Meds for Life

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  • Warfarin (Coumadin) 2-10mg PO OD, target INR 2-3
    • Initiating requires bridging with UFH/LMWH for at least 5 days and INR in target
  • Fondaparinux (Arixtra) 2.5mg-10mg SQ OD (weight based)
  • Rivaroxaban (Xarelto) 15mg PO BID 3wk, then 20mg PO OD
  • Apixaban (Eliquis) 10mg PO BID 1wk, then 5mg PO BID
    • 2.5mg PO BID if 2 out of 3: age >80, Cr >133, weight <60kg, (for Afib only)
  • Dabigatran (Pradaxa) 150mg PO BID, requires 5d LMWH/UFH bridge
  • UFH 10,000u IV then 50 to 70 units/kg (5,000 to 10,000u) q4-6h
    • STEMI: Initial 60 units/kg (max: 5,000u) IV Bolus, then 12 units/kg/hour (maximum: 1,000 units/hour) continuous IV until PCI or no CP >48hr (target aPTT 1.5-2.5x control or anti-Xa 0.3-0.7, adjust 100-150u/hr)
    • VTE: Initial 80 units/kg IV bolus, then 18 units/kg/hour (target aPTT 1.5-2.5x control or anti-Xa 0.3-0.7, adjust 100-150u/hr)
    • Ex. Anti-Xa <0.2 = 6000u bolus, rate+250u/hr; 0.2-0.34 = 3000u bolus, rate+150u/hr; 0.35-0.67 = -0.32 no change (check Xa in AM); 0.68-0.8 = Rate-150u/hr, check Xa in 6hr; >0.8 = Stop infusion x1hr, rate-250u/hr, next Xa in 6h
    • Prophylaxis: 5,000u subcut q8-12h
  • Enoxaparin (Lovenox) 1mg/kg SQ q12h rounded to 10, or 1.5mg/kg SQ OD
    • Intermediate dose 1mg/kg once daily
    • Prophylaxis: 40mg subcut q24h
    • Prophylaxis (high dose): 30-40mg subcut q12h
  • Anti-Xa target: 0.6-1.2 U/ml (institution dependent) – non-DOAC calibrated
    • Prophylaxis anti-xa target: 0.2-0.5 with LMWH
  • Dalteparin (Fragmin) 200 units/kg SQ OD/can split BID (if cancer then 1 mo, then 150u/kg SQ OD), no true max but upper limit 18,000-24,000u/day OR
    • 46 to 56 kg: 10,000 units once daily
    • 57 to 68 kg: 12,500 units once daily
    • 69 to 82 kg: 15,000 units once daily
    • ≥83 kg: 18,000 units once daily
    • Prophylaxis: 5000u subcut q24h
  • Tinzaparin (Innohep) 175 units/kg SQ OD, no true max but upper limit 18,000u/day
  • Protamine Sulphate (Antidote UFH) 1-1.5mg per 100u UFH IV slow + continuous
    • If LMWH, 50mg max (60% reversal)
  • Octaplex (PCC – Antidote VKA) – 4 ml/min IV or 3 minute bolus (500 units = 20mls), target INR 1.5
    • Pretreatment INR: 1.6-1.9: 500u = 20cc PCC
    • Pretreatment INR: 2 to 3: 1000u = 40cc PCC (~25 units/kg; maximum dose: 2,500 units)
    • Pretreatment INR: 3 to 5: 2000u = 80cc PCC (~35 units/kg; maximum dose: 3,500 units) <- dosing for Apix reversal
    • Pretreatment INR: >5: 3000u = 120cc PCC (~50 units/kg; maximum dose: 5,000 units)
  • Vitamin K 2.5-5mg PO, or 1-10mg IV slow infusion (IV preferred in urgent cases)
  • TXA 1g IV over 10 mins, q30min – BID/TID x3d
  • TXA (Cyklokapron) 1-1.5g PO 3-4 times daily
  • Octaplex (PCC) for apixaban reversal based on apixaban calibrated Anti-Xa level:
    • Anti-Xa >50 ng/mL: PCC 50 IU/kg within 30m of OR
    • Anti-Xa 30-50 ng/mL: no reversal prior to OR, if bleeding intra-op consider 50 IU/kg
    • Anti-Xa <30 ng/mL: No need for PCC


Note: Avoid LMWH or DOACs in renal failure, good for cancer or pregnancy


  • LMWH Sliding scale for thrombocytopenia: e.g. Fragmin
    • Plt <25: None
    • Plt 25-50: Proph dosing vs none
    • Plt >50: Proph OD vs BID
    • Based on symptoms and clot burden
  • Protamine Sulphate (Antidote UFH) 1-1.5mg per 100u UFH IV slow + continuous
  • If LMWH, 50mg max (60% reversal)
  • Octaplex (PCC – Antidote VKA) – 4-8 ml/min IV or 3 minute bolus, target INR 1.5
  • Pretreatment INR 1.6-1.9: 20cc of PCC
  • Pretreatment INR 2 to 3: 20 units/kg (or 40cc of PCC)
  • Pretreatment INR 3 to 6: 35 units/kg (or 80cc of occ)
  • Pretreatment INR >6: 40 units/kg
  • Add 10IU/kg if target INR<1.2
  • Under normal circumstances the dose should not exceed 3000 IU with a maximum infusion speed of 8mL/min. For severe acute bleed with unknown INR, give 2000 IU.
  • Vitamin K 2.5-5mg PO, or 1-10mg IV slow infusion over 30min (24h to full effect)



  • Aspirin (ASA) 81-325mg PO OD
  • Dipyridamole
  • Clopidogrel (P2Y12i) 75-300mg PO OD
  • Ticagrelor (P2Y12i) 180mg PO OD initial, or 90mg PO BID
  • GPIIb/IIIa Inhibitors (abciximab, eptifibatide)



  • Effects: Mad as a hatter, blind as a bat, red as a beet, hot as a hare, dry as a bone, bladder and bowels lose their tone, heart goes off alone
  • Confusion (delirium), blurry vision (dilated pupils), flushed skin, dry skin (anhidrosis), dry mucous membranes, tachycardia, constipation, urinary retention, bronchodilator (as in COPD)
  • See nausea medications
  • Benztropine (Cogentin) 1-4mg OD/BID PRN, max 6g/d
  • Atropine 0.5mg IV q3-5m (3mg max) – ACLS Bradycardia
  • Buscopan 10-20mg PO/PR/SC/IV q6-8h, q4h PRN (Anti-Chol)
  • Dimenhydrinate (Gravol) 25-50mg PO q4-6h PRN, max 400mg daily (if IV max 25mg q6h) (Anti-H1)
  • Diphenhydramine (Benadryl) 25-50mg PO q4-8h, 10-50mg IV q6h



