Paramedicine 2 Drugs: Cardiology

Acetylsalicylic Acid

Aspirin

Aspirin Class

Analgesic, anti-platelet , anti-inflammatory

Aspirin MOA

Aspirin is an NSAID that inhibits COX-1 and COX-2 enzymes. By blocking these enzymes, it reduces the formation of prostaglandins and thromboxane, molecules that mediate inflammation, pain, and blood clotting. Aspirin decreases platelet aggregation to help prevent and/or treat heart attacks.

Aspirin Onset

15-30 minutes

Aspirin Duration

4-6 hours

Aspirin Monitoring

Pulse, SPO2, BP

Aspirin Indications

ACS Symptoms

Aspirin Contraindications

(C) Gastrointestinal bleeding

(C) Hemorrhagic stroke

(C) Bleeding disorders

Aspirin dose

Adults: 4 tabs of 81mg each (324mg)

*NO PEDS

Adenosine

Adenocard

Adenosine drug class

Antiarrhythmic

Adenosine MOA

Adenosine works by binding to adenosine receptors in the heart, especially the A1 receptor in the AV node, which slows conduction and prolongs refractory periods. This interrupts reentrant arrhythmias, especially in cases of supraventricular tachycardia (SVT), and helps restore normal rhythm

Adenosine Onset

immediate

Adenosine Duration

10 seconds

Adenosine Monitoring

Pulse, SPO2, BP, EKG 4 lead, EKG 12 lead

Adenosine Indications

(I) Stable narrow-complex supraventricular tachycardia

Adenosine Contraindications

(C) Heart blocks, Wide complex tachycardia of unknown origin, Wolff-Parkinson White Syndrome with atrial fibrillation

Adenosine Adverse Reactions

(AR) Light-headedness

(AR) Headache

(AR) Diaphoresis

(AR) Palpitations

(AR) Chest pain

(AR) Hypotension

(AR) Shortness of breath

(AR) Transient periods of sinus bradycardia, sinus pause, or bradyasystole

(AR) Nausea

Adenosine Dose

(Adult)

Symptomatic stable SVT

6 mg rapid push followed by 12 mg rapid push if ineffective

Adenosine Dose Peds

Initial dose 0.1 mg/kg rapid push followed by 0.2 mg/kg rapid IV/IO push if ineffective

Steps to administering Adenosine

- Adenosine should be administered to stable narrow-complex supraventricular tachycardia of rates above 150 bpm with cardiac etiology

- Select an IV site close to the heart such as the left AC is preferable

- Select a large gauge IV preferably 20 or larger

- Defibrillation pads should be applied • Advise the patient of the side effects

- Push the print button on the monitor

- Rapidly administer Adenosine

- Rapid flush with 20 mL of normal saline or continuous normal saline infusion with pressure

Amiodarone

Cordarone

Amiodarone's Drug Class

Class III antidysrhythmic

Amiodarone MOA

Amiodarone is a class III antiarrhythmic agent that blocks potassium, sodium, and calcium channels, prolonging repolarization and the refractory period in cardiac cells. This action stabilizes the cardiac rhythm and prevents arrhythmias by decreasing automaticity, and decreasing AV conduction.

Amiodarone Onset

1-2 minutes

Amiodarone Duration

30-45 minutes

Amiodarone monitoring

Pulse, SPO2, BP, EKG 4 lead, EKG 12 lead

Amiodarone Indications

(I) Stable pulsatile atrial and ventricular dysrhythmias

(I) Cardiac arrest with a ventricular dysrhythmia

(I) Prophylaxis of recurring ventricular dysrhythmias or arrhythmias

Amiodarone Adverse Reactions

(AR) Hypotension

(AR) Dizziness

(AR) Bradycardia

(AR) Atrioventricular conduction abnormalities

Amiodarone Dose (Adult) for Cardiac Arrest v-fib/v-tach

300 mg IV/IO push followed by 150 mg IV/IO push following ACLS time frames

Amiodarone Dose (Adult) for Stable pulsatile atrial / ventricular dysrhythmias OR prophylaxis of recurring ventricular dysrhythmias

150 mg over 10 minutes IV drip

Amiodarone Dose (Peds) for Cardiac Arrest v-fib/v-tach

5 mg/kg IV (max 300 mg) push following PALS time frames. may repeat x2 (max of 150 mg)

