Cardiac Drugs Flashcards
ALBUTEROL (Ventolin, Proventil)
CLASS: Sympathomimetic
ROUTE: inhaled (nebulizer) also via ET tube
DOSE: nebulized
Adult: 2.5 mg in 2.5 mL NS over5-15 min
Pediatric: same
NOTE: * if pt improving after first dose 2 additional may be given
If no improvement after first doss combine with atrovent for 2 and 3 dose
DRUG ACTION: (Beta 2 agonist) peripheral vasodilation (min), BRONCHODIALATION,
uterine smooth muscle relaxation
INDICATIONS: Bronchospasms from asthma or COPD,
*Second line drug for allergic reactions unresponsive to Epi or Benadryl
* Anaphylaxis gets Epi first
PRECAUTIONS: known heart disease
SIDE EFFECTS: restlessness, hypertension, tachycardia-palpations
RELATIVE CONTRAINDICATION: pregnancy only in life threatening situations. (Can
increase HR and BGL in fetus)
ASPIRIN (Acetylsalicylic acid, ASA ECOTRIN)
CLASS: Analgesic (non-narcotic),
Anti-inflammatory (NSAID) non steroid anti-inflammatory
Antipyretic (lowers fever)
Antiplatelet aggregator (unsticks platelets)
ROUTE: Oral “chewed”
DOSE:
Adult: 325mg (81mg X 4) baby aspirin given even if pt took their own
Pediatric: NOT GIVEN contact med control
DRUG ACTION: reduces platelet stickiness. Blocks pain impulses in the CNS, reduces
fever and inflammation
INDICATIONS: Chest pain believed to be of cardiac origin
PRECAUTIONS: any significant bleeding
SIDE EFFECTS: non in pre-hosp
CONTRAINDICATIONS: aspirin allergy, aspirin induced asthma, hemorrhagic stroke
Ipratropium Bromide (Atrovent)
CLASS: anticholinergic, bronchodilator
ROUTE: inhaled via nebulizer
DOSE: combined with 2.5 mg of albuterol
Adult: 0.5 mg in 2.5 mL NS
Pediatric: over 1 same as adult Under 1 y/o .25 mg in 2.5mL NS
DRUG ACTION: Bronchodialation, drying of secretions
INDICATIONS: bronchospasms from asthma or COPD
that does not respond to 1 st dose of Albuterol.
PRECAUTIONS: notify Med control prior to giving to pt with Hx of: glaucoma (can increase
humor in eye), Prostatic hypertrophy (enlarged prostate), bladder neck obstruction
SIDE EFFECTS: Dry mouth, cough or worsening of symptoms, GI disturbance, Blurred vision.
CONTRAINDICATIONS: sensitivity to Soybeans or peanuts, sensitivity to atropine.
Anaphylaxis needs Eppi first
Epi 1:10,000 (Epi 1:10)
CLASS: Sympathomimetic
ROUTE: IV PUSH
DOSE:
Adult: CARDIAC ARREST- 1 mg IVP
ANAPHYLAXIS- 0.1mg - 0.2mg SLOW IVP (0.1mg/min)
Profound bradycardia - 2-10 mcg/min IVPB (Mix 1mg in 500mL NS)
Pediatric: Cardiac Arrest - 0.01mg/Kg IVP
Anaphylaxis/ Profound symptomatic Bradycardia
0.01mg/Kg IVP SLOW (0.1mg/min - max .3mg per dose)
DRUG ACTION: Alpha-peripheral vasoconstriction
Beta 1- increase HR and strength
Beta 2- broncodialation
INDICATIONS: Cardiac Arrest / Anaphylaxis (non- responsive to Epi 1:1) /
Pedi Bradys that are UNRESPONSIVE to other treatment (like
O2 / Ventilations)
PRECAUTIONS: CPR- none
Anaphylaxis- use cautiously on Pt with COPD, CHF, Hx of AMI Or heart disease, over 45y/o,
HTN, arrhythmias and labor Monitor ECG, massage inj site, Pt on Beta blockers may need
Higher doses of epi and or Glucagon
SIDE EFFECTS: TACHYarrhythmias, VENTRICULAR arrhythmias, flushing, N&V, chest pain
CONTRAINDICATIONS: none
NOTE: DON’T MIXWITH SOUDIUM BICARB
Amiodarone HCL
Cord a ron e®)
Class: Antiarrhythmic
____________________________
Route: IV or10 push only ________________________ Adult Dose: Ventricular fibrillation; pulseless ventricular tachycardia
