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CCN > Meds exam 2 > Flashcards

Meds exam 2 Flashcards

1
Q

Adenosine: Action / Indications

A

Antiarrhythmic, slows conduction through AV node.

Used to restore sinus rhythm in pts with atrial tach, slows down tachyarrythmias for diagnostic purposes.

NOT EFFECTIVE FOR ATRIAL FIB AND ATRIAL FLUTTER

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2
Q

Adenosine: Dose

A

Bolus: 6mg IV push over 1-2 secs
If no response in 1-2 mins: 12 mg IV push
If no response: Another 12 mg IV push

Half life 10 secs

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3
Q

Adenosine: Nursing considerations

A

Vagal maneuvers should be tried first.

Must be pushed quickly followed by rapid flush.

Pt may have transient AV blocks, asystole, slow rhythms,

Side effects: Facial flushing, chest pressure, SOB (WARN PTS FIRST!)

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4
Q

Atropine: Action, indications

A

Anticholinergic, anti PSNS drug

works to block PSNS, prevents action of Ach results in more SNS relative to PSNS and increase in HR

Used for symptomatic bradycardia, heart blocks

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5
Q

Atropine: Dose

A

0.5mg IV push q 2-5mins, max 3 mg

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6
Q

Atropine: Nursing considerations

A

Monitor tachycardia

SE: Dilated pupils, dry mouth

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7
Q

Epinephrine: Action

A

Sympathomimetic, produced by adrenal medulla and has beta 1, beta 2, alpha effects (primarily Beta)

Beta 1: Increase CO, + inotrope, + chronotrope

Beta 2: Bronchodilation in lungs

Alpha: Vasoconstriction, thus increase BP

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8
Q

Epinephrine: indications

A

Cardiac arrest, symptomatic bradycardia, severe shock states, severe hypotension, resp distress due to bronchospasm or anaphylaxis

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9
Q

Epinephrine: Dose

A

May be mcg/kg/min or mcg/min

In cardiac arrest: Bolus 1mg q 3-5mins

Continuous infusion: 4mg in 250cc NS/D5W @ 1mcg/min titrated up (1-20 mcg/min)

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10
Q

Epinephrine: Nursing considerations

A

Monitor increased BP, HR
Correct hypovolemia first
Use central line
**Use caution for cardiac pts as causes increase in myocardial O2 demand and MI

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11
Q

Fentanyl: Action, indications

A

Narcotic analgesic, synthetic opioid

Blocks opiate receptors in CNS, reducing pain transmission. Rapid onset, short duration with less hypotension than morphine (less histamine release)

Used for pre-procedural analgesic, pain management in hypotensive pts, used in anesthesia with hypnotic agent such as propofol

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12
Q

Fentanyl: Dose

A

IVP: 25 - `100mcg
IV infusion: Initiate at 25-50 mcg/hr and titrate

Onset 1-2 mins, duration 30-60 mins

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13
Q

How potent is fentanyl?

A

100mcg fentanyl equivalent to 10mg morphine (recall 1000 mcg = 1 mg)

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14
Q

Fentanyl: Nursing considerations

A

Rapid infusion may cause resp depression.

Can cause decreased GI motility, bradycardia

Keep airway resus equipment on hand

Can accumulate with hepatic impairment (perform sedation vacation to prevent accumulation)

Antidote: Narcan

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15
Q

Metoprolol: Action, indications

A

Beta blocker

  • inotrope
  • chronotrope
    Decrease in myocardial O2 demand

Treatment or prophylaxis of tachyarrythmias, heart failure, hypertension, angina, acute MI or post MI

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16
Q

Metoprolol: Dose

A

Bolus: 5mg IV push over 1-2 mins, may repeat q 5 - 10 mins

Total IV dose = 15mg

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17
Q

Metoprolol: Nursing considerations

A

High doses can block beta 2 receptors in lungs leading to bronchoconstriction

Caution in pts with heart failure, bronchospastic disease

Side effects: CHF, pulmonary edema, bradyarrythmias, AV blocks, hypotension

Caution when used with Ca channel blockers

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18
Q

Midazolam: Action, indication

A

Sedative (benzodiazepine), is a direct CNS depressant and fastest acting shortest duration of benzos

Hypnotic, anti-anxiety, sedative, amnesic, anticonvulsant effects

Used for procedural sedation, agitation, sedation with NMBAs, seizure activity

19
Q

Midazolam: Dose

A

Bolus 1-4mg over 2-3 mins
Infusion: 1-5mg/hr (100mg in 100cc D5W)

Onset: 1-2 mins, duration 20-30 mins

20
Q

Midazolam: Nursing considerations

A

Too little / too much may lead to agitation, hyperactivity, paradoxical effect in very young / elderly

Adverse effects: Resp depression, hypotension

Half life 1-5 hrs

Pts can develop tolerance and withdrawal

21
Q

Morphine: Action, indications

A

Narcotic analgesic, opiate

Blocks opiate receptors in CNS, reducing pain transmission. Relaxes smooth muscle in vessel beds causing vasodilation. Decreases preload, afterload, O2 demand

Analgesic of choice for MI induced pain, may be used in CHF for pulmonary edema

22
Q

Morphine: Dose

A

IVP: 2-4 mg, slowly
**Rapid push causes adverse effects

Infusion: Initiate at 2-4 mg/hr titrate up

Onset 5 mins, duration 4-5 hrs (much longer than fentanyl)

23
Q

Morphine: Nursing considerations

A

SE: Resp depression, hypotension, brady, decreased GI motility, decreased LOC

Antidote: Narcan

24
Q

Nitroglycerin: Action

A

Vasodilator / Nitrate

Relaxes smooth muscle and vessel beds (predominantly venous dilation, decreases preload)

