Pharm Drugs (antirryhmtics).txt

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Anonymous
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100550
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Pharm Drugs (antirryhmtics).txt
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2011-09-08 14:09:02
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Cardiovascular Drug
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Antiarrythmic Agents
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  1. "Class I & III affects the ________
    • Class II & IV affects the ________"
    • "rhythm
    • rate
    • "
  2. "Sodium channel blockers
    • Block fast sodium channels responsible for phase _________________ of action potential
    • "
    • "Class I
    • 0 depolarization"
  3. "Moderate sodium blockade
    • Prolongation of repolarization
    • Examples:
    • Quinidine
    • Procainamide"
    • "Class 1a
    • "
  4. "Mild sodium blockade
    • Shortens repolarization
    • Examples:
    • Lidocaine
    • Phenytoin
    • "
    • "Class 1b
    • "
  5. "Marked sodium blockade
    • No change in repolarization
    • Examples:
    • Flecanide
    • Propafenone
    • "
    • "Class 1c
    • "
  6. "Beta-adrenergic antagonists
    • Inhibits sympathetic nervous activity
    • Decrease heart rate and cardiac contractility
    • Examples:
    • Metoprolol
    • Propranolol
    • "
    • "Class II
    • "
  7. "Potassium channel blockade
    • May also possess some alpha- and beta-adrenergic and calcium-channel blocking properties
    • Main effect: prolonged refractory periods
    • Examples:
    • Amiodarone
    • Sotalol
    • Ibutilide
    • "
    • "Class III
    • "
  8. "Calcium-channel blockers
    • Decrease SA and AV nodal conduction, as well as cardiac contractility
    • Examples:
    • Diltiazem
    • Verapamil
    • "
    • "Class IV
    • "
  9. must be administered rapidly due to short half-life
    Adenosine
  10. Drugs given for patients in cardiac arrest should be followed by 1 to 2 minutes of
    CPR
  11. "Medications that may be administered via ETT (remember NAVEL):
    • "
    • "N
  12. "Atropine sulfate Mechanisms of Action
  13. "
    • "-Via direct vagolytic action enhances SA node automaticity
    • -AV node conduction
    • "
  14. "Atropine sulfate Indications
    • "
    • "-Sinus bradycardia
    • -Pulseless electrical activity (PEA)
    • -2nd degree block, type 2
    • -3rd degree block with new, wide QRS
    • -Class IIB asystole (is a state of no cardiac electrical activity)
  15. "
  16. "Atropine sulfate Dosages
    • "
    • "-Intravenous bolus 0.5 to 1 mg every 3 - 5 minutes until -symptoms have resolved
    • -The full vagolytic dose of .04mg/kg or 3mg total
    • -Asystole, a dose of 1mg every 3 - 5 minutes
    • "
  17. "Epinephrine Mechanisms of Action
    • "
    • "-Peripheral vasoconstrictor
    • -Improves coronary and cerebral perfusion
    • When used in cardiac arrest the following responses will increase:
    • -Coronary and cerebral flow
    • -Inotropic state (muscular contraction)
    • -Automaticity (Heart rate increase)
    • -MVO2 (mixed venous oxygen content), SVR (systemic vascular resistance), BP and HR
    • "
  18. "Atropine sulfate Medication Classifications
    • "
    • "Parasympatholytic
    • Anticholinergic
    • Vagolytic
    • "
  19. "Epinephrine Medication Classifications
    • "
    • "Vasopressor
    • Vasoconstrictor
    • Natural catecholamine (fight or flight)
    • "
  20. "Epinephrine Indications
    • "
    • "Cardiac arrest resulting from:
    • -V-fib
    • -Pulseless V-tach
    • -Asystole
    • -PEA (Pulseless electrical activity)
    • Epinephrine infusion can be used to treat profound,
    • symptomatic bradycardia that is refractory to:
    • -Atropine
    • -Dopamine
    • "
  21. Do not mix Epinephrine with
    • "sodium bicarbonate!!!!!!
    • "
  22. "Epinephrine Contraindications
    • "
    • "-Anesthesia with inhalant anesthetics
    • -Hypertension
    • -During labor
    • -Hyperthyroidism (hyperthyroidism (overactive thyroid gland) symptoms such as irritability, tachycardia, heat intolerance, increased sweating)
    • -Organic brain damage
    • -Patients receiving digitalis (Digitalis medicines strengthen the force of the heartbeat by increasing the amount of calcium in the heart's cells.)
