Drug Box 2-2A

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Drug Box 2-2A
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2011-11-29 20:35:54
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Drug Box 2-2A
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  1. Adenosine

    Generic Name
    adenosine
  2. Adenosine

    Brand Name
    Adenocard
  3. Adenosine

    Class
    antiarrhythmic, endogenous nucleoside
  4. Adenosine

    Mechanism of Action
    • * Slows conduction time through AV node; can interrupt re-entrant pathways through the AV node.
    • * Slows sinus rate.
    • * Larger doses decrease BP by decreasing peripheral resistance.
  5. Adenosine

    Indications and Field Use
    • * Conversion of supraventricular tachycardias with no known atrial fibrillation or atrial flutter.
    • * Wide complex tachycardia of uncertain origin unresponsive to lidocaine.
  6. Adenosine

    Contraindications
    • * Sick sinus syndrome, 2nd or 3rd degree AV blocks; except in patients with a functioning ventricular pacemaker.
    • * Use cautiously in patients with known asthma
    • * Patients on theophylline and related methylxanthines.
    • * Patients on dipyridamole (Persantine) or carbamazepine (Tegretol).
    • * Cardiac transplant patients are more sensitive to adenosine and require only a small dose (relative).
    • * Known atrial fibrillation or atrial flutter.
    • * Pregnancy (no controlled studies)
  7. Adenosine

    Adverse Reactions
    • * CV: Transient dysrhythmias (systole, bardycardia, PVC's) occur in 55% of patients (none reported as irreversible). Palpitations, chest pressure, chest pain, hypotension, transient hypertension; facial flushing, sweating.
    • * Resp: Dyspnea, hyperventilation, tightness in throat, bronchospasm.
    • * CNS: Lightheadedness, headache, dizziness, paresthesias, apprehension, blurred vision, neck-back pain.
    • * GI: Nausea, metallic taste
  8. Adenosine

    Adult Dosage
    • * Initial: 6 mg rapid IV/IO push over 1-3 seconds
    • * Administration procedure: 18ga IV/IO, AC↑, Press Print on Monitor, Use hub closest to IV catheter to push drug, immediate 20mL flush in other hub.
    • * Repeat: 12 mg rapid IV/IO push over 1-3 seconds if needed.
  9. Adenosine

    Pediatric Dosage
    • * Initial: 0.1 mg/kg as a rapid IV/IO push.
    • * Administration procedure: Largest IV/IO, Press print on monitor, Use hub closest to IV Catheter to push drug, immediate 2-3mL flush in other hub.
    • * Repeat: If no response, dose may be doubled 1 time (0.2 mg/kg) using same administration procedure. Maximum singe dose: Should not exceed 12 mg.
    • * Infants with SVT associated with shock: Adenosine may precede cardioversion if vascular access is available, but cardioversion should not be delayed while IVaccess is achieved.
  10. Adenosine

    Bonus Points
    Incompatibilities / Drug interactions
    • * Adenosine is not blocked by Atropine.
    • * Theophylline and related methylxanthines (caffeine ) in therapeutic concentrations decrease effectiveness.
  11. Adenosine

    Bonus Points
    Special Notes
    • * Dysrhythmias may recur (short half life).
    • * Second dose must be prepared and available.
    • * Check for crystallization in cold climates.
  12. Amiodarone

    Generic Name
    Amiodarone
  13. Amiodarone

    Brand Name
    Amiodarone
  14. Amiodarone

    Class
    Antiarrhythmic Agent
  15. Amiodarone

    Mechanism of Action
    • * Multiple effects on sodium, potassium and calcium channels.
    • * Prolongs action potential, refractory period.
    • * Ventricular automaticity (potassium channel blockade).
    • * Slows membrane depolarization and impulse conduction (sodium channel blockade).
    • * Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic activity (calcium channel and β-blockade).
    • * Dilates coronary arteries due to calcium channel and alpha-adrenergic blocking action.
  16. Amiodarone

    Indications for Use
    • * Treatment of: defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin.
    • * Control hemodynamically stable ventricular tachycardia when cardioversion unsuccessful.
    • * Adjunct to cardioversion of SVT and PSVT.
    • * Rate control in atrial fibrillation or flutter
  17. Amiodarone

    Contraindications
    • * Bradycardia
    • * Second or third degree heart block unless a functioning pacemaker is present
    • * Cardiogenic shock
    • * Hypotension
    • * Pulmonary congestion
  18. Amiodarone

    Adverse Reactions
    • * Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, atrio-ventricular block
    • * Torsades de Pointes (prolongs QT interval), congestive heart failure
    • * GI & Hepatic: nausea, vomiting, abnormal liver function tests
    • * Skin: slate-blue pigmentation
    • * Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia
  19. Amiodarone

