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ACLS Drugs
List of Drugs Used In ACLS (2013)
70
Pharmacology
Graduate
06/11/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
What are the 16 drugs used in ACLS?
Definition

1) Adenosine

2) Amiodarone

3) Aspirin/ASA

4) Atropine

 

5) Beta-Adrenergic Blockers Atenolol, Metoprolol, Propranolol

6) Diltiazem, Verapamil, Calcium channel blockers

7) Dobutamine

8) Dopamine

 

9)   Epinephrine

10) Glycoprotein, IIb/IIIa Inhibitors, ReoPro, Integrilin, Aggrastat

11) Lidocaine

12) Magnesium Sulfate

 

13) Morphine Sulfate

14) Nitroglycerin

15) Nitro-prusside

16) Vasopressin

Term
Indications for Adenosine?
Definition

DOC for paroxysmal supraventricular tachycardia (PSVT) and can be used diagnostically for stable, narrow or wide complex tachycardias of unknown type

Term
MOA Adenosine
Definition

Decreases Tachycardias associated with the AV node:

 

--   no negative inotropic (strength of muscle contraction) effects

 

-- acts directly on sinus pacemaker cells & AV chronotropic and dromotropic (conduction speed) nodal conductivity

Term
Adenosine Dosage?
Definition

6mg IV push rapidly over 1-3 seconds in most proximal injection port

 

If no response after 1-2 min, administer 12mg over 1-3 seconds

 

Conversion rate after the second dose is 92%

Term
Primary side effect of Adenosine?
Definition

Transient Asystole: facial flushing, lightheadedness, paresthesia, headache, diaphoresis, palpitations, chest pain, hypotension, nausea, metallic taste and shortness of breath.

 

Use two syringe technique

Term
Amiodarone indications?
Definition

V-Fib

 

Pulseless V-Tach

 

Narrow and Wide Complex Tachycardias

 

Tachycardias associate with Wolff-Pakinson White Syndrome

Term
MOA of Amiodarone?
Definition

beta-blocker like and potassime channel blocker like actions on the SA node and AV nodes

 

Increases the refractory period via sodium and potassium channel effects and slows intra-cardiac conduction of the cardiac action potential via sodium channel effects

Term
Dosage of Amiodarone?
Definition

Cardiact Arrest (vf/-vf):

First Dose: 300 mg iv/io push

Second Dose: 150mg iv/io push

 

Tachyarrhythmias:

Rapid infusion: 150mg over first 10 min. 15mg min, may repeat every 10 min as needed.

Slow infusion: 360mg iv over 6 hours, 1 mg min.

Maintenance infusion: 540 mg over 18 hours (0.5 mg per min).

Term

Amiodarone comes in ____ ____ and therefore must be scored and a ______ needle used to aspirate the contents. Tubing must have ______. It is made in ______, a soap-like substance that easily bubbles if aspirated too quickly. It must then be mixed in ____ - _____ ML D5W for a rapid IVP. Do not adminster if prolonged ____.

Definition

glass ampules;

 

filtered;

 

filter;

 

"tween";

 

20 - 30;

 

QT

Term
Aspirin indications?
Definition

All patients with ACS, unless hypersensitive to ASA

Term
MOA of Aspirin?
Definition

Anticoagulant properties by blocking formation of thromboxane A2

Term
Aspirin Dosage?
Definition

160 - 325mg non-enteric coated or baby aspirin or 2-4 p.o. tablets. May give rectally.

Term
Contraindications of Aspirin?
Definition

Relatively contraindicated in people with active ulcers or asthma and contraindicated for hypersensitivity to ASA

Term
Atropine indications?
Definition

Bradycardia rhythms to increase heart rate

Term
MOA of Atropine?
Definition

Increase the heart rate by blocking vagus nerve stimulation, allowing the heart to intrinsically increase in rate.

Term
Atropine Dosage?
Definition

0.5mg/3mg max

Term

Atropine: if greater thatn 3mg or less than 0.5mg is used, this is considered a _____ dose. May cause worsening of myocardial ischemia, worsening of AV blocks, and may cause PVC's or ventricular tachycardia. May result in undesired tachycardia.

