Cardiac Drugs 04/02 Flashcards Preview

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Flashcards in Cardiac Drugs 04/02 Deck (54):
1

Atropine Sulfate: Drug Classification

Anticholinergic / Parasypatholytic

2

Atropine Sulfate: MOA

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

3

Atropine Sulfate: Indications/Field use

- Symptomatic bradycardia
- Premedication for RSI with bradycardia <50 bpm
- Organophosphate poisoning

4

Atropine Sulfate: Side Effects/Adverse RXNs

- Blurred Vision
- Dilated Pupils
- Dry mouth
- Tachycardia
- Drowsiness
- Confusion

5

Atropine Sulfate: Dose

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

7

Atropine Sulfate: Precautions

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.

8

Atropine Sulfate: Pharmacokinetics

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

9

Atropine Sulfate: Contraindications

None in EMS

10

Atropine Sulfate: Drug-Drug interactions

None

11

Metoprolol (Lopressor): Class

Beta Blocker

12

Metoprolol (Lopressor): Side effects/ Adverse RXNs

- Bradycardia
- Hypotension
- Lethargy
- Dyspnea
- Wheezing
- Dizziness

13

Metoprolol (Lopressor): MOA

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

14

Metoprolol (Lopressor): Indications

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

15

Metoprolol (Lopressor): Pharmacokinetics

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

16

Metoprolol (Lopressor): Dose

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

17

Diltiazem (Cardizem): Class

Ca2+ Channel Blocker

18

Metoprolol (Lopressor): Drug-Drug interactions

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

Additive effects with digoxin.

19

Metoprolol (Lopressor): Contraindications

- Hypotension
- Decompensated cardiogenic shock
- Suspected cocaine ingestion

20

Diltiazem (Cardizem): Indications/Field use

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

21

Metoprolol (Lopressor): Precautions

May exacerbate asthma, COPD, bronchospasm, or CHF

23

Diltiazem (Cardizem): MOA

*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.

25

Diltiazem (Cardizem): Pharmacokinetics

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

26

Diltiazem (Cardizem): Dose

(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

Diltiazem (Cardizem): Precautions

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