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Medications > Cardiac Medications > Flashcards

Cardiac Medications Flashcards

1
Q

Adenocard

(mechanism of action)

A

♦ Blocks the transmission of impulses through the AV node by binding to the Adenosine-1 receptor. Slows conduction time through the AV node. Finally causes arterial vasodilation by binding to vascular endothelial tissue.

♦ Hyperpolarizes atrial tissues, reducing the duration of the atrial action potential.

♦ Adenosine reduces the diastolic depolarization phase of the sinoatrial nodal pacemaker cells.

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2
Q

Adenocard

(onset-duration)

A

Onset: Immediate

Half Life: < 10 sec

Duration: 1-2 min

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3
Q

Adenocard

(side effects)

A

Because adenosine decreases conduction through the AV node,

♦ First-, Second-, or Third-degree heart blocks are possible effects

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4
Q

Adenocard

(indications)

A

♦ PSVT

♦ SVT

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5
Q

Adenocard

(contraindications)

A

♦Do not administer for wide QRS tachycardia

♦Caution in patients with WPW syndrome who present with A-fib w/ RVR

Contraindicated → sick sinus node syndrome or symptomatic bradycardia, →2nd or 3rd-degree AV block, except in patients with a functioning artificial pacemaker in place.

Avoid adenosine with S/S of unstable angina or cardiovascular instability because they may be at increased risk for cardiovascular adverse events.

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6
Q

Adenocard (adult dose)

A

♦ SVT → 6 mg rapid IO/IV bolus initial dose

If SVT rhythm has not changed after 5 minutes, repeat second dose of 12 mg rapid IO/IV bolus

♦ V-Tach → 12 mg rapid IO/IV bolus for stable monomorphic, regular wide complex tachycardia that may be SVT with aberrancy

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7
Q

Adenocard

(pediatric dose)

A

Supraventricular Tachycardia

♦ 0.1 mg/kg (over 1-2 seconds) IO/IV followed by rapid saline flush; max initial dose of 6 mg

♦ 0.2 mg/kg within 1-2 minutes of continuing SVT=given rapid IO/IV; max single dose of 12 mg

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8
Q

Adenocard

(pregnancy safe)

A

Pregnancy Class C

There are no adequate human studies of the effects of this drug on the fetus; however, adenosine is a naturally occurring material and dispersed widely in the body; fetal effects are not anticipated.

Adenosine should be used during pregnancy only if clearly needed.

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9
Q

Amiodarone

(mechanism of action)

A

Class III antiarrhythmic agent

♦ Blocks sodium, potassium and calcium channels

♦ Decreases AV conduction and sinus node function

(also depresses automaticity of both the SA and AV nodes directly (class II effect) and slows conduction in the His-Purkinje system and in the accessory pathway of patients with Wolff-Parkinson-White syndrome)

The drug relaxes both smooth and cardiac muscle, causing decreases in coronary and peripheral vascular resistance, left ventricular end-diastolic pressure and systolic blood pressure, thereby decreasing afterload.

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10
Q

Amiodarone

(side effects)

A

Hypotension,

bradycardia,

AV block,

asystole,

PEA,

hepatoxicity

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11
Q

Amiodarone

(indications)

A

♦ Shock resistant V-Fib

♦ Pulseless V-Tach

♦ Ventricular Tachycardia

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12
Q

Amiodarone

(contraindications)

A

♦ Iodine hypersensitivity

Due to the incorporation of iodine into its chemical structure, it is contraindicated in patients with iodine hypersensitivity.

♦ Cardiogenic shock - due to potential negative inotropic effects
♦ Marked Sinus Bradycardia
♦ 2nd or 3rd degree AV Block

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13
Q

Amiodarone

(adult dose)

A

Pulseless V-Tach / V-Fib
♦ Rapid 300 mg IO/IV
♦ Repeat once at 150 mg IO/IV

V-Tach with a pulse
♦ Rapid 150 mg IO/IV bolus.

May repeat once if patient remains in unstable V-Tach to a total dose of 300 mg over 20 minutes.

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14
Q

Amiodarone

(pediatric dose)

A

Pulseless V-Tach / V-Fib
♦ Rapid 5 mg/kg IO/IV bolus

Ventricular Rhythm – Post Resuscitation
♦ 5 mg/kg IO/IV over 20 minutes.

Repeat doses of 5 mg/kg IO/IV over 20 minutes; maximum 15 mg/kg.

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15
Q

Amiodarone

(pregnancy safe)

A

Pregnancy Class D

Amiodarone crosses the placenta and can cause fetal harm when administered to a pregnant woman.

Reported risks include neonatal bradycardia; QT prolongation; periodic ventricular extrasystoles; neonatal hypothyroidism

(Amiodarone and a major metabolite, desethylamiodarone (DEA), are excreted in human milk, suggesting that breast-feeding could expose the nursing infant to a significant dose of the drug.)

