Any Pearls of Wisdom regarding the following cardiac meds?

  1. Anything that stands out in your mind about any of these? I'm all ears. Thanks.

    1. Amiodarone
    2. Angiomax
    3. Adenosine
    4. Corlopam
    5. Covert
    6. Dobutrex
    7. Dopamine
    8. Integrilin
    9. Flolan
    10. Propanolol
    11. Lidocaine
    12. Natrecor
    13. Milrinone
    14. Pronestyl
    15. Reopro
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  2. 16 Comments

  3. by   AuntieRN
    Angie, not sure if this is exactly what you are looking for or if you are looking for easy ways to remember them or not...but Adenosine I remember is used for cardioversions. You give it IVP quickly in one port of the IV line, however you have to be pushing in saline at the same time. It works very quickly. That's all I can remember at this moment. (sorry I just got off work..my third twelve...) I have the books pharm made incredibly easy and Straight A's in Pharm. I will look them up for you later. Let me know if you are looking for general info or for stuff like numonics (sp?) to help you remember them.
  4. by   EricJRN
    Amiodarone is serious stuff. Half-life of days to weeks. As far as ACLS is concerned, it can be used in place of lidocaine on some of the algorithms, but I'm not sure how strong the science is.

    Last I read, one of the big studies on amio vs lidocaine was finding that more amio patients had a pulse return and made it to ER alive, but that very few of those lived to discharge. I remember it being described as 'changing the location of death' - from being pronounced in the ER to dying in ICU. Anyone know if there is more encouraging data now?
  5. by   utahliz
    Amiodarone--long half-life, something life 41 days, also a serious side effect is pulmonary fibrosis. We use it most often for Afib.

    I understand adenosine causes 'pauses' before it causes rhythm conversion. Have never used it or seen it used (new grad, 8 months into SICU, taking ACLS soon).

    Propanolol is an old beta-blocker, the first I believe. Now used less frequently than newer beta blockers, except in extended release formulation. We use half-doses of beta blockers for pts. in or prone to Afib, even if not hypertensive.

    Integrilin is a glycoprotein II/IIA inhibitor (something like that) which inhibits coagulation by a different mechanism than heparin. Our MI pts are frequently on Integrilin gtts for 72 hrs concurrent with a heparin gtt. Bolus of integrilin followed by set infusion rate, heparin gtt titrated to PTT parameters.

    Natrecor=BNP analogue. For vasodilation in CHF pts.

    milrinone=Primacor. Vasodilator, seems to act more on pulmonary vasculature. Last week I had a pt. maxed on Primacor and Levophed--Levo to support BP, Primacor to keep PA pressures reasonable.

    I guess I've learned more than I thought the last several months!
  6. by   augigi
    What type of info are you after, exactly? I presume you could just look them up if you wanted drug info...?

    Integrilin (eptifibatide): anti-platelet aggregation drug (GP IIb/IIIa antagonist) which is great as it has a short half life and can be given IV for acute coronary syndrome or post PCI to reduce mortality or repeat MI. Also seen it used in some VAD patients who were platelet-hypersensitive according to TEG.
  7. by   UM Review RN
    Quote from vlsgrl
    Angie, not sure if this is exactly what you are looking for or if you are looking for easy ways to remember them or not...but Adenosine I remember is used for cardioversions. You give it IVP quickly in one port of the IV line, however you have to be pushing in saline at the same time. It works very quickly. That's all I can remember at this moment. (sorry I just got off work..my third twelve...) I have the books pharm made incredibly easy and Straight A's in Pharm. I will look them up for you later. Let me know if you are looking for general info or for stuff like numonics (sp?) to help you remember them.
    I'm just looking for little bits of wisdom. For instance, watch the IV site really carefully with any pressor and expect mottled extremities.

    Anything you've experienced or that stands out in your mind about a particular med.
  8. by   neneRN
    Amiodarone- never shake to mix and always give with a filter; watch for hypotension. Best to have running IVF running to prevent irritation to the vein.

    Adenosine- remember to tell the pt that they're going to feel really funny for a few seconds, but it will pass. They almost always c/o feeling like they're going to pass out, or have a panicky weird feeling. Pts almost always say, "I never want to get that medicine again", so it helps if they know to expect it. (also, remind yourself you may feel funny if your pts loses a heartbeat for a few seconds; it will come back.) Remember to slam it in, and don't give it into an IV lower than the AC; the half life is so short it may not make it to the heart- I like to have another nurse there to push the flush behind me so I'm not wasting a second. I also squeeze the IVF bag for a few seconds after the flush. Also, keep in mind that often, this will not convert your pt to a normal rhythym; it may only slow it for a few seconds, allowing you to see the underlying rhythym. i.e., pt may actually be in an A flutter or rapid Afib.

