This document provides information on pharmacology for ACLS. It summarizes 7 common medications used in ACLS including indications, dosages, and precautions. Adenosine is described as used for stable narrow-complex SVT and unstable narrow-complex re-entry tachycardia. Amiodarone is indicated for refractory VF/VT and recurrent hemodynamically unstable VT. Atropine is the first drug for symptomatic sinus bradycardia and may be beneficial for AV block or asystole. Epinephrine is indicated for cardiac arrest, symptomatic bradycardia, and hypotension. Lidocaine is an alternate to amiodarone for cardiac arrest from VF/VT and for
This document provides information on pharmacology for ACLS. It summarizes 7 common medications used in ACLS including indications, dosages, and precautions. Adenosine is described as used for stable narrow-complex SVT and unstable narrow-complex re-entry tachycardia. Amiodarone is indicated for refractory VF/VT and recurrent hemodynamically unstable VT. Atropine is the first drug for symptomatic sinus bradycardia and may be beneficial for AV block or asystole. Epinephrine is indicated for cardiac arrest, symptomatic bradycardia, and hypotension. Lidocaine is an alternate to amiodarone for cardiac arrest from VF/VT and for
This document provides information on pharmacology for ACLS. It summarizes 7 common medications used in ACLS including indications, dosages, and precautions. Adenosine is described as used for stable narrow-complex SVT and unstable narrow-complex re-entry tachycardia. Amiodarone is indicated for refractory VF/VT and recurrent hemodynamically unstable VT. Atropine is the first drug for symptomatic sinus bradycardia and may be beneficial for AV block or asystole. Epinephrine is indicated for cardiac arrest, symptomatic bradycardia, and hypotension. Lidocaine is an alternate to amiodarone for cardiac arrest from VF/VT and for
This document provides information on pharmacology for ACLS. It summarizes 7 common medications used in ACLS including indications, dosages, and precautions. Adenosine is described as used for stable narrow-complex SVT and unstable narrow-complex re-entry tachycardia. Amiodarone is indicated for refractory VF/VT and recurrent hemodynamically unstable VT. Atropine is the first drug for symptomatic sinus bradycardia and may be beneficial for AV block or asystole. Epinephrine is indicated for cardiac arrest, symptomatic bradycardia, and hypotension. Lidocaine is an alternate to amiodarone for cardiac arrest from VF/VT and for
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ACLS Pharmacology
flushing
chest pain or tightness
brief periods of asystole or bradycardia
ventricular ectopy
Less effective in patients taking theophylline or caffeine
If administered for irregular, polymorohic wide-complex
tachycardia/VT, may cause deterioration
Transient periods of sinus bradycardia and ventricular
ectopy are common after termination of SVT
Safe and effective pregnancy
Adult Dosage: IV Rapid Push
1. Adenosine Class: Antidysrhythmics TACHY
Place patient in mild reverse Tredelenburg position
before administration of drug
Initial bolus of 6mg given rapidly over 1 to 3 seconds
followed by NS bolus of 20ml; then elevate the extremity
A second dose (12mg) can be given in 1 to 2 minutes if
needed
Indications:
stable narrow-complex SVT
unstable narrow complex re-entry tachycardia
Record rhythm strip during administration
Regular and monomorphic wide complex tachycardia
Draw up adenosine dose and flush in 2 separate
syringes
Attach both syringes to the IV injection port closest to
patient
Clamp IV tubing above injection port
Injection Technique:
Precautions / Contraindications:
Contraindicated in poison/ drug-induced tachycardia or
second-or third degree heart block.
Transient side effects
ACLS Pharmacology Push IV adenosine as quickly as possible (1 to 3 Maximum cumulative dose: seconds) 2.2g IV over 24hrs. May be administered as follows: While maintaining pressure on adenosine plunger, push Rapid infusion: 150 mg IV over first 10 minutes as NS flush as rapidly as possible after adenosine needed Unclamp IV tubing Slow infusion: 360 mg over 6hours (1mg per minute)
2. Amiodarone
Maintenance infusion :540mg IV over 18 hours (0.5mg
per minute)
Class: Antidysrhytmics, III
Indications:
VF/pulseless VT unresponsive to shock delivery, CPR,
and a vasopressor
Recurrent, hemodynamically unstable VT
May be used for treatment of some atrial and ventricular
arrhythmias
Precautions / Contraindications:
Rapid infusion may lead to hypotension
Do not administer with other drugs that prolong QT
interval (eg, procainamide)
Terminal elimination is extremely long.
Adult Dosage: VF/VT Cardiac arrest Unresponsive to CPR, Shock, and Vasopressor
May be beneficial in presence of AV nodal block or
ventricular asystole.
Organophosphate poisoning (eg, nerve agent)
Precautions/Contraindications:
Use with caution in presence of myocardial ischemia and
hypoxia
Avoid in hypothermic bradycardia
Will not be effective for infranodal (type II) AV block and
new third-degree block with wide QRS complexes.
Doses of atropine <0.5mg may result in paradoxical
slowing of heart rate.
Adult Dosage: Bradycardia (With or Without ACS)
ACLS Pharmacology 0.5mg IV every 3 to 5 minutes as needed, not to exceed total dose of 0.04mg/kg (total 3mg) Use shorter dosing interval (3minutes) and higher doses in severe clinical conditions.
Extremely large doses (2-4 mg or higher) maybe needed
Indications:
Cardiac arrest: VF, pulseless VT, asystole, PEA
4. Dopamine
Symptomatic bradycardia
IV Infusion
Severe hypotension
Class: Inotropic Agents
Anaphylaxis, severe allergic reactions
Indications:
Second-line drug for symptomatic bradycardia
Use for hypotension (SBP 70 TO 100 mm Hg) with
signs and symptoms of shock.
