vasoactive drugs Flashcards
trade name of adenosine
Adenocard, Adenocor,
dose of adenosine
6 mg over 1-2 seconds 12 mg second dose 20 mL flush
onset of adenosine
rapid
DOA adenosine
very breif
uses of adenosine
Paroxysmal SVT including those associated with accessory bypass tracts (WPWS);
not effective for a.fib/flutter, vtach
metabolism of adenosine
Blood and tissue to inosine\
then to AMP and hypoxanthine
elimination of adenosine
Erythrocytes and vascular endothelial cells
a/e adenosine
Arrhythmias,
hypotension,
bronchospasm in patients with asthma
contraindications of adenosine
Second or third degree AV block, sick sinus syndrome, symptomatic bradycardia; known or suspected bronchoconstriction, asthma
Atenolol category
beta blocker
beta 1 selective
Antianginal,
antihypertensive,
atenolol b receptors
b 1 selective
dose of atenolol
HTN PO 25-50 mg
May also be used for angina, a.fib, post-MI, thyrotoxicosis
onset of atenolol
1 hour
peak of atenolol
2-4 hours
uses of atenolol
Tx HTN, angina, post-MI, acute ETOH withdrawal, SVT, a.fib, migraine h/a prophy
metabolism of atenolol
hepatic
elimination of atenolol
Feces 50%,
urine 40%
major side effects of atenolol
Bradycardia, hypotension, 2nd degree AV block, bronchospasm, wheezing
contraindications of atenolol
Sinus bradycardia, SAnode d/f, heart block greater than first degree, cardiogenic shock, uncompensated heart failure, pulmonary edema, pregnancy
cation with atenolol certain conditions
Caution: diabetes, myasthenia gravis, PVD, raynauds, pheochromocytoma (use alpha blocker first), thyroid disease
calcium chloride dosage acute symptomatic
Acute symptomatic 200-1000 mg Q1-3 days
Beta blocker OD 20mg/kg over 5-10min followed by infusion 20mg/kg
calcium chloride dosage Cardiac arrest with hyperkalemia/magnesemia or hypocalcemia and how fast
Cardiac arrest with hyperkalemia/magnesemia or hypocalcemia 500-1000mg over 2-5 min
calcium chloride with beta blocker overdose
Beta blocker OD 20mg/kg over 5-10min followed by infusion 20mg/kg
onset of calcium chloride
immediate
uses of calcium chloride
Treat hypocalcemia, emergent tx of severe hypermagnesemia, beta blocker OD, severe hyperkalemia, malignant arrhythmias
elimination of calcium chloride
feces
AE with calcium chloride
Acidosis, hyperphophatemia, hypokalemia, hypomagnesemia, tissue necrosis, hot flash, vasodilation
absolute contraindication with calcium chloride
digoxin overdose
calcium chloride forms a precipitate with WHAT and do no give with it then?
Do not give with bicarb or phosphate containing solutions to avoid precipitation;
what electrolyte imbalance should you give hyperkalemia with
Preferred in hyperkalemia with circulatory compromise
how do CaCl and Calcium Gluconate compare
Amp of 10% CaCl contains three times (3x) more Ca than amp of 10% Ca gluconate
dose of calcium gluconate
Hypocalcemia ionized Ca 4-5 mg/dL or 1-1.2mmol/L
1000-2000 mg over 2 hrs
elimination calcium gluconate
feces
adverse effects of calcium gluconate
Risk for hyperphosphatemia,
hypokalemia,
hypomagnesemisa,
kidney stones
contraindications of calcium gluconate
v.fib,
hypercalcemia,
concomitant use of IV Ca gluconate and ceftriaxone; caution in pts on digitalis bc hypercalcemia promotes cardiotoxicity
what must you NOT give calcium gluconate with? and what would happen if you did
Do not give with bicarb or phosphate containing solutions to avoid precipitation
trade name of clonadine
catapres
category of clonadine
Alpha2 adrenergic agonist;
antihypertensive
dose of clonadine PO
PO 0.1mg BID
TD 0.1mg/24hr patch
dose of clonadine for pain epidural
Pain epidural: 30 mcg/hr titrate MAX >40mcg/
onset of PO clonidine
PO 0.5-1hr
TD 2-3 days
peak of PO clonidine
6-10 hours
uses of clonidine
Tx HTN,
ADHD,
cancer pain,
neuropathic pain,
metabolism of clonidine
hepatic
elimination of clonidine
urine
major adverse effects of clonidine
Bradycardia/tachycardia,
hypotension
contraindications with clonadine
Epidural administration: infection at site; concurrent anticoagulation, bleeding diathesis, administration above C4 dermatome; caution with drugs with SA/AV nodal blocking properties
how do alpha 2:1
Alpha2:Alpha1
220:1
trade name of digoxin
digitalis
category of digoxin
Antiarrhythmic;
cardiac glycoside
dose of digoxin with SVT
SVT: 0.5-1mg give ½ of total digitalizing dose as the initial dose than ¼ of the TDD in each of the 2 subsequent doses at 6-8 hr interval
onset of digoxin IV
5-60 min IV
onset of digoxin PO
PO 1-2 hrs
DOA digoxin
DOA 3-4 days
uses of digoxin
Sequential sugar hydrolysis in the stomach or
reduction of lactone ring by intestinal bacteria
A-fib with RVR
A-flutter
*NO LONGER THE FIRST CHOICE WITH these- BB or Ca channel blockers are best
metabolism of digoxin
urine
major adverse effects of digoxin
Junctional rhythm, heart block, PR prolongation, Vtach/vfib, Noncardiac side effects: GI—anorexia, N/V, and abd pain: CNS—visual disturbances, headache, drowsiness, confusion vision changes (yellow/blurred vision),
contraindications of digoxin
Hypersensitivity; vfib
what can lead to cardiac toxicity?
