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AZDHS Drug Profiles > Cardiac Drug Profiles AZDHS > Flashcards

Cardiac Drug Profiles AZDHS Flashcards

1
Q

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Class?

A

Analgesic, antipyretic, anti-inflammatory

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2
Q

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Mechanism of Action?

A

blocks thromboxane A2

a potent platelet aggregate and vasoconstrictor.

Decreased platelet aggregation.

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3
Q

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Indications?

A

 Chest pain or other signs/symptoms suggestive of acute myocardial infarction
 ECG changes suggestive of acute myocardial infarction
 Unstable angina
 Pain, discomfort, fever in adult patient only

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4
Q

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Contraindications?

A

 Bleeding ulcer, hemorrhagic states, hemophilia
 Known hypersensitivity
 Children and adolescents

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5
Q

ACETYLSALICYLIC ACID, ASPIRIN, ASA adult dosage?

A

 Cardiac: 160- 325 mg

 Pain/discomfort/fever: 325 mg po

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6
Q

ACETYLSALICYLIC ACID, ASPIRIN, ASA peds dosage?

A

Not recommended for prehospital use in children

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7
Q

ACETYLSALICYLIC ACID, ASPIRIN, ASA Routes?

A

Oral

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8
Q

ACETYLSALICYLIC ACID, ASPIRIN, ASA Adverse Reactions?

A

Use with caution in the patient with history of asthma

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9
Q

ADENOSINE Class?

A

Antiarrhythmic, endogenous nucleoside

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10
Q

ADENOSINE Mechanism of Action?

A

 Slows conduction time through AV node; can interrupt re-entrant pathways through the AV node.

 Slows sinus rate.

 Larger doses decrease BP by decreasing peripheral resistance.

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11
Q

ADENOSINE Indications?

A

 Conversion of SVT with no known atrial fibrillation or atrial flutter.
 Undifferentiated regular monomorphic wide-complex tachycardia

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12
Q

ADENOSINE Contraindications?

A

 Sick sinus syndrome, 2nd or 3rd degree AV blocks; except in patients with a functioning ventricular pacemaker.

 Use cautiously in patients with known asthma

 Known atrial fibrillation or atrial flutter.

 Pregnancy (no controlled studies)

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13
Q

ADENOSINE Adverse Reactions?

A

CV: Transient dysrhythmias (systole, bardycardia, PVC’s) occur in 55% of patients (none reported as irreversible). Palpitations, chest pressure, chest pain, hypotension, transient hypertension; facial flushing, sweating.

Resp: Dyspnea, hyperventilation, tightness in throat, bronchospasm.

CNS: Lightheadedness, headache, dizziness, paresthesias, apprehension, blurred vision,
neck-back pain.

GI: Nausea, metallic taste.

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14
Q

ADENOSINE Adult Dosage?

A

Initial: 6 mg rapid IV bolus over 1-3 seconds
Follow immediately with 20 ml normal saline flush.

Repeat: If no response in 1-2 minutes repeat w/ 12 mg

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15
Q

ADENOSINE Peds Dosage?

A

Initial: 0.1 mg/kg as a rapid IV bolus.
Follow immediately with 2-3 ml normal saline flush.

Repeat: If no response, dose may be doubled 1 time (0.2 mg/kg)

Max Dose: 12mg

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16
Q

ADENOSINE Routes?

A

Rapid IV Push

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17
Q

AMIODARONE Class?

A

Antiarrhythmic Agent

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18
Q

AMIODARONE Indications?

A

Treatment of: defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin.

Control hemodynamically stable ventricular tachycardia when cardioversion unsuccessful.

Adjunct to cardioversion of SVT and PSVT. Rate control in atrial fibrillation or flutter.

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19
Q

AMIODARONE Contraindications?

A 
Bradycardia
Second or third degree heart block unless a functioning pacemaker is present
Cardiogenic shock
Hypotension
Pulmonary congestion
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20
Q

AMIODARONE Adult dosage?

A

No Pulse: VF/Pulseless VT- 300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push

Pulse: Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with cardioversion- 150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes

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21
Q

AMIODARONE Peds Dosage?

A

VF/Pulseless VT- 5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes two times to a total maximum of 15 mg/kg/day

Probable VT with pulse- 5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15 mg/kg/day

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22
Q

AMIODARONE Routes?

