Birthing Center OB/MB Nurses Guide: Intravenous Push (IVP) Drug List Approved for RN Administration

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Mildred Wells
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1 RATE OF Butorphanol tartrate (Stadol) - Narcotic Analgesic mg q3-4 h - 2 mg/ml 2 mg/min Obstetrical pain relief Monitor for maternal and newborn respiratory depression, mental status change and blood pressure; decreased fetal heart rate variability Dextrose 50 % - Carbohydrate 25 gm - 25gm/50 ml 10ml/min Hypoglycemia treatment Phlebitis risk, pain at injection site Large bore IV access Hyperglycemia, pulmonary edema, confusion Page 1 of 9

2 RATE OF Diazepam (Valium) - Benzodiazepine Anti-anxiety Anti-convulsant 2-10 mg q3-4 h 30mg/8 hrs 5 mg/ml 5 mg/min Severe recurrent seizure control Muscle relaxant/sedative /hypnotic prior to invasive procedures May only be given as IVP for seizures Phlebitis risk, pain at injection site Do not mix with other drugs or solutions 0.22 micron filter required for IVPB option Flumazenil Crosses the placenta and may affect the fetus Drowsiness hypotension, respiratory depression, laryngospasm, bradycardia, tachycardia Diphenhydramine (Benadryl) - Histamine-1 antagonist mg q2-4 h 50 mg/dose 400 mg/day 50 mg/ml 25 mg/min Allergic reaction treatment Sedation Dilute to 25mg/ml in D5W or NS Hypotension, tachycardia, sedation, dizziness, insomnia Use with caution with other CNS depressants Page 2 of 9

3 RATE OF Dolasetron mesylate (Anzemet) - Anti-emetic 12.5 mg q6 h 25 mg 12.5 mg/ ml 25 mg/30 seconds Prophylaxis and treatment of post-operative and chemoinduced nausea/vomiting HTN, tachycardia, headache, and urinary retention Caution in patients at risk for QT prolongtaion Epinephrine (Adrenaline Chloride) Anaphylaxis Only - Anaphylaxis/ Sympathomimeti c mg IM/SQ every mg/ml 1mg/minute Watch for injection site blanching/ Extravasation Use 1:1000 in anaphylaxis Tachycardia, hypertension, nervousness, restlessness, headache, dizziness HR, BP Famotidine (Pepcid) - Histamine-2 antagonist 20 mg q12 h 40 mg 20 mg/5ml 20 mg/2 Treatment for GERD, GI ulcer, heartburn and prophylaxis for stress ulcer under hospitalization Headaches, dizziness, confusion, mental status changes Flumazenil (Rumazicon) - Benzodiazepine antagonist 0.2 mg over 30 seconds initially; can repeat with 0.3 mg Give no more than 1 mg/dose or 3mg/hour 0.1mg/ml 0.2 mg over seconds Use large vein and free flowing IV to minimize pain Patient may need additional doses in case of re-sedation. Caution with seizures patient Page 3 of 9

4 RATE OF Furosemide (Lasix) - Loop diuretic mg 80 mg (May vary) 10 mg/ml 1-2 Urinary output maintenance Pulmonary edema reduction Consider IVPB over 5-10 mins Hypotension, headache, dizziness, fluid and electrolyte imbalances Glucagon - Emergency treatment of symptomatic hypoglycemia mg/min (May be repeated 1-2 times) - 1mg/ml 1mg/minute 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 Heparin Bolus (Heparin Drip Protocol) - Anti-coagulant Varies-3,000-8,000 units 8,000 units Usual: 10,000 units/ml Over 1 minute Protamine Bleeding, APTT, HCT, Hgb Thrombocytopenia (HIT- Heparin induced) Heparin sodium (Heparin Hep- Lock) - Anti-coagulant Central line flush 300 units instilled into Central Catheter units/ml - Protamine Bleeding, APTT, Hct, Hgb, thrombocytopenia (HIT) Page 4 of 9

5 RATE OF Hydralazine (Apresoline) LDR only Antihypertensive mg q4-6 h. For preeclampsia/ eclampsia: 5-10 mg q20-30 min as needed 40 mg 20 mg/ml Over 3-5 Control of hypertension with eclampsia and preeclampsia. Given when DBP > 110 Postural hypotension, tachycardia. Decreased uteroplacental flow may occur with maternal decreased BP, which may lead to fetal distress. Monitor fetus with continuous EFM **Monitor BP closely** Ketorolac (Toradol) - NSAID mg q6 h 60 mg/dose 120 mg/day Max 5 days 30 mg/ml Over > 15 seconds Short term management of moderately severe, acute pain Requires renal dosing adjustment Do not use in laboring or nursing mothers May cause GI pain or bleeding; do not use preoperatively, in patients with bleeding risk, or in patients on aspirin or NSAIDS Edema, drowsiness, headache Labetalol (Normodyne; Trandate) LDR only Antihypertensive Initial dose: 20 mg May give additional doses of mg q10 mins up to 300 mg total dose 300 mg total dose - 20 mg/ 2 Hypertensive emergency treamtnet Contraindicated for patients with uncompensated CHF, bradycardia May cause dizziness, orthostatic hypotension, N/V, bronchospasm, dyspnea, arrhythmias, nasal stuffiness, vivid dreams Crosses the placenta and breast milk Cardiac and BP monitors are required for IV administration Page 5 of 9

