Makindo Medical Notes"One small step for man, one large step for Makindo" |
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MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd. |
Related Subjects: |Emergency Drugs |Emergency Drug Antidotes |Emergency Cardiac Drugs |Emergency Endocrine Drugs |Emergency Gastrointestinal Drugs |Emergency Haematology Drugs |Emergency Neuropsychiatric drugs |Emergency Pain drugs |Emergency Respiratory drugs |Emergency Obstetric and Gynaecology Drugs |Emergency Paediatric Drugs
DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
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Acetylcysteine | Replenishes glutathione stores, serves as a glutathione substitute, and enhances sulfate conjugation of acetaminophen(paracetamol) | 150 mg/kg in 200 mL D5W over 1 hr, then 50 mg/kg in 500 mL D5W over 4 hrs, then 100 mg/kg in 1 L D5W over 16 hrs (21 total hrs; may need continuous LFTs and APAP level until liver enzymes normalize) | 140 mg/kg x1, then 70 mg/kg every 4h x17 doses (72 hrs total) | Acetaminophen(paracetamol) overdose | Hypersensitivity rxn (stop infusion, switch to PO or slow infusion), rare. Can also occur with PO. Pregnancy Category B. |
Adenosine | Acts on A1 receptors in AV node, causing temporary heart block | 6 mg IV RAPID push, may give 12 mg IV every 2 min if no effect x2 | N/A | Stable SVT, stable narrow complex tachycardia | Prodysrhythmic, avoid in preexisting 2nd/3rd degree heart block, Pregnancy Category C |
Albuterol/Salbutamol | Selective beta2 agonist | 2.5-5 mg q20 min for 1st hour, then 2.5-10 mg every 1-4 hrs PRN (alt: 10-15 mg over 1 hr) | N/A | Acute bronchospasm, hyperkalemia | Hypokalemia, tachycardia, hyperglycaemia, Pregnancy Category C |
Amiodarone | Blocks K efflux (Class III), also has Class I (Na), II (Beta), and IV (Ca) effects | Pulseless VF/VT: 300 mg IV push, then 150 mg IV push if needed. Stable wide complex tachy: 150 mg IV over 10 min, then 1 mg/min x 6 hrs, then 0.5 mg/min | N/A | Pulseless VT/VF, wide complex tachydysrhythmias | Hypotension, prodysrhythmic, Pregnancy Category D |
Atropine | Direct anticholinergic | Organophosphate/carbamate toxicity: 1-6 mg IV q3-5 min PRN until secretions stop. Bradycardia (adult): 0.5 mg IV q3-5 min (max 3 mg) | N/A | Organophosphate/carbamate poisoning, bradycardia | Hyperthermic patients, tachydysrhythmias, Pregnancy Category C |
Calcium gluconate/chloride | Increases serum calcium, stabilizes cardiac myocytes | 10% solution (1 g per 10 mL) IV | N/A | Hyperkalemia, hypocalcemia with dysrhythmia | Dysrhythmia, tetany; CaCl more potent than Ca gluconate. Severe phlebitis with CaCl if peripheral. Prefer CVC. Pregnancy Category C |
Diazepam (Valium) | Enhances inhibitory effects of GABA | 2-10 mg IV/IM every 6h PRN | 2-10 mg PO every 6h PRN | Seizure abortion, alcohol withdrawal, agitation, muscle spasm | Respiratory depression, hypotension, Pregnancy Category D |
Diltiazem (Cardizem) | Inhibits Ca influx in myocardium > vascular smooth muscle; prolongs AV nodal conduction | 0.25 mg/kg IV x1, may repeat 0.35 mg/kg IV after 15 min; infusion 5-15 mg/hr | N/A | Stable AFib with RVR, stable SVT | Iatrogenic hypotension, bradycardia, Pregnancy Category C |
