Cardiac drugs

Question 1

Adrenaline ADM/ADX

Answer 1

INDICATED: Cardiac arrest, Anaphylaxis, Life threat Asthma.

ACTION: is a sympathomimetric that stimulates both A & B- adrenergic recepters. Enhances blood flow during cpr.

CONTRA: Non is cardiac arrest. No repeat dose for hypothermic pts.

SIDE EFFECTS: none.

CAUTIONS: Severe hypotension for pts on beta blockers, half doses given unless profound hypotension.

Question 2

Amiodarone AMO

Answer 2

INDICATED: Cardiac arrest

ACTION: Anti arrhythmic. Blocks sodium & potassium channels in cardiac muscle. Acts to stabilise & reduce electrical irritability of c/m.

CONTRA: Non is cardiac arrest.

SIDE EFFECTS: Bradycardia, hypotension, flushing, Bronchospasm, Arrhymias - T de P.

Question 3

Aspirin ASP

Answer 3

INDICATED: Adults with Clinical or ECG evidence of MI or Ischemia.

ACTION: Anti platelet/ reduce clot formation, Analgesic, Anti pyretic and anti inflammatory.

CONTRA: Know allergy or sensitivity. Children < 16, GI bleed, Haemophillia or other clotting disorder, Severe hepatic disease.

CAUTIONS: Asthma, Pregnancy and kidney or liver failure. (Benefit of 300 mg may out weigh the risk.)

SIDE EFFECTS: GI bleeding, Wheez in some asthmatics.

Question 4

Atropine ATR

Answer 4

INDICATED: Symptomatic bradycardia with ANY of these signs;

• Absolute bradycardia (pulse < expected age
• Paroxysmal ventricular arrhythmias requiring suppression

CONTRA: Not to treat bradycardia in hypthermia

ACTION: may reverse vagal overdrive, increase HR in Sinus brady (blocking vagal activity), enhance A-V conduction.

SIDE EFFECTS: Dry mouth, blurred vision, pupil dilation. Tachycardia, Confusion / Hallucinations. Retention of urine in elderly. Do not use (<100mcg) dose, may cause paradoxical bradycardia.

Question 5

Glyceryl Trinitrate GTN

Answer 5

INDICATED: Cardiac C/P due to MI or Angina. Acute cardiogenic pulmonary oedema.

ACTION: Potent vasodilator: Coronary arteries/relief of coronary spasm. Systemic veins (lower pre-load). Reduce BP.

CONTRA: Hypotension (Systolic BP <90mmHg), Hypovolaemia, Head trauma, Cerebral bleed. Viagra type drugs (Silenafil) within 24hrs. Unconscious Pts.

Question 6

Morphine Sulphate MOR

Class A controlled drug. (Shed 2, Misuse of Drugs Regs 1985)

Answer 6

INDICATED: Pain in suspected MI (drug of 1st choice). Severe pain as part of balanced analgesic regimen.

ACTION: Strong OPIOID analgesic. Useful for treating continuous, severe musculoskeletal and soft tissue pain. Produces sedation, euphoria and analgesia. May depress respriation and induce hypotension.

CONTRA: Not for children under 1 yr.

• Resp depression (adult <9 GCS)
• Known hypersensitivity to MOR

CAUTIONS: Known severe renal / hepatic impairment. smaller doses may be used.
Extreme caution in Pregnancy. (Entonox 1st choice)
Great caution in Chest injs.
Any patient wit COPD, Asthma etc.
Acute Alcohol intoxication.
Medications: prescribed anti depressants, sedatives, major tranquillisers.

SIDE EFFECTS: Resp depression. Cardiovascular depression, Nausea / Vomiting. Drowsiness, Pupil constriction

SPECIAL PRECAUTIONS: Naloxone can be used to reverse MOR related resp / cardio depression.
(refer to Ondansertron/ Metaclopramide guidelines)