CA vasodilation increases O2 delivery and decreases O2 demand

25
Q

Nitroglycerin: Indications

A

Prevention / treatment of angina by increasing CA blood flow

ACS ischemic chest pain
Acute and chronic heart failure to decrease preload and pulmonary congestion
Pulmonary edema

26
Q

Nitroglycerin: Dose

A

Continuous infusion: 20 - 200 mcg/min or 1 - 10 mcg/kg/min

Titrate 5 mcg/min up q5min as needed for angina until pt is pain free

** Mix in glass bottle / low absorbing tubing

Duration: Less than 20 mins

27
Q

Nitroglycerin: Nursing considerations

A

Use central line, may cause arterial vasodilation (watch hypotension)

Titrate up / down slowly
May be converted to transdermal patch

Pt may develop tolerance > 2 days

Side effects:
Hypotension (peripheral vasodilation)
Headache (cerebral vasodilation)
Tachycardia (compensation to decreased BP)

28
Q

Nitroprusside: Action, indications

A

Vasodilator, antihypertensive

Potent vasodilator and causes relaxation for vessel beds (predominantly arterial, reduces afterload)

Mainly reduces afterload, some decreased preload

Used for control of hypertensive crisis, acute heart failure, used in OR to minimize blood loss, post-op to control BP following vascular surgeries. Used for short time only

29
Q

Nitroprusside vs Nitroglycerin: Action?

A

Nitroglycerin mainly dilates venous system while nitroprusside dilates arterial system

30
Q

Nitroprusside: Dose

A

Continuous infusion: 0.5 mcg/kg/min, titrate up by 0.2mcg to MAX of 8mcg/kg/min

Works immediately when initiated, short half life 10 mins

Cover bag with foil as drug breaks down from light

31
Q

Nitroprusside: Nursing considerations

A

Monitor for hypotension, titrate very slowly. Use central line.

Metabolized to cyanide and then thiocyanide. Monitor pts for cyanide toxicity and check serum levels

32
Q

What are signs of thiocyanate toxicity?

A

Tinnitus, blurred vision, confusion, delirium, muscle spasm

33
Q

Norepinephrine: Action, indications

A

Sympathomimetic, vasopressor

Used primarily for alpha effects (peripheral vasoconstriction, increase BP) but has some beta 1 effects (+ inotrope)

Used for severe hypotension, BP less than 70, pts with vasodilatory shocks following fluid bolus

34
Q

Norepinephrine: Dose

A

Continuous infusion: Start at 2mcg / min, titrate up to desired response

2 - 5 mcg/min = alpha and beta 1 effects
> 5mcg/min = alpha effects
Soft max 20mcg/min

May also be measured as mcg/kg/min, dose would be 0.03 - 2.0 mcg/kg/min

35
Q

Norepinephrine: Nursing considerations

A

Correct hypovolemia first or vasoconstriction may cause CA ischemia. Monitor BP, HR, U/O, use central line

Recommended to mix in D5W as loses potency in NS

Titrate slowly

Adverse effects:
Intense vasoconstriction, necrosis to peripheral limbs, renal failure d/t renal artery vasoconstriction

36
Q

Propofol: Action

A

Anesthetic agent, sedative / hypnotic at lower doses

Acts directly on CNS to decrease neuro APs, crosses blood brain barrier to decrease ICP.
Decrease in SNS tone may result in vasodilation (Decrease HR, RR, BP)
Anti anxiety, hypnotic, amnesic properties

37
Q

Propofol: Indications

A

Used in OR as anesthetic agent, in ICU as procedural sedation and as continuous infusion to maintain sedation

Short acting, allows for frequent neurological assessments in ICU

38
Q

Propofol: Dose

A

Bolus loading dose given by MD: 10-20 mg (warn pts of local pain)

Continuous infusion: 5-50 mcg/kg/min

Onset 40 secs duration 3-10mins

*Possible synergistic effects with narcotics and other sedatives

39
Q

Propofol: Nursing considerations

A
  • No preservatives, high risk of infection, change lines / bottle q12h
  • Monitor triglycerides if used more than 3 days
  • Dietician to follow
  • Use central line or large peripheral vein (irritating)
  • Risk of resp depression - should be used only with intubated pts
  • Should be weaned off
  • **NO ANALGESIC PROPERTIES
  • **Do not mix with other meds
  • Causes discoloration of urine (light green)
  • Caution in pts with egg allergies
  • Risk for propofol infusion syndrome (PRIS)
40
Q

What is propofol infusion syndrome?

A

Associated with dose > 67 mcg/kg/min for more than 48 hrs, believed to cause impaired utilization of fatty acids in cardiac and skeletal muscle cells.

Pt develops severe metabolic acidosis, rhabdomyolysis, acute renal failure. Treatment is supportive and stop propofol

41
Q

Vasopressin: Action, indications

A

Vasoconstrictor, antidiuretic (endogenous hormone ADH)

  • Directly stimulates vessel smooth muscle contraction, causing increased afterload and BP
  • Causes increased re-absorption of water from renal tubules to increase BP

Used for shock states for decreased SV, septic shock when pt is on max levo. V fib arrest, treatment of bleeding esophageal varices

42
Q

Vasopressin: Dose

A

Continuous infusion: 0.4 - 3.2 units /hr

Onset 1-3 mins, half life 20 mins

Mixed: 20 - 40 units / 100 cc or 100 units / 250cc D5W

43
Q

Vasopressin: Nursing considerations

A

Mesenteric ischemia, ischemia of fingers / toes, central line, risk of MI r/t CA vasoconstriction (though less risk than epinephrine)

CCN (27 decks)

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