Essential IV Medications for Urgent Care Clinics
Every urgent care clinic must stock a core set of IV medications including epinephrine, naloxone, dextrose 50%, diphenhydramine, and normal saline as the absolute minimum for managing life-threatening emergencies. 1
Core Emergency IV Medications
Resuscitation and Reversal Agents
- Epinephrine (1:10,000 and 1:1,000) - For anaphylaxis, cardiac arrest, and severe asthma/bronchospasm
- Naloxone - For opioid overdose reversal (20-40mg supply for a 100kg patient) 1
- Dextrose 50% - For hypoglycemia (250g supply) 1
- Flumazenil - For benzodiazepine reversal (6-12mg supply) 1
- Atropine - For symptomatic bradycardia (45-165mg supply) 1
Antihistamines and Anti-inflammatory
- Diphenhydramine - For allergic reactions and as adjunct for anaphylaxis
- Methylprednisolone - For severe allergic reactions, asthma, COPD exacerbations
- Hydrocortisone - Alternative steroid for adrenal insufficiency
Analgesics
- Morphine or hydromorphone - For severe pain management 1
- Ketorolac - Non-opioid analgesic for moderate to severe pain
- Acetaminophen IV - For pain and fever (particularly useful when oral route unavailable) 1
Cardiac Medications
- Labetalol - For hypertensive emergencies (20-80mg IV bolus) 1
- Nitroglycerin - For acute coronary syndrome and pulmonary edema (5-100 μg/min) 1
- Adenosine - For PSVT (6-12mg) 1
Antiemetics
- Ondansetron - For nausea and vomiting
- Metoclopramide - Alternative antiemetic
Antibiotics
- Azithromycin - For respiratory infections (500mg IV) 2
- Ceftriaxone - Broad-spectrum antibiotic for severe infections
IV Fluids
- Normal Saline (0.9% NaCl) - For fluid resuscitation, medication dilution
- Lactated Ringer's - Alternative crystalloid for fluid resuscitation
- Dextrose 5% in Water (D5W) - For medication dilution and mild dehydration
Prioritization Based on Clinic Setting
Minimum Essential IV Medications (All Urgent Care Clinics)
- Epinephrine
- Naloxone
- Dextrose 50%
- Diphenhydramine
- Normal saline
- Methylprednisolone
- Ondansetron
- Ketorolac
Additional Medications (Based on Patient Population and Distance to Hospital)
- For clinics >30 minutes from hospital: Add labetalol, adenosine, and broader antibiotic coverage
- For clinics serving pediatric populations: Ensure appropriate pediatric dosing and formulations
- For clinics in areas with high cardiac event rates: Add nitroglycerin
Implementation Considerations
Storage and Monitoring
- Maintain temperature-controlled storage for all medications
- Implement regular checks for expiration dates
- Stock sufficient quantities for treating at least one 100kg patient for initial stabilization 1
Administration Safety
- Use standardized concentration preparations when possible
- Implement double-check protocols for high-alert medications (heparin, insulin, vasopressors) 3
- Ensure proper labeling of all prepared medications
Staff Training
- Regular competency assessments for IV medication preparation and administration
- Simulation training for emergency medication administration
- Protocols for managing adverse reactions to IV medications
Common Pitfalls to Avoid
- Understocking critical medications: Always maintain minimum quantities of life-saving medications like epinephrine and naloxone
- Overlooking alternative routes: When IV access is difficult, consider alternatives like intranasal (fentanyl, midazolam, naloxone) 4 or intraosseous routes for emergencies
- Inadequate dilution protocols: Ensure proper dilution guidelines are available for medications requiring specific concentrations
- Neglecting weight-based dosing: Have dosing charts readily available, especially for pediatric patients 1
- Failing to check expiration dates: Implement a regular medication inventory system
By maintaining this core set of IV medications and following proper administration protocols, urgent care clinics can effectively manage most emergencies until transfer to a higher level of care if needed.