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Flashcards in Meds Deck (17):
1

What are the indications for sodium bicarb? and dosage

*Treats hyperkalemia, acidosis, drives K+ back into cells during periods of acidosis. Can use THAM too

Dosing: 5-10 mEq per unit

2

MOA for CaCl and indications for use and dosage

((Membrane stabilizer??))
Use calcium chloride for hypocalcemia due to hemodilution. Normal range Mike said is about 1.0, .07 would be considered low. They will give at the end of the case because it plays a big role in the coagulation cascade and has a positive inotropic effect for the heart. DO NOT GIVE UNTIL X CLAMP IS OFF 10 MINS!

Dosage: 0.5-1.0 gram

3

MOA for heparin and indications for use

MOA: Inhibits thrombosis, binds to ATlll activating this complex, inhibits conversion of prothrombin ll to thrombin lla. Inhibits fibrin stabilizing factor (Vlll).
Heparin is administered before CPB is initiated. Heparin is AT-lll dependent, so ATlll must be present for the inactivation to occur. If it's not you can give AT-lll (expensive) or ((plasma???))

4

MOA for Potassium Chloride and indications for use

Potassium: intracellular cation
Chloride: extracellular cation
MOA: Alters acid/base status. Regulates nerve conduction and muscle contraction in the heart.
Indications: Hypokalemia, arrest the heart

Should not be given to patients with renal failure or hyperkalemia

NOTE: When checking that first blood gas don't worry about a K of say 5.6 because you just have a lot of high K cardioplegia

Treatment for hyperkalemia:
*NaHCO3
*Polarizing agents (mag sulfate)
*Lidocaine

5

MOA of furosemide and indications for use and dosage

Furosemide/Lasix
MOA: Loop diuretic, inhibits reabsorption of water in the nephron by blocking the sodium/potassium/chloride cotransporter
Indications: Edema and hypertension

Dosage: 20-40 mg (single dose)

6

MOA of lidocaine and indications for use and dosage

Lidocaine/Xylocaine
MOA: Lidocaine works by depressing ventricular excitability and increasing stimulation threshold of the ventricle during diastole. Lidocaine is an antiarrythmic. Lidocaine doesn't affect SA node. Does not produce a decrease in cardiac contractile force or arterial pressure.
Indications: Local anesthetic and cardiac depressant, used as an anti arrhythmic agent.
Treats ventricular tachycardia

Dosage: 100mg (pre dosed vial is 100mg)

7

MOA of Magnesium sulfate and indications for use and dosage

MOA: Plays an important role in neurochemical transmission and muscular excitability. Produces vasodilation and lowers blood pressure
Indications: Helps stabilize the membrane, thereby preventing refractory ventricular fibrillation, refractory ventricular tachycardia or refractory ventricular ectopy.

Dosage: 1-2 gm

8

MOA of Mannitol and indications for use and dosage

Mannitol/Osmitrol
MOA: An osmotic diuretic that elevates blood plasma osmolarity, causes an increased flow of water from interstitial fluid and plasma, very effective oxygen radical scavanger

Indications: Increases patients urine output, cerebral edema, reduces elevated intraoccqular pressure, promotes urinary excretion of toxic substances

Dosage:
*12.5 gm/50 ml vial
*500ml (osmitrol 20%)
*100-250 ml in prime or during initiation of CPB (Some prime pump with this, keeps kidneys working)
*100 ml during reperfusion

9

MOA of Protamine Sulfate and indications for use

MOA: Reverses the effects of heparin by causing a breakdown of the heparin-antithrombin-lll complex

Indications: To reverse heparin

Adverse reactions: If rapidly administered (severe hypotension), bradycardia, anaphylactoid reactions

10

MOA Methylpednisolone Sodium Succinate and dosage

*Solumedrol
MOA: Potent anti-inflammatory steroid that inhibits leukocyte infiltration at the site of inflammation, interferes with mediators of inflammatory response, and suppresses humoral immune responses.

Indications: Given during circulatory arrest cases for cerebral protection, and heart transplants for immunosuppression (e.g. treatment for "fish allergy")

Dosage: Up to 1 gm

11

MOA Albumin and indications for use and dosage

Albuminar-5/25
MOA: Blood volume expander, albumin is an osmotically active protein that causes a temporary increase in blood volume. Infusion of albumin 5% is oncotically equivalent to human plasma of an equal volume by the amount infused. Give for a volume deficit.
Infusion of albumin 25% is oncotically equivalent to five times human plasma volume and increases blood volume by 3.5 times the amount infused. Give when an increase in osmotic or oncotic pressure is necessary.

