Term
| A concentrated mass of a pharmaceutical substance administered intravenously for therapeutic or diagnostic purposes |
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Definition
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Term
Class I
–Sodium channel blockers
–Block what? |
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Definition
| fast sodium channels responsible for phase 0 depolarization of action potential |
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Term
What class provides Moderate sodium blockade and what does it do to Repolarization?
What are some examples? |
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Definition
Class 1a of Antiarrythmic Agents
–Prolongation of repolarization
examples: Quinidine, Procainamide |
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Term
What provides class provides Mild sodium blockade and what does it do to the repolarization?
What are some examples? |
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Definition
Class 1b of Antiarrythmic Agents
–Shortens repolarization
examples: Lidocaine, Phenytoin |
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Term
What provides class provides Marked sodium blockade and what does it do to repolarization?
What are some examples? |
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Definition
Class 1c of Antiarrythic Agents
–No change in repolarization
examples: Flecanide, Propafenone |
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Term
–Beta-adrenergic antagonists
–Inhibits sympathetic nervous activity
–Decrease heart rate and cardiac contractility
What are some examples? |
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Definition
Class 2 Antiarrthmic Agents
examples: Metoprolol, Propanolol |
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Term
–Potassium channel blockade
–May also possess some alpha- and beta-adrenergic and calcium-channel blocking properties
–Main effect: prolonged refractory periods
What are some examples? |
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Definition
Class 3 Antiarrythmic Agents
examples: Amiodarone, Sotalol, Ibutilide |
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Term
| What are some Class 1a antiarrythmic drugs? |
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Definition
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Term
| What are some Class 1b antiarrythmic drugs? |
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Definition
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Term
| What are some Class 1c antiarrythmic drugs? |
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Definition
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Term
–Beta-adrenergic antagonists
–Inhibits sympathetic nervous activity
–Decrease heart rate and cardiac contractility
What are some examples? |
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Definition
Class II Antiarrythmic Agents
Examples: Metoprolol, Propranolol |
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Term
–Potassium channel blockade
–May also possess some alpha- and beta-adrenergic and calcium-channel blocking properties
–Main effect: prolonged refractory periods
What are some examples? |
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Definition
Class III Antiarrythmic Agents
Examples: Amiodarone, Sotalol, Ibutilide |
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Term
–Calcium-channel blockers
–Decrease SA and AV nodal conduction, as well as cardiac contractility
What are some examples? |
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Definition
Class IV Antiarrythmic Agents
Examples: Diltiazem, Verapamil |
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Term
| Atropine sulfate medicine classifications |
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Definition
•Parasympatholytic
•Anticholinergic
•Vagolytic |
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Term
| Excessive doses of Atropine can cause anticholinergic syndrome: |
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Definition
•Delirium
•Tachycardia
•Coma
•Flushed and hot skin
•Ataxia
•Blurred vision |
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Term
| Indications for Epinephrine |
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Definition
•Cardiac arrest resulting from:
•V-fib
•Pulseless V-tach
•Asystole
•PEA |
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Term
| Medication Classifications of Epinephrine |
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Definition
•Vasopressor
•Vasoconstrictor
•Natural catecholamine |
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Term
| What is the primary beneficial effect of epinephrine |
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Definition
| Produces favorable redistribution of blood flow during cardiac arrest |
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Term
Indications for Lidocaine
(Ventricular antiarrhythmic) |
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Definition
First antiarrhythmic to use for treatment of: Ventricular ectopy V-tach Wide complex tachycardia May improve AV conduction To prevent recurrent V-fib after V-tach and V-fib have terminated
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Term
| Lidocaine maintenance dose should be decreased to what percent with what factors? |
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Definition
•In non-cardiac arrest an initial bolus of 1-1.5 mg/kg drip (2-4mg/min)
•2nd bolus of 0.5mg/kg after 10mins
•Additional bolus 0.5 - .75 mg/kg every 5-10min for a maximum dose of 3mg/kg
•Start a Lidocaine drip of 2 - 4 mg/min.
