MEDICATIONS Flashcards
from recorded lectures
Milrinone
classification, indication, action, route, conditions
Classification
* Inotrope-vasodilator
Indications
* short term cardiac management, variety
* SAH for vasospasm
Actions
* increases FOC, stroke volume, CO
* decreases afterload and preload
* delivers calcium to muscle cells
Given via
* continuous infusion
* central line ONLY
Conditions
* when stopping, watch for signs of decreased CO
* arrhythmias
* need for concurrent vasopressors
Compare calcium gluconate and chloride
classification, indication, action, route, conditions
Calcium gluconate
* given for routine electrolyte replacement
* can be give via central line or peripheral, + PO
* helps with smooth muscle contraction, vascular
* blood density and clotting
Calcium chloride
* indicated for severe deficiencies
* 3x more Ca
* given in emergencies
* only via central line
Dobutamine
classification, indication, action, route, conditions
Classification
* sympathomimetic / inotrope
Indications
* concerns with heart muscles
* cardiogenic shock, HF, MI, surgery
Actions
* Beta 1 selective, strong inotrope
* increases FOC = increases SV + CO better perfusion
* little effect on HR until high doses
Given via
* continuous infusions via central line ONLY
Conditions
* correct hypovolemia, requires fluid in body
* titrate slowly
* low doses may drop BP
* arrhythmias
Atropine
Classification
* anticholinergic
* parasympathetic blocker
Indications
* symptomatic bradycardia
Actions
* blocks PSNS
* prevents/blocks acetycholine from cholinergic receptor site; heart rate cannot go down anymore, ^ HR
* blocks vagal effects on SA and AV
Conditions
* given with symptoms only…
* hypotension, altered LOC, signs of shock, ischemic chest discomfort, acute HF
* temporary may need other treatments
* can be given for AV heart blocks
Given via
* IV push 1 mg every 3-5 mins
* max 3 mg
Adenosine
Classification
* antiarrhythmic
Indications
* atrial tachycardia, 150-250 BPM
* or slow tachycardic rhythms for easier diagnosis
Actions
* block/slow electrical conduction through the AV node to stop atrial firing
* goal is to slow HR & convert to sinus
Given via
* initial 6 mg IVP, 1-3 seconds
* 1-2 mins later: 12 mg IVP
* peripheral IV closest to heart
* follow by 20 ml saline
* half life = 10 seconds
Conditions
* brief episode of asystole
* AV blocks/ slow HR possible after
* chest pain, SOB, facial flushing
Differentiate each non-depolarizing NMBA
Pancuronium
* long elimination
* renal elminination
* PSNS blocked, HR increase
Cisatracurium
* intermediate
* eliminated via blood stream
* used for pt with renal/hepatic failure
Atracurium
* intermediate
* eliminated via blood stream
* histamine release !!
* used for pt with renal/hepatic failure
Rocuronium
* intermediate
* rapid onset
* hepatic elimination
* rapid intubation
Norepinephrine
classification, indication, action, route, conditions, adverse effects
Classification
* sympathomimetic
* vasopressor
Indication
* hypotension
* shocks
* rescue med, good for most issues
* mostly for alpha affect, vasoconstriction
Action
* increase BP!
* low dose: beta 1 increases contractility (stroke volume)
* high dose: alpha - vasoconstriction (afterload affects stroke volume)
Given via
* beta1 range: 2.5-5 mcg/min
* alpha range: 5-20 mcg/min
* 4/8/16 mg in 250 ml D5W
* ONLY continuous infusion via central line
Conditions
* correct hypovolemia first, have enough fluid for it to work
* titrate slowly, goal usually MAP
* monitor BP, HR, urine output / kidney function at high doses
Adverse effects
* myocardial ischemia
* ischemic bowel
* necrotic toes, fingers
* skin
Vasopressin
classification, indication, action, route, conditions
Classification
* vasoconstrictor
* antidiuretic hormone
Indication
* vasodilatory shock for increased afterload
* management of esophageal varices, squeezes vessels for less risk of rupture
* diabetes insipidus (lack of ADH) donors are at risk, high urine output
Action
Primary (blood vessel)
* vasculature smooth muscle constriction
* increases afterload and BP
Secondary (kidney)
* increases fluid volume by reabsorbing water from renal tubule
* brings it from nephron into blood
* increases preload and BP
Given via
* continuous infusion 0.4-3.4 units/hour
* 20-40 units in 100 ml
Conditions
* monitor for ischemia; fingers, toes, skin, gastrointestinal
* often used with other drugs; levo
* recommended via central line
Epinephrine
classification, indication, action, route, conditions
Classification
* sympathomimetic
* catecholamine
Indication
* block anaphylaxis by blocking mast cells
* cardiac arrest
* symptomatic bradycardia
* septic shock - squeeze, levo first
* cardiogenic shock
* profound hypotension
* bronchospasm - asthma
Action - beta 1&2 primarily, alpha increase CO
Beta 1
* + inotrope to increase contractitility
* + chronotrope to increase heart rate
* increase cardiac output!
