CARDIAC DRUG REVIEW. WHAT DO YOU “SEE” WHEN YOU STIMULATE BETA.
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Transcript of CARDIAC DRUG REVIEW. WHAT DO YOU “SEE” WHEN YOU STIMULATE BETA.
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CARDIAC DRUG REVIEW
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WHAT DO YOU “SEE” WHEN YOU STIMULATE BETA
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VASODILATEBRONCHODILATE+CHRONOTROPE+INOTROPE
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EPI’S OTHER NAME?
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ADRENALIN
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WHAT DOES EPI DO THAT NOREPI AND DOPAMINE DO NOT DO?
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BETA 2BRONCHODILATOR
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1:1000 MEANS?
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1 GRAM/1000 ML
1MG/1ML
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WHO IS THIS 1:1 GIVEN TO?
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ALIVE PATIENTSASTHMA/ALLERGIC
REACTIONSAFEST ROUTE
DOSE?How many mls is each dose?
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HOW DO YOU MIX AN EPI INFUSION?
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1 MG /250 ML
RUN AT ?
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Epi is given first line to what pulseless rhythms?
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V FibV TachAsystolePEA
How often?What dilution?
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Why is Epi given during a resusucitation?
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Alpha action-vasoconstriction throughout body
Perfuses the heart and brainCPR directs perfusion to the
above
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Use ANS terms to describe Epinephrine.
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Alpha stimulatingBeta stimulatingSympathomimeticAdrenergicCatecholamine
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What are 4 generic rules for ANS pressor agents?
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Don’t abruptly DC infusion/taper
BP must be monitoredin Trauma-never first lineTissue sloughing may
occur-watch site
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What are 4 generic rules for Catecholamines?
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Bicarb inactivates themAssess if currently on a Symp drugif on Beta Blocker may need to increase doseDo not work if pH to acid (below 7.2)
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Other names for Dopamine?
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Intropin
Dopastat
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How is Dopamine different from the other alpha agents?
List FIVE
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No IV bolusInfusion onlyDopaminergic-dilates
renal/mesentericCauses hypotensionGiven based on weight
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Mix a Dopamine drip?
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400 mg/250 ml
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The Dopaminergic effects occur MAINLY at what rate?
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1-4 mcg/kg/min
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Describe what happens when Dopamine is infused at 5-10 mcg/kg/min.
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primarily Betasome vasoconstriction, more closer to 10
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10-20 mcg/kg/min of Dopamine results in
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predominately alpha actions with substantial vasoconstriction
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Finish this-at 10 mcg/kg/ min you run Dopamine at
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20 or 30 or 40
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Your patient is in cardiac arrest. What drugs could you administer via the ETT?
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EpinephrineVasopressin
Don’t really give these anymore-but OK ETLidocaineAtropine
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Indications for Vasopressin?
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Cardiac arrest
don’t worry abouthemodynamic support in vasodilatory shock
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Dose of Vasopressin?
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40 units
How many times can you repeat the dose?
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How is Vasopressin different from the other pressors?
List Four
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Not alpha, ANS, sympathetic, Beta, etc
Bolus only“units”not as bad at irritating/stimulating
the heartlong half life-10-20 minutes
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What are the S&S of Symptomatic Bradycardia?
List Five
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hypotensionaltered LOCsigns of shockischemic chest discomfortacute heart failure
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First line drug for the treatment of symptomatic bradycardia isWHY?
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ATROPINEonly action is to increase
heart rate, no other demand on the heartWhat is the first line NON drug for
the rx of symptomatic brady?
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Describe Atropine using ANS words.
List Four
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Parasympatholytic+ chronotropeAnticholinergicParasympathetic blockingVagolytic
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What is a non-cardiac use for Atropine?
Describe
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Organophosphate poisoning
Organophosphates stimulate the Parasympathetic nervous system. Atropine blocks this.
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What is the dose of Atropine?
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0.5 mg IV bolus
What may happen if you give less than that?
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Total dose of Atropine?
Two answers!
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3 mg0.04 mg/kg
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What side effect of Atropine interferes with your assessment?
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Dilates pupils!
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Atropine may not work in symptomatic brady if the patient is
WHY?
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hypotensive or has myocardial hypoxiacan’t get to where it needs
to goORheart cannot respond
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Another + chronotrope you could give AFTER Atropine, Dopamine, Epi and a TCP is
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ISUPREL!
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Using ANS terms, describe Isuprel
List Four
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pure Beta+ chronotrope+ inotropeSympathomimeticCatecholamine
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What would Isuprel do directly to BP?
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lower it, cause hypotension
What would it do indirectly to the BP?
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Your patient is in A Fib, HR of 220. You want to slow the rate with a medication.
List two that would be appropriate.
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VerapamilDiltiazem
What are the other names for the above drugs?
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What are the actions of these two drugs?
List MAIN three
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Negative chronotrope (at AV)Negative inotropeCoronary and peripheral
vasodilation
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Why might the CCB cause CHF or make it worse?
Which one is worse at the above?