  • Lorazepam (Ativan) 0.1mg/kg OR 2-4mg IV repeat x1 q5-10m + 2mg/min PRN infusion
  • IM lorazepam should be double dose of IV
    • Diazepam 0.1mg/kg IV;  Midazolam 0.05mg/kg IV (initial); Midazolam 10mg IM (>40kg)
    • Phenytoin (Dilantin) 1-1.5g/hr IV OR 20m/gkg at 25-50mg/min
    • Fosphenytoin 20mg/kg phenytoin equivalent at 100-150mg phenytoin equivalent/min
    • Midazolam (if refractory) 0.2mg/kg IV bolus at 2mg/min, infusion at 0.1mg/kg/hr titrate upwards until seizure breaks
    • Propofol 1-2mg/kg loading dose over 5 minutes, infusion up to 10-12mg/kg/hr
    • Pentobarbital 5mg/kg over 10 minutes, repeat until seizure breaks
    • Phenobarbital 15-20mg/kg (infused at 50-100mg/min), repeat q10min – can be given SUBCUT



  • Haloperidol (Haldol) 0.25-0.5-1-2-5-10mg PO/IV/IM/SQ q1-6h PRN
  • Methotrimeprazine (Nozinan) 5-6.25-12.5mg PO/SQ q1-4h PRN
  • Quetiapine 50mg po qHS
  • Risperidone 0.125-0.25-1-2mg PO q1-2h PRN
  • Loxapine 2-12.5-25mg IM/PO
  • Lorazepam (Ativan) 0.5-2mg IV/IM q30m PRN
  • Midazolam 1-2.5-5mg IV/IM/SQ q5m or q1h PRN
  • Trazodone 25-50mg PO qHS PRN
  • Mirtazapine (Remeron) 7.5-15mg PO qHS PRN
  • If prior seizures give: BZD or phenobarbital 60-90-120mg subcut/IV q4-6
  • If Parkinson’s/Lewy body: BZD or quetiapine



NSAIDs: MOA – inhibition of COX-1 and COX-2 enzymes

  • Ibuprofen (Advil) 200-400mg PO q4-6h PRN, max 1.2g/d
  • Naproxen (Aleve) 250-500mg PO q8-12h, max 1g/d
  • Diclofenac (Voltaren) 50mg PO TID
  • Celecoxib (Celebrex) 200-400 mg OD/BID
  • Ketorolac (Toradol) 10-30mg IV



  • Tramadol 25-50mg PO q4-6h PRN, max 400mg/d
  • Tramacet (Tylenol 325mg/Tramadol 37.5mg) 1-2 tab PO OD PRN
  • Tapentadol 50mg q4-6 hr, max 600mg/d
  • Hydromorphone (Dilaudid) 0.5-2mg PO/IM q4h PRN, max 24mg/d
  • Hydromorphone (Dilaudid) 0.1-1mg SC/IV q2-4h PRN
  • Hydromorphone 0.1-1 mg/hr IV infusion (sedation)
  • Oxycodone (OxyNEO, oxycontin) 5-15mg PO q4h PRN, max 60mg/d
  • Morphine 0.1-0.5mg/kg
  • Morphine 5-20mg PO PRN, max 120mg (watchful dose 90mg PO, no true max)
  • Morphine 2.5-10mg IV/SQ q4h PRN, continuous infusion at 0.8-20 mg/hr
  • Note: reduce dose by 33% when opioid converting due to incomplete cross tolerance
  • Hydromorphone 2mg PO = Oxycodone 5mg PO = Morphine 10mg PO =  Codeine 20mg PO = Tapentadol 25mg PO = Tramadol 67mg PO (?)
  • Morphine 100mg PO/24h = Fentanyl 25mcg/hr (patch or CADD subcut)
  • Morphine 10mg IV = Fentanyl 100mcg IV
  • Morphine 10mg PO q4h = 60mg q24h / 4 -> fentanyl patch 15 mcg/h
  • Watchful dose 90mg in non-cancer
  • Long acting e.g. MS Contin (or dilaudid contin) half the total daily short acting dose @ q12h
  • Hydromorphone 1mg IV = Morphine 5mg IV
  • IV/SQ to PO 1:2
  • Fentanyl 25-50mcg IV q6h PRN can do q15min
  • Breakthrough dosing for opioids: 10% of 24hr dose (rounded) q1-2h
  • 25-30% dose reduction for delirium (and switch from morphine to hydromorph), initial 50% reduction in opioid naive/frail patients
  • Liver failure: Tylenol 2g max, fentanyl, tramadol, hydromorphone less
  • Renal failure: Fentanyl, methadone, HM less
  • Naloxone 2mg IV/IM/SL/SC/ETT split dose 0.4-0.6-1mg stepwise q2-3min
  • Consider micro dosing of 0.04mg steps to achieve balance between pain and sedation
  • Infusion dose is 2/3 of effective bolus dose/hr (in cases of slow-release or long-acting opioids)



  • Acetaminophen (Tylenol) 325-650-975mg PO PRN q4-6h, max 3-4g/d
  • Nabilone (cannabinoid)
  • Ketamine 4-6mg IV or 0.1-1mg/kg/hr (note that induction doses are 0.5-2mg/kg IV push, 50-75-100mg), start 4-6mg/hr infusion appropriate for agitation and pain
  • Baclofen 5mg PO TID, max 80mg/day (muscle relaxant)
  • Gabapentin (Neurontin) 300-900 mg OD/BID/TID, max 2400mg/d (start 100 TID)
  • Pregabalin (Lyrica) 25-150mg OD/BID
  • Duloxetine (Cymbalta) 30-60mg PO OD – SNRI
  • Dexamethasone 10-20mg PO/subcut/IV loading dose, followed by 1-2-4-6mg PO/subcut/IV BID
  • Dexamethasone 10-20mg PO/subcut/IV daily/split BID for 1+ week with slow taper to effective dose
  • Nortriptyline 10-25-100-150mg PO qHS
  • Topical lidocaine 5% gel or patch (toxic dose 5mg/kg without epi, 7mg/kg with epi)



