Crash Cart Medications

ABU DHABI NATIONAL OIL COMPANY
NOVEMBER 2ND, 2019
CRASH CART MEDICATIONS
Das Medical Center
Presented by: Wael Abu Alfahem

OBJECTIVES….
Health care providers will be able to understand and practice
the following about crash cart medications:
• Mechanism of action.
• Main indications.
• Main contraindications.
• Major side effects, Adverse reactions, And considerations.
• Dosage and administration.
Friday, November 8, 2019
CRASHCARTMEDICATIONS
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INTRODUCTION &
HISTORY…..
A crash cart or code cart (crash trolley in UK medical jargon) or "MAX cart" is a set of
trays/drawers/shelves on wheels used in hospitals emergency room, intensive care unit,
clinics and other areas for transportation and dispensing of emergency
medication/equipment at site of medical/surgical emergency for life support protocols
(ACLS/ALS) to potentially save someone's life. The cart carries instruments for
cardiopulmonary resuscitation and other medical supplies while also functioning as a
support litter for the patient.
The crash cart was originally designed and patented by ECRI(Emergency Care Research
Institute) founder, Joel J. Nobel, M.D., while a surgical resident at Philadelphia's Pennsylvania
Hospital in 1965. MAX helped enhance hospital's efficiency in emergencies by enabling
doctors and nurses to save time, thereby increasing the chances of saving a life.
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EMERGENCIES IN WHICH
CRASH CART SHOULD BE
USED…..
• Compromised airway.
• Respiratory distress/ Respiratory arrest.
• Cardiac arrest/ Dysrhythmias.
• Hypoglycemia.
• Anaphylactic reaction.
• Major trauma’s.
• CNS emergencies.
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CONTENTS OF CRASH
CART TROLLEY...
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1) External contents:
• Oxygen supply
• Defibrillator
• Portable suction
• Sphygmomanometer
• Stethoscope
• Crash cart checklist
• Ambu-bag
2) Internal contents:
• Drawer 1: medications
• Drawer 2: medications
• Drawer 3: I.V fluids & access tools.
• Drawer 4: respiratory equipment
• Drawer 5: Miscellaneous

DRUG DOSAGE
CALCULATION TERMS….
• Desired dose
– Quantity of a medication that is to be administered.
• Concentration
– Amount of medication that is present in vial.
• Volume
– Amount of fluid medication is dissolved in.
• Yield
– The amount of drug in 1 mL.
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EMERGENCY CRASH CART
MEDICATIONS …
7

EPINEPHRINE (ADRENALIN)
(1 MG1ML AMPULE)
8
• Mechanism of action:
- It is a catecholamine having a non-specific action on the
adrenoceptors causing an increase in activation of the
sympathetic nervous system(it acts as a vasoconstrictor
by activating α1 receptors, increases cardiac output by
activating β1 receptors, and bronchodilator by activating
β2 receptors).
• Indications
- Pulseless Ventricular Tachycardia (pVT)
- Ventricular Fibrillation (VF)
- Asystole
- Pulseless Electrical Activity (PEA)
- Bradycardia
- Anaphylaxis.
• Contraindications
- Hypersensitivity to adrenaline, angle closure glaucoma.
• Adverse reactions
-Nervousness, restlessness, headache, tremor, anxiety, increased
blood pressure, tachycardia, arrhythmias.
• Considerations
- Do not administer repeated injections of epinephrine at the
same site, as the resulting vasoconstriction may cause tissue
necrosis.
• Dose and administration
For pVT, VF, Asystole, and PEA:
- Give 1mg IV/IO every 3-5 minutes (or give 2mg in 10ml of NS
by ETT).
For Bradycardia:
- Start an infusion with a dose of 2-10 mcg/min IV/IO titrating
to the patient’s response.
For Post ROSC:
- 0.1 to 0.5 mcg/kg/min IV infusion; titrate to effect (A 70 kg adult
patient would receive a dose from 7 to 35 mcg/min).
For Anaphylaxis:
- 0.5 mg I.M(0.5 ml), repeated every 5 to 10 minutes as necessary.

NOREPINEPHRINE BITARTRATE
(LEVOPHED)
4 MG VIAL(1MG1ML)
9
• Mechanism of action
– Potent α 1 agonist and β 1 agonist, resulting in intense
peripheral vasoconstriction, and stimulating cardiac
contractility and dilates coronary arteries, causing increased
systemic vascular resistance and heart rate.
• Indications
– For blood pressure control in certain acute hypotensive
states as Cardiogenic shock and septic shock unresponsive to
fluid resuscitation.
– As an adjunct in the treatment of cardiac arrest and
profound hypotension.
– Hypotensive patients from blood volume deficits except as
an emergency measure to maintain coronary and cerebral
perfusion until volume could be replaced
– mesenteric or peripheral vascular thrombosis.
– patients with profound hypoxia or hypercarbia.
– Headache, anxiety, dizziness, Ischemic injury , bradycardia,
Respiratory difficulty, Extravasation necrosis at injection site.
• Considerations
– Doses should be titrated based on individual patient
response.
– To prevent necrosis in site of extravasation, the area should
be infiltrated as soon as possible with 10 mL to 15 mL of
saline solution containing from 5 mg to 10 mg
phentolamines, an adrenergic blocking agent.
• Dose & Administration
Acute Hypotension & Cardiac Arrest
– Initial: 8-12 mcg/min IV infusion; titrate to effect
– Maintenance: 2-4 mcg/min IV infusion.
Septic shock
– 0.01-3 mcg/kg/min IV infusion.
Post ROSC:
– 0.1 to 0.5 mcg/kg/min IV infusion; titrate to effect (A 70 kg
adult patient would receive a dose from 7 to 35 mcg/min).

AMIODARONE (CORDARONE)
50MGML (3ML AMPULE)
10
– Antiarrhythmic drug, it Blocks sodium channels at rapid
pacing frequencies, and exerts a noncompetitive
antisympathetic action, as a result it Prolongs myocardial cell
action potential duration and refractory period in all cardiac
tissue; and decreases AV and SA conduction.
• Indications
Initiate the use of Amiodarone only after the first line treatments
(defibrillation/cardioversion and epinephrine) have failed to treat:
– Cardiac arrest
– Ventricular Tachycardia (VT)
– Ventricular Fibrillation (VF)
– Stable Supraventricular Tachycardia
– Known hypersensitivity to amiodarone or iodine, 2nd & 3rd
degree heart block, Long QT interval, Cardiogenic shock,
Heart block, Sick sinus syndrome, Symptomatic bradycardia.
– Dizziness, fatigue, malaise, Congestive heart failure,
Hypotension, bradycardia.
• Considerations
– Monitor patient for hypotension.
• Dose and Administration
For Stable Wide-QRS tachycardia with a pulse:
– Give 150 mg by IV over 10 minutes. If the arrhythmia persists
or returns you may repeat the bolus as needed. Follow with
a maintenance infusion of 1mg/min for 6 hours with a
maximum dose of 2.2g given in a 24 hour period.
For Ventricular Fibrillation and Ventricular Tachycardia without
a pulse:
– Give Amiodarone 300mg IV/IO push. If the arrhythmia
persists or returns you may give one additional bolus of
150mg IV/IO push 3-5 minutes after the initial dose. After
conversion of the arrhythmia an amiodarone infusion can be
given at a rate of 1mg/min over 6 hours and then a
0.5mg/min infusion over 18 hours.

