ACLS Drugs

Question 1

Indications for epinephrine

Answer 1

symptomatic bradycardia, anaphylaxis, cardiac arrest.

Question 2

Epi mechanism of action

Answer 2

B1AR stimulation increases chorno, ino, and dromo tropy

B2AR causes bronchodilation in anaphylaxis

Question 3

Precautions with the use of epi

Answer 3

Increased myocardial O2 demand, arrhythmias (increased risk with concurrent volatile anesthetic use)

Question 4

Epi dose: IV and continuous infusion

Answer 4

1 mg IV Q3-5 min, 2-20 mcg/ min continuous

Question 5

Mechanism of action of vasopressin

Answer 5

Increases water reabsorption at the kidney and causes non adrenergic mediated vasoconstriction

Question 6

Vasopressin dose: IV and continuous

Answer 6

40 U IV once to replace 1st or 2nd epi dose in ACLS, 0.02-0.04 U/ min continuous for septic shock

Question 7

1/2 life of vasopressin

Answer 7

10-20 min

Question 8

Indications for sodium bicarb

Answer 8

ph < 7.10, HCO3< 15, hyperkalemia

Question 9

Precautions for sodium bicarb

Answer 9

Ensure adequate ventilation because it combines with H+ to form CO2 which could potentiate the acidosis if unable to ventilate; monitor pH an HCO3 levels frequently

Question 10

Sodium bicarb dose: IV and continuous

Answer 10

1 mEq/kg IV, 2-5 mEq/kg titrated to pH and HCO3

Question 11

Dobutamine mechanism of action

Answer 11

B1AR increases inotropy; B2AR decreases SVR

Question 12

Clinical uses of Dobutamine

Answer 12

cardiogenic shock, decompensated heart failure

Question 13

Dobutamine dose: continuous infusion

Answer 13

2-20 mcg/kg/min

Question 14

Why can you not mix Dobutamine or Dopamine with sodium bicarb?

Answer 14

They are inactivated in alkaline solutions

Question 15

Uses for Atropine and MOA

Answer 15

symptomatic bradycardia, RSI, organophosphate poisoning, and when reversing ND - NMB, used with edrophonium to block parasympathomimetic effects

MOA: aCh competitive antagonist- anticholinergic

Question 16

Atropine dose

Answer 16

0.5mg q 3-4 min to max of 3 mg

Question 17

Atropine precautions

Answer 17

mydriasis (pupil dilation), paradoxical bradycardia at low doses, asystole, hypotension, bronchospasm

Question 18

Adenosine uses and MOA

Answer 18

Used for SVT

Stimulate adenosine receptors in heart and vascular sm. muscle to briefly interrupt AV node conduction

Question 19

Adenosine dose

Answer 19

6 mg then 12 mg if needed

Question 20

Amiodarone uses and MOA

Answer 20

used for VF and pulseless VT

MOA: Non- competitively inhibits A-AR’s and B-AR’s to prolong action potential duration and refractory period

Question 21

Amiodarone dose

Answer 21

150-300 mg over 10 min then 150 mg if needed

Question 22

Amiodarone precautions

Answer 22

Prolongs QT- torsades, coagulopathies, pulmonary toxicities, CYP450 inhibitor

Question 23

Amiodarone duration of action

Answer 23

2 weeks to months after d/c’d

Question 24

Dopamine MOA and uses

Answer 24

MOA Stimulate AAR’s and BAR’s to increase HR and SVR

Used in symptomatic bradycardia, distributive shock, ventricular dysfunction

Question 25

Dopamine dose

Answer 25

2-20 mcg/kg/min continuous infusion

Question 26

Dopamine precautions

Answer 26

Tissue necrosis if infiltrates- use phentolamine, SVT, VT, HTN, ARF

Question 27

T/F Atropine crosses the BBB?

Answer 27

True

Question 28

What causes paradoxical bradycardia after Atropine use?

Answer 28

Low-dose atropine causes bradycardia either by acting on the sinoatrial node or by its effects on central muscarinic receptors increasing vagal activity