Refractory V-fib or pulseless V-tach the initial bolus should be 1 - 1.5mg/kg
Maintenance dose should be decreased by 50% in patients with: •Impaired hepatic blood flow •Acute MI •CHF •> 70 y/o •Circulatory shock |
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Term
•Effects Na+, K+, and Ca2+ channels
•α and β adrenergic blockade
•Coronary and peripheral vasodilation
•Calcium blockade 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
(Atrial and ventricular antiarrhythmic) |
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Term
Precautions with Amiodarone
(Atrial and ventricular antiarrhythmic) |
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Definition
•Hypotension (most common)
•Bradycardia (most common)
•AV blocks
•Must be filtered and placed in glass
•Do not shake! |
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Term
Contraindication for Amiodarone
(Atrial and ventricular antiarrhythmic) |
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Definition
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Term
Amiodarone Dosages
(Atrial and ventricular antiarrhythmic) |
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Definition
•V-fib/V-tach arrest give 300mg IV bolus
•Atrial or ventricular arrhythmias
•150mg over 10min
•Then, 1mg/min for 6hrs then 0.5mg/min
•May repeat the 150mg slow bolus as needed
•Maximum total dose is 2gm/day |
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Term
Mechanisms of Action for Procainamide (pronestyl)
(Ventricular antiarrhythmic) |
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Definition
| Decreases the speed of electrical conduction through the heart muscle, prolongs the electrical phase during which the heart's muscle cells can be electrically stimulated, and prolongs the recovery period during which the heart muscle cells cannot be stimulated. |
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Term
| rarely used to treat V-fib because of prolonged time required to administer effective doses. |
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Definition
Procainamide
(Ventricular antiarrhythmic) |
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Term
Precautions for Procainamide (Pronestyl)
(Ventricular antiarrhythmic) |
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Definition
•Potent vasodilator and modest negative inotropic effects in patients with dysfunction
•Administer with caution in patients with acute MI.
•Induced hypotension after rapid IV administration
•Adverse effects
•EKG shows widening of QRS
•Lengthening of PR and QT intervals shows block or arrest |
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Term
Procainamide (pronestyl) dosages
(Ventricular antiarrhythmic) |
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Definition
•For PVCs and V-tach dose is 20 - 30mg/min until:
•Arrhythmia is suppressed
•Hypotension occurs
•QRS widens by 50%
•17mg/kg is given
•1.2 gm for 70kg patient)
•In urgent situations up to 30mg/min can be given until the 17mg/kg is given.
•The maintenance, continuous infusion rate is 1 - 4mg/min |
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Term
| Procainamide Dosage should be reduced in patients with |
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Definition
| •Dosage should be reduced in patients with: •dysfunction •Renal failure |
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Term
| supplementation may reduce the incidence of post infarct ventricular arrhythmias. |
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Definition
Magnesium sulfate
(Ventricular antiarrhythmic) |
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Term
Magnesium deficiency is associated with
(Ventricular antiarrhythmic) |
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Definition
•Cardiac arrhythmias
•Sudden cardiac death |
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Term
Adverse Reactions of Magnesium Sulfate
(Ventricular antiarrhythmic) |
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Definition
•Complete heart block
•Respiratory
•Depression
•Failure |
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Term
| Dosages for Magnesium Sulfate |
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Definition
•For V-fib or V-tach:
•1 - 2gm diluted in 100ml normal saline administered over 1 - 2 minutes
•Post MI:
•Loading dose = 1 - 2gm in 50 - 100 ml administered over 5 - 60 minutes |
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Term
| Indications for Atropine Sulfate |
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Definition
| •Hemodynamically significant brady arrhythmias and asystole •Symptomatic •Sinus bradycardia •Junctional escape rhythm •2nd degree block, type 1 •3rd degree block with narrow QRS •2nd degree block, type 2 •3rd degree block with new, wide QRS |
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Term
| What is the starting does of Atropine sulfate? Why should you not administer a dose below that dose? |
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Definition
-Administer Intravenous bolus 0.5 to 1 mg every 3 - 5 minutes until symptoms have resolved
-Doses of < 0.5mg can produce paradoxical bradycardia due to central and peripheral parasympathomimetic effects |
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Term
| What is the full vagolytic dose of Atropine Sulfate? |
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Definition
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Term
| In what types of patients should repeated doses of Atropine Sulfate be avoided? |
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Definition
| In patients with ischemic heart disease |
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Term
| What is a Ectopic Ventricular beat? |
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Definition
| This beat, also called a premature ventricular contraction (PVC), occurs before the beat triggered by the heart's normal function. |
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Term
| When using Epinephrine in cardiac arrest what responses will increase? |
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Definition
-Coronary and cerebral flow
-Inotropic state
-Automaticity
-MVO2, SVR, BP and HR |
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Term
| What should you not mix Epinephrine with? |
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Definition
| •Do not mix with sodium bicarbonate. |
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Term
| What can you use to treat profound symptomatic bradycardia that is refractory to Atropine and Dopamine? |
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Definition
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Term
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Definition
-Standard dose is 1mg
-Every 3-5 minutes during CPR |
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Term
| During acute myocardial ischemia, the threshold for the induction of V-fib can be reduced with what drug? |
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Definition
Lidocaine
(Ventricular antiarrhythmic)
It has also been shown to elevate the fibrillation threshold. |
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Term
Dosages for Lidocaine
(Ventricular antiarrhythmic) |
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Definition
•In non-cardiac arrest an initial bolus of 1-1.5 mg/kg drip (2-4mg/min)
•2nd bolus of 0.5mg/kg after 10mins
•Additional bolus 0.5 - .75 mg/kg every 5-10min for a maximum dose of 3mg/kg
•Start a Lidocaine drip of 2 - 4 mg/min.
