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Drugs to KNOW Flashcards

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1
Q

Adenosine) class:

Dynamics:

A

= Misc antiarrhythmic binds to adenosine A1 receptors causes efflux of K & inhibits Ca influx (in autoarhythmic cells)
= Causes hyperpolarization of autorhythmic cells (SA/AV node)
Slows AV conduction w/ very short half-life

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2
Q

Adenosine) indications:

contraindications

A

= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB)
= Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER

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3
Q

Adenosine) Effects:
Dose:

admin notes:

A

= periods of sinus Bcardia/asystole & ventricular ectopy after admin
= 1st dose 6mg rapid IV/IO push followed w/ rapid flush &2nd dose 12mg also rapid push & flush
= rapid push followed by rapid flush 20mL fluid best accomplished w/ 3-way stopcock & 1/2 initial dose in PTs receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access

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4
Q

Amiodarone) Class:
Dynamics:

Indi:

B/c its toxicity indi:
W/ expert consultation may be used for:
Terminal elimination:

A

= Class III antiarrhythmic
= Slows K+ efflux delaying repolarization on all of heart
= VF/Pulseless VT-no/response to shock CPR & Epi, Recurrent hemodynamically unstable VT w/ pulse
= PT w/ life-threatening arrhythmias w/ monitoring
= some atrial & ventricular rhythms w/ life-threatening hypoBP
= Extremely long (half-life lasts max 40 days)

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5
Q

Amiodarone) Contra:
Effects:
Caution b/c:

A

= Allergic, Bradycardias w/ AV blocks, Breastfeeding mothers
= Severe hypotension, Bradycardia, Prolong QT which can lead to TdP
= Toxicity, Causes severe BP drop, Prolong QT which can lead to TdP

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6
Q

Amiodarone) Max total dose per day:
Slow Infusion dose:
Maintenance Infusion dose:
VF/Pulseless & VT Cardiac Arrest Unresponsive 1st Dosage:
VF/Pulseless & VT Cardiac Arrest Unresponsive 2nd Dosage:
Life-Threatening Arrhythmia 1st Dosage:
Life-Threatening Arrhythmia 2nd Dosage:

A

= 2.2 grams
= 360 mg IV 6Hrs (1mg/min)
= 540 mg IV 18Hrs (0.5 mg/min)
= 300 mg IV/O push
= 150 mg IV/O push if needed
= 1st Dose: Rapid Infusion 150 mg/10 mins (15 mg/min)
= 2nd Dose: 150mg/10 mins (15 mg/min) if needed

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7
Q

Aspirin) Class:
Dynamics:

A

= NSAID & COX inhibiter
= Blocks cyclooxygenase (enzyme that’s basically alarm bell for body)
COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot

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8
Q

Aspirin) indications:
Contraindications:

A

= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema

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9
Q

(Aspirin) effects:
Avoid:
dose:

A

=Can cause bromchoconstriction in ~10% asthmatic PTs, N/V, upset GI
= enteric-coated Aspirin when admin/ing to PT w/ cardiac S/S
= 160-325mg PO of non-entric coated ASA

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10
Q

Atropine) class:
Dynamics:

A

= parasympatholytic
= selectively blocks muscarinic receptors inhibiting the parasympathetic NS “Vagus N. Blocker”- letting sympathetic take over

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11
Q

Atropine) indications:

Contraindications:
Avoid:

A

= 1st med/ for symptomatic sinus Bcardia, Maybe beneficial AV block, Organophosphate poisoning (large dose r/q) hypothermic Bcardia
= Allergic to drug, Use w/ extreme caution w/ myocardial ischemia
= causes increased myocardial O2 demand so caution w/ Hblock & Doses <0.5mg may result in paradoxical slowing of the heart
May not be effective for infranodal blocks- be prepared to pace

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12
Q

Atropine) Adverse effects:
Bradycardia (w/ or w/o ACS) Dosage:
severe clinical conditions dosage:
organophosphate poisoning dosage:

A

= Blurred vision, Dry mouth, Dilated pupils, Confusion
=1 mg IV push every 3-5mins as needed (0.04mg/Kg (total 3mg)
=1 mg IVP every 3 mins
= 2-4mg (or higher) IVP

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13
Q

Calcium Chloride) class:
Dynamics:

A

= mineral & electrolyte
= role as electrolyte in body to help propagate nerve impulses & M. Contraction