  • Vomiting Centre: Ach-M (Muscarinic), Histamine (H1), 5HT3
  • Higher cerebral centres (Pain, anxiety, ICP): GABA → Lorazepam, Dexamethasone
  • Chemoreceptor zone (drugs, toxins, lytes): D2, 5HT3, NK1 (substance P)
  • GI Tract (obstruction, constipation, delayed emptying): D2, 5HT3
  • Vestibular Input (Motion): H1, ACh-M → Gravol
  • Complete malignant bowel obstruction: No pro-kinetics, HaLDOL, Gravol, Zofran, Dex, Octreotride

D2 Antagonists:

  • Metoclopramide (Maxeran) 5-10mg PO/SQ/IV TID/QID, q4-6h PRN, max 120g/d (DA R antagonist, prokinetic)
  • Domperidone (Motilium) 5-20mg PO q6-8h, q4h PRN (D2 antagonist, prokinetic)
  • Haloperidol (Haldol) 0.5-2-5mg PO/SC/IV q6-12h, q1h PRN (D2 antagonist)
  • Methotrimeprazine (Nozinan) 5-6.25-12.5-25-50-100 q4-6h PRN (D2 antagonist)
  • Olanzapine (Zyprexa) 2.5-5-10mg PO/IM/?SL QD/BID (D2 antagonist)
  • Prochlorperazine 2.5-10mg IV, max 40mg/day (D2-R antagonist + AntiChol + AntiH)
  • Loxapine (non QT)


  • Dimenhydrinate (Gravol) 25-50mg PO q4-6h PRN, max 400mg daily (if IV max 25mg q6h) (Anti-H1)
  • Gravol is the only clear non-QT prolonging antiemetic
    • Diphenhydramine (Benadryl) 25-50mg PO q6-8h, max 400mg (1st gen Anti-H1)
    • Diphenhydramine (Benadryl) 10-50mg IV/IM q6h, max 400mg
    • Betahistine (Serc) 8-16 mg PO TID  or 24 mg BID, max 48 mg (Anti-H1,H3)
    • Meclizine (Antivert) 25-50mg PO q4-6h PRN (Anti-H1)


  • Buscopan (Hyoscine butylbromide) 10-20mg PO/PR/SC/IV q6-8h, q4h PRN (Anti-Chol, for MBO, also slows gastric motility)
  • Scopolamine (Hyoscine hydrobromide) 0.2-0.4mg subcut q2-4h PRN  (Anti-Chol)
  • Scopolamine transdermal patch (motion sickness)


  • Ondansetron (Zofran) 4-8mg IV/NG/PO q6-8-12h or BID/TID PRN (5HT antagonist)


  • Dexamethasone 10mg IVx1 followed by 4-8mg PO OD/BID (Corticosteroid) – for MBO
  • Octreotide 200mg TID subQ (for MBO, decreases secretions/increases absorption)
  • Lorazepam (Ativan) 0.5-1-2mg PO/IV/SL q4-6h PRN, up to 10mg/d




  • Penicillin G 2-4M units IV q4-6h, CrCl 10-50: 75% dose
  • Penicillin V 250-500mg PO TID/QID
  • Cloxacillin 2g IV q4-6h


  • Ampicillin 1-2g IV q4-6hr, CrCl 10-50: q6-q12
  • Amoxicillin 250-1000mg PO TID, CrCl 10-30: 250-500mg PO q12h
  • Amox-Clav 875/125mg PO BID, CrCl 10-30 250-500mg PO q12h

Anti-pseudomonal PCN:

  • Piperacillin-Tazobactam 3.375-4.5g IV q6h, CrCl<15: 2.25g IV q8h


  • Imipenem 500-1000mg IV q6h, adjust to CrCl
  • Meropenem 1g IV q8h (2g if CNS infection), CrCl 25-50: 1g q12h, CrCl 10-25: 0.5 q12h, CrCl<10: 500g 24h
  • Ertapenem 1g IV q24h, CrCl <30: 500g q24h
  • Imipenem 500-100mg IV q6h, adjust to CrCl

1st Cephalosporin:

  • Cefazolin 1-2g IV q8h, CrCl 11-34: 50% dose q12h
  • Cephalexin 250-100mg PO QID, CrCl 10-50: 500mg q8-12h

2nd Cephalosporin:

  • Cefuroxime 125-500mg PO QID, 750-1500mg IV q8h, CrCl 10-30: q24h

3rd Cephalosporin:

  • Ceftriaxone 1-2g IV q24h, 2g IV q12h for CNS
  • Ceftazidime 1-2g IV q8-12h, CrCl 30-50: 1g q12h, CrCl15-30: 1g q12h

4th/5th Cephalosporins: Do these even exist?


  • Tobramycin 5-7mg/kg IV q24h (Tobra bomb x1 IV in severe cases)
  • Gentamicin 5-7mg/kg IV q24h
  • Amikacin 7.5mg/kg q12h


  • Ciprofloxacin 500-750mg PO BID or 400mg IV BID, CrCl 30-50: 250-500 q12h, CrCl 5-30: 250-500 q18h
  • Moxifloxacin 400mg PO/IV daily
  • Levofloxacin 500-750mg PO/IV daily, CrCl 10-19: 250mg q48h
  • Norfloxacin 400mg PO BID, CrCl <30: 400mg daily


  • Azithromycin 500mg x1 day one, then 250mg PO/IV daily thereafter day 2
  • Clarithromycin 250-500mg PO q6-12h, CrCl <30: dec by 50%
  • Erythromycin 250-500mg PO q6-12h, CrCl<10: dec by 50%


  • Doxycycline 100mg PO q12h
  • Tetracycline 500mg PO QID, CrCl 50-80: q8-12h, CrCl 10-50: q12-24h
  • Tigecycline 100mg IV, then 50mg q12h


  • Trimethoprim-Sulfamethoxazole (Septra) 1-2 SS/DS tabs PO BID, 5mg of TMP/kg IV q6h (CNS infection), (8-20mg/kg/day IV q6-12h)
  • DS tab = 160mg TMP and 800mg SMX, undiluted IV contains TMP 16mg/ml + SMX 80mg/ml in D5W
  • CrCl 15-30: dec by 50%, CrCl<15: full dose q48h


  • Clindamycin 150-450mg PO QID or 300-600mg IV q6-12h


  • Vancomycin 15-20mg/kg IV q12h, can start 1-1.5g IV q12h empirically
  • Trough levels pre-4th dose, or pre-3rd whichever timing fits better and then every 3rd or 4th pre-dose after that
  • Target levels 10-15 for not so serious infections, 15-20 for serious infections