•Refractory V-fib or pulseless V-tach the initial bolus should be 1 - 1.5mg/kg |
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Term
| •Torsades de Pointes (treatment of choice) |
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Definition
Magnesium Sulfate
(Ventricular antiarrhythmic) |
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Term
Indications for Magnesium Sulfate
(Ventricular antiarrhythmic) |
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Definition
•Suspected hypomagnesemic state with anterior MI
•Torsades de Pointes (treatment of choice)
•Severe refractory V-fib |
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Term
•Helps to clarify the diagnoses for
•Atrial flutter (A-flutter)
•Atrial fibrillation (A-fib)
•Atrial/ventricular (A/V) tachycardia
•Short lived response
•With a half-life of 5 seconds, PSVT may recur |
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Definition
Adenosine
(Supraventricular antiarrhythmic) |
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Term
Mechanism of Action for Adenosine
(Supraventricular antiarrhythmic) |
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Definition
•Used to bring the heart back into a normal rhythm.
•Not useful for all types of irregular heartbeats
•May be used to test the heart for coronary artery disease
•Slows conduction AV node
•Terminates paroxysmal supraventricular tachycardia (PSVT)
•Includes PSVT with WPW that is due to reentry pathways
•Produces transient AV or VA block in arrhythmias not due to reentry |
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Term
Indications for Adenosive
(Supraventricular antiarrhythmic) |
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Definition
•PSVT
•Wide complex tachycardia of uncertain type
•A-fib or flutter
•Will not terminate arrhythmia, but may clarify the diagnoses |
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Term
| Dosages for Adenosine (Supraventricular antiarrhythmic) |
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Definition
•6 mg rapid bolus over 1 - 3 sec followed by a 20ml flush
•If no response within 1 - 2 min administer 12mg in the same manner.
•If there is still no response, administer another 12mg. |
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Term
Verapamil (Isoptin)
What is the medication classification? |
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Definition
•Supraventricular anti-arrhythmic
•Calcium channel blocker |
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Term
Mechanism of Action for Verapamil (Isoptin)
•Supraventricular anti-arrhythmic
•Calcium channel blocker |
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Definition
| •Calcium-channel blocker •Affects the amount of calcium found in heart and muscle cells. •Relaxes blood vessels, which can reduce the amount of work the heart has to do. •Used to treat chest pain caused by angina, high blood pressure, and controls heart rate in certain conditions •Blocks calcium ions and possibly Na+ ions •The net effect is to lengthen the refractory period of the AV node and limit response to: Atrial flutter and Atrial fibrillation •Reduces afterload •Decreases inotropy |
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Term
Indications for Verapamil (Isoptin)
•Supraventricular anti-arrhythmic
•Calcium channel blocker |
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Definition
•Treatment of PSVT
•Slows ventricular response
•Atrial flutter
•Atrial fibrillation |
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Term
What dose of Verapamil will maintain the Cardiac Output even in moderate disease?
