| PAMIDRONATE
(AREDIA) |
60 - 90 mg/ 1000 ml
Minimum dilution: 60-90mg/500ml
(Usually over 4 hours) |
24 hours
(Range:
2 to 24 hours) |
NS / D5W |
Stability/Misc.
 |
Restricted to oncology.
Serum calcium levels should be corrected for serum albumin before
determining dose. Corrected calcium= serum calcium + 0.8 (4 - serum
albumin). Dosage: Moderate hypercalcemia (12- 13.5 mg/dl): 60 to 90 mg.
Severe hypercalcemia (> 13.5 mg/dl): 90 mg. The manufacturer recommends that
the repeat dose not be given sooner than 7 days after the initial dose in
order to allow full response to this dose. MOA: biphosphonate
compound-inhibits bone resorption (anti-osteoclast activity). Has little
effect on bone remineralization. Relative potency of biphosphonate agents:
Risedronate (Actonel)>> (pamidronate & alendronate(Fosamax))
>> Etidronate(Didronel) |
|
| PANCURONIUM
(PAVULON) |
12.5 to 25 mg/ 250 ml
50 mg/ 50 ml (Undiluted-viaflex)
(Note: Strongly suggest intermittent
dosing. This is the preferred regimen. The half-life of Pavulon is @ 110
minutes.) Neuromuscular blockade reversal: Neostigmine: 0.03 to 0.08 mg/kg |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 48 hours
(REF or RT)
[Supplied: 1 mg/ml (10 ml vial); 2mg/ml (2 &5ml vial/amp);
Refrigerate] Nondepolarizing skeletal muscle blocker-competes
with acetylcholine at the neuromuscular junction. Intermittent dosing: 0.1 to 0.2
mg/kg (usually 0.1) q1-3h (range: 0.04 to 0.2) Continuous infusion: Loading
dose: 0.04 to 0.10 mg/kg , f/b 1 to 1.7 mcg/kg/min or 0.06 to 0.1
mg/kg/hr. Onset: 2-3 minutes.
Incremental doses slightly increase magnitude of blockade and significantly increase
the duration of action. Cautions: Increases in HR, BP and excessive salivation and sweating
may occur. Concurrent use of corticosteroids will decrease pancuronium
effectiveness and may increase risk and severity of myopathy resulting in
prolonged flaccid paralysis following discontinuation of neuromuscular
blocking agent. |
|
| PANTOPRAZOLE
(PROTONIX) |
| Usual
Diluents |
| NS , D5W ,
LR |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
[40 mg] [100 ml] [15-30
min]
Bolus dose:
[80 mg] [80 ml] [5 minutes]
(Total volume = 100ml)
Continuous infusion (8 mg/hr)
[80 mg] [80 ml] [ 10 ml/hr]
(Total volume = 100ml)
Minimum dilution: Diluted vial (4 mg/ml) can
be administered over at least 2 minutes. |
|
Stability/Misc.
|
Stability:
The reconstituted solution may be stored for up to 2 hours at room
temperature prior to further dilution; the admixed solution may be stored
for up to 24 hours at room temperature prior to intravenous infusion. Both
the reconstituted solution and the admixed solution do not need to be
protected from light.
Reconstitution: dilute 40 mg vial with
10 ml normal saline.
Maximum rate: 3 mg/min.
Note: In-line filter is NOT required with
the revised formulation currently being offered by the manufacturer.
Usual dosage:
Gastroesophageal Reflux Disease with history
of Erosive Esophagitis: 40 mg
IV once daily for 7 to 10 days.
Continuous
infusion:
Prevention of peptic ulcer rebleeding in high-risk patients or
endoscopic evidence of active bleeding: 80 mg IV bolus over 5-15 minutes,
followed by 8 mg/hr x 72 hours (maximum). No additional benefit found for
tx > 72 hrs.
Zollinger-Ellison Syndrome:
80 mg q 8-12 hrs daily. Starting dose: 80 mg IV q12h.
