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For shock-refractory VF/pulseless VT, evidence-based algorithms support amiodarone 300 mg IV/IO bolus after the second shock and epinephrine administration, followed by a possible additional 150 mg dose if VF/VT persists. The goal is to stabilize myocardial membranes and facilitate defibrillation success while uninterrupted, high-quality CPR remains the cornerstone. Lidocaine is an alternative antiarrhythmic if amiodarone is unavailable, but infusion dosing is inappropriate during cardiac arrest; a bolus (e.g., 1–1.5 mg/kg) would be considered instead. Adenosine treats AV-nodal dependent supraventricular tachycardias, not ventricular fibrillation. Slow amiodarone infusions are used for stable wide-complex tachyarrhythmias, not pulseless rhythms where rapid bolus delivery is indicated. Paramedic pharmacology objectives stress correct indications, dosing, sequence relative to defibrillation and epinephrine, and the importance of minimizing pauses in compressions. Continuous rhythm analysis, attention to reversible causes (H’s and T’s), and prompt defibrillation attempts drive outcomes more than drug choice, but appropriate antiarrhythmic use can improve termination of malignant ventricular rhythms.