-
Amiodarone
- (Cordarone, Pacerone) Antidysrhythmic
- Des: Antidysrhythmic that prolongs duration of the action potential & refractory period & relaxes smooth muscles, reducing peripheral vascular resistance & increasing coronary blood flow.
- Ind: 1)life-threatening ventricular & supraventricular dysrhythmias 2)frequently atrial fibrillation.
- CI: 1)cardiogenic shock 2)severe sinus bradycardia 3)advanced heart block.
- PC: none
- Dose: 150-300 mg IV over 10 min, then 1 mg/min over next 6 hours. Ped: 5 mg/kg IV/IO, then 1.5mg/kg/day.
-
Bretylium
- (Bretylol) Antidysrhythmic
- Des: suppresses ventricular tachydysrhythmias including vfib w/ reentry mechanisms.
- Ind: ventricular fibrillation & ventricular tachycardia refractory to lidocaine
- CI: none
- PC: 1)digitalized patients 2)digitalis-induced dysrhythmias
- Dose: 5 mg/kg IV, then 10 mg/kg/15 to 30 min, to a max 30 mg/kg
-
Lidocaine
- (Xylocaine) Antidysrhythmic
- Des: antidysrhythmic that suppresses automaticity & raises stimulation threshold of the ventricles. also causes sedation, anticonvulsant, & analgesic effects.
- Ind: 1)pulseless ventricular tachycardia 2)ventricular fibrillation 3)ventricular tachycardia (w/ pulse)
- CI: 1)hypersensitivity to amide-type local anesthetics 2)supraventricular dysrhythmias 3)stokes-adams syndrome 4)2nd- & 3rd-degree heart blocks 5)bradycardias
- PC: 1)hepatic or renal impairment 2)CHF 3)hypoxia 4)respiratory depression 5)hypovolemia 6)myasthenia gravis 7)shock 8)elderly
- Dose: cardiac arrest: 1-1.5 mg/kg IV repeated every 3-5 min up to 3 mg/kg, follow conversion with a drip of 2-4 mg/min. Ped: 1 mg/kg IV, repeat/3-5 min up to 3 mg/kg, follow conversion with a drip of 20-50 mcg/kg/min. ventricular tachycardia (w/ pulse): 1 to 1.5 mg/kg slow IV (consider lower dose for elderly). May repeat at one-half dose every 5-10 min until conversion up to 3 mg/kg. Follow conversion with an infusion of 2 to 4 mg/min. Ped: 1 mg/kg, followed by a drip at 20-50 mg/kg/min.
-
Procainamide
- (Pronestyl) Antiarrhythmic
- Des: prolongs ventricular repolarization, slows conduction, and decreases myocardial excitability
- Ind: ventricular fibrillation and pulseless ventricular tachycardia refractory to lidocaine.
- CI: hypersensitivity to procainamide or procaine, myasthenia gravis, & 2nd- or 3rd-degree heart block.
- PC: hypotension, cardiac enlargement, CHF, AMI, ventricular dysrhythmias from digitalis, hepatic or renal impairment, or bronchial asthma.
- Dose: 20-30 mg/min IV drip. Stop points: (1) up to 17mg/kg to effect, then 1 to 4 mg/min (2) ectopy resolves (3) QRS complex widens more than 50% from original (4) hypotension ensues. Ped: 15 mg/kg/IV/IO over 30-60 min.
|
|
