Antiarrhythmic Drugs (9) Flashcards
Amiodarone
Brand Name: Cordarone
Classification: Class III antiarrhythmic
Action: Prolongs action potential and duration in cardiac tissues through sodium, potassium, and calcium channels; block α and β adrenergic receptors
Indications: Maybe consider for V-Tach, V-fib that is unresponsive to CPR defib, and vasopressor therapy
Contraindications: Breastfeeding, Bradycardia, High-grade heart block, Hypersensitivity
Dose: 150-300 mg
Routes: IV
Adverse Effects: Hypotension, Bradycardia, Prolonged PR, QRS, and QT
Other: Constant ECG monitoring, Now first-line agent in V-fib and tachycardia
Lidocaine
Brand Name: Xylocaine
Classification: Class 1B antiarrhythmic, local anesthetic
Action: Amide-type local anesthetic; slows depolarization and automaticity
Indications: May be considered for: V-Tach, V-fib what is unresponsive to CPR, Defib, and vasopressor therapy, or Local Anesthetic
Contraindications: Should not be administer to patients receiving IV calcium channel blockers
Dose: 1.0-1.5 mg/kg
Routes: IV
Adverse Effects: Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
Other: Use with caution when administered with other antiarrhythmics
Procainamide
Brand Name: Pronestyl
Classification: Class Ia antiarrhythmic; local anesthetic
Action: Ester-type local anesthetic; reduces automaticity and AV conduction
Indications: V-Tach w/ pulse, pre-excited A-Fib
Contraindications: Do not administer to pts receiving IV calcium channel blockers
Dose: 20-50mg/min
Routes: IV
Adverse: Drowsiness, slurred speech, confusion, seizures, hypotension
Other: Carefully monitor ECG (QRS duration) during administration
Phenytoin
Brand Name: Dilantin
Classification: Class Ib antiarrhythmic; anticonvulsant
Action: Depresses automaticity and AV conduction; reduces voltage and spread of electrical discharges in motor cortex
Indications: Life-threatening arrhythmias from digitalis toxicity; & seizures
Contraindications: bradycardia, high-grade heart block, hypersensitivity
Dose: 15-18mg/kg
Routes: IV
Adverse: Drowsiness, dizziness, headache, hypotension, arrhythmias, nausea, vomiting
Other: Fosphenytoin is preferred for seizure
Adenosine
Brand Name: Adenocard
Classification: Nucleoside
Action: Slows AV conduction; short half-life
Indications: Supraventricular Tachyarrhythmias (SVT)
Contraindications: A-Fib, Torsades de pointe
Dose: 6 mg
Routes: IV
Adverse Effects: Facial flushing, Headache, Chest Pain, Nausea
Other: Should be given by rapid IV push followed by saline bolus, Arrhythmias common following administration
Esmolol
Brand Name: Brevibloc
Classification: Class II antiarrhythmic; beta blocker
Action: slows heart rate through selective blockage of B1 receptors; short half life
Indications: Tachycardia
Contraindications: Asthma, heart block, bradycardia, cardiogenic shock
Dose: 50-100 mcg/kg/min
Routes: IV
Adverse: Bradycardia, hypotension, CHF, lethargy
Other: Hypotension is common but dose related; should not be administered to pts receiving calcium channel blockers
Labetalol
Brand Name: Trandate, Normodyne
Classification: Class II antiarrhythmic; beta blocker
Action: lowers BP through nonselective blockage of B receptors (and limit blockage of A2 receptors)
Indications: Hypertensive emergency
Contraindications: Asthma, heart block, bradycardia, cardiogenic shock
Dose: 10-20mg
Routes: IV, PO
Adverse: Bradycardia, hypotension, CHF, lethargy
Other: Should not be administered to pts receiving calcium channel blockers
Diltiazem
Brand Name: Cardizem
Classification: Class IV antiarrhythmic; calcium channel blocker
Action: Lowers BP by relaxing vascular smooth muscle; slows AV conduction
Indications: A-fib w/ Rapid Ventricular Rate (RTR) and Stable narrow-complex Tachyarrhythmias
Contraindications: Hypotension, CHF, Cardiogenic shock, Wide-complex V-Tach
Dose: 15-20 mg
Routes: IV
Adverse Effects: Nausea, Vomiting, Dizziness, Headache, Hypotension
Other: Can be given IV bolus or IV infusion. Calcium chloride can reverse some of the untoward effects
Magnesium Sulfate
Brand Name: Magnesium Sulfate
Classification: Mineral/electrolyte
Action: Physiologic calcium-channel blocker; bronchodilator
Indications: Torsades des pointes, Asthma, Hypertensive disorders of pregnancy
Contraindications: High-Degree Heart block, Shock, Dialysis, Hypocalcemia, V-fib/pulseless V-Tach in adults
Dose: 1-2 g
Routes: IV
Adverse Effects: Flushing, Sweating, Bradycardia, Respiratory Depression, Hypothermia
Other: Can cause cardiac conduction problems in conjunction with digitalis