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16
Q

Atropine

(mechanism of action)

A

♦ Increases the firing of the SA node and AV node opposing the actions of the vagus nerve by blocking the acetylcholine receptor sites.

♦ Increases cardiac output, dries secretions. Atropine reverses the muscarinic effects of cholinergic poisoning due to agents with acetylcholinesterase inhibitor activity by acting as a competitive antagonist of acetylcholine at muscarinic receptors.

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17
Q

Atropine

(side effects)

A

Tachycardia,

Dry mouth, thirst,

Flushing of skin,

Blurred vision,

Headache,

Pupillary dilation,

Urinary retention

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18
Q

Atropine

(indications)

A

♦ Anticholinergic drug used in bradycardias

♦ Organophosphate poisoning (to block the parasympathetic response)

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19
Q

Atropine

(contraindications)

A

♦ Tachycardia,

♦ Glaucoma,

♦ A-Fib/Flutter w/RVR

Atropine-induced tachycardia may cause ischemia, extend or initiate myocardial infarcts, and stimulate ventricular ectopy and fibrillation.

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20
Q

Atropine

(adult dose)

A

Bradycardia
♦ 0.5 mg IO/IV;
♦Repeat every 3 – 5 minutes to a total of 3 mg

Organophosphate Poisoning
♦ 1–2 mg IO/IV;
♦Repeat dose every 5 minutes as needed
Max total dose of 6 mg

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21
Q

Atropine

(pediatric dose for bradycardia)

A

Bradycardia
♦ 0.02 mg/kg IO/IV
♦ Minimum dose of 0.1 mg

♦ Maximum single dose of 0.5 mg (child) and 1 mg (adolescent)
♦ May repeat once

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22
Q

Atropine

(pediatric dose for organophosphate poisoning)

A

Organophosphate Poisoning
♦ 0.02mg/kg IO/IV
(min 0.1mg / max 1mg)

♦ Repeat every as needed to
max total dose of 6 mg

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23
Q

Atropine

(pediatric dose for RSI)

A

Rapid Sequence Intubation
♦ 0.02 mg/kg IO/IV

  • *Minimum** dose of 0.1 mg
  • *Maximum** dose of 1 mg
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24
Q

Atropine

(pregnancy safe)

A

Pregnancy Class C

There are risks to the fetus and mother associated with untreated severe or life-threatening muscarinic effects; life-sustaining therapy for the pregnant woman should not be withheld due to potential concerns regarding the effects of atropine on the fetus.

(There are no data on atropine concentrations in human milk after intravenous or ocular administration, the effects on the breast-fed infant, or the effects on milk production.)

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25
Q

Cardizem (Diltiazem)

(mechanism of action)

A

Class IV Antiarrthmic/Calcium Channel Blocker

Decreases heart rate and B/P by inhibiting calcium ion influxes across the cell membrane during cardiac depolarization.

♦ Dilates coronary arteries, peripheral vessels; reduces myocardial oxygen consumption and slows SA/AV node conduction times through its negative inotropic, chronotropic and dromotropic effects.

In addition, total peripheral resistance, systemic blood pressure, and afterload are decreased effectively increasing coronary blood flow.

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26
Q

Cardizem (Diltiazem)

(onset and duration of action)

A

Onset: 2-5 min

time to peak effect is 15 minutes.

Half Life: 3.5 - 9 hrs

Duration: 1 - 3 hrs after IV ggt up to 10 hours

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27
Q

Cardizem (Diltiazem)

(side effects)

A

Diltiazem can precipitate or exacerbate heart failure or cause excessive bradycardia or cardiac conduction abnormalities (heart blocks) in patients with ventricular dysfunction, severe bradycardia, cardiogenic shock, or congestive heart failure and/or patients taking beta-adrenergic blocking agents.

Diltiazem decreases peripheral resistance and can worsen hypotension

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28
Q

Cardizem (Diltiazem)

(indications)

A

♦ Rate control in refractory atrial fibrillation

♦ SVT

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29
Q

Cardizem (Diltiazem)

(contraindications)

A

♦ Diltiazem can precipitate or exacerbate heart failure or cause excessive bradycardia or cardiac conduction abnormalities in patients with ventricular dysfunction, severe bradycardia, cardiogenic shock, or congestive heart failure and/or _patients taking beta-adrenergic blocking agents._

♦ Diltiazem decreases peripheral resistance and can worsen hypotension. should not be used in patients with SBP < 90 mmHg

Due to its inhibitory effects on AV node conduction, diltiazem is contraindicated in patients with preexisting second- or third-degree AV block or previous conduction abnormalities.

♦ Use of diltiazem for treatment of atrial fibrillation or flutter may precipitate severe ventricular arrhythmias and is contraindicated in patients with Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome.