CALCIUM CHLORIDE 10%
(10 ML PREFILLED SYRINGE)
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– Moderates nerve and muscle performance by regulating the
action potential excitation threshold, Increases cardiac
contractile state.
• Indications
– Hypocalcemia, hyperkalemia, hypermagnesemia, associated
illnesses.
– In cardiac resuscitation, particularly after open heart surgery,
calcium chloride (calcium chloride) has been used when
epinephrine has failed to improve weak or ineffective
myocardial contractions.
– Hypersensitivity to calcium.
– Hypercalcemia, ventricular fibrillation, pulseless ventricular
tachycardia, or pulseless electrical activity, digitalis toxicity.
– Syncope, cardiac arrest, dysrhythmia, bradycardia, local
“burning” sensation, tingling sensations, a calcium taste, a
sense of oppression or “heat wave”.
• Considerations
– Do not use routinely in cardiac arrest.
– This solution is suitable only for intravenous use. Calcium chloride
(calcium chloride) solution injection into muscle or into subcutaneous
or perivascular tissue may cause severe necrosis and sloughing.
HYPOCALCEMIA:
– Usual dose: 500 to 1000 mg by slow intravenous injection, every 1 to 3
days depending on response and/or serum calcium.
Repeat injections may be needed because of rapid calcium excretion.
Maximum rate: 1 mL/min
HYPERKALEMIA:
– Dose is titrated by constant ECG monitoring
Maximum rate: 1 mL/min.
HYPERMAGNESEMIA:
– Initial dose: 500 mg by slow intravenous injection
ASYSTOLE:
– 500 to 1000 mg by slow intravenous injection

CALCIUM GLUCONATE 10%
(100MGML AMPULE)
12
– A membrane stabilizer, Moderates nerve and muscle
performance via action potential threshold
regulation.
• Indications
– Hyperkalemia, hypocalcemia, Reverses ECG changes
pending correction of the extracellular potassium
concentration.
– As a potential antidote in suspected calcium channel
blocker overdoses.
– hydrofluoric acid poisoning and iatrogenic
magnesium intoxication.
– Ventricular fibrillation, digitalis toxicity,
hypercalcemia.
– Syncope, cardiac arrest, dysrhythmia, bradycardia,
hypotension, local burning sensation.
• Considerations
– Do not administer by IM or SQ.
Hypocalcemia:
– Initial dose: 1000 to 2000 mg intravenously (IV)
– Subsequent doses (as needed): IV bolus: 1000 to 2000 mg
every 6 hours, Continuous IV infusion: Initiate at 5.4 to 21.5
mg/kg/hour.
– Maximum IV bolus infusion rate: 200 mg/min.
Hyperkalemia:
– The National Kidney Foundation recommends: 6.8 mmol
calcium (30 mL of calcium gluconate 10% solution)
intravenously for membrane potential stabilization.

MAGNESIUM SULFATE 50%
(10 ML AMPULE)
13
– A sodium/potassium agonist that decreases acetylcholine in
motor nerve terminals and acts on myocardium by slowing
rate of S-A node impulse formation and prolonging
conduction time. Magnesium is necessary for the movement
of calcium, sodium, and potassium in and out of cells, as well
as stabilizing excitable membranes.
• Indications
– Magnesium is primarily used to treat torsades de pointes
(polymorphic VT associated with a prolonged QT interval),
hypomagnesaemia, and digitalis toxicity.
– improve pulmonary function in patients with asthma; causes
relaxation of bronchial smooth muscle independent of
serum magnesium concentration.
– Hypersensitivity to any component of the formulation.
– Hypocalcemia (May result in respiratory distress)
– Magnesium should be used with caution in patients that
have a history or renal failure.
– Calcium deficiency, Upset stomach, Diarrhea, Nausea,
Vomiting, Lowered blood pressure, Decreased heart rate,
Respiratory paralysis, Confusion, Cardiac arrhythmias, Coma,
Cardiac arrest.
• Considerations
– Recommended that the drug not be administered in the 2
hours before (cesarean) delivery if possible due to
interaction with neuromuscular-blocking agents
intraoperatively.
– Administer to keep the magnesium levels greater than 2
mmol/L, when it reaches normal level, stop administration.
• Dose & administration
Torsades de Pointes
– Give loading dose 1-2g slow IV/IO bolus diluted in 10 ml
(D5W, NSS) typically over 5-20 minutes, followed with a
maintenance infusion of 0.5-1g/hr. (Magnesium should be
diluted in 50-100ml of D5W, NS).

SODIUM BICARBONATE 8.4 %
(50 ML VIAL)
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– It works by increasing blood bicarbonate, which
buffers excess hydrogen ion and raises blood pH, it
buffers metabolic acidosis and lactic acid buildup.
• Indications
– Metabolic acidosis during cardiac arrest, circulatory
insufficiency due to shock, anoxia or severe
dehydration, uncontrolled diabetes, tricyclic
antidepressant over dose, aspirin over dose.
– Metabolic/respiratory alkalosis, hypokalemia,
electrolyte imbalances.
– Hypernatremia, Hypokalemia, Hypercalcemia, tetany,
Metabolic alkalosis, Tissue sloughing, Cellulitis,
Aggravated CHF, Cerebral hemorrhage, Edema.
• Considerations
– Repeat as needed in tricyclic antidepressant
overdose until QRS narrows.
– Precaution with diabetic patients as it might cause
harm with certain medical condition like DKA.
– mild acidosis: the usual dosage is 1 to 2 mEq per kg
of body weight, administered slowly, may repeat
with 0.5 mEq/kg 10 minutes later one time, or as
indicated by the patient's acid-base status.
– severe acidosis: 2 to 5 mEq per kg of body weight
may be administered over a 4 to 8 hour period.
– Emergencies: 300 to 500 mL of the 5% Sodium
Bicarbonate .

