Ventura County Medical Center/Santa Paula Hospital Intravenous Medication Guidelines for Adults DOU SPH-DOU. Telemetry/ Oncology
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1 SPH- Acetazolamide (Diamox) Adenosine (Adenocard) Aminocaproic Acid (Amicar) Aminophylline Amiodarone (Cordarone) IVB IVB B Push over 3 minutes. Monitor BP. (MD at bedside) B B B (MD at bedside) IV Infusion A- fib rate control only Drug must be given RAPIDLY OVER 1-2 SECONDS. Initial Bolus: 6mg IV Push over 1-2 seconds. Followed by RAPID SALINE FLUSH 20 ml. Use crash cart monitor at bedside. Argatroban (Argatroban ) ICU VCMC ICU SPH VCMC 3 North/Tele Obtain baseline PT, PTT, CBC, CMP. Do not start for INR>2.5 or PTT>100. Discontinue all Heparin products. Infusion requires dedicated IV line and programmable pump. Refer to protocol for further information. Requires documentation of two (2) RN s for double-checking 1
2 Bumetanide SPH- (Bumex ) Butorphanol (Stadol) IV Push over 1-2 minutes IV Push over 3-5 minutes Calcium Gluconate 10% Calcium chloride 10% Chlorpromazine (Thorazine) B B B B Do not mix with Sodium Bicarbonate or Phosphate infusions. EXTRAVASATION PRECAUTION Maybe Harmful. IV push over 10 minutes or B as directed. CaGluconate solution should be warmed to body temperature. Contraindicated with digitalized patients, hypercalcemia, ventricular fibrillation B B B EXTRAVASATION PRECAUTION Maybe Harmful. IV push over 10 minutes or B as directed B B B B Check blood pressure before and 15 minutes after administration. Chlorthiazide (Diuril) Use at least 18mL of Sterile Water to dilute for. Rate of administration is 100mg/min. 2
3 Conjugated Estrogen SPH- (Premarin IV ) Cosyntropin (Cortrosyn ) Deferoxamine (Desferal) Follow MD s Instructions For acute iron intoxication IM preferred if patient not in shock Desmopressin Acetate (DDAVP ) Dexamethasone B B B B (Decadron ) Dexmedetomidine (Precedex ) IV Infusion Administer over at least 30 seconds. See ICU, P & P guidelines Diazepam (Valium) Digoxin in single bolus dose < 0.5 mg (Lanoxin ) (max: 10mg/dose) (max: 10mg/dose) (max: 5 mg/dose) (max: 5 mg/dose) B on 2W/3W/OB IV Push maximum rate: 5mg/min over 2 3 minutes. B infuse over 15 minutes for maintenance dose and when NPO. Side effects: dysrhythmias, vomiting, nausea, CNS disturbance. 3
4 Dihydroergotamine (D.H.E. ) SPH- Total IV dose not to exceed 2mg. Diltiazem (Cardizem ) Max rate = 15 mg/hr Max rate=15 mg/hr Diphenhydramine (Benadryl ) Dobutamine Dolasetron (Anzamet ) LD = 0.25 mg/kg over 2 min. May repeat with 2 nd dose of 0.35 mg/kg in 15 min. Infusion rate = mg/hr. s should not be used for longer than 24 hours. Maximum dose of 20 mg/hr. Maximun rate is 10mg/min. Do not mix with sodium bicarbonate. Avoid extravasation. See ICU protocol. Dopamine Do not mix with sodium bicarbonate. Avoid extravasation. See ICU protocol. 4
5 Drotrecogin Alfa (Xigris ) Edrophonium (Tensilon ) - 1 st 24 hrs in ICU. MD must be present. SPH- after 24 hours in if stable after 24 hours in Tele if stable Bleeding Precautions. See Sepsis Protocol Drip 24 mcg/kg/hr (actual body weight) Infuse for 96 hours through a dedicated line. May interrupt drip for procedures or surgery per physician order Administer 1-10mg undiluted dose seconds. Total maximum dose should not exceed 40 mg. Enalaprilat (Vasotec ) Epinephrine (Adrenalin ) B B B B Slow intravenous push over 5 min. Initial dose mg. Maximum IV dose is 2.5mg. Avoid IV use in patients with unstable HR and AMI. See ICU, P & P guidelines Caution: Look-alike/Sound-Alike Eptifibatide (Integrilin ) IV Loading Dose B IV loading dose B IV Infusion IV loading dose B Bleeding Precautions. 5
