Makindo Medical Notes

🧪 MOA: Replenishes glutathione stores, serves as a glutathione substitute, and enhances sulfate conjugation of acetaminophen (paracetamol).

💉 Dose IV: 150 mg/kg in 200 mL D5W over 1 hr, then 50 mg/kg in 500 mL D5W over 4 hrs, then 100 mg/kg in 1 L D5W over 16 hrs (21 total hrs; may need continuous LFTs and APAP level until liver enzymes normalise).

💊 Dose PO: 140 mg/kg ×1, then 70 mg/kg every 4h ×17 doses (72 hrs total).

🎯 Indication: Paracetamol overdose.

⚠️ Notes: Hypersensitivity reactions (consider switching to PO or slowing infusion). Can occur with PO. Pregnancy B.

🧪 MOA: Acts on A1 receptors in AV node, causing transient AV block.

💉 Dose IV: 6 mg rapid IV push; if no effect, 12 mg IV every 2 min ×2.

🎯 Indication: Stable SVT / stable narrow‑complex tachycardia.

⚠️ Notes: Avoid in pre‑existing 2nd/3rd‑degree AV block without pacing; can be pro‑arrhythmic. Pregnancy C.

🧪 MOA: Selective β2‑agonist.

💨 Dose Neb: 2.5–5 mg every 20 min for 1st hour, then 2.5–10 mg every 1–4 hrs PRN (alt: 10–15 mg over 1 hr).

🎯 Indication: Acute bronchospasm; hyperkalaemia.

⚠️ Notes: Hypokalaemia, tachycardia, hyperglycaemia. Pregnancy C.

🧪 MOA: Class III (K⁺ efflux blocker) with Class I/II/IV effects.

💉 Dose IV: Pulseless VF/VT: 300 mg IV push, then 150 mg IV push if needed. Stable wide‑complex tachy: 150 mg IV over 10 min, then 1 mg/min ×6 hrs, then 0.5 mg/min.

🎯 Indication: Pulseless VT/VF; wide‑complex tachyarrhythmias.

⚠️ Notes: Hypotension; pro‑arrhythmic risk. Pregnancy D.

🧪 MOA: Antimuscarinic (anticholinergic).

💉 Dose IV: OP/carbamate toxicity: 1–6 mg every 3–5 min PRN until secretions stop. Bradycardia (adult): 0.5 mg every 3–5 min (max 3 mg).

🎯 Indication: OP/carbamate poisoning; bradycardia.

⚠️ Notes: Avoid in hyperthermia and tachyarrhythmias. Pregnancy C.

🧪 MOA: Increases serum calcium; stabilises cardiac myocytes.

💉 Dose IV: 10% solution (1 g per 10 mL).

🎯 Indication: Hyperkalaemia; hypocalcaemia with dysrhythmia.

⚠️ Notes: CaCl more potent than gluconate; CaCl peripherally → severe phlebitis (prefer CVC). Pregnancy C.

🧪 MOA: Enhances GABAergic inhibition.

💉 Dose IV/IM: 2–10 mg every 6h PRN. 💊 PO: 2–10 mg every 6h PRN.

🎯 Indication: Seizure abortion; alcohol withdrawal; agitation; muscle spasm.

⚠️ Notes: Respiratory depression; hypotension. Pregnancy D.

🧪 MOA: Non‑DHP Ca²⁺ channel blocker; slows AV conduction.

💉 Dose IV: 0.25 mg/kg once; may repeat 0.35 mg/kg after 15 min; infusion 5–15 mg/hr.

🎯 Indication: AF with RVR; stable SVT.

⚠️ Notes: Hypotension; bradycardia. Pregnancy C.

🧪 MOA: β1 > β2 agonist.

💉 Dose IV: 2–20 mcg/kg/min.

🎯 Indication: Decompensated HF; refractory hypotension.

⚠️ Notes: Tachycardia; hypotension if hypovolaemic; PVCs. Pregnancy B.

🧪 MOA: α1, β1, dopaminergic agonist (dose dependent).

💉 Dose IV: <5 mcg/kg/min = dopaminergic; 5–10 = β; 10–20 = α.

🎯 Indication: Decompensated HF; hypotension.

⚠️ Notes: Tachyarrhythmias; tissue necrosis if extravasation (prefer CVC). Pregnancy C.

🧪 MOA: Dopamine antagonist / α‑antagonist.

💉 Dose IV: 1.25–2.5 mg every 4h PRN.

🎯 Indication: Antiemetic; migraine abortion.

⚠️ Notes: QT prolongation (torsades risk); NMS; EPS. Pregnancy C.

🧪 MOA: α/β agonist.

