Adult Critical Care IV Guide

Adult Critical Care IV Info Card


 

Amiodarone (Cordarone)

Argatroban (ARGATROBAN)

Diltiazem (Cardizem)

DOPamine (Intropin)

DOBUTamine (Dobutrex)

Epinephrine (Adrenalin)

Esmolol (Brevibloc)

Lidocaine (Xylocaine)

Milrinone (Primacor)

Methylprednisolone (Solu-Medrol)

NiCARdipine (Cardene)

Nitroglycerin (Tridil)

NORepinephrine (Levophed)

PENTObarbital (Nembutal)

Phenylephrine (Neo-Synephrine)

Procainamide (Pronestyl)

Sodium nitroprusside (Nipride)

Thiopental (Pentothal)

Vasopressin (Pitressin)

 

 

 

 

 

 

 

 

 

 

 

 

 

Amiodarone (Cordarone)

Argatroban (ARGATROBAN)

Diltiazem (Cardizem)

DOPamine (Intropin)

DOBUTamine (Dobutrex)

Epinephrine (Adrenalin)

Esmolol (Brevibloc)

Lidocaine (Xylocaine)

Milrinone (Primacor)

Methylprednisolone (Solu-Medrol)

NiCARdipine (Cardene)

Nitroglycerin (Tridil)

NORepinephrine (Levophed)

PENTObarbital (Nembutal)

Phenylephrine (Neo-Synephrine)

Procainamide (Pronestyl)

Sodium nitroprusside (Nipride)

Thiopental (Pentothal)

Vasopressin (Pitressin)


 

 

 

 

 

 

 

 

 

 

 

 

 

Amiodarone (Cordarone)

Argatroban (ARGATROBAN)

Diltiazem (Cardizem)

DOPamine (Intropin)

DOBUTamine (Dobutrex)

Epinephrine (Adrenalin)

Esmolol (Brevibloc)

Lidocaine (Xylocaine)

Milrinone (Primacor)

Methylprednisolone (Solu-Medrol)

NiCARdipine (Cardene)

Nitroglycerin (Tridil)

NORepinephrine (Levophed)

PENTObarbital (Nembutal)

Phenylephrine (Neo-Synephrine)

Procainamide (Pronestyl)

Sodium nitroprusside (Nipride)

Thiopental (Pentothal)

Vasopressin (Pitressin)

 

 

 

 

 

 

 

 

 

 

 

 

 

Amiodarone (Cordarone)

Argatroban (ARGATROBAN)

Diltiazem (Cardizem)

DOPamine (Intropin)

DOBUTamine (Dobutrex)

Epinephrine (Adrenalin)

Esmolol (Brevibloc)

Lidocaine (Xylocaine)

Milrinone (Primacor)

Methylprednisolone (Solu-Medrol)

NiCARdipine (Cardene)

Nitroglycerin (Tridil)

NORepinephrine (Levophed)

PENTObarbital (Nembutal)

Phenylephrine (Neo-Synephrine)

Procainamide (Pronestyl)

Sodium nitroprusside (Nipride)

Thiopental (Pentothal)

Vasopressin (Pitressin)

 

 

 

 

 

 

 

 

 

 

 

 

 

Amiodarone (Cordarone)

Argatroban (ARGATROBAN)

Diltiazem (Cardizem)

DOPamine (Intropin)

DOBUTamine (Dobutrex)

Epinephrine (Adrenalin)

Esmolol (Brevibloc)

Lidocaine (Xylocaine)

Milrinone (Primacor)

Methylprednisolone (Solu-Medrol)

NiCARdipine (Cardene)

Nitroglycerin (Tridil)

NORepinephrine (Levophed)

PENTObarbital (Nembutal)

Phenylephrine (Neo-Synephrine)

Procainamide (Pronestyl)

Sodium nitroprusside (Nipride)

Thiopental (Pentothal)

Vasopressin (Pitressin)

Antiarrhythmic

 

Amiodarone (Cordarone) - management of life-threatening recurrent VF or hemodynamically unstable VT.

Bolus: 150 mg/100 mL D5W over 10 min

Standard Conc: 900 mg/500 mL D5W

Initial Rate: 1mg/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

Bolus: 500mg - 1gm over 30 min

Standard Conc: 2 gm/500 mL D5W, NS   -   Max Conc. 2 gm/250 mL   -    Maint: 1-6 mg/min

Adverse Effects: hypotension, AV-block, bradycardia, lupus-like syndrome, fever, rash, thrombocytopenia
and hemolytic anemia

 

Lidocaine (Xylocaine) - ventricular arrhythmias

Standard Conc: 2 gm/500 mL D5W

Usual Rate: 1-4 mg/min

Adverse Effects: confusion, hypotension, lightheadedness, diplopia, seizures, and tinnitus
?Contraindicated in complete or 2nd degree AV Block


Beta Blockade

 

Esmolol (Brevibloc)- control of ventricular rate in atrial fib/flutter and noncompensating sinus tachycardia

Standard Conc: 2500 mg/250 mL NS   -   Max: 20 mg/mL in D5W, NS   -   Central line recommended for max conc

Loading Dose: 500 mcg/kg/min over 1 min   -    Maint. Dose: 50mcg/kg/min
If HR not controlled repeat loading dose and rate by 50 mcg/kg/min (max 200 mcg/kg/min);
rebolus with 500 mcg/kg/min over 1 min before each increase in rate

?Contraindications: sinus bradycardia, AVB>1°, cardiogenic shock


Calcium Channel Blocker

 

