Drugs - Calculation, Preparation and Dosage

DRUGS CALCULATION AND PREPARATION
DOPAMINE & DOBUTAMINE
Preparations :
Dopamine : 200mg in 5.0 mls
Dobutamine : 250 mg in 20.0 mls
Calculations:
Microchamber: Syringe Pump:
6 X Body Weight (kg) = x mg 3 X Body Weight (kg ) = x mg
x mg dilute in 100 mls of x mg dilute in 50 mls of
Normal Saline /Dextrose Saline Normal Saline/Dextrose Saline
Rate :
1 mls/hour = 1 mcg/kg/min
Dose :
5.0 mcg/kg/min - 20 mcg/kg/min
Titrate with response
1 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

MIDA + MORPHINE
SEDATION : ANALGESIA INFUSION
Preparation :
Morphine 30 mg + Midazolam (Dormicum) 30 mg
Dilute with 30 mls of Normal Saline
Rate :
1mls /hour = 1mg of Morphine and Midazolam/hour
Dose:
3 mg/hour (3 mls /hour )

To titrate with effect
ADRENALINE INFUSION
Preparation : 1mg/ml
Dilute 3.0 mg (3mls ) of Adrenaline

with 47 mls of Normal Saline
in 50 mls Syringe
Rate :
1 mls /hour = 1mcg/min
Dose :
1- 20 mcg/min
to titrate with BP

I/V SOLUMEDROL INFUSION REGIME

Preparation :
500mg /8mls/vial = 62.5 mg/ml
1.Bolus Dose : 3.Maintenanace Dose :

Bolus Dose = 30mg/kg Dosage per hour = 5.4mg/kg/hour
To deliver in 15 mins to deliver for 23 hours
Calculation : Calculations :
30 X Body Weight (kg) = x mls 5.4 X Body Weight (kg) x 23 = xmls
62.5 62.5
e.g : Body weight 70 kg e.g : Body weight 70 kg

30 x 70 = 33.6 mls 5.4 x 70 x 23 = 139.1 mls
62.5 62.5
1 vial =8mls 1 vial =8mls
33.6 mls = 33.6 = 4.2 vials ~4 vials 139.1 mls = 139.1 = 17.3 vials ~ 17
vials
8 8

4 vials in 50 mls Syringe and run in 15 mls 17 vials put in 1 unit of Normal saline
2. maintain I/V line with normal saline for 45 mins run in 23 hours
STREPTOKINASE INFUSION
Preparation :
1.5 megaunit / 2 mls
Dilute 1.5 mega unit of Streptokinase (2mls) with 8 mls of Water for injection
10 mls dilution
Put the 10 mls dilution into 90 mls of Dextrose 5% or Normal Saline in a

Microchamber
Run over 1 hour

INSULIN INFUSION
Preparation :
100 iu / ml
Use 50 mls Syringe

Take 50 iu of insulin (0.5 mls )
Dilute with 2 mls Haemacel / Gelafundin + 48 mls of Normal Saline = 50 mls dilution
Rate :
1 ml / hour = 1 iu /hour
Sliding Scale regime :
Dextrostix (mmol/l) Insulin Infusion rate iu/hour

0 - 5 none
5 - 10 2
10 - 15 3
15 - 20 4
> 20 6

Rough rule - Infusion rate = Blood sugar

5
ATROPINE INFUSION
Preparation :
1 mg / 1ml
Dilute 10 mg of Atropine (10 mls = 10 ampoules )

in 40 mls of Normal Saline in a 50 mls Syringe = 50 mls
dilution
Rate:
5 mls / hour = 1mg / hour

to titrate with effect
HEPARIN INFUSION :
Preparation : Preparation :
5000 iu / ml 1000 iu / ml
(BLUE label) ( RED label)
Syringe out 4 mls (20 000 iu ) Syringe out 5 mls (5000 iu ) x 4

vials
dilute with 20 mls of Normal Saline
in 20 mls syringe
Dose :
1000 iu / hour = 1 mls / hour

