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)