Ems Pharmacology Reference

Front 1

Procainamide

Back 1

Trade Name: Pronestyl, Procan, Promine
Generic Name: Procainamide HCL
Classification: Anti-arrhythmic

Actions: Same actions as for Lidocaine and Bretylium. An added advantage of Procainamide, unlike Lidocaine and Bretylium, is that it has some anti-arrhythmic effects on supra-ventricular rhythms and atrial ectopic pacemakers.

Indications: PVC's and ventricular tachycardia refractory to Lidocaine. SVT not responding to Adenosine.

Contraindications: Heart blocks

Side effects: Hypotension, dizziness, bradycardia, Torsades de Pointes

Route of Administration: Slow IV loading infusion, IV maintenance infusion

Dosage range (adult): IV loading infusion: 20 mg/min by adding 1 gram (1g/10ml) to 40ml NS to equal 20 mg/ml. Infuse using a 60 gtts/ml IV administration set @ 60 gtts/min. Infuse until either the arrhythmia is suppressed, hypotension develops, the QRS complex widens by 50%, or a total of 17mg/kg has been given. Maintenance infusion: 1-4 mg/min.

Dosage range (Pediatric): Rare to use

Drip Mixture (Adult): 1 gram in 500ml NS to equal a 2mg/ml concentration.

Supplied: 10ml vials of 1 gram (100mg/ml), or 2 ml vials of 1 gram (500 mg/ml)

Special Considerations: This drug takes a long time to completely administer.

Front 2

Verapamil

Back 2

Trade Name: Calan, Isoptin
Generic Name: Verapamil
Classification: Calcium ion antagonist (calcium channel blocker)

Actions: Verapamil blocks the entry of calcium into both cardiac and smooth muscle causing prolonged refractory periods. Useful in controlling re-entry arrhythmia's such as atrial fibrillation and atrial flutter. With its vasodilating properties, Verapamil will increase coronary artery perfusion, decrease afterload, and cause a decrease in blood pressure. Negative inotropic drug which increases myocardial oxygen consumption.

Indications: Second line drug after Adenosine for narrow complex supra-ventricular tachycardias with a stable blood pressure that do not require cardioversion. In the absense of Wolff-Parkinson White Syndrome (WPW), it is the drug of choice for symptomatic atrial fibrillation and atrial flutter with rapid ventricular response.

Contraindications: Should be avoided in patients taking beta blockers. It should not be given to patients with WPW, known Sick Sinus Syndrome, any wide complex tachycardia , heart failure, or heart blocks.

Side Effects: Hypotension, possible asystole, ventricular fibrillation.

Route of Administration: IV slow push over 1-3 mins. (onset of action may take 3-5mins)

Dosage Range (Adult): 2.5 to 5mg initial dose. May repeat at 5-10 mg every 15-30 minutes. Patients over 70 years of age should receive smaller doses ( 2-4mg) over a longer period of time (3-4mins).

Supplied: 5mg/2ml (2.5mg/ml) ampules and prefilled syringes

Special Considerations: Continually monitor the patient's blood pressure for signs of hypotension before, during, and after administration. Avoid using in conjunction with Sodium Bicarbonate or patients taking theophylline.

Overdose: Calcium chloride may be useful in reversing the hypotensive side effects of a Verapamil overdose.

Front 3

Vasopressin

Back 3

Trade Name: None
Generic Name: Vasopressin ( Antidiuretic Hormone)
Classification: Synthetic Hormone

Actions: An endogenous pituitary hormone (antidiuretic hormone) which normally effects renal absorption of water in the kidneys. At higher doses, Vasopressin exhibits systemic and coronary artery vasoconstriction.

Indications: One time dose administered for patients in ventricular fibrillation and pulseless ventricular tachycardia.

Contraindications: None in the above situation

Side effects: Bronchial constriction

Route of Administration: IVP

Adult Dosage: 40 units one time dose

Pediatric Dosage: Not to be used

Supplied: 20 units/ml multidose vials

Special Considerations: half-life is approximately 10-20mins.

Front 4

Acetylsalyicylic acid (Aspirin)

Back 4

Classification: Anti-inflammatory salicylate

Effects: Blocks the formation of thromboxane A2 which causes platelets to aggregate and arteries to constrict. Therefore, the use of aspirin will reduce the overall mortality from AMI, reduce nonfatal reinfarction, and reduce nonfatal stroke.

Indications: Cardiac chest pain

Contraindications: Known allergy - be particularly careful in asthmatics - 10% will have a severe allergic reaction. Avoid in patients with a current GI bleed and in patients who have taken their own aspirin in the past 4 hours. Suspected stroke.

Side Effects: Upset stomach

Administration: Have patient chew and swallow 2 baby aspirin (162mg)