Cardiology Drugs Flashcards
(134 cards)
1
Q
Class I antidysrhythmic
A
Na channel blocker works in ventricles slows conduction decreases repolarization rate widens QRT with prolonged QT interval Ind: lower blood pressure / decrease SVR
2
Q
Adenosine MOA / Description
A
decreases conduction of electrical impulses through the AV Node / interrupts AV reentry pathways in PSVT
rapid onset: 20-30sec
rapid half life: 10sec
3
Q
Adenosine Indications
A
symptomatic PSVT / Atrial dysrhythmias with RVR / wide complex tachycardias / can be therapeutic or diagnostic
4
Q
Adenosine class
A
Class V anti-arrhythmic (misc)
5
Q
Adenosine contraindications
A
irregular AFib / polymorphic tach (torsade de pointes / 2nd/3rd degree block
6
Q
Adenosine Precautions / Side effects
A
Pre: Typically causes arrhythmias / Transient Asystole /Asthma
SE: facial flushing, headache, SOB, dizziness, nausea
7
Q
Adenosine Dose / Pharmocokinetics
A
6mg IV/IO rapid followed by flush
12mg follow up after 2 min
12mg follow up after 2 more minutes
30mg max
Onset: 20-30sec
Peak: 20-30sec
Duration: 30sec
Half-Life: 10sec
8
Q
Class II antidysrhythmic
A
Beta adrenergic antagonist ends with OLOL Ind: lower blood pressure / decrease SVR also block Ca channels should not be us with Ca blocker
9
Q
Class III
A
K channel blocker
prolongs absolute refractory period, repolarization, and QT intervals
IND: atrial or vent tach
10
Q
Class IV Antidysrhythmic
A
Ca channel blocker
decreases SA/AV automaticity and conduction
Blocks B1 receptors
11
Q
Amiodarone Class
A
Class III Antiarrhythmic - K channel blocker (primarily)
also some Na channel blocker properties
12
Q
Amiodarone MOA / Description
A
improves the rate of ROSC in adults with refractory V-Fib and PV-Tac
can also be used in supraventricular tachycardias
prolongs the action potential duration in ALL cardiac tissues
13
Q
Amiodarone Indications
A
V-Tac / V-Fib
Can also be used for: A-FIb / stable regular narrow tach
to control rapid ventricular rate due to accessory pathways
14
Q
Amiodarone Contraindications
A
Brest feeding Pts in cardiogenic shock
2nd/3rd blocks, symptomatic bradycardia
15
Q
Amiodarone Precautions / Side Effects
A
Prec: Pts with latent/manifest heart failure
SE: hypotension, bradycardia, increased PVCs, prlonged PRs, QRSs, and QTs / monitor for pulmonary toxicity (dyspnea/cough)
16
Q
Amiodarone Dose / Pharmocokinetics
A
V-Fib / PV-Tac = 300mg IV/IO/1min / repeat 150mg up to 450mg total
Narrow-tach = 150mg IV/IO/10min, repeat as necessary /
followed by 1mg/min infusion over 6hrs, then 0.5mg/min as needed
Onset: 2-3days oral
Peak: 3-7hrs oral
Duration: varies
1/2 life: 40-55days
17
Q
Atropine Sulfate Class
A
Anticholinergic: blocks acetylcholine / inhibits sympathetic nervous system
18
Q
Atropine Sulfate MOA / Description
A
parasympatholytic used to increase heart rate in hemodynamically significant (unstable) bradycardias
+ chronotropic properties / no inotropic effect
Antidote in organophosphate poisonings
19
Q
Atropine Sulfate Indications
A
Heomodynamically significant bradycardia with a pulse
20
Q
Atropine Sulfate Contraindications
A
none in emergency situations
21
Q
Atropine Sulfate Precautions / Side Effects
A
Prec: coronary artery disease b/c the increased HR may worsen ischemia / can worsen bradycardia associated w/ 2:2 & 3rd degree blocks
SE: blurred vision, dilated pupils, dry mouth, tachycardia, drowsiness, confusion
22
Q
Atropine Sulfate Dosage / Pharmocokinetics
A
0.5mg IV / repeat every 3-5min until max dose of 3mg is reached
Onset: immediate
Peak: 2-4min
Duration: 4hrs
1/2 life: 2-3hrs
