Meds Week 7 Flashcards
Class: class V antidysrhythmic
Adenosine
Indications: SVT or PSVT unresponsive to Valsalva maneuver, regular/monomorphic WCT
Adenosine
Mechanism of action: often referred to as “chemical cardioversion”; slows heart rate by depressing
automaticity in the SA node, slowing conduction of the SA and AV nodes, and inhibiting re-entry
through the AV node
Adenosine
Side effects: flushed skin, chest pain or pressure, nausea, dyspnea, hypotension, heart blocks,
bradycardia, asystole, transient premature complexes, seizures, blurred vision, headache, tingling,
numbness, lightheadedness, dizziness, shortness of breath, bronchoconstriction in asthmatic patients,
metallic taste, throat tightness
Adenosine
Contraindications: hypersensitivity, sinus tachycardia or atrial fibrillation/flutter, despite rate >150, 2nd or 3 rd
degree AV block, sick sinus syndrome, WPW and atrial fibrillation, not effective in the elimination of atrial
flutter, heart transplant, use of carbamazepine (Tegretol),
Adenosine
Precautions: may produce new dysrhythmias that are usually transient
Adenosine
Interactions: carbamazepine (Tegretol) and dipyridamole (Persantine) intensify its effects; antagonized by methylxanthines such as caffeine and theophylline
Adenosine
Routes of administration: rapid IVP/IO (preferably in the AC with an 18-20 gauge IV; administered
over 1-2 seconds and immediately flushed with NaCl)
Adenosine
Prehospital considerations: cannulate a large proximal vein with 18-20g IV, IV port closest to patient
and immediately flush with 10 mL NaCl to ensure rapid administration; run a 6-second ECG strip before,
during, and after administration; patients usually have a 10-second period of escape beats or asystole
before sinus node starts up again – patient may have feeling of impending death and can be frightening;
if WCT is origin, adenosine likely to be ineffective at cardioversion
Adenosine
Adenosine ____ or ____ RIVP followed by _______; may repeat to max dose of _____
6 mg or 12 mg RIVP followed by 10-20
mL NaCl; may repeat to max dose of 24
mg
LA County Adenosine adequate perfusion (narrow or wide
QRS):________ RIVP followed by 10-
20 mL NaCl after _ ,
repeat 12 mg if no conversion
poor perfusion (narrow QRS):
_ RIVP followed by 10-20 mL NaCl,
repeat 12 mg
adequate perfusion (narrow or wide
QRS): 6 or 12 mg RIVP followed by 10-
20 mL NaCl after Valsalva maneuver,
repeat 12 mg if no conversion
poor perfusion (narrow QRS):
12 mg RIVP followed by 10-20 mL NaCl,
repeat 12 mg
Class: class III antidysrhythmic: potassium channel blocker
Amiodarone
Indications: all tachydysrhythmias including v-fib, v-tach with or without a pulse, wide complex
tachycardia of unknown origin, atrial tachycardia, SVT, a-fib, a-flutter, junctional tachycardia; also used
to treat non-exertional angina
Amiodarone
Mechanism of action: slows heart rate by prolonging the duration of phase 3 (repolarization) of the
cardiac action potential and increases refractory periods without significantly effecting resting
potential (by blocking sodium and potassium channels); relaxes smooth muscles causing vasodilation
especially in coronary arteries; also has anti-anginal and sympatholytic properties
Amiodarone
Side effects: headache, dizziness, hypotension, pulmonary toxicity, muscle weakness, numbness,
tingling, fatigue, cardiogenic shock, anorexia, nausea, vomiting, bradydysrhythmias, CHF
Amiodarone
Contraindications: hypersensitivity, 2
nd and 3
rd degree heart blocks, sick sinus syndrome, profound
bradycardia, cardiogenic shock, neonates, none in cardiac arrest
Amiodarone
Precautions: use caution in children and patients with Hashimoto’s thyroiditis, goiter, history of
thyroid dysfunction, CHF, electrolyte imbalance or who are hypersensitive to iodine
Amiodarone
Interactions: increases digoxin levels and enhances other ventricular antiarrhythmics; incompatible
with sodium bicarbonate, heparin and aminophylline, none in cardiac arrest
Amiodarone
Prehospital considerations: monitor HR, BP, and ECG closely post resuscitation; should not be used
routinely in cardiac arrest – only use in VF and VTach without pulses unresponsive to attempted
defibrillation x2 (LA County)
Amiodarone
Amiodarone
pulseless v-fib or v-tach (arrest):
_______, repeat ______ in 3-5 mins PRN
tachydysrhythmias with a pulse:
______ IVPB over 10 minutes (___ mg/min),
repeat PRN
maintenance infusion: ________IVPB
pulseless v-fib or v-tach (arrest):
300 mg, repeat 150 mg in 3-5 mins PRN
tachydysrhythmias with a pulse:
150 mg IVPB over 10 minutes (15 mg/min),
repeat PRN
maintenance infusion: 1 mg/min IVPB