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14
Q

Calcium Chloride) indications:

Contraindications:

A

= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem
= cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD

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15
Q

Calcium Chloride) effects:

Dose:
Hypotension following admin/ Diltiazem:

A

= Bcardia w/ rapid injection, May produce severe coronary spasm & asystole, Burning sensation @ site of admin/, PERCIPITATE w/ Na-Bicarb
= 0.5-1gram slow IV over 3-5mins
= 250-500mg

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16
Q

Diltiazem/Cardizem)class:
pharmacodynamics:

A

= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels

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17
Q

Diltiazem/Cardizem)indi/s:

Contraindications:

A

= 1st med for AFib/Flutter w/ RVR (>150bpm), 2nd med for SVT refractory to Adenosine
= hypoBP, CHF/cardio/shock, Wide-complex Tcardia, WPW, Hypersensitivity

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18
Q

Diltiazem/Cardizem)effects:
1st dose:
2nd dose:

A

= HypoBP, Pos/ CHF if used w/ beta-blockers , N/V/D, Dizziness, H/A
= 0.25mg/kg w/ max dose of 20mg
= 0.35 mg/kg w/ max dose of 25mg

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19
Q

Dopamine) class:
pharmacodynamics

A

= sympathetic agonist
= A/B agonist rate dependent vasopressor +chron/in/Drom/otropic

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20
Q

Dopamine) indications:

Contraindications:

A

= CHF, HypoBP w/ shock signs, 2nd med for sympathetic Bcardia (after Atropine)
= hypovolemic PTs til’ vol/ replaced, pheochromocytoma, Dont mix w/ sodium bicarb

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21
Q

Dopamine) Effects:

Dosing:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:

A

= HyperBP, Palp/s, H/A, Dizzy, Can worsen C-ischemia, necrosis W/ Extravasation
= 2–20 mcg/kg/min Titrate to response
= 5-10mcg/kg/min
= 10-20 mcg/kg/min

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22
Q

Epinephrine 1:10) Class:
Dynamics:

A

= SNS agonist, Sympathomimetic
= Powerful Alpha and Beta agonist

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23
Q

Epinephrine 1:10) Effects:

(Adult) Cardiac Arrest dose:
(Adult) Bradycardia dose:
(PEDI) Bradycardia/Cardiac Arrest dose:
(PEDI) Hypoperfusion & Severe anaphylaxis dose:

A

= Palpitations, Anxiety, Jitters, H/A, Dizziness, HyperBP, Tcardia, Can worsen cardiac ischemia
= 1mg IVP/IOP every 3-5 mins
= 2-10 mcg/min IV/IO infusion
= 0.01 mg/kg or 0.1 mL/kg
= 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag

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24
Q

Epinephrine 1:10) Indications:
Contraindications:

A

= Cardiac arrest, Bcardia, Normovolemic hypoBP, Anaphylaxis, Asthma
= rewards over risks so really none

