Cardiac Drug Notes

Question 1

Dobutamine

• MOA?
• Cardio effects?
• Administration?
• Indications?
• Contraindications?

Answer 1

Beta 1 agonist
Increases contractility & HR
Peripheral ( if no central)
Trtmt: Cardiogenic shock and severe heart failure
Contra: Idiopathic hypertrophic subaortic stenosis

Question 2

Milrinone

• MOA?
• cardio effects?
• Administration?
• indications?

Answer 2

PDE 3 inhibitor (increases cAMP)
Increase in contractility, decrease in PVR & SVR
Central line
Low EF & Pul HTN (same as liberty swan ganz indications)

Question 3

Epi

• MOA?
• cardio effects?
• Administration?
• indications?

Answer 3

Beta & Alpha agonist
Increase Contractility, HR, & BP
Central line ( if peripheral flush with 20mL and elevate extremity)
Acute allergic rxns, profound refractory hypotension, ventricular fibrillation, VT, PEA, and asystole. It is the first drug of choice for cardiac arrest.

Question 4

Dopamine

• MOA?
• RENAL/cardio effects?
• Administration?
• indications?

Answer 4

Dopaminergic agonist, Alpha and Beta agonist

2-5mcg/kg/min =renal vasodilation
5-10mcg/kg/min = increase HR (beta)
>10 mcg/kg/min = increase BP (alpha)

ALWAYS Central line NEVER peripheral

The vasopressor choice for spinal cord injury pts (no phenylephrine)

Question 5

Levophed

• MOA?
• cardio effects?
• Administration?
• indications?

Answer 5

More alpha than beta receptor agonism
Potent vasoconstriction, increase in HR & contractility
ALWAYS Central line NEVER peripheral

Question 6

Which cardio drugs will you NEVER give peripherally?

Answer 6

Levophed, dopamine, Calcium chloride

Question 7

Vasopressin

• MOA?
• cardio effects?
• Administration?
• indications?

Answer 7

Direct vasoconstrictor
BP increase
SHOULD be Central line
Popular option in shock states( if refractory to norepinephrine)

Question 8

Calcium

• use?
• cardio effects?
• Administration? Ca Chloride vs Ca Gluconate
• indications?

-Potassium chloride infusion rates pheriperhal vs central

Answer 8

Kickstart heart after cardioplegia washout & massive blood transfusion’s rare side effect of hypocalcemia
Increase in cardiac contractility
Calcium Cholride = Central (C’s match), Calcium Gluconate = peripheral
Both given over 10 mins
During rewarming?

CaK peripheral is 10 mEq/Hr vs central is 20 mEq/Hr

Question 9

Nitroglycerin

• use?
• cardio effects?
• Administration?
• indications?

Answer 9

Quick vasodilator
Lowers BP, decreases O2 heart demand, increases oxygen supply, and increases pulmonary shunt
sublingual / IV
Chest pain, some Coronary ischemia

Question 10

Nipride

• use?
• cardio effects?
• Administration?
• indications?

Answer 10

Potent vasodilator
Lowers BP, more potent than NTG
Light sensitive bag
Chest pain, if NTG ineffective use

Question 11

Cardene

• use?
• cardio effects?
• Administration?
• indications?

Answer 11

• This resulting 10mL syringe will have 0.5mg/mL, infused at 5-15mg/hr