Medications for Cardiac Related Complaints

Question 1

lidocaine 2%

Answer 1

A local anesthetic and CLASS IB ANTIARRTHMIC that blocks sodium channels, therefore, increasing the recovery period after repolarization and suppressing automaticity in the His-Purkinje system and depolarization in the ventricles.

Question 2

lidocaine 2% Indications

Answer 2

Analgesic for intraosseous infusion, an alternative to amiodarone in ventricular fibrillation or pulseless ventricular tachycardia, and stable monomorphic ventricular tachycardia.

Question 3

lidocaine 2% Adverse Effects

Answer 3

Seizures, drowsiness, tachycardia, bradycardia, confusion, and/or hypotension.

Question 4

lidocaine 2% Adult Dosage and Administration

Answer 4

Cardiac Arrest from ventricular tachycardia or pulseless ventricular tachycardia:
1-1/5 mg/kg IV

Perfusion Dysrhythmia (stable ventricular tachycardia)
0.5-0.75 mg/kg every 5-10 minutes with a max total dose of 3 mg/kg

Question 5

lidocaine 2% Special Considerations

Answer 5

Lidocaine is metabolized by the liver. Those with liver disease or poor liver perfusion secondary to shock or congestive heart failure are more likely to experience side effects.

Question 6

magnesium sulfate

Answer 6

an ELECTROLYTE that reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction. It stabilizes the potassium pump, correcting repolarization, and shortens the Q-T interval in the presence of ventricular arrhythmias due to drug toxicity or electrolyte imbalance.

Question 7

magnesium sulfate Indications

Answer 7

Antiarrhythmic: Torsade de Pointes associated with prolonged QT interval.

Respiratory: Severe bronchospasm unresponsive to continuous albuterol, ipratropium, and IM epinephrine.

Obstetrics: Eclampsia: Pregnancy greater than 20 weeks gestational age or post-partum with seizures.

Question 8

magnesium sulfate precautions

Answer 8

Bradycardia, hypotension, and respiratory depression.

Question 9

magnesium sulfate Adverse Reactions

Answer 9

Bradycardia, hypotension, and respiratory depression.

Question 10

magnesium sulfate Dosage and Administration

Answer 10

Torsades de Pointes (caused by prolonged QT interval):
Adult - 2 g IV bolus
Pediatric - not indicated

Question 11

nitroglycerin

Answer 11

An ANTIAGINAL AGENT that relaxes vascular smooth muscle thereby dilating peripheral arteries and veins causing pooling of venous blood and decreased venous return to the heart which then decreases preload. Also reduces left ventricular systolic wall tension which decreases afterload.

Onset = 1-3 minutes
Duration = 20-30 minutes

Question 12

nitroglycerine Indications

Answer 12

Pain or discomfort due to suspected Acute Coronary Syndrome.
Pulmonary edema due to congestive heart failure.

Question 13

nitroglycerine Contraindications

Answer 13

Suspected right ventricular ST-segment elevation MI (inferior STEMI) pattern plus ST elevation in right-sided precordial leads.
Hypotension (less than 100 systolic).
Recent use of erectile dysfunction medication.

Question 14

nitroglycerine Adverse Reactions

Answer 14

Hypotension, headache, and syncope

Question 15

nitroglycerine Dosage and Administration

Answer 15

Chest Pain:
0.4 mg sublingually or spray every 5 minutes as needed up to a total of 3 doses for persistent chest pain.

Pulmonary Edema: 0.4 mg sublingually or spray every 5 minutes as needed titrated to symptoms and blood pressure OR 1 inch of nitro paste on the patient’s left anterior chest for CHF/Pulmonary Edema.

Pregnancy Class C.

Question 16

adenosine (Adenocard)

Answer 16

A miscellaneous ANTIDYSRHYTHMIC, a naturally occurring nucleoside, used to treat STABLE, ATRIAL TACHYCARDIA by slowing electrical conduction through the AV node, decreasing the automaticity of the SA node.

Question 17

adenosine (Adenocard) Indications

Answer 17

Indications: Narrow-complex supraventricular tachyarrhythmia.

Question 18

adenosine (Adenocard) Contraindications

Answer 18

Contraindications: Sick sinus syndrome, second- or third-degree heart block, poison/drug-induced tachycardia, asthma or bronchospasm, wide or irregular tachycardia, and heart transplant patients.

