Adenosine (Adenocard)

 CLASS:

Adenosine (Adenocard)

 Indications:

Conversion of PSVT to sinus rhythm.

(Paroxysmal supraventricular tachycardia)  

May convert re-entry SVT due to Wolff-Parkinson-White syndrome. 

Most forms of stable narrow-complex SVT.

Not effective in converting atrial fibrillation/flutter or V-tach.

Adenosine (Adenocard)

 Mechanism of Action:

Slows conduction through the AV node

The drug of choice for re-entry SVT.

Slows heart rate by acting directly on the sinus pacemaker cells by slowing impulse formation.

Can interrupt re-entrant pathways;

Can be used diagnostically for stable, wide-complex tachycardia of unknown origin after two doses of lidocaine

Adenosine (Adenocard)

How Supplied:

Adenosine (Adenocard)

Adult Dosage and Administration:

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 second dose of 12–mg rapid IV bolus over 1–3 seconds.

Adenosine (Adenocard)

Pedi Dosage and Administration:

Initial dose 0.1 mg/kg rapid IV/IO push (maximum first dose, 6 mg), followed by a 5- to 10-mL saline flush.

Second dose 0.2 mg/kg rapid IV/IO push (maximum second dose, 12 mg), followed by a 5- to 10-mL saline flush

Adenosine (Adenocard)

 Drug Interactions:

Methylxanthines (theophylline-like drugs) antagonize the effects of adenosine.

Dipyridamole (Persantine) potentiates the effect of adenosine.

Carbamazepine (Tegretol) may potentiate the AV node blocking effect of adenosine.

Adenosine (Adenocard) 

Contraindications:

Second- or third-degree AV block (if no pacemaker is present) 

Sick sinus syndrome (if no pacemaker present),

Bronchoconstrictive or bronchospastic lung disease (asthma, COPD), poison- or drug-induced tachycardia

Adenosine (Adenocard) 

Adverse reactions/Side effects:

Headache

Dizziness

Dyspnea

Bronchospasm

Dysrhythmias

Palpitations

Hypotension

Chest pain

Facial flushing

Cardiac arrest

Nausea

Metallic taste

Pain in the head or neck

Paresthesia

Diaphoresis. 

Generally short duration and mild

Adenosine (Adenocard)

 Duration of Action:

Onset: Seconds.

Peak effect: Seconds

Duration: 12 seconds

Adenosine (Adenocard) 

Special Considerations:

Pregnancy safety: Category C

May cause bronchoconstriction in asthma patients.

Evaluate elderly for signs of dehydration requiring fluid replacement prior to administering adenosine.

Short half-life limits side effects in most patients.

Amiodarone (Cordarone, Pacerone)

 CLASS:

Amiodarone (Cordarone, Pacerone)

 Indications:

VFib

Pulseless VTach

Unstable VTach in patients resistant to other therapy.

Amiodarone (Cordarone, Pacerone)

 Mechanism of Action:

Blocks sodium and myocardial potassium channels, delaying repolarization increasing the duration of action potential.

Amiodarone (Cordarone, Pacerone)

How Supplied:

50 mg/mL vials and prefilled syringes.

For rapid infusion, add 150 mg/3 mL to a 10-mL D5W (1.5 mg/mL) run at 600 mL/h on infusion pump.

Amiodarone (Cordarone, Pacerone)

Adult Dosage/Administration:

Vfib, Pulseless Vtach unresponsive to CPR, defibrillation, and vasopressors:

300 mg IV/IO push. Initial dose can be followed one time in 3–5 minutes at 150 mg IV/IO push.

Recurrent life-threatening ventricular dysrhythmias:

Maximum cumulative dose: 2.2 g IV/24h 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.

