Commonly Used IV Cardiac

Medications for Adults

Commonly Used IV
Cardiac Medications
for Adults
This pocket reference contains information for nurses
about vasoactive intravenous medications.

NOTE: This pocket reference card is for quick reference only

and is not an all-inclusive resource. Dose adjustments may
need to be made for older adults or for those with renal

x≤
impairment or other organ dysfunction. Please review and
120procedures P
follow your institutional policies and beforeC
÷=+
clinical use. For additional questions
80about these medications,
including drug interactions, refer to a pharmacology resource
I
or call the pharmacy department140 at your institution. O

To order more cards, call

1 (800) 899-AACN or visit www.aacn.org. Prod #400820
Copyright ©2019 American Association of Critical-Care Nurses REV 11/19
Antidysrhythmic Medications
Generic Name Uses Therapeutic Effects Adverse Effects Dose/Half-Life (Adult) Key Considerations
Adenosine PSVT, WPW. Slows AV node con- Cardiac arrest, Initially give 6 mg IV over 1-2 sec. Use port closest to insertion site.
Not effective duction; interrupts bradycardia, MI, If no response within 1-2 min, give Follow with rapid bolus of 20 mL
in AFib/flutter reentry pathways AV block, 12 mg rapid IV push. 0.9% NS flush.
or VT bronchospasm, Half-life: less than 10 sec
hypotension,
flushing, chest
discomfort
Amiodarone Treatment and Prolongs action Hypotension, Pulseless VT or VF: After EPINEPH- Use solutions held in polyvinyl
prophylaxis for potential phase 3, cardiac arrest, rine with no response to defibrilla- chloride bags within 2 h of dilution.
patients with prolongs refractory dysrhythmias, tion, give 300 mg IV push. Use solutions held in glass or
unstable VT/VF period, decreases ARDS, CHF, Ventricular dysrhythmias: 150 mg IV polyolefin containers within 24 h
SA node function abnormal liver over 10 min; follow with infusion of 1 of dilution.
and AV conduction and thyroid mg/min x 6 h, then 0.5 mg/min for 18 h. Central vein route preferred
function tests,
Maintenance IV dose: 0.5 mg/min. Needs in-line filter
prolonged
PR and QTc Recommended maximum IV
intervals dose is 2.2 gm in 24 h
Half-life: 28 d
Atropine Acute Increases HR Doses less 0.5 mg IV push, repeat every 3–5 If atropine fails to increase HR,
symptomatic by reversing than 0.5 mg min to max 3 mg. consider TCP, or dopamine 2–20 mcg/
bradycardia cholinergic-mediated may cause kg/min, or epinephrine 2–10 mcg/min.
decreases in HR slowing of HR. Atropine is unlikely to work in a
Increased HR patient who has undergone
may worsen cardiac transplantation; 2nd
ischemia degree type II or 3rd degree heart
block unlikely to respond to atropine 2
Digoxin Control of Increases force Bradycardia, Loading dose: 0.25 mg IV Q 6 h x Monitor serum drug levels. Thera-
ventricular re- of contraction. heart block. 4 doses (total 1.0 mg); then peutic serum level is 0.8-2 ng/mL.
sponse in AFib/ Decreases conduc- Toxicity: 0.125-0.375 mg IV Q 24 h. Inject Toxic serum level is greater than
flutter, PSVT tion through the AV CNS and GI over 3-5 min. 2 ng/mL.
node, decreasing symptoms May also use weight-based dosing. Hypokalemia potentiates toxic effects.
ventricular rate
Anticipate reduced dose based on
creatinine clearance in patients
with severe kidney impairment.
Half-life: 1.5-2 d

Diltiazem Control of rapid Ca++ channel block- Bradycardia, IV: 0.25 mg/kg/actual body Ensure weight-based dosing for
ventricular er, slows SA, AV hypotension, weight IV over 2 min. After 15 min loading doses.
rate in AFib/ node conduction, AV block, CHF, may repeat with 0.35 mg/kg/ Cautious use in patients with
flutter, rapid causes arterial edema, rash actual body weight IV over 2 min. cardiomyopathy.
conversion of vasodilation Continuous infusion of 5-15 mg/h
SVT to NSR may be used for up to 24 h
Half-life: 3-4.5 h

