ACLS Drugs Extensive

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spy187
ID:
292709
Filename:
ACLS Drugs Extensive
Updated:
2015-01-09 20:16:52
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ACLS Trade Class Ind Contra Dose Mec
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Description:
ACLS medications: trade name, indications, contraindications, dosages, mechanism of action
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  1. atropine sulphate
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    • Atropine
    • Ind: symptomatic
    •  - sinus bradycardia
    •  - Junctional escape rhythm
    •  - 2° block type 1
    •  - 3° block with narrow QRS

    •  - Bronchial Asthma
    •  - Bronchospasm with COPD

    Contra: none in emergent setting

    • Dose:
    •  Symptomatic Bradycardia
    •   - 0.5 mg IV q 3-5 min
    •  [max 3mg / 0.04mg/kg]

    • Bronchospasms
    •   - NEB 0.5-1.0 mg placed in 2-3ml NS

    • Failed RSI
    •  - 0.01mg/kg (min 0.5mg)

    • Class:
    • anticholinergic
    • parasympatholytic
    • antidysrhythmic

    • Mechanism of action:
    • blocks ACh receptors, inhibiting parasympathic stimulation


  2. nitroglycerin
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    • Nitrostat, Nitrodur,Nitrol
    • Ind:
    •  - Sublingual
    •   - ischemic chest pain
    •   - Cardiogenic pulmonary edema

    • - IV
    •   - unstable angina
    •   - CHF associated with MI

    • Contra:
    •  - severe anemia
    •  - hypotension (SBP<100mmHg)
    •  - uncorrected hypovolemia
    •  - head trauma/ cerebral hemorrhage/stroke
    •  - pericarditis
    •  - pericardial tamponade
    •  - RVI

    • Dose:
    •  chest pain/pulmonary Edema
    •  - 0.3-0.4 mg SL spray max 3 sprays
    •  - 10-20mcg/min,
    •     increase by 5-10mcg/min q 5min
    •     titrate to desired clinical response
    •     max 200mcg/min

    • Class:
    • organic nitrate
    • vasodilator
    • antianginal

    • Mechanism of action:
    • metabolized by body to produce Nitric Oxide
    •  - smooth muscle relaxant
    •  - decreased venous return        
    •      decrease ventricular work

    •  - peripheral vasodilation
    •  - coronary artery vasodilation
  3. morphine sulphate
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    • MS Contin, Epimorph
    • Ind:
    •  - chest pain due to AMI/ACS
    •  - Acute pulmonary edema
    •  - moderate to severe pain
    •  - anxiety/apprehension

    • Contra:
    •  - hypotension
    •  - Respiratory/CNS depression
    •  - head trauma & decreased LOC
    •  - MAIOs
    •  - significant pulmonary disease

    • Dose:
    •  2-10mg IV q 5 min
    •  5-15mg IM

    • Class:
    • opiod analgesic
    • narcotic

    • Mechanism of action:
    • works on opiod receptors
    •  - analgesia & sedation
    •  - vasaldilation
    •    - mast cell degranulation
    •    - suppression of alpha receptors
    •  - decrease venous return to heart
    •    - decrease myocardial work load/MVO2
    •    - preload decreased
    •    - afterload decreased
  4. lidocaine
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    • Xylocard, Xylocaine
    • Ind:
    • - surface anesthesia for nasal, oral respiratory   procedures
    • - VTach/Vfib refractory to amiodarone
    • - significant ventricular ectopy seen with
    •    AMI/ischemia
    •    (runs of PVC, > 6PVC a min)

    • Contra:
    •  - bradycardia with ventricular escape rhythms
    •  - 2° mobitz type II
    •  - 3° heart block with wide QRS

    • Dosage:
    •  VF/pulseless VT
    •    1-1.5mg/kg q 5-10 min
    •    [max 3mg/kg]
    •  VT with pulse/ significant PVCs/ wid complex tachycardia
    •   1-1.5mg/kg q 5 min
    •   PRN 0.5-0.75 mg/kg to max 3mg/kg
    • ROSC
    •   drip 2-4 mg/min

    • Class:
    • class Ib antiarrhythmic
    • Sodium channel blocker

    • Mechanism of action:
    • depress depolarization of ventricles
    • depress automaticity of ventricles
    • (decrease action potential conduction)
    • suppress ventricular ectopy
    • increase VF threshold

    • little effect on atrial tissue
    • does not significantly affect myocardial contractlility
  5. procainamide
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Pronestyl

    • Ind:
    •  - when lidocaine has failed
    •  - when lidocaine contraindicated
    •  - Wide complex tachycardia that cannot be distinguished from VT
    •  - refractory/pulsless VT/ VFib