•Supraventricular anti-arrhythmic
•Calcium channel blocker |
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Definition
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Term
Dosages for Verapamil (Isoptin)
•Supraventricular anti-arrhythmic
•Calcium channel blocker |
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Definition
Initial dose is 2.5 - 5.0 mg IV over 2 minutes
Repeat doses are 5 - 10 mg given every 15 - 30 min to a maximum of 20mg.
Supplied in 5mg and 10mg ampules or syringes
Protect from light
Discard if precipitated or discolored |
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Term
| What is the classification of Diltiazem (Cardizem) |
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Definition
| •Supraventricular antiarrhythmic •Ca++ channel blocker |
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Term
Mechanism of Action for Diltiazem (Cardizem)
•Supraventricular anti-arrhythmic
•Calcium channel blocker |
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Definition
•Slow channel activity in cardiac and vascular smooth muscle can be inhibited by Ca++ channel blockers.
•Produces direct potent negative chronotropic effect with only mild direct inotropic effect
•Fewer hemodynamic effects than verapamil
•Less myocardial depression than verapamil in patients with dysfunction
•Slows conduction and prolongs refractoriness in the AV node
•Useful for terminating SVT |
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Term
Indications of Diltiazem
•Supraventricular anti-arrhythmic
•Calcium channel blocker |
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Definition
•Ventricular rate control for A-fib and A-flutter
•Terminates and prevents PSVT |
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Term
Dosages for Diltiazem (Cardizem
•Supraventricular anti-arrhythmic
•Calcium channel blocker) |
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Definition
•Initial bolus of 0.25 mg/kg (20 mg for the average patient) IV over 2 minutes
•For control of ventricular response rate in A-fib or A-flutter
•The bolus dose is followed by a maintenance infusion of 5 - 15 mg/hr titrated to the heart rate.
•Infusion duration exceeding 24hrs and infusion rates above 5mg/hr not recommended
•If satisfactory ventricular rate control is not achieved
•A 0.35 mg/kg bolus over 2 - 5 minutes may be given after initial bolus.
•For PSVT give a bolus of 0.25mg/kg over 2 minutes.
•If PSVT fails to convert:
•A second bolus of 0.35mg/kg can be given 15 minutes after the initial dose. |
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Term
| Procardia (Niphedipine) Mechanisms of action (•Ca++ channel blocker) |
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Definition
•Dilates main coronary arteries and arterioles in both normal and ischemic areas of the heart
•Inhibits spasms of coronary arteries
•Spontaneous
•Catheter induced
•Ergonovine
•Reduces myocardial oxygen demand and afterload by peripheral arteriole dilation
•Negative inotropic effect on myocardium SA and AV conduction is slowed
•Negative chronotropic effect is possible
•Worsening of heart block has been observed |
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Term
Procardia (Niphedipine) Indications
(•Ca++ channel blocker) |
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Definition
•Relief of coronary artery spasm
•Relief of effort induced angina |
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Term
Dosages for Procardia (Niphedipine)
(•Ca++ channel blocker) |
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Definition
•10 - 20 mg TID for control of angina
•Maximum dosage is 180mg/day () |
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Term
| Beta-blockers mechanism of Action |
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Definition
| –Reduce and inhibit the effects of catecholamines via competitive antagonism at beta-adrenergic receptor sites |
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Term
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Definition
–Reduction in heart rate (negative chronotropy)
–Reduction in myocardial contractility (negative inotropy)
–Reduction in blood pressure
•All of the above decrease myocardial oxygen consumption and demand
•Redistribution of blood flow from adequately supplied areas of myocardium to ischemic regions |
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Term
| Beta-2 blockade potentially harmful effects: |
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Definition
–Bronchoconstriction
–Reduction in glycogenolysis
–Blunting of sympathetic responses in hypoglycemia (tachycardia, diaphoresis) |
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Term
| refers to agents that primarily work on beta-1 receptors with minimal or no effect on beta-2 receptors |
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Definition
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Term
| Propanolol and Metoprolol (Beta blocker) Mechanisms of Action |
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Definition
•Reduce and inhibit the effects of catecholamines by blocking their ability to bind to beta adrenergic receptors
•Propranolol is a non-selective agent affecting
•Beta-1 receptors
•Beta-2 receptors
•Metoprolol at low dosage is beta-1 selective.
