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drugs Flashcards

1
Q

mechanism of adenosine

A

produces a negative chronotropic effect on the SA and AV node

(primarily AV)

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2
Q

the chemical cardioverter

A

adenosine

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3
Q

indications of adenosine

A

Stable PSVT
questioning wide complex tachy as reentery SVT
diagnostic tool (slows rhythm enough to diagnose it)

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4
Q

precautions of adenosine

A

poison/drug induced
2nd or 3rd HB
less effective if pt on theophylline or caffeine
reduce if dipyrdamole or carbamazepine

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5
Q

dose of adenosine

A

6mg, 12mg, 12mg, rapid push 1-3 seconds
immediate flush 20ml NS
elevate extremity

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6
Q

Amiodarone mechanism

A

affects sodium, potassium, and calcium channels, prolongs phase III of action potential, also has alpha and beta blocking properties

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7
Q

expected effect of adenosine

A

asystole

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8
Q

indications of amiodarone

A

ventricular (vtach and vfib) and atrial arrhythmias

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9
Q

half life of amiodarone

A

40 days! or… something super long!

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10
Q

precautions of amiodarone

A

> 2.2g associated with hypotension
watch other QT prolonging drugs
long half life
resembles T4 hormone

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11
Q

dose of amiodarone for unstable patients

A

300mg first dose second dose 150mg over 3-5 minutes

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12
Q

dose of amiodarone for stable patients

A

150mg

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13
Q

dose of amiodarone for maintenance

A

540mg IV over 18 hours (0.5mg/min)

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14
Q

asprin mechanism

A

inhibits platelet cyclooxygenase

blocks thromboxane A2 for the lfie of the platelet

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15
Q

indications of aspirin

A

ACS
cardio-protective
NOT analgesic properties

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16
Q

precautions of asprin

A

relative contraindication active ulcer/asthma

absolute contraindication:hypersensitivity

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17
Q

dose of asprin

A

160mg to 325mg non-enteric coated, chewed. Rectal suppository 300mg when pt cannot tolerate PO.
No one can REALLY decide what the proper dose is
Most people get 325

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18
Q

Atropine Sulfate Mechanism

A

parasympatholytic (block parasympathetic tone) and anticholinergic (dries everything up)
Also used in kids when intubating!
Makes the heart beat faster!

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19
Q

Indications for atropine Sulfate

A

bradycardia, organophosphate poisoning

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20
Q

precautions of atropine sulfate

A

worsen bradycardia mobitz II or 3rd degree HB

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21
Q

dose of atropine sulfate

A

0.5mg-1mg IV q 3-5min not exceed 3mg or 0.03 mg/Kg.

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22
Q

which BB has a really short half life

A

esmolol

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23
Q

which BB is great for stroke?

A

labetalol

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24
Q

Mechanism of beta blockers

A

beta-adrenergic blockers- blocks beta receptors of the sympathetic nervous system.

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25
Q

indications of BB

A

rate control in a-fib/flutter/PSVT, when cardioversion not an option. Antihypertensive therapy for stroke

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26
Q

precautions of BB

A

used with CCB’s may cause hypotension, careful with Failure, and bronchospastic disease. Myocardial depression, cocaine induced ACS especially propanolol

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27
Q

3 different BB

A

metoprolol
esmolol
labetalol

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28
Q

metoprolol dose

A

IV 5mg q5min max 15mg,

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29
Q

labetalol dose

A

10mg over 1-2 min q 10 or double max 150mg, infusion 2-8mg/min. (great for stroke)

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30
Q

esmolol dose

A

0.5mg/kg over 1min 4min infusion at 0.05mg/kg/min max 0.3mg/kg/min total 200ug/kg (really short half life!)