23
Q
Calcium Chloride Class
A
Calcium supplement
24
Q
Calcium Chloride MOA / Description
A
MOA: replaces Ca in cases of hypocalcemia / increased inotropic effect
Desc: provides elemental calcium
25
Calcium Chloride Indications
acute hyperkalemia
acute hypocalcemia
calcium channel blocker toxicity/OD (nifedipine, verapamil, diltiazem
26
Calcium Chloride Contraindications
Pt on Digitalis because it may precipitate digitalis toxicity
27
Calcium Chloride Precautions / Side Effects
Prec: must flush line between Ca chloride and Na bicarb to avoid precipitation / tissue necrosis
SE: bradycardia, arrhythmias, syncope, nausea, vomiting, cardiac arrest
28
Calcium Chloride Dose / Pharmocokinetics
2-4mg/kg IV/IO repeat every 10min as needed
should only be given in emergency setting
Onset: Immediate
Peak: unknown
Duration: varies
1/2 life: NA
29
Diltiazem (Cardizem) Class
Class III antiarrhythmic (Ca channel blocker)
30
Diltiazem (Cardizem) MOA / Description
MOA: causes vascular dilation or coronary arteries / relaxation of vascular smooth muscle / slows conduction through the AV node / slows rapid ventricular rate associated with A-Fib and A-flut
Desc: calcium channel blocker
31
Diltiazem (Cardizem) Indications
Narrow complex tachycardias (A-Fib / A-Flut)
| recurrent SVT refractory to vagal maneuvers and adenosine
32
Diltiazem (Cardizem) Contraindications
severe hypotension, CHF, cardiogenic shock
V -Tac
WPW syndrome
33
Diltiazem (Cardizem) Precautions / Side Effects
Prec: systemic hypotension / keep refrigerated (can be kept at room temp for 1month)
SE: nausea, vomiting, dizziness, headache, bradycardia, heart block, hypotension, asystole
34
Diltiazem (Cardizem) Dose /Pharmocokinetics
initial: 0.25mg/kg IV/IO over 2min
Additional bolus 0.35mg/kg over 2min
maintenance infusion 5-15mg/hr titrate for effect
Onset: 3min
Peak: 7min
Duration: 1-3hrs
1/2 life: 2hrs
35
Furosemide (Lasix) Class
Diuretic
36
Furosemide (Lasix) MOA / Description
MOA: inhibits the reabsorption of Na and chloride in kidneys / cause venous dilation within 5min / diuretic effect in 5-15min
Desc: Same as above
37
Furosemide (Lasix) Indications
adjunct to Nitro and ACE inhibitors
CHF
Pulmonary edema
38
Furosemide (Lasix) Contraindications
Pregnancy unless life threatened
| Sulfa allergy
39
Furosemide (Lasix) Precautions / Side Effects
Precautions: dehydration, electrolyte depletion, hypotension / protect from light
SE: headache,dizziness, hypotension, volume depletion, potassium depletion, arrhythmias, diarrhea, nausea, vomiting
40
Furosemide (Lasix) Dose / Pharmocokinetics
40mg IV/IO slow push for Pt ALREADY on oral furosemide
20mg IV/IO slow push for Pt NOT on oral furosemide
Up to 80-120mg in severe cases
Onset: 5-10min
Peak: 30min
Duration: 2hrs (vasodilation) / 6hrs (diuresis)
1/2 life: 30min
41
Labetalol Class
Class II antiarrhythmic / Non-selective beta-blocker
42
Labetalol MOA / Description
non selective Beta1/2 and Alpha1 blocker / inhibits peripheral vasoconstriction, thus causing peripheral vasodilation / lowers blood pressure by decreasing cardiac output through Beta1 blocking properties
43
Labetalol Indications
Hypertensive emergency (elevated BP w/ AMS, CP, renal failure)
NOT HTN w/ headache or HTN associated anxiety
44
Labetalol Contraindications
Bronchial asthma, CHF, Heart block, bradycardia, cardiogenic shock
45
Labetalol Precautions / Side Effects
Precautions: continuously monitor BP, pulse rate, ECG, respiratory status / anticipate postural hypotension / Pt should be supine at all times during med administration
