ADENOSINE

Action Therapeutic Effects Uses Contraindications

Slows conduction through the Restores normal sinus rhythm Conversion to sinus rhythm of AV block, preexisting second-
atrioventricular (AV) and in patients with paroxysmal paroxysmal supraventricular and third-degree heart block or
sinoatrial (SA) nodes. Can supraventricular tachycardia. tachycardia (PSVT) including sick sinus rhythm without
interrupt the reentry pathways PSVT associated with accessory pacemaker, since a heart block
through the AV node. bypass tracts (Wolff-Parkinson- may result. Also
Depresses left ventricular White syndrome). "Chemical" contraindicated in atrial flutter,
function, but effect is transient thallium stress test. atrial fibrillation, and
due to short half-life. ventricular tachycardia
because the drug is ineffective.

CAUTION USE
Asthmatics, pregnancy
(category C), hepatic and renal
failure.

Route & Dosage Adverse Effects Nursing Assessment Patient & Family Education
& Drug Effects
SVT Adult: CNS: Headache, • Monitor for S&S of Note: Flushing may occur along
IV 6 mg rapid IV bolus (over 1– lightheadedness, dizziness, bronchospasm in with a feeling of warmth as
2 s); may repeat in 1–2 min with tingling in arms (from IV asthma patients. Notify drug is injected.
12 mg IV push, 2 times (total of infusion), apprehension, physician immediately.
3 doses with max: 12 mg dose) blurred vision, burning • Use a hemodynamic
sensation (from IV infusion). monitoring system
Neonate/Infant/Child: during administration;
IV 0.05 mg/kg; may increase CV: Transient facial monitor BP and heart
dose by 0.05 mg/kg q2 min flushing, sweating, rate and rhythm
continuously for several
(max: 0.25 mg/kg/dose or 12 palpitations, chest pain, atrial minutes after
mg/dose) fibrillation or flutter. administration.

Respiratory: Shortness of Note: Adverse effects are

breath, generally self-limiting due to
transient dyspnea, chest short half-life (10 s).
pressure.
Note: At the time of conversion
GI: Nausea, metallic taste, to normal sinus rhythm, PVCs,
tightness in PACs, sinus bradycardia, and
throat. Other: Irritability in sinus tachycardia, as well as
children. various degrees of AV block, are
seen on the ECG. These usually
last only a few seconds and
resolve without intervention.

AMIODARONE
Action Therapeutic Effects Uses Contraindications
Structurally related to By direct action on smooth Prophylaxis and treatment of Hypersensitivity to
thyroxine. Class III muscle, decreases peripheral life-threatening ventricular amiodarone, or benzyl alcohol;
antiarrhythmic; also has resistance and increases arrhythmias and cardiogenic shock, severe sinus
antianginal and antiadrenergic coronary blood flow. Blocks supraventricular arrhythmias, bradycardia, advanced AV
properties. Totally unrelated to effects of sympathetic particularly with atrial block unless a pacemaker is
other antiarrhythmics. Acts stimulation. fibrillation. available, severe sinus-node
directly on all cardiac tissues. dysfunction or sick sinus
Prolongs duration of action syndrome, bradycardia,
potential and refractory period congenital or acquired QR
without significantly affecting prolongation syndromes, or
resting membrane potential. history of torsade de pointes;
 severe liver disease, children.
Safety during pregnancy
(category D) or lactation is not
established.

CAUTIOUS USE
Hepatic disease, cirrhosis;
Hashimoto's thyroiditis, goiter,
thyrotoxicosis, or history of
other thyroid dysfunction; CHF,
left ventricular dysfunction;
hypersensitivity to iodine; older
adults; Fabry disease, especially
with visual disturbances;
electrolyte imbalance,
hypokalemia,
hypomagnesemia,
hypovolemia; preexisting lung
disease, COPD; open heart
surgery.