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31
Q

diltiazem mechanism

A

blocks voltage-gaited Ca channels in cardiac and blood vessels

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32
Q

indications of diltiazem

A

Controls ventricular rate in a-fib/flutter refractory SVT(narrow)

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33
Q

precautions of diltiazem

A 
wide QRS
poisons/drug induced tachycardia
WPW
SSS
AV block w/o pacer
Watch with BB
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34
Q

class of diltiazem

A

non-dihydro CCB

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35
Q

dose of diltiazem

A

15mg to 20mg (0.25mg/kg) over 2 min

re-bolus in 15 min at 20-25mg maintenance infusion 5-15mg/h

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36
Q

which population has trouble tolerating diltiazem IV

A

geriatric (watch them get the first half of the dose… then give second if they’re okay)

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37
Q

dopamine mechanism

A

dose dependent in IV form acting on the sympathetic nervous system. Effects alpha 1, Beta 1-2, and dopamine receptors

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38
Q

indication of dopamine

A

2nd line bradycardia, hypotensive BP

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39
Q

precautions of dopamine

A

always correct volume first, caution with cardiogenic shock/CHF may cause tachyarrhythmia’s and excessive vasoconstriction, don’t mix with bicarb.

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40
Q

two pressors you can use

A

epi or dopamine (both chronotropic and inotropic properties)

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41
Q

dose of dopamine

A

2-20 mcg/kg/min titrate to response

start out on 2 and keep turning drip up until happy with the BP (titrate to effect)

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42
Q

when can you use to correct cardiogenic shock after using dopa if NS doesnt work

A

pressor

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43
Q

dobutamine mechanism

A

Primarily effects Beta 1, some beta 2 and some dopamine

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44
Q

indications of dobutamine

A

Pump problems (Heart Failure). Cardiogenic shock

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45
Q

precautions of dobutamine

A

Pressures between 70-100mmhg no signs of shock, tachyarrhythmias, BP fluctuations, n/HA, less effective in elderly, don’t mix with sodium bicarb

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46
Q

dosing of dobutamine

A

2-20 mcg/kg/min titrate HR not >10% base line

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47
Q

mechanism of epinephrine

A

Primarily effects Alpha 1, however also effects alpha 2 and beta 1

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48
Q

indications of epiphenephrine

A

Cardiac arrest: VF, pulseless VT, asystole, PEA.
As a second line in tx bradycardia, and hypotension. Anaphylaxis
First line drug in cardiogenic shock.

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49
Q

main job of epinephrine

A

vasoconstriction

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50
Q

precautions of epinephrine

A

Spike in BP, increase in myocardial O2 demand, high doses needed to tx poison/drug induced shock

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51
Q

dosing of epinephrine

A

IV/IO 1mg (10ml of 1: 10,000) q 3-5min

Infusion rate 0.1-0.5mcg/kg/min. Profound bradycardia: 2-10mcg/min

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52
Q

what does IO stand for

A

intra-osseous: needle ground into the medullary cavity

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53
Q

1:1000 strength of epi used for….

A

anaphylaxis..IM or SQ

54
Q

1:10,000 strength of epi used for

A

cardiac arrest

55
Q

how often should you have epi

A

every other cycle (every 4 minutes)

56
Q

which two pressors can you use for bradycardia

A

dopamine and epinephrine

57
Q

inferior wall MIs

A

bradycardia

eventually hypotensive because RV infarct

58
Q

which side of the heart primes which side

A

right primes the left

59
Q

Don’t give epi to what kind of MI

A

inferior wall

60
Q

treatment for inferior wall MI

A

fluid restore!

don’t give nitrate!

61
Q

fibrinolytics mechanism

A

acts on fibrin rich clots, converting plasminogen to plasmin,
plasmin breaks down fibrin in clot

62
Q

indications of fibrinolytics

A

ST elevation >1mm in >2 contiguous leads/new LBBB

63
Q

precautions of fibrinolytics

A

Active internal bleeding w/in 21d(not menses) Hx CVA or intra spinal event w/in 3mo (stroke, AV mal, neoplasm, aneurysm,), trauma or surgery w/in 14d, Aortic dissection, uncontrolled HTN, bleeding disorders, prolonged CPR w/ evidence of thoracic trauma, LP w/in 7d, non compressible arterial puncture, during the 1st 24h of ischemic stroke NO ASA NO Heprin if given

64
Q

major contraindication of fibrinolytics

A

recent bleed

65
Q

4 fibrinolytic drugs

A

alteplase
reteplase
streptokinase
tenecteplase

66
Q

rescue PCI

A

fibrinolytics when waiting to get them to a cath lab

67
Q

mechanism of flumazenil

A

competitively inhibits the activity at the benzodiazepine recognition site on the GABA / benzodiazepine receptor complex

68
Q

indications of flumazenil

A

severe benzo OD (ie. respiratory depression)

69
Q

precautions of flumazenil

A

may need redosing recurrent respiratory depression, not use with TCA, seizure hx pt or chronic BZD users, or ETOH’s, do not mix with other antidotes.