Amiodarone Dose (Peds) for Stable pulsatile atrial / ventricular dysrhythmias OR prophylaxis of recurring ventricular dysrhythmias

5 mg/kg over 20 minutes IV drip

Atropine Sulfate Drug class

Anticholinergic

Atropine Sulfate MOA

Atropine is an anticholinergic drug that blocks the action of acetylcholine on muscarinic receptors in the heart and other tissues. In the heart, it blocks vagal (parasympathetic) activity, leading to an increase in heart rate (chronotropy)

Atropine Onset

1-2 minutes

Atropine Duration

2-6 hours

Atropine Monitoring

Pulse, SPO2, BP, EKG 4 lead, EKG 12 lead

Notes: May not be effective in 2nd or 3rd degree heart blocks.

Atropine Indications

Symptomatic stable bradycardia

Atropine Contraindications

(C) Myasthenia gravis

Atropine Adverse Reactions

(AR) Tachycardia

(AR) Paradoxical bradycardia when pushed too slowly

(AR) Palpitations

(AR) Dysrhythmias

(AR) Headache

(AR) Anticholinergic effects

(AR) Nausea/vomiting

Atropine Dose (Adults) for Symptomatic Stable Bradycardia

1 mg IV every 3 minutes (max of 3 mg)

Atropine Dose (Peds) for Symptomatic Stable Bradycardia

0.02 mg/kg (min of 0.1 mg) IV

Calcium Chloride Drug Class

electrolyte

Calcium Chloride MOA

Calcium chloride provides an immediate source of calcium, which is essential for muscle contraction, nerve function, and blood clotting. It helps stabilize cardiac cell membranes, particularly during hyperkalemia, and restores normal cardiac electrical activity by increasing myocardial contractility.

Calcium Chloride Onset

Rapid

Calcium Chloride Duration

30-60 minutes

Calcium Chloride Monitoring

Pulse, SPO2, BP, EKG 4 lead, EKG 12 lead

Notes: A minimum of 50 mL of normal saline should be given between the bolus of calcium chloride and the bolus of sodium bicarbonate

Calcium Chloride Indications

(I) Hyperkalemia

Calcium Chloride Adverse Reactions

(AR) Bradycardia

(AR) Hypotension

Calcium Chloride Dose (Adults)

1 gram Iv push

Diltiazem

Cardizem

Cardizem (diltiazem) Class

calcium channel blocker

Cardizem (diltiazem) MOA

Diltiazem is a calcium channel blocker that inhibits the entry of calcium into cells, particularly in the heart and vascular smooth muscle. By decreasing calcium influx, it reduces myocardial contractility and slows conduction through the AV node.

Cardizem (diltiazem) Onset

2-5 minutes

Cardizem (diltiazem) Duration

1-3 hours

Cardizem (diltiazem) Monitoring

Pulse, SPO2, BP, EKG 4 lead, EKG 12 lead

Notes: Must be administered over 2 minutes

Cardizem (diltiazem) Indications

(I) Stable narrow-complex SVT or atrial fibrillation with RVR

Cardizem (diltiazem) contraindications

(C/AR) Hypotension

Cardizem (diltiazem) Adverse reactions

(AR) Bradycardia

(AR) Chest pain

(AR) Nausea/vomiting

(AR) Dizziness

Cardizem (diltiazem) Dose Adults

Symptomatic stable atrial fibrillation with RVR 0.25 mg/kg IV over 2 minutes (max of 25 mg)

If ineffective: 0.35 mg/kg IV over 2 minutes (max of 35 mg)

Epinephrine

Adrenaline

Epinephrine Class

Sympathomimetic

Epinephrine MOA

Epinephrine acts on both alpha and beta adrenergic receptors. It stimulates alpha-1 receptors on blood vessels, causing vasoconstriction and increasing blood pressure. It also stimulates beta-1 receptors in the heart, increasing heart rate and contractility. Beta-2 receptors in the lungs are also activated, leading to bronchodilation

Epinephrine Onset

1-2 minutes

Epinephrine Duration

5-10 minutes

Epinephrine Monitoring

Pulse, SPO2, BP, EKG 4 lead, EKG 12 lead

Epinephrine Indications/Positives

• (I) Severe respiratory distress with low tidal volume

(I) Pediatric stridor (croup, epiglottitis)

