Group 3A Flashcards
Epinephrine
Class
Sympathomimetic
Epinephrine
MOA
-Alpha 1 (A1) - Increased systemic vascular resistance (bronchial, cutaneous, renal, & visceral arterial constriction)
-Beta 1 (B1) - Positive inotropic, chronotropic and dromotropic actions
-Beta 2 (B2) - Bronchial smooth muscle relaxation & mild dilation of skeletal vasculature
-Increased myocardial workload and oxygen demand
-Histamine blocker
Epinephrine
Indications
- Cardiac Arrest (V-Fib, PVT, asystole, PEA)
- Severe Bronchospasm (asthma, bronchiolitis)
- Hypotension (refractory to any other therapy)
- Bradycardia
- Anaphylaxis
- Croup
Epinephrine
Adult Dose & Route
- Pulseless arrest
1 mg (10 mL of 1:10,000) IV/IO, repeat every 3-5 min. (No max dose)
-Hypo-perfusion, symptomatic bradycardia or R.O.S.C. (To maintain SBP >90 or MAP >65 mmHg)
10-20 mcg (1-2 mL) IV/IO push every 2 min., (1 mL Epi 1:10,000 in 9mL NS = 10mcg/mL)
2-10 mcg/min IV/IO (2mL of 1:1,000 added to 250 mL D5W/NS gives 8 mcg/mL)
Anaphylaxis/Asthma
0.3 - 0.5 mg (0.3 - 0.5 mL of 1:1000) IM via lateral thigh or deltoid, may repeat every 5–15 min.
1 mg (10 mL of 1:10,000) IV/IO over 5 minutes
2 - 4 mcg/min IV/IO continuous infusion (2 mL of 1:1,000 added to 250 mL D5W/NS gives 8mcg/mL)
Epinephrine
Onset
Peak
Duration
Onset of Action: -IV/IO: < 2 minutes -IM: 3-10 minutes
Peak Effect: -IV/IO: < 5 minutes -IM: 20 minutes
Duration of Action: -IV/IO: 5-10 minutes. -IM: 20-30 minutes
Amiodarone
Class
- Antiarrhythmic agent
Amiodarone
MOA
-Potassium channel blocker slows ventricular automaticity
-Sodium channel blocker slows membrane depolarization & impulse conduction
-Calcium channel blocker & b-blocker: negative chronotropic activity in nodal tissue; rate reduction
-Prolongs refractory period
-Dilates coronary arteries due to calcium channel & alpha-adrenergic blocking action
Amiodarone
Indications
-VF/PVT, polymorphic VT (Torsades) & wide-complex tachycardia with a pulse of uncertain origin
-Hemodynamically stable ventricular tachycardia when cardioversion unsuccessful
-Adjunct to cardioversion of SVT & PSVT
-Rate control in atrial fibrillation and flutter
Amiodarone
Adult Dose & Route
-VF/PVT:
300 mg IV/IO push over a minute, may repeat in 3-5 minutes with 150 mg IV/IO slow push (if needed)
-Wide-complex tachycardia, more than 5 PVCs in a minute, refractory A-fib or flutter, SVT:
150 mg in 100 mL D5 IV/IO over 10 minutes, may repeat in 10 minutes (if needed)
-Infusion after ROSC:
1 mg/min IV/IO drip over 6 hours, then 0.5 mg/min IV/IO over 18 hours, (Max dose 2.2 gm/day)
Amiodarone
Onset of Action
Peak Effect
Duration of Action
Onset: 1-2 minutes
Peak: 10 minutes
Duration: varies
Lidocaine
Class
-Antiarrhythmic
-Anesthetic post-intraosseous insertion
Lidocaine
MOA
-Decreases automaticity
-Equals conduction speed among cardiac muscle fibers
-increased ventricular fibrillation threshold
Lidocaine
Indications
-Suppression of ventricular arrhythmias (V-tach/V-fib, PVCs)
-Prophylaxis against recurrence after conversion from ventricular tachycardia or v-fib
-Frequent PVCs (>6/min or 2 or more in a row; multiform PVCs or R-on-T phenomenon)
-Pre-intubation for head trauma or suspected intracranial hemorrhage
Lidocaine
Adult Dose & Route
-VF/PVT:
1-1.5 mg/kg IV/IO push, may repeat with 0.5 - 0.75 mg/kg IV/IO push in 5-10 minutes (max total dose 3mg/kg)
-Wide-complex tachycardia, more than 5 PVCs in a minute, refractory A-fib or flutter, SVT:
1-1.5 mg/kg IV/IO push, may repeat in 5-10 minutes with 0.5 - 0.75 mg/kg IO push PRN. (Max total dose 3mg/kg)
-Infusion after ROSC:
1-4 mg/min, (1G in 250 mL NS gives 4mg/mL)
-Post IO insertion pain management
2 mL of 2% Lidocaine and wait 2 minutes, right after IO confirmation
Lidocaine
Onset of Action
Peak Effect
Duration of Action
Onset: < 3 minutes
Peak: 5 - 10 minutes
Duration: 10 - 20 minutes for bolus doses
