Cardiac Misc

Hormone, Vasopressor

• - Description: Vasopressin is a hormone with strong vasopressive and antidiuretic properties but that may
• precipitate angina and/or AMI.

• - Indications: To increase peripheral vascular resistance in arrest (CPR) or to control bleeding from esophageal
• varices.

• - Contraindications: Chronic nephritis with nitrogen retention, ischemic heart disease, PVCs, advanced arteriosclerosis, or 1st stage of labor.
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• - Precautions: Epilepsy, migraine, heart failure, angina, vascular disease, hepatic impairment, elderly, and children.
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• - Dosage/Route: Cardiac Arrest: 40 units IV. Esophageal varices: 0.2 to 0.4 units/min IV drip.

Anticoagulant

• - Description: Heparin is a rapid-onset anticoagulant, enhancing the effects of
• antithrombin III and blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin.

- Indications: To prevent thrombus formation in acute MI.

- Contraindications: Hypersensitivity; active bleeding or bleeding tendencies; recent eye, brain, or spinal surgery; shock.

- Precautions: Alcoholism, elderly, allergies, indwelling catheters, elderly, menstruation, pregnancy, or cerebral embolism.

- Dosage/Route: 5,000 units IV, then 20,000 to 40,000 units over 24 hours.

Thrombolytic

• - Description: Recombinant DNA–derived form of human tPA promotes thrombolysis by
• forming plasmin. Plasmin, in turn, degrades fibrin and fibrinogen and, ultimately, the clot.

- Indications: To thrombolyse in acute myocardial infarction, acute ischemic stroke, and pulmonary embolism.

• - Contraindications: Active internal bleeding, suspected aortic dissection, traumatic CPR, recent hemmorhagic
• stroke (6 months), intracranial or intraspinal surgery or trauma (2 month), pregnancy, uncontrolled hypertension, or hypersensitivity to thrombolytics.

- Precautions: Recent major surgery, cerebral vascular disease, recent GI or GU bleeding, recent trauma, hypertension, patient > 75 years, current oral anticoagulants, or hemorrhagic ophthalmic conditions.

Sympathomimetic Agent

- Description: Norepinephrine is a naturally occurring catecholamine and causes vasoconstriction, cardiac stimulation, and increased blood pressure ,myocardial oxygen demand, and coronary blood flow.

- Indications: Refractory hypotension and neurogenic shock.

- Contraindications: Hypotension due to uncorrected hypovolemia.

- Precautions: Hypertension, severe heart disease, elderly, MAO inhibitor therapy, Monitor blood pressure frequently and infuse the drug through the largest vein available as it may cause tissue necrosis.

• - Dosage/Route: 0.5 to 30 mcg/min IV, titrated to BP.
• Pedi: 0.01 mcg/kg/min (rarely used).

Vasodilator/Nitrate

- Description:  relaxes blood vessels, increasing the blood and oxygen supply to the heart.

- Indications:  Nitroglycerin infusions are used to help relieve the pain associated with angina that does not respond to oral (by mouth) treatment; to control blood pressure; and to help treat congestive heart failure.

- Contraindications: hypotension, uncorrected hypovolemia, increased intracranial pressure, constrictive pericarditis and pericardial tamponade

- Precautions/side effects: headache, severe hypotension, reflex tachycardia

- Dosage: 0.2 - 1.5 mcg/kg/minute

Calcium Channel Blocker

• - Description: Verapamil is a calcium channel blocker that slows AV conduction, suppresses reentry dysrhythmias
• such as PSVT, and slows ventricular responses to atrial tachydysrhythmias. Verapamil also dilates coronary arteries and reduces myocardial oxygen demand.

- Indications: PSVT refractory to adenosine, atrial flutter, and atrial fibrillation with rapid ventricular response.

- Contraindications: Severe hypotension, cardiogenic shock, 2nd- or 3rd-degree heart block, CHF, sinus node disease, and accessory AV pathways, WPW syndrome. It should not be administered to persons taking beta blockers.

- Precautions: MI with coronary artery occlusion, or myocardial stenosis.

- Dosage/Route: 2.5 to 5 mg IV bolus over 2 to 3 min, then 5 to 10 mg after 15 to 30 min to a max of 30 mg in 30 min