Cardiac Drugs 1 Flashcards
Procainamide HCl (Pronestyl) Class
Antidysrhythmic
Procainamide HCl (Pronestyl) mechanism of action
Suppresses phase 4 depolarization in normal ventricular muscle and purkinje fibers, reducing ectopic pacemaker’s automaticity; suppresses intraventricular conduction.
Procainamide HCl (Pronestyl) Iindications
Stable monomorphic VT with normal QT interval, reentry SVT uncontrolled by vagel maneuvers and adenosine, stable wide-complex tachycardia of unknown origin, AF with rapid ventricular rate in patients with Wolff parkinson white syndrome.
Procainamide HCl (Pronestyl) contraindications
Torsades de pointes, second and third degree heart AV block(without functioning artificial pacemaker), preexisting QT prolongation, digitalis toxicity, tricyclic antidepressant overdose.
Procainamide HCl (Pronestyl) adverse reactions/side effects
Confusion, seizures, hypotension, bradycardia, reflex tachycardia, centricular dysrhythmias, AV blocks, asystole, widening of PR, QRS, and QT intervals, nausea, vomiting
Procainamide HCl (Pronestyl) drug interactions
increases plasma levels of amiodarone and quinidine
Procainamide HCl (Pronestyl) dosage and administration adult (recurrent VF/pulseless VT)
20mg/min slow IV infusion until the dysrythmia is suppressed, hypotension, QRS widens by greater than 50% of its pretreatment width,
If urgent up to 50 mg/min
max of 17mg/kg
Procainamide HCl (Pronestyl) adult maintenence dose
1 to 4 mg/min in saline or d5w
Procainamide HCl (Pronestyl) duration of action
onset: 10 to 30 minutes,
peak: variable
Duration: 3 to 6 hours
Procainamide HCl (Pronestyl) pregnancy safety category
Category C
Procainamide HCl (Pronestyl) pediatric dosage and administration
loading dose of 15 mg/kg IV/IO over 30 to 60 mins.
Procainamide HCl (Pronestyl) special considerations
Potent vasodialation and negative inotropic effects. Hypotension may occur with rapid infusion. administer cautiously to patients with cardiac, hepatic, or renal insufficiency. asthma or digitalis induced dysrythmias.
Adenosine(Adenocard) class
Antidysrhythmic
Adenosine(Adenocard) mechanism of action
Slows conduction through the AV node, can interrupt reentrant AV nodal pathways.
Adenosine(Adenocard) indications
Conversion of narrow complex regular tachycardia to sinus rhythm. May conver reentry SVT due to wolf parkinson white syndrome. Can be used diagnostically for stable, regular, monomorphic wide complex tachycardia. Adenosine may treat the VT or it may help diagnose the underlying rhythm.
Adenosine(Adenocard) contraindications
hypersensitivity, second or third degree av block, sick sinus syndrome, other sinus node disease unless a funcioning artificial pacemaker is present; bronchoconstrictive or bronchospastic lung disease(COPD, Asthma), poison or drug induced tachycardia.
Adenosine(Adenocard) adverse reactions/side effects
Generally short duration and mild; headache, dizziness, dyspnea, bronchospasm, dysrhythmias, palpitations, hypotension, chest pain, facial flushing, cardiac arrest, nausea, metallic taste, pain in the head or neck, paresthesia, diaphoresis.
Adenosine(Adenocard) drug interactions
methylxanthines antagonize the effects of adenosine. Dipyridamole potentiates the effect of adenosine, carbamazepine(Tegretol) may potentiate the AV node blocking effect of adenosine.
Adenosine(Adenocard) adult dosage and administration
6 mg rapid IV bolus over 1-3 seconds, followed by a 20 mL saline flush and elevate the extremity. If no response after 1-2 minutes administer second dose of 12mg.
