Week 9

Question 1

Amiodarone

Answer 1

amiodarone Antiarrhythmic

Brand: Cordarone

MOA: Lengthens absolute refractory period in hopes of S.A. node to take over. Na+, K+, Ca++ channel blocker. Slows sinus rate, increases PR & QT intervals.

IND: V-tach & perfusing V-tach, WPW, V-fib, stable perfusing

CON: hypotension, Severe sinus node dysfunction, bradycardia, 2 & 3 heart block, shock, sensitivity.

Adverse: Hypotension, anorexia, malaise, fatigue, tremors, n/v
Dose/Route:
Pulseless V-Fib/V-Tach Refractory to defib: 300mg IV push (2nd dose 150mg)
Perfusing V-tach/WPW: 150mg
Maintenance: 1mg/min for 6 hrs; 0.5mg/min 18hrs max daily dose 2.2g
Pedi.—0.5mg/kg. 300mg 30min.

SPCL: half life 44-48 days. Prego Class D, photosensitive

Question 2

Procainamide

Answer 2

procainamide Antidysrhythmic

Brand: Pronestyl

MOA: Slows conduction through myocardium, elevates v-fib threshold, suppress ventricular ectopic activity. Na+, K+ channel blocker.

IND: V-tach, V-fib, WPW, refractory to electricity.

CON: high degree heart block, escape rhythms?WTF?! Bradycardia

Adverse: n/v, anxiety, convulsion, widening QRS.

Dose/Route: 20mg/min until max 17mg/kg
Maintenance—1-4mg/min
Pedi.—15mg/kg drip

SPCL: Class C pregnancy. Stop when: 1) dysrhythmia is eliminated, 2)hypotension ensues, 3)QRS widens by 50%, 4)max dose of 17mg/kg is reached.

Question 3

Mag Sulfate

Answer 3

magnesium sulfate Electrolyte-Antidysrhythmic-Anticonvulsant
MOA: CNS depressant, smooth muscle relaxant, dilation of bronchial

IND: Polymorphic V-tach (torsades de pointes) (often caused by malnutrition). Bronchospasm

CON: Shock, heart block, GI obstruction hypotension, hypothermia, bradycardia, dialysis, renal insufficiency.

Adverse: potentiates digoxin/digitalis, flushing respiratory depression, hypotension, hypothermia, bradycardia.
Dose/Route: VF or VT—1-2g in 1-2 min. (3rd/4th line treatment)
Torsade de Pointes—5-10g @ 1g/min
Pedi—25-50mg/kg over 2-5 min.
Infusion—max 2g/30-60min.
Resp.—1-2g @ 1g/min
Pedi 25-50mg/kg over 2-5min.
OBGYN/Eclamptic Seizures—2-4g IV Drip @ 1g/min
Special: Prego Class A. Do not exceed 1g a minute, burns injection site. Ca++ is antidote. Renal failure = electrolyte dysfunction.

Question 4

Lidocaine

Answer 4

lidocaine Antidysrhytmic-Anesthetic

Brand: Xylocaine

MOA: Suppress, ventricular ectopy, increases v-fib threshold, reduces velocity of electric impulse through conductive system. Sodium channel blocker. Decreases depolarization, decreases automaticity

IND: V-fib & v-tach refractory to electricity.

CON: sensivity, high degree AV block, bradycardia

Adverse: anxiety, drowsiness, dizziness, confusion, n/v, seizures, widening QRS complex.

Dose/Route: 1-1.5mg/kg max dose 3mg/kg 5-10 min.
Maintenance—1-4mg/min
Pedi—1mg/kg

Special: Prego Class B. Don’t make them seize.