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Pharmicology > Cardiac > Flashcards

Cardiac Flashcards

1
Q

amiodarone

Ventricular Fibrillation / Pulseless Ventricular Tachycardia

A

Patient Safety Considerations
IV/IO amiodarone is not compatible when administered concurrently with sodium bicarbonate. Either initiate a second IV line or ensure the existing IV line is flushed completely

Class
Antiarrhythmic

Adult Dosage
300 mg IV/IO

Repeat 150 mg IV/IO q 5 minutes prn to a total maximum of 450 mg

EMS Contraindications
None when used in emergency situations

Notes
Can be administered undiluted if followed by at minimum a 10 mL flush

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2
Q

Adenosine

A

Patient Safety Considerations
Do not administer adenosine if the patient is taking carBAMazepine (Tegretol) or dipyridamole (Persantine)

Class
Anti Arrhythmic

EMS Indications
Narrow complex tachycardia / Paroxysmal supraventricular tachycardia / PSVT associated with Wolff-Parkinson-White syndrome

Adult Dosage
12 mg rapid IVP with a rapid 20 mL normal saline flush
Do not repeat dose

EMS Contraindications	
Known hypersensitivity
Pre-existing 2nd / 3rd degree AV block
Sinus node disease (sick sinus syndrome)
Symptomatic bradycardia
Atrial fibrillation / atrial flutter
Active bronchospasm / severe asthma
Patient taking carBAMazepine (Tegretol) or dipyridamole (Persantine)

Notes
Treatment of choice for most episodes of PSVT
Half-life is 0.6 – 1.5 seconds, therefore, it must be administered very rapidly by IV push in a large, proximal vein (antecubital fossa) followed immediately by a rapid normal saline flush
May induce a brief (less than 5 seconds) period of asystole that the patient may find distressing; warn the patient about the possibility of a brief uncomfortable sensation while the medication is acting
Adenosine is potentially dangerous in the treatment of atrial fibrillation or atrial flutter due to the risk of inducing ventricular arrhythmias

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3
Q

amiodarone

Ventricular Tachycardia

A

Class
Antiarrhythmic

Mandatory OLMC - Ventricular tachycardia

Adult Dosage
150 mg IV/IO dilute in 250 mL D5W bag and infuse over 10 minutes with a 10 gtt set and in-line filter at 4 drops per second

Do not repeat dose

EMS Contraindications
Hypersensitivity to amiodarone or iodine
Cardiogenic shock, sinus bradycardia, or AV block (2nd or 3rd degree) unless a pacemaker is present
Cardiovascular collapse, severe atrial hypotension
Patients predisposed to intracranial hypertension
Acute hepatitis
Thyroid dysfunction
Interstitial pulmonary disease

Notes
Use with caution if renal failure present
Consider initiating a second IV line or ensure the existing IV line is flushed completely after amiodarone administration
Do not exceed 30 mg/minute
Must be diluted prior to administration
Observe for signs of pulmonary toxicity
Progressive apnea
Cough
Fever
Pleuritic pain
Top
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4
Q

atropine

Bradycardia / Heart Block

A

Class
Anticholinergic

Adult Dosage
0.5 mg IV/IO
q 3 – 5 minutes prn to a total maximum of 3 mg

EMS Contraindications
Hypersensitivity

Notes
First-line drug for acute symptomatic bradycardia in the absence of immediately reversible causes
Immediate pacing may be considered over atropine in patients who have a symptomatic 2° type II or 3° heart block as atropine can be unreliable
It is clinically inappropriate to administer to patients with a history of heart transplant because of the de-nervation of the heart

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5
Q

calcium chloride

Asystole / PEA

A

Class
Electrolyte

Adult Dosage
1 g SIVP/IO
Do not repeat dose

EMS Contraindications
Hypersensitivity
Hypercalcemia
Patients with digitalis toxicity

Notes
Avoid extravasation due to the risk of tissue irritation / necrosis
Not recommended for routine treatment in cardiac arrest outside of hyperkalemia, hypocalcemia or hypermagnesemia

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6
Q

calcium chloride

Ventricular Fibrillation / Pulseless Ventricular Tachycardia

A

Class
Electrolyte

Adult Dosage
1 g SIVP/IO
Do not repeat dose

EMS Contraindications
Hypersensitivity
Hypercalcemia
Patients with digitalis toxicity

Notes
Avoid extravasation due to the risk of tissue irritation / necrosis
Not recommended for routine treatment in cardiac arrest outside of hyperkalemia, hypocalcemia or hypermagnesemia

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7
Q

epiNEPHrine (1:10,000)

Asystole / PEA

A

Immediately flush 20 – 30 mL of IV solution after IV administration of any medication to maximize its circulation and availability

Class
Sympathomimetic

Adult Dosage
1 mg IV/IO
q 3 – 5 minutes prn

EMS Contraindications
None when used in emergency situations

Notes
Used primarily because of its alpha adrenergic effects (i.e. vasoconstriction) in resuscitation
Vasoconstriction increases cerebral and coronary blood flow during CPR

