Cardiac Drugs

Front 1

Amiodarone (Cordarone, Pacerone)

Back 1

Class- Antiarrhythmic

Mechanism of action- Sodium, Potassium channel Blocker

Indications- V-fib/pulseless V-tach and unstable V-tach in patients
refractory to other therapy.

Contraindications- Allergic, cardiogenic shock, sinus
bradycardia and second- or third-degree AV block

Adverse reactions- Hypotension, bradycardia, prolongation of the
P-R,, QRS, and Q-T intervals.

How supplied- Ampules containing 150 mg/3 mL (50 mg/mL) and
prefilled syringes containing 150 mg/3 mL (50 mg/mL)
.
Dosage- Symptomatic v-fib/pulseless v-tach 300 mg IV/IO push (diluted in 20–30 mL D5W). Initial dose can be followed one time in 3–5 minutes at 150 mg IV/IO push.
Recurrent life-threatening ventricular arrhythmias: Maximum dose is 2.2 g/24 hours,

Special considerations Pregnancy safety: Category D. Monitor
patient for hypotension. May worsen arrhythmias or precipitate new arrhythmias

Front 2

Aspirin

Back 2

Class- Platelet inhibitor, anti-inflammatory.

Mechanism of action- Prostaglandin inhibition.

Indications New onset chest pain. Signs and symptoms suggestive of recent cerebrovascular
accident.

Contraindications- active ulcer disease or asthma.

Adverse reactions- Heartburn, GI bleeding, prolonged bleeding, N/V
.
Drug interactions- Use with caution in patients allergic to NSAIDs.

Dosage and administration- 160 mg to 325 mg PO (chewed if
possible).

Special considerations Pregnancy safety: Category D. Not recommended
in pediatric population.

Front 3

Atropine Sulfate

Back 3

Class- Anticholinergic

Mechanism of action- Parasympatholytic: inhibits action of acetylcholine
increases heart rate in symptomatic bradys

Indications- Hemodynamically unstable bradycardia, asystole,
bradycardic (< 60 beats/min) PEA, organophosphate poisoning, bronchospastic pulmonary disorders

Contraindications -Tachycardia, unstable cardiovascular
status in acute hemorrhage and myocardial ischemia

Adverse reactions- Headache; dizziness; palpitations; N/V,tachycardia; arrhythmias; flushed, hot, dry skin.

Supplied in- Prefilled syringes: 1 mg in 10 mL (0.1 mg/mL). Nebulizer:
0.2% (1 mg in 0.5 mL) and 0.5% (2.5 mg in 0.5 mL).

Dosage and administration- Asystole or bradycardic PEA: 1 mg
IV/IO push. May repeat every 3–5 minutes to a maximum of 3 doses (3 mg). Unstable bradycardia:
0.5 mg IV/IO every 3–5 minutes as needed, not to exceed
total dose of 3 mg

Special considerations Pregnancy safety: Category C. Moderate
doses may cause pupillary dilation.

Front 4

Diltiazem Hydrochloride (Cardizem,
Lyo-Ject)

Back 4

Class- Calcium channel blocker.

Mechanism of action- Blocks calcium ions from cardiac muscle;
prevents spasm of coronary arteries. Arterial and venous
vasodilator. Reduces preload and afterload. Reduces myocardial oxygen
demand.

Indications- Control of rapid ventricular rates due to A-flutter,
A-fib, and re-entry SVT; Angina pectoris.

Contraindications- Hypotension, sick sinus syndrome, second- or
third-degree AV block, cardiogenic shock, wide-complex tachycardias,
poison/drug-induced tachycardia.

Adverse reactions Bradycardia, second- or third-degree AV blocks,
chest pain, CHF, syncope. V-Fib, V-tach, nausea, vomiting, dizziness,
dry mouth, dyspnea, headache.

How supplied- 25 mg/5-mL vial; 50 mg/10-mL vial. Nonrefrigerated:
Lyo-Ject syringe.

Dosage and administration- Initial bolus: 0.25 mg/kg (average
dose 15–20 mg) IV over 2 minutes. may rebolus
in 15 minutes: 0.35 mg/kg (average dose 20–25 mg) IV over
2 minutes. Maintenance infusion of 5–15 mg/h

Special considerations Pregnancy safety: Category C. Use with caution
in patients with renal or hepatic dysfunction. PVCs may be
noted at time of conversion of PSVT to sinus rhythm.

Front 5

Dopamine (Intropin)

Back 5

Class- Sympathomimetic, inotropic agent.

Mechanism of action- Increases systemic vascular resistance, dilates renal and splanchnic vasculature. Increases myocardial contractility and stroke volume.