(I) Cardiac arrest

(I) Symptomatic bradycardia

(I) Hypotension/Hypoperfusion

(P) Tachycardia

(P) Hypertension

(P) Increased ventricular contractility

(P) Bronchodilation

Epinephrine Adverse Reactions

(AR) Tachycardia

(AR) Hypertension

(AR) Tremors

(AR) Dyspnea

(AR) Headache

(AR) Nausea and vomiting

(AR) Dysrhythmias

Epinephrine Concentrations

1:1 or 1:1,000

1:10 or 1:10,000

Epinephrine Indications and doses (Adults) 1:1,000

1:1,000

Severe Respiratory Distress / Status Asthmaticus

0.3 mg IM

Epinephrine Indications and doses (Adults) 1:10,000

1:10,000

Cardiac Arrest

1 mg IV q 3-5 minutes

Epinephrine Indications and doses (Peds) 1:1,000

1:1,000

Severe Respiratory Distress / Status Asthmaticus

0.01 mg/kg IM

Pediatric stridor (croup, epiglottitis)

3 mg of 1:1,000 nebulized

Epinephrine Indications and doses (Peds) 1:10,000

1:10,000

Cardiac Arrest

0.01 mg/kg IV q 3-5 minutes

Bradycardia (including neonate/newborn bradycardia) • 0.01 mg/kg IV q 3-5 minutes

Lidocaine

Xylocaine

Lidocaine Class

Antidysrhythmic (Class IB), local anesthetic

Lidocaine MOA

Blocks fast voltage-gated sodium channels in cardiac myocytes, shortening the action potential duration and refractory period. This suppresses automaticity in ventricular ectopic foci and slows conduction, making it useful in treating ventricular arrhythmias (e.g., V tach, V-fib). Local Anesthetic Effects: Blocks sodium channels in nerve cells, preventing depolarization and transmission of pain signals.

Lidocaine Onset

1-2 minutes

Lidocaine Duration

10-20 minutes

Lidocaine Monitoring

Pulse, SPO2, BP, EKG 4 lead, EKG 12 lead

Lidocaine Indications

(I) Stable pulsatile ventricular dysrhythmias

(I) Cardiac arrest with a ventricular dysrhythmia (I) Prophylaxis of recurring ventricular dysrhythmias

(I) Anesthetic following conscious IO

Lidocaine Contraindications

(C) WPW

(C) AV block

Lidocaine adverse reactions

(AR) Seizure

(AR) Hypotension

(AR) Bradycardia

(AR) Dysrhythmias

Adult Conscious IO Lidocaine dose

40 mg slow IO push

Adult Vfib/vtach Cardiac arrest lidocaine dose

1.5 mg/kg IV push

Adult pulsatile v-tach lidocaine dose

1.5 mg/kg IV drip over 10 minutes

Pediatric conscious IO lidocaine dose

1 mg/kg up to max of 40 mg slow IO push

Pediatric vfib/vtach cardiac arrest lidocaine dose

1 mg/kg IV push

Pediatric pulsatile vtach lidocaine dose

1 mg/kg IV drip over 20 minutes

Magnesium Sulfate Class

Electrolyte, tocolytic

Magnesium MOA

Magnesium sulfate acts as a calcium antagonist, reducing the influx of calcium into cells, especially smooth muscle cells. This leads to muscle relaxation and vasodilation. In the case of asthma, it reduces bronchospasm, and in preeclampsia, it helps prevent seizures by stabilizing neuronal membranes.

Magnesium onset

1 minute

Magnesium Duration

30 minutes

Magnesium Monitoring

Pulse, SPO2, BP, EKG 4 lead, EKG 12 lead

Magnesium Indications

(I) Status asthmaticus/COPD non responsive to beta adrenergic drugs

(I) Cardiac arrest only if torsades de pointes is suspected

Magnesium Contraindications

(C) Bradycardia/heart block

(C) Hypotension

Magnesium adverse reactions

(AR) Bradycardia

(AR) Respiratory depression

(AR) Nausea and vomiting

Magnesium Adult status asthmaticus dose

2 Grams over 10 minutes

Magnesium Adult cardiac arrest torsades dose

•2 Grams IV/IO push

Magnesium Pediatric Dose: Status Asthmaticus

50mg/kg over 10 minutes