6th Floor and 7 East Nurses' Guide: Intravenous Push - University of ...

6 th Floor and 7 East Nurses’ Guide:Intravenous Push (IVP) Drug List – Approved for RN AdministrationUniversity of Kentucky Chandler Medical CenterUpdated:12/08If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must beobtained through collaboration with pharmacy and the patient care managerGENERIC NAME(BRAND NAME(S))RESTRICTEDAREATHERAPEUTICCATEGORYTYPICAL ADULTDOSEMAXIMUM ADULTDOSEMAXIMUMCONCENT-RATION*MAXIMUM RATEOFADMINISTRATION**ADMINISTRATIONCONSIDERATIONSADVERSEEFFECTS/COMMENTSMONITORING PARAMETERSAdenosineMD should bepresent duringadministration- Antiarrhythmic 6 mg rapid IVP(2-3 seconds),followed byrapid 10 ml NSflushIf no response in 1-3 minutes repeat at12 mg as above andmay repeat as athird dose of 12 mg3 mg/ml Rapid IVPOver 2-3secondsPatients ontheophylline,caffeine prepsor dipyridamoleshould notreceive thisdrug;Dose followedby rapid 10ccNSMonitor for transientbradycardia, asystole, andventricular rhythms mayoccur,PSVT may re-occur.Atropine Sulfate - Antiarrhythmic/Anti-cholinergicBumetanide(Bumex)- Diuretic/AcutePulmonaryEdema, CHF, andRenal disease0.5-1 mg/min 0.04 mg/kg 1mg/ml 1 mg or lessover 1 minute0.5-1 mg over1-2 minutesCan be givenvia ETT at 2-3times thenormal doseTelemetryCaution in thepresence ofmyocardialischemiaTelemetry10 mg/day 0.25 mg/ml - Pain at injectionSiteMonitor VS and EKG;Minor side effects: Drymouth, dizziness, andpalpitationsMonitor labs; Multipledrug interactions;dizziness; N&V,hypotension and decreasecalcium and K+Butorphanol(Stadol)- Narcotic/Relief ofmoderate pain0.5-2 mg over3-5 minutes2 mg/dose 2 mg/ml 2 mg over 3-5minutes- N&V, sedation, diplopia,palpitations, respiratorydepression, Caution withactivityPage 1 of 9

6 th Floor and 7 East Nurses’ Guide:Intravenous Push (IVP) Drug List – Approved for RN AdministrationUniversity of Kentucky Chandler Medical CenterUpdated:12/08If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must beobtained through collaboration with pharmacy and the patient care managerGENERIC NAME(BRAND NAME(S))ChlorothiazideSodium (Diuril)Cosyntropin(Cortrosyn)DexamethasoneSodium Phosphate(Decadron)RESTRICTEDAREATHERAPEUTICCATEGORY- Diuretic/Antihypertensiveagent- DiagnosticAgent- Antiemetic; AntiinflammatoryDextrose 50% - Carbohydrate/SymptomaticHypoglycemiaTYPICAL ADULTDOSEMAXIMUM ADULTDOSEMAXIMUMCONCENT-RATION*MAXIMUM RATEOFADMINISTRATION**ADMINISTRATIONCONSIDERATIONS0.5 – 1 gram 2 grams/day 28 mg/ml Slow IVP Extravasationmust beavoided. DoNOT give SC orIM1 mcg or 250mcg250 mcg – 750 mcg - Over 2 minutes Blood drawsmust be atspecific timesindicated byMD order. Nosteroids orspironolactoneday before orday after4 mg 10 mg 4 mg/ml Maximum rate:Over 1 minuteSlower ifitching 3-5minutes25 gm - 25 gm/50ml 10 ml/min Phlebitis risk,pain at injectionsite; Large boreIV accessADVERSEEFFECTS/COMMENTSMONITORING PARAMETERSMonitor electrolytes, rash,hypotensionHypertension, flushing.Peak cortisolconcentration occurs 45-60 min afteradministration- Insomnia, nervousness,increased appetite, fluidretentionHyperglycemia, confusionDiazepam(Valium)Dihydroergotamine(D.H.E 45)- Benzodiazepine;Anti-anxiety,Anticonvulsant- AntimigraineAgent2-10 mg/dose 30 mg/8hrs 5 mg/ml 5 mg/minute Phlebitis risk,pain at injectionsite0.22 micronfilter requiredfor IVPB admin0.3-1mg/dose 6 mg/week 1mg/ml Over 2-3minutesBradycardia; tachycardia,drowsiness, hypotension,hypoventilation- HTN, Headache,dizziness, N/VPage 2 of 9

