ACLS Pharmacology Flashcards
know all the drugs from the ACLS book
This drug is the first used for most forms of stable narrow-complex SVT and is effective in terminating those due to reentry involving AV node or sinus node.
Adenosine
is Adenosine safe and effective in pregnancy?
Yes
when is adenosine contraindicated?
in poison or drug induced tachycardia or second- or third-degree heart block
what are the side effects of adenosine?
flushing, chest pain or tightness, brief periods of asystole or bradycardia, ventricular ectopy
what is a common thing to see after giving adenosine?
transient periods of sinus bradycardia and ventricular ectopy are common after termination of SVT
what are the steps taken when pushing adenosine?
- place the patient in mild Trendelenburg
- initial bolus of 6 mg given rapidly over 1 to 3 seconds followed by NS bolus of 20 ml, then elevate the extremity
- a second dose can be given in 1 to 2 minutes if needed
what should you be doing as you are giving adenosine?
record a rhythm strip
what is the half life of amiodarone?
40 days
when is amiodarone indicated?
VF/ pulseless VT unresponsive to shock delivery, CPR, and a vasopressor
- recurrent, hemodynamically unstable VT
amiodarone used for VF/ pVT cardiac arrest unresponsive to shock, CPR, and Vasopressor, what would be the first dose?
300 mg IV/IO push for the first dose
- if a second dose is needed, 150 mg IV/IO push
amiodarone used for life threatening arrhythmias, what is the maximum dose?
Rapid
Slow
Maintenance
2.2 g IV over 24 hours.
Rapid - 150 mg IV over 10 minutes (150 mg Q 10 min)
Slow - 360 mg IV over 6 hours (1 mg per minute)
Maintenance - 540 mg IV over 18 hours (0.5 mg per minute)
How can some drugs be given if you don’t have IV access
The endotracheal (ET) route for drug delivery may be used when a life-threatening or serious condition requires immediate drug intervention, but intravenous or intraosseous access is not readily available
what are the two acronyms for drugs that can be given via ET tube
adults and peds
adults - NAVEL
Peds - LEAN
Naloxone, atropine, Vasopressin (adults only), epinephrine, Lidocaine
what is the first line drug for symptomatic sinus bradycardia?
atropine
when is atropine unlikely to be effective?
Type II second degree or third degree AV block in nonmodal tissue
what is something to consider when using atropine in the presence of myocardial ischemia and hypoxia?
it increases myocardial O2 demand
what may be the effect of using a dose of atropine that is less than 0.5 mg?
may cause paradoxical slowing of the heart
what is the recommended dose of atropine for bradycardia?
0.5 mg IV Q 3 to 5 minutes PRN, not to exceed a total dose of 0.04 mg per kg (total 3 mg)
when would you use a lager dose of atropine (2 to 4 mg or higher)
in a case of Organophosphate Poisoning, or nerve agent
what is the second line drug for symptomatic bradycardia?
Dopamine
after atropine
aside from being the second line drug after atropine, when would you use Dopamine?
for hypotension with SBP >70 - 100 mmHg with signs and symptoms of shock
what are 4 contraindications/ considerations when administering Dopamine?
- correct hypovolemia with volume replacement before using
- use with caution with cardiogenic shock with CHF
- May cause tachyarrhythmias, excessive vasoconstriction
- do not mix with sodium Bicarb
what is the typical IV administration of Dopamine?
2 to 20 mcg/kg per minute, titrate to patient response and taper slowly
what are the 4 indications for epinephrine listed in the ACLS book?
cardiac arrest with VF, pulseless VT, asystole, PEA
- Symptomatic bradycardia can be considered after atropine as an alternative infusion to dopamine
- Severe hypotension; can be used when pacing and atropine fail, when hypotension accompanies bradycardia, or with phosphodiesterase enzyme inhibitor
- Anaphylaxis, severe allergic reactions; combine with large fluid volume, corticosteroids, and antihistamines
what are some contraindications/ precautions for epinephrine?
raising BP and HR may increase O2 demand on myocardium
- higher doses do not improve survival outcomes and may contribute to post resuscitation myocardial dysfunction
- higher doses may be required to treat poison/ drug induced shock
epinephrine used for cardiac arrest, what is the dose?
IV/IO dose; 1 mg (10 ml 0f 1:10,000 solution) administered Q 3 to 5 minutes during resuscitation. Follow each dose with 20 ml flush, elevate arm for 10 to 20 seconds after dose
when would a higher dose of epinephrine be warranted?
higher doses (up to 0.2 mg/kg) may be used for specific indications such as B-blocker or calcium channel blocker overdose)
what would the dose for epinephrine be for continuous infusion?
Initially 0.1 to 0.5 mcg/kg per minute (for 70 kg patient; 7 - 35 mcg per minute) titrate response
what would the dose be for epinephrine given the endotracheal route?
2 to 2.5 mg diluted in 10 ml NS
what drug can be used as an alternative to amiodarone in cardiac arrest from VF/pVT?
Lidocaine
what are the 4 indications for using Lidocaine as per the ACLS manual?
- stable monomorphic VT with preserved ventricular function
- stable polymorphic VT with preserved LV function when ischemia is treated and electrolyte balance is corrected
- can be used for polymorphic VT with baseline
- QT interval prolongation if torsades suspected
what are the doses used for Lidocaine in cardiac arrest from VF/pVT
initial dose; 1 to 1.5 mg/kg IV/IO
- for refractory VF, may give an additional 0.5 to 0.75 mg/kg IV push, repeat in 5 to 10 minutes; max dose 3 doses or total 3mg/kg
what would the dose be for a maintenance infusion of Lidocaine?
1 to 4 mg per minute (30 to 50 mcg/kg per minute)
when is magnesium used in cardiac arrest
torsades or suspected hypomagnesemia
aside from cardiac arrest, what are the indications for using magnesium sulfate as stated in the ACLS manual
life - threatening ventricular arrhythmia due to digitalis toxicity
what are some contraindications/ considerations for using magnesium sulfate?
occasional fall in blood pressure with rapid administrations
- Use with caution if renal failure if present.
what are the doses for administering Magnesium sulfate in cardiac arrest (due to hypomagnesemia or Torsades de Pointes)?
1 to 2 g (2 to 4 ml of a 50% solution diluted in 10 ml (eg D5W or NSS) given IV/IO)
what are the doses for magnesium sulfate used to treat Torsades de Pointes with a pulse or AMI with hypomagnesemia?
what is the loading dose and what do you follow with?
loading dose of 1 to 2 g mixed in 50 to 100 ml of dilutent over 5 to 60 minutes IV
- follow with 0.5 to 1 g per hour IV (titrate to control TdP)
