Pharmacology 2 Flashcards
Diphenhydramine
BENADRYL
CLASS:antihistamine
MOA: prevent histamine from reaching the receptor sites
INDICATIONS: reduce bronchi spaz,rashes,hives associated with allergic reactions
CONTRAINDICATIONS: severe asthmatic or COPD
ADVERSE: hypotension,reflex tachy,sedation,thick secretions
DOSE: 25-50 mg IV ,IM
Where are H1 receptor sites
Smooth muscle, bronchi
Where are H2 receptor sites
Stomach mucosa, and responsible for secretion of gastric acids
When histamines are released what happens
Widening of capillaries, decreased BP, increased gastric juice,tightening if bronchi muscles, increased mucus production-due to decrease in capillary membrane
Ketamine
KETALAR CLASS: anesthetic MOA: dissociative anesthesia; dissociates CNS from outside stimuli INDICATIONS: Agitated delirum DOSE: IM MFD 4mg/kg
Promethazine
PHENERGAN
MOA: blocks H1 receptors (smooth Muscle) without blocking the secretions of histamine.
INDICATIONS: allergy, motion sickness, nausea & vomiting, sedation
DOSE: 25 mg IM or IV
Famotidine
MOA
Dose: 20mg. Or 2.0mg/kg
Epineprhine
ADRENALIN
MOA: Sympathomimetic-alpha and beta stimulating
Alpha:vasoconstriction
Beta 1:increase heart rate- positive chronotrope- Increases strength of contraction-positive inotrope
Beta 2: relaxes bronchiolar smooth muscle
INCREASES CARDIAC OUTPUT
INDICATIONS: PNB, Hypotension, Shock, Asthma, Allergic reaction
DOSE;1:10,000= 1mg in arrest
0.3-0.5 mg 1:1000 allergic
1mg in 250 ml NS - infusion
Vasopressin
MOA: High doses acts as a non-adrenergic peripheral VASOCONSTRICTOR-direct stimulation of smooth muscle
INDICATIONS: ventricular fibrillation, pulseless vent tachy, Asystole, PEA
MAy replace EPI in either first or second dose.
DOSE: 40 Units
Isuproterenol
ISUPREL
MOA: Sympatohmimetic
Beta only
BETA 1 Positive chronotrope-rate SA & AV–positive inotrope-force
BETA 2: basodilation of renal, skeletal and mesenteric circulation–relax bronchiolar smooth muscle
INDICATIONS: Symptomatic Bradycardia with pulses–NEVER FIRST LINE
Norepinephrine
LEVOPHED
MOA: sympathomimetic-pressor-alpha and beta stimulating.
ALPHA-peripheral vasoconstriction-increases BP
BETA 1 ONLY- increases strentgh of contraction-positive inotrope
INDICATIONS: severe hypotension
Dopamine
DOPASTAT
MOA: sympathomimetic-alpha and beta stimulating-PRESSOR
ALPHA: peripheral vasoconstriction-increases BP
BETA 1: increases heart rate-positive chronotrope-increases strength of contraction-positive inotrope
INDICATIONS: Hypotension, Shock
DOSE:traditional range-2-20 mcg/kg/min– 400mg/250 ml NS
Atropine
ALWAYS FIRST LINE FOR SYMPTOMATIC BRADY
MOA: Parasympatholytic-beta blocker
reduces vagal tone. Positive chronotrope-increases rate of discharge of SA node.
Increases rate of impulse conduction of AV node
INDICATIONS: Symptomatic Bradycardia-with pulses
Hypotension, altered mental status, signs of shock
DOSE: 0.5mg IV bolus–3 mg total
Adenosine
ADENOCARD
MOA: Negative Chronotrope-decreases heartrate. Depresses conduction through AV node to interrupt re-entry. Depresses sinus node Activity
INDICATIONS: Stable SVT with narrow QRS
DOSE: 6 mg initial rapid IV, 12 mg second, total 30 mg..follow with 20 ml saline flush
Digitalis
No dose
Isuprel
No dose
Lidocaine
MOA anesthetic-quiets ventricles
NO DOSE
Mag sulfate
MOA stabilize cell membranes
DOSE: torsdes de pointes pulseless 1-2gr in 10ml D5W
Pulse: 1-2gr in 50-100ml D5
Norepinephrine
MOA : sympathomimetic - pressor
Alpha and beta stimulator
Amiodarone
MOA: anti arrhythmic
DOSE: pulseless vtach 1st 300mg iv. 2nd 150mg iv
Pulse: 150 mg in 100ml D5W
Calcium chloride
MOA: positive inotrope / positive inotrope
DOSE: 500-1000mg
Diltiazem
MOA: calcium channel blocker
DOSE: iv 0.25 mg/kg
**15 min repeat dose 0.35mg/kg
sodium bicard
1 meq/kg IV
Procainamide
20 mg/min IV
50 mg/min IV URGENT situations
Promethazine
Antihistamine, GI agent
DOSE: 25 mg Allergy
Verapamil
Calcuim Channel Blocker
DOSE: 5mg IV—-2.5 mg at a time
What drug is used for Torsades de pointes and dose
Mag Sulfate
pulseless 1-2 g in 10 ml D5W
pulse 1-2 g in 50-100 ml D5W
What drug is used for Eclapmsia
Mag sulfate-lowers BP–2-4 grams
What drug/drugs could we use for hyperkalemia
Sodium Bicarb and Calcium chloride
What drugs
1
test
test
what does Ispurel do directly to BP
lower it and causes hypotension
what drug can be given to A Fib of 220 to slow HR
verapimil diltrazem
