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Cardiac Drugs 119
| Question | Answer |
|---|---|
| Aspirin (ASA - Acetylcalicylate Acid) Class | Antiplatelet |
| Aspirin (ASA - Acetylcalicylate Acid) Description | Decreases platelet stickiness, blocks pain impulses in CNS, reduces fever and inflammation. |
| Aspirin (ASA - Acetylcalicylate Acid) Onset and Duration | Up to 45 minutes |
| Aspirin (ASA - Acetylcalicylate Acid) Indications | Chest pain believed to be of cardiac origin |
| Aspirin (ASA - Acetylcalicylate Acid) Contraindications | ASA allergy, ASA induced asthma |
| Aspirin (ASA - Acetylcalicylate Acid) Supplied | 1 325mg tablet, or 4 81mg child tablets |
| Aspirin (ASA - Acetylcalicylate Acid) Dose/Route | 325mg Oral (chewed) |
| Nitroglycerin (Nitrostat) Class | Vasodilator |
| Nitroglycerin (Nitrostat) Description | Coronary and systemic vasodilator - decreases PVR, preload, and afterload. Decreases cardiac workload and oxygen demand. |
| Nitroglycerin (Nitrostat) Onset and Duration | Very quick, <5 minutes |
| Nitroglycerin (Nitrostat) Indications | Chest pain believed to be of cardiac origin, pulmonary edema associated with CHF. |
| Nitroglycerin (Nitrostat) Contraindications | BP <90, Pulse <50 or >100, ICP, ED drugs within 24 hours (Cialis 48 hrs) |
| Nitroglycerin (Nitrostat) Adverse Reactions | Hypotension, headache, postural hypotension/syncope, reflex tachycardia |
| Nitroglycerin (Nitrostat) Supplied | Spray or tablet |
| Nitroglycerin (Nitrostat) Dose/Route | Sublingual spray or tablet 0.4mg, may be given up to 3 times at 5 minute intervals if SBP remains above 90mmHG |
| Nitroglycerin (Nitrostat) Special notes | Monitor BP closely, have patient sit or lie down. Perform 12 lead ECG to rule out inferior MI, establish IV prior to admin with suspected inferior MI. |
| Epinephrine 1:1000 Class | Sympathomimetic |
| Epinephrine 1:1000 Description | Stimulates alpha, beta 1 and beta 2 andrenergic receptors |
| Epinephrine 1:1000 Onset and Duration | 5-10 minutes |
| Epinephrine 1:1000 Indications | Allergic reaction/anaphylaxis, bronchospasm refractory to inhaled beta agonists, to make epi infusion for adult refractory bradycardia |
| Epinephrine 1:1000 Contraindications | Allergic reaction: none; refractory bronchospasm: heart disease, PMHx AMI, >45 years old, arrythmias, labor. |
| Epinephrine 1:1000 Adverse reactions | HTN, tachycardia/tachyarrhythmias, flushing, headache, nausea/vomiting, chest pain. |
| Epinephrine 1:1000 Supplied | 1mg/1ml, vial or ampoule |
| Epinephrine 1:1000 Dose/Route | Subcutaneous or IV infusion Allergic reaction: 0.3mg - 0.5mg SQ - repeat in 15-20 minutes if indicated. Adult bradycardia: mix 1mg in 250ml or 500ml NS, run at 1-10mcg.min titrated to effect. Ped allergic reaction: 0.01mg/mg Ped IV: 0.1-1mcg/mg/min |
| Epinephrine 1:1000 Special Notes | Follow all IV doses with a 20ml NS flush, monitor ECG closely, patients on beta blockers may need glucagon or higher doses of epi. |
| Vasopressin (Pitressen) Class | Naturally occuring Antidiuretic Hormone (ADH) |
| Vasopressin (Pitressen) Description | Potent peripheral vasoconstrictor |
| Vasopressin (Pitressen) Onset and Duration | 10-20 minute onset, 30-60 minute duration. |
| Vasopressin (Pitressen) Indications | Alternate pressor for epinephrine for patients in cardiac arrest. Low resistance shock. |
| Vasopressin (Pitressen) Contraindications | responsive patients with coronary artery disease (CAD) |
| Vasopressin (Pitressen) Adverse reactions | Chest pain, abdominal distress, bronchoconstriction |