6 Esomeprazole SPH- (Nexium ) Ethacrinic Acid (Edecrine ) Reconstitute vial with 5 ml Sodium Chloride. Give over 3 minutes Vial is stable for 12 hours once admixed Flush line with saline before and after administration. B B B DO NOT PUSH Rate: 1mg/ml solution at 10 to 15 mg per minute. Caution: Hypotension, phlebitis, ototoxicity, hypokalemia. Famotidine (Pepcid ) Fentanyl (Sublimaze ) BLACK BOX WARNING Flumazenil (MD must be present at bedside) ( - L&D only) IV Push over 2 minutes IV Push over 3-5 minutes 6
7 Fosphenytoin SPH- (Cerebyx ) Furosemide (Lasix ) /B ( for Anasarca only) no more than 10 mg/min. Glucagon IM Usual dose mg usually produces a response in 5-20 minutes. May repeat if response delayed for insulin shock in 20 minutes. Fast IV Push 1mg = 1 Unit over 1 minute. Monitor heart rate. Haloperidol (Haldol ) BLACK BOX WARNING Heparin IM Usual dose mg depending on the severity of the agitation and the patient's condition. Monitor QT prolongation and torsades de pointes. See Administration Policy. Infusion pump required. Guardrail Drug. Requires documentation of two (2) RN s for doublechecking. 7
8 Hydralazine SPH- Hydrocortisone (Solu-Cortef ) Hydromorphone (Dilaudid ) Insulin, Regular Human Ketorolac (Toradol ) BLACK BOX WARNING Slow IV Push over 3-5 minutes IV Push 1mg over 1 minute. 2W,3W & 4N max dose is 1mg over 1 minute. Check Vital signs after 15 minutes. Only REGULAR insulin may be administered by the IV route. For continuous infusions, conc. 100unit / 100ml (1 unit/ml). Infusion Pump Required. Guardrail Drug Requires documentation of two (2) RN s for doublechecking IV Push over 30 seconds. Maximum IV dose is 30mg. IM route is preferred. 8
9 Labetalol (Trandate, Normodyne ) Lepirudin (rdna) (Refludan ) Lidocaine SPH- ( L&D only) Initial dose 0.25mg/kg (20mg) over 2 min. May repeat at 10 minutes intervals with mg. Dose 1-4 mg/min. BP monitoring is required q 5min for 15 minutes. Monitor blood pressure before injection, 5 and 10 minutes after injection, and routinely thereafter. See ICU IV guidelines. Baseline PTT before start of therapy. Don t start if INR > 2.5. Bolus of up to 0.2 mg/kg (max 22 mg). Refer to protocol for infusion rates. Must use dedicated IV line for infusion. Reconstituted solution good for 24 hours at room temperature. Infusion pump required, Requires documentation of two (2) RN s for doublechecking Infusion Pump Required. Guardrail Drug TELEMETRY REQUIRED. Loading dose: mg given at mg/min. Do not exceed mg in one hour period. Standard concentration 2gm/500ml (4 mg/ml). 9
10 Levothyroxine SPH- (Synthroid ) Give 100mcg/mL over 1 minute Lorazepam Maximum Dose Allowed 32 mg/24 hrs Telemetry: Max Dose Allowed 16 mg/24 hrs 2 W/3 W Max Dose Allowed 16 mg/24 hrs Physician orders must contain monitoring parameters for BP and respiratory rate or pulse oximetry. Use caution in elderly patients with compromised pulmonary function. Push over 1 minutes. Monitor respiratory depression and apnea for 15 minutes. Maximum rate 2mg/min. Usual Dose: 2 4 mg every 2 hours prn. Dilute with equal volume of NS, D5W, SW. For status epilepticus 4mg dose given over 2 to 5 min; may repeat in minutes: usual maximum dose: 8 mg in 12 hours. Dilute with equal amounts of normal saline. Reversal Agent: Flumazenil 10
11 Magnesium Sulfate Mannitol B SPH- B IV Infusion B IV Infusion B ( OB only) (Dialysis nurse must administer) Meperedine (Demerol Methylergonovine (Methergine ) ( OB/L&D only) Infuse 1g- 2g per hour. In ICU/ can give 4gm/100ml if patient fluid restricted. Infusion Pump Required. Guardrail Drug. Adverse effects: Respiratory depression, cardiac arrest, hypotension, respiratory failure, heart block. Each 50ml of Mannitol 25% should be over 5 minutes. Continuous infusion of 20% mannitol may also be used. A 5 micron filter must be used in-line. If crystals are present, return to Pharmacy. Infusion Pump Required. Guardrail Drug Used for rigors in Post Op. IV push 2-3 minutes with BP monitoring. Usual dose 1ml (0.2mg) may repeat every 2-4 hours as needed. 11
