Dose treatment of drug extravasation

Adult: 5-10 mg diluted in 10 mL NS infiltrated into area of extravasation within 12 hrs. Ped: 0.1-0.2 mg/kg diluted in 10 mL NS infiltrated into area of extravasation within 12 hrs. Dose (diagnosis of pheochromocytoma): Children: 0.05-0.1 mg/kg/dose IV/IM, maximum single dose: 5 mg. Adult: 5 mg IV/IM. Dose (surgery for pheochromocytoma: hypertension):

Adult: 5 mg IV/IM given 1-2 hrs before procedure, repeat prn q2-3 hrs.

Children: 0.05-0.1 mg/kg/dose IV/IM given 1-2 hrs before procedure, repeat prn every 2-4 hr until hypertension is controlled; max dose: 5 mg. Dose (hypertension crisis): adult: 5-20 mg IV. Adverse effects: may cause hypotension, reflex tachycardia, cerebrovascular spasm, arrhythmias, stimulation of gastrointestinal tract, hypoglycemia. Comments: use with caution in renal impairment, coronary or cerebral arteriosclerosis.

Phenylephrine (Neo-Synephrine)

Actions: alpha adrenergic agonist (direct) producing vasoconstriction.

Indications: hypotension; SVT; symptomatic relief of nasal and nasopharyngeal congestion; mydriatic; treatment of wide-angle glaucoma. Dose (adult): bolus: 50-200 mcg IV; infusion: 20-180 mcg/min (usual range: 40-80 mcg/min). Dose (ped): bolus: 0.5-10 mcg/kg IV; infusion: 0.10.5 mcg/kg/min.

Clearance: hepatic metabolism; renal elimination. Contraindications: pheochromocytoma, severe hypertension, bradycardia, ventricular tachyarrhythmias, narrow-angle glaucoma. Adverse effects: hypertension, reflex bradycardia, microcirculatory constriction, uterine contraction, uterine vasoconstriction.

Phenytoin (Dilantin)

Actions: anticonvulsant effect: stabilizes neuronal membranes and inhibits depolarization; antiarrhythmic effect: blocks calcium uptake during depolarization, prolongs effective refractory period, suppresses ventricular pacemaker automaticity, shortens action potential in the heart. Indications: seizure management, ventricular arrhythmias, digoxin-induced arrhythmias, refractory ventricular tachycardia, used for epidermolysis and trigeminal neuralgia. Dose (status epilepticus):

Adult: load 15-20 mg/kg IV (max: 1500 mg); maintenance dose: 300 mg/day or 5-6 mg/kg/day in 3 divided doses or 1-2 divided doses if using extended release.

Infants/children: load 15-20 mg/kg IV; maintenance dose (2-3 divided doses): 6 months-3 yrs: 8-10 mg/kg/day, 4-6 yrs: 7.5-9 mg/kg/day, 7-9 yrs 7-8 mg/kg/day, 10-16 yrs 6-7 mg/kg/day. Neonates: load 15-20 mg/kg IV; maintenance of 5-8 mg/kg/day in 2 divided doses (may give every 8 hrs if needed). Dose (anticonvulsant): children/adult: load 15-20 mg PO/IV (administer oral dose in 3 divided doses given every 2-3 hrs to decrease GI effects), followed by maintenance dose: 300 mg/day or 5-6 mg/kg/day in 3 divided doses.

Dose (antiarrhythmic): 1.5 mg/kg IV every 5 minutes until arrhythmia is suppressed or maximum dose: 1015 mg/kg.

Clearance: hepatic metabolism; renal elimination. Contraindications: heart block, sinus bradycardia. Therapeutic levels: seizure threshold: 10-20 mg/L (free and bound phenytoin), 1-2 mg/L (free only phenytoin).

Adverse effects: may cause nystagmus, diplopia, ataxia, drowsiness, gingival hyperplasia, gastrointestinal upset, hyperglycemia, hirsutism, SLE-like and Stevens-Johnson syndromes; IV form may cause hypotension, arrhythmias, bradycardia, cardiovascular collapse, CNS depression, respiratory arrest, venous irritation and pain. Comments: induces hepatic microsomal enzymes; crosses the placenta; significant interpatient variation in dose needed to achieve therapeutic concentration; use caution in renal and hepatic impairment.

Phosphorus (NeurtraPhos, K-Phos) Actions: electrolyte replacement. Indications: hypophosphatemia, constipation, colonoscopy preparation.

Dose (acute hypophosphatemia): 5-10 mg/kg/dose IV over 6 hrs.

Dose (maintenance replacement): adults: 1.5-2 gm IV over 24 hrs or 3-4.5 gms/day PO in 3-4 divided doses; ped: 15-45 mg/kg IV over 24 hrs or 30-90 mg/kg/day PO in 3-4 divided doses. Clearance: kidneys reabsorb 80% of dose. Adverse effects: may cause tetany, hyperphosphatemia, hyperkalemia, hypocalcemia; IV administration may cause hypotension, renal failure. Comments: use caution in cardiac and renal impairment patients; recommended infusion rate: <3.1 mg/kg/hr of phosphate.