6 th Floor and 7 East Nurses’ Guide:Intravenous Push (IVP) Drug List – Approved for RN AdministrationUniversity of Kentucky Chandler Medical CenterUpdated:12/08If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must beobtained through collaboration with pharmacy and the patient care managerGENERIC NAME(BRAND NAME(S))RESTRICTEDAREATHERAPEUTICCATEGORYTYPICAL ADULTDOSEMAXIMUM ADULTDOSEMAXIMUMCONCENT-RATION*MAXIMUM RATEOFADMINISTRATION**ADMINISTRATIONCONSIDERATIONSADVERSEEFFECTS/COMMENTSMONITORING PARAMETERSDiltiazem - Calcium channelblocker0.25 mg/kgload- 5 mg/ml - Dilute in 50 mlNS and infuseover 5-15minutesHypotension, bradycardia,fatigue, prolonged QTinterval, EKGDiphenhydramine(Benadryl)- Antihistamine;Histamine 1Antagonist12.5-50 mg q2-4H50 mg/dose400 mg/dayTelemetry50 mg/ml 25 mg/minute Dilute to 25mg/ml in D5Wor NSHypotension, tachycardia,sedation, dizziness,insomniaDolasetronMesylate(Anzemet)- Antiemetic 12.5 mg over30 seconds25 mg 12.5 mg/0.625 ml25 mg over 30secondsCaution inpatients at riskfor prolongedQT intervalHTN, Headache, UrinaryRetention, TachycardiaEptifibatide(Integrilin)- Antiplatelet 180 mcg/kg 22.6 mg 2 mg/ml Over 1-2minutesBolus followedby continuousinfusion IV dripBleeding, dizziness,NauseaTelemetryEpinephrine(AdrenalineChloride)- AnaphylacticreactionsSympathomimetic(Cardiac arrest)0.3-0.5mgIM/SQ every15-20 minutesas needed1mg IVP every3-5 minutes- 1mg/ml 1mg/min;May be givenmore rapid incardiac arrestCan be givenvia ETT at 2-3times thenormal doseWatch forinjection siteblanching/ExtravasationUse 1:1000 inanaphylaxisUse 1:10,000 incardiac arrestTelemetryTachycardia,hypertension, nervousness,restlessness, headache,dizziness, HR, BPPage 3 of 9

6 th Floor and 7 East Nurses’ Guide:Intravenous Push (IVP) Drug List – Approved for RN AdministrationUniversity of Kentucky Chandler Medical CenterUpdated:12/08If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must beobtained through collaboration with pharmacy and the patient care managerGENERIC NAME(BRAND NAME(S))Famotidine(Pepcid)RESTRICTEDAREATHERAPEUTICCATEGORY- Gastrointestinal;Histamine 2AntagonistTYPICAL ADULTDOSEMAXIMUM ADULTDOSEMAXIMUMCONCENT-RATION*MAXIMUM RATEOFADMINISTRATION**20 mg q 12H 40 mg 20 mg/5ml 20 mg over 2minutesADMINISTRATIONCONSIDERATIONSADVERSEEFFECTS/COMMENTSMONITORING PARAMETERS- Headaches, dizziness,confusion, mental statuschangesFlumazenil(Rumazicon)- BenzodiazepineAntagonist0.2 mg over 30seconds initial,can repeat with0.3 mgGive no more than 1mg per dose or 3mg/hour0.1mg/ml0.2 mg over15-30 secondsUse large veinand free flowingIV to minimizepainPt. may need additionaldoses in case of resedation.Caution withseizure patient.Furosemide(Lasix)- Loop Diuretic/Volume overloadGlucagon - Emergencytreatment ofsymptomatichypoglycemia20 - 40 mg 80 mg but can varywidely0.5-1mg/min(May berepeated 1-2times)10 mg/ml 1-2 minutes(ConsiderIVPB over 5-10 minutes)- 1mg/ml 1mg/min Mayprecipitatewith NS, K+and Calcium;Compatiblewith D5W- Hypotension, headache,and dizzinessUnstable hypoglycemicdiabetic may not respond& will need IV Dextroseinstead;N/V, hypokalemia inoverdose, urticaria,respiratory distress andhypotensionGranisetron HCL(Kytril)5HT3 BlockerPrevention of N/Vsecondary tochemotherapy10 mcg/kggiven 30minutes priorto chemoUndiluted over30 secondsHeadache, diarrhea,constipation, hypertension,feverHaloperidol(Haldol)- Antipsychotic/Agitation2-10 mg Varies with patient 5 mg/ml 5 mg/min Start with lowerdoses ingeriatricDrowsiness, hypotension,Extrapyramidal effects,bradycardia, tachycardiaPage 4 of 9

