Intravenous Push (IVP) Drug List Approved for RN Administration

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Rose Garrett
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1 Acute Care 1111Page Floor Nurses 1 of 8 Guide: Bumetanide (Bumex) - Diuretic/Acute Pulmonary Edema, CHF, and Renal disease mg over 1-2 RATE 10 mg/day 0.25 mg/ml 2 mg over 2 Pain at injection Site Monitor labs; Multiple drug interactions; dizziness; N&V, hypotension, and decrease calcium and K+ Chlorothiazide Sodium (Diuril) - Diuretic/Antihypertensive agent g 2 g/day 28 mg/ml Slow IVP Extravasation MUST be avoided. Do NOT give SC or IM Monitor electrolytes, rash, hypotension Cosyntropin (Cortrosyn) - Diagnostic Agent 1 mcg or 250 mcg mcg - Over 2 Blood draws must be at specific times indicated by MD order. No steroids or spironolactone day before or day of test. Hypertension, flushing. Peak cortisol concentration occurs min after administration Dexamethasone Sodium Phosphate (Decadron) - Antiemetic; Antiinflammatory 4 mg 10 mg 4 mg/ml Maximum rate: Over 1 minute Slower if itching Over Insomnia, nervousness, increased appetite, fluid retention Dextrose 50% - Carbohydrate/ Symptomatic hyperglycemia 25 gm - 25 gm/50ml 10 ml/min Phlebitis risk, pain at injection site; Large bore IV access Hyperglycemia, confusion Page 1 of 8

Diuretic/Antihypertensive agent 0.5 1 g 2 g/day 28 mg/ml Slow IVP Extravasation MUST be avoided.

2 Acute Care 2222Page Floor Nurses 2 of 8 Guide: Diazepam (Valium) - Benzodiazepine; Anti-anxiety, Anticonvulsant, 2-10mg/ dose RATE 30 mg/8hrs 5 mg/ml 5 mg/minute Phlebitis risk, pain at injection site 0.22 micron filter required for IVPB admin Bradycardia; tachycardia, drowsiness, hypotension, hypoventilation Dihydroergotamine (D.H.E 45) - Antimigraine Agent 0.3-1mg/dose 6 mg/week 1mg/ml Over HTN, Headache, dizziness, N/V Diphenhydramine HCL (Benadryl) - Antihistamine; Histamine 1 Antagonist mg q 2-4H 50 mg/dose 400 mg/day 50 mg/ml 25 mg/minute Dilute to 25 mg/ ml in D5W or NS Hypotension, tachycardia, sedation, dizziness, insomnia Dolasetron Mesylate (Anzemet) - Antiemetic 12.5 mg over mg 12.5 mg/ ml 25 mg over 30 Caution in patients at risk for prolonged QT interval HTN, headache, urinary retention, tachycardia Epinephrine (Adrenaline Chloride) Anaphylaxis Only - Anaphylaxis/ Sympathomimetic mg IM/SQ every as needed - 1mg/ml 1mg/min Watch for injection site blanching/ Extravasation Use 1:1000 in anaphylaxis Tachycardia, hypertension, nervousness, restlessness, headache, dizziness HR, BP Famotidine (Pepcid) - Gastrointestinal; Histamine 2 Antagonist 20 mg q 12H 40 mg 20 mg/5ml 20 mg over 2 - Headaches, dizziness, confusion, mental status changes Page 2 of 8

3-1mg/dose 6 mg/week 1mg/ml Over 2-3 - HTN, Headache, dizziness, N/V Diphenhydramine HCL (Benadryl) - Antihistamine; Histamine 1 Antagonist 12.

