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All 50 Drugs
| DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
| Acetylcysteine | Replenishes 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 OD | hypersensitivty rxn (stop infusion, switch to PO or slow infusion rate), rare. Can also see hypersensitivity rxn with PO as well. Pregnancy category B. |
| Adenosine | Acts on A1 receptors in AV node, causing temporary heart block | 6 mg IV RAPID push, may giev 12 mg IV q2 minutes if no effect x 2 | N/A | Stable SVT, stable narrow complex tachycardia | prodysrhythmic, do not give in preexisting 2nd/3rd degree heart block, pregnancy category C |
| Albuterol | Selective beta2 agonist | 2.5-5 mg q20 min for 1st hour, then 2.5-10 mg q1-4 hours prn (alt, 10-15 mg over 1 hour) | N/A | Acute bronchospasm, hyperkalemia | Hypokalemia, tachycardia, hyperglycemia, preg category C |
| Amiodarone | Blocks K efflux (Class III antidysrhythmic); also has Na channel blocking (class I), beta blocking (class II), and Ca channel blocking (class IV) properties | Pulseless 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 thereafter | N/A | Pulseless VT/VF, wide complex tachydysrhythmias | Causes hypotension, can be prodysrhythmic, Preg category D |
| Atropine | Direct anticholinergic | Organophosphate/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 dose | N/A | Organophosphate/carbamate poisoning, bradycardia | hyperthermic patients, tachydysrhythmias, preg category C |
| Calcium gluconate/chloride | Increases serum calcium, stabilizes cardiac myocytes | 10% IV solution (gluconate or chloride) contains 1 g per 10 mL | N/A | Hyperkalemia, hypocalcemia with dysrhythmia | dysrhythmia, 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 GABA | 2-10 mg IV/IM q6hrs PRN | 2-10 mg PO q6hrs PRN | Seizure abortion, alcohol withdrawal, agitation, muscle spasm | Respiratory depression, hypotension, preg category D |
| Diltiazem (Cardizem) | inhibits calcium influx in myocardium > vascular smooth muscle; prolongs AV nodal conduction | 0.25 mg/kg IV x1, may give 0.35 mg/kg IV x1 after 15 minutes; continous infusion 5-15 mg/hr | N/A | Stable Afib with RVR, stable SVT | Iatrogenic hypotension, bradycardia, Preg category C |
| Dobutamine | Beta 1 agonist > beta 2 agonist | 2-20 mcg/kg/min IV | N/A | Decompensated heart failure, refractory hypotension | tachycardia, hypotension if not euvolemic, PVCs, Preg B |
| Dopamine | Alpha1, 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 effects | N/A | Decompensated heart failure, hypotension | tachydysrhythmias, tissue necrosis if extravastion or arterial administration occurs -> need CVC, Preg C |
| Droperidol (Inapsine) | Dopamine receptor antagonist/alpha receptor antagonist | 1.25-2.5 mg IV q4hrs PRN | N/A | Antiemetic, migraine abortion | QT prolongation (i.e. Torsades), NMS, extrapyramidal side effects, Preg C |
| Epinephrine | alpha and beta receptor agonist | ACLS: 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 IV | N/A | Anaphylaxis, ACLS arrest, PALS/NRP arrest, severe asthma | Beware dosing errors!, tissue necrosis (needs toadministered via central venous line), dysrhythmias, Preg C |
| Enoxaparin (lovenox) | Binds to antithrombin III and inactives Factor Xa > thrombin | 1 mg/kg SQ q12 hrs OR 1.5 mg/kg SQ q24 hrs | N/A | PE, NSTEMI, unstable angina | Monitor 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 |
| Esmolol | Selective beta1 antagonist | 500 mcg/kg loading dose -> then continuous infusion of 50-300 mcg/kg/min | N/A | Aortic dissection | Precipitated CHF, hypotension, bronchospasm, Preg C |
| Esomeprazole (Nexium) | inhibits parietal cell hydrogen-potassium ATPase (PPI) | 80 mg IV bolus followed by 8 mg/hour | N/A | Upper GI bleed (non-variceal) | Fairly benign when used acutely, Preg B |