Route & Dosage Adverse Effects Nursing Assessment Patient & Family Education
& Drug Effects
Arrhythmias CNS: Peripheral neuropathy • Monitor BP • Check pulse daily once
Adult: PO Loading Dose 800– (muscle weakness, wasting carefully during infusion stabilized, or as
1600 mg/d in 1–2 doses for 1– numbness, tingling), fatigue, and slow the infusion if prescribed. Report a
3 wk PO Maintenance Dose abnormal gait, dyskinesias, significant hypotension pulse <60.
400–600 mg/d in 1–2 doses IV dizziness, paresthesia, occurs; bradycardia • Take oral drug
Loading Dose 150 mg over 10 headache. should be treated by consistently with
min followed by 360 mg over slowing the infusion or respect to meals.
next 6 h IV Maintenance Dose discontinuing if
540 mg over 18 h (0.5 mg/min), CV: Bradycardia, hypotension necessary. Monitor • Become familiar with
may continue at 0.5 mg/min (IV), sinus arrest, cardiogenic heart rate and rhythm potential adverse
Convert IV to PO Duration of shock, CHF, arrhythmias; AV and BP until drug reactions and report
infusion <1 wk use 800–1600 block. response has stabilized; those that are
mg PO, 1–3 wk use 600–800 mg report promptly bothersome to the
PO, >3 wk use 400 mg PO Special Senses: Corneal symptomatic physician.
microdeposits, blurred vision, bradycardia. Sustained • Use dark glasses to ease
Child: PO Loading Dose 10–15 optic neuritis, optic monitoring is essential photophobia; some
mg/kg/d or 600–800 mg/1.73 neuropathy, permanent because drug has an patients may not be
m2/d, in 1–2 divided doses for blindness, corneal unusually long half-life. able to go outdoors in
4–14 d cycle or until adequate degeneration, macular • Monitor for S&S the daytime even with
control of arrhythmia PO degeneration, photosensitivity. of: Adverse effects, such protection.
Maintenance Dose 5 mg/kg/d particularly conduction • Follow
or 200–400 mg/1.73 m2/d GI: Anorexia, nausea, vomiting, disturbances and recommendation for
once daily, may be able to constipation, hepatotoxicity. exacerbation of regular ophthalmic
reduce to 2–5 mg/kg/d 5 d per arrhythmias, in patients exams, including
week Metabolic: Hyperthyroidism or receiving concomitant funduscopy and slit-
hypothyroidism; may cause antiarrhythmic therapy lamp exam.
Note: Correct hypokalemia and neonatal hypo- or (reduce dosage of • Wear protective
hypomagnesemia prior to hyperthyroidism if taken during previous agent by 30– clothing and a barrier-
initiation of therapy. pregnancy. 50% several days after type sunscreen that
amiodarone therapy is physically blocks
Respiratory: (Pulmonary started); drug-induced penetration of skin by
toxicity) Alveolitis, pneumonitis hypothyroidism or ultraviolet light (e.g.,
(fever, dry cough, dyspnea), hyperthyroidism (see titanium oxide or zinc
interstitial pulmonary fibrosis, Appendix F), especially formulations) to
fatal gasping syndrome with IV during early treatment prevent a
in children. period; pulmonary photosensitivity
toxicity (progressive reaction (erythema,
dyspnea, fatigue, pruritus); avoid
cough, pleuritic pain,
Skin: Slate-blue pigmentation,
photosensitivity, rash. Other:
With chronic use, angioedema.
fever) throughout exposure to sun and
therapy. sunlamps.
• Lab tests: • Do not breast feed
Baseline and periodic while taking this drug
assessments should be without consulting
made of liver, lung, physician.
thyroid, neurologic, and
GI function. Drug may
cause thyroid function
test abnormalities in
the absence of thyroid
function impairment.
• Monitor for
elevations of AST and
ALT. If elevations persist
or if they are 2–3 times
above normal baseline
readings, reduce
dosage or withdraw
drug promptly to
prevent hepatotoxicity
and liver damage.
• Auscultate chest
periodically or when
patient complains of
respiratory symptoms.
Check for diminished
breath sounds, rales,
pleuritic friction rub;
observe breathing
pattern. Drug-induced
 pulmonary function
problems must be
distinguished from CHF
or pneumonia. Keep
physician informed.
• Anticipate
possible CNS symptoms
within a week after
amiodarone therapy
begins. Proximal muscle
weakness, a common
side effect, intensified
by tremors presents a
great hazard to the
ambulating patient.
• Assess severity
of symptoms.
Supervision of
ambulation may be
indicated.

