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EPINEPHRINE

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Title: EPINEPHRINE


1
CARDIOVASCULAR PHARMACOLOGY Prof.Alsaeed
2
Objectives
  • Pharmacology 1
  • Pharmacology 2

3
PHARMACOLOGY 1
  • DRUGS AFFECTING
  • CO
  • HR
  • PVR

4
PHARMACOLOGY 1
  • VASOPRESSORS USED TO TREATE CARDIAC ARREST
  • ADRENERGIC VASOPRESSOR
  • EPINEPHERINE
  • NON- ADRENERGIC VASOPRESSOR
  • VASOPRESSIN
  • INOTROPIC AND VASOPRESSOR AGENTS USED TO SUPPORT
    CIRCULATION
  • ADRENERGIC AGONISTS
  • NON- ADRENERGIC AGONISTS
  • (VASOPRESSIN)

5
  • 3-INODILATORS
  • PHOSPHODIESTRASE INHIBITORS
  • INAMRINONE
  • MILRINONE
  • CARDIAC GLYCOSIDES
  • DIGOXIN
  • 4-VASODILATORS ß BLOCKERS
  • VASODILATORS
  • NITROGLYCERINE
  • SODIUM NITROPRUSSIDE
  • ß BLOCKERS
  • PROPRANOLOL
  • METOPRELOL
  • ATENOLOL
  • ESMOLOL
  • LABETALOL

6
PHARMACOLOGY 2
  • AGENTS FOR CONTROL OF RateRhythm

7
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8
ADRENERGIC RECEPTORS
9
EPINEPHRINE
Mechanism of Action
  • Systemic vascular resistance
  • Systemic arterial pressure
  • Heart rate
  • Contractile state
  • Myocardial oxygen requirement
  • Improved cerebral and myocardial blood flow from
    vasoconstriction and increased perfusion pressure

10
EPINEPHRINE
Indications
Cardiac Arrest
  • Ventricular fibrillation
  • Asystole
  • EMD (consider noncardiac causes)

11
EPINEPHRINE
  • Indications
  • Symptomatic bradycardia after other
    measures(atropine,dopamine ,transcutaneouse
    pacing) have failed (Class IIb)
  • Sever hypotension
  • Anaphylaxis

12
EPINEPHRINE
Dosage
  • In cardiac arrest
  • 1 mg (10 mL 110,000 solution)
  • IV push every 3 to 5 minutes.
  • If this fails, higher doses of epinephrine (up to
    0.2 mg/kg) are acceptable but not recommended
    (there is growing evidence that it may be
    harmful).
  • Precautions
  • Be aware of increased MVO2
  • can precipitate myocardial ischemia
  • Avoid mixing with alkaline solutions
  • Can induce myocardial ectopy

13
VASOPRESSIN
  • Mechanism of action
  • Is a non-adrenergic peripheral vasoconstrictor
    by directly stimulating smooth muscle V1
    receptors without increase of myocardial oxygen
    consumption because it has no B-adrenergic
    activity
  • Indications
  • Alternative pressor to epinephrine for the
    treatment of shock-Refractory VF in adults
  • A systole or pulseless electrical activity
  • Refractory cardiac arrest after treatment with
    epinephrine
  • Septic shock and sepsis syndrome

14
VASOPRESSIN
  • Dose
  • Shock-Refractory VF/pulseless VT
  • 40 U IV, single dose, 1 time only
  • As a Class Indeterminate action, it is acceptable
    to resume epinephrine
  • 1 mg IV push every 3 to 5 minutes if there was
    no response in 5 to 10 minutes to a single IV
    dose of vasopressin.
  • Precautions
  • Skin pallor
  • Nausea
  • Intestinal cramps
  • Bronchial constriction
  • Uterine contractions in women

15
NOREPINEPHRINE
Indications (temporarily only)
  • Cardiogenic shock
  • Absence of peripheral vasoconstriction with
    hypotension
  • Dosage
  • 16µg/mL, bitartrate IV in 5 dextrose in water
  • Initial Infusion
  • 0.5-2µg/min titrate (2-12µg/min)

16
NOREPINEPHRINE
Precautions
  • Hypovolemia
  • Arrhythmias
  • Extravasation
  • Excessive elevations of BP

Monitor BP, ECG and venous site
17
DOPAMINE
Mechanisms of Action
  • Precursor of epinephrine
  • Alpha- and beta- receptor stimulator
  • Dopaminergic receptor stimulator
  • Low dose
  • Dilates renal and mesenteric vessels
  • Venoconstricts
  • Arterial resistance may vary
  • High dose
  • Alpha effects dominate
  • Arterial and venous constriction including
    renal and mesenteric vessels

