MED QUIZ 3 Flashcards
Adenosine, Atropine, Epinephrine, Lidocaine, Amiodarone, Calcium Chloride
ADENOSINE - AKA
ADENOCARD
ADENOSINE - CLASS
ANTIARRHYTHMIC
ADENOSINE - MOA
SLOWS SA AND AV NODE CONDUCTION, INTURRUPTING SUPREVENTRICULAR TACHYCARDIA
ADENOSINE - INDICATIONS
- SVT
- STABLE MONOMORPHIC WIDE-COMPLEX TACHYCARDIA SUSPECTED TO BE WIDE COMPLEX SVT
ADENOSINE - CONTRAINDICATIONS
- Drug-induced tachycardia
- Atrial fibrillation with wolf-Parkinson-white syndrome
- Suspected ventricular tachycardia
- Second or third degree atrioventricular block (if not pacemaker present)
- Sick sinus syndrome (if not pacemaker present)
- Bronchoconstrictive or bronchospastic lung disease (asthma, COPD)
ADENOSINE - ADVERSE REACTIONS/SE
GENERALLY VERY SHORT LIVED
CNS: headache, dizziness
RESPIRATORY: dyspnea, bronchospasm
CV: arrhythmias, sinus pause/asystole, palpations, hypotension, chest pain, cardiac arrest
GI/GU: Nausea, metallic taste
MUSCULOSKELETAL: pain in head or neck
OTHER: paresthesia, flushing, diaphoresis, “sense impending doom”
ADENOSINE - DOSE ADMINISTRATION ADULT NAT
INTIAL DOSE: 6mg rapid IV push
SECOND DOSE (no response): 12 mg rapid IV push
ADENOSINE - DOSE ADMINISTRATION PEDI NAT
INITIAL DOSE: 0.1 mg/kg rapid IV push (MAX first dose 6 mg)
SECOND DOSE (no response): 0.2 mg/kg rapid IV push (MAX second dose 12 mg)
ADENOSINE - DOSE ADMINISTRATION ADULT RI
NARROW COMPLEX TACHYCARDIA (regular rhythm):
12 mg rapid push IV (may repeat x1)
WIDE COMPLEX TACHYCARDIA (QRS (≥0.12sec) + (rhythm is regular with monomorphic complexes):
ADENOSINE 12 mg rapid IV push (may repeat x1)
ADENOSINE - DOSE ADMINISTRATION PEDI RI
NARROW COMPLEX TACHYCARDIA:
VAGALMANEUVER FIRST
MEDICAL CONTROL for authorization to administer ADENOSINE 0.2 mg/kg
rapid IV push [max 12 mg], may repeat x1.
~ administered via a proximal vein and should be followed by a rapid flush of 5 ml normal saline~
ADENOSINE - DURATION OF ACTION
onset: seconds
peak: seconds
duration: seconds
ADENOSINE - SPECIAL CONSIDERATIONS
- Adenosine administration should be followed by a 10 ml flush of NS FOR ADULTS. Adenosine should be administered via a proximal vein and should be followed by a rapid flush of 5 ml normal saline FOR PEDI.
- Adenosine is not indicated in patients with sinus tachycardia, atrial fibrillation or atrial flutter. NO EFFECT ON VENTRICULAR TACHYCARDIA.
–> Adenosine is not the first line agent for the management of atrial fibrillation, but may considered if the patient has a history of conversion with adenosine or to aid rhythm identification.
–> First line agents for rate control in irregular tachycardias (atrial fibrillation) are calcium channel blockers. As per protocol, Adenosine may be considered to assist with diagnosis or if patient has history of Adenosine conversion, but Adenosine is NOT mandated - MAY CAUSE BRONCHOCONSTRICTION IN ASTHMA PT
- EVALUATE ELDERLY FOR DEHYDRATION REQUIRING FLUID REPLACEMENT PRIOR TO ADMINISTERING ADENOSINE.
- initial dose for adenosine should be reduced to 6 mg and the repeat dose should be reduced to 12 mg in patients taking dipyridamole and those that are status post cardiac transplant.
