50 Drugs 2

21: Glucagon – GlucaGen

MOA: stimulates cAMP production independent of beta receptor, increases gluconeogenesis and glycogenolysis

Dose: Beta-blocker/Ca channel blocker toxicity: 3-10 mg IV loading dose, then 1-10 mg/hour IV continuous infusion if responsive to loading dose

Hypoglycemia: 1 mg IV/SQ/IM

Emergent Indications: beta-blocker toxicity, Ca channel blocker toxicity, hypoglycemia

Where you’ll get in Trouble: anaphylactoid reaction, can cause hypotension, emesis (aspiration risk in altered patient), Preg B

22: Haloperidol – Haldol

MOA: Antagonist at D1 and D2 receptors

Dose: 5-10 mg PO/IM/IV q 2 hours (max 100 mg/day)

Emergent Indications: agitation, psychosis

Where you’ll get in Trouble: do not give for dementia-related psychosis, NMS, EPS, QT prolongation, Preg C

23: Heparin

MOA: binds to antithrombin III thereby potentiating inactivation of thrombin and factors IX, Xa, XI, XII; prevents fibrinogen → fibrin; preferential inactivation of thrombin over other clotting factors

Dose: Venous thromboembolism: 80 units/kg IV x 1, then 18 units/kg/hour

ACS or Afib: 60 units/kg IV x 1, then 12 units/kg/hr

Emergent Indications: thromboembolism; ACS (enoxaparin preferred for NSTEMI)

Where you’ll get in Trouble: bleeding (protamine may be given for reversal), dosing errors, Preg C

24: Hydrocortisone – SoluCortef

MOA: produces multiple gluco and mineralocorticoid effects

Dose: Adrenal insufficiency: 100mg IV bolus, then 50 mg IV q 6 hours x24 hours followed by a taper

Septic shock: 50 mg IV q 6 hours Status asthmaticus: 1-2 mg/kg IV q 6 hours x24 hours followed by a maintenance regimen

Emergent Indications: acute adrenal insufficiency, status asthmaticus, vasopressor refractory septic shock

Where you’ll get in Trouble: immunosuppression, hyperglycemia, Preg C

25: Hydromorphone – Dilaudid

MOA: opioid agonist producing analgesia with adjunctive sedative effects

Dose: 1-2 mg IV q 3-6 hours

Emergent Indications: Analgesia

Where you’ll get in Trouble: Respiratory depression, vasodilation (hypotension), 1 mg of IV Dilaudid is approximately equal to 7 mg of IV morphine, Preg C


26: Insulin Regular

MOA: ↑ peripheral glucose uptake, increased inotropy, shifts potassium intracellularly

Dose: Hyperkalemia: 5-10 units IV x 1 CCB overdose: 1 unit/kg bolus given with 25 grams of dextrose if initial BG < 250 mg/dL; then initiate insulin drip at 0.1 – 1 unit/kg/hr titrated to SBP along with 0.5 g/kg/hr of dextrose titrated to maintain BG 100 – 200 mg/dL DKA/HHS: 0.1 unit/kg bolus followed by continuous infusion 0.1 unit/kg/hour

Emergent Indications: hyperkalemia, DKA/HHS, CCB overdose

Where you’ll get in Trouble: hypokalemia, hypoglycemia, only regular insulin can be given IV, Preg B


27: Ketamine – Ketalar

MOA: Acts on cortex and limbic system, NMDA receptor antagonist

Dose: Subdissociative: 0.1-0.5 mg/kg IV

Procedural sedation: 0.5-1 mg/kg IV

RSI induction: 2 mg/kg IV

Emergent Indications: analgesia, sedation, RSI induction

Where you’ll get in Trouble: emergence reactions (treat with benzos or barbs), laryngospasm, IOP increase, ICP increase, tachycardia, hypertension, Preg D

28: Labetolol – Trandate

MOA: alpha1, beta1, and beta2 antagonist

Dose: Bolus dose: 20-80 mg IV q 10 minutes PRN

Continuous infusion: 1-8 mg/min titrated to effect

Emergent Indications: hypertensive emergency

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


29: Lorazepam – Ativan

MOA: Enhances inhibitory effects of GABA

Dose: Usual bolus dose: 1-2mg IV Usual continuous infusion: 1-10 mg/hr

Emergent Indications: delirium tremens, status epilepticus, serotonin syndrome, agitation

Where you’ll get in Trouble: respiratory depression, hypotension, Preg D

30: Magnesium Sulfate

MOA: participates in physiologic processes

Dose: Eclampsia: 2-4 grams IV over 5 minutes

Pulseless torsades: 2 grams IV push

Asthma exacerbation: 2 grams over 15 minutes

Emergent Indications: torsades, ventricular dysrhythmias, eclampsia, status asthmaticus

Where you’ll get in Trouble: respiratory depression, hypotension, Preg A


31: Mannitol – Osmitrol

MOA: osmotic diuretic

Dose: 1 gram/kg IV x 1

Emergent Indications: elevated ICP, impending herniation

Where you’ll get into trouble: may cause dehydration, osmotic nephrosis


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