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Meds Flashcards

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1
Q

What is the concentration for Amiodarone?

A

900 mg/500 ml = 1.8 mg/ml

450 mg/250 ml = 1.8 mg/ml

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2
Q

Amiodarone MOA

A

Amio = Antiarrhythmic

— acts to relax the smooth muscle that line the vascular wall

— Increases Cardiac Index by a small amt

— Decreases peripheral vascular resistance (afterload)

— Also decreases cardiac conduction by blocking certain electrical signals in the heart

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3
Q

Amiodarone Dose (gtt)

A

— First 6 hrs = 1mg/min

— Next 18 hrs = 0.5mg/min

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4
Q

Amiodarone treats:

A

— V-tach

— V-fib

— A-fib

— Wide complex tachycardia

— Paroxysmal SVT

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5
Q

Amiodarone Code Blue Dose

for V-tach/V-fib

A

— 1st dose = 300mg rapid bolus

— persistent VT/VF = 150mg

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6
Q

Epinepherine MOA

A

AKA = Adrenaline

— Enhances myocardial contractility (inotrope)

— Increases HR (chronotrope)

— Increases venous return

= RESULTS in increased CO and BP

— Also increases metabolism and glucose

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7
Q

Epinepherine Treatment

A

Cardiogenic and Anaphyplactic Shock

= b/c it increases BP, HR & airflow thru the lungs via bronchodilation

(b/c it hits X3 receptors, lacks sensitivity - more Beta and Beta 2 than Alpha)

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8
Q

Epinephrine Gtt Concentration

A

4mg/250ml = 16mcg/ml)

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9
Q

Epinephrine Gtt Dose

A

2-10 mcg/min

(reminder: push dose the same 2-10 mcg)

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10
Q

Epinephrine how to mix & push dose

A

Push dose 2-10 mcg q 2-5 min

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11
Q

Esomolol MOA

A

By blocking the adrenergic activity of epinephrine and norepinephrine, it decreases inotropic contractility, heart rate, and conduction.

Esmolol increases atrioventricular refractory time, decreases oxygen demand of the myocardium, and decreases atrioventricular conduction.

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12
Q

Esmolol Treatment

A

Will decrease HR and BP

— AAA, high BP and HR during surgery

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13
Q

Esmolol Concentration

A

2.5grams/250ml = 10mg/1ml

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14
Q

Esmolol Gtt Dose

A

5-200mcg/kg/min

(titration up/down by 2.5mcg)

Short-acting BB

— Onset: 1-2 min

— Peak: 5 min

— ½ life: 9 min

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15
Q

Diltiazem MOA

A

aka Cardizem - CCB/Antihypertensive

—diltiazem inhibits the inflow of calcium ions into the cardiac, smooth muscle during depolarization. Reduced intracellular calcium concentrations equate to increased smooth muscle relaxation resulting in arterial vasodilation and, therefore, decreased blood pressure.

Heart rate—It is also considered a rate-control drug as it reduces heart rate. Diltiazem is exerts hemodynamic actions by reducing blood pressure, systemic vascular resistance, the rate-pressure product, and coronary vascular resistance while increasing coronary blood flow.

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16
Q

Diltazem Treatment

A

= diltiazem works by inhibiting the movement of calcium ions across cardiac (heart) muscle and the smooth muscle lining blood vessel walls. This effect dilates (widens) blood vessels, reducing how hard the heart has to work to pump blood around the body, which reduces blood pressure.

