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ACP Study Cards > Cardiac Medications > Flashcards

Cardiac Medications Flashcards

1
Q

What is the classification of

Adenosine?

A

Antiarrhythmic and Endogenous Nucleoside

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2
Q

What are the indications for Adenosine?

A

Conversion and termination of supraventricular tachycardias.

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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.

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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.

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5
Q

What is the mechanism of action of Adenosine?

A

Adenosine slows conduction of electrical impulses through the AV node.

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6
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.
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7
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.
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8
Q

What is the classification of Amiodarone?

A

Class 3 Antiarrhythmic

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9
Q

What are the indications of Amiodarone?

A
  • VFib
  • Pulseless VTach
  • Unstable VTach
  • Recurrent VTach following cardio version
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10
Q

What are the contraindications or Amiodarone administration?

A
  • Hypersensitivity
  • Cardiogenic Shock
  • Marked symptomatic sinus bradycardia
  • Second or third-degree AV node block.
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11
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.
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12
Q

What is the paediatric dose of Amiodarone?

A

Trick question, sucks! Safety and efficacy in children not established. Call Clinicall.

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13
Q

What are the onset, peak, and duration of IV Amiodarone?

A

Onset: 2 minutes
Peak: 20 minutes
Duration: 2 hours

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14
Q

What are potential adverse effects of Amiodarone?

A
  • Hypotension is most common; in patients with a perfuming 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.
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15
Q

Likely effect of Amiodarone OD?

A
  • Hypotension, bradycardia, cardiogenic shock.

- DC Amiodarone, provide volume replacement, transcutaneous pacing as needed.

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16
Q

What is a particular risk of Amiodarone administration?

A

Amiodarone is toxic to tissues if extravasation occurs.

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17
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.

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18
Q

What is the classification of Atropine?

A
  • Anticholinergic

- Antimuscarinic

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19
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)
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20
Q

What are the contraindications of administration of Atropine (6)?

A
  • Hypersensitivity
  • Tachycardia
  • Narrow-angle glaucoma
  • Thyrotoxicosis
  • Prostatic hypertrophy
  • Myasthenia Travis
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21
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
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22
Q

What is the paediatric dose of Atropine?

A
  • 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
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23
Q

What is the mechanism of action of Atropine?

A

Competitive antagonist for acetylcholine at muscarinic receptors.

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24
Q

What are the onset, peak, and duration for Atropine?

A

Onset: < 2 minutes (IM/IV)
Peak: 3 minutes (IM); 2-4 minutes(IV)
Duration: 2-6 hours (IM/IV)

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25
Q

What are the common adverse effects of Atropine?

A
  • Tachycardia
  • Dry mouth
  • Headaches
  • Blurred Vision
  • Dysphagia
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26
Q

What are the two warnings for Atropine?

A
  • Atropine pupillary dilation (assessment of pupils may be unreliable)
  • Atropine may lose some potency after 4+ weeks of storage at temperatures above 40 degrees C
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27
Q

What is the classification of Calcium Chloride?

A

Electrolyte

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28
Q

What are the indications for administration of Calcium Chloride?

A
  • 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.
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29
Q

What are the contraindications for Calcium Chloride administration?

A
  • Hypersensitivity to Calcium Chloride?

- Primary or Secondary Hypercalcemia

30
Q

What is the adult dose and proper administration of Calcium Chloride?

A
  • 1g IV administered over 3 minutes

- May repeat once after 10 minutes if indications still present

31
Q

What is the paediatric dosing for Calcium Chloride?

A

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.

32
Q

What are the onset and duration of Calcium Chloride?

A

Onset: 5-15 minutes
Duration: Dose dependent (effects may persist up to 4 hours)

33
Q

What are the adverse effects of Calcium Chloride administration?

A
  • Tissue irritation
  • Hypotension, arrhythmias, or cardiac arrest may occur if given too quickly
  • May precipitate or worsen acidosis, cor pulmonale, or renal and respiratory disease.
34
Q

What are the warnings for administration of Calcium Chloride?

A
  • 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.
  • Patients taking digoxin and receiving calcium are at elevated risk for arrhythmias.
35
Q

What is the classification of Epinephrine?

A
  • Catecholamine

- Sympathomimetic

36
Q

What are the ACP cardiac indications for Epinephrine?

A
  • Cardiac Arrest
  • Peri-arrest hypotension
  • Significant bradycardia
37
Q

What are the dosages for Epinephrine for cardiac conditions?

A

Cardiac Arrest: 1 mg IV/IO every 3-5 minutes, max dose 3-4 mg.
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

38
Q

What is the paediatric dosing for epinephrine in cardiac arrest?

A

Cardiac Arrest: 0.01mg/kg IV/IO

39
Q

What is the onset, peak, and duration of epinephrine?

A

Onset: 30-90 seconds (IM); 30 seconds (IV)
Peak: 4-10 minutes (IM); 3-5 minutes (IV)
Duration: 5-10 minutes (IM/IV)

40
Q

What is the effect of an overdose on epinephrine?

A
  • Hypertension and increased HR

- Risk of cerebral hemorrhage

41
Q

Cautions of epinephrine administration in cardiac patients?

A
  • 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.
42
Q

Drug interactions of epinephrine?

A
  • Beta blockers can limit effectiveness or epi’s inotropic and bronchodilator effects.
  • Arrhythmias can develop in patients taking antiarrhythmic medications
43
Q

What is the classification of Lidocaine?

