Drips Flashcards
Heparin Mechanism of action and classification?
Classification: Anticoagulant
Mechanism of Action: reversibly binds to and activates antithrombin III (ATIII), resulting in the inactivation of Factor IIa (thrombin) and Factor Xa.
Heparin half-life?
1.5hrs
Heparin route and onset?
IV: immediate
Sub-Q: 20-60 mins
What lab is needed prior to the administration of subq heparin and what is the normal value?
Platelet
Norm: 150-450K
What is HIT and when does it occur?
- An immune mediated response where clots begin to form within blood vessels using available platelets
- Usually 4-12 days after start of heparin therapy
Nicardipine brand name?
Cardene
Cardene class and MOA?
Classification: CCB (anti-hypertensive)
Mechanism of Action: inhibits the influx of extracellular calcium across the myocardial and vascular smooth muscle cell membranes.
Nicardipine:
Onset, duration and half-life?
Onset: 10 mins
Duration: < 8hrs
Half-Life: 2-4 hrs
Cardene AE?
low BP
reflex tachycardia
HA
N/V
Nicardipine contra-indications?
- Low bp and EF < 55%
- Liver disease (drug is metabolized by the liver)
Cardene dose range?
5-15 mg/hr
Diltiazem brandname?
Cardizem
Cardizem class and MOA?
Classification: CCB (anti-hypertensive)
Mechanism of Action: inhibits the influx of extracellular calcium across the myocardial and vascular smooth muscle cell membranes.
Diltiazem:
Onset, duration and half-life?
Onset: 3 min
Duration:
- Bolus: 1-3 hrs
- Continuous: 0.5-10 hrs
Half-Life: 3-5 hrs
Indications of IV Diltiazem?
ventricular rate control in A-Fib/Flutter, conversion of SVT
Indications of oral Diltiazem?
HTN, spasm prevention during radial artery graft harvesting, migraines, angina
Cardizem dosing?
Initial bolus: 0.25mg/kg over 2 mins
Infusion Rate: 5-15 mg/hr
Dobutamine brandname?
Dobutrex
Dobutrex class and MOA?
Classification: Direct Beta 1 agonist
MOA: increase cardiac contractility and stroke volume, mild positive chronotropic effects (↑HR)
Dobutamine:
onset, peak, duration, and half-life
Onset: 1-10 min
Peaks:10-20 min
Duration: minutes
Half-Life: 2 min
Dobutrex dose range?
2.5-20- mcg/kg/min
Dobutamine AE?
Tachycardia, H/A, tremors, anxiety ventricular arrythmias, hypokalemia, can trigger A-Fib
Dopamine class and MOA?
- Classification: A1 & B1 Agonist
- MOA: has positive inotropic and chronotropic effects
Dopamine indications?
- HF
- shock after fluid replacement fails
- renal failure
- low CO when SVR is low and BP is marginal
Dopamine AE?
H/A, HTN, angina, tachycardia, ectopy, myocardial ischemia, > increased of arrhythmias at moderate dose, tissue necrosis can occur with extravasation
Dopamine low dose range and effect?
- 0.5-3 mcg/kg/mL (low dose)
- dilation of afferent/efferent renal arterioles (increased blood flow and UO)
Dopamine mod dose range and effect?
- 3-10 mcg/kg/min,
- increased renal flow and CO, contractility and HR (primarily B1 = pos inotropic effect)
Dopamine high dose range and effect?
- > 10 mcg/kg/min
- inc renal flow, peripheral vasoconstriction & pos inotropic effects
Epinephrine dose range?
0.02-3 mcg/kg/min
Epinephrine concentration(s)?
4, 8, 16mg/250mL D5W
(1:1,000)
Dopamine:
onset, duration and half-life?
Onset: 5 min
Duration: <10 min
Half-Life: 2 min
Epinephrine:
onset, duration and half-life?
Onset: immediate
Duration: 5-10 mins
Half-Life: 2 mins
Esmolol brandname?
Brevibloc
Esmolol class and MOA?
- Class: Mostly B1, B2 at high doses & Type II Anti-arrhythmic
Esmolol dose range?
50-200 mcg/kg/min
Esmolol:
onset, duration and half-life?
Onset: 2-10 min
Duration: 10-30 min
Half-Life: 9 min
Esmolol indications?
HTN, Sinus tachy, SVT, Afib, A-Flutter
Esmolol Contra-Indication?
- cardiogenic shock
- pulmonary HTN
- IV admin of CCB
- uncompensated HF
- 2nd/3rd degree heart block (except if Pt has a PM)
Fentanyl brandname?
Sublimaze
Fentanyl MOA?
opioid that inhibits ascending pain pathways, increasing the pain threshold
Fentanyl:
onset, duration and half-life?
Onset: immediate
Duration: 30-60 min
Half-Life: 2-4 hrs
Fentanyl Dose Range:
200 mcg/kg/min (max)
Fentanyl Contraindication?
(caution)↓HR or respiration, renal/hepatic/resp disease, head injuries, altered LOC increased ICP, MAOI use within 14days, elderly
Fentanyl AE?
- drowsy, N/V
Rare – confusion, blurred vision, chills orthostatic ↓BP, constipation - risk for paralytic ileus
Labetalol class and MOA?
