Nurs 211 Med Cards From Syllabus.docx · Version 1.docx

Generic: Morphine

Brand: Duramorph, Infumorph P/F, Arymo ER

Category: Narcotic Analgesic Action: binds w/ opiate receptors in the CNS; inhibits pain reception; Increases venous capitance; decreases systemic vascular resistance; decreases myocardial Ox demand and cardiac workload Dosage and Routes: 2-4 mg IV slow over 1-5 minutes; repeat as needed Side Effects: Hypotension, respiratory depression; decreases anxiety by blocking catecholamine; confusion, dizziness, seizures, constipation Cautions: Used for cardiac CP and acute CHF; titrate to relieve pain; ongoing pain = ongoing ischemia; reverse effects w/narcan

Generic: Nitroglycerine

Brand: Nitrostat, Rectiv, Nitrolingual

Category: Vasodilator Action: Relaxes venous smooth muscle, dilates coronary blood vessels; decreases LV filling pressure, systemic vascular resistance, myocardial Ox requirements and myocardial ischemia; used to relieve anginal pain and AMI pain; increases CO in CHF/MI Dosage and Routes: Tab/spray – 1 q 5 min x 3 SL; IV – 12.5-25 mcg/min and tritrate for effect to max of 200 mcg/min Side Effects: Hypotension; severe h/a (hypotension can worsen ischemia) Cautions: Contraindicated w/hypotension and RV infarct (RV relies on filling to generate pressure and provide RV output) Suspect inferior MI, get R side ECG Don’t give if SBP < 90 Don’t mix w/other drugs Binds to plastic; use glass bottles and nitro tubing

Generic: nitroprusside sodium

Brand: Nipride RTU, Nitropress

Category: Vasodilator Action: Acts on cardiac smooth muscle to cause vasodilation; CV reflexes not inhibited – will have reflex tachycardia and increased rennin release Used in hypertensive crisis; AMI w/dopamine adjunct LVF w/Ox, MS and loop diuretic Dosage and Routes: 50-100 mg to 250 mL D5W. Begin at 0.1 mcg/kg/min Titrate to pt effect Side Effects: Rapid response; hypotension can be severe Cautions: BP changes rapidly at small doses; needs to be protected from light; extended use can lead to cyanide toxicity; needs to be infused in separate line

Generic: Aspirin

Brand: Bayer Aspirin (with caffeine), Ecotrin, E.C. Prin

Category: Anti-platelet aggregat Action: Prevents formation of the platelet aggregating substance (thromboxane A2); keeps platelets from aggregating & arteries from constricting; Used for all pts w/an ACS – especially if going for PTCA or receiving fibrinolytics; effective for secondary prevention of MI Dosage and Routes: 160-325 mg as soon as sx begin; then give daily Side Effects: Upset stomach; N/V; dyspepsia; thrombocytopenia (watch for unusual bleeding) Cautions: Do not give ECASA or buffered ASA for ACS; relatively contraindicated in pts w/active bleeding, ulcer disease or asthma

Generic: Clopidogrel

Brand: Plavix

Category: Anti-platelet aggregate Action: Blocks ADP receptors on platelets preventing clumping Dosage and Routes: 300 mg loading dose then 75 mg daily Side Effects: Prolonged bleeding Cautions: Contraindicated in pts w/active bleeding pathologies ie bleeding ulcers, ICB; relative contraindications in pts w/bleeding disorders, hepatic impairment, recent surgery or pregnancy

Generic: Abciximab/ Tirofiban/ Eptifibatide Brand: Reopro/Aggrastat/Integrilin Category: Glycoprotein IIb/IIIa inhibitors Action: Inhibits platelet aggregation by blocking receptors of platelet surface membranes; final common pathway for platelet aggregation (consider for treatment of ACS) Dosage and Routes: Variable per/drug; Wt based bolus/gtt; Mcg/kg/min (reopro = mcg/min) Side Effects: Bleeding (monitor frequently; may need platelets); variable rates of platelet recovery (Integrilin = 4-8 hrs; Reopro = 48 hours) Cautions: Evaluate bleeding risk w/anti-platelet therapy screening tool for recent surgery; bleeding disorder, low platelet count (< 150,000 mm3)

