General Cardiovascular Flashcards
List of meds that have some impact on cardiovascular system. Noninclusive to diretics, IV fluids, and electrolytes
Adenosine (Adenocard)
Type: Antidysrhythmic
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MOA:
Short-acting drug that slows conduction through the AV node; Restore sinus rhythm in patients with SVT and Terminates regular tachycardias caused by reentrant AV nodal pathways
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Indications: First-line drug for most forms of stable, regular, narrow-complex SVT | Can be considered for marrow-complex reentry tachycardia while preparing for cardioversion | Can be used diagnostically for stable, regular, monomorphic wide-complex tachycardia
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Contraindications: Known hypersensitivity | Second- or third-degree AV block or sick sinus syndrome or other sinus node disease | Poison- or drug-induced tachycardia | Use with caution in patients with a history of seizure disorder | May induce bronchospasm in a patient with bronchoconstrictive or bronchospastic lung disease (ex: asthma and COPD)
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Adverse Reactions: Generally transient and of short duration | Flushing, sweating, dizziness, nervousness, paresthesia, hypotension, feeling of impending doom, severe bronchospasm | A brief period of most any dysrhythmia (like asystole) can occur during pharmacologic conversion
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Drug Interactions: Additive effects are possible if used in combination with beta blockers | Methylxanthines (like caffine and theophylline-like drugs) block the actions of adenosine | Dipyridamole (Persantine) potentiates the effect | Carbamazepine (Tegretol) may potentiate the AV node blocking effect | Nicotine can enhance the cardiovascular effects | An increase in angina-like chest discomfort or heart rate | A decrease in BP may be observed
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Dosages:
Adult.
6-mg rapid IV/IO bolus over 1 to 3 second followed by a 10-mL saline flush; Additional 12-mg dose if needed after 1 to 2 minutes over the same time frame; Maximum total dosage is 30 mg
Paediatric.
Initial dose 0.1 mg/kg (max first dose of 6mg) rapid IV/IO push over 1 to 3 seconds followed by a 5- to 10-mL saline flush; Second dose 0.2 mg/kg (max second dose of 12mg) rapid IV/IO push followed by a 5- to 10-mL saline flush
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Duration: Onset: Seconds | Peak effect: Seconds | Duration: 10 seconds
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Special Conditions: Pregnancy safety: Category C | Monitor the ECG and record a rhythm, strip during administration | Ineffective in converting AF, atrial flutter, or VT | Should NOT be administered for hemodynamically unstable, irregularly irregular, or polymorphic wide-complex tachycardias
Amiodarone (Cordarone, Pacerone)
Type: Antidysrhythmic (Class III)
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MOA:
Blocks sodium, potassium, and calcium channels; Prolongs the action potential’s duration and Delays repolarization; Decreases AV conduction and sinoatrial (SA) node function
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Indications: Cardiac arrest resulting from VF or pulseless VT after CPR, defibrillation, and epinephrine | Stable, regular narrow-complex tachycardia if the rhythm persists despite vagal maneuvers or adenosine or the tachycardia is recurrent | To control the ventricular rate in AF with a rapid ventricular response without preexcitation | Stable wide-complex tachycardia | Stable monomorphic VT | Polymorphic VT with a normal QT interval
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Contraindications: Known hypersensitivity | Iodine hypersensitivity | Cardiogenic shock | Second- of third-degree AV block | Sick sinus syndrome or other sinuse node disease (unless a functioning artificial pacemaker is present)
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Adverse Reactions: Hypotension | Heart failure | Worsening of dysrhythmias | Prolonged QT interval | Bradycardia | AV block | Dizziness | Fatigue | Cough | Progressive dyspnea | N/V | Burning at the IV site | Stevens-Johnson syndrome
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Drug Interactions: May increase the effects of digoxin, disopyramide, fentanyl, lidocaine, procainamide, quinidine, or warfarin | Cimetidine may increase amiodarone levels | Use with beta blockers or calcium channel blockers may potentiate bradycardia, sinus arrest, and AV blocks | Persistent use of echinacea can potentiate amiodarone’s hepatotoxic effects
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Dosages:
Adult.
Initial dose 300 mg IV/IO push ; Second dose 150 mg IV/IO push ; Loading dose 150 mg IV/IO over 10 minutes ; Max cumulative dose of 2.2 g IV/IO per 24 hours
Paediatric.
