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  1. What is the classification of Atropine Sulfate?
    Anticholinergic (antimuscarinic)
  2. What are the actions of Atropine Sulfate?
    • Competes reversibly w/ acetylcholine @ site of the muscarinic receptor
    • Receptors affected, in order from most to least sensitive: salivary, bronchial, sweat glands, eye, heart, & GI tract
  3. What are the indications of Atropine Sulfate?
    Symptomatic bradycardia, asystole or PEA, nerve agent exposure, organophosphate poisoning
  4. What are the adverse effects of Atropine Sulfate?
    decreased secretions resulting in dry mouth & hot skin temp, intense facial flushing, blurred vision or dilation of pupils w/ subsequent photophobia, tachycardia, restlessness; may cause paradoxical bradycardia if admin. is too low or too slow
  5. What are the contraindications of Atropine Sulfate?
    Acute MI; myasthenia gravis; GI obstruction; closed-angle glaucoma; known sensitivity to atropine, belladonna alkaloids, or sulfites. Not effective for infranodal (type II) AV block & new third-degree block w/ wide QRS complex
  6. What are the dosages for Atropine Sulfate?
    • Symptomatic Bradycardia: ADULT: 0.5mg IV/IO every 3-5 min to max dose of 3mg; ADOLESCENT: 0.02mg/kg (range 0.1-1mg/dose)IV/IO up to total dose of 2mg; PEDI: 0.02mg/kg (range 0.1-0.5mg/dose)IV/IO to total dose of 1mg
    • Asystole/PEA: 1mg IV/IO every 3-5 min, to max dose of 3mg. May admin ETT @2-2.5mg dilute in 5-10mL NS
    • Nerve Agent/Organophosphate Poisoning: ADULT: 2-4mg IV/IM repeat if needed every 20-30 min til symptoms dissipate, severe cases, initial dose can be as large as 2-6mg admin IV, repeat doses of 2-6mg can be admin IV/IM every 5-60 min; PEDI: 0.05mg/kg IV/IM every 10-30 as needed until symptoms dissipate; INFANTS <15LBS: 0.05mg/kg IV/IM every 5-20 min as needed til symptoms dissipate
  7. What is the classification of Epinephrine?
    Adrenergic agent, inotropic
  8. What are the actions of Epinephrine?
    Binds strongly w/ both alpha & beta receptors, producing increased BP, increased HR, bronchodilation
  9. What are the indications of Epinephrine?
    Bronchospasm, allergic & anaphylactic reactions, restoration of cardiac activity in cardiac arrest
  10. What are the adverse effects of Epinephrine?
    Anxiety, headache, cardiac arrhythmias, HTN, nervousness, tremors, chest pain, nausea/vomiting
  11. What are the contraindications of Epinephrine?
    Arrhythmias other than VF, asystole, PEA; cardiovascular disease; HTN; cerebrovascular disease; shock secondary to causes other than anaphylactic shock; closed-angle glaucoma; diabetes; pregnant women in active labor; known sensitivity to epinephrine or sulfites
  12. What are the dosages for Epinephrine?
    • Cardiac Arrest: 1:10000 solution. ADULT: 1mg IV/IO; may repeat every 3-5 min; PEDI: 0.01mg/kg IV/IO repeat every 3-5 min as needed (max dose 1mg)
    • Symptomatic Bradycardia: 1:10000 solution. ADULT: 1mcg/min as cont. IV infusion, usually 2-10mcg/min IV, titrate to effect; PEDI: 0.01mg/kg IV/IO may repeat every 3-5 min (max dose 1mg), if ETT admin 0.1mg/kg
    • Asthma Attacks and Certain Allergic Reactions: 1:1000 solution. ADULT: 0.3-0.5mg IM/SC may repeat every 10-15 min (max dose 1mg); PEDI: 0.01mg/kg IM/SC (max dose 0.5mg)
    • Anaphylactic Shock: 1:10000 solution. ADULT: 0.1mg IV slow over 5 min or IV infusion 1-4mcg/min titrate to effect; PEDI: cont. IV infusion rate 0.1-1mcg/kg/min titrate to respone
  13. What is the classification of Dopamine (Intopin)?
    Adrenergic agonist, inotropic, vasopressor
  14. What are the actions of Dopamine?
    Stimulates alpha & beta adrenergic receptors, @ moderate doses (2-10mcg/kg/min) stimulates beta1 receptors resulting in inotropy & increased cardiac output while maintaining dopaminergic-induced vasodilatory effects, @ high doses (>10mcg/kg/min)alpha adrenergic agonism predominates & increased peripheral vascular resistance & vasoconstriction result
  15. What are the indications of Dopamine?
    hypotension & decreased cardiac output associated w/ cardiogenic shock & septic shock, hypotension after return of spontaneous circulation following cardiac arrest, symptomatic bradycardia unresponsive to atropine
  16. What are the adverse effects of Dopamine?
    Tachycardia, arrhythmias, skin & soft tissue necrosis, severe HTN from excessive vasoconstriction, angina, dyspnea, headache, nausea/vomiting
  17. What are the contraindications of Dopamine?
    Pheochromocytoma, VF, VT, or other ventricular arrhythmias, known sensitivity (including sulfites); correct any hypovolemia w/ volume fluid replacement before admin.
