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Drug Formula - (update 2010)

Drug formulaATROPINE , ADRENALINE 2AMINOPHYLINE 4AMIODARONE 5ANTIVENOM 6ADENOSINE 7CALCIUM GLUCONATE 8DOBUTAMINE 8-11DOPAMINE 12 –

13DIGOXIN 14FRUSEMIDE 15POTASIUM CHLORIDE 16LABETOLOL 17LYTIC COCKTAIL 18LIGNOCAINE 19-

20MAGNESIUM SULPHATE 21MIDAMORPHINE 22OMEPERAZOLE 23PHENYTOIN 24NORCURON 25TRAMADOL 26SALBUTAMOL 27SLIDING SCALE 28STREPTOKINASE 29SOLUMEDROL 30ISORSORBIDE DINATRADE 31ISOPRENALINE 32ANTIDOT 33DRUG FORMULA MG/ML TO MCG/ML 34ANTIVENOM 36

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Adrenaline 1mg/mLa. single dose

3mg + 47ml Normal Saline : 50ml

1ml/hr : 1ug/mnt

b. double dose

6mg +44ml N/S : 50 ml

1ml/hr :2ug/mntAnaphylaxis *stable(IM administration @ Lateral Thigh)Adrenaline IM dose – adults0.01ml - 0.5 mg IM (= 500 micrograms = 0.5 mL of 1:1000) adrenalineAdrenaline IM dose – children (The equivalent volume of 1:1000 adrenaline is shown in brackets)> 12 years: 500 micrograms IM (0.5 mL) i.e. same as adult dose300 micrograms (0.3 mL) if child is small or prepubertal> 6 – 12 years: 300 micrograms IM (0.3 mL)> 6 months – 6 years: 150 micrograms IM (0.15 mL)< 6 months: 150 micrograms IM (0.15 mL)

*Unstable

Dilute 1:1000 into 10mls NS => 1:10,000 dilution

IV access : 0.1ml – 5ml * repeated after 5min if patient not responsive

In Paeds : To consult with paediatric team/specialist

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Aminophyline 250mg/10ml

250mg +90ml N/S : 100 ml

Run in chamber over 20 mnt or as order by doctorContraindications:-

Known allergies/ peptic ulcer/ severe renal or liver impairment

Careful in Pregnancy, elderly and children

Dosage: 6mg/kg over 30min and maintenance 0.5-0.9mg/kg/hr

Therapeutic plasma concentration is narrow

Cimetidine/propanolol/Erythromycin => increase plasma concentration

Alcohol/barbiturates/ phenytoin => decrease plasma concentration

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Amiodarone 150mg/5ml

150mg in 20ml N/S give by bolus over 10 Minutes

(may be repeated another cycle if non resolving )

Follow by maintainence infusion 1mg/min for first 6 hoursContraindications/Precautions:-

Severe sinus bradycardia/ Advance AV block/ Severe liver disease and porphyria

Cautious in thyroid dysfuction, pre-existing lung disease and electrolytes imbalance

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Antivenom

1 vail dilute in 10cc water for injection

4 vail = 40 cc + 200 ml NS run over 1 hour

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Adenosine 6mg/3mlShould be given in large bore line ie- brachial region and after bolus NS raised the arm high above the heart.

Kindly remind the patient that he will feel his heart stop/heaviness on his chest prior to administration. – attached the cardiac monitoring before administration of this drugs.

1 vail = 6mg --give bolus in 3-5 second

+(followed) 20ml NS –push fast

If still not revert...

2 vail = 12mg—give bolus in 3-5 second

+(followed) 20 ml NS—push fast

If still not revert....

2 vail =12mg(max dose) + (followed) 20ml NS Contraindication in:-

Sick sinus syndrome/ 2nd+3rd degree heart block => asystole

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Calcium Gluconate 1g/10ml1 ampul = 1g/10ml + 20ml NS

run over 1-2 hour or as order by doctorUses:

Treatment –ve Calcium balance, hypoparathyroidism, vit D deficiency, MgSO4 toxicity.

Contraindications:-

Ventricular fibrillations, metastatic bone disease, intracardiac/IM/SC routes, renal calculi, predispose to hypercalcemia ie-hyperparathyroidism

Cautious in digitalized patient, renal/cardiac insufficiency and sarcoidosis.

