Lidocaine (Systemic)
Kelas obat: Agen Antineoplastik
Panganggone Lidocaine (Systemic)
Aritmia ventrikel
Alternatif kanggo obat antiarrhythmic liyane (contone, amiodarone, procainamide, sotalol) kanggo perawatan akut aritmia ventrikel sing ngancam nyawa kayata sing kedadeyan sawise MI utawa sajrone prosedur manipulatif jantung kayata bedhah jantung.
Digunakake sajrone serangan jantung kanggo perawatan refraktori (yaiku, tahan kanggo CPR, defibrilasi, lan vasopressor [epinefrin]) VF utawa pulseless VT. Dianggep minangka alternatif kanggo amiodarone kanggo panggunaan iki ing pedoman ACLS saiki ing wong diwasa; ing pasien pediatrik, bukti saiki ndhukung panggunaan amiodarone utawa lidocaine.
Alternatif kanggo agen antiarrhythmic liyane utawa kardioversi listrik sing disinkronake ing perawatan VT monomorphic hemodynamically stabil; Nanging, agen liyane (contone, procainamide, sotalol, amiodarone) luwih disenengi.
Status Epileptikus
Pengobatan status epileptikus† [off-label], minangka pilihan pungkasan.
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Carane nggunakake Lidocaine (Systemic)
Umum
Aritmia Ventrikel
Administrasi
Administrasi IV. Wis diwenehake IM (formulasi IM ora kasedhiya kanggo komersial maneh ing AS).
Uga wis diwenehake liwat tabung endotrakeal† [off-label] utawa injeksi intraosseous (IO)† [off-label] sajrone resusitasi jantung nalika administrasi IV ora bisa ditindakake. Sanajan administrasi endotrakeal† [off-label] uga bisa, administrasi IV utawa IO† [off-label] luwih disenengi amarga pangiriman obat lan efek farmakologis sing luwih bisa diprediksi. (Deleng Penyerapan ing Farmakokinetik.)
Administrasi IV
Kanggo informasi kompatibilitas solusi lan obat, deleng Kompatibilitas ing Stabilitas.
Administrasi minangka injeksi bolus IV kanggo wiwitan perawatan aritmia ventrikel. Infus IV pangopènan bisa uga dibutuhake kanggo njaga irama sinus normal yen terapi antiarrhythmic oral ora bisa ditindakake.
Injeksi sing ngandhut pengawet ora kudu diwenehi IV.
Aja nglebokake aditif menyang larutan lidocaine ing dekstrosa 5%, amarga dosis dititrasi kanggo respon.
Aja ditambahake menyang rakitan transfusi getih.
Aja nggunakake solusi lidocaine sing kasedhiya ing komersial ing dekstrosa 5% kanthi sambungan seri karo wadhah plastik liyane; panggunaan kasebut bisa nyebabake embolisme udara.
Tingkat AdministrasiAdministrasi dosis bolus IV kanthi tingkat 25-50 mg / menit.
Administrasi infus pangopènan kanthi tingkat 1-4 mg / menit (14-57 mcg / kg saben menit) ing wong diwasa utawa 10-50 mcg / kg saben menit ing pasien pediatrik.
Kanggo populasi liyane, deleng Populasi Khusus miturut Dosis lan Administrasi.
Administrasi Endotrakeal
Kanggo administrasi endotrakeal ing wong diwasa, dosis encer ing 5-10 mL saka 0,9 % injeksi natrium klorida utawa banyu steril.
Ing pasien pediatrik, siram karo 5 ml injeksi natrium klorida 0,9% sawise dosis diwenehake.
Pengenceran ing banyu steril bisa nambah panyerepan lidocaine .
Dosis
Kasedhiya minangka lidocaine hydrochloride; dosis dituduhake ing syarat-syarat uyah.
Pasien Pediatrik
Aritmia Ventrikel IVSinau klinis sing dikontrol kanggo netepake dosis pediatrik durung ditindakake.
