WHAT DO YOU SEE WHEN YOU STIMULATE BETA
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1 CARDIAC DRUG REVIEW
2 WHAT DO YOU SEE WHEN YOU STIMULATE BETA
3 VASODILATE BRONCHODILATE +CHRONOTROPE +INOTROPE
4 EPI S OTHER NAME?
5 ADRENALIN
6 WHAT DOES EPI DO THAT NOREPI AND DOPAMINE DO NOT DO?
7 BETA 2 BRONCHODILATOR
8 1:1000 MEANS?
9 1 GRAM/1000 ML 1MG/1ML
10 WHO IS THIS 1:1 GIVEN TO?
11 ALIVE PATIENTS ASTHMA/ALLERGIC REACTION SAFEST ROUTE DOSE? How many mls is each dose?
12 HOW DO YOU MIX AN EPI INFUSION?
13 1 MG /250 ML RUN AT?
14 Epi is given first line to what pulseless rhythms?
15 V Fib V Tach Asystole PEA How often? What dilution?
16 Why is Epi given during a resusucitation?
17 Alpha action-vasoconstriction throughout body Perfuses the heart and brain CPR directs perfusion to the above
18 Use ANS terms to describe Epinephrine.
19 Alpha stimulating Beta stimulating Sympathomimetic Adrenergic Catecholamine
20 What are 4 generic rules for ANS pressor agents?
21 Don t abruptly DC infusion/taper BP must be monitored in Trauma-never first line Tissue sloughing may occur-watch site
22 What are 4 generic rules for Catecholamines?
23 Bicarb inactivates them Assess if currently on a Symp drug if on Beta Blocker may need to increase dose Do not work if ph to acid (below 7.2)
24 Other names for Dopamine?
25 Intropin Dopastat
26 How is Dopamine different from the other alpha agents? List FIVE
27 No IV bolus Infusion only Dopaminergic-dilates renal/mesenteric Causes hypotension Given based on weight
28 Mix a Dopamine drip?
29 400 mg/250 ml
30 The Dopaminergic effects occur MAINLY at what rate?
31 1-4 mcg/kg/min
32 Describe what happens when Dopamine is infused at 5-10 mcg/kg/min.
33 primarily Beta some vasoconstriction, more closer to 10
34 10-20 mcg/kg/min of Dopamine results in
35 predominately alpha actions with substantial vasoconstriction
36 Finish thisat 10 mcg/kg/ min you run Dopamine at
37 20 or 30 or 40
38 Your patient is in cardiac arrest. What drugs could you administer via the ETT?
39 Epinephrine Vasopressin Don t really give these anymore-but OK ET Lidocaine Atropine
40 Indications for Vasopressin?
41 Cardiac arrest don t worry about hemodynamic support in vasodilatory shock
42 Dose of Vasopressin?
43 40 units How many times can you repeat the dose?
44 How is Vasopressin different from the other pressors? List Four
45 Not alpha, ANS, sympathetic, Beta, etc Bolus only units not as bad at irritating/stimulating the heart long half life minutes
46 What are the S&S of Symptomatic Bradycardia? List Five
47 hypotension altered LOC signs of shock ischemic chest discomfort acute heart failure
48 First line drug for the treatment of symptomatic bradycardia is WHY?
49 ATROPINE only 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?
50 Describe Atropine using ANS words. List Four
51 Parasympatholytic + chronotrope Anticholinergic Parasympathetic blocking Vagolytic
52 What is a non-cardiac use for Atropine? Describe
53 Organophosphate poisoning Organophosphates stimulate the Parasympathetic nervous system. Atropine blocks this.
54 What is the dose of Atropine?
55 0.5 mg IV bolus What may happen if you give less than that?
56 Total dose of Atropine? Two answers!
57 3 mg 0.04 mg/kg
58 What side effect of Atropine interferes with your assessment?
59 Dilates pupils!
60 Atropine may not work in symptomatic brady if the patient is WHY?
61 hypotensive or has myocardial hypoxia can t get to where it needs to go OR heart cannot respond
62 Another + chronotrope you could give AFTER Atropine, Dopamine, Epi and a TCP is
63 ISUPREL!
64 Using ANS terms, describe Isuprel List Four
65 pure Beta + chronotrope + inotrope Sympathomimetic Catecholamine
66 What would Isuprel do directly to BP?
67 lower it, cause hypotension What would it do indirectly to the BP?
