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Common Drugs Used in CPR - ACLS Reference Guide

💊 Common Drugs Used in CPR

ACLS Pharmacology Reference Guide for Healthcare Providers

DRUG	MAIN ACLS USE	DOSE/ROUTE	NOTES
Adenosine Antiarrhythmic	Narrow PSVT/SVT Wide QRS tachy - AVOID adenosine in irregular wide QRS	6 mg IV bolus, may repeat with 12 mg in 1 to 2 min	Rapid IV push close to the hub, followed by a saline bolus Continuous cardiac monitoring during administration Causes flushing and chest heaviness
Amiodarone Antiarrhythmic	VF/pulseless VT VT with pulse Tachy rate control	VF/VT: 300 mg dilute in 20 to 30 mL May repeat 150 mg in 3 to 5 min	Anticipate hypotension, bradycardia and gastrointestinal toxicity Continuous cardiac monitoring Very long half life (up to 40 days) Do not use in 2nd or 3rd degree heart block Do not administer via the ET tube route
Atropine Anticholinergic	Symptomatic bradycardia Specific toxins/overdose (e.g. organophosphates)	Bradycardia: 0.5 mg IV/ET every 3 to 5 minutes Max dose: 3 mg Toxins: 2 to 4 mg IV/ET may be needed	Cardiac and BP monitoring Do not use in glaucoma or tachyarrhythmias Minimum dose 0.5 mg
Dopamine Vasopressor	Shock/CHF	2 to 20 mcg/kg/min Titrate to desired blood pressure	Fluid resuscitation first Cardiac and BP monitoring
Epinephrine Vasopressor	Cardiac Arrest Anaphylaxis Symptomatic bradycardia/Shock	Cardiac Arrest: Initial: 1.0 mg (1:10000) IV or 2 to 2.5 mg (1:1000) ETT every 3 to 5 min Anaphylaxis: 500 mcg IM, repeat every five minutes as needed Bradycardia: 2 to 10 mcg/min infusion, titrate to response	Continuous cardiac monitoring Note: Distinguish between 1:1000 and 1:10000 concentrations Give via central line when possible
Lidocaine Antiarrhythmic (Recommended when Amiodarone is not available)	Cardiac Arrest (VF/VT) Wide complex tachycardia with pulse	Cardiac Arrest: Initial: 1 to 1.5 mg/kg IV loading Second: Half of first dose in 5 to 10 min Maintain: 1 to 4 mg/min Wide complex: Initial: 0.5 to 1.5 mg/kg IV	Cardiac and BP monitoring Rapid bolus can cause hypotension and bradycardia Use with caution in renal failure
Magnesium Sulfate Electrolyte	Cardiac arrest/Pulseless torsades Torsades de pointes with pulse	Cardiac Arrest: 1 to 2 gm diluted in 10 mL D5W IVP With Pulse: 1 to 2 gm IV over 5 to 60 min Maintain: 0.5 to 1 gm/hr IV	Cardiac and BP monitoring Rapid bolus can cause hypotension and bradycardia Use with caution in renal failure Calcium chloride can reverse hypermagnesemia
Procainamide Antiarrhythmic	Wide QRS tachycardia Preferred for VT with pulse (stable)	20 to 50 mg/min IV until rhythm improves, hypotension occurs, QRS widens by 50% or MAX dose is given MAX dose: 17 mg/kg Drip: 1 to 2 gm in 250 to 500 mL at 1 to 4 mg/min	Cardiac and BP monitoring Caution with acute MI May reduce dose with renal failure Do not give with amiodarone Do not use in prolonged QT or CHF
Sotalol Antiarrhythmic (3rd line anti-arrhythmic)	Tachyarrhythmia Monomorphic VT	100 mg (1.5 mg/kg) IV over 5 min	Do not use in prolonged QT

📌 ACLS Drug Administration Guidelines:

IV/IO Access: Preferred route for medication administration during cardiac arrest
ET Tube Route: Only if IV/IO not available - use 2-2.5 times IV dose
Epinephrine: 1 mg every 3-5 minutes during cardiac arrest
Amiodarone: First dose 300 mg, second dose 150 mg for refractory VF/pulseless VT
Adenosine: Give rapid IV push followed immediately by saline flush
Atropine: Minimum dose 0.5 mg to avoid paradoxical bradycardia

⚠️ Critical Safety Alerts:

Amiodarone and Procainamide should NOT be given together - increased risk of hypotension and arrhythmias
Epinephrine concentration: Cardiac arrest uses 1:10,000 (0.1 mg/mL), NOT 1:1,000
Adenosine: Causes transient asystole - be prepared for this normal effect
Calcium chloride: Only for specific conditions (hyperkalemia, calcium channel blocker overdose)
Magnesium: Specifically for torsades de pointes, not routine cardiac arrest