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25
Fentanyl) class: pharmacodynamics: Potency:
= synthetic narcotic (schedule 2 opioid) = opioid Analgesia & sedation through binding to opiate receptor = Fentanyl > morphine (100mcg fentanyl = 10mg of Morphine) 1F = 10M
26
Fentanyl) indications: Contraindications:
= Moderate to severe pain =Hypersensitivity to med, Uncorrected SBP<90
27
Fentanyl) effects: dose: Admin notes:
= Resp/ arrest/depres/, AMS, Bcardia & Prolong of QT interval, +vagal tone b/c suppress/ sympathetic path/s, HypoBP, N/V = 1mcg/kg IV/O(max 100mcg) may repeat PRN in 5-10mins (Max 1mL per nare) if admin/ed IN = Chest wall rigidity so admin slowly, Depresses every- thing/where
28
Furosemide/Lasix) class: pharmacodynamics:
= Loop diuretic = Blocks absorption of Na, Cl, & water from kidney thus +urinination
29
Furosemide/Lasix) indications: Contraindications:
= Acute pulmonary edema in PTs w/ SBP >90-100mmHg (w/o signs of shock) Hypertensive emergencies = Hypovolemia Hypotension Hypokalemia or other suspected electrolyte abnormalities
30
Furosemide/Lasix) effects Adult Dose: intial dose doesnt work: new-onset pulmonary edema w/ suspected hypovolemia:
= pos/ dehydration/acute electrolyte imbalance, Tinnitus/deaf = 0.5-1 mg/kg over 1-2 mins. IVP = double 1st dose to 2 mg/kg over 1-2 mins = <0.5mg/kg slow IV
31
Glucagon) class: pharmacodynamics:
= Hormone = Binds to Glucagon receptors & stim/s adenyl cyclase & +cAMP thus an up-reg/ Ca channels in SA & AV nodal cells
32
Glucagon) cardiac indications: Contraindications:
= Bradycardia suspected from Beta-Blocker or Ca-Channel Blocker OD = Bradycardia from etiology (disease origin), Known hypersensitivity
33
Glucagon) effects Dose:
= Anxiety, Chest palp/s, H/A, N/V, Hyperglycemia = 3-10mg IV slowly over 3-5 mins Followed w/ infusion 3-5mg per hour
34
Lidocaine) Class: Dynamics:
= Ib Antiarrhythmic = Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity in ventricles
35
Lidocaine) Ind: Contra: Effects:
= Stable monomorphic VT w/ preserved LVF & Alternative to Amiodarone in cardiac arrest by VF/pVT = Shouldn’t use if PT already received IV Ca channel blockers, Not given prophylactically in AMI setting = Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
36
Lidocaine) Max dose: Cardiac Arrest from VF/pVT dose: Refractory VF dose: Perfusing Arrhythmia dose: Maintenance Infusion dose:
= 3 mg/kg = 1-1.5 mg/kg IV/IO = may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins = may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins = 1-4mg/min (30-50 mcg/kg/min)
37
Mag-Sulfate) Class: Dynamics:
= Misc. Airway med, Mineral, powerful noradrenergic bronchodilator = Organic Salt act as a physiologic Ca-channel blocker Bronchodilator
38
Mag-Sulfate) Indi: Contra: Effects:
= cardiac arrest only if Torsades de Pointes (Tdp) suspected, Tdp w/ pulse = AMI not recommended, High degree AV block, HypoBP, VFib/Tach = Bcardia, HypoBP, Diaphoresis, Resp/ depres/, Hypothermia
39
Midazolam) class: pharmacodynamics:
= benzodiazepine = Binds w/ GABA receptors causing an influx of chloride
40
Midazolam) indications: Contraindications:
= Active seizures, RSI induction, Chemical restraint, Anxiety, Sedation = History of hypersensitivity to drug
41
Midazolam) effects
= Hypotension, Respiratory depression/apnea, N/V Amnesia
42
Midazolam) Adult dose (active seizures): Pediatric dose (active seizures) IV/O: Pediatric dose (active seizures) IM/IN: Adult & Pedi dose for induction agent (RSI): ET Tube bucking:
= 0.1mg/kg in 2mg increments IV/IO (max 5mg) → 5mg IM/IO = 0.1mg/kg in 2mg increments IV/IO (max 5mg) = 0.2mg/kg (max 5mg) = 0.1-0.3mg/kg (max 10mg), Onset=2-5mins, Duration= 15-30mins = 0.05mg/kg IV/IO 1-2mins (maintain SBP) stop when bucking stopped
43
Morphine) class pharmacodynamics
= narcotic (schedule II Opioid) = Analgesia & sedation through binding to opiate receptor
44
Morphine) indications: Contraindications:
= Ischemic chest pain not relieved by Nitro = Known hypersensitivity to drug Uncorrected hypoBP (SBP<90)
45
Morphine) effects STEMI dose: NSTEMI-ACS dose:
= Resp/ depres/arrest, HypoBP, N/V/D = 2-4mg IV/O (slow) may admin/ addition/ 2-8mg IV 5-15min intervals = 0.1mg/kg IV/IO (slow) or IM up to 10mg