DIGOXIN
Action Therapeutic Effects Uses Contraindications
Widely used cardiac glycoside Increases the contractility of Rapid digitalization and for Digitalis hypersensitivity,
of Digitalis lanata. Acts by the heart muscle (positive maintenance therapy in CHF, ventricular fibrillation,
increasing the force and inotropic effect). atrial fibrillation, atrial flutter, ventricular tachycardia unless
velocity of myocardial systolic paroxysmal atrial tachycardia. due to CHF. Full digitalizing
contraction (positive inotropic dose not given if patient has
effect). It also decreases received digoxin during
conduction velocity through
the atrioventricular node.
Action is more prompt and less
prolonged than that of digitalis
and digitoxin.
Route & Dosage
Digitalizing Dose
Adult: PO 10–15 mcg/kg (1 mg)
in divided doses over 24–48 h
IV 10–15 mcg/kg (1 mg) in
divided doses over 24 h
Child: PO/IV <2 y, 40–60
mcg/kg; 2–10 y, 20–40 mcg/kg;
>10 y, 10–15 mcg/kg (1.5–2
mg)
Neonate: PO/IV 30–50 mcg/kg
previous week or if slowly
excreted cardiotonic glycoside
has been given during previous
2 wk.
CAUTIOUS USE:
Renal insufficiency,
hypokalemia, advanced heart
disease, acute MI, incomplete
AV block, cor pulmonale;
hypothyroidism; lung disease;
pregnancy (category A),
lactation, premature and
immature infants, children,
older adults, or debilitated
patients.
Adverse Effects Nursing Assessment Patient & Family Education
& Drug Effects
CNS: Fatigue, muscle weakness, • Take apical • Report to physician if
headache, facial neuralgia, pulse for 1 full min, pulse falls below 60 or
mental depression, noting rate, rhythm, rises above 110 or if you
paresthesias, hallucinations, and quality before detect skipped beats or
confusion, drowsiness, administering drug. other changes in
agitation, dizziness. • Withold rhythm, when digoxin is
medication and notify prescribed for atrial
CV: Arrhythmias, hypotension, physician if apical pulse fibrillation.
AV block. Special Senses: Visual falls below ordered • Suspect toxicity and
disturbances. parameters (e.g., <50 or report to physician if
GI: Anorexia, nausea, vomiting, 60/min in adults and any of the following
diarrhea. occur: Anorexia,
Premature neonate: PO/IV 20 Other: Diaphoresis, recurrent <60 or 70/min in
mcg/kg malaise, dysphagia. children).
• Be familiar with
Maintenance Dose patient's baseline data
Adult: PO/IV 0.1–0.375 mg/d (e.g., quality of
Child: PO/IV <2 y, 7.5–9 peripheral pulses, blood
mcg/kg/d; 2–10 y, 6–7.5 pressure, clinical
mcg/kg/d; >10 y, 0.125–0.25 symptoms, serum
mg/d electrolytes, creatinine
Neonate: 6–7.5 mcg/kg/d clearance) as a prescribed, do not skip
Premature neonate: 3.75 foundation for making
mcg/kg/d assessments.
• Lab tests:
Baseline and periodic
serum digoxin,
potassium, magnesium,
and calcium. Draw
blood samples for
determining plasma
digoxin levels at least 6
h after daily dose and
preferably just before
next scheduled daily
dose.
• Monitor for S&S
of drug toxicity: In
children, cardiac
arrhythmias are usually
reliable signs of early
toxicity. Early indicators
in adults (anorexia,
nausea, vomiting,
diarrhea, or visual
disturbances.
• Weigh each day under
standard conditions.
Report weight gain >1
kg (2 lb)/d.
• Take
digoxin PRECISELY as
or double a dose or
change dose intervals,
and take it at same time
each day.
• Do not to take OTC
medications, especially
those for coughs, colds,
allergy, GI upset, or
obesity, without prior
approval of physician.
• Continue with brand
originally prescribed
unless otherwise
directed by physician.
• Do not breast feed
while taking this drug
without consulting
physician.
nausea, vomiting,
diarrhea, visual
disturbances) are rarely
initial signs in children.
• Monitor I&O
ratio during
digitalization,
particularly in patients
with impaired renal
function. Also monitor
for edema daily and
auscultate chest for
rales.
• Monitor serum
digoxin levels closely
during concurrent
antibiotic–digoxin
therapy, which can
precipitate toxicity
because of altered
intestinal flora.
• Observe
patients closely when
being transferred from
one preparation (tablet,
elixir, or parenteral) to
another; when tablet is
replaced by elixir
potential for toxicity
increases since 30% of
drug is absorbed.
DILTIAZEM
Action
Slow channel blocker with
pharmacologic actions similar
to those of verapamil. Inhibits
calcium ion influx through slow
channels into cell of myocardial
and arterial smooth muscle
(both coronary and peripheral
blood vessels). As a result,
intracellular calcium remains at
subthreshold levels insufficient
to stimulate cell excitation and
contraction. Slows SA and AV
node conduction
(antiarrhythmic effect) without
affecting normal arterial action
potential or intraventricular
conduction.
Route & Dosage
Therapeutic Effects Uses Contraindications
Dilates coronary arteries and Vasospastic angina Known hypersensitivity to drug;
arterioles and inhibits coronary (Prinzmetal's variant or at rest sick sinus syndrome (unless
artery spasm; thus myocardial angina), chronic stable (classic pacemaker is in place and
oxygen delivery is increased effort-associated) angina, functioning); second- or third-
(antianginal effect). essential hypertension. IV degree AV block; severe
form: Atrial fibrillation, atrial hypotension (systolic <90 mm
By vasodilation of peripheral flutter, supraventricular Hg or diastolic <60 mm Hg);
arterioles, drug decreases total tachycardia. patients undergoing
peripheral vascular resistance intracranial surgery; bleeding
and reduces arterial BP at rest aneurysms. Safe use during
(antihypertensive effect). pregnancy (category C),
lactation, or in children is not
established.
CAUTIOUS USE:
CHF (especially if patient is also
receiving beta blocker),
conduction abnormalities;
renal or hepatic impairment;
older adults.
Adverse Effects Nursing Assessment Patient & Family Education
& Drug Effects
Hypertension CNS: Headache, fatigue, • Check BP and ECG • Make position changes
Adult: PO 60–120 mg dizziness, asthenia, drowsiness, before initiation of slowly and in stages;
sustained-release b.i.d. (usual nervousness, insomnia, therapy and monitor light-headedness and
range: 240–360 mg/d) or 120– confusion, tremor, gait particularly during dizziness (hypotension)
540 mg of CD or LA once daily abnormality. dosage adjustment are possible.
period. • Do not drive or engage
Atrial Fibrillation CV: Edema, arrhythmias, • Lab tests: Do baseline in other potentially
Adult: IV 0.25 mg/kg IV bolus angina, second- or third-degree and periodic liver and hazardous activities
over 2 min, if inadequate AV block, bradycardia, CHF, renal function tests. until reaction to drug is
response, may repeat in 15 min flushing, hypotension, syncope, • Monitor for and report known.
with 0.35 mg/kg, followed by a palpitations. S&S of CHF. • Keep follow-up
continuous infusion of 5–10 • Monitor for headache. appointments and
mg/h (max: 15 mg/h for 24 h) GI: Nausea, constipation, An analgesic may be physician informed.
anorexia, vomiting, diarrhea, required. • Do not breast feed
impaired taste, weight • Supervise ambulation while taking this drug
increase. Skin: Rash. as indicated. without consulting
physician.

