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Advanced Med Surg > Pharm 1: Cardiac, Peds > Flashcards

Pharm 1: Cardiac, Peds Flashcards

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1
Q

Sodium channel blockers-Action

A

block Na entry into cell during depolarization
stabilize cardiac membranes
results in decrease in conduction speed and myocardial excitability
Treat A and V arrythmias

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2
Q

Na channel blockers-Examples

A 
quinidine sulfate/gluconate
procainamide (Procar)
disopyramide (Norpace)
lidocaine
phenytoin (DIlantin)
propafenone (Rythmol)
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3
Q

Most common AE of Quinidine

Most dangerous AE

A

Most common: diarrhea

Most dangerous: Lengthening QT interval, puts pt at r/f V-tach

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4
Q

AE of procainamide

A

arthralgia and skin rashes

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5
Q

Common AEs of antidysrhythmics

A

GI upset: n/v/d

Dzns, HA, blurred vision, tinnitus

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6
Q

CI of disopyramide (Norpace)

A

poor LV function

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7
Q

ACLS 2nd choice/SJH 1st choice for treating V-tach

A

lidocaine

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8
Q

lidocaine admin

A 
IM/IV
Bolus dose +
Maintenance dose (1-4 mg/min)
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9
Q

Na channel blocker used to treat arrythmias d/t Digoxin toxicity

A

phenytoin (Dilantin)

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10
Q

AE of phenytoin

A

HoTN, Bradycardia
Thrombophlebitis
gingival hyperplasia

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11
Q

Na channel blockers used only for severe refractory life-threatening Ventricular arrythmias, can by proarrhythmic

A

propafenone (Rythmol)

flecainide (Tambocor)

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12
Q

Cardioselective Beta Blockers

A

metoprolol

atenolol

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13
Q

nonselective BBs

A

propanolol
nadolol
labetelolol
timolol

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14
Q

BBs used to treat these arrythmias

A

Afib
Aflutter
paroxysmal SVT

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15
Q

CI of BBs

A

Asthma (caution with cardioselectives)

use caution with CHF pt (low dose, increase slowly)

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16
Q

AE of BBs

A

Bradycardia
HoTN
Dzns, fatigue
Heart block

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17
Q

BB action

A

block SNS stimulation of the heart:

decrease HR, contractility, BP, automaticity, and myocardial O2 demand

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18
Q

K channel blockers-action and examples

A

prolong the action potential and refractory period of the cardiac cycle–prolong repolarization

Amiodorone

CC areas only:
bretylium
ibutilide
dofetilide (Toursad’s risk)

