Dosages Flashcards
Warfarin
in DVT/PE
0.5-6 mg PO daily
INR has to be 2-3
Heparin (UFH) IV
in ACS
IV Bolus: 60-70 IU/Kg (Max 5,000 IU)
Then 12-15 IU/Kg/h Infusion,
aPTT Q6H (x1.5-2.5)
Heparin (UFH) IV
in DVT/PE (Tx)
IV Bolus: 80 IU/Kg
Then 18 IU/Kg/h Infusion,
aPTT Q6H, x (1.5-2.5)
Heparin (UFH)
in DVT/PE (Prophylaxis)
SC 5,000 IU Q12H or Q8H
Enoxaparin
in ACS
SC 1 mg/kg BID (Max 100 mg BID)
If age>75y then 0.75 mg/kg BID
Enoxaparin
in DVT/PE (Tx)
SC 1 mg/kg BID
Or 1.5 mg/kg Q24H
Enoxaparin
in DVT/PE (Prophylaxis)
SC 30-40 mg Q24H
Clopidogrel (Plavix)
in ACS
Loading dose 300-600 mg
Maintenance 75-150 mg/day
ASA
in ACS vs Stroke
ACS: 160-325 mg
Stroke: 160 mg
Prasugrel
in ACS
Loading dose 60 mg
Then 10 mg/day
Metoprolol IV
in ACS
IV 5 mg over 1-2 min Repeat Q5min,
PO can be started 15 min after IV
Metoprolol PO
in ACS
PO Initial 25-50 mg QID
Target 100 mg BID
Carvedilol
in CHF
Initial 3.125 mg BID
Target 25 mg BID
Labetalol in HTN
Initial 50 mg BID
Usual 200 mg BID
(Alpha1+Beta1 blocker)
Atenolol
Initial 25-50 mg/day
Target 100 mg/day
Do not use in Pregnancy
Nitroglycerin SL
in ACS
SL 0.3-0.6 mg PRN Q5min
Nitroglycerin Spray
in ACS
SL 0.4 mg PRN Q5min
Verapamil
in ACS
Initial 80 mg
Max 160 mg TID
(If IR form: TID, If SR form: BID)
Amlodipine
Initial 2.5 mg/day
Max 10 mg/day Once daily
Nifedipine XL
in HTN or Raynaud’s
Initial 30 mg/day
Usual 60 mg/day
Raynaud’s 30 mg/day
Enalapril
in ACS, CHF, HTN
Initial 2.5 mg BID
Target 10-20 mg BID
Losartan
Initial 50 mg/day
Target 100-150 mg/day
Furosemide PO and IV
PO: Initial 20-80 mg SD If needed: increase by 20-40 mg Q6-8H
IV: 20-40 mg Single injection If needed: may repeat Q2H
Hydrochlorothiazide
Initial 12.5-25 mg/day
Usual 25-100 mg/day
Spironolactone
in CHF
Initial 12.5 mg/day
Target 25-50 mg/day
Atorvastatin
10-80 mg/day At any time of the day
Gemfibrozil
300-1200 mg/day Divided BID 30 min prior to meals
Glyburide
PO 2.5-20 mg/day
If >10 mg, then divide in 2 doses
Metformin (Glucophage)
500-1500 or 2500 mg/day Divided BID or TID
Calcium Gluconate
in Hyperkalemia (ER)
IV 10 ml of a 10% Solution Over 2-5 min
Ferrous Sulfate
in IDA
120 mg/day (105-200 mg/day) elemental iron In 3 divided doses 60 mg elemental iron/ 300 mg Ferrous Sulfate
Asthma Acute Exacerbation
Salbutamol + Ipratropium bromide dosage
pMDI 4-8 puffs Q15-20 min x3 (Both)
Asthma Acute Exacerbation
Oral Prednisone dosage
40-60 mg PO
Asthma Acute Exacerbation
IV Corticosteroids dosage
Methylprednisolone 60-80 mg IV
Or Hydrocortisone 200 mg IV
Asthma Acute Exacerbation in Children
Prednisone Oral dosage
1-2 mg/kg PO
Asthma Acute Exacerbation in Children
IV Corticosteroid dosage
Methylprednisolone 2 mg/kg IV Or Hydrocortisone 5-8 mg/kg
ACLS
Defibrillation in VF or Pulseless VT
360 J Monophasic Or 200 J Biphasic
ACLS
Epinephrine in VF or Pulseless VT
1 mg IV Q3-5 Minutes
ACLS
Amiodarone in VF or Pulseless VT
First dose: 300 mg IV (slowly: within 10 minutes)
Then: 150 mg IV (slowly: within 10 minutes)
ACLS
Vasopressin in VF or Pulseless VT
40 units IV
Can replace 1st or 2nd dose of Epinephrine
ACLS
Mg in Torsades
2-5 gr IV,
(slowly: within 3-5 minutes)
ACLS
VT with Pulse (If Persistent)
- Cardioversion…….?
