Mod 3 Drugs

Antidysrhythmic

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.

SVT refractory to vagal maneuvers including WPW.

2nd & 3rd degree AV heart block, symptomatic bradycardia, sick sinus syndrome, hypersensitivity.

Place pt in semi-fowlers as they will typically develop arrhythmias at the time of conversion. Use cautiously in pt's with asthma.

Syncope, dizziness, dyspnea, n/v, headache, palpitations, chest pain, hypoperfusion, dysrhythmias. Side effects are self limiting due to the short half life.

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.

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.

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)

• Onset= rapid
• Half life= appx 10 seconds

Class III antidysrhythmic, potassium channel blocker

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.

Life threatening ventricular & supraventricular dysrhythmias. VF, VT, SVT, WPW, A-Fib, A-Flutter

Hypersentivity, cardiogenic shock, sever sinus bradycardia, AV block

Pt's with severe liver disease, pregnancy, nursing mothers

CHF, angioedema, hypotension, AV block, hepatotoxicity, cardiogenic shock, fatigue, bradycardia, sinus arrest, permenant blindness, n/v, prolongs the QT interval.

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.

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

5 mg/kg IV/IO

Class IV antidysrhythmic, calcium channel blocker

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.

• SVT refractory to adenosine
• Rapid A-Fib or A-Flutter

Hypersensitivity, sick sinus syndrome, 2nd & 3rd degree AV block, hypotension, WPW, wide complex tachycardia

• Avoid patients receiving oral beta blockers
• Monitor for hypotension resulting from peripheral vasodilation
• Use caution in patients with CHF

Chest pain, bradycardia, hypotension, syncope, CHF, dysrhythmias, n/v, headache, sweating, dizziness, dyspnea, 2nd/3rd degree AV block, palpitations

beta blockers may increase digoxin levels

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

Class Ib antidysrhythmic, sodium channel blocker

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.

VF, VT (pulseless or not)

• Malignant PVC's
• -more that 6 unifocal PVC's in one minute
• -multifocal PVC's
• -couplets
• -R on T phenomena

Hypersensitivity, supraventricular dysrhythmias, untreated sinus bradycardia, 2nd degree mobitz II AV block, 3rd degree AV block, stokes-adams syndrome

CNS depression may occur in doses greater than 300 mg/hr, liver or renal disease, CHF, hypovolemia, shock, myasthenia gravis

Altered mental status including confusion, bradycardias, hypotension, seizures

Use caution when administering with beta blockers & procainamide as drug toxicity may result.

• 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

Adult: 1-1.5 mg/kg IVP, repeat at 1/2 dose, q 5-10 minutes, max 3 mg/kg

1-4 mg/min

• absorption: 3 minutes
• duration: 10-20 minutes
• half life- 1.5-2 hours

Hormone (ADH), vasopressor

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.

Cardiac arrest

Chronic nephritis, ischemic heart disease, PVC's, first stage of labor

Use with caution in patients with epilepsy, migrain, asthma, heart failure, or angina pectoris

n/v, abdominal cramps, HTN, bradycardia, PAC's, MI

Epinephrine,heparin, alcohol, phenytoin, neostigmine, thiazide, diuretics, carbamazepine

40 units IVP/IO single dose only

May replace the first or second dose of epinephrine in cardiac arrest

Sympathomimetic

• 1:1000, 1 mg in 1 mL (1mg/mL)
• 1:10000, 1 mg in 10 mL (0.1mg/mL)

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.

Cardiac arrest (asystole), VF, pulseless VT, PEA, symptomatic bradycardia, anaphylaxsis, severe reactive airway disease

Hypersensitivity to sympathomimetic amines

Protect from light

Can be deactivated by sodium bicarbonate, therefore flush IV line between administration of epi & bicarb.

Effects can be intensified by antidepressants

Increased myocardial oxygen demand, can cause palpitations, anxiety, headache, CVA, syncope, HTN, tachydysrhythmias, tissue necrosis with repeated injections or extravasation of IV.

May increase hypotension caused by phenothiazines, alpha and beta blockers, can be deactivated by alkaline solutions (sodium bicarbonate).

• 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

• 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

Prepare 1 mg of 1:1000 in 250 NS

• Adult: 2-10 mcg/min
• Pediatric: 0.1-1.0 mcg/kg/min

Nitrostat, Nitro-Bid, Tridil

Nitrate

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.

• Chest pain associated with angina pectoris or AMI
• Acute pulmonary edema
• CHF

Hypersensitivity, head trauma, patients in shock (systolic<90), patients with increased ICP

• 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

Hypotension, palpitations, tachycardia, syncope, dry mouth, n/v, headache, dizziness, skin rash

May cause hypotension when used in conjunction with alcohol & antihypertensives (beta blockers).

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)

• Onset= 1-3 minutes SL, 30 minutes TD
• Half life= 1-4 minutes

• Recommend two IV's or a twin cath in place to administer infusion.
• Do not shake aerosol spray as it may effect metered dose.