| Etomidate | GABA-like effects on brain stem reticular formation causing hypnosis | 0.3 mg/kg IV | N/A | RSI induction | Adrenal/cortisol depression (although questionable clinical significance for single administration), lowers seizure threshold, Preg C |
| Fentanyl | opioid agonist producing analgesia with adjunctive sedative effects | 25-100 mcg IV q 1-2 hours; recommended dose 1 mcg/kg | N/A | Analgesia, sedation adjunct | respiratory depression, vasodilation (hypotension), laryngospasm, Preg C |
| Fomepizole | Inhibits alcohol dehydrogenase | 15 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 pH | N/A | Methanol or ethylene glycol toxicity | Fairly safe, Preg C |
| Fosphenytoin | stabilizes voltage dependent neuronal Na channels to stop seizure activity | 15-20 mg/kg IV loading dose administered at 150 mg/min | N/A | Status epilepticus | rapid administration can cause hypotension or dysrhythmias, give with patient on monitor, Preg D |
| Furosemide | inhibits Na and Cl reabsorption in distal renal tubule and ascending loop of Henle | usual dose in ED 20-40 mg IV, reassess, increase to desired effect (maximum single dose 200mg) | N/A | Pulmonary edema, CHF exacerbation, hyperkalemia (if they pee) | volume depletion, hypokalemia, metabolic alkalosis, ototoxicity, Preg C |
| Glucagon | Stimulates cAMP production independent of beta receptor, increases gluconeogenesis and glycogenolysis | Beta-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/IM | N/A | Beta-blocker tox, calcium channel blocker tox, hypoglycemia | Anaphylactoid 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/A | Agitation, psychosis | Dementia-related psychosis, NMS, EPS, QT prolongation, Preg C |
| Heparin | binds to antithrombin III thereby potentiating inactivation of thrombin and factors IX, Xa, XI, XII; prevents fibrinogen → fibrin; preferential inactivation of thrombin over other clotting factors | Venous 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/A | Venous thromboembolism, ACS (enoxaparin preferred for NSTEMI) | Bleeding (protamine sulfate may be given for reversal), bleeding, Preg C |
| Hydrocortisone | multiple gluco- and corticosteroid effects | Adrenal 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 regimen | N/A | Acute adrenal insufficiency, status asthmaticus, vasopressor refractory shock, | Immunosuppression, hyperglycemia, Preg C |
| Hydromorphone (Dilaudid) | opioid agonist producing analgesia with adjunctive sedative effects | 1-2 mg IV q 3-6 hrs | N/A | Analgesia | Respiratory depression, vasodilation (hypotension), 1 mg of IV Dilaudid is approximately equal to 7 mg of IV morphine, Preg C |
| Insulin regular | Increased peripheral glucose uptake, increased inotropy, shifts potassium intracellularly | Hyperkalemia: 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/hr | N/A | Hyperkalemia, CCB OD, DKA/HHS | Hypokalemia, hypoglycemia, only regular insulin can be given IV, Preg B |
| Ketamine | NMDA receptor antagonist, acts on cortex and limbic system | Subdissociative: 0.1-0.5 mg/kg IV, procedural sedation: 0.5-1 mg/kg IV, RSI induction: 2 mg/kg IV | N/A | Analgesia, sedation, RSI induction | emergence reactions (treat with benzos or barbs),laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D |
| Labetalol | Alpha 1, beta 1, and beta 2 antagonist | Bolus dose: 20-80 mg/IV q10 minutes PRN, Continous infusion: 1-8 mg/min continuous infusion titrated to effect | N/A | Hypertensive emergency | Precipitated CHF, bradycardia, bronchospasm, Preg C |
| Lorazepam (Ativan) | Enhances inhibitory effects of GABA | Usual bolus dose: 1-2 mg IV, usual continous infusion: 1-10 mg/hr | N/A | delirium tremens, status epilepticus, serotonin syndrome, agitation | Respiratory depression, hypotension, preg category D |
| Magnesium sulfate | Participates in physiologic processes | Eclampsia: 2-4 g IV over 5 minutes, Pulseless Torsades: 2 g IV push, Asthma exacerbation: 2 g IV over 15 minutes | N/A | Torsades, ventricular dysrhythmias, status asthmaticus, eclampsia | Hypotension, respiratory depression, Preg A |