Esmolol ST, SVT, Cardioselective beta Hypotension, Loading dose of 500 mcg/kg IV IV Infusion ONLY: Infuse in a large
AFib/flutter, blocker, slows sinus bradycardia, over 1 min, followed by infusion vein.
intraoperative rate, decreases CO, heart block, of 50 mcg/kg/min for 4 min; Avoid butterfly needles and very
tachycardia, or reduces BP heart failure, repeat procedure every 5 min, small veins.
hypertension bronchospasm increasing infusion by 25-50
mcg/kg/min to maximum of 200 Do not administer by direct IV injection.
mcg/kg/min Do not stop abruptly.
Half-life: 9 min Discard if discolored or contains
precipitate.

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Ibutilide Rapid conver- Prolongs action Polymorphic More than 60 kg: 1 mg IV infused Have ACLS equipment and per-
sion of AFib/ potential and repo- VT, torsades de over 10 min sonnel on hand during and after
flutter of recent larization, and slows pointes, heart Less than 60 kg: give 0.01 mg/kg administration.
onset sinus rate and AV block, QTc IV over 10 min. May repeat once Cautious use with uncorrected
conduction prolongation, after 10 min if needed electrolyte abnormalities.
hypotension,
bradycardia Half-life: 2-12 h Correct Mg++ and K+ before
administering.

Lidocaine PVCs, VT, VF Decreases depolar- Cardiac arrest, IV: 1-1.5 mg/kg IV over 2-3 min. Loading dose may be administered
ization, automaticity, bradycardia, May repeat doses of 0.5-0.75 via ETT.
excitability of the hypotension, mg/kg in 10-15 min to a total of 3 Endotracheal dose is 2-2.5 times
ventricle during CNS toxicity, mg/kg/24 h. IV dose.
diastole nausea, and Continuous infusion: 1-4 mg/min
vomiting with Monitor serum drug level.
repeated doses Half-life: 1.5-2 h Toxicity at serum level greater than
6 mcg/mL
May exacerbate mental impair-
ment in older adults

Metoprolol Treatment of Cardioselective beta Hypotension, Post MI: 5 mg IV every 2 min x 3; Overdose may cause profound
patients with blocker, decreases bradycardia, then after 15 min may administer bradycardia, hypotension, and
stable acute MI. HR, BP, and CO. CHF PO bronchospasm.
Also used off- Reduces severity of Half-life: 3-4 h May exacerbate mental impair-
label for SVT myocardial ischemia ment in older adults

4
Procainamide AFib, PSVT, Increases stimu- VF, asystole, Loading: 20-50 mg/min IV Paradoxical, extremely rapid
PVCs, VT lation threshold tachycardia, until dysrhythmia suppressed, ventricular rate may occur during
of ventricles and PR or QTc hypotension ensues, QRS treatment of patients with atrial
His-Purkinje system prolongation, duration increases greater than fibrillation (AFib) or flutter.
Decreases myocar- hypotension, 50%, or maximum dose of Infusion may need to be reduced if QRS
dial excitability and bradycardia, GI 17 mg/kg given widens 50%, or if PR interval exceeds
conduction velocity, effects Maintenance infusion: 1-4 mg/min 0.20 sec, or if BP drops rapidly.
and depresses myo- Half-life: 3-4 h Lower degrees of heart block may
cardial contractility progress to complete heart block.

