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Advanced Med Surg > Pharm 1: Cardiac, Peds > Flashcards

Pharm 1: Cardiac, Peds Flashcards

1
Q

Sodium channel blockers-Action

A

block Na entry into cell during depolarization
stabilize cardiac membranes
results in decrease in conduction speed and myocardial excitability
Treat A and V arrythmias

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2
Q

Na channel blockers-Examples

A 
quinidine sulfate/gluconate
procainamide (Procar)
disopyramide (Norpace)
lidocaine
phenytoin (DIlantin)
propafenone (Rythmol)
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3
Q

Most common AE of Quinidine

Most dangerous AE

A

Most common: diarrhea

Most dangerous: Lengthening QT interval, puts pt at r/f V-tach

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4
Q

AE of procainamide

A

arthralgia and skin rashes

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5
Q

Common AEs of antidysrhythmics

A

GI upset: n/v/d

Dzns, HA, blurred vision, tinnitus

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6
Q

CI of disopyramide (Norpace)

A

poor LV function

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7
Q

ACLS 2nd choice/SJH 1st choice for treating V-tach

A

lidocaine

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8
Q

lidocaine admin

A 
IM/IV
Bolus dose +
Maintenance dose (1-4 mg/min)
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9
Q

Na channel blocker used to treat arrythmias d/t Digoxin toxicity

A

phenytoin (Dilantin)

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10
Q

AE of phenytoin

A

HoTN, Bradycardia
Thrombophlebitis
gingival hyperplasia

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11
Q

Na channel blockers used only for severe refractory life-threatening Ventricular arrythmias, can by proarrhythmic

A

propafenone (Rythmol)

flecainide (Tambocor)

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12
Q

Cardioselective Beta Blockers

A

metoprolol

atenolol

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13
Q

nonselective BBs

A

propanolol
nadolol
labetelolol
timolol

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14
Q

BBs used to treat these arrythmias

A

Afib
Aflutter
paroxysmal SVT

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15
Q

CI of BBs

A

Asthma (caution with cardioselectives)

use caution with CHF pt (low dose, increase slowly)

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16
Q

AE of BBs

A

Bradycardia
HoTN
Dzns, fatigue
Heart block

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17
Q

BB action

A

block SNS stimulation of the heart:

decrease HR, contractility, BP, automaticity, and myocardial O2 demand

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18
Q

K channel blockers-action and examples

A

prolong the action potential and refractory period of the cardiac cycle–prolong repolarization

Amiodorone

CC areas only:
bretylium
ibutilide
dofetilide (Toursad’s risk)

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19
Q

use of this type of antidysrhythmic with warfarin increases the risk of bleeding

A

K channel blockers

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20
Q

K channel blockers-admin

A

PO, IV gtt

loading dose, maintenance dose

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21
Q

Most common AE of amiodorone

A

corneal microdeposits causing
visual halos
photophobia
dry eyes

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22
Q

most dangerous AE of amiodorone

A

Pulmonary toxicity with alveolar damage, leads to pulmonary fibrosis

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23
Q

CCBs-Action and examples

A

Slow conduction and prolong refractory period
verapamil
diltiazem

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24
Q

Indication of CCbs

A

Afib, Aflutter, SVT

tachycardias at SA and AV nodes

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25
Q

AE of CCBs

A 
**Constipation (can be severe)
Bradycardia
Heart block
HoTN, Dzns
Dyspnea
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26
Q

antidysrhythmic med can be used for “chemical cardioversion”

A

adenosine

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27
Q

adenosine admin

A

give RAPID IVP due to very short half life

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28
Q

adenosine action

A

stops heart so SA node can pick up, converts SVT to SR

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29
Q

Adrenergic agonists-action

A

SNS stimulants, goal is to increase perfusion

Cause: vasoconstriction, increased HR, bronchodilation, pupil dilation, and inhibit GI activity

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30
Q

all adrenergic agonists are IV in CC areas except

A

dobutamine

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31
Q

adrenergic agonist, endogenous catecholamine that stimulates alpha and beta receptors and can increase BG levels

A

epinephrine

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32
Q

indications of epinephrine

A

Emergency ACLS protocols
acute asthma
anaphylaxis

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33
Q

AE of epinephrine

A

vasoconstriction leading to increased BP

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34
Q

adrenergic agonist that primarily stimulates alpha receptors, is a potent vasoconstrictor

A

norepinephrine (Levophed)

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35
Q

indications of norepinephrine

A

Shock, HoTN

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36
Q

isoproterenol action

A

adrenergic agonist

stimulates Beta receptors causing bronchodilation, cardiac stimulation

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37
Q

indications for isoproterenol

A

heart block

septic shock

38
Q

Adrenergic agonist with dose-dependent action

A

dopamine
low dose-vasodilation of renal vessels, enhanced renal flow
high dose- potent peripheral vasoconstriction

39
Q

dobutamine action

A

stimulates Beta-1 receptors to increase contractility

40
Q

dobutamine admin

A

through PIV or CVAD
**2nd IV site is needed
Venous irritating, danger of tissue damage if infiltration occurs.
DO NOT stop med abruptly

41
Q

indications for dobutamine

A

HF

Cardiac Post ops (r/f CHF)

42
Q

major AE/danger of dobutamine

A

Arrythmias

43
Q

IV gtt Dopa-1 agonist for Hypertensive crisis

A

fenoldopam

44
Q

alpha adreneric agonist, given IV short term to increase BP

A

phenylephrine

45
Q

Vaccinations at 2, 4, and 6 mos (6)