Refractory VF/pulseless VT: 5 mg/kg IV/IO bolus ; can repeat if needed to max cumulative dose of 15mg/kg IV per 24 hours (2.2g in adolescents per 24 hours) ; Max single dose of 300mg.
Poor perfusing ventricular or atrial sysrhythmias: loading dose 5mg/kg IV/IO over 20 to 60 minutes (max single dose of 300mg) ; can repeat if needed to max cumulative dose of 15mg/kg IV per 24 hours (2.2g in adolescents per 24 hours)
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Duration: Onset: 2 hours | Peak effect: 3 to 7 hours | Duration: Variabled
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Special Conditions: Pregnancy safety: Category D ; may cause fetal death ; Lactating women should not breastfeed following use | May worsen or precipitate new dysrhythmias | Monitor for hypotension and increasing PR and QT intervals | Dosage may change per the most current International Liaison Committee on Resuscitation (ILCOR) recommendations
Aspirin (Acetylsalicylic Acid)
Type: Platelet inhibitor, NSAID, Anti-inflammatory agent
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MOA:
Prevents thromboxane A2 formation to prevent platelet aggregation and plug formations | Has antipyretic and analgesic properties
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Indications: New-onset chest discomfort suggestive of ACS
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Contraindications: Hypersensitivity to ASA or NSAIDs | Bleeding disorders | Hemolytic anemia | Lactating mothers
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Adverse Reactions: Anaphylaxis | Bronchospasm/wheezing in allergic patients | GI bleeding | Epigastric distress | N/V | Heartburn | Reye syndrome
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Drug Interactions: Increased risk of bleeding with anticoagulants and other NSAIDs | Diminished effects of ACE inhibitors and loop diuretics | Antacids reduce ASA absorption | Increased risk of hypoglycemia occurs with administration of oral hypoglycemic drugs | Effects are decreased by corticosteroids | Increased bleeding can occur when ASA is taken with certain herbs (ex: quai, feverfew, garlic, ginger, ginkgo, Korean ginseng, and saw plametto - because these herbs interfere w/ platelet aggregation)
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Dosages:
Adult.
162 mg to 325 mg orally (chewable)
Paediatric.
Not recommended
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Duration: Onset: 15 to 30 minutes | Peak effect: 1 to 2 hours | Duration: 4 to 6 hours
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Special Conditions: Pregnancy safety: Category D | If there are no contraindications, non–enteric-coated, chewable aspirin should be given as soon as possible to all patients with a suspected ACS after symptom onset
Digoxin (Lanoxin)
Type: Inotropic agent, Cardiac glycoside, Antidysrhythmic
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MOA:
(not listed per textbook)
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Indications: Heart failure | alternative frug for reentry SVT | ventricular rate control in atrial flutter and AF
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Contraindications: Known hypersensitivity | VF | VT | digitalis toxicity | Hypokalemia, hypomagnesemia, and hypercalcemia potentiate digitalis toxicity
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Adverse Reactions: N/V | anorexia (early sign of toxicity) | fatigue | headache |blurred yellow or green vision | seizures | confusion | dysrhythmias | skin rash
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Drug Interactions: Amiodarone, verapamil, and quinidine may increase serum digoxin concentrations | concurrent use of digoxin and verapamill may lead to severe AV block | Diuretics may potentiate cardiac toxicity | St. John’s wort can reduce the effects of digoxin effectiveness and licorice can potentiate its effects
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Dosages:
(not listed per textbook)
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Duration: (not listed per textbook)
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Special Conditions: Can prolong the PR interval and cause ST-segment changes on the EKG; careful cardiac monitoring is essential | Calcuim channel blockers or beta blockers are generally preferred for heart rate control in pts w/ AF; adenosine is preferred to tx reentry SVT | Cardioversion should be AVOIDED if pt is taking digoxin, but if the situation is life-threatening, use a lower energy dose (10 to 20 joules)