• First Dose - 300 mg -standing order
• Second Dose - 150 mg -standing order
Stable or unstable, sustained ventricular tachycardia with pulse
• 150 mg - over 10 minutes -BIOTEL AUTHORIZATION ONLY
Pediatric Dose: Ventricular fibrillation; pulseless ventricular tachycardia; stable, unstable, sustained, or
non-sustained ventricular tachycardia with a pulse
• 5 mg/kg in 100 mL NS slow push over 30 minutes - BIOTEL AUTHORIZATION
ONLY
Drug Action: • Alters movement of sodium, potassium and calcium through normal channels thereby
o Increasing the refractory period of all cardiac tissues
o Slowing repolarization
o Decreasing automaticity
• Alpha and beta blocker
Onset: Within minutes
Duration: Variable
Indications: • Ventricular fibrillation or pulseless ventricular tachycardia that does not respond to
initial defibrillation attempts
• Sustained ventricular_tachycardia with a pulse
Precautions: • Do not shake (prevents foaming); draw-up with large gauge needle
• Protect from light
• Avoid contact with plastic; administer at closest IV port
• Use with caution in renal failure patients
Side Effects: • Bradycardia
• Hypotension
Epi 1:1000
Epi 1:1
CLASS: Sympathomimetic
ROUTE: IM IVPB (piggy back rarely) NEVER IVP
DOSE: Adult Asthmatic/ Anaphylaxis 0.3mg-0.5mg IM
Profound bradycardia - 2-10 mcg/min IVPB
(Mix 1mg in 500mL NS)
Pediatric: Asthmatic/ anaphylaxis 0.01mg/Kg IM (max .3mg per dose)
Profound bradycardia 0.1-1.0 mcg/Kg/min IVPB
(Mix 1 mg in 250mL NS)
DRUG ACTION: Alpha-peripheral vasoconstriction
Beta 1- increase HR and strength
Beta 2- broncodialation
INDICATIONS: Allergic reaction/ Anaphylactic shock/ Bronchospasm due to
Asthma ONLY (not COPD or cardiac wheezes)
PRECAUTIONS: monitor ECG, massage inj site, Pt on Beta blockers may need
Higher doses of epi and or Glucagon
SIDE EFFECTS: TACHYarrhythmias, VENTRICULAR arrhythmias, H.A., flushing,
N&V, chest pain
CONTRAINDICATIONS: ASTHMA: heart disease/ Hx of AMI/ over 45y/o /
Arrhythmias/ labor
ALLERGIC REACTION: none
Nitroglycerin (Nitro, Nitrostat)
CLASS: Vasodilator
ROUTE: SubLingual (SL) spray or tablet
DOSE:
Adult: .4mg SL up to 3 doses
Pediatric: NONE in Pre-hosp
NOTE: *subsequent does after 5 min PRN until pt in PAIN FREE
* May also repeat for pulmonary edema
DRUG ACTION: dilation of ALL systemic vessels causing decrease in PVR, Dilation of
Coronary arteries, relieves ANGINAL pain
INDICATIONS: *Chest pain or symptoms of ischemic cardiac pain
*Pulmonary edema associated with CHF (reduces preload by keeping blood
in peripheral vessels, reduces afterload decreasing resistance
PRECAUTIONS: for chest pain must obtain a 12 lead to asses for inferior wall MI if suspected
Est IV prior to Nitro, obtain BP and PR before and after ea. dose and every 5 min
SIDE EFFECTS: hypotension, HEADACH, postural hypotension/ syncope, reflex
tachycardia, stinging or bitterness under tongue
CONTRAINDICATION: SYSTOLIC BP UNDER 90mm Hg, HR less than 50 or over 100,
Head injury or increased intracranial press,
VIAGRA OR LEVITRA w/in 24 hr. CIALIS w/in 48
MORPHINE SULFATE
CLASS: Opioid analgesic, (schedule II drug)
ROUTE: IV, IO
DOSE:
Adult: 2-4 mg slow IV over 1-5 min q 5-30 min; titrated to effect
Pediatric: 0.1-0.2 mg/kg to a max total dose 15 mg
Causes vomiting in 50% of Pt.
