Understanding the amiodarone pediatric dose for PALS is one of the most clinically critical skills any healthcare provider can develop. In pediatric advanced life support scenarios, amiodarone is the first-line antiarrhythmic for shock-refractory ventricular fibrillation and pulseless ventricular tachycardia. The AHA-recommended dose is 5 mg/kg IV/IO, which can be repeated up to two additional times for a maximum cumulative dose of 15 mg/kg per resuscitation event. Getting this dose right under pressure requires thorough preparation, and the best way to build that confidence is through structured study and repeated practice testing.
Understanding the amiodarone pediatric dose for PALS is one of the most clinically critical skills any healthcare provider can develop. In pediatric advanced life support scenarios, amiodarone is the first-line antiarrhythmic for shock-refractory ventricular fibrillation and pulseless ventricular tachycardia. The AHA-recommended dose is 5 mg/kg IV/IO, which can be repeated up to two additional times for a maximum cumulative dose of 15 mg/kg per resuscitation event. Getting this dose right under pressure requires thorough preparation, and the best way to build that confidence is through structured study and repeated practice testing.
PALS pharmacology is a broad and demanding topic that encompasses not just antiarrhythmics but also vasopressors, atropine for bradycardia, adenosine for SVT, sodium bicarbonate, calcium, glucose, and many other agents. Each drug has a specific indication, weight-based dosing formula, route of administration, and set of contraindications that you must commit to memory before your certification exam. The breadth of content can feel overwhelming at first, but breaking the material into logical drug classes makes it far more manageable and allows you to build a coherent mental model of how each medication fits into clinical decision-making.
The good news is that the AHA has organized PALS pharmacology around well-defined algorithms, so once you understand the algorithmic context for each drug, the dosing and indications become intuitive rather than arbitrary facts to memorize. For example, knowing that epinephrine 0.01 mg/kg IV/IO is given every three to five minutes during cardiac arrest places the drug squarely inside the cardiac arrest algorithm, which provides a scaffolding for recall. Understanding the full picture of pals pharmacology alongside its algorithmic context dramatically improves both retention and clinical application during high-stakes scenarios.
Practice questions are an indispensable tool for mastering PALS pharmacology. Research consistently shows that retrieval practice — actively recalling information through testing — produces stronger long-term retention than passive review of notes or slides. When you answer a question about amiodarone pediatric dosing for PALS and get immediate feedback, your brain encodes that information more deeply than if you simply re-read the drug table a dozen times. This is why mixing reading with quiz-based review is the most efficient study strategy for certification exams.
In this comprehensive guide, you will find everything you need to master PALS pharmacology, from a complete drug-by-drug breakdown of doses and indications to clinical pearls that distinguish dangerous distractors on the exam. We cover epinephrine, amiodarone, adenosine, atropine, lidocaine, calcium, glucose, sodium bicarbonate, magnesium, and dopamine. Each section is designed to mirror the exact knowledge level tested on the PALS written exam and the skills stations, so you can use this resource as a one-stop preparation hub throughout your certification journey.
Whether you are preparing for your initial PALS certification or a two-year renewal, pharmacology questions routinely make up a substantial portion of both the written and scenario-based assessments. Many candidates who struggle with PALS do so not because they cannot perform CPR or operate a defibrillator, but because they freeze when asked to recall a specific weight-based dose or cannot justify their drug choice within the algorithm. This guide addresses that gap directly, giving you the conceptual framework and clinical context you need to answer pharmacology questions accurately and confidently every time.
By the end of this article, you will have a thorough understanding of all major PALS drugs, their mechanisms, their weight-based dosing calculations, and the clinical situations in which they are indicated. You will also have access to carefully curated practice quizzes that reinforce every concept covered here. Consistent, targeted practice is the fastest path to certification success, and this guide is designed to make that practice as effective and efficient as possible for busy healthcare professionals.
Amiodarone and lidocaine are the primary antiarrhythmics in PALS, used for shockable rhythms (VF and pVT) that do not convert after two defibrillation attempts. Amiodarone is preferred; lidocaine is an acceptable alternative when amiodarone is unavailable.
Epinephrine is the cornerstone vasopressor in PALS cardiac arrest. Dopamine is used for post-resuscitation hemodynamic support. These agents restore perfusion pressure during shock and bridge the patient to definitive care.
Atropine blocks vagal tone to increase heart rate in symptomatic bradycardia with a pulse. A minimum dose of 0.1 mg is mandatory to avoid paradoxical bradycardia. Atropine is not routinely used in pulseless arrest in current AHA guidelines.
