ACLS Pharmacology Summary Table

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 convert a-fib, a-flutter or VT
– Diagnosis maneuver=stable narrow-complex SVT

Adenosine – Precautions/Contraindications
– Contraindication in poison/drug induced tachycardia or 2nd/3rd degree heart block
– Transient side effects= flushing, chest pain, tightness, brief asystole/bradycardia, ventricular eectopy
– Less effective when taking theophylline or caffeine
– Reduce initial dose to 3mg when receiving dipyridamole or carbamazepine, heart transplant patients or by central venous access
– In Irregular, Polymorphic, wide-complex tachycardia/VT, may cause deterioration
– Transient periods of sinus bradycardia and ventricular ectopy common after termination of SVT
– Safe and effective in Pregnancy

Adenosine – Adult Dosage
IV Rapid Flush:
– Place in mild reverse Trendelenburg position before admin
– Initial bolus of 6mg rapidly over 1-3 seconds then NS bolus of 20mL, then elevate
– 2nd dose can be given in -2 minutes if needed

Injection Technique:
– Record rhythm strip during admin
– Draw up adenosine dose and flush in 2 separate syringes
– Attach both syringes to IV injection port closest to patient
– Clamp IV above injection point
– Push IV Adenosine as quickly as possible
– Push NS flush RAPIDLY after adenosine
– Unclamp IV tubing

Amiodarone – Indications
– Associated with toxicity
– Use in patients w/ life-threatening arrhythmias
—- VF/pulseless VT unresponsiveness to shock delivery, CPR, vasopressor
—- Recurrent, hemodynamically unstable VT
– May be use to treat some atrial/ventricular arrhythmias

Amiodarone – Precautions/Contraindications
** CAUTION** – Multiple complex drug interactions
– Rapid infusion may lead to hypotension
– Don’t administer w/ other drugs that prolong QT intervals (procainamide)
– Terminal elim is extremely long (1/2 life lasts up to 40 days)

Amiodarone – Adult Dosage
VF/VT Cardiac Arrest Unresponsive to CPR, Shock, Vasopressor
– First Dose: 300mg IV/IO push
– Second Dose (if needed): 150mg IV/IO push

Life-Threatening Arrhythmias
– Max cumulative dose: 2.2g IV over 24 hrs as follows:
— Rapid Infusion: 150mg IV over 1st 10 mins, may repeat every 10
— Slow Infusion: 360mg IV over 6 hrs
— Maintenance Infusion: 540mg IV over 18 hrs

Atropine Sulfate – Indications (Can be endo tube admin)
– 1st Drug for symptomatic sinus bradycardia
– May be beneficial in presence of AV nodal block
**Not likely effective for type 2 or third degree AV block or non-nodal tissue block**
– Routine use during PEA or asystole is unlikely to have therapeutic benefit
– Organophosphate poisoning: extremely marge doses may be needed

Atropine Sulfate – Precautions/Contriandications (Can be endo tube admin)
– Use w/ caution in presence of myocardial ischemia & hypoxia. Increases myocardial oxygen demand
– Avoid in hypothermic bradycardia
– May not be effective for infranodal AV block & new 3rd degree block w/ wide QRS complexes – Be prepared to pace or give catecholamines
– Doses of atropine <0.5mg may result in paradoxical slowing of heart rate

Atropine Sulfate – Adult Dosage (Can be endo tube admin)
Bradycardia (w/ or w/o ACS):
– 0.5mg IV every 3-5 mins as needed, not to exceed total of 3mg
– Use shorter dosing interval (3 mins) & give higher doses in severe clinical conditions

Organophosphate Poisoning:
– Extremely large doses (2-4mg or higher) may be needed

Dopamine – Indications (IV Infusion)
– 2nd-line drug for symptomatic bradycardia (after atropine)
– Use for hypotension w/ signs/symptoms of shock

Dopamine – Precautions/Contraindications (IV Infusion)
– Correct hypovolemia w/ volume replacement before initiate dopamine
– Caution when using cardiogenic shock w/ accompanying CHF
– May cause tachyarrhythmias, excessive vasoconstriction
– DON’T mix w/ sodium bicarbonate

Dopamine – Adult Dosage (IV Infusion)
IV Admin:
– Usual infusion rate is 2-20 mcg/kg per min
– Titrate to patient response, taper slowly

