ACLS Drugs Latest 2023 Graded A+

ACLS Drugs Latest 2023 Graded A+ ACLS Drugs ✔✔VF/VT: -Epinephrine -vasopressin -amiodarone -lidocaine Asystole/PEA: -Epinephrine -Vasopressin Bradycardia: -Atropine -Epinephrine Tachycardia: -adenosine -ami ...

ACLS Drugs Latest 2023 Graded A+ ACLS Drugs ✔✔VF/VT: -Epinephrine -vasopressin -amiodarone -lidocaine Asystole/PEA: -Epinephrine -Vasopressin Bradycardia: -Atropine -Epinephrine Tachycardia: -adenosine -amiodarone Adenosine ✔✔6 mg over 1-2 seconds followed by 20 ml NS bolus. If not successful, administer 12 mg in 1-2 minutes. Adenosine indication ✔✔To revert Paroxysmal SVT to normal sinus rhythm by slowing cardiac conduction. Adenosine precautions ✔✔Some *side effects* of adenosine administration incude flushing, chest pain/tightness, brief asystole or bradycardia. *2nd and 3rd degree block* is contraindicated. Make sure that adenosine is not used for irregular, polymorphic wide-complex tachycardia and *unstable VT*. Use in these cases may cause clinical deterioration. Safe and effective in pregnancy Amiodarone Dosage ✔✔V-fib/V-tach - First dose: 300mg bolus. 2nd dose: 150mg (in 3-5 minutes if no conversion) *The maximum cumulative dose in a 24 hour period should not exceed 2.2 grams.* For Tachycardia other than pulseless VT/VF: 150 mg over 10 minutes → repeat as needed if VT recurs → maintenance infusion of 1mg/min for 6 hours *Amiodarone should only be diluted with D5W* Amiodarone Indication ✔✔Class: Antiarrhythmic. Treats both supraventricular arrhythmias and ventricular arrhythmias. *Primarily treats V-fib and V-tach* that occurs during cardiac arrest. Should only be used *after* first line drugs (epinephrine and vasopressin) fail in treating VT/VF. *VF/pulseless VT unresponsive to shock delivery, CPR, and a vasopressor* Amiodarone Precautions ✔✔*Amiodarone should not be used for polymorphic VT as it associated with a prolonged QT interval which is made worse with anti-arrhythmic drugs.* Do not administer with other drugs that prolong QT interval (procainamide) *Bradycardia* and *2nd and 3rd degree block* are contraindicated. Atropine Sulfate Dosage ✔✔Bradycardia (w/ or w/o ACS) - 0.5 mg IV every 3-5 minutes prn *not to exceed total dose of 0.04 mg/kg* (total 3 mg) - Use shorter dosing interval (3 minutes) and higher doses in severe clinical situations *Can be given via ET tube* Atropine Sulfate Indications ✔✔*First drug for symptomatic sinus brady* Anticholinergic; blocks action of vagas nerve on heart -> increased heart rate May be beneficial in presence of AV nodal block. *Not likely to be effective for type II 2nddegree or 3rd degree AV block or a block in non-nodal tissue* Would not help during PEA or asystole Atropine Sulfate Precautions ✔✔*Atropine should be used cautiously in the presence of myocardial ischemia and hypoxia since it increases oxygen demand of heart and can worsen ischemia.* Avoid in hypothermic bradycardia Dopamine Dosing ✔✔*IV administration* -infusion rate is *2-20 mcg/kg per minute* -titrate to patient response;taper slowly Dopamine indication ✔✔Second-line drug for symptomatic bradycardia (*after atropine*) Use for low BP (<70 to 100) with s/s of shock Dopamine precautions ✔✔Correct hypovolemia with volume replacement before initiating dopamine May cause excessive vasoconstriction and tachyarrhythmias *do not mix with sodium bicarbonate* Epinephrine dosage ✔✔*Cardiac arrest*: IV 1 mg (10 ml of 1:10,000 solution) administered ever 3-5 minutes *Continuous infusion post-cardiac arrest*: 0.1-0.5 mcg/kg/min; titrate to response *ET tube route*: 2-2.5 mg diluted in 10 ml NS *IV infusion for Bradycardia*: 1 mg epinephrine mixed with 500 ml NS or D5W. Infusion run at 2-10 mcg per minute infusion; titrate to patient response Can be given via ET tube Available in *1:10,000 and 1:1,000 concentrations* Epinephrine indications ✔✔Primary drug used in the pulseless arrest algorithm Second-line drug for *symptomatic bradycardia* Used for its potent *vasoconstrictive effects* (improves perfusion pressure to brain and