Cardiovascular Drugs




INTRODUCTION



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Antiarrhythmic Medications Class Dose Mechanism
Procainamide Ia


  • IV: Loading dose: 10–15 mg/kg over 30–60 min; in adults, maximum dose range: 1000–1500 mg



  • Maintenance: Continuous IV infusion: 20–80 mcg/kg/minute; maximum daily dose: 2000 mg/24 hr

 Decreases atrial and ventricular automaticity, vagolytic effect
Lidocaine Ib


  • IV: Loading dose: 1 mg/kg/dose; follow with continuous IV infusion; may administer second bolus if delay between initial bolus and start of infusion is >15 min



  • Continuous IV infusion: 20–50 mcg/kg/min

 Affects ventricular tissue
Mexiletine


  • PO: 1.4–5 mg/kg/dose (mean: 3.3 mg/kg/dose) given every 8 hr

Phenytoin


  • IV/PO: Loading dose: 15–20 mg/kg



  • Maintenance therapy: Initial: 5 mg/kg/day in divided doses

Flecainide Ic


  • PO: Initial: 1–3 mg/kg/day or 50–100 mg/m2/day in three divided doses

 Slows conduction velocities throughout the myocardium
Propafenone


  • PO: Initial 200–300 mg/m2/24 hr divided in three or four equal doses or 8–10 mg/kg/24 hr in three or four equal doses

Esmolol II


  • Initial IV bolus: 100–500 mcg/kg over 1 min



  • Continuous IV infusion: Initial rate: 25–100 mcg/kg/min

 Lowers heart rate, decreases automaticity, slows AV nodal conduction
Propranolol


  • PO: Initial: 0.5–1 mg/kg/day in divided doses every 6–8 hr; max 16 mg/kg/day

Metoprolol


  • PO: Initial: 0.5–1 mg/kg/dose (maximum initial dose: 25 mg/dose) twice daily

Ibutilide III


  • <60 kg: 0.01 mg/kg over 10 min



  • ≥60 kg: 1 mg over 10 min

 Prolongs repolarization and refractoriness of atrial, nodal, and ventricular tissue
Sotalol


  • Initial: Infants, children, and adolescents: 2 mg/kg/day divided every 8 hr
Amiodarone


  • IV: Loading dose: 5 mg/kg (maximum: 300 mg/dose) given over 60 min



  • Continuous IV infusion (if needed): Initial: 5 mcg/kg/min; increase incrementally as clinically needed
Verapamil IV


  • IV:



  • 0.1–0.3 mg/kg/dose (usual dose: 2–5 mg/dose); maximum dose: 5 mg/dose; may repeat dose in 15–30 min if response inadequate

 Slows conduction in sinus and AV nodes
Diltiazem


  • Adults:



  • Initial bolus dose: 0.25 mg/kg actual body weight over 2 min

Digoxin Misc


  • Please consult pharmacy for patient-specific dosing

 Directly suppresses AV node conduction
Adenosine Misc


  • Rapid IV, IO: Initial: 0.1 mg/kg (maximum initial dose: 6 mg/dose)
Magnesium Misc


  • IV, IO: 25–50 mg/kg/dose
Atropine Misc


  • IV, IO: 0.02 mg/kg/dose; minimum dose recommended by pediatric advanced life support (PALS): 0.1 mg; is not recommended in patients <5 kg
Isoproterenol Misc


  • Continuous IV infusion:



  • 0.05–2 mcg/kg/min; titrate to effect





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Continuous Infusion Medications Dose Range (route = IV) Mechanism
Alprostadil


  • 0.01–0.4 mcg/kg/min

 Vasodilation by means of direct effect on vascular and ductus arteriosus smooth muscle
Amiodarone


  • Load 5 mg/kg over 60 min



  • Drip 3–15 mcg/kg/min

 Class III antiarrhythmic; alpha- and beta-blocking properties; affects sodium, potassium, and calcium channels; prolongs the action potential and refractory period in myocardial tissue; decreases AV conduction and sinus node function
Bumex (bumetanide)


  • 0.008–1 mg/hr

 Diuretic that inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal renal tubule
Dobutamine


  • 2–20 mcg/kg/min

 Beta-adrenergic receptors and some alpha-receptor agonism, resulting in increased contractility and heart rate, also stimulates beta- and alpha-receptors in the vasculature
Dopamine


  • 2–20 mcg/kg/min

 Direct and indirect action via release of norepinephrine
Epinephrine


  • 0.02–1 mcg/kg/min

 Endogenous catecholamine with potent alpha and beta effects
Esmolol


  • Load: 500 mcg/kg over 1 min



  • Maintenance: 50–500 mcg/kg/min

 Blocks response to beta-adrenergic stimulation
Furosemide


  • 0.05–10 mg/hr

 Diuretic that inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal renal tubule
Heparin


  • Load: 75 units/kg



  • 10–35 units/kg/hr

 Inhibits thrombin-activated conversion of fibrinogen to fibrin
Isoproterenol


  • 0.02–2 mcg/kg/min

 Stimulates beta-receptors, resulting in increased heart rate and contractility
Lidocaine


  • Load: 1 mg/kg, repeat 10–15 min for two doses



  • Maintenance: 20–50 mcg/kg/min

 Blocks fast sodium channels with rapid association dissociation
Milrinone


  • 0.1–0.75 mcg/kg/min

 Phosphodiesterase inhibitor in cardiac and vascular tissue, resulting in vasodilation and inotropic effects
Nicardipine


  • 0.5–5 mcg/kg/min

 Inhibits calcium ion uptake, resulting in a relaxation of coronary vascular smooth muscle and coronary vasodilation
Nitroglycerin


  • 0.25–20 mcg/kg/min

 Vasodilating agent that dilates peripheral veins and arteries
Nitroprusside


  • 0.3–10 mcg/kg/min

 Direct-acting vasodilator
Norepinephrine


  • 0.01–2 mcg/kg/min

 Stimulates beta-adrenergic receptors and alpha-adrenergic receptors, causing increased contractility and heart rate, as well as vasoconstriction
Phenylephrine


  • 0.05–0.5 mcg/kg/min

 Direct-acting alpha-adrenergic agonist
Procainamide


  • Load: 3-6 mg/kg/dose over



  • 5 min



  • (Max dose: 100 mg/dose)



  • Maintenance: 20–80 mcg/kg/min



  • Max: 2 g/day

 Blocks fast sodium channels with intermediate association/dissociation
Vasopressin (bleeding)


  • 2–10 milliunits/kg/min

 Acts on smooth muscle receptors (V2) in the capillaries and small arterioles, causing them to vasoconstrict
Vasopressin (shock)


  • 0.17–8 milliunits/kg/min



  • Usual range: 0.3–2 milliunits/kg/min

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Jan 14, 2019 | Posted by in PEDIATRICS | Comments Off on Cardiovascular Drugs

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