Adenosine & Lidocaine

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Author:
cjl410
ID:
169123
Filename:
Adenosine & Lidocaine
Updated:
2012-09-05 19:48:59
Tags:
Phoenix College Paramedic 2012 2013 Drug Profiles Adenosine Lidocaine
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Description:
PCC Drug Profile - Adenosine & Lidocaine
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  1. Generic name for Adenosine?
    Adenosine
  2. Brand name for Adensoine?
    Adenocard
  3. Class of Adenosine?
    Antiarrhthmic
  4. Mechanism of Action of Adenosine?
    • Slows Sinus rate
    • Slows conduction through the AV node
    •      Interrupts reentrant pathways
  5. Indications and field use for Adenosine?
    • SVT refractory to vagal maneuvers (including WPW syndrome)
    • Why?
    •      Interrupts reentry pathways

    • Wide QRS tachycardia of unknown origin refractory to lidocaine/amiodarone
    • Why?
    •      Interrupts reentry pathways
  6. Dosage for Adenosine?
    • All dosage VERY rapid IV push over 1-3 seconds followed by 20cc NS flush with patient supine.  
    •      16 or 18 guage in the AC
    •      Use injection port closest to hub
    •      Have ECG printing during administration

    • Adult
    • 6mg rapid IV push with 20cc NS flush.  May repeat twice every two minutes wtih 12 mg
  7. Contraindications of Adenosine?
    • Known allergy/hypersensitivity
    • Sick sinus syndrom or 2nd/3rd degree block
    • Asthma
    • Carbamazepine (Tegretol) use
    • Known A-Fib/A-Flutter
    • Pregnancy (patch)
    • Heart transplants (reduce dose)
  8. Drug Interactions with Adenosine?
    • Methylxanthines (theophylline, aminophylline) reduce effectiveness so larger dose might be needed
    • Persantine increases effectiveness so smaller dose needed
  9. Side effects of Adenosine? 
    • (short half life of 5-10 seconds limits duration of side effects)
    • Transient dysrhthmias
    •      asystole
    •      bradycardia
    •      PVCs
    • Chest pain/SOB
    • Hypo/Hypertension
    • Flushing
    • Bronchospasm
    • Headache/Dizziness
    • Paresthesias
    • Nausea
  10. Onset of Action for Adenosine?
    Immediate
  11. AZ Drug Box Supply of Adenosine?
    5 x 6mg in 2cc prefilled syringes or vial
  12. Generic name for Lidocaine?
    Lidocaine HCL
  13. Brand name for Lidocaine?
    Xylocaine
  14. Class of Lidocaine?
    • Sodium channel blocker
    • Antiarrythmic
  15. Mechanism of Action for Lidocaine?
    • Blocks sodium channels decreasing automaticity
    •      Prolongs phase 4 depolarization 
    •      Terminates re-entry
    •      Increases v-fib threshhold
  16. Indications and Field Use for Lidocaine?
    • Cardiac arrest
    •      Ventricular fibrillation/pulsless Ventricular Tachycardia only

    •      Why?
    •           Blocks sodium channels decreasing depolarization

    • Supression of ventricular arrythmias
    •      Ventricular techycardia with pulse
    •      Wide QRS tachycardia of unknown origin
    •      Prevent recurrance of VFib/VTach
    •      Frequent PVCs
    •           >6/min
    •           R on T
    •           Couplets
    •           Multiform
    •           Why?
    •                Blocks sodium channels decreasing depolarization
  17. IV push, ETT, or infusion
    • Adult - 
    • 1.0 - 1.5mg/kg IV push
    • Every 5-10 minutes at 1/2 original dose up to 3mg/kg max

    If successful - infusion at 2-4mg/min by adding 1gm to 250cc NS

    • Cardiac arrest - 20cc NS flush after giving
    • ETT dose - double IV dose
  18. Contraindications of Lidocaine?
    • Known allergy / hypersensitivity
    • 3rd degree heart block
    • Extreme caution in 2nd degree heart block
    • Idoventricular rythym
    • Ventricular arrythmias with pulse <60
  19. Drug Interactions with Lidocaine?
    Decrease infusion by 1/2 with patients older than 70, shock, liver, or kidney disease
  20. Side effects of Lidocaine?
    • Conduction problems
    • Hypotension
    • Agitation
    • Drowsiness
    • Confusion
    • Deafness
    • Parasthesias
    • Twitching
    • Seizures
  21. Onset of Action for Lidocaine?
    1-5 minutes
  22. AZ Drug Box Supply of Lidocaine?
    • 4 x 100mg in 5cc prefilled syringe
    • 1 x 1Gm in 25cc vial
    • 1 x 2Gm in 500cc premixed bag

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