LA County Amiodarone pulseless v-fib or v-tach (arrest):
______, then repeat ______ after 2x
defibrillation (450 mg max)
LA County pulseless v-fib or v-tach (arrest):
300 mg, then repeat 150 mg after 2x
defibrillation (450 mg max)
Class: parasympatholytic/anticholinergic, antidysrhythmic, bronchodilator, antidote
Atropine
Indications: symptomatic bradycardia in adults, suspected AV block or increased vagal tone in pediatrics,
organophosphate or nerve agent poisoning, pretreatment for RSI/DSI
atropine
Indications: pretreatment for RSI/DSI
atropine
Mechanism of action: blocks cholinergic receptors thereby increasing chronotropy and dromotropy
(increasing conduction through AV node and blocking vagal tone), causing bronchodilation, reduced
respiratory secretions and decreased GI secretions and motility
atropine
Side Effects: tachycardia, hypertension, palpitations, increased myocardial oxygen demand, seizures,
dizziness, confusion, dilated pupils, blurred vision, mucous plugs, difficulty swallowing, dry mouth, hot
and dry skin, increased intraocular pressure, headache
atropine
Contraindications: none in emergency settings
atropine
Precautions: not recommended for neonates; use caution in patients with glaucoma (can cause
increased intraocular pressure), 2nd and 3rd degree heart blocks (generally ineffective) or suspected
AMI (atropine will increase myocardial oxygen demand); if paradoxical bradycardia develops, wait 2-3
minutes as the bradycardia will often resolve itself with no corrective action required
atropine
Interactions: none for IV/IM/IO administration
atropine
Atropine
parasympatholytic: _____, repeat PRN
every 3-5 minutes, ____ total max
antidote: _____, repeat PRN every 3-5
minutes
parasympatholytic: 1 mg, repeat PRN
every 3-5 minutes, 3 mg total max
antidote: 2 mg, repeat PRN every 3-5
minutes
Atropine
LA County
cardiac dysrhythmia: _____, repeat PRN
every 3-5 minutes, _____ total max
antidote: _____, repeat PRN every 5
minutes until patient is asymptomatic;
also supplied in disaster caches
as DuoDote (_______)
LA County
cardiac dysrhythmia: 1 mg, repeat PRN
every 3-5 minutes, 3 mg total max
antidote: 2 mg, repeat PRN every 5
minutes until patient is asymptomatic;
also supplied in disaster caches
as DuoDote (2.1 mg atropine and 600 mg
pralidoxime)
Class: antidysrhythmic: Class IV calcium channel blocker, antihypertensive, antianginal
diltiazem
Indications: symptomatic a-fib, a-flutter, SVT, PSVT; at-home medication for angina, Prinz-Metal
angina and hypertension
diltiazem
Mechanism of action: inhibits calcium influx across cell membranes causing coronary vasodilation
and smooth muscle relaxation that decreases PVR, blood pressure and myocardial oxygen demand;
slows SA/AV node conduction
diltiazem
Side effects: headache, edema, nausea, CHF, hypotension, bradycardia, heart block, vomiting,
weakness, dizziness
diltiazem
Contraindications: hypersensitivity, hypotension, 2
nd and 3
rd degree heart blocks, sick sinus
syndrome, AMI, wide-complex tachycardias, WPW or other accessory pathway syndromes
diltiazem
Precautions: use caution in patients with CHF or renal disease
diltiazem
Interactions: do not use concomitantly with beta blockers; in case of overdose, administer calcium
chloride, a fluid challenge and glucagon
diltiazem
diltiazem
IV: ______ or _____, repeat in
15 min at ______ or ______
IVPB: _____ for 24 hrs
IV: 15-20 mg or 0.25 mg/kg, repeat in
15 min at 20-25 mg or 0.35 mg/kg
IVPB: 5-15 mg/hr for 24 hrs
Class: sympathomimetic, catecholamine, inotropic agent, vasopressor, antidysrhythmic bronchodilator
epinephrine (0.1 mg/mL)
Indications: cardiac arrest (asystole, PEA, v-fib, pulseless v-tach)
epinephrine (0.1 mg/mL)
Mechanism of action: acts directly on alpha and beta receptors of the sympathetic nervous system
(SNS) to increase inotropy, chronotropy, dromotropy, automaticity, systemic vascular resistance and
bronchial smooth muscle dilation; decreases vascular permeability
epinephrine (0.1 mg/mL)
Side effects: tachycardia, hypertension, palpitations, anxiety, tremors, dysrhythmias, headache, chest
pain, ventricular fibrillation, seizures, dizziness, nausea, vomiting
epinephrine (0.1 mg/mL)
Contraindications: no contraindications in cardiac arrest
epinephrine (0.1 mg/mL)
Precautions: will increase myocardial oxygen demand; may potentially increase myocardial ischemia;
use caution in patients with underlying cardiovascular disease or who are pregnant; protect from light
epinephrine (0.1 mg/mL)
Interactions: epinephrine is pH dependent and can be inactivated by alkaline solutions such as