Diltiazem (Cardizem, Dilacor, Diltiaz)
Type: Calcium channel blocker, Antidysrhythmic (Class IV), Antianginal agent
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MOA:
Inhibits extracellular calcium ion influx across membranes of myocardial cells and vascular smooth muscle cells, resulting in inhibition of cardiac and vascular smooth muscle coontraction and therby dilating the main coronary and sestemic arteries | No effect on serum calcium concentrations | Substantial inhibitory effects on the cardiac conduction system, acting principally at the AV node, w/ some effects at the SA node | Less-negative inotropic effects than verapamil
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Indications: Stable narrow-QRS tachycardia; if Rhythm persists despite vagal maneuvers or administration of adenosine, or if the tachycardia is recurrent | To control the ventricular rate in patients with AF or atrial flutter without preexcitation
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Contraindications: Known hypersensitivity | Hypotension | Cardiogenic shock | Wide-complex tachycardia (may lead to hemodynamic deterioration and VF) | Second- or third-degree AV block | Sick sinus syndrome or other sinus node disease | Poison- or drug-induced tachycardia | AF or atrial flutter associated with an accessory bypass tract (ex: Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome) | Avoid use in patients with left ventricular systolic dysfunction or decompensated heart failure | Use with extreme caution in patients taking oral beta blockers
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Adverse Reactions: Dizziness | Weakness | Headache | Dyspnea | Dysrhythmias including cardiac arrest | Heart failure | Peripheral edema | Hypotension | Syncope | Chest pain | N/V | Dry mouth
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Drug Interactions: Use with caution in patients taking medications that affect cardiac contractility | Simultaneous use with IV beta blockers can result in decreased cardiac contractility, bradycardia (including AV blocks), and hypotension | Increased risk of sudden cardiac death when given concurrently with erythromycin
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Dosages:
Adult.
Initial dose: 15 to 20 mg (0.25 mg/kg) IV/IO slowly over 2 minutes ; After 15 minutes: a second bolus of 20 to 25 mg (0.35 mg/kg) IV/IO can be given slowly over 2 minutes
Patients older than age 65: require a maximum initial dose of 10 mg IV/IO and second dose of 20 mg IV/IO ; Maintenance infusion: 5 to 15 mg/h titrated to a physiologically appropriate heart rate
Paediatric. Not recommended
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Duration: Onset: 2 to 5 minutes | Peak effect: Usually within 7 minutes | Duration: 1 to 3 hours
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Special Conditions: Pregnancy safety: Category C | Dysrhythmias may be observed during pharmacologic conversion | Carefully monitor BP and EKG before, during, and after administration
DOBUTamine Hydrochloride (Dobutrex)
Type: Adrenergic, Inotropic agent
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MOA:
Synthetic catecholamine that primarily simulates beta-1 receptors with minor stimulation of beta-2 and alpha-1 receptors | Increases myocardial contractility and stroke volume, resulting in increased cardiac output w/ modest chronotropic effects | Increases renal blood flow secondary to increased cardiac output
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Indications: Heart failure with a SBP of 70 to 100 mm Hg and no signs of shock
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Contraindications: Known hypersensitivity | Suspected or known poison/drug-induced shock | SBP less than 100 mm Hg and signs of shock | Idiopathic hypertrophic subaortic stenosis
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Adverse Reactions: Headache | Dyspnea | Tachycardia | Hypertension | Chest pain | Dysrhythmias | N/V
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Drug Interactions: Incompatible with sodium bicarbonate and furosemide | Beta blockers may blunt the inotropic effects
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Dosages:
Adult.
IV infusion at 2 to 20 mcg/kg/min titrated to desired effect
Paediatric.
