Ib |
Net effect: Depress conduction with NO change in or shortened APD (repolarization)MOA: Weakly blocks fastNa+ channels: ↓ membrane responsiveness; may shorten APD & end resting membrane potential (ERP) by ↑ K+ conductance |
Lidocaine |
Approved: VF, VT |
1–1.5 mg/kg IV/IO x1; 0.5–0.75 mg/kg IV repeat in 3–5 min (max 3 mg/kg)Maintenance: 30–50 ug/kg/min |
SE: Hypotension; neuro (↓ CNS, dizziness, drowsiness and seizures at high levels). Warnings: prophylactic use in AMI; (Warning: reduce maintenance dose if liver disease or left ventricular dysfunction); Adam-Stokes Syndrome.Pregnancy Risk: B |
II |
Net effect:↓ chronotropy & inotropy by inhibition of β |
Esmolol & other β-blockers |
Approved: VT, AFib, AFlutter, Intraoperative HTN |
Doses vary based on indication. Please see prescribing recommendations. |
SE: Bradycaerdia, hypotension, exacerbation of heart failure, bronchospasm Warning: Asthma (especially moderate to severe), decompensated HFPregnancy Risk: C |
III |
Net effect: Prolong repolarization (recovery) by effective refractory period and APD.MOA: inhibition of K+ conductance |
Amiodarone |
Approved: VT, VFOther Uses: AFib, AFlutter, PSVT |
Inj: Pulseless VT/VF: 300 mg IV/IO push in 20 cc ; Other VT/VF: 150 mg IV × 10 min, then 360 mg IV × 6h, then 540 mg × 18h |
Note: Can be used in patients with impaired left ventricular dysfunction and WPW.SE: Hypo & hyperthyroidism (inj&tab contain 37% iodine), pulmonary fibrosis, liver toxicity, blue discoloration of skin, optic neuropathy/neuritis, QT prolongation.Warning: heart block; Pregnancy Risk: D |
Net effect: ↓ chronotropy & inotropy; MOA: ↓ SA & AV nodal conduction of Ca+ through a blockade of voltage gated Ca+ channels |
Diltiazem |
Approved: AFib, AFlutter |
15–20 mg IV × 2 min; Repeat in 15 min at 20–25 mg |
SE: Bradycardia, HB, worsening of HF, ↓ BPWarnings: WPW, sick sinus syndrome, HBPregnancy Risk: C |
Verapamil |
Approved: Angina, AFib, AFlutter |
2.5–5 mg IV over 2 min; then 5–10 mg (if needed) q15–30min (max dose 20mg). |
|
Other |
Net effect: ↓ chronotropy & ↓ inotropy; MOA: PNS; ↑ gK & ↑ gCa |
Digoxin |
Approved: AFib, AflutterHF |
0.4–0.6 mg IV over ≥5 min; may repeat 0.1–0.3 mg IV over ≥5 min |
SE: Arrhythmias, N/VWarnings: Bradycardia, HB, renal failure, hypokalemia.Pregnancy Risk: C |