Drugs and doses you should know

Question 1

Adenosine

MOA
Dose
Indication
Think about

Answer 1

MOA: acts on A1 receptors in AV node causing temporary heart block

Dose: 6mg IV RAPID push, may give 12mg IV q 2 minutes if no effect x2

Emergent Indications: stable SVT, stable narrow complex tachycardias

Where you’ll get in Trouble: WPW, wide complex..

Question 2

Albuterol (also known as Salbutamol)

MOA
Dose
Indication (2)
Think about

Answer 2

MOA: selective beta2 agonist

Dose: 2.5 - 5 mg q20min for 1st hour, then 2.5-10 mg q 1-4 hours prn (alt, 10-15 mg over 1 hour, neb)

Emergent Indications: acute bronchospasm (asthma), hyperkalemia

Think about: hypokalemia, tachycardia

Question 3

Calcium gluconate

MOA
Dose
Indication
Think about (meh, not really)

Answer 3

MOA: stabilize myocardium, increases serum calcium

Dose: Calcium gluconate 2g IV (10% IV solution contains 1 gram per 10 mL)

Emergent Indications: hyperkalemia, hypocalcemia with dysrhythmia

Think about: dysrhythmia, tetany

Question 4

Diazepam (Valium)

MOA (receptors)
Dose
Indication (2)
Think about

Answer 4

MOA: enhances inhibitory effects of GABA

Dose: 2-10 mg PO/IV/IM q 6 hours PRN

Emergent Indications: Seizure abortion, alcohol withdrawal, agitation, muscle spasm

Where you’ll get in Trouble: respiratory depression, hypotension

Question 5

Diltiazem

Answer 5

MOA: inhibits calcium influx in myocardium > vascular smooth muscle;
prolongs AV nodal conduction
Dose: 0.25 mg/kg IV x1; may give 0.35 mg/kg IV x1 after 15 minutes;
continuous infusion 5-15 mg/hr
Emergent Indications: stable Afib with RVR, stable SVT
Where you’ll get in Trouble: iatrogenic hypotension, bradycardia, Preg C

Question 6

Epinephrine

Answer 6

MOA: alpha and beta receptor agonist

Dose:
ACLS: 1 mg 1:10,000 IV
PALS: 0.01 mg/kg 1:10,000 IV
Anaphylaxis: 0.1-0.5 mg 1:1,000 IM/SQ (IM preferred)
Peds anaphylaxis/asthma: 0.01 mg/kg 1:1,000 IM/SQ (max single dose 0.3 mg)
Hypotension refractory to IVF: 1-10 mcg/min IV

Emergent Indications: anaphylaxis, ACLS arrest, PALS/NRP arrest, severe asthma

Where you’ll get in Trouble: dosing errors (10 fold errors), tissue necrosis (needs to administered via central venous line), dysrhythmias, Preg C

Question 7

fentanyl

Answer 7

MOA: opioid agonist producing analgesia with adjunctive sedative effects

Dose: 25-100 mcg IV q 1-2 hours; recommended dose 1 mcg/kg

Emergent Indications: pain control, sedation adjunct

Where you’ll get in Trouble: respiratory depression, vasodilation (hypotension), laryngospasm, Preg C

Question 8

furosemide

Answer 8

MOA: inhibits Na and Cl reabsorption in distal renal tubule and ascending loop of Henle
Dose: usual dose in ED 20-40 mg IV, reassess, increase to desired effect
(maximum single dose 200mg)
Emergent Indications: pulmonary edema, CHF exacerbation, hyperkalemia
(if making urine)
Where you’ll get in Trouble: volume depletion, hypokalemia, metabolic alkalosis,
ototoxicity, Preg C

Question 9

glucagon

Answer 9

MOA: stimulates cAMP production independent of beta receptor, increases gluconeogenesis
and glycogenolysis
Dose: Beta-blocker/Ca channel blocker toxicity: 3-10 mg IV loading dose,
then 1-10 mg/hour IV continuous infusion if responsive to loading dose
Hypoglycemia: 1 mg IV/SQ/IM
Emergent Indications: beta-blocker toxicity, Ca channel blocker toxicity, hypoglycemia
Where you’ll get in Trouble: anaphylactoid reaction, can cause hypotension, emesis
(aspiration risk in altered patient), Preg B

