Emergency cardiac drugs
Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.
Emergency cardiac drugs (brand name Adenocard) — Antiarrhythmic and emergency cardiac agents; Endogenous nucleoside (adenosine), anticholinergic (atropine), class III (amiodarone), class IB (lidocaine), electrolyte (magnesium).
Identification
- Therapeutic class: Antiarrhythmic and emergency cardiac agents.
- Pharmacologic class: Endogenous nucleoside (adenosine), anticholinergic (atropine), class III (amiodarone), class IB (lidocaine), electrolyte (magnesium).
Pharmacology
- Mechanism of action: Adenosine briefly blocks the AV node to stop supraventricular tachycardia; atropine increases heart rate by blocking vagal tone; amiodarone and lidocaine treat ventricular arrhythmias; magnesium treats torsades de pointes.
- Onset / peak / duration: Adenosine seconds (very short); atropine within minutes.
- Half-life / therapeutic level: Adenosine less than 10 seconds; lidocaine narrow margin.
Clinical use
- Indications: Supraventricular tachycardia (adenosine), symptomatic bradycardia and organophosphate poisoning (atropine), ventricular arrhythmias and arrest (amiodarone, lidocaine), torsades (magnesium).
- Usual dose, route, frequency: Adenosine 6 mg rapid IV push then 12 mg, immediately followed by a saline flush; atropine 0.5 to 1 mg IV; per ACLS protocols.
- Maximum dose / adjustments: Adenosine via the closest port with a fast flush; atropine doses below 0.5 mg can paradoxically slow the heart.
Safety
- Contraindications: Adenosine in second or third degree block or sick sinus without a pacemaker; atropine caution in narrow-angle glaucoma.
- Black box warning: None for these in emergency use.
- Interactions: Adenosine effect altered by caffeine and theophylline (reduced) and dipyridamole (enhanced); QT-prolonging drugs with amiodarone.
- Pregnancy / lactation: Used in emergencies.
- High-alert: No.
Adverse effects
- Common side effects: Adenosine causes brief flushing, chest pressure, and a sense of impending doom and a short asystolic pause; atropine causes dry mouth and tachycardia.
- Serious effects to report: Prolonged asystole, new arrhythmia, severe bradycardia or tachycardia.
- Antidote / reversal: Supportive care; adenosine effect self-terminates quickly.
Nursing process
- Assessment before administration: ECG and rhythm, heart rate, IV access close to the heart (adenosine).
- Interventions during therapy: Give adenosine as a rapid push followed immediately by a saline flush and warn the patient about a brief pause and flushing; continuous ECG.
- Monitor: ECG and rhythm, heart rate, blood pressure.
- Evaluation / expected outcome: Restored normal rhythm or rate.
Patient teaching
- Patient teaching: Adenosine causes a brief, uncomfortable but expected pause and flushing.
- Notify provider if: Not applicable (monitored setting).
- Administration tips: Adenosine fast push and immediate flush via a proximal port.