Drugs Flashcards
GTN infusion
10 mcg/minute
Amiodarone
5mg/kg child.
300mg IV bolus
900mg IVI over 24 hours
Dobutamine
2.5 - 15mcg/kg/min IVI (typical 100-200mcg/min)
Lignocaine
1mg/kg IV bolus (75-100mg) over 1-2 minutes
Infusion 4mg/minute if successful for one hour then
1-3mg/min IVI
Sodium nitroprusside
0.3 mcg/kg/minute IVI max 10mcg/kg/min
Esmolol
500 mcg/kg/min IV over one minute (bolus)
50 - 200 mcg/kg/min IV infusion
Labetalol
2-4mg/min until BP in target range, then 5-20mg/hour
Isoprenaline
1-4mcg/min max 30mcg/min
10-20mcg bolus
Adrenaline or Noradrenaline
10mcg bolus
1-4mcg/min (0.05 - 0.1mcg/kg/min) max 100
Metaraminol
0.5 - 1 mg bolus every 2-5 minutes
Vasopressin
0.6 units/hour
Fentanyl
Induction 2-10mcg/kg
Sedation 1-4mcg/kg IV
Ketamine
Induction 2-4mg/kg IV
Sedation 1-2mg/kg IV or 2-4mg/kg IM
Propofol
Induction 2mg/kg IV
Sedation 0.5-1mg/kg
Rocuronium
1.2mg/kg IV
Suxamethonium
1-2mg/kg IV
Atropine
600mcg (20mcg/kg) bolus
Calcium
Child 0.5mL/kg (50mg/kg)
adult 10mL of 10%
Sodium bicarbonate
1mmol/kg
Hyperkalaemia
10U actrapid + 50mL of 50% glucose
Nebulised salbutamol 10-20mg
Calcium 10mL of 10%
Procainamide
20-50mg/minute slow push until
- hypotension
- widening of QRS
- improvement in rhythm
- or max 17mg/kg (1.2g for 70kg adult)
Rapid AF
- DCCV 100J if unstable
- Metoprolol PO 25-50mg or IV 2.5 - 5mg
- Verapamil IV 2.5-10mg (avoid if heart failure/hypotension)
If unable to cardiovert and has heart failure, give
- amiodarone 300mg IV over 30-60mins
RHYTHM control
- can use flecainide if normal LV function and no coronary artery disease 1.5-2mg/kg IV (150mg) over 10minutes
SVT (AVNRT or AVRT with orthodromic conduction)
- Vagal manouevres
- DCCV if unstable
- Adenosine 6/12/18mg IV push with 30ml flush
- 0.1mg/kg in child - Verapamil 2.5-10mg IV slow push (contraindicated in heart failure or hypotension)
- Metoprolol 2.5 - 5mg max 15mg
AVRT with antidromic conduction
OR
AF with WPW
- DCCV if unstable or if unsure (could be VT)
2. Procainamide 20-50mg/min until max 17mg/kg
Pantoprazole
IV bolus 80mg then
Infusion 8mg/hour
Octreotide
For suspected variceal bleeding
50mcg bolus
then
50mcg/hour infusion
IVABx for Infective Endocarditis
- Benzylpenicillin 1.8q q4h IV
PLUS
- Flucloxacillin 2g IV q4h
PLUS
- Gentamicin 5-7mg/kg load
REPLACE
Benpen with Vancomycin if MRSA suspected
IVABx for cholangitis
Gentamicin
PLUS
Amoxicillin/ampicillin 2g IV q6h
for patients with chronic biliary obstruction, add
Metronidazole 500mg IV bd
(+ early biliary tract decompression - ERCP/MRCP/surgery)
ABx for Clostridium Difficile infection
MILD
Metronidazole 400mg PO q8h for 10 days
OR
Vancomycin 125mg PO q6h for 10 days
NB - ORAL
Spontaneous Bacterial Peritonitis Rx
Ceftriaxone 2g IV daily
May require albumin 20% 7.5mL/kg within 6 hours of diagnosis and 5mL/kg IV as a single dose on day 3 if impaired renal function or jaundice, due to high risk of developing hepatorenal syndrome
PREVENTION = trimethoprim + sulfamethoxazole 160+800mg daily
Rx Meningitis
For adults and children 2 months or older