Calcium chloride, sodium bicarbonate, glucose (dextrose), and magnesium sulfate address specific reversible causes of arrest. These agents are not given routinely but are indicated when laboratory or clinical evidence confirms the underlying metabolic derangement.
Adenosine is the first-line pharmacologic agent for stable SVT in pediatric patients. The first dose is 0.1 mg/kg rapid IV push (max 6 mg), followed by a 0.2 mg/kg second dose (max 12 mg) if the first dose fails to convert the rhythm.
Epinephrine is the single most important drug in the PALS cardiac arrest algorithm, and understanding its dosing and mechanism is non-negotiable for certification. The standard dose is 0.01 mg/kg given intravenously or intraosseously every three to five minutes throughout the resuscitation. Using the 0.1 mg/mL concentration (1:10,000), this translates to 0.1 mL/kg per dose, which many providers find easier to calculate under pressure. Epinephrine stimulates both alpha-adrenergic and beta-adrenergic receptors, raising aortic diastolic pressure, improving coronary perfusion pressure, and increasing myocardial contractility — all critical components of effective resuscitation.
The amiodarone pediatric dose for PALS is 5 mg/kg IV/IO, administered as a rapid infusion for pulseless VF or pVT after the second unsuccessful defibrillation attempt. This dose can be repeated up to two additional times during the same resuscitation event, for a maximum cumulative dose of 15 mg/kg per arrest. When amiodarone is given during cardiac arrest, it does not need to be diluted or infused slowly — rapid bolus administration is appropriate in pulseless arrest. However, in perfusing rhythms such as stable VT, amiodarone should be infused over 20 to 60 minutes to avoid hypotension.
Lidocaine is an acceptable alternative to amiodarone for VF and pVT and is particularly useful in settings where amiodarone is unavailable. The PALS lidocaine dose is 1 mg/kg IV/IO bolus. Lidocaine works by blocking fast sodium channels in the myocardium, stabilizing the cardiac membrane and suppressing ectopic pacemaker activity. It has a faster onset than amiodarone and does not cause the prolonged QT or thyroid dysfunction associated with long-term amiodarone use, but in the acute arrest setting these distinctions are less clinically relevant than simply having a drug available and knowing how to dose it.
Adenosine is the drug of choice for pediatric supraventricular tachycardia when the patient is hemodynamically stable. The first dose is 0.1 mg/kg, given as a rapid IV push followed immediately by a normal saline flush to ensure rapid central delivery — ideally through an antecubital or more proximal vein. The maximum first dose is 6 mg.
If the first dose fails to terminate the arrhythmia, a second dose of 0.2 mg/kg (maximum 12 mg) is administered. Adenosine works by transiently blocking AV nodal conduction, effectively breaking the reentrant circuit responsible for most pediatric SVT, and it has a half-life of less than ten seconds.
Atropine is the primary agent for symptomatic bradycardia that is causing hemodynamic compromise and is not responding to oxygenation and ventilation. The pediatric atropine dose is 0.02 mg/kg IV/IO, with a minimum dose of 0.1 mg (to prevent paradoxical bradycardia) and a maximum single dose of 0.5 mg. It can be repeated once. Atropine works by blocking muscarinic receptors, reducing vagal tone and allowing the sinoatrial node to increase its firing rate. In PALS, bradycardia most often results from hypoxia, so fixing the airway and providing oxygenation is always the first intervention before reaching for atropine.
Magnesium sulfate is a niche but important drug in PALS, indicated for the treatment of torsades de pointes and hypomagnesemia-associated ventricular arrhythmias. The pediatric dose is 25 to 50 mg/kg IV/IO, with a maximum dose of 2 grams per administration. Magnesium acts as a physiological calcium antagonist, stabilizing the cardiac membrane and suppressing the triggered activity responsible for torsades.
Providers must be able to recognize torsades de pointes on an ECG strip — it appears as polymorphic VT with a characteristic twisting of the QRS complexes around the isoelectric baseline — because it is the key indication that distinguishes magnesium from other antiarrhythmics.
Dopamine is used in the post-resuscitation phase of PALS care for hemodynamic support in patients with persistent hypotension after return of spontaneous circulation. Depending on the infusion rate, dopamine produces different clinical effects: low doses (2–5 mcg/kg/min) predominantly stimulate dopaminergic receptors, moderate doses (5–10 mcg/kg/min) provide primarily beta-1 adrenergic effects increasing cardiac output, and higher doses (10–20 mcg/kg/min) produce alpha-adrenergic vasoconstriction. This dose-dependent pharmacology makes dopamine a flexible agent in the post-arrest period, but providers must titrate carefully and monitor for arrhythmias.
