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What is the functional class of adenosine?
What is the mechanism of action for Adenocard?
A nuturally occuring nucleoside that decreases conduction throught the AV node & interrupts AV & SA re-entry pathways thus restoring normal sinus rhythm in patients with SVT.
What are the indications for using adenosine?
SVT refractory to vagal maneuvers including WPW.
What are the contraindications for adminisering Adenocard?
2nd & 3rd degree AV heart block, symptomatic bradycardia, sick sinus syndrome, hypersensitivity.
What are some precautions that should be considered when using adenosine?
Place pt in semi-fowlers as they will typically develop arrhythmias at the time of conversion. Use cautiously in pt's with asthma.
What are some side effects of Adenocard?
Syncope, dizziness, dyspnea, n/v, headache, palpitations, chest pain, hypoperfusion, dysrhythmias. Side effects are self limiting due to the short half life.
What are the drug interactions for adenosine?
Pt's on caffine & xanthines (aminophylline & theophylline) may require larger doses as they antagonize adenosine. Pt's on dipridamole (Persantine) & carbamazepine (Tegretol) may require smaller doses as they potentiate the effect's adenosine.
What is the adult dose and route for Adenocard?
6 mg rapid IVP followed by 10-20 mL NS flush. If no conversion after 1-2 minutes then 12 mg rapid IVP followed by 10-20 mL. If no conversion again after 1-2 minutes then 12 mg rapid IVP followedNS flush. mg rapid IVP followed by 10-20 mL NS flush.
What is the pediatric dose for adenosine?
0.1 mg/kg IVP/IO (max single dose 6 mg), may repeat once in 1-2 minutes at 0.2 mg/kg IVP/IO (max second 12 mg)
What are is the onset and half life for adenocard?
- Onset= rapid
- Half life= appx 10 seconds
What is the functional class of amiodarone?
Class III antidysrhythmic, potassium channel blocker
What is the mechanism of action for Cordarone?
Directly acts on all cardiac tissue. Prolongs the duration of the action potential & refractory period (by blocking potassium channels) w/o significantly affecting the resting membrane potential. The IV form relaxes smooth muscle, decreases peripheral vascular resistance & increases coronary blood flow. Also blocks sodium channels and sympathetic stimulation.
What are the indications for amiodarone?
Life threatening ventricular & supraventricular dysrhythmias. VF, VT, SVT, WPW, A-Fib, A-Flutter
What are the contraindications for administering Cordarone?
Hypersentivity, cardiogenic shock, sever sinus bradycardia, AV block
What precautions need to be considered before administering amiodarone?
Pt's with severe liver disease, pregnancy, nursing mothers
What are the side effects of Cordarone?
CHF, angioedema, hypotension, AV block, hepatotoxicity, cardiogenic shock, fatigue, bradycardia, sinus arrest, permenant blindness, n/v, prolongs the QT interval.
What are the drug interactions for amiodarone?
Increases digoxin levels & enhances pharmacological effects of procainamide, lidocaine, quinidine, & oral anticoagulants. Concurrent use of calcium channel blockers, beta blockers, fentanyl, & cimetidine may potentiate sinus bradycardia.
What is the adult dose and route of Cordarone?
With a pulse: 150 mg in 50-100 mL NS, infusion over 10 minutes. Dose may be repeated after 10 minutes.
No pulse: 300 mg IVP, repeat in 3-5 minutes at 150 mg IVP
Maintenance infusion: 1 mg/min over 6 hours
What is the pediatric dose and route for amiodarone?
5 mg/kg IV/IO
What is the functional class of diltiazem?
Class IV antidysrhythmic, calcium channel blocker
What is the mechanism of action for Cardizem?
Inhibits the ion influx through slow channels into cells of the myocardial and smooth muscle, causing intracellular calcium to remain at sub-threshold levels, insufficient to stimulate cell excitation and contraction. Reduces peripheral vascular resistance by inhibiting the contractility of vascular smooth muscle and dilation of the coronary arteries. Also inhibits coronary artery spasm and slows SA & AV node conduction w/o affecting atrial action potential.
What are the indications for diltiazem?