Diltiazem (Cardizem) - HR control during atrial fib and flutter for 24 hours

Standard Conc: 125 mg/125 mL D5W, NS

Loading Dose: 0.25 mg/kg over 2 min; if inadequate response, 0.35 mg/kg over 2 min

Initial Rate: 5 mg/hr   -   Max Rate: 15 mg/hr
Adverse Effects: HR, BP, pruritis

?Contraindications: AVB > 1°, WPW syndrome, V-tach, SSS, short PR syndrome

 

NiCARdipine (Cardene) - antianginal, antihypertensive

Standard Conc: 25 mg/250 mL D5W, NS

Initial Rate: 5 mg/hr, increase by 2.5 mg/hr q 15 min to a max of 15 mg/hr ~ Usual maint rate after response is achieved: 3 mg/hr

Adverse Effects: flushing, HR, palpitations, angina


Inotrope

 

Milrinone (Primacor) - PCWP, SVR, MAP

Standard Conc: 40 mg/200 mL D5W   -   Max Conc: 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 Conc: 500 mg/250 mL D5W   -   Central line administration   -   

Max Conc: 1250 mg/250 D5W or NS

Initial Rate: 2-20 mcg/kg/min

Max Rate: 40 mcg/kg/min

Adverse Effects: HTN, tachycardia, arrhythmia, angina


Sympathomimetics

 

DOPamine (Intropin) - BP, PCWP, HR

Standard Conc: 800 mg/500 mL D5W   -   Central line administration

Max Conc: 800 mg/250 mL D5W or NS

Initial Rate: 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, N/V

 

Epinephrine (Adrenalin) - HR, contractility, Com cardiac workload PA pressures, can convert asystole to NSR

Standard Conc: 4 mg/250 mL D5W   -    NS Max Conc: 1 mg/10 mL ~~ Central line administration

Initial Rate: 0.5-10 mcg/min, then titrate (Note: at 20 mcg/min pure alpha effects occur)

Adverse Effects: tachycardia, arrhythmia, PE, HTN, HA, resp. distress


Sympathomimetic/Vasopressors

 

NORepinephrine (Levophed) - BP PA pressure, SVR, myocardial workload

Standard Conc: 4 mg/250 mL D5W only - Central line administration

Max Conc: 16 mg/250 mL D5W only

Initial Rate: 0.5-1 mcg/min; titrate to desired response

Usual Range: 2-30 mcg/min

Adverse Effects: brady or tachycardia, peripheral vasoconstriction, HA, HTN, arrhythmia,
urine output, acidosis, hyperglycemia

 

Phenylephrine (Neo-Synephrine) - BP, SVRM PA pressure, myocardial workload

Usual Conc: 50 mg/250 mL NS   -   Max Rate: 360 mcg/min

Initial Rate: 100-180 mcg/min   -   Maint Rate: 40-60 mcg/min

Adverse Effects: HTN, HA, V-tach, renal perfusion, metabolic acidosis, severe bradycardia, restlessness

 

Vasopressin (Pitressin)- For unlabeled use in septic shock - Central line administration

Standard Conc: 100 units/100 mL D5W, NS

Initial Rate: 0.04 units/min (range: 0.01-0.04 units/min)

Adverse Effects: arrhythmias, cardiac arrest, CO, angina, myocardial ischemia,
and periph constriction. Doses > 0.04 units/min associated with more cardiovascular adverse effects.


Vasodilators

 

Sodium nitroprusside (Nipride) - BP, SVR, PCWP, CO Protect from light
Standard Conc: 50 mg/250 mL D5W Max Conc: 100 mg/250 mL D5W only
Initial Rate: 0.3-0.5 mcg/kg/min; titrate by 0.5 mcg/kg/min increments
Average Dose: 3 mcg/kg/min Max Dose: 10 mcg/kg/min
Adverse Effects: metabolic acidosis, severe hypotension, HA, nausea, dyspnea, LOC,
thiocyanate toxicity (esp .with prolonged infusion >2 mcg/kg/min).

 

Nitroglycerin (Tridil) - BP, SVR, PCWP, may HR Non-PVC tubing

Standard Conc: 50 mg/250 mL D5W

Initial Rate: 5 mcg/min, increasing by 5 mcg/min q 3-5 min up to 20 mcg/min,
Then titrate in increments of 10-20 mcg/min up to 200 mcg/min

Max Rate: doses of up to 640 mcg/min have been used

Adverse Effects: severe hypotension, reflex tachycardia, HA, N/V

Note: assoc. with development of tolerance over 24-48 hrs.


Miscellaneous

 

PENTObarbital (Nembutal) - barbiturate used to induce coma

Standard Conc: undiluted 50 mg/mL

Dose: 10 mg/kg over 30 min, then 5 mg/kg/hr x 3 hours, then 1-2.5 mg/kg/hr thereafter
If ICP > 20 mmHG 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 Conc: 25 mg/mL D5W, NS

20 mg/kg over 1 hour, then 10 mg/kg/hr x 6 hours, then 3 mg/kg/hr thereafter

Must be intubated. Monitor EEG (i.e. burst suppression 30-45 sec) and hemodynamic status

 

Methylprednisolone (Solu-Medrol) - For spinal cord injury

Bolus: 30 mg/kg in 100 mL D5W, NS - over 30 minutes

Maint Dose: 5.4 mg/kg in 500 mL x 23 hours

 

Argatroban (ARGATROBAN)
Standard Conc: 250 mg/250 mL D5W, NS

Initial Rate: 2 mcg/kg/min (0.5 mcg/kg/min in severe hepatic dysfunction)