Intravenous access is the preferred route for PALS drug delivery, but intraosseous access is equally effective and should be established without delay when IV access cannot be obtained within 60 to 90 seconds. All PALS medications — including epinephrine, amiodarone, adenosine, atropine, and electrolytes — can be given IO at the same doses as IV. The tibia and humerus are the most common IO insertion sites in pediatric patients, and commercially available IO devices like the EZ-IO make placement fast and reliable even during active resuscitation.
Endotracheal drug delivery (via ET tube) was historically used as a last resort when neither IV nor IO access was available. Current AHA guidelines de-emphasize this route because absorption is unpredictable and serum drug levels achieved are significantly lower than IV or IO administration. If ET delivery is absolutely necessary, the NAVEL drugs — Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine — can be given via ET tube at higher doses (typically 2–10 times the IV dose) diluted in 5 mL of normal saline.
Weight-based dosing is the foundation of all pediatric pharmacology and is a consistent source of errors during resuscitation. The Broselow tape (length-based resuscitation tape) is the gold standard tool for estimating pediatric weight when actual weight is unknown, and it also provides pre-calculated drug doses and equipment sizes by color zone. Teams should use the Broselow tape proactively at the start of any pediatric resuscitation so that dosing decisions do not slow down the team during critical interventions.
For the PALS exam, you must be able to calculate doses manually given a child's weight in kilograms. Common test scenarios present a weight in kg and ask you to calculate the correct dose of epinephrine, amiodarone, or adenosine. Practice this calculation until it is automatic: amiodarone 5 mg/kg for a 20 kg child = 100 mg; epinephrine 0.01 mg/kg for a 15 kg child = 0.15 mg = 1.5 mL of 1:10,000 solution. Setting up these calculations as a proportion (dose per kg × weight in kg) works reliably under pressure.
In the PALS pulseless arrest algorithm, the timing and sequence of drug administration relative to CPR and defibrillation is a testable concept. Epinephrine should be given as soon as IV/IO access is established, ideally within the first or second CPR cycle. For shockable rhythms (VF/pVT), the sequence is: shock → CPR → establish access → epinephrine → CPR → shock → amiodarone or lidocaine → CPR → shock. Amiodarone is given after the third shock if the rhythm remains shockable, not at the beginning of the arrest.
A common exam question tests whether candidates know that epinephrine is given in both shockable and non-shockable arrest rhythms, while amiodarone is only indicated for shockable rhythms (VF and pVT). During PEA and asystole, amiodarone has no role; epinephrine and treatment of reversible causes (the Hs and Ts) are the focus. Understanding this distinction prevents a very common testing error and also reflects sound clinical reasoning about the pathophysiology underlying each rhythm.
In pulseless cardiac arrest, amiodarone 5 mg/kg can be given as a rapid IV/IO bolus. However, in a patient with a perfusing rhythm (such as stable VT with a pulse), amiodarone must be infused slowly over 20 to 60 minutes to prevent severe hypotension. The PALS exam frequently tests this distinction — knowing when rapid bolus is appropriate versus when a slow infusion is required can be the difference between a correct and incorrect answer.
Dosing calculation errors are one of the most preventable sources of harm in pediatric emergencies, and PALS pharmacology questions frequently test your ability to perform accurate weight-based arithmetic under pressure. The key to flawless calculation is developing a consistent mental framework. Start by converting the child's weight to kilograms if given in pounds (divide pounds by 2.2). Then multiply the weight in kg by the dose per kg. Finally, convert the calculated dose to the correct volume based on the available drug concentration. Practicing this three-step process repeatedly before your exam ensures it becomes automatic.
Let us work through a concrete example using amiodarone. A 25 kg child presents in VF that has not responded to two defibrillation attempts. What is the correct amiodarone dose? Step one: weight is 25 kg. Step two: dose is 5 mg/kg, so 5 × 25 = 125 mg. Step three: amiodarone is available as 50 mg/mL, so 125 mg ÷ 50 mg/mL = 2.5 mL.
The provider draws up 2.5 mL and gives it as a rapid IV/IO bolus. If the rhythm persists, the same calculation applies to the second and third doses, for a maximum of 375 mg total (15 mg/kg × 25 kg). This type of step-by-step calculation is exactly what the exam expects.
Now consider adenosine for a 30 kg child with SVT and adequate perfusion. First dose: 0.1 mg/kg × 30 kg = 3 mg. Adenosine is available as 3 mg/mL, so the volume is 1 mL, given as a rapid push followed by a 5–10 mL NS flush. If the first dose fails, the second dose is 0.2 mg/kg × 30 kg = 6 mg = 2 mL.