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19
Q

use of this type of antidysrhythmic with warfarin increases the risk of bleeding

A

K channel blockers

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20
Q

K channel blockers-admin

A

PO, IV gtt

loading dose, maintenance dose

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21
Q

Most common AE of amiodorone

A

corneal microdeposits causing
visual halos
photophobia
dry eyes

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22
Q

most dangerous AE of amiodorone

A

Pulmonary toxicity with alveolar damage, leads to pulmonary fibrosis

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23
Q

CCBs-Action and examples

A

Slow conduction and prolong refractory period
verapamil
diltiazem

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24
Q

Indication of CCbs

A

Afib, Aflutter, SVT

tachycardias at SA and AV nodes

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25
AE of CCBs
``` **Constipation (can be severe) Bradycardia Heart block HoTN, Dzns Dyspnea ```
26
antidysrhythmic med can be used for "chemical cardioversion"
adenosine
27
adenosine admin
give RAPID IVP due to very short half life
28
adenosine action
stops heart so SA node can pick up, converts SVT to SR
29
Adrenergic agonists-action
SNS stimulants, goal is to increase perfusion | Cause: vasoconstriction, increased HR, bronchodilation, pupil dilation, and inhibit GI activity
30
all adrenergic agonists are IV in CC areas except
dobutamine
31
adrenergic agonist, endogenous catecholamine that stimulates alpha and beta receptors and can increase BG levels
epinephrine
32
indications of epinephrine
Emergency ACLS protocols acute asthma anaphylaxis
33
AE of epinephrine
vasoconstriction leading to increased BP
34
adrenergic agonist that primarily stimulates alpha receptors, is a potent vasoconstrictor
norepinephrine (Levophed)
35
indications of norepinephrine
Shock, HoTN
36
isoproterenol action
adrenergic agonist | stimulates Beta receptors causing bronchodilation, cardiac stimulation
37
indications for isoproterenol
heart block | septic shock
38
Adrenergic agonist with dose-dependent action
dopamine low dose-vasodilation of renal vessels, enhanced renal flow high dose- potent peripheral vasoconstriction
39
dobutamine action
stimulates Beta-1 receptors to increase contractility
40
dobutamine admin
through PIV or CVAD **2nd IV site is needed Venous irritating, danger of tissue damage if infiltration occurs. DO NOT stop med abruptly
41
indications for dobutamine
HF | Cardiac Post ops (r/f CHF)
42
major AE/danger of dobutamine
Arrythmias
43
IV gtt Dopa-1 agonist for Hypertensive crisis
fenoldopam
44
alpha adreneric agonist, given IV short term to increase BP
phenylephrine
45
Vaccinations at 2, 4, and 6 mos (6)
``` Hep B DTap Hib IPV Prevnar RV ```
46
Vaccine at birth (1)
Hep B
47
Vaccines around 1 year (12-15 mos) (4)
Hib Prevnar MMR Varicella
48
Hep A vaccine admin
2 doses, 6 mos apart | 12-23 mos
49
DTap schedule
2,4,6, 15-18, 4-6 yr | then:TDap schedule
50
Vaccines before entering kindergarten (4-6 yr) (4)
DTap MMR Varicella IPV
51
Vaccines at 11-12 yr (2)
HPV (3 doses) | Menactra (MCV-4)
52
Vaccine at 16-18 yr
Menactra
53
Vaccines CI in severe immunodeficiency and pregnancy
MMR Varicella (can vaccinate child, just cover any pox) Zoster (HCV)
54
Live vaccines
intranasal flu RV MMR Varicella
55
SubQ vaccines
MMR | Varicella
56
oral vaccine
RV
57
Prevnar (PCV-13) vaccine is for
Pneumoccoal disease Strep pneumo pneumonia, OM, sepsis, meningitis
58
Menactra (MCV-4) vaccine is for
meningococcus | bacterial meningitis
59
TDap schedule
11-12 years Boost every 10 years with Td Also: any time needed over 7 yrs for catch up use TDap instead of DTap Give TDap to pregnant teens during each pregnancy
60
CI to TDap or DTap
encephalopathy not attributable to an identifiable cause within 7d of previous dose
61
when to start flu vaccine
6 mos
62
no live intranasal flu to
under 2 years old pregnant chronic disease state
63
who else gets HepA
travel teen males who have sex with other males illicit drug use close contact with international adoptee
64
only injection site for up to 1 year old
Vastus lateralis
65
AE of lidocaine
CNS effects: confusion, dizziness, drowsiness, tremors, slurred speech
66
most effective to reduce LDL
statins
67
get these tests before statin use begins
LFTs (and periodically) kidney function LDL/HDL levels
68
CIs of statins
Liver dysfunction caution with coumadin avoid grapefruit
69
avoid grapefruit with these meds
statins
70
concurrent use with coumadin can increase risk of bleeding
statins and K channel blockers
71
cholestyramine (Questran) med type and admin
Bile Acid Sequestrant | dissolve powder in 120 mL; give other meds 1 hour before or 4 hours after
72
activate lipoprotein lipase enzyme that breaks down cholesterol; inhibits TGI synthesis in liver
Fibric Acid Derivatives
73
AE of nicotinic acid use to decrease LDL and increase HDL
Flushing and warmth of face
74
this med can be taken with statins to reduce cholesterol
cholesterol-absorption inhibitor= ezetimbe (Zetia) Vytorin=Zetia+Zocor
75
this decreases the amount of cholesterol stored in the body
exercise
76
major AE of oral steroids
Mood Swings also hunger; take with food to protect GI lining Don't stop abruptly
77
Anti-RSV Monoclonal Antibody given to high risk infants (preemies, severe CP issues
Synagis | passive immunity-give once per month
78
no cough and cold products for <2 years old because
don't want to mask infection, sepsis can develop quickly; proof of efficacy lacking and cannot articulate side effects which can be dangerous: tachycardia arrythmias sedation
79
Risk of ARF in dehydrated child who takes
ibuprofen
80
med errors in adults vs. kids
equal freqency | 3x higher rate of potentially harmful outcomes in kids
81
newborns are vulnerable to CNS toxicity from meds d/t
immature BBB
82
Glucocorticoids are only give short term to kids to avoid
suppression of growth
83
Can be used with Coumadin in prosthetic heart valve pt
Dipyridamole (Persantine) | Antiplt
83
IM/SQ absorption may be decreased in kids d/t
immature peripheral circulation and heat regulation
84
Therapeutic aPTT
Around 60 | 1.5-2x normal
85
Indications for IV heparin
Use when immediate effect needed...evolving CVA,PE,DVT
86
Indications for SQ Heparin
Immobility, bed rest, traction
87
Heparin AE
``` Bleeding Anemia Fever Edema Low plts ```
88
Warfarin indications
Prevent and treat DVT, PE, Afib emboli, emboli due to prosthetic heart valves
89
Warfarin dose determines by
pT/INR from 3 days ago
90
Anticoagulants action and types
Inhibit clotting factors IV/SQ heparin, lovenox Oral (inhibit Vit K) warfarin
91
Indications for anti platelet meds
Decrease plts aggregation that causes most arterial thrombi Prevent AMI, Reinfarction, CVA, Int Claudication

Advanced Med Surg (6 decks)

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