Commonly Used Medications in PALS

Drug

Classification

Indications

Dose/Administration

Possible Side effects

Considerations

Adenosine Antiarrhythmic SVT 1st dose = 0.1 mg/kg rapid IV push to max of 6 mg.

 

2nd dose = 0.2 mg/kg rapid IV push to max of 12 mg.

Dizziness, headache, metallic taste, shortness of breath, hypotension, slow or fast heart rate, nausea, flushing, sweating Cardiac monitoring during administration; administer through central line if available; flush with saline following administration
Amiodarone Antiarrhythmic SVT; VT with pulses; VF; VT without pulse SVT or VT with pulse 5mg/kg load over 20-60 minutes to 300 mg max

 

VF or VT without pulse: 5mg/kg rapid bolus to 300 mg max

Headache; dizziness; tremors; syncope; hypotension; bradycardia; CHF; nausea, vomiting, diarrhea; rash; skin discoloration; hair loss; flushing; coagulation problems Monitor ECG and blood pressure

 

Use with caution in patients with a perfusing rhythm, hepatic failure.

 

Contraindicated for 2nd or 3rd degree heart block

Atropine Anticholinergic Symptomatic bradycardia; toxins and overdoses Bradycardia: 0.02 mg/kg IV with 0.5 mg max dose; may repeat one time; By ETT: 0.04-0.06 mg/kgToxins/overdose: 0.02-0.05 mg/kg repeated every 20-30 minutes until symptoms reverse Headache; dizziness; confusion; anxiety; flushing; visual difficulties; pupil dilation; dry mouth; tachycardia; high or low blood pressure; nausea; vomiting; constipation; urinary retention; painful urination; rash; dry skin Monitor ECG, oxygen, and BP; Administer before intubation if bradycardic;Contraindicated in glaucoma and tachyarrhythmias
Epinephrine Catecholamine Vasopressor, Inotrope Anaphylaxis; Asthma; symptomatic bradycardia; croup; shock; cardiac arrest; toxins or overdose Anaphylaxis: 0.01 mg/kg every 15 min to max of 0.3mg

 

Asthma: (1:1000) 0.01 mg/kg subcutaneous every 15 minutes to max 0.3 mg

 

Symptomatic bradycardia; 0.01 mg/kg IV every 3-5 minutes to max dose of 1 mg

 

Croup: 0.25 ml Racemic epi solution via nebulizer Cardiac arrest: 0.01 mg/kg (1:10000) IV or 0.1 mg/kg (1:1000) per ETT every 3 to 5 minutes   Shock: 0.1 to 1 mcg/kg per minute IV infusion   Toxins/ODs: 0.01 mg/kg (1:10000) IV to max dose of 1 mg

Tremors; anxiety; headaches; dizziness; confusion; hallucinations; dyspnea; SVT; VT; palpitations; hypertension; nausea; vomiting; hyperglycemia; hypokalemia; vasoconstriction Available in 1:1000 and 1:10000 concentrations so the team must be aware of which concentration is being used; Monitor BP, oxygen, and ECG; Give via central line if possible; Do not give in cocaine induced ventricular tachycardia

Drug

Classification

Indications

Dose/Administration

Possible Side effects

Considerations

Oxygen Elemental gas Hypoxia; Respiratory distress or failure; shock; trauma; cardiac arrest In resuscitation, administer at 100% via high flow system and titrate to response to maintain oxygen saturation > 94% Headache; dry nose, mouth; airway obstruction if secretions become dry Monitor oxygen saturation;Insufficient flow rates may cause carbon dioxide retention
Albumin Plasma volume expander Shock, trauma, burns 0.5 to 1 g/kg by rapid infusion Fluid overload; increased respiratory rate; flushing; rash; hypocalcemia Use within 4 hours of opening vial
Albuterol Bronchodilator Asthma, bronchospasm, hyperkalemia 2.5 mg if weight< 20kg5 mg if weight >20 kg Tremors; anxiety; headaches; bad taste; dry nose/throat; dyspnea; wheezing; tachycardia; hypotension; nausea; vomiting; flushing Should not be used with tachyarrhythmias
Alprostadil Prostaglandin vasodilator Maintain patency of ductus arteriosis in congenital heart disease Initial 0.05 to 0.1 mcg/kg/min

 

Maintenance 0.01 to 0.05 mcg/kg/min

Seizures; apnea; vasodilation; hypotension; bradycardia; cardiac arrest; diarrhea; renal failure; flushing; hypoglycemia; DIC; hypocalcemia; fever May cause tissue sloughing; should be refrigerated until administered.
Calcium chloride Electrolyte Hypocalcemia; hyperkalemia; consider for calcium channel blocker overdose In cardiac arrest: 20 mg/kg IV bolus into central line

 

In non-arrest: infuse over 30-60 min

Hypotension; cardiac arrhythmias; cardiac arrest; burn or sclerosis of peripheral veins; hypercalcemia Monitor ECG and BP

 

Contraindicated in digitoxicity or hypercalcemia; flush IV tubing before and after administration

Dexamethasone Corticosteroid Croup; asthma 0.6mg/kg for one dose (max dose 16 mg) Headache; insomnia; seizures; psychosis; visual difficulties; hypertension; edema; tachycardia; osteoporosis; diarrhea; nausea; GI bleeding; flushing; sweating; poor wound healing; hyperglycemia; sodium and fluid retention; hemorrhage; hypokalemia Can be given PO, IM or IV
Dextrose Carbohydrate Hypoglycemia 0.5 to 1 g/kg Sclerosis of veins; hyperglycemia Do not administer during resuscitation unless hypoglycemia is documented; use point of care glucose monitoring

 

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