The maximum second dose is 12 mg, so this child has not yet reached the ceiling. These calculations follow the same logical framework every time, and committing to that consistency is what prevents errors during stressful real-world resuscitations.
Sodium bicarbonate is one of the metabolic agents in PALS that is frequently misused. It is indicated when there is documented metabolic acidosis, hyperkalemia, tricyclic antidepressant overdose, or prolonged arrest with inadequate ventilation. The dose is 1 mEq/kg IV/IO. Importantly, bicarbonate should never be given routinely in cardiac arrest without a specific indication, because it can cause hypernatremia, hyperosmolarity, paradoxical intracellular acidosis, and it inactivates catecholamines if mixed in the same line. The PALS exam tests this knowledge by presenting a scenario where bicarbonate is tempting but inappropriate, rewarding candidates who can identify the specific indication requirement.
Calcium chloride and calcium gluconate are both forms of calcium used in PALS, but they differ significantly in elemental calcium content. Calcium chloride 10% provides approximately three times more elemental calcium per milliliter than calcium gluconate, making it more potent for rapid correction of hypocalcemia, hypermagnesemia, or calcium channel blocker toxicity. The pediatric dose of calcium chloride is 20 mg/kg (0.2 mL/kg of 10% solution). Calcium gluconate is preferred in non-arrest situations because it is less irritating to veins. Exam questions on this topic often test whether you know the dose difference and the specific situations favoring each formulation.
Glucose administration is indicated in pediatric arrest or post-arrest care when documented hypoglycemia is present. The dose is 0.5 to 1 g/kg IV/IO, using D10W (10% dextrose) at 5–10 mL/kg for neonates and infants, or D25W (25% dextrose) at 2–4 mL/kg for older children. Hypoglycemia is one of the reversible causes in the H's and T's (specifically listed under metabolic causes), and it is particularly common in neonates and small infants, who have limited glycogen reserves. Point-of-care blood glucose should be checked in every pediatric arrest to avoid missing this easily correctable cause.
Naloxone (Narcan) is a life-saving drug in the opioid overdose context and is occasionally referenced in PALS for respiratory depression or arrest secondary to opioid toxicity. The dose is 0.01 mg/kg IV/IO/IM/IN for opioid-associated respiratory depression; higher doses may be needed for complete reversal of synthetic opioids. Naloxone is on the NAVEL list of drugs that can be given via endotracheal tube in the absence of IV/IO access. With the pediatric opioid exposure crisis in the United States, understanding naloxone's role has become increasingly important in PALS training, and exam writers have incorporated more opioid-related scenarios in recent years.
Preparing for the PALS written exam requires both conceptual understanding and the ability to apply knowledge under timed conditions. The AHA PALS exam consists of multiple-choice questions that test knowledge of algorithms, pharmacology, rhythm recognition, and pediatric assessment. Pharmacology questions tend to be high-yield because they test specific, measurable knowledge — either you know the amiodarone pediatric dose for PALS is 5 mg/kg or you do not. This makes pharmacology one of the best topics to study systematically, because the payoff for memorization is direct and predictable.
One of the most effective study strategies for PALS pharmacology is creating a drug card for each major medication with five fields: drug name, indication, dose (mg/kg), maximum dose, and one clinical pearl or contraindication. Reviewing these cards daily for two to three weeks before your exam will entrench the information in long-term memory. Pairing each card review with a practice question on that drug reinforces the material through active retrieval and helps you see how the drug is tested in the context of a clinical scenario rather than in isolation.
Understanding the Hs and Ts is essential for the pharmacology portion of PALS because many of the electrolyte and metabolic drugs (calcium, bicarbonate, glucose, magnesium) exist specifically to treat reversible arrest causes. The Hs include: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, and Hypothermia. The Ts include: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary), and Thrombosis (coronary). Knowing which drug or intervention addresses each cause allows you to answer scenario-based questions logically rather than relying on rote memorization of a disconnected drug list.
Rhythm recognition is inseparably linked to PALS pharmacology because the correct drug choice depends entirely on accurately identifying the underlying rhythm. A provider who misidentifies SVT as sinus tachycardia will not reach for adenosine; one who misidentifies VF as artifact will not give amiodarone. PALS exam scenarios typically present an ECG or rhythm strip alongside a clinical description and ask you to identify the rhythm and select the appropriate intervention. Practicing rhythm strips alongside drug dosing is therefore more efficient than studying them as separate topics.