Generic: Metoprolol/Atenolol

Brand: Lopressor, Toprol XL/Tenormin

Category: Beta Blockers Action: Blocks catecholamines from binding to B-adrenergic sites; decreases HR, BP, myocardial contractility and Ox consumption (decreasing MI extension); slows AV condution to control VF/VT and SVT’s; controls htn and tachycardias (if LVF not depressed); used in AMI to decrease reinfarction, ischemia and VF Dosage and Routes: Depends on drug chosen Side Effects: May cause refractory hypotension when given w/Ca channel blockers; May cause bronchospasms in asthmatics Cautions: Avoid in CHF/LVF (worsens myocardial depression) bradycardic or hypotensive pts

Generic: Fondaparinux

Brand: Arixtra

Category: Anti-Coagulant Action: Inhibits thrombin formation by factor Xa inhibition Dosage and Routes: STEMI 2.5 mg IV bolus followed by 2.5 mg subcut every 24 hours for up to 8 days; UA/NSTEMI 2.5 mg subcut every 24 hours Side Effects: Bleeding; can be used as anticoagulant in patients with history of HIT Cautions: Contraindicated in patients with creatinine clearance <30 ml per minute; caution with creatinine clearance 30 – 50 ml/min; increased risk of catheter thrombosis in patients undergoing PCI

Generic: Heparin - Unfractionated Heparin

Brand:

Category: Anti-Coagulant Action: Combines w/anti thrombin III to prevent conversion of prothrombin to thrombin; prevents thrombus formation and extension of existing thrombi Dosage and Routes: Bolus 60-70 IU/kg (max 4000 IU); infusion rate 12 IU/kg (max rate 1000 IU/hr for pts > 70 kg) Side Effects: Bleeding; monitor all sites and do neuro checks Cautions: Keep PTT 50-70 (2-2.5 x’s normal); may need to increase doses if also running ntg; use for pts w/MI and fibrinolytics or having PTCA; screen for recent surgery, severe HTN; GIB or other bleeding disorder; decrease dosing guidelines when running w/fibrinolytics to reduce chance of ICB

Generic: Lovenox - Low Molecular Wt Heparin

Brand:

Category: Anti Coagulant Action: Use for high risk, unstable angina, non Q-wave MI; more predictable response than unfractionated heparin (works higher in the coag cascade; inhibits thrombin directly (anti Xa) and indirectly (binds w/anti thrombin III) Dosage and Routes: 1mg/kg SC bid for 2-8 days Side Effects: Bleeding Cautions: No need to follow PT/PTT; do not give if platelets < 100,000 or hx of HIT

Generic: Tenecteplase – an enzyme Brand: TNKase Category: Fibrinolytic Action: Causes clot to dissolve (more fibrin specific than tPa); use for ST elevation MI < 6 hours from onset Dosage and Routes: Wt based; give 30-50 mg IVP over 5 seconds (max = 50 mg) Side Effects: Bleeding (CVA, tamponade); Reperfusion dysrhythmias (don’t treat unless symptomatic); has less incidence of ICH Cautions: Complete a thrombolytic inclusion/exclusion assessment (same criteria as tPA – recent surgery, bleeding, bleeding disorder, severe HTN)

Bradyarrythmias etc.

