| Drug |
Standard
Dilution |
Infusion
Rate |
Diluents* |
| CALCIUM
CHLORIDE |
0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml |
30
min
60
min |
D5W
/ NS |
Stability/Misc.
 |
1 gram= 13.6 meq/10 ml. Normal
range: 8.4 to 10.2 mg/dl
Ionized Ca++: 1.19 to 1.29. Maximum IV rate: 100mg (1 ml)/ min.
Too
rapid injection may decrease BP/ cardiac syncope.
|
| |
| CALCIUM
GLUCONATE |
0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
Continuous infusion: Initially multiply (
0.5 x WT(kg) X 24 ) / 93 mg = number of grams of
calcium gluconate needed. Add calculated amount to 500 to 1000 ml
D5W or NS. A continuous infusion may be used in symptomatic patients
with hypocalcemia. |
30
min
60
min
--------------
0.3 to 2 mg/kg/hr
based on elemental calcium
|
D5W
/ NS |
Stability/Misc.
|
1 gram= 4.65
meq (93 mg) 10 ml.
Maximum IV rate: 1.5 ml/min or approximately 1 gram/ 7 minutes Too rapid injection may decrease
blood pressure or cause cardiac syncope. Calcium administration: (Onset: rapid
Duration: 30min to 2 hours. ). Recommended only in cases of hyperkalemia, hypocalcemia, or calcium antagonist blockade.
Treatment of
hypocalcemia: Acute hypocalcemic tetany (unless induced by alkalosis): give
1 gram calcium gluconate IV over 5 - 15 minutes. After 1-2 hours may be
necessary to repeat dose or add 2-3 grams calcium gluconate to 250-500ml and infuse over 12-24hours. Alternatively:
Symptomatic patient: give 1 gram
calcium gluconate over 5 - 15 minutes q1-2hours. If Tetany returns after
6 hours (3 grams calcium gluconate given) start continuous infusion [5-10g of
calcium gluconate /1000 ml D5W infused at rate to prevent tetany-usually 30 to 100 ml/hr]. Make sure magnesium levels are corrected
first - patients with hypocalcemia and hypomagnesemia will not respond to
calcium replacement. Alternative
therapy: give 0.3 to 2 mg elemental calcium/kg/hour as a continuous
infusion. Asymptomatic
patient: 1 gram calcium gluconate IV q6-12h with careful monitoring of Ca++ levels.
Monitoring: during intensive therapy, monitor calcium levels at
least twice daily.
Differentiation of hypoparathyroidism vs Vitamin D
deficiency: Hypoparathyroidism: Decreased serum Ca++/serum PO4
increased/Alk phos normal. Vitamin D
deficiency: decreased Ca++ & PO4/ Alk phos
increased.
Calcium channel blocker blockade:
give 0.01 to 0.04 ml/kg of 10% CaCl IV over 5-10min; may
repeat q10minutes. May also use calcium gluconate 0.5-0.8g IV q10min. Some recommend 1gram CaCL over
5 minutes, q10-20min x 3 to 4 doses. Some degree of hypercalcemia may be
necessary. Calcium therapy is more effective in overcoming mild toxicity vs massive overdose since calcium channel blockade is noncompetitive.
PSVT Conversion:
1 gram of 10% CaCl over 2-3 minutes has been used to prevent hypotension associated with verapamil in PSVT conversion.
|
| |
| CASPOFUNGIN
ACETATE (CANCIDAS) |
35 to 75 mg/ 250 ml |
1 hour |
NS |
Stability/Misc.
