The starting dose of Nipride is 0. Nitroglycerin is a nitrate and a strong vasodilator, dilating coronary arteries and decreasing preload.
It is classified as an anti-anginal and antihypertensive drug, as well as a vasodilator. It is used in acute angina, hypertensive crisis, pulmonary edema, congestive heart failure, and myocardial infarction. It is the drug of choice for cocaine-induced MI. It is always prepared in a glass bottle with vented tubing. Caution must be used in the presence of oral nitrates, inferior wall MI and sexual performance-enhancing drugs as life-threatening hypotension can ensue.
It can cause severe bradycardia and hypotension. His Troponin is elevated, and he is positive for cocaine on a drug screen. What is the drug of choice for a cocaine-induced myocardial infarction? Nitroglycerin is a nitrate and a strong vasodilator, dilating coronary arteries, and decreasing preload.
Nitroglycerin is used for myocardial infarction and angina. Nitroglycerin administration is used cautiously in the presence of oral nitrates, inferior wall MI and sexual performance-enhancing drugs as life-threatening hypotension can ensue. Nitroglycerin can adhere to plastic.
Nitroglycerin must be hung in a glass bottle with vented tubing. He denies the use of oral nitrates. His troponin is severely elevated. Diltiazem Cardizem is a calcium channel blocker and anti-arrhythmic for heart rate control during atrial fibrillation, atrial flutter, multifocal atrial tachycardia, and atrial fibrillation with a rapid ventricular response.
Do not use for wide complex QRS tachycardias. The antidote for diltiazem is calcium. It is mixed as a drip. An initial bolus, for acute rate control, of 5mgmg 0. Titration is done until a physiologically appropriate heart rate is reached. Blood pressure must be monitored every five minutes as diltiazem can rapidly decrease blood pressure. Start low and go slow with diltiazem; most patients respond well to 5mg IV push.
Atrial fibrillation with rapid ventricular response at a rate of will need to be treated with an antiarrhythmic. Which antiarrhythmic is the best choice for this patient? The drug of choice for atrial fibrillation is Diltiazem.
It is a calcium channel blocker. The usual initial loading dose is? An initial bolus of diltiazem for atrial fibrillation for acute rate control, of 5mgmg 0. Diltiazem is an anti-arrhythmic used for rate control in atrial fibrillation. Its mechanism of action is the slowing of calcium in vascular and cardiac muscle tissue. What is the antidote for diltiazem? The anti-dote for diltiazem is calcium. The patient heart rate responds to the calcium channel blocker, and the heart rate is now The physician orders a diltiazem drip to be started.
The drip has been infusing for 15 minutes. How is the drip titrated? Amiodarone is for the management of life-threatening recurrent VF or hemodynamically unstable VT and cardiac arrest.
It is an anti-arrhythmic. The bolus may be repeated if needed. It has a day half-life. It can cause hypotension, bradycardia, proarrhythmic events, peripheral neuropathy, thyroid dysfunction, thyroid storm, nausea, vomiting, and pulmonary toxicity.
Administer through a central venous catheter with an in-line filter. Amiodarone is associated with a high incidence of extravasation. The ambulance crew started an IV and Normal Saline. The patient has an AICD in place, but it is not functional. The doctor wants to start an antiarrhythmic. Which medication is the best choice? A continuous drip infusion follows an Amiodarone mg bolus. The total time is 24 hours.
Many vasoactive medications have serious side effects. Which medication puts the patient at risk for a thyroid storm? It can cause hypotension, bradycardia, ectopy and arrhythmic events, peripheral neuropathy, thyroid dysfunction, thyroid storm, nausea, vomiting, and pulmonary toxicity.
A patient on an Amiodarone drip is exhibiting signs and symptoms of thyroid dysfunction. The Amiodarone drip is discontinued. The first dose of Cordarone is due in 12 hours. What is the next action for the nurse? Cordarone is Amiodarone and will cause a thyroid storm. The Amiodarone infusion has a long half-life of 53 days.