    • Contra:
    •  - high degree heart block
    •  - myasthenia gravis
    •  - CHF
    •  - renal failure
    •  - systemic lupis
    •  - long qt or torsades de points

    • Dosage:
    •  20-30mg/min IV bolus
    •  infusion 1-4 mg/min
    •  max 17/mg/kg

    • Discontinue if:
    •  - arrhythmia supressed
    •  - Hypotension occurs
    •  - QRS lengthens by 50%
    •  - reach max dose of 17mg/kg

    • Class:
    • class Ia antiarrhythmic
    • Sodium channel blocker

    • Mechanism of Action:
    • -Shortens absolute refractory period of AV node

    • - Prolongs absolute refractory period & duration of AP in 
    •  His-Purkinjie system
    • - suppress ventricular ectopy
    • - increase VF threshold
  6. atenolol
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    • Tenormin
    • 5-10mg IV over 5 min
    • repeat 5mg after 1o min if arrhythmia returns
  7. metoprolo tartate
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Lopressor

    5-10mg SIVP q 5min max 15mg
  8. propanolol
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Inderal

    • 0.1mg/kg SIVP
    • divide into 3 doses & give @ 2-3 min intervals
  9. esmolol
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Brevibloc

    • LD 500mcg/kg over 1 min
    • MD 50mg/kg/min over 4 min
  10. atropine
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    atropine sulphate

    • 0.5 mg q 3-5 min
    • max 3mg / 0.04mg/kg
  11. isoproterenol
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Isuprel

    • 2-10mcg/min
    • titrated to desired response
    •  HR 60bpm
  12. verapamil
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Isoptin

    • 2.5-5mg over 2 min
    • if no response
    • 5-10mg q 15-30 min
    • max 20mg
  13. diltiazem
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Cardizem

    • 0.25mg/kg (15-20mg) IV over 2 min
    • 15 min later
    • 0.35mg/kg (20-25mg) IV over 2 min

    • A. Fib with RVR 
    • infuse 5-15mg/hr
  14. adenosine
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Adenocard

    6mg RIVP

    repeat x2 @ 12mg RIVP
  15. magnesium sulphate
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Magnesium Sulphate

    • Pulselss VT/VF
    •  2g in 10ml admin over 1-2 min

    • Acute MI, hypomagnesemia
    • LD 1-2g mixed in 50-100ml admin over 45-60 min

    • Torsades de Pointes
    • 2g iv in 10 ml over 5 min

    • Bronchospasm
    • 2g in 50 ml infused over 10 min
  16. amiodarone hydochloride
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Cordarone

    • Cardiac Arrest
    • 300mg IVP
    • repeat 150mg q 3-5 min
    • max 2.2g IV/24hr

    • Stable Wide Complex tachycarida
    • Rapid infusion
    • 150mg IV over 10 min (15mg/min)
    • repeat q 10 min as needed

    • Slow infusion
    • 360mg IV over 6 hrs (1mg/min)

    • Maintenance infusion
    • 540mg over 18hrs (0.5mg/min)
  17. epinephrine
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Adrenalin

    • Cardiac Arrest
    • 1mg 1:10,000 IV bolus q 3-5 min

    • Infusion:
    • 2-10mcg/min
  18. norepinephrine
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Levophed


    • 0.5-30mcg/min
    • titrate to effect
  19. dopamine
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Inropin

    2-20mcg/kg/min
  20. dobutamine
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Dobutrex

    2-20mcg/kg/min
  21. calcium choloride
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Calcium Chloride

    • 2-4mg/kg (500mg-1g) slow iv bolus
    • repeat q 10 min prn

    • for Calcium channel blocker toxicity
    •  4x regular dose
    •  8-16mg/kg
    •  in 2-4 mg incrments
  22. digitalis
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Lanoxin, Digoxin

    • 0.25mg SIVP ever 2hrs
    • up to of LD 1.5mg
  23. sodium nitroprusside
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Nipride

    • 0.1-5mcg/kg/min
    • may ned 10mcg/kg/min
  24. sodium bicarbonate
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Sodium Bicarbonate

    • 1mEq/kg initially
    • 0.5mEq/kg q 10 min prn
  25. furosemide
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Lasix

    • 0.5-1mg/kg
    •  - 20mg for pt not taking furosemide
    •  - 40mg for pt on oral Lasix

    if not effective in 20 min, double initial dose
  26. vasopressin
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Vasopressin, Pitressin

    40 units IV single dose, 1 time only
  27. acetylsalicylic acid
    Trade Name
    Indications
    Contraindications
    Dose
    Class
    Mechanism of action
    Asprin

    160-320mg PO chewed

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