Cardiology Drugs Flashcards
Class I antidysrhythmic
Na channel blocker works in ventricles slows conduction decreases repolarization rate widens QRT with prolonged QT interval Ind: lower blood pressure / decrease SVR
Adenosine MOA / Description
decreases conduction of electrical impulses through the AV Node / interrupts AV reentry pathways in PSVT
rapid onset: 20-30sec
rapid half life: 10sec
Adenosine Indications
symptomatic PSVT / Atrial dysrhythmias with RVR / wide complex tachycardias / can be therapeutic or diagnostic
Adenosine class
Class V anti-arrhythmic (misc)
Adenosine contraindications
irregular AFib / polymorphic tach (torsade de pointes / 2nd/3rd degree block
Adenosine Precautions / Side effects
Pre: Typically causes arrhythmias / Transient Asystole /Asthma
SE: facial flushing, headache, SOB, dizziness, nausea
Adenosine Dose / Pharmocokinetics
6mg IV/IO rapid followed by flush
12mg follow up after 2 min
12mg follow up after 2 more minutes
30mg max
Onset: 20-30sec
Peak: 20-30sec
Duration: 30sec
Half-Life: 10sec
Class II antidysrhythmic
Beta adrenergic antagonist ends with OLOL Ind: lower blood pressure / decrease SVR also block Ca channels should not be us with Ca blocker
Class III
K channel blocker
prolongs absolute refractory period, repolarization, and QT intervals
IND: atrial or vent tach
Class IV Antidysrhythmic
Ca channel blocker
decreases SA/AV automaticity and conduction
Blocks B1 receptors
Amiodarone Class
Class III Antiarrhythmic - K channel blocker (primarily)
also some Na channel blocker properties
Amiodarone MOA / Description
improves the rate of ROSC in adults with refractory V-Fib and PV-Tac
can also be used in supraventricular tachycardias
prolongs the action potential duration in ALL cardiac tissues
Amiodarone Indications
V-Tac / V-Fib
Can also be used for: A-FIb / stable regular narrow tach
to control rapid ventricular rate due to accessory pathways
Amiodarone Contraindications
Brest feeding Pts in cardiogenic shock
2nd/3rd blocks, symptomatic bradycardia
Amiodarone Precautions / Side Effects
Prec: Pts with latent/manifest heart failure
SE: hypotension, bradycardia, increased PVCs, prlonged PRs, QRSs, and QTs / monitor for pulmonary toxicity (dyspnea/cough)
Amiodarone Dose / Pharmocokinetics
V-Fib / PV-Tac = 300mg IV/IO/1min / repeat 150mg up to 450mg total
Narrow-tach = 150mg IV/IO/10min, repeat as necessary /
followed by 1mg/min infusion over 6hrs, then 0.5mg/min as needed
Onset: 2-3days oral
Peak: 3-7hrs oral
Duration: varies
1/2 life: 40-55days
Atropine Sulfate Class
Anticholinergic: blocks acetylcholine / inhibits sympathetic nervous system
Atropine Sulfate MOA / Description
parasympatholytic used to increase heart rate in hemodynamically significant (unstable) bradycardias
+ chronotropic properties / no inotropic effect
Antidote in organophosphate poisonings
Atropine Sulfate Indications
Heomodynamically significant bradycardia with a pulse
Atropine Sulfate Contraindications
none in emergency situations
Atropine Sulfate Precautions / Side Effects
Prec: coronary artery disease b/c the increased HR may worsen ischemia / can worsen bradycardia associated w/ 2:2 & 3rd degree blocks
SE: blurred vision, dilated pupils, dry mouth, tachycardia, drowsiness, confusion
Atropine Sulfate Dosage / Pharmocokinetics
0.5mg IV / repeat every 3-5min until max dose of 3mg is reached
Onset: immediate
Peak: 2-4min
Duration: 4hrs
1/2 life: 2-3hrs
Calcium Chloride Class
Calcium supplement
Calcium Chloride MOA / Description
