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 Camiré, 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 Camiré, 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 6–8 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
<1 week IV infusion: 800-1600 mg/day

59. Cordarone injection
D5W NSS
NaHCO3
- mg/ml
central venous
catheter mg/ml
infusion pump
central line peripheral line
-

60. Cordarone injection
-
-
- cardiac arrest
-
- Hypo/hyperthyroidism
-

61. Digoxin injection
Digoxin inj 0.5mg/ 2 ml/ ampule
(onset)
(peak) (duration)
Lanoxin injection
0.25 mg/mL
(2 mL)
- - -
Indication)
1. Congestive Heart Failure
2. Reduce ventricular rate

62. Digoxin injection
•
•
• K+
mEq/L)
• Digitalis Intoxication
•
•
•

63. Digoxin injection
• Double check
• K+ Digoxin K+
mEq/L
•
o HR
o - HR
o HR
• IV

64. Digoxin injection
Monitoring)
• Digoxin monitor EKG
Digoxin HR
•
Digitalis
Intoxication
• K+
• Digitalis Intoxication

65. Digoxin injection
• Digitalis Intoxication
monitor
EKG
• -
Activated charcoal mg/kg

66. Potassium chloride
(Potassium Chloride injection) ml
Contains KCl 1.5 gm or 20 mEq
Indication)
Hypokalemia K+
K+ mEq/L
cardiac arrhythmia)

67. Potassium chloride
• IV push bolus
•
• K+
•
• Double check
• - mEq/L)

68. Potassium chloride
• Double check
• IV push bolus
• IV K+ loading
• Infusion pump
peripheral line : Maximum concentration 80 mEq/L ; Max
rate of admin : 10 mEq/hour
central line : Maximum concentration 150 mEq/L
central line) 200 mEq/L ;
Max rate of admin : 40 mEq/hour

69. Potassium chloride
Monitoring)
• - mEq/hr HR , BP
EKG
• - mEq/L - HR
BP -
• BP
mmHg HR
-
• K+
• K+

70. Potassium chloride
• K+
HR BP
K+
K+
• K+ mEq/L K+
hyperkalemia
T wave
tall peak T) EKG
monitor EKG
• hyperkalemia
-

71. Potassium chloride
• -
potassium
glucose 40-50 ml+
regular insulin (RI)
5-10 unit IV push
Capillary blood
glucose
• K+
Cation exchange resin kayexalate
kalimate
30-60 g
kayexalate

72. Pre-test Post-
test

73. Pre-test Post-test
1. Adrenaline
A.
(peripheral vascular disease)
B. intravenous infusion
infusion pump
C. 48
D. IV site 1
C
: 24

74. Pre-test Post-test
2.
Adrenaline
A.
B.
C.
D.
D
:
BP>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 Camiré, MD, Eric Moyen, MD, Henry

95. 25%
75%
< 1
1 1 -2

96. Pre test- Post
test
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Pre test Post test
Pre test
Post test

97. 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

98. 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

99. 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

100. Pre test
0%
10%
20%
30%
40%
50%
60%
70%
80%
Atropine Dobutamine Adenosine
35%
52.50%
62.50%62.50%
75% 75%

101. 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%

102. 54.97%
80%
67%
72.14%
79%
85% 82% 84%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Pre test
Post test

103. 
1

69% 83%

Atropine 35% 62.50%
Dobutamine 52.50% 75%
Adenosine 62.50% 75%

104. 
54.97%
79%

105.  Focus

sedative drug

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