ACLS Pharmacology

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 vasopressor.
*Recurrent, hemodynamically unstable VT

ATROPINE SULFATE
indications for use
*First drug for symptomatic bradycardia
*May be beneficial in pressence of AV nodal block
*Organophosphate poisonning

DOPAMINE
indications for use
*Second line drug for symptomatic bradycardia
*For hypotension with signs and symptoms of shock

EPINEPHRINE
indications for use
*Cardiac arrest: VF, pulseless VT, asystole, PEA
*Symptomatic bradycardia
*Severe hypotension
*Anaphylaxis, severe allergic reactions

LIDOCAINE
indications for use
*Alternative to amiodarone in cardiac arrest from VF/VT
*Stable monophasic VT with preserved ventricular function
*Stable polymorphic VT with normal baseline QT interval & preserves LV function
*Stable polymorphic VT with baseline QT-interval prolongation if torsades suspected

MAGNESIUM SULFATE
indications for use
*For use in cardiac arrest only if torsades-de-pointes or suspected hypomagnesemia present
*Life threatening ventricular arrhyhmias due to digitalis toxicity

VASOPRESSIN
indications for use
*Alternative to epinephrine in treatment of adult shock refractory VF
*Alternative to epinphrine in asystole, PEA
*Useful for hemodynamic support in vasodilatory shock

ADENOSINE
adult dosage
*Initial bolus of 6 mg given RAPIDLY OVER 1 TO 3 SECONDS followed by 20 ml bolus of NS, then elevate extremity
*Second dose of 12 mg can be given after 1 to 2 minutes if needed

AMIODARONE
adult dosage
*VF/VT Cardiac Arrest* First dose 300 mg IV/IO push, Second dose if needed 150 mg IV/IO push
*Life Tnhreatening Arrhythmias* 2.2 g IV over 24 hours. Rapid infusion: 150 mg IV over 10 minutes, may repeat every 10 minutes. Slow infusion: 360 mg IV over 6 hours. Maintenamce infusion: 540 mg IV over 18 hours.

ATROPINE SULFATE – Bradycardia
adult dosage
*Bradycardia: 0.5 mg every 3 to 5 minutes as needed to maximum of 3 mg.
*Shorter intervals and higher doses in severe conditions to maximum of 3 mg.

DOPAMINE
adult dosage
* 2 to 20 mcg/kg/min IV
*Titrate to patient response, taper slowly

EPINEPHRINE – Cardiac Arrest
adult dosage
*Cardiac Arrest: 1 mg (10 ml of 1:10,000 solution) every 3 to 5 minutes IV/IO during resuscitation followed by 20 ml NS flush. Elevate arm for 10 to 20 seconds.
*Continuous infusion 0.1 to 0.5 mcg/kg/min, titrate to response
*Endotracheal route: 2 to 2.5 mg diluted in 10 ml NS

LIDOCAINE – Cardiac Arrest
adult dosage
*Cardiac Arrest VF/VT: Initial dose 1 to 1.5 mg/kg IV/IO
*Refractory VF may give addional 0.5 to 0.75 mg/kg IV push, repeat in 5 to 10 minutes. Max 3 doses or 3 mg/kg

LIDOCAINE – Perfusing Arrhythmia
*Stable VT, wide-complex tachycardia of uncertain types, significant ectopy: 0.5 to 0.75 mg/kg and up to 1 to 1.5 mg/kg may be used. Repeat 0.5 to 0.75 mg/kg every 5 to 10 minutes. Maximum dose: 3 mg/kg

LIDOCAINE – Maintenance Infusion
adult dosage
*1 to 4 mg per minutes (30 to 50 mcg/kg/min)

ATROPINE SULFATE – Organophosphate Poisoning
adult dosage
*Organophosphate poisoning: Extremely large doses 2 to 4 mg or higher if needed.

EPINEPHRINE – Profound Bradycardia or Hypotension
adult dosage
*Hypotension: 2 to 10 mcg/min infusion, titrate to response

MAGNESIUM SULFATE – Cardiac Arrest
adult dosage
*Due to Hypomagnsemia of Torsades-de-Pointes): 1 to 2 g (2 to 4 ml of 50% solution) diluted in 10 ml of D5W IV/IO

MAGNESIUM SULFATE – Torsades de Pointes with pulse or AMI with Hypomagnesemia
adult dosage
*Loading dose of 1 to 2 g mixed in 50 to 100 ml of D5W over 5 to 60 minutes IV.
*Follow with 0.5 to 1.0 g per hour IV (titrate to control Torsades)

VASOPRESSIN – Cardiac Arrest
adult dosage
*One dose of 40 units IV/IO push. May replace 1st or 2nd dose of epinephrine.

VASOPRESSIN – Vasodilitory shock
adult dosage
Continuous infusion of 0.02 to 0.4 units per minute

ACLS Medications that can be given via endotracheal tube
Atropine Sulfate, Epinephrine, Lidocaine, Vasopressin

ADENOSINE
precautions / contraindications
*poison / drug induced tachcardia, 2nd or 3rd degree heart block** side effects include: flushing, cheat pain/tightness, brief periods of asystole or bradycardia, ventricular ectopy** larger doses may be required if taking theophylline of caffine** may cause deterioration for irregular polymorphic wide complex tachycardia/VT

AMIODARONE
precautions / contraindications
*MULTIPLE COMPLEX DRUG INTERACTIONS** rapid infusion may lead to hypotension** Cumulative doses >2.2 g over 24 hours associated with significant hypotension** do not administer with other drugs that prolong QT interval** Half life lasts up to 40 days

ATROPINE SULFATE
precautions / contraindications
*Caution in pressence of myocardial ischemia & hypoxia** avaoid in hypothermic bradycardia** May not be effective for infranodal AV block & new 3rd degree block with wide QRS complexes** Doses <0.5 mg may result in paradoxical slowing of heart rate

DOPAMINE
precautions / contraindications
*Correct hypovolemia with volume replacement before initiating dopamine** use with caution in cardiogenic shock with CHF** May cause tachyarrhythmias, excessive vasoconstriction** do not mix with sodium bicarbonate

EPINEPHRINE
precautions / contraindications
*Raising BP and increasing heart rate may cause myocardial ischemia, angina, myocardial O2 demand** High doses do not improve survival or neurologic outcomes, may contribute to post resuscitation myocardial dysfunction** higher doses may be required for poison/drug induced shock.

LIDOCAINE
precautions / contraindications
*PROPHOLACTIC USE IN AMI IS CONTRAINDICATED** reduce maintenance dose in pressence of impaired liver function or LV dysfunction** D/C infusion immediately if signs of toxicity develope

MAGNESIUM SULFATE
precautions / contraindications
*Occasional fall in BP with rapid administration** use caution if renal failure is present

VASOPRESSIN
precautions / contraindications
*Potent peripheral vasoconstrictor, increased peripheral vascular resistance may provoke cardiac ischemia and angina** not recommended for responsive patients with coronary artery disease.

Ventricular Fibrillation and pulseless Ventricular Tachycardia Case Medications
*Epinepherine** used as a pressor 1mg / 3-5 min. following shock or no shock

*Vasopressin** used as a pressor 40 units can be used in place of 1st and 2nd Epi treatment

*Amioderone** used as an anti-arrythmatic only following second shock (1st round) 300mg, (2nd round) 150mg

*Lidocaine** used as an anti-arrythmatic only when *Amioderone** is not available

*Magnesium Sulfate** used as an anti-arrythmatic indicated with Torsades de Pointes

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 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 …

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 …

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 WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY …

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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