ACLS Drug

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Adenosine  inj (6 mg / 2 ml)

Indication

          Treatment  of  Paroxysmal  Supraventricular  Tachycardia (PSVT)

          Not  infective  in  atrial  flutter , Atrial  Fibrillation  or  ventricular  tachycardia

Dosage form/strength

          Injection  solution  6 mg /2 ml

Dosage  and  Administration

          Double  syring  technique  :  (Open the IV line near the heart) followed by NSS Flush.

drug administration

1. To ensure absolute systemic circulation of the drug, administer either directly into the rapid intravenous bolus (repid intraveneous bolus) within 1 to 2 s or intravenously (IV line) if: injected into the line connected to the vein It should be injected as close to the venous line as possible, followed by a rapid intravenous NSS to allow the drug to enter the central department.

          2. NSS  Flush  For pediatric use >= 5 ml, in adults approximately 20 ml.

Instructions for administering the drug

-Before giving the drug, place the patient in the supine position. (no pillow)

-Administer the drug by injecting IV repid push within 1-3 seconds.

-Do not allow Lower arm, hand, lower leg , or foot

-After the injection, raise the arm in which the injection was given. in order for the drug to work on the heart fully

Mixing and Stabilization
  Do not mix drugs / After opening the drug should not be stored.

Adult dose

Initiate 6 mg Repid iv bolus in 1-2s, followed by NSS Flush.

If unresponsive to treatment within 1-2 minutes, a second dose should be given with an increase of 12 mg.

If a second dose

Contraindication   (Contraindications)

1.      hypersensitivity  to  Adenosine

2.      Seconds  or  third  AV  block

3.      Sinus  node  dysfunction,such  as  sick  sinus  syndrome  or symptomatic  bradycardia

4.      Asthma , COPD

Adverse  drug  Reaction

CVS   :   facial   flushing,  hypotention,   AV  block,   chest  pain,  ST  segment  depresstion

CNS   :   headache , Dizziness

GI   :   Nuasea

Respiratory   :  Dyspnea ,  Hyperventilation

Monitering

- EKG monitering during dosing

- Heart Rate , BP immediately after drug administration and every 2 minutes for 3 cycles

-Clitical point : Heart rate < 60 /min BP<90/60 mmHg

** In the event that the drug is repeated and does not respond, try to review the reasons as follows. Incorrect injection method (injecting or flushing saline following is not fast enough, open the forearm line at the forearm).

Precaution and warning (Caution/Warning )

1.Avoid concomitant use with dipyridamole and methylxanthines (eg Theophylline / aminophylline).

2 Because of the possibility of transient atrial fibrillation during supraventricular tachycardia, normal sinus rhythm administration should be in the hospital. The ECG is always monitored.

3 Patients with atrial fibrillation / flutter and an accessory bypass tract may develop an abnormal ECG conduction through an abnormal pathway.

4 Because of the potential risk of torsade de pointes, adenosine should be used with caution in patients with prolonged QT interval, regardless of congenital etiology. drug induction or from burning for energy

 

ADRENALINE   INJECTION (EPINEPHRINE)

Available dosage form: Adrenaline injection 1 mg in 1 ml , ampoule [concentration 1:1000].

Major Risks 1. A rapid IV infusion may occur. cerebrovascular hemorrhage or cardiac

Arrhythmias should be adjusted with caution.

2. With immediate discontinuation of the drug, rebound hypotension may occur, and the dose should be gradually reduced.

3. Injection of IM in the hip area can cause atherosclerosis, leading to muscle death.

4. adrenaline overdose : arrhythmia, palpitations, dilated pupils high blood pressure

Selection/Procurement - Selection of drugs with a protective container form.

- Drugs taken into the treasury The remaining term is from 1 year or more.

- As an emergency drug, there must be sufficient quantity and quality always available.

STORAGE/STABILITY - The drug has not been opened. Stored at a temperature not exceeding 25 ° C, shelf life 2 years (according to the company)

- The drug has not been activated. Stored at a temperature of 26 – 40 °C, shelf life is 1 year (from the date of

out of storage at a temperature not exceeding 25 °C)

    - Drugs that have been mixed or diluted have a shelf life of 24 hours.

- Drugs that are brown or precipitate should not be used as they have deteriorated.

prescription

Indications / How to use / Dosage

1.Anaphylaxis

pediatric IV/SC ; 0.01 mg/kg/dose (diluted to a concentration of 1:10,000 then 0.1 ml/kg/dose) every 15 minutes, 2 doses, then every 4 hours (max dose 0.5 mg).