Indications: Hypoproteinemia w/ w/o edema. Low concentration of plasma protein with resulting decreased blood volume, "third spacing"

Dosage:
*5% albumin-50ml/250ml/500ml
*25% albumin-50ml/100ml

12

MOA Aminocaproic acid and indications for use and dosage

*AMICAR
MOA: Inhibits fibrinolysis, binds with plasminogen, once bound, plasminogen cannot bind to fibrin and cannot activate plasmin, if plasmin cannot activate this equals no fibrinolysis (no clot breakdown)

Indications: Treatment for excessive postoperative bleeding

Adverse reactions: Bradycardia, hypotension, peripheral ischemia, thrombosis

Drug interactions: Should not be administered with factor IX complex concentrates or anti-inhibitor coagulant concentrates due to increased risk of thrombosis

Dosage:
*5-10 mg (75-150 mg/kg) over 15-30 mins
*10-15 mg/kg/hr

13

MOA of Antithrombin lll and indications for use and dosage

*Thrombate III
MOA: Vitamin K dependent enzyme that directly inhibits thrombin (inhibits thrombin equals no conversion of fibrinogen to fibrin equals no clot)
AT-lll is an alpha 2 glycoprotein present in human plasma

Indications: Treatment of antithrombin lll dependent heparin resistance requiring anticoagulation. Given on bypass when heparin is not providing a therapeutic effect. Heparin is antithrombin lll dependent (no ATlll equals no anticoagulation)

*comes direct from pharmacy, not in OR, too expensive

Dosage:
*IU = (desired-baseline AT-lll level) x wt (kg) / 1.4

14

MOA of Desmopressin Acetate and indications for use and dosage

*DDAVP
MOA: Imitates actions of ADH (antidiuretic hormone, aka vasopressin), stimulates water reabsorption in the kidneys, factor VIII activator, promotes the release of von williebrand factor which increases factor Vlll release in plasma and plasminogen activator equals a clot

Indications: Hemophilia A and von willebrand disease (type 1), used after bypass to decrease bleeding (anesthesia provides)

Contraindications: Known moderate to severe renal impairment

Dosage: 0.3 mcg/kg (diluted in 50 ml)

15

MOA of Factor Vlla and indications for use and dosage

*Novoseven
MOA: Recombinant human coagulation factor Vlla, initiates the conversion of thrombin to prothrombin equaling tissue factor cascade (aka extrinsic pathway), combines with tissue factor activating factors X to Xa and IX to IXa, factor Xa then converts prothrombin (factor ll) to thrombin (factor lla), leading to formation of a hemostatic plug by converting fibrinogen (factor l) to fibrin (factor la)

Indications: Treatment of bleeding episodes in patients with hemophilia A or B with inhibitors and in acquired hemophilia along with prevention of bleeding in surgical interventions or invasive procedures in these individuals, treatment of bleeding episodes in patients with congenital factor Vll deficiency and prevention of bleeding in surgical interventions or invasive procedures in these individuals

Dosage: 15-30 mcg/kg q 4-6 hours

*Said he never used it, very expensive, used when they can't stop bleeding

16

MOA of Methylene blue and indications for use and dosage

*Rember
MOA: Nitric oxide synthase inhibitor used to treat methemoglobinemia, chocolate arterial blood, decreased ability of RBC's to unload oxygen to the tissues

Indications: Treatment of drug induced methemoglobinemia, treatment of vasoplegia (refractory hypotension), septic shock and anaphylactic shock-elevating the blood pressure and SVR

Adverse reactions: Cardiac arrhythmias-tachycardia, hypertension

Dosage: 2 mg/kg (on pump)
1 mg/kg/hr (central line infusion)

17

MOA of Neosynephrine and indications of use and dosing

*Phenylephrine HCL
Indications: Maintenance of blood pressure in the treatment of shock. Used on bypass to maintain BP
MOA: Peripheral resistance is increased to raise arterial pressure. Coronary blood flow is increased.
Normal MAP range about 60-90

Dose was about 100 mcg?? (book says 0.1-0.5 mg IV. May be given IV drip with 10mg added to 250 to 500 ml of sodium chloride solution, the rate adjusted according to patient response.