EPINEPHRINE
Action Therapeutic Effects Uses Contraindications
Constricts bronchial arterioles Temporary relief of Hypersensitivity to
Naturally occurring and inhibits histamine release, bronchospasm, acute sympathomimetic amines;
catecholamine obtained from thus reducing congestion and asthmatic attack, mucosal narrow-angle glaucoma;
animal adrenal glands; also edema and increasing tidal congestion, hypersensitivity hemorrhagic, traumatic, or
prepared synthetically. Acts volume and vital capacity. and anaphylactic reactions, cardiogenic shock; cardiac
directly on both alpha and beta Relaxes uterine smooth syncope due to heart block or dilatation, cerebral
receptors; the most potent musculature and inhibits carotid sinus hypersensitivity, arteriosclerosis, coronary
activator of alpha receptors. uterine contractions. Imitates and to restore cardiac rhythm insufficiency, arrhythmias,
Strengthens myocardial all actions of sympathetic in cardiac arrest. Ophthalmic organic heart or brain disease;
contraction; increases systolic nervous system except those preparation is used in during second stage of labor;
but may decrease diastolic on arteries of the face and management of simple (open- for local anesthesia of fingers,
blood pressure; increases sweat glands. angle) glaucoma, generally as toes, ears, nose, genitalia.
cardiac rate and cardiac output. an adjunct to topical miotics Safety during pregnancy
and oral carbonic anhydrase (category C) or lactation is not
inhibitors; also used as established.
ophthalmic decongestant.
Relaxes myometrium and CAUTIOUS USE:
inhibits uterine contractions; Older adult or debilitated
prolongs action and delays patients; prostatic
systemic absorption of local hypertrophy; hypertension;
and intraspinal anesthetics. diabetes mellitus;
Used topically to control hyperthyroidism; Parkinson's
superficial bleeding. disease; tuberculosis;
psychoneurosis; in patients
with long-standing bronchial
asthma and emphysema with
degenerative heart disease; in
children <6 y of age.