68 Your patient is in A Fib, HR of 220. You want to slow the rate with a medication. List two that would be appropriate.
69 Verapamil Diltiazem What are the other names for the above drugs?
70 What are the actions of these two drugs? List MAIN three
71 Negative chronotrope (at AV) Negative inotrope Coronary and peripheral vasodilation
72 Why might the CCB cause CHF or make it worse? Which one is worse at the above?
73 They are both negative inotropes Verapamil is the stronger inotrope, not a big worry in Diltiazem
74 You would administer Dilt/Verap to Narrow QRS tachy only in what situation?
75 if Adenosine had not worked
76 The CCB are contraindicated in what TACHY rhythms? Name TWO, be specific.
77 WPW in A Fib V tach Any wide QRS tachy of unknown origin Also-- Sick Sinus Syndrome Second/Third degree block
78 Your pt received?? at the Urgent Care for her Tachy. You must not give the pt a CCB now. What is the drug?
79 Beta Blocker IV
80 Describe the 1 st AND 2 nd dose of Diltiazem. Be specific
81 0.25 mg/kg over 2 minutes is reasonable first dose In 15 minutes repeat dose is 0.35 mg/kg over 2 minutes is a reasonable dose for the average pt
82 Describe the first and second dose of Verapamil Be Specific
83 Initial dose 5 mg IV bolus Repeat dose 5-10 mg in minutes if dysrhythmia persists and no adverse response to first dose
84 What may be tried prior to the admin of CCB in a stable patient?
85 Vagal maneuvers
86 Your pt is in A fib, hypotensive and deteriorating rapidly you should
87 Cardiovert If patient is unstable in ANY tachycardia, cardioversion rules!
88 You have overdosed your patient with Verapamil. What drug could you give to attempt to prevent toxic effects?
89 Calcium Chloride
90 What is the dose of Calcium?
91 mg 10% solution
92 Administer with extreme caution IF AT ALL to patients on
93 Digoxin, Digitalis etc May precipitate what?
94 What is a non-overdose indication of CA++? How does Calcium help in this setting?
95 Known or suspected hyperkalemia helps stabilize the myocardial cell membrane
96 What does Bicarb do? Talk Chemistry!
97 decreases acid by combining with H+ and then with ventilation eliminating CO2
98 What must the patient be doing when giving Bicarb?
99 Breathing! on their own or via ETT
100 What is the dose of Bicarb?
101 1 meq/kg or?
102 Never mix with.. Name TWO
103 Calcium Catecholamines
104 What overdose would you use Bicarb for?
105 Cyclic Antidepressant
106 What are the indications for Mag Sulfate? Name Three
107 Torsade de Pointes Eclampsia Asthma life threatening dysrhythmias due to dig toxicity
108 What is the dose of Mag when treating Torsade? Both pulseless and with a pulse
109 1-2 grams diluted in 10 ml D5W pulseless 1-2 grams in ml D5W with a pulse
110 What are two actions of Mag that would help treat Eclampsia?
111 Smooth muscle relaxer =vasodilation CNS depressant
112 What are the two main actions of Adenosine?
113 Negative chronotrope Weak bronchoconstrictor so..cautious with what patients?
114 What are the top three side effects of Adenosine? They occur commonly.
115 Facial Flushing Dyspnea Chest pressure/pain
116 Describe the dosing of Adenosine, including max.
117 6 mg IV bolus over 1-3 seconds repeat in 1-2 minutes 12 mg may repeat a second 12 mg total dose 30 mg
118 For Adenosine to be most effective List four steps for administration
119 Start IV proximal, close to central circ Give as close to injection site as possible Inject rapidly Administer a small bolus of fluid (20ml) and elevate arm
120 Describe how Adenosine is beneficial in A Fib/Flutter
121 May help to diagnose but will not treat
122 What are the Sympathetic NS actions of Amiodarone?
123 Alpha blocker Vasodilation Beta blocker negative chronotrope negative inotrope negative dromotrope
124 What channels does it affect?
125 Na K Ca Thus -slows conduction through vents -slows heart rate and AV node conduction -increases refractory period (atria/vent)
126 What two PNB rhythms may receive Amiodarone?
127 V TACH V FIB Why would you never give this drug to PEA or Asystole?
128 What are the side effects of Amiodarone? List two and describe why they are side effects.
129 Hypotension alpha blocker Brady beta blocker AV block beta block and calcium blocked TDP increase QT
130 Amiodarone dose in PNB is
131 300 mg IV/IO second dose in 3-5 minutes consider 150 mg in practice most do not dilute mls/20-30 mls D5W
132 Amiodarone dose in Tachy WITH a pulse is
133 150 mg in 100 ml D5W over 10 minutes (15mg/min) no one uses this May repeat every 10 minutes as needed
134
135 Rhythm is WPW with A fib The two drugs used to treat this rhythm are?
136 Procainamide should be given until List all 4
137 dysrythmia is suppressed QRS duration increases by > 50% hypotension occurs total dose of 17 mg/kg is administered
138 Procainamide decreases excitability in what part of the heart?
139 Atria Purkinje fibers Ventricles
140 Do not use Procainamide in what ventricular rhythm?
141 Torsades Why? Do not give with what drug because they both do the same as above?
142 A patient is in Ventricular escape at a rate of 40 with frequent PVCs. What would happen to the rhythm if Lidocaine was given?
143 Lidocaine (or Pronestyl or Cordarone) could eliminate all ventricular response and patient could go into Asystole.
144 What action does Lido have that Amiodarone nor Procainamide have?
145 It helps decrease an elevation in ICP it is an anesthetic
146 Lidocaine, because it is an anesthetic has CNS side effects. List Four
147 Altered LOC Slurred speech Visual disturbances Muscle twitching Seizures
148 The end are you exhausted?
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