MICA Pharmacology Flashcards
Adenosine
Pharmacology
6mg in 2ml
A naturally occurring purine nucleoside found in all body cells
Actions
- slows conduction velocity though the AV node, resulting in termination of re-entry circuit activity within or including the AV nodal pathway
Adenosine
Indications
- AVRNT with adequate or inadequate perfusion but not deteriorating rapidly
- AVRT and assoc WPW syndrome or other accessory tract SVT with adequate or inadequate perfusion but not deteriorating rapidly
Adenosine
Contraindications
- Second degree or third degree AV block (may produce prolonged sinus arrest/AV blockage)
- AF
- Atrial flutter
- Ventricular tachyarrhythmias
- Known hypersensitivity.
Adenosine
Precautions
- Adenosine may provoke bronchospasm in the asthmatic patient
- Adenosine is antagonist by methlyanthines (caffeine, theophyllines drug used of COPD and asthma). The drug may not be effective in patients with large caffeine intake or those on high doses of theophylline medications
Adenosine
Side effects
Usually brief and transitory
- Transient arrhythmia (including asystole, bradycardia, or ventricular ectopy) may be experienced following reversion
- Chest pain
- Dyspnoea
- Headache or dizziness
- Nausea
- Skin flushing
Adenosine
Doses
If BP <90
6mg IV
Repeat @ 2/60 12mg IV. One further dose given at 2/60
Amiodarone
Pharmacology
150mg in 3ml
Class III anti-arrhythmic agent
Amiodarone
Indications
- VF/ pulseless VT refractory to cardioversion
2. Sustained or recurrent VT
Amiodarone
Contrainidcations
- VF/pulseless VT refractory to cardioversion - nil significance in this setting
- VT contra if pregnant
- TCA OD
- Do not administer if VT follows ondansetron administration
Amiodarone
Precautions
Nil of significance
Amiodarone
Side effects
- Hypotension
2. Bradycardia
Amiodarone
Special notes
Onset: 2min
Peak: 20min
Duration: 2hours
Incompatible with normal saline. Must be diluted with glucose 5%
Amiodarone
Dose
Cardiac arrest
After 3 DCCS 300mg IV/IO
After 5 DCCS 150mg IV/IO
Conscious VT stable
- 5mg/kg IV max 300mg over 20/60
Atropine
Pharmacology
600mcg in 1ml
1200mcg in 1ml
An anticholinergic agent
Actions
- inhibits the actions of acetylcholine on post ganglionic cholinergic nerves at the neuro-effector site e.g. as a vagal blocker and allows sympathetic effect to;
- increase HR to increasing SA node firing rate
- increase the conduction velocity through AV node
- antidote to reverse the effects of cholinesterase inhibitors (organophosphate insecticides) at the post ganglionic neuro-effector sites of cholinergic nerves to:
- reduce the excessive salivary, sweat, GIT and bronchial secretions and
- relax smooth muscles
Atropine
Indications
- Unstable bradycardia
- Organophosphate OD with excessive cholinergic effects
- Hypersalivation as a side effect of ketamine
Atropine
Contraindications
Previous heart transplant
Atropine
Precautions
- Atrial flutter
- AF
- Myocardial infarction
- Do no increase HR above 100 except children under 6years
- Glaucoma
Atropine
Side effects
- Tachycardia
- Palpitations
- Dry mouth
- Dilated pupils
- Visual blurring
- Retention of urine
- Confusion, restlessness (in large doses)
- Hot, dry skin (in large doses)
Atropine
Special notes
Onset <2min
Peak <5min
Duration 2-6hours
10ml flush of saline MUST be administered after atropine if adrenaline is also going to be administered
Atropine
Doses
Bradycardia unstable
- 600mcg IV
- 1200mcg IV @3-5/60 if inadequate response
Adequate response
- 600mcg IV @3-5/60 as required max 3g 5doses
Organophosphate poisoning
1200mcg @5/60
Calcium gluconate
Pharmacology (mode of action)
- electrolyte - replaces depleted serum calcium
- calcium directly antagonises the effects of hyperkalaemia on myocardial cells, but has no effect on potassium levels
- hypocalaemia is associated with blood transfusions due to the addition of citrate to packed red cell concentrate. Citrate chelates ionised calcium, reducing plasma concentrations.
