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Flashcards in Meds exam 2 Deck (43)
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1

Adenosine: Action / Indications

Antiarrhythmic, slows conduction through AV node.

Used to restore sinus rhythm in pts with atrial tach, slows down tachyarrythmias for diagnostic purposes.

NOT EFFECTIVE FOR ATRIAL FIB AND ATRIAL FLUTTER

2

Adenosine: Dose

Bolus: 6mg IV push over 1-2 secs
If no response in 1-2 mins: 12 mg IV push
If no response: Another 12 mg IV push

Half life 10 secs

3

Adenosine: Nursing considerations

Vagal maneuvers should be tried first.

Must be pushed quickly followed by rapid flush.

Pt may have transient AV blocks, asystole, slow rhythms,

Side effects: Facial flushing, chest pressure, SOB (WARN PTS FIRST!)

4

Atropine: Action, indications

Anticholinergic, anti PSNS drug

works to block PSNS, prevents action of Ach results in more SNS relative to PSNS and increase in HR

Used for symptomatic bradycardia, heart blocks

5

Atropine: Dose

0.5mg IV push q 2-5mins, max 3 mg

6

Atropine: Nursing considerations

Monitor tachycardia

SE: Dilated pupils, dry mouth

7

Epinephrine: Action

Sympathomimetic, produced by adrenal medulla and has beta 1, beta 2, alpha effects (primarily Beta)

Beta 1: Increase CO, + inotrope, + chronotrope

Beta 2: Bronchodilation in lungs

Alpha: Vasoconstriction, thus increase BP

8

Epinephrine: indications

Cardiac arrest, symptomatic bradycardia, severe shock states, severe hypotension, resp distress due to bronchospasm or anaphylaxis

9

Epinephrine: Dose

May be mcg/kg/min or mcg/min

In cardiac arrest: Bolus 1mg q 3-5mins

Continuous infusion: 4mg in 250cc NS/D5W @ 1mcg/min titrated up (1-20 mcg/min)

10

Epinephrine: Nursing considerations

Monitor increased BP, HR
Correct hypovolemia first
Use central line
**Use caution for cardiac pts as causes increase in myocardial O2 demand and MI

11

Fentanyl: Action, indications

Narcotic analgesic, synthetic opioid

Blocks opiate receptors in CNS, reducing pain transmission. Rapid onset, short duration with less hypotension than morphine (less histamine release)

Used for pre-procedural analgesic, pain management in hypotensive pts, used in anesthesia with hypnotic agent such as propofol

12

Fentanyl: Dose

IVP: 25 - `100mcg
IV infusion: Initiate at 25-50 mcg/hr and titrate

Onset 1-2 mins, duration 30-60 mins

13

How potent is fentanyl?

100mcg fentanyl equivalent to 10mg morphine (recall 1000 mcg = 1 mg)

14

Fentanyl: Nursing considerations

Rapid infusion may cause resp depression.

Can cause decreased GI motility, bradycardia

Keep airway resus equipment on hand

Can accumulate with hepatic impairment (perform sedation vacation to prevent accumulation)

Antidote: Narcan

15

Metoprolol: Action, indications

Beta blocker

- inotrope
- chronotrope
Decrease in myocardial O2 demand

Treatment or prophylaxis of tachyarrythmias, heart failure, hypertension, angina, acute MI or post MI

16

Metoprolol: Dose

Bolus: 5mg IV push over 1-2 mins, may repeat q 5 - 10 mins

Total IV dose = 15mg

17

Metoprolol: Nursing considerations

High doses can block beta 2 receptors in lungs leading to bronchoconstriction

Caution in pts with heart failure, bronchospastic disease

Side effects: CHF, pulmonary edema, bradyarrythmias, AV blocks, hypotension

Caution when used with Ca channel blockers

18

Midazolam: Action, indication

Sedative (benzodiazepine), is a direct CNS depressant and fastest acting shortest duration of benzos

Hypnotic, anti-anxiety, sedative, amnesic, anticonvulsant effects

Used for procedural sedation, agitation, sedation with NMBAs, seizure activity

19

Midazolam: Dose

Bolus 1-4mg over 2-3 mins
Infusion: 1-5mg/hr (100mg in 100cc D5W)

Onset: 1-2 mins, duration 20-30 mins

20

Midazolam: Nursing considerations

Too little / too much may lead to agitation, hyperactivity, paradoxical effect in very young / elderly

Adverse effects: Resp depression, hypotension

Half life 1-5 hrs

Pts can develop tolerance and withdrawal

21

Morphine: Action, indications

Narcotic analgesic, opiate

Blocks opiate receptors in CNS, reducing pain transmission. Relaxes smooth muscle in vessel beds causing vasodilation. Decreases preload, afterload, O2 demand

Analgesic of choice for MI induced pain, may be used in CHF for pulmonary edema

22

Morphine: Dose

IVP: 2-4 mg, slowly
**Rapid push causes adverse effects

Infusion: Initiate at 2-4 mg/hr titrate up

Onset 5 mins, duration 4-5 hrs (much longer than fentanyl)

23

Morphine: Nursing considerations

SE: Resp depression, hypotension, brady, decreased GI motility, decreased LOC

Antidote: Narcan

24

Nitroglycerin: Action

Vasodilator / Nitrate

Relaxes smooth muscle and vessel beds (predominantly venous dilation, decreases preload)

CA vasodilation increases O2 delivery and decreases O2 demand

25

Nitroglycerin: Indications

Prevention / treatment of angina by increasing CA blood flow

ACS ischemic chest pain
Acute and chronic heart failure to decrease preload and pulmonary congestion
Pulmonary edema

26

Nitroglycerin: Dose

Continuous infusion: 20 - 200 mcg/min or 1 - 10 mcg/kg/min

Titrate 5 mcg/min up q5min as needed for angina until pt is pain free

** Mix in glass bottle / low absorbing tubing

Duration: Less than 20 mins

27

Nitroglycerin: Nursing considerations

Use central line, may cause arterial vasodilation (watch hypotension)

Titrate up / down slowly
May be converted to transdermal patch

Pt may develop tolerance > 2 days

Side effects:
Hypotension (peripheral vasodilation)
Headache (cerebral vasodilation)
Tachycardia (compensation to decreased BP)

28

Nitroprusside: Action, indications

Vasodilator, antihypertensive

Potent vasodilator and causes relaxation for vessel beds (predominantly arterial, reduces afterload)

Mainly reduces afterload, some decreased preload

Used for control of hypertensive crisis, acute heart failure, used in OR to minimize blood loss, post-op to control BP following vascular surgeries. Used for short time only

29

Nitroprusside vs Nitroglycerin: Action?

Nitroglycerin mainly dilates venous system while nitroprusside dilates arterial system

30

Nitroprusside: Dose

Continuous infusion: 0.5 mcg/kg/min, titrate up by 0.2mcg to MAX of 8mcg/kg/min

Works immediately when initiated, short half life 10 mins

Cover bag with foil as drug breaks down from light