinus syndrome

**Use CAUTIOUSLY in potassium imbalances

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29
Q

SIDE EFFECTS OF:

PROPAFENONE (Rhythmol)

A
  • CNS: dizziness, shaking, weakness
  • EENT: blurred vision
  • CV: supraventricular arrhythmias, ventricular arrhythmias, conduction disturbances, angina, hypotension, bradycardia
  • GI: Altered taste, constipation, dry mouth
  • DERM: rash
  • MS: Joint pain
30
Q

ROUTE/DOSE OF:

PROPAFENONE (Rhythmol)

A
  • PO (Adults): 150 mg q8 hours.

* May be gradually increased at 3-4 day intervals as required up to 300 mg q8-12 hours

31
Q

NURSNG CARE FOR:

PROPAFENONE (Rhythmol)

A
  • Therapy should be initiated in a hospital with facilities for cardiac rhythm monitoring as most serious side effects are seen within the first 2 weeks of therapy
  • Monitor BP and pulse periodically throughout therapy
  • May cause prolongation of PR or QT intervals
  • Assess client for signs of CHF. May require reduction of d/c of therapy
32
Q

Generic name for CORDARONE

A

AMIODARONE

33
Q

CLASSIFICATION OF:

AMIODARONE (Cordarone)

A

Class III Antiarrhythmics

34
Q

USE OF:

AMIODARONE (Cordarone)

A
  • Control of supraventricular and ventricular dysrhythmias unresponsive to less toxic agents
  • Management and prophylaxis of recurring ventricular fibrillation and unstable ventricular tachycardia unresponsive to other drug therapy
35
Q

ACTION OF:

AMIODARONE (Cordarone)

A
  • Prolongs action potential and refractory period; inhibits adrenergic stimulation by preventing the release of norepinephrine from the sympathetic nerve sites
  • Slows the sinus rate, increases PR and QT intervals, and decreases peripheral vascular resistance (vasodilates)
36
Q

CONTRAINDICATIONS OF:

AMIODARONE (Cordarone)

A
  • Bradycardia
  • Sinus node dysfunction
  • Second and third degree AV block
  • Cardiomegaly

*Used cautiously in liver, pulmonary and thyroid disease

37
Q

SIDE EFFECTS OF:

AMIODARONE (Cordarone)

A
  • CNS: peripheral neuropathy, tremors, paresthesia, headache, malaise, fatigue, insomnia, abnormal taste and smell
  • CV: CHF, hypotension, bradycardia
  • DERM: blue-gray skin discoloration
  • ENDO: thyroid dysfunction
  • GI: abnormal liver function
38
Q

ROUTE/DOSE OF:

AMIODARONE (Cordarone)

A
  • IV: 150 mg over 10 minutes, followed by 360 mg over the next 6 hours and then 540 mg over the next 18 hours. Continue infusion at 0.5 mg/minute until oral therapy is initiated
  • ACLS guidelines for pulseless VTACH/VFIB: 300 mg IVP, may repeat once after 3-5 minutes with 150 mg IVP
  • PO: 400 mg/day
39
Q

NURSING CARE FOR:

AMIODARONE (Cordarone)

A
  • When giving to a client on Digoxin, be aware that the dose of Digoxin should be reduced by 50%
  • Hypokalemia should be corrected before therapy
  • Instruct client to avoid sun exposure
  • IV administration should occur through a central line. IV solution must be administered using glass bottles and a filter.
40
Q

GENERIC NAME FOR:

CARDIZEM

A

DILTIAZEM

41
Q

CLASSIFICATION OF:

DILTIAZEM (Cardizem)

A

Class IV Antiarrhythmics (Calcium channel blockers)

42
Q

USES FOR:

DILTIAZEM (Cardizem)

A
  • Treatment of supraventricular tachyarrhythmias and rapid ventricular rates in atrial fibrillation or flutter
  • Management of all forms of angina pectoris
  • Treatment of mild to moderate hypertension
43
Q

ACTION OF:

DILTIAZEM (Cardizem)

A
  • Inhibits the transport of calcium into myocardial and vascular smooth muscle cells.
  • Systemic vasodilation resulting in decreased BP.
  • Coronary vasodilation resulting in decreased frequency and severity of angina.
  • Suppression of dysrhythmias.
44
Q

CONTRAINDICATIONS OF:

DILTIAZEM (Cardizem)

