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Cardiac Drugs Flashcards

1
Q

Adenosine) class:

Dynamics:

A

= Misc antiarrhythmic binds to adenosine A1 receptors causes efflux of K & inhibits Ca influx (in autoarhythmic cells)
= Causes hyperpolarization of autorhythmic cells (SA/AV node)
Slows AV conduction w/ very short half-life

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2
Q

Adenosine) indications:

contraindications

A

= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB)
= Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER

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3
Q

Adenosine) Effects:
Dose:

admin notes:

A

= periods of sinus Bcardia/asystole & ventricular ectopy after admin
= 1st dose 6mg rapid IV/IO push followed w/ rapid flush &2nd dose 12mg also rapid push & flush
= rapid push followed by rapid flush 20mL fluid best accomplished w/ 3-way stopcock & 1/2 initial dose in PTs receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access

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4
Q

Albuterol) Dynamics:
Indications:
Contraindications:

A

=B agonist w/ preference of B2 receptors
=Brocospasm, Anaphylaxsis/ asthma/ Allergies, Hyperkalemia
= jitters & Known hypersensitivity

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5
Q

Albuterol) Adverse effects:
Adult Broncospasm dose:
Hyperkalemic dose:
Pedi Dose:

A

= Palp/s, Anxiety, Jitters, Dizzy, Tcardia
= 2.5mg/3mg via SVN→ repeat 15-20mins as needed
= 10-20mg via LVN over 15 mins→ repeat as needed
= 1.25-2.5mg/1.5-3mL SVN

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6
Q

Amiodarone) Class:
Dynamics:

Indi:

B/c its toxicity indi:
W/ expert consultation may be used for:
Terminal elimination:

A

= Class III antiarrhythmic
= Slows K+ efflux delaying repolarization on all of heart
= VF/Pulseless VT-no/response to shock CPR & Epi, Recurrent hemodynamically unstable VT w/ pulse
= PT w/ life-threatening arrhythmias w/ monitoring
= some atrial & ventricular rhythms w/ life-threatening hypoBP
= Extremely long (half-life lasts max 40 days)

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7
Q

Amiodarone) Contra:
Effects:
Caution b/c:

A

= Allergic, Bradycardias w/ AV blocks, Breastfeeding mothers
= Severe hypotension, Bradycardia, Prolong QT which can lead to TdP
= Toxicity, Causes severe BP drop, Prolong QT which can lead to TdP

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8
Q

Amiodarone) Max total dose per day:
Slow Infusion dose:
Maintenance Infusion dose:
VF/Pulseless & VT Cardiac Arrest Unresponsive 1st Dosage:
VF/Pulseless & VT Cardiac Arrest Unresponsive 2nd Dosage:
Life-Threatening Arrhythmia 1st Dosage:
Life-Threatening Arrhythmia 2nd Dosage:

A

= 2.2 grams
= 360 mg IV 6Hrs (1mg/min)
= 540 mg IV 18Hrs (0.5 mg/min)
= 300 mg IV/O push
= 150 mg IV/O push if needed
= 1st Dose: Rapid Infusion 150 mg/10 mins (15 mg/min)
= 2nd Dose: 150mg/10 mins (15 mg/min) if needed

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9
Q

Aspirin) Class:
Dynamics:

A

= NSAID & COX inhibiter
= Blocks cyclooxygenase (enzyme that’s basically alarm bell for body)
COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot

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10
Q

Aspirin) indications:
Contraindications:

A

= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema

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11
Q

Aspirin) effects:
Avoid:
dose:

A

=Can cause bromchoconstriction in ~10% asthmatic PTs, N/V, upset GI
= enteric-coated Aspirin when admin/ing to PT w/ cardiac S/S
= 160-325mg PO of non-entric coated ASA

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12
Q

Atropine) class:
Dynamics:

A

= parasympatholytic
= selectively blocks muscarinic receptors inhibiting the parasympathetic NS “Vagus N. Blocker”- letting sympathetic take over

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13
Q

Atropine) indications:

Contraindications:
Avoid:

A

= 1st med/ for symptomatic sinus Bcardia, Maybe beneficial AV block, Organophosphate poisoning (large dose r/q) hypothermic Bcardia
= Allergic to drug, Use w/ extreme caution w/ myocardial ischemia
= causes increased myocardial O2 demand so caution w/ Hblock & Doses <0.5mg may result in paradoxical slowing of the heart
May not be effective for infranodal blocks- be prepared to pace