Dobutamine | Beta1 agonist > Beta2 agonist | 2-20 mcg/kg/min IV | N/A | Decompensated heart failure, refractory hypotension | Tachycardia, hypotension if not euvolemic, PVCs, Pregnancy Category B |
Dopamine | Alpha1, Beta1, dopaminergic agonist | <5 mcg/kg/min = dopaminergic; 5-10 mcg/kg/min = beta; 10-20 mcg/kg/min = alpha | N/A | Decompensated heart failure, hypotension | Tachydysrhythmias, tissue necrosis if extravasation, need CVC, Pregnancy Category C |
Droperidol (Inapsine) | Dopamine receptor antagonist/alpha receptor antagonist | 1.25-2.5 mg IV every 4h PRN | N/A | Antiemetic, migraine abortion | QT prolongation (Torsades), NMS, EPS, Pregnancy Category C |
Epinephrine/Adrenaline | Alpha and Beta receptor agonist | ACLS: 1 mg 1:10,000 IV (PALS: 0.01 mg/kg), Anaphylaxis: 0.1-0.5 mg 1:1,000 IM, Hypotension: 1-10 mcg/min IV | N/A | Anaphylaxis, ACLS/PALS/NRP arrest, severe asthma | Dosing errors, tissue necrosis (needs CVC), dysrhythmias, Pregnancy Category C |
Enoxaparin (Lovenox) | Binds antithrombin III, inactivates Factor Xa > thrombin | 1 mg/kg SQ(SC) every 12h or 1.5 mg/kg SQ(SC) every 24h | N/A | PE, NSTEMI, unstable angina | Monitor anti-Xa in renal impairment/obesity. Spinal anesthesia/puncture = contraindication. Pregnancy B |
Esmolol | Selective Beta1 antagonist | 500 mcg/kg loading dose, then 50-300 mcg/kg/min infusion | N/A | Aortic dissection | Precipitated CHF, hypotension, bronchospasm, Pregnancy C |
Esomeprazole (Nexium) | Inhibits parietal cell H+/K+ ATPase (PPI) | 80 mg IV bolus, then 8 mg/hr infusion | N/A | Upper GI bleed (non-variceal) | Generally benign acutely, Pregnancy B |
Etomidate | GABA-like effects on reticular formation causing hypnosis | 0.3 mg/kg IV | N/A | RSI induction | Adrenal suppression (questionable), lowers seizure threshold, Pregnancy C |
Fentanyl | Opioid agonist producing analgesia and sedation | 25-100 mcg IV every 1-2h; ~1 mcg/kg | N/A | Analgesia, sedation adjunct | Respiratory depression, hypotension (vasodilation), laryngospasm, Pregnancy C |
Fomepizole | Inhibits alcohol dehydrogenase | 15 mg/kg IV load, then 10 mg/kg every 12h x4, then 15 mg/kg every 12h until EG <20 mg/dL and asymptomatic with normal pH | N/A | Methanol or ethylene glycol toxicity | Fairly safe, Pregnancy C |
Fosphenytoin | Stabilizes voltage-dependent neuronal Na channels | 15-20 mg/kg IV load at 150 mg/min | N/A | Status epilepticus | Rapid admin can cause hypotension/dysrhythmias, need monitoring, Pregnancy D |
Furosemide | Inhibits Na/Cl reabsorption in distal tubule and loop of Henle | 20-40 mg IV initially, reassess; up to 200 mg single dose | N/A | Pulmonary edema, CHF exacerbation, hyperkalemia (if diuresis) | Volume depletion, hypokalemia, metabolic alkalosis, ototoxicity, Pregnancy C |
Glucagon | Increases cAMP independent of beta receptor, gluconeogenesis, glycogenolysis | Beta-blocker/CCB tox: 3-10 mg IV load, then 1-10 mg/hr IV. Hypoglycemia: 1 mg IV/IM/SQ | N/A | Beta-blocker tox, CCB tox, hypoglycemia | Anaphylactoid rxn, hypotension, emesis (aspiration risk), Pregnancy B |
Haloperidol (Haldol) | Dopamine receptor antagonist (D1/D2) | 5-10 mg PO/IM/IV every 2h (max 100 mg/day). Lower doses in elderly start at 1 mg IM | N/A | Agitation, psychosis | Dementia-related psychosis, NMS, EPS, QT prolongation, Pregnancy C |
