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Flashcards in Meds Deck (18)
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What are the functions of Ca++?

1) Cardiac action potential
2) Increase FOC, smooth muscle contraction
3) Blood clotting factor in coag cascade
4) Bone density


What is calcium gluconate indicated for, and how is it given?

For electrolyte replacement.

1-2g IV in 100cc D5W over 1 hr


What is the corrected calcium calculation and why is it used?

50% of calcium is ionized but 45% bound to albumin and 5% to other elements

Corrected Ca++ = Ca(m) + [0.02 x (40-alb) ]


What is calcium chloride used for, and how is it given?

For severe hypocalcemia, hyperkalemia, Ca++ channel blocker OD, cardiac arrest, CRRT protocol

1g in 100cc D5W CVC over 1 hr or push

Must administer centrally, pre loaded syringe available


How is calcium gluconate and calcium chloride different?

Calcium chloride has 3x the elemental / ionized calcium, used for emergencies, centrally administered, can be pushed via pre-filled syringe


What class of drug is dopamine?

Sympathomimetic, inotrope, vasopressor


What are the doses of dopamine and effects?

1) Low / Dopaminergic / Renal ( < 3 mcg/kg/min) mild renal vasodilation, increase U/O

2) Moderate / Intermediate / Beta (3 - 10 mcg/kg/min) Beta-1 selective, cardiac inotrope cronotrope dromotrope

3) High / alpha / pressor (10 - 20 mcg/kg/min)
Alpha selective, vasoconstriction


When is dopamine indicated and how is it given?

Acute severe hypotension, sepsis (4th line), symptomatic bradycardia (but dobutamine and milrinone are better)

400mg in 250cc --> 5mg/kg/min titrate (start at beta dose)

Give centrally


What must be considered when given inotropes?

Inotropes increase FOC. Hypovolemia must be resolved first so that the heart has something to pump


What is dobutamine's drug class?

Sympathomimetic inotrope, beta 1 selective mild beta 2


What is the effect of dobutamine?

Inotropic, mild vasodilation

Increase FOC, CO, decrease afterload and preload


Does dobutamine affect renal vessels?

No. Any increase in U/O is related to increase GFR and CO


When is dobutamine indicated and how is it given?

Reversible heart failure / post op, shock, CHF, pharmacologic stress testing

5 - 15mcg/kg/min given centrally


What are nursing considerations for dobutamine and milrinone?

Little change to HR so good med for cardiac patients, but high doses will cause tachycardia and arrhythmias from enhanced AV conduction. Fix hypovolemia


What is milrinone's drug class? What is its mechanism of action?

Cardiac inotrope, vasodilator

Inhibits phosphodiesterase type III which is an enzyme that destroys cAMP (regulates Ca++ passage to heart). Inhibition therefore overall raises the level of Ca++ in the cardiac cells and increases FOC as well as allows mild vasodilation in vasculature resulting in increased SV


When is milrinone indicated and how is it given?

Reversible heart failure / post op, shock, CHF, weaning off cardiopulmonary bypass

Loading: 50mcg / kg over 10-15 mins
Continuous: 0.25 - 0.75 mcg/kg/min

Mix 20mg in 80mls D5W/NS to give 100 mls
Give centrally


What are the similarities and differences between dobutamine and milrinone?

Increase FOC, CO, SV
Decrease afterload, preload
Use central line
Good for cardiac patients (not chronotropic) but can cause tachycardia at high doses
Similar indications

Sympathomimetic vs Cardiac inotrope
Beta 1 selective vs enzymic inhibition
Milrinone has loading dose and LONG half life (2-4hrs)


Why should we monitor pts after stopping milrinone?

Long half life 2-4 hrs, med is bound to plasma proteins and continue to release. Monitor pts > 4hrs to ensure hemodynamics remain stable