Adenosine, Amniodorone, Procainamide, Lidocaine, Diltiazem

ADENOSINE(Adenocard)

100

Adenosine (Adenocard) is:Class: Antidysrhythmic. 1.Explain the Mechanism of action

Mechanism of action: 1.Slows conduction through the AV node; 2. Slows heart rate by acting directly on the sinus pacemaker cells by slowing impulse formation.

200

List the following info for use of Adenosine (Adenocard) 1. Name 3(4) indications for the use of Adenosine 2. Name 2 (3) contraindications for use of Adenosine

Indications: 1.Conversion of PSVT to sinus rhythm. 2.May convert re-entry SVT due to Wolff-Parkinson-White syndrome. 3.Most forms of stable narrow-complex SVT. 4.Can be used diagnostically for stable, wide-complex tachycardia of unknown origin after two doses of lidocaine. Contraindications: 1.Second- or third-degree AV block, sick sinus syndrome,2. bronchoconstrictive or bronchospastic lung disease, 3.poison- or drug-induced tachycardia.

300

Name the indicated below for the use of ADENOSINE 1. List 10 (16) Adverse Reactions/ Side Effects in the use of ADENOSINE (Adenocard)

Adverse reactions/side effects: 1.Generally short duration and mild; 2.headache, 3.dizziness,4. dyspnea, 5.bronchospasm, 6.dysrhythmias, 7.palpitations, 8/hypotension, 9.chest pain,10. facial flushing, 11.cardiac arrest, 12.nausea,13. metallic taste, 14.pain in the head or neck, 15.paresthesia, 16.diaphoresis

400

List 3 drug interactions in the use of ADENOSINE (ADENOCARD)

Drug interactions:1. Methylxanthines (theophylline-like drugs) antagonize the effects of adenosine.2 Dipyridamole (Persantine) potentiates the effect of adenosine. 3.Carbamazepine (Tegretol) may potentiate the AV node blocking effect of adenosine.

500

List the following for use of Adenosine: 1. Adult Dose and Administration 2. Adult Second Dose 3. Pediatric Initial Dose and Administration 4. Pediatric secondary dose

Dosage and administration: 1. Adult: 6-mg rapid IV bolus over 1–3 seconds, followed by a 20-mL saline flush and elevate extremity. If no response after 1–2 minutes, administer 2. second dose of 12–mg rapid IV bolus over 1–3 seconds. 3. Pediatric: Initial dose 0.1 mg/kg rapid IV/IO push (maximum fi rst dose, 6 mg), followed by a 5- to 10-mL saline flush. 4. Pediatric second dose 0.2 mg/kg rapid IV/IO push (maximum second dose, 12 mg), followed by a 5- to 10-mL saline flush.

AMNIODORONE(Cordarone)

100

Amniodorone is: Class: Antidysrhythmic 1. Give the mechanism of Action for AMNIODORONE

Mechanism of action: Blocks sodium channels, potassium channels and calcium channels blocker, delaying repolarization and increasing the duration of action potential. Alpha and beta blocking effects

200

List the following information for use of Amniodorone: 1. List 3(3) indications for the use of AMNIODORONE 2.List 3(5) contraindications for use of AMNIODORONE

Indications: 1.Ventricular fibrillation, 2pulseless ventricular tachycardia, 3.unstable ventricular tachycardia in patients refractory to other therapy. Contraindications: 1.Known hypersensitivity to amiodarone or iodine, 2.cardiogenic shock, 3.sinus bradycardia, 4.second- or third degree AV block (if no pacemaker is present), 5.severe sinus node dysfunction.

300

List the following when using AMNIODORONE (Cordarone) 1. List 10(17) possible adverse reaction/ side effects for AMNIODORONE 2. List 3 (5) Possible Drug Interactions for use of AMNIODORONE.

Adverse reactions/side effects:1. Dizziness, 2.fatigue, malaise, 3.tremor, 4.ataxia, 5.lack of coordination, 6.adult respiratory distress syndrome,7. pulmonary edema, 8.cough, 9.progressive dyspnea, 10.congestive heart failure, 11.bradycardia, 12.hypotension, 13.worsening of dysrhythmias, 14.prolonged QT interval, 15.nausea, 16.vomiting, 17. burning at IV site. Drug interactions: 1.Use with digoxin may cause digitalis toxicity. 2.Antidysrhythmics may cause increased serum levels. 3. Beta blocker and calcium channel blockers may potentiate bradycardia, 4. sinus arrest, and 5. AV heart blocks

400

List the following for AMNIODORONE 1. Adult dose VFIB/Pulseless VTACH/Unrespoinsive to CPR, Defibrillation and Vasopressors: 2. Secondary Adult dose/ and Max cumulative dose 3. Recurrent Life thretening Ventricular Dysrhythmias: 4.max cumulative dose and rapid infusion

1. 300 mg IV/IO push. 2. 150 mg IV/IO push. 3. Recurrent life-threatening ventricular dysrhythmias: 4.Maximum cumulative dose: 2.2 g IV/24 h administered as follows: Rapid infusion: 150 mg IV/IO over 10 minutes (15 mg/minute). May repeat rapid infusion (150 mg IV/IO) every 10 minutes as needed

500

List the following in the use of AMNIODARONE. 1. Pediatric Dose for: Refractory VFIB/Pulseless VTACH 2. Pediatric Max single Dose 3. Perfusing SVT and VTACH loading dose.

1. 5 mg/kg IV/IO bolus. Can repeat the 5 mg/kg IV/IO bolus up to a total dose of 15 mg/kg per 24 h. 2. Maximum single dose: 300 mg. 3. Loading dose 5 mg/kg IV/IO over 20–60 minutes (maximum single dose of 300 mg). Can repeat to maximum dose of 15 mg/kg/day (2.2 g in adolescents). Maximum single dose: 300 mg.

PROCAINAMIDE(Pronestly)

100

PROCAINAMIDE HYDROCHLORIDE (Pronestl) is: Class; Antidysrhythmic. 1. List the mechanism of action for PROCAINAMIDE(3)

Mechanism of action: 1. Sodium channel and potassium channel blocker. 2.Suppresses phase 4 depolarization in normal ventricular muscle and Purkinje fibers, reducing ectopic pacemaker’s automaticity; 3.suppresses intraventricular conduction.

200

In the use of PROCAINAMIDE HYDROCHLORIDE (Pronestly) 1. List 3(4) Indications for the use of Procainamide 2. List 3(5) Contraindications in the use of Procainamide

Indications: 1.Stable monomorphic ventricular tachycardia with normal QT interval, 2.reentry SVT uncontrolled by vagal maneuvers and adenosine, 3.stable wide complex tachycardia of unknown origin, 4.atrial fibrillation with rapid ventricular rate in patients with Wolff-Parkinson-White syndrome. Contraindications: 1.Torsades de pointes, 2.second- and third degree heart atrioventricular block (without functioning artificial pacemaker), 3.preexisting QT prolongation, 4.digitalis toxicity, 5.tricyclic antidepressant overdose

300

1. List 6(10) possible Adverse reaction/side effects when using Procainamide. 2. list 1 possible drug interaction when using Procainamide (Pronestl)

Adverse reactions/side effects: 1.Confusion, 2.seizures, 3.hypotension,4. bradycardia, 5.reflex tachycardia, 6.ventricular dysrhythmias,7. AV blocks, 8.asystole, 9.widening of PR, QRS, and Q-T intervals, 10.nausea, vomiting. Drug interactions: Increases plasma levels of amiodarone and quinidine.

400

Give the following proper dosing and administration when using Procainamide for the following indications: 1. ADULT Recurrent VFIB/Pulseless VTACH 2. IN Adult Urgent Situation and MAX DOSE 3. Other Indications 4. Maintenance infusion Dose 5. Pediatric Loading Dose

1. 20 mg/min slow IV infusion (maximum dose: 17 mg/kg). 2. up to 50 mg/min may be administered (maximum dose: 17 mg/kg). 3. Other indications: 20 mg/min slow IV infusion until any one of the following occurs: Dysrhythmia suppression, hypotension, QRS widens by >50% of its pretreatment width, or total dose of 17 mg/kg has been given. 4.Maintenance infusion: 1–4 mg/min (diluted in D 5 W or normal saline). Reduce dose in presence of renal insuffi ciency. 5.Pediatric: Loading dose 15 mg/kg IV/IO over 30–60 minutes.

500

For Dopamine list the following: 1.Onset 2. Peak Effect 3. Duration 4. List 4(6) special considerations in use of Dopamine

Duration of action: 1. Onset: 10–30 minutes. 2.Peak effect: Variable. 3. Duration: 3–6 hours. Special considerations: 1.Pregnancy safety: Category C. 2.Potent vasodilation and 3.negative inotropic effects. 4.Hypotension mayoccur with rapid infusion. 5.Administer cautiously to patients with cardiac, hepatic, or renal insuffi ciency. 6.Administer cautiously to patients with asthma or digitalis-induced dysrhythmias

LIDOCAINE HYDROCHLORIDE(Xylocaine)

100

Lidocaine (Xylocaine) is: Class: Antidysrhythmic. What is the Mechanism of Action in the use of Lidocaine

Mechanism of action: Sodium channel blocker. Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization.

200

1. Name 3(4) Indications for the use of Lidocaine (Xylocaine) 2. Name 3(4) Contraindications for the use of Lidocaine

Indications:1. Alternative to amiodarone in cardiac arrest from ventricular tachycardia, 2.ventricular fibrillation, 3.stable widecomplex tachycardia (poly- or monomorphic) with normal baseline QT interval, 4.stable monomorphic VT with preserved ventricular function. Contraindications: 1.Hypersensitivity, 2.second- or third-degree AV block in the absence of an artificial pacemaker, 3.prophylactic use in AMI, wide complex ventricular escape beats with bradycardia, 4.tricyclic antidepressant overdose

300

1. List 8 (13) Adverse Reactions/side effects when using Lidocaine. 2. List 2 possible Drug interactions when using Lidocaine

Adverse reactions/side effects: 1.Anxiety, 2.drowsiness, 3.confusion,4. seizures, 5.slurred speech, 6.respiratory arrest, 7.hypotension, 8.bradycardia, 9.dysrhythmias, 10.cardiac arrest, 11.AV block,12. nausea,13 vomiting. Drug interactions: 1.Procainamide may exacerbate CNS effect. 2.Metabolic clearance is decreased in patients with liver disease or in patients taking beta blockers.