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14
Q

Atropine) Adverse effects:
Bradycardia (w/ or w/o ACS) Dosage:
severe clinical conditions dosage:
organophosphate poisoning dosage:

A

= Blurred vision, Dry mouth, Dilated pupils, Confusion
=1 mg IV push every 3-5mins as needed (0.04mg/Kg (total 3mg)
=1 mg IVP every 3 mins
= 2-4mg (or higher) IVP

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15
Q

Calcium Chloride) class:
Dynamics:

A

= mineral & electrolyte
= role as electrolyte in body to help propagate nerve impulses & M. Contraction

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16
Q

Calcium Chloride) indications:

Contraindications:

A

= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem
= cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD

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17
Q

Calcium Chloride) effects:

Dose:
Hypotension following admin/ Diltiazem:

A

= Bcardia w/ rapid injection, May produce severe coronary spasm & asystole, Burning sensation @ site of admin/, PERCIPITATE w/ Na-Bicarb
= 0.5-1gram slow IV over 3-5mins
= 250-500mg

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18
Q

Captopril) class:
Dynamics

A

= ACE inhibitors
= Prevents production of angiotensin II by inhibiting it (ACE)—> causes vasodilation & helps reduce amount of water held back by kidneys

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19
Q

Captopril) indications
Contraindications

A

= Severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
=Pregnancy , Angioedema, Hypersensitivity to ACH inhibitors

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20
Q

Captopril) effects:
Dose:

A

=Allergic reaction, Dry cough, Dizziness ,Taste changes (long term)
=25mg PO

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21
Q

Diazepam/ Vallium) class:
pharmacodynamics:

A

= benzodiazepine
= binds w/ GABA receptors causing a influx of chloride

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22
Q

Diazepam/ Vallium) indications:
Contraindications:

A

= Tcardia due to stimulant OD, Sustained seizures Anxiety Sedation
= known hypersensitivity

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23
Q

Diazepam/ Vallium) effects:
dose:

A

= Resp/ depres/, N/V, Sedation/amnesia
= 2.5-10mg in 2.5mg increments slow IV/IO/IM

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24
Q

Diltiazem/Cardizem)class:
pharmacodynamics:

A

= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels

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25
Diltiazem/Cardizem)indi/s: Contraindications:
= 1st med for AFib/Flutter w/ RVR (>150bpm), 2nd med for SVT refractory to Adenosine = hypoBP, CHF/cardio/shock, Wide-complex Tcardia, WPW, Hypersensitivity
26
Diltiazem/Cardizem)effects: 1st dose: 2nd dose:
= HypoBP, Pos/ CHF if used w/ beta-blockers , N/V/D, Dizziness, H/A = 0.25mg/kg w/ max dose of 20mg = 0.35 mg/kg w/ max dose of 25mg
27
Dobutamine) class: Dynamics:
= synthetic sympathetic agonist = A&B agonist w/ inotropic prop/s > Chronotropic prop/s
28
Dobutamine)indi: Contras:
= cardiac pump prob/s (CHF) w/ hypotension “baby Dope” = hypovolemia til’ fluid replacing, DONT MIX W/ Sodium Bicarb
29
Dobutamine) effects: dose:
= Hypertension, H/A, Dizziness, Can worsen cardiac ischemia, tissue necrosis w/ Extravasation = 2-20mcg/kg/min- titrate so heart rate doesn’t increase by >10% of baseline
30
Dopamine) class: pharmacodynamics
= sympathetic agonist = A/B agonist rate dependent vasopressor +chron/in/Drom/otropic
31
Dopamine) indications: Contraindications:
= CHF, HypoBP w/ shock signs, 2nd med for sympathetic Bcardia (after Atropine) = hypovolemic PTs til' vol/ replaced, pheochromocytoma, Dont mix w/ sodium bicarb
32
Dopamine) Effects: Dosing: Adult & Pedi Cardiac dose: Adult & Pedi Vasopressor dose:
= HyperBP, Palp/s, H/A, Dizzy, Can worsen C-ischemia, necrosis W/ Extravasation = 2–20 mcg/kg/min Titrate to response = 5-10mcg/kg/min = 10-20 mcg/kg/min
33
Enalapril) class: pharmacodynamics
= ACE inhibitor = Prevents production of angiotensin II by inhibiting (ACE)- causes vasodilation & helps reduce amount of water held back by kidneys
34
Enalapril) indications: Contraindication:
= severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP = Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors
35
Enalapril) effects: dose:
= Allergic, Dry Cough, Dizziness, Taste changes (long term) = Initial 2.5mg PO & Titrate to 20mg PO
36
Epinephrine 1:10,000) Class: Dynamics:
= SNS agonist, Sympathomimetic = Powerful Alpha and Beta agonist
37
Epinephrine 1:10,000) Indications: Contraindications:
= Cardiac arrest, Bcardia, Normovolemic hypoBP, Anaphylaxis, Asthma = rewards over risks so really none
38
Fentanyl) class: pharmacodynamics: Potency:
= synthetic narcotic (schedule 2 opioid) = opioid Analgesia & sedation through binding to opiate receptor = Fentanyl > morphine (100mcg fentanyl = 10mg of Morphine) 1F = 10M
39
Fentanyl) indications: Contraindications:
= Moderate to severe pain =Hypersensitivity to med, Uncorrected SBP<90
40
Epinephrine 1:10,000) Effects: Admin via: (Adult) Cardiac Arrest dose: (Adult) Bradycardia dose: (PEDI) Bradycardia/Cardiac Arrest dose: (PEDI) Hypoperfusion & Severe anaphylaxis dose:
= Palpitations, Anxiety, Jitters, H/A, Dizziness, HyperBP, Tcardia, Can worsen cardiac ischemia = IV infusion drip = 1mg IVP/IOP every 3-5 mins = 2-10 mcg/min IV/IO infusion = 0.01 mg/kg or 0.1 mL/kg = 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag
41
Fentanyl) effects: dose: Admin notes:
= Resp/ arrest/depres/, AMS, Bcardia & Prolong of QT interval, +vagal tone b/c suppress/ sympathetic path/s, HypoBP, N/V = 1mcg/kg IV/O(max 100mcg) may repeat PRN in 5-10mins (Max 1mL per nare) if admin/ed IN = Chest wall rigidity so admin slowly, Depresses every- thing/where
42
Furosemide/ Lasix) class: pharmacodynamics:
= Loop diuretic = Blocks absorption of Na, Cl, & water from kidney thus +urinination
43
Furosemide/ Lasix) indications: Contraindications:
= Acute pulmonary edema in PTs w/ SBP >90-100mmHg (w/o signs of shock) Hypertensive emergencies = Hypovolemia Hypotension Hypokalemia or other suspected electrolyte abnormalities
44
Furosemide/ Lasix) effects Adult Dose: intial dose doesnt work: new-onset pulmonary edema w/ suspected hypovolemia:
= pos/ dehydration/acute electrolyte imbalance, Tinnitus/deaf = 0.5-1 mg/kg over 1-2 mins. IVP = double 1st dose to 2 mg/kg over 1-2 mins = <0.5mg/kg slow IV
45
Glucagon) class: pharmacodynamics:
= Hormone = Binds to Glucagon receptors & stim/s adenyl cyclase & +cAMP thus an up-reg/ Ca channels in SA & AV nodal cells
46
Glucagon) cardiac indications: Contraindications:
