Midterm Drugs Flashcards
Adenosine
Class
Antiarrhythmic, endogenous nucleotide
Adenosine
Mechanism of Action
Slows conduction time through the AV node; can interrupt re-entrant pathways; slows heart rate; acts directly on sinus pacemaker cells. The drug of choice for re-entry SVT. Can be used diagnostically for stable, wide-complex tachycardias (suspected SVT with aberrancy).
Adenosine
Indications
Regular tachycardias (narrow and wide). Conversion of PSVT to sinus rhythm. May convert re-entry SVT due to Wolff-Parkinson-White syndrome. Not effective in converting atrial fibrillation/flutter, or V-tach.
Adenosine
Adverse Reactions
Facial flushing, shortness of breath, chest pain, headache, paresthesia, diaphoresis, palpitations, hypotension, nausea
Adenosine
Adult Dosing
6 mg over 1 – 3 seconds, followed by a 20 mL saline flush and elevate the patients extremity.
If no response after 1 – 2 minutes, administer 12 mg over 1 – 3 seconds; maximum total dose 30 mg.
Adenosine
Pediatric Dose
0.1 – 0.2 mg/kg rapid IV; maximum single dose of 12 mg.
Adenosine
Duration:
12 seconds
Albuterol
Class
Sympathomimetic, bronchodilator
Albuterol
Mechanism of Action
Selective beta-2 agonist that stimulates adrenergic receptors of the sympathetic nervous system resulting in smooth muscle relaxation in the bronchial tree and peripheral vasculature.
Albuterol
Indication
Treatment of bronchospasm in patients with reversible obstructive airway disease (COPD/Asthma). Prevention of exercise-induced asthma.
Albuterol
Adverse Reactions
Often dose-related and include restlessness, tremors, dizziness, palpitations, tachycardia, nervousness, peripheral vasodilation, nausea, vomiting, hyperglycemia, increased blood pressure, and paradoxical bronchospasm
Albuterol
Adult Dosing
Administer 2.5 mg. Dilute 0.5 mL of 0.5% solution for inhalation with 2.5 mL normal saline in nebulizer and administer over 10 – 15 minutes. MDI – 1 – 2 inhalations with 5 minutes between inhalations.
Albuterol
Pediatric Dose
Administer a solution of 0.01 – 0.03 mL diluted in 2 mL of 0.9% NS. May be repeated every 20 minutes three times.
Albuterol
Duration
Duration: 3 – 4 hours
Amiodarone
Class
Antiarrhythmic
Amiodarone
Mechanism of Action
Blocks sodium channels and myocardial potassium channels.
Amiodarone
Indications
V-fib/pulseless and unstable V-tach
Amiodarone
Adverse Reactions
Hypotension, bradycardia, prolongation of the P-R, QRS, and Q-T intervals.
Amiodarone
Adult Dose: V-fib/ pulseless V-tach unresponsive to CPR, defibrillation, and
vasopressors:
300 mg IV/IO push. Initial dose may be followed one time with in 3 – 5 minutes at 150 mg IV/IO push.
Amiodarone
Adult Dose: Recurrent life-threatening ventricular arrhythmias:
Maximum cumulative dose is 2.2 g/24 hours administered as: 150 mg IV/IO over 10 minutes (15 mg/min). May repeat rapid infusion (150 mg IV/IO) every 10 minutes as needed.
Amiodarone
Adult Dose: Maintenance infusion:
540 mg IV/IO over 18 hours (0.5 mg/min).
Amiodarone
Pediatric Dose:
Perfusing supraventricular and ventricular tachycardias:
Loading dose of 5 mg/kg IV/IO over 20 – 60 minutes with a maximum single dose of 300 mg. Can be repeated to a maximum of 15 mg/kg/day.
Amiodarone
Duration
Duration: 30 – 45 minutes
Amiodarone
Pediatric Dose:
Refractory V-fib/pulseless V-tach:
5 mg/kg IV/IO bolus, which may be repeated up to a total dose of 15 mg.kg per 24 hours. Maximum single dose is 300 mg.
Atropine
Class
Parasympatholytic-Parasympathetic blocker (Anticholinergic)
Atropine
Mechanism of Action
Potent parasympathetic blocker used to increase the heart rate in hemodynamically significant bradycardia (accompanied by hypotension, shortness of breath, chest pain, AMS, and/or shock). It blocks acetylcholine receptors, inhibiting parasympathetic stimulation. The effects are primarily chronotropic, and atropine has almost no inotropic effect. It acts as an antidote for organophosphate poisoning.
Atropine
Indications
Hemodynamically significant bradycardia with a pulse; organophosphate poisoning
Atropine
Adverse Reaction
Blurred vision, dilated pupils, dry mouth, tachycardia,
drowsiness, urinary retention, and confusion
Atropine
Adult Dose
0.5 mg IV repeated every 3-5 minutes until a maximum of 3 mg is reached.
Atropine
Pediatric Dose
0.02 mg/kg minimum dose of 0.1 mg, max single dose of 0.5 mg.
Atropine
Duration
4 hours
Calcium Chloride
Class
Electrolyte
Calcium Chloride
Mechanism of Action
Increases cardiac contractility (positive chronotropic effect) and may enhance ventricular automaticity.
