MOA, Special Considerations, Adverse Reactions, Onset/Duration Flashcards
Epinephrine: MOA
Direct acting alpha and beta agonist.
* Alpha: Bronchial, cutaneous, renal, and viceral arteriolar vasoconstriction. 🐍 Increases blood pressure and inproves perfusion.
* Beta 1: Positive inotropic and chronotropic actions - increases automaticity - increased heart rate and contractility.💪🏻💨🫀
* Beta 2: Bronchial smooth muscle relaxation and dilation of skeletal vasculature.🫁🧘 Blocks histamine release. 🤧
Epinephrine: Adverse Reactions
- Hypertension
- Dysrhythmias
- Pulmonary edema
- Anxiety😬
- Psychomotor agitiation 🫨
- Angina
- Headache
- Restlessness
Epinephrine: Drug Interactions
- Potentiates with other sympathomimetics.
- Deactivated by alkaline solutions.
- MAOI’s may potentiate effects of epi.
Epinephrine: Onset/Duration
Onset: Immediate
Peak: Minutes
Duration: Several minutes
Amiodarone: MOA
- Prolongation of action potential.
- Non-competitive aplha and beta sympathetic blocking effects.
- Calcium channel blocking effects.
Amiodarone: Adverse Reactions
- Hypotension
- Bradycardia
- PEA
- CHF
- Nausea
- Fever
Amiodarone: Drug Interactions
Will precipitate w/ Sodium Bicarbonate - Incompatable.
Amiodarone: Onset/Duration
Onset: 5-15 minutes
Peak: Variable
Duration: Variable (30-40 days)
Amiodarone: Special Considerations
- Preg. CAT C.
- Administer cautiously in patients with HF or poor systolic function.
Nitroglycerine: MOA
- Smooth muscle relaxant acting on vascular, bronchial, intestinal, and unterine smooth muscle.
- Dilation of arterioles and veins in the periphy - reduces preload and afterload.
- Decreases workload of the heart and thereby reduces myocardial O2 demand.
Nitroglycerine: Adverse Reactions
- Headache
- Hypotension
- Syncope
- Reflex tachycardia
- Flushing
- Nausea
- Vomiting
- Diaphoresis
- Muscle twitching
Nitroglycerine: Drug Interactions
Addative effects with other vasadilators.
Nitroglycerine: Onset/Duration
Onset: 1-3 minutes
Peak: 5-10 minutes
Duration: 20-30 minutes
IV: 1-10 minues after discontinued.
Nitroglycerine: Special Considerations
- Preg. CAT C
- Hypotension more common in geriatric.
- Decomposes in sunlight.
- Keep in airtight containers.
- Active ingredient may sting SL.
Aspirin: MOA
Prostoglandin inhibitor: reduces pain.
Blocks thromboxane A2: makes platelets less sticky.
Aspirin: Drug Interactions
Use caution in patients with NSAID allergy.
Aspirin: Adverse Reactions
- Heartburn
- GI bleeding
- Nausea/Vomiting
- Wheezing in allergic patients
- Prolonged bleeding
Aspirin: Onset/Duration
Onset: 30-45min
Peak: Variable
Duration: Variable
Aspirin: Special Considerations
Pregnancy CAT D.
Atropine Sulfate: MOA
- Increases conduction through the AV node.
- Increases HR in life-threatening bradydysrhythmias.
- Parasympatholitic: Inhibits action of acetylcholine at postganglionic parasympathetic neuroeffector sites.
Leads to increased HR, bronchiodilation, and **reduced secretions. **
Atropine Sulfate: Adverse Reactions
- Headache
- Dizziness
- Nausea/Vomiting
- Tachycardia
- Palpitations
- Dysrhythmias
- Paradoxical bradycardia when pushed slowly or at low doses.
- Flushing
- Anticholinergic effects: blurred vision, dry mouth, urine retention.
Atropine Sulfate: Drug Interactions:
Effects enhanced by:
* antihistamines
* antipsychotics
* benzodiazepines
* antidepressants
Atropine Sulfate: Onset/Duration
Onset: Immediate
Peak: 1-2 mins
Duration: 2-6 hrs
Atropine Sulfate: Special Considerations
- Preg. CAT C
- Moderate doses dialte pupils
Lidocaine: MOA
Decreasesd automaticity by slowing the rate of spontaneous phase 4 depolarization.
Raises the V-Fib threshold.
Lidocaine: Adverse Reactions
- Slurred speech
- Seizures
- AMS
- Confusion
- Lightheadedness
- Blurred vision
- Bradycardia
Lidocaine: Drug Interactions
- Apnea induced w/succinylcholine may be prolonged w/ high doses of lidocaine.
