Standard Concentration

Transcription

1 Adenosine (Adenocard) X X MD present X MD present 6 mg/2 ml Adults: Bolus: 6 mg over 1-2 sec followed by a 20 ml saline flush. Peds Bolus: Give over 1-2 sec followed by 5-10 ml flush Slower rates are not recommended. Lower doses are recommended via central route. Albumin X X X 5% or 25% Adult Infusion: 5%- 2-4mL/min; 25% 1 ml/min Peds Infusion : 5% over min. Not to exceed 2-4 ml/min ; 25% over 1-2 hours not to exceed 1 ml/min Amiodarone X X GR 150mg/50ml bolus 400mg/250ml maintenance Antithymocyte Globulin (Rabbit) (Thymoglobulin) X X X GR 5mg/mL Doses generally dispensed in 500ml volume Adult Bolus: 15 mg/min Adult Infusion: not to exceed 30 mg/min Peds: Children will have 5 separate 1 mg/kg aliquots Each aliquot given over 5-10 minutes with 5-10 minutes in between. Adult Infusion: mg/kg dose over 6 hours and subsequent doses over 4 hours. Peds Infusion: Administer first dose A continuous ECG rhythm strip should be run during dosing to document drug effects. HR and BP should be monitored continuously during and for 30 minutes after therapy (Longer if patients also received digoxin or verapamil). A second or third dose may be given at 1 to 2 minute intervals if arrhythmia persists. Contraindicated in bronchiospastic disease, bradycardia. 25% solution is hypertonic. CVP monitoring recommended in ICU patients treated for shock. Dilute with Normal Saline, rapid infusion may cause hypotension, and decrease in serum calcium. Monitor vital signs and fluid balance. Continuous cardiac monitoring required, Thyroid function and LFT s should be monitored frequently. Monitor for hand/foot edema and pulmonary function tests. In children, repeat loading dose of 5 mg/kg may be given 30 minutes after initial bolus, if arrhythmia control has not been achieved. Calcium Chloride 10% should be at the bedside In-line filtration required. Skin test recommended prior to first dose, have anaphylaxis kit at bedside. monitor for shortness of breath, hives, flu-like syndrome; monitor WBC and platelets. Premed first two doses with

2 Antithymocyte Globulin (Equine) or lymphocyte immune globulin (Atgam) Atropine X X MD present X X X GR Generally dispensed in 500ml volume, may be higher or lower depending on dose. X MD present Various, check concentration over 6 hours and subsequent doses over 4 hours. Adult Infusion: mg/kg over 4-6 hrs. Peds Infusion: Give over 4-6 hours. Some patients may require longer infusions. Adult Bolus: mg/min, slow injection may cause paradoxical bradycardia Peds Bolus: Give over 1 minute Bretylium (Bretylol) X 50 mg/ml Adult Bolus 5mg/kg undiluted over 1 min; Adult Infusion 1-2 mg/min Peds Bolus: For lifethreatening emerg give over sec. Peds Infusion: Give over at least 8 minutes. Bumetanide (Bumex) X X X 0.25 mg/ml Adult Bolus: 1-4 mg over 1-2 min Peds: Give bolus over 1-2 min; Intermittent infusion over 5 min Buprenex X X X 0.3 mg/ml Adult Bolus 0.3 mg over at least 2 min acetaminophen, diphenhydramine +/- steroids. In-line filtration required. Skin test recommended prior to first dose, have anaphylaxis kit at bedside. monitor for shortness of breath, hives, flu-like syndrome; monitor WBC and platelets. Premed first two doses with acetaminophen, diphenhydramine +/- steroids. Monitor Heart rate, blood pressure, pulse, mental status; intravenous administration requires a cardiac monitor Continuous monitoring EKG, heart rate, blood pressure; requires a cardiac monitor. Rapid administration may cause nausea and vomiting. Monitor blood pressure, serum electrolytes, renal function CNS depressant; Monitor pain relief, respiratory and mental status, CNS depression, blood pressure