Sawetara dokter nyaranake dosis awal 0,5-1 mg / kg minangka injeksi IV kanthi cepet (yaiku, bolus); Dosis bisa diulang miturut respon pasien, nganti dosis total maksimal 3-5 mg / kg. Infus pangopènan 10–50 mcg/kg saben menit.
Resusitasi Pediatrik IV/IO†Kanggo VF shock-refractory utawa VT pulseless: 1 mg/kg wiwitan, banjur infus pangopènan 20–50 mcg/ kg saben menit. Yen wektu antarane dosis bolus awal lan wiwitan infus IV>15 menit, baleni dosis bolus.
Endotrakeal†Dosis optimal ora ditemtokake, nanging biasane 2-2,5 kaping dosis IV sing disaranake.
Dewasa
Ventrikel Arrhythmia IVDosis awal biasanipun 50-100 mg diterbitake minangka injeksi IV langsung. Yen respon sing dikarepake ora bisa ditindakake, dosis kapindho bisa diwenehake 5 menit sawise rampung injeksi pisanan.
Kanggo VT monomorphic hemodynamically stabil: AHA nyaranake dosis awal 1-1,5 mg / kg, banjur 0,5 –0,75 mg/kg diulang kanthi interval 5 nganti 10 menit yen perlu, nganti total dosis maksimal 3 mg/kg.
ACLS IV/IO†Kanggo VF refraktori utawa VT tanpa pulsa: 1– 1,5 mg/kg minangka dosis awal, banjur 0,5–0,75 mg/kg diulang kanthi interval 5 nganti 10 menit yen perlu, nganti total 3 dosis (utawa nganti 3 mg/kg).
†Dosis optimal ora ditetepake, nanging biasane 2-2,5 kaping dosis IV sing disaranake.
Status Epileptikus† IVKaping pisanan, 1 mg/kg. Sawise 2 menit, administrasi 0,5 mg / kg yen kejang ora mandheg. Infus pangopènan 30 mcg/kg saben menit kanggo nyegah kambuh kejang.
Batesan Resep
Dewasa
Aritmia Ventrikel IVDosis total maksimal 200-300 mg liwat wektu 1 jam.
Populasi Khusus
Gagal Hepatik
Disaranake dosis sing ati-ati lan individual.
Gangguan Ginjal
Modifikasi dosis ora dibutuhake.
Penurunan Output Jantung
Dosis bolus sing luwih cilik bisa uga dibutuhake.
Sawetara dokter nyaranake tarif infus <30 mcg/kg saben menit ing pasien CHF.
Pasien Mbutuhake Terapi Berpanjangan
Bisa tambah setengah umur sawise infus tahan>24 jam; nyuda dosis sing cocog (contone, nganti 50%) kanggo ngindhari akumulasi obat lan potensial keracunan.
Pènget
Kontraindikasi
Pènget/PanandhapPènget
Pemantauan Jantung
Pemantauan ECG sing terus-terusan perlu sajrone administrasi IV. Mungkasi infus yen ana tandha-tandha depresi jantung sing gedhe banget (contone, prolongation saka interval PR lan kompleks QRS, katon utawa aggravation saka aritmia).
Reaksi ParahPeralatan lan obat-obatan resusitasi kudu langsung kasedhiya kanggo manajemen efek samping sing abot. efek jantung, ambegan, utawa CNS. Mungkasi terapi yen ana reaksi sing abot; institute prosedur resusitasi darurat lan langkah-langkah dhukungan liyane sing dibutuhake.
Reaksi sing abot bisa uga didhisiki ngantuk lan paresthesia.
Reaksi Sensitivitas
HipersensitivitasReaksi hipersensitivitas sing mungkin (contone, lesi kulit, urtikaria, edema, reaksi anafilaktoid).
Pancegahan Umum
Terapi BerpanjanganBisa tambah setengah umur sawise infus sing tahan >24 jam; nyuda dosis sing cocog (pirsani Pasien Mbutuhake Terapi Berpanjangan miturut Dosis lan Administrasi).