Adenosine(Adenocard) pediatric dosage and administration
initial dose of 0.1 mg/kg rapid IV/IO push, second dose 0.2mg/kg rapid IV/IO push. maximum second dose of 12mg
Adenosine(Adenocard) duration of action
onset: seconds
peak effect: seconds
duration: 12 seconds
Adenosine(Adenocard) pregancy safety category
C
Adenosine(Adenocard) special considerations
Not effective in converting AF or atrial flutter or VT. Short half life limits advers effects in most patients. brief period of most any dysrhythmia, including asystole may occur during pharmacological conversion. Reduce the dose by one half in patients on dipyridamole(Persantine), carbamazepine(Tegretol), those with transplanted hearts, or given via a central IV line
Amiodorone(Cardarone, Pacerone) class
Antidysrhythmic
Amiodorone(Cardarone, Pacerone) mechanism of action
Blocks sodium, potassium, and calcium channels; prolongs the action potential and repolarization; decreases AV conduction and sinoatrial(SA) node function.
Amiodorone(Cardarone, Pacerone) indications
Stable, regular narrow complex tachycardia if the rhythm persists despite vagal maneuvers or adenosine or the tachycardia is recurrent; to control the ventricular rate in stable, irregular narrow complex tachycardia(AF); to control the ventricular rate in preexcited atrial dysrhythmias with conduction over and accessory pathway; stable monomorphic VT; polymorphic VT with a normal QT interval; cardiac arrest resulting from VF or pulseless VT after CPR, defibrillation, and a vasopressor.
Amiodorone(Cardarone, Pacerone) contraindications
hypersensitivity, cardiogenic shock, second or third degree AV block or sick sinus syndrome or other sinus node disease unless a funtioning artificial pacemaker is present
Amiodorone(Cardarone, Pacerone) adverse reactions/side effects
Dizziness, fatigue, malaise, tremor, ataxia, lack of coordination, ARDS, pulmonary edema, cough, progressive dyspnea, heart failure, bradycardia, hypotension, worsening of dysrhythmias, prolonged QT interval, nausea, vomiting, burning at IV site, stevens johnson syndrome.
Amiodorone(Cardarone, Pacerone) drug interactions
Use with digoxin may cause digitalis toxicity. Beta blockers and calcium channel blockers may potentiate bradycardia, sinus arrest, and AV blocks.
Amiodorone(Cardarone, Pacerone) adult dosage and administration for VF/pulseless VT
300 mg IV/IO push. initial dose can be followed once in 3 to 5 mins at 150 mg IV/IO push.
Amiodorone(Cardarone, Pacerone) adult dosage for other indications(not VF/pulselessVT)
Loading dose of 150 mg IV/IO over 10 minutes; may repeat every 10 minutes if needed.
Amiodorone(Cardarone, Pacerone) adult maintenance dosage
after conversion, follow with a 1mg/min infusion for 6 hours and then .5 mg/min maintenence infusion over 18 hours. maximum cumulative dosage of 2.2 IV/IO per 24 hours.
Amiodorone(Cardarone, Pacerone) pediatric dosage refractory VF/pulseless VT
5mg/kg IV/IO bolus. Can repeat the 5mg/kg IV/IO bolus up to a total dose of 15 mg/kg per 24 hours(2.2 g in adolescents) maximum single dose 300mg
Amiodorone(Cardarone, Pacerone) pediatric dosage for perfusing ventricular or atrial dysrhythmias
Loading dose 5mg/kg IV/IO over 20 to 60 mins(maximum single dose of 300mg) can repeat to a maximum dose of 15 mg/kg per day(2.2g in adolescents.)
Amiodorone(Cardarone, Pacerone) duration of action
onset: 2 hours
peak effect: 3 to 7 hours
duration: unknown
Amiodorone(Cardarone, Pacerone) pregancy safety category
D; drug may cause fetal harm. fetal risk and maternal benefit should be considered in the mergency setting. Lactating women should not breastfeed following use.
Amiodorone(Cardarone, Pacerone) special considerations
may worsen or precipitate new dysrhythmias. Monitor the patient for hypotension and increasing PR and QT intervals. Dosage may change in accordance with the most current ILCOR recommendations.
Atropine Sulfate class
anticholinergic agent
Atropine Sulfate mechanism of action
inhibits the action of acetylcholine at postganglionic parasympathetic neuroeffector sites. increases heart rate in symptomatic bradydysrhythmias
Atropine Sulfate indications
hemodynamically unstable bradycardia, organophosphate poisoning, nerve agent exposure, RSI in pediatrics, beta-blocker or calcium channel blocker overdose.
