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DRUG NAME

CRITICAL CARE INTRAVENOUS MEDICATIONS CHART

ONSET CONCENTRATION UNIT OF MEASUREMENT DRUG CLASS HOW TO TITRATE

Amiodarone Bumex (Bumetanide) Cardizem (Diltiazem) Cardene (Nicardipine) Cisatracurium (Nimbex) Corlopam (Fenoldopam) Dexmedetomdine (Precedex) Diprivan (Propofol) Dobutamine Dopamine Epinephrine Brevibloc (Esmolol) Fentanyl Furosemide (Lasix)

Nonspecific 2-3 min

450mg / 250ml D5W only Can not mix in NS 10mg / 100ml NS Can Mix in D5W 100mg / 100 ml Can mix in NS and D5W 20mg / 200ml 40mg / 200ml Can mix in NS and D5W 200mg / 200ml NS Can mix in D5W 20mg/500ml Can mix in NS and D5W 200mcg / 50ml Can mix in NS and D5W 1000mg / 100 ml vial 500mg / 50 ml vial Pre-Mixed 500mg / 250ml (Standard) Can mix in NS and D5W 400mg / 250ml (Standard) Can mix in NS and D5W 5mg / 250ml (Standard) Can mix in NS and D5W 2500 mg / 250 ml Pre-Mixed 1mg / 100ml NS (Standard) Can mix in D5W 100mg / 100 ml or 200 mg / 200 ml Can mix in NS and D5W

minutes

10 min

2-3 min

10 min 1 min seconds 1-10 min 5 min minutes 2-10 min seconds

Continuous Infusion ­ mg/min Common dose: 1mg / min for 6 hrs, then 0.5 mg /min infusion IV Bolus Dose ­ mg/hr Dose: 0.5 ­ 1 mg slow IVP over 1-2 min or Continuous Infusion ­ mg/hour Usual Dose: 1 mg/hr or (MD preference) Continuous Infusion ­ mg/hour Dose: 5 ­ 15 mg/ hr Titrate 5 mg/hr increments to desire effect Continuous Infusion ­ mg/hour Dose: 2.5 ­ 15 mg / hour Titrate 2.5 mg/hr increments Q 15 min Rotate IV infusion site Q 12 hr if given in periph. IV. If doubled need Central Line Continuous Infusion ­ mcg/kg/min May give IV loading dose: 0.1 mcg/kg Usual Range: 1 ­ 10 mcg/kg/min Titrate 2 mcg/kg/min increments Continuous Infusion ­ mcg/kg/min Dose: Initial 0.1 mcg/kg/min Avg. rate = 0.25 ­ 0.5 mcg/kg/min Loading dose = 1mcg / kg over 10 minutes Continuous Infusion - mcg/kg/hr Avg rate = 0.2 ­ 0.7 mcg/kg/hr Continuous Infusion ­ mcg/kg/min Dose: Usual range = 5-50 mcg/kg/min Continuous Infusion ­ mcg/kg/min Dose: 2 ­ 20 mcg/kg/min Continuous Infusion ­ mcg/kg/min Dose: 2 ­ 20 mcg/kg/min Continuous Infusion mcg/kg/minute - OR - mcg/min Usual Range: 1 ­ 10 mcg/min 0.05 ­ 1 mcg/kg/min Continuous Infusion ­ mcg/kg/min Dose: Usual Range = 50-200 mcg/kg/min Continuous Infusion ­ mcg/hour Usual Range: 50 ­ 300 mcg/hr Titrate 25 mcg/hr increments IV Bolus Dose ­ mg Dose: 20 ­ 40 mg slow IVP over 1-2 min or Continuous Infusion - mg / hr Usual Dose: 10 - 20 mg/hr or (MD pref.)

Antiarrhythmic Dose ordered per MD based on UOP or PCWP Increase rate 5 mg/hr Q 15 min to desired Heart Rate Start @ 5 mg/hr then increase rate 2.5 mg Q 15 min. attempt to decrease to 3 mg/hr once B/P controlled Titrate to 2 - 4 twitches on Peripheral Nerve Stimulator (TOF) or per MD orders Titrate 0.05 ­ 0.1 mcg/kg/min increments Q15 until target BP Titrate 0.1mcg/kg/hr Q10min Increments to desired level of Sedation (Max dose = 1.5 mcg/kg/hr) Increase 5 mcg/kg/min Q 5 minutes based on sedation (BIS or RASS) Increase rate 1 - 4 mcg/kg/hr Q 10 minutes Increase rate 1 - 4 mcg/kg/hr Q 10 minutes Increase 0.01 mcg/kg/min Q 15 minutes. Titrate to effect desired per MD Usual Titration: 50mcg/kg/min increments Increase rate 25 mcg/hr based on pain control Dose ordered per MD based on UOP and or PCWP

Loop Diuretic Ca Channel Blocker Ca Channel Blocker Neuromuscular Blockade (Paralytic) Vasodilator Sedative (Alpha2 ­ Adrenergic Agonist) Conscious Sedation Vasopressor Vasopressor Vasopressor Cardiac Stimulant Antiarrhythmic / Beta Blocker Narcotic Analgesic Loop Diuretic