💉 Dose: ACLS: 1 mg 1:10,000 IV (PALS: 0.01 mg/kg). Anaphylaxis: 0.1–0.5 mg 1:1,000 IM. Hypotension: 1–10 mcg/min IV.

🎯 Indication: Anaphylaxis; cardiac arrest algorithms; severe asthma.

⚠️ Notes: Dosing errors; tissue necrosis; arrhythmias. Pregnancy C.

🧪 MOA: Potentiates ATIII; inhibits Xa > IIa.

💉 Dose SQ: 1 mg/kg every 12h or 1.5 mg/kg every 24h.

🎯 Indication: PE; NSTEMI; unstable angina.

⚠️ Notes: Monitor anti‑Xa if renal impairment/obesity; neuraxial procedures contraindicated. Pregnancy B.

🧪 MOA: Selective β1‑blocker.

💉 Dose IV: 500 mcg/kg load; 50–300 mcg/kg/min infusion.

🎯 Indication: Aortic dissection.

⚠️ Notes: May precipitate CHF; hypotension; bronchospasm. Pregnancy C.

🧪 MOA: PPI (H⁺/K⁺ ATPase inhibitor).

💉 Dose IV: 80 mg bolus then 8 mg/hr infusion.

🎯 Indication: Non‑variceal upper GI bleed.

⚠️ Notes: Generally well tolerated acutely. Pregnancy B.

🧪 MOA: GABA‑mimetic hypnosis.

💉 Dose IV: 0.3 mg/kg.

🎯 Indication: RSI induction.

⚠️ Notes: Possible adrenal suppression; lowers seizure threshold. Pregnancy C.

🧪 MOA: Opioid μ‑agonist.

💉 Dose IV: 25–100 mcg every 1–2h (~1 mcg/kg).

🎯 Indication: Analgesia; sedation adjunct.

⚠️ Notes: Respiratory depression; hypotension (vasodilation); laryngospasm. Pregnancy C.

🧪 MOA: Alcohol dehydrogenase inhibitor.

💉 Dose IV: 15 mg/kg load; then 10 mg/kg every 12h ×4; then 15 mg/kg every 12h until EG <20 mg/dL and asymptomatic with normal pH.

🎯 Indication: Methanol / ethylene glycol toxicity.

⚠️ Notes: Generally safe. Pregnancy C.

🧪 MOA: Voltage‑gated Na⁺ channel stabiliser.

💉 Dose IV: 15–20 mg/kg load at 150 mg/min.

🎯 Indication: Status epilepticus.

⚠️ Notes: Rapid admin → hypotension/arrhythmias; cardiac monitoring required. Pregnancy D.

🧪 MOA: Loop diuretic (Na⁺/Cl⁻ reabsorption inhibition).

💉 Dose IV: 20–40 mg initially; reassess; up to 200 mg single dose.

🎯 Indication: Pulmonary oedema; CHF exacerbation; hyperkalaemia (if diuresis).

⚠️ Notes: Volume depletion; hypokalaemia; metabolic alkalosis; ototoxicity. Pregnancy C.

🧪 MOA: ↑cAMP independent of β‑receptor; gluconeogenesis & glycogenolysis.

💉 Dose IV/IM/SQ: β‑blocker/CCB tox: 3–10 mg load then 1–10 mg/hr. Hypoglycaemia: 1 mg.

🎯 Indication: β‑blocker or CCB toxicity; hypoglycaemia.

⚠️ Notes: Anaphylactoid reactions; hypotension; emesis (aspiration risk). Pregnancy B.

🧪 MOA: Dopamine (D1/D2) antagonist.

💉 Dose PO/IM/IV: 5–10 mg every 2h (max 100 mg/day). Elderly: start 1 mg IM.

🎯 Indication: Agitation; psychosis.

⚠️ Notes: Dementia‑psychosis warning; NMS/EPS; QT prolongation. Pregnancy C.

🧪 MOA: Potentiates ATIII; inhibits thrombin and factors IX, X, XI, XII.

💉 Dose IV: VTE: 80 u/kg bolus then 18 u/kg/hr. ACS/AF: 60 u/kg bolus then 12 u/kg/hr.

🎯 Indication: VTE; ACS (LMWH preferred in NSTEMI).

⚠️ Notes: Bleeding risk; protamine reverses. Pregnancy C.

🧪 MOA: Glucocorticoid/mineralocorticoid effects.

💉 Dose IV: Adrenal crisis: 100 mg bolus then 50 mg every 6h ×24h then taper. Septic shock: 50 mg every 6h. Status asthmaticus: 1–2 mg/kg every 6h ×24h then maintenance.

🎯 Indication: Adrenal insufficiency; severe asthma; vasopressor‑refractory shock.

⚠️ Notes: Immunosuppression; hyperglycaemia. Pregnancy C.