Indications- Cardiogenic, septic or spinal shock, hypotension with
low cardiac output states, distributive shock.

Contraindications- Hypovolemic shock, tachyarrhythmias, V-fib.

Adverse reactions- Cardiac arrhythmias, hypertension, increased
myocardial oxygen demand; extravasation may cause tissue necrosis.

How supplied- 200 mg/5 mL–400 mg/5 mL prefilled syringes, ampules
for IV infusion; 400 mg in 250-mL D5W premixed solutions.

Dosage- 2–20 mcg/kg/min titrated to patient response

Always monitor drip rate. Avoid extravasation injury.

Front 6

Epinephrine (adrenalin)

Back 6

Class- Sympathomimetic

Mechanism of action- Direct-acting alpha- and beta-agonist. Alpha:
vasoconstriction. Beta-1: positive inotropic, chronotropic, and dromotropic
effects. Beta-2: bronchial smooth muscle relaxation and
dilation of skeletal vasculature.

Indications Cardiac arrest (V-fib/pulseless V-tach, asystole, PEA),
symptomatic bradycardia as an alternative infusion to dopamine,
severe hypotension secondary to bradycardia when atropine and
transcutaneous pacing are unsuccessful, allergic reactions, anaphylaxis,
asthma.

Contraindications- Hypertension, hypothermia, pulmonary edema,
myocardial ischemia, hypovolemic shock.

Adverse reactions- Hypertension, tachycardia, arrhythmias, pulmonary
edema, anxiety, restlessness, psychomotor agitation, nausea,
headache, angina.

How supplied 1:1,000 solution: ampules and vials containing
1 mg/mL. 1:10,000 solution: prefilled syringes containing 1 mg in
10 mL (0.1 mg/mL). Auto-injector (EpiPen): 0.5 mg/mL (1:2,000).

Dosage- Mild allergic reactions and asthma:
0.3–0.5 mg (1:1,000) SC. Anaphylaxis: 0.1 mg (1 mL of
1:10,000) IV/IO over 5 minutes. Cardiac arrest: IV/IO dose: 1 mg
(10 mL of 1:10,000 solution) every 3–5 minutes during resuscitation.
Follow each dose with 20 mL flush and elevate arm for 10 to 20 seconds
after dose.

Front 7

Lidocaine Hydrochloride (Xylocaine)

Back 7

Class Antiarrhythmic

Mechanism of action- Decreases automaticity by slowing the rate of
phase 4 depolarization.

Indications- Alternative to amiodarone in cardiac arrest from
V-fib/pulseless V-tach, stable monomorphic V-tach, stable polymorphic
V-tach with normal baseline QT interval.

Contraindications- Hypersensitivity, second- and third-degree
AV blocks in the absence of artificial pacemaker, Stokes-Adams syndrome,
wide-complex ventricular escape beats with bradycardia.

Adverse reactions- Slurred speech, seizures (with high doses),
altered mental status, confusion, lightheadedness, blurred vision,
bradycardia.

How supplied- 100 mg in 5-mL prefilled syringes and ampules
(20 mg/mL), 1-g and 2-g additive syringes, 1-g and 2-g vials in
30 mL of solution.

Dosage- Cardiac arrest from V-fib/pulseless
V-tach: Initial dose: 1–1.5 mg/kg IV/IO. Repeat dose: 0.5–0.75 mg/kg,
repeated in 5–10 minutes to maximum dose of 3 mg/kg..
Maximum total dose is 3 mg/kg. Maintenance infusion:
1–4 mg/min (30–50 ìg/kg/min); can dilute in D5W or normal saline.

Front 8

Midazolam (Versed)

Back 8

Class- Short-acting benzodiazepine CNS depressant.

Mechanism of action- Anxiolytic and sedative, memory impairment.

Indications- Sedation, anxiolytic prior to endotracheal or nasotracheal
intubation; administer for conscious sedation.

Contraindications- Glaucoma, shock, coma, alcohol intoxication,
overdose, depressed vital signs, concomitant use with other CNS
depressants, barbiturates, alcohol, narcotics.

Adverse reactions- Hiccough, cough, oversedation, N/V,
injection site pain, headache, blurred vision, hypotension, respiratory
depression, and arrest.

How supplied- 2-, 5-, 10-mL vials (1 mg/mL); 1-, 2- , 5-, 10-mL vials
(5 mg/mL).

Dosage- 2.0–2.5 mg slow IV over
2–3 minutes; may be repeated to total maximum: 0.1 mg/kg.

Front 9

Morphine Sulfate (Astramorph)

Back 9

Class- Opioid analgesic (schedule II narcotic)

Mechanism of action- Alleviates pain through CNS action, suppresses
fear and anxiety centers in brain; depresses brain stem respiratory
centers, decreases preload and afterload, which
decreases myocardial oxygen demand.

