Cardiac Drugs Flashcards
Adenosine/ adenocard
Name/Class: ADENOSINE (Adenocard)/Antidysrhythmic
Description: Adenosine is a naturally occurring agent that can “chemically cardiovert” PSVT to a normal sinus rhythm. It has a half-life of 10 seconds and does not cause hypotension.
Indications: Narrow, complex paroxysmal supraventricular tachycardia refractory to vagal maneuvers.
Contraindications: Atrial Fibrilation, 2nd- and 3rd-degree heart block, sinus node disease, or Acute asthma.
Precautions: It may cause transient dysrhythmias especially asystole, COPD.
Dosage/Route: 6 mg rapidly (over 1 to 2 sec) IV, then flush the line rapidly with saline. If ineffective, 12 mg in 1 to 2 mins, may be repeated.
Pedi: 0.1 mg/kg (over 1 to 2 sec) IV followed by rapid saline flush, then 0.2 mg/kg in 1 to 2 min to max 12 mg.
AMIODARONE (Cordarone, Pacerone)
Name/Class: AMIODARONE (Cordarone, Pacerone)/Antidysrhythmic ( KCL Blocker)
Description: Amiodarone is an Antidysrhythmic that prolongs the duration of the action potential and refractory period and relaxes smooth muscles, reducing peripheral vascular resistance and increasing coronary blood flow.
Indications: Life-threatening ventricular and supraventricular dysrhythmias, frequently atrial fibrillation 2nd Line.
Contraindications: cardiogenic shock, severe sinus bradycardia, or advanced heart block.
Precautions: Hepatic impairment, pregnancy, nursing mothers, children.
Dosage/Route: 150mg over 10 minutes pt with pulses or 300 mg pulseless IVP
Pedi: 5 mg/kg IV/IO, then 15 mg/kg/day.
ASPIRIN (Acetylsalicylic Acid)
Name/Class: ASPIRIN (Acetylsalicylic Acid) Analgesic, Antipyretic, Platelet Inhibitor, Anti-inflammatory
Description: Aspirin inhibits agents that cause the production of inflammation, pain, and fever. It relieves mild to moderate pain by acting on the peripheral nervous system, lowers body temperature in fever, and powerfully inhibits platelet aggregation.
Indications: Chest pain suggestive of an MI.
Contraindications: Hypersensitivity to salicylates, active ulcer disease, asthma.
Precautions:, Bleeding disorders, Varicies
Dosage/Route: 324 mg PO (chewable).
Atropine
Name/Class: ATROPINE/Parasympatholytic
Description: Atropine blocks the parasympathetic nervous system, specifically the vagal effects
on heart rate. May increase myocardial oxygen demand. Decreases airway secretions.
Indications: Hemodynamically significant bradycardia and organophosphate poisoning.
Contraindications: None in the emergency setting. 2nd degree type 2 and above heart blocks are class 2B (not recommended)
Precautions: AMI, glaucoma.
Dosage/Route: Symptomatic bradycardia: 0.5 mg -1 mg IV/IO. Repeat 3 to 5 min to 3 mg.
Pedi: 0.02 mg/kg IV, may repeat in 5 min up to 1 mg
Organophosphate poisoning: 2 to 5 mg IV/IM/IO q10 to 15 min.
Pedi: 0.05 mg/kg IV/IM/IO q10 to 15 min.
BRETYLIUM (Bretylol)
Name/Class: BRETYLIUM (Bretylol)/Antidysrhythmic (KCL Blocker)
Description: Bretylium causes a release of norepinephrine, depresses ventricular fibrillation, and reduces ectopy. Bretylium suppresses ventricular tachydysrhythmias including vfib with reentry mechanisms.
Indications: Ventricular fibrillation and ventricular tachycardia refractory to lidocaine.
Contraindications: None
Dose: Dosage/Route: 5 mg/kg IV, then 10 mg/kg/15 to 30 min, to a max 30 mg/kg.
DOBUTAMINE (Dobutrex)
Name/Class: DOBUTAMINE (Dobutrex)/Sympathomimetic
Description: Dobutamine is a synthetic catecholamine and beta agent that increases the strength of cardiac contraction without appreciably increasing rate.
