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Chapter 14: 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 ...

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