Epinephrine
Pharm: Adrenergic, agonist/sympathomimetic
Therapeutic: Anti-asthmatic, bronchodilator, vasopressor, cardiac stimulant
Stimulates alpha-adrenergic receptors, beta 1 adrenergic receptor, beta 2 adrenergic receptor.
Relaxes smooth muscle of bronchiole tree, produces cardiac stimulation, dilates skeletal muscle vasculature.
Indications: Management of cardiac arrest by increa
Norepinephrine (Levophed)
Pharm: Sympathomimetic/Alpha and Beta Agonist
Therapeutic: Cardiac Stimulant/ Blood Pressure Stabilizer
Indication: Blood Pressure Stabilizer
Stimulates beta1 adrenergic receptors, alpha adrenergic receptors. Increasing contractility, hr, and producing vasoconstriction. Increase in BP and coronary blood flow.
Adverse Effects: Extravasation -> tissue necrosi
Dopamine
Pharm: Adrenergic agonist/sympathomimetic
Therapeutic: Inotropic agent/ vasopressor
Indications: Adjunct to improve bp, cardiac output, and increase urine output in treatment of shock.
Stimulates dopaminergic and beta1 receptors producing vasodilation and larger doses ->alpha adrenergic receptors causing vasoconstriction.
Adverse Effect:
Atropine
Pharm: anticholinergic
Therapeutic: anti-arrhythmic
Indication: Given preop to decrease oral and respiratory secretions (IM). Treatment of sinus brady and heart blocks (IM,IV), Treatment of exercise induced bronchospasms.
Inhibits action at postganglionic sites in smooth muscle, secretory glands, and CNS.
Beta Blockers (-olol)
Pharm: Beta Adrenergic Receptor Blocker
Therapeutic: Antiarrythmic, antianginal, antihypertensive
Indication: Prevention of MI, decreased mortality post MI, management of stable, symptomatic CHF, AFIB.
Blocks stimulation of beta1
Adverse Effects: Fatigue, weakness, anxiety, depression, dizziness, insomnia, mental status change, nervousness, blurred vi
Cardiac Glycoside - Digoxin
Action: Cause more forceful beats (positive inotropic effect) and slowly.
^ force of contraction= ^ cardiac output
Used to treat HF, AFIB, or tachycardia.
Contraindicated: Heart block, Vfib
Adverse Effects: dysrhythmias, anorexia, n/v/d, headache, weaknes
Renin Inhibitor
Therapeutic: Antihypertensive
Indication: Tx HTN
Action: Inhibits renin resulting in decreased formation of angiotensin II.
Adverse effect: cough, abdominal pain, diarrhea, dyspepsia, reflux, angioedema.
Angiotensin II Receptor Blockers (ARBs)
(-tan -> losartan, valsartan)
Therapeutic: antihypertensive agent
Indication: Management of HTN, Tx of CHF in patients that can not tolerate ACE inhibitors, reduction of stroke risk for CHF.
Blocks receptor for angiotensin II, disables RAAS.
Adverse Effect: Dizziness, HA, fatigue, hypotension, diarrhea, drug induced hep
ACE inhibitor (-pril)
Therapeutic: antihypertensive agent
Indication: Management of HTN, reduction of death to CHF and after MI, slowed progression of left ventricular dysfunction.
Blocks conversion of angiotensin to angiotensin II, a patent vasoconstrictor.
Adverse Effects: Dizziness, fatigue, HA, insomnia, wea
Nitrate
(Isosorbide mononitrate, dinitrate, nitroglycerine)
Pharm: Nitrate
Therapeutic: Antianginal
Indication: Acute (translingual & SL) and long term prophylactic (buccal, transdermal) management of angina pectoris, adjunct tx for CHF.
Increase coronary arterial blood flow by dilating coronary arteries improving collateral flow to ischemic, regions, p
Amiodarone
Prolongs duration of myocardial cell action potential and refractory period by acting directly on cardiac tissue. Decreases AV and Sinus Node function.