Amiodarone (Cordarone, Pacerone)

Pedi Dosage/Administration:

Refractory Vfib/pulseless Vtach:

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. Maximum single dose: 300 mg. Perfusing supraventricular and ventricular tachycardias: Loading dose 5 mg/kg IV/IO over20–60 minutes (maximum single dose of 300 mg). Can repeat to maximum dose of 15 mg/kg/day (2.2 g in adolescents). Maximumsingle dose: 300 mg.

Amiodarone (Cordarone, Pacerone)

Contraindications:

Cardiogenic shock, sinus bradycardia, second- or third-degree AV block (if no pacemaker is present), severe sinus node dysfunction. Known hypersensitivity to amiodarone or iodine,

Amiodarone (Cordarone, Pacerone)

Adverse reactions/ Side effects:

Dizziness

Fatigue

Malaise

Tremor

Ataxia

Lack of coordination

Adult respiratory distress syndrome
Pulmonary edema

Cough

Progressive dyspnea

CHF

Bradycardia

Hypotension

Worsening of dysrhythmias

Prolonged QT interval

Nausea/Vomiting

Burning at IV site

Stevens-Johnson syndrome.

Amiodarone (Cordarone, Pacerone)

Drug Interactions:

Use with digoxin may cause digitalis toxicity. Antidysrhythmics may cause increased serum levels. Beta blocker and calcium channel blockers may potentiate bradycardia, sinus arrest, and AV heart blocks.

Amiodarone (Cordarone, Pacerone)

Duration of Action:

Onset: Immediate

Peak effect: 10–15 minutes

Duration: 30–45 minutes

Amiodarone (Cordarone, Pacerone)

Special Considerations:

Pregnancy safety: Category D. Monitor patient for hypotension. May worsen or precipitate new dysrhythmias.

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

CLASS:

Antiplatelet/Antithrombotic

Aspirin also falls under many other functional classifications

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

Indications:

New onset chest pain suggestive of acute MI

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

 Mechanism of Action:

Prevents platelets from clumping together, or aggregating, and forming emboli.

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

How Supplied:

81-mg, 160-mg, and 325-mg tablets. Chewable and standard.

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

Adult Dosage/Administration:

160 mg to 325 mg PO. Chewing is preferable to swallowing.

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

 Pedi Dosage/Administration:

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

 Contraindications:

Hypersensitivity. Relatively contraindicated in patients with active ulcer disease or asthma.

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

 Adverse reactions/Side effects:

Bronchospasm, anaphylaxis, wheezing in allergic patients, prolonged bleeding, GI bleeding, epigastric distress, nausea, vomiting, heartburn, Reye syndrome.

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

 Drug Interactions:

Use with caution in patients allergic to NSAIDs.

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

 Duration of Action:

Onset: 30–45 minutes

Peak effect: Variable

Duration: Variable

Aspirin (ASA, Bayer, Ecotrin, St. Joseph, and others)

 Special Considerations:

Pregnancy safety: Category D. Not recommended in pediatric population.

Diltiazem (Cardizem)

CLASS:

Calcium channel blocker

Antidysrhythmic

Diltiazem (Cardizem)

Indications:

Controls rapid ventricular rates due to Afib, Atrial flutter, and re-entry SVT.

Diltiazem (Cardizem)

 Mechanism of Action:

Slow calcium channel blocker that blocks calcium ion influx during depolarization of cardiac and vascular smooth muscle

Reduces preload and afterload.

Reduces myocardial oxygen demand

Decreases peripheral vascular resistance and causes relaxation of the vascular smooth muscle, resulting in a decrease of both systolic and diastolic blood pressure

Diltiazem (Cardizem)

How Supplied:

5 mg/mL vials (requires refrigeration) 

100-mg powder (requires reconstitution with attached fluid) for infusion (1 mg/mL) 

Add 125 mg/25 mL to a 100-mL bag of D5W (1 mg/mL)

Diltiazem (Cardizem)

 Adult Dosage/Administration:

Initial dose: 0.25 mg/kg (15–20 mg for the average patient) IV over 2 minutes

If inadequate response, may re-bolus in 15 minutes.

