Actions: Smooth Muscle relaxant, Reduces cardiac work, Dilates arteries, dilates systemic arteries
Inducations: Angina pectoris, Chest pain associated with myocardial infarction.
Contrainducations: Children younger than 12 years of age. Hypotension.
Precautions: Constantly monitor blood pressure, Syncope, Medication must be protected from light.
Side effects: Headache, dizziness, Hypotension.
Dosage: (Nitrostat) one tablet repeated 3-5 minute intervals up to 3 times
Paste(Nitro-bid) 1/2 to 1 inch topical
Spray(Nitrolingual spray)- one spray administered under the tounge, may be repeated in 3-5 minutes, no more that 3 sprays in 15 minute period, should not be inhalded. route- Under the tongue
Class: Platelet inhibitor and anti-inflammatory
Actions: Inhibits platelet aggregation
Indications: New chest pain suggestive of acute myocardial infatction, S/S suggestive of recent stroke
Precautions: Gastrointestinal bleeding, and upset stomach.
Side effects: Heartburn, Nausea and vomiting, Wheezing
Dosage: 160 or 325mg by mouth chewed
Pediatric dose: 10-15mg/kg/dose every 4-6 hours
Amiodarone / Cordarone
Class: Antiarrhytmic (class 3)
Action: Prolongs action of potential and refactory period. Slows the sinus rate, increases PR and QT intervals, Decreases peripheral vascular resistance (a and b adrenergic blockade)
Inducations: Life threating cardiac arrhythmias such as V-tac and V-fib
contrainducations: Severe sinus node dysfunction, Sinus bradycardia, Second and thrid-degree atrioventricular block, Hemodynamically significant bradycardia
Precautions: Heart failure
Side effects: Hypotension, nausea, Anorexia, Malaise(fatigue), Tremors, Pulmonary toxicity, ventricular ectopic beats.
- Dosage: v-Fib or Pulseless V-Tach Adults 300mg may be repeated @ 150mg for recurrent or refactory arrhythmias.
- Narrow-complex tachycardias- dosed @ 150mg IV/IO over 10 minute and repeated as necessary. this can be followed by a 1mg/min infustion over 6 hours, followed by a .5mg/min infustion as needed. total 24 hour dose should not exceed 2.2gm
Pediatric dosage: 5mg/kg IV/IO over 30 minutes. May be repeated twice up to 15/kg max single dose 300mg
Lidocaine / Xylocaine
Class Antiarrhythmic (Class IB)
Actions: Suppresses ventricular ectopic activity, Increases ventricular fibrillation threshold, reduces velocity of electrical impulsee through conductive system.
Inducations: ventricular Tachycardia/Fibrillation refactory of amiodarone
Contraindications: High degree heart blocks, PVC's in conjuction with bradycardia
- Precautions: Dosage should not exceed 300mg/hr, Monitor for CNS toxicity, dosage should be reduced by 50% in patients older than 70 Y/O or who have liver disease.
- In Cardiac arrest, use only bolus therapy.
Side effects: Anxiety, Drowsiness, Dizziness, confusion, nausea and vomiting, convulsions, widening QRS complex.
- Dosage: Bolus: initial bolus of 1.0-1.5mg/kg additinonal bolus of .5-.75mg/kg can be repeated 5-10 mintue intervals untill arrhythmia has been suppressed or 3.0 mg/kg has been administered. reduce dosge by 50% in pt's older than 70.
- Drip after arrhythmia been suppressed a 2-4mg/min infustion my be started to maintain adquate blood levels
Routs IV bolus/Iv infustion
Action: increases cardiac contractility
Inducations: Acute hyperkalemia(elevated potassium) Acute hypocalcemia(decreased calcium level), Calcium channel blocker overdose, abdominal muscle spasm accociated with spider bites and Portuguese man of war stings, antidote for magnesium sulfate.
Contrinducations: pt's receiving digitalis
Precations: IV line should be flushed between calcium choride and sodium bicarbonate admin.
Side effects: Arryhmias(Bradycardia and asytole), Hypotension
dosage: 2-4mg/kg of 10% solution, may be repeated @ 10 minute intervals.
Pediatric dosage: 5-7mg/kg of a 10% solution.
Class: Anticonvulsant and antiarrhythmic
Actions: Central nervous system depressent, Anticonvulsant, Antiarrhythmic.
- Indiactions: Obstetrical- Eclampsia
- Cardiovascular-Torsade de pointes (irregular, polymorphic ventricular tachycardia.
Containducations: Shock, heart block
Precautions: Caution should be used in Pt's receiving digitalis, Hypotension, Calcium choride should be readily available as an antidote if respiratory depression ensues. Use caution in Pt's with renal failure
Side effects: flushing, respiratory depression, drowsiness
Pediatric dosage- not indicated
Adenosine / Adenocard
Actions: Slows atrioventricular conduction
Inducations: Regular tachyarrhythmias(narrow and wide complex)
Contraindications: Torsades, atrial fibrillations, second or thrid degree heart block, hypersenstivity
Precautions: Arrhythmias, including blocks, are common at the time of cardioversion.
side effects: Facial flushing, headache, shortness of breath, dizziness nausea.
Dosage: 6mg given as rapid IV bolus over 1-2 seconds, if after 1-2 min cardioversion does not happen, administer a 12mg dose over 1-2 seconds
route: IV, closet port to the pt.
Pediatric dosage Less than 50kg 0.05-.1mg/kg max dose .3 mg/kg/dose up to 12mg. Greater than 50 kg same as adult.