1.Cardiac Drug

2. . 3. 4 1 30 2556 ) 4. ( ) High Alert Drug 5. The National Co-ordinating Council for Medication Error Reporting and Prevention, USA 6. A < 2 ( 1) root cause analysis 7. 50% 34% 8% 8% 1-2 2-3 3-4 > 4 A 2555 8. J Nurs Manag Saintsing D Novice Remington College of Nursing, Orlando, FL, USA 2011 Apr;19(3):354-9. 9. Eric Camir, MD, Eric Moyen, MD, Henry Thomas Stelfox, MD PhD CMAJ April 28, 2009 vol. 180 no. 9 35 Cardiovascular 25 Sedative Analgesic 23 Anticoagulant 17 Anti-infective 10. 2 Eric Camir, Eric Moyen, Henry Thomas Stelfox, MD PhD 35% 25% 17% 23% cardiovascular sedative anti-infective anticoagulant 11. Joint Commission on Accreditation of Health Care Organization (JCAHO) (Root Cause Analysis, RCA) (Prescribing and TranscribingError) (Dispensing Error) (Administration Error) 12. National Co-ordinating Council of Medication Error Reporting and Prevention (NCC MERP) ( ) 13. : Category A : Category B Category C Category D : Category E Category F 14. 3 A 15. High Alert Drugs) Novice nurse < 2 , , . 16. Cardiac Drug 2. Cardiac Drug < 2 < 2 post test > 80% 17. < 2 20 5 18. Cardiac drug 10 Adrenaline , Atropine, Dobutrex , Dopamin , Levophed , NTG Adenosine , Cordarone , Digoxin KCL electrolyte , , 19. Cardiac drug PowerPoint Computer Pre-Post test 20 < 2 20 1 - 20. 2556 2556 1 . . -8 . . 9 . . -16 . . 17 . . -24 . . 25 . . -31 . . 1 . . -7 . . 8 . . -14 . . 15 . . -21 . . 22 . . -28 . . . . 1. 2. 3. 4. PowerPoint 5. Pre-Post test 6. 7. 21. < 2 Cardiac Drug Cardiac Drug 22. HAD Cardiac Drug Adrenaline Atropine Dobutrex Dopamin Levophed NTG Adenosine Cordarone Digoxin KCL electrolyte 23. Adrenaline Adrenaline injection 1 mg/mL 1:1000 (1 mL) (onset) (peak) (duration) Adrenaline injection 1 mg/mL 1:1000 (1 mL) SC: 3-10 IM: 3-10 IV: SC: 20 IM: 20 IV: 2-5 SC: 20-30 IM: 20-30 IV: 5-10 (Indication) 1. Cardiopulmonary resuscitation (CPR) 2. Anaphylaxis 3. Hypotension 24. Adrenaline (peripheral vascular disease) 25. Adrenaline Double check 24 25 OC 26. Adrenaline 27. Adrenaline Double check : D5W, D5S, NSS, LRS : 24 Double check IV drip Infusion pump 28. Adrenaline (Monitoring) CPR Vital signs ( Heart rate, BP) Anaphylaxis Vital signs ( Heart rate, BP) 10 30 Hypotension IV drip Vital signs ( Heart rate, BP) BP>160/90 mmHg HR > 120 / BP > 120/80 mmHg HR > 180 / IV site 1 29. Adrenaline intravenous infusion infusion pump cardiovascular parameter rebound hypotension tissue necrosis BP>160/90 mmHg HR > 120 / 30. Atropine Sulphate injection Atropine sulphate 0.6 mg/ml (1 ml/ampule) organophosphates carbamates muscarinic receptor digitalis beta blockers cholinergic parasympathetic competitive inhibitor acetylcholine acetylcholine muscarinic receptor 31. Atropine Sulphate injection organophosphates carbamates 1-5 mg 0.05 mg/kg 5 10 atropine atropine 0.5-1 mg 0.01-0.05 mg/kg 0.5 mg 3 mg organophosphates - 1 mg 3- 5 3 mg - 0.5-1 mg 3-5 32. Atropine Sulphate injection atropine urinary sphincter angina pectoris atropine 0.5 mg 33. Atropine Sulphate injection For child : IV push : 0.02 mg/kg minimum dose 0.1 mg , maximum dose 0.5 mg ET tube : 0.03 mg/kg - mg NSS 10 ml : myasthenia gravis , narrow angle glaucoma : : : Adrenaline , Ampicillin, Chloramphenicol, Heparin, Warfarin : IV push ; mg Monitor : Heart rate , BP, Mental status Critical point : Heart rate > 60/ min 34. Dobutamine (onset) (peak) (duration) Dobutamine injection 250 mg/20 mL (12.5 mg/mL) 1-2 10-20 Dobutamine injection 250 mg/20 mL (12.5 mg/mL) (Indication) hypovolemia idiopathic hypertrophic subaortic stenosis myocardial 35. Dobutamine Double check Dopamine 36. Dobutamine Double check DoPAmine Dilution mg/mL 2 mg/mL 2 :1 cardiac output 2.5 20 / / (MAX dose ) 40 / / IV 37. Dobutamine Double check Dopamine D5W , D5S/2 , D5S, D10W, NSS , LRS (Maximum concentration) : 5mg/1mL Dobutamine Sodium bicarbonate Dobutamine sodium bisulfite ethanol : 24 oxidation Double check 38. Dobutamine (Monitoring) BP, HR 1 BP>160/90 mmHg HR > 120 / BP > 120/80 mmHg HR > 180 / infusion pump 1 IV site 1 HR BP 39. Dopamine (onset) (peak) (duration) Dopmin injection 200 mg/ 5mL (40 mg/mL) 1-2 < 5 < 10 Inopin (Dopamine) injection 250 mg/ 10mL (25 mg/mL) 1-2 < 5 < 10 1. Dopmin injection 200 mg/ 5mL (40 mg/mL) 2. Inopin (Dopamine) injection 250 mg/ 10mL (25 mg/m 40. Dopamine (Indication) 1. Low cardiac output 2. Hypotension 3. Poor perfusion of vital organs 41. Dopamine 1 20 mcg/kg/min 50 mcg/kg/min 1 5 mcg/kg/min 20 mcg/kg/min (maximum: 50 mcg/kg/min) 2-5 mcg/kg/min renal blood flow, urine output 5-15 mcg/kg/min cardiac output > 20 mcg/kg/min total peripheral resistance, pulmonary pressure ( Maximum dose : 50 mg/kg/min ) - 1 4 mcg/kg/min 10 30 - 20-30 mcg/kg/min adrenaline norepinephrine - 50 mcg/kg/min urine output urine flow 42. Dopamine Double check DoBUtamine D5W,D5S, NSS, D5S/2 Sodium bicarbonate Dopamine (Maximum concentration) : 3.2 mg/mL 24 Double check (central vein) central line peripheral line Infusion pump (Max rate) 20 mcg/Kg/min IV 43. Dopamine (Monitoring) BP, HR 1 BP>160/90 mmHg HR > 120 / BP > 120/80 mmHg HR > 180 / infusion pump 1 IV site 1 HR BP IV site 44. Norepinephrine (Levophed) continuous I.V. infusion 0.05 0.1 mcg/kg/min ; maximum dose 2 mcg/kg/min 0.5 1.0 mcg/min ; 8 30 mcg/min Hypotension, shock and cardiopulmonary resuscitation 8 12 mcg/min (maximum dose : 30 mcg/min) 0.1 mcg/kg/min 2 mcg/kg/min Upper GI Hemorrhage 8 mg NSS 250 mL intraperitoneal 8 mg NSS 100 mL nasogastric tube 68 2 Levophed injection Norepinephrine base 1 mg/mL (4 mL) 45. Norepinephrine (Levophed) D5W D5S 100 mL NSS oxidation I.V. sodium bicarbonate 24 46. Norepinephrine (Levophed) 1. infusion pump 2. cardiovascular parameter 3. antecubital vein femoral catheter tie-in MONITORING 2 5 47. Nitroglycerin injection Nitroglycerin inj. mg/ mL Nitroglycerin inj. mg/ mL angina) sublingual nitroglycerin beta blockers Angina acute Angina pectoris complication 48. Nitroglycerin injection 1. 90 mm Hg 30 mm 50 100 2. RV infarction inferior wall MI 3. phosphodiesterase inhibitor viagra 24 49. Nitroglycerin injection STEMI - LV failure - - - - recurrent ischemia 24 48 50. Nitroglycerin injection NTG 1amp 50 mg / 10 cc( 1cc = 5 mg ) NTG 1:1 = NTG 20 cc (100 mg) + 5 DW 100 cc NTG 1:2 = NTG 10 cc (50 mg) + 5 DW 100 cc NTG 1:5 = NTG 4 cc (20 mg) + 5 DW 100 cc NTG 1:10 = NTG 2 cc (10 mg) + 5 DW 100 cc Sodium chloride 48 7 5 mcg/min infusion pump 5 mcg/min 3 - 5 20 mcg/min 20 mcg/min 10 