Drugs to KNOW Flashcards
Adenosine) class:
Dynamics:
= Misc antiarrhythmic binds to adenosine A1 receptors causes efflux of K & inhibits Ca influx (in autoarhythmic cells)
= Causes hyperpolarization of autorhythmic cells (SA/AV node)
Slows AV conduction w/ very short half-life
Adenosine) indications:
contraindications
= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB)
= Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER
Adenosine) Effects:
Dose:
admin notes:
= periods of sinus Bcardia/asystole & ventricular ectopy after admin
= 1st dose 6mg rapid IV/IO push followed w/ rapid flush &2nd dose 12mg also rapid push & flush
= rapid push followed by rapid flush 20mL fluid best accomplished w/ 3-way stopcock & 1/2 initial dose in PTs receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access
Amiodarone) Class:
Dynamics:
Indi:
B/c its toxicity indi:
W/ expert consultation may be used for:
Terminal elimination:
= Class III antiarrhythmic
= Slows K+ efflux delaying repolarization on all of heart
= VF/Pulseless VT-no/response to shock CPR & Epi, Recurrent hemodynamically unstable VT w/ pulse
= PT w/ life-threatening arrhythmias w/ monitoring
= some atrial & ventricular rhythms w/ life-threatening hypoBP
= Extremely long (half-life lasts max 40 days)
Amiodarone) Contra:
Effects:
Caution b/c:
= Allergic, Bradycardias w/ AV blocks, Breastfeeding mothers
= Severe hypotension, Bradycardia, Prolong QT which can lead to TdP
= Toxicity, Causes severe BP drop, Prolong QT which can lead to TdP
Amiodarone) Max total dose per day:
Slow Infusion dose:
Maintenance Infusion dose:
VF/Pulseless & VT Cardiac Arrest Unresponsive 1st Dosage:
VF/Pulseless & VT Cardiac Arrest Unresponsive 2nd Dosage:
Life-Threatening Arrhythmia 1st Dosage:
Life-Threatening Arrhythmia 2nd Dosage:
= 2.2 grams
= 360 mg IV 6Hrs (1mg/min)
= 540 mg IV 18Hrs (0.5 mg/min)
= 300 mg IV/O push
= 150 mg IV/O push if needed
= 1st Dose: Rapid Infusion 150 mg/10 mins (15 mg/min)
= 2nd Dose: 150mg/10 mins (15 mg/min) if needed
Aspirin) Class:
Dynamics:
= NSAID & COX inhibiter
= Blocks cyclooxygenase (enzyme that’s basically alarm bell for body)
COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot
Aspirin) indications:
Contraindications:
= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema
(Aspirin) effects:
Avoid:
dose:
=Can cause bromchoconstriction in ~10% asthmatic PTs, N/V, upset GI
= enteric-coated Aspirin when admin/ing to PT w/ cardiac S/S
= 160-325mg PO of non-entric coated ASA
Atropine) class:
Dynamics:
= parasympatholytic
= selectively blocks muscarinic receptors inhibiting the parasympathetic NS “Vagus N. Blocker”- letting sympathetic take over
Atropine) indications:
Contraindications:
Avoid:
= 1st med/ for symptomatic sinus Bcardia, Maybe beneficial AV block, Organophosphate poisoning (large dose r/q) hypothermic Bcardia
= Allergic to drug, Use w/ extreme caution w/ myocardial ischemia
= causes increased myocardial O2 demand so caution w/ Hblock & Doses <0.5mg may result in paradoxical slowing of the heart
May not be effective for infranodal blocks- be prepared to pace
Atropine) Adverse effects:
Bradycardia (w/ or w/o ACS) Dosage:
severe clinical conditions dosage:
organophosphate poisoning dosage:
= Blurred vision, Dry mouth, Dilated pupils, Confusion
=1 mg IV push every 3-5mins as needed (0.04mg/Kg (total 3mg)
=1 mg IVP every 3 mins
= 2-4mg (or higher) IVP
Calcium Chloride) class:
Dynamics:
= mineral & electrolyte
= role as electrolyte in body to help propagate nerve impulses & M. Contraction
Calcium Chloride) indications:
Contraindications:
= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem
= cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD
Calcium Chloride) effects:
Dose:
Hypotension following admin/ Diltiazem:
= Bcardia w/ rapid injection, May produce severe coronary spasm & asystole, Burning sensation @ site of admin/, PERCIPITATE w/ Na-Bicarb
= 0.5-1gram slow IV over 3-5mins
= 250-500mg
Diltiazem/Cardizem)class:
pharmacodynamics:
= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels
Diltiazem/Cardizem)indi/s:
Contraindications:
= 1st med for AFib/Flutter w/ RVR (>150bpm), 2nd med for SVT refractory to Adenosine
= hypoBP, CHF/cardio/shock, Wide-complex Tcardia, WPW, Hypersensitivity
Diltiazem/Cardizem)effects:
1st dose:
2nd dose:
= HypoBP, Pos/ CHF if used w/ beta-blockers , N/V/D, Dizziness, H/A
= 0.25mg/kg w/ max dose of 20mg
= 0.35 mg/kg w/ max dose of 25mg
Dopamine) class:
pharmacodynamics
= sympathetic agonist
= A/B agonist rate dependent vasopressor +chron/in/Drom/otropic
Dopamine) indications:
Contraindications:
= CHF, HypoBP w/ shock signs, 2nd med for sympathetic Bcardia (after Atropine)
= hypovolemic PTs til’ vol/ replaced, pheochromocytoma, Dont mix w/ sodium bicarb
Dopamine) Effects:
Dosing:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:
= HyperBP, Palp/s, H/A, Dizzy, Can worsen C-ischemia, necrosis W/ Extravasation
= 2–20 mcg/kg/min Titrate to response
= 5-10mcg/kg/min
= 10-20 mcg/kg/min
Epinephrine 1:10) Class:
Dynamics:
= SNS agonist, Sympathomimetic
= Powerful Alpha and Beta agonist
Epinephrine 1:10) Effects:
(Adult) Cardiac Arrest dose:
(Adult) Bradycardia dose:
(PEDI) Bradycardia/Cardiac Arrest dose:
(PEDI) Hypoperfusion & Severe anaphylaxis dose:
= Palpitations, Anxiety, Jitters, H/A, Dizziness, HyperBP, Tcardia, Can worsen cardiac ischemia
= 1mg IVP/IOP every 3-5 mins
= 2-10 mcg/min IV/IO infusion
= 0.01 mg/kg or 0.1 mL/kg
= 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag
Epinephrine 1:10) Indications:
Contraindications:
= Cardiac arrest, Bcardia, Normovolemic hypoBP, Anaphylaxis, Asthma
= rewards over risks so really none
Fentanyl) class:
pharmacodynamics:
Potency:
= synthetic narcotic (schedule 2 opioid)
= opioid Analgesia & sedation through binding to opiate receptor
= Fentanyl > morphine (100mcg fentanyl = 10mg of Morphine) 1F = 10M
Fentanyl) indications:
Contraindications:
= Moderate to severe pain
=Hypersensitivity to med, Uncorrected SBP<90
Fentanyl) effects:
dose:
Admin notes:
= Resp/ arrest/depres/, AMS, Bcardia & Prolong of QT interval, +vagal tone b/c suppress/ sympathetic path/s, HypoBP, N/V
= 1mcg/kg IV/O(max 100mcg) may repeat PRN in 5-10mins (Max 1mL per nare) if admin/ed IN
= Chest wall rigidity so admin slowly, Depresses every- thing/where
Furosemide/Lasix) class:
pharmacodynamics:
= Loop diuretic
= Blocks absorption of Na, Cl, & water from kidney thus +urinination
Furosemide/Lasix) indications:
Contraindications:
= Acute pulmonary edema in PTs w/ SBP >90-100mmHg (w/o signs of shock) Hypertensive emergencies
= Hypovolemia Hypotension Hypokalemia or other suspected electrolyte abnormalities
Furosemide/Lasix) effects
Adult Dose:
intial dose doesnt work:
new-onset pulmonary edema w/ suspected hypovolemia:
= pos/ dehydration/acute electrolyte imbalance, Tinnitus/deaf
= 0.5-1 mg/kg over 1-2 mins. IVP
= double 1st dose to 2 mg/kg over 1-2 mins
= <0.5mg/kg slow IV
Glucagon) class:
pharmacodynamics:
= Hormone
= Binds to Glucagon receptors & stim/s adenyl cyclase & +cAMP thus an up-reg/ Ca channels in SA & AV nodal cells
Glucagon) cardiac indications:
Contraindications:
= Bradycardia suspected from Beta-Blocker or Ca-Channel Blocker OD
= Bradycardia from etiology (disease origin), Known hypersensitivity
Glucagon) effects
Dose:
= Anxiety, Chest palp/s, H/A, N/V, Hyperglycemia
= 3-10mg IV slowly over 3-5 mins Followed w/ infusion 3-5mg per hour
Lidocaine) Class:
Dynamics:
= Ib Antiarrhythmic
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity in ventricles
Lidocaine) Ind:
Contra:
Effects:
= Stable monomorphic VT w/ preserved LVF & Alternative to Amiodarone in cardiac arrest by VF/pVT
= Shouldn’t use if PT already received IV Ca channel blockers, Not given prophylactically in AMI setting
= Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
Lidocaine) Max dose:
Cardiac Arrest from VF/pVT dose:
Refractory VF dose:
Perfusing Arrhythmia dose:
Maintenance Infusion dose:
= 3 mg/kg
= 1-1.5 mg/kg IV/IO
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= 1-4mg/min (30-50 mcg/kg/min)
Mag-Sulfate) Class:
Dynamics:
= Misc. Airway med, Mineral, powerful noradrenergic bronchodilator
= Organic Salt act as a physiologic Ca-channel blocker Bronchodilator
Mag-Sulfate) Indi:
Contra:
Effects:
= cardiac arrest only if Torsades de Pointes (Tdp) suspected, Tdp w/ pulse
= AMI not recommended, High degree AV block, HypoBP, VFib/Tach
= Bcardia, HypoBP, Diaphoresis, Resp/ depres/, Hypothermia
Midazolam) class:
pharmacodynamics:
= benzodiazepine
= Binds w/ GABA receptors causing an influx of chloride
Midazolam) indications:
Contraindications:
= Active seizures, RSI induction, Chemical restraint, Anxiety, Sedation
= History of hypersensitivity to drug
Midazolam) effects
= Hypotension, Respiratory depression/apnea, N/V Amnesia
Midazolam) Adult dose (active seizures):
Pediatric dose (active seizures) IV/O:
Pediatric dose (active seizures) IM/IN:
Adult & Pedi dose for induction agent (RSI):
ET Tube bucking:
= 0.1mg/kg in 2mg increments IV/IO (max 5mg) → 5mg IM/IO
= 0.1mg/kg in 2mg increments IV/IO (max 5mg)
= 0.2mg/kg (max 5mg)
= 0.1-0.3mg/kg (max 10mg), Onset=2-5mins, Duration= 15-30mins
= 0.05mg/kg IV/IO 1-2mins (maintain SBP) stop when bucking stopped
Morphine) class
pharmacodynamics
= narcotic (schedule II Opioid)
= Analgesia & sedation through binding to opiate receptor
Morphine) indications:
Contraindications:
= Ischemic chest pain not relieved by Nitro
= Known hypersensitivity to drug Uncorrected hypoBP (SBP<90)
Morphine) effects
STEMI dose:
NSTEMI-ACS dose:
= Resp/ depres/arrest, HypoBP, N/V/D
= 2-4mg IV/O (slow) may admin/ addition/ 2-8mg IV 5-15min intervals
= 0.1mg/kg IV/IO (slow) or IM up to 10mg
Nitroglycerin) class:
pharmacodynamics:
= nitrate
= Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
Nitroglycerin) indications:
Contraindications
= Symptoms suggestive of Myocardial ischemia CHF
= HypoBP (SBP<90 or >30 below baseline BP) Severe Bcardia<50bpm, Tcardia>100bpm, Use of phosphodiesterase inhibitors (Boner pills) in last 48 hours, Increased ICP
Nitroglycerin) effects:
dose:
=H/A, Dizziness, Weakness, Tcardia, HypoBP (tablets lose effectiveness after exposed to sun/air)
= 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg
DONT SHAKE SPRAY B/C AFFECTS DOSE
NORepi) Class:
dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med”
= A/B-adrenergic agonist (A effects > B effects)
NORepi) Indi:
Contra:
Effects:
= Normovolemic hypotension, Septic shock, Cardiogenic shock
= hypovolemia PTs til’ Vol/replacement occurred
= Hypertension, Organ ischemia, Cardiac arrhythmia, Tissue necrosis w/ extravasation, Palpitations, Anxiety, N/V
NORepi) Adult Dose:
Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion
= 0.1–2 mcg/kg/min IV/IO infusion
Ondansetron) class:
pharmacodynamics:
= selective Seratonin 5-HT3 receptor blocker/antagonist
= Serotonin 5-HT3 receptors @the vagal-N. Can initiate the gag reflex when stim/ed; Zofran is antiemetic/antag/ of 5-HT3 receptors inhibiting serotonin release on central/peripheral vagal nerve
Ondansetron) indi/s:
Contra:
= Prevent/control N/B
= Known hypersensitivity to med
Ondansetron)effect:
dose:
= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT
= 4-8mg IV (slow), IM, PO
Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
Procainamide) indications:
Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW)
=Shouldn’t admin to PTs received IV Ca channel blocker
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
1. Termination of rhythm
2. HypoBP
3. Widening QRS>50%
4. Meet the max total dose (17mg/kg)
Procainamide) max dose:
Recurrent VF/VT:
Urgent situations:
Maintenance Infusion:
= (max total dose: 17mg/kg)
= 20mg/min (max total dose: 17mg/kg)
= up to 50mg/min may admin/ to total dose (max 17mg/kg)
= 1-4mg/min
Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
Verapamil) indications:
Contraindications:
= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function
= HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW
Hypersensitivity to med
Verapamil)1.May cause:
2. Effects:
3. Max total dose:
4. 1st dose:
5. 2nd dose:
1.= more profound hypotension response than that of Diltiazem
2.= Severe CHF may result if used w/ beta-blocker, N/V/D, Dizziness, H/A
3.= 20mg
4.=2.5-5mg IV/O bolus 2-3min
5.= 5-10mg over 2-3 mins
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Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol
= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
Amiodarone class & indication
Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
= 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose
Promethazine (Phenergan) Dynamics:
Indications:
Contra:
Dose:
=Antiemetic. H1-receptor blocker
=Nausea & Vomitinf, Peroperative sediation, motion sickness.
= Hypersensitivity, Respiratory diseases(Asthma), Pedi <2 y/o
= IV/IM: 12.5-25 mg, May cause tissue injury if IV extravasation.
Adenosine & Digoxin class
class misc
DIgoxin for
heart failure usually fools refractory Na K pumps
Diltiazem & Verapamil) class
Diltiazem
Verapamil
= class 4 Ca channel blocker
= 1st line med for A-Fib/Flutter w/ RVR >150 bpm, 2nd line med for SVT
refractory to adenosine
= 2nd line med for A-Fib/Flutter w/ RVR. May use as alterative after adenosine, narrow QRS complex tachycardia w/ preserved LV fn.
Adenosine) class:
Dynamics:
= Misc antiarrhythmic binds to adenosine A1 receptors causes efflux of K & inhibits Ca influx (in autoarhythmic cells)
= Causes hyperpolarization of autorhythmic cells (SA/AV node)
Slows AV conduction w/ very short half-life
Adenosine) indications:
contraindications
= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB)
= Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER
Adenosine) Effects:
Dose:
admin notes:
= periods of sinus Bcardia/asystole & ventricular ectopy after admin
= 1st dose 6mg rapid IV/IO push followed w/ rapid flush &2nd dose 12mg also rapid push & flush
= rapid push followed by rapid flush 20mL fluid best accomplished w/ 3-way stopcock & 1/2 initial dose in PTs receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access
Aspirin) Dynamics:
Indications:
Contra:
Dose:
= Blocks Cyclooxygenase (enzyme body alarm). COX acts upon Arachidonic Acid which inturn gen/s Thromboxane A2, a compound that reg/s activation of platelets to form a clot.
