Medication Administration Policy

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<p>Section II</p> <p>Parenteral Medication Administration Guidelines</p> <p>This section can be copied and kept for reference at bedside.Click a letter to quickly navigate the list: A B C D E F G H I J K L M N O P Q R S T U V W X Y ZMedication Generic - (Brand) ABCIXimab (Reopro) Antiplatelet IIb/IIIa How Supplied 2mg/ml 5 ml vial IV Push Conc / Rate Yes 2 mg/ml Give bolus over 1 minute SVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time Percutaneous Coronary Intervention: 0.25 mg/Kg bolus followed by 0.125 mcg/Kg/min infusion (up to max 10mcg/min = 7.2 mg) x 12 hours System Standard Concentration: 7.2 mg/ 250 ml NS (28.8 mcg/ml) AcetaZOLAMIDE (Diamox) Diuretic Acetylcysteine, Nacetylcysteine (Acetadote) 500 mg Vial Yes 100 mg/ml at max rate of 250 mg/min. NO IV Push Preferred ** Verify dose to be given. Discard vial after drawing up correct dose. ** May cause thrombophlebitis Caution with use in patients with asthma and/or history of bronchospasm Common adverse effects: rash, urticaria and pruritus Urticaria and pruritus may be treated with antihistamine (i.e. diphenhydramine) with physician order. Precautions / Comments Stability / Storage Limitations / Restrictions</p> <p>Preprinted order set available Monitor Hgb/Hct, platelets, PT, PTT 6 hours after admin and 24 hrs after administration</p> <p>Do not shake solution or transport via tube system. Administer in separate IV line 0.22 micron filter must be used in preparation!!</p> <p>Reconstitute vial with sterile water only.</p> <p>200 mg/ml 30 ml vial</p> <p>Antidote acetaminophen overdose</p> <p>Acetaminophen overdose: (Prescott Trial Protocol) Loading dose: 150 mg/kg IV over 60 minutes Maintenance dose: 50 mg/kg IV over 4 hours x 1 then 100 mg/kg IV over 16 hours Traditional dosing protocol may be used to dose IV rescue Loading Dose: 140mg/kg IV over 60minutes; Maintenance dose: 70mg/kg IV Q4h x 17 doses. N-acetylcysteine should continue until liver function improves!! Pediatric patients: recommended conc is 40 mg/ml to avoid hyponatremia and seizures.</p> <p>Administer in separate IV line Solution may turn pink/lavender in color still ok to use</p> <p>Acyclovir (Zovirax) Antiviral</p> <p>5 mg/ml 10ml and 20 ml vials</p> <p>NO</p> <p>Up to 350 mg in 50 ml NS or D5W 351-700 mg in 100ml NS or D5W Infuse doses over at least 60 min. Max conc: 7 mg/ml</p> <p>Renal tubular damage with infusions 7mg/ml Dose reduction recommended for CrCl &lt; 50 ml/min</p> <p>Do NOT refrigerate precipitate may form.</p> <p>Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication.</p> <p>1</p> <p>Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009</p> <p>Section IIMedication Generic - (Brand) Adenosine (Adenocard) How Supplied 3 mg/ml 2 ml vial, 3 mg/ml 2 ml and 4 ml syringe IV Push Conc / Rate Yes, 6 mg rapidly over 2 seconds followed with saline flush. May then give 12mg 1-2 min later, followed by another 12 mg 1-2 min later if needed. NO</p> <p>Parenteral Medication Administration GuidelinesSVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time IV Push Preferred Precautions / Comments Stability / Storage Limitations / Restrictions * See footnote Continuous ECG, BP monitoring recommended during administration</p> <p>This section can be copied and kept for reference at bedside.