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Drips Flashcards

1
Q

Heparin Mechanism of action and classification?

A

Classification: Anticoagulant
Mechanism of Action: reversibly binds to and activates antithrombin III (ATIII), resulting in the inactivation of Factor IIa (thrombin) and Factor Xa.

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2
Q

Heparin half-life?

A

1.5hrs

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3
Q

Heparin route and onset?

A

IV: immediate
Sub-Q: 20-60 mins

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4
Q

What lab is needed prior to the administration of subq heparin and what is the normal value?

A

Platelet
Norm: 150-450K

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5
Q

What is HIT and when does it occur?

A
  • An immune mediated response where clots begin to form within blood vessels using available platelets
  • Usually 4-12 days after start of heparin therapy
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6
Q

Nicardipine brand name?

A

Cardene

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7
Q

Cardene class and MOA?

A

Classification: CCB (anti-hypertensive)
Mechanism of Action: inhibits the influx of extracellular calcium across the myocardial and vascular smooth muscle cell membranes.

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8
Q

Nicardipine:
Onset, duration and half-life?

A

Onset: 10 mins
Duration: < 8hrs
Half-Life: 2-4 hrs

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9
Q

Cardene AE?

A

low BP
reflex tachycardia
HA
N/V

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10
Q

Nicardipine contra-indications?

A
  • Low bp and EF < 55%
  • Liver disease (drug is metabolized by the liver)
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11
Q

Cardene dose range?

A

5-15 mg/hr

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12
Q

Diltiazem brandname?

A

Cardizem

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13
Q

Cardizem class and MOA?

A

Classification: CCB (anti-hypertensive)
Mechanism of Action: inhibits the influx of extracellular calcium across the myocardial and vascular smooth muscle cell membranes.

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14
Q

Diltiazem:
Onset, duration and half-life?

A

Onset: 3 min
Duration:
- Bolus: 1-3 hrs
- Continuous: 0.5-10 hrs
Half-Life: 3-5 hrs

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15
Q

Indications of IV Diltiazem?

A

ventricular rate control in A-Fib/Flutter, conversion of SVT

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16
Q

Indications of oral Diltiazem?

A

HTN, spasm prevention during radial artery graft harvesting, migraines, angina

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17
Q

Cardizem dosing?

A

Initial bolus: 0.25mg/kg over 2 mins
Infusion Rate: 5-15 mg/hr

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18
Q

Dobutamine brandname?

A

Dobutrex

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19
Q

Dobutrex class and MOA?

A

Classification: Direct Beta 1 agonist
MOA: increase cardiac contractility and stroke volume, mild positive chronotropic effects (↑HR)

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20
Q

Dobutamine:
onset, peak, duration, and half-life

A

Onset: 1-10 min
Peaks:10-20 min
Duration: minutes
Half-Life: 2 min

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21
Q

Dobutrex dose range?

A

2.5-20- mcg/kg/min

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22
Q

Dobutamine AE?

A

Tachycardia, H/A, tremors, anxiety ventricular arrythmias, hypokalemia, can trigger A-Fib

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23
Q

Dopamine class and MOA?

A
  • Classification: A1 & B1 Agonist
  • MOA: has positive inotropic and chronotropic effects
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24
Q

Dopamine indications?

A
  • HF
  • shock after fluid replacement fails
  • renal failure
  • low CO when SVR is low and BP is marginal
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25
Q

Dopamine AE?

A

H/A, HTN, angina, tachycardia, ectopy, myocardial ischemia, > increased of arrhythmias at moderate dose, tissue necrosis can occur with extravasation

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26
Q

Dopamine low dose range and effect?

A
  • 0.5-3 mcg/kg/mL (low dose)
  • dilation of afferent/efferent renal arterioles (increased blood flow and UO)
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27
Q

Dopamine mod dose range and effect?

A
  • 3-10 mcg/kg/min,
  • increased renal flow and CO, contractility and HR (primarily B1 = pos inotropic effect)
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28
Q

Dopamine high dose range and effect?