3 Acute Care 3333Page Floor Nurses 3 of 8 Guide: Flumazenil (Rumazicon) - Benzodiazepine Antagonist 0.2 mg over 30 initial, can repeat with 0.3mg Give no more than 1 mg per dose or 3mg/hour 0.1mg/ml RATE 0.2 mg over Use large vein and free flowing IV to minimize pain Pt. may need additional doses in case of re-sedation. Caution with seizure patient. Furosemide (Lasix) - Loop Diuretic/ Volume overload mg 80 mg but can vary widely 10 mg/ml 1-2 (Consider IVPB over 5-10 ) - Hypotension, headache, and dizziness Glucagon - Emergency treatment of symptomatic hypoglycemia mg/ min (May be repeated 1-2 times) - 1 mg/ml 1 mg/min May precipitate with NS, K+ and Calcium; Compatible with D5W Unstable hypoglycemic diabetic may not respond & will need IV Dextrose instead; N/V, hypokalemia in overdose, urticaria, respiratory distress and hypotension Granisetron HCL (Kytril) 5HT3 Blocker Prevention of N/V secondary to chemotherapy 10 mcg/kg given 30 prior to chemo Undiluted over 30 Headache, diarrhea, constipation, hypertension, fever Haloperidol Lactate (Haldol) - Antipsychotic/ Agitation 2-5 mg Varies with patient 5 mg/ml 5 mg/min Start with lower doses in geriatric patients Drowsiness, hypotension, Extrapyramidal effects, bradycardia, tachycardia Page 3 of 8

Furosemide (Lasix) - Loop Diuretic/ Volume overload 20-40 mg 80 mg but can vary widely 10 mg/ml 1-2 (Consider IVPB over 5-10 ) - Hypotension, headache, and dizziness Glucagon - Emergency treatment of

4 Acute Care 4444Page Floor Nurses 4 of 8 Guide: Heparin Bolus (Heparin Drip Protocol) - Anti-coagulant Varies- 3, ,000 units 8,000 units Usual: 10,000 units/ml RATE Over 1 minute Antagonist is Protamine Bleeding, APTT, HCT, Hgb Thrombocytopenia (HIT- Heparin induced) Heparin (for flush of Central line catheter) Hydrocortisone Sodium Phosphate (Hydrocortone Phosphate) - Anti-coagulant 300 units instilled into Central Catheter - Anti-inflammatory agent Corticosteroid units/ml - Antagonist is Protamine Bleeding, APTT, HCT, Hgb Thrombocytopenia (HIT- Heparin induced) mg - 50 mg/ml Over Insomnia, nervousness BP Hydrocortisone Succinate (Solu- Cortef) - Anti-inflammatory (IV given usually in emergency) mg 1 gm/24 hour - Over 1 minute Caution in elderly May need to taper therapy Monitor electrolytes; May mask signs of infection Hydromorphone (Dilaudid) - Narcotic Analgesic 1-4 mg - 4 mg/ml Each 1 mg over 2-3 Reversal agent Naloxone (Narcan) Palpitations, hypotension, dizziness, drowsiness, BP, RR Insulin (Regular only) Push for hyperkalemia only - Pancreatic Hormone/ Hyperglycemia 5-10 units over units - 10 Push for hyperkalemia only; Only Regular Insulin can be given IV Monitor Finger Stick Blood Sugars Page 4 of 8

units instilled into Central Catheter - Anti-inflammatory agent Corticosteroid - 100 units/ml - Antagonist is Protamine Bleeding, APTT, HCT, Hgb Thrombocytopenia (HIT- Heparin induced) 15-240 mg - 50

5 Acute Care 5555Page Floor Nurses 5 of 8 Guide: Ketorolac (Toradol) - NSAID/Short-term management of modsevere pain mg IV q 6 hours 120 mg/day Max. 5 days RATE 30 mg/ml Over > 15 Requires renal dose adjustment Edema, drowsiness, headache Avoid in patients with active or recent bleeds Levothyroxine (Synthroid) - Thyroid hormone mcg (½ of oral dose) mcg/ml 100mcg/min -Prepare immediately before administration, with 5ml Normal saline. -Do not mix with any other IVF -Do not further dilute drug Symptoms of hyperthyroidism nervousness, tremor, headache, tachycardia, heat intolerance, etc. Lorazepam (Ativan) - Benzodiazapine 2-4 mg diluted with equal volume of IVF 8 mg/12hrs 2 mg/ml 2 mg/minute Can easily cause infiltration with IVP, Consider IVPB over 5-10 min; Reversal agent- Flumazenil Sedation, hypotension, dizziness, headache, HR, BP, RR Meperidine (Demerol) - Narcotic Analgesic mg q 2-4 hours mg/ml Over 5 Dilute to 10 mg/ ml with NS Reversal agent- Naloxone (Narcan) Sedation, hypotension, dizziness, BR, RR Page 5 of 8

oral dose) - 100 mcg/ml 100mcg/min -Prepare immediately before administration, with 5ml Normal saline.

