Antidysrhythmic Medications Overview

Amiodarone

• Class III antidysrhythmic
• Prolongs the QRS duration and QT interval
• Inhibits automaticity
• Can be used for VF and pulseless VT, Wide complex tachycardia in stable patients
• Contraindications: Hypersensitivity, cardiogenic shock, long QT syndrome
• Precaution: Avoid breastfeeding, Caution with Hepatic disease due to long half-life
• Possible Side Effects: Hypotension, Bradycardia

Adenosine

• Antidysrhythmic, non-specific class
• A naturally occurring nucleoside
• Slows conduction through the AV node
• Can be used for Stable SVT/monomorphic wide complex tachycardia
• Contraindication: Hypersensitivity, atrial flutter or fibrillation, WPW
• Possible Side Effects: Headache, CP

Atropine

• Anticholinergic, toxicity antidotes
• Parasympathetic blocker
• Can be used for symptomatic bradycardia
• Contraindications: Hypersensitivity
• RELATIVE CONTRAINDICATIONS: Narrow-angle glaucoma, GI obstruction, severe ulcerative colitis, thyrotoxicosis
• Possible Side Effects: dilated pupils, tachycardia, dry mouth

Aspirin

• Antiplatelet agent, Non-steroidal anti-inflammatory drug (NSAID)
• Inhibits synthesis of prostaglandin
• Inhibits platelet aggregation
• Can be used for Acute coronary syndrome
• Contraindications: Hypersensitivity to NSAIDs, bleeding disorders, lactating mother, thrombocytopenia
• Possible Side Effects: GI bleeding

Calcium Chloride

• Antidotes, other; Electrolyte
• Essential for neurotransmission, muscle contraction, and many signal transduction pathways
• Can be used for Hyperkalemia/Calcium channel blocker and Beta blocker OD
• Contraindications: Hypercalcemia, Hypersensitivity, Hypokalemia
• Possible Side Effects: Tissue necrosis at injection site, Bradycardia, and Hypotension

Dopamine

• Inotropic agent; catecholamine; pressor
• Endogenous catecholamine
• Low dose stimulates mainly dopaminergic receptors, renal and mesenteric vasodilation
• Higher dose stimulates both beta-1-adrenergic and dopaminergic receptors
• Large dose stimulates alpha-adrenergic receptors
• Can be used for Cardiogenic/distributive shock
• Contraindications: Hypersensitivity, ventricular fibrillation, Tachyarrhythmias
• WARNING: Dopamine is a vesicant and can cause severe tissue damage if extravasation occurs
• Possible Side Effects: Nervousness, headache, arrhythmias, CP, dyspnea, N/V

Epinephrine

• Alpha/beta adrenergic agonist
• Strong alpha-adrenergic effects
• Strong beta-1 effects
• Moderate beta-2-adrenergic effect
• Can be used for ROSC, Cardiac arrest, Bradycardia/Hypotension
• Contraindications: Hypersensitivity
• Possible Side Effects: Palpations, tachycardia, hypertension, N/V, anxiety

Ketamine

• General anesthetics, systemic
• Produces dissociative anesthesia
• Blocks NMDA receptors
• Stimulates the sympathetic NS
• Can be used for Pain management
• Contraindications: Hypersensitivity
• WARNING: Overdose may lead to panic attacks and aggressive behavior
• Possible Side Effects: Tachycardia, Laryngospasm, hallucinations, increased intraocular pressure, and vomiting

Labetalol

• Beta-blockers, alpha activity
• Nonselective beta blocker
• alpha-blocker
• Can be used for Severe hypertension/pre-eclampsia
• Contraindications: Hypersensitivity, Bradycardia, Hypotension, myocardial damage, heart block, hypermagnesemia, hypercalcemia
• Possible Side Effects: Bradycardia, hypotension, CHF, bronchial asthma, AV blocks

Lidocaine

• Ib antiarrhythmic and local anesthetic agent
• Na+ channel blocker
• Can be used for Pulseless VT/VF, Dangerous PVC’s
• Contraindications: 2nd and 3rd degree AV blocks
• Possible side effects: Hypotension, bradycardia, >70 y/o, Hepatic disease

