week 5 pam 103

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kevinkuczma
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week 5 pam 103
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2014-02-20 03:58:31
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pam drugs
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  1. Atenolol (Tenormin)
    Class
    Selective beta-blocker (Class II arrhythmic)
  2. Atenolol (Tenormin)
    Action
    • Atenolol selectively blocks Beta-1 adrenergic receptors.
    • It causes a reduction in HR, cardiac contractility, BP, and myocardial oxygen demand.
  3. Atenolol (Tenormin)
    Indication
    • Stable, narrow-complex tachycardias if rhythm remains uncontrolled or unconverted by Adenosine or vagal maneuvers or if SVT is recurrent.
    • Controls ventricular rate in PTs with Atrial fibrillation or flutter.
    • Certain forms of polymorphic VT (associated with acute ischemia, familial long QT syndrome, catecholinergic)
  4. Atenolol (Tenormin)
    Contraindications
    • Bradycardia
    • Asthma
    • COPD
    • Decompensated CHF
  5. Atenolol (Tenormin)
    Precautions
    • Due to the risk of bradycardia Atropine should be available.
    • In bradycardia refractory to atropine, transcutaneous pacing should be utilized.
    • It can precipitate CHF in PTs who are predisposed to the condition and should be used with caution in these PTs.
  6. Atenolol (Tenormin)
    Side Effects
    • Bradycardia.
    • Hypotension.
    • Lethargy.
    • CHF.
    • Dyspnea.
    • Wheezing.
    • Weakness.
  7. Atenolol (Tenormin)
    Adult Dose
    IV, IO: 5mg over 5 minutes. It can be repeated at 5mg in 10 minutes if the arrhythmia persists or recurs.
  8. Atenolol (Tenormin)
    Route
    • IV
    • IO
  9. Atenolol (Tenormin)
    Ped dose
    Safety and effectiveness has not yet been established
  10. Esmolol (Brevibloc)
    Class
    Beta-blocker (Beta-1 selective)
  11. Esmolol (Brevibloc)
    Action
    • Decreases heart rate.
    • Decreases atrioventricular conduction
  12. Esmolol (Brevibloc)
    Indications
    • Stable, narrow-complex tachycardias.
    • Rate control of Atrial fibrillation or flutter.
    • Certain forms of polymorphic VT.
  13. Esmolol (Brevibloc)
    contraindications
    • Sinus Bradycardia.
    • Heart block greater than 1st degree.
    • Cardiogenic shock.
    • Overt CHF.
    • Asthma
  14. Esmolol (Brevibloc)
    precautions
    • Hypotension is common and is usually dose related.
    • PTs with CHF may have worsening symptoms.
    • May worsen Asthma
  15. Esmolol (Brevibloc)
    side effects
    • Dizziness.
    • Diaphoresis.
    • Hypotension.
    • Nausea.
  16. Esmolol (Brevibloc)
    adult dose
    Preparation: Place 2.5g ampules in 500cc of D5W, yielding a concentration of 10mg/cc.

    Loading dose:500mcg/kg/min for 1 minute then reduce to maintenance dose.

    • Maintenance dose: 50mcg/kg/min; if ineffective after 4 minutes, repeat loading dose and increase maintenance dose to 100mcg/kg/min; may repeat as
    • needed until a total maintenance dose of 300mcg/kg/min has been achieved.
  17. Esmolol (Brevibloc)
    route
    iv only
  18. Esmolol (Brevibloc)
    ped dose
    100-500mcg/kg/min loading dose over 1 minute, followed by 25-50mcg/kg/min maintenance infusion
  19. Lidocaine (Xylocaine)
    class
    Antiarrhythmic (Class II)
  20. Lidocaine (Xylocaine)
    action
    • Suppresses ventricular ectopic activity.
    • Increases ventricular fibrillation threshold.
    • Reduces velocity of electrical impulses through conductive system
  21. Lidocaine (Xylocaine)
    indication
    Ventricular tachycardia/fibrillation refractory to amiodarone.
  22. Lidocaine (Xylocaine)
    contraindication
    • High-degree heart blocks.
    • PVCs in conjunction with bradycardia
  23. Lidocaine (Xylocaine)
    precautions
    • Dosage should not exceed 300mg/hr.
    • Monitor for CNS toxicity.
    • Dosage should be reduced by 50% in PTs older than 70 y/o with liver disease.
    • In cardiac arrest, use only in bolus therapy
  24. Lidocaine (Xylocaine)
    side effects
    • Anxiety.
    • Drowsiness. 
    • Dizziness.
    • Confusion.
    • N/V.
    • Convulsions.
    • Widening of QRS complex
  25. Lidocaine (Xylocaine)
    route
    • IV bolus,
    • IV infusion
  26. Lidocaine (Xylocaine)
    ped dose
    1mg/kg
  27. Procainamide (Pronestyl)
    class
    Antiarrhythmic (Class IA)
  28. Procainamide (Pronestyl)
    action
    • Slows conduction through myocardium.
    • Elevates ventricular fibrillation threshold.
    • Suppresses ventricular ectopic activity
  29. Procainamide (Pronestyl)
    indication
    • Ventricular tachycardia with a pulse.
    • Pre-existing atrial fibrillation
  30. Procainamide (Pronestyl)
    contraindication
    • High-degree heart blocks.
    • PVCs in conjunction with bradycardia
  31. Procainamide (Pronestyl)
    precautions
    • Dosage should not exceed 17mg/kg.
    • Monitor for CNS toxicity
  32. Procainamide (Pronestyl)
    side effects
    • Anxiety.
    • Nausea.
    • Convulsions.
    • Widening of QRS complex
  33. Procainamide (Pronestyl)
    adult dose
    • Initial: 20mg/min until arrhythmia
    • is abolished, hypotension ensues, QRS complex is widened by 50% of original
    • width, or total of 17mg/kg has been given.

    • Maintenance: 1-4mg/min
    • .
  34. Procainamide (Pronestyl)
    route
    • Slow IV bolus,
    • IV drip
  35. Procainamide (Pronestyl)
    ped dose
    rarely used

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