ATROPINE SULFATE
(0.5 MG1 ML AMPULE)
15
– Increases heart rate in life-threatening Brady
dysrhythmias by inhibiting the actions of
acetylcholine on structures innervated by
postganglionic sites (smooth/cardiac muscle, SA/AV
nodes).
• Indications
– Hemodynamically unstable bradycardia.
– Specific Toxins/overdose (e.g. organophosphates).
– Tachycardia, hypersensitivity, angle closure
glaucoma.
– Drowsiness, confusion, headache, tachycardia,
palpitations.
• Considerations
– Moderate doses may cause pupillary dilation.
• Dose and Administration:
– Give Atropine 0.5mg IV/IO. You may repeat this every
3 to 5 minutes with a maximum dose of 3mg (6
doses).
– 2 to 4 mg IV/ET may be needed in case of Specific
Toxins/overdose (e.g. organophosphates)

DOPAMINE HYDROCHLORIDE(INTROPIN)
40 MGML (5 ML AMPULE)
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– Endogenous catecholamine, acting on both
dopaminergic and adrenergic neurons, Increases
myocardial contractility and stroke volume; dose
dependent.
• Indications
– Symptomatic bradycardia.
– Severe hypotension.
– Hypersensitivity to dopamine.
– Hypovolemic shock.
– Pheochromocytoma.
– Tachydysrhythmias.
– Compromised renal function.
– Headache, anxiety, dyspnea, Nausea, Vomitting,
dysrhythmias, Kidney failure.
• Considerations
– Effects are dose-dependent, Monitor blood pressure
closely.
Myocardial infarction and CHF:
– Initial dose: 2 to 10 mcg/kg/min IV by continuous
infusion, titrate to patient response.
– Maintenance dose: 2 to 50 mcg/kg/min IV by
continuous infusion.
Bradycardia:
– 2 to 20 mcg/kg/min IV by continuous infusion, titrate
to patient response.
Post ROSC:
– 5 to 10 mcg/kg/min IV by continuous infusion, titrate
to patient response.

Continue…
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Hemodynamic Conditions
– 1-5 mcg/kg/min IV (low dose): May increase urine
output and renal blood flow.
– 5-15 mcg/kg/min IV (medium dose): May increase
renal blood flow, cardiac output, heart rate, and
cardiac contractility.
– 20-50 mcg/kg/min IV (high dose): May increase
blood pressure and stimulate vasoconstriction; may
not have a beneficial effect in blood pressure; may
increase risk of tachyarrhythmias.
– May increase infusion by 1-4 mcg/kg/min at 10-30
min intervals until optimum response obtained
– Titrate to desired response.

ADENOSINE
3MGML (2ML VIAL)
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– Works through receptors called purinergic adenosine
receptors, it slows impulse formation in the SA node;
slows conduction time through AV node; depresses
left ventricular function and restores normal sinus
rhythm, This occurs by activation of specific
potassium channels, driving potassium outside of
cells, and inhibition of calcium influx, disrupting the
resting potential of the slow nodal cardiac myocyte,
prolonging depolarization and thus slowing down
conduction within these cells.
• Indications
– Narrow PSVT/SVT.
– Wide QRS Tachyarrhythmia.
– Broncho-constrictive or Broncho-spastic lung disease,
2nd & 3rd degree heart block, Long QT interval,
Polymorphic wide-complex tachycardia, Unstable VT,
sick sinus syndrome.
– Chest pain, Shortness of breath, Feeling faint,
Lowering blood pressure, Diaphoresis, Nausea,
Metallic taste, Facial flushing.
• Considerations
– Evaluate elderly for signs of dehydration.
– avoid adenosine in irregular wide QRS.
– Consider a lower dose of 3mg for patients that: Take
carbamazepine, take dipyridamole, Have a history of
heart transplant, and Administration by central line.
– 1st dose: Give 6mg IV/IO over 1-3 seconds,
immediately followed by 20ml of NS by rapid IV/IO.
– 2nd dose: If the patient still has an SVT rhythm 1-2
minutes later give 12mg IV/IO over 1-3 seconds,
immediately followed by 20ml of NS by rapid IVP/IO.

DILTIAZEM (CARDIZEM)
(5 MG ML VIAL)
19
– A calcium channel blocker that inhibits calcium
movement across cell membranes of cardiac and
smooth muscle, causes vasodilation, decreases heart
rate and contractility, slows SA and AV conduction.
– Reduces myocardial oxygen demand.
• Indications
– Narrow complex tachycardia.
– Hypotension, Sick sinus syndrome, SAAV nodes
disturbances, bradycardia, COPD, CHF.
– Dizziness, weakness, headache, dyspnea, Lethargy,
Nausea, Sore throat, Cough, Fainting, Bradycardia,
Irregular heart beat, Shortness of breath, and Edema.
• Considerations
– Use with caution in patients with renal or hepatic
dysfunction.
The dose of Diltiazem may vary depending on the patient’s
symptoms, medical history, and physician orders. However,
standard general doses for Atrial flutter, Atrial fibrillation, and
SVT are the following:
– 1st dose: Give 0.25mg/kg (between 10-20mg) IV/IO
over 2 minutes.
– 2nd dose: Give 0.35mg/kg (between 20-25mg) IV/IO
over 2 minutes.
– Common subsequent infusion: Give 5-20mg/hr IV/IO
infusion to a maximum duration of 24 hours.

VERAPAMIL HYDROCHLORIDE (ISOPTIN)
2.5MG/ML AMPULE
20
– Prolongs AV nodal refractory period, it inhibits
voltage-dependent calcium channels. Specifically, its
effect on L-type calcium channels in the heart causes
a reduction in ionotropy and chronotropy, thus
reducing heart rate and blood pressure.
• Indications
– Paroxysmal supraventricular tachycardia, atrial
flutter, and atrial fibrillation with rapid ventricular
response.
– Wolff-Parkinson-White syndrome, Lown-Ganong-
Levine syndrome, Hypotension, AV block of second-
or third-degree, Decompensated cardiac failure
(pulmonary edema, hypoperfusion or hypotension),
Continuous or intermittent inotropic therapy acting
through beta-receptor agonism.
– Dizziness, headache, hypotension, bradycardia,
pulmonary edema, nausea.
• Considerations
– Each dose should be administered over at least 2
minutes under continuous ECG and blood pressure
monitoring.
– Initial dose: 5 to 10 mg (0.075 to 0.15 mg/kg body
weight) given as an intravenous bolus over at least 2
minutes.
– Repeat dose: 10 mg (0.15 mg/kg body weight) 30
minutes after the first dose if the initial response is
not adequate.
– Older patients: The dose should be administered
over at least 3 minutes to minimize the risk of
unwanted drug effects.

