Meds Week 7 Flashcards
(67 cards)
Class: class V antidysrhythmic
Adenosine
Indications: SVT or PSVT unresponsive to Valsalva maneuver, regular/monomorphic WCT
Adenosine
Mechanism of action: often referred to as “chemical cardioversion”; slows heart rate by depressing
automaticity in the SA node, slowing conduction of the SA and AV nodes, and inhibiting re-entry
through the AV node
Adenosine
Side effects: flushed skin, chest pain or pressure, nausea, dyspnea, hypotension, heart blocks,
bradycardia, asystole, transient premature complexes, seizures, blurred vision, headache, tingling,
numbness, lightheadedness, dizziness, shortness of breath, bronchoconstriction in asthmatic patients,
metallic taste, throat tightness
Adenosine
Contraindications: hypersensitivity, sinus tachycardia or atrial fibrillation/flutter, despite rate >150, 2nd or 3 rd
degree AV block, sick sinus syndrome, WPW and atrial fibrillation, not effective in the elimination of atrial
flutter, heart transplant, use of carbamazepine (Tegretol),
Adenosine
Precautions: may produce new dysrhythmias that are usually transient
Adenosine
Interactions: carbamazepine (Tegretol) and dipyridamole (Persantine) intensify its effects; antagonized by methylxanthines such as caffeine and theophylline
Adenosine
Routes of administration: rapid IVP/IO (preferably in the AC with an 18-20 gauge IV; administered
over 1-2 seconds and immediately flushed with NaCl)
Adenosine
Prehospital considerations: cannulate a large proximal vein with 18-20g IV, IV port closest to patient
and immediately flush with 10 mL NaCl to ensure rapid administration; run a 6-second ECG strip before,
during, and after administration; patients usually have a 10-second period of escape beats or asystole
before sinus node starts up again – patient may have feeling of impending death and can be frightening;
if WCT is origin, adenosine likely to be ineffective at cardioversion
Adenosine
Adenosine ____ or ____ RIVP followed by _______; may repeat to max dose of _____
6 mg or 12 mg RIVP followed by 10-20
mL NaCl; may repeat to max dose of 24
mg
LA County Adenosine adequate perfusion (narrow or wide
QRS):________ RIVP followed by 10-
20 mL NaCl after _ ,
repeat 12 mg if no conversion
poor perfusion (narrow QRS):
_ RIVP followed by 10-20 mL NaCl,
repeat 12 mg
adequate perfusion (narrow or wide
QRS): 6 or 12 mg RIVP followed by 10-
20 mL NaCl after Valsalva maneuver,
repeat 12 mg if no conversion
poor perfusion (narrow QRS):
12 mg RIVP followed by 10-20 mL NaCl,
repeat 12 mg
Class: class III antidysrhythmic: potassium channel blocker
Amiodarone
Indications: all tachydysrhythmias including v-fib, v-tach with or without a pulse, wide complex
tachycardia of unknown origin, atrial tachycardia, SVT, a-fib, a-flutter, junctional tachycardia; also used
to treat non-exertional angina
Amiodarone
Mechanism of action: slows heart rate by prolonging the duration of phase 3 (repolarization) of the
cardiac action potential and increases refractory periods without significantly effecting resting
potential (by blocking sodium and potassium channels); relaxes smooth muscles causing vasodilation
especially in coronary arteries; also has anti-anginal and sympatholytic properties
Amiodarone
Side effects: headache, dizziness, hypotension, pulmonary toxicity, muscle weakness, numbness,
tingling, fatigue, cardiogenic shock, anorexia, nausea, vomiting, bradydysrhythmias, CHF
Amiodarone
Contraindications: hypersensitivity, 2
nd and 3
rd degree heart blocks, sick sinus syndrome, profound
bradycardia, cardiogenic shock, neonates, none in cardiac arrest
Amiodarone
Precautions: use caution in children and patients with Hashimoto’s thyroiditis, goiter, history of
thyroid dysfunction, CHF, electrolyte imbalance or who are hypersensitive to iodine
Amiodarone
Interactions: increases digoxin levels and enhances other ventricular antiarrhythmics; incompatible
with sodium bicarbonate, heparin and aminophylline, none in cardiac arrest
Amiodarone
Prehospital considerations: monitor HR, BP, and ECG closely post resuscitation; should not be used
routinely in cardiac arrest – only use in VF and VTach without pulses unresponsive to attempted
defibrillation x2 (LA County)
Amiodarone
Amiodarone
pulseless v-fib or v-tach (arrest):
_______, repeat ______ in 3-5 mins PRN
tachydysrhythmias with a pulse:
______ IVPB over 10 minutes (___ mg/min),
repeat PRN
maintenance infusion: ________IVPB
pulseless v-fib or v-tach (arrest):
300 mg, repeat 150 mg in 3-5 mins PRN
tachydysrhythmias with a pulse:
150 mg IVPB over 10 minutes (15 mg/min),
repeat PRN
maintenance infusion: 1 mg/min IVPB
LA County Amiodarone pulseless v-fib or v-tach (arrest):
______, then repeat ______ after 2x
defibrillation (450 mg max)
LA County pulseless v-fib or v-tach (arrest):
300 mg, then repeat 150 mg after 2x
defibrillation (450 mg max)
Class: parasympatholytic/anticholinergic, antidysrhythmic, bronchodilator, antidote
Atropine
Indications: symptomatic bradycardia in adults, suspected AV block or increased vagal tone in pediatrics,
organophosphate or nerve agent poisoning, pretreatment for RSI/DSI
atropine
Indications: pretreatment for RSI/DSI
atropine
