Meds

Question 1

What is the first-line drug for hypotension in septic shock?

Answer 1

Noradrenaline (norepinephrine)

📈 Start: 0.02 µg/kg/min
💉 Route: Central line via syringe driver
📈 Usual range: 0.02–1 µg/kg/min
⚙️ Pump rate (standard 4 mg in 50 mL)
→ ≈ 1–25 mL/hr (for 70 kg, depending on dose)
📘 Titrate to maintain MAP ≥65 mmHg

Question 2

What is the 2nd-line agent for refractory hypotension?

Answer 2

Vasopressin

💉 Route: Central line infusion
📈 Fixed dose: 0.03 units/min (≈1.8 units/hr)
📘 Not titrated; used as adjunct to noradrenaline.

Question 3

What can be added for persistent hypotension despite dual vasopressors?

Answer 3

Hydrocortisone 50 mg IV QDS (for possible adrenal insufficiency)

Question 4

What is first-line for acute hypertension (ICU or emergency setting)?

Answer 4

GTN (Glyceryl Trinitrate) infusion

📈 Start: 5–10 µg/min
📈 Range: up to 200 µg/min
⚙️ Pump rate (50 mg in 50 mL = 1 mg/mL)
→ 5 µg/min = 0.3 mL/hr, 100 µg/min = 6 mL/hr
📘 Reduce gradually to avoid rebound hypertension.

Question 5

What is first-line for long-term BP control in stable patients?

Answer 5

💊 Amlodipine (CCB) — if >55 or Black origin
💊 Ramipril (ACE inhibitor) — if <55 or diabetic

Question 6

What is first-line for agitation or delirium in ICU?

Answer 6

Haloperidol

📈 Dose: 0.5–2 mg PO/IV PRN
📈 Max: 10 mg/24 hr
📘 ECG monitor (QT prolongation risk)

Question 7

What is an alternative if haloperidol contraindicated (e.g. prolonged QT)?

Answer 7

Quetiapine

📈 Start: 25–50 mg PO nocte
📈 Range: up to 200 mg/day
📘 Fewer extrapyramidal effects, useful in hyperactive delirium.

Question 8

What sedative is first-line for ventilated ICU patients?

Answer 8

Propofol

📈 Range: 0.5–4 mg/kg/hr
💉 Route: Central line infusion
⚙️ Pump rate (1% = 10 mg/mL)
→ ~3–15 mL/hr for a 70 kg patient
📘 Avoid >4 mg/kg/hr due to risk of Propofol Infusion Syndrome.

Question 9

Alternative sedative with opioid properties?

Answer 9

Remifentanil

📈 Range: 0.05–2 µg/kg/min
💉 Route: Central infusion
⚙️ Pump rate (2 mg in 50 mL = 40 µg/mL)
→ ≈ 5–20 mL/hr for 70 kg
📘 Rapid offset, good for weaning trials.

Question 10

Adjunct sedative/analgesic with antihypertensive effects?

Answer 10

Clonidine

📈 Bolus: 150 µg IV
📈 Infusion: 0.5–2 µg/kg/hr
📘 Reduces norad requirements; causes bradycardia/hypotension

Question 11

What is Digoxin used for?

Answer 11

AF rate control and heart failure with AF

📈 IV dose: 500 µg, then 250 µg q6h ×2 (max 1 mg/24h loading)
📈 Maintenance: 125–250 µg once daily
📘 Adjust for renal function; monitor K⁺ and digoxin level (0.8–2.0 µg/L).
⚠️ Toxicity = bradycardia, visual halos, nausea.

Question 12

What is first-line for stress ulcer prophylaxis in ICU?

Answer 12

Omeprazole 20–40 mg OD IV/PO
📘 Reduces gastric bleeding risk on ventilators.

Question 13

Alternative to omeprazole?

Answer 13

Lansoprazole 30 mg OD PO/NG
📘 Slightly quicker onset, more consistent absorption via NG tube.

💬 Which is better?
➡️ Clinically equivalent for acid suppression.

Omeprazole preferred if IV needed.

Lansoprazole better if enteral route (esp. NG).

Question 14

First-line bronchodilator neb?

Answer 14

Salbutamol

Route: Neb / IV

Neb: 2.5–5 mg q4–6h (max 40 mg/day)

IV bolus: 250 µg over 1 min

Infusion: 1–20 µg/min

Example mix: 10 mg/50 mL → start 15 mL/hr ≈ 50 µg/min

Notes: Check K⁺, HR, tremor.

Question 15

Mucolytic therapy for sputum clearance?

Answer 15

Carbocisteine 750 mg TDS, reduce to BD once improved.
💨 Adjunct: Hypertonic saline neb (3–7%, 2–5 mL TDS).

Question 16

First-line in hypertensive emergency (IV control)?

Answer 16

GTN infusion (for ACS/pulmonary oedema) or labetalol IV (for neuro causes).

Question 17

First-line anti-arrhythmic for AF with fast ventricular rate?

Answer 17

Beta-blocker (metoprolol IV) or amiodarone IV if LV dysfunction.

Question 18

First-line steroid in acute asthma/COPD exacerbation?

Answer 18

Prednisolone

Route: PO

Start: 20–40 mg daily

Range: 5–60 mg OD

Max: 100 mg/day

Notes: Morning dose, taper if >40 mg > 1 wk.

Or if unable to swallow

Route: IV / IM / PO

Stress dose: 50 mg IV q6h or 100 mg stat → 50 mg q6h

Infusion: 200 mg/50 mL at 2 mL/hr (≈ 4 mg/hr)

Max: 300–400 mg/24 h

Notes: Add in refractory shock; taper as pressors fall.

Question 19

First-line anti-emetic?

Answer 19

Ondansetron

Route: IV / PO

Start: 4 mg IV/PO q8h

Range: 4–8 mg q8–12h

Max: 16 mg/24 h

Notes: QT prolongation, constipation.

Question 20

First-line for simple constipation?

Answer 20

Macrogol (Movicol / Cosmocol)

Route: PO / NG

Start: 1–2 sachets daily

Range: 1–3 sachets/day

Max: up to 8 sachets/day (esp. faecal impaction)

Notes: Osmotic laxative → draws water into stool; mix each sachet in 125 mL water.

Question 21

If stool is hard and dry?

Answer 21

Lactulose

Route: PO / NG

Start: 15 mL BD

Range: 15–45 mL 1–3×/day

Max: ~60–90 mL/day

Notes: Osmotic; adjust for 2 soft stools/day. Used also for hepatic encephalopathy (aim 2–3 loose stools).

Question 22

If stool is soft but difficult to pass?

Answer 22

Senna

Route: PO (tablet or syrup)

Start: 7.5–15 mg nocte

Range: 7.5–30 mg at night

Max: 30 mg/24 h

Notes: Stimulant laxative; avoid long-term use (colonic atony risk).

Question 23

If severe faecal impaction?

Answer 23

Phosphate Enema

Route: PR (rectal enema)

Dose: 1 enema (≈ 128 mL) as single dose

Max: Usually once; rarely repeat after 24 h

Notes: Rapid onset (5–15 min). Avoid in renal impairment or bowel obstruction (phosphate load, perforation risk).