Term
| Atropine. Epinephrine. Lidocaine. Amiodarone. Procainamide. MagSulfate. Adenosine. Verapamil. Diltiazem. Procardia. Propanolol. Esmolol. Atenolol. CaCl. |
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Definition
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Term
| Norepinephrine. Phenylephrine. Dopamine. Dobutamine. Vasopressin. Nitroglycerin. Morphine. Sodium Nitroprusside. Hydralazine. Inamrinone. Milrinone. Digitalis. Furosemide. |
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Definition
| Vasopressor and Vasodilator Agents |
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Term
| Heparin. ReoPro. Aggrastat. Bivalirudin. Argatroban. Integrilin. Protamine Sulfate. Activase(tPA). Retavase. |
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Definition
| Anticoagulants and Antagonists |
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Term
Sodium channel blockers
-Block fast Na+ channels needed for phase 0 depolarization of action potential
3 SubClasses: 1a 1b 1c. |
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Definition
Vaugh-Williams Antiarrhythmics
Class 1 |
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Term
Moderate Na+ blockade
-Prolongation of repolarization
Quinidine. Procainamide |
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Definition
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Term
Mild Na+ blockade
-Shortens repolarization
Lidocaine. Phenyoin |
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Definition
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Term
Marked Na+ blockade
No change in repolarization
Flecanide. Propafenone |
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Definition
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Term
Beta-adrenergic antagonists
Inhibits sympathetic nervous activity
Decrease HR(chronotropy)& contractility(in otropy)
metoprolol. propanolol |
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Definition
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Term
Potassium channel blockade
May also possess A & B-adrenergic and CCB properties
Main effect: prolong refractory periods
amiodarone. sotalol. Ibutilide |
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Definition
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Term
Calcium-channel blockers
Decrease SA & AV nodal conduction, as well as cardiac contractility
Diltiazem. Verampamil. |
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Definition
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Term
During AMI= higher doses in short time
Has a pulse= smaller dose, long time
EXCEPTION= Adenosine, rapid due to short half-life.
FLUSH WITH 10-20ML OF IV FLUID |
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Definition
Intravenous meds in emergencies.
Follow with 1-2min of CPR |
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Term
Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine
Double Dose because of losses in tube and large alveolar area |
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Definition
Endotracheal Route Meds via ETT
N
A
V
E
L
Dilute with 10ml NS
Instill deep into trachea, follow with PPV |
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Term
0.5 if they're alive.1 if they're dead every 3-5min.
Full vagolytic dose 0.4mg/kg or 3mg total
Asystole, 1mg every 3-5min
Endotracheal atropine, 1-2mg diluted in 10ml NS or sterile H20 |
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Definition
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Term
Parasympatholytic
Anticholinergic
Vagolytic |
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Definition
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Term
| Alpha vasoconstricts sending blood to heart making it pump faster/harder to get the blood out. Beta1 affects HR/squeeze. Beta2 affects lungs. |
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Definition
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Term
Brady arrhythmias / asystole
Bradycardia
Junctional escape rhythm
2nd Degree, 1 or 2
3rd Degree, narrow QRS or new, wide QRS
Class IIB asystole
PEA |
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Definition
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Term
<0.5mg can cause bradycardia due to central/peri parasympathomimetic effect
-avoid multidose in ischemic disease
-Admin 0.5mg dose
-V-fib/V-tach possible after admin
-Excessive dose can cause anticholinergic syndrome: Delium, Tachy, coma, Flushed, ataxia, blurred vision |
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Definition
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Term
Anhidrosis
Anticholinergic psychosis
Blurred vision
bradycardia
dilation of pupils
drymouth
urinary retention |
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Definition
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Term
Vasopressor
Vasoconstrictor
Natural catecholamine |
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Definition
Epinephrine
Classification |
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Term
Alpha/Beta stimulation
Peripheral vasoconstrictor
(+) coronary/cerebral perfusion
Favorable redistribution of blood during MI
During MI:(+)Coronary/central flow, Inotropic state, Automaticity, MVO2, SVR, BP, HR |
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Definition
Epinephrine
Mechanism of Action |
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Term
MI from:
V-fib
Pulseless V-tach
Asystole
PEA
Tx of bradycardia unreactive to Atropine/Dopamine |
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Definition
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Term
May cause MI
May induce ventricular ectopy
Discontinue continuous IV infusion
Don't mix with Sodium Bicarbonate (forms a precipitate) |
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Definition
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Term
Inhalant anesthetics containing epi
HTN
During childbirth
Hyperthyroidism
Organic Brain Syndrome
Current Digitalis use |
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Definition
Epinephrine
Contraindications |
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Term
Anxiety, Dizziness, dyspnea, palpitations, cerebrovascular hemorrhage, fibrillation, H/A, Pulmonary edema, pupil dilation
tachy, death |
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Definition
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Term
IV, ETT
1mg every 3-5min during CPR
ETT is 2x normal the IV dose |
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Definition
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Term
| Ventricular antiarrhythmic |
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Definition
Lidocaine
Medication classification |
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Term
Decreases automaticity. Suppresses Ventricular arrhythmias
-may terminate reentrant V arrhythmias
-further depresses conduction in reentrant pathways
-reduces slope of phase 4 diastolic depolarization
-During AMI, threshold to induce V-fib is lowered
-Elevate fibrillation threshold
Doesn't affect BP, Contractility.
