Term
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Definition
Therapeutic Classification
anti arrhythmic, vagolytic, parasympatholytic
MOA
decreases action of parasympathetic nervous system;
increases conduction velocity and heart rate;
enhances conduction through AV junction - blocks acetylcholine's effects on the SA and AV node, increasing the conduction velocity;
decreases the action of the parasympathetic nervous system on bronchial, salivary, and sweat glands, resulting in decreased secretions.
Indications
symptomatic bradycardia; bradyarrhythmias; asystole; organophosphate poisoning
Contraindications
none in asystole; tachycardia
Side effects
tachycardia; dry mouth; blurred vision; photophobia; dilated pupils; confusion, agitation; rebound bradycardia and palpitations following low doses
Dosage
Symptomatic bradycardia: 0.5 mg rapid IV push q 3-5 min to total of 0.04 mg/kg (total 3 mg) [use shorter dosage intervals (3 min) and higher doses in severe clinical conditions]
Asystole/PEA: 1.0 mg rapid IV push q 3-5 min to maximum of 3 mg. (ET administration: 2-3 mg diluted in 10 ml)
Organophosphate poisoning: 2-4 mg IV push q 15 min. |
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Term
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Definition
Therapeutic Classification
anti hypertensive
MOA
reduces sympathetic outflow from vasopressor sites in the brain
Indications
hypertension
Contraindications
hypotension
Side Effects
dry mouth; sedation
Dosage
OEMS: 0.1 mg PO q 10-15 min |
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Term
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Definition
Therapeutic Classification
inotropic agent
MOA
stimulates alpha and beta receptors; increases cardiac contractility and stroke volume; causes little, if any, increase in heart rate
Indications
cardiogenic shock (short term management); CHF with BP < 100 mmHg (short term management)
Contraindications
hypovolemic shock; atrial fibrillation; bradycardia; suspected or known poison/drug-induced shock
Side Effects
tachycardia with increased risk of myocardial ischemia or infarction; hypertension; chest pain/palpitations; nausea/vomiting
Dosage
FOR IV INFUSION ONLY
2-20 mcg/kg/min titrated to increase heart rate no more than 10% above baseline
500 mg in 500 ml NS or LR |
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Term
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Definition
Therapeutic Classification
inotropic agent; vasopressor
MOA
stimulated beta-1 and alpha and dopamine receptors; effects are dose dependent
Indications
cardiogenic shock or bradycardia; hemodynamically significant hypotension in the absence of hypovolemia
Contraindications
hypovolemic shock; pheochromocytoma [a tumor of the sympatho-adrenal system that produces catecholamines (epi and norepi) and causes hypertension]
Side Effects
tachycardia with increased risk of myocardial ischemia or infarction; hypertension; tissue necrosis following infiltration; nausea/vomiting; headache
Dosage
FOR IV INFUSION ONLY
ACLS and OEMS: 2-20 mcg/kg/min
Titrate to BP of 90 mmHg or per local protocol |
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Term
epinephrine
Bronkaid Mist, Primatine Mist, EpiPen, Adrenalin |
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Definition
Therapeutic Classification
bronchodilator; vasodilator; nasal decongestant
MOA
stimulates alpha and beta receptors; rapid onset with short duration of action
Indications and Dosage
Cardiac Arrest
1 mg (1:10,000) IV push q 3-5 min (ETT: 2-2.5 mg)
Bronchospasm/developing anaphylaxis
0.3-0.5 mg of (1:1,000) SQ
Anaphylaxis (with severe profound hypotension)
0.5 mg (1:10,000) IV push over 5-10 min
Profound Bradycardia (can be considered after atropine as an alternative infusion to dopamine)
2-10 mcg/min (mix 1 mg of 1:1,000 to 500 ml NS or D5W)
Contraindications
NONE in cardiac arrest; hypovolemic shock; hypertension; hyperthyroid disease
Side Effects
tachycardia; hypertension; angina and/or myocardial infarction; tremors/palpitations |
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Term
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Definition
Therapeutic Classification
bronchodilator; cardiac stimulant
MOA
stimulates beta receptors; action on beta-1 adrenergic receptors increases cardiac output; relaxes broncial smooth muscles
Indications
symptomatic bradycardia (not drug of choice) refractory to atropine; refractory torsades unresponsive to MgSO; poisoning from beta blockers; temporary control of bradycardia in heart transplant pts (denervated hearts unresponsive to atropine)
Contraindications
ischemic heart disease; in the setting of an acute MI
Side Effects
increased myocardial oxygen demand (may increase ischemia in MI patient); significant dysrhythmias; headache; hypertension; nausea/vomiting
Dosage
FOR IV INFUSION ONLY
2-10mcg/min titrated to adequate heart rate
2 mg in 500 ml NS, LR
OEMS: Per specific protocol |
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Term
labetalol
Transdate, Normodyne |
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Definition
Therapeutic Classification
antihypertensive
MOA
blocks beta-1 and beta-2 receptors; inhibits peripheral vasoconstriction, promotes vasodilation; decreases cardiac output, thereby reducing blood pressure
Indications
hypertensives emergencies
Contraindications
severe bronchospasm; bronchial asthma; bradycardia, second or third degree block; hypotension; cardiogenic shock; CHF; pregnancy
Side Effects
bronchoconstriction; bradycardia; hypotension; pulmonary edema; bronchospasm; blurred vision
Dosage
20 mg slow IV push (over 2 minutes)
can be repeated at 10 min intervals at doses of 20-40 mg to a maximum total dose of 300 mg
2 mg/min IV drip |
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Term
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Definition
Therapeutic Classification
antihypertensive
MOA
blocks beta-1 receptors (adrenergic receptors); reduces the influence of the sympathetic nervous system
Indications
hypertension; angina following MI
Contraindications
hypotension; bradycardia, second and third degree heart blocks; cardiogenic shock
Side Effects
hypotension; bradycardia; pulmonary edema; CHF; bronchospasm
Dosage
5 mg SLOW IV push (over 5 min)
repeat q 2-3 min to a total of 15 mg |
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Term
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Definition
Therapeutic Classification
vasopressor
MOA
directly stimulates alpha adrenergic receptors which causes peripheral vasoconstriction
Indications
acute hypotensive states; severe cardiogenic shock and hemodynamically significant hypotension (SBP<70 mm Hg); agent of last resort for management of ischemic heart disease and shock
Contraindications
hypotension due to hypovolemia; severe hypoxia
Side Effects
headache; dizziness; bradycardia; arrhythmias; necrosis at the IV site if infiltration
Dosage
ACLS: 0.5-1.0 mcg/min titrate to improve BP (4 mg in 250 ml D5W0
OEMS: 2-12 mcg/kg/min |
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Term
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Definition
Therapeutic Classification
antihypertensive; antiarrhythmic; antianginal
MOA
blocks beta-1 and beta-2 receptors; blocks adrenergic receptors
Indications
refractory supraventricular arrhythmias;
ventricular tachycardia refractory to other medications
rapid atrial fibrillation and atrial flutter
angina and myocardial ischemia;
reduce mortality in post-MI patients;
hypertension
Contraindications
severe bronchospasm; bradycardia, second or third degree block; hypotension; CHF; COPD
Side Effects
bronchoconstriction; bradycardia; hypotension
Dosage
1 mg slow IV push (over 1 minute) q 5 min until desired effect or total of 5 mg. |
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