Cardiac Drugs

CARDIAC DRUGS - QUICK REFERENCE See also BP Medications

Adenosine (Adenocard) 6 mg IV bolus, may repeat at 12 mg IV bolus. for SVT, Narrow Complex Tachycardia or Wide Complex Tachycardia
(Ref: NEJM 12/1991;325:1621 Review) * Adverse effects: dyspnea, flushing, chest discomfort or pain. * Supply: 6mg/2mL vial * Duration: less than 1 minute.

Amrinone (Inocor) 0.75 mg/kg loading over 2-3 min, may repeat loading dose x1 30 min later prn, then 5-10 ug/kg/min. (Max: <10mg/kg/day)
* Adverse risks: thrombocytopenia, arrhythmia, hypotension
* Supply: 20 mL ampule of 5mg/mL

Atropine 0.5 - 1.0 mg IV * Adverse risks: increased myocardial O2 consumption with tachycardia, ventricular tachycardia or fibrillation * Supply: 1 mg/10 ml, 0.5 mg/5 ml

Bretylium (Bretylol) 250 - 500 mg or 5 mg/kg IV bolus, may repeat in 5 min at 10mg/kg, then 1 - 2 mg/min infusion * Adverse risks: N&V, postural hypotension, bradycardia, increased PVC, dizziness * Supply: 500 mg/10 ml; add 1 gm to 100-250 mL D5W (10-4 mg/mL conc.)

Cardizem (Diltiazem) IV bolus for rate control of atrial fib/flutter. * Start 0.25 mg/kg IVP over 2 min (ave pt= 20mg dose), after 15 min if inadequate response, 0.35 mg/kg (ave pt = 25 mg dose) over 2 min;
Infusion Rx start at 5 mg/h, range 10 - 15 mg/h. * Adversr risks: hypotension, arrhythmia, bradycardia, AV block, CHF, dizziness.
* Supply: 5-10 mL vial of 5 mg/mL

Dobutamine (Dobutrex) start 2 - 3 ug/kg/min, increase by 2 - 3 ug/kg/min q10 - 15min IV infusion, optimal maintenance doses : 7.5 - 20 ug/kg/min (Max: 40 ug/kg/min) * Adverse risks: tachycardia, dysrhythmias, headaches, anxiety, tremors, etc. * Supply: 250 mg/20 mL vial; add 250 mg in 250-500 mL D5W (1000-500 ug/mL conc.) * Duration: 10 - 12 min

Dopamine (Intropin) usually up to 20 ug/kg/min IV infusion; (Max 20-50 ug/kg/min) (1-2 ug/kg/min dopaminergic; 2-5 ug/kg/min inotropic; 5-20 ug/kg/min vasoconstriction Alpha1) * Adverse risks: tachyarrhythmia, GI upset, angina, excessive vasoconstriction. * Supply: 200 mg/5 mL; add 200 mg in/ 500 mL D5W = 400 ug/mL)

Epinephrine 0.5 - 1.0 mg IV * Adverse risks: tachyarrhythmia & increased myocardial O2 use. * Supply: 1 mg/1 ml of 1:1000, 1 mg/10 ml of 1:10,000

Isoproterenol (Isusprel) 2 - 20 ug/min IV (B agent effects: inotropic, chronotropic, vasodilatation, bronchodilatation)) * Usual dose 1 - 5 ug/min, up to 20 ug/min * Adverse risks: tachyarrhythmia, PVC & increased myocardial O2 use. * Supply: 1 mg/5 ml amp, may be added in 250-500 ml D5W = 4-2 ug/ml conc.

Lidocaine 50 - 100 mg or 1 - 1.5 mg/kg IV bolus, may repeat in 3-5min upto total 3mg/kg loading, then 1 - 4 mg/min infusion * Adverse risks: CNS & myocardial depression, seizure * Supply: 100 mg/10 ml (1%), 100 mg/5 ml (2%); add 1 gm in 250 mL D5W = 4 mg/mL conc.