Cardiac arrhythmia (toxicity) can be precipitated by hypokalemia, hypomagnesemia, hypoxia, hypercalcemia, hypernatremia, renal failure
class of anti arrhythmic of diltiazem
Class IV
category of diltiazem
anti-arrythmic
calcium channel blocker
dose of diltiazem and use
if it is repeated what is the dose?
Afib/flutter: 0.25 mg/kg over 2 min bolus (~20mg); may repeat after 15 min at 0.35 mg/kg over 2 min (~25mg);
infusion dose of diltiazem
cont inf 10 mg/hr
may increase rate in 5mg/hr increments up to 15mg/hr
onset of diltiazem
3 minutes
peak of diltiazem
2-5 minutes
DOA diltiazem
1-3 hours
use of diltiazem
control of rapid rate in a-fib a-flutter
metabolism of diltiazem
hepatic
elimination of diltiazem
urine
adverse effects of diltiazem
Hypotension,
av block,
elevated ast/alt,
stevens-johnson syndrome
contraindications with diltiazem
Sick sinus syndrome, 2nd or 3rd degree block, severe hypotension, cardiogenic shock, concomitant administration with IV beta blocker, WPWS, vtach
trade name of esmolol
Brevibloc
classification of esmolol
B-1 selective beta blocker
intubation dose of esmolol
Intubation 1-2mg/kg
HTN dose of esmolol w/tachycardia
bolus (mg/kg)
HTN/tachycardia 80mg initial bolus (1mg/kg) over 30 sec
infusion dose of esmolol
& infusion
followed by 150 mcg/kg/min infusion max 300 mcg/kg/min
onset of esmolol
2-10 minutes
peak of esmolol
10-30 minutes
DOA esmolol
unknown
metabolism of esmolol
In RBCs by blood cell esterases
excretion of esmolol
urine
uses of esmolol
Treatment of SVT and Afib/flutter;
tx of intraoperative and postoperative tachycardia and or HTN
major adverse effects of esmolol
Hypotension, bradycardia, bronchospasm, CHF, pulmonary edema
contraindications with esmolol
Sinus bradycardia,
heart block greater than 1st degree,
cardiogenic shock,
uncompensated cardiac
fenlodopam categoty
dopamine 1 agonist
arteriol vasodilation
fanlodopam trade name
corlopam
fenlodopam dose
0.03-0.1mcg/kg/min may increase by 0.05-0.1mcg/kg/min Q15min
max dose of fenlodopam
max 1.6 mcg/kg/min
onset of fenlodopam
10 minutes
duration of action of fenlodopam
1 hour
metabolism of fenlodopam
hepatic
excretion of fenlodopam
Urine 90%. 10% feces
uses of fenlodopam
Severe HTN
A/E fenlodopam
Hypotension, flushing, dizziness, h/a, nausea, hypokalemia, increases HR
caution with fenlodopam
Use with caution in patients with glaucoma as it increases IOP
trade name of hydralazine
apresoline
category of hydralazine
Direct vasodilator;
phenothalazine derivative
dose of hydralazine
10-20 mg Q 4-5 hrs PRN
onset of hydralazine
5-10 minutes
peak of hydralazine
1-4 hours
DOA hydralazine
15-30 minutes
metabolism of hydralazine
hepatic
elimination of hydralazine
urine
use of hydralazine
HTN