Medications Flashcards
DOPamine action
+ Chronotropic
+ Ionotropic
Increase HR
Increase Contractility
DOPamine indications
Bradyarrhythmia/hemodynamic compromise (2nd line)
After cardiac arrest
DOPamine dose
Bradyarrhythmia: 5-20 mcg/kg/min titrate to effect
After cardiac arrest: 5-20 mcg/kg/min
DOPamine cautions
can increase myocardial oxygen demand
can cause ventricular arrhythmias
Adenosine action
Slows conduction of impulses through the AV node
Adenosine indications
Regular narrow-complex tachyarrhythmias/no hemodynamic
compromise
Regular narrow-complex tachyarrhythmias/hemodynamic
compromise (do not delay cardioversion)
Regular monomorphic wide-complex tachyarrhythmias/no hemodynamic compromise
Adenosine dose
Has an extremely short half-life; administer over 1–2 s, at a site as
close to the heart as possible
6 mg by rapid IV/IO push follow by 10 to 20-mL NS flush
If not effective after 1–2 min, 12 mg by rapid IV/IO push followed by 10 to 20-mL NS flush
Adenosine cautions
Therapeutic effects can be blocked by the presence of caffeine or theophylline
VF possible if adenosine is administered for unstable, irregular or polymorphic wide complex tachycardias
Can temporarily evoke a transiently slow ventricular rate or complete cessation of electrical activity; as drug is eliminated, electrical activity resumes
Amiodarone action
Class III antiarrhythmic; delays repolarization and prolongs the QT interval
Amiodarone indications
Shock-refractory VF/pulseless VT
Refractory tachyarrhythmia with a pulse/hemodynamic compromise
Wide-complex tachyarrhythmia/no hemodynamic compromise
Amiodarone dose
For VF/pulseless VT:
* First dose: 300 mg IV/IO bolus
* Second dose: 150 mg after 3–5 min
For tachyarrhythmia with a pulse:
* 150 mg IV over 10 min; may repeat as needed if arrhythmia recurs
* Maintenance infusion: 1 mg/min for first 6 hours
Amiodarone cautions
Do not use with other drugs that prolong QT interval
Atropine action
Blocks the effect of acetylcholine released by the vagus nerve at muscarinic receptors, thereby increasing the rate of firing of the SA node and conduction through the AV node.
Atropine indications
Bradyarrhythmia/hemodynamic compromise
Atropine dose
1 mg IV bolus every 3–5 min, up to a max dose of 3 mg
Atropine cautions
Use in patients with acute coronary ischemia or myocardial infarction may have negative outcomes because of increased heart rate and myocardial oxygen demand
IV/IO doses of less than 0.1 mg may cause paradoxical bradycardia
Epinephrine action
Acts on both α- and ß-adrenergic receptors; induces systemic
vasoconstriction and increases heart rate and contractility
Epinephrine indications
Cardiac arrest (VF, pulseless VT, pulseless electrical activity, asystole)
After cardiac arrest
Bradyarrhythmia/hemodynamic compromise (second-line agent)
Epinephrine dose
For VF/pulseless VT/pulseless electrical activity/ asystole:
* 1 mg IV/IO followed by 10 to 20-mL NS flush every 3–5 min
For post–cardiac arrest care:
* 2-10 mcg/min IV/IO
For bradyarrhythmia:
* 2–10 mcg/min titrated to effect
Epinephrine cautions
Increased blood pressure, heart rate and myocardial oxygen demand may cause myocardial ischemia
Lidocaine action
Class Ib antiarrhythmic (sodium channel blocker); delays repolarization and slightly increases the QT interval
Lidocaine indications
VF/pulseless VT
Lidocaine dose
First dose: 1–1.5 mg/kg IV/IO followed by 10 to 20-mL NS flush
Subsequent doses: 0.5–0.75 mg/kg IV/IO followed by 10 to 20-mL NS
flush every 5–10 min, up to a max dose of 3 mg/kg
Lidocaine cautions
Do not use prophylactically in patients with acute myocardial infarction
Monitor patient for toxicity
Reduce maintenance dose in patients with hepatic disease or left ventricular dysfunction
Do not alternate between amiodarone and this medication