Oxazolidinones: (MAOI, risk of serotonin syndrome)

  • Linezolid 600mg PO/IV q12h


  • Daptomycin 4-6mg/kg q12h, up to 8-12mg/kr in MRSA, CrCl<30: dosing q48h


  • Flagyl 500mg PO/IV BID (preferred)/TID, if c. diff then 500mg q8h


Empiric Abx:

  • Gram +ve: 1st gen cephalosporins (cephalexin, cefazolin)
  • Gram -ve: 3rd gen cephalosporins (CTX)
  • Anaerobes: Metronidazole
  • Pseudomonas: Ceftaz
  • All of the above: pip-tazo
  • AmpC inducible: Carbapenems (Mero)
  • ESBL: Carbapenems (Mero)
  • MRSA: Vanco
  • VRE: Daptomycin (not for lungs)

Pseudomonal Coverage: Pip-tazo, FQs (except Moxi and Nor), Carbapenems (except Erta), Ceftaz, Cefipime (4th gen), Aminoglycosides

MRSA coverage: Clinda, Doxy, Septra, Vanco, Dapto, Linezolid



  • Fluconazole (Diflucan) 12mg/kg IV/PO loading dose, then 6mg/kg daily (800mg then 400mg) PO daily 7-14d
  • CrCl<50: dec by 50%
    • Caspofungin 70mg IVx1, then 50mg IV daily
    • Anidulafungin 20MG iv X1, THEN 100MG iv DAILY
    • Nystatin 400,000-600,000 units QID; swish in the mouth and retain for as long as possible (several minutes) before swallowing
    • Acyclovir 10mg/kg IV q8h, CrCL 25-50: q12h, CrCl 10-24 q24h, CrCl <10: 50% dose q24h
    • For shingles: 800mg PO five times daily x7d
      • Valacyclovir 1000mg PO TID x7d for shingles
      • Famciclovir 500mg TID x7d for shingles



  • Prune juice PO TID with meals
  • Psyllium (Metamucil/Fibre) 2.5-30g PO OD/BID (bulking agent)
  • Senna 8.6-17.2mg PO QD/BID PRN (stimulant, opiate PPx)
  • Lactulose 10-20mg/15-30ml PO q6h/qhs/OD (osmotic)
  • PEG3350 (Restoralax) 17g PO OD/BID (osmotic )
  • Bisacodyl (Dulcolax): 5-15mg PO daily (stimulant)
  • Suppositories: glycerine, dulcolax (bisacodyl), soap suds, Sodium phosphate fleet (oral or PR – not for renal failure due to high PO4), tap water
  • Golytely 4L PO, last option
  • Methylnatrexone
  • Colace (Docusate) 100mg PO BID (stool softener, opiate PPx) – poor efficacy, do not use



  • Sensitizers: (Take before meals, before breakfast if OD and before supper if OD)
  • Metformin: 250mg OD/BID, max 2500mg + B12 supplement 500-1,000 mcg PO OD (if low)
  • Glitazones (TZD): Rosiglitazone (4mg PO OD/BID max 8mg), Pioglitazone (15mg PO OD max 45mg) – Don’t use TZDs
  • Secretagogues:
  • Sulfonyureas: Glyburide (2.5mg PO OD/BID max 20mg), Gliclazide (80mg PO BID max 320mg), Gliclazide MR (30mg PO OD max 120mg)
  • Meglitinides: Repaglinide 0.5 mg PO AC (every meal) max 4mg/dose or 16 mg/day (good for renal insufficiency)
  • Other:
  • Alpha glucoside inhibitors: Acarbose 25mg PO AC max 100mg (depends on weight!)
  • DDP4-inhibitors (Gliptins): Sitagliptin (100mg PO OD), Linagliptin (5mg PO OD)
  • Incretin (GLP-1) analogues: Liraglutide (0.6mg OD SubQ max 1.8mg), Exenatide
  • SGLT2-inhibitors: Canagliflozin (100mg OD 300mg max), Dapagliflozin (5mg PO OD 10mg max), Empagliflozin (10mg PO OD max 25mg)



  • Long/Basal: NPH, N, Glargine (Lantus), Detemir (Levemir)
  • Medicine: 0.1 – 0.2u/kg/day sc
  • Community: Initiate 5u or 10u qhs sc, Titrate 10% by 1-2u q3-4d until AM FBS = 4 – 7 mmol/L
  • Can split long acting between morning and night if lunch and dinner high sugars
  • If NPO with maint fluids: dec 30-50% basal, d/c bolus
  • If continuous tube feeds: dec 30% basal can do split q12, may consider q6 bolus if required
  • If 12h continuous tube feeds: dec 50% TDD, choose NPH q12 ¼ @2000 ¾ @0800 for daytime feedings, reverse if night time feeding
  • Short/Prandial: Regular (R),Novolin Toronto
  • Rapid: Lispro (Humalog), Aspart (NovoRapid), Glulisine (Apidra)
  • Medicine: Total dose: 0.5u/kg (40% of total dose – basal insulin qHS) 20% of total dose TID with meals (60%) – prandial insulin 15-30 min before meals Eg. 80kg pt – 0.5u/kg = 16u basal (40%); 8u TID (20% x 3 = 60%)
  • Community: Start 5u sc with meals, Titrate AM to HS to target, Monitor 2h PPG, Start injection TID or only single meal as required, If poor control: inj TID sc; If mediocre control: inj qAM sc; Still aim for ~2/3rds split (40% basal / 60% prandial)
  • Premixed: HumuLin, NovoLin
  • Medicine: Estimate total starting daily dose (0.3-0.6 units/kg); Divide daily dose: 2/3 before breakfast; 1/3 before supper
  • Community:  From scratch:  Start 5-10u QD-BID and titrate; From other insulins: Calculate approximate amount of basal and prandial units and divide 2/3rd – 1/3rd AM and PM





Correction Scale




Correction if < 60 U/day

Consider if on 60-100 U/day

Consider if >100 U/day

10.1- 14.0 mmol/l

2 U

3 U

6 U

14.1-18 mmol/l

3 U

4 U

8 U

18.1-22 mmol/l

4 U

6 U

10 U

>22.1 mmol/l

5 U call MD

8 U and call MD

14 U and call MD



Type of Fluid




IF = ¾ ECF


1000cc D5W 83cc 250cc 667cc
1000cc ⅔ ⅓ 139cc 417cc 444cc
1000cc NS or RL 250cc 750cc 0
500cc 5% Alb 500cc 0 0
100cc 25% Alb 500cc -400cc 0
500cc Pentaspan 750cc -250cc 0
1 Unit RCC 400cc 0 0

