Vasoactive Drips: A guide to starting and titrating critical care drips (FL INITIAL Autonomous Practice - Pharmacology)

A 54-year-old (y/o) male presents to the emergency room (ER) complaining of feeling weak and dizzy. He has a history of gout, diabetes, gastroesophageal reflux disease (GERD), and psoriasis. He is allergic to sulfa. His glucose is 96. He is pale, clammy, and lethargic. His vital signs are a heart rate of 101, blood pressure of 78/50 mmHg, oxygen saturation of 94%, temperature of 97.8, and respirations of 24. A 16 gauge (16g) peripheral IV is established, an electrocardiogram (ECG) is completed (sinus tachycardia), and oxygen therapy 3 liters (L) nasal cannula (NC) is started. After 3 L of normal saline (NS), his blood pressure is 80/40. Which medication should the doctor order?

1. Dopamine
2. Dobutamine
3. Levophed
4. Diltiazem

Rationale:

Levophed (norepinephrine) is an alpha/beta-agonist, causing vasoconstriction and increased blood pressure. It is used for severe hypotension, shock, or bradycardia. Dopamine and dobutamine are contraindicated with a sulfa allergy.

The physician orders a Levophed drip to be started at 0.5 mcg/min with parameters ordered to keep SBP > 90 and heart rate less than 120. After 20 minutes, the patient's vital signs were a heart rate of 106, blood pressure of 88/42, and saturation of 96%. What is the subsequent titration?

1. 10 mcg/min
2. 5 mcg/min
3. 3 mcg/min
4. 1 mcg/min

Rationale:

Levophed has a rapid onset and short half-life. Incremental increases in the drip will improve blood pressure rapidly. Monitor the vital signs every five minutes and increase the drip after 20 minutes if necessary to meet the parameters.

A 70 y/o male presents to the ER via ambulance with profound hypotension. He has no vital signs and is in asystole. He has agonal respirations. No IV access is established. Upon arrival, the ER team begins CPR, administering oxygen with a bag-mask bag and starting a peripheral IV. What is the BEST drug of choice for this patient?

1. Amiodarone
2. Dopamine
3. Heparin
4. Epinephrine

Rationale:

Epinephrine is used for profound refractory hypotension, VF, VT, PEA, and asystole. It is the first drug of choice for cardiac arrest.

The patient is transferred to the intensive care unit (ICU), and the hospitalist in the ICU orders an epinephrine drip to start at 2 mcg/min. The patient is 90 kg and 5 feet 4 inches. His glucose is 94. He is lethargic and pale. He is now intubated and on a ventilator. His oxygen saturation is 94%. He has adequate urine output. The pharmacy brings you epinephrine 1 mg in 250 ml of D5W. What is the rate of the infusion in ml/hr?

1. 35
2. 60
3. 30
4. 90

Rationale:

EXAMPLE: The physician orders epinephrine 2 mcg/min titrate for SBP > 100, heart rate > 80, and heart rate < 110.

This medication is mixed at the bedside. Epinephrine 1 mg is added to 250 ml D5W.

A 54 y/o female in the ICU starts to have a decrease in blood pressure and urine output. Her blood pressure is 88/40, and her urine output is less than 30 ml/hr. She has received 2 L of NS and remains hypotensive. What is the best drug of choice for this patient?

1. Epinephrine
2. Levophed
3. Diltiazem
4. Dopamine

Rationale:

Dopamine is an adrenergic agonist used for central hypotension, heart failure, and increased renal and mesenteric perfusion in the absence of hypovolemia.

Dopamine is ordered for the patient at 5 mcg/kg/min. The patient has a history of diabetes and fibromyalgia. She weighs 75 kg and is 5 feet 7 inches tall. Her heart rate is 80, and her blood pressure is 90/60. The dopamine is 400 mg in 250 ml D5W. What will the infusion rate be in ml/hr?

1. 64
2. 32
3. 14
4. 26

Rationale:

EXAMPLE: The physician orders dopamine 5 mcg/kg/min titrate to keep SBP > 100 and MAP > 65.

The hospital pharmacy has premixed dopamine 400 mg/250 ml D5W. Your patient weighs 75 kg.

Here is an explanation of each element:

• 5 is the order of Dopamine 5 mcg
• 75 kg is the patient weight
• 60 minutes (# of minutes in an hour)
• 400 mg of dopamine in 250 ml D5W (change mg to mcg/1 mg =1000 mcg)

Dopamine is a positive inotrope used for central hypotension. It can also increase renal perfusion. Monitoring urine is essential. The patient has no urine output for 24 hours. The doctor orders dopamine 40 mcg/kg/min. Is this the correct infusion amount?