- Adenosine……?
- 100 J Synchronized
- 1st dose: 6 mg IV 2nd dose: 12 mg IV (Must be regular and monomorphic)
ACLS
VT with Pulse (If Not Persistent) With Narrow QRS
Vagal Maneuver Or Adenosine 6 mg then 12 mg Or Beta blocker Or CCB
ACLS
VT with Pulse (If Not Persistent) With Wide QRS
(No Adenosine) Procainamide 20-50 mg IV slow Or Amiodarone 150 mg IV slow And Consult
ACLS
Asystole or PEA
(Not shockable)
Epinephrine 1 mg + CPR 2 min/5 cycles And repeat Manage 5 Hs and 5 Ts
ACLS
Bradicardia<50 If 2nd or 3rd degree Heart Block
Atropine 0.5 mg Q3-5 Minutes Max 6 doses Or Transcutaneous Pacing Rate 80, Amplitude: Capture+10
ACLS
Bradicardia<50 If 2nd or 3rd degree Heart Block Alternative treatments
Dopamine Infusion 2-10 mcg/kg/min
Or Epinephrine 1 mg Q4-6 Minutes
Status Epilepticus 6-10 minutes
2 large bore IV Saline
Dextrose 50% 50 ml IV
Thiamine 100 mg IM or IV
Lorazepam 2 mg IV, Repeat once
Status Epilepticus 6-10 min (If no IV access)
Midazolam 5 mg IM, repeat once
Or Diazepam pr 20 mg (Either rectal gel or IV Solution)
Status Epilepticus In 11-30 minutes
(Two traditional choices)
First: Phenytoin 20 mg/kg IV
Then: Phenobarbital 20 mg/kg IV
Status Epilepticus In 11-30 minutes
(Two new alternatives)
Midazolam 10 mg IV bolus
Or Propofol 2-5 mg/kg IV bolus
Respiratory Suppression in Opioids overdose:
Naloxone dosage
Adults and Children >5y:
0.4-2 mg Q2-3 Minutes IV
In Children <5y:
0.01 mg/kg Q2-3 Minutes IV
Equivalent Doses of Opioids:
10 mg Morphine IV = ….. mg Morphine PO
60 mg PO
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Fentanyl
0.1 mg Fentanyl IV
(Fentanyl has no Oral form)
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Hydromorphone
2 mg IV
Or 5 mg PO
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Meperidine (Pethidine)
75 mg IV
Or 300 mg PO
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Codein
120 mg IV
Or 200 mg PO
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Oxycodone
10 mg PO
(Oxycodone is only oral)
Gout
Colchicine in Acute Attack
First: 1.2 mg
Then: 0.6 mg 1 h later
Gout
Prednisone in Acute Attack
0.5 mg/kg PO daily For 5 days