Epinephrine – Indications (Can be endo tube admin)
Available in 1:10,000 & 1:000 concentrations
Cardiac Arrest:
– VF, Pulseless VT, asystole, PEA
Symptomatic Bradycardia:
– Can be considered after atropine as an alt infusion to dopamine
Severe Hypotension:
– Can be used when pacing & atropine fails, when hypotension accompanies bradycardia, or w/ phosphodiesterase enyme inhibitor
Anaphylaxis, Severe Allergic Reations:
– Combine w/ large fluid volume, corticosteroids, antihistamines

Epinephrine – Precautions/Contraindications (Can be endo tube admin)
Available in 1:10,000 & 1:000 concentrations
– Raising blood press & increasing heart rate may cause myocardial ischemia, angina, increase myocardial oxygen demand
– High doses DON’T improve survival or neurological outcome
– May contribute to postresuscitation myocardial dysfunction

Epinephrine – Adult Dosage (Can be endo tube admin)
Available in 1:10,000 & 1:000 concentrations
Cardiac Arrest:
– IV/IO Dose: mg admin every 3-5 mins during resus. Follow each dose w/ 20mL flush, elevate arm for 10-20 seconds after dose
Higher Dose:
– May be used for specific indications (B-Blocker or calcium channel blocker OD)
Continuous Infusion:
– Initial rate: 0.1-0.5 mcg/kg per min (for 70 kg patient; 7-35); titrate to response
Endotracheal Route:
– 2-2.5mg diluted in 0mL NS
Profound Bradycardia or Hypotension:
– 2-10mcg per min infusion; titrate to response

Lidocaine – Indications (Can be endo tube admin)
– Alternate to amiodarone in cardiac arrest from VF/VT
– Stable monomorphic VT w/ preserved ventricular function
– Stable polymorphic VT w/ normal baseline QT interval & preserved LV function when ischemia is treated & electro balance is corrected
– Can be used for stable polymorphic VT w/ baseline T-interval prolongation if torsades suspected

Lidocaine – Precautions/Contraindications (Can be endo tube admin)
**Prophylactic use in AMI is contraindication**
– Reduce maintenance dose (not loading) in presence of impaired liver function or LV dysfunction
– Discontinue infusion immed if signs of toxicity develop

Lidocaine – Adult Dosage (Can be endo tube admin)
Cardiac Arrest From VF/VT:
– Initial Dose: 1-1.5 mg/kg IV/IO
– For refractory VF may give additional 0.5-0.75 mg/kg IV push, repeat in 5-10 min, max 3 doses or total of 3mg/kg
Perfusing Arrhythmia:
*For stable VT, wide-complx tachycardia or certain type, signif ectopy*
– Doses ranging 0.5-0.75mg/kg & up to 1-.5 mg/kg may be used
– Repeat 0.5-0.75mg/kg every 5-10 mins; max total dose= 3mg/kg
Maintenance Infusion:
– 1-4mg per min (30-50 mcg/kg per min)

Magnesium Sulfate – Indications
– Recommended for use in cardiac arrest only if torsades de pointes or suspected hypomagnesemia is present
– Life-threat ventric arrhythmias due to digitalis toxicity
– Routine admin in hospitalized patients w/ AMI is NOT recommended

Magnesium Sulfate – Precautions/Contraindications
– Occasional fall in blood press w/ rapid admin
– Use w. caution if renal failure present

Magnesium Sulfate – Adult Dosage
Cardiac Arrest (Due to Hypomagnesemia or Torsades de Pointes):
– 1-2g given IV/IO
Torsades de Pointes w/ a Pulse or AMI w/ Hypomagnesemia:
– Loading dose – 1-2g mixed in 50-100mL of diluent over 5-60 min IV
– Follow w/ 0.5-1g per hour IV (titrate to control torsades)

Vasopressin – Indications (can be endo tube admin)
– May be used as alt pressor to epinephrine in treatment of adult shock-refractory VF
– May be useful alt to epinephrine in asystole, PEA
– May be useful for hemodynamic support in vasodilatory shock (septic)

Vasopressin – Precautions/Contraindications (can be endo tube admin)
– Potent peripheral vasoconstrictor. Increased periph vascular resistance may provoke cardiac ischemia and angina
– Not recommended for responsive patients w/ coronary artery disease

Vasopressin – Adult Dosage (can be endo tube admin)
IV Admin Cardiac Arrest:
– 1 dose of 40 units IV/IO push may replace either 1st or 2nd dose of epinephrine. Epinephrine can be admin every 3-5 mins during cardiac arrest
Vasodilatory Shock:
– Continuous infusion of 0.02-0.04 units per min

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 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 …

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 …

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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