EPINEPHERINE

ACLS DRUGS { Indications:

z Cardiac arrest for VF, pulseless VT,
PEA and asystole
z Symptomatic bradycardia
AS PER THE 2006 GUIDELINES z Severe hypotension

{ Precautions:
z Raising BP and heart rate may lead to
increased O2 demand and ischemia

EPINEPHERINE VASOPRESSIN

{ Dosage: z Indications:
z 1 mg (10ml of 1:10,000 soln) q3–5min { Alternative pressor to Epi for adult VF,
PEA and asystole
{ May be useful for hemodynamic support
{ Administration: in vasodilatory shock
z IV/IO (intraosseous)
z ETT 2 – 2.5 mg in 10 ml N/S z Precautions:
z Continuous infusion 2 – 10 mics/min { May provoke cardiac ischemia
{ Not recommended for responsive adults
with cardiac disease

VASOPRESSIN AMIODARONE

{ Dosage:
z 40 U IV/IO
{ Administration:
z One dose only in cardiac arrest
z May replace 1st or 2nd dose of Epi
z May be given via ETT – dose uncertain
{ Indications:
z Recurrent VF
z Hemodynamically unstable VT
{ Precautions:
z Do not administer with other drugs that
prolong QT interval (eg. Procainamide)
z Doses > 2.2 g/24 hours are associated
with significant hypotension

1
AMIODARONE LIDOCAINE
{ Dosage: { Indications:
z Cardiac arrest – 300 mg push IV/IO followed by z Alternative to Amiodarone in VT/VF

150 mg push in 3-5 min z Stable monomorphic VT with normal EF

z Stable polymorphic VT under some conditions

z Recurrent life-threatening ventricular

arrhythmias – 150 mg IV over 10 min followed { Precautions:
by 150 mg IV q10min prn z Do not use prophylactically in AMI

z Reduce maintenance dose in impaired liver or left

{ Administration (ongoing): ventricular function

z Discontinue if toxicity appears
z Slow infusion - 360 mg over 6 hours
z Maintenance - 540 mg over 18 hours

LIDOCAINE LIDOCAINE
{ Dosage: (Arrest) { Dosage (Maintenance)
z 1-1.5 mg/Kg IV/IO push
z Mix 2 Gm in 500 cc N/S or D5W
z Repeat at half dose in 5–10 minutes

z Maximum of 3 doses or 3 mg/Kg z Administer at 1 – 4 mg/min (15 – 60

z Via ET tube – 2-4 mg/Kg cc/hr)

{ Dosage (Perfusing Arrhythmia)

z Stable VT, wide complex tachy doses of 0.5-0.75
mg/kg up to 1–0.5 mg/Kg
z Repeat 0.5–0.75 mg/Kg every 5–10 minutes

z Maximum dose 3 mg/Kg

ATROPINE ATROPINE
{ Indications: { Dosage:
z First drug for symptomatic sinus brady z Asystole – 1 mg IV/IO q3-5min
z May be useful in AV block-not Mobitz II z Bradycardia – 0.5 mg IV q3-5min
z After Epi for asystole and brady PEA

{ Administration:
{ Precautions:
z Total dose for asystole – 3 mg
z Use with caution in ischemia
z Total dose for bradycardia – 3 mg or
z Avoid in hypothermic bradycardia
0.04 mg/kg
z With low doses or in high degree blocks
z Via ETT – 2 – 3 mg in 10 ml H2O or N/S
may cause slowing of heart rate

2
ADENOSINE
{ Indications:
z Stable narrow complex PSVT
z Unstable narrow complex PSVT while preparing
for cardioversion
z Wide complex tach known to be PSVT
{ Precautions:
z Do not use for drug induced tach/block
z Initial dose 3 mg or less for heart transplants,
pts. taking dipyrimadole and carbamazepine
z Can cause bronchospasm in reactive airway
disease
BETA BLOCKERS
{ Indications:
z Use for patients with ACS – reduces VF
z Adjunct to fibrinolytics – reduces
ischemia and reinfarction
z Slows or converts supraventricular tach
{ Precautions:
z With CCBs can cause severe hypotension
z Avoid in bronchospastic disease, cardiac
failure, hypotension or bradycardia
BETA BLOCKERS
{ Dosage and Administration:
{ Labetolol:
z 10 mg IV over 1 -2 min; repeat or
double dose every 10 minutes to
maximum of 150 mg OR
z Give initial bolus and start drip at
2-8 mics/min
z For hypertension associated with stroke
may bolus up to 300 mg
ADENOSINE
{ Dosage:
z IV – 6 mg rapid push followed by flush
z Doses 2 & 3 -12mg after 1–2 min each
{ Administration:
z Record rhythm during administration
z Draw up flush; put drug and flush into
port closest to patient; clamp tubing
z Administer both as fast as possible
BETA BLOCKERS
{ Dosage & Administration: (AMI Regimen)
z Metoprolol – IV – 5 mg slowly at 5 min
intervals to total of 15 mg; follow with
50 mg po bid x 24 hr; then 100 mg bid
z Atenolol – 5 mg slowly over 5 min; wait
10 min and repeat dose; wait 10 min; if
tolerated start 50 mg po q12h x 2; then
100 mg od
CALCIUM CHANNEL BLOCKERS
{ Indications:
z Slows or converts rapid atrial fib/flutter
z 2nd line after Adenosine to convert
PSVT in normotensive patients
{ Precautions:
z Avoid in patients on beta blockers
z Avoid in rapid a fib/flutter and WPW
z Do not use for wide complex tachys
3
CALCIUM CHANNEL BLOCKERS
{ Dosage and Administration:
z Diltiazem – IV 15 – 20 mg (.25mg/kg)
over 2 min; wait 15 min; second dose
20 – 25 mg (.35 mg/kg) over 2 min;
maintenance infusion 5 – 15 mg/hr
titrated to heart rate

z Verapmil – IV 2.5–5 mg over 2–3 min;

wait 15–30 min; give 5–10 mg over 2– 3
min; maximum dose 20 mg OR
5 mg q15min to total of 30 mg