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          ADENOSINE 
         (Adenocard)
Class:  A ntidysrhythmic Description: a normal sinus rhythm, it has a half-life of 10 seconds and does not  cause hypotension    a naturally occurring agent that can chemically cardiovert PSVT to   narrow complex paroxysmal supraventricular tachycardia Contraind:  asthma  hypersensitivity, 2nd and 3rd degree heart block, sinus node disease,   It may cause transient dysrhythmias, COPD Dosage:
Adult:12mg IV in 1-2 min, may be repeated once
6 mg rapid IV push, over 1-2 seconds if ineffective
Precautions:
Indications: refractory to a vagal maneuver
           AMIODARONE
 (Cordarone, Pacerone)
Class: antidysrhythmic Description: and relaxes smooth muscles, reducing peripheral vascular resistance and increasing coronary blood flow prolongs the duration of the action potential and refractory period Indications: frequently atrial fibrillation life-threatening ventricular and supraventricular dysrythmias, Contraind: advanced heart block hypersensitivity, cardiogencic shock, severe sinus bradycardia, or Precautions: hepatic impairment, pregnancy, nursing mothers, children Dosage: Adult hours (without pulse) 300 mg IVP then in 10 minutes 150 mg : (with pulse) 150mg IV over 10 min, then 1 mg/min 6
CARDIZEM ( DILTIAZEM)
Class: calcium channel-blocking agent Description: ionic influx of contraction sustaining Ca action potential, and causes coronary vasodilation. slows conduction, prolongs refractoriness in the AV node by blocking the++ during phase 2 and 3 of the Indications: Atrial Fibrillation or Atrial Flutter Contraind: supraventricular), Severe Congestive Heart Failure, Cardiogenic shock Sinus Node or AV Node dysfunction without Pacemaker: 1. 2 2. Sick Sinus Syndrome Wolff-Parkinson-White Syndrome, Wide Complex Tachycardia (unlessnd & 3rd Degree AV Blocks Precautions: Dosage: a. Must have B/P > 100 mm/hg. b. May repeat once at 0.35 mg/kg after 15 min. 0.25 mg/kg IV over 2 minutes
DIAZEPAM (valium)
Uses:  seizures Class:  antianxiety, hypnotic, anticonvulsant, sedative Descriptions:  tremors, induces amnesia, and reduces the incidence and recurrence of seizures. It relaxes muscle spasms in orthopedic injuries and produces amnesia for painful procedures (cardioversion) a benzodiazepine sedative and skeletal muscle relaxant that reduces Indications: cardioversion, muscle tremors due to injury, and acute anxiety major motor seizures, status epilepticus, premedication before Contraind:  vital signs, obstetric patients, neonates hypersensitivity to the drug, shock, coma, acute alcholoism, depressed Precautions: addiction, elderly or very ill patients, or copd. Due to short half life seizure activity may recur. psychoses, depression, myasthenia gravis, hepatic or renal impairment, Dosage:
Seizures: Adult:
5 to 10 mg IV/IM Peds: .5 to 2 mg IV/IM Acute anxiety: Adult: 2 to 5 mg IV/IM Peds: .5 to 2 mg IV/IM Premedication: Adult: 5 to 15 mg IV
DOBUTAMINE (Dobutrex)
Class: sympathomimetic Description: cardiac contraction without appreciably increasing rate a synthetic catecholamine and beta agent that increases the strength of Indications: to increase cardiac output in CHF/ cardiogenic shock Contraind: hypovolemia without fluid resuscitation hypersensitivity to sympathomimetic amines, ventricular tachycardia, and Precautions: atrial fibrillation or preexisting hypertension Dosage: Adult: 2 to 20 mcg/kg/min IV Pedi: same as adult
DOPAMINE (Intropin)
