Transcript ACLS Medications - Mid-State Technical College

Bradycardia
 Atropine
 Dopamine infusion
 Epinephrine infusion
Atropine
 Mechanism of Action
Inhibits the actions of
acetycholine on structures
innervated by postganglionic
sites (smooth/cardiac muscle,
SA/AV nodes)
Atropine
 Indications
 First drug for symptomatic sinus bradycardia
 May be beneficial in AV block or asystole
 Second drug in asystole or slow PEA
 Organophosphate poisoning; large dose may be needed
 Precautions
 MI and hypoxia – atropine increases oxygen demand
 Avoid in hypothermia
 Not effective for 2nd type II or new 3rd degree block (may slow
the rhythm)
 Doses < 0.5 mg may cause a paradoxical slowing
Atropine
Don’t delay pacing for severely
symptomatic (unstable)
patients.
 Asystole or slow (<60)PEA
 1 mg IV/IO push
 Repeat every 3 to 5 minutes (if rhythm persists) to max. of 3
mg.
 Bradycardia
 0.5 mg IV every 3-5 minutes as needed; max. of 3 mg.
 Use shorter dosing interval and higher doses in severe clinical
situations
 Endotracheal Administration
 2-3 mg diluted in 10 mL water or NS
 Organophosphate Poisoning
 Large doses (2-4 mg or higher) may be necessary
Dopamine
 Mechanism of Action
Stimulates adrenergic
receptors; dose dependent.
Dopamine
 Indications
 Second-line drug for symptomatic bradycardia
 Hypotension with signs and symptoms of shock
 Precautions
 Correct hypovolemia with volume before initializing
 Use caution with cardiogenic shock and associated CHF
 May cause tachydysrhythmias; excessive vasoconstriction
 Don’t mix with sodium bicarbonate
 IV Administration
 Infusion at 5-20 mcg/kg/min.
 Titrate to patient response; taper slowly
Epinephrine
 Mechanism of Action
Stimulates adrenergic receptors
and is not dose dependent like
dopamine.
Epinephrine
 Indications
 Cardiac arrest

VF; VT; asystole; PEA
 Symptomatic bradycardia
 After atropine; alternative to dopamine
 Severe hypotension
 When atropine and pacing fail; hypotension accompanying
bradycardia; phosphodiesterase enzyme inhibitors
 Anaphylaxis; severe allergic reactions
 Combine with large fluid volume; corticosteroids;
antihistamines
Epinephrine
 Precautions
 May increase myocardial ischemia, angina, and oxygen
demand
 High doses do not improve survival; may be detrimental
 Higher doses may be needed for poison/drug induced shock
 Dosing
 Cardiac arrest 1 mg (1:10,000) IV/IO every 3-5 min.
 High dose up to 0.2 mg/kg for specific drug OD’s
 Infusion of 2-10 mcg/min.
 Endotracheal of 2-2.5 times normal dose
 SQ/IM 0.3-0.5 mg
Tachycardia
 Adenosine
 Diltiazem
 Metoprolol
 Amiodarone
 Lidocaine
 Magnesium Sulfate
Adenosine
 Mechanism of Action
Slows impulse formation in the
SA node; slows conduction
time through AV node;
depresses left ventricular
function and restores NSR.
Adenosine
 Indications
 1st drug for stable, narrow complex, regular SVT
 May consider for unstable SVT while preparing for
cardioversion
 Wide-complex tachycardia thought to be, or determined
to be reentry SVT
 Does not convert atrial fibrillation, atrial flutter, or VT
 Diagnostic maneuver; stable narrow-complex SVT
Adenosine
 Contraindications/Precautions
 Poison/drug induced tachycardia is contraindicated
 2nd and 3rd degree block is contraindicated
 Transient side effects; flushing, CP, asystole, brady,
ectopy
 Less effective with theophylline or caffeine
 If used for VT may cause worsening of clinical condition
 Transient periods of sinus brady or ventricular ectopy
common after termination of SVT
 Safe in pregnancy
Adenosine
 Place supine or mild reverse Trendelenburg
 6 mg rapidly followed by 20 mL flush
 May repeat at 12 mg every 1-2 minutes if unsuccessful
Diltiazem
 Mechanism of Action
Inhibits calcium movement across
cell membranes of cardiac and
smooth muscle. Causes
vasodilation, decreses heart rate
and contractility, slows SA and
AV conduction.
Diltiazem
 Indications
 Controlling ventricular rate in a-fib or flutter
 After adenosine to treat refractory reentry SVT if
adequate blood pressure
 Contraindications/Precautions
 Do not use with wide-complex rhythms
 Do not use with poison/drug induced tachycardia
 Avoid in WPW
 Avoid in AV nodal blocks
 Blood pressure may drop from peripheral vasodilation
Diltiazem
 Rate control
 15-20 mg (0.25 mg/kg) IV over 2 minutes
 After 15 min. another 20-25 mg (0.35 mg/kg) IV over 2
minutes, if needed
 Maintenance Infusion
 5-15 mg/hour; titrated to physiologically appropriate
heart rate
Metoprolol
 Mechanism of Action
Selectively blocks beta-1 receptors,
slowing sinus heart rate,
decreasing cardiac output, and
decreasing BP.
Metoprolol
 Indications
 Administer to all patients with suspected MI or unstable
angina, absent contraindications
 Second-line agent for SVT refractory to adenosine
 To reduce myocardial ischemia in MI patients with
elevated heart rate and/or blood pressure
 Emergency antihypertensive therapy for acute
hemorrhagic or ischemic stroke
Metoprolol
 Contraindications/Precautions
 Hemodynamically unstable patients should not receive