= Cardiac signs/symptoms with ischemic etiology /suspected MI
= Allergy to medication. Bronchospasm, Angioedema.
=160-325 mg PO of nonenteric coated ASA.
Ibuprofen) Dynamics:
Indications:
Contra:
Dose:
= Anti-inflammatory & antipyretic via inhibition of prostaglandins.
= Mild - moderate pain, Fever, Inflammation.
= Hypersensitivity, Bronchospasm, Angioedema.
= 200-800 mg PO q6-8 hours, Max daily dose: 3200 mg
Ketorolac (Toradol) Dynamics:
Indications:
Contra:
Dose:
= Anti-inflammatory & antipyretic through inhibition of prostaglandins
= Mild-moderate pain, Fever, Inflammation, Renal calculi
= Hypersensitivity, Bronchospasm, Angioedema
= 15mg IV, 30mgIM
Nubain) Dynamics:
Indications:
Contra:
Dose:
= Synthetic opiate agonist/antagonist
= Moderate to severe pain
= Hypersensitivity, respiratory depression.
= 10-20 mg IV/IO/SQ/IM
Diazepam) Dynamics:
Indications:
Contra:
Dose:
= Benzodiazepine Binds with GABA receptors causing an influx of Cl
= TachyC from stimulant OD, Sustained seizure, Anxiety, Sedation,
= Hypersensitivity
= 2.5-10 mg in 2.5 mg increments slow IV/IO/IM.
Flumazenil) Dynamics:
Indications:
Contra:
Dose:
= Benzodiazepine Antagonist
= Competitively blocks benzos @ GABA/benzo receptor complex
= Benzodiazepines overdose
= Hypersensitivity
= 0.2 mg IV/IO q30 seconds Max up to 3 mg total dose
Magnesium Sulfate) Dynamics:
Indications:
Contra:
Dose:
= Organic Salt act as a physiologic Ca channel blocker
= Bronchial Asthma, Torsades de Pointes (TdP) w/ or w/o a pulse, Eclampsia w/ active seizures
= Routine admin in PT’s w/AMI not recommended, High-degree HB, Shock, Dialysis, Hypocalcemia, V-fib/pulseless V-Tach,
= Respriatory: 1-2 grams IV/IO over 10-20 minutes
Tdp w/pulse: 1-2 grams mixed in 50-100 mL over 5-60 minutes
Cardiac arrest due to hypomagnesemia or TdP: 1-2 grams in 10 mL
Eclampsia: 1-4 grams
Metoprolol) Dynamics:
Indications:
Contra:
Dose:
= ß-Blocker
= Hypertension, 2nd line med for A-Fib or A-Flutter w/ RVR, & SVT
= HR<45, 2nd or 3rd degree heart block
= 5 mg IV/IO q 5 min (up to 3 doses)
Cardioversion/vert) Indication
Rhythms
intial & after Doses:
= UNSTABLE} SBP <90 & AMS
= Bradycardia, AF w/ SVR,
= 50-100J then 200J 300J 360J
Defib) indication
Contra:
Rhythms
Initial & after doses:
= “Dead fibers” TdP (only rhythm defib awake)
= Asystole VT w/ Pulse stable
= pVT, VF, TdP
= 100J 200J 300J 360J
Pacing) indication
Rhythms
Initial & after:
= “pick up the pace” <50BPM UNSTSBLE} SBP <90 & AMS
= BPM <50
= 80BPM mA till’ capture
2-20mcg cardiac vasopressor meds:
Dopamine, Epi 1:10 (adult brady),
Monophasic monitor Jules max
Biphasic monitor Jules max
360J
200J
0.1 - 0.5 mcg/kg/min vasopressor med:
Norepi,
Vasopressor meds:
= Epi 1:10, NorEpi, Dopamine
Antiarrhythmics for pVT, TdP, VF
pVT/ TdP= Lidocaine & Aminodarone
Tdp= Mag-Sulfate
1st line med for A-Fib&Flutter w/ RVR & 2nd line med for SVT
that is refractory to adenosine.
Diltiazem 0.25mg/kg (max 20mg) 0.35mg/kg (max 25mg)