- SVT refractory to adenosine
- Rapid A-Fib or A-Flutter
What are the contraindications for Cardizem?
Hypersensitivity, sick sinus syndrome, 2nd & 3rd degree AV block, hypotension, WPW, wide complex tachycardia
What precautions need to be considered when administering diltiazem?
- Avoid patients receiving oral beta blockers
- Monitor for hypotension resulting from peripheral vasodilation
- Use caution in patients with CHF
What side effects may be encountered after administration of Cardizem?
Chest pain, bradycardia, hypotension, syncope, CHF, dysrhythmias, n/v, headache, sweating, dizziness, dyspnea, 2nd/3rd degree AV block, palpitations
What drug interations are there with diltiazem?
beta blockers may increase digoxin levels
What is the dose and route for Cardizem?
Bolus: 0.25 mg/kg slow IVP, may repeat in 15 minutes at 0.35 mg/kg slow IVP
IV infusion: 5-15 mg/hr, titrate to heart rate
What is the functional class of Xylocaine?
Class Ib antidysrhythmic, sodium channel blocker
What is the mechanism of action for lidocaine?
Suppresses the depolarization & automaticity in the His-Purkinje system. Suppresses ventricular ectopy & increases the ventricular threshold for dysrhythmias; however it decreases the ventricular threshold for difibrillation.
What are the indications for Xylocaine?
VF, VT (pulseless or not)
- Malignant PVC's
- -more that 6 unifocal PVC's in one minute
- -multifocal PVC's
- -R on T phenomena
What are the contraindications for lidocaine?
Hypersensitivity, supraventricular dysrhythmias, untreated sinus bradycardia, 2nd degree mobitz II AV block, 3rd degree AV block, stokes-adams syndrome
What precautions need to be need to be taken with administration of Xylocaine?
CNS depression may occur in doses greater than 300 mg/hr, liver or renal disease, CHF, hypovolemia, shock, myasthenia gravis
What are the side effects of lidocaine?
Altered mental status including confusion, bradycardias, hypotension, seizures
What drug interactions are there with Xylocaine?
Use caution when administering with beta blockers & procainamide as drug toxicity may result.
What is the dose and route of lidocaine for cardiac arrest?
- Adult: 1-1.5 mg/kg IVP, repeat at 1/2 dose, q 5 minutes, max 3 mg/kg
- 2-4 mg/kg ET, q 3-5
Note- a single dose of 1.5 mg/kg IVP is acceptable if moving on to amiodarone.
Pediatric: 1 mg/kg IV/IO/ET
What is the dose and route of Xylocaine for a patient with a pulse?
Adult: 1-1.5 mg/kg IVP, repeat at 1/2 dose, q 5-10 minutes, max 3 mg/kg
What is the dose for an infusion of lidocaine?
What is the absorption, duration & half life of Xylocaine?
- absorption: 3 minutes
- duration: 10-20 minutes
- half life- 1.5-2 hours
What is the functional class of Pitressin?
Hormone (ADH), vasopressor
What is the mechanism of action for vasopressin?
Possesses pressor & antidiuretic properties. Increases nephron distal tube reabsorption of water. In unnaturally high doses it acts as a non-adrenergic vasoconstrictor by stimulating smooth muscle receptors. Used as an alternative to epinephrine during CPR.
What are the indications for Pitressin?
What are the contraindications for vasopressin?
Chronic nephritis, ischemic heart disease, PVC's, first stage of labor
What are the precautions for Pitressin?
Use with caution in patients with epilepsy, migrain, asthma, heart failure, or angina pectoris
What are the side effects of vasopressin?
n/v, abdominal cramps, HTN, bradycardia, PAC's, MI
What drugs may interact with Pitressin?
Epinephrine,heparin, alcohol, phenytoin, neostigmine, thiazide, diuretics, carbamazepine
What is the dose and route for vasopressin?
40 units IVP/IO single dose only
May replace the first or second dose of epinephrine in cardiac arrest
What is the functional class of epinephrine?
How is Adrenalin supplied?
- 1:1000, 1 mg in 1 mL (1mg/mL)
- 1:10000, 1 mg in 10 mL (0.1mg/mL)
What is the mechanism of action for epinephrine?
