Antidysrythmics Flashcards
1
Q
Lidocaine (Xylocaine)
-Mechanism of action
A
- Suppresses automaticity and deplo is His/purkinjie system.
- Suppresses ventricular ectopy and increases vent threshold for dysrhythmias, but increases threshold for defib.
2
Q
Lidocaine
-Indication
A
- VT w/pulse
- Alt second-line therapy to Amiodarone in CA (VF/Pulse VT) and hemodynamially stable, wide complex monomorphic VT
- malignant PVC >6 Unifocal PVC/min Multifocal PVC’s Couplets R on T Phenomena
- Pain control w/ I/O
3
Q
Lidocaine (Xylocaine)
- Contraindications
A
- Hypersensitivity
- Supraventricular Dysrhythmias
- Untreated Sinus Brady
- 2nd Degree Mobitz II HB
- 3rd Degree HB
- Stokes-Adams Syndrome
4
Q
Lidocaine (Xylocaine)
- Precautions
A
- CNS depression may occur in doses greater than 300 mg/hr
- Liver/Renal disease
- CHF
- Hypovolemia
- Shock
- Myasthenia Gravis
5
Q
Lidocaine (Xylocaine)
- Side Effects
A
- AMS (including Confusion)
- Bradycardia
- Hypotension
- Seizures
6
Q
Lidocaine (Xylocaine)
- Interactions
A
- Caution when administered with B-Blockers or procainamide as drug toxicity may result.
7
Q
Lidocaine
-Dosage/Route: CA
A
- No pulse:
>Adult: 1-1.5 mg/kg IVP, repeat at half of initial dose q 5 minutes; max of 3mg/kg. (Single dose of 1.5 if moving to amiodarone) ETT: 2-4 mg/kg q 3-5 minutes
>Pedi: 1 mg/kg IVP/IO/ETT
8
Q
Lidocaine
-Dosage/Route: CA w/ a pulse, and Infusion
A
CA-
>1-1.5 mg/kg IVP, repeat at 1/2 initial dose q 5-10 minutes; max of 3 mg/kg.
>Infusion- 1-4 mg/min using “+1 rule”
9
Q
Lidocaine
-I/O Pain Control
A
- Adult: 0.5 mg/kg max of 40 mg IVP 1% or 2%
- Pedi: 0.5 mg/kg IVP 1% or 2%
10
Q
Lidocaine (Xylocaine)
- Pharmacokinetics: Absorption/Duration/Half-Life
A
- Absorption: 3 minutes
- Duration: 10-20 minutes
- Half-Life: 1.5-2 hrs
11
Q
Amiodarone (Cordarone)
-Functional Class
A
- Class III Antidysrhythmic (K+ channel blocker)
12
Q
Amiodarone (Cordarone)
- Mechanism of Action
A
- Acts directly on all cardiac tissue.
- Prolongs action potential and refractory period durations by blocking Ka+ without significantly effecting resting membrane potential. Also blocks Na+
- IV relaxes vascular smooth muscle, decreasing PVR and increases coronary blood flow.
- Blocks effects of sympathetic stimulation.
13
Q
Amiodarone (Cordarone)
-Indications
A
- Life-threatening ventricular and supraventricular dysrhythmias.
- VF, VT, A-fib, A-flutter, SVT, and WPW.
14
Q
Amiodarone (Codarone)
-Contraindications
A
- Hypersensitivity to Iodine
- Cardiogenic Shock
- Severe Sinus Brady
- Av Block
15
Q
Amiodarone (Cordarone)
- Precautions
A
- Severe liver disease
- Pregnancy
- Nursing mothers
16
Q
Amiodarone (Cordarone)
- Interactions
A
- Increases Digoxin levels and enhances pharmacological effets of procainamide, lidocaine, quinidine, and oral coagulants.
- Concurrent use of CCB, B-Blockers, fentanyl, or Cimetidine may potentiate sinus brady.
17
Q
Amiodarone (Cordarone)
- Side Effects
A
- CHF
- Angioedema
- Hypotension
- AV Blocks
- Hepatotoxicity
- Cardiogenic Shock
- Bradycardia
- Sinus Arrest
- Prolonged Q-T interval
- Fatigue
- N/V
- Permanent Blindness
18
Q
Amiodarone (Cordarone)
-Dosage/Route: Pulse, Pulseless, and Maintenance infusion
A
Adult:
- Pulse: 150 mg (in 50-100 mL of NS) IV infusion over 10 min. May repeat once after 10 minutes.
- Pulseless: 300 mg IVP, repeat in 3-5 min at 150 mg IVP
- Maintenance Infusion: 1 mg/min over 6 hrs. Pedi: 5 mg/kg IV/IO
- Post Arrest: 150 mL NS slow IV/IO over 8-10 min
19
Q
Adenosine (Adenocard)
-Functional Class
A
- Antidysrhythmic
20
Q
Adenosine (Adenocard)
-Mechanism of Action
A
- Naturally occurring nucleoside
- Decreases conduction through AV node
- Interrupts AV and SA re-entry pathways restoring normal sinus rhythm in pts with SVT.
