Cardiac Medications Flashcards
1
Q
What is the classification of Adenosine
Adenosine?
A
Antiarrhythmic and Endogenous Nucleoside
2
Q
What are the indications for Adenosine?
A
Conversion and termination of supraventricular tachycardias.
3
Q
What is the adult dose and proper administration of Adenosine?
A
6 mg IV rapid push first dose, 12 mg IV rapid push follow-up dose.
Administer into a proximal vein as close to central circulation as possible. Flush line immediately after administration, preferably with a second flush attached to the same line.
Ensure an ECG is being recorded during administration of Adenosine.
4
Q
What is the paediatric dosing for Adenosine?
A
Initial dose: 0.1 mg/kg to a maximum of 6 mg IV rapid push (60 kg weight for max dose).
Follow-up dose: 0.2 mg/kg to maximum of 12 mg IV rapid push.
5
Q
What is the mechanism of action of Adenosine?
A
Adenosine slows conduction of electrical impulses through the AV node.
6
Q
What are the pharmacokinetics of IV Adenosine?
A
Onset: Rapid
Peak: Rapid
Duration: <10 seconds
7
Q
What are precautions for Adenosine administration?
A
- Arrhythmias, usually transient: Have resus equipment immediately available.
- VF after administration is associated with patients taking digoxin, or digoxin and verapamil.
- Adenosine can worsen bronchoconstriction in patients with COPD or asthma.
8
Q
What are the warnings/precautions for Adenosine?
A
- Rare cases of VFib following adenosine administration to patients taking digoxin or digoxin and verapamil. Recommended CliniCall.
- May worsen bronchoconstriction in patients with COPD or asthma
- Have resuscitation equipment immediately available.
9
Q
What are the potential drug interactions of Adenosine?
A
- Methylxanthines (such as caffeine and theophylline) competitively antagonize the receptor; higher doses may be required.
- Carbamazepine pay produce high degrees of heart block during adenosine use.
- Dipyridamole potentiates effect of adenosine.
10
Q
What are the contraindications for Adenosine?
A
Hypersensitivity
2nd or 3rd degree AV node block
Sick sinus syndrome in patients without an artificial pacemaker.
11
Q
What is the classification of Amiodarone?
A
Antiarrhythmic
- Most associated with Class III antiarrhythmic, but has properties of all 4 classes.
12
Q
What are the indications of Amiodarone?
A
- VFib
- Pulseless VTach
- Unstable VTach
- Recurrent VTach following cardio version
13
Q
What are the contraindications or Amiodarone administration?
A
- Hypersensitivity
- Cardiogenic Shock
- Marked symptomatic sinus bradycardia
- Second or third-degree AV node block.
14
Q
What are the adult dosages of Amiodarone?
A
- VFib and pulseless VTach: 300mg IV push, repeat 150 mg IV after 10 minutes if VF/pVT persists
- Unstable VTach, recurrent VTach following cardioversion: 150mg IV over 10 minutes.
- Stable monomorphic Wide Complex Tachcardia or symptomatic runs of WCT: 150mg IV over 10 minutes.
15
Q
What is the paediatric dose of Amiodarone?
A
Trick question, suckas! Safety and efficacy in children not established. Call Clinicall.
16
Q
What are the onset, peak, and duration of IV Amiodarone?
A
Onset: 2 minutes
Peak: 20 minutes
Duration: 2 hours
17
Q
What are potential adverse effects of Amiodarone?
A
- Hypotension is most common; in patients with a perfusing rhythm who are receiving amiodarone, slow the infusion if hypotension occurs/worsens.
- Nausea/bradycardia
- QT interval prolongation. QTc over 500ms may provoke torsades de pointes.
18
Q
Likely effect of Amiodarone OD?
A
- Hypotension, bradycardia, cardiogenic shock. DC administration, provide volume replacement, transcutaneous pacing as needed.
- DC Amiodarone, provide volume replacement, transcutaneous pacing as needed.
19
Q
What is a particular risk of Amiodarone administration?
A
Amiodarone is toxic to tissues if extravasation occurs.
20
Q
What are potential drug interactions of Amiodarone?
