50 Drugs Every Emergency Physician Should Know

Thanks for using this guide. Please note that this is not meant to represent every drug an EP should know. This is simply a quick guide to many of the common and life saving drugs that we use every day. It does not include antibiotics and it does not include many important pediatric drugs. Use this with care and remember that every patient does not weigh 70kg.

1

MOA: replenishes glutathione stores, serves as glutathione substitute, and enhances sulfate conjugation of acetaminophen (Tylenol)

PO Dose: 140 mg/kg x 1, then 70 mg/kg q 4 hours x 17 doses (72 hours total)

IV Dose: 150 mg/kg in 200ml D5W over 1 hour, 50 mg/kg in 500ml D5W over 4 hours, 100 mg/kg in 1 liter D5W over 16 hours (21 total hours, may need to continue until LFTs and APAP level normalize)

Emergent Indications: acetaminophen (Tylenol) overdose

Where you’ll get in Trouble: hypersensitivity reaction (stop infusion, switch to PO or slow infusion rate), while rare, you can also see hypersensitivity with PO as well, Preg B

2

MOA: acts on A1 receptors in AV node causing temporary heart block

Dose: 6mg IV RAPID push, may give 12mg IV q 2 minutes if no effect x2

Emergent Indications: stable SVT, stable narrow complex tachycardias Where you’ll get in Trouble: prodysrhythmic, do not give in preexisting 2nd or 3rd degree block, Preg C

3

MOA: selective beta2 agonist

Dose: 2.5 – 5 mg q 20 minutes for 1st hour, then 2.5-10 mg q 1-4 hours prn (alt, 10-15 mg over 1 hour)

Emergent Indications: acute bronchospasm, hyperkalemia

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

4

MOA: blocks K efflux (Class III antidysrhythmic); also has Na channel blocking (class I), beta blocking (class II), and Ca channel blocking (class IV) properties

Dose: Pulseless VF/VT: 300mg IV rapid push followed by 150mg IV rapid push if necessary at

next pulse check Stable wide complex tachycardias: 150mg IV over 10 minutes, followed by infusion of 1mg/min x 6hours, then 0.5 mg/min thereafter

Emergent Indications: pulseless VF/VT, Wide complex tachydysrhythmias

Where you’ll get in Trouble: Causes hypotension, prodysrhythmic, Preg D

5

MOA: direct anticholinergic

Dose: Organophosphate/carbamate toxicity: 1-6 mg IV q 3-5 minutes PRN, until dry secretions (can double dose each time until adequate response achieved)

Peds Bradycardia: 0.02 mg/kg IVx1; 0.5 mg maximum single dose; 1 mg max cumulative dose

Adult bradycardia: 0.5 mg IV, 3 mg max cumulative dose

Emergent Indications: Organophosphate/carbamate toxicity, bradycardia

Where you’ll get in Trouble: hyperthermic patients, tachydysrhythmias, Preg C

6

MOA: increases serum calcium, stabilizes cardiac myocytes

Dose: 10% IV solution (gluconate or chloride) contains 1 gram per 10 mL

Emergent Indications: hyperkalemia, hypocalcemia with dysrhythmia

Where you’ll get in Trouble: dysrhythmia, tetany, calcium chloride 3x more potent than calcium gluconate (severe phlebitis with peripheral administration of calcium chloride), Preg C

7

MOA: enhances inhibitory effects of GABA

Dose: 2-10 mg PO/IV/IM q 6 hours PRN

Emergent Indications: Seizure abortion, alcohol withdrawal, agitation, muscle spasm

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

8

MOA: inhibits calcium influx in myocardium > vascular smooth muscle; prolongs AV nodal conduction

Dose: 0.25 mg/kg IV x1; may give 0.35 mg/kg IV x1 after 15 minutes; continuous infusion 5-15 mg/hr

Emergent Indications: stable Afib with RVR, stable SVT

Where you’ll get in Trouble: iatrogenic hypotension, bradycardia, Preg C

9

MOA: beta1 agonist > beta2 agonist

Dose: 2-20mcg/kg/min IV

Emergent Indications: decompensated heart failure, refractory hypotension

Where you’ll get in Trouble: tachycardia, hypotension if not euvolemic, PVCs, Preg B

10

MOA: alpha1, beta1, and dopaminergic agonist

Dose: < 5 mcg/kg/min IV dopaminergic effects (not recommended)

5-10 mcg/kg/min IV primarily beta effects

10-20 mcg/kg/min IV primarily alpha effects

Emergent Indications: decompensated heart failure, hypotension

Where you’ll get in Trouble: tachydysrhythmias, tissue necrosis if extravasation or arterial administration therefore needs to be given through central venous line, Preg C

 

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