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CRITICAL SETTINGS:
ICU, CCU, OT, Emergency
• Epinephrine
• Vasopressors
• Antiarrythmic- amiodarone, lidocaine.
• Other drugs- atropine, calcium, sodium
bicarbonate, thrombolytic Agents (STK, tPA)
Uses:
ventricular arrythmias resulting from MI, digitalis
toxicity, cardiac surgery or cardiac cathterization, general
anesthesia in susceptible patients.
Prof. Dr. RS Mehta, BPKIHS 14
Doses:
Arrythmia
– Dosing should be individualized.
– Treatment for ventricular arrhythmias begins with an
intravenous injection followed by an intravenous infusion
Pre-infusion:
– initially, 50-100 mg iv bolus given at rate of 25-50 mg/min. if
desired response doesn’t occur , give repeat dose at 25-50
mg/min; max dose is 300 mg given over hour
MECHANISM OF ACTION:
It produces dose dependent CNS depression by
activation of GABA receptors.
DOSES:
Induction of Anesthesia
• Adult: IV 2–2.5 mg/kg q10sec until induction onset
• Geriatric: IV 1–1.5 mg/kg q10sec until induction onset.
SIDE EFFECTS:
CNS= involuntary movement, headache, somnolence,
paresthesia, increased ICP, impaired cerebral flow, seizures.
CONTRAINDICATION:
hypersensitivity to the product or soyabean oil, egg, benzyl
alcohol.
NURSING CONSIDERATION:
Patient must be Intubated and ventilated
Monitor: HR, ECG, oxygen saturation, BP
Abrupt discontinuation of infusion may result in rapid
awakening with agitation, anxiety.
CONTRAINDICATION
hypersensitivity, pregnancy(D), breastfeeding, neonates, infants,
severe sinus node dysfunction, cardiogenic shock, bradycardia,
2nd and 3rd degree AV block.
PRECAUTION
children, goiter, hashimoto’s thyroiditis, respiratory disease.
SIDE EFFECTS:
CNS: intracranial hemorrhage.
EENT: epistaxis, gingival bleeding.
RESP: bronchospasm, hemoptysis.
CV: reperfusion arrhythmias, hypotension, recurrent
ischemia/ thromboembolism.
GI: GI bleeding, hepatotoxicity, nausea,
retroperitonial bleeding, vomiting.
CONTRAINDICATION:
active internal bleeding; history of cerebrovascular accident;
recent (within 2 mo) intracranial or intra-spinal injury or trauma;
Intracranial neoplasm, severe uncontrolled hypertension, known
bleeding tendencies; hypersensitivity.
Prof. Dr. RS Mehta, BPKIHS 41
PRECAUTION:
recent (within 10 days) major surgery, trauma, GI or GU
bleeding; severe hepatic or renal disease; recent
streptococcal infection or previous therapy with
anistreplase or streptokinase (within 5 days– 6 mo);
geriatric patients (75 yr; increased risk of intracranial
bleeding); pregnancy, lactation, or children (safety not
established).
Extreme Caution: patients receiving warfarin therapy;
early postpartum period.
Explain need for bed rest and minimal handling during therapy to
avoid injury. Avoid all unnecessary procedures such as shaving
and vigorous tooth brushing
MECHANISM OF ACTION:
Prevents neuromuscular transmission by blocking the
effect of acetylcholine at the myoneural junction.
Therapeutic Effects: Skeletal muscle paralysis.
PRECAUTION:
pregnancy(C), breastfeeding, geriatric or debilitated
patients,cardiac/neuromuscular/respiratory/renal/
hepatic disease, children<2 yrs, hyperkalemia,
myopathy, rhabdomyolysis.