![Page 1: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/1.jpg)
RESUSCITATION PHARMACOLOGY
![Page 2: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/2.jpg)
RESUSCITATION PHARMACOLOGY
• Correct hypoxia• Establish spontaneous circulation
at an adequate blood pressure• Promote optimal cardiac function• Prevent or suppress arrhythmias• Relieve pain• Correct acidosis• Treat congestive heart failure
![Page 3: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/3.jpg)
IMPORTANT DRUGS FOR ACLS
• Oxygen BP
Epinephrine/adrenaline Vasopressin Dopamine
HR Atropine
Ventricular arrhythmia Amiodarone Lidocaine / lignocaine Procainamide Magnesium sulphate
Supraventricular arrhythmia Adenosine Diltiazem Amiodarone
• AMI Morphine Nitroglycerine Aspirin Fibrinolytics
• Misc Sodium bicarbonate Calcium chloride
![Page 4: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/4.jpg)
SCHEME FOR STUDY
• Mechanism of action (why ?)
• Indication (when ?)
• Dosage (how ?) correct dose for the correct indication through the correct route
• Precautions (watch out !)
![Page 5: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/5.jpg)
OXYGEN
• Mechanism of action O2 tension hemoglobin saturation tissue oxygenation
• Indication All patients in ACLS
![Page 6: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/6.jpg)
OXYGEN
• Dosage Spontaneous breathing
1 – 6 L/min via nasal cannula 4 L/min for AMI 6 – 10 L/min via non-breathing face mask
Cardiac arrest 15 L/min using bag mask
• Precaution ?? COAD
![Page 7: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/7.jpg)
Epinephrine / Adrenaline
• Mechanism of Action & adrenergic stimulation SVR, SBP, DBP coronary and cerebral blood flow electrical & strength of myocardium
myocardial O2 requirement automaticity
![Page 8: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/8.jpg)
Epinephrine / Adrenaline
• Indication All patient in cardiac arrest
Severe hypotension Symptomatic bradycardia Anaphylaxis
![Page 9: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/9.jpg)
• Dosage Cardiac arrest
1 mg (10ml 1:10000) IV push Q3-5 min Flush with NS + arm elevation for 10-20s 2 – 2.5x IV dose through ETT
Non-Cardiac arrest 2 - 20g/min
• Precautions Precipitate in alkaline solutions
Epinephrine / Adrenaline
![Page 10: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/10.jpg)
Vasopressin
• Mechanism of action Potent vasoconstrictor SVR, SBP, DBP coronary and cerebral blood flow
• Indication Alternative to 1st and 2nd dose of
epinephrine for VF/ pulseless VT
![Page 11: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/11.jpg)
Vasopressin
• Dosage 40 U IV push 1x
• Precautions May provoke cardiac ischemia
![Page 12: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/12.jpg)
Dopamine
• Mechanism of action Stimulation of dopaminergic, &
adrenergic receptor
• Indication Hypotension (70 – 100mmHg) Second drug for hypotensive
bradycardia
![Page 13: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/13.jpg)
Dopamine
• Dosage 5 - 20g/kg/min Titrate to response
• Precautions Taper gradually Start after volume replacement Do not mix with sodium bicarbonate Monitor IV site
![Page 14: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/14.jpg)
Atropine• Mechanism of action
Block parasympathetic receptor of heart SA node automaticity AV node conduction Not to stimulate the heart
• Indication Symptomatic sinus bradycardia While waiting for pacing (don’t delay) Second drug in asystole / PEA Organophosphate poisoning
![Page 15: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/15.jpg)
Atropine• Dosage
Arrest1mg IV/IO push Q3 – 5min2 – 3mg ETT
Bradycardia0.5mg IV/IO Q3 – 5min
Max. 3mg Extremely large dose may be need for
organophosphate poisoning
![Page 16: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/16.jpg)
Atropine
• Precautions Paradoxical bradycardia with < 0.5mg Worsen myocardial ischaemia Avoid in hypothermic bradycardia Not useful in AV block of
2nd degree Type II3rd degree
![Page 17: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/17.jpg)
Anti-arrhythmics
• Pro-arrhythmics
• Negative inotrope ( force) (+) for Ca channel blocker, -blocker,
procainamide, lignocaine (+) for amiodarone (-) for digoxin
![Page 18: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/18.jpg)
Anti-arrhythmics
• Slow the heart (-ve chronotrope) AV node vs. accessory pathway AV node only
Adenosine, digoxin AV node > accessory pathway
Ca channel blocker, -blockerLidocaine
AV node = accessory pathwayAmiodarone, procainamide
![Page 19: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/19.jpg)
Amiodarone• Mechanism of action
Block Na, K and Ca channels & blocking properties
• Indication VT/VF cardiac arrest refractory to shock
+ epinephrine Recurrent life-threatening VT Other arrhythmias (need expert)
![Page 20: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/20.jpg)
Amiodarone
• Dosage Cardiac Arrest
300mg IV push (in 20-30ml D5)+ 150mg IV push in 3-5 min 1x
Ventricular Tachyarrhythmias150mg IV over 10min
Maintenance1mg/min IV for 6 hours then0.5mg/min IV for 18 hours
Max dose 2.2g/day
![Page 21: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/21.jpg)
Amiodarone
