Medications for Cardiac Related Complaints Flashcards
lidocaine 2%
A local anesthetic and CLASS IB ANTIARRTHMIC that blocks sodium channels, therefore, increasing the recovery period after repolarization and suppressing automaticity in the His-Purkinje system and depolarization in the ventricles.
lidocaine 2% Indications
Analgesic for intraosseous infusion, an alternative to amiodarone in ventricular fibrillation or pulseless ventricular tachycardia, and stable monomorphic ventricular tachycardia.
lidocaine 2% Adverse Effects
Seizures, drowsiness, tachycardia, bradycardia, confusion, and/or hypotension.
lidocaine 2% Adult Dosage and Administration
Cardiac Arrest from ventricular tachycardia or pulseless ventricular tachycardia:
1-1/5 mg/kg IV
Perfusion Dysrhythmia (stable ventricular tachycardia)
0.5-0.75 mg/kg every 5-10 minutes with a max total dose of 3 mg/kg
lidocaine 2% Special Considerations
Lidocaine is metabolized by the liver. Those with liver disease or poor liver perfusion secondary to shock or congestive heart failure are more likely to experience side effects.
magnesium sulfate
an ELECTROLYTE that reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction. It stabilizes the potassium pump, correcting repolarization, and shortens the Q-T interval in the presence of ventricular arrhythmias due to drug toxicity or electrolyte imbalance.
magnesium sulfate Indications
Antiarrhythmic: Torsade de Pointes associated with prolonged QT interval.
Respiratory: Severe bronchospasm unresponsive to continuous albuterol, ipratropium, and IM epinephrine.
Obstetrics: Eclampsia: Pregnancy greater than 20 weeks gestational age or post-partum with seizures.
magnesium sulfate precautions
Bradycardia, hypotension, and respiratory depression.
magnesium sulfate Adverse Reactions
Bradycardia, hypotension, and respiratory depression.
magnesium sulfate Dosage and Administration
Torsades de Pointes (caused by prolonged QT interval):
Adult - 2 g IV bolus
Pediatric - not indicated
nitroglycerin
An ANTIAGINAL AGENT that relaxes vascular smooth muscle thereby dilating peripheral arteries and veins causing pooling of venous blood and decreased venous return to the heart which then decreases preload. Also reduces left ventricular systolic wall tension which decreases afterload.
Onset = 1-3 minutes
Duration = 20-30 minutes
nitroglycerine Indications
Pain or discomfort due to suspected Acute Coronary Syndrome.
Pulmonary edema due to congestive heart failure.
nitroglycerine Contraindications
Suspected right ventricular ST-segment elevation MI (inferior STEMI) pattern plus ST elevation in right-sided precordial leads.
Hypotension (less than 100 systolic).
Recent use of erectile dysfunction medication.
nitroglycerine Adverse Reactions
Hypotension, headache, and syncope
nitroglycerine Dosage and Administration
Chest Pain:
0.4 mg sublingually or spray every 5 minutes as needed up to a total of 3 doses for persistent chest pain.
Pulmonary Edema: 0.4 mg sublingually or spray every 5 minutes as needed titrated to symptoms and blood pressure OR 1 inch of nitro paste on the patient’s left anterior chest for CHF/Pulmonary Edema.
Pregnancy Class C.
adenosine (Adenocard)
A miscellaneous ANTIDYSRHYTHMIC, a naturally occurring nucleoside, used to treat STABLE, ATRIAL TACHYCARDIA by slowing electrical conduction through the AV node, decreasing the automaticity of the SA node.
adenosine (Adenocard) Indications
Indications: Narrow-complex supraventricular tachyarrhythmia.
adenosine (Adenocard) Contraindications
Contraindications: Sick sinus syndrome, second- or third-degree heart block, poison/drug-induced tachycardia, asthma or bronchospasm, wide or irregular tachycardia, and heart transplant patients.
adenosine (Adenocard) Adverse Effects
Chest pain, shortness of breath, diaphoresis, palpitations, lightheadedness, and sense of impending doom.
adenosine (Adenocard) Drug Interactions
Methylxanthines, such as caffeine, antagonize adenosine so a higher dose may be required.
Dipyridamole (Persantine) potentiates the effect of adenosine so reducing the dose may be required.
Carbamazepine may potentiate the AV-nodal-blocking effect of adenosine.
adenosine (Adenocard) Dosing and Administration
Dosage:
Adult - 12 mg IV bolus rapid push followed by a normal saline flush. Contact base for an additional 12 mg IV bolus if no response is observed.
Pediatric - 0.1 mg/kg IV bolus (6 mg max) rapid push followed by a normal saline flush. An additional dose of 0.2 mg/kg (12 mg max) rapid push followed by a normal saline flush if no response is observed.
Pregnancy Class C.
adenosine (Adenocard) Special Considerations
Typically causes short-lived but unpleasant chest discomfort. Always warn your patient before giving medication.
Use with caution in patients with pre-existing bronchospasm and those with a history of atrial fibrillation.
Older adults with no history of PSVT should be evaluated for dehydration and rapid sinus tachycardia requiring volume fluid replacement prior to adenosine.
Transient asystole and AV blocks are common at the time of cardioversion.
A 12-lead EKG should be performed and documented.
Adenosine is not effective in atrial flutter or fibrillation.
Adenosine is safe in patients with a history of Wolff-Parkinson-White syndrome if the rhythm is regular and the QRS complex is narrow.
amiodarone (Cordarone)
a CLASS III POTASSIUM CHANNEL BLOCKER ANTIDYSRHYTHMIC showing class I, class II, class III, and class IV actions. The most major effect is class III which blocks potassium ion channels. This prolongs the cardiac action potential duration as well as the refractory period.
amiodarone (Cordarone) Indications
Indications: Pulseless arrest in patients with shock refractory or recurrent ventricular fibrillation or ventricular tachycardia.
