35 Tan, Aubrey Mae A.

2014070808
4A-Clinical Pharmacy

1. Give an example of a wide and narrow QRS complex.

Narrow complex tachycardia with a 1:1 atrioventricular association

Ventricular tachycardia: Broad QRS complexes with no visible P waves

2. Which is safer for wide QRS, Verapamil or Adenosine phosphate?

Verapamil blocks both activated and inactivated L-type calcium channels. Thus,
its effect is more marked in tissues that fire frequently, those that are less
completely polarized at rest, and those in which activation depends on the
calcium current, such as SA and AV nodes. When verapamil is administered in a
patient with ventricular tachycardia (misdiagnosed as supraventricular
tachycardia), hypotension and ventricular fibrillation may occur. Its inotropic
effects may limit its clinical usefulness in diseased hearts.

Adenosine is a nucleoside that occurs naturally throughout the body. Its half-life
in the blood is less than 10 seconds. Its cardiac mechanism of action involves
activation of an inward rectifier potassium current and inhibition of calcium
current. When given as a bolus dose, adenosine directly inhibits AV nodal
conduction and increases the AV nodal refractory period but has lesser effects
on the SA node.

Adenosine is the safer drug because of its short half-life and its interactions are
minimal.

Albuterol
Albuterol is a selective beta2-adrenergic receptor agonist with pharmacological
properties and therapeutic indications similar to terbutaline. Stimulation of these
receptors activates the Gs adenylyl cyclase cyclic AMP pathway with consequent
reduction in smooth muscle tone. Beta2-adrenergic receptor agonist (e.g.
albuterol, isoproterenol) also increase the conductance of large Ca2+-sensitive
K+ channels in airway smooth muscle, leading to membrane hyperpolerization
and relaxation.

Calcium chloride
Calcium chloride in water dissociates to provide calcium (Ca2+) and chloride (Cl-
) ions. They are normal constituents of the body fluids and are dependent on
various physiological mechanisms for maintenance of balance between intake
and output. For hyperkalemia, the influx of calcium helps restore the normal
gradient between threshold potential and resting membrane potential.

Sodium bicarbonate
Sodium bicarbonate is a systemic alkalizer, which increases plasma bicarbonate,
buffers excess hydrogen ion concentration, and raises blood pH, thereby
reversing the clinical manifestations of acidosis.

Insulin + glucose
Insulin administered with glucose: Facilitates the uptake of glucose into the cell,
which results in an intracellular shift of potassium