cardiac drugs Flashcards by Kristy Zacharias

oxygen

Class: medicinal gas

MOA: enables cells to break down glucose into useable form. Carried from the lungs to the body tissues by hemoglobin in red blood cells. O2 administration increases arterial oxygen (PaO2) and hemoglobin saturation.

Pharmacokinetics: Onset: Immediate; Duration: 2 minutes

Indications: Hypoxia based on physical exam or pulse oximetry

AR/SE: none in emergencies; vasoconstriction; high concentration may cause decreased LOC and respiratory depression in pts with chronic carbon dioxide retention. Hyperoxia can cause free radical induction and oxidative stress.

Contraindications: Non hypoxic patients, no advantage to these pts

Dosage: 1-6 via NC, 10-15 via NRB or BVM

Special Considerations: (P class A)

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epinephrine ; adrenaline

Class: adrenergic; sympathomimetic, vasopressor

MOA: affects both beta (1 & 2) and alpha adrenergic receptors, producing bronchodilation and vasoconstriction, increased chronotropy, inotropy, and dromotropy.

Pharmacokinetics: Onset: Rapid IV; Duration: IV 5-10 min; half-life: 5 minutes

Indications: treatment of cardiac arrest or symptomatic bradycardia; anaphylaxis, reative airway disease; can be used as a pressor

AR/SE: angina, arrhythmias, hypertension, tachycardia, nervousness, restlessness, tremors

Contraindications: known allergy

Dosage: cardiac arrest: 1mg (1:10000) IV/IO EVERY 3-5 MIN bRADYCARDIA or for pressor effect 2-10 mcg/min (drip)

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norepinephrine ; levophed

Class: vasopressor, Sympathomimetic

MOA: stimulates alpha-adrenergic receptors located mainly in the blood vessels, causing constriction; has minor beta 1 effects

Pharmacokinetics: onset- immediate, duration- 1-2 min

Indications: Cardiogenic Shock;severe hypotension not related to hypovolemia

AR/SE: dizziness, anxiety, cardiac arrhythmias

Contraindications: known allergy

Dosage: 0.1-0.5 mcg/kg/min (max of 30 mcg/min) titrate to maintain adequate blood pressure

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dopamine ; intropin

Class: Inotropic, vasopressor, adrenergic, Sympathetic agonist

MOA: stimulates both alpha and beta adrenergic receptors in a dose dependent fashion.

Pharmacokinetics: onset 1-2 minutes; duration 10 minutes

Indications: adjunct to improving BP, cardiac output, and urine output in the treatment of shock unresponsive to fluid replacement; symptomatic bradycardia

AR/SE: arrhythmias, hypotension, headache, N/V.

Contraindications: known allergy; pheochromocytoma (adrenal gland tumor)

Dosage: 2-20 mcg/kg/min IV (2-4 will cause vasodilation, 5-15 beta 1 effects, >15 alpha effects

Special Considerations: Use caution in pts with hypovolemia or MI, correct hypovolemia before administering

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dobutamine ; dobutrex

Class: inotropic, adrenergic, Sympathetic agonist

MOA: increases inotropy by stimulating beta-1 adrenergic receptors with a minor effect on the rate and peripheral blood vessels

Pharmacokinetics: Onset 2-10 min, duration varies; HL: 2 min

Indications: short term management of heart failure caused by decreased contractility

AR/SE: hypertension, increased HR, pVC’s headache, N/V

Contraindications: known allergy

Dosage: 2-20 mcg/kg/min IV titrated to response

Special Considerations: (P class B) use caution in pts with hx of MI or afib; beta blocker may negate the effects

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milrinone ; primacor

Class: inotropic

MOA: increases myocardial contractility and decreases preload and afterload by dilating the vascular smooth muscle, does not work through adrenergic receptors.

Pharmacokinetics: onset 5-15 min, duration 3-6 hrs; HL; 2-3 Hours

Indications: short term treatment of CHF unresponsive to conventional therapy

AR/SE: ventricular arrhythmias, Hypotension, N/V

Contraindications: known allergy, severe aortic or pulmonary valvular heart disease

Dosage: 50 mcg/kg Slow IV/IO (over 10 minutes) followed by infusion of 0.375 mcg/kg/min

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vasopressin ; pitressin

Class: Hormone; vasopressor

MOA: Acts as a non-alpha-adrenergic vasoconstrictor via direct stimulation of smooth muscle receptors. Can be used as an alternative to epinephrine during CPR.

