Medications Flashcards
Adenosine
Special consideration* half the dose for heart transplant and central line administration
Side effects! Bronchospasm in asthmatic patients. Dizziness/flushing
MAX DOSE: 18mg(d1=6mg. D2=12mg)
Albuterol
Beta2 agonist
TREATMENT for bronchospasm secondary to allergic reaction, asthma/cops or reactive airway disease.
DOSAGE: 2.5-5mg q10 min or 10mg over 1hr
MAX: 10mg/ dose
Total 20mg
Amiodarone
Antiarrhythmic, class iii
INDICATIONS: VF or VT( w/ and w/o pulse)
DOSAGE: ( VF/-pulseVT) first 300mg, repeat 150 mg if no change.
(VT +pulse) 150mg over 10 minutes, may repeat x2
INFUSION: 1mg/min for 6 hours, then 0.5mg/min for 18 hours
CONCENTRATION: 450mg/250ml D5= 1.8mg/ml * filter tubing*
SIDE EFFECTS:
Hypotension and bradycardia/ AV blocks
ATROPINE
anticholinergic (antidote)
INDICATIONS: 1.bradycardia and 2.organophosphate poisoning
DOSAGE: 1. 0.5-1mg q3-5 minutes
2. 2-5mg until atropinization (no maximum!)
MAX: 1mg/ dose or 0.04mg/kg total
ONSET/DURATION: 2-10min/ 10-30 minutes
CONTRAINDICATIONS: heart transplant, myasthenia gravis, glaucoma
SIDE EFFECTS: seizures, dyspnea, pulmonary edema
CALCIUM CHLORIDE
1.beta-blocker overdose 2. Calcium channel blocker overdose 3. Hyperkalemia in cardiac arrest
DOSAGE: 1&2 1-2 grams IVP over 5 min q10-20 min. 3. 1g slow over 2 minutes
MAX DOSE: 2grams
**cautions: rapid injection can cause hypotension, bradycardia and cardiac arrest.
CALCIUM GLUCONATE
INDICATIONS: 1. Calcium channel and beta blocker overdose. 2. Magnesium toxicity. 3. Hyperkalemia with widened QRS. 4 calcium replacement during MTP. 5 fluorine gas exposure
DOSAGE: 1/2/3. 1-2 grams over 5 min q10-20 min. 4. 3 grams over 5 min after 1st PRBC REPEAT Q4 units. 5. NEB! 2.5% over 20 minutes
MAX DOSE: q dose 1000mg. Total 3000mg
DEXTROSE
DOSAGE: 12.5-25 grams of D50or D25 SLOW!
DILTIAZEM
Calcium channel blocker
INDICATION: Afib, Aflutter, or SVT
DOSAGE: IV- 0.25 mg/kg over 2 min, repeat 0.35mg/kg q15min x1. INFUSION- 5-15 mg/hr, titrate
MAX- 20mg/dose. 15mg/hr
CONCENTRATION: 100mg/100ml NS
CONTRAINDICATION: heart block, hypotension, VTach
SIDE EFFECTS: edema, bradycardia, hypotension, dyspnea, h/a, n/v
DOBUTAMINE
Adrenergic agonist
INFUSION: 2-30mcg/kg/min
CONCENTRATION: 250mg/ 500ml D5NS. 500mcg/ml
**CAUTIONS: acute mi, afib
SIDE EFFECTS: may exaggerate ventricular ectopic, h/a, dyspnea
EPINEPHRINE
Alpha and beta agonist
INDICATIONS: 1. Allergic rx
2. Bradycardia 3. Hypotension/shock 4. Cardiac arrest
PUSH DOSE EPI CCT
.5-2ml q3-5 minutes. 1ml epi in 9ml NS
DOSAGE:
1IM 0.3-0.5mg q3-5 min
NEB( for stridor) 3mg
2&3 infusion- 2mcg/min, titrate (max 10mcg /min)
4 IV- 1mg q3-5 minutes
CONCENTRATION: 2mg(2ml)/ 250ml D5/NS= 8mcg/ml
ESMOLOL
beta blocker
INDICATIONS: 1 aortic emergencies
2 afib/aflutter
3 SVT
4 hypertension
DOSAGE
1/2/3 IV 500mcg/kg over 2 min, then 50mcg/kg/min (titrate by 50mcg/kg)
4 IV 80mg over 2 min, then 150-300 mcg/kg/min( titrate by 50mcg/kg)
MAX DOSAGE: infusion 300mcg/kg/min
CONCENTRATION: 2500 mg in 250ml D5/NS = 10,000mcg/ml
CONTRAINDICATIONS: asthma/copd, sinus bradycardia, cardiogenic shock
FENTANYL
INDICATIONS: 1. Pain management 2. Post intubation management 3. RSI
DOSAGE: 1IV/IM-0.25-1mcg/kg q5-10 min 2. IV-0.25-3mcg/kg q10 min PRN INFUSION-1-2 mcg/kg/hr
3. 1-3 mcg/kg/hr **MAX 100mcg/dose or 300mcg total
CONCENTRATION: 250mcg/50ml NS
SIDE EFFECTS: bradycardia, increased ICP, resp depression, thoracic muscle rigidity