Atropine Sulfate contraindications
Tachycardia, hypersensitivity, unstable cardiovascular status in acute hemorrhage with miocardial ishemia, narrow angle glaucoma, hypothermic bradycardia.
Atropine Sulfate adverse reactions/side effects
drowsiness, confusion, headache, tachycardia, palpitations, dysrhythmias, nausea, vomiting, pupil dilation, dry mouth/nose/skin, blurred vision, urinary retention, constipation, flushed, hot, dry skin; paradoxical bradycardia when pushed too slowly or when given at low doses.
Atropine Sulfate drug interactions
Potential adverse effects when administered with digitalis, cholinergics, physostigmine. Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics, benzodiazepines, and antidepressants.
Atropine Sulfate adult dose for unstable bradycardia
0.5 mg IV/IO infussion every 3 to 5 mins as needed; maximum total dose of 3mg total. Use shorter dosage intervals and higher doses in severe clinical conditions.
Atropine Sulfate adult dosage for organophosphate poisoning
extremely large doses(2 to 4mg) may be needed.
Atropine Sulfate pediatric unstable bradycardia dosage
0.02mg/kg IV/IO(minimum dosage: 0.01) may repeat once. maximum single dose child: 0.5mg, adolescent:1mg: Maximum total dose child:1mg, adolescent: 3mg.
Atropine Sulfate pregnancy class
C
Atropine Sulfate special considerations
Moderate doses may cause pupillary dilation. Paradoxical bradycardia can occur with doses lower than 0.1 mg. May be ineffective in patients who have had a heart transplant or in infranodal AV blocks.
Calcium Chloride class
Electrolyte
Calcium Chloride mechanism of action
Counteracts the toxicity of hyperkalemia by stabilizing the membranes of the cardiac cells, reducing the likelihood of fibrillation.
Calcium Chloride indications
Hyperkalemia, hypocalcemia, hypermagnesemia, beta blocker and calcium channel blocker overdose
Calcium Chloride contraindications
VF, digitalis toxicity, hypercalcemia.
Calcium Chloride adverse reactions/side effects
Syncope, cardiac arrest, dysrhythmia, bradycardia, hyptension, asystole, peripheral vasodilation, nausea, vomiting, metallic taste, tissue necrosis at injection site, coronary and cerebral artery spasm.
Calcium Chloride drug interactions
may cause severe bradycardia in patients taking digitalis. may antagonize the effects of calcium channel blockers. Do not mix or infuse immediately before or after sodium bicarbonate without intervening flush.
Calcium Chloride adult dosage for hyperkalemia
500 to 1000mg slow IV/IO push(1 to 1.5 mL/minute) to maximum of 3g.
Calcium Chloride adult dosage for beta blocker and calcium channel blocker overdose
3 to 6g(30 to 60mL) IV/IO followed by a continuous hourly infusion of the same dose.
Calcium Chloride pediatric dosage for hyperkalemia
60 - 100 mg/kg IV/IO slowly over 5/10 minutes to a maximum of 3g
Calcium Chloride pediatric dosage for beta blocker and calcium channel blocker overdose
60mg/kg(0.6mL/kg) IV/IO followed by a continuous hourly infusion of the same dose.
Calcium Chloride duration of action
onset: immediate
peak effect: immediate
duration: 30
Calcium Chloride pregnancy safety category
C
Calcium Chloride special considerations
monitor IV site carefully; local infiltration can result in severe tissue necrosis and sloughing. Because this medication is highly irritating, do not administer by either the IM or subcutaneous routes.
DilTIAZem (Cardizem) class
Calcium channel blocker, antidysrhythmic(classIV)
DilTIAZem (Cardizem) mechanism of action
Inhibits extracellular calcium ion influx across membranes of myocardial cells and vascular smooth muscle contraction and thereby dilating main coronary and systemic arteries; no effect on serum calcium concentrations; substantial inhibitory effects on the cardiac conduction system, acting principally at the AV node, with some effects at the SA node.
DilTIAZem (Cardizem) indications
Stable narrow-QRS tachycardia if the rhythm persists despite vagal maneuvers or adenosine or if the tachycardia is recurrent; to control the ventricular rate in patients with AF or atrial flutter.