TBW = Total body water; ECF = Extracellular fluid, ICF = Intracellular fluid, IVF = intravascular fluid, IF = interstitial fluid, RCC = red cell concentrates



2/3 + 1/3 + KCl 40mEq (20mEq if elderly or 75cc/hr) at 100cc/hr no cardiac disease and 75cc/hr if cardiac disease/ elderly

0.5-1.0g/kg (1-2 mL/kg) IV of D50W for adults for antidote

  • Deficit: kg x tbw% x % loss (adults), for peds= kg x % loss x 1000
  • Estimate deficit: 3% = History + HR + O/E, 6% = O/E + vitals△, 9% = CNS△ + oliguria
  • H2O losses 4/2/1 rule: first 10kg = 40cc, 2nd 10kg = 20cc, remaining 1 kg = 1 cc
  • Or 40 + kg = cc/hr maintenance required (multiply by 24 for daily loss)
  • In general 4/2/1 rule overestimates, will have fluid overload, 75-100 cc/hr is a good starting point
  • Replenish rate: initial bolus (20cc/kg, subtract bolus from total), half of deficit in first 8 hours, next half over 16 hours
  • Maintenance lytes: Na = 3 mEq/kg/d; K = 1 mEq/kg/day
  • Maintenance glucose: Adults 100-200 g/day; children 100-200 mg/kg/hr
  • Max KCl replacement 80 mg/d recommended, based on K
  • Target 0.5 cc/kg/hr output
  • In peds, use D5NS for maintenance
  • Albumin 100cc 25% for 4-5L drained (paracentesis) (5-10g of of albumin per L of fluid removed), usually 8g


  • 3 amps bicarb in d5w bag @ 100-250cc/hr





























28 Lac





½ NS





3% NS





D5W ½ NS














28 Lac







⅔ D5W ⅓ NS






Albumin 5%





50 Alb

Albumin 25%





250 Alb







Osmolarity = mOsm/L, Lytes = mEq/L, Glucose or albumin = g/L

Green = isotonic, blue = hypotonic, red = hypertonic



  • Calcium carbonate  500-750-1000-1250 mg po daily, bid or tid
  • Calcitriol 0.25mcg po daily (form of vitamin D that is used to treat low levels of calcium – renal/ parathyroid)
  • Albumin 25% in 100cc IV (corrected Ca – add 0.2 to Ca for every 10 less than 40 in albumin)



  • Calcium gluconate 10ml of 10% solution (1g) IV over 2min (quick save for heart)
  • If non-urgent, infuse over 1hr
    • Calcium Chloride (provides more Calcium compared to Ca-Gluconate) 500-1000mg IV over 2-5min
    • Dextrose 1 amp (50ml of D50W) + 10U regular insulin, repeat POCT glu in 2-4h
    • NaHCO3 50mmol (1 amp) over 5-10 minutes if acidotic
    • Salbutamol 10-20mg neb over 10 min q4h PRN
    • Sodium polystyrene sulfonate (Kayexalate) 15-30g in sorbitol or 100ml H2O PO
    • Furosemide 20-40mg PO/IV q6-8h
    • Fludrocortisone 0.1mg OD/BID PO


HypoKalemia: 100-120mEq replacement = ~1 mmol/L of K

  • Mild-mod (K 3.0-3.5):
  • K+ elixir 40mg PO x1-2  (1.3mmol K/mL, target 20-40 mmol/day, 120mEq to inc 1 K)
  • K-lyte (K Bicarb) 1 tab = 25 mmol K
  • KDur 40mg PO BID (large tablet!)
  • KCl (sustained release or Slow-K) 600mg tab PO OD/BID (8 mmol K/tab, target 20-40 mmol/day)
  • If requiring IV fluids, some bags are pre-mixed with KCl, e.g. 2/3 1/3 + 40mmol KCl, NS + 40 KCl
    • Severe (K <3.0): still prefer PO but if require quickly then IV, or NG if PO difficult
    • 4 x (10 mmol kcl mini bag) IV over 4 hours (1h per 10mEq, causes phlebitis)
      • Must check Mg if K is low: <1 and must check if hypoPhos
      • Mg oxide 2 tabs PO (or 420mg PO daily or BID) – may cause diarrhea
      • Mg sulfate 2g IV over 2 hrs (up to 4-5g at a time)



  • 1g MgSO4 IV = 8mEq mg; Mg Oxide 400mg = 20mgEq mg; MgRougier = 0.4 mEq/mL
  • Mg stores intracellular = drop in levels after replacement
  • Consider PO Mg for ongoing Mg losses (but note Oral Mg may cause diarrhea, worsening hypo Mg)
  • IV replacement:
  • Mild-mod (Mg 0.4-0.66) = MgSO4 2g IV x1-2
  • Severe (Mg < 0.4) = MgSO4 5g IV x1
    • PO replacement: (mild or chronic)
    • Mg Oxide = 400mg 1-2 tabs PO daily
    • MgRougier (liquid) = 1-2 tablespoons (15-30mL) 1-3x daily with meals
      • In emergency/ACLS cases, 4g MgSO4 IV empirically



  • Phosphate Novartis 500mg tabs PO = 16mmol PO4 Pper tab
  • Potassium Phosphate IV = KPhos 22/15 mEq (i.e. 15mmol PO4)
  • Sodium Phosphate IV = NaPhos 20/15 mEq (i.e. 15mmol PO4)
  • PO replacement:
  • Mild (PO4 > 0.4-0.5) = 1 mmol/kg elemental/d, 2-4 doses daily (e.g. Phos Novartis 2 tabs x1 or x2)
  • Mod-Sev (PO4 < 0.4-0.5) = 1.3mmol/kg elemental/d, 2-4 doses daily (e.g. Phos Novartis 2 tabs x3-4 doses BID-QID
  • *Reduce dose by 50% if CKD
  • IV replacement:
  • Mild (PO4 > 0.4) = 0.1-0.25 mmol/kg elemental over 6hrs; e.g. NaPhos 20/15 or KPhos 22/15 IV x1
  • Mod-sev (PO4 < 0.4) = 0.25-0.50 mmol/kg elemental over 8-12 hours; e.g. NaPHOS 20/15 or KPhos 22/15 IV x2


Iron: (from most to least constipating? – likely varying degrees), alternate day dosing once daily

