PALS Pharmacology

Adenosine
• SVT
• 0.1 mg/kg IV/IO rapid push (max 6 mg)
• 2nd dose 0.2 mg/kg IV/IO rapid push (max 12 mg)

Albumin
• Shock, Trauma, Burns
• 0.5 to 1 g/kg (10-20 ml/kg of 5% solution) IV/IO rapid infusion

Albuterol
• Asthma, Anaphylaxis (bronchospasm), Hyperkalemia
• MDI: 4-8 puffs INH q 20 min with spacer (or ET tube if intubated)
• Nebulizer: 2.5 mg/dose (wt ,20kg) or 5 mg/dose (wt >20kg) INH q 20 min PRN
• Continuous nebulizer: 0.5 mg/kg/hr INH (max 20mg/h)

Alprostadil (PGE1)
• Ductal-dependent Congenital Heart Disease (all forms)
• 0.05-0.1 µg/kg/min IV/IO infusion initially, then 0.01-0.05 µg/kg/min IV/IO

Amiodarone
• SVT, VT (with pulses)
• 5 mg/kg IV/IO load over 20-60 min (max 300 mg), repeat to daily max 15 mg/kg (or 2.2 g)
• Pulseless Arrest (VF, PEA, pulseless VT)
• 5 mg/kg IV/IO bolus (max 300mg), repeat to daily max 15 mg/kg (or 2.2 g)

Atropine Sulfate
• Bradycardia (symptomatic)
• 0.02 mg/kg IV/Io (min dose 0.1 mg, max single dose child 0.5 mg, max single dose adolescent 1.0 mg)
• May repeat dose once, max total dose child 1.0 mg, max total dose adolescent 2.0 mg
• 0.04 to 0.06 mg/kg ET
• Toxins/Overdose (eg. Organophosphates, carbamate)
• 0.02-0.05 mg/kg (<12 yrs) or 0.05 mg/kg (>12 yrs) IV/IO initially
• Repeat q 20-30 min until atropine effect is observed (dry mouth, tachycardia, mydriasis) or symptoms reverse.

Calcium Chloride 10%
• Hypocalcemia, Hyperkalemia, Hypermagnesium, Calcium Chanel Blocker Overdose
• 20 mg/kg (0.2 mL/kg) IV/IO slow push during arrest or if severe hypotension, repeat PRN

Dexamethasone
• Croup
• 0.6 mg/kg PO/IM/IV (max 16 mg)

Dextrose (glucose)
• Hypoglycemia
• 0.5-1 g/kg IV/IO (D25W 2-4 ml/kg; D10W 5-10 ml/kg)

Diphenhydramine
• Anaphylactic Shock
• 1-2 mg/kg IV/IO/IM q 4-6 hr (max 50 mg)

Dobutamine
• Congestive Heart Failure, Cardiogenic Shock
• 2-20 µg/kg/min IV/IO infusion.
• Titrate to desired effect

Dopamine
• Cardiogenic Shock, Distributive Shock
• 2-20 µg/kg/min IV/IO infusion
• Titrate to desire effect

Epinephrine
(indications)
Pulseless arrest
bradycardia (symptomatic)
hypotensive shock
anaphylaxis
asthma
Croup
Toxins/Overdose (beta-adrenergic blockers, calcium channel blockers)

Epinephrine (pulseless arrest, symptomatic bradycardia)
• 0.01 mg/kg (0.1 ml/kg) 1:10,000 IV/IO q 3-5 min (max 1mg, 1 ml)
• 0.1 mg/kg (0.1 ml/kg) 1:10,000 ET q 3-5 min

Epinephrine (Hypotensive shock)
• 0.1-1 µg/kg/min IV/IO infusion (consider higher doses if needed)

Epinephrine (anaphylaxis)
• 0.01 mg/kg (0.01 ml/kg) 1:10,000 IM in thigh q 15 min PRN (max 0.5 mg)
• Auto-injector 0.3 mg (wt ≥30 kg) IM or Child Jr auto-injector 0.15 mg (wt 10-30 kg) IM
• 0.01 mg/kg (0.1 ml/kg) 1:10,000 IV/IO q 3-5 min (max 1 mg) if hypotension
• 0.1-1 µg/kg/min IV/IO infusion if hypotension despite fluids and IM injection

Epinephrine (asthma)
• 0.01 mg/kg (0.01 ml/kg) 1:1,000 SQ q 15 min (max 0.5 mg; 0.5 ml)

Epinephrine (Croup)
• 0.25-0.5 ml racemic solution (2.25%) mixed in 3ml NS INH

Epinephrine (Toxins, Overdose)
• 0.01 mg/kg (0.1 ml/kg) 1:10,000 IV/IO (max 1 mg); if no response consider higher doses up to 0.1 mg/kg (0.1 ml/kg) 1:1,000 IV/IO
• 0.1-1 µg/kg/min IV/IO infusion (consider higher doses)

Furosemide
• Pulmonary Edema, Fluid Overload
• 1 mg/kg IV/IM (usual max 20 mg if not chronically on loop diuretic)

Inamrinone
• Myocardial dysfunction and Increased SVR/PVR
• Loading dose: 0.75-1 mg/kg IV/IO slow bolus over 5 min (may repeat twice to max 3 mg/kg), then 5-10 µg/kg/min IV/IO infusion