Gout
NSAID in Acute Attack
Naproxen 750 mg stat
Then 500 mg BID
Situational Aggression
Haloperidol 5 mg PO or IM + Lorazepam 2 mg PO or IM
Olanzapine IM (Immediate Acting)
2.5-10 mg IM
(Should not be used simultaneously with parenteral BZPs like Lorazepam)
BZPs Dosage Equivalents:
5 mg of Diazepam=
…… Clonazepam
Or …… Chlordiazepoxide
0.25 mg Clonazepam
25 mg Chlordiazepoxide
BZPs Dosage Equivalents:
5 mg of Diazepam=
…… mg Alprazolam
Or …. mg Temazepam
0.5 mg Alprazolam
10 mg Temazepam
BZPs Dosage Equivalents:
5 mg of Diazepam=
….. mg Oxazepam
and …..mg Lorazepam
15 mg Oxazepam
1 mg Lorazepam
Universal Antidotes:
Thiamine dosage
100 mg IV or IM
to all patients Or At least: If hx of EtOH or patient looks malnourished
Universal Antidotes:
Dextrose (Glucose)
One Ampoule D50W IV
If low blood sugar on finger-prick
Universal Antidotes:
Naloxone
0.4-2 mg IV or 0.01 mg/kg IV
If opiate overdose suspected
Severe Migraine (ER):
1 L bolus of NS +
………………. Or …………………
Prochlorperazine 10 mg IV
Or Ketorolac 30 mg IV
Moderate Allergic Reaction (Like generalized urticaria)
Treatments (ER)
- …………
- ………..
- ………..
Epinephrine (1:1,000) 0.3-0.5 mg IM (not IV)
+/- IM Diphenhydramine 25-50 mg
+/- Salbutamol 1 cc via MDI
Severe Allergic Reaction
(Anaphylactic shock)
- ABCs +|- Crystlloids
- Epinephrine…………..
- …………
- ………….
Epinephrine (1:1,000) 0.1-0.3 mg IV (or via ETT)
+ Diphenhydramine 50 mg IV (~1 mg/kg)
+ Hydrocortisone 100 mg IV
(Or Methylprednisolone 1 mg/kg IV)
Acute Heart Failure
- Furosemide …….
- If BP >100 then …….
- If BP < 90 then …….
- F: 40-80 mg IV
- Nitroglycerin: SL or IV Infusion
- Dobutamine IV Infusion (if no shock)
or Dopamine IV Infusion (if shock)
Diabetes:
Hyperosmolar Hyperglycemic State
(Total Water deficit ?)
Rehydration with IV NS (Total Water deficit is 100 ml/kg)
+ O2 + monitoring
(but Insulin is controversial)
Hyponatremia
If Mild to Moderate: Water restriction / NPO
If Seizure or Coma…………
100 cc NaCl 3%
Hypokalemia
K+ diuretics
+/- IV solutions with 20-40 mEq/L KCl (over 3-4h)
Hypocalcemia Tx
Calcium Gluconate 1-2 g IV in 10-20 minutes
Hypertensive Crisis
1………..
