E4 Medications Flashcards
Ibutilide (covert)
acute treatment of a flutter, given IV for a new onset pt will convert to NSR either within infusions or 90 minutes of completion
Adenosine
drug of choice for SVT, short half life, given fast iv push to stop SVT, causes brief asystole
Class 1 antidysrhythmics
Sodium channel blockers, results in decreased conduction
Quinidine, procainamide, disopyramide phosphate (norpace)
Procainamide
Class 1A - effective for atiral and ventrical dysrhythmias, used in acute and long term treatment
Treatment of SE (systemic lupus) CBC weekly for SS of infection, watch for EKG changes (widening QRSs, prolonged QT)
Class 1B antidysrhythmics
Sodium channel blockers, accelerate repolarization and have little effect on EKG,
Phenytonin (dilantin)
treatment of atrial, AV and ventricular issues
Class 1B (sodium CB)
Mexiletine
treatment of ventricular problems
Class 1B (sodium CB)
Lidocaine
Class 1B, used as a neuromuscular blocking agent can cause respiratory depression
Class II antidysrhythmic drugs
Beta-adrenergic blockers
Decrease cardiac contractility, slows heart rate, conduction and myocardial contractility, used to mostly treat supraventricular dysrhythmias
Propanolol (nonselective), acebutolol, esmolol (cardio selective)
SE: bradycardia, hypotension, impotence
Class III antidysrhythmic drugs
Prolong (delay) repolarization and slow the rate of electrical conduction
Amiodarone (cordone) treats - a fib, pvcs, ventricular dysrhythmias and cardiac arrest, first line ACLS
Sotalol (betapace) beta blocker but considered a class III
Dronedarone (Multaq)
Class III antridysrhythmic - less toxic and less effective then amiodarone
Dofetilide (Tikosyn)
Class III antidysrhythmic, titrated while monitor ECG
Using with levoquin increases the risk of deadly dusrhythmias
Amiodarone Se/adverse reactions
- Can cause bradycardia (slow the infusion rate) AV block
- IV requires continuous monitoring, switch to PO before DC
- Abruptly ceasing can cause fatal dysrhythmias, PT must be compliant with meds
- LUNG damage: dyspnea, cough, chest pain STOP med, teach pt must report and replace with other med
- Hypo/hyperthyroidism may develop, monitor with periodic blood work
Class IV antidysrhythmic
Block calcium influx, slows automaticity, delays conduction, decreases contractility, slow ventricular rate
Continuous monitoring for IV dosing
Verapamil (Isoptin), Diltiazem (cardizem)
SE: nausea, vomiting, bradycardia, hypotension
Digoxin (Lanoxin)
treatment of supraventricular dysrhythmias, monitor for signs of toxicity (headache, N/V, altered mental status, HALO)
Aspirin, special considerations
Effective for suppressing platelet aggregation
Stop 7 days before procedures (including dental)
CP: chew one 325 mg or 4 81 mg tabs then follow up in ER
Thrombolytic Drugs and their dosing times
Alteplase tPA (Activase) IV bolus then 90 minute infusion
Reteplase rPA (Retavase) 2 doses 30 minutes apart
Tenecteplase TNK-tPA (TNKase) Single IV bolus
Monitoring for adverse effects of thrombolytics
Monitor for hemorrhage 24 hours after infusion, no invasive procedures, limited use of NSAIDS/antiplatelet/anticoags, minimize physical manipulation, AVOID injections
- EKG monitoring
- Pts may experience hypotension when first administered
Oxygen administration
Whenever O2 is <90% (unless COPD or Dr orders say otherwise)
Nitroglycerin
Dilates both veins and arteries, imporves blood flow to ischemia myocardium
Decreased preload/O2 demand, increases cardiac blood flow, decreases BP
0.4 mg SL q5 min x 3
DO NOT give nitro if
BP <90, HR <50 or >100, suspected right ventricle infarctions
Medications for treatment of ED (sildenafil (viagra)) can lead to severe hypotension
Betablockers
Treatment of STEMIs
reduce oxygen demand, increased coronary blood flow, reduce cardiac pain
Contraindications: asthma, COPD (unless cardioselective is used)
pronounced bradycardia <50
severe heart failure/heart block
persistent hypotension
ACE + ARBS
-pril ACE + -sartan ARB
Reduce preload and afterload, contraindicated in hypotension
ACE ‘cough’ use ARB
ACE - contra indicated in renal failure, renal artery stenosis, hypotension
Atrophine sulfate
Muscarinic antagonist - treatment of hemodynamically significant bradycardia and some heart block
- mydriasis and paralysis of ciliary muscles, used for eye procedures
GI uses: slows motility, relaxes biliary tract for gallstones, decreased secretion’s for PUD