18
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19
DOPAMINE
Indications
  • Cardiogenic shock
  • Hemodynamically significant hypotension
  • Congestive heart failure with other agents
  • Dosage
  • Intravenous only
  • Initial infusion rate 2µg/kg/min
  • Increase infusion rate according to BP, urine
    flow response, and clinical response
  • Adjust infusion rate as needed

20
DOPAMINE
Precautions
  • Excessive vasoconstriction
  • Fall in BP
  • Arrhythmias
  • Nausea and vomiting
  • Extravasation
  • Monoamine oxidase inhibitors
  • Pheochromocytoma

21
DOBUTAMINE
Mechanisms of Action
  • Direct beta-adrenergic stimulator
  • Potent inotropic effect but less chronotropic
  • Renal and mesenteric flow follows cardiac output
  • Myocardial work is balanced by increases in
    coronary flow at clinical doses
  • Indications
  • Congestive heart failure
  • Cardiogenic shock
  • Hemodynamically significant hypotension

22
DOBUTAMINE
Dosage
  • Initial infusion rate 0.5µg/kg/min IV
  • Usual infusion rate 2.5-20.0 µg/kg/min IV
  • Titrated to not increase heart rate gt 10
  • Precautions
  • Tachycardia
  • Arrhythmias
  • Caution in coronary artery disease

23
ISOPROTERENOL
Mechanisms of Action
  • Pure beta-adrenergic stimulator (beta-1 and
    beta-2)
  • Potent inotropic effect
  • Potent chronotropic effect
  • Increases cardiac output
  • Increases myocardial oxygen consumption
  • Vasodilation diastolic and mean BP may fall but
    systolic pressure maintained or increased due to
    increased cardiac output

24
ISOPROTERENOL
Indications
  • Hemodynamically significant atropine-refractory
    bradycardia
  • Pacemaker better as soon as possible
  • Contraindicated during cardiac arrest
  • Dosage
  • 2-10 µg/min
  • Titrate to increase heart rate to 60/min

25
ISOPROTERENOL
Precautions
  • Excessive tachycardia
  • Arrhythmias
  • Increased myocardial oxygen consumption
  • Exacerbate digitalis intoxication
  • Hypokalemia

26
AMRINONE
Mechanisms of Action
  • Potent inotropic effect
  • Independent of adrenergic effects
  • Indications
  • Severe refractory heart failure
  • Septic shock
  • Dosage
  • Loading 0.75 mg/kg over 2-3 min
  • Titrate to effect (2-20µg/kg/min

27
AMRINONE
Precautions
  • May induce or worsen ischemia
  • Thrombocytopenia
  • Allergic (sulphonamides)

28
NITROPRUSSIDE
Mechanisms of Action
  • Arterial vasodilation
  • Venous vasodilation
  • Enhanced systolic emptying
  • Increased cardiac output
  • Decreased LVEDP and pulmonary congestion
  • Decreased myocardial oxygen consumption
  • Indications
  • Hypertensive crisis
  • Congestive heart failure

29
NITROPRUSSIDE
Dosage
  • Heart failure dose 0.5µg/kg/min and titrate
  • Average dose 0.5-8.0 µg/kg/min
  • Higher doses may be required for hypertension

IV should be wrapped with aluminum foil
30
NITROPRUSSIDE
Precautions - Hemodynamic Monitoring Essential
  • Imbalance between coronary supply and demand
  • Possible coronary steal
  • Right-to-left shunting
  • Thiocyanate toxicity
  • Cyanide intoxication
  • Hypotension
  • Apprehension, restlessness
  • Chest and abdominal pains
  • Palpitations
  • Dizziness
  • Muscle twitching

31
NITROGLYCERIN
Mechanisms of Action
  • Increased supply theory
  • Coronary artery vasodilation
  • Collateral blood flow
  • Decreases spasm
  • Decreased work theory
  • Venodilation decreases venous return
  • Decreased ventricular volume-less work
  • Arterial dilation if filling pressure is high
  • Smooth muscle relaxation

32
NITROGLYCERIN
Indications
  • Sublingual
  • Angina pectoris
  • Myocardial infarction
  • Intravenous
  • Unstable angina pectoris
  • Acute myocardial infarction
  • Congestive heart failure

