Cardiac- Ventricular Dysrhythmias

Question 1

Amiodarone (Cordarone)

Answer 1

Action: Potassium channel blocker; Prolongs refractory period, Slows sinus rate, Increases PR and QT intervals, slows sinus rate

Indication: Pulseless Vfib/VTach, stable wide TachyC, Stable SVT (after other meds), WPW, Afib/AFlutter

Dose: 300 mg IF DEAD
150 mg over 10 min if alive

SFx: ARDS, CHF, Bradycardia, HypoT,Prolonged QT, Pulm edema

CI: Cardiogenic shock, CHF, High degree heart blocks

Notes: Harms neonates (mothers milk), Stays in body for days

Question 2

Lidocaine (Xylocaine)

Answer 2

Action: Na channel blocker; Shortens refractory period, suppress ectopy, increases Vfib threshold

Indications: Pulseless Vfib,VTach, Stable VTach (after Amiodarone)

Dose: 1 - 1.5 mg/kg slow IVP, (2nd dose) .5 - .75 mg/kg (every 5-10 min, up to 3 mg/kg)

SFx: HypoT, BradyC, Arrhythmia, Resp arrest, Cardiac arrest, seizures

Notes: Does NOT cause vasodilation

Question 3

Magnesium Sulfate (Cardiac)

Answer 3

Action: Electrolyte for nerve transmission and muscle contraction

Indications: Torsades de Pointes, Pulseless Vfib/VTach from Torsades

Dose: 1 -2 grams in 10ml IVP

SFx: Resp/Cardiac arrest (pushed too fast), BradyC, HypoT, Arrhythmia

Notes: Caution in renal failure, Calcium to reverse effects

Question 4

Procainamide (Pronestyl)

Answer 4

Action: Beta blocker (Mainly B1), Prolong refractory period of atria and ventricles, Na/K channel blocker

Indications: Stable VTach, SVT w/o effect from adenosine, secondary for Afib/AFlutter (w/ or w/o WPW) to control rate

Dose: 20-30 mg/min (or 100mg) over 5 min
UNTIL: It works, QRS widens by more than 50%, max dose of 17 mg/kg is reached or HTN develops

SFx: HypoT, Asystole, Ventricular arrhythmia, Prolong QTI

CI: Torsades, Prolonged QTI

Question 5

Epinephrine (Adrenalin)

Answer 5

Action: Alpha and Beta agonist, + chrono, dromo, ino, vasoconstriction

Indication: Symptomatic bradycardia, CA, PEA

Dose: CA- 1 mg IVP every 3-5 min
Symptomatic BradyC- 2-10 mcg/min 1 mg in 500cc until
60 BPM
Peds: .01 mg/kg IV/IO (CA, Symptomatc brady)

SFx: HyperT, TachyC, Arrythmia, angina, Hyperglycemia

Notes: Can worsen MI, TachyC

Question 6

Isoproterenol (Isuprel)

Answer 6

Action: Increase Beta effects (KING beta)

Indication: Torsades (adjunct), hemodynamically significant BradyC, BB OD

Dose: 2 - 10 mcg/min IV/IO drip (1mg/250ml of D5W)

SFx: HyperT, Angina, Arrythmia

Notes: Can severely stress the heart

Question 7

Sotolol (Betapace)

Answer 7

Action: Beta and Potassium channel blocker

Indication: Stable TachyC, VTach, HTN crisis, MI, Vent Arrythmia (PVC’s)

Dose: 100mg over 5 min

SFx: Torsades, Prolonged QT, BradyC, HypoT, Dyspnea

CI: HypoK, HypoMag

Notes: Caution in asthma patients