Pharmacokinetics: onset: varies, duration 30-60 minutes; HL: 10-20 min

Indications: may replace the 1st or second dose of Epinephrine in cardiac arrest, increases peripheral vascular resistance during CPR.

AR/SE: skin blanching, hypertension, bradycardia, abdominal cramps, nausea, minor arrythmia.

Contraindications: known allergy, None when used during CPR

Dosage: 40 units IV/IO (1 time only) can replace 1st or 2nd dose of EpI during cardiac arrest

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metoprolol ; lopressor

Class: antihypertensive, antianginal, beta blocker (beta 1 selective)

MOA: blocks stimulation of Beta-1 adrenergic
receptors

Pharmacokinetics: Onset- IV immediate, duration- IV 5-8 hrs; HL: 3-4 Hrs

Indications: prevention of MI, hypertension, stable narrow complex tachycardias

AR/SE: bradycardia, CHF, pulmonary edema, fatigue, weakness, hypotension

Contraindications: known allergy, uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia, heart block

Dosage: MI: 5mg slow IV every 2 minutes for 3 doses

Special Considerations: should not be administered to pts who received IV calcium channel blockers

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labetalol ; trandate

Classification: beta blocker (non-selective), antihypertensive

MOA: blocks the stimulation of beta1, beta2, and alpha1 adrenergic receptors

Pharmacokinetics: onset 2-5 minutes; duration: 2-4 Hours IV; HL: 3-8 Hours

Indications: used to treat Hypertensive Crisis

AR/SE: bradycardia, CHF, pulmonary edema, orthostatic hypotension, fatigue, weakness, dyspnea

Contraindications: known allergy, bronchial asthma/uncompensated CHF/pulmonary edema/cardiogenic shock/bradycardia/ or heart
block

Dosage: 20 mg slow IV (over 2 minutes) initially. 40 mg may be given every 10 minutes prn to a total dose of 300 mg

Special Considerations: (P class C)

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atenolol ; tenormin

Class: beta blocker (beta 1 selective), antianginal, antihypertensive

MOA: blocks stimulation of beta 1 adrenergic receptors

Pharmacokinetics: onset: <2 min, duration: 24 Hrs; HL: 6-7 Hrs

Indications: management of hypertension and angina pectoris and prevention of MI, stable narrow complex tachycardias not responding to adenosine.

AR/SE: hypotension, bradycardia, cHF, Pulmonary Edema, erectile dysfunction, fatigue, weakness

Contraindications: known allergy, uncompensated CHF, pulmonary edema, cardiogenic shock bradycardia, or heart block

Dosage: 5 mg IV/IO over 5 minutes; may be repeated at 5 mg in 10 minutes.

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esmolol ; brevibloc

Class: beta blocker (beta 1 selective),antihypertensive

MOA: blocks stimulation of beta 1 adrenergic receptors

Pharmacokinetics: onset: <5 min, duration: 10-30 min; HL: 2-9 min

Indications: management of hypertension , stable narrow complex tachycardias not responding to adenosine., controlling ventricular HR in Afib/Aflutter.

AR/SE: hypotension, bradycardia, cHF, Pulmonary Edema, erectile dysfunction, fatigue, weakness

Contraindications: known allergy, uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia, or heart block.

Dosage: 500 mcg/kg loading dose over 1 min. followed by 50 mcg/kg/min for 4 minutes

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lidocaine ; xylocaine

Class: antiarrhythmic

MOA: suppresses automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across cell membranes with little or no effect on the heart rate.