A 
Hep B
DTap
Hib
IPV
Prevnar
RV
46
Q

Vaccine at birth (1)

A

Hep B

47
Q

Vaccines around 1 year (12-15 mos) (4)

A

Hib
Prevnar
MMR
Varicella

48
Q

Hep A vaccine admin

A

2 doses, 6 mos apart

12-23 mos

49
Q

DTap schedule

A

2,4,6, 15-18, 4-6 yr

then:TDap schedule

50
Q

Vaccines before entering kindergarten (4-6 yr) (4)

A

DTap
MMR
Varicella
IPV

51
Q

Vaccines at 11-12 yr (2)

A

HPV (3 doses)

Menactra (MCV-4)

52
Q

Vaccine at 16-18 yr

A

Menactra

53
Q

Vaccines CI in severe immunodeficiency and pregnancy

A

MMR
Varicella (can vaccinate child, just cover any pox)
Zoster (HCV)

54
Q

Live vaccines

A

intranasal flu
RV
MMR
Varicella

55
Q

SubQ vaccines

A

MMR

Varicella

56
Q

oral vaccine

A

RV

57
Q

Prevnar (PCV-13) vaccine is for

A

Pneumoccoal disease
Strep pneumo
pneumonia, OM, sepsis, meningitis

58
Q

Menactra (MCV-4) vaccine is for

A

meningococcus

bacterial meningitis

59
Q

TDap schedule

A

11-12 years
Boost every 10 years with Td
Also: any time needed over 7 yrs for catch up use TDap instead of DTap
Give TDap to pregnant teens during each pregnancy

60
Q

CI to TDap or DTap

A

encephalopathy not attributable to an identifiable cause within 7d of previous dose

61
Q

when to start flu vaccine

A

6 mos

62
Q

no live intranasal flu to

A

under 2 years old
pregnant
chronic disease state

63
Q

who else gets HepA

A

travel
teen males who have sex with other males
illicit drug use
close contact with international adoptee

64
Q

only injection site for up to 1 year old

A

Vastus lateralis

65
Q

AE of lidocaine

A

CNS effects: confusion, dizziness, drowsiness, tremors, slurred speech

66
Q

most effective to reduce LDL

A

statins

67
Q

get these tests before statin use begins

A

LFTs (and periodically)
kidney function
LDL/HDL levels

68
Q

CIs of statins

A

Liver dysfunction
caution with coumadin
avoid grapefruit

69
Q

avoid grapefruit with these meds

A

statins

70
Q

concurrent use with coumadin can increase risk of bleeding

A

statins and K channel blockers

71
Q

cholestyramine (Questran) med type and admin

A

Bile Acid Sequestrant

dissolve powder in 120 mL; give other meds 1 hour before or 4 hours after

72
Q

activate lipoprotein lipase enzyme that breaks down cholesterol; inhibits TGI synthesis in liver

A

Fibric Acid Derivatives

73
Q

AE of nicotinic acid use to decrease LDL and increase HDL

A

Flushing and warmth of face

74
Q

this med can be taken with statins to reduce cholesterol

A

cholesterol-absorption inhibitor=
ezetimbe (Zetia)

Vytorin=Zetia+Zocor

75
Q

this decreases the amount of cholesterol stored in the body

A

exercise

76
Q

major AE of oral steroids

A

Mood Swings
also hunger; take with food to protect GI lining
Don’t stop abruptly

77
Q

Anti-RSV Monoclonal Antibody given to high risk infants (preemies, severe CP issues

A

Synagis

passive immunity-give once per month

78
Q

no cough and cold products for <2 years old because

A

don’t want to mask infection, sepsis can develop quickly; proof of efficacy lacking
and cannot articulate side effects which can be dangerous:
tachycardia
arrythmias
sedation

79
Q

Risk of ARF in dehydrated child who takes

A

ibuprofen

80
Q

med errors in adults vs. kids

A

equal freqency

3x higher rate of potentially harmful outcomes in kids

81
Q

newborns are vulnerable to CNS toxicity from meds d/t

A

immature BBB

82
Q

Glucocorticoids are only give short term to kids to avoid

A

suppression of growth

83
Q

Can be used with Coumadin in prosthetic heart valve pt

A

Dipyridamole (Persantine)

Antiplt

83
Q

IM/SQ absorption may be decreased in kids d/t

A

immature peripheral circulation and heat regulation

84
Q

Therapeutic aPTT

A

Around 60

1.5-2x normal

85
Q

Indications for IV heparin

A

Use when immediate effect needed…evolving CVA,PE,DVT

86
Q

Indications for SQ Heparin

A

Immobility, bed rest, traction

87
Q

Heparin AE

A 
Bleeding
Anemia
Fever
Edema
Low plts
88
Q

Warfarin indications

A

Prevent and treat DVT, PE, Afib emboli, emboli due to prosthetic heart valves

89
Q

Warfarin dose determines by

A

pT/INR from 3 days ago

90
Q

Anticoagulants action and types

A

Inhibit clotting factors

IV/SQ heparin, lovenox

Oral (inhibit Vit K) warfarin

91
Q

Indications for anti platelet meds

A

Decrease plts aggregation that causes most arterial thrombi

Prevent AMI, Reinfarction, CVA, Int Claudication

Advanced Med Surg (6 decks)

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