MOA: replaces Ca in cases of hypocalcemia / increased inotropic effect
Desc: provides elemental calcium
Calcium Chloride Indications
acute hyperkalemia
acute hypocalcemia
calcium channel blocker toxicity/OD (nifedipine, verapamil, diltiazem
Calcium Chloride Contraindications
Pt on Digitalis because it may precipitate digitalis toxicity
Calcium Chloride Precautions / Side Effects
Prec: must flush line between Ca chloride and Na bicarb to avoid precipitation / tissue necrosis
SE: bradycardia, arrhythmias, syncope, nausea, vomiting, cardiac arrest
Calcium Chloride Dose / Pharmocokinetics
2-4mg/kg IV/IO repeat every 10min as needed
should only be given in emergency setting
Onset: Immediate
Peak: unknown
Duration: varies
1/2 life: NA
Diltiazem (Cardizem) Class
Class III antiarrhythmic (Ca channel blocker)
Diltiazem (Cardizem) MOA / Description
MOA: causes vascular dilation or coronary arteries / relaxation of vascular smooth muscle / slows conduction through the AV node / slows rapid ventricular rate associated with A-Fib and A-flut
Desc: calcium channel blocker
Diltiazem (Cardizem) Indications
Narrow complex tachycardias (A-Fib / A-Flut)
recurrent SVT refractory to vagal maneuvers and adenosine
Diltiazem (Cardizem) Contraindications
severe hypotension, CHF, cardiogenic shock
V -Tac
WPW syndrome
Diltiazem (Cardizem) Precautions / Side Effects
Prec: systemic hypotension / keep refrigerated (can be kept at room temp for 1month)
SE: nausea, vomiting, dizziness, headache, bradycardia, heart block, hypotension, asystole
Diltiazem (Cardizem) Dose /Pharmocokinetics
initial: 0.25mg/kg IV/IO over 2min
Additional bolus 0.35mg/kg over 2min
maintenance infusion 5-15mg/hr titrate for effect
Onset: 3min
Peak: 7min
Duration: 1-3hrs
1/2 life: 2hrs
Furosemide (Lasix) Class
Diuretic
Furosemide (Lasix) MOA / Description
MOA: inhibits the reabsorption of Na and chloride in kidneys / cause venous dilation within 5min / diuretic effect in 5-15min
Desc: Same as above
Furosemide (Lasix) Indications
adjunct to Nitro and ACE inhibitors
CHF
Pulmonary edema
Furosemide (Lasix) Contraindications
Pregnancy unless life threatened
Sulfa allergy
Furosemide (Lasix) Precautions / Side Effects
Precautions: dehydration, electrolyte depletion, hypotension / protect from light
SE: headache,dizziness, hypotension, volume depletion, potassium depletion, arrhythmias, diarrhea, nausea, vomiting
Furosemide (Lasix) Dose / Pharmocokinetics
40mg IV/IO slow push for Pt ALREADY on oral furosemide
20mg IV/IO slow push for Pt NOT on oral furosemide
Up to 80-120mg in severe cases
Onset: 5-10min
Peak: 30min
Duration: 2hrs (vasodilation) / 6hrs (diuresis)
1/2 life: 30min
Labetalol Class
Class II antiarrhythmic / Non-selective beta-blocker
Labetalol MOA / Description
non selective Beta1/2 and Alpha1 blocker / inhibits peripheral vasoconstriction, thus causing peripheral vasodilation / lowers blood pressure by decreasing cardiac output through Beta1 blocking properties
Labetalol Indications
Hypertensive emergency (elevated BP w/ AMS, CP, renal failure)
NOT HTN w/ headache or HTN associated anxiety
Labetalol Contraindications
Bronchial asthma, CHF, Heart block, bradycardia, cardiogenic shock
Labetalol Precautions / Side Effects
Precautions: continuously monitor BP, pulse rate, ECG, respiratory status / anticipate postural hypotension / Pt should be supine at all times during med administration
SE: bradycardia, hypotension, lethargy, CHF, dyspnea, wheezing, weakness