AMIODARONE (CORDARONE ) INFUSION

Preparation :
150 mg / 3 mls
Loading Dose :
Dilute 2 ampoules of Amiodarone ( 300 mg / 6 mls )
in 100 mls of Dextrose 5%
use microchamber
run over 1 hour
Maintenance Dose :
Dilute 6 ampoules of Amiodarone (900 mg/18 mls )
in 500mls of Dextrose 5%
run over 24 hours ~ 20 mls/hour

N-ACETYL CYSTEIN INFUSION
Preparation :
2 gm / 10 mls
Regime (dosage) :
150mg/kg in 200 mls of Dextrose 5% over 15 min
then 50mg/kg in 500 mls of Dextrose 5% over 4 hours
then 100 mg/kg in 1 litre of Dextrose over 16 hours
e.g : Body weight = 70 kg

150mg/kg = 150 x 70 = 10500mg =10.5gm
1 ampoule = 2 gm
10.5 gm = 10.5 = 5.25 ampoule ~ 5 ampoules
2

5 ampoules of N- AcetylCystein in 200 mls of Dextrose 5% over 15 min.
AMINOPHYLINE INFUSION :
Preparation :
250 mg / 10 mls
Slow Bolus :
125 mg 250 mg ( 6mg/kg) in 50mls Normal Saline
use syringe pump
run over 20- 30 min
Infusion :
Dose : 0.5 0.9 mg /kg/hour
Dilute 250 mg in 50 mls syringe with Normal Saline = 50 mls dilution

1mls = 250 = 5mg
50
e.g : Body Weight 70 kg

0.5 mg/kg/hour = 0.5 x 70 = 35mg/hour
35mg/hour = 35 = 7 mls/hour

DILANTIN (PHENYTOIN ) INFUSION (adult)
Preparation :
250 mg / 5mls
Loading dose :
10 15 mg/kg ( max :1.5 gm )
dilute in 100 mls of Normal Saline
use microchamber
run over 1 hour
Maintenance dose :
100 mg 8 hourly
DILANTIN (PHENYTOIN ) INFUSION (Paeds)

Loading dose :
15-20 mg/kg
Dilute in 20 mls of Normal Saline

use syringe pump (50 mls syringe )

run over 1 hour
PHENOBARBITONE INFUSION (Paeds )
Preparation :
200 mg / ml
Loading Dose :
15 20 mg/kg
dilute in 50 mls of Normal Saline

use syringe pump ( 50 mls syringe )
run in 1 hour

NITROBID ( GTN ) INFUSION
Preparation :
50 mg / 10 mls
Microchamber
take 5mg ( 1 ml ) of Nitrobid
dilute 5 mg of Nitrobid with 100 mls of Normal Saline
Rate :
6mls / hour = 5 mcg / min
Syringe Pump
Take 5mg ( 1 ml ) of Nitrobid
Dilute 5mg of Nitrobid with 50 mls of Normal Saline

Rate:
3mls / hour = 5 mcg / min
COCKTAIL REGIME ( for hyperkalaemia)
I/V bolus 50 mls of Dextrose 50%
I/V bolus insulin 10 iu
I/V slow bolus 10 mls of Calcium Gluconate
Post Cocktail regime : 12 lead ECG

LEVOPHED ( Noradrenaline ) INFUSION
Preparation :
4mg / 4 mls ( 1 mg /ml )
Calculations:
0.3 x Body Weight (kg) = x mg
x mg dilute in 50 mls of Dextrose 5 % in 50 mls syringe

use syringe pump
Rate :
1 ml / hour = 0.1 mcg / kg / min
Dose :

0.05 - 0.5 mcg / kg / min

DIVC REGIME
6 units of Cryopercipitate
4 units of Platelet
4 units of Fresh Frozen Plasma
3 copies of GXM forms
DIVC SRCREENING
Full Blood Count
Prothrombin Time

LIGNOCAINE ( for stable Ventricular Tarchycardia )

Preparation : Preparation :
Lignocaine Injection 2% Lidocaine Injection
100mg in 5 mls ( 20mg in 1 ml) 500mg / 5 mls (100 mg in 1 ml )
1 st Loading dose : Infusion :