Calcium Chloride
Indications
Hypocalcemia, hyperkalemia, magnesium sulfate overdose, calcium channel-blocker overdose, adjunctive therapy in treatment of insect bites and stings.
Calcium Chloride
Adverse Reactions
Bradycardia, Asystole, hypotension, peripheral vasodilation,
local necrosis, coronary and cerebral artery spasm, nausea and vomiting.
Calcium Chloride
Adult Dose
500 – 1,000 mg (5 – 10 mL of a 10% solution) IV/IO push for hyperkalemia and calcium channel-blocker overdose (repeated as needed).
Calcium Chloride
Pediatric Dose
20 mg/kg (0.2 mL/kg) slow IV/IO push. Maximum 1 g dose; may repeat in 10 minutes.
Calcium Chloride
Duration
15 – 30 minutes, but may persist up to 4 hours depending on
the dose administered.
Dexamethasone (Decadron, Hexadrol)
Class
Corticosteroid
Dexamethasone (Decadron, Hexadrol)
Mechanism of Action
Mechanism of action: Suppress both acute and chronic inflammation; immunosuppressive effects (especially in anaphylaxis). Possibly decreases cerebral edema.
Dexamethasone (Decadron, Hexadrol)
Indications
Anaphylaxis (after epinephrine and Benadryl), asthma, COPD, croup, spinal cord injury, elevated intracranial pressure (prevention and treatment).
Dexamethasone (Decadron, Hexadrol)
Adverse Reactions
GI bleeding, prolonged wound healing, TB. None from a
single dose.
Dexamethasone (Decadron, Hexadrol)
Adult Dose
10-100 mg IV (1mg/kg slow IV bolus)
Dexamethasone (Decadron, Hexadrol)
Pediatric Dose
0.25 – 1.0 mg/kg/dose IV, IO, and IM.
Dexamethasone (Decadron, Hexadrol)
Duration
24 – 72 hours
Dextrose 50%
Class
Carbohydrate, hypertonic solution
Dextrose 50%
Mechanism of Action
Rapidly increase serum glucose levels. Short-term osmotic diuresis
Dextrose 50%
Indications
Hypoglycemia, altered level of consciousness.
Dextrose 50%
Adult Dose
12.5-25g slow IV; may be repeated as necessary
Dextrose 50%
Pediatric Dose
0.5 g/kg/dose slow IV; may be repeated as necessary
Diazepam (Valium)
Class
Benzodiazepine, anxiolytic, sedative-hypnotic, and anticonvulsant
Diazepam (Valium)
Mechanism of Action
Potentiates the effects of inhibitory neurotransmitters. Raises the seizure threshold. Includes amnesia and sedation.
Diazepam (Valium)
Indications
Acute anxiety states, acute alcohol withdrawal (delirium tremens), muscle relaxant, seizure activity, agitation. Analgesia for medical procedures (fracture reduction, cardioversion, pacing).
Diazepam (Valium)
Adult Dose IV
Seizure activity 5 – 10 mg IV q 10 – 15 minutes prn (5 mg over 5 minutes)(maximum single dose, 30 mg).
Diazepam (Valium)
Pediatric Dose IV
0.2 – 0.5 mg slow IV q 2 – 5 minutes up to 5 mg (maximum dose 10 mg/kg).
Diazepam (Valium)
Sedation for cardioversion:
5 – 15 mg IV over 5 – 10 minutes prior to cardioversion.
Diltiazem Hydrochloride (Cardizem, Lyo-Ject) Class
Calcium channel blocker
Diltiazem Hydrochloride (Cardizem, Lyo-Ject) Indications:
Control of rapid ventricular rates due to atrial flutter, atrial fibrillation, and re-entry SVT; angina pectoris.
Diltiazem Hydrochloride (Cardizem, Lyo-Ject) Adult Dose
Initial bolus: 0.25 mg/kg (average does of 15 – 20 mg) IV over 2 minutes. If inadequate response, may repeat bolus in 15 minutes: 0.35 mg/kg (average dose 20 – 25 mg) IV over 2 minutes. Maintenance infusion of 5 – 15 mg/hr
Diltiazem Hydrochloride (Cardizem, Lyo-Ject) Pediatric Dose
Not recommended
Dopamine
Class
Sympathomimetic, inotropic agent
Dopamine
Indications:
Cardiogenic, septic or spinal shock, hypotension with low cardiac output states, and distributive shock.
Dopamine
Adult Dose
IV infusion at 2 – 20 mcg/kg/min titrated to effect 400 mg in 250 ml ( or 800mg/500ml or 1600mg/1000mL)
Dopamine
Pediatric Dose
2 – 20 mcg/kg/min titrated to effect
Dopamine
dilates vessels in kidneys; increased urine output.
2 – 5 mcg/kg/min:
Dopamine primarily vasoconstriction (alpha effects)
o 10 – 20 mcg/kg/min:
Dopamine
increased heart rate (beta effects)
o 5 – 10 mcg/kg/min:
Enoxaparin (Lovenox)
Class
Anticoagulant-low molecular weight heparin/ heparin derivative.