Meds Flashcards
α does what?
Vasoconstrictor (SNS: Vascular bed))
β1 does what?
↑ HR (SNS: heart)
Speeds conduction
↑ contraction force
PNS does what?
↓ HR and conduction speed
Inotrope is?
Causes of + inotrope effect?
Causes of - inotrope effect?
Contractility
+ = digoxin, dopamine, epi
- = verapamil (CCB), acidosis, hypoxemia
Chronotrope is?
Causes of + chronotrope effect?
Causes of - chronotrope effect?
Rate
+ = epi, atropine (antichol)
- = adenosine (antiarrhy), diltiazem (CCB)
Dromotrope is?
Speed of AV conduction
Primary goal of tx is to optimize what first?
Rate/rhythm in diastole
Affecting Stroke Volume: Preload (volume)?
Afterload (resistance)?
Contractility (pump)?
NS
Norepi
Dopamine
Synchronized Countershock used for?
Used when?
Measured in?
Stop impulse during relative refractory (T’s)
Tachy: when pt has pulse but doesn’t respond to pharm
Joules
External Pacemaker used for?
Used when?
Measured in?
Take place of dysfxn’l pacemakers
To capture vents and get a QRS
Milliamps
Amiodarone class?
Action?
Antidysrhy multi-channel blocker
Blocks Na+, K+, Ca2+, α and β
Amiodarone used for what type of pts?
Why?
STABLE pts with normal QTI
Amio can make Long QTI’s become Torsades
Unstable pt’s need quick intervention, amio has 10 min lead
Amiodarone indications?
Vent rhythms (all wide, ugly, bizarre) Rate control of Af and AF
Amiodarone: Initial dose?
Repeat dose?
Special instructions?
150 mg
150 mg
Run minimum of 10 min @ 15mg/min
Amiodarone precautions?
May cause: Vasodilation and hypoTN Torsades Neg inotrope Prolong QTI
t1/2 = 40 days
Lidocaine class?
Action?
Antidysrhy, weak Na+ channel block
Affects vents:
Blocks re-entry
↓ automaticity
↑ Vfib threshold
Lidocaine indications?
PULSELESS VT and Vfib
Stable VT
WCT
Control PVCs in infarct w/o brady
- Only works on re-entry caused Vtach
Lidocaine: Initial dose?
Repeat dose?
Special Instructions?
1 to 1.5 mg/kg
1/2 initial dose
None
Lidocaine precautions?
Toxicity w/ CNS signs
Loss of cardiac compensation is?
Sxs? (7)
Vtach takes over regardless of meds
↓BP ST/T ∆s Chest pain Nausea Diaphoresis ∆ in LOC SOB
Next step in loss of compensation?
electrical
Electrical Intervention in Vtach: Mode?
Initial joules?
(Pt still has pulse)
Synchronized countershock
100 j
Monomorphic Vtach Mgmt: Pharm?
Electrical?
Amiodarone 150 mg or
Lidocaine 1 mg/kg
Sedate
Synch @ 100j
Wide Complex Tachy (WCT) is?
Same as Vtach but of uncertain origin
No normals on the ECG to compare to
WCT mgmt: Pharm?
Same as Vtach + P Adenosine
Adenosine used for WCT if pt meets all 4 criteria?
1) Stable (BP >90)
2) Rhythm undifferentiated (no normal to compare)
3) Rhythm regular
4) Monomorphic QRS’s
Racing heart indicates rhythm from where?
Supervents
Narrow Complex Tachy (NCT) with regular rhythm caused by? (4)
Re-entry SVT
Jxn’l tachy
Arial flutter
Ectopic atrial tachy
NCT w/ reg rhythm tx? (3)
DOC = Adenosine* (if works, re-entry was cause)
CCB (if works, jxn’l was cause)
β-block
*must have HR > 160, narrow QRS and reg rhy to use,
otherwise use a blocker
NCT w/ irregular rhythm caused by? (3)
Atrial fib
Atrial flutter
MAT (wandering)
NCT w/ irregular rhythm tx? (2)
CCB
β-block
Adenosine class?
Action?
Antidys
Effects on supravent tissue: Interrupts RE-ENTRY ↓ SA and AV node ↓ conduction thru AV ↓ HR
t1/2 = 5 seconds
Adenosine indications? (2)
Doesn’t help? (2)
NCT (SVT)
Stable, reg mono WCT
AF or Af
Adenosine: Initial dose?
Repeat dose?
Special inst?
6mg
12mg x 2
Deliver in < 3 sec
Follow w/ flush
NCT electrical mode?
Initial joules?
(Pt w/ s&s of decomp)
Sedate
Synchronized
50 j
Cut off for needing O2?
<94% need O2
Brady tx?
Atropine if:
1) HR <60
2) Pt symptomatic
Atropine class?
Parasympatholytic
Atropine action?
Indirect ↑ HR (inhibits PNS)
↑ AV conduction
Doesn’t fix problem, just buys time
Doesn’t work if issue is in tissue w/ low PNS innervation
Atropine indication?
Brady
Atropine dosing: Initial?
Repeat?
Special instructions?
- 5 mg
- 5 to 1 mg
None
Electrical for brady?
Starting setting?
External pacemaker (TCP)
Lowest milliamps w/ 80 bpm rate
Brady tx if pharm and electric don’t work?
Dopamine
2 to 10 ug/kg/min
Brady w/ 2° Type II or 3° first line tx?
TCP
Nitro should NOT be used when? (5)
SBP < 90 SBP drop >30 HR 100 Recent Phosphodiaesterase Inhib use Inf wall or RV MI