LIDOCAINE HYDROCHLORIDE 2%
(100 MG5ML PREFILLED SYRINGE)
21
– Decreases depolarization, automaticity, and
excitability of ventricle during diastole by increasing
the electrical stimulation threshold, it blocks
permeability of the neuronal membrane to sodium
ions, resulting in inhibition of depolarization of the
ventricle, reversing ventricular dysrhythmias.
• Indications
– 2nd line agent if amiodarone is unavailable.
– Refractory Ventricular fibrillation (VF), (pVT).
– Continuous infusion after return of spontaneous
circulation (ROSC) from VF/pVT .
– Hypersensitivity, second- or third-degree AV block in
the absence of an artificial pacemaker, Bradycardia,
Severe sinoatrial block, Accelerated idioventricular
arrhythmia, Adam-Stokes syndrome, Wolff-
Parkinson-White syndrome, Prior amiodarone
administration, Concurrent administration with a
type 1 antiarrhythmic (i.e. procainamide), Pseudo
cholinesterase deficiency, Impaired liver function.
– Anxiety, Bradycardia, Muscle twitching, Sleepiness
changes in vision, tingling, confusion, vomiting,
hypotension, irregular heart beat.
• Considerations
– Apnea induced with succinylcholine may be
prolonged with high doses of lidocaine.
– Exceedingly high doses can result in coma or death.
– 1st dose: give 1-1.5mg/kg IV/IO.
– Repeat doses: 0.5-0.75mg/kg IV/IO every 5 to 10
minutes with a total maximum loading dose of
3mg/kg.
– Continuous infusion dose for post return of
spontaneous circulation from VF/pVT: Give lidocaine
at 1-4mg/min continuous infusion.

PROCAINAMIDE HCL(PRONESTYL)
500 MGML (2ML VIAL)
22
– Procainamide blocks sodium channels and also has
an effect on potassium channels and so prolongs the
effective refractory period, decreases automaticity
and slows ventricular conduction.
• Indications
– Ventricular tachycardia with a pulse, SVT, Atrial
fibrillation, and Atrial flutter.
– History of QT prolongation
– 2nd and 3rd degree AV block
– Torsade de pointes
– Electrolyte abnormalities
– Congestive heart failure (CHF)
– Systemic lupus erythematosus (SLE)
– Myasthenia gravis
– Severe renal impairment
– Bone marrow depression
– Symptomatic bradycardias
– Ventricular dysrhythmia, Bradycardia ,Hypotention
,Shock Flushing, Angioedema, urticaria, pleurisy,
Polyarthralgia, myalgia, Systemic lupus erythematosus
(SLE), Drug fever.
• Considerations
– Potent vasodilation and negative inotropic effects,
avoid if prolonged QT or CHF.
– Give as an infusion at 20-50mg/min IV/IO, Continue
the infusion until the rhythm converts, hypotension
occurs, the QRS complex duration rises over 50%, or
maximum dose of 17mg/kg given.
– You may also give a maintenance infusion rate at 1-
4mg/min IV/IO.

SOTALOL HYDROCHLORIDE
10 MG10 ML VIAL
23
– It is a non-cardioselective beta-blocker that also
possesses potassium channel blocker properties, it
prolongs the action potential duration and effective
refractory period in atrium and ventricle, and in
nodal and extranodal tissue as it is a potent
competitive inhibitor for potassium current.
• Indications
– Atrial fibrillation, Atrial flutter, Life-threatening
ventricular arrhythmias.
– Prolonged QT syndrome
– Asthma
– History of Bronchospastic disease processes
– Waking heart rate below 50bpm
– Sick sinus syndrome
– Uncontrolled heart failure
– Cardiogenic shock
– Potassium (K+) levels under 4meq/L
– Prolonged QT interval (potential for torsades de
point), Chest pain, Shortness of breath, Bradycardia,
Fatigue, Dizziness, Weakness, Lightheadedness.
• Considerations
– Sotalol exhibits reverse use-dependent effects,
meaning that the maximal potassium current
blocking effect occurs when the heart rate is slow,
increasing the risk of QT prolongation and torsades
de pointes in bradycardic conditions. So, low dose is
enough to exert a beta-blocking effect.
– 100 mg (1.5 mg/kg) over 5 minutes.

METOPROLOL TARTRATE (LOPRESSOR)
1MG/ML, 5MG/ML AMPULE
24
– Selectively blocks beta-1 receptors, slowing sinus heart rate,
decreasing cardiac output, and decreasing BP.
• Indications
– Myocardial infarction, angina pectoris, CHF, Hypertension,
atrial flutter, atrial fibrillation.
– Hypotension, AV block of second- or third-degree,
Decompensated cardiac failure (pulmonary edema,
hypoperfusion or hypotension), Continuous or intermittent
inotropic therapy acting through beta-receptor agonism,
Bradycardia (<45 bpm), Sick sinus syndrome (unless a
permanent pacemaker is in place), Cardiogenic shock,
Untreated phaeochromocytoma, Metabolic acidosis.
– Blurred vision, chest pain or discomfort, confusion, dizziness,
faintness, or lightheadedness when getting up suddenly
from a lying or sitting position, slow or irregular heartbeat,
sweating, unusual tiredness or weakness.
• Considerations
– Metoprolol must be given IV slowly over 5 minutes.
Early Treatment of myocardial infarction:
– Initial dose: 5 mg IV every 2 minutes as tolerated for 3 doses
– Patients tolerant of full IV dose (15 mg): 50 mg orally every 6
hours starting 15 minutes after the last IV dose and
continued for 48 hours.
– Patients intolerant of full IV dose (15 mg): 25 or 50 mg orally
every 6 hours depending on the degree of intolerance
starting 15 minutes after the last IV dose or as soon as their
clinical condition allows.
Late Treatment:
– Maintenance dose: 100 mg orally twice a day.

NITROGLYCERIN
(0.4 MG SUBLINGUAL SPRAY BOTTLE)
25
– Nitroglycerin forms free radical nitric oxide (NO)
which activates guanylate cyclase, resulting in an
increase of guanosine 3'5' monophosphate (cyclic
GMP) in smooth muscle and other tissues. These
events lead to dephosphorylation of myosin light
chains, which regulate the contractile state in
smooth muscle, and relaxes vasculature, bronchial,
uterine, intestinal smooth muscle.
• Indications
– Acute angina pectoris, ischemic chest pain.
– Hypotension SBP> 90 mmHg, tachycardia,
bradycardia<50/min.
– Inferior MI or RV infarction.
– Recent phosphodiesterase inhibitors use; ex:
sildenafil/vardenafil within 24 hours, or tadalafil
within 48 hrs.
– Headache, dizziness, weakness, vomiting,
hypotension.
• Considerations
– Hypotension more common in the elderly.
– Administer while sitting due to rapid onset.
– Advise patient not to inhale or swallow this
medication.
• Dose & Adminstration
– 1 spray (0.4 mg) on or under tongue every 3-5
minutes as needed, up to 3 sprays in 15 minutes; if
pain persists after maximum dose, prompt medical
attention is recommended.