12 Methylprednisolone (Solu-Medrol ) B SPH- B B B mg may repeat every 4-6 hours as needed. 100mg up to 30mg/kg for spinal cord injury: Loading dose of 30mg/kg in NS 100ml. Maintenance of 5.4mg/kg/hr for 23 hours. Push no faster than 100mg/min. B may be given as 50ml over 30 minutes. Metoclopramide (Reglan ) Metoprolol (Lopressor ) Midazolam (Versed ) IV Push over 1-2 minutes Blood pressure monitoring required q 5 minutes for 15 minutes. Maximum dose of 15 mg for Blood Pressure Control 5mg over 1 minute with 5 mg every 5 minutes for 2 doses. Drip Usual dose mg over 2-3 minutes as single dose only. Allow 3-5 minutes between each small injection to evaluate effect. MD order must contain monitoring for drip. Parameters for BP, respiratory rate, pulse oximetry. Doses > 5 mg require moderate (continued) 12
13 Morphine Sulfate PCA SPH- PCA PCA (5 mg max) PCA (comfort measures only) sedation P&P compliance. In GI Lab okay with direct MD supervision. Can cause apnea and cardiac arrest. Contraindicated with Norvir (Ritonavir) Reversal Agent: Flumazenil Usual dose 5mg slow over 2-3 minutes. IV Push max is q 2hours. Vital signs after 15 min, check level of consciousness 1 st 30 minutes. Continuous infusion must contain monitoring parameters for blood pressure and respiratory rate or pulse oximetry. Reversal Agent: Naloxone Nalbuphine (Nubain) in OB only Push as follows: 10mg over 3 to 5 minutes. Caution: Respiratory depression, CNS depression, may increase intracranial pressure. Max single dose 20 mg, max daily dose 160mg Naloxone (Narcan ) Monitor patient after administration for agitation. 13
14 SPH- Neostigmine Usual dose mg over 1-5 minutes. Nitroglycerin Infusion Pump Required. Guardrail Drug Standard concentration of 50mg/250ml D5W (200mcg/ml) Contact MD if persistent headache occurs See specific nitroglycerin, P & P guidelines. Nitroprusside (Nipride ) Norepinephrine (Levophed ) Infusion Pump Required. Guardrail Drug Standard concentration 50mg/250ml D5W See P&P guidelines Infusion Pump Required. Guardrail Drug Standard concentration of 4mg/250ml. Do not run with INSULIN. See P&P guidelines. Check BP every 2 minutes until stabilized at desired level; check every 5 minutes thereafter therapy 14
15 Octreotide (Sandostatin ) Ondansetron SPH- (Zofran ) Oxytocin (Pitocin) Paricalcitol (Zemplar ) Look Alike Sound- Alike Phenobarbital IV Infusion (- OB & 4N only) Pantoprazole (Protonix ) IV Push over 1-2 minutes For doses used in labor induction a controlled infusion device is necessary. Post partum doses may not exceed 20 Units/hr. : 50 mg/min. Don t administer rapidly for it may cause respiratory depression, apnea, laryngospasm or vasodilation with fall in blood pressure. Mix with 10mL NS 15
16 Phenylephrine (Neo-Synephrine ) SPH- For dilute 10mg in 9 ml of NS and give mg over one minute Infusion Pump Required. Guardrail Drug. Use caution in Patient s with Sulfa allergies See P&P guidelines Protect from light Phenytoin (Dilantin ) Physostigmine (Antilirium ) B B B B Patient MUST be on a cardiac monitor for loading dose Use an in-line 0.22micron filter for B solutions due to high potential for precipitation of the solution. Push 0.5 mg Slowly, no more than 1mg/min per minute. Reverse anticholinergic drug effect. Dose: 0.5 to 2 mg. Caution in Patient s with Sulfa allergies. Phytonadione (Vitamin K) B ( reserved for emergency only) B B B must be diluted to 10mg/10ml of NS. Should be given < 1mg/min. Doses greater than 10mg should be prepared in 50ml of D5W and given over 60 minutes. High incidence of reaction with the IVroute. 16