Heparin | Binds antithrombin III, inactivates thrombin and factors IX, X, XI, XII | VTE: 80 u/kg IV bolus then 18 u/kg/hr. ACS/Afib: 60 u/kg IV then 12 u/kg/hr | N/A | Venous thromboembolism, ACS (enoxaparin preferred in NSTEMI) | Bleeding risk (protamine sulfate reversal), Pregnancy C |
Hydrocortisone | Multiple gluco- and corticosteroid effects | Adrenal insuff: 100 mg IV bolus, then 50 mg IV q6h x24h then taper; Septic shock: 50 mg IV q6h; Status asthmaticus: 1-2 mg/kg IV q6h x24h then maintenance | N/A | Acute adrenal insufficiency, status asthmaticus, vasopressor-refractory shock | Immunosuppression, hyperglycemia, Pregnancy C |
Hydromorphone (Dilaudid) | Opioid agonist producing analgesia & sedation | 1-2 mg IV q3-6h | N/A | Analgesia | Respiratory depression, hypotension (vasodilation). 1 mg IV Dilaudid ~7 mg IV morphine. Pregnancy C |
Insulin regular | Increases peripheral glucose uptake, shifts K intracellularly | HyperK: 5-10 units IV x1. CCB OD: 1 u/kg bolus + 25 g Dextrose if BG<250; then 0.1-1 u/kg/hr with Dextrose to maintain BG 100-200 mg/dL. DKA/HHS: 0.1 u/kg bolus + 0.1 u/kg/hr infusion | N/A | Hyperkalemia, CCB overdose, DKA/HHS | Hypokalemia, hypoglycemia. Only regular insulin IV. Pregnancy B |
Ketamine | NMDA receptor antagonist in cortex/limbic system | Subdissociative: 0.1-0.5 mg/kg IV; Procedural sedation: 0.5-1 mg/kg IV; RSI: 2 mg/kg IV | N/A | Analgesia, sedation, RSI induction | Emergence rxn (treat w/ benzo), laryngospasm, ↑IOP, ↑ICP, tachycardia, HTN, Pregnancy D |
Labetalol | Alpha1, Beta1, Beta2 antagonist | Bolus: 20-80 mg IV q10min PRN; Infusion: 1-8 mg/min IV | N/A | Hypertensive emergency | Precipitated CHF, bradycardia, bronchospasm, Pregnancy C |
Lorazepam (Ativan) | Enhances inhibitory effects of GABA | Bolus: 1-2 mg IV; Continuous: 1-10 mg/hr | N/A | Delirium tremens, status epilepticus, serotonin syndrome, agitation | Respiratory depression, hypotension, Pregnancy D |
Magnesium sulfate | Participates in physiologic processes | Eclampsia: 2-4 g IV over 5 min; Torsades: 2 g IV push; Asthma: 2 g IV over 15 min | N/A | Torsades, ventricular dysrhythmias, status asthmaticus, eclampsia | Hypotension, respiratory depression, Pregnancy A |
Mannitol | Osmotic diuretic | 1 g/kg IV x1 | N/A | Elevated ICP, impending herniation | May cause dehydration, osmotic nephrosis |
Methohexital (Brevital) | Ultra short-acting barbiturate: sedation/hypnosis | 1 mg/kg IV, then 0.5 mg/kg q2-5min PRN | N/A | Procedural sedation | Laryngospasm (treat with more methohexital), respiratory depression, hypotension, Pregnancy B |
Methylprednisolone (SoluMedrol) | Multiple gluco- and mineralocorticoid effects | Asthma: 1 mg/kg IV; Allergy: 1 mg/kg IV; PCP PNA: 30 mg IV BID x5 days then taper | N/A | Severe asthma, PCP pneumonia with A-a gradient >35 or PaO2<70, acute hypersensitivity rxn | Immunosuppression, hyperglycemia, Pregnancy C |
Metoclopramide (Reglan) | Dopamine antagonist in chemoreceptor trigger zone | 10 mg IV q6h PRN | N/A | Vomiting prevention and treatment | Tardive dyskinesia, EPS, dystonia, methemoglobinemia, Pregnancy B |
Midazolam (Versed) | Enhances inhibitory effects of GABA | RSI: 0.1 mg/kg IV; Infusion: 1-10 mg/hr; Procedural sedation: 0.02-0.04 mg/kg IV | N/A | Seizure abortion, procedural sedation, ventilator sedation, RSI | Respiratory depression, hypotension, Pregnancy D |