    • "
  23. "Epinephrine Dosages
    • "
    • "Standard dose is 1 mg
    • Every 3 – 5 minutes during CPR
    • Endotracheal tube is 2 times the normal IV dose
    • "
  24. "Lidocaine Medication Classifications
    • "
    • "Ventricular anti-arrhythmic
    • "
  25. "Lidocaine Mechanisms of Action
    • "
    • "-Decreasing automaticity suppresses ventricular arrhythmias
    • -Reduces the slope of phase 4 diastolic depolarization
    • -During acute myocardial ischemia (MI), the threshold for the induction of V-fib is reduced.
    • -Lidocaine has been shown to elevate the fibrillation threshold.
    • "
  26. "Lidocaine Indications
    • "
    • "First antiarrhythmic to use for treatment of:
    • -Ventricular ectopy
    • -V-tach
    • Lidocaine should be given to patients with significant risk factors for malignant ventricular arrhythmias.
    • -Hypokalemia (low potassium)
    • -Myocardial ischemia
    • -Significant ventricular dysfunction
  27. "
  28. "Lidocaine Contra-indications
    • "
    • "-Stokes-Adams syndrome (sudden, transient episode of syncope, occasionally featuring seizures)
    • -Any type of heart block (disrupt atrial & ventricular communication) without an artificial pacemaker in place
    • "
  29. "Lidocaine Dosages
    • "
    • "-Endotracheal tube administration
    • 2 - 2.5 times the intravenous dose (2 - 2.5mg/kg)
    • Administer 100mg/10ml syringe
    • -In non-cardiac arrest an initial bolus of 1-1.5 mg/kg drip (2-4mg/min)
    • -2nd bolus of 0.5mg/kg after 10mins
    • -Additional bolus 0.5 - .75 mg/kg every 5-10min for a maximum dose of 3mg/kg
    • -Start a Lidocaine drip of 2 - 4 mg/min. (Only if rhythm has been restored)
    • -Refractory V-fib or pulseless V-tach the initial bolus should be 1 - 1.5mg/kg
    • "
  30. Lidocaine Medication Supplied in
    • "100mg/5ml syringe for injection
    • 1.0 gm/5ml and 2.0 gm/5ml syringes to prepare continuous infusions
    • Premixed 250ml IV bag = 1gm
    • Premixed 500ml IV bag = 2gm
    • "
  31. "Amiodarone Medication Classifications
    • "
    • "Atrial and ventricular antiarrhythmic
    • "
  32. "Amiodarone Mechanisms of Action
    • "
    • "-Effects Na+, K+, and Ca2+ channels
    • -α and β adrenergic blockade
    • -Coronary and peripheral vasodilation
    • -Calcium blockade lengthens the effective refractory period in cardiac tissue and bypass tract"
  33. "Amiodarone Indications
    • "
    • "-Ventricular rate control of rapid atrial arrhythmias with severe dysfunction refractory to Digitalis
    • -After defibrillation and epinephrine with persistent V-fib and V-tach arrest
    • -Polymorphic V-tach and wide complex tachycardia of uncertain origin that is hemodynamically stable
    • -Adjunct to electrical cardioversion of PSVT
    • -Control rapid ventricular rate due to accessory pathway conduction in preexcited atrial tissue
    • -Atrial and ventricular arrhythmias with severe dysfunction
    • "
  34. "Amiodarone Contra-indications
    • "
    • "Hypotension
    • "
  35. "Amiodarone Dosages
    • "
    • "-V-fib/V-tach arrest give 300mg IV bolus (Dead)
    • -Atrial or ventricular arrhythmias
    • 150mg over 10min (Stable)
    • -Then, 1mg/min for 6hrs then 0.5mg/min
    • -May repeat the 150mg slow bolus as needed
    • -Maximum total dose is 2gm/day
    • "
  36. "Procainamide (Pronestyl) Medication Classifications
    • "
    • "Ventricular antiarrhythmic
    • "
  37. "Procainamide (Pronestyl) Mechanisms of Action
    • "
    • "-Slows intraventricular conduction by reducing slope of phase 0 action potential.
    • -Decreases the speed of electrical conduction through the heart muscle, prolongs the electrical phase during which the heart's muscle cells can be electrically stimulated, and prolongs the recovery period during which the heart muscle cells cannot be stimulated.
    • -Suppresses ventricular ectopy and may be effective when lidocaine has not suppressed it
    • "
  38. "Procainamide (Pronestyl) Indications
    • "
    • "-Is acceptable and probably helpful in persistent cardiac arrest due to V-fib.