A
Amiodarone can potentiate effects of beta blockers, calcium channel blockers, or digoxin. Use with caution in patients taking these medications.
21
Q
What is the classification of Atropine?
A
- Anticholinergic
- Antimuscarinic
- Antimuscarinic
22
Q
What are the indications for Atropine administration? (5)
A
- Restoration of HR in bradydysrhythmias
- Sinus Brady (under 50 bpm) with hemodynamics compromise
- Bradycardia secondary to AV nodal blocks
- Treatment of organophosphate poisoning.
- Control of secretions in palliative care (requires additional endorsement)
23
Q
What are the contraindications of administration of Atropine (6)?
A
- Hypersensitivity
- Tachycardia
- Narrow-angle glaucoma
- Thyrotoxicosis
- Prostatic hypertrophy
- Myasthenia Gravis
24
Q
What is the adult dose of Atropine?
A
CAUTION: Must use correct dose and must administer medication quickly; underdosing or slow administration can cause paradoxical HR slowing.
- For bradycardia: 0.6mg IV push. Maximum dose of 0.04mg/kg (3 mg in 75 kg patient)
- For organophosphate toxicity: 1-2mg IM/IV, repeat every 5-60 minutes until symptoms resolve. MANDATORY CLINICALL CONSULTATION
- Secretion control in palliative care: 0.6 mg IM
25
What is the paediatric dose of Atropine?
- For bradycardia: 0.02 mg/kg IV push; minimum dose 0.1mg, maximum dose 0.04mg/kg
- For organophosphate toxicity: 0.02-0.05 mg IV; repeat every 10-20 minutes until symptoms resolved. MANDATORY CLINICALL CONSULT
26
What is the mechanism of action of Atropine?
Competitive antagonist for acetylcholine at muscarinic receptors, causing parasympatholytic and vagolytic effect.
27
What are the onset, peak, and duration for Atropine?
Onset: < 2 minutes (IM/IV)
Peak: 3 minutes (IM); 2-4 minutes(IV)
Duration: 2-6 hours (IM/IV)
28
What are the common adverse effects of Atropine?
- Tachycardia
- Dry mouth
- Headaches
- Blurred Vision
- Dysphagia
29
What are the two warnings for Atropine?
- Atropine causes pupillary dilation (assessment of pupils may be unreliable)
- Atropine may lose some potency after 4+ weeks of storage at temperatures above 40 degrees C
30
What is the classification of Calcium Chloride?
Electrolyte
31
What are the indications for administration of Calcium Chloride?
- Cardiac Arrest due to suspected HyperK (Renal failure, DKA)
- Suspected HyperK with cardiovascular toxicity (wide QRS complexes, peaked T waves, or hemodynamic instability)
- Calcium Channel Blocker OD with symptomatic bradycardia or hemodynamic instability.
32
What are the contraindications for Calcium Chloride administration?
- Hypersensitivity to Calcium Chloride
Primary or secondary hypercalcemia
| - Primary or Secondary Hypercalcemia
33
What is the adult dose and proper administration of Calcium Chloride?
- 1-2 g IV Infusion over 10 minutes; IV slow push in Cardiac Arrest
- May repeat once in 10 minutes in indications are still present.
| - May repeat once after 10 minutes if indications still present
34
What is the paediatric dosing for Calcium Chloride?
In Cardiac Arrest:
- 20mg/kg IV over 3 minutes, maximum single dose is 1 g (50 kg)
- May repeat once in 10 minutes if indications still present.
All other causes:
- 10mg/kg IV over 15 minutes; maximum single dose of 1 g (100kg)
- May repeat once in 10 minutes if indications still present.
35
What are the onset and duration of Calcium Chloride?
Onset: 5-15 minutes
Duration: Dose dependent (effects may persist up to 4 hours)
36
What are the adverse effects of Calcium Chloride administration?
- Tissue irritation
- Extravasation can cause tissue necrosis
- Hypotension, arrhythmias, or cardiac arrest may occur if given too quickly
- May precipitate or worsen acidosis, cor pulmonale, or renal and respiratory disease.
37
What are the warnings for administration of Calcium Chloride?
- Extravasation can cause tissue necrosis. Do not administer IM or SC.
