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ACritical Care > Pharm > Flashcards

Pharm Flashcards

1
Q

Inotropic

What it affects

(+) vs (-)

A

Affects myocardial contractility (affects contractions)

(+) : increased force of contraction

(-) : decreased force of contraction

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2
Q

Chronotropic

What it affects

(+) vs (-)

A

Affects HR

(+) : increased HR

(-) : decreases HR

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3
Q

Adrenergic receptor sites

A

Alpha and beta

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4
Q

Alpha

Think what?

A

Think vasoconstriction and increased contractility

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5
Q

Alpha a-1 receptor

A

In vascular smooth muscle

Stimulation results in body-wide vasoconstriction
(Increase BP)

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6
Q

Alpha a-2 receptors

Located where
Where it works
What it does

A

Centrally and peripherally located

Oppose effects of SNS:
-decreased secretion of catecholamines

(Vasodilation, vasorelaxation (decreased BP)

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7
Q

Beta B-1 receptor

Think what organ
Effects what

A

Think heart (located there)

Increases: HR/contractility
HR (+Chronotropic)
Conduction/contractility (+ inotropic)

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8
Q

Beta B-2 receptor

Think what organ
Located where
What it does

A

Think lungs
Located in:
Smooth muscle of bronchitis and skeletal blood vessels

Causes:
-vasodilation
-relaxation of bronchial
-uterine and GI smooth muscle
-glycogenolysis (increase BG)

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9
Q

Be careful with who with beta B-2 receptors

A

Resp condition because it can stimulate:

-bronchoconstriction
-hypergylcemia

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10
Q

Dopaminergic receptors

Located where

A

Blood vessels of:

-Coronary arteries
-Renal
-Mesenteric
-Visceral

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11
Q

Preload
Afterload
Cardiac output

A

Preload:
-amount of blood in the hearts ventricles at the end of diastole (resting phase)

Afterload:
Amount of pressure the heart must overcome to pump blood out during a heart beat

Cardiac output:
Amount of blood pumped by the heart each minute

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12
Q

Things to know when titrating a drug

A

Why is it given
What is the desired effect
Whats the parameters
Risk/benefit

Onset/length of action
How fast is the onset/half-life

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13
Q

Analgesics (opioids)

Examples
Side effects
Reversal agents
How we know if we have desired effect

A

Fetanyl, hydromorphone (dilaudid), morphine

SE: resp depression

Reversal agent: narcan

See if pain is controlled and vital signs

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14
Q

Analgesics

Acetaminophen IV (Ofirmev)

Nursing implications
Overdose tx

Dont exceed how much

A

Risk for hepatotoxicity

Reversal agent: acetylcysteine

Dont exceed 4g/day

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15
Q

N-methal-D asparate (NMDA) receptor antagonist

What drug name
Action
Use
SE

A

Katamine (ketalar)

Action: non-barbiturate general anesthetic
-blocks sensory (makes you sleepy)

Use: acute pain, procedures, burn patients

SE:
-HTN, resp depression, N/V, emergence reactions

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16
Q

Benzodiazepine:
midazolam (versed)
Lorazepam (ativan)

Use
Action
SE

A

Use: agitation and sedation

Action:
-Depresses subcortical levels in CNS
-potentiates GABA (less anxious/sedated)

SE: agitation and delirium

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17
Q

Benzodiazepine:
midazolam (versed)
Lorazepam (ativan)

Avoid in who
Reversal agents

A

Avoid in elderly
Be cautious in children

Reversal agent: flumazenil

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18
Q

Propofol (Diprivan)

Action
Use
SE
Need what if continuous infusion
Other precautions (3)

A

Gneral anesthetic,
-rapid onset of sedation and rapid awakening

Use: conscious or unconscious sedation

SE: HOTN, resp depression,
CNS depression (sedation)

(Need intubate if continuous infusion)
Change tubing q 12hrs, monitor triglycerides and infection risk

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19
Q

Dexmedetomidine (precedex)

Action
Use
SE

A

Sedative hypnotic, alpha 2 agonist (vasodilation)