    • -Treats A-fib and A-flutter with Wolff-Parkinson-White syndrome (WPW).
    • -May be useful in suppressing premature ventricular contractions (PVCs) and recurrent V-tach not controlled by lidocaine.
    • "
  39. "Procainamide (Pronestyl) Contra-indications
    • "
    • "-Complete AV block
    • -2nd and 3rd degree heart blocks, unless an electrical pacemaker is operative
    • -Torsade de pointes (uncommon and distinctive form of polymorphic ventricular tachycardia (VT) characterized by a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line)
    • -Induced hypotension after rapid IV administration
    • -Potent vasodilator and modest negative inotropic effects in patients with dysfunction
    • "
  40. "Procainamide (Pronestyl) Dosages
    • "
    • "-17mg/kg is given
    • -1.2 gm for 70kg patient
    • -In urgent situations up to 30mg/min can be given until the 17mg/kg is given.
    • -The maintenance, continuous infusion rate is 1 - 4mg/min
    • "
  41. Procainamide (Pronestyl) Suppied in
    • "Supplied:
    • -10ml vials (100mg/ml)
    • -2ml vials (500mg/ml)
    • "
  42. "Magnesium Sulfate Medication Classifications
    • "
    • "Ventricular antiarrhythmic
    • "
  43. "Magnesium Sulfate Mechanisms of Action
    • "
    • "-Magnesium sulfate supplementation may reduce the incidence of post infarct ventricular arrhythmias.
    • -Hypomagnesemia
    • -Precipitate refractory V-fib
    • -Hinder replenishment of intracellular K+
    • "
  44. "Magnesium Sulfate Indications
    • "
    • "Suspected hypomagnesemic state with anterior MI
    • Torsades de Pointes (treatment of choice)
    • Severe refractory V-fib
    • "
  45. "Magnesium Sulfate Contra-indications
    • "
    • "Administration within two hours of the onset of:
    • -Heart block
    • -Myocardial damage
    • "
  46. "Magnesium Sulfate Dosages
    • "
    • "For V-fib or V-tach:
    • -1 - 2gm diluted in 100ml normal saline administered over 1 - 2 minutes
    • Post MI:
    • -Loading dose = 1 - 2gm in 50 - 100 ml administered over 5 - 60 minutes
    • "
  47. "Adenosine Medication Classifications
    • "
    • "Supraventricular antiarrhythmic
    • "
  48. "Adenosine Mechanisms of Action
    • "
    • "-May be used to test the heart for coronary artery disease
    • -Slows conduction AV node
    • -Terminates paroxysmal supraventricular tachycardia (PSVT)
    • Helps to clarify the diagnoses for:
    • -Atrial flutter (A-flutter)
    • -Atrial fibrillation (A-fib)
    • -Atrial/ventricular (A/V) tachycardia
    • "
  49. "Adenosine Indications
    • "
    • "-PSVT
    • -Wide complex tachycardia of uncertain type
    • -A-fib or flutter
    • -Will not terminate arrhythmia, but may clarify the diagnoses
    • "
  50. "Adenosine Contraindications
    • "
    • "-Atrial flutter
    • -Atrial fibrillation
    • -Ventricular tachycardia
    • -Sick sinus syndrome (sinus node defect)
    • "
  51. "Adenosine Dosages
    • "
    • "-6 mg rapid bolus over 1 - 3 sec followed by a 20ml flush
    • -If no response within 1 - 2 min administer 12mg in the same manner.
    • -If there is still no response, administer another 12mg.
    • "
  52. Adenosine negative drug interatctions
    • "-Theophylline
    • -Caffeine
    • -Theobromine
    • -Dipyridamole
    • "
  53. "Verapamil (Isoptin) Medication Classifications
    • "
    • "-Supraventricular anti-arrhythmic
    • -Calcium channel blocker
    • "
  54. "Verapamil (Isoptin) Mechanisms of Action
    • "
    • "-Affects the amount of calcium found in heart and muscle cells.
    • -Blocks calcium ions and possibly Na+ ions
    • -Used to treat chest pain caused by angina, high blood pressure, and controls heart rate in certain conditions
    • -Reduces afterload
    • -Decreases inotropy
  55. "
  56. "Verapamil (Isoptin) Indications
    • "
    • "-Treatment of PSVT
    • -Slows ventricular response
    • -Atrial flutter
    • -Atrial fibrillation
    • "
  57. "Verapamil (Isoptin) Contraindications
    • "
    • "When associated with accessory bypass tract in:
    • -Atrial fibrillation
    • -Atrial flutter
    • -Cardiogenic shock
    • -Severe congestive heart failure
    • -2nd or 3rd degree heart blocks
    • -Severe hypotension
    • "
  58. Verapamil (Isoptin) Dosages
    • "-Initial dose is 2.5 - 5.0 mg IV over 2 minutes
    • -Repeat doses are 5 - 10 mg given every 15 - 30 min to a maximum of 20mg.
