Cardiac Drug Profiles AZDHS

Question 1

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Class?

Answer 1

Analgesic, antipyretic, anti-inflammatory

Question 2

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Mechanism of Action?

Answer 2

blocks thromboxane A2

a potent platelet aggregate and vasoconstrictor.

Decreased platelet aggregation.

Question 3

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Indications?

Answer 3

 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

Question 4

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Contraindications?

Answer 4

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

Question 5

ACETYLSALICYLIC ACID, ASPIRIN, ASA adult dosage?

Answer 5

 Cardiac: 160- 325 mg

 Pain/discomfort/fever: 325 mg po

Question 6

ACETYLSALICYLIC ACID, ASPIRIN, ASA peds dosage?

Answer 6

Not recommended for prehospital use in children

Question 7

ACETYLSALICYLIC ACID, ASPIRIN, ASA Routes?

Answer 7

Oral

Question 8

ACETYLSALICYLIC ACID, ASPIRIN, ASA Adverse Reactions?

Answer 8

Use with caution in the patient with history of asthma

Question 9

ADENOSINE Class?

Answer 9

Antiarrhythmic, endogenous nucleoside

Question 10

ADENOSINE Mechanism of Action?

Answer 10

 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.

Question 11

ADENOSINE Indications?

Answer 11

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

Question 12

ADENOSINE Contraindications?

Answer 12

 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)

Question 13

ADENOSINE Adverse Reactions?

Answer 13

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.

Question 14

ADENOSINE Adult Dosage?

Answer 14

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

Question 15

ADENOSINE Peds Dosage?

Answer 15

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

Question 16

ADENOSINE Routes?

Answer 16

Rapid IV Push

Question 17

AMIODARONE Class?

Answer 17

Antiarrhythmic Agent

Question 18

AMIODARONE Indications?

Answer 18

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.

Question 19

AMIODARONE Contraindications?

Answer 19

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

Question 20

AMIODARONE Adult dosage?

Answer 20

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

Question 21

AMIODARONE Peds Dosage?

Answer 21

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

Question 22

AMIODARONE Routes?

Answer 22

IV/IO bolus, IV/IO infusion

Question 23

AMIODARONE Mechanism of Action?

Answer 23

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).

Question 24

AMIODARONE Adverse Reactions?

Answer 24

 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

Question 25

ATROPINE SULFATE Class?

Answer 25

``` Anticholinergic agent Antidote Antispasmodic agent Anti-arrhythmic Anti-muscarinic ```

Question 26

ATROPINE SULFATE Mechanism of Action?

Answer 26

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

Question 27

ATROPINE SULFATE Indications?

Answer 27

Symptomatic bradycardia Acetylcholinesterase inhibitor poisoning

Question 28

ATROPINE SULFATE Contraindications?

Answer 28

```  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 ```

Question 29

ATROPINE SULFATE Adverse Reactions?

Answer 29

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

Question 30

ATROPINE SULFATE Adult Dosage? (Symptomatic Bradycardia)

Answer 30

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

Question 31

ATROPINE SULFATE Peds Dosage? (Symptomatic Bradycardia)

Answer 31

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.

Question 32

ATROPINE SULFATE Routes?

Answer 32

IV, IO, IM, ET if necessary

Question 33

CALCIUM CHLORIDE Class?

Answer 33

Electrolyte

Question 34

CALCIUM CHLORIDE Mechanism of Action?

Answer 34

 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

Question 35

CALCIUM CHLORIDE Indication?

Answer 35

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

Question 36

CALCIUM CHLORIDE Contraindication?

Answer 36

Hypercalcemia | Concurrent digoxin therapy

Question 37

CALCIUM CHLORIDE Adverse Reactions?

Answer 37

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

Question 38

CALCIUM CHLORIDE Adult Dosage?

Answer 38

Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10 minutes.

Question 39

CALCIUM CHLORIDE Peds Dosage?

Answer 39

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.

Question 40

CALCIUM CHLORIDE Routes?

Answer 40

IV Bolus

Question 41

CALCIUM CHLORIDE Incompatibilities?

Answer 41

All drugs -- flush line before and after administration

Question 42

DILTIAZEM Class?

Answer 42

Calcium channel blocker, calcium antagonist

Question 43

DILTIAZEM Mechanism Of Action?

