Cardiac Drugs

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Class For Nigroglycerine

Nitrate

Nitroglycerine - Actions

Relaxes smooth muscle, dilates coronary arteries and increases inotrophy.

Nitroglycerine - Indications

CP associated with acute coronary syndrome, acute pulmonary edema

Nitroglycerine - Contraindications

Hypotension, Increased ICP

Nitroglycerine - Precautions

Systolic BP <100, protect from light and moisture

Nitroglycerine - Side effects

Hypotension, tachycardia, headache, nausea/vomiting

Nitroglycerine - Dosage

.4mg up to 3 times.

Atropine - Class

Anticholinergic, Parasympatholytic

Atropine - Actions

Increased HR associated with hemodynamically significant bradycardias by blocking parasympathetic tone.

Atropine - Indications

Symptomatic bradycardias

Atropine - Contraindications

Supraventricular >100, Ventricular >60, v-fib

Atropine - Precautions

Paradoxical bradycardia in 2 degree type II AVB, 3 degree AVB

Atropine - Side Effects

Tachycardia, CP, confusion, dry mouth, blurred vision, dilated pupils

Atropine - Dosage

.5 - 1 mg (Max .04 mg/kg)

Dopamine - Class

Catecholamine, Sympathomimetic

Dopamine - Actions

Increased inotrophic/chronotropic affects, increase O2 consumption, increased PVR, bronchodilation

Dopamine - Indications

Symptomatic bradycardias, pulseless arrests (VF, PVT, PEA, Asystole)

Dopamine - Contraindications

V-Tach, V-fib

Dopamine - Precautions

Atrial tachydysrhythmias, Ventricular dysrhythmias, CP, HTN

Dopamine - Dosage

5-20 mcg/kg/min

Epinephrine - Class

Catecholamine, Sympathomimetic

Epinephrine - Actions

Increases inotrophic/chronotropic/dromotropic affects, increases O2 consumption, increases PTV, bronchodilation

Epinephrine - Indications

Symptomatic bradycardias, pulseless arrests (VF, PVT, PEA, Asystole)

Epinephrine - Contraindications

Tachyarrythmias w/pulse, hypertensive states, cardiovascular disease.

Epinephrine - Precautions

Atrial tachydysrhythmias, ventricular dysrhythmias, CP, HTN

Epinephrine - Side Effects

Tachycardia, CP, HTN

Epinephrine - Dosage

2-10 mcg/min; 1 mg IV

Adenosine - Class

Anti-dysrhythmic; purine nucleoside

Adenosine - Actions

slows conduction through AV node

Adenosine - Indications

Stable PSVT refractory to vagal maneuvers

Adenosine - Contraindications

2 degree type II AVB, 3 degree AVB, Sick Sinus Syndrome

Adenosine - Precautions

Asthma Patients

Adenosine - Side Effects

Facial Flushing, headache, SOB, Dizziness, nausea

Adenosine - Dosage

6mg, 12, mg, 12 mg

Cardiazem - Class

Calcium Channel Blocker

Cardiazem - Actions

Relaxes smooth muscle, decreases PVR, decreases AV conduction, dilates coronary arteries

Cardiazem - Indications

A-fib, A-flutter, SVT refractory to adenosine, hypertensive angina pectoris

Cardiazem - Contraindications

2 degree AVB, 3 degree AVB, hypotensive states

Cardiazem - Precautions

Hypotension, bradycardia, calcium chloride is antidote.

Cardiazem - Side Effects

Nausea/Vomiting, Dizziness, Headache, Heart Block, Hypotension, bradycardia

Cardiazem - Dosgae

.25 mg/kg; 5-15 mg/hr

Furosemide - Class

Loop Diuretic

Furosemide - Actions

Venous dilation, inhibits reabsorption of sodium in Loop of Henle, Diuresis

Furosemide - Indications

Acute pulmonary edema

Furosemide - Contraindications

Allergy to sulfa drugs

Furosemide - precautions

Dehydration, hypotension, slow IV push, protect from light

Furosemide - Side Effects

Dehydration, hypotension, electrolyte depletion

Furosemide - Dosage

40-100 mg.

Morphine - Class

Narcotic Analgesic

Morphine - Actions

Analgesia/sedation, decreases CNS, arterial and venous dilation

Morphine - Indications

CP associated with acute coronary syndrome, acute pulmonary edema, pain relief

Morphine - Contraindications

Hypotension, volume depletion, head injury, abd. pain.

Morphine - Precautions

Addiction/abuse, resp. depression, Narcan as antidote.

Morphine - Side Effects

Nausea/Vomiting, hypotension, resp. depression, abd. cramps, constricted pupils, AMS

Morphine - Dosage

2-5 mg (Up to 15 mg)

Vasopressin - Class

Antidiuretic Hormone

Vasopressin - Action

Stimulates V1 receptor sites causing vasoconstriction

Vasopressin - indications

Pulseless arrest (VF, PVT, PEA, Asystole)

Vasopressin - Contraindications

V-tach w/pulse

Vasopressin - Precautions

May cause myocardial ischemia, CP, HTN

Vasopressin - Side Effects

Tachycardia, CP HTN

Vasopressin - Dose

40 IV IU

Amiodarone - Class

Atrial and Ventricular anti-dysrhythmic

Amiodarone - Action

Blocks the sodium, potassium, and calcium channels, blocks alpha and beta receptors, lengthens QT interval

Amiodarone - Indications

V-fib, pulseless v-tach, stable v-tach w/pulse, stable PSVT refractory to adenosine, WPW

Amiodarone - Contraindications

Junctional escape rhythm, 2 degree type II, 3 degree, Asystole.

