ACLS

A Guide To Crash Cart

Medication Management
Presented By
Mohamed Rawy
Clinical Pharmacist , BSc, BCPS, BCCCP
 Code Blue
- Definition:
- It is generally used to indicate a patient requiring
resuscitation or otherwise in need of immediate
medical attention, most often as the result of a
respiratory or cardiac arrest
 List of Medications
▪ Adenosine ▪ Lidocaine
▪ Amiodarone ▪ Magnesium Sulfate
▪ Atropine ▪ Naloxone
▪ Calcium Chloride ▪ Nitroglycerine
▪ Calcium Gluconate ▪ Norepinephrine
▪ Digoxin ▪ Pheniramine
▪ Dobutamine ▪ Phenytoin
▪ Dopamine ▪ Propranolol
▪ Epinephrine ▪ Protamine Sulfate
▪ Glucagon ▪ Sodium Bicarbonate
▪ Hydrocortisone ▪ Verapamil
 ADENOSINE (Adenocor®)
Presentation - 3mg/mL (2mL Ampoule)
Class - Anti Arrhythmic
- Stable Regular Narrow – Complex PSVT
- Stable Regular Wide – Complex Monomorphic VT
6 mg IV Bolus over 1-2 seconds followed by 20mL NS (if vagal maneuver failed
to terminate), if no response after 2 min you can give 2 nd dose of 12 mg IV
Indication & Bolus followed by 20mL NS & if no response after 2 min you may give 3 rd dose
Dosing of 12-18 mg IV Bolus followed by 20mL NS
If it is given through central line or if patient has heart transplant or if patient
on Carbamazepine or Dipyridamole then reduce initial dose to 3mg then 6mg
then 9mg if needed

Contraindications - Polymorphic Wide Complex VT , Unstable VT

Preparation & - It is given by Rapid IV Bolus followed by Flushing with Normal saline
Administration - Administration is through Peripheral or Central line
Monitoring - ECG , HR , BP

Tip: Adenosine should be administered by RAPID intravenous bolus so that a

significant bolus of adenosine reaches the heart before it is metabolized
 AMIODARONE (Cordarone®)
- 150mg/mL (3mL Ampoule)
Presentation
Class - Anti Arrhythmic
- VT & Vfib
300 mg IV Bolus/IO if not responding to CPR & Epinephrine (after 3rd DC Shock) & then give
150 mg IV Bolus/IO after 2 cycles if not responding to CPR & Epinephrine (after 5 th DC
Shock)
- Wide Complex Tachycardia
Indication & 150 mg over 10 min then 1 mg/kg/min for 6h (360mg) then 0.5 mg/kg/min for 18h (540mg)
Dosing i.e. 1 amp (150mg) IV over 10min then 2 amp (300mg) + 50mL D5W & rate of 6.25mL/h
- SVT
150 mg over 10 min then 1 mg/min for 6h (360mg) then 0.5 mg/min for 18h (540mg)
i.e. one amp (150mg) IV over 10min then 2 amp (300mg) + 50mL D5W & rate of 10mL/h
- AF
Rate Control: 300mg IV over 30-60min then 2 amp (300mg) + 50mL D5W & rate of 10mL/h
(Max dose per day is 2.2g)
Contraindications - 2nd or 3rd degree AV Block , Sick Sinus Syndrome & Cardiogenic Shock
- Hypersensitivity or Evidence of Hepatitis , Pulmonary Fibrosis , Thyroid Dysfunction
Preparation & - Can be given undiluted IV Push in cases of Pulseless VT or Vfib
Administration - Dilute only with D5W when given as an IV Infusion (Max of 2 Amp + 50mL D5W)
- Administration is through Peripheral or Central line
Monitoring - BP , HR , ECG
 ATROPINE
Presentation - 1mg/mL (1mL Ampoule)
Class - Anti cholinergic
- Unstable Bradycardia
Indication & 1 mg IV Bolus then repeat by 1 mg every 3-5 minutes up to max of 3 mg/day
Dosing

Contraindications - 2nd or 3rd degree AV Block

Preparation & - It is given undiluted by Rapid IV Bolus

Administration - Administration is through Peripheral or Central line
Monitoring - HR , BP , Pulse & Mental status

