Download UNDERSTANDING CODE DRUGS

UNDERSTANDING CODE DRUGS
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OXYGEN
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Essential in cardiac arrest and emergency cardiac care
Expired air = 16-17% oxygen
Must given supplemental oxygen @ FIO2 of 100%
Give to all patients with acute chest pain that may be due to cardiac ischemia, suspected hypoxemia of any cause and cardiopulmonary arrest
Do not withhold from patients with COPD
Nasal cannula, masks, positive pressure devices, volume ventilators
Major precaution: ADEQUATE VENTILATION - ensure by measuring end tidal CO2 and pulse oximeter
MEDICATION
INDICATION/DOSAGES
NURSING CONSIDERATIONS
Adenosine
PSVT including PSVT associated with WPW syndrome: 6mg
rapid IVP over 1-3 seconds then 2ml flush; if no response, repeat
12mg dose in 1-2min
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(slows conduction through AV node and interrupts AV
node reentry pathways)
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* Interaction with theophylline, methylxanthines,
and dipyridamole may require dose adjustment or
another drug
CHF refractory to diuretics, vasodilators and conventional
inotropics; Load with 1mcg/kg then 2-15 mcg/kg/min
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Monitor for tachyarrhythmias
Do not mix with dextrose solutions
Symptomatic bradycardia: 0.5- 1.0mg I.V. push q. 3-5 min, not to
exceed a total dose of 0.04mg/kg
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Asystole or PEA: 1mg I.V push q. 3-5min, not to exceed total
dose of 0.04mg/kg
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Relative bradycardia- HR wnl but insufficient to meet demands
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Don’t give less than 0.5mg per dose because the
possible paradoxical effect may further slow heart
rate
Use cautiously in presence of MI
If given via ET tube: dilute 1-2mg in 10ml sterile
water or saline- follow with 1ml flush of NSS
Enhances SA node automaticity and AV
conduction via direct vagolytic action
Half-life= 1 seconds
1 vial = 6mg
Amrinone- rapid acting inotropic. vasodilator similar to
dobutamine
Side effects include- flushing, dyspnea, chest pain
resolving within 1-2 min
Transient sinus bradycardia, ventricular ectopy or
even a brief period of asystole
Mix in NSS
Atropine
(parasympatholytic)
1mg atropine= 10ml bristojet
MEDICATION
INDICATION/DOSAGES
NURSING CONSIDERATIONS
Beta Blockers-
Recurrent VT, VF or rapid PSVT refractory to other therapies
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Angina, atrial flutter and fibrillation
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Propranolol
Metoprolol
Atenolol
Esmolol
VF or pulseless VT unresponsive to defibrillation, epinephrine and 
lidocaine: 5mg/kg IV push; if arrhythmia persists increase to
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(Adrenergic neuronal blocking and antifibrillatory agent) 1mg/kg repeated every 5-10min to MAX dose of 35mg/kg
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Bretylium
Vial = 50mg
Mix 1Gm/25D5W for drip
Stable VT or stable wide-complex tachycardia of uncertain origin:
5-10mg/kg over 8-1min; to MAX dose of 35 mg/kg over 24 hrs; if
loading dose converts arrhythmia, start infusion @ 2 mg/min
(30cc on pump)
(1mg/min = 15cc on pump)
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Reduce HR, BP, myocardial contractility,
myocardial oxygen consumption
Slows AV conduction
Administer slowly IV
Monitor for CHF, bronchospasm
Not a first-line drug
May cause severe hypotension
May induce projectile vomiting
Follow boluses with 2ml saline flush
Treat hypotension with IV fluids, supine position,
Trendelenburg position, norepinephrine may be
required since may be refractory to epinephrine
Hypertension and tachycardia are transient due to
initial stimulation of norepinephrine release
Use with caution in arrhythmias induced by
digitalis toxicity
Hyperkalemia, hypocalcemia, after multiple transfusions or
Calcium channel blocker toxicity: 8-16mg/kg of 10% solution;
repeat if necessary
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Digoxin
atrial fib/flutter; CHF. Slows heart rate, increases force of
contraction and refractory period of AV node
Monitor for nausea, visual disturbances, atrial or
junctional tachycardias, PVCs, heart blocks; K+
Dobutamine- catecholamine- sympathomimeticinotropic vasoactive- alpha and beta effects
Pulmonary congestion ; low cardiac output; hypotension; septic
shock
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1mg/kg/min = 1cc if 6Xwt in Kg/100cc D5W
- 2-2mcg/kg/min
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Calcium Chloride
(increases myocardial contractile function- positive
inotropic effect modulated by effect on SVR + or -)
May cause slowing of HR
May precipitate digitalis toxicity
* Precipitates with Na Bicarb
10ml bristojet = 1Gm
(1ml= 100mg)
Avoid alkaline solutions (Bicarb)
Monitor for tachycardia, hypertension and
ventricular ectopy
Side effects include headache, nausea, tremor and
