MEDICATIONS
AND THEIR USE
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EPINEPHERINE
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EPINEPHERINE
Dose: 1 mg q 3-5 min (1:10,000)
(doses>1mg are not beneficial and do not improve
survival or neurological outcomes and may contribute to
post resuscitation myocardial dysfunction)
PRECAUTIONS:
myocardial ischemia
myocardial irritability = VF
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ATROPINE
MOA: blocks action of acetylcholine at parasympathetic
sites in smooth muscle, secretory glands, and the
central nervous system
HR, CO
Indications:
- symptomatic bradycardia
- HR< 60 bpm and inadequate for clinical
condition
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ATROPINE
Treatment considerations are based on
adequate perfusion
OR
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ATROPINE
DOSE: 0.5 mg q 3-5 min for symptomatic bradycardia
Max. = 3 mg
(usually 2-3 mg is a full vagolytic dose in most patients)
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MAGNESIUM SULFATE
MOA: physiological calcium channel blocker
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SODIUM BICARBONATE
MOA: H+ + HCO3- H2CO3 H20 + CO2
Indications: hyperkalemia
pre-existing metabolic acidosis
eg. DKA
phenobarbital / TCA / aspirin overdose
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DOPAMINE
MOA: precursor of norepinephrine that stimulates
dopaminergic, , and receptors in a dose- dependent
fashion
Dose: 1-5 mcg/kg/min cerebral, renal, mesenteric
vasodilatation
5-10 mcg/kg/min stimulates , 1 receptors
resulting in CO, HR, BP, cardiac contractility
10-20 mcg/kg/min BP ( receptors
predominate)
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DOPAMINE
Indications: severe symptomatic bradycardia (after
atropine), hemodynamically significant hypotension in
absence of hypovolemia
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AMIODARONE
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AMIODARONE
Max. 2.2 g / 24 hr
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AMIODARONE
Dose (cont’d):
Wide Complex Stable Tachycardias
- 150mg IV in 100 ml D5W given over 10 min.
- MR q10 min. prn, then 1mg/min over 6 hrs,
then 0.5mg/min x 18 hrs, then
maintenance 0.5mg/min
t ½ 40 days
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AMIODARONE
Side Effects: BP ( rate of infusion)
sinus bradycardia
EKG Effects:
- prolongation of PR, QRS, and QT intervals
Concerns of administration
- must use large bore angiocath
- must be diluted
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LIDOCAINE
MOA: - only use for ventricular arrhythmias
- automaticity
- ventricular ectopy
- VF threshold directionally proportionate to
plasma concentration
eg. 6mcg/ml-antifibrillatory
eg. 2-5 mcg/ml-controls ventricular ectopy
Dose:
1-1.5 mg/kg/dose x 1, then 0.5 – 0.75 mg/kg q 5-
10 min (max. 3mg/kg) – refractory VF, pulseless VT
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LIDOCAINE
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LIDOCAINE
Reduce Dosage:
use ½ recommended maintenance dose in
patients with:
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PROCAINAMIDE
MOA: supraventricular and ventricular ectopy
use caution in pts. w/ EF < 40%
Indications:
- afib w/ WPW, refractory reentry SVT
- persistent cardiac arrest due to VF/VT
- wide complex tachycardias
- stable VT
(rarely use to treat VT due to prolonged time
required to administer effective doses i.e. rapid
administration= BP)
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PROCAINAMIDE
Dose: 20 mg/min up to 50 mg/min in urgent
situations to max. dose of 17 mg/kg, OR…
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ADENOSINE
MOA: chemically converts the AV node
interrupts AV nodal reentry
Indications:
- PSVT
- DOC for diagnosing supraventricular
tachycardias
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ADENOSINE
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Drug Administration
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Oxygen and Aspirin
Oxygen – 1 - 6 L/min
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Nitroglycerin
Nitroglycerin –
MOA: - initial antianginal for suspected ischemic pain
- preload at lower doses
- afterload at higher doses
- dilates large coronary arteries
- coronary collateral blood
flow to ischemic myocardium
- antagonizes vasospasms
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Nitroglycerin
Nitroglycerin (cont’d)
Dose: SL 0.4mg tab q5min x 3
IV Bolus 12.5-25 mcg if no SL given,
then 10-20mcg/min titrated to effect
(range 50-200 mcg/min)
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Morphine
Morphine
- myocardial O2 requirements
- venous capacitance
- treatment of pain
- SVR
- chest pain w/ ACS unresponsive to nitrates
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Antiplatelet Agents:
Glycoprotein IIB/IIIa agents
Blocks glycoprotein IIb/IIIa receptors on platelets
Blocked receptors cannot attach to fibrinogen
Fibrinogen cannot aggregate platelets to platelets
Indications: Acute Coronary Syndrome
-STEMI or nonSTEMI /UA undergoing PCI
-NONSTEMI/Unstable angina managed medically
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ACE Inhibitors
Mechanism of action
Reduces BP by inhibiting angiotensin-converting
enzyme (ACE)
Alters post-AMI LV remodeling by inhibiting
tissue ACE
Lowers peripheral vascular resistance
by vasodilatation
Reduces mortality and CHF from AMI
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Fibrinolytic Therapy
Breaks up the fibrin network that binds clots together
Mechanism of action
Indirect thrombin inhibitor (with AT III)
Indications
PTCA or CABG
With fibrin-specific lytics
High risk for systemic emboli
Conditions with high risk for systemic emboli,
such as large anterior MI, atrial
fibrillation, or LV thrombus
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ß-Blockers
Absolute
Cautions
Contraindications
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ENDOTRACHEAL TUBE
MEDICATIONS
**ET tube meds not recommended
unless IV/IO access is not available
L idocaine
Epinephrine
Atropine
N arcan
2- 2.5 x normal dose
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CRITICAL POINTS
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