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Cardiac Drug Profiles Flashcards

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1
Q

Acetylsalicyclic Acid Names/Class

A

Acetylsaicylic Acid, ASA, Aspririn

Class: Analgesic, anti inflammatory, antipyretic

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2
Q

ASA Indications

A

CP or s/s suggestive of MI
Unstable Angina
Pain, Discomfort, Fever (adult only)

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3
Q

ASA contraindications

A

Hypersensitivity
Bleeding ulcer, hemorrhagic state, Hemophilia
Children or adolescents

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4
Q

ASA MOA

A

Blocks Thromboxane A2 (platelet aggregate and vasoconstrictor)
Decreases platelet aggregation

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5
Q

ASA adverse reactions

A

Caution with asthma, anaphylaxis in sensitive PT have occurred, Skin eruptions

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6
Q

ASA Dose (adult)

A

Cardiac: 160-325 PO (2-4 pediatric tablets)

Pain/discomfort/fever: 325 mg PO

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7
Q

Adenosine Names/Class

A

Adenosine

Brand: Adenocard

Class: Antiarrythmic, Endogenous nucleoside

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8
Q

Adenosine MOA

A

Slows conduction through AV node
Slows sinus rate
Larger doses decrease BP by decreasing peripheral resistance

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9
Q

Adenosine Indications

A

SVT with no known AFib or Aflutter

Undifferentiated regular monomorphic wide complex tachycardia

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10
Q

Adenosine Contraindications

A

Sick sinus syndrome, 2nd or 3rd degree block (except PT with functioning pacemaker)
Theophylline and related Methylxanthines
Dipyramidole (persantine) and carbamazepine (tegretol)
Known Afib/Aflutter
Pregnancy

Caution: asthma and cardiac tranplant PTs (more sensitive)

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11
Q

Adenosine Adverse Effects

A

CV: Systole bradycardia, and PVCs occur in 55% of PTs, palpitations, chest pressure, chest pain
Resp: Dyspnea, hyperventilation, facial flushing, sweating
CNS: Lightheadedness, headache, dizziness, parathesia apprehension, blurred vision, neck/back pain
GI: N/V, mettalic taste

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12
Q

Adenosine incompatability/interactions

A

Adenosine is not blocked by atropine
Theophylline and methylxanthines decrease effectiveness
Dipyradimole (persantine/blood thinner) and carbamazepine (tegretol/seizure med)) block uptake and potentiate effects

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13
Q

Adenosine Dosage (ad and ped)

A

Adult: 6mg rapid push W/20 ml NS flush, can repeat in 1-2 minutes with 12mg

Ped: 0.1 mg/kg rapid push with 2-3 ml NS flush, may double one time (0.2 mg/kg) MAX DOSE: 12mg

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14
Q

Amiodarone Names/Class

A

Amiodarone

Brand: pacerone, nexterone

Class: Antiarrythmic

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15
Q

Amiodarone MOA

A

Multiple effects on Na, Ca, and K channels
Prolongs action potential, refractory peros
K channel blockade increases ventricular automaticity
Na Channel blockade slows membrane depolirization and impulse conduction
Ca channel and Beta blockade has a negative chronotropic effect
Dilates coronary arteries due to Ca channel and Alpha-adrenergic blocking action

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16
Q

Amiodarone Indications

A

Defib refractory VF/Pulseless VT
Polymorphic VT
Wide complex tachycardia of uncertain origin
Control hemodynamically stable VT with cardoversion is not successful
Adjunct to cardioversion of SVT and PSVT
Rate control in AF/Aflutter

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17
Q

Amiodarone Contraindications

A 
Bradycardia
2nd or 3rd degree heart blocks without  functioning pacemaker
Cardiogenic shock
Hypotension
Pulmonary congestion

Caution: temperature control is needed (77 F)

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18
Q

Amiodarone Adverse reactions

A

CV: Bradycardia, hypotension, asystole/cardiac arrest, AV block, Torsades, CHF
GI/Hepatic: N/V, abnormal liver function test
Skin: Slate blue pigmentation
Other: Fever, Headache, dizziness, fever, flushing, abnormal salivation, photophobia

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19
Q

Amiodarone Incompatibilities/interactions

A

Beta Blockers, Ca channel blockers, and other antiarrythmics are additive and can be proarrhythmic (BP Meds)
Precipates at Y site with Na Bicarb, Furosemide, and heparin

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20
Q

Amiodarone Dose (ad and Ped)

