CRITICAL CARE INTRAVENOUS MEDICATIONS CHART DRUG NAME ONSET CONCENTRATION Amiodarone Nonspecific 450mg / 250ml D5W only Can not mix in NS Bumex (Bumetanide) 2-3 min 10mg / 100ml NS Can Mix in D5W Cardizem (Diltiazem) minutes 100mg / 100 ml Can mix in NS and D5W Cardene (Nicardipine) 10 min 20mg / 200ml 40mg / 200ml Can mix in NS and D5W Cisatracurium (Nimbex) 2-3 min 200mg / 200ml NS Can mix in D5W Corlopam (Fenoldopam) 10 min 20mg/500ml Can mix in NS and D5W Dexmedetomdine (Precedex) 1 min 200mcg / 50ml Can mix in NS and D5W Diprivan (Propofol) seconds Dobutamine 1-10 min Dopamine 5 min Epinephrine minutes Brevibloc (Esmolol) 2-10 min Fentanyl seconds Furosemide (Lasix) Page 1 5 min 1000mg / 100 ml vial 500mg / 50 ml vial Pre-Mixed 500mg / 250ml (Standard) Can mix in NS and D5W 400mg / 250ml (Standard) Can mix in NS and D5W 5mg / 250ml (Standard) Can mix in NS and D5W 2500 mg / 250 ml Pre-Mixed 1mg / 100ml NS (Standard) Can mix in D5W 100mg / 100 ml or 200 mg / 200 ml Can mix in NS and D5W UNIT OF MEASUREMENT Continuous Infusion – mg/min Common dose: 1mg / min for 6 hrs, then 0.5 mg /min infusion IV Bolus Dose – mg/hr Dose: 0.5 – 1 mg slow IVP over 1-2 min or Continuous Infusion – mg/hour Usual Dose: 1 mg/hr or (MD preference) Continuous Infusion – mg/hour Dose: 5 – 15 mg/ hr Titrate 5 mg/hr increments to desire effect Continuous Infusion – mg/hour Dose: 2.5 – 15 mg / hour Titrate 2.5 mg/hr increments Q 15 min Rotate IV infusion site Q 12 hr if given in periph. IV. If doubled need Central Line Continuous Infusion – mcg/kg/min May give IV loading dose: 0.1 mcg/kg Usual Range: 1 – 10 mcg/kg/min Titrate 2 mcg/kg/min increments Continuous Infusion – mcg/kg/min Dose: Initial 0.1 mcg/kg/min Avg. rate = 0.25 – 0.5 mcg/kg/min Loading dose = 1mcg / kg over 10 minutes Continuous Infusion - mcg/kg/hr Avg rate = 0.2 – 0.7 mcg/kg/hr Continuous Infusion – mcg/kg/min Dose: Usual range = 5-50 mcg/kg/min Continuous Infusion – mcg/kg/min Dose: 2 – 20 mcg/kg/min Continuous Infusion – mcg/kg/min Dose: 2 – 20 mcg/kg/min Continuous Infusion mcg/kg/minute -- OR -- mcg/min Usual Range: 1 – 10 mcg/min 0.05 – 1 mcg/kg/min Continuous Infusion – mcg/kg/min Dose: Usual Range = 50-200 mcg/kg/min Continuous Infusion – mcg/hour Usual Range: 50 – 300 mcg/hr Titrate 25 mcg/hr increments IV Bolus Dose – mg Dose: 20 – 40 mg slow IVP over 1-2 min or Continuous Infusion - mg / hr Usual Dose: 10 - 20 mg/hr or (MD pref.) DRUG CLASS HOW TO TITRATE Antiarrhythmic Loop Diuretic Dose ordered per MD based on UOP or PCWP Ca Channel Blocker Increase rate 5 mg/hr Q 15 min to desired Heart Rate Ca Channel Blocker Start @ 5 mg/hr then increase rate 2.5 mg Q 15 min. attempt to decrease to 3 mg/hr once B/P controlled Neuromuscular Blockade (Paralytic) Titrate to 2 - 4 twitches on Peripheral Nerve Stimulator (TOF) or per MD orders Vasodilator Titrate 0.05 – 0.1 mcg/kg/min increments Q15 until target BP Sedative (Alpha2 – Adrenergic Agonist) Conscious Sedation Titrate 0.1mcg/kg/hr Q10min Increments to desired level of Sedation (Max dose = 1.5 mcg/kg/hr) Increase 5 mcg/kg/min Q 5 minutes based on sedation (BIS or RASS) Vasopressor Increase rate 1 - 4 mcg/kg/hr Q 10 minutes Vasopressor Increase rate 1 - 4 mcg/kg/hr Q 10 minutes Vasopressor Cardiac Stimulant Antiarrhythmic / Beta Blocker Narcotic Analgesic Loop Diuretic Increase 0.01 mcg/kg/min Q 15 minutes. Titrate to effect desired per MD Usual Titration: 50mcg/kg/min increments Increase rate 25 mcg/hr based on pain control Dose ordered per MD based on UOP and or PCWP