INTRODUCTION

Nurse’s role is most important in delivering cardiac emergency drugs in terms of proper dose,
route and side effect of particular drug. In hospital setting, emergencies typically occur in
emergency departments and intensive care units. Generally, the “goal of using emergency drugs
is to prevent the patient from deteriorating to an arrest situation”. ‘A registered nurse needs a
physician’s order to administer medications. In emergencies, RNs with advanced cardiac life
support certification can administer selected drugs based on standing orders of the particular
hospital’. Drugs for acute coronary syndrome (ACS) Acute coronary syndrome is a spectrum of
clinical manifestations associated with acute myocardial infarction and unstable angina.

1. NITROGLYCERIN
Class: vasodilator
Mechanism of action: nitroglycerin converts to nitric oxide (NO) in the body. NO then activates
the enzyme guanylyl cyclase, which converts guanosine triphosphate (GTP) to guanosine 3',5'-
monophosphate (cGMP) in vascular smooth muscle and other tissues.
Indication & dosage: nitroglycerin indications include chest pain or discomfort associated with
angina pectoris or suspected acute myocardial infarction, as well as pulmonary edema with
hypertension.
Sublingual - 0.3-0.4 mg to be repeated after 5 min
IV infusion - 50mg/10ml (dilute before use) | 5mcg/min to 20mcg/min
Contraindication: Nitroglycerin is contraindicated in patients that have reported allergic
symptoms to the medication. Known history of increased intracranial pressure, severe anemia,
right-sided myocardial infarction, or hypersensitivity to nitroglycerin are contraindications to
nitroglycerin therapy.
Side effects:
 Bloating or swelling of the face, arms, hands, lower legs, or feet.
 burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings.
 difficult or labored breathing.
 feeling faint, dizzy, or lightheadedness.
 feeling of warmth or heat.
Dosage calculation:
 1 ampule= 50 mg (10 ml)
 PREPARATION: 40 ml NSS + 10 ml NTG
 DRUG CONCENTRATION: 50 mg/ 50 ml = 1mg/1ml
 1mg × 1000 = 1,000mcg /1ml
 Rate of Infusion: Desired Dose × 60
Drug Concentration
 Example: 5 mcg x 60 min = 0.3 ml/hr
1000 mcg

