ACLS Pharmacology

What are the goals of ACLS?
restoration of spontaneous ventilation and circulation
Cerebral perfusion and resuscitation

What is Class I benefit>>> risk?
procedure/treatment or diagnostic test/assessment should be performed/administered

What is Class IIa Benefit >> risk?
it is reasonable to perform procedure/admin treatment or perform diagnostic test or assessment

What is Class IIb Beefit >/ risk?
procedure/treatment or diagnostic test/assessment may be considered

What is Class III Risk >/ benefit?
procedure/treatment or diagnostic test/assessment should not be performed/admin. it is NOT helpful and may be harmful

What are the 3 routes of admin of ACLS drugs?
IV
IO
Endotracheal tube

What is special about dosing if you are giving meds through an endotracheal tube?
you must up the dose 2-2.5 times the IV doseage

What are the components of the Pulseless Arrest Algorithm?
VF/VT
Asystole
PEA (pulseless electrical activity)

What are the 5 core cases Algorithms?
Pulseless Arrest
Bradycardia
Tachycardia (with pulses)
Acute Coronary Syndrome
Acute Stroke

What are the H’s of Causes for Asystole or PEA?
hypovolemia
hypoxia
hydrogen ion (acidosis)
hyper/hypokalemia
hypoglycemia
hypothermia

What are the T’s of Causes of Asystole or PEA?
toxins
tamponade
tension pneumothorax
thrombosis
trauma

What does Adenosine *not* do?
convert a-fib, a-flutter, or VT

What is the MOA of Adenosine?
increase AV node refractoriness

What is Adenosine the first drug for?
most forms of stable narrow-complex PSVT

Who is Adenosine contraindicated in?
poison/drug induces tachycardia
or
2* or 3* heart blocks

What are SE of Adenosine?
flushing
chest pain or tightness
brief periods of asystole or bradycardia
ventricular ectopy

What could Adenosine cause if administered for wide complex tachycardia/ VT?
deterioration (hypotension)

Is Adenosine safe for pregnant women?
yuppers!

What is the half life of Adenosine?
like 3-5 seconds

What are the indications for Amiodarone?
recurrent V fib
recurrent hemo-dynamically unstable V tachycardia

what is MOA of Amiodarone?
sodium channel blocker
beta adrenergic blocker
slows potassium rectifier current (prolongs action potential)
calcium channel blocker

What is assoc with multiple large doses of Amiodarone in a small time frame?
significant hypotension

What should you not administer Amiodarone with?
other drugs that prolong QT interval

What is the half-life of Amiodarone?
up to 40 days

What are the 2 indications for Atropine?
Sx bradycardia
PEA with slow HR

What is the MOA for Atropine?
anticholinergic (increase HR)
increase sinus node automaticity
increase AV conduction via direct vagolytic action

When should you use caution with Atropine?
in the presence of myocardial ischemia and hypoxia
b/c it increases myocardial oxygen demand

What should you avoid Atropine in?
hypothermic bradycardia

What could Atropine maybe be effective in, but definitely not effective in?
may be good for 2nd degree heart block
but definitely useless in 3rd degree heart block

What can doses of Atropine < 0.5 mg result in?
paradoxical slowing of HR

What is the indication for Digoxin?
slow ventricular response in A fib or A flutter
also an alternate drug for reentry SVT

What is the MOA of Digoxin?
binds Sodium-Potassium-ATPase -> cause increase of intracellular Calcium

What are the toxic effects of Digoxin assoc with?
serious arrhythmias

What other drug can reduce the effects of Digoxin?
Amiodarone

What is the indication for Diltiazem?
control Ventricular rate in A fib and A flutter
after Adenosine to treat refractory reentry SVT in pts with narrow complex and adequate BP

What is the MOA of Diltiazem?
CCB

When should you not use CCB (Diltiazem)?
for wide complex tachycardias of uncertain origin
or
poison/drug induced tachycardias

What could happen to BP when using Diltiazem?
it may drop from peripheral vasodilation

Who should you avoid using Diltiazem in?
pts on oral beta blockers

What can Diltiazem cause if admin with IV beta blockers?
severe hypotension!

