Chapter 58 Flashcards by Brina Quintanilla Reyes

Why do we use oxygen as an emergency drug?

To promote optimal airway and breathing before administering any pharmacological agents

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What is the range of oxygen we want our patients to be at ?

94-99%

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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

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Prolonged period of FiO2 above what percentage can lead to oxygen toxicity?

50%

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What is aspirn ?

Decrease platelet aggregation

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How much aspirin do we admitted on onset of chest pain?

( 81mg baby aspirin )

160-325mg

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What does nitroglycerin do?

Diliates coronary arteries, improves blood flow to an ischemic myocardium

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What does nitroglycerin treat? (3)

Angina
Myocardial infarction
Acute carcinogenic pulmonary edema

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What are the 3 adverse effects of nitroglycerin?

Hypotension
Tachycardia
Bradycardia

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What’s super important to note about nitroglycerin?

Don’t give with other ED medications

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What are the 3A’s?

Atropine
Adenosine
Amiodarone

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What do all 3 of these cardiac drugs need to have when monitoring?

Cardiac monitor
Blood pressure
Heart rate
Frequent VS

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What does atropine do?

Treats bradycardia and heart attack

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What are side effects of atropine?

Dysrthythmia
Bradycardia
MI
Restlessness
Anxiety
Pupil dilation
Thirst
Urinary retention

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What does adenosine do?

Treats paroxysmal SVT
Slows conduction through AV node

( turn off and then turn on )

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What are side effects of adenosine?

Brief asystole
Ventricular ectopic
Bradycardia
Flushing
Dyspnea
Chest pain
Hypotension

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What does amiodarone do?

Treatment of life threatening ventricular dysrhythmias and cardiac arrest

Stabilizes heart rate

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What are 2 side effects of amiodarone ?

Hypotension and bradycardia

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What does morphine sulfate do?(4)

Relives chest pain
Treats acute cardiogenic pulmonary edema
Dilated venous vessels
Reduced workload of heart

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What are the 2 adverse effects of morphine sulfate?

Respiratory depression
Hypotension

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What is the antidote if morphine sulfate?

How much dose ?

Naloxone

0.4-2 q2mjn as needed

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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

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What are 4 adverse effects of diltiazem?

Dysrhythmias
Bradycardia
Heart block
Hypotension

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What does lidocaine do?

Treat significant ventricular dysrhythmias by decreasing myocardial irritability

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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