or 2……………
or 3……………
Nitroprusside IV
Fenoldopam IV
Enalapril IV
Prednisone dosage
in GCA
40-60 mg daily PO x 4 weeks Then taper
Ranitidine dosage
in Dyspepsia
150 mg BID
Omeprazole dosage
in GERD
20-40 mg Once daily 30 minutes before food
End of Life Care: Morphine
PO: 5-10 mg Q4-6H + PRN
IV/SC: 2.5-5 mg Q4-6H + PRN
Risperidone dosage
In Delirium vs Dementia
Delirium: 0.5-2 mg/day PO
Dementia: 0.25-2 mg/day PO
Risperidone dosage
In Psychosis vs Mania
Psychosis: 2-8 mg/day PO
Mania: 2-3 mg/day PO
Lithium dosage
In Bipolar disorder (Maintenance)
900-2100 mg/day PO Single daily dose preferred,
Guided by serum concentration (Target: 1-1.2 mmol/L)
Temazepam dosage
in Insomnia
15 mg QHS PRN PO
Insomnia Best BZP Agonist + dosage
Zopiclone 3.75 mg QHS PRN PO
Bupropion dosage
in Smoking Cessation
150 mg PO for 3 days Then 150 mg BID PO
Acetaminophen dosage
in Acute Headache (ER)
650-1300 mg Q4H Only 1 or 2 doses
Dihydroergotamine dosage
in Acute Migraine (ER)
1 Spray (0.5 mg) In each nostril
May repeat in 15 minutes
Max 2 gr (4 sprays) per day
Headache in Children:
Acetaminophen dosage
10-15 mg/kg/dose Q4H PO PRN
Headache in Children:
Ibuprofen dosage
5-10 mg/kg/dose Up to 4 times daily
Post Coital Contraception Oral Method
Levonorgestrel (Plan B) 1.5 mg Single dose within 24h
OCPs Yaz
EE 20 ug + Drospirenone 3 mg
Menopause Estrogen (Vaginal)
Premarin Vaginal Cream 0.625 mg
Acetaminophen in Fever (Children)
PO 10-15 mg/kg/dose Q6H or Q8H
Max daily 75mg/kg or 4 gr
Ibuprofen in Fever (Children)
PO 5-10 mg/kg/dose Q6H or Q8H
Max daily 40 mg/kg or 2.4 gr
Cephalexin Adults & Children
PO
A 250-500 mg Q6H
C 6-12 mg/kg/dose Q6H
Ciprofloxacin Adults only
500-750 mg BID
Clindamycin Adults PO & IV
PO 150-300 mg Q6H
IV 450-600 mg QH8
Amoxicillin/ Clavulanate (Clavulin) Adults & Children
A 250-500 mg Q8H
C 40 mg/kg/day, divided Q8H
Vancomycin IV Adults & Children
IV
A 1 gr Q12H
C 10 mg/kg/dose Q6H
Cefazolin IV Adults and Children
IV
A 1 gr Q8H
C 50-100 mg/kg/day, divided Q8H
Amoxicillin in Strep Sore Throat
Adults & Children
50 mg/kg Once daily
or divided BID x10 days
Max 1 g/day
Azithromycin in Strep Sore Throat
Adults
500 mg x1 day Then 250 mg x4 days Once daily
Children
12 mg/kg x1 day Max 500mg/day Then 6 mg/kg x4 days
Max 250mg/day
SMX/TMP in Cystitis
800/160 mg BID PO (2 Regular Strength tablets Or 1 DS tablet BID)
Nitrofurantoin in Cystitis (Sulfa Allergic)
100 mg BID PO
Ciprofloxacin in Mild to Moderate Pyelonephritis
250-500 mg BID
Gentamicin +|- Ampicillin in Severe Pyelonephritis
G: 3-5 mg/kg/day IV
A: 1 g Q6H IV
Pyelonephritis in Pregnancy
Ceftriaxone 1 g Q24H IM or IV
Acute Sinusitis First Line Tx in Children & Adults
Amoxicillin
Children: 40 mg/kg/day x 10 days Divided TID PO
Adults 500 mg - 1 g TID x 5-7 days
Acute Sinusitis If Amoxicillin fails (Children)
Amoxicillin/Clavulanate x 10 days (7:1)
Children: 45 mg/kg/day (Amoxi Component) Divided BId-TID
Acute Sinusitis If Penicillin Allergic (Adults)
Adults
Doxycycline x 5-7 days 200 mg PO once Then 100 mg BID