Two Minute Infusion:
PROTONIX I.V. for Injection should be reconstituted with 10 mL of 0.9%
Sodium Chloride Injection, USP, per vial to a final concentration of
approximately 4 mg/mL. The reconstituted solution may be stored for up to
2 hours at room temperature prior to intravenous infusion and does not
need to be protected from light. The total volume should be administered
intravenously over a period of at least 2 minutes. Note: 80 mg (2 vials -
each with a concentration of 4 mg/ml) may also be given over at
least 2 minutes.
|
|
| PENICILLIN G |
0 to 4
MU/ 50 ml
Over 4 MU/ 100 ml
Pre-pack : 2 MU/ 50 ml iso D5W |
30 min |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT) / 3
DAYS (REF). Label: Refrigerate. Usual dose: 0.5 to 4 mu
q4-6h. Severe infection: Dosing interval q2-3h (i.e. 3mu q3h). Max dose
per day: up to 80 million units. Renal dosing: >50/ Usual
dose || 10-50/ 75% of usual dose || <10/ 20-50% of usual dose. ||
Hemodialysis/PD:
20-50% of dose usually q6h. Max dose in ESRD: 6 mu/day. |
|
| PENTAMIDINE |
0 to 350 mg/ 250 ml |
60 min |
D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT)
. Label: Protect from light. Dosing:
PCP: 3 to 4 mg/kg IV qd x 14 - 21 day |
|
| PENTOBARBITAL (NEMBUTAL) |
100 mg/ 50 ml
500 mg/ 250 ml
2000 mg/ 250 ml
(Concentrations from 0.5 to 8 mg/ml appear to be stable) |
UD
Max rate: 50 mg/min |
D5W / NS |
Stability/Misc.
|
EXP: 12 to 24 hrs
(RT).
Label: Do not refrigerate. Onset: 15-60 min
Duration: (Oral): 1-4 hrs (IV): 15 min May be given deep IM (max 250mg per
site) or by slow IV injection. Note: can be given IV undiluted. Dosing:
Hypnotic (Adult): Oral: 100-200mg qhs. IM: 150-200mg. IV:
Initially 100mg, may repeat
q1-3min up to 200-500mg total dose. Rectal: 120-200mg at bedtime. Preoperative
sedation: IM: 150-200 mg. Barbiturate coma in head injury patients: IV
loading dose of 5-10 mg/kg over 1 to 2 hours. Maintenance: Initial: 1
mg/kg/hr; may increase to 2-3 mg/kg/hr. Monitor for dose-dependent
cardiovascular and respiratory depression. Maintain serum concentration at 2-4
mg/dl. Supplied: 50mg/ml-1ml, 2 ml, 20ml, 50ml. (C-II) |
|
| PHENOBARBITAL |
0 to 100 mg/ 50 ml
Over 100 mg/ 100 ml |
30 min
UD |
NS |
Stability/Misc.
|
Maximum rate: 100
mg/min. Recommended routes: IV push, IM. Preventative management of status
epilepticus: 15 to 20 mg/kg IV; alternatively, 10 mg/kg followed by another 10
mg/kg if needed. Alcohol withdrawal: 260 mg IV initially, followed by 130mg q30min to
achieve light sedation. |
|
| PHENYLEPHRINE
(NEOSYNEPHRINE) |
40 mg/ 250 ml
(10 to 40 mg/ 250 ml) |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 2 DAYS
(RT). Label:
Do not Refrigerate. (Alpha agonist). May be given IM,SC, IV
push, or by continuous infusion. Treat mild/moderate hypotension, also
PSVT. IV bolus therapy: usual dose: 0.5 mg [range: 0.1 to 1 mg (max)]
repeat q10-15 min
as needed. IV
infusion: usual initial rate: 0.1 to 0.18 mg/min (100 to 180mcg/min)
(titrate). Usual maintenance rate: 40-60 mcg/min. Maximum rate:
infusion rates as high as 10 mcg/kg/min may be required in
shock. PSVT: 0.5 mg rapid IV push, subsequent doses may be increased in
increments of 0.1 to 0.2mg.