Use: intubated pt in ICU

SE: bradycardia (most common)
HOTN

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20
Q

ACLS drugs (know their doses)

A

Adenosine
Amiodarone
Atropine
Dopamine
Epinephrine (adrenalin)

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21
Q

Adenosine

Action
Use

A

Antiarrhythmic:
-slows conductions of AV node
-used in stess/perfusion test

Use: SVT (exam)

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22
Q

Adenosine

Dose

SE (4)
Big one (1)

A

Dose:
6mg IV push over 1-2 seconds followed by 20mL flush fast

If no response, then repeat dose with 12mg and flush fast

SE:
-Flushing, lightheaded, dizziness, chest pain, bronchospasms
-asystole up to 10 seconds

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23
Q

Amiodarone

Action
Use (5)

A

Antiarrhythmic
-prolongs action potential (calm ventricles)

Use:
VT &. VF
rapid atrial rhythms Afib
A flutter, and SVT

24
Q

Amiodarone

Dose: cardiac arrest dose vs continuous infusion

A

Dose:
Cariac arrest: 300mg IV/IO push
-may follow with additional dose of 150mg

Continuous infusion: recurrect VF/VT or atrial rhythms:
1st: 150mg IV loading dose over 10min
2nd: 1mg/min for 6hrs
3rd: 0.5mg/min for 18hrs

