Cardiac Drugs Flashcards
Diltiazem) 1st dose:
2nd dose:
= 0.25 mg/kg (max dose 20 mg)
= 0.35 mg/kg (max dose 25 mg)
Dobutamine) adult dose:
PEDI dose:
= 2-20mcg/kg/min- titrate so HR cant rise>10% baseline (pt HR arrival)
= 2-20mcg/kg/min
Dopamine) Dosing:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:
= 2–20 mcg/kg/min Titrate to patients response
= 5-10mcg/kg/min
= 10-20 mcg/kg/min
Dopamine) Cardiac dose:
Vasopressor dose:
= 5-10mcg/kg/min
= 10-20 mcg/kg/min
Epi 1:10,000) Admin via:
(Adult) Cardiac Arrest dose:
(Adult) Bradycardia dose:
(PEDI) Bradycardia/Cardiac Arrest dose:
(PEDI) Hypoperfusion & Severe anaphylaxis dose:
= IV infusion drip
= 1mg IVP/IOP every 3-5 mins
= 2-10 mcg/min IV/IO infusion
= 0.01 mg/kg or 0.1 mL/kg
= 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag
Lidocaine) Max dose:
Cardiac Arrest from VF/pVT dose:
Refractory VF dose:
Perfusing Arrhythmia dose:
Maintenance Infusion dose:
= 3 mg/kg
= 1-1.5 mg/kg IV/IO
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= 1-4mg/min (30-50 mcg/kg/min)
Lidocaine) Max dose:
Cardiac Arrest from VF/pVT dose:
Refractory VF dose:
Maintenance dose
= 3 mg/kg
= 1-1.5 mg/kg IV/IO
= additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= 1-4mg/min (30-50 mcg/kg/min)
Lidocaine) Max dose:
Perfusing Arrhythmia dose:
Maintenance Infusion dose:
= 3 mg/kg
= 1-1.5 mg/kg IV/IO
= 1-4mg/min (30-50 mcg/kg/min)
Morphine) Analgesia:
STEMI:
NSTEMI-ACS:
= 2-10 mg up to max 20 mg.
= 2-4mg slow IV/O, may admin 2nd dose 2-8mg IV/IO q5-15 mins
= 0.1 mg/kg slow IV/IO or IM up to 10 mg
- Cardiac Pharmacology)
- NA Channel Blockers:
- Beta-Blockers:
- Potassium Channel Blockers:
- Calcium Channel Blockers:
- Miscellaneous:
1= (Vaugh-Will) Classes: 1]Na, 2]Beta, 3]K, 4]Ca, Misc] Adenosine
2= (Procainamide & Lidocaine) both Widened QRS & Prolongs QT
3= (Propranolol) Prolonged PRI & Bradycardias
4= (Amiodarone) Prolonged QT
5= (Diltiazem & Verapamil) Prolonged QT & Bradycardias
6= (Adenosine & Digoxin) Prolonged QT & Bradycardias
1st line IV med in cardiac arrest
Epi
1st line med in cardiac arrest
oxygen
Acetaminophen)
= IV/IO: 1 gram over 10 - 15 minutes, PO: 15 mg/kg
Adenosine & Digoxin class & indication
class misc> Adenosine 1st line med for stable narrow complex SVT,
Regular & monomorphic wide-complex tachyC thought to be from a reentry SVT (SVT w/ BBB) Does not convert A-fib/flutter
Adenosine) indications:
contraindications
= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB)
= Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER
Adenosine) class:
Dynamics:
= Misc antiarrhythmic binds to adenosine A1 receptors causes efflux of K & inhibits Ca influx (in autoarhythmic cells)
= Causes hyperpolarization of autorhythmic cells (SA/AV node)
Slows AV conduction w/ very short half-life
Adenosine) Effects:
Dose:
admin notes:
= periods of sinus Bcardia/asystole & ventricular ectopy after admin
= 1st dose 6mg rapid IV/IO push followed w/ rapid flush &2nd dose 12mg also rapid push & flush
= rapid push followed by rapid flush 20mL fluid best accomplished w/ 3-way stopcock & 1/2 initial dose in PTs receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access
AFib RVR unstable:
120-200j cardioversion
AFib w/ RVR, AF, MAT, JTn Rx:
1st line med:
2nd line med:
IV beta blockers:
Unstable AFib w/ RVR:
Unstable AFl:
= stable meds
= Diltiazem Ca blocker wait 15mins-
= Verapamil Ca blocker wait 2 mins (3mins older PT)
= Labetalol
= 120J-200J, 300J, 360J
= cardiovert 50-100J, 200J, 300J, 360J
