Critical Care Cardiac Meds
What type of drug is Amiodarone? Correct Answer: Antiarrhythmic
What is amiodarone indicated to treat? Correct Answer:
... [Show More] -Tachyarrhythmias (atrial and ventricular).
-Attain rate control of rapid atrial dysrhythmias in patients with impaired LV function that Digoxin isn't able to fix.
What allergy contraindicates the use of amiodarone? Correct Answer: Iodine
Adverse effects of amiodarone Correct Answer: muscle weakness, fatigue, dizziness, hypotension
What indicates that amiodarone therapy should be stopped? Correct Answer: -Prolongation of QT interval, or other signs of heart block or bradycardia.
-In these cases, 2nd line drugs such as lidocaine or adenosine are indicated
What is Torsades? Correct Answer: Torsades de Pointes, or "twisiting of the points" is an ECG reading characterized by varying amplitudes along the isoelectric line. Most often caused by PROLONGED QT, when a R wave "stumbles" on top of a T wave.
-This is why amiodarone is reduced or discontinued when seen causing this.
What type of drug is IV lidocaine? Correct Answer: Antidysrhythmic. (2nd line)
What is lidocaine primarily used to treat? Correct Answer: V-tach (particularly with wide QRS)
V-Fib
Used in place of amiodarone when it causes prolonged QT intervals
Dosage of lidocaine Correct Answer: 1-1.5 mg/kg q 3-5 min
MAX 3-5 mg/kg
Adenosine Correct Answer: Antiarrhythmic (2nd Line)
What does adenosine primarily treat? Correct Answer: -Conversion of PSVT (paroxysmal supraventricular tachycardia) to NSR.
-Basically bringing the heart out of a "randomly rapid firing" state and back to normal rhythm.
-Tachycardia w/ wide QRS complexes
What can we expect to happen immediately after administering Adenosine? Correct Answer: Asystole (flatline)
lasts < 15 seconds
Dosage of adenosine Correct Answer: RAPID PUSH IV!!!
6 mg over 1-3 seconds. Followed with fast push of 20 mL NS.
1-2 minutes between doses.
Actions of Adenosine Correct Answer: decreases activity of SA and AV nodes, interrupting the reentry pathway that is feeding back on itself and causing either the atrial or ventricular tachycardia.
What type of drug is Epinephrine? Correct Answer: Alpha and Beta adrenergic agonist. (SNS stimulator)
What are the primary actions of Epinephrine? Correct Answer: -Peripheral vasoconstriction (alpha 1 stimulation) that increases BP in order to increase perfusion of the heart and brain during CPR.
-Increases contractility --> increased CO --> increase MAP --> increase tissue perfusion.
-Bronchodilator (beta 2 stimulation)
When is Epinephrine used (related to CV) ?? Correct Answer: During CPR
Dosage of Epinephrine Correct Answer: 1 mg IV/IO
q 3-5 min.
Adverse effects of epinephrine Correct Answer: -HTN
-Palpitations
What type of drug is atropine? Correct Answer: Anticholinergic (anti-PNS)
What condition is atropine indicated to treat? Correct Answer: Bradycardia
What is the primary effect that atropine stimulates? How does it do this? Correct Answer: -Increased heart rate.
-Direct vagolytic action, increase SA node automaticity and AV node conduction.
-May also cause increased vasoconstriction and BP.
Adverse effects of atropine Correct Answer: -HA, dizziness
-Unstable BP
-V-tach, V-Fib
AV dissociation
Dosage of atropine Correct Answer: 0.5 - 1 mg q3-5 minutes
Max 0.04 mg/kg
vasopressin (Pitressin) Correct Answer: POTENT peripheral vasoconstrictor
Primary function of vasopressin Correct Answer: INCREASE Blood Pressure
Indications of vasopressin Correct Answer: -Shock
-VF / VT
-Asystole
-PEA
Any condition that calls for increased Cardiac perfusion
Dosage of vasopressin Correct Answer: 40 U IV/IO
to replace the first or second dose of epinephrine
procainamide (Pronestyl) Correct Answer: antiarrhythmic (2nd line)
Action of procainamide Correct Answer: Essentially slows down conduction through the heart.
-Suppresses automaticity in the His-Purkinje system.
-Slows conduction in the atria, ventricles, and His-Purkinje system.
Dosage of procainamide (Pronestyl) Correct Answer: 20 - 30 mg/minute
Repeated until dysrhthmia is suppressed, the QRS complex widens by 50%, or 17mg/kg is reached.
Indications for procainamide Correct Answer: Tachycardia (PSVT, VT)
This is a 2nd line drug after amiodarone
Magnesium sulfate
cardiac indications Correct Answer: Regulates the movement of calcium in and out of cells, affecting cardiac contractility.
Diminished magnesium sulfate leads to dysrhythmias, including refractory VF and Torsades
Magnesium sulfate
Dosage Correct Answer: 1-2 g in 100 mL D5W over 1-2 minutes
Magnesium sulfate
adverse effects Correct Answer: -3rd degree heart block
-Respiratory paralysis
diltiazem (Cardizem)
Type of drug Correct Answer: Calcium Channel Blocker
What is the first line drug used for Torsades de Pointes? Correct Answer: Magnesium sulfate
diltiazem (Cardizem)
mechanism of action Correct Answer: Inhibits the flow of calcium ions into myocardial and vascular smooth muscle cells. Slows conduction, prolongs refractory period, and decreases myocardial contractility
Effect of diltiazem (Cardizem) Correct Answer: -Slows conduction
-Prolongs refractory period
-Decreases myocardial contractility
diltiazem (Cardizem)
Indications Correct Answer: - A-FIB and A-FLUTTER
-Conversion of PSVT to NSR (administered after adenosine).
-Narrow QRS complex tachycardias.
What two drugs are used to cardiovert PSVT to NSR? Correct Answer: 1st = [Show Less]