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ACTAS Pharmacology > Cardiac Pharmacology > Flashcards

Cardiac Pharmacology Flashcards

(47 cards)

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1
Q

Acetylsalicylic Acid: Type

A

Non-steroidal anti-inflammatory drug

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2
Q

Acetylsalicylic Acid: Actions

A
  1. Inhibit platelet function (for up to 7 days)

2. Suppresses inflammation, reduces fever, relieves pain

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3
Q

Acetylsalicylic Acid: Onset

A

Rapidly absorbed from the stomach and small bowel

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4
Q

Acetylsalicylic Acid: Use

A

Suspected myocardial ischaemia - reducing platelet aggregation and limiting clot development

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5
Q

Acetylsalicylic Acid: Adverse effects (3)

A
  1. Allergic reactions (e.g. asthma, angioneurotic oedema, urticaria, rhinitis, shock)
  2. Aggravation of bleeding tendencies
  3. Gastric irritation (unlikely with 1 tablet only)
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6
Q

Acetylsalicylic Acid: Contraindications (4)

A
  1. Known or suspected allergy to salicylates
  2. Known or suspected active bleeding
  3. Known bleeding tendency
  4. Chest pain associated with psychostimulant overdose (due to an increased risk of cerebral haemorrhage)
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7
Q

Acetylsalicylic Acid: Dose

A

1 tablet (300mg) - chewed and swallowed, or dissolved in a small amount of water
1/2 tablet (150mg) if on oral anticoagulant
Single dose only
Administer even when patient is on slow release aspirin

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8
Q

Adenosine: Type

A

Endogenous purine nucleoside, found in all body cells

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9
Q

Adenosine: Action

A

Causes transient inhibition of conduction in the heart, especially in the AV node

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10
Q

Adenosine: Onset/Duration

A

Onset - 5-10 seconds

Duration: approx 10 seconds

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11
Q

Adenosine: Use

A

Treatment of supraventricular tachycardia
Not for the treatment of atrial flutter or fibrillation; however if mistakenly administered to patients in these arrhythmias, the decrease in AV conduction may unmask atrial activity

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12
Q

Adenosine: Adverse effects (7)

A

Common, although transient and generally minor

  1. Arrhythmias at the time of conversion are common (up to 55% patients) - including PVCs, PACs, sinus bradycardia, AV blocks
  2. Transient flushing of the skin
  3. Mild dyspnoea
  4. Chest tightness
  5. Nausea
  6. Headache
  7. Feelings of apprehension and fear
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13
Q

Adenosine: Contraindications (2)

A
  1. 2nd or 3rd degree heart block

2. Known hypersensitivity

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14
Q

Adenosine: Precautions (4)

A
  1. Asthma - may exacerbate bronchospasm
  2. Pregnancy - use only if very poorly perfused
  3. Antagonised by theophylline (Nuelin)
  4. Potentiated by dipyridamole (Persantin, Asasantin) and carbamazepine (Tegretol)
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15
Q

Adenosine: Dose

A

After 12 valsalva x 2
Record 12 lead prior to administration

ADULT: Symptomatic adults only
6mg IV rapid bolus (over 1-2 seconds) - give into fast flowing pump set
If first dose is unsuccessful, give second dose (2 minutes between doses): 12mg IV

PAEDIATRIC: First dose: 0.05mg/kg. Second dose: 0.1mg/kg

Elevate limb if possible
Transport to hospital as incidence of recurrence 10-15%

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16
Q

Adenosine: unpleasant/fearful experience

A

Midazolam pre-dose 1-1.5 mg IV

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17
Q

Adrenaline: Type

A

A naturally occurring catcholamine

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18
Q

Adrenaline: Actions

A
  1. alpha effect: peripheral vasoconstriction
  2. beta 1 effects: increased rate of SA node, increased myocardial contractility, increased AV conduction, increased myocardial irritability
  3. beta 2 effects: bronchodilation, vasodilation of skeletal muscle
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19
Q

Adrenaline: onset/max effect

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A

Onset: IV 30 seconds, IM 30-90 seconds
Max effect: IV 3-5 min, IM 4-10 min
ET use slightly longer times

20
Q

Adrenaline: Adverse effects (3)

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A
  1. Tachycardia
  2. Tachyarrhythmias
  3. Hypertension
21
Q

Adrenaline: Contraindication

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A

Known hypersensitivity

22
Q

Adrenaline: Precautions (3)

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A

These apply to patients with cardiac output only

  1. History of hypertension
  2. History of ischaemic heart disease
  3. Give extremely slowly to patients on MAO inhibitor antidepressants (e.g. Nardil, Parnate) as adrenaline may provoke a greatly exaggerated response. Generally patients on MAOIs with cardiac output should receive no more than 1/4 of the normal dose of adrenaline, titrated to response.
23
Q

Adrenaline: Dose: Cardiac arrest

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A

Adult: 1mg IV/IO - fast push (no limit on number of doses in cardiac arrest)
Paediatric: IV/IO - 0.01mg/kg - fast push (no limit on number of doses in cardiac arrest)
ETT: NEWBORN ONLY - if no IV or IO access - 0.02mg/kg

24
Q

Adrenaline: Dose: Anaphylaxis/Severe life-threatening asthma

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A

Adult: IM 0.5mg - rpt 5 minutely (max. three doses)
If required: IV/IO adrenaline by infusion, titrated to response

Paediatric: IM 0.01mg/kg (up to 50kg) - rpt 5 minutely (max. three doses)
If required: IV/IO adrenaline by infusion, titrated to response

