MEDICATIONS Flashcards
Ipratropium Bromide Dosages
-Adult:
.5mg via handheld neb
Duoneb with 2.5mg albuterol
No repeat dose
-Pediatric
(Over 2/20kg) .5mg w/ 2.5mg Albuterol Duoneb
(Under 2/20kg) .25mg w/ 1.25mg Albuterol
Ipratropium Bromide Classification & MoA
Classifications:
Anti Cholinergic
Bronchodilator
MoA
Inhibits interaction of acetylcholine at receptor site on bronchial smooth muscle.
Ipratropium Bromide Indications, Contraindications, adverse effects
Indications:
Bronchial Asthma, COPD, Emphysema, Chronic Bronchitis, Anaphylaxis, Burns, Toxic Inhalation
Contraindication:
Hypersensitivity
Adverse Effects
Tachycardia, Nausea/vomiting, headache, blurred vision
Albuterol Classifications / MoA
Classifications:
Beta2 Agonist, Sympathomimetic Bronchodilator
MoA
Relaxes bronchial smooth muscle but stimulating Beta2 receptors resulting in bronchodilation and decreased airway resistance.
Albuterol Indications, Contraindications, Adverse Effects
Indications:
Bronchial Asthma, COPD/Emphysema/Chronic Bronchitis, Bronchospasm due to Anaphylaxis, burns, toxic inhalation, crush syndrome > 4 hours
Contraindications:
Tachydysrhythmias
Adverse Effects:
Tachycardia, Anxiety, Dysrhythmias, throat irritation, tremors, palpations, dry mouth.
Albuterol Dosages
-Adult:
2.5MG-5MG via handheld Neb
Duoneb with .5mg Atrovent
-Pediatric (>2/20kg)
2.5mg via Neb
Duoneb with .5mg Atrovent
-Pediatric (<2/20kg)
1.25mg via Neb
Duoneb with .25mg Atrovent
Ondansetron Classifications / MoA
Classification: Antiemetic
MoA: Selective 5-HT3 Serotonin receptor antagonist
Ondansetron Indications / Contraindications
Indications: Control / prevent nausea & vomiting
Contraindications:
Prolonged QT Syndrome
Ondansetron Adverse Effects / Dosages
Adverse Effects: GI Symptoms, Headache,Fever,Blurred Vision, Chest Pain, EKG Changes
Dosages: -Adult: 4mg undiluted slow IV / 4mg ODT Tablet -Pediatric 0.1mg/kg slow IV max 4mg Over 2/20kg 4mg tablet ODT Under 2/20kg 2mg Tablet ODT
Naloxone Classification / MoA/ Pharm
Classification : Narcotic Antagonist
MoA: Reverses all effects due to opioid agents. Reverses respiratory depression and all CNS PNS system effects.
Pharm: Onset within few minutes via IV
IM/ET results in slower onset of action
Naloxone Indications/Contraindications/ Adverse Effects
Indications:
Reverse respiratory and CNS System depression induced by opiates
Contraindications:
Newborns / neonates of addicted mothers.
Adverse Effects:
NONE
Naloxone Dosages
-Adult:
.4mg - 2mg IV/IO/IM or 2mg in 2ml IN, Repeat as necessary to maintain respiratory activity.
-Pediatric:
.1mg/kg IVP/IO/IM/IN up to max initial dose of 2mg, Max of .5mg/kg total dose.
Magnesium Sulfate Classifications
Electrolyte, Antidysrhythmic, Anticonvulsant, CNS Depressant, Smooth Muscle Relaxant
Magnesium Sulfate MoA
As antidysrhythmic, Magnesium sulfate is a physiological calcium channel blocker reducing SA Node impulse formation and prolongs conduction time in the myocardium.
As anticonvulsant, Magnesium sulfate redusces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction.
Magnesium Sulfate Indications / Contraindications
Indications:
Preeclampsia/eclampsia, Torsades des Pointes, Refractory Ventricular Fibrillation, Pulseless Ventricular Tachycardia with suspected hypomagnesemia, Status asthmaticus
Contraindications:
Myasthenia Gravis, Impaired renal function
Magnesium Sulfate Dosages
Eclamptic Seizure:
4g diluted in 50ml NS / D5W and slow IV infusion over 5-10 Min
Torsades De Pointes w/ pulse:
2g diluted in 50ml D5W slow IVP over 10 min.
Refractory VF & Torsades De Pointes w/o Pulse:
Adult : 1-2g diluted in 50ml D5W slow IVP over 2min.
