ACLS Pharmacology Summary Table

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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

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Adenosine First drug for most forms of stable narrow-complex SVT; effective in terminating those due to reentry involving AV …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy ADENOSINE indications for use *First drug for most forms of stable narrow complex SVT. *Effective in terminating those due …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy What are the goals of ACLS? restoration of spontaneous ventilation and circulation Cerebral perfusion and resuscitation What is Class …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Adenosine Indication: stable narrow complex SVT Precaution: posion/drug induce tachycardia or 2 or 3 degree heart block Route: IV …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy VF/ pulseless VT drugs Epinephrine IV/IO (1mg q3-5min) Vasopressin IV/IO (40u can replace first or second dose of EPI …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Adenosine • SVT • 0.1 mg/kg IV/IO rapid push (max 6 mg) • 2nd dose 0.2 mg/kg IV/IO rapid …

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