1. True
2. False

Rationale:

Dopamine is an adrenergic agonist used for central hypotension, heart failure, and increased renal and mesenteric perfusion in the absence of hypovolemia. It is a positive inotrope. Dopamine is mixed with 400 mg in 250 cc/D5W, equaling 1600 mcg/ml. The onset of action is five minutes, and the half-life is two minutes. The dose is 2-20 mcg/kg/min. It is usually started at 5 mcg/kg/min.

The best adrenergic agonist for central hypotension, heart failure, and increased renal perfusion is which of the following?

1. Dobutamine
2. Dopamine
3. Vasopressin
4. Levophed

Rationale:

Dopamine is an adrenergic agonist used for central hypotension, heart failure, and increased renal and mesenteric perfusion in the absence of hypovolemia.

The same ICU patient is on a dopamine drip at 15 mcg/kg/min. Her blood pressure is 102/60. Her heart rate is 70. Her urine output is 30 ml/hr. The physician orders the drip to be titrated down by 5 mcg/kg/min every half hour as long as the SBP > 100. The drip is decreased to 10 mcg/kg/min. Forty-five minutes later, the patient has a heart rate of 110 and blood pressure is 90/58. What is the nurse's next action?

1. Titrate the drip up to 15 mcg/kg/min.
2. Call the physician
3. Keep the drip at 10 mcg/kg/min
4. Start NS intravenous fluids

Rationale:

Titrate drips according to the physician's written parameters and re-verify orders if in doubt.

A 77 y/o male with diabetes and a history of hypertension presents to the ER. He is pale and cool. His glucose is 274. His heart rate is 88, his blood pressure is 72/44, and his oxygen saturation is 94%. He has a history of left ventricular heart failure. What drug do you expect the doctor to order?

1. Vasopressin
2. Epinephrine
3. Dobutamine
4. Lidocaine

Rationale:

Dobutamine is an adrenergic agonist and first-line inotropic. Dobutamine is used for cardiogenic shock and associated hypotension.

Which drug acts as a chemical balloon pump, reducing afterload but increasing heart rate and cardiac contractility?

1. Dopamine
2. Epinephrine
3. Vasopressin
4. Dobutamine

Rationale:

Dobutamine is an adrenergic agonist and first-line inotropic. Dobutamine is used for cardiogenic shock and associated hypotension. It acts as a chemical balloon pump, reducing afterload but increasing the rate and cardiac contractility.

After 3 L of fluid, the same patient remains hypotensive with a blood pressure of 88/42 and a MAP < 60. His urine output is 30 ml/hr. He weighs 85 kg. His oxygen saturation is 92% on a 40% face mask. He can answer questions when aroused. The patient's heart rate is 99. Dobutamine is ordered at 5 mcg/kg/min. Mix 500 mg in 250 ml D5W for 2000 mcg/ml. The infusion pump is set at 7 ml/hr. Two minutes after the infusion, the bedside cardiac monitor shows a heart rate of 126, saturation of 90%, and blood pressure of 72/34. What is the nurse's next action?

1. Titrate the drip to 10mcg/kg/min
2. Stop the drip and call the physician
3. Start one liter of NS
4. 1 and 3

Rationale:

Dobutamine is an adrenergic agonist and first-line inotropic. Dobutamine is used for cardiogenic shock and associated hypotension. It acts like a chemical balloon pump that reduces afterload but increases the rate and cardiac contractility. It increases cardiac output and mild vasodilation. Dobutamine will cause hypotension in the presence of hypovolemia. Stop infusion and address fluid volume losses if hypotension occurs after infusion.

The same patient responds to the discontinuation of the drip and the infusion of a rapid fluid bolus of 3 L. The urine output has increased to 60 ml/hr. The cardiac monitor indicates a sinus rhythm of 89, oxygen saturation of 96% on a 40% face mask, and blood pressure of 100/58. The physician orders the dobutamine to be restarted at 5 mcg/kg/min, titrate to keep SBP >100. After 30 minutes, the heart rate is 86, the blood pressure is 116/64, and the oxygen saturation is 95%. Which of the following actions should the nurse perform?