SE: bradycardia, hypotension, lethargy, CHF, dyspnea, wheezing, weakness
Incompatiblity: Pt who received class IV antiarrhythmics (Ca channel blocker)
Caution: Pt taking antihypertensive agents
46
Labetalol Dose / Pharmocokinetics
2 methods:
1. 20mg IV/IO/2min
Additional 40mg IV/IO/2min every 10min until desired supine BP is achieved max 300mg
2. 500mg in 250mL D5W = 1mg/mL / give 2mg/min until desired supine BP is achieved max 300mg
Onset: 2-5min
Peak: 5-15min
Duration: 2-4hrs
1/2 Life: 3-8hrs
47
Metoprolol (Lopressor) Class
Class II antiarrhythmic (selective Beta blocker)
48
Metoprolol (Lopressor) MOA / Description
Desc: Beta antagonist that blocks both Beta1 and Beta2 receptors / selective for Beta1 with minimal effect on Beta2 at doses <100mg
MOA: reduction in HR, systolic BP, and CO / inhibits tachycardia / reduces incidences of V-Fib and CP
49
Metoprolol (Lopressor) Indications
Suspected or definite Acute MI w/ HTN
Stable, narrow tach if uncontrolled/unconverted by adenosine and vagal maneuvers / or if SVT is recurrent
Controls vent rate in Pts w/ AFib or AFlut
50
Metoprolol (Lopressor) Contraindications
HR <45 / Systolic BP <100 / CHF / Heart block Pts / shock / asthma / bronchospastic disease
51
Metoprolol (Lopressor) Precautions / Side Effects
Prec: be alert for S&S of CHF, bradycardia, shock, heart block, and bronchospasm
SE: bradycardia, hypotension, lethargy, CHF, dyspnea, wheezing, weakness
52
Metoprolol (Lopressor) Dose / Pharmacokinetics
Initial 5mg IV/IO slow push
2nd dose 5mg IV/IO slow 2min later if well tolerated / stable vitals
3rd dose5 mg IV/IO slow 2min later if well tolerated / stable vitals
MAX DOSE 15mg
Onset: immediate
Peak: 20min
Duration: 5-8hrs
Half-Life: 3-4hrs
53
Norepinephrine (Levophed) Class
Sympathetic agonist
54
Norepinephrine (Levophed) Description / MOA
Desc: nonselective catecholamine (sympathetic agonist) heavier towards Alpha
MOA: Alpha receptors = potent peripheral vasoconstriction therefore increased BP in cardiogenic shock or other hypotensive emergencies
55
Norepinephrine (Levophed) Indications
Hypotension (systolic < 70) not related to hypovolemia or septic shock
56
Norepinephrine (Levophed) Contraindications
Hypotension due to hypovolemia / sepsis
57
Norepinephrine (Levophed) Precautions / Side Effects
Prec: monitor BP for HTN / fluids initiated prior to admin of norepi / may cause local tissue necrosis / increases myocardial O2 demand
SE: anxiety, tremors, headache, dizziness, nausea, vomiting
58
Norepinephrine (Levophed) Dose / Pharmacokinetics
0.1-0.5mcg/minute max of 30mcg/min IV/IO
Onset: immediate
Peak: < 1min
Duration: 1-2min
1/2 Life: 3min
59
Aspirin (ASA) Class
Platelet aggregation inhibitor / Anti-inflammatory
60
Aspirin (ASA) MOA / Description
MOA: blocks the formation of thromboxane A2 which causes platelets to aggregate and arteries to constrict
Desc: anti-inflammatory and inhibitor of platelet function
61
Aspirin (ASA) Indications
New CP suggestive of ACS and S&S of recent stroke
62
Aspirin (ASA) Contraindications
Relatively contraindicated in Pts with active ulcer disease and asthma
63
Aspirin (ASA) Precautions / Side Effects
Prec: may cause GI upset/bleeding / Pts with allergies to NSAIDs
SE: heartburn, GI bleeds, nausea, vomiting, wheezing, prolonged bleeding
64
Aspirin (ASA) Dose / Pharmacokinetics
Dose: 160-325mg immediately after onset of CP
Onset: 5-30min
Peak: 15-120min
Duration: 1-4hrs
1/2 life: 15-20min
65
Nitroglycerin Class
Nitrate
66
Nitroglycerin MOA / Description