Adult IV/SC ; 0.1 – 0.5 mg every 10-15 minutes until improvement (max dose 1 mg)

2. CPR in Pulse less VT/VF ;asystolic/pulseless electrical activity

Children IV ;0.01 mg/kg/dose every 3-5 minutes ; To dilute 1:10,000

then inject 0.1 ml/ kg/dose

ET tube ; 0.1 mg/kg (of 1:1000) mixed in NSS 10 ml

Adult IV ; 0.5-1 mg and repeat every 3-5 minutes until symptoms improve.

3. Bronchospasm

Children SC ; 0.01 mg/kg/dose (diluted to a concentration of 1:10,000 then 0.1 ml/kg/dose) every 15-20 minutes, no more than 3 times (max dose 0.5 mg).

Adult IM/SC ; 0.1 – 0.5 mg every 20 minutes – 4 hours until symptoms improve, not more than 3 times.

Contraindications Cardiac arrhythmias , Angle-closure glaucoma

Major adverse reactions: increased blood pressure. fast/irregular heartbeat

drug preparation

Compatible substances : DSW , NSS, Sterile water for injection

Dilution to a concentration of 1: 10,000 use 1 ml of the drug mixed with 9 ml of NSS or Sterile water for injection.

Do not mix with : Sodium bicarbonate ,Ampicillin, Calcium gluconate, Furosemide, Lidocaine.

In case of IV infusion, mix 1 mg (1 ml) in D5W or 250 ml and 500 ml of NSS (according to the table).

The mixed or diluted drug has a shelf life of 24 hours at room temperature and refrigeration.

Brown or precipitated drug should not be used as it has deteriorated.

drug administration

SC/IM in adults does not require dilution. ,In children dilute the drug to a concentration of 1:10,000

IV push Dilute the drug to a concentration of 1:10,000, inject in 5-10 minutes.

Mix ET tube with 10 ml of NSS before administration.

IV Infusion - Mix 1 mg of the drug into 250 - 500 ml of 0.9% NSS Solution or D5W.

- Administer the drug using an infusion pump at a rate of 1- 10 mcg/min.

follow-up

Monitor : Continuously record Heart rate, BP, every 5 minutes until 30 minutes.

Critical point to report to doctor : Child Heart rate > 180/min BP >120/80 mmHg

Adult Heart rate > 120/min BP >140/90 mmHg

Preventing/Troubleshooting Drug Inaccuracies

1. Rapid IV Infusion may occur. cerebrovascular hemorrhage or cardiac arrhythmias, therefore, when IV infusion, an infusion pump should be used.

2. Avoid injecting IM in the hip area, as it can cause atherosclerosis, leading to muscle death.

3. adrenaline overdose : arrhythmia dilated pupils high blood pressure palpitations

Child Heart rate > 180/min BP >120/80 mmHg , Adult Heart rate > 120/min BP >140/90 mmHg, consider dose reduction or discontinuation. no antidote treat according to symptoms




AMIODARONE INJECTION

Available dosage form: Amiodarone injection 150 mg in 3 ml, ampoule.

Major risks 1. IV push injections are at risk of severe hypotension. circulatory system failure

2. Symptoms of poisoning ; sinus bradycardia, and/or heart block , hypotension and QT prolongation

Selection/procurement of emergency drugs must always be of sufficient quantity and quality available.

Storage/Stability

- Unopened medicines are stored at a temperature not exceeding 25 ° C and protected from light.

- The solution is diluted ; Packed in PVC plastic containers, stable for 2 hours.

Packaged in a glass bottle container. 24 hours stable

prescription

Indications / Dosage / How to use :

1. Ventricular arrhythmias QRS narrow : Adult ; IV infusion

The mean dose is 5 mg/kg (total dose in the first 24 hours not to exceed 1,050 mg) as follows:

- Start with a dose of 150 mg (mix 3 ml in 100 ml of D5W ) over 10 minutes (rate 15 mg/min).

- Followed by a 360 mg dose (mix 7.2 ml in 200 ml of D5W ) over 6 hours (rate 1 mg/min).

Followed by a dose of 540 mg (mixed 10.8 ml in 300 ml of D5W ) over 18 hours (rate 0.5 mg/min).

2. Cardiac arrest (CPR) : Adult ; IV push 300 mg mixed in D 5 W 20-30 ml slowly administered 1-2 minutes

Repeat the drug within 5 minutes at a dose of 150 mg mixed with D 5 W 20-30 ml.

Major Adverse Reactions : Hypotension, Heart block, Bradycardia.

drug preparation

Dilution : - Dilute with 5% Dextrose (D 5 W) solution.

; In the case of infusion, the concentration is 1- 6 mg/ml.

; In case of IV push, mix in D 5 W 20-30 ml.

- Diluent solution contained in PVC plastic containers, stable for 2 hours.

Packaged in a glass bottle, stable for 24 hours, protected from light.