Pediatric : 25mg - 50mg/kg diluted in 50ml Slow IV/IO push over 2 minutes. Max dose of 2g
Status Asthmaticus;
1g-2g in 50ml NS / D5W IV over 5-10 min
Methylprednisolone Classifications / MoA
Classifications:
Corticosteroid, Anti-inflammatory, Suppresses immune response
MoA:
Enters target cells and causes many complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects. Thought to stabilize cellular and intracellular membranes. Onset within 1-6 hours
Methylprednisolone Indications / Contraindications / Adverse effects
Indications:
Allergic Reaction, Anaphylaxis, Asthma, COPD
Contraindications:
Known hypersensitivity, Premature Infant, Systemic fungal infection
Adverse Effects: None from single dose
Methylprednisolone Dosages
Adult:
125mg Slow IV/IO/IM
Pediatric:
2mg/kg slow IV/IO/IM (max dose of 125mg)
Epinephrine
Indications, Contraindications, Adverse Effects
Indications:
Cardiac Arrest, Anaphylaxis, Bronchial Asthma, Respiratory Stridor (suspected croup), sympathomimetic bradycardia, return of spontaneous circulation
Contraindications:
Hypertension
Adverse Effects:
Tachydysrhythmias, hypertension, may induce early labor in pregnancy women, headache, nervousness, tremors/shakes, rebound edema after 20-30 minutes in croup patients
Epinephrine
Classification, MoA
Class: Adrenergic Catecolamine, Sympathomimetic Vasopressor
MoA: Administration of epi causes “fight or flight” response
Alpha: Peripheral Vasoconstriction
Beta1: Increased inotropy, chronograph, dromotrophy, automaticity.
Beta2: Bronchodialation & skeletal muscle vasodialation
Epinephrine
Dosage
Anaphylaxis / Asthma:
**for severe anaphylaxis with life threatening manifestations, consider 0.1MG (1:10,000) slow IV/IO infusion over 5 minutes.
Adult: 0.3-0.5mg (1:1,000) SQ/IM
Ped: 0.01mg/kg (1:1,000) SQ / IM Not exceeding 0.3mg
Croup:
Ped: 1:1,000 3mg via nebulizer, diluted in 3mg NS, 1 repeat dose. / 0.01mg/kg (not to exceed .3mg) SC/IM
Furosemide
Classification, MoA
Class: Loop Diuretic
MoA: Inhibits reabsorption of sodium chloride in the loop of Henle & proximal tubule of the nephron in the kidneys.
Furosemide
Indications, Contraindications
Indications: CHF, Pulmonary Edema
Contraindications: Hypovolemia/ Dehydration, Hypokalemia/ electrolyte diffusion
Furosemide
Adverse Effects, Precautions
Adverse Effects: Hypotension, Electrolyte Imbalance
Precaution: Flush line well before & after administration
Furosemide
Dosage
Dosage:
0.5mg-1mg / kg IV/IO
(40mg if not taking Lasix, 80mg If taking lasix)
Diphenhydramine
Classification, MoA, Pharma
Class: Antihistamine
MoA: H1 Receptor antagonist blocking histamine from binding. Reducing Allergic & anaphylactic response.
Pharma: Effects begin 1-5 Min after IV Dose, peak effect 1-4 hours, metabolized by liver
Diphenhydramine
Indications, Contraindications, Adverse Effects
Indications: Allergic Reaction, Anaphylaxis, Dystonic Reactions, chemical restraint
Contraindications: Asthma Exacerbation
Adverse Effects:
Drowsiness, Loss of Coordination, Blurred Vision, Headache, Hypotension, Tachycardia, Palpitations, Thickening of bronchial secretions leading to chest tightness & wheezing.
Diphenhydramine
Dosage
Adult:
25-50mg Slow IV/IO or IM
Pediatric:
1mg / kg (not to exceed 25mg) Slow IV/IO or IM
Nitroglycerine
Classification, MoA, Pharma
Class: Nitrate, Vasodilator
MoA: Vasodilator effect on veins more than arteries, decreases right side heart return (preload), by venous pooling, decreasing Myocardial workload and oxygen consumption.
Pharma:
Absorbed thru oral mucosa or skin, antianginal and vasodilator effects within 1-2 min after admin, half life 1-4 min duration of action less than 5 min.