Side Effects:-

Tinggling sensation at injection site / heat wave (vasodilatation), hypotension, bradycardia, arrythmias, cardiac arrest, local irritation, cellulitis (narcosis if extravasation), constipation, increase inotropic effect of digoxin

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Dobutamine 250mg/20mla)single dose

Body weight x 3

Eg;

Bw(50kg)x3 = 150mg

150mg

---------- x 20 = 12 ML Dobutamine

250mg

12ML Dobutamine + 38 ml NS

1ml/hr = 1ug/kg/mnt

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Dobutamine 250mg/20ml

b)double dose

Body weight x 3

Eg;

Bw (50kg)x3=150mg x 2 = 300mg

300mg

---------- x 40 = 24 ML Dobutamine

500mg

24 ML Dobutamine + 26 ml NS

1ml/hr = 2 ug/kg/mnt

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Dobutamine 250mg/20ml

c)in 100 ml NS

Body weight x 6

Eg;

Bw (50kg)x 6= 300mg

300mg

---------- x 40 = 24 ML Dobutamine

500mg

24 ML Dobutamine + 76 ml NS

1ml/hr = 1 ug/kg/mnt

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Dopamine 200mg/5ml

a)single dose

Body weight x 3

Eg;

Bw(50kg)x3 = 150mg

150mg

---------- x 5 = 3.75 ML Dopamine

200mg

3.75ml Dopamine + 46.25ml D5%

1ml/hr = 1ug/kg/mnt

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Dopamine 200mg/5ml

b)double dose

Body weight x 3

Eg;

Bw(50kg)x3 = 150mg x 2 =300mg

300mg

---------- x 10 = 7.5 ML Dopamine

400mg

7.5ML Dopamine + 42.5 ml D5%

1ml/hr = 2ug/kg/mnt

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Dopamine 200mg/5ml

c)in 100 ml D5%

Body weight x 6

Eg;

Bw(50kg)x6 = 300mg

300mg

---------- x 10 = 7.5 ML Dopamine

400mg

7.5ml Dopamine +82.5 ml D5%

1ml/hr = 1ug/kg/mnt

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Digoxin 0.5mg/2ml

0.5mg in 100ml NS run over 30 minutes to 1 hour

@

0.25mg in 50 ml NS run over 30 minutes to 1 hour (in elderly or patient with other serious ongoing illness ie:- sepsis)

Adverse effects;

Arrythmias, SVT/VT, heart block, GIT, Visual distrubances, gynaecomastia, confusion, restless.

REMEMBER:-

Quinidine, verapamil, nifedipine, amiodarone increase plasma level of digoxin

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Frusemide 20mg/ml

40mg Frusemide in 40ml NS

run 5ml/hr = 5mg

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Potasium Chloride (KCL)

10mg/10ml

Dilute in 40ml NS run over 1-3 hour @ as order by doctor

Caution in:-

Severe renal impairment, haemolytic reactions, untreated addison’s disease, crush syndrome, digitalis intoxication with AV block.

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Labetolol 25mg/5ml

Pure, jadikan 100mg=4ampul=20ml

Run as order by doctor

Iv bolus 25-50 mg every 5-10 min (max 300mg, effect 50 minutes) @

Infusion rate 0.5-2 mg/min

Contraindications:-

Known allergies, periphery vasoconstriction, hypertensive following acute myocardial infarction, not normally given with pt on digitalis -> resistant heart failure+Avblock, asthmatic.

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Lytic Cocktail

1. D50% = 5 ampul2. Actrapid = 10 unit3. Calcium Gluconate = 10mg

Bagi calcium gluconate dahulu...kemudian D50 50cc akhir sekali actrapid 10 unit

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Lignocaine 500mg/5ml

Arrythmia : bolus 1-2 mg/kg over 2 minutes

Infusion : 1-4 mg/min

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Lignocaine 500mg/5ml

@

1G in 50 ml D5%

1ml = 20mg

3ml = 60mg

1 x 60 x 50

1mg/ml = -------------- = 3 ml/mnt

1000

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Magnesium Sulphate (MgSO4)2.47mg/5mlFOR ASTHMA PATIENT

Dilute in 20 ml NS

If order infusion run over 30 mnt 40ml/mntContraindications : Heart block

Cautious in renal impairment, digitalized patient, CNS derpessent or neuromuscular blocking agents.

Watchout for S&S of toxicity

Effects Serum Mg (mEq/L)Deeo tendon reflexes presebt but possibly

hypoactive4-7

Prolonged P-Q interval; Widened QRS complex 5-10Loss of deep tendon reflexes 8-10

Respiratory paralysis 10-13Altered cardiac conduction 15

Cardiac arrest 25Antidote: Calcium Gluconate (IV CaGluconate 1g slow bolus)

Adverse effects:

Bradycardia, diplopia, flushing, headache, hypotension, nausea, shortness of breath, slurred speech, vomiting, weakness.

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MgSO4 cont...

