The Ultimate Guide To ACLS Drugs

Preparing for your ACLS exam requires keeping track of a number of different things, including important algorithms and procedures that you will have to recall in the medical field at any given time. However, due to the rigors a cardiac episode puts on the body, sometimes, some life-saving procedures may not be enough. For this reason, those seeking their ACLS certification will also need to demonstrate knowledge of various medications designed to be used in emergency scenarios.

ACLS Drugs at a Glance

Like any other medication, ACLS drugs are designed for certain situations and certain usage. However, because they are used in an already life-threatening situation, failing to administer them properly could be disastrous.

Preparing for your online ACLS certification can be challenging, especially for first-timers. There are a number of different things you need to commit to memory, including ACLS algorithms and other important acronyms.

Perhaps no material is more critical to the success of your certification test than the medications. Understanding ACLS medications requires a decent amount of memorization. Not only do you need to be familiar with the names of the various drugs, but you’ll also need to know the uses and dosages for each one.

If you’re in the process of studying and preparing for your ACLS certification, here are the main medications you’ll need to know in order to successfully pass the exam.

ACLS Drugs & Pharmacology:

Adenosine

Uses:

• SVT/PSVT
• Wide QRS Tachycardia

Dosages:

• Initial Dose: 6 mg via IV push
• Subsequent Dose: 12 mg via IV Push

Precautions/Side Notes:

• Must be administered as a bolus, followed by a flush
• May cause bronchospasm – use caution with asthmatics
• Flushing and/or chest tightness are common effects

Amiodarone

Uses:

• Pulseless VT
• Ventricular Fibrillation (V-Fib)
• Hypertrophic Cardiomyopathy
• Recurrent Hemodynamically
• Unstable Ventricular Tachycardia
• Supraventricular Tachyarrhythmias

Dosages:

• For VT / V-Fib: 300 mg IV/IO. May administer additional 150 mg following initial dose
• For Tachy / VT: 150 mg IV/IO over 10 minutes. Continuous infusion of 1 mg/min via IV for 6 hours, 0.5 mg/min via IV for subsequent 18 hours

Precautions/Side Notes:

• Atrial fibrillation, supraventricular arrhythmias and hypertrophic cardiomyopathy are typically treated with oral form of amiodarone
• Rapid infusion may cause hypotension
• If cumulative dosing exceeds 2.2 grams in 24 hours, significant hypotension may occur. Avoid administration with any drug that may prolong QT interval.

Atropine

Uses:

• Symptomatic Bradycardia
• Cardiac Arrest

Dosages:

• 0.5 mg via IV (may be repeated every 3 – 5 minutes)
• Maximum dose = 3 mg

Precautions/Side Notes

• Dosage lower than 0.5 mg may cause paradoxical bradycardia

Dopamine

Uses:

• Bradycardia
• Hypotension

Dosages:

• 2 – 20 mcg/kg/min infusion
• Titrated based on clinical response; tapered on/off slowly

Precautions/Side Notes:

• Extravasation may cause tissue damage and necrosis
• Use caution when administering high doses through peripheral IV site
• May cause excessive vasoconstriction / tachyarrhythmias
• Adequate volume resuscitation is required before initiating dopamine therapy

Epinephrine

Uses:

• Cardiac Arrest
• Symptomatic Bradycardia
• Anaphylaxis / Severe Allergic Reactions
• Severe Hypotension

Dosages:

• 1 mg (10 mL of 1:10,000 solution)
• Repeat every 3 – 5 minutes as needed
• IV fluid flush following each dose

Precautions/Side Notes:

• Higher doses may be required in cases of beta-blocker or calcium channel blocker overdoses. Continuous infusion may also be required.
• High dose may not improve survival / neurological outcome
• High dose ceases myocardial dysfunction during post-resuscitation period

Lidocaine

Uses:

• Ventricular Tachycardia
• Ventricular Fibrillation

Dosages:

• Cardiac Arrest from VT / VT: 1 – 1.5 mg/kg via IV/IO
• Refractory VF: Additional 0.5 – 0.75 mg/kg via IV/IO; Repeat every 5 – 10 minutes for maximum of 3 doses, or 3 mg/kg
• Stable VT: 0.5 – 0.75 mg/kg up to 1.5 mg/kg; Repeat in 0.5 – 0.75 mg/kg doses to maximum of 3 mg/kg
• Maintenance Infusion: 1 – 4 mg/min

Precautions/Side Notes:

• Not recommended routinely following cardiac arrest, but may be used following ROSC
• May be used for stable polymorphic ventricular tachycardia with normal baseline QT AND torsades
• If left ventricular dysfunction or impaired liver function are present, decrease maintenance doses
• Do not use prophylactically after myocardial infarction

Magnesium Sulfate

Uses:

• Torsades de Pointes
• Hypomagnesemia (Low Magnesium)
• Digitalis Toxicity

Dosages:

• Initial Dose: 1 – 2 g via IV/IO, diluted in 10 mL D5W
• Infusion Dose: 0.5 – 1 g/hour

Precautions/Side Notes:

• Rapid administration may cause drop in blood pressure
• Very high doses can cause respiratory distress (calcium is antidote)
• Use with caution in patients experiencing renal failure

Procainamide
Uses:
• Ventricular Arrhythmias
• Supraventricular Arrhythmias
Dosages:
• Loading Dose: 15 – 17 mg/kg via IV. Administer over time span of at least 30 minutes
• Maximum Dosage: 1.5 grams
Precautions/Side Notes:
• Serious reactions may occur for ventricular fibrillation, asystole, seizures, decreased platelets, neutrophils (and may also result in hemolytic anemia)
• Other common reactions include hypertension, bradycardia, angioedema, flushing and urticarial
Studying these medications and becoming familiar with their uses, dosages and other important side notes will help you do well on your ACLS exam and also aid you in your future career. Commit them to memory and remember to keep this post handy so you can refer to it during your test.
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