hypokalemia
MEDICATION
INDICATION/DOSAGES
NURSING CONSIDERATIONS
Dopamine-
Hemodynamically significant hypotension:
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catecholamine-vasoconstrictor
low dose- 1-2 mcg/kg/min= cerebral, mesenteric and renal
vasodilation; UOP increase; HR & BP unchanged
(dopaminergic, beta and alpha receptors)
mid dose- 2-1mcg/kg/min= increased cardiac output
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Use lowest dose that produces desired effect
Avoid in hypovolemia, high SVR, pulmonary
congestion or increased preload
Avoid Na Bicarb line
Avoid extravasation
MAO inhibitors potentiate effects
Premix= 400mg/250cc D5W in top drawer of crash cart
high dose- >10mcg/kg/min= increased SVR, PVR, preload
secondary to renal, mesenteric, peripheral arterial and venous
vasoconstriction
toxic dose- >20mcg/kg/min ischemic changes
Symptomatic bradycardia- add norepinephrine if > 20mcg/kg/min
required
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Epinephrine- catecholamine
VF,pulseless VT,PEA, or asystole
(alpha & beta-adrenergic agonist)
-standard dosing: 1mg I.V. push q. 3-5min
1mg epi=
-intermediate dosing: 2-5mg I.V.push over 3-5min
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(10ml of a 1:10,00solution)
-escalating dosing: 1mg,3mg,5mg I.V. push 3 min apart
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or
- high dosing: 0.1mg/kg I.V. push q 3-5min
(1ml of a 1:100solution in multidose vial)
Symptomatic bradycardia: continuous infusion @ 2-1mcg/min;
titrate to hemodynamic response (not used as a first-line drug)
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Each dose given peripherally should be followed
by 20ml fluid flush to ensure delivery to central
circulation
If no IV access available, give 2- 2.5 times the
dose via ET tube; follow with 10ml flush of NSS
Intracardiac administration used only when no
other route available
Increases SVR, BP, cardiac electrical activity,
coronary and cerebral blood flow, strength of
myocardial contraction, automaticity and
myocardial oxygen requirements
MIX 1mg(1ml of a 1:100solution) in 500ml NSS or D5W
Heparin
Venous thrombosis and to prevent deep vein thrombosis and
pulmonary embolism. Anticoagulant inhibits clotting of blood and
fibrin clots.
Hemorrhage, prolonged PTT, GI bleeding, chills, fever,
rhinitis, acute reversible thrombocytopenia.
Antidote: Protamine Sulfate.
Isoproterenol- sympathomimetic with pure beta- potent
inotropic and chronotropic effects)
1mg/25D5W Standard
Temporary control of hemodynamically significant bradycardia
after atropine, pacing, dopamine and epinephrine used; 210mcg/min
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Monitor for tachyarrhythmias and myocardial
ischemia
Contraindicated in digitalis toxicity
MEDICATION
INDICATION/DOSAGES
NURSING CONSIDERATIONS
Lasix
Pulmonary Edema
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Monitor K+, dehydration and hypotension;
electrolytes
(diuretic)
- 20-4mg IVP
Lidocaine
VF or pulseless VT refractory to electrical countershocks and
epinephrine: initially, 1-1.5mg/kg I.V. push; repeat q. 3-5min to
max of 3mg/kg
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Use 2-2.5 times the IV dose when given via ET
tube; followed by 1ml saline flush
If toxic symptoms develop (slurred speech, altered
LOC, muscle twitching and seizures), stop the
drug or reduce the dose
Do NOT give this drug if PVCs occur with
bradycardia or escape rhythm
No longer recommended for VF/VT prophylaxis in
acute MI
* Suppresses ventricular arrhythmias and elevates
the fibrillation threshold (less likely to occur)
(Antiarrhythmic)
100mg = 10ml bristojet
1GM/25D5W= Premix drip in first drawer of crash cart
Stable VT or stable wide-complex tachycardia of uncertain origin:
repeat doses of half the original dose
If lidocaine successfully converts the VF/VT; begin a continuous
infusion @ 2-4mg/min
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(1mg=15cc on pump)
Magnesium
(physiological calcium channel blocker and blocks
neuromuscular transmission)
Torsades de points: Drug of Choice: up to 5- 1gms have been
used
Acute MI with hypomagnesemia: intermittent or continuous
infusion 0.5- 1.gm/hr
Monitor for flushing, sweating, bradycardia and
hypotension; also if toxicity may see depressed
reflexes, flaccid paralysis, circulatory collapse,
respiratory paralysis and diarrhea
5Gm/10ml bristojet
VF/VT with hypomagnesemia: 1-2Gms diluted in 1ml D5W given
IVP over 1-2 min
Morphine
Pulmonary Edema or Ischemic chest pain; 1 to 3 mg slow IV over
1 to 5 min until desired effect achieved
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(increases venous capacitance and reduces SVR,
relieving pulmonary congestion- decreasing
intramyocardial wall tension and myocardial oxygen
requirements)
Monitor for respiratory depression, hypotension,
bradycardia, decreased LOC
Have Narcan available for reversal
Neuromuscular blockers
To relax skeletal muscle; manage patients on ventilators
May need to provide sedatives/ analgesic.
Nitroglycerin
Angina Pectoris; dosing titration to effect
Monitor for headache, hypotension, syncope, faintness
(vasodilator)
50mg/25D5W
MEDICATION
INDICATION/DOSAGES
NURSING CONSIDERATIONS
Norepinephrine
Refractory SHOCK
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(catecholamine- potent alpha (arterial and venous
vasoconstriction) with minimal beta (increase
contractility) effect
Hemodynamically significant hypotension refractory to other
sympathomimetics (septic and neurogenic shock)
- Start with 0.5-1.mcg/min and titrate to effect
MIX 8mg/250cc D5W or NSS
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Increase BP by increasing SVR and thereby
diminishing cardiac output (increases myocardial
oxygen demand, causes myocardial ischemia)
Needs A-line for monitoring BP
Also monitor CO, PCWP, PA pressures
Contraindicated in hypovolemia
Extravasation leads to necrosis- phentolamine
infiltration minimizes sloughing
(32mcg/ml)
Potassium chloride
Low serum K+, low Cl -; digitalis toxicity.
Procainamide
Persistent cardiac arrest due to VF
(suppresses ventricular ectopy and slows
intraventricular conduction)
PVCs or recurrent VT
Dosing: 20-30mg/min until:
Vial= 500mg
MIX 1Gm/25D5W for drip
Monitor K+ and Cl-. Monitor for signs of hyperkalemia
(wide QRS complex, tall, peaked T waves,
disappearing P wave and asystole. Watch for phlebitis,
pain or redness at IV site.
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1) arrhythmia suppressed
2) hypotension occurs
3) PR or QRS widens by 50% of its original width
Monitor BP closely during administration; may
cause precipitous hypotension; infuse cautiously in
acute MI
Contraindicated in patients with preexisting long
QT intervals or torsades de points
* Hypokalemia and hypomagnesemia may
exacerbate arrhythmias
(1mg/min = 15cc on pump)
or MAX dose of 17mg/kg has been given
……..if effective, start drip @ 1-4mg/min
Bristojet= 8.4% 50meq/50ml
Pre-existing metabolic acidosis or prolonged cardiopulmonary
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arrest with abnormal ABG not corrected by CPR and ventilation: 1 
meq/kg IV bolus then ½ dose in 1min prn
Sodium Nitroprusside
Severe Hypertension; 0.5- 8.0mcg/kg/min
Sodium Bicarbonate
(vasodilator)
50mg/25D5W or NSS
Monitor ABGs
Monitor for hypernatremia or hyperosmolarity
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Monitor for hypotension
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Toxicity includes tinnitus, visual blurring, altered
mental status, nausea, abdominal pain,
hyperreflexia, and seizures
MEDICATION
INDICATION/DOSAGES
NURSING CONSIDERATIONS
Thrombolytics
Acute MI with thrombosis; other types of thrombosis
Watch for coagulopathies, bleeding disturbances
Streptokinase
TPA
Verapamil & Diltiazem
Acute and preventive treatment of PSVTs, and slowing ventricular Reduce oxygen demand; decreased SVR caused by
response in atrial flutter and fibrillation
vasodilatation of vascular smooth muscle (coronary
vasodilation)
(Calcium channel blockers-direct negative chronotropic
Verapamil: 2.5-5mg IV bolus over 2 min; repeat dose 5-10mg in
& negative inotropic effect)
15-3min then 5mg q 15 until desired response or total dose of
30mg given
Diltiazem: 0.25mg/kg (20mg for avg patient) IV over 2 min; may
repeat 0.35mg/kg in 15 min; then infusion of 5-15mg/hr titrated to
HR
Versed
To relieve anxiety in ventilated patients; pre-op sedation or
anesthesia induction.
Monitor for respiratory depression, apnea,
laryngospasm, dyspnea, respiratory arrest, PVCs,
amnesia, confusion, and visual disturbances. Have
emergency equipment available.
CONVERSIONS
To change Pounds to Kilograms
44/2.2 = 2kg
2.2 pounds = 1 Kilogram
To convert to Milligrams per Kilogram
An easy way to calculate dosage in kilograms is simply to divide the weight
of the patient in pounds by 2.2. This gives you the patient’s weight in
kilograms.
To calculate the dosage of a drug given in mg/kg, you multiply the number of
milligrams needed times the patient’s weight in kilograms.
Example
Example
1. Patient’s weight is 16pounds.
If the patient is to receive a dose of 5 mg/kg of bretylium, multiply 5 times the
patient’s weight in kilograms. The patients 44 pounds.
160/2.2 = 72.7 kg
44/2.2 = 2kg Then
2. Patient’s weight is 44 pounds.
5mg/kg x 2kg = 10mg bretylium