A

Adult
VF/Pulseless VT: 300 mg IV push over 30-60 seconds, may repeat in 3-5 minutes with 150 mg
Wide complex Tachycardia. Aflut, Afib, SVT with cardioversion: 150 mg Iv over 10 mins, may repeat every 10 mins. (in 50 mL bag of D5W)
Maint infusion post arrest/conversion: 1 mg/min infusion over 6 hours, then 0.5 mg infusion over 18 hours (max daily of 2.2 mg)

mix 450 mg in 250 mL D5W makes 1.8 mg/mL, run at 33.3 mL/hr for 1 mg/min or 16.7 mL for 0.5 mg infusion

Peds:
VF/Pulseless VT: 5 mg/kg (max 300 mg) may repeat every 5 minutes twice to a max of 15 mg/kg/day
Probable VT w/pulse: 5 mg/kg over 20 minutes, can be repeated twice for max of 15 mg/kg/day

Needs to be mixed in D5W bag because it is polyolefin

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21
Q

Atropine Sulfate Names/Class

A

Atropine Sulfate

Class: Anticholinergic, antimuscarinic, antidote, antispasmodic, antiarrhythmic

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22
Q

Atropine Sulfate MOA

A

Blocks ACH as a competitive antagonist at muscarinic receptor sites in smooth muscle, secretory glands and CNS.
Blocks parasympathetic response, allowing sympathetic to take over.
Reverses muscarinic effects of cholinergic poisoning by reversing bronchorea and bronchodilation
At higher doses, may affect the nicotinic receptors

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23
Q

Atropine Sulfate Indications

A 
Symptomatic bradycardia (Sinus, Junctional, or AV block causing hypotension, ventriculat ectopy, CP, or ALOC)
ACH poisoning (organophsophate)
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24
Q

Atropine Sulfate Contraindications

A

Hypersensitivity or Belladonna alkaloid allergy
Acute narrow angle glaucoma
Tachycardia
Obstuctive GI , Renal, or hepatic disease
Myasthenia Gravis (unless using as ACH inhibitor)
Asthma
Thyrotoxicosis
Mobitz Type II and 3rd degree block