- Flush IV lines well prior to and following sodium bicarbonate administration to avoid development of calcium carbonate precipitate. (Or use a separate line for CaCl)
- Patients taking digoxin and receiving calcium are at elevated risk for arrhythmias.
38
What is the classification of Epinephrine?
- Catecholamine
- Sympathomimetic
| - Sympathomimetic
39
What are the ACP cardiac indications for Epinephrine?
- Cardiac Arrest
- Peri-arrest hypotension
- Significant bradycardia
40
What are the dosages for Epinephrine for cardiac conditions?
Cardiac Arrest: 1 mg IV/IO every 3-5 minutes
Peri-arrest hypotension: 10mcg IV/IO slow push every 2-3 minutes as required. (10 mcg = 0.01mg)
Significant bradycardia: 2-10 mcg/minute IV/IO infusion
41
What is the paediatric dosing for epinephrine in cardiac arrest?
Non neonatal Cardiac Arrest: 0.01mg/kg IV/IO
Neonatal cardiac arrest: 0.02mg/kg IV/IO initial dose, 0.03mg/kg IC/IO for subsequent doses
42
Mechanism of Action of Epinephrine for cardiac purposes?
- Alpha-adrenergic activity produces vasoconstriction and reduces vascular permeability.
- Beta-adrenergic activity results in increased chronotropy and inotropy
43
What is the onset, peak, and duration of epinephrine?
Onset: 30-90 seconds (IM); 30 seconds (IV)
Peak: 4-10 minutes (IM); 3-5 minutes (IV)
Duration: 5-10 minutes (IM/IV)
44
Adverse effects of Epi?
- May cause rapid increases in BP and HR
- Anxiety, tremors, dizziness, sweating, palpitations, headache, nausea.
45
What is the effect of an overdose on epinephrine?
- Hypertension and increased HR, possibly leading to cerebral hemorrhage
| - Risk of cerebral hemorrhage
46
Cautions of epinephrine administration in cardiac patients?
- Patients with underlying CAD may develop s/s of angina or MI
- Caution should be used in patients with significant tachydysrhythmias or in context of hypothermia.
47
Drug interactions of epinephrine?
- Beta blockers can limit effectiveness or epi’s inotropic and bronchodilator effects.
- Arrhythmias can develop in patients taking antiarrhythmic medications
48
What is the classification of Lidocaine?
- Class 1B antiarrhythmic
- Local anesthetic
| - Local anesthetic
49
What is the indication for Lidocaine for cardiac reasons?
Control of ventricular arrhythmias (ectopic, brief or sustained VTach, VFib)
50
What are the contraindications for Lidocaine administration?
- Allergy or hypersensitivity
- For systemic administration: 3rd degree AV block, ventricular escape rhythms, WPW
- Contact Clinicall for patients who have CHF; alternative agents may be preferable.
51
What is the adult dose for Lidocaine administration for cardiac cause?
- 1.0-1.5 mg/kg IV bonus
- May repeat at .5-1.0 mg/kg
- Total maximum dose is 3.0 mg/kg
52
What is the paediatric dose for lidocaine administered for rhythm control?
- 1.0-1.5 mg/kg IV bonus
- May repeat at 0.5-1.0mg/kg
- Total maximum dose is 3 mg/kg
53
What is the mechanism of action of lidocaine?
Sodium channel blocker. Decreases duration of the action potential by shortening period of repolarization
54
What are the onset, peak, and duration of lidocaine?
Onset: 45-90 seconds (IV); 1-4 minutes (IO)
Peak: 5-10 minutes (IO) (IV peak effect not in handbook)
Duration: 10-20 minutes (IV); 20 minutes (IO)
55
What are the adverse effects of lidocaine administration?
- Dizziness/lightheadedness/drowsiness/slurred speech
- Hypotension
- Muscle Twitching
- Parasthesia (esp at fingers or lips)
- Tinnitus
- Nausea or vomiting
- Cardiac Arrhythmias
56
What are the drug interactions of lidocaine?
- Increased risk of toxicity in patients taking cimetidine/ranitidine/beta blockers
- Disopyramide- may precipitate bradycardia that can progress to cardiac arrest.