Nitroglycerine
Indications, Contraindications, Adverse Effects
Indications: Treatment of angina, CHF, acute pulmonary Edema, Symptomatic hypertensive crisis
Contraindications: Pediatric under 12yoa, viagra or levitra ingestion within 24 hours, Cialis ingestion within 48 hours, asymptomatic hypotension, BP Systolic below 90mmHg
Adverse Effects: Headache, hypotension, nausea, dizziness, decreased LOC
Nitroglycerine
Dosages
Chest Pain-
0.4mg sublingual every 3-5min 1.2mg max dosage
Pulmonary Edema/CHF;
Low dose 0.4mg SL x3 Dose (repeat in 3-5 min if symptoms persist)
Nitro paste 1” applied to chest wall.
Morphine Sulfate
Classification, MoA, Pharma
Class: Narcotic Analgesic
MoA: Decreases pain perception & anxiety producing euphoria
Decreases respiratory effort, causes peripheral dial action decreasing preload
Decreases left ventricular afterload.
Pharma:
Binds w/ opiate receptors in the CNS, altering perception and response to pain. Onset in less than 5 min after IV Dose, Lasts 4-5 hours, Causes peripheral arterial and venous dilation
Morphine Sulfate
Indications, Contraindications, Adverse Effects
Indications:
Acute MI, Burns, Isolated injuries requiring pain relief, Pulmonary Edema / CHF
Contraindications:
Head Injury, Multisystem trauma, COPD w/ compromised respiratory effort, hypotension
Adverse Effects:
Respiratory depression & arrest, altered mental status, increased fatal tone due to suppression of sympathetic pathways, nausea & vomiting, Bronchospasm, itch,
Morphine Sulfate
Dosage
Adult:
AMI/ Pulmonary Edema:
2mg-10mg slow IV/IO/IM (if systolic over 90mmHg) for pain not relieved by nitro
Isolated Injury:
Single Dose 2-10mg slow IV/IO/IM Addl’ 2-10mg MAX 20MG until pain relieved.
Burn: 2-20mg slow IV/IO/IM
Pediatric: Isolated Inj (including burns eye trauma, frostbite)
Single dose: 0.1mg / kg slow IVP or IM (If systolic over 100mmHg) Max of 10mg
Aspirin
Classification, MoA
Class: Antiplatelet, Antipyretic, Analgesic, anti inflammatory
MoA: Prevents formation of Thromboxane A1, inhibiting the clotting cascade by decreasing platelet aggregation, prolongs bleeding time.
Aspirin
Indications, contraindications, Adverse Effects
Indications: Chest Pain, of suspected cardiac origin acute Coronary syndrome
Contraindications:
Any bleeding disorder
Adverse Effects:
Bleeding
Aspirin
Dosages
81mg - 324mg
Adenosine
Class, MoA, Pharma
• Classification:
▪ Antidysrhythmic Agent
• Mechanism of Action:
▪ Slows conduction by decreasing automaticity in SA and AV Nodes, therefore decreasing
tachycardias that originate above the ventricles.
• Pharmacokinetics:
▪ Onset of action within 5 to 20 seconds following an IV dose; half-life is 6 - 10
seconds.
Adenosine
Indications, Contra, Adverse, Precautions
• Indications:
▪ SVT/PSVT
▪ Wide Complex-Regular Tachycardias of unknown origin (Diagnostic Treatment)
• Contraindications:
▪ Knownhypersensitivity
▪ WPW (Consultation with MED control required)
▪ Confirmed Ventricular Tachycardia, Atrial fibrillation, and Atrial flutter.
• Adverse Effects:
▪ Flushing, dyspnea, chest pressure, nausea, headache, dizziness, and hypotension, Feeling
of impending doom
• Precautions:
▪ Metabolized rapidly, deliver via proximal IV site (antecubitus) or humerol IO. ▪ Caution in asthmatic patients or patients with known heart disease.
▪ Be prepared for up to 40 seconds of asystole.
Adenosine
Dosage
• Dosage:
▪ Administer via rapid IV/IO followed by a rapid NS flush.
• Adult:
• First dose: 6 mg
• Second dose: 12 mg if no response within 2 minutes
• Pediatric:
• First dose: 0.1 mg/kg, maximum dose 6 mg
• Second dose: 0.2 mg/kg, maximum dose 12 mg
Amiodarone
Class, MoA,
• Classification:
▪ Antiarrhythmic
• Mechanism of Action:
▪ Blocks multiple channels : sodium, potassium,and calcium
▪ Blocks alpha and beta-adrenergicreceptors.
▪ Prolongs the effective refractory period
▪ Exerts an anti-fibrillation effect without altering myocardial membrane potential.
