Medications
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| Dobutamine, also known as | Dobutrex
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| Dobutamine Class | Adrenergic Agent
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| Dobutamine Action | Acts primarily as an agonist at beta1, adrenergic receptors w/ minor beta2 and alpha1 effects. Consequently, it increases myocardial contractility and stroke volume w/ minor chronotropic effects, resulting in increased cardiac output.
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| Dobutamine Indications | CHF, cardiogenic shock.
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| Dobutamine Adverse Effects | Tachycardia, PVCs, hypertension, hypotension, palpitations, arrhythmias.
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| Dobutamine Contraindications | Suspected or known poisoning/drug-induced shock, systolic blood pressure <100mm Hg w/ signs of shock, idiopthic hypertrophic subaortic stenosis, known sensitivity (including sulfites). Use with caution in hypertension, recent MI, arrhythmias, hypovolem
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| Dobutamine Dosage: Adult: | 2-20mcg/kg/min IV, IO,. At doses >20mcg/kg/min, increases of heart rate of >10%.
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| Dobutamine Dosage: Pedi: | Same as adult dosing.
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| Dobutamine Special Considerations | Half-life 2 minutes. *Pregnancy class C.
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| Dopamine, also known as | Intropin
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| Dopamine Class | Adrenergic agonist, inotrope, vasopressor.
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| Dopamine Action | Stimulates alpha and beta adrenergic receptors. At moderate doses (2-10mcg/kg/min), it stimulates beta1 receptors, resulting in inotropy and increased cardiac output while maintaining dopaminergic-induced vasodilatory effects. At high doses (>10 mcg/k
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| Dopamine Indications | Hypotension and decreased cardiac output associated w/ cardiogenic shock and septic shock, hypotension after return of spontaneous circulation following cardiac arrest, sympotematic bradycardia unresponsive to atropine.
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| Dopamine Adverse Effects | Tachycardia, arrhythmias, skin an dsoft tissue necrosis, severe hypertension from excessive vasoconsstriction, angina, dyspnea, headache, n ausea/vomiting.
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| Dopamine Contraindications | Phechromocytoma, VF, VT, or other ventricular arrhythmias, k nown sensitivity (including sulfites). Correct any h ypovolemia with volume fluid replacement before administering dopamine.
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| Dopamine Dosage: Adult: | 2-20mcg/kg/min IV, IO infusion. Starting dose 5mcg/kg/min; may gradually increase the infusion by 5-10mcg/kg/min to desired effect. Cardiac dose is usually 5-10mcg/kg/min; vasopressor dose is usually 10-20mcg/kg/min. Little benefit is ga
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| Dopamine Dosage: Pedi: | Same as adult dosing.
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| Dopamine Special Considerations | Half-life 2 minutes. *Pregnancy class C.
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| Heparin, also known as | Unfractionated Heparin
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| Heparin Class | Anticoagulant
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| Heparin Action | Acts on antithrombin III to reduce the ability of the blood to form clots, thus preventing clot deposition in the coronary arteries.
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| Heparin Indications | ACS, acute pulmonary embolism, deep venous thrombosis.
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| Heparin Adverse Effects | Bleeding, thrombocytopenia, allergic reactions.
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| Heparin Contraindications | Predisposition to bleeding, aortic aneurysm, peptic ulceration; known sensitivity or history of heparin-induced thrombocytopenia, severe thrombocytopenia, sulfite sensitivity.
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| Heparin Dosage: Cardiac Indications: Adult: | 60U/kg IV (max 4000 units), followed by 12U/kg/hr (max 1000 units). Once in the hospital, addt’l dosing is determined based on lab blood tests.
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| Heparin Dosage: Cardiac Indications: Pedi: | 75U/kg followed by 20U/kg/hr.
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| Heparin Dosage: Pulmonary Embolism and Deep Vein Thrombosis: Adult: | 80U/kg IV, followed by 18U/kg/hr.
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| Heparin Dosage: Pulmonary Embolism and Deep Vein Thrombosis: Pedi | 75U/kg followed by 20U/kg/hr.
