ACLS Medications

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  • Younas inayat

  • BradycardiaAtropineDopamine infusionEpinephrine infusion

  • AtropineMechanism of ActionInhibits the actions of acetycholine on structures innervated by postganglionic sites (smooth/cardiac muscle, SA/AV nodes)

  • AtropineIndicationsFirst drug for symptomatic sinus bradycardiaMay be beneficial in AV block or asystoleSecond drug in asystole or slow PEAOrganophosphate poisoning; large dose may be neededPrecautionsMI and hypoxia atropine increases oxygen demandAvoid in hypothermiaNot effective for 2nd type II or new 3rd degree block (may slow the rhythm)Doses < 0.5 mg may cause a paradoxical slowing

  • AtropineAsystole or slow (
  • DopamineMechanism of ActionStimulates adrenergic receptors; dose dependent.

  • DopamineIndicationsSecond-line drug for symptomatic bradycardiaHypotension with signs and symptoms of shockPrecautionsCorrect hypovolemia with volume before initializingUse caution with cardiogenic shock and associated CHFMay cause tachydysrhythmias; excessive vasoconstrictionDont mix with sodium bicarbonateIV AdministrationInfusion at 5-20 mcg/kg/min.Titrate to patient response; taper slowly

  • EpinephrineMechanism of ActionStimulates adrenergic receptors and is not dose dependent like dopamine.

  • EpinephrineIndicationsCardiac arrestVF; VT; asystole; PEASymptomatic bradycardiaAfter atropine; alternative to dopamineSevere hypotensionWhen atropine and pacing fail; hypotension accompanying bradycardia; phosphodiesterase enzyme inhibitorsAnaphylaxis; severe allergic reactionsCombine with large fluid volume; corticosteroids; antihistamines

  • EpinephrinePrecautionsMay increase myocardial ischemia, angina, and oxygen demandHigh doses do not improve survival; may be detrimentalHigher doses may be needed for poison/drug induced shockDosingCardiac arrest 1 mg (1:10,000) IV/IO every 3-5 min.High dose up to 0.2 mg/kg for specific drug ODsInfusion of 2-10 mcg/min.Endotracheal of 2-2.5 times normal doseSQ/IM 0.3-0.5 mg

  • TachycardiaAdenosineDiltiazemMetoprololAmiodaroneLidocaineMagnesium Sulfate

  • AdenosineMechanism of ActionSlows impulse formation in the SA node; slows conduction time through AV node; depresses left ventricular function and restores NSR.

  • AdenosineIndications1st drug for stable, narrow complex, regular SVTMay consider for unstable SVT while preparing for cardioversionWide-complex tachycardia thought to be, or determined to be reentry SVTDoes not convert atrial fibrillation, atrial flutter, or VTDiagnostic maneuver; stable narrow-complex SVT

  • AdenosineContraindications/PrecautionsPoison/drug induced tachycardia is contraindicated2nd and 3rd degree block is contraindicatedTransient side effects; flushing, CP, asystole, brady, ectopyLess effective with theophylline or caffeineIf used for VT may cause worsening of clinical conditionTransient periods of sinus brady or ventricular ectopy common after termination of SVTSafe in pregnancy

  • AdenosinePlace supine or mild reverse Trendelenburg6 mg rapidly followed by 20 mL flushMay repeat at 12 mg every 1-2 minutes if unsuccessful

  • DiltiazemMechanism of ActionInhibits calcium movement across cell membranes of cardiac and smooth muscle. Causes vasodilation, decreses heart rate and contractility, slows SA and AV conduction.

