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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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