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Adenosine
Generic Name
adenosine
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Adenosine
Brand Name
Adenocard
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Adenosine
Class
antiarrhythmic, endogenous nucleoside
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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.
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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.
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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)
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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
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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.
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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.
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Adenosine
Bonus Points
Incompatibilities / Drug interactions
- * Adenosine is not blocked by Atropine.
- * Theophylline and related methylxanthines (caffeine ) in therapeutic concentrations decrease effectiveness.
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Adenosine
Bonus Points
Special Notes
- * Dysrhythmias may recur (short half life).
- * Second dose must be prepared and available.
- * Check for crystallization in cold climates.
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Amiodarone
Generic Name
Amiodarone
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Amiodarone
Brand Name
Amiodarone
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Amiodarone
Class
Antiarrhythmic Agent
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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.
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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
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Amiodarone
Contraindications
- * Bradycardia
- * Second or third degree heart block unless a functioning pacemaker is present
- * Cardiogenic shock
- * Hypotension
- * Pulmonary congestion
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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
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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
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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
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Amiodarone
Bonus Points
Duration of Action
Half-life may exceed 40 days.
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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.
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Diltiazem
Generic Name
Diltiazem
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Diltiazem
Brand Name
Cardizem
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Diltiazem
Class
- * Calcium Channel Blocker
- * Calium antagonist
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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.
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Diltiazem
Indications and Field Use
Rapid ventricular rates associated with atrial fibrillation and atrial flutter, and for PSVT refractory to adenosine.
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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
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Diltiazem
Adverse Actions
- * CV: hypotension, bradycardia, heart block, chest pain, and asystole
- * GI: nausea and vomiting
- * CNS: headache, fatigue, drowsiness
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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
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Diltiazem
Pediatric Dosage
The safety and efficacy of this drug for use in children has not been established.
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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
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Calcium Chloride
Generic Name
Calcium Chloride
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Calcium Chloride
Brand Name
Calcium Chloride
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Calcium Chloride
Class
Electrolyte
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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
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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
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Calcium Chloride
Contraindications
- * Hypercalcemia
- * Concurrent digoxin therapy (relative)
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Calcium Chloride
Adverse Action
- * Brady-asystolic arrest
- * Severe tissue necrosis if solution extravasates
- * Use cautiously in patients on digitalis; may cause serious arrhythmias
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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.
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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.
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Calcium Chloride
Bonus Points
Incompatibilities / Drug Interactions
All drugs -- flush line before and after administration
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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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