Route & Dosage Adverse Effects Nursing Assessment Patient & Family Education
& Drug Effects
Cardiac Arrest Special Senses: Nasal burning or • Monitor BP, pulse, • Be aware intranasal
Adult: IV 0.1–1 mg (1–10 mL stinging, dryness of nasal mucosa, respirations, and application may sting
of 1:10,000) q5min as sneezing, rebound urinary output and slightly.
needed Intracardiac 0.1–1 congestion. Transient stinging or observe patient • Administer ophthalmic
mg burning of eyes, lacrimation, closely following IV drug at bedtime or
browache, headache, rebound administration. following prescribed
Child: IV 0.01 mg/kg (0.1 conjunctival hyperemia, allergy, Epinephrine may miotic to minimize
mL/kg of 1:10,000) q5min as iritis; with prolonged use: melanin- widen pulse pressure. mydriasis, with blurred
like deposits on lids, conjunctiva, If disturbances in vision and sensitivity to
needed Intracardiac 0.05– and cornea; corneal edema; loss of cardiac rhythm occur, light (possible in some
0.1 mg/kg lashes (reversible); maculopathy withhold epinephrine patients being treated
with central scotoma in aphakic and notify physician for glaucoma).
patients (reversible). immediately. • Transitory stinging
• Keep physician may follow initial
Body as a informed of any ophthalmic
Whole: Nervousness, restlessness, changes in intake- administration and
sleeplessness, fear, output ratio. that headache and
anxiety, tremors, severe headache, • Use cardiac monitor browache occur
cerebrovascular accident, with patients receiving frequently at first but
weakness, dizziness, syncope, pallor, epinephrine IV. Have usually subside with
sweating, dyspnea. full crash cart continued use. Notify
immediately available. physician if symptoms
Digestive: Nausea, vomiting. • Check BP repeatedly persist.
when epinephrine is • Discontinue
Cardiovascular: Precordial administered IV during epinephrine eye drops
pain, palpitations, hypertension, MI, first 5 min, then q3– and consult a physician
tachyarrhythmias 5min until stabilized. if signs of
including ventricular fibrillation. • Advise patient to hypersensitivity
report to physician if develop (edema of
Respiratory: Bronchial symptoms are not lids, itching, discharge,
and pulmonary edema. relieved in 20 min or if crusting eyelids).
they become worse • Learn how to
Urogenital: Urinary following inhalation. administer
retention. Skin: Tissue necrosis with • Advise patient to epinephrine
repeated injections. report bronchial subcutaneously. Keep
irritation, medication and
Metabolic: Metabolic acidoses, nervousness, or equipment available
elevated serum lactic acid, transient sleeplessness. Dosage for home emergency.
elevations of blood should be reduced. Confer with physician.
glucose. Nervous System: Altered
state of perception and thought, • Monitor blood glucose • Note: Inhalation
psychosis. & HbA1c for loss of epinephrine reduces
glycemic control if bronchial secretions
diabetic. and thus may make
mucous plugs more
difficult to dislodge.
• Report tolerance to
physician; may occur
with repeated or
prolonged use.
Continued use of
epinephrine in the
presence of tolerance
can be dangerous.
• Take medication only
as prescribed and
immediately notify
physician of onset of
systemic effects of
epinephrine.
• Discard discolored or
precipitated solutions.
• Do not breast feed
while taking this drug
without consulting
physician.
MAGNESIUM SULFATE
Action Therapeutic Effects Uses Contraindications
Parenterally: Acts as a CNS Effective parenterally as a CNS Orally to relieve acute Myocardial damage; heart
depressant and also as a depressant, smooth muscle constipation and to evacuate block; cardiac arrest except for
depressant of smooth, skeletal, relaxant and anticonvulsant in bowel in preparation for x-ray certain arrhythmias; IV
and cardiac muscle function. labor and delivery, and cardiac of intestines. Parenterally to administration during the 2 h
Anticonvulsant properties disorders. It is a laxative when control seizures in toxemia of preceding delivery; PO use in
thought to be produced by CNS taken orally. pregnancy, epilepsy, and acute patients with abdominal pain,
depression, principally by nephritis and for prophylaxis nausea, vomiting, fecal
decreasing the amount of and treatment of impaction, or intestinal
acetylcholine liberated from hypomagnesemia. Topically to irritation, obstruction, or
motor nerve terminals, thus reduce edema, inflammation, perforation.
producing peripheral and itching.
neuromuscular blockade. CAUTIOUS USE:
Impaired kidney function;
digitalized patients;
concomitant use of other CNS
depressants; neuromuscular
blocking agents, or cardiac
glycosides; pregnancy
(category A), lactation,
children.