A

IV/IO bolus, IV/IO infusion

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23
Q

AMIODARONE Mechanism of Action?

A

Multiple effects on sodium, potassium and calcium channels.

Prolongs action potential, refractory period.

Ventricular automaticity (potassium channel blockade).

Slows membrane depolarization and impulse conduction (sodium channel blockade).

Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic
activity (calcium  -blockade).

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24
Q

AMIODARONE Adverse Reactions?

A

 Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, atrio-ventricular block
 Torsades de Pointes (prolongs QTc interval), congestive heart failure
 GI & Hepatic: nausea, vomiting, abnormal liver function tests
 Skin: slate-blue pigmentation
 Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia

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25
Q

ATROPINE SULFATE Class?

A 
Anticholinergic agent
Antidote
Antispasmodic agent
Anti-arrhythmic
Anti-muscarinic
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26
Q

ATROPINE SULFATE Mechanism of Action?

A

Blocks the action of acetylcholine as a competitive antagonist at muscarinic receptor sites in smooth muscle, secretory glands, and the CNS. It works by blocking parasympathetic response and allowing sympathetic response to take over, resulting in an increase in cardiac output

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27
Q

ATROPINE SULFATE Indications?

A

Symptomatic bradycardia

Acetylcholinesterase inhibitor poisoning

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28
Q

ATROPINE SULFATE Contraindications?

A 
 Hypersensitivity to atropine
 Glaucoma
 Tachycardia
 Obstructive GI disease
 Hepatic disease
 Renal disease,
 Myasthenia gravis 
 Asthma
 Thyrotoxicosis
 Mobitz type II block (2nd deg Type II AV Block)
 3rd degree heart block
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29
Q

ATROPINE SULFATE Adverse Reactions?

A

Tachydysrhythmias; flushing; ventricular irritability; exacerbation/initiation of angina; acute narrow angle glaucoma; blurred vision; mydriasis; agitation to delirium; bloating; constipation; decreased gastric emptying

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30
Q

ATROPINE SULFATE Adult Dosage? (Symptomatic Bradycardia)

A

0.5 mg every 5 minutes. Do NOT exceed a total dose of 3 mg or 0.04mg/kg if symptoms profound.

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31
Q

ATROPINE SULFATE Peds Dosage? (Symptomatic Bradycardia)

A

0.02 mg/kg (minimum of 0.1 mg), may repeat at 5 minute intervals to a maximum TOTAL dose of 1 mg in children and 2 mg in adolescents

Maximum SINGLE doses: Child 0.5 mg; Adolescent 1 mg.

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32
Q

ATROPINE SULFATE Routes?

A

IV, IO, IM, ET if necessary

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33
Q

CALCIUM CHLORIDE Class?

A

Electrolyte

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34
Q

CALCIUM CHLORIDE Mechanism of Action?

A

 Increases extracellular and intracellular calcium levels
 Stimulates release of catecholamines
 Increases cardiac contractile state (positive inotropic effect)
 May enhance ventricular automaticity
 Inhibits the effects of adenosine on mast cells

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35
Q

CALCIUM CHLORIDE Indication?

A

 Acute hypocalcemia
 Calcium channel blocker OD
 Acute hyperkalemia (known or suspected)
 Hypermagnesemia (Magnesium OD)
 Pre-treatment for IV calcium channel blocker administration

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36
Q

CALCIUM CHLORIDE Contraindication?

A

Hypercalcemia

Concurrent digoxin therapy

37
Q

CALCIUM CHLORIDE Adverse Reactions?

A

 Brady-asystolic arrest
 Severe tissue necrosis if solution extravasates
 Use cautiously in patients on digitalis; may cause serious arrhythmias

38
Q

CALCIUM CHLORIDE Adult Dosage?

A

Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia:

5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10 minutes.

39
Q

CALCIUM CHLORIDE Peds Dosage?

A

Hypocalcemia, calcium channel blocker OD hyperkalemia and hypermagnesemia:
0.2 - 0.25 ml/kg of a 10% solution infused slowly. Should not be repeated without documented calcium deficiency.

40
Q

CALCIUM CHLORIDE Routes?

A

IV Bolus

41
Q

CALCIUM CHLORIDE Incompatibilities?

