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Top 10 Meds
| Question | Answer |
|---|---|
| What class of drug is Amiodarone | Class III antiarrhythmic |
| How does Amiodarone work | It's a potassium channel blocker; slows efflux of potassium and delays repolarization |
| Why would we give amiodarone | V-fib and pulseless V-tach that is unresponsive to CPR, shock delivery, and Epi; hemodynamically stable VT with a pulse |
| What major effects can amiodarone cause | severe hypotension and the half-life is 40 days |
| What are the contraindications for amiodarone | Allergic, bradycardias with AV blocks, breastfeeding mothers |
| Side effects seen with amiodarone | severe hypotension, bradycardia, prolonged QT interval that can lead to TdP |
| Dose of amiodarone for VF/pVT in cardiac arrest; first and then second dose adult and pediatric | Adult: First: 300mg IV/IO, Second: 150mg Pedi: 5mg/kg up to 15mg/kg max |
| Amiodarone dose for V-tach with a pulse; first and then second dose and loading dose for pediatrics | First: 150mg over 10 min Second: the same every 10 min as needed up to a max of 2.2 grams in 24hr (15mg/min) pediatric: 5mg/kg over 20-60 minutes up to max 300mg |
| What is the initial infusion rate for amiodarone and then the maintenance infusion rate | First/slow: 1mg/min (360mg/6hrs) maintenance: 0.5mg/min (540mg/18hrs) not to exceed 2.2g in 24hrs |
| What class of medication is Atropine | Muscarinic blocker/anticholinergic/parasympatholytic; selectively blocks muscarinic receptors |
| Why would you give atropine | symptomatic stable bradycardia and organophosphate poisoning |
| Contraindications for atropine | allergic, caution with MI and hypoxia due to increase work of the heart/O2 demand, hypothermic bradycardia; can have paradoxical slowing of the heart if pushed slow or small amounts |
| Dose of atropine for bradycardia and organophosphate poisoning | Adult Bradycardia: 1mg IVP q 3-5min up to 3mg (0.04mg/kg) Pedi bradycardia: 0.02mg/kg IV/IO (minimum 0.1mg) max single 0.5mg q 3-5 up to 1mg max child adult Organo: 2-4mg or more IVP; pedi 0.02-0.05mg/kg++ |
| Side effects with atropine | blurred vision, dry mouth, dilated pupils, confusion, tachycardia |
| How does ipratropium work | its an anticholinergic and selectively blocks muscarinic receptors |
| why do we use ipratropium | for bronchospasm related to asthma and COPD |
| contraindications for ipratropium | allergic |
| adverse effects of ipratropium | blurred vision, dry mouth, dilated pupils, cough, confusion |
| ipratropium dose for adults and pediatric | adult 500mcg/2.5mL and pedi 250-500mcg/1.25-2.5mL |
| What class of medication is diltiazem and how does it work | its a class IV antiarrhythmic, calcium channel blocker; slows action potential of autorhythmic cells and decreases contraction of contractile cells |
| why would we give diltiazem? | first line symptomatic stable and a heart rate >150 a-fib/flutter with RVR also a second line for SVT following adenosine |
| contraindications for diltiazem | hypotension <90, CHF/cardiogenic shock, wide-complex tachycardia, WPW, or allergic |
| Adverse effects of diltiazem | hypotension, severe CHF if used with beta blocker, N/V/D, dizziness, HA |
| First dose of diltiazem? second if refractory? maintenance? | first: 0.25mg/kg max of 20mg second: 0.35mg/kg max of 25mg maintenance: 5mg/hr |
| epi 1:1000 and 1:10,000 pharmacodynamics | sympathomimetics; potent alpha and beta agonists with more on beta |
| why do we give epi 1:1000 1:10,000? | 1:1: severe bronchospasm, allergies/anaphylaxis 1:10:cardiac arrest, symptomatic bradycardia, normovolemic hypotension |
| dose for adult and pedi 1:1? route? dose for 1:10 for arrest, bradycardia, and hypotension | 1:1= 0.01mg/kg IM; adults 0.3mg IM (max for pedi), 0.5mg severe 1:10= arrest 1mg IVP q 3-5min, pedi 0.01mg/kg, continuous infusion 0.1-1mcg/kg/min brady: 2-10 mcg/min IV/IO infusion hypotension/severe anaphylaxis: 0.1-0.5mcg/kg/min in 1L |
| Class antiarrhythmic for lidocaine | class 1b, sodium channel blocker, delays depolarization and automaticity |
| indication for lidocaine | alternative to amiodarone in arrest from VF/pVT, stable monomorphic VT w/preserved LVF(runs of Vtach or couplet to triplet PVC's) |
| Contraindications for lidocaine | already given calcium channel blocker |
| side effects of lidocaine | drowsy, slurred speech, confusion, seizure, hypotension |
| dose for lidocaine in cardiac arrest dose for perfusing arrythmia maintenance infusion | CA::1-1.5 mg/kg IV/IO, refractory give 0.5-0.75 mg/kg in 5-10min with a max of 3mg/kg perfusing VT: 1-1.5 mg/kg, maintenance infusion: 1-4 mg/min (30-50mcg/kg/min) pediatric 1mg/kg with maintenance 20-50mcg/kg/min |
| How does midazolam work | benzo that binds GABA receptor sites increasing chloride influx and hyperpolarization leading to sedation |
| indications for midazolam | active seizures, RSI, chemical restraint, anxiety, sedation |
| contraindication for midazolam | allergic |
| Midazolam dose for adult & pedi RSI: ETT bucking adult seizure pedi seizure | RSI: 0.1-0.3 mg/kg IV/IO max 10 ETT: 0.05mg/kg slow adult seizure: 0.1-0.2mg/kg max 5 IV, 10IM pedi: 0.1mg/kg in 2mg increments max 5, 0.2mg/kg IN/IM max 10mg |
| how does Adenosine work | binds adenosine receptors causing efflux of potassium and inhibits calcium influx in slow potential cells causing hyperpolarization of autorhythmic cells (SA/AV) and slows AV conduction |
| Indication for adenosine | first line stable narrow complex SVT, regular monomorphic wide-complex tachy thought to be from reentry SVT w/ BBB |
| Contraindication for adenosine | a-fib/a-flutter, TdP, poison/drug induced tachycardia, 2/3rd AVB, WPW |
| side effects of adenosine | transient bradycardia/asystole/ventricular ectopy |
| Dose for adenosine | Adult: first rapid IV 6mg and 20mL flush; pedi: first 0.1mg/kg max of 6mg Adult: second rapid IV 12mg and flush; pedi : second 0.2mg/kg max 12mg |
| action of albuterol | bronchodilator; beta agonist preference for b2 |
| indication for albuterol | bronchospasm, allergies/anaphylaxis, hyperk |
| contraindication for albuterol | allergic |
| side effects of albuterol | palps, anxiety, tremor, HA, dizzy, tachy |
| Dose for adult and pedi albuterol amount for hyperK | Adult: 2.5mg/3mL via SVN q 15-20min Pedi: 1.25-2.5mg/1.5-3mL hyperK: 10-20mg LVN |
Created by:
Lindsey.George