Drug Max dose approved for IVP Dilution Rate Monitoring Parameters. Dilution not necessary (Available in prefilled syringe)

Transcription

1 Drug Max dose approved for IVP Dilution Rate Monitoring Parameters Acetazolamide 500 mg Reconstitute with at least 5ml sterile water (max concentration should not exceed 100mg/ml) mg/min Hypotension Adenosine 6 mg per dose (may repeat with a 12 mg dose) (Available in prefilled syringe) Amiodarone 300 mg If no cardioversion: 300mg IVP rapid bolus (undiluted 50mg/ml) After cardioversion: 150 mg over the FIRST 10 (15mg/min) Add 3 ml of amiodarone to 100 ml D5W. Infuse 100 ml over 10 (Final concentration is 1.5mg/ml) Atropine 1 mg/10ml Max dose 1mg per dose (repeat every 3-5 PRN) Should not exceed 0.04 mg/kg May be diluted in 10 ml sterile water Benztropine 2 mg No need to dilute (available in 1mg/ml ampule) Bumetanide First dose :0.5-1mg IVP No need to dilute (available in a 0.25mg.ml multi-dose vial (2.5mg/10ml)) Infuse each 6 mg dose over 1-2 seconds Over 10 If giving 300mg: Push over 30 seconds Infuse over 1 minute or less Over 1-2 First Dose: 1-2 Second dose and beyond: 2-3 hours (MDD=10 mg) Inject directly into peripheral vein or into IV line followed by a rapid saline flush Concentrations should not exceed 2 mg/ml for infusions longer than 1 hour via peripheral vein. Concentrations greater than 2 mg/ml should be administered via central line Flush with 10 ml 0.9%NS Slow injection may result in paradoxical bradycardia N/A Blood glucose, serum creatinine/bun, Uric acid levels, blood pressure Ototoxicity

2 Calcium Gluconate Usual dose: 2 grams(20 ml of 10%solution) Hyperkalemia (off-label use): 1.5-3g (15-30ml of 10% solution) (available in a 100mg/ml vial) 0.7 meq/min or a 10 ml vial over 7 Give each ml in one minute or less. Do not exceed 2 ml/min Do not exceed 200mg/min Do not mix with sodium bicarbonate or phosphate infusions. Solution should be warmed to body temperature. Large vein is preferred. Patient should be monitored via telemetry Chlorothiazide 1000mg Reconstitute with 18 ml of sterile water (final concentration is 28mg/ml) Colistimethate Half of the total daily dose Every 12 hours Reconstitute with 2 ml of sterile water (final concentration is 75mg/ml) Cosyntropin 0.25mg (1 ml) Dilute 1 ml (0.25mg) in 2-5 ml of 0.9% NS SLOWLY over at least 5 Half the daily total dose should be administered SLOWLY over 3-5 every 12 hours Over 2 Serum creatinine, BUN, Uric acid levels Serum creatinine/bun Serum Cortisol and urinary 17-hydroxycorticosteroid Monitor BP every 5 for 30 Blood glucose, PFTs, serum potassium Dexamethasone 10 mg Dilute in 5-10 ml of D5W or NS Slowly over 5 Dextrose 50% 25 mg Infuse slowly at 3 ml/min Glucose Diazepam 15 mg Give each 5 mg or less over one minute Digoxin 500 mcg (2ml) at a single site Diphenhydramine 100 mg Undiluted (concentration is 25mg/ml) Dilution not required Slowly over at least 5 Slowly over 2-5 (NTE 25mg/min) Monitor bp, cardiac function, and injection site reaction ECG, serum calcium, creatinine/bun, magnesium, potassium, plasma digoxin levels Monitor Atipical pulse and BP prior to and after dose ECG, patient drowsiness, LFTS

3 Enalaprilat Normal: 1.25 mg Patients on diuretic therapy: mg Undiluted Slowly Over 5 Serum BUN/creatinine, monitor for profound hypotension Monitor vital signs every 15 for one hour post dose. Epinephrine 0.1mg/ml Max dose 1mg Infuse over 3-5 IV Flush with 20 ml to ensure delivery. Monitor for arrhythmias and extravasation. Increases in systolic and decreases in diastolic pressure. Epinephrine 1 mg/ml 0.5 mg Dilute 1 ml of epinephrine 9 ml 0.9% NS Esmolol Initial dose of 500mcg/kg followed by 50 mcg/kg/min for the next four doses Dilution not required Ferrlecit Depends on Iron levels Undiluted (available as 62.5 Flumazenil Initial dose: 0.2mg (repeat for four additional doses) Max cumulative dose: 1 mg in sedation reversal 3 mg in Benzodiazepine OD mg elemental iron/5ml) Infuse over 3-5 Initial dose: 1 minute Subsequent dose: 1 minute 12.5mg/min Infuse over 15 seconds in reversal of conscious sedation Infuse over 30 seconds in benzodiazepine overdose Furosemide 80 mg Undiluted Slowly over 1-2 NTE: 10mg/min Glucagon Beta blocker overdose: 3-5 MG (up to 10 mg) Hypoglycemia: 1 mg Dilute with one ml of sterile water provided in package (final concentration is 1 Infuse over 3-5 For hypoglycemia: infuse 1mg/ml over one minute IV Flush with 20 ml to ensure delivery. Monitor for arrhythmias and extravasation. Increases in systolic and decreases in diastolic pressure. HR, serum creatinine, hypotension Central Line only Serum iron, site reaction, ferritin, hgb/hct IV administer in freelyrunning IV into large vein Ototoxicity, glucose, serum BUN, electrolytes, Uric Acid Caution in renal impairment Hypotension, N/V, anaphylaxis, hyperglycemia Dose may be repeated in 20