3 Butorphenol (Stadol) X X X 1 mg/ml, 2 mg/ml Calcium Chloride X 1 gm / 10 ml vial Adult Bolus 1 mg over 2 min; Adult Bolus: 1 ml/min Dialysis: Ca replacement GR in 100 to 250ml and infuse during course of treatment. Peds Bolus: Max rate of X X X 1gm in 50 ml mg/min Adult Infusion or Intermittent infusion 1 gm over 30 min Peds Infusion: Do not exceed mg/kg given over 1 hour; Max conc of 20 mg/ml Calcium Gluconate X Via infusion Via infusion 1 gm / 50 ml Adult Bolus ml/min Adult Infusion: 1gm/ in 100 ml given over 30 min Peds Bolus: Max rate of mg/min Peds Infusion: Do not exceed mg/kg given over 1 hour ( meq/kg/hr); Max Chlorpromazine (Thorazine) conc of 50 mg/ml X X 25mg/ml Adult Bolus 1 mg/min Adult Infusion doses >5mg can be infused over 30 min up to Adjunct to anesthesia: monitor pain relief, respiratory and mental status, blood pressure 1.36 meq Calcium/mL: Do not inject calcium chloride I.M. or administer S.C. or use scalp, small hand or foot veins for I.V. administration since severe necrosis and sloughing may occur. Monitor EKG if calcium is infused faster than 2.5 meq/minute in adults; usual in adult: meq/minute (0.5-1 ml/minute); stop the infusion if the patient complains of pain or discomfort. administer slowly, do not exceed 1 ml/minute in adults (ACLS use: inject into ventricular cavity - not myocardium); do not infuse calcium chloride in the same I.V. line as phosphate-containing solutions meq Calcium/mL: Do not infuse calcium gluconate solutions in the same I.V. line as phosphate-containing solutions Monitor orthostatic blood pressures; tremors, gait changes, abnormal movement in trunk, neck, buccal area, or extremities; monitor target behaviors for which the

4 30 mg Peds: Do not exceed 0.5 mg/minute Cisatracurium X GR 2mg/ml; 10mg/ml Adults and Peds: Bolus mg/kg over 5-15 seconds Infusion: 3 after initial dose Cyclosporine X X X GR 50mg/ml Adults and Peds: Initial Infusion 5-6 mg/kg/day in 2 divided doses over 2 to 12 hrs D 50 W X X X 50% Adults and Peds: Bolus 200 mg/kg over 1 min Dexamethasone (Decadron) X X X Dexmedetomidine (Precedex) Diazepam (Valium) X No titration of infusion 4 mg/ml Adult Bolus 4 mg/min; Adult Infusion scheduled doses can be infused over 30 minutes Peds Bolus: If < 10 mg may give over 1-4 min. Higher doses should be given over min. X 200 mcg / 50 ml Adult Infusion: mcg/kg/hr No titration of infusion GR 5 mg/ml ; 5mg/50 ml infusion Adult Bolus 5 mg/min Adult Infusion agent is given; watch for hypotension, dilute with NS prior to bolus administration. Not for IM use; maintain airway and respiratory support, replete electrolytes in infusions: Monitor vital signs (heart rate, blood pressure, respiratory rate), pain, patient response with peripheral nerve stimulator. Monitor blood pressure and serum creatinine after any cyclosporine dosage changes or addition, modification, or deletion of other medications. Monitor plasma concentrations per protocol. Dilute to maximum concentration of 12.5% for peripheral administration: Do not administer within same tubing as whole blood due to potential hemolysis, administer thiamine ( mg I.V.) in adult patients to prevent Wernicke's encephalopathy Monitor hemoglobin, occult blood loss, serum potassium, and glucose Insure airway and respiratory support measures in place, monitor level of sedation, heart rate, respiration, rhythm. Respiratory, cardiovascular, and mental status; check for orthostasis: provide safety

5 maximum rate 20mg/hr Peds Bolus: Do not exceed 1-2 mg/min. Older children: do not exceed 5 mg/min Dihydroergotamine X X X 1mg/ml Adult Bolus 1mg over 2 minutes Peds Bolus: Give slowly over 2-3 min. Diazoxide (Hyperstat) X X 15 mg/ml Adult Bolus: dose 30 sec Peds Infusion: Give over 30 min. Digoxin (Lanoxin) X X X 250 mcg/ml Adult Bolus:DOSE OVER 5 min (undiluted) Peds Bolus: Give over 5-10 min. Diltiazem (Cardizem) X X GR 5 mg/ml; 1mg/ml infusion Diphenhydramine (Benadryl) Dobutamine X No titration of infusion Adult Bolus 0.25 mg/kg over 2 min. Adult Infusion 5-15 mg/hr X X X 50 mg/ml Adult Bolus mg over 1 min Peds Bolus: Give over 5 min. Do not exceed 2 mg/kg over 2-5 min. Peds Infusion: May be infused over 15 minutes. GR Various, verify concentration Adult and Peds: Infusion measures to prevent falls Potent vasoconstrictor; contraindicated in cardiovascular disease. Monitor for numbness or tingling of fingers, toes, or face drowsiness; heart palpitations, severe nausea or vomiting. Adult: 1-3 mg/kg (maximum 150mg)/dose: Monitor blood pressure, blood glucose, serum uric acid; intravenous administration requires cardiac monitor and blood pressure monitor Heart rate and rhythm should be monitored along with periodic EKGs to assess both desired effects and signs of toxicity: Monitor serum electrolytes, renal function, serum levels. Recommend continuous EKG and blood pressure monitoring Monitor symptom relief, sedation Most patients maintained at < 10 ; maximum concentration in adults= 5 mg/ml: Requires continuous EKG

