ACLS Drugs

ACLS protocol utilizes the highest quality pharmaceuticals in the field of emergency
medicine. In order to prevent further injury, ACLS trained professionals initiate IV access
or intubation in certain situations where immediate intervention is needed, such as
serious cardiac events and stroke. In pre-hospital settings, these pharmaceuticals are
vital to keep the person alive and stable during transport to a medical facility.
The pharmacology used by ACLS providers is the same used in hospitals by physicians
working with the same kind of medical emergencies. ACLS certification courses provide a
vast amount of information about these drugs, and trainees learn to determine which drug
to use in any given clinical situation through the different ACLS algorithms.
Here are some of the most commonly used drugs for various cardiovascular events
utilized in ACLS protocol:
Ventricular Fibrillation/ Ventricular Tachycardia

Vasopressin: Used in the pulseless arrest algorithm to raise blood pressure and
induce moderate vasoconstriction. Has been shown to be more effective than
epinephrine during asystolic cardiac arrest.
Epinephrine: A drug with powerful vasoconstrictive effects, used to increase
cardiac output. Can be given through IV/IO and endotracheal tube.
Amiodarone: Anti-arrhythmic agent used for various tachyarrythmias,
administered through IV/IO.
Lidocaine: Used as an alternative in VT/VF cardiac arrest when amiodarone is
ineffective.

Bradycardia

Epinephrine: Increases heart rate, heart contractility, and conductivity through the
AV node.
Atropine: Increases activity in the SA node by blocking the vagas nerve and
increasing heart rate. Most commonly used drug for bradycardia.
Dopamine

Tachycardia

Adenosine: The main drug used to treat supraventricular tachycardia (stable

narrow-complex). It interrupts re-entry through the AV node and restores normal
sinus rhythm. It is quickly absorbed by red blood cells before being metabolized
by the body.
Beta-blockers: Neutralizes the effects of stress hormones and epinephrine
(adrenaline), which can trigger or exacerbate tachyarrhythmias.
Dilitiazem
Digoxin

Amiodarone

Asystole/PEA

Vasopressin
Epinephrine

Acute Coronary Syndomes

Aspirin
Oxygen
Morphine
Nitroglycerin

Acute Stroke

tPA-tissue: Breaks down blood clots in the treatment of embolic or thrombotic

stroke.
Glucose (D50)
Plasminogen Activator

All of these drugs have specific conditions and dosages for use. These drugs are very
powerful, and also come with some serious side-effects, so ACLS providers must
exercise caution and accurately determine the correct drug and dosages to use. ACLS
training features comprehensive algorithms which professionals follow step-by-step to
ensure that optimal pharmaceutical care is provided.
Our ACLS Pharmaceuticals Review & Tips:
As previously noted, ACLS is a series of medical procedures put in to action using step
by step methods, in order to save a patient suffering from cardiac arrest or certain other
similar medical emergencies. In addition to procedures and techniques, drugs and
medications are also used to help manage a patient and bring him back to life.
There are several sets of medications that are administered throughout the algorithms to
keep the patient recovering, step by step. Furthermore, certain medications are to be
administered immediately or in pre-hospital settings while other sets of medications are to
be administered in the emergency room afterwards.
For ACLS students, it is very important to thoroughly understand a few points regarding
medication administration:

It is very important to know the nature of the drug/drugs

It is crucially important to understand the proper time for administering
medications
It is also very important to understand the proper method of drug administration
The affect of medication is also to be understood, carefully.

ACLS medications are administered for several purposes i.e. to keep a person alive and
protecting and preparing the heart for later interventions.
The American Heart Association has provided protocols for proper medication distribution
and regularly updates these protocols from time to time. Hence, it is very important for all
medical professionals to learn the ACLS protocols and keep updating themselves as
needed. Here is a short outline of the medications administered throughout the Advanced
Cardiac Life Support algorithm.

Pre-Hospital Medications
At the beginning of the Life Support procedure, there are several drugs that can be
administered. These medications are aimed at instant relief and preparing a patient for
further treatment. These medications may be administered:

Orally
Through Intravenous Injections also known as IV
Injected in Bones/IO
Through ET tube

Only Paramedics are certified for drug administration and EMTs are not allowed to
administer medications in an ambulance. However, under some conditions they are
allowed to administer nitroglycerin for relieving chest pain and aspirin.
The typical medications that are used during pre-hospital settings or in an ambulance
are:

Atropine
Diltiazem
Adenosine
Epinephrine
Lidocaine
Magnesium
Verapamil
Vasopressin

There are certain other drugs that are carried by ambulance personnel for relieving chest
pain and other symptoms arising from cardiac arrest, aside from the aforementioned
pharmaceuticals. A few of them are:

Aspirin
Dopamine
Sodium bicarbonate
Morphine
Calcium

Emergency Room Medications

After the patient reaches the emergency room, he is to be administered with several other
medications for proper treatment. These drugs may belong to the primary or secondary
groups of Advance Cardiac Life Support drugs. Primary ACLS medications are those
which are to be administered to keep the patient alive and are generally administered in
pre-hospital settings. However, due to storage or cost issues, there are certain drugs that
cannot be carried in the ambulance and are given to the patient as soon as he arrives to
the emergency room. On the other hand, secondary drugs are those which are to be
administered to weed the root cause out.
The medications that are normally administered in the emergency room settings are:

Digoxin or Amiodarone for normalizing abnormal heart rhythms

Drugs for flushing clots out of heart
Drugs for normalizing Blood pressure i.e. Beta blockers or ACE inhibitors
Drugs for thinning blood to prevent clot formation inside heart or arteries.

In addition to these drugs, several other drugs are detailed in the ACLS protocols issued
by the American Heart Association. The guidelines for Advanced Cardiac Life Support
provide detailed algorithms for treating several cardiac conditions that may end up in
arrest and procedures to fight these conditions in order to save lives. When proper clinical
guidelines are coupled with proper or prescribed drugs, the recovery of patients is
effective and fastidious.

Ventricular Fibrillation

Epinephrine
Vasopressin
Amiodarone
Lidocaine
Magnesium

Asystole/PEA

Epinephrine
Vasopressin

Bradycardia

Atropine
Epinephrine
Dopamine

Tachycardia

Adenosine
Diltiazem
Beta-blockers
Amiodarone
Digoxin
Verapamil
Magnesium

Acute Coronary Syndrome

Oxygen
Aspirin
Nitroglycerine
Morphine
Fibrolynic Therapy
Heparin
Beta-blockers

Acute Stroke Care

tPA (tissue plasminogen activator)

Glucose
Labetolo
Nitroprusside
Nicardipine
Aspirin