  18. What are the dosages of Dopamine?
    ADULT AND PEDI: 2-20mcg/kg/min IV/IO infusion, starting dose 5mcg/kg/min, may gradually increase infusion by 5-10mcg/kg/min to desired effect. Cardia dose usually 5-10mcg/kg/min, vasopressor dose usually 10-20mcg/kg/min. little benefit beyond 20mcg/kg/min
  19. What is the classification of Adenosine (Adenocard)?
    Antiarrhythmic
  20. What are the actions of Adenosine?
    Slows conduction of electrical impulses @ AV node
  21. What are the indications of Adenosine?
    Stable reentry SVT. Does not convert AF, atrial flutter, or VT
  22. What are the adverse effects of Adenosine?
    Generally mild and short-lived: sense of impending doom, complaints of flushing, chest pressure, throat tightness, numbness. Patients will have a brief episode of asystole after admin.
  23. What are the contraindications of Adenosine?
    Sick sinus syndrome, second- or third-degree heart block, poison-/drug-induced tachycardia
  24. What are the dosages of Adenosine?
    • ADULT & CHILDREN >50KG: initial 6mg rapid IV/IO (over 1-3 sec) immediately followed by 20mL NS flush, if rhythm not eliminated after 1-2 min 12mg rapid IV/IO, repeat a second time if required
    • PEDI<50KG: initial 0.1mg/kg IV/IO (max dose 6mg) immediately followed by at least 5mL NS flush, may repeat @ 0.2mg/kg (max dose 12mg)
  25. What is the classification of Diltiazem (Cardizem)?
    Calcium channel blocker, class IV antiarrhythmic
  26. What are the actions of Cardizem?
    Blocks calcium from moving into heart muscle cell, prolonging conduction of electrical impulses through the AV node
  27. What are the indications of Cardizem?
    Ventricular rate control in rapid AF
  28. What are the adverse effects of Cardizem?
    Flushing; headache; bradycardia; hypotension; heart block; myocardial depression; severe AV block; & @ high doses cardiac arrest
  29. What are the contraindications of Cardizem?
    Hypotension, heart block, heart failure
  30. What are the dosages of Cardizem?
    • ADULT: optimum dose is 0.25mg/kg IV/IO over a 2 min period to control rapid AF; 20mg is reasonable for avg. adult patient. A 2nd higher dose of 0.35mg/kg IV/IO (25mg is a typical 2nd dose) may be admin. over a 2 min period if rate control not obtained w/ lower dose. For cont'd reduction in HR, a cont. infusion can be started @ range of 5-15mg/hr
    • PEDI: not recommended
  31. What is the classification of Verapamil (Isoptin)?
    Calcium channel blocker; class IV antiarrhythmic
  32. What are the actions of Verapamil?
    Blocks calcium from moving into heart muscle cell, prolonging conduction of electrical impulses through the AV node. Also dilates arteries
  33. What are the indications of Verapamil?
    AF, HTN, PSVT, PSVT prophylaxis
  34. What are the adverse effects of Verapamil?
    Sinus bradycardia; first-, second-, or third-degree AV block; CHF; reflex sinus tachycardia; transient asystole; AV block; hypotension
  35. What are the contraindications of Verapamil?
    Second- or third-degree AV block (unless functioning artificial pacemaker); hypotension (<90mmHg systolic) or cardiogenic shock; sick sinus syndrome ( unless functioning artificial pacemaker); WPW syndrome; LGL syndrome; severe left ventricular dysfunction; known sensitivity to verapamil or any component of the formulation; atrial flutter or AF and an accessory bypass tract; in infants <1yr
  36. What are the dosages of Verapamil?
    • ADULT: 2.5-5mg IV/IO over 2 min (3 min in elderly), may repeat @ 5-10mg every 15-30 min to max dose of 30mg
    • PEDI: CHILDREN 1-16yrs: 0.1mg/kg IV/IO (max 5mg/dose) over 2 min, may repeat in 30 min to max dose of 10mg; INFANTS <1yr: not recommended
  37. What is the classification of Propranolol (Inderal)?
    Beta adrenergic antagonist, antianginal, antihypertensive, antiarrhythmic class II