what are other names for verapamil and diltiazem
verap (isoptim, calan, verelan)
dilt (cardizem)
what are the actions of verapimil and diltiazem
negative chronotrope(av)
negative inotrope
coronary and vaso dilation
why would calcium channel blocker cause congestive heart failure or make worse
both are negative inotrope: decreases force of heart
you would administer dilt/verap to narrow QRS tachy only in what situation
if adenosine doesn’t work
calcium channel blockers are contradicted in what tachy rhythms
WPW in A-fib, V-tach, wide QRS of unknown origin
if a pt. recieves _____ you can not five a calcium channel blocker
IV Beta blocker
Decribe the first and second dose of dilt
.25 mg/kg over 2 min and .35 mg/kg over 2 min
describe the first and second dose of verapamil
initial dose 5mg repeat dose 5-10 mg
what can be tried 1st instead of CCB in a stable patient
vagal maneuvers
patient in A-fib, hypoterisve and deteriorating rapidly what do you do
cardio version
you have overdosed your patient of verapmil, what drug can you give to prevent toxic effects
calcium chloride
what is dose of calcium chloride?
500-1000 mg
administer verapmil with extreme caution if at all to patient on
digoxin or digitulis
what is a non-overdose indication of calcium chloride
give to patient with suspected hyperkalinia helps stabalize myocordid cell
what does bicarb do?
decreases acid by combining with H+ and then eliminates CO2 with ventilation
what mus patient be doing when giving bicarb
breathing or vic ett
what is dose of bicarb?
1 meq/kg
never mix bicarb with____?
calcium catecholamines
what overdose would bicarb help with?
cyclic antidepressants
what are indications for Magnesium Sulfate
torsade de pointes, Eclampsia, Asthma
what is the dose of mag when treating torsade de pointes
pulseles: 1-2g in 10ml D5W, 1-2g in 50 -100 D5W
what are two actions of mag that help treat Eclampsia
smooth muscle relaxer=vasodilation
CNS depressant
what are two main actions of adenosine
negative chronotrope, weak bronchoconstrictor
what are top 3 side effects of adenosine
flushing, dypnea, chest pressure
what is dosing of adenosine in clude max
.6mg Rapid 1.0mL saline flush
(repeat) 12mg Rapid, 12mg Rapit total of 30 mg
list 4 steps of administrate for adenosine to be most effective
central circ IV, give as close to site as possible, inject rapid, flush needed
describe how adenosine is beneficial in A-fib/Aflut
may help to diagnose but will not treat
what are the symptomatic NS actions of amidoarone
Alpha Blocker-Vasodilation
Beta Blocker- Negative Chronotrope, Negative inotrope
What channels does iF affect
Sodium channels, potassium, calcium -Slow conduction through vents slow HR - increases AV node conduction, increases refrat
what two PNB rhythms may receive amiodarone
V-tach, V-Fib
what are side effects of amiodarone
hypotension-Alpha blocker
Brady- Beta blocker
AV block
TDP
amidodarone dose in PNB
300mg iv, 150mg in 3-5 min
amiodarone dose in tachy with a pulse
150mg in 100mL D5W over 10 min
procanamide should be given until…?
dysrhythmia is suppressed
QRS duration increased by 750%
hypotension
total dose of 17mg/kg
procainamide decreases excitability in what part of the heart
ventricles, atria, purkinje fibers
do NOT use procainamide in what vent rhythm
torsades
what action does lido have that amiodarone nor procainamide have
helps decrease ICP and is an anestheic
list the CNS side effects of lido
altered LOC, slurred speech, visual disturbances, muscle twitching, seizures
what are the endogenous catecholamides
Epi nor epi dopmine
what are some indications for using a beta blocker
reduce angina and v-fib, SUT’s, hypertension, migraine, profuse sweating tremors
what can you treat a beta blocker overdose with
glucagon
list the antidysrhythmic drugs
adenosine, amiodarone, pigoxin, lidocaine, procainamidl, verapamil
list the sympathomimetic drugs
dopamine, isoproterenol (isuprel), epi, nor epi
list the calcium channel blocker
diltiazem, verapamile
list some electrolyte drugs
calcium chloride, mag sulfate, sodium bicarb
the dopaminergic effects occur mainly at what rate?
1-4 mg/kg/min
describe what happens when dopamine is infused at 5-10mcg/kg/min
primarily beta, some vasoconstriction, more closer to 10
10-20 mcg/kg/min of dopamine results in…?
predomiraley alpha with substantial vasoconstriction
finish this at 10 mcg/kg/min you run dopamine at…?
