3/8/06 Drugs
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- Amiodarone - Names
- Cordarone
- Amiodarone - Classification
- Class III antidysrhythmic
- Amiodarone - Action
- prolongs duration of action potential and effective refractory period
-
Amiodarone - Indications
(3) -
recurrent V-fib
hemodynamically unstable V-tach refractory to other treatment
refractory PSVT in conjunction w/cardioversion -
Amiodarone - Contraindications
(5)
b,c,h,p,s -
bradycardia
cardiogenic shock
hypotension
pulmonary congestion
sensitivity to amiodarone -
Amiodarone - Side Effects
(7)
2a,b,d,f,2h -
abnormal salivation
AV conduction abnormalities
bradycardia
dizziness
flushing
headache
hypotension - Amiodarone - Adult Dose, Pulseless Arrest
- 300 mg IV push, diluted in 20 - 30 cc NS. Consider repeating 150 mg IV push in 3 - 5 minutes (max cumulative dose: 2.2 g IV/24 hours)
- Amiodarone - Adult Dose, Wide Complex V-tach
-
rapid infusion: 150 mg IV over 10 minutes (15 mg/min), repeated every 10 minutes as needed.
slow infusion: 360 mg IV over 6 hours (1 mg/min) - Amiodarone - Adult Dose, Maintenance Infusion
- 540 mg IV over 18 hours (0.5 mg/min)
- Amiodarone - Peds Dose, Pulseless Arrest
- 5 mg/kg rapid IV bolus
- Amiodarone - Peds Dose, Perfusing Tachycardias
- loading dose: 5 mg/kg IV/IO over 20 - 60 min (max dose: 15 mg/kg/day IV)
- Amiodarone - Onset
- within minutes
- Amiodarone - Duration
- variable
- Amiodarone - Pregnancy Class
- Class D
-
Amiodarone - Notes
(5) -
must continuously monitor EKG
slow or discontinue infusion if bradycardia or AV block occurs
may potentiate bradycardia & hypotension w/beta blocker and calcium channel blockers
may increase risk of AV block & hypotension w/calcium channel blockers
may increase anticoagulant effects of warfarin - Atropine - Names
- Atropine
- Atropine - Classification
- anticholinergic agent
-
Atropine - Action
(5) -
antagonizes effects of organophosphate insecticides and chemical nerve agents
small doses inhibit salivary & bronchial secretions
moderate doses dilate pupils & increase heart rate
large doses decrease GI motility, inhibit gastric acid secretion, and may block nicotinic receptor sites at autonomic ganglia and the neuromuscular junction
blocked vagal effects result in increased heart rate and enhanced AV conduction w/limited or no inotropic effects -
Atropine - Indications
(4)
a,p,o,u -
asystole
PEA w/absolute bradycardia
organophosphate or nerve gas poisoning
unstable bradycardia -
Atropine - Contraindications
(7)
h,n,2o,2t,u -
hypersensitivity to atropine
narrow angle glaucoma
obstructive disease of GI tract
obstructive uropathy
tachycardia
thyrotoxicosis
unstable cardiovascular status in acute hemmorhage w/MI -
Atropine - Side Effects
(10)
2a,2d,f,h,n,2p,t -
anticholinergic effects
allergic reactions
dizziness
dysrhythmias
flushed hot dry skin
headache
palpitations
paradoxical bradycardia when pushed too slow or dose < 0.5 mg
tachycardia - Atropine - Pregnancy Class
- Class C
- Atropine - Onset
- rapid
- Atropine - Duration
- 2 - 6 hours
-
Atropine - Notes
(2) -
follow ET adminstration with several positive pressure ventilations
dilates pupils and renders them nonreactive, so pupil response may not be useful in monitoring CNS status - Atropine - Adult Dose, Bradydysrhythmias
-
0.5 - 1 mg IV every 3 - 5 minutes for desired response
(max total dose: 0.04 mg/kg) - Atropine - Adult Dose, Asystole/PEA
-
1 mg IV, ET dose 2 - 3 mg diluted to total 10 cc MS, may repeat every 3 - 5 minutes
(max dose: 0.03 - 0.04 mg/kg) - Atropine - Adult Dose, Poison
- 1 - 2 mg IV push every 5 - 15 minutes until atropine effect is observed, then every 1 - 4 hours for at least 24 hours
- Atropine - Peds Dose, Bradycardia
- 0.02 mg/kg/IV/IO/ET (diluted to 3 - 5 cc), (min dose - 0.1 mg; max single dose - 0.5 mg for child or 1 mg for adolescent), may be repeated in 5 minutes for max dose of 1 mg for child or 2 mg for adolescent
- Atropine - Peds Dose Asystole/PEA
- not established
- Atropine - Peds Dose, Poisoning
- 0.02 mg/kg/dose IV, may be repeated every 10 - 20 minutes until atropine effect is observed, then every 1 - 4 hours for at least 24 hours.
- Terbutaline - Names
-
Brethine
Bricanyl - Terbutaline - Classification
-
sympathetic agonist
synthetic sympathomimetic - Terbutaline - Indications
-
bronchial asthma
COPD bronchospasms
preterm labor - Terbutaline - Contraindications
- hypersensitivity
-
Terbutaline - Side Effects
(4)
a,d,n,p -
anxiety
dizziness
nausea
palpitations - Terbutaline - Action
-
causes bronchodilation w/less cardiac effect than epi
relaxes uterine smooth muscle - Terbutaline - Dose
-
12 yo or older only
two inhalations w/MDI, repeated once in one minute - Terbutaline - Pregnancy Class
- Class B
- Terbutaline - Notes
- use caution w/cardiac and hypertensive patients
- Bretylium - Names
- Bretylol
- Bretylium - Classification
- antidysrhythmic
- Bretylium - Action
-
releases norepi
depresses V-fib
reduces ectopy
suppresses ventricular tachydysrhythmias w/reenty mechanisms - Bretylium - Indications
-
V-fib refractory to lidocaine
V-tach refractory to lidocaine - Bretylium - Contraindications
- none in presence of dysrhythmias
- Bretylium - Side Effects
- may induce postural hypotension
- Bretylium - Adult Dose
-
5 mg/kg IV, then 10 mg/kg/15 - 30 minutes to a max of 30 mg/kg
following conversion: 1 - 2 mg/min drip - Bretylium - Peds Dose
- 5 mg/kg IV, repeat 10 mg/kg in 15 - 30 minutes
- Bretylium - Pregnancy Class
- Class C