Dosages Flashcards
Warfarin
in DVT/PE
0.5-6 mg PO daily
INR has to be 2-3
Heparin (UFH) IV
in ACS
IV Bolus: 60-70 IU/Kg (Max 5,000 IU)
Then 12-15 IU/Kg/h Infusion,
aPTT Q6H (x1.5-2.5)
Heparin (UFH) IV
in DVT/PE (Tx)
IV Bolus: 80 IU/Kg
Then 18 IU/Kg/h Infusion,
aPTT Q6H, x (1.5-2.5)
Heparin (UFH)
in DVT/PE (Prophylaxis)
SC 5,000 IU Q12H or Q8H
Enoxaparin
in ACS
SC 1 mg/kg BID (Max 100 mg BID)
If age>75y then 0.75 mg/kg BID
Enoxaparin
in DVT/PE (Tx)
SC 1 mg/kg BID
Or 1.5 mg/kg Q24H
Enoxaparin
in DVT/PE (Prophylaxis)
SC 30-40 mg Q24H
Clopidogrel (Plavix)
in ACS
Loading dose 300mg (but in STEMI 300-600 mg)
Maintenance 75 mg/day LD
ASA
in ACS vs Stroke
ACS: 160-325 mg
Stroke: 160 mg
Prasugrel
in ACS
Loading dose 60 mg
Then 10 mg/day
Metoprolol IV
in ACS
IV 5 mg over 1-2 min Repeat Q5min,
PO can be started 15 min after IV
Metoprolol PO
in ACS
PO Initial 25-50 mg QID
Target 100 mg BID
Carvedilol
in CHF
Initial 3.125 mg BID
Target 25 mg BID
Labetalol in HTN
Initial 50 mg BID
Usual 200 mg BID
(Alpha1+Beta1 blocker)
Atenolol
Initial 25-50 mg/day
Target 100 mg/day
Do not use in Pregnancy
Nitroglycerin SL
in ACS
SL 0.3-0.6 mg PRN Q5min
Nitroglycerin Spray
in ACS
SL 0.4 mg PRN Q5min
Nitroglycerin IV
in ACS
IV Initial 10-150 ug/min
Titrate to symptoms or BP
Verapamil
in ACS
Initial 80 mg
Max 160 mg TID
(If IR form: TID, If SR form: BID)
Amlodipine
Initial 2.5 mg/day
Max 10 mg/day Once daily
Nifedipine XL
in HTN or Raynaud’s
Initial 30 mg/day
Usual 60 mg/day
Raynaud’s 30 mg/day
Enalapril
in ACS, CHF, HTN
Initial 2.5 mg BID
Target 10-20 mg BID
Losartan
Initial 50 mg/day
Target 100-150 mg/day
Furosemide PO and IV
PO: Initial 20-80 mg SD If needed: increase by 20-40 mg Q6-8H
IV: 20-40 mg Single injection If needed: may repeat Q2H
Hydrochlorothiazide
Initial 12.5-25 mg/day
Usual 25-100 mg/day
Spironolactone
in CHF
Initial 12.5 mg/day
Target 25-50 mg/day
Atorvastatin
10-80 mg/day At any time of the day
Gemfibrozil
300-1200 mg/day Divided BID 30 min prior to meals
Glyburide
PO 2.5-20 mg/day
If >10 mg, then divide in 2 doses
Metformin (Glucophage)
500-1500 or 2500 mg/day Divided BID or TID
Calcium Gluconate
in Hyperkalemia (ER)
IV 10 ml of a 10% Solution Over 2-5 min
Insulin
in Hyperkalemia (ER)
Regular IV Bolus 5-10 units, With Dextrose 25-50 g over 5 min
Potassium Chloride
in Hypokalemia (ER)
If K<2.5 then 20-40 mmol IV in the first hour
Monitor ECG and K+ serum
Propylthiouracil (PTU)
in Thyroid Storm
Up to 1200 mg daily In divided doses
Propranolol
in Thyroid Storm
40-60 mg Q6H PO Or 0.5-2 mg IV Slowly Q4-6H
Dexamethasone
in Thyroid Storm
2 mg Q6H PO or IV
Myxedema Coma
Tx
Levothyroxin 300-500 ug IV Then 100 ug IV daily + Hydrocortisone 100 mg Q8H IV
Ferrous Sulfate
in IDA
120 mg/day (105-200 mg/day) elemental iron In 3 divided doses 60 mg elemental iron/ 300 mg Ferrous Sulfate
Folic Acid
in Anemias
1-5 mg daily PO
Vitamin B12
in Anemias
100 ug daily SC or IM Or 500-2000 ug daily PO
Asthma Acute Exacerbation
Salbutamol + Ipratropium bromide dosage
pMDI 4-8 puffs Q15-20 min x3 (Both)
Asthma Acute Exacerbation
Oral Prednisone dosage
40-60 mg PO
Asthma Acute Exacerbation
IV Corticosteroids dosage
Methylprednisolone 60-80 mg IV
Or Hydrocortisone 200 mg IV
Asthma Acute Exacerbation in Children
Prednisone Oral dosage
1-2 mg/kg PO
Asthma Acute Exacerbation in Children
IV Corticosteroid dosage
Methylprednisolone 2 mg/kg IV Or Hydrocortisone 5-8 mg/kg
Asthma Acute Exacerbation in Children
Salbutamol dosage
Nebulized Q20 min x3 1.25-5 mg/dose Or pMDI 6-10 puffs Q20 min x3
ACLS
Defibrillation in VF or Pulseless VT
360 J Monophasic Or 200 J Biphasic
ACLS
Epinephrine in VF or Pulseless VT
1 mg IV Q3-5 Minutes
ACLS
Amiodarone in VF or Pulseless VT
First dose: 300 mg IV (slowly: within 10 minutes)
Then: 150 mg IV (slowly: within 10 minutes)
ACLS
Vasopressin in VF or Pulseless VT
40 units IV
Can replace 1st or 2nd dose of Epinephrine
ACLS
Mg in Torsades
2-5 gr IV,
(slowly: within 3-5 minutes)
ACLS
VT with Pulse (If Persistent)
- Cardioversion…….?
