Cardiac Drugs 1 Flashcards

Question

Amiodorone(Cardarone, Pacerone) mechanism of action

Answer 1

Blocks sodium, potassium, and calcium channels; prolongs the action potential and repolarization; decreases AV conduction and sinoatrial(SA) node function.

Answer 2

Stable, regular narrow complex tachycardia if the rhythm persists despite vagal maneuvers or adenosine or the tachycardia is recurrent; to control the ventricular rate in stable, irregular narrow complex tachycardia(AF); to control the ventricular rate in preexcited atrial dysrhythmias with conduction over and accessory pathway; stable monomorphic VT; polymorphic VT with a normal QT interval; cardiac arrest resulting from VF or pulseless VT after CPR, defibrillation, and a vasopressor.

Answer 3

hypersensitivity, cardiogenic shock, second or third degree AV block or sick sinus syndrome or other sinus node disease unless a funtioning artificial pacemaker is present

Answer 4

Dizziness, fatigue, malaise, tremor, ataxia, lack of coordination, ARDS, pulmonary edema, cough, progressive dyspnea, heart failure, bradycardia, hypotension, worsening of dysrhythmias, prolonged QT interval, nausea, vomiting, burning at IV site, stevens johnson syndrome.

Answer 5

Use with digoxin may cause digitalis toxicity. Beta blockers and calcium channel blockers may potentiate bradycardia, sinus arrest, and AV blocks.

Answer 6

300 mg IV/IO push. initial dose can be followed once in 3 to 5 mins at 150 mg IV/IO push.

Answer 7

Loading dose of 150 mg IV/IO over 10 minutes; may repeat every 10 minutes if needed.

Answer 8

after conversion, follow with a 1mg/min infusion for 6 hours and then .5 mg/min maintenence infusion over 18 hours. maximum cumulative dosage of 2.2 IV/IO per 24 hours.

Answer 9

5mg/kg IV/IO bolus. Can repeat the 5mg/kg IV/IO bolus up to a total dose of 15 mg/kg per 24 hours(2.2 g in adolescents) maximum single dose 300mg

Answer 10

Loading dose 5mg/kg IV/IO over 20 to 60 mins(maximum single dose of 300mg) can repeat to a maximum dose of 15 mg/kg per day(2.2g in adolescents.)

Answer 11

onset: 2 hours peak effect: 3 to 7 hours duration: unknown

Answer 12

D; drug may cause fetal harm. fetal risk and maternal benefit should be considered in the mergency setting. Lactating women should not breastfeed following use.

Answer 13

may worsen or precipitate new dysrhythmias. Monitor the patient for hypotension and increasing PR and QT intervals. Dosage may change in accordance with the most current ILCOR recommendations.

Answer 14

anticholinergic agent

Answer 15

inhibits the action of acetylcholine at postganglionic parasympathetic neuroeffector sites. increases heart rate in symptomatic bradydysrhythmias

Answer 16

hemodynamically unstable bradycardia, organophosphate poisoning, nerve agent exposure, RSI in pediatrics, beta-blocker or calcium channel blocker overdose.

Answer 17

Tachycardia, hypersensitivity, unstable cardiovascular status in acute hemorrhage with miocardial ishemia, narrow angle glaucoma, hypothermic bradycardia.

Answer 18

drowsiness, confusion, headache, tachycardia, palpitations, dysrhythmias, nausea, vomiting, pupil dilation, dry mouth/nose/skin, blurred vision, urinary retention, constipation, flushed, hot, dry skin; paradoxical bradycardia when pushed too slowly or when given at low doses.

Answer 19

Potential adverse effects when administered with digitalis, cholinergics, physostigmine. Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics, benzodiazepines, and antidepressants.

Answer 20

0.5 mg IV/IO infussion every 3 to 5 mins as needed; maximum total dose of 3mg total. Use shorter dosage intervals and higher doses in severe clinical conditions.

Answer 21

extremely large doses(2 to 4mg) may be needed.

Answer 22

0.02mg/kg IV/IO(minimum dosage: 0.01) may repeat once. maximum single dose child: 0.5mg, adolescent:1mg: Maximum total dose child:1mg, adolescent: 3mg.

Answer 23

Moderate doses may cause pupillary dilation. Paradoxical bradycardia can occur with doses lower than 0.1 mg. May be ineffective in patients who have had a heart transplant or in infranodal AV blocks.

Answer 24

Electrolyte

Answer 25

Counteracts the toxicity of hyperkalemia by stabilizing the membranes of the cardiac cells, reducing the likelihood of fibrillation.

Answer 26

Hyperkalemia, hypocalcemia, hypermagnesemia, beta blocker and calcium channel blocker overdose

Answer 27

VF, digitalis toxicity, hypercalcemia.

Answer 28

Syncope, cardiac arrest, dysrhythmia, bradycardia, hyptension, asystole, peripheral vasodilation, nausea, vomiting, metallic taste, tissue necrosis at injection site, coronary and cerebral artery spasm.

Answer 29

may cause severe bradycardia in patients taking digitalis. may antagonize the effects of calcium channel blockers. Do not mix or infuse immediately before or after sodium bicarbonate without intervening flush.

Answer 30

500 to 1000mg slow IV/IO push(1 to 1.5 mL/minute) to maximum of 3g.

Answer 31

3 to 6g(30 to 60mL) IV/IO followed by a continuous hourly infusion of the same dose.

Answer 32

60 - 100 mg/kg IV/IO slowly over 5/10 minutes to a maximum of 3g

Answer 33

60mg/kg(0.6mL/kg) IV/IO followed by a continuous hourly infusion of the same dose.

Answer 34

onset: immediate peak effect: immediate duration: 30

Answer 35

monitor IV site carefully; local infiltration can result in severe tissue necrosis and sloughing. Because this medication is highly irritating, do not administer by either the IM or subcutaneous routes.

Answer 36

Calcium channel blocker, antidysrhythmic(classIV)

Answer 37

Inhibits extracellular calcium ion influx across membranes of myocardial cells and vascular smooth muscle contraction and thereby dilating main coronary and systemic arteries; no effect on serum calcium concentrations; substantial inhibitory effects on the cardiac conduction system, acting principally at the AV node, with some effects at the SA node.

Answer 38

Stable narrow-QRS tachycardia if the rhythm persists despite vagal maneuvers or adenosine or if the tachycardia is recurrent; to control the ventricular rate in patients with AF or atrial flutter.

Answer 39

Hypersensitivity, hypotension, cardiogenic shock, wide-complex tachycardia(may lead to hemodynamic deterioration and VF), second or third degree AV block or sick sinus syndrome or other sinus node disease unless a functioning artificial pacemaker is present, poison or drug induced tachycardia, AF or atrial flutter when associated with an accessory bypass tract(eg wolf parkinson white syndrome)

Answer 40

dizziness, weakness, headache, dyspneea, cough, dysrhythmias, heart failure, peripheral edema, bradycardia, hypotension, AV blocks, syncope, VF, VT, cardiac arrest, chest pain, nausea, vomiting, dry mouth

Answer 41

caution in patients using medications that affect cardiac contractility. should not be administered within 2 to 4 hours of IV beta blockers; doing so may result in decreased cardiac contractility, bradycardia(icluding AV blocks), and hypotension.

Answer 42

Initial dose: 0.25 mg/kg IV over 2 minutes. if inadequate response, may rebolus, in 15 minutes with 0.35 mg/kg IV over 2 minutes. Maintenance infusion of 5 to 15 mg/hr titrated to physiologically appropriate heart rate.

Answer 43

not recommended.

Answer 44

onset: 2 to 5 minutes peak effect: variable; usually within 7 minutes duration: 1 to 3 hours

Answer 45

use with caution in patients with renal or hepatic dysfunction. Carefully monitor BP, heart rate, and ECG before, during, and after administration. Dysrhythmias may be present duringh pharmacologic conversion of PSVT to sinus rhythm.

Answer 46

adrenergic, vasopressor, inotropic agent.

Answer 47

immediate metabolic precursor to norepinephrine. Produces positve inotropic and chronotropic effects. Constrics systemic vasculature, increasing BP and preload. Increases myocardial contractility and stroke volume.

