CVT drugs, summer 2006

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Xylocaine HCL trade name and dose?: Lidocaine
bolus-50-100mg IV push(not to exceed 300mg)
drip premixed 2gm/500 D5W
delivered at drip rate
1mg/min=15ml/hr
2mg/min=30ml/hr
3mg/min=45ml/hr
4mg/min=60ml/hr
Procainamide HCL trade name and dose?: pronestyl
bolus 50mg IV push
drip 1gm/250 D5W
delivered at drip rate
1mg/min=15ml/hr
2mg/min=30ml/hr
3mg/min=45ml/hr
4mg/min=60ml/hr
Procainamide class, indications, effects on?: antiarrhythmics, sodium channel blocker(1A)
tx-PAC, PVC, PAT, maint of NSR post conversion from a-fib and a-flutter
decreases- HR, BP, contractility, conductivity, afterload
Lidocaine class, indications, effects on?: antiarrhythmic, anesthetic
IV- ventricular arrhythmias
Local- anesthetic
decreases conductivity, pain
cordarone trade name and dose?: amiodarone HCL
300mg IV push may consider 2nd dose of 150 mg
Amiodarone HCL class, uses and effects on?: class III antiarrythmics
recurrent V-fib and recurrent unstable V-tach
decreases-HR, BP, afterload
increases- RR
vasodilates-relaxes vascular smooth muscle
Magnesium Sulfate trade name and dose: mag. sulfate
1-2 grams diluted in 10ml D5W or NS over 1-2 min
Magnesium Sulfate Tx of? effects on?: Tx of V-tach, V-fib and TORSADES DE POINTES
decreases HR, BP, RR
Atropine dose?: .5-1.0mg IV push not to exceed 2mg
Atropine class? tx? effects on? contraindications?: antiarrhythmic, anticholinergic, antimuscarinic
tx-symptomatic bradycardia and bradycardic dysrhythmias (heart block) and TO BLOCK VAGAL REFLEX.
increases- HR, BP
contraindicated-acute MI-may promote V-fib and increase O2 demand
Milrinone lactate trade name and dose?: Primacor
loading dose=50mcg/kg.10min
infusion=.5mcg/kg/min
(usually mixed to 200mcg/ml concentration)
Primacor class? indications? effects on?: inotropics
pts w/ acute decompensated Heart failure and AMI
increases CO, w/ mild increases in HR and MVO2
decreases PCWP and vascular resistance
Dopamine brand? concentration, dose and effects with?: Inotropin
concentration 400mg/250 D5W
dopaminergic= 1-2 mcg/kg/min, may increase renal perfusion and decrease SVR
Beta-adrenergic= 5-15 mcg/kg/min increases CO and SV may also cause tachycardia
alpha adrenergic->20mcg/kg/min increases CO, SV, HR(tachycardia), contractility, decreases renal perfusion,
dopamine class? uses?: inotropics, vasopressors, adrenergics
pts w/ low CO and renal insufficiency, severe hypotension and shock, effects are quick onset but short duration
Dobutrex trade and dose?: dobutamine
dose- (mix 500mg/250 D5W or NS) 2.5-10 mcg/kg/min
dobutamine class, indications, effects?: direct acting inotropics, adrenergics
short term mgmt of heart failure or depressed contractility from surgical procedures
increases CO and SV
decreases preload and afterload
contraindicated w/ hypertrophy and cardiomyopathies
phenylephrine brand and dose: neosynephrine
mixed 10mg/100D5W=100mcg/ml
or 40mg/250=160mcg/ml
IV push 50-100 mcg
IV drip 40-60 mcg/min
Neosynephrine class, indications, contraindications?: sympathomimetic, vasopressor
used for rapid vasoconstriction w/ rapid increase in BP, used in severe hypotension and shock
DO NOT use w/ severe HTN and V-tach
Norepinephrine Brand and dose?: Levophed
dose=4mg/250 D5W or NS(16mcg/ml)Initial IV dose 8-12 mcg/min adjust to maintain normal BP
Levophed class, uses, contraindications, effects?: sympahomimetic adrenergic agent, +inotropic and + chronotropic
used for potent peripheral and arterial vasoconstriction (shock and severe hypotension, cardiogenic shock)
contraindication-do not use w/ mesenteric or peripheral vascular thrombosis
increases- BP, SVR, pulmonary pressures and CO
**last drug of choice d/t potency**
epinephrine brand and dose?: adrenaline
dose= mix 1mg/250 NS or D5W
infusion is 1-8 mcg/min(start w/ lower doses as effects are immediate)
adrenaline class, indications, contraindications, effects?: antiasthmatic, bronchodilator, vasopressor, adrenergic
used w/ severe shock and cardiac arrest or for mgmt of airway w/ severe allergic rx
contraindications- Hx of HTN, hyperthyroidism and w/ digitalis
increases HR, contractility
*located in code cart*
Nipride trade and dose?: nitroprusside
mix 50mg/250 D5W ONLY, infuse at rate of .5-10 mcg/kg/min, **always cover w/ foil to protect from light source**
Nitroprusside class, indications, contraindications, effects?: antianginals, nitrates
used in HTN emergencies
potent vasodilator, decreases SVR, increases venous filling pressure
DO NOT use w/ coarctation of AO
prochlorperazine brand and dose?: Compazine
dose 5-10 MG IV push
compazine class, indication, contraindications: antiemetics
used for pre op nausea control or severe vomiting, do not use w/ CHF, valvular disease or heart block
Metoclopramide brand name, class, uses, dose?: Reglan, antiemetic
used for N/V, do not use w/ seizures, renal failure or pts w/ bowel perforations
Dose-10 mg over 2 min
Promethazine brand name, class, uses, dose?: Phenergan, antiemetic
used as mild sedative, N/V
Do not use w/ pts w/ reactions to antihistamines, use caution w/ cardiac patients w/ tachycardia
Dose- 12.5-25 MG IV push
Heparin dose?: in lab=50-80units/kg supplied in 1000u/ml.
