Quiz 2 (Cardiac Drugs)

Question 1

Atropine

Answer 1

Class: Anticholinergic, Parasympatholytic

Action: Inhibits actions of ACh, increases HR, decreases salivation and bronchial secretions, decreases gastric motility

Indications: Hemodynamically unstable bradycardia and organophosphate poisoning

Contraindications: Hypersensitivity, tachycardia, hypothermia pt’s, use caution with active myocardial infarction and hypoxia

Side Effects: Nausea/vomiting, tachycardia, headache, paradoxical bradycardia if given too slow or too small dose, mydriasis, dysrhythmias, flushed, etc.

Doses:
Adult (Brady)- 0.5mg IV/IO q 3-5 mins (max of 3mg)
(Organo poisoning)- 1-5mg IV/IM/IO z 3-5 mins until cessation of bronchial secretions
Peds (Brady)- AND NOT responding to Epi 0.02mg/kg IV/IO (max 1mg)
(Organo poisoning)- 0.2-0.5mg/kg IV/IM/IO may be repeated every 20-30 mins until cessation of bronchial secretions

Question 2

Amiodarone

Answer 2

Class: Class III Antidysrhythmic

Action: Prolongs duration of the action potential and prolongs the refractory period, also has beta adrenergic receptor and calcium channel blocking activity.

Indications: V-fib, hemodynamically unstable V-tach, treatment for some stable atrial rhythms

Contraindications: CHF, cardiogenic shock, bradycardia, 2nd or 3rd degree heart blocks w/ no pacemaker present, hypersensitivity to amiodarone or iodine

Side Effects: Bradycardia, hypotension, headache, CHF, abnormal liver/thyroid functions

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

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

Question 3

Adenosine

Answer 3

Class: Misc. Antidysrhythmia, Endogenous nucleoside

Action: Decreases electrical conduction through the AV Node

Indications: Supraventricular tachycardia’s (SVT/PSVT)

Contraindications: Hypersensitivity, V-tach, A-fib, A-flutter, WPW w/ A-fib/A-flutter, 2nd or 3rd degree heart block, drug-induced tachycardia

Side Effects: Bradycardia, headache, nausea/vomiting, dizziness, flushing, palpitations, angina, SOB, hypotension

Doses:
Adult- 6mg rapid IV/IO push–>20cc saline flush–>12mg rapid IV/IO push–>20cc saline flush

Peds- 0.1mg/kg (max 6mg) IV/IO–>5-10cc saline flush–>may repeat 0.2mg/kg (max 12mg) IV/IO–>5-10cc saline flush

Question 4

Sodium BiCarbonate

Answer 4

Class: PH buffer, alkalizing agent, electrolyte supplement

Action: Short acting, potent acid buffer. Bicarbonate binds to hydrogen ions, to make carbonic acid. This is broken down in the lungs and exhaled as water and carbon dioxide. As a plasma hydrogen ion concentration decreases causing blood pH to rise.

Indications: Tricyclic antidepressant (TCA) overdose, management of metabolic acidosis, prolonged cardiac arrest down time, known preexisting hyperkalemia, DKA, alkalization treatment for specific intoxications/rhabdomyolysis

Contraindications: Hypokalemia, suspected metabolic and respiratory alkalosis, hypernatremia, pt’s w/ chloride loss due to vomiting and GI suction, severe pulmonary edema

Side Effects: Metabolic alkalosis, seizures

Doses:
Adult–>1mEq/kg IV

Peds–>Same as adult but infuse slowly and only if ventilations are adequate