(Chemical Defibrillator)
▪ Slows conduction through the HIS-Purkinje system.
▪ Slows conduction through accessory pathways. (WPW)
Amiodarone
Indications, Contraindications
• Indications:
▪ Ventricular fibrillation
▪ Ventricular tachycardia with and without a pulse
▪ Refractory supraventricular tachycardias to include atrial fibrillation and atrial flutter ▪ Reentry tachycardia rate control (WPW)
• Contraindications:
▪ None in cardiac arrest
▪ SA node dysfunction
▪ Cardiogenic shock
▪ High degree heart block (2nd Degree Type II and 3rd Degree)
▪ Iodine Allergy
Amiodarone
Adverse Effects, Precautions
• Adverse Effects:
▪ Hypotension
▪ Bradycardia
▪ Congestive heart failure
▪ Nausea and vomiting
• Precautions:
▪ Combination with other antiarrhythmics may potentiate arrhythmias
▪ Medication must be carefully withdrawn from vial to avoid air bubbles –
Do not agitate vial
▪ In case of hypotension/bradycardia, STOP infusion and administer fluid bolus of 250 ml – 2 Liters.
Amiodarone
Dosages
Adult
VF/Pulseless VT:
• 1st Dose: 300 mg (diluted in D5W for a total of 20 - 30 ml) IV/IO.
• 2nd Dose:150mg (diluted in D5W for a total of 20-30ml) in 3-5 minutes
(for a maximum total bolus of 450 mg)
Wide Complex Tachycardia with a pulse:
• 150 mg (diluted in D5W for a total of 50 - 100 ml) over 10 minutes
Maintenance infusion:
• 1 mg/min (100 mg in 100 ml D5W)
▪ Pediatric: VF/Pulseless VT:
• 5 mg/kg IV/IO bolus diluted in 20 - 30ml D5W. Repeat every 3 - 5 minutes max 15 mg/kg
VT with a pulse:
• 5 mg/kg IV/IO diluted in 100 ml D5W infused over 20 - 60 minutes
Maintenance Infusion:
• No current AHA recommendations
Atropine
Classification, MoA
• Classification:
▪ Parasympatholytic (vagolyticaction)
▪ Anticholinergic (accelerates the heart rate)
• Mechanism of Action:
▪ Inhibits parasympathetic stimulation by blocking acetylcholine receptors.
▪ Decreases vagal tone resulting in increased heart rate and AV conduction.
▪ Dilates bronchioles and decreases respiratory tract secretions.
▪ Decreases GI secretions.
• Pharmacokinetics:
▪ Accelerated heart rate within minutes of IV injection
▪ Peak effect is seen within the first 15 minutes
Atropine
Indications, Contraindications, Adverse Effects
• Indications:
▪ Symptomatic bradycardia
▪ Cholinergic/Nerve Agent poisoning
▪ Organophosphate Poisoning
• Contraindications:
▪ Known hypersensitivity
▪ Dysrhythmias in which enhancement of conduction may accelerate the ventricular rate and
cause decreased cardiac output.(e.g.atrial fibrillation, atrial flutter, or PAT with block)
• Adverse Effects:
▪ Excessive doses of atropine can cause delirium, restlessness, disorientation, tachycardia,
coma, flushed and hot skin, ataxia, blurred vision, dry mucous membranes.
▪ Ventricular fibrillation and tachycardia have occurred following IV administration of
atropine.
Atropine
Dosages
▪ Bradycardia:
Adult:
• Administer 0.5 mg IV/IO/ET repeated every 3 - 5 minutes to a maximum dose of 3 mg
Pediatric:
• Administer 0.02 mg/kg IV/IO/ET (minimum dose 0.1 mg)
▪ Cholinergic/ Organophosphate poisoning: Adult:
• Administer 1 - 4 mg IV/IO/ET or IM every 5 - 10 minutes or until Atropinization occurs.
Pediatric:
• Administer 0.01 - 0.04 mg/kg IV/IO/ET or IM every 5 - 10 minutes
Diltiazem
Class, MoA
• Classification:
▪ Calcium channel blocker
▪ Antidysrhythmic
• Mechanism of Action:
▪ Binds to open calcium channels preventing repolarization until dissociation.
▪ Decreases SA nodal discharge, AV nodal conduction, afterload, and myocardial contractility.
