Drugs Flashcards
(31 cards)
Epinephrine
Pos chronotropic, inotropic
SNS EFFECTS
-beta1 and 2 agonist
-pos chronotropic, inotropic, inc RR, bronchodilation
-alpha agonist -vasoconstriction at higher doses
Indications
-Cardiac arrest 1mg IV q3-5mins
-symptomatic bradycardia IV 2-10mcg/min
-anaphylaxis 0.1-0.25mg IV q5-15mins
-shock
Atropine
Pos chronotropic, dromotropic, inotropic Reverses PNS EFFECTS Opens ca channels Anticholinergic, vagolytic Accelerates SA INDICATION -bradycardia 0.5-1mg q5mins (max 3mg) -asystole/PEA 1mg iv -1/2 av blocks
Adenosine
Anti arrhythmic Slows av conduction Can restore nsr- chem cardioversion Coronary artery vasodilation INDICATIONS -SVT/Atrial tachycardia - 6 mg rapid IV bolus, repeat in 1-2 mins with 12mg bolus if no result, repeat. Follow each with 20cc NS flush
Amiodarone
Magic for all tachyarrythmias
Inhibits SNS
-beta and alpha antagonist
-slows SA/av conduction, slows HR (inhibits Na/K channels)
-vasodilator
-dec contractility but coupled with dec after load increases CO (inhibits ca channels)
INDICATIONS
-vtach stable pulse - 150mg bolus over 10mins, 1mg/min for 6hrs, then 0.5mg/min for 18hrs
-pulseless vf/vt - 300mg iv, follow with 150mg q3-5mins
Lidocaine
Dec Automaticity in ventricular cells, by inhibiting fast Na channels
INDICATIONS
-ventricular tachyarrythmias
-VT, VF, Wide complex tachy
- 1-1.5mg/kg (70-100mg) iv over 2-3 mins, repeat 0.5-0.75mg/kg (35-50mg) in 5-10 mins (max 3mg/kg), then infuse 1-4mg/min iv
Dopamine
SNS effects catecholamine
-low dose dopaminergic effects -renal and mesenteric vasodilation
-med dose -beta1 agonist -inc HR contractility
-high dose alpha agonist -vasoconstriction
Indications
-symptomatic bradycardia, hypotension, dec CO
- 1-5mcg/kg/min dopaminergic effects, renal perfusion
- 5-15mcg/kg/min beta1 inotropic, chronotropic
- >15mcg/kg/min alpha vasoconstriction
Dobutamine
SNS effects adrenergic agonist
-limited B1 and slight beta2 (may even dec afterload), limited alpha effects - therefore Potent Inotrope
Indications
- mostly to improve contractility
- CHF
Onset 1-10 mins
Duration 10 mins
Dose Start 0.5-1mcg/kg/min, then 2-20 msg/kg/min titrate to desired CO
Levophed
Norepinephrine Dominant alpha effects -vasoconstriction, minor inotropic effects -inc contractility and coronary vasodilation Indications -Sepsis -Severe vasodilation/hypotension
Onset 1-2 mins
Duration 1-2 mins
Dose 1-20mcg/min
Vasopressin
Anti diuretic hormone Binds to vasopressin receptor V1 and V2 V1-vasoconstriction V2-antidiuretic Indications -cardiac arrest, VT/VF, PEA -vasodilatory shock
Onset 30-60 mins
Dose 0.01-0.04units/min
Beta blockers
Beta1&2 antagonist Dec HR, conduction Neg inoptrope Indications -tx MI, angina, htn by dec myocardial o2 demand and co
Ca channel blockers
Neg inotropic dec contractility Neg dromotropic dec av conduction Dilation coronary and peripheral arterioles Dec o2 demand Indications: SVT Atrial tachy Afib/aflutter Angina
ACEi
Inhibits conversion of angiotensin I to II No vasoconstriction Dec BP, dec vasoconstriction, allow diuresis, void Na Dec afterload Indications: HTN CHF STEMI within 24hrs
What meds treat bradycardia?