— Incerased BP, Angina

— A-fib RVR (effective f/ initial ventricular rate control)

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17
Q

Diltiazem Gtt Concentration

A

125mg/125ml = 1mg/1ml

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18
Q

Diltiazem Gtt Dose

A

5-15mg/hr

(Titrate up/down by 5mg)

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19
Q

Dopamine MOA

A

— Inotrope (improves contractility)

to treat the symptoms of low blood pressure, low cardiac output, and improves blood flow to the kidneys

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20
Q

Dopamine Tx

A

Dopamine is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to:

— myocardial infarction (cardiogenic shock)

— trauma

— endotoxic septicemia

— open-heart surgery

— renal failure

— and chronic cardiac decompensation as in CHF

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21
Q

Dopamine Concentration

A

400 mg/250 ml = 1600 mcg/ml

800 mg/250 ml = 3200 mcg/ml

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22
Q

Dopamine Gtt Dose

A

2-20 mcg/kg/min

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23
Q

Dobutamine MOA

A

Dobutamine directly stimulates beta-1 receptors of the heart to increase myocardial contractility and stroke volume, resulting in increased cardiac output.

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24
Q

Dobutamine Tx

A

— Cardiogenic Shock

— Severe Heart Failure - cardiac decompensation d/t depressed myocardial contractility

