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
diltiazem ; cardizem
Class: calcium channel blocker, antiarrhythmic, antihypertensive, antianginal
MOA: inhibits transport of calcium into myocardial and vascular smooth muscle cells. Slows conduction through the av node
Pharmacokinetics: onset 3 min, duration: 1-3 hrs; Hl: 2 hrs
Indications: management of angina, SVT, rapid afib, rapid aflutter
AR/SE: sinus bradycardia, CHF,, asystole, AV blocks, hypotension
Contraindications: known allergy, sick sinus syndrome, 2nd & 3rd degree AV blocks, recent MI, pulmonary congestion, systolic BP lower than 90. wpw
Dosage: 0.25mg/kg IV over 2 minutes may repeat in 15 minutes at 0.35mg/kg
Special considerations: do not administer to pts receiving IV beta blockers, increases risk of CHF, bradycardia, and asystole
amiodarone ; cordarone
Class: antiarhytmic
MOA: Prolongs the action potential and the refractory period; slows the sinus rate, increasing the PR interval and the QT interval; and decreases peripheral vascular resistance
Pharmacokinetics: onset- 1-3 min IV; duration varies; Hl: 40-55 days
Indications: management of Ventricular Fibrillation (VF) and pulseless Ventricular Tachycardia (PVT); can be used for other life-threatening tachyarrhythmias as well
AR/SE: ARDS, Pulmonary Fibrosis, CHF, Pulmonary Toxicity, deteriorating of arrhythmias, bradycaridia, hypotension, dizziness, fatigue, malaise, N/V, constipation, anorexia, tremor
Contraindications: known allergy, pts with cardiogenic shock, pts with 2nd or 3rd decree av blocks
Dosage: cardiac arrest-300 mg IV bolus, may repeat in 3-5 minutes @ 150 mg IV bolus; ventricular arrhythmias- 150 mg over 10 minutes followed by 360 mg over 6 hours.
Special Considerations: (P class D) enters breast milk and causes harm to neonate;
magnesium sulfate
Class: mineral/electrolyte, antiarrhythmic
MOA: plays important role in neurotransmission and muscular activity
Pharmacokinetics: Onset- Immediate, Duration-1hr
Indications: torsades de pointes, hypertension,
AR/SE: diarrhea, bradycardia, respiratory depression, drowsiness, hypotension, hypothermia
Contraindications: known allergy,persistent severe hypertension hypermagnesemia, hypocalcemia, heart block
Dosage: torsades-1-2 grams over 5-60 minutes (followed by infusion 0.5-1 g/hr)
atropine
Class: anticholinergic
MOA: competes with acetylcholine for receptor sites, blocking the stimulation of parasympathetic nerve fibers
Pharmacokinetics: rapid onset; duration 4 hours; HL: 2-3 Hrs
Indications: symptomatic bradycardia
AR/SE: tachycardia, drowsiness, dry mouth, dilated pupils
Contraindications: known allergy, angle closure glaucoma, acute hemorrhage
Dosage: 0.5-1 mg IV over 1 minute; may be repeated every 3-5 minutes not to exceed 3 mg total.
digoxin ; lanoxin
Class: inotropic, Cardiac glycoside
MOA: increased force of myocardial contraction, prolongs refractory period of AV node and decreases conduction through the SA and AV nodes
Pharmacokinetics: onset 5-30 min, duration 3-4 days; HL: 34-44 days
Indications: afib and aflutter to slow ventricular rate, atrial tachycardia
AR/SE: arrhythmias, fatigue, anorexia, N/V/D
Contraindications: known allergy, uncontrolled ventricular arrhythmias, aV block, constrictive pericarditis, pts showing signs of dig toxicity
Dosage: 0.25 mg slow IV every 2 hours up to a total loading dose of 1.5 mg (per physician order)
Special Considerations: (P class C) geriatric pt are very sensitive to toxic effects
aspirin ; asa
Class: Nonopoid analgesic; antipyretic, platelet aggregation inhibitor
MOA: Inhibits synthesis of protstaglandins to reduce pain and fever, does not have significant anti-inflammatory properties, blocks formation of thromboxane A2 which causes platelate aggregation and aterial constriction
Pharmacokinetics: Well absorbed orally, onset 5-30 min, duration 1-4 hours, HL: 15-20 min
Indications: Mild pain, Fever, chest pain suggesting ACS
AR/SE: Liver Failure and Hepatotoxicity with overdose; renal failure with chronic use, GI bleeding
Contraindications: Known hypersensitivity
Dosage: 325 (4 x 81mg = 324 mg)
Special Considerations: (P Class D in 1st Trimester)
heparin
Class: anticoagulant, antithrombotic
MOA: potentiates inhibitory effect of antithrombin
Pharmacokinetics: onset-IV immediate; duration- 2-6 hours; Hl: 90 min.