Class: sympathomimetic Description: appreciably increasing myocardial oxygen consumption. It maintains renal and mesenteric blood flow while inducing vasoconstriction and increasing systolic blood pressure a naturally occurring catecholamine that increases cardiac output without Indications: nonhypovolemic hypotension (70 – 100mmHg) and cardiogenic shock Contraind: tachydysrhythmias, ventricular fibrillation, and pheochromocytoma hypovolemic hypotension without aggressive fluid resuscitation, Precautions: adequate fluid resuscitation of the hypovolemic patient occlusive vascular disease, cold injury, arterial embolism. Ensure Doseage: Adult: 5 mcg/kg/min up to 20 mcg/kg/min, titrate to effect Pedi: same as adult Onset: 5 min
Epinephrine 1:1000 & 1:10,000
Use: V-fib, pulseless Vtach, PEA, asystole, anaphylaxis (subq), 3 Class: (Sympathomimetic) Adrenaline Description: a naturally occurring catecholamine that increases heart rate; cardiac contractile force myocardial electrical activity, systemic vascular resistance, and systolic blood pressure and decreases overall airway resistance and automaticity also, through bronchial artery constriction, may reduce pulmonary congestion and increase tidal volume and vital capacity Indications: restore rhythm in cardiac arrest and severe allergic reactions Contraindications: hemorrhagic or cardiac shock, coronary insufficencey, Organic brain or heart disease, during labor Dose: Arrest: 1:10,000; 1 mg every 3-5 min IV ET: 2 to 2.5 mg Pedi: .01 mg/kg IV / IO All subsequent doses .1 mg/kg IV / IO Allergic reactions: 1:1,000 .3-.5 mg subq 5-15 min as Needed 1:10,000 .5 to 1 mg IV if subq not effective Pedi: 1:1,000 .01 mg/kg subq every 10-15 Min 1:10,000 .01 mg/kg IV if subq dose ineffective rd line symptomatic bradycardia (drip) Onset: less than 2 min
FENTANYL ( sublimaze)
Class: narcotic analgesic Description: but with a more rapid and less-prolonged action a potent synthetic narcotic analgesic similar to morphine and meperidine Indications: induce sedation for endotracheal intubation Contraind: MAO inhibitors within 14 days, myasthenia gravis Precautions: problems, hepatic and renal insufficiency increased intracranial pressure, elderly, debilitated, COPD, respiratory Dosage: A: 25 to 100 mcg slowly IV ( 2 to 3 min) P: 2 mcg/kg slow IV/IM
LABETALOL (Trandate, Normodyne)
Class: beta blocker Description: vasodilation, reduces peripheral vascular resistance, and lowers blood pressure a beta blocker with some alpha blocker charaeristics. It induces Indications: acute hypertensive crisis Contraind: cardiogenic shock asthma, CHF, 2nd and 3rd degree heart block, severe bradycardia, or Precautions: disease COPD, heart failure, hepatic impairment, diabetes, peripheral vascular Dosage: 1 0-20 mg slow IV over 2 minutes
LASIX (Furosemide)
Class: diuretic Description: reabsorption by the kidney, its vasodilating effects reduce venous return and cardiac workload a rapid acting, potent diuretic and antihypertensive that inhibits sodium Indications: congestive heart failure and pulmonary edema Contraind: depletion states, heptic coma, pregnancy ( except in life- threatening circumstances) hypersensitivity to fureosemide or the sulfonamides, fluid and electrolyte Precautions: shock associated with acute MI, gout, or patients receiving digitalis or potassium-depleting steroids infants, elderly, hepatic impairment, nephritic syndrome, cardiogenic Dosage: A: 1mg/kg (40 to 80 mg slow IV) P: 1 mg/kg slow IV
LIDOCAINE (Xylocaine)
Class: antidysrhythmic Description: It also causes sedation, anticonvulsant, and analgesic effects suppresses automaticity and raises stimulation threshold of the ventricles. Indications: tachycardia (w/ pulse) pulseless ventricular tachycardia, ventricular fibrillation, ventricular Contraind: dysrhythmias, stokes-adams syndrome, 2 bradycardias hypersensitivity to amide-type local anesthetics, supraventricularnd and 3rd degree heart blocks and Precautions: hypovolemia, myasthenia gravis, shock, debilitated patients, elderly, family history of malignant hypothermia hepatic or renal impairment, CHF, hypoxia, respiratory depression, Dosage: Cardiac arrest Adult: Follow conversion with a drip of 2 – 4 mg/min 1 – 1.5 mg/kg IV repeated every 3 – 5 min up to 3 mg/kg Pedi: Conversion with a drip of 20 to 50 mcg/kg/min 1 mg/kg IV repeat every 3-5 min up to 3 mg/kg, follow Ventricular tachycardia (w/pulse) Adult: Conversion up to 3 mg/kg. follow conversion with an infusion of 2 – 4 mg/min. 1-1.5 mg/kg slow IV may repeat at ½ dose every 5 to 10 min until Pedi: 1 mg/kg followed by a drip 20 to 50 mg/kg/min