6 Dolasetron X X X 20 mg/ml Adult Bolus: mg over 2 minutes Peds Bolus: Infuse undiluted over 30 sec or give diluted over <15 min. Dopamine X No titration of infusion GR Various verify concentration Adult and Peds: Infusion Dopaminergic = 0.5-2, Beta 1 agonist = 1-10, Alpha agonist= 10+ Droperidol (Inapsine) X X X 2.5 mg/ml Adult Bolus mg over 2-5 minutes Peds Bolus: Give over 2-5 min. Enalaprilat X X 1.25 mg/ml Adult Bolus 1.25 mg over 5 minutes Adult Intermittent infusion: dilute in 50ml NS infuse over 20 minutes. Peds Bolus: Give over 5 min. and blood pressure monitoring, heart rate, CVP, RAP, MAP, urine output; if pulmonary artery catheter is in place, monitor CI, PCWP, and SVR; also monitor serum potassium, avoid extravasation Monitor blood pressure, pulse, symptom response. May cause headache (provide analgesic), drowsiness, and dizziness. Chronic refractory CHF 1-3 ; Requires continuous EKG and blood pressure monitoring; heart rate, CVP, RAP, MAP, urine output; if pulmonary artery catheter is in place, monitor Cl, PCWP, SVR, and PVR. Avoid extravasation BP, HR, resp rate monitoring recommended. Monitor for dystonias, EPS, temperature, serum potassium and magnesium. Avoid use in patients with history of QT prolongation. Clinical response seen within 15 min. Monitor blood pressure, renal function, WBC, serum potassium; blood pressure monitor required during intravenous administration

7 Epinephrine (Adrenalin) X Anaphylaxis Kit only Anaphylaxis kit only GR 1:10,000 1:1,000 Eptifibatide X 200 mcg/ml bolus; 750 mcg/ml infusion Esmolol X GR 10 mg/ml and 250 mg/ml. verify concentration, Adult Bolus mg (max 1mg) over 1-2 min Adult Infusion: 1-10 mg/min Peds Bolus: Give over < 1 min. Ped Infusion: Adult Bolus: 180 mcg/kg over 2 min; Adult Infusion: 2 up to 15 mg/hr Adult and Peds: Bolus 500 ; Infusion ; note concentration of vial if used, different concentrations Famotidine (Pepcid) X X X 10 mg/ml Adult Bolus 20mg over 2 min Peds Bolus: Give over 3-5 min. Max: 10 mg/min. Peds Infusion: May be given over min. Fentanyl (Sublimaze) X PCA only Conscious sedation by MD only GR 50 mcg/ml Adult Bolus 1-2 mcg/kg over 2 min Adult Infusion 1-3 mcg/kg/hr Neonatal Bolus: Give Do not use if pink in color. Requires continuous EKG, HR and blood pressure monitoring via cardiac monitor, pulmonary function, and injection site monitoring to prevent extravasation. Visually inspect for discoloration or particulate matter prior to administration, monitor for bleeding, bruising, avoid unnecessary arterial or venous punctures, assess sheath insertion site and distal pulses of affected leg q 15 minutes 1 st hr, then qhr for next 6 hrs Dilute bolus prior to administration, verify concentration. Monitor blood pressure, heart rate, MAP, EKG, respiratory rate, I.V. site; cardiac monitor and blood pressure monitor required Decrease infusion or discontinue if hypotension, congestive heart failure, etc occur Dilute to 5-10 ml volume for bolus dose Gen care approved for conscious sedation in the presence of MD only. Muscular rigidity may occur with rapid iv administration; monitor respiratory and cardiovascular status, blood pressure, heart