= Bradycardia suspected from Beta-Blocker or Ca-Channel Blocker OD = Bradycardia from etiology (disease origin), Known hypersensitivity
47
Glucagon) effects Ca-blocker OD Dose: Hypoglycemia dose:
= Anxiety, Chest palp/s, H/A, N/V, Hyperglycemia = 3-10mg IV slowly over 3-5 mins Followed w/ infusion 3-5mg per hour = 1mg IM
48
Labetalol) class: pharmacodynamics:
= beta-blocker = Blocks adrenergic stim/ on B-receptors, causing a slowing of HR
49
Labetalol) Indications: Contraindications: Do not administer to PTs w/ STEMI if following present:
= 2nd med/ for SVT after admin/ Adenosine, A-Fib/Flutter w/ RVR Reduce myocardial ischemia in AMI PTs w/ +HRs, Antihypertensive = Increased risk of cardiogenic shock Hypotension Bradycardia = signs of heart failure Low cardiac output
50
Labetalol) Adverse Effects: Max dose: Adult Dose:
= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF = 150mg = 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose
51
Lidocaine) Class: Dynamics:
= Ib Antiarrhythmic = Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity in ventricles
52
Lidocaine) Ind: Contra: Effects:
= Stable monomorphic VT w/ preserved LVF & Alternative to Amiodarone in cardiac arrest by VF/pVT = Shouldn’t use if PT already received IV Ca channel blockers, Not given prophylactically in AMI setting = Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
53
Lidocaine) Max dose: Cardiac Arrest from VF/pVT dose: Refractory VF dose: Perfusing Arrhythmia dose: Maintenance Infusion dose:
= 3 mg/kg = 1-1.5 mg/kg IV/IO = may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins = may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins = 1-4mg/min (30-50 mcg/kg/min)
54
Mag-Sulfate) Class: Dynamics:
= Misc. Airway med, Mineral, powerful noradrenergic bronchodilator = Organic Salt act as a physiologic Ca-channel blocker Bronchodilator
55
Mag-Sulfate) Indi: Contra: Effects:
= cardiac arrest only if Torsades de Pointes (Tdp) suspected, Tdp w/ pulse = AMI not recommended, High degree AV block, HypoBP, VFib/Tach = Bcardia, HypoBP, Diaphoresis, Resp/ depres/, Hypothermia
56
Mag-Sulfate) Effects: Cardiac Arrest from hypomagnesemia or TdP: TdP w/ pulse:
= Flushing, Sweating, B-cardia, Resp/ depres/, Hypothermia = 1-2Gs diluted in 10 mL = 1-2Gs mixed in 50-100 mL admin/ed over 5-60mins
57
Midazolam/ Versed) class: pharmacodynamics:
= benzodiazepine = Binds w/ GABA receptors causing an influx of chloride
58
Midazolam/ Versed) indications: Contraindications:
= Active seizures, RSI induction, Chemical restraint, Anxiety, Sedation = History of hypersensitivity to drug
59
Midazolam/ Versed) effects
= Hypotension, Respiratory depression/apnea, N/V Amnesia
60
Midazolam) Adult dose (active seizures): Pediatric dose (active seizures) IV/O: Pediatric dose (active seizures) IM/IN: Adult & Pedi dose for induction agent (RSI): ET Tube bucking:
= 0.1mg/kg in 2mg increments IV/IO (max 5mg) → 5mg IM/IO = 0.1mg/kg in 2mg increments IV/IO (max 5mg) = 0.2mg/kg (max 5mg) = 0.1-0.3mg/kg (max 10mg), Onset=2-5mins, Duration= 15-30mins = 0.05mg/kg IV/IO 1-2mins (maintain SBP) stop when bucking stopped
61
Morphine) class pharmacodynamics
= narcotic (schedule II Opioid) = Analgesia & sedation through binding to opiate receptor
62
Morphine) indications: Contraindications:
= Ischemic chest pain not relieved by Nitro = Known hypersensitivity to drug Uncorrected hypoBP (SBP<90)
63
Morphine) effects STEMI dose: NSTEMI-ACS dose:
= Resp/ depres/arrest, HypoBP, N/V/D = 2-4mg IV/O (slow) may admin/ addition/ 2-8mg IV 5-15min intervals = 0.1mg/kg IV/IO (slow) or IM up to 10mg
64
Nitroglycerin) class: pharmacodynamics:
= nitrate = Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
65
Nitroglycerin) indications: Contraindications
= Symptoms suggestive of Myocardial ischemia CHF = HypoBP (SBP<90 or >30 below baseline BP) Severe Bcardia<50bpm, Tcardia>100bpm, Use of phosphodiesterase inhibitors (Boner pills) in last 48 hours, Increased ICP, RVI
66
Nitroglycerin) effects: dose:
=H/A, Dizziness, Weakness, Tcardia, HypoBP (tablets lose effectiveness after exposed to sun/air) = 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg DONT SHAKE SPRAY B/C AFFECTS DOSE
67
NORepi/ Levaphed) Class: dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med” = A/B-adrenergic agonist (A effects > B effects)