</p> <p>Dyspnea, flushing and heart-block (asystole) not uncommon with rapid resolution as half-life is only 10 seconds Reflex tachycardia may occur if given too slowly</p> <p>Follow rapid IV push dose with 20 ml NS flush If given into IV line, use closest port to insertion site and follow with NS flush. Elevate extremity</p> <p>Anti-arrhythmic</p> <p>Albumin, Human Serum Plasma Expander Allopurinol (Aloprim) Xanthine oxidase inhibitor</p> <p>5% - 250ml 25% - 50ml bottles</p> <p>500mg/30 ml Vial</p> <p>NO</p> <p>Dose and rate of administration based upon patient condition. Recommended max rate of infusion: 5% at 10 ml/min 25% at 3 ml/min Intermittent Infusion 200-400mg/M/day (Max of 600mg) diluted in 100ml NS/D5W Give over 30 minutes</p> <p>Administer with IV tubing provided by pharmacy.</p> <p>Do not mix with other solutions Limited Indication: Hyperuricemia associated with chemotherapy Dose reduction recommended for CrCl &lt; 20 ml/min Very short half-life necessitating continuous infusion administration Common side effects in adults include: flushing, nausea, abd cramps, tachycardia, hypotension, and edema. Monitor respiratory and cardiac status May cause thrombophlebitis recommend central line administration</p> <p>If diluting 25% albumin, NS is preferred. D5W may be used for limited volumes. DO NOT dilute with sterile water! Stable only 10 hours after dilution at room temp Do NOT refrigerate Reconstitute vial with sterile water only! Further dilute with NS or D5W Stable x 24 hours at room temperature</p> <p>Alprostadil (PGE1)</p> <p>500 mcg/ml 1 ml vial</p> <p>NO</p> <p>Usual dose range for treatment of pulmonary hypertension: 1-150 nanograms/kg/min System Standard Concentration: 1000 mcg/100 ml NS (10 mcg/ml) System Concentrated Concentration: 2000 mcg/100 ml NS (20 mcg/ml) Max conc: 20 mcg/ml</p> <p>* See footnote</p> <p>Vasodilator/ Prostaglandin</p> <p>Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication.</p> <p>2</p> <p>Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009</p> <p>Section IIMedication Generic - (Brand) Alteplase (Activase, TPA, Cathflo) How Supplied 100 mg/ 100 ml (1 mg/ml) vial &amp; 2mg Cathflo vials IV Push Conc / Rate Yes, Up to 15 mg over 2 min. (7.5 mg/min)</p> <p>Parenteral Medication Administration GuidelinesSVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time MI Greater than 67kg: 15 mg over 2 min, 50 mg over 30min, 35 mg over next 60min. MI - 67kg or Less: 15mg over 2min, followed by 0.75mg/kg over 30min, then 0.5mg/kg over 60min. Total dose not to exceed 100mg. Ischemic stroke: 0.9 mg/Kg up to max 90Kg - Give 10% as bolus over 1min, then remainder over 60min Pulmonary Embolism: 100 mg over 2 hours Peripheral Vascular Thrombolysis: Per Interventional Radiology/Interventional Cardiology. Preprinted order sets available. Catheter Clearing: Metro: Give 0.5 ml of 1 mg/ml alteplase and dwell x 60 min. If still occluded, aspirate alteplase, instill 1 ml of 1 mg/ml alteplase and dwell 60 min. If still occluded, aspirate alteplase, instill 2 ml of 1 mg/ml alteplase and dwell 60 min. When patency is restored, withdraw 5-10 ml and discard then flush with 10 ml NS. If catheter capacity is greater than volume of alteplase, then follow dose with NS to fill catheter volume. If patency is not restored after 2 ml dose, contact physician for further orders.(Metro Nursing Clinical Policy MN-11)</p> <p>This section can be copied and kept for reference at bedside.Precautions / Comments Stability / Storage Limitations / Restrictions *See footnote for cardiopulmonary indications (i.e.: AMI, PE). Monitoring is at physician discretion for peripheral vascular indications. No restrictions for alteplase use for catheter clearance or administration of low doses per chest tube.</p> <p>Thrombolytic medication: Monitor for bleeding. Minimize potential risks for bleeding: Establish all IVs prior to therapy. (Minimum of 2 peripheral IVs recommended in addition to thrombolytic infusion site.) Avoid unnecessary arterial/venous punctures, excessive blood sampling, or IM injections for at least 24 hr after d/cd (malnourished patients 48 hr). Apply pressure dressings to all puncture sites.