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PHARMACOLOGY for CCCC MEDIC 2 > MEGACODE > Flashcards

MEGACODE Flashcards

1
Q

WHAT ARE THE PULSELESS ALGORITHMS

A

VFIB/Pulseless VT (shock)(epi/amio/lido) and also PEA JUST CPR AND EPI

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2
Q

What’s in the PEA cycle?

A

Check Rhythm/pulse, 2min CPR,1mg Epi every 3-5- and check H(02,CO2,VOL,TEMP,K), T(Trauma/tox, TP/CT, THROMB L/H, ACS)

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3
Q

What are H/T ?

A

H(02,CO2,VOL,TEMP,potassium), T(Trauma/tox, Tension Pneumo/Cardiac Tamponade, THROMB L/H) and ACS

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4
Q

What are the only shockable rhythms?

A

Vent Fib and pulseless VT

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5
Q

What’s in the VF/pVT cycle?

A

check rhythm/pulse, SHOCK-2minCPR-check rhthym/pulse, SHOCK-2minCPR. In between EPI 1mg/AMIO 300/EPI 1mg/AMIO 150 (or LIDO 1.5, then 0.75mg/kg)

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6
Q

What are the only CARDIOVERT rhythms?

A

UNSTABLE TACH- with ST/SVT/AT/AFLTR 50J, AFIB/MONO VT 100J, POLY VT, 200J.
CALL MEDCON FOR POLYMORPH VTACH.

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7
Q

What is the only PACE rhythm?

A

UNSTABLE BRADY

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8
Q

STABLE BRADY - what do you do?

A

O2/IV/monitor/12 lead- watch vitals and observe - 12 lead

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9
Q

STABLE TACHY - narrow/regular- - what do you do?

A

O2/IV/monitor-VAGAL - Adenosine &flush 6/12/12
BB or CCB
-METOPROLOL(bb) 5mg/1-2 min. May repeat 3X or CARDIZEM(ccb) 0.25mg/kg after 10 min mg/kg

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10
Q

STABLE TACHY - narrow/irregular- - what do you do?

A

O2/IV/monitor- Cardizem 0.25mg/kg then 0.35mg/kg - medcon

BB or CCB
-METOPROLOL(bb) 5mg/1-2 min. May repeat 3X or CARDIZEM(ccb) 0.25mg/kg after 10 min mg/kg

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11
Q

STABLE TACHY - wide/regular- - what do you do?

A

O2/IV/monitor- Adenosine &flush 6/12
then Procainimide 20/30 mg/min w/1mg/min infusion
or Amio 150 to 1mg/min,
Or LIDO 0.5mg/kg to 2-4mg/min,

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12
Q

STABLE TACHY- wide/irregular - - what do you do?

A

O2/IV/monitor- Torsades? 1-2G Mag Sulfate- medcon all others

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13
Q

UNSTABLE BRADY - what do you do?

A

O2/IV/monitor- ATROPINE 1mg (every 3-5mg) x3 [no good for second type 2 or third block] /PACE 70ppm-70mV then Dope 5-20mg/kg then EPI 2-10mcg/kg

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14
Q

UNSTABLE TACHY - narrow/regular- - what do you do?

A

O2/IV/monitor- synchronized cardioversion @50J

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15
Q

UNSTABLE TACHY - narrow/irregular- - what do you do?

A

O2/IV/monitor- synchronized cardioversion AFLTR@50J and AFIB@100J

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16
Q

UNSTABLE TACHY - wide/regular- - what do you do?

A

O2/IV/monitor- synchronized cardioversion @100J

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17
Q

UNSTABLE TACHY- wide/irregular - - what do you do?

A

O2/IV/monitor- synchronized cardioversion @200J- NO SYNC? DFIB AT 200J

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18
Q

ROSC? What do do now?

A

RELAX- YOU GOT PULSE. Get advanced airway ETT with cap @10BPM, 02-92-98%, CO2 35-45, SBP>90 or MAP>65 [temp therapy 30-32 NS, 1L bolus, Norepi 0.1-0.5mcg/g/min, or EPI 2-10cg/min or Dope 5-20 mcg/kg/min0, THE ANTI THAT BROKE IT, get 12 LEAD, check H and T

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19
Q

meds for transcutaneous pacing?

A

Fentanyl/Versed/Ketamine: Fentanyl -1mcg/kg, Versed 1mg-2mg, Ketamine 2-4mg/kg

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20
Q

meds for cardioversion?

A

Fentanyl/Versed/Ketamine: Fentanyl -1mcg/kg, Versed 1mg-2mg, Ketamine 2-4mg/kg

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21
Q

NO DRUGS UNTIL

A

MONITOR

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22
Q

TRISMUS- WHAT DO DO?

A

Try BVM with NPA first- if not. Then sedative and paralytic

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23
Q

TRISMUS-WHAT DOSES?

A

SUCCINYLCHOLINE (anectine), 1-2mg/KG rapid (repeat 1 if necessary/lasts 5-10 minutes), Versed(midazolam) 1-2mg, OR LORAZAPAM(ativan) 2mg IV diluted, 4mg IM (15-30min) no prego.