2. MORPHINE SULPHATE
Class: opioid analgesic
Mechanism of action: morphine has an affinity for delta, kappa, and mu-opioid receptors. This
drug produces most of its analgesic effects by binding to the mu-opioid receptor within the
central nervous system (CNS) and the peripheral nervous system (PNS).
Indication & dosage: Morphine sulfate is indicated for the relief of moderate to severe acute and
chronic pain where use of an opioid analgesic is appropriate. 1-4mg IV over 1-5min to be
repeated q 5-30' until chest pain is relieved
Contraindication: Morphine sulfate is contraindicated in patients with acute or severe bronchial
asthma or hypercarbia. Morphine sulfate is contraindicated in any patient who has or is suspected
of having paralytic ileus. Respiratory depression is the primary risk of morphine sulfate.
Side effects:
 drowsiness.
 stomach pain and cramps.
 dry mouth.
 headache.
 nervousness.
 mood changes.
 small pupils (black circles in the middle of the eyes.
 difficulty urinating or pain when urinating.
Dosage calculation:
3. ATROPINE SULPHATE
Class: Anticholinergic
Mechanism of action: action of atropine is the inhibition of smooth muscle and glands
innervated by postganglionic cholinergic nerves. It also has central nervous system activity,
which may be stimulating or depressing depending upon the dose. Following the administration
of usual clinical doses, atropine produces stimulation of the medulla and higher cerebral centers.
This effect is manifested by mild central vagal excitation and moderate respiratory stimulation.
Atropine sulfate also acts peripherally as a competitive antagonist of the muscarinic actions of
acetylcholine. It does not prevent the release of acetylcholine but antagonizes the effect of
acetylcholine on the effector cells. These actions include vasodilation, drying of the mouth, an
increase in the pulse rate, inhibition of contractions of the gastrointestinal tract, ureter, and
bladder, and reduction of salivary, bronchial, gastric and sweat gland secretions. Following
clinical and larger doses, atropine sulfate causes dilation of the pupils and paralysis of
accommodation and in narrow-angle glaucoma, can increase intraocular pressure.
Indication & dosage: indicated for temporary blockade of severe or life-threatening muscarinic
effects, e.g., as an antisialagogue, an antivagal agent, an antidote for organophosphorus or
muscarinic mushroom poisoning, and to treat bradyasystolic cardiac arrest. Dosage is 0.5-1 mg q
3-5 min
Contraindication: Atropine generally is contraindicated in patients with glaucoma, pyloric
stenosis, thyrotoxicosis, fever, urinary tract obstruction and ileus.
Side effects:
 eye irritation and redness.
 swelling of the eyelids.
 sensitivity to bright light.
 dry mouth.
 red or dry skin.
 blurred vision.
Dosage calculation:
4. DOPAMINE
Class: catecholamine neurotransmitter 
Mechanism of action: Dopamine interacts with specific membrane receptors to produce its
effects. These effects are terminated by re-uptake into the presynaptic neuron by a dopamine
transporter, or by metabolic inactivation by monoamine oxidase B (MAO-B) or catechol-0-
methyltransferase (COMT)
Indication & dosage: Dopamine is a peripheral vasostimulant used to treat low blood pressure,
low heart rate, and cardiac arrest. Low infusion rates (0.5 to 2 micrograms/kg per minute) act on
the visceral vasculature to produce vasodilation, including the kidneys, resulting in increased
urinary flow.
1-5 mcg/kg/min IV (low dose): May increase urine output and renal blood flow
5-15 mcg/kg/min IV (medium dose): May increase renal blood flow, cardiac output, heart rate,
and cardiac contractitlity.
20-50 mcg/kg/min IV (high dose): May increase blood pressure and stimulate vasoconstriction;
may not have a beneficial effect in blood pressure; may increase risk of tachyarrhythmias
Contraindication: contraindicated in patients with pheochromocytoma or uncorrected
tachyarrhythmias including ventricular fibrillation and ventricular tachycardia. Reduce the
dopamine dose if an increased number of ectopic beats is observed. Correct hypovolemia before
dopamine administration.
Side effects:
 a light-headed feeling, like you might pass out (even while lying down);
 chest pain;
 fast, slow, or pounding heartbeats;
 shortness of breath;
 cold feeling, numbness, or blue-colored appearance in your hands or feet; or.
 darkening or skin changes in your hands or feet.
Dosage calculation:
 1 ampoule= 200mg/5ml
 AMOUNT OF DRUG NEEDED per 50 ml infusion solution:
 Amount of drug to dilute = Body weight × 3
 Ex. 70 kg × 3= 210 mg
  Amount of drug = 210mg ×5ml = 5.25ml
200mg
 PREPARATION: 44.75 ml NSS +5.25ml drug = 50ml
 1ml = 210mg x 1000 = 4200mcg
50 ml
 RATE OF INFUSION: mcg x body weight × 60 min
drug concentration
 Example: 5 mcg x 70 x 60 = 5 m/hr
4,200 mcg

5. DOBUTAMINE
Class: Inotropic Agent
Mechanism of action: Dobutamine's ionotropic effect increases contractility, leading to
decreased end-systolic volume and, therefore, increased stroke volume. The increase in stroke
volume leads to an augmentation of the cardiac output of the heart.
Indication & dosage: Dobutamine is indicated for patients who require positive inotropic
support in the treatment of cardiac decompensation due to depressed contractility resulting either
from organic heart disease or from cardiac surgical procedures, especially when a low cardiac
output is associated with raised pulmonary capillary. Dosage 0.5-1 mcg/kg/min IV continuous
infusion initially, then 2-20 mcg/kg/min; not to exceed 40 mcg/kg/min.
Contraindication: contraindicated in patients with acute myocardial infarction, unstable angina,
left main stem disease, severe hypertension, arrhythmias, acute myocarditis or pericarditis,
hypokalemia and idiopathic hypertrophic sub-aortic stenosis.
Side effects:
 rarely reduce the potassium concentrations to hypokalemic levels
 Other rare adverse effects have occurred in one to three percent of the patients, including
nausea, headaches, chest pain, palpitations, and shortness of breath
Dosage calculation:
 1 ampule= 250mg/5mL
 AMOUNT OF DRUG NEEDED in 50 ml solution
 Amount of drug = body weight 3
  Ex. 70 kg × 3= 210 mg
 Amount of drug in ml = 210mg ×5ml = 4.2ml
250MG
 PREPARATION: 45.8 ml NSS + 4.2ml drug = 50 ml
 Rate of Infusion: mcg x body weight × 60 min
Drug concentration
 Example: 4 mcg × 70 kg × 60 = 4ml/hr
4200 mcg/ml

