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