IV infusion at 2 to 20 mcg/kg/min titrated to desired effect
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Duration: Onset: 2 minutes | Peak effect: 10 minutes | Duration: 1 to 2 minutes after infusion discontinued
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Special Conditions: Pregnancy safety: Category B | BP and hemodynamic monitoring recommended | Titrate dose to maintain a heart rate increase of no greater than 10% of baseline | May increase infarct size in patients with MI | May precipitate or exacerbate ventricular ectopy | Older patients may have a significantly decreased response | Patients may become hypotensive from the vasodilatory effect
DOPamine Hydrochloride (Intropin)
Type: Endogenous catecholamine, Adrenergic, Vasopressor, Inotropic agent
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MOA:
Immediate metabolic precursor to norepinephrine (and dose-depandent effects w/ alpha adrenergic, beta adrenergic, and dompaminergic)| Doses of 1 to 2 mcg/kg/min simulate dopamine receptors; causes vasodilation in the renal, mesenteric, coronary, and intracerebral vascular beds | Doses of 2 to 10 mcg/kg/min simulate beta-1 receptors; increases myocardial contractility and enhancing cardiac impulse conduction | Doses of 10 to 20 mcg/kg/min simulate alpha receptors; resulting in vasoconstriction, increased systemic vascular resistence, and increase in BP | Doses greater than 20 mcg/kg/min, alpha stimulations predominate; resultant vasoconstriction can compromise circulation in the limbs
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Indications: Refractory cardiogenic or distributive shock | Hypotension with low cardiac output states | Second-line drug from symptomatic bradycardia
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Contraindications: Known hypersensitivity | Hypovolemia | Pheochromocytoma | Uncorrected tachydysrhythmias | VF
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Adverse Reactions: Headache | Anxiety | Dyspnea | Dysrhythmias | Hypotension | Hypertension | Palpitations | Chest pain | N/V
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Drug Interactions: Inactivated in alkaline solutions (sodium bicarbonate) | MAOIs prolong and potentiate effects | TCAs may potentiate cardiovascular effects | Beta blockers antagonize cardiac effects | When administered with phenytoin, may cause hypotension, bradycardia, and seizures | Simultaneous use of vasopressor may result in severe hypertension
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Dosages:
Adult.
IV/IO infusion at 5 to 20 mcg/kg/min, slowly titrated to patient response
Paediatric.
Safety and effectiveness in children have not been established
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Duration: Onset: Within 5 minutes | Peak effect: 5 to 10 minutes | Duration: Less than 10 minutes
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Special Conditions: Pregnancy safety: Category C | Correct hypovolemia before administering | Should be administered by infusion pump | Extravasation may cause necrosis and sloughing of surrounding tissue | Slow or stop the infusion if tachydysrhythmias or increased ventricular ectopy is observed | Sudden cessation of infusion can result in significant hypotension | Research suggests that pt in cardiogenic or septic shock who are tx’ed w/ norepinephrine have a lower mortality rate than those tx’ed w/ DOPamine
EPINEPHrine
Type: Sympathomimetic, Sympathetic (alpha/beta adrenergic) agonist
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MOA:
Catecholamine with strong alpha adrenergic, strong beta-1, and moderate beta-2 effects | Effects of alpha stimulation result in systemic vasoconstriction, increasing perpheral vascular resistance | Effects of the beta-1 stimulation result in increases in heart rate, myocardial ocntractility, cardiac output, and myocardial oxygen demand | Effects of beta-2 stimulation result in bronchial smooth muscle relaxation | Secondary relaxation effect on the smooth muscle of the stomach, intestine, uterus, and urinary bladder
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Indications: Cardiac arrest | Bradycardia | Shock | Anaphylaxis | Sever refractory wheezing (IM) | Coup/bronchiolitis (nebulized)
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Contraindications: Known hypersensitivity, coronary insufficiency, cardiac dilation | Uncontrolled hypertension | Hypothermia | Pulmonary edema | Myocardial ischemia | Hypovolemic shock
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Adverse Reactions: Nervousness | Restlessness | Headache | Tremor | Dysrhythmias | Chest pain | Increased myocardial oxygen demand | Hypertension | Palpitations | Nausea/vomiting
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Drug Interactions: Potentiates other sympathomimetics | Deactivated by alkaline solutions | MAOIs and antidepressants may potentiate effects | Beta blockers may blunt effects
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Dosages:
Adult.
Anaphylaxis: 0.3 mg IM in the anterolateral thigh ; Additional epinephrine can be administered every 5 to 15 minutes
If wheezing is present: give nebulized albuterol and/or 5 mL of 1 mg/mL epinephrine nebulized
If stridor is present: consider 5 mL of 1 mg/mL epinephrine nebulized
Severe bronchoconstriction with impending respiratory failure: 0.01 mg/kg of 1 mg/mL IM (0.3 maximum)
(An epinephrine IV infusion can be given when cardiovascular collapse is present)
Profound bradycardia with signs of hemodynamic instability: IV/IO infusion of 0.02 to 0.2 mcg/kg/min titrated to a mean arterial pressure greater than 65 mm Hg or IV/IO push dose 10 to 20 mcg boluses every 2 minutes titrated to a mean arterial pressure greater than 65 mm Hg
Shock unresponsive to IV fluids, or cardiogenic shock with signs of fluid overload: IV/IO infusion 0.05 to 0.3 mcg/kg/min
Cardiac arrest: Give 1 mg (0.1 mg/mL) IV/IO every 3 to 5 minutes during resuscitation. Follow each dose with a 20-mL flush and elevate arm for 10 to 20 seconds after dose ; ET: 2 to 2.5 mg diluted in 10 mL NS
Paediatric.
