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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
Q

Amiodarone

SE

Who gets put on this med

A

Bradycardia
HOTN

Unique (QT prolongation)
-d/t heart being so calm

If survive a code you get put on this drip

26
Q

Atropine

Action (3) (4)
Use

A

Action:
Anticholinergic, antiarrhythmix, antidote
-increases SA node automaticity
-AV node conduction
-increases HR (+Chronotropic)
-decreasing vagal tone

Use: symptomatic bradycardia (exam)
-and asystole

27
Q

Atropine

Dose
SE

A

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
Q

What meds can you give if atropine is ineffective

A

Dopamine
Epinephrine

29
Q

Dopamine

Action
Dose

A

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
Q

Dopamine

Use
SE
Line needed

A

Use:
-HOTN not related to hypovolemia
-symptomatic bradycardia after ATROPINE

SE:
-tachycardia
-excessive constriction

Infuse in central line

31
Q

Epinephrine (adrenalin)

Action
Use

A

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 breadycardia

32
Q

Epinephrine (adrenalin)

SE
Dose

A

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
Q

Lidocaine

Action
Use
SE

A

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
Q

Norepinepthrine (levophed)

Action
Use

A

Action: vasopressor
-stimulated A1, A2 (peripheral/arterial vasoconstrict)
-stimulated B1 (increase contractility/dilates coronary arteries

Use:
All HOTN states (trauma, shock, spinla anesthesia)

35
Q

Norepinephrine (levophed)

What is different from epinephrine

A

Epi effected A1/2 and B1/2

Norepi doesnt affect B2 (resp)

36
Q

Norepinephrine (levophed)

SE
How should it be infused

A

—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
Q

Magnesium

Action
Use
SE

A

Electrolyte
Antiarrhythmic

Use:
Torsades de pointes (VT)
Hypomagnesemia

SE:
-respiratory depression
-bradycardia
-HOTN

38
Q

Sodium bicarbonate

Action
Use
Issues we have with it

A

Alkalizing agent

Use:
-metabolic acidosis
-hyperkalemia

Issue: not compatible w/ many drugs
Ex: precipitates w/ epi

39
Q

Calcium channel blockers

Names
Action

A

Diltiazem
Verapamil

Action:
Inhibit CA (slows conduction

40
Q

Calcium channel blockers:
Diltiazem
Verapamil

Use
SE

A

Rate control for:
-Afib
-Aflutter

SE:
HOTN
Bradycardia

41
Q

Beta blockers

Names and what they affect

A

Metoprolol:
Cardioselective (beta1 blocker)

Labetalol:
alpha and beta blocker

Esmolol:
Short acting beta 1

42
Q

Beta blockers
(Metoprolol, labetalol, esmolol)

Use
SE
Which one should we be careful about

A

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
Q

Other drugs commonly used in ICU

A

Dobutamine (dobutrex)
Phenylephrine (neosynephrine)
Nitroglycerin
Nitroprusside (Nipride)
Nicardipine (Cardene)
Vasopressin

44
Q

Dobutamine (dobutrex)

Action
Use

A

Action:
Inotropic agent
cardiac stimulant (direct beta stimulation)
Increases contractility/CO

Use: (helps heart pump)
Cardiac decompensation from:
-HF
-cardiac surgery

45
Q

Dobutamine (dobutrex)

SE

A

Can make heart work too hard (need to be on monitor)

-ventricular ectopy
-myocardial ischemia
-HOTN
-chest pain
-tachycardia

46
Q

Phenylephrine (Neosynephrine)

Aggressive drug:
Action
Use

A

Action: vasopressor (vasoconstriction)
-similar to epi (acts on alpha receptors)
-slows HR
-increases SV
-renal vessel constriction

Use:
-HOTN (extreme situations)

47
Q

Phenylephrine (Neosynephrine)

SE
What type of line to use

A

Bradycardia
HTN

Use central line

48
Q

Nitroglycerin

Action
Use

A

Action:
-antianginal
-antihypertensive
-vasodilator (arterial and venous)
(Reduces heart O2 consumption)
(Decreases preload and afterload)

Use:
Congestive HF
MI
HTN

49
Q

Nitroglycerin

SE
Contraindications

A

HA
Tachycardia
HOTN

Contraindication:
-pt with RV infarction
-use of viagra within 24hours

50
Q

Nitroprusside (Nipride)

Action
Use

A

Action:
-antihypertensive
-vasodilator
(Rapid acting peripheral vasodilator, short 1/2 life)

Use:
Hypertensive crisis
Reduce afterloadin HF and acute pulmonary edema

51
Q

Nitroprusside (Nipride)

SE
Need what device

A

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
Q

Nicardipine (Cardene)

Action
Use
SE

A

Heart dilator:
-antihypertensive
Causes coronary and peripheral blood vessels to relax and dilate

Use:
HTN

SE:
Vasodilation/HOTN/dizzy/HA

53
Q

Vasopressin

Action
Use
What type of line needed

A

Vasoconstriction

Use:
-shock states (distributive)
-restores vascular tone

Need central line

54
Q

Vasopressin

SE

A

vasoconstriction:

-bradycardia
-HTN
-hyponatremia?

(Too much constriction)
-chest pain/ myocardial ischemia

55
Q

Which IV fluids for resuscitation

A

Isotonic (NS/LR)

(Hypertonic increases ICP)

56
Q

Neuromuscular blockades

Names
Must do what with these?

A

Cisatracurium (Nimbex):
-IV

Succinylcholine:
-use for intubations
dont use with hyperkalemia

Must infuse SEDATIVE and PAIN MEDS with paralytics

ACritical Care (7 decks)

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