DRUG NAME

EPINEPHRINE

ADULT DOSE
1mg IV or 2-5 mg IV via ETT 40 units IV For VF or pulseless VT: 300mg IV push 1-1.5 push mg/kg IV

PEDIATRIC DOSE
0.01mg/kg IV or IO or 0.1mg/kg via ETT Not indicated For VF or pulseless VT: 5mg/kg IV push Same 25-50mg/kg IV slow push 15 mg/kg IV load;3-6 mg/kg over 5min,not to exceed 100mg/kg 0.02mg/kg;mini mum dose of 0.1 mg

INDICATI ON
Any pulseless arrhythms VF, PulselessVT VF, pulseless VT,VT with a pulse,SVT VF, pulseless VT,VT with a pulse Torsde de pointes, known hypomagnese mia VT with a pulse

FREQUENCY
Every 3-5 min

VASOPRESSIN AMIODARONE

Single dose,may be followed at 10 min by epinephrine May use 2nddose of 150mg for recurrent VF/VT.In children may be repeated in 5mg/kg doses to a total of 15mg/kg 2nd & subsequent doses of 0.75mg/kg every 5 min to a total dose of 3 mg/kg Single dose

LIDOCAINE MAGNESIUM

1-2g IV slow push

PROCAINAMI DE

17 mg/kg IV slow bolus at maximum rate of 50mg/min PerfusingPatients: 0.5mg Iv push5min, to maximum of 3mg. Pulseless patients: 1mg IV push q 5 min, to maximum of 3mg 6 mg rapid IV push through proximal peripheral line; central line dose is one-half 0.25mg/kg to a maximum dose of 20mg IV push over 2min 500Mcg/kg over 1 min bolus

Continue infusion(4mg/min) until QRS widening>50%,dysrhythmia terminated, onset of hypotension; or 17 mg/kg infused. May be repeated once upto maximum dose of 3mg

ATROPINE

Bradycardia, asystole.

ADENOSINE

0.1mg/kg rapid IV push;maximum dose,6mg Same

SVT

If needed,2nd dose of 12 mg(pediatric,doble initial dose up to 12 mg);3rd dose of 12-18 mg 2nd dose of 0.35mg/kg,maximum dose of 25mg, at 15min;after conversion, start dilitiazem drip at 5-15 mg/H

DILITIAZEM

SVT

ESMOLOL

100-500 Mcg/kg bolus over 1min Not indicated Not indicated

SVT

May give another bolus if desired effect is not achieved; start drip 50Mcg/kg/min Repeat in 10 min, then give 50mg oral load Repeat twice at 5min intervals, then give 50 mg oral load

ATENOLOL METOPROLOL

5mg IV over 5min 5 mg IV push

SVT,MI SVT,MI

EPINEPHRINE (Beta2 Adrenergic Agonists)

Action Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity Increases BP, HR, PR Decreases airway resistance. Indication Asthma Bronchitis Emphysema All cardiac arrest, anaphylaxis Used for symptomatic bradycardia. Relief of bronchospasm occurring during anesthesia Exercised-induced bronchospasm

Nursing Management Monitor V/S. and check for cardiac dysrrhythmias Drug increases rigidity and tremor in patients with Parkinsons disease Epinephrine therapy interferes with tests for urinary catecholamine Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur Massage site after IM injection to counteract possible vasoconstriction. Observe patient closely for adverse reactions. Notify doctor ifadverse reaction develop If blood pressure increases sharply, rapid-acting vasodilators such as nitrates or alphablockers can be given to counteract Medication Classification, Mechanism of action, uses, contraindication, side effects and nursingconsiderations

VASOPRESSIN (Antidiuretic)
Action Increases cyclic adenosine monophosphate (cAMP) which increases water permeabilityat the renal tubuleresulting in decreased urine volume and increased osmolality; causesperistalsis bydirectly stimulating the smooth muscle in the GI tract; directvasoconstrictor without inotropic or chronotropic effects Indications Adjunct in the treatment of GI hemorrhage and esophageal varices; pulseless arrest(ventricular tachycardia [VT]/ventricular fibrillation [VF], asystole/pulseless electricalactivity [PEA]); vasodilatory shock ; donor management in brain-dead patients Nursing consideration Evaluate patient history closely for use cautions. Assess potential for interactions with other pharmacological agents patient may betaking (eg, concurrent use that will block or enhance anti diuretic response). Note: Dosing and administration vary according to purpose for use. I.V. requires use of infusion pump and close monitoring to prevent extravasation (may cause severe necrosis and gangrene). Assess results of laboratory tests, therapeutic effectiveness, and adverse response (eg,cardiac status, blood pressure, CNS status, fluid balance, signs or symptoms of water intoxication, intra nasal irritation) on a regular basis during therapy. Teach patient possible side effects/appropriate interventions and adverse symptoms to report Diltiazem (Cardizem) (50mg/10mL) Classification Anti-anginals Antiarrhythmics Antihypertensive Ca channel blocker Action Inhibits calcium transport into myocardial smooth muscle cells Systemic and coronary vasodilation Indication Hypertension Angina Pectoris SupraventricularArrhythmia Atrial flutter/fibrillation Nursing Management Monitor BP and pulse before therapy, during titration and therapy Monitor I&O and weight