Anaphylaxis: (If weight is less than 25 kg) give 0.15 mg IM in the anterolateral thigh, (if weight is 25 kg or more) give 0.3 mg IM in the anterolateral thigh ; Additional epinephrine can be administered every 5 to 15 minutes
If wheezing is present: give nebulized albuterol and/or 5 mL of 1 mg/mL epinephrine nebulized
If stridor is present: consider 5 mL of 1 mg/mL epinephrine nebulized
(An epinephrine IV infusion can be given when cardiovascular collapse is present)
Profound bradycardia with signs of hemodynamic instability: IV/IO infusion of 0.01 mg/kg every 3 to 5 minutes (10 mcg maximum)
Cardiac arrest: Give 0.01 mg/kg (0.1 mg/mL) IV/IO every 3 to 5 minutes during arrest (1 mg maximum) ; ET: 0.1 mg/kg (1mg/mL) IV/IO every 3 to 5 minutes during arrest (1 mg maximum dose)
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Duration: Onset: Less than 2 minutes IV ; 3 to 10 minutes IM | Peak effect: Less than 5 minutes IV ; 20 minutes IM | Duration: 5 to 10 minutes IV ; 20 to 30 minutes IM
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Special Conditions: Pregnancy safety: Category C ; contraindicated for pts in active labour | Carefully document the dosage, concentration, route, time of administration, and patient’s response to each dose | Administer epinephrine as soon as possible in cardiac arrest associated with PEA or asystole | Reduce the dose of epinephrine in patients taking MAOIs, per the local protocols
Glucagon (GlucaGen)
Type: Hyperglycemic agent, Pancreatic hormone, Insulin antagonist
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MOA:
Increases blood glucose level by stimulating the breakdown of stored glycogen to glucose (glycogenolysis) and inhibiting thesynthesis of glycogen from glucose (glycogenesis) | Unknown mechanism of stabilizing cardiac rhythm in beta blocker overdose | Minimal positive inotropic and chronotropic responses | Decreases GI motility and secretions
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Indications: Altered mental status when hypoglycemia is suspected | Antidote for symptomatic bradycardia caused by beta blocker or calcium channel blocker overdoses
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Contraindications: Known hypersensitivity, pheochromocytoma, hyperglycemia, insulinoma
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Adverse Reactions: Dizziness/headache | Hypotension | Tachycardia | N/V | Rebound hypoglycemia
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Drug Interactions: Incompatible in solution with most other substances | No significant drug interactions with other emergency medications
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Dosages:
Adult.
Hypoglycemia: 1 mg IM/IN; repeat dose until symptoms have resolved
Calcium channel blocker or beta blocker overdose: 5 mg slowly via IV push - repeat in 5 to 10 minutes for total dose of 10mg
Paediatric.
Hypoglycemia: 1 mg IM/IN (≥ 20 kg or 5 years) otherwise 0.5 mg
Calcium channel blocker or beta blocker overdose: 1 mg (25 to 40 kg) or 0.5 mg (less than 25 kg) slowly via IV push every 5 minutes
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Duration: Onset: 1 minute | Peak effect: 5 to 20 minutes | Duration: 60 to 90 minutes
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Special Conditions: Pregnancy safety: Category B ; use in pregnancy only if clearly indicated | Ineffective if glycogen stores are depleted | Document reassessment of vital signs and mental status after administration
HydrALAZINE (Apresoline)
Type: Antihypertensive, Vasodilator
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MOA:
Relaxes arteriolar, but not venous, smooth muscle | Thought to interefere w/ calcium movement in vascular smooth muscle, which is responsible for vasoconstriction, resulting in lower BP
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Indications: Pregnancy-induced hypertension (SBP >= 160 mmHg or DBP >= 100 mmHg) lasting more than 15 minutes with associated preeclampsia symptoms
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Contraindications: Known hypersensitivity, CAB, mitral valve rheumatic heart disease | Use with caution in patients with stroke, known renal disease, or hypotension
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Adverse Reactions: Headache, nausea, flushing, hypotension, palpitations, tachycardia, dizziness, and angina | Paresthesia, numbness, and tingling
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Drug Interactions: MAOIs | Synergistic effects if given simultaneously with other antihypertensives | NSAIDs may diminish the antihypertensive effects
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Dosages:
Adult.
