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Morphine, Lasix, Nitro, Dobutamine, Dopamine, NorEpi > Morphine > Flashcards

Morphine Flashcards

1
Q

What drug class is Morphine Sulfate in?

A

Opioid analgesic

Schedule II drug

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2
Q

What is the onset and duration of Morphine?

A

Onset 1-2 minutes after administration.

Duration 2-7 hours.

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3
Q

What are the indications for Morphine?

A
  • CP associated with ACS unresponsive to nitrates
  • acute cardiogenic pulmonary edema (with or without associated pain)
  • moderate to severe acute and chronic pains
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4
Q

What are the contraindications for Morphine?

A
  • hypersensitivity to narcotics
  • hypovolemia
  • hypotension
  • head injury
  • undiagnosed abdominal pain
  • increased intracranial pressure
  • severe respiratory depression
  • people who have taken MAO Inhibitors within 14 days
  • use with caution in RV infarction
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5
Q

What are adverse reactions of Morphine?

A
  • hypotension in volume depleted patients
  • tachycardia
  • bradycardia
  • palpitations
  • syncope
  • facial flushing, diaphoresis, pruritus
  • Respiratory depression
  • euphoria
  • bronchospasm
  • dry mouth
  • allergic reaction
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6
Q

What are some drug interactions with Morphine?

A
  • CNS depressants may potentiate effects (respiratory depression, hypotension, sedation)
  • phenothiazines may potentiate analgesia
  • MAO Inhibitors may cause paradoxical excitation
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7
Q

How is Morphine supplied?

A

Tablets, suppositories and solution. In emergency care, Morphine is usually given IV.

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8
Q

What is the adult dosage for Morphine for STEMI?

A

2-4mg IV

May give additional doses of 2-8mg IV at 5-15min intervals

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9
Q

What is the adult dosage of Morphine for UA/NSTEMI?

A

1-5mg IV only if symptoms are not relieved by nitrates or if symptoms recur (use with caution)

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10
Q

What is the adult dosage of Morphine for general pain?

A

2-4mg slow IV push over 1-5min every 5-30min

Titrate to effect

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11
Q

What are some special considerations for Morphine?

A
  • pregnancy safety category B (safe if not used for prolonged periods or in high doses; narcotics rapidly cross placenta)
  • not safe for neonates
  • use cautiously with elderly, asthma patients, and patients susceptible to CNS depression
  • use cautiously with chronic pain patients
  • may worsen bradycardia or heart block in inferior MI (vagotonic effect)
  • Naloxone (0.4-2 IV) should be readily available
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12
Q

What drug class is Furosemide (Lasix)?

A

Loop diuretic

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13
Q

What is the onset and duration of Lasix?

A

Onset: (IV) diuretic effects in 15-20min; vascular effects in 5min

Duration: 2 hour

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14
Q

What are the indications for Furosemide?

A
  • acute pulmonary edema in patients with SBP >90-100
  • hypertensive emergencies
  • hyperkalemia
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15
Q

What are the contraindications for Furosemide?

A
  • anuria
  • hypersensitivity
  • hypovolemia/dehydration
  • known hypersensitivity to sulfonamides
  • severe electrolyte depletion (hypokalemia)
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16
Q

What are adverse reactions of Lasix?

A
  • hypotension
  • EKG disturbances associated with electrolyte imbalance
  • dry mouth
  • hypochloremia
  • hypokalemia
  • hyponatremia
  • hypocalcemia
  • hyperglycemia
  • hearing loss can occur (rarely) after too rapid infusion of large doses
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17
Q

What are drug interactions of Furosemide?

A
  • digitalis toxicity may be potentiated because of potassium depletion
  • Furosemide increases ototoxic potential of aminoglycoside antibiotics
  • lithium toxicity may be potentiated because of sodium depletion
  • Furosemide may potentiate therapeutic effects of other antihypertensive drugs
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18
Q

How is Lasix supplied?

A

10mg/mL in 2-, 4-, 8-mL ampules

10mg/mL in 10mL vial

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19
Q

What is the adult dosage of Lasix?