1.0 1.5 mg / kg 500mg(5mls) of lidocaine
to give slow bolus in 2 mins add 45 mls of Dextrose 5 %
= 50 mls dilution
2 nd Loading Dose :(if needed ) 50mls = 500mg
0.75 mg 1.5mg /kg 1ml = 10mg
to give 5- 10 minutes after the Ist Loading Dose
to give slow bolus in 2 mins Dose : 1 4 mg / min
Total loading dose

should not be more than 3.0 m/kg e.g : to give 1.0 mg/min
= 60 mg/hour

= 6mls/hour
DOPAMINE (200mg in 50 mls )
Wt(kg)
45 50 55 60 65 70 75 80 85 90
mcg/kg/min
2.5 1.6ml/h 1.8 2.0 2.2 2.4 2.6 2.8 3.0 3.2 3.4
5.0 3.3 3.7 4.1 4.5 4.9 5.3 5.7 6.1 6.5 6.9
7.5 5.0 5.6 6.1 6.7 7.3 7.8 8.4 9.0 9.6 10.1
10.0 6.7 7.5 8.2 9.0 9.7 10.5 11.2 12.0 12.8 13.5
12.5 8.4 9.3 10.3 11.2 12.1 13.1 14.0 15.0 16.0 16.9
15.0 10.1 11.2 12.3 13.5 14.6 15.7 16.8 18.0 19.1 20.3
17.5 11.8 13.1 14.4 15.7 17.0 18.3 19.7 20.1 22.3 23.6
20.0 13.5 15.0 16.5 18.0 19.5 21.0 22.5 24.0 25.5 27.0
DOBUTAMINE ( 250 mg in 50 mls)
Wt
mcg/kg/min 45 50 55 60 65 70 75 80 85 90
2.5 1.3 ml/h 1.4 1.6 1.7 1.9 2.0 2.2 2.4 2.5 2.7
5.0 2.6 2.9 3.2 3.5 3.8 4.2 4.4 4.8 5.0 5.4
7.5 4.0 4.4 4.9 5.4 5.8 6.3 6.7 7.1 7.6 8.0
10.5 5.4 5.9 6.5 7.1 7.7 8.3 8.9 9.5 10.1 10.7
12.5 6.7 7.1 8.1 8.9 9.7 10.1 11.1 11.9 12.6 13.4
15.0 8.0 8.9 9.8 10.7 11.6 12.5 13.3 14.3 15.1 16.0
17.5 9.3 10.4 11.4 12.5 13.5 14.5 15.6 16.7 17.7 18.6

20.0 10.7 11.9 13.0 14.2 15.4 16.7 17.9 19.0 20.2 21.4
MAGNESIUM SULFATE ( for eclampsia )

Preparation : 2.47 gm (2.5gm) in 5mls ( 0.5 gm in 1ml)
I/V Slow Bolus :

4.0 gm (8mls ) in 10 15 mins
4.0gm (8 mls ) + 12 mls of Dextrose 5 % = 20 mls dilution
use syringe pump and run in 10 15 mins
Rate : 120mls - 80 mls /hour
Infusion :
Dose : 0.5 2.0 gm/hour
2.5 gm (5mls ) + 45 mls of Dextrose 5 % = 50 mls dilution
use syringe pump and run over 5 hours
Rate : 10 mls/hour (0.5 gm/hour)
Continue for 24 hours
Monitor : Antidote : I/V Calcium Gluconate 10mls

over 10 min
Knee reflex off infusion if absent of knee reflex
Respiratory rate of if RR < 16/min

Urine output should be > 20 mls/hour

Continous cardiac monitoring
Continous pulse oxymeter (O2 saturation )
ISOKET (ISOSORBIDE DI NITRATE)
Preparation : 10 mg / 10 mls
20mg of Isoket in 20 mls syringe pure.
Dose :
1 2 ml/ hour

ISOPRENALINE (ISOPREL)
Preparation :
1 mg / 5 mls
3.0 mg (15 mls ) of Isoprenaline + 35mls of Dextrose 5% = 50 mls dilution

use syringe pump
Rate :
1ml / hour = 1mcg / min
Dose :
0.2 mcg / min - 20 mcg / min


Transfusion of Rh D Negative patient in life threatening situation
Emergency requirement of Rh D Negative blood
Liased with Blood Bank Dr
Rh D Negative Blood
Available Not available
Transfuse ABO specific, To contact other Blood Bank

