Drips

Vasopressors:

Drug

Dose

Receptors

Indications

Considerations

Norepinephrine (Levophed)

1 – 100 mcg/min

αα1 > β1

1st line septic shock

Peripheral ischemia, skin necrosis

Phenylephrine (Neosynephrine)

Bolus: 0.05 – 0.5 mg q 10-15 min

Infusion: 40-360 mcg/min

αα1

Used for periprocedural hypotension(Neostick)

or pts w/ tachyarrhythmias

Reflex bradycardia

Peripheral ischemia, skin necrosis

Epinephrine

1 – 40 mcg/min

αα1=β1=β2

Post PEA arrest

Anaphylaxis

Septic shock (severe)

Cardiac shock

Tachy-arrhythmias,

Peripheral ischemia, skin necrosis

Vasopressin

0.04 U/min (no titration); start at

NE > 50

V1, V2, V3

2nd line septic shock, Right heart failure

Hyponatremia

Bradycardia

ANG II

*needs approval by Dr. Rice or Dr. Semler

20 – 40 ng/kg/min

ANG II

Refractory vasodilatory shock

*typically multiple pressors at high doses

Thrombosis:

pt MUST have chemical DVT ppx; contraindicated in heart failure

Dopamine

2 – 20 mcg/kg/min

Dopamine

(1-5 mcg) > β1 (5-10 mcg) >α1 (>10mcg)

Hypotension

Cardiac shock

Renal protection

Tachy-arrhythmias (↑ risk ))

Peripheral ischemia, skin necrosis

Dobutamine

2.5 – 20 mcg/kg/min

β1 >>> β2

Cardiogenic shock

Vasodilation Hypotension

Tachycardia

Tachyphylaxis

Milrinone

0.375 – 0.75 mcg/kg/min

PDE-3

Cardiogenic shock

Hypotension

Renally cleared

Sedatives/Anxiolytics:

Drug

Dose

Class

Metabolism

Side Effects

Propofol

Infusion: 5 – 150 mcg/kg/min

General anesthetic

(GABA R agonist)

Hepatic

Renal (minor)

Severe Hypotension bradycardia

Propofol infusion syndrome

Dexmedetomidine (Precedex)

Infusion: 0.1 – 1.5 mcg/kg/h

Central αα2 agonist

Hepatic

Hypotension

Bradycardia

Midazolam (Versed)

Push: 0.5 – 5 mg

Infusion: 0.25 – 5 mg/h (no max dose)

Benzodiazepine

Hepatic &

Renal

Hypotension

Lorazepam (Ativan)

Push: 0.5 – 10 mg

Infusion: 0.5 – 5 mg/h (no max dose)

Benzodiazepine

Hepatic

Hypotension

Propylene glycol carrier - AG acidosis

Analgesic:

Drug

Dose

Metabolism

Side effects

Fentanyl

Push: 25 – 100 mcg

Infusion: 25 – 400 mcg/h

Hepatic

Hypotension, Serotonin syndrome, chest wall rigidity at high doses

Morphine

Push: 1 – 5 mg q1-2h prn

Infusion: 1 – 5 mg/h

Hepatic/Renal

Hypotension (profound), itching, constipation, HA; avoid in renal failure

Hydromorphone (Dilaudid)

Push: 0.25 – 1 q1-2h prn

Infusion: 0.5 – 3 mg/h

Hepatic

Hypotension, respiratory depression, itching

Anti-Arrhythmics:

Drug

Dose

Indications

Side effects

Comments

Adenosine

6 – 12 mg IV rapid push and flush; may repeat x2

PSVT conversion

Complete AV nodal blockade

10 second half-life

Must have continuous EKG/tele monitor

Amiodarone

ACLS: 300 mg IV push

Non-emergent: 150 mg over 10 min then 0.5 mg/min

Vtach/Vfib

Afib

Pulm, ophthalmic and thyroid toxicity w/ chronic use

Less hypotensive effect than other agents

Safe in heart failure

Diltiazem

Push: 10 – 20 mg q15 min x 2 if no response

Infusion: 5 – 15 mg/h

Afib

Aflutter

PSVT

Bradycardia

Hypotension

Avoid use in pts with HFrEF

Lidocaine

ACLS: 1 mg/kg x 1

Infusion: 1 – 4 mg/min

Vtach

Bradycardia

Heart block

Avoid use in liver failure or heart failure

Procainamide

15 mg/kg over 30 min then 1 – 6 mg/min

Vtach

Refractory afib

Bradycardia

Hypotension

Drug-induced lupus

Cytopenias