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17 Acute Care > Pharma > Flashcards

Pharma Flashcards

1
Q

mainstay of acs management

A

aspirin, oxygen, morphine

ecg!!

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2
Q

molecules to watch in nstemi/ua

A

nitroglycerin, heparin, oral beta blockers, clopidogrel, glycoprotein IIb/IIIa inhibitor

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3
Q

functions of molecules in nstemi

A
  • improve blood flow
  • dissolve clots
  • reduce burden of heart
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4
Q

drugs/molecules involved in acs management

A
  • oxygen
  • acetylsalicylic acid
  • nitroglycerin/nitrates
  • morphine
  • fibrinolytic therapy
  • heparin
  • beta blockers
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5
Q

t/f as long as the patient is breathing, has a heart rate, do an ecg

A

true

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6
Q

molecules involved in the management of vt

A

adenosine and beta blockers, amiodarone

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7
Q

indication for adenosine

A

supraventricular tachycardia (stable)

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8
Q

actions of adenosine

A
  • stimulates adenosine receptors in heart and sm
  • blocks conduction node through av node
  • decreases sinus node automaticity
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9
Q

special considerations for adenosine

A
  • record rhythm strip during administration
  • administer via central venous access
  • theophylline (adenosine receptor antagonist) reduced adenosine effectiveness
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10
Q

indication for amiodarone

A
  • supraventricular tachycardia

- pulseless arrest (vf or pulseless vt)

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11
Q

t/f amiodarone can be used in pts with polymorphic vt (torsades)

A

false, it’s associated with prolonged qt interval which is made worse with antiarrhythmic drugs

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12
Q

t/f amiodarone should ONLY be used after defib/cardioversion and after first line drugs (epi or vasopressin) have failed to convert vt/vf

A

true

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13
Q

actions of amiodarone

A
  • prolongs action potential duration and effective refractory period
  • slows sinus rate
  • prolongs pr and qt intervals
  • noncompet inhib of a-adrenergic and b-adrenergic receptors
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14
Q

contraindications for amiodarone

A

sinus node dysfunction and 2nd degree and 3rd degree av block

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15
Q

precautions for amiodarone

A
  • procainamide
  • hepatic failure
  • inc toxicity for other drugs
  • long half life and drug interactions
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16
Q

primary management for adult bradycardia with pulse

A

atropine (atropa belladonna)

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17
Q

indication for atropine

A
  • symptomatic bradycardia

- toxins/overdose (organophosphate, carbamate)

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18
Q

actions of atropine

A
  • anticholinergic (sns stimulant)
  • blocks acetylcholine and other muscarinic agonists at pns sites
  • increases hr and co (blocks vagal stimulation)
  • reduces saliva production, mydriasis
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19
Q

special considerations for atropine

A
  • blocks bradycardic response to hypoxia = MONITOR WITH PULSE OXIMETER
  • use in child with bradycardia during et intubation
  • document when used in pts with head injury (due to dilation)
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20
Q

contraindications for atropine

A
  • angle closure glaucoma
  • tachyarrhythmias
  • thyrotoxicosis
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21
Q

indication for dopamine

A

cardiogenic shock and distributive shock

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22
Q

actions of dopamine

A
  • catecholamine, vasopressor, inotrope
  • stimulates a-adrenergic receptors (inc svr)
  • stimulates b1-adrenergic receptors
  • sa node = inc hr
  • ventricular effect = inc myocardial contractility, automaticity, conduction velocity
  • stimulates b2-adrenergic receptors (inc hr, dec svr)
  • stimulates dopaminergic receptors (renal, splanchnic dilation)
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23
Q

special considerations for dopamine

A
  • do not mix with nahco3 (inactivates)
  • inhibits tsh
  • dose dependent effects (low dose = dopaminergic and b-adrenergic, high dose = a-adrenergic)
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24
Q

indications for epinephrine

A
  • anaphylaxis
  • bradycardia
  • croup
  • pulseless arrest
  • shock / hypotension
  • toxins/overdose
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25
Q

actions of epinephrine

A
  • stimulates a-adrenergic receptors = inc svr
  • stimulates b1 adrenergic receptors = inc hr, inc myocardial activity
  • stimulates b2 adrenergic receptors = inc hr, bronchodilation, vasodilation of arterioles

