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Commonly Used Medications in ACLS

Types, uses and dosages of drugs change very quickly. For this reason, it is critical that a qualified medical person with up-to-date knowledge of medications be primarily responsible for ordering medications during resuscitation. All members of a resuscitation team should be familiar with the most commonly used drugs, which are listed in the “ACLS Resuscitation Medications” (Table 11, below). NOTE: Doses and uses are based on AHA recommendations. Anyone that administers these drugs should be aware of and competent in the use of these medications. These drugs should only be administered by licensed medical professionals.

Drug Type of Drug Uses Recommended Dosage Side Effects Other Notes
Adenosine Antiarrhythmic Supraventricular tachycardia (SVT) 1st dose = 6 mg rapid IV push followed by saline bolus

2nd dose = 12 mg rapid IV push in
1-2 minutes

Headache, dizziness, metallic taste, dyspnea, hypotension, bradycardia or palpitations, nausea, flushing, sweating Cardiac monitoring during administration;

Administer through central line if available;
Flush with saline following administration;
Give very rapidly

Do not use in 2nd or 3rd degree heart block

Amiodarone Antiarrhythmic Unstable ventricular tachycardia (VT) with pulses; ventricular fibrillation (VF); VT without pulse and unresponsive to shock 300 mg rapid bolus with 2nd dose of 150 mg if necessary to a maximum of 2.2 grams over 24 hours Headache, dizziness, tremors, ataxia, syncope, significant hypotension, bradycardia, CHF, torsades de pointes, nausea, vomiting, diarrhea, rash, skin discoloration, hair loss, flushing, coagulation abnormalities Monitor ECG and BP;

Use with caution in patients with a perfusing rhythm, hepatic failure;

Do not use in 2nd or 3rd degree heart block

Atropine Anticholinergic Symptomatic bradycardia; toxic poisonings and overdoses Bradycardia: 1.0 mg IV every 3-5 minutes with 3 mg max dose; may be given by ET tube

Toxins/overdose: 2-4 mg may be needed until symptoms reverse

Headache, dizziness, confusion, anxiety, flushing, blurred vision, photophobia, pupil dilation, dry mouth, tachycardia, hypotension, hypertension, nausea, vomiting, constipation, urinary retention, painful urination, rash, dry skin Monitor ECG, oxygen, and BP;

Administer before intubation if bradycardia is present;

Contraindicated in glaucoma and tachyarrhythmias;

Doses lower than 0.5mg should not be given since this may result in worsening of bradycardia

Dopamine Catecholamine vasopressor, inotrope Can be given in bradycardia after atropine; can be given for systolic BP <100 mm Hg with signs of shock 2 to 20 mcg/kg/minute infusion titrated to response Headache, dyspnea, palpitations, PVCs, SVT, VT, nausea/ vomiting, acute renal failure Monitor ECG and BP;

If hypovolemic, give fluid boluses first;

Avoid high infusion rates;

Do not mix in alkaline solutions or with sodium bicarbonate

Epinephrine Catecholamine vasopressor, Inotrope Cardiac arrest; anaphylaxis; symptomatic bradycardia after atropine; shock when pacing and atropine are not effective Cardiac arrest: 1.0 mg (1:10000) IV or 2-2.5 mg (1:1000) per ET tube every 3-5 minutes; follow with
0.1-0.5 mcg/kg/minute infusion titrated to response

Symptomatic bradycardia or shock: 2-10 mcg/minute infusion titrated to response

Tremors, anxiety, headaches, dizziness, confusion, SVT, VT, hallucinations, dyspnea, palpitations, chest pain, hypertension, nausea, vomiting, hyperglycemia, hypokalemia, vasoconstriction Available in 1:1000 and 1:10000 concentrations so be aware of which concentration is being used;

Monitor BP, oxygen, and ECG;

Administer via central line if possible to avoid the danger of tissue necrosis;

Do not give in cocaine induced VT

Lidocaine Antiarrhythmic Cardiac arrest from VF or VT
Wide complex tachycardia
Cardiac Arrest: 1-1.5 mg/kg IV bolus; may repeat twice at half dose in 5-10 minutes to total of 3 mg/kg; followed with infusion of 1-4 mg per minute infusion

Wide complex tachycardia with pulse: 0.5-1.5 mg/kg IV; may repeat twice at half dose in 5-10 minutes to total of 3 mg/kg; followed with infusion of 1-4 mg per minute infusion

Seizures, heart block, bradycardia, dyspnea, respiratory depression, nausea, vomiting, headache, dizziness, tremor, drowsiness, tinnitus, blurred vision, hypotension, rash Monitor ECG and BP;

May cause seizures;

Do not give for wide complex bradycardia;

Do not use prophylactically in AMI

Magnesium sulfate Electrolyte; bronchodilator Torsades de pointes; hypomagnesemia; digitalis toxicity Cardiac arrest due to hypomagnesemia or torsades: 1-2 gram IV bolus

Torsades with a pulse: 1-2 gram IV over 5-60 minutes followed by infusion at 0.5-1 gram per hour IV

Confusion, sedation, weakness, respiratory depression, hypotension, heart block, bradycardia, cardiac arrest, nausea, vomiting, muscle cramping, flushing, sweating Monitor ECG, oxygen and BP;

Rapid bolus may cause hypotension and bradycardia;

Calcium chloride is the antidote to reverse hypermagnesemia

Oxygen Elemental gas Hypoxia, respiratory distress or failure, shock, trauma, cardiac arrest In resuscitation, administer at 100% via high flow system and titrate to maintain O2 sat >94% Headache, dry nose, mouth, possible airway obstruction if secretions become dry Monitor oxygen saturation;

Insufficient flow rates may cause carbon dioxide retention

Vasopressin Antidiuretic hormone analogue As alternative to epinephrine for VF, asystole/PEA

Shock

Cardiac arrest: 40 units IV as replacement for 2nd or 3rd dose of epinephrine

Shock: IV infusion of 0.02-0.04 units/ minute

Fever; dizziness; arrhythmia; chest pain; hypertension; nausea; vomiting; abdominal cramping and pain; hives Monitor BP and distal pulses;
Watch for signs of water intoxication;

Deliver through central line if possible to avoid tissue necrosis from IV extravasation

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