| Mannitol | Osmotic diuretic | 1 gm/kg IV x 1 | N/A | Elevated ICP, impending hernation | May 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 PRN | N/A | Procedural sedation | Laryngospasm (give more methohexital), respiratory depression, hypotension, Preg B |
| Methylprednisolone (SoluMedrol) | Multiple gluco- and mineralcorticoid effects | Asthma: 1 mg/kg IV, Hypersensitivity reaction: 1 mg/kg IV, PCP PNA: 30 mg IV BID x 5 days followed by gradual taper | N/A | severe asthma, PCP PNA with elevated A-a gradient or PaO2 < 70 mmHg, acute hypersensitivity reaction | Immunosuppression, hyperglycemia, Preg C |
| Metoclopramide (Reglan) | antagonizes dopamine receptors in the chemoreceptor trigger zone | 10 mg IV q 6 hrs PRN | N/A | Vomiting prevention and treatment | Tardive dyskinesia, extrapyramidal signs, dystonia, methemoglobinemia, Preg B |
| Midazolam (Versed) | Enhances inhibitory effects of GABA | RSI induction: 0.1 mg/kg IV, Usual continuous 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, hypotensive effects, Preg D |
| Morphine sulfate | opioid agonist producing analgesia with adjunctive sedative effects | 2-10 mg IV q2-6 hrs PRN; recommended dose 0.1 mg/kg IV | N/A | Pain control | Respiratory depression, vasodilation (hypotension), Preg C |
| Nimodipine | Ca+ channel blocker that is selective for cerebral arteries | N/A | 60 mg PO q4hrs | Sub-arachnoid hemorrhage | Hypotension (although minimized due to its selectivity), Preg C |
| Nitroglycerin | venodilator, stimulates cGMP production | 5-200 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/min | N/A | CHF, angina | Hypotension, methemoglobinemia, Preg C |
| Nitroprusside | Direct vasodilator, breaks down to release NO | Initiate 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 discontinued | N/A | Hypertensive emergency | CN toxicity, methemoglobinemia, hypotension, Preg C |
| Norepinephrine (Levophed) | alpha 1 agonist > beta 1 agonist | 1-30 mcg/min IV | N/A | Hypotension refractory to IVF | tachydysrhythmias, tissue necrosis if extravastion or arterial administration occurs -> need CVC, Preg C |
| Octreotide | vasoconstricts vessels (more selective for GI vessels), reduces portal vessel pressure | Bleeding esophageal varices: 50 mcg IV bolus, then 50 mcg/hour IV, Sulfonylurea toxicity: 50 mcg subq q 6hrs PRN | N/A | Bleeding esophageal varices, sulfonylurea toxicity | Precipitated biliary disease, Preg 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 | do NOT give for dementia-related psychosis, NMS, EPS, orthostatic hypotension, QTc prolongation, not to be given IV, preg C |
| Ondansetron | Antagonizes serotinin 5HT3 receptors, centrally acting antiemetic | 4-8 mg IV q4-6hrs PRN | N/A | Vomiting prevention and treatment | QT prolongation, torsades (rare), Preg B |
| Phenobarbital | barbiturate, causes sedation, hyponsis, and anesthesia | 20 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/min | N/A | Status epilepticus | respiratory depression, hypotension, preg category D |
| Prednisone | Produces various gluco- and mineralcorticoid effects | N/A | 1 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 reaction | Immunosuppression, GI ulceration/perforation, hyperglycemia, Preg C |
| Propofol | GABAa agonist, Na channel blocker | Procedural 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/min | N/A | Procedural sedation, RSI induction, ventilator sedation | Hypotension, anaphylaxis, bradycardia, apnea, Preg B |
| Protamine sulfate | Ionically binds heparin | 1 mg neutralizes 100 units of heparin (max dose 50 mg), administer at rate of 5 mg/minute | N/A | Heparin induced bleeding | Anaphylaxis in previous use or fish allergy, rapid infusion can cause hypotension, Preg C |
| Rocuronium | Non-depolarizing neuromuscular agent | 1 mg/kg IV | N/A | RSI paralysis | Prolonged paralysis, Preg B |
