Saturday, May 23, 2009

Drugs used in RICU



Adult Dosage & Administration


Atropine sulfate

First-line therapy for symptomatic bradycardia

Second-line therapy for asystole or bradycardic pulseless electrical activity (after epinepherine)

For asystole or PEA - 1 mg IVP; may repeat every 3 - 5 minutes to maximum dose of 0.03 - 0.04 mg/kg

For bradycardia - 0.05 - 1 mg IVP; may repeat every 3 - 5 minutes to maximum dose of 0.03 - 0.04 mg/kg

Endotracheal administration - 2 - 3 mg diluted in 10 ml NS

Use cautiously in patients with myocardial ischemia and/or hypoxia; increases myocardial oxygen demand.


Avoid in hypothermic patients.

Calcium Chloride



Antidote for overdose of calcium channel blocker

8-16 mg/kg IV slowly

Not routinely used for cardiac arrest.


Do not mix with sodium bicarbonate.


To slow ventricular response in atrial fibrillation or atrial flutter

PSVT refractory to other therapy (i.e. vagal maneuvers, adenosine, diltiazem, verapamil)

Loading dose: 10-15 mcg/kg given over at least 5 minutes;


Maintenance dose: affected by body size & renal function

Toxic effects are common & may precipitate arrhythmias.


Avoid electrical cardioversion (and lower current settings) for patients receiving digoxin.


Antidote = digibind.


CHF or pulmonary congestion with hypotension

2-20 mcg/kg/minute titrated so that heart rate doesn't exceed 10% of baseline


(amp. 250mg/5ml)

May cause tachyarrhythmias, fluctuations in BP.


Cardiac & hemodynamic monitoring is recommended.


Hypotension with signs & symptoms of shock

Symptomatic bradycardia (after atropine)

Low (renal) dose - 1-5 mcg/kg/minute

Moderate - 5-10 mcg/kg/minute

High - 10-20 mcg/kg/minute

(amp. 200mg/5ml)

Use only after volume replacement in hypovolemic patient.


May cause tachyarrhythmias, excessive vasoconstriction.


Avoid extravasation administer phentolamine SQ in area of extravasation to minimize tissue necrosis.


Ventricular fibrillation, pulseless ventricular tachycardia, asystole, pulseless electrical activity

Symptomatic bradycardia after atropine & transcutaneous pacing

Severe allergic reactions, anaphylaxis

Cardiac arrest - 1.0 mg IVP; may repeat q 3-5 minutes

Endotracheal administration - 2.0-2.5 mg diluted in 10 ml. NS

Profound bradycardia - 2-10 mcg/minute


If administration causes rapid, marked rise in BP, can see aortic rupture, cerebral hemorrhage, or angina pectoris.




Acute pulmonary edema without signs/symptoms of shock

Hypertensive emergencies

Increased intracranial pressure

0.5-1.0 mg/kg IV over 1-2 minutes; if no response, may double the dose to 1.0 mg/kg IV over 1-2 minutes

Monitor serum electrolytes.


May cause dehydration, hypovolemia, hypotension, & electrolyte imbalance.

Magnesium sulfate

Cardiac arrest related to torsades de pointes or low serum magnesium

VF refractory to lidocaine & bretylium

Torsades de pointes with a pulse

Ventricular arrhythmias associated with digitalis toxicity or tricyclic overdose

Resistant BS

Cardiac arrest -1-2 Gm IVP

Acute myocardial infarction -1-2 Gm. diluted in 50-100 ml 5% dextrose in water IV over 5-60 minutes; follow with 0.5-1.0 Gm/hour IV for up to 24 hours

Torsades de pointes -1-2 Gm. diluted in 50-100 ml 5% dextrose in water IV over 5-60 minutes; follow with 1-4 Gm/hour IV titrated to control the torsades

Rapid IV administration may cause hypotension.


Use with caution in patient with renal disease.


May cause respiratory failure.  Do not administer if patient has absent patellar reflexes, respiratory depression, or oliguria. 


Causes hypotonia.

Morphine sulfate

Chest pain & anxiety associated with acute MI or cardiac ischemia

Acute cardiogenic pulmonary edema

1-3 mg IV over 1-5 minutes; may repeat every 5-30 minutes

Use cautiously in patients with respiratory compromise.


May cause hypotension in patients with hypovolemia.


Antidote: naloxone 0.4-2.0 mg IV.


Chest pain of suspected cardiac origin

Unstable angina

Complications of acute myocardial infarction, including CHF & LV failure

Hypertensive crisis

10-20 mcg/minute infusion titrated to effect

0.3-0.4 mg sublingually every 5 minutes

Monitor VS & EKG during therapy.


