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by evans_c1

Hey I am taking a BSN course and need some help with a question:
Pt. is suffering from v-tach. do you suggest an alpha or beta blocker to alleviate symptoms/signs and why. I know both are sometimes used together but I don't work telemetry. thanks!

[rninme]

Re: V-tach question

stable vs unstable??

There is a big difference in treatment.

[evans_c1]

Re: V-tach question

stable..sorry

[mced]

Re: V-tach question

I would suggest a load of amiodarone to break the V-tach followed by a beta-1 blocker such as metoprolol once they were in a more life-sustaining rhythm.

[mced]

Re: V-tach question

Oh, forgot the why part. Most beta blockers will block circulating catecholamines such as norepinephrine, epinephrine, etc... and have a membrane stabilizing effect that decrease the chances of future tachyarrhythmias.

[rninme]

Re: V-tach question

ok....first, treatment is patient dependent....what is the underlying disease process.

Given the little info.....lol........I'd say beta-blockers.
cardioselective beta-blockers: Primarily act (low doses only) to block stimulation of Beta-receptors in the heart, particularly in the SA and AV nodes, decreasing hr and reducing contractility----lowering CO, w/o blocking beta-2 receptors which would cause bronchoconstriction.
Examples would be: metroprolol, atenolol, esmolol, acebutelol

amiodarone....non-competitive alpha and beta-blocker....also has calcium channel blocking properties.....used as a treatment for vfib and pulseless...not stable vt that is refractory to other antiarrhythmics.

[rjflyn]

Re: V-tach question

ACLS my friends calls for lidocaine or amiodarone for monomorphic VT. For polymorphic VT (torsodes)its asks one to look at the QT interval if its nomal/short the tx is the same, if long the recommendation is magnesium.

http://www.acls.net/newalgo/stach.htm

Rj

[NYNewGrad]

Re: V-tach question

Originally Posted by rjflyn

ACLS my friends calls for lidocaine or amiodarone for monomorphic VT. For polymorphic VT (torsodes)its asks one to look at the QT interval if its nomal/short the tx is the same, if long the recommendation is magnesium.

http://www.acls.net/newalgo/stach.htm

Rj

2005 ACLS algorithm (took the course yesterday) - stable vtach - amiodarone 150mg over 10 min, repeat as needed to max 2.2g/24hrs. And prepare for synchronized cardioversion.

[zacarias]

Re: V-tach question

Sotalol and Amiodarone are the main drugs to treat stable v-tach in my area.

[MARIAN202]

Re: V-tach question

I WOULD SUPPORT AS MY FIRST LINE OF DEFENSE ADENOSINE
STABLE SVT
UNDEFINED STABLE NARROW TACHYCARDIA AS A DIAGNOSTIC MANEUVER
NOT EFFECTIVE IN AFIB, AFLUTTER. OR VT
MECHANISM OF ACTION:
DEPRESS SA & AV NODE ACTIVITY
SLOW AV CONDUCTION
HALF LIFE= 5 SECONDS
PRECAUTIONS:
USUALLY SEE BRIEF ASYSTOLE AFTER ADM OF DRUG
DRUG INTERACTION WITH THEOPHYLLINE, DIPYRIDAMOLE,
7 CARBAMAZEPINE
PT FEEL FLUSHING, DYSPNEA, TRANSIENT CP
DOSE FOLLOWED BY IV PUSH MEDS WITH FLUID BOLUS 10-20 ML
6 MG IV OVER 1-3 SECONDS FOLLOWED BY 20 ML SALINE FLUSH THEN ELEVATE ARM (ATTACH BOTH SYRINGES TO SAME PORT) WAIT 1-2"

REPEAT 12 MG IV RAPID PUSH WAIT 1-2'

REPEAT 12 MG IV RAPID IV PUSH

AMIODARONE (CARDARONE)
WOULD BE MY SECOND LINE OF DEFENSE FOR VF/ PULSELESS VT
VENT ARRTHYTHMIAS -SYMPT PVCs
PREFERRED OVER LIDO
MECHANISM OF ACTION:
ANTI ARRTHYTHMIC POSSESSES ALFA AND BETA ANDRENERGIC BLOCKING
PROLONGS ACTION POTENTIAL DURATION
PROLONGS REFRACTORY PEROID DECREASES AV NODE CONDUCTION
DECREASES SINUS NODE FUNCTION
PRECAUTIONS
HALF LIFE IS LONG
MAY PROLONG QT
MONITOR BP, HR, QT INTERVALS

CONTRAINDICATED IN:
CARDIOGENIC SHOCK, MARKED SINUS BRADY, 2ND OR 3RD BLOCK
DOSE:
300MG IV PUSH IN CARDIAC ARREST (VT/VF)
150 MG IV PUSH FOR TACCHYS WITH PULSE (GIVE OVER 10 MINUTES)
CAN REPEAT ONE 150 MG IN 5 MINS.

DRAW 2 GLASS AMPLES THROUGH A LARGE GAUGE NEEDLE DILUTED IN 20-30 ML OF D5W

MAINTENANCE INFUSION:
1MG/MIN OVER 6 HRS. THEN
0.5 MG/MIN OVER 18 HRS.
MAX OF 2.2 G OVER 24 HRS.