| Drug |
Standard
Dilution |
Infusion
Rate |
Diluents* |
| RANITIDINE (ZANTAC) |
50 mg/ 50 ml
150 mg/ 250 ml (continuous infusion) |
20-30 min
24 hours |
D5W / NS |
Stability/Misc.
 |
EXP: 10 DAYS
(REF). Dosing: 50 mg q6-8h (max 400mg/day) IM/IV. Continuous
infusion: initially 50 mg ivpb x 1, followed by 6.25 mg/hr titrated to gastric
pH >4.0 for prophylaxis or >7 for treatment. Note: Continuous
infusion is preferred in patients who are actively bleeding. |
|
| RIFAMPIN |
600 mg/ 500 ml
Minimum dilution: 600mg/100 ml |
|
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT) |
|
| SODIUM BICARBONATE |
50
meq/ 50 ml vial
May add ordered dose to empty viaflex bag or dilute in 50-1000ml D5W or NS |
UD |
|
Stability/Misc.
|
EXP: 1 DAY
(RT).
Calculation of bicarb deficit: [HCO3 < 10meq/L : Vd= 0.3 x
wt(kg) or if HCO3>10meq/L Vd= 0.5 x wt(kg) ]
Deficit= Vd x [24 - current level]. It is
recommended that 50% of total deficit be given now, and the reminder replaced
over 8-12h. Initial goal: increase serum bicarb level by 4-6 meq/l or increase
pH to >7.2. The subsequent goal is to increase bicarb level to 15 meq/l over
the next 24 hours. Generally, 2 to 5 meq/kg is given over 6 to 12 hrs.
Monitor ABG's q2-3h to assess response. Administer IV either undiluted or
diluted in other IV fluid (50-1000ml) depending on fluid status.
Osmolarity: 2Na + gluc/18 + BUN/2.8 (nml: 280-295).
Labs: Bicarb[22-28], pH [7.35-7.45], pCO2 [35-45], pO2 [75-100],
anion gap [12-14]. **Note: treat hypokalemia or hypocalcemia first if
present. |
|
| SODIUM CHLORIDE 3%(Hypertonic) |
513
meq/ 1000 ml (3%) |
|
|
Stability/Misc.
|
Sodium
(normal
range): 136
to 147 meq/l. The goal of treatment is to get the patient out of immediate danger
(return sodium level to > 120 meq/l). Usually reserved for severe
symptomatic hyponatremia (level usually < 115). The maximum rate of
increase (sodium level) is 2 meq/l/hr. The usual rate is 0.5 to 1 meq/l/hr--
these
lower rates help avoid serious CNS complications (cerebral edema, pontine
myelinolysis,seizures) and/or pulmonary edema.
Calculation of the sodium
deficit: 0.6 x weight(kg) x (desired Na+ - Actual Na+).
Use 0.5 for females. Desired Na+= 120-125 meq/l. Example: 70kg male. Na+= 110
meq/l Desired
target= 125 meq/l. [0.6 x 70kg x (125-110)= 630 meq of Na+ needed]. Amount
needed to increase serum sodium level by 1 meq/l/hr= 0.6 x 70kg x 1.0= 42
meq/hr (safe rate for this patient). 3%--hypertonic saline contains 513
meq/l. Therefore: [desired rate per hr] / 513 x 1000 = infusion rate
(ml/hr). And the total infusion time= [total meq needed] / [meq/hr]
Desired rate= 42/513 meq x 1000= 84 ml/hr Infusion time= [630 meq] / [42
meq/hr] = 15 hrs. Therefore: Infuse 3% saline at 84 ml/hr for 15 hours.
Always verify the infusion rate and the length of infusion (using the
calculations above) versus what is ordered.
|
|
| SODIUM
FERRIC GLUCONATE (FERRLECIT) |
| Usual
Diluents |
| NS |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
--Intravenous dilution: --
[125 mg ] [100 ml] [60 minutes]
--Undiluted--
Ferrlecit® may be administered undiluted as a SLOW IV injection (at
a rate of up to 12.5 mg/min). |
|
Stability/Misc.
|
EXP:
If diluted in saline, use immediately after dilution.
