Critical Care Cardiac Meds QUESTIONS AND ANSWERS| GRADED A

Critical Care Cardiac Meds What type of drug is Amiodarone? Correct Answer: Antiarrhythmic What is amiodarone indicated to treat? Correct Answer: -Tachyarrhythmias (atrial and ventricular). -Attain rate control of rapid atrial dysrhythmias in patients with impaired LV function that Digoxin isn't able to fix. What allergy contraindicates the use of amiodarone? Correct Answer: Iodine Adverse effects of amiodarone Correct Answer: muscle weakness, fatigue, dizziness, hypotension What indicates that amiodarone therapy should be stopped? Correct Answer: -Prolongation of QT interval, or other signs of heart block or bradycardia. -In these cases, 2nd line drugs such as lidocaine or adenosine are indicated What is Torsades? Correct Answer: Torsades de Pointes, or "twisiting of the points" is an ECG reading characterized by varying amplitudes along the isoelectric line. Most often caused by PROLONGED QT, when a R wave "stumbles" on top of a T wave. -This is why amiodarone is reduced or discontinued when seen causing this. What type of drug is IV lidocaine? Correct Answer: Antidysrhythmic. (2nd line) What is lidocaine primarily used to treat? Correct Answer: V-tach (particularly with wide QRS) V-Fib Used in place of amiodarone when it causes prolonged QT intervals Dosage of lidocaine Correct Answer: 1-1.5 mg/kg q 3-5 min MAX 3-5 mg/kg Adenosine Correct Answer: Antiarrhythmic (2nd Line) What does adenosine primarily treat? Correct Answer: -Conversion of PSVT (paroxysmal supraventricular tachycardia) to NSR. -Basically bringing the heart out of a "randomly rapid firing" state and back to normal rhythm. -Tachycardia w/ wide QRS complexes What can we expect to happen immediately after administering Adenosine? Correct Answer: Asystole (flatline) lasts 15 seconds Dosage of adenosine Correct Answer: RAPID PUSH IV!!! 6 mg over 1-3 seconds. Followed with fast push of 20 mL NS. 1-2 minutes between doses. Actions of Adenosine Correct Answer: decreases activity of SA and AV nodes, interrupting the reentry pathway that is feeding back on itself and causing either the atrial or ventricular tachycardia. What type of drug is Epinephrine? Correct Answer: Alpha and Beta adrenergic agonist. (SNS stimulator) What are the primary actions of Epinephrine? Correct Answer: -Peripheral vasoconstriction (alpha 1 stimulation) that increases BP in order to increase perfusion of the heart and brain during CPR. -Increases contractility -- increased CO -- increase MAP -- increase tissue perfusion. -Bronchodilator (beta 2 stimulation) When is Epinephrine used (related to CV) ?? Correct Answer: During CPR Dosage of Epinephrine Correct Answer: 1 mg IV/IO q 3-5 min. Adverse effects of epinephrine Correct Answer: -HTN -Palpitations What type of drug is atropine? Correct Answer: Anticholinergic (anti-PNS) What condition is atropine indicated to treat? Correct Answer: Bradycardia What is the primary effect that atropine stimulates? How does it do this? Correct Answer: -Increased heart rate. -Direct vagolytic action, increase SA node automaticity and AV node conduction. -May also cause increased vasoconstriction and BP. Adverse effects of atropine Correct Answer: -HA, dizziness -Unstable BP -V-tach, V-Fib AV dissociation Dosage of atropine Correct Answer: 0.5 - 1 mg q3-5 minutes Max 0.04 mg/kg vasopressin (Pitressin) Correct Answer: POTENT peripheral vasoconstrictor Primary function of vasopressin Correct Answer: INCREASE Blood Pressure Indications of vasopressin Correct Answer: -Shock -VF / VT -Asystole -PEA Any condition that calls for increased Cardiac perfusion Dosage of vasopressin Correct Answer: 40 U IV/IO to replace the first or second dose of epinephrine procainamide (Pronestyl) Correct Answer: antiarrhythmic (2nd line) Action of procainamide Correct Answer: Essentially slows down conduction through the heart. -Suppresses automaticity in the His-Purkinje system. -Slows conduction in the atria, ventricles, and His-Purkinje system. Dosage of procainamide (Pronestyl) Correct Answer: 20 - 30 mg/minute Repeated until dysrhthmia is suppressed, the QRS complex widens by 50%, or 17mg/kg is reached. Indications for procainamide Correct Answer: Tachycardia (PSVT, VT) This is a 2nd line drug after amiodarone Magnesium sulfate cardiac indications Correct Answer: Regulates the movement of calcium in and out of cells, affecting cardiac contractility. Diminished magnesium sulfate leads to dysrhythmias, including refractory VF and Torsades Magnesium sulfate Dosage Correct Answer: 1-2 g in 100 mL D5W over 1-2 minutes Magnesium sulfate adverse effects Correct Answer: -3rd degree heart block -Respiratory paralysis diltiazem (Cardizem) Type of drug Correct Answer: Calcium Channel Blocker What is the first line drug used for Torsades de Pointes? Correct Answer: Magnesium sulfate diltiazem (Cardizem) mechanism of action Correct Answer: Inhibits the flow of calcium ions into myocardial and vascular smooth muscle cells. Slows conduction, prolongs refractory period, and decreases myocardial contractility Effect of diltiazem (Cardizem) Correct Answer: -Slows conduction -Prolongs refractory period -Decreases myocardial contractility diltiazem (Cardizem) Indications Correct Answer: - A-FIB and A-FLUTTER -Conversion of PSVT to NSR (administered after adenosine). -Narrow QRS complex tachycardias. What two drugs are used to cardiovert PSVT to NSR? Correct Answer: 1st =