drugs Flashcards
1
Q
mechanism of adenosine
A
produces a negative chronotropic effect on the SA and AV node
(primarily AV)
2
Q
the chemical cardioverter
A
adenosine
3
Q
indications of adenosine
A
Stable PSVT
questioning wide complex tachy as reentery SVT
diagnostic tool (slows rhythm enough to diagnose it)
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
5
Q
dose of adenosine
A
6mg, 12mg, 12mg, rapid push 1-3 seconds
immediate flush 20ml NS
elevate extremity
6
Q
Amiodarone mechanism
A
affects sodium, potassium, and calcium channels, prolongs phase III of action potential, also has alpha and beta blocking properties
7
Q
expected effect of adenosine
A
asystole
8
Q
indications of amiodarone
A
ventricular (vtach and vfib) and atrial arrhythmias
9
Q
half life of amiodarone
A
40 days! or… something super long!
10
Q
precautions of amiodarone
A
> 2.2g associated with hypotension
watch other QT prolonging drugs
long half life
resembles T4 hormone
11
Q
dose of amiodarone for unstable patients
A
300mg first dose second dose 150mg over 3-5 minutes
12
Q
dose of amiodarone for stable patients
A
150mg
13
Q
dose of amiodarone for maintenance
A
540mg IV over 18 hours (0.5mg/min)
14
Q
asprin mechanism
A
inhibits platelet cyclooxygenase
blocks thromboxane A2 for the lfie of the platelet
15
Q
indications of aspirin
A
ACS
cardio-protective
NOT analgesic properties
16
Q
precautions of asprin
A
relative contraindication active ulcer/asthma
absolute contraindication:hypersensitivity
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
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!
19
Q
Indications for atropine Sulfate
A
bradycardia, organophosphate poisoning
20
Q
precautions of atropine sulfate
A
worsen bradycardia mobitz II or 3rd degree HB
21
Q
dose of atropine sulfate
A
0.5mg-1mg IV q 3-5min not exceed 3mg or 0.03 mg/Kg.
22
Q
which BB has a really short half life
A
esmolol
23
Q
which BB is great for stroke?
A
labetalol
24
Q
Mechanism of beta blockers
A
beta-adrenergic blockers- blocks beta receptors of the sympathetic nervous system.
25
indications of BB
rate control in a-fib/flutter/PSVT, when cardioversion not an option. Antihypertensive therapy for stroke
26
precautions of BB
used with CCB’s may cause hypotension, careful with Failure, and bronchospastic disease. Myocardial depression, cocaine induced ACS especially propanolol
27
3 different BB
metoprolol
esmolol
labetalol
28
metoprolol dose
IV 5mg q5min max 15mg,
29
labetalol dose
10mg over 1-2 min q 10 or double max 150mg, infusion 2-8mg/min. (great for stroke)
30
esmolol dose
0.5mg/kg over 1min 4min infusion at 0.05mg/kg/min max 0.3mg/kg/min total 200ug/kg (really short half life!)
31
diltiazem mechanism
blocks voltage-gaited Ca channels in cardiac and blood vessels
32
indications of diltiazem
Controls ventricular rate in a-fib/flutter refractory SVT(narrow)
33
precautions of diltiazem
```
wide QRS
poisons/drug induced tachycardia
WPW
SSS
AV block w/o pacer
Watch with BB
```
34
class of diltiazem
non-dihydro CCB
35
dose of diltiazem
15mg to 20mg (0.25mg/kg) over 2 min
| re-bolus in 15 min at 20-25mg maintenance infusion 5-15mg/h
36
which population has trouble tolerating diltiazem IV
geriatric (watch them get the first half of the dose... then give second if they're okay)
37
dopamine mechanism
dose dependent in IV form acting on the sympathetic nervous system. Effects alpha 1, Beta 1-2, and dopamine receptors
38
indication of dopamine
2nd line bradycardia, hypotensive BP
39
precautions of dopamine
always correct volume first, caution with cardiogenic shock/CHF may cause tachyarrhythmia's and excessive vasoconstriction, don’t mix with bicarb.