Question 10

haloperidol (haldol)

Answer 10

MOA: Antagonist at D1 and D2 receptors
Dose: 5-10 mg PO/IM/IV q 2 hours (max 100 mg/day)
Emergent Indications: agitation, psychosis
Where you’ll get in Trouble: do not give for dementia-related psychosis, NMS, EPS,
QT prolongation, Preg C

Question 11

hydromorphone

Answer 11

MOA: opioid agonist producing analgesia with adjunctive sedative effects
Dose: 1-2 mg IV q 3-6 hours
Emergent Indications: Analgesia
Where you’ll get in Trouble: Respiratory depression, vasodilation (hypotension),
1 mg of IV Dilaudid is approximately equal to 7 mg of IV morphine, Preg C

Question 12

insulin regular

Answer 12

MOA: ↑ peripheral glucose uptake, increased inotropy, shifts potassium intracellularly

Dose:

1. Hyperkalemia: 5-10 units IV x 1
2. CCB overdose: 1 unit/kg bolus given with 25 grams of dextrose if initial BG < 25; then initiate insulin drip with dextrose
3. DKA/HHS: 0.1 unit/kg bolus followed by continuous infusion 0.1 unit/kg/hour

Emergent Indications: hyperkalemia, DKA/HHS, CCB overdose

Where you’ll get in Trouble: hypokalemia, hypoglycemia, only regular insulin can be given IV, Preg B

Question 13

ketamine

Answer 13

MOA: Acts on cortex and limbic system, NMDA receptor antagonist

Dose: Subdissociative: 0.1-0.5 mg/kg IV
Procedural sedation: 0.5-1 mg/kg IV
RSI induction: 2 mg/kg IV

Emergent Indications: analgesia, sedation, RSI induction

Where you’ll get in Trouble: emergence reactions (treat with benzos or barbs), laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D

Question 14

Labetalol

Answer 14

MOA: alpha1, beta1, and beta2 antagonist

Dose: Bolus dose: 20-80 mg IV q 10 minutes PRN
Continuous infusion: 1-8 mg/min titrated to effect

Emergent Indications: hypertensive emergency

Where you’ll get in Trouble: precipitated CHF, bradycardia, bronchospasm, Preg C

Question 15

Lorazepam (ativan)

Answer 15

MOA: Enhances inhibitory effects of GABA
Dose: Usual bolus dose: 1-2mg IV
Usual continuous infusion: 1-10 mg/hr
Emergent Indications: delirium tremens, status epilepticus, serotonin syndrome, agitation
Where you’ll get in Trouble: respiratory depression, hypotension, Preg D

Question 16

Lorazepam vs diazepam

• brand names?
• half life?

Answer 16

Lorazepam (ativan)

Diazepam (valium)

Question 17

Magnesium sulfate

Answer 17

MOA: participates in physiologic processes
Dose: Eclampsia: 2-4 grams IV over 5 minutes
Pulseless torsades: 2 grams IV push
Asthma exacerbation: 2 grams over 15 minutes
Emergent Indications: torsades, ventricular dysrhythmias, eclampsia, status asthmaticus
Where you’ll get in Trouble: respiratory depression, hypotension, Preg A

Question 18

mannitol

Answer 18

MOA: osmotic diuretic
Dose: 1 gram/kg IV x 1
Emergent Indications: elevated ICP, impending herniation
Where you’ll get into trouble: may cause dehydration, osmotic nephrosis

Question 19

metoclopramide

Answer 19

MOA: dopamine antagonist

Dose: 10 mg IV q 6 hours PRN

Emergent Indications: vomiting prevention and treatment

Where you’ll get in Trouble: tardive dyskinesia, extrapyramidal symptoms, dystonia

Question 20

midazolam

brand name?

