AAEM 50 Drugs to Know

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(source) – Thanks to Dan Boron-Brenner for putting these into a more useable format!

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All 50 Drugs

DRUGMOADOSE IVDOSE POINDICATIONCONTRAINDICATION
AcetylcysteineReplenishes glutathione stores, serves as a glutathione substitute, and enhances sulfate conjugation of acetaminophen (tylenol)150 mg/kg in 200 mL D5W over 1 hour, 50 mg/kg in 500 mL D5W over 4 hours, 100 mg/kg in 1 liter D5W over 16 hours (21 total hours, may need continuous LFTs and APAP level until liver transaminases normalize)140 mg/kg x 1, then 70 mg/kg q4hrs x 17 doses (for 72 hours total)APAP ODhypersensitivty rxn (stop infusion, switch to PO or slow infusion rate), rare. Can also see hypersensitivity rxn with PO as well. Pregnancy category B.
AdenosineActs on A1 receptors in AV node, causing temporary heart block6 mg IV RAPID push, may giev 12 mg IV q2 minutes if no effect x 2N/AStable SVT, stable narrow complex tachycardiaprodysrhythmic, do not give in preexisting 2nd/3rd degree heart block, pregnancy category C
AlbuterolSelective beta2 agonist2.5-5 mg q20 min for 1st hour, then 2.5-10 mg q1-4 hours prn (alt, 10-15 mg over 1 hour)N/AAcute bronchospasm, hyperkalemiaHypokalemia, tachycardia, hyperglycemia, preg category C
AmiodaroneBlocks K efflux (Class III antidysrhythmic); also has Na channel blocking (class I), beta blocking (class II), and Ca channel blocking (class IV) propertiesPulseless VF/VT: 300mg IV rapid push followed by 150mg IV rapid push if necessary at next pulse check Stable wide complex tachycardias: 150mg IV over 10 minutes, followed by infusion of 1mg/min x 6hours, then 0.5 mg/min thereafterN/APulseless VT/VF, wide complex tachydysrhythmiasCauses hypotension, can be prodysrhythmic, Preg category D
AtropineDirect anticholinergicOrganophosphate/carbamate toxicity: 1-6 mg IV q3-5 minutes PRN until cessation of secretion (can double dose each time until adequate response achieved). Peds bradycardia: 0.02 mg/kg IV x 1; 0.5 mg max single dose; 1 mg max cumulative dose. Adult bradycardia: 0.5 mg IV, 3 mg max cumulative doseN/AOrganophosphate/carbamate poisoning, bradycardiahyperthermic patients, tachydysrhythmias, preg category C
Calcium gluconate/chlorideIncreases serum calcium, stabilizes cardiac myocytes10% IV solution (gluconate or chloride) contains 1 g per 10 mLN/AHyperkalemia, hypocalcemia with dysrhythmiadysrhythmia, tetany, calcium chloride 3x more potent than calcium gluconate (severe phlebitis with peripheral administration of calcium chloride -> CVCs only), Preg category C
Diazepam (Valium)Enhances inhibitory effects of GABA2-10 mg IV/IM q6hrs PRN2-10 mg PO q6hrs PRNSeizure abortion, alcohol withdrawal, agitation, muscle spasmRespiratory depression, hypotension, preg category D
Diltiazem (Cardizem)inhibits calcium influx in myocardium > vascular smooth muscle; prolongs AV nodal conduction0.25 mg/kg IV x1, may give 0.35 mg/kg IV x1 after 15 minutes; continous infusion 5-15 mg/hrN/AStable Afib with RVR, stable SVTIatrogenic hypotension, bradycardia, Preg category C
DobutamineBeta 1 agonist > beta 2 agonist2-20 mcg/kg/min IVN/ADecompensated heart failure, refractory hypotensiontachycardia, hypotension if not euvolemic, PVCs, Preg B
DopamineAlpha1, beta1, and dopaminergic agonist<5 mcg/kg/min IV = dopaminergic effects (not recommended); 5-10 mcg/kg/min IV = beta agonist effects, 10-20 mcg/kg/min IV = alpha agonist effectsN/ADecompensated heart failure, hypotensiontachydysrhythmias, tissue necrosis if extravastion or arterial administration occurs -> need CVC, Preg C
Droperidol (Inapsine)Dopamine receptor antagonist/alpha receptor antagonist1.25-2.5 mg IV q4hrs PRNN/AAntiemetic, migraine abortionQT prolongation (i.e. Torsades), NMS, extrapyramidal side effects, Preg C
Epinephrinealpha and beta receptor agonistACLS: 1 mg 1:10,000 IV (PALS 0.01 mg/kg 1:10,000 IV), Anaphylaxis: 0.1-0.5 mg 1:1,000 IM/SQ (IM preferred), Peds anaphylaxis: 0.01 mg/kg 1:1,000 IM/SQ (max single dose 0.3 mg), Hypotension refractory to IVF: 1-10 mcg/min IVN/AAnaphylaxis, ACLS arrest, PALS/NRP arrest, severe asthmaBeware dosing errors!, tissue necrosis (needs toadministered via central venous line), dysrhythmias, Preg C
Enoxaparin (lovenox)Binds to antithrombin III and inactives Factor Xa > thrombin1 mg/kg SQ q12 hrs OR 1.5 mg/kg SQ q24 hrsN/APE, NSTEMI, unstable anginaMonitor anti Xa levels in renal impairment or obesity (> 150 kg actual body weight), concomitant use with spinal anesthesia/analgesia or spinal puncture is an absolute contraindication (black box warning), Preg B
EsmololSelective beta1 antagonist500 mcg/kg loading dose -> then continuous infusion of 50-300 mcg/kg/minN/AAortic dissectionPrecipitated CHF, hypotension, bronchospasm, Preg C