A

IV
0.5-1mg/kg over 1-2min
If no response, double dose, give over 1-2min

New onset pulmonary edema with hypovolemia
<0.5mg/kg

Hyperkalemia
40-80 mg IV

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20
Q

What are some special considerations for Furosemide?

A
  • Pregnancy safety category C
  • known to cause fetal abnormalities
  • protect it from light and store at room temp; do not use if discolored or yellow
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21
Q

What drug class is Nitroglycerin in?

A

Vasodilator

It is lipid soluble, so it is given PO more rather than IV.

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22
Q

What is the onset and duration of Nitroglycerin?

A

Onset: 1-3min

Duration: 30-60min

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23
Q

What are indications for Nitroglycerin?

A
  • ischemic chest pain
  • CHF
  • AMI
  • hypertensive emergencies with ACS
24
Q

What are contraindications for Nitroglycerin?

A
  • volume depletion
  • hypersensitivity
  • hypotension
  • head injury
  • extreme bradycardia
  • extreme tachycardia
  • right ventricular infarction
  • cerebral hemorrhage
  • recent use of ED drugs
  • aortic stenosis
25
Q

What are adverse reactions of Nitroglycerin?

A
  • transient headache
  • reflex tachycardia
  • hypotension
  • nausea and vomiting
  • postural syncope
  • diaphoresis
  • flushing
26
Q

What are some drug interactions with Nitroglycerin?

A

Other vasodilator may have additive effects.

Do not mix with other drugs.

27
Q

How is Nitroglycerin supplied?

A

Tablets
0.15mg, 0.3mg, 0.4mg

Transdermal paste

Metered spray
0.4mg per spray (do not shake)

28
Q

What is the adult dosage for Nitroglycerin?

A

0.3-0.4mg SL
May repeat to total of 3 doses every 5 min

Metered spray
1-2 sprays at 5min intervals, up to sprays in 15 minutes

29
Q

What are special considerations of Nitroglycerin?

A
  • pregnancy safety category C
  • increased susceptibility to hypotension in elderly
  • decomposed when exposed to light or heat
  • “stings” when given SL
  • use with caution for patients with inferior AMI with possible right ventricular involvement
30
Q

What kind of drug is Dobutamine (Dobutrex)?

A

Sympathomimetic

Synthetic catecholamine that primarily stimulates beta1-adrenergic receptors.
Positive inotropic effects with minimal changes in chronotropic activity.
Great for CHF when an increase in HR is not desired.

31
Q

What is the onset and duration of Dobutamine?

A

Onset: 1-2min, peak after 10min

Duration: 10-15min

32
Q

What are indications for Dobutamine?

A

Pump problems (CHF, pulmonary congestion) with SBP of 70-100 and no signs of shock

33
Q

What are the contraindications of Dobutamine?

A
  • tachydysrhythmias
  • severe hypotension with signs of shock
  • idiopathic hypertrophic subaortic stenosis
  • suspected or known drug-induced shock
34
Q

What are adverse reactions of Dobutamine?

A
  • anxiety
  • headache
  • nausea
  • fluctuations in BP
  • dose related tachydysrhythmias
  • hypertension
  • ventricular ectopic
35
Q

What are some drug interactions with Dobutamine?

A
  • beta-adrenergic antagonists may blunt inotropic responses
  • sympathomimetics and phosphodiesterase Inhibitors may exacerbate dysrhythmia responses
  • incompatible with Lasix and sodium bicarbonate in the same IV line; must have separate IV
36
Q

How is Dobutamine supplied?

A

12.5mg/mL injectable

37
Q

What is the adult dosage for Dobutamine?

A

2-20mcg/kg/min IV

Titrate so HR doesn’t increase by >10% of baseline

38
Q

What are some special considerations for Dobutamine?

