HIGH ALERT CARDIAC DRUGS

ADRENALINE
(EPINEPHRINE)
(1:1000)

NORADRENALINE
(NOREPINEPHRINE)
LEVOPHED
INJ 4mg/4ml

ADENOSINE
ADENOCOR
INJ 6mg/2ml

1=2>
1-adrenergic receptor -> SV
(inotropic),HR(chronotropic) ->CO
2-adrenergic receptor ->
bronchodilation, (small dose)vasodilation ->
BP,renal resistance
-adrenergic receptor -> (high
dose)vasoconstriction -> BP

1>>2
1-adrenergic receptor -> SV
(inotropic),HR(chronotropic) ->CO
-adrenergic receptor ->
vasoconstriction -> BP

adenosine receptor -> K channel,

Ca channel(calcium influx)
AVN,SA node (AV>SA)
vasodilation
bronchospasm

Pulseless arrest (VT/VF,asystole,PEA)

IV/IO 1mg( 1:10,000) every 3-5min
Intratracheal 2-2.5mg dilute 5-10ml NSS or distilled water
Bronchodilator
SQ 0.3-0.5mg(1:1000) every 20min for 3 doses
Hypersensitivity reaction
SQ/IM 0.3-0.5mg(1:1000) every15-20min

IV 0.1mg(1:10,000) over 5min or infuse 1-4mcg/min

Hypotension/shock
Continuous I.V. infusion

0.5-1 mcg/min titrate dose 8-30 mcg/min

Note: 4 mg in 500 mL D5W
4 mcg/min = 30 mL/hour
**D5W or D5NS NSS,alkaline
solution
** NaHCO3IV

PSVT
IV 6mg over 1-2sec via peripheral lineflushNSS

1-2min repeat 12mg X2

Note: central line
second or third degree AV block

By Doctor Heart . http://www.thaiheartclinic.com

/
angina
HR
cardiac arrhythmia, tachycardia
BP
sudden death
ECG monitoring

Urine output
pulmonary edema

renal failure

,

(skin necrosis)
extravasation
Note:

-extravasation infiltrate
phentolamine5-10mgin10-15ml NSS
peripheral(digital)ischemia

HR
BP
ECG monitoring

HR
BP
ECG monitoring

second or third
degree AV block
prolonged sinus pause
sick sinus syndrome
AF,atrial flutter,
VT/VF/torsarde de pointes(<1%)
(bronchospasm)
asthma, COPD
, ,

DOPAMINE
DOPAMEX
INJ 250mg/10ml
Pre-mix 0.8:1,1.6:1

Dose dependent
Low dose(1-3mcg/kg/min) ->
dopaminergic receptor -> renal and
mesenteric vasodilation -> RBF
Intermediate dose(3-10 mcg/kg/min) ->
dopaminergic 1-adrenergic
receptor -> cardiac contractility, HR,CO
RBF
High dose(>10mcg/kg/min) -> adrenergic receptor ->peripheral
vasoconstriction ->BP

- 3-20mcg/kg/min
IVinfusion pump
IV phlebitis

1-adrenergic receptor ->

contractility, HR -> CO
2 -receptor

HR
BP
ECG monitoring
Urine output

pheochromocytoma,
hyperthyroidism
aortic stenosis
CHF,LV dysfunction
2.5-10mcg/kg/min max 40mcg/kg/min
IVinfusion pump

IV phlebitis

severe tissue necrosis

sodium bicarbonate, alkaline solution

ATROPINE
INJ 0.6mg/1ml

Anticholinergic effect competitive

antagonist muscarinic acetylcholine
receptors
parasympathetic(postganglionic cholinergic
nerve) smooth muscle,secretory glands,
CNS-> HR, secretions

idiopathic hypertrophic subaortic

stenosis (IHSS)
Asystole/ slow PEA
1mg IV 3-5 min 3 doses
Intratracheal 2-2.5mg dilute 10ml NSS or distilled water
Bradycardia
0.5-1mg 3-5min total dose 3mg
IV push

HR
BP
ECG monitoring
Uricne output

hypovolemia

sodium bicarbonate, alkaline solution

hypovolemia

severe tissue necrosis

DOBUTAMINE
DOBUTREX
INJ 250mg/20ml

Renal protection
1-3mcg/kg/min
Hypotension

HR
BP
ECG monitoring

Cardiac arrhythmia ectopic

beats
Tachycardia esp. VT/VF
Bradycardia conduction
abnormalities
Hypotension
hypovolemia
Hypertension
Anginal pain
gangrene
Peripheral artery disease
Azotemia dose
Cutaneous necrosis leakage
Cardiac arrhythmia
ventricular ectopic beats
Tachycardia
Hypotension
hypovolemia
Hypertension
Anginal pain
Cutaneous necrosis leakage

Cardiac arrhythmia
Tachycardia
Hypotension
Alteration of consciousness
coma,delirium


Urinary retention

NITROGLYCERIN
Nitroject 50mg/10ml

Relaxation of smooth muscle

vasodilation veins, arteries (
veins ) -> preload, sl.afterload,
dilate coronary arteries

SODIUM
NITROPRUSSIDE
INJ 50mg/2ml

Peripheral vasodilation veins

arterioles -> BP,CO
afterload

AMIODARONE
Cordarone
Tablet 200mg
INJ 150mg/3ml

Class III antiarrhythmic agent(block

repolarizing K current or phase III action
potential -> sinus node function,AV
conduction, prolong AP, refractory period
Block -adrenergic receptor ->
BP,

Angina pectoris esp. ACS, CHF, hypertensive

emergencies
IV 5-200mcg/min
IV infusion
volume depletion RV infarction
hypotension preload
angina hypertrophic obstructive
cardiomyopathy LV outflow obstruction

cardiac tamponade,
constrictive pericarditis,severe mitral stenosis
venous return
Hypertensive crises, heart failure, dissecting aortic
aneurysm
IV 0.5-10mcg/kg/min
IV infusion
heart failure
rebound hypertension
maximum dose 10min
cyanide toxicity
Ventricular arrhythmias, Supraventricular arrhy.
AF,atrial flutter,WPW arrhythmias
pulseless VT/VF 300mg dilute 20ml D5W IV,IO
push 150mg IV push in 3-5min
life-threatening/intractable arrhythmias 150mg IV
10min(repeat 150mg IV 10min) 360mg
6hr 540mg 18hr
cumulative dose 2.2g24hr
prolonged QT interval
BP

HR
BP

HR
BP
ACID-BASE

acidosis

cyanide toxicity

HR
BP
ECG monitoring
Electrolyte esp.
potassium,
magnesium

Hypotension rebound
hypertension()
Tachycardia

Cyanosis
methemoglobinemia
prolonged high dosage(nitrate ion
oxidize hemoglobin
methemoglobin)

Hypotension
Cyanide toxicity(acidosis,tachycardia,
conscious change, convulsion,
almond breath)

Bradycardia/AV block/ sinus node

dysfunction
VT, torsades de pointes

Prolonged QT
CHF( 3%)
Hypothyroidism
Hypotension IV( 16%)
Phlebitis IV conc.>3mg/ml