First line:
-Atropine-vagolytic, opens Ca channels, increases SA and AV conduction
-Dopamine- med dose inc HR and contractility, high dose vasoconstrictor
ACLS:
-Epinephrine- asytole, symptomatic bradycardia, anaphylaxis
What meds treat tachycardia?
First line:
-Amiodarone- blocks beta and alpha and inc contractility, tx atrial and ventricular tachyarrythmias
-Adenosine- chem chardioverts SVTs, restores NSR
-Beta blockers
-ca channel blockers- dec av conduction
ACLS:
-Lidocaine- dec Automaticity of ventricular cells, to ventricular tachyarrythmias
Propofol
- Anesthetic
- Short-acting, lipophilic sedative/hypnotic; causes global CNS depression, presumably through agonist actions on GABAa receptors
Onset 45 sec, duration 3-10 mins
5mcg/kg/min initial, titrate 5-10mcg Q5-10 mins to ~50mcg max
Adverse - Hypotension, hypoventilation/apnea, PRIS - metabolic acidosis/green pee/bradycardia/blocks
Midazolam
Sedation
Binds to GABA receptors, causes hyper polarization of neuronal membranes with chloride ions shift (decreases membrane excitability)
Onset/Duration: 1.5-5min, lasts 2-6 hrs
Dose: procedural 1-2.5mg, sedation 10-50mcg/kg load then 20-100mcg/kg/hr
Adverse: Apnea, resp depression, arrhythmias
Rocuronium
Paralytic - med long acting
Skeletal muscle depolarization inhibitor. Binds to cholinergic receptor.
Onset 1-2 min
Duration: dose dependant 30-60mins
Dose: 50mg
Milrinone
Positive Inotrope, vasodilator dec preload and afterload (including to pulm artery)
No chronotropic effects
Phosphodiesterase 3 enzyme inhibitor
Indications CHF
Onset 5-15 mins
Duration 3-5 hrs
Dose: load 50mcg/kg, then
Infuse 0.375-0.75mcg/kg/min
Ketamine
Anaesthetic with analgesic effects, block NMDA receptor
Onset 30 seconds
Duration 5-10 mins
Dose load 200-750mcg/kg over 3-5mins, then 5-20mcg/kg/min infusion
Adverse: emergence aggression, tachycardia, hypertension, dissociative experience
Fentanyl
Analgesia - short acting, CNS depression, adjunct in anesthesia
Opiate
Onset 1-2 mins
Duration 0.5-1hr
Dose 0.5-1mcg/kg/dose, repeat 30-60 mins
Adverse confusion, resp dep, apnea, arrhythmia, hypotension, nausea
Succinylcholine
Depolarizing neuromuscular blocking agent
paralytic - short acting
Onset 0.5-1min
Duration 4-10 mins
Dose 0.6mg/kg
Adverse apnea, hypotension, bradyarrhythmias
Haloperidol
Antipsychotic - tx of delirium
Dopamine D1, D2 antagonist in CNS
Onset 30-60 mins
Duration 8-12 hrs
Dose 2-10mg max 30mg/day
Adverse sedation, rarely ventricular tachyarrhythmias, prolonged QT
Nozinan
Methotrimeprazine - tx of delirium
Alters effects of dopamine in CNS, alpha antagonist also
Onset 30 mins
Duration 4 hours
Dose 10-20 mg q3h
Adverse bradycardia, orthostatic hypotension, sedation, seizures
Nitroglycerin
Vasodilation- covers to NO and effects vascular smooth muscle, causing primarily venous dilation reducing preload and therefore decreases myocardial workload, minor arterial vasodilation dec afterload and coronary vasodilation increasing myocardial oxygen supply
Onset 1-3 mins
Duration 3-5 mins IV, 30-60 mins sublingual
Dose IV infusion 5mcg/min, increase q3-5 mins based on response to 20mcg/min, then increase by 10-20mcg/min q3-5 mins. Max 200mcg/min. Dose based on hemodynamic response.
Adverse hypotension and dec CO