Amiodarone class & indication
Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse
Amiodarone)arrhythmias) 1st dose=
2nd dose=
1st dosage —> 300mg IV/IO push
2nd dosage—> 150mg IV/IO push if needed
Amiodarone) Max total dose per day:
Slow Infusion dose:
Maintenance Infusion dose:
VF/Pulseless & VT Cardiac Arrest Unresponsive 1st Dosage:
VF/Pulseless & VT Cardiac Arrest Unresponsive 2nd Dosage:
Life-Threatening Arrhythmia 1st Dosage:
Life-Threatening Arrhythmia 2nd Dosage:
= 2.2 grams
= 360 mg IV 6Hrs (1mg/min)
= 540 mg IV 18Hrs (0.5 mg/min)
= 300 mg IV/O push
= 150 mg IV/O push if needed
= 1st Dose: Rapid Infusion 150 mg/10 mins (15 mg/min)
= 2nd Dose: 150mg/10 mins (15 mg/min) if needed
Amiodarone) Max total dose per day:
VF/Pulseless & VT Cardiac Arrest Unresponsive 1st Dosage:
VF/Pulseless & VT Cardiac Arrest Unresponsive 2nd Dosage:
Post ROSC/Slow Infusion dose:
= 2.2 grams
= 300 mg IV/O push
= 150 mg IV/O push if needed
= 360 mg IV 6Hrs (1mg/min)/ 540 mg IV 18Hrs (0.5 mg/min)
Amiodarone) Max total dose per day:
Slow Infusion dose:
Maintenance Infusion dose:
= 2.2 grams
= 360 mg IV 6Hrs (1mg/min)
= 540 mg IV 18Hrs (0.5 mg/min)
Amiodarone) Class:
Dynamics:
Indi:
B/c its toxicity indi:
W/ expert consultation may be used for:
Terminal elimination:
= Class III antiarrhythmic
= Slows K+ efflux delaying repolarization on all of heart
= VF/Pulseless VT-no/response to shock CPR & Epi, Recurrent hemodynamically unstable VT w/ pulse
= PT w/ life-threatening arrhythmias w/ monitoring
= some atrial & ventricular rhythms w/ life-threatening hypoBP
= Extremely long (half-life lasts max 40 days)
Amiodarone) Contra:
Effects:
Caution b/c:
= Allergic, Bradycardias w/ AV blocks, Breastfeeding mothers
= Severe hypotension, Bradycardia, Prolong QT which can lead to TdP
= Toxicity, Causes severe BP drop, Prolong QT which can lead to TdP
Aspirin) dose
=160-325 mg PO of nonenteric coated ASA.
Aspirin) indications:
Contraindications:
= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema
Aspirin) effects:
Avoid:
dose:
=Can cause bromchoconstriction in ~10% asthmatic PTs, N/V, upset GI
= enteric-coated Aspirin when admin/ing to PT w/ cardiac S/S
= 160-325mg PO of non-entric coated ASA
Aspirin) Class:
Dynamics:
= NSAID & COX inhibiter
= Blocks cyclooxygenase (enzyme that’s basically alarm bell for body)
COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot
Atrial-Fib Treatment)Symptomatic & unstable:
Symptomatic & stable:
= Go to the Cables! (Cardioversion@ 120-200J)
= Ca Channel Blocker (Diltiazem & Verapamil) or Beta-Blocker (Labetalol & Metoprolol)
Atropine) class:
Dynamics:
= parasympatholytic
= selectively blocks muscarinic receptors inhibiting the parasympathetic NS “Vagus N. Blocker”- letting sympathetic take over
Atropine) indications:
Contraindications:
Avoid:
= 1st med/ for symptomatic sinus Bcardia, Maybe beneficial AV block, Organophosphate poisoning (large dose r/q) hypothermic Bcardia
= Allergic to drug, Use w/ extreme caution w/ myocardial ischemia
= causes increased myocardial O2 demand so caution w/ Hblock & Doses <0.5mg may result in paradoxical slowing of the heart
May not be effective for infranodal blocks- be prepared to pace
Atropine) Adverse effects:
Bradycardia (w/ or w/o ACS) Dosage:
severe clinical conditions dosage:
organophosphate poisoning dosage:
= Blurred vision, Dry mouth, Dilated pupils, Confusion
=1 mg IV push every 3-5mins as needed (0.04mg/Kg (total 3mg)
=1 mg IVP every 3 mins
= 2-4mg (or higher) IVP