 Secondary dose: 0.35 mg/kg (20–25 mg for the average patient) IV over 2 minutes. Maintenance infusion of 5–15 mg/h titrated to physiologically appropriate heart rate

Diltiazem (Cardizem)

Pedi Dose/Administration:

Diltiazem (Cardizem)

Contraindications:

Hypotension, sick sinus syndrome (without functioning pacemaker present)

Second- or third-degree AV block (without functioning pacemaker present)

Cardiogenic shock, wide-complex tachycardia (ventricular tachycardia may lead to hemodynamic deterioration and ventricular fibrillation)

Poison- or drug-induced tachycardia

Diltiazem (Cardizem)

Adverse reactions/ Side effects:

Dizziness

Weakness

Headache

Dyspnea

Cough

Dysrhythmias

CHF

Peripheral edema

Bradycardia

Hypotension

AV blocks

Syncope

Vfib

Vtach

Cardiac arrest

Chest pain

Nausea/Vomiting

Dry mouth.

Diltiazem (Cardizem)

Drug Interactions:

Caution in patients using medications that affect cardiac contractility

In general, should not be used in patients on beta blockers.

Diltiazem (Cardizem)

Duration of Action:

Onset: 2–5 minutes

Peak effect: Variable

Duration: 1–3 hours

Diltiazem (Cardizem)

Special Considerations:

Pregnancy safety: Category C.

Use with caution in patients with renal or hepatic dysfunction. PVCs may be present on conversion of PSVT to sinus rhythm. 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)

Dopamine Hydrochloride (Intropin)

CLASS:

Sympathomimetic

Vasopressor

Inotropic agent.

Dopamine Hydrochloride (Intropin)

Indications:

Cardiogenic and septic shock

Hypotension with low cardiac output states

Distributive shock

Second-line drug for symptomatic bradycardia.

Dopamine Hydrochloride (Intropin)

Mechanism of Action:

Immediate metabolic precursor to norepinephrine.

Produces positive inotropic and chronotropic effects

Dilates renal and splanchnic vasculature

Constricts systemic vasculature, increasing blood pressure and preload

Increases myocardial contractility and stroke volume

Dopamine Hydrochloride (Intropin)

 How Supplied:

40 mg/mL and 80 mg/mL prefilled syringes and vials for IV infusion

400 mg/250 mL D5W premixed solutions (1,600 μg/mL)

Dopamine Hydrochloride (Intropin)

 Adult Dosage/Administration:

IV/IO infusion at 2–20 μg/kg/min, slowly titrated to patient response

Dopamine Hydrochloride (Intropin)

Pedi Dosage/Administration:

IV/IO infusion at 2–20 μg/kg/min, slowly titrated to patient response

Dopamine Hydrochloride (Intropin)

Contraindications:

Hypovolemic shock

Pheochromocytoma

Tachydysrhythmias

Ventricular fibrillation.

Dopamine Hydrochloride (Intropin)

 Adverse reactions/Side effects:

Extravasation may cause tissue necrosis

Headache

Anxiety

Dyspnea

Dysrhythmias

Hypotension

Hypertension

Palpitations

Chest pain

Increased myocardial oxygen demand

PVCs

Nausea/Vomiting

Dopamine Hydrochloride (Intropin)

 Drug Interactions:

Incompatible with alkaline solutions (sodium bicarbonate)

MAOIs will enhance the effect of dopamine.

Bretylium may potentiate effect of dopamine.

Beta blockers may antagonize effects of dopamine.

When administered with phenytoin, may cause hypotension, bradycardia, and seizures

Dopamine Hydrochloride (Intropin)

Duration of Action:

Onset: 1–4 minutes

Peak effect: 5–10 minutes

Duration: Effects cease almost immediately after infusion is discontinued

Dopamine Hydrochloride (Intropin)

Special Considerations:

Pregnancy safety: Category C.

Effects are dose-dependent.