IV drip is premixed 25000units/250D5W(100u/ml)
Heparin Sodium class, indications, contraindication, reversed with, monitor what___and maintain at____?: anti-coagulant
anti-thrombolytic for interventional cases, facilitates thrombin and prevents conversion of fibrinogen to fibrin
contraindicated w/ bleeding disorders and open ulcerated wounds.
Monitor ACT keep >250secs
Protamine sulfate uses, contraindications, dose?: reverses Heparin
do not use in pts w/ allergy to iodine or on diabetics on NPH insulin
Dose=1mg per 90units of heparin, max dose of 50mg in 10min, give slowly over 10min, stored in HCRU
Diphenhydramine brand name, class, uses, dose?: Benadryl, H1 antagonist antihistamine, used for vertigo or motion sickness
dose 25-50mg IV push
Solumedrol class, use and dose?: intermediate acting coritcosteroid, antiasthmatic, used to treat and prevent allergic reactions in the cath lab.
dose 125 mg IV over 3 min
Solucortef class, use and dose?: antiasthmatic, short acting corticosteroid, used to treat and prevent allergic reactions in the cath lab
dose= 100mg over 3 min
Cimetadine brand name, class, uses, dose?: Tagamet, histamine H2 antagonist used for symptomatic relief of gastroesophageal reflux, contraindicated w/ asthma
dose= 300mg/50ml D5W, administer slowly IV drip or tachycardia will result
Furosemide brand name, class, uses, contraindications, dose, side effect, special consideration?: Lasix, loop diuretic
used for pts w/ acute pulm. edema, acute renal failure, mgmt of pts in CHF, HTN
Do not use w/ electrolyte depletion
dose= 20-40 mg slowly over 2-3min, repeat in 6 hours.
**rapid onset of action**
Do not store in light
**side effect=hypokalemia**
Mannitol: facilitate excretion of contrast, and prophylaxis for acute renal failure. Tx of closed head injury to decrease cerebral edema and intracranial pressure.
dose-12.5-25 grams, IV drip w/ filter at modest rate
IV nitroglycerine uses and dose?: Potent vasodilator used to control symptomatic pt.
dose 10-100mcs/min. Titrate to control chest pain while keeping SBP > 100mmHG. Mixed 50mg/250ml to get 200mcg/ml
nitrostat use and dose?: sublingual form of nitro to alleviate chest pain from angina. 1-2 tabs under tongue
nitropaste use?: transdermal form of nitro used to control/prevent chest pain over long term
abciximab brand name, class, indications, contraindications, dose?: Reopro, IIbIIIa inhibitor used for TX of acute coronary syndrome(unstable angina w/ non-Q wave MI) and in pts undergoing PCI.
Contraindicated w/ Hx of abnormal bleeding within 30 days, severe HTN, major surgery or hemorrhagic stroke last 6wks, HX or s/s of aortic dissection, acute pericarditis, dependency on renal dialysis, PLATELET COUNT <100,000, concomitant use of similar drug.
DOSE-use chart, FILTER!
**refrigerated**
Tirofiban brand name, uses, contraindications, dose? emory protocol?: aggrastat, platelet modifying drug, same as reopro, old school, check creatine clearance. Reduce dose by 1/2 in renal impairment.
