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Cardiac > Medications > Flashcards

Medications Flashcards

0
Q

The first drug given in an acute MI

A

Oxygen

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1
Q

Three classifications of drugs used in treatment of angina

A

Nitrates, beta blockers, oxygen, aspirin, calcium channel blocker’s

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2
Q

This drug is given rapidly IVP to treat SVT

A

Adenosine or Adenocard

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3
Q

Potent after load and preload reducing agent

A

Nitropressside aka nitride

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4
Q

What is digoxin toxicity

A

Arrhythmias, nausea, anorexia, visual disturbances

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5
Q

What are side effects of lidocaine

A

Slurred speech, confusion, Muscle twitching, decreased hearing and seizures are side effects of this medication.

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6
Q

What is protamine sulfate

A

Antagonizes the action of heparin

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7
Q

Three drugs which may be used during acute phase of pulmonary edema

A

What is 02, morphine, nitroglycerin, Lasix and nitropresside

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8
Q

Used in treatment of CHF, may prevent adverse remodeling of the heart

A

What are ACE/ARB’s

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9
Q

Side effects may include widening of QRS by 50%, prolongation of QT interval, heart block, torsades, lupus like syndrome in long-term therapy, hypotension

A

Procainamide, Side effects of

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10
Q

Can be given in the place of epinephrine for the first or second dose

A

vasopressin

40 units IV push for one dose

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11
Q

What are the side effects of amiodarone

A

Hypotension, bradycardia, prolongation of QT interval

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12
Q

Atropine

0.5 mg IV q 3-5 mins

A

Parasympathetic drug use in sympathetic sinus bradycardia.
Not effective in Mobitz type II (infra-nodal block)
Avoid and hypothermic bradycardia

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13
Q

Dopamine infusion

1 - 20 mcg/kg/min

A

Preferred catecholamine for bradycardias, in which, atropine is ineffective or contraindicated.

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14
Q

Tachycardia, hypertension, extravasation (tissue narcoses), excessive vasoconstriction, exacerbate superventricular and ventricular arrhythmias are side effects of what medication?

A

Dopamine effects

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15
Q

Epinephrine

1:10,000 & 1:1,000

A

Used in cardiac arrest, symptomatic bradycardia, severe hypotension, anaphylaxis
Natural catecholamine with both alpha and beta adrenergic agonist activity
Alpha adrenergic effects:
-increase my cardio and three bloodflow
– Increased peripheral vasoconstriction and improves coronary artery perfusion pressure
-produces renal vasoconstriction causing decreased renal bloodflow and urine output

Arrest: 1 mg of 1:10,000 solution q 3 - 5 minutes IVP
Continuous infusion: 2 - 10 mcg/min titrate to affect

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16
Q

May precipitate or exacerbate myocardial ischemia, hypotension, and can induce ventricular ectopy, especially in patients receiving digoxin.

A

Side effects potentially from epinephrine

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17
Q

Adenosine
6 mg IVP slam followed by 20 mL bolus
Repeat in 1 to 2 minutes with 12 mg IVP if needed

A

First dose for most forms of stable narrow complex SVT
Maybe considered for unstable narrow complex reentry tachy

*is not used to convert afib, aflutter or VT

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18
Q

This medication may cause transient side effects that include Flushing, chest pain or tightness, 6-15 seconds of asystole, bradycardia or ventricular ectopy, bronchoconstriction if asthma…

A

What is adenosine

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19
Q

Digoxin (cardiac glycoside)

Loading dose 4-6 mcg/kg over 5 min

A

Used in stable patients with slow ventricular response in afib/aflutter, alternative drug for reentry SVT.
Positive inotrope with a slow onset of action
Toxic to therapeutic ratios are narrow especially in hypokalemia

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20
Q

Class Ia Antiarrhythmics:
Quinidine
Procainamide
Disopyramide

A

Moderate fast sodium channel blockade.

Reduce conductivity and prolong repolarization & the action potential (longer QTs).

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21
Q

Procainamide

A

Arrhythmia suppression, rhythm converted

Class Ia antiarrhythmic

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22
Q 
Class Ib antiarrhythmic:
Lidocaine a.k.a. Xylocaine, Zingo
Mexiletine
Phenytoin a.k.a. dilantin
Tocainide
A

Mild– Fast sodium channel blockade
Slows AV conduction, local anesthetic
Toxic to therapeutic balance delicate

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23
Q

Lidocaine
Cardiac arrest from the VF/VT: 1-1.5 mg/kg, Max 3 mg/kg
repeat 0.5–0.75 MG/KG in 5-10 minutes

A

Alternative to amiodarone in cardiac arrest VT/VF.
Stable monomorphic VT with preserved ventricular function.
Stable polymorphic VT with normal baseline QT interval, and preserved LV function when ischemia is treated and electrolyte balance is corrected.
Stable polymorphic VT with baseline QT interval prolongation in torsades suspected.