Indications- Severe CHF, pulmonary edema, chest pain associated
with acute MI, analgesia for moderate to severe acute and chronic
pain (use with caution).

Contraindications- Head injury, exacerbated COPD, depressed respiratory
drive, hypotension, undiagnosed abdominal pain, AMS, suspected hypovolemia

Adverse reactions- Respiratory depression, hypotension, AMS, N/V, bradycardia, tachycardia,
syncope, facial flushing, euphoria, bronchospasm, dry mouth.

How supplied 10 mg in 1 mL of solution, ampules, and Tubex
syringes.

Dosage- Initial dose: 2–4 mg IV (over
1–5 minutes) every 5–30 minutes. Repeat dose: 2–8 mg at 5- to
15-minute intervals.

Front 10

Norepinephrine (Levophed, Levarterenol)

Back 10

Class Sympathomimetic.

Mechanism of action- Potent alpha-agonist resulting in intense vasoconstriction;
positive chronotropic and increased inotropic effect
with increased cardiac output.

Indications- Cardiogenic shock, significant hypotensive (< 70 mm Hg)
states.

Contraindications- Hypotensive patients with hypovolemia, pregnancy
(relative contraindication).

Adverse reactions- Headache, arrhythmias, tachycardia, reflex
bradycardia; angina pectoris, hypertension; decreased blood flow to
gastrointestinal tract, kidneys, skeletal muscle, and skin.

How supplied 1-mg/mL, 4-mL ampules.

Dosage- Dilute 8 mg in 500 mL of D5W or
4 mg in 250 mL of D5W (16 mg/mL); infuse by IV piggyback at
0.5–1.0 mcg/min, titrated to improve blood pressure (up to 30 mcg/min)

Front 11

Phenytoin (Dilantin)

Back 11

Class Anticonvulsant.

Mechanism of action- Promotes sodium efflux from neurons,
thereby stabilizing the neuron’s threshold against excitability caused
by excess stimulation; in similar fashion, decreases abnormal ventricular
automaticity and decreases the refractory period in the
myocardial conduction system.

Indications- treatment of major motor seizures,
digitalis-induced arrhythmias.

Contraindications- bradycardia, second- and third degree
heart block.

Adverse reactions- Hypotension with too rapid IV push, heart
block, arrhythmias, cardiovascular collapse, N/V,
ataxia, central nervous system depression, pain at injection
site, respiratory depression.

How supplied 50 mg/mL in 2- and 5-mL ampules, 2-mL prefilled
syringes. May be diluted in normal saline (NS) (1–10 mg/mL); use
in-line filter. Note: IV line should be flushed with 0.9% NS before
and after drug administration.

Dosage- Seizures: 10–20 mg/kg slow IV,
not to exceed 1 g or rate of 50 mg/min).
Arrhythmias: 50–100 mg
(diluted) slow IV every 5–15 min PRN; maximum, 1 g.

Front 12

Diazepam (Valium)

Back 12

Class- Benzodiazepine, sedative-hypnotic, anticonvulsant.

Mechanism of action- Potentiates effects of inhibitory neurotransmitters.
Raises seizure threshold. Induces amnesia and sedation.

Indications- Acute anxiety states, acute alcohol withdrawal (delirium
tremens), muscle relaxant, seizure activity, agitation., cardioversion.

Contraindications- Hypersensitivity, glaucoma, coma, shock, substance
abuse, head injury.

Adverse reactions- Respiratory depression, hypotension, drowsiness,
ataxia, reflex tachycardia, nausea, confusion, thrombosis.

How supplied 10 mg/5-mL prefilled syringes, ampules, vials, and
Tubex.

Dosage- 5–10 mg IV q10–15 minutes prn (5 mg over 5 min)
(maximum dose, 30 mg)

Front 13

Digoxin (Lanoxin)

Back 13

Class Inotropic agent.

Mechanism of action- Rapid-acting, increase force of myocardial contraction,
increase refractory period of AV node, and increase total peripheral
resistance.

Indications- CHF, re-entry SVT, especially a- flutter and a-fib.

Contraindications- Ventricular fibrillation, ventricular tachycardia,
digitalis toxicity, hypersensitivity to digoxin.

Adverse reactions- Headache, weakness, blurred yellow or green
vision, confusion, seizures, arrhythmias, nausea, vomiting, and
skin rash.

How supplied- 2-mL ampules of 0.5 mg digoxin; also as tablets, capsules,
and elixirs.

Dosage- Loading dose of 10 to 15 mcg/kg.