Amiodarone - Precautions

May cause hypotension, asystole, PEA, cardiogenic shock, CHF, Bradycardia, Ventricular tachycardia, AV block.

Amiodarone - Side Effects

Hypotension, asystole, PEA, cardiogenic shock, CHF, bradycardia, ventricular tachycardia, AV block.

Amiodarone - Dose

Pulseless: 300 mg IVP repeat in 5 min. 150 mg. Pulse: 150 mg/50 ml over 10 min Maint: 1 mg/min for 1st 6 hours, .5mg/min for next 18 max 2.2g/24 hours.

Lidocaine - Class

Ventricular Anti-dysrhythmic

Lidocaine - Action

decreases vent. depolarization and automaticity, depresses vent. ectopy assoc. w/acute coronary syndrome, increases v-fib threshold

Lidocaine - Indications

V-fib, pulseless v-tach, stable v-tach w/pulse, malignant PVC's

Lidocaine - Contraindications

@ degree type II, 3 degree PEA, Asystole

Lidocaine - Precautions

CNS Depression

Lidocaine - Side Effects

Irritability, confusion, muscle twitching, seizures, coma, death

Lidocaine - Dose

1-1.5 mg/kg IVP q3-5 at 50% Maint: 2-4 mg/min Max: 3 mg/kg

Magnesium Sulfate - Class

Ventricular Antidysrhythmic, electrolyte, anti-convulsant

Magnesium Sulfate - Actions

increases QT interval, replenishes mag. cation, relaxes smooth muscle, depresses CNS

Magnesium Sulfate - Indications

Torsade D' Pointes, situations requiring bronchodilation (asthma, COPD), pregnancy induced HTN seizures

Magnesium Sulfate - Contraindications

2 degree type II, 3 degree, PEA, Asystole

Magnesium Sulfate - Precautions

CNS depression, calcium chloride may be used as anitdote

Magnesium Sulfate - Side Effects

Hypotension, respiratory depression

Magnesium Sulfate - Dose

1-2 G in 50 ml over 5 mins.

Procainamide - Class

Atrial and Ventricular anti-dysrhythmic

Procainamide - Action

Reduces automaticity of pacemaker sites, slows intraventricular conduction

Procainamide - Indications

Recurrent V-Tach, PSVT refractory to adenosine

Procainamide - Contraindications

Sever conduction disturbances, 2 degree Type II, 3 degree AVB, Ventricular escape beats.

Procainamide - Precautions

Hypotension

Procainamide - Side Effects

Hypotension, seizures, bradycardia, heart blocks, respiratory and cardic arrest

Procainamide - Dosage

20-30 mg/min IV drip Max: 17 mg/kg, QRS increases by 50% hypotension

Labetalol - Class

Non-selective beta blocker, selective alpha 1 blocker

Labetalol - Action

Inhibits peripheral vasoconstriction, decreases cardiac output, causes peripheral vasodilation

Labetalol - Indications

Hypertensive crisis

Labetalol - Contraindications

Bronchial asthma, CHF, heart block, bradycardia, cardiogenic shock

Labetalol - Precautions

CHF, bradycardia, shock, heart block, bronchospasm, postural hypotension

Labetalol - Side Effects

Bradycardia, hypotension, lethargy, CHF, dyspnea, wheezing, weakness

Labetalol - Dosage

10 mg IV over 2 mins, repeat at 10-20 mg after 10 mins.

Metaprolol - Class

Selective beta blocker

Metaprolol - Action

Slowing of sinus rate and AV conduction, decreased heart rate and cardiac output, decrease of systolic BP, decrease reflex orthostatic tachycardia, inhibition of catecholamine induced tachycardia

Metaprolol -Indications

Acute MI, angina pectoris, hypertension

Metaprolol - Contraindications

Sinus Bradycardia, heart block, cardiogenic shock, systolic BP < 100, cardiac failure

Metaprolol - Precautions

Bronchospastic diseases, diabetes, hypoglycemia, thyrotoxicosis

Metaprolol - Side Effects

Hypotension, bradycardia, tiredness, dizziness, depression, confusion, short-term memory loss, headache, insomnia.

Metaprolol - Dosage

5 mg slow IVP every 5 mins x3 doses (max 15 mg)

Calcium Chloride - Class

Calcium supplement

Calcium Chloride - Actions

replaces calcium in hypocalcemia, increases myocardial contractile force, increases ventriular automaticity, antidote for mag. Sulfate, minimizes side efects of calcium channel blockers.

Calcium Chloride - Indications

Hypocalcemia, hyperkalemia, calcium channel blocker toxicity, mag. sulfate toxicity.

Calcium Chloride - Contraindications

May precipitate digitalis toxicity in pts. taking Digoxin

Calcium Chloride - Precautions

Flush IV line between calcium chloride and sodium bicarb to avoid precipitation

Calcium Chloride - Side Effects

Bradycardia, ventricular arrhythmias, syncope, nausea/vomiting, cardiac arrest

Calcium Chloride - Dosage

2-4 mg/kg slov IVP

Sodium Bicarbonate - Class

Alkalinizing Agent