ACLS-Drugs-Austin-TX

Drugs most commonly used in an ACLS course

ACLS Pharmacology Summary Table

This table provides information about common drugs used in ACLS.

Drug	Indications	Precautions and contraindications	Adult dosage
Adenosine	-First drug for most forms of stable narrow-complex SVT; effective in terminating those due to reentry involving AV node or sinus node -May consider for unstable narrow-complex reentry tachycardia while preparations are made for cardioversion -Regular and monomorphic wide-complex tachycardia, thought to be or previously defined to be reentry SVT -Does not convert atrial fibrillation, atrial flutter, or VT -Diagnostic maneuver: stable narrow-complex SVT	Contraindicated in poison/ drug-induced tachycardia or second- or third-degree heart blockTransient side effects include flushing, chest pain or tightness, brief periods of asystole or bradycardia, ventricular ectopyLess effective (larger doses may be required) in patients taking theophylline or caffeineReduce initial dose to 3 mg in patients receiving dipyridamole or carbamazepine, in heart transplant patients, or if given by central venous accessIf administered for irregular, polymorphic wide-complex tachycardia/VT, may cause deterioration (including hypotension)Transient periods of sinus bradycardia and ventricular ectopy are common after termination of SVTSafe and effective in pregnancy	IV Rapid Push -Place the patient in mild reverse Trendelenburg position before administration of drugInitial bolus of 6 mg given rapidly over 1 to 3 seconds followed by NS bolus of 20 mL; then elevate the extremity -A second dose (12 mg) can be given in 1 to 2 minutes if needed Injection Technique -Record rhythm strip during administration -Draw up adenosine dose in one syringe and flush in another; attach both syringes to the same or immediately adjacent IV injection ports nearest patient, with adenosine closest to patient; clamp IV tubing above injection portPush IV adenosine as quickly as possible (1 to 3 seconds) -While maintaining pressure on adenosine plunger, push NS flush as rapidly as possible after adenosineUnclamp IV tubing
Amiodarone	Because its use is associated with toxicity, amiodarone is indicated for use in patients with life-threatening arrhythmias when administered with appropriate monitoring 1. VF/pVT unresponsive to shock delivery, CPR, and a vasopressor 2. Recurrent, hemodynamically unstable VT With expert consultation, amiodarone may be used for treatment of some atrial and ventricular arrhythmias. Caution: Multiple complex drug interactions	Rapid infusion may lead to hypotensionWith multiple dosing, cumulative doses >2.2 g over 24 hours are associated with significant hypotension in clinical trials Do not administer with other drugs that prolong QT interval (eg, procainamide)Terminal elimination is extremely long (half-life lasts up to 40 days)	VF/pVT Cardiac Arrest Unresponsive to CPR, Shock, and Vasopressor First dose: 300 mg IV/IO push Second dose (if needed): 150 mg IV/IO push Life-Threatening ArrhythmiasMaximum cumulative dose: 2.2 g IV over 24 hours. May be administered as follows: Rapid infusion: 150 mg IV over first 10 minutes (15 mg/min). May repeat rapid infusion (150 mg IV) every 10 minutes as needed Slow infusion: 360 mg IV over 6 hours (1 mg/min) Maintenance infusion: 540 mg IV over 18 hours (0.5 mg/min)
Atropine sulfate Can be given via endotracheal tube	First drug for symptomatic sinus bradycardiaMay be beneficial in presence of AV nodal block; not likely to be effective for type II second-degree or third-degree AV block or a block in non-nodal tissue Routine use during PEA or asystole is unlikely to have a therapeutic benefit Organophosphate (eg, nerve agent) poisoning: extremely large doses may be needed	Use with caution in presence of myocardial ischemia and hypoxia. Increases myocardial oxygen demandUnlikely to be effective for hypothermic bradycardiaMay not be effective for infranodal (type II) AV block and new third-degree block with wide QRS complexes (in these patients may cause paradoxical slowing; be prepared to pace or give catecholamines)	Bradycardia (With or Without ACS) 1 mg IV every 3 to 5 minutes as needed, not to exceed total dose of 0.04 mg/kg (total 3 mg) Organophosphate Poisoning Extremely large doses (2 to 4 mg or higher) may be needed