MAGNESIUM SULFATE (Magnesium)
Class: electrolyte Description: depressant and anticonvulsant. It also depresses the function of smooth, skeletal, and cardiac muscles an electrolyte that acts as a calcium channel blocker, acting as a CNS Indications: especially torsade do pointes), AMI, eclamptic seizures refractory ventricular fibrillation and pulseless ventricular tachycardia ( Contraind: hypocalcemia heart block, myocardial damage, shock, persistent hypertension, and Precautions: neuromuscular blocking agents renal impairment, digitalized patients, other CNS depressants or Dosage: Ventricular fibrillation or tachycardia: 1-2 g IV over 2 min Torsade de pointes: 1 – 2 g IV over 2 minutes Eclampsia: 2 – 4 g IV/IM
Metoprolol (Lopressor)
Class: beta-blockers Description: receptors on sympathetic nerves, by blocking the action of these nerves metoprolol reduces the heart rate and reduces the force of contraction of heart muscle and thereby lowers blood pressure. blocks the action of the sympathetic nervous system by blocking beta Indications: Hypertension Contraind: asthma. Inferior wall MI CHF, pulmonary edema, bronchospasm, heart block, bradycardia, hypotension, history of Precautions: Use of calcium channel blockers may potentiate side effects Dosage: 5mg every 15 minutes up to 15mg
MIDAZOLAM (versed)
Class: sedative Description: anticonvulsant, and anterrograde amnestic effects a short acting benzodiazepine with CNS depressant, muscle relaxant, Indications: induce sedation before cardioversion or intubation Contraind: coma, or acute alcohol intoxication hypersensitivity to benzodiazepines, narrow angled glaucoma, shock, Precautions: COPD, renal impairment, CHF, elderly Dosage: Adult: 1 to 2.5 mg slow IV Peds: .1 to .15 mg/kg IM 3 mg intra-nasal .05 to .2 mg/kg IV
Morphine Sulfate
Class: narcotic analgesic Description: venous return, and reduced myocardial oxygen demand potent analgesic and sedative that causes some vasodilation, reducing Indications: edema moderate to severe pain and in MI to reduce venous return in pulmonary Contraind: hypotension or volume depletion, acute bronchial asthma, COPD, severe respiratory depression, pulmonary edema due to chemical inhalation hypersensitivity to opiates, undiagnosed head or abdominal injury, Precautions: available to counteract the effects of morphine elderly, children, or debilitated patients, naloxone should be readily Dosage: Adult: 5 to 20 mg IM/ Sub q Pain 2.0 to 10 mg IV Peds: .1 to .2 mg/kg IM/ Subq AMI/ PE 2 mg up to 10mg .05 to .1 mg/kg
NALOXONE (narcan)
Class: narcotic antagonist Description: synthetic narcotics and may reverse respiratory depression a pure narcotic antagonist that blocks the effects of both natural and Indications: narcotic and synthetic narcotic overdose, coma of unknown origin Contraind: hypersensitivity to drug, non-narcotic induced respiratory depression Precautions: shorter than that of most narcotics, hence the patient may return to the overdose state possible dependency (includes newborns), also has a half-life that is Dosage: Adult: .4 to 2 mg IV/IM repeat 2 to 3 min as needed up to 10 mg Peds: .01 mg IV/IM repeated 2 to 3 min as needed up to 10 mg
NITROGLYCERIN (Nitrostat)
