EMERGENCY DRUGS AND CALCULATIONS

THAVAMANI KANDASAMY

ICU - STAFF NURSE

SYSTEMIC CIRCULATION

CHANNELS OF DRUG ADMINISTRATION

• ENTERAL

( ORAL,SL,BUCCAL,RECTAL)

• PARENTERAL

( IM,IV,IA,SC,ID, INTRATHECAL, INTRA ARTICULAR )

• TOPICAL

(EYE,NOSE,EARS,LUNGS,VAGINA,URETHRA,COLON)

DOPAMINE• 1 ampoule= 200mg/5ml

• AMOUNT OF DRUG NEEDED per 50 ml infusion solution : • Amount of drug to dilute = Body weight x 3

• Ex. 70 kg x 3= 210 mgAmount of drug = 210mg x5ml = 5.25ml

2oomg• PREPARATION : 44.75 ml NSS +5.25ml drug = 50ml• 1ml = 210mg x 1000 = 4200mcg• 50ml• RATE OF INFUSION : mcg x body weight x 60 min

drug concentration• Example : 5 mcg x 70 x 60 = 5 ml/hr

4,200 mcg

DOBUTAMINE

• 1 ampule= 250mg/5mL

• AMOUNT OF DRUG NEEDED in 50 ml solution

• Amount of drug = body weightx 3

• Ex. 70 kg x 3= 210 mg

• Amount of drug in ml = 210mg x5ml = 4.2ml

250MG

• PREPARATION : 45.8 ml NSS + 4.2ml drug = 50 ml

• Rate of Infusion : mcg x body weight x 60 min

Drug concentration

• Example: 4 mcg x 70 kg x 60 = 4ml/hr

4200 mcg/ml

LEVOPHED

• 1 ampoule 3mg / 3ml

• PREPARATION : 3 mg +47 ml D5W = 50ml

• DRUG CONCENTRATION : 3mg/50ml=0.06mg/1ml

• 0.06mg x 1000mcg =60mcg/ml

• Rate of Infusion : Desired Dose x 60 min

60 mcg

• Example : 2 mcg x 60 min = 2 ml / hr

60 mcg

NITROGLYCERINE

• 1 ampule= 50 mg ( 10 ml)• PREPARATION: 40 ml NSS + 10 ml NTG

• DRUG CONCENTRATION : 50 mg/ 50 ml = 1mg/1ml• 1mg x 1000 = 1,000mcg /1ml

• Rate of Infusion : Desired Dose x 60 Drug Concentration

• Example : 5 mcg x 60 min = 0.3 ml/hr1000 mcg

ADRENALINE

• 1 ampoule = 1ml/1mg

• PREPARATION: 12 ml of Adrenaline + 38 ml D5W = 50 ml

• DRUG CONCENTRATION = 12 mg/ 50 ml=0.24mg

• 0.24mg x1000= 240mcg /ml

• Rate of Infusion: Desired dose x 60 = ml /hr

240mcg

• Example : 2mcg x 60 min = 0.5 ml/hr

240mcg

INSULIN

• PREPARATION: 49.5 ml NSS + 50 units (0.5 ml R.I )

• Rate of Infusion : Desired Dose x Quantity

50 units

• Example : 3 units x 50 ml = 3 ml / hr

50 units

HEPARIN

• 1 ampule : 25,000 IU / 5ml

• PREPARATION : 45 ml NSS + 25,000 (5 ml) Heparin

• Rate of Infusion : Desired dose x Quantity

Drug Concentration

• Example : 100 units x 50 = 0.2 ml/hr

25, 000 units

LASIX

• 1 ampule = 20mg (2 ml)

• Drug Concentration : 10 ampule = 200mg (20ml)

• PREPARATION: 20 ml Lasix + 20 ml NSS

• 40 ml = 200 mg

• 1 ml = 5mg

• Rate of Infusion : Desire dose x quantity = ml/hr

Drug concentration

• Example : 10 mg/hr x 40 ml = 2 ml /hr

200 mg

PHENYTOIN

• 1 ampoule : 250 mg / 5 ml

• LOADING DOSE: 15 mg/kg at a rate not greater than 50 mg/min for 20 – 30 mins.

