week 6 pam 103

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kevinkuczma
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263429
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week 6 pam 103
Updated:
2014-02-27 14:48:14
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pam 103
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pam drugs
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  1. adenosine
    class
    antiarrhythmic
  2. adenosine
    action
    slows atrioventricular conduction
  3. adenosine
    indication
    regular tachyarrhythmias (narrow and wide complex)
  4. adenosine
    contraindications
    • torsades de pointes 
    • atrial fibrillation
    • second or third degree heart blocks
    • know hypersensitivty to the med
  5. adenosine
    precautions
    • arrhythmias including blocks are common at time of cardioversion
    • use with caution in patients with asthma
  6. adenosine
    side effects
    • facial flushing
    • headache
    • shortness of breath
    • dizziness
    • neausea
  7. adenosine
    dosage
    • 6 mg given as a rapid iv bolus over a 1-2 second period
    • if after 1-2 minutes cardioverssion dose not occur administer a 12 mg dose over 1-2 seconds
  8. adenosine
    route
    iv into the vein and then flushed
  9. adenosine
    ped dose
    • <50 kg: 0.05-0.1 mg kg iv
    • maximum dose: 0.3 mg/kg/dose up to 12 mg
    • >50 kg: same as adult dose
  10. verapamil
    class
    calcium channel blocker
  11. verapamil
    actions
    • slows conduction through the atrioventricular node 
    • inhibits reentry during paroxysmol supraventricular tachycardia (psvt)
    • decreases rate of ventricular response
    • decreases myocardial o2 demand
  12. verapamil
    indication
    • narrow-complex tachycardias including:
    • stable narrow complex tachycardias if rhythm remains uncontrolled or unconverted by adenosine or vagal maneuvers or if svt is recurrent
    • control ventricular rate in patients with atrial fib or flutter
  13. verapamil
    contraindication
    • heart block
    • conduction system disturbances
  14. verapamil
    precautions
    • should not be used in patients receving iv beta blockers
    • hypotension
  15. verapamil
    side effects
    • nausea 
    • vomiting
    • hypotension
    • dizzines
  16. verapamil
    dosage
    • 2.5-5 mg
    • a repeat dose of 5-10 mg can be administered after 15-30 min if psvt does not convert
    • max dose is 30 mg in 30 min
  17. verapamil
    route
    iv
  18. verapamil
    ped dose
    • 0-1 year: 0.1-0.2 mg kg max of 2 mg admin slowly 
    • 1-15 years: 0.1-0.3 mg kg max of 5 mg admin slowly
  19. diltiazem
    class
    calcium channel blocker
  20. diltiazem
    action
    • slows the conduction through the av node
    • causes vasodilation 
    • decreases rate of ventricular response
    • decreases myocardial o2 demand
  21. diltiazem
    indication
    • stable narrow complex tachycardias if rhythm remains uncontrolled or unconverted by adenosine or vagal maneuvers or if svt is recurrent
    • control ventricular rate in patients with atrial fib or flutter
  22. diltiazem
    contraindication
    • hypotension
    • wide complex tachycardia
    • conduction system disturbances
  23. diltiazem
    precautions
    • should not be used in patients receving iv beta blockers
    • hypotension
    • must be kept refrigerated
  24. diltiazem
    side effects
    • nausea and vomiting
    • hypotension
    • dizziness
  25. diltiazem
    dosage
    • 15-20 mg iv bolus ( 0.25 mg/kg ) over 2 min
    • additional bolus doses of 20-25 mg ( 035 mg/kg ) can be administered in 15 min as needed
    • a maintenance infusion of 5-15 mg/hr can be administered for rate control ( titrated to the desired rate )
  26. diltiazem
    route
    iv
  27. diltiazem
    ped dose
    rarely used
  28. amiodarone
    class
    antiarrhythmic (class III)
  29. amiodarone
    action
    • prolongs action potential and refractory period
    • slows the sinus rate: increases PR and QT intervals
    • decreases peripheral vascular resistance
  30. amiodarone
    indication
    Life threatening cardiac arrhythmias such as ventricular tach and ventricular fib
  31. amiodarone
    contraindication
    • severe sinus node dysfunction
    • sinus bradycardia
    • 2nd and 3rd atrioventricular block
    • hemodynamically significant bradycardia
  32. amiodarone
    precaution
    Heart failure
  33. amiodarone
    side effects
    • hypotension
    • nausea
    • anorexia
    • malaise
    • fatigue
    • tremors
    • pulmonary toxicity
    • ventricular ectopic beats
  34. amiodarone
    dosage
    ventricular fib or pulseless v tach (adults): 300 mg maybe repeated atn150 mg for recurent or refactury arrhythmias

    • narrow complex tach: should be dosed at 150 mg IV /IO over 10 minute and repeated as necssary.  this can be fowllowed by a 1 mg/min infushion over a 6 hours, followed by a 0.5 mg/min infushion as needed
    • the 24 hour dose should not exceed 2.2 gm
  35. amiodarone
    route
    iv
  36. amiodarone
    ped dose
    • 5 mgkg iv or io over 30 min may repeat twice up to 15 mg/kg 
    • max singal dose 300 mg

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