6 Acute Care 6666Page Floor Nurses 6 of 8 Guide: Methylprednisolone Sodium Succinate (Solu-Medrol) - Anti-inflammatory agent/ Adrenal Corticosteroid RATE mg mg/ml 125 mg over 3-5 Higher doses give IVPB Only the succinate form can be given IV; Rapid admin. Of high doses can cause circulatory collapse Insomnia, nervousness BP, Monitor Na+ and K+, FSBS Metoclopramide (Reglan) - Cholinergic/ GI stimulant Antiemetic 5-10 mg 10 mg 5 mg/ml 10mg or fraction thereof over 2 >10 mg IVPB over 15 Too rapid rate may cause intense anxiety & restlessness Hypotension, SVT, sedation, dizziness, rash, extrapyramidal effects treat with Benadryl: Caution with hypertension Morphine - Narcotic Analgesic 1-4 mg 8 mg 10 mg/ml 1 mg/min Reversal agent Naloxone (Narcan) Sedation, dizziness, heart palpitation, hypotension, bradycardia, and respiratory depression BP, RR, Oxygen saturation Muromonab-CD3 (Orthoclone, OKT3) 8E Immunosuppressive Agent/ Rejection 5 mg 5 mg 1 mg/ml <1-2 minute Filter each dose through a low protein binding 0.22 micron filter Fever, chilling, dyspnea, wheezing, chest pain, tachycardia, dizziness, shortness of breath, HR, BP, RR, Temperature Page 6 of 8

$Of high doses can cause circulatory collapse Insomnia, nervousness BP, Monitor Na+ and K+, FSBS Metoclopramide (Reglan) - Cholinergic/ GI stimulant Antiemetic 5-10 mg 10 mg 5 mg/ml 10mg or fraction$

7 Acute Care 7777Page Floor Nurses 7 of 8 Guide: Naloxone (Narcan) - Pure Opioid Antagonist RATE mg 24 mg 1 mg/ml Administer a dilute solution of naloxone (0.4mg in 10 ml of saline) IV, very slowly (0.5ml over 2 ) while you watch for the desired effect (titrate to effect). The patient should open his eyes within one to two. If not, continue giving naloxone at the same rate up to 0.8 mg or 20 mls of dilute solution. If patient does not arouse after the initial administration of Naloxone (total dose of 0.8mg) begin looking for other causes of sedation and respiratory depression. Tachycardia, narcotic withdraw, hypertension, hypotension, anxiety, restlessness, Pulmonary Edema, HR, BP, RR Ondansetron (Zofran) - Antiemetic 1-4 mg 4 mg mg over mg consider IVPB over 15 Incompatible with numerous drugs Observe closely for respiratory distress; Ambulate Slowly Pantoprazole (Protonix) - Gastrointestinal; Proton pump inhibitor 40 mg 80 mg 4 mg/ml 40 mg over 2 Reconstitute with 10ml, 0.9% Normal Saline Injection site reactions, headache, dyspepsia, and nausea Page 7 of 8

If not, continue giving naloxone at the same rate up to 0.8 mg or 20 mls of dilute solution. If patient does not arouse after the initial administration of Naloxone (total dose of 0.

8 Acute Care 8888Page Floor Nurses 8 of 8 Guide: Promethazine (Phenegran) IVP only with Central or PICC Line or IVPB over 20 mins - Antiemetic/ Antihistamine RATE mg 50 mg 50 mg/ml IVP: 25 mg/min * Alter volume based upon dosage to be administered Alter duration based upon dose to be administered. IVPB: 20 Monitor for infiltration Hypotension, tachycardia, dizziness, and drowsiness If the medication is not approved for IV push administration and alternative routes of administration are not available, approval for this individual situation must be Updated: 0 Revised by: Christy Taylor, PharmD and Lori Proeschel, PharmD Contact person for revisions: Kimberley Hite (khite2@uky.edu) Page 8 of 8

IVPB: 20 Monitor for infiltration Hypotension, tachycardia, dizziness, and drowsiness If the medication is not approved for IV push administration and alternative routes of

Upstate University Health System Medication Exam - Version A

Upstate University Health System Medication Exam - Version A Name: ID Number: Date: Unit: Directions: Please read each question below. Choose the best response for each of the Multiple Choice and Medication