Side Effects: HTN, Palpitations                                        1st Line

Indications: VFib, VTach, PEA, Asystole

Action: Vasoconstriction, ↑ Ventricular Contraction

Dosage: 1mg q3-5minutes (IVP)

Side Effects: Headache, Dizziness, HTN, VTach/VFib                1st Line

Indications: Symptomatic Bradycardia

Action: ↑Vagolytic action, ↑SA/AV node conduction

↑HR/BP/SVR

Dosage: 0.5-1mg q3-5minutes

Max Dose: 0.04mg/kg

Adenosine

(Adenocard)

Side Effects: Headache, Dizziness, Flushing, Dyspnea,             1st Line

Transient Asystole

Indications: PSVT, Used in wide QRS complex (after amiodarone)

Action: ↓SA/AV node activity. Interupts conduction pathway and helps stop PSVT. Basically stops conduction and allows heart to restart.

Dosage: 6mg/12mg/12mg 1-2 minutes between each dose. Push 1sec.

Amiodarone

(Cardarone)

Side Effects: Muscle weakness, fatigue, dizziness, hypotension  1st Line

Indications: Tachyarrhythmias, AFib, AFlutter, SVT(2nd line), VTach, VFib.

Action: Blocks Na channels slowing the HR. Reduces SVR. ↑CI

Dosage: Cardiac Arrest = 300mg IVP q3-5minutes

  Infusion = 150mg

Max Dosage: 2.2g/24hours

Contraindicated in Iodine Allergies

Vasopressin

(Pitressin)

Side Effects: HTN, Bradycardia, N/V, Tremor, Heart Block       1st Line

Indications: VFib, VTach, PEA

Action: Potent Peripheral Vasoconstrictor

Dosage: 40 Units IV, use after a couple rounds of epinephrine

Lidocaine

(Xylocaine)

Side Effects: Confusion, aphagia

Indications: VFib, VTach(After amiodarone), Tachycardia

Action: ↓Purkingie fiber stimulation

 ↓Spontaneous depolarization of ventricles

Dosage: 1-1.5mg/kg q3-5minutes for VFib/VTach

  0.5-0.75mg/kg q5-10minutes for Tachycardia

Max Dose = 3mg/kg

Procainamide

(Pronestyl)

Side Effects: Agranulocytosis, VFib, Hypotension

Indications: Tachycardia (PSVT, VTach) - after amiodarone

Actions: ↓His Purkinjie Fibers

  ↓Conduction Atria/Ventricle

Dosage: 20-30mg/min repeat until fixed.

Max Dose: 17mg/kg

Side Effects: Respiratory paralysis

Indications: VFib, VTach

Action: ↑Mag

 Regulates Calcium

Dosage: 1-2 grams in 100ml D5W over 1-2minutes

Diltiazem

(Cardizem)

Side Effects: Headache, Hypotension, Constipation

Indication: AFib, AFlutter, PSVT, Complex Tachy

Action: Blocks Calcium ions

↓Conduction of AV node

↓Contractility

Dosage: 0.25mg/kg, then 0.35/kg after 15 minutes

Then use IV infusion

Dopamine

(Intropin)

Side Effects: HTN, Tachycardia, IV infiltration

Indications: Low Dose = Hypotension

  High Dose = Hypotension and Symptomatic Bradycardia

Action: Inotrpic effect = ↑CO/BP

Dosage: Low = 1-3mcg/kg/min

  Moderate = 3-10mcg/kg/min

  High = 10-20 mcg/kg/min

Dobutamine

(Dobutrex)

Side Effects: Tachycardia, HTN, Anginal Pain

Indications: CHF, ↓CO, Cardiogenic shock

Action: ↑Contractility without increasing demand

 ↓Left Ventricl Pressure

Dosage: 0.5-2mcg/kg/min via infusion

Side Effects: Hypotension, Bradycardia, Cardiac arrest

Indications: Asystole or PEA

Action: ↑Contractility

Dosing: 250mg IVP in 5ml of NS.

Don't give with alkaline solutions

Isoproterenol

(Isuprel)

Side Effects: Ventriclular arrhythmias, exavasation

Indications: Rarely used for bradycardia. Not used in cardiac arrest

Action: ↑ Conduction/HR/Contractility/BP/CO/Bronchodilation

Dosage: IV drip 2mg in 500ml D5W at 2mcg/min titrate for HR>60bpm

Don't Push and Don't Mix

Phenylephrine HCl

(Neosynephrine)

Side Effects: Tachy, HTN

Indications: Vascular failure in shock

  ↑BP without increasing HR

Action: ↑Vasoconstriction, ↑BP

Dosage: 10mg in 250mL in 500mL D5W

  Maintanence dose = 0.04-0.06mg/min

Propranalol

(Inderal)

Side Effects: Confusion, Fatigue, Drowsiness, Bradycardia

Indications: Control HTN, Decrease Tachy

Actions: ↓HR/CO/Contractility

  Potentiate Calcium channel blockers

Dosage: 10-60mg (PO) BID

  .5-3mg (IV) .5mg increments (Only for life-threatening dysrhythmias)

Digoxin

(Lanoxin)

Side Effects: N/V, AV BLock, Blurry Vision

Indications: Acute tachydysrhytmias and hemodynamically unstable

Action: ↑Contractility, ↓HR

Dosage: Loading Dose = 0.5-1.0mg

  Maintenance Dose = 0.125-0.25 mg

Toxicity leads to hypokalemia

Furosemide

(Lasix)

Side Effects: Hypotension, Hypokalemia

Indications: Edema for CHF

Action: Rapid diuresis, vasodilation

Dosage: 20-40mg IV (10mg/min)

Nitroglycerin

(Tridil)

Side Effects: Headache, Orthostatic hypotension, anaphalaxis

Inidcations: Acute angina

Action: Relaxes smooth muscle

↑Vasodilation

Dosage: 5-10mcg/min(IV) ↑ by 5mcg q10min until Angina subsides

Sodium Nitroprusside

(Nipride)

Side Effects: Hypotension, Blurred vision

Indications: Rapid ↓BP in HTN crisis, CHF

Action: Relaxes smooth muscle

↑Vasodilation

↓BP/Preload/SVR/Afterload

Dosage: 0.3mcg/kg/min increases slowly q2-3min. Increase until BP controlled

Max Dose: 3mcg/kg/min

Light Sensitivity

Norepinephrine

(Levophed)

Side Effects: Hepatic/Renal necrosis, fatal arrythmias, cerebral hemorhage, extravasation

Indications: Severe HTN

Action: ↑Peripheral Vasoconstriction

Dosage:Initial - 2mg/min

 Range - 2-12mcg/min

Side Effects: None, in the case of cardiac arrest

Indications: Cardiac Arrest

Action: ↑Sats/oxygenation

Dosage: 100% in arrest

No contraidications

Milrinone

(Primacor)

Side Effects: Ventricular ectopics, ↓BP

Indications: Relief of CHF

Action: Rapid positive inotrope

↑Contractility

↑Vasodilation

Dosage: Loading dose = 0.05 mg/kg over 10min

  Maintanence dose = 0.375-0.75mcg/kg

Side Effects: Metabloic Alkalosis, Sodium overload, extravasation

Indications: Severe Acidosis (untreated by other means)

Action: Increases alkalosis by giving you a base

Dosage: 1mEq/kg IV bolus repeat with half dose q10min

Nicardipine

(Cardene)

Side Effects: N/A

Indications: Anti-hypertensive, short term use of BP control

Action: ↓Calcium into smooth muscle

 ↓SVR

Dosage: 50mL/hr (5mg/hr)