    Adult Dosage
    • * VF/Pulseless VT - 300 mg IV/IO push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV/IO push
    • * Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with cardioversion - 150 mg IV/IO over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes.
    • * Maintenance Infusion Post Resuscitation/Conversion - After successful defibrillation, follow with up to 1mg/min IV/IO infusion for 6 hours, then up to 0.5 mg/min IV/IO infusion for up to 18 hours, maximum daily dose is 2.2 grams
  20. Amiodarone

    Pediatric Dosage
    • * VF/Pulseless VT - 5 mg/kg IV/IO push (max 300 mg single dose), may repeat every 5 minutes two times to a total maximum of 15 mg/kg/day
    • * Probable VT with pulse - 5 mg/kg IV/IO administered over 20 minutes may repeat two more times to a total of 15 mg/kg/day
  21. Amiodarone

    Bonus Points
    Duration of Action
    Half-life may exceed 40 days.
  22. Amiodarone

    Bonus Points
    Special Notes
    • * Draw from ampule with at least an 18 gauge needle.
    • * Mix with 20 – 30 mL of D5W prior to administration.
    • * Patient must be on a cardiac monitor–monitor heart rate and rhythm.
    • * Must be administered with an IV infusion pump during interfacility transports.
  23. Diltiazem

    Generic Name
    Diltiazem
  24. Diltiazem

    Brand Name
    Cardizem
  25. Diltiazem

    Class
    • * Calcium Channel Blocker
    • * Calium antagonist
  26. Diltiazem

    Mechanism of Action
    • * Pharmacological: Inhibits calcium ion influx across cell membranes during cardiac depolarization, decreases SA and AV conduction and dilates coronary and peripheral arteries and arterioles.
    • * Clinical effects: Slows the rapid ventricular rate associated with atrial fibrillation and atrial flutter, and reduces coronary and peripheral vascular resistance.
  27. Diltiazem

    Indications and Field Use
    Rapid ventricular rates associated with atrial fibrillation and atrial flutter, and for PSVT refractory to adenosine.
  28. Diltiazem

    Contraindications
    • * Hypotension (less than 90 mmHg systolic)
    • * Acute Myocardial infarction
    • * Cardiogenic shock
    • * Ventricular tachycardia or wide-complex VT of unknown origin
    • * Second or third-degree AV block
    • * Wolff-Parkinson-White (WPW) syndrome
    • * Sick Sinus syndrome
    • * Beta Blocker Use
  29. Diltiazem

    Adverse Actions
    • * CV: hypotension, bradycardia, heart block, chest pain, and asystole
    • * GI: nausea and vomiting
    • * CNS: headache, fatigue, drowsiness
  30. Diltiazem

    Adult Dosage
    * Administer: 0.25 mg/kg IV/IO (usually 20 mg) administered over 2 minutes. Contact medical control for additional Diltiazem orders if rhythm persists
  31. Diltiazem

    Pediatric Dosage
    The safety and efficacy of this drug for use in children has not been established.
  32. Diltiazem

    Bonus Points
    Incompatibilities / Drug Interactions
    • * Avoid use in patients with poison- or drug-induced tachycardia.
    • * Calcium chloride can be used to prevent the hypotensive effects of this drug and treat patients with a calcium channel blocker overdose.
    • * Beta blocker use
  33. Calcium Chloride

    Generic Name
    Calcium Chloride
  34. Calcium Chloride

    Brand Name
    Calcium Chloride
  35. Calcium Chloride

    Class
    Electrolyte
  36. Calcium Chloride

    Mechanism of Action
    • * Increases extracellular and intracellular calcium levelsStimulates release of catecholamines
    • * Increases cardiac contractile state (positive inotropic effect)
    • * May enhance ventricular automaticity
    • * Inhibits the effects of adenosine on mast cells
  37. Calsium Chloride

    Indications and Field Use
    • * Acute hypocalcemia
    • * Calcium channel blocker OD
    • * Acute hyperkalemia (known or suspected)
    • * Hypermagnesemia (Magnesium OD)
    • * Pre-treatment for IV verapamil administration
  38. Calcium Chloride

    Contraindications
    • * Hypercalcemia
    • * Concurrent digoxin therapy (relative)
  39. Calcium Chloride

    Adverse Action
    • * Brady-asystolic arrest
    • * Severe tissue necrosis if solution extravasates
    • * Use cautiously in patients on digitalis; may cause serious arrhythmias
  40. Calcium Chloride

    Adult Dosage
    • * Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 5-10 ml (0.5-1Gm) of CaCl 10% IV/IO. May repeat in 10 minutes.
    • * Pre-treatment for IV verapamil administration: 3 ml of 10% calcium chloride. May be repeated once.
  41. Calcium Chloride

    Pediatric Dosage
    * Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 0.2 - 0.25 ml/kg of a 10% solution IV/IO infused slowly.
  42. Calcium Chloride

    Bonus Points
    Incompatibilities / Drug Interactions
    All drugs -- flush line before and after administration
  43. Calcium Chloride

    Bonus Points
    Special Notes
    Concurrent administration of sodium bicarbonate and calcium chloride will produce a precipitate, calcium carbonate (chalk).

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