5 mg IV; may repeat 10 mg after 20 minutes if indcation persists (goal to decrease MAP by 20%-25%)
Paediatric.
Not usually indicated in the prehospital setting
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Duration: Onset: 5 to 20 minutes | Peak effect: 10 to 80 minutes | Duration: 2 to 12 hours
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Special Conditions: Pregnancy safety: Category C ; NOT recommended for long-term use during pregnancy | Usually lowers DBP more than SBP
Lidocaine HCl (Xylocaine)
Type: Antidysrhythmic (Class Ib), Anesthetic
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MOA:
Cardiac: Inhibits recovery after repolarization, thereby inhibiting recovery after repolarization, and decreasing myocardial excitability and conduction velocity | Local anesthetic: Inhibits ion transport across the neuronal membrane, blocking conduciton of normal nerve impulses | RSI: May decreases ICP response during laryngoscopy
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Indications: Alternative to amiodarone in patients with cardiac arrest from: VT, VF ; Stable monomorphic VT ; or Stable polymorphic VT with normal baseline QT interval when ischemia is treated with electrolyte balance is corrected | Can be used for stable polymorphic VT with baseline QT interval prolongation if TdP is suspected | Can be used as a local anesthetic for various procedures
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Contraindications: Hypersensitivity to lidocaine or amide-type local anesthetics, second- or third-degree AV block in the absence of artifical pacemaker, Stokes-Adams syndrome, wide-complex ventricular escape beats w/ bradycardia, Wolff-Parkinson-White Syndrome | Prophylactic use in AMI is contraindicated
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Adverse Reactions: Drowsiness | Confusion | Seizures | Slurred speech | Hypotension | Dysrhythmias | Cardiac arrest | Nausea/vomiting
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Drug Interactions: Apnea induced with succinylcholine may be prolonged by high doses of lidocaine | Cardiac depression may occur in conjunction with administration of IV phenytoin | Procainamide may exacerbate the CNS effects | Metabolic clearance is decreased in patients with liver disease and patients taking beta blockers
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Dosages:
Adult.
Cardiac arrest (pulseless VT/VF): Initial does: 1 to 1.5 mg/kg IV/IO. Repeat dose: 0.5 to 0.75 mg/kg IV/IO repeated in 5 to 10 minutes. Maximum total dose: 3 mg/k.
Maintenance infusion: 1 to 4 mg/min
Stable VT and stable regular wide-complex tachycardia: Initial does: 1 to 1.5 mg/kg IV/IO. Repeat dose: 0.5 to 0.75 mg/kg IV/IO repeated in 5 to 10 minutes. Maximum total dose: 3 mg/kg.
Maintenance infusion: 1 to 4 mg/min
Local anesthetic dose varies depending on the procedure and anatomic location. If IO on a conscious pt, consider 0.5 mg/kg of lidocaine 0.1 mg/mL slow push through the IO to max of 40mg to mitigate pain of IO med administration
Paediatric.
