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CARDIAC DRUG REVIEW
WHAT DO YOU “SEE” WHEN YOU STIMULATE BETA
VASODILATEBRONCHODILATE+CHRONOTROPE+INOTROPE
EPI’S OTHER NAME?
ADRENALIN
WHAT DOES EPI DO THAT NOREPI AND DOPAMINE DO NOT DO?
BETA 2BRONCHODILATOR
1:1000 MEANS?
1 GRAM/1000 ML
1MG/1ML
WHO IS THIS 1:1 GIVEN TO?
ALIVE PATIENTSASTHMA/ALLERGIC
REACTIONSAFEST ROUTE
DOSE?How many mls is each dose?
HOW DO YOU MIX AN EPI INFUSION?
1 MG /250 ML
RUN AT ?
Epi is given first line to what pulseless rhythms?
V FibV TachAsystolePEA
How often?What dilution?
Why is Epi given during a resusucitation?
Alpha action-vasoconstriction throughout bodyPerfuses the heart and brainCPR directs perfusion to the
above
Use ANS terms to describe Epinephrine.
Alpha stimulatingBeta stimulatingSympathomimeticAdrenergicCatecholamine
What are 4 generic rules for ANS pressor agents?
Don’t abruptly DC infusion/taperBP must be monitoredin Trauma-never first lineTissue sloughing may
occur-watch site
What are 4 generic rules for Catecholamines?
Bicarb inactivates themAssess if currently on a Symp
drug if on Beta Blocker may need to
increase doseDo not work if pH to acid (below
7.2)
Other names for Dopamine?
Intropin
Dopastat
How is Dopamine different from the other alpha agents?
List FIVE
No IV bolusInfusion onlyDopaminergic-dilates
renal/mesentericCauses hypotensionGiven based on weight
Mix a Dopamine drip?
400 mg/250 ml
The Dopaminergic effects occur MAINLY at what rate?
1-4 mcg/kg/min
Describe what happens when Dopamine is infused at 5-10 mcg/kg/min.
primarily Betasome vasoconstriction, more closer to 10
10-20 mcg/kg/min of Dopamine results in
predominately alpha actions with substantial vasoconstriction
Finish this-at 10 mcg/kg/ min you run Dopamine at
20 or 30 or 40
Your patient is in cardiac arrest. What drugs could you administer via the ETT?
EpinephrineVasopressin
Don’t really give these anymore-but OK ET Lidocaine Atropine
Indications for Vasopressin?
Cardiac arrest
don’t worry about hemodynamic support in vasodilatory shock
Dose of Vasopressin?
40 units
How many times can you repeat the dose?
How is Vasopressin different from the other pressors?
List Four
Not alpha, ANS, sympathetic, Beta, etc
Bolus only“units”not as bad at irritating/stimulating
the heart long half life-10-20 minutes
What are the S&S of Symptomatic Bradycardia?
List Five
hypotensionaltered LOCsigns of shockischemic chest discomfortacute heart failure
First line drug for the treatment of symptomatic bradycardia isWHY?
ATROPINEonly action is to increase
heart rate, no other demand on the heart
What is the first line NON drug for the rx of symptomatic brady?
Describe Atropine using ANS words.
List Four
Parasympatholytic+ chronotropeAnticholinergicParasympathetic blockingVagolytic
What is a non-cardiac use for Atropine?
Describe
Organophosphate poisoning
Organophosphates stimulate the Parasympathetic nervous system. Atropine blocks this.
What is the dose of Atropine?
0.5 mg IV bolus
What may happen if you give less than that?
Total dose of Atropine?
Two answers!
3 mg0.04 mg/kg
What side effect of Atropine interferes with your assessment?
Dilates pupils!
Atropine may not work in symptomatic brady if the patient is
WHY?
hypotensive or has myocardial hypoxiacan’t get to where it needs
to goORheart cannot respond
Another + chronotrope you could give AFTER Atropine, Dopamine, Epi and a TCP is
ISUPREL!
Using ANS terms, describe Isuprel
List Four
pure Beta+ chronotrope+ inotropeSympathomimeticCatecholamine
What would Isuprel do directly to BP?
lower it, cause hypotension
What would it do indirectly to the BP?
Your patient is in A Fib, HR of 220. You want to slow the rate with a medication.
List two that would be appropriate.
VerapamilDiltiazem
What are the other names for the above drugs?
What are the actions of these two drugs?
List MAIN three
Negative chronotrope (at AV)Negative inotropeCoronary and peripheral
vasodilation
Why might the CCB cause CHF or make it worse?
Which one is worse at the above?
They are both negative inotropes
Verapamil is the stronger inotrope, not a big worry in Diltiazem
You would administer Dilt/Verapto Narrow QRS tachy only in what situation?
if Adenosine had not worked
The CCB are contraindicated in what TACHY rhythms?
Name TWO, be specific.