30
Q

Cardizem (Diltiazem)

(adult dose)

A

♦ 0.25 mg/kg up to 20 mg IO/IV over 2 minutes if systolic BP > 90

♦ If uncontrolled after 15 minutes → 0.35 mg/kg IV/IO over 2 minutes

31
Q

Cardizem (Diltiazem)

(pediatric dose)

A

Not indicated in current protocols

32
Q

Cardizem (Diltiazem)

(pregnancy safe)

A

Pregnancy Class C

There are no well-controlled studies of diltiazem in pregnancy. Administer diltiazem to pregnant women only if the potential benefit justifies the potential risk to the fetus.

33
Q

Furosemide

(mechanism of action)

A

Furosemide is a loop diuretic that inhibits the reabsorption of sodium, calcium, magnesium, chloride, water and some potassium.

Increases urinary excretion of sodium, chloride, potassium, and hydrogen ions.

The diuresis caused by furosemide can lead to increased aldosterone production, resulting in increased sodium resorption, and increased potassium and hydrogen excretion. Excessive loss of these electrolytes can lead to metabolic alkalosis.

Renal vasodilation occurs following administration of furosemide; renal vascular resistance decreases, and renal blood flow is enhanced.

Reduced peripheral vascular resistance and increased peripheral venous capacitance also occur, and the subsequent decrease in left ventricular filling pressure may contribute to the drug’s beneficial effect in patients with congestive heart failure.

34
Q

Furosemide

(onset and duration)

A

Onset: 10 - 30 min

Half Life: 30 - 60 min

Duration: 2 hrs

35
Q

Furosemide

(side effects)

A

♦ Hypovolemia, hypotension, hyponatremia, hypokalemia.

♦ Loop diuretics may induce metabolic alkalosis associated with hypokalemia and hypochloremia

36
Q

Furosemide

(indications)

A

Acute Pulmonary Edema such as CHF

37
Q

Furosemide

(contraindications)

A

♦ Absolute - Hypersensitivity

♦ Relative - Excessive diuresis with furosemide should be avoided in patients with acute myocardial infarction due to the risk of precipitating shock.

Furosemide is contraindicated in patients with anuria. It should be used cautiously in any patient with renal disease such as severe renal impairment or renal failure.

38
Q

Furosemide

(adult dose)

A

40-80 mg IV

39
Q

Furosemide

(pediatric dose)

A

OLMD Required

40
Q

Furosemide

(pregnancy safe)

A

Pregnancy Class C

Do not use furosemide during pregnancy unless the potential benefit justifies the potential risk to the fetus.

Use caution when administering furosemide to a breast-feeding mother. Furosemide is excreted in human breast milk.

41
Q

Heparin

(mechanism of action)

A

♦ Heparin exerts its anticoagulant action by accelerating the activity of antithrombin III (ATIII) to inactivate thrombin; however, heparin does not lyse existing clots.

♦ High doses of heparin also interfere with platelet aggregation, which, in turn, prolongs the bleeding time, although commonly used therapeutic doses heparin do not affect bleeding time.

42
Q

Heparin

(onset and duration)

A

After intravenous administration, response is almost immediate.

The anticoagulation half-life of heparin is 1, 2.5, and 5 hours when heparin 100, 400, or 800 units/kg, respectively, is given intravenously.

43
Q

Heparin

(side effects)

A

No immediate side effects.

Late side effects include hemorrhages.

44
Q

Heparin

(indications)

A

Anticoagulant therapy

45
Q

Heparin

(contraindications)

A

♦ Severe thrombocytopenia,

♦ Uncontrolled active bleeding

46
Q

Heparin

(adult dose)

A

♦ 5,000 units IO/IV

♦ Consider continuous infusion for extended transports: 12 units/kg/hr,

not to exceed 1,000 units/hr

47
Q

Heparin

(pediatric dose)

A

Not indicated in current protocols

48
Q

Heparin

(pregnancy safe)

A

Pregnancy Class C

In published reports, heparin exposure during pregnancy did not result in increased risk of adverse maternal or fetal outcomes in humans.

Heparin does not cross the placental barrier.

55
Q

Magnesium Sulfate

(mechanism of action)

A

Effects the myocardium, bronchial tree, skeletal and smooth muscle by reducing the release of acetylcholine at the neuromuscular junction reducing muscle contractions and promoting relaxation.