Precautions/Contraindications:
Correct hypovolemia with volume replacement before
initiating dopamine Use with caution in cardiogenic shock with accompanying CHF
May cause tachyarrhythmia, excessive vasoconstrictions
Do not mix with sodium bicarbonate
Adult Dosage: IV Administration
Usual infusion rate is 2 to 20 mcg/kg per minute
Titrate to patient response; taper slowly
Precautions/Contraindications:
Raising blood pressure and increasing heart rate may
cause myocardial ischemia, angina, and increased myocardial oxygen demand
High doses do not improve survival or neurologic
outcome and may contribute to post resuscitation myocardial dysfunction
Higher doses may be required to treat poison/druginduced shock
Adult Dosage: Cardiac Arrest
IV/IO dose: 1mg (10ml of 1:10 000 solution)
administered every 3 to 5 minutes during resuscitation. Follow each dose with 20ml flush, elevate arm for 10-20 seconds after dose
ACLS Pharmacology Higher dose: Higher doses (up to 0.2mg/kg) may be used Endotracheal route: 2 to 2.5mg diluted 10ml NS for specific indications (-blocker or calcium channel Profound Bradycardia or Hyotension blocker overdose) 2 to 10 mcg per minute infusion; titrate to patient Continuous infusion: Initial rate 0.1 to 0.5mcg per minute) response titrate to response
6. Lidocaine Class: Antidysrythmic (Class 1-B)
Indications
Alternate to amiodarone in cardiac arrest VF/VT
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 QTinterval prolongation if torsades suspected
Precautions/Contraindications:
Prophylactic use in AMI is contraindicated
Reduce maintenance dose in presence of impaired liver
function or LV dysfunction.
Discontinue infusion immediately if signs of toxicity
develop
Adult Dosage: Cardiac Arrest From VF/VT
Initial dose: 1 to 1.5 mg/kg IV/IO
For refractory VF may give additional 0.5 to 0.7mg/kg IV
push, repeat in 5 to 10 minutes; maximum 3 doses or total of 3mg/kg
Perfusing Arrhythmia
For stable VT, wide-complex tachycardia of uncertain
type, significant ectopy:
Doses ranging from 0.5 to 0.75mg/kgand up to 1 to 1.5
Recommended for use in cardiac arrest only if torsades
de pointes or suspected hypomagnesia is present
Life-threatening ventricular arrhythmias due to digitalis
toxicity
Precautions/Contraindications:
ACLS Pharmacology Adult Dosage:
Occasional fall in blood pressure with rapid
administration
IV administration
Cardiac arrest: One dose of 40 units IV/IO push may
replace either first or second dose of epinephrine. Epinephrine can be administered every 3 to 5 minutes during cardiac arrest
Vasodilatory shock: Continuous infusion of 0.02 to 0.04
units per unit
Use with caution if renal failure is present
Adult Dosage: Cardiac Arrest (due to Hypomagnesia de Torsades de Pointes)
1 to 2g (2 to 4ml of a 50% solution) diluted in 10ml of
D5W1 over 5 to 60 minutes IV
Torsades de Pointes With a Pulse or AMI With
Hypomagnesia
Loading dose of 1 to 2g mixed in 50 to 100ml
Follow with 0.5 to 1g per hour IV (titrate to control
torsades)
Drugs for ACS (Acute Coronary
Syndromes) MONA M = Morphine
8. Vasopressin Indications
O = Oxygen (for oxygen saturation less than 94%)
N = Nitrates A = Aspirin
May be used as an alternative pressor to epinephrine in
treatment of adult shock refractory VF
May be useful alternative to epinephrine in asystole, PEA
It is preferable to do a 12 Lead ECG, if available, prior to the
administration of nitroglycerin to verify your patients cardiac rhythm status.
May be useful for hemodynamic support in vasodilatory
shock (eg, septic shock)
Morphine: Initial dose is 2 to 4 mg IV over 1 to 5 minutes,
administer slowly and only titrate to effect
Precautions/Contraindications:
Potent Peripheral vasoconstrictor.
Not recommended for responsive patients with coronary
artery disease
May administer to patients with suspected ischemic pain
unresponsive to oxygen and nitrates
ACLS Pharmacology Before administering morphine, be sure that the patients Before administering nitroglycerin, be sure that the systolic blood pressure is >90 mm Hg and they are not patients systolic blood pressure is >90 mmHg and they hypovolemic should not have bradycardia or tachycardia. Remember to reassess and repeat vital signs between Do not give nitroglycerin if the patient has had an erectile doses dysfunction drug within the past week. At IU Health, Fentanyl may be an alternative pain medication to morphine for the unstable patient (ie, systolic blood pressure <90 mm Hg, hypovolemia, Aspirin: 160 to 325 mg given as soon as possible, non-coated bradycardia, etc.) baby or adult aspirin may be used
Nitroglycerin: 1 spray sublingually every 3-5 minutes up to a
total of 3 sprays
Indications Standard therapy for all patients with new
pain/discomfort suggestive of ACS Give within minutes of arrival Nitroglycerin decreases pain in ischemia and is a vasodilator.
Indications Standard therapy for all patients with new
pain/discomfort suggestive of ACS Give within minutes of arrival Aspirin irreversibly binds to platelets and partially inhibits platelet function. Before administering aspirin, make sure patient does not have an aspirin allergy, or recent or active GI bleeding.