Calculation of drip rate (40 mg/250) (ml/hr) =
(mg/min) x 375. |
|
| PHENYTOIN
(DILANTIN) |
100 mg/ 50 ml
200 to 500 mg/ 100 ml
501 to 1500 mg/ 250 ml
Concentrations up to 6.7 mg/ml are stable up to 24 hours
(insignificant loss). Ideally, the solution should be infused within 1 hour
of mixing. Constantly monitor for precipitate formation. Solution should be
filtered with a 0.22 micron filter. |
15 minutes
15-30 minutes
See note |
NS |
Stability/Misc.
|
EXP: 2 HOURS
(RT)
Label: Do not Refrigerate / Use an inline 0.22u filter.
Infusion rates: Max: 50 mg/min Recommended rate for most adults: 40 mg/min.
Elderly (rate): 20 mg/min. Usual IV loading dose: 15 mg/kg TBW
Maintenance dose (started 18-24h after load): 6 mg/kg ibw IV/PO in
divided doses q8 to 12h. (The IV maintenance dose should never be given qd in a
single dose). Oral loading: 16 mg/kg TBW (use adjBW if obese) given
in 3 to 4 divided doses at q2h intervals (divided doses increase
bioavailability as well as decrease potential for Gastrointestinal side effects such as N&V).
The maximum single oral dose should not exceed 400mg in order to minimize
Gastrointestinal side effects and increase absorption. Sampling: 18 to 24h after
loading dose, then q5 to 7 days to assess trend. Average time to steady
state: 10 to 14days. Half-life: 7-42hrs (average=24h) . Capsules/injection= 92%
phenytoin. Elixir/tabs=100% pht. Equation used to estimate the dose
req'd to increase current level to normal range if subtherapeutic: = [0.7
x IBW x (15 - current level) ] / 0.92* * (if capsules/injection used)
Adjusted phenytoin concentration if low serum albumin= measured total concentration / [
(0.2 x albumin) + 0.1] |
|
| PHYTONADIONE (VITAMIN K) |
0 to 20 mg/ 50 ml * (see note)
21 to 50 mg/ 100 ml * (see note) |
30 min
60 min |
NS / D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT).
Label: Protect from light// Do not Refrigerate. ***Warning regarding IV
use: Severe rxn's including death have occurred during and immediately
after IV injection even when precautions have been taken to dilute the
vitamin and avoid rapid infusion. IV route should be restricted to those
situations where other routes are not feasible and the serious risk
involved is considered justified. Preferred routes: IM or SC. Max IV
rate: 1 mg/min. Dosing:
INR< 5 (no bleeding): Decrease dose or omit next dose and resume
warfarin at lower dosage when INR approaches desired range.
INR >5 but <9 (No bleeding): If no additional risk factors
for bleeding: Omit next one or two doses of warfarin and resume warfarin
at lower dosage when INR approaches desired range. Or If increased risk of
bleeding: Omit next dose of warfarin and give Vitamin K 1-2.5 mg orally.
INR > 9 (no bleeding): Hold warfarin and give Vit K 3-5 mg po,
may repeat Vitamin K if INR still elevated at 24-48 hours.
Serious bleeding or INR > 20: Hold warfarin and Vitamin K 10
mg by slow IV infusion (10-20 minutes) and supplement with fresh plasma or
prothrombin complex concentrate. May repeat Vitamin K q12h. Life-threatening
bleeding: Hold warfarin and replace with prothrombin complex concentrate
supplemented with Vit K 10 mg IV. May repeat Vitamin K depending on INR.