A

All drugs – flush line before and after administration

42
Q

DILTIAZEM Class?

A

Calcium channel blocker, calcium antagonist

43
Q

DILTIAZEM Mechanism Of Action?

A

Pharmacological: Inhibits calcium ion influx across cell membranes during cardiac depolarization, decreases SA and AV conduction and dilates coronary and peripheral arteries and arterioles.

Clinical effects: Slows the rapid ventricular rate associated with atrial fibrillation and atrial flutter, and reduces coronary and peripheral vascular resistance.

44
Q

DILTIAZEM Indications?

A

Rapid ventricular rates associated with atrial fibrillation and atrial flutter, and for PSVT refractory to adenosine.

45
Q

DILTIAZEM Contraindications?

A 
 Hypotension (less than 90 mmHg systolic)
 Acute Myocardial infarction
 Cardiogenic shock
 Ventricular tachycardia or wide-complex VT of unknown origin
 Second or third-degree AV block
 Wolff-Parkinson-White (WPW) syndrome
 Sick Sinus syndrome
 Beta Blocker Use
46
Q

DILTIAZEM Adverse Reactions?

A

CV: hypotension, bradycardia, heart block, chest pain, and asystole
GI: nausea and vomiting
CNS: headache, fatigue, drowsiness

47
Q

DILTIAZEM Adult dosage?

A

Initial: 0.25 mg/kg IVP (usually 20 mg) administered over 2 minutes

If response is inadequate, repeat in 15 minutes: 0.35 mg/kg IVP administered over 2 mins

Maintenance infusion:5.0 to 15 mg/hr

48
Q

DILTIAZEM Peds Dosage?

A

The safety and efficacy of this drug for use in children has not been established.

49
Q

DILTIAZEM Route?

A

IV Bolus followed by maintenance infusion

50
Q

DOPAMINE Class?

A

Sympathomimetic

51
Q

DOPAMINE Mechanism of action?

A

Effects are dose-dependent:

1-2 mcg/kg/min Acts on dopaminergic receptors to stimulate cerebral, renal and mesenteric vasculature to dilate; HR and B/P are usually unchanged; may increase urine output

2-10 mcg/kg/min ß1 stimulant action is primary effect (increases cardiac output and partially antagonizes the a-adrenergic-mediated vasoconstriction. Overall effect is increased cardiac output and only modest increase in systemic vascular resistance (SVR)

10-20 mcg/kg/min a-adrenergic effects predominate resulting in renal, mesenteric and peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload

> 20 mcg/kg/min Produces hemodynamic effects similar to norepinephrine; may increase HR and O2 demand to undesirable limits

52
Q

DOPAMINE Indications?

A

Symptomatic bradycardias.

Hemodynamically significant hypotension in the absence of hypovolemia

53
Q

DOPAMINE Contraindications?

A

Hypovolemic shock (relative)
Pheochromocytoma
MAO inhibitors, such as Marplan, Nardil, or Parnate

54
Q

DOPAMINE Adverse Reactions?

A

CV: Cardiac arrhythmias may occur due to increased myocardial oxygen demand (usually tachydysrhythmias), hypertension, hypotension at low doses.

GI: Nausea and vomiting

GU: Renal shutdown (at higher doses)

Other: Extravasation may cause tissue necrosis

55
Q

DOPAMINE Adult Dosage?

A

dosage range 2-20 mcg/kg/min

Preparation: (If premixed not carried) Add 400 mg/ 250 ml NS or Dextrose = 1600 mcg/ml.

Bradycardia: Start at 5 mcg/kg/min

Shock: cardiogenic or septic (non-hypovolemic)
BP 70 systolic: Start drip at 2.5 mcg/kg/min

56
Q

DOPAMINE Peds Dosage?

A

2-20 mcg/kg/min for circulatory shock or shock unresponsive to fluid administration. To prepare infusion for small children: 6 x body wt. in kg = mg added to NS to make 100 ml. With this mixture 1 ml/hr delivers 1 mc/kg/min; titrate to effect.

57
Q

DOPAMINE Route?

A

IV Infusion

58
Q

EPINEPHRINE HCl Class?

A

Sympathomimetic

59
Q

EPINEPHRINE HCl Mechanism Of action?