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They are both negative inotropes
Verapamil is the stronger inotrope, not a big worry in Diltiazem
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You would administer Dilt/Verap to Narrow QRS tachy only in what situation?
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if Adenosine had not worked
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The CCB are contraindicated in what TACHY rhythms?
Name TWO, be specific.
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WPW in A FibV tachAny wide QRS tachy of unknown
originAlso--
Sick Sinus SyndromeSecond/Third degree block
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Your pt received ?? at the Urgent Care for her Tachy.You must not give the pt a CCB now.
What is the drug?
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Beta Blocker IV
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Describe the 1st AND 2nd dose of Diltiazem.
Be specific
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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
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Describe the first and second dose of Verapamil
Be Specific
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Initial dose 5 mg IV bolusRepeat dose 5-10 mg in 15-30
minutes if dysrhythmia persists and no adverse response to first dose
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What may be tried prior to the admin of CCB in a stable patient?
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Vagal maneuvers
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Your pt is in A fib, hypotensive and deteriorating rapidly you should…
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Cardiovert
If patient is unstable in ANY tachycardia, cardioversion rules!
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You have overdosed your patient with Verapamil.
What drug could you give to attempt to prevent toxic effects?
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Calcium Chloride
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What is the dose of Calcium?
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500-1000 mg
10% solution
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Administer with extreme caution IF AT ALL to patients on
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Digoxin, Digitalis etc
May precipitate what?
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What is a non-overdose indication of CA++?
How does Calcium help in this setting?
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Known or suspected hyperkalemiahelps stabilize the myocardial cell
membrane
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What does Bicarb do?
Talk Chemistry!
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decreases acid by combining with H+ and then with ventilation eliminating CO2
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What must the patient be “doing” when giving Bicarb?
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Breathing!
on their own or via ETT
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What is the dose of Bicarb?
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1 mEq/kg
or ?
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Never mix with…..
Name TWO
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CalciumCatecholamines
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What overdose would you use Bicarb for?
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Cyclic Antidepressant
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What are the indications for Mag Sulfate?
Name Three
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Torsade de PointesEclampsiaAsthma
life threatening dysrhythmias due to dig toxicity
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What is the dose of Mag when treating Torsade?
Both pulseless and with a pulse
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1-2 grams diluted in 10 ml D5W
pulseless1-2 grams in 50-100 ml D5W
with a pulse
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What are two actions of Mag that would help treat Eclampsia?
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Smooth muscle relaxer
=vasodilationCNS depressant
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What are the two main actions of Adenosine?
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Negative chronotropeWeak bronchoconstrictor
so..cautious with what patients?
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What are the top three side effects of Adenosine?
They occur commonly.
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Facial FlushingDyspneaChest pressure/pain
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Describe the dosing of Adenosine, including max.
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6 mg IV bolus over 1-3 seconds
repeat in 1-2 minutes 12 mgmay repeat a second 12 mgtotal dose 30 mg
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For Adenosine to be most effective…
List four steps for administration
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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
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Describe how Adenosine is beneficial in A Fib/Flutter
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May help to diagnose but will not treat
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What are the Sympathetic NS actions of Amiodarone?
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Alpha blockerVasodilation
Beta blockernegative chronotropenegative inotropenegative dromotrope
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What “channels” does it affect?
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NaKCa
Thus
-slows conduction through vents
-slows heart rate and ↑ AV node conduction
-increases refractory period (atria/vent)
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What two PNB rhythms may receive Amiodarone?
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V TACHV FIB
Why would you never give this drug to PEA or Asystole?
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What are the side effects of Amiodarone?
List two and describe why they are side effects.
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Hypotensionalpha blocker
Bradybeta blocker
AV blockbeta block and calcium blocked
TDP increase QT
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Amiodarone dose in PNB is
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300 mg IV/IOsecond dose in 3-5 minutes
consider 150 mgin practice most do not dilute
10-15 mls/20-30 mls D5W
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Amiodarone dose in Tachy WITH a pulse is
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150 mg in 100 ml D5W over 10 minutes (15mg/min) no one uses this
May repeat every 10 minutes as needed
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Rhythm is WPW with A fib
The two drugs used to treat this rhythm are?
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Procainamide should be given until
List all 4
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dysrythmia is suppressedQRS duration increases by
> 50%hypotension occurstotal dose of 17 mg/kg is
administered
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Procainamide decreases excitability in what part of the heart?
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AtriaPurkinje fibersVentricles
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Do not use Procainamide in what ventricular rhythm?
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Torsades
Why?Do not give with what drug…
because they both do the same as above?
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A patient is in Ventricular escape at a rate of 40 with frequent PVCs. What would happen to the rhythm if Lidocaine was given?
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Lidocaine (or Pronestyl or Cordarone) could eliminate all ventricular response and patient could go into Asystole.
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What action does Lido have that Amiodarone nor Procainamide have?
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It helps decrease an elevation in ICPit is an anesthetic
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Lidocaine, because it is an anesthetic has CNS side effects.
List Four
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Altered LOCSlurred speechVisual disturbancesMuscle twitchingSeizures
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The end…are you exhausted?