DOSE OBAT-OBATAN CONTINOUS, KOREKSI ELEKTROLIT, DLL

DOSE OBAT-OBATAN CONTINOUS, KOREKSI ELEKTROLIT, DLL

1. DEXMEDETOMIDINE Dexmedetomidine Postoperative Sedation. Dexmedetomidine (0.2 to 0.7 mcg/kg/hour IV) is useful for sedation of postoperative criticalcare patients in an ICU environment, particularly when mechanical ventilation via a tracheal tube is necessary.

2. PROPOFOL Propofol Intravenous Sedation The short context-sensitive half-time of propofol, combined with the short eff ect -site equilibration time, make this a readily titratable drug for production of IV sedation. Prompt recovery without residual sedation and low incidence of nausea and vomiting make propofol particularly well suited to ambulatory conscious sedation techniques. The typical conscious sedation dose of 25 to 100 mcg/kg/minute IV produce minimal analgesic and amnestic effects. In selected patients, midazolam or an opioid may be added to propofol for continuous IV sedation.MidazolamIntravenous Sedation.

3. MIDAZOLAM Midazolam in doses of 1.0 to 2.5 mg IV (onset within 30 to 60 seconds, time to peak effect 3 to 5 minutes, duration of sedation 15 to 80 minutes) is eff ective for sedation during regional anesthesia as well as for brief therapeutic procedures. The most significant side effect of midazolam when used for sedation is depression of ventilation. Midazolam-induced depression of ventilation is exaggerated (synergistic eff ects ) in the presence of opioids and other CNS depressant drugs. Increasing age greatly increases pharmacodynamic variability and is associated with generally increased sensitivity to the hypnotic eff ects of midazolam.

4. Nicardipine Dosis : 5 - 15 mg/jam atau 20—30 mCg/ IV Onset 1 – 5 min, Durasi 3 - 4 jam Amiodarone Dosis 5 mg/kg IV

5. AMINOPHILIN Oral Administration : The extended-release tablets are absorbed slowly over 12 to 24 hours and provide a steady plasma concentration. The recommended dose ranges from 400 to 600 mg/day. Intravenous Administration Loading dose : 5,7mg/kg / Ideal Body Weight. Loading doses should be administered over 30 minutes at a rate not to exceed 21 mg/hr . This dose is for patients who have not taken aminophylline in the past 24 hours.

6. Intravenous Administration Loading dose : 5,7mg/kg / Ideal Body Weight. Loading doses should be administered over 30 minutes at a rate not to exceed 21 mg/hr . This dose is for patients who have not taken aminophylline in the past 24 hours. Maintenance Dose : Up to 1 mg/kg/hour as a constant infusion can be given depending on the ideal body weight and clearance rates. AMINOPHILIN

7. Dosing Considerations Hepatic Impairment: Patients with hepatic dysfunction due to cirrhosis or any other cause require a dose adjustment. The maximum dose for such patients can't exceed 400 mg/day. Renal Impairment: No dose adjustments are needed for renal impairment in adults or children older than three months. However, in infants younger than three months, a large amount of theophylline is excreted in the urine, requiring a dose adjustment. Smokers: Smokers require a higher dose as their clearance rates of theophylline are faster than non-smokers. Concurrent Illness: A good rule of thumb is that the maximum dose should not exceed 400 mg daily due to varying clearance rates for different concurrent illnesses. AMINOPHILIN

8. INOTROPIK & VASOPRESSOR

9. BICNAT Example: Calculate the amount of NaHCO3 necessary to correct a base deficit (BD) of –10 mEq /L for a 70-kg man with an estimated HCO3– space of 30%: NaHCO3 = BD × 30% × body weight in L NaHCO3 = –10 mEq /L × 30% × 70 L = 210 mEq (In practice, only 50% of the calculated dose ( eg , 105 mEq ) is usually infused, after which another blood gas is measured.)

10. TRIPLE DRUG HIPERKALEMIA Calsium Glukonas 10% sebanyak 10 cc dalam waktu 2 menit. Insulin : diberikan 10 unit IV, untuk mencegah hipoglikemia diberikan D40% 50 cc diberikan pelan selama 15-30 menit. Pertimbangkan khusus untuk pasien DM Β 2-agonist: Albuterol 10-20 mg dengan NaCl 0,9% 4cc dengan nebulizer dalam waktu 10 menit.

11. TRIPLE DRUG HIPERKALEMIA

12. KOREKSI KALIUM Koreksi Hipokalemia = [4-(kalium saat ini )] x 0.3 x BB Koreksi Kalium melalui jalur IV perifer tidak melebihi 8 mEq /h Koreksi Kalium lebih cepat (10–20 mEq /h) harus melalui jalur sentral Koreksi Kalium IV tidak melebihi 240 mEq / hari

13. Hipernatremia  Koreksi dengan mengganti Water Deficit dengan D5% in water dalam 48 jam Estimasi Total Body Water (TBW)  Konstanta ( Pria 0.6, Wanita 0.4) x BB Normal TBW x 140 = Present TBW x Present Na Plasma Cari Present TBW, lalu hitung WD Hitung Water Deficit (WD) Normal TBW – Present TBW = …...L ( Habis dalam 48 jam) Hiponatremia Na deficit = TBW x (desired Na – present Na) Laju koreksi : Mild symptoms : 0,5 mEq /L/jam Moderate symptoms : 1 mEq /L/jam Severe symproms : 1,5 mEq /L/jam KOREKSI NATRIUM

14. KOREKSI KALSIUM Hipokalsemia ringan Ca CO3 ( Kalsium Karbonat /tablet kalsium ) 500 mg/ 8 jam Berat Ca Glunoas 1 amp iv pelan-pelan dalam NaCl Hiperkalsemia Terapi diberikan bila ada timbul gejala klinis hidrasi adekuat 3000 - 6000 mL cairan NaCl 0,9% + / oop diuretic (furosemide 20-40 mg/ lV /2 jam) Menghambat reabsorbsi tulang ( Kalsitonin , Bifosfonat , Gallium nitrat ) Mengurangi absorbs kalsium dari usus ( Glukokortikoid [prednisone, 20- 40 mg/ hari ]) Hemodialisis /dialysis peritoneal

15. PLASMA OSMOLALITY Plasma osmolality ( mOsm /kg)