Week 8 Flashcards
Adenosine
Adenosine 6 second half life Antidysrhythmic
Brand: Adenocard
MOA: Slows SVTs; decreases conduction through the AV node without causing negative inotropic effects. Acts on sinus pacemaker cells and vagal nerve terminal to decrease chronotropic effects.
IND: narrow complex SVT
CON: drug induced tachycardia, 2nd & 3rd degree block, sensitivity, (A-fib, A-flutter) not going to do anything, WPW
Adverse: light headed, diaphoresis, palpitations, chest pain flushing, hypotension, sinus brady/pause, metallic taste, asystole, block.
Dose/Route: 6mg rapid RAPID IV push
2nd DOSE: 12mg IV, IO with procedure.
Pedi—initial 0.1mg/kg
2ND dose: 0.2 mg/kg RAPID IV push, MAX single dose 12mg (<50kg)
SPCL: Pregnancy Class C, may produce a brief period of asystole. Caffeine inhibits interaction, proximal vein, large bore, fast push elevate.
Diltiazem
diltiazem Calcium Channel Blocker
Brand: Cardizem
MOA: slows conduction, increases AV node refractory & causes coronary/peripheral vasodilation. Used after Adenosine for reentry SVT in patients with narrow QRS. Blocks Calcium, decreases ventricular response.
IND: A-Flutter or A-FIB with RVR, recurrent SVT
CON: Wide QRS tachycardias, 2nd & 3rd degree heart block, hypotension, cardiogenic shock, sensitivity, dysrhythmias associated with reentry (WPW) & short P-R interval, V-tach, M.I., large amount of depressants.
Adverse: A-flutter, 1st & 2nd degree heart block, bradycardia, hypotension, syncope, n/v, dizziness, headache
Dose/Route: 0.25mg/kg IV over 2 min 2nd dose 0.35mg/kg
(5-15mg/hr IV drip) Pedi- not indicated
SPCL: Prego Class C, caution in renal & hepatic patients, patients on beta blockers, must be refrigerated/shelf life 1 month post room-temperature. Ca++ antidote. Atropine (to support heart rate)
Atropine
atropine sulfate Anticholinergic
MOA: inhibits actions of acetylcholine at postganglionic parasympathetic receptor sites. Blocks parasympathetic stimulation. Increases chronotrope, little inotrope effect
IND: symptomatic bradycardia, organophosphate poisoning.
CON: none in emergency setting, HTN, tachy, acute MI
Adverse: Tachycardia, palpitation, dysrhythmias, headache, dizziness, n/v
Dose/Route:
Brady: 0.5mg every 3-5 min. up to 3mg max single dose IV/IO
Pedi—0.02mg/kg repeated once up to max 0.5mg IV/IO
Poisoning—3-5mg every 5-15min IV/IO
Pedi—0.02-0.05mg/kg IV/IO
RSI: 0.01-0.02mg/kg max single dose 0.5mg IV/IO
Special: Prego Class C, causes pupil dilation. 1st line drug for symp brady, DON’T use in heart transplant patients, Used in RSI to prevent vagal nerve activation
Metoprolol
metoprolol Beta Blocker
Brand: Lopressor
MOA: Decreases heart rate, conduction, contractility, and cardiac output. selective Beta Blocker.
IND: SVT & stable narrow complex tachycardia, A-fib, A-flutter, suspected MI
CON: Hemodynamically unstable patients, signs of low cardiac output, sensitivity, 2nd & 3rd degree heart block, WPW, asthma
Adverse: Bradycardia, AV delays, hypotension, palpitations, n/v, clinical depression.
Dose/Route: 5mg every 2-5 min. intervals total of 15mg IV/IO
Pedi—NOPE
Special: Prego Class C, careful if used with Calcium Channel blockers
