Cardiac Drug Quiz

Question 1

Adenosine

Answer 1

Class: Misc. Antidysrhythmic, endogenous nucleoside
Action: Decreases electrical conduction through the AV node
Indications: Supraventricular Tachycardia’s (SVT/PSVT)
Contraindications: Hypersensitivity, bradycardia, drug-induced tachycardia, 2nd or 3rd degree heart blocks, A-fib, A-Flutter, V-Tach, WPW w/ A-fib/Flutter
Onset: Immediately
Duration: 10-seconds
Dose/Rote:
Adult- 6mg rapid IV/IO push followed by 20cc saline flush, may repeat at 12mg rapid IV push followed by 20cc saline flush
Peds- 0.1mg/kg (max 6mg) IV/IO followed by 5-10cc saline flush. May repeat at 0.2mg/kg (max 12mg) IV/IO followed by 5-10cc saline flush
Side Effects: Dizziness, headache, shortness of breath, hypotension, flushing, palpitations, chest pain, nausea/vomiting

Question 2

Amiodarone

Answer 2

Class: Class III Antidysrhythmic
Action: Prolongs duration of action potential and refractory period. Has beta adrenergic receptor and calcium channel blocking activity.
Indications: V-Fib, hemodynamically unstable V-Tach, treatment for some stable atrial rhythms
Contraindications: CHF, cariogenic shock, bradycardia, 2nd or 3rd degree heart blocks with no pacemaker present, hypersensitivity to amiodarone or iodine
Onset: Within minutes
Duration: Variable, but considered 30-45 days
Dose/Rote:
Adult-
(Pulseless V-Tach/V-fib arrest): 300mg IV/IO may repeat once at 150mg IV/IO
(V-Tach w/ a pulse): 150mg IV drip over 10 minsup to max of 2.2g in 24 hrs

Pedi-
(Pulseless V-Tach/V-fib arrest): 5mg/kg IV/IO
(V-Tach w/ a pulse): 5mg/kg IV drip over 20-60 mins w/ a max of 15mg/kg/day
Side Effects: Bradycardia, hypotension, headache, CHF, abnormal liver/thyroid functions

Question 3

Atropine

Answer 3

Class: Anticholinergic, Parasympatholytic
Action: Inhibits actions of ACh causing increased HR, decreased gastric motility, decreased salivation and bronchial secretions
Indications: Hemodynamically unstable bradycardia and organophosphate poisoning
Contraindications: Tachycardia, hypersensitivity, avoid use w/ hypothermic pt’s, caution in pt’s w/ an active MI and hypoxia
Onset: Rapid
Duration: 2-6 hrs
Dose/Rote:
Adult-
(Bradycardia): 0.5mg IV/IO every 3-5mins up to a max total of 3mg or 0.04mg/kg
(Organo Poisoning): 1-5mg IV/IM/IO repeated 3-5 mins or until cessation of bronchial secretions

Peds-
(Bradycardia, not responding to Epi): 0.02mg/kg IV/IO (min dose of 0.1mg and max single dose of 0.5mg) w/ max total of 1mg for a child and 3mg total for adolescent
(Organo Poisoning, <12y/o): 0.02-0.05mg/kg IV/IM/IO may be repeated every 20-30mins until cessation of bronchial secretions
Side Effects: Tachycardia, paradoxical bradycardia (if given too slow or too small of a dose), mydriasis (dilated pupils), dysrhythmias, headache, nausea/vomiting, dizziness, flushed, blurred vision, urinary retention, constipation

Question 4

Epinephrine 1:10,000

Answer 4

Class: Sympathomimetic
Action: Endogenous catecholamine that stimulates both alpha and beta 1 and 2 adrenergic receptors
Indications: Anaphylaxis, cardiac arrest, asthma, bradycardia (first line in peds, not adults), shock not caused by hypovolemia, severe hypotension accompanied w/ bradycardia when pacing and atropine fails
Contraindications: Hypovolemic shock, caution should be used w/ pt’s w/ known cardiovascular disease or pt’s >45y/o
Onset: 1-2 mins IV, 5-10 mins SQ
Duration: 5-10 mins
Dose/Rote:
Adult-
(Cardiac Arrest): 1mg every 3-5mins w/ no max

Pedi-
(Cardiac Arrest): 0.01mg/kg IV/IO max of 1mg every 3-5mins
Side Effects: Tachycardia, hypertension, anxiety, cardiac dysrhythmias, tremors, dyspnea

Question 5

Lidocaine

Answer 5

Class: Class 1B Antidysrhythmic
Action: Sodium channel blocker that acts primarily on the ventricles during depolarization, decreasing automaticity, suppressing PVC’s, and raising V-fib threshold
Indications: Significant ventricular ectopy w/ ischemia/MI, pulseless V-Tach or V-fib cardiac arrest, stable V-Tach w/ a pulse
Contraindications: Hypersensitivity, prophylactic use in an acute MI, 2nd or 3rd degree heart block in the absence of a pacemaker, Stokes-Adams syndrome
Onset: 30-90secs
Duration: 10-20mins
Dose/Rote:
Adult-
(Cardiac Arrest): 1-1.5mg/kg IV/IO bolus, may be repeated in 5-10mins w/ a max total of 3mg/kg. Bolus is followed by maintenance infusion drip of 1-4mg/min post-cardiac arrest
(PVC’s or V-Tach w/ a pulse): 0.5-0.75mg/kg IV/IO up to 1-1.5mg/kg IV/IO and may be repeated w/ a max total dose of 3mg/kg

Peds:
(Cardiac Arrest): 1mg/kg IV/IO bolus followed by maintenance infusion drip of 10-50mcg/kg/min IV/IO post-cardiac arrest.
(PVC’s or pulseless V-Tach): 1mg/kg IV/IO
Side Effects: Blurred vision, dizziness, hypotension, bradycardia, seizures, altered LOC

Question 6

Nitroglycerin

Answer 6

Class:
Action:
Indications:
Contraindications:
Onset/Duration:
Dose/Rote:
Side Effects:

Question 7

Procainamide

Answer 7

Class: Class 1A Antidysrhythmic
Action: Works on depolarization in normal ventricular muscle and Purkinje fibers, suppressing reentry dysrhythmias by slowing intraventricular conduction
Indications: Stable V-Tach, reentry SVT not controlled by adenosine/vagal maneuvers, A-fib w/ a rapid rate w/ WPW syndrome
Contraindications: 2nd or 3rd degree heart blocks w/o a functioning artificial pacemaker in place, digitalis toxicity, tornadoes de pointes, TCA overdose
Onset: 10-30mins
Duration: 3-6hrs
Dose/Rote:
Adult- 20mg/min slow IV infusion drip w/ a total dose of 17mg/kg. Maintenance drip post-cardiac arrest of 1mg in 250mL of D5W or NS and infuse at 1-4mg/min

Pedi- Loading dose of 15mg/kg IV/IO and infuse over 30-60mins
Side Effects: Hypotension, bradycardia, reflex tachycardia, AV block, widening QRS complex, prolonged P-R or QT interval, PVC’s, V-Tach/V-fib/Asystoles, seizures, CNS depression