Airlife Denver Drug Guidelines

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Adenosine
Pharmacology and Actions

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Adenosine is an endogenous nucleoside, it slows conduction through the AV node, thus being able to terminate the ventricular tachyarrhythmias by interruption of the reentrant pathways.

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Indications for Adenosine use

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Adenosine is indicated for converting paroxysmal supraventricular tachycardias including Wolfe-Parkinson White Syndrome. Adenosine is recommended in the initial diagnosis and treatment of stable, undifferentiated regular, monomorphic wide complex tachycardia. (clinicians should be aware that adenosine should be used with significant caution in the setting of WCT in certain patient).

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Contraindications and Precautions in adenosine use.

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Adenosine is contraindicated in patients with atrial fibrillation (unless using for diagnosis), second or third degree AV block, confirmed ventricular tachycardia, WPW and A-fib, sick sinus syndrome unless a functional pacemaker is in place and in those patients with a known hypersensitivity to the drug. Use with caution in pregnancy.

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Adenosine dosages in Adult Pt's

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1st dosage of 6mg rapid IVP
2nd dosage of 12mg rapid IVP
3rd dosage of 12mg rapid IVP

DO NOT EXCEED 30MG

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Adenosine dosage in the pedi pt.

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1st dosage is 50-100ug/kg IVP.
2nd dosage is 100-200ug/kg IVP.

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Adenosine half life

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Less then 10 sec

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Adverse reactions to Adenosine

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Adverse reactions include initial flushing, hypotension, headache, chest pain, nausea, syncope, shortness of breath, bradycardia and a metallic taste

Front 8

What drugs antagonize Adenosine?

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Effects of adenosine are antagonized by xanthenes such as theophylline and caffeine. Adenosine is potentiated by dipyridamole (Persantine).

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Pharmacology and Actions of Albuterol

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Albuterol relaxes bronchial smooth muscle by stimulating Beta 2 adrenergic receptors.

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Indications of Albuterol use

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1. Albuterol is primarily used to treat bronchial asthma and reversible bronchospasm.
2. Treatment of Hyperkalemia.

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Contraindications and Precautions to albuterol use.

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1. Should be used with caution in patients with cardiovascular disorders including coronary insufficiency and hypertension.
2. Should be used with caution in patients with hyperthyroidism, diabetes mellitus and in patients who are unusually responsive to Beta 2 adrenergics.

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Administration and Dosage of albuterol in the adult pt.

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1. In adults, 2.5 mg/0.5ml is to be mixed with three ml of normal saline and administered via a hand-held Nebulizer. The dose may be repeated every 20 minutes within the first hour as needed.
2. Continuous Neb over 1 hr 10-15mg.

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Administration and Dosage of albuterol in the pedi pt.

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1. In pediatric patients, 0.05 ml/kg (0.15mg/kg) to a maximum of 1.0 ml (5.0 mg) may be diluted with 2 to 3 ml of normal saline administered via hand-held Nebulizer every 20 minutes in the first hour.
2. Continuous Neb over 1 hr 0.5mg/kg for child.

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Side Effects & Special Notes of albuterol use.

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1. Adverse effects of Albuterol include tremor nervousness, tachycardia, palpitations, and occasionally hypertension.
2. Patient exhibiting little relief or rebound constriction may require continuous Nebulizer treatment. Consider adjunct treatments if this occurs.
3. Hypokalemia may occur with continuous Nebulizer treatments.

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Pharmacology and Actions of amiodarone.

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The electrophysiological actions of amiodarone are complex and incompletely understood. Amiodarone has generally been classified as a Vaughan-Williams class III agent, prolonging repolarization by inhibition of outward potassium channels. It also has been shown to have use-dependent class I activity, inhibition of the inward sodium currents, and class II activity. The antiadrenergic effect of amiodarone, however, is different from that of ß-blocker drugs because it is noncompetitive and additive to the effect of ß-blockers

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Indications for amiodarone use.

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1. Hemodynamically stable VT (no CP, no CHF, SBP>100mmHg, no apparent distress). Amiodarone may be started as you are preparing for cardioversion. Patients in VT strong consideration of cardioversion should be considered before deterioration occurs. If transport time is < 10 minutes to a cardiac center and patient is tolerating the fast rate a delay in electrical cardioversion may be considered as the patients condition warrants.
2. Rate control in rapid atrial arrhythmias in pt’s with poor LV function where diltiazem would be poorly tolerated.
3. Recommended after defibrillation and epinephrine in VF arrest or pulseless VT.
4. Ventricular rate control in patients with accessory pathway conduction with rapid rates.

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Contraindications for amiodarone use.

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Cardiogenic shock, marked sinus bradycardia, second-of third-degree AV block unless a functioning pacemaker is available.

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Percautions to amiodarone use.

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Give via large proximal IV or a central line if possible because it may cause severe phlebitis.
Should be infused alone.

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Adverse Reactions to amiodarone use.

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Hypotension (16%), Bradycardia (4.9%), LFT Abnormalities (3.4%), Cardiac arrest (2.9%), CHF (2.1%),

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How do you treat hypotension in amiodarone use?

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treat hypotension by slowing infusion rate, vasopressors, or volume expanding.

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Administration and Dosage of Amiodarone in the adult pt.

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1. Stable wide complex tachycardia:
Loading: 150mg in 150ml D5W IVPB over 10 min.

Re-bolus: After 20 min. if no improvement in ventricular rate and patient continues to be “Stable”-150mg in 150cc D5W IVPB over 10 min.

Maintenance: Consider if transport time > 1 hr.
1.0 mg/min (360mg) over six hours then 0.5 mg/min (540mg) over remaining 18 hrs.

Must infuse by infusion pump. Its effects on water surface tension reduces drop size by 30%, thus volumetric pumps are recommended.

2: In pulseless VT/VF: 300 mg IVP followed by 20 ml of normal saline or D5W; can be repeated at 150 mg.

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Administration and Dosage of amiodarone in the pedi pt.

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Pediatrics: Load 5mg/kg IV over 5-60min. then 5-15 mcq/kg/min IV infusion. Use lowest effective dose.

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What is amiodarone Incompatible with?

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precipitate when mixed with aminophylline, cefamandole, cefazolin, heparin, sodium bicarbonate.