Esomeprazole (Nexium)inhibits parietal cell hydrogen-potassium ATPase (PPI)80 mg IV bolus followed by 8 mg/hourN/AUpper GI bleed (non-variceal)Fairly benign when used acutely, Preg B
EtomidateGABA-like effects on brain stem reticular formation causing hypnosis0.3 mg/kg IVN/ARSI inductionAdrenal/cortisol depression (although questionable clinical significance for single administration), lowers seizure threshold, Preg C
Fentanylopioid agonist producing analgesia with adjunctive sedative effects25-100 mcg IV q 1-2 hours; recommended dose 1 mcg/kgN/AAnalgesia, sedation adjunctrespiratory depression, vasodilation (hypotension), laryngospasm, Preg C
FomepizoleInhibits alcohol dehydrogenase15 mg/kg IV loading dose -> 10 mg/kg q12 hrs x 4 doses -> 15 mg/kg q12 hrs until ethylene glycol levels < 20 mg/dL and patient asymptomatic with a normal pHN/AMethanol or ethylene glycol toxicityFairly safe, Preg C
Fosphenytoinstabilizes voltage dependent neuronal Na channels to stop seizure activity15-20 mg/kg IV loading dose administered at 150 mg/minN/AStatus epilepticusrapid administration can cause hypotension or dysrhythmias, give with patient on monitor, Preg D
Furosemideinhibits Na and Cl reabsorption in distal renal tubule and ascending loop of Henleusual dose in ED 20-40 mg IV, reassess, increase to desired effect (maximum single dose 200mg)N/APulmonary edema, CHF exacerbation, hyperkalemia (if they pee)volume depletion, hypokalemia, metabolic alkalosis, ototoxicity, Preg C
GlucagonStimulates cAMP production independent of beta receptor, increases gluconeogenesis and glycogenolysisBeta-blocker/calcium-channel blocker tox: 3-10 mg IV loading dose, then 1-10 mg/hour IV continuous infusion if responsive to loading dose, hypogylcemia: 1 mg IV/SQ/IMN/ABeta-blocker tox, calcium channel blocker tox, hypoglycemiaAnaphylactoid reaction, hypotension, emesis (aspiration risk in altered patients), Preg B
Haloperidol (Haldol)Dopamine receptor antagonist (D1/D2)5-10 mg PO/IM/IV q 2 hours (max 100 mg/day)N/AAgitation, psychosisDementia-related psychosis, NMS, EPS, QT prolongation, Preg C
Heparinbinds to antithrombin III thereby potentiating inactivation of thrombin and factors IX, Xa, XI, XII; prevents fibrinogen → fibrin; preferential inactivation of thrombin over other clotting factorsVenous thromboembolism: 80 units/kg IV x 1, then 18 units/kg/hr, ACS or Afib: 60 units/kg IV x 1, then 12 units/kg/hr N/AVenous thromboembolism, ACS (enoxaparin preferred for NSTEMI)Bleeding (protamine sulfate may be given for reversal), bleeding, Preg C
Hydrocortisonemultiple gluco- and corticosteroid effectsAdrenal insufficiency: 100 mg IV bolus, then 50 mg IV q6 hrs for 24 hours followed by a taper, Septic shock: 50 mg IV q 6hrs, Status asthmaticus: 1-2 mg/kg IV q6hrs x 24 hrs followed by a maintenance regimenN/AAcute adrenal insufficiency, status asthmaticus, vasopressor refractory shock, Immunosuppression, hyperglycemia, Preg C
Hydromorphone (Dilaudid)opioid agonist producing analgesia with adjunctive sedative effects1-2 mg IV q 3-6 hrsN/AAnalgesiaRespiratory depression, vasodilation (hypotension), 1 mg of IV Dilaudid is approximately equal to 7 mg of IV morphine, Preg C
Insulin regularIncreased peripheral glucose uptake, increased inotropy, shifts potassium intracellularlyHyperkalemia: 5-10 units IV x 1, CCB OD: 1 unit/kg bolus given with 25 grams of dextrose if initial BG< 250 mg/dL; then initiate insulin drip at 0.1 – 1 unit/kg/hr titrated to SBP along with 0.5 g/kg/hr of dextrose titrated to maintain BG 100 – 200 mg/dL, DKA/HHS: 0.1 unit/kg bolus followed by continuous infusion 0.1 unit/kg/hrN/AHyperkalemia, CCB OD, DKA/HHSHypokalemia, hypoglycemia, only regular insulin can be given IV, Preg B
KetamineNMDA receptor antagonist, acts on cortex and limbic systemSubdissociative: 0.1-0.5 mg/kg IV, procedural sedation: 0.5-1 mg/kg IV, RSI induction: 2 mg/kg IV N/AAnalgesia, sedation, RSI inductionemergence reactions (treat with benzos or barbs),laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D
LabetalolAlpha 1, beta 1, and beta 2 antagonistBolus dose: 20-80 mg/IV q10 minutes PRN, Continous infusion: 1-8 mg/min continuous infusion titrated to effectN/AHypertensive emergencyPrecipitated CHF, bradycardia, bronchospasm, Preg C
Lorazepam (Ativan)Enhances inhibitory effects of GABAUsual bolus dose: 1-2 mg IV, usual continous infusion: 1-10 mg/hrN/Adelirium tremens, status epilepticus, serotonin syndrome, agitationRespiratory depression, hypotension, preg category D
Magnesium sulfateParticipates in physiologic processesEclampsia: 2-4 g IV over 5 minutes, Pulseless Torsades: 2 g IV push, Asthma exacerbation: 2 g IV over 15 minutesN/ATorsades, ventricular dysrhythmias, status asthmaticus, eclampsiaHypotension, respiratory depression, Preg A
MannitolOsmotic diuretic1 gm/kg IV x 1N/AElevated ICP, impending hernationMay cause dehydration, osmotic nephrosis
