Drug

Adenosine
Supraventric
ular
tachycardia

Adrenaline
Asystole/
pulseless
arrest,
pulseless
VT/VF
Bradycardia
Hypersensiti
vity
eg.anaphyla
xis

Dose & Administration

IVP 6mg over 1-2s. No response in 1-2 min, give IVP
12 mg, via peripheral line.
May be repeated twice [6mg12mg12mg(max)]
Follow each dose with 20mL rapid saline flush

Reduce initial dose to 3mg if:

-currently receiving CBZ, dipyridamole
-has a transplanted heart
-via central line
IV 1mg q3-5min until return of
spontaneous circulation (-B or CCB
overdose: Up to 0.2mg/kg )
Endothracheal:2-2.5mg q3-5min.Dilute in
5-10mL NS
IVI 2-10mcg/min Or 0.1-0.5mcg/kg/min,
titrate.

Note
CI: 2nd,3rd degree AV block, sick
sinus syndrome,symptomatic
bradycardia,AF/Af, asthma.
Ad rxn: arrhythmia,chest
pressure,flushing.
T1/2: ~10s
Renal&Hepatic failure: No dose
adjustment
-IVI conc NS or D5
4 mcg/mL (1mg/250ml);
16 mcg/mL (4mg/250mL)
-Continuous infcentral line
-SQ slower than IM
-Avoid IM into buttocks
CPP&cerebral perfusion
myocardial work
subendocardial perfusion

IM,SQ: 0.2-0.5mg q5-15min,if niclinical

improvement
IV: 0.1mg over 5min

Hypotension/
shock
Amiodarone
Pulseless VT
or VF

IVI: 0.1-0.5mcg/kg/min, titrate.

Atropine
Bradycardia,
Org.
poisoning
Cal.
gluconate
Cardiac
arrest in
K / Mg
Digoxin
AF, SVT

Bradycardia: IV 0.5mg q3-5min.Max:3mg

or 0.04mg/kg
Doses <0.5mg associated paradoxical
bradycardia

IVP 300mg (or 5mg/kg1). If recur, 150mg.

Return of spontaneous circulation IVI 1
mg/min for 6H , then 0.5 mg/min for 18H.
administering UNDILUTED is preferred
Max dose:2.2 g/day

1.5-3g (15-30 mL) of 10% solution IV over

2 to 5 min

AF:IV 0.25 mg q2H up to 1.5 mg within 24H

SVT: LD IV 0.5-1mg (0.5mg0.25mg0.25mgQ6H)
MD Iv 0.1-0.4mg OD OR PO 0.125-0.5mg OD

Reference range: 0.5-2ng/ml

CI: 2nd,3rd degree AV

block,bradycardia causing syncope,
cardiogenic shock
Ad rxn: hypotension, bradycardia,
AST/ALT 2x
Renal: No adjustment, Liver: or
DC
Dilution: D5%. Conc 2mg/ml [Peri
line]
CI: 2nd degree type II and 3rd degree
AV block
Caution: ACS&MIHRinfarct
size
Cal gluc 9% elemental Cal. (90mg
in 1g)
10% =
100mg/ml=0.465mEq(9.3mg) /ml
elemental Cal
AVOID: ventricular fibrillation, 2nd,3rd
degree AV block
Renal adjustment:
LD: ESRF 50%, AKI not necessary
MD: CrCl 10-50ml/min: 25%-75%
OR Q36H

CrCl <10 ml/min: 10-25% OR

Dobutamin
e
Heart
Failure,
Shock
Dopamine
Shock

IVI 2.5-20mcg/kg/min. Titrate every few

min.
Max: 40mcg/kg/min

IVI 1-5mcg/kg/min, up to
20mcg/kg/min,titrate.
by 1-4mcg/kg/min at 10-30min interval
Max 50mcg/kg/min.