Physostigmine (Antilirium)

Actions: inhibition of cholinesterase, prolongs central and peripheral cholinergic effects. Indications: postoperative delirium, tricyclic antidepressant overdose, reversal of CNS effects of anticholinergic drugs, reversal agent for nondepolarizing blockade.

Dose (nondepolarizing blockade reversal): 0.010.03 mg/kg IV.

Dose (anticholinergic overdose): adults: 0.5-2 mg IV/IM every 15 minutes until response or adverse occurs (repeat 1-4 mg every 30-60 minutes as life-threatening signs recur); ped: 0.01-0.03 mg/kg/dose

IV, repeat every 5-10 minutes to a max total dose of 2 mg or until response or adverse effects occur. Clearance: metabolized by plasma esterases. Contraindications: asthma, gangrene, severe cardiovascular disease, mechanical obstruction of GI or GU tract.

Adverse effects: may cause bradycardia, tremor, convulsions, hallucinations, psychiatric or CNS depression, mild ganglionic blockade, cholinergic crisis.

Comments: physostigmine antidote: atropine; crosses blood-brain barrier.

Potassium (KCL)

Actions: electrolyte replacement. Indications: hypokalemia, digoxin toxicity. Dose (hypokalemia): adult: 10-20 mEq KCL IV over 30-60 minutes (usual infusion: 10 mEq/hr; max dose 150 mEq/day); ped: 0.5-1 mEq/kg/dose KCL IV given as infusion of 0.5 mEq/kg/hr (max: 1 mEq/kg/hr). Clearance: renal.

Adverse effects: may cause irritation, pain, phlebitis at infusion site; rapid or central IV infusion may cause cardiac arrhythmias.

Comments: central venous line is preferable for administration.

Prednisolone (Pred Forte)

Actions: decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; suppresses the immune system. Indications: treatment of a variety disorders, antiinflammatory, immune suppression, allergic states. Dose (adult): 5-60 mg/day IV/IM/PO (as sodium phosphate salt).

Dose (ped): 0.1-2 mg/kg/day IV/IM/PO (as sodium phosphate salt) in divided doses 1-4 times/day. Clearance: renal elimination. Adverse effects: insomnia, nervousness, indigestion, hirsutism, hyperglycemia, diarrhea, HPA axis suppression.

Procainamide (Pronestyl)

Actions: decreases myocardial excitability and conduction velocity and may depress myocardial contractility, by increasing the electrical stimulation threshold of the ventricle/ HIS-Purkinje system and direct cardiac effects.

Indications: atrial and ventricular arrhythmias. Dose (ACLS):

Adult: load: 20-30 mg/min until (1) arrhythmia suppressed, (2) hypotension ensues, (3) the QRS complex widened by 50%, or (4) a total of 1 gm or 17 mg/kg has been given; in refractory VF/VT may give 100 mg IV push every 5 minutes. Ped: load 15 mg/kg IV/IO over 30-60 minutes. Dose (antiarrhythmic):

Adult: load 50-100 mg IV, repeated every 5 minutes until patient controlled (max dose: 1000 mg); maintenance: 1-6 mg/min infusion. Ped: load 2-6 mg/kg/dose IV over 5 minutes (max dose: 100 mg/dose), repeat dose every 5-10 minutes prn up to total maximum of 15 mg/kg; maintenance dose: 20-80 mcg/kg/min by continuous infusion. Standard concentration (adult): 2 gm/500 cc D5W: 30 cc/hr = 2 mg/min. Therapeutic level: 4-10 mcg/mL. Clearance: hepatic metabolism to active metabolite; renal elimination.

Contraindications: myasthenia gravis, complete heart block, SLE, Torsades de pointes. Adverse effects: hypotension, heart block, myocardial depression, ventricular dysrhythmias, lupus, fever, agranulocytosis, GI irritation, lupus-like syndrome, positive Coombs' test, confusion. Comments: use caution in asymptomatic PVCs, digitalis intoxication, CHF, renal or hepatic impairment;

Prochlorperazine (Compazine)

Actions: blocks dopamine (D1 and D2) receptors with neuroleptic and antiemetic effects; antimuscarinic and antihistaminic effects; depresses the reticular activating system.

Indications: management of nausea/vomiting; acute/chronic psychosis. Dose (antiemetic):

Adult: 2.5-10 mg IV (max: 40 mg/day); 5-10 mg IM every 3-4 hrs prn (max: 40 mg/day); 25 mg PR every 12 hrs prn.

Ped: (>10 kg or > 2 yrs): 0.1-0.15 mg/kg/dose IM 3-4 times/day prn. Clearance: hepatic metabolism; renal and biliary Adverse effects: extrapyramidal reactions (reversed by diphenhydramine), orthostatic hypotension, altered temperature regulation, neuroleptic malignant syndrome, leukopenia, cholestatic jaundice. Comments: do not use IV in children; avoid use in patients with severe cardiac or hepatic disease.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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