Drug Group 5A

Question 1

Adenosine

Class

Answer 1

• Antiarrhythmic (endogenous nucleoside)

Question 2

Adenosine

MOA

Answer 2

• Pauses heart rate to assist differentiation between ventricular and non-ventricular arrhythmia origin.
• Slowing conduction by interrupt re-entrant pathways through the av node

Question 3

Adenosine

Indications

Answer 3

• Conversion of supraventricular tachycardia (SVT) with no known atrial fib or flutter present
• Wide complex tachycardia of unknown origin

Question 4

Adenosine

Adult Dose & Route

Answer 4

• initial:
  • 6mg IV/IO fast push, followed quickly with 20mL of NS bolus.
• repeat: may repeat once, if no response to first dose, in 1 – 2 min with • 12mg IV/IO fast push using the same procedure as above.

Question 5

Adenosine

Onset of Action
Peak effect
Duration of Action

Answer 5

Onset of action: seconds

Peak effect: seconds

Duration of Action: 10-12 seconds (drug half-life of 5 seconds)

Question 6

DILTIAZEM (Cardizem)

Class

Answer 6

• Calcium channel blocker

Question 7

DILTIAZEM (Cardizem)

MOA

Answer 7

• Inhibits calcium ion influx across cell membrane during cardiac contraction (depolarization)
• Decreased SA & AV node conduction
• Dilates coronary & peripheral arteries.
• Slows the rapid ventricular response (RVR) associated with a-fib/a-flutter.

Question 8

DILTIAZEM (Cardizem)

Indications

Answer 8

• A-fib/flutter with rapid ventricular response (RVR)
• SVT refractory to adenosine

Question 9

DILTIAZEM (Cardizem)

Adult dose & Route

Answer 9

• Initial:
  • 0.25 mg/kg IV/IO SLOWLY (over 2–3 min.), may give remaining dose in 10 min. if needed
  
  • patients > 65 years old, max dose is 10 mg per dose
• Repeat:
  • 0.35 mg/kg IV/IO SLOWLY (over 2–3 min.), in 15 min. if needed
• Maintenance infusion:
  • 5–15 mg/hr. (5–15gtt/min. with 60 drop set) IV/IO infusion
  *to make infusion: add 20 mL of 5 mg/mL Cardizem to 80 mL of NS
• (DO NOT forget to take 20 mL out of the 100mL bag of normal saline)

Question 10

DILTIAZEM (Cardizem)

Onset of Action
Peak effect
Duration of Action

Answer 10

Onset of action: immediate

Peak effect: 2 hrs. or less

Duration of Action: 4-6 hrs.

Question 11

VERAPAMIL HCL

Class

Answer 11

• Calcium channel blocker

Question 12

VERAPAMIL HCL

MOA

Answer 12

• Blocks calcium ion influx into cardiac muscle cells (depresses effects on cardiac contractility)
• Prolongs refractory period in the av node (slows conduction) due to calcium channel blocking.
• Slows SA node discharge.

Question 13

VERAPAMIL HCL

Indications

Answer 13

• Supraventricular tachycardia (SVT)
• Atrial fib/flutter with rapid ventricular response (RVR)

Question 14

VERAPAMIL HCL

Adult dose & Route

Answer 14

• Initial:
  • 2.5 – 5 mg IV/IO SLOWLY (over 2–3 min.) titrate for effect
• Repeat: may repeat in 15-30 min. as needed with
  • 5–10 mg IV/IO SLOWLY (over 2–3 min.) titrate for effect
• MAX TOTAL DOSE OF 20 MG

Question 15

VERAPAMIL HCL

Onset of Action
Peak effect
Duration of Action

Answer 15

Onset of action: 1-3 min.

Peak effect: 3-5 min

Duration of Action: 2-5 hours

Question 16

CALCIUM CHLORIDE

Class

Answer 16

• Electrolyte

Question 17

CALCIUM CHLORIDE

MOA

Answer 17

• Increases extracellular & intracellular calcium levels.
• Increases cardiac contraction strength (positive inotropic effect)
• Enhance ventricular automaticity.

Question 18

CALCIUM CHLORIDE

Indications

Answer 18

• Acute hypocalcemia
• Calcium channel blocker overdose
• Acute hyperkalemia (known or suspected)
• Hypermagnesemia
• Pre-treatment for verapamil administration

Question 19

CALCIUM CHLORIDE

Adult dose & Route

Answer 19

• Hypocalcemia, calcium channel blocker OD, hyperkalemia, hypermagnesemia:
  • 0.5 – 1 Gm (5 – 10 mL) IV/IO of 10% CaCl IV/IO over 5 min, repeat as needed.
  *ENSURE IV/IO patency before delivery of med.
• Pre-treatment for IV Verapamil administration:
  • 0.3 Gm (3 mL) IV/IO of 10% CaCl IV/IO over 5 min.

Question 20

CALCIUM CHLORIDE

Onset of Action
Peak effect
Duration of Action

Answer 20

Onset of action: seconds

Peak effect: 3-5 minutes

Duration of Action: 15-30 min