57
What is the classification of Magnesium Sulfate?
- Antiarrhythmic
- Electrolyte
| - Smooth muscle relaxant
58
What are the cardiac indications for administration of Magnesium Sulphate?
- Treatment of Torsades de Pointes/Polymorphic VTach
59
What are the contraindication for magnesium sulphate?
- Hypersensitivity to magnesium sulphate
- Second or third degree A/V block
| - Second or Third degree AV block
60
Cautions for Magnesium Sulphate?
- Hypotension
- Concurrent use of neuromuscular blockade
- Myasthenia Gravis
61
What are the adult dosages for magnesium sulphate?
Control of ventricular arrhythmias (including TDP):
- For perfuming rhythms 2g IV over 15 minutes
- In cardiac arrest: 2 g IV push over 1-2 minutes
62
What is paediatric dosing for magnesium sulphate?
Cardiac Arrest: 50mg/kg IV/IO push over 1-2 minutes, maximum 2 g (40 kg max)
TDP/PVT: 50mg/kg IV/IO (max 2 g) over 15 minutes.
| All other causes: 50mg/kg IV/IO infused over 15 minutes
63
What is the mechanism of action of Magnesium Sulphate?
Exact mechanism unknown; appears to alter membrane potential and affect calcium channels, slowing conduction SA impulse formation and SA node conduction time.
64
What are the onset, peak, and duration of magnesium sulphate?
Onset: 1-2 minutes
Peak: <5 minutes
Duration: 30 minutes as anticonvulsant
65
Potential adverse effects of Magnesium Sulphate?
Hypotension
Heart Block
Drowsiness
Respiratory Depression
Arrhythmias
66
Response to Magnesium Sulphate OD?
Calcium Chloride should be available for magnesium sulphate overdose.
67
What are the drug interactions of Magnesium Sulphate?
- May prolong effects of non-depolarizing neuromuscular blockers
- May potentiate effects of calcium channel blockers
68
What is the classification of Sodium Bicarbonate?
- Electrolyte
- Alkalinizing agent/buffer
| - Alkalinizing agent/buffer
69
What are the indications for the use of sodium bicarbonate?
- Known or suspected HyperK
- Tricyclics or salicylate OD
- Suspected or confirmed metabolic acidosis
- Pretreatment prior to weight release in crush injury
70
What are the contraindications for sodium bicarbonate?
- Suspected metabolic alkalosis
- History of excessive vomiting (evidence of chloride loss)
| - History of excessive vomiting (evidence of Chloride loss)
71
What is the adult dosage for sodium bicarbonate?
- 1 mEq/kg IV/IO slow push
- May repeat 0.5 mEq/kg IV/IO slow push every 10-15 minutes as required
- Tricyclic ODs may require doses as high as 2-3 mEq/kg IV/IO
72
What is the paediatric dose for sodium bicarbonate?
Infant
- 1-2 mEq very slow IV/IO
- May repeat 0.5 mEq/kg every 10-15 minutes as required
- Use 4.2% solution for infants
Child
- 1-3 mEq/kg slow IV/IO
- May repeat 0.5 mEq/kg every 10-15 minutes as required.
73
What is the mechanism of action of Sodium Bicarbonate?
Buffers or neutralizes excess acid, raising overall pH.
74
What are the onset, peak, and duration of sodium bicarbonate?
Onset: 1-2 minutes
Peak: 30 minutes
Duration: 1-2 hours
75
What are the potential adverse effects of sodium bicarbonate?
- Metabolic alkalosis may produce hypoxia due to leftward/upward shift of oxyhemoglobin dissociation curve
- Muscle tetany
- Seizures
76
What are the warnings for sodium bicarbonate?
- May paradoxically worsen metabolic acidosis if minute ventilation is insufficient
77
How to set up an epi Infusion?
250mL bag, 1ml 1:1000 epi, 60gtts/min admin set.
78
How to set up an Amiodarone infusion?
50mL bag, 150mg Amiodarone, run for 10 minutes (1 gtts/second)
79
How to set up a Mag Sulfate drip?
250cc bag, with 2 grams of medication, administered over 20 minutes (1 gtt/2 seconds)