Scenario-based learning is especially valuable for integrating pharmacology knowledge across the full PALS framework. In a scenario, you must simultaneously assess the patient, identify the rhythm, determine if the patient is stable or unstable, choose the correct algorithm, select the appropriate drug, calculate the dose, and communicate the order to your team — all within a realistic time frame. Working through written scenarios and practice quizzes that mimic this complexity is the best preparation for both the written exam and the megacode skills station, where providers are evaluated on their ability to lead a complete resuscitation scenario.
Team communication is a dimension of PALS pharmacology that is sometimes overlooked in self-study. When you order a drug during a resuscitation, you must state the drug name, the dose in mg/kg, the calculated dose in mg (and volume in mL if possible), the route, and the rate.
Using closed-loop communication — where the recipient reads back the order and confirms before administering — is a PALS core competency. Practice this verbally even when studying alone: say the full drug order out loud, as if communicating to a nurse. This habit dramatically reduces dosing errors in real clinical situations and is evaluated during PALS skills assessments.
Post-resuscitation pharmacology is the final chapter of the PALS drug story and covers the hemodynamic support and neuroprotective measures used after return of spontaneous circulation (ROSC). Dopamine or epinephrine infusions maintain blood pressure and cardiac output. Targeted temperature management may be considered in specific patient populations. Anti-epileptic drugs may be needed for post-cardiac arrest seizures.
Blood glucose management prevents secondary brain injury from hypoglycemia or hyperglycemia. Understanding that PALS pharmacology extends beyond the arrest itself — into the first hours and days of post-resuscitation care — gives you a comprehensive clinical picture and positions you to answer the most advanced exam questions with confidence.
Building a high-yield study plan for PALS pharmacology in the final two to three weeks before your exam requires prioritizing the topics most likely to appear on the test. Based on the structure of the AHA PALS curriculum, the highest-yield pharmacology areas are: epinephrine for cardiac arrest, amiodarone for shockable rhythms, adenosine for SVT, atropine for bradycardia, and the metabolic/electrolyte agents for reversible arrest causes. These five areas account for the vast majority of pharmacology questions and should receive the most study time. Secondary topics like dopamine infusion dosing and post-resuscitation care deserve attention but can be reviewed more briefly.
Spaced repetition is the most scientifically validated study method for memorizing medical dosing information. Rather than cramming all drug doses into a single long session, reviewing them across multiple shorter sessions spread over days or weeks produces dramatically better long-term retention. Apps like Anki allow you to create digital flashcards with built-in spaced repetition algorithms that present each card at the optimal interval for retention. Many PALS candidates have pre-built Anki decks available online, or you can create your own cards from the drug information in this guide.
Practice tests should form a cornerstone of your final week of PALS preparation. Taking a full-length practice exam under timed conditions simulates the cognitive load of the actual test and reveals any remaining knowledge gaps before exam day. After completing a practice test, reviewing every incorrect answer — even the ones you guessed correctly — is more valuable than simply noting your score. For each wrong answer, trace back to the underlying concept, re-read the relevant section of your study materials, and create a practice question that tests that specific concept again the following day.
On the day of your PALS exam, a few key strategies can improve your performance. Read each pharmacology question stem carefully, paying attention to whether the patient has a pulse or is pulseless — this determines the algorithm and dramatically narrows the drug choices. Eliminate obvious distractors first: if a question asks about VF management and one of the choices is atropine, eliminate it immediately. For dose calculations, write out the arithmetic step-by-step in the scratch space provided, even if the calculation seems simple, because systematic checking prevents arithmetic errors under exam stress.
Maximizing your use of high-quality practice resources between now and exam day is the single most impactful thing you can do to guarantee success. The quizzes linked throughout this article are designed specifically to test PALS pharmacology in the format and style you will encounter on the actual exam. Each question is written to mirror the clinical scenario structure of the AHA written assessment, with carefully crafted distractors that test whether you truly understand the material or are making surface-level guesses. Regular exposure to these questions builds the pattern recognition you need to answer quickly and accurately under pressure.
Remember that PALS certification is not just about passing a test — it is about being able to save a child's life in a real emergency. The pharmacology knowledge you build through this study process is directly applicable to clinical practice, and every dose you memorize, every calculation you practice, and every scenario you work through makes you a more capable and confident resuscitation provider. Take your preparation seriously, use every available resource, and approach the exam knowing that you have done the work to succeed.
As you complete your preparation, make time to review your weak areas one final time and ensure you can confidently calculate drug doses for patients of various weights without hesitation. The most successful PALS candidates are those who have drilled the pharmacology so thoroughly that the answers come automatically, leaving mental bandwidth free for clinical reasoning and team leadership during the scenario-based stations. With disciplined preparation and consistent practice, you are fully capable of achieving a strong score on your PALS pharmacology exam and building the clinical skills to match.