Chapter 58 Flashcards
Why do we use oxygen as an emergency drug?
To promote optimal airway and breathing before administering any pharmacological agents
What is the range of oxygen we want our patients to be at ?
94-99%
Why is it dangerous to have high oxygen in our COPD patients ?
Instead we like to give them what?
Because it can cause loss of hypoxic respiratory drive
CPAP & BIPAP
Prolonged period of FiO2 above what percentage can lead to oxygen toxicity?
50%
What is aspirn ?
Decrease platelet aggregation
How much aspirin do we admitted on onset of chest pain?
( 81mg baby aspirin )
160-325mg
What does nitroglycerin do?
Diliates coronary arteries, improves blood flow to an ischemic myocardium
What does nitroglycerin treat? (3)
Angina
Myocardial infarction
Acute carcinogenic pulmonary edema
What are the 3 adverse effects of nitroglycerin?
Hypotension
Tachycardia
Bradycardia
What’s super important to note about nitroglycerin?
Don’t give with other ED medications
What are the 3A’s?
Atropine
Adenosine
Amiodarone
What do all 3 of these cardiac drugs need to have when monitoring?
Cardiac monitor
Blood pressure
Heart rate
Frequent VS
What does atropine do?
Treats bradycardia and heart attack
What are side effects of atropine?
Dysrthythmia
Bradycardia
MI
Restlessness
Anxiety
Pupil dilation
Thirst
Urinary retention
What does adenosine do?
Treats paroxysmal SVT
Slows conduction through AV node
( turn off and then turn on )
What are side effects of adenosine?
Brief asystole
Ventricular ectopic
Bradycardia
Flushing
Dyspnea
Chest pain
Hypotension
What does amiodarone do?
Treatment of life threatening ventricular dysrhythmias and cardiac arrest
Stabilizes heart rate
What are 2 side effects of amiodarone ?
Hypotension and bradycardia
What does morphine sulfate do?(4)
Relives chest pain
Treats acute cardiogenic pulmonary edema
Dilated venous vessels
Reduced workload of heart
What are the 2 adverse effects of morphine sulfate?
Respiratory depression
Hypotension
What is the antidote if morphine sulfate?
How much dose ?
Naloxone
0.4-2 q2mjn as needed
What is diltiazem?
( this requires careful monitoring of BP and heart rate )
It’s a second line agent after adenosine to treat PSVT
Slows ventricular response rate in a-fib or flutter
What are 4 adverse effects of diltiazem?
Dysrhythmias
Bradycardia
Heart block
Hypotension
What does lidocaine do?
Treat significant ventricular dysrhythmias by decreasing myocardial irritability
We lidocaine we want to be careful when using with patients who have?
Liver impariment
How can you assess a patient who has lidocaine toxicity?
Confusion
Drowsiness
Hearing impairment
Cardiac conduction defects
Myocardial depression
Muscle twitching
Seizures
What does magnesium sulfate do?
Treats refractory ventricular tachycardia and ventricular fibrillation
Cardiac arrest caused by torsades de pointes life threatening ventricular dysrhythmias from digitalis toxicity
What are big things to monitor for magnesium sulfate? Toxicity ? (3)
Respiratory depression & arrest
Circulatory collapse
Cardiac arrest
What is the antidote for magnesium?
Calcium gluconate
Extra information
Adverse effects for magnesium
Hypotension
Bradycardia
Flushing
Sweating
Diarrhea
Respiratory depression
Flaccid paralysis
Deep tendon reflex impairment
Circulatory collapse
What does epinephrine do?
( requires constant cardiac and Hemodynamic monitoring )
Treats profound bradycardia and hypotension, asystole pulseless ventricular tachycardia and ventricular fibrillation also anaphylaxis and severe asthma
What are some adverse effects of epinephrine?
Myocardial ischemia
Dysrhymias
Hypertension
Tachycardia
Angina
Excitabikify
Anxiety
Restlessness
You should never administer epinephrine at the same site of what? And why?
Sodium bicarbonate
Because it’ll deactivate the effects of epinephrine
What does sodium bicarbonate do?
( carefully monitor arterial blood gas results )
Treats severe metabolic acidosis
Hyperkalemia
Acidotic states related to specific drug overdose situations
What are the 3 drugs that are inactived with sodium bicarbonate?
