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Atropine(parasympatholytic)

1mg atropine= 10ml bristojet

Symptomatic bradycardia: 0.5-1.0mg I.V. push q. 3-5 min, not toexceed a total dose of 0.04mg/kg

Asystole or PEA: 1mg I.V push q.3-5min, not to exceed total dose of0.04mg/kg

Relative bradycardia- HR wnl butinsufficient to meet demands

Dont give less than 0.5mg per dose because the possible paradoxical effectmay furtherslow heart rate

Use cautiously in presence of MI

If given via ET tube: dilute 1-2mg in 10ml sterile water or saline- follow with 10ml flush of NSS

Enhances SA node automaticity and AV conduction via direct vagolytic action.

Epinephrine catecholamine

(alpha & beta-adrenergicagonist)

Mix: 2 mg in 250 ml NS or D5WDose 1-4 mcg/kg/min

Incompatable withAminephylin

AmpicillinCephapiranSodium Bicarb.

(10ml of a 1:10,000solution)

or

(1ml of a 1:1000 solutionin multidose vial)

VF,pulseless VT,PEA, or asystole

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Standard dosing: 1mg I.V. push q.3-5min

Intermediate dosing: 2-5mg

I.V.push over 3-5min

Escalating dosing: 1mg,3mg,5mgI.V. push 3 min apart

High dosing: 0.1mg/kg I.V. push q3-5min

Symptomatic bradycardia:continuous infusion @ 2-10mcg/min; titrate to hemodynamic

response (not used as a first-line drug)

MIX 1mg(1ml of a 1:1000 solution)in 500ml NSS or D5W* Each dose given peripherallyshould be followed by 20ml fluid flush to ensure delivery tocentral circulation

* If no IV access available,give 2- 2.5 times the dose viaET tube; follow with 10ml flushof NSS

Intracardiac administrationsed only when no other routeavailable

* Increases SVR, BP, cardiac electrical activity, coronary and cerebral bloodflow, strength of myocardial contraction, automaticity and myocardial oxygenrequirements.

Digoxin Lanoxin

Dose 1-2 mgToxic level 2.4 mg.Can'tt dialize out.Causes ST depression.Shortened QT intervalT Wave flat or inverted.

Digoxinatrial fib/flutter; CHF. Slows heartrate, increases force of contraction and refractory period of AV nodeMonitor for nausea, visual

disturbances, atrial or junctional tachycardias, PVCs, heart blocks; K+

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* Suppresses ventricular arrhythmias and elevates the fibrillation threshold(less likely to occur)

Procainamide1. Used when Lidocaine is ineffective. (suppresses ventricular ectopy and

slows intraventricular conduction)2. Persistent cardiac arrest due to VF.3. PVCs or recurrent VT

Mix 2 Gms in 500 ml NS or LR.

1 mg/min=15ml/hr2 mg/min=30ml/hr3 mg/min=45ml/hr

Bolus 20-50 mg/min

- Dosing: 20-30mg/min until:1) arrhythmia suppressed2) hypotension occurs3) PR or QRS widens by 50% of its original width or MAX dose of 17mg/kghas been given

- if effective, start drip @ 1-4mg/min* Monitor BP closely duringadministration; may cause precipitous hypotension; infuse cautiously in acuteMI* Contraindicated in patients with preexisting long QT intervals or torsades depoints.

* Hypokalemia and hypomagnesemia may exacerbate arrhythmiasProcainamideGive bolus slowly with patient in supine position.Bolus 100 mg every 5 minutes at a rate of 20-30mg per minute until:-Arrhythmia is suppressed.-Hypotension develops.-QRS is widened by 50%.

-17mg/kg Gm has been given.Maintenance infusion - 1-4mg per minute.

Mix 2 Gm in 500ml D5W at 15-60cc/Hr.

May be given orally 1 Gm initially, followed by 250-500mg every 3-4 hours.

Countraindications:a. Complete, second, or third degree heart block.b. CHF,BBB, hepatic or renal impairment.c. Myasthenia gravis.

Uses:

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a. Treatment of ventricular arrhythmias, especially when lidocaine has beenunsuccessful.b. May be used to treat atrial arrhythmias.

Actions:

a. Decreases excitability and slows conduction.b. Depresses automaticity.

Propranolol (Inderal)Beta Blocker.For arrhythmias.Dose:1-3 mg not to exceed 1 mg/minuteevery 5 minutes.Total dose should not exceed 0.1mg/KgGive slowly.