46
Nitroglycerin) class: pharmacodynamics:
= nitrate = Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
47
Nitroglycerin) indications: Contraindications
= Symptoms suggestive of Myocardial ischemia CHF = HypoBP (SBP<90 or >30 below baseline BP) Severe Bcardia<50bpm, Tcardia>100bpm, Use of phosphodiesterase inhibitors (Boner pills) in last 48 hours, Increased ICP
48
Nitroglycerin) effects: dose:
=H/A, Dizziness, Weakness, Tcardia, HypoBP (tablets lose effectiveness after exposed to sun/air) = 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg DONT SHAKE SPRAY B/C AFFECTS DOSE
49
NORepi) Class: dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med” = A/B-adrenergic agonist (A effects > B effects)
50
NORepi) Indi: Contra: Effects:
= Normovolemic hypotension, Septic shock, Cardiogenic shock = hypovolemia PTs til’ Vol/replacement occurred = Hypertension, Organ ischemia, Cardiac arrhythmia, Tissue necrosis w/ extravasation, Palpitations, Anxiety, N/V
51
NORepi) Adult Dose: Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion = 0.1–2 mcg/kg/min IV/IO infusion
52
Ondansetron) class: pharmacodynamics:
= selective Seratonin 5-HT3 receptor blocker/antagonist = Serotonin 5-HT3 receptors @the vagal-N. Can initiate the gag reflex when stim/ed; Zofran is antiemetic/antag/ of 5-HT3 receptors inhibiting serotonin release on central/peripheral vagal nerve
53
Ondansetron) indi/s: Contra:
= Prevent/control N/B = Known hypersensitivity to med
54
Ondansetron)effect: dose:
= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT = 4-8mg IV (slow), IM, PO
55
Procainamide)class: Dynamics:
= 1a antiarrhythmic = Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
56
Procainamide) indications: Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW) =Shouldn’t admin to PTs received IV Ca channel blocker
57
Procainamide)effect: 4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP 1. Termination of rhythm 2. HypoBP 3. Widening QRS>50% 4. Meet the max total dose (17mg/kg)
58
Procainamide) max dose: Recurrent VF/VT: Urgent situations: Maintenance Infusion:
= (max total dose: 17mg/kg) = 20mg/min (max total dose: 17mg/kg) = up to 50mg/min may admin/ to total dose (max 17mg/kg) = 1-4mg/min
59
Verapamil) class: pharmacodynamics:
= IV antiarrhythmic Ca channel blocker = Slows AP of autorhythmic cells in heart by blocking Ca channels
60
Verapamil) indications: Contraindications:
= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function = HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW Hypersensitivity to med
61
Verapamil)1.May cause: 2. Effects: 3. Max total dose: 4. 1st dose: 5. 2nd dose:
1.= more profound hypotension response than that of Diltiazem 2.= Severe CHF may result if used w/ beta-blocker, N/V/D, Dizziness, H/A 3.= 20mg 4.=2.5-5mg IV/O bolus 2-3min 5.= 5-10mg over 2-3 mins
62
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71
Propranolol, Labetalol, Metoprolol) class Labetalol Metoprolol
= class 2 Beta Blockers = 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT's w/elevated HR, Antihypertensive = Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
72
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers = Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF = V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
73
Amiodarone class & indication
Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse
74
Procainamide)effect: 4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP = 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose
75
Promethazine (Phenergan) Dynamics: Indications: Contra: Dose:
=Antiemetic. H1-receptor blocker =Nausea & Vomitinf, Peroperative sediation, motion sickness. = Hypersensitivity, Respiratory diseases(Asthma), Pedi <2 y/o = IV/IM: 12.5-25 mg, May cause tissue injury if IV extravasation.
76
Adenosine & Digoxin class
class misc
77
DIgoxin for
heart failure usually fools refractory Na K pumps
78
Diltiazem & Verapamil) class Diltiazem Verapamil
= class 4 Ca channel blocker = 1st line med for A-Fib/Flutter w/ RVR >150 bpm, 2nd line med for SVT refractory to adenosine = 2nd line med for A-Fib/Flutter w/ RVR. May use as alterative after adenosine, narrow QRS complex tachycardia w/ preserved LV fn.