Pharmacokinetics: onset- <3 Min, duration 10-20 minutes, but up to several hours after continuous infusion; HL: 1.5-2 hrs

Indications: vf, pulseless vt, use after successful conversion from VF, Pulseless VT; wide complex tachycardias, ventricular ectopy in the presence of an MI

AR/SE: Cardiac arrest, seizures, anaphylaxis, confusion, drowsiness, N/V

Contraindications: known allergy, 2nd degree type II and 3rd degree av block

Dosage: 1-1.5 mg/kg may repeat at half the initial dose (0.5-0.75 mg/kg) every 5-10 min up to a total of 3mg/kg. (for continuous infusions: 2-4 mg/min)

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procainamide ; pronestyl

Class: antiarrhythmic

MOA: decreases myocardiac excitability and slows conduction velocity; it reduced automaticity in the various pacemakers of the heart.

Pharmacokinetics: onset- 10-30 min, duration- 3-6 hrs; HL: 3 Hrs

Indications: ventricular and atrial arrhythmias including PAC, PVC, VT, atrial tach; maintain NSR after conversion from a-fib or a-flutter

AR/SE: asystole, heart block, ventricular arrhythmias, seizures, diarrhea, N/V, respiratory and cardiac arrest

Contraindications: known allergy, High Degree av block

Dosage: 20-50 mg/min slow IV (max 17 mg/kg)

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adenosine ; adenocard

Class: antiarrhythmic

MOA: restores NSR by interrupting reentry pathways in the AV node and causes coronary artery vasodilation

Pharmacokinetics: onset immediate, duration 30 sec; HL: 10 sec

Indications: converting paroxysmal supraventricular tachycardia (PSVT) and stable wide complex tachycardias to a NSR

AR/SE: shortness of breath, transient arrhythmias, chest pain, hypotension, hyperventilation, burning sensation, light-headedness, facial flushing

Contraindications: known allergy, 2nd or 3rd degree AV block, sick sinus syndrome, irregular afib or polymorphic vtach

Dosage: 6mg rapid IV push; if unsuccessful, repeat in 1-2 minutes at 12mg rapid IV push, may repeat 12 mg dose again if needed.

Special Considerations: (P class C)

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verapamil ; isoptin

Class: antiarrhythmic, antianginal, calcium channel blocker

MOA: blocks calcium from moving into the heart muscle cell, which prolongs the conduction of electrical impulses through the av node. Also, dilates arteries.

Pharmacokinetics: onset- 5 Min, duration 10-60 min; HL: 2-8 Hrs

Indications: Narrow complex tachycardias-atrial fibrillation, hypertension, psvt, psvt prohylaxis

AR/SE: sinus bradycardia, CHF,, asystole, AV blocks, hypotension

Contraindications: known allergy, sick sinus syndrome, 2nd or 3rd degree av blocks, severe ventricular dysfunction, cardiogenic shock, severe hypotension. wpw

Dosage: 2.5-5 mg IV over 2 minutes; may be repeated with 5-10 mg after 15-30 min

Special considerations: do not administer to pts receiving IV beta blockers, increases risk of CHF, bradycardia, and asystole

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diltiazem ; cardizem

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Class: calcium channel blocker, antiarrhythmic, antihypertensive, antianginal

MOA: inhibits transport of calcium into myocardial and vascular smooth muscle cells. Slows conduction through the av node

Pharmacokinetics: onset 3 min, duration: 1-3 hrs; Hl: 2 hrs

Indications: management of angina, SVT, rapid afib, rapid aflutter

AR/SE: sinus bradycardia, CHF,, asystole, AV blocks, hypotension

Contraindications: known allergy, sick sinus syndrome, 2nd & 3rd degree AV blocks, recent MI, pulmonary congestion, systolic BP lower than 90. wpw

Dosage: 0.25mg/kg IV over 2 minutes may repeat in 15 minutes at 0.35mg/kg

Special considerations: do not administer to pts receiving IV beta blockers, increases risk of CHF, bradycardia, and asystole

amiodarone ; cordarone

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Class: antiarhytmic

MOA: Prolongs the action potential and the refractory period; slows the sinus rate, increasing the PR interval and the QT interval; and decreases peripheral vascular resistance

Pharmacokinetics: onset- 1-3 min IV; duration varies; Hl: 40-55 days

Indications: management of Ventricular Fibrillation (VF) and pulseless Ventricular Tachycardia (PVT); can be used for other life-threatening tachyarrhythmias as well

AR/SE: ARDS, Pulmonary Fibrosis, CHF, Pulmonary Toxicity, deteriorating of arrhythmias, bradycaridia, hypotension, dizziness, fatigue, malaise, N/V, constipation, anorexia, tremor

Contraindications: known allergy, pts with cardiogenic shock, pts with 2nd or 3rd decree av blocks

Dosage: cardiac arrest-300 mg IV bolus, may repeat in 3-5 minutes @ 150 mg IV bolus; ventricular arrhythmias- 150 mg over 10 minutes followed by 360 mg over 6 hours.