Indications: prophylaxis and treatment of various thromboembolic disorders; inhibit clot formation in ACS.
AR/SE: bleeding, anemia, thrombocytopenia
Contraindications: known allergy; uncontrolled bleeding, severe thrombocytopenia or open wounds
Dosage: 60 U/kg IV, followed by 12 U/kg/hr
Special Considerations: (P class C) double check dosages!!
enoxaparin ; lovenox
Class: anticoagulant
MOA: accelerates the formation of antithrombin and deactivates thrombin; prevents fibrinogen from converting to fibrin
Pharmacokinetics: onset-3-5 hours; duration- varies; Hl: 4.5 hours
Indications: inhibit clot formation in acute ACS (STEMI, NSTEMI, unstable angina), pulmonary embolism and DVT
AR/SE: bleeding, anemia, thrombocytopenia
Contraindications: known allergy; uncontrolled bleeding, severe thrombocytopenia or open wounds
Dosage: 30 mg IV plus a 1 mg/kg SC dose (SC dose repeated Q 12 HRS)
clopidogrel ; plavix
Class: antiplatelet, platelet aggregation inhibitor
MOA: inhibits platelet aggregation by inhibiting the binding of ADP to platelet receptors
Pharmacokinetics: Onset within 2 hrs; duration 7-10 days following discontinuation
Indications: reduction of atherosclerotic events in pts at risk including recent MI, ACS, stroke
AR/SE: GI bleeding, bleeding, neutropenia, chest pain, fatigue, depression, epistaxis
Contraindications: known allergy, pathological bleeding disorders
Dosage: 300 mg loading dose, followed by 75 mg daily
tnkase and tpa
Class: thrombolytic, plasminogen activator
MOA: converts plasminogen to plasmin, which then degrades fibrin in blood clots
Pharmacokinetics: onset- within minutes, duration unknown
Indications: treatment of acute Mi an acute stroke
AR/SE: intracranial hemorrhage, gi bleeding, retroperitoneal bleeding, gu tract bleeding, anaphylaxis
Contraindications: known allergy, hx of stroke, recent intracranial or intraspinal injury or trauma, intracranial neoplasm, av malformation, aneurysm
Dosage: per medical direction
Special Considerations: (p class C) use with blood thinner increases risk of bleeding.
sodium bicarbonnate
Class: electrolyte, alkalinizing agent
MOA: counteracts acidosis
Pharmacokinetics: onset immediate, duration 1-2 hrs
Indications: acidosis, drug intoxications (barbiturates, salicylates, methyl alcohol)
AR/SE: alkalosis, hypernatremia, peripheral edema, injection site reaction
Contraindications: known allergy, metabolic alkalosis
Dosage: 1 mEq/kg slow IV push may repeat at half initial dose (0.5 meq/kg) in 10 minutes
Special Considerations: (P class c) do not administer into another line in which another medication has been given, use caution in pts with CHF and renal disease
morphine sulfate
Classification: opioid/narcotic analgesic, opioid agonist
MOA: binds to opiate receptors in the CNS, altering perception to pain and causing some sedation. Also decreases myocardial o2 demand.
Pharmacokinetics: Onset Immediate IV, 10-30 min IM, Duration 2-7 hrs; HL: 1-7 Hrs
Indications: severe pain, pulmonary edema, pain associated with MI
AR/SE: respiratory depression, hypotension, confusion, sedations, N/V, constipation
Contraindications: known allergy, known hypersensitivity to tartazins, bisulfites, or alcohol
Dosage: Adult: 2-5 mg IV (5-10mg IM) q10 min for desired effect Peds( or adults under 50 kg): 0.01mg/kg IV, SQ, IM may repeat for desired effect, max dose 15 mg.
Special Considerations: Use caution in patients with head trauma, increased ICP. Use caution in pts with undiagnosed abdominal pain
nirtous oxide
Classification: medicinal gas, analgesic
MOA: exact MOA unknown, inhalation of 50% mixture of nitrous oxide and oxygen produces CNS depression and rapid pain relief.
