Lidocaine Hydrochloride

Question 0

Lidocaine - Actions

Answer 0

Decreases ventricular excitability by suppressing automaticity in the His-Purkinje system

Question 1

Lidocaine - Class

Answer 1

Antidysrhythmic

Question 2

Lidocaine - Indications

Answer 2

• Ventricular ectopics (coupled, multifocal, bigeminy, trigeminy, runs of VT, or “R on T” phenomena) if greater than 6/min and in the presence of pain or discomfort of suspected cardiac origin
• VT - (or wide complex tachycardia of uncertain type) - that is clinically stable
• Persistent VF & Pulseless VT (after the 2nd or 3rd shock)

Question 3

Lidocaine - Dosage/Route

Answer 3

Ventricular ectopics

• 1 - 1.5 mg/kg slow IVP
• May repeat with 0.5 - 0.75 mg/kg every 5-10 min until ectopy is suppressed or to a max 3 mg/kg
• Use lower doses for pts over 70 yrs, liver failure, shock, CHF:
  
  • Initial bolus of 1 mg/kg, repeat with 0.5 mg/kg q 10 min to a max of 2 mg/kg

VT …- clinically stable

• 1 - 1.5 mg/kg slow IVP
• May repeat with 0.5 - 0.75 mg/kg every 5-10 min until pt converts or to a max of 3 mg/kg

VF/Pulseless VT
* 1 - 1.5 mg/kg IVP, may repeat every 5-10 min with 0.5 - 0.75 mg/kg until conversion or to a max of 3 mg/kg

Question 4

Lidocaine - Side Effects

Answer 4

Toxicity:

Early: TENCAN

• Twitching
• Euphoria
• Numbness
• Combativeness
• Anxiety
• Nausea

Late: SUPPER

• Seizures/convulsions
• Unconsciousness/coma
• Pressure - Low/HoTN
• Prolonged PRI
• ECG- wide QRS
• Rhythm - VF

Question 5

Lidocaine - Contraindications

Answer 5

Idioventricular or escape dysthymias

Question 6

Lidocaine - Special Information

Answer 6

• Acts within 2 min & lasts 10 - 20 min from time of bolus
• In a bradycardia with ventricular escape beats (atrial rate on monitor determined to be < 60) consider atropine before lidocaine
• Use caution in AV blocks (suppressing automaticity may cause further block)

Question 7

Lidocaine - Pediatric Note

Answer 7

Refer to Pediatric Drug Guide.