Adenosine Digoxin

 Antiarrhythmic  Antidysrhythmic, 5th, inotropic agents

 Conversion to sinus rhythm of paroxysmal  Heart failure, A-fib
supraventricular tachycardia  0.4-0.6 mg once then may cautiously give
 6mg rapid bolus, repeat dose 12mg IV bolus additional dose of 0.1-0.3 mg q6-8hrs until
within 1-2 mins adequate
 Slow IV push over 5 mins
Epinephrine
Dobutamine
 Adrenergic Agent choice for cardiac arrest,
Vasopressor used in pulseless VT/VF,  Inotropic agents
asystole and PEA  Low cardiac output and CHF
 1mg IV every 3-5mins or more frequently.  0.5-1 mcg/kg/min IV initially, then 2-20
May be given endotracheal route. mcg/kg/min; not to exceed 40mcg/kg/min
 Stocked 1mg/10mg 1:10,000  Infuse to large vein via infusion pump
 If used for hypersensitivity reaction 0.1-
Dopamine
0.25mgSC
 Inotrophic agents
Amiodarone (anti-dysrhythmics 3rd)
 Hypotension, decrease cardiac output and
 Malignant ventricular arrythmia, poor perfusion of vital organs. Increase
V-Fib/Pulseless V-tach mean arterial pressure in septic shock
 Markedly prolongs action potential and patients in large vein via infusion pump
repolarization
D50W (glucose elevating agents)
 300 mg IV x1 after dose of epinephrine if no
initial response to defibrillation. May repeat  hypoglycemia
10mg IV q5-10min. Rapid IV push if  10-25g (20-50ml 50% solution)
pulseless/no BP  High concentrations should be administered
 Not to exceed 2.2g/day, may be diluted in via central veins and only after appropriate
N.S or D5W dilution
Aminophylline (Xanthine Derivatives) Sodium bicarbonate
 Acute Bronchospasm  Alkalinizing agent
 Methylxanthines directly relaxes the smooth  Cardiac arrect, hyperkalemia
muscle of the respiratory tract  1mEq/kg/dose IV x 1
 6-7mg/kg IV/PO; infuse IV over 20 mins
Potassium chloride (electrolytes)
Atropine Sulfate
 Conduction of nerve impulses in the heart,
 Parasympatholytic contraction of cardiac, smooth muscle
 Anticholinergic  Hypokalemia
 Antidote for organophosphate poisoning  40-100 mEq KCL diluted in an appropriate
 Agent used for symptomatic bradycardia, amount and type of solution to be
PEA intravenously infused once at a rate note to
 0.5-1mg IV push, repeat at 3-5mins exceed 10-40 mEq /hr
 Intervals to max. total dose of 0.4mg/kg
Calcium Gluconate
 May be given via endotracheal route.
Stocked 1mg/10ml
  Antidote, calcium salts  D5W
 Hypoc alcemia (hypocalcemic tetany,
Hydrocortisone (corticosteroids)
hypoparathyroidism) cardiac arrest
(+hyperkalemia, hypocalcemia,  Status asmaticus, anti-inflammatory
hypermagnesemia) immunosuppressive
 1.5-3g IV over 2-5 minutes, diluted in N.S  100mg -500mg PRN, may repeat q2 q4 6hrs
or d%W PRN
 Rapid IV admin; arrythmias, hypotension,
Isoproterenol
MI or vasodilation
 Beta 1/beta2 adrenergic agonist
Calcium Chloride
 V.A’s due to AV heart block, Adams-stokes
 Antidote, calcium salts attacks, cardiac arrests and shock
 Hypocalcemia, arrythmias,  IV bolus: 0.2-0.06 mg initially then doses of
hypermagnesemia 0.01-0.2mg
 500-1000mg IV over 5-10mins  IV infusion: 0.5mcg/min, then doses of 2-
 C/I in Vfib during CPR, PVT 20mcg/min by infusion pump in D5W
 Direct IV, IM, SC or Intracardiac injection
Dexamethasone (corticosteroid)
(extreme cases)