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24
Q

TRISMUS-WHAT OTHER DRUGS

A

BENZO (relax/pain)/PARALYTIC(stop gag)/DISSASOCIATIVE (forget)/Analgesic (discomfort)

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25
Q

TRISMUS- doses for dissasociative and analgesia

A

KETAMINE- 2-4mg/kg IV (6-12mg/kg IM), Fent- 1mcg/kg

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26
Q

Antiarrhythmics list

A

Atropine 4 brady (stops brakes), Adenosine first line 4 ST/SVT/AT/ and MONOVT (fast/liquid dfib 6-6-12 slows AV node), Cardizem 4 Afib/fltr (slows rate/sa and av conduction), Amioderone 4 monoVtach (prolongs abs refract period), Lidocaine 4 mono vtach (decreases irritibility) , Procainamide for monoVtach (slows vent conduction)

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27
Q

Class 1 antidysrrhythmics

A

SODIUM - 1A- slows sodium in cells: Pronestyl/procainamide- suppress ectopic foci- can prolong Qtinterval.
1B- LIDOCAINE- Blocks Sodium in Purkinje fibers

28
Q

Class 2 antidysrhythmics

A

Beta Blocker (blocks chatacholemines epi and norepi)- METAPROLOL - reduces rate during myocardial ischemia and reduces myocardial 02 demand and reduces BP.

29
Q

Class 3 antidysrhythmics

A

PotassiumChannel Blocker - Increase PHASE 1/2/3- for atrial and ventricular tachycardias- prolongs absolute refractory period AMIODERONE -

30
Q

Class 4 antidysrhythmics

A

Calcium Channel Blocker - reduces BP, reduces HR by slowing conduction throuth SA and AV nodes, increases O2 to myocardial cells. SLOWS AV CONDUCTION- Verapamil and Diltiazem/CARDIZEM

31
Q

Class 5 antidysrhythmics - the unknowns

A

ADENOSINE - the heart stopper - liquid DFIB, and Magnesium Sulfate -

32
Q

Action Potential Pneumonics

A

Summit/Plummet/Continue/Plummet (cells) vs Climb/Plummet (nodes)

33
Q

Action potential ions

A

CELLS: Summit (Na+ in)/Plummet (K+OUT)/Continue (Ca+ IN)/Plummet (K+OUT) (cells). NODES: Climb (Ca+IN) /Plummet (K+OUT)

34
Q

OD on BETA BLOCKER-

A

Glucagon 1-5mg

35
Q

OD on CALCIUM CHANNEL BLOCKER?

A

calcium chloride 20mg/kg and Glucagon 1-5mg

36
Q

What do beta blockers do? What drugs?

A

block beta- block sympathetic- block epi/norepi. Extend Phaze 4, and slow conduction. METAPROLOL(lopressor) and PROPRANOLOL (inderall)

37
Q

What do calcium blockers do? What drugs?

A

Slows nodal conduction, extends phase 0 for nodes (climb/calcium).CARDIZEM(diltiazem) and VERAPAMIL

38
Q

What do sodium channel blockers do? What drugs?

A

Extends phase 1, and therefore ERP, LIDOCAINE (1B), PROCAINIMIDE(1A)

39
Q

What do potassium channel blockers do? What drugs?

A

extends phase 3 and therefore ERP, but also QT can initiate Torsades. AMIODERONE.

40
Q

LIDOCAINE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

CLASS 1A SODIUM- VF/pVT- 1-1.5mg/kg (for refractory may give additional 0.5-0.75mg/kg in 5-10 min with MAX of 3mg/kg). STABLE VT -Wide 0,5-1.5 mg/kg same additional. INFUSION: 1-4mg/min. onset 1-5 minutes.

41
Q

ADENOSINE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

(clss 5 unknown). 1st line SVT/Narrow Tach/MonoVtach just REGULAR not for AFIB/AFLTR/VF. RAPID PUSH WITH FLUSH 6/12/12mg for regular narrow, and 6/12 then amio or lido. NOT FOR DRUG INDUCED TACHY or 3rd degree block. ONSET seconds done in 12 seconds. Liquid DFIB- cans stop heart.

42
Q

ATROPINE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

(parasympatholytic) 1st line symptomatic sinus BRADY - may help 1st or 2nd degree type 1 block. 1mg every 3-5 minutes up to 3mg. ORGANOPHOSPHATE POISONING large doses. 2mg to 4mg or more. Onset immediate up to 4-6 hours. Caustion with MI- increases O2 demand. Not for hypothermic brady or second degree type 2 or third degree block.

43
Q

AMIODERONE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

(class 3 PCB) VF/pVT unresponsive to shock and pressor (after shock and epi) 1st 300mg, 2nd 150mg. UNSTABLE VT (caution: lasts long/many interactions/not with prolong QT/ causes hypotension). 150mg/10min rapid, 1mg/min slow, 0.5mg/min maintenance. MAX 2200MG/24hrs. Onset 2 hours peak 3-7 hours duration unknown. No prego. Also blocks sodium and calcium.

