CARDCIAC MEDS (fall 2026)

CARDIAC MEDS (fall 2026)

ET TUBE MEDS (NAVEL)

• Naloxone

• Atropine

• Vasopressin/Valium

• Epinephrine

• Lidocaine

— 2-2.5x more IV/IO dose (twice as much dose)

— total volume of 10mL in adults

— flush with 5mL of NS + 5 manual vent breaths → helps w/ absorption

EPINEPHRINE

• uses: pulseless v tach, v fib, asystole or PEA → first line for CODES

— NEVER PUSH EPI ON PATIENT W/ PULSE

• start compression (2 min cycles) → give EPI every 3-5 mins → reassess rhythm

— code dose → IV/IO: 1mg every 3-5 mins (USE FILTERED NEEDLE)

— concentration: 1mg/10mL

anaphylaxis dose → 0.3 - 0.5mg IM every 3 mins

AMIODARONE

• for ARRHYTHMIAS

• uses: a fib, v fib, v tach w/ pulse, pulseless v tach, SVT, stable ventricular arrhythmias

— dose: (1st dose) 300mg bolus → (2nd dose) 150mg bolus

— INTERACTIONS → digoxin, warfarin, statin meds, iodine (KNOW)

• amiodarone digs a hole, start a war, works stat * eats iodine

— ADRs → BRADYCARDIA & HYPOTENSION

• may cause new onset arrhythmias

• “blue man syndrome” → bluish skin discoloration, skin rash, tissue necrosis

• STORY → mi amor (blue man) had arrhythmias w/ all his hoes & gained 300 lbs, then lost 150 lbs

— nursing implications:

• use in-line 2 MICRO FILTER tubing → helps prevent phlebitis (check IV)

• if possible, use IV via central line → amiodarone can irritate vein

• continuous ECG, BP, HR monitoring → prolonged QT, hypotension, bradycardia

LIDOCAINE

• uses: ventricular arrhythmias → v tach + v fib

• dose → IV: 1-1.5mg/kg & repeat 0.5-0.75mg/kg every 5-10mins (max 3mg/kg)

— rapid onset of 45-90secs & half life of 8-15mins

— side effects: HYPOTENSION, BRADYCARDIA, ARRHYTHMIAS

• O2: respiratory depression, confusion, dizziness, drowsiness, LOC, nervousness, numbness, twitching, seizures

• allergy: nethemoglobinemia

— CAUTION: older patients, patients w/ hepatic or renal impairment

— contraindications: WPW syndrome, strokes-adam syndrome, heart blocks

— nursing implications:

• continue ECG, BP, HR, SpO2 monitoring

• discontinue med if VS decline or toxicity symptoms arise

— numbness, lightheadiness, visual changes, muscle twitching, coma, resp arrest

— administer rapidly during cardiac arrest

— if given via ETT → dilute w/ 5mL + flush + give 5 manual ventilations

— SOME lidocaine has epinephrine → CAUTION SELECTING

ADENOSINE

• for arrhythmias

• uses: SVT w/ pulse, TACHYARRHYTHMIAS

• EXTREME SHORT HALF LIFE → <10secs

— RAPID IV PUSH → left AC is more beneficial

• dose: IV (1st dose) 6mg over 1-2 secs → (2nd) 12mg → (3rd) 12-18mg

— if given via central line: reduce to 3mg → 6mg → 9mg (SMALLER dose)

— followed by a 20mL NS flush

• effects: brief period of ASYSTOLE & attempt to get back to normal sinus

• ADRs: arrhythmias, dyspnea, chest pressure, nausea, cardiac arrest, hypotension

— nursing implications:

• defibrillator + ECG + pads → before giving this med

• 12 lead EKG continuous reading → since this med stops the heart quick

• 3 way stopcock

• peripheral IV → give in biggest IV you can get closest to the heart (AC is best)

ATROPINE

• uses: SYMPTOMATIC bradycardia ONLY & symptomatic AV block

• dose: IV/IO 1mg every 3-5mins until symptoms resolve (max 3mg)

— can give via ETT 2-2.5mg every 3-5mins

— anticholinergic side effects: TACHYCARDIA

• acute glaucoma, pyloric obstruction, complete urinary retentions in pts w/ BPH, formation of mucous plugs, dry mouth, constipation, blurry vision

• can also cause dysrrhythmias including asystole

• nursing implications:

— continuous ECG & BP monitoring

— RAPID INJECTION (slow admin cause paradoxical bradycardia) — drop in systollic

DILTIAZEM

• uses: a fib + a flutter (help with RVR), paroxysmal SVT, HTN, angina

— it slows down the impulses in the heart

• dose: IV 0.25mg/kg IV bolus over 2mins → then 5-15mg/hr

— PO → 120-360mg daily for maintenance

— side effects: PERIPHERAL EDEMA, bradycardia, dysrhythmias, hypotension, dizziness, lightheadedness, fatigue

— nursing implications:

• continuous ECG & BP monitoring

• IV → use 60gtts, titrated based on patient’s response (5mg/hr increments → max 15mg/hr)

• ASSESS FOR EDEMA

• patient teaching → AVOID grapefruit

HEPARIN

• an anticoagulant

• antidote → PROTAMINE SULFATE

• unfractionated heparin & LMWH → need consent form

• uses:

— VTE (venous thrombosis)

