| HALOPERIDOL
LACTATE (HALDOL) |
0 to 50 mg/ 50 ml
51 to 100 mg/ 100 ml
200 mg/ 160 ml (1 mg/ml)
(may dilute all doses to 1 mg/ml) |
As directed |
D5W |
Stability/Misc.
 |
EXP: 7 DAYS
(RT)
Label:
Do not Refrigerate. Haldol may be given IV push. Max IV rate (usual): 5
mg/min. Oral to IV conversion (approximate): oral dose x 0.625 = daily IV dose.
Continuous infusion: Doses of 3 to 25 mg/hr (72 to 600mg/day) have been
studied in critically ill patients requiring mechanical ventilation. Continuous
infusions have also been used to treat severely agitated critically ill
patients: Start 10 mg/hr, adjust as necessary to provide relief from
agitation in increments of 5 mg/hr. |
|
| HEMATIN
(PANHEMATIN) |
313 mg vial/ 43 ml |
10-15 min |
Sterile water |
Stability/Misc.
|
Mix just before use /
Must use 0.22 micron filter. Final concentration: 7 mg/ml or @ 301 mg/ 43 ml per
manufacturer. Remove entire volume with a syringe and add the "amount
ordered" back into the vial. Mix just before use (undergoes rapid
decomposition). Usual dose: 1 to 4 mg/kg/day. Maximum dose: 6 mg/kg.
Mechanism of action: Heme acts to limit the hepatic and/or marrow
synthesis of porphyrin (likely due to inhibition of aminolevulonic acid
synthetase-the enzyme which limits the rate of porphyrin synthesis.)
Nursing
instruction: (1) flush the line with normal saline (2) Add a 0.22 micron
filter to the line-must be used because the solution is not transparent and
any undissolved particulate matter is difficult to see. (3) Infuse Hematin
over 10 to 15 minutes. (4) Use normal saline as a backflush to complete
the infusion. Note: the filter will be stained dark brown. |
|
| HEPARIN |
Standard dilution:
25,000 units/ 250 ml
Loading dose: Give IV push or add to 50 ml D5W. |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT).
Heparin nomogram: Bolus dose: 80
units/kg
Initial infusion rate:
18
units/kg/hr.
RESULTS: [PTT < 37]: 80 units/kg bolus, then increase drip by
4 units/kg/hr
[37 to 47]: 40 units/kg bolus, then
increase drip by 2
units/kg/hr
[PTT: 48 to 71] No change
[PTT: 72 to 93]: Decrease drip by 2 units/kg/hr
[PTT > 93]: Hold infusion 1 hour, then decrease drip by 3
units/kg/hr. Round all estimations to the nearest 100 units. Maximum
initial bolus dose is 10,000 units. Maximum initial continuous
infusion rate is 2300 units/hr. Use the patients total body weight for all
calculations. Cautions: active hemorrhage, acute CVA, History of
thrombocytopenia, baseline labs: PT > 15 ; PTT >48; or Platelets
< 100,000 Monitoring: PTT q6 to 8 hours following heparin therapy
initiation or change in infusion until 2 consecutive therapeutic PTT
levels are achieved at a consistent rate of infusion. Once the patient is
stabilized, a PTT level should be checked qam. If a patient's PTT does not
change significantly from baseline after 2 legitimate attempts to increase
dose, consider heparin resistance (antithrombin III deficiency). Baseline
labs: PT, PTT, CBC (Hgb, Hct, platelet count). QOD labs: Hgb, Hct,
Platelets. Labwork requiring phys attention: (1) PTT > 100 sec (2) Platelet
count < 100,000 or 40% decrease (3) INR > 3.5 (4) Hemoglobin
decrease > 2 gm/dl. Remember: The most significant factor in reducing
recurrent thromboembolism is reaching a therapeutic PTT in < 24 hours.
Heparin
induced thrombocytopenia: Consider changing to a direct thrombin
inhibitor such as Lepirudin, or Argatroban.
Danaparoid has been discontinued by the
manufacturer. |
|
| HYDRALAZINE |
0 to 20 mg/ 50 ml
21 to 40 mg/ 100 ml
> 40 mg/ 250 ml |
30 min
30 min
1 hour |
NS |
Stability/Misc.
|
Manufacturer recommends
IM or IV push. Monitor BP q5min during initial infusion. Usual dosage: 10
to 40 mg IV q4-6h as needed. May be given q20-30min (until adequate response)
for the treatment of severe hypertension. IV push (rate): 10 mg/min. |
|
| HYDROCORTISONE
(SOLU CORTEF) |
0 to 100mg/ 100 ml
101 to 150 mg/ 150 ml
151 to 250 mg/ 250 ml
Minimum dilution:0 to 3000 mg/ 50 ml (4hr stability) |
30 min
30 min
60 min |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT) for
concentration of 1 mg/ml. |
|
| HYDROMORPHONE
(DILAUDID) |
| Usual
Diluents |
| D5W, NS |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
[0 - 100 mg] [100 ml] [Titrate]
|
|
Stability/Misc.
|
EXP:
24 hours RT/REF.