ASPIRIN
100 MG TABLETS
26
– Arachidonic acid is converted to thromboxane A2
due to the activity of the enzyme cyclooxygenase
(COX), thromboxane A2 stimulates platelet
aggregation during the formation of the platelet
plug. Aspirin irreversibly inhibits the enzyme COX,
leading to decreased production of thromboxane A2
and decreased platelet aggregation.
• Indications
– New onset chest pain suggestive of acute myocardial
infarction.
– Sensitivity to active substance.
– Relatively contraindicated in patients with active
ulcer disease or any other upper GI disorders,
asthma.
– Stomach discomfort.
– Bronchospasm, anaphylaxis, wheezing
in allergic patients, prolonged bleeding.
• Considerations
– Not recommended in pediatric population.
– Immediate release: give the patient aspirin (160 to
325 mg) to chew.
– Maintenance dose: 160 to 162.5 mg orally once a day for
30 days post-infarction.
– Use rectal aspirin suppositories 300 mg for patients with
nausea, vomiting, active peptic ulcer, or any other upper
GI disorders.

CLOPIDOGREL (PLAVIX)
75 MG TABLETS
27
– inhibits the binding of adenosine diphosphate (ADP)
to its platelet P2Y12 receptor and the subsequent
ADP-mediated activation of the glycoprotein
GPIIb/IIIa complex, thereby inhibiting platelet
aggregation.
• Indications
– Acute coronary syndrome.
– Prevention of atherothrombotic and
thromboembolic events in atrial fibrillation.
– Hypersensitivity to active substance.
– Active pathological GI bleeding, intracranial
hemorrhage.
– Severe hepatic impairment.
– Diarrhea, rash, itching, Abdominal pain, headache,
chest pain, muscle aches, dizziness.
• Considerations
– Often given with other anticoagulants.
• Dose & Adminstration
– In patients who need an antiplatelet effect within
hours, initiate Plavix with a single 300 mg oral loading
dose and then continue at 75 mg once daily.

ENOXAPARIN(LMWH)/UNFRACTIO
NATED HEPARIN (UFH)
20 MG/0.2 ML; 40 MG/0.4 ML; 60 MG/0.6 ML; 80
MG/0.8 ML; 100 MG/ML; 120 MG/0.8 ML; 150 MG/ML;
300 MG/3 ML
28
– Enoxaparin binds to and potentiates antithrombin (a circulating
anticoagulant) to form a complex that irreversibly inactivates
clotting factor Xa. It has less activity against factor IIa (thrombin)
compared to unfractionated heparin (UFH) due to its low
molecular weight.
• Indications
– DVT prophylaxis in medium and high-risk groups (surgical,
orthopedic and medical patients).
– Treatment of venous thromboembolism in pregnancy.
– Treatment of DVT and PE in non-pregnant women (those with
both high and low risk of recurrence).
– Treatment of STEMI (in both those undergoing percutaneous
coronary intervention and those not).
– Unstable angina.
– Prevention of clotting in extracorporeal circuits.
– Hypersensitivity, active bleeding.
– Coughing up blood, Difficulty with breathing or swallowing, Dizziness,
Headache, Increased menstrual flow or vaginal bleeding, Nosebleeds,
Paralysis, Prolonged bleeding from cuts, Red or black, tarry stools, Red or
dark brown urine, Shortness of breath.
• Considerations
– Heparin does not lyse existing clots.
– Avoid rubbing the injection site after injecting to minimize
bruising.
– LMWH: 1 mg/kg subcutaneously (SC) every 12 hours, It should be
continued for the duration of hospitalization or until PCI is
performed.
– UFH: An initial loading dose of 60 IU/kg (maximum 4,000 IU) with
an initial infusion of 12 IU/kg per hour (maximum 1,000 IU/h)
adjusted per activated partial thromboplastin time (PTT) is
recommended to maintain therapeutic anticoagulation according
to the specific hospital protocol. This regimen is continued for 48
hours or until PCI is performed.
NOTE: Enoxaparin results in a more predictable and efficient
anticoagulation compared to unfractionated heparin, leading to
reduction in recurrent MI events ; however, there is possibly a higher
bleeding risk in patients undergoing PCI. These findings were
demonstrated in the Efficacy and Safety of Subcutaneous Enoxaparin
in Non–Q wave Coronary Events (ESSENCE) trial.

CHLORPHENIRAMINE
10 MG1 ML AMPULE
29
– It is specifically a potent inverse agonist of the
histamine H1 receptor.
• Indications
– Acute urticaria.
– Anaphylaxis.
– Control of allergic reactions.
– Hypersensitivity to the active substance.
– narrow-angle glaucoma.
– bladder neck obstruction.
– symptomatic prostate hypertrophy.
– during acute asthmatic attacks.
– stenosing peptic ulcer.
– Drowsiness, dizziness, constipation, stomach upset,
blurred vision, or dry mouth/nose/throat.
• Considerations
– May cause CNS depression(patient may not allowed
to do tasks like operating machinery or driving).
– Anaphylaxis: 10 to 20 mg intravenous injection as a
single dose.
– Uncomplicated Allergic Conditions: 5 to 20 mg by
intravenous, intramuscular, or subcutaneous
injection as a single dose.

HYDROCORTISONE SODIUM SUCCINATE
(SOLU-CORTEF)
100 MG5 ML VIAL
30
– Anti-inflammatory; immunosuppressive with salt-
retaining actions, it binds to intracellular glucocorticoid
receptors and is translocated into the nucleus, where it
initiates the transcription of glucocorticoid-responsive
genes, such as various cytokines and lipocortins.
Lipocortins inhibit phospholipase A2, thereby blocking
the release of arachidonic acid from membrane
phospholipids and preventing the synthesis of
prostaglandins and leukotrienes, both potent mediators
of inflammation.
• Indications
– Inflammation, Shock due to acute adrenocortical
insufficiency, anaphylaxis, asthma, and COPD.
– Documented hypersensitivity
– Systemic fungal infections
– Idiopathic thrombocytopenic purpura
– Intrathecal administration (injection)
– Administration of live or live attenuated vaccines is contraindicated in
patients receiving immunosuppressive doses of the drug.
– Headache, Aggression, Anxiety, Blurred vision, Decrease
in the amount of urine, Dizziness, Dry mouth, Fast, slow,
pounding, or irregular heartbeat or pulse, Nausea, and
Vomiting.
• Considerations
– May be used in status asthmaticus as a second-line drug.
– The initial dose is 100 mg to 500 mg or more depending
on the severity of the condition.
– This dose may be repeated at intervals of 2, 4, or 6 hours
as indicated by the patient's responses and clinical
condition.
– Acute Adrenal Crisis: 100 mg IV followed by IV infusion
of 200 mg over 24 hours OR 50 mg IV every 6 hours; then
100 mg IV the following day.
– Sepsis: 200 mg per day by continuous IV infusion.

GLUCOSE 50 %
31
– Rapidly increases serum glucose levels.
• Indications
– Hypoglycemia.
– Documented hypersensitivity; severe dehydration.
– Pain or tenderness where an injection was given; or
Flushing (warmth, redness, or tingly feeling) for
several minutes after a glucose injection.
• Considerations
– Do not inject this medicine into a muscle or under
the skin.
– A glucose injection should be given slowly.
– Intravenously: 10-25 g (20-50 ml 50% solution or 40-
100 ml of 25%).