 Hormones and synthetic substitutes
Magnesium Sulfate (antidysrhythmic V,
 Inflammation, cerebral edema and shock
Electrolytes)
 1-6 mg/kg IV or 40mg IV q2-6hrs PRN,
diluted in d5W, N.S.  Hypomagnesemia, toxemia of pregnancy
and torsades de pointes V-tach
Diazoxide (glucose elevating agents)
 With pulse 1-2g slow IV (10ml/D5W) over
 Hyper insulinemic hypoglycemia 5-60 mins, then 0.5-1g/hr IV
 Now in oral form  Cardiac arrest: same as above but over 5-20
 The injectable form used for HTN mins
emergency is no longer available
Methypredinisolone (corticosteroids)
Furosemide (loop diuretic)
 Allergic condition, acute exacerbations of
 Edema asso, w/ CHF, liver cirrhosis & renal multiple sclerosis
dse HTn  10-250 mg IM/IV up to q4hr PRN
 A, Pulmonary edema, HTN Criis, ICP
Nitroglycerine (nitrates)
 0.5-1mg/kg (40mg) IV over 1-2 mins. Or up
to 80mg but should not exceed 200mg  Angina. Renal failure
 Hyperkalemia, hypermagnesemia (hpk: 40-  5mcg/min if unresponsive to SL NTG
80 mg IV: hpm:20-40mg IV/ q3-4hrs PRN  Increase by 5mcg/min q3-5mins up to
20mcg/min
 3ml/hr (50mg in250ml D5W/NS)
Noradrenaline (alpha/beta adrenergic agonist)
Hydralazine (vasodilators)
 Acute hypotension, cardiac arrest,
 HTN crisis, CHF sepsis/septic shock)
 10-50 mg IM, 10-20 mg IV, repeat PRN  Initial: 8-12 mcg/min IV infusion, Titrate
 May induce SLE-Tyypes syndrome
  Extravasation: infiltrate with 10-15ml  Pedia- 1 year and younger initial dose 0.1-
NS+5-10mg of phentolamine mesylate 0.2 mg/kg over 2mins
 monitorBP  1-15 years: initial dose 0.1-0.3mg/kg over 2
mins. Do not exceed 5mg. repeat above dose
Procainamide (antidysrhythmic, 1a)
30mins after initial dose if response is not
 Arrythmia adequate. Repeat dose should not exceed
 IM: 0.5 1g IM q48hr 10mg.
 IV: loading dose 15-18 mg/kg; slowly over
25-30 mins; may repeat q5mins PRN; not to
exceed 1g
 Sol’n 2g/250ml D5W/NS in infusion pump
Propranolol (antidysrhythmic, I)
 Beta-blockers (nonselective) antianginal
NURSING CONSIDERATION
 HTN, angina, Hypertropic SubAortic
Stenosis, Supraventricular arrythmia &  Monitor patient carefully (BP, cardiac
portal HTN rhythm, and output)
 SVA: 1-3mg at 1mg/min 1st repeat q2-5min  Protect IV solution from ligt
until 5mg. Once achived, no additional dose  Monitor patient with renal or hepatic
for at least 4 hrs impairment carefully for possible drug
accumulation and adverse reactions
Vasopressin (antidiuretics)
Dose: IV adult: 150mg loading dose over 10mins,
 Abdominal distention, diabetes insipidus,
followed by 350mg over 6hr at rate of 1mg/min
gastrointestinal hemorrhage and vasodilatory
shock. For maintenance infusion 540mg at 0.5mg/min over
 AD: initial 5 units/IM, repeat q3-4hrs PRN 18hr
up to 10 units
Remember amiodarone should be diluted with D5W
 DI: 5-10 units IM/SC? Intranasal q6-12hrs
 Dilute to NS/D5W and via controlled
infusion device
Verapamil
 Antianginal
 Antiarrhythmic
 Antihypertensive
 Calcium Channel blocker
 Therapeutic actions- Inhibits the movement
of calcium ions across the membranes of
cardiac and arterial muscle cells
 Indication: treatment of SVT, essential
hypertension
 Dose: Adult- IV initial dose 5-10mg over
2mins, may repeat dose 0f 10mg 30mins
after first dose