DOWNERS

Question 1

Nitroglycerine (NTG)

Answer 1

-IV infusion: 5 mcg/min initial, titrate by 10 mcg/min to max of 200 mcg/min Q5 min; Push dose 10-20mcg at a time.
o Concentration: 50mg in 250 mL NS = 200 mcg/mL
o Onset: 1-2 minutes; 5 min duration
o ½ Life: 3 minutes
o C/I: avoid with 24 hour PDE inhibitors(sildenafil)
o Precautions: tolerance avoided with 12 hour nitrate-free period; may cause methemoglobinemia at high doses; diminish plt aggregation/antagonize heparin;

Question 2

Hydralazine

Answer 2

-Adult: 5-20 mg IV Q4H
-Peds: 0.1-0.2 mg/kg Q4H
-Pregnancy induced HTN Dose: 5-10 mg IV Q30min
o Concentration: 20mg/mL
o Onset: 5-20 minutes IV (slow onset!); duration 2-6 hours
o ½ Life: 3-7 hours
Action: indicated for HTN, PIH, CHF; maintains renal and splanchnic BF, use if HR low
o Precautions: potent cerebral vasodilator (high ICP)

Question 3

Phentolamine (Regitine)

Answer 3

-Adult dose (HTN then extravasation): 1-5 mg IV
-Peds dose (HTN then extravasation): 0.05-0.1 mg/kg IV (max 5 mg)
o Concentration: 5-10 mg in 10 mL NS
o Onset: 2 minutes; 10 min duration
o ½ Life: 19 minutes
o Action: HTN from pheochromocytoma; alpha adrenergic extravasation

Question 4

Esmolol

Answer 4

-Adult/peds infusion: 0.5 mg/kg load; 50-300 mcg/kg/min infusion
-Push dose: 5-10 mg at a time
o Concentration: 2,500 mg in 250 mL = 10 mg/mL, titrate to effect
o Onset: 1 minute; 5 minute duration
o ½ Life: 9 minutes

Question 5

Labetalol

Answer 5

-Adult IV push: 5-20 mg Q10 min (max 300 mg)
-Infusion: 2-150 mg/hr
o Concentration: 5mg/mL
o Onset: 1-2 minutes; duration 2-4 hours
o ½ Life: 5.5 hours
o C/I: Avoid in CHF
o Precautions: Crosses placenta, no effect on uterine BF

Question 6

Metoprolol

Answer 6

o Dose Range: 2.5-5 mg IV q2 min (up to 15 mg)
o Concentration: 1mg/mL
o Onset: 1-5 minutes; peak at 20 minutes
o ½ Life: 3-4 hours (DOA)
Action: indicated for HTN, acute MI, angina, stable CHF; tachyarrhythmias, hypertrophic cardiomyopathy, hyperthyroid
o Precautions: Crosses placenta and BBB

Question 7

Cardizem

Answer 7

-IV infusion: 2.5-25 mg load; 2-15 mg/hr infusion
o Concentration: 100mg in 100mL = 1mg/mL
o Onset: 2-3 minutes; 1-10 hour duration with infusion
o ½ Life: 4 hours
o C/I: WBW accessory pathway (doesn’t work). People with WPW syndrome have an extra electrical pathway between the atria and the ventricles, known as an “accessory pathway.” This abnormal pathway directly connects the atria and ventricles at a site other than the AV node
o Precautions: don’t use infusion over 24 hours; caution with BB and wide QRS complexes of unknown etiology and short PR intervals

Question 8

Nicardipine

Answer 8

-IV infusion: 5-15 mg/hr; start at 5 and titrate Q5 min)
o Concentration: 20mg in 200mL = 0.1 mg/mL
o Onset: 1-3 minutes; 10-30 min duration
o ½ Life: 2 min-14 hours depending on infusion time
o C/I: advanced aortic stenosis, decompensated HF