Morphine sulfate | Opioid agonist producing analgesia/sedation | 2-10 mg IV q2-6h PRN; ~0.1 mg/kg IV | N/A | Pain control | Respiratory depression, hypotension (vasodilation), Pregnancy C |
Nimodipine | Ca channel blocker selective for cerebral arteries | N/A | 60 mg PO q4h | Subarachnoid haemorrhage | Hypotension (minimized due to selectivity), Pregnancy C |
Nitroglycerin | Venodilator, stimulates cGMP production | 5-200 mcg/min IV, increase by 10 mcg q3-5min to effect. Higher doses often for pulmonary edema. | N/A | CHF, angina | Hypotension, methemoglobinemia, Pregnancy C |
Nitroprusside | Direct vasodilator, releases NO | Start 0.3 mcg/kg/min, titrate to effect; max 10 mcg/kg/min | N/A | Hypertensive emergency | CN toxicity, methemoglobinemia, hypotension, Pregnancy C |
Norepinephrine (Levophed) | Alpha1 > Beta1 agonist | 1-30 mcg/min IV | N/A | Hypotension refractory to IV fluids | Tachydysrhythmias, tissue necrosis if extravasation, need CVC, Pregnancy C |
Octreotide | Vasoconstricts (GI vessels), reduces portal pressure | Variceal bleed: 50 mcg IV bolus, then 50 mcg/hr infusion; Sulfonylurea tox: 50 mcg SQ q6h PRN | N/A | Bleeding esophageal varices, sulfonylurea toxicity | Can precipitate biliary disease, Pregnancy B |
Olanzapine | Antagonizes dopamine, histamine, alpha1, and 5HT2 receptors | 5-10 mg IM/day (max 30 mg/day) | 5-10 mg ODT/day (max 30 mg/day) | Agitation, psychosis | Not for dementia-related psychosis, NMS, EPS, orthostatic hypotension, QT prolongation, no IV form, Pregnancy C |
Ondansetron | 5HT3 serotonin receptor antagonist (central) | 4-8 mg IV q4-6h PRN | N/A | Vomiting prevention and treatment | QT prolongation, torsades (rare), Pregnancy B |
Phenobarbital | Barbiturate causing sedation/hypnosis | 20 mg/kg IV x1, may repeat 5-10 mg/kg in 20 min (max 30 mg/kg). Max infusion 50 mg/min | N/A | Status epilepticus | Respiratory depression, hypotension, Pregnancy D |
Prednisone | Various gluco- and mineralocorticoid effects | N/A | 1 mg/kg/day PO (usual 5-60 mg based on response) | Asthma exacerbation, PCP PNA (A-a>35 or PaO2<70), allergic rxn | Immunosuppression, GI ulcer/perforation, hyperglycemia, Pregnancy C |
Propofol | GABAa agonist, Na channel blocker | Procedural sedation: 1 mg/kg IV bolus, then 0.5 mg/kg q3min; RSI: 1.5-2.5 mg/kg IV; Vent sedation: 5-50 mcg/kg/min | N/A | Procedural sedation, RSI induction, ventilator sedation | Hypotension, anaphylaxis, bradycardia, apnea, Pregnancy B |
Protamine sulfate | Ionically binds heparin | 1 mg neutralizes 100 u heparin (max 50 mg) at 5 mg/min | N/A | Heparin-induced bleeding | Anaphylaxis in previous use or fish allergy, rapid infusion → hypotension, Pregnancy C |
Rocuronium | Non-depolarizing neuromuscular blocker | 1 mg/kg IV | N/A | RSI paralysis | Prolonged paralysis, Pregnancy B |
Sodium bicarbonate | Increases serum bicarbonate, increases buffer stores | HyperK/met acidosis: 50 mEq IV x1; TCA OD: 1-2 mEq/kg IV bolus; Salicylate tox: 3 amps (150 mEq) in 1 L D5W, bolus then infusion to maintain urine pH 7.5-8 | N/A | Hyperkalemia, TCA toxicity, salicylate toxicity, metabolic acidosis | Caution in CHF, risk of metabolic alkalosis, hypernatremia, Pregnancy C |
Succinylcholine | Depolarizing neuromuscular blocker | 1.5 mg/kg IV (or 3-4 mg/kg IM) | N/A | RSI paralysis | Hyperkalemia, subacute burn/crush injury (↑K), glaucoma (↑IOP), ↑ICP, Pregnancy C |