Acute Sinusitis If Amoxicillin Fails (Adults)
Amoxicillin/Clavulanate x 5-10 days
Adults: 875 mg BID PO
Chronic Sinusitis in Children & Adults
Amoxicillin/Clavulanate X 3 weeks
Ch: 45 mg/kg/day divided TID
Ad: 875 mg BID
Chronic Sinusitis
If Betalactam Allergic Children & Adults
Clindamycin x 3 weeks
Ch: 20-30 mg/kg/day divided TID or QID
Ad: 300 mg QID PO
Otitis Media in Children First Line
Amoxicillin HD:
75-90 mg/kg/day Divided BID or TID
x10 days if <2y
x5 days if >2y
Otitis Media in Children Second Line
Amoxicillin/Clavulanate HD: 75-90 mg/kg/day amoxicillin Divided BID or TID
Otitis Media in Children If frequent bouts
Amoxicillin/Clavulanate
HD: 75-90 mg/kg/day amoxicillin Divided BID or TID
Otitis Media in Children If Penicillin Allergic
Azithromycin (if anaphylaxis) Or Cefuroxim (if rash)
Az: Day 1: 10 mg/kg Once daily Day 2-5: 5 mg/kg Once daily
Cef: 30 mg/kg/day divided BID
Azithromycin in Children 5-day treatment vs 3-day treatment
5-day: Day 1: 10 mg/kg once daily Day 2-5: 5 mg/kg once daily
3-day: 10 mg/kg Once daily for 3 days
Bacterial Meningitis in Adults
Vancomycin + Ceftriaxone
Vancomycin: 15-20 mg/kg Q8-12H
Ceftriaxone: 2 gr Q12-24H
Bacterial Meningitis Post-Exposure Prophylaxis Hemophilus vs Meningococcus
H: Rifampin 20 mg/kg once daily x4 days
M: Rifampin 5-10 mg/kg Q12H x2 days
Cefotaxime in CAP (adults)
1-2 g Q8H IV X 5-10 days
Ceftriaxone in CAP (adults)
1-2 g Q24H IV X 5-10 days
Levofloxacin in CAP (adults)
Oral: 500 mg Q24H x10 days Or 750 mg Q24H x5 days IV: 500 mg once daily
Azithromycin in CAP
Oral: 500 mg 1st day Then 250 mg x4 days
Or 500 mg daily x3 days
Croup First Line Treatment
Dexamethasone 0.2-0.6 mg/kg
PO/IM/IV Single dose
Endocarditis Oral Prophylaxis in Children and Adults
Amoxicillin PO
Children: 50 mg/kg
Adults: 2 g
Endocarditis
Parenteral Prophylaxis in Children and Adults
Ampicillin
Children: 50 mg/kg IV or IM
Adults: 2 g IV or IM
Endocarditis
Oral Prophylaxis in Children and Adults
if Penicillin Allergic
Cephalexin
Children: 50 mg/kg
Adults: 2 g
Endocarditis
Parenteral Prophylaxis in Children and Adults
if Penicillin Allergic
Cefazolin
Children 50 mg/kg IM or IV
Adults 1 g IM or IV
Metronidazole in C.Difficile
PO 500 mg TID x 10-14 days + S.Boulardii
Vancomycin in Severe C. Difficile
PO 125 mg QID x10-14 days
Ciprofloxacin in Travellers Diarrhea
PO 500 mg BID x3 days
Or 750 mg Single dose
H Pylori Eradication Standard triple therapy
PPI BID
Clarithromycin 500 mg BID
Amoxicillin 1 gr BID
x 10-14 days
Trichomoniasis Treatment
Metronidazole 2 g PO Single Dose
Or 500 mg BID PO x7 days (Safe in Pregnancy)
Bacterial Vaginosis Treatment
Metronidazole
Preferred dose: 500 mg BID PO x7 days
Alternative dose: 2 g PO Single Dose
Vulvovaginal Candidiasis Treatment (Uncomplicated)
Clotrimazole 200 mg Vaginal Tablet 1 tab daily PV x3 days
Or 500 mg Vaginal Tablet 1 tab PV Single Dose
Or Fluconazole 150 mg PO x Single Dose
Chlamydia Infection Treatment
Azithromycin 1 g PO Single Dose
Gonorrhea Infection
Ceftriaxone 250 mg IM Single Dose