Magnesium Sulfate

• Electrolyte
• Demonstrates antiarrhythmic effects
• A nonselective calcium antagonist
• Can be used for Torsades de Point/refractory VF and pulseless VT
• Contraindications: Hypersensitivity
• Possible Side-effects: Hypotension, Bradycardia, Respiratory depression

Metoprolol

• Beta-blocker, beta-1 selective
• Blocks response to beta-adrenergic stimulation
• Can be used for Narrow complex tachycardias
• Contraindications: Hypersensitivity, Bradycardia, Hypotension, AV blocks, cardiogenic shock, sick sinus syndrome severe peripheral vascular disease
• WARNING: May cause 1st, 2nd, or 3rd degree AV block
• Possible Side Effects: Hypotension, bradycardia, bronchospasm, CP, N/V, CHF

Nitroglycerin

• Nitrates, anti-anginal
• Causes systemic vasodilation
• Can be used for Cardiac ischemia/MI/Acute pulmonary edema
• Contraindications: Hypersensitivity, Recent use of erectile dysfunction medications, Hypotension, bradycardia, and right ventricular infarction
• Possible Side Effects: Headache, Hypotension, syncope, tachycardia, flushing

Fentanyl

• Synthetic opioid, opioid analgesics (Schedule II) (Pregnancy category C)
• Narcotic agonist-analgesic
• Can be used for Acute pain
• Contraindications: Hypersensitivity
• WARNING: Should be used with caution in the elderly and in patients with hypotension, suspected gastrointestinal obstruction, head injury, and concomitant CNS depressants
• Possible Side Effects: Altered mental status, bradycardia, N/V

Morphine Sulfate

• Opioid analgesic
• Opioid agonist
• Can be used for Acute pain/Cardiac Ischemia/MI/CHF
• Contraindications: Hypersensitivity, respiratory depression, acute bronchial asthma, upper air, GI obstruction, head injuries/ICP, brain tumors, deliriums tremens
• Possible Side Effects: Respiratory depression, Hypotension, altered mental status, N/V, bradycardia

Ondansetron

• Antiemetic, selective 5-HT3 antagonist
• Selective 5-HT3 receptor antagonist
• May cause QT prolongation
• Can be used for Nausea/vomiting
• NOTE: EKG monitoring is recommended in patients who have electrolyte abnormalities, CHF, or bradyarrhythmia’s or who are also receiving other medications that cause QT prolongation
• Contraindications: Hypersensitivity, coadministration with morphine, Long QT syndrome
• Possible Side Effects: Headache, diarrhea, QT prolongation, fever

Promethazine

• Antiemetic
• Histamine H1, dopamine, muscarinic, and NMDA receptor antagonist
• Can be used for N/V
• Contraindications: Pt. on depressants, hypersensitivity
• Possible side-effects: Drowsiness, sedation, blurred vision, tachycardia, dizziness

Sodium Bicarbonate

• Antidote, other
• Increases blood and urinary pH
• Can be used for Metabolic acidosis/Hyperkalemia/tricyclic antidepressant (TCA) overdose
• Contraindications: Documented hypersensitivity, severe pulmonary edema, known alkalosis
• Possible Side Effects: Metabolic alkalosis, hypokalemia

Digoxin

• Has a positive inotropic and a negative chronotropic effect
• Intracellular Na+ and Ca++ increases in the myocardial cells
• Has a narrow therapeutic window
• Can be used for the treatment of mild to moderate heart failure, To maintain control ventricular rate in adult patients diagnosed with chronic atrial fibrillation
• Side effects: Toxicity can lead to N/V, visual changes, arrhythmias, and decreased renal function (causing electrolyte abnormalities)

Furosemide

• A loop diuretic
• Can reduce body potassium levels
• Can be used for Fluid overload with symptoms
• Precautions: Will only work if the patient can produce urine
• Side effects: Profound rapid diuresis, Hypotension