BADDIE RN Today's drug
The last six days

Drug of the Day history

Six days of cards in one scroll — rationale, dosing, monitoring and the pearl. Today's card is Adenosine.

Tuesday, September 8
Alpha and beta agonist catecholamine

⚡Epinephrine

Brand: Adrenalin
High alert

Three very different concentrations. Grabbing the wrong one is the classic sentinel event.

Why it works

Alpha-1 vasoconstriction raises coronary and cerebral perfusion pressure during CPR; beta-1 increases rate and contractility; beta-2 bronchodilates. In anaphylaxis it is IM into the thigh because that absorbs fastest and reliably.

Quick dosing reference

  • ›Cardiac arrest: 1 mg (10 mL of 1:10,000) IV/IO q3–5 min
  • ›Anaphylaxis: 0.3–0.5 mg (1:1000) IM into vastus lateralis q5–15 min
  • ›Infusion: 0.01–0.5 mcg/kg/min titrated to MAP
IV immediate · IM 3–5 min

What you monitor

  • •Continuous ECG, BP, and perfusion
  • •IV site — extravasation causes necrosis (phentolamine antidote)
  • •Glucose and lactate on infusion

Watch out

1:1000 is the IM ampule. 1:10,000 is the arrest syringe. Say the concentration out loud with a second nurse.

Baddie pearl

Arrest = 1:10,000 IV. Anaphylaxis = 1:1000 IM thigh. Never mix them up.

Monday, September 7
Benzodiazepine antagonist

⏱️Flumazenil

Brand: Romazicon
High alert

Reverses versed — and can drop a chronic benzo patient straight into seizures.

Why it works

Competitive antagonist at the GABA-A benzodiazepine site. It restores consciousness and respiratory drive, but removing GABA tone abruptly is exactly what lowers the seizure threshold.

Quick dosing reference

  • ›0.2 mg IV over 15 sec, then 0.2 mg q1 min as needed
  • ›Max total 1 mg (3 mg in an hour)
  • ›Duration 40–60 min — shorter than midazolam
IV 1–2 min · peak 6–10 min

What you monitor

  • •LOC and RR continuously for at least 2 hrs
  • •Seizure precautions at the bedside
  • •Re-sedation as it wears off

Watch out

Avoid in chronic benzodiazepine users, TCA overdose, or anyone on benzos for seizure control.

Baddie pearl

Support the airway first. Flumazenil is a decision, not a reflex.

Sunday, September 6
Alpha-1 and non-selective beta blocker

🩺Labetalol

Brand: Trandate
High alert

The PACU hypertension workhorse — after you rule out pain, bladder, and hypoxia.

Why it works

Blocks alpha-1 (vasodilation, lower SVR) and beta (lower HR and contractility) at roughly a 1:7 ratio IV. That combination drops pressure without the reflex tachycardia you get from a pure vasodilator.

Quick dosing reference

  • ›10–20 mg IV over 2 min, then 20–80 mg q10 min
  • ›Cumulative max around 300 mg
  • ›Infusion: 0.5–2 mg/min titrated to MAP goal
IV 2–5 min · peak 5–15 min · duration 2–4 hrs

What you monitor

  • •BP q5 min after each dose
  • •HR — bradycardia is the limiting side effect
  • •Orthostatics before first ambulation

Watch out

Post-op hypertension is usually pain, a full bladder, or hypoxia. Treat the cause before you flatten the pressure.

Baddie pearl

Check the bladder scanner before you reach for labetalol.

Saturday, September 5
Opioid agonist

💉Hydromorphone

Brand: Dilaudid
High alert

Roughly 5–7x more potent than morphine — the decimal point matters.

Why it works

Mu-receptor agonist that blunts pain transmission centrally. Less histamine release than morphine, so it is gentler on blood pressure — but the respiratory depression curve is steeper because the effective dose is so small.

Quick dosing reference

  • ›PACU titration: 0.2–0.4 mg IV q5–10 min to effect
  • ›Typical adult IV: 0.2–1 mg q2–3 hrs
  • ›IV : PO ratio roughly 1 : 5
IV 5 min · peak 15–20 min · duration 3–4 hrs

What you monitor

  • •RR and sedation score before each dose
  • •Pain score 15 min after each dose
  • •SpO2 and ETCO2 in the sedated patient

Watch out

Never dose off pain score alone. A sedation score that climbs while pain stays flat means stop, not repeat.

Baddie pearl

Sedation always precedes respiratory depression. Watch the eyes, not just the number.

Friday, September 4
5-HT3 antagonist antiemetic

🤢Ondansetron

Brand: Zofran

PONV first-line — and the reason you glance at the QTc before you push.

Why it works

Blocks serotonin receptors in the chemoreceptor trigger zone and vagal afferents in the gut, which is where anesthesia-driven nausea starts. It works best as prevention; once vomiting starts you need a second class.

Quick dosing reference

  • ›PONV treatment: 4 mg IV over 2–5 min
  • ›PONV prophylaxis: 4 mg IV at end of surgery
  • ›Max 16 mg single dose IV (QT risk)
IV 10–30 min · duration 4–8 hrs

What you monitor

  • •QTc on the monitor
  • •Headache (most common complaint)
  • •Actual nausea relief at 15 and 30 min

Watch out

Stacking ondansetron on ondansetron does not work. If 4 mg failed, switch class — dexamethasone, promethazine, or scopolamine.

Baddie pearl

Failed Zofran? Change the receptor, not the dose.

Thursday, September 3
Opioid antagonist

🚨Naloxone

Brand: Narcan
High alert

The PACU rescue drug — but the wrong dose buys you a screaming, tachycardic patient.

Why it works

Competitively displaces opioids from mu receptors, so respiratory drive comes back. It reverses sedation and analgesia at the same time — which is why you titrate to respiratory rate, not to wide-awake.

Quick dosing reference

  • ›Respiratory depression, post-op: 40 mcg (0.04 mg) IV q1–2 min, titrated to RR
  • ›Dilute 0.4 mg in 10 mL NS = 40 mcg/mL for careful titration
  • ›Full arrest/apnea: 0.4–2 mg IV push, repeat q2–3 min
  • ›Intranasal: 4 mg one spray, alternate nostril q2–3 min
IV 1–2 min · IN 2–5 min · duration 30–90 min (shorter than most opioids)

What you monitor

  • •RR, SpO2, ETCO2 and sedation score continuously
  • •BP and HR — abrupt reversal causes catecholamine surge
  • •Re-sedation for at least 2 hours; long-acting opioids outlast naloxone

Watch out

Naloxone wears off before the opioid does. Never send the patient to the floor unmonitored after a reversal.

Baddie pearl

Titrate to breathing, not to awake. 40 mcg at a time keeps pain control intact.

Educational reference only. Doses shown are typical adult ranges and are not a substitute for your facility protocol, pharmacy, prescriber orders, or clinical judgment. Always verify before administration.

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