Incompatiblity: Pt who received class IV antiarrhythmics (Ca channel blocker)
Caution: Pt taking antihypertensive agents
Labetalol Dose / Pharmocokinetics
2 methods:
1. 20mg IV/IO/2min
Additional 40mg IV/IO/2min every 10min until desired supine BP is achieved max 300mg
- 500mg in 250mL D5W = 1mg/mL / give 2mg/min until desired supine BP is achieved max 300mg
Onset: 2-5min
Peak: 5-15min
Duration: 2-4hrs
1/2 Life: 3-8hrs
Metoprolol (Lopressor) Class
Class II antiarrhythmic (selective Beta blocker)
Metoprolol (Lopressor) MOA / Description
Desc: Beta antagonist that blocks both Beta1 and Beta2 receptors / selective for Beta1 with minimal effect on Beta2 at doses <100mg
MOA: reduction in HR, systolic BP, and CO / inhibits tachycardia / reduces incidences of V-Fib and CP
Metoprolol (Lopressor) Indications
Suspected or definite Acute MI w/ HTN
Stable, narrow tach if uncontrolled/unconverted by adenosine and vagal maneuvers / or if SVT is recurrent
Controls vent rate in Pts w/ AFib or AFlut
Metoprolol (Lopressor) Contraindications
HR <45 / Systolic BP <100 / CHF / Heart block Pts / shock / asthma / bronchospastic disease
Metoprolol (Lopressor) Precautions / Side Effects
Prec: be alert for S&S of CHF, bradycardia, shock, heart block, and bronchospasm
SE: bradycardia, hypotension, lethargy, CHF, dyspnea, wheezing, weakness
Metoprolol (Lopressor) Dose / Pharmacokinetics
Initial 5mg IV/IO slow push
2nd dose 5mg IV/IO slow 2min later if well tolerated / stable vitals
3rd dose5 mg IV/IO slow 2min later if well tolerated / stable vitals
MAX DOSE 15mg
Onset: immediate
Peak: 20min
Duration: 5-8hrs
Half-Life: 3-4hrs
Norepinephrine (Levophed) Class
Sympathetic agonist
Norepinephrine (Levophed) Description / MOA
Desc: nonselective catecholamine (sympathetic agonist) heavier towards Alpha
MOA: Alpha receptors = potent peripheral vasoconstriction therefore increased BP in cardiogenic shock or other hypotensive emergencies
Norepinephrine (Levophed) Indications
Hypotension (systolic < 70) not related to hypovolemia or septic shock
Norepinephrine (Levophed) Contraindications
Hypotension due to hypovolemia / sepsis
Norepinephrine (Levophed) Precautions / Side Effects
Prec: monitor BP for HTN / fluids initiated prior to admin of norepi / may cause local tissue necrosis / increases myocardial O2 demand
SE: anxiety, tremors, headache, dizziness, nausea, vomiting
Norepinephrine (Levophed) Dose / Pharmacokinetics
0.1-0.5mcg/minute max of 30mcg/min IV/IO
Onset: immediate
Peak: < 1min
Duration: 1-2min
1/2 Life: 3min
Aspirin (ASA) Class
Platelet aggregation inhibitor / Anti-inflammatory
Aspirin (ASA) MOA / Description
MOA: blocks the formation of thromboxane A2 which causes platelets to aggregate and arteries to constrict
Desc: anti-inflammatory and inhibitor of platelet function
Aspirin (ASA) Indications
New CP suggestive of ACS and S&S of recent stroke
Aspirin (ASA) Contraindications
Relatively contraindicated in Pts with active ulcer disease and asthma
Aspirin (ASA) Precautions / Side Effects
Prec: may cause GI upset/bleeding / Pts with allergies to NSAIDs
SE: heartburn, GI bleeds, nausea, vomiting, wheezing, prolonged bleeding
Aspirin (ASA) Dose / Pharmacokinetics
Dose: 160-325mg immediately after onset of CP
Onset: 5-30min
Peak: 15-120min
Duration: 1-4hrs
1/2 life: 15-20min
Nitroglycerin Class
Nitrate
Nitroglycerin MOA / Description