Methohexital (Brevital)Produces cortical and cerebellar sedation, hypnosis (ultra short-acting barbiturate)1 mg/kg IV, then 0.5 mg/kg q2-5 min PRNN/AProcedural sedationLaryngospasm (give more methohexital), respiratory depression, hypotension, Preg B
Methylprednisolone (SoluMedrol)Multiple gluco- and mineralcorticoid effectsAsthma: 1 mg/kg IV, Hypersensitivity reaction: 1 mg/kg IV, PCP PNA: 30 mg IV BID x 5 days followed by gradual taperN/Asevere asthma, PCP PNA with elevated A-a gradient or PaO2 < 70 mmHg, acute hypersensitivity reactionImmunosuppression, hyperglycemia, Preg C
Metoclopramide (Reglan)antagonizes dopamine receptors in the chemoreceptor trigger zone10 mg IV q 6 hrs PRNN/AVomiting prevention and treatmentTardive dyskinesia, extrapyramidal signs, dystonia, methemoglobinemia, Preg B
Midazolam (Versed)Enhances inhibitory effects of GABARSI induction: 0.1 mg/kg IV, Usual continuous infusion: 1-10 mg/hr, Procedural sedation: 0.02-0.04 mg/kg IVN/ASeizure abortion, procedural sedation, ventilator sedation, RSIRespiratory depression, hypotensive effects, Preg D
Morphine sulfateopioid agonist producing analgesia with adjunctive sedative effects2-10 mg IV q2-6 hrs PRN; recommended dose 0.1 mg/kg IVN/APain controlRespiratory depression, vasodilation (hypotension), Preg C
NimodipineCa+ channel blocker that is selective for cerebral arteriesN/A60 mg PO q4hrs Sub-arachnoid hemorrhageHypotension (although minimized due to its selectivity), Preg C
Nitroglycerinvenodilator, stimulates cGMP production5-200 mcg/min, increase 10 mcg q 3-5 min until desired effect; higher doses are usually required for pulmonary edema -> start at doses >5 mcg/minN/ACHF, anginaHypotension, methemoglobinemia, Preg C
NitroprussideDirect vasodilator, breaks down to release NOInitiate at 0.3 mcg/kg/min IV and titrate to effect; max dose 10 mcg/kg/min; if BP not controlled after 10 minutes at max dose, nitroprusside should be discontinuedN/AHypertensive emergencyCN toxicity, methemoglobinemia, hypotension, Preg C
Norepinephrine (Levophed)alpha 1 agonist > beta 1 agonist1-30 mcg/min IVN/AHypotension refractory to IVFtachydysrhythmias, tissue necrosis if extravastion or arterial administration occurs -> need CVC, Preg C
Octreotidevasoconstricts vessels (more selective for GI vessels), reduces portal vessel pressureBleeding esophageal varices: 50 mcg IV bolus, then 50 mcg/hour IV, Sulfonylurea toxicity: 50 mcg subq q 6hrs PRNN/ABleeding esophageal varices, sulfonylurea toxicityPrecipitated biliary disease, Preg B
Olanzapine Antagonizes dopamine, histamine, alpha1, and 5HT2 receptors5-10 mg IM/day (max 30 mg/day)5-10 mg ODT/day (max 30 mg/day)Agitation, psychosisdo NOT give for dementia-related psychosis, NMS, EPS, orthostatic hypotension, QTc prolongation, not to be given IV, preg C
OndansetronAntagonizes serotinin 5HT3 receptors, centrally acting antiemetic4-8 mg IV q4-6hrs PRNN/AVomiting prevention and treatmentQT prolongation, torsades (rare), Preg B
Phenobarbitalbarbiturate, causes sedation, hyponsis, and anesthesia20 mg/kg IV x1, may repeat with an additional 5-10 mg/kg dose in 20 minutes (max dose 30 mg/kg); max infusion rate 50 mg/minN/AStatus epilepticusrespiratory depression, hypotension, preg category D
PrednisoneProduces various gluco- and mineralcorticoid effectsN/A1 mg/kg/day PO (usual dose 5-60 mg based on patient response)Asthma exacerbation, PCP PNA with A-a gradient >35 or PaO2 < 70mmHg, allergic reactionImmunosuppression, GI ulceration/perforation, hyperglycemia, Preg C
PropofolGABAa agonist, Na channel blockerProcedural sedation: 1 mg/kg IV bolus then 0.5 mg/kg q 3 minutes to effect, RSI: 1.5-2.5 mg/kg IV x 1, Ventilator sedation: 5-50 mcg/kg/minN/AProcedural sedation, RSI induction, ventilator sedationHypotension, anaphylaxis, bradycardia, apnea, Preg B
Protamine sulfateIonically binds heparin1 mg neutralizes 100 units of heparin (max dose 50 mg), administer at rate of 5 mg/minuteN/AHeparin induced bleedingAnaphylaxis in previous use or fish allergy, rapid infusion can cause hypotension, Preg C
RocuroniumNon-depolarizing neuromuscular agent1 mg/kg IVN/ARSI paralysisProlonged paralysis, Preg B
Sodium bicarbonateIncreases serum bicarbonate (increases buffer stores)Hyperkalemia or metabolic acidosis: 50 mEq IV x 1 (1 amp = 50 mEq), TCA toxicity: 1-2 mEq/kg IV bolus to achieve serum pH of 7.45-7.55 and QRS narrowing (effective serum alkalinization unlikely with continuous infusion), Salicylate toxicity: 3 amps (150 mEq) in 1 L D5W given as 10-20 ml/kg bolus, then 2-3 ml/kg/hr; goal urine pH 7.5-8.0N/AHyperkalemia, TCA toxicity, salicylate toxicity, metabolic acidosisCaution in CHF, overshooting into metabolic alkalosis, hypernatremia, Preg C
SuccinylcholineDepolarizing neuromuscular agent1.5 mg/kg (or 3-4 mg/kg IM)N/ARSI paralysisHyperkalemia, subacute burn/crush injury with hyperkalemia, glaucoma (increases IOP), increases ICP, Preg C