Answer 20

Brand: Versed

MOA: enhances inhibitory effects of GABA

Dose:
RSI induction: 0.1 mg/kg IV
Usual continuous infusion: 1-10 mg/hour
Procedural Sedation: 0.02 - 0.04 mg/kg IV

Emergent Indications: seizure abortion, procedural sedation, ventilator sedation, RSI

Where you’ll get in Trouble: respiratory depression, hypotensive effects, Preg D

Question 21

norepinephrine

Answer 21

MOA: alpha1 agonist > beta1 agonist

Dose: 1-30 mcg/min IV

Emergent Indications: hypotension refractory to IVF

Where you’ll get in Trouble: tachydysrhythmias, tissue necrosis if catheter infiltrates or administered through an arterial line therefore needs to be given via a central venous line,
Preg C

Question 22

Octreotide

Answer 22

MOA: vasoconstricts vessels (more selective for GI vessels), reduces portal vessel pressure
Dose: Bleeding esophageal varices: 50 mcg IV bolus, then 50 mcg/hour IV
Sulfonylurea toxicity: 50 mcg SQ q 6 hours PRN
Emergent Indications: bleeding esophageal varices, sulfonlyurea overdose
Where you’ll get in Trouble: Precipitated biliary dz, Preg B

Question 23

olanzapine

Answer 23

MOA: antagonizes dopamine, histamine, alpha1, and 5HT2 receptors
Dose: 5-10mg IM/ODT (max 30mg/day)
Emergent Indications: agitation, psychosis
Where you’ll get in Trouble: do not give for dementia-related psychosis, NMS, EPS,
orthostatic hypotension, QT prolongation, not to be given IV, Preg C

Question 24

ondansetron

Answer 24

MOA: antagonizes serotonin 5-HT3 receptors, centrally acting antiemetic
Dose: usual dose 4-8 mg IV q 4-6 hours PRN
Emergent Indications: vomiting prevention and treatment
Where you’ll get in Trouble: QT prolongation, torsades (rare), Preg B

Question 25

phenobarbital

Answer 25

MOA: barbiturate, causes sedation, hypnosis and anesthesia
Dose: 20 mg/kg IV x 1, may repeat with an additional 5-10 mg/kg dose in 20 minutes
(max dose 30 mg/kg); max infusion rate 50 mg/min
Emergent Indications: status epilepticus
Where you’ll get in Trouble: respiratory depression, hypotension, Preg D

Question 26

propofol

Answer 26

MOA: GABAa agonist, Na channel blocker
Dose: Procedural Sedation: 1 mg/kg IV bolus then 0.5 mg/kg q 3 minutes to effect
RSI induction: 1.5-2.5 mg/kg IV x 1
Ventilator Sedation: 5-50 mcg/kg/min)
Emergent Indications: procedural sedation, RSI induction, ventilator sedation
Where you’ll get in Trouble: hypotension, anaphylaxis, bradycardia, apnea, Preg B

Question 27

Rocuronium

Answer 27

MOA: non-depolarizing neuromuscular agent
Dose: 1mg/kg IV
Emergent Indications: RSI paralysis
Where you’ll get in Trouble: prolonged paralysis, Preg B

Question 28

Sodium bicarb

Answer 28

MOA: increases serum bicarbonate (increases buffer stores)
Dose: Hyperkalemia or metabolic acidosis: 50 mEq IV x 1 (1 amp = 50 mEq)
TCA toxicity: 1-2 mEq/kg IV bolus to achieve a serum pH of 7.45-7.55 and
QRS narrowing; effective serum alkalinization unlikely with continuous infusion
Salicylate toxicity: 3 amps (150mEq) in 1 liter D5W given as 10-20 ml/kg bolus,
then 2-3ml/kg/hr; goal urine pH 7.5-8.0
Emergent Indications: hyperkalemia, TCA toxicity, salicylate toxicity, metabolic acidosis
Where you’ll get in Trouble: caution in CHF, overshooting into metabolic alkalosis,
hypernatremia, Preg C

Question 29

succinylcholine

indication?
dose?

Answer 29

MOA: depolarizing neuromuscular agent

Dose: 1.5 mg/kg (or 3-4 mg/kg IM)

Emergent Indications: RSI paralysis

Where you’ll get in Trouble: hyperkalemia, subacute burn/crush with hyperkalemia, glaucoma (increases IOP), increases ICP, Preg C

https://www.aaemrsa.org/UserFiles/AAEM-RSA50DrugFactsEveryEPShouldKnow.pdf