50 Drugs 1

11: Droperidol – Inapsine

MOA: antagonizes dopamine and alpha adrenergic receptors

Dose: 1.25 – 2.5mg IV q 4 hours PRN

Emergent Indications: vomiting prevention, migraine abortion

Where you’ll get in Trouble: QT prolongation (Torsades), NMS, extrapyramidal side effects, Preg C

 

12: Epinephrine – EpiPen, Adrenalin

MOA: alpha and beta receptor agonist

Dose: 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/asthma: 0.01 mg/kg 1:1,000 IM/SQ (max single dose 0.3 mg) Hypotension refractory to IVF: 1-10 mcg/min IV

Emergent Indications: anaphylaxis, ACLS arrest, PALS/NRP arrest, severe asthma

Where you’ll get in Trouble: dosing errors (10 fold errors), tissue necrosis (needs to administered via central venous line), dysrhythmias, Preg C

 

13: Enoxaparin – Lovenox

MOA: binds to antithrombin III and inactivates factor Xa > thrombin

Dose: 1 mg/kg SQ q 12hours OR 1.5 mg/kg SQ q 24hours

Emergent Indications: PE, NSTEMI, unstable angina

Where you’ll get in Trouble: 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

14: Esmolol – Brevibloc

MOA: selective beta1 antagonist

Dose: 500 mcg/kg loading dose, then continuous infusion of 50-300 mcg/kg/min

Emergent Indications: aortic dissection

Where you’ll get in Trouble: precipitated CHF, hypotension, bronchospasm, Preg C

 

15: Esomeprazole – Nexium

MOA: inhibits parietal cell hydrogen-potassium ATPase (PPI)

Dose: 80 mg IV bolus followed by 8 mg/hour

Emergent Indications: Upper GI bleed (non-variceal)

Where you’ll get in Trouble: fairly benign when used acutely, Preg B

16: Etomidate – Amidate

MOA: GABA-like effects on brain stem reticular formation causing hypnosis

Dose: 0.3 mg/kg IV

Emergent Indications: RSI induction

Where you’ll get in Trouble: cortisol depression (questionable clinical significance for single administration), lowers seizure threshold, Preg C

17: Fentanyl – Sublimaze

MOA: opioid agonist producing analgesia with adjunctive sedative effects

Dose: 25-100 mcg IV q 1-2 hours; recommended dose 1 mcg/kg

Emergent Indications: pain control, sedation adjunct

Where you’ll get in Trouble: respiratory depression, vasodilation (hypotension), laryngospasm, Preg C

 

18:Fomepizole – Antizol

MOA: inhibits alcohol dehydrogenase

Dose: 15 mg/kg IV loading dose, then 10 mg/kg q 12 hours x 4 doses, then 15 mg/kg q 12 hours until ethylene glycol levels < 20 mg/dL and patient asymptomatic with normal pH

Emergent Indications: methanol or ethylene glycol toxicity

Where you’ll get in Trouble: fairly safe, Preg C

 

19: Fosphenytoin – Cerebyx

MOA: stabilizes voltage dependent neuronal Na channels to stop seizure activity

Dose: 15-20 mg/kg IV loading dose administered at 150 mg/min

Emergent Indications: status epilepticus

Where you’ll get in Trouble: rapid administration can cause hypotension or dysrhythmias, give with patient on monitor, Preg D

 

20: Furosemide – Lasix

MOA: inhibits Na and Cl reabsorption in distal renal tubule and ascending loop of Henle

Dose: usual dose in ED 20-40 mg IV, reassess, increase to desired effect (maximum single dose 200mg)

Emergent Indications: pulmonary edema, CHF exacerbation, hyperkalemia (if making urine)

Where you’ll get in Trouble: volume depletion, hypokalemia, metabolic alkalosis, ototoxicity, Preg C

 

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