|
Stability:
24 hours RT / REF. Label: Refrigerate. Vials are stored in the
refrigerator. Reconstitution: 50 and 70 mg vial: add 10.5 ml normal
saline. Transfer 10 ml of the reconstituted solution to 250ml normal
saline IV bag. If using two 50mg vials to obtain the 70mg loading dose,
add 10.5 ml to each vial and then withdraw 14 ml of the reconstituted
solution to 250ml normal saline IV bag. Patients who are fluid
restricted: 50mg dose may be added to 100 ml normal saline. Hepatic
dosing: Patients with moderate hepatic insufficiency should receive 35mg
once daily. To prepare this dose, reconstitute the 50mg vial with 10.5
ml and then withdraw 7 ml from the vial and transfer this to 250ml
normal saline. Dosing: 70 mg loading on day 1, followed by 50mg once
daily thereafter. Patients with moderate hepatic insufficiency should
receive the 70mg loading dose on day 1, and then 35mg IV once daily
thereafter. Indications: treatment of invasive aspergillosis in patients
who are refractory to or intolerant of other therapies (ampho B,
itraconazole etc.). |
| |
| CEFAZOLIN
(ANCEF) |
0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
Pre-pack [1 gram-iso D5W 50ml] |
30
min |
D5W
/ NS |
Stability/Misc.
|
EXP: 2 Days (RT)/
4 Days (REF). Label: Refrigerate. Maximum
dose/day=12 grams. IM injection: 500mg/ 2 ml; 1 gram/ 2.5 ml H20/BS-H20.
Usual dosage: 500mg to 1g ivpb 8h. Severe: 1.5g ivpb q6h. Life
threatening: 6-12g/day. Renal dosing: >55/q6-8h ||
35-54/q8h || 11-34/ 50% usual dose q12h || <10 ml/min/ 50% to full
dose q24-48h. || Hemodialysis: 0.5-1g after dialysis |
| |
| CEFEPIME
HCL (MAXIPIME) |
0
to 2 grams/ 50 ml |
30
min |
D5W
/ NS |
Stability/Misc.
|
EXP: 24 hr (RT)/
7 Days (REF). Label: Refrigerate. IM Injection: 500mg vial/ 1.3 ml; 1
gram vial/ 2.4 ml (Sterile H2O; BS-SW; Lidocaine 0.5 to 1%; Normal
saline). Mild to moderate infection: 500mg to 2g ivpb q12h. Severe: 2g
ivpb q8h. Renal Dosing: >60/ 0.5-2g q12h || 30-60/
0.5g-2g q24h || 11-29/ 0.5g-1g q24h || <10/ 250-500mg q24h or 0.5-2g
q48h. || HD: 1g AD || PD: 1-2g q48h |
| |
| CEFOTAXIME
(CLAFORAN) |
0-2
grams/ 50 ml |
30
min |
D5W
/ NS |
Stability/Misc.
|
EXP: 1 day (RT
/ 5 days (REF). Label: Refrigerate. Mild infection:
1-2g ivpb q12h. Moderate: 1-2g ivpb q8h; Severe: 2g ivpb q6-8h; Life
threatening: 2g ivpb q4h (Max dose/day= 12g). Renal dosing:
>50/ Usual dose || 10-50/ q8-12h || <10/ q24h || HD: 0.5 to 2g
ivpb q24h AD. || PD: 1g ivpb q24h. |
| |
| CEFOTETAN
(CEFOTAN) |
0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml |
30
min |
D5W
/ NS |
Stability/Misc.
|
EXP: 1 DAY (RT);
4 DAYS (REF). Label: Refrigerate. Maximum dose: 3
grams ivpb q12h. Do not exceed q12h interval. IM injection:
1 gram/ 2
ml; 2 grams/ 3 ml SW /BS-SW /NS /0.5 to 1% lidocaine. Usual dose: 1g
ivpb q12h. Severe: 2-3g ivpb q12h. (Max 6g/day). Renal dosing:
>30/ Usual dose || 10-30/ 50% of dose q12h || <10/ 25% of dose
q12h.|| Hemodialysis or PD: 50% of usual dose q24h |
| |
| CEFOXITIN
(MEFOXIN) |
0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml |
30
min |
D5W
/ NS |
Stability/Misc.
|
EXP: 1 Day (RT)/
7 Days (REF). Label: Refrigerate. IM injection: 1 gram/ 2ml ; 2 grams/ 4
ml. (Sterile water or lidocaine 0.5-1%). Usual dose 1g q6-8h.