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24
Q 
Class Ic antiarrhythmics:
flecainide
Propafenone
Moricizine
Encainide
A

Markedly reduces conduction; use only for refractory arrhythmias and are pro-arhythmic

25
Q

Class I I antiarrhythmics:
Beta blockers
– olol

A

Given for myocardial infarction’s and unstable angina
Second line agent after adenosine
Adjunctive agent with fibrinolytic therapy
Beta 1 decreases heart rate, contractibility and conductivity.
beta 2 can produce bronchospasms, vasoconstriction

26
Q

Propranolol

A

Class II Antiarrhythmic
Beta blocker
Noncardiac selective for SVT

27
Q

Labetalol

A

Class II Antiarrhythmic
Cardio selective beta blocker
Used in treatment of acute stroke, hypertensive emergencies and acute aortic dissection

28
Q

Metoprolol

A

Class II Antiarrhythmic

Cardio selective

29
Q

Sotalol a.k.a. Betapace, Sorine

A

Class II Antiarrhythmic
Nonselective beta blocker
Treatment of supraventricular arrhythmias and ventricular arrhythmias without structural heart disease

30
Q

This medication may cause bradycardia, hypertension and arrhythmias (torsades), avoided in patients with poor perfusion due to significant negative inotropic effects. May become toxic with patients with renal impairment.

A

Side effects of Sotalol

31
Q

Side effects of this class of drug include; hypotension, bradycardia; AV conduction delay,bronchospasm, and can cause severe hypotensionwhen given with calcium channels blockers.

A

Beta blockers side effects

32
Q

Class I I I antiarrhythmics:
Amiodarone
Ibutilide
Dofetilide

A

Potassium channel blockers.

Prolongs action potential, prolongs refractory period, Decreases AV conduction.

33
Q

Amiodarone

Arrest dose: 300 mg IVP

A

Used for treatment of life-threatening recurrent ventricular arrhythmias,when they have not responded to other antiarrhythmics.
Half-life of 15 to 40 days IV

34
Q

The side effects of his medication are hypotension, bradycardia, pulmonary fibrosis, liver dysfunction & many drug interactions

A

Side effects of amiodarone

35
Q

Side effects of this medication are that it can cause torsades. Monitor patient for 4 to 6 hours after administration

A

Side effects of ibutilide

36
Q

Ibutilide

A

Class III antiarrhythmic
Treatment of supraventricular arrhythmias, including atrial fibrillation and atrial flutter when duration is less than or equal to 48 hours.

37
Q

Class IV antiarrhythmics:
Diltiazem a.k.a. Cardizem
Verapamil

A

Calcium channel blocker’s

Slow conduction and increase refractory in AV node

38
Q

Precautions of this class of medications are do not use for wide QRS tachycardias of uncertain origin, avoid inpatients with accessory pathway WPW, sick sinus syndrome, second or third degree heart block. Side effects are hypotension

A

Calcium channel blocker’s like cardizem, verapamil

39
Q

Diltiazem

A 
Calcium channel blocker; class IV antiarrhythmics
Controlled ventricular rate in a fib/a flutter. May terminate reentry arrhythmias and require AV nodal conduction for the continuation. Used after adenosine to treat refractory reentry SVT in patients with narrow QRS complexes and adequate blood pressure.
40
Q

Why use vasoactive medications

A

Stabilize hemodynamics
Avert cardiovascular collapse
Restore perfusing rhythm
Improve cardiac output and organ perfusion

41
Q

adrenergic receptors

A

Regulate cardiac, vascular, bronchiolar, and gastrointestinal smooth muscle tone.
Major classes are:
Alpha adrenergic receptors Alpha one and two
Beta-adrenergic receptors beta one and two
Dopaminergic receptors

42
Q

Alpha adrenergic receptors do what?

