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13 Cards in this Set
- Front
- Back
Amiodarone (Cordarone, Pacerone)
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Class- Antiarrhythmic
Mechanism of action- Sodium, Potassium channel Blocker Indications- V-fib/pulseless V-tach and unstable V-tach in patients refractory to other therapy. Contraindications- Allergic, cardiogenic shock, sinus bradycardia and second- or third-degree AV block Adverse reactions- Hypotension, bradycardia, prolongation of the P-R,, QRS, and Q-T intervals. How supplied- Ampules containing 150 mg/3 mL (50 mg/mL) and prefilled syringes containing 150 mg/3 mL (50 mg/mL) . Dosage- Symptomatic v-fib/pulseless v-tach 300 mg IV/IO push (diluted in 20–30 mL D5W). Initial dose can be followed one time in 3–5 minutes at 150 mg IV/IO push. Recurrent life-threatening ventricular arrhythmias: Maximum dose is 2.2 g/24 hours, Special considerations Pregnancy safety: Category D. Monitor patient for hypotension. May worsen arrhythmias or precipitate new arrhythmias |
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Aspirin
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Class- Platelet inhibitor, anti-inflammatory.
Mechanism of action- Prostaglandin inhibition. Indications New onset chest pain. Signs and symptoms suggestive of recent cerebrovascular accident. Contraindications- active ulcer disease or asthma. Adverse reactions- Heartburn, GI bleeding, prolonged bleeding, N/V . Drug interactions- Use with caution in patients allergic to NSAIDs. Dosage and administration- 160 mg to 325 mg PO (chewed if possible). Special considerations Pregnancy safety: Category D. Not recommended in pediatric population. |
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Atropine Sulfate
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Class- Anticholinergic
Mechanism of action- Parasympatholytic: inhibits action of acetylcholine increases heart rate in symptomatic bradys Indications- Hemodynamically unstable bradycardia, asystole, bradycardic (< 60 beats/min) PEA, organophosphate poisoning, bronchospastic pulmonary disorders Contraindications -Tachycardia, unstable cardiovascular status in acute hemorrhage and myocardial ischemia Adverse reactions- Headache; dizziness; palpitations; N/V,tachycardia; arrhythmias; flushed, hot, dry skin. Supplied in- Prefilled syringes: 1 mg in 10 mL (0.1 mg/mL). Nebulizer: 0.2% (1 mg in 0.5 mL) and 0.5% (2.5 mg in 0.5 mL). Dosage and administration- Asystole or bradycardic PEA: 1 mg IV/IO push. May repeat every 3–5 minutes to a maximum of 3 doses (3 mg). Unstable bradycardia: 0.5 mg IV/IO every 3–5 minutes as needed, not to exceed total dose of 3 mg Special considerations Pregnancy safety: Category C. Moderate doses may cause pupillary dilation. |
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Diltiazem Hydrochloride (Cardizem,
Lyo-Ject) |
Class- Calcium channel blocker.
Mechanism of action- Blocks calcium ions from cardiac muscle; prevents spasm of coronary arteries. Arterial and venous vasodilator. Reduces preload and afterload. Reduces myocardial oxygen demand. Indications- Control of rapid ventricular rates due to A-flutter, A-fib, and re-entry SVT; Angina pectoris. Contraindications- Hypotension, sick sinus syndrome, second- or third-degree AV block, cardiogenic shock, wide-complex tachycardias, poison/drug-induced tachycardia. Adverse reactions Bradycardia, second- or third-degree AV blocks, chest pain, CHF, syncope. V-Fib, V-tach, nausea, vomiting, dizziness, dry mouth, dyspnea, headache. How supplied- 25 mg/5-mL vial; 50 mg/10-mL vial. Nonrefrigerated: Lyo-Ject syringe. Dosage and administration- Initial bolus: 0.25 mg/kg (average dose 15–20 mg) IV over 2 minutes. may rebolus in 15 minutes: 0.35 mg/kg (average dose 20–25 mg) IV over 2 minutes. Maintenance infusion of 5–15 mg/h Special considerations Pregnancy safety: Category C. Use with caution in patients with renal or hepatic dysfunction. PVCs may be noted at time of conversion of PSVT to sinus rhythm. |
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Dopamine (Intropin)
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Class- Sympathomimetic, inotropic agent.
