Module 7 - Cardiac Pharmacology Flashcards
(30 cards)
Medication Access
Drugs typically require 1 to 2 minutes to reach the central circulation when given to peripheral access.
Resuscitation drugs are usually administered by bolus injection, followed by a 20 mL bolus of IV fluid.
The intraosseous (IO) route maybe used if IV access isn’t available, with endotracheal administration being another alternative.
Endotracheal administration results in lower blood concentrations of the same dose given intravascularly
Resuscitation
Resuscitation guidelines are evidence – based recommendations. This means that international resuscitation experts meet to evaluate published research and new conclusions in the form of recommendations.
Drugs should be given during CPR as soon as possible after the rhythm is checked. Drug delivery should not interrupt CPR.
What are the two categories of ACLS drugs?
Medications for cardiovascular support:
These are sometimes called pharmacology I category drugs; they alter cardiac output, rate, and peripheral vascular resistance.
Medications for arrest rhythms:
These medications control rate and rhythms.
Name 10 medications for cardiovascular support (pharmacology I category drugs)
Epinephrine Vasopressin Norepinephrine Dobutamine Dopamine Digoxin Inamrinome Milrinone Nitroglycerin Sodium nitroprusside
What are the effects of Epinephrine (pharmacology I category drug) when used for cardiovascular support?
Inotropic/vasopressor
What are the effects of Vasopressin (pharmacology I category drug) when used for cardiovascular support?
Non-adrenergic peripheral, coronary, and renal vasoconstrictor
What are the effects of Norepinephrine (pharmacology I category drug) when used for cardiovascular support?
Inotrope/vasoconstrictor
What are the effects of Dopamine (pharmacology I category drug) when used for cardiovascular support?
Adrenergic agonist/dopamine agonist
What are the effects of Dobutamine (pharmacology I category drug) when used for cardiovascular support?
Inotrope
What are the effects of Nitroglycerin (pharmacology I category drug) when used for cardiovascular support?
Vasodilator
What are the effects of Digoxin (pharmacology I category drug) when used for cardiovascular support?
Inotrope/ventricular rate control
Indications:
digoxin is used in advanced cardiac life support (ACLS) to slow ventricular response in atrial fibrillation or atrial flutter.
Precautions:
Digoxin toxicity is frequently associated with serious arrhythmias.
What are the 3 Specific Pharmacology Agents?
Oxygen: provide 100% O2
Key component in resuscitating and emergency cardiac care.
Used for all patients with acute chest pain due to cardiac ischemia, hypoxemia, and cardiac arrest.
Dosage:
You can provide 22% to 100% FIO2 through positive – pressure ventilation or with a manual resuscitator bag.
Precautions:
Problems with oxygen depend on the concentration and the duration of exposure.
Describe what epinephrine is and does
Natural Catecholamine (naturally occurs the human body) with both alpha and beta effects. Causes peripheral vasoconstriction, leading to improved myocardial and cerebral perfusion to vital organs. Increases BP and the rate and force of contraction.
What dosage of epinephrine should be used during a code?
Dosage:
Standard dose is 1 mg given intravenously every 3 to 5 minutes
Precautions:
Should not be mixed with alkaline solutions such as bicarb (HCO3).
If given in patients who are not in cardiac arrest, could result in hypertension.
What is Vasopressin?
Vasopressin is a naturally occurring antidiuretic hormone (ADH)
In high doses, it acts as a noradrenergic peripheral, coronary, and renal vasoconstrictor.
Indications:
Vasopressin could be considered as an alternative to either the first or second dose of epinephrine and treatment of pulseless arrest. It may be effective in patients with asystole or pulseless electrical activity and in patients who remain in cardiac arrest after treatment with epinephrine.
Dosage:
Single – dose vasopressin is given one time only has 40 units IV/IO.
Precautions: the current evidence for the use of the suppressant in cardiac arrest is promising, but it’s use hasn’t improved the rate of intact survival to hospital discharge.
What is norepinephrine?
Norepinephrine is a potent alpha vasoconstrictor and beta-1 inotrope. Low doses primarily result in inotropic effects, with higher doses producing mixed effects.
Indications:
Norepinephrine is primarily used for severe hemodynamically significant hypotension and low total peripheral vascular resistance refractory to other sympathomimetics.
Dosage: norepinephrine is mixed and infused through a central venous catheter to minimize the risk of extravasation. (If given via IV and it accidentally pops out and drips on skin it will shut down circulation to the entire area)
FYI:
Dosage is 0.5 to 1 µg/minute and titrated to achieve a systolic blood pressure of at least 90 mmHg. The average adult dose is 2 to 12 µg/minute.
What is sodium bicarbonate?
Sodium bicarbonate is a buffer (base) that combines with acid (in effect neutralizing the acid).
Sodium bicarbonate is indicated in situations where there has been a bicarbonate – responsive metabolic acidosis prior to arrest, hyperkalemia, or some drug overdoses.
H2O + CO2 ↔️H2CO3 ↔️H + HCO3
Why must sodium bicarbonate be used with caution during cardiac arrest?
During cardiac arrest, if CO2 removal is compromised, administration of sodium bicarbonate increases the amount of CO2 in the blood. Increased amounts of carbon dioxide in the blood also lowers pH of the blood, and this leads to respiratory acidosis.
What are the indications for administering sodium bicarbonate?
Indications:
Sodium bicarbonate is primarily indicated when the patient was known to have metabolic acidosis prior to the cardiac arrest or when the patient has been in cardiac arrest for a prolonged period of time.
What is a safe dosage of sodium bicarbonate?
Dosage:
1 mEq/kg can be given via IV bolus as an initial dose, followed by half of this does every 10 minutes. Administration of bicarbonate should be guided by arterial blood gas analysis to monitor the patient’s acid/base status. Inducing alkalosis should always be avoided.
What is the main precaution when using sodium bicarbonate?
Sodium bicarbonate rapidly combines with acid to produce carbon dioxide, so good ventilation is essential to eliminate the carbon dioxide.
Name for Positive Inotropic Drugs?
Positive inotropic drugs make your heart beat more strongly end efficiently. Digoxin Inamrinone Dopamine Dobutamine (Dobutrex)
What is Inamrinone and what is it used for?
Inamrinone is a phosphodiesterase inhibitor or with positive inotropic effects and vasodilating effect, which decreases afternoon.together, these effects result in increased cardiac output it.
Indications:
It is used in the treatment of heart failure refractory and diuretics, vasodilators, and conventional inotropic agents.
Precautions:
Inamrinone may cause tachyarrhythmia, hypotension or thrombocytopenia.
What are the indications and dosages of Dopamine?
Indications:
Dopamine is a second – line drug after atropine for symptomatic bradycardia. It is used for hypertension (systolic blood pressure equals 70 to 100 mmHg) with signs and symptoms of shock.
Dosage:
Effects are dose-dependent. Low doses (1 to 2 µg/kg per minute) stimulate the dopaminergic receptors to produce cerebral, renal, and mesenteric vasodilation.
Note: Mesenteric attaches to the intestinal track.
When administered at 2 to 10 µg/kg per minute dopamine stimulates the beta-1 and alpha receptors. The main effect is to increase cardiac output.
At doses greater than 10 µg-kg per minute, dopamine’s alpha – adrenergic effect predominates.
