ACLS IMPORTANT PHARMACOLOGY NOTES

    

PHARMACOLOGY IN ACLS:

DRUG	INDICATION	DOSE/ROUTE	CONSIDERATIONS
Adenosine	Narrow PSVT/SVT Wide QRS tachycardia, avoid adenosine in irregular wide QRS	6 mg IV bolus, may repeat with 12 mg in 1 to 2 min.	Rapid IV push close to the hub, followed by a saline bolus Continuous cardiac monitoring during administration Causes flushing and chest heaviness
Amiodarone	VF/pulseless VT VT with pulse Tachycardia rate control	VF/pulseless VT: 300mg dilute in 20 to 30ml., may repeat 150mg every 3 to 5 minutes Stable VT with a pulse: 150mg bolus followed by amiodarone drip (300 mg should only be used in a code situation)	Anticipate hypotension, bradycardia, and gastrointestinal toxicity Continuous cardiac monitoring Very long half-life (up to 40 days) Do not use in 2nd or 3rd-degree heart block Do not administer via the ET tube route
Atropine	Symptomatic Bradycardia	0.5 mg IV/IO every 3 to 5 minutes Max Dose: 3 mg	Cardiac and BP monitoring Do not use in glaucoma or tachyarrhythmias Minimum dose 0.5 mg
	Specific Toxins/overdose (e.g. organophosphates)	2 to 4 mg IV/IO may be needed
Dopamine	Shock/CHF	2 to 20 mcg/kg/min Titrate to desired blood pressure	Fluid resuscitation first Cardiac and BP monitoring
Epinephrine	Cardiac Arrest	Initial: 1.0 mg (1:10000) IV or 2 to 2.5 mg (1:1000) ET every 3 to 5 min Maintain: 0.1 to 0.5 mcg/kg/min Titrate to desire blood pressure	Continuous cardiac monitoring NOTE: Distinguish between 1:1000 and 1:10000 concentrations Give via central line when possible
	Anaphylaxis	0.3-0.5 mg IM Repeat every 5 mins as needed
	Symptomatic bradycardia/Shock	2 to 10 mcg/min infusion Titrate to response
Lidocaine (Lidocaine is recommended when Amiodarone is not available)	Cardiac Arrest (VF/VT)	Initial: 1 to 1.5 mg/kg IV loading Second: Half of first dose in 5 to 10 min Maintain: 1 to 4 mg/min	Cardiac and BP monitoring Do not use in wide complex bradycardia May cause seizures
	Wide Complex Tachycardia with Pulse	Initial: 0.5 to 1.5 mg/kg IV Second: Half of first dose in 5 to 10 min Maintain: 1 to 4 mg/min
Magnesium Sulfate	Cardiac Arrest/pulseless Torsades	Cardiac Arrest: 1 to 2 gm diluted in 10 mL D5W IVP	Cardiac and BP monitoring Rapid bolus can cause hypotension and bradycardia Use with caution in renal failure Calcium chloride can reverse
	Torsades de Pointes with pulse	If not Cardiac Arrest: 1 to 2 gm IV over 5 to 60 min Maintain: 0.5 to 1 gm/hr IV
Procainamide	Wide QRS Tachycardia Preferred for VT with pulse (stable)	20 to 50 mg/min IV until rhythm improves, hypotension occurs, QRS widens by 50% or MAX dose is given MAX dose: 17 mg/kg Drip = 1 to 2 gm in 250 to 500 mL at 1 to 4 mg/min	Cardiac and BP monitoring Caution with acute MI May reduce dose with renal failure Do not give with amiodarone Do not use in prolonged QT or CHF
Sotalol	Tachyarrhythmia Monomorphic VT 3rd line anti-arrhythmic	100 mg (1.5 mg/kg) IV over 5 min	Do not use in prolonged QT