MOA: rapid smooth muscle relaxant that reduces cardiac work and dilates coronary arteries, results in increased coronary blood flow and improved perfusion of ischemic myocardium / causes vasodilation which decreased preload leading to decreased ventricular filling therefore reduced O2 demand
Desc: smooth muscle relaxant used for angina
Nitroglycerin Indications
CP associated with ACS and acute pulmonary edema (unless accompanied by hypotension) / first line therapy for acute CHF
Nitroglycerin Contraindications
Hypotension / possible increased ICP / Pt in shock
Nitroglycerin Precautions / Side Effects
Prec: Pts develop tolerance / deteriorates quickly especially if exposed to light
SE: headache, dizziness, weakness, tachycardia, hypotension, orthostasis, skin rash, dry mouth, nausea, vomiting
Nitroglycerin Dose / Pharmacokinetics
Dose: 0.4mg SL repeated every 3-5min up to 3 tablets
Onset: 1-3min
Peak: 5-10min
Duration: 20-30min
1/2 life: 1-4min
Nitroglycerin Paste Class
Nitrate
Nitroglycerin Paste Description / MOA
Desc: 2% solution of nitro and special absorbent pasted / absorbed into systemic circulation through skin / longer duration of action
MOA: smooth muscle relaxant
Nitroglycerin Paste Indications
CP associated with angina pectoris or AMI
Nitroglycerin Paste Contraindications
Increased ICP / Hypotension / Shock
Nitroglycerin Paste Precautions / Side Effects
Prec: increased tolerance / postural syncope may occur
SE: headache, dizziness, weakness, tachycardia, hypotension, orthostasis, skin rash, dry mouth, nausea, vomiting
Nitroglycerin Paste Dose / Pharmacokinetics
Dose: 1/2-1” of Niro-Bid Ointment is applied
Onset: 30min
Peak: varies
Duration: 3-6hrs
1/2 Life: 1-4min
Epinephrine 1:10000 (Adrenalin) Class
Sympathetic Agonist
Epinephrine 1:10000 (Adrenalin) MOA / Description
Desc: catecholamine with both Alpha and Beta adrenergic stimulant effect
MOA: acts directly on Alpha and Beta receptors / causes increased HR, cardiac contractile force, electrical activity in myocardium, systemic vascular resistance, BP, automaticity
Epinephrine 1:10000 (Adrenalin) Indications
Cardiac arrest, severe anaphylaxis, severe reactive airway disease, symptomatic bradycardia refractory to to atropine
Epinephrine 1:10000 (Adrenalin) Contraindications
Pts who do not require extensive cardiopulmonary resuscitative efforts / with simple allergic reactions and asthma 1:10 should be used IM
Epinephrine 1:10000 (Adrenalin) Precautions / Side Effects
Prec: protect from light / can be deactivated by alkaline solutions like Sodium Bicarb
SE: palpitations, anxiety, tremors, headache, dizziness, nausea, vomiting, strong inotropic and chronotropic properties cause increased myocardial O2 demand
Epinephrine 1:10000 (Adrenalin) Dose / Pharmacokinetics
Cardiac arrest (adult): 1mg of 1:10 IV/IO every 3-5min / ETT dose is increased 2-2.5times
Cardiac Arrest (child): 0.01mg/kg IV/IO (0.1mL/kg) every 3-5min
Severe anaphylaxis/asthma (adult): 0.05-0.1mg IV/IO of 1:10 every 5-15min / 1:1 IM / epi drip may be required
Severe anaphylaxis/asthma (child): 1:1 IM / 0.01mg/kg IV/IO every 5-15min
Onset: < 2min
Peak: < 5min
Duration: 5-10min
1/2 Life 5min
Magnesium Sulfate Class
Antiarrhythmic
Magnesium Sulfate MOA / Description
MOA: physiological Calcium channel blocker and blocks neuromuscular transmission / hypomagnesemia is associated with arrhythmia, cardiac insufficiency and sudden death
Desc: essential element in numerous biochemical reactions in the body
Magnesium Sulfate Indications
Torsade de pointes (irregular, polymorphic VTac associated with prolonged QT)
Magnesium Sulfate Contraindications
