trade name of adenosine
Adenocard, Adenocor,
dose of adenosine
6 mg over 1-2 seconds 12 mg second dose 20 mL flush
onset of adenosine
rapid
DOA adenosine
very breif
uses of adenosine
Paroxysmal SVT including those associated with accessory bypass tracts (WPWS);
not effective for a.fib/flutter, vtach
metabolism of adenosine
Blood and tissue to inosine\
then to AMP and hypoxanthine
elimination of adenosine
Erythrocytes and vascular endothelial cells
a/e adenosine
Arrhythmias,
hypotension,
bronchospasm in patients with asthma
contraindications of adenosine
Second or third degree AV block, sick sinus syndrome, symptomatic bradycardia; known or suspected bronchoconstriction, asthma
Atenolol category
beta blocker
beta 1 selective
Antianginal,
antihypertensive,
atenolol b receptors
b 1 selective
dose of atenolol
HTN PO 25-50 mg
May also be used for angina, a.fib, post-MI, thyrotoxicosis
onset of atenolol
1 hour
peak of atenolol
2-4 hours
uses of atenolol
Tx HTN, angina, post-MI, acute ETOH withdrawal, SVT, a.fib, migraine h/a prophy
metabolism of atenolol
hepatic
elimination of atenolol
Feces 50%,
urine 40%
major side effects of atenolol
Bradycardia, hypotension, 2nd degree AV block, bronchospasm, wheezing
contraindications of atenolol
Sinus bradycardia, SAnode d/f, heart block greater than first degree, cardiogenic shock, uncompensated heart failure, pulmonary edema, pregnancy
cation with atenolol certain conditions
Caution: diabetes, myasthenia gravis, PVD, raynauds, pheochromocytoma (use alpha blocker first), thyroid disease
calcium chloride dosage acute symptomatic
Acute symptomatic 200-1000 mg Q1-3 days
Beta blocker OD 20mg/kg over 5-10min followed by infusion 20mg/kg
calcium chloride dosage Cardiac arrest with hyperkalemia/magnesemia or hypocalcemia and how fast
Cardiac arrest with hyperkalemia/magnesemia or hypocalcemia 500-1000mg over 2-5 min
calcium chloride with beta blocker overdose
Beta blocker OD 20mg/kg over 5-10min followed by infusion 20mg/kg
onset of calcium chloride
immediate
uses of calcium chloride
Treat hypocalcemia, emergent tx of severe hypermagnesemia, beta blocker OD, severe hyperkalemia, malignant arrhythmias
elimination of calcium chloride
feces
AE with calcium chloride
Acidosis, hyperphophatemia, hypokalemia, hypomagnesemia, tissue necrosis, hot flash, vasodilation
absolute contraindication with calcium chloride
digoxin overdose
calcium chloride forms a precipitate with WHAT and do no give with it then?
Do not give with bicarb or phosphate containing solutions to avoid precipitation;
what electrolyte imbalance should you give hyperkalemia with
Preferred in hyperkalemia with circulatory compromise
how do CaCl and Calcium Gluconate compare
Amp of 10% CaCl contains three times (3x) more Ca than amp of 10% Ca gluconate
dose of calcium gluconate
Hypocalcemia ionized Ca 4-5 mg/dL or 1-1.2mmol/L
1000-2000 mg over 2 hrs
elimination calcium gluconate
feces
adverse effects of calcium gluconate
Risk for hyperphosphatemia,
hypokalemia,
hypomagnesemisa,
kidney stones
contraindications of calcium gluconate
v.fib,
hypercalcemia,
concomitant use of IV Ca gluconate and ceftriaxone; caution in pts on digitalis bc hypercalcemia promotes cardiotoxicity
what must you NOT give calcium gluconate with? and what would happen if you did