70
Q

dose of flumazenil

A

0.2mg IV over 15 sec, 2nd dose 0.3mg over 30sec, 3rd 0.5mg over 30sec then q 1min to response or total 3mg

71
Q

mechanism of glucagon

A

normally released by the pancreas, causes the liver to breakdown glycogen to glucose.

72
Q

indications of glucagon

A

hypoglycemia, BB or CCB OD

73
Q

precautions of glucagon

A

N,V
hyperglycemia
not helpful in someone who doesn’t have any glycogen storage

74
Q

dosing of glucagon

A

3-10mg IV over 3-5 min,

3-5mg/hr infusion rate

75
Q

lidocaine mechanism

A

decreases the depolarization, automaticity, and excitability in the ventricles during the diastolic phase.

76
Q

indications of lidocaine

A

Alternative to Amiodarone in VF/VT, stable polymorphic VT with baseline QT prolonged if torsades suspected, stable monomorphic VT

77
Q

precautions of lidocaine

A

not used as prophylactic in AMI, reduce infusion rates in liver/ventricle dysfunction, d/c if signs of toxicity develops

78
Q

dosing of lidocaine

A

IV/IO 1-1.5mg/kg initial second 0.5-0.75 mg/kg q5 max repeat 3 times. Infusion 1-4mg/min or 30-50mcg/kg/min

79
Q

magnesium sulfate mechanism

A

Magnesium sulfate reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction.

80
Q

indications of magnesium sulfate

A

Only with suspected torsades de pointes or hypomagnesemia, Digitalis toxicity

81
Q

precautions of magnesium sulfate

A

Hypotension, careful with renal failure pts

82
Q

dosing of magnesium sulfate

A

1-2g IV/IO over 5-20 min in arrest, 1-2g IV/IO over 5-60min in pt with pulse/stable. Infusion at 0.5 to 1g/h IV

83
Q

alternative to amiodarone

A

lidocaine

84
Q

class of lidocaine

A

sodium channel blocker

85
Q

polymorphic vtach AKA

A

torsades de pointes

86
Q

monomorphic vtach

A

1 type of waveform

87
Q

who is torsades seen in

A

electrolyte abnormalities

ESRD who hasn’t gotten dialysed

88
Q

MONA

A

morphine
oxygen
nitrates
asprin

89
Q

mechanism of morphine sulfate

A

primarily affects the opoid receptors, helping for pain

90
Q

indications of morphine sulfate

A

CP with ACS

91
Q

precautions of morphine sulfate

A

Administer slowly, may cause respiratory depression, histamine release causes itching, n/v, also found to cause constriction of coronary arteries. Caution with RV dysfunction.

92
Q

dosing of morphine sulfate

A

“enough until they aren’t in pain”

2-4mg IV or additional at 2-8mg q 5-15min intervals, UA/NSTEMI 1-5mg IV only if pain not relieved by Nitrates.

93
Q

mechanism of naloxone

A

opiate receptor blockade

94
Q

indications of naloxone

A

Respiratory, neurological depression due to opiate OD/intoxication

95
Q

precautions of naloxone

A

severe opiate withdrawl lower titration, ½ shorter than most narcotics-monitor, anaphylactic rxn have been seen, Avoid in meperidine-induced seizures. Careful in pt with seizure hx.