•Effects only beta-1 adrenergic receptors
•In high doses selectivity is lost
•Both agents reduce:
•Heart rate
•Blood pressure
•Myocardial contractility
•Causes a decrease in contractility
•A-V nodal conduction that causes a controlled ventricular response in supraventricular tachyarrhythmias |
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Term
| Propanolol and Metoprolol (Beta blocker) are most effective on arrhythmias due to: |
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Definition
•Excessive beat stimulation
•Myocardial ischemia |
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Term
| What drugs are used for treatment of IHSS and what do these drugs do for IHSS? |
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Definition
Propanolol and Metoprolol
•Slows the heart rate
•Reduces outflow tract obstruction that occurs with exercise
•Treatment of hypertension from tachycardia if the function is not severely depressed |
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Term
Drug that controls arrhythmias that are refractory to other treatments:
•V-fib
•V-tach
•Supraventricular tachycardias
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Definition
Propranolol and Metoprolol
(Beta Blockers) |
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Term
Propanolol and Metoprolol indications
(Beta blocker) |
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Definition
•Control of arrhythmias that are refractory to other treatments:
•V-fib
•V-tach
•Supraventricular tachycardias
•Most effective on arrhythmias due to:
•Excessive beat stimulation
•Myocardial ischemia
•Control ventricular response in:
•A-fib
•A-flutter
•PSVT
•The treatment for idiopathic hypertrophic subaortic stenosis (IHSS):
•Slows the heart rate
•Reduces outflow tract obstruction that occurs with exercise
•Treatment of hypertension from tachycardia if the function is not severely depressed |
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Term
| Indications for Propanolol and Metoprolol (Beta blocker) |
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Definition
| •Control of arrhythmias that are refractory to other treatments: •V-fib •V-tach •Supraventricular tachycardias •Most effective on arrhythmias due to: •Excessive beat stimulation •Myocardial ischemia •Control ventricular response in: •A-fib •A-flutter •PSVT •The treatment for idiopathic hypertrophic subaortic stenosis (IHSS): •Slows the heart rate •Reduces outflow tract obstruction that occurs with exercise •Treatment of hypertension from tachycardia if the function is not severely depressed |
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Term
Mechanisms of Action Esmolol
(Beta blocker) |
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Definition
| Hemodynamically similar to propanolol |
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Term
| Indications for Esmolol (Beta blocker) |
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Definition
•Supraventricular rhythm (SVR) requiring short term ventricular rate control pre- and post-op
•A-fib
•A-flutter
•SVR is not decreased.
•Beta-1 selectivity is short lived.
•Adds margin of safety for the critically ill patient |
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Term
| Precautions for Esmolol (Beta blocker) |
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Definition
•Continuous observation during administration
•Patient
•Blood pressure
•ECG
•Administer through central vein
•Intended for short term use only |
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Term
| Dosages for Esmolol (Beta blocker) |
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Definition
•5gm/500ml of normal saline or D5W for a concentration of 10mg/ml
•Loading dose
•250 - 500 mcg/kg/min for 1 min
•Followed by 25 - 50 mcg/kg/min infusion
•Titrate at 25 - 50 mcg/kg/min every 5 minutes to effect |
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Term
| Mechanisms of Action Atenolol (Beta blocker) |
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Definition
•Reduces
•Heart rate
•Cardiac output
•Blood pressure
•MVO2
•Redistribution of blood flow from adequately supplied areas of the heart to ischemic areas
•Acts within 1 - 2 minute
•Lasts 3 - 4 hours |
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Term
| Indications for Atenolol (Beta blocker) |
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Definition
•Reduces the incidence of:
•Recurrent MI
•Size of the infarct
•Fatal dysrhythmias |
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Term
| Dosages for Atenolol (Beta blocker) |
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Definition
•5 mg IV
•If initial dose well tolerated repeat in 10 minutes
•If IV dose well tolerated then give 50mg orally 10 minutes after last bolus.
•Repeat in 12 hours. |
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Term
| Medication class of Calcium Chloride |
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Definition
|
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Term
| Mechanisms of action for calcium chloride |
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Definition
•Ca++ ions increase the force of myocardial contraction
•In response to electrical depolarization Ca++ ions in sarcoplasmic reticulum are transferred to actin and myosin filament sites to initiate myofibril shortening.
