Cardiac Drugs 4/16 Flashcards Preview

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Flashcards in Cardiac Drugs 4/16 Deck (35):
1

Dopamine HCL (Intropin): Classification

Sympathomimetric/ Sympathetic agonist/ Catecholamine

2

Dopamine HCL (Intropin): MOA

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**

3

Dopamine HCL (Intropin): Pharmacokinetics

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

4

Dopamine HCL (Intropin): Indications

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

5

Dopamine HCL (Intropin): Contraindications

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

6

Dopamine HCL (Intropin): Side FX/ Adverse RXNs

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

7

Dopamine HCL (Intropin): Dose

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

8

Dopamine HCL (Intropin): Precautions

Must be kept out of direct sunlight

9

Dopamine HCL (Intropin): Drug-Drug interactions

NONE

10

Norepinephrine (Levophed): Class

Sypathomimetric/ Sympathetic agonist/ Catecholamine

11

Norepinephrine (Levophed): MOA

*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

12

Norepinephrine (Levophed): Pharmacokinetics

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

13

Norepinephrine (Levophed): Indications

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

14

Norepinephrine (Levophed): Contraindications

~ Hypovolemia

15

Norepinephrine (Levophed): Side FX/ Adverse RXNs

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

16

Norepinephrine (Levophed): Dose

(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

17

Norepinephrine (Levophed): Precautions

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

18

Norepinephrine (Levophed): Drug-Drug interactions

MAOI and TCA may potentiates cardiovascular effects.

19

Calcium Chloride: Class

Mineral / Electrolyte

20

Calcium Chloride: MOA

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

21

Calcium Chloride: Pharmacokinetics

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

22

Calcium Chloride: Indications

~ 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)

23

Calcium Chloride: Contraindications

~ hyperkalemia
~ patient taking digoxin

24

Calcium Chloride: Side FX/ Adverse RXNs

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

25

Calcium Chloride: Dose

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

26

Calcium Chloride: Precautions

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

27

Calcium Chloride: Drug-Drug interactions

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

28

Calcium Gluconate: Class

Mineral/ Electrolyte

29

Calcium Gluconate: MOA

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

30

Calcium Gluconate: Pharmacokinetics

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

31

Calcium Gluconate: Indications

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

32

Calcium Gluconate: Contraindications

~ Hypercalcemia
~ Patient taking digoxin

33

Calcium Gluconate: Side FX/ Adverse RXNs

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

34

Calcium Gluconate: Dose

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

35

Calcium Gluconate: Precautions

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”