Some studies indicate stability up to 42 days. Usual rate: 0.2 to 2 mg/hr.
|
|
| IBUTILIDE
(CORVERT) |
0 to 1 mg/ 50 ml |
10 min |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT) / 2
DAYS (REF). May be administered
undiluted as well. Indications: rapid conversion of
A-fib/flutter of recent onset. Dosing: patient wt >60kg: 1 mg over 10
minutes.
If
< 60kg: 0.01 mg/kg over 10 minutes. If the arrhythmia does not terminate
within 10 minutes after the 1st dose, a 2nd dose may be given 10 minutes after the
completion of the first infusion. MOA : prolongs action potential duration
and increases both atrial & ventricular refractoriness (class III agent). |
|
| IMMUNE GLOBULIN
|
Dilute
with diluent provided. |
Initial rate: 0.5 ml/kg/hr. Max 4ml/kg/hr |
|
Stability/Misc.
|
EXP: 1 DAY (REF)
Label:
Do not shake/ Refrigerate.
Immune globulins with
high concentrations of IgA: (1) Venoglobulin-S (2) Gamimune-N (3)
Gammar-P IV (4) Sandoglobulin (5) Panglobulin
Immune
globulins with low concentrations of IgA: (1) Polygam S/D (2)
Gammagard S/D
Before dispensing, determine if the patient has an
IgA deficiency: In patients with IgA deficiency, IgA can be antigenic and
anti-IgA antibodies can develop rapidly leading to anaphylaxis when a
product containing significant concentrations of IgA is administered.
Therefore, use Polygam S/D or Gammagard S/D for IgA deficient patients. Overview:
IgG is comprised of 4 subclasses c a distribution similar to normal serum
(IgG1 thru IgG4). IgG1 is the major component in IGIV preparations. IgG1
is involved in tissue protection, complement activation and virus
inactivation. Bacterial cells are opsonized by IgG1, making them more
prone to phagocytosis. Treatment of immune deficient states probably depends on
straightforward replacement of missing antibodies. Immunomodulatory doses
of IVIG for autoimmune conditions are considerably larger & are
thought to promote blockade of Fc receptors in macrophages (preventing
phagocytosis of circulating opsonized platelets or cells tagged c
autoantibodies). IVIG may also neutralize pathogenic auto-antibodies, and
possibly down regulate IgG production. According to the National
Institutes of Health, the commercially available products are equally
effective and they may be used interchangeably. (Exception: IgA deficient
patients). |
|
| IMIPENEM/CILIST.
(PRIMAXIN) |
0 to 500 mg/ 100 ml
up to 1 gram/ 250 ml |
30 min
60 min |
NS |
Stability/Misc.
|
EXP: 4 HRS
(RT) / 24
HRS (REF). Label: Refrigerate. Usually restricted to one of the following:
(1) Serious nosocomial infections, especially those involving resistant organisms;
polymicrobial infections (mixed gram pos/negative + anaerobes). (2) As an
alternative to combination therapy for serious intra-abdominal infections. It is used
alone, thus avoiding the ototoxic & nephrotoxic effects of
amino-glycosides. (3) Pseudomonas infections caused by organisms resistant to
both piperacillin & Fortaz. IM injection: 500 mg/ 2ml (1%
lidocaine)
forms a suspension-shake well. Dosing: Mild
to moderate infection: 250-500mg ivpb q6-8h. Severe infection: 500mg to 1g
ivpb q6-8h. Max dose/day= 50mg/kg/day or 4g/day. Renal dosing:
31-70/ 500mg q6-8h || 21-30/ 500mg q8-12h max || 0-20/ 250-500mg q12h max.
|| HD: 250 mg AD + q12h. || PD: max dose= 1gram/day i.e. 500mg ivpb q12h. |
|
| INAMRINONE
(INOCOR) |
300 mg/ 240 ml (total volume
=300ml)
Minimum dilution: 300mg/60 ml
Conc= 2.5 mg/ml Total volume=120ml |
Titrate |
NS |
Stability/Misc.