400

List proper DOSING and administration when using Lidocaine 1. Adult cardiac Arrest/ Pulseless VTACH/VFIB Initial Dose 2. Repeat Dose for Cardiac Arrest/Pulseless VTACH/VFIB 3. Maximum Total Dose: 4. Dose Range For Stable VTACH/Wide Complex Tach/ Significant Ectopy 5. Endotracheal Dose 6. Maintenance infusion

1. 1–1.5 mg/kg IV/IO. 2. Repeat dose: 0.5–0.75 mg/kg IV/IO repeated in 5–10 minutes. 3. Maximum total dose: 3 mg/kg. 4. : Dose range 0.5–0.75 mg/kg and up to 1–1.5 mg/kg. Repeat 0.5–0.75 mg/kg every 5–10 minutes. Maximum total dose: 3 mg/kg. 5. 2–4 mg/kg. 6. 1–4 mg/min (30–50 μg/kg/min); can dilute in D 5 W or normal saline

500

List the proper dosing and administration for use of Lidocaine in the following. 1. Pedatric IV/IO Dose 2. Pediatric Max Dose 3. Pediatrics Continious IV/IO infusion Dosing 4. Pediatric endotrachael dose

1. 1 mg/kg rapid IV/IO push. 2. Maximum dose 100 mg. 3. Continuous IV/IO infusion: 20–50 μg/kg/min. Repeat bolus dose (1 mg/kg) when infusion is initiated if bolus has not been given within previous 15 minutes. 4. Endotracheal dose: 2–3 mg/kg

DILTIAZEM(Cardizem)

100

Diltiazem(Cardizem is Class: Calcium channel blocker, antidysrhythmic. What is the Mechanism of action for this drug. (3)

Mechanism of action: 1.Slow calcium channel blocker that blocks calcium ion influx during depolarization of cardiac and vascular smooth muscle. 2,Decreases peripheral vascular resistance and causes relaxation of the vascular smooth muscle, resulting in a decrease of both systolic and diastolic blood pressure. 3.Reduces preload and afterload. Reduces myocardial oxygen demand.

200

For Diltiazem (Cardizem) 1. List one indication for the use of Diltiazem (Cardiazem) 2. Name 4(6) contraindications when using Diltiazem

Indications: 1.Controls rapid ventricular rates due to atrial fibrillation, atrial fl utter, and re-entry supraventricular tachycardia. Contraindications: 1.Hypotension,2. sick sinus syndrome (without functioning pacemaker present), 3.second- or third-degree AV block (without functioning pacemaker present), 4.cardiogenic shock, 5.wide-complex tachycardia (ventricular tachycardia may lead to hemodynamic deterioration and ventricular fibrillation), 6.poison- or drug-induced tachycardia.

300

List the Following referring to Diltiazem (Cardizem) 1. List 10 Adverse Reactions/Side effects 2. List 2 Possible Drug Interactions

Adverse reactions/side effects: 1.Dizziness, 2.weakness, 3.headache, 4.dyspnea, 5.cough, 6.dysrhythmias, 7.CHF, 8.peripheral edema 9.bradycardia, 10.hypotension, 11.AV blocks, 12.syncope, 13.ventricular fibrillation, 14.ventricular tachycardia, 15.cardiac arrest, 16.chest pain,17. nausea, 18.vomiting, 19.dry mouth. Drug interactions: 1.Caution in patients using medications that affect cardiac contractility. 2.In general, should not be used inpatients on beta blockers

400

Dosing and Administration for Diltiazem (Cardizem) 1. Adult Initial Dose and administration 2. Adult Secondary Dose 3. Maintenance infusion dose 4. Pediatric Dose

1. 0.25 mg/kg (15–20 mg for the average patient) IV over 2 minutes. If inadequate response, may re-bolus in 15 minutes. 2. Secondary dose: 0.35 mg/kg (20–25 mg for the average patient) IV over 2 minutes. 3. Maintenance infusion of 5–15 mg/h titrated to physiologically appropriate heart rate. 4. Not Recommended in Peds/ do not use

500

List 2(3) special consideraions when using Diltiazem (Cardizem)

Special considerations: 1.Pregnancy safety: Category C. 2.Use with caution in patients with renal or hepatic dysfunction. 3.500-mg dose of calcium chloride 5 minutes prior to administration of diltiazem can help to block the hypotensive effects in borderline hypotensive patients (blocks baroreceptors in the great vessels).