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