| Vasopressin (Pitressen) Supplied | liquid, in vials |
| Vasopressin (Pitressen) Dose/Route | IV Push. Adult CPR - 40U one time only. Replaces the first or second dose of epinephrine. Not recommended for peds. |
| Vasopressin (Pitressen) Special notes | In responsive patients, watch for the development of cardiac ischemia and angina. |
| Atropine Class | Antiocholonergic |
| Atropine Description | blocks the neurotransmitter acetylcholine in the central and peripheral nervous system. |
| Atropine Onset and Duration | Rapid onset, 2-6 hour duration. |
| Atropine Indications | Symptomatic sinus bradycardia. Organophosphate poisoning (insecticides). Nerve agent exposure (Sarin gas). |
| Atropine Contraindications | Avoid in hypothermic bradycardia, PEA, asystole. Use with caution in presence of myocardial ischemia and hypoxia (AMI). Not effective for type II AVB and new third degree block with wide QRS complexes. |
| Atropine Adverse reactions | Tachycardia, dilated pupils, anticholinergic effects (dry mouth, blurred vision, photophobia). Doses of atropine <0.5mg may result in paradoxical slowing of the heart rate. |
| Atropine Supplied | 1mg/10ml vial |
| Atropine Dose/Route | Symptomatic Bradycardia: 0.5mg IV every 3-5 minutes as needed. Max dose 0.4mg/kg (total of 3mg). Organophosphate poisoning IM (2-4mg IM) q 15 minutes until excessive secretions are diminished. |
| Amiodarone Class | Antiarrhythmic, sympatholytic |
| Amiodarone Description | Alters the movement of sodium, potassium, and calcium through normal channels in all cardiac tissue. Alpha and beta blcoking properties. Increases refractory period of cardiac tissue, slows repolarization, decreases automaticity. |
| Amiodarone Onset and Duration | Half life of 40 days. |
| Amiodarone Indications | VF/VT cardiac arrest unresponsive to CPR, shock, and vasopressor. Recurrent, hemodynamically unstable VT. Option in stable, wide QRS tachycardia. |
| Amiodarone Contraindications | absolute contraindication is allergic reaction. Do not administer with other drugs that prolong the QT interval. Trauma patients. |
| Amiodarone Adverse reactions | Rapid infusion may lead to hypotension. Bradycardia, hypotension, heart block. |
| Amiodarone Supplied | Ampules and vials, 150mg increments |
| Amiodarone Dose | First dose 300mg IV/IO, second dose (if needed) 150mg IV/IO. Max cumulative: 2.2g IV over 24 hours. In stable, wide QRS tachycardia, first dose is 150mg over 10 minutes. Followed by maintenance infusion of 1mg/minute for the first 6 hours. |
| Amiodarone Special notes | With expert consult, may be used to treat some atrial and ventricular arrhythmias. Do not shake, draw up med with large gauge needle. Protect from light. Avoid contact with plastic; administer at closest IV port. Frequently check BP, HR, and ECG. |
| Epinephrine 1:10,000 Class | Sympathomimetic |
| Epinephrine 1:10,000 Description | stimulates alpha, beta 1 and beta 2 andrenergic receptors |
| Epinephrine 1:10,000 Onset and Duration | Onset: 1-2 minutes, Duration: 5-10 minutes |
| Epinephrine 1:10,000 Indications | Cardiac arrest, anaphylaxis, beta blocker or calcium channel blocker OD, ped bradycardia unresponsive to other treatment. |
| Epinephrine 1:10,000 Adverse reactions | HTN, tachycardia/tachyarrhythmias, flushing, headache, nausea/vomiting, chest pain |
| Epinephrine 1:10,000 Supplied | 1mg/10ml |
| Epinephrine 1:10,000 Dose/Route | Adult Cardiac arrest: 1mg IV/IO push q 3-5 minutes, Adult Anaphylaxis: 0.1mg - 0.2mg slow push over 1 minute. Ped cardiac arrest 0.01mg/kg rapid push q 3-5 minutes. Ped anaphylaxis: 0.01 mg/kg slow push. |