•Ca++ effects in a normal heart
•Positive inotropic
•Vasoconstricting
•Raises arterial BP |
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Term
| Indications for Calcium Chloride |
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Definition
•Used in the treatment of:
•Hypocalcemia
•Acute hyperkalemia
•Ca++ channel blocker toxicity |
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Term
| Calcium chloride should not be administered in the SAME LINE as what? |
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Definition
|
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Term
| Contraindications for Calcium Chloride |
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Definition
•Ventricular fibrillation
•Potential for existing digitalis toxicity |
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Term
| Dosages for Calcium chloride |
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Definition
•100mg/ml packaged in a 10ml prefilled syringe or ampule of a 10% solution
•2 - 4mg/kg IVP repeated every 10 minutes
•Calcium gluceptate
•500 - 700mg
•Calcium gluconate
•500 - 800mg
•Calcium chloride is preferred because it produces consistently higher plasma levels. |
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Term
|
Definition
•Hemodynamically significant brady arrhythmias and asystole
•Symptomatic
•Sinus bradycardia
•Junctional escape rhythm
•2nd degree block, type 1
•3rd degree block with narrow QRS
•Class IIB asystole
•Pulseless electrical activity (PEA)
•2nd degree block, type 2
•3rd degree block with new, wide QRS |
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Term
Verapamil (Isoptin)Adverse Reactions that cause increased ventricular response in what?
•Supraventricular anti-arrhythmic
•Calcium channel blocker |
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Definition
-Atrial flutter
-Fibrillation
-WPW |
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Term
| What does Lidocaine do to the action potential? |
|
Definition
| Reduces the slope of phase 4 diastolic depolarization |
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Term
| What does Procainamide (Pronestyl) do to the action potential phase 4? |
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Definition
| In normal ventricular muscle and Purkinje fibers, the drug suppresses phase 4 diastolic depolarization reducing automaticity of ectopic pacemaker |
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Term
| What does Procainamide (Pronestyl) do to the action potential phase 1? |
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Definition
•Slows intraventricular conduction by reducing slope of phase 0 action potential.
•If conduction is already slowed, as in ischemic tissue, further slowing of conduction may terminate re-entry. |
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Term
| Suppresses ventricular ectopy and may be effective when lidocaine has not suppressed it |
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Definition
|
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Term
| Adverse Reactions of Atropine |
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Definition
| •Anhidrosis •Anticholinergic psychosis •Blurred vision •Temporary bradycardia •Dilation of pupils •Dryness of mouth •Urinary retention |
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Term
| Contraindications of Epinephrine |
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Definition
•Anesthesia with inhalant anesthetics
•Hypertension
•During labor
•Hyperthyroidism
•Organic brain damage
•Patients receiving digitalis |
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Term
| Precautions of Epinephrine |
|
Definition
•May potentiate myocardial ischemia
•May induce ventricular ectopy
•Discontinue a continuous IV infusion immediately.
•Do not mix with sodium bicarbonate.
•Forms a precipitate |
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Term
| Adverse Reactions of an Average dose of Epinephrine |
|
Definition
•Anxiety
•Dizziness
•Dyspnea
•Palpitations |
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Term
| Adverse Reactions of an Overdose of Epinephrine |
|
Definition
•Cerebrovascular hemorrhage
•Fibrillation
•Severe headache
•Pulmonary edema
•Pupil dilation
•Tachycardia
•Death |
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Term
| Contraindications of Lidocaine |
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Definition
•Known sensitivity to lidocaine
•Stokes-Adams syndrome
•Any type of heart block without an artificial pacemaker in place |
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Term
| Adverse Reactions of Lidocaine |
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Definition
•Excessive doses can produce:
•Myocardial depression
•Induce heart block
•Depress spontaneous discharge from the SA node |
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Term
| Adverse Reactions of Amiodarone |
|
Definition
•Pulmonary
•Fibrosis
•Infiltration
•Corneal lipofusion deposits
•Skin photosensitivity |
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Term
| This may neutralize the effects of Magnesium |
|
Definition
|
|
Term
|
Definition
-decrease in deep tendon reflexes
-heart block
-respiratory paralysiss
-hypotension
-cardiac arrest |
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|
Term
| Contraindications for Calcium chloride |
|
Definition
•Ventricular fibrillation
•Potential for existing digitalis toxicity |
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|