DRUG ACTION: Natural opium alkaloid that acts primarily as an analgesic.
Peripheral vasodilator which helps decrease preload and afterload
Helps decrease myocardial oxygen demand in myocardial infarctions
INDICATIONS: Chest pain associated with ACS unresponsive to nitrates
Pulmonary edema, with or without associated pain
Moderate to severe acute or chronic pain
PRECAUTIONS: Pregnancy considerations
FENTANYL (Sublimaze)
CLASS: Opioid analgesic
ROUTE: IV, IO, IN
DOSE:
Adult: 1-2 mcg/kg (Max 200 mcg)
Pediatric: 1-2 mcg/kg (rarely used in pre-hospital setting)
NOTE: Onset: 1-2 minutes IV / Duration: ½ to 1 hour
DRUG ACTION: Binds with receptor sites in the brain to produce analgesic effects,
Used in conjunction with benzodiazepines for conscious sedation
INDICATIONS: Pain control, Sedation for invasive airway procedures (RSI and PAI)
PRECAUTIONS: Pregnancy, Used with caution in the elderly,
Severe respiratory/cardiac disorders
Have Naloxone (Narcan) close!!!
SIDE EFFECTS: Respiratory depression, Bradycardia, Hypotension/Hypertension,
Nausea and vomiting
CONTRAINDICATION: Respiratory depression, HypoTN, Head Injury,
Adenosine (Adenocard)
CLASS: Antidysrhythmic (Atrial) parasympathetic blocker
ROUTE: IV IO FAST PUSH
DOSE:
Adult: 6mg 1 st 12 mg 2 nd followed by 20cc NS rapid push
Pediatric: 0.1 mg/kg 1 st 0.2mg/kg 2 nd followed by 10cc NS rapid push (max 6mg 1 st 12mg 2 nd )
DRUG ACTION: slows PSVT, causes transient complete heart block, vasodilation
INDICATIONS: narrow complex tachy’s (PSVT) like WPW, stable narrow-complex tachy’s
May be CONSIDERED for undifferentiated regular stable wide-complex tachycardia.
PRECAUTIONS: EKG, up to 15 sec of asystole, bronchoconstriction in asthma pt, use LG vein, place in
mild trendelenburg, doesn’t work on A-FL, A-fib, V tach
SIDE EFFECTS: flushing, HA, diaphoresis, CP, HypoTN, nausea, SOB, palpitations
CONTRAINDICATION: Drug-induced tachycardia, Second or third degree block
Hypersensitivity to Adenosine
Diltiazem (Cardizem)
CLASS: Calcium channel blocker for atrial arrhythmias
ROUTE: IVP slow
DOSE:
Adult: 0.25 mg/kg IVP slow repeated in 15 min @ 0.35 mg/kg IVP
Maintiance: 5-15mg/Hr titrate to heart rate (Concentration: 125 mg in 100 mL)
Pediatric: Not used
DRUG ACTION: blocks calcium movement relaxes smooth muscle, vasodilation,
neg chronotrope, neg inotrope, decrease myocardial O2 demand
INDICATIONS: STABLE Pt with A-Fib, A-FL, A-tach, PSVT unresponsive to adenosine
PRECAUTIONS: BP, flush line well, inform Med Control on pt on beta blocker or DIG
SIDE EFFECTS: A-FL, 1 st and 2 nd heart block, Bradycardia, HypoTN, CP, N&V,
Sick sinus syndrome
CONTRAINDICATION: HypoTN, Wide complex tachycardias, History of WPW
2 nd or 3 rd degree heart blocks
ANTIDOTE: calcium chloride
Magnesium sulfate
CLASS: electrolyte- calcium channel blocker, relaxes muscle / anticonvulsant
ROUTE: IV, IO, IVPB
DOSE Adult:
• Refractory bronchospasms and elamptic seizure: 2Gr in 250ml NS IVPB 6-10min
• Torsades de Pointes -With a pulse: 1-2 grams in 50-100 mL NS IVPB over 5-60 min
