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Pharm III Test 1
Terms in this set (74)
What are the electrolytes that manage cardiac rhythms or dysrhythmias?
Calcium, Sodium, and Potassium
What is A flutter?
multiple P-waves preceding each QRS complex
How is A flutter documented?
What is A Fib?
no p waves present, and the QRS completeness occur on a very irregular basis
What treats A Fib and A flutter?
Beta Blockers and Calcium channel blockers
What do beta blockers do?
The Beta blockers serve as a general myocardial rate depressant.
How do calcium channel blockers work?
The Calcium Channel Blockers delay conduction, thereby slowing the rate due to the delayed response.
What is paroxysmal Supraventricular Tachy (PSVT)?
Yields a very accelerated ventricular rate, due to a Rapid Ventricular Response (RVR) to the impulses from the SA node, which is in turn being stimulated by either a reentrant conduction pathway, or an ectopic atrial foci
What drug is used to dx and treat PSVT?
How does adenosine work?
briefly block AV Node conduction
What other drugs are used to treat PSVT?
Beta blockers and calcium channel blockers
What are premature ventricular contractions?
These are contractions stimulated from other foci within the ventricle, but that do not use the conduction pathway.
Why do PVC have wide complexes?
The wide complex is due to the slow conduction from myocardial cell to myocardial cell, spreading around the heart.
What are the meds used to treat frequent PVCs?
Lidocaine and Amiodarone
Followed by beta and calcium blockers
What does amiodarone do?
extends the Q-T interval, and carries the risk of R-On-T if the Q-T interval is too long.
What can R on T events trigger?
R-On-T events can trigger Torsades de Pointes, a fatal rhythm.
What is ventricular tachycardia?
can either be sustained or non sustained (reported by the number of wide complex beats in a "run")
What are the medications for V Tach?
lidocaine, amiodarone and even ACLS protocol drugs
What is Torsades de Pointes?
variation of V tach
usually preceded by a prolong Q-T interval and is a rhythm which often deteriorates into ventricular fibrillation
What are the meds for Torsades de pointes?
based on ACLS protocol
What happens to cardiac output for Vfib?
no cardiac output
What is the tx for V fib?
ACLS protocol drugs and defibrillate when indicated
What are shockable rhythms?
V fib, sustained V tach, and Torsades
What rhythm can you not shock?
What are class I drugs?
Fast sodium channel blockers
What dugs are in Ia?
quinidine, procainamide, and disopyramide
They delay depolarization
What do class Ia drugs treat?
Used for A fib, PAC, PVC, V tach, WPW
What are the Ib drugs?
phenytoin and lidocaine
What do Ib drugs do?
Block sodium channels
Increase or decrease APD
What is Lidocaine used to treat?
What is phenytoin used for?
V tach caused by digitalis toxicity and long QT syndrome
What are Ic drugs?
flecainide and propafenone
What are Ic drugs used for?
A fib/flutter, WPW, supraventricular tachy
What are class II drugs?
Beta blockers (atenolol, metaprolol)
What do beta blockers do?
Reduce or block sympathetic nervous system stimulation, thus reducing transmission of impulses in the heart's conduction system
Depress phase 4 depolarization
What are beta blockers used to treat?
supra ventricular and vetricular dysrhythmias
angina and HTN
What are class III drugs?
amiodarone, dronedarone, dofetilide, sotalol*, ibutilide
What do class III drugs do?
Increase APD and prolong depolarization in phase 3
What are class III drugs used to treat?
Life-threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter that is resistant to other drugs
What are class IV drugs?
calcium channel blockers
What do class IV drugs do?
Depress phase 4 depolarization
Reduce AV node conduction
What do class IV drugs treat?
Used for paroxysmal supraventricular tachycardia; rate control for atrial fibrillation and flutter
What is an unclassified antidysrhythmic?
What does adenosine do?
Slows conduction through the AV node
Very short half-life—less than 10 seconds
Only administered as fast IV push
What may adenosine cause?
May cause asystole for a few seconds
What is adenosine used to treat?
Used to convert paroxysmal supraventricular tachycardia to sinus rhythm
What are side effects to antidysrhythmics?
ALL antidysrhythmics can cause dysrhythmias!
What is general anesthesia?
a drug-induced state altering the impulses to the CNS and resulting in reduced pain and sensation for the entire body.
What needs to happen if someone is under general anesthesia?
Due to the impaired CNS impulses, General Anesthesia requires either direct ventilator support, or the availability of ventilator support, depending on the depth of anesthesia.
What is Local anesthesia?
Local Anesthesia, again a drug-induced alteration of nerve conduction, but instead of CNS communication, it affects conduction of spinal or peripheral nerves, and results in altered or eliminated pain.
What are four levels of sedation?
What is Minimal sedation?
Sedation provides relief from anxiety (anxiolysis) while leaving the patient completely capable of responding to normal levels of stimulation.
What is considered moderate sedation?
Moderate Sedation or Analgesia is often referred to as Conscious Sedation. This is a state where the patient is able to respond purposefully to stimulation.
What is considered deep sedation?
Deep Sedation or Analgesia offers a state where on repeated or painful stimulation, the patient will make a purposeful response.
What is considered general anesthesia
General Anesthesia describes a state where the is no response to painful stimulus.
What is the most common sedative used in the ICU?
What are the benefits to using Versed?
rapid onset and anterograde amnesia
What is a negative with using versed?
long term use requires a iterated withdrawal to avoid seizures
What is propofol?
it is used for sedation and also an anxiolytic, anticonvulsant, reducing intracranial pressure and antiemesis
What are disadvantages to using propofol?
hypotension and reduced CO
What is thiopental used for?
refractory status epilecticus
What is the opioid of choice?
Fentanyl because its lack of accumulated metabolites
What is the downside of using morphine?
used only for limited periods due to the accumulation of metabolite morphine-6-glucuronide, which can result in renal failure.
What are neuromuscular blocking agents not?
they are not sedatives or analgesics
How do you asses the level of paralysis?
train of Four
What is the typical dose for propofol?
What do you need to change when giving propofol?
the IV tubing ever 12 hrs because its high lipid content
What do you also need to give with propofol?
an analgesic because it has no pain relieving properties
What sedative has a faster offset, propofol or versed?
propofol it simplifies the sedation vacation
What is the dosing for Midazolam (versed)?
What should you administer first the versed or the analgesic?
the analgesic to better asses the level of sedation
What are some sedation scales?
Riker Sedation-Agitation Scale (RSAS) and the Richmond Agitation Sedation Scale (RASS)
What are some neuromuscular blockage agents?
What one is used for short term paralysis?
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