44
Q

CARDIZEM- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

(class 4 CCB) STABLE/NARROW/IRREGULAR TACH Afib/Afltr: 0.25mg/kg after 10 min 0.35mg/kg. (infuse at 10mg/hr)

45
Q

PROCAINAMIDE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

(1A sodium)- Stable monomorphic VT (or re-entry sVT after adenosine and vagal, or with stable wide complex tach of unknown origin). NOT WITH TORSADES or second or third heart block. 20-30mg/min up to 17mg/kg OR dysrhythmia ends, or HYPOT, or QRS widens >50%.

46
Q

METAPROLOL- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

BETA 1 BLOCKER- stops epi and norepi - Stable monomorphic Tachy - after adenosine and vagal. 5mg/1-2 minutes up to 3X onset 1-2minute up to 3-4 hours. No breastfeed/NOT WITH DILTIAXEM or VERAPAMIL - don’t block calcium and beta

47
Q

GLUCAGON- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

OVERDOSE on Beta blockers or Calcium Channel Blockers - 0.05 to 0.15 mg/kg IV/IO/3-5 minutes. 0.05 to 0.10mg/min infusion. Onset 1 minute up to 1.5hours.

48
Q

CALCIUM CHLORIDE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

OVERDOSE on Beta blockers or Calcium Channel Blockers (also hyperkalemia, hypocalcemia, hypermagnesemia)- BETA OD: 20MG/KG max 1G. CALCIUM OD: 500mg to 1000mg. Onset 1-3 minutes. Up to 30 minutes or even 4 hours. IV preferred

49
Q

SUCCINYLCHOLINE_ WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

TRISMUS - a PARALYTIC - SUCCINYLCHOLINE (anectine), 1-2mg/KG rapid (repeat 1 if necessary/lasts 5-10 minutes), warn patient

50
Q

MIDAZOLAM- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

TRISMUS or PACE or CARDIOVERSION 1-2MG. Onset 1-3 minutes for 4-6 hours (no prego- monitor- reduce by 50% for geriatric).

51
Q

KETAMINE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

dissasociative TRISMUS or PACE or CARDIOVERSION 2-4mg/kg IV/IO 6-12mg/kg IM - 30second onset for 5-10 minutes (could cause hypertension and resp depression)

52
Q

MAGNESIUM SULFATE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING

A

CARDIAC ARREST - due to hypomagnesemia or Torsades de Pointes: 1-2 g (2-4 ml of 50% solution into 10ml NS). TORSADES W/PULSE or AMI with HYPO: 1-2G mixed in 50-100ml NS over 5-60 minutes. Follow with 500-1000mg/hour infusion. Onset IMMEDIATE with IV/IO- up to 30 minutes. NOT WITH HEART BLOCK! drop in BP

53
Q

Dopamine- WHEN/HOW MUCH/WHAT/HOW LONG/WARNING

A

SECOND for symptomatic BRADY after atropine. Also for hypotension. 5-20 mcg/kg/min TITRATE. Don’t mix with sodium bicarb. VOLUME before squeeze. Not with CHF. Onset 1-4 minutes stops when infusion stops.

54
Q

EPINEPHRINE- WHEN/HOW MUCH/WHAT/HOW LONG/WARNING

A

VF/pulselessVT/Asystole/PEA- Symptomatic Brady after atropine (and dope). Severe Hypotension when pacing and atropine fail. Or when brady and hypor- or with phosphodiesterase enzyme inhibitor. Anaphylaxis (combine with fluid volume/corticosteroids and antihistamines). DOSE - 1mg every 3-5 minutes WITH FLUSH. infusion of 0.1-0.5 mcg/kg/min. TITRATE. ETT route- 2-2.5mg in 10mlNS. PROFOUND BRADY: 2-10mcg/min titrate.

55
Q

50J - WHEN?

A

Sinus Tach. A Flutter. SVT

56
Q

100J- WHEN?

A

A Fib. Mono VTACH

57
Q

200J- WHEN?

A

Poly VTACH or vfib

58
Q

LVAD triangle- initial

A

Skin Color and Temp- Cap refill- Check LOC

59
Q

LVAD perfusion ok? LOC check

A

Hypoxia/BGL/OD/STROKE (aeioutipps)

60
Q

LVAD- perfusion not ok? What next?

A

Look listen alarms and hum

61
Q

LVAD IS FUNCTIONING - now what?

A

Check MAP>50 and or petCO2>20

62
Q

LVAD functioning and MAP>50 and PETCO2>20mmHg what next

A

DO NOT PERFORM CPT- follow local protocols contact medcon

63
Q

Goal MAP and CO2 for LVAD

A

MAP>50 and PETCO2>20mmHg

64
Q

LVAD not functioning- now what?

A

Attempt to restart- power- ask people- call number

65
Q

Can’t get LVAD to start–

A

MEDCON- Perform compressions (upper)

PHARMACOLOGY for CCCC MEDIC 2 (11 decks)

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