sodium bicarbonate; effects are intensified in patients taking antidepressants
epinephrine (0.1 mg/mL)
epinephrine (0.1 mg/mL)
cardiac arrest: _____IV/IO, repeat q 3-5
min of the 0.1 mg/mL concentration
(1:10000)
cardiac arrest: 1 mg IV/IO, repeat q 3-5
min of the 0.1 mg/mL concentration
(1:10000)
epinephrine (0.1 mg/mL)
LA County
cardiac arrest: ____IV/IO, repeat q 5 min
of the 0.1 mg/mL concentration (1:10000) x2
only, max 3 mg
LA County
cardiac arrest: 1 mg IV/IO, repeat q 5 min
of the 0.1 mg/mL concentration (1:10000) x2
only, max 3 mg
Class: antidysrhythmic: Class IB sodium channel blocker; local anesthetic
lidocaine
Indications: patients responsive to pain that have IO access, ventricular dysrhythmias including v-fib,
v-tach with or without a pulse, wide QRS complexes, tachycardia of unknown origin, post-conversion
management of v-tach and v-fib
lidocaine
Mechanism of action:
antidysrhythmic: increases v-fib threshold; decreases automaticity and dromotropy
through fast sodium channel blockade in neuronal membrane, preventing generation of
action potentials, thereby suppressing ventricular ectopy and dysrhythmias
anesthetic: prevents conduction of nerve impulses
lidocaine
Side effects: bradycardia, hypotension, headache, dizziness, lightheadedness, drowsiness, cardiac
arrest, widening QRS complex, dyspnea, respiratory depression, respiratory arrest, seizures, nausea,
vomiting, anxiety, confusion, paresthesia, restlessness, slurred speech, blurred vision, tinnitus, muscle
twitching
lidocaine
Contraindications: none when used for anesthesia in IO placement, hypersensitivity, 2nd and 3rd degree heart blocks, Wolf-Parkinson-White (WPW) syndrome, bradycardia, junctional and
idioventricular rhythms
lidocaine
Precautions: reduce doses (initial and subsequent) by 50% in patients more than 70 years old and
those who have hepatic or renal disease, CHF, or are in shock
lidocaine
Interactions: no significant interactions when used in IO placement, beta blockers, quinidine,
phenytoin (Dilantin), cimetidine (Tagamet) and H2 blockers potentiate the effects of lidocaine;
barbiturates decrease its effects
lidocaine
Routes of administration: slow IVP (50 mg/min), IO, IVPB
lidocaine
lidocaine
cardiac arrest: _____, repeat at
_____ every 3-5 minutes (____
total max)
post-conversion IVPB: ____ IVPB (mix ___ into ___ mL NaCl for a solution of
____/mL)
cardiac arrest: 1-1.5 mg/kg, repeat at
0.5-0.75 mg every 3-5 minutes (3 mg/kg
total max)
post-conversion IVPB: 1-4 mg/min IVPB
(mix 1 g into 250 mL NaCl for a solution of
4 mg/mL)
Prehospital considerations: should be given pre-infusion of IV fluids/meds through IO in responsive
patients; lidocaine 2% should be used; slow infusion is necessary to ensure lidocaine remains in medullary
space; base order is not needed to administer lidocaine as part of the IO procedure
lidocaine
lidocaine
LA County
pain management for IO use (other
than cardiopulmonary arrest): ____
____ slow IO push
LA County pain management for IO use (other
than cardiopulmonary arrest): 2%
40 mg slow IO push
Class: antidysrhythmic: Class IA sodium channel blocker (C)
procainamide
Indications: all tachydysrhythmias including SVT, PSVT, a-fib, a-flutter, v-tach, v-fib, a-fib with WPW
procainamide
Mechanism of action: decreases dromotropy and automaticity and increases refractory period to
suppress ventricular ectopy, decrease myocardial excitability and increase the lengths of the QRS
complex and the QT interval; mild negative inotropic properties
procainamide
Side effects: hypotension, dizziness, headache, ventricular dysrhythmias, heart blocks, widening QRS
complex, lengthened QT interval, seizures, confusion, weakness, irritability, nausea, vomiting
procainamide
Contraindications: hypersensitivity, 2
nd and 3
rd degree heart blocks, Torsades de Pointes,
bradycardia, digitalis toxicity
procainamide
Precautions: discontinue procainamide administration if the QRS complex or QT interval widens by
50% or more, dysrhythmias are suppressed or patient becomes hypotensive; use caution in pediatrics
and patients with a possible AMI, hepatic or renal disease, CHF, asthma, myasthenia gravis and
hypotension; treat hypotension by placing patient in the sock position, giving a fluid bolus and
considering vasopressors
procainamide
Interactions: potentiates the effects of neuromuscular blockers and anticholinergics; use with antihypertensives can cause severe hypotension
procainamide
procainamide
IV: _____ over ___ min
IVPB: _____; ______max
IVPB maintenance: ______
IV: 100 mg over 5 min
IVPB: 20 mg/min; 17 mg/kg max
IVPB maintenance: 1-4 mg/min