1. Titrate the drip to 7 mcg/kg/min.
2. Continue to monitor vital signs every five minutes
3. Start the NS bolus again
4. Stop the drip and call the physician

Rationale:

Dobutamine is an adrenergic agonist and first-line inotropic. Dobutamine is used for cardiogenic shock and associated hypotension. This drug will cause hypotension in the presence of hypovolemia. Stop infusion and address fluid volume losses if hypotension is noted after infusion. The onset is 1-2 minutes, and the half-life is two minutes. Dobutamine is fast-acting, and vital signs are done continuously on the bedside monitor and documented frequently. Each facility has a policy on the frequency of vital sign documentation. Every 5-15 minutes is standard for vital sign documentation with a patient on a vasoactive drip.

A 69 y/o female with a urinary tract infection spikes a temperature of 103 degrees orally. Her heart rate is 120, her blood pressure is 80/56, and her oxygen saturation is 93%. Levofloxacin 750 mg IV is administered, blood cultures are ordered, and 1 liter of NS is administered. She is making about 10 ml of urine an hour. The doctor ordered another L of NS. Her blood pressure is now 74/40. The physician says she needs to go to the ICU for septic shock. Before she is transferred from the ER to the ICU, which of the following should the physician order?

1. Dopamine
2. Dobutamine
3. Vasopressin
4. Norepinephrine

Rationale:

Vasopressin is an antidiuretic hormone. It has unlabeled use in septic shock. It requires central line administration but can be administered peripherally until central access is established. Its two primary functions are to retain water in the body and to constrict blood vessels.

Which of the following is the antidiuretic hormone used for septic shock?

1. Levophed
2. Epinephrine
3. Cordarone
4. Vasopressin

Rationale:

Vasopressin is an antidiuretic hormone. It has unlabeled use in septic shock.

A 53 y/o male is in cardiac arrest. He is pulseless, with a waveform of VF on the monitor. He is receiving CPR and has had one automated external defibrillator (AED) shock of 120 joules. VF is still on the monitor. He did not respond to the one dose of IV epinephrine. What is the next drug of choice?

1. Atropine
2. Vasopressin
3. High dose epinephrine
4. Levophed

Rationale:

Vasopressin is an antidiuretic hormone. It has unlabeled use in septic shock. It also treats PEA and VF. ACLS guidelines no longer recommend Vasopressin to replace the first or second dose of epinephrine (Craig-Brangen & Day, 2021).

A 34 y/o male, 75 kg, with high blood pressure, comes to the ER with a headache. His blood pressure is 220/117. His heart rate is 80, and oxygen saturation is 99% on room air. He denies chest pain, shortness of breath, and fever. He said he is on Lasix but has gained weight. He did not respond to oral clonidine administration. The healthcare provider wants to start a drip to control the blood pressure. Which of the following is the best vasodilator choice for a hypertensive crisis?

1. Amiodarone
2. Heparin
3. Dopamine
4. Nipride

Rationale:

Nipride (sodium nitroprusside) is indicated for hypertensive crisis, acute pulmonary edema, and congestive heart failure. It decreases cardiac afterload and is a potent vasodilator.

Which drug is cyanide toxic and must have thiocyanate levels monitored?

1. Phenobarbital
2. Heparin
3. Nitroglycerin
4. Nipride

Rationale:

Nipride is cyanide toxic, and thiocyanate levels must be monitored.

The same patient has been on a Nipride drip at 5 mcg/kg/min for 20 minutes. His blood pressure is now 192/100, his heart rate is 84, and his oxygen saturation is 98%. The physician ordered the Nipride drip to be titrated to keep the diastolic blood pressure < 90 and the heart rate > 60 and < 120. What is the subsequent titration of the Nipride?

1. 1 mcg/kg/min
2. 3 mcg/kg/min
3. 7 mcg/kg/min
4. 10 mcg/kg/min

Rationale:

The starting dose of Nipride is 0.4-4 mcg/kg/min and slowly titrated until desired effect. It cannot be stopped abruptly, which may cause rebound hypertension and seizures. Doses should be titrated every five minutes until the desired effect is achieved (Khan. 2022). Each facility has its policies and follows the healthcare provider's orders. However, when in doubt, check with the pharmacist and suggest that a consultation with a cardiac specialist or other specialists may be applicable, depending on the circumstances.

A 41 y/o male with a history of cocaine use comes in with a complaint of chest pain. His heart rate is 116, and his blood pressure is 166/74. His pulse oximeter reading is 100% on 2 L of oxygen via nasal cannula. His troponin is elevated, and he is positive for cocaine on a drug screen. What is the drug of choice for a cocaine-induced myocardial infarction?