    • -Supplied in 5mg and 10mg ampules or syringes
    • "
  59. "Diltiazem (Cardizem) Medication Classifications
    • "
    • "Supraventricular antiarrhythmic
    • Ca++ channel blocker
    • "
  60. "Diltiazem (Cardizem) Mechanisms of Action
    • "
    • "-Useful for terminating SVT (Supraventricular tachycardia )
    • -Slow channel activity in cardiac and vascular smooth muscle can be inhibited by Ca++ channel blockers.
    • -Slows conduction and prolongs refractoriness in the AV node
  61. "
  62. "Diltiazem (Cardizem) Indications
    • "
    • "Ventricular rate control for A-fib and A-flutter
    • Terminates and prevents PSVT
    • "
  63. "Diltiazem (Cardizem) Contra-indications
    • "
    • "-IV beta blockers combined with Ca++ channel blockers
    • -Hemological and electrophysiological effects will be synergistic
    • Avoid or use caution in:
    • -Patients with Sick sinus syndrome
    • -AV block in absence of fixed pacemaker
    • "
  64. "Diltiazem (Cardizem) Dosages
    • "
    • "-Initial bolus of 0.25 mg/kg (20 mg for the average patient) IV over 2 minutes
    • -The bolus dose is followed by a maintenance infusion of 5 - 15 mg/hr titrated to the heart rate.
    • -Infusion duration exceeding 24hrs and infusion rates above 5mg/hr not recommended
    • -If satisfactory ventricular rate control is not achieved
    • -A 0.35 mg/kg bolus over 2 - 5 minutes may be given after initial bolus.
    • -For PSVT give a bolus of 0.25mg/kg over 2 minutes.
    • If PSVT fails to convert:
    • A second bolus of 0.35mg/kg can be given 15 minutes after the initial dose.
  65. "
  66. "Procardia (Niphedipine) Medication Classifications
    • "
    • "Ca++ channel blocker
    • "
  67. "Procardia (Niphedipine) Mechanisms of Action
    • "
    • "-Dilates main coronary arteries and arterioles in both normal and ischemic areas of the heart
    • -Inhibits spasms of coronary arteries
    • -Reduces myocardial oxygen demand and afterload by peripheral arteriole dilation
    • -Negative inotropic effect on myocardium SA and AV conduction is slowed
    • "
  68. "Procardia (Niphedipine) Indications
    • "
    • "Relief of coronary artery spasm
    • Relief of effort induced angina
    • "
  69. "Procardia (Niphedipine) Contraindications
    • "
    • "Acute heart failure may occur in patients with borderline dysfunction.
    • "
  70. Procardia (Niphedipine) Dosage
    • "10 - 20 mg TID for control of angina
    • Maximum dosage is 180mg/day ()
    • "
  71. "Reduce and inhibit the effects of catecholamines via competitive antagonism at beta-adrenergic receptor sites
    • "
    • Beta-blockers
  72. "Beta-1 blockade effects:
    • "
    • "Reduction in heart rate (negative chronotropy)
    • Reduction in myocardial contractility (negative inotropy)
    • Reduction in blood pressure
    • "
  73. "Beta-2 blockade potentially harmful effects:
    • "
    • "Bronchoconstriction
    • Reduction in glycogenolysis
    • Blunting of sympathetic responses in hypoglycemia (tachycardia, diaphoresis)
    • "
  74. Beta-1 selectivity refers to
    • "agents that primarily work on beta-1 receptors with minimal or no effect on beta-2 receptors
    • "
  75. "Propranolol and Metoprolol Medication Classifications
    • "
    • "Beta blocker
    • "
  76. "Propranolol and Metoprolol Mechanisms of Action
    • "
    • "Propranolol is a non-selective agent affecting
    • -Beta-1 receptors
    • -Beta-2 receptors
    • Metoprolol at low dosage is beta-1 selective.