WPW in A FibV tachAny wide QRS tachy of unknown
originAlso--
Sick Sinus Syndrome Second/Third degree block
Your pt received ?? at the Urgent Care for her Tachy.You must not give the pt a CCB now.
What is the drug?
Beta Blocker IV
Describe the 1st AND 2nd dose of Diltiazem.
Be specific
0.25 mg/kg over 2 minutes15-20 is reasonable first dose
In 15 minutes repeat dose is 0.35 mg/kg over 2 minutes20-25 is a reasonable dose for
the average pt
Describe the first and second dose of Verapamil
Be Specific
Initial dose 5 mg IV bolusRepeat dose 5-10 mg in 15-30
minutes if dysrhythmia persists and no adverse response to first dose
What may be tried prior to the admin of CCB in a stable patient?
Vagal maneuvers
Your pt is in A fib, hypotensiveand deteriorating rapidly you should…
Cardiovert
If patient is unstable in ANY tachycardia, cardioversionrules!
You have overdosed your patient with Verapamil.
What drug could you give to attempt to prevent toxic effects?
Calcium Chloride
What is the dose of Calcium?
500-1000 mg
10% solution
Administer with extreme caution IF AT ALL to patients on
Digoxin, Digitalis etc
May precipitate what?
What is a non-overdose indication of CA++?
How does Calcium help in this setting?
Known or suspected hyperkalemia helps stabilize the myocardial cell
membrane
What does Bicarb do?
Talk Chemistry!
decreases acid by combining with H+ and then with ventilation eliminating CO2
What must the patient be “doing” when giving Bicarb?
Breathing!
on their own or via ETT
What is the dose of Bicarb?
1 mEq/kg
or ?
Never mix with…..
Name TWO
CalciumCatecholamines
What overdose would you use Bicarb for?
Cyclic Antidepressant
What are the indications for Mag Sulfate?
Name Three
Torsade de PointesEclampsiaAsthma
life threatening dysrhythmias due to dig toxicity
What is the dose of Mag when treating Torsade?
Both pulseless and with a pulse
1-2 grams diluted in 10 ml D5Wpulseless
1-2 grams in 50-100 ml D5Wwith a pulse
What are two actions of Mag that would help treat Eclampsia?
Smooth muscle relaxer=vasodilationCNS depressant
What are the two main actions of Adenosine?
Negative chronotropeWeak bronchoconstrictor
so..cautious with what patients?
What are the top three side effects of Adenosine?
They occur commonly.
Facial FlushingDyspneaChest pressure/pain
Describe the dosing of Adenosine, including max.
6 mg IV bolus over 1-3 secondsrepeat in 1-2 minutes 12 mgmay repeat a second 12 mgtotal dose 30 mg
For Adenosine to be most effective…
List four steps for administration
Start IV proximal, close to central circ
Give as close to injection site as possible
Inject rapidlyAdminister a small bolus of fluid
(20ml) and elevate arm
Describe how Adenosine is beneficial in A Fib/Flutter
May help to diagnose but will not treat
What are the Sympathetic NS actions of Amiodarone?
Alpha blockerVasodilation
Beta blocker negative chronotrope negative inotrope negative dromotrope
What “channels” does it affect?
NaKCa
Thus -slows conduction through vents-slows heart rate and ↑ AV node conduction-increases refractory period (atria/vent)
What two PNB rhythms may receive Amiodarone?
V TACHV FIB
Why would you never give this drug to PEA or Asystole?
What are the side effects of Amiodarone?
List two and describe why they are side effects.
Hypotension alpha blocker
Brady beta blocker
AV block beta block and calcium blocked
TDP increase QT
Amiodarone dose in PNB is
300 mg IV/IOsecond dose in 3-5 minutes
consider 150 mgin practice most do not dilute 10-15 mls/20-30 mls D5W
Amiodarone dose in TachyWITH a pulse is
150 mg in 100 ml D5W over 10 minutes (15mg/min) no one uses this
May repeat every 10 minutes as needed
Rhythm is WPW with A fib
The two drugs used to treat this rhythm are?
Procainamide should be given until
List all 4
dysrythmia is suppressedQRS duration increases by
> 50%hypotension occurstotal dose of 17 mg/kg is
administered
Procainamide decreases excitability in what part of the heart?
AtriaPurkinje fibersVentricles
Do not use Procainamide in what ventricular rhythm?
Torsades
Why?Do not give with what
drug…because they both do the same as above?
A patient is in Ventricular escape at a rate of 40 with frequent PVCs. What would happen to the rhythm if Lidocaine was given?
Lidocaine (or Pronestyl or Cordarone) could eliminate all ventricular response and patient could go into Asystole.
What action does Lido have that Amiodarone nor Procainamidehave?
It helps decrease an elevation in ICP it is an anesthetic
Lidocaine, because it is an anesthetic has CNS side effects.
List Four
Altered LOCSlurred speechVisual disturbancesMuscle twitchingSeizures
The end…are you exhausted?