heart) and also for its ability to *increase cardiac output* (increase HR, increase heart muscle contractility, and increase conductivity through AV node) *Cardiac arrest*: VF, pulseless VT, asystole, PEA *severe hypotension*: Can be used when pacing and atropine fail, when hypotension accompanies brady *Anaphylaxis, severe allergic reactions*: combine with large fluid volume, corticosteroids, and antihistamines. Ephinephrine precautions ✔✔Epinephrine should be used with caution in patients suffering from myocardial infarction since epinephrine increases heart rate and raises blood pressure. *This increase in HR and BP can increase myocardial oxygen demand and worsen ischemia.* Lidocaine indication ✔✔Used to treat ventricular arrhythmias *V-fib and V-tach* Alternative to amiodarone if it is ineffective in cardiac arrest from VF/VT Stable monomorphic VT with preserved left ventricular function Stable polymorphoc VT with normal baseline QT interval *The overall benefits of lidocaine for the treatment arrhythmias in cardiac arrest has come under scrutiny. It has been shown to have no short term or long term efficacy in cardiac arrest.* Lidocaine dosage ✔✔*Cardiac arrest from VT/VF:* -initial dose: 1 to 1.5 mg/kg IV -for refractory VF: give additional 0.5 to 0.75 mg/kg IV push, repeat in 5-10 minutes; *maximum 3 doses* or total of 3 mg/kg *Perfusing Arrhythmia* For stable VT, wide-complex tachycardia of uncertain type and significant ectopy: -Doses Range from 0.5 to 0.75 mg/kg and up to 1 to 1.5mg/kg -Repeat 0.5 to 0.75 mg/kg every 5-10 minutes with maximum total dose of 3 mg/kg *Maintenance infusion*: 1 to 4 mg/min (30-50 mcg/kg/min) Lidocaine precautions ✔✔Symptoms of lidocaine toxicity progress in the following predictable pattern. It begins with numbness of the tongue, lightheadedness, and visual disturbances and progresses to muscle twitching, unconsciousness, and seizures, then coma, respiratory arrest, and cardiovascular depression. There are several conditions that increase the potential for lidocaine toxicity: -*Liver dysfunction* increases the risk of toxicity due to lidocaine being metabolized by the liver. -*Low protein* increases the risk of toxicity because lidocaine is protein bound. -*Acidosis* can also increase the risk of toxicity since acidosis increase the potential of lidocaine to dissociate from plasma proteins. Magnesium sulfate dosage ✔✔*Cardiac arrest (due to hypomagnesemia or Torsades de Pointes)*: 1 to 2 g (3 to 4 ml of a 50% solution) diluted in 10 ml of D5W *Torsades de Pointes* with a pulse or AMI with hypomagnesemia: -loading dose of 1 to 2 g mixed in 50 to 100 ml of D5W over 5 to 60 minutes IV -Follow with 0.5 to 1 g per hour IV (titrate to control torsades) Magnesium sulfate indication ✔✔Recommended for cardiac arrest *only if torsades de pointes or suspected hypomagnesemia* is present Life-threatening ventricular arrhythmias due to digitalis toxicity Routine administrationin hospitalized patients with AMI is *not* recommended Magnesium sulfate precaution ✔✔Occasional fall in BP with rapid administration Use with caution if renal failure is present Vasopressin dosage ✔✔*Cardiac arrest*: 40 units of vasopressin IV/IO push may be given to replace the first or second dose of epinephrine. Epinephrine can be administered ever 3-5 minutes during cardiac arrest May be given IV or ET tube Vasopressin indication ✔✔Antidiuretic hormone (ADH); Raises blood pressure by inducing moderate vasoconstriction, and it has been shown to be *more effective than epinephrine in asystolic cardiac arrest* One major indication for vasopressin over epinephrine is its *lower risk for adverse side effects* Indication: *Alternative to epinephrine in treatment of adult shock refractory VF and asystole/PEA.* May be useful for hemodynamic support in vasodilatory shock (septic shock) Vasopressin precaution ✔✔Potent peripheral constrictor. Increased peripheral vascular resistance may provoke cardiac ischemia and angina. Not recommended for responsive patients with coronary artery disease