cardiac arrhythmia medications

Question 1

V-tach & -fib

Answer 1

• only 2 reasons to use defibrillator
• Vasopressors: epinephrine
• Antiarrhythmics: amiodarine, lidocaine

Question 2

PEA/ Asystole

Answer 2

CPR

Epinephrine

Question 3

Tachycardia

Answer 3

Stable: Vagal; adenosine
unstable(tachycardic and increased BP): cardiovert
regular: 50+100 joules
irregular: 120+200 joules

Question 4

bradycardia

Answer 4

atropine
epinephrine drip
dopamine drip

Question 5

medication access

Answer 5

peripheral access:route of choice; quicker, easier

Intraosseous access: goes into bone marrow, usually goes in to shin, never sternum

Question 6

things to remember

Answer 6

Alpha + constrict
Beta + dilate
Beta: 1 heart, 2 lungs

Question 7

Epinephrine

Answer 7

natural catecholamine

• alpha properties
• vasoconstriction
• Increased SVR= Increased BP
• increased contractility, CO, HR
• routing blood to brain and heart
• Beta properties: Bronchodilator
• No maximum dose

Question 8

Amiodarone

Answer 8

• works on Na+ and K+ channels
• apha and beta properties
• ONLY 2 doses during arrest
• IV drip= complex dosing
• continuous EKG monitoring
• hypotension is common
• must take BP before giving it
• antiarhhythmic

Question 9

lidocaine

Answer 9

alternative to amiodarone

• suppresses ventricular ectopy
• suppresses conduction of reentry pathways
• IV push
• IVgtt= maintenance
• MAX dose= 3mg/kg (3 boxes per code)

Question 10

procainamide

Answer 10

-suppresses ventricular ectopy
-slows conduction through myocardium
-IV or PO
-initial loading dose- 20 mins
gtt thereafter
DC if QRS widens >50% of baseline- VTach getting worse

Question 11

torsade de pointes

Answer 11

give 1-2 gms IV

-could be repeated

Question 12

sequence

Answer 12

shock
drug
shock
drug
shock
meds: vasopressor, antiarrhythmic, vasopressor, antiarrhythmic
-After drug is given, circuate for 2 mins using CPR
-dont mix and match drugs- finish 1 drug before starting another- mixing makes them pro-arrhythmics

Question 13

vagal maneuvars

Answer 13

only attempt if tachycardia is stable

• cough
• bear down
• gag
• do not do carotid massage

Question 14

adenosine

Answer 14

• stable tachycardia
• slows conduction through SA and AV nodes
• depressed left ventricular function-dont give to someone with left ventricular issues unless necessary
• converts tachycardia rhythms into NSR
• given rapid Iv push over 1-3 secs
• brief asystole or bradycardia
• transient fushing +/or CP
• dosing 6-12mg

Question 15

beta blockers

Answer 15

stable tachycardia

• controls rate & ventricular response
• decreased HR, force of contraction, BP, AV conduction, & myocardial O2 consumption
• end in “OLOL” [metoprolol, atenolol, propanolol, esmolol, labetolol]
• caution with CHF & pulmonary disease- if heart slows down too much can send pt into CHF or pulmonary edema

Question 16

calcium channel bockers

Answer 16

• controls ventricuar rate in AFIB & Aflutter
• inhibits Ca+ion influx into myocardial cells
• slow AV& SA conduction
• may decrease contractility
• vasodilates smooth muscle to decrease afterload and BP
• antidote= CaCl 10% solution

Question 17

verapomil

Answer 17

Calcium channel blocker

• given after adenosine use with normal/elevated BP
• not to be used with hypotension
• may repeat doses

Question 18

diltiazem

Answer 18

• given after adenosine use
• IV loading the IV gtt
• caution with CHF

Question 19

synchronized cardioversion

Answer 19

• unstable tachycardia
• slows rhythm down
• 50-100 joules
• step back- dont know which p waves it will shock on

Question 20

amiodarone

Answer 20

preserved cardiac function
-avoid AV blocking agents
unstable tachycardia

Question 21

atropine

Answer 21

-symptomatic bradycardia
-drug of choice
-increases HR
-blocks parasympathetic nervous system
enhances conduction at the AS and AV nodes
-IV push
-prepare for transcutaneous pacing

Question 22

epinephrine (bradycardia)

Answer 22

given as gtt

• increases contractiity, HR, CO
• doesnt mess with BP

Question 23

dopamine (bradycardia)

Answer 23

low dose= renal perfusion
moderate dose= cardiac doses, beta 1 receptors
increase contractility, CO, HR
high dose= vasopressor doses- alpha receptors
vasoconstriction, can cause tacycardia

Question 24

what to do in asystole/PEA?

Answer 24

epinephrine
CPR- 5 cycles (30:2)
consider aborting resuscitation efforts

Question 25

on top of the crash cart

Answer 25

• monitor/ defibrillator
• respiratory box
• sharps container

Question 26

on the side of the crash cart

Answer 26

backboard

O2 tank

Question 27

top drawer if crash cart

Answer 27

medications

Question 28

the second drawer of crash cart

Answer 28

• airway

- respiratory equiment

Question 29

third drawer of crash cart

Answer 29

• circulation

- IV supplies

Question 30

fourth drawer of crash cart

Answer 30

• circulation

- IV fluids/ tubing

Question 31

fifth drawer of crash cart

Answer 31

• cardiac

- chest procedures

Question 32

sixth drawer of the crash cart

Answer 32

special procedures

• cutdown tray
• central line tray
• external pacemaker

Question 33

treat chest pain with:

Answer 33

MONA
M-morphine-only if nitro doesnt work, decrease pain, anxiety, beta 2 (dilates)
O-Oxygen
N- Nitroglycerin- can give 3X SL, 5 mins apart
A- Aspirin: 160-325mg, chewable to get in system faster

Question 34

search for and treat these contributing factors: (the H’s)

Answer 34

hypovolemia
hypoxia
hydrogen ions(Acidosis, dont give sodium bicarb w/o 
                           confirmation)
hypo-/hyperkalemia
hypoglycemia
hypothermia (you cannot die cold)

Question 35

search for and treat these contributing factors: (the T’s)

Answer 35

toxins
tamponade (cardiac)
tension pneumothorax
thrombosis (coronary/pulmonary)
trauma (hypovolemia, increasing ICP)