ACLS PHARMACOLOGY QUESTIONS
AND ANSWERS WITH COMPLETE
SOLUTIONS LATEST UPDATED
2026/2027
Symptomatic Bradycardia Management
Clinical Presentation: A heart rate of 42 bpm with signs of poor perfusion
(diaphoresis and a BP of 80/60 mmHg). Initial Action: Administer Atropine 0.5
mg intravenously. This dose may be repeated every 3–5 minutes until a maximum
of 3 mg is reached.
Magnesium Sulfate in Cardiac Arrest
Specific Indication: Magnesium is not a routine drug for cardiac arrest. Its use is
primarily reserved for Pulseless Ventricular Tachycardia associated with
Torsades de Pointes.
Stable Wide-Complex Tachycardia
Clinical Presentation: A patient with a rapid (138 bpm), irregular, wide-complex
rhythm who is currently asymptomatic and hemodynamically stable.
Management: Because irregular wide-complex tachycardias are potentially life-
threatening and complex to diagnose, the priority is to seek expert consultation
and obtain a 12-lead ECG before administering potentially harmful rhythm-control
drugs.
Contraindications for Nitrates (Nitroglycerin)
Primary Constraint: In a suspected STEMI patient, do not administer nitrates if
they have used a Phosphodiesterase inhibitor (such as Sildenafil or Vardenafil)
within the previous 24 hours (or Tadalafil within 48 hours). Reasoning: This
combination can lead to severe, refractory hypotension.
, Criteria for Treating Bradycardia
Requirement: Bradycardia alone does not always require intervention. Treatment
is only indicated when the slow rate results in symptomatic instability, such as:
Hypotension
Acute heart failure
Signs of shock
Ischemic chest pain
Acute change in mental status
Endotracheal Drug Delivery (The NAVEL Mnemonic)
Context: When IV or IO access is impossible, certain medications can be
delivered via the endotracheal tube (ET), typically at 2–2.5 times the IV dose.
Eligible Drugs:
Naloxone
Atropine
Vasopressin (removed from many 2025/2026 guidelines, but traditionally
included)
Epinephrine
Lidocaine
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a
second shock. Which drug and dose should be administered first by the IV/IO
route? -ANSWER ✔✔Epinephrine 1 mg
A patient is in refractory ventricular fibrillation. High quality CPR is in progress,
and shocks have been given. One dose of epinephrine was given after the second
shock. An antiarrhythmic drug was given immediately after the third shock. What
AND ANSWERS WITH COMPLETE
SOLUTIONS LATEST UPDATED
2026/2027
Symptomatic Bradycardia Management
Clinical Presentation: A heart rate of 42 bpm with signs of poor perfusion
(diaphoresis and a BP of 80/60 mmHg). Initial Action: Administer Atropine 0.5
mg intravenously. This dose may be repeated every 3–5 minutes until a maximum
of 3 mg is reached.
Magnesium Sulfate in Cardiac Arrest
Specific Indication: Magnesium is not a routine drug for cardiac arrest. Its use is
primarily reserved for Pulseless Ventricular Tachycardia associated with
Torsades de Pointes.
Stable Wide-Complex Tachycardia
Clinical Presentation: A patient with a rapid (138 bpm), irregular, wide-complex
rhythm who is currently asymptomatic and hemodynamically stable.
Management: Because irregular wide-complex tachycardias are potentially life-
threatening and complex to diagnose, the priority is to seek expert consultation
and obtain a 12-lead ECG before administering potentially harmful rhythm-control
drugs.
Contraindications for Nitrates (Nitroglycerin)
Primary Constraint: In a suspected STEMI patient, do not administer nitrates if
they have used a Phosphodiesterase inhibitor (such as Sildenafil or Vardenafil)
within the previous 24 hours (or Tadalafil within 48 hours). Reasoning: This
combination can lead to severe, refractory hypotension.
, Criteria for Treating Bradycardia
Requirement: Bradycardia alone does not always require intervention. Treatment
is only indicated when the slow rate results in symptomatic instability, such as:
Hypotension
Acute heart failure
Signs of shock
Ischemic chest pain
Acute change in mental status
Endotracheal Drug Delivery (The NAVEL Mnemonic)
Context: When IV or IO access is impossible, certain medications can be
delivered via the endotracheal tube (ET), typically at 2–2.5 times the IV dose.
Eligible Drugs:
Naloxone
Atropine
Vasopressin (removed from many 2025/2026 guidelines, but traditionally
included)
Epinephrine
Lidocaine
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a
second shock. Which drug and dose should be administered first by the IV/IO
route? -ANSWER ✔✔Epinephrine 1 mg
A patient is in refractory ventricular fibrillation. High quality CPR is in progress,
and shocks have been given. One dose of epinephrine was given after the second
shock. An antiarrhythmic drug was given immediately after the third shock. What