A
  • > 10 mcg/kg/min
  • inc renal flow, peripheral vasoconstriction & pos inotropic effects
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29
Q

Epinephrine dose range?

A

0.02-3 mcg/kg/min

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30
Q

Epinephrine concentration(s)?

A

4, 8, 16mg/250mL D5W
(1:1,000)

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31
Q

Dopamine:
onset, duration and half-life?

A

Onset: 5 min
Duration: <10 min
Half-Life: 2 min

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32
Q

Epinephrine:
onset, duration and half-life?

A

Onset: immediate
Duration: 5-10 mins
Half-Life: 2 mins

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33
Q

Esmolol brandname?

A

Brevibloc

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34
Q

Esmolol class and MOA?

A
  • Class: Mostly B1, B2 at high doses & Type II Anti-arrhythmic
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35
Q

Esmolol dose range?

A

50-200 mcg/kg/min

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36
Q

Esmolol:
onset, duration and half-life?

A

Onset: 2-10 min
Duration: 10-30 min
Half-Life: 9 min

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37
Q

Esmolol indications?

A

HTN, Sinus tachy, SVT, Afib, A-Flutter

38
Q

Esmolol Contra-Indication?

A
  • cardiogenic shock
  • pulmonary HTN
  • IV admin of CCB
  • uncompensated HF
  • 2nd/3rd degree heart block (except if Pt has a PM)
39
Q

Fentanyl brandname?

A

Sublimaze

40
Q

Fentanyl MOA?

A

opioid that inhibits ascending pain pathways, increasing the pain threshold

41
Q

Fentanyl:
onset, duration and half-life?

A

Onset: immediate
Duration: 30-60 min
Half-Life: 2-4 hrs

42
Q

Fentanyl Dose Range:

A

200 mcg/kg/min (max)

43
Q

Fentanyl Contraindication?

A

(caution)↓HR or respiration, renal/hepatic/resp disease, head injuries, altered LOC increased ICP, MAOI use within 14days, elderly

44
Q

Fentanyl AE?

A
  • drowsy, N/V
    Rare – confusion, blurred vision, chills orthostatic ↓BP, constipation
  • risk for paralytic ileus
45
Q

Labetalol class and MOA?

A
  • Classification: Alpha1 and non-selective Beta Adrenergic Blocker (Antihypertensive)
  • Mechanism of Action: slows sinus HR and decreases peripheral resistance
46
Q

PO Labetolol:
onset, duration and half-life?

A

Onset: 0.5-2hrs
Duration: PO: 8-12 hrs
Half-Life: 6-8 hrs

47
Q

IV Labetolol:
onset, duration and half-life?

A

Onset: 2-5 hrs
Duration: 2-4 hrs
Half-Life: 6-8 hrs

48
Q

Labetolol contraindications?

A

asthma, cardiogenic shock uncompensated HF, 2nd/3rd degree heart block (except w/ PM)

49
Q

Labetolol AE?

A

drowsy, dizzy, excessive fatigue, dyspnea, peripheral edema, depression, anxiety, constipation, diarrhea, abd discomfort

50
Q

How must labetolol be d/c and why?

A

need to taper to discontinue, abrupt withdrawal may cause:
- myocardial ischemia
- CP
- diaphoresis
- palpitations
- H/A
- tremors which may mask symptoms of acute hypoglycemia.

51
Q

Nitroglycerin dose range?

A

5-200 mcg/min

52
Q

Nitroglycerin:
onset, duration and half-life?

A

Onset: 2-5 min
Duration: 10-20 min
Half-Life: 1-4 mins

53
Q

Norepinephrine brandname?

A

Levophed

54
Q

Levophed class and MOA?

A

Class: adrenergic agonist
Mechanism of Action:
- A1 & A2: peripheral vasoconstriction
- B1: ↑CO (+ inotropic effect), coronary vasodilation, ↑HR

55
Q

Norepinephrine concentration(s)?

A

4, 8, 16 mg/250mL D5W

56
Q

Norepinephrine:
onset, duration and half-life?

