Basic ACLS medication Summary

                                                                   ACLS MEDICATION SUMMARY

 

 

ADENOSINE             Slows conduction through the AV node

(Antiarrhythmic)         Interrupts AV nodal reentry pathways

                                  Dosage: 6mg rapid bolus followed by 20 mg Saline flush

                                  12 mg may be given twice if no response in 1-2 min

                                  Onset: Immediate, Duration: 10 seconds

 

AMIODARONE IV        Amiodarone slows intraventricular conduction

(Antiarrhythmic)           Beta blockade causes slowing of the heart rate & vasodilation

                                    Prolongs refractory period in all cardiac tissue

                                    Arrest: 300 mg IV push; repeat 150 mg after 3-5 minutes x 2

                                    V-Tach: 150 mg IV over 10 minutes; repeat q 10 minutes

                                    Maximum: 2.2 g IV in 24 hours

 

ASPIRIN                    Blocks formation of clots and prevents arterial constriction

(Antiplatelet)              Dosage: 160 – 325 mg P.O.  Most effective if chewed

 

ATROPINE                 Restores normal AV conduction in low degree AV blocks and bradycardias

(Parasympatholytic)   Bradycardia: 0.5 mg q 3-5 min. Max: 3 mg

                                   Onset: Rapid, Duration: 2 - 6 hours

                       

DILTIAZEM                  Produces direct potent negative chronotropic effects & mild negative

(Calcium channel        inotropic actions

blocker)                       It slows conduction and prolongs refractoriness in the AV node.

                                    It has minimal effects on the bypass tracts (bundle of Kent).

                                    Never to be given in cases of V-Tach

                                    PSVT: 20 mg over 2 min., After 15 min 25 mg

                                    For A-Fib/flutter: Follow the bolus with 5 -15 mg/hr titrated to heart rate

                                    Onset: 2 - 5 Minutes, Duration: 1 - 3 hours

                                    Calcium channel blocker & Beta blockers together are contraindicated

                                    because their effects are synergistic

           

DOPAMINE                Stimulates dopaminergic, beta, and alpha receptors

(Catecholamine)         Is indicated for hemodynamically significant hypotension in the absence

                                    of hypovolemia

                                    Dopaminergic effects:  2 - 5 mcg/kg/min

                                    Beta & Alpha effects:  5-10 mcg/kg/min

                                    Alpha & Beta effects: 10-20 mcg/kg/min

 

 

 

 

EPINEPHRINE           A natural catecholamine with both A & B adrenergic activity

(Catecholamine)         It makes V-fib more susceptible to defibrillation

                                    It improves circulation during CPR

                                    Bolus: 1 mg 3-5 min during pulselessness (can be given by infusion)

                                    Drip:  2-10 mcg/min IV drip (for bradycardias)

                                    Onset: 1 - 2 minutes, Duration: 5 - 10 minutes

 

 

ISOPROTERENOL     Beta agonist used for symptomatic bradycardia when pacemaker is not

(Catecholamine)          available and for transplanted heart.  Also, used for refractory torsade de pointes

                                    Bradycardia: Infuse 2-10 mcg/min; titrate to heart rate

                                    Torsade: Titrate to increase rate until VT is suppressed

 

LIDOCAINE                Suppresses ventricular arrhythmias by decreasing automaticity

(Antiarrhythmic)          Prolongs conduction and refractoriness in ischemic tissue

                                   Increases the fibrillation & decreases the defibrillation threshold

                                   Does not affect myocardial contractility, B/P, or atrial rate.

                                   Cardiac arrest: 1.0 - 1.5 mg/kg IV bolus; ½ dose repeated q 3-5 min;

                                   Non-arrest: 1.0-1.5 mg/kg followed by IV drip of 1-4 mg/min.  Second

                                   bolus of 0.5 - 0.75 mg/kg q 5 - 10 min.