Rapid reversal required for urgent surgery or dental extraction: Hold
warfarin and give Vitamin K 2-4 mg orally. May repeat Vitamin K 1-2 mg
orally if INR remains
high at 24 hours. [Chest 1998 (suppl), 114: S445-S469] |
|
| PIPERACILLIN |
0 to 2 grams/ 50 ml
Over 2 grams/ 100 ml |
30 min |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT) / 7
DAYS (REF). Label: Refrigerate. IM
injection: Dissolve each gram with 2 ml. Maximum of 2 grams per injection
site. (May use SW, BS-SW, NS, 0.5 to 1% lido). Mild infection: 3-4g
ivpb q6-8h Serious infection: 3-4g ivpb q4-6h (200-300mg/kg/day) Maximum
24g/day. Renal dosing: >40/ No change || 20-40/ 4g
q8h || <20/ 4g q12h || HD/PD: 2g q8h. || Alternatively: >50/q4-6h ||
10-50/ q6-8h || <10/ q8h |
|
| ZOSYN (Piper/Tazobactam) |
2.25 grams/ 50 ml
3.375 and 4.5 grams/ 100 ml |
30 min |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT)
/ 7 DAYS (REF). Label: Refrigerate. Cannot be given IM.
Dosing: Mild infection: 3.375g ivpb q6h. Moderate to
severe: 3.375g ivpb q4h. Renal dosing: >40/ 3.375g q6h ||
20-40/ 2.25g q6h || <20/ 2.25g q8h || HD: Max 2.25g q8h. 0.75g AD. ||
PD: 2.25g q8h |
|
| POTASSIUM CHLORIDE |
Floors:10
meq/ 100 ml or
20 meq/250 ml or 40 meq/ 500 ml.
ICU's:20 meq/ 100 ml |
Floors:
(10 meq/hr)
ICU's:
(10-20 meq
/hr) |
NS / D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT)
[Normal range: 3.5 to 5 meq/L]
General guidelines - Review the disclaimer
Treatment of hypokalemia: Level < 2.5:
(life-threatening):
(a) ECG monitoring necessary (transfer to ICU)
(b) Give KCL at 20 to 40 meq/hr depending on severity
(c) Monitor K+ levels hourly
(d) Decrease rate to max of 20 meq/hr when patient is no longer in
immediate danger (eg normal ECG, or level > 2.5)
K+ level: 2.5 to 3.0:
(a) ECG monitoring recommended
(b) Infuse K+ at 10-20 meq/hr x 2 hrs (ICU) or 10 meq/hr x 2-4 hrs
(floors).
(c) Order K+ levels q2h (ICU) q4h (floor).
(d) Repeat infusion as above if K+ < 3.0
(e) Consider oral replacement if patient is asymptomatic K+ level
K+ level: 3 to 3.5: Oral therapy
recommended unless npo. Give 20 to 40 meq po bid-tid. Follow levels
closely.
General info:
*Dextrose solutions containing K+ may cause transient worsening of
hypokalemia and should be avoided if possible.
*In the majority of cases (not critical) K+ rate of infusion should not
exceed 10 meq/hr.
*The amt of K+ to be replaced is difficult to estimate, therefore,
frequent K+ levels should be obtained.
*Extreme caution should be used in patients with renal failure (reduce
rate of administration).
*Maximum rate without cardiac monitoring: 20 meq/hr
*The maximum single oral dose should not exceed 50 meq (gastric
irritation, potential for cardiac arrest, etc.)
*hypokalemia potentiates the effects of digoxin. If ischemic heart disease
or PVC's are absent and patient not on digoxin, one may elect to withhold
replacement of K+ until level< 3.2.
Treatment of
hyperkalemia (K+ level > 5):
Therapeutic approach:
**Rule out pseudohyperkalemia: (hemolyzed specimen, severe leukocytosis,
fist clenching during phlebotomy, lab error.) Obtain ECG or rpt K+
level.
**Stop all K+ intake (IV/PO) **Check pH, corrent acidosis if present. For
every 0.1 decline in pH from 7.4(nml) results in an increase in K+ of 0.6
meq/L.
**Check Ca++, Mg++, BUN/creat.
**Identify underlying cause if necessary (eg renal failure,
mineralocorticoid deficiency etc).
Emergencies (cardiac toxicity or K+ > 6.1) (Note: the following
measures are instituted immediately & f/b kayexalate. Withhold Calcium
gluconate if K+ < 6.5. Patient must be on monitor) (1) Give Calcium
gluconate 1-2g over 15-30 minutes. Used to counteract the neuromuscular
and cardiac effects of hyperkalemia. May give more rapidly if ECG has
deteriorated to a sine wave or worse-give 0.5 to 1g Calcium gluconate
over 3 to 5 minutes.