ORAL GLUCOSE (INSTA-GLUCOSE)
30 GM TUBE
32
– Provides an increase
in circulating blood glucose levels.
• Indications
– Conscious patients
with suspected hypoglycemia
– Decreased level of consciousness, nausea, vomiting.
– Nausea, vomiting
• Considerations
– Must be swallowed. Glucose is not absorbed
sublingually or buccally.
– 4-20 g as a single dose; may repeat after 15 minutes
if monitoring of blood glucose shows continued
hypoglycemia.

GLUCAGON(GLUCAGEN)
1 MG/ VIAL
33
– strongly opposes the action of insulin; it raises the
concentration of glucose in the blood by promoting
glycogenolysis, which is the breakdown of glycogen (the
form in which glucose is stored in the liver), and by
stimulating gluconeogenesis, which is the production of
glucose from amino acids and glycerol in the liver.
– Treats cardiotoxicity by activating myocardial adenylcyclase
in a way not blocked by β-blockade.
• Indications
– Altered level of consciousness when hypoglycemia is
suspected.
– Indicated for severe hypoglycemic reactions in patients with
diabetes treated with insulin.
– Beta-blocker poisoning, calcium channel blocker poisoning.
– Hypersensitivity.
– Pheochromocytoma.
– Insulinoma.
– Dizziness, headache, hypertension, tachycardia, nausea,
vomiting.
• Considerations
– Should be used in conjunction with 50% dextrose whenever
possible.
– Hypoglycemia: give 1 mg (1 unit) IM/SC/IV if no IV for
dextrose, Repeat q15min once or twice; give dextrose as
soon as it is available and if no response.
– Beta-blocker poisoning: give 3 to 10 mg IV bolus; if no clinical
response may repeat bolus dose; if clinical response with
bolus, start continuous infusion at 3 to 5 mg/hour; titrate
infusion rate to achieve adequate hemodynamic response.
– Calcium channel blocker poisoning: 3 to 10 mg IV bolus; if no
clinical response may repeat bolus dose; if clinical response
with bolus, start continuous infusion at 3 to 5 mg/hour;
titrate infusion rate to achieve adequate hemodynamic
response.

LABETALOL
5MG/ML, 1000MG/20ML VIAL
34
– It is an adrenergic receptor blocking agent that has
both selective alpha1-adrenergic and nonselective
beta-adrenergic receptor blocking actions in a single
substance, by a result it cause Blood pressure
reduction without reflex tachycardia.
• Indications
– Moderate to severe hypertension.
– Hypersensitivity to labetalol or any component of the
formulation; severe bradycardia; heart block greater
than first degree (except in patients with a
functioning artificial pacemaker); cardiogenic shock,
bronchial asthma.
– Fatigue, Weakness, Dizziness, Tingling of the scalp or
skin.
• Considerations
– Blood pressure monitoring immediately before the injection
and at 5 and 10 minutes after injection in supine position to
evaluate response; pulse rate, and ECG should be monitored
continuously as well.
I.V injections:
– Initial dose: 20 mg by slow IV injection over a 2-minute
period. Additional injections of 40 to 80 mg can be given at
10 minute intervals until a desired supine blood pressure is
achieved or a total of 300 mg has been used.
SLOW CONTINUOUS IV INFUSION:
The solution for injection should be prepared according to the
manufacturer suggested guidelines for a resultant solution of 1
mg/mL or 2 mg/3 mL:
– For 1 mg/mL, the diluted solution should be administered at
a rate of 2 mL/min to deliver 2 mg/min.
– For 2 mg/3 mL, the diluted solution should be administered
at a rate of 3 mL/min to deliver approximately 2 mg/min.
– The effective IV dose is usually in the range of 50 to 200 mg.

NICARDIPINE HYDROCHLORIDE
10 MG10 ML AMPULE
35
- It is a calcium entry blocker (slow channel blocker or
calcium ion antagonist) that inhibits the
transmembrane influx of calcium ions into cardiac
muscle and smooth muscle without changing serum
calcium concentrations, relaxing blood vessels so
blood can flow more easily.
• Indication
- used with or without other medications to treat high
blood pressure (hypertension).
- also used to prevent certain types of chest pain
(angina).
- Allergy to this medicine.
- Should not be used in case of aortic stenosis.
- Caution with acute heart failure, and acute
pulmonary edema.
- Blurred vision, Confusion, Dizziness, Faintness or
lightheadedness when getting up from a lying or
sitting position suddenly, Sweating, Unusual
tiredness or weakness.
• Considerations
- Precautions in case of liver or kidney disease.
- 5 mg/hour IV infusion; infusion rate may be
increased by 2.5 mg/hour every 5 to 15 minutes
(rapid and gradual titration, respectively) up to a
maximum of 15 mg/hour, until desired blood
pressure reduction is achieved; infusion rate should
be decreased to 3 mg/hour following achievement of
the blood pressure goal using rapid titration.

NALOXONE HYDROCHLORIDE
(NARCAN)
0.4MG/ML IN 1ML AMPULE
36
– It is a non-selective and competitive opioid receptor
antagonist. It works by reversing the depression of
the central nervous system and respiratory system
caused by opioids.
• Indications
– Opiate overdose, complete or partial reversal of
central nervous system and respiratory depression
induced by opioids.
– Hypersensitivity to naloxone.
– Headache, Agitation, Flushing, Sweating, Nausea,
Vomiting, Restlessness, Trembling ,Body pain,
Hypertension, Hypotension, Pulmonary edema,
Seizures, Brain disease, Coma, Changes in heart
rhythm.
• Considerations
– Use with caution in narcotic-dependent patients.
Known or suspected opioids overdose with respiratory
arrest:
– Initial dose: 0.4 mg IM/IV; Or may Give 2 mg IN.
– If desired response is not obtained, doses should be
repeated at every 4 minute intervals as necessary.
– If no response is observed with a total dose of 10 mg, the
diagnosis of opioid-induced or partial opioid-induced toxicity
should be questioned
– Supplemental doses administered IM have been shown to
produce a longer lasting effect.
Opioids sedation:
– Intravenous Infusion:
– -A concentration of 0.004 mg/mL may be administered by IV
infusion; titrate in accordance with patient's response.

AMINOPHYLLINE
250MG /10ML AMPULE
37
– relaxes the smooth muscle of the bronchial airways
and pulmonary blood vessels and reduces airway
responsiveness to histamine, methacholine,
adenosine, and allergen.
• Indications
– Persistent bronchospasm, COPD exacerbation.
– Aminophylline is contraindicated in patients with a
history of hypersensitivity to theophylline or other
components in the product including
ethylenediamine.
– Nausea/vomiting, stomach/abdominal pain,
headache, trouble sleeping, diarrhea, irritability,
restlessness, nervousness, shaking, or increased
urination may occur.
• Considerations
– ensure proper catheter or needle position prior to
and during infusion. Avoid extravasation.
– Bolus dose: 5mg/kg over 20min.
– IV infusion: 0.5mg/kg/h.