Dopamine IV infusion	Second-line drug for symptomatic bradycardia (after atropine)Use for hypotension (systolic blood pressure ≤70-100 mm Hg) with signs and symptoms of shock	Correct hypovolemia with volume replacement before initiating dopamine Use with caution in cardiogenic shock with accompanying CHF May cause tachyarrhythmias, excessive vasoconstriction Do not mix with sodium bicarbonate	IV Administration Usual infusion rate is 5-20 mcg/kg per minute.Titrate to patient response; taper slowly
EpinephrineCan be given via endotracheal tubeAvailable in 1:10 000 and 1:1000 concentrations	Cardiac arrest: VF, pulseless VT, asystole, PEA Symptomatic bradycardia: Can be considered after atropine as an alternative infusion to dopamine Severe hypotension: Can be used when pacing and atropine fail, when hypotension accompanies bradycardia, or with phosphodiesterase enzyme inhibitor Anaphylaxis, severe allergic reactions: Combine with large fluid volume, corticosteroids, antihistamines	Raising blood pressure and increasing heart rate may cause myocardial ischemia, angina, and increased myocardial oxygen demandHigh doses do not improve survival or neurologic outcome and may contribute to postresuscitation myocardial dysfunctionHigher doses may be required to treat poison/drug-induced shock	Cardiac ArrestIV/IO dose: 1 mg (10 mL of 0.1 mg/mL solution) administered every 3-5 minutes during resuscitation; follow each dose with 20 mL flush, elevate arm for 10-20 seconds after dose Higher dose: Higher doses (up to 0.2 mg/kg) may be used for specific indications (β-blocker or calcium channel blocker overdose) Continuous infusion: Initial rate: 0.1-0.5 mcg/kg per minute (for 70-kg patient: 7-35 mcg/min); titrate to response Endotracheal route: 2–2.5 mg diluted in 10 mL NS Profound Bradycardia or Hypotension 2-10 mcg/min infusion; titrate to patient response
Lidocaine Can be given via endotracheal tube	-Alternative to amiodarone in cardiac arrest from VF/pVT -Stable monomorphic VT with preserved ventricular function -Stable polymorphic VT with normal baseline QT interval and preserved LV function when ischemia is treated and electrolyte balance is corrected -Can be used for stable polymorphic VT with baseline QT-interval prolongation if torsades suspected	Contraindication: Prophylactic use in AMI is contraindicatedReduce maintenance dose (not loading dose) in presence of impaired liver function or LV dysfunctionDiscontinue infusion immediately if signs of toxicity develop	Cardiac Arrest From VF/pVT Initial dose: 1-1.5 mg/kg IV/IOFor refractory VF, may give additional 0.5-0.75 mg/kg IV push and repeat in 5-10 minutes; maximum 3 doses or total of 3 mg/kg Perfusing Arrhythmia For stable VT, wide-complex tachycardia of uncertain type, significant ectopy:Doses ranging from 0.5-0.75 mg/kg and up to 1-1.5 mg/kg may be usedRepeat 0.5-0.75 mg/kg every 5-10 minutes; maximum total dose: 3 mg/kg Maintenance Infusion 1-4 mg/min (30-50 mcg/kg per minute)
Magnesium sulfate	Recommended for use in cardiac arrest only if torsades de pointes or suspected hypomagnesemia is present -Life-threatening ventricular arrhythmias due to digitalis toxicity -Routine administration in hospitalized patients with AMI is not recommended	Occasional fall in blood pressure with rapid administrationUse with caution if renal failure is present	Cardiac Arrest (Due to Hypomagnesemia or Torsades de Pointes) 1-2 g (2-4 mL of a 50% solution diluted in 10 mL [eg, D5W, normal saline] given IV/IO) Torsades de Pointes With a Pulse or AMI With Hypomagnesemia Loading dose of 1-2 g mixed in 50-100 mL of diluent (eg, D5W, normal saline) over 5-60 minutes IVFollow with 0.5-1 g per hour IV (titrate to control torsades)

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