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8
Q

epiNEPHrine (1:10,000)

Ventricular Fibrillation / Pulseless Ventricular Tachycardia

A

Immediately flush 20 – 30 mL of IV solution after IV administration of any medication to maximize its circulation and availability

Class
Sympathomimetic

Adult Dosage
1 mg IV/IO
q 3 – 5 minutes prn

EMS Contraindications
None when used in emergency situations

Notes
Used primarily because of its alpha adrenergic effects (i.e. vasoconstriction) in resuscitation
Vasoconstriction increases cerebral and coronary blood flow during CPR

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9
Q

fentanyl (Sublimaze)

Bradycardia / Heart Block

A

Class
Narcotic analgesic

Dosage
50 mcg SIVP/IO
q 3 minutes prn to a total maximum of 250 mcg

Maintenance Dosage
250 mcg/hr in 50 mcg increments

EMS Contraindications
Hypersensitivity
Systolic BP less than 90 mmHg
Monoamine oxidase inhibitor therapy within last 14 days

Notes
The goal is to provide enough comfort in order for the patient to tolerate the pacing rather than being pain free
Caution in use in myasthenia gravis
Use cautiously if evidence of ETOH or drug intoxication
May cause respiratory depression and hypotension; monitor vital signs closely post administration

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10
Q

magnesium sulfate

Ventricular Fibrillation / Pulseless Ventricular Tachycardia

A

Class
Electrolyte

Adult Dosage
2 g IV/IO
Do not repeat dose

EMS Contraindications
Any degree of heart block
Renal failure

Notes
Suppresses automaticity

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11
Q

magnesium sulfate

Ventricular Tachycardia

A

Class
Antiarrhythmic

Adult Dosage
2 g IV/IO dilute in 50 mL normal saline bag and infuse over 5 minutes
Do not repeat dose

EMS Contraindications
Any degree of heart block
Renal failure

Notes
Suppresses automaticity in depolarized cells
Used as an antiarrhythmic drug
Has a short duration of action; physiologically, it has two effects:
interferes with calcium uptake in bronchial smooth muscle
interferes with acetylcholine release
May cause respiratory depression; monitor vital signs closely post administration

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12
Q

metoPROLOL (Lopressor)

Atrial Fibrillation / Atrial Flutter

A

Class
Beta-blocker

Mandatory OLMC - stable (BP greater than 80 mmHg) and symptomatic (altered LOC, ischemic chest pain, or significant SOB and/or CHF) atrial fibrillation or atrial flutter

Adult Dosage
Mandatory OLMC - 5 mg SIVP

q 5 minutes prn to a total maximum of 15 mg or HR less than
110 bpm or BP less than 100 mmHg

EMS Contraindications	
Hypersensitivity
Second and third degree AV blocks
Bradycardia less than 50 bpm
Systolic BP less than 100 mmHg
Severe acute heart failure
Bronchospastic COPD, reactive airway disease
Recent (less than 24 hrs) cocaine use
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13
Q

morphine

Acute Coronary Syndrome (Suspected)

A

Class
Narcotic analgesic

Adult Dosage
2.5 mg SIVP/IO
q 5 minutes prn to a total maximum 15 mg

EMS Contraindications
Hypersensitivity
Systolic BP less than 100 mmHg

Notes
Has vagotonic properties that can aggravate bradycardias
Use with caution in the presence of inferior or right ventricular infarct due to the drop in preload
Use with caution if evidence of ETOH or drug intoxication
May cause respiratory depression and hypotension; monitor vital signs closely post administration
Use with caution with other drugs that are sedatives / depressants

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14
Q

sodium bicarbonate

Asystole / PEA

A

Class
Alkalinizing agent

Adult Dosage
Excited Delirium Syndrome(ExDS)
2 mEq/kg SIVP/IO
NO REPEAT

Pre-existing Hyperkalemia, or TCA overdose
1 mEq/kg SIVP/IO
NO REPEAT

EMS Contraindications
None when used in emergency situations

Notes
Routine use in cardiac arrest is not recommended
Avoid extravasation due to the risk of tissue irritation / necrosis
Corrects acidosis from prolonged arrest situation

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15
Q

sodium bicarbonate

Ventricular Fibrillation / Pulseless Ventricular Tachycardia

A

Class
Alkalinizing agent

EMS Indications
Cardiac arrest resulting from ExDS, prolonged resuscitation, pre-existing hyperkalemia (renal failure), or TCA or ASA overdose

Adult Dosage
Excited Delirium Syndrome(ExDS)
2 mEq/kg SIVP/IO
NO REPEAT

Pre-existing Hyperkalemia, or TCA overdose
1 mEq/kg SIVP/IO
NO REPEAT

EMS Contraindications
None when used in emergency situations

Notes
Routine use in cardiac arrest is not recommended
Avoid extravasation due to the risk of tissue irritation / necrosis
Corrects acidosis from prolonged arrest situation

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Pharmicology (6 decks)

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