- Adenosine……?
- 100 J Synchronized
- 1st dose: 6 mg IV 2nd dose: 12 mg IV (Must be regular and monomorphic)
ACLS
VT with Pulse (If Not Persistent) With Narrow QRS
Vagal Maneuver Or Adenosine 6 mg then 12 mg Or Beta blocker Or CCB
ACLS
VT with Pulse (If Not Persistent) With Wide QRS
(No Adenosine) Procainamide 20-50 mg IV slow Or Amiodarone 150 mg IV slow And Consult
ACLS
Asystole or PEA
(Not shockable)
Epinephrine 1 mg + CPR 2 min/5 cycles And repeat Manage 5 Hs and 5 Ts
ACLS
Bradicardia<50 If 2nd or 3rd degree Heart Block
Atropine 0.5 mg Q3-5 Minutes Max 6 doses Or Transcutaneous Pacing Rate 80, Amplitude: Capture+10
ACLS
Bradicardia<50 If 2nd or 3rd degree Heart Block Alternative treatments
Dopamine Infusion 2-10 mcg/kg/min
Or Epinephrine 1 mg Q4-6 Minutes
Status Epilepticus In 0-5 minutes
Oral Airway Oxygen Venous Blood ABG ECG monitor Pulse oximetry
Status Epilepticus 6-10 minutes
2 large bore IV Saline
Dextrose 50% 50 ml IV
Thiamine 100 mg IM or IV
Lorazepam 2 mg IV, Repeat once
Status Epilepticus 6-10 min (If no IV access)
Midazolam 5 mg IM, repeat once
Or Diazepam pr 20 mg (Either rectal gel or IV Solution)
Status Epilepticus In 11-30 minutes
(Two traditional choices)
First: Phenytoin 20 mg/kg IV
Then: Phenobarbital 20 mg/kg IV
Status Epilepticus In 11-30 minutes
(Two new alternatives)
Midazolam 10 mg IV bolus
Or Propofol 2-5 mg/kg IV bolus
Respiratory Suppression in Opioids overdose:
Naloxone dosage
Adults and Children >5y: 0.4-2 mg Q2-3 Minutes IV
In Children <5y: 0.1 mg/kg Q2-3 Minutes IV
Equivalent Doses of Opioids:
10 mg Morphine IV = ….. mg Morphine PO
60 mg PO
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Fentanyl
0.1 mg Fentanyl IV
(Fentanyl has no Oral form)
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Hydromorphone
2 mg IV
Or 5 mg PO
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Meperidine (Pethidine)
75 mg IV
Or 300 mg PO
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Codein
120 mg IV
Or 200 mg PO
Equivalent Doses of Opioids
10 mg Morphine IV (=60 mg Morphine PO)
Convert to Oxycodone
10 mg PO
(Oxycodone is only oral)
Gout
Colchicine in Acute Attack
First: 1.2 mg
Then: 0.6 mg 1 h later
Gout
Prednisone in Acute Attack
0.5 mg/kg PO daily For 5 days
Gout
NSAID in Acute Attack
Naproxen 750 mg stat
Then 500 mg BID
Situational Aggression
Haloperidol 5 mg PO or IM + Lorazepam 2 mg PO or IM
Olanzapine IM (Immediate Acting)
2.5-10 mg IM
(Should not be used simultaneously with parenteral BZPs like Lorazepam)
BZPs Dosage Equivalents:
5 mg of Diazepam=
…… Clonazepam
Or …… Chlordiazepoxide
0.25 mg Clonazepam
25 mg Chlordiazepoxide
BZPs Dosage Equivalents:
5 mg of Diazepam=
…… mg Alprazolam
Or …. mg Temazepam
0.5 mg Alprazolam
10 mg Temazepam