Class of Aspirin

Analgesic

Anti-pyretic

Anti-inflammatory

Anti-platelet

Site of action for 

Aspirin

Blood

Inhibits the production of thromboxane

Blocks synthesis of prostaglandins peripherally

Lowers temp by vasodilation

list the last action of 

Aspirin 

Prevents sensitization of pain receptors

List the indications of

Aspirin

(4)

AMI

Prevents blood clots

Ischemic chest pain

Stroke (occlusive)

List contraindications of

Aspirin

- blood clotting disorder

- Hemophilia

- recent Hx of GI bleed

- Reyes Syndrome

- Von Willebrand's disease

- Breatfeeding & alcoholics

What is a typical dose for

aspirin

>12 y.o. 325-650 mg

Oral / rectal

Warfarin

Ardeparin

Hydrocodone

List side effects of

Aspirin

- GI irritation

- GI bleeding

- Tinnitus

- Hypersensitivity Rx 

- Prolonged bleeding time

What are the toxic levels of

Aspirin

150-300 mg/kg Mild toxicity

300-500 mg/kg Serious toxicity

>500 mg/kg Lethal toxicity

occurs in children who have been given aspirin for chicken pox or the flu

acute damage to brain and liver function

Deficiency of Von Willebrand factor protien required for platelet aggregation

Can be hereditary or acquired

Onset of

Aspirin

Half-life of

Aspirin

Classification for

Diltiazem

Class 4 antidysrhythmic

Ca++ channel blocker

site of action for

Diltiazem

Cardiac and vasculature dilator

Negative dromotrope

Indications for 

Diltiazem

A-fib & A-flutter

MAT

PSVT

Contraindications for 

Diltiazem

- Hypotension

- V-tac

- AMI

- Sick Sinus Syndrome

- WPW

- 2nd / 3rd degree heart block

Availability & forms of 

Diltiazem

PFS and vials

5mg-1ml (25/5 or 50/10)

Adult dose for 

Diltiazem

10 mg over 2 minutes

(repeat every 10-15 min as nec)

MAX: 40 mg

What is your typical (usual) dose for 

Diltiazem

0.25 mg/kg IV over 2 minutes

(usual is approx. 20 mg)

Repeat dose is 0.35 mg/kg

Precautions for possible interaction with

Diltiazem

- Potentiates versed 

- Potentiates aspirin

- DO NOT combine with beta blockers or Lasix

Side effects of 

Diltiazem

- 1st and 2ng degree heart blocks

- ventricular dysrhythmias

- Bradycardia

- hypotension

- syncope

- Chest pain

What is the class of 

Epi

Smpathomimetic

adrenergic catacholamine

Site of action for 

Epinephrine

Alpha 1

Beta 1 & 2 adrenergic receptors

What is the Alpha 1 characteristics for 

Epinephrine

- Condtricts blood vessels & smooth muscle

- Stimulates glucose production

- Decreases GI venous supply

What are the Beta 1 characteristics of 

Epinephrine

What are the Beta 2 characteristics of 

Epinephrine

Relaxes smooth muscle of lungs, blood vessels, uterus and cerebellum

What is the onset of

Epinephrine

IV - 1-2 minutes

SubQ/IM - 5-10 minutes

List the actions of 

Epinephrine

- Constricts blood vessels

   (primary reason in cardiac arrest)

- Increases HR

- Increases contractility of ventricles

- Decreases blood supply to GI

- Counteracts histamine

- Dilates bronchioles

Indications for 

Epinephrine

- Anaphylaxis

- Cardiac arrest

- Symptomatic braadycardia

- Severe hypotension with bradycardia

   (When atropine and pacing have failed)

- Croup (ped's - neb)

Contraindications of 

Epinephrine

- none-in cardiac arrest of life threatening situations

- Hypersensitivity

- pt's with heart disease

- hypovolemic shock

Availability of 

Epinephrine

PFS or vial

What is your dose for an adult in severe bradycardia of

Epinephrine

(Unusual, but...)

infusion is 2-5 mcg/min

Prefered for ped's in bradycardia

What is your dose for pulseless arrest of an adult pt of

Epinephrine

1 mg (1:10,000)IV/IO

every 3-5 minutes

What is your dose of Epi for pulseless arrest of a ped's pt of

0.01 mg/kg

every 3-5 minutes

What is your adult dose for Epi in an anaphylactic Rx 

Mild: 0.3-0.5 mg (1:1,000)

IM or SubQ

OR

Severe: 0.3-0.5 mg (1:10,000)

slow IV

(Or 1-4 mcg/min)

0.01 mg/kg (1:1,000)

SubQ/IM

Max: 0.3 mg

Will increase myocardial O2 demand

Ischemic heart disease

pulmonary edema

HTN

Side effects of

Epinephrine

Anxiety

Tachycardia

HTN

Arrhythmias

V-fib

Tremors

Class of 

Atropine

Antidysrhythmic

Anticholinergic/parasympatholytic/Antimuscarinic

Site of action for 

Atropine

-Increases HR

(by blocking vagal nerve stimulation)