Do not give with bicarb or phosphate containing solutions to avoid precipitation
trade name of clonadine
catapres
category of clonadine
Alpha2 adrenergic agonist;
antihypertensive
dose of clonadine PO
PO 0.1mg BID
TD 0.1mg/24hr patch
dose of clonadine for pain epidural
Pain epidural: 30 mcg/hr titrate MAX >40mcg/
onset of PO clonidine
PO 0.5-1hr
TD 2-3 days
peak of PO clonidine
6-10 hours
uses of clonidine
Tx HTN,
ADHD,
cancer pain,
neuropathic pain,
metabolism of clonidine
hepatic
elimination of clonidine
urine
major adverse effects of clonidine
Bradycardia/tachycardia,
hypotension
contraindications with clonadine
Epidural administration: infection at site; concurrent anticoagulation, bleeding diathesis, administration above C4 dermatome; caution with drugs with SA/AV nodal blocking properties
how do alpha 2:1
Alpha2:Alpha1
220:1
trade name of digoxin
digitalis
category of digoxin
Antiarrhythmic;
cardiac glycoside
dose of digoxin with SVT
SVT: 0.5-1mg give ½ of total digitalizing dose as the initial dose than ¼ of the TDD in each of the 2 subsequent doses at 6-8 hr interval
onset of digoxin IV
5-60 min IV
onset of digoxin PO
PO 1-2 hrs
DOA digoxin
DOA 3-4 days
uses of digoxin
Sequential sugar hydrolysis in the stomach or
reduction of lactone ring by intestinal bacteria
A-fib with RVR
A-flutter
*NO LONGER THE FIRST CHOICE WITH these- BB or Ca channel blockers are best
metabolism of digoxin
urine
major adverse effects of digoxin
Junctional rhythm, heart block, PR prolongation, Vtach/vfib, Noncardiac side effects: GI—anorexia, N/V, and abd pain: CNS—visual disturbances, headache, drowsiness, confusion vision changes (yellow/blurred vision),
contraindications of digoxin
Hypersensitivity; vfib
what can lead to cardiac toxicity?
Cardiac arrhythmia (toxicity) can be precipitated by hypokalemia, hypomagnesemia, hypoxia, hypercalcemia, hypernatremia, renal failure
class of anti arrhythmic of diltiazem
Class IV
category of diltiazem
anti-arrythmic
calcium channel blocker
dose of diltiazem and use
if it is repeated what is the dose?
Afib/flutter: 0.25 mg/kg over 2 min bolus (~20mg); may repeat after 15 min at 0.35 mg/kg over 2 min (~25mg);
infusion dose of diltiazem
cont inf 10 mg/hr
may increase rate in 5mg/hr increments up to 15mg/hr
onset of diltiazem
3 minutes
peak of diltiazem
2-5 minutes
DOA diltiazem
1-3 hours
use of diltiazem
control of rapid rate in a-fib a-flutter
metabolism of diltiazem
hepatic
elimination of diltiazem
urine
adverse effects of diltiazem
Hypotension,
av block,
elevated ast/alt,
stevens-johnson syndrome
contraindications with diltiazem
Sick sinus syndrome, 2nd or 3rd degree block, severe hypotension, cardiogenic shock, concomitant administration with IV beta blocker, WPWS, vtach
trade name of esmolol
Brevibloc
classification of esmolol
B-1 selective beta blocker
intubation dose of esmolol
Intubation 1-2mg/kg
HTN dose of esmolol w/tachycardia
bolus (mg/kg)
HTN/tachycardia 80mg initial bolus (1mg/kg) over 30 sec
infusion dose of esmolol
& infusion
followed by 150 mcg/kg/min infusion max 300 mcg/kg/min
onset of esmolol
2-10 minutes
peak of esmolol
10-30 minutes
DOA esmolol
unknown
metabolism of esmolol
In RBCs by blood cell esterases
excretion of esmolol
urine
uses of esmolol