Do not mix with : NSS, solutions containing Sodium bicarbonate, Cefazolin, Furosemide.

drug administration

IV infusion : -Use the infusion pump every time.

IV push : For urgent/emergency use, mix in D 5 W 20-30 ml, slowly administered for 1-2 minutes.

sticking

as a result

Monitor : Heart rate, BP after dosing every 15 minutes for 3 cycles and monitor EKG during dosing.

Critical point report to doctor : Heart rate < 60 /min , BP < 90/60 mmHg, heart block



Preventing/Troubleshooting Drug Inaccuracies

- drug interaction ;

amiodarone increases serum digoxin levels, requires a 50% dose reduction of digoxin

amiodarone increases serum aminophylline levels need to adjust the dose Aminophylline 33%

- Symptoms of poisoning, symptomatic treatment






ATROPINE INJECTION

Available dosage form: Atropine sulfate injection 0.6 mg in 1 ml, ampoule.

Significant risks Symptoms of poisoning: blurred vision, dilated pupils, dry mouth, urinary retention, rapid heartbeat. high blood pressure

​increased body temperature

Selection/procurement of emergency drugs must always be of sufficient quantity and quality available.

Storage/Stability Unopened medicines should be stored at < 25 °C , opened medicines should be used within 24 hours.

prescription

Indications / Dosage / How to use :

For adults ; IV push

1. Symptomatic sinus bradycardia : 0.5-1 mg repeated every 3-5 minutes, total dose not to exceed 3 mg or not to exceed 0.04 mg/kg.

2. Asytolic or Slow PEA(Pulseless Electrical Activity) : 1 mg, repeated every 3-5 minutes, total dose not more than 0.04 mg/kg.

3. Anticholinesterase overdose (Antidote of organophosphate or carbamate poisoning ) : 1-2 mg repeated every 10 – 20 min until muscarinic symptoms are controlled or when atropine effect occurs, after which every 1-4 hours the total dose in 24 The first hour does not exceed 50 mg.

For child : IV push ; 0.02 mg/kg or minimum dose 0.1 mg , maximum dose 0.5 mg

ET tube ; 0.03 mg/kg or 2-3 mg mixed in 10 ml NSS

Contraindications : myasthenia gravis , narrow –angle glaucoma

Major adverse reactions: dry mouth, blurred vision, dilated pupils and visual impairment, urinary congestion, rapid pulse.

drug preparation

Dilution agent : Do not dilute.

Do not mix with : Adrenaline, Ampicillin, Chloramphenicol, Heparin, Warfarin.

Drug administration : IV push ; The infusion rate is 0.6 mg in 1 minute.

follow-up

Monitor: Every 5 minutes until clinical symptoms are controlled by monitoring Heart rate, BP, Mental status.

Critical point (report doctor) : Heart rate > 60/ min bradycardia , asystolic Heart rate > 120/ min Antidote

Preventing/Troubleshooting Drug Inaccuracies

Overdose symptoms: blurred vision, dilated pupils, dry mouth, urinary retention, rapid heartbeat

high blood pressure increased body temperature

Correction: Physostigmine 1-2 mg SC or Slow IV (0.5 mg or 0.02 mg/kg for children)




DOPAMINE INJECTION

Available dosage form: Dopamine hydrochloride injection 250 mg in 10 ml, ampoule.

Major risk

1. Overdose: hypertension, arrhythmia , tachycardia, acute renal failure

2. Abrupt discontinuation of the drug may cause severe hypotension, the dose should be reduced gradually.

Selection/procurement of emergency drugs must always be of sufficient quantity and quality available.

Storage/Stability unopened medicine Store at a temperature not exceeding 25 °C and protected from light.

The diluted solution is stable for 24 hours at room temperature. and prevent light from the solution that turns darker or brown. Do not use because it has deteriorated.

prescription

Indications / dosage / method of use

Shock with increased cardiac output, blood pressure, urine flow after adequate hydration.

Adult : IV infusion using an infusion pump ; 1-5 mcg/kg/min gradually increase the dose 1-4 mcg/kg/min every 10-30 minutes until desired response is achieved. In the event that the patient has severe symptoms may increase dose by 5-10 mcg/kg/min every 10-30 minutes ; Maximum dose 20 -50 mcg/kg/min. Discontinuation should be reduced gradually, as abrupt discontinuation may result in hypotension.

-The following conditions should be corrected prior to drug administration: hypovolemia, acidosis, hypercapnia, hypoxia.

- The effect of the drug on the blood system

Low : 1-3 mcg/kg/min renal blood flow , urine out put

: 3-10 mcg/kg/min renal blood flow , heart rate, cardiac contraction, cardiac output

High dose : > 10 mcg/kg/min causes vasoconstriction to increase blood pressure.