| Sodium bicarbonate | Increases 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 7.5-8.0 | N/A | Hyperkalemia, TCA toxicity, salicylate toxicity, metabolic acidosis | Caution in CHF, overshooting into metabolic alkalosis, hypernatremia, Preg C |
| Succinylcholine | Depolarizing neuromuscular agent | 1.5 mg/kg (or 3-4 mg/kg IM) | N/A | RSI paralysis | Hyperkalemia, subacute burn/crush injury with hyperkalemia, glaucoma (increases IOP), increases ICP, Preg C |
Antidotes
| DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
| Acetylcysteine | Replenishes 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 OD | hypersensitivty rxn (stop infusion, switch to PO or slow infusion rate), rare. Can also see hypersensitivity rxn with PO as well. Pregnancy category B. |
| Atropine | Direct anticholinergic | Organophosphate/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 dose | N/A | Organophosphate/carbamate poisoning, bradycardia | hyperthermic patients, tachydysrhythmias, preg category C |
| Fomepizole | Inhibits alcohol dehydrogenase | 15 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 pH | N/A | Methanol or ethylene glycol toxicity | Fairly safe, Preg C |
| Glucagon | Stimulates cAMP production independent of beta receptor, increases gluconeogenesis and glycogenolysis | Beta-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/IM | N/A | Beta-blocker tox, calcium channel blocker tox, hypoglycemia | Anaphylactoid reaction, hypotension, emesis (aspiration risk in altered patients), Preg B |
| Insulin regular | Increased peripheral glucose uptake, increased inotropy, shifts potassium intracellularly | Hyperkalemia: 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/hr | N/A | Hyperkalemia, CCB OD, DKA/HHS | Hypokalemia, hypoglycemia, only regular insulin can be given IV, Preg B |
| Protamine sulfate | Ionically binds heparin | 1 mg neutralizes 100 units of heparin (max dose 50 mg), administer at rate of 5 mg/minute | N/A | Heparin induced bleeding | Anaphylaxis in previous use or fish allergy, rapid infusion can cause hypotension, Preg C |
| Sodium bicarbonate | Increases 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 7.5-8.0 | N/A | Hyperkalemia, TCA toxicity, salicylate toxicity, metabolic acidosis | Caution in CHF, overshooting into metabolic alkalosis, hypernatremia, Preg C |
Cardiac
| DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
| Adenosine | Acts on A1 receptors in AV node, causing temporary heart block | 6 mg IV RAPID push, may giev 12 mg IV q2 minutes if no effect x 2 | N/A | Stable SVT, stable narrow complex tachycardia | prodysrhythmic, do not give in preexisting 2nd/3rd degree heart block, pregnancy category C |
| Amiodarone | Blocks K efflux (Class III antidysrhythmic); also has Na channel blocking (class I), beta blocking (class II), and Ca channel blocking (class IV) properties | Pulseless 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 thereafter | N/A | Pulseless VF/VT, wide complex tachydysrhythmias | Causes hypotension, can be prodysrhythmic, Preg category D |
| Atropine | Direct anticholinergic | Organophosphate/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 dose | N/A | Organophosphate/carbamate poisoning, bradycardia | hyperthermic patients, tachydysrhythmias, preg category C |
| Calcium gluconate/chloride | Increases serum calcium, stabilizes cardiac myocytes | 10% IV solution (gluconate or chloride) contains 1 g per 10 mL | N/A | Hyperkalemia, hypocalcemia with dysrhythmia | dysrhythmia, 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 conduction | 0.25 mg/kg IV x1, may give 0.35 mg/kg IV x1 after 15 minutes; continous infusion 5-15 mg/hr | N/A | Stable Afib with RVR, stable SVT | Iatrogenic hypotension, bradycardia, Preg category C |