5 min

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CRITICAL CARE INTRAVENOUS MEDICATIONS CHART

DRUG NAME ONSET CONCENTRATION

Heparin Insulin (regular) Levophed (Norepinephrine)

seconds 30 min seconds

25,000 units / 250ml Can mix in NS and D5W 100 units / 100ml NS only Can not mix in D5W 4mg / 250ml (Standard) Can mix in NS and D5W 2 grams / 500ml (4mg/ml) Can mix in NS and D5W 125mg / 125 ml Can mix in NS and D5W 1.5mg / 250ml = (6 mcg/ml) Can mix in NS and D5W 20mg / 250ml (Standard) Can mix in NS and D5W 50mg / 250ml D5W only, or 100mg / 250ml D5W only Can not mix in NS 25mg / 250ml (Standard) Can mix in NS and D5W 50mg / 100 ml (Standard) Can mix in NS and D5W 40mg / 200ml Can mix in NS and D5W 2 grams / 250ml Can mix in NS and D5W 20 units / 100ml (Standard) Can mix in NS and D5W 20mg / 100ml (Standard) Can mix in NS and D5W

Lidocaine Midazolam (Versed) Natrecor (Nesiritide) Neosynephrine (Phenylephrine) Nipride (Nitroprusside) Nitroglycerin Pavulon (Pancuronium) Primacor (Milrinone) Pronestyl

45-90 seconds 1-5 min 15 min seconds < 2 min seconds 2-3 min 5-15 min minutes

Continuous Infusion ­ units/hour Dose: Weight-based --OR-- PTT-based Continuous Infusion ­ units/hour Dose: Based upon blood glucose level Continuous Infusion mcg/kg/minute -- OR -- mcg/min Usual Range: 0.5 ­ 30 mcg/min 0.01 ­ 3 mcg/kg/min Continuous Infusion ­ mg/min Usual Range: 1 ­ 4 mg/min 1mg/min = 7.5 ml/hr 3 mg/min = 22.5 ml/hr 2 mg/min = 15 ml/hr 4 mg = 30 ml/hr Continuous Infusion ­ mg/hour Usual Range: 1 ­ 10 mg/hr Titrate 1 mg/hr increments IV bolus: 2 mcg/kg over 60 seconds Continuous Infusion: 0.01 mcg/kg/min Continuous Infusion ­ mcg/min Usual Range: 100 ­ 180 mcg/min Continuous Infusion ­ mcg/kg/min Dose: 0.3 ­4 mcg/kg/min Titrate 0.5 mcg/kg/min increments Maximum = 10 mcg/kg/min Continuous Infusion ­ mcg/min Usual Range: 1 ­ 200 mcg/min Continuous Infusion ­ mg/kg/hr May give loading dose: 0.1 mg/kg slow IVP Usual Range: 0.02 ­ 0.1 mg/kg/hr Titrate: 0.02 mg/kg/hr increments Continuous Infusion ­ mcg/kg/min Usual Range: 0.375 ­ 0.75 mcg/kg/min Continuous Infusion ­ mg/min Usual Range: 1 ­ 4 mg / min 1mg/min = 7.5 ml/hr 3 mg/min = 22.5 ml/hr 2 mg/min = 15 ml/hr 4 mg/min = 30 ml/hr Continuous Infusion ­ units/min Range: 0.01 ­ 0.1 units/min Usual Dose: 0.04 units/min fixed dose OR Units / hr Usual Dose: 0.2 ­ 0.9 units / hr Continuous Infusion ­ mcg/kg/min May give loading dose: 100 mcg/kg IVP Usual Dose: 0.6 ­ 1.2 mcg/kg/min Titrate: 0.2 mcg/kg/min

UNIT OF MEASUREMENT

DRUG CLASS

HOW TO TITRATE

Anticoagulant Hormone Agent Vasopressor

Based on PTT and Per Protocol per MD orders Based on Blood Glucose Per protocol per MD order Increase rate 5 mcg /min Q 3 ­ 5 minutes

Antiarrhythmic Benzodiazepine (Sedative) B N P Acutely Decompensated CHF Vasopressor Vasodilator Vasodilator Neuromuscular Blockade (Paralytic) + Inotrope and Vasodilator Antiarrhythmic Vasopressor for Septic Shock and Tx GIB Neuromuscular Blockade (Paralytic) Increase rate 1 mg/hr based on sedation (titrate to lowest dose possible) If ordered, may be increased by 0.005 mcg/kg/min Q3hr (max = 0.03 mcg/ kg/min) Increase rate 5 mcg/min Q 3 ­ 5 min. Increase rate 0.5 mcg/kg/min Q 3 ­ 5 min. Increase rate 5mcg/min Q 3-5 min. May increase 10mcg/min if exceeds 20 Titrate to 2 ­ 4 twitches on Peripheral Nerve Stimulator (TOF) or MD order. Dose ordered per MD

Vasopressin

minutes

Increase rate in 0.2 ­ 0.5 units / hr. Q 15 minutes Titrate to effect. Titrate to 2 ­ 4 twitches on Peripheral Nerve Stimulator (TOF) or MD orders

Vecuron (Vecuronium)

2-3 min

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Updated 5/09 KE/ MS /CW

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