4 (1mg=1unit) mg/ml) as needed Glycopyrrolate 0.2 mg Undiluted or may dilute to a Each dose (0.2mcg) over N/A concentration of 2mcg/ml 1-2 Hydralazine 40 mg Undiluted 5mg/min ANA titer, serum creatinine/bun Hydrocortisone Sodium succinate 500 mg ACT-O-VIALS: Add premeasured 2 ml diluent Each dose (500 mg or less) over 3-5 Blood glucose, PFTs, serum potassium provide with vial Regular vials: 2 ml of bacteriostatic water in each 100 mg vial Hydromorphone Opiod naïve patients:2mg Opiod Tolerant: 4 mg Undiluted Infuse each 2mg over 2-3 Hypotension, respiratory depression Iron sucrose 100 mg Undiluted (available as Slowly over 2-5 Site reaction Labetalol Levocarnitine 20 mg initial dose followed by 40-80mg After dialysis: 20 mg/kg T2DM: 5mg/kg Metabolic disorders: 50mg/kg 100mg/5ml vial) Available in 5mg/ml vial Each 20 mg dose over 2 Over 2-3 Keep patient supine for 3 hours after infusion. Monitor BP before dose and every 5 for 15 after dose Give into the venous return line after each dialysis session Levothyroxine 500 mcg Dilute with 5ml of 0.9% NS Over 1-2 N/A Lidocaine 300 mg per one hour 50mg/min ECG monitoring, HR, pulse ONLY the 5 ml, 50 mg, 100 mg dosage sizes should be used Lorazepam 4 mg Dilute with equal volume of 0.9%NS, D5W, or sterile water Magnesium Sulfate 5 grams Dilute the 50% injection with 5% dextrose or 0.9% NS. Maximum final concentration 2mg/min 150mg/minute (1.5% of 10 ml solution) Monitor respiratory status and O2 sat. Hyper-magnesia, BP, renal function, respiratory status

5 should not exceed 20% (200mg/ml) Methylprednisolone sodium succinate 125 mg Act-O-Vial: Add premeasured diluent provided with vial 40mg vial: 1ml bacteriostatic water 125mg vial: 2 ml bacteriostatic water Over 3-5 Metoclopramide 10 mg No dilution necessary under Over mg. Doses greater than 10 mg should be diluted in at least 50 ml 0.9% NS or D5W Metoprolol 15 mg (three doses of 5 mg) Each 5 mg dose: Over 1-2 Morphine Sulfate 15 mg/70kg or can be diluted with 5 ml of sterile water or 0.9% NS) Naloxone 0.4-2mg (max dose of 10 mg) (Available in 0.4mg/ml vial or 2mg/ml injection) Ondansetron 16 mg per dose (available in a 4mg/2ml vial) Protamine 50 mg Intended for use without dilution (10mg/ml) Sodium Bicarbonate (8.4%) 100 meq (Available as a 1mEQ/ml autoject) Vasopressin 40 units (One time dose to replace first or second dose of epinephrine (Available in 20u/ml vials Infuse over 4-5 Infuse each 0.4mg over 15 seconds Not less than 30 seconds; preferably over 2-5 mins Infuse slowly over 10 (5mg/min) Infuse over no less than five (10ml/min) Infuse rapidly Blood glucose, PFTs, serum potassium, glucose May repeat 4-6 hours as needed Spinal cord injury: Up to 500 mg over 2-3 Signs of extrapyramidal side effects should be monitored Blood pressure, heart rate, ECG. Monitor BP every 5 for 15 Respiratory rate, blood pressure, anaphylaxis, and cardiac function Respiratory depression Doses may be repeated every 2-3 QT prolongation at high doses (32mg) ECG abnormalities Blood pressure, heart rate, heparin titration test, PT Time Muscle tetany, extravasation, severe alkalosis Follow infusion with 20 ml flush

6 Sources used: Micromedex Facts and comparisons Up to Date Globalrph Lexi-comp