• MAINTENENCE DOSE: followed by 100 mg every 6-8 hours

PROPHYLAXIS: 200-600 mg/day PO/IV

• ANTIARRYTHMIC : 10 mg IV every 15 minutes until arrhythmia stops

AMIODARONE

• 1 ampoule = 150 mg (3ml)

• LOADING DOSE : 1 ampule ( 150 mg /3 ml) + 12 ml D5W

• A .MAINTANENCE DOSE : 360 mg in 6 hours

• 360 mg x 3 ml = 7.2 ml

150 mg

• 7.2 ml ( amiodarone) + 42.8 ml D5%W = 50 ml = 8.3 ml/hr

B. 540 mg in 18 hours

• 540 mg x 3 ml = 10.8 ml

150 mg

• 10.8 ml ( amiodarone ) + 39.2 ml D5%W= 2.7ML /hr

OMEPRAZOLE• 1 vial = 40 mg

• PREPARATION : 5 vial (200mg) Omeprazole + 50 ml NS

• 50 ml = 200mg

• 1 ml = 4 mg

• Rate of Infusion : Desired dose x Quantity = ml/hr

Drug Concentration

• Example : 8 mg x 50 ml = 2 ml /hr

200mg

•

LABETALOL

• 1 ampule(20 ml) = 100 mg

• Preparation : 20 ml Labetalol + 30 ml NSS

• Drug Concentration : 1 ml = 2 mg

• Rate of Infusion : Desired Dose x Quantity

Drug concentration

• Example : 5 mg x 50 = 2.5 ml / hr

100 mg

HYDRALAZINE

• 1 ampoule = 20 mg • PREPARATION: 20 mg dilute in 1 ml water of inj.• LOADING DOSE: 10-20 mg over 3-5 minutes, further dilute

with 10 ml NS over 3-5 mins.• then repeat after 20-30 minutes.

• INFUSION: Reconstitute 3 ampoules (60 mg) Hydralazinewith 1 ml water of inj. Each.

• Make up to 60 ml with NSS.

• Drug Concentration: 1 ml : 1 mg

• Note : Give rate between 2 and 15 mg / hr depending on BP and pulse.

VASOPRESSIN

• 1 ampoule = 20 units / 1 ml• USUAL DOSE: 0.01 to 0.03 units/ minute• PREPARATION : 20 units in 50 ml NSS

• DRUG CONCENTRATION: 20units / 50ml = 0.4units / ml

• Rate of Infusion: Desired Dose x 60Drug Concentration

• Example : 0.01 units/min x 60 = 1.5 ml/hr0.4 units / ml

PHENYLEPHRINE

• 1 ampoule: 10 mg / 1ml

• PREPARATION: 10 mg in 250 ml NSS

• 1ml = 40 mcg/min

• Rate of Infusion : Desired Dose x 60 = ml/hr

40 mcg/ml

• Example : 1 mcg /min x 60 = 1.5 ml/hr

40 mcg/ min

PROPOFOL

• INFUSION: 1 ampoule: 200 mg = 20 ml

• PREPARATION : 500 mg = 50 ml without dilution

• DRUG CONCENTRATION: 1 ml = 10 mg

• Rate of Infusion : Desired Dose x quantity

Drug Concentration

• Example : 10 mg x 50ml = 1ml/hr

500mg

SANDOSTATIN ( OCTREOTIDE)

• 1 ampoule : 100 mcg/ml

• 3 ampules (300 mcg /3 ml) + 27 ml NSS = 30 ml

• Drug Concentration: 30 ml = 300 mcg

• 1 ml = 10 mcg

• NOTE : 25 MCG BOLUS FOLLOWED BY 25 – 50 MCG / HR

ATRACURIUM

• 1 ampule : 25 mg ( 2.5 ml)

• PREPARATION : 4 ampule (100mg) + 40 ml NSS

• DRUG CONCENTRATION: 100 mg /50ml

• Rate of Infusion: Desired Dose x 50 ml

Drug Concentration

• Example : 5 mg x 50 ml = 5 ml / hr

100mg

FENTANYL

• INFUSION:1 ampoule = 500 mcg (10 ml)

• PREPRATION : 10 ml Fentanyl + 40 ml NSS

• Drug Concentration : 50 ml = 500 mcg

• 1 ml = 10 mcg

• Rate of Infusion : Desired Dose x Quantity

Drug Concentration

• Example : 25 mcg x 50 ml = 2.5 ml

500mcg

DORMICUM( MIDAZOLAM)

• 1 ampoule = 15 mg (3ml)

• PREPARATION: 45 mg ampule (9 ml) + 36 ml NSS• Drug Concentration : 45mg /45ml =1mg/1ml

• Rate of Infusion : Desired Dose x QuantityDrug Concentration

• Example : 2mg x 45 ml = 2ml / hr 45mg