Definition

Vagolytic

Term

Indications for Beta-Adrenergic Blockers Atenolol, Metoprolol, Propranolol?

Definition

Post-infarction protection FROM incidence of VF and decrease myocardial ischemia. Refractory tachycardias.

Term
MOA of Beta Blockers?
Definition

Competitive antagonists at the adrenergic beta receptors. They slow the heart rate and lessen the force of contraction.

Term
Beta Blocker Contraindications?
Definition

Bradyarrhythmias

Heart Block

Hypotension

CHF

Hx of bronchospasm

Wolff - Parkinson White

Term

Indications of Calcium Channel blockers: Diltiazem, Verapamil.

Definition

Inhibiting the movement of calcium ions across cell membranes. It decreases atrial automaticity, reduces AV conduction velocity, and prolongs AV nodal refractory period.

 

Also, depresses myocardial contractility, reduces vascular smooth muscle tone, and dilates coronary arteries in normal and ischemic tissues.

Term
Dosages of Diltiazem and Verapamil?
Definition

Diltiazem: 0.25 mg /kg (over 2 min, e.g., 20 mg) then 0.35 mg/kg (over 2 min, e.g., 25 mg) in 15 min, infuse 5-15 mg per hour.

 

Verapamil: 2.5 to 5 mg IV over 2 minutes. 5 to 10mg

q 15 - 30 minutes to a max of 20mg.

Term

Calcium Channel Blockers: watch for _____, espeically in hypovolemic patients. Other reactions are: dizziness, headache, nausea and vomitting, bradycardia, complete AV block. and peripheral edema.

 

Give ______ _______ as reversal agent for calcium channel blocker overdose.

Definition

hypotension

 

calcium chloride

Term
Dobutamine Indications?
Definition

Congestive Heart Failure associated with poor cardiac output, but no shock.

Term
MOA of Dobutamine?
Definition

positive inotropic drug, resulting in increased myocardial contracture, thus improving cardiac output

Term
Dobutamine dosaging?
Definition

1 gram mixed in 250 ML normal saline.

 

Starting dose: 2. mcg/kg/min IV/IO then titrated up to 20 mcg/kg/min.

Term

Dobutamine may cause ______ secondary to its _____ properties.

 

____ may result from Dobutamine's ____ properties; do not permit the herat rate to increase by ____ of its original rate.

 

Dobutamine may cause an increase in _____ ______. It is recommended that Dobutamine be titrated and controlled by a volumetric infusion pump. Continuous cardiac monitoring is a necessity, and frequent blood pressure measurement is Recommended.

Definition

hypotension;

 

beta-2;

 

Tachycardia;

 

beta-1;

 

10 %;

 

ventricular ectopy

Term
Dopamine indications?
Definition

Treatment of hypotension that is not volume related

 

Term
MOA of Dopamine?
Definition

Alpha properties used to treat hypotension: greater than 10 mcg/kg/min

 

Dopaminergic properties result in vasodilation of renal, mesenteric, and cerebral arteries: 1-2 mcg/kg/min

 

Similar to dobutamine (beta-1 properties): 5-10 mcg/kg/min

Term

Dopamine: profound _____ may result in the presence of ______. Always treat the underlying _______ before using Dopamine. May increase both supraventricular and ____ ____. At higher doses, myocardial blood flow may be reduced. Use with a volumetric infusion device.

Definition

tachycardia;

 

hypovolemia;

 

hypovolemia;

 

ventricular ectopy

Term
Epinephrine indications?
Definition

Bradycardias refractory to other interventions as a drip.

 

First drug of choice in all ACLS situations where the patient is pulseless.

 

E-very P-ulseless I-ndividual Gets 1mg epi.

Term
MOA of Epinephrine?
Definition

Improved coronary and cerebral perfusion is the primary beneficial effect of epinephrine during cardiac arrest.

 

May also increase automaticity and make VF more susceptible to DC counter shock.

