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ER IV Drug list
Drug Indication Dosage Notes
Adenosine PSVT Conversion 6 mg IV push, may repeat
12 mg IV q 1-2 min x 1-2 doses
Amiodarone VF/Pulseless VT 300 mg IV/IO
Wide Complex Tach 150 mg IV x 1 over 10 min
Then 1 mg/min x 6 hrs, then 0.5 mg/min x 18 hrs
Atropine ACLS Brady 0.5 mg IV/IO q 3-5 min, to max 3 mg
ACLS Asystole 1 mg IV/IO q 3-5 min
Cardiogen shock/brady 0.5 mg IV/IO q 3-5 min
Organophosphate poison 2 mg IV/IO q 5 min
Calcium Chloride Hypocalcaemia .5- 1gm IV over 10 min use central line if possible
CCB overdose 1-2 g IV over 10 min, repeat q 20 min x 5 doses prn
Calcium Gluconate Hypocalcaemia 1.5 – 3 gm IV over 10 min may use peripheral IV
CCB overdose 3-6 g IV over 15-20 min
Dexamethasone Croup 0.6 mg/kg PO x 1
Diazepam Seizure 5-10 mg IV q 5-10 min, max 30 mg
Diltiazem AF/Flutter/PSVT 0.25 mg/kg IV, 5-15 mg/hr infusion
Digoxin CHF/AF/PSVT 4-6mcg/kg IV, then ¼ loading dose q 8 h x 2
Dobutamine Cardiac decompensation Start 2 mcg/kg/min. Range 2-20 mcg/kg/min
Dopamine Cardiac decom/Shock Start 2-5 mcg/kg/min. Maint 1-20 mcg/kg/min
Epinephrine ACLS-VT/Vib/PEA 1 mg (1:10,000) IV q 3-5 min
Brady/cardiac output maint. 2-10 mcg/min
Anaphylaxis 0.3-0.5 mg (1:1000) IM, max 1 mg (Peds: 0.01 mg/kg)
Infusion: start 5 mcg/min
‘Push Dose’ 5 – 10 mcg IV q 3-5 min
Fentanyl Sedation/pain 25-50 mcg IV, infusion start 25mcg/hr titrate
RSI 50-100mcg IV (1-1.5 mcg/kg)
Flumazenil Benzodiazepine OD 0.2-0.5 mg IV q min x 5 doses max,
Infusion 0.1-0.4 mg/hr
Glucagon Hypoglycemia 1 mg SC/IM/IV
Beta Blocker OD 3-5 mg IV, 1-5 mg/hr IV infusion
Haloperidol Acute psychosis 5-10 mg IV/IM
Hydralazine HTN crisis 10-20 mg IV q 2-4 hr
Hydrocortisone Status asthmaticus 300-400 mg/day IV divided q 6
Septic Shock 200-300 mg/day IV divided q 6
Isoproterenol Shock/Hypotension 0.5-30 mcg/min IV
Brady due to
CCB/BBlocker OD 0.04 mg IV then 2-10 mcg/min
Torsades to shorten QTc 0.04 mg IV then 2-10 mcg/min
Ketamine RSI induction 2 mg/kg
Proc Sed 1-2 mg/kg IV over 1 min
Dissociative dose –analgesia 0.3 mg/kg
Peds Proc. Sedation 0.5- 1.5 mg/kg IV over 1 min
Ketofol 1:1 Ketamine/Propofol. Proc Sedation: 0.3 – 0.5 mg/kg
Labetalol HTN emerg start 20 mg IV, max 300 mg total 2 mg/min IV
Lipid Emulsion Local Anesth/TCA/BBlocker,1.5 ml/kg bolus, then 0.25 ml/kg/min for
1st Gen antipsychotic OD 30-60 min. Repeat bolus for persistent asystole
Lorazepam Seizure/Status 3-4 mg IV/IO. Repeat x 1 q 10 min
Mannitol Cerebral Edema 0.25 – 1 gm/kg IV
Magnesium Sulfate Symptom. HypoMg 1 - 4 gm IV
Seizure/Preeclampsia 4 gm IV then 1-2 gm/hr IV
Vent. Arrhyth/Torsades 2 gm IV
Methylprednisolone Anaphylaxis 1-2 mg/kg PO daily
Metoprolol Acute MI 5 mg IV q 2 min x 3 doses
After 15 min give 50 mg PO q 6 h
Midazolam Proc. Sedation 1-2 mg IV q 2-3 min, max 5 mg
RSI 0.3 mg/kg IV
Agitation, violent behavior 5 -10 mg IM
Seizure 10 mg IM
Morphine Analgesic 2-5 mg IV prn (0.05 – 0.1 mg/kg)
Naloxone Opioid OD 0.1 mg IV/IO or 0.4 mg IM
0.0025 – 0.16 mg/kg/hr IV
Nitroglycerin Angina start 5 mcg/min
Acute Pulm Edema 50 mcg/min to max 200-400 mcg/min
Norepinephrine Hypotension/Sepsis Start 0.1 mcg/kg/min. Titrate. Max 2 mcg/kg/min
Phenobarbital Seizure 10-20 mg/kg IV x1. May repeat 10 mg/kg
Phenylephrine Shock 50-100 mcg/min IV
Mild hypotension 10 – 150 mcg IV q 10 min (onset 1 min, duration 15-20 min)
“Push Dose” mix 10 mg in 100 ml N/S = 100mcg/ml
Procainamide Wide complex tachy/SVT 100 mg IV q 5 – 10 min. Max 1.5 gm
Propofol Procedural Sedation 0.5 – 1.5 mg/kg IV
RSI 1.5 – 3 mg/kg
Infusion -post intubation start 5 mcg/kg/min. x 5 min, then titrate (5-50mcg/kg/min)
Ranitidine Anaphylaxis itch 50 mg IV
Rocuronium Intubation 0.6 – 1.2 mg/kg IV
Succinylcholine RSI paralysis 1-2 mg/kg IV (can pre medicate with atropine)
Sotalol VT/VF 75- 100 mg IV q 12 h
TNKase STEMI 90 kg=50 mg
Vasopressin VF/VT/Asystole/PEA 40 units IV/IO
Verapamil PSVT conversion 2.5-10 mg IV
Atr. Fib/Flutter 2.5-10 mg IV
Xylocaine Status Seizure 1 mg/kg IV bolus
VF/VT 0.5-0.75 mg/kg IV q 5-10 min. Then 1-4 mg/min
Cardiovascular Effects of IV ER Drugs
Alpha 1 – Agonists cause vasoconstriction. Antagonists cause vasodilation
Alpha 2 – CNS mediated, agonists cause hypotension, sedation.