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Antidotes

DRUGMOADOSE IVDOSE POINDICATIONCONTRAINDICATION
AcetylcysteineReplenishes glutathione stores, serves as a glutathione substitute, and enhances sulfate conjugation of acetaminophen (tylenol)150 mg/kg in 200 mL D5W over 1 hour, 50 mg/kg in 500 mL D5W over 4 hours, 100 mg/kg in 1 liter D5W over 16 hours (21 total hours, may need continuous LFTs and APAP level until liver transaminases normalize)140 mg/kg x 1, then 70 mg/kg q4hrs x 17 doses (for 72 hours total)APAP ODhypersensitivty rxn (stop infusion, switch to PO or slow infusion rate), rare. Can also see hypersensitivity rxn with PO as well. Pregnancy category B.
AtropineDirect anticholinergicOrganophosphate/carbamate toxicity: 1-6 mg IV q3-5 minutes PRN until cessation of secretion (can double dose each time until adequate response achieved). Peds bradycardia: 0.02 mg/kg IV x 1; 0.5 mg max single dose; 1 mg max cumulative dose. Adult bradycardia: 0.5 mg IV, 3 mg max cumulative doseN/AOrganophosphate/carbamate poisoning, bradycardiahyperthermic patients, tachydysrhythmias, preg category C
FomepizoleInhibits alcohol dehydrogenase15 mg/kg IV loading dose -> 10 mg/kg q12 hrs x 4 doses -> 15 mg/kg q12 hrs until ethylene glycol levels < 20 mg/dL and patient asymptomatic with a normal pHN/AMethanol or ethylene glycol toxicityFairly safe, Preg C
GlucagonStimulates cAMP production independent of beta receptor, increases gluconeogenesis and glycogenolysisBeta-blocker/calcium-channel blocker tox: 3-10 mg IV loading dose, then 1-10 mg/hour IV continuous infusion if responsive to loading dose, hypogylcemia: 1 mg IV/SQ/IMN/ABeta-blocker tox, calcium channel blocker tox, hypoglycemiaAnaphylactoid reaction, hypotension, emesis (aspiration risk in altered patients), Preg B
Insulin regularIncreased peripheral glucose uptake, increased inotropy, shifts potassium intracellularlyHyperkalemia: 5-10 units IV x 1, CCB OD: 1 unit/kg bolus given with 25 grams of dextrose if initial BG< 250 mg/dL; then initiate insulin drip at 0.1 – 1 unit/kg/hr titrated to SBP along with 0.5 g/kg/hr of dextrose titrated to maintain BG 100 – 200 mg/dL, DKA/HHS: 0.1 unit/kg bolus followed by continuous infusion 0.1 unit/kg/hrN/AHyperkalemia, CCB OD, DKA/HHSHypokalemia, hypoglycemia, only regular insulin can be given IV, Preg B
Protamine sulfateIonically binds heparin1 mg neutralizes 100 units of heparin (max dose 50 mg), administer at rate of 5 mg/minuteN/AHeparin induced bleedingAnaphylaxis in previous use or fish allergy, rapid infusion can cause hypotension, Preg C
Sodium bicarbonateIncreases serum bicarbonate (increases buffer stores)Hyperkalemia or metabolic acidosis: 50 mEq IV x 1 (1 amp = 50 mEq), TCA toxicity: 1-2 mEq/kg IV bolus to achieve serum pH of 7.45-7.55 and QRS narrowing (effective serum alkalinization unlikely with continuous infusion), Salicylate toxicity: 3 amps (150 mEq) in 1 L D5W given as 10-20 ml/kg bolus, then 2-3 ml/kg/hr; goal urine pH 7.5-8.0N/AHyperkalemia, TCA toxicity, salicylate toxicity, metabolic acidosisCaution in CHF, overshooting into metabolic alkalosis, hypernatremia, Preg C

