Milrinone Flashcards

Please note that the drug card information is for Educational Use ONLY, and the source is from Carrie Bowman's glossary of drug cards permitted by use of Georgetown NAP students. No permission is given to use these cards for anything other than as a study resource for our program.

1
Q

What is the trade name of Milrinone Lactate?

A

Primacor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the formal drug classification of Milrinone?

A

Milrinone Lactate is a bypyridine inotropic/vasodilator agent with phosphodiesterase inhibitor activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the clinical uses of Milrinone?

A

-short term treatment of patients with acute decompensated heart failure, managment of acute LV dysfunction following cardiac surgery, weaning patients from cardiopulmonary bypass, calcium antagonist intoxication, and short term IV therapy of congestive heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Is Milrinone good for CHF?

A

Inotrope of choice for severe congestive heart failure patients taking beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the MOA of Milrinone?

A

Selective phosphodiesterase inhibitors act by selectively inhibiting Phosphodiesterase (PDE) III, which is the heart specidifc enzyme responsible for the degradation of cAMP/ cGMP. This inhibition decreases hydrolysis of cAMP and cGMP in the myocardium and vascular smooth muscle, which leads to increased intracellular concentrations in the heart and vascular smooth muscle

  • the increased intracellular cAMP concentrations activate protein kinases that promote phosphorylation and increase intracellular calcium stores
  • The increase in intracellular calcium in the heart increases contractility and inotropy
  • Increased cAMP in the vascular smooth muscle causes vasodilation and decreases peripheral vascular resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the onset of action of IV Milrinone?

A

5-15 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When does the peak response occur for IV Milrinone?

A

after 5 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is Milrinone excreted?

A

approximately 80% of the drug is excreted unchanged by the kidneys; therefore it should be decreased in patients with severe renal diease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the E 1/2 time of Milrinone?

A

2.5 Hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which patients have a prolonged 1/2 life of Milrinone?

A

patients with severe CHF have a reduction in systemic clearance and therefore have prolonged 1/2 life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the Volume of Distribution of Milrinone? What is special about the peds/ children?

A
  1. 32 - 0.45 L/kg
    - Infants and children demonstrate a larger volume of distribution and clearance of milrinone compared with adults, and thus need higher loading dose.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is Milrinone protein bound?

A

70% protein bound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the side effects of Milrinone?

A
  • Cardiac dysrhythmias, including ventricular and supraventricular arrhythmias
  • Hypotension
  • Angina
  • Headaches
  • Hypokalemia
  • Tremor
  • Thrombocytopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are precautions/warnings to Milrinone?

A
  • Avoid in severe obstructive aortic or pulmonary vascular disease
  • Ensure ventricular rate controlled in afib
  • Adjust dose in renal dysfunction
  • Monitor and correct fluid and electrolyte problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is Milrinone NOT recommended for use?

A

in acute MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a contraindication to the use of Milrinone?

A

Hypersensitivity to Milrinone, inamrinone, or any component of the formulation; concurrent use of inamrinone

17
Q

What are the drug interactions with Milrinone?

A

-None noted. Milrinone is compatible with other adrenergic agonists

18
Q

Which drug will form precipitation if given with Milrinone?

A

Milrinone and furosemide will form a precipitate when administered in the same IV line

19
Q

With regards to IV infusion, which drugs are compatible with Milrinone, which drugs are not?

A

Compatible: Atropine, Calcium Chloride, Digoxin, Epi, Lidocaine, Morphine, Propranolol, and sodium Bicarbonate

Incompatible: Furosemide and Procainamide

20
Q

What is the loading dose for Milrinone?

A

Loading dose: 50 mcg/kg IV over 10 minutes

21
Q

What is the maintenance dose for Milrinone, and not to exceed?

A

0.375 - 0.75 mcg/kg/min not to exceed 1.13 mcg/kg/day

22
Q

When should you omit a loading dose of Milrinone and initiated maintenance doses?

A

if Hypotension is a problem

23
Q

What is the standard dilution of Milrinone?

A

For a final concentration of 0.2mg/ml: Dilute Primacor 1mg/mL (10mL) with 40 mL diluents (final volume: 50mL)

Administration requires an infusion pump; continuous IV infusion; 20mg/100 ml 0.9% sodium chloride or D5W (0.2 mg/mL)