外科加護病房常用藥
Cardiovascular Agents
‧Amiodarone；Cordarone® (150mg/3ml/amp)
‧Diltiazem；Herbesser ® (10mg/amp)
‧Epinephrine；Bosmin® (1mg/ml/amp)
‧Isosorbid dinitrate；Isoket® (10mg/10ml/amp)
‧Labetalol ；Trandate® (25mg/5ml/amp)
‧Lidocaine；Xylocaine® (100mg/5ml/amp)
‧Magnesium sulfate；MgSO4（2g/20ml/amp）
‧Milrinone；Primacor® (10mg/10ml/vial)
‧Nicardipine；Perdipine® (10mg/10ml/amp)
‧Nitroglycerin；NTG；Millisrol® (50mg/100ml/vial)
‧Nitroprusside；Nipride® (50mg/vial)
‧Norepinephrine；Levophed® (4mg/4ml/amp)
‧Procainamide；Pronestyl® (1g/10ml/vial)
Adenosine (6mg/2ml/amp)
劑量：
6 mg iv over 2 to 3 secs (do not dilute)
followed by N/S 10 ml flush, if not working in 5 min, try 12 mg
then another 12 mg ( max, 30mg) or 18mg if needed
作用：Antiarrhythmic Agent
監測項目：BP, heart rate, EKG
Amiodarone；Cordarone® (150mg/3ml/amp) 僅可用D5W稀釋
劑量： First 24 hours: 1000 mg according to following regimen
Step 1: 150 mg (100 ml) over first 10 minutes (mix 3 ml in 100 ml D5W)
or 150mg iv bolus
Step 2: 360 mg (200 ml) over next 6 hours ( 6A' in 500 ml D5W, run 33ml/hr x 6 hours, then 17ml/hr x 18 hours)
Step 3: 540 mg (300 ml) over next 18 hours
Breakthrough VF or VT: 150 mg supplemental doses in 100 ml D5W over 10 minutes
or 150mg iv bolus
作用：Antiarrhythmic Agents
監測項目：Heart rate (EKG) and rhythm throughout therapy; assess patient for signs of thyroid dysfunction (thyroid function tests and liver enzymes), lethargy, edema of hands, feet, weight loss, and pulmonary toxicity (baseline pulmonary function tests)
Digoxin (250ug/1ml/amp)
劑量：
1 amp slow push
1 amp dilute with N/S 10ml (20ml), slow push
RAPID DIGITALIZATION - LOADING DOSE REGIMEN (IV)
DOSAGE SUMMARY: Patients with CHF and normal sinus rhythm
- Total loading dose, 10 mcg/kg lean body weight (range 8 - 12 mcg/kg)
or 0.6 - 1 mg intravenously
Initial dose, 5 mcg/kg (or 0.4 –0.6 mg, approximately one-half the total dose);
additional fractions (0.1 to 0.3 milligrams) given at 6 to 8 hour intervals
until clinical response
Maintenance dose, 0.075 to 0.35 mg/day
作用：Inotropic Agent
監測項目：heart rate and rhythm, EKG , digoxin serum levels, renal function, electrlyte (K+, Mg++, Ca++)
Diltiazem；Herbesser ® (10mg/amp)
泡製：1 vial + D5W or N/S 5ml--bolus
10vial + D5W or N/S 100ml--infusion
劑量：
Initial dose: 0.25mg/kg or 20 mg (2 vial) iv bolus over 2 min
Repeat dose: 15 min after then 0.35/kg or 25 mg iv bolus
if needed, infusion 10 mg/hr (100mg add in N/S 100 ml) rate may be increased in 5 mg/hr increments up to 15mg/hr as needed
作用：Calcium Channel Blocking Agent
監測項目：BP, EKG, liver function test
Dobutamine (250mg/20ml/amp)
泡製：1amp + D5W or N/S 100 ml (2ml/hr =1ug/kg/min)
劑量：start with 5ug/kg/min (10ml/hr) and increase as needed
usual rate: 2-20 ug/kg/min
作用：Vasopressors Used In Shock（β1>β2 >α）
監測項目：BP, heart rate, EKG, CVP, RAP, MAP, urine output; if pulmonary artery catheter is in place, monitor CI, PCWP, and SVR; also monitor k+ (k+ ↓)
保存: 稀釋後可保存24小時
Dopamine (200mg/5ml/amp)
泡製：
(1) 1amp + D5W or N/S 95ml （2ml/hr =1ug/kg/min）
(2) 2amp + D5W or N/S 500ml（4.5ml/hr =1ug/kg/min）
劑量：start with 5ug/kg/min (1)10ml/hr (2) 22.5ml/hr and increase as needed
usual rate: 2-20ug/kg/min
監測項目：BP, heart rate, EKG, urine output, renal function, decreased perfusion
作用：Vasopressors Used In Shock
1-3 ug/kg/min 以dopaminergic 受器效果為主，增加腎臟血流
3-10 ug/kg/min 以β1 受器效果為主，增加心臟收縮力
10-20 ug/kg/min 以α 受器效果為主，增加血壓(SVR↑)
keep SBP >100-110mmHg or MAP 90-105mmHg(1/3SBP+2/3DBP)