Term
Epinephrine Dosage?
Definition

Cardiac arrest: 1 mg q 3-5 min IV.

 

For bradycardias: 2-10 mcg/minute IV infusion. No end point to epinephrine IVP in an arrest.

Term

 

Epinephrine: may cause worsening of myocardial ischemia and may cause ___ or ventricular tachycardia. May result in undersired _____. In the crash cart, a pre-mixed dose is available in a __:_______ concentration. This equals ____ mg/ML and therefore, the initial dose is ____ ML of ___:_____ IVP.

 

Definition

PVCs;

 

tachycardia;

 

1:10,000;

 

0.1;

 

10;

 

1:10,000

Term

Indications of Glycoprotein, IIb/IIIa inhibitors, ReoPro, Integrilin, Aggrastat?

Definition

Acute coronary syndromes without ST-segment elevation

Term
MOA of Glycoprotein?
Definition

Inhibit platelet aggregation via inhibition of integrin glycoprotein IIb/IIIa receptor in the membrane of platelets.

Term
Contraindications of Glycoprotein IIb/IIIa inhibitors?
Definition

Active internal bleeding or bleeding disorder in past 30 days, history of intracranial hemorrhage, or other bleeding, surgical procedure or trauma within 1 month, platelete count < 150,000/mm3 hypersensitivity and concomitant use of another GP IIb/IIIa inhibitor.

Term
Lidocaine Indiciations?
Definition

Stable wide complex tachycardias, V-Fib/pulseless V-Tach. Alternative to amiodarone

Term

MOA of Lidocaine?

Definition

Suppresses ventricular ectopy. Elevates V-Fib threshold. Tachycardia: 0.5 - 0.75 mg/kg. Increase the dose if necessary.

Term
Lidocaine dosages?
Definition

Cardiac Arrest:

 

1-1.5 mg/kg/IVP 1st dose

 

0.5 - 0.75 mg/kg in V-Fib 2nd dose and any subsequent dose

 

2-4 mg/min continuous infusion after return of spontaneous circulation

 

Maximum dose of 3mg/kg

Term
Memory aid for Lidocaine?
Definition

if the arrhythmia is wide, use lide!

 

Term
Magnesium Sulfate indications?
Definition

management of arrhythmias, particularly torsades de pointes, and arrhythmias secondary to a tricyclic antidepressant overdose or digitalis toxicity.

 

The drug is also considered as a class IIA agent (probably helpful) for refractory ventricular fibrillation and ventricular tachycardia after administration of lidocaine.

Term
MOA of Magnesium Sulfate?
Definition
Electrolyte Replacement!
Term
Magnesium Sulfate Dosage?
Definition

Cardiac arrest: 1-2 grams in 10 mL over 5-20 min

 

Torsades (with pulse): 1-2 grams in 50 mL over 5-60 min

Term
Morphine Sulfate Indications?
Definition

Analgesic and choice in acute coronary syndromes.

 

Used as an adjunct to lasix to aid reabsorption of fluids in pulmonary edema.

Term
MOA of Morphine Sulfate?
Definition

Relieves pulmonary congestion by increasing venous capacitance, allowing the client to tolerte a little more volume.

 

Also lowers myocardial oxygen demand by its effect of decreasing afterload via its vaso-dilatory properties.

Term
Dosage of Morphine Sulfate?
Definition

2-4 mg q 5 minutes titrated to effect.

 

10 mg max

Term

Morphine Sulfate: if nitroglycerin fails to relieve the chest pain, then morphine should be given. Morphine should be withheld if nitroglycerin relieves the pain. Monitor for hypotension and respiratory depression.

Definition
Statement. Not a question
Term
Nitroglycerin and Nitro-prusside indications?
Definition
Chest pain from ACS unresponsive to nitrates.
Term
MOA of Nitroglycerin and Nitro-prusside?
Definition

Potent vasodilatory properties. Reduces afterload by reducing sytemic vascular resistance.

Term
Nitroglycerin, Nitro-prusside dosage?
Definition

0.3 - 0.4 mg SL Q5Min. 3 sprays max.