</p> <p>Reconstitution must be with sterile water. Conc 0.01-1 mg/ml stable 24 hours (if diluent is NS after reconstitution) Avoid shaking reconstituted solution. Do not transport via tube system. Administer via separate IV line.</p> <p>*HIGH ALERT MEDICATION* Do not confuse with other thrombolytic medicines Thrombolytic</p> <p>Amikacin (Amikin) Antibiotic/ Aminoglycoside</p> <p>250 mg/ml 2 ml &amp; 4 ml vials</p> <p>NO</p> <p>*Use 2 mg dose initially for hemodialysis catheters and fistulas * Dilute in 100 ml D5W or NS Max conc: 5mg/ml Infuse over 60 minutes</p> <p>Aminoglycoside dosing and monitoring service available from pharmacy upon physician order. Monitor renal function.</p> <p>Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication.</p> <p>3</p> <p>Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009</p> <p>Section IIMedication Generic - (Brand) Aminocaproic Acid (Amicar) Hemostatic / Antifibrinolytic How Supplied 250 mg/ml 20 ml Vial IV Push Conc / Rate NO</p> <p>Parenteral Medication Administration GuidelinesSVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time Intermittent infusion: Typically 1 Gm in 50 ml NS/D5W Infuse over 60 minutes. Continuous infusion: System Standard Concentration: 5 gm/250 ml NS (20 mg/ml) Usual dose range: 1 1.25 Gm/hr Cardiac Surgery: Loading dose: 10 gm/40 mL drawn up in a syringe &amp; administered IV over 20 minutes. Maintenance Drip: 2 gm/hr (40mL/hr) during surgery. (10 gram/40 mL added to 150mL NS; total volume 200 mL). Precautions / Comments Stability / Storage Limitations / Restrictions</p> <p>This section can be copied and kept for reference at bedside.</p> <p>Hypotension, bradycardia, arrhythmia with too rapid infusion Recommended max dose: 30 Gm/24 hr</p> <p>Expiration dating: 7 days refrigerated.</p> <p>Aminophylline See</p> <p>TheophyllineAmiodarone (Cordarone) 50 mg/ml 3 ml vial, ampule Yes, V. fib or Pulseless V-tach: Give 300 mg undiluted over 30 seconds. Follow with 20ml NS flush. May give 150 mg after 3 5 min if V.fib/pulseless Vtach persists Bolus: 150 mg / 100ml D5W (PVC) System Standard Conc: 450 mg / 250 ml D5W (Excel Bag) (1.8 mg/ml) System Concentrated conc: 600 mg/88 ml D5W (total volume 100 ml) (Excel Bag) (6 mg/ml) Central line only! Usual starting dose: Bolus 150 mg in 100ml D5W over 10 min. then 60 mg/hr x 6 hours then 30 mg/hr x 18 hours via infusion. Central Line Required if concentration exceeds 2 mg/ml Two-hour stability if mixed in Poly Vinyl Chloride (PVC) plastic container. Infusions running longer than 2 hrs require Excel or glass containers. Stable 24 hours after dilution with D5W in Excel or glass. Use of in-line 0.22 micron filter required for infusions. Check with pharmacist for compatibility information. * See footnote</p> <p>Anti-arrhythmic</p> <p>Monitoring: Continuous EKG MonitoringBP - Monitor during loading dose: Continuous or q15min x 3; then q4-6hr while stable on infusion. Decreasing rate or stopping infusion may alleviate hypotension and/or bradycardia Preprinted order set available for new onset A.Fib</p> <p>Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication.</p> <p>4</p> <p>Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009</p> <p>Section IIMedication Generic - (Brand) Amphotericin B (Fungizone) How Supplied 50 mg and 100 mg vials IV Push Conc / Rate NO</p> <p>Parenteral Medication Administration GuidelinesSVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time Optional Test dose: 0.1 mg/kg up to 1 mg in 50 ml D5W. Infuse over 10-30 min Doses &lt; 25 mg/250 ml D5W 26-50 mg/500 ml D5W Infuse over 3 hours Precautions / Comments Stability / Storage Limitations / Restrictions</p> <p>This section can be copied and kept for reference at bedside.