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Drugs > Cardiac Drugs 04/02 > Flashcards

Cardiac Drugs 04/02 Flashcards

(54 cards)

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1
Q

Atropine Sulfate: Drug Classification

A

Anticholinergic / Parasypatholytic

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2
Q

Atropine Sulfate: MOA

A

Muscarinic ACH-R antagonist —> inhibits parasympathetic stimulation in SA and AV nodal cells —> prevents K+ flux and hyperpolarization —> positive chronotropy, no inotropic effect.

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3
Q

Atropine Sulfate: Indications/Field use

A
  • Symptomatic bradycardia
  • Premedication for RSI with bradycardia <50 bpm
  • Organophosphate poisoning
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4
Q

Atropine Sulfate: Side Effects/Adverse RXNs

A
  • Blurred Vision
  • Dilated Pupils
  • Dry mouth
  • Tachycardia
  • Drowsiness
  • Confusion
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5
Q

Atropine Sulfate: Dose

A

Bradycardia (ADULT): 0.5mg IV, IO q 3-5 mins up to 3 mg
RSI (ADULT): 0.5mg-1mg IV, IO
Organophosphate (ADULT): 2-5mg IV, IO, IM q 5min until S/S resolve.

Bradycardia (PEDI): 0.02mg/kg IV, IO; MIN single dose 0.1mg; MAX single dose 0.5mg
RSI (PEDI): 0.02 mg/kg IV, IO
Organophosphate (PEDI): 0.05mg/kg IV, IO, IM q 5 min until S/S resolve

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7
Q

Atropine Sulfate: Precautions

A

Do not give less than 0.5mg (ADULT) or 0.1mg (PEDI) — causes paradoxical effect.

May cause paradoxical slowing/ineffective if used w/ 2 degree; Type II / 3 degree Heart block.

Caution with acute MI - increases myocardial oxygen demand.

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8
Q

Atropine Sulfate: Pharmacokinetics

A

Onset: Immediate
Peak: 2-4 mins
Duration: 4 hours
Half-life: 2-3 hours

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9
Q

Atropine Sulfate: Contraindications

A

None in EMS

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10
Q

Atropine Sulfate: Drug-Drug interactions

A

None

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11
Q

Metoprolol (Lopressor): Class

A

Beta Blocker

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12
Q

Metoprolol (Lopressor): Side effects/ Adverse RXNs

A
  • Bradycardia
  • Hypotension
  • Lethargy
  • Dyspnea
  • Wheezing
  • Dizziness
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13
Q

Metoprolol (Lopressor): MOA

A

Beta 1 R - agonist —> inhibits extracellular calcium entry and calcium release from sarcoplasmic reticulum in cardiac cells —> negative chronotropy, inotropy, dromotropy.

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14
Q

Metoprolol (Lopressor): Indications

A
  • Rapid ventricular arrests (>150) associated with a-fib, a-flutter
  • PSVT refractory to adenosine
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15
Q

Metoprolol (Lopressor): Pharmacokinetics

A

Onset: immediate
Peak: 20 mins
Duration: 13-19 hours
Half-life: 3-4 hours

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16
Q

Metoprolol (Lopressor): Dose

A

(ADULT): 5mg slow IV, IO q 5min, max total dose 15mg

(PEDI): N/A

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17
Q

Diltiazem (Cardizem): Class

A

Ca2+ Channel Blocker

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18
Q

Metoprolol (Lopressor): Drug-Drug interactions

A

Do not give to PT receiving IV Ca2+ Chanel blockers, will increase risk of profound bradycardia.

Additive effects with digoxin.

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19
Q

Metoprolol (Lopressor): Contraindications

A
  • Hypotension
  • Decompensated cardiogenic shock
  • Suspected cocaine ingestion
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20
Q

Diltiazem (Cardizem): Indications/Field use

A
  • Rapid ventricular rates (>150) associated w/ a-fib, a-flutter.
  • PSVT refractory of adenosine.
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21
Q

Metoprolol (Lopressor): Precautions

A

May exacerbate asthma, COPD, bronchospasm, or CHF

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23
Q

Diltiazem (Cardizem): MOA

A
  • SMC* Ca2+ channel blocker —> inhibits Ca2+ entry and subsequent interaction between actin and myosin in smooth muscle cells —> smooth muscle relaxation and dilation of blood vessels.
  • Cardiac* Ca2+ channel blocker —> negative chronotropy, inotropy, dromotropy.
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25
Q

Diltiazem (Cardizem): Pharmacokinetics

Study These Flashcards
A

Onset: 3 mins
Peak: 7 minutes
Duration: 1-3 hours
Half-life: 2 hours

26
Q

Diltiazem (Cardizem): Dose

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A

(ADULT):
1st dose - 0.25mg/kg slow IV, IO over 2 min (MAX dose 20mg)
2nd dose - 0.35mg/kg Slow IV, IO over 2 min (MAX dose 20mg)

(PEDI): NOT FOR PEDI

27
Q

Diltiazem (Cardizem): Precautions

Study These Flashcards
A

Must be discarded after one month w/o refrigeration.