FOR SEVERE PRE-ECLAMPSIA/ECLAMPSIA

IV Regime (Zuspan)

=> Loading Dose : 4g MgSO4

=> Then 8mls (4gm)+12mls NS => 20mlsGive Slow bolus 10-15min

Then Maintenance25gm/50mls (10vial) in infusion pumpRun 2cc/hr (1gm/h)For 24H after fits/deliveryif recurrent fits occur – give 2g/10min

IM Regime (Pritchard)

Loading dose- Deep IM injection 5gm (10mls) at each buttock (total 10gm-20msl)

Maintenance dose – deep IM injection 2.5gm (5mls) each buttock every 4H

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Midamorphine

Midazolam 30mg

+

Morphine 30mg

+

21ml NS = 30ml

1mls = 1mg Midazolam + 1mg Morphine

Infusion rate (0.02-0.2mg/kg/hr)

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Omeperazole 40mg/vail

1 vail(40mg) + 10ml water for injection

Give bolus

Infusion : 1vail(40mg) +10mls water for injection +30ml NS

Run order by doctor.1ml = 1 mg Omeprazole

In UGIB – 80mg stat then infusion 8mg/hr

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Phenytoin 250mg/5ml

750mg(3ampul) +85ml NS = 100ml

Run over 1 hour @ as order by doctorIn status epilepticus : 15-20mg/kg (both adult n paeds)Maximum dose 1.5g

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Nocuron 4mg/ml

Intubating dose 0.1 mg/kg

Duration action 20-30 minutes

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Tramadol 50mg/ml(1-2 mg/kg –stat dose)

100mg + 48ml NS

Run as order by doctorMaximum dose 15mg/hr

Dosage: 2-8mcg/kg/min (infusion)

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Salbutamol 0.5mg/ml

3 mg(6 ampules) in 50cc D5%

Loading Dose = 250 mcg = 0.25 mg (0.5 ml)

Infusion = 5-20 mcg/min Contraindications:

Known hypersensitivity, threatened abortion during 1 st and 2nd trimester, toxaemia in pregnancy, antepartum haemorrhage, placentae previa

Cautious in thyrotoxicosis, serious heart or circulation disorders, DM, HPT, lactation

Side Effects

Headaches, tension, tachycardiac, peripheral vasodilatation, tremors, hypokalemia, transient muscle cramps and paradoxical bronchospasm (inhalers)

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Sliding Scale

50 unit Actrapid + 49.5 ml NS = 50ml

Plan A = 6ml/hr

Plan B = 12ml/hr

In infusion pump

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Streptokinase 1.5m unit/vail

1vail dilute in 10ml NS + 90ml NS =100ml

Run over 1 hour

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Solumedrol

(methylprednisolone sodium succinate)

30mg/kg bodyweight over 1 hour

Maintain dose= 5.4mg/kg/bw over 23 hour

Contraindications

Hypersensitivity, premature infant ( Gasping Syndrome), known hypersensitivity, systemic fungal infections

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Isosorbide Dinatrate 10mg/10ml30mg isoket + 20ml NS = 50ml

1 mls/hr=10ug/min

Rate : 2-10mg/H

Contraindications

In patient with raised ICP

Side Effects

Hypotension, reflex tachycardia, headaches

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Sodium Bicarbonate

1-2 mmol/kg in slow iv over 20-30 minutes

Side effects:

Local : phlebitis, warm @ injection site, venous thrombosis, extravasation of MgSO4 may cause severe necrosis of the area.

Systemic: Metabolic alkalosis, hypokalemia,nausea, vomiting, increase thirst, slow breathing, weakness, irritability

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Isoprenaline

1- 10mcg/kg/mnt

3mg in 50mls D5%

Xml/hr = x mcg/mnt

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Antidots

Fuller’s earth

15% = 60G Fuller’s earth dilute in 400cc water give 20 ml

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ANTI DOT PARACAETAMOL

N – Acetylcytene 5mg/25ml

150mg/kg in 200ml D5% over 15 min

Then

50mg/kg in 500ml D5% over 4 hour

Then

100mg/kg in 500ml D5% over 16 hour

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DRUG CONCENTRATION IN MG/ML OR MCG/ML.

1MG =1000MCG

1GM=1000MG

FORMULA MG/ML=AMOUNT OF DRUG IN THE SOLUTION (MG) VOLUME OF SOLUTION(ML)

EX;200MG OF DRUG IN 500 ML TO DETERMINE MG/ML

200 MG / 500ML = 0.4 MG/ML

TO DETERMINE MCG/ML, FIRST CHANGE MG TO MCG

200MG X 1000 MCG/MG = 200,000MCG

THEN DIVIDE MCG BY ML OF SOLUTION

200000MCG/500ML = 400 MCG/ML.

