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Key Acute Care Adult Medications


This reference includes a combination of FDA-labeled as well as off-labeled indications. Refer to DailyMed for the labeling status of the individual medications.

See: Considerations for prescribing drugs to pregnant women

See also: Key Acute Care Pediatric Medications

A

Drug Indications/Dosage
Adenosine SVT
6 mg; second dose: 12 mg (may repeat 12 mg dose once)
Albumin Shock, Trauma, Burns
25 g/dose IV/IO rapid infusion (max dose 6g/kg/24 hr or 250 grams/48 hrs)
Albuterol Asthma, Anaphylaxis (bronchospasm), Hyperkalemia
  • MDI: 4 to 8 puffs INH q 20 minutes PRN with spacer (OR ET if intubated)
  • Nebulizer: 2.5 - 5 mg/dose INH q 20 minutes PRN
  • Continuous nebulizer: 0.5 mg/kg per hour INH (max 20 mg/h)
Aminophylline Treatment of Phosgene induced pulmonary edema (off label - anecdotal evidence)
Aminophylline 5- 6 milligrams/kilogram IV loading dose over 20 minutes followed by
  • >12 yr health nonsmokers: 0.7 mg/kg/hr
  • The total daily dose may also be administered IV divided Q4- 6 hr
  • See Harriet Lane Handbook for level monitoring information
  • Maintain a serum level of 10 to 20 micrograms/milliliter.
See Phosgene - Emergency Department/Hospital Management Treatment section for off label dosing recommendations
Amiodarone Refractory pulseless VT/VF
300 mg Max total dose: 2.2 grams/24 hrs; can be followed by 150mg

 Perfusing tachycardia
150 mg over 10 minutes; max total dose 2.2 grams/24 hr
Amyl Nitrite Antidote for Cyanide Toxicity
Amyl nitrite perle should be broken onto a gauze pad and heal under the nose, placed under the lip of a facemask, or over the Ambu-valve intake. The patient should inhale for 30 seconds of each minute and a new perle should be utilized every three minutes if sodium nitrite infusions will be delayed. Amyl nitrite is not FDA-approved.

See Hydrogen Cyanide - Prehospital Management and Hydrogen Cyanide - Emergency Department/Hospital Management Treatment section for cyanide specific dosing recommendations
Atropine Sulfate Bradycardia (symptomatic)
  • 0.5 mg bradycardia
  • May repeat every 3-5 min
  • Max total dose: 3 mg
  • 1 mg - cardiac arrest
Toxins/Overdose (e.g., nerve agent organophosphate, carbamate)
2 mg - 6m autoinjector/IV/IO/IM, repeat q5 to 10 min until atropine effect (dry mouth, decreased resistance to ventilation, dyspnea) is observed

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C

Drug Indications/Dosage
Calcium Chloride 10% Hypocalcemia, Hyperkalemia, Hypermagnesemia, Calcium Channel Blocker Overdose
Dosing for non-life-threatening situations, refer to Harriet Lane Handbook, or DailyMed for dosing recommendations

Cardiac Arrest or Severe Hypotension
250-500 mg/dose IV Q 10 minutes PRN

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D

Drug Indications/Dosage
Dexamethasone
max 16 mg/day, multiple indications, see Harriet Lane Handbook
Dextrose (Glucose) Hypoglycemia
25 gms (50ml of 50% solution)
Diazepam For prolonged seizures/status epilepticus
  • Autoinjector - use 2-3 initially (10 mg each)
  • IV 10 mg Q10 - 15 min (up to 30 mg)
  • Rectal gel 0.2 mg/kg - may repeat in 4-12 hours prn

See Nerve Agents - Prehospital Management and Nerve Agents - Emergency Department/Hospital Management Treatment section for nerve agent specific dosing recommendations
Diphenhydramine Anaphylactic Shock
50 -75 mg IV
Dobutamine Congestive Heart Failure, Cardiogenic Shock
2 to 20 μg/kg per minute IV/IO infusion; titrate to desired effect
Dopamine Cardiogenic Shock, Distributive Shock
  • 2 to 10 μg/kg per minute IV/IO infusion; titrate to desired effect - bradycardia
  • 2 to 20 μg/kg per minute IV/IO infusion; titrate to desired effect - hypotension