A

Pharmacological Effects:

Direct acting a and ß agonist; a-bronchial, cutaneous, renal, and visceral arterial constriction (increased systemic vascular resistance); ß1-positive inotropic and chronotropic actions (increases myocardial workload and oxygen requirements), increases automaticity and irritability; ß2 bronchial smooth muscle relaxation and dilation of skeletal vasculature.

Other: blocks histamine release

Clinical Effects:

Cardiac Arrest-increases cerebral and myocardial perfusion pressure; increases systolic and diastolic blood pressures; increases electrical activity in the myocardium; can stimulate spontaneous contractions in asystole.

Bradycardia-increases heart rate, increases BP; Bronchospasm/Anaphylaxis-reverse signs/symptoms

60
Q

EPINEPHRINE HCl Indications?

A

 Cardiac arrest - VF/Pulseless VT; asystole; PEA
 Severe bronchospasm, i.e., bronchiolitis, asthma.
 Anaphylaxis.
 Bradycardia
 Hypotension unresponsive to other therapy
 Croup

61
Q

EPINEPHRINE HCl Contraindications?

A

None known for cardiac arrest Hypothermia, relative contraindication

62
Q

EPINEPHRINE HCl Adverse Reactions?

A

CV: Hypertension, ventricular dysrhythmias; tachycardia; angina
CNS: Anxiety, agitation
GI: Nausea/vomiting

63
Q

EPINEPHRINE HCl Adult dosage?

A

Pulseless Arrest:
IV/IO: 1 mg of 1:10,000 solution repeat every 3 - 5 minutes or, ET: Give 2 - 2.5 mg via the ET tube.

Anaphylaxis and asthma:
Give 0.3 - 0.5 mg of 1:1,000 solution IM (preferred), SC, or inject SL, may repeat every 15 to 20 minutes;

or in extreme cases only, may be asked to use 1:10,000 solution and give 0.1 mg every 5 minutes IV/IO or continuous IV/IO infusion of 1 - 4 mcg/min to prevent need for multiple injections.

64
Q

EPINEPHRINE HCl Peds Dosage?

A

Pulseless Arrest or Refractory Bradycardia:

IV/IO: 0.01 mg/kg of 1:10,000 repeat every 3 - 5 minutes, maximum single dose 1 mg.

ET: 0.1 mg/kg of 1:1,000; diluted with NS to a volume of 3 - 5 mL prior to instillation or followed with flush of 3 - 5 mL of NS after instillation repeat every 3 - 5 minutes, maximum single dose 10 mg.

Asthma/anaphylaxis:
Use 1:1,000 solution; give 0.01 mg/kg IM (preferred), SC (maximum single dose of 0.5 mg/dose).

65
Q

EPINEPHRINE HCl Routes?

A

Cardiac: IV push, IV infusion, ET, or IO

Asthma/anaphylaxis/bronchiolitis: IM, SC, SL injection, IV, ET, IO

66
Q

LIDOCAINE HCL Class?

A

Antiarrhythmic, local anesthetic

67
Q

LIDOCAINE HCL Mechanism of action?

A

Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization.

Terminates re-entry by decreasing conduction in re-entrant pathways (by slowing conduction in ischemic tissue, equalizes conduction speed among fibers).

Increases ventricular fibrillation threshold.

68
Q

LIDOCAINE HCL Indications?

A

 Suppression of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, PVC’s).
 Prophylaxis against recurrence after conversion from ventricular tachycardia or ventricular fibrillation.
 Pain management after IO insertion in conscious patients.

69
Q

LIDOCAINE HCL Contraindications?

A

 Known hypersensitivity/allergy.
 Use extreme caution in patients with conduction disturbance (second or third degree
block).
 Do not treat ectopic beats if heart rate is

70
Q

LIDOCAINE HCL Adverse Reactions?

A

CV: May also cause SA nodal depression or conduction problems and hypotension in large doses, or if given too rapidly. Excessive doses in pediatric patient may produce myocardial and circulatory depression.

CNS: In large doses drowsiness, disorientation, paresthesias, decreased hearing acuity, muscle twitching, agitation, focal or generalized seizures.

71
Q

LIDOCAINE HCL Adult Dosage?