1. Heparin
2. Nipride
3. Lidocaine
4. Nitroglycerin

Rationale:

Nitroglycerin is a nitrate and a strong vasodilator that dilates coronary arteries and decreases preload. It is classified as an anti-anginal and antihypertensive drug and a vasodilator. It is used in acute angina, hypertensive crisis, pulmonary edema, congestive heart failure, and myocardial infarction. It is the drug of choice for cocaine-induced myocardial infarction.

Nitroglycerin is used for myocardial infarction and angina. In an unstable inferior wall myocardial infarction, the dose is started at 10 mcg/min.

1. True
2. False

Rationale:

Nitroglycerin administration is used cautiously in the presence of oral nitrates, inferior wall myocardial infarction, and sexual performance-enhancing drugs, as life-threatening hypotension can ensue.

What are some of the special precautions used when hanging nitroglycerin?

1. Protect from light and give a bolus before administration
2. Use a glass bottle and vented tubing
3. Monitor glucose levels
4. Monitor bicarbonate levels

Rationale:

Nitroglycerin can adhere to plastic. Nitroglycerin must be hung in a glass bottle with vented tubing.

A 55 y/o male comes to the ER with chest pain and left jaw pain for 20 minutes. His heart rate is 71, blood pressure is 132/68, and oxygen saturation is 99%. He denies the use of oral nitrates. His chest pain is 8/10. His chest pain comes down to 6/10 after three sublingual nitroglycerines. His troponin is severely elevated. His current blood pressure is 156/79. The provider orders nitroglycerin 50 mg/250 ml at 10 mcg/min. How many ml/hr will the pump be set?

1. 5
2. 10
3. 3
4. 6

Rationale:

Nitroglycerin 50 mg/250 ml is 200 mcg/ml.

1x60 = 0.3 10 mcg/min x 0.3/200 mcg = 3 ml/hr

Atrial fibrillation with rapid ventricular response at a rate of 188 will need to be treated with an antiarrhythmic. Which antiarrhythmic is the best choice for this patient?

1. Amiodarone
2. Lidocaine
3. Esmolol
4. Diltiazem

Rationale:

Diltiazem (Cardizem) is a calcium channel blocker and antiarrhythmic for heart rate control during atrial fibrillation, atrial flutter, multifocal atrial tachycardia, and atrial fibrillation with a rapid ventricular response.

The drug of choice for atrial fibrillation is diltiazem. It is a calcium channel blocker. Which of the following is the usual initial loading dose?

1. 0.25 mg/kg over two minutes
2. 0.40 mg/kg over two minutes
3. 10 mg
4. 20 mg

Rationale:

An initial bolus of diltiazem for atrial fibrillation for acute rate control of 5-20 mg (0.25 mg/kg over two minutes; if there is inadequate response, 0.35 mg/kg over two minutes) IV push is usually administered to evaluate the response and blood pressure tolerance.

Diltiazem is an antiarrhythmic used for rate control in atrial fibrillation. Its mechanism of action is slowing calcium in vascular and cardiac muscle tissue. What is the antidote for diltiazem?

1. Epinephrine
2. Benadryl
3. Calcium
4. Steroids

Rationale:

Diltiazem (Cardizem) is a calcium channel blocker and antiarrhythmic for heart rate control during atrial fibrillation, atrial flutter, multifocal atrial tachycardia, and atrial fibrillation with a rapid ventricular response. Please do not use it for wide-complex QRS tachycardias. The antidote for diltiazem is calcium.

A 44 y/o male with atrial fibrillation and rapid ventricular rate (RVR) with a heart rate of 156 is being given 10 mg of diltiazem IV bolus. The patient's heart rate responds to the calcium channel blocker, and the heart rate is now 90. The physician orders a diltiazem drip to be started. 125 mg (25 ml) of diltiazem is mixed with 125 ml of NS. The 1:1 drip is ordered to infuse at 5 mg/hr with parameters to keep the SBP > 100 and the heart rate < 110 but > 50. The drip has been infusing for 15 minutes. The patient's vital signs are a heart rate of 133 and a blood pressure of 134/80. How is the drip titrated?

1. Stop the drip
2. Call the physician and stop the drip
3. Increase the drip to 10 mg/hr
4. Decrease the drip to 2 mg/hr

Rationale:

For acute rate control, an initial bolus of 5-20 mg (0.25 mg/kg over two minutes; if inadequate response, 0.35 mg/kg over two minutes) IV push is usually administered to evaluate the response and blood pressure tolerance. The drip is then started at 5 mg/hr (5 ml/hr) and titrated up by 2-5 mg every 15-30 minutes for effect to a maximum dose of 15 mg/hr (15 ml/hr).