Ipratropium Bromide
• Asthma
• 250-500 µg INH q 20 min PRN x 3 doses

Lidocaine
• VF/Pulseless VT, Wide complex Tachycardia (with pulses)
• 1 mg/kg IV/IO bolus
• Maintenance: 20-50 µg/kg/min IV/IO infusion (repeat bolus dose if infusion initiated >15 min after initial dose
• 2-3 mg/kg ET

Magnesium sulfate
• Asthma (refractory status asthmaticus), Torsade de Pointe, Hypomagnesemia
• 25-50 mg/kg IV/IO bolus (pulseless VT)
• over 10-20 min (VT with pulses)
• slow infusion over 15-30 min (status asthmaticus)
• Max 2 g

Methylprednisone
• Asthma (status asthmaticus), Anaphylactic shock
• Load: 2 mg/kg IV/IO/IM (max 80 mg); use acetate salt IM
• Maintenance: 0.5 mg/kg IV/IO q 6 hrs (max 120 mg/d)

Milrinone
• Myocardial Dysfunction and increased SVR/PVR
• Loading dose: 50-75 µg/kg IV/IO over 10-60 min followed by 0.5-0.75 µg/kg/min IV/IO infusion

Naloxone
• Narcotic (opiate) Reversal
• Total reversal required (for narcotic toxicity secondary to overdose): 0.1 mg/kg IV/IO/IM/SQ bolus q 2 min PRN (max 2 mg)
• Total reversal not required (eg., for respiratory depression associated with therapeutic narcotic use): 1-5 µg/kg IV/IO/IM/SQ; titrate to desired effect
• Maintain reversal: 0.002-0.16 mg/kg/hr IV/IO infusion

Nitroglyceron
• CHF, Cardiogenic shock
• 0.25-0.5 µg/kg/min IV/IO infusion, may increase by 0.5-1 µg/kg/min q 3-5 min PRN to 1-5 µg/kg/min (max 10 µg/kg/min)
• Adolescents: 10-20 µg/min, increase by 5-10 µg/min every 5-10 min PRN to 200 µg max

Norepinephrine
• Hypotensive (usu distributive) Shock (eg., low SVR and fluid refractory)
• 0.1-2 µg/kg/min IV/IO infusion, titrate to desire effect.

Procainimide
• SVT, A-flutter, VT (with pulses)
• 15 mg/kg IV/IO load over 30-60 min (do not use routinely with amiodarone)

Sodium Bicarbonate
• Metabolic Acidosis (severe), Hyperkalemia
• 1mEq/kg IV/IO slow bolus
• Sodium Channel blocker Overdose (eg. Tricyclic anti-depressant)
• 1-2 mEq/kg IV/IO bolus until serum pH is >7.45 (7.5-7.55 for severe overdose) followed by IV/IO infusion of 150 mEq NaCHO3/L solution to maintain alkalosis

Sodium nitroprusside
• Cardiogenic Shock (eg., associated with high SVR), Severe Hypertension
• 1-8 µm/kg/min (wt <40 kg) OR 0.1-5 µg/kg/min (wt >40kg) IV/IO infusion

Terbutaline
• Asthma (status asthmaticus), Hyperkalemia
• 0.1-10 µg/kg/min IV/IO infusion; consider 10 µg/kg IV/IO load over 5 min
• 10 µg/kg SQ q 10-15 min until IV/IO infusion is initiated (max 0.4 mg)

Hydrocortisone
• Adrenal Insufficiency
• 2 mg/kg IV blous (max 100 mg)

Oxygen
• Hypoxia, Hypoxemia, Shock, Trauma, Cardiopulmonary Failure, Cardiac Arrest
• Adminester 100% O2 via high-flow O2 delivery system (if spontaneous ventilations) or ET (if intubated); titrate to desire effect.

Epinephrine Classification Sympathomimetic, sympathetic agonist, catecholamine, antidysrhythmic, vasopressor, inotropic agent, bronchodilator Epinephrine Mechanism of Action Acts directly on Alpha & Beta receptors of the Sympathetic Nervous system. Beta effects are more profound than Alpha effects. Effects include: -Increased HR (chronotropy) …

ADENOSINE indications for use *First drug for most forms of stable narrow complex SVT. *Effective in terminating those due to reentry involving AV node or sinus node. AMIODARONE indications for use *VF/pulseless VT unresponsive to shock delivery, CPR, and a …

Adenosine – Indications – First drug for most forms of stable narrow-complex SVT – Effective in terminating reentry involving AV node/sinus node – Narrow-complex reentry tachycardia while prepping for cardioversion – Wide-complex tachycardia, thought to be reentry SVT – Doesn’t …

1. A drug, given as a 100-mg single dose, results in a peak plasma concentration of 20 μg/mL. The apparent volume of distribution is (assume a rapid distribution and negligible elimination prior to measuring the peak plasma level): A. 0.5 …

What Medications Have Weight Based doses for adults? Doses? Diltiazem – 0.25mg/kg Slow IVP, repeat in 15min @ 0.35mg/kg slow ivp Lidocaine – Cardiac Arrest – 1-1.5mg/kg IVP, repeat at half q 5min max 3mg, single dose of 1.5mg/kg of …

VF/ pulseless VT drugs Epinephrine IV/IO (1mg q3-5min) Vasopressin IV/IO (40u can replace first or second dose of EPI Amiodarone IV/IO (First dose: 300mg bolus. 2nd dose: 150mg) Asystole/PEA drugs Epinephrine IV/IO (1mg q3-5min) Vasopressin IV/IO (40u can replace first …

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