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Drugs used in cath lab
1. Drugs used in Cath lab
Dr.Farrukh Masood
PGR Cardiology
2. Common drugs used in cath lab
• Isotonic Saline
• Lignocaine
• Antiplatelets
• Vasodilators
• Anticoagulants
• Inotropes
• Emergency drugs------Atropine and Adrenaline
3. Isotonic Saline
Indication
General
• Extracellular fluid replacement
• Treatment of metabolic abnormalities
• Mild Sodium depletion
Use in Cath Lab
Hydration to prevent CIN
Flushing cathlab catheters and lines
mixed with heparin
Dilution of various drugs
Hypotension in patients with RV
infarct
4. NS use to prevent CIN
• Dosage---1-1.5ml/kg/hr 3-6hrs before and 12-24hr after the procedure.
• In High risk patients like CKD , POSIDON trial has deviced LVEDP
guided hydration therapy .
5.
6.
7. Use with Caution
• Fluid overload
• Decompensated congestive heart failure
• Decompensated Cirrhosis
• ESRD
• Don’t give NS without replenishing or checking potassium status .
8. Inj Lignocaine
• Moa-It alters the voltage gated Na-
channels leading to decreased
depolarization in neurons leading to
local anesthetic effect
• Moa-It is class II antiarrhythmic drug
i.e it enhances phase 4 depolarization
in partially depolarized or stretched
purkunji fibres ..Indicated in
Ventricular Arrhythmias
9. Dosage
• 2% lignocaine vial have 10ml volume containing 200mg lignocaine
• As a local anesthetic ,about 10ml is instilled for femoral approach and 3ml for radial approach to
achieve local anesthetic effect
• In Pulseless VT after defibrillation
• 1-1.5 mg/kg slow IV bolus over 2-3 minutes
• May repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to 3 mg/kg total if refractory VF or
pulseless VT
• Continuous infusion: 1-4 mg/min IV after return of perfusion
• In Hemodynamically stable VT
• 1-1.5 mg/kg; repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to 3 mg/kg total; follow with 1-
4 mg/min continuous infusion
10. Side effects
• Allergic reaction at injection site
• If given IV it can cause arrhythmias and Cardiac arrest
12. Aspirin
• It is irreversible Cycloxxygenase Inhibitor leading to decreased production of
thromoxaneA2 and is a potent antiplatelet.
• In Primary PCI----Loading Dose-81-325mg---300mg
• Maintanance dose-75mg daily for indefinite period.
• Side Effects-Gastric ulceration leading to Pain epigastrium and GI bleed.
• Others are tinnitus, asthama, vomiting
13. Clopidogrel
• Clopidogrel is an inhibitor of platelet activation and aggregation through the
irreversible binding of its active metabolite to the P2Y12 class of ADP
receptors on platelets.
• Dosage- 600mg loading dose in PCI followed by maintenance dose of 75
mg for atleast 12 months along with aspirin.
• Side effects- HAEMORRHAGE (ESPECIALLY GASTRO-INTESTINAL OR INTRA-
CRANIAL , GASTRO-INTESTINAL UPSET , PEPTIC ULCER , PANCREATITIS
,HEADACHE , FATIGUE , DIZZINESS , PARAESTHESIA , RASH/PRURITUS
14. Tirofiban
(agrastat)
• It competitively binds GpIIb/IIIa receptors and blocks
fibrinogen and vwf mediated platelet aggregation.
• Indicatated in PCI in high risk patients classIIa B
recomendation
• Dose-25microgram/kg bolus over 30 mins and maintance
infusion @0.15microgram/kg for upto 18 hours.
• Practically … 1ml agrastat contains 250mcg so in 70 kg
adult we need 8ml agrastat mixed with 2ml NS as a bolus
dose in 10cc syringe during PCI.
• Recovery of platelet aggregation starts after 4 hrs.
• S/E---Bleeding, Thrombocytopenia
16. Unfractionated Heparin
• MOA-It binds antithromin, a cofactor and induces conformational change
resulting in inhibition of factor Xa and thrombin inhibition at faster rate.
• Its half life is short about 30 mins.
• Dosage-70U/Kg as bolus or loading dose about 5000U
• Maintaince dose of 12-15U /kg
• S/E-Bleeding,HIT,Osteoporosis,Derranged LFTs
• Protamine sulfate is antidote …1 mg/IV neutralizes 100 U of heparin.
17. Uses of Heparin In cath Lab
• Flushing Cath lab Hardware with Saline
• 3000U heparin after femoral sheath and 4000U after radial access.
• In PCI if used with GPIIIb/IIa inhibitor heparin is given @50-70U/kg and
if without GPIIIb/IIa inhibitors then 70-100U/kg
• In PCI Heparin is given to achieve ACT 250 -300 in hemotech device and
300-350 in hemochrom device
19. Nitroglyceine
• Organic nitrate which is converted to NO,that stimulate guanylate ccyclase enzyme which in turns
synthesize cGMP, eventually resulting dephosphorylation of myosin light chain of vascular
smooth muscle fibre. Subsequet Ca++ release causes smooth muscle relaxation & vasodilatation.
• Dilates both vascular bed with venous predominant effect.
• Decreases both preload & afterload,also reduces both systolic & diastolic BP.
• Used as vasodilator & anti-antiginal drug in effort angina,UA,CSA,NSTEMI,hyprtensive crisis
etc.
• Has oral tablet,sublingual spray,IV infusion form. 10 ml ampoule; 1ml contains 5mg (5000 µg)
GTN. For IV infusion, 1amp mixed with 40NS & infuse @ 5 µg/min or 0.3ml/hr. Can be
increased by 0.3ml/hr every 10 min.
20. • Max dose 200-250 µg/min (12-15 ml/hr).
• In cath lab,0.2 ml (1000 µg)dissolved with 9.8 ml NS from where 1ml solution is
taken in each several syringe.
• 1ml dissolved GTN is given after PTCA balloon inflation to dilated the blood
vessels during PCI. Several injections may be needed accordingly.
• Side effects: Hypotension, headache,facial flushing,light
headedness,syncope,tachycardia,methemoglinemia,nitrate tolerance etc.
• Contraindications: Acute Inferior MI with RV involvement, HOCM, Use of
Sildenafil or related drugs,cardiac tamponade or constrictive pericarditis
21. Adenosine
• It slows down the conduction time through AV node
• Mainly DOC in SVTs
• Causes maximum coronary vasodilation witth minimal BP drop.
• Causes transient bradycardia for 5-10 s
• Indication---Rx for no reflow phenomenon
• Induction of hyperemia in FFR
• Dosage-30-90micrograms for left system and 10-50microgram for right system
• Always rule out Airway reactive disease before giving adenosine
22.
23. Verapamil
• Its Non-dihydropyridine Calcium channel blocker
• Indication—Coronary no reflow
• To prevent radial spasm
• Dose-50-200microgram intracoronary
• S/E----AV block ,Myocardial Depression
24. Calculation
• Each isoptin injection contains 2.5mg/ml so 2500mcg/ml
• Dilute it in 20 ccNS its concentration would be 125mcg and can be given
intracoronary