Atropine) Bradycardia (w/ or w/o ACS) dose:
Severe dose:
Organophosphate poisoning:
=1 mg IVP 3-5mins as needed (Don’t exceed 0.04mg/Kg (total 3mg))
=1mg IVP (3mins) in severe clinical conditions
=2-4mg (or higher) IVP
Calcium Chloride) class:
Dynamics:
= mineral & electrolyte
= role as electrolyte in body to help propagate nerve impulses & M. Contraction
Calcium Chloride) indications:
Contraindications:
= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem
= cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD
Calcium Chloride) effects:
Dose:
Hypotension following admin/ Diltiazem:
= Bcardia w/ rapid injection, May produce severe coronary spasm & asystole, Burning sensation @ site of admin/, PERCIPITATE w/ Na-Bicarb
= 0.5-1gram slow IV over 3-5mins
= 250-500mg
Cardioversion (synchronized) for:
= Tachyarrhythmias w/ pulse unstable} AFib, AF, ASVT, PSVT, SVT, VT w/ pulse
Cardioversion for:
higher start:
lower start:
= VT, SVT, ASVT, PSVT, too fast HR “convert down”
= ST>100J, 200J, 300J, 360J
= ASVT, PSVT, SVT> 50-100J (AF w/ RVR 120-200J)
Cardiovert is for:
“conVERT to normal” too fast
Defib for:
amounts:
= ventricle arrhythmias: VFib, Pulseless VT, TdP
= 120-200 joules for biphasic defibrillators & 300-360 joules for monophasic
Diltiazem/Cardizem)class:
pharmacodynamics:
= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels
Diltiazem/Cardizem)indi/s:
Contraindications:
= 1st med for AFib/Flutter w/ RVR (>150bpm), 2nd med for SVT refractory to Adenosine
= hypoBP, CHF/cardio/shock, Wide-complex Tcardia, WPW, Hypersensitivity
Diltiazem/Cardizem)effects:
= HypoBP, Pos/ CHF if used w/ beta-blockers , N/V/D, Dizziness, H/A
Diltiazem) 1st dose:
2nd dose:
= 0.25mg/kg w/ max dose of 20mg
= 0.35 mg/kg w/ max dose of 25mg
Dobutamine) class:
Dynamics:
= synthetic sympathetic agonist
= A&B agonist w/ inotropic prop/s > Chronotropic prop/s
Dobutamine)indi:
Contras:
= cardiac pump prob/s (CHF) w/ hypotension “baby Dope”
= hypovolemia til’ fluid replacing, DONT MIX W/ Sodium Bicarb
Dobutamine) effects:
dose:
= Hypertension, H/A, Dizziness, Can worsen cardiac ischemia, tissue necrosis w/ Extravasation
= 2-20mcg/kg/min- titrate so heart rate doesn’t increase by >10% of baseline
Dobutamine) dose:
=2-20mcg/kg/min- titrate so HR doesn’t increase by >10% of baseline
Dopamine) class:
pharmacodynamics
= sympathetic agonist
= A/B agonist rate dependent vasopressor +chron/in/Drom/otropic
Dopamine) indications:
Contraindications:
= CHF, HypoBP w/ shock signs, 2nd med for sympathetic Bcardia (after Atropine)
= hypovolemic PTs til’ vol/ replaced, pheochromocytoma, Dont mix w/ sodium bicarb
Dopamine) Effects:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:
= HyperBP, Palp/s, H/A, Dizzy, Can worsen C-ischemia, necrosis W/ Extravasation
= 5-10mcg/kg/min
= 10-20 mcg/kg/min
Dopamine) dose:
=5-20mcg/kg/min & Titrate to PT response (DONT OPEN “WIDE OPEN”)
Epinephrine 1:10,000) Class:
Dynamics:
= SNS agonist, Sympathomimetic
= Powerful Alpha and Beta agonist
Epinephrine 1:10,000) Effects:
Admin via:
(Adult) Cardiac Arrest dose:
(Adult) Bradycardia dose:
(PEDI) Bradycardia/Cardiac Arrest dose:
(PEDI) Hypoperfusion & Severe anaphylaxis dose:
= Palpitations, Anxiety, Jitters, H/A, Dizziness, HyperBP, Tcardia, Can worsen cardiac ischemia
= IV infusion drip
= 1mg IVP/IOP every 3-5 mins
= 2-10 mcg/min IV/IO infusion
= 0.01 mg/kg or 0.1 mL/kg
= 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag
Epinephrine 1:10,000) Indications:
Contraindications:
= Cardiac arrest, Bcardia, Normovolemic hypoBP, Anaphylaxis, Asthma
= rewards over risks so really none
Epinephrine 1:10,000): Cardiac arrest:
Bradycardia dose:
Normovolemic hypotension & severe anaphylaxis:
=1mg IVP/IOP every 3-5mins
=2-10mcg/min IV/IO infusion (0.002-
=2-10mcg per min—> mix 1mg of Epi 1:10,000 into a 1 liter bag of fluid
Labetalol) class:
pharmacodynamics:
= beta-blocker
= Blocks adrenergic stim/ on B-receptors, causing a slowing of HR
Labetalol) Indications:
Contraindications:
Do not administer to PTs w/ STEMI if following present:
= 2nd med/ for SVT after admin/ Adenosine, A-Fib/Flutter w/ RVR Reduce myocardial ischemia in AMI PTs w/ +HRs, Antihypertensive
= Increased risk of cardiogenic shock Hypotension Bradycardia
= signs of heart failure Low cardiac output
Labetalol) Adverse Effects:
Max dose:
Adult Dose:
= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF
= 150mg
= 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose
Labetalol):
10mg IV/IO push over 1-2mins & May repeat every 10mins to a max dose of 150mg
Lidocaine) Class:
Dynamics:
= Ib Antiarrhythmic
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity in ventricles
Lidocaine) Ind:
Contra:
Effects:
= Stable monomorphic VT w/ preserved LVF & Alternative to Amiodarone in cardiac arrest by VF/pVT
= Shouldn’t use if PT already received IV Ca channel blockers, Not given prophylactically in AMI setting
= Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
Lidocaine) Refractory VF dose:
Perfusing Arrhythmia dose:
Maintenance Infusion dose:
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= 1-4mg/min (30-50 mcg/kg/min)
Lidocaine): Cardiac arrest from VF/pVT:
Perfusing Arrhythmia:
Maintenance Infusion:
=1-1.5mg/kg IV/IO
For refractory VF, may give additional 0.5-0.75mg/kg IV/IO in 5-10mins→ max dose is 3mg/kg
=1-1.5mg/kg IV/IO
For refractory VF, may give additional 0.5-0.75mg/kg IV/IO in 5-10mins→ max dose is 3mg/kg
=1-4mg/min (30-50mcg/kg/min)
“Lol”
Beta-Blockers
MONA):
M:
O:
N:
A:
= Morphine, Oxygen 94-98%, Nitro, Aspirin
= Morphine: never
= Oxy: maybe
= Nitro maybe: 2nd w/ MI if not contra (decrease afterload)
= Aspirin: maybe (most important) should always 1st line
Morphine) class
pharmacodynamics
= narcotic (schedule II Opioid)
= Analgesia & sedation through binding to opiate receptor
Morphine) indications:
Contraindications:
= Ischemic chest pain not relieved by Nitro
= Known hypersensitivity to drug Uncorrected hypoBP (SBP<90)
Morphine): STEMI:
NSTEMI-ACS:
= 2-4mg IV/IO (slow); may give + doses of 2-8mg IV at 5-15min intervals
=0.1mg/kg IV/IO (slow) or IM up to 10mg
Nitroglycerin) class:
pharmacodynamics:
= nitrate
= Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
Nitroglycerin) indications:
Contraindications
= Symptoms suggestive of Myocardial ischemia CHF
= HypoBP (SBP<90 or >30 below baseline BP) Severe Bcardia<50bpm, Tcardia>100bpm, Use of phosphodiesterase inhibitors (Boner pills) in last 48 hours, Increased ICP
Nitroglycerin) effects:
dose:
=H/A, Dizziness, Weakness, Tcardia, HypoBP (tablets lose effectiveness after exposed to sun/air)
= 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg
DONT SHAKE SPRAY B/C AFFECTS DOSE
NORepi) Class:
dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med”
= A/B-adrenergic agonist (A effects > B effects)
NORepi) Indi:
Contra:
Effects:
= Normovolemic hypotension, Septic shock, Cardiogenic shock
= hypovolemia PTs til’ Vol/replacement occurred