33
NITROGLYCERIN
Dosage
  • Sublingual
  • 0.3 or 0.4 mg sublingual may be repeated twice at
    3-5 minute intervals
  • Intravenous
  • Continuous infusions starting at 10-20 µg/min and
    increase by 5-10 µg/min every 5-10
  • minutes until desired response is obtained or
    bolus of 50 µg followed by an infusion

34
NITROGLYCERIN
Precautions
  • Headache
  • Hypotension
  • Syncope
  • Methemoglobinemia
  • Hypoxemia
  • Bradycardia

35
BETA BLOCKERS-PROPRANOLOL METOPROLOL
Mechanisms of Action
  • Beta-adrenergic receptor blockade
  • Competitive with adrenergic stimulants
  • Action depends on level of adrenergic influence
  • Antiarrhythmia effect (quinidine effect)
  • Indications
  • Recurrent VT/VF
  • Refractory PSVT
  • Post infarction protection

36
BETA BLOCKERS-PROPRANOLOL METOPROLOL
Dosage - Propranolol
  • 1.0-3.0 mg slow IV dose every 5 min
  • Do not exceed 0.1 mg/kg every 5 min

- Metoprolol
  • 5 mg IV every 5 min to 15 mg

37
BETA BLOCKERS-PROPRANOLOL METOPROLOL
Precautions
  • Cardiac failure
  • Bradycardias or AV block
  • Asthma or bronchospastic disease

38
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39
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40
Anti-arrhythmic drugs
PHARMACOLOGY 2
41
PROCAINAMIDE
Mechanisms of Action
  • Suppresses ventricular ectopy
  • Elevates VF threshold
  • Indications
  • Usually used when lidocaine has not controlled
  • ventricular arrhythmias
  • Ventricular premature complexes
  • Recurrent ventricular tachycardia

42
PROCAINAMIDE
Dosage
  • 100 mg over 5 min (20 mg/min) until one of the
    following
  • Arrhythmia suppressed
  • Hypotension
  • QRS complex widened by 50 of original width
  • Total of 1 gm administered

43
PROCAINAMIDE
Infusion Dosage
  • 1-4 mg/min
  • Reduce in presence of renal failure
  • Monitor blood levels in renal failure and with
    infusions
  • gt 3 mg/min or gt 24 hr
  • Precautions
  • Monitor systemic pressure for hypotension
  • Observe ECG for increased PR and QT intervals,
    QRS
  • widening and heart block

44
LIDOCAINE
Mechanisms of Action
  • Suppresses ventricular ectopy
  • Elevates VF threshold
  • Indications
  • Shock-Refractory VF/pulseless VT
  • Ventricular premature complexes especially in
  • ischemia/infarction
  • Ventricular tachycardia
  • Prophylactic administration

45
LIDOCAINE
Dosage VF/VT
  • 1-1.5 mg/kg IV push followed by 0.5-0.75mg/kg
    every 5-10 min as needed 3 mg/kg
  • Use infusion of 2-4 mg/min after termination of
    arrhythmia
  • Dosage PVCs
  • 1 mg/kg followed by 0.5 mg/kg every 2-5 min as
  • needed to 3 mg/kg
  • Infusion Rate
  • 2 mg/min after 1 mg/kg
  • 3 mg/min after 2 mg/kg
  • 4 mg/min after 3 mg/kg

46
LIDOCAINE
Dosage Prophylaxis of VF
  • 1.5 mg/kg followed by 0.5 mg/kg at 8-10 min
    intervals to a total of 2 mg/kg unless persistent
    ectopy
  • Infusion at 2-4 mg/min

47
LIDOCAINE
Precautions
  • Clinical indication of toxicity usually
    CNS-related
  • Muscle twitching
  • Slurred speech
  • Altered consciousness
  • Decreased hearing
  • Seizures

48
LIDOCAINE
Reduced Dosage
  • Decreased cardiac output (cardiogenic shock, CHF)
  • Hepatic dysfunction
  • Elderly patients (gt 70 yr)

In all of these, use one-half recommended bolus
and observe response
49
Adenosine
  • Not in Vaughan Williams class
  • Purine nucleotide (activates adenosine receptors)
  • Slows AV nodal conduction
  • Acute Rx
  • Termination of SVT/ diagnosis of VT
  • Given IV only (rapid bolus)
  • T1/2 lt 2seconds

50
Adenosine- adverse effects
  • Feeling of impending doom!
  • Flushing, dyspnoea, chest pain, transient
    arrhythmias
  • Contraindicated in asthma, heart block

