Adenosine
Amiodarone
Atropine
Calcium Gluconate
Dobutamine
Dopamine
Epinephrine
Glucagon
Ibutilide
Isoproterenol
Lidocaine
Magnesium
Nitroglycerin
Nitroprusside
Norepinephrine
Vasopressin
A few of us will be working on completing these Med Cards, so this list will be edited as we go.
Vasopressin
A few of us will be working on completing these Med Cards, so this list will be edited as we go.
Adenosine (Adenocard)
Class: antidysrhythmic
Action: slows conduction at AV node, interrupts reentry, restores normal sinus with PSVT.
Dose:
>50kg, IV bol: 6 mg + 20 mL saline flush. May repeat 12mg q1-2 min
child, infant, neonate <50kg, IV bol: 0.1mg/kg up to 0.3mg/kg/dose
Pharmacokinetics: ½ life 10 seconds
Adverse effects: Severe hypotension, atrial/ventrical tachydysrhythmias, AV block, cardiac arrest, bronchospasms with asthmatics. Seizures.
Common side effects: flushing, palpitations, sweating, hypotension, dyspnea.
Nursing considerations:
Will interact with ginger (toxicity), dig, verapamil (v-fib)
Monitor EKG, vitals—expect transient dysrhythmia.
Monitory resp status—d/c if respiration status are negatively impacted.
Seizure precautions.
TX for OD: Defib + vasopressor + theophylline.
Amiodarone
Class: antidysrhthmic
Action: prolongs action potential and refractory period=increases PR and QT intervals, decreases sinus rate, decreases peripheral vascular resistance.
Dose:
IV 150 mg rapid loading over 10 min, then 360 mg over 6 hrs, then maintenance 540 mg over 18 hrs.
PO loading 800-1600mg/day for 3 weeks, then 400mg/day
Pharmacokinetics: peak 2-7 hr, onset 1-3 weeks
Adverse effects: sinus arrest, AV block, hepatotoxicity, pulmonary fibrosis/toxicity, ARDS, dyspnea with neonates.
Common side effects: n/v, rash, photosensitivity, phlebitis.
Nursing considerations:
grapefruit interaction (toxicity)
TX for OD: O2, vent, EKG, Dopamine (circulatory depression), diazepam/thiopental/isoproterenol
Atropine
Class: antidysrhythmic, anticholinergic (parasympatholytic) antimuscarinic
Action: blocks Ach at parasympathetic neuroeffector sites=blocks vagal stimulation in the heart=increases C.O., HR, dries secretions
Dose: Adult: IV Bol 0.5-1mg q3-5min max 3 mg; Child: IV bol 0.01mg/kg up to 0.4 mg or 0.3 mg/m^2 q4-6hr, minimum of 0.1 mg to avoid paradoxical rxt. Max 0.5mg dose
Pharmacokinetics: peak 2-4 min
Adverse effects: tachycardia, coma, paralytic ileus,
Common side effects: h/a, dizziness, involuntary mov’t, confusion, psychosis, flushing, angina, urinary retention
Nursing considerations: con’t EKG for PAC, PVC, eye pain, assess I&O, bladder distension, hypertension (esp inc. intraocular pressure pain), bronchodilation.
TX for OD: O2 vent, ECK, dopamine for circulatory depression, diazepam or thiopental for seizures, additional antidysrhythmics if tachydysrhythmias develop.
Calcium Gluconate
Class: calcium electrolyte replacement
Action: used to maintain nervous, muscular, skeletal function, enzymre rxn, cardiac contractility, coagulation of blood, endocrine secretory, exocrine glands
Dose: IV: 0.5-2 g @ 0.5 ml/min of 10% sol’n, max 3g.
Pharmacokinetics: onset immediate, duration 0.5-2hr.
Adverse effects: Cardiac arrest, short QT, heart block, dysrhythmias, coma, extravasation
Common side effects:Drowsiness, lethargy, HA/N/V--toxicity
Nursing considerations: Assess EKG changes, CVP, PAWP, hypocalcemia (tetany), hypercalcemia, seizure precautions.
Tx for OD: none listed
Dobutamine
Class: adrenergic direct-acting B1-agonist=cardiac stimulant
Action: increases cardiac contractility, increases C.O. WITHOUT increasing HR.
Dose: adult and child IVF 2-40 mcg/kg/min
Pharmacokinetics: Onset 1-2 min, peak 10 min.
Adverse effects: PVC, palp, tachycardia, angina, s/s O2 deprivation,
Common side effects: muscle cramps, dyspnea, NV heartburn
Nursing considerations: medication is a sulfite derivative, first correct hypovolemia, check for and treat decreased oxygenation or perfusion. EKG and PCWP and CVP.
Tx for OD: reduce, D/C, B-blocker, lidocaine or propranolol for severe ventricular tachydysrhythmias.
Dopamine
Class: adrenergic/catecholamine
Action: causes increased cardiac output, acts on B1 and A-receptors=vasoconstriction, renal and mesenteric vasodilation, positive inotropic effects=increased C.O. USED FOR CARDIOGENIC, SEPTIC SHOCK
Dose: Adult 2-50 mcg/kg/min up—titrate by 5-10 mcg/kg/min increments.
Pharmacokinetics: onset 5 min, duration <10min.
Adverse effects: palpitations, angina, ectopic beats, wide QRS complex, tachycardia, hypertension
Common side effects: n/v/d, ha, feelings of anxiety, dyspnea
Nursing considerations: MONITOR FOR EXTRAVASATION.
Tx for OD: D/C IV, give short acting a-adrenergic blocker
Epinephrine
Class: catecholamine, bronchodilator, nonselective adrenergic agonist, vasopressor
Action: B1 and B2 adrenergic agonist=bronchodilation/bronchovasodilation, cardiac and CNS stimulation vasoconstriction of A-receptors at high doses
Dose: Adult: 0.3 mg IM
Pharmacokinetics: onset 1-5 min
Adverse effects: cerebral hemorrhage
Common side effects: palpitation, tachydysrhythmias, increased T wave, anorexia, n/v, sweating, tremors.
Nursing considerations: Do not used with MAOI or tricyclicsàhypertensive crises.
Tx for OD: Administer a/b blockers.
Glucagon
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Ibutilide
Class: antidysrhythmic
Action: prolongs action potential and refractory period—AIDS WITH A-FIB/FLUTTER
Dose: >60kg IVF 1mg over 10 min, may repeat after 10 min; <60kg IVF0.01 mg/kg over 10 min, may repeat after 10 min.
Pharmacokinetics: half life 6 hr
Adverse effects: sinus arrest, CHF, polymorphic ventricular tachycardia/torsades de pointes, prolongued QT interval
Common side effects: hypotension, bradycardai, undle branch block, AV block, syncope.
Nursing considerations: EKG of minimum 4 hr to check for dysrhythmias. D/C as soon as atrial fib/flutter ceases. QT interval is rate dependent=increased chances of ectopic foci
Isoproterenol
DISCONTINUED BY FDA http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview&DrugName=ISOPROTERENOL%20HYDROCHLORIDE
Lidocaine
Class:
Action: treats VF or pulseless VTach—given after d-fib and epi or vasopression
Dose: 1-1.5 mg/kg IV over 2-3 min, may repeat with 0.5-0.75 mg/kg over 2-3 min in 5-10 min up to 3 mg/kg.
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Tx for OD:
Magnesium
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Nitroglycerin
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Nitroprusside
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Norepinephrine
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Vasopressin
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