20,30,40
what cardiac arrest drugs can be admin. through the ett
Epi vasopressin, also used to be lido and atrophine
indications for vasopressin
cardiac arrest
dose of vasopressin..can you repeat dose?
no and 40 units, 2 vials
how is vasopressin different from other pressors
bolus only in units, long half life 10-20 mins, not as irritating/stimulating to the heart not alpha or ans
what are the signs and symptoms of symptomatic brady?
chest pain (ischemic) hypotension signs of shock altered IOC acute heart failure
first line drug for symptomatic brady is and why?
atrophine: only action is to increase heart rate- no other demand on heart-
what is first line non drug for symptom brady
trancutaneous pacing
describe atrophine using ANS words
parasympatholytic parasympathetic blocking vagolytic anticholinergic positive chronotrope
what is non-cardiac use for atropine
organophosphate poison
what is dose of atropine..what happens if you give a less amount of dose
Brady- .5mg IV max 3mg, it will slow heart rate
what is max doses of atropine
3mg and .04mg/kg
what side affect of atropine can interfere with assesment
dilated pupils
atropine may not work in sympt. Brady if the patient is…?
hypotnesive, can’t get where needs to go or heart can’t respond
another and chronotrope you could after atropite, dopamine, epi, and a TCP is…?
isuprel
using ANS terms describe isuprel
pure beta and positive chronotrope and positive inotrope
sympathomimetic, catecholamine
list 4 steps of administrate for adenosine to be most effective
central circ IV, give as close to site as possible, inject rapid, flush needed
describe how adenosine is beneficial in A-fib/Aflut
may help to diagnose but will not treat
what are the symptomatic NS actions of amidoarone
Alpha Blocker-Vasodilation
Beta Blocker-Chronotrope, Negative inotrope
What channels do Amiodarone affect
Sodium channels, potassium, calcium -Slow conduction through vents slow HR - increases AV node conduction, increases refrat
what two PNB rhythms may receive amiodarone
V-tach, V-Fib
what are side effects of amiodarone
hypotension-Alpha blocker
Brady- Beta blocker
AV block
TDP
amidodarone dose in PNB
300mg iv, 150mg in 3-5 min
amiodarone dose in tachy with a pulse
150mg in 100mL D5W over 10 min
procanamide should be given until…?
dysrhythmia is suppressed
QRS duration increased by 750%
hypotension
total dose of 17mg/kg
procainamide decreases excitability in what part of the heart
ventricles, atria, purkinje fibers
do NOT use procainamide in what vent rhythm
torsades
what action does lido have that amiodarone nor procainamide have
helps decrease ICP and is an anestheic
list the CNS side effects of lido
altered LOC, slurred speech, visual disturbances, muscle twitching, seizures
what are the endogenous catecholamides
Epi, nor epi ,dopmine
what are some indications for using a beta blocker
reduce angina and v-fib, SVT’s, hypertension, migraine, profuse sweating tremors
what can you treat a beta blocker overdose with
glucagon
list the antidysrhythmic drugs
adenosine, amiodarone, digoxin, lidocaine, procainamidl, verapamil
list the sympathomimetic drugs
dopamine, isoproterenol (isuprel), epi, nor epi
list the calcium channel blockers
diltiazem, verapamile
list some electrolyte drugs
calcium chloride, mag sulfate, sodium bicarb
the dopaminergic effects occur mainly at what rate?
1-4 mg/kg/min
decribe what happens when dopamine is infused at 5-10mcg/kg/min
primarily beta, some vasoconstriction, more closer to 10
10-20 mcg/kg/min of dopamine results in…?
predomiraley alpha with substantial vasoconstriction
finish this at 10 mcg/kg/min you run dopamine at…?
20,30,40
what cardiac arrest drugs can be admin. through the ett
Epi vasopressin, also used to be lido and atrophine
indications for vasopressin
cardiac arrest
dose of vasopressin..can you repeat dose?
no and 40 units, 2 vials
how is vasopressin different from other pressors
bolus only in units, long half life 10-20 mins, not as irritating/stimulating to the heart not alpha or ans
what are the signs and symptoms of symptomatic brady?
chest pain (ischemic) hypotension signs of shock altered IOC acute heart failure
first line drug for symptomatic brady is and why?
atrophine: only action is to increase heart rate- no other demand on heart-
what is first line non drug for symptom brady
trancutaneous pacing
describe atrophine using ANS words
parasympatholytic parasympathetic blocking vagolytic anticholinergic tchrontrope
what is non-cardiac use for atropine
organophosphate poison
what is dose of atropine..what happens if you give a less amount of dose
Brady- .5mg IV max 3mg, it will slow heart rate
what is max doses of atropine
3mg and .04mg/kg
what side affect of atropine can interfere with assesment
dilated pupils
atropine may not work in sympt. Brady if the patient is…?
hypotnesive, can’t get where needs to go or heart can’t respond
another pos chronotrope you could after atropite, dopamine, epi, and a TCP is…?
isuprel
using ANS terms describe isuprel
pure beta and chronotrope and inotrope
sympathomimetic, catecholamine