40
two pressors you can use
epi or dopamine (both chronotropic and inotropic properties)
41
dose of dopamine
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)
42
when can you use to correct cardiogenic shock after using dopa if NS doesnt work
pressor
43
dobutamine mechanism
Primarily effects Beta 1, some beta 2 and some dopamine
44
indications of dobutamine
Pump problems (Heart Failure). Cardiogenic shock
45
precautions of dobutamine
Pressures between 70-100mmhg no signs of shock, tachyarrhythmias, BP fluctuations, n/HA, less effective in elderly, don’t mix with sodium bicarb
46
dosing of dobutamine
2-20 mcg/kg/min titrate HR not >10% base line
47
mechanism of epinephrine
Primarily effects Alpha 1, however also effects alpha 2 and beta 1
48
indications of epiphenephrine
Cardiac arrest: VF, pulseless VT, asystole, PEA.
As a second line in tx bradycardia, and hypotension. Anaphylaxis
First line drug in cardiogenic shock.
49
main job of epinephrine
vasoconstriction
50
precautions of epinephrine
Spike in BP, increase in myocardial O2 demand, high doses needed to tx poison/drug induced shock
51
dosing of epinephrine
IV/IO 1mg (10ml of 1: 10,000) q 3-5min
| Infusion rate 0.1-0.5mcg/kg/min. Profound bradycardia: 2-10mcg/min
52
what does IO stand for
intra-osseous: needle ground into the medullary cavity
53
1:1000 strength of epi used for....
anaphylaxis..IM or SQ
54
1:10,000 strength of epi used for
cardiac arrest
55
how often should you have epi
every other cycle (every 4 minutes)
56
which two pressors can you use for bradycardia
dopamine and epinephrine
57
inferior wall MIs
bradycardia
| eventually hypotensive because RV infarct
58
which side of the heart primes which side
right primes the left
59
Don't give epi to what kind of MI
inferior wall
60
treatment for inferior wall MI
fluid restore!
| don't give nitrate!
61
fibrinolytics mechanism
acts on fibrin rich clots, converting plasminogen to plasmin,
plasmin breaks down fibrin in clot
62
indications of fibrinolytics
ST elevation >1mm in >2 contiguous leads/new LBBB
63
precautions of fibrinolytics
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
major contraindication of fibrinolytics
recent bleed
65
4 fibrinolytic drugs
alteplase
reteplase
streptokinase
tenecteplase
66
rescue PCI
fibrinolytics when waiting to get them to a cath lab
67
mechanism of flumazenil
competitively inhibits the activity at the benzodiazepine recognition site on the GABA / benzodiazepine receptor complex
68
indications of flumazenil
severe benzo OD (ie. respiratory depression)
69
precautions of flumazenil
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
dose of flumazenil
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
mechanism of glucagon
normally released by the pancreas, causes the liver to breakdown glycogen to glucose.
72
indications of glucagon
hypoglycemia, BB or CCB OD
73
precautions of glucagon
N,V
hyperglycemia
not helpful in someone who doesn't have any glycogen storage
74
dosing of glucagon
3-10mg IV over 3-5 min,
| 3-5mg/hr infusion rate
75
lidocaine mechanism
decreases the depolarization, automaticity, and excitability in the ventricles during the diastolic phase.
76
indications of lidocaine
Alternative to Amiodarone in VF/VT, stable polymorphic VT with baseline QT prolonged if torsades suspected, stable monomorphic VT
77
precautions of lidocaine
not used as prophylactic in AMI, reduce infusion rates in liver/ventricle dysfunction, d/c if signs of toxicity develops
78
dosing of lidocaine
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
magnesium sulfate mechanism
Magnesium sulfate reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction.