Answer 43

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.

Question 44

DILTIAZEM Indications?

Answer 44

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

Question 45

DILTIAZEM Contraindications?

Answer 45

```  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 ```

Question 46

DILTIAZEM Adverse Reactions?

Answer 46

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

Question 47

DILTIAZEM Adult dosage?

Answer 47

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

Question 48

DILTIAZEM Peds Dosage?

Answer 48

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

Question 49

DILTIAZEM Route?

Answer 49

IV Bolus followed by maintenance infusion

Question 50

DOPAMINE Class?

Answer 50

Sympathomimetic

Question 51

DOPAMINE Mechanism of action?

Answer 51

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

Question 52

DOPAMINE Indications?

Answer 52

Symptomatic bradycardias. | Hemodynamically significant hypotension in the absence of hypovolemia

Question 53

DOPAMINE Contraindications?

Answer 53

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

Question 54

DOPAMINE Adverse Reactions?

Answer 54

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

Question 55

DOPAMINE Adult Dosage?

Answer 55

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

Question 56

DOPAMINE Peds Dosage?

Answer 56

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.

Question 57

DOPAMINE Route?

Answer 57

IV Infusion

Question 58

EPINEPHRINE HCl Class?

Answer 58

Sympathomimetic

Question 59

EPINEPHRINE HCl Mechanism Of action?

Answer 59

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

Question 60

EPINEPHRINE HCl Indications?

Answer 60

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

Question 61

EPINEPHRINE HCl Contraindications?

Answer 61

None known for cardiac arrest Hypothermia, relative contraindication

Question 62

EPINEPHRINE HCl Adverse Reactions?

Answer 62

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

Question 63

EPINEPHRINE HCl Adult dosage?

Answer 63

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.

Question 64

EPINEPHRINE HCl Peds Dosage?

Answer 64

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).

Question 65

EPINEPHRINE HCl Routes?

Answer 65

Cardiac: IV push, IV infusion, ET, or IO | Asthma/anaphylaxis/bronchiolitis: IM, SC, SL injection, IV, ET, IO

Question 66

LIDOCAINE HCL Class?

Answer 66

Antiarrhythmic, local anesthetic

Question 67

LIDOCAINE HCL Mechanism of action?

Answer 67

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.

Question 68

LIDOCAINE HCL Indications?

Answer 68

 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.

Question 69

LIDOCAINE HCL Contraindications?

Answer 69

 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

Question 70

LIDOCAINE HCL Adverse Reactions?

Answer 70

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.

Question 71

LIDOCAINE HCL Adult Dosage?

Answer 71

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.

Question 72

LIDOCAINE HCL Peds Dosage?

Answer 72

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.

Question 73

LIDOCAINE HCL Routes?

Answer 73

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

Question 74

NITROGLYCERIN Class?

Answer 74

Vasodilator, organic nitrate, antianginal

Question 75

NITROGLYCERIN Mechanism of action?

Answer 75

 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

Question 76

NITROGLYCERIN Indications?

Answer 76

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

Question 77

NITROGLYCERIN Contraindications?

Answer 77

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

Question 78

NITROGLYCERIN Adverse Reactions?

Answer 78

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

Question 79

NITROGLYCERIN Adult dosage?

Answer 79

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

Question 80

NITROGLYCERIN Peds Dosage?

Answer 80

Not used

Question 81

NITROGLYCERIN Routes?

Answer 81

SL or IV

Question 82

VERAPAMIL HCl Class?

Answer 82

Calcium channel blocker

Question 83

VERAPAMIL HCl Mechanism of action?

Answer 83

 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.

Question 84

VERAPAMIL HCl Indications?

Answer 84

SVT | A-fib/A-Flutter

Question 85

VERAPAMIL HCl Contraindications?

Answer 85

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

Question 86

VERAPAMIL HCl Adverse Reactions?

Answer 86

```  Extreme bradycardia  Asystole  AV block  Hypotension  Congestive heart failure ```

Question 87

VERAPAMIL HCl Adult Dosage?

Answer 87

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

Question 88

VERAPAMIL HCl Peds Dosage?

Answer 88

IV form not used in children in the field

Question 89

VERAPAMIL HCl Routes?

Answer 89

IV Slow push