Contraindications to Phaeochromocytoma, Tacchyarrhythmia, Ventricular fibrillation.

Major adverse reactions hypertension, chest pain, palpitation, tachycardia, olicurea

drug preparation

Diluent : D 5 W, D5 N/2 , D 5 S , NSS, LRS

- dilution 1 : 1 means the concentration is 1 mg/ml ;4 ml of the drug is mixed with the IV solution to obtain 100 ml

- dilution 2 : 1 means the concentration is 2 mg/ml ; 8 ml of the drug is mixed with the IV solution to obtain 100 ml

The diluted solution is stable for 24 hours at room temperature. and light protection

Solution that has turned darker or brown. Do not use as it has deteriorated.

Do not mix with : alkaline solutions such as Amphotericin B, Ampicillin, Irons salts.

Gentamicin, Potassium chloride, Sodium bicarbonate

drug administration

IV infusion using an infusion pump

To stop the drug, reduce the dose gradually. Due to abrupt discontinuation of the drug, severe hypotension may occur.

DOPAMIN
follow-up

Monitor :

- BP, Heart rate , EKG, Urine output before and during administration

- During drug administration, record vital sign, EKG every 15 minutes, 3 cycles, if stable, measure every 2-4 hours.

- Check the infusion pump every 1 hour.

- Check the IV site every 1 hour throughout the period of drug administration.

Critical point (report to physician) : Adult ; BP > 140/ 90 mmHg or BP < 90/ 60 mmHg Heart rate > 120 beats/min.

Preventing/Troubleshooting Drug Inaccuracies

- Overdose symptoms: including high blood pressure, arrhythmia, acute renal failure.

Decrease the rate or stop the medication.

- If redness, swelling, dark circles are found in the IV site, change the position of the drug.

- When stopping the drug, gradually reduce the rate of drug administration to prevent severe hypotension




MAGNESIUM SULFATE INJECTION

Magnasium sulfate10% in 10 ml, ampule (MgSO4 = 1 g, Mg 98 mg = 8.12 mEq/ml= 4 .06 mmol).

Magnasium sulfate50% in 2 ml, ampule (contains MgSO4 = 1 g, Mg 98mg = 8.12 mEq/ml= 4 .06 mmol).

major risk Too rapid administration of the drug may cause hypotension , asystolic.

Toxic symptoms: Nausea, vomiting, diarrhea, CNS depression, respiratory depression, flushing.

Selection/procurement of emergency drugs must always be of sufficient quantity and quality available.

Storage/Stability unopened medicine Store at a temperature not exceeding 25 ° C.

The diluted solution is stable for 24 hours at room temperature. (Do not refrigerate)

prescription

Indications / dosage / method of use

Adults:

1. Hypomanesemia : IM or IV slowly push ; 1 g every 6 hours 4 dose , 8-12 g/day in severe cases

2. Pre-eclampsia, Eclampsia

IVslowly push ; 10 % MgSO4 2 - 4 g given in 5-10 min ,then

IV infusion ; 50 % MgSO4 20 ml (10 g) in D5W or NSS 1000 ml ; rate 1-2 g/hr

Max ; 30-40 g/day

3. Torsades VT / VF : IV slowly push 1-2 minutes

; 50% MgSO4 1-2 g diluted in D 5 W ; 50-100 ml every 10 – 15 min.

(child : 25-50 mg/kg IV ; max 2 g )

Contraindications heart block, hepatitis

Major adverse reactions: diarrhea, CNS depression, respiratory depression, hypotension, asystolic.

drug preparation

Diluent : NSS, D5W, RLS

drug administration

IM concentration 25% or not more than 50 %

IV slowly push 10 % concentration ; 10 ml 1 minute ; rate < 150 mg/min

IV infusion diluted to a concentration of not more than 10% (maximum concentration 100 mg/ml) ; rate < 150 mg/min

follow-up

Monitor : BP , Respiratory rate , serum Mg, serum Cr. , knee jerks reflex, urine output,toxic symptoms

Critical point (doctor report) :

in adults ; BP < 90/ 60 mmHg or > 140/100,

Respiratory rate < 14 / min , Loss of reflex

Heart rate < 60 /min , urine output < 100 ml / 4 hours

Serum Mg > 2.5 mg/ml

Preventing/Troubleshooting Drug Inaccuracies

- Do not give the drug at a rate that is too fast. due to hypotension

- Toxic symptoms: diarrhea, CNS depression, respiratory depression, flushing, discontinue the drug.

Symptomatic and antidote ;calcium gluconate 10% inj. 10 20 ml IV 1-3 min.

Normal serum Mg = 1.7 – 2.3 mg/dL (1.2 – 2.0 mEq/L)