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