Question 19

adenosine (Adenocard) Adverse Effects

Answer 19

Chest pain, shortness of breath, diaphoresis, palpitations, lightheadedness, and sense of impending doom.

Question 20

adenosine (Adenocard) Drug Interactions

Answer 20

Methylxanthines, such as caffeine, antagonize adenosine so a higher dose may be required.
Dipyridamole (Persantine) potentiates the effect of adenosine so reducing the dose may be required.
Carbamazepine may potentiate the AV-nodal-blocking effect of adenosine.

Question 21

adenosine (Adenocard) Dosing and Administration

Answer 21

Dosage:
Adult - 12 mg IV bolus rapid push followed by a normal saline flush. Contact base for an additional 12 mg IV bolus if no response is observed.

Pediatric - 0.1 mg/kg IV bolus (6 mg max) rapid push followed by a normal saline flush. An additional dose of 0.2 mg/kg (12 mg max) rapid push followed by a normal saline flush if no response is observed.

Pregnancy Class C.

Question 22

adenosine (Adenocard) Special Considerations

Answer 22

Typically causes short-lived but unpleasant chest discomfort. Always warn your patient before giving medication.
Use with caution in patients with pre-existing bronchospasm and those with a history of atrial fibrillation.
Older adults with no history of PSVT should be evaluated for dehydration and rapid sinus tachycardia requiring volume fluid replacement prior to adenosine.
Transient asystole and AV blocks are common at the time of cardioversion.
A 12-lead EKG should be performed and documented.
Adenosine is not effective in atrial flutter or fibrillation.
Adenosine is safe in patients with a history of Wolff-Parkinson-White syndrome if the rhythm is regular and the QRS complex is narrow.

Question 23

amiodarone (Cordarone)

Answer 23

a CLASS III POTASSIUM CHANNEL BLOCKER ANTIDYSRHYTHMIC showing class I, class II, class III, and class IV actions. The most major effect is class III which blocks potassium ion channels. This prolongs the cardiac action potential duration as well as the refractory period.

Question 24

amiodarone (Cordarone) Indications

Answer 24

Indications: Pulseless arrest in patients with shock refractory or recurrent ventricular fibrillation or ventricular tachycardia.
Wide complex tachycardia not requiring immediate cardioversion
May be helpful in rate control of supraventricular rhythms after ALL pharmacologic therapies have been ineffective.

Question 25

amiodarone (Cordarone) Contraindications

Answer 25

Contraindications: Second- or third-degree AV block and cardiogenic shock. Liver patients. Pregnancy.

Question 26

amiodarone (Cordarone) Adverse Reactions

Answer 26

Hypotension, Bradycardia

Question 27

amiodarone (Cordarone) Dosage and Administration

Answer 27

Dosage:

Adult Pulseless Arrest (Refractory ventricular tachycardia/ventricular fibrillation) -
300 mg IV bolus. Administer an additional 150 mg IV bolus in 3-5 minutes if shock refractory or recurrent VT/VF remains.
Symptomatic Ventricular Tachycardia and undifferentiated wide complex tachycardia with a pulse (contact base) -
150 mg bolus infusion over 10 minutes.

Pediatric (contact base) - 5 mg/kg IV bolus for pulseless arrest (refractory VT/VF).

Question 28

amiodarone (Cordarone) Special Consideration

Answer 28

A 12-lead EKG should be performed and documented when available. Amiodarone is preferred to adenosine for treatment of undifferentiated wide complex tachycardia with a pulse.

Question 29

atropine sulfate

Answer 29

An ANTICHOLINERGIC PARASYMPATHOLYTIC medication that competes with acetylcholine at the site of the muscarinic receptor.

Question 30

atropine sulfate Indications

Answer 30

Indications: Symptomatic bradycardia, nerve agent exposure, or organophosphate poisoning.

Question 31

atropine sulfate Precautions

Answer 31

Precautions: Acute myocardial infarction because you don’t want to stimulate the heart, myasthenia gravis, GI obstruction because a parasympatholytic will decrease the motility of the GI tract, closed-angle glaucoma because a parasympatholytic will increase intraocular pressure, known sensitivity to atropine, belladonna alkaloids, or sulfates.