GLUCAGON
BB antidote, hypoglycemia
INDICATIONS: 1. Hypoglycemia 2. Beta blocker overdose
DOSAGE: 1. IM 0.5-1mg may repeat x1
2. IV 3-10 mg may repeatx1,then INFUSION 3-5 mg/hr
CONCENTRATION: 5mg/50ml D5
SIDE EFFECTS: decreased gastric motility, n/v, tachycardia, transient hypertension
HALDOL
Antipsychotic
INDICATIONS: 1. Acute psychotic disorders 2.nausea/vomiting
DOSAGE: 1.IM 2.5-5mg
2.IV1mg q6hr
***risk of torsades w/ iv use
IPRATROPIUM
Anticholinergic agent
Bronchodilator
INDICATIONS: acute bronchospasm
DOSAGE: 500mcg q 15min
MAX 2,000mcg total
KETAMINE
general anesthetic
INDICATIONS: 1.agitation 2. Pain
3. RSI/KAI/crash airway 4. Sedation/post intubation
DOSAGE: 1. IV 1-2mg/kg
IM 2-4mg/kg
2. IV 0.1-0.2 mg/kg q10 min
IM 0.5mg/kg q10 min
3. IV 1-2mg/kg
4. IV 0.3-0.5 mg/kg q10-15 min
INFUSION 1-4mg/kg/hr titrate by 0.25mg/kg/hr
CONCENTRATION: 500mg/100ml D5/NS
SIDE EFFECTS: arrhythmia/ tachycardia, hallucinations, decreased resp drive, tremors, hyper/hypo tension
LABETOLOL
INDICATIONS: 1. Aortic emergency 2. Cardiogenic pulm edema 3. CVA 4. Pregnancy induced HTN 5. HTN
DOSAGE: 1-3. 10-20 mg q10 min
4-5. 10-20mg, increase by 20mg for repeat doses
MAX- 40mg/dose and total
CONTRAINDICATIONS: asthma, cardiogenic shock, bradycardia
TX GOAL: SBP <160 or map <100
LIDOCAINE
Anti-arrhythmic
INDICATIONS: 1.VF/ pulseless VT
2. VT w/ pulse 3. Significant ventricular ectopy
DOSAGE: 1. IV 1-1.5 mg/kg, INFUSION 2-4mg/min
2/3. IV 0.5-1.5 mg/kg, INFUSION 2-4 mg/min
MAX: 3mg/kg total
SIDE EFFECTS: hypotension, seizures
ATIVAN
INDICATIONS: 1.agitation 2. Seizure 3. Agitation 4. Acute alcohol withdrawal
DOSAGE: 1. 0.5-2mg q10-30 min
2. 2-4 mg q5 min
3. 2mg q5min x2
4. 2-4mg PRN
MAX: 4mg/dose, 8mg total
SIDE EFFECTS: vasodilation, paradoxical reaction, CNS depressant
MAG SULFATE
Anticonvulsant/ electrolyte replacement
INDICATIONS: 1.Bronchospasm 2. Preeclampsia 3.seizure from eclampsia 4. Torsades w/ pulse 5. Torsades w/o pulse 6. Tricyclic overdose
DOSAGE: 1/4. infusion 2g/ 50ml over 10-20 min q 10min
2. Infusion 4g/50ml over 20 min, then 2g/hr
3. 4 grams/50ml over 5 min, then 2g/hr
5/6. IV 2g/10ml slow, q3 min
**MAX 4g/dose. Total-none
Duration: 30min
SIDE EFFECTS: dysrhythmia, CV collapse, hypotension, vertigo/blurred vision
MANNITOL
Osmotic diuretic
INDICATIONS: cerebral edema and increased ICP
DOSAGE: initial infusion- 1g/kg over 20min, then 0.25g/kg IVP q4hr
***CAUTIONS: incompatible with most drugs, FILTER TUBING!, crystallizes in low temps
SIDE EFFECTS: Chest pain, CHF, peripheral edema, tachycardia, HA, seizures
SOLUMEDROL
INDICATIONS: allergic reaction, Bronchospasm, altitude illness
DOSAGE: 125mg total
REGLAN
INDICATIONS: nausea/vomiting
DOSAGE: 10mg, slow q6hr
METOPROLOL
INDICATIONS: 1. Acute coronary syndrome 2. Afib/flutter 3. CVA 4. HTN 5. Tachycardia
DOSAGE: 1.PO 25mg
2-5. IV 5mg over 2 min, q 5min
**MAX 5mg/dose; 15mg total
SIDE EFFECTS: dizziness, h/a, hypotension, bradycardia, av block, peripheral edema, heart failure
VERSED
Anticonvulsant/ Benzodiazepines
INDICATIONS: 1. Anxiety/ agitation/ sedation. 2. Post-intubation sedation 3. Seizure 4. Shivering
DOSAGE: 1. IV/IM 2.5-5mg PRN
2. IV 1-2mg q10 or INFUSION 1-8mg/hr
3. IV/IM 2.5-5mg q3min IN 5mg q10 x2
4. IV 0.05mg/kg
***MAX 5mg/dose, no total max
SIDE EFFECTS: arrhythmia, hypotension, CNS depression
MORPHINE
INDICATIONS: burn management and cardiogenic pulm edema.