8 over 5 min. Peds Bolus: Give over 3-5 min. Doses > 5mcg/kg should be given over 5-10 min. Fosphenytoin X X X GR 50 mg/ml Adult Bolus 150 mg/min Neonatal Bolus: Max: 0.5 mg/kg/min Peds Bolus: Max: 1-3 mg/kg/min up to 150 mg/min. Furosemide (Lasix) X X X GR 10 mg/ml Adult Bolus 10 mg/min < 40mg or 4mg/min > 400mg Peds Bolus: Give over 3-5 min. Max: 0.5 mg/kg/min. Glucagon X X X 1 mg/1 ml bolus 10mg/50ml infusion Adult Bolus: 0.5mg over 1 minute; Adult Infusion: 1-5 mg/hr Peds Bolus: < 20 kg: mg/kg; Max: 1 mg; > 20 kg: mg IV push Glycopyrrolate X X X 0.2 mg/ml Adult Bolus 0.1 mg over 2 min Peds Infusion: Give over min. Max 20 mcg/min Granisetron X X X 1 mg/ml Adult Bolus: 1 mg over 30 seconds; Adult Infusion: dose may be diluted in 30ml rate. Blood pressure, vital signs (with I.V. use), plasma level monitoring, CBC, liver function tests Monitor weight and I & O daily; blood pressure, serum electrolytes, renal function; in high doses, monitor hearing Repeat as needed at 2-3 minute intervals: Monitor heart rate; anticholinergic effects Monitor blood pressure, pulse, symptom response. May cause headache (provide analgesic), drowsiness, and dizziness.

9 Haloperidol (Haldol) X X X 2 mg/ml 5 mg/ml Heparin X X X GR 5,000unit/0.5ml 7,500 units/ml 10,000units/ml 20,000units/ml and given over 15 minutes Peds Bolus: Infuse over 30 sec undiluted Peds Infusion: Dilute in ml and give over min. Adult Bolus mg over 2-5 min Adult Infusion 10 mg/hr Adult Bolus units/kg over 2 minutes; Adult Infusion units/kg/hr Peds Bolus: units/kg over 10 minutes Peds Infusion: units/kg/hr. Hydralazine (Apresoline) X X 20 mg/ml Adult Bolus: 10mg/min Peds Bolus: Give over 1-2 min. Do not exceed 0.2 mg/kg/min or 5 mg/min whichever is less. Hydrocortisone sodium succinate (SoluCortef) X X X 50 mg/ml Adult Bolus doses < 100mg over 1 min, Adult Infusion 100 mg over 30 min Peds Bolus: Give over 3-5 min. Doses > 500 mg should be given over 10 min. Peds Infusion: Give Dose depends on severity of agitation; Monitor orthostatic blood pressure, HR and for abnormal movement (extrapyramidal symptoms); EKG monitoring recommended for infusion. Monitor platelet counts, aptt, hemoglobin, hematocrit and signs of bleeding. Draw aptt 3-6 hours after each dose change Monitor blood pressure (monitor closely with I.V. use), standing and sitting/supine, heart rate Monitor blood pressure, weight, serum glucose, and electrolytes

10 over min. Hydromorphone (Dilaudid) X No titration of infusions PCA Intermittent dosing only PCA 1mg/mL Adult Bolus 1mg per minute up to 2mg Adult Infusion 6 mg/hr Peds Bolus: Give over 2-3 min. Inamrinone (Inocor) X X GR 5 mg/ml Adult Bolus: mg/kg (0.75mg/kg) over 2-3 min Peds Bolus: Give over 2-3 min. Neonatal Infusion: 3-5 Peds Infusion: 5-10 Monitor pain scale, blood pressure, respiratory status Implement fall precautions. Higher infusion rates may be required for opioid tolerant patients. Do not mix in dextrose containing solutions. Continuously monitor cardiac index, stroke volume, systemic vascular resistance, and pulmonary vascular resistance (if Swan-Ganz catheter available); CVP, SBP, DBP, heart rate, daily platelet count, CBC, liver function and renal function tests Insulin X X X GR 1 unit / ml infusion, see vial for concentration Isoproterenol X No titration of infusions Ketorolac (Toradol) X X X 15 mg/ml 30 mg/ml Adult Infusion Titrated to BG range ordered. Usually 1-5 units/hr Peds Infusion: usual is units/kg/hr GR 4 mcg/ml Adult Infusion or 2-10 mcg/min. Range 1-20 mcg/min depending on response Peds Infusion: NOTE DIFFERENCE IN DOSING Adult Bolus mg over 2 minutes Peds Bolus: Give over 1- Drug may adsorb to IV bag and tubing, when new tubing needed, prime, wait 30 minutes, then flush tubing prior to starting infusion. Monitor Urine glucose and acetone, serum glucose, electrolytes, Hb A 1c, lipid profile Requires continuous EKG, HR, respiratory rate, arterial blood gas, arterial blood pressure and CVP monitoring Caution in elderly, renally impaired or patients with CV disease; Stop before surgery due to prolonged bleeding. Monitor

