Cardiology Meds Doses

Question 1

Aspirin

Answer 1

162-325mg orally

Question 2

Epinephrine ADULT
1mg/mL= 1:1,000
0.1mg/mL= 1:10,000

Answer 2

Cardiovascular collapse:

-IV infusion (0.5mcg/kg/min) of 1mg/mL epi when present despite repeated epi IM doses & at least 60mL/kg isotonic fluid boluses

Prepare infusion by mixing 1mg 1mg/mL epi in 250mL NS (4mcg/mL)

Profound bradycardia w/ signs of hemodynamic instability:

-IV/IO infusion of 0.02 - 0.2mcg/kg/min 1mg/mL epi titrated to a MAP>65

-Or IV/IO push dose 10-20mcg boluses (1-2mL) every 2min titrated to a MAP>65
-Prep push dose by adding 1mL of 1mg/mL epi to 9mL of NS; results in 10mcg/mL concentration

Shock unresponsive to IV fluids or Cardiogenic shock w/ signs of fluid overload:

-IV/IO infusion 0.05 - 0.3mcg/kg/min

Cardiac arrest:

-Give 1mg of 0.1mg/mL IV/IO every 5min. Follow each dose with a 20mL flush & elevate arm for 10-20 sec after each dose

Question 3

Nitro (Tridil)

Answer 3

-SL: 0.3-0.4mg every 5min x 3 doses
-Spray: 1-2 every 5min x 3 doses

-IV: 12.5-25mcg bolus (if no SL or spray is given) then 10mcg/min infusion, increase by 10mcg/min every 5min until desired effect or max of 200mcg/min

-Paste: place on chest & don’t rub in

-Mild S/S of CHF/ pulmonary edema:
0.4mg SL may repeat every 5min

Severe s/s of CHF/ pulmonary edema:
-SBP 100-150: 0.4mg SL
-SBP 150-200: 0.8mg SL
-SBP 200+: 1.2mg SL

Question 4

Atropine

Answer 4

ADULT:

Symptomatic bradycardia:
0.5-1mg IV/IO every 5min, max of 3mg

Acetylcholinesterase inhibitor poisoning: extremely large doses

PEDIATRIC

Symptomatic bradycardia:
-0.02mg/kg IV/IO
-Max single dose 0.5mg
- max total: 1mg

Acetylcholinesterase inhibitor poisoning younger then 12yo:

-0.05mg/kg then repeat & double every 5min

Acetylcholinesterase inhibitor poisoning 12yo or older:
-1mg IV/IO then repeat & double every 5min

Question 5

Glucagon (Beta blocker/ Calcium channel blocker OD) for symptomatic bradycardia

Answer 5

Adult
-5mg slowly via IV push repeat in 5min

Pediatric
-1mg(25-40kg) or 0.5mg if they weigh less, slow via IV push every 5min

Question 6

Lidocaine (Alternative to Amiodarone for pt in cardiac arrest)

Answer 6

ADULT:

Cardiac arrest

Stable VT & stable reg. wide-complex tachycardia:

-1-1.5mg/kg IV/IO
Repeat dose:
0.5-0.75mg/kg after 5min
Max total dose: 3mg/kg
Maintenance infusion: 1-4mg/min

Pediatric
IV/IO: 1mg/kg push
Maintenance infusion:
20-50mcg/kg/min repeat after 15min
ET dose: 2-3mg/kg
RSI: 1-2mg/kg IV/IO

Question 7

Calcium gluconate (Hypocalcemia, hyperkalemia, beta blocker/ calcium channel blocker OD)

Answer 7

Adult:
1.5-3g (15-30mL of 10% solution) slow IV/IO push over 5min

Pediatric:
60mg/kg slow IV/IO push over 10 min

Question 8

Labetalol (Normodyne, Trandate)
Moderate/ severe hypertension

Answer 8

Adult:
-10mg IV push over 2min, may repeat or double every 10min to a max dose of 150mg
-Infusion: 2-8mg/min, titrated to BP

Pediatric: not recommended

Question 9

Sodium Bicarb
(Cardiac arrest due to hyperkalemia or TCA OD)

Answer 9

Adult & Pediatric:
1mEq/kg slow IV/IO push

Question 10

Furosemide (Lasix) loop diuretic
(CHF, pulmonary edema, hypertensive crisis)

Answer 10

Adult:
0.5-1mg/kg IV over 2min. Can double to 2mg/kg slowly over 2min

Pediatric: 1mg/kg IV/IO

Question 11

Magnesium sulfate
(Antidysrhythmic)

Answer 11

Adult:

Cardiac arrest due to hypomagnesemia or TdP:
1-2g IV/IO

TdP w/ pulse or AMI w/ hypomagnesemia:
-loading dose of 1-2g in 50-100mL of D5W or NS over 5-60min IV. Follow w/ 0.5-1g/h IV

Pediatric:
-pulseless VT w/ TdP:
-TdP w/ pulse or hypomagnesemia:
25-50mg/kg IV/IO bolus of a 50% solution
2g maximum

TdP w/ pulse or hypomagnesemia:

Question 12

Terbutaline (Brethine)
(Premature contractions but contraindicated w/ tachydysrhythmias)

Answer 12

Adult:
-0.25mg subcutaneous, may repeat in 15-30min
-Maximum dose: 0.5mg in 4hr period

Pediatric:
Not recommended

Question 13

Adenosine (Antidysrhythmic)
-1st line for most stable, reg. & narrow complex SVT
-Contraindicated for 2nd/3rd HB, sick sinus syndrome

Answer 13

Adult:
-6mg rapid IV/IO then flush w/ 10mL saline. Add 12mg over 2min if needed
-Max dose: 30mg

Pediatric:
-0.1mg/kg rapid IV/IO then saline flush, then second dose of 0.2mg/kg

Question 14

Amiodarone (Antidysrhythmic class 3)
(Contraindications 2nd/3rd HB, SSS)

Answer 14

Adult:
-Cardiac arrest? First dose: 300mg IV
-Cardiac arrest? Second dose: 150mg
-Loading dose:
150mg IV/IO over 10min

Pediatric:
5mg/kg IV/IO bolus
Max dose: 15mg/kg IV per 24hrs

Question 15

Diltiazem (Cardizem, Dilacor)
-Antidysrhythmic Class IV, calcium channel blocker OD
-stable narrow QRS tachycardia

Answer 15

Adult:

Initial dose:
-0.25mg/kg slow IV/IO over 2min
-After 15min: 0.35mg/kg over 2min

65YO+ max initial dose:
-10mg IV/IO & second dose of 20mg

Maintenance infusion:
5-15mg/h titrated to get good HR

Pediatric:
Not recommended

Question 16

Verapamil (Isoptin, Calan)
-stable narrow QRSA tachycardia
-control vent. rate in pt w/ AF or A flutter w/out preexcitation

Answer 16

Adult:
2.5-5mg IV bolus over 2min

Repeat dose:
5-10mg every 15min for a max of 20mg

Alternative dose:
5mg IV bolus every 15min max of 30mg

Pediatric: Consult Med. Direction