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INTRODUCTION

  • In addition to medications in this formulary chapter, the following categories of medications can be found in the identified chapters:

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Respiratory
Medication Dose Mechanism Comment
Albuterol Intermittent 2.5 mg nebulization or ß2-agonist: bronchodilation via airway smooth muscle relaxation Frequent re-evaluation needed, especially if tachycardic
Continuous nebulization from 5–20 mg/hr Side effects: tremor, tachycardia, agitation, hypokalemia
Acetylcysteine Infants: 1–2 mL of 20% solution or 2–4 mL of 10% solution (undiluted); three to four times daily Exerts mucolytic action through its free sulfhydryl group, which opens up the disulfide bonds in the mucoproteins, thus lowering mucous viscosity
Children and adolescents: 3–5 mL of 20% solution or 6–10 mL of 10% solution (undiluted); administer three to four times daily
Ipratropium 125–500 mcg nebulization q6–8 hr Inhaled anticholinergic (inhibit cGMP) bronchodilator Systemic SEs rare due to poor absorption from lung
Saline nebulization 0.9%, 3%, 7% 3% solution: 4 mL inhaled every 2 hr Pretreatment with a bronchodilator is recommended to prevent potential bronchospasm
≥6 years and adolescents: inhalation: 7% solution: 4 mL inhaled twice daily
Terbutaline Load: 2–10 mcg/kg IV Systemic ß2-agonist SEs same as albuterol
Infusion: 0.08–1 mcg/kg/min Stop infusion and obtain ECG for chest pain or ST changes

SE: Side Effects

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Neurologic
Medication Route Dose Mechanism
Midazolam IV bolus Loading dose: 0.15–0.2 mg/kg Enhances GABA activity
IV infusion 0.06–0.5 mg/kg/hr
Intramuscular 0.2 mg/kg/dose, may repeat every 10–15 min, maximum dose: 6 mg
Buccal 0.2–0.5 mg/kg once; maximum dose: 10 mg
Intranasal 0.2 mg/kg once; maximum dose: 10 mg
Lorazepam IV bolus 0.1 mg/kg maximum: 4 mg, slow IV over 2–5 min; may repeat in 5–15 min
Diazepam IV bolus 0.1–0.3 mg/kg/dose given over 3–5 min, every 5–10 min; maximum dose: 10 mg/dose
Rectal 2–5 years: 0.5 mg/kg
6–11 years: 0.3 mg/kg
≥12 years and adolescents: 0.2 mg/kg
Fosphenytoin IV bolus 15–20 mg PE/kg; maximum dose: 1500 mg PE Stabilizes voltage-gated sodium channels
Administer at 1–3 mg PE/kg/min up to a maximum of 150 mg PE/min
Levetiracetam IV bolus 20–60 mg/kg; dose should not exceed adult initial range: 1000–3000 mg Thought to have multiple sites of action, including calcium channels, glutamate receptors, and GABA modulation
Pentobarbital IV bolus Loading dose: 5 mg/kg Enhances GABA activity
IV infusion Initial: 0.5–1 mg/kg/hr
Phenobarbital IV bolus 15–20 mg/kg; maximum dose: 1000 mg

PE: Phenytoin equivalent; GABA: gamma-aminobutyric acid.

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Miscellaneous
Medication Dose Mechanism Comment
Albumin 0.5–1 g/kg/dose IV Provides increase in intravascular oncotic pressure Administration rate:
Use 5% in hypovolemic or intravascularly depleted patients 5% = 2–4 mL/min
Use 25% in fluid/Na restricted patients 25% = 1 mL/min (after initial volume replacement)
Diphenhydramine

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