Signs of heart failure
Low cardiac output
Increased risk for cardiogenic shock
 Relative contraindications: 1st, 2nd, 3rd degree blocks;
active asthma; reactive airway disease; severe
bradycardia; hypotension < 100 mmHg
 Concurrent administration of calcium channel blockers
can cause serious hypotension
 Monitor cardiac and pulmonary status throughout
Amiodarone
 Mechanism of Action
Prolongs myocardial cell action
potential duration and refractory
period by direct action on all
cardiac tissue; decreases AV and
SA conduction rates.
Amiodarone
 Indications
 Life threatening dysrhythmias



VF/pulseless VT unresponsive to shock, CPR, and vasopressor
Recurrent hemodynamically unstable VT
Seek expert opinion for other uses
 Contraindications/Precautions
 Bradycardia
 2nd and 3rd degree block
 Do not administer with meds that prolong QT interval
(procainamide)
Amiodarone
 VF/VT – 300 mg IV/IO in 20-30 mL NS. Can follow
with ONE dose of 150 mg in 3-5 minutes, if needed.
 Life threatening dysrhythmias
 150 mg over 10 minutes. May repeat every 10 minutes as
needed.
Lidocaine
 Mechanism of Action
Decreases depolarization,
automaticity, and excitability of
ventricle during diastole by direct
action, reversing ventricular
dysrhythmias.
Lidocaine
 Indications
 Alternative to amiodarone in VF/VT arrest
 Stable monomorphic VT
 Malignant PVC’s
 Can be used if Torsades is suspected
 Contraindications/Precautions
 Prophylactic use in AMI is contraindicated
 Reduce maintenance dose in liver impaired patients
 Discontinue infusion if toxicity develops
Lidocaine
 Cardiac Arrest
 Initial dose is 1-1.5 mg/kg
 Refractory VF 0.5-0.75 mg/kg in 5-10 min. Max 3 mg/kg
 Endotracheal dose 2-4 mg/kg
 Perfusing Dysrhythmia
 0.5-0.75 mg/kg up 1-1.5 mg/kg dosing range. Repeat if
necessary at lower range to total dose of 3 mg/kg
 Maintenance Infusion
 1-4 mg/min
Magnesium Sulfate
 Mechanism of Action
Increases magnesium levels in
cases where prolonged QT
interval is thought to be
secondary to hypomagnesemia.
Magnesium Sulfate
 Indications
 Torsades is suspected in cardiac arrest
 Lfe-threatening ventricular dysrhythmias in digitalis OD
 Precautions
 Fall in BP with rapid administration
 Use caution in renal failure
 Dosing
 Arrest 1-2 g over 5-20 min.
 Torsades w/ pulse 1-2 g over 5-60 min.
Vasopressin
 Mechanism of Action
Causes vasoconstriction with
reduced blood flow, increasing
core perfusion during cardiac
arrest.
Vasopressin
 Indications
 Alternative to epinephrine in adult refractory VF/VT
 Alternative to epinephrine in asystole or PEA
 Contraindications/Precautions
 Potent peripheral vasoconstrictor (increased demand
upon resuscitation)
 Dosing
 Single dose of 40 u that replaces either the 1st or 2nd dose
of epinephrine. Epinephrine can be resumed 3-5
minutes after
 Can be used endotracheally; no suggested dose