|
Class: Antiarrhythmic
|
|
Drug
|
Use
|
Concentration
|
Dose |
Notes
|
|
Amiodarone (Cordarone®)
|
Management of life-threatening recurrent VF or
hemodynamically unstable VT.
|
Standard: 900 mg/500 mL D5W
|
Bolus: 150 mg/100 mL D5W
over 10 min
Standard:
1 mg/min (33.3 mL/hr) for 6 hrs then 0.5 mg/min
(16.6 mL/hr)
|
Adverse Effects: Hypotension, bradycardia,
proarrhythmic events, peripheral neuropathy,
thyroid dysfunction, nausea, vomiting, pulmonary
toxicity
|
|
Procainamide (Pronestyl®)
|
VT, PVC, PAT, A-fib
|
Standard:2 gm/500mL D5W, NS;
Max: 2 gm/250 mL
|
Bolus:
500 mg – 1 gm over 30 min
Standard: 1-6 mg/min
|
Adverse Effects: Hypotension, Av-block,
bradycardia, lupus-like syndrome, fever, rash,
thrombocytopenia and hemolytic anemia
|
|
Lidocaine (Xylocaine®)
|
ventricular arrhythmias
|
Standard:2 gm/500 mL
|
1-4 mg/min
|
Adverse Effects: Confusion, hypotension,
lightheadedness, diplopia, seizures, and
tinnitus
►Contraindicated
in complete or 2nd degree AV block
|
|
Class: Beta Blockers
|
|
Drug |
Use
|
Concentration
|
Dose
|
Notes
|
|
Esmolol (Breviblock®)
|
Control of ventricular rate in atrial
fib/flutter and noncompensating sinus
tachycardia
|
Standard: 2500 mg/250mL NS;
Max: 20 mg/mL in D5W, NS
|
Loading: 500 mcg/kg/min over 1
min
Maint.: 50 mcg/kg/min
|
If HR not controlled repeat loading dose and
é rate by 50
mcg/kg/min (max 200 mcg/kg/min);
►Central
line recommended for max concentration
►Contraindications:
sinus bradycardia,
AVB > 1°, cardiogenic shock
|
|
Class: Calcium Channel Blockers
|
|
Drug |
Use
|
Concentration
|
Dose
|
Notes
|
|
Diltiazem (Cardizem®) |
HR control during atrial fib and flutter for 24
hours |
Standard: 125 mg/125 mL D5W, NS |
Loading: 0.25 mg/kg over 2 min;
if inadequate response, 0.35 mg/kg over 2 min
Initial: 5 mg/hr
Max Rate: 15 mg/hr
|
↓HR,
↓BP,
pruritis
Contraindications:
AVB > 1°, WPW syndrome, V-tach, SSS,
short PR syndrome |
|
NiCARdipine (Cardene®) |
Antianginal, antihypertensive |
Standard: 25 mg/250 mL D5W, NS |
5 mg/hr, increase by 2.5 mg/hr q 15 min to a max
of 15 mg/hr
After response is achieved: 3 mg/hr
|
Adverse effects:
flushing,
↑HR,
palpitations, angina |
|
Class: Inotrope
|
|
Drug
|
Use
|
Concentration
|
Dose
|
Notes
|
|
Milrinone (Primacor®) |
↓PCWP,
↓SVR,
↓MAP |
Standard: 40 mg/200 mL D5W
Max. 40 mg/200 mL
|
Loading: 50 mcg/kg over 10 min
Maint: 0.375 – 0.75 mcg/kg/min |
Adverse Effects:
↑PVC,
ventricular arrhythmia, ventricular fib, SV
arrhythmia, angina, hypotension, HA |
|
DOBUTamine (Dobutrex®) |
↑SV,
↑contractility,
↑CO,
↑HR |
Standard: 500 mg/250 mL D5W
Max: 1250 mg/250 mL D5W or NS
|
Initial: 1-5 mcg/kg/min up to
20 mcg; titrate by 1-4
mcg/kg/min q 10-30 min
Max Rate: 50 mcg/kg/min
|
Note:
alpha effects predominate above 10
mcg/kg/min)
Adverse Effects:
tachycardia, arrhythmia, HA, NV |
|
Epinephrine (Adrenalin®) |
↑HR,
↑contractility,
↑cardiac
workload
↑PA
pressures,
↑CO,
can convert asystole to NSR |
Standard: 4 mg/250 mL D5W, NS
Max: 1 mg/10 mL |
Initial: 0.05-10 mcg/min, then
titrate |
►Central
line administration
Note:
at 20 mcg/min pure alpha effects occur)
Adverse Effects:
tachycardia, arrhythmia, PE, HTN, HA,
resp. distress
|
|
Class: Sympathomimetics
|
|
Drug |
Use
|
Concentration
|
Dose
|
Notes
|
|
DOPamine (Intropin®) |
↑BP,
↑PCWP,
↑HR |
Standard: 800 mg/500 mL D5W
Max: 800 mg/250 mL D5W
|
Initial: 1-5 mcg/kg/min up to
