Adenosine

• Use: Supraventricular Tachycardia (SVT)
• Mechanism of Action: Blocks Adenosine Receptors of AV Nodal Cells
• Contraindications:
  • Asthma or Bronchospasm
  • Second/Third Degree Heart Block
• Dose: 6 mg IV Rapidly Over 1-3 Seconds
  • Can Repeat with 12 mg Doses if Needed
  • Decrease Dose by 50% if Given Through a Central Line (3 mg/6 mg)
• The Heart May Enter Ventricular Asystole for a Few Seconds After Administration Causing Pharmacologic Cardioversion

Amiodarone

• Use: Atrial Fibrillation, Atrial Flutter, Ventricular Tachycardia, Ventricular Fibrillation
• Mechanism of Action: Potassium-Blocker
• Dose:
  • Atrial Fibrillation/Flutter and Stable Ventricular Tachycardia:
    • Bolus: 150 mg and Repeat if Needed
    • Continuous: 1 mg/min for 6 Hours, then 0.5 mg/min
  • Pulseless Ventricular Tachycardia and Ventricular Fibrillation:
    • First Dose: 300 mg Bolus
    • Second Dose: 150 mg
• Transition to Oral Amiodarone:
  • < 1 Week IV Treatment: Oral 800-1,600 mg Daily (Divided Doses)
  • 1-3 Weeks IV Treatment: Oral 600-800 mg Daily
  • ≥ 3 Weeks IV Treatment: Oral 400 mg Daily
• Less Cardiac Depression than Diltiazem – Favored Agent in Concomitant Heart Failure
• Can Convert to Sinus Rhythm and May Risk Clot Embolization

Atropine

• Use: Sinus Bradycardia, AV Blocks
• Dose: 0.5-1.0 mg Every 3-5 Minutes (Maximum 3 mg Total)

Digoxin

• Use: Atrial Fibrillation, Atrial Flutter
• Mechanism of Action: AV Node Inhibition and Ionotropic Stimulation by Na-K ATPase Pump Inhibition
• Dose:
  • First: 0.25 mg Every 2-4 Hours for a Maximum Total Dose of 1.0-1.5 mg
  • Then: 0.125-0.375 mg Daily
• Used Only as an Adjunctive Therapy
• Slow-Acting and Should Not Be Used as the Sole Therapy

Diltiazem

• Use: Atrial Fibrillation, Atrial Flutter
• Mechanism of Action: Calcium Channel Blocker
• Dose:
  • Bolus: 0.25 mg/kg and Repeat a Second Bolus of 0.35 mg/kg After 15 Minutes if Needed
  • Continuous Infusion: 5-15 mg/hr
• Superior to Amiodarone After the First Hour of Therapy
• Negative Inotropic Effects but Used Safely in Moderate-Severe Heart Failure

Epinephrine

• Use: Cardiac Arrest
  • Pulseless Ventricular Tachycardia
  • Ventricular Fibrillation
  • Pulseless Electrical Activity (PEA)
  • Asystole
• Code Dosing: 1 mg Every 3-5 Minutes

Esmolol

• Use: Atrial Fibrillation, Atrial Flutter
• Mechanism of Action: β-Blocker
• Ultra-Short-Acting Allows Rapid Dose Titration
• Dose:
  • Bolus: 500 mcg/kg
  • Continuous: 50-300 mcg/kg/min

Magnesium Sulfate (MgSO4)

• Use: Multifocal Atrial Tachycardia (MAT), Torsades de Pointes (TdP)
• Mechanism of Action: β-Blocker
• Dose: Bolus 2 g, Then Infuse 6 g Over 6 Hours

Metoprolol

• Use: Atrial Fibrillation, Atrial Flutter, Multifocal Atrial Tachycardia (MAT)
• Mechanism of Action: β-Blocker
• Dose: 5 mg Every 5-10 Minutes as Needed (Maximum of 3 Doses)

Procainamide

• Use: Wolff-Parkinson-White (WPW) Syndrome
• Mechanism of Action: Binds to Fast Sodium Channels Inhibiting Recovery After Repolarization
• Dosing: 15 mg/kg Total Dose at 20-50 mg/min

Verapamil

• Use: Multifocal Atrial Tachycardia (MAT)
• Mechanism of Action: Calcium Channel Blocker
• Dose: 0.25-5.0 mg Every 15-30 Minutes (Total Dose of 20 mg)
• Contraindicated in Heart Failure