6. ISOPROTERENOL
Class: beta-1 and beta-2 adrenergic receptor agonist
Mechanism of action: Increased heart rate. Increased heart contractility. Relaxation of bronchial,
gastrointestinal, and uterine smooth muscle. Peripheral vasodilation.
Indication & dosage: Indicated For mild or transient episodes of heart block that do not require
electric shock or pacemaker therapy. For serious episodes of heart block and Adams-Stokes
attacks (except when caused by ventricular tachycardia or fibrillation). Dosage- IV bolus: 0.02-
0.06 mg (1-3 mL of a 1:50,000 dilution), initially, THEN doses of 0.01-0.2 mg.
IV infusion: 5 mcg/min (1.25 mL of a 1:250,000 dilution), initially, THEN doses of 2-20
mcg/min based on patient's response.
Contraindication: Use of isoproterenol hydrochloride injection is contraindicated in patients
with tachyarrhythmias; tachycardia or heart block caused by digitalis intoxication; ventricular
arrhythmias which require inotropic therapy; and angina pectoris.
Side effects:
 Headache.
 Dizziness.
 Upset stomach.
 Flushing.
 Fatigue.
 Nervousness.
 Diaphoresis.
 Blurred vision.
 Dosage calculation:
IV infusion via peripheral administration (in emergencies):
The dose used for severe bradycardia is 1 – 4micrograms/min given by intravenous infusion.
 Isoprenaline sulfate 5mg/5ml injection (unlicensed)
 Remove 2.25ml from a 500ml bag of 5% Glucose
 Add 2.25mls (2.25mg) of isoprenaline to a 500ml bag of 5% Glucose Agitate to mix
 Do NOT use Sodium Chloride 0.9%
This provides a final concentration of 2mg in 500mls (isoprenaline hydrochloride), which is
equivalent to 4micrograms/ml.
Commence infusion at a rate of 1micrograms/min (15mls/hr).
Dose in microgram/min 1 2 3 4 5 6 7 8 9 10
Infusion rate (ml/hr) 15 30 45 60 75 90 105 120 135 150

 Consider titrating up in steps of 1microgram/min at intervals of 2-3 minutes, until a

satisfactory heart rate is achieved or adverse effects such as hypotension or ventricular
arrhythmias occur.
(Usual max: 10micrograms/min)

7. EPINEPHRINE
Class: alpha- and beta-adrenergic agonists.
Mechanism of action: Through its action on alpha-1 receptors, epinephrine induces increased
vascular smooth muscle contraction, pupillary dilator muscle contraction, and intestinal sphincter
muscle contraction.
Indication & dosage: indicated in the emergency treatment of type I allergic reactions, including
anaphylaxis. It is also used to increase mean arterial blood pressure in adult patients with
hypotension associated with septic shock. Dosage-
IV
Recommended dose: 0.5-1.0 mg (5-10 mL)
During a resuscitation effort, 0.5 mg (5 mL) IV q5min
Intracardiac
Intracardiac injection if there has not been sufficient time to establish an IV route
Usual dose ranges from 0.3-0.5 mg (3-5 mL)
Endotracheal tube
Alternatively, if the patient has been intubated, epinephrine can be injected via the endotracheal
tube directly into the bronchial tree at the same dosage as for IV injection
2-2.5 mg q3-5min until IV/IO access established or spontaneous circulation restored
Contraindication: There are no absolute contraindications against using epinephrine. Some
relative contraindications include hypersensitivity to sympathomimetic drugs, closed-angle
glaucoma, anesthesia with halothane. Another unique contraindication to be aware of is
catecholaminergic polymorphic ventricular tachycardia.
Side effects: common side effects include: -
 Tachycardia
 Hypertension
 Headache
 Anxiety
 Apprehension
 Palpitations
 Diaphoresis
 Nausea
 Vomiting
 Weakness and tremors
Dosage calculation:
 1 ampoule = 1ml1mg
 PREPARATION: 12 ml of Adrenaline + 38 ml D5W = 50 ml
 DRUG CONCENTRATION = 12 mg/ 50 ml=0.24mg
 0.24mg x1000= 240mcg / ml
 Rate of Infusion: Desired dose × 60 = ml/hr
240mcg
 Example: 2mcg × 60 min = 0.5 ml/hr
240mcg