Dopaminergic response:

2–4 μg/kg/min: dilates vessels in kidneys; increased urine output. Beta-adrenergic response: 4–10 μg/kg/min: positive chronotropic and inotropic effects. Adrenergic response: 10–20 μg/kg/min: primary alpha stimulant/vasoconstriction.

Greater than 20 μg/kg/min: reversal of renal effects/override of alpha effects, consider other agents such as epinephrine or norepinephrine infusions. Should be administered by infusion pump.

Epinephrine (Adrenalin)

CLASS:

Epinephrine (Adrenalin)

Indications:

Cardiac arrest (asystole, PEA, Vfib and pulseless Vtach)

Symptomatic bradycardia as an alternative infusion to dopamine

Severe hypotension secondary to bradycardia when atropine and transcutaneous pacing are unsuccessful

Allergic reaction

Anaphylaxis

Asthma.

Epinephrine (Adrenalin)

Mechanism of Action:

Direct-acting alpha and beta agonist

Alpha: Vasoconstriction

Beta-1: Positive inotropic, chronotropic, and dromotropic effects

Beta-2: Bronchial smooth muscle relaxation and dilation of skeletal vasculature

Blocks histamine receptors

Epinephrine (Adrenalin)

How Supplied:

1:1,000 solution: Ampules and vials containing 1 mg/mL.

1:10,000 solution: Prefilled syringes containing 0.1 mg/mL

Auto-injector (EpiPen): 0.5 mg/mL (1:2,000)

Epinephrine (Adrenalin)

Adult Dosage/Administration:

Mild allergic reactions and asthma: 0.3–0.5 mg (0.3–0.5 mL 1:1,000) SC

Anaphylaxis: 1 mg (10 mL of 1:10,000) IV, IO over 5 minutes

Cardiac arrest: IV/IO dose: 1 mg (10 mL, 1:10,000 solution) 3–5 minutes during resuscitation. Follow each dose with a 20-mL flush and elevate arm for 10–20 seconds after dose

Continuous infusion: Add 1 mg (1 mL of a 1:1,000 solution) to 250 mL normal saline or D5W (4 μg/mL). Initial infusion rate of 1 μg/min titrated to effect (typical dose: 2–10 μg/min).

Endotracheal (ET) dose: 2–2.5 mg diluted in 10 mL normal saline. Profound bradycardia or hypotension: 2–10 μg/min; titrate to patient response.

Higher dose: Higher doses (up to 0.2 mg/kg) may be used for specific indications: (beta blocker or calcium channel blocker overdose).

Epinephrine (Adrenalin)

Pedi Dosage/Administration:

Pediatric: Mild allergic reactions and asthma: 0.01 mg/kg (0.01 mL/kg) of a 1:1,000 solution SC maximum of 0.3 mL).

Anaphylaxis/Severe status asthmaticus: 0.01 mg/kg (0.01 mL/kg) IM of a 1:1,000 solution (maximum single dose: 0.3 mg).

Cardiac arrest: IV/IO dose: 0.01 mg/kg (0.1 mL/kg) of a 1:10,000 solution every 3–5 minutes during arrest.

All ET doses 0.1 mg/kg (0.1 mL/kg) of a 1:1,000 solution mixed in 3–5 mL of saline until IV/IO access is achieved.

Epinephrine (Adrenalin)

Contraindications:

Hypertension

Hypothermia

Pulmonary edema

Myocardial ischemia
Hypovolemic shock.

Epinephrine (Adrenalin)

Adverse reactions/Side effects:

Nervousness

Restlessness

Headache

Tremor

Pulmonary edema

Dysrhythmias

Chest pain

Hypertension

Tachycardia

Nausea

Vomiting.

Epinephrine (Adrenalin)

Drug Interactions:

Potentiates other sympathomimetics

Deactivated by alkaline solutions

MAOIs may potentiate effect

Beta blockers may blunt effects

Epinephrine (Adrenalin)

Duration of Action:

Onset: Immediate

Peak effect: Minutes

Duration : Several minutes

Epinephrine (Adrenalin)

Special Considerations:

Pregnancy safety: Category C.