🧪 MOA: Opioid μ‑agonist.

💉 Dose IV: 1–2 mg every 3–6h.

🎯 Indication: Analgesia.

⚠️ Notes: Respiratory depression; hypotension. 1 mg IV ≈ 7 mg IV morphine. Pregnancy C.

🧪 MOA: ↑Peripheral glucose uptake; shifts K⁺ intracellularly.

💉 Dose IV: HyperK: 5–10 units once. CCB OD: 1 u/kg bolus + 25 g dextrose if BG <250; then 0.1–1 u/kg/hr with dextrose to maintain BG 100–200 mg/dL. DKA/HHS: 0.1 u/kg bolus + 0.1 u/kg/hr infusion.

🎯 Indication: Hyperkalaemia; CCB overdose; DKA/HHS.

⚠️ Notes: Hypokalaemia; hypoglycaemia. Only regular insulin IV. Pregnancy B.

🧪 MOA: NMDA receptor antagonist.

💉 Dose IV: Analgesia (sub‑dissociative): 0.1–0.5 mg/kg. Procedural: 0.5–1 mg/kg. RSI: 2 mg/kg.

🎯 Indication: Analgesia; procedural sedation; RSI induction.

⚠️ Notes: Emergence reactions (treat with benzo); laryngospasm; ↑IOP/↑ICP; tachycardia; hypertension. Pregnancy D.

🧪 MOA: α1/β1/β2 antagonist.

💉 Dose IV: Bolus 20–80 mg every 10 min PRN; infusion 1–8 mg/min.

🎯 Indication: Hypertensive emergency.

⚠️ Notes: CHF exacerbation; bradycardia; bronchospasm. Pregnancy C.

🧪 MOA: Enhances GABAergic inhibition.

💉 Dose IV: Bolus 1–2 mg; infusion 1–10 mg/hr.

🎯 Indication: Delirium tremens; status epilepticus; serotonin syndrome; agitation.

⚠️ Notes: Respiratory depression; hypotension. Pregnancy D.

🧪 MOA: Modulates neuromuscular and cardiac excitability.

💉 Dose IV: Eclampsia: 2–4 g over 5 min. Torsades: 2 g push. Asthma: 2 g over 15 min.

🎯 Indication: Torsades/ventricular arrhythmias; status asthmaticus; eclampsia.

⚠️ Notes: Hypotension; respiratory depression. Pregnancy A.

🧪 MOA: Osmotic diuretic.

💉 Dose IV: 1 g/kg once.

🎯 Indication: Elevated ICP; impending herniation.

⚠️ Notes: Dehydration risk; osmotic nephrosis.

🧪 MOA: Ultra‑short‑acting barbiturate (sedation/hypnosis).

💉 Dose IV: 1 mg/kg, then 0.5 mg/kg every 2–5 min PRN.

🎯 Indication: Procedural sedation.

⚠️ Notes: Laryngospasm (treat with more methohexital); respiratory depression; hypotension. Pregnancy B.

🧪 MOA: Glucocorticoid/mineralocorticoid effects.

💉 Dose IV: Asthma: 1 mg/kg. Allergy: 1 mg/kg. PCP PNA: 30 mg IV BID ×5 days then taper.

🎯 Indication: Severe asthma; PCP pneumonia with A–a gradient >35 or PaO2 <70; acute hypersensitivity reaction.

⚠️ Notes: Immunosuppression; hyperglycaemia. Pregnancy C.

🧪 MOA: Dopamine antagonist in chemoreceptor trigger zone.

💉 Dose IV: 10 mg every 6h PRN.

🎯 Indication: Vomiting prevention and treatment.

⚠️ Notes: Tardive dyskinesia/EPS; dystonia; methaemoglobinaemia. Pregnancy B.

🧪 MOA: Benzodiazepine; GABA potentiation.

💉 Dose IV: RSI: 0.1 mg/kg. Infusion: 1–10 mg/hr. Procedural: 0.02–0.04 mg/kg.

🎯 Indication: Seizure abortion; procedural/ventilator sedation; RSI.

⚠️ Notes: Respiratory depression; hypotension. Pregnancy D.

🧪 MOA: Opioid μ‑agonist.

💉 Dose IV: 2–10 mg every 2–6h (~0.1 mg/kg).

🎯 Indication: Analgesia.

⚠️ Notes: Respiratory depression; hypotension (vasodilation). Pregnancy C.

🧪 MOA: Dihydropyridine Ca²⁺ blocker selective for cerebral arteries.

💊 Dose PO: 60 mg every 4h.

🎯 Indication: Subarachnoid haemorrhage.

⚠️ Notes: Hypotension (minimised by selectivity). Pregnancy C.

🧪 MOA: Venodilator; ↑cGMP.