— treatment & prophylaxis, ACS, ischemic heart disease, valvular issues, peripheral arterial occlusion, a fib, ECMO/line patency, hemodialysis

— only anticoagulant safe to use during pregnancy or breastfeeding

• given IV & SUBQ in lower concentrations for both

• dose: weight based continuous infusion + titrate based on patient response

• side effects: MAJOR BLEEDING & FALL RISK

— educate on bleeding → bruise could indicate superficial bleeding

— thrombocytopenia (HIT) → immune decrease platelets often paired w/ thrombosis

→ monitor platelets for 30%-60% decrease (forms clots & leads to ischemia)

— chills, hyperkalemia, osteoporosis (w/ long term use)

• contraindications:

— do NOT give is they have ACTIVE BLEEDING, had recent trauma in the last 3 months, history of intracranial hemorrhage, ischemic stroke, GI ulcers, coagulapathies, bleeding disorder

• nursing implications:

— heparin drips should be WEIGHT BASED protocol (accurate weight is important)

— monitor aPTT or anti-xa level every 6hrs & titrate based on response

→ aPTT: usually 25-35secs — goal: for value to be 1.5-2.5 times the baseline aPTT for therapeutic affects

→ anti-xa titrate target usually 0.3-0.5 unit/mL

— MONITOR LABS: H/H, platelets, PT, potassium

— HIGH ALERT MED

— assess skin, circulation, sensation → be on the lookout for thrombocytopenia to prevent more clots from forming

NITRATES/NITROGLYCERIN

• causes VASODILATOR

• uses: angina, STEMI, acute coronary syndrome, arterial HTN, HR, anal fissures

• NITROGLYCERIN → sublingual dose 0.4mg (every 5mins 3x times for angina)

• side effects: most due to vasodilation

— HEADACHES, lightheadedness, dizziness, flushing, syncope, N/V, orthostatic hypotension, reflex tachycardia (d/t drop in BP, compensatory mechanism)

• contraindications:

— use of PDE inhibitors → causes extra vasodilation (tadalafil, sildenafil, vardenafil)

— active or recent BLEEDING

— HYPOVOLEMIA → make sure to correct it before

— hypertrophic cardiomyopathy, increased intracranial pressure, cerebral hemorrhage

• nursing implications:

— stored in BLACK glass because light sensitive

— monitor BP (stop & hold if <90), HR, SpO2 → due to vasodilation

• continuous ECG monitoring

• IV tubing → 60gtts duo vent spike — IV titrating protocols

NOREPINEPHRINE

• vasoconstrictor (elevates BP + HR)

• antidote: PHENTOLAMINE

• uses: severe hypotension → usually when no responsive to fluids & SHOCK

• ADRs:

— cardiac arrhythmias, peripheral ischemia, gangrene, rebound hypotension after discontinuing, cause decrease sensitivity to insulin, extravasation can cause tissue necrosis (give phentolamine SUBQ)

• contraindications:

— HYPOVOLEMIA → must be corrected before to avoid further decrease in blood flow, ischemia & tissue hypoxia from vasoconstriction

— known/active thrombosis → may cause ischemia

• nursing implications:

— used in central line

— continuous ECG, BP, HR, SpO2 monitoring

— monitor & titrate based on CVP, PEP, CO, CI — goal: MAP >65 & SBP >90

— frequent IV, heart, lungs, circulation, sensation, skin, LOC check

— look for s/sx of less perfusion (check TOES for circulation & STOP med if there is NO circulation)

DOPAMINE

• vasoconstrictor (elevates HR + BP + contractility + cardiac output)

• uses: for bradycardia, hypotension & shock

• ADRs: STOP if its causing too many issues

— ventricular arrhythmias, a fib, ectopic beats

— tachycardia, widened QRS complex

— angina, palpitations

— extravasation → cause necrosis, sloughing, gangrene

• contraindications:

— TACHYARRHYTHMIAS, v fib, pheochromocytoma, HYPOVOLEMIA

• nursing implications:

— central line

— continuous ECG & hemodynamic status monitoring

— frequent IV, heart, lungs, circulation, sensations, skin, LOC checks

DOBUTAMINE

• vasoconstrictor (elevates HR + BP + contractility + cardiac output)

• uses: for acute decompensated HF, inotropic support, shock (2nd line), stress test

• ADRs: angina, tachycardia, HTN, ventricular arrhythmia, PVCs, N/V, headache, dyspnea, extravasation

• contraindications:

— SULFA ALLERGY

— contraindicated: if have hypertrophic cardiomyopathy & taking MAOIs

• nursing interventions: monitor for tachycardia, arrhythmias, BP, myocardial ischemia

— central line

— continuous ECG, BP, SpO2 monitoring

— hemodynamic status: MAP, CVP, CO, CI

— frequent IV, heart, lungs, circulation, sensations, skin, LOC checks

ISOPROTERENOL

— ISO MAKES THE HEART GO

• increases HR + contractility

• peripheral vasodilation → relaxation of bronchial, GI, uterine smooth muscle

• uses: bradydysrhythmias, heart blocks (during cardiac arrest), CHF, shock

• ADRs: TACHYARRHYTHMIAS

— headache, dizziness, flushing, fatigue, nervousness, diaphoresis, blurred vision

• contraindications:

— SULFA ALLERGY

— tachy or ventricular dysrhythmias → can worsen them

— angina → increases cardiac workload

— cardiac glycoside toxicity (DIGOXIN) → DONT GIVE