6 th Floor and 7 East Nurses’ Guide:Intravenous Push (IVP) Drug List – Approved for RN AdministrationUniversity of Kentucky Chandler Medical CenterUpdated:12/08If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must beobtained through collaboration with pharmacy and the patient care managerGENERIC NAME(BRAND NAME(S))RESTRICTEDAREATHERAPEUTICCATEGORYTYPICAL ADULTDOSEMAXIMUM ADULTDOSEMAXIMUMCONCENT-RATION*MAXIMUM RATEOFADMINISTRATION**ADMINISTRATIONCONSIDERATIONSADVERSEEFFECTS/COMMENTSMONITORING PARAMETERSHeparin Bolus(Heparin DripProtocol)- Anti-coagulant Varies-3,000--8,000 units8,000 units Usual:10,000units/mLOver 1 minuteAntagonist isProtamineBleeding, APTT, HCT,HgbThrombocytopenia (HIT-Heparin induced)Heparin(for flush of Centralline catheter)HydrocortisoneSodium Phosphate(HydrocortonePhosphate)- Anti-coagulant 300 unitsinstilled intoCentralCatheter- AntiinflammatoryagentCorticosteroid- 100 units/ml - Antagonist isProtamine15-240 mg - 50 mg/ml Over 3-5minutesBleeding, APTT, HCT,HgbThrombocytopenia (HIT-Heparin induced)- Insomnia, nervousnessBPHydrocortisoneSuccinate (Solu-Cortef)- Antiinflammatory(IV usually givenin emergency)15-240 mg 1 g/24 hour - Over 1 minute Caution inelderlyMay need totaper therapy.Monitor electrolytes; Maymask signs of infection.Hydromorphone(Dilaudid)- NarcoticAnalgesic1- 4 mg - 4 mg/ml Each 1 mgover 2-3minutesReversal agent-Naloxone(Narcan)Palpitations, hypotension,dizziness, drowsiness, BP,RRInsulin (Regularonly)HyperKalemiaOnlyKetorolac(Toradol)- PancreaticHormone/Hyperglycemia- NSAID/ShorttermManagementof mod-severepain5-10 units over10 seconds15 mg-30 mgIV q 6 hours10 units - 10 seconds Only RegularInsulin can begiven IV120 mg/dayMax. 5 days30 mg/ml Over >15secondsRequires renaldose adjustmentMonitor Finger StickBlood SugarsEdema, drowsiness,headacheAvoid in patients withactive or recent bleedsPage 5 of 9

6 th Floor and 7 East Nurses’ Guide:Intravenous Push (IVP) Drug List – Approved for RN AdministrationUniversity of Kentucky Chandler Medical CenterUpdated:12/08If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must beobtained through collaboration with pharmacy and the patient care managerGENERIC NAME(BRAND NAME(S))RESTRICTEDAREATHERAPEUTICCATEGORYTYPICAL ADULTDOSEMAXIMUM ADULTDOSEMAXIMUMCONCENT-RATION*MAXIMUM RATEOFADMINISTRATION**ADMINISTRATIONCONSIDERATIONSADVERSEEFFECTS/COMMENTSMONITORING PARAMETERSLevothyroxine(Synthroid)- Thyroid hormone 50-100 mcg(1/2 of oraldose)- 100 mcg/ml 100 mcg/min -Do not mixwith any otherIVF-Do not furtherdilute drugSymptoms ofhyperthyroidismnervousness,tremor,headache,tachycardia, heatintolerance,etc.Lidocaine - Antiarrhythmic/V-tach1-1.5 mg/kg(usually 100mg carbojectsyringe) IVPover 2-3minutes3 mg/kg 50 mg/ml Over 2-3minutesCan be givenvia ETT at 2-2..5 times thenormal doseTelemetryContraindicated in patientswith existing heart blocks;Doses should be decreasefor elderly and hepaticpatientsLorazepam(Ativan)- Benzodiazepine 2-4 mg dilutedwith equalvolume ofIVF8 mg/12hrs 2 mg/ml 2 mg/minute Can EasilycauseInfiltration withIVP, ConsiderIVPB over 5-10minutes;Reversal agent-FlumazenilSedation, hypotension,dizziness, headache, HR,BP, RRMeperidine(Demerol)- NarcoticAnalgesic25-100 mg q2-4 hours- 100 mg/ml Over 5 minutes Dilute to 10mg/ml with NSReversal agent-Naloxone(Narcan)Sedation, hypotension,dizziness, constipationBP, RRPage 6 of 9

