Core & ACLS Meds.txt

• PSVT
• Regular Narrow-complex Tachycardia

• IV Bolus Dosage (no IO):
• 6 mg rapid IV push – 1st dose
• 12 mg rapid IV push – 2nd dose
• 12 mg rapid IV push – 3rd dose

• V-Fib
• Pulseless V-Tach
• Arrhythmias

• 300 mg – 1st dose
• 150 mg – 2nd dose

Arrhythmias

• Bradycardia
• Asystole, slow PEA

• 0.5 mg q. 3-5 minutes PRN
• 1 mg q. 3-5 minutes (up to 3 mg)

• Symptomatic Bradycardia
• Hypotension

2-10 μg/kg/min

Pulseless Arrest

1 mg (1:10,000) every 3-5 minutes

• V-Fib
• Pulseless V-Tach

• 1-1.5 mg/kg (1st dose)
• 0.5-0.75 mg/kg every 5-10 minutes to a max. dose of 3 mg/kg

• Torsades de pointes
• Hypomagnesemia

1-2 g in 10 ml D5W over 5-20 minutes

• Chest pain
• Pulmonary edema

2-4 mg q. 5-30 minutes

• Chest pain
• ACS

0.3 – 0.4 mg (Sublingual)

• A-Fib
• A-Flutter
• PSVT

2.5-5 mg over 2-5 minutes

Endogenous nucleoside

Doses are followed by a saline flush. Two subsequent doses of 12 mg each may beadministered at 1 – 2 minute intervals. Use the port closest to cannulation. The AHArecommends that the dose be cut by half if administering through a central line, or in thepresence of Dipyridamole or Carbamazepine. Larger doses may be required in the presence ofcaffeine or Theophylline.

Antiarrhythmic

Cumulative doses >2.2 g/24 hours are associated with significant hypotension. Do notadminister with other drugs that prolong QT interval (i.e., Procainimide). Terminal elimination isextremely long – half life lasts up to 40 days. During arrest, IV bolus should be deliveredslowly, over 1 – 3 minutes.

Parasympathetic Blocker

Used only in symptomatic bradycardia or in PEA with heart rate < 60. (Not indicated inSecond Degree Type II or Third Degree heart block.) Doses < 0.5 mg may result in paradoxicalslowing of the heart. ET route discouraged, but can be used if IV/IO access not available.

Catecholamine

Titrate to patient response. Correct hypovolemia with volume replacement beforeinitiating Dopamine. May cause tachyarrhythmias. Do not mix with Sodium Bicarbonate.

Catecholamine

First line drug in all pulseless rhythms. Increases myocardial oxygen demand, and maycause myocardial ischemia or angina. ET route is discouraged, but if used give 2-2.5 mg of a1:1000 solution diluted in 10 ml normal saline.

Antiarrhythmic

May repeat at 0.5-0.75 mg/kg every 5-10 minutes to a max. dose of 3 mg/kg. Use withcaution in presence of impaired liver; discontinue if signs of toxicity develop. Prophylactic usein AMI is contraindicated. ET route discouraged, but can be used if IV/IO access not available.

Electrolyte

A fall in blood pressure may be noted with rapid administration. Dose is given over 5-20minutes during cardiac arrest, 5-60 minutes in living patients. Use with caution in renal failure.

Opiate / Analgesic

Administer slowly and titrate to effect; may cause hypotension. May cause respiratory depression – be prepared to support ventilations. Naloxone is the reversal agent.

Vasodilator

Most commonly given sublingually as tablet or spray – repeat up to 3 doses at 5 minuteintervals. Hypotension may occur. Do not use with Viagra or other phosphodiasteraseinhibitors; with severe bradycardia or tachycardia; or in presence of RV infarction or inferior MI.Do not mix with other drugs.

Calcium Channel Blocker

Alternative drug after Adenosine to terminate PSVT with adequate blood pressure andpreserved LV function. Can cause peripheral vasodilation and hypotension. Use with extremecaution in patients receiving oral β-blockers.

• Packaged: 1mg in 10cc
• Dose: .5mg-1mg max dose 3mg
• Actions: Potent anticholinergic (parasympathetic blocker) that reduces vagal tone and thus increases automatically the SA node and increases A-V conduction

• Packaged: Premixed unit dose of 2.5mg in 2.5ml NS.
• Dose: 2.5mg in 3cc
• Actions: Primarily a beta-2 sympathomimetic and as such produces bronchodialtion, because of its greater specificity for beta 2 adrenergic it produces fewer cardiovascular side affects and more prolonged bronchodilation than isoproterenol.

• Packaged: 6mg/2ccDose: 6mg, 12mg, 12mg,
• Actions: decreasing conduction through the AV node. 1/2 life is less than: 10

• Packaged: 150mg in 2cc
• Dose: 150mg in conscious pt. 300mg in unstable
• Actions: Blocks sodium channels at rapid pacing frequencies and exerts non-competitive antisympathetic action. One of its main effects with prolonged administrations is to lengthen cardiac action potential. In addition, it produces a negative chronotropic effect nodal tissue. It also blocks potassium channels, which contributes to showing which contributes to slowing of conduction prolongedness of refractoriness. Its vasodilatory action can decrease cardiac workload and consequently myocardial oxygen consumption.