Generic: Epinephrine Brand: EpiPen, EpiPen 2-Pak, Bronchial Mist Refill Category: Sympatho mimetic (mimics effects of CNS); vasodilator, catecholamine Action: Optimizes CO, circulation and BP; A-adrenergic effects = vasoconstriction (increases BP, HR, blood flow to brain and heart); increases Ox consumption; Badrenergic – will start a non-beating heart Dosage and Routes: 1 mg IVP q 3-5 minutes Side Effects: Cardiac ischemia (increased myocardial ox demand); tachycardia Cautions:

Generic: Atropine

Brand: Atropen

Category: Anti cholinergic Action: Blocks the normal vagal inhibition of the SA node (areas of the heart not served by the vagus nerve will not respond to atropine) Dosage and Routes: 0.5 mg IVP to a total of 3 mg Side Effects: Contains sulfite – can cause allergic rxs; drowsiness, confusion, tachycardia, dry mouth, slowing of GI motility, dilated pupils; hot flushed skin Cautions: Can accelerate atrial rate in 3rd and 2nd degree Type II AV blocks and produce increased AV nodal block; do not give w/AMI as the increased HR can worsen inschemia; slow administration and small doses can cause paradoxical slowing of the heart rate

Generic: Dopamine Brand: Category: Vasopressor; Adrenergic Action: Dose dependant; 5 mcg/kg/min enhances cerebral, renal and mesenteric blood flow by vasodilation (dopaminergic effect); 5-10 mcg/kg/min = cardiac dose; increases HR, myocardial contractility, BP, HR and CO (B1 and a-adrenergic effects); 10-20 mcg/kg/min = vasopressor dose; causes peripheral, arterial and vasoconstriction; used in low BP (alpha adrenergic effects) Dosage and Routes: 1-20 mcg/kg/min titrate to effect Side Effects: Tachycardia (decreases CO); H/A, anxiety, ventricular dysrhythmias, extreme peripheral vasoconstriction; not compatible w/alkaline solutions Cautions: Use in pts w/hypovolemia only after volume replacement; Wean slowly to prevent rebound hypotension; If doses > 20 mcg/kg/min are needed, add Levophed infusion; Use w/nipride to optimize CO

Generic: Dobutamine

Brand:

Category: Adrenergic Inotrope Action: Synthetic CNS stimulant, stimulates B1 receptors in myocardium; increases CO by increasing HR and decreasing PVR; minimal effect on BP Dosage and Routes: 2-20 mcg/kg/min (titrate by 2-3 mcg/kg/min) Side Effects: Tachycardia, BP fluctuations, H/A, Nausea Cautions: Not compatible w/heparin; Contraindicated in poison or drug induced shock; Give for CHF w/SBP of 70-100 and no s/s of shock (can also add nipride to decrease afterload); Give for septic shock only after correction of hypovolemia; Hemodynamic monitoring is recommended for optimal use

Generic: Procainamide

Brand: Pronestyl, Procan, Procanbid

Category: Antidysrhythmic Action: Treatment of wide variety of arrhythmias Dosage and Routes: 20 mg/min with maximum total dose 17 mg/kg Side Effects: Can cause hypotension in patients with impaired LV function Cautions: Dosage needs to be decreased with renal dysfunction; Use with caution with other drugs that prolong QT interval

Generic: Sodium Bicarbonate Brand: Category: Metabolic buffer Action: Buffering agent converts to carbonic acid then CO2 and excreted through the lungs; Reverses acidosis (give if pH < 7.25) Dosage and Routes: 1mEq/kg IV bolus then ½ the dose q 10 min based on ABG’s Side Effects: Extravasation can cause sloughing Hyperreflexia, twitching, tetany and burning at injection site Can encourage CHF Cautions: Use for cardiac arrest of long duration after CPR and ventilation (primary method of acidosis correction) Use for metabolic acidosis, hyperkalemia and TCA/phenobarb OD Rapid correction of acidosis causes hypokalemia Incompatible w/dextrose solutions