If not available,to transfuse
O Rh D negative packed cell
If not available in time If available in time

Transfuse
Treating Dr to decide whether
To transfuse Rh D positive blood
Determine presence of anti-D
Negative positive
Transfuse Rh Positive 1.decide to wait for Rh D Negative blood

2.or transfise Rh-D Positive blood as life
saving procedure
for women in child bearing age

need to give anti-D IgG within 72 hours monitor anti-D titre in patient
For others Anti-D should be considered weekly for 4 weeks then
KIV exchange transfusion once monthly for 6/12
Rh-D Negative blood is available

POLYVALENT / MONOVALENT ANTI-SNAKE VENOM SERUM
Dilute 2 vials of anti-snake Venom Serum with 10mls of water for injection (each vial) = 20 mls
dilution .
Put the 20 mls dilution into 30mls Normal Saline = 50 mls dilution
Use syringe pump
Run in 1 - 2 hours
In patient with hx of allergy - asthma,eczema or drug allegry to give :

Antihistamine
Hydrocortisone
15-30 minutes before administration of the anti-snake venom serum
If allergic reaction /anaphylactic reaction develop after the administration of the anti snake venom
serum :
Intramuscular injection of 1 mls of 1 : 1000 adrenaline

MANNITOL INFUSION (adult) MANNITOL INFUSION

((Paeds)
Preparation : 20 % ,25 % ,12.5 % Preparation : 20 % ,25 % ,12.5 %
Dose : Dose:
0.5 1 gm / kg (adult) 0.25 0.5 gm / kg (Paeds)
Mannitol 20 % - 2.5 5.0 mls/kg Mannitol 20 % - 1.25 2.5 mls/kg

Mannitol 25 % - 2.0 4.0 mls /kg Mannitol 25 % - 1.0 2.0 mls /kg
Mannitol 12.5 % - 4.0 8.0 mls/kg Mannitol 12.5 % - 2.0 4.0 mls/kg
To run over 1 hour To run over 2 hour

Use Microchamber Drip Use Microchamber Drip
Calculations : Calculations :
Body Weight 70 kg Body Weight 30 kg
Mannitol 20% Mannitol 20%
Total volume of Mannitol needed (1gm/kg ) Total volume of Mannitol needed (0.5gm/kg )
= 5.0 x 70 = 2.5 x 30
= 350 mls = 75 mls

350 mls of Mannitol 20 % to run in 1 hour 75 mls of Mannitol 20 % to run in 2 hour
BRICANYL INFUSION
Bricanyl 0.5 mg ( 1 amp )
Bricanyl 3 mg ( 6 amp ) dilute : 50 ml Normal Saline
Run 3 ml / H

FLUMAZENIL (Anexate ) Benzodiazepine Overdose
Preparation :
0.5 mg / 5 mls
Dilute 0.5 mg ( 5mls ) of Flumazenil in 5 mls of Normal Saline or Dextrose

5 % = 10 mls dilution
Benzodiazepine Overdose
I/V 0.2 mg (in 30 sec )
30 sec
No improvement
I/V 0.3 mg (in 30 sec)
60 sec
No improvement
I/V 0.5 mg (in 30 sec)
at interval of 60 sec
total (max ) of 3.0 mg
Resedation :
I/V 1.0 mg at 20 mins interval
Max of 3.0mg / hour

NALOXONE (Narcan) for OpiodsOverdose
Preparation:
0.4 mg / ml
Dose :
I/V 0.4 mg 2.0 mg
Repeated dose with interval of 2-3 mins
Max : 6 mg

PRALIDOXIME for Organophosphate Poisoning
Preparation :
Single dose vial 1 gm
Add 20 mls of sterile water for injection into the vial = 20 mls dilution
Add the 20 mls dilution of Pralidoxime into 80 mls of Normal Saline in
Microchamber drip = 100mls
Run over 15 30 mins
(Rate : 400mls-200mls/hour )
If after 1 hour muscle weakness has not been relieved second dose is
indicated.
Additional doses may be given cautiously if muscke weakness persist.