Moderate-severe: 2g q6-8h. Severe: 2g q4h. Renal dosing:
10-50/ q8-12h || <10/ q24-48h || HD: give 1g after Dialysis: e.g.
Give Cefoxitin 1 gram ivpb M-W-F after dialysis + a supplemental dose on
Sunday. |
| |
| CEFTAZIDIME
(FORTAZ) |
0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
Prepack:1&2 grams/ iso D5w 50ml |
30
min |
D5W
/ NS |
Stability/Misc.
|
EXP: 1 DAY (RT)
; 7 DAYS (REF) Label: Refrigerate. Maximum dose: 2 grams
ivpb q8h. IM injection: 500mg/ 1.5
ml; 1 gram/ 3 ml SW /
BS-SW / 0.5-1% lidocaine. (Intragluteal or lateral aspect of
thigh). Usual dose: 1g ivpb q8-12h. Severe: 2g ivpb q8-12h. (Max
dose/day= 6 grams). Renal dosing: Crcl 30-50/ q12h
|| 10-30/ q24h || <10/ q48h |
| |
| CEFTRIAXONE
(ROCEPHIN) |
0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
Prepack:1&2 grams/ iso D5w 50ml |
30
min |
D5W
/ NS |
Stability/Misc.
|
EXP: 1 DAY (RT)
/ 10 DAYS (REF). Label: Refrigerate. Total daily dose should not exceed
4 grams. IM injection preparation: 250 mg/ 0.9 ml; 500mg/ 1.8 ml; 1
gram/3.6 ml; 2grams/ 4.2 or 7.2 ml H20;BS-H20; 0.5 to 1% lidocaine.
Usual dose: 1-2g ivpb q24h. Severe: 2g ivpb q12h. No dosage
adjustments req'd in renal failure. PD: 750mg ivpb q12h |
| |
| CEFUROXIME
(ZINACEF) |
0 to 750 mg/ 50 m
Over 750 mg/ 100 ml |
30
min |
D5W
/ NS |
Stability/Misc.
|
EXP: 1 DAY (RT)
; 7 DAYS (REF). Label: Refrigerate.
IM injection:
750 mg vial/ 3ml SW. Usual: 750mg to 1.5g ivpb q8h. Severe: 1.5g
ivpb q6-8h. Renal Dosing: >20/q8h || 10-20/ q12h ||
<10/ 750mg q24h. || Hemodialysis: Give single dose after dialysis or
give 750mg q12h. || PD: 750mg-1.5g q24h. |
| |
CHLORAMPHENICOL
(CHLOROMYCETIN) |
0 to 2 grams/ 50 ml
Over 2 grams/ 100 ml |
30
min
60 min |
D5W
/ NS |
Stability/Misc.
|
EXP: 1 DAY (RT).
Supplied: 1 gram vial (Powder)-dilute with 10 ml. Dosing: 12.5 to 25
mg/kg q6h IVPB. Reduce dose in hepatic disease. |
| |
| CHLORPROMAZINE (THORAZINE) |
25 mg/ 100 ml
50 mg/ 100 ml |
30 min
50-60 min |
NS / D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT). Label: Do not refrigerate// Monitor BP closely.