MOA: rapid smooth muscle relaxant that reduces cardiac work and dilates coronary arteries, results in increased coronary blood flow and improved perfusion of ischemic myocardium / causes vasodilation which decreased preload leading to decreased ventricular filling therefore reduced O2 demand
Desc: smooth muscle relaxant used for angina
67
Nitroglycerin Indications
CP associated with ACS and acute pulmonary edema (unless accompanied by hypotension) / first line therapy for acute CHF
68
Nitroglycerin Contraindications
Hypotension / possible increased ICP / Pt in shock
69
Nitroglycerin Precautions / Side Effects
Prec: Pts develop tolerance / deteriorates quickly especially if exposed to light
SE: headache, dizziness, weakness, tachycardia, hypotension, orthostasis, skin rash, dry mouth, nausea, vomiting
70
Nitroglycerin Dose / Pharmacokinetics
Dose: 0.4mg SL repeated every 3-5min up to 3 tablets
Onset: 1-3min
Peak: 5-10min
Duration: 20-30min
1/2 life: 1-4min
71
Nitroglycerin Paste Class
Nitrate
72
Nitroglycerin Paste Description / MOA
Desc: 2% solution of nitro and special absorbent pasted / absorbed into systemic circulation through skin / longer duration of action
MOA: smooth muscle relaxant
73
Nitroglycerin Paste Indications
CP associated with angina pectoris or AMI
74
Nitroglycerin Paste Contraindications
Increased ICP / Hypotension / Shock
75
Nitroglycerin Paste Precautions / Side Effects
Prec: increased tolerance / postural syncope may occur
SE: headache, dizziness, weakness, tachycardia, hypotension, orthostasis, skin rash, dry mouth, nausea, vomiting
76
Nitroglycerin Paste Dose / Pharmacokinetics
Dose: 1/2-1" of Niro-Bid Ointment is applied
Onset: 30min
Peak: varies
Duration: 3-6hrs
1/2 Life: 1-4min
77
Epinephrine 1:10000 (Adrenalin) Class
Sympathetic Agonist
78
Epinephrine 1:10000 (Adrenalin) MOA / Description
Desc: catecholamine with both Alpha and Beta adrenergic stimulant effect
MOA: acts directly on Alpha and Beta receptors / causes increased HR, cardiac contractile force, electrical activity in myocardium, systemic vascular resistance, BP, automaticity
79
Epinephrine 1:10000 (Adrenalin) Indications
Cardiac arrest, severe anaphylaxis, severe reactive airway disease, symptomatic bradycardia refractory to to atropine
80
Epinephrine 1:10000 (Adrenalin) Contraindications
Pts who do not require extensive cardiopulmonary resuscitative efforts / with simple allergic reactions and asthma 1:10 should be used IM
81
Epinephrine 1:10000 (Adrenalin) Precautions / Side Effects
Prec: protect from light / can be deactivated by alkaline solutions like Sodium Bicarb
SE: palpitations, anxiety, tremors, headache, dizziness, nausea, vomiting, strong inotropic and chronotropic properties cause increased myocardial O2 demand
82
Epinephrine 1:10000 (Adrenalin) Dose / Pharmacokinetics
Cardiac arrest (adult): 1mg of 1:10 IV/IO every 3-5min / ETT dose is increased 2-2.5times
Cardiac Arrest (child): 0.01mg/kg IV/IO (0.1mL/kg) every 3-5min
Severe anaphylaxis/asthma (adult): 0.05-0.1mg IV/IO of 1:10 every 5-15min / 1:1 IM / epi drip may be required
Severe anaphylaxis/asthma (child): 1:1 IM / 0.01mg/kg IV/IO every 5-15min
Onset: < 2min
Peak: < 5min
Duration: 5-10min
1/2 Life 5min
83
Magnesium Sulfate Class
Antiarrhythmic
84
Magnesium Sulfate MOA / Description
MOA: physiological Calcium channel blocker and blocks neuromuscular transmission / hypomagnesemia is associated with arrhythmia, cardiac insufficiency and sudden death
Desc: essential element in numerous biochemical reactions in the body
85
Magnesium Sulfate Indications
Torsade de pointes (irregular, polymorphic VTac associated with prolonged QT)
86
