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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 α1 > 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
α1 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 α1=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
ANG II 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 Metabolism Side Effects
Propofol Infusion: 5 – 150 mcg/kg/min General anesthetic (GABA R agonist) Hepatic, Renal (minor) 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 α2 agonist Hepatic Hypotension, bradycardia
Midazolam (Versed) Push: 0.5 – 5 mg
Infusion: 0.25 – 5 mg/h (no max dose)
Benzodiazepine Hepatic & Renal Hypotension, risk of benzodiazepine 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 Hepatic Hypotension. Propylene glycol carrier – AGMA
Ketamine Push: 1-2 mg/kg
Infusion: 0.2 mg/kg/h, titrate by 0.1 q15min
NDMA antagonist Hepatic Delirium/hallucination – use caution in patients with psychiatric history, hypertension, tachycardia
Pretreat with 0.4 mg IV glycopyrrolate to avoid hyper-salivation


Drug Dose Metabolism Side effects
Fentanyl Push: 25 – 100 mcg
Infusion: 25 – 400 mcg/h
Hepatic Hypotension, Serotonin syndrome, chest wall rigidity at high doses
Morphine Push: 1 – 5 mg q1-2h prn
Infusion: 1 – 5 mg/h
Hepatic/Renal Hypotension (profound), itching, constipation, HA; avoid in renal failure
Hydromorphone (Dilaudid) Push: 0.25–1mg q1-2h prn
Infusion: 0.5–3 mg/h
Hepatic Hypotension, respiratory depression, itching


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
Amiodarone 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 pts, caution if off therapeutic AC
Diltiazem 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
Lidocaine 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


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/h (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 emergency, 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