Tip: Atropine should be administered by RAPID intravenous bolus because

slow injection may result in paradoxical bradycardia
 Calcium Chloride
Presentation - 100mg/mL (5mL & 10mL Ampoule) - Calcium Salt , Antidote
- Hypocalcemia
1 g (10mL) diluted with 100mL D5W or NS over 10-20 min via central line , repeat
bolus dose if symptoms persist
- Hyperkalemia (K >6.5 or if ECG Changes)
0.5-1 g (5-10mL) over 2-5 min , repeat doses after 5min if ECG changes persist or
Indication & recur , then every 30-60 min as needed
Dosing - Cardiac Arrest … Routine use is not recommended unless Ca or Mg
0.5-1 g (5-10mL) as a rapid IV / IO bolus , may repeat as necessary
- BB or CCB over dose
20 mg/kg over 5 to 10 minutes (maximum: 1 to 2 g/dose); may repeat every 10
to 20 minutes for 3 to 4 additional doses or initiate a continuous infusion of
20 to 40 mg/kg/hour titrated to improve hemodynamic response
Contraindications - Ventricular Fibrillation , Asystole
- Central line is a must or Deep Veins , Not for IM or SC administration
Preparation & - Can be given Undiluted Rapid IV Bolus in cases of Cardiac Arrest or by
Administration Continuous infusion in cases of chronic hypocalcemia or BB over dose
- For other indications, Dilute first & give by IV Infusion (Max of 100mg/min)
- Do not infuse Calcium in the same line with Glycophos or NaHco3
Monitoring - Ionized & Total Ca , Albumin , P , Mg , Infusion site , ECG & BP
 Calcium Gluconate (Calcionate®)
Presentation - 1000mg/10mL (1 ampoule 10% ) - Calcium Salt , Antidote
- Hypocalcemia
- 1-2 g (10-20mL) diluted with 50mL D5W or NS over 10-20 min PL or CVL , repeat
bolus dose if symptoms persist
- Hyperkalemia (K >6.5 or if ECG Changes)
- 1-3 g (10-30mL) over 2-5 min , repeat doses after 5min if ECG changes persist
Indication & or recur , then every 30-60 min as needed
Dosing - Cardiac Arrest … Routine use is not recommended unless Ca or Mg
- 1.5-3 g (15-30mL) as a rapid IV / IO bolus , may repeat as necessary
- BB or CCB over dose
- 60 mg/kg over 5 to 10 minutes (maximum: 3 to 6 g/dose); may repeat every
10 to 20 minutes for 3 to 4 additional doses or initiate a continuous infusion
of 60 to 120 mg/kg/hour titrated to improve hemodynamic response
Contraindications - Ventricular Fibrillation , Asystole
- Peripheral line or Central line , Not for IM or SC administration
Preparation & - Can be given Undiluted Rapid IV Bolus in cases of Cardiac Arrest or by
Administration Continuous infusion in cases of chronic hypocalcemia or BB over dose
- For other indications, Dilute first & give by IV Infusion (Max of 200mg/min)
- Do not infuse Calcium in the same line with Glycophos or NaHco3
Monitoring - Ionized & Total Ca , Albumin , P , Mg , Infusion site , ECG & BP
 Digoxin (Lanoxin®)
Presentation - 0.5mg/2mL (2mL Ampoule)
Class - Anti Arrhythmic
- Atrial Fibrillation or Atrial Flutter
- SVT
Indication & 0.25 - 0.5 mg over several minutes , Repeat doses of 0.25 mg Q6h up to a
maximum of 1.5mg/day (3 Ampoules of 0.5mg)
Dosing ( Narrow Therapeutic Index )
( Has Anti dote called Digifab for Digoxin Toxicity )
- Ventricular Fibrillation
Contraindications - 2 nd or 3rd degree AV Block (in absence of pacemaker)

- WPW (Wolf Parkinson White Syndrome)

- HCM (Hypertrophic Cardiomyopathy)
- It is given undiluted or diluted with NS , D5W & SWFI (Dilution is 1:4)
Preparation & - Slow IV Injection over ≥5 minutes
Administration - Given through a Peripheral or Central line
- May be given by IM route if necessary but no more than 2mL per injection
site & massage of injection site after injection (May cause intense pain)
Monitoring
 Dobutamine (Dobutrex®)
Presentation - 250mg/20mL (20mL Ampoule)
Class - Inotrope (increase Heart Contractility & Heart Rate)
- Acute Decompensated Heart Failure
- Cardiogenic Shock
Start with 2-5 mcg/kg/min … usual dosing range is 2-10 mcg/kg/min while
Maximum infusion rate is 20mcg/kg/min
Indication & Example:
Dosing for 70kg patient if we start with 5 mcg/kg/min then the infusion rate will be:
1. Dilute 250mg Dobutamine in 50mL D5W or NS (Concentration is 5mg/mL)
2. 5mcg/kg/min = 5*70*1*60= 21000 mcg = 4.2mL/h
Contraindications - Hypertrophic cardiomyopathy with outflow tract obstruction
- Observe closely if used in patient with Established Arrhythmias
Preparation & - Dilute each 250mg with 50mL D5W or NS (5000 mcg/mL)
Administration - It is given By Continuous IV Infusion through a Central line