A

Onset: rapid acting
Duration: 1-2 mins
Half-Life: 3 mins

57
Q

Phenylephrine class and MOA?

A

Class: Alpha 1 Agonist
Mechanism of Action: ↑SVR & diastolic pressure

58
Q

Phenylephrine dose range?

A

0.5-9 mcg/kg/min

59
Q

Phenylephrine :
onset, duration and half-life?

A

Onset: immediate
Duration: 15-20 min
Half-Life: 5 mins

60
Q

Phenylephrine indications?

A

shock and low BP

61
Q

Considerations for administration of phenylephrine?

A

may cause necrosis if infiltrates, KIDNEYS (↓blood flow, high pressure), use caution in patients with arterial grafts

62
Q

Phenylephrine AE?

A

Common: ↓CO, HTN, reflex bradycardia, anxiety, metabolic acidosis, ↓urine
Rare: arrhythmia

63
Q

Precedex class and MOA?

A

Class: Selective A2 Agonist
Mechanism of Action: inhibits NE release = sedation

64
Q

Precedex dose ranges?

A

0.1-0.7 mcg/kg/hr

65
Q

Precedex concentration(s)?

A

200mg/50mL or 400mg/100mL

66
Q

Precedex contraindications?

A

AV block

67
Q

Precedex:
onset, duration and half-life?

A

Onset: 5-10 min
Duration: 1-2 hrs
Half-Life: 6 min

68
Q

Precedex AE?

A

↓BP, HR, resp depression, N, constipation, thirst/dry mouth

69
Q

Primacor brandname?

A

Milrinone

70
Q

Milrinone class and MOA?

A

Classification: phosphodiesterase III Inhibitor
Mechanism of Action: moderate inotrope and potent vasodilator (A/V)

71
Q

Milrinone dose range?

A

0.25-0.75 mcg/kg/min

72
Q

Primacor (milrinone):
onset, duration and half-life?

A

Onset: 5-15 min
Duration:
Half-Life: 2.5 hrs w/ normal renal funct

73
Q

Primacor (milrinone) indications?

A

acute HF, inotropic support following cardiac surgery, pts waiting for transplant

74
Q

Primacor AE?

A

↓BP, ventricular arrhythmias, H/A, angina, hypokalemia, thrombocytopenia

75
Q

Propofol brandname?

A

(Diprivan)

76
Q

Propofol class and MOA?

A

Classification: short acting sedative
Mechanism of Action: GABA agonist

77
Q

Propofol dose range?

A

1 - 50 mcg/kg/mL (max)

78
Q

Propofol:
onset, duration, and half-life?

A

Onset: 60 secs
Duration: 3-10 min
Half-Life: 40 mins

79
Q

Propofol AE?

A

apnea, low BP, resp/myocardial depression

80
Q

Vasopressin is also called?

A

ADH

81
Q

Vasopressin physiologic effect?

A

water conservation and increase in BP

82
Q

Vasopressin dose range for shock?

A

0.04 units/min fixed rate

83
Q

Vasopressin dose range for GI bleed?

A

0.2-0.4 units/min

84
Q

Vasopressin dose for cardiac arrest?

A

40 unit IV bolus

85
Q

Vasopressin:
onset, duration, and half-life?

A

Onset: unknown
Duration: 30-60 mins
Half-Life: 10-20 mins

86
Q

Vasopressin indications?

A

Diabetes Insipidus, GI bleed, cardiac arrest, shock states

87
Q

Vasopressin AE?

A
  • 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
88
Q

Versed class and MOA?

A

Classification: benzodiazepine
Mechanism of Action: GABA agonist

89
Q

Versed aka?

A

midazolam

90
Q

Versed dose range?

A

1-6 mg/hr

91
Q

Versed:
onset, duration, and half-life?

A

Onset: 3-5 mins
Duration: 2 hrs
Half-Life: 2-6 hrs

92
Q

Versed AE?

A

respiratory depression, hiccups, low BP, drowsy, H/A

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