May cause syncope in asthmatic children.

May increase myocardial oxygen demand.

To mix an infusion add 1 mg of epinephrine 1:1,000 to 500 mL D5W for a yield of 2 mcg/mL. Many states and systems are pulling away from IV/IO/IM administration of 1:1,000 and replacing it with auto-injectors due to the vascular side effects of solo epinephrine 1:1,000 injection.

Epinephrine Racemic (Micronefrin)

CLASS:

Epinephrine Racemic (Micronefrin)

Indications:

Bronchial asthma

Prevention of bronchospasm

Croup

Laryngotracheobronchitis

Laryngeal edema.

Epinephrine Racemic (Micronefrin)

Mechanism of Action:

Stimulates beta-2 receptors in lungs: bronchodilation with relaxation of bronchial smooth muscles.

Reduces airway resistance

Useful in treating laryngeal edema

Inhibits histamine release

Epinephrine Racemic (Micronefrin)

How Supplied:

Metered-dose inhaler: 0.16–0.25 mg/spray

Solution: 7.5, 15, 30 mL in 1%, 2.25% solution

Epinephrine Racemic (Micronefrin)

Adult Dosage/Administration:

MDI: 2–3 inhalations, repeated every 5 minutes PRN.

Solution: dilute 5 mL (1%) in 5 mL saline, administer over 15 minutes.

Epinephrine Racemic (Micronefrin)

Pedi Dosage/Administration:

Solution:

Dilute 0.25 mL (0.1%) in 2.5 mL saline

(if less than 20 kg) Dilute 0.5 mL in 2.5 mL saline

(if 20–40 kg) Dilute 0.75 mL in 2.5 mL saline

(if greater than 40 kg) Administer via hand-held nebulizer.

Epinephrine Racemic (Micronefrin)

Contraindications:

Hypertension

Underlying cardiovascular disease

Epiglottitis

Epinephrine Racemic (Micronefrin)

Adverse reactions/Side effects:

Headache

Anxiety

Fear

Nervousness

Respiratory weakness

Palpitations

Tachycardia

Dysrhythmias

Nausea

Vomiting.

Epinephrine Racemic (Micronefrin)

Drug Interactions:

MAOIs and bretylium may potentiate effect.

Beta blockers may blunt effects.

Epinephrine Racemic (Micronefrin)

Duration of Action:

Onset: Within 5 minutes

Peak effect: 5–15 minutes

Duration: 1–3 hours

Epinephrine Racemic (Micronefrin)

Special Considerations:

May cause tachycardia and other dysrhythmias. Monitor vital signs.

Excessive use may cause bronchospasm.

May have a strong rebound effect after drug wears off.

Metoprolol Tartrate (Lopressor)

CLASS:

Beta blocker

Beta-1 selective

Antihypertensive

Antidysrhythmic.

Metoprolol Tartrate (Lopressor)

Indications:

PSVT

Atrial flutter

Atrial fibrillation

Reduces myocardial ischemia and damage in patients with AMI.

Metoprolol Tartrate (Lopressor)

Mechanism of Action:

Decreases heart rate

Conduction velocity

Myocardial contractility

Cardiac output

Used to control ventricular response in SVT (PSVT, Afib, Aflutter)

Considered second-line agent after adenosine, diltiazem, or digitalis derivative

Metoprolol Tartrate (Lopressor)

How Supplied:

Metoprolol Tartrate (Lopressor)

Adult Dosage/Administration:

5 mg slow IV push at 5-minute intervals to a total of 15 mg.

Metoprolol Tartrate (Lopressor)

Pedi Dosage/Administration:

Metoprolol Tartrate (Lopressor)

Contraindications:

Heart failure

Second- or third-degree AV block

First-degree heart block(if PR interval is equal or greater than 0.24 seconds)

Sick sinus syndrome, cardiogenic shock

Bradycardia.