— Decreased CO

— may help with CHF

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25
Dobutamine Gtt Concentration
500 mg/250 ml = 2mg/ml
26
Dobutamine Gtt Dose
2-20 mcg/kg/min
27
Ketamine MOA
= a dissociative anesthetic Anes to induce and sustain decreased LOC/sedation and tx pain
28
Ketamine Tx
— Induction & general anesthesia — pain control — status epilecticus — also used in shock cases b/c it provides cardiac stimultation
29
Ketamine Gtt Concentration
Gtt 100 Mg/1ml = 1mg/1ml (vial 500mg/10ml = 50mg)
30
Ketamine Gtt Dose
Non-wt based = 10-40 mg/hr — check on this dosage but also the wt based dose 0.5-6 mg/kg/hr — titration by 0.5
31
Ketamine IVP
How to make: — Vial: 500 mg/ 10 ml = 50 mg/1ml = IVP LOCATION = — Pull from Bag: 100mg/100ml…check on how to pull from a bag IVP Amt = 25-50mg
32
Ketamine Induction dose
1-2mg/kg IVP | (followed by 0.5mg/kg g5 min IVP)
33
Nicardipine (Cardende) MOA
CCB that works to relax blood vessels so blood can flow more easily —\> potent vasodilator —\> produces selective responses in the coronary vs the systemic vascular system. = Decreases BP
34
Nicardipine (Cardene) Tx
— AAA — Systolic HF — Hypertensive encephalopathy — Intracerebral hemorrhage (½ agents preferred for) — Pre/Eclampsia
35
Nicardipine (Cardene) Gtt Dose
5-15 mg/hr (titrate up/down by 2.5) (boluses 100mcg) Rapid Acting Anti-Hypertensive: — Onset: 1-2 min — ½ Life: 40 min
36
Nicardipine (Cardene) Gtt Concentration
25mg/250 ml = 0.1 mg/ml When mixing bag: 25mg/10ml vial goes into 25mg/250ml
37
Levophed (Norepinepherine) MOA
— Potent vasocontstrictor = Inc’ed BP — mild inotrophy for a little extra sqeeze = why it’s a first line medication
38
Levophed (Norepinepherine) Tx
— Hypotension (that don’t respond to fluids) — Brady — 1st line for Sepsis — Cardiogenic and hypoveolemic shock \*\*\*\* Med works better @ a 7.2 pH and above \*\*\*\*
39
Levophed (Norepinerpherine) Gtt Concentration
4mg/250ml = 16 mcg/ml 8mg, 16mg and 32mg for extra concentration
40
Levophed (Norepinepherine) Gtt Dose
2-20 mcg/min Onset: 1-2 min ½ Life: 3 min Duration; 5-10 min
41
Nitroglycerin MOA
Decreases the work of the heart with increased blood flow to it. 1. Vasodilator: — relaxation of the smooth muscles, causing arteriolar and venous dilation = causing relaxative with increased blood flow to veins, arteries and cardiac tissue — reduces cardiac preload and afterload — reduces Coronary artery spasm, decreasing SVR as well as decreasing SBP/DBP
42
NItroglycerin Tx
-Chest pain — HTN — Control HF — CHF Exacerabations
43
Nitroglycerin Gtt Concentration
50mg/250ml = 200mg/1ml
44
Nitroglycerin Gtt Dose
5-60 mcg/min MAX: 200mcg/min Onset: ½ life: duration:
45
Nitroprusside (Nipride) MOA
Vasodilator = Decreases BP — powerful vasodilator for afterload reduction that relaxes the vascular smooth muscle and produce dilitation of peripheral arteries and veins
46
Nitroprusside (Nipride) Tx
— HTN — manage acute HF — HTN Emergency — Acute mitral regurg — induce controlled hypotension
47
Nitroprusside (Nipride) Gtt Concentration
50 mg/250ml = 200 mcg/1 ml
48
Nitroprusside (Nipride) Gtt Dose
0.5 - 5.0 mcg/kg/min MAX: 10 mcg/kg/min (short-term)
49
How long does it take for Succinylcholine (paralytic) to take effect?
45 seconds
50
Succ's contraindications:
– Increased K+ – Caution with burn pt's
51
How long does it take for Vecuronium (paralytic) to take effect?
2-3 min
52
How long does it take for Ketamine as an induction dose to take effect?
2 min
53
Ketamine induction dose:
1-2 mg/kg vial = 500mg/10ml
54
Propofol Induction Dose:
(reduced dose of) 0.5-1mg/kg 20 ml…no mg listed…..
55
Agents of Induction available:
Ketamine - 1st line Etomidate - 2nd line Propofol
56
Ketamine induction dose:
1mg/kg IV/IO
57
Etomidate induction dose:
0.3 mg/kg IV vial = 20mg/10ml = 2mg/1ml
58
Succ's induction dose:
1.5 mg/kg IV/IO vial = 200mg/10 ml = 20mg/ml
59
Vec induction dose:
0.1 mg/kg IV/IO vial = 10mg/10ml = 1mg/1ml
60
What's the sequence for induction meds?
IVP sedation first then paralytic immediately after
61
Ketamine MOA
**Sedation, amnesia, anxiolytic and sympathomimetic** – rapid onset, short half-life – increases cardiovascular and CBF – protective airway reflexes left intact
62
Meds that lower BP:
— Labetalol * — Nicardipine — Propanolol (need to request) — Nimodipine (need to request)
63
Labetolol dose
10-40mg IV — wait 20 min b/t doses (may also serve to stabilize arrythmias of brain injury pts)
64
Propanolol dose
1mg q6 hrs IV — Penetrates BBB — Controls neuro storming in stroke and TBI
65
Nicardipine dose
— 5-15 mg/hr — 100 mcg boluses
66
Nimodipine usage and dose
For intracranial vasospam (doesn’t stop them but helps) — anueurysmal dz — 60 mg PO q4hrs for 14-21 days
67
Regarding ACS, preferred first line induction med for mech vent is \_\_\_\_\_\_\_\_\_\_\_.
Etomidate
68
Which induction med to avoid in ACS patients?
Ketamine— Increases metabolic demand, Inc HR and BP (avoid specifically in MI/Heart Failure; neg inotrope)
69
Which med specifically to use caution with in an ACS pt d/t hypotension:
Propofol
70
Which induction/anesthesia meds are OK to use in ACS pt’s?
Versed (benzo = cardiac stable) Fentanyl or Precedex (watch out for Brady/hypoT with precedex though)
71
First line pressor for Cardiogenic Shock:
Norepinepherine 5-20 mcg/min Start at 5mcg/min increase by 2-5mcg/min q15 min titrate to MAP \>65mmHg
72
Cardiogenic Shock preferred Inotrope:
Dobutamine 1-40 mcg/kg/min Start at 1mcg/kg/min increase by 2-5 mcg q15 min
73
What meds in the allowance standard increase BP (hypotensive vasodilators)?
74
What meds in the allowance standard decrease BP?

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