Supplied: [62.5 mg/ 5 ml ampule]
Recommended dosage: repletion treatment of iron deficiency in
hemodialysis: 10 mL of Ferrlecit® (125 mg of elemental iron).
Most patients will require a minimum cumulative dose of 1.0 gram of
elemental iron, administered over eight sessions (125mg per session) at
sequential dialysis treatments, to achieve a favorable hemoglobin or
hematocrit response. Ferrlecit® has been administered by infusion
or by slow IV injection during the dialysis session itself. |
|
| SODIUM
PHOSPHATE |
Floors: 15 mmol/ 250
ml
ICU's: 15 mmol/ 100 ml |
4-6 hours
2-4 hours |
NS / D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT). |
|
| STREPTOKINASE |
250,000 u/ 50 ml
1,500,000 u/ 50 to 250 ml |
30 min
60 min |
NS / D5W |
Stability/Misc.
|
Prepare just before
use. Avoid shaking to prevent foaming. Acute MI: Give 1.5 million
IU over 60 min. PE: Loading dose: 250,000 iu over 30min, followed
by 100,000 iu/ hr x 24 hrs. (x 72 hrs for DVT).
Reconstitute the 250, 600, 750k with 5 ml NS. 1.5 mu with 10ml. Do not add more
than 1.5 mu to an IV solution (limited stability). Review
contraindications. Obtain baseline CBC, hct, platelet, PT/PTT, CPK, CPKmb,
fibrinogen. Give benadryl 50mg & hydrocortisone 100mg IV x 1, then
start infusion. Start lidocaine 1 mg/kg load, followed by 2 mg/min over 1st 24hrs.
Give IV heparin 1000 u/hr--begin 2 hours post streptokinase. ECG at end q1h x
3, then q8h x 3. |
|
| STREPTOMYCIN |
Prescribed dose/ 100 ml
(Not approved for IV use, however, has been used in pts c
insufficient muscle mass.) |
30-60 min |
NS / D5W |
Stability/Misc.
|
[Refrigerate]
// Dosing: (Tuberculosis): 15 mg/kg (Max=1 gram) IM
once daily or 25-30 mg/kg administered twice weekly (maximum 1.5 grams/dose) or three
times weekly (Maximum 1 gram/dose). Streptomycin usually replaces ethambutol in
the 4 drug regimen [INH, Rifampin, Pyrazinamide, streptomycin].
[CRCL: 10-50// q24-72h or 750mg 2 to 3x/week] [CRCL < 10//
q72-96hrs instead of once daily] Serum level monitoring: Adjust dose to
maintain a trough < 4 mcg/ml. |
|
| SUCCINYLCHOLINE |
Supplied: 20&50 mg/ml-10ml vial
100 mg/ml-5,10,20 ml vial |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(REF) Label: Refrigerate. Depolarizing
skeletal muscle blocker. Indications: procedures of short duration
such as endotracheal intubation. [Onset: (IM): 2-3 minutes (IV):30-60
seconds] [Duration: (IM): 10-30min (IV): 4-6 min.] Dosing: Adults:
0.6 mg/kg (0.3 to 1.1) over 10-30 seconds, up to 150mg total dose.
Maintenance:
0.04 to 0.07 mg/kg every 5 to 10 minutes as needed. Continuous infusion: 2.5 mg/min (0.5 to
10 mg/min). Dilute to 1-2 mg/ml. |
|
SYNERCID
(150mg of quinupristin and 350mg of dalfopristin) |
Prescribed
dose/ 250 ml
Note: if patient complains of pain at injection site add prescribed dose
to 500 ml D5W. |
60 minutes |
D5W |
Stability/Misc.
|
Stability:
RT: 5 hours ; REF: 54 hours. Label: refrigerate. Reconstitution:
dilute vial with 5 ml sterile water or D5W (concentration = 100 mg/ml). Do
not shake. // If patient has a central line, may add prescribed dose to
100 ml D5W. Supplied: 500mg vial (150mg of quinupristin and 350mg
of dalfopristin) --keep refrigerated. Dosing: 7.5 mg/kg every 8 to
12 hours. Dosage adjustment not required in renal failure. |
|