80
indications of magnesium sulfate
Only with suspected torsades de pointes or hypomagnesemia, Digitalis toxicity
81
precautions of magnesium sulfate
Hypotension, careful with renal failure pts
82
dosing of magnesium sulfate
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
alternative to amiodarone
lidocaine
84
class of lidocaine
sodium channel blocker
85
polymorphic vtach AKA
torsades de pointes
86
monomorphic vtach
1 type of waveform
87
who is torsades seen in
electrolyte abnormalities
| ESRD who hasn't gotten dialysed
88
MONA
morphine
oxygen
nitrates
asprin
89
mechanism of morphine sulfate
primarily affects the opoid receptors, helping for pain
90
indications of morphine sulfate
CP with ACS
91
precautions of morphine sulfate
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
dosing of morphine sulfate
"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
mechanism of naloxone
opiate receptor blockade
94
indications of naloxone
Respiratory, neurological depression due to opiate OD/intoxication
95
precautions of naloxone
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
dosing of naloxone
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
what's the effect of naloxone
instant withdraw symptoms: vomiting, itching, agitated
98
brand name of naloxone
narcan
99
dose of narcan that police carry
2mg
100
mechanism of nitroglycerine
vasodilation of coronary arteries
101
indications of nitroglycerine
ACS assoc. chest pain, AMI/CHF in the first 24-48h, recurrent CP/pulmonary congestion, hypertensive urgency in ACS
awesome for CHF
102
precautions of nitroglycerine
```
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
dosing of nitroglycerine
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
side effect of nitroglycerine
bad headache
105
nitroprusside mechanism
Relaxes arterial and venous smooth muscle by inhibiting cCMP( cyclic guanosine monophosphate)
106
indications of nitroprusside
Hypertensive crisis, reduce afterload in HF ,acute pulmonary edema, and acute mitral or aortic valve regurgitation.
107
precautions of nitroprusside
Hypotension, cyanide poisoning, recently taken phosphodiesterase inhibitors
108
dosing of nitroprusside
0.1mcg/kg/min increase q 3-5min ave dose 5-10mcg/kg/min
109
brand of norepinephrine
levophed
110
last ditch efforts for shock
norepi
111
mechanism of norepi
stimulates alpha 1 and beta 1 receptors
112
indications of norepi
severe cardiogenic shock
113
precautions of of norepi
Increases myocardial o2 requirements, Increases BP/HR, arrhythmias, extravasations causes tissue necrosis, hypovolemia, poisonings/drug induced hypotension requires higher doses.
114
dosing of norepi
0.1-0.5mcg/kg/min
115
procainamide mechanism
Class 1a (sodium channel blocker), Depresses myocardial excitability and conduction in the: atrium , bundle of HIS, and ventricle
116
if in Vfib for 45 minutes what should we use?
procainamide
117
indications of procainamide
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
precautions of procainamide
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
dosing of procainamide
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
sodium bicarb mechanism
systemic alkalizer
121
indications of sodium bicarb
Hyperkalemia, bicarbonate responsive acidosis-DKA, OD- TCA, ASA, Cocaine, diphenhydramine
122
precautions of sodium bicarb
Not recommended for Cardiac Arrest, follow ABG or use in acidosis
123
dosing of sodium bicarb
1mgEq/kg IV bolus
124
DDAVP aka....
vasopressin AKA ADH
125
mechanism of vasopressin
: Induces vasoconstriction by activating V-1 receptors which cause and increase in cellular calcium. (alpha 1 properties)
126
indications of vasopressin
alternative to epi in shock or refractory VT, asystole, PEA, maybe useful in vasodilatory shock (sepsis)
127
can use this drug closely with other drugs
vasopressin
128
precautions of vasopressin
potent peripheral vasoconstrictor provoke cardiac ischemia/angina, not recommended in responsive pts with CAD
129
this is not used as often because it comes in a vial instead of a pre-filled syringe
vasopressin
130
dose of vasopressin
40U IV/IO replace 1st or 2nd epi. Continuous infusion 0.02-0.04U/min
