Good Sam Basic Pharmacology Flashcards by Migz Campos

cardiac patient with CP
SBP>100, HR>60
pain unrelieved by NTG

metoprolol 
5mg over 2min 
q 5min 
pay repeat twice 
MAX 15mg

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pain relieved by NTG SL

NTG infusion
5mcg / min
titrated for SBP>90

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Bradydysrhythmias

First line medication

Dopamine

5-10 mcg/kg/min IVPB

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Bradydysrhythmias

CCT medication

Epinephrine
2-10 mcg/min
IV infusion titrated to response

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SVT

CCT medication

metoprolol
5mg IVP over 2min
may repeat to a total of 15mg

diltiazem
.25mg/kg IVP over 2min
may repeat in 15min with .35mg/kg IVP over 2min

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rapid atrial dysrhythmias

stable

diltiazem

-.25mg/kg IVP over 2min
-may repeat in 15min with .35mg/kg IVP over 2min
-maintenance infusion of 5-15mg/h
—titrated to HR control and SBP>90mmHg

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rapid atrial dysrhythmias

unstable

Versed for sedation (2mg up to 10mg) 
-atrial fibrillation @200J 
-atrial flutter @100J 
repeat sync cardioversion @200, 300, 360J 
-no response, consider cardiogenic shock

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When giving Diltiazem….

do not give it in the same IV as furosemide

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rapid atrial dysrhythmias

post-conversion continuous infusion

Diltiazem

5-15mg/h IV infusion

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rapid atrial dysrhythmias

critical care contact medication control for orders

amiodarone
150mg IV over 10min
—-followed by 1mg/min infusion

metoprolol
5mg IVP over 2 min
–may repeat q 5min to a total of 15mg

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persistent V-Tach w/ pulse that is unresponsive to previous therapy

magnesium sulfate

2G in 10mL NS IV over 2 min

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persistent V-Tach w/ no pulse that is unresponsive to previous therapy

magnesium sulfate

2G in 10mL NS IV over 2 min

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induction of hypothermia after ROSC requires what infusion

2 L chilled .9% NS

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pulmonary edema

stable

BP >100 mmHg
--NTG .4mg SL 
---repeat q5 min 
----limit???
NTG infusion 
5mcg/min 
---titrate for relief, maintain SBP>90mmHg 
---if SBP>100mg, & hx of pulmonary edema: contact medical control for furosemide 40mg IV/IO

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pulmonary edema

unstable

<60 HR bradydysrhythmia SOP

>59 HR cardiogenic shock SOP

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pulmonary edema

critical care standing medical orders

NTG 
--5mcg/min 
---titrate for relief, maintain SBP>90mmHg
Dobutamine
--2-20mcg/kg/min

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pulmonary edema

critical care common continuation medications

milrinone 
--.375 - .77 mg/kg/h 
----max 1.13 mg/kg/24h 
inamrinone 
--5-10 mcg/kg/min 
----max 18mg/kg/24h

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Adult cardiogenic shock

HR >99, and only inotropic support is needed

dobutamine
5 mcg/kg/min
titrate q 2min to achieve SBP>89
—max 20 mcg/kg/min

adult cardiogenic shock

hypotension unresponsive to fluid boluses and initial vasopressor administration

epinephrine
— .1 mcg/kg/min
— titrate q 2min to achieve SBP>89mmHg
—maximum 20mcg/kg/min
vasopressin
— begin .4 units/min IV
—once SBP>89, titrate q 5min to .01 units/min

note about Vasopressin. p26

“preferred second-line vasopressor for septic shock and should be the last vasopressor to be discontinued once started”

adult cardiogenic shock

critical care common continuation medications

epinephrine
– 5mcg/min
– titrated q2min up to 15mcg/min to maintain BP
norepinephrine
– 10mcg/min
—titrated q2min up to 30mcg to maintain BP
– .1 - .5 mcg/kg/min for weight-based dosing
phenylephrine
– 100mcg/min
—titrated q 2min up to 180mcg/min to maintain BP
– .5 - 2mcg/kg/min for weight based dosing
—may be given as IV bolus of .1 - .5mg q 10min

adult drug assisted intubation-rapid sequence
Pre-Medicate
1) head injury/CVA
2) bradycardia