Diltiazem
Indications, Contraindications, Adverse Effects
• Indications: ▪ Stable uncontrolled atrial flutter or fibrillation with sustained rates greater than 120/min. ▪ Second-line medication for stable regular-narrow complex tachydysrhythmias. (SVT,PSVT) • Contraindications: ▪ Known hypersensitivity ▪ Shock or hypotension ▪ High degree heart block (2nd Type II or 3rd degree) ▪ Heart failure ▪ Ventricular tachycardia • Adverse Effects: ▪ Hypotension ▪ Dysrhythmias ▪ Nausea and vomiting ▪ Headaches
Diltiazem
Dosages
▪ Adult:
Initial:
• 0.25 mg/kg slow IV/IO over 5 minutes (Generally accepted max of 20 mg first dose) Repeat in 15 minutes:
• 0.35 mg/kg slow IV/IO over 5 minutes (Generally accepted max of 25 mg second
dose)
Maintenance Infusion:
• 5 - 15 mg/hour titrated to rate
Dopamine
Class, MoA
• Classification:
▪ Sympathomimetic
▪ Inotropic Agent
▪ Vasopressor
• Mechanism of Action:
▪ Alpha-and beta-adrenergic receptor stimulator
▪ Dopaminergic receptor stimulator
▪ Precursor of norepinephrine
• Low dose: 1 - 2 mcg/kg/min (Renal Dose)
- Dilates renal and mesenteric blood vessels
• Moderate Dose: 2 - 10 mcg/kg/min (Cardiac Dose)
- Beta1 stimulating effecton heart results in increased cardiac output and chronotropy
• High dose: 10 - 20 mcg/kg/min (Vasopressor Dose)
- Alpha1 stimulating effects may reverse mesenteric and renal artery dilatation resulting in decreased blood flow, causing increased preload due to effects on venous system.
- Widespread peripheral vasoconstriction.
Dopamine
Pharma, Adverse
• Pharmacokinetics:
▪ Extremely rapid onset of action
▪ Extremely brief duration of action
▪ The rate of administration may be used to control the effect of dopamine.
• Adverse Effects: ▪ Anginal pain ▪ Tachydysrhythmias ▪ Nausea and vomiting ▪ Hypertension
Dopamine
Indications, Contraindications
• Indications:
▪ Cardiogenic shock (after conservative volume replacement = 5-10ml/kg) ▪ Shock (All Etiologies - after sufficient volume replacement)
▪ Symptomatic bradycardia (after Atropine administration)
• Contraindications:
▪ Pre-existing tachydysrhythmias
▪ Uncorrected hypovolemia
Dopamine
Dosages
▪ For IV infusion use only.
▪ In general, the infusion rate is adjusted to blood pressure and clinical response.
(Systolic BP less than 90)
▪ Adult:
• 2 - 20 mcg/kg/min IV drip titrated to BP of 90mmHg systolic.
Initial infusion typically starts at 5 mcg/kg/min, titrate to desired response.
▪ Pediatric:
• 2 - 20 mcg/kg/min IV drip titrated age specific BP or medical consultation selected BP;
Initial infusion rate is 2 mcg/kg/min
Lidocaine
Class, MoA
• Classification:
▪ Antidysrhythmic
▪ Na+ (Sodium) Channel blocker
• Mechanism of Action:
▪ Suppresses ventricular dysrhythmias by stabilizing cell membranes.
▪ Blocks fast sodium channels increasing recovery period during
repolarization.
▪ Increases Ventricular fibrillation threshold.
▪ Acts only on Ventricular rhythms.
Lidocaine
Indications, Contraindications
• Indications:
▪ Ventricular tachycardia (VT) with/without a pulse
▪ Ventricular fibrillation(VF)
▪ Prevent recurrence of ventricular fibrillation/tachycardia after
defibrillation and conversion to supraventricular, perfusing rhythm. (Maintenance Drip)
▪ Reduce or eradicate ventricular ectopy (Malignant PVC’s)
▪ Decrease intracranial pressure with Rapid Sequence Intubation (Controversial)
▪ Via IO for numbing from pain experienced from IO Infusion
• Contraindications:
▪ AV blocks
▪ Sensitivity to lidocaine
▪ Idioventricular escape rhythms
▪ Accelerated idioventricular rhythm
▪ Sinus bradycardia or arrest or block
▪ Stokes-Adams Syndrome
▪ Wolff-Parkinson-White (WPW)
Lidocaine
Adverse Effects, Precautions
• Adverse Effects:
▪ Lidocaine may cause clinical evidence of toxicity usually related to the central nervous
system.
▪ Toxicity:
• Early: muscle twitching, slurred speech, altered mental status, decreased hearing, paresthesia(pinsandneedles), anxiety,apprehension,visual disturbances,nausea, numbness, difficulty breathing or swallowing, decreased heart rate.