Use NTG tubing.


Do not mix with other drugs.


Cardiogenic shock

Hemodynamically significant hypotension

Start at 0.5-1.0 mcg/minute; titrate to 30 mcg/minute 

Increases myocardial oxygen requirements and may induce arrhythmias, therefore use cautiously in patient with cardiac ischemia.


Extravasation causes tissue necrosis.

Sodium Bicarbonate

Known preexisting hyperkalemia

Known preexisting bicarbonate-responsive acidosis

Overdosage of tricyclic antidepressants or aspirin

May be used in prolonged resuscitation with effective ventilation or upon return of spontaneous circulation after long arrest

Initial dose: 1 mEq/kg IV bolus

Repeat half of initial dose every 10 minutes thereafter

Given dose:

1/6BWt.x deficit

ABG analysis of pH, pCO2, and base deficit is helpful in guiding bicarbonate therapy.


Harmful in hypoxic lactic acidosis, i.e. cardiac arrest & CPR without intubation/adequate ventilation.

Sodium Nitroprusside

Hypertensive crisis

To reduce afterload in heart failure, acute pulmonary edema, or acute mitral or aortic valve regurgitation

Begin at 0.10 mcg/kg/minute and titrate upward every 3-5 minutes to desired effect (up to 5.0 mcg/kg/minute)

Drug is light-sensitive; therefore, wrap drug reservoir in aluminum foil.


May cause thiocyanate toxicity: blurred vision, tinnitis, confusion, hyperreflexia, seizures.


Use with an infusion pump; closely monitor blood pressure during therapy.


PSVT with narrow QRS complex & adequate blood pressure

2.5-5.0 mg bolus over 1-2 minutes; may administer 5-10 mg if needed 15-30 minutes after initial dose

Maximum dose = 30 mg.

Expect BP to drop

due to peripheral vasodilation.


IV calcium can

restore BP; some clinicians recommend administering ca prophylactically

prior to Verapamil.

Heparin / Cal-heparin

Prophylaxis and treatment of PE

AF with embolization

Diagnosis and treatment of DIC

Prevention of clotting in arterial and cardiac surgery

Prophylaxis and treatment of peripheral arterial embolism.

In blood transfusions, extracorporeal circulation, and dialysis procedures and in blood samples

Loading dose: 80 IU/Kg


Maintenance dose:

18 IU/Kg/hr IV


Prophylactic dose:

5000 IU/12hrs Sc


Follow up with PTT aiming to become double normal.


Regular platelet count monitoring.


Antidote= protamine sulphate (1mg neutralizes 1mg heparin or 100 unit)


Not used in bleeding tendencies or recent stroke or active PU.









Unstable angina


In dialysis machine

Prophylactic dose: 1mg/Kg/d Sc/IV


Therapeutic dose: 1mg/Kg/12hrs Sc/IV

Low molecular weight heparin (enoxaparin or fraxiparin).


FU renal function, K+ and platelets.




Acute severe asthma


COPD exacerbation


P. edema


Increase diaphragmatic motility

Loading dose: 6mg/Kg/20mins


Maintenance dose:

0.6mg/Kg/hr IV slowly

Slowly IV diluted in fluids.


Monitoring dose for side effects and drug interactions.



Muscle relaxant after ventilation (neuromuscular blocker).

Initial dose: 2.5-3 mcg/kg/min


Infusion: 0.1-2 mg/kg


(amp. 25mg/2.5ml or 50mg/5ml)

Caution with hypotension and hypotonia.

Midazolam (Dormicum)


Procedural sedation




Acute aggression or delirium


Status epilepticus


After MV

Loading dose: 0.02-0.1 mg/Kg (as valium)


Maintenance dose: 0.04-0.2 mg/Kg/hr


1ml, 3ml, 10ml amp. With conc. 5mg/ml and

Oral form 7.5mg tab.

Relative contraindications in hypotension, hypersensitivity, glaucoma and drug interactions.


Fastest onset, shortest duration.

Doxapram (Dopram)

Stimulate respiration in:




Drug induced CNS depression


Chronic pulmonary disease with hypercapnea



IV: 0.5-1 mg/Kg single injection with 5 min interval, maximum 2 mg/Kg


Infusion: 1-3 mg/min, maximum 300 mg/d


(400mg amp.)

Not with epilepsy, PE, cerebral injuries or ischemia, mechanical disorders of ventilation, severe hypertension.


Slow infusion to prevent hemolysis, seizures.


Monitor ECG.

1 comment:

Rana said...

Gazaky allah kol kheer ya a7la Chestaweya fel donya..;)
May allah bless u isa..

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