Sunday, November 25, 2012

More Cardiac Drugs

Here are a few more drugs that use can use in the prehospital setting for treating patient's who have a cardiac-related emergency. We will break each drug down into 12 parts; name, class, MOA, route, indications,  contraindications, side effects, onset/duration, considerations, adult and peds dosage, and how the drug is supplied.

The following drugs include: Atropine, Dopamine, Furosemide, and Lidocaine.


Atropine
  • Brand Name: Atropine
  • Class: Anticholinergic 
  • MOA: Blocks AcH receptors in the parasympathetic nervous system, which allows the sympathetic nervous system to take over, and increase the heart rate
  • Indications: Bradycardia, Organophosphate poisoning  
  • Contraindications: Allergy, High-Degree heart blocks
  • Side Effects: Arrhythmias, Tachycardia, Anticholinergic effects, Facial flushing
  • Onset/Duration: Immediate/2 hours
  • Considerations: Tachycardia is NOT a contraindication for organophosphate position 
  • Dosage
    • ADULT: 
      • Bradycardia: 0.5mg - 1.0mg IVP
      • Organophosphate Poisoning: Hundreds of mg to reverse 
    • PEDS 0.02mg/kg IV (max of 0.5mg)
  • Supplied: 1mg / 10mL
  • Routes: IV, IO, ET*

Dopamine
  • Brand Name: Intropin 
  • Class: Sympathomimetic 
  • MOA: Increased cardiac contractility (intropic) causing peripheral vasoconstriction  
  • Indications: Hypotension, Cardiogenic Shock 
  • Contraindications: Allergy, Hypovolemic Shocks
  • Side Effects: VTACH, HTN, Palpitations
  • Onset/Duration: 5-10 minutes / Varies
  • Considerations: 
  • Dosage:
    • ADULT: 2-20mcg/kg/min (titrate)
    • PEDS: 2-20mg/kg/min (titrate) 
  • Supplied: 400mg vials
  • Routes: IV

Furosemide
  • Brand Name: Lasix
  • Class: Diuretic
  • MOA: Blocks the reabsorption of Na and K in the Loop of Henle
  • Indications: CHF, Pulmonary Edema
  • Contraindications: Allergy, Dehydrations
  • Side Effects: Hypotension, Dehydrations, Electrolyte imbalances
  • Onset/Duration: 20 minutes / 6 hours
  • Considerations: Lasix does pass through the placenta barrier, causing fetal harm
  • Dosing
    • ADULT: 40-80mg IV (0.5-1.0mg/kg)
    • PEDS: DO NOT USE
  • Supplied: 40mg / 10mL
  • Routes: IV

Lidocaine
  • Brand Name: Xylocaine
  • Class: Antiarrhythmic (sodium channel blocker)
  • MOA: Suppresses ventricular activity, which slows the velocity of the electrical impulses in the heart
  • Indications: VTACH, VFIB
  • Contraindications: Allergy, High-Degree Heart Blocks
  • Side Effects: Widened QRS, Anxiety, Dizziness, Confusion (AMS), N&V
  • Onset/Duration: 5 minutes / Varies 
  • Considerations: None
  • Dosing
    • ADULT
      • VTACH: 1.5 mg/kg IV --> 0.5-0.75mg/kg 
      • VFIB: 1.5 mg/kg IV --> 0.5-0.75mg/kg
      • Post Conversion: 2-4mg/min
    • PEDS:
      • VTACH: 1mg/kg IV
      • VFIB: 1mg/kg IV
      • Post Conversion: 20-25mcg/kg/min
  • Supplied: 100mg/ 10mL
  • Routes: IV, IO, IV Infusion 

*If giving medication via ET tube, you have to increase the dose. Even though we are able to give certain drugs via ET tube, it is recommend that you try to give the medication IV. Only do ET adm as a LAST resort. 

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