Route & Dosage
Hypomagnesemia Seizures
Adult: IM/IV Mild, 1 g q6h for 4
doses; Severe, 250 mg/kg
infused over 4 h
Adverse Effects Nursing Assessment Patient & Family Education
& Drug Effects
Body as a Whole: Flushing, • Observe constantly • Drink sufficient water
sweating, extreme thirst, when given IV. Check BP during the day when
sedation, confusion, depressed and pulse q10–15 min drug is administered
reflexes or no reflexes, muscle
Child: IV 20–100 mg/kg q4–6h weakness, flaccid paralysis, or more often if orally to prevent net
prn hypothermia. indicated. loss of body water.
• Lab tests: Monitor • Recommended daily
Total Parenteral Nutrition CV: Hypotension, depressed plasma magnesium allowances of
Adult: IV 0.5–3 g/d cardiac function, complete levels in patients magnesium are
heart block, circulatory receiving drug obtained in a normal
collapse. parenterally (normal: diet. Rich sources are
1.8–3.0 mEq/L). Plasma whole-grain cereals,
Respiratory: Respiratory levels in excess of 4 legumes, nuts, meats,
paralysis. mEq/L are reflected in seafood, milk, most
depressed deep tendon green leafy vegetables,
Metabolic: Hypermagnesemia, reflexes and other and bananas.
hypocalcemia, dehydration, symptoms of • Do not breast feed
electrolyte imbalance including magnesium intoxication while taking this drug
hypocalcemia with repeated (see ADVERSE without consulting
laxative use. EFFECTS). Cardiac physician.
arrest occurs at levels in
excess of 25 mEq/L.
Monitor calcium and
phosphorus levels also.
• Early indicators of
magnesium toxicity
(hypermagnesemia)
include cathartic effect,
profound thirst, feeling
of warmth, sedation,
confusion, depressed
deep tendon reflexes,
and muscle weakness.
• Monitor respiratory
rate closely. Report
 immediately if rate falls
below 12.
• Test patellar reflex
before each repeated
parenteral dose.
Depression or absence
of reflexes is a useful
index of early
magnesium
intoxication.
• Check urinary output,
especially in patients
with impaired kidney
function. Therapy is
generally not continued
if urinary output is less
than 100 mL during the
4 h preceding each
dose.
• Observe newborns of
mothers who received
parenteral magnesium
sulfate within a few
hours of delivery for
signs of toxicity,
including respiratory
and neuromuscular
depression.
• Observe patients
receiving drug for
hypomagnesemia for

PROCAINAMIDE
Action
Amide analog of procaine
hydrochloride with cardiac
actions similar to those of
quinine. Class IA antiarrhythmic
agent. Depresses excitability of
myocardium to electrical
stimulation, reduces
conduction velocity in atria,
ventricles, and His-Purkinje
system. Increases duration of
refractory period, especially in
the atria.
Therapeutic Effects
Produces slight change in
contractility of cardiac muscle
and cardiac output; suppresses
automaticity of His-Purkinje
ventricular muscle. Produces
peripheral vasodilation and
hypotension, especially with IV
use.
improvement in these
signs of deficiency:
Irritability, choreiform
movements, tremors,
tetany, twitching,
muscle cramps,
tachycardia,
hypertension, psychotic
behavior.
• Have calcium gluconate
readily available in case
of magnesium sulfate
toxicity.
Uses Contraindications
Prophylactically to maintain Myasthenia gravis;
normal sinus rhythm following hypersensitivity to
conversion of atrial flutter or procainamide or procaine;
fibrillation by other methods. blood dyscrasias; complete AV
Also to prevent recurrence of block, second and third degree
paroxysmal atrial fibrillation AV block unassisted by
and tachycardia, paroxysmal pacemaker.
AV junctional rhythm,
ventricular tachycardia, CAUTIOUS USE:
ventricular and atrial Patient who has undergone
premature contractions. Also electrical conversion to sinus
cardiac arrhythmias associated rhythm; hypotension, cardiac
with surgery and anesthesia. enlargement, CHF, MI,
 coronary occlusion, ventricular
dysrhythmia from digitalis
intoxication; hepatic or renal
insufficiency; electrolyte
imbalance; bronchial asthma;
history of SLE. Safety during
pregnancy (category C) or
lactation is not established.

Route & Dosage Adverse Effects
Arrhythmias CNS: Dizziness, psychosis.
Adult: PO 1 g followed by 250–
500 mg q3h or 500 mg–1 g q6h CV: Severe hypotension,
sustained release (b.i.d. for pericarditis, ventricular
Procanbid) IM 0.5–1 g q4–6h fibrillation, AV block,
until able to take PO IV 100 mg tachycardia, flushing.
q5min at a rate of 25–50
mg/min until arrhythmia is GI: Bitter taste, nausea,
controlled or 1 g given, then 2– vomiting, diarrhea, anorexia,
6 mg/min (all mostly PO).
Child: PO 40–60 mg/kg/d
divided q4–6h IV 3–6 mg/kg q Hematologic: Agranulocytosis
10–30 min (max: 100 mg/dose), with repeated use;
then 0.02–0.08 mg/kg/min thrombocytopenia.
Body as a Whole: Fever, muscle
and joint pain, angioneurotic
edema, myalgia, SLE-like
syndrome (50% of patients on
large doses for 1 y):
Nursing Assessment
& Drug Effects
• Check apical
radial pulses before
each dose during period
of adjustment to the
oral route.
• Patients with
severe heart, liver, or
kidney disease and
hypotension are at
particular risk for
adverse effects.
• Monitor the
patient's ECG and BP
continuously during IV
drug administration.
• Discontinue IV
drug temporarily when
(1) arrhythmia is
interrupted, (2) severe
Patient & Family Education
• Keep a record of
weekly weight. Notify
physician if weight gain
of 1 kg (2 lb) or more is
accompanied by local
edema.
• Record and
report date, time, and
duration of fibrillation
episodes when taking
maintenance doses:
Light-headedness,
giddiness, weakness, or
faintness.
• Keep a record of
pulse rates. Report to
physician changes in
rate or quality.
Polyarthralgias, pleuritic pain, toxic effects are • Report to
pleural effusion. Skin: present, (3) QRS physician signs of
Maculopapular rash, pruritus. complex is excessively reduced procainamide
erythema, skin rash. widened (greater than control: Weakness,
50%), (4) PR interval is irregular pulse,
prolonged, or (5) BP unexplained fatigability,
drops 15 mm Hg or anxiety.
more. Obtain rhythm • Do not double
strip and notify dose or change an
physician. interval because a
• Ventricular previous dose was
dysrhythmias are missed. Take
usually abolished within procainamide at evenly
a few minutes after IV spaced intervals around
dose and within an hour the clock unless
after PO or IM otherwise prescribed.
administration. • Do not breast
• Report feed while taking this
promptly complaints of drug without consulting
chest pain, dyspnea, physician.
and anxiety.
Digitalization may have
preceded procainamide
in patients with atrial
arrhythmias.
Cardiotonic glycosides
may induce sufficient
increase in atrial
contraction to dislodge
atrial mural emboli,
 with subsequent
pulmonary embolism.
• Therapeutic
procainamide blood
levels are reached in
approximately 24 h if
kidney function is
normal but are delayed
in presence of renal
impairment.