Pts in shock / persistent severe HTN / 3rd degree AV block / Pts who routinely undergo dialysis / known hypocalcemia
Magnesium Sulfate Precautions / Side Effects
Prec: slow push to minimize side effects / use caution in Pts with known renal insufficiency / hypermanesemia can occur Calcium chloride/gluconate should be available as antidote
SE: flushing, sweating, bradycardia, decreased deep tendon relexes, drowsiness, respiratory depression, arrhythmia, hypotension, hypothermia, itching, rash
Incompatibility: can cause cardiac conduction abnormalities if administered with digitalis
Magnesium Sulfate Dose / Pharmacokinetics
Dose: 1-2g diluted in 10mL of D5W for Torsade de Points
1-2g diluted in 100mL of D5W over 15min
Onset: Immediate
Peak: varies
Duration: 1hr
1/2 Life: NA
Morphine Class
Narcotic analgesic
Morphine MOA / Description
MOA: CNS depressant that acts on opiate receptors in brain , providing analgesia and sedation / decreases myocardial O2 demand
Desc: CNS depressant
Morphine Indications
severe pain associated with MI, kidney stones, etc. use in PE and CHF has been limited in favor of more vasoactive agents (nitro, ACE inhibitors)
Morphine Indications
severe pain associated with MI, kidney stones, etc. use in PE and CHF has been limited in favor of more vasoactive agents (nitro, ACE inhibitors)
Morphine Indications
severe pain associated with MI, kidney stones, etc. use in PE and CHF has been limited in favor of more vasoactive agents (nitro, ACE inhibitors)
Morphine Contraindications
Pts who are volume depleted / severe hypotension / undiagnosed head injury or abdominal pain
Morphine Precautions / Side Effects
Prec: high tendency for addiction or abuse / Schedule II medication / respiratory depression / narcan should be available
SE: nausea, vomiting, abdominal cramps, blurred vision, constricted pupils, AMS, headache, respiratory depression
Morphine Dose / Pharmacokinetics
Dose: 2-10mg IV with additional 2mg IV every few minutes until pain is relieved or respiratory depression occurs / 5-15mg IM / normally given with antiemetic to help prevent nausea/vomiting
Onset: IV = immediate / IM = 15-30min
Peak: IV = 20min / IM = 30-60min
Duration: 2-7hrs
1/2 Life: 1-7hrs
Lidocaine Class
Antiarrhythmic
Lidocaine Description / MOA
Desc: local anesthetic / used to treat life threatening ventricular arrhythmias
MOA: depresses depolarization and automaticity in ventricles with very little effect on atrial tissue
Lidocaine Indications
VTach and VFib refractory to Amiodarone
Lidocaine Contraindications
2nd degree type 2 block / 3rd degree block
Lidocaine Precautions / Side Effects
Prec: CNS depression may occur when dose exceeds 300mg/hr / high doses can result in coma and death / routine prophylactic lidocaine therapy fo AMI in no longer recommended
SE: drowsiness, slurred speech, seizure, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
Lidocaine Precautions / Side Effects
Prec: CNS depression may occur when dose exceeds 300mg/hr / high doses can result in coma and death / routine prophylactic lidocaine therapy fo AMI in no longer recommended
SE: drowsiness, slurred speech, seizure, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
Lidocaine Precautions / Side Effects
Prec: CNS depression may occur when dose exceeds 300mg/hr / high doses can result in coma and death / routine prophylactic lidocaine therapy fo AMI in no longer recommended
SE: drowsiness, slurred speech, seizure, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