79
Adenosine) class: Dynamics:
= Misc antiarrhythmic binds to adenosine A1 receptors causes efflux of K & inhibits Ca influx (in autoarhythmic cells) = Causes hyperpolarization of autorhythmic cells (SA/AV node) Slows AV conduction w/ very short half-life
80
Adenosine) indications: contraindications
= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB) = Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER
81
Adenosine) Effects: Dose: admin notes:
= periods of sinus Bcardia/asystole & ventricular ectopy after admin = 1st dose 6mg rapid IV/IO push followed w/ rapid flush &2nd dose 12mg also rapid push & flush = rapid push followed by rapid flush 20mL fluid best accomplished w/ 3-way stopcock & 1/2 initial dose in PTs receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access
82
Aspirin) Dynamics: Indications: Contra: Dose:
= Blocks Cyclooxygenase (enzyme body alarm). COX acts upon Arachidonic Acid which inturn gen/s Thromboxane A2, a compound that reg/s activation of platelets to form a clot. = Cardiac signs/symptoms with ischemic etiology /suspected MI = Allergy to medication. Bronchospasm, Angioedema. =160-325 mg PO of nonenteric coated ASA.
83
Ibuprofen) Dynamics: Indications: Contra: Dose:
= Anti-inflammatory & antipyretic via inhibition of prostaglandins. = Mild - moderate pain, Fever, Inflammation. = Hypersensitivity, Bronchospasm, Angioedema. = 200-800 mg PO q6-8 hours, Max daily dose: 3200 mg
84
Ketorolac (Toradol) Dynamics: Indications: Contra: Dose:
= Anti-inflammatory & antipyretic through inhibition of prostaglandins = Mild-moderate pain, Fever, Inflammation, Renal calculi = Hypersensitivity, Bronchospasm, Angioedema = 15mg IV, 30mgIM
85
Nubain) Dynamics: Indications: Contra: Dose:
= Synthetic opiate agonist/antagonist = Moderate to severe pain = Hypersensitivity, respiratory depression. = 10-20 mg IV/IO/SQ/IM
86
Diazepam) Dynamics: Indications: Contra: Dose:
= Benzodiazepine Binds with GABA receptors causing an influx of Cl = TachyC from stimulant OD, Sustained seizure, Anxiety, Sedation, = Hypersensitivity = 2.5-10 mg in 2.5 mg increments slow IV/IO/IM.
87
Flumazenil) Dynamics: Indications: Contra: Dose:
= Benzodiazepine Antagonist = Competitively blocks benzos @ GABA/benzo receptor complex = Benzodiazepines overdose = Hypersensitivity = 0.2 mg IV/IO q30 seconds Max up to 3 mg total dose
88
Magnesium Sulfate) Dynamics: Indications: Contra: Dose:
= Organic Salt act as a physiologic Ca channel blocker = Bronchial Asthma, Torsades de Pointes (TdP) w/ or w/o a pulse, Eclampsia w/ active seizures = Routine admin in PT's w/AMI not recommended, High-degree HB, Shock, Dialysis, Hypocalcemia, V-fib/pulseless V-Tach, = Respriatory: 1-2 grams IV/IO over 10-20 minutes Tdp w/pulse: 1-2 grams mixed in 50-100 mL over 5-60 minutes Cardiac arrest due to hypomagnesemia or TdP: 1-2 grams in 10 mL Eclampsia: 1-4 grams
89
Metoprolol) Dynamics: Indications: Contra: Dose:
= ß-Blocker = Hypertension, 2nd line med for A-Fib or A-Flutter w/ RVR, & SVT = HR<45, 2nd or 3rd degree heart block = 5 mg IV/IO q 5 min (up to 3 doses)
90
Cardioversion/vert) Indication Rhythms intial & after Doses:
= UNSTABLE} SBP <90 & AMS = Bradycardia, AF w/ SVR, = 50-100J then 200J 300J 360J
91
Defib) indication Contra: Rhythms Initial & after doses:
= "Dead fibers" TdP (only rhythm defib awake) = Asystole VT w/ Pulse stable = pVT, VF, TdP = 100J 200J 300J 360J
92
Pacing) indication Rhythms Initial & after:
= "pick up the pace" <50BPM UNSTSBLE} SBP <90 & AMS = BPM <50 = 80BPM mA till' capture
93
2-20mcg cardiac vasopressor meds:
Dopamine, Epi 1:10 (adult brady),
94
Monophasic monitor Jules max Biphasic monitor Jules max
360J 200J
95
0.1 - 0.5 mcg/kg/min vasopressor med:
Norepi,
96
Vasopressor meds:
= Epi 1:10, NorEpi, Dopamine
97
Antiarrhythmics for pVT, TdP, VF
pVT/ TdP= Lidocaine & Aminodarone Tdp= Mag-Sulfate
98
1st line med for A-Fib&Flutter w/ RVR & 2nd line med for SVT that is refractory to adenosine.
Diltiazem 0.25mg/kg (max 20mg) 0.35mg/kg (max 25mg)

Cardiology (20 decks)

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