CRITICAL CARE INTRAVENOUS MEDICATIONS CHART DRUG NAME ONSET CONCENTRATION 25,000 units / 250ml Can mix in NS and D5W 100 units / 100ml NS only Can not mix in D5W UNIT OF MEASUREMENT Continuous Infusion – units/hour Dose: Weight-based --OR-- PTT-based Continuous Infusion – units/hour Dose: Based upon blood glucose level Continuous Infusion mcg/kg/minute -- OR -- mcg/min Usual Range: 0.5 – 30 mcg/min 0.01 – 3 mcg/kg/min Continuous Infusion – mg/min Usual Range: 1 – 4 mg/min 1mg/min = 7.5 ml/hr 3 mg/min = 22.5 ml/hr 2 mg/min = 15 ml/hr 4 mg = 30 ml/hr Continuous Infusion – mg/hour Usual Range: 1 – 10 mg/hr Titrate 1 mg/hr increments Heparin seconds Insulin (regular) 30 min Levophed (Norepinephrine) seconds 4mg / 250ml (Standard) Can mix in NS and D5W Lidocaine 45-90 seconds 2 grams / 500ml (4mg/ml) Can mix in NS and D5W Midazolam (Versed) 1-5 min 125mg / 125 ml Can mix in NS and D5W Natrecor (Nesiritide) 15 min 1.5mg / 250ml = (6 mcg/ml) Can mix in NS and D5W IV bolus: 2 mcg/kg over 60 seconds Continuous Infusion: 0.01 mcg/kg/min Neosynephrine (Phenylephrine) seconds Nipride (Nitroprusside) < 2 min 20mg / 250ml (Standard) Can mix in NS and D5W 50mg / 250ml D5W only, or 100mg / 250ml D5W only Can not mix in NS Continuous Infusion – mcg/min Usual Range: 100 – 180 mcg/min Continuous Infusion – mcg/kg/min Dose: 0.3 –4 mcg/kg/min Titrate 0.5 mcg/kg/min increments Maximum = 10 mcg/kg/min Nitroglycerin seconds 25mg / 250ml (Standard) Can mix in NS and D5W Continuous Infusion – mcg/min Usual Range: 1 – 200 mcg/min 2-3 min 50mg / 100 ml (Standard) Can mix in NS and D5W 5-15 min 40mg / 200ml Can mix in NS and D5W Pronestyl minutes 2 grams / 250ml Can mix in NS and D5W Vasopressin minutes 20 units / 100ml (Standard) Can mix in NS and D5W Vecuron (Vecuronium) 2-3 min 20mg / 100ml (Standard) Can mix in NS and D5W Pavulon (Pancuronium) Primacor (Milrinone) Page 2 Continuous Infusion – mg/kg/hr May give loading dose: 0.1 mg/kg slow IVP Usual Range: 0.02 – 0.1 mg/kg/hr Titrate: 0.02 mg/kg/hr increments Continuous Infusion – mcg/kg/min Usual Range: 0.375 – 0.75 mcg/kg/min Continuous Infusion – mg/min Usual Range: 1 – 4 mg / min 1mg/min = 7.5 ml/hr 3 mg/min = 22.5 ml/hr 2 mg/min = 15 ml/hr 4 mg/min = 30 ml/hr Continuous Infusion – units/min Range: 0.01 – 0.1 units/min Usual Dose: 0.04 units/min fixed dose OR Units / hr Usual Dose: 0.2 – 0.9 units / hr Continuous Infusion – mcg/kg/min May give loading dose: 100 mcg/kg IVP Usual Dose: 0.6 – 1.2 mcg/kg/min Titrate: 0.2 mcg/kg/min Updated 5/09 KE/ MS /CW DRUG CLASS HOW TO TITRATE Anticoagulant Based on PTT and Per Protocol per MD orders Hormone Agent Vasopressor Based on Blood Glucose Per protocol per MD order Increase rate 5 mcg /min Q 3 – 5 minutes Antiarrhythmic Benzodiazepine (Sedative) Increase rate 1 mg/hr based on sedation (titrate to lowest dose possible) B N P Acutely Decompensated CHF If ordered, may be increased by 0.005 mcg/kg/ min Q3hr (max = 0.03 mcg/kg/min) Vasopressor Increase rate 5 mcg/min Q 3 – 5 min. Vasodilator Increase rate 0.5 mcg/kg/min Q 3 – 5 min. Vasodilator Increase rate 5mcg/min Q 3-5 min. May increase 10mcg/min if exceeds 20 Neuromuscular Blockade (Paralytic) Titrate to 2 – 4 twitches on Peripheral Nerve Stimulator (TOF) or MD order. + Inotrope and Vasodilator Dose ordered per MD Antiarrhythmic Vasopressor for Septic Shock and Tx GIB Increase rate in 0.2 – 0.5 units / hr. Q 15 minutes Titrate to effect. Neuromuscular Blockade (Paralytic) Titrate to 2 – 4 twitches on Peripheral Nerve Stimulator (TOF) or MD orders