Special Considerations: (P class D) enters breast milk and causes harm to neonate;

magnesium sulfate

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Class: mineral/electrolyte, antiarrhythmic

MOA: plays important role in neurotransmission and muscular activity

Pharmacokinetics: Onset- Immediate, Duration-1hr

Indications: torsades de pointes, hypertension,

AR/SE: diarrhea, bradycardia, respiratory depression, drowsiness, hypotension, hypothermia

Contraindications: known allergy,persistent severe hypertension hypermagnesemia, hypocalcemia, heart block

Dosage: torsades-1-2 grams over 5-60 minutes (followed by infusion 0.5-1 g/hr)

atropine

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Class: anticholinergic

MOA: competes with acetylcholine for receptor sites, blocking the stimulation of parasympathetic nerve fibers

Pharmacokinetics: rapid onset; duration 4 hours; HL: 2-3 Hrs

Indications: symptomatic bradycardia

AR/SE: tachycardia, drowsiness, dry mouth, dilated pupils

Contraindications: known allergy, angle closure glaucoma, acute hemorrhage

Dosage: 0.5-1 mg IV over 1 minute; may be repeated every 3-5 minutes not to exceed 3 mg total.

digoxin ; lanoxin

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Class: inotropic, Cardiac glycoside

MOA: increased force of myocardial contraction, prolongs refractory period of AV node and decreases conduction through the SA and AV nodes

Pharmacokinetics: onset 5-30 min, duration 3-4 days; HL: 34-44 days

Indications: afib and aflutter to slow ventricular rate, atrial tachycardia

AR/SE: arrhythmias, fatigue, anorexia, N/V/D

Contraindications: known allergy, uncontrolled ventricular arrhythmias, aV block, constrictive pericarditis, pts showing signs of dig toxicity

Dosage: 0.25 mg slow IV every 2 hours up to a total loading dose of 1.5 mg (per physician order)

Special Considerations: (P class C) geriatric pt are very sensitive to toxic effects

aspirin ; asa

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Class: Nonopoid analgesic; antipyretic, platelet aggregation inhibitor

MOA: Inhibits synthesis of protstaglandins to reduce pain and fever, does not have significant anti-inflammatory properties, blocks formation of thromboxane A2 which causes platelate aggregation and aterial constriction

Pharmacokinetics: Well absorbed orally, onset 5-30 min, duration 1-4 hours, HL: 15-20 min

Indications: Mild pain, Fever, chest pain suggesting ACS

AR/SE: Liver Failure and Hepatotoxicity with overdose; renal failure with chronic use, GI bleeding

Contraindications: Known hypersensitivity

Dosage: 325 (4 x 81mg = 324 mg)

Special Considerations: (P Class D in 1st Trimester)

heparin

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Class: anticoagulant, antithrombotic

MOA: potentiates inhibitory effect of antithrombin

Pharmacokinetics: onset-IV immediate; duration- 2-6 hours; Hl: 90 min.

Indications: prophylaxis and treatment of various thromboembolic disorders; inhibit clot formation in ACS.

