1. IV Infusion Drugs ACLS Drugs
Steven Wright, MSN, RN
Coordinator, Education/Cardiac Rehab
South Baldwin Regional Medical Center

2. Objectives
Determine the indications for use of various intravenous drugs
Be familiar with mixing and infusion parameters for each drug
Identify precautions and contraindications of each drug
Review nursing considerations for IV drug infusion

3. AMIODARONE (Cordarone) Antiarrhythmic
Dose
Bolus: 150 mg over 10 min
Drip: 1 mg/min x 6 hrs, then 0.5 mg/min x 18 hrs
ACLS Dose
300 mg IVP, 150 mg IVP
Mix
Bolus: 150 mg in 100 ml D5W
Drip: 900 mg in 500 ml D5W in glass container
1.8 mg/ml
Use vented tubing for infusion

4. Diltiazem (Cardizem) A-fib/A-flutter rate control
Dose
Bolus: 0.25 mg/kg over 2 min
Typical mg bolus
Drip: 5-15 mg/hr
Mix
125 mg in 100 ml D5W, LR, D5 ½ NS
1 mg/ml

5. Dobutamine (Dobutrex) Heart Failure
Dose
2-20 mcg/kg/min
Mix
500 mg in 250 ml of NS, D5W, LR, D5 ½ NS
2000 mcg/ml

6. Dopamine (Intropin) Heart Failure/Renal Insufficiency
Dose
Renal: 1-3 mcg/kg/min
Inotropic: 3-10 mcg/kg/min
Vasopressor: mcg/kg/min
Mix
400 mg in 250 ml of NS, D5W, LR, D5 ½ NS
1600 mcg/ml

7. Eptifibatide (Integrilin) Platelet aggregation inhibitor
Dose
Bolus: 180 mcg/kg
For PCI give 180 mcg/kg bolus 10 min after first
Drip:
Creatinine <2 mg/dl infuse at 2 mckg/kg/min
Creatinine 2-4 mg/dl infuse at 1 mcg/kg/min
Mix
Infuse undiluted directly from 100 ml vial

8. Epinephrine (Adrenaline) Hypotension
Dose
2-10 mcg/min
ACLS Dose
1 mg IVP every 3-5 min
Mix
4 mg in 250 ml D5W
16 mcg/ml

9. Esmolol (BreviBloc) Hypertension/a-fib, flutter rate control
Dose
Bolus: 500 mcg/kg over 1 min
Drip: mcg/kg/min
ACLS dose
500 mcg/kg over 1 min, then 4 min infusion at 50 mcg/kg/min. Max 4 min dose 200 mcg/kg
Mix
2.5 GM in 250 ml NS, D5W, D5 ½ NS
10,000 mcg/ml

10. Furosimide (Lasix) Acute pulmonary edema
Dose
1-4 mg/min
ACLS dose
0.5-2 mg/kg over 1-2 min
Mix
200 mg in 100 ml D5W, NS, LR
2 mg/ml

11. Heparin Anticoagulation
Dose
Bolus: 80 units/kg
Drip: 18 units/kg/hr
Adjust as needed per protocol
Mix
10,000 units in 250 ml D5W, NS
40 units/ml
10,000 units in 100 ml for fluid restricted patient
100 units/ml

12. Isoproterenol (Isuprel) Bradycardia
Dose
1-10 mcg/min
Mix
1 mg in 250 ml D5W
4 mcg/ml

13. Labetalol (Normodyne, Trandate) Hypertension
Dose
2-6 mg/min
Mix
500 mg in 150 ml D5W, LR
Results in 250 ml of solution
2 mg/ml

14. Lidocaine Anti arrhythmic
Dose
1-4 mg/min
ACLS Dose
VF/VT
1-1.5 mg/kg repeat 5 to 10 min to max dose of 3 mg/kg
Stable VT, wide complex tachycardia
mg/kg repeat 5 to 10 min to max dose of 3 mg/kg
Mix
1 GM in 250 ml NS, D5W
4 mg/ml

15. Milrinone (Primacor) Heart Failure
Dose
Bolus: 50 mcg/kg over 10 min
Drip: mcg/kg/min
Mix
50 mg in 250 ml D5W, NS, LR
200 mcg/ml
20 mg in 100ml D5W, NS, LR

16. Nesiritide (Natrecor) Acute decompensated heart failure
Dose
Bolus: 2 mcg/kg over 1 min
Drip: 0.01 mcg/kg min
Mix
1.5 mg in 250 ml D5W, NS, D5 ¼ NS, D5 ½ NS
6 mcg/ml