Inotropic and Vasopressor Medications

All vasopressors can cause tissue necrosis if infiltration occurs. Central catheter infusion preferred. Notify provider for all infiltrations, and consult phar-
macy for possible antidote. For DOPamine and norepinephrine extravasation: Anticipate infiltrating affected area with 10-15 mL of sterile saline containing
5-10 mg of phentolamine. Consult pharmacist if phentolamine is not available.
Generic Name Uses Therapeutic Effects Adverse Effects Dose/Half-Life (Adult) Key Considerations
DOPamine Hypotension Effects are dose Tachycardia, 2-20 mcg/kg/min IV infusion. Correct hypovolemia before or
associated related. dysrhythmias, Titrate to desired BP/HR/MAP/ concurrently with DOPamine
with shock; Beta-1 stimulant 2-10 angina, vaso- SVR response infusion.
bradycardia mcg/kg/min constriction, Start with lower initial doses in
or heart block hypotension, Half-life: 2 min
increases contractility older adults due to decreased
unresponsive to headache organ function and comorbidities.
atropine/cardi- Alpha stimulant
ac pacing 10-20 mcg/kg/min
increases vasocon-
striction and BP 5
EPINEPHrine Hypotension Increases Tachycardia, 1-10 mcg/min IV infusion Monitor blood glucose levels,
unresponsive contractility acute hyperten- (average dose) because EPINEPHrine causes
to volume Increases HR sion, extreme Start at low dose and titrate insulin resistance.
resuscitation Increases SVR hyperglycemia, upward to desired BP/MAP/HR Doses less than 2 mcg/min may
or decreased ST segment response. decrease SVR, resulting in
CO requiring Relaxes smooth depression
muscle of the bron- Cardiac arrest: see ACLS protocol hypotension.
inotropic indicative of
support chial tree, produces myocardial Half-life: 2 min Do not use if solution appears
cardiac stimulation ischemia, and discolored or contains precipitate.
Beta-1, beta-2, and increasing Older adults may be more sensitive
alpha stimulant dysrhythmia to the effects of beta-adrenergic
receptor agonists.
Norepinephrine Hypotension Increases contractility Tachycardia, Start at 0.5 mcg/min IV infusion. Correct hypovolemia before
unresponsive Increases HR dysrhyth- Usual dose is 2-12 mcg/min, up to initiating.
to fluid volume mias, severe 30 mcg/min. Do not use if solution appears
resuscitation Increases SVR hypertension, Titrate to desired BP/MAP/SVR. brown or contains precipitate.
Increases systemic myocardial
BP and coronary ischemia, Half-life: 2 min Monitor for decreased peripheral
blood flow dyspnea perfusion.
Beta-1 and alpha Usually less pronounced adverse
stimulant effects than EPINEPHrine.

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Vasopressor Medications
All vasopressors can cause tissue necrosis if infiltration occurs. Central line infusion preferred. Notify provider for all infiltrations, and consult pharmacy
for possible antidote. For DOPamine and norepinephrine extravasation: Anticipate infiltrating affected area with 10-15 mL of sterile saline containing 5-10 mg
of phentolamine. Consult pharmacist if phentolamine is not available.
Generic Name Uses Therapeutic Effects Adverse Effects Dose/Half-Life (Adult) Key Considerations

Angiotensin II Hypotension Increases blood Thromboem- Start IV at 20 ng/kg/min. Dilute in 0.9% NS.
(Giapreza) in adults with pressure by bolic events May titrate every 5 min by Ensure VTE prophylaxis.
septic or other vasoconstriction increments of up to 15 ng/kg/min
distributive and increased as needed to achieve a MAP of
shock aldosterone release 75 mm Hg.
Indicated in During the first 3 hours, the
adults with maximum dose should not
septic or other exceed 80 ng/kg/min.
distributive
shock only who 3-48 hours, titrate angiotensin II
have a down by 5-15 ng/kg/min every
minimum of 2 5 min. Then titrate down other
vasopressors vasopressors.
with escalating Maintenance dose should not
doses exceed 40 ng/kg/min.

7
Phenylephrine Hypotension, Increases SVR Myocardial Infuse IV at 100-180 mcg/min Assess for continued hypotension;
salvage therapy Increases systolic ischemia, reflex to maximum of 300 mcg/min; if present, assess if additional IV
in septic shock BP bradycardia, titrate to goal BP/MAP/SVR. fluids are needed.
mild CNS Half-life: 2.5 h Do not use if solution appears
Alpha stimulant stimulation, brown or contains precipitate.
tachycardia,
and palpita- May also be dosed as mcg/kg/min.
tions with large Check institution policy before IV
dosages bolus; IV bolus therapy may be out
of RN scope of practice.
Vasopressin Used as an Increases SVR Myocardial Infuse IV at 0.01-0.04 unit/min If used to augment vasopressors,
adjunct in A hormone (anti- ischemia, Usual dosage for sepsis 0.03 it should be to attempt a reduction
septic shock diuretic) that causes abdominal unit/min in the vasopressor dose.
when vasopres- vasoconstriction, cramps, nau- Do NOT infuse at a rate greater
sors and fluid sea, vomiting, Half-life: 10-20 min
water retention, and than 0.04 unit/min, because it may
resuscitation urine concentration confusion, wa- cause cardiac arrest.
are ineffective ter intoxication
in maintaining
goal BP/MAP
IV uses are
off-label.

