The following information is for educational purposes only. Clinical interpretation must be used in the healthcare setting and within limits of competency. Please check local guidance and protocols as well as indications and contraindications of medications.
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Drug
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Dose Range
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Additional information
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Fentanyl IV
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25-400mcg/hr
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Opiate of choice in renal impairment
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Propofol IV
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0-300mg/hr Max 4mg/kg/hr (IBW)
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Short acting. No analgesic properties. Hypotensive effect.
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Midazolam IV
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0-10mg/hr
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Accumulates in renal impairment and in obesity – may take days to clear
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Morphine IV
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1-10mg/hr
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Avoid use in renal impairment
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Thiopentone IV
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3-8mg/kg/hr (ABW)
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Used for raised ICP. Risk of accumulation. Can cause disruption of potassium homeostasis. Aim K+ to be lower end of normal range
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Ketamine IV (analgesia)
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Loading dose: 0.2mg/kg (ABW) STAT Initial maintenance: 0.3mg/kg/hr (ABW) and titrate (up to 0.6mg/kg/hr)
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May lower seizure threshold. Very hallucinogenic and can induce catatonia. NOT indicated for ‘normal’ acute pain.
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Drug
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Dose Range
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Additional information
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Atracurium
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Used for cardiovascularly stable patients at low risk of bronchospasm. Histamine release. Short duration of action
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Cisatracurium
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Lacks histamine-releasing effects therefore used in cardiovascularly unstable patients at risk of bronchospasm. More potent & slightly longer duration of action than atracurium
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Rocuronium
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Most rapid onset of non-depolarising agents
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Drug
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Dose Range
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Additional information
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Adenosine
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3mg bolus
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Rapid intravenous injection. If no response after 1-2 min, give 6mg. If no response after 1-2 min, give 12mg
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Amiodarone
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Loading dose of 300mg over 1 hour (prescribe as a STAT dose). Then start infusion of 900mg over 23 hrs
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Digoxin
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IV/PO/Enteral loading dose of 0.5-1mg in 1-2 divided doses 4-8 hours apart, dependent on response
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Maintenance dose 62.5-250 mcg/day depending on plasma levels and clinical response. Therapeutic plasma level 0.8 – 2microgram/L
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GTN IV
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0.5-10 mg/hr
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rw every 24hr due to ceiling effect
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Labetolol IV
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15-120 mg/hr
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Drug
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Dose Range
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Additional information
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Noradrenaline
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0.01 – 1 mcg/kg/min (IBW)
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>0.25mcg/kg/min – seek senior review
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Adrenaline
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0.01 – 1 mcg/kg/min (IBW)
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>0.25mcg/kg/min – seek senior review
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Dobutamine
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2.5 – 20 mcg/kg/min (IBW)
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Terlipressin
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0.05-0.2 mg/hour
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Drug
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Dose Range
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Additional information
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Aminophylline IV
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5mg/kg loading dose then 0.3-1 mg/kg/hr (IBW)
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Patients taking oral theophylline / aminophylline should not receive a loading dose. Start continuous infusion at 0.5mg/kg/hr and adjust according to plasma theophylline concentration
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Salbutamol IV
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0.18 – 1.2 mg/hr
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Epoprostenol nebulised
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5 – 20 nanograms/kg/min (ABW)
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For pulmonary hypertension or hepato-pulmonary syndrome
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Ketamine IV (Bronchospasm & asthma)
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0.5 – 2.5 mg/kg/hr (ABW)
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Dose should be maintained at the minimum amount providing adequate response; increased adverse cardiovascular effects with increased dose
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Renal function
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Drug
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Patient Weight (ABW)
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Dose
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eGFR> 30ml/min
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Enoxaparin S/C
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<50kg
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20mg OD
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50-100kg
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40mg OD
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101-150kg
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80mg OD (or 40mg BD)
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>150kg
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120mg OD (or 60mg BD)
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eGFR < 30ml/min or RRT
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Heparin S/C
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<100kg
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5000 units BD
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>100kg
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5000units TDS
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Drug
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Dose Range
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Additional information
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Metoclopramide IV
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10mg TDS (max 3-5 days)
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Avoid long-term use, due to risk of neurological side effects
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Erythromycin IV
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250mg 6hourly
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Risk of prolonged QTc syndrome – daily ECGs
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