A naturally occuring catecholmine that acts directly on the alpha & beta (more profound) adrenergic receptors. This causes positive inotropic, dromotropic, and chronotropic effects as well as increased systemic vascular resistance and BP.
What are the indications for Adrenalin?
Cardiac arrest (asystole), VF, pulseless VT, PEA, symptomatic bradycardia, anaphylaxsis, severe reactive airway disease
What are the contraindications for epinephrine?
Hypersensitivity to sympathomimetic amines
What precautions need to be taken with Adrenalin?
Protect from light
Can be deactivated by sodium bicarbonate, therefore flush IV line between administration of epi & bicarb.
Effects can be intensified by antidepressants
What are the side effects of epinephrine?
Increased myocardial oxygen demand, can cause palpitations, anxiety, headache, CVA, syncope, HTN, tachydysrhythmias, tissue necrosis with repeated injections or extravasation of IV.
What drug interations are there with Adrenalin?
May increase hypotension caused by phenothiazines, alpha and beta blockers, can be deactivated by alkaline solutions (sodium bicarbonate).
What are the adult and pediatric doses and routes for epinephine for a person in cardiac arrest?
- Adult: 1 mg 1:10,000 IVP, q 3-5 minutes
- 2-2.5 mg 1:1000 ET, in 10 mL NS, q 3-5 minutes
- Pediatric: 0.01 mg/kg 1:10,000 IV/IO
- 0.1 mg/kg 1:1000 ET, in 3-5 mL NS, q 3-5 minutes
What are the adult and pediatric doses and routes of Adrenalin for anaphylaxsis or asthma attack?
- Adult: 0.3-0.5 mg 1:1000 SQ, q 5-15 minutes.
- If ineffective give: 0.1-0.5 mg 1:10,000 IVP, q 5-15 minutes
- Pediatric: 0.01 mg/kg 1:1000 SQ,
- If ineffective give: 0.01 mg/kg 1:10,000 IVP, q 5-15 minutes
What is the dose for an infusion of epinephrine for symptomatic bradycardia?
Prepare 1 mg of 1:1000 in 250 NS
- Adult: 2-10 mcg/min
- Pediatric: 0.1-1.0 mcg/kg/min
What are the brand names for nitroglycerin?
Nitrostat, Nitro-Bid, Tridil
What is the functional class of nitro?
What is the mechanism of action for nitro?
Rapid vascular smooth muscle relaxant that increases coronary blood flow and improves perfusion of the ischemic myocardium. This results in decreased venous return to the heart, alleviation of chest pain, and a decrease in preload & afterload in the left ventricle.
What are the indications for nitro?
- Chest pain associated with angina pectoris or AMI
- Acute pulmonary edema
What are the contraindications for nitro?
Hypersensitivity, head trauma, patients in shock (systolic<90), patients with increased ICP
What are the precautions regarding nitro?
- Protect form light and air.
- Monitor vitals closely as it may cause orthostatic hypotension.
- Phosphodiesterase type 5 (PDE-5) inhibitors:
- Viagra (sildenafil) in the last 24 hrs
- Cialis (tadalafil) in the last 48 hrs
- Levitra (vardenafil) in the last 48 hrs
What are the side effects of nitro?
Hypotension, palpitations, tachycardia, syncope, dry mouth, n/v, headache, dizziness, skin rash
What drug interactions are there with nitro?
May cause hypotension when used in conjunction with alcohol & antihypertensives (beta blockers).
What is the dose and route for nitro?
0.4 mg SL (or 1/150 gr) tablet or spray, q 5 minutes, prn, with BP>100
1-2 inches TD paste
Infusion: 10 mcg/min via IV infusion pump, increasing by 5-10 mcg/min q 5 min, to relieve chest pain or pulmonary edema (if BP>100)
What is the onset and half life of nitro?
- Onset= 1-3 minutes SL, 30 minutes TD
- Half life= 1-4 minutes
What are two important side notes regarding nitro?
- Recommend two IV's or a twin cath in place to administer infusion.
- Do not shake aerosol spray as it may effect metered dose.