CCRN Meds Flashcards
Pharmacodynamics of Alpha Adrenergic Drugs?
causes Arterial vasoconstriction
Pharmacodynamics of Alpha Blockers
Arterial vasodilation.
When thinking Alpha, think ARTERIAL
Beta 1 Adrenergic Drugs
stimulates the heart
Beta 2 adrenergic and beta 2 agonists rugs
Stimulates the lungs, bronchodilators
Caution about beta adrenergic blockers?
neg inotropes and can mask signs of hypoglycemia
Type: phenylephrine
alpha adrenergic drugs
Type: norepinephrine
alpha adrenergic drugs.
What drugs increases serum digoxin
amiodarone, ahminoglycosides, captopril, carvedilol, diltiazem, esmolol, ibuprofen, quinidine, verapamil
Nitroprusside action?
Decreases preload and afterload
Signs of nitroprusside toxicity?
hypotension OR increase dose to control BP, confusion, agitation, N/V, twitching
What do nitrates do?
dilate veins andarteries
- not admin with erection enhancing medication, may cause severe hypotension
Amiodarone may do what to EKG?
Prolong QT, lowers HR
What med would be used for SBradycardia?
Atropine 0.5mg IV repeated in 5 min intervals up to 3mg and transcutaneous pacemaker.
Caution of Atropine usage?
Ensure adequate tissue perfusion to vital organs. Accidental overdoses will need hemodynamic support until metabolized and excreted
Med for afib RVR?
CC blockers like IV diet, or beta blockers. Dilt is admin bolls of .25mg/kg given over a min, followed by second dose.
A/C, INR 2-3
Med for sinus tachycardia?
Adenosine. 6mg rapid bolus, followed by 12 mg after 1-2 min.
Drug can cause brief systolic as SA/AV node is rest from reentry and NSR return.
Tx for narrow supraventriciular tachycardia? How come it can cause asystole?
Tx amiodarone bolus of 150mg over 10 min, followed by initiation of a continuous infusion at 1mg/min. Could attempt synchronized cardioversion if pt is hemodynamically stable. If pt is hemodynamically unstable, immediate defibrillation is required. Can lead to Torsades de pointes.
Torsades is a type of ventricular tachycardia that shows polymorphous origination. Tx?
IV MgSO4 1-2 grams over 30-60seconds. Can repeat 5-15min.
How are ventricular/wide tachycardias treated?
Vagam maneuvers. Adenosine and CC blockers can be even for a symptomatic rhythm.
How should you treat V fib?
immediate CPR and or defibrillation. Rhythm should be confirmed and pulses checked.
How would you tx systole?
epinephrine or vasopressin.
Epinephrine is administered 1 mg IV every 5 min until return of rhythm. Vasopressin 40 u is given as a one time dose in replacement for 1 or 2 dose of epinephrine. Cont CPR should be continue with freq pulse checks to ensure adequate compressions. Pt will need intubation if not immediately converted to ensure adequate oxygenation
What are beta blockers affect on the body?
reduce heart rate and contractility, while increasing diastolic filling pressures. (atenolol, metoprolol, esmolol, labetalol). Drugs should be not be withdrawn rapidly to prevent rebound effects like unstable angina, HTN, and MI.
How do ACEI meds work? Name two meds
Angiotensin converting enzyme inhibitors causes vasodilation and afterload reduction, decreased L ventricular workload. Drugs block conversion of angiotensin I to angiotensin II. i.e captopril and enalapril. Complication is hypotension, esp in volume depleted pt.
What does ACEI stand for?
Angiotensin concerting enzyme inhibitors.
How does ARB work?
Angiotensin II receptor blockers works similarly to ACEIs. Primary func is to blocks the effects of angiotensin II (a potent chemical that causes the vessels to contract). The vessels dilate and reduces BP. Meds: losartan, irbesartan, valsartan. Hf and HTN responds well to ARB. Can also be used to prevent renal failure.
ARBs stand for?
Angiotensin II receptor blockers
ARB med examples?
Losartan, irbesartan, valsartan
Function of inotropics?
improve cardiac contractility
Inotropic pathophys? what happens to electrolytes?
Func to improve cardiac contractility. So improved CO by decreased filling pressures.
Digoxin is a cardiac glycoside, regulates HR and classified as a weak inotrope. Although it’s a positive inotrope that strengthens the heart beat by increasing the amount of calcium in the heart’s cells. Med draws potassium and sodium into the cells, which prevents the Ca from leaving the cells.
Dobutamine is another example. Milrinone directly relaxes vascular smooth muscle and increases myocardial contractility. Most inotropes cause tachycardia.