    Dopamine- watch IV site carefully- know that you use regitine for infiltration. Also watch for tachycardia, (esp for pts who already have a fast HR when you start it) may need to switch to another pressor if they get going too fast. Monitor urine output.

    Lidocaine- don't push too fast; you could cause seizures.
    Last edit by neneRN on Sep 18, '06
  9. by   UM Review RN
    Quote from neneRN
    Amiodarone- never shake to mix and always give with a filter; watch for hypotension. Best to have running IVF running to prevent irritation to the vein.

    Adenosine- remember to tell the pt that they're going to feel really funny for a few seconds, but it will pass. They almost always c/o feeling like they're going to pass out, or have a panicky weird feeling. Pts almost always say, "I never want to get that medicine again", so it helps if they know to expect it. (also, remind yourself you may feel funny if your pts loses a heartbeat for a few seconds; it will come back.) Remember to slam it in, and don't give it into an IV lower than the AC; the half life is so short it may not make it to the heart- I like to have another nurse there to push the flush behind me so I'm not wasting a second. I also squeeze the IVF bag for a few seconds after the flush. Also, keep in mind that often, this will not convert your pt to a normal rhythym; it may only slow it for a few seconds, allowing you to see the underlying rhythym. i.e., pt may actually be in an A flutter or rapid Afib.

    Dopamine- watch IV site carefully- know that you use regitine for infiltration. Also watch for tachycardia, (esp for pts who already have a fast HR when you start it) may need to switch to another pressor if they get going too fast. Monitor urine output.

    Lidocaine- don't push too fast; you could cause seizures.

    Exactly what I'm looking for. Thanks so much, and please feel free to share more!
  10. by   TiffyRN
    My cardiac experience is 4 years out of date but I really remember hating cordarone drips (amiodarone). I've never seen such consistent damage to veins. Like every 8 hrs or less having to resite iv's. Not because they infiltrated but because they developed phlebitis, red streaks going up the length of the vein, so no resiting higher up on the same vein. Hated hated hated cordarone drips but they worked great to convert A-fib!
  11. by   AlabamaBelle
    We've had several children in our PICU who are on Flolan drips. Flolan is dosed in nanograms. We double and triple check the dosage. It can be either IV or given through the ventilator circuit. The most important thing to know about Flolan is to be hyper-vigilant in watching the infusion - do not let the bag run dry - it could be potentially lethal. Used in patients with pulmonary hypertension.

    Cindy, RN
  12. by   floridaRNtoo
    Hi. I hope you are using your drug references. A nurse infused Corvert to a hypomagnesic patient. Patient developed Torsades. You can guess it wasn't pretty. She was so devestated she resigned. I am glad you are reaching out for information.
    I agree with those listing phlebitis problems with amiodarone drips. Check your IV site frequently.
  13. by   cardiacRN2006
    Quote from EricEnfermero
    Amiodarone is serious stuff. Half-life of days to weeks. As far as ACLS is concerned, it can be used in place of lidocaine on some of the algorithms, but I'm not sure how strong the science is.

    Last I read, one of the big studies on amio vs lidocaine was finding that more amio patients had a pulse return and made it to ER alive, but that very few of those lived to discharge. I remember it being described as 'changing the location of death' - from being pronounced in the ER to dying in ICU. Anyone know if there is more encouraging data now?
    I just took ACLS on Sat, and Amio was all over the place. It was strongly encouraged to use in place of Lidocaine. They didn't mention anything about survival rates vs other antiarrythmics...
  14. by   nuangel1
    Quote from neneRN
    Amiodarone- never shake to mix and always give with a filter; watch for hypotension. Best to have running IVF running to prevent irritation to the vein.

    Adenosine- remember to tell the pt that they're going to feel really funny for a few seconds, but it will pass. They almost always c/o feeling like they're going to pass out, or have a panicky weird feeling. Pts almost always say, "I never want to get that medicine again", so it helps if they know to expect it. (also, remind yourself you may feel funny if your pts loses a heartbeat for a few seconds; it will come back.) Remember to slam it in, and don't give it into an IV lower than the AC; the half life is so short it may not make it to the heart- I like to have another nurse there to push the flush behind me so I'm not wasting a second. I also squeeze the IVF bag for a few seconds after the flush. Also, keep in mind that often, this will not convert your pt to a normal rhythym; it may only slow it for a few seconds, allowing you to see the underlying rhythym. i.e., pt may actually be in an A flutter or rapid Afib.

    Dopamine- watch IV site carefully- know that you use regitine for infiltration. Also watch for tachycardia, (esp for pts who already have a fast HR when you start it) may need to switch to another pressor if they get going too fast. Monitor urine output.

    Lidocaine- don't push too fast; you could cause seizures.


    excellent post .

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