A
  • pregnancy safety category C
  • administer via infusion pump to ensure precise flow rate
  • monitor BP closely
  • do not mix with sodium bicarbonate
  • may exacerbate ischemia if HR increases
  • Lidocaine should be readily available
  • correct hypovolemia before Dobutamine
  • elderly may have significantly decreased responses
39
Q

What kind of drug is Dopamine (Intropin)?

A

Sympathomimetic

Increases cardiac output, myocardial contractility and rises BP. Acts primarily on Alpha1 and Beta1 adrenergic receptors.
Second line drug for bradycardia after Atropine.

40
Q

What is the onset and duration of Dopamine?

A

Onset: 2-4min

Duration: 10-15min

41
Q

What are the indications for Dopamine?

A
  • hypotension in the absence of hypovolemia

- symptomatic bradycardia (second line drug after Atropine)

42
Q

What are contraindications for Dopamine?

A
  • tachydysrhythmias
  • Vfib
  • patients with pheochromocytoma (tumor of the adrenals that produces Adrenaline, causing high BP and tachy)
43
Q

What are some adverse reactions of Dopamine?

A
  • tachycardia
  • hypertension
  • increased oxygen demand of the heart
  • headache
  • anxiety
  • N/V
44
Q

What are some drug interactions with Dopamine?

A
  • deactivated with alkaline solutions (sodium bicarbonate and Lasix)
  • MAO Inhibitors may potentiate Dopamine effects
  • sympathomimetic she and phosphodiesterase Inhibitors may exacerbate dysrhythmia response
  • beta-adrenergic antagonists may blunt inotropic response
  • when given with phenytoin, hypotension, bradycardia and seizures may develope
45
Q

How is Dopamine supplied?

A

200, 400, 800 mg in 5mL profiled syringe and ampule for IV infusion (piggyback)

46
Q

What is the adult dosage of Dopamine?

A

Infusion at 2-20mcg/kg/min, titrate to patient response, taper slowly

47
Q

What are some special considerations for Dopamine?

A
  • pregnancy safety category C
  • infuse through large, stable vein to avoid possibility of extravasation injury
  • use infusion pump
  • monitor for signs of compromised circulation
  • correct hypovolemia before using Dopamine
  • do not mix with Sodium Bicarbonate
48
Q

What type of drug is Norepinephrine (Levophed)?

A

Sympathomimetic

Alpha1 and Beta1 adrenergic agonist. Last resort in management of ischemic heart disease because it tends to constrict renal and mesenteric blood vessels.

49
Q

What is the onset and duration of Norepinephrine?

A

Onset: 1-3min

Duration: 5-10min

50
Q

What are the indications for Norepinephrine?

A
  • severe cardiogenic shock
  • neurogenic shock
  • inotropic support
  • significant hypotension (SBP <70)
51
Q

What are the contraindications for Norepinephrine?

A

Hypotension patients with hypovolemia

52
Q

What are some adverse reactions of Norepinephrine?

A
  • headache
  • dysrhythmias
  • tachycardia
  • reflex bradycardia
  • angina pectorals
  • hypertension
53
Q

What are some drug interactions with Norepinephrine?

A
  • can be deactivated with alkaline solutions
  • MAO Inhibitors and bretylium may potentiate the effects of catecholamines
  • beta-adrenergic antagonists may blunt inotropic response
  • sympathomimetic and phosphodiesterase Inhibitors may exacerbate dysrhythmia response
54
Q

How is Norepinephrine supplied?

A

1mg/mL, 4mL ampule

55
Q

What is the adult dosage of Norepinephrine?

A

Dilute 4mg in 250mL of D5W or D2NS

Begin infusion at 0.1-0.5mcg/kg/min titrate to desired effect

56
Q

What are some special considerations for Norepinephrine?

A
  • pregnancy safety category C
  • may cause fetal anoxia when used in pregnancy
  • infuse through a large, stable vein to avoid extravasation and tissue necrosis
  • use infusion pump
  • do not give in the same IV as alkaline infusions
  • may induce dysrhythmias

Morphine, Lasix, Nitro, Dobutamine, Dopamine, NorEpi (1 decks)

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