Treatment of SVT and Afib/flutter;
tx of intraoperative and postoperative tachycardia and or HTN
major adverse effects of esmolol
Hypotension, bradycardia, bronchospasm, CHF, pulmonary edema
contraindications with esmolol
Sinus bradycardia,
heart block greater than 1st degree,
cardiogenic shock,
uncompensated cardiac
fenlodopam categoty
dopamine 1 agonist
arteriol vasodilation
fanlodopam trade name
corlopam
fenlodopam dose
0.03-0.1mcg/kg/min may increase by 0.05-0.1mcg/kg/min Q15min
max dose of fenlodopam
max 1.6 mcg/kg/min
onset of fenlodopam
10 minutes
duration of action of fenlodopam
1 hour
metabolism of fenlodopam
hepatic
excretion of fenlodopam
Urine 90%. 10% feces
uses of fenlodopam
Severe HTN
A/E fenlodopam
Hypotension, flushing, dizziness, h/a, nausea, hypokalemia, increases HR
caution with fenlodopam
Use with caution in patients with glaucoma as it increases IOP
trade name of hydralazine
apresoline
category of hydralazine
Direct vasodilator;
phenothalazine derivative
dose of hydralazine
10-20 mg Q 4-5 hrs PRN
onset of hydralazine
5-10 minutes
peak of hydralazine
1-4 hours
DOA hydralazine
15-30 minutes
metabolism of hydralazine
hepatic
elimination of hydralazine
urine
use of hydralazine
HTN
adverse effects of hydralazine
Tachycardia, increased ICP, lupus like syndrome, pancytopenia, peripheral neuropathy, skin
contraindications of hydralazine
Mitral valve rheumatic heart disease
Amrinone trade name
Inocor
Amrinone category
Phosphodiesterase enzyme inhibitor
dose amrinon
0.75 mg/kg IV bolus over 2-3 min
followed by maintenance of 5-10 mcg/kg/min
maintenance dose of amrinon
IV bolus
followed by maintenance of 5-10 mcg/kg/min
onset of amrinon
2-5 minutes
peak of amrinon
30 min to 2 hrs
DOA amrinon
10 min
metabolism of amrinon
hepatic
elimination of amrinon
urine
use of amrinon
Short term therapy in pts with intractable heart failure
major adverse effects of amrinon
Arrhythmias, hypotension, n/v, thrombocytopenia, hepatotoxicity
amrinon contraindications
Hypersensitivity, patients with severe aortic or pulmonic valvular disease
category of labetalol
Blocks alpha,
beta1,
beta 2
labetalol receptors PO B1:B2
1:3
labetalol recepotrs IV B1: B2
1:17
dose of labetalol
20 mg IV over 2 min; may administer 40-80 mg at 10 min
max dose of labetalol
300 mg
infusion dose of labetalol
2 mg/min
onset of labetalol
2-5 minutes
peak of labetalol
5-15 min
DOA of labetalol
2-18 hours
metabolism of labetalol
hepatic
elimination of labetalol
urine
major adverse effects of labetalol
Hypotension, bronchospasm, ventricular arrhythmias, hyperkalemia, hepatotoxicity
contraindications of labetalol
Severe bradycardia, heart block, asthma, non compensated heart failure, cardiogenic shock
trade name of labetalol
Normodyne
category of lisinopril
Inhibitor of ACE
dose of lisinopril
CHF 2.5-5mg PO initially up to 20-40 mg
HTN PO 10 mg to 40 mg
onset of lisinopril
1 hour
peak of lisinopril
6 hours
DOA of lisinopril
24 hours
elimination of lispinopril
urine
uses of lisinopril
Acute MI, CHF, HTN
major adverse effects of lisinopril
Hypotension,
dizziness,
increased BUN/creatinine,
angioedema
contraindications of lisinopril
cardiogenic shock Lisinopril Inhibitor of ACE CHF 2.5-5mg PO initially up to 20-40 mg HTN PO 10 mg to 40 mg 1hr 6hrs 24hrs Urine Acute MI, CHF, HTN Hypotension, dizziness, increased BUN/creatinine, angioedema Hypersensitivity, angioedema; concomitant use with aliskiren in pts with DM
trade name of metoprolol
lopressor
category of metoprolol
beta 1 selective
dose of metoprolol for afib
A.fib IV 2.5-5mg Q2-5min;
dose of metoprolol HTN
HTN 1.25-5mg A6-12 hrs IV
MI 5mg Q5min up to 3 doses
peak of metoprolol
20 minutes
DOA of metoprolol
5-8 hours
metabolism of metoprolol
hepatic
excretion of metoprolol
urine
uses of metoprolol
angina
HTN
MI
major adverse effects of metoprolol
Bradycardia, heart block, hypotension, pulmonary edema, bronchospasm
contraindications of metoprolol
Hypersensitivity, sinus brady, heart block, cardiogenic shock, overt heart failure, sick sinus syndrome, PAD
category of milrinone
Selective phosphodiesterase inhibitor
milrinone trade name
milrinone lactate
dose of milrinone
Loading 50 mcg/kg over 10 min
follow by maint inf 0.375-0.75mcg/kg/min
maintenance dose of milrinone
follow by maint inf 0.375-0.75mcg/kg/min
onset of milrinone
5-15 minutes
metabolism of milrinone
hepatic
excretion of milrinone
urine
treatment uses of milrinone
Tx heart failure; inotropic therapy
adverse effects of milrinone
Ventricular arrhythmia, thrombocytopenia, angina, hypotension, h/a, hyperthermia
contraindications of milrinone
Hypersensitivity;
caution in pts w/ renal insufficiency and aortic/pulmonic valvular disease
category of nicardipine
calcium channel blocker
trade name of nicardipine
cardene
dose of nicardipine
IV 5mg/hr initially;
max of nicardipine
max 15mg/hr
onset of nicardipine
10 minutes
DOA of nicardipine
8 hours
metabolism of nicardipine
hepatic
excretion of nicardipine
urine
uses of nicardipine
Chronic stable angina, HTN
major adverse side effects of nicardpine
Flushing,
hypotension
, edema,
exacerbation angina pectoris
contraindications with nicardipine
Hypersensitivity;
advanced aortic stenosis
caution- may increase angina or MI, use with beta blockers may worsen HF
category of nitroglycerine
Nitrate/antianginalVenodilator
how does nitroglycerine affect vessels?
Nitroglycerine forms free nitric oxide which activates guanylate cyclase to increase cGMP smooth muscle relaxant
dose of nitroglycerine
IV 5mcg/min up to 400mcg/min
max dose of nitroglycerine
400 mcg/min
onset of nitroglycerine
immediate
peak of nitroglycerine
immediate
use of nitroglycerine
Tx or prevention angina pectoris,
acute decompensated heart failure,
perioperative HTN
metabolism of nitroglycerine
Hepatic;
nonhepatic via RBC and vascular walls
elimination of nitroglycerine
urine
major adverse side effects of nitroglycerine
hypotension
tachycardia
flushing
dizziness
what conditions can you not give nitroglycerine with?
, constrictive pericarditis,
pericardial tamponade,
restrictive cardiomyopathy,
SUBLINGUAL- early MI, increased ICP, severe anemia
hypersensitivity to certain things are contraindicated with nitro
Hypersensitivity to organic nitrates or components,
hypersensitivity to corn,
what medications can you not give nitroglycerine with?
concurrent use of phosphodiesterase inhibitors,
concurrent use with riociguat
trade name of nitroprusside
nipride
nitropress
category of nitroprusside
direct acting ventilator and arteriol dilator
how does nitroprusside work?