Beta 2
* broncodilation in lungs
Alpha
* vasoconstriction increasing BP
* afterload
Given via
* IVP: 0.1mg/ml, 1 mg preloaded q3-5 min
* continuous infusion 4 mg/250 ml, 1-20 mcg/min
* beta 5-10 mcg/min
* alpha 10-20 mcg/min
Conditions
* need fluid on board, correct hypovolemia first
* titrate slowly to BP, MAP, CO goal
* central line ONLY
* caution with cardiac patients, increases myocardial O2 demand
* ROUTES: inhalation, intracardiac, IM, SC, IV
Monitor for
* ischemia, digits, toes, kidneys etc
* arrhythmias
* tachycardia
Propofol
classification, indication, action, route, conditions
Classification
* sedative, low dose
* anesthetic, high dose
Indication
* sedation
* elevated ICP
* status epilepticus
* bedside procedures
* anesthetic in OR
Action
* decreases nerve cell action potentials in CNS through gaba modulation
* … propofol binds to gaba receptor site (in nerve) allowing more chloride ions to flow through
* this lowers the resting membrane potential, requires stronger stimulus and more time to depolarize
* less nerves are firing in the brain; sedation
Given via
* continuous infusion 5-50 mcg/kg/min
* ICP: 10-20 mg by MD
* undiluted 10 mg/ml
Conditions
* titrate to a goal, wean off
* quick onset and short acting
* should not be mixed with anything, use aseptic technique
* monitor triglycerides
* central lines prefered
Watch for PRIS (propofol infusion syndrome)
* dysfunction of mitochrondria…
* altered metabolism, altered ATP production
* severe metabolic acidosis, bradycardia, multi-organ failure
Side effects
* apnea, respiratory depression
* depresses SNS: bradycardia, hypotension
* light green urine, is ok
Midazolam/versed
classification, indication, action, route, conditions
Classification
* sedative
* benzodiazepine
Indication
* sedation prior to procedures
* seizure activity
* anxiety/restlessness
* w/ NMBAs
Action
* direct CNS depressant
* fastest acting + shortest duration of benzos
* hypnotic, antianxiety, sedative, amnesic effects as well
* anticonvulsant effects
Given via
* IVP 1-4 mg over 2 mins
* continuous infusion 1-7mg/hr
* onset 1-5 mins
* comes in 1mg/ml or 5mg/ml
Conditions
* monitor for repiratory depression, apnea, hypotension
* titrate to SAS
Nitroglycerin
classification, indication, action, route, conditions
Classification
* vasodilator
Indication
* angina (vasodilation of coronary arteries)
* acute coronary syndrome, MI
* heart failure
* pulmonary edema
Action
* relaxes smooth muscle of arterial and venous beds, middle layer
* dilates arteries to decrease afterload
* dilates veins to decrease preload
* coronary artery vasodilation increases O2 delivery and O2 demand of myocardium
Given via
* continuous infusion 50-100 mcg/250 ml
* 5 mcg/min. titrate q5mins, max 20 mcg/min ^ at a time
* glass bottle or polyolefin bag
Conditions
* central line preferred
* titrate slowly
Side effects: hypotension, headache, tachycardia
Fentanyl
classification, indication, action, route, conditions
Classification
* narcotic analgesic
* synthetic opiod
Indication
* moderate to severe pain
* pre-procedural analgesic, cath lab
* pain management in hypotensive patients
* anesthesia with hypnotic agent
Action
* blocks opiate receptors in CNS, reducing pain transmission
Given via
* IVP: 25-100 mcg over 1-2 mins
* continuous infusion: 25-50 mcg/hour titrate to goal
* 10x more potent than morphine
* onset is 1-2 min, duration 30-60 mins
Conditions
* rapid infusion can depress respiratory
* decrease GI motility
* prolonged use causes drug accumulation
* accumulation with hepatic impairment
Side effects
* ^ + hypotension, bradycardia
Amiodarone
classification, indication, action, route, conditions
Classification
* antiarrhythmic
Indication
* suppress arrhythmia
* atrial rhythms: tachycardia, fib, flutter (rhythm/rate control, conversion)
* ventricular rhythms: tachycardia, fib (stable, pulseless)
Action
* Class I - blocks Na channels to decrease automaticity
* Class II - beta blocker
* Class III - blocks K channels to lengths absolute refractory
* Class IV - blocks Ca channels for vasodilation
Mainly works because cells cannnot respond to a stimulus for longer
Given via
* IVP or mini bag infusion, then continuous infusion
* 150-300 mg loading dose
* 0.5 mg/min
Conditions
* QT interval can be lengthened
* monitor bradycardia, hypotension
* liver damage
* pulmonary toxicity
Magnesium
classification, indication, action, route, conditions
Classification
* electrolyte
* anticonvulsant, laxative
Indication
* hypomagnesemia
* torsades de pointes
* cardiac protection
* seizures from toxemia
* therapeutic temperature managment protocol - aids in cooling
Action
* 300 functions in many enzymes
* cardiac electrophysiology
* nerve conduction
* muscle contraction
* vasospasm
Given via
* 1-2 g in 100 mL IV over 1 hour
Conditions
* correcting mag first makes it easier to correct others