A

Pulseless VF/VT: Initial bolus of 1.0-1.5 mg/kg IV PUSH every 3-5 minutes to a total of 3 mg/kg. An initial bolus of 1.5 mg/kg should be given for cardiac arrest situations. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min

Antidysrhythmic or rhythms with a pulse: Initial boluses can be given as 0.5-0.75 mg/kg, up to 1.0-1.5 mg/kg, IV PUSH and additional boluses can be given as 0.5-0.75 mg/kg every 5-10 minutes to a total dose of 3 mg/kg. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min

IO pain management 20-40 mg, very slow IO push.

72
Q

LIDOCAINE HCL Peds Dosage?

A

Initial Bolus doses: 1 mg/kg, may repeat 1 time in 3-5 minutes for VF/Pulseless VT or in 15 minutes if used for refractory dysrhythmias with a pulse (VT with pulse, significant ventricular ectopy).

Infusion with return of spontaneous rhythm, optional: 20-50 mcg/kg/min; prepared by adding 120 mg (3mL) of 1 Gm/25 ml (40 mg/ml) solution to 97 ml of NS, yielding 1200 mcg/ml.

IO pain management, 0.1 mg/kg, not to exceed adult dosage.

73
Q

LIDOCAINE HCL Routes?

A

IV bolus, followed by IV infusion. May be given ET if IV is delayed

74
Q

NITROGLYCERIN Class?

A

Vasodilator, organic nitrate, antianginal

75
Q

NITROGLYCERIN Mechanism of action?

A

 Smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle
 Reduces workload on the heart by causing blood pooling (decreased preload)
 Arteriolar vasodilation (decreased afterload)
 Coronary artery vasodilation
 Increases blood flow to myocardium
 Decreases myocardial O2 demand

76
Q

NITROGLYCERIN Indications?

A

 Angina
 Myocardial infarction
 Congestive heart failure with pulmonary edema

77
Q

NITROGLYCERIN Contraindications?

A

 Hypovolemia
 Increased Intra cranial pressure
 Hypotension (relative)

78
Q

NITROGLYCERIN Adverse Reactions?

A

CV: Hypotension, reflex tachycardia, bradycardia, decreased coronary perfusion at high doses (secondary to hypotension), headache secondary to dilation of meningeal vessels.

79
Q

NITROGLYCERIN Adult dosage?

A

SL for Chest pain: 1/150 gr (0.4 mg) tablet or one full spray, may repeat x 3

SL for Pulmonary edema: 1-2 of the 1/150 gr (0.4 mg) tablets may be given SL every 5-10 minutes as long as the systolic BP is greater 90-100 systolic

80
Q

NITROGLYCERIN Peds Dosage?

A

Not used

81
Q

NITROGLYCERIN Routes?

A

SL or IV

82
Q

VERAPAMIL HCl Class?

A

Calcium channel blocker

83
Q

VERAPAMIL HCl Mechanism of action?

A

 Blocks calcium ion influx into cardiac and smooth muscle cells causing a depressant effect on the contractile mechanism resulting in negative inotropy.
 Reduces contractile tone in vascular smooth muscle resulting in coronary and peripheral vasodilation.
 Slows conduction and prolongs refractory period in the AV node due to calcium channel blocking.
 Slows SA node discharge.
 In summary, decreases myocardial contractile force and slows AV conduction.

84
Q

VERAPAMIL HCl Indications?

A

SVT

A-fib/A-Flutter

85
Q

VERAPAMIL HCl Contraindications?

A 
AV block
Sick sinus syndrome
Any wide QRS complex tachycardia WPW
Shock
Severe CHF
IV beta blocker
Hypotension
86
Q

VERAPAMIL HCl Adverse Reactions?

A 
 Extreme bradycardia
 Asystole
 AV block
 Hypotension
 Congestive heart failure
87
Q

VERAPAMIL HCl Adult Dosage?

A

2.5 - 5 mg slow IV push over 2-3 minutes. May rebolus in 15-30 minutes with 5-10 mg IV push until a maximum dose of 30 mg

88
Q

VERAPAMIL HCl Peds Dosage?

A

IV form not used in children in the field

89
Q

VERAPAMIL HCl Routes?

A

IV Slow push

AZDHS Drug Profiles (2 decks)

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