• Pulseless: 1-2 grams in 10 mL NS slow IV Push or IO
NOTE: You can never administer more than a 20% solution. Ok to use on PREGO
DRUG ACTION: rev. Mag deficiency, relaxes smooth muscle/ CNS depressant
INDICATIONS: Eclamptic Seizures, Asthma refractory to Albuterol or Atrovent,
Torsade de Pointes (TdP) - with pulse and pulseless, Hypomagnesaemia
PRECAUTIONS: BP, RESP, EKG, LOC, muscle strength
SIDE EFFECTS: bradycardia, HypoTN, resp depression, depressed reflexes, flaccid paralysis,
Facial flushing
CONTRAINDICATION: shock, bradycardia, heart blocks, chronic renal disease/ dialysis
Antidote: calcium chloride (Disappearance of the patellar reflex is a useful clinical sign to
detect the onset of magnesium intoxication)
PROCAINAMIDE
CLASS: Antiarrhythmic/ Atrial and Ventricular
ROUTE: IV / IO
Adult: 20-50 mg/min IV for urgent ventricular rhythms - max total 17 mg/kg
Maintenance infusion 1-4 mg/min
Pediatric: Loading dose 15 mg/kg IV /IO over 30-60 minutes
NOTE: Stop the medication when: Arrhythmia is suppressed, HypoTN,
QRS widens over 50%, Max dose (17mg/kg)
DRUG ACTION: Suppresses depolarization of ventricular muscle and purkinje fibers
Suppresses reentry dysrhythmias, potent vasodilating
INDICATIONS: Stable wide-complex regular tachycardia with a pulse
Reentry SVT (PSVT) uncontrolled by adenosine and vagal maneuvers (if normotensive)
Atrial fibrillation with rapid rate (RVR) in WPW syndrome
PRECAUTIONS: Be very aware of the potent vasodilating and negative inotropic effects!!
Monitor BP and pulse Ox, EKG, Use with caution with Amiodarone, Can create arrhythmias,
Hypokalemia and hypomagnesmia
Norepinephrine (Levophed)
CLASS: Sympathomimetic
ROUTE: IVPB
DOSE Adult: 8-12 mcg/min dilute 8mg in 500mL NS
Pediatric: none
DRUG ACTION: Alpha (some Beta) adrenergic agonist, potent vasodialator
INDICATIONS: severe cardiac shock, neurogenic shock, hemodynamically significant hypoTN,
BP less than 70, Epi drip didn’t work, ROSC and BP less than 90
PRECAUTIONS: may cause fetal anoxia when used during Preg. Infuse thru Lg stable vein,
Don’t use in same IV line as an alkaline solution, use infusion pump if possible
SIDE EFFECTS: HA, dysrhythmias, tachycardia, angina pectoris, HTN,
Tissue necrosis with infiltration
CONTRAINDICATION: Hypovolemia
Dopamine
CLASS:
Sympathomimetic
ROUTE: IVPB
DOSE Adult: Bradycardia 2-10mcg/kg per min
Cardiogenic shock 5-10 mcg/kg per min
Post cardiac arrest (ROSC) hypotension 5-10 mcg/kg per min
Pediatric: not used
NOTE: always 1600 mcG/mL
DRUG ACTION: low dose ´renal dose”
Moderate dose- “cardiac dose” beta 1 effect
High dose- “vasopressor dose”- alpha adrenergic effect
INDICATIONS: HypoTN in absence of hypovolemia/ HypoTN (SBP 70-90) w s/s of
Cardiogenic shock/ ROSC hypoTN SBP less than 90/ symptomatic bradycardia if atropine
Is ineffective
PRECAUTIONS: monitor BP pulse Ox EKG, large IV, flush after giving, don’t mix with
Bicarb/ correct hypovolemia first
SIDE EFFECTS: tachy, HTN, angina, HA, anxiety, N&V, palpitations, Vent arrhythmias,