IV/IO dose: 1 mg/kg IV/IO push
Maintenance IV/IO infusion: 20 to 50 mcg/kg/mins. Repeat bolus dose if infusion started more than 15 minutes after initial bolus dose
ET dose: 2 to 3 mg/kg
RSI: 1 to 2 mg/kg IV/IO
Local anesthetic dose varies depending on the procedure and anatomic location
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Duration: Onset: 1 to 5 minutes | Peak effect: 5 to 10 minutes | Duration: 10 to 20 minutes
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Special Conditions: Pregnancy safety: Category B | Reduce the maintenance infusion in the presence of impaired liver function or left ventricular dysfunction | Discontinue the infusion immediately if signs of toxicity develop
Magnesium sulfate
Type: Electrolyte, Class V antidysrhythmic
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MOA:
Depresses the CNS, blocks peripheral neuromuscular transmission, and produces anticonvulsant effects | Decreases the amount of acetylcholine released at the endplate by motor nerve impulses, slows the rate of SA node impulse formation in the myocardium, and prolongs conduction time | Promotes calcium, potassium, and sodium movement in and out of cells and stabilizes excitable membranes | Induces uterine relaxation | Can cause bronchodilation after beta agonists and anticholinergics have been administered
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Indications: Management of TdP | Severe bronchoconstriction with impending respiratory failure | Seizure during the third trimester of pregnancy or in the postpartum patient
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Contraindications: Known hypersensitivity, heart block, myocardial damage, diabetic coma, hypermagnesemia, hypercalcemia | Use with caution in patients with known renal insufficiency
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Adverse Reactions: Drowsiness | CNS depression | Respiratory depression/tract paralysis | Vasodilation | Possible hypotension and bradycardia with rapid administration | Decreased deep tendon reflexes
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Drug Interactions: May enhance the effects of other CNS depressants | Serious changes in overall cardiac function may occur with cardiac glycosides
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Dosages:
Adult.
Severe hypertension lasting more than 15 minutes with associated preeclampsia symptoms: Give 4 g of a 20% solution IV/IO over 20 minutes, followed by 1 g/h IV/IO, if available
Seizure activity associated with pregnancy greater than 20 weeks’ gestation: Give 4 g of a 50% solution IV/IO over 10 to 20 minutes, followed by 1 g/h IV/IO, if available
Cardiac arrest due to hypomagnesemia or TdP: Give 1 to 2 g IV/IO
TdP with pulse or AMI with hypomagnesemia: Loading dose of 1 to 2 g in 50 to 100 mL of D5W or NS over 5 to 60 minutes IV. Follow with 0.5 to 1 g/h IV
Status asthmaticus: 1 to 2 g IV over 15 to 30 minutes
Severe bronchoconstriction/impending respiratory failure: 40 mg/kg IV over 10 to 15 minutes (2 g maximum)
Paediatric.
Pulseless VT with TdP: 25 to 50 mg/kg IV/IO bolus of a 50% solution (2 g maximum)
TdP with pulses or hypomagnesemia: 25 to 50 mg/kg IV/IO of a 50% solution over 10 to 20 minutes (2 g maximum)
Status asthmaticus: 25 to 50 mg/kg IV/IO of a 50% solution over 15 to 30 minutes (2 g maximum)
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Duration: Onset: Immediate | Peak effect: Variable | Duration: 30 minutes
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Special Conditions: Pregnancy safety: Category D ; Due to confirmed evidence of human fetal risk, must be used cautiously, although administration may be justified | To treat magnesium toxicity: Stop the infusion, Give calcium gluconate 1 g IV in cases of impending respiratory arrest, Support the patient’s ventilatory effort | Do NOT abbreviate magnesium sulfate to avoid confusion with morphine sulfate
Milrinone (Primacor)
Type: Inotrope
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MOA:
Increases myocardial contractility; Has a direct dilating effect on vascular smooth muscle; Does not possess beta adrenergic properties
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Indications: Heart failure in postoperative cardiovascular surgical patients | Shock with high systemic vascular resistance
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Contraindications: Known hypersensitivity | Reduce the dose in patients with renal dysfunction
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Adverse Reactions: Headache | N/V | Hypotension | Hypokalemia | Bronchospasm | SVT | Ventricular dysrhythmias |
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Drug Interactions: Synergistic with catecholamines
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Dosages:
Consult medical direction or follow the dosing ordered by the sending physician
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Duration: Onset: 5 to 15 minutes | Peak effect: Unknown | Duration: 3 to 6 hours
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Special Conditions: Pregnancy safety: Category C | Hemodynamic monitoring is required | Closely monitor BP and heart rate
NIFEdipine (Procardia, Adalat, Nifedical)
Type: Calcium channel blocker
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MOA:
Inhibits movement of calcium ions across cell membranes; Inhibits cardiac and vascular smooth muscle contraction, thereby dilating the main coronary and systemic arteries, reducing preload and afterload, and reducing myocardial oxygen demand; Does NOT prolong AV nodal conduction
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Indications: HAPE prevention and treatment | Pregnancy-induced hypertension (SBP >= 160 mmHg or DBP >= 110 mmHg) lasting more than 15 minutes with associated preeclampsia symptoms
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Contraindications: Known hypersensitivity to calcium channel blockers | Cardiogenic shock | Immediate-release preparation (sublingually or orally) for urgent or emergent hypertension
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Adverse Reactions: Headache/dizziness | Nervousness | Weakness | Mood changes | Dyspnea | Cough/wheezing | Heart failure | MI | Ventricular dysrhythmias | Hypotension | Syncope | Nausea, abdominal discomfort, diarrhea
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Drug Interactions: Beta blockers may potentiate NIFEdipine’s effects | Effects of theophylline may be increased | Antihypertensives may potentiate the hypotensive effects
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Dosages:
Adult.