(2) Administer 50ml (1 amp) Sodium bicarb IV over 5min. Repeat as
necessary-especially if patient is acidotic (common in renal failure).
Increased risk in patients with CHF. Onset: immediate Duration: 2-3 hr.
Normally repeated in 15 minutes if ECG changes persist. ECG changes: Tall
thin T-waves, Prolonged PR-interval, widened QRS, loss of P-wave.
(3) Admin 1 amp of 50% dextrose IVP over 5 min plus 10u insulin IV. Repeat
in 15min if serum K+ still toxic. Alternatively, admin 500 ml 10% dext +
10-15u insulin over 1 hr. Glucose is unnecessary if blood sugar is
elevated. Onset: 15-45 minutes. Duration: 4-6hrs. (4) Administer 15 to 50g
of kayexalate po now. May repeat q6h. (If npo: give 25-50g by rectal
retention enema (retain for 1hr). Oral: 1 gram/ 1 meq K+. Onset:
1-2hrs. Duration: 4-6hrs. Use caution in patients who cannot tolerate even
a small increase in sodium load (eg severe CHF; marked edema; etc.) Note:
Never administer kayexalate alone for symptomatic hyperkalemia because of
the slow onset.
Patients with K+ < 6 meq/L with no ECG changes: Administer
kayexalate as above. Consider lasix 20 to 40mg IVpush in the
volume-overloaded patient or when inadequate K+ excretion contributes to
hyperkalemia.
|
|
| POTASSIUM PHOSPHATE |
Floors:15 mmol / 250 ml
ICU's:15 mmol/ 100 ml |
Floors:
4-8 hours
ICU's: 2 hours |
|
Stability/Misc.
|
EXP: 1 DAY
(RT). [Supplied: 15 mmol PO4 (and 22 meq K+) / 5 ml vial].
Normal range:
2.5 to 4.5 mg/dl.
Dosing:
*Mild to moderate hypophosphatemia (1.3 to 2.5 mg/dl): Oral therapy
adequate: 2.5 to 5 mg/kg of PO4 bid-tid or approx 1-2 pkts (250 mg=8 mmol/packet)
of Neutra-phos bid to tid. Manufacturer recommends: 1-2 packets 4 times
daily (after
meals and at bedtime)
*Severe hypophosphatemia (PO4 < 1.2 mg/dl): Give 0.16 to 0.25
mmol/kg IVPB q6 to 8 hours until serum level reaches 2 mg/dl. Doses as
high as 0.5 mmol/kg may be given if level is below 0.7 mg/dl.
*Alternatively: (level < 2 mg/dl) (ICU pt): give 15 mmol
NaPO4 in 100 ml NS over 2 to 6 hrs; repeat q6h to max of 45 mmol/24 hours.
[Crit Care Med 1995;23:1204.] |
|
| PROCAINAMIDE
(PRONESTYL) |
Loading dose: 1 gram/ 50 ml
Continuous infusion: 1 to 2 grams/ 250 ml |
Titrate |
D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT).
Label: Do not Refrigerate. (Tx: PVC, VT,
A-fib/flutter, PAT) Dosing: Loading: 100mg q5min (max 25 to 50 mg/min)
until arrhythmia disappears or adverse effects up to (17 mg/kg max if
normal renal function, otherwise max of 12 mg/kg). If arrhythmia disappears, start IV infusion: 2
to 6 mg/min (Usual maintenance dose with renal/cardiac failure: 1 to 2 mg/min) . If
arrhythmia reappears, repeat bolus as above. Side effects: Severe hypotension
with rapid infusion; bradycardia, AV block, V-fib. Alternate loading regimen:
Add 1g/ 50 ml D5W-20 mg/min x 25 to 30 min, wait 10min for distribution,
if no response continue with loading. (Note: 20 mg/min= 60 ml/hr-1 g/50ml).