Generic: Calcium Chloride Brand: Category: Electrolyte replacement Action: Increases force of contraction by working directly on myocardial muscle (positive inotrope effect); Improves vascular tone; Used for hyperkalemia, hypocalcemia; Used as antidote for Ca-channel or Beta-blocker OD Dosage and Routes: 8-16 mg/kg (5-10 ml) of 10% sol’n slow IVP and repeat PRN Side Effects: Hypotension, bradycardia and prolonged PRI; Paresthesias and burning at injection site Cautions: Not routinely used in Cardiac arrest Not compatible w/sodium Bicarb Extravasation will cause severe necrosis

(V TACH w/pulse, V-FIB, PULSELESS V TACH)

Generic: Epinephrine

Brand:

Category: Adrenergic Action: Optimizes CO, circulation and BP; A-adrenergic effects = vasoconstriction (increases BP, HR, blood flow to brain and heart); increases Ox consumption; Badrenergic – will start a non-beating heart Dosage and Routes: 1 mg IV (1:10,000) q 3-5 minutes; ETT requires 2-2.5 x’s IV dose Side Effects: Cardiac ischemia (increased myocardial ox demand); tachycardia Cautions: Escalating and high dose schedules may be used; Can increase myocardial irritability and propensity for V-fib; High doses can lead to poor neurologic resuscitation

Generic: Vasopressin Brand: Vasostrict Category: Naturally occurring ADH Vasopressor Action: Optimize CO, circulation and BP; Smooth muscle constriction; Increases HR, BP, CO, myocardial Ox demand; Produces higher return to circulation than epi; Powerful vasoconstrictor; Does not increase cardiac irritability Dosage and Routes: 40 u IVP x 1; Half-life 10-20 minutes Side Effects: N/V, sweating, tremor, pounding in head, vertigo, reflex brady; Can cause sloughing (use large vein); Not recommended for pts w/CAD (can cause cardiac ischemia) Cautions:

Generic: Amiodarone Brand: Nexterone, Pacerone Category: Anti dysrhythmic Action: Slows conduction and prolongs refractoriness through AV node via action on Na, Ca and K channels; Stabilizes cell membranes; Inhibits A- and B-adrenergic activity; As a vasodilator it decreases cardiac workload and myocardial Ox consumption Dosage and Routes: 300 mg IV in 20-30 ml D5/NS (persistant VF/VT); 2nd dose of 150 mg may be req’d; Gtt may be started (not > 2.2 gm/24 hrs) Side Effects: Progressive cough/dyspnea; Hypotension; Malaise, involuntary movements Cautions: Hypokalemia, hypomagnesemia decrease effectiveness; Use w/caution w/COPD pts; Contraindicated in 2nd and 3rd degree heart blocks

Generic: Lidocaine

Brand: Lidoderm, Xylocaine, Recticare

Category: Anti dysrhythmic Action: Increases ventricular vibrillation threshold and decreases ventricular irritability (blocks fast Na channels) Dosage and Routes: 1-1.5 mg/kg IVP for VT (repeat ½ initial dose if not resolved in 510 min); Persistant VT/VF – repeat q 3-5 minutes (max dose 3 mg/kg); Maint. Gtt = 1-4 mg/min Side Effects: Tremors, seizures, respiratory compromise (CHF) may indicate lidocaine toxicity Cautions: Advanced age and compromised liver function necessitate lowering maint. Dose; Use lowest dose possible; Do not give w/2nd or 3rd degree heart block or idioventricular rhythm

Generic: Magnesium sulfate

Brand:

Category: Electrolyte replacement Action: Slows conduction through SA node, prolongs conduction and refractory times; Torsades des Pointes; Arrhythmias that are caused by hypomagnesemia (alcoholics, poorly nourished) Dosage and Routes: 1-2 mg in 10 cc/D5W IVP (cardiac arrest) 1-2 gm in 50-100 cc D5W over 5-60 min (stable TDP) Gtt 0.5-1g/hr IV for up to 24 hrs Side Effects: Sweating, flushing, weakness, prolongs PRI Cautions: Can cause hypotension, heart block and cardiac arrest if given too rapidly; Can cause severe hypocalcemia; Routine use is considered class indeterminate; Use w/caution if renal failure is present