Wide complex tachycardia not requiring immediate cardioversion
May be helpful in rate control of supraventricular rhythms after ALL pharmacologic therapies have been ineffective.
amiodarone (Cordarone) Contraindications
Contraindications: Second- or third-degree AV block and cardiogenic shock. Liver patients. Pregnancy.
amiodarone (Cordarone) Adverse Reactions
Hypotension, Bradycardia
amiodarone (Cordarone) Dosage and Administration
Dosage:
Adult Pulseless Arrest (Refractory ventricular tachycardia/ventricular fibrillation) -
300 mg IV bolus. Administer an additional 150 mg IV bolus in 3-5 minutes if shock refractory or recurrent VT/VF remains.
Symptomatic Ventricular Tachycardia and undifferentiated wide complex tachycardia with a pulse (contact base) -
150 mg bolus infusion over 10 minutes.
Pediatric (contact base) - 5 mg/kg IV bolus for pulseless arrest (refractory VT/VF).
amiodarone (Cordarone) Special Consideration
A 12-lead EKG should be performed and documented when available. Amiodarone is preferred to adenosine for treatment of undifferentiated wide complex tachycardia with a pulse.
atropine sulfate
An ANTICHOLINERGIC PARASYMPATHOLYTIC medication that competes with acetylcholine at the site of the muscarinic receptor.
atropine sulfate Indications
Indications: Symptomatic bradycardia, nerve agent exposure, or organophosphate poisoning.
atropine sulfate Precautions
Precautions: Acute myocardial infarction because you don’t want to stimulate the heart, myasthenia gravis, GI obstruction because a parasympatholytic will decrease the motility of the GI tract, closed-angle glaucoma because a parasympatholytic will increase intraocular pressure, known sensitivity to atropine, belladonna alkaloids, or sulfates.
atropine sulfate Adverse Effects
Anticholinergic toxidrome in overdose - “blind as a bat, mad as a hatter, dry as a bone, red as a beet.” May cause paradoxical bradycardia if the dose administered is too low or if the drug is administered too slowly.
atropine sulfate Dosage for Hemodynamically Unstable Bradycardia
0.5 mg IV bolus. Repeat at 3-5 minute intervals to a maximum dose of 3 mg.
Pediatric: 0.02 mg/kg IV bolus. Minimum dose is 0.1 mg, max dose is 0.5 mg.
atropine sulfate Dosage for Poisoning/Overdose
2 mg/kg IV or IM for signs of moderate/severe toxicity. Contact base for additional doses.
Pediatric: Under 40 kg - 0.02 mg/kg IV/IM for moderate to severe toxicity. Minimum dose is 0.1 mg. Contact base for additional doses.
atropine sulfate Special Considerations
The half-life is 2.5 hours. Atropine can be given in 2nd and 3rd-degree heart blocks however is found to be ineffective. Do not delay pacing in this patient if they are in peri-arrest when pacing is indicatded.
Pregnancy Class C.
epinephrine (Adrenaline) Indications
Indications: Pulseless arrest, anaphylaxis, asthma, and bradycardia with poor perfusion.
epinephrine (Adrenaline) Adverse Reactions
Tachycardia and tachydysrhythmia.
Hypertension
Anxiety
May precipitate angina pectoris.
epinephrine (Adrenaline) for Pulseless Arrest
Adult:
1 mg (10mL of 1:10,000) IV bolus. Repeat every 3 compression cycles (every 6 minutes). After 3 mg, additional doses are not routinely recommended.
Pediatric:
0.01 mg/kg (0.1mL/kg of 1:10,000) IV. Repeat dose every 3-5 minutes
epinephrine (Adrenaline) for Bradycardia
Adult:
Bradycardia with hypotension and poor perfusion refractory to other interventions: Continuous infusion titrated to effect.
Pediatric: (Contact Base)
0.01 mg/kg (1 mL/kg of 1:100,000) IV.
epinephrine (Adrenaline) as a Vasopressor
Indications:
Severe allergic reaction/Anaphylaxis
Hypotension with poor perfusion refractory to adequate fluid resuscitation
Bradycardia with signs or poor perfusion.
Contraindications: DO NOT use a vasopressor infusion in pediatric patients under the age of 12.
Dosage and Administration:
Inject 1 mg epinephrine into 1000 mL normal saline to achieve 1 mcg/mL concentration.
This means 1 mL of 1:000 or 10 mL of 1:10,000 - either way, 1 mg of drug.
Use a MACRO drip set.
Adult IV: Begin infusion wide open to gravity to give small amounts of fluid. Typical volumes are less than 100 mL of total fluid. Titrate to desired hemodynamic effect with the goal BP of greater than 90 systolic, improved respiratory status (bronchodilation), and improved perfusion/mentation.
Pregnancy Class C.
aspirin (ASA)
an ANTIPLATELET, nonnarcotic analgesic, and antipyretic that prevents the formation of a chemical known as thromboxane A2, therefore, inhibiting platelets from aggregating.
aspirin (ASA) Indications
Symptoms of suspected acute coronary syndrome.
aspirin (ASA) Adverse Effects
Anaphylaxis, angioedema, bronchospasm, bleeding, stomach irritation, nausea/vomiting.
aspirin (ASA) Contraindications
Active GI bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children.
aspirin (ASA) Dosage
324 mg (4 81 mg baby aspirin)
aspirin (ASA) Special Considerations
Patients with suspected acute coronary syndrome taking anticoagulants can still be given ASA. Do not use enteric-coated ASA. Do not give to pediatrics due to the risk of Reye’s Syndrome.
Pregnancy Class D.