If patient responds start maintenance infusion: 2 to 6 mg/min. Stop infusion if QRS
widens > 50%. Steady state: 24hrs (IV) / 48 hrs (oral).
Calculation of drip rate (1 gram/250 ml) ml/hr: = (mg/min) x 15 |
|
| PROCHLORPERAZINE (COMPAZINE) |
0 to 20mg/ 50 ml |
30 min |
NS / D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT).
Label: Protect from light. Single doses normally should
not exceed 10mg. Maximum rate (IVPush): 5 mg/min (usual: 2.5 mg/min).
Usual rate(infusion): 1 mg/min. Maximum recommended dose/day: 40 mg. Some
studies have used high dose Compazine (30-40mg) over 20-30min prior to
chemotherapy. |
|
| PROPOFOL (DIPRIVAN) |
1000 mg/ 100 ml (vial)
500 mg/ 50 ml (vial)
[Concentration: 10 mg/ml] |
Titrate |
|
Stability/Misc.
|
Label: Do not
Refrigerate / Shake well before use/ Replace IV tubing
q6-12h. Dosing: (ICU sedation in intubated/mechanical
vent patients): initially 0.3 mg/kg/hr for at least 5min. Then increase by 0.3 to 0.6
mg/kg/hr q5-10min until desired level of sedation. Alternative (initial
dosing): 1-3 mg/kg/hr-titrate to effect. Usual dose req'd for maintenance: 1.5
to 4.5 mg/kg/hr.
Calculation of rate (ml/hr) = (mg/kg/hr) x 0.1 (Note: changes in
the rate of administration should be made slowly (>5 min) in order to
minimize hypotension and avoid acute overdosage. Monitoring:
Patients
should be monitored for early signs of significant hypotension and/or
cardiovascular depression, which may be profound. |
|
| PROPRANOLOL HCL (INDERAL) |
1 mg/ 50 ml
15 mg/ 250ml |
10-15 min
Titrate |
NS / D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT)
[Supplied: 1 mg/ml amp] Dosing: Life-threatening
arrhythmia: usually 1- 3 mg (maximum rate: 1 mg/min)-may dilute in
D5W-50ml. After 3 mg infused, may repeat in 2 minutes. Subsequent doses no sooner
than 4 hours. May start IV infusion: usual rate: 2 to 3 mg/hr. Titrate to
HR/BP. Oral to IV conversion: An equivalent IV dose cannot be
predicted with any precision because of the highly variable metabolic
and
bioavailability characteristics of oral propranolol, as well as
significant variability in patient response. Therefore, careful titration of an
IV dose is necessary (start continuous infusion: 2 to 3 mg/hr-titrate to
HR/BP). Average bioavailability of oral propranolol: (30-40%) ( range:
16-60%). Propranolol is well absorbed, however, there is an extensive
first pass metabolism. Variations in metabolism result from differences in
hepatic blood flow, intrinsic clearance, genetic makeup, etc. |
|
| PROTAMINE |
Dilute 50 mg vial
with 5 ml sterile water (10mg/ml). Normally given undiluted. May add to 25-50 ml NS / D5W. |
|
|
Stability/Misc.
|
Treatment
of heparin overdose:
If immediate, give 1 mg (up to 1.5mg) IV for every 100u of heparin infused
in preceding 2 hours. Give by slow IV injection (50mg over 10minutes). Maximum of 50mg in
any 10 minute period. May dilute with 25-50ml NS/D5W and infuse over 10-20
minutes. Obtain PTT 5-15min after protamine administration. If 30 minutes to 1 hour
have elapsed before starting protamine: use 0.5 to 0.75 mg/100 u of
heparin (in preceding 2 hours). If > 2 hours have elapsed: use 0.25 to 0.375mg/
100units. Symptoms of overdose of protamine include hypertension, and
possible hemorrhage due to paradoxical anticoagulation with higher doses (eg
> 100mg). [Too rapid administration can cause
severe hypotensive and anaphylactoid reactions. Facilities to treat shock
should be available.] |
|
