ACLS Drug Therapy
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| What is the first drug given in a pulseless rhythm? | A vaso-constricting drug.
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| What are the two vasopressors that are recommended by the AHA? | Epinephrine and Vasopressin
Either may be the first drug given in a pulseless arrest.
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| What rhythms are considered to be pulseless arrests? | Ventricular Fibrillation, Ventricular Tachycardia,
PEA; Pulseless Electrical Activity Asystole
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| Name a catecholamine that increases blood flow to the heart and brain, increases heart rate and blood pressure, and makes the heart more responsive to defibrillation. | Epinephrine
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| What is the usual dose of epinephrine? | 1 mg IV push (IVP) with repeated doses every three to five minutes according to patient response. Each IV dose is followed by 20 mL normal saline (NS) flush.
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| Name a drug that has a direct vagolytic effect, which increases the heart rate due to a parasympathetic action accelerating the rate of the sinus node discharge and improving AV conduction? | Atropine
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| What drug is used to treat patients with symptomatic sinus bradycardia and symptomatic AV heart blocks? | Atropine
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| What drug is not recommended for second-degree AV heart block Mobitz Type II or third-degree AV block with wide QRS complexes? | Atropine
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| What is the recommended treatment for second-degree AV heart block Mobitz Type II or third-degree AV block with wide QRS complexes? | Immediate pacing
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| What is the drug of choice (after epinephrine or vasopressin) for asystole and PEA? | Atropine
It is only given to patients in PEA who have an absolute bradycardia (heart rates less than 60), after epinephrine or vasopressin has failed.
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| For asystole or PEA, atropine is given as a bolus injection into a large peripheral vein. What is the dose to be given? | 1 mg IVP every three to five minutes up to a maximum of 3 doses or 3 mg.
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| What is the dose in symptomatic bradycardia? | 0.5 mg to 1 mg IVP, repeated every three to five minutes as needed to a total dose of 3 mg or 0.04 mg/kg. Each dose should be followed by 20 mL NS IV flush.
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| Which drug will cause pupils to become dilated, causes tachycardia increases the oxygen requirement of the heart, worsens ischemia or increase an area of infarct in an acute MI. | Atropine
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| What is a hormone that promotes reabsortion of water in the kidneys and causes peripheral vasoconstiction? | Vasopressin
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| What is an alternate vasopressor and has a longer half-life than epinephrin | Vasopressin
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| What may also be given to replace the first or second dose of epinephrine? | Vasopressin
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| What is the recommended dose of vasopressin? | 40 units administered IVP Vasopressin is usually supplied in crash carts as a 20 unit vial. You will need 2 vials to equal 40 units.
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| If a pulseless rhythm persists after delivery of 1 or 2 shocks plus high-quality CPR, what drug may be given before or after epinephrine. | Vasopressin
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| Name a drug that has a direct vagolytic effect, which increases the heart rate due to a parasympathetic action accelerating the rate of the sinus node discharge and improving AV conduction. | Atropine
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| What two types of heart rhythms are treated with Atropine? | Symptomatic sinus bradycardia
Symptomatic AV heart blocks
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| Atropine is not recommended for what two heart rhythms? | Second-degree AV heart block
Mobitz Type II
or
Third-degree AV block with wide QRS complexes
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| What is the recommemded treatment for Second-degree AV heart block Mobitz Type II or Third-degree AV block with wide QRS complexes? | Immediate pacing
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| What is the drug of choice (after epinephrine or vasopressin) for asystole and PEA? | Atropine
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| What medication is only given to patients in PEA who have an absolute bradycardia (heart rates less than 60), after epinephrine or vasopressin has failed. | Atropine
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| What is the dose of Atropine given for asystole or PEA? | 1 mg IVP every three to five minutes up to a maximum of 3 doses or 3 mg.
Each dose should be followed by 20 mL NS IV flush. Atropine is most commonly supplied in prefilled syringes with 1 mg in 10 mL.
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| What is the dose of Atropine for symptomatic bradycardia? | 0.5 mg to 1 mg IVP, repeated every three to five minutes as needed to a total dose of 3 mg or 0.04 mg/kg.
Each dose should be followed by 20 mL NS IV flush. Atropine is most commonly supplied in prefilled syringes with 1 mg in 10 mL.
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| What drug is indicated for shock-refractory ventricular fibrillation and pulseless ventricular tachycardia? | Amiodarone
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| What drug is used to treat wide-complex tachycardias and is used as an adjunct in electrical cardioversion of paroxysmal supraventricular tachycardia (PSVT)? | Amiodarone
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| What drug is used for rate control in atrial fibrillation or atrial flutter and can be used in the management of stable tachycardia. | Amiodarone
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| The recommended dose of amiodarone for ventricular fibrillation and pulseless ventricular tachycardia? | 300 mg IVP
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| What is an antiarrythmic drug that works by slow initiation of SA node impulses and blocking AV conduction reentry? | Adenosine
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| hat drug is especially effective on re-entry tachycardia such as PSVT? | Adenosine
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| What is the drug of choice for most narrow-complex tachycardias? | Adenosine
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| What drug is preferred over verapamil because of its transient effects, and because it does not produce hypotension? | Adenosine
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| What does the ACLS guideline recommend for unstable wide-complex tachycardia of unknown type? | Cardioversion
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| What is a drug commonly used after establishing a normal sinus rhythm (NSR), after an arrest situation? | Dopamine
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| At what dose does Dopamine augment cardiac output by increasing heart rate and myocardial contractility? | 10 mcg/kg/min to 20 mcg/kg/min, it raises blood pressure by causing peripheral vasoconstriction.
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| Dopamine is always administered via IV drip into a large vein with an infusion pump. What is the standard concentration? | 400 mg in 250 mL D5W
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| Although dopamine is generally considered to be a safe drug, monitor blood pressure frequently and take the following precautions. . | 1. Monitor for arrhythmias.
2. Monoamine oxidase (MAO) inhibitor can potentiate the action of dopamine.
3. Observe IV site for infiltration.
4. Do not give sodium bicarbonate (NaHCO3) in infusion line.
5.Use caution with hypovola or an ischemic heart
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