Lidocaine Flashcards

1
Q

Lidocaine (xylocaine)

Class

A
  • Antiarrhythmic
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2
Q

Lidocaine (xylocaine)

MOA

A
  • Decrease automaticity by slowing the rate of phase 4 depolarization
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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
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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
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5
Q

Lidocaine (xylocaine)

Adverse reactions

A
  • SZ (with high doses)
  • Altered mental status
  • Confusion
  • Slurred speech
  • Light-headedness
  • Blurred vision
  • Bradycardia
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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
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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
  • 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
  • Maint. infuse: 1-4 mg/min (30-50 µg/kg/min) diluted
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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
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9
Q

Lidocaine (xylocaine)

Duration

A
  • Onset: 1-3 min
  • Peak: 5-10 min
  • Duration: varies (15min - 2hrs)
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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
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