cardiac drugs Flashcards
oxygen
Class: medicinal gas
MOA: enables cells to break down glucose into useable form. Carried from the lungs to the body tissues by hemoglobin in red blood cells. O2 administration increases arterial oxygen (PaO2) and hemoglobin saturation.
Pharmacokinetics: Onset: Immediate; Duration: 2 minutes
Indications: Hypoxia based on physical exam or pulse oximetry
AR/SE: none in emergencies; vasoconstriction; high concentration may cause decreased LOC and respiratory depression in pts with chronic carbon dioxide retention. Hyperoxia can cause free radical induction and oxidative stress.
Contraindications: Non hypoxic patients, no advantage to these pts
Dosage: 1-6 via NC, 10-15 via NRB or BVM
Special Considerations: (P class A)
epinephrine ; adrenaline
Class: adrenergic; sympathomimetic, vasopressor
MOA: affects both beta (1 & 2) and alpha adrenergic receptors, producing bronchodilation and vasoconstriction, increased chronotropy, inotropy, and dromotropy.
Pharmacokinetics: Onset: Rapid IV; Duration: IV 5-10 min; half-life: 5 minutes
Indications: treatment of cardiac arrest or symptomatic bradycardia; anaphylaxis, reative airway disease; can be used as a pressor
AR/SE: angina, arrhythmias, hypertension, tachycardia, nervousness, restlessness, tremors
Contraindications: known allergy
Dosage: cardiac arrest: 1mg (1:10000) IV/IO EVERY 3-5 MIN bRADYCARDIA or for pressor effect 2-10 mcg/min (drip)
norepinephrine ; levophed
Class: vasopressor, Sympathomimetic
MOA: stimulates alpha-adrenergic receptors located mainly in the blood vessels, causing constriction; has minor beta 1 effects
Pharmacokinetics: onset- immediate, duration- 1-2 min
Indications: Cardiogenic Shock;severe hypotension not related to hypovolemia
AR/SE: dizziness, anxiety, cardiac arrhythmias
Contraindications: known allergy
Dosage: 0.1-0.5 mcg/kg/min (max of 30 mcg/min) titrate to maintain adequate blood pressure
dopamine ; intropin
Class: Inotropic, vasopressor, adrenergic, Sympathetic agonist
MOA: stimulates both alpha and beta adrenergic receptors in a dose dependent fashion.
Pharmacokinetics: onset 1-2 minutes; duration 10 minutes
Indications: adjunct to improving BP, cardiac output, and urine output in the treatment of shock unresponsive to fluid replacement; symptomatic bradycardia
AR/SE: arrhythmias, hypotension, headache, N/V.
Contraindications: known allergy; pheochromocytoma (adrenal gland tumor)
Dosage: 2-20 mcg/kg/min IV (2-4 will cause vasodilation, 5-15 beta 1 effects, >15 alpha effects
Special Considerations: Use caution in pts with hypovolemia or MI, correct hypovolemia before administering
dobutamine ; dobutrex
Class: inotropic, adrenergic, Sympathetic agonist
MOA: increases inotropy by stimulating beta-1 adrenergic receptors with a minor effect on the rate and peripheral blood vessels
Pharmacokinetics: Onset 2-10 min, duration varies; HL: 2 min
Indications: short term management of heart failure caused by decreased contractility
AR/SE: hypertension, increased HR, pVC’s headache, N/V
Contraindications: known allergy
Dosage: 2-20 mcg/kg/min IV titrated to response
Special Considerations: (P class B) use caution in pts with hx of MI or afib; beta blocker may negate the effects
milrinone ; primacor
Class: inotropic
MOA: increases myocardial contractility and decreases preload and afterload by dilating the vascular smooth muscle, does not work through adrenergic receptors.
Pharmacokinetics: onset 5-15 min, duration 3-6 hrs; HL; 2-3 Hours
Indications: short term treatment of CHF unresponsive to conventional therapy
AR/SE: ventricular arrhythmias, Hypotension, N/V
Contraindications: known allergy, severe aortic or pulmonary valvular heart disease
Dosage: 50 mcg/kg Slow IV/IO (over 10 minutes) followed by infusion of 0.375 mcg/kg/min
vasopressin ; pitressin
Class: Hormone; vasopressor
MOA: Acts as a non-alpha-adrenergic vasoconstrictor via direct stimulation of smooth muscle receptors. Can be used as an alternative to epinephrine during CPR.
Pharmacokinetics: onset: varies, duration 30-60 minutes; HL: 10-20 min
Indications: may replace the 1st or second dose of Epinephrine in cardiac arrest, increases peripheral vascular resistance during CPR.
AR/SE: skin blanching, hypertension, bradycardia, abdominal cramps, nausea, minor arrythmia.