8. SODIUM BICARBONATE
Class: Alkalinizing Agent
Mechanism of action: The main therapeutic effect of sodium bicarbonate administration is
increasing plasma bicarbonate levels, which are known to buffer excess hydrogen ion
concentration, thereby raising solution pH to combat clinical manifestations of acidosis.
Indication & dosage: Sodium Bicarbonate Injection, USP is indicated in the treatment of
metabolic acidosis which may occur in severe renal disease, uncontrolled diabetes, circulatory
insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac
arrest and severe primary lactic acidosis. Dosage- 1 mEq/kg/dose IV x1; base subsequent doses
on results of arterial blood pH and PaCO2 as well as calculation of base deficit
Contraindication: Due to rapid alkalotic effects, sodium bicarbonate is contraindicated in those
with signs/symptoms or laboratory values indicating underlying metabolic or respiratory
alkalosis due to the potential for exacerbation of symptoms.
Side effects:
 Metabolic alkalosis.
 Headache.
 Muscle pain and twitching.
 Nausea or vomiting.
 Bradypnea.
 Nervousness or restlessness.
 Unpleasant taste.
 Increased frequency in urination.
Dosage calculation:

ANTIARRHYTMICS

1. ADENOSINE
Class: class V antiarrhythmic agent
Mechanism of action: Adenosine has a role in slowing down the heart rate enough to assist in
diagnosis. It can also terminate specific reentrant tachycardia involving the AV node, including
AV nodal reentrant tachycardia (AVNRT), orthodromic AV reentrant tachycardia (AVRT), and
antidromic AVRT.
Indication & dosage: Adenosine is indicated as an adjunct to thallium-201 in myocardial
perfusion scintigraphy in patients unable to adequately exercise. It is also indicated to convert
sinus rhythm of paroxysmal supraventricular tachycardia. Build, train, & validate predictive
machine-learning models with structured datasets. Dosage- Adenocard: 6 mg IVP over 1-3
seconds (maybe given IO) followed by rapid flush with 20 mL NS, if no conversion within 1-2
minutes, give 12 mg IVP, repeat a second time if necessary (30 mg total).
Contraindication: contraindicated in patients with known adenosine hypersensitivity. Dyspnea,
throat tightness, flushing, erythema, rash, and chest discomfort have occurred after adenosine
administration. Symptomatic treatment may be required.
Side effects:
 Diarrhea.
 feeling of warmth.
 indigestion.
 loss of appetite.
 nausea or vomiting.
 passing of gas.
 redness of the face, neck, arms, and occasionally, upper chest.
 stomach pain, fullness, or discomfort.
Dosage calculation:

2. VERAPAMIL
Class: calcium-channel blocker
Mechanism of action: Verapamil is in a class of medications called calcium-channel blockers. It
works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases
the supply of blood and oxygen to the heart and slows electrical activity in the heart to control
the heart rate.
Indication & dosage: The Food and Drug Administration (FDA) approved indications for
verapamil include angina (chronic stable, vasospastic or Prinzmetal variant), unstable angina
(crescendo, preinfarction), hypertension as add-on therapy, paroxysmal supraventricular
tachycardia (PSVT) prophylaxis, and supraventricular tachycardia (SVT). Dosage- 80 mg PO
q8hr initially; usual range: 80-120 mg PO q8hr; not to exceed 480 mg/day
Contraindication: Verapamil should not be used in those with HCM and systemic hypotension
or severe difficulty breathing at rest.
Side effects:
 Constipation.
 Feeling or being sick (nausea or vomiting)
 Flushing of the face and neck.
 Headaches.
 Feeling dizzy or tired.
 Swollen hands, ankles or feet.
Dosage calculation:

3. DILTIAZEM
Class: calcium-channel blocker
Mechanism of action: Diltiazem inhibits the inflow of calcium ions into the cardiac muscle
during depolarization. Reduced intracellular calcium concentrations increase smooth muscle
relaxation, resulting in arterial vasodilation and decreased blood pressure.
Indication & dosage: It is used in many clinical scenarios as an antihypertensive, anti-
arrhythmic, and anti-anginal. FDA-approved indications include atrial arrhythmia, hypertension,
paroxysmal supraventricular tachycardia, and chronic stable angina. Dosage-
Angina
Conventional: 30 mg PO q6hr; increased every 1 or 2 days until angina controlled (usually 180-
360 mg/day PO divided q6-8hr); not to exceed 360 mg/day
Cardizem CD, Cartia XT, Dilt-CD: 120-180 mg/day PO; titrate over 7-14 days; maintenance
range usually 120-320 mg/day; not to exceed 480 mg/day
DilacorXR, Dilt-XR: 120 mg/day PO; titrate after 7-14 days; maintenance range usually 120-
320 mg/day; not to exceed 540 mg/day
Tiazac, Taztia XT: 120-180 mg/day PO; titrate after 7-14 days; maintenance range usually 120-
320 mg/day; not to exceed 540 mg/day
Cardizem LA, Matzim LA: 180 mg/day PO; titrate after 14 days; maintenance range usually
120-320 mg/day; not to exceed 360 mg/day

Hypertension
Cardizem CD, Cartia XT, Dilt-CD: 180-240 mg/day PO; titrate after 14 days; maintenance
range usually 180-420 mg/day; not to exceed 480 mg/day
Dilacor XR, Dilt-XR: 180-240 mg/day PO; titrate after 14 days; maintenance range usually 180-
420 mg/day; not to exceed 540 mg/day
Tiazac, Taztia XT: 120-240 mg/day PO; titrate after 14 days; maintenance range usually 180-
420 mg/day; not to exceed 540 mg/day
Cardizem LA, Matzim LA: 180-240 mg/day PO; titrate after 14 days; maintenance range usually
120-540 mg/day
Extended-release twice-daily dosing: 60-120 mg PO q12hr; may be adjusted after 14 days;
maintenance range usually 240-360 mg/day

Paroxysmal Supraventricular Tachycardia

0.25 mg/kg (average adult dose, 20 mg) direct IV over 2 minutes; after 15 minutes, may repeat
bolus by administering 0.35 mg/kg actual body weight over 2 min (average adult dose, 25 mg)
direct IV if first dose tolerated but response inadequate; some clinicians suggest additional
doses q15min
Use weight-based dosing for lower-body-weight patients
Continuous infusion: 10 mg/hr IV initially; increased to no more than 15 mg/hr for up to 24
hours

Atrial Fibrillation/Flutter
0.25 mg/kg (usual adult dose, 20 mg) direct IV over 2 minutes; after 15 minutes, may repeat
bolus by administering 0.35 mg/kg actual body weight over 2 min (average adult dose, 25 mg)
direct IV if first dose tolerated but response inadequate; some clinicians suggest additional
doses q15min
Use weight-based dosing for lower-body-weight patients
Continuous infusion: 10 mg/hr IV initially; increased to no more than 15 mg/hr for up to 24
hours
Contraindication: contraindicated in patients with sick sinus syndrome except in the presence of
a functioning ventricular pacemaker. Patients with second- or third-degree AV block except in
the presence of a functioning ventricular pacemaker. Patients with severe hypotension or
cardiogenic shock.
Side effects:
 dizziness or lightheadedness.
 flushing.
 headache.
 weakness.
 slow heartbeat.
 vomiting.
 diarrhea.
 constipation.
Dosage calculation:

4. LIDOCAINE
Class: class Ib antiarrhythmic agent
Mechanism of action: lidocaine slows the rise of the cardiac action potential during phase 0,
thereby increasing the effective threshold potential.
Indication & dosage: Indicated for ventricular arrhythmias, particularly those associated with
acute myocardial infarction. It has been shown to terminate ventricular tachycardia, and it has
been given to suppress multiple ventricular extrasystoles. Dosage-
1-1.5 mg/kg slow IV bolus over 2-3 minutes
May repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to 3 mg/kg total if refractory VF or
pulseless VT
Continuous infusion: 1-4 mg/min IV after return of perfusion
Administer 0.5 mg/kg bolus and reassess infusion if arrhythmia reappears during constant
infusion
If IV not feasible may use IO/ET
Endotracheal (loading dose): 2-3.75 mg/kg (2 to 2.5 recommended IV dose); dilute in 5-10 mL
0.9% saline or sterile water
Contraindication: contraindicated in patients with a known history of hypersensitivity to local
anesthetics of the amide type. The following conditions preclude the use of spinal anesthesia:
Severe hemorrhage, shock or heart block. Local infection at the site of proposed puncture.
Side effects:
 Bluish-colored lips, fingernails, or palms blurred or double vision.
 chest pain or discomfort.
 cold, clammy, pale skin.
 continuing ringing or buzzing or other unexplained noise in the ears.
 cough.
 dark urine.
 difficulty breathing.
 difficulty swallowing.
Dosage calculation:

5. AMIODARONE
Class: antiarrhythmic
Mechanism of action: blocks potassium currents that cause repolarization of the heart muscle
during the third phase of the cardiac action potential. As a result amiodarone increases the
duration of the action potential as well as the effective refractory period for cardiac cells
(myocytes).
Indication & dosage: indicated for the treatment of recurrent hemodynamically unstable
ventricular tachycardia and recurrent ventricular fibrillation
Contraindication: You should not use amiodarone if you have: a serious heart condition called
"AV block" (2nd or 3rd degree), unless you have a pacemaker; a history of slow heartbeats that
have caused you to faint; or. if your heart cannot pump blood properly Dosage-
Stable Monomorphic or Polymorphic Ventricular Tachycardia (Off-label)
150 mg IV bolus in 10 minutes; may repeat q10min as necessary, THEN
1 mg/min IV for 6 hours, THEN
0.5 mg/min IV for 18 hours; not to exceed 2.2 g/24hr
For breakthrough episodes of VF or hemodynamically unstable VT , repeat the initial load

ACLS, Pulseless Ventricular Fibrillation/Ventricular Tachycardia (Off-label)

300 mg IV or intraosseous push after dose epinephrine if no initial response to defibrillation
May follow initial dose with 150 mg IV q3-5min

Ventricular Arrhythmias
PO
Load: 800-1600 mg PO qDay for 1-3 weeks until response; once adequate arrhythmia control
achieved, reduce dose to 600-800 mg/day for 1 mo; THEN reduce to maintenance dose
Maintenance dose: 400 mg PO qDay
IV
150 mg over first 10 min (15mg/min), followed by 360 mg over next 6 hr (1 mg/min), THEN 540
mg over remaining 18 hr (0.5 mg/min), for a total of 1000 mg over 24 hr before administering
maintenance infusion
Maintenance: 0.5 mg/min for a total 720 mg/24hr at a concentration of 1-6 mg/mL (360
mg/200mL), or 1.8 mg/mL Nexterone at rate of 278 mL/min
Duration of therapy: May continue to administer 0.5 mg/min for 2-3 weeks regardless of
patient's age, renal function or ventricular function
Side effects:
 constipation.
 loss of appetite.
 headache.
 decreased sex drive.
 difficulty falling asleep or staying asleep.
 flushing.
  changes in ability to taste and smell.
 changes in amount of saliva.
Dosage calculation:
 1 ampoule = 150 mg (3ml)
 LOADING DOSE: 1 ampule (150 mg /3 ml) + 12 ml D5W
 MAINTANENCE DOSE: 360 mg in 6 hours
 360 mg × 3 ml = 7.2 ml
150 mg
 7.2 ml (amiodarone) + 42.8 ml D5%W = 50 ml = 8.3 ml/hr B. 540 mg in 18 hours
 540 mg x 3 ml = 10.8 ml
150 mg
 10.8 ml (amiodarone) + 39.2 ml D5%W= 2.7ML /hr