AR/SE: bleeding, anemia, thrombocytopenia

Contraindications: known allergy; uncontrolled bleeding, severe thrombocytopenia or open wounds

Dosage: 60 U/kg IV, followed by 12 U/kg/hr

Special Considerations: (P class C) double check dosages!!

enoxaparin ; lovenox

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Class: anticoagulant

MOA: accelerates the formation of antithrombin and deactivates thrombin; prevents fibrinogen from converting to fibrin

Pharmacokinetics: onset-3-5 hours; duration- varies; Hl: 4.5 hours

Indications: inhibit clot formation in acute ACS (STEMI, NSTEMI, unstable angina), pulmonary embolism and DVT

AR/SE: bleeding, anemia, thrombocytopenia

Contraindications: known allergy; uncontrolled bleeding, severe thrombocytopenia or open wounds

Dosage: 30 mg IV plus a 1 mg/kg SC dose (SC dose repeated Q 12 HRS)

clopidogrel ; plavix

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Class: antiplatelet, platelet aggregation inhibitor

MOA: inhibits platelet aggregation by inhibiting the binding of ADP to platelet receptors

Pharmacokinetics: Onset within 2 hrs; duration 7-10 days following discontinuation

Indications: reduction of atherosclerotic events in pts at risk including recent MI, ACS, stroke

AR/SE: GI bleeding, bleeding, neutropenia, chest pain, fatigue, depression, epistaxis

Contraindications: known allergy, pathological bleeding disorders

Dosage: 300 mg loading dose, followed by 75 mg daily

tnkase and tpa

Class: thrombolytic, plasminogen activator MOA: converts plasminogen to plasmin, which then degrades fibrin in blood clots Pharmacokinetics: onset- within minutes, duration unknown Indications: treatment of acute Mi an acute stroke AR/SE: intracranial hemorrhage, gi bleeding, retroperitoneal bleeding, gu tract bleeding, anaphylaxis Contraindications: known allergy, hx of stroke, recent intracranial or intraspinal injury or trauma, intracranial neoplasm, av malformation, aneurysm Dosage: per medical direction Special Considerations: (p class C) use with blood thinner increases risk of bleeding.

sodium bicarbonnate

Class: electrolyte, alkalinizing agent MOA: counteracts acidosis Pharmacokinetics: onset immediate, duration 1-2 hrs Indications: acidosis, drug intoxications (barbiturates, salicylates, methyl alcohol) AR/SE: alkalosis, hypernatremia, peripheral edema, injection site reaction Contraindications: known allergy, metabolic alkalosis Dosage: 1 mEq/kg slow IV push may repeat at half initial dose (0.5 meq/kg) in 10 minutes Special Considerations: (P class c) do not administer into another line in which another medication has been given, use caution in pts with CHF and renal disease

morphine sulfate

Classification: opioid/narcotic analgesic, opioid agonist MOA: binds to opiate receptors in the CNS, altering perception to pain and causing some sedation. Also decreases myocardial o2 demand. Pharmacokinetics: Onset Immediate IV, 10-30 min IM, Duration 2-7 hrs; HL: 1-7 Hrs Indications: severe pain, pulmonary edema, pain associated with MI AR/SE: respiratory depression, hypotension, confusion, sedations, N/V, constipation Contraindications: known allergy, known hypersensitivity to tartazins, bisulfites, or alcohol Dosage: Adult: 2-5 mg IV (5-10mg IM) q10 min for desired effect Peds( or adults under 50 kg): 0.01mg/kg IV, SQ, IM may repeat for desired effect, max dose 15 mg. Special Considerations: Use caution in patients with head trauma, increased ICP. Use caution in pts with undiagnosed abdominal pain

nirtous oxide

Classification: medicinal gas, analgesic MOA: exact MOA unknown, inhalation of 50% mixture of nitrous oxide and oxygen produces CNS depression and rapid pain relief. Pharmacokinetics: rapid onset (2 minutes), duration 2-5 min Indications: moderate to severe pain AR/SE: lightheadedness, N/V, drowsiness, decreased respirations Contraindications: known allergy, pts with decreased LOC, thoracic trauma, respiratory compromise, abdominal distention, pts who cannot follow simple instructions Dosage: Self-administered Special considerations: do not administer for abdominal pain if intestinal blockage is a possibility, nitrous oxide may collect in the obstructed space and aggravate the obstruction.