Requires tight titration, has short half life
Anticholinergic effects - increased HR, decreased secretions, relaxation of bronchi
Adverse: dysrhythmias, MI, continuous monitoring when giving IV
Magnesium sulfate + severe adverse
Arrest associated with hypomagnesemia, treats ventircular dysrhythmias
Adverse: neuromuscular blockade - hypotension, bradycardia, respiratory depression, decreased tendon reflexes
Mag sulfate antidote
Calcium gluconate
Epinephrine
Treat profound bradycardia/hypotension
Causes peripheral vasoconstriction, improves perfusion to brain and heart (increased CO)
SE: myocardial ischemia, peripheral tissue ischemia
Sodium bicarbonate
Corrects metabolic acidosis associated with cardiac arrests, monitor ABGS
Mannitol
osmotic diuretic used to treat cerebral edema and increased ICP
Used FILTERED needle
Assess: IO, electrolytes, hydration status, neuro status, must DC if signs of CHF or pulmonary edema occur
When would naloxone be administered
When opioid overdose is suspected, can also be administered to pts with coma of unknown etiology (after 10 minutes with no reaction another cause should be suspected)
Flumazenil (romazicon)
reversal agent for benzodiazepine medications, may lead to withdrawal seizures
Activated charcoal
prevents the absorption of toxins by binding, given via NG, best within 30 minutes of ingestion
SE: vomiting (risk of aspiration) black stools
Dopamine
treats hypotension and bradycardia, goal to increase BP to perfuse organs
can over vasoconstrict and cause poor organ perfusion, low dosages and gradual weaning
- Continuous monitoring: EKG, VS, UO
- Acidosis may occur, give sodium bicarb in another IV line
- Extravasation - assess for edema, coolness and paleness
Treatment for IV infilration/extravasation
Phentolamine (Reignite) SQ
Doubutamine
Tx: heart failure especially when caused by shock, increase HR and force of contraction
Gradual weaning important + continuous monitoring
Risk of myocardial ischemia
Norepinephrine
vasoconstrictor used in shock when dopamine and dobutamine fail to increase the BP
- continuous monitoring, risk of poor perfusion to tissues/organs including heart, risk of extravasation
Tx of anaphylactic shock
- epinephrine - drug of choice
- diphenhydramine HCl: antihistamine administered with epi to treat shock
- steroids can also be used to reduce inflammation and the allergic response
Albuterol neb can also be used to reverse bronchoconstriction
Treatment of hypoglycemic shock
Dextrose 50% - high-carb solution given IV, phlebitis and extravasation are risks
Glucagon - pancreas-produced hormone that elevates the BS by stimulating glycogenolysis
Labetalol
Uses in hypertensive crisis, lowers HR, BP
Reduces vasoconstriction that results from sympathetic nervous system stimulation
SE: hypotension, dysrhythmias, bronchospasm, bradycardia
Requires continuous monitoring
Nitroprusside sodium
used in hypertensive crisis, immediate venous and arterial vasodilation
- Requires continuous BP monitoring
- Short duration (10 min)
- Protective foil kept in place to protect from light
Signs of toxicity: vomiting, hypotension, SOB, liver damager/t cyanide poisoning
Furosemide (in terms of ER meds)
Treatment of pulmonary edema, promotes renal excretion of water, sodium, chloride, mag, hydrogen and calcium, lowers the BP
Monitor: electrolytes (POTASSIUM) IO, respiratory status, lung sounds and VS
Morphine sulfate (er meds)
Treatment of multiple emergencies including pulmonary edema
Produces venous vasodilation, decreases pulmonary congestion, decreased cardiac preload and decreased BP
Antiestrogen drugs
tamoxifen, toremifene, fulvestrant
tumor cells must have estrogen receptors since the estrogen stimulates growth
Tamoxifen (Soltamox)
used for prevention and treatment of breast cancer, effective in both pre/post menopausal women
Adverse: menstrual irregularities, hot flashes, fluid retention, DVT, PE, CNA, endometrial cancer
Aromatase inhibitors
Tumor cells must have estrogen receptors, contraindicated in premenopausal women
No risk of endometrial CA, little risk of DVT, PE, CVA
anastrozole, letrozole, exemestane
Anastrozole (Arimidex)
Estrogen depletion shrinks the tumor
SE: menopause symptoms, HTN, msk pain, osteoporosis/fractures
Drug of choice for post menopausal women as it has fewer side effects
Androgen Deprivation Therapy