Direct acting venous and arteriolar smooth muscle relaxer; releases NO spontaneously
dose of nitroprusside
0.3-0.5 mcg/kg/min
max dose of nitroprusside
max 10 mcg/kg/min
onset of nitroprusside
less than 2 minutes
DOA nitroprusside
1-10 minutes
uses of nitroprusside
HTN, acute decompensated HR
metabolism of nitroprusside
Combines with hgb to form
cyanide and cyanmethemoglobin
excretion of nitroprusside
urine
major adverse effects of nitroprusside
Hypotension,
flushing,
cyanide toxicity when max dose is used for long periods (even >10 min), increased ICP
contraindications with nitroprusside
Compensatory HTN (aortic coarctation, av shunt),
controlled hypotension in pts with inadequate cerebral circulation/moribund pts ,
high output HF with reduced SVR,
congenital optic atrophy or tobacco amblyopia
phenoxybenzamine trade name
dibenzyline
MOA/category of phenoxybenzamine
alpha 1 blocker
dose of phenoxybenzamine
PO 10 mg up to 20-40 mg BID or TID
oset phenoxybenzamine
several hours
DOA phenoxybenzamine
3 days
excretion of phenoxybenzamine
urine/bile
uses of phenoxybenzamine
Symptomatic pheochromocytoma, (tx sweating)
micturition problems associated with neurogenic bladder, outlet obstruction,
treatment of hypertensive crisis caused by sympathomimetic amines
major adverse side effects phenoxybenzamine
hypotension
tachycardia
contraindications of phenoxybenzamine
hypersensitivity
shock
phentolamine category
nonselective alpha blocker
dose of phentolamine extravasation NE
5-10 mg in 10-15 mL NS
HTN w/pheo dose of phentolamine
5mg 1-2 hrs before surgery; 5mg during surgery;
HTN crisis with phentolamine dose
HTN crisis 1-5 mg bolus up to 15 mg max
max dose of phentolamine
1-5 mg
onset of phentolamine
1-2 min
DOA phentolamine
10-30 minutes
metabolism of phentolamine
hepatic
excretion of phentolamine
urine
uses of phentolamine
Diagnosis of pheo;
management of extravasation of sympathomimetic vasopressors,
tx hypertensive crisis
adverse effects of phentolamine
Tachycardia, bradycardia, HTN, h/a, pain at injection site
contraindications of phentolamine
hypersensitivity
prazosin category/moa
Competitive inhibitor of postsynaptic alpha receptors leading to vasodilation of veins and arterioles and decrease in total peripheral resistance and BP
dose of prazosin
HTN PO 1mg 2-3x/day; max 20 mg
onset of prazosin
2 hours
peak of prazosin
2-4 hours
DOA prazosin
10-24 hours
metabolism of prazosin
hepatic
elimination of prazosin
feces
urine
major adverse s/e prazosin
Palpitation, dizziness, h/a, weakness, nausea, angina, floppy iris syndrome, orthostatic hypotension
contraindications of prazosin
hypersensitivity
propranolol category
Nonselective beta blocker B1&2
dose of propranolol
20-80 mg PO
IV 1-3 mg/dose
onset of propranolol
1-2 hours
peak of propranolol
1-4 hours
DOA propranolol
6-12 hours
metabolism propranolol
hepatic
excretion propranolol
urine
uses of propranolol
Management HTN, angina, pheo, tremor, supraventricular arrhythmias
major adverse effects of propranolol
Bradycardia, CHF, hypotension, fatigue, hyperglycemia, hyperkalemia, bronchospasm
contraindications propranolol
Hypersensitivity, uncompensated HF, sick sinus syndrome, bradycardia, cardiogenic shock, asthma
trade name of propranolol
propranolol
moa/ category propranolol
beta 1 & 2 blocker
dose of timolol
10 mg BID
onset of timolol
15-45 minutes
peak of timolol
0.5- 2.5 hours
DOA timolol
4 hours
metabolism timolol
hepatic
excretion timolol
urine
uses of timolol
Tx HTN angina, prophy migraine
adverse effects of timolol
Bradycardia, fatigue, bronchospasm, hyperglycemia, hyperkalemia, pulm edema, CHF
contraindications with timolol
Hypersensitivity, sinus brady, sinus node d/f, heart block, cardiogenic shock, uncompensated cardiac failure, bronchospastic disease
category of verapamil
calcium channel blocker
dose of verapamil po
80-120 mg PO
dose of verapamil IV
IV 0.075-0.15mg/kg over 2 min and then 0.005mg/kg/min continuous infusion
po onset verapamil
PO 1-2 hrs
IV onset verapamil
IV 1-5 min
peak of verapamil
Immediate release 1-2 hrs
DOA verapamil PO
PO 6-8 hrs
DOA verapamil IV
IV 10-20 min
metabolism verapamil
hepatic
excretion verapamil
urine
uses verapamil
SVT, afib/flutter, HTN, angina
major A/E verapamil
Gingival hyperplasia, hypotension, conduction block, increased hepatic enzymes, arrhythmia, decreased neuromuscular transmission
contraindications verapamil
Hypersensitivity, severe LV D/Hypotension, cardiogenic, sick sinus syndrome, heart block, afib/flutter, WPWs, concurrent sue IV beta blocker