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E

Drug Indications/Dosage
Epinephrine Pulseless Arrest, Bradycardia (symptomatic)
  • 1 mg (1:10,000) IV/IO q 3 to 5 minutes
  • 2-2.5 mg (1:1000 ET) q 3 to 5 minutes
Hypotensive Shock
  • 2-10 mcg/min IV/IO infusion
Anaphylaxis
  • 0.5 mg:1000 IM in thigh q 15 minutes PRN
  • Auto-injector 0.3 mg (wt ≥30 kg) IM
  • 0.01 mg/kg (0.1 mL/kg) 1:10,000 IV/IO q 3 to 5 minutes (max 1 mg) if hypotensive
  • 0.1 to 1 max 0.5 mg; 0.5 mL μg/kg per minute IV/IO infusion if hypotension despite fluids and IM injection
Asthma
  • 0.5 mg; 0.5 mL 1:1000 SQ q 15 minutes
Croup
  • 0.75 mL racemic solution (2.25%) diluted to 3 mL with normal saline for inhalation
  • Give via nebulizer over 15 minutes PRN, do not routinely give more frequently then Q1-2 hr
Toxins/Overdose (e.g., beta-adrenergic blocker, calcium channel blocker)
  • 1 mg, 1:10,000 IV/IO ; if no response consider higher doses up to 0.1 mg/kg (0.1 mL/kg) 1:1000 IV/IO
  • 0.1 to 1 μg/kg per minute IV/IO infusion (consider higher doses)

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F

Drug Indications/Dosage
Furosemide Pulmonary Edema, Fluid Overload
20 - 40 mg IM, IV/24 hrs divided Q6-12h

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H

Drug Indications/Dosage
Hydrocortisone Adrenal insufficiency
2 mg/kg IV bolus (max 100 mg)
Hydroxocobalamin Antidote for Cyanide Toxicity
A dose of 70mg/kg (not to exceed 5 grams initially) administered over 30 minutes is recommended. This dose can be given IV push in situations of cyanide induced cardiac arrest

See Hydrogen Cyanide - Prehospital Management and Hydrogen Cyanide - Emergency Department/Hospital Management Treatment section for cyanide specific dosing recommendations

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I

Drug Indications/Dosage
Inamrinone Myocardial Dysfunction and Increased SVR/PVR
Loading dose: 0.75mg/kg IV/IO slow bolus over 10-15 minutes; 5-15 μg/kg per minute IV/IO infusion
Ipratropium Bromide Asthma - ED, ICU
500 μg INH q 20 minutes x 3 doses (PRN) then Q2-4h PRN

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L

Drug Indications/Dosage
Lidocaine VF/Pulseless VT, Wide-Complex Tachycardia (with pulses)
  • 1 - 1.5 mg/kg IV/IO bolus, additional doses 0.5-0.75 mg/kg (max total 3mg/kg)
  • Maintenance: 1-4 mg/min (20 to 50 μg/kg) per minute IV/IO infusion (repeat bolus dose if infusion initiated >15 minutes after initial bolus)
  • 2 to 3 mg/kg ET
Lorazepam Prolonged Seizures/Status Epilepticus
4 mg IV, may repeat in 10-15 minutes

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M

Drug Indications/Dosage
Magnesium Sulfate Asthma (refractory status asthmaticus), Torsades de Pointes
  • 1 -2 grams IV/IO bolus (pulseless VT, VF- associated with torsades) over 5 to 20 minutes
  • 1-2 grams (VT with pulses - associated with torsades) over 5-60 minutes
  • 2 grams X 1 (status asthmaticus) over 20 minutes
Hypomagnesemia
  • IV/IM 25-50 mg/kg/dose Q4-6h x 3-4 doses (maximum single dose: 2 gm)
Methylprednisolone Asthma (status asthmaticus), Anaphylactic Shock
  • Load: 2 mg/kg IV/IO/(IM max 80 mg) use acetate salt IM
  • Maintenance: (max 120 mg/d)divided Q6h
Midazolam Prolonged Seizures/Status Epilepticus
10 mg IM
Milrinone Myocardial Dysfunction and Increased SVR/PVR
Loading dose: 50 to 75 μg/kg IV/IO over 10 to 60 minutes followed by 0.5 to 0.75 μg/kg per minute IV/IO/infusion

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N

Drug Indications/Dosage
Naloxone Narcotic (opiate) Reversal
  • 2 mg - total reversal required (for narcotic toxicity secondary to overdose)
  • 0.4-2 mg/dose - total reversal not required (e.g., for respiratory depression associated with therapeutic narcotic use): 1 to 5 μg/kg IV/IO/IM/SQ; titrate to desired effect
  • Maintain reversal: 0.002 to 0.16 mg/kg per hour IV/IO infusion
Nitroglycerin Congestive Heart Failure, Cardiogenic Shock
  • Begin with 5 mcg per minute IV/IO infusion, may increase 5 mcg per minute q 3 to 5 minutes PRN to 1 to 5 μg/kg up to 20 mcg/min (max 20 mcg per minute) If no response increase 10 mcg/min every 3 to 5 minutes PRN to min PRN to a max of 200 mcg/min
Norepinephrine Hypotensive (usually distributive) Shock (ie, low SVR and fluid refractory)
1 to 20 mcg/per minute IV/IO infusion; titrate to desired effect