6. PROCAINAMIDE
Class: class 1A anti-arrhythmic
Mechanism of action: binds to fast sodium channels inhibiting recovery after repolarization. It
also prolongs the action potential and reduces the speed of impulse conduction.
Indication & dosage: treat ventricular arrhythmias, supraventricular arrhythmias, atrial flutter,
atrial fibrillation, AV nodal re-entrant tachycardia, and Wolf-Parkinson-White syndrome.
Dosage-
Arrhythmia
Adjust dose to patient's response
IM Administration
0.5-1 g IM q4-8hr
IV Administration
Loading dose: 100-200 mg/dose or 15-18 mg/kg; infuse slowly over 25-30 min not to exceed 50
mg/min; may repeat q5min PRN not to exceed 1 g
Contraindication: contraindicated in patients with second- or third-degree AV block, unless
controlled by a pacemaker, due to the risk of additive cardiac depression. In general, use
procainamide cautiously in patients with certain types of cardiac disease.
Side effects:
  cardiac toxicity
 bradycardia
 hypotension
 drug-induced lupus erythematosus-like syndrome and blood dyscrasias.
 QRS, QTc, and PR prolongation are the most potentially harmful cardiac side effects of
procainamide and may become worse when levels of procainamide rise.
Dosage calculation:

Drugs can be used during Cardiac Arrest:

• Adrenalin Injection, 0.1mg/ml
• Amiodarone Injection, 50mg /ml Atropine sulfate Injection, 1mg/ml in 1 ml ampoule
• Lidocaine Injection 5mg/ml,10mg/ml, 20mg/ml in 20ml vial
• Magnesium Sulfate Injection, 2%, 5%, 10%, 20%, 50% in 20ml
• Procainamide Hydrochloride Injection,100mg/ml in 10ml vial
• Sodium Chloride Injection 0.9% (Normal Saline), 10ml, 20ml, 500ml,1000ml;
235mg/ml, 3% in 500ml Injection, 30%- 30mg in 10ml
• Oxygen inhalation etc.

Nurse’s responsibilities in administration cardiac emergency drugs:

• To ensure safe medication administration, the nurse should be aware of what is ordered,
and need to recognize when a prescribed dose of a medication is too high or low.
• More education and experience are associated with improved patients‟ safety. When
administering medications, Nurses are accountable for knowing why the medication is being
used, what are the possible side effects to be monitored. Steps to nursing standard called 6 rights
of medication administration that includes right medication, right dose, right client, right route,
right time, and right documentation.
• Report all medication errors that do and do not harm patients.
• Understanding potential errors may provide key information on how medication errors as
a whole can be prevented.
• Nurses working in an environment where individuals are punished for making mistakes
can result in omission of error reporting and encourage hiding mistakes, ultimately making it
difficult to identify errors and to prevent them from happening.
• Nurse has to monitor vital signs TPR & BP timely/as and when required. Nurse also has
to monitor excessive sweating, shaking of extremities etc.

CONCLUSION
Nurses must have thorough knowledge regarding cardiac emergency drugs in terms of dose,
route, side effects, classification, care, prevention of side effects etc. while handling with the
mentioned drugs. Nurse also updates her knowledge with regard to cardiac emergency drugs
timely/periodically by reading journals, attending workshops, conferences, training programs etc.

REFERENCES
1. https://reference.medscape.com/drug/procanbid-pronestyl-procainamide-342306
2. https://go.drugbank.com/drugs/DB00640#
3. https://www.ncbi.nlm.nih.gov/books/NBK535451/
4. Soar J, Donnino MW, Andersen LW, Berg KM, Böttiger BW, Callaway CW, Deakin
CD, Drennan I, Neumar RW, Nicholson TC, O’Neil BJ, Paiva EF, Parr MJ, Reynolds JC,
Ristagno G, Sandroni C, Wang TL, Welsford M, Nolan JP, Morley PT. Antiarrhythmic
drugs for cardiac arrest in adults and children consensus on science and treatment
recommendations. Brussels, Belgium: International Liaison Committee on Resuscitation
(ILCOR) Advanced Life Support Task Force. 2018.
5. https://chemm.hhs.gov/countermeasure_atropine-sulfate.htm#:~:text=Mechanism%20of
%20action,depressing%20depending%20upon%20the%20dose
6. Lee YH, Lee KJ, Min YH, Ahn HC, Sohn YD, Lee WW, Oh YT, Cho GC, Seo JY, Shin
DH, Park SO, Park SM. Refractory ventricular fibrillation treated with esmolol.
Resuscitation. 2016; 107:150–155. doi: 10.1016/j.resuscitation.2016.07.243