Metoprolol Tartrate (Lopressor)

Adverse reactions/ Side effects:

Weakness

Dizziness

Depression

Bronchospasm

Wheezing

Dyspnea

Bradycardia

Pulmonary edema

CHF

AV blocks

Hypotension

Heart failure

nausea

Indigestion.

Metoprolol Tartrate (Lopressor)

Drug Interactions:

Metoprolol may potentiate antihypertensive effects when given to patients taking calcium channel blockers or MAOIs

Catecholamine-depleting drugs may potentiate hypotension

Sympathomimetic effects may be antagonized

Signs of hypoglycemia may be masked

Metoprolol Tartrate (Lopressor)

Duration of Action:

Onset: 1–2 minutes

Peak effect: 5–10 minutes

Duration: 3–4 hours

Metoprolol Tartrate (Lopressor)

Special Considerations:

Pregnancy safety: Category C.

Metoprolol must be given slow IV over 5 minutes. Concurrent IV administration with IV calcium channel blocker such as verapamil or diltiazem can cause severe hypotension

Metoprolol should be used with caution in patients with liver or renal dysfunction, hypotension, and COPD

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

CLASS:

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Indications:

Acute angina pectoris

Ischemic chest pain

Hypertension

CHF

Pulmonary edema.

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Mechanism of Action:

Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestinal smooth muscle

Dilation of arterioles and veins in the periphery

Reduces preload and afterload, decreasing workload of the heart and thereby myocardial oxygen demand

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

How Supplied:

Tablets:

0.3 mg (1/200 grain)

0.4 mg (1/150 grain)

0.6 mg (1/100 grain)

NTG spray:

0.4 mg/actuation

NTG IV (Tridil):

200 μg/mL in D5W glass vials

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Adult Dosage/Administration:

Tablet: 0.3–0.4 mg sublingually; may repeat in 5 minutes to maximum of 3 doses.

NTG spray: 1–2 sprays for 0.5–1 second at 5-minute intervals to a maximum of 3 sprays in 15 minutes.

NTG IV infusion: Begin at 10 μg/min; increase by 10 μg/min every 3–5 minutes until desired effect.

To a maximum of 200 μg/min.

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Pedi Dosage/Administration:

Not recommended

IV infusion: 0.25–0.5 μg/kg/min IV, IO titrated by 1 μg/kg/min (max dose: 5 μg/kg/min).

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Contraindications:

Hypotension

Hypovolemia

Intracranial bleeding or head injury

Pericardial tamponade

Severe bradycardia or tachycardia

RV infarction

Previous administration in the last 24 hours: tadalafi l (Cialis) (48 hours), vardenafi l (Levitra), sildenafi l (Viagra).

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Adverse reactions/Side effects:

Headache

Dizziness

Weakness

Reflex tachycardia

Syncope

Hypotension

Nausea/Vomiting

Dry mouth

Muscle twitching

Diaphoresis

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Drug Interactions:

Additive effects with other vasodilators.

Incompatible with other drugs IV.

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Duration of Action:

Onset: 1–3 minutes

Peak effect: 5–10 minutes

Duration: SL: 20–30 minutes

IV: 1–10 minutes after discontinuation of infusion

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Special Considerations:

Pregnancy safety: Category C.

Hypotension more common in the elderly.

If 12-lead ECG shows inferior wall infarct, rule out right ventricular infarct via right-sided 12-lead ECG prior to administering nitroglycerin.

Nitroglycerin decomposes when exposed to light or heat, must be kept in airtight containers.

Must be administered only with an infusion pump direct from bottle with a vented IV set and non-PVC tubing.

Active ingredient may have stinging effect when administered.

Sodium Bicarbonate

CLASS:

Systemic Hydrogen Ion Buffer

Alkalizing agent.