Indications: To increase cardiac output in congestive heart failure/cardiogenic shock.
Contraindications: Hypersensitivity to Sympathomimetic amines, ventricular tachycardia, and hypovolemia without fluid resuscitation.
Precautions: Atrial fibrillation or preexisting hypertension.
Dosage/Route: 2 to 20 mcg/kg/min IV.
Pedi: Same
Dopamine (Intropin)
Name/Class: DOPAMINE (Intropin)/Sympathomimetic
Description: Dopamine is a naturally occurring catecholamine that increases cardiac output without appreciably increasing myocardial oxygen consumption. It maintains renal and mesenteric blood flow while inducing vasoconstriction and increasing systolic blood pressure.
Indications: Nonhypovolemic hypotension (70 to 100 mmHg) and cardiogenic shock.
Contraindications: Hypovolemic hypotension without aggressive fluid resuscitation, tachydysrhythmias, ventricular fibrillation, and pheochromocytoma.
Precautions: Ensure adequate fluid resuscitation
of the hypovolemic patient.
Dosage/Route: 2 to 20 mcg/kg/min. 5 mcg/kg/min starting cardiac dose, titrated to effect.
Pedi: same as adult.
Diltiazem (Cardizem)
Name/Class: DILTIAZEM (Cardizem)/Calcium Channel Blocker
Description: Diltiazem is a slow calcium channel blocker similar to verapamil. It dilates coronary and peripheral arteries and arterioles, thus increasing circulation to the heart and reducing peripheral vascular resistance.
Indications: Supraventricular tachydysrhythmias (atrial fibrillation, atrial flutter, and PSVT refractory to adenosine) and to increase coronary artery perfusion in angina.
Contraindications: Hypersensitivity, sick sinus syndrome, 2nd- or 3rd-degree heart block, systolic BP < 90, diastolic BP < 60, wide-complex tachycardia and WPW.
Precautions: CHF (especially with beta blockers), conduction abnormalities
Dosage/Route: 0.25 mg/kg IV over 2 min, may repeat as needed with 0.35 mg/kg.
Epinephrine (Adrenalin)
Name/Class: EPINEPHRINE (Adrenalin)/Sympathomimetic
Description: Epinephrine is a naturally occurring catecholamine that increases heart rate, cardiac contractile force myocardial electrical activity, systemic vascular resistance, and systolic blood pressure and decreases overall airway resistance and automaticity. It also, through bronchial artery constriction, may reduce pulmonary congestion and increase tidal volume and vital capacity.
Indications: To restore rhythm in cardiac arrest and severe allergic reactions, COPD, Asthma
Contraindications: Narrow angle glaucoma; hemorrhagic, traumatic, or cardiac shock;
Dosage/Route: Arrest: 1 mg of 1:10,000 IV q3 to 5 min (ET: 2 to 2.5 mg 1:1,000).
Pedi: 0.01 mg/kg 1:10,000 IV/IO. All subsequent doses 0.1 mg/kg IV/IO. No max.
Adult Bradycardia (2-5mcg/min) IV Drip mix 1mg/250cc
Allergic reactions: 0.3 of 1:1,000 IM q5 to 15 min as needed or 0.5 to 1 mg of 1:10,000 IV if IM dose ineffective or severe reaction. Consider IV Drip 2-10mcg/min if severe
Pedi: 0.01 mg/kg (Max 0.5) of 1:1,000 IM/10 to 15 min or 0.01 mg/kg of 1:10,000 IV if IM dose ineffective or severe.
Asthma/COPD 0.01mg/kg to max of 0.3mg 1-1,000 SQ
Eptifibatide (integrilin)
Name/Class: EPTIFIBATIDE (Integrilin) Glycoprotein IIb/IIIa inhibitor, platelet aggregation inhibitor
Description: Prevents the aggregation of platelets by binding to the glycoprotein IIb/IIIa receptor, preventing the binding of fibrinogen and von Willebrand factors.
