Nursing 228 Complex Adult Nursing

Treatment of Common Dysrhythmias: Drug Assignment

Directions: Please complete this worksheet prior to coming to the Cardiac Dysrhythmia lecture

Drug / Used In / Action / Administration (route, rate) / Precautions
Atropine / ·  Symptomatic Bradycardia
·  Asystole / Increases heart rate by inhibiting action of vagus nerve, decreased GI and respiratory secretions / 0.5-1mg IVP every 3-5 minutes
ET Tube (ETT) / ·  Not effective for AV blocks, avoid use in patients with narrow-angle glaucoma
·  Side effects: drowsiness, confusion, blurred vision, tachycardia, dry mouth urinary retention
·  Continuous cardiac and B/P monitoring
Adenosine (Adenocard) / supraventricular tachycardia (PSVT)
(does not convert atrial flutter or fibrillation) / slows conduction time through the AV node, produces coronary artery vasodilation / Given by rapid (1-3 seconds) IV push near hub of IV followed by 20 mg NS flush. Half-life is < 5 seconds / ·  causes asystole after injection
·  patients with asthma (may cause bronchospasm)
·  Contraindicated in 2nd & 3rd degree heart block
Amiodarone / ·  Ventricular fib,
·  pulseless V tach
·  rate control of Atrial fib / slows sinus rate, increases PR and QT intervals, vasodilation / 300 mg IVP for cardiac arrest; can be used orally to suppress dysrhythmias / ·  use filtered needle
·  dilute in D5W
·  Adverse effects: Hypotension and bradycardia
Ditiazem (Cardizem) / SVT, PSVT, slow ventricular response in atrial fibrillation and atrial flutter / ·  Blocks influx of calcium and sodium into the cell
·  Slows conduction prolongs AV node refracteriness
·  Systemic vasodilation causing ↓BP / Initial bolus 0.25 mg/kg (max 25 mg). Give over 2 minutes
IV drip rate at 5-15 mg/hr / ·  Hypotension, bradycardia, AV block, asystole, headache, vasodilation, heart failure.
·  Grapefruit juice increases serum levels & effects
·  Elevates digoxin levels
Drug / Used In / Action / Administration (route, rate) / Precautions
Digoxin / Control of ventricular rate in supraventricular tachydysrhythmia
(primary use is in heart failure) / Decrese conduction through AV node and decrease automaticity in SA node / PO 1-1.5 mg in 3-4 doses over 24 hrs. maintenance: 0.125 -0.5 mg daily / ·  Quinidine can double digoxin levels
·  Monitor for digoxin toxicity
Epinephrine / cardiac arrest, V fib, pulseless V tach, asystole, PEA, anaphylactic reactions / maintenance of heart rate and blood pressure, bronchodilation / 1 mg of the 1:10,000 solution given every 3-5 minutes (flush after giving)
ETT route / ·  Extravasation – use phentolamine
·  May cause hyperglycemia in diabetics
·  May cause anginal pain, tachycardia, dysrhythmias
Lidocaine / Ventricular tachycardia, ventricular fibrillation, suppression of ectopy (PVC’s) / Blocks cardiac sodium channels (slows conduction through atria, reduces automaticity in ventricles, accelerates repolarization / bolus 1/1.5 mg/kg, Maintanence drip – 1-4 mg/min
ETT route / ·  Excessive doses can cause neurological changes, myocardial depression, and circulatory depression
·  Toxicity - drowsiness, disorientation, decreases hearing, parasthesia, muscle twitching, agitation, seizures
Can cause – heart block, SA node dysfunction, AV node conduction disorders (junctional rhythms)
Magnesium Sulfate / Magnesium deficiency
life threatening arrhythmias / Magnesium replacement / 1-2 gm over 1-2 hours / Mag. Deficiency can cause sudden cardiac death, dysrhythmias, and decrease left ventricular function
Drug / Used in: / Action / Administration (route, rate) / Precautions
Dobutamine / Heart failure, pulmonary edema, low cardiac output, hypotension with pulmonary congestion / increased cardiac output and decreased peripheral vasodilation / 2 – 20 mcg/kg/min / PVC’s, hypotension, phlebitis, thrombocytopenia, tachycardia
Dopamine / Symptomatic bradycaria (after atropine), symptomatic hypotension that is not a result of hypovolemia, shock, renal failure / ·  Low dose dopamine (1-2 mcg/kg/min) produces cerebral, renal, and mesenteric vasodilation
Increase in urinary output without significant change to heart rate or blood pressure
·  2-10 mcg/kg/min – vasoconstriction of renal, mesenteric, and peripheral circulation / 2 – 10 mcg/kg/min dependent upon action desired / ·  ↑ HR, BP, Ectopy, Myocardial oxygen consumption, N/V, phlebitis, extravisation
Narcan / to reverse respiratory depression resulting from narcotic administration / Opiate antagonist / 0.4 – 2 mg IV given over 1-2 minutes / ·  if given too rapidly can induce projectile vomiting
·  has a shorter half-life than most narcotics; can have a recurrence of depressed respirations (may have to repeat the dose)
·  if given to person who is physically dependent on opioids, causes an immediate withdrawal reaction

See Table 27-1 on page 690 of Brunner & Suddarth for a summary of antiarrhythmic medications; Keys & Hayes, Chapter 57

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