Lidocaine Precautions / Side Effects
Prec: CNS depression may occur when dose exceeds 300mg/hr / high doses can result in coma and death / routine prophylactic lidocaine therapy fo AMI in no longer recommended
SE: drowsiness, slurred speech, seizure, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
Lidocaine Dose / Pharmacokinetics
Dose: Hemodynamically stable monomorphic VTach
Initial: 1.0-1.5mg/kg / boluses of 0.5-0.75mg/kg repeated every 5-10min / max dose of 3.0mg/kg / once arrhythmia is suppressed a 2-4mg/min drip should be initiated
Reduce by 50% for >70YO / liver disease / heart failure / bradycardias / conduction disturbances
Onset: < 3min
Peak: 5-7min
Duration: 10-20min
1/2 Life: 1.5-2hrs
Procainamide (Pronestyl) Class
Antiarrhythmic
Procainamide (Pronestyl) Description / MOA
Desc: ester-type local anesthetic / used for life threatening ventricular arrhythmias refractory to other antiarrhythmics
MOA: suppresses ventricular ectopy / reduces automaticity of various pacemaker sites / slows intraventricular conduction to a much greater degree than Lidocaine
Procainamide (Pronestyl) Indications
VTac w/ pulse / pre-excited AFib
Procainamide (Pronestyl) Contraindications
severe conduction system disturbances, especially 2nd or 3rd degree blocks
Procainamide (Pronestyl) Precautions / Side Effects
Prec: avoid in Pts with prolonged QT syndrome or CHF / hypotension is common
SE: drowsiness, seizures, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
Procainamide (Pronestyl) Dose / Pharmacokinetics
Dose: 20-50mg/min until arrhythmia is suppressed / discontinue if: arrhythmia is suppressed, Hypotension occurs, QRS is widened by 50% of original width, a total of 17mg/kg has been administered
Maintenance infusion of 1-4mg/kg (generally 1g in 500mL of D5W or NS = 2mg/mL
Onset: 10-30min
Peak: 15-20min
Duration: 3-6hrs
1/2 Life: 3hrs
Clopidogrel (Plavix) Class
Platelet aggregation inhibitor (ADP Inhibitor)
Clopidogrel (Plavix) Description / MOA
Desc: adenosine diphosphate (ADP) platelet aggregation inhibitor
MOA: inhibits platelet aggregation by selectively binding to adenlyate cyclase-coupled ADP receptors on the surface of platelets
Clopidogrel (Plavix) Indications
Treatment of ACS / recent MI, stroke, or established peripheral vascular disease
Clopidogrel (Plavix) Contraindications
presence of a hemostatic disorder / active pathological bleeding (eg: bleeding peptic ulcer, intracranial bleeding, etc)
Clopidogrel (Plavix) Precautions / Side Effects
Prec: Pts taking NSAIDS
SE: increased risk of bleeding, fever, allergic reactions, myalgias, arthralgia, bronchospasm, skin rash
Clopidogrel (Plavix) Dose / Pharmacokinetics
Non STE ACS (UA/NSTEMI): 300mg loading dose PO, followed by 75mg PO once daily in combo w/ ASA 75-325mg PO once daily)
STEMI: 75mg PO once daily w/ ASA 75-325 PO
Recent MI, Stroke, or established peripheral arterial disease: 75mg once daily
Onset: 2hrs
Peak: 3-7days
Duration: 7-10days
1/2 Life: 7-8hrs
Heparin Class
Anticoagulant (unfractionated)
Heparin Description / MOA
Desc: rapid acting anticoagulant prepared from bovine lung tissue or porcine intestinal mucosa
MOA: indirect inhibitor of thrombin, blocks the conversion of prothrombin to thrombin / prevents the conversion of fibrinogen to fibrin
Heparin Indications
inhibit clot formation in ACS / adjunct in fibrinolysis / helps prevent PE and DVT
Heparin Contraindications
Hypersensitivity to pork and beef products
Heparin Precautions / Side Effects