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Cardiac

DRUGMOADOSE IVDOSE POINDICATIONCONTRAINDICATION
AdenosineActs on A1 receptors in AV node, causing temporary heart block6 mg IV RAPID push, may giev 12 mg IV q2 minutes if no effect x 2N/AStable SVT, stable narrow complex tachycardiaprodysrhythmic, do not give in preexisting 2nd/3rd degree heart block, pregnancy category C
AmiodaroneBlocks K efflux (Class III antidysrhythmic); also has Na channel blocking (class I), beta blocking (class II), and Ca channel blocking (class IV) propertiesPulseless VF/VT: 300mg IV rapid push followed by 150mg IV rapid push if necessary at next pulse check Stable wide complex tachycardias: 150mg IV over 10 minutes, followed by infusion of 1mg/min x 6hours, then 0.5 mg/min thereafterN/APulseless VF/VT, wide complex tachydysrhythmiasCauses hypotension, can be prodysrhythmic, Preg category D
AtropineDirect anticholinergicOrganophosphate/carbamate toxicity: 1-6 mg IV q3-5 minutes PRN until cessation of secretion (can double dose each time until adequate response achieved). Peds bradycardia: 0.02 mg/kg IV x 1; 0.5 mg max single dose; 1 mg max cumulative dose. Adult bradycardia: 0.5 mg IV, 3 mg max cumulative doseN/AOrganophosphate/carbamate poisoning, bradycardiahyperthermic patients, tachydysrhythmias, preg category C
Calcium gluconate/chlorideIncreases serum calcium, stabilizes cardiac myocytes10% IV solution (gluconate or chloride) contains 1 g per 10 mLN/AHyperkalemia, hypocalcemia with dysrhythmiadysrhythmia, tetany, calcium chloride 3x more potent than calcium gluconate (severe phlebitis with peripheral administration of calcium chloride -> CVCs only), Preg category C
Diltiazem (Cardizem)inhibits calcium influx in myocardium > vascular smooth muscle; prolongs AV nodal conduction0.25 mg/kg IV x1, may give 0.35 mg/kg IV x1 after 15 minutes; continous infusion 5-15 mg/hrN/AStable Afib with RVR, stable SVTIatrogenic hypotension, bradycardia, Preg category C
DobutamineBeta 1 agonist > beta 2 agonist2-20 mcg/kg/min IVN/ADecompensated heart failure, refractory hypotensiontachycardia, hypotension if not euvolemic, PVCs, Preg B
DopamineAlpha1, beta1, and dopaminergic agonist<5 mcg/kg/min IV = dopaminergic effects (not recommended); 5-10 mcg/kg/min IV = beta agonist effects, 10-20 mcg/kg/min IV = alpha agonist effectsN/ADecompensated heart failure, hypotensiontachydysrhythmias, tissue necrosis if extravastion or arterial administration occurs -> need CVC, Preg C
Epinephrinealpha and beta receptor agonistACLS: 1 mg 1:10,000 IV (PALS 0.01 mg/kg 1:10,000 IV), Anaphylaxis: 0.1-0.5 mg 1:1,000 IM/SQ (IM preferred), Peds anaphylaxis: 0.01 mg/kg 1:1,000 IM/SQ (max single dose 0.3 mg), Hypotension refractory to IVF: 1-10 mcg/min IVN/AAnaphylaxis, ACLS arrest, PALS/NRP arrest, severe asthmaBeware dosing errors!, tissue necrosis (needs toadministered via central venous line), dysrhythmias, Preg C
EsmololSelective beta1 antagonist500 mcg/kg loading dose -> then continuous infusion of 50-300 mcg/kg/minN/AAortic dissectionPrecipitated CHF, hypotension, bronchospasm, Preg C
Furosemideinhibits Na and Cl reabsorption in distal renal tubule and ascending loop of Henleusual dose in ED 20-40 mg IV, reassess, increase to desired effect (maximum single dose 200mg)N/APulmonary edema, CHF exacerbation, hyperkalemia (if they pee)volume depletion, hypokalemia, metabolic alkalosis, ototoxicity, Preg C
LabetalolAlpha 1, beta 1, and beta 2 antagonistBolus dose: 20-80 mg/IV q10 minutes PRN, Continous infusion: 1-8 mg/min continuous infusion titrated to effectN/AHypertensive emergencyPrecipitated CHF, bradycardia, bronchospasm, Preg C
Magnesium sulfateParticipates in physiologic processesEclampsia: 2-4 g IV over 5 minutes, Pulseless Torsades: 2 g IV push, Asthma exacerbation: 2 g IV over 15 minutesN/ATorsades, ventricular dysrhythmias, status asthmaticus, eclampsiaHypotension, respiratory depression, Preg A
Nitroglycerinvenodilator, stimulates cGMP production5-200 mcg/min, increase 10 mcg q 3-5 min until desired effect; higher doses are usually required for pulmonary edema -> start at doses >5 mcg/minN/ACHF, anginaHypotension, methemoglobinemia, Preg C
NitroprussideDirect vasodilator, breaks down to release NOInitiate at 0.3 mcg/kg/min IV and titrate to effect; max dose 10 mcg/kg/min; if BP not controlled after 10 minutes at max dose, nitroprusside should be discontinuedN/AHypertensive emergencyCN toxicity, methemoglobinemia, hypotension, Preg C
Norepinephrine (Levophed)alpha 1 agonist > beta 1 agonist1-30 mcg/min IVN/AHypotension refractory to IVFtachydysrhythmias, tissue necrosis if extravastion or arterial administration occurs -> need CVC, Preg C