IPRATROPIUM (ATROVENT)
20MCG/METER INHALATION AEROSOL
40MCG/METER INHALATION AEROSOL
250MCG/2ML NEBULIZATION SOLUTION
38
– relatively selective β 2-adrenergic bronchodilator
Inhibits interaction of acetylcholine at receptor sites
of bronchial smooth muscle.
• Indications
– Persistent bronchospasm, COPD exacerbation.
– Hypersensitivity to ipratropium, atropine, or any
component of the formulation.
– Dry mouth, Cough, Headache, Nausea, Dizziness,
Difficulty breathing.
• Considerations
– Shake well before use.
– Inhalation aerosol: 2 inhalations (34 mcg) orally four
times a day, or as needed up to 12 inhalations in 24
hours.
– Nebulizer inhalation solution: 500 mcg three or four
times a day by oral nebulization, with doses 6 to 8
hours apart.

ALBUTEROL (VENTOLIN)
ORAL INHALATION, 0.1MG/DOSE;
NEBULIZER SOLUTION, 2.5MG/2.5ML
39
– It is a beta 2 adrenergic agonist. The pharmacologic
effects of albuterol sulfate are attributable to
activation of beta 2 adrenergic receptors on airway
smooth muscle.
• Indications
– Treatment of bronchospasm in patients with
COPD/asthma).
– Hypersensitivity reactions to albuterol.
– Often dose-related and include Feeling nervous and
excitable, Headache, Dizziness, Upset stomach or
throwing up, Shakiness, Throat irritation, Runny
nose.
• Considerations
– May precipitate angina pectoris and dysrhythmias.
– The usual dosage for adults and children is 2
inhalations repeated every 4 to 6 hours; in some
patients, 1 inhalation every 4 hours may be sufficient.

FUROSEMIDE (LASIX)
10 MG/ML (2 ML, 4 ML, 10 ML) AMPULES
40
– is a potent diuretic works by blocking the absorption
of sodium, chloride, and water from the filtered fluid
in the kidney tubules, causing a profound increase in
the output of urine (diuresis).
• Indications
– Ascites, Congestive Heart Failure, Edema, Nephrotic
Syndrome, Renal Failure, Liver Cirrhosis, Pulmonary
Edema, Hypertension.
– Hypersensitivity to furosemide or any component of
the formulation.
– Hypovolemia, anuria, hypotension.
– Dizziness, headache, ECG changes, weakness.
• Considerations
– Ototoxicity, deafness, and projectile vomiting can
occur with rapid administration.
Initial dose:
– 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM
once; may repeat with the same dose or increase by
20 mg no sooner than 2 hours after the previous
dose until the desired diuretic effect has been
obtained.
Maintenance dose:
– Administer the dose that provided the desired
diuretic effect once or twice a day.

PHENYTOIN
50 MG/ML (5 ML AMPULE)
41
– anti-epileptic drug, also called an
anticonvulsant.works by causing voltage-dependent
block of voltage gated sodium channels, slowing
down impulses in the brain that cause seizures.
• Indications
– Prophylaxis and treatment of major motor seizures,
status epilepticus.
– Hypersensitivity to phenytoin, other hydantoins, or
any component of the formulation.
– concurrent use of delavirdine.
– history of prior acute hepatotoxicity attributable to
phenytoin.
– Sinus bradycardia, sinoatrial block, second- and third-
degree heart block.
– congenital anomalies, hepatic necrosis, ataxia,
confusion, constipation, depression, dizziness,
drowsiness, fatigue, mental status changes,
myasthenia, nervousness, numbness, tremor.
• Considerations
– Carefully monitor vital signs and observed for signs of
respiratory depression.
– this drug should not be given IM because of the risk
of necrosis, abscess formation, and erratic
absorption.
LOADING DOSE:
– 10 to 15 mg/kg IV (not to exceed 50 mg/min in adults).
MAINTENANCE DOSE:
– The loading dose should be followed by maintenance doses
by oral or IV administration every 6 to 8 hours.

DIAZEPAM
5 MG/ML (2 ML, 10 ML)
42
– It is a benzodiazepine. It works by increasing the
activity of a neurotransmitter called GABA in the
brain, keep the nerve activity in the brain in balance,
and is involved in reducing anxiety, relaxing muscles
and inducing sleepiness.
• Indications
– Anxiety.
– Seizures, and Status epilepticus.
– Hypersensitivity to diazepam or any component of
the formulation; acute narrow-angle glaucoma;
untreated open-angle glaucoma; myasthenia gravis,
severe respiratory impairment, severe hepatic
impairment.
– Drowsiness, Fatigue, Diarrhea, Rash, Euphoria, Ataxia
(loss of balance).
• Considerations
– The IV route is preferred; however, the IM route may
be used if IV administration is impossible.
– Monitor V/S continuously.
– 5 to 10 mg IV once, repeated at 10 to 15 minute
intervals to a maximum dose of 30 mg if necessary.

TRANEXAMIC ACID
1000 MG/10 ML (10 ML)
43
– It is a synthetic reversible competitive inhibitor to the
Lysine receptor found on plasminogen. The binding
of this receptor prevents plasmin (activated form of
plasminogen) from binding to and ultimately
stabilizing the fibrin matrix, preventing the break
down of blood clots.
• Indications
– Heavy bleeding(menstrual, post operative, major
trauma injuries).
– short-term prevention in patients with hemophilia.
– Hypersensitivity to tranexamic acid or any
component of the formulation; Acquired defective
color vision; active intravascular clotting;
subarachnoid hemorrhage.
– Nausea, Diarrhea, stomach pain or discomfort,
Vomiting, chills, fever, severe headache (throbbing),
back or joint pain, muscle pain, difficulty moving,
runny or stuffy nose, unusual bleeding, anaphylaxis.
• Considerations
– Monitor hemodynamics and watch of
thromboembolic events.
– one gram bolus in 100 mL of normal saline over 10
minutes (slow intravenous push). Rapid infusion may
cause hypotension. May repeat a 1 gram dose over
the next 8 hours, but do not exceed a total of 2
grams.

