Pharmacokinetics
:. Plasma peak levels are reached within 1.2 hours after a single dose. Sixty-five percent of the drug is excreted in the urine unchanged.
Dosage
: Initial dose should of 4 to 5 g in 250 mL of diluent should be infused over an hour. This if followed by a continuing infusion at the rate of 4 mL (1 g) per hour in 50 mL of diluent. The infusion may be continued until the bleeding is controlled or up to a maximum of 8 hours.
Indications:. Fibrinolytic bleeding following heart surgery. It should be used in addition to fresh whole blood transfusions, fibrinogen infusions, and other emergency measures that may be required.
Contraindications
: It should be avoided should when there is evidence of an active intravascular clotting process. It must not be used in the presence of DIC without concomitant heparin. Hence, appropriate tests such as Platelet count (low in IDC), Protamine paracoagulation test (positive in DIC), and euglobulin clot lysis test (abnormal in fibrinolysis but normal in DIC) must be performed before administering the drug.
Warning:
Subendocardial hemorrhages, fatty degeneration of the myocardium, and rarely, skeletal muscle weakness with necrosis of muscle fibers has been reported following prolonged administration.
Adverse Effects:
Include edema, headache, malaise. Rarely, allergic and anaphylactoid reactions may be seen. Local reactions: may occur at injection site.
Overdose: Overdosage can to transient hypotension or severe acute renal failure.
Adenosine I.V. [ Adenocort]
It is an endogenous nucleoside used for rapid convertion of PSVT.
Mechanism of Action: Adenocard (adenosine) slows A-V. and interrupt the reentry pathways through the A-V node. It can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT), including PSVT associated with Wolff-Parkinson-White Syndrome.
Hemodynamics: The intravenous bolus dose of 6 or 12 mg Adenocard (adenosine) usually has no systemic hemodynamic effects. Larger doses are may decrease blood pressure.
Pharmacokinetics: The Drug acts with in one to two minutes. The half-life is less than 10 seconds.
Dosage: 6 mg IV bolus (67% rhtym covertion to sinus in patients with PSVT) or 12 mg IV bolus (converts 92% of PSVT to sinus rhythm).
Indications: PSVT with or without WPW. Adenosine is does not convert atrial flutter, atrial fibrillation, or ventricular tachycardia, to normal sinus rhythm, even though it may slow the rate transiently.
Contraindications: Second- or third-degree A-V block, sick sinus syndrome, symptomatic bradycardia, or Known hypersensitivity to adenosine
Warning: Can cause prolonged asystole, V. fibrillation, or bronchoconstriction. Causion must be xercised in patients asthma or COPD because of bronchospasm.
Adverse Effects: Common side effects are facial flushing, headache, sweating, palpitations, chest pain, shortness of breath/dyspnea, chest pressure, dizziness, apprehension, blurred vision, burning sensation.
Overdose: Try IV theophyllines
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