Lasix

(diuretic)

Mix 200 mg in 200 ml D5W NS RL1Mg psr ml

Incompatable withDobutamine

0.25-0.75 mg per kg per minPulmonary Edema- 20-40 mg IVPMonitor K+, dehydration and hypotension; electrolytes

Magnesium Sulphate (MSO4)

Mix in D5W NS

1gm in 50 ml - Give over 1 hour2gm in 50 ml - Give over 2 hour3gm in 50 ml - Give over 3 hour

(physiological calcium channel blocker and blocks neuromusculartransmission)

5Gm/10ml bristojet

Torsades de points: Drug of Choice: up to 5- 10 gms have been used

Acute MI with hypomagnesemia:

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intermittent or continuous infusion0.5- 1.0 gm/hr

VF/VT with hypomagnesemia:1-2Gms diluted in 10 ml D5W given

IVP over 1-2 min

Monitor for flushing, sweating, bradycardia and hypotension; also if toxicitymay see depressed reflexes, flaccid paralysis, circulatory collapse, respiratoryparalysis and diarrhea

Magnesium Mg 1.5-2.4

Action: Acts as coenzyme in metabolism of CHO and proteins, Regulatesneuromuscular excitability and phosphate level, acts as a cofactor in ATPmaintenance.

Regulated by kidney function and parathyroid hormone.

Daily requirement 250 mg.

has higher concentration in cerebrospinal fluid than in serum. 35% is bound toprotein. Stored in bone, muscle and soft tissue.

Calcium Ca

1. Mix 500mg/100ml D5W or NS.2. Give over 30 minutes.

Calcium Chloride(increases myocardial contractile function-positive inotropic effectmodulated by effect on SVR + or -)

10ml bristojet = 1Gm

(1ml= 100mg)

0 Hyperkalemia, hypocalcemia, after multiple transfusions or Calciumchannel blocker toxicity: 8-16mg/kg of 10% solution; repeat if necessary-May cause slowing of HR- May precipitate digitalis toxicity-Precipitates with Na Bicarb

Normal Lab values: 8.8-10.5

Action: Serves as framework for bones and teeth. Essential for blood clotting,for normal functioning of the central nervous system and for musclecontraction and neuromuscular stability. Stabilizes cell membranes.

Regulated by Parathyroid hormone, thyrocalcitonin, vitamin D, kidney

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function.

Daily requirement 800 mg

Major concentration is in the bone. 50% of serum Ca++ is bound to protein.

Normal gastric acidity is necessary for absorption in the gut.

Dopamine

catecholamine-vasoconstrictor(dopaminergic, beta and alphareceptors)

Rember to fill the tank.

Mix 200 or 400 mg in 500 mg of D5W.

Premix= 400mg/250cc D5W

Hemodynamically significant hypotension:

low dose-1-2 mcg/kg/min=cerebral, mesenteric and renal vasodilation; UOP increase;HR & BP unchanged

mid dose- 2-10 mcg/kg/min= increased cardiac output

high dose- >10mcg/kg/min=increased SVR, PVR, preloadsecondary to renal, mesenteric,peripheral arterial and venousvasoconstriction

toxic dose- >20mcg/kg/minischemic changes

Symptomatic bradycardia- add

norepinephrine if > 20mcg/kg/minrequired

If infiltrates use regitine phentolamine. Give multiple 1ml iniections SQ in acircle around area of infiltration.

Ehould be given via central line.

* Use lowest dose that produces desired effect

* Avoid in hypovolemia, high SVR, pulmonary congestion or increased

preload

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Stimulates cardic beta recgptors.

Incompatable withAcyclovir

Alkalyne SolutionsAltapaseAminophyllineLasix

Dont mix with bicarb solutions.

1mg/kg/min = 1cc if 6Xwt inKg/100cc D5W

Pulmonary congestion ; low

cardiac output; hypotension;septic shock- 2-20 mcg/kg/min

-Avoid alkaline solutions (Bicarb)-Monitor for tachycardia, hypertension and ventricular ectopy

-Side effects include headache, nausea, tremor and hypokalemia

Nipride (Sodium Nitroprusside)

1. Mix 50 mg in 250 ml in D5W2. Dose- 0.5-10 mcg/kg/min

Breaks down into Cynide. Cynide levels should be checked every 24 hours.

Antidote for Cynide is Sodium Thiosulfate.

Mix 12.5 gm in 50 mlGive every 24-48 hours.

Early confusion

Monitor blood pressure via art. line.(vasodilator)

50mg/250 D5W or NSS

Severe Hypertension; 0.5- 8.0mcg/kg/min* Monitor for hypotension

* Toxicity includes tinnitus, visual blurring, altered mental status, nausea,

abdominal pain, hyperreflexia, and seizures.

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Nitroglycerin (TNG)

Mix 50 mg in 500 ml D5W.

Mix in glass bottles only.

Special tubing.

Start at 5 mcg/min then titrate up every 3-9 minutes.

(vasodilator)

50mg/250 D5W

Angina Pectoris; dosing titrationto effect

Monitor for headache, hypotension, syncope, faintness.

Vasopressin

Mix 100 units in 250 ml D5W

Run with Have TNG hooked up and ready to counteract it.

0.2-0.4 units/min

0.1u/min=15 ml/hr0.2u/min=30ml/hr0.3u/min=45ml/hr0.4u/min=60ml/hr

Ativan Lorazapam1. Mix 50 mg in 100 ml.

2. If giving IV dilute with sodium chloride in a syrange first it is very thick.