|
EXP:
1 Day (RT). Label: Do not refrigerate/ Protect from light. Supplied:
[100mg/20 ml ampule] Dosing: initially 0.75 mg/kg IV bolus over
2-3 min, then start maintenance infusion 5 - 10 mcg/kg/min. Additional
bolus of 0.75 mg/kg may be given 30 minutes after treatment starts. Max
dose/day: 10 mg/kg. Mechanism of Action:
Phosphodiesterase inhibitor with positive inotropic and vasodilator
activity. Renal failure:
Clcr<10 mL/minute: Administer 50% to 75% of dose. ADMINISTRATION
— May be administered undiluted for I.V. bolus doses. For continuous
infusion: Dilute with 0.45% or 0.9% sodium chloride to final
concentration of 1-3 mg/mL. |
|
| INFLIXIMAB
(REMICADE) |
Prescribed
dose/ 250 ml
Recommended concentration (0.4 to 4 mg/ml) |
2 hours
Infusions < 2 hours are not recommended. |
NS |
Stability/Misc.
|
Stability:
Use immediately. Infusion should begin within 3 hours of
preparation. Label: Do not shake. Reconstitute
each vial with 10 ml of sterile water for injection using a syringe with a
21-gauge needle or smaller. Direct stream to sides of vial. Do not use if
vacuum not present in vial. Gently swirl solution by rotating vial to
dilute; do not shake. May foam upon reconstitution; allow to stand for 5
minutes. Solution is colorless to light yellow and opalescent; a few
translucent particles may develop as infliximab is a protein. Do not use
if opaque particles, discoloration, or other particles occur. Withdraw
volume of total infliximab dose from infusion container containing 250 ml
0.9% NaCl. Slowly add total dose of infliximab for a concentration ranging
from 0.4 to 4 mg/ml. Mix gently. Do not reuse or store any portion of
infusion. Use an in-line, sterile, non-pyrogenic,
low protein-binding filter with 1.2 micron pore size or less.
Dosing: Crohn's disease: 5 milligrams/kilogram (mg/kg) via
intravenous (IV) infusion. In patients with fistulizing disease, an
initial 5 milligrams/kilogram dose should be followed with additional 5
milligrams/kilogram doses at 2 and 6 weeks after the first infusion.
Rheumatoid arthritis: The recommended dose is 3 milligrams/kilogram via
intravenous infusion followed with additional doses of 3
milligrams/kilogram at 2 and 6 weeks after the first infusion then every 8
weeks thereafter. Infliximab should be given with methotrexate . Supplied:
100mg vial (refrigerate) |
|
| INSULIN |
| Usual
Diluents |
| NS |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
Usual final
concentrations:
0.5 unit/ml or 1 unit/ml
(ICU's only)
[120 units/ 240 ml] [Titrate]
[100 units] [100 ml] [Titrate]
|
|
Stability/Misc.
|
EXP: 1 DAY (RT/REF) |
|
| IRON DEXTRAN
(IMFERON) |
(Test dose)
25 mg/ 100 ml normal saline
Prescribed dose/ 250 to 1000ml
(Usually 500 ml normal saline)
Length of infusion: Test dose is infused over 5min. Total dose infusion:
infuse Over 2 to 6 hours. |
5 minutes
2-6 hours |
NS |
Stability/Misc.
|
Parenteral iron treatment should be administered only when iron deficiency is not correctable
with oral treatment. A test dose of 25 mg
infused over 5 minutes should be given. Infusion should then be stopped for 1
hour. If there is no reaction after 1 hour continue. Fatal anaphylactic
reactions are
possible. May also be given IM or slow IVP (1 ml/min x 2 min = 100 mg).
Epinephrine should be immediately available. Total amount of iron
dextran required in ml (Total dose infusion) = 0.0442 (14.8 -
observed Hgb) x IBW + (0.26 x IBW). Parenterally administered iron does
not give a faster response compared to oral administration, therefore, the rate of
recovery from anemia should be the same. Reticulocyte count will increase in
3-4 days and peak in 7-10 days. |
|
| ISOPROTERENOL
(ISUPREL) |
1 mg/ 250 ml
(1 to 2 mg/ 250 to 500 ml) |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT)
(B1/B2) agonist. IV infusion: 2 to 20 mcg/ min. Usual initial rate: 5
mcg/min. Titrate to HR/BP. May give IV Push (must use 1:50,000 dilution).
Calculation of drip rate 1 mg/250 ml (ml/hr) = 15 x mcg/min. eg: 5 mcg/min
= 75 ml/hr |
|