Magnesium Sulfate Contraindications
Pts in shock / persistent severe HTN / 3rd degree AV block / Pts who routinely undergo dialysis / known hypocalcemia
87
Magnesium Sulfate Precautions / Side Effects
Prec: slow push to minimize side effects / use caution in Pts with known renal insufficiency / hypermanesemia can occur Calcium chloride/gluconate should be available as antidote
SE: flushing, sweating, bradycardia, decreased deep tendon relexes, drowsiness, respiratory depression, arrhythmia, hypotension, hypothermia, itching, rash
Incompatibility: can cause cardiac conduction abnormalities if administered with digitalis
88
Magnesium Sulfate Dose / Pharmacokinetics
Dose: 1-2g diluted in 10mL of D5W for Torsade de Points
1-2g diluted in 100mL of D5W over 15min
Onset: Immediate
Peak: varies
Duration: 1hr
1/2 Life: NA
89
Morphine Class
Narcotic analgesic
90
Morphine MOA / Description
MOA: CNS depressant that acts on opiate receptors in brain , providing analgesia and sedation / decreases myocardial O2 demand
Desc: CNS depressant
91
Morphine Indications
severe pain associated with MI, kidney stones, etc. use in PE and CHF has been limited in favor of more vasoactive agents (nitro, ACE inhibitors)
92
Morphine Indications
severe pain associated with MI, kidney stones, etc. use in PE and CHF has been limited in favor of more vasoactive agents (nitro, ACE inhibitors)
93
Morphine Indications
severe pain associated with MI, kidney stones, etc. use in PE and CHF has been limited in favor of more vasoactive agents (nitro, ACE inhibitors)
94
Morphine Contraindications
Pts who are volume depleted / severe hypotension / undiagnosed head injury or abdominal pain
95
Morphine Precautions / Side Effects
Prec: high tendency for addiction or abuse / Schedule II medication / respiratory depression / narcan should be available
SE: nausea, vomiting, abdominal cramps, blurred vision, constricted pupils, AMS, headache, respiratory depression
96
Morphine Dose / Pharmacokinetics
Dose: 2-10mg IV with additional 2mg IV every few minutes until pain is relieved or respiratory depression occurs / 5-15mg IM / normally given with antiemetic to help prevent nausea/vomiting
Onset: IV = immediate / IM = 15-30min
Peak: IV = 20min / IM = 30-60min
Duration: 2-7hrs
1/2 Life: 1-7hrs
97
Lidocaine Class
Antiarrhythmic
98
Lidocaine Description / MOA
Desc: local anesthetic / used to treat life threatening ventricular arrhythmias
MOA: depresses depolarization and automaticity in ventricles with very little effect on atrial tissue
99
Lidocaine Indications
VTach and VFib refractory to Amiodarone
100
Lidocaine Contraindications
2nd degree type 2 block / 3rd degree block
101
Lidocaine Precautions / Side Effects
Prec: CNS depression may occur when dose exceeds 300mg/hr / high doses can result in coma and death / routine prophylactic lidocaine therapy fo AMI in no longer recommended
SE: drowsiness, slurred speech, seizure, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
102
Lidocaine Precautions / Side Effects
Prec: CNS depression may occur when dose exceeds 300mg/hr / high doses can result in coma and death / routine prophylactic lidocaine therapy fo AMI in no longer recommended
SE: drowsiness, slurred speech, seizure, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
103
Lidocaine Precautions / Side Effects
Prec: CNS depression may occur when dose exceeds 300mg/hr / high doses can result in coma and death / routine prophylactic lidocaine therapy fo AMI in no longer recommended
SE: drowsiness, slurred speech, seizure, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