May improve AV conduction. |
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Definition
Lidocaine
Mechanisms of Action |
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Term
Use first for:
Ventricular ectopy
V-tach
Wide complex tachy
may improve AV conduction
prevent recurrent V-Fib after terminating V-Fib/V-tach
Patients with risk for malignant ventricular arrhythmias
Hypokalemia
MI
Significant ventricular dysfunction |
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Definition
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Term
Observe for toxicity
Sedation, disorientation
decreased hearing, parasthesia
agitation, twitching
SEVERE SIDE EFFECTS:
Grand Mal seizures
Respiratory Arrest
TX OF TOXICITY:
stop lidocaine. Admin anticonvulsants if necessary |
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Definition
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Term
sensitivity to lidocaine
Stokes-Adams syndrome
Heart block without pacemaker installed |
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Definition
Lidocaine
ContraIndications |
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Term
Excessive Dose can produce:
Myocardial depression
heart block
Depress spontaneous discharge from SA node |
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Definition
Lidocaine
Adverse Reactions |
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Term
IV and ETT routes
ETT: 2-2.5x IV dose(2-2.5mg/kg)
Admin 100mg/10ml syringe
Follow with forceful Ambubag
Non-cardiac arrest: bolus of 1-1.5mg/kg drip(2-4mg/min)
2nd bolus of 0.5mg/kg after 10mins
Additional bolus 0.5-.75mg/kg every 5-10min up to 3mg/kg
Start a Lidocaine drip of 2-4mg/min |
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Definition
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Term
Refractory V-Fib or pulseless V-Tach the initial bolus should be 1-1.5mg/kg
Maintenance dose decreased by 50% in patients with:
Impaired Hepatic blood flow
AMI
CHF
>70 years old
Circulatory shock
half-life is increased after 24-48hrs of continuous infusion therapy |
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Definition
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Term
Supplied in:
100mg/5ml syringe
1g/5ml and 2g/5ml syringes to prepare continuous infusions
Premixed 250ml IV bag = 1gm
Premixed 500ml IV bag = 2gm |
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Definition
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Term
| Atrial and Ventricular antiarrhythmic |
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Definition
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Term
Effects Na+, K+, Ca2+ channels
A & B adrenergic blockade
Coronary & peripheral vasodilation
Calcium blockae lengthens the effective refractory period in cardiac tissue and bypass tract.
Sodium channel blockade inhibits inactivated sodium channels at high stimulation frequencies. |
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Definition
Amiodarone
Mechanism of Action |
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Term
Ventricular rate control of rapid atrial arrhythmias with severe dysfunction refractory to Digitalis
-AFTER defib/epi with persistent V-fib an V-tach arrest
-Polymorphic V-tach, wide complex tachy of unknown origin, but stable
Adjunct to electrical cardioversion of PSVT
Chemical conversion if A-fib
Control rapid ventricular rate due to accessory pathway conduction in preexcited atrial tissue
Atrial/Ventricular arrythmias with severe dysfunction |
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Definition
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Term
Hypotension, Brady, AV block, Must be filtered and placed in glass. DON'T SHAKE
Contraindication: Hypotension |
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Definition
Amiodarone
Precautions, Contraindication |
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Term
Pulmonary Fibrosis
Infiltration
Corneal lipofusion deposits
Skin photosensitivity |
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Definition
Amiodarone
Adverse Reactions |
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Term
IV, PO(tablets).