• Packaged: 25mg in 5cc
• Dose: .25mg/kg for first dose, .35mg/kg in second dose
• Actions: Calcium channel blocker that slows AV nodal conduction time and prolong AV refractoriness.

• Packaged: 10 grams in 10ML
• Dose: 4mg/kg IV slow
• Actions: Increases the force of myocardial contraction; calcium may either increase or decrease systemic vascular resistance

• Packaged: 400mg in 250 cc's making for a 1600mcg/ml
• Dose: 400mg in 250cc for a 1600mcg/cc concentration
• Actions: It exerts an inotropic effect on the myocardium resulting in increased cardiac output, peripheral vasoconstriction and a marked increase in pulmonary occlusive pressure

• Packaged: 1mg in 10cc for 1:10,000 concentration
• Dose: 1mg in 10cc IV 1:10,000 or for anaphylaxis .3mg sub Q 1:1,000
• Actions: Sympathomimetic, which stimulates both alpha and beta adrenergic receptors causing immediate bronchodilation, increase in heart rate and increase in the force of cardiac contraction as well as increasing vascular resistance which may enhance defibrillation

• Packaged: 10mg/ml Vials.
• Dose: 1mg/kg slow IV over 2:00
• Actions: Inhibits the reabsorption of Sodium Chloride in the proximal and distal renal tubules as well as in the loop HenleHas a direct venodilating effect in acute pulmonary edema.With IV admnistration onset of venodilation is in 5-10:00 and diuresis will occure in 20-30:00.

• Packaged: 1ml Ampule (10mg/ml).
• Dose: 2-10mg IV Slowly every 5:00 until desired response max is 10mg
• Action: Narcotic analgesic, which depresses the CNS and sensitivity to pain. Increases venous capacitance, decreases venous return and produces mild peripheral vasodilatation. Also decreases myocardial oxygen demand.

• Packaged: Spray 0.4mg metered dose. Bottle 1/150gr = 0.4mg per tablet.
• Dose: .4mg (1 tablet or 1 spray) max is 3 doses
• Action: direct vasodilator which acts principally on the venous system although it also produces direct coronary artery vasodilatation as a result. There is a decrease in venous return which decreases the workload on the heart and thus decreases myocardial oxygen demand.

• Packaged: 2cc Ampule (1mg/1ml.) 10ml Vial (4mg/10ml.) 1ml Ampule/Vial (0.4mg/1ml).
• Dose: 2mg IV, IM, ET, SC may repeat every 2-3:00
• Action: antagonizes the effects of opiates by competing at the same receptor
• sites. When given IV the action is apparent within 2:00. IM or SC
• administration is slightly slower

• Packaged: 10gm Vial of a 10% solution
• Dose:
• Action: Prevents or controls convulsions by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the endplate by the motor nerve impulse. Mag is said to have a depressant effect on the CNS but does not affect the mother or fetus when used in eclampsia and pre-eclampsia. Also acts peripherally to produce vasodilatation.

• Packaged: 2mg/2ml, 10mg/2ml and 5mg/5ml vials
• Dose: 2mg IV slowly
• Action: Short-acting benzodiazepine CNS depressant that produces sedation and lack of recall.

• Packaged:
• Dose: 5-20mg IV 20mg is max
• Action: Benzodiazepine which depresses the limbic system, thalamus, and hypothalamus resulting in calming effects. Also a muscle relaxant

• Packaged: 5ml Preload syringes (100mg/5ml)250ml NS with IGM Lidocaine premixed.
• Dose: 1 - 1.5mg/kg max dose is 3mg/kg (Adult use 2% Peds. use 1% solution) or make a drip 1g in 250ml
• Action: Decreases ventricular automaticity and raises the ventricular fibrillation threshold

• Packaged:
• Dose: 40 units in 2cc's
• Action: normally and anti diuretic hormone. In unnaturally high doses (more than needed for diuretic) vasopressin acts as a non adrenergic peripheral vasoconstrictor. Acts by direct stimulation of smooth muscle V1 receptors. During CPR increases coronary perfusion pressure, vital organ blood flow, ventricular fibrillation median frequency, and cerebral oxygen delivery.

• Packaged: 50ml syringe (1mEq/1ml).
• Dose: 1meq/kg
• Action: an alkalizing agent used to buffer acids present in the body during and after severe hypoxia. It combines with excess acids present in the body to form a weak volatile acid which is broken down into CO2 and H2O. Only effective with adequate ventilation

• Packaged: 1cc (50mg/1ml) Ampoule or Vial.
• Dose: 25-50mg IV or 50mg IM max is 400mg per day
• Actions: An antihistamine with anticholinergic (drying) and sedative side effects. Prevents but does not reverse histamine mediated responses, particularly on the smooth muscles of the airway, GI tract, uterus, and blood vessels.

• Packaged: 81mg chewable tablets. 325mg tablets
• Dose: 324mg in 4 tablets
• Actions: analgesic, anti-inflammatory, and antipyretic, blocks the formation of thromboxane A- 2 (which causes platelets to aggregate and arteries to constrict). Reduces overall mortality in MI.