104
Lidocaine Precautions / Side Effects
Prec: CNS depression may occur when dose exceeds 300mg/hr / high doses can result in coma and death / routine prophylactic lidocaine therapy fo AMI in no longer recommended
SE: drowsiness, slurred speech, seizure, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
105
Lidocaine Dose / Pharmacokinetics
Dose: Hemodynamically stable monomorphic VTach
Initial: 1.0-1.5mg/kg / boluses of 0.5-0.75mg/kg repeated every 5-10min / max dose of 3.0mg/kg / once arrhythmia is suppressed a 2-4mg/min drip should be initiated
Reduce by 50% for >70YO / liver disease / heart failure / bradycardias / conduction disturbances
Onset: < 3min
Peak: 5-7min
Duration: 10-20min
1/2 Life: 1.5-2hrs
106
Procainamide (Pronestyl) Class
Antiarrhythmic
107
Procainamide (Pronestyl) Description / MOA
Desc: ester-type local anesthetic / used for life threatening ventricular arrhythmias refractory to other antiarrhythmics
MOA: suppresses ventricular ectopy / reduces automaticity of various pacemaker sites / slows intraventricular conduction to a much greater degree than Lidocaine
108
Procainamide (Pronestyl) Indications
VTac w/ pulse / pre-excited AFib
109
Procainamide (Pronestyl) Contraindications
severe conduction system disturbances, especially 2nd or 3rd degree blocks
110
Procainamide (Pronestyl) Precautions / Side Effects
Prec: avoid in Pts with prolonged QT syndrome or CHF / hypotension is common
SE: drowsiness, seizures, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory arrest, cardiac arrest
111
Procainamide (Pronestyl) Dose / Pharmacokinetics
Dose: 20-50mg/min until arrhythmia is suppressed / discontinue if: arrhythmia is suppressed, Hypotension occurs, QRS is widened by 50% of original width, a total of 17mg/kg has been administered
Maintenance infusion of 1-4mg/kg (generally 1g in 500mL of D5W or NS = 2mg/mL
Onset: 10-30min
Peak: 15-20min
Duration: 3-6hrs
1/2 Life: 3hrs
112
Clopidogrel (Plavix) Class
Platelet aggregation inhibitor (ADP Inhibitor)
113
Clopidogrel (Plavix) Description / MOA
Desc: adenosine diphosphate (ADP) platelet aggregation inhibitor
MOA: inhibits platelet aggregation by selectively binding to adenlyate cyclase-coupled ADP receptors on the surface of platelets
114
Clopidogrel (Plavix) Indications
Treatment of ACS / recent MI, stroke, or established peripheral vascular disease
115
Clopidogrel (Plavix) Contraindications
presence of a hemostatic disorder / active pathological bleeding (eg: bleeding peptic ulcer, intracranial bleeding, etc)
116
Clopidogrel (Plavix) Precautions / Side Effects
Prec: Pts taking NSAIDS
SE: increased risk of bleeding, fever, allergic reactions, myalgias, arthralgia, bronchospasm, skin rash
117
Clopidogrel (Plavix) Dose / Pharmacokinetics
Non STE ACS (UA/NSTEMI): 300mg loading dose PO, followed by 75mg PO once daily in combo w/ ASA 75-325mg PO once daily)
STEMI: 75mg PO once daily w/ ASA 75-325 PO
Recent MI, Stroke, or established peripheral arterial disease: 75mg once daily
Onset: 2hrs
Peak: 3-7days
Duration: 7-10days
1/2 Life: 7-8hrs
118
Heparin Class
Anticoagulant (unfractionated)
119
Heparin Description / MOA
Desc: rapid acting anticoagulant prepared from bovine lung tissue or porcine intestinal mucosa
MOA: indirect inhibitor of thrombin, blocks the conversion of prothrombin to thrombin / prevents the conversion of fibrinogen to fibrin
120
Heparin Indications
inhibit clot formation in ACS / adjunct in fibrinolysis / helps prevent PE and DVT
121
Heparin Contraindications
Hypersensitivity to pork and beef products
122