Prec: do not use in Pts with active major bleeding or thrombocytopenia / caution in Pts with chronic alcoholism, Hx of atrophy or anaphylaxis, and pregnant (especially the last trimester)
SE: CNS confusion and dizziness / Cardiovascular: edema, CP, irregular heart beat / Injection site: irritation, pain, erythema, bruising / Other: bleeding complications, agioedema, rash, urticaria
Interactions: NSAIDS, warfarin, antiplatelet agents
Heparin Dose / Pharmacokinetics
Adult STEMI / unstable angina: 60U/kg IV (max of 4000U) followed by 12U/kg/hr (max 1000U/hr) often given with alteplase (rtPA)
Adult NSTEMI / unstable angina: 60-70U/kg IV bolus (max 5000U) followed by 12-15U/kg/hr infusion
Pediatric: 50U/kg followed by IV infusion based on lab values and body mass
Onset: Immediate
Peak: 2-3min
Duration: 2-6hrs
1/2 Life: 90min
Esmolol (Brevibloc) Class
Class II antiarrhythmic (selective Beta blocker)
Esmolol (Brevibloc) Description / MOA
Desc: Beta1 selective blocker w/ very short half life
MOA: Beta1 blocker / rapid onset / shourt duration of action (9min) / used to slow rapid heart rates in Pts with SVT, AFlut, AFib /
Esmolol (Brevibloc) Indications
Stable, narrow complex Tachs refractory to adenosine or vagal maneuvers or if SVT is recurrent
Control ventricular rate in Pts with AFib or AFlut
Certain forms of polymorphic VT (associated with acute ischemia, familial Long QT Syndrome, catecholaminergic
Esmolol (Brevibloc) Contraindications
Pts with sinus bradycardia, heart block greater than first degree, cardiogenic shock, overt CHF
Esmolol (Brevibloc) Precautions / Side Effects
Prec: hypotension which is primarily dose related (may need to reduce dose) / CHF may worsen / Pts with bronchospastic diseases (asthma/COPD) should not use unless medical control physician deems that the benefits outweigh the risks
SE: bradycardia, dizziness, hypotension, lethargy, CHF, dyspnea, wheezing, weakness
Incompatibilities: Pts who received IV Calcium channel blockers / Morphine can increase the blood levels of esmolol
Esmolol (Brevibloc) Dose / Pharmacokinetics
Loading dose: 500mcg/kg over 1min
Maintenance dose: 50mcg/kg/min for 4min
If therapeutic effect is not seen then repeat loading dose of 500mcg/kg followed by 100mcg/kg/min for 4min
Can be tirated at 4min intervals by repeating the loading dose and increasing the maintenance dose by 5omcg/kg/min
Max maint dose is 300mcg/kg/min
Onset: < 5min
Peak: 10-20min
Duration: 10-30min
1/2 Life: 2-9min
Sodium Nitroprusside (Nitropress, Nipride) Class
Antihypertensive and vasodilator
Sodium Nitroprusside (Nitropress, Nipride) Description / MOA
Desc: potent vasodilator used in management of HTN emergencies
MOA: dilates both peripheral arteries and peripheral veins causing immediate reduction in BP / occasionally used for severe CHF (although not approved)
Use almost always requires ICU admission
Sodium Nitroprusside (Nitropress, Nipride) Indications
HTN emergency
Sodium Nitroprusside (Nitropress, Nipride) Contraindications
None when used in the management of life threatening HTN crisis
Sodium Nitroprusside (Nitropress, Nipride) Precautions / Side Effects
Prec: once infusion is prepared it must be immediately wrapped to protect from light, quickly inactivated / shouldn’t be used in peds or pregnant women / dose should be reduced in elderly Pts / constant monitoring of BP and HR required
SE: dizziness, headache, hypotension, CP, dyspnea, palpitations, nausea, vomiting / can also cause cyanide toxicity in higher doses