furosemide ; lasix

Class: Loop diuretic MOA: inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule; increases the renal excretion of water, sodium, chloride, magnesium, potassium, and calcium Pharmacokinetics: Onset –IV 5 min; duration- IV 2 hrs Indications: edema due to heart failure; hypertension AR/SE: dehydration, hypokalemia, hypovolemia, hypochloremia, hypomagnesemia, hyponatremia, metabolic alkalosis Contraindications: known allergy, severe liver disease, diabetes Dosage: 40 mg IV (or double pts daily dose up to 80 mg IV)

nitroglycerin ; nitrostat, nitro-bid iv ; ntg

Class: antianginal, nitrate MOA: increases coronary blood flow by dilating coronary arteries; produces vasodilation and decreases left ventricular end-diastolic pressure and pre-load, reduces myocardial oxygen consumption Pharmacokinetics: onset- SL 1-3 min, IV Immediate; duration- SL 30-60 min, IV several minutes Indications: (SL)acute management of angina pectoris, (IV) adjunct treatment of acute MI and treatment of CHF associated with acute MI AR/SE: hypotension, tachycardia, dizziness, headache, N/V, weakness Contraindications: known allergy, pericardial tamponade or pericarditis, pts taking medications for erectile dysfunction Dosage: sl- 0.4mg repeated every 5 for two additional doses prn iv- 5 mcg/min may increase by 5 mcg/min up to 30 mcg/min if necessary; paste: ½ to 1 inch Special Considerations: (P class c) pts may be on this at home for long term management of angina or as adjunct treatment to chf

enalapril ; vasotec

Class: Ace inhibitor, antihypertensive MOA: blocks the conversion of angiotensin I to angiotensin II (vasoconstrictor), resulting in systemic vasodilation Pharmacokinetics: Onset 15-30 min, duration 6-12 hrs; HL; 1-2 days Indications: CHF, hypertension AR/SE: angioedema, cough, hypotension, taste disturbance, dizziness Contraindications: known allergy, hx of angioedema from previous Ace inhibitors Dosage: 1.25 mg IV over 5 minutes every 6 hours Special Considerations: (P Class C 1st trimester, D 2nd/3rd trimester)

captopril ; capoten

Class: Ace Inhibitor, antihypertensive MOA: blocks the conversion of angiotensin I to angiotensin II (vasoconstrictor), resulting in systemic vasodilation Pharmacokinetics: Onset-5-6 min; duration- 2-12 hrs; HL: 2 Hrs Indications: management of CHF, can be used in hypertensive emergencies as well AR/SE: cough, angioedema, hypotension, taste disturbances Contraindications: known allergy, pts with hx of angioedema from previous Ace inhibitors Dosage: 12.5 -25 mg PO Special Considerations: (P class c 1st trimester, D 2nd/3rd trimester)

nitroprusside ; nipride, nitropress

Classification: antihypertensive, vasodilator MOA: produces peripheral vasodilation by direct action on both arteriolar and venous smooth muscle Pharmacokinetics: absorbs completely; onset immediate; duration 1-10 minutes Indications: hypertensive crisis, cardiac failure, control hypertension in acute stroke AR/SE: dyspnea, dissiness, headache, abd pain, N/V Contraindications: known allergy, pts with decreased cerebral perfussion Dosage: 0.3 mcg/kg/min may be increase prn up to 10mcg/kg/min; not to exceed 10 min at 10 mcg/kg/min

hydralazine ; apresoline

Class: vasodilator, antihypertensive MOA: direct-acting peripheral arteriolar vasodilator Pharmacokinetics: Onset 5-15 min IV, Duration 2-6 hrs IV; HL: 2-8 hrs Indications: moderate to severe hypertension, pre-eclampsia AR/SE: tachycardia, sodium retention, edema, orthostatic hypotension, N/V/D Contraindications: known allergy, intolerance to tartazine Dosage: 10 mg slow IV may repeat in 4-6 hours if needed

calcium chloride

Class: calcium supplement MOA: Causes significant increase in myocardial contractile force and increases ventricular automaticity Pharmacokinetics: Onset immediate IV, Duration varies Indications: acute hyperkalemia, hypocalcemia, calcium channel blocker toxicity. AR/SE: Bradycardia, arrhythmias, syncope, N/v, cardiac arrest Contraindications: known allergy, use caution in pts taking digitalis, it can precipitate toxicity Dosage: 2-4 mg/kg IV, may be repeated every 10 minutes.

cardiac drugs Flashcards

(35 cards)