Heparin Precautions / Side Effects
Prec: do not use in Pts with active major bleeding or thrombocytopenia / caution in Pts with chronic alcoholism, Hx of atrophy or anaphylaxis, and pregnant (especially the last trimester)
SE: CNS confusion and dizziness / Cardiovascular: edema, CP, irregular heart beat / Injection site: irritation, pain, erythema, bruising / Other: bleeding complications, agioedema, rash, urticaria
Interactions: NSAIDS, warfarin, antiplatelet agents
123
Heparin Dose / Pharmacokinetics
Adult STEMI / unstable angina: 60U/kg IV (max of 4000U) followed by 12U/kg/hr (max 1000U/hr) often given with alteplase (rtPA)
Adult NSTEMI / unstable angina: 60-70U/kg IV bolus (max 5000U) followed by 12-15U/kg/hr infusion
Pediatric: 50U/kg followed by IV infusion based on lab values and body mass
Onset: Immediate
Peak: 2-3min
Duration: 2-6hrs
1/2 Life: 90min
124
Esmolol (Brevibloc) Class
Class II antiarrhythmic (selective Beta blocker)
125
Esmolol (Brevibloc) Description / MOA
Desc: Beta1 selective blocker w/ very short half life
MOA: Beta1 blocker / rapid onset / shourt duration of action (9min) / used to slow rapid heart rates in Pts with SVT, AFlut, AFib /
126
Esmolol (Brevibloc) Indications
Stable, narrow complex Tachs refractory to adenosine or vagal maneuvers or if SVT is recurrent
Control ventricular rate in Pts with AFib or AFlut
Certain forms of polymorphic VT (associated with acute ischemia, familial Long QT Syndrome, catecholaminergic
127
Esmolol (Brevibloc) Contraindications
Pts with sinus bradycardia, heart block greater than first degree, cardiogenic shock, overt CHF
128
Esmolol (Brevibloc) Precautions / Side Effects
Prec: hypotension which is primarily dose related (may need to reduce dose) / CHF may worsen / Pts with bronchospastic diseases (asthma/COPD) should not use unless medical control physician deems that the benefits outweigh the risks
SE: bradycardia, dizziness, hypotension, lethargy, CHF, dyspnea, wheezing, weakness
Incompatibilities: Pts who received IV Calcium channel blockers / Morphine can increase the blood levels of esmolol
129
Esmolol (Brevibloc) Dose / Pharmacokinetics
Loading dose: 500mcg/kg over 1min
Maintenance dose: 50mcg/kg/min for 4min
If therapeutic effect is not seen then repeat loading dose of 500mcg/kg followed by 100mcg/kg/min for 4min
Can be tirated at 4min intervals by repeating the loading dose and increasing the maintenance dose by 5omcg/kg/min
Max maint dose is 300mcg/kg/min
Onset: < 5min
Peak: 10-20min
Duration: 10-30min
1/2 Life: 2-9min
130
Sodium Nitroprusside (Nitropress, Nipride) Class
Antihypertensive and vasodilator
131
Sodium Nitroprusside (Nitropress, Nipride) Description / MOA
Desc: potent vasodilator used in management of HTN emergencies
MOA: dilates both peripheral arteries and peripheral veins causing immediate reduction in BP / occasionally used for severe CHF (although not approved)
Use almost always requires ICU admission
132
Sodium Nitroprusside (Nitropress, Nipride) Indications
HTN emergency
133
Sodium Nitroprusside (Nitropress, Nipride) Contraindications
None when used in the management of life threatening HTN crisis
134
Sodium Nitroprusside (Nitropress, Nipride) Precautions / Side Effects
Prec: once infusion is prepared it must be immediately wrapped to protect from light, quickly inactivated / shouldn't be used in peds or pregnant women / dose should be reduced in elderly Pts / constant monitoring of BP and HR required
SE: dizziness, headache, hypotension, CP, dyspnea, palpitations, nausea, vomiting / can also cause cyanide toxicity in higher doses
