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MICA Pharmacology Flashcards

1
Q

Adenosine

Pharmacology

A

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

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2
Q

Adenosine

Indications

A
  1. AVRNT with adequate or inadequate perfusion but not deteriorating rapidly
  2. AVRT and assoc WPW syndrome or other accessory tract SVT with adequate or inadequate perfusion but not deteriorating rapidly
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3
Q

Adenosine

Contraindications

A
  1. Second degree or third degree AV block (may produce prolonged sinus arrest/AV blockage)
  2. AF
  3. Atrial flutter
  4. Ventricular tachyarrhythmias
  5. Known hypersensitivity.
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4
Q

Adenosine

Precautions

A
  1. Adenosine may provoke bronchospasm in the asthmatic patient
  2. 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
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5
Q

Adenosine

Side effects

A

Usually brief and transitory

  1. Transient arrhythmia (including asystole, bradycardia, or ventricular ectopy) may be experienced following reversion
  2. Chest pain
  3. Dyspnoea
  4. Headache or dizziness
  5. Nausea
  6. Skin flushing
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6
Q

Adenosine

Doses

A

If BP <90
6mg IV

Repeat @ 2/60 12mg IV. One further dose given at 2/60

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7
Q

Amiodarone

Pharmacology

A

150mg in 3ml

Class III anti-arrhythmic agent

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8
Q

Amiodarone

Indications

A
  1. VF/ pulseless VT refractory to cardioversion

2. Sustained or recurrent VT

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9
Q

Amiodarone

Contrainidcations

A
  1. VF/pulseless VT refractory to cardioversion - nil significance in this setting
  2. VT contra if pregnant
  3. TCA OD
  4. Do not administer if VT follows ondansetron administration
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10
Q

Amiodarone

Precautions

A

Nil of significance

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11
Q

Amiodarone

Side effects

A
  1. Hypotension

2. Bradycardia

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12
Q

Amiodarone

Special notes

A

Onset: 2min
Peak: 20min
Duration: 2hours

Incompatible with normal saline. Must be diluted with glucose 5%

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13
Q

Amiodarone

Dose

A

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

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14
Q

Atropine

Pharmacology

A

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
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15
Q

Atropine

Indications

A
  1. Unstable bradycardia
  2. Organophosphate OD with excessive cholinergic effects
  3. Hypersalivation as a side effect of ketamine
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16
Q

Atropine

Contraindications

A

Previous heart transplant

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17
Q

Atropine

Precautions

A
  1. Atrial flutter
  2. AF
  3. Myocardial infarction
  4. Do no increase HR above 100 except children under 6years
  5. Glaucoma
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18
Q

Atropine

Side effects

A
  1. Tachycardia
  2. Palpitations
  3. Dry mouth
  4. Dilated pupils
  5. Visual blurring
  6. Retention of urine
  7. Confusion, restlessness (in large doses)
  8. Hot, dry skin (in large doses)
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19
Q

Atropine

Special notes

A

Onset <2min
Peak <5min
Duration 2-6hours

10ml flush of saline MUST be administered after atropine if adrenaline is also going to be administered

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20
Q

Atropine

Doses

A

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

21
Q

Calcium gluconate

Pharmacology (mode of action)

A
  • 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.
22
Q

Calcium gluconate

Indications

A
  1. Cardiac arrest where hyperkalaemia is suspected

2. Following transfusion of PRCC (hems only)

23
Q

Calcium gluconate

Contraindications

A
  1. Suspected digoxin toxicity
24
Q

Calcium gluconate

Precautions

A

Monitor injection site carefully and stop administration immediately if extravasation occurs

25
Calcium gluconate | Side effects
1. Hypercalcaemia 2. Tissue necrosis (extravasation) 3. Rapid administration may cause - hot flushes - chalky taste - hypotension - bradycardia - cardiac arrhythmias (AV dissociation, ventricular ectopics, VT and VF) - syncope - cardiac arrest
26
Frusemide | Pharmacology
40mg in 4ml A diuretic Action - causes venous dilation and reduces venous return - promotes diuresis
27
Frusemide | Indications
Consider in cardiogenic APO
28
Frusemide | Contraindications
Nil of significant
29
Frusemide | Precautions
Hypotension
30
Frusemide | Side effects
Hypotension
31
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
32
Heparin | Pharmacology
5000units in 5ml Anticoagulant Inactivates clotting factor IIa (thrombin) and Xa by binding to antithrombin III
33
Heparin | Indications
Acute STEMI
34
Heparin | Contrainidcations
1. Known allergy or hypersensitivity 2. Active bleeding (excluding menstration) 3. Oral anticoagulants (eliquis, apixaban, dabigatran, rivaroxaban, warfarin) 4. Bleeding disorders 5. Hx of heparin induced thrombocytopenia 6. Severe hepatic impairment/disease, including oesophageal varices 7. Recent trauma or surgery <3weeks
35
Heparin | Precautions
Renal impairment
36
Heparin | Side effects
1. Bleeding 2. Bruising and pain at injection site 3. Hyperkalaemia 4. Thrombocytopenia (mild to severe)
37
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
38
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
39
Rocuronium | Indications
Intubation to provide skeletal muscle paralysis
40
Rocuronium | Contraindications
Nil of significant
41
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)
42
Rocuronium | Side effects
CV - tachycardia - hypotension Other - anaphylaxis (rare)
43
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)
44
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
45
Tenectaplase | Indications
Acute STEMI
46
Tenectaplase | Contraindications
1. Major surgery in the past 3months 2. Significant head injury in the past 3months. 3. Major trauma in the past 3months 4. Stroke/TIA in the past 3months 5. ICH at any time 6. GI or genitourinary bleed in the past month 7. Current bleeding disorder, active bleeding (excluding mensuration), or bleeding tendencies 8. Anticoagulants or glycoprotein IIb/IIIa inhibitors 9. Allergy to tenecteplase or gentamicin
47
Tenecetaplase | Precaution
1. Age >75 2. Non-compressible vascular puncture 3. History of liver disease 4. SBP >160 or DBP >110 5. Low body weight 6. Active peptic ulcer 7. Anaemia 8. Acute pericarditis or subacute bacterial endocarditis 9. Traumatic or prolonged >10min CPR 10. Pregnant or within 1week port partum 11. HR >120
48
Tenectaplase | Side effects
1. Bleeding including injection site, ICH, internal bleeding 2. Transient hypotension 3. Infrequent allergic reactions, fever, chills, rash, nausea, headache, bronchospasm, vascultitis, nephritis and anaphylaxis

AV CPG's (11 decks)

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