DilTIAZem (Cardizem) contraindications
Hypersensitivity, hypotension, cardiogenic shock, wide-complex tachycardia(may lead to hemodynamic deterioration and VF), second or third degree AV block or sick sinus syndrome or other sinus node disease unless a functioning artificial pacemaker is present, poison or drug induced tachycardia, AF or atrial flutter when associated with an accessory bypass tract(eg wolf parkinson white syndrome)
DilTIAZem (Cardizem) adverse reactions/side effects.
dizziness, weakness, headache, dyspneea, cough, dysrhythmias, heart failure, peripheral edema, bradycardia, hypotension, AV blocks, syncope, VF, VT, cardiac arrest, chest pain, nausea, vomiting, dry mouth
DilTIAZem (Cardizem) drug interactions
caution in patients using medications that affect cardiac contractility. should not be administered within 2 to 4 hours of IV beta blockers; doing so may result in decreased cardiac contractility, bradycardia(icluding AV blocks), and hypotension.
DilTIAZem (Cardizem) adult dosage and administration
Initial dose: 0.25 mg/kg IV over 2 minutes. if inadequate response, may rebolus, in 15 minutes with 0.35 mg/kg IV over 2 minutes. Maintenance infusion of 5 to 15 mg/hr titrated to physiologically appropriate heart rate.
DilTIAZem (Cardizem) pediatric dosage
not recommended.
DilTIAZem (Cardizem) duration of action
onset: 2 to 5 minutes
peak effect: variable; usually within 7 minutes
duration: 1 to 3 hours
DilTIAZem (Cardizem) pregancy safety category
C
DilTIAZem (Cardizem) special considerations
use with caution in patients with renal or hepatic dysfunction. Carefully monitor BP, heart rate, and ECG before, during, and after administration. Dysrhythmias may be present duringh pharmacologic conversion of PSVT to sinus rhythm.
Dopamine HCl (Intropin) class
adrenergic, vasopressor, inotropic agent.
Dopamine HCl (Intropin) mechanism of action
immediate metabolic precursor to norepinephrine. Produces positve inotropic and chronotropic effects. Constrics systemic vasculature, increasing BP and preload. Increases myocardial contractility and stroke volume.
Dopamine HCl (Intropin) indications
cardiogenic and septic shock, hypotension with low cardiac output states, distributive shock, second line drug for symptomatic bradycardia
Dopamine HCl (Intropin) contraindications
hypersensitivity, hypvolemic shock, pheochromocytoma, uncorrected tachydysrhythmias, VF.
Dopamine HCl (Intropin) adverse reactions/side effects
extravasation may cause tissue necrosis. Headache, anxiety, dyspnea, dysrhythmias, hypotension, hypertension, palpitations, chest pain, increased myocardial oxygen demand, nausea, vomiting
Dopamine HCl (Intropin) drug interactions
incompatible with alkaline solutions(sodium bicarb). MAOIs will enhance the effect of DOPamine. When administered with phenytoin, may cause hypotension, bradycardia, and seizure.
Dopamine HCl (Intropin) adult dosage and administration
IV/IO infusion at 5 to 20 mcg/kg per minute, slowly titrated to patient response.
Dopamine HCl (Intropin) pediatric dosage
IV/IO infusion at 5 to 20 mcg/kg per minute, slowly titrated to patient response.
Dopamine HCl (Intropin) duration of action
onset:1 to 4 minutes
peak effect: 5 to 10 minutes
duration: effects cease almost immediately after infusion is discontinued.
Dopamine HCl (Intropin) pregnancy safety category
C use with caution with pregnant and breastfeeding women.
Dopamine HCl (Intropin) special considerations
effects are dose dependent. Beta adrenergic response: 5 to 10 mcg/kg/min: positive chronotropic and inotropic effects.
Alpha-adrenergic response: 10-20 mcg/kg per minute: vasoconstriction and increase in BP.
Over 20 mcg/kg/min: alpha effects predominate and may compromise circulation in the limbs. should be administered by infusion pump.
