Cardiac Drug Card Notes Flashcards
inotropes
dobutamine
milrinone
epinephrine
vasopressors
dopamine levophed vasopressin calcium potassium chloride
vasodilators
Nitroglycerin
Nipride
Cardene
Glucose control
insulin
antiarrhythmics
magnesium
amiodarone
coagulation drugs
amicar
desmopressin (DDAVP)
dobutamine effects
beta 1 agonist
increase contractility
increase HR
administration of dobutamine
may be given peripheral line if no central line
milrinone effects
phosphodiesterase inhibitor increases cAMP increase contractility decreased PVR decreased SVR and BP
what is milrinone usually given with?
infusion of vasopressor
indications for milrinone
low EF/CO
pulmonary HTN
can milrinone be administered via peripheral line?
NO only central line
epinephrine effects
alpha and beta agonist
increases contractility
increases HR and BP
where should epi be administered?
centrally
dopamine effects
dopaminergic, alpha, and beta agonist
renal vasodilation
increases HR
increases BP
dopamine renal vasodilation dose
2-5mcg/kg/min
dopamine increases HR dose
5-10 mcg/kg/min
dopamine increases BP dose
> 10mcg/kg/min
where should dopamine be administered?
ONLY central line
levophed preparation
4mg in 250mL bag for 16mcg/mL
or 10mL syringe with 16mcg/mL for bolus
what is the usual bolus for levophed
4-16mcg (.25-1cc)
levophed effects
ALPHA and beta agonist
powerful vasoconstrictor
increase contractility
increase HR
where should levophed be administered?
central vein
vasopressin preparation
5 vials (100units) in 100mL bag to make 1unit/mL
when is vasopressin popular?
shock states when in refractory to NE
where should vasopressin be administered?
central line
what are the two types of calcium
calcium chloride
calcium gluconate
when is calcium considered
treat hypocalcemia due to massive transfusion
increase cardiac contractility (after cardioplegia)
which calcium can be given peripherally?
calcium gluconate
which calcium must be given through a central line
calcium chloride
calcium gluconate is ___ as potenet as calcium chloride
1/3
what is the time frame that calcium should be given over?
10minutes
if running potassium through a peripheral line is can be run up to
10mEq/hr
if running potassium through a central line it can be run up to
20mEq/hr
Nitroglycerin (NTG) effects
decreases BP (vasodilator) short onset, short duration
when is NTG given
coronary ischemia
decreases myocardial oxugen demand (decrease preload and afterload)
increases myocardial oxygen supply (coronary vasodilation)
increases pulmonary shunting
nipride
a more potent version of NTG, used when NTG is ineffective.
what is special about nipride
it is sensitive to light and it should be in a UV protective bag, provided in box
cardene
calcium channel blocker that is an alternative to nitroglycerin
cardene preparation
5mg (2mL) in 8mL N/S to make
0.5mg/mL
cardene lower BP bolus
0.25-0.5mg
cardene infusion preparation
25mg in 250mL bag to make 100mcg/mL
cardene infusion rate
5-15mg/hr
insulin danger
bc its high concentration of 100units/mL
when bolusing insulin what syringe do you use
TB syringe
insulin infusion preparation
1mL (100units) in 100mL bag
when do you give antiarrhythmics
off pump CABG when lifting heart
CPB prior to cardioplegia washout
how fast can you give magnesium?
slowly over 10min
how fast can you give amiodarone?
slowly over 10min
amicar
antifibrinolytic that helps preserve clotting factors as blood goes through CPB machine and reduces bleeding post bypass
amicar bolus doses
1vial is 5g (20mL)
liberty- 5g bolus prior to incision
MAHI- 10g bolus prior to incision
amicar infusion prep and rate
2 vials in 500mL LR
50mL per hr (1g)
desmopressin (DDAVP)
synthetic antidiuretic hormone (ADH)
when is DDAVP indicated?
diabetes insipidus
coagulopathies during surgery
what does DDAVP stimulate the release of?
vWF and increases factor VIII
when is DDAVP usually used for cardiac?
end of operation if oozing after protamine administration
how fast can DDAVP be adminitered?
slowly bc it can cause hypotension