Calcium gluconate
Indications
- Cardiac arrest where hyperkalaemia is suspected
2. Following transfusion of PRCC (hems only)
Calcium gluconate
Contraindications
- Suspected digoxin toxicity
Calcium gluconate
Precautions
Monitor injection site carefully and stop administration immediately if extravasation occurs
Calcium gluconate
Side effects
- Hypercalcaemia
- Tissue necrosis (extravasation)
- Rapid administration may cause
- hot flushes
- chalky taste
- hypotension
- bradycardia
- cardiac arrhythmias (AV dissociation, ventricular ectopics, VT and VF)
- syncope
- cardiac arrest
Frusemide
Pharmacology
40mg in 4ml
A diuretic
Action
- causes venous dilation and reduces venous return
- promotes diuresis
Frusemide
Indications
Consider in cardiogenic APO
Frusemide
Contraindications
Nil of significant
Frusemide
Precautions
Hypotension
Frusemide
Side effects
Hypotension
Frusemide
Special notes
The effects of vasopressor medications will often be reduced after treatment with frusemide.
Onset 5min
Peak 20-60min
Duration 2-3 hours
Heparin
Pharmacology
5000units in 5ml
Anticoagulant
Inactivates clotting factor IIa (thrombin) and Xa by binding to antithrombin III
Heparin
Indications
Acute STEMI
Heparin
Contrainidcations
- Known allergy or hypersensitivity
- Active bleeding (excluding menstration)
- Oral anticoagulants (eliquis, apixaban, dabigatran, rivaroxaban, warfarin)
- Bleeding disorders
- Hx of heparin induced thrombocytopenia
- Severe hepatic impairment/disease, including oesophageal varices
- Recent trauma or surgery <3weeks
Heparin
Precautions
Renal impairment
Heparin
Side effects
- Bleeding
- Bruising and pain at injection site
- Hyperkalaemia
- Thrombocytopenia (mild to severe)
Heparin
Special notes
Dont give IM
Onset immediate
Duration 3-6hours
The half life is 60min as such a patient who has received a bolus dose will require a repeat dose if their travel time is >1hour to to PCI
Rocuronium
Pharmacology
50mg in 5ml
Non-depolarising neuromuscular blocking agent
Action
Competes with ACh to block cholinergic receptors located at motor endplate or striated muscles
Rocuronium
Indications
Intubation to provide skeletal muscle paralysis
Rocuronium
Contraindications
Nil of significant
Rocuronium
Precautions
Status epilepticus - consult with receiving hospital for ongoing maintenance of paralysis if required for patient safety reason (can’t monitor underlying seizure activity to provide ongoing sedation)
Rocuronium
Side effects
CV
- tachycardia
- hypotension
Other
- anaphylaxis (rare)
Rocuronium
Special notes
Onset: adequate intubation conditions are established within 60seconds in nearly all patients
Duration: varies depending on dose (up to 60min for 1mg/kg) however, repeat doses required prior to previous dose wearing off to prevent any problems ( asynchronous ventilation, rise in ICP)
Tenectaplase
Pharmacology
50mg in pre filled syringe
Fibrinolytic, a modified form of tissue plasminogen activator tPA that binds to fibrin and converts plasminogen to plasmin
Tenectaplase
Indications
Acute STEMI
Tenectaplase
Contraindications
- Major surgery in the past 3months
- Significant head injury in the past 3months.
- Major trauma in the past 3months
- Stroke/TIA in the past 3months
- ICH at any time
- GI or genitourinary bleed in the past month
- Current bleeding disorder, active bleeding (excluding mensuration), or bleeding tendencies
- Anticoagulants or glycoprotein IIb/IIIa inhibitors
- Allergy to tenecteplase or gentamicin
Tenecetaplase
Precaution
- Age >75
- Non-compressible vascular puncture
- History of liver disease
- SBP >160 or DBP >110
- Low body weight
- Active peptic ulcer
- Anaemia
- Acute pericarditis or subacute bacterial endocarditis
- Traumatic or prolonged >10min CPR
- Pregnant or within 1week port partum
- HR >120
Tenectaplase
Side effects
- Bleeding including injection site, ICH, internal bleeding
- Transient hypotension
- Infrequent allergic reactions, fever, chills, rash, nausea, headache, bronchospasm, vascultitis, nephritis and anaphylaxis