11 Labetalol Trandate) (Normodyne, X X GR 5 mg/ml Adult Bolus 20mg or 1-2 mg/kg over 2 min, whichever is lower Peds Bolus: Give over 2-3 min. Max: 2 mg/min. Lepirudin X X X 5 mg/ml bolus 0.2mg/ml infusion 5 min. pain scale, renal liver function, CBC, signs of bleeding, Adult Bolus: up to 0.4 mg/kg over 30 seconds Adult Infusion: 0.15 mg/kg/hr Lidocaine X X GR 10 or 20mg/mL Adult Bolus mg/kg over 2-3 minutes Adult Infusion 1-4 mg/min Peds Bolus: Give over 2-4 min. Max 0.7 mg/kg/min not to exceed 50 mg/min. Peds Infusion: Lorazepam (Ativan) X No titration of infusions Intermittent dosing only GR 2mg or 4mg/mL Adult Bolus 2mg/min Adult Infusion:1-3 mg/hour Peds Bolus: Give over 3-5 min. Do not exceed 2 mg/min or 0.05 mg/kg whichever is less. Peds Infusion: mg/kg/hr Magnesium X X X GR 1000 mg / 2 ml Adult Infusion 1-3 gm over 30 min Peds Infusion: Infuse Monitor BP supine and standing, HR pre and post dose. BP and cardiac monitoring recommended; monitor for signs/symptoms of orthostatic hypotension Monitor PTT, signs/symptoms of bleeding Requires continuous cardiac monitoring, EKG, HR, BP, daily renal, liver function and serum electrolytes, serum levels per protocol. Bolus doses- dilute with equal volume of diluent; contains polyethylene glycol, propylene glycol and benzyl alcohol; Monitor respiratory and cardiovascular status, blood pressure, heart rate, symptoms of anxiety Adults: Dilute up to 3 gm in 50 ml of NS

12 over 2-4 hours. Do not exceed 1 meq/kg/hr Mannitol (Osmitrol) X X X 20% or 25% Adult Bolus UOP 12.5 gm over 5 minutes Adult Infusion: ICP 1.5-2g/kg over > 30 minutes Peds Bolus: Test bolus can be given over 3-5 min. Peds Infusion: Give over > 30 minutes. Meperidine (Demerol) X X X 10 mg/ml Adult Bolus: 25 mg over 2 min Adult Infusion mg per hour Peds Bolus: Give over at least 5 min. Do not exceed 25 mg/min. Methyldopa X X 50 mg/ml Adult Infusion mg over 30 minutes Peds Infusion: Give over min. Metoclopramide (Reglan) X X X 5 mg/ml Adult Bolus 10 mg over 1-2 min Peds Infusion: Give over min. Max: 5 mg/min. Methylergonovine (Methergine) Methylprednisolone sodium succinate(solumedrol) X 0.2 mg/ml Adult Bolus 0.2 mg over 1 min X X X Varies by vial size Adult Bolus: 125 mg over 2 minutes Adult Infusion: Direct injection not recommended; avoid extravasation to prevent edema and necrosis; In-line 5 micron filter should always be used. Monitor renal function, daily fluid I & O, serum electrolytes, serum and urine osmolality; for treatment of elevated intracranial pressure, maintain serum osmolality mosm/kg Monitor Pain relief, respiratory and mental status, blood pressure; observe patient for excessive sedation, CNS depression, seizures, respiratory depression, lower dose in elderly, renal/liver dysfunction Monitor CBC, LFT s Blood pressure, standing and sitting/lying down, CBC, liver enzymes, Coombs' test (direct); blood pressure monitor required during I.V. administration Monitor periodic renal function test; monitor for dystonic reactions; monitor for signs of hypoglycemia in patients using insulin and those being treated for gastroparesis; monitor for agitation and irritable confusion Monitor blood pressure and pulse. IV administration my induce sudden hypertension and cerebrovascular accident Monitor blood pressure and serum glucose and electrolytes Methylprednisone acetate is for IM use only.

13 5.4mg/kr/hr; Adult Intermittent infusion: mg over 30 minutes Ped Bolus: Dose <1.8 mg/kg or 125mg give over 3-15 minutes; > 2 mg/kg or > 250 mg give over min; Dose 15 mg/kg or 500 mg give over at least 30 min; Dose >1000 mg give over 1 hour Metoprolol (Lopressor) X X 1 mg/ml Adult Bolus 5 mg rapidly every two minutes for up to three doses: Adult Infusion: 5mg in 50 ml NS over 30 minutes Midazolam (Versed) X No titration of infusion Conscious sedation by MD only GR 1 mg/ml 5 mg/ml Adult Bolus 1 mg/min Adult Infusion 2-10 mg per hour Neonatal Bolus: Give over 5 min. Peds Bolus: Give over 2-5 min. Peds Infusion: mg/kg/hr Milrinone (Primacor) X X GR 200 mcg/ml Adult Infusion: Peds Bolus: Give over 15 min. Peds Infusion: Monitor Blood pressure, apical and radial pulses, fluid I & O, daily weight, respirations, mental status, and circulation in extremities before and during therapy Avoid abrupt withdrawal to avoid BP changes Gen care approved for conscious sedation in the presence of MD only. Monitor Respiratory and cardiovascular status, blood pressure, blood pressure monitor required during I.V. administration Cardiac monitor and blood pressure monitoring required; serum potassium