Another anti-arrhythmic should be ordered. Use caution in the elderly as completed heart block can occur. It can also cause confusion, hypotension, lightheadedness, diplopia, seizures, and tinnitus. Lidocaine Xylocaine is a ventricular anti-arrhythmic medication.
For ventricular arrhythmias, a It suppresses ventricular arrhythmia by decreasing automaticity. The onset is seconds. Use caution in the elderly as a complete heart block can occur. It is contraindicated in a complete or 2nd degree AV block, and the dose needs to be decreased for those patients with congestive heart failure or hepatic disease.
The bedside alarm is indicating a change in heart rate to The patient is lethargic but arousable to noxious stimuli. What is the next action? Esmolol Brevibloc is indicated for sinus tachycardia to control heart rate and ventricular response, supraventricular tachycardia, and hypertension.
It is a selective beta-blocking agent and antiarrhythmic. Esmolol will decrease heart, cardiac output, and SVR, which will decrease the cardiac oxygen demand. It is imperative that dosing is accurate as the drug acts rapidly. The half-life is 9 minutes. The drug may or may not be given as a bolus secondary to its very quick onset. Mix 2. Do not stop the medication abruptly.
Esmolol Brevibloc is indicated for sinus tachycardia, control heart and ventricular response, supraventricular tachycardia, and hypertension. She is 36 weeks pregnant. She is in no pain and is not in labor. IV access is established, and an ECG is completed. The doctor wants to start an anti-arrhythmic. What is the best choice for this patient? Amiodarone is contraindicated in pregnant and lactating patients.
Atropine and Nitroglycerin are not anti-arrhythmic medications. She has been on the drip for 36 hours. She has NKA, and her weight is 90kg. Her vital signs have been within parameters for 12 hours. The nest action of the nurse is? Esmolol Brevibloc is indicated for sinus tachycardia, for heart rate control and ventricular response, supraventricular tachycardia, and hypertension. Her glucose is Twenty-four hours later, the same patient remains in the ICU. The oxygen saturation is She is alert and oriented.
She is in no distress. The drip cannot be stopped abruptly. The patient has vital signs on the lowest end of the parameters, so titration is not indicated per the order. The vital signs are continuous. The physician needs to be called and determine if the parameters should be changed for the vital signs and the drip titration. Adenosine is used to treat paroxysmal supraventricular tachycardia and Wolff- Parkinson-White Syndrome.
This type of arrhythmia is deadly. Initially, an adenosine 6 mg rapid bolus over seconds with a 10ml normal saline flush immediately after the intravenous push is administered for PSVT. If not effective within minutes, 12 mg may be given again; a third 12 mg bolus if needed for persistent SVT; maximum single dose: 12 mg. Adenosine is an extremely strong vasodilator in most vascular beds. Adenosine is thought to work through the activation of purine receptors.
There is evidence to support both inhibition of the slow inward calcium current reducing calcium uptake, and activation of adenylate cyclase. Adenosine modulates sympathetic neurotransmission lessening vascular tone — adenosine blocks faulty circuitry in the heart, which causes irregular heart rhythm. Adenosine slows conduction time through the A-V node and interrupts the reentry pathways through the A-V node. A transient episode of asystole will occur after the administration of adenosine.
This is usually self-limited, secondary to the extremely short half-life of adenosine. The patient usually returns to their normal underlying rhythm after the administration of adenosine. Patients frequently complain of chest pain and shortness of breath after the administration of adenosine.
J Am Coll Cardiol. Although dosages may vary based on physician orders, protocols and age, a standard initial dose is 0. Treatment of hemodynamically unstable patients in narrow QRS complex AF with RVR requires synchronized cardioversion at J initially, and should not be delayed for administration of an anti-arrhythmic agent.
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Please review our refund policy. May be administered with meals if GI irritation becomes a problem. Advise patient to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually.
Instruct patient on concurrent nitrate or beta-blocker therapy to continue taking both medications as directed and to use SL nitroglycerin as needed for anginal attacks. Encourage patient to comply with other interventions for hypertension weight reduction, low-sodium diet, smoking cessation, moderation of alcohol consumption, regular exercise, and stress management.
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