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Inotropic and Vasodilator Medications
Generic Name Uses Therapeutic Effects Adverse Effects Dose/Half-Life (Adult) Key Considerations
DOBUTamine Cardiac Decreases preload Tachycardia, 2-10 mcg/kg/min (up to 40 mcg/ Correct hypovolemia before
decompensa- and afterload, and hypertension, kg/min) DOBUTamine infusion.
tion, positive enhances myocardial anginal pain, Titrate to desired BP/MAP/CO Monitor for hypokalemia.
inotropic agent contractility, stroke dysrhythmias
in myocardial volume, and CO Half-life: 2 min Extravasation may cause tissue
dysfunction, without increasing necrosis.
sepsis oxygen demand. Start with lower initial doses in
Beta-1, beta-2 older adults due to decreased
stimulation organ function and comorbidities.
Improves renal
blood flow and urine
output by
increasing CO

Milrinone Short-term Phosphodiesterase Ventricular Initial bolus of 50 mcg/kg over Assess for hemodynamic response
management inhibitor. Relaxes dysrhythmias, 10 min. Maintenance infusion and resolution of symptoms of
of heart failure, vascular muscle, SVT, hypoten- of 0.375-0.75 mcg/kg/min for heart failure.
positive inotro- causing vasodilation sion, diuresis, desired CO/MAP Anticipate reduced dose based
pic agent when Decreases preload hypokalemia, Maximum daily dose of 0.59-1.13 on decreased creatinine clearance
unresponsive to and afterload, headache mg/kg in patients with severe kidney
other therapy resulting in impairment.
Half-life: 2.4 h
increased CO
Increases
contractility

