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BKAT Medications (Latest 2023 – 2024)
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N itroprusside - Mechanism of Action : Decreases Preload and AFTERLOAD through vasodilation Side effects/Precautions:
- No sunlight
- Cyanide toxicity
- Hypotension Used for: acute hypertensive episodes Dobutamine - Mechanism of Action: Positive inotrope- effects contractility Dopamine - Low dose (0.5-4mcg): Stimulates dopaminergic receptors and increases renal and mesenteric perfusion "Renal dose" Mid-range dose (4-10mcg): Stimulates beta receptors to increase contractility and heart rate High range dose (greater than 10mcg): Stimulates alpha receptors - vasoconstriction and increase in BP Side effects:
- Ventricular dysrhythmias
- Tachycardia
- Infiltration = necrosis (Vasoconstriction of capillary beds)
Antidote: regitine (phentolamine) - same for levophed necrosis tPA - Thrombolytic Monitor for bleeding 9 Risk: hemorrhagic CVA Diltiazem (Cardizem) - CCB, slows ventricular rate by slowing conduction through SA and AV node Watch for:
- hypotension Used for: Slowing ventricular rate in A-Fib/flutter Amiodarone (Cordarone) - Anti arrhythmic Prolongs cardiac potential duration MUST use a 0.22 micron filter for infusion watch for:
- hypotention
- Prolonged QT
- bradycardia Used for: A-fib and stable VT (with pulse)- 150mg over 10 min. VTp/VF: 300mg/150mg
Cortisone - exogenous corticosteroid for insufficient adrenal activity or hypersensitivity/inflammatory reactions. Chronic use: must be tapered off to prevent acute adrenal insufficiency Digoxin - Cardiac glycoside Increases contractility, slows HR by decreasing conduction through the AV node, monitor for hypotension, bradycardia and symptoms of toxicity (Nausea/yellow vision/ halos), paroxysmal atrial tachycardia- PAT- with block) Will not cause rapid conduction or hypertension (either correct) Lidocaine - Antiarrhythmic Suppresses automaticity and depolarization Used for ventricular dysrhythmias Lidocaine toxicity: Mental confusion/change in LOC (monitor serum levels) Narcotics (Morphine, dilaudid) - hold in pt with suppressed respirations Best vasopressors for septic shock - - Norepinephrine
- Epinephrine
- Vasopressin Complication of using thromboembolitics - - Allergic reaction
- Bleeding
- Stroke
Digoxin toxicity - - Confusion
- Irregular pulse
- Loss of appetite
- N/V/Diarrhea
- Vision changes (blind spots, blurred vision, Changes in colors, spots)
- Decreased output
- Difficulty breathing when lying down
- Excessive nighttime urination Drug adjustments to be made for patients in renal failure - Decrease dose or increase the space during between doses (not cleared as well through kidneys) Use of dilantin - IV causes bradycardia precipitates with anything other than NACL crystalizes with dextrose Dosage of milrinone - Bolus (50mcg/kg over 10 minutes) and then gtt (0.375-0.75 mcg/kg/min). Precipitates with lasix Longer half-life. Not titrated Doses of nitroglycerin - 5 - 200 mcg/min Start low Immediate response Dosage of nitroprusside - 0.5-0.10 mcg/min
Drugs to decrease preload/CVP/PAWP - Beta blockers and ca channel blockers Drugs to increase contractility - positive inotropes, dobutamine, dopamine, milrinone and digoxin Drugs to increase afterload/SCR/PVR - Vasopressors: Epi, Norepi, dopamine and neosynephrine Drugs to increase preload/CVP/PAWP - Volume- colloid, crystalloids, hetastarch Dysrhythmia control - antiathrymthmics, pacemaker, AICD Drugs to treat increased ICP - Osmotic diuresis (Mannitol), sedation/analgesics. reduce fever. antihypertensives, vasodilators (Strict management of SBP) Asystole - epinephrine Heparin reversal - protamine sulfate Humalin R/ Novolin R (Regular/short acting insulin) - Onset: 30 min Peak: 2-3 hours Duration: 3-6 hours Indication for dopamine/inotropin - Acts on SNS to increase HR and BP Indicated for hypotension, low CO, Decreased renal blood flow. Use for bradycardia Indications for norepinephrine/Levophed - Indicated for diastolic hypotension (Decreased SVR) and septic shock
Stimulates A and B receptors Increased Contractility, HR and vasoconstriction Indications for Dobutamine/Dobutrex - Beta I stimulator Used to increase CO for systolic Heart Failure, Cardiogenic shock, MV regurgitation, Post MI, Post Cardiac Surgery, C/P bypass for "Stunned" myocardium. Indications for epinephrine/Adrenalin - Stimulates A and B receptors. Used post cardiac surgery for "Stunned" myocardium. ACLS protocol Bronchial relaxation at low doses, increased contractility at high doses Indications for milrinone/Primacor - Positive inotrope with vasoactive activity Increases CO and decreases SVR. Used in CHF and to increase CO Indications for nitroglycerine/nitrostat - Direct relaxation of vascular smooth muscle and vasodilation. Used for HTN, angina, CHF and MI to decrease O2 demands. Indications for nitroprusside/Nipride - Causes peripheral vasodilation by acting on venous and arterial smooth muscle. Decreases BP, SVR, preload, and afterload increasing the CO. Used for HTN, CHF and hypertensive emergency
Use central line Inactivated by sodium bicarb Can cause acidosis Ectopic beats, tachycardia, tissue necrosis SE Epinephrine - Ischemia (myocardial, mesenteric, renal) Tachycardia Hyperglycemia HA Tissue necrosis SE Milrinone - Renal excretion Arrythmias Decreased BP HA Hypokalemia SE of nitroglycerin - Caution for patient dependent of preload for CO (Inferior wall MI or right sided MI) may see tolerance after 24 h Hypotension, reflux tachycardia, HA, flushing, nausea SE of nitroprusside - make sure there is adequate volume and BP is above 90 has incompatabilities (Can use with nitro and heparin) Can cause thiocyanate toxicity with higher doses Monitor for metabolic acidosis
SE hypotension, HA, Nausea/vomiting SE of phenylephrine/neosynephrine - alpha stimulator Used during C/P bypass Anesthesia induced huypotension , vascular failure in shock, Vasocintricts the artiolres without cardiac affect Se of vasopressin - Skin/mesenteric ischemia, bradycardia, decreased uop, result in hyponatremia. caution with neurosurgical patients Treatment of dopamine etravassation - phentaolmine 5-10mg and possibly nitropaste to vasodilate Treatment of Norepi, epi, dobutamine, neosynpheine extravasation - phentaolmine 5-10mg Causes adrenal crisis - steroids what to see with lidocaine toxicity in the heart - ventricular irritability