  38. What are the actions of Propranolol?
    Nonselective beta antagonist that binds w/ both beta1 & beta2 receptors. inhibits the strength of the heart's contractions, as well as HR, resulting in decreased cardiac oxygen consumption
  39. What are the indications of Propranolol?
    Angine; narrow-complex tachycardias that originate from either a reentry mechanism (reentry SVT) or an automatic focus (junctional, ectopic, or multifocal tachycardia) uncontrolled by vagal maneuvers & adenosine in patients w/ preserved ventricular function; AF & atrial flutter in patients w/ preserver ventricular function; HTN; migraine headaches
  40. What is the classification of Metoprolol (Lopressor, Toprol XL)?
    Beta agrenergic antagonist, antianginal, antihypertensive, class II antiarrhythmic
  41. What are the actions of Metoprolol?
    inhibits the strength of heart's contractions, as well as HR decreasing cardiac oxygen consumption. Saturates beta receptors & inhibits dilation of bronchial smooth muscle (beta2 receptor)
  42. What are the indications of Metoprolol?
    ACS, HTN, SVT, atrial flutter, AF, thyrotoxicosis
  43. What are the adverse effects of Metoprolol?
    tiredness, dizziness, diarrhea, heart block, bradycardia, bronchospasm, drop in BP
  44. What are the contraindications of Metoprolol?
    Cardiogenic shock, AV block, bradycardia, known sensitivity. Use caution in hypotension, chronic lung disease (asthma & COPD)
  45. What are the dosages of Metoprolol?
    • Cardiac Indications?
    • ADULT: 5mg slow IV/IO over a 5 min period, repeat @ 5 min intervals up to a total of 3 infusions totaling 15mg IV/IO
    • PEDI: Not recommended
  46. What is the classification of Atenolol (Tenormin)?
    Beta adrenergic antagonist, antianginal, antihypertensive, class II antiarrhythmic
  47. What are the actions of atenolol?
    inhibits the strength of the heart's contractions & HR, decreasing cardiac oxygen consumption. Saturates the beta receptors & inhibits dilation of bronchial smooth muscle (beta2 receptors)
  48. What are the indications of atenolol?
    ACS, HTN, SVT, atrial flutter, AF
  49. What is the classification of Esmolol (Brevibloc)?
    Beta adrenergic antagonist, class II antiarrhythmic
  50. What are the actions of Esmolol?
    inhibits the strength of the heart's contractions, as well as HR, decreasing cardiac oxygen consumption
  51. What are the indications of Esmolol?
    ACS, MI, acute HTN, supraventricular tachyarrhythmias, thyrotoxicosis
  52. What is the classification of Amiodarone (Cordarone)?
    antiarrhythmic, class III
  53. What are the actions of Amiodarone?
    Acts directly of the myocardium to delay repolarization & increase the duration of action potential
  54. What are the indications of Amiodarone?
    Ventricular arrhythmias; second-line agent for atrial arrhythmias
  55. What are the adverse effects of Amiodarone?
    Burning @ injection site, hypotension, bradycardia
  56. What are the contraindications of Amiodarone?
    Sick sinus syndrome, second- & third-degree heart block, cardiogenic shock, when episodes of bradycardia have caused syncope, sensitivity to benzyl alcohol & iodine
  57. What are the dosages of Amiodarone?
    • VF & pulseless VT:
    • ADULT: 300mg IV/IO, may be followed by 1 dose of 150mg in 3-5 min; PEDI: 5mg/kg (max dose 300mg), may repeat 5mg/kg IV/IO up to 15mg/kg
    • Relatively stable patients w/ arrhythmias such as PVCs pr wide-complex tachycardia w/ a strong pulse:
    • ADULT: 150mg in 100mL D5W IV/IO over a 10 min period, may repeat in 10 min up to a max dose of 2.2g over 24 hr; PEDI: 5mg/kg very slow IV/Io (over 20-60 min), may repeat in 5mg/kg doses up to 15mg/kg (max dose 300mg)
  58. What is the classification of Lidocaine (Xylocaine)?
    Antiarrhythmic, class IB
  59. What are the actions of Lidocaine?
    Blocks sodium channels, increasing recovery period after repolarization; suppresses automaticity in the His-Purkinje system & depolarization in the ventricles
  60. What are the indications of Lidocaine?
    Ventricular arrhythmias, when amiodarone is not available; cardiac arrest from VF/VT, stable monomorphic VT w/ preserved ventricular function, stable polymorphic VT w/ normal baseline QT interval & preserved left ventricular function (when ischemia & electrolyte imbalance are treated), stable polymorphic VT w/ baseline QT prolongation suggestive of torsades de pointes