-Decreases GI & respiratory secretions

Onset of action for 

Atropine

Half-life for

Atropine

Action for

Atropine

Indications for 

Atropine

-Symptomamtic bradycardia

-low degree heart block

-pestacide poisoning 

(Organophosphate)

Contraindications for 

Atropine

Narrow angle glaucoma

acute hemmorrhage

Tachycardia

Obstructive disease of GI

*no contra's in the arrest setting

Availability / forms of

Atropine

Vial

Amp

Auto-injector

PFS

1 mg/10 ml

Adult dose for bradycardia of

Atropine

0.5-1.0 mg every 3-5 min

Max: 2 mg

Adult dose for pesticide poisoning of 

Atropine

1-2 mg

IV

Pediatric dose for bradycardia of 

Atropine

0.02 mg/kg

Max: 2 mg

Pediatric dose for pesticide poisoning of

Atropine

< 12 y.o.

0.02-0.05 every 20-30 min

> 12 y.o.

2 mg IV

*minimum dose must be 0.1 mg

Precautions for 

Atropine

- Intra abdominal infections

- OB (lactation)

- Infant with downs syndrome

Side effects of 

Atropine

- Drowsiness

- Confusion

- Dry mouth/constipation

- pulmonary edema

- Blurred vision

- Tachycardic palpations

- urinary hesitancy

- Flushing and decreased sweating

What is the trade name for 

Amiodarone

Cordarone

What is the class for 

Amiodarone

Site of action for 

Amiodarone

Affects sodium, calcium and potassium channels 

Has Alpha and Beta adrenergic properties

Onset of action

Amiodarone

Half-life of

Amiodarone

list actions of 

Amiodarone

- Prolongs the duration of the action potential

- Prolongs the effective refractory period

- Non-competitively inhibits Alpha & Beta receptors and posesses vagolytic and calcium channel blocking properties

- Negative dromotrope

Indications for 

Amiodarone

Recurrent V-fib

Sustained V-tac

V-tac/V-fib refractory

Contraindications for 

Amiodarone

- Hypotension

- Cardiogenic shock

- Bradycardia

- 2nd or 3rd degree heart block

**Do not use with drugs that prolong QT intervals(Procainamide)

Availability/Forms of 

Amiodarone

Vial

150 mg/3 ml

(heard there was a 450mg vial too)

Adult dose for cardiac arrest of

Amiodarone

300 mg (diluted in 20-30 cc NS)

Repeat with 150 mg in 3-5 minutes

What is your dose for V-tac / V-fib with a pulse of 

Amiodarone

150 mg over 10-15 min

15 mg/min

Repeat in 10-15 minutes as nec

Amiodarone administration may increase a pt's level of what substance?

Digoxin

And lead to Digoxin intoxication

Fentanyl

- It may cause hypotension, bradycardia and decreased cardiac output

list 3 of the 8 side effects of 

Amiodarone

- Hypotension

- Bradycardia

- Prolonged QT interval

- Vasodilation

- Hypotension

- V-tac / V-fib

- Hepatoxicity

Trade name for 

Lyidocaine

Xylocaine

What is the class of

Lidocaine

Antidysrhythmic 

(type 1-B)

Site of action fo r

Lidocaine

Depresses automaticity of purkinje fibers

Depresses action potential

Onset of action

Lidocaine

30-90 seconds

Half-life of 

Lidocaine

1.5 - 2 hours

Action of 

Lidocaine

(3)

- Increases ventricular threshold

(Increases refractory period of cells)

- Blocks fast sodium channel

- Decreases phasee 4 depolarization

(depresses automaticity/Decreases act.pot.)

Indications for 

Lidocaine

- Stable monomorphic V-tac wiht a pulse

- Pulseless V-tac and V-fib

- Malignant PVC's

- Prophylactic for ICP (pre RSI)

Contraindications for 

Lidocaine

- Advanced AV block

- IVR/Bradycardia

- Adam-stokes Syndrome

- Hypotension

- WPW

Available and preparations of

Lidocaine

PFS 

2% = 100 mg

20% = 1g/5 ml or 1 g/250 ml

What is the adult dose for Lidocaine in a cardiac arrest situation?

1 - 1.5 mg/kg

(adults is usually 1.5 mg/kg)

Max: 2 doses

3 mg / 45 gtts/min

(remember clock method)

When Lidocaine is used concurrently with Amiodarone, Procainamide or beta blockers, what do you have to use caution for?

It can cause cardiac depression when used with those drugs

Cut your dose in 1/2

List side effects of

Lidocaine

- Decreased HR

- Hypotension

- Seizures

- Tinnitus

What are some signs of toxicity of 

Lidocaine

- Tinnitus

- Seizures

- Fasciculation

- Slurred Speech

- ALOC

What must you do if a pt complains of Tinnitus when you are administering Lidocaine?

