Meds exam 2 Flashcards
Adenosine: Action / Indications
Antiarrhythmic, slows conduction through AV node.
Used to restore sinus rhythm in pts with atrial tach, slows down tachyarrythmias for diagnostic purposes.
NOT EFFECTIVE FOR ATRIAL FIB AND ATRIAL FLUTTER
Adenosine: Dose
Bolus: 6mg IV push over 1-2 secs
If no response in 1-2 mins: 12 mg IV push
If no response: Another 12 mg IV push
Half life 10 secs
Adenosine: Nursing considerations
Vagal maneuvers should be tried first.
Must be pushed quickly followed by rapid flush.
Pt may have transient AV blocks, asystole, slow rhythms,
Side effects: Facial flushing, chest pressure, SOB (WARN PTS FIRST!)
Atropine: Action, indications
Anticholinergic, anti PSNS drug
works to block PSNS, prevents action of Ach results in more SNS relative to PSNS and increase in HR
Used for symptomatic bradycardia, heart blocks
Atropine: Dose
0.5mg IV push q 2-5mins, max 3 mg
Atropine: Nursing considerations
Monitor tachycardia
SE: Dilated pupils, dry mouth
Epinephrine: Action
Sympathomimetic, produced by adrenal medulla and has beta 1, beta 2, alpha effects (primarily Beta)
Beta 1: Increase CO, + inotrope, + chronotrope
Beta 2: Bronchodilation in lungs
Alpha: Vasoconstriction, thus increase BP
Epinephrine: indications
Cardiac arrest, symptomatic bradycardia, severe shock states, severe hypotension, resp distress due to bronchospasm or anaphylaxis
Epinephrine: Dose
May be mcg/kg/min or mcg/min
In cardiac arrest: Bolus 1mg q 3-5mins
Continuous infusion: 4mg in 250cc NS/D5W @ 1mcg/min titrated up (1-20 mcg/min)
Epinephrine: Nursing considerations
Monitor increased BP, HR
Correct hypovolemia first
Use central line
**Use caution for cardiac pts as causes increase in myocardial O2 demand and MI
Fentanyl: Action, indications
Narcotic analgesic, synthetic opioid
Blocks opiate receptors in CNS, reducing pain transmission. Rapid onset, short duration with less hypotension than morphine (less histamine release)
Used for pre-procedural analgesic, pain management in hypotensive pts, used in anesthesia with hypnotic agent such as propofol
Fentanyl: Dose
IVP: 25 - `100mcg
IV infusion: Initiate at 25-50 mcg/hr and titrate
Onset 1-2 mins, duration 30-60 mins
How potent is fentanyl?
100mcg fentanyl equivalent to 10mg morphine (recall 1000 mcg = 1 mg)
Fentanyl: Nursing considerations
Rapid infusion may cause resp depression.
Can cause decreased GI motility, bradycardia
Keep airway resus equipment on hand
Can accumulate with hepatic impairment (perform sedation vacation to prevent accumulation)
Antidote: Narcan
Metoprolol: Action, indications
Beta blocker
- inotrope
- chronotrope
Decrease in myocardial O2 demand
Treatment or prophylaxis of tachyarrythmias, heart failure, hypertension, angina, acute MI or post MI
Metoprolol: Dose
Bolus: 5mg IV push over 1-2 mins, may repeat q 5 - 10 mins
Total IV dose = 15mg
Metoprolol: Nursing considerations
High doses can block beta 2 receptors in lungs leading to bronchoconstriction
Caution in pts with heart failure, bronchospastic disease
Side effects: CHF, pulmonary edema, bradyarrythmias, AV blocks, hypotension
Caution when used with Ca channel blockers
Midazolam: Action, indication
Sedative (benzodiazepine), is a direct CNS depressant and fastest acting shortest duration of benzos
Hypnotic, anti-anxiety, sedative, amnesic, anticonvulsant effects
Used for procedural sedation, agitation, sedation with NMBAs, seizure activity
Midazolam: Dose
Bolus 1-4mg over 2-3 mins
Infusion: 1-5mg/hr (100mg in 100cc D5W)
Onset: 1-2 mins, duration 20-30 mins
Midazolam: Nursing considerations
Too little / too much may lead to agitation, hyperactivity, paradoxical effect in very young / elderly
Adverse effects: Resp depression, hypotension
Half life 1-5 hrs
Pts can develop tolerance and withdrawal
Morphine: Action, indications
Narcotic analgesic, opiate
Blocks opiate receptors in CNS, reducing pain transmission. Relaxes smooth muscle in vessel beds causing vasodilation. Decreases preload, afterload, O2 demand
Analgesic of choice for MI induced pain, may be used in CHF for pulmonary edema
Morphine: Dose
IVP: 2-4 mg, slowly
**Rapid push causes adverse effects
Infusion: Initiate at 2-4 mg/hr titrate up
Onset 5 mins, duration 4-5 hrs (much longer than fentanyl)
Morphine: Nursing considerations
SE: Resp depression, hypotension, brady, decreased GI motility, decreased LOC
Antidote: Narcan
Nitroglycerin: Action
Vasodilator / Nitrate
Relaxes smooth muscle and vessel beds (predominantly venous dilation, decreases preload)
CA vasodilation increases O2 delivery and decreases O2 demand
Nitroglycerin: Indications
Prevention / treatment of angina by increasing CA blood flow
ACS ischemic chest pain
Acute and chronic heart failure to decrease preload and pulmonary congestion
Pulmonary edema
Nitroglycerin: Dose
Continuous infusion: 20 - 200 mcg/min or 1 - 10 mcg/kg/min
Titrate 5 mcg/min up q5min as needed for angina until pt is pain free
** Mix in glass bottle / low absorbing tubing
Duration: Less than 20 mins
Nitroglycerin: Nursing considerations
Use central line, may cause arterial vasodilation (watch hypotension)
Titrate up / down slowly
May be converted to transdermal patch
Pt may develop tolerance > 2 days
Side effects:
Hypotension (peripheral vasodilation)
Headache (cerebral vasodilation)
Tachycardia (compensation to decreased BP)
Nitroprusside: Action, indications
Vasodilator, antihypertensive
Potent vasodilator and causes relaxation for vessel beds (predominantly arterial, reduces afterload)
Mainly reduces afterload, some decreased preload
Used for control of hypertensive crisis, acute heart failure, used in OR to minimize blood loss, post-op to control BP following vascular surgeries. Used for short time only
Nitroprusside vs Nitroglycerin: Action?
