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| ==Lidocaine== | | ==Table== |
| === Adult Dosing ===
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| *Loading dose = 1-1.5 mg/kg
| | {| class="wikitable" style="width: 641px; height: 711px;" |
| **Additional boluses of 0.5-0.75 mg/kg q5-10min up to max of 3mg/kg
| | |- |
| **If effective start infusion of 2mg/min | | ! Class |
| | ! Known as |
| | ! Examples |
| | ! Mechanism |
| | ! Clinical uses |
| | |- |
| | ! Ia |
| | | fast-channel blockers-Affect QRS complex |
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| | *Quinidine |
| | *[[Procainamide]] |
| | *Disopyramide |
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| === Contraindications ===
| | | (Na<sup>+</sup>) channel block (intermediate association/dissociation) |
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| | *Ventricular arrhythmias |
| | *prevention of paroxysmal Recurrent atrial fibrillation (triggered by Vagus nerve overactivity) |
| | *procainamide in [[Wolf Parkinson White (WPW)]] |
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| *High SA or AV block | | |- |
| | ! Ib- Do not affect QRS complex |
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| | *[[Lidocaine]] |
| | *Phenytoin |
| | *Mexiletine |
| | *Tocainide |
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| === Indications ===
| | | (Na<sup>+</sup>) channel block (fast association/dissociation) |
| | | |
| | *treatment and prevention during and immediately after Myocardial infarction, though this practice is now discouraged given the increased risk of Asystole |
| | *Ventricular tachycardia |
| | *[[Atrial Fibrillation (Main)|Atrial fibrillation]] |
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| *Treatment of ventricular arrhythmias and ectopy | | |- |
| **Considered 2nd-line to amiodarone for tx of V-fib and pulseless v-tach | | ! Ic |
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| | *[[Flecainide]] |
| | *Propafenone |
| | *Moricizine |
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| === Mechanism of Action ===
| | | (Na<sup>+</sup>) channel block (slow association/dissociation) |
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| | *prevents Paroxysmal atrial fibrillation |
| | *treats Recurrent tachyarrhythmias of abnormal conduction system. |
| | *contraindicated immediately post-myocardial infarction. |
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| *Class Ib | | |- |
| **Binds to fast Na channels in inactive state thereby inhibiting recovery after repolarization | | ! II |
| **Acts preferentially on ischemic tissue | | | [[Beta-blockers]] |
| ***Elevates V-fib threshold | | | |
| ***Suppresses ventricular ectopy | | *Propranolol |
| *Little effect on vascular tone, contractility or cardiac output | | *[[Esmolol]] |
| | *Timolol |
| | *[[Metoprolol]] |
| | *[[Atenolol]] |
| | *Bisoprolol |
| | *[[Labetalol]] |
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| === Adverse Drug Rxns ===
| | | beta blocking<br>Propranolol also shows some class I action |
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| | *decrease Myocardial infarction mortality |
| | *prevent recurrence of Tachyarrhythmias |
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| *CNS | | |- |
| **Abrupt change in MS, drowsiness, confusion, sz | | ! III |
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| | *[[Amiodarone]] |
| | *[[Sotalol]] |
| | *[[Ibutilide]] |
| | *Dofetilide |
| | *Dronedarone |
| | *E-4031 |
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| === Kinetics ===
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| | K<sup>+</sup> channel blocker |
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| *Onset of action = 45-90s
| | Sotalol is also a β-blocker |
| *Duration of action = 10-20min
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| == [[Procainamide]] ==
| | Amiodarone has Class I, II, and III activity |
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| | *In [[Wolf Parkinson White (WPW)]] |
| | *(sotalol:) Ventricular tachycardias and Atrial fibrillation |
| | *(Ibutilide:) Atrial flutter and [[Atrial Fibrillation (Main)|Atrial fibrillation]] |
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| == [[Esmolol]] ==
| | |- |
| | ! IV |
| | | slow-channel blockers |
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| | *Verapamil |
| | *[[Diltiazem]] |
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| == [[Labetalol]] ==
| | | Ca<sup>2+</sup> channel blocker |
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| | *prevent recurrence of Paroxysmal supraventricular tachycardia |
| | *reduce Ventricular rate in patients with [[Atrial Fibrillation (Main)|Atrial fibrillation]] |
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| == [[Sotalol]] ==
| | |- |
| | ! V |
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| | *[[Adenosine]] |
| | *[[Digoxin]] |
| | *[[Magnesium sulfate]] |
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| == Amiodarone ==
| | | Work by other or unknown mechanisms (Direct nodal inhibition). |
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| | Used in supraventricular arrhythmias, |
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| === Adult Dosing ===
| | Or in the case of [[magnesium sulfate]], used in [[torsade de pointes]]. |
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| *V-fib/pulseless V-tach
| | |} |
| **Loading dose = 300mg IV bolus followed by 150mg bolus prn
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| *Stable V-tach or SVT
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| **Loading dose = 150mg IV in 100mL D5W over 10min
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| ***Follow by infusion of 1mg/min x 6hr; 0.5mg/min thereafter
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| === Contraindications === | | ==See Also== |
| | *[[Arrhythmias (DDX)]] |
| | *[[Atropine]] |
| | *[[Isoproterenol]] |
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| *Iodine or shellfish allergy
| | ==References== |
| *Pregnancy | | <references/> |
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| | *Katzung & Trevor's Pharmacology |
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| === Indications ===
| | [[Category:Pharmacology]] [[Category:Cardiology]] |
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| *Ventricular and supraventricular arrhythmias
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| *1st line for pulseless V-tach/V-fib
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| *Used for atrial arrhythmias in pts w/ decr EF
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| === Mechanism of Action ===
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| *Class III - Inhibits potassium channels
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| **Impairs SA and AV node conduction
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| **Decreases automaticity
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| **Prolongs refractory period in accessory pathways
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| *Also has class I & II properties
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| === Adverse Drug Rxns ===
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| *Bradycardia, hypotension
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| *Prolonged QT
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| == Ibutilide ==
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| === Adult Dosing ===
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| *Loading dose = 1mg IV in 50mL D5W over 10min (wt>60kg)
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| *Loading dose = 0.01mg/kg IV in 50mL D5W over 10min (wt<60kg)
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| *Dose may be repeated 10min after completion of 1st dose
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| === Contraindications ===
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| === Indications ===
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| *Rapid conversion of recent-onset A-fib/flutter to NSR
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| === Mechanism of Action ===
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| *Class III - Prolongs AP and refractory period
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| === Adverse Drug Rxns ===
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| *QT prolongation, V-tach, torsades
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| *Observe for 4hr after infusion
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| === Kinetics ===
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| *Onset of action = 20-30min
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| *Duration of action = 24hr
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| == Diltiazem ==
