Page 264 - Critical Care Notes

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CC MEDS
succinylcholine, Anectine: Neuromuscular blocker (depolarizing–ultrashort).
Uses: Facilitation of endotracheal intubation, skeletal muscle relaxation dur-
ing orthopedic manipulations. Dosages: IV 0.6 mg/kg, then 2.5 mg/min as
needed; IM 2.5 mg/kg, not to exceed 150 mg.
tenecteplase, TNKase: Thrombolytic enzyme. Use: AMI. Dosages: Adult <60 kg:
IV bolus 30 mg, give over 5 sec. Adult <70 kg: IV bolus 35 mg, give over 5 sec.
Adult ≥70–<80 kg: IV bolus 40 mg, give over 5 sec. Adult ≥80–<90 kg: IV bolus
45 mg, over 5 sec. Adult ≥90 kg: IV bolus 50 mg, give over 5 sec.
tirofiban, Aggrastat: Antiplatelet. Use: Acute coronary syndrome in combina-
tion with heparin. Dosages: IV 0.4 mcg/kg/min × 30 min, then 0.1 mcg/kg/min
for 12–24 hr after angioplasty or atherectomy.
tubocurarine, Tubarine: Neuromuscular blocker. Uses: Facilitation of endotra-
cheal intubation, skeletal muscle relaxation during mechanical ventilation,
surgery or general anesthesia. Dosages: IV bolus 0.4–0.5 mg/kg, then
0.8–0.10 mg/kg 20–45 min after first dose if needed for long procedures.
urokinase, Abbokinase: Thrombolytic enzyme. Uses: Venous thrombosis, PE,
arterial thrombosis, arterial embolism, arteriovenous cannula occlusion,
lysis of coronary artery thrombi after MI. Dosages: Lysis of pulmonary
emboli: IV 4,400 international units/kg/hr for 12–24 hr, not to exceed 200 mL;
then IV heparin, then anticoagulants. Coronary artery thrombosis: Instill
6,000 international units/min into occluded artery for 1–2 hr after giving IV bolus
of heparin 2,500–10,000 units. May also give as IV infusion 2 million–
3 million units over 45–90 min. Venous catheter occlusion: Instill 5,000
international units into line, wait 5 min, then aspirate; repeat aspiration
attempts every 5 min for 1/2 hr; if occlusion has not been removed, cap line
and wait 1/2–1 hr, then aspirate; may need second dose if still occluded.
vasopressin, Pitressin: Pituitary hormone, vasoconstrictor. Uses: Diabetes
insipidus (non-nephrogenic/nonpsychogenic), abdominal distention postop-
eratively, bleeding esophageal varices, sepsis. Dosages: Diabetes insipidus:
IM/SC 5–10 units 2–4 times a day as needed; IM/SC 2.5–10 units every
2–3 days for long-term therapy. Abdominal distention: IM 5 units, then
every 3–4 hr, increasing to 10 units if needed. Sepsis IV infusion 0.03 units/hr,
may titrate up to 0.04 units/hr for BP.
verapamil, Calan: Antianginal agent, antiarrhythmic agent (class IV), calcium
channel blocker, calcium channel blocker-nondihydropyridine. Uses: Labeled
indications: Treatment of HTN, angina pectoris, SVT. Unlabeled indications:
Hypertrophic cardiomyopathy, bipolar disorder. Dosages: Angina PO immediate
release initial 80–120 mg 3 times/day. Extended release initial 180 mg once daily
at bedtime; if inadequate response, may increase dose at weekly intervals to
240 mg once daily, then 360 mg once daily, then 480 mg once daily. Chronic
atrial fibrillation (rate-control), PSVT prophylaxis: PO immediate release
240–480 mg/day in 3–4 divided doses. HTN: PO immediate release 80 mg
3 times/day. Sustained release 120–140 mg/day in 1–2 divided doses. Extended
release usual dose range 120–360 mg once daily. SVT: IV 2.5–5 mg over 2 min;
second dose of 5–10 mg may be given 15–30 min after the initial dose.
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