25
Adrenaline: Dose: Bradyarrthymias resistant to atropine
Adult and paediatric: IV/IO by infusion - titrated to response
26
Adrenaline: Dose: Severe upper airway swelling
Adult: IM 0.5mg - rpt 5 minutely (max 3 doses) Paediatric: Weight >10kg - nebulise 5ml 1:1000; weight < 10kg - nebulise 0.5ml/kg 1:1000 (make volume up to 5ml with saline, as required). Single dose only
27
Adrenaline: Dose: Critically ill shocked patients unresponsive to fluid boluses
Adult and paediatric: IV/IO adrenaline by infusion - titrated to response
28
Adrenaline Infusion
1mg in 500ml normal saline (2mcg/ml) 20 drops/min = 1 ml/min = 2mcg/min (titrate as required) Utilising a burette will achieve more accurate dosing (ALWAYS use a burette with paediatric patients) Remember to label the flask with a medication label
29
Amiodarone: Type
Potent anti-arrhythmic agent
30
Amiodarone: Actions (7)
Complex electrophysiological and pharmacological profile: 1. Prolongs the action potential duration; increases the refractoriness of all cardiac tissues 2. Blocks Na+ channels (class I action) 3. Has some anti-adrenergic effects (class II action) 4. Ca2+ blockade (class IV action) 5. Prolongs QT interval - reflects global prelongation of repolarisation 6. When given IV, there is a significant effect on the AV nose which causes a delay in nodal conduction 7. Also effective for accessory pathway conduction
31
Amiodarone: Adverse Effects
When given IV can cause vasodilation, negative inotropic effects and hypotension (dose and rate dependent) Occasionally may cause: 1. Bradycardia (especially in older patients) 2. Phlebitis 3. Hot flushes/sweating
32
Amiodarone: Contra-indications (2)
1. Known hypersentivity | 2. Cross sensitivity to iodine
33
Amiodarone: Dose: VT/VF Cardiac arrest
Adult: 300mg IV/IO - over 30-60 seconds Paediatric: 5mg/kg IV/IO (to maximum 300mg) - over 30-60 seconds
34
Amiodarone: Dose: VT, AF & A.Flutter - with cardiac output
Adult: 150mg IV via Springfuser (made up to 7ml total volume with normal saline; 7ml will run over 10 min) (VT - if extremely compromised, may be given over 5 minutes by slow IV injection) No repeat dose for either treatment regime Paediatric: 5mg/kg IV (to maximum 150mg) via Springfuser (made up to 7ml). (VT if extremely compromised, may be given over 5min by slow IV injection) No repeat doses
35
Amiodarone: Special note: drug interactions
Significant potential drug interactions - the following may potentiate the actions of amiodarone: * digoxin * phenytoin (Dilantin) * beta blockers * calcium channel blockers * other antiarrhythmics
36
Atropine Sulphate: Type
Parasympathetic blocking agent
37
Atropine Sulphate: Actions (4)
Large number of actions. Those important in the pre-hospital setting: 1. Blocks the action of the vagus nerve on the heart 2. Increases the rate of the sinus node 3. Increases speed of conduction through the AV node 4. Reduces the amount of secretions from some glands (e.g. tear and salivary glands)
38
Atropine Sulphate: Onset/max effect/half life
Onset IV: 2 min. Max effect: 5 min | IV half-life adult: 2-3 hours, paed: approx 6.5 hours
39
Atropine Sulphate: Uses (2)
1. Bradyarrhythmias with poor perfusion 2. Organophosphate poisoning/spider bite with cholingeric symptoms (to increase heart rate irrespective of BP and/or assist airway maintenance by reducing excess salivation)
40
Atropine Sulphate: Adverse effects (7)
1. Tachycardia 2. Palpitations 3. Blurred vision 4. Dry mouth 5. Confusion 6. Urinary retention 7. Increased body temperature (by decreasing sweating)
41
Atropine Sulphate: Contraindication
Known hypersensitivity
42
Atropine Sulphate: Precautions (2)
1. Care needed in patients with glaucoma | 2. Aim not to increase heart rate above 100/min
43
Atropine Sulphate: Dose: Bradyarrhythmias
Adult: IV/IO: 600mcg fast push Repeat once after 3-5 minutes, if required Paediatric: not used
44
Atropine Sulphate: Dose: Organophosphate poisoning/cholinergic symptoms of spider bite
IV/IO Adult initial dose 600mcg - fast push IV/IO paediatric initial dose 0.01mg/kg - fast push Repeat every 3-5 min, while ever cholinergic symptoms present Double each rpt dose as required. No upper limit on doses. Continue use even if BP is not low. May be used IM (0.01mg/kg) in these circumstances if: * IV access is not available, or * there are multiple patients affected, or * AP crew only on scene, prior to ICP back up arriving Rpt every 5min, while ever cholinergic symptoms present. Double each dose as required. No upper limit on doses - max IM dose dictated by volume into muscle. Continue use even if BP not low
45
Glyceryl Trinitrate: Type
Nitrate smooth muscle relaxant and vasodilator
46
Glyceryl Trinitrate: Presentations (2)
White 300mcg or 600mcg sublingual tablets | Metered dose pump spray - multiple patient use - 400mcg/dose - 200 dose bottle
47
Glyceryl Trinitrate: Actions (2)
1. Arterial and venous vasodilation | 2. Dilation of collateral coronary vessels

ACTAS Pharmacology (2 decks)

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