V-fib/V-tach arrest 300mg IV bolus
Atrial or Vent arrhythmias: 150mg/10min
Then, 1mg/min for 6hr, then 0.5mg/min
May repeat the 150mg slow bolus PRN
Max total dose is 2gm/day |
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Definition
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Term
(-)dromotropy, prolongs phase when heart came be stimulated, and recovery when it can't
Suppress ventricular ectopy, effective when lidocaine doesn't work
Suppresses phase4 diastolic depolarization reducing automaticity of ectopic pacemaker
Slows intraventricular conduction by reducing slope of phase 0 action potential
Ischemia-induced slowing of conduction may be slowed further terminating re-entry |
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Definition
Procainamide (Pronestyl)
Ventricular antiarrhythmic
MOA |
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Term
Is acceptable/helpful in persistant cardiac arrest due to V-fib
-rarely used in V-fib due to long admin time
-suppressing PVCs an recurrent V-tach refractory to lidocaine
-WPW A-fib and A-flutter |
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Definition
Procainamide (Pronestyl)
Indications |
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Term
Potent vasodilator, modest (-)inotropy
Caution in AMI
Hypotension after rapid IVP
widening QRS
Lengthening of PR & QT intervals shows blocks or arrest |
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Definition
Procainamide (Pronestyl)
Precautions |
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Term
Complete AV block
2nd & 3rd degree heart blocks
Torsade de pointes
Past reaction to drug |
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Definition
Procainamide (Pronestyl)
Contraindications |
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Term
Anorexia
Bruising
Hypotension with a BP drop over 15mmHg
PR interval prolongation
QRS complex widening
Asystole
V-fib
V-tach |
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Definition
Procainamide (Pronestyl)
Adverse Reactions |
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Term
Only comes in IV
PVCs/V-tach give 20-30mg/min until:
Hypotension
QRS widens by 50%
17mg/kg is given
maintenance continuous rate is 1-4mg/min
Reduced dose in: dysfunction & Renal failure
Supplied: 10x100mg vial
2x500mg vial |
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Definition
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Term
lower post-MI ventricular arrhythmias
Hypomagnesemia precipitates V-fib, hinders replenishment of intracellular K+. Also linked to Sudden Cardiac Death & arrhythmias |
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Definition
Magnesium Sulfate
Ventricular Antiarrhythmic
MOA |
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Term
low Mag with anterior MI
Torsades de Pointes (Tx of choice)
Severe refractory V-fib |
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Definition
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Term
Hypotension. Asystole
Admin within 2hr of Heart Block, Myocardial damage |
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Definition
Mag
Precautions, Contra-Indications |
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Term
IV
Complete Heart Block
Respiratory Depression/Failure |
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Definition
Mag
Route
Adverse Reactions |
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Term
For V-fib/V-tach
1-2g in 100ml NS over 1-2min
Post-MI:
1-2g in 50-100ml over 5-60min |
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Definition
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Term
Can test heart for CAD
Slows AV node conduction
Terminates PSVT
causes transient AV or VA block in beats not due to reentry
Helps clarify Dx for:
A-flutter, A-fib, A/V tachy
Short lived response
With 5sec half-life, PSVT may reoccur |
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Definition
Adenosine
Supraventricular Antiarrhythmic
MOA |
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Term
PSVT
wide complex unknown tachy
A-fib/flutter
will not stop beat, could help Dx |
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Definition
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Term
Side effects common, but 1-2mins
dyspnea, chest pain
brady & V ectopy after ending SVT
Caution pts w Hx:
brady
conduction defects
denervated transplanted hearts |
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Definition
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Term
IV only.
6mg over 1-3sec, 20ml flush
No response after 1-2min, again w 12mg
Still no response, repeat 12mg |
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Definition
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Term
These drugs block Adenosine:
Theophylline
Caffeine
Thebromine
Dipyridamole, blocks uptake, potentiates its effects |
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Definition
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Term
3:2 Na+ ratio inside cell
3:2 K+ ratio outside cell
Nerves: -70mV
Pacemaker: -45 to -60mV
Muscle -90mV |
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Definition
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Term
Resting Potential
repolarized by Na/K pumps
Magnesium supply needed for pumps to work correctly |
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Definition
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Term
Rapid Depolarization.
Vertical upstroke on graph
Stimulus applied to cell
Na+ rushes in moving cell towards (+) |
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Definition
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Term
Vertical Overshoot
closure of Na+ channels
K+ leak from cell moving line back down |
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Definition
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Term
Plateau
Ca+ enters cell causing contraction in a slow, sustained manner |
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Definition
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Term
Sudden increase in repolarization
K+ into cell causes rapid (-) return
Na/K pumps causing restoration |
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Definition
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Term
First half of action potential
can not be stimulated |
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Definition
| Absolute Refractory Period |
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Term
2nd half of action potential
stimulated with a strong stimulus |
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Definition
| Relative Refractory Period |
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Term
vasodilation
Tx chest pain from angina, HTN
Blocks Ca+ and some Na+
Vasodilation from Ca+ & a1 block
Primary action on 2 nodes
LENGTHEN REFRACTORY PERIOD of AV node limiting response to:
A-fib/flutter. reduces afterload, (-)inotropy. 5-10mg will maintain CO even in moderate disease. |
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Definition
Verapamil(Isoptin)
CCB class IV
MOA |
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