14 Morphine Sulfate X X X GR 4 mg/ml 10 mg/ml 15 mg/ml. Adult Bolus: 4mg over 2 min Adult Infusion 5-20 mg per hour Peds Bolus: Give over at least 5 min. Neonatal Infusion: mg/kg/hr Peds Infusion: usual mg/kg/hr Naloxone (Narcan) X X Intermittent GR 0.4 mg/ml Adult Bolus 0.4mg over dosing only 1 mg/ml 2 min Adult Infusion mg per hr titrate to patient s response Peds Bolus: Give over 1 minute Neostigmine X 0.25 mg/ml; Adult Bolus 0.5 2mg 0.5 mg/ml; given slowly; maximum 1 mg/ml 5 mg Peds Bolus: Give over several minutes Nesiritide X X X 6 mcg/ml Adult Bolus: 2 mcg/kg over 60 seconds Adult Infusion: 0.01 Monitor pain scale, Blood pressure, respiratory status Implement fall precautions Higher infusion rates may be required for opioid tolerant patients Monitor Respiratory rate, heart rate, blood pressure; Verify concentration used is correct Caution in patients with asthma or COPD, may restrict airways; monitor respirator and airway status, heart rate, BP, periodically monitor vital capacity and muscle strength. Be alert for cholingeric crisis Do not administer via a heparin coated catheter, prime IV tubing with 25 ml of infusion prior to connection with vascular port access. Nicardipine X GR 2.5 mg/ml Adult Infusion 5-15 mg/hr Ped Infusion: Initial dose:0.5-5 Nitroglycerin X X GR 100mcg/ml Adult Infusion 25 mcg/min titrated to Monitor BP and Heart rate Cardiac monitoring required, Monitor blood pressure, heart rate, ekg

15 patient comfort; Maximum 400 mcg/min Ped Infusion: Nitroprusside X GR 50mg/250ml Adult Infusion Ped Infusion: Initial dose: ; Max: 10 Norepinephine X X Adult Telemetry bed, no titration, max dose 1 mg/hr with charge nurse approval based on staffing Octreotide X X X GR 50, 100, 500 mcg/ml GR 4mg/250ml Adult Bolus 8-12 mcg/min Adult Infusion 2-4 mcg/min Peds Infusion: Adult Infusion mcg/hr Peds Infusion for GI bleed: 1 mcg/kg bolus followed by 1 mcg/kg/hr Ondansetron X X X 4mg/5ml Adult Bolus 4mg over 2 min Peds Bolus: Give over 2-5 min. May be given Protect from light; Monitor Blood pressure, heart rate; monitor for cyanide and thiocyanate toxicity; monitor acid-base status as acidosis can be the earliest sign of cyanide toxicity; monitor thiocyanate levels if requiring prolonged infusion (>3 days) or dose > 4 ute or patient has renal dysfunction; monitor cyanide blood levels in patients with decreased hepatic function; cardiac monitor and blood pressure monitor required Max concentration 64 mcg/ml ; Requires cardiac monitoring, BP, HR, EKG, UOP, If intra arterial monitoring available, monitor CVP, serum electrolytes, monitor skin temp and color of extremities, avoid extravasation Infusion for esophageal varices in adults. Monitor blood pressure, pulse. May cause headache, drowsiness, and dizziness.

