DRUG NAME MECHANISM OF DOSAGE INDICATIONS CONTRA ADVERSE SIDE EFFECT NURSING

ACTION INDICATIONS REACTION RESPOMSIBILITIES

GENERIC This used to treat ADULT: Finally, Contraindicat
bradycardia, Nausea
ASSESMENT:
NAME: certain types of amiodarone is ed in patients  History: Hypersensit
AMIODARONE
injectable solution
serious (possibly 50mg/mL indicated for with second hypothyroidism ivity to amiodarone,
fatal) irregular the treatment or third- sinus node
BRAND NAME: 150mg/100mL vomiting
heartbeat (such of
degree heart or dysfunction, heart
CORDARONE (Nexterone) ventricular arr
as persistent 360mg/200mL block who do hyperthyroidis block, severe
hythmias, bradycardia,
DRUG ventricular (Nexterone) not have fatigue
specifically
CLASSIFICATI fibrillation/tachyca tablet pacemakers.  m, pulmonary hypokalemia,
monomorphic
ON: rdia). It is used to Amiodarone lactation, thyroid
100mg VT, non- toxicity, ocular  tremor
ANTIARRHYT dysfunction,
restore 200mg Torsades contraindicati
HMIC deposits, pregnancy
normal heart rhyt 400mg polymorphic ons also
VT (secondary  Physical: Skin color,
hm and maintain Stable include and liver functi lack of
to myocardial lesions; reflexes,
a regular, steady Monomorphic or patients with
ischemia and coordination gait, eye
heartbeat. Amiod Polymorphic pre-excitation on
not associated examination; P, BP,
arone is known Ventricular (Wolff- derangements auscultation,
with prolonged
as an anti- Tachycardia (Off- QTc), as well Parkinson- constipation continuous ECG
arrhythmic drug. label) as for White monitoring; R,
It works by 150 mg IV bolus in pulseless vent syndrome) adventitious sounds,
blocking certain 10 minutes; may ricular and insomnia baseline chest X-
electrical signals repeat q10min as fibrillation (VF concurrent ray; liver evaluation;
in the heart that necessary, THEN ) and pulseless atrial LFTs, serum
can cause an VT that fail to fibrillation headache
1 mg/min IV for 6 electrolytes, T4, and
irregular heart hours, THEN convert after T3
CPR,
beat. 0.5 mg/min IV for 18 stomach pain
hours; not to exceed
2.2 g/24hr DIAGNOSIS:
For breakthrough decreased • Decreased Cardiac
episodes of VF or Output, related to cardiac
sex drive or arrhythmias • Risk for
hemodynamically
unstable VT , repeat performance Injury, related to adverse
effects of drug • Impaired
the initial load
Gas Exchange, related to
Dosing pulmonary damage
uncontrollable
considerations secondary to side effects
Initiate in hospital of drug • Risk for
with experienced or unusual Imbalanced Nutrition,
personnel related to gastrointestinal
movements of distress secondary to side
ACLS, Pulseless
the body effects of drug
Ventricular
Fibrillation/Ventricul
PLANNING:
ar Tachycardia (Off-
The patient will:
label)
• Demonstrate ability to
300 mg IV or
measure own pulse.
intraosseous push
• Describe the need to
after dose
change positions slowly
epinephrine if no
to prevent postural
initial response to
hypotension.
defibrillation
• Remain free of
May follow initial
physical injury.
dose with 150 mg IV
• Maintain adequate
q3-5min
nutrition.
Dosing
• Demonstrate adequate
considerations
respiratory function.
Rapid IV push if
pulseless/no BP
Ventricular
Arrhythmias
INTERVENTION:
PO
 WARNING: Reser
Load: 800-1600 mg
ve use for life-
PO qDay for 1-3
weeks until threatening
response; once arrhythmias;
adequate serious toxicity,
arrhythmia control including
achieved, reduce arrhythmias,
dose to 600-800 pulmonary toxicity
mg/day for 1 mo; can occur.
THEN reduce to  Monitor cardiac
maintenance dose rhythm
Maintenance dose: continuously.
400 mg PO qDay  Monitor for an
IV extended period
150 mg over first 10 when dosage
min (15mg/min), adjustments are
followed by 360 mg made.
over next 6 hr (1  WARNING: Monit
mg/min), THEN 540 or for safe and
mg over remaining effective serum
18 hr (0.5 mg/min),
levels (0.5–2.5
for a total of 1000
mcg/mL).
mg over 24 hr
before administering  WARNING: Doses
maintenance of digoxin,
infusion quinidine,
Maintenance: 0.5 procainamide,
mg/min for a total phenytoin, and
720 mg/24hr at a warfarin may need
concentration of 1-6 to be reduced
mg/mL (360 one-third to one-
mg/200mL), or 1.8 half when
mg/mL Nexterone at amiodarone is
rate of 278 mL/min started.
Duration of therapy:  Give drug with
May continue to meals to decrease
administer 0.5 GI problems.
mg/min for 2-3  Arrange for
weeks regardless of ophthalmologic
patient's age, renal examinations;
function or reevaluate at any
ventricular function sign of optic
Dosing
neuropathy.
considerations
 Arrange for
Conventional IV
preparation contains
periodic chest X-
polysorbate 80 and ray to evaluate
pulmonary status
benzyl alcohol (every 3–6 mo).
Newer IV  Arrange for
formulation regular periodic
(Nexterone) does blood tests for
not contain liver enzymes,
polysorbate 80 or thyroid hormone
benzyl alcohol levels.
Conversion to oral
amiodarone after IV EVALUATION:
administration Evaluate the
<1 week IV infusion: effectiveness of drug
800-1600 mg/day therapy by confirming
1-3 week IV that patient goals and
infusion: 600-800 expected outcomes are
mg/day met.
>3 week IV infusion:
400 mg/day