51
Verapamil
  • Class IV (calcium channel blocker)
  • Prolongs conduction and refractoriness in AV
    node, slows rate of conduction of SA node
  • Acute Rx /prophylaxis
  • Used IV/oral
  • SUPRAVENTRICULAR NOT VENTRICULAR ARRHYTHMIAS
    (cardiovascular collapse)
  • Do not use IV verapamil with ß- blocker (heart
    block)
  • T1/2 6-8 hours

52
Verapamil- adverse effects
  • Heart failure
  • Constipation
  • Bradycardia
  • Nausea

53
Digoxin
  • Not in Vaughan Williams class
  • Cardiac glycoside (digitalis, foxglove)
  • Act on Na/K-ATPase of cell membrane (inhibits
    Na/K pump, increases intracellular Na and
    calcium)/ increases vagal activity
  • Increase cardiac contraction and slows AV
    conduction by increasing AV node refractory period

54
Digoxin
  • Atrial fibrillation or flutter (controls
    ventricular rate)
  • Acute Rx/prophylaxis
  • Oral/IV
  • Loading and maintenance doses
  • T1/2 36 hours
  • Excreted by kidneys
  • Narrow therapeutic index
  • Therapeutic drug monitoring
  • Reduce dose in elderly/renal impairment

55
Digoxin adverse effects
  • Arrhythmias, heart block, anorexia, nausea,
    diarrhoea, xanthopsia, gynaecomastia, confusion,
    agitation
  • AE potentiated by hypokalaemia and
    hypomagnesaemia
  • Overdose Digibind (digoxin binding antibody
    fragments), phenytoin for ventricular
    arrhythmias, pacing, atropine

56
AMIODARONE
57
Mechanism of action and properties
AMIODARONE
  • Is a complex agent with multiple effects on
    Na,K,and Ca channels
  • It prolong the refractory period and thus the QT
    interval on ECG
  • Posses both alpha and beta adrenergic blocking
    properties

58
AMIDARONE
  • It is iodine-containing and has a very long
    half-life (26-127 days).
  • Protein binding can displace digoxin or warfarin,
    so increasing their actions.
  • Given intravenously, the anti-arrhythmic action
    occurs within a few hours given orally this may
    take 1-3 weeks.
  • Amiodarone is the least negatively inotropic
    anti-arrhythmic with the exception of digoxin.

59
Indications
AMIDARONE
  • Shock-Refractory VF/ pulseless VT
  • AF and Atrial flutter
  • Stable narrow-complex tachycardia
  • Stable monomorphic VT

60
Dose of administration Cardiac arrest
AMIODARONE
  • 300 mg IV push (diluted in 20 to 30 ml D5W)
  • If VF/ pulseless VT recurs consider
    administration of 150 mg IV infusion in 3-5
    minutes
  • An infusion of 1 mg/min for 6 hours can be given
    and then 0.5 mg/min (maximum cumulative dose of
    2.2 g IV per 24 hours
  • Stable tachycardias, AF, and Atrial flutter
  • Rapid infusion of 150 mg IV followed by 1mg/min
    for 6 hours and then 0.5mg/min for 18 hours
  • The initial dose my be repeated after 10 minutes

61
IV Amiodarone Dosing
Max 2.1g / 24 h
1,200
1,000
540 mg/18h
800
720 mg/24h
Total mg Dose
600
360 mg/6h
400
300 mg
200
150 mg/10min
0
Cardiac Arrest
Perfusing Rhythm
Recurrences
Maintenance
Amiodarone I.V. should, whenever possible, be
administered through a CVL, and an in-line filter
should be used during administration.

62
Side effects
AMIODARONE
  • Hypotension and bradycardia
  • Reversible corneal micro-deposits
  • Metallic taste
  • Alveolitis
  • Slate grey discoloration of skin
  • Arrhythmias (torsades)
  • Hypothyroidism
  • Ataxia
  • Peripheral neuropathy
  • Hepatitis
  • Photosensitivity
  • Hyperthyroidism

63
MAGNESIUM
  • Mechanism of action
  • Magnesium is essential for the proper
    function
  • of myocardial cells
  • Indications
  • Stable polymorphic VT with prolonged QT interval
    suggestive of torsades de pointes
  • Persistent or recurrent VF/pulseless VT
    associated with a known hypomagnesemic stats
  • Life-threatening ventricular arrhythmias caused
    by digitalis toxicity