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| Heparin Special Considerataions | Half-life approx 90 minutes. *Pregnancy class C.
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| Insulin, Regular...also known as | Humulin R, Novolin R
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| Insulin, Regular Class | Hormone
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| Insulin, Regular Action | Binds to a receptor on the membrane of cells and facilitates the transport of glucose into cells.
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| Insulin, Regular Indications | Hyperglycemia, insulin-dependent diabetes mellitus, hyperkalemia.
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| Insulin, Regular Adverse Effects | Hypoglycemia, tachycardia, palpitations, diaphoresis, anxiety, confusion, blurred vision, weakness, depression, seizures, coma, insulin shock, hypokalemia.
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| Insulin, Regular Contraindications | Hypoglycemia, known sensitivity.
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| Insulin, Regular Dosage: Ketoacidosis: Adult: | 0.1U/kg IV, IO, or subQ. Because of poor perfusion of the peripheral tissues, subQ admin. is much less effective than the IV, IO route. IV, IO insulin has very short half-life, therefore IV, IO insulin w/o an infusion is not that effective. Rate for
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| Insulin, Regular Dosage: Ketoacidosis: Pedi: | None listed in book.
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| Insulin, Regular Dosage: Hyperkalemia: Adult: | 10U IV, IO of regular insulin (Insulin R), coadministered with 50ml of D50W over 5 minutes.
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| Insulin, Regular Dosage: Hyperkalemia: Pedi: | 0.1U/kg Insulin R IV, IO.
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| Insulin, Regular Special Considerations | Only regular Insulin can be given IV, IO. *Pregnancy class B.
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| (Humulin R, Novolin R)
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| Class | Hormone
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| Adverse Effects | Hypoglycemia, tachycardia, palpitations, diaphoresis, anxiety, confusion, blurred vision, weakness, depression, seizures, coma, insulin shock, hypokalemia.
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| Contraindications |
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| Dosage Ketoacidosis |
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| 0.1U/kg IV, IO, or subQ. Because of poor perfusion of the peripheral tissues, subQ admin. is much less effective than the IV, IO route. IV, IO insulin has very short half-life, therefore IV, IO insulin w/o an infusion is not that effective. Rate for
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| Pedi | 0.1U/kg Insulin R IV, IO.
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| Special Considerations |
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| Mannitol, also known as | (Osmitrol)
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| Class | Osmotic diuretic
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| Mannitol Action | Facilitates the flow of fluid out of tissues (including the brain) and into interstitial fluid and blood, thereby dehydrating the brain and reducing swelling. Re-absorption by the kidney is minimal, consequently increasing urine output.
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| Mannitol Indications | Increased ICP.
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| Mannitol Adverse Effects | Pulmonary edema, headache, blurred vision, dizziness, seizures, hypovolemia, nausea/vomiting, diarrhea, electrolyte imbalances, hypotension, hypertension, sinus tach, PVCs, angina phlebitis.
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| Contraindications | Active intracranial bleeding, CHF, pulmonary edema, severe dehydration. Use w/ caution in hypovolemia, renal failure.
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| Mannitol Dosag:e Adult: | 0.5-2g/kg IV, IO followed by 0.25-1g/kg admin’d every 4 hrs.
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| Mannitol Dosage: Pedi: | 0.25-1g/kg IV, IO followed by 0.25-0.5g/kg every 4 hrs.
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| Mannitol Special Considerations | Mannitol should not be given in the same IV, IO line as blood. *Pregnancy class C.
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| Propofol, also known as | Diprivan
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| Propofol Class | Anesthetic
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| Propofol Action | Produces rapid and brief state of general anesthesia.
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| Propofol Indications | Anesthesia induction.
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| Propofol Adverse Effects | Apnea, cardiac arrhythmias, asystole, hypotension, hypertension, pain at injection site.
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| Propofol Contraindications | Hypovolemia, known sensitivity (including soybean oil, eggs).
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| Propofol Dosage: Adult and Pedi: | A general induction dose used to produce a state of unconsciousness rapidly is 1.5-3mg/kg IV, IO.
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| Propofol Special Considerations | None listed in book.
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