17. Nicardipine (Cardene) Hypertension/Heart Failure
Dose
5-15 mg/hr
Mix
25 mg in 250 ml D5W, NS, D5 ½ NS
0.1 mg/ml

18. Nitroglycerin Angina/vasodilator
Dose
5-200 mcg/min
Titrate to relief of chest pain
Mix
50 mg in 250 ml NS, D5W
200 mcg/ml
Mix in glass bottle only
Use vented tubing

19. Norepinephrine (Levophed) Hypotension
Dose
2-30 mcg/min
Mix
4 mg in 250 ml D5W
16 mcg/ml

20. Phenylephrine (Neo-synephrine) Hypotension
Dose
20-80 mcg/min
Mix
20 mg in 250 ml D5W
80 mcg/ml
10 mg in 250 ml D5W
40 mcg/ml

21. Procainamide (Pronestyl) Antiarrhythmic
Dose
1-4 mg/min
ACLS Dose
20-50 mg/min to total dose of 17 mg/kg
Mix
1 GM in 250 ml D5W, NS
4 mg/ml

22. Sodium Nitroprusside (Nipride) Hypertension
Dose
mcg/kg/min
Titrate to desired effect every 3-5 minutes
Mix
50 mg in 250 ml D5W, NS
200 mcg/ml
Protect from light

23. Vassopressin (Pitressin) Diabetes insipidus, GI bleeding
Dose
Diabetes insipidus: units/kg/hr
GI Bleed: units/min
ACLS Dose
40 units IVP to replace 1st or 2nd epinephrine dose
Mix
D. insipidus: 20 units in 500 ml D5W
0.04 units/ml
GI Bleed: 20 units in 100 ml D5W
0.2 units/ml

24. Part 2 Not covered in infusion drugs
ACLS Drugs
Part 2
Not covered in infusion drugs

25. ACE Inhibitors AMI afterload reducers/HTN
Enalapril
Initially 2.5 mg, titrate as needed to 20 mg BID
Captopril
mg tid as tolerated
Lisinopril
Initially 5 mg, then to 10 mg daily after 48 hours
Ramipril
2.5-5 mg BID as tolerated
Start within 24 hrs of onset for AMI, CHF w/LVEF <40%

26. Adenosine (Adenocard) PSVT conversion
6 mg rapid IVP followed by NS bolus of 20 ml
Repeat w/12 mg after 1-2 min if needed
May repeat w/12 mg after 1-2 min if needed
2010 ACLS protocol does not include third dose
Recommends cardioversion if 12 mg dose not successful
Converts PSVT to SR after brief period of asystole

27. Aspirin Inhibits platelet aggregation
Dose mg
Within minutes of onset of symptoms
Chew and swallow non-enteric coated

28. Atropine Bradycardia Dose No longer recommended for asystole/slow PEA
Bradycardia: 0.5 mg every 3-5 min
Total dose 3 mg
No longer recommended for asystole/slow PEA

29. Beta Blockers AMI to preserve LV function
Metoprolol
5 mg IV q 5 min to 15 mg total
Convert to PO at mg daily
Atenolol
5 mg slow IV, repeat in 10 minutes
Convert to PO 50 mg BID
Propranolol
0.1 mg/kg slow IVP in 3 doses at 2 min intervals
Max dose 1 mg/min
Repeat in 2 min if necessary
Carvedilol
mg PO after hemodynamically stable
Target dose is 25 mg

30. Clopidogrel (Plavix) ACS anti-platelet aggregation
Initial dose 300 mg
Then 75 mg daily for 3-9 months
At least 12 months with drug-eluting stent

31. Digoxin Atrial fib/flutter: PSVT
Dose
Initial IV: mcg/kg of lean body weight
Maintenance PO: mg daily

32. Flumazenil (Romazicon) Benzodiazopine antagonist
1st dose 0.2 mg over 15 seconds
If no adequate response give 2nd dose in 1 min
2nd dose 0.3 mg over 30 seconds
If no adequate response give 3rd dose in 1 min
3rd dose 0.5 mg over 30 seconds
If no adequate response may repeat every min
Total dose 3 mg

33. Mannitol Increased ICP
Initial dose: GM/kg over 5-10 min
Follow-up dose: GM/kg every 4-6 hr
Use in-line filter for infusion

34. Naloxone Hcl (Narcan) Opiate antagonist
Dose
0.4-2 mg
Repeat until response is adequate
6-10 mg max over 10 min
Monitor patient for return of opiate symptoms. Half life of naloxone is much less than half life of most opiates.

35. Verapamil (Calan) PSVT/Atrial fib/flutter
1st dose
2.5-5 mg over 2 minutes
2nd dose
5-10 mg
May repeat every 15 to 30 min if needed
Max dose 20 mg
Contraindicated with Tikosyn