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34 Cards in this Set

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Adenosine (endogenous nucleoside)

Indicated for?

IV Bolus Dosage?
PSVT or Narrow Complex Tachycardia

6mg - 1st dose
12 mg - 2nd dose
12 mg - 3rd dose
(1-2 min intervals between)
Amiodarone (antiarrhythmic)

Indicated for?

IV Bolus Dosage?

Infusion Dosing?
V-Fib/Pulseless V-Tach
300 mg - 1st dose
150 mg - 2nd dose

Infusion dosing:
Loading: 150 mg over 10 minutes, then
360 mg IV over 6 hours
540 mg IV over 18 hours
Aspirin (NSAID)

Indicated for?

PO dose?

Suppository Dose?
Chest Pain/ACS

PO Dose: 160-325 mg

Suppository dose: 300 mg
Atropine (parasympathetic blocker)

Indicated for?

IV Bolus Dosage?
Bradycardia
0.5 mg q 3-5 min as needed

PEA, Asystole
1 mg q 3-5 min
Atropine special considerations
Only used in bradycardias for *symptomatic* patients. Only used in PEA if rate is *slow*. The maximum dosage is 3 mg. Doses of Atropine < .5 mg may result in paradoxical slowing of the heart. NOT indicated in 2nd degree type I or third degree heart block.
Adenosine considerations
Doses are followed by a saline flush. Two subsequent doses of 12 mg each may be administered at 1 - 2 min intervals. Use the port closest to cannulation. The AHA recommends that the dose be cut by half if administering through a central line, or in the presence of Dipyridamole or Carbamazepine. Larger doses are required in the presence of caffeine or Theophylline.
Amiodarone considerations
Cumulative doses > 2.2 g/24 hours are associated with significant hypotension. Do not administer with other drugs that prolong QT interval (ie, Procainamide). Terminal elimination is extremely long - half life lasts up to 40 days.
Digoxin (cardiac glycoside antiarrhythmic)

Indicated for?

IV Bolus Dosage?
A-Fib/ A-Flutter

10 - 15 mics/kg lean body weight
Digoxin considerations
Reduce Digoxin dose by 50% when initiating Amiodarone due to drug interaction. Toxicity may cause serious arrhythmias.
Diltiazem (calcium channel blocker)

Indicated for?

IV Bolus Dosage?
A-Fib/A-Flutter

15-20 mg over 2 minutes
Diltiazem considerations
Do not use in wide-QRS tachycardias of uncertain origin. May cause hypotension.
Dopamine (catecholamine)

Indicated for?

IV dosage?
Symptomatic Bradycardia, Hypotension

1-5 mic/kg/min - renal perfusion
5-15 mic/kg/min - cardiac dose
10 - 20 mic/kg/min - vasopressor dose
Dopamine considerations
Titrate to patient response. Correct hypovolemia with volume replacement BEFORE initiating Dopamine. May cause tachyarrhythmias. Do not mix with Sodium Bicarbonate.
Epinephrine (catecholamine)

Indicated for?

IV dosage?

Infusion dosage?
V-Fib/Pulseless V-Tach, PEA, Asystole, Symptomatic Bradycardia
1 mg every 3-5 minutes

Infusion dosage 1 mg in 500mL of D5W or NaCl at 1 mic/min titrated to effect
Epinephrine considerations
First line drug in all pulseless rhythms. Bolus given in 10mL of a 1:10,000 solution. May cause myocardial ischemia, angina, and increased myocardial oxygen demand. ET route is discouraged, but if used 2-2.5 mg diluted in 10 mL NaCl.
Lidocaine (antiarrhythmic)

Indicated for?

IV dosage?

Infusion dosage?
V-Fib/Pulseless V-Tach, Stable V-Tach
1-1.5 mg/kg

Infusion dosage: 1-4 mg/min (30-50 mic/kg/min)
Lidocaine considerations
May repeat at 0.5-0.75 mg/kg every 5-10 minutes to maximum dose 3mg/kg. Prophylactic use in AMI is contraindicated. Use with caution in presence of impaired liver. Discontinue infusion if signs of toxicity develop.
Magnesium sulfate (electrolyte)

Indicated for?

IV dosage?
Cardiac arrest if torsades or Hypomagnesemia

1-2g in 10 mL D5W over 20 minutes
Magnesium sulfate considerations
occasional fall in blood pressure with rapid administration. Use with caution in renal patients.
Morphine sulfate (opiate analgesic)

Indicated for?

IV dosage?
Chest pain
Pulmonary edema

2-4 mg every 5-30 minutes
Naloxone (opiate antagonist)

Indicated for?

IV dosage?
Narcotic overdose

0.4-2mg
Naloxone considerations
If needed, can administer up to 10mg in 10 minutes. Monitor for recurrent respiratory depression. May cause opiate withdrawal. ET route discouraged, but can be used if IV/IO access not available.
Nitroglycerine (vasodilator)

Indicated for?

IV dosage?
Chest pain/ACS

12.5-25 mics
Nitroglycerine considerations
Most commonly given sublingually as a tablet or spray. The dose is 0.3-0.4 mg. Repeat up to 3 doses at 5 minute intervals. Hypotension or bradycardia may occur. Do not use with Viagra and similar drugs.
Nitroprusside (vasodilator)

Indicated for?

IV dosage?
Hypertensive crisis

0.1 mic/kg/min, titrate upward to effect
nitroprusside considerations
May cause hypotension. Use with catution with Viagra and similar drugs. Light-sensitive--bag and tubing must be covered with opaque material.
Procainamide (antiarrhythmic)

Indicated for?

IV dosage?

Infusion dosage?
Wide variety of arrhythmias

IV drip dosage - 20mg/min

Infusion dosage: 1-4 mg/min
Procainimide considerations
Maximum dosage is 17mg/kg. In presence of cardiac or renal dysfunction, reduce max dose to 12mg/kg. Can cause arrhythmias in presence of AMI, hypokalemia, or hypomagnesemia. Use with caution with other drugs that prolong the QT interval such as Amiodarone.
Sodium Bicarbonate (buffer)

Indicated for?

IV dosage?
Acidosis, hyperkalemia

1 mEq/kg
Sodium bicarbonate considerations
Not recommended for routine use in cardiac arrest patients. If available, use arterial blood gas analysis to guide bicarbonate therapy.
Vasopressin (hormone)

Indicated for?

IV dosage?
V-fib/V-Tach
PEA, Asystole

10 U IV/IO
Vasopressin considerations
Only given one time. May cause cardiac ischemia and angina. May replace first or second dose of Epi. Not recommended for responsive patients with coronary artery disease.
Verapamil (calcium channel blocker)

Indicated for?

IV dosage?
A-Fib/A-Flutter
PSVT

2.5-5 mg over 2-5 minutes
Verapamil considerations
Alternative drug after Adenosine to terminate PSVY with adequate blood pressure and preserved LV function. Can cause peripheral vasodilation and hypotension. Use with extreme caution in patients receiving oral beta blockers.