  • Ferrous Gluconate PO
  • Ferrous Sulfate PO
  • Ferromax 50-300mg PO OD
  • Optifer (Heme-iron) PO
  • Proferrin PO
  • Venofer IV



  • Trickle feeds: ENT-resource 2.0 vanilla, 20cc/hr, flush water q6h
  • Vit B12 1000mcg-1200mcg-2000mcg po daily, 1000mcg IM qmonthly
  • Vit D 1000U po daily
  • Vit E 400U po with supper
  • Vit C 500mg po daily-bid
  • Glucosamine/ Chondroiton 500mg tab – 1 tab po daily
  • Sodium bicarbonate 1000mg po daily-bid
  • VitB and VitC with folic acid (Replavite) 1 tab po qAM

EtOH cocktail:

  • Multivitamins 1 tab PO daily
  • Thiamine 100-250mg IV/IM daily x3-5d, then 100mg PO TID x1-2wk, then 100mg PO daily thereafter
  • Or if not very serious, just do PO
    • Folate 400mcg PO daily (if included in multivit, can omit)
    • Vit B6 2mg PO daily (if included in multivit, can omit



  • HFA = hydrofluoroalkane inhalers (previously known as metered dose inhaler MDI), can be used with spacer
  • DPI = similar to HFA but uses dry power instead of liquid mist, cannot be used with a spacer
  • SMI =  soft mist inhalers, a slow moving mist that you inhale



  • Salbutamol (Albuterol/Ventolin) MDI 100mcg 1-2 puffs PRN or 2.5-5mg NEB PRN (up to 40mg/d in severe exacerb)
  • Fenoterol MDI 100mcg 1-2 puffs PRN
  • Terbutaline DPI 500mcg INH PRN


  • Formoterol (Foradil) MDI 6-24mcg INH BID, DPI 4.5-9-12mcg, 1-2 doses BID (max 54mcg/d)
  • Salmeterol (Serevent) MDI 25-50mcg INH BID, DPI 50mcg, 1-2 doses BID (max 20mcg/d)


  • Ipratropium (Atrovent) MDI 20mcg 2 puffs QID or 500mcg NEB QID


  • Tiotropium (Spiriva) MDI 18mcg INH daily or SMI 2.5mcg 1-2 doses daily

ICS: (low-medium-high dosage and note different forms available)

  • Beclomethasone (Qvar) MDI 50-100-200+ mcg BID
  • Budesonide (Pulmicort/TEVA) MDI/DPI 100-200-400+ mcg BID, NEB solution 0.125, 0.25, 0.5mg/ml
  • Ciclesonide (Alvesco) MDI 80-160-320+ mcg once daily
  • Fluticasone Propionate (Flovent) MDI/DPI 50-100-125-250+ mcg BID
  • Mometasone (Asmanex) MDI 110-220-440+ mcg one daily

Combination ICS + LABA:

  • Formoterol + Budesonide (Symbicort) DPI 4.5-9mcg/80-160-320mcg 1-2 doses BID
  • Salmeterol + Fluticasone Propionate (Advair) MDI 25mcg/50-125-250mcg or DPI 50mcg/100-250-500mcg 1-2 doses BID
  • Formoterol + Beclomethasone MDI 6mcg/100mcg 1-2 doses BID
  • Vilanterol + Fluticasone Furoate (Breo Ellipta) DPI 25mcg/100-200mcg 1 dose daily
  • Formoterol + Mometasone (Zenhale) MDI 5mcg/50-100-200mcg 1-2 doses BID



  • S/E: Weight gain, skin thinning, acne, hirsutism, striae, cataract, glaucoma, HTN, PUD, pancreatitis, hepatitis, hypokalemia, amenorrhea, infertility, osteoporosis, AVN, psychiatric, DM, infections/immunosuppresion
  • Prednisone 50mg PO OD x5 days
  • 1.5mg dexamethasone = 8 methylprednisolone = 10mg prednisone = 10mg prednisolone = 40mg hydrocortisone = 50mg cortisone
  • Prednisone 5-60mg PO daily with tapering 5mg/day
  • Day 1: 30mg → 10/5/5/10
  • Day 2: 25mg → 5/5/5/10
  • Day 3: 20mg → 5/5/5/5
  • Day 4: 15mg → 5/5/5/0
  • Day 5: 10mg → 5ac/0/0/5hs
  • Day 6: 5mg → 5ac/0/0/0
  • Prednisone 1mg/kg/day PO (max 80mg/day)
  • Prednisolone 1.5-2mg/kg (max 120mg) every other day
  • COPDe 40-60mg PO 5-14d
  • Taper required if: 20mg+ pred >3 wks, bedtime >5mg pred for more than a few weeks, cushingoid
  • No taper: any dose <3wks, alternate 10mg pred
  • In between, unclear if taper required



  • Mupirocin 2% (Bactroban) Ointment TID 3-5-10d
  • Protopic (tacrolimus) (immune modulator, non-steroidal)
  • Erythromycin ointment BID (up to 6-8 weeks)
  • Selenium sulphide shampoo (anti-fungal)
  • Terbinafine (lamasil) cream/gel (anti-fungal)
  • Ketoconazole (Nizoral) 1-2% shampoo/cream/ointment (anti-fungal)
  • Clotrimazole 1-2% cream/ointment (anti-fungal, candidiasis)
  • Itraconazole PO 200mg BID for 1st week of month for 2-3mo (anti-fungal)
  • Nystatin cream/ointment (candida) BID – oral formula for oral candidiasis
  • Hydrocortisone 1% and Clotrimazole 1% cream – 1app daily
  • Zinc oxide 20% paste apply to affected area BID (diaper rash)
  • Topical anti-viral (Acyclovir, Penciclovir) or oral anti-viral (Famiciclovir, Valaciclovir)
  • Permetrin 5% Cream/Lotion (anti-parasitic, scabies)
  • Glaxal base or aquifor moisturizer
  • (x1 steroid potency) Hydrocortisone 1%
  • (x3) Hydrocortisone 2%<, 17-valerate 0.2%, desonide, mometasone furorate
  • (x6) Betamethasone 0.1%, 17-valerate 0.1%, amcinonide
  • (x9) Bethamethasone, diproprionate 0.05%, flucinonide 0.05%
  • (x12) Clobetasol proprionate, betamehtasone, dipropionate ointment, halobetasol propionate





  • Atorvastatin (Lipitor) 20-40-80mg po daily
  • Rosuvastatin (Crestor) 20mg po qHS