Epinephrine (Adrenalin) class
sympathomimetic
Epinephrine (Adrenalin) mechanism of action
Direct acting alpha and beta agonist. Alpha: vasoconstriction. Beta 1: Positive inotropic, chronotropic, and dromotropic effects. Beta 2: bronchial smooth muscle relaxation and dilation of skeletal vasculature. Blocks histamine receptors.
Epinephrine (Adrenalin) indications
Cardiac arrest(asystole, PEA, VF, and pulseless VT), symptomatic bradycardia as an alternative infusion to Dopamine, hypotension from shock other than hypovolemia, allergic reaction, anaphylaxis, asthma
Epinephrine (Adrenalin) contraindications
None in emergency setting. Relative contraindications include hypertension, hyperthermia, pulmonary edema, myocardial ischemia, hypovolemic shock.
Epinephrine (Adrenalin) adverse/side effects
Nervousness, restlessness,headache, tremor, pulmonary edema, dysrhythmias, chest pain, hypertension, tachycardia, nausea, vomiting
Epinephrine (Adrenalin) drug interactions
potentiates other sympathomimetics. Deactivated by alkaline solutions, MAOIs may potentiate effect. Beta blockers may blunt effects
Epinephrine (Adrenalin) adult dosage and administration for cardiac arrest
IV/IO: 1mg(10 mL of 0.1 mg/mL{1:10000}) every 3 to 5 mins during resuscitation. Follow each dose with a 20 mL flush and elevate arm for 10 to 20 seconds after dose.
Continuous infusion: Add 1mg to 250 mL normal saline or d5w.
Epinephrine (Adrenalin) adult dose in profound bradycardia or hypotension
2 to 10 mcg/min titrated to patient response.
Higher dose: up to 0.2 mg/kg may be used in specific indications, such as beta blocker or calcium channel blocker overdose.
Epinephrine (Adrenalin) pediatric dose for cardiac arrest
IV/IO: 0.01 mg/kg(0.1mL/kg) of a 1mg/mL(1:10000) solution every 3 to 5 minutes during arrest.
ET: 0.1 mg/kg(0.1 mL/kg) of a 1mg/mL(1:1000) solution mixed in 3 to 5 mL of saline until IV/IO access is established. maximum single dose IV: 1mg
maximum single dose ET: 2.5
Epinephrine (Adrenalin) pediatric dose for symptomatic bradycardia
IV/IO: 0.01 mg/kg(0.1 mL/kg) of a 0.1mg(1:10000) solution
Epinephrine (Adrenalin) neonate dosage for bradycardia
0.01 to 0.03 mg/kg of 0.1 mg/mL(1:10000) solution IV followed by 0.5 mL to 1mL normal saline flush to clear the line. dosage may be repeated every 3 to 5 minutes if bradycardia persists.
Epinephrine (Adrenalin) duration of action
onset: immediate
peak effect: minutes
duration: several minutes
Epinephrine (Adrenalin) pregnancy safety category
C Contraindicated for patients in active labor.
Epinephrine (Adrenalin) special considerations
May cause syncope in asthmatic children. May increase myocardial oxygen demand
Lidocaine HCl (Xylocaine) class
antidysrhythmic(class Ib), anesthetic
Lidocaine HCl (Xylocaine) mechanism of action
Cardiac: decreases automaticity by slowing the rate of spontaneous phase 4 depolarization. Local anesthetic: inhibits transport of ions across the neuronal membrane, blocking conduction of normal nerve impulses.
Lidocaine HCl (Xylocaine) indications
Alternative to amiodarone in cardiac arrest from VT, VF, stable wide complex tachycardia(poly or monomorphic) with normal baseline QT interval. Also used as a local anesthetic for various procedures, including intubation and IO infusions.
Lidocaine HCl (Xylocaine) contraindications
Hypersensitivity, second or third degree IV block in the absence of an artificial pacemaker, stokes adams syndrome, prophylactic use in AMI, wide complex ventricular escape beats with bradycardia.
Lidocaine HCl (Xylocaine) adverse reactions/ side effects
anxiety, drowsiness, confusion, seizures, slurred speach, respiratory arrest, hypotension, bradycardia, dysrhythmias, cardiac arrest, AV black, nausea, vomiting.