SOTALOL
Action Therapeutic Effects Uses Contraindications
Has both class II and class III Produces significant reductions Treatment of life-threatening Hypersensitivity to sotalol;
antiarrhythmic properties. in both systolic and diastolic ventricular arrhythmias bronchial asthma, sinus
Slows heart rate, decreases AV blood pressure. Antiarrhythmic (sustained ventricular bradycardia, sick sinus
nodal conduction, and properties are effective in tachycardia) and maintenance syndrome; second and third
increases AV nodal controlling ventricular of normal sinus rhythm in degree heart block, long QT
refractoriness. arrhythmias as well as atrial patients with atrial syndrome, cardiogenic shock,
fibrillation/flutter. fibrillation/flutter. uncontrolled CHF; chronic
bronchitis, emphysema;
hypokalemia <4 mEq/L;
creatinine clearance of <40
mL/min; lactation.

CAUTIOUS USE:
CHF, electrolyte disturbances,
recent MI, diabetes, sick sinus
rhythm, renal impairment;
 pregnancy (category B);
concomitant use of drugs
which prolong the QT segment,
and antiarrhythmic drugs;
excessive diarrhea, or profuse
sweating.

Route & Dosage Adverse Effects Nursing Assessment Patient & Family Education
& Drug Effects
Ventricular Arrhythmias CV: AV block, hypotension, • Monitor ECG • Be aware of
(Betapace) aggravation of CHF, although the for initial baseline and risk for hypotension
Adult: PO Initial dose of 80 incidence of heart failure may be periodically thereafter and syncope,
mg b.i.d. or 160 mg q.d. lower than for other beta- (especially when especially with
taken prior to meals, may blockers, life-threatening ventricular doses are increased) concurrent treatment
increase every 3–4 d in 40– arrhythmias, including polymorphous because with catecholamine-
160 mg increments (most ventricular tachycardia or torsades de proarrhythmic events depleting drugs (e.g.,
patients respond to 240– pointes, bradycardia, dyspnea, chest most often occur reserpine,
320 mg/d in 2 or 3 divided pain, palpitation, bleeding (<2%). within 7 d of initiating guanethidine).
doses, doses >640 mg/d therapy or increasing • Take radial
have not been studied) CNS: Headache, fatigue, dose. pulse daily and report
dizziness, weakness, lethargy, • Lab test: marked bradycardia
Atrial Fibrillation/flutter depression, lassitude. Baseline serum (pulse below 60 or
(Betapace AF) electrolytes. Correct other established
Adult: PO Initial dose of 80 GI: Nausea, vomiting, diarrhea, electrolyte parameter) to
mg b.i.d., may increase dyspepsia, dry imbalances of physician.
every 3–4 d (max: 240 mg/d mouth. Urogenital: Impotence, hypokalemia or • Type 2
in 1–2 divided doses) decreased libido. hypomagnesemia diabetics are at
prior to initiating increased risk for
Metabolic: Hyperglycemia. Special therapy. hyperglycemia. All
Senses: Visual • Monitor diabetics are at risk of
cardiac status possible masking of
disturbances. Respiratory: Respiratory carefully, including symptoms of
complaints. ECG, throughout hypoglycemia.
therapy. Exercise • Do not
Skin: Rash. special caution when abruptly discontinue
sotalol is used drug because of the
concurrently with risk of exacerbation of
other antiarrhythmics, angina, arrhythmias,
digoxin, or calcium and possible
channel blockers. myocardial infarction.
• Monitor • Do not breast
patients with feed while taking this
bronchospastic drug.
disease (e.g.,
bronchitis,
emphysema) carefully
for inhibition of
bronchodilation.
• Monitor
diabetics for loss of
glycemic control. Beta
blockage reduces the
release of
endogenous insulin in
response to
hyperglycemia and
may blunt symptoms
of acute hypoglycemia
(e.g., tachycardia, BP
changes).
VERAPAMIL
Action
Inhibits calcium ion influx
through slow channels into
cells of myocardial and arterial
smooth muscle. Dilates
coronary arteries and arterioles
and inhibits coronary artery
spasm. Decreases and slows SA
and AV node conduction
without affecting normal
arterial action potential or
intraventricular conduction.
Associated vasodilation of
arterioles decreases total
peripheral vascular resistance
and reduces arterial BP at rest.
May slightly decrease heart
rate.
Therapeutic Effects
Dilates coronary arteries and
inhibits coronary artery spasm,
which increases myocardial
oxygen delivery and produces
an antianginal effect. Also
decreases nodal conduction,
which results in an
antiarrhythmic effect.
Uses Contraindications
Supraventricular Severe hypotension (systolic
tachyarrhythmias; Prinzmetal's <90 mm Hg), cardiogenic shock,
(variant) angina, chronic stable cardiomegaly, digitalis toxicity,
angina; unstable, crescendo or second- or third-degree AV
preinfarctive angina and block; Wolff-Parkinson-White
essential hypertension. syndrome including atrial
flutter and fibrillation;
accessory AV pathway, left
ventricular dysfunction, severe
CHF, sinus node disease, sick
sinus syndrome (except in
patients with functioning
ventricular pacemaker). Safe
use during pregnancy (category
C), lactation, or in children
(oral) is not established.

