ALS Medications

Question 1

Adrenaline - Dose and Route ( In cardiac arrests)

Answer 1

1mg (10mL 1 : 10,000) IV

Question 2

Adrenaline - When to use ( In cardiac arrests)

Answer 2

Shockable - after 3rd Shock and then every other loop (3-5 mins)
Non-shockable - ASAP then every other loop (3-5 mins)

Question 3

Adrenaline MOA (2 things)

Answer 3

Alpha-adrenergic effects cause systemic vasoconstriction which increases cerebral and coronary perfusion.
Beta-adrenergic effects are inotropic and chronotropic which may be beneficial but also increase oxygen demand of myocardial tissue.

Question 4

Amiodarone - Dose, route ( In cardiac arrests)

Answer 4

300mg bolus IV followed by 150mg future dose.

Question 5

Amiodarone - when to use in cardiac arrest

Answer 5

Only used in shockable rhythms.

Give after 3rd shock. Further reduced dose given if still shockable following a further 2 shocks (total five shocks)

Question 6

Amiodarone MOA

Answer 6

Stabilises membrane of cardiac myocytes which increases duration of action potential and refractory period producing anti-arrhythmic effects.

Question 7

Calcium - Dose and route

Answer 7

10mL 10% calcium chloride IV

Question 8

Calcium - When to use

Answer 8

PEA caused by hyperkalaemia, hypocalcaemia or OD of calcium channel blocking drugs

Question 9

Sodium Bicarbonate - Dose and Route

Answer 9

50mmol (50mL of 8.4%) IV

Question 10

Sodium Bicarbonate - when to use

Answer 10

consider in shockable and non-shockable rhythms caused by hyperkalaemia or TCA OD

Question 11

When to use IV fluids in Cardiac Arrest

Answer 11

When hypovolaemia may be a contributing factor

Question 12

Which IV fluids to use in Cardiac Arrest ( and one to avoid)

Answer 12

Sodium chloride or Hartmanns, or Blood in major haemorrhage. Avoid dextrose as this is rapidly distributed away from the intravascular space and may cause hyperglycaemia which is detrimental to neurological recovery)

Question 13

Fibrinolytics - when would you consider?

Answer 13

If PE is suspected. Consider use but none are licensed.

Question 14

Adenosine - Dose and Route

Answer 14

6mg IV bolus. If unsuccessful give up to 2 further 12mg doses after 1-2 minute intervals.

Question 15

Adenosine - Indication

Answer 15

Paroxysmal SVT with re-entrant circuits. (regular, narrow VT without response to vagal manoeuvres)

Question 16

Adenosine - MOA and two things to remember

Answer 16

naturally occurring purine nucleotide which blocks conduction through the AV node
Preferable to other antiarrhythmics in heart failure
Remember to warn patients they will briefly feel nauseous, sweaty, chest discomfort and sense of doom.

Question 17

Adrenaline - indications and relevant doses outside of cardiac arrest (3)

Answer 17

2nd line for cardiogenic shock - 0.05 to 1 mcg per kg IV
Bradycardia - alternative to pacing in patients with adverse features who do not respond to atropine - 2-10mcg per min IV.
Anaphylaxis 0.5mg IM every 5 mins.

Question 18

Amiodarone - Indications outside of cardiac arrest (3).

Answer 18

control of haemodynamically stable monomorphic VT, polymorphic VT, broad complex tachycardia of uncertain origin.
Chemical cardioversion or control of pre-excited atrial arrhythmias such as AF.
To increase the likelihood of success of electrical cardioversion.

Question 19

Amiodarone - Dose and Route

Answer 19

300mg IV over 10-60 mins bolus

followed by 900mg over 24 hours

Question 20

Aspirin - indication, dose, route, MOA

Answer 20

ACS ASAP
300mg crushed or chewed orally
antiplatelet action prevents thrombus formation

Question 21

Atropine - indication, dose

Answer 21

bradycardia, AV block causing haemodynamic instability

500mcg IV - repeated doses up to 3mg

Question 22

Beta Blockers - indication

Answer 22

rate control in AF and atrial flutter

In narrow complex regular tachycardia which has not resolved with vagal manoeuvres and adenosine (probable flutter)

Question 23

Verapamil - MOA, Indications,

Answer 23

Calcium channel blocker, rate control in AF and flutter. Helps preserve ventricular function if given within 48 hours of onset. Stable, regular, narrow tachycardias which have not responded to adenosine and vagal manoeuvers.

Question 24

Digoxin - MOA, Indication, Dose

Answer 24

cardiac glycoside which slows ventricular rate. AF with fast ventricular response, 500mcg IV over 30 mins.

Question 25

Inotropic drugs - indications, examples

Answer 25

Hypotension in absence of hypovolaemia, cardiogenic shock. Dobutamine, noradrenaline.

Question 26

Magnesium dose and route

Answer 26

2g IV over 10 mins

Question 27

Magnesium Indications (2)

Answer 27

Polymorphic VT, Digoxin toxicity

Question 28

Nitrates, indication, dose

Answer 28

ACS without hypotension (<90 systolic) GTN spray 1 o2 sublingual