  • DiltiazemIndicationsControlling ventricular rate in a-fib or flutterAfter adenosine to treat refractory reentry SVT if adequate blood pressureContraindications/PrecautionsDo not use with wide-complex rhythmsDo not use with poison/drug induced tachycardiaAvoid in WPWAvoid in AV nodal blocksBlood pressure may drop from peripheral vasodilation

  • DiltiazemRate control15-20 mg (0.25 mg/kg) IV over 2 minutesAfter 15 min. another 20-25 mg (0.35 mg/kg) IV over 2 minutes, if neededMaintenance Infusion5-15 mg/hour; titrated to physiologically appropriate heart rate

  • MetoprololMechanism of ActionSelectively blocks beta-1 receptors, slowing sinus heart rate, decreasing cardiac output, and decreasing BP.

  • MetoprololIndicationsAdminister to all patients with suspected MI or unstable angina, absent contraindicationsSecond-line agent for SVT refractory to adenosineTo reduce myocardial ischemia in MI patients with elevated heart rate and/or blood pressureEmergency antihypertensive therapy for acute hemorrhagic or ischemic stroke

  • MetoprololContraindications/PrecautionsHemodynamically unstable patients should not receiveSigns of heart failureLow cardiac outputIncreased risk for cardiogenic shockRelative contraindications: 1st, 2nd, 3rd degree blocks; active asthma; reactive airway disease; severe bradycardia; hypotension < 100 mmHgConcurrent administration of calcium channel blockers can cause serious hypotensionMonitor cardiac and pulmonary status throughout

  • AmiodaroneMechanism of ActionProlongs myocardial cell action potential duration and refractory period by direct action on all cardiac tissue; decreases AV and SA conduction rates.

  • AmiodaroneIndicationsLife threatening dysrhythmiasVF/pulseless VT unresponsive to shock, CPR, and vasopressorRecurrent hemodynamically unstable VTSeek expert opinion for other usesContraindications/PrecautionsBradycardia2nd and 3rd degree blockDo not administer with meds that prolong QT interval (procainamide)

  • AmiodaroneVF/VT 300 mg IV/IO in 20-30 mL NS. Can follow with ONE dose of 150 mg in 3-5 minutes, if needed.Life threatening dysrhythmias150 mg over 10 minutes. May repeat every 10 minutes as needed.

  • LidocaineMechanism of ActionDecreases depolarization, automaticity, and excitability of ventricle during diastole by direct action, reversing ventricular dysrhythmias.

  • LidocaineIndicationsAlternative to amiodarone in VF/VT arrestStable monomorphic VTMalignant PVCsCan be used if Torsades is suspectedContraindications/PrecautionsProphylactic use in AMI is contraindicatedReduce maintenance dose in liver impaired patientsDiscontinue infusion if toxicity develops

  • LidocaineCardiac ArrestInitial dose is 1-1.5 mg/kgRefractory VF 0.5-0.75 mg/kg in 5-10 min. Max 3 mg/kgEndotracheal dose 2-4 mg/kgPerfusing Dysrhythmia0.5-0.75 mg/kg up 1-1.5 mg/kg dosing range. Repeat if necessary at lower range to total dose of 3 mg/kgMaintenance Infusion1-4 mg/min

  • Magnesium SulfateMechanism of ActionIncreases magnesium levels in cases where prolonged QT interval is thought to be secondary to hypomagnesemia.

  • Magnesium SulfateIndicationsTorsades is suspected in cardiac arrestLfe-threatening ventricular dysrhythmias in digitalis ODPrecautionsFall in BP with rapid administrationUse caution in renal failureDosingArrest 1-2 g over 5-20 min.Torsades w/ pulse 1-2 g over 5-60 min.

  • VasopressinMechanism of ActionCauses vasoconstriction with reduced blood flow, increasing core perfusion during cardiac arrest.

  • VasopressinIndicationsAlternative to epinephrine in adult refractory VF/VTAlternative to epinephrine in asystole or PEAContraindications/PrecautionsPotent peripheral vasoconstrictor (increased demand upon resuscitation)DosingSingle dose of 40 u that replaces either the 1st or 2nd dose of epinephrine. Epinephrine can be resumed 3-5 minutes afterCan be used endotracheally; no suggested dose