= Hypertension, Organ ischemia, Cardiac arrhythmia, Tissue necrosis w/ extravasation, Palpitations, Anxiety, N/V
NORepi) Adult Dose:
Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion
= 0.1–2 mcg/kg/min IV/IO infusion
Nubain) Dose:
= 10-20 mg IV/IO/SQ/IM
Ondansetron (Zophran):
= 4-8mg IV (slow), IM, PO
Ondansetron) class:
pharmacodynamics:
= selective Seratonin 5-HT3 receptor blocker/antagonist
= Serotonin 5-HT3 receptors @the vagal-N. Can initiate the gag reflex when stim/ed; Zofran is antiemetic/antag/ of 5-HT3 receptors inhibiting serotonin release on central/peripheral vagal nerve
Ondansetron) indi/s:
Contra:
= Prevent/control N/B
= hypersensitivity & prolong QT
Ondansetron)effect:
dose:
= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT
= 4-8mg IV (slow), IM, PO
Oxy freeradicals affect what most:
Definition:
= Neurons & cardio myocytes the most killing them
= apopcytosis cell suicide
Pacing is for:
“picking up the pace” too slow
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
Procainamide) max dose:
Recurrent VF/VT:
Urgent situations:
Maintenance Infusion:
= 17mg/kg) or 4 ending points
= 20mg/min (max total dose: 17mg/kg)
= up to 50mg/min may admin/ to total dose (max 17mg/kg)
= 1-4mg/min
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
= 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose 20mg/min (max total dose: 17mg/kg)
Procainamide): Recurrent VF/VT:
Maintenance Infusion:
Urgent situationships:
= 20mg/min (max total dose: 17mg/kg)
= 1-4mg/min
= up to 50mg/min may be admin/ to total dose of 17mg/kg
Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol
= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
Sinus Bradycardia med line:
= 1st Atropine ~3x then Dopamine 2nd line (5-10mcg >10 vaso constricts) Epi slow infusion 2-10 mcg if dopamine dont work
Sinus Tach Rx:
Narrow & Wide complex tach Rx:
= has a cause (Fever, Vomiting, Bleeding) treat underlying cause
= S/S acute, Stable meds, Unstable cardiovert/
SVT AV stable Rx:
SVT unstable:
= Vagal fixes 25%, Adenosine push & keep printing ECG > Diltiazem, Verapamil,
= 50-100/200/300/360J, make sure sync b/c monitor picks tallest wave which can be T wave
Sync Cardioversion:
TCP:
Cardioversion
= “defib in sync”
= “Pick up the pace”
= “Convert/ to slower & normal”
TCP dose & check:
= 60-80Ma (80 1st) Mechanical beat w/ every electrical beat & increase by 2Mili-Amps
Thiamine)
= 100 mg IV/IO/IM
Transcutaneous Pacing (TCP) for:
measurement:
= Unstable bradyCs, heart blocks,
= 60-80 milliamps
Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
Verapamil) indications:
Contraindications:
= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function
= HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW, Hypersensitivity
Verapamil)1.May cause:
2. Effects:
= more profound hypotension response than that of Diltiazem
= Severe CHF may result if used w/ beta-blocker, N/V/D, Dizziness, H/A
Verapamil): 1st:
2nd:
Max dose:
=2.5-5mg IV/O bolus /2-3mins
= 5-10mg over 2-3 mins
=20mg
WCT monomorphic VT stable:
WCT monomorphic VT Unstable:
= Procainamide 20-50mg/min until 4 ending points, Amiodarone: Max dose 2.2grams in 24Hrs, Sotalol: 100mg (1.5mg/kg), Lidocaine: 1-1.5mg/kg repeat at ½ dose every 5-10mins max of 3mg/kg
= cardioversion: 100J, 200J, 300J, 360J
Mag-Sulfate) Arrest due to suspected hypomag/Tdp:
Tdp w/ pulse:
Maintenance infusion:
= 1-2grams diluted in 10mL
= 1-2grams mixed in 50-100mL admin/ over 5-60mins
=0.5-1gram per hour
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