25
Amiodarone SE Who gets put on this med
Bradycardia HOTN Unique (QT prolongation) -d/t heart being so calm If survive a code you get put on this drip
26
Atropine Action (3) (4) Use
Action: Anticholinergic, antiarrhythmix, antidote -increases SA node automaticity -AV node conduction -increases HR (+Chronotropic) -decreasing vagal tone Use: symptomatic bradycardia (exam) -and asystole
27
Atropine Dose SE
Dose: -bradycardia: 0.5mg IV q3-5min Max dose 3mg 1-2mg in 10ml NS or sterile water via ETT SE: -tachycardia -will not work in patient post heart transplant d/t vagus nerve severed*
28
What meds can you give if atropine is ineffective
Dopamine Epinephrine
29
Dopamine Action Dose
Action: Inotropic agent, vasopressor, cardiac stimulant Dose: Moderate doses (stimulates beta receptors) -increase contractility/CO High does (stimulates alpha receptors) -vasoconstriction -increased SVR (systemic vascular resistance)
30
Dopamine Use SE Line needed
Use: -HOTN not related to hypovolemia -symptomatic bradycardia after ATROPINE SE: -tachycardia -excessive constriction Infuse in central line
31
Epinephrine (adrenalin) Action Use
Action: Vasopressor Cardiac stimulant (A1, A2, B1, B2) (Increase contractility, SVR, BP, HR, improves coronary artery/cerebral perfusion) Use: VF, pulseless VT, PEA, asystole Or alternative infusion to dopamine for symptomatic bradycardia
32
Epinephrine (adrenalin) SE Dose
SE: Tachycardia HTN Dose: 1mg IV/IO 2-2.5mg in 10ml NS via ETT (repeat q3-5min) IV infusion: 1mg/250ml NS start infusion 1mcg/min, titrate range 2-10mcg/min
33
Lidocaine Action Use SE
Action: antiarrhythmic (when IV) -suppresses ventricular dysrhythmias Use: Alternate to amiodarone Or for refractory VF/VT SE: Neuro toxicity (exam) Bradycardia, prolonged PRI, widened QRS, resp depression
34
Norepinepthrine (levophed) Action Use
Action: vasopressor -stimulated A1, A2 (peripheral/arterial vasoconstrict) -stimulated B1 (increase contractility/dilates coronary arteries Use: All HOTN states (trauma, shock, spinla anesthesia)
35
Norepinephrine (levophed) What is different from epinephrine
Epi effected A1/2 and B1/2 Norepi doesnt affect B2 (resp)
36
Norepinephrine (levophed) SE How should it be infused
—Increases myocardiac O2 requirements —Risk for extravasation and tissue necrosis -if given peripherally —Myocardial ischemia (Infuse through central line) Increased risk of amputation (vasoconstricts blood from limbs) (does it to put blood to heart)
37
Magnesium Action Use SE
Electrolyte Antiarrhythmic Use: Torsades de pointes (VT) Hypomagnesemia SE: -respiratory depression -bradycardia -HOTN
38
Sodium bicarbonate Action Use Issues we have with it
Alkalizing agent Use: -metabolic acidosis -hyperkalemia Issue: not compatible w/ many drugs Ex: precipitates w/ epi
39
Calcium channel blockers Names Action
Diltiazem Verapamil Action: Inhibit CA (slows conduction
40
Calcium channel blockers: Diltiazem Verapamil Use SE
Rate control for: -Afib -Aflutter SE: HOTN Bradycardia
41
Beta blockers Names and what they affect
Metoprolol: Cardioselective (beta1 blocker) Labetalol: alpha and beta blocker Esmolol: Short acting beta 1
42
Beta blockers (Metoprolol, labetalol, esmolol) Use SE Which one should we be careful about
Use: Post MI HR and BP control Afib / Aflutter SE: HOTN Bradycardia labetolol its b2 causes bronchoconstriction (so be careful with chronic lung disease patients)
43
Other drugs commonly used in ICU
Dobutamine (dobutrex) Phenylephrine (neosynephrine) Nitroglycerin Nitroprusside (Nipride) Nicardipine (Cardene) Vasopressin
44
Dobutamine (dobutrex) Action Use
Action: Inotropic agent cardiac stimulant (direct beta stimulation) Increases contractility/CO Use: (helps heart pump) Cardiac decompensation from: -HF -cardiac surgery
45
Dobutamine (dobutrex) SE
Can make heart work too hard (need to be on monitor) -ventricular ectopy -myocardial ischemia -HOTN -chest pain -tachycardia
46
Phenylephrine (Neosynephrine) Aggressive drug: Action Use
Action: vasopressor (vasoconstriction) -similar to epi (acts on alpha receptors) -slows HR -increases SV -renal vessel constriction Use: -HOTN (extreme situations)
47
Phenylephrine (Neosynephrine) SE What type of line to use
Bradycardia HTN Use central line
48
Nitroglycerin Action Use
Action: -antianginal -antihypertensive -vasodilator (arterial and venous) (Reduces heart O2 consumption) (Decreases preload and afterload) Use: Congestive HF MI HTN
49
Nitroglycerin SE Contraindications
HA Tachycardia HOTN Contraindication: -pt with RV infarction -use of viagra within 24hours
50
Nitroprusside (Nipride) Action Use
Action: -antihypertensive -vasodilator (Rapid acting peripheral vasodilator, short 1/2 life) Use: Hypertensive crisis Reduce afterloadin HF and acute pulmonary edema
51
Nitroprusside (Nipride) SE Need what device
HOTN HA Tinnitus With prolonged us (cyanide toxicity) *keep IV bag in opaque cover to prevent this* Need arterial line so you can titrate med rapidly (its rapid acting so we need to be able to see results)
52
Nicardipine (Cardene) Action Use SE
Heart dilator: -antihypertensive Causes coronary and peripheral blood vessels to relax and dilate Use: HTN SE: Vasodilation/HOTN/dizzy/HA
53
Vasopressin Action Use What type of line needed
Vasoconstriction Use: -shock states (distributive) -restores vascular tone Need central line
54
Vasopressin SE
vasoconstriction: -bradycardia -HTN -hyponatremia? (Too much constriction) -chest pain/ myocardial ischemia
55
Which IV fluids for resuscitation
Isotonic (NS/LR) (Hypertonic increases ICP)
56
Neuromuscular blockades Names Must do what with these?
Cisatracurium (Nimbex): -IV Succinylcholine: -use for intubations *dont use with hyperkalemia* Must infuse SEDATIVE and PAIN MEDS with paralytics

ACritical Care (14 decks)

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