| NAFCILLIN |
0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
Prepack:
1 gram/50 ml iso-D5W
2 grams /100 ml iso-D5W |
30 min
60 min |
D5W / NS |
Stability/Misc.
 |
EXP: 1 DAY
(RT) ;
7 DAYS (REF) Label: Refrigerate. IM injection: 500 mg vial/ 1.8 ml SW or BS-SW or
NS. 1 gram/ 3.4
ml. 2 gram vial/ 6.6 ml. Mild to moderate infection: 500mg to
1 gram ivpb q4h or 1-2g ivpb q6h. Severe: 1-2g ivpb q4h. Renal dosing:
No dosage changes required for renal failure. || Renal + Hepatic dysfcn:
decrease dose by 50%. |
|
| NALOXONE
(NARCAN) |
2 mg/ 500 ml
Fluid restricted: 4 mg/ 250 ml |
Titrate.
Usual rate 0.4 mg/hr |
D5W / NS |
Stability/Misc.
|
Dosing:
Treatment of narcotic-induced respiratory depression: 0.4 to 2 mg IV / SC/ IM
repeat every 2-3 minutes as needed (if no response after 10 mg --- ?
narc). IV infusion: ( 2
mg/500 ml per manufacturer) Usual infusion rate: @ 0.4 mg/hr (100 ml/hr)-titrate
to respiratory rate/ level of consciousness. |
|
| NESIRITIDE
(NATRECOR) |
| Usual
Diluents |
| D5W, NS,
D5-1/2NS |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
| [1.5 mg] [250 ml] [As
directed] |
|
Stability/Misc.
|
Restrictions:
Restricted to Cardiology Consult
Preparation: Reconstitute one 1.5-mg vial of Natrecor by adding 5 mL of
diluent removed from a pre-filled 250-mL plastic IV bag containing the
diluent of choice.
The following preservative-free diluents are recommended for
reconstitution: 5% Dextrose Injection (D5W), USP; 0.9% Sodium Chloride
Injection, USP; 5% Dextrose and 0.45% Sodium Chloride Injection, USP, or
5% Dextrose and 0.2% Sodium Chloride Injection, USP.
Do not shake the vial.
Rock the vial gently so that all surfaces, including the stopper, are in
contact with the diluent to ensure complete reconstitution. Use only
a clear, essentially colorless solution. The IV bag should be inverted
several times to ensure complete mixing of the solution.
Label: Monitor BP closely.
Stability: (reconstituted vials / solutions): 24 hours RT or REF.
Dosing: IV bolus of 2 µg/kg (over 1 minute) followed by a
continuous infusion of 0.01 mcg/kg/min. Withdraw bolus dose from the
infusion bag. Higher initial dosages are not recommended.
Calculation: Bolus Volume (ml) = 0.33 × Patient Wt (kg).
Infusion Rate (ml/hr) = 0.1 × Patient wt (kg). There is limited
experience with administering Natrecor for longer than 48 hours.
Indications: IV treatment of patients with acutely decompensated
CHF who have dyspnea at rest or with minimal activity.
Actions: venous and arterial vasodilation (decreased PCWP etc),
plus mild diuretic effect. |
|
| NICARDIPINE
(CARDENE) |
25 mg/ 240 ml (Total
vol= 250
ml) |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT).
Higher concentrations can be used if the patient has a central line (25 to
50 mg / 100 ml).
Treat
hypertension: initially 5 mg/hr-if not effective increase dose 2.5 mg/hr
every 5 to 15 minutes
to a maximum of 15 mg/hour. Postop hypertension: 10 to 15 mg/hour for initial control,
followed by maintenance infusion of 1 to 3 mg/hr. IV to PO conversion: 20mg
orally q8h= 0.5
mg/hr; 30mg orally q8h= 1.2 mg/hr ; 40mg orally q8h= 2.2 mg/hr. Supplied: 25 mg/10
ml ampule. |
|
| NITROGLYCERIN |
50 mg/ 250 ml
0 to 100 mg/ 250 ml (glass)
(Max conc: 0.4 mg/ml) |
Titrate |
D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT)
Label:
Do not Refrigerate Dosing: (HTN/ CHF/ angina):
initial infusion rate 5 mcg/min. May increase by
5 mcg/min every 3 to 5 minutes until response. If 20 mcg/minute is inadequate, increase by
10 to 20 mcg/min every 3 to 5 minutes. Calculation of drip rate (50 mg/250 ml) ml/hr
= mcg/min x 0.3 (eg 5 mcg/min=@ 2ml/hr ; 20mcg/min = 6 ml/hr etc.) |
|
| NITROPRUSSIDE
(NIPRIDE) |
50 mg/ 250 ml
(50 to 100 mg/ 250 ml) |
Titrate |
D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT) Label:
Protect from light. Onset: immediate. Duration: 1 to 10
minutes. Treat
hypertensive emergency. IV infusion rate: 0.5 to 10 mcg/ kg/
min--titrate to
BP. Dosing: Initial: 0.3 to 0.5 mcg/kg/min--increase by 0.5 mcg/kg/min
increments. (usual dose: 3 mcg/kg/min-rarely need > 4 mcg/kg/min).
Note: when > 500 mcg/kg is administered by continuous infusion at > 2
mcg/kg/min--cyanide is produced faster than can be handled by endogenous
mechanisms. Maximum infusion rate: 10 mcg/kg/min. Calculation of
drip rate 50 mg/250 ml (ml/hr) = wt (kg) x mcg/min x 0.3.
