Week 9 ACLS drugs (Dopamine, Epinephrine and Lidocaine)

Question 1

Dopamine
Pharmacology and Actions

Answer 1

• Endogenous catacholamine
• Acts on both dopaminergic and adrenergic neurons
• Dose dependent effects:
  
  • 1-2mcg/kg/min - dilates renal and mesenteric blood vessels, no effect on HR or BP
  • 2-10mcg/kg/min - beta effects on heart increase CO w/out greatly increasing HR or BP
  • 10-20mcg/kg/min - alpha peripheral effects causing vasoconstriction increasing SVR and BP
  • 20-40mcg/kg/min - aplha effects reverse dilation of renal and mesenteric vessels with decreased flow. Increases HR and O2 demand to undesirable limits.

Question 2

Dopamine
Indications

Answer 2

• Treatment of refractory cardiogenic or distributive shock

Question 3

Dopamine
Absolute Contraindications

Answer 3

• Hypovolemia
• Dopamine Allergy

Question 4

Dopamine
Precautions and Side Effects

Answer 4

• May induce tachyarrythmias, infusion should be decreased or stopped
• High doses (10 mcg/kg) may cause peripheral vasoconsctriction
• Dopamine will inactivate in alkaline solutions
• Consider hypovolemia and treat with appropraite fluids before administration
• Best administered by infusion pump to regulate rate. Hazardous when used in field w/out pump. Monitor closely.

Question 5

Dopamine

Administration

Answer 5

Route: IV / IO

Onset: immediate

Peak Effect: 5-10 minutes

Duration: effects during infusion

Question 6

Epinephrine

Pharmacology and Actions

Answer 6

• Catecholamine with aplha and beta effects which increase HR and BP
• Potent bronchodilator

Question 7

Epinephrine

Indications

Answer 7

• Cardiac Arrest
• Bradycardia
• Anaphylaxis
• Shock
• IM for severe refractory wheezing
• Nebulized for croup and bronchiolitis

Question 8

Epinephrine

Absolute Contraindications

Answer 8

• Uncontrolled hypertension is a relative contraindication
• Epinephrine Allergy

Question 9

Epinephrine

Precautions and Side Effects

Answer 9

• Epinephrine increases cardiac work and can precipitate angina, MI or major disrythmias in an individual with ischemic heart disease

Question 10

Epinephrine

Administration

Answer 10

Route: ( IV / IO ) and [IM]

Onset: ( < 2 minutes ) [3 - 10 minutes]

Peak Effect: ( < 5 minutes ) [20 minutes]

Duration: ( 5 - 10 minutes ) [20 - 30 minutes]

Code dose: (1mg/1mL) 1mg in 10cc

Push dose: (1mg/10mL) 0.1mg in 10cc

Anaphylaxis: (1mg/1mL) 0.3mg

Question 11

Lidocaine

Pharmacology and Actions

Answer 11

• Antiarryhtmic drug that decreases automaticity by slowing rate of depolarization
• Terminates re-entry by decreasing conduction in re-entry pathways
• Local anesthesia for pain control caused by infusion of fluids or medications via IO site

Question 12

Lidocaine

Indications

Answer 12

• Cardiac arrest due to V Fib of Pulseless V Tach
• Wide complex tachycardia w/ pulse
• Pain management after IO in conscious pt

Question 13

Lidocaine

Absolute Contrindications

Answer 13

• Bradycardia
• Lidocaine Allergy

Question 14

Lidocaine

Precautions and Side Effects

Answer 14

• At higher doses may cause CNS stimulation, seizure, depression and respiratory failure
• Toxicity is more likely in elderly pts and pts with CHF or impaired liver function

Question 15

Lidocaine

Administration

Answer 15

Route: IV / IO

Onset: Less than 3 minutes

Peak Effect: 5 - 10 minutes

Duration: 10 - 20 minutes