💉 Dose IV: 5–200 mcg/min; increase by 10 mcg every 3–5 min to effect (often higher for pulmonary oedema).

🎯 Indication: CHF; angina.

⚠️ Notes: Hypotension; methaemoglobinaemia. Pregnancy C.

🧪 MOA: Direct vasodilator; NO donor.

💉 Dose IV: Start 0.3 mcg/kg/min; titrate to effect; max 10 mcg/kg/min.

🎯 Indication: Hypertensive emergency.

⚠️ Notes: Cyanide toxicity; methaemoglobinaemia; hypotension. Pregnancy C.

🧪 MOA: α1 > β1 agonist.

💉 Dose IV: 1–30 mcg/min.

🎯 Indication: Hypotension refractory to IV fluids.

⚠️ Notes: Tachyarrhythmias; tissue necrosis if extravasation (prefer CVC). Pregnancy C.

🧪 MOA: Splanchnic vasoconstriction; ↓ portal pressure.

💉 Dose IV/SQ: Variceal bleed: 50 mcg IV bolus, then 50 mcg/hr infusion. Sulfonylurea tox: 50 mcg SQ every 6h PRN.

🎯 Indication: Bleeding oesophageal varices; sulfonylurea toxicity.

⚠️ Notes: May precipitate biliary disease. Pregnancy B.

🧪 MOA: Antagonist at dopamine, histamine, α1, and 5‑HT2 receptors.

💉 Dose IM: 5–10 mg/day (max 30 mg/day). 💊 ODT: 5–10 mg/day (max 30 mg/day).

🎯 Indication: Agitation; psychosis.

⚠️ Notes: Not for dementia‑related psychosis; NMS/EPS; orthostatic hypotension; QT prolongation; no IV form. Pregnancy C.

🧪 MOA: 5‑HT3 receptor antagonist (central).

💉 Dose IV: 4–8 mg every 4–6h PRN.

🎯 Indication: Nausea/vomiting prevention and treatment.

⚠️ Notes: QT prolongation; torsades (rare). Pregnancy B.

🧪 MOA: Barbiturate causing sedation/hypnosis.

💉 Dose IV: 20 mg/kg once; may repeat 5–10 mg/kg in 20 min (max 30 mg/kg). Max infusion 50 mg/min.

🎯 Indication: Status epilepticus.

⚠️ Notes: Respiratory depression; hypotension. Pregnancy D.

🧪 MOA: Various glucocorticoid/mineralocorticoid effects.

💊 Dose PO: 1 mg/kg/day (usual 5–60 mg based on response).

🎯 Indication: Asthma exacerbation; PCP pneumonia (A–a >35 or PaO2 <70); allergic reaction.

⚠️ Notes: Immunosuppression; GI ulcer/perforation; hyperglycaemia. Pregnancy C.

🧪 MOA: GABA_A agonist; Na⁺ channel blocker.

💉 Dose IV: Procedural: 1 mg/kg bolus, then 0.5 mg/kg every 3 min; RSI: 1.5–2.5 mg/kg; Vent sedation: 5–50 mcg/kg/min.

🎯 Indication: Procedural sedation; RSI induction; ventilator sedation.

⚠️ Notes: Hypotension; anaphylaxis; bradycardia; apnoea. Pregnancy B.

🧪 MOA: Ionically binds heparin.

💉 Dose IV: 1 mg neutralises 100 u heparin (max 50 mg) at 5 mg/min.

🎯 Indication: Heparin‑induced bleeding.

⚠️ Notes: Anaphylaxis (history of prior use/fish allergy); rapid infusion → hypotension. Pregnancy C.

🧪 MOA: Non‑depolarisng neuromuscular blocker.

💉 Dose IV: 1 mg/kg.

🎯 Indication: RSI paralysis.

⚠️ Notes: Prolonged paralysis. Pregnancy B.

🧪 MOA: Increases serum bicarbonate; increases buffer stores.

💉 Dose IV: HyperK/metabolic acidosis: 50 mEq once. TCA OD: 1–2 mEq/kg bolus. Salicylate tox: 3 amps (150 mEq) in 1 L D5W; bolus then infusion to maintain urine pH 7.5–8.

🎯 Indication: Hyperkalaemia; TCA toxicity; salicylate toxicity; metabolic acidosis.

⚠️ Notes: Caution in CHF; risk of metabolic alkalosis/hypernatraemia. Pregnancy C.

🧪 MOA: Depolarising neuromuscular blocker.

💉 Dose: 1.5 mg/kg IV (or 3–4 mg/kg IM).

🎯 Indication: RSI paralysis.

⚠️ Notes: Hyperkalaemia risk; subacute burn/crush injury (↑K); glaucoma (↑IOP); ↑ICP. Pregnancy C.