Tachycardia. Barbara Furry RNC, MS, CCRN. Class code: 670

Transcription

1 Barbara Furry RNC, MS, CCRN Class code: 670 Tachycardia Drugs to Tx SVT s Adenosine Diltiazem Verapamil Metoprolol, Atenolol, Esmolol, Propranolol Amiodarone Digoxin Procainamide Drugs to Tx Ventricular Arrhythmias Procainamide Amiodarone Sotolol Lidocaine Magnesium

2 Adenosine Briefly depresses sinus node rate and slows conduction time through AV node. Adenosine Stable, narrow complex, regular tachycardias Unstable narrow complex regular tachycardias while preparing for cardioversion Does not convert atrial fibrillation, atrial flutter, or VT Stable, regular, monophoric, wide complex tachycardia as a therapeutic and diagnostic maneuver New dosing: 6mg and then if needed 12mg. No third dose. Adenosine Contraindications/Precautions Contraindicated in asthma Transient side effects; flushing, CP, asystole, bradycardias Patients taking dipyridamole or carbamazepine, post cardiac transplant and when given via a central vein reduce dose

3 Diltiazem Slows AV conduction, vasodilates, negative inotrope Diltiazem Controlling ventricular rate in a fib or flutter Contraindications/Precautions Do not use with wide complex rhythms Only given to patients with narrow complex tachycardias regular or irregular Avoid in patients with heart failure and pre excited AF or flutter or rhythms consistent with VT Metoprolol : Reduce effects of circulating catecholamines, reduce HR, AV node conduction, BP, and acts as a negative inotrope Stable, narrow complex tachycardias if rhythm remains uncontrolled

4 Metoprolol Contraindications/Precautions Hemodynamically unstable patients should not receive Decompensated heart failure Asthma Obstructive airway disease Procainamide Sodium and potassium channel blocker Pre excited atrial fibrillation Precautions Bradycardias, hypotension, torsades de points. Avoid in patients with QT prolongation Sotolol Potassium channel blocker and nonselective beta blocker Indication Hemodynamically stable monomorphic VT Precautions Avoid in patients with QT prolongation, can cause bradycardia, hypotension, torsades de pointes Dosing 1.5mg/kg infused over 5 minutes

5

6 Amiodarone Multichannel blocker (sodium, potassium, calcium and noncompetitive alpha & beta blocker) Pulseless VT or VF, atrial fibrillation, stable, narrow, regular tachycardias, control rate in accessory pathways conduction Precautions Hypotension Lidocaine Second line antiarrhythmic for monomorphic VT Antiarrhythmics Class I Sodium Channel Blockers: Procainamide, Lidocaine, Flecainide Class II Beta Blockers Class III K Channel Blockers: Amiodarone, Sotalol, Ibutilide. Class IV Calcium Channel Blockers: Non Dihydropyridines. Others Adenosine, Digoxin, Magnesium Sulfate

7 Vasopressin Because the effects of vasopressin have not been shown to differ from those of epinephrine in cardiac arrest, 1 dose of 40 units IV/IO may replace either the first or second dose of epinephrine Bradycardia Atropine Dopamine infusion Epinephrine infusion

8 Atropine First drug for acute, symptomatic bradycardia Precautions Use with caution in ACS Not effective in patients with a heart transplant because transplanted heart lacks vagal innervation Doses < 0.5 mg may cause a paradoxical slowing Dopamine A catecholamine with both alpha and beta adrenergic actions Begin infusion at 2 10 mcg/kg/min Epinephrine A catecholamine with alpha and beta adrenergic actions Begin infusion at 2 10 mcg/min With both Dopamine and Epinephrine infusions, be sure and assess the patients volume status!