Epinephrine
Norepinephrine
Dopamine
When do you only give sodium bicarbonate? After doing what?
Adequate resuscitative efforts
Ventilation
IV fluids
Drug therapy fail to correct acidosis
( last effort )
What does mannitol do?
Osmotic diuretic
To treat cerebral edema and reduce increasing intracranial pressure
When giving mannitol what do you have to use?
Use 2 filters since it’s highly irritating to veins
What do you want to monitor for mannitol?
Neurologic status
Blood pressure
Electrolytes
Serum osmolaity
intakes & Outakes
What does naloxone do?
Extra notes
Monitor patient for combative or violent behavior
Requires careful monitoring for recurrent respiratory depression and hypotension
Reverses the effects of opiate drugs by competitively binding to opiate receptor sites
What does activated charcoal do?
( contact poison control )
Prevents absorption of toxin in body if ingested substances is known to be affected by charcoal in the GI tract
How much do you give of activated charcoal?
When is this drug given ?
Depends on how much position is ingested
30-60mins after ingestion
Activated charcoal causes the stool to be ?
We also want to monitor after giving this medication for?
Black
Vomiting and aspiration
We don’t give activated charcoal with?
Milk products
What does dopamine do?(2)
Treats hypotensive shock states
Increases heart rate in bradycardia when unresponsive to atropine
Why do we want to taper off dopamine when giving them?
( notes ; dopamine requires continuous heart and BP monitoring )
To avoid severe hypotension
If dopamine leaks out of the IV, what can happen?
necrosis
What’s the antidote for dopamine?
Extravasation
( phentolamine 5-10mg diluted in 10-15ml NS info area )
What are 4 adverse effects of dopamine?
Tachycardia
Dysrhythmias
Myocardial ischemia
Nausea/vomiting
What does dobutamine do?
( requires continuous cardiac and BP monitoring )
Improved cardiac contractility and increased HR, mild vasodilation
What do we use dobutamine in?
Used in shock to improve cardiac output
Do we taper off gradually for dobutamine?
Yes
What are some adverse effects of dobutamine?
Myocardial ischemia
Tachycardia
Dysrhythmias
Headache
Nausea
Tremors
What does albuterol do?
Broncho dilator in anaphylactic shock, asthma, COPD, inflammatory narrowing of airways
How do we give albuterol?
What do we monitor for?
Nebulizer or MDI
Breath sound, subjective feelings of respiratory distress
What are some adverse effects of albuterol?
Tachycardia
Tremors
Nervousness
Dysthrymias
Hypertension
What does diphenhydramine do?
Antihistamine administered with epinephrine to treat anaphylactic shock
Notes
Some adverse effects of diphenhydramine
Drowsiness
Sedation
Confusion
Vertigo
Excitability
Hypotension
Tachycardia
Gi distress
Dry mouth
What two drugs treat hypoglycemia?
Dextrose 50
Glucagon
How do we give dextrose 50?
Monitor for what ? (2)
Can cause?
IV in large vein or central line
Phlebitis & extravasation
Hyperglycemia - monitor blood glucose, osmotic diuresis ( urine output)
How can we give glucagon?
Adverse effects?
SQ,IM,IV
Nausea, vomiting, hypersensitive, bronchodpams
Respiratory distress
What is hypertensive crisis?
( pulmonary edema )
180-200S
————-
120D
Labetalol does what?
Lowers heart rate, BP, myocardial contractility, myocardial oxygen combustion
Reduces vasoconstriction resulting from sympathetic nervous system stimulation
What are adverse effects of labetalol?
Hypotension
Bradycardia
Dysrhythmias
Bronchospams
Dizziness
What does nitroprusside do?
Artieral and venous vasodilator to reduce severe hypertension
Nitroprusside we want to monitor for?
Thiocyanate toxicity & cyanide
Do we protect nitroprusside from the light?
Yes
What does furosemide do?
Promotes renal excretion of water, sodium, chloride, magnesium, hydrogen, calcium, potassium
Has peripheral and renal vasodilation effects that can lower BP
What are 3 big furosemide adverse effects?
Severe hypovolemia
Dehydration
Electrolye imbalance
What do we want to monitor in furosemide users?
Fluid & electrolytes
BUN
Creatinine
Breaths sounds
I&O
