Cardiac medications Flashcards
Adrenaline
-Acts on both heart and lungs.
In lungs causes bronchodilation.
-Low doses act on Beta 1 and Beta 2 receptors= increases Heart rate and contractility- Cardiac output.
-In high doses will further increase heart rate and contractility.
-Alpha 1 effects = vasoconstriction
Receptors:
Alpha 1, beta 1, beta 2
Dilution:
6mg in 100mls nacl SS
12mg in 100mls nacl DS
24mg in 100mls nacl QS
1mg/1ml neat 20mins nacl flush
Indications:
Cardiac arrest
Infection
Severe asthma attack
PEA
Bronchospasm
anaphylaxis
Arrthmias-VT,VF, First line treatment in ALS.
Adverse reactions: Palpitations, sweat, confusion, headache , Tremors, pupil changes: constriction and dilation
Nursing considerations:
Need to change to norad asap.
Causes heart to work harder, increases blood sugar levels, increases HR, increases heart contractility
Relaxalation of smooth muscles in airways to improve breathing . Provides body extra energy.
-Infusion used for patients with recent cardiac arrest and on transfer to hospital.
Atropine
Blocks the vagus nerve and increases Heart rate
Indications: bradycardia/bradarrthymia with haemodynamic instability
Decreases secretions
Dilution: 600mcg
Push 20mins nacl push
Nursing consideration:
Slow push = further reduce heart rate
Adverse reactions:
Dilated pupils =neurological obs, blurred vision, dizziness, dry mouth, nausea/vomiting, constipation, sensitivity to light
Amiodarone
Treatment of arrhythmias (AF, flutter,VT, VT)
Class III antiarrhythmic drugs.
Chemical cardio version: blocks sodium channels = slowly production and prolongation of refractories in AV node
Indications: AF, Flutter, VF, pulseless VT, cardiac arrest
Dilution and presentation: 150mls vials
Starting: 300mg in 5% dextrose over 30mins
maintenance: 900mg-1200mg in 5% dextrose over 24 hours.
Cardiac arrest 3mg in 6mls followed by ALS after 3rd shock
Adverse reaction: hypotension, hypersensitivity,Brady, blurred vision,dizziness.
Considerations: draw up slowly to prevent bubbly, and cloudy mixture.
Made up in occ bottle only.
Noradrenaline
Causes vasoconstriction to blood vessels. Increases systemic vascular resistance, increase BP,oxygen perfusion,increases contractibility ad Heart rate.
Receptors: alpha 1, beta 1
Indications: restores BP hypotensive State: sepsis. Target MAP to maintain adequate organ perfusion, Target CPP
Dilution: infusion cvc/PICC.
8mg in 100mls nacl SS
16mg in 100mls nacl DS
32mg in 100mls nacl QS
Peripheral: 4mg/4ml in 500mls nacl
Adverse reaction: can cause poor peripheral perfusion. Necrotic extremities =neuro vascular obs
Nursing considerations:
Do not bolus
Based on ideal body weight.
Metaraminol
Vasoconstrictor: Stimulates Alpha effects- peripheral vasoconstriction: Increase BP and Increases Systemic Vascular Resistance (afterload).
-Indirect effects on sympathetic nerve endings causing the release of endogenous noradrenaline.
Receptors: Alpha 1
Indications: Short-term management of acute hypotension.
Dilution: 10mg/20mls NaCl. or 20mg in NaCl (o.5mg/ml).
Premade: 3mgs in 6 mls.
Adverse reactions: Peripheral extravasation injuries: leaking fluid/ medication into extravascular tissue= poor peripheral perfusion.
Nursing considerations: Do not bolus unless under the orders of MO, Not effective immediately, use syringe driver, titrate to target MAP, Use 3-way taps and Neurovascular observations are required.
Dobutamine
Beta 1 -Improves Cardiac Output by increasing contractility and stroke volume with minimal increase in Heart Rate.
Beta 2 - peripheral vasodilation (depends on dose) augments the increase in cardiac output.
Receptors: Beta 1 and Beta 2
Indications: Heart failure, Cardiogenic shock, HTN, Agina, Post CABG.
Dilution: 500mg in 100mls Nacl SS
Emergency setting only 250mg in 250mls NaCl. 1mg/ml large vein.
Initial dose: 5mcg/kg/min (3-5mls/hr) Max dose 40mcg/kg/min.
Adverse Reactions: Chest pain. Tachycardia, trouble breathing.
Nursing considerations: requires central access. Based on ideal body weight, wean slowly as instructed by MO and Do not stop immediately, orange line, labeled, three-way tap.
The peripheral vasodilation effects is also beneficial in septic shock to decrease the small vessel shunting and improve oxygen delivery in the capallaries.
Onset of action is 1-10mins with a peak effect seen within 10-20mins.
Metabolised by the liver and tissues to inactive metabolites that are eliminated by the kidneys
Contraindicated…idiopathic hypertrophic subaortic stenosis… in this situation it requires the opposite action (ie. Beta blocker or calcium channel blocker).
Vasopressin
-Also known as an anti-diuretic hormone: regulates the body’s retention of water.
-High doses act on smooth muscle receptors to cause peripheral vasoconstriction and increase SVR and BP.
-less potently acts on the kidney to promote water reabsorption.
Receptors: -V1: smooth muscle, V2: renal ducts, V3: pitutary gland.
Indications: To increase BP in vasodilatory shock when low SVR persists despite fluid resuscitation and first-line vasopressor.
Can only be used for cardiac effects in patients with septic shock and variceal bleeding.
Dilution: 20 units in 50mls NaCl SS.
Adverse Effects: Hyponatraemia ( due to water retention), Myocardial, mesenteric or peripheral ischemia.
Nursing consideration: can cause contraction of small vessels and smooth muscle of the gut. ( watch for increased lactate).
GTN
- A nitrate vasodilating agent.
-low doses = vasodilation, hence off loading the heart and reducing preload.
-At higher doses, it acts as an arterial dilator reducing after load.
-Decreases oxygen demand.
-Causes relaxation of the coronary arteries (useful in angina).
Indications: - Control of increase BP peri-operatively and post-operatively
-Angina
-Open heart surgery where LIMA conduit has been used.
Dilution: 50mg in 100mls 5% dextrose.
Nursing considerations:
Watch SaO2 and ABG’s as may cause shunting and V/Q mismatch.
Prefer administration via a central line.
Non-PVC giving set
Spare infusions
Documentation
K+
Normal Values: 3.5-5mmols. 80% of K+ is excreted in urine and the remaining is in sweat.
Dilutions:
CVC: 10mmols in 50mls/NaCl over 30mins or 20mmols in 100mls NaCl over 1 hour.
PIVC: 10mmols in NaCl over 1 hr
Neat infusion: 40mmols in 40mls.
Adverse Effects:
-Hypokalemia < 3.5mmols: Fatigue, malaise, confusion, muscle weakness, cramping, pain, paralysis, vomiting, nausea, shallow resps, weak pulse, ECG changes: dysrhythmias, ST depression, inverted T waves, diarrhea.
Hyperlalemia >5 mmols. Lethagery to confusion, muscle weakness, calf pain, anxiety, numbness and tingling, irritability and restlessness, nausea, vomiting, ECG changes: Peaked T waves, widening QRS.
Nursing Considerations: Continuous cardiac monitoring, Neat infusion requires ABG’s 1-2 hourly. Record and maintain fluid balance.
Mg+
Phosphate