A
  • Hypersensitivity
  • Sick sinus syndrome
  • Second and third degree AV block
  • Blood pressure <90mmHG
  • Recent MI
  • Pulmonary congestion
  • CHF
  • Cardiogenic shock
  • Wolff-Parkinson-White syndrome
45
Q

SIDE EFFECTS OF:

DILTIAZEM (Cardizem)

A
  • CV: sympathetic and orthostatic hypotension, bradycardia, conduction disturbances, heart failure, edema
  • DERM: flushing, sweating
  • CNS: headache, tremors
  • GI: esophageal reflux, constipation
  • GU: urinary retention
46
Q

ROUTE/DOSE OF:

DILTIAZEM (Cardizem)

A

PO- Adults: 30-120 mg, 3-4 times/day or 60-120 mg BID as SR capsules or 180-240 mg daily as CD or XR capsules

IV-Adults: 0.25 mg/kg. May repeat in 15 minutes with a dose of 0.35 mg/kg. May follow with a continuous infusion at 10 mg/hour (range 5-15mg/hr) for up to 24 hours

47
Q

NURSING CARE FOR:

DILTIAZEM (Cardizem)

A
  • Client must be on EKG monitor.
  • Monitor BP and pulse before and frequently during administration.
  • Assess for signs of CHF.
  • Report bradycardia or prolonged hypotension promptly.
  • Do not open, crush, break, or chew sustained release capsules/tablets.
  • Direct IV may be administered undiluted.
  • Monitor digoxin levels for toxicity.
48
Q

GENERIC NAME FOR:

ADENOCARD

A

ADENOSINE

49
Q

CLASSIFICATION OF:

ADENOSINE (Adenocard)

A

Miscellaneous Antiarrhythmics

50
Q

USES FOR:

ADENOSINE (Adenocard)

A
  • Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm (NSR) when vagal maneuvers are unsuccessful
  • Diagnostic agent to assess myocardial perfusion defects
  • ACLS: First-line drug therapy in ACLS protocol for PSVT
51
Q

ACTION OF:

ADENOSINE (Adenocard)

A
  • Slows AV conduction and interrupts re-entry through accessory pathways. Also produces coronary artery vasodilation.
  • Has extremely short half-life of <10 seconds
  • Onset- Immediate
  • Peak-within seconds
  • Duration: 1-2 minutes
52
Q

CONTRAINDICATIONS OF:

ADENOSINE (Adenocard)

A
  • Hypersensitivity
  • Sick sinus syndrome
  • Second and third degree AV block
  • Use with caution in asthma
53
Q

SIDE EFFECTS OF:

ADENOSINE (Adenocard)

A
  • CNS: dizziness, headache, apprehension, blurred vision, tingling, numbness
  • CV: palpitations, chest pain, hypotension, transient dysrhythmias, bradycardia
  • DERM: facial flushing, sweating, burning sensation
  • RESP: dyspnea, bronchospasm in asthmatics, hyperventilation
  • GI: metallic taste, tight throat
54
Q

ROUTE/DOSE OF:

ADENOSINE (Adenocard)

A

IV-Adults: 6mg by rapid IV bolus. If no result, repeat 1-2 minutes later as 12 mg rapid bolus. This dose may be repeated (single dose not to exceed 12 mg)

55
Q

NURSING CARE FOR:

ADENOSINE (Adenocard)

A
  • Client must be on EKG monitor.
  • Administer over 1-2 seconds via direct IV or into proximal IV line. Follow with rapid NSS flush to ensure injection reaches systemic circulation.
  • Crystals may form when the drug is refrigerated; warm to room temperature to dissolve.
  • Give undiluted.
56
Q

GENERIC NAME FOR:

LANOXIN

A

DIGOXIN

57
Q

CLASSIFICATION OF:

DIGOXIN (Lanoxin)

A

Miscellaneous Antiarrhythmics

58
Q

USES OF:

DIGOXIN (Lanoxin)

A

Treatment of CHF, tachyarrhythmias, atrial fibrillation or flutter with rapid ventricular response; paroxysmal atrial tachycardia

59
Q

ACTION OF:

DIGOXIN (Lanoxin)

A
  • Increases the force of myocardial contraction (Positive Inotrope)
  • Prolongs refractory period of the AV node and slows conduction through the SA and AV nodes (Negative Chromotrope)
60
Q

CONTRAINDICATIONS OF:

DIGOXIN (Lanoxin)

A
  • Bradycardia
  • Ventricular tachycardia or fibrillation
  • AV block
  • Constrictive pericarditis

**Use with caution in electrolyte imbalance (Hypokalemia, Hypomagnesemia, Hypercalcemia)

***Use with caution in renal failure due to decreased renal excretion of the drug

61
Q

SIDE EFFECTS OF:

DIGOXIN (Lanoxin)

A
  • CV: arrhythmias, bradycardia
  • CNS: fatigue, headache, weakness
  • EENT: blurred vision, yellow vision, HALO APPEARANCE (A HALLMARK SIGN OF DIGOXIN TOXICITY)
  • GI: anorexia, nausea, vomiting
62
Q

ROUTE/DOSE OF:

DIGOXIN (Lanoxin)

A
  • Digitalizing dose: for rapid effect, a larger initial loading dose should be given in several divided doses over 12-24 hours
  • IV- ADULT: 0.6-1 mg given as 50% of the dose initially and additional fractions given at 4-8 hour intervals
  • PO- ADULT: 0.75-1.25 mg given as above
  • Maintenance dose: Adult PO 0.063-0.5 mg/day

**NORMAL THERAPEUTIC BLOOD LEVEL: 0.5-2

63
Q

NURSING CARE FOR:

DIGOXIN (Lanoxin)

A
  • Monitor apical pulse for 1 full minute before administration, hold and notify physician if pulse<60 bpm in an adult
  • Notify physician before giving dose if client has electrolyte imbalances; (hypokalemia, hypomagnesemia, or hypercalcemia) May make client more susceptible to digitalis toxicity
  • IV doses may be given undiluted over 5 minutes
  • Y-site incompatible with propofol, amphotericin B and fluconazole
64
Q

GENERIC NAME FOR:

ATROPEN

A

ATROPINE

65
Q

CLASSIFICATION OF:

ATROPINE (AtroPen)

A

Miscellaneous Antiarrhythmics

66
Q

USES FOR:

ATROPINE (AtroPen)

A
  • Multiple uses; also an anticholinergic drug
  • IV: treatment of sinus bradycardia and heart block
  • IM: pre-op use is to decrease oral and respiratory secretions
  • PO: adjunctive therapy in the management of peptic ulcer disease and irritable bowel syndrome
67
Q

ACTION OF:

ATROPINE (AtroPen)

A
  • Blocks the effect of stimulation of cholinergic receptors by acetylcholine
  • Inhibits the effects of stimulation of the parasympathetic nerves, thus permitting the effects of the sympathetic nervous system to predominate
68
Q

CONTRAINDICATIONS OF:

ATROPINE (AtroPen)

A
  • Narrow-angle glaucoma
  • Asthma
  • Urinary or GI obstruction
  • Intestinal atony
  • Paralytic Ileus
  • Myasthenia Gravis
  • Ulcerative Colitis
  • Hiatal Hernia
  • Serious hepatic and renal disease
69
Q

SIDE EFFECTS OF:

ATROPINE (AtroPen)

A
  • CNS: Ataxia, restlessness, confusion
  • CV: tachycardia, palpitations, hypertension
  • GI: Dry mouth, constipation
  • GU: urinary hesitancy, retention
  • EENT: blurred vision, increased intraocular pressure
  • DERM: decreased sweating, flushing, rash, elevated body temperature
70
Q

ROUTE/DOSE OF:

ATROPINE (AtroPen)

A
  • IV-ADULTS: 0.5-1.0 mg; may repeat as needed q 5 minutes; (q3-5 minutes in ACLS guidelines) May administer via endotracheal tube- use 2-10 times the IV dose
  • IV-CHILD: 0.01-0.03 mg/kg (range is 0.1-0.5 mg in child or up to 1 mg in adolescents); May repeat q 5 minutes up to a total dose of 1 mg in child (2mg in teens)
71
Q

NURSING CARE FOR:

ATROPINE (AtroPen)

A
  • Direct IV may give undiluted or dilute in 10 ml sterile water.
  • Do not add to IV solution.
  • Administer as a rate of 0.6 mg over 1 minute.
  • When given over 1 minute, may cause paradoxical bradycardia, which usually resolves in approximately 2 minutes.
79
Q

Generic name for PRONESTYL

A

PROCAINAMIDE

Pharm Acute (1 decks)

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