Indications: Unstable angina and NSTEMI (ACS) being managed medically.
Contraindications: Any prior intracranial hemorrhage, known malignant intracranial neoplasm, suspected aortic dissection, significant closed head trauma or facial trauma within 3 hours.
Precautions/Side Effects: Cerebral hemorrhage, pulmonary hemorrhage, hypotension, GI bleeding, internal bleeding, anaphylactic shock.
Dosage/Route: Medical management 180 ug/kg IV bolus over 1-2 minutes, followed by a 2 ug/kg infusion for 72-96 hours.
Heparin
Name/Class: HEPARIN (Heparin)/Anticoagulant
Description: Heparin is a rapid-onset anticoagulant, enhancing the effects of antithrombin III and blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin.
Indications: To prevent thrombus formation in acute MI.
Isoproterenol (Isuprel)
Name/Class: ISOPROTERENOL (Isuprel)/Sympathomimetic
Description: Isoproterenol is a synthetic sympathomimetic that results in increased cardiac output by increasing the strength of cardiac contraction and somewhat increasing rate.
Indications: Bradycardia refractory to atropine when pacing is not available
Contraindications: Cardiogenic shock.
Precautions: Tachydysrhythmias and those associated with digitalis and acute myocardial infarction.
Dosage/Route: Bradycardia: 2 to 10 mcg/min titrated to cardiac rate.
Pedi: 0.1 mcg/kg/min titrated to cardiac rate.
Lidocaine (Xylocaine)
Name/Class: LIDOCAINE (Xylocaine)/Antidysrhythmic (NA+ Blocker)
Description: Lidocaine is an antidysrhythmic that suppresses automaticity and raises stimulation threshold of the ventricles. It also causes sedation, anticonvulsant, and analgesic effects.
Indications: Pulseless ventricular tachycardia, ventricular fibrillation, ventricular tachycardia (w/ pulse).
Contraindications: Hypersensitivity to amide-type local anesthetics, supraventricular dysrhythmias, Bradycardia, Fasicular Blocks
Precautions: Hepatic or renal impairment, CHF, hypoxia, respiratory depression, hypovolemia, myasthenia gravis, shock, elderly
Dosage/Route: Cardiac arrest: 1 to 1.5 mg/kg IV repeated every 3 to 5 min up to 3 mg/kg, Consider ½ dose for elderly follow conversion with a drip of 2 to 4 mg/min. 1Gram/250cc ,
Pedi: 1 mg/kg IV, repeat/3 to 5 min up to 3 mg/kg, follow conversion with a drip of 20 to 50 mcg/kg/min.
Metoprolol (Lopressor)
Name/Class: METOPROLOL ( Lopressor) / Beta Blocker
Description: Metoprolol is a beta-adrenergic blocking agent that reduces heart rate, cardiac output, and BP
Indications: AMI, SVT
Contraindications: Cardiogenic shock, sinus bradycardia 0.24, asthma or COPD, Inferior Wall AMI
Precautions: Hypersensitivity, hepatic or renal impairment, CHF controlled by digitalis and diuretics, AV conduction defects, diabetics, or Peripheral vascular disease.
Dose: 5mg slow IVP q 5min up to 3 doses while watching HR and BP.
Nitroglycerin (Nitrostat)
Name/Class: NITROGLYCERIN (Nitrostat)/Nitrate
Description: Nitroglycerin is a rapid smooth muscle relaxant that reduces peripheral vascular resistance, blood pressure, venous return, and cardiac workload.
Indications: Chest pain associated with angina and acute myocardial infarction, and acute pulmonary edema.
Contraindications: Hypersensitivity, tolerance to nitrates, severe anemia, head trauma, hypotension, increased ICP, patients taking ED Drugs, glaucoma, and shock.
Precautions: May induce headache that is sometimes severe. Nitroglycerin is light sensitive and will lose potency when exposed to the air.
Dosage/Route: 1 tablet (0.4 mg) SL. May be repeated/3 to 5 min up to 3 tablets,
or 1 inch of topical ointment, or 0.4 mg (one spray) SL up to 3 sprays/25 min.