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25
Atropine Sulfate Adverse reactions
Major: Tachydysrhythmias, flushing, ventricular irritability, angina, acute narrow angle glaucoma, blurred vision, pupil dilation (mydriasis), agitation to delirium, bloating, constipation, decrease GI activity Minor: Dry mouth/mucous membranes, loss of taste, N/V, Urinary retention, nueromuscular weakness, decreased sweating/increase body temp
26
Atropine Sulfate Incompatibilities/reactions
Thiopental, cimetidine, pentobarbital, floxacillin, metaraminol, methohexital, NE, NA bicarb Increases effects of anticholinergics, cannaboids, and KCl. Decreases effects of phenothiazines, ACHesterase inhibitors, and secretin Atropine and psychotropics may have additive anticholinergic effects (dry mouth, blurry vision, etc) Pramintide may increase effectiveness ACHesterase inhibitors may decrease effect of atropine
27
Atropine Sulfate Dose (ad and Ped)
Adult: Symptomatic Bradycardia: 0.5 mg every 5 minutes MAX of 3mg or 0.04 mg/kg Organophosphate poisoning: initial 1-5 mg IV/IO every 5 minutes until signs abate, IV infusion of 0.5 - 1 mg or 10-20% loading dose/hr. Repeat every 10 mins. IM Atropen: 2mg as soon as exposure is known, if severe symptoms develop, give 2 more doses (MAX of 3) Severe symptoms immediately admin (3) 2mg doses Peds: Symptomatic bradycardia: 0.02 mg/kg IV/IO every 5 mins (MAX of 1mg in children/2mg in adolescents. Organophosphate poisoning: 0.03-0.05 mg/kg every 10-20 mins until signs abate, then every 1-4 hrs for 24 hrs IM: Same guidelines as adult <15 lbs (6.8 kg): not recommended, admin atropine .05mg/kg 15-40 lbs (6.8kg-18kg): 0.5 mg/dose 40-90 lbs (18-41kg): 1mg/dose >90lbs (41kg): 2mg/dose
28
Calcium Chloride Names/Class
Calcium Chloride Class: Electrolyte
29
Calcium Chloride MOA
Positive inotropic effect Inhibits effects of adenosine on mast cells Stimulate release of Catelcholamines May enhance ventricular automaticity
30
Calcium Chloride Indications
``` Hypocalcemia Ca channel blocker OD (Amlodipine, diltiazem, verapamil) Acute HyperK Hypermagnesemia (OD) Pretreat for Ca Channel blockers ```
31
Calcium Chloride Contraindications
``` Hypercalcemia Digoxin therapy (relative) ```
32
Calcium Chloride Adverse reaction
Brady-asystolic arrest | Tissue necrosis with extravasation
33
Calcium Chloride Incompatabilities/Interactions
ALL DRUGS, flush line before and after admin
34
Calcium Chloride Doses (ad and ped)
Adult: Hypocalcemia, Ca Channel OD, HyperK, and HyperMag: 5-10 mL (0.5-1gm) may repeat in 10 mins Pretreatment for Ca Channel blockers: 3 mL, may repeat once Peds: Hypocalcemia, Ca Channel OD, HyperK, and HyperMag: 0.2-0.25 mL/kg slow infusion, do not repeat w/o documented Ca deficiency
35
Diltiazem Names/Class
Diltiazem Brand: Cardizem Class: Ca Channel blocker, Calcium antagonic
36
Diltiazem MOA
Pharmacological: Decreases SA/AV conduction and dilates coronary and peripheral arteries and arterioles by inhibiting Ca ion influx across cell membranes during cardiac depolarization Clinical effects: Slows rapid ventricular rate associated with Afib/Aflutter, reduces coronary and peripheral resistance
37
Diltiazem indications
Rapid Ventricular Rates with Afib/Aflut | Paroxysmal SVT refractory to adenosine
38
Diltiazem Contraindications
``` Hypotension below 90mm/Hg AMI Cardiogenic shock VTach or wide complex VT of unknown origin 2nd or 3rd degree AV block WPW Sick sinus syndrome Beta blocker use ```
39
Diltiazem Adverse reactions
CV: Hypotension, bradycardia, heart block, chest pain, asystole GI: N/V CNS: Headache, fatigue, drowsiness
40
Diltiazem Incompatibilties/reactions
Avoid in PTs with suspected poison/drug induced tachycardia | CaCl can be used to prevent hypotensive effects and treat CaCl blocker poisoning
41
Diltiazem Dose (ad)
Adult: 0.25 mg/kg over 2 minutes, if no response, repeat in 15 minutes at 0.35 mg/kg over 2 mins Maintenance infusion of 5-15 mg/hr
42
Dopamine Names/Class
Dopamine Brand: Inotropin Class: Sympathomimetic
43
Dopamine MOA
1-2 mcg/min: acts on dopaminergic receptors to stimulate cerebral, renal, and mesenteric vasculature to dilate. HR and BP are usually unchanged, may increase urine output 2-10 mcg/min: Beta 2 stimulant, antagonizes A-Adrenergic mediated vasoconstriction. Results in Increased cardiac output, and modest increase in systemic vascular resistance 10-20 mcg/min: A Adrenergic effects resulting in renal, mesenteric, and venous vasoconstriction. marked increase in SVR, pulmonary vascular resistance, and further increased preload >20 mcg/min: Hemodynamic effects similar to NE, may increase in HR and O2 demand to undesirable limits.