Lidocaine HCl (Xylocaine) drug interactions
Apnea induced with succinylcholine may be prolonged with high doses of lidocaine. Cardiac depression may occur in conjunction with IV phenytoin. Procainamide may exacerbate CNS effect. Metabolic clearance is decreased in patients with liver disease or in patients taking beta blockers
Lidocaine HCl (Xylocaine) adult dosage for cardiac arrest/pulseless VT/VF
initial dose 1 to 1.5 mg/kg IV/IO repeat dose: 0.5 to 0.75mg/kg IV/IO repeated in 5 to 10 minutes. maximum total dose 3mg/kg
Lidocaine HCl (Xylocaine) adult dose for stable VT, and wide complex tachycardia of unknown etiology
maintenence infusion: 1 to 4 mg/min(30 to 50mcg/kg per minute); can dilute in d5w or normal saline.
Lidocaine HCl (Xylocaine) pediatric dose.
IV/IO : 1 mg/kg rapid IV/IO push
maximum dose: 100mg
continuos IV infusion: 20 to 50 mvg/kg per min.
repeat bolus dose(1mg/kg) when infusion is initiated if bolus has not been given within previous 15 minutes.
Lidocaine HCl (Xylocaine) duration of action
onset: 1 to 5 mins
peak effect: 5 to 10 minutes
duration: variable(15min to 2 hr)
Lidocaine HCl (Xylocaine) pregnancy safety category
B
Lidocaine HCl (Xylocaine) special considerations
reduce maintenance infusion by 50% if patient is older than age 70, has liver or renal disease, is in heart failure, or is in shock. a 75 to 100mg bolus maintains blood levels for only 20 minutes(if not in shock). exceedingly high doses of lidocaine can result in death and coma. Cross reactivity with other forms of local anesthetics.
Norepinephrine Bitrate(Levophed) class
Sympathomimetic, vasopressor
Norepinephrine Bitrate(Levophed) mechanism of action
potent alpha agonist resulting in intense peripheral vasoconstriction, positive chronotropic and increased inotropic effect(from 10% beta effect) with increased cardiac output. Alpha adrenergic activity resulting in peripher vasoconstriction and bet adrenergic activity leading to inotropic stimulation of the heart and coronary artery vasodilation.
Norepinephrine Bitrate(Levophed) indications
cardiogenic shock, unresponsive to fluid resuscitation, significant hypotensive(less than 70mm Hg) states, first line vasopressor in septic shock.
Norepinephrine Bitrate(Levophed) contraindications
hypotensive patients with hypovolemia, pregnancy(relative)
Norepinephrine Bitrate(Levophed) adverse reactions/side effects
headache, anxiety, dizziness, restlessness, dyspnea, bradycardia, hypertension, dysrhythmias, chest pain, peripheral cyanosis, cardiac arrest, nausea, vomiting, urinary retention, renal failure, decreased blood flow to the GI tract, kidneys, skeletal muscle, and skin tissue necrosis from extravasation
Norepinephrine Bitrate(Levophed) drug interactions
Can be dactivated by alkaline solutions. Sympathomimetic and phosphodiesterase inhibitors may exacerbate dysrhythmias. bretylium may potentiate the effects of catecholamines.
Norepinephrine Bitrate(Levophed) adult dosage
0.1 to 0.5 mcg/kg per minute( in 70 kg adult, 7 to 35 mcg/min)
Norepinephrine Bitrate(Levophed) pediatric dosage
begin at 0.1 to 2 mcg/kg per minute IV infusion, adjust rate to achieve desired change in BP and systemic perfusion. Titrated to patient response.
Norepinephrine Bitrate(Levophed) duration of action
onset: 1 to 3 minutes
peak effect: variable
duration: 5 to 10 minutes, lasts only 1 minute after infusion discontinued
Norepinephrine Bitrate(Levophed) pregnancy safety category
C. use cautiously during pregnancy and while breastfeeding. May cause fetal anoxia when used in pregnancy.
Norepinephrine Bitrate(Levophed) special considerations
Infuse norepinephrine through a large, stable vein to avoid extravasation and tissue necrosis. Often used with low dose dopamine to spare decreased renal and mesenteric blood flow. Drug or poison induced hypotension may require higher doses to achieve adequate perfusion.