Thiazides: (NaCl blocker)

  • HCTZ 12.5-25mg PO qAM
  • Chlorthalidone 12.5-25-50-100mg PO OD, max 100mg/d
  • Indapamide 1.25-5mg PO OD
  • Metalozone 2.5-10mg PO 30-60min before furosemide (if diuretic resistant)

Non-DHP CCBs: Heart-specific

  • Verapamil 80-160mg PO TID (if SR, total daily dose will remain same but OD)
  • Verapamil 0.075-0.15mg/kg (usually 2.5-5mg push) IV over 2 min
  • Diltiazem 15-20mg (0.25 mg/kg) slow push IV over 2 min, repeat 0.35 mg/kg in 15-30m
  • Diltiazem 120-480mg PO OD

DHP CCBs: Vessel-specific

  • Amlodipine 2.5-5-7.5-10mg PO OD, max 10mg/d
  • Nifedipine 10-20mg PO TID, max 180mg/d
  • Nifedipine SR: 30-60-90mg PO OD, max 120mg/d


  • Hydralazine 10mg PO q6h PRN, max 300mg/d (arterial)
  • Hydralazine 10-20mg IV q4-6h PRN, max 80mg/d
  • Nitroglycerin spray 0.4mg sublingual PRN or q5min x3 (up to 3 doses) (not for R infarct, check V4R and if inferior infarct need to confirm not R infarct involved)
  • Nitroglycerine patch 0.2-0.4-0.8 mg/hr transdermal, 12h on/12h off
  • Nitroglycerine infusion at 5mcg/min IV
  •  increased by 5mcg/min q5min to effect, effective dose is 5-100 mcg/min, max 200 mcg/min
  • Start 50mcg/min, may need pressors
    • Labetalol (α1B1B2): 5-20mg IV bolus, then 20-80mg q10min (crisis) OR 2mg/min IV infusion (loading) then 2-8mg/min, max total 300mg
    • Sodium nitroprusside: 0.25-10 mcg/kg/min (crisis) – NOT for ischemic heart disease
    • Start infusion at 0.25 mcg/kg/min, titrate upward q5min to effect, effective dose is 2-5 mcg/kg/min, max 10
    • More of an arterial dilator, whereas nitroglycerin is more of a venodilator
      • BiDil (Hydralazine/Isosorbide Nitrate): 37.5mg/25mg PO TID


  • Extended Release Metoprolol Succinate (β1) 12.5mg-25-50, max 200mg, OD
  • Metoprolol Tartrate (β1) 50mg PO  BID, max 400mg/day
  • Metoprolol (β1) 1mg-5mg IV over 1 min, q5min x3
  • Bisoprolol (β1) 1.25-2.5-10mg PO OD, max 10mg/d
  • Atenolol (β1) 50-150mg po qHS
  • Carvedilol (α1β1β2): 3.125mg, max 25mg, BID
  • Labetalol (α1β1β2): 100-800mg PO OD/BID; 10-20mg IV push over 2 minutes q1h PRN (max 80mg/dose; total 300mg/d)
  • Esmolol (fast-acting β1) 0.5mg/kg over 1min followed by 50 mcg/kg/min, can repeat bolus after 4min if response inadequate and increase infusion to 100/150/200 mcg/kg/min (can repeat every 4 min and increase infusion up to 200)


  • Lisinopril 5mg, max 40mg, OD
  • Ramipril 2.5-5-7.5-10mg, max 20mg, PO qhs
  • Perindopril (Coversyl) 2-16mg OD, max 16mg/d
  • Captopril 6.25-50mg PO TID or q6h (fast acting)
  • Enalapril 1.25-10mg PO BID
  • Enalaprilat 0.625-1.25-5mg IV over 5 min q6-8h


  • Valsartan 40mg, max 320, OD
  • ARNI/ARB (Sacubitril/Valsartan) (ARNI acts on neprilysin, decreases BNP action) entreso
  • Candesartan

Loop diuretic: (NaKCl blocker)

  • Furosemide/Lasix: 20-40mg, Max 120 (sort of), OD/BID PO/IV (PO:IV = 2:1)
  • Normal renal function -> 40-80mg IV bolus, can give BID if good response, max 80mg
  • Renal insufficiency -> 100-200mg IV bolus, can give BID, max 200mg

K-Sparing diuretic:

  • Spironolactone: 25-37.5mg OD/BID



  • Dopamine
  • Moderate doses 3-10mcg/kg/min: β effects predominate
  • Higher doses 5-15mcg/kg/min: α effects predominate <– preferred dosing range
    • Dobutamine: 2.5-5mcg/kg/min increase 3-5mcg/kg/min, usual range 5-20 mcg/kg/min
    • Milrinone: 50mcg/kg over 10min, then infuse at 0.375-0.75mcg/kg/min, max daily 1.13mg/kg



  • Norepi (levophed) (α+β1): 0.02-3.5mcg/kg/min titrate upwards to target MAP 65, if MAP not achieved at 3.5 then a second pressor is required (usually vasopressin, or dopamine –  this is site dependent)
  • TOH uses 2-30 mcg/min (non-weight based dosing), don’t bolus
    • Dopamine:
    • Moderate doses 3-10mcg/kg/min: β effects predominate
    • Higher doses 5-15mcg/kg/min: α effects predominate <– preferred dosing range
      • Vasopressin (ADH, AVP): 0.01-0.04 units/min (usually 0.03) or 2 units/h
      • Epi (α+β1,2) 1mg IV bolus or 0.05-0.5mcg/kg/min, from crash cart can push 0.5cc each time
      • Phenylephrine 50-100mcg IV bolus; 0.1-1.0 mcg/kg/min IV infusion (caution in pHTN)
      • Ephedrine


Digoxin: NaK ATPase inhibitor

  • Digoxin 0.5mg IV followed by 0.25mg IV q6h x2 for full loading dose, then 0.125-0.25mg PO daily (frail elderly with low BMI should consider 0.0625mg PO daily), therapeutic range 0.6-1.2ng/ml (toxic >2.4)


Alpha blocker:

  • Terazosin 2-20mg PO daily (a1 blocker)
  • Phentolamine 1-5mg IV q5-15min push


Alpha 2 agonist: Clonidine for anti-hypertensive, Dexmed for sedation

  • Clonidine 0.1mg PO BID, recommended <0.6mg/day, risk of rebound HTN when stopped
  • Dexmedetomidine (Precedex) 1mcg/kg over 10 minutes loading, followed by 0.2-1.5mcg/kg/hr titrated to effect, generally recommended duration <72hrs