Contraindications: known allergy, None when used during CPR
Dosage: 40 units IV/IO (1 time only) can replace 1st or 2nd dose of EpI during cardiac arrest
metoprolol ; lopressor
Class: antihypertensive, antianginal, beta blocker (beta 1 selective)
MOA: blocks stimulation of Beta-1 adrenergic
receptors
Pharmacokinetics: Onset- IV immediate, duration- IV 5-8 hrs; HL: 3-4 Hrs
Indications: prevention of MI, hypertension, stable narrow complex tachycardias
AR/SE: bradycardia, CHF, pulmonary edema, fatigue, weakness, hypotension
Contraindications: known allergy, uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia, heart block
Dosage: MI: 5mg slow IV every 2 minutes for 3 doses
Special Considerations: should not be administered to pts who received IV calcium channel blockers
labetalol ; trandate
Classification: beta blocker (non-selective), antihypertensive
MOA: blocks the stimulation of beta1, beta2, and alpha1 adrenergic receptors
Pharmacokinetics: onset 2-5 minutes; duration: 2-4 Hours IV; HL: 3-8 Hours
Indications: used to treat Hypertensive Crisis
AR/SE: bradycardia, CHF, pulmonary edema, orthostatic hypotension, fatigue, weakness, dyspnea
Contraindications: known allergy, bronchial asthma/uncompensated CHF/pulmonary edema/cardiogenic shock/bradycardia/ or heart
block
Dosage: 20 mg slow IV (over 2 minutes) initially. 40 mg may be given every 10 minutes prn to a total dose of 300 mg
Special Considerations: (P class C)
atenolol ; tenormin
Class: beta blocker (beta 1 selective), antianginal, antihypertensive
MOA: blocks stimulation of beta 1 adrenergic receptors
Pharmacokinetics: onset: <2 min, duration: 24 Hrs; HL: 6-7 Hrs
Indications: management of hypertension and angina pectoris and prevention of MI, stable narrow complex tachycardias not responding to adenosine.
AR/SE: hypotension, bradycardia, cHF, Pulmonary Edema, erectile dysfunction, fatigue, weakness
Contraindications: known allergy, uncompensated CHF, pulmonary edema, cardiogenic shock bradycardia, or heart block
Dosage: 5 mg IV/IO over 5 minutes; may be repeated at 5 mg in 10 minutes.
esmolol ; brevibloc
Class: beta blocker (beta 1 selective),antihypertensive
MOA: blocks stimulation of beta 1 adrenergic receptors
Pharmacokinetics: onset: <5 min, duration: 10-30 min; HL: 2-9 min
Indications: management of hypertension , stable narrow complex tachycardias not responding to adenosine., controlling ventricular HR in Afib/Aflutter.
AR/SE: hypotension, bradycardia, cHF, Pulmonary Edema, erectile dysfunction, fatigue, weakness
Contraindications: known allergy, uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia, or heart block.
Dosage: 500 mcg/kg loading dose over 1 min. followed by 50 mcg/kg/min for 4 minutes
lidocaine ; xylocaine
Class: antiarrhythmic
MOA: suppresses automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across cell membranes with little or no effect on the heart rate.
Pharmacokinetics: onset- <3 Min, duration 10-20 minutes, but up to several hours after continuous infusion; HL: 1.5-2 hrs
Indications: vf, pulseless vt, use after successful conversion from VF, Pulseless VT; wide complex tachycardias, ventricular ectopy in the presence of an MI
AR/SE: Cardiac arrest, seizures, anaphylaxis, confusion, drowsiness, N/V
Contraindications: known allergy, 2nd degree type II and 3rd degree av block
Dosage: 1-1.5 mg/kg may repeat at half the initial dose (0.5-0.75 mg/kg) every 5-10 min up to a total of 3mg/kg. (for continuous infusions: 2-4 mg/min)
procainamide ; pronestyl
Class: antiarrhythmic
MOA: decreases myocardiac excitability and slows conduction velocity; it reduced automaticity in the various pacemakers of the heart.
Pharmacokinetics: onset- 10-30 min, duration- 3-6 hrs; HL: 3 Hrs
Indications: ventricular and atrial arrhythmias including PAC, PVC, VT, atrial tach; maintain NSR after conversion from a-fib or a-flutter
AR/SE: asystole, heart block, ventricular arrhythmias, seizures, diarrhea, N/V, respiratory and cardiac arrest
Contraindications: known allergy, High Degree av block
Dosage: 20-50 mg/min slow IV (max 17 mg/kg)
adenosine ; adenocard
Class: antiarrhythmic
MOA: restores NSR by interrupting reentry pathways in the AV node and causes coronary artery vasodilation
Pharmacokinetics: onset immediate, duration 30 sec; HL: 10 sec
Indications: converting paroxysmal supraventricular tachycardia (PSVT) and stable wide complex tachycardias to a NSR
AR/SE: shortness of breath, transient arrhythmias, chest pain, hypotension, hyperventilation, burning sensation, light-headedness, facial flushing
Contraindications: known allergy, 2nd or 3rd degree AV block, sick sinus syndrome, irregular afib or polymorphic vtach
Dosage: 6mg rapid IV push; if unsuccessful, repeat in 1-2 minutes at 12mg rapid IV push, may repeat 12 mg dose again if needed.
Special Considerations: (P class C)
verapamil ; isoptin
Class: antiarrhythmic, antianginal, calcium channel blocker
MOA: blocks calcium from moving into the heart muscle cell, which prolongs the conduction of electrical impulses through the av node. Also, dilates arteries.
Pharmacokinetics: onset- 5 Min, duration 10-60 min; HL: 2-8 Hrs
Indications: Narrow complex tachycardias-atrial fibrillation, hypertension, psvt, psvt prohylaxis
AR/SE: sinus bradycardia, CHF,, asystole, AV blocks, hypotension
Contraindications: known allergy, sick sinus syndrome, 2nd or 3rd degree av blocks, severe ventricular dysfunction, cardiogenic shock, severe hypotension. wpw
Dosage: 2.5-5 mg IV over 2 minutes; may be repeated with 5-10 mg after 15-30 min
Special considerations: do not administer to pts receiving IV beta blockers, increases risk of CHF, bradycardia, and asystole