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Vasodilator Medications
All vasodilator medications can cause severe hypotension. Close monitoring of BP is warranted.
Generic Name Uses Therapeutic Effects Adverse Effects Dose/Half-Life (Adult) Key Considerations
Labetalol Management Alpha, beta-1, beta-2 Orthostatic IV PUSH: 20 mg over 2-3 min. Lower BP gradually to avoid
of hypertensive blocker hypotension, At 10 min intervals, may give cerebral ischemia or infarction,
urgency and Decreases SVR bronchospasm, additional 40-80 mg optic nerve infarction, angina,
emergency without reflex AV block, myocardial ischemia, or MI.
IV infusion: 1-2 mg/min; titrate to
tachycardia bradycardia Patient should remain supine
desired BP/MAP
Decreases BP during infusion and for 3 h after IV
Total dose for both routes:
administration.
Moderate decrease 300 mg
in preload and Do not use if solution is discolored
Half-life: 2.5-8 h
afterload or contains precipitate.
Risk of hypotension increased
in older adults with age-related
peripheral vascular disease.
Also may exacerbate mental impairment
NiCARdipine Management of Ca++ channel blocker Hypotension, Dose for patients not receiving PO Change IV site every 12 h if admin-
hypertension depresses vascular orthostatic niCARdipine: 5 mg/h IV infusion istered via peripheral line.
smooth muscle hypotension, For rapid titration: titrate 2.5 mg/h Monitor BP and HR during infusion.
contraction palpitations, every 5 min. Older adults may have increased
Decreases SVR peripheral
For gradual titration: titrate sensitivity to effects; half-life may
and BP edema, tachy-
2.5 mg/h every 15 min be prolonged.
dysrhythmia
Increases HR and Maximum dose: 15 mg/h
CO
Decrease to 3 mg/h after
reaching BP goal
Half-life: 14.4 h
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Nitroglycerin Acute coronary Dilates coronary ar- Headache, IV Infusion rate: 5-200 mcg/min. Must be mixed in glass bottle. Spe-
syndrome, de- teries, and improves hypovolemia, Start infusion at 5 mcg/min, and cial tubing may be recommended
compensated collateral blood flow hypotension, increase by 5 mcg/min every to reduce absorption into polyvinyl
heart failure to ischemic areas in bradycardia, 3-5 min. chloride tubing.
myocardium reflex To avoid irreversible hypotension, DO
Titrate to desired BP or CP relief.
Decreases myo- tachycardia, NOT administer nitrates within 24 h
flushing, Half-life: 1-4 min
cardial oxygen of patient taking PDE-5 inhibitors
demand, and orthostatic such as sildenafil, tadalafil, vardenafil.
increases peripheral hypotension
If used with alteplase, it may
vasodilation reduce thrombolytic effect of
Strong preload alteplase.
reduction, mild af- Effects may be increased in older
terload reduction adults; lower-end initial doses may
be indicated.
Nitroprusside Hypertensive Potent vasodilator, Severe hypo- Once solution is prepared, it Use cautiously in patients with hypo-
urgency and acts directly on tension, lethal must be used within 24 h. natremia, hypothyroidism, or severe
emergency arterial and venous levels of cya- Start at 0.1-0.5 mcg/kg/min IV. hepatic or renal impairment.
smooth muscle nide toxicity, Titrate every 5-15 min in incre- Discontinue infusion if desired
Decreases SVR, reflex tachycar- ments of 0.5 mcg/kg/min. response does not occur within 10
moderate preload dia, confusion, min at maximum dose.
Maximum dose: 10 mcg/kg/min
reduction, strong tinnitus,
Titrate to desired BP/MAP/SVR Monitor thiocyanate levels (cya-
afterload reduction hyperreflexia,
nide toxicity). Thiocyanate half-life
headache, vom- Half-life: less than 10 min
is 3 days.
iting, seizures
Cover with opaque material.
Solution may have faint brown tint.
Do not use if solution appears blue,
green, or dark red.
Extravasation causes tissue sloughing.
Hypotensive effects may be
increased in older adults. 11
Legend: ACLS, advanced cardiovascular life support; AFib, atrial fibrillation; ARDS, adult respiratory distress syndrome; AV, atrioventricular; BP, blood pressure;
CHF, congestive heart failure; CNS, central nervous system; CO, cardiac output; CP, chest pain; ETT, endotracheal tube; GI, gastrointestinal; HR, heart rate; IV, in-
travenous(ly); MAP, mean arterial pressure; max, maximum; MI, myocardial infarction; NS, normal saline; NSR, normal sinus rhythm; PDE-5, phosphodiesterase-5;
PSVT, paroxysmal supraventricular tachycardia; PVC, premature ventricular contraction; Q, every; RN, registered nurse; SA, sinoatrial; ST, sinus tachycardia; SVR,
systemic vascular resistance; SVT, supraventricular tachycardia; TCP, transcutaneous pacemaker; VF, ventricular fibrillation; VT, ventricular tachycardia; VTE,
venous thromboembolism; WPW, Wolff-Parkinson-White

REFERENCES
American Heart Association. Part 7: Adult Advanced Cardiovascular Life Support: Web-based Integrated 2010, 2015 & 2018 American Heart Association
Guidelines for CPR and ECC. eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-7-adult-advanced-cardiovascular-life-support.
Accessed October 7, 2019.
Burns SM, Delgado SA. AACN Essentials of Critical Care Nursing. 4th ed. McGraw Hill Education; 2019.
Center Watch. (2018, October 31). Giapreza. Retrieved from FDA Approved Drugs: http://www.centerwatch.com/drug-information/fda-approved-drugs/
drug/100248/giapreza-angiotensin-ii-Epocrates. https://online.epocrates.com/. Updated continuously. Accessed June 30, 2016.
Gahart BL, Nazareno AR, Ortega MQ. Gahart’s 2016 Intravenous Medications: A Handbook for Nurses and Health Professionals. 32nd ed. Elsevier; 2016.
La Jolla Pharmaceuticals. (2018, October 31). Giapreza. Retrieved from https://www.giapreza.com/
Urden LD, Stacy KM, Lough ME. Critical Care Nursing: Diagnosis and Management. 8th ed. Elsevier; 2018.
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