TEEX Paramedic Drug Quiz 3 – Cardiac- Exam QA

Adenosine - Class - ANSWER-Antiarrhythmic Adenosine - Action - ANSWER-Slows conduction through the AV node (6 Second 1/2 life) Adenosine - Indications - ANSWER-Narrow Complex Tachycardias; Wide, monomorphic Adenosine - Contraindications - ANSWER-1. 2°; 3° heart block, sick sinus syndrome (wandering pacemaker) 2. Incompatible Meds: Tegretol - Epilepsy, Theophylline or other xanthines (coffee) Adenosine - Precautions - ANSWER-1. Arrhythmias, including block. (common during cardioversion) Adenosine - Side Effects - ANSWER-1. Facial flushing, headache, SOB, Dizziness, N/V 2. Can cause transient asystole (Short time of asytole) Adenosine - Adult Dose - ANSWER-6mg / 1-2sec followed by rapid 20mL saline flush; if after 1-2min no response, 12mg / 1-2sec followed by 20mL saline flush. RIVP Adenosine - Pediatric Dose - ANSWER-1st dose - 0.1mg / kg (max 6.0mg) 2nd dose - 0.2mg / kg (max of 12.0mg) Weight less than 50kg (first dose) Adenosine - Route - ANSWER-Rapid IV push. Should be given ideally through left AC. Adenosine - Supplied - ANSWER-6mg / 2mL vial or prefilled syringe Adenosine - Onset / Duration - ANSWER-Onset: seconds Duration: 12sec Amiodarone (Cordarone) - Class - ANSWER-Antiarrhythmic Amiodarone (Cordarone) - Action - ANSWER-1. Prolongs action potential duration in cardiac tissue 2. Blocks sodium channels at rapid pacing frequencies 3. Blocks myocardial potassium channels. Slows conduction and prolongs refractory period 4. Potent vasodilator Amiodarone (Cordarone) - Indications - ANSWER-1. Pulseless VT and VFib 2. Polymorphic VT (Greater than 100BPM with continuously varying QRS complex) 3. SVT refractory to Adenosine 4. Wide complex tachycardia of unknown etiology Amiodarone (Cordarone) - Contraindications - ANSWER-1. Cardiogenic Shock 2. Severe sinus node dysfunction (Sinus brady, 2nd and 3rd degree HB) 3. Symptomatic bradycardia Amiodarone (Cordarone) - Precautions - ANSWER-1. Patients with latent or manifest heart failure (Will exacerbate condition) 2. Renal failure patients Amiodarone (Cordarone) - Side Effects - ANSWER-1. Hypotension (possibly prolonged following conversion from VF) 2. Negative inotropic and chronotropic effect (force/rate) 3. Increased ventricular beats 4. Prolonged PR interval, QRS complex and QT interval 5. Look for signs of pulmonary toxicity (dyspnea & cough) Amiodarone (Cordarone) - Adult Cardiac Arrest Dose - ANSWER-1st - 300mg IVP 2nd - 15mg IVP Max of 2.2G / 24Hrs Amiodarone (Cordarone) - Adult Wide Complex Stable Tachycardia - ANSWER-150mg / 10min (15mg / min) as needed Max of 2.2G / 24Hrs Amiodarone (Cordarone) - Adult Slow Infusion - ANSWER-360mg / 6Hrs (1mg / min) Amiodarone (Cordarone) - Pediatric Dose - ANSWER-5mg / kg over 30min IV,IO. Repeat twice, up to 15mg / kg Max 300mg Amiodarone (Cordarone) - Supplied - ANSWER-150mg / 3mL Amiodarone (Cordarone) - Onset / Duration - ANSWER-Onset: Minutes via IV Duration: Hours depending on route Atropine Sulfate - Class - ANSWER-Parasympatholytic (Anticholinergic) Atropine Sulfate - Action - ANSWER-1. Blocks acetylcholine (Ach) receptors. 2. Decrease parasympathetic tone and thus increases heart rate. 3. Decreases GI secretions Atropine Sulfate - Indications - ANSWER-1. Symptomatic bradycardia (PVC's, Hypotension, decreased LOC) 2. Symptomatic heart block 3. Organophosphate poisoning Atropine Sulfate - Contraindications - ANSWER-No contraindications in emergency situations Atropine Sulfate - Precautions - ANSWER-1. AFib & AFlutter with rapid ventricular response 2. Glaucoma & COPD; can worsen hypertension 3. 