PEDIATRIC:
injectable solution
 50mg/mL
 150mg/100mL
(Nexterone)
 360mg/200mL
(Nexterone)
tablet
 100mg
 200mg
 400mg

Drug Resistant
Refractory Cardiac
Arrhythmias (Off-
label)
PO
 Age <1 year:
 600-800
mg/1.73 m²
q24hr or divided
q12hr; continue
therapy for 4-14
days and/or until
adequate
control
achieved; if
initial treatment
effective,
decrease
dosage to 200-
400 mg/1.73 m²
q24hr or divided
q12hr  
 Age >1 year:
Until adequate
control, 10-15
mg/kg/day PO
qDay or divided
q12hr; if
effective, reduce
to 5 mg/kg/day
PO qDay or
divided q12hr  
IV
 Loading dose
(limited data): 5
mg/kg IV over
30-60 min
 Maintenance
dose: 0.005
mg/kg/min IV
infusion; may
increase to 20
mcg/kg/min per
24 hr; consider
converting to
oral therapy
 within 24-48 hr
Pulseless
Ventricular
Tachycardia or
Ventricular
Fibrillation (PALS
dosing) (Off-label)
5 mg/kg IV/IO rapid
bolus; not to exceed
300 mg/dose; may
repeat twice to
maximum 15 mg/kg
during acute
treatment  
Supraventricular
Tachycardia (Off-
label)
Infants/children/
adolescents: 5 mg/kg
IV over 1 hr initially;
follow with 5
mg/kg/day for 47 hr  
Maintenance: 10-20
mg/kg/day for 7-10
days; follow with 3-20
mg/kg/day
Dosing
Considerations
In a pediatric trial of
61 patients, aged 30
days to 15 years,
hypotension (36%),
bradycardia (20%),
and atrioventricular
block (15%) were
common dose-related
adverse events and
were severe or life-
threatening in some
cases
Injection site reactions
were seen in 5 (25%)
of the 20 patients
receiving amiodarone
HCI injection through
a peripheral vein,
irrespective of dose
regimen
Conventional IV
amiodarone contains
the preservative
benzyl alcohol; there
have been reports of
fatal “gasping
syndrome” in
neonates (children
aged less than 1
month) following the
administration of IV
solutions containing
the preservative
benzyl alcohol
Newer IV formulation
(Nexterone) does not
contain polysorbate 80
or benzyl alcohol
GENERIC Flecainide works ADULT: Documented, contraindicat  Body as a Stomach ASSESMENT:
NAME: by blocking the tablet life- ed in patients Whole– problems.
FLECAINIDE
Nav1. 5 sodium  50mg threatening with pre- malaise, fever; Symptoms
channel in the  100mg ventricular existing Cardiovascular may include:
BRAND NAME:  150mg
heart, slowing the arrhythmias. second- or – tachycardia, constipation. .
TAMBOCOR
upstroke of the Arrhythmias Paroxysmal third-degree sinus pause or ..
DRUG cardiac action (Prevention) supraventricu AV block, or arrest; Vision
CLASSIFICATI potential. This lar with right Gastrointestina problems.
ON: thereby PSVT and paroxysmal tachycardias bundle l– vomiting,
atrial fibrillation
Symptoms
ANTIARRHYT slows conduction  (PSVT), branch block diarrhea DIAGNOSIS:
 50 mg PO BID; may include:
HMIC of the electrical paroxysmal when
may increase by blurred vision.
impulse within the atrial associated ...
50 mg every 4
heart, i.e. it days; do not fibrillation/flutt with a left PLANNING:
Low blood
"reduces exceed 300 er (PAF) in hemiblock
pressure.
excitability". mg/day patients (bifascicular
Symptoms
Sustained VT without block), unless
may
 100 mg PO BID structural a pacemaker INTERVENTION:
include: dizzin
initiated in heart is present to
hospital; may ess. ...
disease. sustain the EVALUATION:
increase by 50 cardiac Uncontrollabl
mg every 4 rhythm e shaking of
days; do not parts of your
should
exceed 400 body, such as
mg/day
complete
heart block your hands,
Dosing Considerations occur. arms, head,
or legs.
Steady-state plasma
levels not achieved for Headache.
3-5 days, so increases
in dosage should not
be made less than
every 4 days
Loading dose not
recommended, due to
increased incidence of
proarrhythmic events
and CHF
Patients intolerant to
BID dosing may
require 8hr dosing
Once adequate
control of arrhythmia
has been achieved,
may reduce dose,
provided there is no
loss of efficacy
After 5 doses/steady
state, obtain ECG
after initiation or
change of dose;
obtain plasma trough
flecainide levels 1
hour predose
Usual trough plasma
levels: 0.2-1 mcg/mL
When given
