Adenosine - Drug Description

Adenosine - Primary Uses: - SVT/PSVT - Wide QRS Tachycardia - Dose: - First Dose: 6 mg IV Push - Second Dose: 12 mg IV Push - Cautions/Notes - Must be given as a bolus, followed by a flush - Can cause bronchospasm – use caution in asthmatics - Flushing / chest tightness are common Amiodarone - Primary Uses: - Pulseless VT - Ventricular Fibrillation (V-Fib) - Recurrent Hemodynamically Unstable Ventricular Tachycardia - Hypertrophic Cardiomyopathy - Supraventricular Tachyarrhythmias - Dose: - VT / V-Fib: 300 mg IV/IO. May give 150 mg after initial dose - Tachy / VT: 150 mg IV/IO over 10 minutes. Continuous infusion of 1 mg/min IV for 6 hours, 0.5 mg/min IV for next 18 hours - Cautions/Notes - Atrial fibrillation, hypertrophic cardiomyopathy and supraventricular arrhythmias are often treated with oral form of amiodarone - Rapid infusion causes hypotension - If cumulative dosing exceeds 2.2 grams in 24 hours, significant hypotension can occur. Avoid administration with any drug that may prolong QT interval Atropine - Primary Uses: - Symptomatic Bradycardia - Cardiac Arrest - Dose: - 0.5 mg IV (Repeat every 3 – 5 minutes - Max dose: 3 mg - Cautions/Notes - Dose less than 0.5 mg may cause paradoxical bradycardia Dopamine - Primary Uses: - Bradycardia - Hypotension - Dose: - 2 – 20 mcg/kg/min infusion - Titrated based on clinical response; tapered on/off slowly - Cautions/Notes - Extravasation causes tissue damage and necrosis - Use caution if giving high doses through peripheral IV site - May cause excessive vasoconstriction / tachyarrhythmias - Adequate volume resuscitation required before initiating dopamine therapy Epinephrine - Primary Uses: - Cardiac Arrest - Symptomatic Bradycardia - Anaphylaxis / Severe Allergic Reactions - Severe Hypotension - Dose: - 1 mg (10 mL of 1:10,000 solution) - Repeat every 3 – 5 minutes - IV fluid Flush following each dose - Cautions/Notes - Higher doses often needed in cases of beta-blocker or calcium channel blocker overdoses. A continuous infusion may be required - High dose does not improve survival / neurological outcome - High dose ceases myocardial dysfunction in post-resuscitation period Lidocaine - Primary Uses: - Ventricular Tachycardia - Ventricular Fibrillation - Dose: - Cardiac Arrest from VT / VT: 1 – 1.5 mg/kg IV/IO - Refractory VF: Additional 0.5 – 0.75 mg/kg IV/IO; Repeat every 5 – 10 minutes for max of 3 doses, or 3 mg/kg - Stable VT: 0.5 – 0.75 mg/kg up to 1.5 mg/kg; Repeat in 0.5 – 0.75 mg/kg doses to max of 3 mg/kg - Maintenance Infusion: 1 – 4 mg/min - Cautions/Notes: - Not recommended routinely after Cardiac Arrest, but can be used following ROSC - Can also be used for stable polymorphic ventricular tachycardia with normal baseline QT AND torsades - Decrease maintenance doses if left ventricular dysfunction or if impaired liver function - Not used prophylactically after myocardial infarction Magnesium - Primary Uses: - Torsades de Pointes - Hypomagnesemia (low magnesium) - Digitalis Toxicity - Dose: - Initial Dose: 1 – 2 g IV/IO diluted in 10 mL D 5W - Infusion Dose: 0.5 – 1 g/hour - Cautions/Notes: - Rapid administration may drop blood pressure - Very high doses can cause respiratory distress (calcium is antidote) - Use with caution for patients with renal failure Procainamide - Primary Uses: - Ventricular Arrhythmias - Supraventricular Arrhythmias - Dose: - Loading Dose: 15 – 17 mg/kg IV. Give over at least 30 minutes - Max: 1.5 grams - Cautions/Notes: - Serious reactions can occur for ventricular fibrillation, asystole, seizures, decreased platelets, neutrophils (and can result in hemolytic anemia) - Other common reactions include hypertension, bradycardia, angioedema, flushing and urticarial