Assess for CHF Routine serum Digoxin monitoring

Adenosine (Adenocard) (6mg/2mL) Classification Nucleoside Indication To convert paroxysmal supraventicular tachycardia (PSVT) to sinus rhythm Action A naturally occurring nucleoside that acts on the AV node to slow conduction and inhibit re entry pathways. Also useful in treating PSVTs, including those with accessory by pass tracts (Wolff-Parkinson-White syndrome) Nursing Management ALERT: by decreasing conduction through the AV node, drug may produce first-, secondor third-degree heart block. Patients who develop high-level heart block after a single dose shouldnt receive additional doses. ALERT: new arrhythmias, including heart block and transient a systole, may develop;monitor cardiac rhythm and treat as indicated. If solution is cold, crystals may form; gently warm solution to room temperature. Dont use solutions that arent clear. Drug lacks preservatives. Discard unused portion Magnesium sulfate (50%(500mg/mL)) Classification Anticonvulsant Indication Treatment of hypomagnesaemia accompanied by signs of tetany Control of HTN Encephalopathy & convulsions Prevention & control of convulsions in patients w/ preeclampsia or eclampsia Prevention of hypomagnesaemia in patients receiving TPN Action May decrease acetylcholine released by nerve impulses, but its anticonvulsant mechanism is unknown Nursing Management Monitor the following: I.V.: Rapid administration: ECG monitoring, vital signs, deep tendon reflexes; magnesium, calcium, and potassium levels; renal function during administration. Obstetrics: Patient status including vital signs, oxygen saturation, deep tendon reflexes,level of consciousness, fetal heart rate, maternal uterine activity. Oral: Renal function; magnesium levels;bowel movements Amiodarone Classification: Cardiac Drugs Indication: Ventricular and supraventricular arrhythmias.

Action: Blocks potassium chloride leading to prolongation of action potential duration

Nursing Measures: Monitor cardiac rhythm continuously. Monitor for an extended period when dosage adjustments are made. Monitor for safe and effective serum levels (0.52.5 mcg/mL). Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need to bereduced one-third to one-half when amiodarone is started. Give drug with meals to decrease GI problems. Arrange for ophthalmologic exams; reevaluate at any sign of optic neuropathy. Arrange for regular periodic blood tests for liver enzymes, thyroid hormone levels. Drug dosage will be changed in relation to response of arrhythmias; you will need to be hospitalized during initiation of drug therapy; you will be closely monitored when dosageis changed. Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray, eye exam,blood tests Procainamide (Pronestyl)1 gm Classification Antiarrhythmics Action Blocks open Na channels and prolong the cardiac action potential. This results in slowed conduction and ultimately the decreased rate of rise of the action potential may result on the widening of QRS on ECG Indication Supraventricular and ventricular arrhythmias. Treatment ofWolf-Parkinson-White Syndrome Nursing Management Assess cardiovascular status before therapy . Assess pulmonary, hepatic and thyroid. function before and during therapy. Monitor fluid and electrolytes, I&O, K, Na and Cl. Monitor ECG, BP. Assess vision Lidocaine (Xylocaine) 100 mg bolus 1 gm Classification CV drugs: Antiarrhythmics Anesthetic Action Increases electrical stimulation of ventricle and His-Purkinje system by direct action ontissues, resulting to decrease depolarization, automaticity and excitability in ventriclesduring diastolic phase Indication Anesthesia Arrhythmias Control of Status Epilepticus refractory to other treatments Nursing Management Assess pt before and after therapy Pts infusion must be on cardiac monitor Monitor ECG, if QT or QRS increases by 50% or more, withhold the drug

Monitor BP, check for rebound HPN after 1-2 hrs Assess respiratory status, oxygenation and pulse deficits Assess renal and liver function Monitor CNS symptoms Monitor blood levels Atropine Sulfate (4mg/mL) Classification Anticholinergic Indication Pre-op meds/pre-anesthetic meds To restore cardiac rate and arterial pressure during anesthesia when vagal To lessen the degree of A-V heart block To overcome severe carotid sinus reflex Antidote for cholinergic toxicity Nursing Management Monitor VS. Report increase HR Monitor for constipation, oliguria. Instruct to take 30 minutes before meals Eat foods high in fiber and drink plenty fluids. Can cause photophobia Instruct client not to drive a motor vehicle or participate in activities requiring alertness.