Nitroglycerin (Tridil) IV infusion, start at 5 ug/min, then may increase at increment of 5 ug/min q3 - 5min till response seen. May give up to 80 - 160 ug/min if needed. * Adverse risks: hypotension * Supply: 1 amp=50mg/10ml added in 250 - 500 ml D5W

Nitroprusside (Nipride) IV infusion * Ave dose 3 ug/kg/min, range 0.5 - 8 ug/kg/min (Max=800 ug/min) * Adverse risks: hypotension, N&V, headache, dizziness, restlessness, muscle twitching; cyanide poisoning (check blood thiocyanate, >10mg/100ml is considered toxic, >20mg/100ml may be fatal.
* Supply: 1 amp=50 mg, added in 500 ml = 100 ug/ml.

Procainamide (Pronestyl) 200 - 1000 mg IV, usually start @ 20 mg/min till total of 1 g (17mg/kg) or hypotensive, or QRS >50% wider, or PVC suppressed; then maintenance dose 2 - 6 mg/min. * Adverse risks: hypotension, prolonged QRS & QT interval * Supply: 2 mL vial of 500mg/mL, 10 mL vial of 100 mg/mL; add 1 gm in 250 mL = 4 mg/mL

Propranolol (Inderal) usual dose 1 - 3 mg IV or at rate 0.5 - 1 mg/min to total dose of 0.15 - 0.2 mg/kg
* Adverse risks: bradycardia, AV block, hypotension, mental depression, bronchospasm, etc.
* Supply: 1mg/1mL ampule

Verapamil (Isoptin) 0.075 - 0.15 mg/kg IV (usually about 5 - 10 mg IVP)
* Adverse risks: bradycardia, AV block, hypotension, tachycardia, dizziness, etc.
* Supply: 5mg/2mL, 10mg/4mL vial

Thrombolytic agents:

Anistreplase (Eminase) 30 units IV over 2-5 min
* Adverse risks: arrhythmia/conduction disorders (38%), hypotension (10%), bleeding
* Supply: 30 units vial

Streptokinase (Kabikinase, Streptase) 1.5 million units IV over 60 min for acute MI;
For PE or DVT: 250,000 u IV over 30 min, followed by 100,000 u/hr infusion for 24-72 hr.
* Adverse risks: bleeding, fever & chills, rare anaphylactoid reaction
* Supply: 1.5 million u vial,250,000 u , 750,000 u vials.

tPA = alteplase (Activase) 60 mg first hour (6-10 mg IV bolus over 1-2 min, then the rest over the first hour by infusion, followed by 20 mg over the second hr by infusion, and 20 mg over the third hour. For PE: 100 mg infusion over 2 hours. * Adverse risks: bleeding, arrhythmias.
* Supply: 100mg. 50 mg, 20 mg vial

Anti-arrhythmic Agents:

Class IA: Quinidine, Procainamide, Norpace (Disopyramide)
- increase QRS & QT interval, decrease conduction velocity & automaticity, increse effective refractory period & action potential duration.

Class IB: Lidocaine, Phenytoin (Dilantin), Mexiletine (Mexitil), Tonocard (Tocainide), Moricizine (Ethmozine)
- phenytoin decreases QT interval, others may or may not; decrease conduction velocity & automaticity, may decrease effective refractory period & action potential duration.

Class IC: Flecainide (Tambocar), Propafenone (Rythmol), Encainide, Lorcainide
Flecainide 300 mg PO for PSVT or atrial fibrillation conversion; maintenance 100-200 mg bid PO
Propafenone (Rythmol) 150-300 mg bid PO
- increase QRS & QT & PR interval, decrease conduciton velocity & automaticity, increase effective refractory period, may increase action potential duration.

Class II: Beta blockers as Propranolol (Inderal), Sectral (acebutolol), Esmolol
- decrease QT interval, decrease conduction velocity & automaticity, increase effective refractive period.

Class III: Amiodarone (Cordarone) 200 mg, Sotalol (Betapace), Bretylium
Amiodarone 200 mg tab, start high loading dose of 800 mg for a few days, then 400 mg/d
Sotalol 80-160-240 mg tab. Start 80 mg bid, up to 160 mg bid PO
- increase QRS, QT, PR intervals, decrease conduction velocity & automaticity, increase effective refractory period & action potential duration.

Class IV: Calcium blockers as verapamil, diltiazem
- no change in QRS or QT interval, may or may not increase PR interval, no change in conductin velocity or automaticity, or effective refractory period, decrease action potential duration.

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