16 diluted over 15 minutes. OKT3 X X X 5 mg/5ml Adult and Peds: Bolus dose in less than 1 min Oxytocin X X X GR 10units/ml Infusion: units/min, max dose 30 milliunits/min Pamidronate X X X Varies by dose Adult Infusion mg over 4 to 24 hrs Peds Infusion: Give over Pancuronium (Pavulon) X GR 1 mg/ml 2 mg/ml 4-24 hours. Adult Bolus 1mg over 2 minutes Peds Bolus: Give over at least 1 minute Paracalcitrol (Zemplar) X X X 5 mcg/ml Adult Bolus: mcg/kg over 2 minutes Pentazocine (Talwin) X X X 30 mg/ml Adult Bolus mg over 2 minutes Adult Infusion 1-5 mg per hour Pentobarbital (Nembutal) X GR 6mg/ml Adult Bolus 50 mg/min, max rate Adult Pentobarb coma: LD 5mg/kg over 3-5 minutes, Adult Infusion Chest X ray prior to 1 st dose to confirm lungs are clear, Premedicate 30 minutes before first dose with hydrocortisone, acetaminophen, H2 blocker and diphenhydramine; and before subsequent doses as above without hydrocortisone. Monitor for increased temperature and pulmonary edema. Monitor fluid intake and output, fetal monitoring Adult infusions require adequate volume ml to insure adequate hydration Monitor Heart rate, blood pressure, assisted ventilation status; cardiac monitor, blood pressure monitor, and ventilator required Serum calcium and phosphorus should be monitored closely (e.g., twice weekly) during dose titration; monitor for signs and symptoms of vitamin D intoxication; serum PTH Vesicant; insure good blood flow in iv site; monitor pain scale, BP, HR, respiratory status Infusion doses titrated to serum concentration of mcg/ml or flat EEG or cardiac depression; parenteral solutions highly alkaline, avoid extravasation, monitor respiratory status, cardiovascular

17 Phenylephrine (Neosynephrine) 1-4 mg/kg/hr Peds Pentobarb Coma: LD of mg/kg over 1-2 hours followed by 1-5 mg/kg/hr X GR 30mg/250ml Adult Bolus mg/min, Adult Infusion mg/min Peds Bolus: Give over sec Peds Infusion: Phenobarbital X X X 30 mg/ml Adult Bolus not greater than 60 mg/min Peds Loading Dose: Give over at least 20 min. Do not exceed 1 mg/kg/min or 30 mg/min Peds Maintenance Dose: Give over 3-5 min. Do not exceed 1 mg/kg/min or 30 mg/min Phenytoin (Dilantin) Sodium X X X GR 50 mg/ml Adult Bolus Do not exceed 40 mg/min Loading doses will be dispensed in 250ml Neonatal Bolus: Max: 0.5 mg/kg/min Peds Bolus: Max: 1-3 mg/kg/min up to 50 mg/min. status, CNS status Monitor Blood pressure, heart rate, arterial blood gases, central venous pressure Phenobarbital serum concentrations, mental status, CBC, LFTs, seizure activity Avoid extravasation, administer via inline 0.22 micron Monitor vital signs, symptoms, and IV flow rate q 15 minutes during the infusion and for 1 hour after the infusion. Consider reducing the infusion rate in patients with known cardiac disease or abnormal EKG, or in patients > 60 years of age. Patients >55 years of age AND unstable prior to onset of seizure activity, patients with known cardiac disease, and

18 Potassium Chloride X X X GR 10 meq/50 ml; 20 meq/100 ml Procainamide X No titration of infusion Prochlorperazine (Compazine) Adult Infusion 10 meq/hr Peds/Neonates meq/kg/hr, not to exceed 10 meq/hr GR 1 gm/250 ml Adult Bolus mg/min Adult Infusion 1-6 mg/min Peds Bolus:Give over min. Do not exceed mg/min. Peds Infusion: X X X 5 mg/ml Adult Bolus 1mg/ml/min Peds Bolus: Max 5 mg/min Promethazine (Phenergan) X X X 25 mg/ml Adult and Peds Bolus Do not exceed 25mg/min Propiomazine (Largon) X 20 mg/ml Adult Bolus 10mg/min Propofol X GR 10 mg/ml Adult Bolus 0.5 mg/kg over 3-5 min, Adult Infusion patients with changing vital signs should be placed on a cardiac monitor during the infusion and for 1 hour after the infusion. This may require transferring the patient to a unit that can provide cardiac monitoring. If ADULT patient has continuous cardiac monitoring and central line administration,(icu setting) rate can be 40 meq/hr, DO NOT BOLUS THIS DRUG Monitor serum potassium, avoid extravasation; Pharmacy max concentrations per bag of central TPN 200 meq/l, peripheral TPN 80 meq/l, IV maintenance bag, 80 meq/l Monitor for hypotension during rapid infusion Use extreme care to avoid extravasation; dilute 10:1 prior to administration Cardiac monitor, blood pressure monitor, and ventilator required; serum triglyceride levels should be obtained prior to initiation of therapy (ICU setting) and every 3-7 days