HAPE prevention and treatment: 30 mg of the extended-release preparation orally every 12 hours or 20 mg of the extended-release preparation orally every 8 hours
Pregnancy-induced hypertension: 10 mg orally and may repeat 10 to 20 mg orally every 20 minutes, twice, for persistent, severe hypertension with preeclampsia symptoms. Goal is to reduce MAP by 20% to 25%.
Paediatric.
Data are unavailable
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Duration: Onset: 15 to 30 minutes | Peak effect: 1 to 3 hours | Duration: 6 to 8 hours
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Special Conditions: Pregnancy safety: Category C | Can be used for HAPE treatment when descent is impossible or delayed and reliable access to supplemental oxygen or portable hyperbaric therapy is unavailable | Hypotension is less common when the extended-release preparation is used but may develop when the medication is given to patients with intravascular volume depletion | Reassess vital signs every 10 minutes during transport
Nitroglycerin (NGT)
Type: Vasodilator, Nitrate, Antianginal
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MOA:
Smooth muscle relaxant, which acts on the vasculature, bronchial, uterine, and intestinal smooth muscle | Dilated peripheral arterioles and veins | Reduces peripheral vascular resistance, preload, and afterload, decreasing the heart’s workload and myocardial oxygen demand
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Indications: Ischemic-type chest pain | Acute and symptomatic hypertension | Heart failure | Pulmonary edema
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Contraindications: Known hypersensitivity | Hypotension | Hypovolemia | Intracranial bleeding or head injury | Pericardial tamponade | Severe bradycardia or tachycardia | RV infarction | Previous administration of sildenafil or vardenafil within 24 hours or tadalafil within 48 hours | Use with caution in patients with: Hepatic disease, Anemia, Diabetes mellitus, Pregnancy, Breastfeeding
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Adverse Reactions: Headache | Dizziness | Weakness | Reflex tachycardia | Syncope | Hypotension | N/V | Dry mouth | Muscle twitching | Diaphoresis
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Drug Interactions: Increased hypotensive effect with alcohol, beta blockers, calcium channel blockers, antihypertensives, benzodiazepines, phenothiazines, and other vasodilators | Incompatible with other drugs given IV | Hawthorn increases NTG levels
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Dosages:
Adult.
SL: 0.3 to 0.4 mg; may repeat in 3 to 5 minutes to a maximum of 3 doses
Spray: 1 or 2 sprays; may repeat in 3 to 5 minutes to a maximum of 3 doses
NTG IV: 12.5 to 25 mcg bolus (if no SL or spray is given), then begin 10 mcg/min infusion, increase by 10 mcg/min every 3 to 5 minutes until symptom response or desired effect (maximum dose: 200 mcg/min)
Paediatric.
Not recommended
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Duration: Onset: 1 to 3 minutes | Peak effect: 5 to 10 minutes | Duration: 20 to 30 minutes SL ; 1 to 10 minutes after discontinuation of IV infusion
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Special Conditions: Pregnancy safety: Category C ; has been used safely during pregnancy ; use caution w/ breastfeeding women and monitor infants for adverse effects | Hypotension is more common in older patients | If a 12-lead ECG shows an inferior wall infarct, rule out RV infarction via right-side 12-lead ECG before administering NTG | It must be kept in an airtight container | IV NTG must be administered only with an infusion pump direct from the bottle with a vented IV set and non-polyvinyl chloride tubing | The active ingredient may have stinging effect when administered