44
Dopamine indications
Symptomatic bradycardias | Hemdoynamically significant hypotension in absence of hypovolemia
45
Dopamine Contraindications
``` Pheochromocytoma MAO inhibitors (causes HTN crisis) ``` Relative: hypovolemic shock
46
Dopamine Adverse reactions
CV: Arrythmias from increased O2 demand, HTN, hypotension at lower doses GI: N/V GU: Renal shutdown at higher doses Extravasation causes necrosis
47
Dopamine Incompatabilities/interatctions
ANY ALKALINE SOLUTION
48
Dopamine Dose (ad and ped)
Adult: 2-20 mcg/min (400mg/250 mL NS or DX makes 1600 mcg/mL. Bradycardia starts at 5 mcg/min Cardiogenic/Non hypovolemic septic shock : BP <70 systolic start at 5mcg/min. BP >70 start at 2.5 mcg/min Peds: 2-20 mcg/min for circulatory shock or shock unresponsive to fluid admin. 6 x kg = mg to add to NS to make 100 mL (1mL/hr delivers 1 mcg/kg/min, titrate)
49
Epinephrine Names/CLass
Epinephrine HCL May be called adrenaline Class: Sympathomimetic
50
Epinephrine MOA
Pharm: Alpha and Beta agonist, increase SVR with visceral arterial constricton. Beta1: positive ino/chronotoropic effects (increase Myocardial workload and O2 demand, increased automaticity and irritability. Beta 2: bronchial smooth muscle relaxation and dilation of skeletal vasculature. (blocks histamine release) Clinical effect: Cardiac arrest use increases cerebral and Myocardial perfusion pressures, systolic and diastolic BP, electrical activity in the heart. Can stimulate contractions in asystole. Bradycardia: increases HR/BP. Reverses S/S of anaphylaxis and bronchospasm
51
Epinephrine Indications
Cardiac arrest: VF/PVtach, asystole, PEA Severe bronchospasm Anaphylaxis Bradycardia, refractory w/profound hypotension (monitored) Hypotension unresponsive to other therapy (monitored) Croup
52
Epinephrine Contraindications
Non in cardiac arrest | Hypothermia is relative
53
Epinephrine adverse reactions
CV: HTN, Ventricular dysrythmias, tachycardia, angina CNS: Anxiety and agitation GI: N/V
54
Epinephrine incompatibilities/interactions
Potentiates other sympathomimetics | Reacts with alkaline solutions
55
Epinephrine Adult Dose
Pulseless arrest: 1mg 1:10000 every 3-5 mins ET: 2-2.5 mg 1:10000 Hypotension/symptomatic bradycardia: 1 mg/500mL NS @ 1 mcg/min titrated (2-10 mcg/min and not frontline) Anaphylaxis: 0.3-0.5 mg 1:1000 every 10-15 mins. May be asked to give 1:10000 @ 0.1 mg every 5 mins or continuous infusion of 1-4 mg/min
56
Epinephrine Ped dose
Pulseless arrest/refractory bradycardia: 0.01 mg/kg 1:10000 every 3-5 mins, max of 1mg dose ET: .01 mg/kg of 1:1000 diluted or flushed with 3-5mL NS, max dose 10mg Asthma/anaphylaxis: 0.01 mg/kg 1:1000 max dose of 0.5 IV infusion: 0.1-1 mcg/kg/min Croup: 3mg 1:1000 in 3mL NS via SVN Neonatal (1st 12 hours of life): Cardiac arrest/refractory bradycardia: 0.01-0.03 mg/kg 1:10000 every 3-5 mns ET: 0.1 mg/kg of 1:10000 every 3-5 mins if vascular access unavailable or failure to respond to positive pressure ventilation.
57
Lidocaine Name/class
Lidocaine Brand: lidopen Class: anti-arrhythmic, local anesthetic (Class I drug)
58
Lidocaine MOA
Na Channel Blocker, decreases automatcity by slowing rate of phase 4 depolarization Decreases conductions in reentrant pathways Increases VF threshold
59
Lidocaine Indications
Vtach, VF, PVCs Prophylaxis against Vtach/VF after conversion Pain management after IO insertion in conscious patients
60
Lidocaine Contraindications
Extreme caution with 2nd or 3rd degree blocks | Not for ectopic beats if HR is <60, treat bradycardia instead
61
Lidocaine Adverse reaction
CV: may cause SA nodal depression/conduction problems and hypotension in lower doses or if given too rapidly. CNS: larger doses cause drowsiness, disorientation, parathesias, decreased hearing, muscle twitching, agitation, focal/generalized seziures
62
Lidocaine Incompatibility/reactions
NONE
63
Lidocaine Dose (ad and ped)