Yen terapi pangopènan perlu, agen antiarrhythmic lisan dianjurake.
Efek Sistem SarafMungkin otot twitching utawa tremor , kejang, semaput, lan koma; bisa uga digandhengake karo dosis dhuwur utawa overdosis.
Efek KardiovaskularKamungkinan hipotensi, aritmia, blok jantung, ambruk kardiovaskular, lan bradikardia, sing bisa nyebabake serangan jantung ing pasien kanthi konsentrasi lidocaine plasma sing dhuwur utawa cacat konduksi miokard.
Kamungkinan aritmia ventrikel serius utawa pamblokiran jantung ing pasien karo sinus bradikardia.
Kamungkinan tambah sensitivitas kanggo efek depresan jantung ing pasien karo nodus sinus sing lara utawa ora normal.
Kemungkinan tambah tingkat ventrikel ing pasien karo fibrilasi atrium.
Mungkin aliran getih koroner mundhak ing pasien sing ngalami MI anyar.
Kamungkinan depresi miokard lan sirkulasi.
Ati-ati disaranake nggunakake ing pasien kanthi bentuk blok jantung, CHF, hipoksia sing ditandhani, depresi pernapasan abot, hipovolemia, utawa kejut.
Efek PernafasanKamungkinan depresi pernapasan lan penahanan; bisa uga digandhengake karo dosis dhuwur utawa overdosis.
Efek LokalKamungkinan thrombophlebitis lokal ing pasien sing nampa infus IV sing dawa.
Infiltrasi jaringan bisa nyebabake iskemia lokal, ciloko jaringan, lan ulcerasi.
Interferensi Tes LaboratoriumKonsentrasi CK (CPK) serum sing bisa meningkat sing ana gandhengane karo injeksi IM. Pemisahan isoenzim perlu nalika nemtokake CK digunakake kanggo diagnosa MI akut.
Populasi Tertentu
KandhutanKategori B.
LaktasiDistribusi menyang susu. Gunakake kanthi ati-ati.
Panggunaan PediatrikKeamanan lan khasiat ora ditetepake ing studi klinis sing dikontrol; Nanging, lidocaine wis digunakake kanggo perawatan aritmia ventrikel ing bayi lan bocah-bocah.
Gangguan HepatikGunakake kanthi ati-ati. (Deleng Farmakokinetik lan uga deleng Gangguan Hepatik ing Dosis lan Administrasi.)
Gagal GinjalGunakake kanthi ati-ati ing gangguan ginjel sing abot. (Deleng Eliminasi: Populasi Khusus, miturut Farmakokinetik.)
Efek Sabar sing Umum
Efek SSP sing ala (contone, ngantuk, pusing, disorientasi, kebingungan, pusing, gemeter, psikosis, gugup, kuatir, agitasi, euforia, tinnitus, gangguan visual, paresthesia, kangelan ngulu, dyspnea, wicara lelucon, rasa panas, kadhemen, utawa mati rasa), mual, muntah.
Apa obatan liyane bakal mengaruhi Lidocaine (Systemic)
Agen Antiarrhythmic
Interaksi farmakologis potensial (efek jantung aditif utawa antagonis lan keracunan aditif) kanthi administrasi bebarengan agen antiarrhythmic (contone, fenitoin, procainamide, propranolol, quinidine).
Obat Spesifik
Obat
Interaksi
Komentar
Cimetidine
Turunan reresik lidokain
Pantau konsentrasi lidokain serum lan amati kanthi teliti kanggo pratandha keracunan lidokain
Fenitoin
Kamungkinan metabolisme lidokain meningkat
Kepentingan klinis ora dingerteni
Propranolol
Penurunan reresik lidokain
Pantau konsentrasi lidokain serum lan amati kanthi teliti kanggo tanda-tanda keracunan lidokain
Succinylcholine
Peningkatan neuromuskular efek pamblokiran
Katon penting mung ing dosis lidocaine sing luwih dhuwur tinimbang sing digunakake sacara klinis
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