VERY FAST RHYTHMS

Generic: Adenosine

Brand: Adenocard

Category: Anti-dysrhythmic Action: Suppresses dysrhythmias and optimizes cardiac function by slowing conduction through AV node and accessory pathways; restoring NSR in pts w/symptomatic PSVT Dosage and Routes: 6 mg rapid IVP No change; 12 mg rapid IVP; May repeat 12 if no change Side Effects: Transient chest pain, dyspnea, flushing; may see asystole or bradycardia Cautions: 10 second half-life; Give in large vein w/rapid saline flush; Can cause transient asystole, bradycardia or ventricular ectopy; Don’t give in wide-complex tachycardias – can cause severe hypotension

Generic: Metoprolol/Atenolol Brand: Lopressor, Toprol XL/ Tenormin Category: Beta Blockers Action: Blocks catecholamines from binding to B-adrenergic sites; decreases HR, BP, myocardial contractility and Ox consumption (decreasing MI extension); slows AV condution to control VF/VT and SVT’s; controls htn and tachycardias (if LVF not depressed); used in AMI to decrease reinfarction, ischemia and VF Dosage and Routes: Depends on drug chosen Side Effects: May cause refractory hypotension when given w/Ca channel blockers; May cause bronchospasms in asthmatics Cautions: Avoid in CHF/LVF (worsens myocardial depression) bradycardic or hypotensive pts

Generic: Verapamil Brand: Verelan, Calan, Verelan PM Category: Ca channel Blocker Action: Supresses dysrhythmias; decreases HR, myocardial contractions, myocardial oxygen consumption; slows AV node conduction; Used in A-fib, A-flutter and PSVT w/good LVF Dosage and Routes: 2.5 - 5 mg IVP over 2 minutes; May give 5–10 mg IVP in 15-30 minutes if needed; Max dose = 20 mg Side Effects: May cause hypotension (IV calcium is antagonist) and may decrease myocardial contractility in pt with poor LVF Cautions: Causes peripheral vasodilation; Avoid concomitant use with IV beta-blockers as can cause refractory hypotension; May exacerbate CHF (decreases contractility); Do not give for wide complex tachycardias or VT (can suppress ventricular activity and lead to systole)

Generic: Diltiazem Brand: Cardizem, Tiazac, Cartia XT Category: Ca channel Blocker Action: Inhibits calcium movement across myocardium/vascular smooth muscle decreasing heart rate and myocardial contractility and myocardial oxygen demand; Slows AV conduction; Used for A-fib/A-flutter rate control; PSVT refractory to adenosine Dosage and Routes: Bolus 0.25 mg/kg (15-20 mg) over 2 minutes Repeat if needed in 15 min w/0.35mg/kg (20-25 mg); Maint. Infusion: 5-15 mg/hr; titrate to heart rate Side Effects: Transient hypotension, dizziness, SOB, peripheral edema, AV block, angina; Has fewer negative side effects than verapamil Cautions: Causes peripheral vasodilation and refractory hypotension; Decreased myocardial contractility can worsen CHF; Do not use in wide complex tachycardias

Generic: Digoxin

Brand: Lanoxin, Digox, Lanoxin Pediatric

Category: Cardiac glycoside; Anti-dysrhythmic Action: Slows ventricular response in A-fib/A-flutter by slowing conduction through AV node; Increases cardiac contractility increasing CO Dosage and Routes: Loading dose: 10-15 mcg/kg Maintenance dose based on wt and create clearance (has narrow therapeutic range) Side Effects: Toxic effects are common – can cause dysrhythmias similar to those that warranted therapy (V-tach, V-fib, PAT, A-fib); headache, confusion, SOB, N/V, palpitations, dizziness, yellow-green halos or blurred vision Cautions: Avoid electrical cardioversion if pt is on dig; can cause V-tach/V-fib Monitor K+, Mg, Ca++ - low levels can worsen dysrthythmias

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