A 65 y/o male presents to the ER via ambulance with VF. The ambulance crew started an IV and NS. The patient has an automatic implantable cardioverter defibrillator (AICD) in place, but it is not functional. The healthcare provider wants to start an antiarrhythmic. Which medication is the best choice?

1. Norepinephrine
2. Lidocaine
3. Dopamine
4. Amiodarone

Rationale:

Amiodarone is for the management of life-threatening recurrent VF or hemodynamically unstable VT and cardiac arrest. It is commonly used for VF pulseless and VT unresponsive to shock delivery and CPR. It is an antiarrhythmic.

The initial bolus dose of amiodarone for life-threatening VF or unstable VT is 20 mg IV push.

1. True
2. False

Rationale:

The dosing is standard for all patients with a 150 mg/100 ml D5W (1.5 mg/ml) bolus over ten minutes. The bolus may be repeated if needed. A 300 mg bolus, diluted in 100 ml D5W over 10 minutes, may also be used for VF, VT, and cardiac arrest unresponsive to CPR.

A continuous drip infusion follows an amiodarone 300 mg bolus. The amiodarone drip will infuse for _______hours before transitioning to oral Cordarone.

1. 72
2. 48
3. 24
4. 36

Rationale:

A 300 mg bolus, diluted in 100 ml D5W over ten minutes, may also be used for VF, VT, and cardiac arrest unresponsive to CPR. The drip is mixed 450 mg/250 ml D5W and runs at 1 mg/min (33 ml/hr) for six hours, then 0.5 mg/min (16 ml/hr) for 18 hours with a transition to oral Cordarone after the drip is discontinued. The total time is 24 hours.

Many vasoactive medications have serious side effects. Which medication puts the patient at risk for a thyroid storm?

1. Nipride
2. Diltiazem
3. Amiodarone
4. Adenosine

Rationale:

It has a 53-day half-life. It can cause hypotension, bradycardia, ectopy and arrhythmic events, peripheral neuropathy, thyroid dysfunction, thyroid storm, nausea, vomiting, and pulmonary toxicity.

A patient on an amiodarone drip exhibits signs and symptoms of thyroid dysfunction. The amiodarone drip is discontinued. The patient's vital signs are stable. The first dose of Cordarone is due in 12 hours. Which of the following should the nurse do?

1. Administer Cordarone as scheduled.
2. Monitor the heart rate.
3. Restart the drip.
4. Do not administer Cordarone.

Rationale:

Cordarone is amiodarone and may cause a thyroid storm. The amiodarone infusion has a long half-life of 53 days. Another antiarrhythmic should be ordered.

Rationale:

Use caution in older adults, as a complete heart block can occur. It can also cause confusion, hypotension, lightheadedness, diplopia, seizures, and tinnitus.

A 65 y/o female patient is on lidocaine 2 mg/min for VT of 160. The bedside alarm indicates a change in heart rate to 49. The patient is lethargic but arousable to noxious stimuli. Her oxygen saturation is 95%. Her blood pressure is 106/58. What is the next action?

1. Start dopamine
2. Hang NS
3. Stop Lidocaine
4. Retake vital signs

Rationale:

Lidocaine (Xylocaine) is a ventricular antiarrhythmic medication. It is usually premixed but should be 2 G/500 ml D5W, 4 mg/ml. For ventricular arrhythmias, a 1-1.5 mg/kg IV bolus over 2-3 minutes is initiated. The dose may be repeated for a total of 2 mg/kg. This action is followed by the initial drip start-up at 1-4 mg/minute. It suppresses ventricular arrhythmias by decreasing automaticity.

Which medication is used for sinus tachycardias, especially ventricular rates?

1. Lidocaine
2. Nitroglycerin
3. Dopamine
4. Esmolol

Rationale:

Esmolol (Brevibloc) is indicated for sinus tachycardia, heart rate and ventricular response control, SVT, and hypertension. It is a selective beta-blocking agent and antiarrhythmic.

A 34 y/o female presents to the ER with an SVT of 199. She is 36 weeks pregnant. Her blood pressure is 149/77. She is in no pain and is not in labor. Her oxygen saturation is 96% on two liters via nasal cannula. IV access is established, and an ECG is completed. The doctor wants to start an antiarrhythmic. What is the best choice for this patient?