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| === Adult Dosing ===
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| *Loading dose = 0.25mg/kg (max=20mg) IV bolus over 2min
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| **If ineffective after 15min: 0.35mg/g (max=25mg) over 2min
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| **If effective: Start infusion at 5-15mg/hr
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| === Contraindications ===
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| *Wide-complex tachycardia due to bypass tract
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| === Indications ===
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| *Conversion of PSVT to NSR
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| *Slow RVR in a-fib/flutter
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| === Mechanism of Action ===
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| *Class IV - Inhibits Ca influx
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| **Slows AV nodal conduction
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| === Adverse Drug Rxns ===
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| Bradycardia, CHF, AV block, BBB, hypotension
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| === Kinetics ===
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| *Onset of action = 2-3min (IV)
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| *Duration of action = 1-3hr (IV)
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| == Atropine ==
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| === Adult Dosing ===
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| *Loading dose = 0.5mg rapid IV bolus q3-5min (max = 0.04 milligram/kg)
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| *May be given IM, IO, SC
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| === Indications ===
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| *Symptomatic sinus or AV nodal bradycardia
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| === Mechanism of Action ===
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| *Parasympatholytic
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| **Increases sinus/AV conduction
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| === Adverse Drug Rxns ===
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| *Increased O2 consumption
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| *If given slowly (or <0.5mg) may lead to paradoxical bradycardia
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| === Kinetics ===
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| *Onset of action = 2-4min
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| *Duration of action = 5hr
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| == Adenosine ==
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| === Adult Dosing ===
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| *6mg rapid IV bolus over 1-2s
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| **If ineffective can try 12mg 2min later
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| ***If still ineffective can try another 12mg
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| === Contraindications ===
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| *2nd, 3rd AV block
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| *Sick sinus syndrome
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| *Reentrant SVTs not involving AV node are not terminated
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| *No effect on anterograde WPW
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| === Indications ===
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| *Conversion of reentrant PSVT to NSR
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| === Mechanism of Action ===
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| *Negative inotropic, dromotropic, chronotropic effects
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| *Transient AV nodal block
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| === Adverse Drug Rxns ===
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| *Bronchoconstriction (responds to bronchodilators)
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| *Bradyarrhythmia
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| *Hypotension (if given too slowly)
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| === Kinetics ===
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| Onset of action = 20-30s Duration of action = 60-90s
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| == Digoxin ==
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| === Adult Dosing ===
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| *Loading dose = 0.25 mg IV q2hr until effect (max total = 1.5 mg
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| === Contraindications ===
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| *WPW
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| **Increases conduction velocity in atrial tissue
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| === Indications ===
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| *RVR control in a-fib/flutter, PSVT
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| === Mechanism of Action ===
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| *Inhibits NaK pump
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| **Positive inotropy
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| *Negative chronotropy/dromotropy
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| **Indirect vagal stimulator
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| === Adverse Drug Rxns ===
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| *GI - N/V, diarrhea, abd pain
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| *CV - Bradycardia, SA/AV block, ventr arrhythmias
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| === Kinetics ===
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| Onset of action = 1.5-4hr (IV)
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| == Isoproterenol ==
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| === Adult Dosing ===
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| 2-10mcg/min IV by continuous infusion
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| === Indications ===
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| *Refractory torsades
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| *Refractory symptomatic bradycardia
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| === Mechanism of Action ===
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| *Beta agonist
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| === Adverse Drug Rxns ===
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| *Dramatic increase in O2 demand
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| *V-tach (use lowest dose possible)
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| === Kinetics ===
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| *Onset of action = 1-5min
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| *Duration of action = 1-2hr
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| == Magnesium ==
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| === Adult Dosing ===
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| *Loading dose = 1-2gm in 10mL D5W over 1-2min (cardiac arrest)
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| *Loading dose = 1-4gm in 50-100 D5W over 20-60min (spontaneous circulation)
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| === Contraindications ===
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| === Indications ===
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| *Torsades
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| *Refractory v-tach/fib (regardless of Mg level)
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| === Mechanism of Action ===
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| *Increases vasomotor tone
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| *Prolongs AV conduction; prolongs refractoriness
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| === Adverse Drug Rxns ===
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| *Hypotension (rare)
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| === Kinetics ===
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| *Onset of action = Immediate
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| *Duration of action = 30min
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| === Source ===
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| Tintinalli
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| <br/>[[Category:Drugs]] <br/>[[Category:Cards]] <br/><br/><br/>
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