Monitoring - BP , HR , ECG , CVP , MAP , UOP

 Dopamine
Presentation - 200mg/5mL (5mL Ampoule)
Class - Inotrope & Vasopressor
- Unstable Bradycardia Non-responsive to Atropine
Start with 5 mcg/kg/minute; increase by 5 mcg/kg/minute every 2 minutes
until desired effect; maximum dose: 20 mcg/kg/minute
- Acute Decompensated Heart Failure
Start with 5 to 15 mcg/kg/minute
Indication & - Septic Shock
Dosing Star with 2 to 5 mcg/kg/minute; titrate to a goal MAP up to 20 mcg/kg/minute
- Cardiogenic Shock
Start with 0.5 to 20 mcg/kg/minute; titrate based on clinical end point
Example:
for 70kg patient if we start with 5 mcg/kg/min then the infusion rate will be:
1. Dilute 200mg Dopamine in 50mL D5W or NS (Concentration is 4mg/mL)
2. 5mcg/kg/min = 5*70*1*60= 21000 mcg = 5.2mL/h
Contraindications - Phenocromocytoma , Uncorrected Arrhythmias , VF
Preparation & - Dilute each 200mg with 50mL D5W or NS (4000 mcg/mL)
Administration - It is given By Continuous IV Infusion through a Central line
Monitoring - BP , HR , ECG , CVP , MAP , UOP
 Epinephrine (Adrenaline®)
Presentation - 1mg/1mL (1mL Ampoule) = 1:1000 (1g in 1000mL) - Inotrope & Vasopressor
- Unstable Bradycardia Non-responsive to Atropine
2 - 10 mcg/min , titrate to desired effect , usual dose range: 8 - 40 mcg/min
- Anaphylaxis & Anaphylactic Shock (1:1000)
0.5 mg IM,IV or IO Undiluted , Repeat every 5-15 min if no response for
approximately of 2 doses , if no response then initiate infusion with fluid
resuscitation by a rate of 0.1 - 0.2 mcg/kg/min
Indication & - Cardiac Arrest (1:10.000) … Dilute 1 amp of 1:1000 with 10mL NS = 1:10.000
Dosing 1 mg IV , IO is given every 3-5 minutes until ROSC
- Septic Shock & Cardiogenic Shock
0.01 to 0.2 mcg/kg/minute; titrate to goal MAP or end-organ perfusion; usual
dose range: 0.01 to 0.5 mcg/kg/minute; maximum dose range for refractory
shock: 0.5 to 2 mcg/kg/minute
Ex: for 70kg patient if we start with 0.1 mcg/kg/min then the infusion rate will
1. Dilute 2mg Epinephrine in 50mL D5W (Concentration is 4mg/mL)
2. 5mcg/kg/min = 0.1*70*1*60= 420 mcg = 10.5mL/h
Contraindications - No contraindications
Preparation & - Dilute each 2mg with 50mL D5W (40 mcg/mL) for IV C.Infusion through CVL
Administration - During ACLS, it can be given IV; IO, and ETT (2-2.5mg+10mL NS through ET)
Monitoring - BP , HR
 Glucagon
Presentation - 1mg/1mL (1mL Ampoule)
Class - Antidote for BB or CCB Toxicity
- BB or CCB Toxicity
Start with 3 - 10 mg IV bolus; if no clinical response within 10 min may repeat
bolus dose; if clinical response with bolus, start continuous infusion at 3 - 5
mg/hour; titrate infusion rate to achieve adequate hemodynamic response
Hypoglycemia
Indication & IV dextrose should be administered as soon as it is available; if patient fails to
Dosing respond to glucagon, IV dextrose must be given
Administer 1 mg IM, IV, SUBQ & may repeat in 15 minutes as needed
Example:
for 70kg patient if we start with 1 mg/h then the infusion rate will be:
1. Dilute 50mg Glucagon in 50mL D5W or NS (Concentration is 1mg/mL)
2. 1 mg/h = 1 mL/h
Contraindications - Insulinoma & Phenochromocytoma
Preparation & - It can be given directly by IV or IM or SC
Administration - Dilute each 50mg with 50mL D5W or NS ( 1 mg/mL )
- It is given By Continuous IV Infusion through Peripheral or Central line
Monitoring - BP , BGL , HR , ECG , Allergic Reactions
 Hydrocortisone (Solucortef®)
Presentation - 100mg/2mL (100mg Vial)
Class - Corticosteroid
- Septic Shock (inadequate response to Fluid resuscitation & vasopressors)
Indication & 50mg QID or 100mg TID IV Bolus
Dosing - Anaphylactic Shock (inadequate response to Epinephrine or if Asthmatic)
200mg IM or IV Bolus