96
Q

dosing of naloxone

A

0.04-0.4mg titrate to ventilations resume, 6-10mg in short time ,10min q 2-3 if needed, IM/SQ 0.4-0.8mg

97
Q

what’s the effect of naloxone

A

instant withdraw symptoms: vomiting, itching, agitated

98
Q

brand name of naloxone

A

narcan

99
Q

dose of narcan that police carry

A

2mg

100
Q

mechanism of nitroglycerine

A

vasodilation of coronary arteries

101
Q

indications of nitroglycerine

A

ACS assoc. chest pain, AMI/CHF in the first 24-48h, recurrent CP/pulmonary congestion, hypertensive urgency in ACS
awesome for CHF

102
Q

precautions of nitroglycerine

A 
Hypotension 30 mmHg below baseline
HR  100mmHg
use with phosphodiesterase inhibiters
RV infarction
don’t decrease MAP >25% from initial reading Nitrate-free interval recommended
103
Q

dosing of nitroglycerine

A

1 (0.3 to 0.4 tablet) x 3 q 5min, or 1-2 sprays for 0.5-1 second q5min= 0.4mg per dose, Max 3 sprays, Infusion rate 10mcg/min titrate by 10mcg/min until desired effect

104
Q

side effect of nitroglycerine

A

bad headache

105
Q

nitroprusside mechanism

A

Relaxes arterial and venous smooth muscle by inhibiting cCMP( cyclic guanosine monophosphate)

106
Q

indications of nitroprusside

A

Hypertensive crisis, reduce afterload in HF ,acute pulmonary edema, and acute mitral or aortic valve regurgitation.

107
Q

precautions of nitroprusside

A

Hypotension, cyanide poisoning, recently taken phosphodiesterase inhibitors

108
Q

dosing of nitroprusside

A

0.1mcg/kg/min increase q 3-5min ave dose 5-10mcg/kg/min

109
Q

brand of norepinephrine

A

levophed

110
Q

last ditch efforts for shock

A

norepi

111
Q

mechanism of norepi

A

stimulates alpha 1 and beta 1 receptors

112
Q

indications of norepi

A

severe cardiogenic shock

113
Q

precautions of of norepi

A

Increases myocardial o2 requirements, Increases BP/HR, arrhythmias, extravasations causes tissue necrosis, hypovolemia, poisonings/drug induced hypotension requires higher doses.

114
Q

dosing of norepi

A

0.1-0.5mcg/kg/min

115
Q

procainamide mechanism

A

Class 1a (sodium channel blocker), Depresses myocardial excitability and conduction in the: atrium , bundle of HIS, and ventricle

116
Q

if in Vfib for 45 minutes what should we use?

A

procainamide

117
Q

indications of procainamide

A

stable monomorphic VT with normal QT and preserved LV function. Reentry SVT if BP stable and 1st line doesn’t work. Stable wide complex tachycardia of unknown origin. Afib with rapid rate/ WPW

118
Q

precautions of procainamide

A

Cardiac/renal dysfunction reduce dose. Proarrhythmic in setting of AMI, hypokalemia, or hypomagnesaemia, may induce hypotension in LV impaired pt, Use caution with other drugs that prolong QT

119
Q

dosing of procainamide

A

20mg/min IV, max 17mg/kg, or 20mg/kg infusion until arrhythmia suppression/hypotension/ QRS widening >50% max dose 17mg/kg given. Maintenance infusion 1-4mg/min. Max dosed reduced in cardiac/renal dysfunction to 12mg/kg, 1-2 mg/min infusion

120
Q

sodium bicarb mechanism

A

systemic alkalizer

121
Q

indications of sodium bicarb

A

Hyperkalemia, bicarbonate responsive acidosis-DKA, OD- TCA, ASA, Cocaine, diphenhydramine

122
Q

precautions of sodium bicarb

A

Not recommended for Cardiac Arrest, follow ABG or use in acidosis

123
Q

dosing of sodium bicarb

A

1mgEq/kg IV bolus

124
Q

DDAVP aka….

A

vasopressin AKA ADH

125
Q

mechanism of vasopressin

A

: Induces vasoconstriction by activating V-1 receptors which cause and increase in cellular calcium. (alpha 1 properties)

126
Q

indications of vasopressin

A

alternative to epi in shock or refractory VT, asystole, PEA, maybe useful in vasodilatory shock (sepsis)

127
Q

can use this drug closely with other drugs

A

vasopressin

128
Q

precautions of vasopressin

A

potent peripheral vasoconstrictor provoke cardiac ischemia/angina, not recommended in responsive pts with CAD

129
Q

this is not used as often because it comes in a vial instead of a pre-filled syringe

A

vasopressin

130
Q

dose of vasopressin

A

40U IV/IO replace 1st or 2nd epi. Continuous infusion 0.02-0.04U/min

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