Scenario – you are the IV pharmacist in a critical care pharmacysatellite, which provides services from 0800 to 1630. At 1615, youreceived the following order: • Epinephrine continuous infusion in0.9% sodium chloride. Begin at 0.01 mcg/kg/minute and titrate tomaximum of 0.5 mcg/kg/min per standard blood pressure protocol. Useadjusted body weight for calculations due to large fluid gain overthe past few days. You look up the patient and find the followinginformation JB is male, 6 foot 1 inch in height, and his currentweight is 177 kg, with a 30 kg increase over the last few days. Inaddition, he has only one central line for all current medications.Fortunately, he has only three other meds infusing: •Piperacillin/Tazobactam 4.5 gm q12 hours • 0.9% normal saline 1000mls, with 100 mEq Sodium Bicarbonate infusing at 50 mls/hr. •Midazolam infusion at 0.1 mg/hour
You have received a request from the RN to get enough of theepinephrine drip to get through the next 24 hours, since thepatient is so critical
1. What is JB’s ideal body weight?
a. 74.9 kg
b. 79.9 kg
c. 84.9 kg
d. 89.9 kg
2. What is the adjusted weight for dosing the epinephrine?
a. 118.7 kg
b. 123.7 kg
c. 128.7 kg
d. 133.7 kg
3. At maximum rate, how much mg epinephrine would JB need in anhour?
a. 3.6 mg
b. 3.7 mg c. 3.9 mg
d. 4.0 mg
4. The standard preparation for an epinephrine drip is 8 mg/250mls of 0.9ml sodium chloride. Given that the standard concentrationof epinephrine is 1 mg/ml, how much would you need to add to the250 ml bag to compound it?
a. 8 ml
b. 10 ml
c. 12 ml
d. 14 ml
5. Assuming the 250ml bag of 0.9% sodium chloride is exactly 250mls, what is the final concentration of the epinephrine?
a. 31 mcg/ml
b. 35 mcg/ml
c. 39 mcg/ml
d. 44 mcg/ml
6. Given the standard preparation for the drip (8 mg/250 ml),what would be the rate (per hour) to deliver 1 mg?
a. 29.5 ml/hr
b. 31.2 ml/hr
c. 33.0 ml/hr
d. 34.5 ml/hr