- Ceftriaxone 50mg/kg (2g) IV bd
PLUS
- dexamethasone 0.15mg/kg (10mg) IV q6h, preferably starting before or with the first dose of antibiotics
If Listeria is suspected (age > 50, immunocompromised, pregnant or debilitated, alcoholics) ADD
- benpen 60mg/kg (2.4g) IV q4h
If HSV suspected
- aciclovir 10mg/kg IV q8h
IVABx necrotising fasciitis
- Benzylpenicillin 1.8g q4h (2.4g if requiring ICU)
PLUS EITHER
- Clindamycin 600mg q8h
OR - Lincomycin 600mg IV q8h
PLUS
- IVIG 2g/kg IV as a single dose ASAP, but not later than 72 hours
PID Empiric treatment
NON SEVERE
- Ceftriaxone 500mg in 2mL 1% lignocaine IM or 500mg IV stat
+ Metronidazole 400mg PO bd for 14/7
+ either
Doxycycline 100mg PO bd for 14/7
or
Azithromycin 1g PO stat, repeated 1 week later
SEVERE
- Ceftriaxone 2g IV daily
+ Azithromycin 500mg IV daily
+ Metronidazole 500mg IV bd
Thrombolysis for Stroke, PE
Alteplase
PE = 100mg over 2 hours (10% bolus can be given up front)
CVA = 0.9mg/kg (max 90mg) over 60mins (give 10% as a bolus over one minute)
Care of the Dying drugs
Pain
- fentanyl 25mcg subcut q4h
Agitation
- Haloperidol 0.5-1mg subcut q4h
- midazolam 2.5mg subcut q1h
Nausea
- ondansetron 4-8mg subling q8h
- haloperidol 0.5-1mg subcut q4h
Secretions
- glycopyrrolate 0.1-0.2mg subcut q4h
Thyroid Storm
Propranolol 60-80mg PO q4h or 0.5mg IV aliquots
Propylthiouracil (PTU) 500-1000mg load, then 250mg q4h
(Inhibition of thyroid hormone synthesis)
Lugol’s iodine 5-7 drops PO tds
(inhibition of thyroid hormone release)
Hydrocortisone 300mg IV then 100mg tds
(inhibit T3->T4 conversion, treat adrenal insufficiency)
or
Dexamethason 2-4mg IV qid
Consider diazepam for anxiolysis
Midazolam for status epilepticus
- 2-0.3mg/kg (5-10mg) buccal/intranasal x 2
- 15mg/kg IV/IO
- 2mg/kg IM
Sodium valproate
40mg/kg IV load (max 3g)
Levetiracetam
10-20mg/kg IV
Phenytoin
20mg/kg IV load
Phenobarbitone
20mg/kg IV load max rate 60mg/min
Nimodipine
60mg PO q4h
to prevent vasoconstriction in SAH
Pre-term labour drugs
- Antenatal corticosteroids
- < 35 weeks gestation
- betamethasone 11.4mg IM then second dose in 24 hours - Tocolysis
- nifedipine 20mg PO
- repeat for a total of 3 doses 30mins apart if contractions persist
- maintenance therapy = 20mg q6h for 48 hours - Antibiotics
- GBS prophylaxis if established labour, regardless of status
- if chorioamnionitis present, give
ampicillin 2g IV
+ gentamicin 5mg/kg IV
+ metronidazole 500mg IV - Neuroprotection
- gestational age 24-30 weeks
- magnesium sulfate 4g loading bolus IV over 20mins
- maintenance 1g/hr for 24 hours or until birth
Post partum Haemorrhage
Supportive/resuscitative care TXA 1g over 10 minutes Uterine massage Oxytocin 5 units IV then 10 units/hr Empty bladder Bimanual compression Uterine balloon tamponade OT
Pre-eclampsia
Target SBP 140-160mmHg and DBP 90-100mmHg
- labetalol 20-50mg IV
- hydralazine 5-10mg IV
- nifedipine 10-20mg PO
Eclampsia
Magnesium sulfate
- 4g IV over 10-15 minutes
- infusion 1-2g/h continued for 24 hours after the last seizure
Diazepam up to 10mg IV when magnesium not immediately available