Pharmacokinetics: rapid onset (2 minutes), duration 2-5 min
Indications: moderate to severe pain
AR/SE: lightheadedness, N/V, drowsiness, decreased respirations
Contraindications: known allergy, pts with decreased LOC, thoracic trauma, respiratory compromise, abdominal distention, pts who cannot follow simple instructions
Dosage: Self-administered
Special considerations: do not administer for abdominal pain if intestinal blockage is a possibility, nitrous oxide may collect in the obstructed space and aggravate the obstruction.
furosemide ; lasix
Class: Loop diuretic
MOA: inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule; increases the renal excretion of water, sodium, chloride, magnesium, potassium, and calcium
Pharmacokinetics: Onset –IV 5 min; duration- IV 2 hrs
Indications: edema due to heart failure; hypertension
AR/SE: dehydration, hypokalemia, hypovolemia, hypochloremia, hypomagnesemia, hyponatremia, metabolic alkalosis
Contraindications: known allergy, severe liver disease, diabetes
Dosage: 40 mg IV (or double pts daily dose up to 80 mg IV)
nitroglycerin ; nitrostat, nitro-bid iv ; ntg
Class: antianginal, nitrate
MOA: increases coronary blood flow by dilating coronary arteries; produces vasodilation and decreases left ventricular end-diastolic pressure and pre-load, reduces myocardial oxygen consumption
Pharmacokinetics: onset- SL 1-3 min, IV Immediate; duration- SL 30-60 min, IV several minutes
Indications: (SL)acute management of angina pectoris, (IV) adjunct treatment of acute MI and treatment of CHF associated with acute MI
AR/SE: hypotension, tachycardia, dizziness, headache, N/V, weakness
Contraindications: known allergy, pericardial tamponade or pericarditis, pts taking medications for erectile dysfunction
Dosage: sl- 0.4mg repeated every 5 for two additional doses prn iv- 5 mcg/min may increase by 5 mcg/min up to 30 mcg/min if necessary; paste: ½ to 1 inch
Special Considerations: (P class c) pts may be on this at home for long term management of angina or as adjunct treatment to chf
enalapril ; vasotec
Class: Ace inhibitor, antihypertensive
MOA: blocks the conversion of angiotensin I to angiotensin II (vasoconstrictor), resulting in systemic vasodilation
Pharmacokinetics: Onset 15-30 min, duration 6-12 hrs; HL; 1-2 days
Indications: CHF, hypertension
AR/SE: angioedema, cough, hypotension, taste disturbance, dizziness
Contraindications: known allergy, hx of angioedema from previous Ace inhibitors
Dosage: 1.25 mg IV over 5 minutes every 6 hours
Special Considerations: (P Class C 1st trimester, D 2nd/3rd trimester)
captopril ; capoten
Class: Ace Inhibitor, antihypertensive
MOA: blocks the conversion of angiotensin I to angiotensin II (vasoconstrictor), resulting in systemic vasodilation
Pharmacokinetics: Onset-5-6 min; duration- 2-12 hrs; HL: 2 Hrs
Indications: management of CHF, can be used in hypertensive emergencies as well
AR/SE: cough, angioedema, hypotension, taste disturbances
Contraindications: known allergy, pts with hx of angioedema from previous Ace inhibitors
Dosage: 12.5 -25 mg PO
Special Considerations: (P class c 1st trimester, D 2nd/3rd trimester)
nitroprusside ; nipride, nitropress
Classification: antihypertensive, vasodilator
MOA: produces peripheral vasodilation by direct action on both arteriolar and venous smooth muscle
Pharmacokinetics: absorbs completely; onset immediate; duration 1-10 minutes
Indications: hypertensive crisis, cardiac failure, control hypertension in acute stroke
AR/SE: dyspnea, dissiness, headache, abd pain, N/V
Contraindications: known allergy, pts with decreased cerebral perfussion
Dosage: 0.3 mcg/kg/min may be increase prn up to 10mcg/kg/min; not to exceed 10 min at 10 mcg/kg/min
hydralazine ; apresoline
Class: vasodilator, antihypertensive
MOA: direct-acting peripheral arteriolar vasodilator
Pharmacokinetics: Onset 5-15 min IV, Duration 2-6 hrs IV; HL: 2-8 hrs
Indications: moderate to severe hypertension, pre-eclampsia
AR/SE: tachycardia, sodium retention, edema, orthostatic hypotension, N/V/D
Contraindications: known allergy, intolerance to tartazine
Dosage: 10 mg slow IV may repeat in 4-6 hours if needed
calcium chloride
Class: calcium supplement
MOA: Causes significant increase in myocardial contractile force and increases ventricular automaticity
Pharmacokinetics: Onset immediate IV, Duration varies
Indications: acute hyperkalemia, hypocalcemia, calcium channel blocker toxicity.
AR/SE: Bradycardia, arrhythmias, syncope, N/v, cardiac arrest
Contraindications: known allergy, use caution in pts taking digitalis, it can precipitate toxicity
Dosage: 2-4 mg/kg IV, may be repeated every 10 minutes.
