Page 261 - Critical Care Notes

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Torsades de pointes or VF/pulseless VT associated with torsades de
pointes: IV, IO: 1–2 g over 15 min or faster with cardiac arrest. Parenteral
nutrition supplementation: IV 8–24 mEq elemental magnesium/day.
metoprolol, Lopressor: Antianginal agent; beta blocker, beta-1 selective. Uses:
Labeled indications: Treatment of angina pectoris, HTN, or hemodynamically
stable AMI. Unlabeled indications: Treatment of ventricular arrhythmias,
atrial ectopy, migraine prophylaxis, essential tremor, prevention of reinfarc-
tion and sudden death after MI; prevention and treatment of atrial fibrilla-
tion and atrial flutter; multifocal atrial tachycardia; symptomatic treatment
of hypertrophic obstructive cardiomyopathy; management of thyrotoxicosis.
Dosages: Angina: PO immediate release: initial: 50 mg twice/day, max dose
400 mg/day; increase dose at weekly intervals to desired effect. Extended
release: Initial: 100 mg/day (max 400 mg/day). Atrial fibrillation/flutter
(ventricular rate control), SVT: IV 2.5–5 mg every 2–5 min (max total
dose: 15 mg over a 10–15 min period). Maintenance PO immediate release
25–100 mg twice daily. Heart failure: PO extended release: initial: 25 mg
once daily; may double dosage every 2 wk as tolerated. HTN PO immediate
release: initial: 50 mg twice daily, increase dose at weekly intervals to
desired effect. Max dose 450 mg/daily. Extended release: initial 25–100 mg
once daily; increase doses at weekly intervals to desired effect. Max dose
400 mg/daily. HTN/ventricular rate control: IV initial dose 1.25–5 mg
every 6–12 hr; titrate initial dose to response. AMI: IV 5 mg every 2 min for
3 doses in early treatment of MI, thereafter give 50 mg PO every 6 hr begin-
ning 15 min after last IV dose and continue for 48 hr, then a maintenance
dose of 100 mg twice daily. Thyrotoxicosis: PO immediate release 25–50 mg
every 6 hr.
midazolam, Versed: Sedative, hypnotic, antianxiety. Uses: Preoperative seda-
tion, general anesthesia induction, sedation for diagnostic endoscopic pro-
cedures, intubation. Dosages: Preoperative sedation: IM 0.07–0.08 mg/kg
1/2–1 hr before general anesthesia. Induction of general anesthesia: IV
(unpremedicated patients) 0.3–0.35 mg/kg over 30 sec, wait 2 min, follow
with 25% of initial dose if needed; (premedicated patients) 0.15–0.35 mg/kg
over 20–30 sec, allow 2 min for effect. Continuous infusion for intubation
(critical care): IV 0.01–0.05 mg/kg over several min; repeat at 10–15 min
intervals, until adequate sedation; then 0.02–0.10 mg/kg/hr by continuous
infusion; adjust as needed.
milrinone, Primacor: Inotropic/vasodilator agent with phosphodiesterase activ-
ity. Uses: Short-term management of advanced CHF that has not responded
to other medication; can be used with digitalis. Dosages: IV bolus 50 mcg/kg
given over 10 min; start infusion of 0.375–0.75 mcg/kg/min; reduce dose in
renal impairment.
naloxone, Narcan: opioid-agonist, antidote. Uses: Respiratory depression
induced by opioids, pentazocine, propoxyphene; refractory circulatory
shock, asphyxia neonatorum, coma, hypotension. Dosages: Opioid-induced
respiratory depression: IV/SC/IM 0.4–2 mg; repeat every 2–3 min if needed.
CC MEDS