56
Q

Magnesium Sulfate

(onset and duration)

A

Onset: Immediate

Duration: 30 min

57
Q

Magnesium Sulfate

(side effects)

A

Bradycardia,

Hypotension,

Hyporeflexia,

Diaphoresis and Drowsiness,

Decreased Respiratory Rate,

Flaccid Paralysis

58
Q

Magnesium Sulfate

(indications)

A

♦ Torsades de Pointe

♦ Digitalis induced ventricular arrhythmias

♦ Anticonvulsant in eclampsia

♦ Suspected hypomagnesium

59
Q

Magnesium Sulfate

(contraindications)

A

Hypermagnesium

Hypocalcemia

Anuria

Heart block

Active labor

60
Q

Magnesium Sulfate

(adult dose)

A

⇒ Eclampsia / Pre-Eclampsia
♦ 4 grams IO/IV over 20 minutes

⇒ Pulseless V-Tach / V-Fib
♦ refractory V-Tach unresponsive to Amiodarone or in Torsades de Pointes, administer 2 grams slow IO/IV push over 20 minutes.

⇒ Reactive Airway Disease
♦ 2 grams IO/IV over 10 minutes.

♦ transferrs with Mag Sulfate infusing, continue at current rate. If rate is > 4 grams/hr, contact receiving MD.

61
Q

Magnesium Sulfate

(pediatric dose)

A

⇒ Pulseless V-Tach / V-Fib
refractory V-Tach unresponsive to Amiodarone or in Torsades de Pointes, administer

♦ 50 mg/kg slow IO/IV over 20 minutes
♦ Maximum 2 grams

62
Q

Lidocaine (Xylocaine)

(mechanism of action)

A

♦ Lidocaine’s antiarrhythmic effects result from its ability to inhibit the influx of sodium through the “fast” channels of the myocardial cell membrane, increasing the recovery period after repolarization

♦ Lidocaine suppresses automaticity and decreases the effective refractory period and the action potential duration** **in the His-Purkinje system at concentrations that do not suppress automaticity at the SA node.

63
Q

Lidocaine (Xylocaine)

(onset and duration)

A

Onset: Immediate

Duration: 10 to 20 minutes

64
Q

Lidocaine (Xylocaine)

(side effects)

A

Hypotension,

Decreased LOC,

Irritability,

Muscle Twitching,

Eventually Seizures

65
Q

Lidocaine (Xylocaine)

(indications)

A

Pain Management for IO insertion

Cardiac Arrest

66
Q

Lidocaine (Xylocaine)

(contraindications)

A

Known sensitivity

67
Q

Lidocaine (Xylocaine)

(adult dose)

A

40 mg 2% for IO insertion

⇒ Cardiac Arrest

♦ 1.5mg/kg IV/IO followed by 0.75 mg/kg

up to max dose of 3mg/kg

Followed by a maintenance infusion of 2-4 mg/min

68
Q

Lidocaine (Xylocaine)

(pediatric dose)

A

0.5mg/kg (max dose 40 mg) for IO insertion

♦ Not indicated for pediatric arrest.

69
Q

Lidocaine (Xylocaine)

(pregnancy safe)

A

Pregnancy Calss B

Local anesthetics are known to cross the placenta rapidly and, when administered for epidural, paracervical, pudendal, or caudal block anesthesia, and to cause fetal toxicity.

There are, however, no adequate and well-controlled studies in pregnant women.

70
Q

Magnesium Sulfate

(pregnancy safe)

A

Pregnancy Class D

Positive evidence of human fetal risk based on adverse reaction data

Potential benifits may warrant use of the drug in pregnant women despite potential risks.

(don’t ask me, I have no idea why it is ok to give a pregnant eclamtic patient after reading this)

71
Q

Lidocaine (Xylocaine)

I/O Infusion Dose

(adult and pediatric dose)

A

♦ 40 mg of 2% over 120 seconds prior to NS flush (adults)

→ may repeat at 20 mg

♦ 0.5 mg/kg 2% max initial dose 40 mg over 120 seconds

→ may repeat at half the initial dose

→ flush with NS 10 mL (adult) 5 mL for pediatric

72
Q

Nitroglycerin

(mechanism of action)

A

♦ Converts into nitric oxide in the body which in turn causes vasodilation by relaxing smooth muscle which decreases myocardial workload and oxygen demand

► Works more on veins than arteries

► Can also improve coronary collateral circulation

73
Q

Nitroglycerin

(onset and duration)

A

1 - 4 minute duration

74
Q

Nitroglycerin

(side effects)

A

Headache

Dizziness

Hypotension

75
Q

Nitroglycerin

(indications)

A

Chest Pain / ACS

CHF / Pulmonary Edema

76
Q
A
77
Q

Nitroglycerin

(contraindications)

A

Increased ICP

Hypotension/Shock

Glaucoma

Use of Viagra/Levitra (24 hrs)

Cialis (36hrs)

78
Q

Nitroglycerin

(adult dose)

A

Sublingual 0.4 mg q 5 min

IV Infusion

5 mcg/min → increasing by 5-20 mcg/min

up to a max of 200 mcg/min

(infusion recommended for long transports)

Medications (7 decks)

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