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Endocrine

DRUGMOADOSE IVDOSE POINDICATIONCONTRAINDICATION
GlucagonStimulates cAMP production independent of beta receptor, increases gluconeogenesis and glycogenolysisBeta-blocker/calcium-channel blocker tox: 3-10 mg IV loading dose, then 1-10 mg/hour IV continuous infusion if responsive to loading dose, hypogylcemia: 1 mg IV/SQ/IMN/ABeta-blocker tox, calcium channel blocker tox, hypoglycemiaAnaphylactoid reaction, hypotension, emesis (aspiration risk in altered patients), Preg B
Hydrocortisonemultiple gluco- and corticosteroid effectsAdrenal insufficiency:100 mg IV bolus, then 50 mg IV q6 hrs for 24 hours followed by a taper, Septic shock: 50 mg IV q 6hrs, Status asthmaticus: 1-2 mg/kg IV q6hrs x 24 hrs followed by a maintenance regimenN/AAcute adrenal insufficiency, status asthmaticus, vasopressor refractory shock, Immunosuppression, hyperglycemia, Preg C
Insulin regularIncreased peripheral glucose uptake, increased inotropy, shifts potassium intracellularlyHyperkalemia:5-10 units IV x 1, CCB OD: 1 unit/kg bolus given with 25 grams of dextrose if initial BG< 250 mg/dL; then initiate insulin drip at 0.1 – 1 unit/kg/hr titrated to SBP along with 0.5 g/kg/hr of dextrose titrated to maintain BG 100 – 200 mg/dL, DKA/HHS: 0.1 unit/kg bolus followed by continuous infusion 0.1 unit/kg/hrN/AHyperkalemia, CCB OD, DKA/HHSHypokalemia, hypoglycemia, only regular insulin can be given IV, Preg B
PrednisoneProduces various gluco- and mineralcorticoid effectsN/A1 mg/kg/day PO (usual dose 5-60 mg based on patient response)Asthma exacerbation, PCP PNA with A-a gradient >35 or PaO2 < 70mmHg, allergic reactionImmunosuppression, GI ulceration/perforation, hyperglycemia, Preg C

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GI

DRUGMOADOSE IVDOSE POINDICATIONCONTRAINDICATION
Droperidol (Inapsine)Dopamine receptor antagonist/alpha receptor antagonist1.25-2.5 mg IV q4hrs PRNN/AAntiemetic, migraine abortionQT prolongation (i.e. Torsades), NMS, extrapyramidal side effects, Preg C
Esomeprazole (Nexium)inhibits parietal cell hydrogen-potassium ATPase (PPI)80 mg IV bolus followed by 8 mg/hourN/AUpper GI bleed (non-variceal)Fairly benign when used acutely, Preg B
Metoclopramide (Reglan)antagonizes dopamine receptors in the chemoreceptor trigger zone10 mg IV q 6 hrs PRNN/AVomiting prevention and treatmentTardive dyskinesia, extrapyramidal signs, dystonia, methemoglobinemia, Preg B
Octreotidevasoconstricts vessels (more selective for GI vessels), reduces portal vessel pressureBleeding esophageal varices: 50 mcg IV bolus, then 50 mcg/hour IV, Sulfonylurea toxicity: 50 mcg subq q 6hrs PRNN/ABleeding esophageal varices, sulfonylurea toxicityPrecipitated biliary disease, Preg B
OndansetronAntagonizes serotinin 5HT3 receptors, centrally acting antiemetic4-8 mg IV q4-6hrs PRNN/AVomiting prevention and treatmentQT prolongation, torsades (rare), Preg B