or Urine output > 60ml/hr or 1000ml/day
Epinephrine；Adrenaline；Bosmin® (1mg/ml/amp)
方法一
1 mg IV push, may repeat q3-5 min
may given 2-2.5mg dose via ETT if no IV access
方法二
泡製：1amp + D5W 250 ml (4ug/ml)
劑量：start with 1ug/min (15ml/hr) and increase as needed
usual rate: 1-4 ug/min
作用：Vasopressors Used In Shock（β1=β2 >α）
監測項目：BP, heart rate, EKG, Pulmonary function, site of infusion for blanching, extravasation
Isosorbid dinitrate；Isoket® (10mg/10ml/amp)
泡製：2 amp + D5W 80ml (0.2mg/ml, 3ml/hr =10ug/min)
劑量：start with 10ug/min (3ml/hr)
In general, a dose of 2-7mg/hr (10-35ml/hr) is suitable; may be increased up to 10 mg/hr if necessary
作用：Vasodilator/Nitrates
監測項目：BP, heart rate
Labetalol ；Trandate® (25mg/5ml/amp)
方法一
50 mg IV push ( > 1min) , may repeat q5 min, total dose≦200mg
方法二
泡製：8amp + D5W or NS 160 ml (1mg/ml)
劑量：start with 15-20ml/hr and increase as needed
maximum dose : 160mg/hr
作用：Agent For Hypertensive Emergencies
監測項目：BP, heart rate, EKG
保存: 稀釋後可保存24小時
Lidocaine；Xylocaine® (100mg/5ml/amp)
方法一
5-10 mg IV push, may repeat q5-10 min
Max: 300mg/15ml/hr
方法二
泡製：5 amp + D5W 75ml (5mg/ml, 12ml/hr =1mg/min)
劑量：start with 1mg/min (12ml/hr), may be increased if necessary
作用：Antiarrhythmic agents
Magnesium sulfate；MgSO4（2g/20ml/amp）
劑量：
preeclampsia 10-14g IV or IM x 1
hypomagnesemia IM 1g Q6H x 4, IV 5g x 1
cardiac arrhythmias 1-2g IV bolus over 1-2 min, repeat prn
hypomagnesemia - emergent 1-2 g in 100 ml D5W over 1-2 minutes
torsade de pointes 1-2 g in 50-100 ml D5W over 5 to 60 min, then 0.5-1g/hr
Milrinone；Primacor® (10mg/10ml/vial)
泡製：1 amp + D5W or N/S 90ml (0.1mg/ml, 3ml/hr =10ug/min)
劑量：loading dose: 50ug/kg (~ 3ml, >10min IV)
maintenance dose: 0.5ug/kg/min (18ml/hr)
作用：Inotropic Agent/Vasodilator
監測項目：BP, heart rate, serum potassium
Nicardipine；Perdipine® (10mg/10ml/amp)
泡製：6amp in D5W or N/S 100ml (0.6 mg/ml, 6ml/hr =1ug/kg/min)
也可稀釋為0.1mg/ml
劑量：start with 1ug/kg/min (6ml/hr) and increase as needed
usual rate: 1-6 ug/kg/min
作用：Calcium Channel Blocking Agent
監測項目：BP, heart rate, EKG
Nitroglycerin；NTG；Millisrol® (50mg/100ml/vial)
劑量：10ug/min（1.2ml/hr）up to 400ug/min
作用：Vasodilator/Nitrates
監測項目：BP, heart rate
Nitroprusside；Nipride® (50mg/vial)
泡製：(1) 1 vial + D5W 140ml (0.36mg/ml, 2ml/hr =10ug/min)
(2) 1 vial + D5W 250ml (0.2mg/ml)
劑量：
start with (1)10ug/min (2ml/hr) or (2) 0.3 ug/kg/minute (5ml/hr)
In general, a dose of 0.3-0.5 ug/kg/minute; increase 0.5 mcg/kg/minute,
usual dose: 3ug/kg/minute; maximum: 10ug/kg/minute
作用：Agent For Hypertensive Emergencies
監測項目：
BP, heart rate; monitor for cyanide and thiocyanate toxicity; monitor acid-base status as acidosis can be the earliest sign of cyanide toxicity; monitor thiocyanate levels if requiring prolonged infusion (>3 days) or dose ≧4 mcg/kg/minute or patient has renal dysfunction;
Norepinephrine；Levophed® (4mg/4ml/amp)
泡製：2amp + D5W or N/S 92 ml (10ml/hr = 0.2ug/kg/min)
劑量：start with 0.2ug/kg/min (10ml/hr) and increase as needed
usual rate: 0.5-30ug/min
監測項目：BP, heart rate, EKG, decreased perfusion
作用：Vasopressors Used In Shock（β1>α>β2）
to establish a low normal BP (systolic, 80-100mmHg)
Procainamide；Pronestyl® (1g/10ml/vial)
泡製：2amp + D5W or N/S 92 ml (10ml/hr = 0.2ug/kg/min)
劑量：start with 0.2ug/kg/min (10ml/hr) and increase as needed
usual rate: 0.5-30ug/min
監測項目：BP, heart rate, EKG, decreased perfusion
作用：Vasopressors Used In Shock（β1>α>β2）
to establish a low normal BP (systolic, 80-100mmHg)