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Patrick Barney

Most have order sets in Epic. Typically choose “Titration Allowed” in ICU

Drug Dose Receptors Indications Considerations
Norepinephrine (Levophed) 1 – 100 mcg/min αα1 > β1 1st line septic shock Peripheral ischemia, skin necrosis
Phenylephrine (Neosynephrine)

Bolus: 0.05 – 0.5 mg q 10-15 min

Infusion: 40-360 mcg/min

αα1 Periprocedural hypotension (Neostick), pts w/ tachyarrhythmias, Critical AS or HOCM with severe LVOT obstruction and shock Reflex bradycardia, Peripheral ischemia, skin necrosis
Epinephrine 1 – 40 mcg/min αα1=β1=β2 Post PEA arrest, Anaphylaxis, Septic shock (severe), Cardiogenic shock Tachy-arrhythmias, Peripheral ischemia, skin necrosis
Vasopressin 0.04 U/min (no titration) V1, V2, V3 2nd line septic shock, Right heart failure Hyponatremia, Bradycardia


needs approval from MICU leadership

20 – 40 ng/kg/min ANG II Refractory vasodilatory shock Thrombosis pt MUST have chemical DVT ppx. Contraindicated in heart failure
Dopamine 2 – 20 mcg/kg/min Dopamine (1-5 mcg) > β1 (5-10 mcg) >α1 (>10mcg) Hypotension, Cardiogenic shock Tachy-arrhythmias, peripheral ischemia, skin necrosis
Dobutamine 2.5 – 20 mcg/kg/min β1 >>> β2 Cardiogenic shock Vasodilation Hypotension, Tachycardia, Tachyphylaxis
Milrinone 0.375 – 0.75 mcg/kg/min PDE-3 Cardiogenic shock Hypotension, renally cleared
Drug Dose Class Side effects
Propofol Infusion: 5 – 150 mcg/kg/min General anesthetic (GABA R agonist)

Severe hypotension, bradycardia, hypertriglyceridemia, propofol infusion syndrome (rare)

Monitor for toxicity with q4 day TGs and CK

Dexmedetomidine (Precedex) Infusion: 0.1 – 1.5 mcg/kg/h Central αα2 agonist Hypotension, bradycardia
Midazolam (Versed)

Push: 0.5 – 5 mg

Infusion: 0.25 – 5 mg/h (no max dose)

Benzodiazepine Hypotension, risk of BNZ withdrawal if used for long periods with sudden discontinuation
Lorazepam (Ativan)

Push: 0.5 – 10 mg

Infusion: 0.5 – 5 mg/h (no max dose)

Benzodiazepine Hypotension, propylene glycol carrier - AGMA

Push: 1-2mg/kg

Infusion: 0.2mg/kg/hr, titrate by 0.1 q15min

NDMA antagonist

Delirium/hallucination – use caution in patients with psychiatric hx, hypertension, tachycardia

Pretreat with 0.4mg IV glycopyrrolate to avoid hyper-salivation

Drug Dose Side effects

Push: 25 – 100 mcg

Infusion: 25 – 400 mcg/h

Hypotension, Serotonin syndrome, chest wall rigidity at high doses

Push: 1 – 5 mg q1-2h prn

Infusion: 1 – 5 mg/h

Hypotension (profound), itching, constipation, HA; avoid in renal failure
Hydromorphone (Dilaudid)

Push: 0.25 – 1 q1-2h prn

Infusion: 0.5 – 3 mg/h

Hypotension, respiratory depression, itching
Drug Class/MOA Dose Indications Side effects Comments
Esmolol Beta blocker

Bolus: 1mg/kg over 30s

Infusion: 50-300mcg/kg/min (max 300)

Aortic dissection, HTN emergency Bradycardia, hypotension Titrate to desired BP or HR. Caution in HFrEF
Nicardipine CCB Infusion: 5-15mg/hr (max 15) HTN emergency Bradycardia, hypotension Titrate to desired BP, avoid in HFrEF
Nitroprusside Metabolized to NO vasodilatory effect (arterial roughly = venous) Infusion: 0.3mcg/kg/min; titrate q2min to max 10mcg/kg/min HTN E, flash pulmonary edema, HFrEF for afterload reduction Hypotension, cyanide toxicity Contraindicated in hepatic and renal failure
Nitroglycerin NO mediated venous > arterial vasodilation Infusion: start 0.25mcg/kg/min, titrate by 1mcg/kg/min q15min (max 10mcg/kg/min) Refractory angina, flash pulmonary edema, HTN emergency Hypotension, headache, palpitations Contraindicated in severe RHF and concurrent use of PDE-5 inhibitor
Drug Dose Indications Side effects Comments
Adenosine 6 – 12 mg IV rapid push and flush; may repeat x2 PSVT conversion Complete AV nodal blockade

10 second half-life

 Must have continuous EKG/tele monitor


ACLS: 300 mg IV push

Non-emergent: 150 mg over 10 min then 0.5 mg/min

Vtach/Vfib, Afib Pulm, ophthalmic and thyroid toxicity w/ chronic use Less hypotension than other agents, safe in heart failure. May chemically cardiovert patients, caution if off therapeutic AC

Push: 10 – 20 mg q15 min x 2 if no response

Infusion: 5 – 15 mg/h

Afib, Aflutter, PSVT Bradycardia, hypotension Avoid use in pts with HFrEF

ACLS: 1 mg/kg x 1

Infusion: 1 – 4 mg/min

Vtach Bradycardia, Heart block Avoid use in liver failure/ Okay for HFrEF. Often 1st line CCU med for VT/ May need to check levels if using for longer than 24 hours
Procainamide 15 mg/kg over 30 min then 1 – 6 mg/min Vtach, refractory afib Bradycardia, hypotension Drug-induced lupus, cytopenias

Last update: 2022-06-02 13:28:55