20 mcg; titrate by 1-4 mcg/kg/min q 10-30 min
Max Rate: 50 mcg/kg/min |
Note:
alpha effects predominate above 10
mcg/kg/min)
Adverse Effects:
tachycardia, arrhythmia, HA, NV |
|
Epinephrine (Adrenalin®) |
↑HR,
↑contractility,
↑cardiac
workload
↑PA
pressures,
↑CO,
can convert asystole to NSR |
Standard: 4 mg/250 mL D5W, NS
Max: 1 mg/10 mL |
Initial: 0.05-10 mcg/min, then
titrate |
►Central
line administration
Note:
at 20 mcg/min pure alpha effects occur)
Adverse Effects:
tachycardia, arrhythmia, PE, HTN, HA,
resp. distress |
|
Class: Sympathomimetic / Vasopressors
|
|
Drug |
Use
|
Concentration
|
Dose
|
Notes
|
|
Norepinephrine (Levovphed®) |
↑BP,
↑PA
pressure,
↑SVR,
↑myocradial
workload |
Standard:
4 mg/250 mL D5W
only
Max: 16 mg/250mL D5W
only |
Initial:
0.5-1 mcg/min: titrate to desired
response
Usual 2-30 mcg/min |
►Central
line administration
Adverse Effects:
brady or tachycardia, peripheral
vasoconstriction, HA, HTN, arrhythmia, ↓urine
output, acidosis, hyperglycemia |
|
Phenylephrine (Neo-Synephrine®) |
↑BP,
↑SVRM,
↑PA pressure,
↑myocardial
workload |
Standard: 100 units/100 mL D5W,
NS |
Initial: 0.05 units/min
Max: 360 mcg/min
Maint Rate: 40-60 mcg/min |
Adverse Effects:
arrhythmias, cardiac arrest, ↓CO, angina,
myocardial ischemia and periph constriction.
Doses > 0.04 units/min associated with more
cardiovascular adverse effects |
|
Vasopressin (Pitressin®) |
For unlabeled use in septic shock |
Standard: 100 units/100mL D5W,
NS |
Initial: 0.04 units/min
(range 0.01-0.04 units/min) |
►Central
line administration |
|
Class: Vasodilators
|
|
Drug |
Use
|
Concentration
|
Dose
|
Notes
|
|
Sodium nitroprusside (Nipride®) |
↓BP,
↓SVR,
↓PCWP
↓CO |
Standard:
50 mg/250 mL D5W
Max: 100 mg/250 mL D5W |
Average Dose: 3 mcg/kg/min
Max: 10 mcg/kg/min |
►Protect
from light
Adverse Effects:
metabolic acidosis, severe hypotension,
HA, nausea, dyspnea, LOC, thiocyanate toxicity
(esp. with prolonged infusion > 2 mcg/kg/min) |
|
Nitroglycerin (Tridyl®) |
↓BP,
↓SVR,
↓PCWP, may
↑HR
|
Standard: 50 mg/250 mL D5W |
Initial: 5 mcg/min, increasing
by 5 mcg/min q 3-5 min up to 20 mcg/min
Max Rate doses of up to 640
mcg/min have been used
Then titrate in increments of 10-20 mcg/min up
to 200 mcg/min |
►Non
PVC tubing
Adverse Effects:
severe hypotension, reflex tachycardia,
HA, N/V
Associated with development of tolerance over
24-48 hrs. |
|
Class: Miscellaneous
|
|
Drug |
Use
|
Concentration
|
Dose
|
Notes
|
|
PENTObarbital (Nembutal®) |
Barbiturate used to induce coma |
Standard:
undiluted 50 mg/mL |
10 mg/kg over 30 min, then 5 mg/kg/hr × 3 hours,
then 1-2.5 mg/kg/hr thereafter
If ICP > 20 mg HG and pentobarb conc < 3 mg/dL
may admin additional 5 mg/kg |
♦♦Must
be intubated. Monitor EEG (i.e. burst
suppression 30-45 sec) and hemodynamic status♦♦
|
|
Thiopental (Pentothal®) |
Barbiturate used to induce coma |
Standard:
25 mg/mL D5W, NS |
20 mg/kg over 1 hour, then 10 mg/kg/hr × 6
hours, then 3 mg/kg/hr thereafter |
♦♦Must
be intubated. Monitor EEG (i.e. burst
suppression 30-45 sec) and hemodynamic status♦♦ |
|
Methylprednisolone (Solumedrol®) |
For spinal cord injury |
|
Bolus: 30 mg/kg in 100 mL D5W NS over 30 minutes
Maint: 5.4 mg/kg in 500 mL × 23 hours |
|
|
Argatroban (ARGATROBAN®) |
|
Standard:
250 mg/250 mL D5W, NS |
Initial 2 mcg/kg/min
(0.5 mcg/kg/min in severe hepatic dysfunction) |
|