ACLS Drugs Indication, MOA and Dose

Question 1

Epinephrine

Answer 1

1 mg Q 3-5 minutes for cardiac arrest, no max dose. Sympathomimetic agent with alpha and beta adrenergic activity. Increases heart rate, force of contraction, conduction velocity and causes bronchial dilation.

Question 2

Vasopressin

Answer 2

40 units replacing either the first or second dose of epinephrine in cardiac arrest. Natural antidiuretic hormone, stimulates V1 receptor in endothelium of vasculature. Improves perfusion of heart, lungs and brain via vasoconstriction of peripheral vasculature. Does not increase myocardial oxygen consumption. half life 5-10 minutes

Question 3

Amiodarone

Answer 3

300 mg bolus with a 150 mg bolus dose 5 minutes after if necessary in shock and epi resistant VF/VT. Class III antiarrhythmic, blocks Na, Ca and K channels along with beta receptors. Decreases AV conduction velocity and SN function. Prolongs action potential and refractory period. Decreases HR.

Question 4

Lidocaine

Answer 4

2nd line (non-ACLS algorithm) alternative to Amiodarone. 1-1.5 mg/kg IV in 250 ml NS. May repeat in 3-5 minutes. Max dose 3mg/kg. Class Ib antiarrhythmic. Increases electrical stimulation threshold of ventrical and decreases permeability to sodium ions. Shortens refractory period. Inhibition of depolarization and blockade of conduction.

Question 5

Atropine

Answer 5

.5-1mg Q 3-5 min (max 3 mg) for symptomatic bradycardia. Parasympathetic stimulation, enhances sinus node automaticity and enhances AV conduction by direct vagolytic action. ** use with caution in myocardial ischemia and hypoxia **

Question 6

Magnesium Sulfate

Answer 6

1-2g in 10 ml of D5W IV push for Torsades de pointes. (also used for TCA or digoxin overdose). Facilitates repolarization by enhancing intracellular potassium influx. Dilation of coronary arteries.

Question 7

Dopamine

Answer 7

2-10 mcg/kg/minute for symptomatic bradycardia when atropine is ineffective. Catecholamine precursor to norepinephrine. Stimulates DA, beta and alpha adrenergic receptors (dose-related). Increases HR and BP. do not mix with sodium bicarb

Question 8

Dobutamine

Answer 8

2.5-20 mcg/kg/min IV for hypotension secondary to low cardiac output or cardiogenic shock. Stimulates beta 1 receptors. Little effects on alpha and beta2 receptors. (not on algorhythm)

Question 9

Norepinephrine

Answer 9

.5 -1 mcg/min for shock refractory to fluid replacement and severe hypotension in post cardiac arrest care. Alpha and beta adrenergic stimulation, vasoconstrictor. Increases contractility and HR, Impoves coronary blood flow.

Question 10

Adenosine

Answer 10

6mg IVP follow by 12mg IVP if required for stable, narrow complex, regular tachycardias. Endogonous purine nucleoside that causes transient heart block of AV node. Depresses sinus node rate and AV node conduction. causes vasodilation.

Question 11

Isoproterenol

Answer 11

2-10mcg/min for refractory torsades de pointes.

Question 12

Sotalol

Answer 12

100 mg over 5 minutes for refractory torsades de pointes and stable, wide QRS tachycardia (according to tachycardia ACLS algorithm). Synthetic sympathomimetic amine with pure beta adrenergic activity plus ionotropic/chronotropic activity. Increases heart rate, increases contratility, decreases MAP.

Question 13

Procainamide

Answer 13

20-50 mg/min for hemodynamically stable monomorphic VT. Na/K channel blocker that opens sodium channels and prolongs action potential. widens QRS segment.

Question 14

Naloxone

Answer 14

.4-2 mg IV Q 2 minutes. Up to 10 mg in 10 minutes for opioid toxicity. competes with and replaces narcotic agonists at narcotic receptor sites. (not part of algorithm.)