INC HR, BRONCHODILATION, VASODILATION OF ARTERIOLES

26
Q

precautions for epinephrine

A
  • inactivated in alkaline solutions
  • dose dependent effects
  • increased o2 reqs
  • anaphylaxis = im @ thigh
  • rebound effect
27
Q

categories of cardiac arrest

A
  • asystole or pulseless electrical activity

- vtach or vfib (need to shock immediately)

28
Q

molecules involved in cardiac arrest

A

epi = first line after cpr, both asystole and vtach/vfib

amiodarone or lidocaine = for refractory vtach/vfib

29
Q

indication for lidocaine

A
  • vfib/pulseless vtach

- wide complex tach with pulses

30
Q

actions of lidocaine

A
  • inc electrical stimulation of ventricle and his-purkinje system = stabilize cardiac membrane
  • reduces intracranial pressure via inhibition of sodium channels = reduced metabolic activity
31
Q

post-cardiac arrest algorithm

A
  • optimize ventilation and oxygenation (92%)

- treat hypotension ( sbp <90 mmhg) = iv/io bolus, vasopressor infusion, ecg

32
Q

when the patient can follow commands, he can go to __

A

cardiac catheterization lab and advanced critical care

33
Q

advanced critical care

A

read

34
Q

indications for dobutamine

A

congestive heart failure and cardiogenic shock

35
Q

actions of dobutamine

A
  • catecholamine, b-adrenergic
  • b1 = inc myocardial, inc hr
  • b2 = inc hr, vasodilation, contraction
  • zero net a-receptor effect

INC CARDIAC OUTPUT

36
Q

special considerations for dobutamine

A
  • inactivated in alkaline solution

- extravasation = tissue ischemia and necrosis

37
Q

indications for norepinephrine

A

hypotensive shock (low svr and unresponsive to fluid resuscitation)

38
Q

actions of ne

A
  • inotrope, vasopressor, catecholamine
  • activates a-adrenergic receptors (inc smooth muscle tone)
  • activates myocardial b1 adrenergic receptors (inc contractility and hr)
39
Q

special considerations for ne

A
  • inactivated in alkaline solns

- iv infiltrations = tissue ischemia and necrosis

40
Q

the 4 serious side effects of dobutamine

A
  • premature ventricular contractions
  • myelosuppression
  • neutropenia
  • anemia
41
Q

actions of sodium bicarbonate

A
  • alkalinizing agent, electrolyte

- increases plasma bicarbonate = forms co2

42
Q

drugs that sodium bicarbonate inactivates

A

catecholamines: dopamine, epinephrine, ne, dobutamine

43
Q

special considerations for sodium bicarbonate

A
  • ensure adequate ventilation due to co2 production

- can form insoluble caco salts

44
Q

actions of furosemide

A
  • loop diuretic
  • ascending loop of henle: inhibits resorption of na and cl; excretion of na, cl, ca, mg, and water
  • inc potassium excretion
45
Q

3 adverse effects of sodium bicarbonate

A
  • respiratory depression
  • calculi
  • hypernatremia
46
Q

indications for intubation

A
  • rapid progression of oxygen requirement over hours
  • lack of improvement on >50 L/min of high flow o2 and fio2 50%
  • evolving hypercapnia (abg), increasing work of breathing, increasing tidal volume, worsening mental status
  • hemodynamic instability or multiorgan failure
47
Q

pre-treatment intubation drugs

A

oxygen, fentanyl, lidocaine

48
Q

induction/sedation drugs for intubation

A

etonamide, ketamine, propofol, midalozam

49
Q

paralysis drugs for intubation

A

succinylcholine, rocuronium, sugammadex

50
Q

2 physiologic events that happen during intubation

A
  • pressor response: inc bp and hr due to upper airway manipulation
  • intracranial hypertension: gag and cough reflex
51
Q

actions of fentanyl

A
  • suppress cough reflex

- decrease catecholamine discharge

52
Q

lidocaine

A

read

53
Q

etomidate

A

read

54
Q

ketamine

A

read

55
Q

propofol

A

read

56
Q

midalozam

A

read

57
Q

t/f sedation is a must prior to paralysis

A

true

58
Q

the only depolarizing neuromuscular blocking agent

A

succinylcholine

59
Q

rocuronium

A

read

60
Q

sugammadex

A

read –off switch to rocuronium

17 Acute Care (7 decks)

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