| Epinephrine 1:10,000 Special notes | Monitor ECG closely, patients on beta blockers may need glucagon or higher doses of epi, do NOT mix with sodium bicarbonate. |
| Lidocaine HCL (Xylocaine) Class | Ventricular Anti-arrhythmic |
| Lidocaine HCL (Xylocaine) Description | Decreases automaticity of ventricular cells; increases ventricular fibrillation threshold. A topical or local anesthetic. |
| Lidocaine HCL (Xylocaine) Onset and Duration | Nearly immediate, has a 10-20 minute half life. |
| Lidocaine HCL (Xylocaine) Indications | Ventricular rhythms of irritability: PVC's (usually >6 min) with AMI. Runs of V-tach. V-fib. Prophylaxis: to prevent reccurence of V-fib or V-tach after initial defibrillation or cardioversion. As a premedication for PAI. |
| Lidocaine HCL (Xylocaine) Contraindications | Ventricular escape beats/rhythms associated with bradycardia or heart blocks (will cause asystole) |
| Lidocaine HCL (Xylocaine) Supplied | White powder to be reconstituted. Gel. Liquid. |
| Lidocaine HCL (Xylocaine) Dose/Route | IV/IO/ETT. Give IV push followed by IV drip if rhythm is converted. IV gtt is 1gm/250ml. Vfib/pulseless v-tach: 1.5mg/kg Unstable v-tach: 1.0-1.5mg/kg Stable v-tach: 1.0mg/kg Salvos or runs of v-tach or PVC's: 1.0mg/kg. Pediatric: 1mg/kg |
| Lidocaine HCL (Xylocaine) Special notes | Consider a reduced dose if >65 yo or those with PMHx of liver disease or CHF. Continually monitor E#CG, BP, and LOC. If Bradycardia is present with PVC's or runs of V-tach, treat bradycardia first. |
| Dopamine Class | Sympathomimetic |
| Dopamine Description | Stimulates beta 1 receptors mediating it's positive inotropic and choronotropic effects. In addition, it stimulates both alpha1 and alpha2 receptors which mediate smooth muscle vasoconstriction. |
| Dopamine Onset and Duration | Onset within 5 minutes, duration less than 10 minutes. |
| Dopamine Indications | Symptomatic bradycardia if atropine is ineffective. Post cardiac arrest hypotensions <90. Use for hypotension 70-90 SBP with S/S of cardiogenic shock. |
| Dopamine Contraindications | Hypovolemica shock |
| Dopamine Adverse reactions | Hyper/hypotension, tachycardia/bradycardia, angina, palpations, ventricular arrhythmias especially with high dosages. |
| Dopamine Drug interactions | Levodopa, Phenytoin (Dilantin) |
| Dopamine Supplied | liquid, must be diluted for administration. Put 400mg in 250ml D5W |
| Dopamine Dose/Route | Bradycardia: 2-10mcg/kg/min. Post cardiac arrest hypotension: 5-10mcg/kg/min. Cardiogenic shock: 5-10mcg/kg/min. |
| Dopamine Special notes | Low doses: dopaminergic effects Moderate doses: Beta1 andrenergic effects, positive ino/chronotrope High doses: alpha andrenergic effects. |
| Levophed (Norepinephrine) Class | Sympathomimetic |
| Levophed (Norepinephrine) Description | Primarily alpha with some minimal beta1 (positive inotrope) effects. Power vasopressor, natural catecholamine. |
| Levophed (Norepinephrine) Indications | Critical hypotension. Cardiogenic shock with BP <70 (or if Dopamine not available BP <90) Post resuscitation hypotension after medical arrest when BP <90. Septic shock, Neurogenic Shock, Inotropic support. |
| Levophed (Norepinephrine) Contraindications | Hypotension due to hypovolemia. Pregnancy (may cause fetal anoxia) |
| Levophed (Norepinephrine) Dose/Route | IV Piggyback infusion: Adult average: 8-12 mcg/min. Start at 0.5-1.0mcg and increase to effect. Dilution: add 4mg in 250ml NS. (16mcg/ml) |
| Levophed (Norepinephrine) Special notes | DO NOT USE FOR HYPOVOLEMIC SHOCK!!! |
