PALS Medications To Study

Every drug you need to know in order to pass your PALS exam.

There are many areas you need to be familiar with in order to pass your Pediatric Advanced Life Support (PALS) exam, but perhaps none require more studying than the medications. This requires knowing more than the names of the drugs that will show up on your exam. You need to know their primary uses, which drug to administer in certain situations, and the dosages of that particular drug. Additionally, there is other information about each drug you need to be familiar with in order to adequately prepare yourself for a given situation.

There are some questions on the exam that you can use practical experience, prior medical knowledge, and a bit of common sense to come up with an answer – which theoretically don’t require as much studying. However, the medications and dosages do not fall under that category. There’s really no way around it, this is a part of the exam that you need to have memorized. Thankfully, we have listed all of them here to help you out. 

Here is a quick reference sheet that shows you everything you need to know about the medications that will appear on your PALS exam:

Adenosine

Primary Use: 

- SVT/PSVT

- Wide QRS Tachycardia

Dose:

- First Dose: 0.1 mg/kg IV Push (Max: 6 mg.)

- Second Dose: 0.2 mg/kg IV Push (Max: 12 mg.)

Cautions/Notes: 

- Must be given as a bolus, followed by a flush

- Can cause bronchospasm - use caution in asthmatics

- Flushing/chest tightness are common

Amiodarone 

Primary Uses:

- Pulseless VT

- Ventricular Fibrillation (V-Fib)

- Recurrent Hemodynamically Unstable Ventricular Tachycardia

- Hypertrophic Cardiomyopathy

- Supraventricular Tachyarrhythmias (SVT)

Dose:

-  Pulseless VT / V-Fib: 5 mg/kg bolus (Max Dose: 300 mg)

- VT / SVT: 5 mg/kg over 20-60 minutes (Max Dose: 300 mg) 

Cautions/Notes:

- Rapid infusion causes hypotension

- If cumulative dosing exceeds 2.2 grams in 24 hours, significant hypotension can occur. Avoid administration with any drug that may prolong QT interval

Atropine

Primary Uses:

- Symptomatic Bradycardia

Dose:

- 0.02 mg/kg IV (Repeat every 3 – 5 minutes 

- Max single dose: 0.5 mg

Cautions/Notes:

- Dose less than 0.1 mg may cause Paradoxical Bradycardia

- Max Total Dose: 1 mg (Child) / 3 mg (Adolescent)

Dopamine

Primary Uses:

- Bradycardia

- Hypotension 

Dose:

- 2 – 20 mcg/kg/min infusion

- Titrated based on clinical response; tapered on/off slowly

Cautions/Notes:

- Extravasation causes tissue damage and necrosis

- Use caution if giving high doses through peripheral IV site

- May cause excessive vasoconstriction / tachyarrhythmias

- Adequate volume resuscitation required before initiating dopamine therapy

Epinephrine

Primary Uses:

- Cardiac Arrest

- Symptomatic Bradycardia

- Severe Hypotension

- Anaphylaxis / Severe Allergic Reactions 

Dose:

- 0.01 mg/kg IV/IO (0.1 mL of 1:10,000 solution)

- Repeat every 3 – 5 minutes

- IV fluid Flush following each dose

Cautions/Notes:

- Higher doses often needed in cases of beta-blocker or calcium channel blocker overdoses. A continuous infusion may be required

- High dose does not improve survival / neurological outcome

- High dose ceases myocardial dysfunction in post-resuscitation period

Glucose

Primary Uses:

- Hypoglycemia

Dose:

- 0.5 – 1 g/kg IV/IO

Cautions/Notes:

-  < 30 Days Old: D₁₀W 5 – 10 mL/kg IV/IO

-  30 Days – 2 Years Old: D₂₅W 2 – 4 mL/kg IV/IO

- > 2 Years Old: D₅₀W 1 – 2 mL/kg IV/IO

Lidocaine

Primary Uses:

- Cardiac Arrest from VT / VF

- Ventricular Tachycardia

- Ventricular Fibrillation 

Dose:

- 1 mg/kg IV/IO bolus

- Maintenance Infusion: 20 – 50 mcg/kg/min

Cautions/Notes:

- Can also be used for stable polymorphic ventricular tachycardia with normal baseline QT AND torsades

- Decrease maintenance doses if left ventricular dysfunction or if impaired liver function

- Not used prophylactically after myocardial infarction 

Magnesium

Primary Uses:

- Torsades de Pointes

- Hypomagnesemia (low magnesium)

- Digitalis Toxicity 

Dose:

-  Initial Dose: 25 – 50 mg/kg IV/IO over 15 – 30 minutes, diluted in 10 mg/mL D₅W

- Max: 2 g

Cautions/Notes:

-  Rapid administration may drop blood pressure

- Very high doses can cause respiratory distress (calcium is antidote)

- Use with caution for patients with renal failure

Naloxone

Primary Uses:

- Opioid Reversal

Dose:

- 0.01 – 0.1 mg/kg

- Max single dose:2 mg 

Procainamide

Primary Uses:

- Ventricular Arrhythmias

- Supraventricular Arrhythmias (SVT)

Dose:

-  Loading Dose: 15 –mg/kg IV/IO. Give over at least 30 minutes

Cautions/Notes:

- Serious reactions can occur for ventricular fibrillation, asystole, seizures, decreased platelets, neutrophils (and can result in hemolytic anemia)

- Other common reactions include hypertension, bradycardia, angioedema, flushing and urticaria 

Sodium Bicarbonate

Primary Uses:

- Metabolic Acidosis

Dose:

- 1 mEq/kg IV/IO (given slowly)

- Max: 50 mEq 

Cautions/Notes:

- Ensure adequate ventilation before administering (prevent or correct respiratory acidosis)

- Monitor pH with ABG results

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