Drugs - Amiodorone, Epinephrine, Atropine

Question 1

Amiodarone: Action/Kinetics

Answer 1

Blocks sodium channels at rapid pacing frequencies. This delays repolarization and increases the duration of the action potential. After IV use, Amiodarone relaxes vascular smooth muscle, reduces peripheral vascular resistance (after load)

Question 2

Amiodarone: indications

Answer 2

VF and pulseless VT refractory to defibrillation

Stable and Unstable VT refractory to cardioversion

Question 3

Amiodarone: Contraindications

Answer 3

Hypersensitivity
Cardiogenic shock
Bradycardia
AV blocks

Question 4

Amiodarone: adult dose

Answer 4

Pulseless VF/VT: 300 mg IV push
Consider repeating 150 mg IV push in 3-5 minutes

Wide complex tachycardia (stable): 150mg rapid IV (15mg/min) over first 10 minutes

May repeat 150 mg rapid infusion IV every 10 minutes as needed

Question 5

Amiodarone: Pediatric

Answer 5

Pulseless VF/VT: 5mg/kg IV/IO bolus

Perfusing VT: 5mg/kg IV/IO over 20-60 min.

Question 6

Epinephrine: Generic Name and Classification

Answer 6

Epinephrine hydrochloride

Sympathomimetic Cardiac stimulant, bronchodilator, vasopressor, anti allergic

Question 7

Epinephrine: action/kinetics

Answer 7

Cardiac stimulant (pos. Inotropic effect, pos. Chronotropic effect), stimulates alpha and beta adrenergic receptors within the sympathetic nervous system, increases myocardial and cerebral blood flow during CPR. Vasoconstriction

Question 8

Epinephrine: contraindications

Answer 8

Angle closure glaucoma
Shock (other than anaphylactic)
Organic brain damage
Cerebral arteriosclerosis
Labor and delivery
**do not use to treat overdose of adrenergic blocking agents**

Question 9

Epinephrine: dosage adult

Answer 9

Cardiac arrest: 1mg (1:10,000) administered IV every 3-5 minutes during resuscitation

Anaphylaxis: 0.3-0.5 mg (1:1000) IM or SQ; 0.3-0.5 mg (1:10,000) dilution if hypotensive or poor perfusion

Asthma: with severe bronchoconstriction 0.3-0.5 mg SQ (1:1000)

Question 10

Epinephrine: pediatric dose

Answer 10

Cardiac arrest: 0.01 mg/kg (1:10,000) up to 1mg IV or IO

Anaphylaxis: 0.01 mg/kg (1:1000) SQ or IM up to 0.3 mg if patient was exposed to commonly recognized allergen and has respiratory distress

Question 11

Atropine: Generic name and Classification

Answer 11

Atropine sulfate

Anti arrhythmic, anticholinergic, antidote

Question 12

Atropine: action/kinetics

Answer 12

Anticholinergic that inhibits acetylcholine at the parasympathetic neuroeffector junction.

Increase HR by the decrease in Vagal effects on the AV and SA node

Question 13

Atropine: indications

Answer 13

Hemodynamically unstable bradycardia
Organophosphate Poisoning or nerve agent exposure
Beta blocker or calcium channel blocker overdose

Question 14

Atropine: contraindications

Answer 14

Hypothermic bradycardia

Narrow angle glaucoma

Question 15

Atropine: adult dosage

Answer 15

0.5-1.0 mg IV every 3-5 minutes as needed up to a total of 3 mg

Organophosphate poisoning: 2-4 mg repeated until blood pressure and heart rate are stable

Question 16

Atropine: pediatric dosage

Answer 16

0.02 mg/kg IV/IO/ET up to 0.5 for child up to 1.0 adolescent
May be repeated once in 5 minutes

No organophosphate poisoning dosage

Question 17

Amiodarone: Generic Name and Classification

Answer 17

Amiodarone Hydrochloride

Anti arrhythmic