Must be diluted-12.5mg/50ml vial and 250ml bag(remove 50 from bag and inject 50 from vial.)=50mcg/ml
Dose-use chart, EMORY protocol-for interventional procedures--> loading dose of 10mcs/kg over 3min(from bag) followed by maint. drip of 0.1 mcs/kg/min for 12-24 hrs post procedure.
Dosing protocol for unstable angina=0.4 mcg/kg/min over 30 mins from the bag followed by 0.1 mcg/kg/min for 12 hours(verify w/ DR.)
**refrigerated?**
Eptibatide uses and dose?: integralin, platelet modifier similar to reopro and aggrastat with like contraindications-add creatine >4.0!
dose-acute coronary syndrome and PCI=180 mcg/kg followed by infusion of 2.0 mcg/kg/min for 18-24 hrs
DO NOT DILUTE!
supplied in 10ml bolus vial and 100ml infusion vials.
**refrigerated?**
What do you need to do before administration of anticoagulants?: check serum creatinine and platelet account.
Creatinine clearance formulas?: male= (140-age)(wt in kg)/ 72x(serum creatine)
females= (140-age)(wt in kg)(0.85)/ 72x(creatinine)
To safely administer sedation you must have what 4 things?: oxygen, suction, crash cart, airway kit
Meperidine brand name, class, schedule, indications, dose?: demerol-narcotic analgesic
for moderate to severe pain. CNS depressant class II
dose-IV 25-50mg, onset 1-5min, lasting 2-4hr.
Morphine Sulfate class, schedule, use, dose?: narcotic analgesic(opioid)-schedule II.
used for severe pain
drug of choice for chest pain
CNS depressant
dose-2-10mg IV q4-6hrs peak effects in 15-20 min, duration 3-7 hrs
**vaso and veno dilator**
Sublimaze brand name, class, schedule, uses, dose?: Fentanyl-narcotic(opioid analgesic), schedule II
used for severe pain and anxiety, synthetic-stronger than morphine
Dose-25-50 mcg, IV slowly over 2 min max dose 100mcg, onset of action 1 min.
check pts weight
Innovar AKA, indications, dose?: fentanyl/droperidol-used for sedation/analgesia for surgical and diagnostic procedures. CNS depressant. synthetic opioid.
Dose- .5-2 ml slowly over 2 min, onset immediate, lasts 30-60 min
Narcotic antagonist? uses and dose?: Narcan(naloxone)
to reverse respiratory and CNS depression d/t narcotic overodosage
Dose-0.1-1 mg,IV. onset 1-2 min
Midazolam brand name, class, uses, dose?: Versed-benzodiazepines
used for sedative as well as analgesic effects(short diagnostic procedures)
dose-1-2mg,IV slowly.
max dose is 4 mg, short acting CNS depressant
Diazepam brand name, class, uses, dose?: Valium- benzodiazepine
An anxiolytic, muscle relaxant, a sedative/hypnotic and CNS depressant.
Dose- 2-5 mg,IV slowly max dose is 10mg.
What does CNS depressant mean? What are side effects of narcotics and benzo's?: these drugs decrease HR, RR, BP and respirations, compromise airway and may cause confusion, restlessness, nausea and vomiting.
Benzodiazepine antagonist?: Romazicon(flumazenil)
Used for complete or partial reversal of the effects of benzodiazepines.
Dose-0.2 mg, administered over 15secs, repeated, if necessary every 60 seconds until desired level of consciousness is achieved. No more than 1mg at a time or no more than 3mg in one hour.
drip rate calculation formula?: dose x 60 x kg/ supply

example: dopamine 400mg/250ml=1600mcg/ml(concentration)
order:11mcg/kg/min

11mcg X 60 x 50kg/1600mcg/ml=20ml/hr
delivery dependent on body weight? delivered in mcg/kg/min: dopamine=400mg/250ml=1600mcg/ml
dobutrex=500mg/250ml=2000mcg/ml
nipride=50mg/250ml=200mcg/ml
primacor=50mg/250ml=200mcg/ml
delivery independent on body weight? deliverd in mg or mcg/min: Nitro=50mg/250ml=200mcg/ml
Neo=10mg/100ml=100mcg/ml
Epi=1mg/250ml=4mcg/ml
Lidocaine=2grams/500ml=4mg/ml
Pronestyl=1gram/250ml=4mg/ml
Levophed=4mg/250ml=16mcg/ml
CLcr and CRs What do they stand for and what is the unit of measurement?: creatinine clearance in ml/min
serum creatinine in mg/dl
1mg=____mcg 1gram=______mg 1kg=_____lbs: 1mg=1000mcg
1gram=1000mg
1kg=2.2lbs

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