                                   Max: of 3 mg/kg Bolus

                                   The maintenance doses should be reduced by 50% in pt over 70 years old

                                   or with liver dysfunction

           

METOPROLOL            Beta blocking effects used in all MI’s and unstable angina’s

(Beta-Blocker)             Second line for SVT’s; can be used to slow rate and lower B/P

                                    Dosage: 5 mg slow IV q 5 minutes for a total of 15 mg

                                    Onset: 1 - 2 minutes, Duration: 3 - 4 hours

 

MIDAZOLAM               It is a short acting Benzodiazepine which has CNS depressant effect

(Benzodiazepine)        Indicated for sedation prior to cardioversion

                                    Anesthesia occurs 2-3 min after injection

                                    Dosage: 1-2 mg as needed

                                    Onset: 1 - 3 minutes, Duration: 2 - 6 hours (dose dependent)

 

MORPHINE                 It reduces systemic vascular resistance, lowers myocardial oxygen demands, and           

(Narcotic)                     relieves pain.

                                    Treatment of choice for pain and cardiogenic pulmonary edema.

                                    Dosage: 2-4 mg q 5 minutes slow IV until desired effect

                                    Onset: 1 - 2 minutes, Duration: 2 - 7 hours

 

NARCAN                    Temporarily reverses the effects of narcotics

(Opioid antagonist)     Dosage: 0.4-2.0 mg IV q 2 minutes

                                   Onset: 2 minutes, Duration: 30 – 60 minutes

 

NOREPINEPHRINE   It increases blood pressure by vasoconstriction

(Catecholamine)         It increases myocardial oxygen demands

                                   Indicated for hypotension caused by decreased vascular resistance

                                   Dosage: Start with 0.5-1.0 mcg/min through a central line; ↑ 30 mcg/min

           

SODIUM                      It is the most widely used buffer agent

BICARBONATE          Indicated for confirmed acidosis, hyperkalemia, or tricyclic or

(Electrolyte)                phenobarbital overdose

                                    Indicated when other recommended ACLS efforts have failed

                                    Dosage: 1 mEq/kg IV bolus, repeat 0.5 mEq/kg q 10 min

                                    Onset: 2 - 10 minutes, Duration: 30 - 60 minutes

           

VASOPRESSIN          Naturally occurring antidiuretic hormone

(Antidiuretic                Can replace epinephrine in algorithm for V-Fib only (class IIB)

Hormone)                   Causes vasoconstriction which improves CPR

                                   Dosage: 40 units IV or IO (One dose only)

 

VERAPAMIL               Exerts potent negative chronotropic and negative inotropic effects

(Calcium channel        Slows conduction and prolongs refractory period in AV node

Blocker)                       Recommended for PSVTs in stable patients

                                    Not recommended in cases of WPW

                                    Dosage: 2.5 – 5.0 mg slow IV bolus, repeat 5 - 10 mg in 15-30 min Max: 20 mg

                                    Onset: 2 - 5 minutes, Duration: 30 - 60 minutes

                                    Should be avoided in wide complex tachycardia

 

 

CALCIUM 10%           Increases the force of myocardial contractions

(Electrolyte)                Indicated for Hyperkalemia (>7 meq/l), hypocalcemia, or CCB toxicity

                                   Hyperkalemia & channel blocker: 8-16 mg/kg slow IV (5-10 ml)

                                   Prophylaxis: 2-4 mg/kg slow IV q 10 min (2 ml)

 

 

NITROGLYCERIN       It dilates large coronary arteries, antagonizes vasospasms, and increases

(Nitrate)                       coronary collateral blood flow

                                    Can be fatal for patients taking Viagra, Cialis, Levitra, Revatio or Staxyn

                                    Dosage: 1 tablet or spray q 5 min

                                    Dosage for IV NTG: Indicated for unstable angina, MI, and congestive heart failure.  

                                    Bolus of 12.5-25 mcg IV. Drip 10-20 mcg/min

 

PROCAINAMIDE        It suppresses ventricular ectopy and slows intraventricular conduction

(Antiarrhythmic)          It is indicated for wide variety of arrhythmias

                                   Dosage: 20 mg/min for 5 min to max of 17 mg/kg followed by drip 1-4 mg/min 

                                   Dosage for recurrent VF/VT: 50 mg/min IV is acceptable