Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Emergency Drugs - Cardiac

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Check all doses with BNF or equivalent UK guidelines

DRUG (UK Name)	MOA	DOSE IV	DOSE PO	INDICATION	CONTRAINDICATION / CAUTION
Adenosine	Acts on A1 receptors in the AV node to transiently block conduction	6 mg IV rapid push; if no effect, 12 mg IV after 1–2 min; may repeat 12 mg once	N/A	Stable SVT, stable narrow complex tachycardia	Avoid in 2nd/3rd degree AV block without pacing; can cause transient bradycardia/asystole; check BNF for pregnancy
Amiodarone	Class III antiarrhythmic (K+ channel block), also Class I, II, IV effects	VF/VT arrest: 300 mg IV push, then 150 mg if needed Stable wide complex tachy: 150 mg IV over 10 min, then infusion (1 mg/min x6h, then 0.5 mg/min)	N/A	VF/VT, wide complex tachyarrhythmias	Hypotension, potential proarrhythmia; long half-life; check BNF for pregnancy advice
Atropine	Anticholinergic, reduces vagal influence on SA/AV node	Organophosphate poisoning: 1–6 mg IV every 3–5 min until secretions stop Paediatric bradycardia: 0.02 mg/kg IV once (max single 0.5 mg, max total 1 mg) Adult bradycardia: 0.5 mg IV every 3–5 min (max 3 mg)	N/A	Bradycardia, organophosphate/carbamate poisoning	Hyperthermia, tachyarrhythmias; consult BNF for pregnancy
Calcium Gluconate/Chloride	Increases serum Ca²⁺, stabilises cardiac membrane	Typically 10% solution: 1 g (in 10 mL) IV	N/A	Hyperkalaemia, hypocalcaemia with arrhythmias	CaCl is more irritant and 3x more potent than Ca gluconate; central line preferred for CaCl; check BNF for pregnancy
Diltiazem	Non-dihydropyridine Ca²⁺ channel blocker; slows AV conduction	0.25 mg/kg IV bolus, may repeat 0.35 mg/kg IV after 15 min; infusion 5–15 mg/h	N/A	Stable AF with RVR, stable SVT	May cause hypotension, bradycardia; use caution in heart failure; check BNF for pregnancy
Dobutamine	Beta-1 agonist (with some Beta-2)	2–20 micrograms/kg/min IV infusion	N/A	Acute heart failure, cardiogenic shock	Tachycardia, arrhythmias; ensure adequate volume status; check BNF for pregnancy
Dopamine	Alpha, Beta-1, and dopaminergic receptor agonist (dose-dependent)	<5 micrograms/kg/min (renal/dopaminergic - not typically recommended) 5–10 micrograms/kg/min (beta effects) 10–20 micrograms/kg/min (alpha effects)	N/A	Hypotension, heart failure	Arrhythmias, tissue necrosis with extravasation (use central line); check BNF for pregnancy
Adrenaline (Epinephrine)	Alpha and Beta agonist	Cardiac arrest: 1 mg of 1:10,000 IV every 3–5 min Anaphylaxis: 0.5 mg of 1:1,000 IM (adults) Hypotension/shock: 1–10 micrograms/min IV infusion (titrate)	N/A	Cardiac arrest, anaphylaxis, severe hypotension, severe asthma	Risk of arrhythmias, extravasation injury; verify doses carefully; consult BNF for pregnancy
Esmolol	Short-acting selective Beta-1 blocker	500 micrograms/kg IV loading, then 50–300 micrograms/kg/min infusion	N/A	Aortic dissection (rate control), arrhythmias	Can precipitate heart failure, hypotension, bronchospasm; check BNF for pregnancy
Furosemide (Frusemide)	Loop diuretic inhibiting Na⁺/K⁺/2Cl⁻ in ascending loop	20–40 mg IV initially, reassess; can go up to 200 mg single dose if needed	N/A	Acute pulmonary oedema, fluid overload states	Hypovolaemia, electrolyte depletion, ototoxicity; check BNF for pregnancy
Labetalol	Combined alpha and beta blocker	Bolus: 20–80 mg IV every 10 min PRN; Infusion: 1–8 mg/min titrated	N/A	Hypertensive emergencies	Can precipitate heart failure, bradycardia, bronchospasm; check BNF for pregnancy
Magnesium Sulfate	Essential electrolyte, membrane stabiliser, reduces neuromuscular excitability	Eclampsia: 2–4 g IV load over ~5 min Torsades: 2 g IV push Asthma: 2 g IV over 15 min	N/A	Eclampsia, torsades de pointes, severe asthma	Hypotension if given rapidly, respiratory depression if overdosed; safe in pregnancy (commonly used for eclampsia)
Glyceryl Trinitrate (GTN, Nitroglycerin)	Venodilator, increases cGMP	5–200 micrograms/min IV, increase by 10 micrograms every 3–5 min until desired effect	N/A	Angina, CHF, acute pulmonary oedema	Hypotension, headache, rare methemoglobinaemia; check BNF for pregnancy
Sodium Nitroprusside	Direct vasodilator via NO release	Start at 0.3 micrograms/kg/min IV, titrate; max 10 micrograms/kg/min. If no control after 10 min at max, stop.	N/A	Hypertensive emergencies	Cyanide toxicity (prolonged infusion), methemoglobinaemia, hypotension; check BNF for pregnancy
Norepinephrine (Noradrenaline)	Potent alpha-1 > beta-1 agonist	1–30 micrograms/min IV infusion (titrate to BP)	N/A	Refractory hypotension (septic shock, other shock states)	Arrhythmias, extravasation injury (use central line); check BNF for pregnancy

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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