Mechanism of action- Increases systemic vascular resistance, dilates renal and splanchnic vasculature. Increases myocardial contractility and stroke volume. Indications- Cardiogenic, septic or spinal shock, hypotension with low cardiac output states, distributive shock. Contraindications- Hypovolemic shock, tachyarrhythmias, V-fib. Adverse reactions- Cardiac arrhythmias, hypertension, increased myocardial oxygen demand; extravasation may cause tissue necrosis. How supplied- 200 mg/5 mL–400 mg/5 mL prefilled syringes, ampules for IV infusion; 400 mg in 250-mL D5W premixed solutions. Dosage- 2–20 mcg/kg/min titrated to patient response Always monitor drip rate. Avoid extravasation injury. |
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Epinephrine (adrenalin)
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Class- Sympathomimetic
Mechanism of action- Direct-acting alpha- and beta-agonist. Alpha: vasoconstriction. Beta-1: positive inotropic, chronotropic, and dromotropic effects. Beta-2: bronchial smooth muscle relaxation and dilation of skeletal vasculature. Indications Cardiac arrest (V-fib/pulseless V-tach, asystole, PEA), symptomatic bradycardia as an alternative infusion to dopamine, severe hypotension secondary to bradycardia when atropine and transcutaneous pacing are unsuccessful, allergic reactions, anaphylaxis, asthma. Contraindications- Hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock. Adverse reactions- Hypertension, tachycardia, arrhythmias, pulmonary edema, anxiety, restlessness, psychomotor agitation, nausea, headache, angina. How supplied 1:1,000 solution: ampules and vials containing 1 mg/mL. 1:10,000 solution: prefilled syringes containing 1 mg in 10 mL (0.1 mg/mL). Auto-injector (EpiPen): 0.5 mg/mL (1:2,000). Dosage- Mild allergic reactions and asthma: 0.3–0.5 mg (1:1,000) SC. Anaphylaxis: 0.1 mg (1 mL of 1:10,000) IV/IO over 5 minutes. Cardiac arrest: IV/IO dose: 1 mg (10 mL of 1:10,000 solution) every 3–5 minutes during resuscitation. Follow each dose with 20 mL flush and elevate arm for 10 to 20 seconds after dose. |
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Lidocaine Hydrochloride (Xylocaine)
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Class Antiarrhythmic
Mechanism of action- Decreases automaticity by slowing the rate of phase 4 depolarization. Indications- Alternative to amiodarone in cardiac arrest from V-fib/pulseless V-tach, stable monomorphic V-tach, stable polymorphic V-tach with normal baseline QT interval. Contraindications- Hypersensitivity, second- and third-degree AV blocks in the absence of artificial pacemaker, Stokes-Adams syndrome, wide-complex ventricular escape beats with bradycardia. Adverse reactions- Slurred speech, seizures (with high doses), altered mental status, confusion, lightheadedness, blurred vision, bradycardia. How supplied- 100 mg in 5-mL prefilled syringes and ampules (20 mg/mL), 1-g and 2-g additive syringes, 1-g and 2-g vials in 30 mL of solution. Dosage- Cardiac arrest from V-fib/pulseless V-tach: Initial dose: 1–1.5 mg/kg IV/IO. Repeat dose: 0.5–0.75 mg/kg, repeated in 5–10 minutes to maximum dose of 3 mg/kg.. Maximum total dose is 3 mg/kg. Maintenance infusion: 1–4 mg/min (30–50 ìg/kg/min); can dilute in D5W or normal saline. |
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Midazolam (Versed)
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Class- Short-acting benzodiazepine CNS depressant.