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Heme

DRUGMOADOSE IVDOSE POINDICATIONCONTRAINDICATION
Enoxaparin (lovenox)Binds to antithrombin III and inactives Factor Xa > thrombin1 mg/kg SQ q12 hrs OR 1.5 mg/kg SQ q24 hrsN/APE, NSTEMI, unstable anginaMonitor anti Xa levels in renal impairment or obesity (> 150 kg actual body weight), concomitant use with spinal anesthesia/analgesia or spinal puncture is an absolute contraindication (black box warning), Preg B
Heparinbinds to antithrombin III thereby potentiating inactivation of thrombin and factors IX, Xa, XI, XII; prevents fibrinogen → fibrin; preferential inactivation of thrombin over other clotting factorsVenous thromboembolism: 80 units/kg IV x 1, then 18 units/kg/hr, ACS or Afib: 60 units/kg IV x 1, then 12 units/kg/hr N/AVenous thromboembolism, ACS (enoxaparin preferred for NSTEMI)Bleeding (protamine sulfate may be given for reversal), bleeding, Preg C

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Neuro/Psych

DRUGMOADOSE IVDOSE POINDICATIONCONTRAINDICATION
Diazepam (Valium)Enhances inhibitory effects of GABA2-10 mg IV/IM q6hrs PRN2-10 mg PO q6hrs PRNSeizure abortion, alcohol withdrawal, agitation, muscle spasmRespiratory depression, hypotension, preg category D
Droperidol (Inapsine)Dopamine receptor antagonist/alpha receptor antagonist1.25-2.5 mg IV q4hrs PRNN/AAntiemetic, migraine abortionQT prolongation (i.e. Torsades), NMS, extrapyramidal side effects, Preg C
Fosphenytoinstabilizes voltage dependent neuronal Na channels to stop seizure activity15-20 mg/kg IV loading dose administered at 150 mg/minN/AStatus epilepticusrapid administration can cause hypotension or dysrhythmias, give with patient on monitor, Preg D
Haloperidol (Haldol)Dopamine receptor antagonist (D1/D2)5-10 mg PO/IM/IV q 2 hours (max 100 mg/day)N/AAgitation, psychosisDementia-related psychosis, NMS, EPS, QT prolongation, Preg C
KetamineNMDA receptor antagonist, acts on cortex and limbic systemSubdissociative: 0.1-0.5 mg/kg IV, procedural sedation: 0.5-1 mg/kg IV, RSI induction: 2 mg/kg IV N/AAnalgesia, sedation, RSI inductionemergence reactions (treat with benzos or barbs),laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D
Lorazepam (Ativan)Enhances inhibitory effects of GABAUsual bolus dose: 1-2 mg IV, usual continous infusion: 1-10 mg/hrN/Adelirium tremens, status epilepticus, serotonin syndrome, agitationRespiratory depression, hypotension, preg category D
MannitolOsmotic diuretic1 gm/kg IV x 1N/AElevated ICP, impending hernationMay cause dehydration, osmotic nephrosis
Methohexital (Brevital)Produces cortical and cerebellar sedation, hypnosis (ultra short-acting barbiturate)1 mg/kg IV, then 0.5 mg/kg q2-5 min PRNN/AProcedural sedationLaryngospasm (give more methohexital), respiratory depression, hypotension, Preg B
Midazolam (Versed)Enhances inhibitory effects of GABARSI induction:0.1 mg/kg IV, Usual continuous infusion: 1-10 mg/hr, Procedural sedation: 0.02-0.04 mg/kg IVN/ASeizure abortion, procedural sedation, ventilator sedation, RSIRespiratory depression, hypotensive effects, Preg D
NimodipineCa+ channel blocker that is selective for cerebral arteriesN/A60 mg PO q4hrs Sub-arachnoid hemorrhageHypotension (although minimized due to its selectivity), Preg C
Olanzapine Antagonizes dopamine, histamine, alpha1, and 5HT2 receptors5-10 mg IM/day (max 30 mg/day)5-10 mg ODT/day (max 30 mg/day)Agitation, psychosisdo NOT give for dementia-related psychosis, NMS, EPS, orthostatic hypotension, QTc prolongation, not to be given IV, preg C
Phenobarbitalbarbiturate, causes sedation, hyponsis, and anesthesia20 mg/kg IV x1, may repeat with an additional 5-10 mg/kg dose in 20 minutes (max dose 30 mg/kg); max infusion rate 50 mg/minN/AStatus epilepticusrespiratory depression, hypotension, preg category D