Answer 48

cardiogenic and septic shock, hypotension with low cardiac output states, distributive shock, second line drug for symptomatic bradycardia

Answer 49

hypersensitivity, hypvolemic shock, pheochromocytoma, uncorrected tachydysrhythmias, VF.

Answer 50

extravasation may cause tissue necrosis. Headache, anxiety, dyspnea, dysrhythmias, hypotension, hypertension, palpitations, chest pain, increased myocardial oxygen demand, nausea, vomiting

Answer 51

incompatible with alkaline solutions(sodium bicarb). MAOIs will enhance the effect of DOPamine. When administered with phenytoin, may cause hypotension, bradycardia, and seizure.

Answer 52

IV/IO infusion at 5 to 20 mcg/kg per minute, slowly titrated to patient response.

Answer 53

IV/IO infusion at 5 to 20 mcg/kg per minute, slowly titrated to patient response.

Answer 54

onset:1 to 4 minutes peak effect: 5 to 10 minutes duration: effects cease almost immediately after infusion is discontinued.

Answer 55

C use with caution with pregnant and breastfeeding women.

Answer 56

effects are dose dependent. Beta adrenergic response: 5 to 10 mcg/kg/min: positive chronotropic and inotropic effects. Alpha-adrenergic response: 10-20 mcg/kg per minute: vasoconstriction and increase in BP. Over 20 mcg/kg/min: alpha effects predominate and may compromise circulation in the limbs. should be administered by infusion pump.

Answer 57

sympathomimetic

Answer 58

Direct acting alpha and beta agonist. Alpha: vasoconstriction. Beta 1: Positive inotropic, chronotropic, and dromotropic effects. Beta 2: bronchial smooth muscle relaxation and dilation of skeletal vasculature. Blocks histamine receptors.

Answer 59

Cardiac arrest(asystole, PEA, VF, and pulseless VT), symptomatic bradycardia as an alternative infusion to Dopamine, hypotension from shock other than hypovolemia, allergic reaction, anaphylaxis, asthma

Answer 60

None in emergency setting. Relative contraindications include hypertension, hyperthermia, pulmonary edema, myocardial ischemia, hypovolemic shock.

Answer 61

Nervousness, restlessness,headache, tremor, pulmonary edema, dysrhythmias, chest pain, hypertension, tachycardia, nausea, vomiting

Answer 62

potentiates other sympathomimetics. Deactivated by alkaline solutions, MAOIs may potentiate effect. Beta blockers may blunt effects

Answer 63

IV/IO: 1mg(10 mL of 0.1 mg/mL{1:10000}) every 3 to 5 mins during resuscitation. Follow each dose with a 20 mL flush and elevate arm for 10 to 20 seconds after dose. Continuous infusion: Add 1mg to 250 mL normal saline or d5w.

Answer 64

2 to 10 mcg/min titrated to patient response. Higher dose: up to 0.2 mg/kg may be used in specific indications, such as beta blocker or calcium channel blocker overdose.

Answer 65

IV/IO: 0.01 mg/kg(0.1mL/kg) of a 1mg/mL(1:10000) solution every 3 to 5 minutes during arrest. ET: 0.1 mg/kg(0.1 mL/kg) of a 1mg/mL(1:1000) solution mixed in 3 to 5 mL of saline until IV/IO access is established. maximum single dose IV: 1mg maximum single dose ET: 2.5

Answer 66

IV/IO: 0.01 mg/kg(0.1 mL/kg) of a 0.1mg(1:10000) solution

Answer 67

0.01 to 0.03 mg/kg of 0.1 mg/mL(1:10000) solution IV followed by 0.5 mL to 1mL normal saline flush to clear the line. dosage may be repeated every 3 to 5 minutes if bradycardia persists.

Answer 68

onset: immediate peak effect: minutes duration: several minutes

Answer 69

C Contraindicated for patients in active labor.

Answer 70

May cause syncope in asthmatic children. May increase myocardial oxygen demand

Answer 71

antidysrhythmic(class Ib), anesthetic

Answer 72

Cardiac: decreases automaticity by slowing the rate of spontaneous phase 4 depolarization. Local anesthetic: inhibits transport of ions across the neuronal membrane, blocking conduction of normal nerve impulses.