Repeat magnesium 2-4g IV over 10mins if second seizure
HTN treatment as for pre-eclampsia
Delivery
Modified Parkland Formula
3-4mLs x TBSA % burn x weight (kg) = total in first 24 hours
- 1/2 in first 8 hours since injury
- 1/2 in second 16 hours since injury
- Hartmann’s
- add maintenance fluid in kids
Mannitol
0.25 - 1g/kg
Hypertonic saline
3mL/kg of 3% over 10 minutes
Dabigatran reversal
Idarucizumab 5g IV over 10-20 minutes
FFP
Prothrombinex 25-50IU/kg
FVIIa 100mcg/kg
dialysis
Rivaroxaban, apixaban reversal
Andexanet alfa
TXA
Prothrombinex
LMWH Reversal
Protamine sulfate
1mg per 100U of dalteparin IV
1mg per 1mg of enoxaparin (max 50mg) IV over 10 mins
Warfarin reversal
Vitamin K 5-10mg IV
Prothrombinex 25-50IU/kg
FFP 150-300mL
If prothrombinex unavailable, increase FFP dose to 15mL/kg
IVABx for epidural abscess
Flucloxacillin 2g IV q6h
PLUS
Ceftriaxone 2g IV bd
PLUS
Vancomycin 20-30mg/kg IV if risk of MRSA
Prostaglandin infusion
0.1mcg/kg/min
Effect usually seen within 30-60mins
DKA in children - fluid and insulin
Fluid
[(Maintenance + Deficits) - Fluid bolus already given] / 48
Insulin
0.1units/kg/hr actrapid infusion
Asthma in children
Salbutamol
- <20kg: 6 puffs or 2.5mg neb
- > 20kg: 12 puffs or 5mg neb
- IV: bolus 100mcg/kg over 20mins (max 5mg)
- IVI: 1mcg/kg/min
Ipratropium
- < 20kg: 4puffs or 250mcg neb
- > 20kg: 8 puffs or 500mcg neb
Magnesium
- 500mg nebs
- IV bolus 50mg/kg (0.2mmol/kg) over 20mins max 8mmol/2g
- IVI 30mg/kg/hr (0.01-0.05mmol/kg/hr)
Hydrocortisone
- 4mg/kg q4-5h IV
Prednisone
- 2mg/kg load
Lignocaine (local anaesthetic)
Max dose = 3mg/kg
7mg/kg with adrenaline
Bupivocaine
Max dose = 2mg/kg plain
3mg/kg with adrenaline
Prilocaine
Max dose 6mg/kg plain
3mg/kg for Bier’s block
Rx for peritoneal dialysis associated peritonitis
Nystatin 500,000 IU PO qid \+ Cefazolin 15mg/kg IP \+ Gentamicin 0.6mg/kg (50mg) IP
CHANGE
Cefazolin to Vancomyin 30mg/kg (2g) IP if MRSA
OPTIONAL
heparin 500U/L each exchange
Methylene Blue
For methaemoglobinaemia
1mg/kg over 5mins, repeat dose at 30-60mins
Octreotide for Sulfonylurea toxicity
50mcg bolus then 25mcg/hr infusion
Naloxone
0.4 - 2mg IV/IM/SC
Infusion 1-10mcg/kg/hr
Activated charcoal
1g/kg (child)
50g adult
NAC
150mg/kg loading dose
50mg/kg over 4 hours
100mg/kg over 16 hours
Treatment of:
- acute mountain sickness
- high-altitude cerebral oedema
- high-altitude pulmonary oedema
Everyone needs descent and oxygen
Hyperbaric oxygen when descent not possible
Specific:
- acute mountain sickness = acetazolamide 250mg PO bd
- high-altitude cerebral oedema = dexamethasone 8mg PO followed by 4mg qid
- high-altitude pulmonary oedema = nifedipine SR 10mg initially followed by 20-30mg bd
Thrombolysis in STEMI
- Aspirin 300mg PO
- Clopidogrel 300mg PO
TENECTEPLASE <60kg: 30mg 60-70kg: 35mg 70-80kg: 40mg 80-90kg: 45mg >90kg: 50mg (remember, half of top number until maxing out over 90kg)
CLEXANE
Age < 75yrs = load 30mg IV, then 1mg/kg sc bd (start 15 mins after bolus)
Age >75yrs = no load. 0.75mg/kg sc bd.
