Lidocaine Flashcards
1
Q
Lidocaine (xylocaine)
Class
A
- Antiarrhythmic
2
Q
Lidocaine (xylocaine)
MOA
A
- Decrease automaticity by slowing the rate of phase 4 depolarization
3
Q
Lidocaine (xylocaine)
Indications
A
- Alternative to amiodarone in cardiac arrest, from:
- VF
- Pulseless VT
- Stable monomorphic VT
- Stable polymorphic VT with normal baseline QTi
4
Q
Lidocaine (xylocaine)
Contraindications
A
- Hypersensitivity
- 2nd & 3rd deg AV block in absence of artificial pacemaker
- Stokes-Adams syndrome
- Prophylactic use in AMI
- Wide-complex vent escape beats with bradycardia
5
Q
Lidocaine (xylocaine)
Adverse reactions
A
- SZ (with high doses)
- Altered mental status
- Confusion
- Slurred speech
- Light-headedness
- Blurred vision
- Bradycardia
6
Q
Lidocaine (xylocaine)
Drug Interactions
A
- Apnea induced with succinylcholine may be prolonged with high doses of lidocaine
- Cardiac depression may occur in conjunction with IV phenytoin (Dilantin)
- Procainamide exacerbates CNS effects
- Metabolic clearance is decreased in pts with liver disease or taking beta-blockers
7
Q
Lidocaine (xylocaine)
Adult Dosage
A
-
Cardiac arrest from VF/pulseless VT;
- Initial dose 1 - 1.5 mg/kg IV
- Repeat dose in 5 - 10 min at 0.5 - 0.75 mg/kg
- Max of 3 mg/kg
- Initial dose 1 - 1.5 mg/kg IV
-
Stable VT, Wide Complex Tach of uncertain type, significant ectopy:
- From 0.5 - 0.75 mg/kg through 1 - 1.5mg/kg
- Repeat 0.5 - 0.75mg/kg q 5-10min
- Max of 3 mg/kg
- From 0.5 - 0.75 mg/kg through 1 - 1.5mg/kg
- Maint. infuse: 1-4 mg/min (30-50 µg/kg/min) diluted
8
Q
Lidocaine (xylocaine)
Ped Dosage
A
Ped:
-
Bolus dose:
- 1mg/kg rapid IV push
- Max 100mg
-
Continuous infusion:
- 20-50 µg/kg/min
- Administer bolus dose when infusion initiated if bolus has not been given within previous 15 min
9
Q
Lidocaine (xylocaine)
Duration
A
- Onset: 1-3 min
- Peak: 5-10 min
- Duration: varies (15min - 2hrs)
10
Q
Lidocaine (xylocaine)
Special Considerations
A
- Preg Cat: B
- Reduce maintenance infusion by 50% if pt over 70 yo, has liver or renal disease, or is in CHF or shock
- A 75-100mg bolus maintains blood levels for only 20 min
- Exceedingly high levels can result in coma/death
- Not for reperfusion arrhythmias after fibrinolytic therapy
- Cross-reactivity with other forms of local anesthetics