Sodium Bicarbonate

Indications:

Metabolic acidosis during cardiac arrest

Tricyclic Antidepressant

Aspirin & Phenobarbital overdose

Hyperkalemia

Crush injuries.

Sodium Bicarbonate

Mechanism of Action:

Buffers metabolic acidosis and lactic acid buildup in the body caused by anaerobic metabolism secondary to severe hypoxia by reacting with hydrogen ions to form water and carbon dioxide.

Sodium Bicarbonate

How Supplied:

Vials:

1 mEq/mL of an 8.4% solution in 10ml and 50mL

Prefilled syringe:

0.5 mEq/mL of a 4.2% solution in 2.5ml, 5ml, and 10mL 

Sodium Bicarbonate

Adult Dosage/Administration:

1 mEq/kg slow IV, IO push may repeat at 0.5 mEq/kg every 10 minutes.

Sodium Bicarbonate

Pedi Dosage/Administration:

1 mEq/kg slow IV, IO push (dilute in small children to 4.2%)

Sodium Bicarbonate

Contraindications:

Metabolic and respiratory alkalosis

Hypokalemia

Electrolyte imbalance due to severe vomiting or diarrhea.

Sodium Bicarbonate

Adverse reactions/Side effects:

Hypernatremia

Metabolic alkalosis

Tissue sloughing

Cellulitis, or necrosis at injection site

Seizure

Fluid retention

Hypokalemia

Electrolyte imbalance

Tetany

Sodium retention

Peripheral edema.

Sodium Bicarbonate

Drug Interactions:

Increases the effects of amphetamines

Decreases the effects of benzodiazepines, tricyclic antidepressants

May deactivate sympathomimetics (dopamine, epinephrine, (norepinephrine)

Sodium Bicarbonate

Duration of Action:

Onset: Seconds

Peak effect: 1–2 minutes

Duration: 10 minutes

Sodium Bicarbonate

Special Considerations:

Pregnancy safety: Category C

Repeat as needed in tricyclic antidepressant overdose until QRS narrows.

Must be used in conjunction with effective ventilation and chest compressions in cardiac arrest. Avoid contact with other medications; may precipitate or inactivate them.

Always flush IV line well before and after injecting. Use with caution in patients with CHF and renal disease due to high sodium concentration.

Monitor patient closely for signs and symptoms of fluid overload.

Vasopressin (Pitressin)

CLASS:

Vasopressin (Pitressin)

Indications:

Alternative vasopressor to the first or second dose of epinephrine in cardiac arrest

Alternative to epinephrine in asystole & PEA.

Vasopressin (Pitressin)

Mechanism of Action:

Stimulation of smooth muscle receptors.

Potent vasoconstrictor when given in high doses.

Vasopressin (Pitressin)

How Supplied:

Vasopressin (Pitressin)

Adult Dosage/Administration:

40 U one-time dose IV/IO to replace the first or second dose of epinephrine in cardiac arrest. 0.02–0.04 U/min continuous.

Vasopressin (Pitressin)

Pedi Dosage/Administration:

0.4–1 unit/kg IV/IO to a maximum of 40 units to replace the first or second dose of epinephrine in cardiac arrest.

Vasopressin (Pitressin)

Contraindications:

Use with caution in patients with coronary artery disease, epilepsy, or heart failure.

Vasopressin (Pitressin)

Adverse reactions/Side effects:

Dizziness

Headache

Bronchial constriction

MI

Chest pain

Angina

Cardiac dysrhythmia

Decreased cardiac output

Abdominal cramps

Diarrhea/Nausea/Vomiting

Paleness

Sweating

Vasopressin (Pitressin)

Drug Interactions:

Vasopressin (Pitressin)

Duration of Action:

Onset: Immediate

Peak effect: Variable

Duration: Variable

Vasopressin (Pitressin) Special

Considerations:

Pregnancy safety: Category C.

May increase peripheral vascular resistance and provoke cardiac ischemia and angina.