MRN:  
Last Name:  
First Name:  
Date of Birth:  
Gender:  
Unit:  
Date:  
Weight in KG  
Confirm Weight  
Drug
Alprostadil (NICU, PICU or ED only)   Hydrocortisone Endocrine Dosing   Nitroglycerin (NICU, PICU or ED only)
Aminocaprioic Acid (PICU or ED only)   Hydromorphone (NICU, PICU or ED only)   Nitroprusside (NICU, PICU or ED only)
Aminophylline (NICU, PICU or ED only)   Insulin   Norepinephrine (NICU, PICU or ED only)
Amiodarone (NICU, PICU or ED only)   Isoproterenol (NICU, PICU or ED only)   Octreotide (NICU, PICU or ED only)
Aprotinin (PICU or ED only)   Ketamine (NICU, PICU or ED only)   Pentobarbital (NICU, PICU or ED only)
Bumetanide (NICU, PICU or ED only)   Labetolol (PICU or ED only)   Phenylephrine (NICU, PICU or ED only)
Calcium CHLORIDE (PICU or ED only)   Lepirudin (PICU or ED only)   Procainamide (PICU or ED only)
Calcium GLUCONATE (PICU or ED only)   Lidocaine (PICU or ED only)   Propofol (PICU or ED only)
cycloSPORINE   Lorazepam (NICU, PICU or ED only)   Quinidine Gluconate (PICU or ED only)
DOBUTamine (NICU, PICU or ED only)   MethylPREDNISolone Endocrine Dosing   Ranitidine (PICU or ED only)
DOPamine (NICU, PICU or ED only)   MethylPREDNISolone Spinal Cord Dosing   Remifentanil (PICU or ED only)
Doxepram (NICU, PICU or ED only)   Midazolam (NICU, PICU or ED only)   Sodium Bicarbonate (NICU, PICU or ED only)
EPINEPHrine (NICU, PICU or ED only)   Milrinone (NICU, PICU or ED only)   TACROlimus
Epoprostenol Flolan (PICU or ED only)   Morphine (NICU, PICU or ED only)   Terbutaline (NICU, PICU or ED only)
Esmolol (NICU, PICU or ED only)   Naloxone Itching   Urokinase
Fentanyl (NICU, PICU or ED only)   Naloxone Reversal (PICU or ED only)   Vasopressin DI (NICU, PICU or ED only)
Furosemide (NICU, PICU or ED only)   Nesiritide (PICU or ED only)   Vasopressin Pressor (NICU, PICU or ED only)
Heparin   NICARdipine (PICU or ED only)   Vecuronium (NICU, PICU or ED only)
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© 2004-05, Christoph U. Lehmann, MD and Michael A. Veltri, Pharm.D
Johns Hopkins University