• Late:convulsions, hypotension, coma, widening of QRS complex, prolongation of the P-R interval, hearing loss, hallucinations.
• Precautions:
▪ Reduce the dosage in patients with decreased cardiac output, liver dysfunction, and
the elderly. (Age over 70)
▪ Bolus doses should be administered over a 1-minute period, except in ventricular
fibrillation/ pulseless ventricular tachycardia, when they are administered IV/IO.
▪ Inactivated in alkaline solutions such as Sodium Bicarb. Use a separate IV line or flush
thoroughly before administration through same line.
Lidocaine
Dosages
▪ Adult VT with pulse:
• 0.5 - 1.5 mg/kg slow IV/IO every 5 - 10 minutes as needed, up to 3 mg/kg.
• Repeat doses are half of initial doses when using 1mg/kg or greater.
▪ Adult VT without pulse:
• 1 - 1.5 mg/kg IV/IO bolus initially followed by repeat doses every 5 - 10 minutes to
a maximum of 3 mg/kg.
• Repeat doses are half of initial dose.
▪ Pediatric VT With/Without pulse:
• 1 mg/kg slow IV/IO bolus every 5 - 10 minutes, as needed, to maximum of
3 mg/kg.
▪ IO administration for numbing during IO Infusion: Adult:
• 20 - 40 mg slow IO push
Pediatric
• 0.5 mg/kg slow IO push
▪ For maintenance infusion of post arrest patients:(ROSC)
• 1-4mg/min. Calculate the total lidocaine administered and administer your
maintenance at the next whole number of milligrams per minute. (i.e.administered 1.5mg/kg during arrest, your maintenance infusion will be 2
mg/min)
▪ How to Mix: 1 gm/250ml D5W
▪ Concentration: 4 mg/ml
▪ Dose:1–4mg/min
Metoprolol
Class, MoA
• Classification:
▪ Beta blocker
• Mechanism of Action:
▪ Decreases chronotropy, dromotropy, and inotropy, thus reducing cardiac output as well as O2 demand. Blocks beta receptors in the bronchial smooth muscle, inhibiting bronchodilation.
Metoprolol
Indications, Contra
• Indications:
▪ Refractory PSVT/SVT
▪ Atrial Fibrillation / Atrial flutter with a sustained ventricular rate greater than 120 ▪ Acute Coronary Syndromes associated with STEMI and Tachycardia
• Contraindications:
▪ Heart rate less than 100 bpm (relative)
▪ Systolic blood pressure less than 90 mmHg
▪ 2nd or 3rd degree AV heart block
▪ Asthma attack or COPD exacerbation
▪ Shock
Metoprolol
Adverse Effects
• Adverse Effects:
▪ Hypotension ▪ Dysrhythmias ▪ CHF
▪ Nausea and Vomiting ▪ CNS changes
Metoprolol
Dosages
▪ Adult: • 5 mg slow IVP over 5 minutes • May repeat x2 every 5 minutes • Stop infusion if SBP less than 90 mmHg or patient develops trouble breathing ▪ Pediatric: • Not included in any pediatric protocol
Verapamil
Class, MoA
• Classification:
▪ Calcium channel blocker ▪ Antidysrhythmic
• Mechanism of Action:
▪ Binds to open calcium channels preventing repolarization until dissociation.
▪ Decreases SA nodal discharge, AV nodal conduction, afterload and myocardial
contractility.
▪ Dilates coronary arteries.
Verapamil
Indications, Contra
• Indications:
▪ Stable uncontrolled atrial flutter or fibrillation with RVR
▪ Second line medication for stable narrow complex tachydysrhythmias (PSVT/SVT)
• Contraindications:
▪ Known hypersensitivity
▪ Shock or Hypotension
▪ WPW
▪ Sick sinus syndrome
▪ High degree heart block (2nd Type II or 3rd)
▪ Heart failure
▪ Ventricular tachycardia
Verapamil
Adverse Effects, Precautions
• Adverse Effects: ▪ Hypotension ▪ Dysrhythmias ▪ Nausea and vomiting ▪ Headaches • Precautions: ▪ Avoid in nursing mothers and administer during pregnancy only if benefits justify risk to fetus
Verapamil
Dosage
▪ Adult: Initial: • 2.5 - 5 mg IV/IO over 2 minutes. Repeat: • 5 - 10mg in 15 to 30 minutes. Max 20 mg. ▪ Pediatric: • Not Indicated