- Active Peptic ulcer

Contraindications - Systemic fungal infections
- Not for Epidural injection
- It can be given directly by IV or IM or SC
Preparation & - Reconstitute each 100mg Vial with 2mL SWFI , can be given undiluted or
Administration diluted with 50mL NS o D5W & Infused over 20-30 min
- Vial stability is 4h (RT) ONLY (Concentrations of 2mg/mL up to 60mg/mL)
- Administration is through Peripheral or Central line
Monitoring - BP
 Lidocaine (Xylocaine®)
Presentation - 2% Ampoule (5mL Ampoule contain 100mg) - Antiarrhythmic
- 20% Vial (50mL vial contain 1000mg)
- Sudden Cardiac arrest due to Ventricular Fibrillation or Pulseless
Indication & Ventricular Tachycardia
Dosing 1-1.5mg/kg (~100mg) IV Bolus or Intraosseous, Repeat with 0.5-0.75 mg/kg
every 5-10 min as necessary (Maximum cumulative dose is 3mg/kg in 1h
period) follow this with Continuous Infusion of 1-4 mg/min (1-2mg/min if
Elderly or Liver disease or HF)
Endotracheal dosing is 2-3.75mg/kg … Dilute with 5-10mL NS or Sterile Water
- Adams-Stokes Syndrome , WPW & Severe degrees of Heart Block “Unless
Contraindications functioning pacemaker”
- Hypersensitivity to Lignocaine or another amide local anesthesia
- It can be given by IV Bolus (25-50mg/min or more rapidly in cardiac arrest ) ,
IV Infusion , IO & Endotracheal
Preparation & - Dilute 4 ampules 2% (400mg) with 50mL D5W** or NS (Maximum
concentration is 8mg/mL)
Administration - Administration is through Peripheral or Central line
- Watch for Lidocaine Toxicity (DCL , Slurred speech , Blurred vision ,
Bradycardia, Seizures) … Antidote is IV fat emulsion
Monitoring - BP , HR , ECG , LFT
 Magnesium Sulfate
Presentation - 10% (2.5 g/25mL Ampoule)
Class - Electrolyte , Antidote , Antiarrhythmic
- Eclampsia or Preeclampsia
Loading dose of 4-6g over 15-30 minutes followed by 1-2g/h (maximum is 3g/h)
continuous infusion for a least 24h , if seizures occurs while on continuous
infusion then a bolus of 2-4g may be administered over ≥ 5 minutes with
frequent monitoring of toxicity
Indication & - Asthma/COPD Exacerbation
Dosing 2g as a single dose IV Bolus over 20 minutes
- Torsades de Pointes
1-2g (dilute in 50-100mL) Over 5-60 minutes , if no response may repeat dose up
to 4g in 1h , may follow with a continuous infusion of 0.5-1g/h
- Hypomagnesemia
According to severity of magnesium deficiency “Refer to ICU Protocol”
Contraindications - Use with caution in Myasthenia Gravis & Renal Impairment
Preparation & - It can be given by IV Bolus (Not more than 150mg/min) or IV Infusion
Administration - Administration is through Peripheral or Central line
- Preparation: Undiluted or Diluted (to not more than 20% … i.e 200mg/mL)
Monitoring - ECG , Mg Level , UOP
 Naloxone
Presentation - 0.4mg/mL (1mL Ampoule )
Class - Antidote
- Opioid Overdose
0.4-2mg IV “Preferred”, may need to repeat doses every 2-3 min if no response
(up to 10mg … if no response after 10mg then check another cause of
respiratory depression)
Indication &
For long acting opioids or long acting formulations … you can use continuous