Class: nitrate Description: blood pressure, venous return, and cardiac workload a rapid smooth muscle relaxant that reduces peripheral vascular resistance, Indications: acute pulmonary edema chest pain associated with angina and acute myocardial infarction, and Contraind: hypotension, increased ICP, patients taking sildenafil, glaucoma, and shock hypersensitivity, tolerance to nitrates, severe anemia, head trauma, Precautions: sensitive and will lose potency when exposed to the air may induce headache that is sometimes severe. Nitroglycerin is light Dosage: .4 mg (one spray) SL ½ inch of topical ointment
Nitrous Oxide ( nitronox)
Class: gas Description: nitrous oxide. Effects last only 2 to 5 min after administration ceases a self-administered analgesic gas composed of 50% oxygen and 50% Indications: (including hyperventilation) musculoskeletal, burn, and ischemic chest pain and sever anxiety Contraind: COPD, head injury, impaired mental status, or drug intoxication possible bowel obstruction, pneumothorax or tension pneumothorax, Precautions: use in well ventilated area, may cause nausea and vomiting Dosage: the mask self administered inhalation until the pain is relieved or the patient drops
PROCAINAMIDE (Pronestyl)
Class: antiarrhythmic Description: myocardial excitability prolongs ventricular repolarization, slows conduction, and decreases Indications: lidocaine ventricular fibrillation and pulseless ventricular tachycardia refractory to Contraind: hypersensitivity to procainamide or procaine, myasthenia gravis, and 2nd and 3 rd degree heart blocks Precautions: from digitalis, hepatic or renal impairment, electrolyte imbalance, or bronchial asthma hypotension, cardiac enlargement, CHF, AMI, ventricular dysrhythmias Dosage: Adult: Mg/min 20 to 30 mg/min IV drip up to 17 mg/kg to effect, then 1 to 4 Pedi: 15 mg/kg/IV/IO over 30 to 60 min
Sodium Bicarbonate ( NaHCO3)
Class: alkalizing agent Description: metabolic acidosis and in the treatment of some overdoses provides bicarbonate to assist the buffer system in reducing the effects of Indications: hyperkalemia tricyclic antidepressant and barbiturate overdose, refractory acidosis or Contraind: none when used in severe hypoxia or late cardiac arrest Precautions: vasopressors and may precipitate with calcium chloride may cause alkalosis if given in too large a quantity, it may also deactivate Dosage: Adult: 1 mEq/kg IV, then .5 mEq/kg/ 10 min Peds: same as adult (may be given IO)
VASOPRESSIN (Pitressin)
Class: hormone, vasopressor Description: may precipitate angina and/or AMI a hormone with a strong vasopressive and antidiuretic properties but that Indications: bleeding from esophageal varices to increase peripheral vascular resistance in arrest (CPR) or to control Contraind: advanced arteriosclerosis, or 1 chronic nephritis with nitrogen retention, ischemic heart disease, PVC’s,st stage of labor Precautions: impairment, elderly, and children epilepsy, migraine, heart failure, angina, vascular disease, hepatic Dosage: Arrest: 40 units IV Esophageal varices .2 to .4 units/ min IV drip
VERAPAMIL (Isoptim, Calan)
Class: calcium channel blocker Description: slows ventricular responses to atrial tachydysrhythmias. Verapamil also dilates coronary arteries and reduces myocardial oxygen demand. slows AV conduction, suppresses reentry dysrhythmias such as PSVT, and Indications: rapid ventricular response PSVT refractory to adenosine, atrial flutter, and atrial fibrillation with Contraind: sinus node disease, and accessory AV pathways, WPW syndrome. It should not be administered to persons taking beta-blocker severe hypotension, cardiogenic shock, 2nd or 3rd degree heart block, CHF, Precautions: myocardial stenosis hepatic and renal impairment, MI with coronary artery occlusion, or Dosage: Adult: 30 min to a max of 30 mg in 30 min 2.5 to 5 mg IV bolus over 2-3 min, then 5-10 mg after 15 to Pedi: age 1-15 .1 to .3 mg/kg (not to exceed 5 mg) newborn .1 to .2 mg/kg (not to exceed 2 mg)
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