Answer 73

Alternative to amiodarone in cardiac arrest from VT, VF, stable wide complex tachycardia(poly or monomorphic) with normal baseline QT interval. Also used as a local anesthetic for various procedures, including intubation and IO infusions.

Answer 74

Hypersensitivity, second or third degree IV block in the absence of an artificial pacemaker, stokes adams syndrome, prophylactic use in AMI, wide complex ventricular escape beats with bradycardia.

Answer 75

anxiety, drowsiness, confusion, seizures, slurred speach, respiratory arrest, hypotension, bradycardia, dysrhythmias, cardiac arrest, AV black, nausea, vomiting.

Answer 76

Apnea induced with succinylcholine may be prolonged with high doses of lidocaine. Cardiac depression may occur in conjunction with IV phenytoin. Procainamide may exacerbate CNS effect. Metabolic clearance is decreased in patients with liver disease or in patients taking beta blockers

Answer 77

initial dose 1 to 1.5 mg/kg IV/IO repeat dose: 0.5 to 0.75mg/kg IV/IO repeated in 5 to 10 minutes. maximum total dose 3mg/kg

Answer 78

maintenence infusion: 1 to 4 mg/min(30 to 50mcg/kg per minute); can dilute in d5w or normal saline.

Answer 79

IV/IO : 1 mg/kg rapid IV/IO push maximum dose: 100mg continuos IV infusion: 20 to 50 mvg/kg per min. repeat bolus dose(1mg/kg) when infusion is initiated if bolus has not been given within previous 15 minutes.

Answer 80

onset: 1 to 5 mins peak effect: 5 to 10 minutes duration: variable(15min to 2 hr)

Answer 81

reduce maintenance infusion by 50% if patient is older than age 70, has liver or renal disease, is in heart failure, or is in shock. a 75 to 100mg bolus maintains blood levels for only 20 minutes(if not in shock). exceedingly high doses of lidocaine can result in death and coma. Cross reactivity with other forms of local anesthetics.

Answer 82

Sympathomimetic, vasopressor

Answer 83

potent alpha agonist resulting in intense peripheral vasoconstriction, positive chronotropic and increased inotropic effect(from 10% beta effect) with increased cardiac output. Alpha adrenergic activity resulting in peripher vasoconstriction and bet adrenergic activity leading to inotropic stimulation of the heart and coronary artery vasodilation.

Answer 84

cardiogenic shock, unresponsive to fluid resuscitation, significant hypotensive(less than 70mm Hg) states, first line vasopressor in septic shock.

Answer 85

hypotensive patients with hypovolemia, pregnancy(relative)

Answer 86

headache, anxiety, dizziness, restlessness, dyspnea, bradycardia, hypertension, dysrhythmias, chest pain, peripheral cyanosis, cardiac arrest, nausea, vomiting, urinary retention, renal failure, decreased blood flow to the GI tract, kidneys, skeletal muscle, and skin tissue necrosis from extravasation

Answer 87

Can be dactivated by alkaline solutions. Sympathomimetic and phosphodiesterase inhibitors may exacerbate dysrhythmias. bretylium may potentiate the effects of catecholamines.

Answer 88

0.1 to 0.5 mcg/kg per minute( in 70 kg adult, 7 to 35 mcg/min)

Answer 89

begin at 0.1 to 2 mcg/kg per minute IV infusion, adjust rate to achieve desired change in BP and systemic perfusion. Titrated to patient response.

Answer 90

onset: 1 to 3 minutes peak effect: variable duration: 5 to 10 minutes, lasts only 1 minute after infusion discontinued

Answer 91

C. use cautiously during pregnancy and while breastfeeding. May cause fetal anoxia when used in pregnancy.

Answer 92

Infuse norepinephrine through a large, stable vein to avoid extravasation and tissue necrosis. Often used with low dose dopamine to spare decreased renal and mesenteric blood flow. Drug or poison induced hypotension may require higher doses to achieve adequate perfusion.

Cardiac Drugs 1 Flashcards

(120 cards)