64
MAGNESIUM
  • Dose
  • Persistent VF/pulseless VT
  • 1-2 g(2-4 ml of 50 solution) diluted in 10 ml
    of D5W
  • IV push over 1 to 2 minutes
  • Polymorphic VT (torsades de pointes)
  • Initial dose of 1-2 g diluted in 50-100 ml of
  • D5W over 5 to 60 minutes IV and a maintenance
  • dose of 0.5-1 g /h IV
  • Precautions
  • Hypotension
  • Use magnesium with caution if renal failure is
    present

65
AHA Recommendations
  • Class I

- definitely helpful, - excellent Level I
evidence
  • Class IIa

- acceptable, probably helpful - good supportive
evidence
  • Class IIb

- acceptable, possibly helpful - fair supportive
evidence
  • Class III

- not indicated, may be harmful
  • Class Indeterminate

- not recommended - insufficient data
66
Tachyarrhythmic Agents
?-Blocker
Drug/Recommeded Use (Class)
Amiodarone
Ca-Blocker
Lidocaine
Magnesium
Procainamide
VF/Pulseless VT IIb
IND IND IIb
Wide-complex tachycardia IIb IIb
Stable VT IIb IIb IIa
PSVT (preserved cardiac function) IIa I
I IIa
PSVT (impaired cardiac function) IIb
Atrial fibrillation/flutter IIa I I
IIa (preserved cardiac function)
Atrial fibrillation/flutter IIb
IIb (impaired cardiac function)
Atrial fibrillation/flutter (WPW) IIb
III III IIb
Atrial fibrillation/flutter (impaired IIb ca
rdiac function plus WPW)
67
Tachyarrhythmic Agents
?-Blocker
Drug/Recommeded Use (Class)
Amiodarone
Ca-Blocker
Lidocaine
Magnesium
Procainamide
VF/Pulseless VT IIb
IND IND IIb
Wide-complex tachycardia IIb IIb
Stable VT IIb IIb IIa
PSVT (preserved cardiac function) IIa I
I IIa
PSVT (impaired cardiac function) IIb
Atrial fibrillation/flutter IIa I I
IIa (preserved cardiac function)
Atrial fibrillation/flutter IIb
IIb (impaired cardiac function)
Atrial fibrillation/flutter (WPW) IIb
III III IIb
Atrial fibrillation/flutter (impaired IIb ca
rdiac function plus WPW)
68
Tachyarrhythmic Agents
?-Blocker
Drug/Recommeded Use (Class)
Amiodarone
Ca-Blocker
Lidocaine
Magnesium
Procainamide
VF/Pulseless VT IIb
IND IND IIb
Wide-complex tachycardia IIb IIb
Stable VT IIb IIb IIa
PSVT (preserved cardiac function) IIa I
I IIa
PSVT (impaired cardiac function) IIb
Atrial fibrillation/flutter IIa I I
IIa (preserved cardiac function)
Atrial fibrillation/flutter IIb
IIb (impaired cardiac function)
Atrial fibrillation/flutter (WPW) IIb
III III IIb
Atrial fibrillation/flutter (impaired IIb ca
rdiac function plus WPW)
69
Tachyarrhythmic Agents
?-Blocker
Drug/Recommeded Use (Class)
Amiodarone
Ca-Blocker
Lidocaine
Magnesium
Procainamide
VF/Pulseless VT IIb
IND IND IIb
Wide-complex tachycardia IIb IIb
Stable VT IIb IIb IIa
PSVT (preserved cardiac function) IIa I
I IIa
PSVT (impaired cardiac function) IIb
Atrial fibrillation/flutter IIa I I
IIa (preserved cardiac function)
Atrial fibrillation/flutter IIb
IIb (impaired cardiac function)
Atrial fibrillation/flutter (WPW) IIb
III III IIb
Atrial fibrillation/flutter (impaired IIb ca
rdiac function plus WPW)
70
Tachyarrhythmic Agents
?-Blocker
Drug/Recommeded Use (Class)
Amiodarone
Ca-Blocker
Lidocaine
Magnesium
Procainamide
VF/Pulseless VT IIb
IND IND IIb
Wide-complex tachycardia IIb IIb
Stable VT IIb IIb IIa
PSVT (preserved cardiac function) IIa I
I IIa
PSVT (impaired cardiac function) IIb
Atrial fibrillation/flutter IIa I I
IIa (preserved cardiac function)
Atrial fibrillation/flutter IIb
IIb (impaired cardiac function)
Atrial fibrillation/flutter (WPW) IIb
III III IIb
Atrial fibrillation/flutter (impaired IIb ca
rdiac function plus WPW)
71
Tachyarrhythmic Agents
?-Blocker
Drug/Recommeded Use (Class)
Amiodarone
Ca-Blocker
Lidocaine
Magnesium
Procainamide
VF/Pulseless VT IIb
IND IND IIb
Wide-complex tachycardia IIb IIb
Stable VT IIb IIb IIa
PSVT (preserved cardiac function) IIa I
I IIa
PSVT (impaired cardiac function) IIb
Atrial fibrillation/flutter IIa I I
IIa (preserved cardiac function)
Atrial fibrillation/flutter IIb
IIb (impaired cardiac function)
Atrial fibrillation/flutter (WPW) IIb
III III IIb
Atrial fibrillation/flutter (impaired IIb ca
rdiac function plus WPW)
72
SODIUM BICARBONATE
Mechanisms of Action
Reacts with H ions, as in metabolic acidosis
  • HCO3- H ? H2CO3 ? CO2 H2O
  • Indications
  • Consider in cardiac arrest only after more
    definitive
  • treatment
  • Metabolic acidosis
  • Dosage
  • 1 mEq /kg initially, then no more than one-half
    this
  • dose at 10 min intervals

73
SODIUM BICARBONATE
Precautions
  • Worsened mixed-venous (and intracellular)
    acidosis from CO2 formation and retention
  • Hyperosmolality and hypernatremia
  • Metabolic alkalosis
  • Acute hypokalemia

74
SODIUM BICARBONATE
Conclusions
  • Clinically serious side effects, especially
    CO2 formation
  • No definite evidence of benefit in arrest
  • No basis for routine use
  • Consider only after known beneficial therapy
  • May be helpful in documented preexisting
    metabolic acidosis

75
MORPHINE
Mechanisms of Action
  • CNS Analgesic
  • Hemodynamic
  • Increased venous capacitance
  • Decreased systemic vascular resistance
  • Reduced myocardial oxygen needs
  • Indications
  • Acute myocardial infarction
  • Acute pulmonary edema

76
MORPHINE
Dosage
  • Small (2-5 mg) intravenous increments titrated to
    desired analgesic or hemodynamic effect
  • Precautions
  • Depression of ventilation
  • Systemic hypotension, especially in
  • Volume-depleted patients
  • Patients with increased systemic resistance


77
CALCIUM CHLORIDE
Mechanisms of Action
  • Increases cardiac contractile state
  • Indications
  • Acute hyperkalemia
  • Hypocalcaemia
  • Calcium channel blocker adverse effects
  • No indication in cardiac arrest if any of above
    conditions present

78
CALCIUM CHLORIDE
Dosage
  • 2-4 mg/kg of 10 solution IV and repeated as
    needed at 10 min intervals
  • Precautions
  • Bradycardia with rapid injection
  • Caution in digitalized patients
  • Precipitates as carbonate salt in bicarbonate
    solution

79
FUROSEMIDE
Indications
  • Acute pulmonary edema
  • Dosage
  • 40 mg slowly IV
  • Precautions
  • Dehydration
  • Hypovolemia
  • Hypotension
  • Hyperosmolality
  • Hypokalemia

80
ATROPINE
Mechanisms of Action
Parasympatholytic (vagolytic) action
  • Accelerates rate of sinus node discharge
  • Improves atrioventricular conduction
  • May restore cardiac rhythm in a systole

81
ATROPINE
Indications
  • Bradycardia (sinus or AV nodal block) with
    hypotension or ventricular ectopy
  • Ventricular a systole
    Dosage

  • 0.5 mg IV every 5 min as needed in bradycardia
  • For a systole use 1.0 mg IV and repeat in 5 min
    if needed
  • Total maximum dose 3 mg (0.04 mg/kg)
  • For endotracheal injection 1.0-2.0 mg diluted in
    10 mL water

82
ATROPINE
Precautions
  • Increased myocardial oxygen demand worsened
    ischemia
  • Ventricular tachycardia or fibrillation

83
OXYGEN
Impairment of Oxygenation During Cardiac Arrest
  • Expired air 16 to 17 oxygen
  • Low cardiac output
  • Intrapulmonary right-to-left shunt
  • Ventilation/perfusion mismatching
  • Effects of Oxygen Administration
  • Elevate Oxygen tension
  • Increase oxygen content
  • Improve tissue oxygenation

84
OXYGEN
Indications
  • Acute chest pain
  • Suspected hypoxemia of any cause
  • Cardiopulmonary arrest
  • Precautions
  • Toxicity
  • Obstructive lung diseases

85
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