Cardiac Drugs 4/16

Question 1

Dopamine HCL (Intropin): Classification

Answer 1

Sympathomimetric/ Sympathetic agonist/ Catecholamine

Question 2

Dopamine HCL (Intropin): MOA

Answer 2

A1 agonist —> 2nd messenger release of calcium in VSMC —> peripheral vasoconstriction —increased SVR —> increased BP

B1 agonist —> increased intracellular Ca2+ in cardiac cells —> positive inotropy, chronotropy, dromotropy

Mechanism is dose-dependent

Question 3

Dopamine HCL (Intropin): Pharmacokinetics

Answer 3

Onset: < 5 mins
Peak: 5-8 mins
Duration: <10 mins
Half-life: 2 mins

Question 4

Dopamine HCL (Intropin): Indications

Answer 4

~ cardiogenic shock
~ symptomatic bradycardia
~ septic shock following fluid resuscitation

Question 5

Dopamine HCL (Intropin): Contraindications

Answer 5

Uncorrected hypovolemia (if profoundly hypotension, may give fluids concurrently)

Question 6

Dopamine HCL (Intropin): Side FX/ Adverse RXNs

Answer 6

~ Nervousness
~ HA
~ Dysrhythmias (a-fib, PVC’s)
~ Tachycardia
~ Chest pain
~ Dyspnea
~ N+V
~ Extravasation necrosis

Question 7

Dopamine HCL (Intropin): Dose

Answer 7

ADULT:
2-5mcg/kg/min IV, IO infusion (low dose) causes increased blood flow to messengers and renal (GUT)
5-10mcg/kg/min IV, IO infusion (medium dose) stimulates beta effects
10-20 mcg/kg/min IV, IO infusion (high dose) stimulates alpha effects
PEDI: 2-20mcg/kg/ min IV, IO infusion

Question 8

Dopamine HCL (Intropin): Precautions

Answer 8

Must be kept out of direct sunlight

Question 9

Dopamine HCL (Intropin): Drug-Drug interactions

Answer 9

NONE

Question 10

Norepinephrine (Levophed): Class

Answer 10

Sypathomimetric/ Sympathetic agonist/ Catecholamine

Question 11

Norepinephrine (Levophed): MOA

Answer 11

• Primary* A1 agonist —> 2nd messenger release of calcium in VSMC —> peripheral vasoconstriction —> increased SVR —> increased BP
• Secondary* B1 agonist —> increased intracellular Ca2+ in cardiac cells —> positive inotropy, chronotropy, dromotropy

Question 12

Norepinephrine (Levophed): Pharmacokinetics

Answer 12

Onset: <1 min
Peak: <2 min
Duration: < 1-2mins
Half-life: 3 min

Question 13

Norepinephrine (Levophed): Indications

Answer 13

~ cardiogenic shock
~ septic shock following fluid resuscitation
~ neurogenic shock

Question 14

Norepinephrine (Levophed): Contraindications

Answer 14

~ Hypovolemia

Question 15

Norepinephrine (Levophed): Side FX/ Adverse RXNs

Answer 15

~ Reflex bradycardia
~ anxiety
~ HA
~ dysrhythmias 
~ tremulousness
~ dizziness
~ N+V

Question 16

Norepinephrine (Levophed): Dose

Answer 16

(ADULT) 1-30mcg/min IV, IO infusion - titration to systolic blood pressure 90 mm HG
(PEDI) 0.1mcg/kg/min IV, IO infusion - titration to normotensive systolic BP

Question 17

Norepinephrine (Levophed): Precautions

Answer 17

Can cause tissue necrosis with extravasation.
Caution with CAD
leads to increased myocardial O2 demand

Question 18

Norepinephrine (Levophed): Drug-Drug interactions

Answer 18

MAOI and TCA may potentiates cardiovascular effects.

Question 19

Calcium Chloride: Class

Answer 19

Mineral / Electrolyte

Question 20

Calcium Chloride: MOA

Answer 20

Replacement of elemental Ca2+ —> dissociates rapidly to Ca2+ and Cl- ions —> positive inotropy and chronotropy.

Question 21

Calcium Chloride: Pharmacokinetics

Answer 21

Onset: immediate
Peak: unknown
Duration: varies
Half-life: N/A

Question 22

Calcium Chloride: Indications

Answer 22

~ Acute hyperkalemia
~ Ca2+ channel blocker toxicity
~ Crush syndrome
~ abdominal muscle spasm from Brown Recluse Spider or Man of War jellyfish.
~ cardiac arrest 2 degree to suspected hyperkalemia (known dialysis patient)

Question 23

Calcium Chloride: Contraindications

Answer 23

~ hyperkalemia

~ patient taking digoxin

Question 24

Calcium Chloride: Side FX/ Adverse RXNs

Answer 24

~ Bradycardia
~ Dysrhythmias
~ N+V 
~ Syncope 
~ Cardiac arrest

Question 25

Calcium Chloride: Dose

Answer 25

(ADULT): 1 g slow IV, IO over 5 minutes | (PEDI): 20 mg/kg slow IV, IO

Question 26

Calcium Chloride: Precautions

Answer 26

Can cause tissue necrosis at injection site; ensure patent IV line.

Question 27

Calcium Chloride: Drug-Drug interactions

Answer 27

Forms PPT with NaHCO3, flush tubing between administration. Digitalis toxicity when administered to patient currently taking digitalis/digoxin - inhibits Ca2+ channels causing “stone heart”

Question 28

Calcium Gluconate: Class

Answer 28

Mineral/ Electrolyte

Question 29

Calcium Gluconate: MOA

Answer 29

Replacement of elemental calcium —> dissociates rapidly to Ca2+ and Gluconate ions —> positive inotropy and chronotropy.

Question 30

Calcium Gluconate: Pharmacokinetics

Answer 30

Onset: Immediate Peak: Unknown Duration: Varies Half-life: N/A

Question 31

Calcium Gluconate: Indications

Answer 31

~ acute hyperkalemia ~ Ca2+ channel blocker toxicity ~ cardiac Arrest 2 degree to suspected hyperkalemia (known dialysis patient, etc)

Question 32

Calcium Gluconate: Contraindications

Answer 32

~ Hypercalcemia | ~ Patient taking digoxin

Question 33

Calcium Gluconate: Side FX/ Adverse RXNs

Answer 33

``` ~ Bradycardia ~ Dysrhythmias ~ N+V ~ Syncope ~ Cardiac Arrest ```

Question 34

Calcium Gluconate: Dose

Answer 34

(ADULT): 2g slow IV, IO over 5 mins | (PEDI): 60mg slow IV, IO over 5 mins

Question 35

Calcium Gluconate: Precautions

Answer 35

Can cause tissue necrosis at injection site, ensure patent IV line Digitalis toxicity when administered to patient currently taking digitalis/digoxin — inhibits Ca2+ channels causing “stone heart”