Antiarrhythmics
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Section 8 - MEDICATION GUIDELINES
8.06 ANTIARRHYTHMICS
Adenosine (ADENOCARD) / Antiarrhythmic
DESCRIPTION/ACTION:
- It is a natural occurring agent that can "chemically cardiovert" Paroxysmal Supraventricular Tachycardia (PSVT) to a normal sinus rhythm.
- It has a half-life of 5 seconds and does not cause hypotension like Verapamil.
- Restores normal sinus rhythm by interrupting re-entrant pathways in the AV node.
- Slows conduction time through the AV node.
- Produces coronary artery vasodialation.
INDICATIONS:
- Narrow complex (PSVT) refractory to vagal maneuvers.
CONTRAINDICATIONS:
- 2nd and 3rd Degree Heart Block, Sick Sinus Syndrome, or known hypersensitivity to the medication.
PRECAUTIONS:
- It may cause transient arrhythmias.
- It may cause bronchospasm in asthma patients.
- Heart transplant patients may only require a smaller dosage and patients on Theophylline based medications may require larger dosage, contact MEDICAL CONTROL for consult.
DOSAGE:
- IV 12 mg by rapid IV bolus, if no results repeat 1-2 minutes later as 12 mg rapid IV bolus. Maximum total dose 24 mg.
- Pediatrics - Refer to Handtevy System for patient specific dosage
- Premies - 13 y/o: 0.1 mg/kg (1st dose), 0.2 mg/kg (2nd dose)
Atropine Sulfate / ANTIMUSCARINICS / ANTIDOTES
DESCRIPTION / ACTION:
- It blocks the parasympathetic nervous system and it’s inhibiting effects on heart rate.
- It does not increase the strength of cardiac contraction.
INDICATIONS:
- Symptomatic Bradycardia, Asystole if clinically indicated (vagally induced), and Organophosphate Poisoning.
CONTRAINDICATIONS:
- None in the emergency setting.
PRECAUTIONS:
- Give no more than 3.0 mg for cardiac-related problems. May cause a decrease in ventricular rate in the presence of 2nd Degree Mobitz II and 3rd Degree Heart Block.
DOSAGE:
- 0.5 mg - 1.0 mg IVP AND refer to appropriate PRACTICE PARAMETER for specific dosage.
- Refer to Handtevy System for pediatric specific dosage.
Lidocaine 2% (XYLOCAINE) / Antidysrrhythmic
DESCRIPTION:
- Lidocaine is an agent that increases the fibrillation threshold thereby reducing the development of ectopy and Ventricular Fibrillation.
INDICATIONS:
- More than 6 unifocal PVCs / minute, multifocal PVCs, R on T phenomenon, couplets, runs of PVCs, Ventricular Tachycardia, and in V-Fib/Pulseless Ventricular Tachycardia.
- May be used to enhance RSI in head injuries and may be useful in seizures caused by head injuries.
CONTRAINDICATIONS:
- 2nd degree Mobitz II and 3rd Degree Heart Blocks and bradycardias.
PRECAUTIONS:
- Side effects include: lowering LOC, confusion, irritability, muscle spasm, seizures, coma and possibly death.
DOSAGE:
- 0.5 - 1.5 mg / kg AND refer to appropriate PRACTICE PARAMETER for specific dosages.
- Refer to Handtevy System for pediatric specific dosage.
Diltiazem (CARDIZEM) / Calcium Channel Blocker
DESCRIPTION:
- Slows conduction through the SA / AV node, Causes vasodilation.
INDICATIONS:
- ATRIAL FIBRILLATION, ATRIAL FLUTTER. PRACTICE PARAMETER (4.03)
CONTRAINDICATIONS:
- HYPOTENSION, wide complex tachycardia, conduction system disturbances.
PRECAUTIONS:
- CHF, Hypotension, renal disease.
DOSAGE:
- 0.25 mg/kg IV bolus over 2 minutes AND refer to appropriate PRACTICE PARAMETERS for specific dosages.