- Classification: Alpha1 and non-selective Beta Adrenergic Blocker (Antihypertensive)
- Mechanism of Action: slows sinus HR and decreases peripheral resistance
PO Labetolol:
onset, duration and half-life?
Onset: 0.5-2hrs
Duration: PO: 8-12 hrs
Half-Life: 6-8 hrs
IV Labetolol:
onset, duration and half-life?
Onset: 2-5 hrs
Duration: 2-4 hrs
Half-Life: 6-8 hrs
Labetolol contraindications?
asthma, cardiogenic shock uncompensated HF, 2nd/3rd degree heart block (except w/ PM)
Labetolol AE?
drowsy, dizzy, excessive fatigue, dyspnea, peripheral edema, depression, anxiety, constipation, diarrhea, abd discomfort
How must labetolol be d/c and why?
need to taper to discontinue, abrupt withdrawal may cause:
- myocardial ischemia
- CP
- diaphoresis
- palpitations
- H/A
- tremors which may mask symptoms of acute hypoglycemia.
Nitroglycerin dose range?
5-200 mcg/min
Nitroglycerin:
onset, duration and half-life?
Onset: 2-5 min
Duration: 10-20 min
Half-Life: 1-4 mins
Norepinephrine brandname?
Levophed
Levophed class and MOA?
Class: adrenergic agonist
Mechanism of Action:
- A1 & A2: peripheral vasoconstriction
- B1: ↑CO (+ inotropic effect), coronary vasodilation, ↑HR
Norepinephrine concentration(s)?
4, 8, 16 mg/250mL D5W
Norepinephrine:
onset, duration and half-life?
Onset: rapid acting
Duration: 1-2 mins
Half-Life: 3 mins
Phenylephrine class and MOA?
Class: Alpha 1 Agonist
Mechanism of Action: ↑SVR & diastolic pressure
Phenylephrine dose range?
0.5-9 mcg/kg/min
Phenylephrine :
onset, duration and half-life?
Onset: immediate
Duration: 15-20 min
Half-Life: 5 mins
Phenylephrine indications?
shock and low BP
Considerations for administration of phenylephrine?
may cause necrosis if infiltrates, KIDNEYS (↓blood flow, high pressure), use caution in patients with arterial grafts
Phenylephrine AE?
Common: ↓CO, HTN, reflex bradycardia, anxiety, metabolic acidosis, ↓urine
Rare: arrhythmia
Precedex class and MOA?
Class: Selective A2 Agonist
Mechanism of Action: inhibits NE release = sedation
Precedex dose ranges?
0.1-0.7 mcg/kg/hr
Precedex concentration(s)?
200mg/50mL or 400mg/100mL
Precedex contraindications?
AV block
Precedex:
onset, duration and half-life?
Onset: 5-10 min
Duration: 1-2 hrs
Half-Life: 6 min
Precedex AE?
↓BP, HR, resp depression, N, constipation, thirst/dry mouth
Primacor brandname?
Milrinone
Milrinone class and MOA?
Classification: phosphodiesterase III Inhibitor
Mechanism of Action: moderate inotrope and potent vasodilator (A/V)
Milrinone dose range?
0.25-0.75 mcg/kg/min
Primacor (milrinone):
onset, duration and half-life?
Onset: 5-15 min
Duration:
Half-Life: 2.5 hrs w/ normal renal funct
Primacor (milrinone) indications?
acute HF, inotropic support following cardiac surgery, pts waiting for transplant
Primacor AE?
↓BP, ventricular arrhythmias, H/A, angina, hypokalemia, thrombocytopenia
Propofol brandname?
(Diprivan)
Propofol class and MOA?
Classification: short acting sedative
Mechanism of Action: GABA agonist
Propofol dose range?
1 - 50 mcg/kg/mL (max)
Propofol:
onset, duration, and half-life?
Onset: 60 secs
Duration: 3-10 min
Half-Life: 40 mins
Propofol AE?
apnea, low BP, resp/myocardial depression
Vasopressin is also called?
ADH
Vasopressin physiologic effect?
water conservation and increase in BP
Vasopressin dose range for shock?
0.04 units/min fixed rate
Vasopressin dose range for GI bleed?
0.2-0.4 units/min
Vasopressin dose for cardiac arrest?
40 unit IV bolus
Vasopressin:
onset, duration, and half-life?
Onset: unknown
Duration: 30-60 mins
Half-Life: 10-20 mins
Vasopressin indications?
Diabetes Insipidus, GI bleed, cardiac arrest, shock states
Vasopressin AE?
- Myocardial ischemia at high doses
- H20 intoxication (confusion, drowsy, H/A, weight gain, seizures, coma)
- abd cramps d/t vasoconstriction within the intestinal/gastric mucosa
Versed class and MOA?
Classification: benzodiazepine
Mechanism of Action: GABA agonist
Versed aka?
midazolam
Versed dose range?
1-6 mg/hr
Versed:
onset, duration, and half-life?
Onset: 3-5 mins
Duration: 2 hrs
Half-Life: 2-6 hrs
Versed AE?
respiratory depression, hiccups, low BP, drowsy, H/A