Adult: PVfib/VT: initial bolus of 1-1.5 mg/kg IV push every 3-5 mins to a total of 3mg/kg. Initial bolus of 1.5 should be given in cardiac arrest situations. Antidyshrythmic/ rhythm w/o pulse: initial bolus of 0.5-0.75 mg/kg up to 1-1.5 mg/kg. Additional bolus of 0.5-0.75 mg/kg given every 5-10 mins to max of 3mg/kg. Maintenance dose: 1-2 gm in 250 mL NS/D5W admin drip at 2-4 mg/min. Reduce dose by half in PTs older than 70, or with hepatic/renal disease, or poor perfusion state IO pain management: 20-40 mg VERY SLOW IO push Peds: VF/PVtach: initial bolus of 1 mg/kg repeated 1 time in 3-5 mins/15 mins for refractory dysrythmias with a pulse. Maintenance: add 120 mg (3mL) of 1gm/25mL (40mg/mL) to 97mL NS for 1200 mcg/min administered at 20-50 mcg/kg/min. 1ml/kg/hr delivers 20mcg/kg/min. 2.5ml/kg/hr delivers 50 mcg/kg/min. Reduce to <20mcg/kg/min for those with low cardiac output, severe CHF, or compormised hepatic perfusion. Avoid unless infusion pump is used. IO pain managment: 0.1 mg/kg not to exceed adult dose
64
Nitroglycerin Name/Class
Nitroglycerin Brand: Nitrostat Class: vasodilator, organic nitrate, antianginal
65
Nitroglycerin MOA
Smooth muscle relaxant on vascular, uterine, bronchial, and intestinal smooth muscle Decreases preload by reducing workload on the heat causing blood pooling Arteriolar vasodilation (decrease afterload) Coronary artery vasodilation Increase bloodflow to myocardium, descrease O2 Demand
66
Nitroglycerin Indication
Angina MI CHF with pulmonary edema
67
Nitroglycerin contraindications
Hypovolemia/hypotension (above 90-100 systolic) | Sexual enhancement drugs
68
Nitroglycerin adverse reactions
CV: hypotension, reflex tachycardia, bradycardia, headache, decrease coronary perfusion at higher doses
69
Nitroglycerin Incompatabilities/reactions
Other vasodilators | Pulmonary HTN
70
Nitroglycerin Dose (ad)
SL for chest pain: 1/150gr (0.4mg tab) or one full spray repeated 3 times SL for pulmonary edema: 1-2 0.4 mg tablets every 5-10 minutes (monitor BP) IV infusion (inter-facility on infusion pump): start at 5ug/min and increase by 5ug increments, titrate
71
Norepinephrine (interfacilty only) Name/class
Norepinephrine (interfacilty only) Brand: Noradrenaline Class: sympathomimetic, Alpha/beta adrenergic agonist, inotropic cardiac stimulant, vasopressor
72
Norepinephrine (interfacilty only) MOA
Stimulates A1 and B1 receproes in sympathetic system causing vasoconstriction, increase BP, enhance contractility, and decrease HR.
73
Norepinephrine (interfacilty only) Indications
Severe hypotension from cardiogenic, septic, or nuerogenic shock refractory to fluid bolus or when bolus is contraindicated
74
Norepinephrine (interfacilty only) Contraindications
Hypotension caused by blood volume deficit, profound hypoxia/hypercarbia Mesenteric or peripheral vascular thrombosis
75
Norepinephrine (interfacilty only) Adverse reactions
``` CNS: headache, anxiety CV: bradycardia, severe HTN, arrythmias Respiratory difficulty Skin: irritation/necrosis w/extravasation Ischemic injury ```
76
Norepinephrine (interfacilty only) Incompatibility/interactions
Alpha-adrenergic blockers (antagonizes NE effect) Antihistamines, ergot alkaloids, guanethidine, MAO inhibitors, oxytocin, TCAs, severe HTN Bretylium, inhalation anesthetics, increased risk of arrythmias
77
Norepinephrine (interfacilty only) Dose (ad and ped)
Adult: initial dose of 2-4 mcg/min Maint: adjust rate to a normal BP of 80-100 systolic, average is 1-12 mcg/min, max of 30mcg/min Ped: 0.1-2 mcg/kg/min (2 is max)
78
Vasopressin Name/Class
Vasopressin Brand: vasostrict Class: Pituitary hormone (antidiuertic)
79
Vasopressin MOA
Vasoconstriction of peripheral, cerebral, pulmonary and coronary vessels
80
Vasopressin Indications
adult shock refractory VF/PVtach
81
Vasopressin Contraindications
Responsive PT with CAD | HTN
82
Vasopressin Adverse Reactions
``` Provoking of cardiac ischemia and angine Abdominal distress N/V Tremors Necrosis with extravasation ```
83
Vasopressin Incompatability/interactions
NONE in pre-hospital setting
84
Vasopressin Dose (ad)
VF/PVtach : 40 U may replace the FIRST or SECOND dose of epi
85
Verapamil Name/Class
Verapamil HCL Brand: Calan Class: Ca Channel blocker
86
Verapamil MOA
Blocks Ca influx causing depressant on contractile mechanism (negative inotropy) Reduced vascular smooth muscle tone resulting in coronary and peripheral vasodilation Slows SA node discharge DECREASES MYOCARDIAL CONTRACTILE FORCE AND SLOWS AV CONDUCTION
87
Verapamil Indications
SVT | AFib/Aflutter with RVR (>100 BPM)
88
Verapamil contraindications
``` AV block SIck sinus ANY wide complex tachycardia WPW Shock Severe CHF IV beta blocker Hypotension ```
89
Verapamil Adverse reactions
``` Extreme bradycardia Asystole AV block Hypotension CHF ```
90
Verapamil Incompatability/interation
IV beta blocker
91
Verapamil Dose (ad)
2.5-5 mg SLOW IV push over 2-3 mins. May rebolus in 15-30 mins w/5-10mg until max dose of 30 mg

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