CALCULATING MCG/KG/MIN.

YOU MUST KNOW ;

WT IN KG , INFUSION RATE (ML/HR) DRUG CONCERTRATION

FORMULA ; MCG/KG/MIN = MCG/ML X ML/HR

KG X 60 MIN /HR

EX AQ 75 KG PATIENT IS RECEIVING DOPA AT 20 ML/HR. THERE

IS 250 MG OF DOPA IN 250 ML OF D5W

TO DETERMINE DOSAGE BEING GIVEN IN MCG/KG/MIN

FIRST CHANGE MG TO MCG ;

250 MG = 250000 MCG

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THEN DEVIDE THE DOSE BY THE AMOUNT OF SOLUTION

250000 MCG/250 ML = 1000 MCG / ML

NOW ALL THREE PARAMETER ARE KNOWN

MCG/KG/MIN = MCG/ML X ML/HR

KG X 60

=1000 X 20

75 X 60

= 20,000 = 4.44 MCG/KG/MIN

CALCULATING THE AMOUNT OF FLUID TO INFUSE

FORMULA ML/HR = MCG/KG/MIN ORDERED X KG X 60

MCG/ML

EX. 70 KG PATEINT IS TO RECEIVE DOPA AT 6 MCG/KG/MIN

THERE IS 400MG OF DOPA IN 250 ML D5W

TO DETERMINE THE INFUSION RATE IN ML ;

FIRST CHANGE THE MG TO MCG/MG

400 MG = 400,000 MCG

Then devide the dosage by amount of solution ;

400000 mcg

= 1600 mcg/ml

250 ml

Now all three parameter are known

Ml/hr = mcg/kg/min ordered x kg x 60 min = 6 x 70 x x60 = 25200 =

Mcg / ml 1600 1600

=16 ml/hr

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Dilution anti venom

GUIDE FOR DOSAGE

Grade for envenomation Dosage

Minimal Not Indicated

Moderate 20-40 mls(2-4 vials)

Severe 50-90 mls(5-9 vials)

Very Severe 100-150 mls(10-15 vials)

Grades of envenomationMinimal No pain to moderate pain, erythema, oedema 2.5-15 cm, no systemic

involvementModerate Severe pain, tenderness, oedema 25-40cm, erythema, petechia,

vomiting, fever and weaknessSevere Widespread pain, oedema 40-50cm, ecchymosis, systemic signs,Very Severe Rapid swelling, ecchymosis, CNS symptoms, visual disturbance, shock,

convulsion

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FORMULAS USED IN FLUID ADMINISTRATION

BASAL FLUID MAINTENANCE.

1500 ML / M 2 BSA / 24 HRS = ML /24 HR ( CALCULATE AS ML/HRS )

GENERAL GUIDELINES ; UP TO 10 KG = 100 ML / KG/ 24 HRS

11 - 20 KG = 50 ML/KG /24 HRS PLUS

100 ML/KG FOR FIRST 10 KG

20 KG = 20 -25 ML/KG/24 HRS PLUS 50 ML/KG FOR EACH KG 11 THROUGH 20 PLUS

100 ML / KG FOR FIRST 10 KG

VOLUME REPLACEMENTWITH CRYSTALLOID

ADMINISTER 3 ML FOR EVERY ML LOST.FOR FLUID CHALLENGES ADMINISTER ;

IV BOLOS 20 ML/KG N/S RL IN CHILDREN

IV BOLOS OF 200 – 300 ML RL IN SURGICAL PATIENT

IV BOLOS OF 200 – 300 ML NS IN ADULT MEDICAL PATIENT

VOLUME REPLACEMENT WITH COLLOID0

ADMINISTER 1 ML FOR EVERY CC LOST

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HAEMODYNAMIC FORMULA AND VALUES

PARAMETER FORMULA NORMAL RANGECARDIAC OUTPUT HR X SV 4 – 8 L/MIN

CARDIAC INDEX CO/BSA 2.2 – 4.0 L/MIN/M 2STROKE VOLUME CO X 1000

HR650 -150 ML / BEAT

MAP 2(DBP) + SBP3

70 - 105 MMHG

CVP MEASURED 2 - 6 MMHG

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NORADRENALINE DILUTIONSINGLE DOSE

NORADRENALINE 4MG DILUTE DGN 50 ML D5%

(1 AMPULE )

DOUBLE DOSE

NORADRENALINE 8MG DILUTE DGN 50 ML D5%

(2 AMPULE )

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