Question 32

atropine sulfate Adverse Effects

Answer 32

Anticholinergic toxidrome in overdose - “blind as a bat, mad as a hatter, dry as a bone, red as a beet.” May cause paradoxical bradycardia if the dose administered is too low or if the drug is administered too slowly.

Question 33

atropine sulfate Dosage for Hemodynamically Unstable Bradycardia

Answer 33

0.5 mg IV bolus. Repeat at 3-5 minute intervals to a maximum dose of 3 mg.

Pediatric: 0.02 mg/kg IV bolus. Minimum dose is 0.1 mg, max dose is 0.5 mg.

Question 34

atropine sulfate Dosage for Poisoning/Overdose

Answer 34

2 mg/kg IV or IM for signs of moderate/severe toxicity. Contact base for additional doses.

Pediatric: Under 40 kg - 0.02 mg/kg IV/IM for moderate to severe toxicity. Minimum dose is 0.1 mg. Contact base for additional doses.

Question 35

atropine sulfate Special Considerations

Answer 35

The half-life is 2.5 hours. Atropine can be given in 2nd and 3rd-degree heart blocks however is found to be ineffective. Do not delay pacing in this patient if they are in peri-arrest when pacing is indicatded.

Pregnancy Class C.

Question 36

epinephrine (Adrenaline) Indications

Answer 36

Indications: Pulseless arrest, anaphylaxis, asthma, and bradycardia with poor perfusion.

Question 37

epinephrine (Adrenaline) Adverse Reactions

Answer 37

Tachycardia and tachydysrhythmia.
Hypertension
Anxiety
May precipitate angina pectoris.

Question 38

epinephrine (Adrenaline) for Pulseless Arrest

Answer 38

Adult:
1 mg (10mL of 1:10,000) IV bolus. Repeat every 3 compression cycles (every 6 minutes). After 3 mg, additional doses are not routinely recommended.

Pediatric:
0.01 mg/kg (0.1mL/kg of 1:10,000) IV. Repeat dose every 3-5 minutes

Question 39

epinephrine (Adrenaline) for Bradycardia

Answer 39

Adult:
Bradycardia with hypotension and poor perfusion refractory to other interventions: Continuous infusion titrated to effect.

Pediatric: (Contact Base)
0.01 mg/kg (1 mL/kg of 1:100,000) IV.

Question 40

epinephrine (Adrenaline) as a Vasopressor

Answer 40

Indications:
Severe allergic reaction/Anaphylaxis
Hypotension with poor perfusion refractory to adequate fluid resuscitation
Bradycardia with signs or poor perfusion.

Contraindications: DO NOT use a vasopressor infusion in pediatric patients under the age of 12.

Dosage and Administration:
Inject 1 mg epinephrine into 1000 mL normal saline to achieve 1 mcg/mL concentration.
This means 1 mL of 1:000 or 10 mL of 1:10,000 - either way, 1 mg of drug.
Use a MACRO drip set.

Adult IV: Begin infusion wide open to gravity to give small amounts of fluid. Typical volumes are less than 100 mL of total fluid. Titrate to desired hemodynamic effect with the goal BP of greater than 90 systolic, improved respiratory status (bronchodilation), and improved perfusion/mentation.

Pregnancy Class C.

Question 41

aspirin (ASA)

Answer 41

an ANTIPLATELET, nonnarcotic analgesic, and antipyretic that prevents the formation of a chemical known as thromboxane A2, therefore, inhibiting platelets from aggregating.

Question 42

aspirin (ASA) Indications

Answer 42

Symptoms of suspected acute coronary syndrome.

Question 43

aspirin (ASA) Adverse Effects

Answer 43

Anaphylaxis, angioedema, bronchospasm, bleeding, stomach irritation, nausea/vomiting.

Question 44

aspirin (ASA) Contraindications

Answer 44

Active GI bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children.

Question 45

aspirin (ASA) Dosage

Answer 45

324 mg (4 81 mg baby aspirin)

Question 46

aspirin (ASA) Special Considerations

Answer 46

Patients with suspected acute coronary syndrome taking anticoagulants can still be given ASA. Do not use enteric-coated ASA. Do not give to pediatrics due to the risk of Reye’s Syndrome.

Pregnancy Class D.