  • Amiodarone 150mg IV bolus over 10 min, q10-15 min, max 2.2g/d (300mg – arrest), then infusion @ 1 mg/min for 6h, then 0.5 mg/min for 18 hours
  • Amiodarone IV infusion 900-1200mg/d (10-20 mg/kg/day)
  • Procainamide 20-50mg/min, max 17mg/kg, then 1-4mg/min maintenance infusion until suppressed arrhythmia
  • Atropine 0.5-1.0mg IV fast push q3-5m, max of 0.04 mg/kg (max ~3mg/d)
  • Adenosine 6mg IV rapid push over 3 seconds, may repeat 12 mg IV q2-3m x2
  • nDHP CCB (dilt and verap) – see above
  • Epi 1 mg IV q3-5 min no max – for ARREST only, anaphylaxis is 0.3mg IM thigh
  • Lidocaine 1-1.5 mg/kg (~50mg), repeat at 0.5-0.75 mg/kg q5-10 min, max 3 mg/kg (~150mg)
  • Magnesium sulphate 1-2g IV push dilauted in 10 ml NS (may drop BP, renal failure)
  • Sodium bicarbonate 1 mEq/kg IV, may repeat half dose in 10m


Receptor effects:

  • α1 effects: vasoconstriction
  • β1 effects:
  • Heart: HR+ (SA node), conduction+ (AV), contractility+
  • Posterior pit: ADH secretion
  • Kidney: vasoconstriction, renin release
    • β2 effects:
    • Arterial vasodilation (and bronchodilation)
    • Kidney: Renin release (BP+), vasodilation



  • Throat lozenge 1 loz po tid PRN
  • Nystatin 500,000U swish and swallow qid
  • Saliva substitute 1 spray po PRN
  • Normal saline spray 1 spray nasal q4h PRN
  • Cetirizine (Reactine) 5-10mg PO daily (2ng gen Anti-H1)
  • Loratidine (Claritin) 5mg PO OD/BID(2nd gen Anti-H1)
  • Steroid nasal sprays q12 2-3w: flunisolide (Rhinalar), budesonide (Rhinocort), Triamcinolonoe (nasacort), Beclomethasone (beconase), mometasone furoate monohydrate (nasonex)
  • Nasal lubricants: Saline, NeilMed, Rhinaris, Secaris, Polysporin, Vaseline
  • Decongestants: Xylometazoline (Otrivin), Oxymetazoline (Dristan), Phenylephrine (Neosynephrine)


▪   Latanoprost eye drops – 1 drop in each eye qHS
▪   Cosopt eye drops – 1 drop in each eye bid
▪   Tobradex eye drops 2 drops in each eye q4h
▪   Timolol 0.5% eye drops 1 drop in both eyes bid



  • Pantoprazole 40mg PO daily/ bid or 40mg IV bolus BID (PPI)
  • Pantoprazole 80mg IV then 8mg/hour infusion for 72h
  • Octreotide 50mcg IV bolus followed by 50mcg/hr infusion (Somatostatin)
  • Metoclopramide (Maxeran) 5-10mg SQ ac and qHS (DA R antagonist and pro-kinetic)
  • Metoclopramide (Maxeran) 5-10mg po/IV q6h PRN
  • Erythromycin IV 3mg/kg over 5 minutes (at least 15 minutes prior to EGD)
  • Ranitidine (Zantac) 75-150mg PO BID (H2 receptor antagonist)
  • Antacid 30ml po bid PRN
  • Domperidone 10mg po daily-tid (peristaltic stimulant)
  • Budesonide 9mg po daily (steroid)
  • Cholestyramine 4g po daily (prevents bile acid absorption, anti-diarrheal)
  • Anusol 1 application pr PRN (hemorrhoids)
  • Pink lady (1:1 lidocaine 2% viscous + antacid 30ml)
  • Calcium carbonate 500mg PO QID PRN (Antacid)
  • Sucralfate 1g ac meals/tid PO (for ulcers/acid)
  • Loperamide (Imodium) 4mg PO , max 16mg/day – (gut opioid receptor) NOT for gastro





  • Epi (1:1000) 0.3-0.5mg IM lateral thigh (which is 0.3-0.5 mL from the 1:1000 syringe)
  • Epi (1:1000) 5-15 mcg/min IV
  • Diphenhydramine (Benadryl) 50mg IM/IV (1st gen anti-H1) OR cetirizine (reactine) 10mg PO x1 (2ng gen anti-H1)
  • Ranitidine 50mg IV (anti-H2)
  • Methylprednisone 125mg IV or 1mg/kg IV q6h x 24h
  • If on β-blockade, glucagon 1-5mg IV over 5 min, then infuse 5-15mcg/min titrated to response
  • May consider a SABA (ventolin)



  • Pantaloc 80mg IV bolus, then infuse at 8mg/h x 48-72 hours (or 40mg IV BID x48-72hr)
  • Obtain 2 large bore IV
  • CBC, type and screen, transfuse as necessary
  • Octreotide 50 mcg IV bolus then 50 mcg/h after  (splanchnic artery vasoconstriction)
  • NS 1L bolus
  • Ceftriaxone 2g IV x 1 then 1g q24 h x 5 days



  • NS 1L bolus
  • Metoclopramide (Maxeran) 10 mg IV
  • Ketorolac (Toradol) 10-30mg IV
  • Acetaminophen 975mg PRN q4-6 hrs, max 4g/day
  • Magnesium 1g IV over 15 minutes
  • Dexamethasone 10mg IV (for chronic)
  • Intranasal sphenopalatine ganglion block 3cc of 2% lido without epi, slow administration over 30 seconds



  • Glycopyrrolate 0.2-0.4mg subcut q2-4h PRN for secretions (less sedating)
  • Hyoscine Hydrobromide (Scopolamine) 0.2-0.4mg subcut q2-4h PRN for secretions (more sedating)
  • Eyes: artificial tears, lacri-lube eye ointment
  • Noses: Salinex nasal gel
  • Oral: Regular mouth care, gels, biotene
  • GI: Suppository PRN, Tylenol PR PRN
  • GU: Pads, foley PRN
  • Skin: Pressure area care
  • D/C Vitals, investigations, life-prolonging treatments, ICD, ?oxygen, fluids
  • ROS: Pain, dyspnea, anxiety, delirium, PO intake, bowel/bladder function, goals of care, mood