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O

Drug Indications/Dosage
Oxygen Hypoxia, Hypoxemia, Shock, Trauma, Cardiopulmonary Failure, Cardiac Arrest
Administer 100% O2 via high-flow O2 delivery system (if spontaneous ventilations) or ET (if intubated); titrate to desired effect

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P

Drug Indications/Dosage
Pralidoxime Nerve Agent/Organophosphate Antidote
20 mg/kg - 50 mg/kg IV, IM (max dose 2 grams) 1-3 autoinjectors

See Nerve Agents - Prehospital Management and Nerve Agents - Emergency Department/Hospital Management Treatment section for nerve agent specific dosing recommendations
Procainamide SVT, Atrial Flutter, VT (with pulses)
20 mg/min IV/IO until arrhythmia suppressed) (do not use routinely with Amiodarone) 1-4 mg/min (maintenance rate)

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S

Drug Indications/Dosage
Sodium Bicarbonate Cardiac Arrest, Metabolic Acidosis (severe), Hyperkalemia
See Harriet Lane Handbook for dosing for specific indications

Routine use of sodium bicarbonate in cardiac arrest is not recommended. When used in special situations, the typical initial dose is 1 mEq/kg [max of one to two 50 mL syringes (44.6 to 100 mEq)] and then the dosage should be guided by the bicarbonate concentration or calculated base deficit from blood gas analysis or laboratory measurement (Neumar et al, 2010). See Daily Med

See Phosgene - Emergency Department/Hospital Management Treatment section for off label dosing recommendations
Sodium Nitrite
As soon as IV access has been achieved in a symptomatic patient DC the perles and initiate IV sodium nitrite (ASAP).
  • The usual adult dose is 10 mL of a 3% solution (300 mg) infused over absolutely no less than 5 minutes

See Hydrogen Cyanide - Prehospital Management and Hydrogen Cyanide - Emergency Department/Hospital Management Treatment section for cyanide specific dosing recommendations
Sodium Nitroprusside Cardiogenic Shock (i.e., associated with high SVR), Severe Hypertension
0.1 to 5 μg/kg per minute (wt >40 kg) IV/IO infusion, usual dose is 3-4 mcg/kg/min, max dose 10 mcg/kg/min
Sodium Thiosulfate Antidote for Cyanide Toxicity
IV sodium thiosulfate
  • The adult dose is 50 ml of a 25% solution (12.5 grams infused over 10 - 20 minutes).
  • Repeat one-half of the initial dose in 30 minutes if there is an inadequate clinical response or at 2 hours for prophylaxis
See Hydrogen Cyanide - Prehospital Management and Hydrogen Cyanide - Emergency Department/Hospital Management Treatment section for cyanide specific dosing recommendations


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When prescribing drugs for pregnant women take into consideration the following information:


  • There are scarce data regarding maternal and fetal outcomes after exposure of pregnant women to various hazardous chemicals, gases, agents, etc.
  • There are also scarce data regarding maternal and fetal outcomes in pregnant women who have received treatments and antidotes to various hazardous chemicals, gases, agents, etc.
  • The physiologic changes of pregnancy allow the woman to adapt to the physical and metabolic demands of the fetus. These changes are fully established by the middle of the second trimester of pregnancy and persist until approximately 4 to 6 weeks post partum. They include increased RBC mass, increased total plasma volume, increased respiratory perfusion, decreased air exchange, increased renal blood flow and function, transport of various substances across the placenta, etc. All of these changes can affect the extent of any hazardous exposures and also the efficacy of any treatments.
  • Whenever such treatments and/or managements are contemplated, a general rule of thumb that should be followed is: The mother's well being and safety should outweigh that of her unborn fetus. Therefore, a potentially lifesaving treatment should not be withdrawn or withheld because of the pregnancy or out of fear of harming a fetus.
  • The gestational age (i.e. trimester of pregnancy) of the pregnant woman should be taken into consideration whenever exposures are managed and/or treatments are planned.
  • In general, if the exposure and/or planned treatment occurs during the early part of pregnancy (e.g. first trimester and early second trimester), the pregnant woman (dosing wise) can be managed as would any (non pregnant) adult.
  • If the exposure and/or planned treatment occurs during the latter half of pregnancy (late second and third trimesters), "dosing should follow normal guidelines for adults, unless specific information is available to suggest specific alterations to dosing are warranted".
  • Breast feeding mothers can be handled on a case by case basis. In general, all of the above information applies to breast-feeding women as well.
  • Pregnancy Categories: Refer to DailyMed regarding Pregnancy Categories and additional pregnancy-related information.


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