A

Predominately regulate vascular smooth muscle tone.
When in antagonist stimulate receptors, vasoconstriction occurs.
Aka catecholamines:
norepinephrine (most potent)
Epinephrine(2nd most potent)
Isoproterenol
Phenylephrine

43
Q

Beta adrenergic receptors

A

Beta-1 adrenergic receptors are the adrenergic receptors of the heart. -concentrate in the sinus node and ventricles, beta-1 receptors are excitatory. Ex. Increase rate & strength of contractibility.
Beta-2 adrenergic receptors are the beta-adrenergic receptors of the rest of the body. -leads to vasodilation

44
Q

Dopaminergic receptors

A

Located in the smooth muscle cells in the cerebral, coronary, renal, and splenchic vascular bed.
Also present in proximal renal tubular cells and in the pituitary gland.
Activation result in vasodilation of the above vascular beds.

45
Q

Vasopressors do what?

A

Increased blood pressure

46
Q

Positive inotropes cause what?

A

Increased contractility

47
Q

Negative inotropes cause what?

A

Decrease contractibility

48
Q

Side effects of this medication are: bradycardia, fullness of head, headache, hypertension, tingling of extremities, tremulousness, ventricular extrasystole, and V tachycardia (short paroxysm), vertigo.

A

Phenylephrine, Side effects of

49
Q

Phenylephrine

A

Sympathomimetic similar to epinephrine. Acts primarily on alpha-adrenergic receptors.
Renal vasoconstriction will occur. A potent, long lasting vasoconstrictor unique in that it slows heart rate, increases stroke volume and does not induce any change in the rhythm of the pulse.

50
Q

Norepinephrine a.k.a. Levophed

A

Naturally occurring catecholamine chemical similar to epinephrine. Causing arterial and venous vasoconstriction, increases myocardial contractibility
Potent vasoconstrictor and inotropic agents treats severe hypotension SBP less than 70, with a low total peripheral resistance.last resort for management of cardiogenic shock.

51
Q

The side effects of this medication are: contra indicated for hypotension caused by hypovolemia, Monitor blood pressure closely during therapy, may increase myocardial oxygen requirements, May precipitate arrhythmias, ischemic necrosis and sloughing due to infiltration.

A

Side effects of norepinephrine

52
Q

Vasopressin

A

Non-adrenergic, naturally occurring hormone, also known as antidiuretic hormone. Use for pulseless arrest (PEA), Has shown to increase coronary perfusion pressure, vital organ bloodflow, cerebral oxygen delivery.

53
Q

Side effects of this medication are: pallor of skin,nausea, intestinal cramps, urge to defecate,bronchial constriction, and a uterine contractions in women, May cause serious myocardial ischemia, vascular dysrhythmia

A

Vasopressin, side effects of

54
Q

Dobutamine

A

Synthetic catecholamine; adrenergic stimulant
Stimulates beta-1 and alpha-1 adrenergic receptors
Stimulates alpha-1 adrenergic receptors that is balanced by beta-2 stimulation -vasoconstriction balanced by vasodilation.
Variable affects the blood pressure
Treatment of patients with severe systolic heart failure or who cannot tolerate vasodilation

55
Q

Nitropressside aka nitride

A

Potent - direct peripheral vasodilator that affects both venous and arterial smooth muscle. Reduces preload and afterload.
Immediate onset of action, effects cease within minutes of stopping
Useful for treatment of severe heart failure and hypertensive emergencies

57
Q

Side effects of this medication include: hypotension, headache, nausea, giddiness,faintness, or syncope, tachycardia and paradoxical bradycardia, hypoxemia from increase in ventilation perfusion mismatch.

A

Nitrates, side effects of

59
Q

Side effects of this medication are: tachy arrhythmias,fluctuations in BP, headaches, tremor, hypokalemia, and nausea

A

Dobutamine, Side effects of

60
Q

Side effects of this medication are: hypotension, carbon dioxide retention, and thiocyanate toxicity. Induced hypotension candy severe; it may precipitate myocardial ischemia, infarction, or stroke.

A

Nitroprusside a.k.a. nitride, Side effects of

61
Q

Ace inhibitor

A

Inhibits formation of converting enzyme, thus formation of aldosterone.
Examples: Captopril, Enalapril, lisinopril
SE:
Monitor for hyper kalemia and decreased renal function. Cough is a side effect

62
Q

nitrates

A

Vasodilator, bind to specific vascular receptors that relax and dilate vascular smooth muscle. Dilate large coronary conduit arteries, antagonizes Vaso spasms, and increases coronary collateral bloodflow to ischemic myocardium.
Indications: angina pectoris, acute pulmonary edema and CHF, acute MI

63
Q

This medication is contraindicated with RV infarction, SBP less than 90, severe bradycardia or extreme tachycardia.

A

Precautions of nitrates

Cardiac (3 decks)

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