- Cardiac depression may occur in conjunction with IV Dilantin.
- Metabolic clearance decreased in patients w/ liver disease or those patients taking beta-blockers.
Lidocaine: Onset/Duration
Onset: 1-5min
Peak: 5-10min
Duration: Variable (15min-2hrs)
Lidocaine: Special Considerations
- Preganacy CAT B
- Reduce maintenance infusions by 50% if patient is over 70yo, has liver disease, CHF, or shock.
- A 75-100mg bolus maintains levels for only 20 minutes
- If bradycardia occurs w/PVC’s - always treat with Atropine!
- Exceeedingly high doses of Lidocaine can result in coma/death.
- Avoid lidocaine for reperfusion dysrhythmias after thombolytic therapy.
Metoprolol (Lopressor): MOA
- Selective inhibitor of beta-1 adregeneric receptors.
- Completely blocks beta-1 receptors (blocks the effects of adrenaline on the heart).
- Little or no effect on beta-2 receptors at doses <100mg.
Leads to a decrease in HR, BP, and myocardial O2 demand.
Metoprolol (Lopressor): Adverse Reactions
- Patients with respiratory conditions may experience bronchospasm.
- Bradycardia
- Palpitations
- Edema
- CHF
- Reduced peripheral circulation
- Drowsiness
- Insomnia
Metoprolol (Lopressor): Drug Interactions
- Drugs with slow AV conduction (Digoxin) - effects may be additive with beta-blockers.
- May blunt the hyperglycemic action of Glucogon.
- Verapamil or Diltiazem may have synergistic or addative pharmacological effects when taken concurrently with beta-blockers - Avoid concurent IV use.
Metoprolol (Lopressor): Onset/Duration
`
Onset: 1-3 min.
Duration: 3-4 hrs.
Metoprolol (Lopressor): Special Considerations
Pregancy CAT C (CAT D in 2nd & 3rd trimester)
Diltiazem (Cardizem): MOA
- Block influx of calcium ions into cardiac muscle.
- Arteriol and venous vasodilator.
- Reduces pre-load and afterload.
- Reduces myocardial O2 demand.
**Slows the conduction of electrical impulses through the AV node. **
Diltiazem (Cardizem): Adverse Reactions
- Bradycardia
- 2nd or 3rd degree AV blocks
- Chest pain
- CHF
- Syncope
- V-Fib/V-Tach
- Nausea/Vomiting
- Dizziness
- Dry Mouth
- Dyspnea
- Headache
Diltiazem (Cardizem): Drug Interactions
- Use caution in patients using medications that affect cardiac contractitlity.
- In general, shoudl not be used in patients on beta-blockers.
Diltiazem (Cardizem): Onset/Duration
Onset: 2-5 min
Peak: Variable
Duration: 1-3 hrs
Diltiazem (Cardizem): Special Considerations
- Preg. CAT C
- Use caution in patioents w/ renal or hepatic (liver) dysfunction.
Adenosine: MOA
- Binds to Adenosine receptors in the heart which activates potassium channels and inhibits calcium influx.
- ⬆️ temporarily blocks the AV node’s conduction (briefly stops the heart);
- which can be used diognostocally to identify certain types of arrhythmias.
Adenosine: Adverse Reactions
- Dizziness
- Dyspnea
- Hypotension
- Bronchospasm
- Palpitations
- Arrythmias
- Transient AV Block
Adenosine: Onset/Duration
Onset: Immediate
Duration: 12 seconds
Adenosine: Drug Interations
- Methylxanthines (theophylline-like drugs) antagonize the effects of adenosine.
- Dipyridamole (Persantine) potentiates the effects of adenosine.
- Carbamazepine (Tegretol) may potentate the AV Node blocking effects of adenosine.
Adenosine: Special Considerations
- Short half-life limits side effects in most patients.
- Preg. CAT C.
Calcium Chloride: MOA
- Increases amount of calcium ions in the body directly affecting intracellular calcium levels.
- ⬆️ increases myocardial contractile force as well as ventricular automaticity.
Calcium Chloride: Adverse Reactions
- Nausea/Vomiting
- Hypercalcemia
- Bradycardia
- Hypotension
- Tissue Necrosis
- Arrythmias
Calcium Chloride: Onset/Duration
Onset: 1-3 min
Peak: 3-5 min
Duration: 20-30 min
Calcium Chloride: Special Considerations
Preg. CAT C
Calcium Chloride: Drug Interactions
-
Do not mix with Sodium Bicarbonate in running IV, flush prior to administration in
same IV line - May worsen dysrhythmias secondary to digitalis.
- May antagonize effects of Verapamil.