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Pain

DRUGMOADOSE IVDOSE POINDICATIONCONTRAINDICATION
Fentanylopioid agonist producing analgesia with adjunctive sedative effects25-100 mcg IV q 1-2 hours; recommended dose 1 mcg/kgN/AAnalgesia, sedation adjunctrespiratory depression, vasodilation (hypotension), laryngospasm, Preg C
Hydromorphone (Dilaudid)opioid agonist producing analgesia with adjunctive sedative effects1-2 mg IV q 3-6 hrsN/AAnalgesiaRespiratory depression, vasodilation (hypotension), 1 mg of IV Dilaudid is approximately equal to 7 mg of IV morphine, Preg C
KetamineNMDA receptor antagonist, acts on cortex and limbic systemSubdissociative: 0.1-0.5 mg/kg IV, procedural sedation: 0.5-1 mg/kg IV, RSI induction: 2 mg/kg IV N/AAnalgesia, sedation, RSI inductionemergence reactions (treat with benzos or barbs),laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D
Morphine sulfateopioid agonist producing analgesia with adjunctive sedative effects2-10 mg IV q2-6 hrs PRN; recommended dose 0.1 mg/kg IVN/APain controlRespiratory depression, vasodilation (hypotension), Preg C

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Respiratory


DRUG
MOADOSE IVDOSE POINDICATIONCONTRAINDICATION
AlbuterolSelective beta2 agonist2.5-5 mg q20 min for 1st hour, then 2.5-10 mg q1-4 hours prn (alt, 10-15 mg over 1 hour)N/AAcute bronchospasm, hyperkalemiaHypokalemia, tachycardia, hyperglycemia, preg category C
Epinephrinealpha and beta receptor agonistACLS: 1 mg 1:10,000 IV (PALS 0.01 mg/kg 1:10,000 IV), Anaphylaxis: 0.1-0.5 mg 1:1,000 IM/SQ (IM preferred), Peds anaphylaxis: 0.01 mg/kg 1:1,000 IM/SQ (max single dose 0.3 mg), Hypotension refractory to IVF: 1-10 mcg/min IVN/AAnaphylaxis, ACLS arrest, PALS/NRP arrest, severe asthmaBeware dosing errors!, tissue necrosis (needs toadministered via central venous line), dysrhythmias, Preg C
EtomidateGABA-like effects on brain stem reticular formation causing hypnosis0.3 mg/kg IVN/ARSI inductionAdrenal/cortisol depression (although questionable clinical significance for single administration), lowers seizure threshold, Preg C
Furosemideinhibits Na and Cl reabsorption in distal renal tubule and ascending loop of Henleusual dose in ED 20-40 mg IV, reassess, increase to desired effect (maximum single dose 200mg)N/APulmonary edema, CHF exacerbation, hyperkalemia (if they pee)volume depletion, hypokalemia, metabolic alkalosis, ototoxicity, Preg C
KetamineNMDA receptor antagonist, acts on cortex and limbic systemSubdissociative: 0.1-0.5 mg/kg IV, procedural sedation: 0.5-1 mg/kg IV, RSI induction: 2 mg/kg IV N/AAnalgesia, sedation, RSI inductionemergence reactions (treat with benzos or barbs),laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D
Magnesium sulfateParticipates in physiologic processesEclampsia: 2-4 g IV over 5 minutes, Pulseless Torsades: 2 g IV push, Asthma exacerbation: 2 g IV over 15 minutesN/ATorsades, ventricular dysrhythmias, status asthmaticus, eclampsiaHypotension, respiratory depression, Preg A
Methylprednisolone (SoluMedrol)Multiple gluco- and mineralcorticoid effectsAsthma: 1 mg/kg IV, Hypersensitivity reaction: 1 mg/kg IV, PCP PNA: 30 mg IV BID x 5 days followed by gradual taperN/Asevere asthma, PCP PNA with elevated A-a gradient or PaO2 < 70 mmHg, acute hypersensitivity reactionImmunosuppression, hyperglycemia, Preg C
PropofolGABAa agonist, Na channel blockerProcedural sedation: 1 mg/kg IV bolus then 0.5 mg/kg q 3 minutes to effect, RSI: 1.5-2.5 mg/kg IV x 1, Ventilator sedation: 5-50 mcg/kg/minN/AProcedural sedation, RSI induction, ventilator sedationHypotension, anaphylaxis, bradycardia, apnea, Preg B
RocuroniumNon-depolarizing neuromuscular agent1 mg/kg IVN/ARSI paralysisProlonged paralysis, Preg B
SuccinylcholineDepolarizing neuromuscular agent1.5 mg/kg (or 3-4 mg/kg IM)N/ARSI paralysisHyperkalemia, subacute burn/crush injury with hyperkalemia, glaucoma (increases IOP), increases ICP, Preg C

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