Dosing infusion of naloxone calculated dose is based on 2/3 of initial effective dose
Bolus (i.e 0.4-10mg) to be on an hourly basis , one-half (1/2) of the initial bolus
dose should be re-administered 15 minutes after initiation of the continuous
infusion to prevent a drop in naloxone levels
Contraindications - Hypersensitivity to naloxone
- Use with caution in Cardiovascular disorders (Ex.arrhythmias) & if Seizures
- It can be given by IV , IM , SC , Intranasal , Inhalation & Endotracheal
Preparation & - No dilution is necessary for IV or IM OR dilute 0.4-2mg (1mL) with 9mL NS or
Administration SWFI for lower doses (ex.20-40mcg)
- Dilution for IV infusion is done by adding 2mg Naloxone to 500mL NS or D5W
- Dilution for Inhalation is done by adding 2mg to 3mL NS
- Administration is through Peripheral or Central line
Monitoring - RR , HR , BP , Oxygen Saturation , ABG
 Nitroglycerine (Nitronal®)
Presentation - 50mg/50mL (50mL Vial )
Class - Anti angina , Vasodilator
- Antianginal
5-10mcg/min , titrate every 5-10 min by 5-20mcg increments up to 400mcg/min
- Hypertensive Emergency
- Acute Decompensated Heart Failure
5mcg/min , titrate every 5 min by 5-20mcg increments up to 200mcg/min
Indication & Example:
Dosing for patient with BP 200/120 Start with infusion rate 5mcg/min ?
So 10*60=600mcg=0.6mg … Syringe contain 50mg/50ml … so start with
infusion rate of 0.6mL
Tachypyhlaxis occurs within 24-48h of continuous administration
- Receiving of PDE-5 inhibitors (Ex. Sildenafil) within past 24h or Taladafil (48h)
Contraindications - Severe hypotension (Shock) or Severe Bradycardia or Severe Tachycardia
- Increased Intracranial Pressure
- HOCM with LVOT
Preparation & - It is given by IV Infusion
Administration - Administration is through Peripheral or Central line
Monitoring - BP , HR
 Norepinephrine (Levophed®)
Presentation - 4mg/4mL (Each Ampoule contain 4mg NE Bitartrate = 4mg NE Base)
Class - Vasopressor
- Septic Shock
- Post cardiac arrest Shock
0.05-0.15 mcg/kg/min (~5-15mcg/min) , titrate to a goal MAP of 65mmHg up to
1-3.3 mcg/kg/min (~80-250mcg/min)
- Cardiogenic Shock
Indication & 0.05 mcg/kg/min (~5mcg/min) , titrate based on clinical end point (eg, BP, end-
Dosing organ perfusion) Usual dose range is ~ 5-30 mcg/min
Ex. For 80kg patient if we start with 0.05 mcg/kg/min then the infusion rate will
1. Dilute 4mg Norepinephrine in 50mL D5W (Concentration is 80mcg/mL)
2. 0.05mcg/kg/min = 0.05*80*1*60= 420 mcg = 3mL/h
Contraindications - Avoid in patients with mesenteric or peripheral vascular thrombosis
- It is given by an IV Infusion
Preparation & - Administration is through Central line ONLY
Administration - Dilution is with D5W ONLY “or D5W/NS … Never use NS only”
- Dilution: (Single=4mg+50mL ),(Double=8mg+50mL),(Quadrant=16mg+50mL)
- Stability is 24h RT
Monitoring - BP , HR , Tissue Ischemia
 Pheniramine (Pirafen®)
Presentation - 5mg/1mL (1mL Ampoule = 5mg Chlorpheniramine maleate)
Class - Antihistaminic
Indication & - Anaphylactic Shock (inadequate response to Epinephrine or if Asthmatic)
Dosing 10-20mg IV Slowly over 1 minute (Up to 40mg/day)