</p> <p>Test Dose no longer considered necessary &amp; no longer recommended. Monitoring: VS q15 min x 1 hr then q 1 hr for at least 1 hr post-infusion. Administer any pre-medications 30 minutes prior to starting daily infusion Premeds must be per physician order. Recommended pre-medications: Acetaminophen 500-1000 mg PO or 650 mg PR ; Diphenhydramine 25-50 mg PO/IV ; Hydrocortisone 25-50 mg IV (use only in pt history of severe rigors) Sodium loading recommended to prevent nephrotoxicity. 500 ml NS before and after infusion. Lower volume (i.e. 250 ml) may be consider in pt with cardiac compromise or develop HTN during NS infusion. Monitor VS q15 min x 1 hr then q 1 hr for at least 1 hr post-infusion. Administer any pre-medications 30 minutes prior to starting daily infusion See Amphotericin B for recommended pre-meds. Monitor VS q15 min x 1 hr then q 1 hr for at least 1 hr post-infusion. Administer any pre-medications 30 minutes prior to starting daily infusion See Amphotericin B for recommended pre-meds. Penicillin derivative check allergies</p> <p>Use D5W only Protect from light. Do NOT filter Amphotericin may cause renal wasting of K+, Mg+2, HCO3and Na+ Daily monitoring recommended. Supplementation may be required.</p> <p>Anti-fungal</p> <p>Amphotericin B Lipid Complex (Abelcet) Anti-fungal</p> <p>100 mg vial</p> <p>NO</p> <p>3 - 5mg / Kg / Day typical dose Dilute with D5W to final concentration of 2 mg / ml. Infuse over 2 hours</p> <p>Use D5W only Gently agitate solution prior to beginning infusion and every 2 hours. Stable 6 hr at room temp Use D5W only Gently agitate solution prior to beginning infusion and every 2 hours. Stable 6 hrs after dilution at room temp</p> <p>Amphotericin B Liposomal (AmBisome) Anti-fungal</p> <p>50 mg Vial</p> <p>NO</p> <p>3 5 mg/Kg/Day typical dose Dilute with D5W to final concentration of 1-2 mg/ml Infuse over 2 hours</p> <p>Ampicillin Antibiotic/ Beta-lactam</p> <p>0.5, 1 &amp; 2 Gm Vial</p> <p>NO</p> <p>Up to 1 Gm 50ml NS 2Gm 100ml NS Infuse dose over 30 min</p> <p>Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication.</p> <p>5</p> <p>Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009</p> <p>Section IIMedication Generic - (Brand) Ampicillin / Sulbactam (Unasyn) Antibiotic/ Beta-lactam Anidulafungin (Eraxis) Antifungal How Supplied 1.5 &amp; 3 Gm Vial (2/3 amp, 1/3 sulbactam) 50 mg vial IV Push Conc / Rate Not advised</p> <p>Parenteral Medication Administration GuidelinesSVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time 150 or dyspnea, bronchospasm, cyanosis or febrile reaction occurs. Anaphylaxis may occur. Diphenhydramine 50mg IV and epinephrine 1 mg (1 ml) required at bedside. Pre-medication with a corticosteroid, antihistamine and acetaminophen 1 hr prior to infusion is recommended Moderate fever and chills common during infusion decreasing rate may relieve *See footnote Do not shake or transport via tube system Do not mix with other solutions Central line administration preferred. Addition of hydrocortisone and heparin recommended if infusing peripherally. Use 0.22micron in-line filter Metro: preprinted order set available</p> <p>Immunosuppressant</p> <p>Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication.</p> <p>7</p> <p>Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009</p> <p>Section IIMedication Generic - (Brand) Argatroban *HIGH ALERT MEDICATION* How Supplied 100 mg/ml 2.5 ml Vial IV Push Conc / Rate NO</p> <p>Parenteral Medication Administration GuidelinesSVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time System Standard Conc: 250mg/ 250ml NS (1mg/ml) Treatment of Heparin Induced Thrombocytopenia: Start at 0.5-2 mcg/kg/min and titr...</p>

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