- Jacquelyn McClary
Agent | Dosage | Comments |
---|---|---|
Adenosine (Adenocard) | 50 μg/kg rapid IV (over 1-2 sec) followed immediately by NS flush Increase dose every 2 min by 50-μg/kg increments if no response; max dose 250 μg/kg | Facial flushing, irritability, and transient arrhythmias (asystole) may occur. Apnea in a premature infant has been reported. Monitor ECG and blood pressure continuously during administration. |
Alprostadil (prostaglandin E 1 ) | Starting dose: 0.05-0.1 μg/kg/min continuous IV infusion Maintenance dose: after response observed titrate down to lowest effective dose, which may be as low as 0.01 μg/kg/min | May cause apnea, fever, hypotension, and flushing. |
Amiodarone | Loading dose: 5 mg/kg IV over 30-60 min Maintenance dose: 7-15 μg/kg/min continuous IV infusion | Monitor ECG and blood pressure continuously for bradycardia and hypotension. Administration into central line preferred to minimize risk of extravasation. |
Atropine | 0.01-0.03 mg/kg IV push or IM Repeat every 10-15 min to max 0.04 mg/kg May be given via endotracheal tube | Low dosages may result in paradoxical bradycardia. |
Calcium chloride 10% (27 mg elemental Ca 2+ per mL) | 35-70 mg/kg (0.35-0.7 mL/kg), 10-20 mg/kg elemental calcium IV over 10-30 min | Dilute with NS to a final concentration of 20 mg/mL. Stop infusion if HR <100. Extravasation may lead to tissue necrosis. |
Calcium gluconate 10% (9.3 mg Ca 2+ per mL) | Emergency dose: 100-200 mg/kg (1-2 mL/kg), 10-20 mg/kg elemental calcium IV over 10-30 min Maintenance dose in IV fluids: 200-800 mg/kg/day (20-80 mg/kg/day elemental calcium) | Dilute with NS to a final concentration of 50 mg/mL. Stop infusion if HR <100. Extravasation may lead to tissue necrosis. |
Digoxin | Loading dose (digitalization): divided into 3 doses over 24 hr given by slow IV push or PO
| Avoid hypokalemia, hypomagnesemia, hypocalcemia, and hypercalcemia. Assess renal function. Monitor HR rate and heart rhythm. Follow serum drug concentrations with a target range of 1-2 ng/mL. |
Dobutamine | 2-25 μg/kg/min continuous IV infusion | Tachycardia may occur at high dosages. Hypotension risk increases in hypovolemic patients.Tissue ischemia with extravasation; inject phentolamine into affected area as soon as possible. |
Dopamine | 2-20 μg/kg/min continuous IV infusion “Renal dose”: 2-5 μg/kg/min Cardiac stimulation: 5-15 μg/kg/min Vasoconstriction: >5 μg/kg/min | Pharmacologic effect is dose dependent. Extravasation may lead to necrosis; inject phentolamine into affected area as soon as possible. |
Epinephrine | Emergency dose: 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 concentration) IV push; 0.1 mg/kg ET followed by 1 mL NS Continuous IV infusion: 0.02-1 μg/kg/min | Monitor HR and blood pressure continuously. Infiltration may cause tissue necrosis; inject phentolamine into affected area as soon as possible. |
Esmolol (Brevibloc) | Supraventricular tachycardia: 100 μg/kg/min continuous IV infusion; increase by 50-100 μg/kg/min every 5 min; usual max 200 μg/kg/min Postoperative hypertension: 50 μg/kg/min continuous IV infusion; increase by 25-50 μg/kg/min every 5 min; usual max 200 μg/kg/min | Monitor ECG continuously.May cause hypotension at high dosages. |
Hydralazine (Apresoline) | 0.1-0.5 mg/kg/dose IV or IM q6-8h; increase gradually to max 2 mg/kg/dose q6h 0.25-1 mg/kg/dose PO q6-8h, or twice the IV dose | Administration with a β-blocker may increase antihypertensive effect and decrease the hydralazine dose required. |
Ibuprofen lysine (NeoProfen) | First dose: 10 mg/kg IV over 15 min Second and third doses (starting 24 hr after first dose): 5 mg/kg IV over 15 min q24h | Monitor urine output and signs of bleeding. |
Indomethacin (Indocin) | 3 doses given IV over 30 min q12-24h Age at first dose determines dosing regimen:
| Monitor urine output, electrolytes, blood urea nitrogen, creatinine, and platelet count. Monitor for signs of bleeding. |
Isoproterenol (Isuprel) | 0.05-0.5 μg/kg/min continuous IV infusion; max dose 2 μg/kg/min | May cause arrhythmias and hypoxemia. Correct acidosis prior to starting therapy. |
Lidocaine | Bolus dose: 0.5-1.0 mg/kg IV push over 5 min; may repeat every 10 min to a max of 5 mg/kg Continuous IV infusion: 10-50 μg/kg/min | May cause CNS toxicity—monitor for seizures, apnea, respiratory depression. High dosages may cause bradycardia, heart block, hypotension—monitor ECG, HR, and blood pressure continuously.Contraindicated in cardiac failure and heart block. |
Milrinone (Primacor) | Loading dose: 50-75 μg/kg/min over 15-60 min Continuous IV infusion: 0.25-0.75 μg/kg/min | Loading dose optional based on status of patient. Correct hypovolemia prior to initiation of therapy. Blood pressure may decrease 5%-9% after loading dose and HR may increase 5%-10%. |
Naloxone (Narcan) | 0.1 mg/kg IV push repeated every 2-3 min until opioid effect reversed; may need to repeat doses every 20-60 min; may be given IM, SC, or ET, but not recommended due to delayed onset of action | Not recommended as part of the initial resuscitation of newborns with respiratory depression. |
Neostigmine (Prostigmin) | 0.04-0.08 mg/kg slow IV push (IM and SC administration have delayed onset of action) | Give in addition to atropine 0.02 mg/kg to reverse neuromuscular blockade. |
Nicardipine (Cardene) | 0.5 μg/kg/min continuous IV infusion; titrate up to 2 μg/kg/min | Monitor blood pressure, HR, and heart rhythm continuously. May take up to 2 days to see final effect of dose. |
Procainamide (Pronestyl) | Bolus dose: 7-10 mg/kg IV over 1 hr Continuous IV infusion: 20-80 μg/kg/min | Monitor for hypotension (increased with rapid infusion), bradycardia, arrhythmias. Monitor serum levels, especially in patients with hepatic or renal impairment, or those receiving high dosages.Monitor CBC for neutropenia, thrombocytopenia regularly. |
Propranolol (Inderal) | 0.01 mg/kg/dose IV push over 10 min q6h; titrate up to max 0.15 mg/kg/dose q6h 0.25 mg/kg/dose PO q6h; titrate up to max 3.5 mg/kg/dose q6h | Monitor ECG continuously during acute treatment of arrhythmias.Monitor blood glucose for hypoglycemia. Monitor blood pressure. |
Sodium nitroprusside (Nipride) | 0.25-0.5 μg/kg/min continuous IV infusion; titrate up every 20 min. Usual maintenance dose is <2 μg/kg/min Hypertensive crisis: doses up to 10 μg/kg/min can be used for no longer than 10 min | Monitor HR and intraarterial blood pressure continuously.May produce severe hypotension and cyanide/thiocyanate toxicity; increased risk of toxicity with prolonged treatment, high dosages, and renal or hepatic impairment.Protect drug from light. |