Professional Development Presents. May 2016 Medication of the Month. Milrinone Drip IN2731

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1 Med of the Month For any question regarding May 2016 Med of the Month: Milrinone Drip You may contact: Sherr Ann Arabit MSN, RN-BC, CCRN/Professional Development Department Ext 4196

2 Professional Development Presents May 2016 Medication of the Month Milrinone Drip IN2731 OBJECTIVE: To discuss the use of Milrinone in treating Congestive Heart Failure BRAND NAME: Milrinone Injection, Milrinone Lactate Injection PHARMACOLOGIC CATEGORY: Inotrope, Phosphodiesterase-3Enzyme Inhibitor ROUTE/DOSAGE ADMINISTRATION: For IV use only via continuous infusion pump

3 Inotropic support in heart failure: Short-term treatment of CHF unresponsive to conventional therapy with Digoxin, diuretics and vasodilators USE: Off-Label Inotropic therapy for patients unresponsive to other acute heart failure therapies (eg, Dobutamine); Outpatient inotropic therapy for heart transplant candidates; Palliation of symptoms in end-stage heart failure patients who cannot otherwise be discharged from the hospital and are not transplant candidates; Perioperative inotropic support for heart transplant recipients Preparation for Administration: 20mg in 100ml D5W standard concentration Bolus: 50mcg/kg IVP over 10min Maintenance: 0.5 mcg/kg/min Titrate to effect (0.375 to 0.75mcg/kg/min) Duration usually hours (not to exceed 5 days) Compatibility: Stable in D 5 W, LR, 1 / 2 NS, NS. Contraindications Hypersensitivity to Milrinone or any component of the formulation, severe aortic valve disease, severe pulmonary valve disease and acute MI Warnings/Precautions Concerns related to adverse effects: Prolonged use of Milrinone drip shown to be unsafe or ineffective. Arrhythmias: Ventricular arrhythmias, including nonsustained ventricular tachycardia and supraventricular arrhythmias, have been reported. Observe closely for arrhythmias in this very high-risk patient population; sudden cardiac death has been observed. Due to the prolonged half-life as compared to other inotropic agents, ventricular or atrial arrhythmias may persist even after discontinuation of milrinone especially in patients with renal dysfunction.

4 Ensure that ventricular rate is controlled in atrial fibrillation/flutter before initiating; may increase ventricular response rate. Hypotension: Hypotension may occur. Monitor blood pressure closely. Hypotension may be prolonged especially in patients with renal dysfunction. Vigorous diuresis may contribute to hypotension; cautious administration of fluids may be required to prevent hypotension. If hypotension occurs, consider dose reduction or temporary discontinuation. Disease-related concerns: Cardiovascular disease: Not recommended for use in patients with severe obstructive aortic or pulmonic valvular disease in lieu of surgical relief of the obstruction; may aggravate outflow tract obstruction in hypertrophic cardiomyopathy. Use cautiously in patient with Atrial fibrillation or A-flutter Electrolyte imbalance: Correct electrolyte disturbances, especially hypokalemia or hypomagnesaemia, prior to use and throughout therapy to minimize the risk of arrhythmias. Renal impairment: Use with caution in patients with renal impairment; reduction in infusion rate recommended. Hypotension may be prolonged in patients with renal dysfunction. Nursing: Physical Assessment/Monitoring Monitor cardiac/hemodynamic status continuously during therapy and serum potassium level at regular intervals. Monitor for fluid retention. Monitor patient s Vital signs particularly Blood Pressure, Heart Rate and Cardiac Rhythm Do not administer Lasix in same line as precipitate will form. Medication Patient Education with HCAHPS Considerations Discuss specific use of drug and side effects with patient as it relates to treatment. Patient may experience headache. Have patient report immediately to prescriber angina, tachycardia, severe dizziness, syncope, ecchymosis, hemorrhaging, or arrhythmia

5 Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). NOTE: Non- Titratable Milrinone Drip (maintenance dose only) will be added to the list of medications that could be administered on a Telemetry unit. Reference: Lexicomp Online 2016 Submitted By: Maryvelle R. Capangpangan, BSN, RN-BC Sherr Ann Arabit MSN, RN-BC, CCRN Reviewed and Approved by: RBMC Pharmaceutical Services

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