Exam 1 Pharmacology Flashcards
Adenosine, Amiodarone, Epinephrine, Atropine, Lidocaine, Magnesium, Levetiracetam, Simvastation
Adenosine MOA
GIves the heart a break for the SA node to take back control in a normal sinus rhythm
Adenosine med type
Antidysrhythmic
- Bring heart back to normal sinus rhythm
Adenosine can treat
PSVT (IV adenosine 1st)
Myocardial perfusion stress imaging study (vasodilator)
**chemical cardioversion
Adenosine injection half-life
short 10 seconds
What should you let the patient know before giving them adenosine (if able)?
chest pressure after giving the medication is common
Adenosine injection
antecubital close to heart not on bone prominences
Adenosine IV is given
rapid (1-2 secs)
followed by 20 mL flush rapidly
stop cock setup
Adenosine half-life IV
2-3 seconds
The nurse give the PSVT patient 6mg of adenosine. After giving it IV, the patient’s rhythm goes asystole, what should the nurse do?
continue to monitor as asystole immediately after injection is okay
What equipment should be in the room when receiving adenosine?
BP cuff
12 lead
cardiac monitor
defibrillator and AID-ready
What does the nurse need to assess for on an adenosine patient?
flushing
dizziness
chest pain
palpation
can faint
Adenosine doses
6mg (1st) - 12 mg (2nd)
HCP can continue or go to cardioversion
Adenosine is less effective in patients taking
caffeine
theophylline
T/F: Adenosine is safe for pregnant women.
True
For a rapid IVP of adenosine, place the patient in what position
reverse trendelenburg (mild)
Amiodarone MOA
blocks K, Na ions channels and antagonizing alpha and beta-adrenergic receptors(prolonging repolarization)
- slows nerve impulses of the heart and into normal rhythm
Amiodarone used for
VFib
VTach unresponsive to shock delivery
CPR
Vasopressor
VTach unstable hemodynamically
Amiodarone drug interactions
Beta-blockers
procainamide
iodine
pregnant women
grapefruit juice
Amiodarone do not give to
pregnant women or people with iodine allergies
Amiodarone ACLS doses
1 -
2 -
1st = 300 mg
2nd = 150 mg
CPR algorithm SHOCKABLE
Call help
start CPR (30:2)
attach defibrillator
SHOCKABLE (VTach or VFib)
- Shock
- CPR 2 minutes
- IV/IO access
- SHOCK
- CPR 2 min
- Epinephrine 3-5 minutes
- SHOCK - CPR 2 minutes
- Amiodarone or lidocaine
- Repeat
What is the ratio of CPR and breaths
30:2
CPR Quality
- depth
- rate
- allow for
2 inches
100-120 bpm
chest recoil
If you are the person giving CPR, count
out loud
CPR Algorithm NONSHOCKABLE
Call help
start CPR (30:2)
attach defibrillator
NONSHOCKABLE (Asystole/PEA)
- Epinephrine ASAP
- CPR 2 minutes
- Epinephrine 3-5 minutes
Repeat until causes reversed
Biphasic Shock
120-200 J
Monophasic Shock
360 J
Epinephrine dosages in CPR
1 mg every 3-5 minutes
Amiodarone dosages in CPR
1st = 300 mg Bolus
2nd = 150 mg
Lidocaine dosages in CPR
1st = 1-1.5 mg/kg
2nd = 0.5-0.75 mg/kg
When an advanced airway has been placed then the ratio is moved to
1 breath every 6 seconds (10 bpm) with continuous chest compression
Reversible Causes of Asystole/PEA
Hs and Ts
- Hypovolemia
- Hypoxia
- Hydrogen ions (acidosis)
- Hypo/Hyperkalemia
- Hypoglycemia
- Hypothermia
- Tension Pneumothorax
- Tamponade, cardiac
- Toxins
- Thrombosis, pulmonary
- Thrombosis, coronary
Maximum amiodarone dose over 24 hours
2.2 g
Rapid infusion of amiodarone may lead to
hypotension
Epinephrine is given for
Cardiac arrest: VFib, pulseless VTach, asystole, PEA
Symptomatic bradycardia
Severe hypotension
Severe allergic reaction
Epinephrine is given every ________ in a code
3-5 minutes
Epinephrine raises
BP and HR
- causing Myocardial ischemia, angina, increased O2 demand
T/F: Epinephrine improves survival post-resuscitation.
False, high doses do not guarantee neurological outcome
Epinephrine dosage
1 mg in 10 mL NS every 3-5 minutes in a Code
Epinephrine side effects
Tachycardia
HTN
HA
anxiety
palpations
sweat
N/V
weakness
tremors
Atropine Sulfate MOA
increases the heart rate and improves the atrioventricular conduction by blocking the parasympathetic influences on the heart.
Atropine is used for
symptomatic bradycardia
- not in AV Heart Blocks
PEA/asystole
Organophosphate poisoning
Atropine caution with
myocardial ischemia
hypoxia
increase O2 demand
not for hypothermia bradycardia
Atropine dosages for bradycardia
0.5 mg IV every 3-5 minutes
Atropine dosages for organophosphate poisoning
2-4mg (Disaster Mgmt)
Atropine should not exceed
0.04mg/kg (total 3mg)
Dopamine
2nd line drug to symptomatic bradycardia (after atropine)
- hypotension (SBP < 70-100) with s/s of shock
Dopamine caution with
cardiogenic shock with CHF
Dopamine should not be mixed with
sodium bicarbonate
Dopamine may cause
tachyarrhythmias
excessive vasoconstriction
What should be used before atropine with hypovolemia
volume replacement
What can be substituted for atropine in a code
Lidocaine
Lidocaine is used in
VFib
pVTach
stable polymorphic VTach
QT prolongation if torades suspected
Lidocaine can be given during a code only if
doctor says to give
Lidocaine is contraindicated if
reduce dose due to impaired liver function
Dosage for Lidocaine
1-1.5 mg/kg every 5-10 minutes max 3 doses
Magnesium Sulfate is given for
Torsades de Pointes
suspect hypomagnesium
Mag occassionally has what with rapid infusion
BP falling
Use Mag cautiously if
renal failure
What do you need before giving Mag even in a code?
Mag level
Endotracheal tube drugs if IV is not available or started
Lidocaine
Epinephrine
Atropine
Narcan
Levetiracetam is given for
controlling seizures
tx epilepsy
Levetiracetam can have an increased risk of side effects with
Carbamazepine
Ginkgo
Levetiracetam SIDE EFFECTS
aggression, delusions
anxiety, depression
personality change
chills
cough
cry
tachypnea with dizziness
dry mouth
N/V/D
INSOMNIA/sleepiness
Levetiracetam adverse effects
unusual thoughts and behaviors
- dizzy, drowsy,
Levetiracetam monitoring
renal dysfunction
Simvastatin
Tx cholestrol and high triglyceride levels
- help prevent clogged blood vessels
Simvastatin adverse effects
rhabdomyolysis (paralytic)
- muscle breakdown and kidney damage
- tea/red colored urine
- dysrhythmias
muscle pain
tenderness
weakness
cramps
Simvastatin patients should avoid drinking
grapefruit juice
Simvastatin is given
At night ( Flushing )