| Dobutamine | Beta 1 agonist > beta 2 agonist | 2-20 mcg/kg/min IV | N/A | Decompensated heart failure, refractory hypotension | tachycardia, hypotension if not euvolemic, PVCs, Preg B |
| Dopamine | Alpha1, 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 effects | N/A | Decompensated heart failure, hypotension | tachydysrhythmias, tissue necrosis if extravastion or arterial administration occurs -> need CVC, Preg C |
| Epinephrine | alpha and beta receptor agonist | ACLS: 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 IV | N/A | Anaphylaxis, ACLS arrest, PALS/NRP arrest, severe asthma | Beware dosing errors!, tissue necrosis (needs toadministered via central venous line), dysrhythmias, Preg C |
| Esmolol | Selective beta1 antagonist | 500 mcg/kg loading dose -> then continuous infusion of 50-300 mcg/kg/min | N/A | Aortic dissection | Precipitated CHF, hypotension, bronchospasm, Preg C |
| Furosemide | inhibits Na and Cl reabsorption in distal renal tubule and ascending loop of Henle | usual dose in ED 20-40 mg IV, reassess, increase to desired effect (maximum single dose 200mg) | N/A | Pulmonary edema, CHF exacerbation, hyperkalemia (if they pee) | volume depletion, hypokalemia, metabolic alkalosis, ototoxicity, Preg C |
| Labetalol | Alpha 1, beta 1, and beta 2 antagonist | Bolus dose: 20-80 mg/IV q10 minutes PRN, Continous infusion: 1-8 mg/min continuous infusion titrated to effect | N/A | Hypertensive emergency | Precipitated CHF, bradycardia, bronchospasm, Preg C |
| Magnesium sulfate | Participates in physiologic processes | Eclampsia: 2-4 g IV over 5 minutes, Pulseless Torsades: 2 g IV push, Asthma exacerbation: 2 g IV over 15 minutes | N/A | Torsades, ventricular dysrhythmias, status asthmaticus, eclampsia | Hypotension, respiratory depression, Preg A |
| Nitroglycerin | venodilator, stimulates cGMP production | 5-200 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/min | N/A | CHF, angina | Hypotension, methemoglobinemia, Preg C |
| Nitroprusside | Direct vasodilator, breaks down to release NO | Initiate 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 discontinued | N/A | Hypertensive emergency | CN toxicity, methemoglobinemia, hypotension, Preg C |
| Norepinephrine (Levophed) | alpha 1 agonist > beta 1 agonist | 1-30 mcg/min IV | N/A | Hypotension refractory to IVF | tachydysrhythmias, tissue necrosis if extravastion or arterial administration occurs -> need CVC, Preg C |
Endocrine
| DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
| Glucagon | Stimulates cAMP production independent of beta receptor, increases gluconeogenesis and glycogenolysis | Beta-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/IM | N/A | Beta-blocker tox, calcium channel blocker tox, hypoglycemia | Anaphylactoid reaction, hypotension, emesis (aspiration risk in altered patients), Preg B |
| Hydrocortisone | multiple gluco- and corticosteroid effects | Adrenal 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 regimen | N/A | Acute adrenal insufficiency, status asthmaticus, vasopressor refractory shock, | Immunosuppression, hyperglycemia, Preg C |
| Insulin regular | Increased peripheral glucose uptake, increased inotropy, shifts potassium intracellularly | Hyperkalemia: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/hr | N/A | Hyperkalemia, CCB OD, DKA/HHS | Hypokalemia, hypoglycemia, only regular insulin can be given IV, Preg B |
| Prednisone | Produces various gluco- and mineralcorticoid effects | N/A | 1 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 reaction | Immunosuppression, GI ulceration/perforation, hyperglycemia, Preg C |
GI
| DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
| Droperidol (Inapsine) | Dopamine receptor antagonist/alpha receptor antagonist | 1.25-2.5 mg IV q4hrs PRN | N/A | Antiemetic, migraine abortion | QT 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/hour | N/A | Upper GI bleed (non-variceal) | Fairly benign when used acutely, Preg B |