0.9% SODIUM CHLORIDE (NORMAL SALINE)
COMPOSITION PER ONE LITER: SODIUM 154 MEQ, CHLORIDE 154
MEQ
44
– Replaces water and electrolytes.
• Indications
– Heat-related problems (heat exhaustion, heat stroke)
– Freshwater drowning
– Hypovolemic shock.
– Alkalosis with dehydration.
– Water and salt depletion caused by diarrhea,
vomiting, severe diuresis.
– Hyponatremia.
– Irrigation.
– Dilution with certain drugs.
– Should not be used in patients with congestive heart
failure, renal disease, and cirrhosis.
– Pre eclamptic patients.
– Dehydration with severe hypokalemia.
– Rare in therapeutic dosages.
• Considerations
– Large volume may lead to hyperchloremic acidosis.

LACTATED RINGER’S (HARTMANN’S
SOLUTION)
COMPOSITION PER ONE LITER: SODIUM 130 MEQ, POTTASIUM 4 MEQ,
CALCIUM 3 MEQ, CHLORIDE 109 MEQ, BICARBONATE 28 MEQ
45
– Replaces water and electrolytes.
• Indications
– Hypovolemic shock; keep open IV.
– Replace fluids in post-operation patients, burns.
– Diarrhea induced hypokalemia, metabolic acidosis.
– DKA.
– Should not be used in patients with congestive heart
failure or renal failure.
– Liver disease.
– Addison’s disease.
– Vomiting or NGT induced alkalosis.
– Certain drugs: amphotericin, thiopental, ampicillin,
doxycycline.
• Considerations
– Same i.v line should not be used for blood
transfusion as clumping occurs.

5% DEXTROSE IN WATER (D5W)
COMPOSITION PER ONE LITER: GLUCOSE 50 GM
46
– Provides nutrients in the form of dextrose as well as
free water.
• Indications
– For dilution of concentrated drugs for intravenous
infusion.
– Prevention and treatment of dehydration.
– Prevention of ketosis in starvation, vomiting,
diarrhea.
– Correction of hypernatremia.
– Should not be used as a fluid replacement for
hypovolemic states.
– Cerebral edema.
– Acute ischemic stroke.
– Hyponatremia.
– Uncontrolled DM.
• Considerations
– Should not be used with phenytoin.
– Same i.v line should not be used for blood
transfusion as clumping occurs.

5% DEXTROSE IN 0.9% SODIUM CHLORIDE
(D5NS)COMPOSITION PER ONE LITER: GLUCOSE 50 GM,
SODIUM 154 MEQ, CHLORIDE 154 MEQ
47
– Replaces free water and electrolytes and provides
nutrients in the form of dextrose.
• Indications
– Heat-related disorders, freshwater drowning.
– Salt depletion, hypovolemia.
– Correction of vomiting or NGT aspiration induced
alkalosis and hypochloremia.
– Should not be given to patients with impaired cardiac
or renal function.
– Severe hypovolemic shock.
• Considerations
– More than 25gm/hr should be avoided.

DRUG INFUSION
CALCULATIONS TIPS…
• The universal formula is:
Example:
Administer heparin 5,000 units I.V. push. Available is heparin 10,000 units/mL. How many mL will you need to
administer to achieve a 5,000 unit dose?
Answer: X = 0.5 mL
48

CONTINUE…
• Calculation with dose or rate per hour or minute(mL/hr , mcg/min , mcg/kg/min):
Example #1:
Your 65 kg patient has dopamine ordered at 6 mcg/kg/min. The IV has 400 mg of
dopamine in 250 mL. What IV rate is correct?
1. Always determine the dose of medication per mL (Drug Concentration)
400 mg dopamine = 1.6 mg dopamine/mL fluid
250 mL fluid
2. Do you need to convert your dose from mg to mcg? mcg to mg? grams to mcg?
1.6 mg = 1600 mcg dopamine/mL fluid
3. Use a streamlined equation where you only need 4 items:
A. Ordered amount of drug
B. Pt. weight (most of the time)
C. Number of minutes in an hour (always the same!!)
D. Dose/mL (calculated in #1)
PRESENTATIONTITLE
49

CONTINUE…
Ordered amount of drug x pt’s weight x 60 (minutes/hr) = 6 (rate) x 65 (pt weight) x 60 (minutes/hr) = 23400 = 14.6; round to 15 mL/hour
Drug concentration 1600 (mcg dopamine/mL) 1600
4. If the drug is not weight based, simply exclude the weight from the equation.
Ordered amount of drug x pt’s weight (NA in this example) x 60 (minutes/hr)
Drug concentration
5. What if you have the rate and need to calculate the dose:
Example #2
Your 70 kg patient has dopamine (400 mg in 250 mL) running at 26 mL/hour. How many
mcg/kg/min is the patient receiving?
PRESENTATIONTITLE
50

CONTINUE…
You can use your same formula
1. Determine the amount of medication per mL.
400/250 = 1.6 mg/mL
2. Do you need to convert your dose?
Yes 1.6 mg x 1000 = 1600 mcg)
3. Use your streamlined equation, but you will have an “X” to solve for
“X”(Ordered amount of drug) x 70 (pt’s weight) x 60 (minutes/hr) = 26
1600 (Drug concentration)
Solve for “X” by cross multiplying; X = 26 x 1600 = 41600 = 9.9; round to 10 mcg/kg/min.
70 x 60 4200
PRESENTATIONTITLE
51

CONTINUE…
4. If the drug is not weight based, simply exclude the weight from the equation:
Ordered amount of drug x pt’s weight (NA in this example) x 60 (minutes/hr)
Drug concentration
5. What if you have the rate and need to calculate the dose:
You can use your same formula:
 Determine the amount of medication per mL.
 Do you need to convert your dose?
 Use your streamlined equation, but you will have an “X” to solve for:
“X”(Ordered amount of drug) x (pt’s weight) x (minutes/hr) = given rate/hr
(Drug concentration)
PRESENTATIONTITLE
52

I.V INFUSION CALCULATIONS TIPS….
• Calculate IV Rate : mL/hour or minute
- Total IV volume (mL) ÷ time (hour or minute) = mL/hour or minute
• Calculate IV Rate : drops/minute
- [Total IV volume (mL) ÷ time (minute)] x drop factor (gtt/mL) = drops/minute
• Calculate IV Rate : Remaining Time of Infusion
- [Volume remaining (in mL) ÷ drops per minute] x drop factor (gtt/mL) =
minutes remaining
53

CONCLUSION…
• Healthcare providers are required to know the names, class,
mechanism of action, adverse reactions and side effects,
interactions, indications, contraindications, complications,
routes of administration, dose, and specific administration
considerations for many emergency medications and
intravenous fluids.
54

REFERENCES
• American Heart Association Guidelines 2015, CPR & ECC provider manual.
• ARTICLE : American Heart Association 2018 Focused Update On Advanced Cardiovascular Life
Support Use Of Antiarrhythmic Drugs During And Immediately After Cardiac Arrest,
Http://ahajournals.org
• Oxford Handbook Of Emergency Medicine 4th edition.
• https://www.ncbi.nlm.nih.gov/
• https://www.drugs.com/
• https://www.nursingcenter.com/
55

THANK YOU
56

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