Contraindications - Hypersensitivity to the active ingredient

- Receipt of MAOI in the past 14 days (Anticholinergic effects)
Preparation & - It can be given directly by IV or IM or SC
Administration - Administration is through Peripheral or Central line
Monitoring - Sedation
 Phenytoin (Epanutin®)
Presentation - 250mg/5mL (5mL Ampoule)
Class - Antiepileptic
- Status Epilepticus
Loading dose of 20mg/kg “No maximum dose” IV Infusion with rate no more
than 50mg/min (i.e if 1000mg , then infuse over ~30 min) & if necessary, may
give an additional dose of 5 to 10 mg/kg 10 minutes after the loading dose;
Indication & maximum total loading dose: 30 mg/kg , followed after 8-12h by a maintenance
Dosing dose of 4-7mg/kg in 2-4 divided doses
- Epilepsy
Loading dose of 15mg/kg “No maximum dose” IV Infusion with rate of no more
than 50mg/min (i.e if 1000mg , then infuse over ~30 min) OR use Non weight
based dose of 1-1.5g followed after 8-12h by a maintenance dose of 4-7mg/kg in
2-4 divided doses
Contraindications - Bradycardia , Adams-Stokes , Sick Sinus Syndrome , 2nd & 3rd degree AV Block

Preparation & - It is given by IV Infusion

Administration - Administration is through Peripheral or Central line
- Dilute with Normal Saline ONLY to a final concentration of ≥ 5mg/mL
- Stable for 4h Only after preparation
Monitoring - BP , ECG , HR , Infusion site reactions (Extravasation)
 Propranolol (Mayestrotense®)
Presentation - 1mg/1mL (1mL Ampoule)
Class - Antiarrhythmic
Indication & - Atrial Fibrillation
Dosing 1mg IV Over 1min , repeat as needed every 2 min up to maximum of 3 doses
OR 1-3 mg IV , repeat as needed every 2 min up to maximum of 2 doses
- Hypersensitivity to the active ingredient
Contraindications - Cardiogenic Shock , Severe Bradycardia , Sick Sinus Syndrome , Heart Block
- Severe PAD , Phenochromocytoma & Hemangeol
Preparation & - It can be given directly by IV Bolus at a rate of 1mg/min
Administration - Administration is through Peripheral or Central line
Monitoring - BP , HR
 Protamine Sulfate (Prosulf®)
Presentation - 50mg/5mL (5mL Ampoule)
Class - Antidote for Heparin
UFH Reversal (100% Neutralization) LMWH Reversal (60% Neutralization)
A. If UFH was given by SC Injection A. If Enoxaparin was ≤ 8h
1mg for each 100 IU Heparin 1mg for each 1mg Enoxaparin
B. If UFH was given by IV Injection B. If Enoxaparin was from 8 to 12h
If last dose of heparin was from 1h then 0.5mg for each 1mg Enoxaparin
Indication & give 1mg for each 100 IU & if last dose C. If Enoxaparin > 12h
Dosing was from 2h then 0.5mg for each 100 IU May not give Protamine
C. If UFH was given by IV Infusion
Calculate dose based on heparin
administered in the last 2-3h
Ex. If patient receive 1250 IU/h So dose
of protamine sulfate will be 25-37.5mg
Contraindications - Hypersensitivity to the active ingredient
Preparation & - Dilute with 50mL NS or D5W
Administration - Slow IV Push (50mg Over 10min)
- Administration is through Peripheral or Central line
Monitoring - BP , aPTT , ACT , Signs of hypersensitivity reactions
 Sodium Bicarbonate
Presentation - 25mEq/25mL (25mL Ampoule) … 1mL=1mmol=1mEq=84mg NaHco3
Class - Antiarrhythmic
Indication & - Cardiac Arrest due to Metabolic acidosis or hyperkalemia or TCA toxicity
Dosing 1mEq/kg/dose Once and repeat doses according to ABG readings

Contraindications - No significant contraindications

Preparation & - It can be given directly by IV Bolus at a rate of 1mg/min
Administration - Administration is through Peripheral or Central line
Monitoring - Serum electrolytes (Na , K , Ca) , ABG
 Verapamil (Isoptin®)
Presentation - 5mg/2mL (1mL Ampoule)
Class - Antiarrhythmic
Indication & - Atrial Fibrillation
Dosing 5-10mg IV Push over 2-3min , Repeat dose after 15-30 min if no response for
another 1-2 doses , if there is adequate response after 1-2 doses then may
start continuous infusion with 5mg/h & titrate to a goal HR and can increase
dose up to 20mg/h
- Supraventricular Tachycardia
- Ventricular Tachycardia
5-10mg IV Push over 2-3min , Repeat dose after 15-30 min if no response for
another 1 dose , if no response then consider alternative therapy
- Hypersensitivity to the active ingredient
Contraindications - Cardiogenic Shock , Severe Bradycardia , Sick Sinus Syndrome , Heart Block
- Severe PAD , Phenochromocytoma & Hemangeol
Preparation & - It can be given directly by IV Push over 2-3 min
Administration - Administration is through Peripheral or Central line
Monitoring - BP , HR , LFT
References:
- ACLS AHA guidelines
- ACLS Cardiac arrest PEA & Asystole algorithm
- ACLS Tachycardia algorithm
- ACLS Bradycardia algorithm
- Lexicomp