2nd degree Type II & 3rd degree heart block in AMI patients Atropine Sulfate - Side Effects - ANSWER-1. Palpations & tachycardia 2. Headache, dizziness and anxiety 3. Dry mouth, papillary dilation, blurred vision 4. Urinary retention (especially older males) 5. Overdose - hot, blind, dry, red, & mad "Hot as a hare, Blind as a bat, Dry as a bone, Red as a beet, and Mad as a hatter" Atropine Sulfate - Adult Bradycardia Dose - ANSWER-0.5mg - 1.0mg very 3=5mins (Max 3mg) Atropine Sulfate - Adult Organophosphate Poisoning Dose - ANSWER-2mg - 5mg Atropine Sulfate - Pediatric Bradycardia Dose - ANSWER-0.02mg / kg NOT INDICATED IN NEWBORNS Atropine Sulfate - Pediatric Organophosphate Dose - ANSWER-0.05mg / kg (Max 0.5mg) NOT INDICATED IN NEWBORNS Atropine Sulfate - Route - ANSWER-IV, IO, IM, ET Atropine Sulfate - Supplied - ANSWER-1.0mg / 10mL prefilled syringe Atropine Sulfate - Onset / Duration - ANSWER-Onset: Immediate Duration: Peak 2-4mins, 4-6Hrs Calcium Chloride 10% - Class - ANSWER-Electrolyte Calcium Chloride 10% - Action - ANSWER-Increases cardiac contractility Calcium Chloride 10% - Indications - ANSWER-1. Acute hyperkalemia 2. Acute hypocalcemia 3. Calcium channel blocker OD (Nifedipine, Verapamil) 4. Magnesium Sulfate Antidote (for OD) 5. Abdominal spasms associated with spider bite or Portuguese Man-O-War sting Calcium Chloride 10% - Contraindication - ANSWER-Digitalis use (foxglove), can result in sudden cardiac death from VF Calcium Chloride 10% - Precautions - ANSWER-1. Extravasation can cause tissue necrosis 2. Precipitates with sodium bicarbonate will form calcium carbonate (chalk) in tubing. (use a different line.) 3. Rapid IVP can cause VF Calcium Chloride 10% - Side Effects - ANSWER-1. Arrhythmias (Bradycardia, Asystole, VF) 2. Hypotension & Vasodilation 3. Nausea / Vomiting 4. Coronary and cerebral artery spasm 5. Metallic / chalk taste Calcium Chloride 10% - Adult Dose - ANSWER-500mg - 1000mg of 10% solution / 5mins IV Repeat every 10min Calcium Chloride 10% - Pediatric Dose - ANSWER-20mg / kg (Max 1G) IV,IO SP NOT INDICATED IN NEWBORNS Calcium Chloride 10% - Supplied - ANSWER-1G / 10mL 1mL of 10% solution = 13.6mEq Ca++ Calcium Chloride 10% - Onset / Duration - ANSWER-Onset: 1-3mins Duration: 20-30mins up to 4Hrs dose dependent Diltiazem (Cardizem) - Class - ANSWER-Calcium channel blocker Diltiazem (Cardizem) - Action - ANSWER-1. Vasodilation 2. Slows conduction through AV node 3. Slows rapid ventricular rate associated with AFib/AFlutter 4. Dilates coronary arteries 5. Negative inotrope (Force) Diltiazem (Cardizem) - Indications - ANSWER-Rapid ventricular rates 1. AFib / AFlutter 2. Stable, narrow complex tachycardias refractory to Adenosine Diltiazem (Cardizem) - Contraindications - ANSWER-1. Hypotension or cardiogenic shock 2. VT or wide complex tachycardia 3. Wolf-Parkinson's White syndrome Diltiazem (Cardizem) - Precautions - ANSWER-1. Can cause systemic hypotension (Calcium chloride will prevent) 2. Kept refrigerated 4. Avoid in patients using beta blockers Increased risk of CHF, Bradycardia, and Asystole Diltiazem (Cardizem) - Side Effects - ANSWER-1. N / V 2. Dizziness, headache 3. Bradycardia, heart blocks, asystole 4. Hypotension Diltiazem (Cardizem) - Adult Dose - ANSWER-20mg / 2min (0.25mg / kg) SIVP or piggyback Diltiazem (Cardizem) - Pediatric Dose - ANSWER-No indicated Diltiazem (Cardizem) - Supplied - ANSWER-25mg / 5mL Vial, or 50mg / 10mL Diltiazem (Cardizem) - Onset / Duration - ANSWER-Onset: 2-5min Duration: 1-3Hrs Dopamine (Intropin) - Class - ANSWER-Sympathominmetic Dopamine (Intropin) - Action - ANSWER-1. Increase cardiac contractility 2. Cause peripheral vasoconstriction 3. Increases chronotropic and isotropic effects (rate, force) 4. Dilation of mesenteric and renal arteries promoting urination (reason its preferred over norepi) Low dose: <10mcg / kg / min (Beta effects predominate) High dose: >10mcg / kg / min (Alpha effects) Dopamine (Intropin) - Indications - ANSWER-1. Cardiogenic shock 2. Any shock refractory to fluid resuscitation 3. Hypotension secondary to bradycardia post resuscitation Dopamine (Intropin) - Contraindications - ANSWER-1. Hypovolemic shock (If no fluid resuscitation has been preformed) 2. Uncorrected tachycardia or VF Dopamine (Intropin) - Precautions - ANSWER-1. Ventricular irritability 2. Do not mix with sodium bicarb Dopamine (Intropin) - Side Effects - ANSWER-1. VT 2. Hypertension 3. Headache, angina, N / V Dopamine (Intropin) - Adult Dose - ANSWER-5mcg - 20mcg / kg / min (titrate to effect of LOC, BP, and urine output) (IV Drip only) Dopamine (Intropin) - Pediatric Dose - ANSWER-5mcg - 20mcg / kg / min (IV Drip only) Dopamine (Intropin) - Onset / Duration - ANSWER-Onset: 1-4min Duration: Effects stop immediately once infusion is DC.