Nitroglycerin mainly dilates venous system while nitroprusside dilates arterial system
Nitroprusside: Dose
Continuous infusion: 0.5 mcg/kg/min, titrate up by 0.2mcg to MAX of 8mcg/kg/min
Works immediately when initiated, short half life 10 mins
Cover bag with foil as drug breaks down from light
Nitroprusside: Nursing considerations
Monitor for hypotension, titrate very slowly. Use central line.
Metabolized to cyanide and then thiocyanide. Monitor pts for cyanide toxicity and check serum levels
What are signs of thiocyanate toxicity?
Tinnitus, blurred vision, confusion, delirium, muscle spasm
Norepinephrine: Action, indications
Sympathomimetic, vasopressor
Used primarily for alpha effects (peripheral vasoconstriction, increase BP) but has some beta 1 effects (+ inotrope)
Used for severe hypotension, BP less than 70, pts with vasodilatory shocks following fluid bolus
Norepinephrine: Dose
Continuous infusion: Start at 2mcg / min, titrate up to desired response
2 - 5 mcg/min = alpha and beta 1 effects
> 5mcg/min = alpha effects
Soft max 20mcg/min
May also be measured as mcg/kg/min, dose would be 0.03 - 2.0 mcg/kg/min
Norepinephrine: Nursing considerations
Correct hypovolemia first or vasoconstriction may cause CA ischemia. Monitor BP, HR, U/O, use central line
Recommended to mix in D5W as loses potency in NS
Titrate slowly
Adverse effects:
Intense vasoconstriction, necrosis to peripheral limbs, renal failure d/t renal artery vasoconstriction
Propofol: Action
Anesthetic agent, sedative / hypnotic at lower doses
Acts directly on CNS to decrease neuro APs, crosses blood brain barrier to decrease ICP.
Decrease in SNS tone may result in vasodilation (Decrease HR, RR, BP)
Anti anxiety, hypnotic, amnesic properties
Propofol: Indications
Used in OR as anesthetic agent, in ICU as procedural sedation and as continuous infusion to maintain sedation
Short acting, allows for frequent neurological assessments in ICU
Propofol: Dose
Bolus loading dose given by MD: 10-20 mg (warn pts of local pain)
Continuous infusion: 5-50 mcg/kg/min
Onset 40 secs duration 3-10mins
*Possible synergistic effects with narcotics and other sedatives
Propofol: Nursing considerations
- No preservatives, high risk of infection, change lines / bottle q12h
- Monitor triglycerides if used more than 3 days
- Dietician to follow
- Use central line or large peripheral vein (irritating)
- Risk of resp depression - should be used only with intubated pts
- Should be weaned off
- **NO ANALGESIC PROPERTIES
- **Do not mix with other meds
- Causes discoloration of urine (light green)
- Caution in pts with egg allergies
- Risk for propofol infusion syndrome (PRIS)
What is propofol infusion syndrome?
Associated with dose > 67 mcg/kg/min for more than 48 hrs, believed to cause impaired utilization of fatty acids in cardiac and skeletal muscle cells.
Pt develops severe metabolic acidosis, rhabdomyolysis, acute renal failure. Treatment is supportive and stop propofol
Vasopressin: Action, indications
Vasoconstrictor, antidiuretic (endogenous hormone ADH)
- Directly stimulates vessel smooth muscle contraction, causing increased afterload and BP
- Causes increased re-absorption of water from renal tubules to increase BP
Used for shock states for decreased SV, septic shock when pt is on max levo. V fib arrest, treatment of bleeding esophageal varices
Vasopressin: Dose
Continuous infusion: 0.4 - 3.2 units /hr
Onset 1-3 mins, half life 20 mins
Mixed: 20 - 40 units / 100 cc or 100 units / 250cc D5W
Vasopressin: Nursing considerations
Mesenteric ischemia, ischemia of fingers / toes, central line, risk of MI r/t CA vasoconstriction (though less risk than epinephrine)
