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15 Cards in this Set

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Adenosine
A/m
Decreases electrical conduction through the AV node.
Blocks reentry pathways through the AV & SA node in PSVT
Can restore NSR from PSVT (including WPW)
Adenosine
Use
PSVT (including WPW) that is refractory to common vagal manuevers.
Adensoine
Contra
2nd & 3rd degree heart block
Sick Sinus Syndrome
Known sensitivity
Concomitant Persantine or Tegretol use
Dysrhythmias other than PSVT
Reactive airway disease
Adenosine
SE
CNS: Dizziness, syncope
CV: PVCs, PACs, sinus tach, sinus brady, AV blocks, cp, facial flushing headache
R: SOB, bronchoconstriction
GI: Nausea
Adenosine
Interactions
Additive/potential reactions: Digoxin, calcium channel blockers, Presantine, Tegretol
Antagonize: methlyxanthines
Adenosine
Dose
6mg rapid IVP followed with 10-30cc NS flush IVP. 12mg IVP if not conberted in 1-2 min. May repeat 12mg again in 2 min prn.
Adenosine
Admin/Notes
Rapid IV bolus as close to vein as possible over 1-2 seconds. Must be given rapidly. IV dose must be followed immediately by 10-30ml NS flush.
N: Antecubital veins (large) are preferable to hand or forearm veins.
Procainamide
A/M
Reduces automaticity of pacemaker sites and slows intraventricular conduction to a larger degree than lidocaine.
Slightly decreases contractility of cardiac muscle tissue and reduces cardiac output. It can produce peripheral vasodilatation and hypotension.
Procainamide
Uses
Recurrent VF or pulseless VT refractory to lidocaine
Ventricular ectopy refractory to lidocaine (PVCs, stable VT)
Procainamide
Contra
High degree AV block (unless pacemaker present and functioning), significant bradycardia, Torsades de pointes, or other conduction system disturbances, hypersensitivity.
Use with caution in myocardial infarction, CHF, digitalis toxicity, hepatic and renal dysfunction.
Procainamide
SE
CNS: confusion, drowsiness, seizure
CV: brady, hypotension, heart blocks, dysrhythmias, VF
R: Arrest
GI: N + V
Procainamide
Interaction
May have either antagonistic or additive effects when combined with other antidysrhythmics. Additive effects occur with antihypertensive drugs.
Procainamide
Dose
20mg/min until: dysrhythmia is terminated OR QRS widens by 50% OR Heart block/hypotension result OR 17mg/kg is given.
Follow with maintenance dose of 1-4 mg/min
Procainamide
Admin
Adminsiter as IV solution as indicated. Inspect solution for discoloration. Monitor ECG, BP, singns of CNS toxicity.
Procainamide
Notes
Solution should be clear to pale yellow.
If cardiac rhythm disturbances are present in the setting of malignant hyperthermia, procainamide should be considered as primary agent.
Procainamide is no longer recommended by AHA for arrest protocol.