| Metoclopramide (Reglan) | antagonizes dopamine receptors in the chemoreceptor trigger zone | 10 mg IV q 6 hrs PRN | N/A | Vomiting prevention and treatment | Tardive dyskinesia, extrapyramidal signs, dystonia, methemoglobinemia, Preg B |
| Octreotide | vasoconstricts vessels (more selective for GI vessels), reduces portal vessel pressure | Bleeding esophageal varices: 50 mcg IV bolus, then 50 mcg/hour IV, Sulfonylurea toxicity: 50 mcg subq q 6hrs PRN | N/A | Bleeding esophageal varices, sulfonylurea toxicity | Precipitated biliary disease, Preg B |
| Ondansetron | Antagonizes serotinin 5HT3 receptors, centrally acting antiemetic | 4-8 mg IV q4-6hrs PRN | N/A | Vomiting prevention and treatment | QT prolongation, torsades (rare), Preg B |
Heme
| DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
| Enoxaparin (lovenox) | Binds to antithrombin III and inactives Factor Xa > thrombin | 1 mg/kg SQ q12 hrs OR 1.5 mg/kg SQ q24 hrs | N/A | PE, NSTEMI, unstable angina | Monitor 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 |
| Heparin | binds to antithrombin III thereby potentiating inactivation of thrombin and factors IX, Xa, XI, XII; prevents fibrinogen → fibrin; preferential inactivation of thrombin over other clotting factors | Venous 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/A | Venous thromboembolism, ACS (enoxaparin preferred for NSTEMI) | Bleeding (protamine sulfate may be given for reversal), bleeding, Preg C |
Neuro/Psych
| DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
| Diazepam (Valium) | Enhances inhibitory effects of GABA | 2-10 mg IV/IM q6hrs PRN | 2-10 mg PO q6hrs PRN | Seizure abortion, alcohol withdrawal, agitation, muscle spasm | Respiratory depression, hypotension, preg category D |
| Droperidol (Inapsine) | Dopamine receptor antagonist/alpha receptor antagonist | 1.25-2.5 mg IV q4hrs PRN | N/A | Antiemetic, migraine abortion | QT prolongation (i.e. Torsades), NMS, extrapyramidal side effects, Preg C |
| Fosphenytoin | stabilizes voltage dependent neuronal Na channels to stop seizure activity | 15-20 mg/kg IV loading dose administered at 150 mg/min | N/A | Status epilepticus | rapid 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/A | Agitation, psychosis | Dementia-related psychosis, NMS, EPS, QT prolongation, Preg C |
| Ketamine | NMDA receptor antagonist, acts on cortex and limbic system | Subdissociative: 0.1-0.5 mg/kg IV, procedural sedation: 0.5-1 mg/kg IV, RSI induction: 2 mg/kg IV | N/A | Analgesia, sedation, RSI induction | emergence reactions (treat with benzos or barbs),laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D |
| Lorazepam (Ativan) | Enhances inhibitory effects of GABA | Usual bolus dose: 1-2 mg IV, usual continous infusion: 1-10 mg/hr | N/A | delirium tremens, status epilepticus, serotonin syndrome, agitation | Respiratory depression, hypotension, preg category D |
| Mannitol | Osmotic diuretic | 1 gm/kg IV x 1 | N/A | Elevated ICP, impending hernation | May 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 PRN | N/A | Procedural sedation | Laryngospasm (give more methohexital), respiratory depression, hypotension, Preg B |
| Midazolam (Versed) | Enhances inhibitory effects of GABA | RSI induction:0.1 mg/kg IV, Usual continuous 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, hypotensive effects, Preg D |
| Nimodipine | Ca+ channel blocker that is selective for cerebral arteries | N/A | 60 mg PO q4hrs | Sub-arachnoid hemorrhage | Hypotension (although minimized due to its selectivity), Preg C |
| 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 | do NOT give for dementia-related psychosis, NMS, EPS, orthostatic hypotension, QTc prolongation, not to be given IV, preg C |
| Phenobarbital | barbiturate, causes sedation, hyponsis, and anesthesia | 20 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/min | N/A | Status epilepticus | respiratory depression, hypotension, preg category D |