• Precautions Multiple drug interaction Long half-life (up to 40 days) Hypotension with rapid/repeated dose Prolong QT interval
![Page 22: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/22.jpg)
Lidocaine / lignocaine
• Mechanism of Action Block Na channel ventricular ectopy excitability in ischemic tissue
• Indication Alternative to amiodarone in cardiac
arrest from VT/VF Stable VT with good LV
![Page 23: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/23.jpg)
Lidocaine / Lignocaine• Dosage
Loading1-1.5mg/kg IV push (arrest)0.5-0.75mg/kg IV push (stable VT)+ 0.5-0.75mg/kg IV Q3 - 5minUp to 3mg/kgETT: 2-4mg/kg 1x
Maintenance1-4mg/min IV
![Page 24: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/24.jpg)
Lidocaine / Lignocaine• Precautions
Not recommended as prophylaxis in MI
Reduce dose Impaired liver functionPoor LV
Stop infusion if signs of toxicity occurs
![Page 25: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/25.jpg)
Procainamide
• Mechanism of Action Block Na channel ventricular ectopy conduction
• Indication Suppression of recurrent VF/VT Other tachy-arrhythmias
![Page 26: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/26.jpg)
Procainamide• Dosage
Recurrent VF/VT 20mg/min (up to 50mg/min) infusion until
o Arrhythmias suppressiono Hypotensiono QRS widen by 50%o 17mg/kg given (60mins for 70kg
patient)
Maintenanceo 1 – 4mg/min
![Page 27: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/27.jpg)
Procainamide
• Precautions Hypotension Reduce to 12mg/kg max in patient
with heart / renal failure Prolong QT interval Pro-arrhythmic, esp. in AMI, K, Mg
![Page 28: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/28.jpg)
Magnesium Sulphate
• Drug of choice for Torsades de Pointes
• Dosage 1-2g IV over 5-20min Then infusion 0.5 – 1g/hr Titrate to control torsades
![Page 29: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/29.jpg)
Adenosine / ATP
• MECHANISM OF ACTION SA node and AV node Short half-life < 5s
• INDICATION Termination of PSVT Diagnostic maneuver for stable
narrow complex SVT
![Page 30: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/30.jpg)
Adenosine / ATP
• DOSAGE 6mg adenosine / 10mg ATP, follow by
20ml NS 12mg adenosine / 20mg ATP in 1-2min if
no response A third dose of 12mg / 20mg ATP in 1-
2min
• PRECAUTIONS Flushing, dyspnoea, chest pain
![Page 31: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/31.jpg)
Diltiazem
• MECHANISM OF ACTIONCa channel blocker automaticity conduction
• INDICATIONRate control for AFTerminate stable re-entry SVT if
adenosine fails
![Page 32: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/32.jpg)
Diltiazem• DOSAGE
15-20mg IV over 2 min Repeat in 15 min at 20-25mg IV PRN Then 5-15mg/hr Titrate to effect
• PRECAUTIONS Not to be used in
Wide complex tachycardia of uncertain origin
Drug induced tachycardia WPW syndrome with AF
![Page 33: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/33.jpg)
DRUGS for AMI
• “MONA greets all MI patients”
M = MorphineO = OxygenN = NitrateA = Aspirin
![Page 34: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/34.jpg)
Morphine
• MECHANISM OF ACTIONRelieve pain myocardial oxygen demand
• INDICATIONChest pain no responding to nitratePulmonary edema
![Page 35: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/35.jpg)
Morphine
• DOSAGE2-4mg IV Q5-30minTitrate to effect
• PRECAUTIONSHypotensionCNS / respiratory depression
![Page 36: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/36.jpg)
Nitroglycerin
• MECHANISM OF ACTION Vasodilation
preload, afterloadCoronary artery vasodilation
• INDICATION Ischemic chest pain Ongoing or recurrent ischaemia in MI Pulmonary edema, hypertensive urgency
![Page 37: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/37.jpg)
Nitroglycerin
• DOSAGESL : 0.5mg Q 5minIV : start with 10-20g/min
• PRECAUTIONSPhosphodiesterase inhibitor for
erectile dysfunctionHypotensionHeadache
![Page 38: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/38.jpg)
Aspirin• MECHANISM OF ACTION
Inhibit platelet action
• INDICATION All patient with ACS
• DOSAGE 162-325mg PO (300mg) Chewing
• PRECAUTIONS Peptic ulcer, asthma
![Page 39: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/39.jpg)
Fibrinolytics• MECHANISM OF ACTION
Reperfusion of myocardium
• INDICATION ST elevation MI or new LBBB <12hr from onset
• CHOICE Streptokinase Alteplase
• PRECAUTIONS Screen for contraindications
![Page 40: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/40.jpg)
Calcium Chloride• INDICATION
Hyper KHypo CaCa channel blocker / -blocker
overdose
• DOSAGE5-10ml 10% CaCI2
![Page 41: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/41.jpg)
Sodium Bicarbonate• INDICATION
Hyper K Bicarbonate responsive acidosis (DKA) Tricyclic antidepressant overdose
• DOSAGE 1mmol/kg IV bolus Monitor ABG
• PRECAUTIONS Not routine for cardiac arrest
![Page 42: function loadScript(url){ var script = document.createElement('script'); script.type = 'text/javascript'; script.src = url; document.getElementsByTagName('head')[0].appendChild(script);](https://reader035.vdocuments.us/reader035/viewer/2022070522/577cca051a28aba711a52913/html5/thumbnails/42.jpg)
THANK YOU