Pharm 28-30 (Adenosine, Amiodarone, Atropine)

Question 1

Adenosine (Adenocard): Class?

Answer 1

Misc. antidysrhythmic, endogenous nucleoside

Question 2

Adenosine (Adenocard): Action?

Answer 2

Decreases electrical conduction through the AV node without causing negative inotropic effects

Question 3

Adenosine (Adenocard): Indications?

Answer 3

Supraventricular tachycardias (SVT/PSVT)

Question 4

Adenosine (Adenocard): Contraindications? (8)

Answer 4

1.Hypersensitivity 2.Bradycardia 3.Drug induced tachycardia 4.2nd or 3rd degree heart blocks 5.A-Fib 6.A-Flutter 7.V-Tach 8.WPW with A-Fib/flutter.

Question 5

Adenosine (Adenocard): Onset/Duration?

Answer 5

Onset: Immediate

Duration/half-life: 10 seconds

Question 6

Adenosine (Adenocard): Dose/Route?

Answer 6

Adult: 6 mg rapid IV/IO push followed by 20 cc saline flush. May repeat in 1-2 min at 12mg rapid IV push followed by 20 cc saline flush.

Peds: 0.1mg/kg (max 6mg) IV/IO followed by 5-10 cc saline flush. May repeat in 1-2 min at 0.2 mg/kg (max 12mg) IV/IO followed by 5-10 cc saline flush.

Question 7

Adenosine (Adenocard): Side effects? (8)

Answer 7

1.Dizziness 2.Headache 3.Nausea/Vomiting 4.Shortness of breath 5. Flushing 6.Hypotension 7.Palpitations 8.Chest pain

Question 8

Adenosine (Adenocard): Notes?

Answer 8

Methylxanthine classified stimulants (caffeine & theophylline) usage will antagonize adenosine

Question 9

Amiodarone (Cordarone): Class?

Answer 9

Class III antidysrhythmic

Question 10

Amiodarone (Cordarone): Action?

Answer 10

Prolongs duration of the action potential and prolongs the refractory period, also has beta adrenergic receptor and calcium channel blocking activity. Works on both the ventricles and the atria

Question 11

Amiodarone (Cordarone): Indications? (3)

Answer 11

1.V-Fib 2.Hemodynamically unstable V-Tach 3.Treatment for some stable atrial rhythms

Question 12

Amiodarone (Cordarone): Contraindications? (5)

Answer 12

1. Hypersensitivity to amiodarone or iodine 2.CHF 3.Cardiogenic shock 4.Bradycardia 5.2nd or 3rd degree heart blocks with no pacemaker present

Question 13

Amiodarone (Cordarone): Onset/Duration?

Answer 13

Onset: within minutes
Duration: Variable but considered 30 – 45 days

Question 14

Amiodarone (Cordarone): Dose/Route?

Answer 14

Adult: Pulseless V-Tach/V-Fib arrest - 300mg IV/IO may repeat once at 150mg IV/IO. V-Tach with a pulse 150mg IV drip over 10 minutes up to max of 2.2g in 24 hours

Peds: Pulseless V-Tach/V-Fib arrest - 5mg/kg IV/IO. V-Tach with a pulse 5mg/kg IV drip over 20-60 minutes with a max of 15mg/kg/day.

Question 15

Amiodarone (Cordarone): Side effects? (6)

Answer 15

1.Bradycardia 2.Hypotension 3.CHF 4.Headache 5.Abnormal liver/thyroid functions. 6.In rare cases can cause pulmonary fibrosis

Question 16

Amiodarone (Cordarone): Notes?

Answer 16

None

Question 17

Atropine Sulfate: Class?

Answer 17

Anticholinergic, Parasympatholytic

Question 18

Atropine Sulfate: Action?

Answer 18

Inhibits actions of acetylcholine (mostly at muscarinic receptor sites) causing decreased salivation and bronchial secretions, increased heart rate and decreased gastric motility.

Question 19

Atropine Sulfate: Indications? (2)

Answer 19

1.Hemodynamically unstable bradycardia 2.Organophosphate or nerve gas poisoning

Question 20

Atropine Sulfate: Contraindications? (4)

Answer 20

1.Hypersensitivity 2.Tachycardia 3.Avoid use with hypothermic pts 4.Caution in pts with an active MI and hypoxia

Question 21

Atropine Sulfate: Onset/Duration?

Answer 21

Onset: Rapid
Duration: 2-6 hours

Question 22

Atropine Sulfate: Dose/Route?

Answer 22

Adult: Bradycardia – 0.5 mg IV/IO q 3-5 min up to max total of 3 mg
Organophosphate poisoning – 1 to 5mg IV/IM/IO repeated 3-5 min until cessation of bronchial secretions

Peds: Bradycardia NOT responding to Epi- 0.02mg/kg IV/IO (min dose of 0.1 mg and max single dose 0.5 mg) with maximum total of 1 mg for a child and 3 mg for an adolescent.
Organophosphate peds < 12 yrs old - 0.05mg/kg IV/IM/IO may be repeated every 20-30 mins until cessation of bronchial secretions.

Question 23

Atropine Sulfate: Side effects? (9)

Answer 23

1.Tachycardia 2.Paradoxical bradycardia if given too slow or too small of dose 3.Dysrhythmias 4.Mydriasis (dilated pupils) 5.Headache 6.Nausea/vomiting 7.Dizziness 8.Flushed 9.Anticholinergic effects (dry mouth/nose/skin, blurred vision, urinary retention, constipation)

Question 24

Atropine Sulfate: Notes?

Answer 24

Effects of atropine may be potentiated by antihistamines, procainamide, quinidine, antipsychotics, antidepressants, and thiazides