    • -Effects only beta-1 adrenergic receptors
    • -In high doses selectivity is lost
    • Both agents reduce:
    • -Heart rate
    • -Blood pressure
    • -Myocardial contractility
    • -Causes a decrease in contractility
    • -A-V nodal conduction that causes a controlled ventricular response in supraventricular tachyarrhythmias
    • "
  77. Propranolol and Metoprolol indications
    • "Control of arrhythmias that are refractory to other treatments:
    • -V-fib
    • -V-tach
    • Supraventricular tachycardias
    • Most effective on arrhythmias due to:
    • -Excessive beat stimulation
    • -Myocardial ischemia
    • -Control ventricular response in:
    • -A-fib
    • -A-flutter
    • -PSVT
    • The treatment for idiopathic hypertrophic subaortic stenosis (IHSS):
    • -Slows the heart rate
    • -Reduces outflow tract obstruction that occurs with exercise
    • "
  78. Propranolol and Metoprolol contraindications
    • "Bronchial asthma
    • Cardiogenic shock
    • Complete heart block
    • "
  79. Propranolol and Metoprolol dosage
    • "Propranolol
    • -IV 0.1mg/kg divided into 3 equal dosages at 2 - 3 minute intervals
    • -Rate of administration should not exceed 1mg/min.
    • Metoprolol
    • -5 - 10mg slow IV push at 5 minute intervals
    • -Total of 15mg
    • "
  80. "Esmolol Medication Classifications
    • "
    • "Beta blocker
    • "
  81. "Esmolol Mechanisms of Action
    • "
    • "Hemodynamically similar to propranolol
    • "
  82. Esmolol Indications
    • "-Supraventricular rhythm (SVR) requiring short term ventricular rate control pre- and post-op
    • -A-fib
    • -A-flutter
    • -SVR is not decreased.
    • -Beta-1 selectivity is short lived.
    • "
  83. Esmolol Contraindications
    • "-Not intended for chronic use when transfer to another agent is anticipated
    • -Overt cardiac failure
    • -2nd or 3rd degree heart block
    • -Concurrent use of Epinephrine
    • "
  84. Esmolol Dosage
    • "-5gm/500ml of normal saline or D5W for a concentration of -10mg/ml
    • Loading dose
    • -250 - 500 mcg/kg/min for 1 min
    • -Followed by 25 - 50 mcg/kg/min infusion
    • -Titrate at 25 - 50 mcg/kg/min every 5 minutes to effect
    • "
  85. "Atenolol Medication Classifications
    • "
    • "Beta blocker
    • "
  86. "Atenolol Mechanisms of Action
    • "
    • "Reduces:
    • -Heart rate
    • -Cardiac output
    • -Blood pressure
    • -MVO2
    • -Redistribution of blood flow from adequately supplied areas of the heart to ischemic areas
    • -Acts within 1 - 2 minute
    • -Lasts 3 - 4 hours
    • "
  87. Atenolol Indications
    • "Reduces the incidence of:
    • -Recurrent MI
    • -Size of the infarct
    • -Fatal dysrhythmias
    • "
  88. "Atenolol Contraindications
    • "
    • "-Sinus bradycardia
    • -Heart block greater than 1st degree (Medium-Grade AV block)
    • -Cardiogenic shock
    • -Overt cardiac failure
    • "
  89. Atenolol Dosage
    • "5 mg IV
    • If initial dose well tolerated repeat in 10 minutes
    • If IV dose well tolerated then give 50mg orally 10 minutes after last bolus.
    • Repeat in 12 hours.
    • "
  90. "Calcium chloride Medication Classifications
    • "
    • "Inotropic (Squeeze effect)
    • "
  91. "Calcium chloride Mechanisms of Action
    • "
    • "-Ca++ ions increase the force of myocardial contraction
    • C-a++ effects in a normal heart
    • -Positive inotropic
    • -Vasoconstricting
    • -Raises arterial BP
    • "
  92. "Calcium chloride Indications
    • "
    • "Hypocalcemia
    • Acute hyperkalemia
    • Ca++ channel blocker toxicity
    • "
  93. "Calcium chloride Contraindications
    • "
    • "Ventricular fibrillation
    • Potential for existing digitalis toxicity
    • "
  94. Calcium chloride Dosages
    • "100mg/ml packaged in a 10ml prefilled syringe or ampule of a 10% solution
    • 2 - 4mg/kg IVP repeated every 10 minutes
    • Calcium gluceptate
    • 500 - 700mg
    • Calcium gluconate
    • 500 - 800mg
    • "
  95. Calcium chloride is preferred because
    • "it produces consistently higher plasma levels.
    • "

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