| Sodium Bicarbonate Class | Electrolyte, Alkalinizing agent |
| Sodium Bicarbonate Description | Bicarbonate drives serum potassium back into cells. In Tricyclic Antidepressant overdose, Bicarbonate will rapidly unblock sodium channels in cardiac cells. |
| Sodium Bicarbonate Onset and Duration | Onset: 2-10 minutes. Duration: 30-60 minutes. |
| Sodium Bicarbonate Indications | Hyperkalemic cardiac arrests (renal failure or dialysis). Suspected acidosis during cardiac arrest from renal failure, methanol ingestion, or ASA overdose. Prolonged cardiac arrest. Widened QRS or AV block from TCA OD. |
| Sodium Bicarbonate Contraindications | Not recommended for routine use in cardiac arrest. |
| Sodium Bicarbonate Adverse reactions | Almalosis, tissue sloughing with infiltration. |
| Sodium Bicarbonate Drug interactions | Precipitates when combined with calcium chloride and forms calcium carbonate which is like stone. |
| Sodium Bicarbonate Dose/Route | 1 mEq/kg for adults and pediatrics. |
| Sodium Bicarbonate Special notes | Ensure adequate ventilation to eliminate CO2. Will deactivate catecholamines and does not mix well with others. Assure IV patency. |
| Calcium Chloride Class | Electrolyte |
| Calcium Chloride Description | Positive inotrope. Aids re-entry of calcium into muscles in Calcium Channel Blocker OD or MgSO4 toxicity. Balances hyperkalemia by counteracting the effects of high K on nerves and muscles. Will not lower K but will buy time for other therapies to work. |
| Calcium Chloride Onset and Duration | Onset: 5-15 minutes. Duration: up to 4 hours. |
| Calcium Chloride Indications | Calcium channel blocker toxicity, beta blocker toxicity, mag sulfate toxicity, hyperkalemic cardiac arrests associated with renal failure, methanol, ASA, TSA, or DKA. Hypocalcemia. |
| Calcium Chloride Contraindications | V-fib during cardiac resuscitation. Digitalis toxicity. Hypercalcemia. |
| Calcium Chloride Adverse Reactions | Tissue necrosis if infiltrated. Causes dig toxicity if given to a patient on digitalis. Rapid infusion or OD will cause bradycardias, hypotension, and asystole. |
| Calcium Chloride Drug interactions | Incompatible with all meds. |
| Calcium Chloride Supplied | 10% solution in 10ml. 1Gm in 10ml (100mg/ml) |
| Calcium Chloride Dose/Route | SLOW IV Push (1ml over 1 minute) Adults: 8-16mg/kg of 10% solution. Peds: 20mg/kg as above. May be repeated in 10 minutes. |
| Magnesium Sulfate Class | Electrolyte, Anticonvulsant, smooth muscle relaxer |
| Magnesium Sulfate Description | Reverses magnesium deficiency. Physiologic Calcium Channel blocker. CNS depressant. Relaxes smooth muscle. |
| Magnesium Sulfate Onset and Duration | Onset: immediate. Duration: 30 minutes. |
| Magnesium Sulfate Indications | Seizures of eclampsia. Torsades. Suspected hypomagnesemia. Status asthmaticus refractory to b-andrenergic drugs. Refractory v-fib/v-tach due to mag deficiency - often seen in alcoholics, anorexics,diarrhea. Refractory bronchospasm in adults asthma. |
| Magnesium Sulfate Contraindications | shock/hypotension. Respiratory depression. Heart blocks. Chronic renal disease/dialysis. |
| Magnesium Sulfate Adverse reactions | Wqhen given too fast - muscle weakness or paralysis, respiratory depression, CNS depression, hypotension, shock, bradycardias. |
| Magnesium Sulfate Supplied | As a liquid in bristojets and vials. Comes in a variety of concentrations. |
| Magnesium Sulfate Dose/Route | IV Push/IV Piggyback Torsades w/pulse, Refractory bronchospasm, peds pulseless arrest: 1-2 gms in 250cc NS IVPB over 20 minutes. CPR: 1-2 gms in 250cc WO via microdrip or IV push. Preeclampsia and Eclampsia: 1-4gms IV. |