suppresses androgen production in testes, after 18-24 months disease progression resumes
Gonadotropin-Releasing hormone agonists and Gonadotropin-releasing hormone antagoinists
Leuprolide (Lupron depot)
Androgen receptor blocker used in treatment of prostate cancer
Route: SQ daily, IM weekly or monthly
SE: hot flashes, ED, gynecomastia, loss of libido, loss of muscle mass, DM, MI, CVA, osteoporosis
Cetuximab (Erbitux)
IV - epidermal growth factor tyrosin kinase inhibitor, inhibits the pathway for cell division results in limited cell proliferation
SE: interstitial lung disease, pts should report breathing difficulties
Gefitinib (Iressa)
Oral EGFRI
Teaching: st. johns wort decreases levels of drug in system
Tyrosine Kinase Inhibitor (TKI)
Stops proliferation of cancer medications, resistance can develop
Gold standard for chronic myeloid leukemia (CML)
Imatinib mesylate (Gleevec)
Tyrosine Kinase Inhibitor
SE: N/V, headache, fatigue
CBC to be done weekly r/t neutropenia + thrombocytopenia
Contents of tablet are toxic GLOVES must be worn if tablet is crushed or broken
Sirafenib (Nexavar)
Multi-Tyrosine Kinase inhibitor, inhibits the activity of specific cancer cells in the vasculature
Treatment of renal cell, hepatocellular and thyroid carcinomas
SE: diarrhea, fatigue, dysrhythmias, HIGH risk of bleeding
Vemurafenib (Zelboraf)
BRAF V600E Kinase inhibitor
Treatment of metastatic melanoma, suppresses tumor growth
SE: cutaneous squamous cell carcinoma, steven-johnson syndrome, fatal dysrhythmias
Rituximab (Rituxan)
CD-Directed antibodies treatment of b-cell non-hodgkins lymphoma and b-cell chronic leukemia
Stimulates the immune system to cause lysis of the cancer cells
SERIOUS SE: hypotension, bronchospasm, angioedema (crash cart when infusing)
Tumor lysis syndrome
Cyclophosphamide
anti-cancer drug that can have anti-cancer effects and neutropenia but not neurotoxicity. interferes with growth & spread of cancer cells (disrupts RNA and DNA synthesis)
given PO or IV, active form converted in liver
SE: N/V, diarrhea, loss of appetite, hair loss, increased infection risk, bone marrow suppression
indications: Hodgkin’s, Non-Hodgkins, multiple myeloma, solid tumors of the head, neck, ovary, and breast
can cause damage to the bladder
need to have regular blood tests while on the medication
SEVERE emetogenic potential IV drug
Vincristine
disrupts the formation of the mitotic spindle during cell division = prevents cancer cells from dividing and proliferating (disrupts mitosis). effective ONLY during the M phase “bone marrow sparing”
typically given IV, extravasation can occur and damage tissues near the vein
SE: peripheral neuropathy, constipation, hair loss, N/V
indications: Hodgkin’s, Non-Hodgkins, acute lymphocytic leukemia, Wilms’ tumor, rhabdomyosarcoma, Kaposi’s sarcoma, breast cancer, bladder cancer
need to have regular blood tests while on the medication, NOT to be used during pregnancy unless benefits outweigh the risks
MINIMAL emetogenic potential IV drug
Filgrastim (Neupogen)
stimulates bone marrow to produce more WBC (neutrophils) to help fight infection. used to prevent or treat neutropenia
given IV or SQ
SE: bone pain, muscle aches, headaches, fatigue, injection site reactions
increases risk of spleen enlargement or rupture
ondansetron (zofran)
blocks serotonin which is involved in nausea and vomiting. helps to prevent N/V with chemo drugs
SE: headache, constipation, diarrhea, dizziness, fatigue
careful w patients with hx of heart disorders, electrolyte imbalances, liver disease
dexamethasone
corticosteroid with anti-inflammatory and immunosuppressant properties. helps to reduce inflammation with certain cancers
can be given tablet, injection, eye drops
SE: weight gain, fluid retention, mood changes, insomnia, indigestion, nausea
Bevacizumab (Avastin)
Angiogenesis inhibitor: reduces the vascular growth that supports the tumor, does not kill tumor but prevents further growth
Treatment of colon, lung, brain, renal and cervical/ovarian CA
SE: Boxed for GI perforations, wound dehiscence, impaired wound healing, hemorrhage and fistula formation
Should not be used 28 days after a major surgery
Bortezomib (Velcade)
Proteasome inhibitor: suppresses cancer cell division promoting apoptosis, treats multiple myloma
SE: N/V, anorexia, hematologic issues, peripheral neuropathy
Teaching: St. Johns wort can decrease the levels of bortezomib
