Exam II: CV Drugs Bolus and Infusion Dosages

Question 1

Epinephrine -
Bolus
Infusion:
Low dose
Moderate dose
Large dose

Answer 1

Epinephrine
Bolus: 10 to 100 mcg for moderate hypotension
1 to 3 mg for circulatory collapse/pulseless
Infusion: Low dose (0.01-0.03 mcg/kg/min) Beta-2 dominant
Moderate dose (0.03-0.15 mcg/kg/min) Beta-1 dominant
Large dose (> 0.15 mcg/kg/min) Beta and Alpha-1, but Alpha-1 dominant

Question 2

Norepinephrine -
Infusion
Low dose
Moderate dose
High dose
Bolus

Answer 2

Norepinephrine
Infusion: 1 – 20 mcg/min
0.02 – 0.4 mcg/kg/min (4 mg in 250 ml)
Low dose: beta-1 selective
High dose: alpha-1, beta-1- increase SVR, BP, but decrease HR

Bolus: 4-16 mcgs DILUTE (less bradycardia than phenylephrine)

Question 3

Dopamine -
Infusion
Low dose
Moderate dose
High dose

Answer 3

Dopamine
Infusion: Low dose (1-2 mcg/kg/min) – D1
Moderate dose (2-10 mcg/kg/min) – beta1 - heart
High dose (10-20 mcg/kg/min) – alpha1 - peripheral vessels

Question 4

Dobutamine -
Infusion

Answer 4

Dobutamine
Infusion: 0.5-15 mcg/kg/min – more beta1 than beta2

Question 5

Noncatecholamines

Question 6

Ephedrine -
Bolus

Answer 6

Ephedrine
Bolus: 2.5-10 mg (dilute 50mg in 10ml or in 5 ml)

Question 7

Phenylephrine -
Bolus
Infusion

Answer 7

Phenylephrine
Bolus: 50-100 mcg (double dilute in 10ml)
Infusion: 0.15-0.75 mcg/kg/min (mix 10 mg in 250 ml)
*will frequently put on micro gtt and titrate to effect

Question 8

Vasopressin -
Bolus
Infusion

Answer 8

Vasopressin
Bolus: 0.5 – 1 unit (dilute 20 units in 20ml)
Infusion: 0.1 – 1.0 U/min (40 U in 100 ml)
Low dose 0.03 – 0.04 U/min

Question 9

Alpha 2 Agonist

Question 10

Dexmedetomidine -
loading/infusion

Answer 10

Dexmedetomidine
Loading/Infusion: 1 mcg/kg over 10 mins, then 0.5-1 mcg/kg/hr
(awake crani – 0.1 – 0.3 mcg/kg/hr)

Question 11

Selective PDE Inhibitor

Question 12

Milrinone -
Infusion: Bolus

Answer 12

Milrinone (Primacor)
Infusion: Bolus 50 mcg/kg, then 0.5 mcg/kg/min (0.375-0.75 mcg/kg/min)

Question 13

Inotropes

Question 14

CaCl -
Bolus

Answer 14

CaCl
Bolus: 250mg – 1 gm (over 10 min – may dilute in 100 ml)

Question 15

Glucagon -
Bolus

Answer 15

Glucagon
Bolus: 1 – 5 mg IV (Nagelhout says over 2-5 mins)

Question 16

Alpha 1 Antagonists

Question 17

Phentolamine -
Bolus
Infusion

Answer 17

Phentolamine
Bolus: 5-10 mg every 5-15 min (30 – 70 mcg/kg)
Infusion: 1 – 10 mcg/kg/min

Question 18

Beta Antagonists

Question 19

Propranolol -
Bolus

Answer 19

Propanolol (Inderal)
Bolus: 0.05 mg/kg (0.5-1 mg) q 5 mins

Question 20

Metoprolol -
Titrate to
Bolus

Answer 20

Metoprolol (Lopressor)
Titrate to HR 60-80 and SBP >100 mm Hg
Bolus: 5 mg IV (if HR > 80); 2.5 mg IV (if HR 60-80); hold if HR <60 or SBP <100mm Hg

Question 21

Esmolol -
Bolus
Infusion

Answer 21

Esmolol (Brevibloc)
Bolus: 0.2 - 0.5 mg/kg IV
(Laryngoscopy 150mg 2 mins prior to)
Infusion: 50-200 mcg/kg/min (2.5 gm in 250 ml)

Question 22

combined alpha and beta antagonist

Question 23

Labetalol-
Bolus
Infusion

Answer 23

Labetalol (Normodyne, Trandate)
Bolus: 0.1-0.5 mg/kg IV
Infusion: 2-8 mg/min (200mg in 200 ml)

Question 24

ACEIs

Question 25

Enalapril - Bolus

Answer 25

Enalapril (Vasotec) Bolus: 0.625-1.25 mg IV

Question 26

CCBs

Question 27

Nicardipine - Infusion

Answer 27

Nicardipine (Cardene) Infusion: Titrate – start at 5 mg/hr, increase by 2.5 mg/hr every 15 mins to a max of 15 mg/hr (25 mg in 240 ml or 50 mg in 250 ml)

Question 28

Nimodipine - PO

Answer 28

Nimodipine (Nimotop) 0.7 mg/kg PO, then 0.35 mg/kg q4 hrs

Question 29

Diltiazem - Bolus Infusion

Answer 29

Diltiazem (Cardizem) Bolus: 0.25 mg/kg IV over 2 mins, May repeat in 15 min Infusion: 5 -15 mg/hr (125 mg in 125 ml)

Question 30

Vasodilators

Question 31

Sodium Nitroprusside - Infusion

Answer 31

Sodium Nitroprusside Infusion: Initial rate 0.25-1 mcg/kg/min – titrate up to 8 mcg/kg/min Should not exceed 2 mcg/kg/min (cyanide toxicity) (50 mg in 250 ml)

Question 32

Nitroglycerine - infusion

Answer 32

Nitroglycerine Infusion: up to 2 mcg/kg/min

Question 33

Hydralazine - Bolus

Answer 33

Hydralazine (Apresoline) Bolus: 10 – 20 mg IV (Onset 10-20 mins) – consider 5 mg increments

Question 34

Adenosine - Bolus Infusion

Answer 34

Adenosine Bolus: 6 mg, then 12 mg, then 18 mg IV (Can repeat with 60 seconds) Infusion: for deliberate hypotension, doses range from 5 - 50 mcg/kg/min to 140 mcg/kg/min to 220 mcg/kg/min