A
  • Class 1B antiarrhythmic

- Local anesthetic

44
Q

What is the indication for Lidocaine for cardiac reasons?

A

Control of ventricular arrhythmias (ectopic, brief or sustained VTach, VFib)

45
Q

What are the contraindications for Lidocaine administration?

A
  • 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.
46
Q

What is the adult dose for Lidocaine administration for cardiac cause?

A
  • 1.0-1.5 mg/kg IV bonus
  • May repeat at .5-1.0 mg/kg
  • Total maximum dose is 3.0 mg/kg
47
Q

What is the paediatric dose for lidocaine administered for rhythm control?

A
  • 1.0-1.5 mg/kg IV bonus
  • May repeat at 0.5-1.0mg/kg
  • Total maximum dose is 3 mg/kg
48
Q

What is the mechanism of action of lidocaine?

A

Sodium channel blocker. Decreases duration of the action potential by shortening period of repolarization

49
Q

What are the onset, peak, and duration of lidocaine?

A

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)

50
Q

What are the adverse effects of lidocaine administration?

A
  • Dizziness/lightheadedness/drowsiness/slurred speech
  • Hypotension
  • Muscle Twitching
  • Parasthesia (esp at fingers or lips)
  • Tinnitus
  • Nausea or vomiting
  • Cardiac Arrhythmias
51
Q

What are the drug interactions of lidocaine?

A
  • Increased risk of toxicity in patients taking cimetidine/ranitidine/beta blockers
  • Disopyramide- may precipitate bradycardia that can progress to cardiac arrrest.
52
Q

What is the classification of Magnesium Sulfate?

A
  • Antiarrhythmic

- Smooth muscle relaxant

53
Q

What are the cardiac indications for administration of Magnesium Sulphate?

A
  • Treatment of Vfib and VTach refractory to first-line antiarrhythmics
  • Recurrent, intermittent episodes of wide-complex tachycardia
  • Treatment of Torsades de Pointes
  • Seizures in pregnancy associated with HTN
54
Q

What are the contraindication for magnesium sulphate?

A
  • Hypersensitivity to magnesium sulphate

- Second or Third degree AV block

55
Q

What are the adult dosages for magnesium sulphate?

A

Control of ventricular arrhythmias (including TDP):
- For perfuming rhythms 2g IV over 15 minutes
- In cardiac arrest: 4 g IV push
Management of seizures in pregnancy
- Clinicall consult recommended
- Cardiac monitoring required
- 4-6g IV over 20 minutes as loading dose, then 1-2 g/hour
- Alternatively, 5 g can be given IM (bilateral buttocks) followed by 5 g IM every 4 hours
- If seizures persist after loading dose, up to 4g IV can be given over 5 minutes.

56
Q

What is paediatric dosing for magnesium sulphate?

A

Cardiac Arrest: 50mg/kg IV/IO push, maximum 2 g (40 kg max)

All other causes: 50mg/kg IV/IO infused over 15 minutes

57
Q

What is the mechanism of action of Magnesium Sulphate?

A

Exact mechanism unknown; appears to alter membrane potential, slowing conduction and relaxing smooth muscle.

58
Q

What are the onset, peak, and duration of magnesium sulphate?

A

Onset: 1-2 minutes
Peak: <5 minutes
Duration: 30 minutes as anticonvulsant

59
Q

What are the drug interactions of Magnesium Sulphate?

A
  • May prolong effects of non-depolarizing neuromuscular blockers
  • May potentiate effects of calcium channel blockers
60
Q

What is the classification of Sodium Bicarbonate?

A
  • Electrolyte

- Alkalinizing agent/buffer

61
Q

What are the indications for the use of sodium bicarbonate?

A
  • Known or suspected HyperK
  • Tricyclics or salicylate OD
  • Suspected or confirmed metabolic acidosis
  • Pretreatment prior to weight release in crush injury
62
Q

What are the contraindications for sodium bicarbonate?

A
  • Suspected metabolic alkalosis

- History of excessive vomiting (evidence of Chloride loss)

63
Q

What is the adult dosage for sodium bicarbonate?

A
  • 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
64
Q

What is the paediatric dose for sodium bicarbonate?

A

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.

65
Q

What is the mechanism of action of Sodium Bicarbonate?

A

Buffers or neutralizes excess acid, raising overall pH.

66
Q

What are the onset, peak, and duration of sodium bicarbonate?

A

Onset: 1-2 minutes
Peak: 30 minutes
Duration: 1-2 hours

67
Q

What are the potential adverse effects of sodium bicarbonate?

A
  • Metabolic alkalosis may produce hypoxia due to leftward/upward shift of oxyhemoglobin dissociation curve
  • Muscle tetany
  • Seizures
68
Q

What are the warnings for sodium bicarbonate?

A
  • May paradoxically worsen metabolic acidosis if minute ventilation is insufficient
69
Q

How to set up an epi Infusion?

A

250mL bag, 1ml 1:1000 epi, 60gtts/min admin set.

70
Q

How to set up an Amiodarone infusion?

A

50mL bag, 150mg Amiodarone, run for 10 minutes (1 gtts/second)

71
Q

How to set up a Mag Sulfate drip?

A

250cc bag, with 2 grams of medication, administered over 20 minutes (1 gtt/2 seconds)

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