Supresses Arrhythmias.
Indication: for a wide variety of ventricular and atrial arrhythmias. Decrease m
Lidocaine
Anesthetic- Inhibits conduction of nerve impulses. Temporary loss of sensation
Anti arrhythmic- Inhibits ventricular arrhythmia.
(V tach & Vfib)
Procainamide
Prolongs duration of myocardial cell action potential and refractory period by acting directly on cardiac tissue.
Decreases AV and sinus function.
Suppress arrhythmia (V-tach, SVT, A fib w/ RVR)
Two types of calcium channel blockers
-pines: more selective to vascular smooth muscle
Ex: Amlodipine, Nifedipine
HTN & Angina
-Non-dihydropyridines: more selective to myocardium
Ex: Verapamil and Diltiazem
-Antiarrythmic for afib w/ RVR and SVT due to effect on myocytes and nodal tissue.
Calcium Channel Blocker
Adverse Effects, Contraindication, Teaching
Monitor bradycardia, hypotension + orthostatic, tachycardia, signs and symptoms of HF (weight gain, dyspnea, edema)
Could cause first degree block.
Contraindicated: 2nd and 3rd degree blocks
Do not take with grapefruit juice.
Increase fiber because it dec
Ketamine
A form of an anesthetic used for anesthesia, amnesia, analgesic
w/out complete loss of consciousness (conscious sedation)
Can cause: Hallucinations, sympathetic (Stress) stimulation, ?B/P, ? HR, may ? ICP
Quick onset 1-2 min and duration 5-10 min
Can be g
Dexmedetomidine (Precedex)
Short acting alpha 2 receptor agonist w/ sedative properties (May require breakthrough sedative)
Some analgesic properties
Minimal amnesic properties-> patient easy to arouse
Causes: Brady cardia, Hypotension
Doesn't cause resp depression while extubating
Propofol (Diprovan)
Adverse Effects: Injection site pain, allergic reaction (soybeans and eggs), pancreatitis due to increase in triglycerides, Propofol infusion syndrome (Brady arrhythmias. Asystole, metabolic acidosis, Rhabdomyolysis, hyperlipidemia).
FDA approved anesthet
Benzodiazepines
Can be used as sedative, antianxiolytic, anticonvulsant, muscle relaxer and to induce amnesia
What can occur by using this class of meds?
�Tolerance
�Resp depression (especially in elderly, hepatic, and renal insufficiency)
�Association has been found bet
Midazolam (Versed)
Short acting
Bolus or cont IV
Long term use = ?metabolites (elderly, renal & hepatic insuf)
Lorazepam (Ativan)
Intermediate acting
IM, Bolus, Cont IV infusion
Med is lipophilic = builds up in fat cells causing prolonged effect
Valium (Diazepam)
Not used much in critical care for sedative effect
Usually used for severe ETOH withdrawal
PO or IV push but NOT cont infusion
Benzo Antidote
Flumazenil (Romazicon)
Five reasons to use sedation
Amnesia
Ventilator tolerance
Anxiety/Fear
Safety & agitation
Sleep deprivation
Succinylcholine
Resistant to Acetylcholinesterase (an enzyme that rapidly breaks down Ach as to not overstimulate nerves, muscles, and exocrine glands).
Leads to prolonged depolarization Leads to transient fasciculations= intermittent flickering of muscles which eventual
Depolarizing Agent NMBA
(Sucs is the only one)
Ach receptor agonist = Mimic acetylcholine
Ach is the chief neurotransmitter of PNS of ANS (Contracts smooth muscle, dilates blood vessels, increase body secretions, slows HR)
Non-Depolarizing NMBA
Competitive ANTAGONISTS
They bind to Ach recpetors not allowing the ion channels to open, thus not allowing ions through to bind to Ach receptors, thus inhibiting depolarization or contraction.
Used to facilitate:
�Mechanical ventilation
�Tracheal Intubat