6 RATE OF Lorazepam (Ativan) - Benzodiazepine 2-4 mg 8 mg/12 hrs 2 mg/ml 2 mg/minute Anxiety, agitation, sedation with amnesia Acute seizure Dilute with equal volume of IVF IVP can easily cause infiltration Consider IVPB over 5-10 Flumazenil Sedation, hypotension, dizziness, headache, HR, RR Meperidine (Demerol) - Narcotic analgesic mg q2-4 h mg/ml Over at least 5 Obstetrical pain relief Dilute to 10 mg/ml with NS Naloxone Maternal and newborn respiratory depression Decreased fetal heart rate variability Sedation, hypotension, dizziness, constipation Page 6 of 9

7 RATE OF Metoclopramide (Reglan) - Cholinergic Anti-emetic GI stimulant 5-10 mg q6-8h 20 mg 5 mg/ml 10 mg or fraction thereof over 1-2 High doses >10 mg require IVPB over at least 15 Relief of GERD, prevention and treatment of postoperative nausea and vomiting Too rapid administration rate may cause intense anxiety and drowsiness Contraindicated in GI bleed/ obstruction/perforation and seizure disorders Caution with hypertension Drowsiness, dizziness, sedation, rash, diarrhea, BP changes, palpitation, extrapyramidal effects (may be treated with Benadryl) Notify MD if involuntary movements Morphine sulfate - Narcotic analgesic 1-4 mg q2-4 h as needed 8 mg 10mg/ml 1mg/minute Obstetrical pain relief Naloxone Maternal and newborn respiratory depression Decreased fetal heart rate variability Sedation, dizziness, heart palpitation, hypotension, bradycardia Page 7 of 9

8 RATE OF Naloxone (Narcan) - Pure opioid antagonist Reversal of opioid-induced resp depression: mg Opiate overdose: mg 0.8 mg 10 mg 1 mg/ml Administer a dilute solution of Naloxone (0.4 mg in 10 ml of NS) IV very slowly (0.5 ml 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 ml of dilute solution. If the patient does not arouse, begin looking for other causes of sedation and respiratory depression. - Tachycardia, narcotic withdrawal, hypertension, hypotension, anxiety, restlessness, RR Ondansetron (Zofran) - Anti-emetic 1-4 mg 4 mg mg over 2-5 > 4 mg Consider IVPB over 15 Incompatible with numerous drugs Observe closely for respiratory distress Advise patient to ambulate slowly Page 8 of 9

9 RATE OF Pantoprazole (Protonix) Proton pump inhibitor 40 mg 80 mg 4mg/ml 40mg/ 2 Reconstitute with 10 ml NS Injection site reactions, headache, dyspepsia and nausea Promethazine HCL (Phenergan) Via Central or PICC line only - Anti-histamine Anti-emetic mg q4-6 h 50 mg 50 mg/ml 25 mg/minute 20 mins-ivpb Acute N/V Via Central or PICC line only because of high risk for tissue damage from extravasation Monitor for infiltration IVPB over 20 Avoid in patients with history of seizures Hypotension, tachycardia, dizziness and drowsiness Terbutaline (Brethine) LDR only Tocolytic mg Slow IVP over mg/ml 0.03 mg/minute Treatment of uterine tetany or to relax the uterus during external version May cause tachycardia, shortness of breath, chest pain, nervousness and tremor Monitor serum potassium, BP, HR and RR Monitor neonate for hypoglycemia * Alter volume based upon dosage to be administered ** Alter duration based upon dose to be administered. by: MyChan Nguyen, PharmD Developed by: Carol Komara, RN, MSN (Nursing Staff Development); Julia Ho PharmD (Pharmacy Services) Approved by: Kimberley Hite, PharmD; Gwen Moreland, PCM Contact person for revisions: Kimberley Hite, PharmD (khite2@uky.edu) Page 9 of 9

Intravenous Push (IVP) Drug List Approved for RN Administration

Intravenous Push (IVP) Drug List Approved for RN Administration Acute Care 1111Page Floor Nurses 1 of 8 Guide: Bumetanide (Bumex) - Diuretic/Acute Pulmonary Edema, CHF, and Renal disease 0.5-2 mg over 1-2 RATE 10 mg/day 0.25 mg/ml 2 mg over 2 Pain at injection Site