 

50 mg in 250 ML D5W per protocol.

Term

Nitroglycerin & Nitro-prusside: potent vasodilator, important to monitor blood pressure. IF the systolic is less than 100, then there should be consideration for withholding the drug.

Definition
Statement. Not a question.
Term
Indications for Norepinephrine/Levophed?
Definition

Blood pressure support and severe cardiogenic shock. Last resort for ischemic heart disease.

Term
MOA of Norepinephrine/Levophed?
Definition

stimulates alpha-, beta 1-, and beta 2 - adrenergic receptors in dose-related fashion. It is indicated for non-volume related hypotension.

Term
Norepinephrine/Levophed dosage?
Definition

Mix: 4mg of Norephinephrine in 250 ML of normal saline.

 

Start at 2 mcg/min and titrate up for desired effect.

Term

Norepinephrine/Levophed: may cause worsening of myocardial ischemia and may cuase PVC's or ventricular arrhythmias. May result in undesired tachycardia. Do not use Norepinephrine without correcting underlying hypovolemia. Norepinephrine should always be used with a volumetric pump.

Definition
Statement. Not a question.
Term
Oxygen indications?
Definition

Ischemia secondary to ACS. Respiratory distress or failure.

Term
MOA of Oxygen?
Definition

An increase in arterial oxygen tension, an increase in hemoglobin saturation and an increase in tissue oxygenation. Keep ROSC patients saturations ≥94%.

Term
Oxygen Dosage?
Definition

NC: 1- 6 LPM 21 - 44%

 

Vent: 4 - 12 LPM 24 - 50%

 

Partial: 6 - 10 LPM 35 - 60%

 

NRB: 6 - 15 LPM 60 - 100%

 

BVM: 95 - 100%

Term

Oxygen: Baseline SaO2 readings should be performed while the patient is breathing ____ air.

Definition
room
Term
Procainamide indications?
Definition

Indicated for ventricular arrhythmias not controlled by Lidocaine.

 

Not a first drug of choice for treatment of ventricular arrhythmias.

Term
MOA of Procainamide?
Definition

Suppresses phase - 4 depolarization in normal ventricular muscle and Purkinje Fibers, reducing the automaticity of ectopic pacemakers.

 

Also suppresses reentry dysrhythmias by slowing intraventricular conduction.

 

Procainamide may be effective in treating PVCs and recurrent ventricular tachycardia that cannot be controlled with lidocaine.

Term
Dosage of Procainamide?
Definition

20 - 50 mg/min.

 

Maximum dose: 17 mg/kg.

 

Maintenence Infusion (after resuscitation from cardiac arrest) is 1-4 mg/min.

 

For infusion, mix 2 grams of Procainamide in 500 ML normal saline.

Term
End points to Procainamide administration?
Definition

suppression of arrhythmia, hypotension, widening of the QRS greater than 50% of original width, and maximum dose reached.

Term
Sodium Bicarbonate indications?
Definition

If cardiac arrest persists, then a bolus of bicarb will not hurt and may potentially help.

 

Useful in ASA O.D., hyperkalemia, DKA, TCA O.D. ROSC after long arrest interval.

Term
Sodium Bicarbonate dosage?
Definition

Give 1 mEq/kg IV; you may repeat iwth 0.5 mEq/kg q 10 min.

Term

Sodium Bicarbonate: watch for metabolic alkalosis, hypoxia, rise in intracellular pCO2 and increased tissue acidosis.

Definition
Statement. Not a question.
Term
Vasopressin indications?
Definition
All cardiac arrests.
Term
MOA for Vasopressin?
Definition

Potent peripheral vasoconstriction and shunting of blood while having no beta adrenergic effects.

 

Does not directly stimulate the heart.

Term
Vasopressin dosage?
Definition

40U IVP X 1: may be used as an alternative pressor in place of first or second dose of epi in cardiac arrest cases.

 

Epi can be adminstered every 3-5 min during the arrest.

 

 

Vasopressin may be used as an alternative to epinephrine in all pulseless arrests.

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