Code drugs

Question 1

What drug is given for SVT? What do we do first?

Answer 1

Adenosine, get the pt to bear down first triggering the vagus nerve

Question 2

What should you warn your patient about with Adenosine

Answer 2

they’re gonna feel like SHIT, their heart is stopping and restarting

Question 3

What is the chemical cardioversion drug?

Answer 3

Adenosine

Question 4

When can I not give adenosine?

Answer 4

For anything that’s not SVT- no heart blocks

Question 5

Side effects of adenosine?

Answer 5

Chest pain, flushing, brief asystole or bradycardia, ventricular ectopy

Question 6

Adenosine administration?

Answer 6

6mg IVP bolus over 1-3 seconds followed by a 20ml flush then elevate the extremity.
2nd dose of 12mg can be given in 1-2 mins if needed.
PUT IN A LARGE BORE IV AT THE AC OR HIGHER!!!!
Can give in pregnancy because its in and out of the body quick

Question 7

Amiodarone: Why do we give it? (what dysrhythmia)?

Answer 7

VF, VT unresponsive to shock/cpr/prressors, recurrent hemodynamically unstable VT

Question 8

Amiodarone: Whats a major adverse effect? What should the nurse monitor?

Answer 8

1. POTENTIATES ARRHYTHMIAS, nurse should monitor for Torsades
2. BB warning for Pulmonary and liver toxicities (monitor PFTs and liver enzymes)
3. Do not give with other drugs that prolong QT interval (torsades risk)

Question 9

Amiodarone: How does it work?

Answer 9

Decreases the defib threshold, making the body respond easier to the shock (shock is more effective)

Question 10

Admiodarone: dosage

Answer 10

1st dose: 300 mg IV push
2nd dose: 150 mg IVP (if needed)
always hang on a pump
Max dose: 2.2g/24hrs
Rapid infusion: 150mg IVPB/10mins (can repeat every 10 mins)
Slow infusion: 360 mg/6hrs (1mg/min)
Maintenance infusion:540mg/18hrs
Change rate after 6 hours!!

Question 11

Atropine: When do we give it?

Answer 11

Symptomatic (dizziness, hypotension, syncope, diaphoretic) sinus brady 1st line drug, also for organophosphate poisoning in extremely high doses

Question 12

Atropine:

1. How does it work?
2. When should we not give it?
3. Whats a quick way to remember when to not give?

Answer 12

1. anticholinergic drug that blocks the action of the vagus nerve (want HR faster)
2. Not for 2nd degree type 2 and 3rd degree heart blocks. Consider epi/dope and external pacing. WONT WORK ON HEART TRANSPLANT PTS (no vagus nerve)
3. ” no p waves= dont give the drug with a P in it”

Question 13

Atropine:

1. When should I not give it? Why?
2. What happens if the dose is below 0.5 mg?

Answer 13

1. Use cautiously in MI/hypoxia (increases myocardial o2 demand), avoid in hyperthermic bradycardia (Slowly warm pt)
2. May result in paradoxical slowing of the HR, this is why we never want a dosage below 0.5 mg

Question 14

Atropine:

1. Dosage
2. What should we do if atropine administration doesn’t help the bradycardia?

Answer 14

1. 0.5mg IV every 3-5 mins as needed. Don’t exceed the total dose of 0.04mg/kg (total 3mg)
2. Consider pacing or epi/dope

Question 15

Dopamine:

1. Why do we give it?
2. Whats the major side effect?

Answer 15

1. 2nd line for symptomatic brady
   - use for hypotension (SBP <70) with sxs of shock
2. Causes tachyarrhythmias while increasing BP and contractility

Question 16

Dopamine:

1. What do I need to do before giving dope?
2. What do I need to watch for?
3. What should I not mix with this? Why?

Answer 16

1. Correct hypovolemia
2. Tachyarrhythmias, vasoconstriction (blue fingertips), extravasation (watch iv sites- prefer a CL)
3. Don’t mix with sodium bicarb (wouldnt work)

Question 17

Dopamine:

1. Rate?
2. How do we titrate?
3. What about when we want to taper?

Answer 17

1. 2 to 20 mcg/kg/min
2. titrate to response
3. Taper slowly (rebound brady) so keep on a heart monitor!

Question 18

Epinephrine:

1. When do we give?
2. When would this be used for symptomatic bradycardia?
3. How does this work?

Answer 18

1. Cardiac arrest- VF, pulseless VT, asystole, PEA, severe hypotension, anaphylaxis
2. Drug of choice if atropine is un-effective
3. Vasoconstrictor, so it increases MAP, which increases perfusion of blood to the heart and brain

Question 19

Epinephrine:

1. Contraindications?
2. How is it given?

Answer 19

1. Increased HR and BP can cause myocardial ischemia, angina, and increased myocardial demand
2. Anaphylactic dose is IV ONLY (will cause a cardiac event if pushed)

Question 20

Epinephrine:

1. Dosage for cardiac arrest
2. Dosage for profound bradycardia

Answer 20

1. 10 ml every 3-5 mins with a 20 ml saline flush after. Elevate arm after. Continuous infusion of 0.1-0.5 mcg/kg/min
2. 2-10 mcg/min infusion

Question 21

Lidocaine:

1. When do we give it?
2. What do we need to know before giving?
3. Drug class?

Answer 21

1. Alternative to amiodarone in cardiac arrest VF/ pulseless VT
2. weight-this is weight based!
3. sodium channel blocker

Question 22

Lidocaine:

1. Dosage for VF/PVT?
2. Dosage for perfusing arrhythmia?
3. Dosage for maintenance dose?

Answer 22

1. 1-1.5 mg/kg IV. May have additional dose of 0.5-0.75mg/kg IV repeat in 5 mins for a max of 3 doses (or total 3mg/kg)
2. 0.5-0.75mg/kg IV, repeat in 5 mins for a total of 3 doses or 3mg/kg
3. 1-4mg/minute IV (30-50 mcg/kg)

Question 23

Lidocaine:

1. Toxicity symptoms?
2. What should I do to the dosage if my pt has impaired liver function/ LV dysfunction?
3. When should I discontinue this drug?

Answer 23

1. dizziness, drowsiness, fatigue, twitching, mouth numbness, slurred speech, tremors, GI effects, respiratory distress/arrest
2. Reduce maintenance dose but not loading dose
3. D/C for signs of toxicity

Question 24

Magnesium sulfate:

1. When is this given?
2. What is it/ what does it do?

Answer 24

1. Torsades or when low mag, or for life threatening ventricular arrhythmias due to dig toxicity
2. Smooth muscle relaxer that decreases respirations

Question 25

Magnesium sulfate: 1. What is the main adverse effect if given too fast? 2. What should the nurse watch for? 3. How should this be given? 4. Dosage for cardiac arrest? 5. dosage for torsades (with a pulse) or a MI with hypomagnesemia?

Answer 25

1. Respiratory depression or arrest with rapid administration. 2. Occasional drop in BP and respirations with rapid administration 3. SLOWLY... too fast causes hypotension and tachycardia and the pt might need a ventilator 4. 1-2g diluted in 10ml (ns/d5w) given IV 5. Loading dose of 1-2 grams mixed in 50-100 ml of dilutent over 5-60 min