28
Diltiazem (Cardizem): Side Effects/ Adverse RXNs
- N+V - Dizziness - HA - Bradycardia - Heart block - Hypotension
29
Diltiazem (Cardizem): Contraindications
- Hypotension - Decompensated carcinogenic shock - Ventricular tachycardia - WPW
30
Diltiazem (Cardizem): Drug-Drug interactions
Do not give to PT receiving IV beta blockers, will increase risk of profound bradycadia.
31
Amiodarone HCL (Cordarone): Indications/Field Use
- Cardiac Arrest (VF, Pulseless VT) | - Wide Complex Tachycardia
32
Amiodarone HCL (Cordarone): MOA
* Primary* Class III antiarrhythmic/K+ channel blocker —> Prolongs phase 3 repolarization of refractory period of non-pacemaker action potential. * Secondary* Class IA Antiarrhythmic/ NA+ channel blocker —> Decreases amplitude of phase 0 depolarization of non-pacemaker action potential. * Secondary* Class II Antiarrhythmic/ Non-competitive Beta blocker —> NEGATIVE chronotropy, inotropy, dromotropy. * Secondary* Class IV Antiarrhythmic/ Weak Ca2+ channel blocker —> NEGATIVE chronotropy, inotropy, dromotropy.
33
Amiodarone HCL (Cordarone): Side Effects/Adverse RXNs
- Hypotension - Bradycardia - Dyspnea - Cough - Dizziness - Prolonged PR, QRS, QT intervals
34
Amiodarone HCL (Cordarone): Pharmacokinetics
Onset: Immediate Peak: 30-45mins Duration: varies Half-life: 40-55 days
35
Amiodarone HCL (Cordarone): Dose
VF/Pulseless VT (ADULT): 300mg IV, IO, repeat dose 150mg IV, IO in 3-5min PRN VT + Pulse (ADULT): 150mg IV, IO over 10 min, may repeat ONCE in 10 min Maintenance (ADULT): 1mg/min first six hours, then 0.5mg/min for 18 hours VF/Pulseless VT (PEDI): 5 mg/kg IV, IO; MAX 300mg, MAX TOTAL DOSE 15mg/kg VT + Pulse (PEDI): 5mg/kg IV, IO over 20-60 min; max dose 300mg
36
Amiodarone HCL (Cordarone): Class
Antidysrhythmic
40
Adenosine: Classification
Antidysrhythmic (Class V) / Nucleoside
41
Adenosine: Pharmacokinetics
Onset: Immediate Peak: Immediate Duration: 30-45 seconds Half Life: 6 seconds
41
Amiodarone HCL (Cordarone): Drug-Drug interactions
Reduces renal and non-renal clearance of digoxin. Decreases bio transformation and clearance of warfarin —> enhanced anticoagulation Potentiates procainamide and quinidine.
42
Amiodarone HCL (Cordarone): Contraindications
Hypersensitivity
43
Adenosine: Indications/Field Use
- SVT (PSVT) / Narrow Complex Tachycardia - Diagnostic maneuver: stable narrow complex SVT - Wide regular monomorphic tachycardia
44
Amiodarone HCL (Cordarone): Precautions
Caution PT’s w/ heart failure.
45
Adenosine: MOA
Adenosine (A1) R-agonist —> Slows AV conduction by activation of G-protein second messengers, decreasing cAMP and inhibiting calcium entry into the cardiac pacemaker cells.
45
Adenosine: Dose
Adult: - 1st dose 6mg rapid IVP (proximal vein), 22cc NS flush. - 2nd dose 12mg rapid IVP, 20cc NS flush. Pedi: - 1st dose 0.1mg/kg IV/IO rapid push (proximal vein). MAX 6mg - 2nd dose 0.2mg/kg IV/IO rapid push MAX 12mg
47
Adenosine: Side Effects/Adverse RXNS
- Facial Flushing - HA - Chest Pain - Dizziness - DOOM!
49
Adenosine: Contraindications
~ WPW **Controversial/if given for WPW, may cause paradoxical increase in heart rate.
49
Adenosine: Precautions
Print rhythm strip before administering adenosine.
49
Adenosine: Drug-Drug interactions
Methylxanthines (ie Caffeine) are non-specific competitive antagonists for adenosine receptors — double the dose for PT’s taking large amounts.
50
Lidocaine (Xylocaine): MOA
Class IB antiarrhythmic/weak Na+ channel blocker —> Decreases slope and amplitude of phase 0 depolarization for non-pacemaker action potential.
52
Lidocaine (Xylocaine): Class
Antidysrhythmic
52
Lidocaine (Xylocaine): Pharmacokinetics
Onset: < 3 mins Peak: 5-7 mins Duration: 10-20 mins Half-Life: 1.5-2 hours
52
Lidocaine (Xylocaine): Indications/Field Use
- VF, VT | - Anesthetic effect for IO use
52
Lidocaine (Xylocaine): Contraindications
- NONE
53
Lidocaine (Xylocaine): Side effects/ Adverse RXNs
- Flushing - Sweating - Itching - Rash - Bradycardia - Drowsiness - Seizures - Confusion - Hypotension - N + V - Heart Block
53
Lidocaine (Xylocaine): Doses
(ADULT): VF, pulseless 1st dose: 1-1.5mg/kg IV,IO; 2nd dose 0.5-0.75mg/kg IV, IO repeat q 5-10 min up to 3 doses or MAX TOTAL 3mg/kg then 1-4mg/min maintenance. VT w/ pulse: 0.5-1.5mg/kg IV, IO, then 1-4mg/min maintenance Anesthetic: 0.5mg/kg UP TO 50mg (PEDI): 1mg/kg IVP, repeat after 15 min PRN, maintenance 20-50mcg/kg/min Anesthetic: 0.5mg/kg up to MAX 50mg
54
Lidocaine (Xylocaine): Precautions
PT 70+ yrs or know hepatic failure - reduce maintenance dose by half
54
Lidocaine (Xylocaine): Drug-Drug interactions
Potentiates procainamide, phenytoin, quinidine, and Beta blockers

Drugs (4 decks)

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