Class: antiarrhythmic

Indications: alternative to Amniodorone in cardiac arrest  from  V-fib/pulselessness V-tach, stable monomorphic V-tach, stable polymorphic V-tach with normal baseline QT

Contraindications: hypersensitivity, second or third degree atrioventricular (AV) blocks, Stokes-Adams ssyndrome, prophylactic use in acute acute myocardial infarction (AMI) ,

Dose: Adult:cardic arrest from V-fib/pulseless V-tach: 1-1.5mg/kg IV/IO repeat dose in 5-10 min at 0.5-0.75 mg/kg to max dose of 3 mg/kg.  Pediatric: rapid IV/IO dose 1mg/kg IV/IO push Max dose 100 mg

Mechanism of Action: decreases automaticity by slowing phase 4 depolarization

Side Effect: slurred speech, seizures (high doses) altered mental status

Supplied: 100 mg in 5mL syringes or ampules

Duration of Action: Onset 1-3 min Peak 5-10 min duration variable 15 min to 2 hours

Special Consideration: Pregnancy C monitor BP & respiratory

Class: Vasodialtor

Indications: acute angina, hypertension, CHF, Pulmonary edema, ischemic chest pain

Contraindicatons: hypotension, hypovolemia, intercranial bleeding, or head injury, administration of viagra, Revatio, Levitra, or Cialis in last 24 hours

Dose: Adult: tablets: 0.-0.4 mg SL (repeat every 3-5 min max 3 doses). Spray: 0.4 mg under tongue(1-2 sprays). IV infusion: begin at 10-20 micrograms/min and increase by 5-10 micrograms/ min every 5 min until desired effect. Pediatric: not recommended

Mechanism of Action: Smooth muscle relaxant: vascular, bronchole, utirine

Side effects: headache, hypotesion, syncope

Supplied: Tablets : 0.15mg, 0.3mg, 0.4mg, 0.6mg, NTG spray 0.4-0.8 mg

Duration: onset:1-3 min, Peak: 5-10 min, Duration: 20-30  min

Special consideration: pregnancy C, hypotension, NTG decomposes with light and heat 

Class: Antidiuretic hormone

Indications: Alternate to vasopressor for first or second (not both) doses of epinepherine in cardiac arrest, may be useful in vasodilatory (septic) shock

Contraindications: responsive patients with coronary artery disease

Dose: Adult: 40-unit one time dose IV/IO to replace the first or second dose of epinepherine. Pediatric not recommended

Mechanism of Action: Stimulation of V1 smooth muscle receptors, vasoconstrictors (high doses)

Side Effects: Bronchoconstriction, ischemic chest pain, neausea, vomiting

Supplied: 1mL vials containing 20 units

Duration: Onset: immediate, Duration: variable

Special Consideration: pregnancy C, Peripherial vascular resistance

Class: Endogenous nucleotide

Indications:Conversion of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm, may convert re-entry supraventricular tachycardia (SVT) due to Wolff-Parkison-White (WPW) syndrome

Contraindications: 2nd or 3rd degree heart blockage or sick sinus syndrome , A-fib/flutter, V-tach, hypersensitivity to adenosine, poison- induced tachycardia

Dose: Adult: 6mg over 1-3 sec, followed by 20 mL of saline flush, if no response after 1-2 minutes, repeat with 12 mg over -3 sec ( to max dose of 0 mg) Pediatric: 0.1-0.2 mg/kg rapid IV; max single dose 12mg

Mechanism of Action: Slows conduction time through the AV node

Side Effects: Facial flushing, shortness of breath

Supplied: 3mg/mL flip top vials for IV injection

Duration: Onset and Peak: seconds, Duration:12 seconds

Special Considerations: Short half life, limits side effects

Class: antiarrhythmic

Indications: Stable monomorphic V-tach with normal QT interval, re-entry supraventricular tachycardia (SVT) uncontrolled vagal maneuvers and adnosine, stable wide-complex tachycardia of unknown origin, A-fib with rapid ventricular rate in Wolff-Parkinson-White (WPW) syndrome pts

Contraindications: Torsade de pointes, 2nd and 3rd degree AV block digitalis toxicity, tricylic antidepressant overdose

Dose: Adult: recurrent V-fib/ pulseless V-tach: 20mg/min (up tp 50mg/min in urgent situations) IV infusion to max 17mg/kg. Pediatric: Loading dose of 15mg/kg IV/IO over 0-60 min

Mechanism of Action: Suppresses phase 4 depolaration

Side Effects: Widening of PR, QRS, & QT intervals, hypotension

Spplied: 1g in 10mL vials, 1g in 2mL vials for  infusion

Duration: onset: 10-30 min peak: variable Duration: 3-6 hours

Special considerations: pregnancy C, vasodialating, inotropic effects, hypotension