Any Pearls of Wisdom regarding the following cardiac meds?

nuangel1, BSN, RN · Sep 18, 2006

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 .

nuangel1, BSN, RN · Sep 18, 2006

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

never heard of this med .i'll lokk it up.

nuangel1, BSN, RN · Sep 18, 2006

My cardiac experience is 4 years out of date but I really remember hating cordarone drips (amiodarone).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!

thats good to know cuz in my experience er/icu i have never seen that when i used amiodarone.

Indy, LPN, LVN · Sep 19, 2006

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

1. Well everyone knows amiodarone, so I guess it's obvious. The thing that I always remember is that Amio and Lido use the same IV protocol at my facility; and amio PO stays in your system for 6 months so PFT's may be good to have on smokers before putting them on it.

...I'm gonna skip to what I've had experience with.

3. Adenosine: I have never used it, we don't use it on the floor here unless in a code, and I'm not on the code team. So basically I remember it can work to slow the heart down but be careful 'cause it has a good tendency to just stop it too.

7. Dopamine is a booger for me lately. I saw a lot of patients stable on it when I first started to work, but the few people I've tried to titrate on it, didn't do so well. Our protocol says it can be titrated in either 1/2 mcg or one mcg at a time and I've learned that 1/2 mcg is definitely the way to go, and it may take 10-20 minutes for a side effect to be felt - so going the minimum of 10 minutes between titrations is kinda dumb if you're doing 1 mcg when you raise the dose. I really wish there was a cliff notes or "dummy's guide" to this drug to go with the protocol, 'cause it tells you what you can do, not what you should do. I keep in mind the order dopamine works on the body's receptors to remember when it's doing what you want it to do: pee, raise blood pressure, wheeze. Pee is the dopamine receptors, that's good; raise blood pressure is what we normally want when it starts working on other receptors, and wheeze/chest pain/sob is when it's gone too far and grabbing all the receptors, need to back off. It is so difficult to back off a dose and wait that 10-20 minutes to see if chest pain/wheeze goes away before declaring time to go to ICU/call the doctor! Especially if their blood pressure's yucky to begin with. I really, really don't like this drug.

8. Integrillin- I've only seen one IV site hematoma from this drug, and it was manageable 'cause it was caught quickly. I don't let people on integrillin get up and walk around; if they're lucky I get 'em a bedside commode.

12. Natrecor- not too much experience with, it seems less popular in my facility than Inocor but uses the same protocol. Since it tends to make people pee buckets, daily weights are needed to adjust the dose.

15. Reopro- Mostly same precautions as Integrillin... for bleeding as well as because the recipients of both are probably in the middle of an MI or post plasty and were in the middle of an MI. They're still high risk for both falling out unexpectedly and big problems if they do. I think reopro runs 12 hours where the integrillin runs 18 hours.

Medic2RN, BSN, RN, EMT-P · Sep 19, 2006

I have something to add to neneRN's good Adenosine advice. I have used it several times in the field and it is a scary medication to give. Watch the monitor immediately after administration and you will see an asystolic rhythm until the slower (hopefully) rhythm appears. In my protocols, if the patient remains asystolic then we give Aminophylline to counteract and abolish the affect of the adenosine. Yes, most patients do not like this drug.