SODIUM BICARBONATE ( for metabolic Acidosis pH < 7.2 )
Preparation :
Sodium Bicarbonate 8.4 % ( 10 mls)
1 mls contain 1mmol (1 mEq/l ) of Sodium and Bicarbonate ion.
Dose :
Adult : Dose (mmol) = Base Deficit ( mEq/l ) x Body Weight (kg) = x mls of 8.4 % Sodium Bicarbonate
3
Administer (half of the calculated amount ) over 20 - 30 min in a syringe pump

Monitor the acid-base balance
Paeds : (use the 4.2 % solution )

< 5 kg : Dose (mmol) = Base deficit (mEq/l) x Body Weight (kg) = x mls of 4.2% Sodium
Bicarbonate
4
> 5 kg : Dose (mmol) = Base deficit (mEq/l) x Body Weight (kg) = x mls of 4.2 % sodium
bicarbonate
6

MAGNESIUM SULPHATE ( for Severe Acute Asthma )
Preparation : 2.47 gm (2.5gm) in 5mls ( 0.5 gm in 1ml)
Dose :
2.0 mg slow bolus
Take 4 mls of MgSo4 and dilute in 46 mls of Normal saline = 50 mls

dilution
Use Syringe Pump
Run the 50 mls dilution in 10-20 mins

OMEPRAZOLE 40 MG
- 40 MG DILUTE : 20 ML NORMAL SALINE
8 MG = 4 ML

PANTOPRAZOLE
40 MG dilute in 40 ml
1 mg = 1 ml
Run 8 mg / H = 8 ml / H

Drugs - Calculation, Preparation and Dosage

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DRUGS CALCULATION AND PREPARATION

DOPAMINE & DOBUTAMINE

1 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

SEDATION : ANALGESIA INFUSION

2 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

To titrate with effect

Dilute 3.0 mg (3mls ) of Adrenaline

3 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

I/V SOLUMEDROL INFUSION REGIME

1.Bolus Dose : 3.Maintenanace Dose :

e.g : Body weight 70 kg e.g : Body weight 70 kg

1 vial =8mls 1 vial =8mls

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Put the 10 mls dilution into 90 mls of Dextrose 5% or Normal Saline in a

Run over 1 hour

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Use 50 mls Syringe

Sliding Scale regime :

Dextrostix (mmol/l) Insulin Infusion rate iu/hour

6 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

Rough rule - Infusion rate = Blood sugar

Dilute 10 mg of Atropine (10 mls = 10 ampoules )

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to titrate with effect

Syringe out 4 mls (20 000 iu ) Syringe out 5 mls (5000 iu ) x 4

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AMIODARONE (CORDARONE ) INFUSION

9 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

N-ACETYL CYSTEIN INFUSION

then 50mg/kg in 500 mls of Dextrose 5% over 4 hours

then 100 mg/kg in 1 litre of Dextrose over 16 hours

e.g : Body weight = 70 kg

10 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

5 ampoules of N- AcetylCystein in 200 mls of Dextrose 5% over 15 min.

Dilute 250 mg in 50 mls syringe with Normal Saline = 50 mls dilution

e.g : Body Weight 70 kg

11 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

DILANTIN (PHENYTOIN ) INFUSION (adult)

DILANTIN (PHENYTOIN ) INFUSION (Paeds)

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use syringe pump (50 mls syringe )

PHENOBARBITONE INFUSION (Paeds )

dilute in 50 mls of Normal Saline

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NITROBID ( GTN ) INFUSION

14 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

I/V bolus 50 mls of Dextrose 50%

I/V bolus insulin 10 iu

I/V slow bolus 10 mls of Calcium Gluconate

Post Cocktail regime : 12 lead ECG

15 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

LEVOPHED ( Noradrenaline ) INFUSION

x mg dilute in 50 mls of Dextrose 5 % in 50 mls syringe

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0.05 - 0.5 mcg / kg / min

4 units of Fresh Frozen Plasma

3 copies of GXM forms

17 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

LIGNOCAINE ( for stable Ventricular Tarchycardia )

1 st Loading dose : Infusion :

Total loading dose

18 Jabatan Kecemasan & Trauma HRPZ 11-WSR2010

DOBUTAMINE ( 250 mg in 50 mls)