| Procainamide Class | Antiarrhythmic |
| Procainamide Description | This medication depresses depolarization, which slows automaticity and/or conduction velocity. |
| Procainamide Onset and Duration | Onset: immediate. Duration: 2.5-4.5 hours. |
| Procainamide Indications | Adult: wide complex tachycardia with a pulse of unknown origin. |
| Procainamide Contraindications | second and third degree blocks, preexisting hypotension, digitalis toxicity, torsades de pointes, ticyclic antidepressant toxicity. |
| Procainamide Adverse reactions | bradycardia, hypotension, reflex tachycardia, cardiac arrhythmia, QRS widening, and less frequently PR and QT prolongation. Central nervous system are rare effects (confusion, hallucination, mental depression) |
| Procainamide Drug interactions | Other antiarrhythmics, anticholinergics (atropine), antihistamines, antihypertensives. |
| Procainamide Supplied | multidose 10ml vial providing 100mg/ml and 2ml vials providing 500mg/ml |
| Procainamide Dose | Adult: 20-50mg/min IV STOP WHEN ONE OF THE FOLLOWING OCCURS: Arrhythmia is suppressed hypotension occurs QRS widens greater than 50% Max dose of 17mg/kg achieved. Maintenance infusion: 1-4mg/min. |
| Adenosine (Adenocard) Drug Class | Endogenous nucleoside Antidysrhythmic |
| Adenosine (Adenocard) How Supplied | vial, or bristojet |
| Adenosine (Adenocard) Indications | Narrow complex tachycardias (SVT, PSVT) |
| Adenosine (Adenocard) Route | IV or IO FAST, follow with a 20cc NS bolus |
| Adenosine (Adenocard) Dose | Adult PSVT ACLS 6mg rapid followed by 20ml NS flush ACLS If no response, 12mg rapid followed by an additional 12mg if needed. Pediatric 0.1mg/kg rapid If no response, double the dose |
| Adenosine (Adenocard) Action | Slows PSVT by decreasing elecctrical conduction through the AV node Acts directly on SA node and vagal nerve to decrease chronotropic activity. |
| Adenosine (Adenocard) Onset and Duration | Immediate onset, lasts 7-10 seconds. |
| Adenosine (Adenocard) Precautions | Monitor ECG closely Expect a brief period of asystole (up to 15 seconds) followed by return to sinus rhythm. May produce bronchoconstriction in asthma patients. |
| Adenosine (Adenocard) Side Effects | Light headedness headache palpitations chest pain flushing nausea |
| Adenosine (Adenocard) Contraindications | Second or third degree blocks |
| Diltiazem Drug Class | Calcium Channel Blocker |
| Diltiazem Dose and Route | Adult: 0.25mg/kg slow IV Push (over 2 minutes) Second dose: 0.35 mg/kg 15 minutes after initial dose. Infusion: 125mg in 100ml. Run at 5-15mg/hr Pediatric: currently not recommended |
| Diltiazem Drug Action | Blocks movement of calcium into muscle Vasodilation by relaxing vascular smooth muscle Slows conduction trough AV Node Decreases ventricular response in SVT Negative inotrope and chronotrope Dilates coronary arteries |
| Diltiazem Indications | A fib or A flutter with rapid ventricular rate (RVR) PSVT unresponsive to Adenosine |
| Diltiazem Precautions | Monitor BP closely Incompatible with Lasix; flush IV line well Inform Med Control if patient is on digitalis or beta blockers Shelf life is only 1 month |
| Diltiazem Side Effects | Hypotension Bradycardia Heart Blocks Asystole Nausea and vomiting PVCS p conversion of SVT |
| Diltiazem Contraindications | Hypotension Wide complex tachycardias WPW 2 or 3 degree heart blocks |
| Diltiazem Antidote | Calcium Chloride |
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