Pain
| DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
| Fentanyl | opioid agonist producing analgesia with adjunctive sedative effects | 25-100 mcg IV q 1-2 hours; recommended dose 1 mcg/kg | N/A | Analgesia, sedation adjunct | respiratory depression, vasodilation (hypotension), laryngospasm, Preg C |
| Hydromorphone (Dilaudid) | opioid agonist producing analgesia with adjunctive sedative effects | 1-2 mg IV q 3-6 hrs | N/A | Analgesia | Respiratory depression, vasodilation (hypotension), 1 mg of IV Dilaudid is approximately equal to 7 mg of IV morphine, Preg C |
| Ketamine | NMDA receptor antagonist, acts on cortex and limbic system | Subdissociative: 0.1-0.5 mg/kg IV, procedural sedation: 0.5-1 mg/kg IV, RSI induction: 2 mg/kg IV | N/A | Analgesia, sedation, RSI induction | emergence reactions (treat with benzos or barbs),laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D |
| Morphine sulfate | opioid agonist producing analgesia with adjunctive sedative effects | 2-10 mg IV q2-6 hrs PRN; recommended dose 0.1 mg/kg IV | N/A | Pain control | Respiratory depression, vasodilation (hypotension), Preg C |
Respiratory
DRUG | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
| Albuterol | Selective beta2 agonist | 2.5-5 mg q20 min for 1st hour, then 2.5-10 mg q1-4 hours prn (alt, 10-15 mg over 1 hour) | N/A | Acute bronchospasm, hyperkalemia | Hypokalemia, tachycardia, hyperglycemia, preg category C |
| Epinephrine | alpha and beta receptor agonist | ACLS: 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 IV | N/A | Anaphylaxis, ACLS arrest, PALS/NRP arrest, severe asthma | Beware dosing errors!, tissue necrosis (needs toadministered via central venous line), dysrhythmias, Preg C |
| Etomidate | GABA-like effects on brain stem reticular formation causing hypnosis | 0.3 mg/kg IV | N/A | RSI induction | Adrenal/cortisol depression (although questionable clinical significance for single administration), lowers seizure threshold, Preg C |
| Furosemide | inhibits Na and Cl reabsorption in distal renal tubule and ascending loop of Henle | usual dose in ED 20-40 mg IV, reassess, increase to desired effect (maximum single dose 200mg) | N/A | Pulmonary edema, CHF exacerbation, hyperkalemia (if they pee) | volume depletion, hypokalemia, metabolic alkalosis, ototoxicity, Preg C |
| Ketamine | NMDA receptor antagonist, acts on cortex and limbic system | Subdissociative: 0.1-0.5 mg/kg IV, procedural sedation: 0.5-1 mg/kg IV, RSI induction: 2 mg/kg IV | N/A | Analgesia, sedation, RSI induction | emergence reactions (treat with benzos or barbs),laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D |
| Magnesium sulfate | Participates in physiologic processes | Eclampsia: 2-4 g IV over 5 minutes, Pulseless Torsades: 2 g IV push, Asthma exacerbation: 2 g IV over 15 minutes | N/A | Torsades, ventricular dysrhythmias, status asthmaticus, eclampsia | Hypotension, respiratory depression, Preg A |
| Methylprednisolone (SoluMedrol) | Multiple gluco- and mineralcorticoid effects | Asthma: 1 mg/kg IV, Hypersensitivity reaction: 1 mg/kg IV, PCP PNA: 30 mg IV BID x 5 days followed by gradual taper | N/A | severe asthma, PCP PNA with elevated A-a gradient or PaO2 < 70 mmHg, acute hypersensitivity reaction | Immunosuppression, hyperglycemia, Preg C |
| Propofol | GABAa agonist, Na channel blocker | Procedural 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/min | N/A | Procedural sedation, RSI induction, ventilator sedation | Hypotension, anaphylaxis, bradycardia, apnea, Preg B |
| Rocuronium | Non-depolarizing neuromuscular agent | 1 mg/kg IV | N/A | RSI paralysis | Prolonged paralysis, Preg B |
| Succinylcholine | Depolarizing neuromuscular agent | 1.5 mg/kg (or 3-4 mg/kg IM) | N/A | RSI paralysis | Hyperkalemia, subacute burn/crush injury with hyperkalemia, glaucoma (increases IOP), increases ICP, Preg C |