19 Ped Bolus: Induction dose over sec Propranolol (Inderal) X 1 mg/ml Adult Bolus 1 mg/min Ped Bolus: Give over 10 min. Max: 1 mg/min. Protamine Sulfate X X X 10 mg/ml Adult Bolus 5mg per minute up to 50mg max dose Ped Bolus: Give over 10 min. Max: 5 mg/min. Ranitidine (Zantac) X X X 25 mg/ml Adult Bolus 50 mg over 5 min Adult Infusion 50mg over 30 min Ped Infusion: Give over min. Remifentanyl X Bolus: 50 mcg/ml, Adult Bolus: 50 mcg Infusion 5mg/ 100 over 2 minutes ; Infusion ml Retavase X X 10.9 units/2ml Adult Bolus 10 units diluent over 2 minutes Ritodrine (Yotopar) X 0.3 mg/ml Adult Bolus mcg/min Sodium Bicarbonate X X X 50 meq/50 ml Adult Bolus 10 meq/min Adult Infusion 1 meq/kg/hr Ped Bolus in emergency: Give over 3-5 min, Max < 1-2 meq/kg/min not to exceed 10 meq/min. Ped Infusion: Infuse over at least 2 hours. Max: 1 meq/kg/hr thereafter; daily sedation levels using standardized scale Monitor BP, HR Continue to monitor coagulation; may cause allergic reaction in pt s allergic to fish. Rapid administration may result in hypotension. 1mg protamine neutralizes approximately 100 units of heparin must be diluted prior to IV administration Respiratory and cardiovascular status, blood pressure, heart rate. Monitor for signs of bleeding (hematuria, GI bleeding, gingival bleeding) Monitor hydration status and blood glucose concentrations Rapid administration in children may result in hypernatremia, decreased CSF pressure. Avoid extravasation

20 Steptokinase X Varies Adult Infusion for MI 1.5 million units over 60 min Tacrolimus X X X GR 5mg/ml Adult Infusion mg/kg/day; in 2 divided doses over 2-12 hours Ped Infusion: mg/kg/day as continuous infusion or in 2 divided doses Tirofiban X 50 mcg/ml Adult Infusion: up to 0.4 Tissue Plasminogen Activator- Thrombolytic Tissue Plasminogen Activator Cath Clear X X 1mg/ml Adult Bolus: 15 mg over 1-2 minutes Adult Infusion Systemic thrombosis, mg/kg/hr; Acute MI dose up to 50mg over 30 minutes Ped with systemic thrombosis: mg/kg/hr X X X 2mg/ml Catheter occlusion; dosed per lumen, instill volume in lumen over 1-2 minutes Urokinase X X Variable Adult Bolus for PE Loading dose, 4400 iu/kg over 10 minutes, Contact physician if patient currently on heparin- increased bleeding risk. Infusion should be slowed if BP falls by 25 mm Hg or terminated if asthmatic symptoms appear. Monitor BP, PT, aptt, platelets, hematocrit, fibrinogen Should not be diluted or infused in PVC containers, use polyethylene tubing and glass containers, monitor renal, hepatic function, serum electrolytes, glucose and blood pressure; tacrolimus level Insure no air in line; may be administered via same line as heparin; monitor for bleeding, bruising Dosing for systemic thrombosis, acute MI, stroke, PE varies, monitor BP, temp, CBC, reticulocyte count, platelet count, fibrinogen, plasminogen, PT, PTT, antithrombin III, Protein C, urinalysis, signs of bleeding Dose for thromboses in pediatric patients is based upon limited literature. Leave in lumen for 1-2 hours then aspirate out of catheter, do not infuse into patient, flush catheter with NS Indicated for acute MI or other occlusive disorder. Monitor BP, temp, CBC, reticulocyte count, platelet count,

21 Vasopressin X GR Bolus 20 unit/ml (0.5 or 1 ml), infusion 1 unit/ml Adult Infusion 4400 IU/kg/hr Adult Bolus for pulseless VTach 40 units over sec; Adult Infusion 0.5 milliunits/kg/hr to max of 0.1 units/kg/hr Peds Infusion for DI: milliunit/kg/hr. Peds Infusion for CV support: units/kg/hr Vecuronium (Norcuron) X GR 1mg/mL Adult Bolus mg/kg over seconds Adult Infusion mcg/mg/min Peds Bolus: Give over 1-2 min. Peds Infusion: mg/kg/hr. Verapamil (Isoptin, X X GR 2.5 mg/ml Adult Bolus mg Calan) over 2 minutes Zolendrate (Zometa) X X X 4mg/100 ml Adult Infusion: 4 mg over minutes fibrinogen, plasminogen, PT, PTT, antithrombin III, Protein C, urinalysis, signs of bleeding Use central vein to avoid tissue damage; Monitor BP, HR, serum and urine sodium, urine specific gravity, urine and serum osmolality, UOP Monitor airway, BP and HR Max total dose 20mg; geriatric: not less than 3 min; monitor BP Monitor serum creatinine prior to each dose. Serum electrolytes, phosphate, magnesium, and hemoglobin/hematocrit should be evaluated regularly. Monitor serum calcium to assess response and avoid over-treatment.