What are the indications for Dopamine?
2nd line for symptomatic bradycardia
use for hypotension with S/S of shock

What is the MOA of Dopamine?
endogenous catecholamine

What should you do before you admin dopamine?
correct hypovolemia with volume replacement

What condition should you use caution with if admin Dopamine?
cardiogenic shock with accompanying CHF

What could Dopamine cause?
tachyarrhythmias
excessive vasoconstriction

What should you absolutely not mix Dopamine with?
sodium bicarb

What are the indications for Epinephrine?
cardiac arrest
Sx bradycardia
severe hypotension
anaphylaxis

Who is the 1:10,000 dose of Epinephrine for?
cardiac arrest in adults

Who is the 1: 1,000 dose of Epinephrine for?
cardiac arrest in peds

What is the MOA of Epinephrine?
endogenous catecholamine
alpha 1 agonist (increases vasoconstriction)
beta 1&2 agonist (increases: HR, strength of heart contractions, electrical activity in the myocardium, automaticity)
increased cerebral perfusion
increased myocardial perfusion pressure

What is the bad part of raising BP and HR from epinephrine?
you increase myocardial oxygen demand and may cause myocardial ischemia and angina

What can high doses of Epinephrine contribute to?
post-resuscitation myocardial dysfunction

What is the indication for Lidocaine?
alt to Amiodarone in cardiac arrest from VF/VT

What is the MOA of Lidocaine?
sodium channel blocker
decreases automaticity of conduction tissue
increases electrical stimulation threshold

What is contraindicated with the use of Lidocaine?
prophylaxis use in AMI

What should you do to the dose of Lidocaine in the presence of impaired liver function or LV dysfunction?
reduce the maintenance dose

What is the indication of Magnesium Sulfate?
suspected Torsades de Pointes or
suspected hypomagnesemia
life threatening ventricular arrhythmias from dig toxicity

What is the MOA of Magnesium Sulfate?
slows SA nodal conduction

What can happen to BP with rapid admin of Magnesium Sulfate?
occasional fall in BP

What kind of pt should you use caution with Magnesium Sulfate?
renal failure pts

What are the indications of Vasopressin?
alt pressor to Epi in Tx of *adult shock-refractory VFib*
alt to epi in Tx of *asystole and PEA*

What is the MOA of Vasopressin?
peptide released from posterior pituitary
pressor effects, antidiuretic effects

What is vasopressin?
a potent peripheral vasoconstrictor

What could Vasoprssin provoke with increased peripheral vascular resistance?
cardiac ischemia and angina

Who is Vasopressin not recommended for?
responsive pts with CAD

What are the indications for Verapamil?
alt drug (after adenosine) to terminate PSVT with narrow complex QRS and adequate BP and preserved LV function

What is the MOA of Verapamil?
CCB

What are the effects of Verapamil?
decreased HR
prolonged myocardial conduction (SA and AV)
decreases force of contraction

Who are the only pts that should get Verapamil?
pts with narrow-complex PSVT
or
known supraventricular arrhythmias

Adenosine – Indications – First drug for most forms of stable narrow-complex SVT – Effective in terminating reentry involving AV node/sinus node – Narrow-complex reentry tachycardia while prepping for cardioversion – Wide-complex tachycardia, thought to be reentry SVT – Doesn’t …

ADENOSINE indications for use *First drug for most forms of stable narrow complex SVT. *Effective in terminating those due to reentry involving AV node or sinus node. AMIODARONE indications for use *VF/pulseless VT unresponsive to shock delivery, CPR, and a …

Adenosine First drug for most forms of stable narrow-complex SVT; effective in terminating those due to reentry involving AV node or sinus node Amiodarone Because its use is associated with toxicity, it is indicated for use in patients with life-threatening …

Adenosine Indication: stable narrow complex SVT Precaution: posion/drug induce tachycardia or 2 or 3 degree heart block Route: IV rapid push Dosage: 6 mg follow by a 20mL of NS raise extremity, second dosage of 12 mg if needed, 1-2min …

VF/ pulseless VT drugs Epinephrine IV/IO (1mg q3-5min) Vasopressin IV/IO (40u can replace first or second dose of EPI Amiodarone IV/IO (First dose: 300mg bolus. 2nd dose: 150mg) Asystole/PEA drugs Epinephrine IV/IO (1mg q3-5min) Vasopressin IV/IO (40u can replace first …

Adenosine • SVT • 0.1 mg/kg IV/IO rapid push (max 6 mg) • 2nd dose 0.2 mg/kg IV/IO rapid push (max 12 mg) Albumin • Shock, Trauma, Burns • 0.5 to 1 g/kg (10-20 ml/kg of 5% solution) IV/IO rapid …

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