Dosage rates
well within product labeling have resulted in toxicity. Early signs of
toxicity appear to be related to formation of cyanide. [Nitroprusside +
hemoglobin---(oxidation)---- met-hemoglobin ----cyanmet-hemoglobin + 4 cyanide ions-----liver
(rhodanase
& thiosulfate)----thiocyanate formation. Cyanide toxicity more likely
if hepatic dysfunction is present; thiocyanate toxicity more likely if
there is renal dysfunction or
prolonged infusion. Cyanide toxicity symptoms: acidosis (decreased affinity of
oxygen to hemoglobin resulting in anaerobic metabolism-increased lactic acid etc.,
tachycardia, coma, convulsions, almond smell on breath. Patients with
decreased hepatic or
renal function are at the highest risk of developing toxicity. Cyanide toxicity
may cause death or irreversible ischemic injury as a result of profound
hypotension and metabolic acidosis. To prevent cyanide toxicity, initial
infusion rates should not exceed 0.3 mcg/kg/min, and maximum rates of 10
mcg/kg/min should not be maintained for more than 10 minutes. Monitoring:
Monitor for cyanide and thiocyanate toxicity; monitor acid-base status
(acidosis may be earliest sign of cyanide toxicity; monitor thiocyanate levels
if prolonged infusion (>3-4 days) or dose > 4 mcg/kg/min or renal
dysfunction; monitor cyanide levels in patients with decreased hepatic
function. Cyanide toxicity:
Patients exhibiting dyspnea and impaired mental status should be treated with
the commercial cyanide antidote kit [ (1) amyl nitrate: inhale vapor for
15-30 seconds every 2 to 3 minutes. (2) Sodium nitrate: 300mg over 2-4 min (3) Sodium
thiosulfate: 12.5g (25 ml of 50% solution) IV; may repeat with
6.25 grams in 30 minutes),
without waiting for chemical confirmation of toxicity. Some studies have used
hydroxocobalamin which chelates cyanide (large doses required).
Thiosulfate infusions have been co-administered with nitroprusside to
prevent toxicity. |
|
| NOREPINEPHRINE
(LEVOPHED) |
8 mg/ 250 ml
(4 to 16 mg/ 250 ml) |
Titrate |
D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT)
Used to maintain blood pressure in hypotensive states. Most potent vasoconstrictor
(Norepi
>>> phenylephrine). Dosage: initially 8 to 12 mcg/min -titrate to
blood pressure ( Usual target: SBP: 80-100 or MAP=80). Usual maintenance: 2 to 4 mcg/min. Note:
doses as high as 0.5 to 1.5 mcg/kg/min for 1-10days have been used in
septic shock.)
Calculation of drip rate 8 mg/ 250 ml (ml/hr) = mcg/min x
1.875. Administer through a central line (large vein). |
|
| OCTREOTIDE ACETATE
(SANDOSTATIN) |
0 to 200 mcg/ 50 ml
600 mcg/ 250 ml (25 mcg/hr)
1250 mcg/ 250 ml (50 mcg/hr) |
15-30 min
Usually 25 to 50 mcg/ hr. |
NS |
Stability/Misc.
|
EXP: 2 DAYS
(RT).
Synthetic octapeptide. Mimics the action of naturally occuring
somatostatin and decreases the secretion of gastroenterohepatic peptides
that may contribute to adverse symptoms in patients with metastatic tumors,
VIPomas. Octreotide-potent inhibitor of GH, insulin, and glucagon secretion. Also
decreases splanchnic blood flow and inhibits release of serotonin, gastrin,
vasoactive intestinal peptide. T1/2= 1.5hr (30x > than natural
somatostatin). Dosing:
Reduce output of GI fistulas: 50 to 200 mcg q8h Variceal
bleeding: 50 mcg bolus f/b 25 to 50 mcg/hr (up to 5 days). Aids
related diarrhea: (prolongs intestinal transit time): 100 to 500 mcg
SC tid Short bowel (ileostomy) syndrome: 25 mcg/hr infusion
or 50 mcg SC bid. Diarrhea due to chemotherapy: 50 to 100 mcg SC
tid Irritable bowel syndrome: 100 mcg qd to 125 mcg SC
bid Acromegaly: 50 to 100 mcg SC tid Carcinoid
tumors:100-600 mcg in 2-4 dd. VIPomas: 200-300 mcg/day in 2-4
dd. |
|
| ONDANSETRON
(ZOFRAN) |
All doses / 50 ml |
15 min |
D5W / NS |
Stability/Misc.
|
EXP: 2 DAYS
(RT or REF).
Dosing: 32 mg over 15min given 30min prior to chemo. Alternatively, give
0.15 mg/kg 30 minutes prior to chemotherapy, followed by repeat doses 4 &
8 hours post
first dose. |
|
| OXYTOCIN
(PITOCIN) |
10 to 40 units/ 1000 ml |
Titrate |
LR / NS |
Stability/Misc.
|
[Supplied: 10
units/ml-1 &10 ml vial] Labor induction: 0.001 to 0.002
units/min; increase by 0.001 to 0.002 units q15-30min until contraction pattern
is established(3-4 good contractions/10 min). Max: 0.02 units/min Postpartum
bleeding: 3-10 units IM or 10 to 40 units by IV infusion in 1000 ml at
a rate sufficient to control uterine atony. Abortion: Infusions of
0.01 to 0.02 units/min are normally admin. Maximum doses should rarely
exceed 0.02 units/min. |