Route & Dosage Adverse Effects Nursing Assessment Patient & Family Education
& Drug Effects
Angina CNS: Dizziness, vertigo, • Monitor • Monitor radial
Adult: PO 80 mg q6–8h, may headache, fatigue, sleep therapeutic pulse before each dose,
increase up to 320–480 mg/d in disturbances, depression, effectiveness. Drug notify physician of an
divided doses (Note: Covera-HS syncope. should decrease angina irregular pulse or one
must be given once daily h.s.) frequency, nitroglycerin slower than established
CV: Hypotension, congestive consumption, and guideline.
Hypertension heart failure, bradycardia,
Adult: PO 40–80 mg t.i.d. or 90– severe tachycardia, peripheral episodes of ST segment • Adhere to
240 mg sustained-release 1–2 edema, AV block. deviation. established guidelines
times/d up to 480 mg/d (Note: • Establish for exercise program.
Covera-HS must be given once GI: Nausea, abdominal baseline data and • Do not drive or
daily h.s.) discomfort, constipation, periodically monitor: BP engage in potentially
elevated liver enzymes. and pulse. hazardous activities
Supraventricular Tachycardia, • Lab tests: until response to drug is
Atrial Fibrillation Body as a Whole: Flushing, Baseline and periodic known.
Adult: PO 240–480 mg/d in pulmonary edema, muscle liver and kidney • Decrease intake
divided doses IV 5–10 mg IV fatigue, diaphoresis. functions. of caffeine-containing
direct, may repeat in 15–30 min • Instruct patient beverage (i.e., coffee,
if needed Skin: Pruritus. to remain in recumbent tea, chocolate).
Child: IV <1 y, 0.1–0.2 mg/kg; position for at least 1 h • Change
1–15 y, 0.1–0.3 mg/kg (2–5 mg) after dose is given to positions slowly from
diminish subjective lying down to standing
effects of transient to prevent falls because
asymptomatic of drug-related vertigo
hypotension that may until tolerance to
accompany infusion. reduced BP is
• Monitor for AV established.
block or excessive • Notify physician
bradycardia when of easy bruising,
infusion is given petechiae, unexplained
concurrently with bleeding.
digitalis. • Do not use OTC
• Monitor I&O drugs, especially
ratio during IV and early aspirin, unless they are
oral maintenance specifically prescribed
therapy. Renal by physician.
impairment prolongs • Do not breast
duration of action, feed while taking this
increasing potential for drug without consulting
toxicity and incidence of physician.
adverse effects. Advise
patient to report
gradual weight gain and
evidence of edema.
• Monitor ECG
continuously during IV
administration.
Essential because drug
action may be
prolonged and
incidence of adverse
reactions is highest
during IV
administration in older
adults, patients with
impaired kidney
function, and patients
of small stature.
• Check BP shortly
before administration
of next dose to evaluate
degree of control
during