Beta 1 – heart effects: inotropic (strength of contraction), chronotropic (heart rate), dromotrophic (‘conduction’)
Beta 2 – Lung effects: agonists cause bronchodilation, antagonists cause bronchoconstriction
β1 β 1 β1
Drug α1&2 Inotr Chron Dromo β2 V/C V/D
Phenylephrine |+++ | | | | | | | |Epinephrine |+++ |+++ |++ |++ |++ | | | |Norepinephrine |+++ |++ |++ |++ |o | | | |Dobutamine |o/+ |+++ |++ |o |+ | | | |Dopamine
0.5-2mcg/k/min
5-10
10-20 |
o
+
++ |
+
++
++ |
o
o
o |
|
|
|
o
SVR/CO
SVR | |Digoxin | | + | _ | | | | | |Amiodarone | | + | |-SA/-AV | | | | |Atropine | | | + |+SA/AV | | | | |Ca Chloride/Gluconate | | + | | | | | | |Dihydropyridone – Amlodipine (Nifedipine) |Arterial V/D
No venous V/D | _ | _ | _ | | | + | |Non-dihyd - Phenylakytlamine
Verapamil |Min. Art V/D | _ _ | _ | _ | | | 0 | |Non-dihyd. - Benzothiazepine
Diltiazem |Arterial V/D | _ | _ | | | | + | |Beta Blockers | _
| _ | _ _ |-SA/AV | + | | | |Nitroglycerine |Low dose ven V/D
High dose art V/D | |+ | | + | | | |ACE Inhibitors | | - | | | | | + | |Mg Sulfate | | | | | + | | | |Isoproterenol |+ V/D via B2 receptors | + | + | | + |+ SBP
-DBP | + | |Ketamine * | | _ | + | | | | | |Fentanyl ** | | | _ | | | + | | |Morphine *** | | _ | | | | | ++ | |Propofol **** | | | | | | | ++ | |Midazolam # | | | | | | | | |
* Ketamine – negative inotrope but due to secondary CNS simulation causes increase in pulmonary BP, heart rate, cardiac output and myocardial O2 demand. Usually there will be no changed in systemic vascular resistance.
** Fentanyl – Usually has minimal or no effect on BP, LV Pressure and cardiac output. Initial boluses can decrease MAP. May have some negative Chronotropy (decrease HR) that can be treated with atropine.
*** Morphine – lowers BP via decreasing alpha adrenergic tone mediated through the CNS.
****Propofol – can cause large reduction in MAP via venous and arterial vasodilation. It also blocks normal baroreceptor mediated tachycardia which would normally counteract these changes.
# Midazolam – has minimal CV effects.
Mixing Instruction for Push Dose Pressors and Ketofol
Epinephrine:
Take a 10 cc N/S syringe. Discard 1 cc.
Take a preloaded syringe of Epi 1:10,000 from the cardiac drawer.
Take the bottom stopper off the syringe.
With the 9 cc Saline syringe, draw out 1 cc Epi (1:10,000)
You now have 10 mls of Epinephrine 10 mcg/ml
Dose is 0.5 – 2 ml (5-20 mcg) q 2-5 min
Onset 1 minute, duration 2-5 minutes.
Phenylephrine:
With a 5 ml syringe, draw 1 ml of 10mg/ml (1 vial) Phenylnephrine.
Mix it in 100 cc minibag of normal saline
Draw out 3 – 5 cc of solution.
This is now Phenylephrine of 100 mcg/ml
Put labels on both the minibag and the syringe
Dose is 50 – 100 mcg/min ie give 0.5 – 1 ml q 2-5 minutes.
Action is within 1 minutes and lasts for 10-20 min.
Ketofol
Take 20 cc syringe. Draw up 10 cc of Propofol 10 mg/ml (100 mg Propofol)
Then draw up 2 ml of Ketamine 50 mg/ml (100 mg Ketamine)
Then draw up 8 cc of Normal Saline to fill the 20 cc syringe.
You know have 20 ml of Ketofol at 10 mg/ml
Dosage: Procedural sedation – 0.3 -0.5 mg/kg.
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