Heart Failure
5-15mcg/kg/min, prefer lower dose.
Fluphenazi
ne
decanoate
psychosis
Hydrocortis
one
Asthma

IM, SQ 12.5-25mg q2-4wks. Titrate

cautiously.
>50mg needed, by 12.5mg.
Max: 100mg
IV 100mg QID over 30s

Q48H
-Choice in CO in adequate LVFP &
MAP
-Choose lower dose in HF: ad/ef
Ad/ef: /BP, hypersensitivity
>20mcg/kg/min may not hv benefit
on BP,
tachyarrhythmia, consider E or
NE.
1-5 mcg/kg/min: RBF,UO
5-15mcg/kg/min: RBF, HR
>15 mcg/kg/min: BP, SVR
Depot formulation,T1/2 ~14days
IM 4mg=PO 10mg
IMPO once Sx stabilized
Ad ef: hypotension,EPS
IV bolus : 50mg/mL (500mg over
10min)
IVI: 1mg/mL over 20-30min

IV,IM 200mg
Aanaphylaxis
Lidocaine
Pulseless VT
or VF

Hemodynami
cally stable
monomorphi
c VT
Magnesium
sulphate
TdP or VF/VT
associated
with TdP
Nitroglyceri
n
Angina/LVF/
Hypertension
crisis

IV 1-1.5mg/kg. IF refractory 0.5-0.75mg/kg

q5-10min. (max cumulative dose: 3mg/kg)
After return of circulation: 1-4mg/min.
Reappearance of arrhythmia during inf:IVB
0.5mg/kg

Use if amiodarone not available

MD in CHF,shock,hepatic disease
(T1/2):
Initial: 10mcg/kg/min
(Max 1.5mg/min Or 20mcg/kg/min)
Inf rate: 2g/250mL
D51mg/min=7.5mL/H

IV 1-1.5mg/kg. IF refractory 0.5-0.75mg/kg

q5-10min
(max cumulative dose: 3mg/kg)

Continous inf : 1-4mg/min

IV 1-2g over 15min

5mcg/min,by 5mcg/min q3-5min to

20mcg/min.
If no response, by 10-20mcg/min q35min.
Max: 400mcg/min

1g MgSO4=98.6mg elemental
Mg=8.12mEq elemental Mg
IVP Max rate: 150mg/min
IVI Max rate: 2g/H
Rapid admhypotension , asystole
CI:
-hypotension (SBP<90 or 30below
baseline)
-extreme bradycardia (<50bpm),
-tachycardia in absence of
HF(>100bpm)
-right ventricular MI
-coadm PDE-5 (24H if
Sildenafil&Vardenafil,

Noradrenali
ne
Hypotension/
shock

0.01-3mg/kg/min OR
8-12mvg/min, titrate. Usual MD: 24mcg/min OR
0.1-0.5mcg/kg/min, titrate. (ACLS 2010)

Verapamil
PSVT/AF/Af

IVP 2.5 to 5mg over 2 minutes; may

repeat 5-10 mg every 15-30 min
Max total dose:20-30 mg

Pethidine

IM/SQ 50-100mg q3-4H

48H if Tadalafil )
Conc: 50mg/250mL, 50mg/500mL,
Min conc: 100mg/250mL D5
IVI conc NS or D5
16 mcg/mL (4mg/250mL);
32 mcg/mL (8mg/250mL)
- Alkaline inactivate NE (eg.
NaHCO3)
- Not proven survival benefit
compared with
epinephrine
Avoid in patients with HF and preexcited AF or flutter or rhythms
consistent with VT
Infuse over 3min in elderly

References:
1. O'Gara, Patrick T., et al. "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial InfarctionA
Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice
Guidelines." Journal of the American College of Cardiology 61.4 (2013): e78-e140.

2. BNF 60th edition

3. Lexi comp mobile. Updated August 2014.
4. Micromedex Mobile.
5.
6.
7.
8.
9.
10.

*Atropine in PEA or asystole is unlikely to have a therapeutic benefitremoved from the

cardiac arrest algorithm
LVF=Left Ventricular Failure, LVFP=Left Ventricular Filling Pressure, RBF= renal blood
flow,TdP=Torsade de pointes
1mg=1000mcg