- Theophylline and caffeine (methylxanthines) competitively antagonize adenosine’s
effects; an increased dose of adenosine may be required. - First line agents for rate control in irregular tachycardias (atrial fibrillation) are calcium channel blockers. As per protocol, Adenosine may be considered to assist with diagnosis or if patient has history of Adenosine conversion, but Adenosine is NOT mandated
ATROPINE SULFATE- CLASS
ANTICHOLINERGIC AGENT
ATROPINE SULFATE - MOA
INHIBITS THE ACTION OF ACETYLCHOLINE RESULTING IN INCREASED HEART RATE
ATROPINE SULFATE- INDICATIONS
BRADYCARDIA
ATROPINE SULFATE - CONTRAINDICATIONS
- TACHYCARDIA
- HYPERSENSITIVITY
- BRADYCARDIA DUE TO ACUTE HEMORRHAGE
- NARROW-ANGLE GLAUCOMA
ATROPINE SULFATE - ADVERSE REACTIONS/SE
- CNS: drowsiness, confusion, headache
- CV: tachycardia, palpations, arrhythmias, paradoxical bradycardia (doses less than 0.1 mg)
- GI/GU: N/V
- OTHER: pupil dilation
- ANTICHOLINERGIC EFFECTS: dry mouth/nose/skin, blurred vision, urinary retention, constipation, flushed, hot, dry skin
ATROPINE SULFATE - DRUG INTERACTIONS
ENHANCED BY ANTIHISTAMINES, PROCAINAMIDE, QUINIDINE, ANTIPSYCHOTICS, BENZODIAZEPINES, & ANTIDEPRESSANTS
ATROPINE SULFATE - DOSAGE AND ADMINISTRATION ADULT NAT
0.5 mg IV/IO every 3-5 min as needed (MAX: 3 mg)
ATROPINE SULFATE - DOSAGE AND ADMINISTRATION PEDI NAT
0.02 mg/kg IV/IO (MIN dose: 0.1 mg; MAX single dose: 0.5 mg) may repeat x1 in 3-5 min if needed
ATROPINE SULFATE - DOSAGE AND ADMINISTRATION ADULT RI
BRADYCARDIA <60:
0.5-1.0 mg IV, repeat every 3-5 min to achieve HR >60 (MAX dose 3 mg)
… OR transcutaneous pacing AND consider NS 250-500 ml IV
ATROPINE SULFATE - DOSAGE AND ADMINISTRATION PEDI RI
BRADYCARDIA <60 ( believed to be related to increased vagal tone or primary AV conduction block):
0.02 mg/kg IV (MIN dose 0.1 mg; MAX dose 0.5 mg) (may repeat x1)
AND EPI AND (IF INEFFECTIVE) TCP
ATROPINE SULFATE - DURATION OF ACTION
onset: immediate
peak: rapid to 1-2 min
duration: 2-6 hrs
ATROPINE SULFATE - SPECIAL CONSIDERATIONS
- Atropine sulfate should be used cautiously in the setting of myocardial ischemia/infarction
as increased heart rate may worsen ischemia or infarction size. - Atropine sulfate may be ineffective for treating bradycardia related to atrioventricular
block (AVB) occurring below the AV node (type II second-degree block or third-degree [complete] block with wide QRS complex). Immediate TCP may be warranted in these patients. Atropine sulfate is also ineffective in patients who are status post cardiac
transplant. - IN PARAMEDIC SCOPE ALSO USED TO REVERSE ORGANOPHOSPHATE/NERVE AGENT/BETA BLOCKER/CA CHANNEL BLOCKER OVERDOSE
EPINEPHRINE (CARDIAC)- AKA
ADRENELINE
EPINEPHRINE (CARDIAC)- CLASS
SYMPATHOMIMETIC
EPINEPHRINE (CARDIAC)- MOA
- bronchodilation
- VASOCONSTRICTION
- INCREASED HR AND CONTRACTILE STRENGTH
EPINEPHRINE (CARDIAC)- INDICATIONS
- CARDIAC ARREST
- severe asthma
- croup
- allergic reaction
EPINEPHRINE (CARDIAC)- CONTRAINDICATIONS
- HYPOTHERMIA
- HYPOVOLEMIC SHOCK
- MYOCARDIAL ISCHEMIA
- pulmonary edema
- hypertension