21
Q
Adenosine (Adenocard)
-Indications
A
- SVT refractory to Vagal Maneuvers
- Wolf-Parkinson-White syndrome
- Symptomatic monomorphic wide-complex tachycardia w/ regular rhythm
22
Q
Adenosine (Adenocard)
-Contraindications
A
- 2 and 3 deg heart block
- Symptomatic Bradycardia
- Sick Sinus Syndrome
- Hypertension
23
Q
Adenosine (Adenocard)
- Precautions
A
- Place Pt in semi-fowlers as they will typically develop arrhythmias at the time of conversion.
- Caution with Asthma pts.
24
Q
Adenosine (Adenocard)
- Interactions
A
- Pts taking caffeine or xanthines (aminophylline/ theophylline) may require larger doses as they antagonize adenosine.
- Pt in dipyridamole (Persantine) and carbamazepine (Tergretol) may require smaller doses as these drugs potentiate adenosine’s effects.
25
Adenosine (Adenocard)
- Side Effects
- Side effects usually self-limiting due to short half-life
- Syncope
- Palps
- C/P
- Hypotension
- Dysrhythmias
- Dyspnea
- Dizz
- N/V
26
Adenosine (Adenocard)
-Dosage/Route
- Adult- 6 mg rapid IVP, following w/ 10-20 mL NS. No conversion in 1-2 min. 12 mg rapid IVP, follow w/ 10-20 mL NS. No conversion in 1-2 minutes follow with additional 12 mg rapid IVP and 10-20 mL flush.
- Pedi- Med Control Option
\>0.1 mg/kg IVP/IO (max single of 6 repeat once in 1-2 min at 0.2 mg/kg max dose of 12.
27
Diltiazem (Cardizem)
-Functional Class
- Class IV antidysrhythmic (Ca Channel Blocker)
28
Diltiazem (Cardizem):
-Mechanism of Action
- Inhibits Ca+ influx in slow channel cells of myocardial and arterial smooth muscle.
- Ca+ is kept at sub threshold making cells unavailable for excitation and contraction.
- Reduces PVR by inhibiting smooth vascular muscle contraction. Causes Coronary artery diolation.
- Inhibits coronary spasm and also slows SA and AV conduction.
29
Diltiazem (Cardizem)
-Indication
- SVT refractory to adenosine
- Rapid A-fib and A-flutter
30
Diltiazem (Cardizem)
-Contraindication
- Hypersensitivity
- Sick Sinus Syndrome
- 2 and 3 deg heart block
- Hypotension
- WPW
- w/ wide complex tachycardia
31
Diltiazem (Cardizem)
- Precautions
- Avoid in pts taking oral B-Blockers
- Monitor for hypotension resulting from peripheral vasodilation.
- Caution with CHF
32
Diltiazem (Cardizem)
- Interactions
- B-Blockers may increase digoxin levels.
33
Diltiazem (Cardizem)
- Side Effects
- C/P
- Bradycardia
- Hypotension
- Syncope
- CHF
- Dysrhythmias
- 2nd/3rd degree AV block
- Dyspnea
- Palps
- N/V, H/A, Sweating and dizz
34
Diltiazem (Cardizem)
-Dosage/Route
- Bolus: 0.25 mg/kg slow IVP, repeat in 15 min at 0.35 mg/kg slow IVP.
- IV Infusion: 5-15 mg/hr, titrate to HR
35
Metoprolol (Lopressor)
-Functional Class
- Class II Antidysrhythmic (Beta Blocker)
36
Metoprolol (Lopressor)
-Mechanism of Action
- Blocks Beta-1 receptors located on cardiac muscle with little to no effect on B-2 in doses less than 100 mg.
- Reduces HR and CO at rest and during exercise and lowers BP.
37
Metoprolol (Lopressor)
-Indications
- C/P associated with AMI and ACS
- Angina Pectrois
- SVT
38
Metoprolol (Lopressor)
-Contraindications
- Hypersensitivity
- Sinus Brady
- Heart Block gtr than 1 (except when w/ PC)
- Cardiogenic Shock
- Uncompensated Cardiac Failure
- Pregnancy 2nd/3rd trimester
- Asthma/COPD
39
Metoprolol (Lopressor, Toprol-XL)
- Side Effects
- Bronchospasm
- Bradycardia
- Palps
- Edema
- CHF
- Reduced Peripheral Circulation
- Drowsiness
- Insomnia
40
Metoprolol (Lopressor, Toprol-XL)
- Interactions
- Drugs which slow AV conduction (Digoxin) as the effects may be accumulative with B-Blockers
- Glucagon: Metoprolol may blunt the hyperglycemic action of glucagon.
- Verapamil or Diltiazem may have synergistic pharmacological effects when taken concurrently with B-Blockers.
41
Metoprolol (Lopressor, Toprol-XL)
- Precautions
- Impaired Hepatic/Renal Function
- CHF controlled by Digitalis or Diuretics
- Do not mix with IV CCB
42
Metoprolol (Lopressor)
-Dosage/Route
- 5 mg slow IVP (over 2-5 min) q 5 min x3; max of 15 mg
- Acute MI: Maintain systolic \>100 and HR \>60
- SVT: Maintain HR 90-100.
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