concomitantly with
amiodarone, reduce
flecainide dose by
50% and monitor
closely
Dose cautiously in
patients with history of
MI or CHF
When switching from
another antiarrhythmic
to flecainide, allow >2-
4 plasma half-lives to
elapse before starting
flecainide; if
discontinuation of
previous drug may
produce life-
threatening
arrhythmias, consider
hospitalizing patient
Dosage Modifications
Renal impairment
 Severe (<35
mL/min): 100
mg PO qDay or
50 mg PO BID
 >25 mL/min:
100 mg PO BID
Hepatic impairment
 Use only if
benefits
outweigh risk;
monitor plasma
levels regularly;
reduce dose as
necessary
Narcolepsy (Orphan)
Orphan designation of
a fixed dose
combination of
modafinil and
flecainide for
narcolepsy
Sponsor
 Theranexus SA;
86 Rue de
Paris; Orsay,
France
PEDIATRIC:
tablet
 50mg
 100mg
 150mg
Arrhythmias
<6 months: 50
mg/m²/day PO divided
q8-12hr  
≥6 months: 100
mg/m²/day PO divided
q8-12hr
Not to exceed 200
mg/m²/day
Dosing Considerations
Usual therapeutic
level: 200-500 ng/mL;
some may require
<800 ng/mL for
adequate control
Steady-state plasma
levels not achieved for
3-5 days, so increases
in dosage should not
be made less than
every 4 days
Loading dose not
recommended, due to
increased incidence of
proarrhythmic events
and CHF
Patients intolerant to
BID dosing may
require 8hr dosing
Once adequate
control of arrhythmia
has been achieved,
may reduce dose,
provided there is no
loss of efficacy
After 5 doses/steady
state, obtain ECG
after initiation or
change of dose;
obtain plasma trough
flecainide levels 1
hour predose
Usual trough plasma
levels: 0.2-1 mcg/mL
When given
concomitantly with
amiodarone, reduce
flecainide dose by
50% and monitor
closely
Dose cautiously in
patients with history of
MI or CHF
When switching from
another antiarrhythmic
to flecainide, allow >2-
4 plasma half-lives to
elapse before starting
flecainide; if
discontinuation of
previous drug may
produce life-
threatening
arrhythmias, consider
hospitalizing patient
Dosage Modifications
Renal impairment
 Severe (<35
mL/min): 100
mg PO qDay or
50 mg PO BID
 >25 mL/min:
100 mg PO BID
Hepatic impairment
 Use only if
benefits
outweigh risk;
monitor plasma
levels regularly;
reduce dose as
necessary
GENERIC  unique mechani ADULT: CORVERT In Contraindicat that may be affecting the ASSESMENT:
NAME: sm works by an injectable solution jection is ed in patients associated with cardiovascula
IBUTILIDE
activation of a  0.1mg/mL indicated for who have the r system (e.g.,
BRAND NAME: specific inward Atrial
the rapid previously administration arrhythmogen
CORVERT sodium current, Fibrillation/Flutter conversion of demonstrated of CORVERT  ic affects,
thus producing its atrial hypersensitivi was nausea, affects on
DRUG therapeutic <60 kg: 0.01 mg/kg fibrillation or ty which occurred cardiac
CLASSIFICATI response in which (0.1 mL/kg) IV infusion atrial flutter of to ibutilide fu with a conduction,
ON: a repeat after 10 recent onset marate or any frequency palpitation,
ANTIARRHYT minutes PRN  
prolonged action  to sinus of the other greater than hypotension, DIAGNOSIS:
HMIC >60 kg: 1 mg (one
potential vial) IV infusion, rhythm. product 1% more hypertension), 
increases repeat after 10 Patients with components. in ibutilide- nausea, and
myocytes' cardiac minutes PRN atrial If you provide treated headache PLANNING:
refractoriness in arrhythmias additional patients than reported in
case of atrial Renal Impairment of longer keywords, those treated ≤5.1% of
fibrillation and Dose adjustment not duration are you may be with placebo. patients.
flutter necessary less likely to able to INTERVENTION:
respond browse
Hepatic Impairment
to CORVERT through our EVALUATION:
Dose adjustment not . database of
necessary Scientific
Response
Documents.

GENERIC ASSESMENT:
NAME:

BRAND NAME:

DRUG
CLASSIFICATI
ON:
ANTIARRHYT
DIAGNOSIS:
HMICS

PLANNING:

INTERVENTION:

EVALUATION:

GENERIC ASSESMENT:
NAME:

DIAGNOSIS:
BRAND NAME:

DRUG PLANNING:
CLASSIFICATI
ON:
ANTIARRHYT
HMICS INTERVENTION:

EVALUATION: