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Objectives
5 Rights of Medication
Administration
Right Patient
Right Route
Right Dose
Right Time
Right Medication
Negative
Thinkers..
Beta receptors..
What Beta-blockers do
Renin-Angiotensin-Aldosterone
System (RAAS)
Case Study
52 y/o female with history of HTN, EF=
50% and diet controlled DM presented to
the ED with fatigue. Admitted for
observation and stress test the following
day. Home meds: Lisinopril and MVI.
Now c/o nausea and diaphoretic. 12- lead
EKG ST inversion in Lateral leadsCall
the doctor & get ready for________.
Heparin
Anticoagulation action by accelerating the
activity of antithrombin III to inactive
thrombin. Does NOT lyse existing clots.
Measures: aPTT goal 1.5-2 times control
(50-70)
25,000 units in 250mL of D5W.
Concentration: 100units/mL.
Dosing: units/hour
Integrilin (Eptifibatide)
Anaphylactic shock
Bleeding
GI bleed
Hematuria
Hypotension
IC bleed
Platelet dysfunction
Stroke
Thrombocytopenia
Nitroglycerin
Diaphoresis
Flushing
Headache
Hypotension
Nausea/Vomiting
Orthostatic
hypotension
Palpitations
Rash
Sinus Tachycardia
Syncope
Tolerance
Weakness
Metoprolol (Lopressor)
Beta 1-receptor: decrease in heart rate,
decrease in both systolic and diastolic
blood pressure (chron). Decreased CO (-)
Indications: MI, angina, atrial fibrillation
and flutter, HF, HTN
Dose:
25-100mg
po twice daily
2.5-5mg IV
AV block
Blurred vision
Bradycardia
Constipation
Hypotension
Impotence
Insomnia
Jaundice
Peripheral edema
Jaundice
Depression
Dyspnea
Headache
Dopamine
0.5-2mcg/kg/min: Vasodilatation
2-10mcg/kg/min: Increased HR, CO, BP
>10mcg/kg/min: PVR, renal vasoconstriction
Angina
Anxiety
Arrhythmia
Bradycardia
Dyspnea
Hypertension
Hypotension
Palpitations
Nausea/Vomiting
Sinus Tachycardia
V- tach
V-fib
Dobutamine
Stimulates beta1-adrenergic receptors,
causing increased contractility and heart
rate, with little effect on beta2- or alphareceptors
Indications: Cardiac surgery, Cardiogenic
shock, HF
Dose: 250mg in 250mL D5W (1:1)
0.5-40mcg/kg/min
Angina
Arrhythmia
Fatigue
Headache
HTN
Hypokalemia
Nausea/vomiting
Palpitations
Phlebitis
Skin necrosis
Sinus tachycardia
Ventricular
tachycardia
Primacor (Milrinone)
Angina
Atrial fibrillation/flutter
Atrial tachycardia
Headache
Hypotension
Palpitations
PVCs
Syncope
Thrombocytopenia
Amiodarone
Bradycardia
Heartblock
Hypotension
Tremors
Headaches
Abnormal LFTs
Visual disturbances
Optic neuritis
Neuropathy
Blue discoloration of
the skin
Pulmonary fibrosis
Diltiazem
Hypotension
Flushing
Peripheral edema
Heart failure
Bradycardia
Digoxin
Inhibits Na-K ATPase membrane pump.
Indications: Atrial fibrillation/flutter, HF,
PSVT
Dose: 10-15mcg/kg IV or PO in 3 divided
doses q6-8 hrs with first dose = , then po
q6 x2 (ie: 500mcg x1, then 250mcg q6 x2.
Then 125-350mcg per day
Hypokalemia
Nausea/vomiting
SJS
PVCs
Syncope
Psychosis
Bradycardia
AV block
Fatigue
Depression
Headache
Sinus tachycardia
Weakness