6 th Floor and 7 East Nurses’ Guide:Intravenous Push (IVP) Drug List – Approved for RN AdministrationUniversity of Kentucky Chandler Medical CenterUpdated:12/08If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must beobtained through collaboration with pharmacy and the patient care managerGENERIC NAME(BRAND NAME(S))RESTRICTEDAREATHERAPEUTICCATEGORYTYPICAL ADULTDOSEMAXIMUM ADULTDOSEMAXIMUMCONCENT-RATION*MAXIMUM RATEOFADMINISTRATION**ADMINISTRATIONCONSIDERATIONSADVERSEEFFECTS/COMMENTSMONITORING PARAMETERSMethylprednisoloneSodium Succinate(Solu-Medrol)- Antiinflammatoryagent/ AdrenalCorticosteroid40-250 mg - 62.5 mg/ml 125 mg over3-5 minutesHigher dosesgive IVPBOnly thesuccinate formcan be given IV;Rapid admin. ofhigh doses cancausecirculatorycollapseInsomnia, nervousnessBP; Monitor Na+ and K+,FSBSMetoclopramide(Reglan)Metoprolol(Lopressor)- Cholinergic/GI StimulantAntiemetic5-10 mg 10 mg 5 mg/ml 10 mg orfraction thereofover 2minutes;>10 mgIVPB - 15minutes- Beta blocker 5-10 mg - 1 mg/ml Dilute in 50 mlPB and infuseover 5-15minutesMidazolam (Versed) - Benzodiazepine/Sedation0.5 mg to 2 mgover 2 minutes2 mg on 6 th floor 5 mg/ml Over 2-5minutesToo rapid ratemay causeintense anxietyand drowsinessTelemetryReversal agent-FlumazenilTelemetryHypotension, SVT,Sedation, dizziness, rash,extrapyramidal effectstreat with Benadryl:Caution with hypertensionHypotension, bradycardia,fatigueSedation, Respiratorydepression, drowsiness,HA,Monitor pt. closely-HR,BP, RR, and SpO2MorphineSulfate- NarcoticAnalgesic1-8 mg 10 mg 10 mg/ml 1mg/min Reversal agent-Naloxone(Narcan)Sedation, dizziness, heartpalpitation, hypotension,bradycardia, andRespiratory depressionBP, RR, OxygensaturationPage 7 of 9

6 th Floor and 7 East Nurses’ Guide:Intravenous Push (IVP) Drug List – Approved for RN AdministrationUniversity of Kentucky Chandler Medical CenterUpdated:12/08If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must beobtained through collaboration with pharmacy and the patient care managerGENERIC NAME(BRAND NAME(S))RESTRICTEDAREATHERAPEUTICCATEGORYTYPICAL ADULTDOSEMAXIMUM ADULTDOSEMAXIMUMCONCENT-RATION*MAXIMUM RATEOFADMINISTRATION**ADMINISTRATIONCONSIDERATIONSADVERSEEFFECTS/COMMENTSMONITORING PARAMETERSMuromonab-CD3(Orthoclone, OKT3)- ImmunosuppressiveAgent/Rejection5 mg 5 mg 1mg/ml

6 th Floor and 7 East Nurses’ Guide:Intravenous Push (IVP) Drug List – Approved for RN AdministrationUniversity of Kentucky Chandler Medical CenterUpdated:12/08If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must beobtained through collaboration with pharmacy and the patient care managerGENERIC NAME(BRAND NAME(S))Ondansetron(Zofran)Pantoprazole(Protonix)RESTRICTEDAREATHERAPEUTICCATEGORYTYPICAL ADULTDOSEMAXIMUM ADULTDOSEMAXIMUMCONCENT-RATION*MAXIMUM RATEOFADMINISTRATION**- Antiemetic 1-4 mg 4 mg - 1-4 mg over 2-5 minutes- Gastrointestinal;Proton pumpinhibitor>4 mgconsider IVPBover 15minutes40 mg 80 mg 4 mg/ml 40 mg over 2minutesADMINISTRATIONCONSIDERATIONSIncompatiblewith numerousDrugsReconstitutewith 10ml, 0.9%NaCl.ADVERSEEFFECTS/COMMENTSMONITORING PARAMETERSObserve closely forrespiratory distress;Ambulate SlowlyInjection site reactions,headache, dyspepsia, andnauseaPromethazine HCL(Phenergan)Via Central orPICC line only, orIVPB over 10minutesVasopressinCardiac arrest only- Antiemetic/Antihistamine- Hormone/Vfib and SepticShock/ PotentVasoconstrictor12.5 mg-25 mg 50 mg 50 mg/ml 25 mg/ minute High risk fortissue damagesecondary toextavasation;Via Central orPICC line only,or IVPB over10 minutes40 units IVsingle dose40 units 20 units/ml 40 units IVsingle dose* Alter volume based upon dosage to be administered ** Alter duration based upon dose to be administered.Use Caution inelderly.Can be givenvia ETT at 2-3times thenormal doseHypotension, tachycardia,dizziness, drowsinessMonitor BP and HR.Updated: 12/08Revised by: Christy Taylor, PharmD and Lori Proeschel, PharmDApproved by: Nina Barnes, Staff Development; Leslie Cumming-Kinney, RN; and Kimberley Hite, MS, PharmDContact person for revisions: Kimberley Hite, MS, PharmD (khite2@uky.edu)Page 9 of 9