Sample Drug 5
Classification
Sedative
Analgesic
Dissociative anesthetic
Indications
PCP: Analgesia
ACP: Analgesia
ACP: Induction of sedation prior to intubation
ACP: Procedural sedation
ACP: Severe agitation or excited delirium syndrome
Contraindications
Hypersensitivity or allergy to ketAMINE
Unable to manage the adverse effects of ketAMINE
Conditions where elevated blood pressure may be harmful
Age < 6 months
Adult dosages
PCP: Analgesia
Requires additional training and endorsement
- Intransal: 0.75 mg/kg
- May repeat 0.5 mg/kg after 20 minutes
- Contact CliniCall for additional dosing instructions
- See Procedure Pxx for intranasal drug administration guidelines
ACP: Analgesia
- Intravenous/Intraosseous: 0.3 mg/kg slow push
- May repeat 0.15 mg/kg after 5 minutes
- Maximum total dose 0.6 mg/kg in 45 minutes
- Intramuscular: 0.5 mg/kg
- May repeat 0.3 mg/kg after 45 minutes
ACP: Procedural Sedation
- Intravenous/Intraosseous: 0.1-0.5 mg/kg slow push every 60 seconds to effect
- Consider starting at 0.5 mg/kg; use subsequent doses of 0.25 mg/kg or less as needed
- Titrate to effect
ACP: Anesthesia Induction
- Intravenous/Intraosseous: 2 mg/kg if shock index < 1
- Intravenous/Intraosseous: 1 mg/kg if shock index ≥ 1
ACP: Maintenance of Anesthesia
- ½ of required induction dose every 10-15 minutes as required
ACP: Excited Delirium
- Intramuscular: 4-5 mg/kg bolus
- Maximum volume of administration:
- Deltoid: 2 mL
- Lateral thigh: 4-5 mL
- Gluteal: 5 mL
- Maximum volume of administration:
Pediatric Considerations And Dosing
Avoid in infants (< 6 months of age)
PCP: Not authorized
ACP: Analgesia
- Intravenous/Intraosseous: 0.3 mg/kg slow push
- Maximum single dose 20 mg
- Repeat every 2-3 minutes to total maximum of 0.6 mg/kg
- Intramuscular: 0.5 mg/kg
- May repeat 0.3 mg/kg after 45 minutes
- Intranasal: 1.5 mg/kg
- May repeat 1 mg/kg at 20 minutes
- Maximum dose of 50 mg
- See Procedure Pxx for intransal drug administration guidelines
ACP: Procedural Sedation
- See adult dosing guidelines
ACP: Excited Delirium
- CliniCall consult required for any patient under 12 years of age
- See adult dosing guidelines
Pharmocokinetics
Onset:
Intravenous/Intraosseous: anesthetic effects within 30 seconds
Intramuscular: anesthetic effects within 3-4 minutes
Intranasal: analgesic effects within 5-10 minutes
Duration:
Intravenous/Intraosseous: 5-10 minutes, recovery 1-2 hours
Intramuscular: 12-15 minutes, recovery 3-4 hours
Intranasal: up to 60 minutes of analgesic effects
Adverse Effects
Emergence phenomenon: confusion, delirium, excitement, hallucinations
Tachycardia and hypertension (> 10%)
Laryngospasm (< 1%)
Bradycardia and hypotension (1-10%)
Anaphylaxis (< 1%)
Hypersalivation (< 1%)
Extreme muscle rigidity or tone (< 1%)
Nystagmus, increased intraocular pressure
Apnea and respiratory depression (rare; transient reaction with rapid IV bolus dose)
Erythema, morbiliform rash, rash at injection site
Warning And Precautions
Severe hypertension (systolic BP > 180 mmHg)
Subarachnoid hemorrhage or epidural hematoma with severe hypertension
Myocardial ischemia or cardiac arrhythmias