1) lidocaine
- - 1mg/kg
- –max dose 100mg
2) atropine
- - .5mg
- – .5mg

adult drug assisted intubation-rapid sequence

Sedate (two options)

midazolam
– 5mg IV/IO
Etomidate
– .5mg/kg

adult drug assisted intubation-rapid sequence

defasiculating dose administered 1-3min prior to succs

Vecuronium
– .01 mg/kg
Rocuronium
– .05-.06 mg/kg IV/IO

adult drug assisted intubation-rapid sequence | succinylcholine dose

1mg/kg

adult drug assisted intubation-rapid sequence | paralysis maintenance

``` vecuronium -- .1mg/kg ---up to 10mg rocuronium -- .1-.2 mg/kg PRN ```

adult continued sedation for the intubated patient what four drugs for sedation? what two drugs for analgesia? what two drugs for maintenance of paralysis?

Versed, Ativan, Propofol, Precedex Morphine, Fentanyl Rocuronium, Vecuronium

adult continued sedation for the intubated patient | sedation...

Versed -- bolus: 2-5mg max:10mg -- infusion: .05-.1 mg/kg/h q5min until sedation Ativan -- bolus: 2-4mg -- infusion: .05-.1 mg/kg/h q5min until sedation Propofol -- bolus: none -- infusion: 5-25mcg/kg/min q 5min by 5-10mcg/kg/min Precedex -- bolus: none -- infusion: .2-.7mcg/kg/hr q 5min until sedation

adult continued sedation for the intubated patient | analgesia

morphine -- bolus: 2-5mg q5min to max of 10mg -- infusion: 1-10mg/h until pain level decreases fentanyl -- bolus: .5mcg/kg up to 2mcg/kg q30min -- infusion: .7-10mcg/kg/h until pain level decreases

adult continued sedation for the intubated patient | maintenance of paralysis

``` vecuronium -- bolus: .1mg/kg q35-40min ---max single dose 10mg -- infusion: .8-1.2 mcg/kg/min ---titrated q 10min for continued paralysis rocuronium -- bolus: .45-.6mg/kg ---PRN based on patient condition -- infusion: 10-12mcg/kg/min --- titrated q 10min for continued paralysis ```

Adult cardiogenic shock | HR >99, and only inotropic support is needed

dobutamine 5 mcg/kg/min titrate q 2min to achieve SBP>89 ---max 20 mcg/kg/min

adult cardiogenic shock | hypotension unresponsive to fluid boluses and initial vasopressor administration

epinephrine --- .1 mcg/kg/min --- titrate q 2min to achieve SBP>89mmHg ---maximum 20mcg/kg/min vasopressin --- begin .4 units/min IV ---once SBP>89, titrate q 5min to .01 units/min

note about Vasopressin. p26

"preferred second-line vasopressor for septic shock and should be the last vasopressor to be discontinued once started"

adult cardiogenic shock | critical care common continuation medications

epinephrine -- 5mcg/min -- titrated q2min up to 15mcg/min to maintain BP norepinephrine -- 10mcg/min ---titrated q2min up to 30mcg to maintain BP -- .1 - .5 mcg/kg/min for weight-based dosing phenylephrine -- 100mcg/min ---titrated q 2min up to 180mcg/min to maintain BP -- .5 - 2mcg/kg/min for weight based dosing ---may be given as IV bolus of .1 - .5mg q 10min

adult drug assisted intubation-rapid sequence Pre-Medicate 1) head injury/CVA 2) bradycardia

1) lidocaine - - 1mg/kg - --max dose 100mg 2) atropine - - .5mg - -- .5mg

adult drug assisted intubation-rapid sequence | Sedate (two options)

midazolam -- 5mg IV/IO Etomidate -- .5mg/kg

adult drug assisted intubation-rapid sequence | defasiculating dose administered 1-3min prior to succs

Vecuronium -- .01 mg/kg Rocuronium -- .05-.06 mg/kg IV/IO