1. Amiodarone
2. Esmolol
3. Atropine
4. Nitroglycerin

Rationale:

Amiodarone is contraindicated in pregnant and lactating patients. Atropine and nitroglycerin are not antiarrhythmic medications.

A 61 y/o female is on an esmolol drip at 70 mcg/kg/min for SVT. She has been on the drip for 36 hours. The orders for the drip are to keep the heart rate < 110 and > 60 and to keep the SBP < 160 and > 90. She has no known allergies, and her weight is 90 kg. Her vital signs have been within parameters for 12 hours. However, her vital signs have changed; her heart rate is 146, and her blood pressure is 150/90. The next action of the nurse is:

1. Titrate the drip to 75 mcg/kg/min
2. Titrate the drip to 65 mcg/kg/min
3. Stop the drip and call the physician
4. Continue vital signs every five minutes

Rationale:

Esmolol (Brevibloc) is indicated for sinus tachycardia, heart rate control and ventricular response, SVT, and hypertension. It is imperative that dosing is accurate as the drug acts rapidly. Half-life is nine minutes. The drip may be started at 50 mcg/kg/min and titrated up to 300 mcg/kg/min every five minutes to control heart rate, cautiously monitoring blood pressure during titration. Do not stop the medication abruptly.

The same patient has a heart rate of 101 and a blood pressure of 128/60. Her glucose is 76. Her urine output is 60 ml/hr. The esmolol remains at 75 mcg/kg/min. What is the nurse's next action?

1. Increase drip to 80 mcg/kg/min
2. Call the physician
3. Continue to monitor vital signs every five minutes
4. Start a NS fluid bolus

Rationale:

The vital signs are within the parameters of the esmolol order.

Twenty-four hours later, the same patient remains in the ICU. The esmolol drip is 75 mcg/kg/min. The heart rate is 60, and the blood pressure is 90/62. The oxygen saturation is 98. She is alert and oriented. The urine output is 60 ml/hr. She is in no distress. Which of the following is the nurse's next action?

1. Stop the drip
2. Call the physician
3. Increase the drip
4. Document vital signs every 60 minutes.

Rationale:

The drip cannot be stopped abruptly. The patient has vital signs on the lowest end of the parameters, so titration is not indicated per the order. The vital signs are continuous. The physician needs to be called to determine if the parameters for the vital signs and the drip titration should be changed.

A 16 y/o female with WPW is brought to the ER by her mom with a complaint of, "Her heart rate is high again." The cardiac monitor shows a heart rate of 220 and a blood pressure of 92/44. Which medication will the doctor order for rate control?

1. Adenosine
2. Lidocaine
3. Nitroglycerin
4. Diltiazem

Rationale:

Adenosine is used to treat PSVT and WPW syndrome; this type of arrhythmia is deadly. It is an antiarrhythmic.

What is the amount of the first dose of adenosine?

1. 12 mg
2. 18 mg
3. 6 mg
4. 28 mg

Rationale:

Adenosine is used to treat PSVT and WPW syndrome; this type of arrhythmia is deadly. It is an antiarrhythmic. Initially, an adenosine 6 mg rapid bolus (over 1-2 seconds) with a 10 ml NS flush is administered immediately after the IV push for PSVT. If not effective within 1-2 minutes, 12 mg may be given again; a third 12 mg bolus if needed for persistent SVT; maximum single dose: 12 mg.

A 16 y/o female with WPW is in the ER. Her heart rate is 275, and her blood pressure is 112/62. The physician wants to order another dose of adenosine. Which is the next dose for this patient?

1. Lidocaine 12 mg
2. Diltiazem 12 mg
3. Adenosine 12 mg
4. Amiodarone 12mg

Rationale:

Adenosine is used to treat PSVT and WPW syndrome; this type of arrhythmia is deadly. It is an antiarrhythmic. It is administered in three bolus doses, only 6 mg, then 12 mg, and finally 12 mg per the ACLS dosing recommendations.

The 16 y/o female with WPW now has a heart rate of 110. Her blood pressure is 120/74. She is admitted to the ICU for monitoring of her PSVT. After successfully correcting the WPW with the adenosine bolus, the healthcare provider orders an adenosine drip. What will the infusion rate be in ml/hr?

1. 6 mg
2. 12 mg
3. 18 mg
4. No drip indicated

Rationale:

Adenosine is never given as a continuous infusion.