Cardiac Drugs Flashcards
Adenosine) class:
Dynamics:
= 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
Adenosine) indications:
contraindications
= 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
Adenosine) Effects:
Dose:
admin notes:
= 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
(Albuterol) Dynamics:
Indications:
Contraindications:
=B agonist w/ preference of B2 receptors
=Brocospasm, Anaphylaxsis/ asthma/ Allergies, Hyperkalemia
= jitters & Known hypersensitivity
(Albuterol) Adverse effects:
Adult Broncospasm dose:
Hyperkalemic dose:
Pedi Dose:
= 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
(Amiodarone) Class:
Dynamics:
Indi:
B/c its toxicity indi:
W/ expert consultation may be used for:
Terminal elimination:
= 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)
(Amiodarone) Contra:
Effects:
Caution b/c:
= 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
(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:
= 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
(Aspirin) Class:
Dynamics:
= 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
(Aspirin) indications:
Contraindications:
= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema
(Aspirin) effects:
Avoid:
dose:
=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
(Atropine) class:
Dynamics:
= parasympatholytic
= selectively blocks muscarinic receptors inhibiting the parasympathetic NS “Vagus N. Blocker”- letting sympathetic take over
(Atropine) indications:
Contraindications:
Avoid:
= 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
(Atropine) Adverse effects:
Bradycardia (w/ or w/o ACS) Dosage:
severe clinical conditions dosage:
organophosphate poisoning dosage:
= 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
(Calcium Chloride) class:
Dynamics:
= mineral & electrolyte
= role as electrolyte in body to help propagate nerve impulses & M. Contraction
(Calcium Chloride) indications:
Contraindications:
= 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
(Calcium Chloride) effects:
Dose:
Hypotension following admin/ Diltiazem:
= 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
(Captopril) class:
Dynamics
= ACE inhibitors
= Prevents production of angiotensin II by inhibiting it (ACE)—> causes vasodilation & helps reduce amount of water held back by kidneys
(Captopril) indications
Contraindications
= Severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
=Pregnancy , Angioedema, Hypersensitivity to ACH inhibitors
(Captopril) effects:
Dose:
=Allergic reaction, Dry cough, Dizziness ,Taste changes (long term)
=25mg PO
(Diazepam) indications:
Contraindications:
= Tcardia due to stimulant OD, Sustained seizures Anxiety Sedation
= known hypersensitivity
(Diazepam) class:
pharmacodynamics:
= benzodiazepine
= binds w/ GABA receptors causing a influx of chloride
(Diazepam) effects:
dose:
= Resp/ depres/, N/V, Sedation/amnesia
= 2.5-10mg in 2.5mg increments slow IV/IO/IM
(Diltiazem/Cardizem)class:
pharmacodynamics:
= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels
(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
(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
(Dobutamine) class:
Dynamics:
= synthetic sympathetic agonist
= A&B agonist w/ inotropic prop/s > Chronotropic prop/s
(Dobutamine)indi:
Contras:
= cardiac pump prob/s (CHF) w/ hypotension “baby Dope”
= hypovolemia til’ fluid replacing, DONT MIX W/ Sodium Bicarb
(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
(Dopamine) class:
pharmacodynamics
= sympathetic agonist
= A/B agonist rate dependent vasopressor +chron/in/Drom/otropic
(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
(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
(Enalapril) class:
pharmacodynamics
= ACE inhibitor
= Prevents production of angiotensin II by inhibiting (ACE)- causes vasodilation & helps reduce amount of water held back by kidneys
(Enalapril) indications:
Contraindication:
= severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
= Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors
(Enalapril) effects:
dose:
= Allergic, Dry Cough, Dizziness, Taste changes (long term)
= Initial 2.5mg PO & Titrate to 20mg PO
(Epinephrine 1:10,000) Class:
Dynamics:
= SNS agonist, Sympathomimetic
= Powerful Alpha and Beta agonist
(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
(Epinephrine 1:10,000) Indications:
Contraindications:
= Cardiac arrest, Bcardia, Normovolemic hypoBP, Anaphylaxis, Asthma
= rewards over risks so really none
(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
(Fentanyl) indications:
Contraindications:
= Moderate to severe pain
=Hypersensitivity to med, Uncorrected SBP<90
(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
(Furosemide) class:
pharmacodynamics:
= Loop diuretic
= Blocks absorption of Na, Cl, & water from kidney thus +urinination
(Furosemide) 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
(Furosemide) 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
(Glucagon) class:
pharmacodynamics:
= Hormone
= Binds to Glucagon receptors & stim/s adenyl cyclase & +cAMP thus an up-reg/ Ca channels in SA & AV nodal cells
(Glucagon) cardiac indications:
Contraindications:
= Bradycardia suspected from Beta-Blocker or Ca-Channel Blocker OD
= Bradycardia from etiology (disease origin), Known hypersensitivity
(Glucagon) effects
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
(Labetalol) class:
pharmacodynamics:
= beta-blocker
= Blocks adrenergic stim/ on B-receptors, causing a slowing of HR
(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
(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
Lidocaine) Class:
Dynamics:
= Ib Antiarrhythmic
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity in ventricles
(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
(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)
(Mag-Sulfate) Class:
Dynamics:
= Misc. Airway med, Mineral, powerful noradrenergic bronchodilator
= Organic Salt act as a physiologic Ca-channel blocker Bronchodilator
(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
(Mag-Sulfate) Effects:
Bronchodilation Adult Dose:
Bronchodilation Pedi Dose:
= Flushing, Sweating, B-cardia, Resp/ depres/, Hypothermia
= 1-2G IV/IO over 10-20 mins (Infusion)
= 25-50 mg/kg IV/IO (max 2G) over 15-30 mins (Infusion)
(Midazolam) class:
pharmacodynamics:
= benzodiazepine
= Binds w/ GABA receptors causing an influx of chloride
(Midazolam) indications:
Contraindications:
= Active seizures, RSI induction, Chemical restraint, Anxiety, Sedation
= History of hypersensitivity to drug
(Midazolam) effects
= Hypotension, Respiratory depression/apnea, N/V Amnesia
(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
(Morphine) class
pharmacodynamics
= narcotic (schedule II Opioid)
= Analgesia & sedation through binding to opiate receptor
(Morphine) indications:
Contraindications:
= Ischemic chest pain not relieved by Nitro
= Known hypersensitivity to drug Uncorrected hypoBP (SBP<90)
(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
(Nitroglycerin) class:
pharmacodynamics:
= nitrate
= Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
(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
(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
(NORepi) Class:
dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med”
= A/B-adrenergic agonist (A effects > B effects)
(NORepi) 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
(NORepi) Adult Dose:
Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion
= 0.1–2 mcg/kg/min IV/IO infusion
(Ondansetron) 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
(Ondansetron) indi/s:
Contra:
= Prevent/control N/B
= Known hypersensitivity to med
(Ondansetron)effect:
dose:
= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT
= 4-8mg IV (slow), IM, PO
(Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
(Procainamide) indications:
Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW)
=Shouldn’t admin to PTs received IV Ca channel blocker
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
(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
(Sodium Bicarbonate)class:
Dynamics:
= Alkalinizing agent
= raises plasma bicarbonates, buffers excess hydrogen concentration, raises blood pH & reverses clinical manifestations of acidosis
(Sodium Bicarbonate) indications:
Contraindications:
= Suspected hyperkalemia & bicarbonate-responsive acidosis (DKA, OD w/: TCA, Aspirin, Cocaine)
= PTs in cardiac arrest, precipitates with med admin/ed
(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
(Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
(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
(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
Titrate to effect & CONSTANTLY check BP & HR:
= NORepi, Epi 1:10, Dopamine, Dobutamine