The IV route is very
irritating and should be reserved for severe cases only (intractable
hiccups-- oral or IM dosing were not effective). Intractable hiccups: (1) 25 to 50 mg
po tid -qid. (2) 25-50mg IM if hiccups persist for 2-3 days (3) Last
choice: slow IV infusion: 25- 50mg/500- 1000 ml NS. If irritation at
the IM injection site is a problem use the dilution listed at the
beginning. IV therapy should be reserved for recumbent patients because of the
potential for severe hypotension. |
| |
| CIMETIDINE
(TAGAMET) |
0 to 300mg/ 50 ml
400 mg/ 100 ml
900 mg/ 100 to 250 ml
901 to 2400mg/ 250 to 1000 ml |
30 min
30 min
24 hours
24 hours |
NS / D5W |
Stability/Misc.
|
EXP: 7 DAYS
(RT/REF). Patients requiring > 300mg/dose may be a good candidate for continuous
infusion. Renal dosing: >40/ q6h; 20 to 40/ q8h; 5 to 20/q12h;
<5/200 mg q12h. Tagamet may be given IM. |
| |
| CIPROFLOXACIN
(CIPRO) |
200 mg/ 100 ml
400 mg/ 250 ml
Pre-pack: 400mg/ 200 ml D5W |
60 min |
D5W |
Stability/Misc.
|
EXP: 14 DAYS
(RT/REF). Cipro 400mg ivpb produces the same levels as 500mg tablet. Oral dosing:
250-750mg po q12h; cystic fibrosis: 750mg po q8h. IV dosing:
200-400mg ivpb q12h. Febrile neutropenic patient: 400mg ivpb q8h. Renal
dosing: >50/ no change || 10-50/ 50-75% of usual dose q12h ||
<10/50% of usual dose q12. Alternatives: [200mg ivpb or 250mg po
q12h] or [400 mg ivpb or 500mg po q24h]. || HD/PD: 250-500mg po or
200-400mg ivpb q24h AD or 200mg ivpb or 250mg po q12h. |
| |
| CISATRACURIUM
(NIMBEX) |
New
hospital standard (Detroit VA)
(Use 200mg/20ml vials)
200 mg/ 180 ml (Total volume=200 ml)
or 100 mg/ 90 ml (Total volume =100 ml)
40 mg/ 80 ml (Total volume=100 ml)
100 mg/ 200 ml (Total volume=250 ml)
200 mg/ 400 ml (Total volume=500 ml)
(Concentration= 0.4 mg/ml)*
|
Titrate |
NS / D5W |
Stability/Misc.
|
EXP: 1 DAY (RT/REF).
[Supplied: 10mg/ 5ml and 20 mg/10 ml vials (In refrigerator)]. Usual
dilution: 0.1 to 0.4 mg/ml. Dosing: Intermittent: initial dose: 0.15 to 0.2
mg/kg IV bolus followed by 0.03 mg/kg IV q40-60min. Continuous infusion:
0.1 to
0.2 mg/kg IV bolus followed by 1 to 3 mcg/kg/min. The average infusion rate for
long term use in the ICU is approximately 3 mcg/kg/min (range: 0.5 to 10.2
mcg/kg/min). In some cases, re-administration of the bolus dose may be
req'd while titrating. Dosage reductions are not required in renal or
hepatic failure.
Drug of choice in the following cases (1)
hemodynamically significant increases in HR (e.g. >20%) while paralyzed
with pancuronium or MAP>110. (2) Concurrent corticosteroid administration
(>72hrs) (3) Significant renal dysfunction (CRCL < 30 ml/min)
(4) History of asthma or bronchospasm. |
| |
| CLINDAMYCIN
(CLEOCIN) |
0 to 600 mg/ 50 ml
Up to 1200 mg/ 100 ml |
30 min
40 to 60 min |
D5W / NS |
Stability/Misc.
|
EXP: 2 DAYS (RT)
/ 10 DAYS (REF). Label: Refrigerate. Maximum dose/day: 4800
mg. May be given IM. Usual oral dose: 150-450mg
po q6h. Usual IV dose: 600mg ivpb q6-8h or 900mg ivpb q8h.
Maximum daily dose= 4800mg. Renal Dosing: No dosage
adjustments req'd for renal failure |
| |
| CORLOPAM
(See Fenoldopam) |
|
|
|