mcg/min 3 - 5 200 mcg/min Methemoglobinemia 51. Nitroglycerin injection 90 mm Hg 30 mm .Hg 50 100 RV infarction inferior wall MI 52. Nitroglycerin injection 1. IV Infusion 2. Dilution 5% Dextrose Inj. B.P. 0.9% NSS 3. , 4. , 5. Monitor Blood pressure, Heart rate, PCWP Nitroglycerin Injection 53. Adenosine Adenosine drug of choice paroxysmal supraventricular tachycardia(SVT) sinus rhythm SVT reentry SVT cardioversion ) Adenosine K channel cAMP-induced Ca influx adenosine arrhythmia atrial flutter, atrial fibrillation, atrial ventricular tachycardia Drug interaction adenosine receptor blocker theophylline, caffeine adenosine uptake inhibitor dipyridamole Adenosine 3 mg / ml , 2 ml vial (Adenocor ) [ 6 mg / 2 ml vial ] 54. Adenosine 1. IV heart 2. 3-way syringe 20 ml saline flush 3. monitor EKG 4. 6 mg 1-3 12 mg 12 55. Adenosine Drug interaction - theophylline, caffeine - dipyridamole persantin,posanin) On EKG monitor 56. Cordarone injection Amiodarone injection 150mg/3ml Ventricular arrhythmias life-threatening recurrent ventricular fibrillation(VF) hemodynamically unstable ventricular tachycardia (VT) 57. Cordarone injection : 5% dextrose IV infusion 20 - Intravenous injection Hypersensitivity to amiodarone, iodine, severe sinus-node dysfunction, bradycardia cause syncope 58. Cordarone injection Children: Arrhythmias: Loading dose 5 mg/kg over 30 min, Maintenance dose 2-20 mg/kg/day by continuous infusion Adult: Breakthrough VF or VT : 150 mg supplemental doses in 100 ml D5W over 10 min Pulseless VF or VT : IV push: initial 300 mg in 20-30 ml NSS or D5W, supplemental dose of 150 mg followed by infusion of 1 mg/min for 6 hr then 0.5 mg/min (Max daily dose 2.1 gm) guideline 160/90 mmHg HR > 120 / 75. Pre-test Post-test 3. DOBUTAMINE A. IV PUSH B. SODIUM BICARBONATE C. hypovolemia D. D : dobutamine Sodium bicarbonate 76. Pre-test Post-test Dobutamin A B hypovolemia C Dilution Dobutamin 2 : 1 D 24 oxidation C Dilution mg/mL 77. Pre-test Post-test DOPAMINE (2: 1) IV DRIP 10 CC/ hr drip cc 5% DW 100 ml ( DOPAMINE 1 amp 250 MG / 10 ml) A. 4 CC B. 8 CC C. 10 CC D. 12 CC B : DOPAMINE (2: 1) IV DRIP 10 CC/ hr : DOPAMINE 2 mg : 5% DW 1 ml 5% DW 100 ml 2 mg X 100 ml / 1 ml = 200 mg DOPAMINE 1 amp 250 MG / 10 ml mg = 8 ml 78. Pre-test Post-test DOPAMINE A. (central vein) central line peripheral line B. drip BP C. drip D. IV site B : rate of infusion 79. Pre-test Post-test oxidation Levophed A. NSS B. 5% D W C. 5% D NSS D. Sterile water A : D5W D5S 100 ml NSS oxidation 80. Pre-test Post-test 8. Levophed A. infusion pump B. BP C. D. D : infusion pump cardiovascular parameter 81. Pre-test Post-test 9. Atropine A. B. Bradycardia C. D. B : Atropine parasympathetic competitive inhibitor acetylcholine acetylcholine muscarinic receptor : Atropine 82. Pre-test Post-test Atropine A. Atropine 1 mg 3-5 3 mg B. Atropine Antidote Carbamate, Organophosphate C. IV D. myasthenia gravis) C : Atropine Sinus bradycardia) - mg IV - mg mg/kg Endotracheal tube - mg sterile water NSS 10 narrow-angle glaucoma, 83. Pre-test Post-test 11. Nitroglycerin injection A. pulmonary congestion B. RV infarction inferior wall MI C. PVC) D. C : %DW NSS 84. Pre-test Post-test Nitroglycerin injection STEMI