DOSAGE: 2-5mg q5-15min
**MAX 5mg/dose, 20mg total
NARCAN
Opioid antagonist
INDICATIONS: altered LOC, respiratory depression from known opioid ingestion
DOSAGE: IV/IM 0.4-2mg q2-4 PRN
IN(MAD) 2mg( 1mg/nostril) q2-4 min
***no max total dose
CARDENE
Calcium channel blocker
INDICATION: hypertension
DOSAGE: infusion 5-15 mg/he, titrate by 2.5 q5-15 min until desired effect.
SIDE EFFECTS: angina, h/a, hypotension, palpitations, n/v
Nitroglycerin
INDICATIONS: cardiogenic pulm edema, hypertension, ischemic chest pain.
DOSAGE: SL 0.4mg q5 min x3 doses
INFUSION 20mcg/min titrate q5min to MAX of 400mcg
NOREPINEPHRINE
Alpha and beta agonist
INDICATIONS: bradycardia and hypotension/shock
DOSAGE: 2-30mcg/min titrate
CONCENTRATION: 4mg/250ml d5/ns
Phenylephrine
Alpha-adrenergic agonist
INDICATIONS: hypotension/shock and bridge to definitive pressor
DOSAGE:
IVP: 50-200 mcg q2-5 min (no max)
INFUSION: 0.5-6mcg/kg/min **MAX 200mcg/min
MUST CHECK EXTREMITY PERFUSION Q5min
SIDE EFFECTS: chest pain, edema, seizure, tachycardia, electrolyte imbalance
POTASSIUM CHLORIDE
INDICATIONS: 1.hypokalemia
2.Use with insulin drip for low potassium
DOSAGE: 10-20 meq/hr
CONCENTRATION: 20meq/ 100mlNS
PROCAINAMIDE
Anti-arrhythmic
INDICATION: ventricular arrhythmia
DOSAGE: 20-50mg/min
**MAX 17mg/kg
***discontinue once arrhythmia resolves, hypotension occurs or if QRS widens by 50% or more
CONCENTRATION:
1gram/ 250ml D5/NS
PROPOFOL
INDICATIONS: anesthesia induction and management
DOSAGE: IVP 0.5-1.5 mg/kg q 5-10 min
INFUSION: 50-200mcg/kg/min
SIDE EFFECTS: hypotension and bradycardia
ROCURONIUM
INDICATIONS: RSI, skeletal muscle relaxant for mechanical ventilation IN SEDATED PATIENTS!
DOSAGE: IV 1mg/kg, then 0.2mg/kg q30-45 min OR
INFUSION 10mcg/kg/min
CONCENTRATION: 100mg/100ml
SPECIAL CONSIDERATIONS: electrolyte imbalance, metabolic/resp acidosis increase length of paralysis. Watch for peripheral vascular resistance
SODIUM BICARBONATE
INDICATIONS: 1.hyperkalemia 2. Metabolic acidosis 3. Tricyclics overdose
DOSAGE: 1. 50meq over 5 min
2. 1meq/kg, may repeat based on abg
3. 1meq/kg, repeat to maintain QRS <100ms, INFUSION 15-20meq/hr
CONCENTRATION: 50meq in 250
TXA
INDICATIONS: post-partum hemorrhage ongoing hemorrhage with shock
DOSAGE: 1g/ 100ml, max 2g
CONTRAINDICATIONS: more than 3 hours since hem., subarachnoid, thromboembolic disease
VASOPRESSIN
Antidiuretic hormone/ vasopressor
INDICATIONS: 1. Hypotension unresponsive to other agents.
2. Septic shock unresponsive to other agents
DOSAGE: 1. IVP 4U, then INFUSION 0.04U/min, NO TITRATION
2. INFUSION 0.03U/min, NO TITRATION
TX GOAL: map > 60, TBI MAP >80
CONCENTRATION: 20unite in 250ml D5/NS
CAUTIONS: asthma, CKD, seizure disorder
SIDE EFFECTS: hypertension, mesenteric ischemia, hyponatremia
VECURONIUM
Paralytic
INDICATIONS: RSI, post intubation muscle relaxant adjunct to sedation
DOSAGE: IV 0.1mg/kg q30-60 min
INFUSION: 1mcg/kg/min
CONCENTRATION: 10mg/50ml
VITAMIN K
INDICATIONS: warfarin reversal. To correct INR >4.5
DOSAGE: 1-10mg over 20 min
CONCENTRATION: 10mg/50ml NS