  61. What are the adverse effects of Lidocaine?
    Toxicity (anxiety, apprehension, euphoria, nervousness, disorientation, dizziness, blurred vision, facial paresthesias, tremors, hearing disturbances, slurred speech, seizures, sinus bradycardia), seizures w/o warning, cardiac arrhythmias, hypotension, cardiac arrest, pain @ injection site
  62. What are the contraindications of Lidocaine?
    AV block; bleeding; thrombocytopenia; known sensitivity to lidocaine, sulfite, or paraben. Use w/ caution in bradycardia, hypovolemia, cardiogenic shock, Adams-Stokes syndrome, WPW syndrome
  63. What are the dosages of Lidocaine?
    • Pulseless VT & VF: ADULT IV/IO: 1-1.5mg/kg, may repeat @ half the original dose (0.5-0.74mg/kg) every 5-10 min to a max dose of 3mg/kg, if maintenance infusion warranted, rate 1-4mg/min; ADULT ETT: 2-10mg/kg diluted in 10mL NS; PEDI IV/IO: 1mg/kg (max 100mg) if maintenance infusion warranted, rate 20-50mcg/kg/min; PEDI ETT: 2-3mg/kg followed by 5 mL NS flush
    • Perfusing Ventricular rhythms: ADULT: 0.5-0.75mg/kg IV/IO (up to 1-1.5mg/kg may be used), repeat 0.5-0.75mg/kg every 5-10 min to max total dose 3mg/kg. Maintenance infusion of 1-4mg/min (30-50mcg/kg/min) acceptable; PEDI: 1mg/kg IV/IO, may repeat every 5-10 min to max dose of 3mg/kg. maintenance infusion rate 20-50mcg/kg/min
  64. What is the classification of Procainamide (Pronestyl)?
    Antiarrhythmic, class IA
  65. What are the actions of Procainamide?
    Blocks influx of sodium through membrane pores, consequently suppresses atrial & ventricular arrhythmias by slowing conduction in myocardial tissue
  66. What are the indications of Procainamide?
    Alt. to amiodarone for stable monomorphic VT w/ normal QT interval & preserved ventricular function, reentry SVT if uncontrolled by adenosine & vagal maneuvers if BP stable, AF w/ rapid rate in WPW syndrome
  67. What is the classification of Magnesium Sulfate?
    electrolyte, tocolytic, mineral
  68. What are the actions of Magnesium Sulfate?
    required for normal physiologic functioning, a cofactor in neurochemical transmission & muscular excitability, controls seizures by blocking peripheral neuromuscular transmission, a peripheral vasodilator & an inhibitor of platelet function
  69. What are the indications of Magnesium Sulfate?
    Torsades de pointes, cardiac arrhythmias associated w/ hypomagnesemia, eclampsia & seizure prophylaxis in preeclampsia, status asthmaticus
  70. What are the adverse effects of Magnesium Sulfate?
    Magnesium toxicity (flushing, diaphoresis, hypotension, muscle paralysis, weakness, hypothermia, & cardiac, CNS, or respiratory depression)
  71. What are the contraindications of Magnesium Sulfate?
    AV block, GI obstruction. Use caution w/ renal impairment
  72. What are the dosages of Magnesium Sulfate?
    • Pulseless VF/VT w/ Torsades de Pointes or Hypomagnesemia: ADULT: 1-2g in 10mL D5W IV/IO over 5-10 min; PEDI: 25-50mg/kg IV/IO over 10-20 min, may admin faster for torsades de pointes (max single dose 2g)
    • Torsades de Pointes w/ pulse or cardia arrhythmias w/ hypomagnesemia: ADULT: 1-2g in 50-100mL D5W IV/IO over 5-60 min, follow w/ 0.5-1g/hr IV/IO titrate to control torsades.; PEDI: 25-50mg/kg IV/IO over 10-20 min (max 2g/dose)
    • Eclampsia & seizure prophylaxis in preeclampsia: ADULT: 4-6g IV/IO over 20-30 min then infusion @ 1-2g/hr
    • Status Asthmaticus: ADULT: 1.2-2g slow IV/IO over 20 min; PEDI: 25-50mg/kg dilute in D5W slow IV/IO over 10-20 min
  73. What is the classification of Vasopressin?
    nonadrenergic vasoconstrictor
  74. What are the actions of Vasopressin?
    Causes vasooconstriction independent of adrenergic receptors or neural innervation
  75. What are the indications of Vasopressin?
    Adult shock-refractory VF or pulseless VT, asystole, PEA, vasodilatory shock
  76. What are the adverse effects of Vasopressin?
    cardiac ischemia, angina
  77. What are the contraindications of Vasopressin?
    responsive patients w/ cardiac disease
  78. What are the dosages of Vasopressin?
    • ADULT: 40 U IV/IO may replace either the 1st or 2nd dose of epinephrine
    • May be given ET but optimal dose is not known

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