complication A. LV failure B. C. recurrent ischemia D. D : STEMI LV failure , , , recurrent ischemia, pulmonary congestion 24 48 85. Pre-test Post-test 13. Adenosine A. IV Rapid Bolus syringe 20 ml saline flush B. IV C. D5W D5S 100 ml drip infusion pump D. A : IV heart 3-way syringe 20 ml saline flush monitor EKG 6 mg 1-3 12 mg 86. Pre-test Post-test 14. Adenosine A. drug of choice paroxysmal supraventricular tachycardia(SVT) sinus rhythm B. Adenosine C K channel cAMP-induced Ca influx D adenosine arrhythmia atrial flutter, atrial Fibrillati , atrial ventricular tachycardia D Adenosine drug of choice paroxysmal supraventricular tachycardia(SVT) sinus rhythm SVT reentry SVT cardioversion ) Adenosine 87. Pre-test Post-test Cordarone A D5W NSS B 48 C NaHCO3 D Cardiac arrest VT/Pulseless VT dose mg mg A Cordarone D5W NSS NaHCO3 Cardiac arrest VT/Pulseless VT dose mg mg 88. Pre-test Post-test Cordarone A. Cardiac arrhythmia B. Hypertension C. D. B : , , cardiac arrest Hypo/hyperthyroidism 89. Pre-test Post-test Digoxin A Congestive Heart Failure B Reduce ventricular rate C Myocardial infarction D Atrial Fibrillation C Digoxin Indication Congestive Heart Failure , Reduce ventricular rate Atrial Fibrillation 90. Pre-test Post-test Digitalis A. B. C. D. Digitalis Intoxication D 91. Pre-test Post-test 50 drip KCl inj.40 mEq. in NSS 1000 cc. rate 80 ml/hr. KCL mEq /hr A. 3.2 mEq /hr B. 5.2 mEq /hr C. 6.4 mEq /hr D. 10.0 mEq /hr A KCL 40mEq/L rate 80ml/hr ml K mEq 1 ml K 0.04 mEq 80 ml K = 3.2mEq hr mEq rate maximum rate mEq/hr 92. Pre-test Post-test 20. KCL A. Serum potassium > 4.5 mEq/L B. arrhythmia EKG C. Urine output < 30 mL/hour Oligulia D. D : IV push bolus K+ HR BP K+ 93. Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug information handbook 2000 2001 8th ed. Ohio : Lexi Comp Inc.; 2000. Trissel LA. Handbook on injectable drugs. 12 th ed. Bethesda: American Society of Health Systems Pharmacists; 2003. McEvoy GK editor. AHFS drug information. Bethesda: American Society of Health Systems Pharmacists; 2002. American College of Chest Physicians Consensus Conference onAntithrombotic Therapy, Chest 2001 Jan;119(1 Suppl):1S- 370S Eric Camir, MD, Eric Moyen, MD, Henry 94. 25% 75% < 1 1 1 -2 95. Pre test- Post test 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Pre test Post test Pre test Post test 96. Pre test- Post test 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% < 1 1 1 -2 55% 83% 76% 90% Pre test Post test 97. 88% 52.50% 77.50% 77.50% 35% 95% 75% 90% 87.50% 62.50% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Pre test Post test 98. 67.50% 62.50% 67.50% 65% 92.50% 87.50% 75% 80% 80% 100% 0% 20% 40% 60% 80% 100% 120% Pre test Post test 99. Pre test 0% 10% 20% 30% 40% 50% 60% 70% 80% Atropine Dobutamine Adenosine 35% 52.50% 62.50%62.50% 75% 75% 100. Pre test 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% KCl Adrenaline Dopamine Levophed 92.50% 88% 77.50% 77.50% 100% 95% 90% 87.50% 101. 54.97% 80% 67% 72.14% 79% 85% 82% 84% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Pre test Post test 102. 1 69% 83% Atropine 35% 62.50% Dobutamine 52.50% 75% Adenosine 62.50% 75% 103. 54.97% 79% 104. Focus sedative drug www.Slideshare.net