17 Potassium Chloride Pralidoxime (Protopam ) Procainamide (Pronestyl ) B B B SPH- B B B Maximum of 10mEq/hr for Peripheral line. Maximum of 20mEq/hr for Central linewith cardiac monitoring. The maximum potassium concentration for administration is 40mEq/100ml via a central line in the ICU ONLY. INFUSION PUMP REQUIRED. Dilute dose in 100ml of NS and infuse over 30 minutes. May be given IM or SC if IV administration not possible When indicated for organophosphate pesticide poisoning first administer atropine Must wear protective clothing. NTE 200mg/min Loading Dose of mg q 5 min until arrhythmia is controlled or blood pressure drops. Should be given at a rate not to exceed mg/min. maintenance dose 1-4mg/min. The maximum loading dose is 1000mg Infusion Pump Required. Guardrail Drug PO or IM are the routes preferred, IV should only be used for emergencies Monitor ECG and BP continuously 17
18 Prochlorperazine SPH- (Compazine ) IV Push over 1-2 minutes. Promethazine (Phenergan ) Black Box Warning Caution: This drug is a known vesicant. B B B B mg as starting IV dose and start using other drugs Concentration should never exceed 25mg/ml Blood pressure monitoring required 5 10 min following administration. Rapid IV push may result in orthostatic hypotension and dystonic reactions. Stop immediately if patient complains of pain. (continued) Avoid extravasation administer via running IV line at port furthest from patient s vein, or through a large bore vein (not hand or wrist). May precipitate with Heparin. IM route preferred 18
19 Propofol (Diprivan ) Propranolol (Inderal ) Protamine Sulfate by MD only SPH- Infusion rate of 5-50 mcg/kg/min (0.3 to 3 mg/kg/hr) or higher may be required. Comes in premixed vials with a concentration of 10mg/ml. Titrate in increments of 5 to 10 mcg/kg/min over 5 to 10 minutes until desired level of sedation is achieved. May administer lidocaine to decrease the pain. DO NOT HANG FOR LONGER THAN 12 HOURS IV ADMINISTRATION SETS SHOULD BE CHANGED EVERY 12 HOURS. CONTAINS NO PRESERVATIVES. Usual dose mg dilute with NS. Maximum rate of administration should not exceed 1 mg/min. May repeat dose in 2 minutes; but must wait at least 4 hours thereafter for any subsequent doses. Blood pressure and heart rate must be monitored every 5 minutes for 15 minutes following each dose. Used to treat Heparin Overdosage. Give Slow IV Push no faster than 5mg/minute 19
20 Reteplase (Retavase ) Rocuronium SPH- Limited to MI indications in thrombolytic therapy MD must be present for intubation. Caution: PARALYZING AGENT Succinylcholine (Anectine ) Caution: PARALYZING AGENT Terbutaline (Brethine, Bricanyl ) Urokinase (Abbokinase ) ICU/ER only ( L&D only) Dose: mg/kg over seconds. MD must be present for intubation. Limited use in tocolysis or pre-term labor. Begin infusion at 10 mcg/min, may increase by 5 mcg/min increments up to a maximum dose of 25mcg/min. Infusion Pump Required. Guardrail Drug Infusion Pump Required. Guardrail Drug Prepare 100,000 Units/ml solution. 20
21 Vasopressin (Pitressin ) SPH- Infusion Pump Required. Guardrail Drug Usual dosage range is 0.2 to 0.9 units/ml. EXTRAVASATION PRECAUTION. See P&P ICU guidelines on vasopressin Vecuronium (Norcuron ) Caution: PARALYZING AGENT Initial dose mg/kg slow over 2-3 minutes. Maintenance dose suggested mg/kg slow over 2-3 minutes. For infusion dose = 0.5 to 2.5 mg/kg/min (1-5 mg/hr). PATIENT MUST BE INTUBATED. Verapamil 5 to 10 mg over 2-3 minutes. May repeat 10 mg in 30 minutes if necessary. Continuous EKG monitoring required to assess therapeutic efficacy or arrhythmic potential. References: Package Insert, Clinical Drug Data, 10 th Edition 21
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