68
NORepi/ Levaphed) Indi: Contra: Effects:
= Normovolemic hypotension, Septic shock, Cardiogenic shock = hypovolemia PTs til’ Vol/replacement occurred = Hypertension, Organ ischemia, Cardiac arrhythmia, Tissue necrosis w/ extravasation, Palpitations, Anxiety, N/V
69
NORepi/ Levaphed) Adult Dose: Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion = 0.1–2 mcg/kg/min IV/IO infusion
70
Ondansetron/ Zofran) class: pharmacodynamics:
= selective Seratonin 5-HT3 receptor blocker/antagonist = Serotonin 5-HT3 receptors @the vagal-N. Can initiate the gag reflex when stim/ed; Zofran is antiemetic/antag/ of 5-HT3 receptors inhibiting serotonin release on central/peripheral vagal nerve
71
Ondansetron/ Zofran) indi/s: Contra:
= Prevent/control N/B = Known hypersensitivity to med
72
Ondansetron/ Zofran) effect: dose:
= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT = 4-8mg IV (slow), IM, PO
73
Procainamide)class: Dynamics:
= 1a antiarrhythmic = Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
74
Procainamide) indications: Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW) =Shouldn’t admin to PTs received IV Ca channel blocker
75
Procainamide)effect: 4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP = 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose
76
Procainamide) max dose: Recurrent VF/VT: Urgent situations: Maintenance Infusion:
= (max total dose: 17mg/kg) = 20mg/min (max total dose: 17mg/kg) = up to 50mg/min may admin/ to total dose (max 17mg/kg) = 1-4mg/min
77
Sodium Bicarbonate)class: Dynamics:
= Alkalinizing agent = raises plasma bicarbonates, buffers excess hydrogen concentration, raises blood pH & reverses clinical manifestations of acidosis
78
Sodium Bicarbonate) indications: Contraindications:
= Suspected hyperkalemia & bicarbonate-responsive acidosis (DKA, OD w/: TCA, Aspirin, Cocaine) = PTs in cardiac arrest, precipitates with med admin/ed
79
Sodium Bicarbonate) effects: Suspected acidosis dose: Hyperkalemia:
= May precipitate when admin/ w/ other meds, May cause alkalosis, Hyperirritability, Tetany = 1mEq/kg IV Bolus = 50mEq IV Bolus
80
Verapamil) class: pharmacodynamics:
= IV antiarrhythmic Ca channel blocker = Slows AP of autorhythmic cells in heart by blocking Ca channels
81
Verapamil) indications: Contraindications:
= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function = HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW Hypersensitivity to med
82
Verapamil)1.May cause: 2. Effects: 3. Max total dose: 4. 1st dose: 5. 2nd dose:
1.= more profound hypotension response than that of Diltiazem 2.= Severe CHF may result if used w/ beta-blocker, N/V/D, Dizziness, H/A 3.= 20mg 4.=2.5-5mg IV/O bolus 2-3min 5.= 5-10mg over 2-3 mins
83
Titrate to effect & CONSTANTLY check BP & HR:
= NORepi, Epi 1:10, Dopamine, Dobutamine
84
Defibrillation) Indications: Contraindications:
= VFib, Pulseless VT, TdP = PEA, Core temp <86 F
85
Defibrillation) Measuring unit: Max Biphasic setting: Max Monophasic setting:
= Joules = (Zoll) 200J = (Lifepak) 360J
86
Defibrillation) Adult Doses) TdP: VF: VT:
= 200/300/360J = 100/200/300/360J = 100/200/300/360J
87
Transcutaneous Pacing) Indications: Contraindications:
= Unstable: bradycardias, heart blocks, ect = Pulseless
88
Transcutaneous Pacing) Measuring unit: Monitor Steps: Adult Doses:
= (Ma) Miliamps = Apply pads, set rate 60–80 bpm, gradually increase mA until capture on R waves seen on ECG = 60BPM: Typical threshold currents range from 40-80 mA
89
Cardioversion) Indications: Common Rhythms: Contraindications:
= Unstable >150 BPM = AFib&Flutter w/ RVR, SVT, Stable VT, Tachycardia = PEA, VF, TdP
90
Cardioversion) Measuring unit: Max Biphasic setting: Max Monophasic setting: Monitor Steps: If re-cardioverting:
= (J) Joules = (Zoll) 200J = (Lifepak) 360J = Sync on R wave (change lead if needed) = Sync again
91
Cardioversion) Adult Doses) A-Fib: SVT: A-Flutter: Unstable VT: Multifocal Atrial Tachycardia (MAT): Junctional Tachycardia (JT):
= 120-200J / 300J /360J = 50–100/200J / 300J /360J = 50-100/200J / 300J /360J = 100/200J / 300J /360J = 50–100/200/300/360J = 50–100/200/300/360J

Old Drug cards (11 decks)

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