Mechanism of action- Anxiolytic and sedative, memory impairment. Indications- Sedation, anxiolytic prior to endotracheal or nasotracheal intubation; administer for conscious sedation. Contraindications- Glaucoma, shock, coma, alcohol intoxication, overdose, depressed vital signs, concomitant use with other CNS depressants, barbiturates, alcohol, narcotics. Adverse reactions- Hiccough, cough, oversedation, N/V, injection site pain, headache, blurred vision, hypotension, respiratory depression, and arrest. How supplied- 2-, 5-, 10-mL vials (1 mg/mL); 1-, 2- , 5-, 10-mL vials (5 mg/mL). Dosage- 2.0–2.5 mg slow IV over 2–3 minutes; may be repeated to total maximum: 0.1 mg/kg. |
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Morphine Sulfate (Astramorph)
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Class- Opioid analgesic (schedule II narcotic)
Mechanism of action- Alleviates pain through CNS action, suppresses fear and anxiety centers in brain; depresses brain stem respiratory centers, decreases preload and afterload, which decreases myocardial oxygen demand. Indications- Severe CHF, pulmonary edema, chest pain associated with acute MI, analgesia for moderate to severe acute and chronic pain (use with caution). Contraindications- Head injury, exacerbated COPD, depressed respiratory drive, hypotension, undiagnosed abdominal pain, AMS, suspected hypovolemia Adverse reactions- Respiratory depression, hypotension, AMS, N/V, bradycardia, tachycardia, syncope, facial flushing, euphoria, bronchospasm, dry mouth. How supplied 10 mg in 1 mL of solution, ampules, and Tubex syringes. Dosage- Initial dose: 2–4 mg IV (over 1–5 minutes) every 5–30 minutes. Repeat dose: 2–8 mg at 5- to 15-minute intervals. |
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Norepinephrine (Levophed, Levarterenol)
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Class Sympathomimetic.
Mechanism of action- Potent alpha-agonist resulting in intense vasoconstriction; positive chronotropic and increased inotropic effect with increased cardiac output. Indications- Cardiogenic shock, significant hypotensive (< 70 mm Hg) states. Contraindications- Hypotensive patients with hypovolemia, pregnancy (relative contraindication). Adverse reactions- Headache, arrhythmias, tachycardia, reflex bradycardia; angina pectoris, hypertension; decreased blood flow to gastrointestinal tract, kidneys, skeletal muscle, and skin. How supplied 1-mg/mL, 4-mL ampules. Dosage- Dilute 8 mg in 500 mL of D5W or 4 mg in 250 mL of D5W (16 mg/mL); infuse by IV piggyback at 0.5–1.0 mcg/min, titrated to improve blood pressure (up to 30 mcg/min) |
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Phenytoin (Dilantin)
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Class Anticonvulsant.
Mechanism of action- Promotes sodium efflux from neurons, thereby stabilizing the neuron’s threshold against excitability caused by excess stimulation; in similar fashion, decreases abnormal ventricular automaticity and decreases the refractory period in the myocardial conduction system. Indications- treatment of major motor seizures, digitalis-induced arrhythmias. Contraindications- bradycardia, second- and third degree heart block. Adverse reactions- Hypotension with too rapid IV push, heart block, arrhythmias, cardiovascular collapse, N/V, ataxia, central nervous system depression, pain at injection site, respiratory depression. How supplied 50 mg/mL in 2- and 5-mL ampules, 2-mL prefilled syringes. May be diluted in normal saline (NS) (1–10 mg/mL); use in-line filter. Note: IV line should be flushed with 0.9% NS before and after drug administration. Dosage- Seizures: 10–20 mg/kg slow IV, not to exceed 1 g or rate of 50 mg/min). Arrhythmias: 50–100 mg (diluted) slow IV every 5–15 min PRN; maximum, 1 g. |
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Diazepam (Valium)
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Class- Benzodiazepine, sedative-hypnotic, anticonvulsant.
Mechanism of action- Potentiates effects of inhibitory neurotransmitters. Raises seizure threshold. Induces amnesia and sedation. Indications- Acute anxiety states, acute alcohol withdrawal (delirium tremens), muscle relaxant, seizure activity, agitation., cardioversion. Contraindications- Hypersensitivity, glaucoma, coma, shock, substance abuse, head injury. Adverse reactions- Respiratory depression, hypotension, drowsiness, ataxia, reflex tachycardia, nausea, confusion, thrombosis. How supplied 10 mg/5-mL prefilled syringes, ampules, vials, and Tubex. Dosage- 5–10 mg IV q10–15 minutes prn (5 mg over 5 min) (maximum dose, 30 mg) |
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Digoxin (Lanoxin)
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Class Inotropic agent.
Mechanism of action- Rapid-acting, increase force of myocardial contraction, increase refractory period of AV node, and increase total peripheral resistance. Indications- CHF, re-entry SVT, especially a- flutter and a-fib. Contraindications- Ventricular fibrillation, ventricular tachycardia, digitalis toxicity, hypersensitivity to digoxin. Adverse reactions- Headache, weakness, blurred yellow or green vision, confusion, seizures, arrhythmias, nausea, vomiting, and skin rash. How supplied- 2-mL ampules of 0.5 mg digoxin; also as tablets, capsules, and elixirs. Dosage- Loading dose of 10 to 15 mcg/kg. |