Shut off your maintanence dose

What should your second dose of Lidocaine be?

1/2 your first dose

1.5 mg 1st = 0.75 mg for 2nd

What is the class of medication for 

Dopamine

Adrinergic Dopaminergic

Catacholamine Sympathomimetic

What is the site of action for 

Dopamine

Naturally occuring catacholamine 

Chemical precursor of Norepi

Generally dependant on its effects

What is the onset of

Dopamine

2-4 minutes

What is the duration of

Dopamine

Site of action for

Dopamine at

1-2 mcg/kg/min

Dilation of renal, Mesenteric and cerebral arteries

(dopamine receptors)

Site of action for

Dopamine at

2-10 mcg/kg/min

Inotropic, Chronotropic

(Beta receptors)

Site of action for

Dopamine at

10-20 mcg/kg/min

Vasoconstriction of renal, mesenteric and peripheral arteries/veins

(Alpha and Beta)

Site of action for

Dopamine at 

>20 mcg/kg/min

Mimics pure alpha effects similar to Norepi like effects.

*occasionally used in hospital at this range

List indications for the use of

Dopamine

(7)

- Cardiogenic shock

- Cardiogenic shock with Pulmonary edema

- Hypovolemic shock

      (hypotension, after fluid resucitation)

- Neurogenic shock

- Septic Shock

- Refractory symptomatic bradycardia

- Hypotension after ROSC

List contraindications of

Dopamine

Hypovolemic shock

Pt's with known pheochromocytoma

Tachydysrhythmias

Women on Oxytocin

Forms available and prep of

Dopamine

PFS and Amp's

200, 400, 800 mg in 5 ml

Adult dose for 

Dopamine

2-20 mcg/kg/min

*Generally not to exceed 20 mg w/o contacting Medical control

What is your Ped's dose of 

Dopamine

Same as adult but 10 mcg/kg/min

is a good starting point..

TCA's

MAOI's

Bretylium

Precipitates in....(?)

List side effects of 

Dopamine

- Dysrhythmias

- HTN, HA

- N/V, Dizziness

- Ectopy

- Bradycardia

- Tremors

- Angina, AMI

- Pain

- Tachy, V-fib & V-tac

Nitrostat

Tridil

What is the classification of 

Nitro

Nitrate

(another name for the class is 

anti-anginal)

Site of action for

Nitro

Breaks down nitric Oxide in the 

Smooth muscle

Onset of

Nitro

Tabet of spray

1-4 minutes 

Ointment

20-60 minutes

Half life of

Nitro

Tablet/Spray

Up to 30 minutes

Action of

Nitro

(3)

Relaxes smooth muscle

Decreases preload and afterload

Dilate coronary arteries

What are your indications for the use of

Nitro

Ischemic chest pain

Pulmonary edema (incl. CHF)

HTN "crisis"

Contraindications of

Nitro

Hypotension

Bradycardia

ED drugs within 24 hours

Availability and Prep of

Nitro

Spray/Tablet/paste

*Spray and Tablet are 0.4 mg per

0.4 mg

repeat in 5 minutes

Adult dose of Nitro

for a pt with Edema

0.4 - 0.6 mg SL

Repeat in 5 minutes if nec. 

AND

diastolic pressure = >100

Precautions to keep in mind when administering Nitro

-ED drugs

-Inferior wall (right sided) MI

Side effects of

Nitro

- HA

- Hypotension

- Reflex Tachycardia

(because of hypotension)

Signs of toxicity of

Nitro

Severe hypotension

Trade name for

Adenosine

Adenocard

Classification of

Adenosine

-Slows tachy rhythms associated with AV node via modulation of the Auto N.S. 

-Slows conduction through AV node and blocks re-entry pathways through the AV node

Onset of

Adenosine

30 seconds or less

Duration of 

Adenosine

10 seconds

Action of 

Adenosine

- Additive effects - Digoxin, Ca++ channel blockers

- Antagonistic effects - Mathylxanthenes

- Potentiating effects - dipyridamole

Indications for the use of 

Adenosine

- SVT's (including WPW), refractory to vagal meneuvers

- Stable regular monomorphic wide complex tachycardias (that could be atrial in origin)

Contraindications of

Adenosine

- 2nd or 3rd degree heart blocks

- Sick sinus syndrome

- known hypersensitivity

- Pregnancy ( C )

- Known A-fib or A-flutter

- Irregular wide complex tachy's

Availability & forms of

Adenosine

What is your dose sequence of

Adenosine

- 1st - 6 mg rapid IV bolus followed by a 20 cc flush and elevate extremities

- 2nd - If no response after 1-2 minutes, 12 mg 

- 3rd - after 2 additional min, another 12

(per ACLS, no 3rd dose necessary)

What precautions must be taken into consideration when administering 

Adenosine

May cause refractory bronchospasms

Use with caution with pt's with COPD and Asthma

Side effects of

Adenosine

Flushing

Chest pain

Dyspnea